CEDAW/C/49/D/17/2008 concludes that Ms. da Silva Pimentel Teixeira was not ensured appropriate services in connection with her pregnancy. 7.5 The State party argued that the inappropriateness of the service is not imputable to it, but to the private health-care institution. It stated that the allegations revealed a number of poor medical practices attributable to a private institution that led to Ms. da Silva Pimentel Teixeira’s death. It acknowledged shortcomings in the system used to contract private health services and, by extension, the inspection and control thereof. The Committee therefore notes that the State is directly responsible for the action of private institutions when it outsources its medical services and that, furthermore, the State always maintains the duty to regulate and monitor private health-care institutions. In line with article 2 (e) of the Convention, the State party has a due diligence obligation to take measures to ensure that the activities of private actors in regard to health policies and practices are appropriate. In this particular case, the State party’s responsibility is strongly anchored in the Brazilian Constitution (articles 196-200) which affirms the right to health as a general human right. The Committee therefore concludes that the State party has failed to fulfil its obligations under article 12, paragraph 2, of the Convention. 7.6 The Committee notes that the author claims that the lack of access to quality medical care during delivery is a systematic problem in Brazil, especially with regard to the way human resources are managed in the Brazilian health system. The Committee also takes note of the argument of the State party that specific medical care was not denied because of an absence of public policies and measures within the State party, as there are a number of policies in place to address the specific needs of women. The Committee refers to its general recommendation No. 28 (2010) on the core obligations of States parties under article 2 of the Convention and notes that the policies of the State party must be action- and results-oriented as well as adequately funded. 23 Furthermore, the policy must ensure that there are strong and focused bodies within the executive branch to implement such policies. The lack of appropriate maternal health services in the State party that clearly fails to meet t he specific, distinctive health needs and interests of women not only constitutes a violation of article 12, paragraph 2, of the Convention, but also discrimination against women under article 12, paragraph 1, and article 2 of the Convention. Furthermore, the lack of appropriate maternal health services has a differential impact on the right to life of women. 7.7 The Committee notes the author’s claim that Ms. da Silva Pimentel Teixeira suffered from multiple discrimination, being a woman of African descent and on the basis of her socio-economic background. In this regard, the Committee recalls its concluding observations on Brazil, adopted on 15 August 2007, where it noted the existence of de facto discrimination against women, especially women from the most vulnerable sectors of society such as women of African descent. It also noted that such discrimination was exacerbated by regional, economic and social disparities. The Committee also recalls its general recommendation No. 28 (2010) on the core obligations of States parties under article 2 of the Convention, recognizing that discrimination against women based on sex and gender is inextricably linked to other factors that affect women, such as race, ethnicity, religion or belief, health, status, age, class, caste, and sexual orientation and gender identity. The Committee notes that the State party did not rule out that __________________ 23 20 Para. 28. 11-51699