meet the requirements of availability, accessibility, acceptability, and quality.94 Both the Commission and the Court have taken these concepts into account and have incorporated them into the analysis of various cases.95 68. As for the reproductive health of women, it must be stressed that, since 1998, the Commission indicated that it must rank high in legislative initiatives and health programs nationwide and locally and stated its concern over serious difficulties that women encounter in the public health sector, in general because of the absence of resources, the absence of a regulatory framework for reproductive health, the precariousness of the conditions for the delivery of services, and the shortage of indispensable professionals and materials. It also expressed its concerned over the high rates of maternal mortality in the region and the obstacles that women encounter in order to receive adequate healthcare services during pregnancy and after childbirth.96 The InterAmerican Commission also believes there are certain fundamental obligations that require immediate priority measures, such as the application of measures to reduce preventable deaths because of pregnancy or childbirth, especially so that women can have effective access to emergency obstetric services and to prenatal and postpartum healthcare services.97 69. The state’s obligations to provide adequate services in connection with pregnancy, childbirth, and postpartum care have been recognized in Article 12 of the Convention on the Elimination of All Forms of Discrimination against Women.98 As for the inter-American region, the Belém do Pará Convention establishes the right of women to a life without any violence. Article 7 of the Belém do Pará Convention requires states to act in order to prevent, punish, and eliminate violence against women by adopting a series of public measures and policies which include preventing this violence. These obligations reinforce and complete the obligations that states have under the American Convention. 70. The Belém do Pará Convention has established parameters to identify when an act constitutes violence and defines in its Article 1 that “violence against women shall be understood as any act or conduct based on gender, which causes death or physical, sexual or psychological harm or suffering to women, whether in the public or in the private sphere.” On the basis of the obligation mentioned above, the states have the obligation to “refrain from engaging in any act or practice of violence against women and to ensure that their authorities, officials, personnel, agents, and institutions act in conformity with this obligation.” 99 To enforce this protection, the Court has deemed that it is not enough for states to refrain from violating rights, it is imperative for them to adopt positive measures, to be determined on the basis of the specific needs for protection of the subject of the right and that this duty of the state becomes especially relevant when violations of women’s sexual and reproductive rights are involved.100 71. In connection with these obligations, the Commission observes that the Committee on the Elimination of Discrimination against Women (CEDAW) stated that it is the obligation of states parties to guarantee women’s right to safe motherhood and to emergency obstetric services.101 This Committee has stressed that: “Women have to right to be fully informed, by properly trained personnel, of their options in agreeing to treatment or research, including likely benefits and potential adverse effects of proposed procedures and available alternatives.”102 In addition, when ascertaining whether or not a state has fulfilled its obligations stemming from the Convention on the Elimination of All Forms of Violence against Women, the Committee has evaluated whether the ailments reported by the patient were duly taken into account by the medical staff, whether the UN, Committee on Economic, Social, and Cultural Rights. General Comment No. 14, E/C.12/2000/4, 11 August 2000, para. 12. IACHR. Report No 2/16. Case 12.484. Merits. Cuscul Pivaral et al. Guatemala, April 13, 2016, para. 106; I/A Court H.R. Case of Poblete Vilches et al. v. Chile. Merits, Reparations, and Costs. Judgment of March 8, 2018. Series C No. 349, para. 120. 96 IACHR, Report of the Inter-American Commission on Human Rights on the Status of Women in the Americas, OEA/Ser.L/V/II.100, Doc.17, October 13, 1998; IACHR, Access to Maternal Health Services from a Human Rights Perspective, June 7, 2010, para. 41. 97 IACHR, Access to Maternal Health Services from a Human Rights Perspective, June 7, 2010. 98 Said Convention establishes that: “States Parties shall ensure to women appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary, as well as adequate nutrition during pregnancy and lactation.” Article 12, Convention on the Elimination of All Forms of Discrimination against Women, adopted by the UN General Assembly in its resolution 34/180 of December 18, 1979. 99 Belém do Pará Convention, Article 7(a). 100 I/A Court H.R. Case of I.V. v. Bolivia. Preliminary Objections, Merits, Reparations, and Costs. Judgment of November 30, 2016. Series C No. 329, para. 250. 101 CEDAW, General recommendation No. 24, UN Doc. A/54/38/Rev.1, chap. I, Twentieth session (1999). 102 CEDAW, General recommendation No. 24, UN Doc. A/54/38/Rev.1, chap. I, Twentieth session (1999), para. 20 94 95 17