In A Broken Health Care System, This Initiative Is Working Hard To Prevent Maternal Deaths

In January 2012, dozens of women from extremely backward classes (EBC) gathered at a government-run middle school in Kapafora village in Araria, around dusk. An NGO had organised a sterilisation camp, and the women were promised a 600 rupee incentive if they went through with the procedure. When the tubectomy operations began (sealing of the fallopian tubes in women to prevent pregnancy), all basic procedures of the operation were shoved down the bin.

Within two hours, as many as 53 women were operated upon that night by a single surgeon. The operations were performed on the bare benches of the school under a torch light. There was no pre-operative checkup, the medicines were past their expiry date, and the operations were conducted without supervision. In his report, the investigating officer noted how women were lying on the floor “scattered like livestock”.

Why Reproductive Rights

Colin Gonsalves. Source: Twitter

It was in order to prevent such gross human rights violations that lawyer Colin Gonsalves decided to start the Reproductive Rights Initiative (RRI), an initiative solely focussed on working on issues related to reproductive rights under the Human Rights Law Network over a decade ago.

Explaining the motivation to start such an initiative, he says, “It (reproductive rights) is an area of very extreme violation of human rights, which is unrecognised in the country as yet. For example, most of the human rights organisations, the NHRC, and even the courts were unaware of the fact that it is such an extreme violation.”

“Take, for example, sterilisation,” he points out, “Sterilisation of women and then throwing them on the ground in dirty unhygienic conditions is such an extreme thing. Thousands of women are sterilised and yet it was not part of court cases, it was not part of NHRC agenda, it was not part of the human rights organisations agenda. It was one area of darkness where extreme violations took place. That is why we took this up,” he says.

One of the few organisations working at the intersection of law and reproductive rights in the country, RRI actively works towards promoting a rights-based approach to reproductive health care throughout India. It does this work not only through litigation, but also by conducting fact-finding reports to ascertain situation on the ground, providing free legal aid to the poor and organising events and workshops to promote awareness around reproductive rights in the country through as many as 30 units.

One of the major breakthroughs accomplished by the initiative came in 2005 when the Supreme Court for the first time passed guidelines on conducting sterilisation procedures. The guidelines asked for a system of an approved panel of doctors for conducting sterilisation, preparation of uniform copies of the proforma of consent and formation of a quality assurance committee among other things.

“I know that they (the government) don’t take court orders seriously but in the case of women and reproductive rights they take it like a joke,” Gonsalves says. That despite passage of guidelines sterilisations like the one that happened at Araria still continue to happen in India underscores why RRI’s work is so important today.

Sanjai Sharma (who has been working with RRI for the past 10 years) believes every reproductive rights case is important. “Each one is crucial and important because ultimately what happens is if your right to reproductive health is being violated, you end up dying. For us, the most important thing is the right to life and the right to health. If those are being violated, it is an important case,” Sharma told YKA.

Major Impact

Since its formation, RRI has been instrumental in making courts take notice of various violations happening in case of reproductive rights. The 2005 Supreme Court order in the Ramakant Rai petition became one of the first major court orders on mass sterilisation. Another set of guidelines on mass sterilisations were also given in 2016 on RRI’s intervention. “It was in our favour. The court asked for national health policy to be formed as quickly as possible and that burden should not fall on women. It also said that men should also be sterilised and that camp culture should be closed,” says Madhulika Masih, a member who works with RRI.

A significant recognition of reproductive rights also came in another case fought by RRI in 2010 when a Scheduled Caste woman Shanti Devi died while delivering her baby at her home. Devi had gone to many after hospitals, but all demanded high fees for admission, which Devi couldn’t afford. On RRI’s intervention, the Delhi High Court ordered an audit into her death. It was a first of its kind order that recognised that maternal deaths cannot be ignored.

More recently, two abortion cases that made news last year were also fought by the lawyers of RRI. The Supreme Court allowed two women to terminate their pregnancy beyond the 20th week, which is allowed only under the exceptional circumstance of there being a threat to the life of the woman.

Challenges

Despite these groundbreaking cases, activists and lawyers at RRI believe there is a lot of ground to cover when it comes to improving the state of reproductive rights in the country.

Sneha Mukherjee points at abortion laws as one such area. Mukherjee, who argued cases relating to abortion in the Supreme Court last year points out how India still hasn’t updated its abortion laws since the Medical Termination of Pregnancy Act (MTP Act) came into effect in 1971.

While the court allowed two women to terminate their pregnancy beyond the 20th week in the case she fought, it didn’t allow another woman, whose child would be born with Down Syndrome, to terminate her pregnancy. RRI is, therefore, challenging the constitutional validity of the section of the MTP Act that prevents such abortions in the Supreme Court in a pending petition. “If I know that the child won’t survive, or that it will suffer, then I should have the right to choose,” Mukherjee says.

Pritisha Borah (left) and Madhulika Masih, HRLN

Pritisha Borah, another member, talks about another area that needs attention – the growing proportion of tubectomies among total sterilisations. “Forceful sterilisation was being done on men since the Indira Gandhi Regime. After there was criticism, the focus shifted from male to female sterilisation. If you see the statistics now, female sterilisation is much higher than male sterilisation,” Borah says. Borah is right. In 1980-81 the percentage of tubectomies to total sterilisations was 78.6. This proportion had steadily risen to 98.1 by 2014-15. It is only recently that courts have started making observations against this.

Sija and Deepak Kumar Singh, lawyer-activists at RRI, point to non-delivery of schemes related to maternal health such as the Janani Suraksha Yojana (JSY) and the Indira Gandhi Matritva Sahyog Yojana (IGMSY) as another area that needs work. Explaining why monitoring scheme implementation is important, he says, “Bleeding takes place after delivery. If you are anaemic, there is a very high possibility of death due to bleeding,” he says, adding that the latest National Family Health Survey indicates that about 50 percent of women in the reproductive age group are anaemic. Incidentally, this was also pointed out in the Shanti Devi case.

Government apathy, too, can take a toll on those working in the field. Says Borah, “Every day is a long struggle between us and the state. It is a challenge because sometimes you feel very happy and sometimes you feel very low, like nothing is going on.” This is, of course, apart from hurdles that come with working in a patriarchal setup. “If you talk about women’s rights, if you talk about contraceptives, abortions, vagina, these people- the men- they think we are talking in jargon,” she adds.

What do they then think can help in changing the situation of reproductive rights? Masih says that it things could change fast if men too actively start working in the sector. “We want change to happen but currently, it’s just the women who are doing this work. It has to be both ways. Until men too get actively involved, I don’t see major changes happening,” she says.

Featured Image: Max Pixel

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