Holding

The Court held that the sterilisation programme, being a component of population control and family planning, is governed by Entry 20A of the Concurrent List, rendering the Union of India primarily responsible for its effective implementation, and that unsafe sterilisation practices violate the right to life under Article 21.

Summary

The Supreme Court heard a public‑interest writ filed by health‑rights activist Devika Biswas after a 2012 sterilisation camp in Bihar resulted in unsafe, unsanitary procedures and several deaths. The petition sought directions to ensure that sterilisation, a component of the national population‑control programme, is carried out ethically, with informed consent, gender‑neutral incentives and proper monitoring. The Court held that the sterilisation programme falls under Entry 20A of the Concurrent List, making the Union of India primarily responsible for its implementation, and that unsafe practices violate the right to life under Article 21, which includes the right to health and reproductive liberty. It observed that the Union cannot shift the burden to the states and must ensure compliance with standards, gender equity, and transparency in the Family Planning Indemnity Scheme. The Court issued a series of supplementary directions on doctor panels, consent checklists, quality‑assurance committees, annual reporting, compensation, phasing out camps, and the formulation of a National Health Policy, and disposed of the writ.

Issues considered

The constitutional classification of the sterilisation programme – whether it is a public‑health matter under State List Entry 6 or a population‑control/family‑planning matter under Concurrent List Entry 20A.
The Union of India's liability and responsibility for implementation and monitoring of the national sterilisation programme.
Whether unsafe and unethical sterilisation procedures infringe the right to life, health and reproductive rights under Article 21.
The gender bias in incentives and whether it violates equality and substantive equality principles.
The adequacy of existing guidelines, the Family Planning Indemnity Scheme, and the need for transparent audit and compensation mechanisms.
The necessity of a National Health Policy and its impact on the sterilisation programme.

Legislation cited

Constitution of Indias. Art.21, s. Art.32, s. Constitution (Forty‑second) Amendment Act, 1976, s. Entry 20A of List III (Concurrent List), s. Entry 6 of List II (State List)
Family Planning Indemnity Scheme, 2013
National Health Policy (draft)

Subjects

SterilisationPopulation controlFamily planningRight to lifeArticle 21Public healthFederalismGender equityInformed consentNational Health PolicyFamily Planning Indemnity SchemeQuality Assurance Committee

Judgment

[2016] 5 S.C.R. 773

DEVIKA BISWAS A
v.
UNION OF INDIA & ORS.
(Writ Petition (Civil) No.95 of2012)
SEPTEMBER 14, 2016 B

[MADAN B. LOKUR AND UDAY UMESH LALIT, JJ.)
Constitution of India:
Art. 32 - Public interest litigation - Unsafe and unethical
sterilization - In 2012, a single surgeon performed sterilization c
procedure on 53 women in a government school in a district in
Bihar - Entire camp conducted in highly unsanitary conditions in
an unprofessional and unethical manner - Women underwent
tremendous physical pain and anguish and were traumatized - Not
given any pre-procedure counseling and had no idea about the
D
potential risks of undergoing sterilization - A/legations regarding
occurrence of similar instances in Bihar, Kera/a, Madhya Pradesh,
Maharashtra and Rajasthan - Writ petition by health rights activist
raising issue of sterilization procedures carried out on women and
also on men and sought series of directions - During pendency of
the writ petition, allegations regarding sterilization camps conducted E
in a district in Chhattisgarh - Various affidavits filed by the States
- In view thereof, issuance of certain directions to the Centre and
States regarding conducting of ethical sterilization of women and
men programme across the country.
Art. 32 - Sterilization program - Whether a public health issue F
- Held: Sterilization program is not only a public health issue but a
national campaign for population control and family planning -
Union of India erred in saying that it is concern of each State since
it is a "Public health" issue covered by Entry 6 of List II in the
Seventh Schedule (the State List) by overlooking the Concurrent
List, Entry 20A which is Population Control and Family Planning -
G
Treating a national program as a public health issue has to stop
and somebody must take ownership of the Population Control and
Family Planning program.

H
773
774 SUPREME COURT REPORTS [2016] 5 S.C.R.

