Two cases were filed in the Delhi High Court concerning the right to maternal health for poor, urban women, focusing specifically on the government’s failure to ensure that pregnant women are able to access essential services and entitlements guaranteed under various government benefit schemes.
One case sought accountability for the maternal death of Shanti Devi, a migrant woman belonging to a scheduled caste. The other case sought accountability for the denial of health services experienced by Fatema, a young, urban, poor woman suffering from epilepsy and severe anemia who was forced to deliver a child in public under a tree and without any medical assistance.
Despite qualifying for benefits under various government schemes, such as the Janani Suraksha Yojana (JSY), the Integrated Child Development Scheme (ICDS), the National Maternity Benefit Scheme (NMBS), the Antyodaya Anna Yojana (AAY) and the National Family Benefit Scheme (NFBS), Shanti Devi and Fatema were repeatedly denied the medical care, rations, and financial support they were entitled to, resulting in humiliation, suffering, and—for Shanti Devi—death.
The petitions highlighted the deficiencies in the implementation of a cluster of schemes, funded by the Government of India, which were meant to reduce infant and maternal mortality. The issues common to both petitions concerned the systemic failure resulting in denial of benefits to two women below the poverty line (BPL) during their pregnancy and immediately thereafter.
The Delhi High Court consolidated these cases and issued a landmark ruling holding that the denial of maternal health care is a violation of fundamental constitutional and human rights, including the right to life. The Court recognized that the petitions focused on two inalienable survival rights that form part of the right to life: the right to health, which includes the right to access government (public) health facilities, receive a minimum standard of treatment and care, and the reproductive rights of the mother, and the right to food, which is integral to the right so life and health.
The Court emphasized that the Indian Government is obligated to ensure maternal health services under the judicially recognized Constitutional rights to health and reproductive rights, as well as under international human rights instruments, such as the UDHR, CEDAW, and ICESCR. The Court held that “no woman, more so a pregnant woman should be denied facility or treatment at any stage irrespective of her social and economic background… This is where inalienable right to health which is so inherent in the life get enforced.”
The Court issued a series of orders to address both the individual suffering of the two women and the systemic breakdowns in the government’s maternal health policies and programs. In Shanti Devi’s case, the Court found that her death was “clearly avoidable” and ordered monetary compensation. For Fatema, the Court held that her fundamental rights—including the rights to life and health—had been violated when she was denied assistance and forced to give birth under a tree. The Court ordered compensation and medical treatment for her epilepsy.
In addition to the individual remedies, the Court issued a series of orders aimed at strengthening maternal health care policies. Under the National Family Benefit Scheme (NFBS), the death of a family’s breadwinner entitles the family to compensation, and the Court established that a pregnant woman who is a homemaker should also be recognized as breadwinners for her household, so that her family will be provided with reparations under the NFBS following her death.
Finally, the Court stated that a woman who otherwise qualifies for health care benefits must have access to care even when she migrates from one state to another, and that the onus falls on the government to ensure that the benefits promised by the state reach women.
Laxmi Mandal is the first decision in India to recognize maternal mortality as a human rights violation and to order compensation and other relief for such violations. The decision clearly articulates the right to maternal health as an unequivocal, legally enforceable right, and it establishes that women who are deprived of this right must be provided with compensation.