Integrating international policy standards in the implementation of postnatal care: a rapid review

Introduction International legal and political documents can assist policy-makers and programme managers in countries to create an enabling environment to promote maternal and newborn health. This review aimed to map and summarise international legal and political documents relevant to the implementation of the WHO recommendations on maternal and newborn care for a positive postnatal experience. Methods Rapid review of relevant international legal and political documents, including legal and political commitments (declarations, resolutions and treaties) and interpretations (general comments, recommendations from United Nations human rights treaty bodies, joint United Nations statements). Documents were mapped to the domains presented in the WHO postnatal care (PNC) recommendations; relating to maternal care, newborn care, and health systems and health promotion interventions, and by type of human right implied and/or stated in the documents. Results Twenty-nine documents describing international legal and political commitments and interpretations were mapped, out of 45 documents captured. These 29 documents, published or entered into force between 1944 and 2020, contained content relevant to most of the domains of the PNC recommendations, most prominently the domains of breastfeeding and health systems interventions and service delivery arrangements. The most frequently mapped human rights were the right to health and the right to social security. Conclusion Existing international legal and political documents can inform and encourage policy and programme development at the country level, to create an enabling environment during the postnatal period and thereby support the provision and uptake of PNC and improve health outcomes for women, newborns, children and families. Governments and civil society organisations should be aware of these documents to support efforts to protect and promote maternal and newborn health.


INTRODUCTION
The postnatal period is defined as the period immediately following the birth of the newborn to 6 weeks (42 days) after birth. 1 It is a period where postpartum women and newborns face high burden of mortality and morbidity. 2A crucial component of the maternal and newborn care continuum, postnatal care (PNC) services provide the platform for the care of women and newborns during this critical period.PNC includes care of the woman and the newborn, as well as health BMJ Global Health systems policies and programmes designed to support families and improve the quality of PNC.The ultimate objective of PNC is to prevent complications after childbirth, promote healthy practices, garner support from broader families and communities, and meet health, developmental and social needs. 2 Yet the importance of PNC has long been overlooked by policymakers, health workers and communities [3][4][5] due to complex, multifactorial issues, including potentially diminished perceived urgency and importance of PNC relative to antenatal and intrapartum care.This has resulted in poor coverage and quality of care for women and newborns, 6 and lost opportunities to promote health and well-being, particularly among disadvantaged groups. 7n 2022, the WHO published the WHO recommendations on maternal and newborn care for a positive postnatal experience. 2 This updated and expanded guideline reflects an important global shift in the exclusive focus of care; from reducing death and serious illness following birth to comprehensive, holistic care and support to promote health and well-being; to ensuring that women and newborns survive and thrive.It describes a 'positive postnatal experience' as the desired endpoint for all women, partners, parents, caregivers and families after birth.A positive postnatal experience is defined as one in which women and families receive information and reassurance in a consistent manner from motivated health workers, and where both the women's and babies' health, social and developmental needs are recognised, within a resourced and flexible health system that respects their cultural context. 2 International legal and political documents are key tools to advance global health, human rights and equity in sexual and reproductive health. 8 9hese documents can help to reduce health inequalities, influence social and structural determinants of health, support stronger health systems, and create healthier and safer workplaces and communities. 10 11o inform policy dialogue and integrated planning of programmes, WHO has created a compendium of health systems policies that support delivery of reproductive, maternal, newborn and child health interventions across multiple sectors. 9The WHO Maternal, Newborn, Child and Adolescent Health and Ageing Data Portal contains legal and policy data, including national policies, strategies, laws and regulations. 12 13hese data allow for analysis of the policy environment and its effects on maternal and newborn health. 14 15here is also a global abortion policies database 16 that includes all relevant legislation, guidelines and constitutions to promote accountability and transparency with regard to national abortion laws and practices.Further, in the area of respectful maternity care, WHO has mapped pathways between types of mistreatment and their connection with human rights standards, and explored how human rights treaty bodies have expressed these issues to inform strategies within health systems. 17 18variety of international documents exist to support women, newborns and families in the postnatal period, which can facilitate an enabling environment for the implementation of the PNC guideline.Yet, in many countries, insufficient legislative commitments have been made for priority indicators on maternity protection (measures to protect the health of the woman and newborn and provide employment and income security during maternity) or regulation against the marketing of breastmilk substitutes. 19 20here is no comprehensive mapping of international legal and political documents (such as treaties, conventions, and interpretations of legal and political commitments) relevant to the postnatal period and the implementation of PNC.Providing a mapping of how these documents relate to the WHO recommendations on PNC could thereby help national legislators, policymakers, programme managers, and civil society organisations strengthen the design and/or review of existing policies, strategies and practices to create an enabling and empowering environment for PNC.Such a mapping should also help to position PNC within international standards and human rights-based frameworks, through which states are obliged to respect, protect and fulfil human rights as per the commitments they have made under international human rights law. 21 22his rapid review aimed to identify the available international legal and political documents relevant to the postnatal period and PNC, and determine how the content of these documents pertains to the implementation of the WHO recommendations on maternal and newborn care for a positive postnatal experience. 2

