From the Field to the Judge’s Bench Published by Human Rights Law Network(HRLN), a division of Socio Legal Information Centre(SLIC). For more details about our works, visit us at http://hrln.org

1.
From
the
Field
to
the
Judge’s
Bench:
Developing
Litigation
Strategies
to
Improve
the
Lives
of
Women
24th
–
25th
November
2012
Assam
Association
A-­‐14
B
Qutab
Institutional
Area,
New
Delhi
IN
COLLABORATION
WITH
HEALTHWATCH
FORUM
–
BIHAR
INITIATIVE
FOR
HEALTH
AND
EQUITY
IN
SOCIETY
WOMEN’S
ASSOCIATION
MARCHING
AHEAD
MANASI
SWASTHYA
SANSTHAN
ALL
INDIA
DRUG
ACTIONNETWORK
JANADHIKAR
MANCH
-­‐
BIHAR

2.
From
the
Field
to
the
Judge’s
Bench:
Developing
Litigation
Strategies
to
Improve
the
Lives
of
Women
IN
COLLABORATION
WITH
HEALTHWATCH
FORUM
–
BIHAR
INITIATIVE
FOR
HEALTH
AND
EQUITY
IN
SOCIETY
WOMEN’S
ASSOCIATION
MARCHING
AHEAD
MANASI
SWASTHYA
SANSTHAN
ALL
INDIA
DRUG
ACTIONNETWORK
JANADHIKAR
MANCH
-­‐
BIHAR

3. Human
Rights
Law
Network’s
Vision
•
To
protect
fundamental
human
rights,
increase
access
to
basic
resources
for
marginalized
communities,
and
eliminate
discrimination.
•
To
create
a
justice
delivery
system
that
is
accessible,
accountable,
transparent,
efficient,
affordable,
and
works
for
the
underprivileged.
•
To
raise
the
level
of
pro-­‐bono
legal
experience
for
the
poor
to
make
the
work
uniformly
competent
as
well
as
compassionate.
•
To
professionally
train
a
new
generation
of
public
interest
lawyers
and
paralegals
to
be
comfortable
in
the
world
of
law
as
well
as
in
social
movements
and
to
learn
from
such
movements
to
refine
legal
concepts
and
strategies.
FROM
THE
FIELD
TO
THE
JUDGE’S
BENCH:
DEVELOPING
LITIGATION
STRATEGIES
TO
IMPROVE
THE
LIVES
OF
WOMEN
January
2013
©
Socio
Legal
Information
Centre*
Editor:
Kerry
McBroom
Coordinator:
Karla
Torres
Printed
at:
Rudra
Printers,
181,
First
Floor,
Bapu
Park,
Kotla
Mubarakpur,
New
Delhi
–
110003.
Published
by:
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Rights
Law
Network
(HRLN)
A
division
of
Socio
Legal
Information
Centre
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Road,
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Delhi
–
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India
Ph:
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Human
Rights
Law
Network.

4. Table
of
Contents
Introduction……………………………………………………………………………………………………………………………...1
Welcome
Address……………………………………………………………………………………………………………………...2
Access
to
Sexual
Health
Education:
Helping
Youth
Exercise
their
Rights………………………………………3
National
Entitlements:
There
is
No
Benefit
if
There
is
No
Implementation…………………………………...6
Access
to
Contraception:
Supporting
Women
to
Achieve
the
Highest
Standard
of
Sexual
and
Reproductive
Health………………………………………………………………………………………………………………..11
Skilled
Birth
Attendants
in
the
Field:
How
a
Shortage
in
Human
Resources
and
Training
Jeopardizes
Women’s
Maternal
Health……………………………………………………………………………………..16
Child
Marriage:
Protecting
the
Rights
and
Lives
of
India’s
Children……………………………………………18
Hysterectomies:
Insurance
Fraud
and
Reproductive
Rights………………………………………………………23
Status
of
Family
Planning
in
India………………………………………..........................................................................27
Experiences
from
the
Field:
Francis
Elliot’s
Personal
Recount………………………………………………......29
Devika
Biswas
vs.
Union
of
India
and
Ors.:
Female
Sterilization
in
India………………………………………30
Female
Sterilization
in
India:
A
State
by
State
Recount
from
Uttar
Pradesh,
Rajsathan,
Odisha,
Madhya
Pradesh,
and
New
Delhi…………………………….………………………………………………………………..34
List
of
Participants………………………………………………………………………………………………………………......47

5. Introduction
Over
two
days,
activists
and
advocates
gathered
to
discuss
some
of
the
most
pressing
reproductive
rights
issues
in
India.
Activist
presented
on
a
wide
range
of
topics
ranging
from
child
marriage
to
sexual
health
education
to
female
sterilization
all
with
the
aim
to
determine
how
these
reproductive
rights
violations
can
be
advanced
through
public
interest
interventions.
Our
purpose
was
to
bring
grassroots
level
activists,
policy
experts,
and
advocates
together
to
bridge
the
gap
between
activists
in
the
field
and
advocates
in
the
courtroom.
In
this
way,
together,
we
can
promote
reproductive
rights
as
human
rights.
Reproductive
rights
violations
in
India
are
fomented
and
compounded
by
cultural,
religious,
and
societal
contexts.
Any
approach
to
address
reproductive
rights
violations
in
India
must
be
committed,
crosscutting,
and
collaborative.
There
is
no
silver
bullet
to
right
these
wrongs,
just
like
there
is
also
no
panacean,
hierarchical,
or
methodical
method
of
bringing
an
end
to
them
either.
Instead,
a
comprehensive,
multi-­‐faceted
approach
to
advocacy
is
necessary.
This
approach
must
embrace
field
level
activism
and
litigation,
policy
advocacy
and
demonstrations;
all
efforts
undertaken
as
pieces
of
a
bigger,
cohesive,
picture
to
eradicate
the
ills
of
rampant
reproductive
rights
violations.
Reproductive
Rights
in
India
The
1994
Cairo
International
Conference
on
Population
and
Development
(ICPD)
defines
reproductive
rights
as
follows:
Reproductive
Rights
rest
on
the
recognition
of
the
basic
right
of
all
couples
and
individuals
to
decide
freely
and
responsibly
the
number,
spacing
and
timing
of
their
children
and
to
have
the
information
and
means
to
do
so,
and
the
right
to
attain
the
highest
standard
of
sexual
and
reproductive
health.
They
also
include
the
right
of
all
to
make
decisions
concerning
reproduction
free
of
discrimination,
coercion
and
violence.1
In
India
today,
women
young
and
old
are
victims
of
one
of
the
highest
maternal
mortality
rates
in
the
world,
coercive
population
control
policies,
forced
sterilization,
a
lack
of
comprehensive
sexual
health
education,
limited
information
regarding
contraception,
inadequate
access
to
contraception,
and
persistent
child
marriages.
All
of
these
issues
continue
compromising
the
lives
of
millions
of
women,
female
adolescents,
and
girl
children
in
violation
of
their
reproductive
rights.
The
following
paragraphs
provide
a
short
background
on
each
reproductive
rights
issue
discussed
during
our
National
Consultation.
Following
each
issue
is
a
summary
of
the
information
presented
and
the
recommended
ways
forward.
1
Chapter
VII,
Reproductive
Rights
and
Reproductive
Health,
International
Conference
on
Population
and
1

