The High Court of Madhya Pradesh has passed a landmark final judgment in the case of Sandesh Bansal v. Union of India (PIL) W.P. 9061/2008, recognizing that a woman’s right to survive pregnancy and childbirth is a fundamental right protected under Article 21 of the Indian Constitution. Filed in 2008 by Sandesh Bansal, a health activist and member of the Jan Adhikaar Manch, as part of Human Rights Law Network’s national strategy to use litigation as a means of addressing India’s high maternal mortality & morbidity, the case sought accountability for the government's failure to respect, protect, and fulfill the rights of pregnant women. Advocate Jayshree Satpute, who argued the final hearings in the matter noted the judgment as a "a significant step forward for women's health in India, as a growing number of High Courts have begun to recognize reproductive rights as fundamental rights and order life-saving reliefs."
Madhya Pradesh is the India's third most populous state, and as noted by the Honorable Court "afflicted with the worst indicators in India" such as high rates of illiteracy, mortality, morbidity and people living below the poverty line. Poor socio-economic conditions persist despite enactment of the National Rural Health Mission (NRHM), a public health scheme funded by the Central Government to address India’s shockingly high maternal and infant mortality in furtherance of its public health duties as provided by the Indian Constitution and international human rights law. Relying upon extensive government research and reports, such as the State Programme Implementation Plan, Common Review Mission, and a Registrar's report submitted during the pendency of the litigation, the Court documented the failure of the government to implement the NRHM, noting dilapidated facility conditions, non-availability of skilled personnel, essential medicines, and access to timely and consistent matenal health services. The Court further rejected the government's claim that financial constraints served as a barrier to full implementation, noting that over 17100 lakhs remained unspent at the end of 2009.
As the Court eloquently explained,
" 22. (…) we observe from the material on record that there is shortage not only of the infrastructure but of the man power also which has adversely affected the effective implementation of the [National Rural Health Mission] which is turn is costing the life of mothers in the course of mothering. It be remembered that the inability of women to survive pregnancy and child birth violates her fundamental rights as guaranteed under Article 21 of the Constitution of India. And it is primary duty of the government to ensure that every woman survives pregnancy and child birth, for that, the State of Madhya Pradesh is under obligation to secure their life.
In recognition of the fundamental nature of these rights, the Court ordered immediate implementation of the NRHM, with a focus on strengthening infrastructure, providing access to timely maternal health services, skilled personnel, effective referral and grievance redressal mechanisms. A time bound plan for “strict and timely” implementation was ordered consistent with NRHM, with the Court setting specific directives, such as:
- 24 hours availability of trained woman as ASHA/Community health worker
- Two staff nurses at the primary health centre to ensure round the clock service therein
- Three staff nurses at the primary health centers to ensure round the clock service therein.
- Uninterrupted electricity supply and the water supply to the sub-centers and public health centers.
- Ensure proper modern sanitation.
- Ensure that in all 227 Community Health Centers in the State of Madhya Pradesh the availability of 24 hours delivery services including normal and assisted deliveries it has 30-35 beds. To be equipped with man and machine at par with the Indian Public Health standards, which would include Essential and Emergency Obstetric Care Unit, so that round the clock hospital like services are available.
- Ensure availability of vehicle round the clock under Janani Express Yojana.
- Ensure that every pregnant women and new born is vaccinated with Tetanus, BCG, Polio, DPT
- To set-up all 87 Rogi Kalyan Samitis
- Constitute monitoring committee at District Block level and ensure complete documentation of each and every patient.
The Human Rights Law Network (HRLN) is a collective of lawyers and social activists dedicated to the use of the legal system to advance human rights in India and the sub-continent. To learn more visit www.hrln.org
Advocate Jayshree Satpute
Advocate Anubhav Jain