A Arts. 21, 32 - Right to life - Unsafe and unethical sterilization
procedures - Endanger two important components of the right to
life under Art. 21-right to health and reproductive rights of a person
- Right to life under Art. 21 includes right to lead a dignified and
meaningful life and right to health is an integral facet of the right
to life.
B
Right to reproductive health - There is a recognition of the
need to respect and protect the reproductive rights and reproductive
health of a person - Reproductive rights have been recognized as
an aspect of personal liberty under Art.21 - Freedom to exercise
these reproductive rights would include the right to make a choice
c regarding sterilization on the basis of informed consent and free
from any form of coercion - It is necessary that the policies and
incentive schemes on sterilization are made gender neutral and
unnecessary focus on female sterilization is discontinued.
National Health Policy - National Health Policy not yet
D . finalized despite the passage of more than one and a half years -
Issuance of direction to Union of India to take a. decision on or
before December 31, 2016 on whether it would like to frame National
Health Policy or not.
Sterilization program - Female versus male sterilization -
E Percentage of males being sterilized is so remarkably low as
compared to females - Documents on record indicate that the
incentive given to males for undergoing a sterilization procedure is
less than it is for females and would be one of the reasons - Union
of India to look into it, at least for reasons of gender equity.
F Disposing of the writ petition, the Court
HELD: 1.1 The fundamental error that the Union of India
made (repeated in its affidavits) was by asserting that the effective
implementation of the sterilization program is the concern of each
State since it is a "Public health" issue covered by Entry 6 of List
G II in the Seventh Schedule (the State List) of the Constitution.
Apart from the fact that the various entries in the Seventh
Schedule relate to legislative power, the Union oflndia completely
overlooked the more appropriate Entry in the Concurrent List
that is Entry 20A, "Population Control and Family Planning",
inserted by the Constitution (Forty-second) Amendment Act, 1976.
H
DEVIKA BISWAS v. UNION OF INDIA & ORS. 775

If the sterilization program is intended for population control and A
family planning, there is no earthly reason why the Union oflndia
should refer to and rely on Entry 6 of the State List and ignore
Entry 20A of the Concurrent List. Population control and family
planning has been and is a national campaign over the last so
many decades. Therefore, the responsibility for the success or
B
failure of the population control and family planning program (of
which sterilization procedure is an integral part) must rest
squarely on the shoulders of the Union of India. It is for this
reason that the Union of India has been taking so much interest
in promoting it and has spent huge amounts over the years in
encouraging it. It is rather unfortunate that the Union of In<Jia is c
now treating the sterilization program as a Public Health issue
and making it the concern of the State Government. This is simply
not permissible and appears to be a case of passing the buck.
[Para 69) [803-F-H; 804-A-C]
1.2 When the Union oflndia formulates schemes of national D
importance such as family planning, their implementation is
undoubtedly dependent on the State Governments since they
have the requisite mechanism for implementing the schemes and
can also take into account the needs that are particular to the
State and its people. In this manner, the cooperation of the Union
of India and all State Governments is indispensable to the success E
of such national programs. Adverting to the provisions of the
Constitution that allow for such coordination between the Union
and States, the Justice Sarkaria Commission held that these
provisions are not repugnant to but instead further the principle
of federalism. [Para 71) (804-H; 805-A-B] F
1.3 In the same manner, it is imperative for both the Union
of India and the State Governments to implement schemes
announced by the Union of India in a manner that respects the
fundamental rights of the beneficiaries of the scheme. Given the
structure of cooperative federalism, the Union of India cannot G
confine its obligation to mere enactment of a scheme without
ensuring its realization and implementation. [Para 72) (805-C]
1.4 Apart from anything else, by not giving the sterilization
program the importance it deserves (apart from other methods
of population control and family planning) and trying to pass the H
776 SUPREME COURT REPORTS [2016] 5 S.C.R.

A buck to the State Governments, the Union of India is attempting
to find an excuse for failure in its duty of effectively monitoring a
program of national importance. This game of passing the parcel
and treating a national program as a public health issue has to
stop and somebody must take ownership of the Population
Control and Family Planning program. [Para 73] [805-D-E]
B
2.1 A perusal of the various affidavits on record indicates
that the sterilization program is virtually a relentless campaign
for female sterilization. This is more or less confirmed from the
figures available on the website of the Ministry of Health and
Family Welfare of the Government of India. [Para 79) [806-H;
c 807-A]
2.2 It was conceded by all the counsels that the sterilization
program cannot be targeted primarily towards women but must
also actively include the sterilization of men as well. Without going
into the merits and demerits of the incentives given for
D undergoing the sterilization procedure, the documents on record
indicate that the incentive given to males for undergoing a
sterilization procedure is less than it is for females and that may
perhaps be one of the reasons why the percentage of males being
sterilized is so remarkably low as compared to females. This is
an area that the Union of India must address itself to, if nothing
E else then at least for reasons of gender equity. [Para 80] [807-C-
E]
3.1 The manner in which sterilization procedures have
reportedly been carried out endanger two important components
of the right to life under Article 21 of the Constitution-the right
F to health and the reproductive rights of a person. The right to
life under Article 21 includes the right to lead a dignified and
meaningful life and the right to health is an integral facet of the
right to life. [Paras 81, 82] [807-E-G]
3.2 Over time, there has been recognition of the need to
G respect and protect the reproductive rights and reproductive
health of a person. Reproductive health has been defined as "the
capability to reproduce and the freedom to make informed, free
and responsible decisions. It also includes access to a range of
reproductive health information, goods, facilities and services to
enable individuals to make informed, free and responsible
H
DEVIKA BISWAS v. UNION OF INDIA & ORS. 777

