December 21, 2016

People’s Convention on Maternal and Reproductive Health Rights
Organized by NAMHHR, CommonHealth, Scavengers Dignity Forum & Dalit Alliances, Wada Na Todo Abhiyan, Jan Swasthya Abhiyan

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Over the past 10 years, maternal and child health has taken centre stage in health policies and programmes in India. In order to tackle high rates of maternal and neonatal mortality, the government of India has taken various measures to incentivize institutional deliveries, strengthen health systems, increase allocations, remove financial barriers, improve immunization coverage, and implement regular tracking systems. In this time, India has apparently experienced a decline in its maternal mortality ratio (MMR) from 301 (in 2006) to (178 in 2013) maternal deaths per 100,000 live births, however, these numbers are likely highly under-reported. Similarly Neonatal and Infant Mortality continues to be a serious challenge for India. Although rates of mortality have dropped over the past three decades, one fourth of all deaths of children under six years of age, occur in India. According to UNICEF, 1.34 million children aged under five, 1.05 million infants, and 0.748 million newborns die every year in India. Even going by conservative estimates, about 45,000 women die due to childbirth every year in India, and most of these deaths are preventable. The rates of decline of MMR vary widely between different states with 12% of global maternal deaths occurring within nine states of northern and eastern India. Although institutional delivery coverage has increased over the years, this in itself has been insufficient to reduce MMR. Critical issues such as quality of antenatal and post natal care, risk identification, availability of emergency obstetric care, behavior of staff during delivery, availability of abortion and contraceptive services, continue to be a challenge. Survey data shows that out-of-pocket expenses for poor families have not reduced, despite the efforts to reduce financial barriers. Moreover, the government of India is pushing for privatization of in various modes such as contracting out services via Public Private Partnerships, for which there is no evidence of increased equity, but on the contrary they have been known to encourage unscrupulous practices.

Why Should Other Social Movements Care about Maternal and Infant Mortality

The issue of maternal and reproductive morbidity and mortality is intersectional in that social location plays a role in determining outcomes for women and children, and social determinants such as access to nutrition, sanitation and poverty also strongly influence health. The biggest burden of maternal and infant mortality falls on women from marginalized communities and the poor. The latest available national level survey data – the NFHS3 (2005-6) shows disparities in women’s access to maternal health services – women belonging to scheduled castes and tribes are less likely to receive antenatal care and skilled birth attendance. UNICEF also notes that there are gross disparities in mortality indicators with Scheduled Castes, Scheduled Tribes and minorities having a higher IMR and U5MR. Further, there are specific problems faced by women belonging to marginalized communities – such as abusive behavior, neglect and culturally inappropriate services. Despite overwhelming evidence that there are disparities in maternal health indicators, the government of India does not publish disaggregated data on these. In fact datasets from three rounds of the annual health survey which were conducted in high-focus states with the express purpose of contributing to meaningful tracking of progress towards improved health status have not been released and any kind of disaggregated analysis is rendered impossible. Although maternal death reviews are meant to fix accountability, they are not being conducted in many cases and the findings are also not made public. Thus there is a situation of prevailing silence around issues of equity and accountability, suggesting that it is a problem that is being wished away rather than tackled. In this situation it is critical that civil society actors raise the issue in a concerted manner and facilitated a grassroots demand for accountability.

The Need for A People’s Convention:

Over the course of the Millennium Development Goals, indigenous civil society organizations have continuously dialogued with the state to influence its “input” – i.e. policy and program design, to make it responsive and relevant to women’s realities. Coalitions like NAMHHR and CommonHealth have systematically documented maternal health rights violations in the field and repeatedly held policy dialogues at the national level, to impress upon policy makers the need for rethinking their approach to address emerging issues. The policy dialogues have received attention from policy makers and elected representatives, however there is a need to complement this with mobilization and dialogue with the system, closer to the grassroots to demand accountability for maternal and child health services. It is critical to make maternal and child health a core concern of communities, especially marginalized communities, and grassroots movements that represent them.
Building on these experiences, we perceive the need for greater synergy among groups working at the grassroots level, to generate a nationwide campaign to demand maternal and child health rights. Not limiting ourselves to health rights groups, a wider alliance of political groups (especially those representing marginalized communities, including dalit rights groups, minority rights groups, disability rights groups, groups working on other social rights such as right to food) must be built so that the agenda of maternal health is owned by us collectively. The Sustainable Development Goals, several of which address reproductive and child health, are meant to guide the government of India’s future policy and programmatic priorities and for which India will be held accountable at international forums; these can become a rallying point around which communities can be mobilized to demand for better maternal and reproductive health services, building on such mobilization that has already begun through networks such as the Wada Na Todo Abhiyan.