6. Welcome
Address
Sonali
Regmi,
Center
for
Reproductive
Rights
(CRR)
Ms.
Regmi
presented
on
the
work
of
her
organization,
the
CRR.
The
CRR
is
an
international
NGO
based
in
the
United
States,
which
has
been
working
on
reproductive
rights
for
20
years.
The
organization
recently
opened
regional
offices
in
Latin
America,
Africa,
Europe,
and
Asia.
Ms.
Regmi
is
based
at
the
Asian
regional
office,
which
is
based
in
Kathmandu.
Ms.
Regmi
began
her
presentation
by
stating
that
as
reproductive
rights
are
not
fully
recognized
as
human
rights,
the
CRR
works
to
connect
reproductive
rights
to
the
larger
human
rights
framework.
She
told
the
participants
that
there
is
a
clear
link
to
the
right
to
life
and
the
right
to
health
but
that
reproductive
rights
also
engage
a
myriad
of
other
rights.
She
also
stated
that
reproductive
rights
are
inherently
connected
to
women’s
rights
and
that
the
CRR
uses
international
standards
such
as
the
ICPD
and
the
Beijing
Declaration
to
promote
women’s
rights
in
the
area
of
reproductive
health
law.
Ms.
Regmi
told
the
participants
that
the
CRR
focuses
on
reducing
maternal
mortality,
increasing
access
to
contraception,
improving
access
to
safe
and
affordable
abortions,
and,
more
recently,
preventing
harmful
traditional
practices
including
child
marriage.
Ms
Regmi
shared
that
the
CRR
is
now
focusing
on
child
marriage,
as
there
is
a
link
between
this
practice
and
maternal
deaths.
She
told
the
participants
that
CRR
felt
it
was
essential
to
begin
working
against
child
marriage,
as
when
people
are
married
at
a
young
age,
they
generally
do
not
know
their
rights.
This
means
that
young
married
people
often
have
limited
access
to
contraception
and
are
unaware
of
their
right
to
decide
on
number
and
spacing
of
children
which
in
turn
leads
to
greater
maternal
mortality.
The
strategies
employed
by
the
CRR
include
litigation,
amicus
briefs,
and
advocacy
before
treaty
committees.
The
CRR
focuses
on
advocacy
at
both
a
national
and
international
level
by
taking
litigation
to
national
courts
but
also
appalling
to
international
treaty
monitoring
bodies
which
offer
an
extra
forum
if
domestic
remedies
fail
to
create
change.
Ms.
Regmi
told
the
participants
that
the
CRR
also
works
on
policy
reforms
and
initiatives
where
lacunas
exist
in
reproductive
rights.
Finally,
Ms.
Regmi
shared
that
the
CRR
also
conducts
training
for
lawyers
and
judges
to
sensitize
them
to
reproductive
rights
issues
and
the
human
rights
framework.
She
told
the
participants
that
training
helps
ensure
more
comprehensive
and
supportive
orders
from
the
courts.
She
stated
that
they
have
spent
ten
years
working
with
judges
in
Nepal,
which
has
led
to
good
judgments,
such
as
the
2009
Lakshmi
judgment.
This
case
concerned
a
women
who
was
pregnant
for
the
fifth
time
and
who
wanted
an
abortion.
Abortion
is
legal
in
Nepal
but
the
women
and
her
husband
could
not
afford
the
1,200
rupees
that
they
were
quoted
at
the
public
hospital
for
the
procedure.
She
therefore
had
to
continue
her
pregnancy
against
her
will.
In
their
judgment,
the
court
utilized
a
reproductive
rights
framework
and
held
that
access
to
abortion
was
a
constitutional
right
and
directed
that
the
government
formulate
a
separate,
rights
based
law
for
abortion.
Ms.
Regmi
highlighted
that
this
was
a
very
good
judgment,
but
stated
that
implementation
was
poor
and
that
no
law
had
so
far
been
created.
In
order
to
combat
this,
the
CRR
had
begun
working
with
national
human
rights
institutions
in
order
to
ensure
implementation
of
judgments.
In
this
case
Ms.
Regmi
stated
that
the
CRR
was
working
with
the
National
Women’s
Commission
in
Nepal
to
produce
a
draft
bill.
She
shared
that
working
with
such
groups
can
often
make
it
easier
to
get
the
legislation
through
for
enactment.
2

7. Access
to
Sexual
Health
Education
Background
Information
In
its
report
on
adolescent
and
youth
development
for
the
formulation
of
India’s
12th
Five
Year
Plan,
the
Working
Group
on
Adolescents
and
Youth
Development
listed
the
following
as
one
of
its
objectives:
“g)
Facilitate
access
to
all
sections
of
youth
to
basic
nutrition
and
health
especially
related
to
reproductive
and
sexual
health
information
and
facilities
and
services
…”2
This
is
a
not
a
new
sentiment.
The
Working
Group
for
the
11th
Five
Year
Plan
made
a
similar
recommendation
and
stressed
that
a
lack
of
information
on
sexual
and
reproductive
health
leads
to
early
and
unwanted
pregnancies,
the
spread
of
HIV,
sexually
transmitted
infections
(STIs),
and
Reproductive
Tract
Infections
(RTIs).
The
Working
Group
noted
that
although
“adolescents
want
sexuality
education,”
there
is
“resistance
from
adults
in
the
family
and
community,”
adding
that
even
teachers
“feel
inhibited
to
discuss
issues
related
to
sexuality
and
reproductive
health.”3
The
Ministry
of
Human
Resource
Development
in
collaboration
with
the
National
AIDS
Control
Organization
developed
the
Adolescent
Education
Programme
(AEP),
a
sexual
health
education
curriculum.
Although
the
drafters
envisioned
AEP
as
a
nation-­‐wide
curriculum,
several
states
including
Rajasthan,
Chhattisgarh,
Madhya
Pradesh,
and
Uttar
Pradesh
have
rejected
the
AEP
curriculum
arguing
that
it
leads
to
devious
and
harmful
sexual
activities.
In
addition
to
being
banned
in
several
states,
several
important
NGOs
criticized
the
AEP
for
being
out
of
touch
with
the
youth
of
today.
The
AEP
suffered
from
serious
flaws
and
focused
on
“abstinence
only
until
marriage,”
as
a
means
of
avoiding
unplanned/early
pregnancies,
HIV,
RTIs,
and
STIs.
An
improved,
comprehensive,
sexual
health
education
is
essential
to
preventing
early/unplanned
pregnancies,
the
spread
of
HIV,
RTIs,
STDs,
and
to
ensuring
that
women
achieve
the
highest
standard
of
sexual
and
reproductive
health.
Legal
advocacy
to
pressure
the
Government
to
a)
work
with
NGOs
on
developing
a
new
and
improved
curriculum
and
b)
implementing
it
on
a
national
scale
can
be
effective
and
will
improve
the
lives
of
women
in
India.
Information
Presented
Gopika
Bashi,
The
YP
Foundation
(TYPF)
Representing
TYPF,
Projects
Manager
Ms.
Gopika
Bashi
presented
on
TYPF’s
work
and
aims.
TYPF
is
a
youth-­‐run
and
led
organization
with
partnerships
in
18
Indian
states.
TYPF
works
to
promote,
protect,
and
advance
young
people’s
health
and
human
rights
through
youth-­‐led
leadership
building,
strengthening,
and
initiatives.
Their
target
age
groups
are
5-­‐9,
10-­‐14,
15-­‐19,
and
20-­‐25
(following
the
United
Nations
definition
of
youth).
TYPF
focuses
on
working
with
young
people
both
in
and
out
of
school
and
collaborates
with
young
people
from
lower
income
communities
and
youth
from
the
disabled,
LGBT,
children
of
sex
workers,
living
with
HIV,
and
who
have
been
orphaned,
abandoned
or
live
in
government
care.
2
Report
of
Working
Group
on
Adolescents
and
Youth
Development,
Dept.
Of
Youth
Affairs,
M/o
YA&S
for
Formulation
of
the
12th
Five
Year
Plan
(2012-­‐2017),
Ministry
of
Youth
Affairs
&
Sports,
2011,
p.
68.
3
Draft
Final
Report
of
the
Working
Group
on
Youth
Affairs
and
Adolescents’
Development
for
Formulation
of
11th
Five
Year
Plan
(2007-­‐2012),
p.
12.
3

