The future in the mirror: Incorporating strategies for the defense and promotion of economic, social, and cultural rights into the mainstream human rights agenda

Human Rights Quarterly

Volumn 27, Issue 4, 2005, Pages 1200-1244

  Yamin, Alicia Ely ^a,b,c  

^a HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

^b Center for Economic and Social Rights   (United States)

^c Center for Policy Analysis on Trade and Health   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

HUMAN RIGHTS; LOCAL PARTICIPATION; NONGOVERNMENTAL ORGANIZATION; STRATEGIC APPROACH;

PERU; SOUTH AMERICA;

EID: 27844466783     PISSN: 02750392     EISSN: None     Source Type: Journal    
DOI: 10.1353/hrq.2005.0056     Document Type: Review

References (219)

1. This prologue is based on a true case history. Ministerio de Salud-Proyecto 2000 Lima-Perú, Elena-Mujer sin Apoyo, in Mujeres de Negro: La Muerte Materna en Zonas Rurales del Perú: Estudio de Casos 84-88 (1999).
2. Not only are the centers far away and expensive to access, but indigenous women are often looked down upon and mistreated by the health center staff. Their cultural traditions and religious beliefs surrounding childbirth are generally not honored. Indeed, in general the health centers have long been known as "houses of death," where women often end up going to die because the centers do not possess the capacities necessary to resolve obstetric complications. See Alicia Pinzás, Jererquías de Género en el Mundo Rural 89 (2001);
3. Alicia Ely Yamin, Castillos de Arena en el Camino Hacia la modernidad: Una perspectiva desde derechos humanos sobre el proceso de reforma al sector Salud en el Parú (1990-2000) y las implicancias en la muerte materna [Sandcastles on the Road to Modernity: A Human Rights Perspective on the Process of Health Sector Reform in Peru (1990-2000) and Implications for Maternal Mortality], 89 (2003) [hereinafter Castillos de Arena];
4. See also Jeanine Anderson, Tendiendo Puentes: Calidad de atención desde la Perspecitiva de las Mujeres Rurales y los Proveedores de los Servicios de Salud (2001).
5. Instituto Nacional de Estadística e Informática, Encuesta Nacional Demográfica y de Salud Familiar 2000, 115 (2001) [hereinafter ENDES].
6. Note that revised estimates from WHO, UNICEF, and UNFPA place Peru's maternal mortality ratio for 2000 at 410 deaths per 100,000 live births, rather than the 185 deaths per 100,000 live births cited in ENDES. WHO, UNICEF & UNFPA, Maternal Mortality IN 2000: Estimates Developed by WHO, UNICEF, and UNFPA (2004), available at www.unicef.org/infobycountry/ perustatistics.html.
7. See, e.g., Alicia Ely Yamin, Challenges and Possibilities for Innovative Praxis in Health and Human Rights: Reflections from Peru, 6 Health & Hum. Rts. 35, 36-40 (2002).
8. Often the cultural is omitted for convenience sake. At other times the omission is deliberate and strategic. Although not the main topic of this essay, this author believes that while cultural dimensions of rights may require different strategies, it is critical not to repeat the mistakes of the past with respect to different categories of rights by marginalizing this set of rights even within ESCR. The conceptual framework of ESCR is indeed precarious if we cannot attend to the implications for ethnic, racial, and cultural minorities and ensure that they enjoy the right to celebrate their cultural traditions as well as participate actively in the cultural life of their countries. Further, the "E," "S," and "C" are perhaps better conceptualized as dimensions of classes of rights; often one right, such as health, has "economic," "social," and "cultural" dimensions.
9. For arguments about adapting the "shame and blame" strategy, which has been refined for civil and political rights, see Kenneth Roth, Defending Economic, Social and Cultural Rights: Practical Issues Faced by an International Human Rights Organization, 26 Hum. Rts. Q. 63 (2004).
10. Certain NGOs - principally in Latin America, Asia, and Africa, but some in the North as well - have been engaging in different forms of ESC rights for many years. Yet, it is fair to say that most mainstream human rights groups are still struggling with how to most effectively incorporate ESC rights into their strategies and methods.
11. Much of this discussion recently has occurred in the pages of this journal: See Roth, supra note 6;
12. Leonard S. Rubenstein, How International Human Rights Organizations Can Advance Economic, Social and Cultural Rights: A Response to Kenneth Roth, 26 Hum. Rts. Q. 845 (2004);
13. Kenneth Roth, Response to Leonard S. Rubenstein, 26 Hum. Rts. Q. 873 (2004);
14. Leonard S. Rubenstein, Response by Leonard S. Rubenstein, 26 Hum. RTS. Q. 879 (2004);
15. Mary Robinson, Advancing Economic, Social and Cultural Rights: The Way Forward, 26 Hum. RTS. Q 866 (2004).
16. Other journals have entertained similar debates. See, e.g., Flavia Piovesan, Social, Economic and Cultural Rights and Civil and Political Rights, Sur Int'l J. Hum. Rts. 21 (2004), available at www.surjournal.org/eng/busca.php;
17. Emilio Garcia Méndez, Origin, Concept and Future of Human Rights: Reflections for a New Agenda, Sur Int'l J. Hum. Rts. 7 (2004), available at www.surjournal.org/eng/busca.php.