METHODS
This review followed established approaches to rapid review, 23 24 where systematic review methods related to topic refinement, setting eligibility criteria, searching, study selection, data extraction and other review components are streamlined and processes accelerated to complete the review efficiently in a short time. 23

Inclusion and exclusion criteria
International documents comprising legal and political commitments (declarations, resolutions and treaties), interpretations (general comments, recommendations from United Nations (UN) human rights treaty bodies, joint UN statements) and other nonbinding documents (action plans, strategies, frameworks, resolutions, political declarations) pertinent to the postnatal period and PNC were included.Documents about specific population groups or documents that were not expressly relevant to the postnatal period or PNC were excluded.Table 1 lists the inclusion and exclusion criteria.S3).

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Correspondence with key informants and initial web searches (phase 1 of the search) were carried out in May 2021 and June 2021, respectively.Key informants were contacted again in January 2023 (phase 2 of the search) to check whether any additional documents BMJ Global Health had been published prior to submission of the current manuscript.

Screening and selection
A database of all documents retrieved was created and continually updated by HS, with support from AMW.One author (HS or AMW) screened the titles and abstracts/ summary text of all records and a second author (MB) independently verified 25% of the records.Full-text documents were assessed against the inclusion criteria by one author (HS or AMW) and a second author (MB) independently verified 25%.Results were compared and discrepancies resolved by discussion and returning to the documents.Reasons for exclusion of any documents were recorded.

Data extraction
Key data from all included documents were extracted using a predefined data extraction pro forma in Microsoft Excel.The data extraction pro forma was piloted on 2-3 documents to ensure fit for purpose and relevancy of defined fields.Data extraction fields included type of document, year of publication, individual or organisation responsible for developing the document, summary of main purpose, and a categorisation of the type of right relevant to the implementation of the PNC recommendations.Fields included in the data extraction pro forma and examples of data extracted are presented in online supplemental table S4.

Assessment of risk of bias
The purpose of the review was to provide an overview of the available international legal and political documents; critical appraisal of the documents including risk of bias was not required.

Categorisation of documents for mapping against WHO PNC domains
Eligible documents were categorised into (1) those not applicable for the mapping against the WHO PNC domains and (2) those applicable for the mapping: 1. Documents not applicable for the mapping against WHO PNC domains: Key international legal documents are pieces of international human rights law that signatory countries are obliged to implement and provide frameworks from which legal and political commitments and interpretations of these commitments have been developed.While highly relevant, these documents were not applicable for the mapping as they do not provide the granularity needed for PNC implementation as opposed to the subsequent, more specific documents derived from them.Broad statements on human rights and health, or women's, children's and adolescent's health that outline the application of human rights approaches to health and the realisation of the health rights of women, children and adolescents were also deemed inapplicable for the mapping, as these were considered less relevant for the implementation of programmes or recommendations.For example, many of these documents are reports of UN Special Rapporteurs, with a mandate to monitor specific human rights or rights-relevant issues or raise the profile of specific issues pertinent to the protection of human rights, many of which relate to health.The result of these reports, and other strategies or roadmaps produced by UN agencies, may ultimately support improved uptake of PNC services.2. Documents applicable for mapping against WHO PNC domains: These included international legal and political commitments and interpretations of these commitments.International legal and political commitments include political declarations and resolutions to act, while interpretations of legal and political commitments often serve to clarify country reporting duties and suggest approaches for implementation.These documents provide important standard-setting and guidance and are oriented towards action relevant to the implementation of PNC.S5).