8. Promoting
Artist Rights &
Livelihood
Opportunities
Mental Health
and Substance
Abuse
prevention.
Digital Media,
IT and
Learning
Young People
working with
their
Communities
Education
Sexual and
Reproductive
Health and
Rights
(Life Schools &
Formal Education) &
Health
(Hygiene &
Sanitation)
Governance &
Democracy
(RTE & RTI)
Ms.
Bashi
noted
the
lack
of
knowledge
on
how
to
involve
young
people
in
policy
making
and
national
programmes
and
sees
a
need
to
create
safe
spaces
for
young
people
to
communicate
directly
with
decision
makers.
To
strengthen
youth
leadership,
TYPF
engages
youth
in
a
constant
dialogue
on
issues
including
child
marriage,
unsafe
abortion,
gender
discrimination,
HIV/AIDS,
and
a
lack
of
youth-­‐friendly
health
services.
TYPF’s
programme
objectives
between
2011-­‐2013
include
increasing
young
people’s
understanding
and
awareness
of
their
Sexual
and
Reproductive
Health
Rights
(SRHR),
advocating
for
the
implementation
of
comprehensive
sexual
education
(CSE)
in
Uttar
Pradesh,
National
Capital
Region,
and
Maharashtra,
and
mentoring
50
youth
leaders
to
enable
the
implementation
of
CSE
at
the
district
level.
To
this
end,
partnership
is
vital
to
the
campaign’s
successful
implementation.
Ms.
Bashi’s
presentation
also
highlighted
the
youth
friendly
monitoring
and
evaluation
framework
that
TYPF
employs.
Additionally,
Ms.
Bashi
shared
several
complimentary
policy
responses
to
TYPF’s
approach
to
CSE
promotion.
These
have
included
structuring
the
HIV
Prevention
for
Youth
and
Adolescents
Programme,
serving
on
UNESCOs
Global
Advisory
Group
for
Sexuality
Education,
producing
data
that
is
being
used
in
a
pilot
to
strengthen
school
mechanisms
and
train
teachers
in
12
zones
of
Delhi,
and
creating
adolescent
strategies
to
ensure
CSE
for
out
of
school
youth
in
UNFPA’s
Country
Programme
8.
TYPF
has
faced
several
challenges
in
implementing
its
organizational
objectives.
These
include
that
a)
it
has
multiple
partners,
which
can
make
forward
movement
time
consuming,
b)
its
monitoring
and
evaluation
process
needs
to
work
for
young
people
and
also
create
credible
evidence
from
the
field,
c)
its
approach
is
a
novel
process
for
government
agencies,
which
can
take
time
to
build
trust,
and
d)
its
entry
points
for
advocacy
change
constantly,
requiring
consistent
monitoring
and
constant
building
of
new
relationships.
Dipa
Nag
Chowdhury,
MacArthur
Foundation
Ms.
Nag
Chowdhury
spoke
on
the
reality
of
policy
and
policy
making
in
New
Delhi.
For
example,
policy
makers
in
the
capitol
are
unwilling
to
deal
with
child
marriage.
In
states
where
child
marriage
is
endemic,
Ms.
Nag
Chowdhury
stressed
that
advocacy
is
as
important
as
law.
As
girls
get
married,
they
need
specialized
services
that
do
not
necessarily
or
always
fall
under
women’s
services.
This
is
especially
detrimental
to
women
who
depend
on
comprehensive
health
services
in
their
teen
and
mature
ages.
Ensuring
sexual
health
education
is
an
important
way
of
providing
4

9. young
people,
especially
young
girls,
with
the
skills
and
tools
to
protect
themselves
and
give
them
a
happier,
safer,
and
healthier
life,
particularly
as
regards
to
HIV/AIDS.
Shocking
instances
of
gang
rape
of
children
can
be
used
to
highlight
the
need
for
and
push
for
greater
sexual
health
education.
To
this
end,
government
services
and
education
must
complement
each
other.
Ms.
Nag
Chowdhury
also
noted
that
even
in
states
where
sexual
health
education
is
being
taught,
it
is
not
being
taught
well.
Senior
Advocate
Colin
Gonsalves
Acting
as
facilitator
and
moderator,
Mr.
Gonsalves
asked
who
amongst
our
participants
saw
the
potential
for
a
PIL
in
the
presentation
on
access
to
sexual
health
education.
One
woman
recognized
that
a
PIL
could
be
filed
to
make
CSE
compulsory
in
school.
Another
woman
shared
that
often
teachers
feel
uncomfortable
teaching
sexual
health
education
to
their
students.
She
recommended
a
PIL
that
includes
a
request
for
a
centre
where
students
can
speak
to
social
workers
and
psychologists
that
offer
sexual
health
counselling
for
children
and
parents.
One
man
noted
that
developing
a
PIL
first
requires
significant
‘homework’.
He
shared
that
female
biology
teachers
are
uncomfortable
teaching
male
students
about
their
reproductive
systems
and
instead
avoid
the
subject.
Therefore,
before
a
PIL
can
be
filed,
CSE
and
CSE
instructors
must
be
sensitised.
Judges
in
particular
must
be
sensitised.
Another
woman
was
of
the
opinion
that
sexual
health
education
needs
to
happen
within
the
sphere
of
the
family:
if
parents
are
given
the
resources
to
teach
their
children
about
sexual
health,
there
is
no
need
for
it
to
be
taught
outside
of
the
home.
Finally,
one
woman
shared
about
the
need
for
counselling
of
children
who
have
suffered
sexual
violence.
Recommended
Ways
Forward
The
ban
on
sexual
health
education
is
the
starting
point
for
a
PIL.
While
it
is
in
place,
it
is
arbitrary,
discriminatory,
and
unconstitutional
because
it
deprives
the
young
people
of
India
with
education
necessary
for
them
to
lead
a
healthy
life.
(Constitution
of
India:
Right
to
life,
Article
21).
Mr.
Gonsalves
agreed
that
the
‘backward
cultural
angle’
must
be
handled
sensitively.
Mr.
Gonsalves
also
suggested
that
to
start
a
PIL,
we
must
develop
a
sample
to
show
what
sexual
health
education
means
and
what
it
comprises.
In
order
to
do
so,
Mr.
Gonsalves
counselled,
we
must
look
at
successful
international
examples.
He
also
stressed
that
there
must
be
a
coalition
of
groups
backing
the
PIL.
He
agreed
that
caution
must
be
taken
to
avoid
filing
a
PIL
that
reaches
farther
than
judges
are
willing
to
go
sharing
that
perhaps
there
should
be
an
attempt
to
reach
out
to
and
educate
judges
before
a
PIL
is
filed.
Issue
Sexual
Health
Education
PIL
Status
•
•
•
Background
gathering
Coalition
building
Drafting
Complimentary
Advocacy
Partners
Strategies
• Sensitization
• HRLN
workshops
• The
YP
• Youth
Awareness
Foundation
Raising
• MacArthur
workshops
Foundation
5

10. National
Entitlements
Background
Information
As
last
recorded,
India’s
Maternal
Mortality
Rate
(MMR)
is
212
deaths
for
every
100,000
live
births.
According
to
the
United
Nations
Population
Fund,
as
of
2010,
one
third
of
all
maternal
deaths
in
the
world
take
place
in
India
and
Nigeria
alone,
14%
and
20%
respectively.
In
order
to
address
its
high
MMR,
the
Indian
government
developed
several
national
benefit
and
incentive
schemes
to
promote
maternal
health
vis
a
vis
institutional
deliveries
and
ante-­‐
and
post-­‐natal
care.
Notwithstanding,
these
schemes
have
had
moderate
success
due
in
large
part
to
their
lack
of
implementation.
The
following
is
a
short
description
of
some
of
the
national
entitlements
available
to
pregnant
and
lactating
women
in
India.
National
Rural
Health
Mission
(NRHM)
The
National
Rural
Health
Mission
(NRHM)
was
launched
to
strengthen
public
health
systems
in
rural
areas.
NRHM’s
aim
is
to
provide
effective
health
care
to
India’s
rural
population
with
a
special
focus
on
states
that
have
poor
public
health
indicators
and/or
weak
infrastructure.
Through
NRHM,
state
governments
are
provided
central
government
funds
to
improve
the
state’s
public
healthcare
systems.
In
this
way,
states
bear
the
responsibility
of
identifying
and
assisting
their
most
broken
district
public
healthcare
systems.
Janani
Shishu
Suraksha
Karyakram
(JSSK)
JSSK
is
a
scheme
developed
under
NRHM.
The
scheme
ensures
free
services
to
pregnant
women
including
cashless
delivery
at
a
government
centre,
caesarean
section
if
needed,
medicines,
drugs
and
consumables,
diagnostics
facilities
including
ultrasound,
provision
of
blood
units
without
payment
of
testing
charges,
exemption
from
all
user
charges
and
free
diet
during
the
stay
at
the
facility
(three
days
in
case
of
normal
delivery
and
seven
days
in
case
of
a
caesarean
section)
and
free
transportation
home.
Janani
Suraksha
Yojana
(JSY)
NRHM
launched
the
JSY
scheme
to
promote
institutional
delivery
and
to
reduce
neo-­‐natal
mortality.
The
JSY
scheme
entails
specific
guidelines
for
health
care
during
pregnancy:
The
scheme
provides
financial
assistance
to
Below
Poverty
Line
(BPL),
Scheduled
Caste
(SC),
and
Scheduled
Tribe
(ST)
pregnant
women
who
obtain
antenatal
care,
undergo
institutionalized
delivery,
and
seek
postpartum
care.
Under
the
JSY
scheme,
ASHAs
are
assigned
to
every
village
to
serve
as
a
link
between
the
pregnant
woman
and
governmetn
schemes
and
facilities.
The
ASHA’s
responsibilities
include:
• Identifying
pregnant
women
as
a
beneficiaries
of
the
schemes
and
reporting
or
facilitating
registration
for
ante-­‐natal
care
(ANC);
• Providing
and/or
helping
women
receive
at
least
three
ANC
checkups
including
Tetanus
injections
and
Iron
Folic
Acid
tablets;
6

