Tackling the 'Elephant in the Room': Putting Gender Justice at the Core of a Rights-Based Maternal Health Policy Advocacy Agenda

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United Nations Population Fund observes that maternal mortality is the single largest health inequity in the world, with 99 percent of deaths occurring in developing countries. Research suggests that violations of women’s right to equality, lack of adequate recognition of women’s rights to life and health and poverty are key determinants of women’s ability to access the requisite obstetric care. The failure of traditional public health approaches to tackle the issue has led many health activists to consider alternative frameworks and re-frame the debate as a human rights issue to secure political priority. However, the growing literature on human rights-based approach (HRBA) to maternal health lacks empirical evidence to confirm this optimistic speculation by health activists and practitioners while development theorists continue to debate the concrete contributions of the human rights paradigm to human development and poverty alleviation efforts. Further, public policy scholars, particularly in the social constructivist tradition, caution us about the complexities (including unintended outcomes) involved in using framing as a strategy for mobilizing resources for progressive policy reform.Hence, this paper evaluates the potential of HRBA to development through examination of the historic and countrywide proclamation of maternal mortality as a human right violation (in a public interest litigation case) in a 2010 High Court verdict in India (claimed to be the first of its kind at a country-level). The research employs a qualitative case study approach including fifty key informant interviews with state and non-state officials.Preliminary findings point to negligible impact of the new framing in provoking institutional change and no alteration in policy design; more importantly, the verdict fails to address the root causes of the issue, i.e. women’s social status. A deeper enquiry reveals: 1) a significant contradiction in the narratives of HRBAs to maternal health advanced by activist groups, which fail to explicitly link maternal health outcomes to its root cause and instead focus on the medicalized and technocratic dimensions of the problem that (regrettably) reverberate the attitude within state machinery and global health agencies; and 2) the inherent contradiction in human rights advocacy that spearheads mobilization around a shared recognition of the problem and solutions, yet its highly abstract, normative and subjective nature renders it more difficult for advocacy groups to outline a shared tactic, to achieve the desired objective(s). Situating these findings against the debates in the “gender justice” literature, the paper draws attention to the ways that gender and other inequalities may inform law and rights agendas of different well intentioned groups, including state-supported projects, that limit themselves to seeking recognition of maternal health rights intended to improve a demand driven public health system but fail to seek active citizenship for women who can pursue state accountability for just governance and can stake women’s claim to new entitlements arising from the needs articulated by those women affected by lack of rights and influences. The findings will be of interest to scholars in political science, human rights and development, women’s studies and practitioners engaged in advocating for better maternal health outcomes.