As a first step towards building such an alliance, we propose to host a 2-day “People’s Convention on Maternal and Child Health Rights” in Delhi in mid-December. This convention would bring together organizations and movements working on various issues and across different states, to amplify voices of their constituencies at the national level and develop a common and synergistic agenda for a grassroots campaign in the future.
The objectives of the convention will be as follows:
1 – To understand the issues of maternal and reproductive health and its determinants from the life experiences and field realities of diverse marginalized groups
2 – To explore synergy between various field-based and issue-based groups and campaigns to generate a nation-wide collaborative accountability agenda to address preventable maternal and reproductive morbidity and mortality
3- To strengthen the conversation between rights groups working at the national and sub-national level, and build intersectional cross-movement alliances to address maternal and reproductive health
The 2-day Convention will bring together approximately 100 participants from across the country, who are advocating for the rights of women and would be interested in taking on board the issue of maternal and child health in their mobilization. These include grass root organizations, movements and Networks like Right To Food Campaign, Bebaak Collective, other groups working on Tribal’s Rights, Right to Education, LGBTQ rights, minority rights, land rights and Rights of Single Women (Ekal Nari Shakti Sangathan).
Dates: 16- 17 December
Venue: Indian Social Institute, New Delhi

September 26, 2016

Chronicles of Deaths Foretold: Part 2 - Policy recommendations

Data from the health ministry shows that only 42% of maternal deaths are being reported. Out of them 67% are institutional deliveries. Nearly 20% of women are dying during transit.
Experiences from the field indicate the same.

“We have 120 medical colleges, only 55 are reporting maternal deaths to us. We have sensitized them, but it is not picking up,” saidDr. Veena Dhawan from the Ministry of Health and Family Welfare.
She listed many initiatives of the government to reduce maternal deaths. “But the implementation lies in the hands of the State governments. We can only make policies at the Centre,” she said.  
The report was presented to Dr. Veena Dhawan, assistant commissioner, maternal health, Ministry of Health and Family Welfare and Dr. Prasanth of National Health System Resource Centre.


In the two-day consultation, organized during the release of report “Chronicles of Deaths Foretold,” activists strongly demanded accountability for lapses when a woman dies. They said that there should be enquiry into maternal deaths, responsibility fixed and culprits punished. When there are protocols, then someone should be punished if they are not followed and lead to deaths.

Based on the report and the consultation on maternal health, the civil society organizations came up with recommendations. Five suggestion that NAMHHR believes have to be implemented immediately are:
  1. Ante-natal check-up (ANC) must identify high-risk cases – use RED FLAG to signify a high risk for all providers
  2. EMERGENCY HELP DESK in all facilities used by ‘populations at risk’ with compounded vulnerabilities
  3. Develop Adverse Outcome Management protocols, monitor use in HPDs
  4. Blood storage at all FRUs; in emergency situations, no donor requirement
  5. Free REFERRAL transport to tertiary facilities with paramedic (EMT)- even if across state border; a simple PHONE CALL to next facility  
The 10 medium-term recommendations are
  1. System of using MCTS information to prevent/prepare for any adverse outcomes
  2. Skill training of all nurses and ANMs in safe childbirth, including ANMs in sub-centres/community
  3. Adequate  nurse/ANM posts & appointments according to case-load
  4. Ensuring visits to each CHC by a Gynaecologist at least once every 15 days
  5. Ensuring  essential drugs for maternal survival are available, and using generics
  6. Providing Iron-sucrose injections for very anaemic women at CHC/PHC
  7. Strong feedback loops for JSSK, with User participation
  8. Acknowledgement and Regulation of the private sector  including informal providers
  9. Stronger monitoring of data based on AHS estimates; counting numbers of anaemic women, checking maternal death reports and doing CB-MDR with CSO support
  10. Involvement of PRIs in identification of maternal deaths, process of death review & community awareness
  11. Free hearse service for bereaved families
Dr. Abhijit Das, director, Centre for Health and Social Justice, said that the government should create a feedback mechanism from community experience. We can use ICT for a platform through which every citizen can provide their experience. It will be anonymous but will have important indicators like geographical area and facility where the person was treated. This can further be consolidated and feedback sent to specific facilities for their improvement.

“We do not need new schemes and announcements. We need to ensure implementation of what already exists. We need to hold people accountable when they do not implement policies,” said Renu Khanna from Sahaj, Gujarat.
Jashodhara Dasgupta from Sahayog, nodal organization that prepared the report, said that an overhaul of the current system is the need of the hour. “Our evidence through the report shows that the current way of working has not produced results. The model of JSY+ ASHA+ EmOC/JSSK has not worked, especially in marginalised areas and communities. We have rethink and look beyond the existing system”.

Sterilisation judgment: Beginning of a longer battle to reorient family planning programme