18. As discussed below, part of the argument made is that we need to reassess the boundaries of "the human rights community." Further, at certain points in the article, references are made to actors in the larger human rights movement, i.e. women's rights and labor rights, etc., in relation to ESC rights.
19. Physicians for Human Rights and the Science and Human Rights Program of the American Association for the Advancement of Science are notable in these regards. See, e.g., Physicians for Human Rights & United Nations Assistance Mission in Sierra Leone, War-Related Sexual Violence in Sierra Leone: A Population-Based Assessment (2002);
20. Physicians for Human Rights, Maternal Mortality in Herat Province, Afghanistan: The Need to Protect Women's Rights (2002);
21. Physicians for Human Rights, Women's Health and Human Rights in Afghanistan: A Population-Based Assessment (2001);
22. Physicians for Human Rights & Program on Forced Migration & Health, War Crimes in Kosovo: A Population-Based Assessment of Human Rights Violations Against Kosovar Albanians (1999);
23. Physicians for Human Rights, The Taliban's War on Women: A Health and Human Rights Crisis in Afghanistan (1998);
24. Making the Case: Investigating Large Scale Human Rights Violations Using Information Systems and Data Analysis (Patrick Ball et al. eds., 2000), available at http://shr.aaas.org/mtc/.
25. For example, the Truth and Reconciliation Commission's revelation that 54 percent of the disappeared during Peru's brutal civil conflict were indigenous in origin, carries implications for the nature of societal reconciliation as well as restitution. See Comision de la Verdad y Reconciliatcion, Informe Final de la Comision de la Verdad and Reconciliacion, Los Rostros y Perfiles de la Violencia, in Seccion Primera: Exposicion General del Proceso 21 Annex 3: Statistical Compendium (Aug. 2003), available at www.cverdad.org.pe/ifinal/pdf/ AESTADISTICO/ANEXO%20ESTAD%CDSTICO(PARA%20CD).pdf.
26. See, e.g., Patrick Ball et al., State Violence in Guatemala, 1960-1996: A Quantitative Reflection (1999).
27. See also Lynn L. Amowitz et al., Human Rights Abuses and Concerns about Women's Health and Human Rights in Southern Iraq, 291 J. Am. Med. Ass'n 1471 (2004);
28. Women's Health and Human Rights in Afghanistan: A Population-Based Assessment, supra note 10.
29. For a manual on how to most effectively use statistical analysis in human rights monitoring, see Herbert Spirer & Louise Spirer, Data Analysis for Monitoring Human Rights (1994).
30. For example, see the following reports by Physicians for Human Rights: War-Related Sexual Violence in Sierra Leone: A Population-Based Assessment, supra note 10;
31. Maternal Mortality in Herat Province, Afghanista, supra note 10;
32. Women's Health and Human Rights in Afghanistan: A Population-Based Assessment, supra note 10;
33. War Crimes in Kosovo: A Population-Based Assessment of Human Rights Violations Against Kosovar Albanians, supra note 10.
34. See, e.g., Tessa Wardlaw & Deborah Maine, Process Indicators for Maternal Mortality Programmes, Safe Motherhood Initiatives: Critical Issues 24 (Marge Berer & T.K. Sundari Ravindran eds., 1999);
35. Oona M.R. Campbell, Measuring Progress in Safe Motherhood Programmes: Uses and Limitations of Health Outcome Indicators, in id. at 31.
36. Alicia Ely Yamin & Deborah P. Maine, Maternal Mortality as a Human Rights Issue: Measuring Compliance with International Treaty Obligations, 21 Hum. Rts. Q. 563 (1999).
37. Roth, supra note 6, at 65.
38. See, e.g., Lynn P. Freedman, Using Human Rights in Maternal Mortality Programs: From Analysis to Strategy, 75 Intl. J. Gyn. & Obs. 51 (2001).
39. See Kate Raworth, Measuring Human Rights, 15 Ethics & Intl. Aff. 111, 118 (2001);
40. Maria Green, What We Talk About When We Talk About Indicators: Current Approaches to Human Rights Measurement, 23 Hum. Rts. Q. 1062 (2001).
41. Raworth, supra note 18, at 114.
42. id.
43. See Helen Watchirs, Review of Methodologies Measuring Human Rights Implementation, 30 J. Law, Med. & Ethics 716, 717 (2002);
44. Todd Landham, Measuring Human Rights: Principle, Practice, and Policy, 26 Hum. Rts. Q. 906 (2004).
45. Raworth, supra note 18, at 114-15.
46. See, e.g., Motherhood Initiative, Safe Motherhood: A Matter of Human Rights and Social Justice, available at www.safemotherhood.org/ facts_and_figures/humang_rights.htm.
47. Deborah Maine et al. Guidelines for Monitoring the Availability and Use of Obstetric Services (1997) (issued by UNICEF, WHO, & UNFPA);
48. See also Marge Berer & T.K. Sundari Ravindran, Preventing Maternal Mortality: Evidence, Leadership, Resources, Action, in Safe Motherhood Initiatives: Critical Issues 3, supra note 14.