decisions about their reproductive behaviour." This Court has A
recognized reproductive rights as an aspect of personal liberty
u/Art.21 of the Constitution. The freedom to exercise these
reproductive rights would include the right to make a choice
regarding sterilization on the basis of informed consent and free
from any form of coercion. [Paras 85, 86) [808-C-D; 809-A-B)
B
3.3 It has been emphasized by this Court that the State's
obligation in respect of fundamental rights must extend to ensuring
that the rights of the weaker sections of the community are not
exploited by virtue of their position. Thus, the policies of the
Government must not mirror the systemic discrimination
prevalent in society but must be aimed at remedying this c
discrimination and ensuring substantive equality. In this regard,
it is necessary that the policies and incentive schemes are made
gender neutral and the unnecessary focus on female sterilization
is discontinued. [Para 87) (810-C-F]
C.E.S.C. Limited & Ors. v. Subhash Chandra Bose & D
Ors. 1991 (2) Suppl. SCR 267 : (1992) 1 SCC 441;
Paschim Banga Khet Mazdoor Samity v. State of W.B.
1996 (2) Suppl. SCR 331 : (1996) 4 SCC 37; Bandhua
Mukti Morcha v. Union of India & Ors. 1984 (2) SCR
67:(1984)3 SCC 161; Suchita Srivastava v. ChandiKarh
Administration (2009) 9 SCC 1 - referred to. E
Ms. A. S. v. Hungary CEDAW/C/36/D/412004 m1ailable
at http://www. un. orglwomenwatchldaw/cedaw/protocol/
decisions-views/Decision %204-2004%20-%20 -
referred to.
Committee on Economic, Social and Cultural Rights, F
General Comment No. 22 (2016) May 2, 2016, E/C.121
GC/22 para 6, https://documents-dds-ny.un.org/doc/
UNDOCIGENIG 161089132/P DFIG 16089 32.pdf
referred to.
4. While it is generally the case of the Union oflndia and all G
the States that the guidelines given by this Court in Ramakant
Rai (I) are being followed, it is found that at least in respect of
some of them, there is still much more that needs to be done for
their effective implementation not only in letter but also in spirit.
Some fine tuning is also necessary in view of the passage of time, H
778 SUPREME COURT REPORTS [2016] S S.C.R.

A change in circumstances and the need to use technology to the
optimum. Accordingly the following supplementary directions are
issued:
(i) The State-wise, district-wise or region-wise panel of
doctors approved for carrying out the sterilization procedure,
B must be accessible through the website of the Ministry of Health
and Family Welfare of the Government of India as well the
corresponding Ministry or Department of each State Government
and each Union Territory. The list should contain all necessary
particulars of each doctor. This exercise should be completed on
or before December 31,2016 and thereafter list be updated every
c quarter.
(ii) The contents of the checklist prepared pursuant to the
directions given in Ramakant Rai (/) should be explained to the
proposed patient in a language that he or she understands and
the proposed patient should also be explained the impact and
D consequences of the sterilization procedure. The checklist
prepared pursuant to the direction given in Ramakant Rai (/)
with the said modifications should be prepared in the local or
regional language on or before December 31, 2016.
(iii) The details and necessary particulars of each member
E of the Quality Assurance Committee and the District Quality
Assurance Committee set up in every State and District should
be accessible from the website of the Ministry of Health and
Family Welfare of the Government of India as well the
corresponding Ministry or Department of each State Government
F and each Union Territory on or before December 31, 2016 and
thereafter updated every quarter.
(iv) The QAC must publish an Annual Report (on the
website of the Ministry of Health and Family Welfare of the
Government of India as well the corresponding Ministry or
G
Department of each State Government and each Union Territory)
containing not only the statistical information number of persons
sterilized as well as the number of deaths or complications arising
out of the sterilization procedure, but also non-statistical
information in the form of a report card indicating the meetings
held, decisions taken, work done and the achievements of the
H
DEVIKA BISWAS v. UNION OF INDIA & ORS. 779

