Complications during childbirth and pregnancy are a main source

of death and disability among women of reproductive age.

Approximately 536,000 women die from pregnancy-related

complications each year. Developing countries suffer most

profoundly, accounting for 99% of deaths. The world's nations, by

endorsing U.N. Millennium Development Goals, recognized that

most deaths are preventable; they have pledged to reduce maternal

mortality by 75% by 2015. This Article assesses the barriers

presented by user fees - formal charges for health services still

charged by many countries - to the attainment of MDGs. It shows

that user fees hamper healthcare access, particularly in emergencycare

settings, and fail in meeting their intended purposes of

generating funds and improving equity, quality and

decentralization of health care. The Article analyzes fees' adverse

impact through a human rights lens that privileges each woman

with an assessment of her health, unlike the MDGs which assess

aggregate improvements and benchmarks. Finally, the Article

explores alternatives to user fees, including universal health

insurance schemes, tax schemes, and debt forgiveness programs

and policies. It offers a guiding framework for assessing health

financing systems - a framework that is centered on the needs of

the poorest and most marginalized community members and that

emphasizes accountability.