49. Yamin & Maine, supra note 15, at 591-606.
50. Freedman, supra note 17, at 56.
51. Yamin & Maine, supra note 15, at 601-06.
52. Yamin, Castillos de Arena, supra note 2, at 215-48.
53. Lynn P. Freedman, Shifting Visions: "Delegation" Policies and the Building of a "Rights-Based" Approach to Maternal Mortality, 57 J. Am. Med. Women's Ass'n 154 (2002).
54. For discussion of availability and accessibility, see The Right to the Highest Attainable Standard of Health, General Comment No. 14, U.N. CESCR, Econ., Soc. & Cult. Rts. Comm, 22nd Sess., ¶ 12, U.N. Doc. E/C.12/2000/4 (2000) [hereinafter ESC Committee General Comment No. 14]; International Covenant on Economic, Social and Cultural Rights, adopted 16 Dec. 1966, G.A. Res. 2200 (XXI), U.N. GAOR, 21st Sess., Supp. No. 16, U.N. Doc. A/6316 (1966), 993 U.N.T.S. 3 (entered into force 3 Jan. 1976) [hereinafter ICESCR]; Convention on the Elimination of All Forms of Discrimination Against Women, adopted 18 Dec. 1979, arts. 12(1), (2), art. 14(2)(b), G.A. Res. 34/180, U.N. GAOR, 34th Sess., Supp. No. 46, U.N. Doc. A/34/46 (1980) (entered into force 3 Sept. 1981), 1249 U.N.T.S. 13, reprinted in 19 I.L.M. 33 (1980) [hereinafter Women's Convention].
55. See Standard Minimum Rules for the Treatment of Prisoners, adopted Aug. 30, 1955 by the First United Nations Congress on the Prevention of Crime and the Treatment of Offenders, ESOCR Res. 663C, U.N. Doc. A/CONF/611, Annex I (approved 21 July 1957).
56. Yamin & Maine, supra note 15, at 565.
57. Therese McGinn, Internally Displaced Persons in Colombia: A Public Health Analysis, in Learning to Dance: Advancing Women's Reproductive Health and Well-Being from the Perspectives of Public Health and Human Rights 63, 67 (Alicia Ely Yamin ed., 2005).
58. Interim report of the Special Rapporteur of the Commission on Human Rights on the Right of Everyone to Enjoy the Highest Attainable Standard of Physical and Mental Health, Mr. Paul Hunt, U.N. GAOR, 58th Sess., Agenda Item 117(c), UN Doc. A/58/427 (2003) [hereinafter Hunt Interim Report].
59. Id.
60. See, e.g., Freedman, supra note 17, at 58-59.
61. See generally Yamin & Maine, supra note 15;
62. Freedman, supra note 17.
63. See Watchirs, supra note 21, at 717;
64. United Nations Development Programme, Human Development Report 2000, at 89 (2000).
65. Stephen P. Marks, The New Partnership of Health and Human Rights, 2 Hum. Rts. Dialogue 21 (2001), available at http:/www.carnegiecouncil.org.
66. See the discussion of the competencies of the Peruvian Defensoría del Pueblo, which include inter alia rights to healthy environment, water, and education, available at www.ombudsman.gob.pe.
67. Substantive Issues Arising in the Implementation of the International Covenant On Economic, Social and Cultural Rights, Draft General Comment No. 9: The domestic application of the covenant, U.N. ESCRC, 19th Sess., Agenda Item 3, at ¶¶ 9-15, U.N. Doc. E/C.12/1998/24 (1998).
68. See also Philip Alston & Gerrard Quinn, The Nature and Scope of State Parties' Obligations under the International Covenant on Economic, Social and Cultural Rights, 9 Hum. Rts. Q. 156, 169-71 (1987);
69. Scott Leckie, Another Step Towards Indivisibility: Identifying the Key Features of Violations of Economic, Social and Cultural Rights, 20 Hum. Rts. Q. 81, 118-20 (1998).
70. For a discussion of justiciability criteria relating to health specifically, See Brigit Toebes, The Right to Health as a Human Right in International Law 238-40 (1999).
71. ICESCR, supra note 30, art. 12;
72. Women's Convention, supra note 30.
73. ICESCR, supra note 30, art. 10(2).
74. Women's Convention, supra note 30, art. 12(1).
75. Id. art. 12(2).
76. Id. art. 12. The Women's Convention discusses eliminating discrimination in health care and measures for those time periods;
77. ICESCR, supra note 30, arts. 2, 12. ICESCR discusses maximum available extent of resources in Article 2 and medical services for all in Article 12.
78. General Comment 3: The Nature of States Parties Obligations (art. ¶ 1 of the Covenant), U.N. CESCR, 5th Sess., ¶ ¶ 2, 9-12, U.N. Doc 14/12/90 (1990).
79. ESC Committee General Comment No. 14, supra note 30, ¶ ¶ 14, 21.
80. Id. ¶ 44;
81. see also Government of the Republic of South Africa and Others v. Grootboom and Others, 2000 (11) BCLR 1169 (CC), ¶ 13, available at www.concourt.gov.za/.