-- By Maya Palit
In April 2012, Salamuni and her husband, a rickshaw puller based in Bundelkhand, visited a hospital in Chitrakoot. She was pregnant and ill, and they assumed she would get better medical treatment there. The doctor on call, Ranjana Sharma, was aggressive in her attempts to convince Salamuni to have a sterilisation operation. Despite Salamuni insisting that she was too weak, Sharma made her sign a document, gave her an injection, and initiated an abortion as well as sterilisation before the anaesthesia kicked in. According to Salamuni’s account, the doctor spent three hours pumping air into her to locate the nerve, and when she screamed from the pain, the sari she was wearing was stuffed in her mouth before she lost consciousness. She had to spend eight days recovering at a hospital in Allahabad after the ordeal because the bleeding wouldn’t stop, she told activists from Sahayog, a women’s reproductive health advocacy group.
Salamuni’s case was an extreme version of the scores of botched sterilisation jobs that are frighteningly common in India. Earlier this year, the central government reported 113 deaths caused by tubectomy surgeries in the last year, but several women’s health activists have rejected this as a conservative estimate, and the National Alliance on Maternal Health and Human Rights (NAMHHR) suggested during a press conference last Friday that approximately 1,000 of the 4 to 5 million women who undergo sterilisation die every year. This has been attributed to the appalling conditions under which the abdominal operation is conducted – often in dharamshalas, under torchlight at night, sometimes with very poor hygiene and unsanitary tools like bicycle pumps and rusty scalpels.
The particularly horrific case of the 18 women who died in 2014 after contracting septicemia and other complications in a sterilisation camp in Bilaspur, Chhattisgarh is now widely known. RK Gupta, the doctor who operated on 83 of those women over five hours was briefly put in police custody but then released because of insufficient evidence. The news that in the same year he had been rewarded for his ‘record’ career of 50,000 surgeries only epitomises the target-obsessed mentality of the Family Planning programme.
It was the gory details of a similar incident that took place four years ago — when 53 Dalit and Scheduled Caste women were operated on at night in a government school in Araria, Bihar — that convinced the Supreme Court last week to direct the Centre to end sterilisation camps across the country, acting on a petition filed in 2012 by health rights activist Devika Biswas. Activists working on maternal health and human rights have since organised meetings to discuss the implications of the judgment. While they welcomed the decision, they were not optimistic about the 3-year transition period which the Court provided the Centre, and said that until an actual blueprint is written out to end these mass camps, it is difficult to say what impact the judgement will have.
Kavita Krishnan, Secretary of the All India Progressive Women’s Association and member of the CPM pointed out at the conference that the family planning debate is still very much centred on tackling population control rather than focusing on women’s reproductive rights: "The question [should not be] about which is the next best technological fix in contraception but about what actions will empower women to gain control over their bodies, and encourage men to take responsibility for contraception," she said. Unfortunately, the focus on population control has governed family planning since the late 80s, ever since the Pomeroy method of tubal ligation through laparoscopy made abdominal operations easier to conduct. And as Deepa Dhanraj’s 1991 film Something Like A War shows, doctors had begun conducting them in unsanitary situations early on: “I spend 45 seconds per operation. I have conducted 3,13,939 operations, this year, more than two thousand in schools and government halls…” says one gynaecologist in the film.
Abhijit Das, co-founder of Healthwatch Forum and a trained doctor working at the Centre for Health and Social Justice in Delhi, added that paranoia about the population explosion has been so deeply ingrained in the public mindset that the government feels justified in its search for quick-fix solutions. The alternative, he says, is aiming for population growth to be spread over years: “India has a very young population. What you want is for reproduction to take place over time, rather than people having many babies and getting sterilised at 24. Sterilisation should also happen later because it has been associated with high regret and hysterectomy rates.”
One of the most crucial questions that was raised at the NAMHHR conference concerned the (lack of) temporary contraceptive and alternatives in the family planning programme. The post-partum intra-uterine contraceptive device (PPIUCD) is another measure that has been gaining popularity. Rajdev Chaturvedi, from the Gramin Punarnirman Sansthan in Azamgarh, Uttar Pradesh, spoke about increasing cases of the device being inserted without women’s consent or knowledge after they give birth. He was also skeptical about the impact of the judgment, claiming that the real change would involve the improvement of access to counselling for women regarding contraception, as at the moment they are targeted while they are vulnerable and in pain during deliveries.
Jashodhara Dasgupta, a coordinator of Sahayog who also works with Healthwatch Forum, UP, emphasised the importance of expanding the objectives of family planning to include a variety of contraceptives so that women can make “informed choices”. These include measures for those who find the PPIUCD invasive or adolescents at the start of their sexual lives, for whom sterilisation is entirely unnecessary. “The government has put off a long-term vision that encompasses the diversity of people’s needs for so long,” she said.
But the reason that non-consensual sterilisation is so rampant in the first place is because doctors are given annual (unofficial) targets or ELAs (Expected Levels of Achievement) to fulfil. Although the recent Supreme Court judgement directs the government against encouraging “incentivised consent” or setting even informal targets for health workers, this may well conflict with India’s commitment to providing contraceptive services to 48 million additional users as part of its family planning goals for 2020. And as of last year, more than 80 percent of the annual family planning budget was spent on promoting sterilisation. Even though the most recent National Family Health Survey statistics suggest that female sterilisation has decreased overall in many states in the last decade, in states like Andhra Pradesh, as many as 68.3 percent of women across rural and urban areas have undergone sterilisation — it doesn’t look like a problem that can be completely eradicated right away.
It remains to be seen, then, whether this judgement will be the beginning of a much longer battle to reorient the family planning programme.
The Ladies Finger (TLF) is a leading online women’s magazine delivering fresh and witty perspectives on politics, culture, health, sex, work and everything in between.

September 23, 2016

Chronicles of Deaths Foretold:Part 1 - Experiences from the field

Sunita Devi (name changed) breathed last in a district hospital in Godda district of Jharkhand while delivering her baby. Devi was 28 year-old and died due to absence of blood in the hospital. She was already delayed in reaching the hospital as her family took time in arranging money for the ambulance.

The family had to mourn two deaths as her child too was still born. The family also had a debt of Rs 15,000 by the end of entire affair.

“Such experiences discourage people from going back to the public health system. If a woman delivers her first child in a health facility, she resists going through the same experience for future deliveries,” said Jiban, an activist from Odisha.

Devi’s story is one of the 20 from Jharkhand that have been documented in the report “Chronicles of Deaths Foretold,” released 19th August, 2016 in Delhi. Like her, most of the women died of heavy bleeding. Either there was no provision of blood in the hospital, or they were asked to pay a hefty sum of Rs 2000-3000 per bottle. By the time families from economically weaker sections arranged for the money, women were dead.

