A/HRC/14/20/Add.2 quality and participation. Second, identifying some key right-to-health processes and mechanisms, such as a national maternal health strategy, situational analysis encompassing maternal mortality, indicators and benchmarks, referral systems and mechanisms for monitoring, accountability and redress. Although closely related, the values and principles tend to be abstract, and the processes and mechanisms more operational and functional. Because maternal mortality reduction depends upon an effective district health system, the third step applies these right-to-health values, principles, processes and mechanisms to the six essential building-blocks that together make up a functioning health system: health services; a health workforce; a health information system; medical products, vaccines and technologies; health financing; and leadership, governance and stewardship.6 15. These are not only building-blocks for a health system, they are also building-blocks for a national maternal health strategy, as well as for the realization of the right to health. Take the first building-block: health services. For maternal mortality reduction, health services must include: sexual and reproductive health education; family planning; antenatal care; skilled birth attendance; emergency obstetric care (EmOC); postnatal care; and safe abortion where legal. Each of the other five building-blocks (health workforce, etc.) also has a vital contribution to make to maternal mortality reduction. The building-blocks are interdependent. 16. The right-to-health approach to maternal mortality requires that the right-to-health values and principles (step one) and processes and mechanisms (step two) are consistently and systematically applied to each of the building-blocks so far as they relate to maternal health (step three). 17. The right-to-health approach to maternal mortality requires countries to prioritize those interventions that are the best available to them, taking into account epidemiological evidence, resource availability and other human rights considerations. Today, there is a growing international consensus around four cornerstone interventions to reduce maternal mortality: family planning, skilled birth attendance, effective referral networks and EmOC.7 These are the measures required by international human rights law. In some contexts, additional (not alternative) measures, such as community-based access to antibiotics and misoprostol, where supported by evidence, may have an important role to play. 18. Crucially, the right-to-health approach to maternal mortality is not optional. Because the right to health gives rise to legally binding obligations, States are required to apply this approach to maternal mortality. Moreover, they are required to put in place those measures arising from the application of the right-to-health approach to maternal mortality, such as a national maternal health strategy, outreach programmes for disadvantaged women, sexual and reproductive health education, family planning, skilled birth attendance, effective referral systems, EmOC, and independent monitoring, accountability and redress mechanisms. IV. A selection of maternal mortality issues in Rajasthan and Maharashtra 19. When the right-to-health approach to maternal mortality signalled in chapter III is applied to Rajasthan and Maharashtra, a wide range of important issues comes to light. 6 7 6 World Health Organization (WHO), Everybody’s Business: Strengthening Health Systems (Geneva, 2007), p. v. See, for example, Millennium Project, Who’s Got the Power? Transforming Health Systems for Women and Children (London, Task Force on Child Health and Maternal Health, 2005). GE.10-12866