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Monday, April 24, 2017
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Nature of the Case

In this public interest litigation, a health rights activist challenged the State Governments’ practice of subjecting women (and occasionally men) to sterilization procedures in dangerous and unsanitary sterilization camps where informed consent is often not obtained from patients prior to conducting the procedures. The Supreme Court found these practices – focused mainly on poor, rural women – to be in violation of the right to health and more specifically reproductive rights, two key components of the right to life under the Indian Constitution.

Enforcement of the Decision and Outcomes

The case is an attempt by the Supreme Court to monitor and force implementation of its earlier decision in Ramakant Rai. This is in keeping with the doctrine of the ‘continuing mandamus’ where courts in India are not content merely with the making of orders but are equally concerned about the implementation of court orders.

Significance of the Case

This decision was widely celebrated by women’s rights activists in India. Poonam Muttreja, executive director of the Population Foundation of India commented, “We welcome the Supreme Court judgment which we consider a landmark one. Providing quality services to and upholding the dignity of women will now be placed strongly on the national agenda.” The decision must be contextualized in the context of an estimated four million tubal ligations (female sterilizations) every year in India, more than any other country. Advocates have long campaigned for better regulation or elimination of sterilization camps, and more investment in alternative forms of contraception.

The decision was noteworthy given its focus on both specific incidents, as well as the wider context (such as informal sterilization targets set by State governments) that give rise to conditions encouraging non-consensual sterilizations. The case confirmed the need for free and informed consent prior to sterilization procedures; in the absence of such consent, sterilizations are considered to be involuntary or coerced, and constitute serious human rights violations, as confirmed in CEDAW’s General Recommendation No. 24 on women and health. Vulnerable groups, for example, women, persons living in poverty, ethnic and indigenous minorities, persons with disabilities, or with HIV, transgender persons and intersex persons, have historically been the target of such practices, in India and across the world. This case also highlights quality of care (including pre- and post-operation) as a core component of the right to health, as set forth in CESCR General Comment No. 14 on the right to health.

The UN interagency statement ‘Eliminating forced, coercive and otherwise involuntary sterilization’ provides useful international guidance on a human rights-based approach to sterilization. While recognizing that sterilization remains an important option for individuals and couples to control their fertility, the statement reaffirms that sterilization practices should be available, accessible, acceptable, of good quality, and free from discrimination, coercion and violence, and based on the full, free and informed decision-making of the person concerned.

Groups Involved in the Case

Human Rights Law Network, National Alliance for Maternal Mortality and Human Rights, Health Watch Forum, Population Foundation of India.