year etc. The first such Annual Report covering the calendar year A
2016 should be published on the websites mentioned above on
or before March 31, 2017.
(v) During 2010-2013, more than Rs.SO crores have been
disbursed towards compensation in cases of as many as 363
deaths. Apart from steps taken by Bihar and Chhattisgarh during B
the pendency of the writ petition to mitigate the sufferings of the
patients, this Court has not been told of any death audit conducted
by any State Government or Union Territory fo respect of any
patient, nor of any steps taken against any doctor or anybody
else involved in the sterilization procedure that has resulted in
the death of a patient or any failure or any other complication
c
connected with the sterilization procedure. There is a need for
transparency coupled with accountability and the death of a patient
should not be treated as a one-off aberration. Therefore, it is
directed that the Annual Report prepared by the QAC must
indicate the details of all inquiries held and remedial steps taken. D
(vi) With regard to the implementation of the Family
Planning Indemnity Scheme (FPIS), there does not seem to be
any definitive information with regard to the number of claims
filed, the claims accepted and in which category (death, failure,
complication etc.), claims pending (and since when) and claims E
rejected and the reasons for rejection. The QAC is directed to
include this information in the Annual Report and the Ministry of
Health and Family Welfare of the Government of India as well as
the State Governments should make this information accessible
on the website, including the quantum of compensation paid under ·
each category and to the number of persons. F
(vii) The Solicitor General is directed to furnish the full
details of the funds utilized under the FPIS. In addition thereto,
the Ministry of Health and Family Welfare should conduct an audit
to ensure that the funds given by the Government of India have
been utilized for the purpose for which they were given for the G
period from 2013-14 onwards.
(viii) The quantum of compensation fixed under the Family
Planning Indemnity Scheme (FPIS) deserves to be increased
substantially and the burden thereof must be equally shared by
H
780 SUPREME COURT REPORTS [2016] 5 S.C.R.

A the Government oflndia and the State Government. The quantum
of compensation is not fixed but suggestion is made, following
the example of the State of Chhattisgarh, that the amount should
be doubled and shared equally.
(ix) The Union of India should make efforts to ensure that
B sterilization camps are discontinued as early as possible but in
any case within the period of three years. The Union of India and
the State Governments must simultaneously ensure that Primary
Health Centres are strengthened.
(x) Although the Union of India has stated that no targets
have been fixed for the implementation of the sterilization
c program, it appears that there is an informal system of fixing
targets. It is left to the good sense of the each State Government
and Union Territory to ensure that such targets are not fixed so
that health workers and others do not compel persons to undergo
what would amount to a forced or non-consensual sterilization
D merely to _achieve the target.
(xi) The decisions taken in the high level meetings as well
as the National Summit on Family Planning should be scrupulously
implemented by the Ministry of Health and Family Welfare of the
Government of India. The said Ministry should also ensure
effective implementation of the decisions.
E
(xii) The Union of India is directed to ensure strict
adherence to the guidelines and standard operating procedures
in the various manuals issued by it. The Sterilization program is
not only a Public Health issue but a national campaign for
Population Control and Family Planning. The Union of India has
F overarching responsibility for the success of the campaign and it
cannot shift the burden of implementation entirely on the State
Governments and Union Territories on the ground that it is only
a public health issue.
(xiii) None of the States-Madhya Pradesh, Maharashtra,
G Rajasthan and Kerala gave any acceptable response to the
allegations made concerning mismanagement in at least one
sterilization camp and there is no option but to assume that the
camps that have been referred to in the writ petition were
mismanaged as alleged by the petitioner. The Chief Justice of
H the High Court in the States of Madhya Pradesh, Maharashtra,
DEVIKA BISWAS v. UNION OF INDIA & ORS. 781

Rajasthan and Kerala is requested to initiate a suo moto public A
interest petition to consider the allegations made by the petitioner
in respect of the sterilization camp(s) held in these States (the
allegations not having been specifically denied) and any other
similar laxity or unfortunate mishap that might be brought to the
notice of the Court and pass appropriate orders thereon. The
B
Chief Justice of the Patna High Court is requested to ensure
speedy completion of the investigations and proceedings relating
to the mishap on January 07,2012 in the sterilization camp in the
Government School, Araria district as well as the mishap in
Chhapra in Saran district that led to cancellation of the
accreditation of the Maternity and Surgical Clinic on March 24, c
2012.
(xiv) The State of Chhattisgarh is directed to implement
the recommendations given in the Ms. Anita Jha Report at the
earliest.
(xv) The National Health Policy has not yet been finalized D
despite the passage of more than one and a half years. The Union
of India is directed to take a decision on or before December31,
2016 on whether it would like to frame a National Health Policy
or not. In case it is worthwhile to have a National Health Policy, it
should take steps to announce it at the earliest and keep issues E
of gender equity in mind as well. [Para 88] [810-F-H; 811-A-H;
812-A-H; 813-A-H; 814-A-H; 815-A-E]
Ramakant Rai (I) & Am: v. Union of India & Ors. (2009)
16 sec 565 - relied on.
Case Law Reference F

1991 (2) Suppl. SCR 267 referred to Para 82
1996 (2) Suppl. SCR 331 referred to Para 82
1984 (2) SCR 67 referred to Para 83 G
(2009) 9 sec 1 referred to Para 86
(2009) 16 sec 565 relied on Para 88
CIVIL ORIGINAL JURISDICTION: Writ Petition (C) No. 95
of2012. H
782 SUPREME COURT REPORTS [2016] 5 S.C.R.

