The Reproductive Rights Initiative (RRI) works toward the realization in India of reproductive rights as defined in the Programme of Action of the International Conference on Population and Development (1994), which “rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. They also include the right of all to make decisions concerning reproduction free of discrimination, coercion and violence.”
One of the many issues the Initiative focuses on is the right of women to survive pregnancy with dignity. Approximately 117,000 women and girls die each year in India due to pregnancy related causes. This accounts for 25% of all maternal deaths globally. For every maternal death there are estimated to be between 30-50 temporary or chronic cases of maternal morbidity. The majority of these maternal deaths and pregnancy related illnesses and disabilities are preventable.
According to the latest Government statistics (2004-2006), India has a Maternal Mortality Ratio (MMR) [insert link to map] of 254, i.e. the number of maternal deaths per 100,000 live births. However, the World Health Organisation (WHO) calculated a MMR of 450 for 2005. Even relying upon the conservative Government figure, India has one of the highest MMRs in the world, higher than in 120 countries including India’s neighbouring states of Bangladesh, China, Nepal and Sri Lanka.
This is because, in addition to factors such as poverty, poor nutrition, gender discrimination, caste discrimination, unhygienic living conditions, lack of access to education and low literacy rates, and lack of access to contraception and family planning, the public health system in India fails in its legal obligations to provide adequate maternal health care, basic and comprehensive emergency obstetric care and access to safe medical termination of pregnancy.
“For a middle income country of its stature, the rate of maternal deaths in India is shocking.”
Paul Hunt, Former United Nations Special Rapporteur on the Right to Health
Another issue of particular concern to the Initiative pertains to population control policies. India, with more than 1 billion inhabitants, has the second largest population in the world. Despite, the consensus on population reached at the International Conference on Population and Development (1994), there is alarming evidence of a resurgence of coercive population measures being introduced at the state level in an effort to discourage fertility. These measures are being levied against both men and women, for example through the use of social and economic incentives and disincentives, but have an especially devastating impact on women. The two-child norm policy for example is linked to gender-based violence and female infanticide.
Against this backdrop, the RRI at HRLN uses the legal system to combat violations of reproductive rights, ensure implementation of reproductive rights schemes, and to demand accountability where implementation is left wanting.
What We Do?
- Promote a rights-based approach to reproductive health care throughout India.
- Encourage dialogue and collaboration between women’s rights organisations, health groups, lawyers and judges to utilise the legal system more effectively.
- Conduct fact-findings all around India to ascertain the situation on the ground.
- Provide pro bono legal aid for the poor, marginalised and vulnerable whose reproductive health rights have been violated.
- File Public Interest Litigation Cases (PILs) concerning reproductive rights to both High Courts and the Supreme Court of India, which rely on Constitutional, legislative and international human rights law provisions.
- Provide advocates and social activists with a concise summary of the main facts, legal arguments and court orders in HRLN’s PLIs through the publication of the “Mera Haq” (My Right) Legal Case Series.
- Produce “know-your-rights” materials to increase awareness among Indian women and their partners about contraception, family planning and other reproductive health issues.
- Organise events to promote reproductive rights issues, such as the “Mera Haq (My Right): Surviving Pregnancy with Dignity photographic exhibition held in Delhi, 21-28 May 2010.
- Conduct educational workshops and training seminars for activists to build capacity.
- Work in conjunction with the Women’s Justice Initiative, People’s Health Rights Initiative, Dalit Rights Initiative, and the Child Rights Initiative, to ensure that Dalit, Adivasi, and adolescent girls are recognised as special-risk groups of maternal mortality and morbidity.
Issues Of Concern
- Preventable maternal mortality and morbidity
- The right to food and nutrition
- Safe access to medical termination of pregnancy
- Information and access to family planning and contraception
- Coercive population control policies and strategies including; sterilisation, the two-child norm, social and financial inducements to discourage fertility
It is because of the PILs brought by the RRI that reproductive rights have become justiciable in Indian courts and our team has had a number of real successes; RRI filed a PIL against the negligent (many women had no knowledge of what was happening to them) and abusive (incidents of bicycle pumps being used in place of surgical equipment had been reported) sterilisation of women in state sponsored mass sterilisation camps. The case had a massive countrywide impact and set legal precedent ensuring access to safe and regulated sterilisation in the future. (See: Ramakant Rai & U.P. and Bihar Healthwatch Vs. Union of India).
Many public hospitals in India have weak infrastructures, poor operational conditions and lack essential equipment and medical supplies. Lack of functioning blood banks and blood storage facilities is of particular concern because lack of access to blood accounts for approximately 50% of all maternal deaths in India. The RRI was therefore delighted that after filing its petition in Madhya Pradesh (MP), which sought legal remedies following lengthy delays and illegal demands for money from the Bhind district hospital who had applied for a licence to set up a blood bank and conduct blood transfusions, the licence was immediately granted. Furthermore, the PIL resulted in major infrastructural overhauls of water and sanitation systems and an order that all Government health centres in MP be equipped with electricity. (See: Sandesh Bansal v Union of India, Writ Petition No 9061/2008).
Despite the appalling circumstances surrounding the case of Shanti Devi, a member of a Scheduled Caste who died delivering her baby daughter at home without any medical assistance, it is one of RRI’s greatest successes to date due to the ground breaking order issued by the Delhi High Court in March 2010. The Court ordered a maternal death audit be carried out with respect to the pregnancy-related death of Shanti Devi, thus setting both a national and international legal precedent by ensuring accountability for a maternal death. (See: Laxmi Mandal Vs. Deen Dayal Hari Nager Hospital & Ors).
In a case of Jaitun, emblematic of the multiple rights violations suffered by Indian women and girls as they attempt to vindicate their right to survive pregnancy with dignity and a illustrative of the corruption and collusion on the part of the Sate and public health actors, which is endemic throughout India, RRI’s PIL secured an order for the Union of India to devise a set of instructions to ensure that persons living below the poverty line (BPL) get their entitlements to free medical care. (See: Jaitun v Maternity Home, MCD, Jangpura & Ors).
“Reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health .This should also include the right of all to make decisions concerning reproductive health free of discrimination, coercion and violence” ~ International Cairo Programme of Action, 1994.