Centre for Health and Resource Management v. State of Bihar and Others (2011)


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CHARM v. State of Bihar and Others is a public interest litigation petition filed in March 2011 by the Center’s partner in India, Human Rights Law Network. It seeks legal accountability from the state government of Bihar for its failure to provide essential maternal health care, including safe abortion services, in public health facilities, leading to shockingly high rates of maternal mortality.  In 2011, at the request of our partner, the Center for Reproductive Rights prepared a supplementary brief in the case discussing the legal obligations under international human rights law for the state government to ensure the right to survive pregnancy and childbirth.

Filing Date: March 2011

Country: Bihar, India

Plaintiff(s): Centre for Health and Resource Management (CHARM)

Center Attorney(s): Melissa Upreti and Payal Shah

Co-Counsel/Cooperating Attorneys: Human Rights Law Network (HRLN)

Summary: In March 2011, the Center’s partner in India, the Human Rights Law Network (HRLN), filed a public interest litigation petition before High Court of Judicature at Patna (High Court) seeking accountability for denials of maternal health care, including safe abortion services, in the state of Bihar in India.  This case, CHARM v. State of Bihar and Others C.W.J.C. No. 7650/2011, focuses on the district of Munger, where health conditions are emblematic of the poor quality of medical services available to pregnant women throughout the state of Bihar.  The CHARM petition argues that the Bihar government is obligated to ensure access to maternal health services under the Indian Constitution as well as international human rights law, and cites the recent decision by the Delhi High Court establishing the right to reproductive health in two other maternal health cases brought by HRLN.  HRLN has requested the Center to submit a supplementary brief in this case discussing the international human rights commitments that obligate the Bihar government to take steps to reduce maternal mortality and ensure access to safe abortion services.

The CHARM petition is based on violations of the right to survive pregnancy and childbirth documented by HRLN during a fact-finding mission in Munger, including explicit non-compliance with the Indian Public Health Standards and the National Rural Health Mission’s service guarantees. Some examples of the government’s failure to ensure these guarantees cited in the petition include collection of fees by health officials for referral and registrations of pregnancy, even though such services should be free for pregnant women, dilapidated and unsanitary health facilities that lack electricity, toilets, running water, and blood supplies, failure to provide transportation for pregnant women needing to reach health facilities, and the unavailability of safe abortion services. Further, women in Munger are routinely unable to obtain cash payments guaranteed to them under national maternal health policies. The petition also alleges that the absence of a grievance redressal system denies women due compensation for violations suffered, and leaves no mechanism to provide feedback to the government that could result in reform.

Notably, this petition argues for the first time that the failure to ensure access to maternal health care and safe abortion services constitutes a violation of the right to be free from cruel, inhuman and degrading treatment (CIDT) due to the foreseeable pain and suffering caused to pregnant women.  HRLN’s attorneys argue that this right is particularly violated for poor women seeking maternal health care in Munger’s government health centers, as they are effectively “imprisoned” by poverty. Like pregnant women held in state custody, poor women in Bihar are also left without an alternative to relying on the government for reproductive health care, and as such, the denial of life-saving maternal health care to poor women in Munger’s health facilities constitutes a violation of the right to be free from CIDT.

The approach taken in this case is part of a broader undertaking to seek legal accountability for violations of the right to survive pregnancy and the right to safe abortion in India. The Center has also contributed supplementary briefs in, among others, Sandesh Bansal v. Union of India &amp, Ors., W.P. No. 9061/2008 and in Snehalata Singh v. The State of Uttar Pradesh &amp, Ors., W.P. No. 14588/2009, both maternal health cases,.  Like in many states in India, maternal mortality and morbidity is an ongoing crisis in Bihar, and the Center hopes that in filing this brief, which contains undeniable evidence of reproductive rights violations, much-needed justice will result.

On March 20, 2012 the High Court issued an interim order requiring the Bihar Health Secretary to provide an expense report that accounts for every rupee spent under the National Rural Health Mission. The state government now has less than three weeks to produce receipts for expenses totaling close to $680 million, a task which aims to highlight the shortcomings of the government in implementing the program and subsequently address existing gaps. This order affirms the obligation of the government to respect, protect, and fulfill the right to access to maternal health care.