A Pinky Anand, ASG, Colin Gonsalves, Sr. Adv., Jugal Kishore Gilda,
Adv. General, Ms. Olivia Bang, Ms. Jyoti Mendiratta, Rishabh Jain, Ms.
Snidha Mehra, Ansh Singh Luthra, Ms. Somya Rathore, Shadman Ali,
Ajay Kumar Singh, Raj iv Nanda, Ms. Sunita Sharma, Ms. Rekha Pandey,.
R.S. Nagar, Ms. Sunita Rani Singh, Mohan Pd. Gupta, D.S. Mahra, A.P.
Mayee, A. Selvin Raja, Gopal Singh, Shivam Singh, AdvityaAwasthi,
B
Kabir Dixit, Advs. for the appearing parties. ·
The Judgment of the Court was delivered by
MADAN B. LOKUR, J. 1. This public interest petition raises
very important issues concerning the entire range of conduct and
c management, under the auspices of State Governments, of sterilization
procedures wherein women and occasionally men are sterilized in camps
or in accredited centres. The issues raised also include pre-operation
procedures and post-operative care or lack of it. A sterilization surgery
does not appear to be complicated and yet several deaths have taken
place across the country over the years. Undoubtedly, this needs looking
D into by the Government oflndia and the State Governments and remedial
and corrective steps need to be taken. Persons who are negligent in the
performance of their duties must be held accountable and the victims·
and their family provided for. It is time that women and men are treated
with respect and dignity and not as mere statistics in the sterilization
E program.
2. The petitioner Devika Biswas is a public spirited individual of
Araria district in Bihar. She is a health rights activist with extensive
professional experience in the development and health sectors. She has
worked in Uttar Pradesh, Delhi, Jharkhand and Bihar in her capacity as
F a health rights activist. She has also been associated with the Integrated
Child Development Scheme in Bihar and has published articles and books
in her field of specialization.
3. Sometime in 2005 the issue of sterilization procedures for
females and males under the Population Control and Family Planning
G program or the Public Health program of the Government oflndia came
up for consideration before this Court in a petition filed by Ramakant
Rai. The petition was substantially decided by this Court on 1st March
2005 by passing several directions. The directions are reported as
Ramakant Rai (/) & Anr. v. Union of India & Ors. 1

H
1
(2009) 16 sec 565
DEVIKA BISWAS v. UNION OF INDIA & ORS. 783
• [MADAN B. LOKUR, J.]

4. Pursuant to the directions given by this Court, the Government A
oflndia published a Quality Assurance Manual for Sterilization Services
(in 2006); Standards for Female and Male Sterilization (in 2006); and
Standard Operating Procedures for Sterilization Services in Camps (in
2008). These manuals really form the procedural and substantive basis
for conducting sterilization procedures both of females and males in the
B
c country under the population control and family planning program or the

public health program.
5. What seems to have provoked Devika Biswas in filing a writ
petition under Article 32 of the Constitution in this Court is that on 7th
January 2012 as many as 53 women underwent a sterilization procedure
in a camp in highly unsanitary conditions in Kaparfora Government Middle
c
School, Kursakanta, Araria district in Bihar between 8 p.m. and I 0 p.m.
through a single surgeon. In fact, some of the broad issues concerning
the sterilization camp held on 7th January 2012 as found on investigation
by Devika Biswas, included an absence of pre-operative tests on the
women or proposed patients; they were not given any counseling of any D
kind at all; they had no idea about the potential dangers and outcomes of
the sterilization procedure; the sterilization procedures were carried out
in a.school and not in a government hospital or a private accredited
hospital; running water was not available at the site; the sterilization
procedures were carried out under torch light with- the women being
E
placed on a school desk; the surgeon did not have any gloves or at least
did not change the gloves available with him; no emergency arrangements
were made etc. etc. Essentially, the entire camp was conducted in
unsanitary conditions, in an unprofessional and unethical manner. What
is worse is that the camp was conducted under the auspices of an NGO
called Jai Ambey Welfare Society who had been granted accreditation F
by the District Health Society only a few months earlier that is on 29th
November, 2011 apparently without following any formal and transparent
procedure.
6. As a result of the sterilization camp, many women who were
operated upon underwent tremendous physical pain and anguish and G
were traumatized. Consequently, a series of complaints were filed and
they were registered at Kursakanta Police Station on 8th January 2012
being S.DE No.135/12, 136/12, 137/12 and 144/12. Some of these
complaints were inquired into by the State authorities and it was found
that the sterilization camp was a success except that an expired medicine
H
784 SUPREME COURT REPORTS [2016] 5 S.C.R.

