84 Afulukwe-Eruchalu and Durojaye/Maternal mortality in Africa developing countries.3 Six of the eleven countries that accounted for 65 per cent of maternal deaths worldwide were African countries.4 The adult lifetime risk of maternal death5 in 2008 was highest in subSaharan Africa at 1 in 31 while in developed regions the lifetime risk was 1–1 in 4300.6 Accordingly, resolution 135 was timely, in that the African Commission on Human and Peoples’ Rights (African Commission) recognised that African countries had both a regional and international obligation, under the African Women’s Rights Protocol and the United Nations Millennium Development Goals (MDGs), to improve maternal health.7 It expressed concern that no progress had been made towards reducing maternal mortality and declared preventable maternal mortality in Africa a violation of the rights to life, dignity, equality and non-discrimination.8 It concluded by urging African governments to individually and collectively implement its specified recommendations, discussed in the section below, in order to reduce maternal deaths in the continent.9 The African Commission’s resolution’s call for a collective effort to address maternal mortality materialised in 2009 when the Campaign for the Accelerated Reduction of Maternal Mortality in Africa (CARMMA), a joint initiative of the African Union Commission and United Nations Population Fund (UNFPA), was launched.10 Its core objective was to generate amplified action towards improving maternal health by expanding the availability and use of universally accessible health services, including those pertaining to sexual and reproductive health, which are critical for reducing maternal mortality, and ensuring accountability.11 Currently, out of the 55 African Union (AU) member states, 46 have already launched CARMMA while 6 more are taking steps towards doing so.12 Despite these regional commitments, a majority of African countries did not make adequate progress to meet MDG 5 which required the reduction of maternal mortality ratio (MMR) by three quarters (75 per cent) between 1990 and 2015.13 Indeed, the MDGs deadline coincided with the release of the latest statistics on the world’s maternal mortality trend by the World Health Organization et al and yielded some insight into why most African countries were categorised as having made inadequate progress to meet 3 As above 1. Democratic Republic of Congo, Ethiopia, Kenya, Nigeria, Sudan, United Republic of Tanzania WHO et al (n 2 above) 1. 5 The probability that a 15-year old female will die eventually from a maternal cause. As above. 6 As above. 7 African Commission (n 1 above). 8 As above. 9 As above. 10 http://www.carmma.org/ (accessed 19 October 2017). 11 As above. 12 http://www.carmma.org/scorecards. 13 United Nations Economic Commission for Africa et al, ‘MDG Report 2015: Assessing Progress in Africa Toward the Millennium Development Goals’ (2015). 4