82. See, e.g., Minister of Health v. Treatment Action Campaign, 2002 (10) BCLR 1075 (CC) (public health evidence on efficacy and safety point to provision of Nevirapine for prevention of mother-to-child-transmission of HIV/AIDS), available at www.concourt.gov.za;
83. Cortez et al. v. Instituto Venezolano de Seguros Sociales, 00-0995 (Supreme Court of Venezuela, Constitional Chamber 2002), (retrogression in providing ARV treatment impermissible when ARVs commonly available on market), available at http://www.tsj.gov.ve/decisiones/scon/Mayo/ 881-080502-00-0095.htm.
84. Almost fifteen years ago, Deborah Maine and colleagues developed the "three delays model," which is commonly used to explain why women die in obstetric emergencies: they die because of delays in deciding to seek treatment; they die because of delays in reaching treatment; and they die because of delays in receiving adequate treatment at the health facility. In Elena's case, her husband initially sought care when he noticed her to be ill. The CHW at the village level could not provide appropriate care and had to travel over an hour to find a doctor. The doctor did not show up for hours, and when he did, he arguably did not have appropriate experience or training in manual removal of the placenta. The nonfunctional state of the ambulance at the second health center caused further delays, as did the absence of the more senior doctor and the resulting failure to administer stabilizing medication. Deborah Maine, Safe Motherhood Programs: Options and Issues (1991).
85. The district "hospital" mentioned in the case was in Huancane, part of the referral network of the larger San Roman hospital. Raquel Hurtado, Muerte Materna en los Establecimientos de Salud Pública del Departamento de Puno: Una Aproximación a la Problemática Desde el Enfoque de loa Derechos Humanos 73 (2002) (final report for the US Agency for International Development).
86. Compare Ran Hirschl, "Negative" Rights vs. "Positive" Entitlements: A Comparative Study of Judicial Interpretations of Rights in an Emerging Neo-Liberal Economic Order, 22 Hum. Rts. Q. 1060 (2000).
87. Asbjørn Eide & Allan Rosas, Economic, Social and Cultural Rights: A Universal Challenge, in Economic, Social and Cultural Rights: A Textbook 17 (Asbjørn Eide et al. eds., 1995).
88. For one of the first elaborations of the tripartite obligations of states to respect, to protect and to fulfill rights, see Report on the Right to Food as a Human Right, U.N. ESCOR Comm'n. on Hum. Rts., 39th Sess., Agenda Item 11, U.N. Doc. E/CN.4/Sub.2/1987/23 (1987).
89. Alvarez v. Estado Colombiano, SU.819/99 (Corte Constitucional de Colombia 1999) (judgment to unify jurisprudence on right to health and social security services), available at http:/bib.minjusticia.gov.co/ jurisprudencia/CorteConstitucional/1999/Tutela/su819-99.htm.
90. Id.
91. see, e.g., Minister of Health v. Treatment Action Campaign, supra note 50;
92. Alvarez v. Caja Costarricense de Seguro Social, Exp. 5778-V-97, No. 5934-97 (Sala Constitucional de la Corte Suprema de Justicia de Costa Rica 1997) (social security institute obliged to provide ARV treatment), available at www.laccaso.org/documentos%20word/COSTA %20RICA-%20Sentencia-%20vih-sida-Medicamentos-instituto%20Seg.doc;
93. Jofre Mendoza et al. v. Minister of Health, Decision No. 0749-2003-RA, Case No. 0749-2003-RA (Constitutional Tribunal of Ecuador 2004) (aspects of right to health relating to right to receive ARVs are fully justiciable).
94. See also Sheetal Shah, Illuminating the Possible in the Developing World: Guaranteeing the Human Right to Health in India, 32 Vand. J. Transnat'l L. 435 (1999).
95. See Martin Scheinin, Economic and Social Rights as Legal Rights, in Economic, Social and Cultural Rights: A Textbook, supra note 54, at 41.
96. See Toebes, supra note 41.
97. See Victor Abramovich, Combining Legal and Political Actions in the Struggle for Social Rights, in Derechos Economicos, Sociales y Culturales en America Latina: del Invento a la Herramienta, Mexico City: Plaza y Valdés (Alicia Ely Yamin ed., forthcoming 2005).
98. In the United States, decisions based on equal protection grounds have had effects on ESC rights. See, e.g., Brown v. Board of Education, 347 U.S. 483 (1954). In Brown I, a constitutional decision, the US Supreme Court held that segregation in educational facilities is inherently unequal.
99. See, e.g., Jofre Mendoza et al. v. Minister of Health, supra note 58;
100. Alvarez v. Caja Costarricense de Seguro Social, supra note 58.
101. See discussion of Mariela Viceconte case and of noncompliance with a judicial order issued by the Supreme Court of Argentina in 1998, cited in Centro de Estudios Legales y Sociales, Derechos Humanos en Argentina ch. XI (2001) (government ordered to manufacture and distribute vaccine that it had stated policy to undertake), available at www.cels.org.ar/ Sitel_cels/publicacionesfinformes_pdf/2001.Capitulo11.pdf.