11. •
•
•
•
•
•
•
•
Preparing
a
micro
birth
plan;
Identifying
a
functional
government
health
center
or
an
accredited
private
health
institution
for
referral
and
delivery,
immediately
upon
registration;
Counseling
women
for
institutional
delivery;
Escorting
the
beneficiary
woman
to
the
pre-­‐determined
health
center
and
staying
with
her
until
she
is
discharged;
Arranging
to
immunize
the
newborn
until
the
age
of
14
weeks;
Informing
the
Auxilary
Nurse
Midwife
(ANM)/Medical
Officer
(MO)
about
the
birth
or
death
of
the
child
or
mother;
Performing
a
post-­‐natal
visit
within
7
days
of
delivery
to
track
the
mother’s
health;
Counseling
for
initiation
of
breast-­‐feeding
to
the
newborn
within
one-­‐month
of
delivery
and
its
continuance
until
3-­‐6
months
and
promoting
family
planning;
and
Facilitating
the
payment
of
financial
assistance
immediately
following
the
delivery.
•
Additionally,
the
JSY
scheme
ensures
that
BPL
women
receive
Rs.
500
for
home
delivery.
National
Maternity
Benefit
Scheme
(NMBS)
NMBS
is
a
social
assistance
scheme
meant
to
provide
financial
assistance
to
pregnant
BPL
women.
The
beneficiary
woman
must
be
a
permanent
resident
of
a
village
and
the
entitlement
is
valid
up
to
any
number
of
births.
NMBS
is
the
result
of
a
2001
Supreme
Court
order
in
PUCL
vs.
Union
of
India
and
Ors.,
(Writ
(Civil)
Petition
No.
196
of
2001).
Under
NMBS:
• All
BPL
pregnant
women
should
be
paid
Rs.
500,
8–12
weeks
prior
to
delivery
for
each
of
the
first
two
births;
and
• The
benefit
under
NMBS
must
be
paid
irrespective
of
place
of
delivery
and
age.
The
Supreme
Court
has
said
that
the
JSY
and
NMBS
schemes
are
distinct
and
that
women
should
have
access
to
benefits
under
both
schemes.
In
reality,
unfortunately,
they
are
interpreted
as
the
same
scheme
and
women
usually
only
receive
money
under
JSY.
Information
Presented
Javid
Chowdhury,
Former
Secretary
of
Health,
Ministry
of
Health
and
Family
Welfare
Mr.
Chowdhury
began
by
saying
that
there
is
no
explicit
right
to
health
and
no
statutory
right
for
anyone
who
wishes
to
access
health
rights
in
India.
The
Constitution
covers
the
Right
to
Equality,
Right
to
Public
Discrimination,
and
Right
to
Life,
but
there
is
no
explicit
right
to
health.
Mr.
Chowdhury
shared
that
the
Indian
government
had
recently
introduced
a
draft
National
Health
Act,
which
sought
to
reduce
the
requirements
for
approaching
the
Appeals
Courts
through
PILs.
However,
this
effort
proved
ineffective
because
the
Act
tried
to
a)
provide
everything
to
everyone,
which
achieves
nothing,
and
b)
centralize
the
powers,
which
are
state-­‐bound.
Therefore,
a
reasonable
National
Health
Act
should
be
formed
through
which
citizens
can
approach
subordinate
authorities
for
implementation.
7

12. Mr.
Chowdhury
also
suggested
several
issues
to
file
a
PIL
on
that
could
have
far-­‐reaching
impacts.
These
included:
• Great
Deficiency
of
Statistical
Data:
o As
Health
Minister,
when
malaria
cases
were
on
the
increase,
Mr.
Chowdhury
struggled
to
ensure
that
the
Ministry
reported
the
true
number
of
malaria
cases.
The
clerk
in
the
Ministry
insisted
that
there
be
no
variation
in
the
figures
for
the
same,
so
the
official
data
indicated
that
deaths
due
to
malaria
were
less
than
1,000
even
though
the
actual
figure
had
gone
up
to
several
thousands.
The
honest
thing
for
the
Indian
government
to
do
in
such
cases
is
to
accept
that
it
does
not
have
the
appropriate
and
accurate
statistics.
o One
great
service
NGOs
have
accomplished
is
that
they
have
pushed
for
better
statistics
and
demographic
information
via
PILs.
For
example,
if
a
PIL
were
raised
on
this
issue
to
higher
courts,
these
would
in
turn
raise
the
issue
to
the
government.
There
is
no
statistical
base
in
the
country
and
it
is
important
to
insist
on
one.
Our
national
statistical
organizations
are
some
of
the
best
in
the
world
but
unfortunately,
this
is
not
true
where
public
health
records
are
concerned.
• Dismal
Infrastructure
in
Health
Care:
o The
underlying
reason
for
this
issue
is
a
lack
of
resources,
which
is
substantial
and
extremely
damaging.
Mr.
Chowdhury
called
for
PILs
to
be
filed
asking
the
government
to
allocate
more
resources
in
public
health
facilities.
o Resources
per
capita
for
primary
health
care
are
approximated
at
Rs.
204
per
health
care
facility.
Under
the
current
situation,
it
is
impossible
to
ensure
a
person’s
right
to
life
through
accessible,
adequate
health
care.
The
recent
Supreme
Court
intervention
in
the
Mid-­‐Day
Meal
Scheme
was
important
and
helpful,
but
Mr.
Chowdhury
stressed
that
it
is
also
important
to
interact
and
provide
health
education
in
rural
areas.
NRHM
has
been
moderately
successful,
he
admitted,
because
it
has
attempted
to
interact
with
villager
and
because,
when
NRHM
provisions
have
not
been
implemented,
PILs
have
been
filed
to
ensure
they
are
implemented.
Unfortunately,
through
the
years,
important
suggestions
have
not
been
implemented.
The
Planning
Commission
recently
convened
and
issued
an
important
report
on
the
subject.
For
example,
the
Planning
Commission
recommended
that
70%
of
health
care
resources
be
allocated
for
primary
health
care.
This
would
ensure
that
90%
of
health
problems
are
dealt
with
at
the
primary
level.
Mr.
Chowdhury
urged
legal
activists
to
support
the
report.
NRHM
called
for
a
reduction
in
the
gap
between
strong
and
weak
states,
but
a
review
after
six
years
of
implementation
shows
that
this
has
not
been
effective.
Mr.
Chowdhury
suggested
that
PILs
be
filed
to
redirect
more
money
to
weaker
areas.
Mr.
Chowdhury
noted
that
there
is
a
tendency
in
the
Indian
government
to
demarcate
NGO
activities
from
government
activities
and
stressed
that
it
is
time
to
do
away
with
that.
Finally,
Mr.
Chowdhury
re-­‐focused
on
public
health
stating
that
although
diseases
like
malaria
can
be
treated
symptomatically,
this
approach
is
not
taken.
Moreover,
drugs
should
be
made
available
free
of
cost
to
poorer
sections
of
the
society
in
order
to
increase
the
outreach
of
health
services.
Mr.
Chowdhury
stressed
the
necessity
of
public
health
access
and
proper
implementation
of
corresponding
schemes.
8

