Summary
A public interest petition filed in 2013 alleged that unnecessary hysterectomies were performed on women, many from Scheduled Castes, Scheduled Tribes and backward communities, under the Rashtriya Swasthya Bima Yojana and other schemes in Bihar, Chhattisgarh and Rajasthan, often by private hospitals. The States' affidavits showed substance in the allegations. The Union issued Guidelines to Prevent Unnecessary Hysterectomies in 2022 providing for district, State and national monitoring committees. The Supreme Court held that the right to health is intrinsic to Article 21 and that the women's rights were seriously violated, directed all States and Union Territories to adopt and implement the Guidelines within three months and to blacklist hospitals performing unnecessary or non-consensual hysterectomies, and disposed of the petition.
Issues
- What directions should issue to prevent unnecessary hysterectomies performed under government health schemes and to secure the right to health of the affected women.
Provisions considered
- Article 21, Constitution of IndiaThe right to health is an intrinsic element of the right to life; performance of unnecessary hysterectomies on women who could have received alternative treatment was a serious violation of their fundamental rights. (¶ 5)
- Article 32, Constitution of IndiaThe public interest petition was entertained and disposed of with directions binding all States and Union Territories to adopt and implement the Union's 2022 Guidelines. (¶¶ 1, 13, 23)
Held
- The Guidelines to Prevent Unnecessary Hysterectomies, 2022 issued by the Ministry of Health and Family Welfare, which require line-listing and quarterly audit of hysterectomies, particularly in women under 35 and 40, and the constitution of District, State and National Hysterectomy Monitoring Committees, must be adopted by all States and Union Territories within three months, implemented without delay with compliance reported to the Ministry, and brought to the notice of all public and private hospitals. (¶¶ 6, 9, 13)
- The suggestion that certification by two doctors, required under the Ayushman Bharat scheme for hysterectomies on women below forty, be extended to all women is left to a considered decision by the Union once data is captured on the Ministry's portal and the committees are constituted, having regard to the risk of denying treatment to women who genuinely need it; the National Committee must review the landscape every six months. (¶¶ 14, 15, 16, 17)
- All States and Union Territories must take stringent action in accordance with law to blacklist hospitals once it is detected that an unnecessary hysterectomy was performed or that the procedure was undertaken without the patient's informed consent. (¶¶ 18, 19)
- The Union's proposed action plan, including a grievance portal for hysterectomy beneficiaries within three months and a National Hysterectomy Monitoring Committee within four to six weeks, is noted; the Union shall take all steps under the Guidelines to effectuate the public interest. (¶¶ 12, 21)
Result
Writ petition disposed of with directions: all States and Union Territories to adopt the 2022 Guidelines within three months, implement them and report compliance to the Ministry of Health and Family Welfare, ensure hospitals are aware of them, and blacklist hospitals found performing unnecessary or non-consensual hysterectomies; the Guidelines annexed to the judgment; pending applications disposed of.