Synthesis of findings
The documents for inclusion in the mapping were then scrutinised to determine the type of right, as stated or implied in the document, namely the (1) right to health (including the right to the highest attainable standard of health; equal access to care and a health system enabling environment for breastfeeding);(2) right to social security (including paid leave; maternity protection; family benefits and breastfeeding arrangements at work);(3) right to information (related to protection from harmful marketing) and ( 4) other human rights relevant to PNC (including the right to identity (legal registration of the birth); freedom from torture and other ill treatment; and right to decide the number, spacing and timing of children).box 1 Key international legal documents relevant to postnatal care

Patient and public involvement
Patients and the public were not directly involved in this review.All sourced documents were publicly available.Results will be shared via social media, and with key stakeholders involved in the adaptation and implementation of the WHO PNC recommendations.
The authors of this manuscript recognise gender diversity among birthing individuals.In line with the WHO recommendations on maternal and newborn care for a positive postnatal experience, this manuscript uses the terms 'woman'or 'mother'as inclusive of all individuals who have given birth, even if they may not identify as a woman or as a mother.

Document flow
Figure 1 presents the document flow.In total, 4700 records were identified from searches, shared by key informants, or sourced internally.After removing duplicates and records deemed irrelevant based on screening of titles or summary text, 103 relevant documents underwent detailed review.Fiftyeight documents were excluded based on ineligible scope, population, context or document type.The remaining 45 eligible documents comprised 16 key international legal documents or broad statements on human rights (not applicable for the mapping exercise) and 29 international legal and political commitments and interpretations of these commitments (described in the following section).

Documents not applicable for mapping against WHO PNC domains (n=16)
Eight key international legal documents were adopted or entered into force between 1948 and 2000.These documents are listed box 1, with further detail provided in online supplemental table S6).Another eight documents containing broader statements on human rights and health, or women's, children's and adolescent's health were published between 2004 and 2021 and are listed in online supplemental table S7.   no documents were identified are not shown in table 2; these related to maternal health in the areas of nutritional interventions and physical activity, preventive measures and interventions for common physiological signs/symptoms).Figure 2 summarises the distribution of documents mapped across the 13 PNC domains, which highlight at a glance where supportive legal and political commitments or interpretations of these commitments exist, and where gaps are evident.Together, the 29 captured documents contained content relevant to 10 of the 13 PNC domains and were published between 1944 and 2020.The PNC domains for which there were documents containing supportive declarations, statements or recommendations, include breast feeding (addressed 22 times across 6 legal and political commitments and 6 interpretations of legal and political commitments) and health systems interventions and service delivery arrangements for PNC (addressed 17 times across 6 legal and political commitments and 11 interpretations of legal and political commitments).In relation to health systems and service delivery, identified documents covered issues related to birth registration, parental leave and entitlements, equal access to health services and respectful care.No documents contained statements relevant to maternal nutritional interventions and physical activity, preventive measures for the woman, or interventions for common maternal physiological signs/symptoms.Only one document addressed maternal mental health.For a summary of content extracted from the documents to inform this mapping exercise, see online supplemental table S8.

Documents included in mapping against WHO PNC domains (n=29)
Of the legal and political commitments (n=12), six documents stipulated actions relevant to breast feeding.These included the Innocenti Declaration on the protection, promotion and support of breast feeding 25 and World Health Assembly (WHA) Resolutions 27.43, 26 55.25 27 and 69 28 around infant and young child nutrition.Six legal and political commitments were deemed relevant to the provision of health system interventions and service arrangements, including Human Rights Council (HRC) Resolutions 22/7 29 and 28/13 30 around birth registration, and HRC Resolution 33/11 31 on the prevention of mortality and morbidity in children under 5 years of age.Two legal and political commitments (HRC Resolutions 33/18 32 and 41/14 33 ) contained actions applicable to social, behavioural and community interventions for PNC; both referring to policies and healthcare services that address discrimination and equality.
Of the interpretations of legal and political commitments (n=17), six suggested strategies or approaches for implementing or supporting provisions for breastfeeding.These included general comments on International Covenant on Economic, Social and Cultural Rights (ICESCR) (2020) 34 and the Convention on the Rights of the Child (CRC) (2013), 35 the Maternity Protection Recommendation R191 (2000), 36 as well as a joint UN statement on infant and young child feeding (1981). 37leven of the interpretations of legal and political commitments suggested or clarified human rights provisions relevant to health systems interventions and service delivery arrangements, including general comments on ICESCR (2000 and 2008), 38 39 the Convention on the Elimination of All Forms of Discrimination against