13.
Jashodhara
Das
Gupta,
SAHAYOG
Mrs.
Das
Gupta
began
by
referring
to
a
chapter
in
the
Planning
Commission
Committee
Report,
which
dealt
with
citizen
engagement.
In
the
past
7-­‐8
years,
she
reported,
many
laws
have
been
framed
for
uplifting
the
poor,
including
those
targeting
health,
education,
employment,
and
women’s
rights.
These
laws
have
only
been
possible
due
to
Jan
Andolan
i.e.,
People’s
Movements.
The
Movement
for
Food
has
been
growing
strong
and
many
schemes
including
JSY
and
JSSK
have
been
created
to
give
entitlements
to
the
poor.
Had
their
intended
beneficiaries
actually
accessed
these
entitlements,
the
Right
to
Food
Commission,
for
example,
would
have
proved
more
successful
in
its
last
11
years
of
implementation.
In
many
cases,
complimentary
successful
judgments
have
also
been
issued.
Nevertheless,
the
challenge
of
implementation
still
remains.
According
to
Mrs.
Das
Gupta,
there
are
two
elements
of
implementation:
1.
Making
a
facility
available
to
the
court:
This
would
require
infrastructure,
resources,
manpower,
etc.
Most
recently,
in
the
Planning
Commission,
a
budget
was
created
for
providing
universal
health
in
the
next
few
years.
2.
Accountability:
Even
after
obtaining
judgments
that
are
in
favour
of
the
public,
if
there
is
no
accountability,
judgments
are
ineffective.
Mrs.
Das
Gupta
explored
the
meaning
of
accountability
saying
that
it
has
two
essential
elements.
The
first
is
a
hierarchical
system
for
managerial
accountability.
Here,
reporting
to
a
higher
authority
is
necessary.
It
is
mandatory
that
a
budget
be
made
to
account
for
expenses.
However,
this
is
not
the
kind
of
accountability
Mrs.
Das
Gupta
referred
to.
Instead,
she
wanted
to
talk
about
social
accountability,
which
has
more
to
do
with
the
relationship
between
the
implementers
of
these
schemes
and
their
intended
beneficiaries.
Mrs.
Das
Gupta
shared
that
her
last
26
years
of
experience
in
Uttar
Pradesh
with
adivasis,
Dalits,
and
other
marginalized
communities
made
her
realize
that
India’s
schemes
system
shows
an
unequal
power
struggle
between
the
implementers
and
the
beneficiaries.
For
example,
remote
areas
do
not
benefit
from
these
schemes
because
there
is
no
parity
in
their
implementation.
Poor
villagers
do
not
know
whom
to
approach
if
they
want
to
obtain
a
BPL
card
or
a
Dalit
certificate.
Under
JSY,
pregnant
women
are
told
they
will
receive
Rs.
2,400
if
they
deliver
in
public
hospitals.
Yet,
once
they
go
to
public
hospitals,
they
are
treated
roughly
and
rudely
turned
away.
Mrs.
Das
Gupta
stressed
that
to
file
a
PIL,
we
must
make
sure
that
we
have
the
support
of
the
People’s
Movement.
It
is
of
no
use
to
press
for
a
change
through
litigation
without
their
support.
Women
in
poorer
areas
are
not
satisfied
with
the
family
planning
schemes.
Entitlements
are
available,
but
they
do
not
reach
the
poor.
Under
JSSK,
everything
from
transport,
treatment,
and
post-­‐operative
checks
are
meant
to
be
free
of
cost.
Additionally,
women
are
meant
to
receive
Rs.
2,400
for
institutional
delivery
under
JSY.
Instead,
a
recent
survey
reveals
that
women
end
up
spending
around
Rs.
1,277
during
their
pregnancy
and
delivery.
It
is
necessary,
then,
for
people
to
claim
the
benefits
to
which
they
are
entitled.
If
people
remain
unaware
of
these
schemes,
they
are
of
no
use.
Mrs.
Das
Gupta
noted
that
lawyers
must
form
relationships
with
villagers
with
the
help
of
the
People’s
Movement
and
NGOs
working
on
these
issues.
9

14. Mrs.
Das
Gupta
concluded
her
remarks
stating
that
judgments
are
of
no
use
if
they
are
limited
to
paper.
Instead,
we
must
all
work
together
to
ensure
that
these
judgments
reach
their
intended
beneficiaries.
Advocate
Shamik
Naraian:
Mr.
Naraian
stressed
that
we
need
to
be
vigilant
and
make
sure
that
the
implementation
of
these
schemes
is
being
continuously
measured.
Advocates
and
NGOs
should
also
work
collaboratively
to
make
sure
positive
judgments
are
implemented.
Recommended
Ways
Forward
Issue
PIL
Status
Non-­‐Implementation
• Background
of
National
gathering
Entitlements
• Coalition
building
• Fact
Finding
• Drafting
Complimentary
Strategies
• Monitoring
Committees
to
oversee
implementation
• Impose
fines
on
non-­‐participating
public
health
facilities
10
Advocacy
Partners
•
SAHAYOG

15. Access
to
Contraception
Background
Information
Access
to
contraception
in
India
is
an
essential
element
to
improving
women’s
health.
Nevertheless,
Frederika
Meijer,
India’s
representative
to
the
United
Nations
Population
Fund,
recently
revealed
that
the
estimated
number
of
women
without
access
to
contraceptives
in
India
sits
at
28
million,
which
accounts
for
10%
of
the
world’s
unmet
need.
If
access
to
contraceptives
was
provided
to
Indian
women,
Ms.
Meijer
noted,
“unintended
pregnancies
would
drop
by
two
third[s]
and…[it]
would
save
[the]
lives
of
thousands
of
women
and
newborns.”
Nevertheless,
according
to
the
Annual
Health
Survey,
“at
least
one-­‐fifth
of
CMW
[currently
married
women]
are
yet
to
meet
their
family
planning
requirement…”
Young
women
are
also
implicated
in
India’s
unmet
need.
UNICEF
recently
reported
that
with
243
million
adolescents,
India
has
the
highest
number
of
adolescents
in
the
world.4
A
2011
report
revealed
that
condom
use
is
staggeringly
low
among
adolescents
who
engage
in
premarital
sex;
only
an
alarming
27%
of
young
men
have
ever
used
a
condom
and
just
7%
of
young
women
have
used
a
condom.5
Information
Presented
Dipika
Jain,
Professor
Jindal
School
of
Law,
Centre
for
Health
Law,
Ethics
and
Technology
(CHLET)
Ms.
Jain
shared
that
her
organization,
Centre
for
Health
Law,
Ethics
and
Technology
(CHLET)
has
recently
undertaken
an
evidence-­‐based
research
project
because
she
“
wanted
to
know
what's
going
on
in
the
field
rather
than
depend
entirely
on
theoretical
data."
CHLET
began
collecting
data
for
its
study
in
September
2012
by
visiting
5
districts
in
Haryana
to
investigate
women’s
access
to
contraceptives.
The
study’s
findings
could
then
be
used
to
gauge
the
availability
of
and
access
to
contraceptives
in
Haryana
districts
and
for
a
possible
PIL
on
the
issue.
Ms.
Jain
shared
the
following
background
information
to
provide
context
to
the
issue.
There
are
14
different
varieties
of
contraceptives
available
in
India,
of
which
10
have
been
scientifically
declared
'effective'.
The
national
list
of
essential
medicines
includes
hormonal
contraceptives,
condoms,
and
copper-­‐T.
CHLET’s
study
was
concerned
with
whether
or
not
the
medicines
listed
on
the
national
list
of
effective
medicines
are
readily
available
in
hospitals
and
whether
married
women
are
aware
of
them.
If
they
are,
CHLET
questioned
why
women
do
not
avail
themselves
of
them
or
know
to
avail
themselves
of
them,
CHLET
wondered
whether
women
failed
to
seek
access
to
contraceptives
because
of
socio-­‐cultural
barriers
or
whether
there
are
other
reasons.
Ms.
Jain
reported
that
29%
of
India’s
MMR
could
be
prevented
if
women
had
access
to
safe,
effective
contraceptives.
Unfortunately,
of
the
budget
assigned
to
procurement
and
dissemination
of
contraceptives
in
India
for
2012,
about
68.75%
was
left
unused.
This
led
CHLET
to
conclude
4
UNICEF
defines
adolescents
as
those
who
are
between
the
ages
of
10
and
19.
5
K.G.
Santhya,
et.
Al.,
Condom
Use
Before
Marriage
and
Its
Correlates:
Evidence
from
India,
International
Perspectives
on
Sexual
and
Reproductive
Health
Vol.
37,
No.
4,
Guttmacher
Institute,
2011.
11