102. See, e.g., Government of the Republic of South Africa and Others v. Grootboom and Others, supra note 49.
103. Id. ¶ 42.
104. Id. ¶ 43.
105. Id.
106. Minister of Health v. Treatment Action Campaign, supra note 50 (court orders extension of Nevirapine treatment to prevent mother to child transmission of HIV and development of HIV/AIDS policy meeting specific criteria to be monitored by court).
107. Id.
108. See, e.g., Cortez et al. v. Instituto Venezolano de Seguros Sociales, supra note 50 (violation of the right to life and prohibition on discrimination in Venezuelan Constitution, in that the failure of the social security institute to provide antiretroviral treatment on a regular schedule can provoke an inexorable destruction of the immune system, in addition to viral resistance, which leads to opportunistic infections and death).
109. Alvarez v. Estado Colombiano, supra note 56;
110. Alvarez v. Caja Costarricense de Seguro Social, supra note 58;
111. Cortez et al. v. Instituto Venezolano de Seguros, Sociales, supra note 50.
112. Alvarez v. Caja Costarricense de Seguro Social, supra note 58.
113. The Right to Life, General Comment No. 6, U.N. CCPR, 16th Sess., ¶ 5, U.N. Doc. A/37/40 (1982).
114. Id.
115. See, e.g., Concluding Observations of the Human Rights Committee: Peru, U.N. CCPR, Hum. Rts. Comm., 58th Sess., ¶ ¶ 13, 15, U.N. Doc. CCPR/C/79/Add.72 (1996);
116. Concluding Observations of the Human Rights Committee: Poland, U.N. CCPR, Hum. Rts. Comm ¶ 11, U.N. Doc. CCPR/C/79/Add.110 (1999).
117. See generally Craig Scott, The Interdependence and Permeability of Human Rights Notrms; Towards A Partial Fusion of the International Covenants on Human Rights, 27 Osgoode Hall L.J. 769 (1989).
118. See generally Victor Abramovich & Christian Courts, Los derechos sociales como derechos exigibles (2002).
119. Albie Sachs, Enforcement of Social and Economic Rights, Speech at the Centre for the Study of Human Rights, London School of Economics (27 Feb. 2003) (draft transcript), cited in Vinodh Jaichand, Public Interest Litigation Strategies for Advancing Human Rights in Domestic Systems of Law, 1 Sur Intl. J. Hum. Rts. 127, 131 (2004), available at www.surjournal.org/eng/busca.php.
120. See, e.g., Ministerio de Salud-Proyecto 2000 Lima-Perú, Salvarse Con Bien: EL Parto de la Vida en los andes y Amazonia del Perú 69-72 (1999).
121. See the discussion in David Kennedy, The Dark Sides of Virtue: Reassessing, International Humanitarianism 12 (2004).
122. See ESC Committee General Comment No. 14, supra note 30, ¶ 12.
123. Not only does litigation in general fail to address many of the underlying institutional and structural factors, but a strategy based on identifying individual violators to be prosecuted may sometimes prove counterproductive, detracting attention from such issues. In Elena's case, for example, focusing attention on the individual doctors establishes an adversarial relationship between provider and health system user and ignores the underlying reasons for the lack of availability and access to necessary services. For instance, it is unclear why the second doctor was not present at the health center, but in the absence of evidence of misfeasance, we might ask whether it is reasonable to require a doctor fulfilling his mandated rural service to be on duty twenty-four hours a day, seven days a week. if not, the staffing and rotation policies of Peru's rural health centers and hospitals need to be revised so that no woman who faces an obstetric emergency is put at risk. Although, of course, patients must be protected from abuse and negligence, a strategy that inclividualizes fault and ignores the larger context may only serve to perpetuate a system which undermines both patients' and health providers' rights.
124. See Rubenstein, supra note 8, at 850-55.
125. Much of this work is being done by women's rights groups. See generally, e.g., Negotiating Reproductive Rights; Women's Perspectives Across Countries and Cultures (Rosalind P. Petchesky & Karen Judd eds., 1998).
126. Alice M. Miller, Sexual Orientation as a Human Rights Issue, in Learning To Dance: Advancing Womens's Reproductive Health and Well-Being from the Perspectives of Public Health and Human Rights, supra note 33, at 159.
127. Charles Ngwena, Substantive Equality in South African Health Care: The Limits of Law, 4 Med. L. Intl. 111, 126 (2000).
128. See, e.g., Human Rights Watch, World Report 2001 Introduction: "A Human Rights Framework" (2001): On a societal level, respect for civil and political rights, including the right to elect one's government, allows the disadvantaged to have a voice in the direction of their nation's social and economic development. These rights permit citizens to press their government to take on such issues as increasing the minimum wage, protecting union activists from retaliation, enforcing prohibitions on discrimination, regulating extraction industries, or ensuring that investments are made with social values in mind. Available at www.hrw.org/wr2k1/intro.
129. See generally Joseph Stiglitz, Globalization and ITS Discontents (2002);
130. David Korten, When Corporations Rule the World (1996).
131. See Deborah Maine, What's So Special about Maternal Mortality, in Safe Motherhood Initiatives: Critical Issues, supra note 15, at 175-82. Note that prenatal care has other effects on infant health.
