da Silva Pimentel vs Brazil, Communication no. 17/2008, U.N. DOC. CEDAW/C/49/D/17/2008.

Case Name and Citation: 

da Silva Pimentel vs Brazil, Communication no. 17/2008, U.N. DOC. CEDAW/C/49/D/17/2008.

Court Name and Bench: 

The case was decided by the UN Committee on the Elimination if Discrimination against Women  (CEDAW) 

The bench consisted of the committee members, acting under the Optional Protocol to the  Convention. 

Date of Judgement: 

25 July, 2011. 

Parties Involved: 

Petitioner: Maria de Lourdes, mother of the deceased da Silva Pimentel (representing her family). She was represented by the Center for Reproductive Rights and Advocacia Cidadã pelos Direitos  Humanos.  

Respondent: The State of Brazil. 

Facts of the Case: 

The victim, Alyne da Silva Pimentel Teixeira, had a daughter on 2 November, 1997. On 11  November 2002, while six months pregnant, she went to the Casa de Saúde Nossa Senhora da  Glória de Belford Roxo health centre, where the attending medical specialist, checked her and  prescribed medication. The medical specialist also scheduled for 13 November 2002, routine blood  and urine tests. 

Da Silva Pimentel’s condition worsened significantly over the past two days. On 13 November  2002, she returned to the health center along with her mother, seeking medical attention before the  scheduled tests. Ultrasound revealed no fetal heartbeat, and she delivered a 27-week stillborn fetus,  becoming disoriented immediately afterward. 

On 14 November 2002, approximately 14 hours after the delivery, Ms. da Silva Pimentel  underwent a procedure to remove retained placental tissue. Despite the procedure, her condition deteriorated further. Doctors sought to transfer her to better-equipped hospitals, but although  Hospital Geral de Nova Iguaçu had space, it refused ambulance support. Unable to secure private  transport, she remained in critical condition for eight hours, the last two hours in a comatose state.  

On 15 November 2002 at 9:45 p.m., she arrived at the hospital and her condition worsened, with  blood pressure dropping to zero. With no beds available, she was placed in the emergency hallway. Her medical records were not transferred by the medical staff to the hospital. On 16 November,  she died from digestive haemorrhage. Later her mother received the medical records and found  out that the fetus has been dead for days. On 11 February 2003, her husband filed a claim for  compensation. 

Maria de Lourdes da Silva Pimentel, mother of the deceased Alyne da Silva Pimentel Teixeira,  submitted a communication on her own behalf and on behalf of her family. she alleged that the  State violated Alyne’s rights to life and health, as protected under Articles 2 and 12 of the  Convention on the Elimination of All Forms of Discrimination against Women. This case became  one of the first ever maternal mortality case decided by an international human rights body. 

Issue Raised: 

1. Whether the state has taken immediate actions to address the victims right to life during  pregnancy and childbirth under Article 2 of CEDAW. 
2. Whether the state has ensured access to quality medical treatment during delivery under  Artiy12 of CEDAW. 

Argument of the Parties: 

Petitioner’s Argument: 

1. The petitioner argues that Article 2 of CEDAW obliges states to take immediate actions  against discrimination, particularly when a woman’s right to life is threatened during  pregnancy and childbirth. 
2. The petitioner further argues that Article 2(c) requires States to not only have measures  against discrimination but also ensure their effective implementation, including judicial  mechanisms. Failure to do so constitutes a violation under Article 12.
3. The petitioner asserts that the obligations under Articles 2 and 12 regarding health care are  immediately binding because the rights to life and non-discrimination demand urgent  action. 
4. The petitioner claims that the death of Ms. da Silva Pimentel resulted from Brazil’s failure  to provide quality medical care during childbirth, violating Articles 2 and 12. 

Respondents Argument: 

1. The State party emphasizes that the right to health, established under Articles 6 and 196 of  the Brazilian Federal Constitution, creates both positive and negative obligations. Public  health services, delivered through public policies, constitute the State responsible for this  right, with both proactive and defensive duties. 
2. The State further states that, the government and private sectors have different  responsibilities, with state having exclusive right to regulate and control, while private  hospitals are limited to providing medical and pharmaceutical services. 
3. The state party argues against the allegations that it violated articles 2 and 12 by failing to  eliminate discrimination against women, by stating that most public policies addressing  women’s rights are under development. 
4. The state party further states that the victims death was non maternal, with the probable  cause being digestive hemorrhage. 
5. The State party rejects the author’s claim that the events demonstrate a systemic failure to  protect women’s rights or a lack of commitment to reducing maternal mortality. 

The state party concludes that it has not been indifferent or negligent regarding it’s obligations to  implement health policies providing specific care for some women. 

Courts Reasoning: 

With regard to Articles 2 and 12 of the Convention, the Committee first established that the death  of the petitioners daughter qualified as a maternal death, based on uncontested factual evidence  and expert opinion demonstrating a causal link to pregnancy-related obstetric complications.  

It further determined that the death resulted from the State party’s failure to provide adequate and  timely maternal health services. 

The Committee also held that the unsatisfactory treatment by the private health facility was  attributable to the State under Article 2e, as the State has a duty to exercise due diligence in  supervising and regulating private healthcare providers. This lack of proper oversight likewise  amounted to a violation of Article 12. 

The Committee further concluded that Brazil breached Articles 12 and 2c of CEDAW by failing  to establish an effective system capable of ensuring adequate judicial protection and the  availability of appropriate remedies for the victim. 

Judgement/Ratio Decidendi: 

The Committee found Brazil responsi for violating its obligations under Articles 2© and 2€, as  well as Article 12 of CEDAW, interpreted in light of Article 1 and the Committee’s General  Recommendations Nos. 24 and 28, by failing to ensure equal protection, prevent discrimination,  and guarantee women’s right to health. 

The Committee recommended that Brazil grant adequate compensation to the petitioner and the  deceased’s family. It further urged the State to guarantee women’s right to safe motherhood by  ensuring accessible and affordable emergency obstetric care on a non-discriminatory basis. 

The ratio decidendi in this case is that the state, in accordance with article 2 and 12 of CEDAW,  has a duty to ensure accessible, timely, and adequate maternal healthcare, including emergency  obstetric services, to all women without discrimination, and to effectively regulate and monitor  both public and private healthcare providers, while also providing effective judicial remedies when  such rights are violated. 

Significance of the Case: 

This case is a milestone for clarifying the scope of State obligations under CEDAW in relation to  maternal health and discrimination.  

It establishes that preventable maternal death constitutes a violation of women’s rights to health  and non-discrimination, and affirms that States bear responsibility not only for public healthcare  but also for regulating and monitoring private providers.

The committee further underscores that inadequate maternal health services can amount to  systemic discrimination, particularly where factors such as race and socio-economic status are  present. 

Conclusion: 

It is the duty of every State to uphold women’s rights by providing comprehensive, non discriminatory maternal healthcare and exercising due diligence over all healthcare providers. 

Failure to provide adequate and timely healthcare may lead to discrimination against the health of  women in healthcare facilities, which in turn may lead to severe consuquen. 

Reference(S): 

1. Da Silva Pimentel vs Brazil, Communication no. 17/2008, U.N. DOC.  CEDAW/C/49/D/17/2008. 
2. Convention on the Elimination of All Forms of Discrimination against Women.  adopted on 18 December 1979. 
3. The Constitution of the Federative Republic of Brazil, 1988. 
4. CEDAW, ‘General Recommendation No 24’ (1999) UN Doc A/54/38.
5. CEDAW, ‘General Recommendation No 28’ (2010) UN Doc CEDAW/C/GC/28.