16. that
although
the
Indian
government
has
sufficient
resources
to
provide
better
access
to
contraception,
these
resources
are
being
wasted.
Of
CHLET’s
findings,
Ms.
Jain
presented
only
a
“microcosm”
of
the
study
that
is
indicative
of
the
study’s
overall
findings.
The
study
focused
on
women,
doctors,
and
ASHA
workers.
In
the
District
of
Sonipat,
for
example,
Ms.
Jain
found
that
the
civil
hospitals
she
visited
open
and
close
erratically,
at
times
only
staying
open
for
2
hours
at
a
time.
Moreover,
ASHA
workers
do
not
work
in
the
reproductive
or
obstetric
departments
but
instead
confine
their
work
to
the
hospital’s
pharmacies.
Moreover,
the
counseling
on
'reproductive
health'
these
hospitals
provide
rarely
goes
beyond
HIV
prevention.
When
the
study
group
attempted
to
access
medicines
from
the
hospital’s
pharmacies,
the
team
was
told
that
that
contraceptive
pills
and
medicines
meant
for
free
distribution
were
actually
being
sold.
Moreover,
the
contraceptives
were
past
their
expiry
date.
The
team
found
a
general
shyness
about
contraception
and
reproductive
health.
No
one
the
group
spoke
with
knew
about
female
condoms
though
most
had
an
idea
about
male
condoms
and
copper-­‐Ts,
which
were
the
most
common
method
of
contraception
used.
The
team
also
found
that
many
people
were
reluctant
to
go
to
government
hospitals
because
they
were
“mistreated”
or
kicked
out.
Instead,
people
preferred
going
to
private
clinics.
The
group
next
visited
colleges
in
the
district
to
talk
to
unmarried
women.
The
group
found
that
78%
of
them
think
that
contraception
is
an
issue
of
health
rather
than
of
sexuality.
Although
over
78%
of
them
had
some
knowledge
about
contraceptives,
most
of
them
knew
nothing
about
government
entitlements
in
this
regard.
Of
note,
98%
of
the
girls
the
group
spoke
to
said
that
there
are
some
cultural
or
social
barriers
that
prevent
them
from
being
upfront
or
frank
about
reproductive
health
or
from
approaching
people
for
guidance
or
assistance
in
matters
pertaining
to
the
same.
When
asked
how
the
girls
knew
of
contraception
methods,
they
responded:
44%
from
TV
programs,
22%
through
friends
and/or
peers,
and
5.5%
(one
girl)
through
books.
The
group
asked
each
hospital
it
visited
what
forms
of
contraception
it
made
available.
The
study
revealed
that
87%
of
the
hospitals
had
copper-­‐Ts
while
only
a
few
had
birth
control
pills.
None
of
the
hospitals
in
the
study
gave
birth
control
pills
on
prescription.
Instead,
they
provided
them
over
the
counter.
The
group
also
found
that
none
of
the
staff
the
group
spoke
to
knew
of
injectable
contraceptives.
CHLET
noted
that
this
was
especially
surprising
since,
as
observed
in
Nepal,
Thailand,
and
other
countries,
injectable
contraceptives
are
one
of
the
most
effective
and
hassle-­‐
free
methods
of
contraception.
On
speaking
with
healthcare
workers,
most
stated
that
sterilization
is
the
most
effective
method
of
contraception.
They
noted
that
it
is
widely
recommended
and
extensively
administered.
When
asked
if
they
provided
family
counseling,
the
replies
were
mixed.
Many
healthcare
staff
workers
do
offer
family
planning
counseling.
Some,
however,
expressed
that
they
are
too
shy
to
counsel
patients
and
only
give
family
counseling
to
fellow
women.
The
staff
asserted
that
they
always
take
a
woman’s
consent
before
administering
female
sterilization.
However,
some
personal
accounts
testify
to
the
contrary.
Female
sterilization
is
the
most
common
method
of
contraception
in
India
and
very
few
people
know
about
female
condoms
as
an
alternative
although
they
are
non-­‐
permanent
and
inexpensive.
Ms.
Jain
commented
that
most
women
prefer
not
to
use
contraceptives
until
they
have
had
a
son.
Nevertheless,
most
women
claimed
they
wanted
to
space
their
deliveries
illustrating
that
there
is
a
certain
level
of
awareness
about
family
planning.
12

17.
Kalpana
Mehta,
Manasi
Swasthya
Sansthan
Ms.
Mehta
shared
that
in
India,
contraceptives
were
intended
neither
for
health
purposes
nor
sexual
reasons,
but
simply
for
population
control.
The
singular
reason
behind
the
whole
initiative
was
to
curb
births.
Since
their
introduction
in
India,
drastic
population
control
measures
have
been
adopted
including
having
men
aged
16
to
60
forcefully
sterilized.
Ms.
Mehta
questioned
how
a
health
mission,
referring
to
NRHM,
is
expected
to
succeed
when
many
people
still
lack
basic
food,
nutrition,
and
sanitation
provisions.
So
that
distributing
contraceptives
to
people
without
improving
their
standards
of
health
is
tantamount
to
spreading
morbidity.
Ms.
Mehta
spoke
of
a
memo,
released
in
1969,
that
revealed
how
given
the
current
mortality
rates,
a
couple
needs
to
have
at
least
six
children
to
be
sure
that
a
single
surviving
son
will
survive
into
adulthood.
Around
this
same
time,
technology
for
detecting
the
gender
of
the
fetus,
also
known
as
amneocentisis,
was
developed.
The
government
endorsed
the
practice,
the
idea
being
that
it
would
give
people
the
option
of
having
a
son
and
therefore
limit
reproduction.
This
would
in
turn
reduce
India’s
birth
rate
and
reign
in
India's
population
explosion.
In
other
words,
“[couples
would
have]
a
son
without
the
unecessary
reproduction
of
females.”
According
to
Ms.
Mehta,
in
the
year
after
amniocentesis
was
introduced,
800
abortions
were
performed.
She
reported
that
of
these,
799
were
of
female
fetusus;
one
of
the
fetusus
was
actually
a
male
fetus
that
was
mistaken
for
a
female
fetus.
Ms.
Mehta
recalls
that
birth
rates
did
initially
decline.
However,
the
sex
ratio
also
declined.
The
sex
ratio,
she
noted,
is
now
so
disturbingly
skewed
that
in
certain
villages
of
Haryana,
girls
are
kidnapped
and
brought
from
states
like
Kerala
to
become
brides
of
Haryana
men
because
there
simply
are
not
enough
females
left
Haryana.
Nevertheless,
it
took
10
years
for
the
Indian
government
to
develop
any
kind
of
law
to
address
the
issue
of
sex-­‐selective
abortion.
Even
today,
with
a
law
on
the
books,
implementation
remains
a
distant
dream.
Ms.
Mehta
shared
that
in
her
hometown,
where
sex-­‐selection
is
a
prolific
trade,
there
has
only
been
one
case
in
which
the
Pre-­‐
Conception
Pre-­‐Natal
Diagnotic
Technologies
Act
(PCPNDT)
has
been
implemented.
In
the
case,
six
doctors
who
had
been
running
an
illicit
ultrasound
clinic
were
each
fined
Rs.
1,000
for
violating
the
law.
Ms.
Mehta
spoke
of
how
women
who
were
provided
with
oral
birth
control
pills
as
part
of
family
planning
in
India
would
throw
them
into
their
fields
because
apparently
the
hormones
in
them
facilitate
robust
plant
growth.
Ms.
Mehta
shared
that
birth
control
pills
have
been
shown
to
slow
down
the
libido,
drastically
increase
the
chances
of
all
forms
of
cancer,
cause
blood
pressure
issues,
and
give
rise
to
potentially
lethal
blood
clots.
Dependence
on
pills,
she
commented,
encourages
the
spread
of
STDs
and
HIV/AIDS.
She
questioned:
“why
would
men
use
condoms
when
a
woman
is
already
on
the
pill?
What
couple
in
their
right
mind
would
go
for
double
contraception?”
Birth
control
pills
market
themselves
as
being
98%
effective.
Condoms
hover
around
80%
effective.
Although
birth
control
pills
are
more
effective
than
other
forms
of
non-­‐permanent
contraception,
because
they
are
taken
continously
over
a
long
period
of
time,
sometimes
from
the
onset
of
puberty
to
menopause,
their
adverse
effects
ought
to
be
researched
and
taken
very
13