Prepared by the National Alliance for Maternal Health and Human Rights (NAMHHR), the report documents in details the events that led to 139 maternal deaths in seven districts of four states of India – Jharkhand, Odisha, Uttar Pradesh and West Bengal. All these women are from marginalised communities. Study areas like Godda in Jharkhand or Mayurbhanj in Orissa are tribal dominated, Murshidabad and Malda and West Bengal have poor Muslim populations whilst in Azamgarh, Banda and Mirzapur in Uttar Pradesh, most women who died were from either Dalit or OBC or Muslim backgrounds.

The aim of the report was not to look at medical reasons of death – which are usually recorded as heart attacks. The aim was to find causes that led to delays in their treatment that ultimately resulted in their deaths.

The narratives show that women are going to health facilities, but the health facilities are not equipped to handle emergency cases, leading to colossal number of deaths. This situation is different than what existed a decade ago when pregnant women were seen as not seeking services of a health facility.

Lack of blood transfusion facility, disruptive ambulance services, lack of empathy from staff and unavailability of doctors are reversing the trend, as is evident from data on Janani Suraksha Yojana.

According to an analysis by Centre for Budget and Governance Accountability (CBGA), there has been a steep decline in JSY beneficiaries in the last five years. Devi’s home-state saw a decline of as much as 35.4% from 2010-11 to 2014-15. While in 2010-11, JSY was used by 386354 for pregnancy related services, by 2014-15, only 249455 women were using it. Women in other states are also rejecting the model.  In West Bengal, the decrease has been of 37.1%, in Odisha 6.6% and in Uttar Pradesh it has been 0.7%.

Experiences from the field, as captured by the report, show that public health facilities are equipped to deal only with routine check-ups and deliveries. They are unable to manage emergency situations. To begin with, high-risk women are not even picked up by the health system to take care of during delivery. Devi was aneamic and weak. Her weight was lower than required of a pregnant woman. She had delivered five children before. All these were clear signs of her being high risk. But still, not only the health system did not register her as someone who needs special attention, but could not treat her when she reached the district hospital, with meager support from neighbouring primary health centre (PHC)and Community Health Centre (CHC).

Devi died of heavy bleeding. The child had probably died even before reaching the hospital

In another case in UP, a woman was referred to a CHC by the PHC. The nurse at CHC realised that she needed to be taken to District Hospital (DH). But the woman had to wait till next morning for the doctor to arrive for referral to the DH. By the time doctor at CHC arrived, she had died, leaving her unborn child also dead.

“These are common stories in Azamgarh in UP. Government officials keep saying that there are no maternal deaths, but our experience and data show otherwise,” said Rajdev, who conducted the study in Azamgarh, UP. He was speaking at the national consultation organized during the launch of the report.

Health activists and experts showed their frustration saying that things have not moved in the right direction despite presence of so many schemes, programmes and incentives.

“It is the government’s duty to conduct maternal death reviews (MDR). As civil society, we can only tell them “how to,” said Abhijit Das, director, Centre for Health and Social Justice.

The government is not regular in conducting MDR. Even when it does, data is not made public. There is no analysis based on the reviews to improve or change the situation.

“We need to realize that a pregnancy is not a disease. It is something that can be managed and we all know it is simple. Unfortunately, in the lack of political will, saving women has emerged as a big public health issue,” said senior journalist T K Rajalakshmi, who works with fortnightly Frontline.

Jashodhara Dasgupta from Sahayog, the nodal organization which conducted the study, said, “The report is titled such because the formula of institutional delivery has not worked. Women reached the hospital as soon as they realised that they need care, but the hospitals failed them as they were not ready with the required facilities. Thus, scripts of their deaths were written while drafting policy and their deaths were foretold."

The report also shows that Janani Shishu Suraksha Karyakram (JSSK) --  entitlement to free maternal health services -- does not work at the point of delivery. Violations have been reported from every state from where the case studies have been collected. Often women’s families have had to arrange money for ambulance and expected expenses on diagnostics, medicines, supplies and in some cases informal payments, which led to delay in reaching healthcare facilities. For poor families this is catastrophic and discourages them from going to hospitals the next time.

Failure of the health system in providing something as simple as contraceptive services and counseling kept cropping up time and again in all the regions. A 40-year-old woman in Banda district of UP died during her 12th pregnancy. She had 10 live births and went for induced abortion by consuming pills for the 11th time. As the 12th pregnancy was also unwanted, she went for abortion by similar method. The woman consumed five pills without any proper medical advice. She died in less than 24-hours due to heavy bleeding. Despite reaching a public hospital, she could not be saved.

The public health system is clearly not reaching women for guidance on contraceptives. It is then doubly failing them by not providing access to safe abortion services, even after, like in the present case, they have previous record of abortions. The State’s neglect is responsible for innumerable deaths and morbidity. Behavioural issues of healthcare staff in public health facilities were faced by majority of families interviewed. Coming from marginalized backgrounds, they are not treated as equals by the government staff and this discouraged many women from seeking care in public health facilities.

