In Pursuit of Justice

The Brazilian government still has to take big steps to fulfill the historic CEDAW Committee’s ruling on maternal mortality.

Twenty-eight-year-old Alyne de Silva Pimentel, a poor Afro-Brazilian woman with a young daughter, was six months pregnant with her second child when she began to experience severe nausea and abdominal pain.  When her symptoms intensified, she sought help at a private health center. Five days later, on November 16, 2002, after a series of egregious oversights and precarious medical care, Alyne died. She had spent the last 21 hours of her life lying largely unattended in a hospital hallway.

Two years ago, for the first time ever, an international human rights body ruled on a maternal mortality case. Alyne’s story made history when the United Nations Committee on the Elimination of Discrimination against Women (CEDAW) compelled the Brazilian government to guarantee all women, regardless of race or income, quality maternal health care.

While the Brazilian government has taken some important steps, Senator Ana Rita, president of the Human Rights Commission of the Brazilian Senate, convened a public hearing on November 14th to catalyze further progress. The Center testified at that hearing, standing up as it always has for the rights of Alyne’s family.

The details of Alyne’s death are shocking. Despite symptoms indicating a catastrophic illness—including the induced delivery of her stillborn fetus, followed by severe hemorrhaging, vomiting, and an eventual coma-like state—Alyne’s condition was repeatedly discounted by medical staff at the two facilities where she sought treatment. But 11 years later, we find that the details of Alyne’s final days continue to illustrate an alarming reality in Brazil. It is clear that Alyne’s status as a poor Afro-Brazilian—a historically marginalized population in Brazil—played a deadly role in the low-quality care she received.

Afro-Brazilian women are seven times more likely than white women to die from pregnancy-related causes, and 90% of maternal deaths in Brazil are considered preventable. Had Alyne’s pain been taken seriously, had she received immediate surgery to stop internal bleeding, had she been transferred in a timely way to the hospital—had her caretakers reacted appropriately to her condition, it is likely Alyne would be alive today.

Brazil’s initial response to the landmark CEDAW decision in 2011 included several admirable actions. The government settled on an amount to compensate Alyne’s family for their loss and offered to make certain symbolic gestures to acknowledge that the government failed to protect her and to present a public apology. Further, an interministerial group was created to determine a working plan and indicators of compliance with the CEDAW Committee’s decision.

However, while the government has expressed a sincere commitment to change, there have been no signs that it has fully embraced and implemented the measures necessary to prevent avoidable maternal deaths such as the one Alyne experienced. Significant challenges remain:

  • Although the interministerial working group legally operated from May to October 2013, the group has not announced any of the compliance indicators, and the Center is unaware of the development of a working plan to make progress toward implementation.
  • A distressing report from the Brazilian Platform of Economic, Social, Cultural and Environmental Human Rights (DHESCA platform) revealed that, 10 years later, precarious conditions persist in the two health facilities where Alyne was treated.
  • Perhaps most importantly, 11 years after her death Alyne’s family has still not received any compensation or acknowledgment despite the promises from the Brazilian government. In fact, during the recent public hearing, the government did not even send a representative from the Secretariat of Women’s Policies that could be accountable for the implementation of the case.

“All women—regardless of where they live, how much money they have, or their race—have a fundamental right to timely and appropriate maternal health services without discrimination,” said Mónica Arango, the Center’s Regional Director for Latin America and the Caribbean.

“Alyne was denied that right. As recognized by the CEDAW Committee in its decision, the government must provide individual reparations as well as implement the policy recommendations set forth in the decision.”

Today, Alyne’s surviving mother and daughter, five years old when she lost her mother, still wait for meaningful justice in this tragic and unnecessary death. Now practically a woman herself, Alyne’s daughter joins millions of Brazilian women who have yet to see their government deliver on the assurance of a basic human right.

As the harrowing details of Alyne’s death remain an all-too-familiar story, the Center continues to urge the Brazilian government to comply with the recommendations set forth by the CEDAW Committee that recommend further steps to guarantee that all women—particularly those most vulnerable to discrimination—have access to timely and safe maternal health services.