In 2007, Pro-Public, a human rights organization, filed a public interest writ petition raising the issue of lack of adequate measures by the government in preventing and providing health care services for uterine prolapse. The petition argued that despite the Constitutional recognition of reproductive health as a woman’s fundamental right, studies revealed that approximately 600,000 Nepali women are suffering from different types of uterine prolapse and among these women, approximately 200,000 need immediate treatment. However, effective programs have not been initiated by the State for the prevention and treatment of uterus prolapse.
The petition sought directive orders to the government to:
- provide free counseling, treatment, and health care services for prevention and treatment of uterine prolapse throughout the country via community outreach clinics and subsequently submit a periodic report of the actions taken to the Court;
- draft a reproductive health rights bill
- form a special committee under the coordination of the Ministry of Women, Children and Social Welfare, comprising of representatives from relevant ministries and organizations involved in women’s health issue and, based on the committee’s recommendation, issue appropriate orders to the government; and
- implement public awareness campaigns on uterine prolapse as women’s reproductive health problem through national media.
The Supreme Court issued a directive order to the Office of the Prime Minister and the Council of Ministers to prioritize drafting a reproductive health rights bill in coordination with women’s and reproductive health experts and representatives and submit it before the Legislature-Parliament. The Court also issued an order of mandamus to the Ministry of Women, Children and Social Welfare and the Ministry of Health and Population to prioritize developing a special program and take necessary actions to provide free counseling, treatment, health care services, and facilities to aggrieved women via various health centers; and to implement effective programs to raise public awareness about women’s reproductive health and resolving problems relating to uterus prolapse.
The Court acknowledged uterine prolapse as a matter concerning women’s health, thereby making it necessary to entertain it as an issue of constitutional and legal right. The Court held that the right relating to women’s health is an integral part of right to life, and the proper protection of the right to life is not possible unless the State provides basic facilities or protection for the health of a human being. The Court also emphasized that matters relating to reproductive health is not only an issue related to right to health and a right recognized under international treaties, but is also recognized as a human right of women under Article 20 (2) of the Interim Constitution. Thus, being a fundamental right, meaningful and effective execution of this right is expected from the State. Furthermore, the right to reproductive health is related to other rights of a woman, including the right to freedom, right to equality, right against torture, right to privacy, and right to social justice. Therefore, it is necessary to take into consideration the interrelation of various rights.
Highlighting the significance of enacting laws on reproductive health rights, the Court stated that although this right has been constitutionally recognized, no laws have been formulated to define the right and neither has any institutional mechanism been developed for its execution, which leads to lack of practical realization of this right by the people.
Uterine prolapse has been one of the causes of poor health among women in Nepal; however, the state failed to pay attention to this issue until it was questioned by the Court. The recognition of reproductive health rights as fundamental rights by the Interim Constitution of Nepal in 2007 provided an opportunity to raise this issue for judicial scrutiny. In this case, the Supreme Court recognized uterine prolapse as a human rights issue with implications for women’s fundamental rights and ordered the government to increase public awareness about women’s reproductive rights, implement policies to address the high prevalence of uterine prolapse, and draft a reproductive health bill. As a result, the government launched initiatives to prevent uterine prolapse, including by providing subsidies for corrective treatment and for organizing mobile camps to perform uterine prolapse surgeries. In May 2014, the government also adopted a Procedural Guidelines on Prevention and Treatment of Women’s Uterine Prolapse. While the reproductive health rights bill is yet to be tabled, the process of drafting the bill has been initiated in Nepal, which is a progressive step.