Take Stringent Action Against Hospitals For Unnecessary Or Forced Hysterectomies; Follow Union's Guidelines : Supreme Court

A bench of Chief Justice DY Chandrachud and Justice JB Pardiwala was hearing a writ petition filed by one Dr Narendra Gupta, who claimed that several women living below the federal poverty line in these states were unnecessarily compelled to undergo hysterectomies. The petitioner alleged that owing to the inadequacy of the government healthcare programmes, these women had to travel long distances to seek medical attention in private hospitals, where they were coerced into agreeing to have their uteri removed so that the hospital could rake in high insurance fees from the government under various health insurance schemes. Not only did this lead to aggravated menstrual health problems but also exposed these women to increased cancer risk.

Alleging the violation of fundamental rights under Articles 14, 15, and 21, this 2013 petition sought the establishment of monitoring, inspection, and accountability mechanisms in the private healthcare industry, as well as an independent monitor for regulating the Rashtriya Swasthya Bima Yojana (RSBY) scheme, compensation for medical costs and violation of constitutional rights, improved rural healthcare infrastructure, and the suspension and criminal liability of involved doctors.

Additional Solicitor-General Aishwarya Bhati, appearing for the health ministry, told the bench that a comprehensive set of guidelines had been framed to regulate unnecessary hysterectomies. “Because of the reported cases of abuse, a need was felt to frame these guidelines. The challenges were identified and to address them, a comprehensive mechanism was laid down for treatment. We are proposing that a very strong and robust mechanism of monitoring and evaluation must be there.” The law officer told the bench that the centre's action plan to tackle this problem included the inauguration of a grievance portal, as well as the creation of national, state, and district-level hysterectomy monitoring committees to regulate hysterectomies, especially with respect to women below the age of forty.

“Since sufficient steps have now been taken by the union government in framing the guidelines, and in view of the steps taken by the state governments to identify any instances of hysterectomies without the informed consent of women, we see no reason to keep the petition alive,” the bench observed, directing the Centre to take ‘necessary’ steps in accordance with the guidelines to address this issue and engage with the states and the union territories to ensure the expeditious adoption of the said guidelines. Further, the chief justice pronounced, “…We note from the MoFHW guidelines that a national committee is required to review landscape and take necessary policy decisions as required, which should be done once every six months.”

Before concluding, Chief Justice Chandrachud also weighed two suggestions offered by the counsel for the petitioner, Kawalpreet Kaur – first, that hysterectomies on women under the age of 40 years could only be conducted after two doctors certified the course of action, and second, blacklisting of hospitals and healthcare facilities found to have coerced women into getting hysterectomies without their informed consent.

With respect to the first suggestion, the additional solicitor-general pointed out that the insufficiency of the government-run healthcare apparatus could lead to women in need of treatment being turned away because of such a restrictive condition. Deferring to the centre’s submission, Chief Justice Chandrachud said, “We will let the government take a considered view on this.” In response to the recommendation to blacklist hospitals found to have violated the norms laid down, Bhati informed the bench that an act, namely, the Clinical Establishments (Registration and Regulation) Act, 2010 and rules framed under it, already existed. “Take necessary action in accordance with the law then,” the CJI replied.

Case Title

Dr Narendra Gupta v. Union of India & Ors. | Writ Petition (Civil) No. 131 of 2013

Citation : 2023 LiveLaw (SC) 310

Unnecessary hysterectomies- from the counter affidavits filed by the States of Rajasthan, Bihar and Chhattisgarh, it emerges that there is a considerable degree of substance in the facts 

Constitution of India - Article 21 - The right to health is an intrinsic element of the right to life under Article 21 of the Constitution. Life, to be enjoyed in all its diverse elements, must be based on robust conditions of health. There has been a serious violation of the fundamental rights of the women who underwent unnecessary hysterectomies. 

Unnecessary hysterectomies-Union government shall take all necessary steps in accordance with the Guidelines to effectuate the public interest which is sought to be achieved.

Unnecessary hysterectomies- All the States and Union Territories must take stringent action for blacklisting hospitals once it is detected that any unnecessary hysterectomy was carried out or that the procedure was taken recourse to without the informed consent of the patient. We direct that necessary action be taken in accordance with law - Para 19

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