September 21, 2016

New Delhi, Sep 16 2016
A national alliance of organisations working on maternal health rights today called for setting up of an independent monitoring commission to look at the audits and reports that are commissioned by the government to review its family planning programme.  An oversight body of parliamentarians, women's rights organisations and academicians needs to be constituted immediately, said Jashodhara Dasgupta of HealthWatch Forum U.P, adding that such measures would support Wednesday's landmark Supreme Court order in the case of Devika Biswas vs Union of India and others (Writ petition (Civil) No.95 of 2012), that ruled against mass sterilisation camps and called for greater transparency in the family planning programme. Dasgupta said, speaking at a press conference organised in New Delhi today by the National Alliance for Maternal Health and Human Rights (NAMHHR) and HRLN through whom the petition had been filed, activists from across the country and public health experts welcomed the judgement as an important step towards reproductive health justice for women in India.

Petitioner Devika Biswas  appreciated the order acknowledging the government’s failure  opining at the same time that mass sterilisation camps should be stopped immediately rather than being given a buffer period of three years. She felt government accountability needed to be emphasised through ensuring redressal and compensation for the women who had suffered, which was currently lacking.  "Civil society and media now need to vigilantly monitor the implementation of the SC order by informing communities that the practice is soon to be banned," said Biswas.

"Government accountability needed to be emphasised through ensuring redressal and compensation for the women who had suffered, which was currently lacking.  "Civil society and media now need to vigilantly monitor the implementation of the SC order by informing communities that the practice is soon to be banned."          - DEVIKA BISWAS

Kavita Krishnan, Secretary AIPWA expressed concern at the press conference that the issue was still being framed as  a population control problem rather than a question of reproductive justice for all women. She emphasized,"The question is not about which is the next best technological fix in contraception but about what actions will empower women to gain control over their bodies, and encourage men to take responsibility for contraception."

Described as the single largest operation ever to take place anywhere in the world, equivalent only to the cataract eye surgeries, about 4-5 million women in India undergo sterilisations each year, and the estimate is that close to 1000 women die every year due to the appalling conditions in which sterilisations are carried out by public health system.“The family planning program in India adopted a mass surgery approach in the 1970’s in Ernakulam, Kerala, where men underwent vasectomy by the hundreds. This same approach was applied, however, to the more complicated procedure of female sterilization which involved an abdominal operation, a grossly inappropriate move in hindsight,” said  Abhijit Das, Convener of  NAMHHR.

Sanjai Sharma of HRLN recounted the long struggle of over two decades to highlight concerns about quality of care in sterilization camps. Specifically he referred to the Ramakant Rai v Union of India case, which the present judgment refers to and expressed surprise that the Supreme Court orders in that case from 2005 have not been implemented as yet on the ground.

Ajay Lal of the Maternal Health Rights Campaign in Madhya Pradesh spoke about the  conditions prevailing insterilization camps in the state. He related observations from 28 camps in 12 districts of M.P in 2016, describing that even now camps were  being held in unsanitary conditions in dharamshalas and schools apart from public health centres, and cycle pumps were being used to pump air into the abdomen, a gross violation of standard operating procedures. Rajdev Chaturvedi  from Healthwatch, Uttar Pradesh who is also a member of the quality assurance committee (QAC) in the district of Azamgarh, said that the committee was constituted three years ago but no meeting has been held. He also spoke of emerging issues related to family planning, especially that of fraudulent records of post-partum IUCDs and stealth insertion of IUCDs without women’s knowledge after delivery. From Chhattisgarh Dr Yogesh Jain  ofJan Swasthya Sahayog provided his observations following the Bilaspur incident where 13 women died after sterilization operations in 2014. He mentioned that the Anita Jha commission report which inquired into the matter had not inspired any confidence as it merely shifted the blame onto an external party – the drug manufacturer – even though evidence pointed to the contrary. In response to the case, the public health facilities had altogether stopped conducting sterilization camps and now women who needed the procedure had to go to neighbouring states or pay a private provider to avail of these services. This is an unintended consequence of the issue and ultimately ends up harming women.

The press conference ended with a call to use this judgment as an impetus to launch a larger public movement against  the 'violation of women's bodily rights' by  highlighting  concerns around the implementation of the family planning program with regard to quality of care and informed choice and maintaining pressure on the government for greater accountability.

August 11, 2016

Abortion- A question of human rights

We are a group of persons from across the country working with women over several decades around issues of their rights and health. In response to the article, “A tricky debate on abortion” (Aug. 3, 2016), we would like to contest from the perspective of women’s rights the arguments made by the author. 
Worldwide, it is estimated that 46 million women seek abortion every year and the World Health Organisation estimates that close to half of these happen in unsafe conditions. In India, around 20 million women seek to terminate an unwanted pregnancy every year. Even today, due to the stigma around women’s sexuality and abortion itself, a woman dies every two hours of an unsafe abortion. What makes this statistic even more tragic is that in our country, as the article points out, we have had a law permitting abortion access under certain conditions since 1971; however, this has not ensured widespread access to safe abortion services.
Right to bodily integrity

