61. Under the general duty to protect health, the State is obligated to guarantee access to essential health services, to ensure effective and quality medical services and to promote better health conditions for the population.52 This right also encompasses timely and appropriate health care in accordance with the principles of availability, accessibility, acceptability and quality, the application of which will depend on the prevailing conditions in each state. Compliance by the State with its obligation to respect and ensure the right to health must include special care for vulnerable and marginalized groups.53 62. Moreover, the Court has ruled on different occasions on the States’ specific obligations regarding health care during pregnancy, childbirth and post-partum and has established that they must provide an adequate and differentiated care during those stages.54 In accordance with the Court’s case law, “States must design appropriate health-care policies that permit assistance to be provided by personnel who are adequately trained to attend to births, policies to prevent maternal mortality with adequate pre-natal and post-partum care, and legal and administrative instruments for health-care policies that permit cases of maternal mortality to be documented adequately.”55 The Court has also referred to the relationship between poverty and the lack of adequate medical care as causes of high maternal mortality and morbidity.56 63. The Universal System of Human Rights also has treaties that refer to the obligations of States in the area of health care during pregnancy, childbirth and post-partum, which have been interpreted by their respective monitoring bodies. The International Covenant on Economic, Social and Cultural Rights establishes, in its Article 12,57 that the States Parties recognize the right to the enjoyment of the highest attainable standard of physical and mental health, which includes the obligation to adopt measures to reduce stillbirth. The UN Committee on Economic, Social and Cultural Rights interpreted Article 12 in its General Comment No. 14 by stating that it may be understood as requiring the adoption of measures to improve maternal health and health care before and after birth;58 in other words, measures to avoid preventable maternal deaths.59 Later, 52 Cf. Case of Poblete Vilches et al. v. Chile, supra, para. 118 and Case of Manuela et al. v. El Salvador, supra, para. 185. Cf. Case of Cuscul Pivaral et al. v. Guatemala. Preliminary Objection, Merits, Reparations and Costs. Judgment of August 23, 2018. Series C No. 359, para. 39 and Case of Manuela et al. v. El Salvador, supra, para. 185. 53 Cf. Case of the Xákmok Kásek Indigenous Community v. Paraguay. Merits, Reparations and Costs. Judgment of August 24, 2010. Series C, No. 214, para. 233 and Cf. Case of I.V. v. Bolivia. Preliminary Objections, Merits, Reparations and Costs. Judgment of November 30, 2016, Series C. No. 329. See also: Advisory Opinion OC-29/22, supra, paras. 153–159. 54 55 Case of the Xákmok Kásek Indigenous Community v. Paraguay, supra, para. 233. Cf. Case of the Xákmok Kásek Indigenous Community v. Paraguay, supra, para. 233 and Case of Cuscul Pivaral et al. v. Guatemala, supra, para. 132. Similarly, the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health has stated that “[w]omen living in poverty and in rural areas, and women belonging to ethnic minorities or indigenous populations, are among those particularly at risk” of maternal mortality. Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, UN Doc. A/61/338, September 13, 2006, paras. 7 and 10. 56 “Article 12. 1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. 2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for: (a) the provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child; […]”. International Covenant on Economic, Social and Cultural Rights. Argentina ratified this treaty on August 8, 1986. 57 58 Cf. UN Committee on Economic, Social and Cultural Rights. General Comment No. 12 (2000), para. 14. According to the expert opinion presented before the Court by Regina Tamés Noriega, the World Health Organization defines maternal mortality as “[t]he death of a woman while pregnant or within 42 days of termination of pregnancy, 59 17