A/HRC/20/25/Add.1 reducing by two thirds the under-5 mortality rate,60 and progress in maternal health has resulted in reductions in the fertility rate from 7.8 to 5.7 births per woman. 61 55. At the same time, Timor-Leste continues to experience one of the highest rates of chronic child undernutrition in the world; almost 60 per cent of children under 5 years of age are stunted; 33 per cent are severely stunted; and 45 per cent are underweight.62 There has been a slight deterioration in these outcomes over the last 10 years.63 Malnutrition among women is also a serious concern; a third of Timorese women are underweight. 64 These health outcomes are attributable not only to widespread poverty, but also to food insecurity, vulnerability to recent food price spikes, and the low productivity of the Timorese agricultural sector, which primarily revolves around subsistence farming. 56. While the Special Rapporteur welcomes the initiative of the Government to implement a nutrition campaign, information and education must be complemented by strengthening measures to address the complex issue of malnutrition, including measures to improve agricultural production, monitor food insecurity, and support food assistance programmes. 57. While the Constitution enshrines the right to free universal health care, in practice people living in poverty, particularly those in rural areas, are far from realizing this right. Many barriers remain that prevent people from accessing health care; for example, remote communities face long distances and difficult and costly travel to access health care facilities, which are often poorly equipped and staffed. 65 Particularly concerning is the access to maternal health, generally insufficient in the whole country, but considerably worse outside Dili.66 58. The incidence of maternal mortality in Timor-Leste is one of the highest in the world. More than 40 per cent of Timorese women who die between the ages of 15 and 49 die from pregnancy-related complications.67 This is an unacceptable and preventable reality, and illustrates the urgent need for the Government to identify maternal mortality as a priority area for attention and resource allocation. High rates of maternal mortality are suggestive not only of failures in the health-care system and in the provision of other public services, but of structural discrimination and a lack of political will to prioritize the rights of women.68 59. The Special Rapporteur calls on the Government to increase expenditure and adopt policies that strengthen health systems, giving priority to maternal health. 69 These policies must be accompanied by access to information, including on sexual and reproductive health, regardless of marital status or age; access to voluntary family planning and legal and 60 61 62 63 64 65 66 67 68 69 16 Timor-Leste, Millennium Development Goals Indicators, available from www.mof.gov.tl/about-theministry/statistics-indicators/millennium-development-goals-indicators/?lang=en. Strategic Development Plan, p. 33. Demographic and Health Survey, p. 150. Ibid., pp. xxvii, 150-151. Ibid., p. 165. A. Zwi and others, Timor-Leste Health Care Seeking Behaviour Study, University of New South Wales (Sydney, 2009), pp. 8, 16, 26-27, 54. For example, 53 per cent of women in urban areas deliver in a health facility compared with only 12 per cent in rural areas. Demographic and Health Survey, pp. 119–120. Ibid., pp. xxvi and 112. See for example the report of the Office of the United Nations High Commissioner for Human Rights (OHCHR) on preventable maternal mortality and morbidity and human rights (A/HRC/14/39). See the report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health (A/61/338), para. 19.