This is one of the reasons that over the last three decades, international human rights bodies, including those of the UN, have paid attention to the issue of abortion and have called upon states to remove barriers to access to safe abortion. Internationally accepted human rights law supports the right to choose whether to continue a pregnancy or not within the framework of the right to life, right to health, and right to autonomy and bodily integrity. There is enough evidence that non-availability of safe abortion kills — where abortion laws are not restrictive, morbidity and mortality due to unsafe abortion are much lower. 
A woman’s decision to terminate a pregnancy is not a frivolous one. Abortion is often the only way out of a very difficult situation — pregnancy resulting from coerced or non-consensual sex, ignorance that pregnancy may result even from the first sexual intercourse, inability to use a method of contraception due to a husband’s (or other’s) objection, fear of side effects, not receiving information and counselling at the appropriate time, wrong use of methods, discontinuities in use because of various reasons including not receiving supplies regularly, and, of course, method failure. An abortion is a carefully considered decision taken by a woman who fears that the welfare of the children she already has, and of other members of the household that she is obliged to care for with limited financial and other resources, may be compromised by the birth of another child. These are decisions taken by responsible women who have few other options; they are women who would ideally have preferred to prevent an unwanted pregnancy, but are unable to do so. We have reported this in the many studies published by us. And if the pregnancy was the result of sexual violence and the woman does not want to continue with the pregnancy, then forcing her to do so represents a violation of the woman’s bodily integrity and aggravates her mental trauma, impeding her healing and recovery from violence. 
The question of ethics
The article refers to “strong ethical objections to abortion per se”. It is worth mentioning here that abortion is permitted for social or economic reasons in 80 per cent of developed countries, as compared with only 16 per cent of developing countries. According to international human rights law, a person is vested with human rights only at birth; an unborn foetus is not an entity with human rights. The ethical issues here are not just of the rights of the foetus. The foetus is not an independent entity and depends completely on the welfare of the woman. Without her well-being, one cannot talk about the well-being of the foetus. We also need to consider the fact that the woman herself is a living human being in the here and now — the pregnancy takes place within her body and has profound effects on her health, mental well-being and life. Thus, how she wants to deal with this pregnancy must be a decision she and she alone can make. 
The article also juxtaposes women’s choice to continue or terminate a pregnancy with the right of a disabled person to live. We would like to present the grim reality that adult women and young girls face when they are pregnant against their wishes or when a wanted pregnancy can become difficult to continue if the foetus is diagnosed as having serious abnormalities. The state does not offer any special relief for parents of disabled children and the entire burden of medical care, education, daily care and future security falls on the individuals alone. It is also not true that most serious foetal abnormalities can be diagnosed before 20 weeks — abortion for serious foetal anomaly often is needed after 20 weeks as tests are mostly done at 18 weeks and results can take three or more weeks. 
We would like to state that upholding the rights of the disabled does not conflict with upholding women’s reproductive rights. Many disability rights activists are pro-abortion rights and those who uphold reproductive rights are also supportive of the rights of persons with disability to make reproductive choices, to not have to face coerced sterilisation and/or abortion. 
A basic right

Perhaps the time has come for us to discuss whether women in India are indeed equal citizens and whether the right to control their own body and fertility and motherhood choices are primary to their empowerment. The judiciary and lawmakers need to maintain a secular outlook and strive to ensure that the women citizens of this country have equal citizenship rights in consonance with the Constitution and with accepted international covenants on human rights. These include a right to life for the woman, as also a right to dignity and a right to benefit from scientific progress. Religion and other traditional frameworks are inherently imbued with patriarchy and cannot be used by a secular state to direct its laws and policies. 
Let us not lose sight of the basic right of women: the right to autonomy and to decide what to do with their own bodies, including whether or not to get pregnant and stay pregnant. 
Suchitra Dalvie, Sundari Ravindran, Subha Sri B., Renu Khanna (CommonHealth); Jashodhara Dasgupta (National Alliance for Maternal Health and Human Rights); Sana Contractor (Centre for Health and Social Justice); Rupsa Mallik (CREA); Padma Deosthali (CEHAT); Sarojini N., Deepa V. (SAMA).

The rebuttal appeared in the hindu

March 07, 2016

An Open Letter to the Prime Minister of India on the occasion of 107th International Women’s Day, 8 March 2016

Hon’ble Prime Minister,

We, the undersigned women’s organizations and other concerned groups, convey our greetings on the occasion of 8th March, Women’s Day. This day has been celebrated for more than a hundred years to commemorate the women’s movement’s struggles for equality, justice and peace across almost all countries of the world.

On this memorable occasion, we are aware that you and your colleagues will be making speeches and statements to indicate how much this nation values the contribution of its women to the country’s progress. We expect that many will praise women as mothers, caring family members and hard workers; we hope some will acknowledge the diverse struggles of women everywhere in securing freedom from violence and ensuring peace.

We appreciate your earlier efforts to promote the value of daughters and encourage education for the girl child. We therefore look forward to more announcements from you this year that will indicate just how much this nation, and your government, shows appreciation for the women of this country. We would especially like to draw your attention to women’s work that produces food, goods, services, and care for the household as well as children who will be the future workforce of India; yet women’s care work continues to remain invisible, unsupported and unshared. You must have noticed how everywhere women work simultaneously in fields, forests, water bodies, and at home; providing water, fuel, fodder, cooking, cleaning, caring of children, sick, elderly, yet they are often unpaid and sometimes get much lesser wages than men on farms, work sites, factories, and markets. In fact unpaid care and household work by women, even though it is ten times as much as men, remains unrecognized and unaccounted for in the System of National Accounts (SNA).

The McKinsey report (The Power of Parity, 2015) points out how the gender gap in employment is exacerbated by unfair conditions for working women who become pregnant. In India 95% women workers are in the informal and unorganized sector and do not receive any wage compensation during pregnancy and after childbirth, although we expect them to rest, gain weight, improve their own health and then provide the baby with exclusive breastfeeding for six months. The Economic Survey of India 2016 (Ministry of Finance, Government of India) points out that ‘42.2% Indian women begin pregnancy too thin and do not gain enough weight during pregnancy’ and recommends that ‘some of the highest economic returns to public investment in human capital in India lie in maternal and early life health and nutrition interventions.’

