The case of Martha Sabar : Are Health Systems Failing Mothers?

On the final day of #16Days of Activism against gender-based violence, read how the Socio-Legal Information Centre (SLIC) and Human Rights Law Network made the law more responsive to pregnant women’s needs.

Martha Sabar of Deopur village in Gajapati district was 20 years old and pregnant. She was admitted at the Darabangha primary health centre (PHC) and later shifted to DHH in Paralakhemundi where she died on March 25, 2015. Martha came from a rural village belonging to a marginalized tribal group. During her first trimester, her antenatal screening identified her as someone who would have a high-risk pregnancy. Throughout her pregnancy, Martha experienced bleeding. She couldn’t move, remaining in bed. Despite being recognized as high-risk, no health worker came to visit her.

RELEVANT SUSTAINABLE GOALS

Martha was eventually moved to a nearby government primary health center, but they refused to provide her with treatment. Her family was forced to take her to the District Headquarters Hospital. Rather than be transferred to an ambulance, her family had to take her on a public bus. A journey of 70 km.

Martha reached the District Headquarters Hospital at night, where no medical officers could admit her. She was refused service in the morning because she did not have the right identification papers – an Aadhaar card, issued to every pregnant woman to enable them to access free services in government facilities.

She sat outside on the road for 168 hours.

The family was forced to take her to a private clinic owned by the Obstetrics and Gynaecology specialist who worked in the government-run District Headquarters Hospital. By the time Martha received medical attention, she had died.

Maternal Health In India : Silent Crisis

In 2016 with the support of AmplifyChange, SLIC started auditing maternal deaths in ten states across India. As a result, SLIC audited 45 maternal deaths. These shocking deaths shed light on huge gaps in government health services – especially access to care and the quality of care for pregnant women and lactating mothers.

Some of the incidents were heart-wrenching for the SLIC team. They showed the gross negligence of healthcare providers in providing basic antenatal and post-natal care. These deaths highlighted the need to stop obstetric violence and abuse, which healthcare providers in India have normalized, and no punitive action has been taken against obstetric violence.

Martha Sabar was one such case. Martha and her family deserved justice for what happened to her. But, left unchallenged, lessons cannot be learned from Martha’s case, and the health system is left to repeat its failures.

The Government of India has introduced various schemes to reduce maternal and infant mortality. Numerous rights to treatment should have been provided to Martha Sabar, including free ambulance service for the transportation of expectant mothers, critical post-natal care, nutritional care, cash benefits, and hospital care. However, none of these were provided to Martha before she died.

Human Rights Law Network took the state to court on 27th October 2022. They successfully filed a petition in the Odisha High Court. In making his judgment, judge Justice Murladharan stated:

“There is a system designed to provide adequate care for pregnant women in each of these villages, yet they are not properly administered. This is a direct violation of the basic fundamental right of a woman to survive pregnancy and childbirth. The government of India has created multiple schemes to help provide services that guarantee pregnant women that right. However, in this particular instance, there was a breakdown in the referral mechanisms, which prevented antenatal care from being distributed, prevented the doctor from being able to understand his patient’s condition when she arrived, and a failure to get her to a hospital in time could treat her in time. These failed to avert preventable maternal mortality, violating her right to survive pregnancy and childbirth.”

The High Court directed the state to compensate the family and take action against the health workers and managers involved. But, crucially, they also ordered that a maternal death audit be conducted for every maternal death to ensure that the cause of death is ascertained and institutional deaths are understood and prevented.

The judgment, albeit late, brought the family of Martha Sabar some closure. Nonetheless, the case demonstrated the need for the state to strengthen reproductive rights and the gaps in the health system. By ensuring that the government, the judiciary, and society look at health care through a justice lens, SLIC and many other civil society organizations are helping to use the law for good and to strengthen health systems.