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Women (CEDAW) (1999) 40 and the CRC (2013), 35 all of which relate to the right to access to care and the right to paid leave and maternity protection.Four interpretations of legal and political commitments offered recommendations for or approaches to implementing rights relevant to the provision of postpartum contraception, including general comments on the ICESCR (2000 and 2016) 39 41 and on CEDAW (1999), 40 which all clarify and affirm access to reproductive health services including contraception as a human right.
In terms of type of right, the right to health was the most frequently addressed in the documents (n=14), particularly as it related to achieving the highest attainable standard of health and creating a health system enabling environment for breastfeeding (both n=6).The right to social security was also frequently addressed (n=11), including in terms of breastfeeding arrangements at work (n=7) and maternity protection (n=6).Seven documents addressed the right to information related to protection from harmful marketing of breastmilk substitutes.Some documents focused on more than one type of right; for example, the HRC Resolution 33/18 32 focused on both the right to the highest attainable standard of health and the right to freedom from torture and other ill treatment; and HRC Resolution 41/14 33 focused on the right to social security in relation to paid leave, maternity protection and family benefits.

DISCUSSION
We identified several key international legal documents and broader statements on human rights and health relevant to the postnatal period and PNC.In addition, a mapping of international legal and political commitments and interpretations of these commitments demonstrated content supportive of most of the domains of the WHO recommendations on maternal and newborn care for a positive postnatal experience. 2 The domains of breastfeeding and health systems and service delivery interventions for PNC included in the WHO guideline had the most documents associated with them, followed by the domain of postpartum contraception.In relation to health systems and service delivery, mapped documents covered issues related to birth registration, parental leave and entitlements, equal access to health services and respectful care.The most frequently mapped human rights covered were the right to health and the right to social security.
Efforts over the last decades in the areas of breastfeeding are notable and translate in the number of documents covering these topics identified in this review.Regarding breastfeeding, duty bearers can be guided by the seven policy priorities to protect, promote and support breastfeeding set out by the Global Breastfeeding Collective. 42Its 2021 scorecard indicates action is needed particularly around implementing the code of marketing of breastmilk substitutes, maternity leave and increasing the numbers of baby-friendly health facilities. 43The WHO Nutrition Landscape Information System 44 can be used to track the legal status of the Code in countries.
Several documents included related to maternity/ parental leave and breastfeeding in the workplace, and clearly describe the rights and statutory social support that should be available to women and partners as they transition to parenthood and return to work.Parental leave may lead to better maternal, infant and child health 45 through higher uptake of immunisation, breastfeeding and PNC services. 46 47owever, the offer of parental leave and other benefits is often limited due to economic constraints, social and political norms, pre-existing inequalities and other complex factors, particularly in low-income and middle-income countries. 19 20 48 range of documents also recognise birth registration, the foundation of legal identity, 21 as crucial for improving maternal, neonatal and child health outcomes and access to healthcare services. 49 50However, coverage of birth registration still falls short in many countries, due to barriers to accessing birth registration services, policy and regulatory challenges, and inadequate or absent civil registration systems. 48Country efforts to adopt, adapt, and implement PNC recommendations could support integration of birth registration into health services, before discharge from health facilities after birth or at subsequent postnatal contacts.
Continued efforts around postpartum family planning and contraceptive information and services is vital to protecting sexual and reproductive health rights, particularly where barriers such as cost, access to services, and lack of or insufficient education and counselling are present. 51A systematic review found that offering modern contraception as part of PNC, and integration of family planning and immunisation services, including intrafacility referrals between services, may increase use of contraceptives and is likely to reduce both unintended pregnancies and pregnancies that are too closely spaced. 52n the current review, no documents were identified in relation to maternal care in areas that could be considered as more clinical or health promotion focused, such as nutritional interventions and physical activity, preventive measures and interventions for common physiological signs/symptoms.This may reflect a potentially diminished focus on women's physical health and wellbeing following childbirth, as compared with that of the newborn.Such interventions and services are important for women to access after giving birth to obtain the information and support needed to stay healthy and understand when to seek healthcare.Self-care may facilitate PNC implementation with respect not only to these domains, but also around postpartum contraception, and could potentially be translated into policy action. 11he WHO guideline on self-care interventions for health and well-being, 2022 revision 53 outlines evidence-based recommendations to support individuals, communities BMJ Global Health and countries to adopt self-care interventions, some of which pertain to PNC and can potentially increase access to care and improve health outcomes.Importantly, such interventions should be used in addition to interaction with the health system, not as a replacement. 54Only one document addressed maternal mental health interventions, despite the adverse effects of postpartum depression and anxiety on the health and well-being of women and their newborns, and on mother-child relationships.Duty bearers can be guided by the WHO guide for integration of perinatal mental health in maternal and child health services 55 to increase maternal mental health support seeking and provision of quality, respectful, judgement-free care.