132. A healthy skepticism brought to bear by human rights NGOs can itself be beneficial in a situation in which development groups and donors are not in a position to "out" the government. As Roth writes, "[T]echnical assistance to a government that lacks a good-faith desire to respect rights can be counter-productive by providing a façade of conscientious striving that enables a government to deflect pressure to end abusive practices." Roth, supra note 6, at 67.
133. The Washington Office on Latin America and the Centro de Estudios Legales y Sociales (Center for Legal and Social Studies) in Argentina are among many NGOs that are working in collaboration with different levels of government on issues relating to citizen security and human rights.
134. Rubenstein, supra note 8, at 856-57.
135. Mujeres de Negro: La Muerte Materna en Zonas Rurales del Perú: Estudio de Casos, supra note 1, at 176 (unofficial translation).
136. See, e.g., Hilary Charlesworth & Christine Chinkin, The Boundaries of International Law: A Feminist Analysis 226-44 (2000).
137. Noreen Burrows, International Law and Human Rights: The Case of Women's Rights, in Human Rights: From Rhetoric to Reality 82 (Tom Campel et al. eds., 1986),
138. cited in Charlesworth & Chinkin, supra note 95, at 230.
139. See Fourth World Conference on Women: Action for Equality, Development, and Peace, Beijing Declaration and Platform for Action, U.N. GAOR, U.N. Doc. A/CONF.177/20 (1995), reprinted in Report of the Fourth World Conference on Women (1995) (recommended to the UN General Assembly by the Committee on the Status of Women on 7 Oct. 1995) [hereinafter Beijing Platform for Action].
140. Susana Chiarotti, Mujeres y derechos Humanos: Convergencias y Tensiones entre dos Movimientos Sociales (Women and Human Rights: Convergences and Tensions Between Two Social Movements), in Derechos Económicos, Sociales y Culturales en América Latina: Del Invento a la Herramienta, supra note 61.
141. See, e.g., Human Rights Watch, Doubles Standards: Womens's Property Rights Violations in Kenya (2003) (property rights abuses perpetuate women's inequality in public and private spheres, doom development efforts, and undermine the fight against HIV/AIDS).
142. See also The Taliban's War on Women: A Health and Human Rights Crisis in Afghanistan, supra note 10;
143. Women's Health and Human Rights in Afghanistan: A Population-Based Assessment, supra note 10.
144. María Eugenia Morales de Sierra v. Guatemala, Case 11.625, Inter-Am.C.H.R., OEA/ser.L/V/II.111, doc.20 rev. (2001), available at www.cidh.oas.org/annualrep/2000eng/ChapterIII/Merits/ Guatemala11.625.htm.
145. Article 3: The Equal Rights of Men and Women to the Enjoyment of all Economic, Social and Cultural Rights, General Comment No. 16, U.N. ESCOR, Comm. on Econ., Soc. & Cult. Rts., 34th Sess., ¶ 8., U.N. Doc. E/C.12/2005/3 (2005) (unedited version).
146. Note, however, that despite enormous success in having states adopt legislation, in practice gender-based violence appears to be as big a scourge as ever. See Gender Integration of the Human Rights of Women and the Gender Perspective: Violence Against Women, Report of the Special Rapporteur on Violence against Women, its Causes and Consequences, Mrs. Radhika Coomaraswamy, U.N. ESCOR, Comm'n on Hum. Rts., 59th Sess., Item 12(a) of the provisional agenda, Addendum 1, at 1-17, U.N. Doc. E/CN.4/ 2003/75/Add.1 (2003).
147. Yamin, Castillos de Arena, supra note 2, at 136-70.
148. See id. at 117-70.
149. Specifically, in the decade of the 1990s, in this area of health alone, Peru received $44.4 million in financing from the World Bank for the "Health and Basic Nutrition Project" to target improvements in maternal and infant health. USAID contributed $30 million to "Project 2000" (1995-2000/02) which was aimed at improving obstetric services and response capacity in the communities. In 1998, the Maternal-Infant Insurance Scheme, co-financed by the World Bank and the Inter-American Development Bank (IDB), was inaugurated. In 1999 the government undertook the "Contingency Plan for the Reduction of Maternal Mortality" (Plan de Contingencia para la Reducción de la Muerte Materna), to which most of Peru's international donors contributed. With the exception of the contingency plan, these projects were conceived and managed apart from the Maternal-Perinatal Program in the Ministry of Health. See also Juan Arroyo, La Reforma Silenciosa: Politicas Sociales y de Ssalud en el Perú de los 90, at 11-31 (2000);
150. Christina Ewig, Gender Equity and Neoliberal Social Policy: Health Sector Reform in Peru (2001) (unpublished Ph.D. dissertation in political science, University of North Carolina at Chapel Hill) (on file with author).
151. Christina Ewig, The Politics of Health Sector Reform in Peru (2002) (paper prepared for the Woodrow Wilson Center Workshops on the Politics of Education and Health Reforms, Wash., D.C., 18-19 Apr. 2002).
