Negotiating Provider Resistance to Rights Based Approaches in Mexico

Session: Applying Human Rights Based Approaches to Preventing Maternal Mortality and Morbidity: Strategies, Challenges and Lessons from Civil Society Experiences in Four Countries

Presenter: Valentina Zendejas, Instituto de Liderazgo Simone de Beauvoir

While disseminating the TGN with the government, the local Officer of the High Commission on Human Rights collaborated with members of the civil society platform CPMSM (Comité Promotor por una Maternidad Segura en Mexico), facilitating a meeting with the federal Minister of Health. The Ministry of Health in Mexico is responsible only for making public policies and surveillance, none of the implementation of the fragmented health system (Private insurance, EIMSS, ISSSTE and Seguro Popular) is under the Ministry of Health. However it was hoped that high-level interaction would faciliate implementation of the TGN within the provinces.  When 18 maternal deaths occurred between January – May 2014 in the prosperous province of Jalisco, the CPMSM planned to apply the TGN while conducting verbal autopsies to establish causes of death, analyze health system gaps and bring out the perspective of families, towards articulating recommendations for improving service quality. However, the provincial health officials and providers were somewhat threatened by the notion of human rights especially for the poor or indigenous communities. They associated it with court cases, compensation claims or punitive action; and despite repeated efforts over six months, refused to provide any contact information of the deceased women.   The members of CPMSM modified their original strategy and leveraged contact with an influential parliamentarian to obtain access to the Director of the Jalisco Civil Hospital. A space has been negotiated to discuss ways of operationalizing the TGN through formation of a Working Group among hospital staff who will be facilitated by CPMSM to study the TGN. The sensitive nature of maternal deaths led to health managers’ reluctance to disclose information and resistance to rights-based approaches. It is important to build providers’ understanding of human rights based approaches for accountability, that incorporate redress, remedy and guarantee of non-repetition to prevent similar deaths in future.