Laws, policies and regulations support the fulfilment of human rights.A variety of documents included in this review relate to the right to health, social security, information and identity, among others.They can assist efforts to strengthen the capacity of countries to integrate a human rightsbased approach to policies and programmes, advocate for health-related human rights. 22Making these links explicit by updating existing policies, strategies and practices may support and encourage all relevant duty bearers to act to support these rights, strengthen the implementation of PNC, help meet the health and social needs of women, newborns, parents and families 9 and ensure a positive postnatal experience.A human rights-based situation analysis may also help in efforts to redress inequity.Important policies include universal health coverage (UHC), policies to end hospital detention for non-payment of bills and paid parental leave, alongside investment in community-oriented care including accessible maternity centres and outpatient services. 5 56hile they do not necessarily guarantee action, international standards form a solid foundation for countries to ensure an enabling environment for implementation of the PNC guideline. 9As countries implement PNC recommendations, they could be encouraged to analyse their own current laws and policies related to international standards, and adapt their legislations to advance implementation of international standards. 9In addition, PNC services provide a platform for integrated provision of health and social services aligned with legislations on birth registration, breastfeeding protection and support, and postpartum contraception.Once country policies and legislations are updated to meet these standards, it becomes imperative to monitor and evaluate their implementation and effects over time.Mechanisms exist to monitor and report on interdisciplinary priority policies and targets, 12 19 20 44 57 including Sustainable Development Goals (SDG) targets on health, including contraception and other SDGs related to breastfeeding, birth registration, social protection and maternity benefit coverage, sexual and reproductive rights, and ending discrimination and violence against women.
Several documents identified recognise and protect the health and social needs of women, newborns, parents and families in the continuum of pregnancy, women's and child health. 9 54Others have also looked at international documents that have been used to restrict the exposure of children to unhealthy foods and beverage marketing. 58Our results should encourage countries to consider wider effects of their legislation on maternal and child health beyond essential PNC.Such effects may relate to care at work during pregnancy (related to healthy working environments, working times, time off for antenatal care, protection from hazardous or unhealthy work), 59 care of small and sick babies, and child-care beyond first few weeks after birth.Our results should also inspire the human rights standard setting systems at international and regional levels to draw on WHO normative guidance in their standard setting for health, both in terms of strengthening the evidence base of human rights standards and in developing human rights standards around the PNC domains for which there were fewer supportive documents.
The rapid review methodology lent itself well to the nature of the current review, as the objective was to capture and categorise international documents relevant to the implementation of PNC.This objective did not necessitate systematic review of research databases, rigorous assessment of methodological or reporting bias, or other important components of traditional systematic reviews.Nonetheless, while we are confident that the relevant major documents were captured, some less prominent documents may have been missed.As our search focused on documents related specifically to essential, routine PNC, it is possible that other relevant documents were not captured if they referred only to broader maternity care or were specific to pregnancy, experience of care or care for women and newborns with specific conditions or complications.We also recognise that some international documents address issues related to parental leave and entitlements after perinatal death or for parents of preterm or low birthweight infant.In addition, we elected to exclude regional documents due to difficulties in ensuring coverage across all regions.Results are also limited by the scope of the recommendations in the WHO PNC guideline.For example, the PNC guideline or other WHO guideline do not include specific recommendations related to tobacco or alcohol use or exposure during the postnatal period, when strategies and frameworks exist to support governments reduce its harmful use. 60 61Lastly, while we provide a summary of the content for each of the documents, no content analysis was performed on the strength of language of the statements relevant to the postnatal period or PNC.