Sir, on the occasion of Women’s Day we would earnestly request you to announce some substantial entitlements for women that would show very tangibly how much this country values women’s contribution to society and their families: as workers, as mothers and as valuable members of communities.
      I.        At the very least, we expect your leadership in immediate implementation of the National Food Security Act 2013, within which:
a.    The Central Scheme for Maternity Entitlements should immediately be up-scaled from its pilot phase into at least 200 high-priority districts especially including those with a larger proportion of tribal (ST) population. The universal guarantee of at least Rs. 6000/- is only to be read as a beginning, and it should subsequently be rationalised as wage compensation.
b.    Maternity entitlements in all sectors must be universal and unconditional, and not linked to the number of children or age of the woman, as that is fundamentally discriminatory to both women and children.
c.    Supplementary nutrition through locally prepared foods – preferably hot cooked meals to be supplied to all pregnant and lactating women at the local Angawadicentre. The money invested for such a meal is highly inadequate currently under the ICDS program, leading to poor quality and quantity of the supplementary nutrition
d.    The public distribution system must provide universal access to 10 kgs of cereals, I kg of pulses and 1 kg of oil rations under the NFSA.
     II.        We also hope within a short time to see:
a.    The progressive realisation of nine months of maternity leave (three months before childbirth to six months after) with full compensation of wages for all women, calculated at least according to minimum wages at prevalent rates. This revision of the Maternity Benefits Act (1961) should recognise women’s work in all spheres, markets, domestic, for care and reproduction and subsistence; and guarantee maternity entitlements to all pregnant women, adoptive parent(s), surrogate mothers etc without discrimination.
b.    Large scale campaigns that call upon men to increase their contribution to care work and domestic chores, and reduce the burden on women.
c.    Creche and breastfeeding facilities at every work place and community (through Anganwadi-cum-creches) to be made mandatory to ensure women can continue to work and care for the infant.
d.    Financial resources for maternity entitlements and crèches should come from all economic activities in the country  as a state obligation to ensure entitlements and services, since reproduction is a social function which benefits the family, society and the nation
 Sir, on the occasion of Women’s Day, while paying compliments and appreciating the role of women, we are sure the government would want to change the embarrassingly inadequate allocation of 400 crores for Maternity Entitlements against the requirement of 15000 crore annually.  We urge you to translate rhetoric into action by allocating resources for social security in maternity, and acknowledging unpaid reproductive work done by women in this country, even as you greet them on this Women’s Day.
Dipa Sinha, Sejal Dand, Jashodhara Dasgupta and Sudeshna Sengupta
 On behalf of
  • Right to Food Campaign, India, 
  • National Alliance for Maternal Health and Human Rights (NAMHHR),
  • Working Group for Children under Six, 
  • Alliance for Right to Early Childhood Development
Jashodhara Dasgupta: 9910203477
Sejal Dand: 08130200062
Dipa Sinha: 9650434777
Sudeshna  Sengupta: 9811065400
Also endorsed by the following 135 organizations and individuals from across India:

