corresponding exams were conducted on a timely basis, and whether the quality of the services were adequate in the circumstances or for the pregnancy’s stage of development and possible complications that might have come from it.103 72. The Commission also notes that the Committee on ESCR has also understood that states have the basic obligation of ensuring adequate prenatal and postpartum maternal healthcare services.104 The Regional Task Force for the Reduction of Maternal Maternity indicated that maternal health is part of the right to health and that maternal mortality is viewed as an indicator of poorly functioning healthcare systems.105 As for the Office of the United Nations High Commissioner for Human Rights, it indicated that the state must identify the obstacles hindering the effective enforcement of women’s rights to maternal health, for example, on the basis of information about what is happening, who are the ones affected, and mainly which factors prevent women, or certain women, from having a safe pregnancy and a childbirth and from more widely enjoying their rights to sexual and reproductive health. In that framework, it indicates that emergency obstetric care is a basic obligation in line with international law, and it is basic maternal health interventions that rely the most on the sound functioning and coordination of the health system.106 73. As for preeclampsia and eclampsia, the Commission highlights certain data brought to the fore by the World Health Organization. Thus, the WHO has indicated that hypertensive disorders of pregnancy affect about 10% of all pregnant women around the world and, among them, preeclampsia is noteworthy for its impact on maternal and neonatal health and that, in Latin America, one quarter of all maternal deaths have been associated with these complications.107 For the WHO, “the majority of deaths related to hypertensive disorders can be avoided by providing timely and effective care to women presenting with such complications.” Although the WHO indicates that “the diagnosis, screening and management of pre-eclampsia remain controversial, as does the classification of its severity,” it adds that “it is generally accepted that the onset of a new episode of hypertension during pregnancy (with persistent diastolic blood pressure of >90 mm Hg) with the occurrence of substantial proteinuria (>0.3 g/24 h) can be used as criteria for identifying preeclampsia.”108 Likewise, it refers to obesity as one of the risk factors for preeclampsia. 4. Analysis of the case 74. The Commission is not competent to ascertain what caused Ms. Britez’s death and, as it has already been established, “for purposes of determining the international responsibility of the State for failing to uphold one of the principles associated with the right to health and tied by its interconnectedness to the rights to life and integrity, it is not necessary to establish the cause of death by clear and convincing evidence.”109 75. Nor is it the Commission’s responsibility to appraise the expertise conducted domestically, but the Commission is required to determine whether the state did everything that was reasonably within its reach to prevent Ms. Britez’s death, in accordance with its international obligations. In that respect, in a case similar to the present one, the European Court indicated that, as an international court, it was required to investigate whether the domestic authorities did what could be reasonably expected of them and, in particular, as a matter of principle, whether or not they fulfilled their obligation to protect the patient’s physical integrity, particularly through the administration of appropriate medical treatment.110 76. Both bodies of the inter-American system have indicated that prevention measures to be enforced upon a state must be determined in the light of the characteristics and circumstances of each concrete case. Specifically, in the instant case, the Commission observes that Ms. Cristina Britez’s condition as a pregnant Regarding this, see: CEDAW, Views, Communication 17/2008, Forty-ninth session, 27 September 2011, paras. 7.3 and 7.4 Committee on ESCR. General comment No. 14. UN Doc. E/C.12/2000/4, 11 August 2000. 105 Regional Task Force for the Reduction of Maternal Mortality, Overview of the Situation of Maternal Morbidity and Mortality: Latin America and the Caribbean, December 2017. 106 United Nations, Technical guidance on the application of a human rights-based approach to the implementation of policies and programmes to reduce preventable maternal morbidity and mortality, July 2, 2012. 107 WHO, WHO Recommendations for prevention and treatment of preeclampsia and eclampsia, 2014. 108 WHO, WHO Recommendations for prevention and treatment of preeclampsia and eclampsia, 2014. 109 IACHR, Report No. 1, Case 12.695. Merits. Vinicio Antonio Poblete Vilches and family. Chile. April 13, 2016, para. 135. 110 European Court of Human Rights. Case of Mehmet Şentürk and Bekir Şentürk v Turkey. Judgment of 9 April 2013, para. 89. 103 104 18