CONCLUSION
This rapid review provides a comprehensive mapping of international legal and political documents relevant to facilitating implementation of the WHO recommendations on maternal and newborn care for a positive postnatal experience. 2 It shows that such documents do exist and their contents support most of the domains of PNC outlined in the WHO guideline.Taking a human rights-based approach to the implementation of the PNC recommendations helps to encourage all duty bearers to better enable women, newborns and families to realise their right to health in the postnatal period and beyond.

Contributors
The study was conceived by MB, HS and AP.HS completed searches and with MB, AP and AMW, carried out screening and assessment of documents and correspondence with key informants.AL, AN, MSc and MSt were key informants.HS and AMW completed the mapping of documents against PNC domains and developed a descriptive summary of results.HS and AMW drafted the manuscript and revised it with MB and AP.All authors contributed to the content and development of the manuscript and reviewed the manuscript prior to submission.HS is the guarantor.Disclaimer The author is a staff member of the World Health Organization.The author alone is responsible for the views expressed in this publication and they do not necessarily represent the views, decisions or policies of the World Health Organization.
Competing interests AMW, SG, AP and MB were involved in the development of the WHO recommendations on maternal and newborn care for a positive postnatal experience referred to in this review.HS was involved in one of the reviews that contributed to said WHO guideline.AL reports regularly providing lectures and presentations related to human rights considerations, specifically related to abortion, within the context of their employment at WHO (no payments have been made for these activities).AMW, HS and MS were independent consultants working with WHO at this time this review was undertaken.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not applicable.
Provenance and peer review Not commissioned; externally peer reviewed.

Data availability statement
The data relevant to the review are included in the article or uploaded as supplementary information.
Supplemental material This content has been supplied by the author(s).It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed.Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ.BMJ disclaims all liability and responsibility arising from any reliance placed on the content.Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Open access
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Figure 2
Figure 2 International legal and political documents supporting the implementation of postnatal care by type of right and postnatal care domain.

Funding
The United States Agency for International Development (USAID) and HRP (the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction), a cosponsored programme executed by the WHO, funded this research.The views of the funding bodies have not influenced the content of this manuscript.The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

Table 1
Inclusion and exclusion criteria

Table 2
presents the mapping of the 29 documents by PNC domain and type of right (NB: domains in which

Table 2
Mapping of international legal and political commitments and interpretations against postnatal care domains For a summary of content extracted from the documents to inform this mapping exercise, see online supplemental tableS8.Colour key: blue= right to social security; green=other rights; orange=right to health; yellow=right to information.*Three domains are not shown: no documents were identified in relation to maternal care in the areas of nutritional interventions and physical activity, preventive measures and interventions for common physiological signs/symptoms.†Other-right to identity.‡Right to health-highest attainable standard of health.§Other-right to freedom from torture and other ill treatment.¶Right to social security-breastfeeding arrangements at work.**Right to social security-maternity protection.† †Right to social security-family benefits.‡ ‡Right to information-related to protection from harmful marketing.§ §Right to health-health system enabling environment for breast feeding.¶ ¶Right to health-equal access to care.***Right to social security-paid leave.† † †Other-right to decide number, spacing and timing of children.CEDAW, Convention on the Elimination of All Forms of Discrimination against Women; CRC, Convention on the Rights of the Child; GC, general comment; HRC, UN Human Rights Council; ICESCR, Convention on Economic, Social and Cultural Rights; ILO, International Labour Organization; UN, United Nations; WHA, World Health Assembly.