A had been given to the women. On the other hand, the study and the
investigations carried out by Devika Biswas along with a journalist called
Francis Elliott concluded that the sterilization camp did not meet any of
the requirements laid down by this Court or by the Government oflndia
and that this was confirmed by the women who were operated upon as
well as their relatives.
B
7. Devika Biswas then felt compelled to file a public interest
litigation in this Court to ensure that sterilization procedures nationwide
are conducted in accordance with accepted legal norms, medical
procedures and the provisions of the manuals and that those women and
men who suffer due to the failure or complications in implementing the
c norms, procedures and provisions are given adequate compensation. That
is really the core issue raised by Devika Biswas and that such instances
are not repeated. ·
8. In this context, Devika Biswas says in her writ petition that on
9th February 2008 the State Health Society in Bihar issued a memorandum
D to the Civil Surgeon in each district in the State. The result of this
memorandum was that sterilization procedures could now be conducted
in accredited private health facilities also in a camp mode. The
memorandum also mentioned that the State Government would provide
funds to the private facilities and the motivators as per the Government
E ofindia norms for conducting sterilization procedures. However it was
made clear that extra funds for camp management, transportation etc.
would not be provided by the Government to the accredited private
facilities.
9. This was followed by another memorandum dated 9th February
F 2009 regarding sterilization procedures carried out at government
institutions by empanelled private doctors. The memorandum issued by
the State Health Society of Bihar to the Civil Surgeon in all districts
stated that an em panel led private doctor might also be pennitted to carry
out family planning sterilization procedures in government institutions.
The Quality Assurance Committee of the distr.ict was entitled to employ
G private do.ctors including contractual doctors whose term had expired
for carrying out the sterilization procedures.
10. The petition filed by Devika Biswas goes on to say that in
2010 a Non Government Organization (NGO) called the Centre for
Health and Social Justice released a report concerning the quality of
H
DEVIKA BlSWAS v. UNION OF INDIA & ORS. 785
,.
[MADAN B. LOKUR, J.]

care and consequences of female sterilization procedures in Bundi district A
of Rajasthan in 2009-10. According to the report 749 women (mainly
underprivileged) were sterilized at Public Health Centres, Community
Health Centres or Camps. They were interviewed by researchers who
found that a significant number of them were not counseled about the
permanent nature of the sterilization procedure and almost 88% of them
B
told the researchers that they did not receive any information about
potential complications, failures or side effects of the sterilization
procedure. The report indicated that while the internationally accepted
failure rate is 0.5% the failure rate in Bundi district in Rajasthan was
2.5% that is 5 times the acceptable international standard.
11. Similarly, in February 2012 a Fact Finding Mission by a social
c
activist reported that sterilization procedures carried out in three districts
in Maharashtra, that i~, Nagpur, Chandrapur and Gadchiroli found that
sterilization camps were routinely conducted in unsanitary and unsafe
facilities.
12. Again in February 2012 a sterilization camp in Madhya Pradesh D
was conducted in Balaghat district without following any of the established
procedures and tribals were lured into sterilization camps by motivators
who collected a substantially large amount over and above the financial
norms fixed by the Government oflndia.
13. In Kerala also a similar story was repeated in July 2011 E
highlighting that sterilization procedures were not conducted in
accordance with the prescribed requirements of law or the procedures
laid down by the Government oflndia. In paragraph 40 of the writ petition,
Devika Biswas submits that "In July 2011, a local journalist in Wayanad
and the Chiefofthe Kattunayakan tribe, who serves as the President of F
the Primitive Tribal Association, met with health workers in Kerala. They
shared stories of men and women who were told by the govenlment
health workers that it was compulsory to undergo sterilization. The Chief
is concerned about government coercion and compulsion in sterilization
and its effect on the tribe's population."
G
14. In this background, Devika Biswas prayed for a series of
directions including setting up a committee to investigate the facts relating
to the sterilization camp held on ih January 2012 and to initiate
departmental and criminal proceedings against those who were involved
in the sterilization camp. It is also prayed that the guidelines given in the
H
786 SUPREME COURT REPORTS (2016) 5 S.C.R.