  1. Abha Bhaiya, JAGORI Rural, HP
  2. Adarsh Sharma, Former Director, NIPCCD
  6. AMAN BIRADARI, Gujarat
  7. ANANDI, Area Networking And Development Initiatives Gujarat 
  8. Anjali Bopat, SWADHAR, Maharashtra
  10. Anubha Rajesh, ICFI
  11. Asha Singh, Lady Irwin College
  12. Ashalatha- MAKAAM Mahila Kisan Adhikar Manch, 
  14. Arundhati Dhuru and Suhas Kolhekar NATIONAL ALLIANCE FOR PEOPLE’S MOVEMENTS
  15. Bharat Randive, researcher
  16. Bharti Kumar& Sophy Joseph, National Law University, Delhi
  17. Bimla Chandrasekhar, EKTA RESOURCE CENTRE FOR WOMEN, Madurai
  18. Biswa Ranjan Patnaik, CARE India
  20. Chandan Kumar, ACTION AID India
  21. Chhaya Pachauli and Narendra Gupta, PRAYAS
  22. Chinu Srinivasan LOCOST
  23. Chirashree Ghosh, DELHI FORUM For Crèches And Childcare Services, NEENV
  24. Devaki Nambiar, Public Health Researcher, New Delhi
  26. Devika Singh, Zakiya Kurien, Nikita Agarwal, ALLIANCE FOR RIGHT TO ECD
  27. Dr. Kavita Bhatia, Independent researcher 
  28. Dr. Mohan Rao, Professor, CSMCH JNU Delhi
  30. Gabriel Dietrich Pennurimai Iyakkam
  31. Geeta Menon & others, STREE JAGRUTI SAMITI 
  34. HEALTHWATCH FORUM Uttar Pradesh
  35. Hema Srinivas
  36. Imrana Qadeer ex Professor JNU Delhi
  37. Inayat Singh Kakar, Research Associate TISS, Mumbai
  40. Isfaqur Rahaman,  ELLORA VIGYAN MANCHA, Guwahati, Assam
  43. Jahnvi Andharia, Neeta Hardikar, ANANDI, Gujarat
  44. Jameela Nashid
  45. Jameela Nishat
  48. Jayashree Satpute, NAZDEEK, Assam
  49. Jigisha Shastri
  50. Juhi Jain
  51. Kavita Bhatia, independent researcher
  52. Kavita  Kuruganti, ASHA
  53. Kavita Panjabi, Professor, Jadavpur University.
  56. Lakshmi LIngan, TISS Mumbai
  57. Lakshmi Menon
  58. Lalita Ramdas, Alibag, Raigad, Maharashtra
  59. Mahesh Pandya, PARYAVARAN MITRA , Gujarat
  61. Mandavi Jaykar, Jindal Global Law School
  62. Manisha Gupte, Women's Health Rights Activist, Pune
  63. Manmohan Sharma, VOLUNTARY HEALTH ASSOCIATION, Punjab, Chandigarh
  65. Mohan Rao, Professor CSM-CH JNU
  66. Moumita Biswas, ALL INDIA COUNCIL OF CHRISTIAN WOMEN, National Council of Churches in India
  67. Mridul Eapen, CENTRE FOR DEVELOPMENT STUDIES, Trivandrum
  68. Mridula Bajaj, Amrita Jain and Sonia Sharma, MOBILE CRECHES
  69. Mujaheed Nafees, SHALA MITRA SANGH, Gujarat
  70. Nasim Ansari, TARUN CHETNA, Pratapgarh UP
  71. Neeru Chaudhury, CHILDREACH India 
  72. Nina P Nayak, Bangalore
  73. Niranjan Aradhya, CENTRE FOR CHILD AND LAW, National Law School of India University, Bangalore
  74. Padma Bhate-Deosthali, Mumbai
  75. Padmini Swaminathan, TISS, Hyderabad
  76. Pallavi Gupta, Public Health Practitioner Delhi
  77. Pallavi Sobti Rajpal, UTTHAN, Gujarat
  79. Poonam Kathuria SWATI Gujarat
  80. Prasad Chacko, HDRC St. Xavier’s College, Gujarat
  81. Preeti Darooka, PWESCR Programme on Women’s Economic, Social and Cultural Rights
  82. R. Padmini, CHILD RIGHTS TRUST, Bangalore
  83. R. Srivatsan, ANVESHI Research Centre for Women's Studies, Hyderabad
  84. Radha Holla Bhar, New Delhi
  85. Radhika Desai,  Feminist Scholar and Independent Researcher, Hyderabad 
  86. Rahul Purkayastha, Centre of MEDICAL & SALES REPRESENTATIVES UNION (North East Region)
  87. Rajalakshmi RamPrakash, Independent Researcher, Chennai
  88. Rajni Palriwala, Professor of Sociology, Delhi University 
  89. Rakhi Sehgal, Hero Honda Theka Mazdoor Sangathan/NEW TRADE UNION INITIATIVE
  90. Raman VR, Public Health Practitioner, New Delhi
  91. Ravi Duggal, Health Researcher and Activist, Mumbai
  93. Rekha Sharma Sen, IGNOU
  94. Renu Khanna SAHAJ Vadodara
  95. Ridhi Sethi, Researcher  
  96. Rohit Prajapati Activist
  98. Rukmini Rao, GRAMYA Resource Centre
  99. Sachin Kr. Jain, VIKAS SAMVAD, Madhya Pradesh
  100. Sadhna Arya, University of Delhi
  102. SAMA Women’s Health organization, Delhi
  103. SAMYAK Pune
  104. Sandipan Paul, Freelance Consultant, ECCE
  105. Sandhya YK SAHAYOG
  106. Sanjib Sikdar, DESHABANDHU CLUB, Cachar, Assam
  107. Santosh Mahindrakar, Research Scholar JNU
  108. Sarojini N.B., New Delhi
  109. SATHI, Pune
  110. Satish Kumar Singh, MENENGAGE New Delhi
  111. Satnam Singh, JSA Haryana
  113. Seema Kulkarni- SOPPECOM 
  114. Shakeel, CHARM, Bihar
  115. Sheila Devaraj, APSA
  116. Shewli, TISS Mumbai
  117. Shishir Chandra, MASVAW. UP 
  118. Shraddha Chickerur, Doctoral Candidate, University of Hyderabad
  119. Soma KP, Collective for Advancement of Womens Land and Livelihoods Rights 
  120. Soumik Bannerjee, Jharkhand
  122. Sukriti Gangola, IPE Global
  124. Suneeta Dhar, New Delhi. 
  125. Suroor Mander , Advocate
  126. Susana Barria, Public Services International (PSI) India affiliates
  127. Susie Tharu, Hyderabad
  128. SWAYAM, Kolkata
  129. Trupti Shah SAHIYAR Gujarat
  130. Uma V Chandru, CHET (Centre For Health Ecologies And Technology) Bangalore
  131. Usha Abrol, KGNMT, Karnataka
  132. Usha Rani K, APD India
  133. Usha Seethalakshmi
  134. Vasudeva Sharma, CHILD RIGHTS TRUST
  135. Vasudha Iyengar
  136. Veena Poonacha
  137. Veena Shatrugna, ex-Dy. Director, National Institute of Nutrition
  138. Venita Kaul, CECED Centre For Early Childhood Education And Development
  139. Vimala Ramakrishnan, New Delhi
  141. Yogesh Jain, JAN SWASTHYA SAHYOG, Chhattisgarh
  142. Yogesh Kumar, SAMARTHAN- Centre for Development Support, Bhopal