Rebecca Cook speaks in a soft voice, but that voice is heard around the world. She is an internationally renowned expert on health law and ethics, and women's rights. Cook, a professor in the Faculty of Law, the Faculty of Medicine, and the Joint Centre for Bioethics (JCB), is the recipient of many national and international honours, including a 1999 Fellowship of the Royal Society of Canada and the 1998 Ludwick and Estelle Jus Memorial Human Rights Prize.

Cook's most recent major project is a discussion document for the World Health Organization (WHO) entitled, Advancing Safe Motherhood through Human Rights. The three-year study was written with her husband, Bernard Dickens, also a law, medicine, and JCB professor, and two recent law school graduates, Andrew Wilson and Susan Scarrow.

In 1987, several governmental and non-governmental organizations joined forces to address the global problem of maternal mortality through the Safe Motherhood Initiative. They aimed to reduce maternal mortality by 50 per cent from 1990 to 2000 and by 75 per cent by 2015. The research focused on improving health interventions, but in the mid-1990s, WHO officials realized that the targets would not be met without additional measures.

"The exclusive approach to improving health interventions was an important step, but others were needed," says Cook. "That's when we were asked to assess the feasibility of a human rights approach to safe motherhood - that is, how human rights could be applied to require governments to more adequately address these issues."

Cook says her research methods involve taking research done within other disciplines to use in a legal context. In the case of safe motherhood, social science and public health research "can be applied through the human rights framework to encourage governments to implement human rights relating to women."

Cook must account not only for the perspectives of the different disciplines, but also for a variety of national contexts. She finds working at the international level gives her the opportunity to see how particular problems are dealt with in various settings: "It opens up my vision and perspectives on dealing with these problems in my research."

But there are some difficulties with the broad, global context. Cook says it can be a long time before you see results, so you have to have patience and be able to accept uncertainty. "You wonder if it can make any dent in a particular poor resource setting, whether it's here in Canada or in a southern country."

Cook's research interests were in part inspired by an early career as an activist. After graduate studies at Tufts and Harvard, Cook worked for International Planned Parenthood from 1973 to 1978. "Working in developing countries, I saw through first-hand experience how women, if they were empowered, could make a difference in their lives and in the lives of their families."

She went on to law school and then taught at the Columbia School of Public Health, while working on a doctorate at Columbia Law School. "I tried to pick issues in my research that have been neglected by the academic community but would, if researched from a legal point of view, have an impact on women's lives."

However, Cook makes a clear distinction between the work of researchers and the work of activists. "The primary purpose is to ensure that the research is done well and to a standard that I am proud of. If that, once it's done, has a further additional purpose of providing activists with a tool, that's all to the better."

Cook, 54, has been at U of T since 1987. She says that over the course of her research career, there has been an increase in interest and amount of work done in the area. "When I started working on my doctorate, there was a page of citations of international legal literature focusing on women's rights issues. Now, the literature is so voluminous, the Bora Laskin Law Library has created an online resource centre to make it accessible. That research has generated informed debates, respect for different perspectives, and better understanding of how human rights might be more effectively applied to improve the situations of women living in widely different circumstances."

Each year, just over half a million women suffer pregnancy-related deaths that could have been prevented through access to adequate health care. The causes of death range from high blood ressure to massive haemorrhage during birth or unsafe abortion.

Access to services that would make pregnancy safer, such as pregnancy monitoring and skilled attendance at births, is considered a human right but is systematically denied in many countries. Women, particularly in poor resource settings, generally lack empowerment - that is, the power to advocate on their own behalf and influence their own daily lives and life choices. Changing this has become the goal of the Safe Motherhood Initiative, which was started in 1987 by international organizations including the World Health Organization (WHO).

WHO experts feared health measures alone would not be enough to meet the goal of reducing maternal mortality by 75 per cent from 1990 to 2015. U of T law professors Rebecca Cook and Bernard Dickens, and WHO interns Andrew Wilson and Susan Scarrow were asked to look at ways to apply human rights to safe
motherhood. Their three-year study resulted in Advancing Safe Motherhood through Human Rights.

The human rights approach looks beyond the immediate health concern to the underlying socio-economic condition. An example of such a condition is child marriage. In many parts of the developing world, social and religious customs support marriage of girls before their bodies are physically ready for childbearing. A significant number of maternal and infant deaths could be prevented if conditions were set to postpone marriage until after the age of 18, thus delaying first births.

"In many parts of the world, girls are married by the age of 15 and have their first child by 16. It can even be younger," says Cook. "I don't think you can talk about child marriage in isolation from women's situations - whether or not they have access to alternatives to marriage, such as education, employment or training. In many situations, women just do not have access to alternatives to child marriage."

The study focuses on poor resource settings, whether they are in the developed or developing world. In developed countries, the maternal mortality rate tends to be significantly higher among marginalized populations such as the aboriginal peoples of Canada, the U.S., and Australia. Cook calls this "an embarrassment," but emphasizes that 99 per cent of preventable maternal deaths occur in developing countries. "It is the largest disparity of any public health indicator North and South, which is pretty staggering."

Advancing Safe Motherhood through Human Rights is intended as a framework for further work with governments in applying human rights in individual countries. Cook describes it as a first phase in a very long project, saying it is too early to gauge the potential impact.

Human rights have historically been applied to compel governments to prevent torture or ensure free speech, but not towards requiring governments to address preventable causes of death, such as deaths related to motherhood. "That has always been left to the health sector - it hasn't been viewed as a significant problem of social justice. There are ways that we hope the WHO document will begin to forge a path so that others will follow."