A manuals prepared by the Government of India should be scrupulously
adhered to so that such incidents do not recur in any part of the country
and if they do, additional compensation should be paid to the women in
distress.
15. In this writ petition, we are primarily concerned with the
B affidavits of the Union of India, the States of Bihar, Kerala, Madhya
Pradesh, Maharashtra and Rajasthan since allegations have been made·
in respect of sterilization camps held in these States only. However,
during the course of hearing of this writ petition, allegations surfaced
with regard to sterilization camps conducted in Bilaspur district,
Chhattisgarh [between 8th and 10th November 2014) and so we are
c also concerned with the allegations made in respect of the camps
conducted in that State as well.
16. What was brought to our notice with regard to the sterilization
camps conducted in Bilaspur district was that as many as 137 women
were subjected to a sterilization procedure and unfortunately 13 of them
D died. Many others complained of problems such as vomiting, difficulty
in breathing, severe pain etc. They were taken to nearby hospitals and
discharged after necessary treatment. It appeared that some women
who had not undergone" a sterilization procedure also had similar
complaints and some of them died thereby increasing the number of
E deaths to over 13. Undoubtedly, this was a matter of great concern
brought to our notice during the pendency of the writ petition.
Orders passed by this Court.
17. Notice in the writ petition was issued on 2'' April 2012 ang
thereafter the petition was taken up for active consideration only on 30
F January 2015 when the Social Justice Bench of this Court was seized of
this matter and after completion of pleadings and instructions received
by the learned Additional Solicitor General from the Union oflndia.
th
18. On 30 January 2015 after hearing learned counsel, a request
was made by us to the learned Sqlicitor General to ensure that a chart
G be prepared giving the status of implementation of each direction given
in Ramakant Rai (I). Details with regard to the implementation of the
Family Planning Indemnity Scheme, 2013 were also sought particularly
with regard to the release and utilization offunds under the said Scheme.
19. During the hearing, the events in Bilaspur, Chhattisgarh
H (mentioned above) also came up for consideration and so the State of
DEVIKA BISWAS v. UNION OF INDIA & ORS. 787
[MADAN B. LOKUR, J.]

Chhattisgarh was required to file an affidavit stating the steps taken to A
ameliorate the conditions of the persons who had faced the recent tragedy.
The State Government was also required to indicate the action taken
against the doctors involved and steps taken to educate the people in
Chhattisgarh with regard to the sterilization procedure and its impact..
20. The petition was then taken up for consideration on 20th B
March 2015 when it w;1fi noted that even though Chhattisgarh had filed
an affidavit dated 19t February 2015, it had not given sufficient
particulars and details with regard to the action taken subsequent to the
mishap in the sterilization camp. Chhattisgarh was therefore required to
file a proper and detailed affidavit including a copy of a sample FIR, post
mortem report and charge sheet filed, if any.
c
21. With regard to an affidavit filed by the Union of India in
relation to the implementation of the Family Planning Indemnity Scheme,
2013 it was noted thatthe manner ofutilization offunds was not indicated.
The learned Solicitor General assured this Court that full details in this
regard would be furnished and also an audit would be conducted to D
ensure that the funds are utilized for the purpose for which they have
been given by the Government of India to the State Governments.
Unfortunately, these details have not yet been furnished and we have
only the figures giving the budget approved as well as the expenditure
incurred by the State Governments and Union Territories. E
th
22. On 17 April 2015 the writ petition was again taken up for
consideration and as an interim measure the Secretary in the Ministry of
Health and Family Welfare of the Government oflndia was directed to
hold a meeting with his counterparts in the States and the Union Territories
to arrive at a consensus on the effective implementation of the various F
schemes relating to sterilization [of females and males], the Family
Planning Indemnity Scheme, 2013 and the directions given in Ramakant
Rai (I).
23. Chhattisgarh was also required to file a Status Report on the
progress made by a Commission set up by it (the Ms. Anita Jha G
Commission) to look into the tragedy that had occurred in the sterilization
camps held in Bilaspur.
24. The learned Advocate General appearing for the State of
Chhattisgarh stated that he would look into the issue of taking action
against the manufacturer of the drug used in the sterilization camps and
H
788 SUPREME COURT REPORTS [2016] 5 S.C.R.

A the feasibility of filing a charge sheet against the offenders and to step
up efforts to arrest the absconding persons or if necessary to declare
them proclaimed offenders.
25. In the hearing on ]4th August 2015 it was noted that the
Secretary in the Ministry of Health and Family Welfare had held a meeting,
' B as earlier directed, on 15'h May 2015. It was noted that one of the
suggestions given in that meeting was that similaF high level meetings
should be conducted every six months. Accordingly, we expected the
Secretary in the Ministry of Health and Family Welfare to conduct a
similar meeting after six months that is on or about J Sth November 2015.
c 26. As far as Chhattisgarh is concerned, it was noted that it had
filed an affidavit and the learned Advocate General stated that the Ms.
AnitaJha Commission submitted its report on 1Oth August 2015 and that
the report was likely to be considered by the State Cabinet in the next
c01,1ple of weeks.

