Petition against five government institutions seeking mandamus for provision of services for women’s health relative to uterus prolapse, implementation of educational programs, and the drafting of a bill on women’s reproductive health.
The government of Nepal responded by providing funding and surgical centers to perform hysterectomies to remedy uterine prolapse, but reduced available funding and targets for such surgeries in 2010.
Though the government has put measures in place to make surgical treatment accessible to women affected by uterine prevention, very little has been done with a focus on education and prevention.[1] The 2008 draft National Multi-Sectoral Strategic Plan for the Prevention and Management of Uterine Prolapse 2008-2017, a potentially positive step which allocated specific responsibilities to all relevant ministries to prevent and treat this condition, has not been adopted as an official policy.[2] Under this Plan, the Ministry of Women, Children, and Social Welfare, Ministry of Labour and Employment and Ministry of Health and Population were all responsible for implementing awareness raising policies and other preventive measures.
In its 2014 report “Nepal: Unnecessary burden: Gender discrimination and uterine prolapse in Nepal”, Amnesty International, also a member organization of ESCR-Net, identified wide-spread gender discrimination as increasing women and girls’ risk of uterine prolapse in Nepal. Risk factors for uterine prolapse, rooted in gender discrimination, include a lack of health-related information, adolescent pregnancy (often linked to early marriage), lack of control over sexual conduct, multiple pregnancies and a lack of control over reproduction, physical labour during and after pregnancy, lack of access to skilled birth attendants and a lack of adequate nutrition. Citing this case, the report found that the government has failed to adequately address this underlying gender discrimination and reduce women’s risk of this condition. In early 2014, Amnesty International also launched a campaign calling on the government of Nepal to recognize the high prevalence of uterine prolapse in Nepal as a human rights issue, and to take action to prevent the condition by urgently addressing the underlying gender discrimination women and girls face. This is a part of Amnesty International’s My Body My Rights campaign, which urges governments to respect, protect and fulfill sexual and reproductive rights.
Implementation of the 2008 Nepali Supreme Court decision will be reviewed, along with other human rights issues, by the UN Committee on Economic, Social and Cultural Rights this November. The list of issues from the Committee includes this request: “please clarify whether the State party has taken steps to enact effective laws and policies to reduce the exposure of women and girls to the risk factors for uterine prolapse and to implement the Supreme Court ruling in Prakash Mani Sharma v. Government of Nepal (2008).”
[2] Unnecessary Burden: Gender Discrimination and Uterine Prolapse in Nepal, Amnesty International (2014) at 10, 51.
[3] Id. at 53.
The case confirmed Nepal’s legal commitments under its constitution to effectively implement the right to health, including reproductive health. Noting a lack of definition in domestic law relative to reproductive health, the Court relied upon international health and human rights principles to define women’s rights to reproductive health and the State’s obligations to ensure enjoyment of those rights. The Court understood that reproductive health includes “decision regarding reproduction, voluntary marriage, decision as to conceive or not, decision to abort a child pursuant to law, period and determination of number of children, reproductive education, and freedom from sexual violence which have also been prescribed in various treaties and declarations”.
The Court further recognized that, pursuant to the Nepal Treaty Act, treaties which the State has ratified, acceded to, approved or accepted should be treated as law. This case marked the first application of the human rights framework to the issue of uterine prolapse.[1]
The rate of uterine prolapse has remained high after the implementation of plans by the State and the problem is ongoing.
[1] Payal Shah, Uterine Prolapse and Maternal Morbidity: A Human Rights Imperative in Nepal, 2 Drexel L. Rev. 491 at 517.
Updated on August 2014.
Groups involved in litigation: Pro Public, Women’s Rehabilitation Center, Safe Motherhood Network Federation
Groups involved in the campaign for sexual and reproductive right in Nepal: Amnesty International