CEDAW/C/49/D/17/2008 and commitment of state and municipal authorities. The need for impact assessments of policies through indicators and benchmarks had been discussed by the Committee in reference to Brazil, but Brazil had not addressed any effort to such results-based monitoring. 14 5.7 The distinction between obligations of conduct and obligations of result is critical to understanding the right to health. When States act to implement this right, they not only need to create policies designed to realize the right (an obligation of conduct), but also must ensure that those policies actually achieve the desired results (an obligation of result). 5.8 The author argues that the programmes of the State party have not demonstrated the concrete measures and outcomes as required by the Convention. Although the National Pact to Reduce Maternal and Neonatal Death establishes laudable goals for the reduction of maternal mortality, the high levels of maternal mortality have not meaningfully changed. This is due to at least three factors. First, there are a variety of coordination problems. Secondly, Brazil’s health policies need to be backed up by adequate funding which is equitably allocated: although 10 per cent of Government spending is dedicated to health, spending on maternal health is minimal in comparison with other programmes. Brazil spent only $96 per capita on health in 2003, a distressingly low figure. Thirdly, policies are not linked to the achievement of results through health indicators and benchmarks. For example, financing of the health system is not linked to results, which in turn are not sufficiently evaluated. 5.9 The author challenges the reasoning of the State party, according to which the communication does not offer a single link between Ms. da Silva Pimentel Teixeira’s gender and the possible medical errors committed and therefore they do not fall within the definition of discrimination set out in the Convention. The author argues that this reasoning overlooks the definition of discrimination described in the Convention and other international human rights treaties. Discrimination includes State actions which have the effect of creating a barrier to the enjoyment of human rights, including the right to the highest attainable standard of health. Under article 1 of the Convention, discrimination against women is defined as “any distinction, exclusion or restriction made on the basis of sex which has the effect or purpose of impairing or nullifying the recognition, enjoyment or exercise by women … of human rights”. Article 2, paragraph (d), of the Convention requires that States “refrain from engaging in any act or practice of discrimination against women and to ensure that public authorities and institutions shall act in conformity with this obligation”. To ensure the realization of the right to health, States must provide access to maternal health services in a non-discriminatory manner. This requirement is not formalistic, but rather requires States to address the “distinctive features and factors which differ for women in comparison to men”, including the biological factors associated with reproductive health. 15 The denial or neglect of health-care interventions that only women need is a form of discri mination against women. 5.10 The grossly negligent health care provided to the victim constitutes a form of de facto discrimination under the Convention. The State party has recognized that __________________ 14 15 11-51699 See CEDAW/C/BRA/CO/6. See the Committee’s general recommendation No. 24, paras. 11 and 12, and general recommendation No. 25 (2004) on article 4, para. 1, of the Convention (temporary special measures), para. 8. 15