152. Yamin, Castillos de Arena, supra note 2, at 120-25.
153. See Jim Yong Kim et al., Sickness Amidst Recovery: Public Debt and Private Suffering in Peru, in Dying For Growth: Global Inequality and the Health of the Poor 127 (Jim Yong Kim et al. eds., 2000) [hereinafter Dying for Growth];
154. Ewig, supra note 105, at 16-20.
155. Note that this exclusive focus need not be the case. In addition to the numerous references to international assistance and cooperation, Article 28 of the Universal Declaration of Human Rights explicitly proclaims that "everyone is entitled to a social and international order in which rights and freedoms set forth in the declaration can be fully realized." (emphasis added). Universal Declaration of Human Rights, adopted 10 Dec. 1948, G.A. Res. 217A (III), U.N. GAOR, 3d Sess. (Resolutions, Pt. 1), at 71, art. 28, U.N. Doc. A/810 (1948), reprinted in 43 Am. J. Int'l L. 127 (Supp. 1949).
156. Chris Jochnick, Confronting the Impunity of Non-State Actors: New Fields for the Promotion of Human Rights, 21 Hum. Rts. Q. 56, 59 (1999).
157. United Nations Development Programme, Human Development Report 2002 (2002),
158. cited in Piovesan, supra note 8, at 35.
159. Stiglitz, supra note 89, at 21-22.
160. Doe v. Unocal Corp, 2002 U.S. App. LEXIS 19263 (9th Cir. 2002) (government of Myanmar acted as an agent on behalf of Unocal and Total SA, forcibly relocating villagers, cutting them off from their livelihoods, as well as torturing people and forcing them to work on the gas exploitation project); Decision Regarding Communication No. 155/96, ACHPR/Comm/A044/1 (African Commission on Human and Peoples' Rights 2002) (holding Nigerian government responsible for directly violating and failing to protect the rights to life, health, and housing of the Ogoni people) [hereinafter Ogoniland Case].
161. Piovesan, supra note 8, at 35.
162. See Joyce V. Millen & Timothy H. Holtz, Transnational Corporations and the Health of the Poor, in Dying For Growth, supra note 107, at 183.
163. Doe v. Unocal Corp, supra note 112, at 32-33;
164. Ogoniland Case, supra note 112, ¶ ¶ 51-55.
165. Rubenstein, supra note 8, at 864.
166. Public Citizen, Report of the International Fact-Finding Mission on Water Sector Reform in Ghana (2002), available at www.citizen.org/ documents/factfindingmissionGhana.pdf.
167. The IMF is generally less susceptible to advocacy than the World Bank and that was the case in this situation. For a discussion of the issues involved in holding international financial institutions accountable under human rights law, See Daniel D. Bradlow, The World Bank, the IMF and Human Rights, 6 Transnat'l L. & Contemp. Probs. 47 (1996).
168. See also generally Balakrishnan Rajagopal, Crossing the Rubicon: Synthesizing the Soft International Law of the IMF and Human Rights, 11 B.U. Int'l L. J. 81 (1993);
169. Ibrahim F.I. Shihata, The World Bank and Human Rights: An Analysis of the Legal Issues and the Record of Achievements, 17 Denv. J. Int'l' L. & Pol'y 39 (1988).
170. This is especially notable in the work on NGOs in the South, where the inadequacy of the state-focused model is readily apparent. See, e.g., Demanding Accountability: Civil-Society Claims and the World Bank Inspection Panel (Dana Clark et al. eds., 2003);
171. see also the materials and courses prepared by of the Plataforma Interamericana de Derechos Humanos, Democracia y Desarrollo, available at www.pidhdd.org.
172. See, e.g., working groups on trade and human rights, budgets, and business, which function as part of the ESCR-Net, available at www.escr-net.org.
173. The Special Representative will have a mandate to (a) identify and clarify standards of corporate responsibility and accountability for transnational corporations and other business enterprises with regard to human rights; (b) elaborate on the role of states in effectively regulating and adjudicating the role of transnational corporations and other business enterprises with regard to human rights, including through international cooperation; (c) research and clarify the implications for transnational corporations and other business enterprises of concepts such as "complicity" and "sphere of influence"; (d) develop materials and methodologies for undertaking human rights impact assessments of the activities of transnational corporations and other business enterprises; and (e) compile a compendium of best practices of states and transnational corporations and other business enterprises. Promotion and Protection of Human Rights: Human Rights and Transnational Corporations and other Business Enterprises, U.N.ESCOR, Comm'n on Hum. Rts., 61st Sess., Agenda Item 17, U.N. Doc. E/CN.4/2005/L.87 (2005).
174. Kennedy, supra note 81, at 11.
175. John Gershman & Alec Irwin, Getting a Grip on the Global Economy, in Dying for Growth, supra note 107, at 7.
176. Id.
177. The number of people around the world living in poverty increased by 100 million people in the last decade of the twentieth century, while world income actually increased by an average of 2.5 percent annually; Stiglitz, supra note 89, at 5.
178. Endes, supra note 3, at 111 (charts 8.1, 8.2).
179. See, e.g., Antonio Ugalde & Jeffrey T. Jackson, Las Políticas de Salud del Banco Mundial;
180. Una Revisión Crítica, 73 Cuadernos Med. Soc. 45 (1997);
181. Sigrun I. Skogly, Structural Adjustment and Development: Human Rights - An Agenda for Change, 15 Hum. Rts. Q. 751 (1993).