18. seriously.
In
fact,
some
research
has
already
been
done.
Ironically,
however,
this
research
is
usually
carried
out
by
the
very
same
drug
manufactures
that
manufacture
and
market
birth
control
pills.
Recently,
the
drug
industry
discovered
that
estrogen
is
the
root
cause
of
many
of
the
side-­‐effects
associated
with
birth
control
pills.
In
2002,
the
government
of
India
assured
the
public
that
it
would
cease
to
allow
the
sale
of
birth
control
pills
with
such
damaging
hormones
under
the
National
Family
Planning
Scheme.
Instead,
the
government
began
using
contraceptive
injections.
These
injectible
contraceptives,
however,
carry
more
than
10
times
as
many
hormones
as
contraceptive
pills.
Ms.
Mehta
noted
that
injectible
contraceptives
are
by
and
large
provider-­‐controlled.
For
example,
a
doctor
may
inject
a
woman
who
visits
a
hospital
for
other,
non-­‐reproductive
health
purposes.
With
birth
control
pills,
however,
a
woman
always
has
the
option
to
throw
them
away
if
she
would
rather
not
take
them.
Injecting
women
with
contraceptives
means
that
reproducitve
rights
are
being
curtailed
instead
of
being
safeguarded.
Ms.
Mehta
noted
that
there
is
a
certain
level
of
coercion
in
the
government's
vehement
patronage
of
drug
companies
and
their
products.
The
American
government,
together
with
the
American
corporate
sector,
is
interested
in
maintaining
a
wide
market
for
its
products
to
ensure
a
hefty
accumulation
of
profit.
It
is
because
of
this
push
for
profit
that
American
drugs
are
so
conspicuous
in
the
market.
What
is
more,
the
Indian
government
tries
to
hide
the
drugs’
negative
side
effects
to
keep
women
in
the
dark
about
the
risks.
Ms.
Mehta
recalls
once
comparing
an
Indian
and
American
brand
of
the
same
generic
birth
control
pill
and
finding
that
the
Indian
packaging
had
19
listed
side-­‐effects
where
the
American
packaging
listed
47
side-­‐effects.
Ms.
Mehta
stressed
that
we
need
to
understand
the
entity
we
are
locking
horns
with
because
the
authorities
we
need
to
fight
in
our
battle
for
the
protection
and
promotion
of
reproductive
rights
do
not
just
include
the
Indian
government.
On
a
personal
note,
Ms.
Mehta
shared
that
she
found
it
“absurdly
anticlimactic”
when
people
talk
of
India’s
“unmet
needs
of
contraception.”
She
asked
“What
do
we
understand
as
'needs'?”
Especially
in
light
of
millions
of
people
who
lack
access
to
food
and
potable
water.
She
questioned
how
we
can
expect
these
same
people
to
use
government
grants
for
contraceptive
injections
that
cost
upwards
of
Rs.
1,500.
Ms.
Mehta
also
shared
that
she
resents
the
popular
correlation
made
between
contraception
use
and
maternal
mortality
rates.
Ms.
Mehta
commented,
“women
who
die
during
childbirth,
who
go
into
labor
in
pithy
environs
outside
of
proper
clinics,
who
do
not
receive
proper
aid
and
support
during
the
process
of
child
birth,
they
do
not
die
for
unwanted
children.
These
women
nearly
always
wanted
the
child
they
died
delivering.
Having
handed
them
contraceptives
would
not
have
necessarily
saved
their
life,
when
they
after
all,
wanted
to
have
a
child.”
Maternal
mortality,
Ms.
Mehta
suggested,
is
to
be
addressed
using
greater,
more
systematic
measures
and
safeguards.
To
link
it
to
access
to
contraception
is
tantamount
to
trivilalizing
the
whole
issue.
14

19. Senior
Advocate
Colin
Gonsalves,
HRLN
Mr.
Gonsalves
began
by
outlining
the
issues
needing
the
most
attention
saying,
“firstly
we
need
to
talk
about
unmet
needs,”
stressing
that
in
many
areas
poor
men
and
women
are
seeking
contraceptives
but
cannot
access
them.
Next,
Mr.
Gonsalves
underscored
the
need
to
discuss
dangerous
forms
of
contraception
and
the
availability
of
contraception
over
the
counter
without
the
need
of
a
prescription.
Mr.
Gonsalves
shared
that
only
recently,
HRLN
had
a
case
on
drug
prices
in
which
the
Supreme
Court
said
that
the
government
has
to
bring
348
essential
medicines
under
price
control
ordering
it
to
follow
the
1995
cost-­‐based
method
of
price
control.
Currently,
the
drug
market
in
India
produces
anywhere
between
a
200%
and
800%
profit.
Recommended
Ways
Forward
Issue
Access
to
Contraception
PIL
Status
• Background
gathering
• Coalition
building
• Fact
Finding
• Drafting
Complimentary
Strategies
• Regulating
the
dispensing
of
birth
control
pills
(i.e.,
only
available
with
prescription)
• Research
and
highlight
negative
side-­‐
effects
of
contraceptives
15
Advocacy
Partners
•
•
•
•
HRLN
Dipika
Jain
-­‐
Jindal
Global
University
Centre
for
Health
Law,
Ethics
and
Technology
Kalpana
Mehta
–
Manasi
Swasthya
Sansthan

20. Skilled
Birth
Attendants
in
the
Field
Background
Information
The
status
of
skilled
birth
attendants
in
India
is
illustrative
of
the
government’s
disservice
to
the
women
of
this
country.
A
lack
of
human
resources,
training,
and
compensation
leaves
skilled
birth
attendants
disenfranchised
and
ill-­‐equipped
to
handle
the
medical
needs
of
pregnant
women
the
country
over.
A
skilled
birth
attendant
without
proper
training
or
compensation
is
a
skilled
birth
attendant
without
agency
or
accountability.
This
is
a
dangerous
combination,
especially
where
the
health
of
women
and
children
are
at
stake.
If
India
is
to
achieve
its
Millennium
Development
Goal
on
maternal
mortality,
it
must
invest
in
the
proper
sourcing,
training,
and
compensation
of
skilled
birth
attendants.
Information
Presented
Dr.
Prakasamma,
ANSWERS
Dr.
Prakasamma
presented
on
how
an
acute
shortage
and
lack
of
patronage
affect
the
quality
of
care
women
and
their
children
receive.
Dr.
Prakasamma
began
by
highlighting
the
recent
governmental
push
for
institutional
delivery
and
explaining
that
of
all
pregnancies,
only
15%
result
in
complications.
The
push
for
institutional
delivery
was
based
on
evidence
showing
that
the
presence
of
skilled
birth
attendants
at
the
time
of
delivery
reduced
maternal
mortality
as
did
the
availability
of
essential
obstetric
services
provided
to
women
near
their
home.
Skilled
birth
attendants
are
accredited
health
professionals
(e.g.,
midwives,
doctors,
nurses,
and
ANMS)
who
have
been
educated
and
trained
to
proficiency
in
skills
necessary
to
manage
uncomplicated
pregnancies,
deliveries,
and
post-­‐natal
care
as
well
as
in
the
identification,
management,
and
referral
of
complications
in
women
and
newborns.
This
categorization
does
not
include
dais
or
ASHAs.
The
current
situation
in
the
field
sees
an
acute
shortage
at
all
levels
of
staffing,
extremely
unhygienic
facilities,
evidence
of
harmful
practices,
and
anecdotal
evidence
of
abuse.
At
the
community
level,
a
single
ANM
can
optimally
cater
to
100
births
per
year.
In
practice,
this
number
is
so
great
that
a
single
ANM
is
unable
meet
the
needs
of
the
women
in
her
community.
Moreover,
even
when
a
majority
of
women
access
institutions
for
health
care,
continuity
of
care
requires
a
full
time
and
dedicated
provider.
A
continuity
of
care
requires
7-­‐10
antenatal
check-­‐ups,
education
on
and
preparation
for
delivery,
at
least
one
interaction
with
an
obstetrician,
and
coordination
for
delivery.
Moreover,
comprehensive
care
requires
coordinating
with
an
ASHA,
arranging
for
transport,
receiving
the
required
JSY
payment,
postnatal
care
and
follow-­‐up
checkups
at
home.
In
the
months
following
delivery,
a
mother
and
child
also
require
panoply
of
services
including
immunizations,
growth
monitoring,
infant
illness
treatment,
contraceptive
support
for
the
mother,
and
infant
and
maternal
nutrition
and
vitamin
supplements.
According
to
a
recent
survey,
India
has
more
than
200,000
ANMS
in
the
public
health
system,
with
most
ANMs
posted
in
sub-­‐centres.
However,
there
has
been
a
steady
decline
in
the
number
of
facilities
and
the
skill
level
and
readiness
of
ANMs.
In
fact,
ANMs
are
now
becoming
a
rare
sight
in
far-­‐flung
villages.
In
order
to
properly
care
for
pregnant
women
and
newborn
children,
India
needs
a
minimum
of
250,000
skilled
ANMs
providing
services,
following
up
with
patients,
and
16

