Sandesh Bansal v. Union of India and others (PIL) W.P. No. 9061/2008
This public interest litigation (PIL) was filed in July 2008 against the government of Madhya Pradesh over the lack of implementation of maternal health schemes in the state. The High Court of Madhya Pradesh delivered its landmark order in February 2012. The court held that a woman’s inability to survive pregnancy and childbirth violates her fundamental right to live, as guaranteed under Article 21 of the Indian Constitution. The court recommended that the government take various measures to improve maternal health care in the state.
The petitioner, Sandesh Bansal, is a health activist and member of Jan Adhikaar Manch, a nongovernmental organization (NGO) working to raise concern over the high maternal mortality rate (MMR) in Madhya Pradesh as a part of their “Save our Mothers” campaign. The case was also part of Human Rights Law Network’s (HRLN’s) national litigation strategy to address India’s high maternal mortality and morbidity rates. Petitioner alleged that the state failed to provide basic and adequate maternal healthcare. Petitioner contended that the state has the third highest MMR with 498 deaths per 100,000 live births. Petitioner further contended that women were dying because of the high cost of health care, the failure of the public health system, the lack of qualified medical staff, an appropriate transport in rural areas, and other cultural and social factors that obstruct women’s access to effective and adequate health care. Petitioner substantiated these claims by relying on, inter alia, the November 2007 appraisal report of the Common Review Mission (set up under the National Rural Health Mission (NHRM)). Using this report, the petitioner alleged that the State had been ineffective in the implementation of the NHRM Plan according to the Central Government’s public health duty to address India’s high maternal and infant mortality rates.
The respondent state of Madhya Pradesh, while conceding that the facilities in the government hospitals were not proper and recognizing the applicability of health guidelines under NHRM, submitted that efforts had been made to meet the goals set by NHRM with the available resources. Respondent relied on an affidavit filed by the Director of Public Health and Family Welfare of Madhya Pradesh and returns filed by the Central Government. To test the validity of the claims of the respondent regarding availability of staff and facilities in health centers, the court conducted a random inspection in some centers. The court concluded that the resulting report reflected dismal conditions, contrary to the state’s submissions. The entire report was reproduced to enable the government to address the shortcomings.
Based on the record, the court found dilapidated facility conditions, a shortage of skilled personnel and essential medicines, and a lack of access to timely and consistent maternal health services in the hospitals that prevented the effective implementation of the NHRM Plan. The court pointed out the detrimental effect on the lives of mothers and that the conditions violated their fundamental right to live, guaranteed under Article 21 of the Indian Constitution. The court emphasized that “it is the primary duty of the government to ensure that every woman survives pregnancy and child birth,” due to the state’s obligation to secure their life.
The court rejected the government’s claim that financial constraints served a barrier to the Plan’s implementation and noted that funds remained unspent in 2009. The court also recommended that the state take specific and timely measures to achieve implementation of the Plan, including 24-hour availability of trained community health workers and delivery services, modern sanitation, water and utility services to the Primary Health Centers (PHCs), more staff nurses at PHCs, and vaccinations and complete documentation of every patient. The court concluded by highlighting the poverty and mortality levels in Madhya Pradesh, challenging the state to rise to the occasion and make “drastic efforts” to implement the Plan and achieve its goals.
Interim Orders issued by the High Court of Madhya Pradesh when the case was still pending led to the setting up of a blood bank and construction of a water tank to improve the conditions at the PHCs.
In this landmark decision, the court recognized that the right to maternal health care and right to survive childbirth is an aspect of the Right to Life as enshrined in Article 21 of the Indian Constitution. The court found that this right imposed a burden on the state to provide adequate maternal healthcare. Advocate Jayshree Satpute, who argued the final hearings in the case, noted that the judgment is “a huge 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.”
For their contributions, special thanks to ESCR-Net member: the Program on Human Rights and the Global Economy (PHRGE) at Northeastern University.