182. See Carlos Vilas, Neoliberal Social Policy: Managing Poverty (Somehow), 29 NACLA Report on the Americas 16 (1996);
183. Dying For Growth, supra note 107, at 130.
184. Maria Garduño Andrade, Poros y Grietas de los modelos de gestión en salud [Pores and Fissures in Models of Health Management], in Saude, Equidade e Género: Um Desafío as Políticas Públicas [Health, Equity and Gender: A Challenge for Public Policies] 113, 122 (2000);
185. See also, Asa Cristina Laurel] & Oliva López Arellano, Market Commodities and Poor Relief: The World Bank Proposal For Health, 26 Int'l J. Health Serv. 1 (1996).
186. See John Rawls, The Law of Peoples, in On Human Rights: The Oxford Amnesty Lectures 41 (Stephen Shute & Susan Hurley eds., 1993).
187. For a critique of this view, See Charlesworth & Chinkin, supra note 95, at 29-37.
188. Similar human rights-based arguments can be made about the primacy of health concerns when interpreting trade or intellectual property agreements. See, e.g., Human Rights and Intellectual Property, U.N. ESCOR, Econ., Soc. & Cult. Rts. Comm., 27th Sess., Agenda Item 3, ¶ 12, U.N Doc. E/C.12/2001/15 (2001) [hereinafter Statement on Human Rights and Intellectual Property].
189. Human Development Report 2002, supra note 110, at 208.
190. Id. at 206.
191. See The Nature of States Parties Obligations, General Comment No. 3, U.N. CESCR, 5th Sess., ¶ 8, U.N. Doc. E/1991/23, Annex III at 86 (1991).
192. See Kennedy, supra note 81, at 19.
193. Yamin, Castillos de Arena, supra note 2, at 224-36.
194. ESC Committee General Comment No. 14, supra note 30, ¶ 17.
195. International Covenant on Civil and Political Rights, adopted 16 Dec. 1966, G.A. Res. 2200 (XXI), U.N. GAOR, 21st Sess., Supp. No. 16, arts. 14, 19, 25, U.N. Doc. A/6316 (1966), 999 U.N.T.S. 171 (entered into force 23 Mar. 1976).
196. Freedman, supra note 17, at 58.
197. For discussions of this concept in development generally, see People-Centered Development: Contributions Toward Theory and Planning Frameworks (David C. Korten & Rudi Klauss eds., 1984).
198. For an excellent discussion of taxonomies of participation and its use in neoliberal discourse, See R.K. Murthy et al., Draft 2: Sexual and Reproductive Rights in Service: Accountability and Community Participation 2 (2003) (paper delivered at the Expert Consultation on Decentralisation, Integration of Service Programmes, Community Participation and Accountability as These Pertain to Sexual and Reproductive Rights and Health, 24-25 Apr. 2003) (on file with author).
199. See, e.g., Magaly Huggens Castañeda, Género, participación, empoderamiento y control social, in Saude, Equidade e Género, supra note 128, at 244;
200. Murthy, Klugman, Weller & Aizenberg, supra note 139, at 2.
201. Freedman, supra note 17, at 58.
202. Yamin, Castillos de Arena, supra note 2, at 233-34.
203. Yngeborg Villena, Sistematización: Mesa Multisectorial por una Maternidad Saludable y Segura 1999-2001, at 30-32 (2001).
204. Yamin, Castillos de Arena, supra note 2, at 233-34.
205. Villena, supra note 143, at 39.
206. See, e.g., Abramovich, supra note 61;
207. Victor Abramovich, Courses of Action in Economic, Social and Cultural Rights: Insstruments and Allies, 2 Sur: Int'l. J. Hum. Rts. 181 (2005), available at www.surjournal.org/.
208. See Neil Stammers, Social Movements and the Construction of Human Rights, 21 Hum. Rts. Q. 980, 989-93 (1999).
209. Abramovich, supra note 61.
210. The Center for Economic and Social Rights, for example, has gone out of its way to work with social movements and networks such as the Poor Person's Human Rights Network in the United States. See available at www.cesr.org.
211. For the text of the initiative and a discussion of the campaign, see available at www.aprodeh.org.pe/desc/saludm̌panhas.htm.
212. See id. at 850-55.
213. Oscar Vilhena Vieira & A. Scott Dupree, Reflections on Civil Society and Human Rights, 1 Sur: Int'l J. Hum. Rts. 61-62 (2004).
214. Id. at 62.
215. For a discussion of the connection between abortion and maternal mortality in Peru, see Delicia Ferrando, EL Aborto. Clandestino en el Peru (2002).
216. See also M. Berer, Making Abortions Safe: A Matter of Good Public Health Policy and Practice, 78 Bull. World Health Org. 580 (2000).
217. For example, some human rights groups will focus on ESC issues that are compatible with their organizational strengths in certain subject areas; others will place priority on inarguably egregious cases, as often has been done in civil and political rights advocacy; and yet others may take different tracks focused on developing new methodologies.
218. Paul Farmer uses the term "pathologies of power. Paul Farmer, Pathologies of Power: Health, Human Rights and the New War on the Poor 146 (2003).
219. Compare Roth, supra note 6, at 72.