21. documenting
their
services.
More
importantly,
India
needs
ANMs
that
are
dedicated
and
skilled
maternal
and
child
health
providers,
not
multi-­‐purpose
providers.
A
lack
of
ANMs
and
skilled
birth
attendants
means
that
the
health
of
pregnant
women
and
newborn
children
is
unnecessarily
placed
at
risk.
A
low
availability
of
facilities
and
providers
means
that
infection
prevention
measures
are
ignored,
facilities
are
poorly
organized
for
routine
deliveries
and
unprepared
for
complicated
deliveries,
and
that
patients
are
victimized
by
unsensitized
staff.
On
a
micro-­‐level,
this
also
means
that
many
facilities
operate
under
very
unhygienic
circumstances
without
disinfection
practices,
sterile
labor
sets,
gloves
or
even
hand-­‐
washing
protocols.
Dr.
Prakasamma
stressed
that
labour
rooms,
especially,
should
be
as
emergency-­‐prepared
as
intensive
care
units
(ICUs)
stocked
with
adequate
supplies
of
emergency
drugs
and
equipment,
blood
supplies
and
blood
storage
units,
and
staffed
with
skilled
personnel
who
are
able
to
handle
emergency
situations.
The
Indian
government
recently
implemented
a
training
program.
However,
the
program,
which
lasted
only
two
weeks,
has
been
slow
moving,
ad
hoc,
and
ineffective.
Notably,
the
program
did
not
incorporate
a
sensitization
element.
It
is
a
lack
of
sensitization
that
spurs
the
neglect
and
physical
and
emotional
abuse
of
women
at
public
health
facilities.
Advocate
Sandhya
Raju,
HRLN
Advocate
Raju
stressed
that
there
needs
to
be
a
strengthening
of
ASHAs
in
the
field
through
training,
skills
building,
and
capacity
building.
Most
importantly,
skilled
birth
attendants
must
learn
to
be
accountable
for
their
training
and
the
services
they
provide.
Government
hospitals,
too,
must
ensure
basic
hygienic
environments
for
their
patients.
To
provide
anything
less
gives
rise
to
a
strong
PIL.
Infrastructure
must
be
bolstered
in
India’s
public
health
facilities
so
that
facilities
adhere
to
NRHM
and
Indian
Public
Health
Standards
(IPHS)
and
provide
all
of
the
essential
mandated
services.
Advocate
Raju
also
stressed
that
public
health
facilities
need
to
be
held
accountable
for
all
of
the
funds
and
resources
they
receive,
especially
in
light
of
the
services
they
fail
to
provide.
Recommended
Ways
Forward
Issue
Shortage
of
Skilled
Birth
Attendants
in
the
Field/Poor
Labour
Rooms
PIL
Status
• Background
gathering
• Coalition
building
• Fact
Finding
• Drafting
Complimentary
Advocacy
Partners
Strategies
• Sensitization
• HRLN
training
of
public
• Dr.
Prakasamma
-­‐
health
facility
ANSWERS
staff
• Auditing
of
public
health
facility
labour
rooms
17

22. Child
Marriage
Background
Information
According
to
UNICEF,
47%
of
girls
in
India
are
married
by
age
18
and
18%
of
girls
are
married
by
age
15.6
Experts
agree
that
child
marriage
contributes
to
poor
health
indicators,
lower
levels
of
education,
high
rates
of
maternal
and
infant
mortality,
and
increased
HIV
infection
rates.
Data
shows
that
girls
between
the
ages
of
15
and
19
are
twice
as
likely
as
girls
between
the
ages
of
20
and
24
to
die
of
pregnancy
related
complications.7
Child
marriage
persists
in
the
face
of
the
Prohibition
of
Child
Marriage
Act
(2006).
Tradition,
honor,
gender
inequality,
security,
and
socio
economic
instability
perpetuate
child
marriage.
Moreover,
the
government
has
done
little
to
ensure
implementation
of
the
Prohibition
of
Child
Marriage
Act,
including
posting
Child
Marriage
Prohibition
Officers.
In
fact,
tracking
data
between
the
first
National
Family
Health
Survey
and
its
most
recent
iteration,
there
has
been
little
difference
in
the
percentage
of
women,
age
20-­‐24
who
were
married
between
the
ages
of
15
and
20
(NFHS-­‐1,
45%,
NFHS-­‐2,
44%,
and
NFHS-­‐3,
46%).8
Child
marriage
affects
all
women
in
India
and
especially
those
who
are
too
young
to
advocate
for
their
rights.
Information
Presented
Dinesh
Sharma,
Rural
Development
Society
and
Vocational
Training
Organization
(RUDSOVOT)
Mr.
Sharma
shared
the
experiences
of
his
organization,
the
Rural
Development
Society
and
Vocational
Training
Organization
(RUDSOVOT),
during
a
three-­‐year
project
in
Sawai
Madhopur,
Rajasthan.
RUDSOVOT
conducted
research
on
child
marriage
in
five
districts
and
31
villages.
RUDSOVOT
selected
the
Sawai
Madhopur
area
as
Rajasthan
has
the
second
highest
rate
of
child
marriage
in
India;
82%
of
women
in
the
State
are
married
before
they
reach
18.
In
Sawai
Madhopur,
the
average
ages
of
marriage
are
18.3
for
men
and
14.9
for
women.
RUDSOVOT
conducted
their
research
through
household
surveys
and
through
focus
group
discussions.
Mr.
Sharma
also
stressed
the
importance
of
advocacy
and
awareness
campaigning
during
the
project.
In
this
vein,
RUDSOVOT
held
meetings
with
key
decision
makers
in
children’s
lives
including
parents,
village
heads,
and
schoolteachers.
RUDSOVOT
also
held
advocacy
meetings
and
workshops
and
reached
out
to
five
local
NGOs
and
several
government
departments
to
further
spread
awareness
of
the
project.
Furthermore,
RUDSOVOT
opened
Youth
Information
Centres
and
Youth
Groups
to
educate
adolescents
on
child
marriage.
They
also
initiated
a
peer
education
programme
where
they
trained
selected
girls
and
boys
in
the
district
so
that
they
in
turn
could
educate
their
peers.
The
project
also
led
to
the
creation
of
immunization
camps
to
vaccinate
children
with
DT
and
TT
injections.
Finally,
RUDSOVOT
released
a
magazine
called
Yuva
Ankur,
which
incorporated
personal
stories
of
problems
faced
by
young
adults.
6
UNICEF
Statistics,
India,
2010.
7
Pregnant
Adolescents:
Delivering
on
Global
Promises
of
Hope,
The
World
Health
Organization,
2006.
8
National
Family
Health
Survey
(NFHS-­‐3)
2005-­‐2006,
Ministry
of
Health
and
Family
Welfare,
p.
35.
18