CEDAW/C/49/D/17/2008 disadvantaged groups and that the duty to eliminate discrimination in access t o health care includes the responsibility to take into account the manner in which societal factors, which can vary among women, determine health status. 3.3 The author submits that the obligations in the field of health care under articles 2 and 12 of the Convention are obligations of immediate effect, because the rights to life and non-discrimination are immediately enforceable and violations require urgent governmental action. Referring to the International Covenant on Economic, Social and Cultural Rights, the author argues that the obligations to “ensure” are more immediate in character and not subject to the qualification of progressive realization, in contrast to obligations to “recognize”. 3.4 The author claims that Brazil failed to ensure access to q uality medical treatment during delivery, thereby violating its duties under articles 2 and 12 of the Convention. 3 Given that the main reason pregnant women die is because of avoidable delays in obtaining proper emergency care during a complicated pregnancy — as was the case for Ms. da Silva Pimentel Teixeira — skilled assistance at pregnancy, including assistance that provides for obstetric emergencies, is a vital factor in preventing maternal death. 3.5 While Ms. da Silva Pimentel Teixeira was treated by a gynaecologistobstetrician and thus nominally had access to a skilled health -care professional, the poor quality of the care she received was a critical factor in her death. A competent health-care provider would reportedly have been alerted to the fact that the severe nausea and abdominal pain of which Ms. da Silva Pimentel Teixeira complained during her sixth month of pregnancy was a sign of a potentially serious problem and would have ordered appropriate treatment. Had blood and urine t ests been performed the same day, it would have been discovered that the foetus had died and that delivery should be induced immediately. This would have prevented Ms. da Silva Pimentel Teixeira’s condition from deteriorating. 3.6 The author alleges that Ms. da Silva Pimentel Teixeira should have had surgery immediately after her labour was induced in order to remove the afterbirth and placenta, which had not been fully expelled during the process of delivery as they normally are, and which may have caused her haemorrhaging and complications and, ultimately, her death. They state that she also should have been transferred to a better-equipped facility for the surgery, given that the surgery took place in response to an abnormal situation. Instead, Ms. da Silva Pimentel Teixeira had been operated on the morning following the delivery and the surgery was performed at the health centre. Attempts to transfer her to a hospital reportedly did not begin until a full day after Ms. da Silva Pimentel Teixeira had begun to haemorrhage severely. The transfer, which had reportedly taken over eight hours, was ineffective in helping her obtain skilled care because she was left largely unattended in a makeshift area in the hallway of the hospital for 21 hours until she died. The inability to make a timely and effective referral was another example of the incompetent care that Ms. da Silva Pimentel Teixeira received. __________________ 3 11-51699 In this connection, the author makes reference to general recommendation No. 24 (1999) of the Committee on the Elimination of Discrimination against Women on article 12 of the Convention (women and health) and to general comment No. 14 (2000) of the Committee on Economic, Social and Cultural Rights on the right to the highest attainable standard of health (art. 12). 5