D 27. The learned Advocate General informed us that two charge
sheets had been filed in connection with the tragedy and that no FIR
was pending investigation. He further stated that some scientific reports
were expected from a Forensic Science Laboratory and a supplementary
charge sheet would be filed, if necessary, immediately thereafter.

E 28. With regard to two absconding persons concerned with the
tragedy, it was stated by the learned Advocate General that they had
been declared proclaimed offenders and a reward had also been
announced for their whereabouts.
29. In the hearing on 4'h December 2015 we were informed that
F the report given by Ms. Anita Jha had since been accepted by the State
Cabinet. Subsequently, on 29'h March 2016 we were informed that an
Action Taken Report on the Ms. Anita Jha Commission Report had
been placed before the Legislative Assembly.
30. Since the proceedings in this case were not adversarial in
nature we requested the learned Additional Solicitor General appearing .
G
in the matter as well as the learned Senior Counsel to sit down and give
suggestions on how to implement the Standard Operatins Procedures
and the Guidelines laid down by the Union of India in the matter of
sterilization procedures.
31. On 4'h August 2016 when we heard the writ petition, we
H
DEVIKA BISWAS v. UNION OF INDIA & ORS. 789
[MADAN B. LOKUR, J.]

were informed that a meeting was in fact held between the learned A
Additional Solicitor General, learned Senior Counsel for Devika Biswas
and officials of the Ministry of Health and Family Welfare of the
Government of India and that an affidavit in this regard had also been
filed. We then heard learned counsel for the parties and reserved
judgment.
B
Affidavits filed by the Union of India
32. The Ministry of Health and Family Welfare of the Government
·of India has filed as many as I 0 (ten) affidavits. It is not necessary to
traverse each of them in detail. However, it is necessary to highlight the
broad submissions made. These are: C
(i) It is admitted that the Union oflndia received a complaint with
regard to the sterilization camp held on 7'h January 2012 and a report
had been called for in this regard. A report has since been received from
the concerned authorities in the State of Bihar and Dr. Abhay Kumar
Chowdhary, a contract physician at the Primary Health Centre had since D
been dismissed and it had further been ordered that he may not be
employed in any government work in future. First Information Reports
(FIRs 1 were lodged in respect of the events of 7'h January 2012,
investigations have concluded and charge-sheets filed.
(ii) The Government oflndia has published several Manuals for E
the guidance of the State Governments and Union Territories in respect
of sterilization procedures and conducting such camps. These are:
(a) Standards for Female and Male Sterilization, 2006;
(b) Quality Assurance Manual for Sterilization Services, 2006;
F
(c) Standard Operating Procedures for Sterilization Services in
Camps, 2008;
(d) Fixed Day Static Approach for Sterilization Services, 2008;
(e) Family Planning Insurance Scheme;
(f) Compensation Scheme for Acceptors of Sterilization (revised G
on 31" October 2006 and improved with effect from 7'h
September 2007);
(g) Standards and Quality assurance in Sterilization Services, 2014
including Standard Operating Procedure for camps;
H
790 SUPREME COURT REPORTS [2016] 5 S.C.R.

A (h) Reference manual for Female Sterilization, 2014;
(i) Reference Manual for Male Sterilization, 2013;
(j) Manual for Family Planning Ind~mnity Scheme, 2013 (updated
in 2016);
(k) Frequently Asked,Questions, 2016.
B
(iii) Public Health is a State subject occurring in Entry 6 of List II
of the Seventh Schedule of the Constitution. The Government oflndia
only plays a supportive and facilitative role in achieving health welfare
schemes and it is essentially the State Government that is in the best
position to monitor the quality of services in accordance with agreed
C . benchmarks.
(iv) The following funds have been approved and utilized (in lakhs)
by the States under the Family Planning Indemnity Scheme, 2013:
Approval Expenditure Approval Expenditure
2013-14 2013-14 2014-15 2014-15 (till end
D of 3rd quarter)
1566.69 675.59 1485.80 828.19

At this stage it may be mentioned that the coverage under the
Family Planning Indemnity Scheme is as follows:
Section Coverage Limits
E ·'

I. Death following sterilization (inclusive Rs. 2 lakh
of death during process of sterilization
operation) in hospital or within 7 days
from the date of discharge from the
hospital
F 2. Death following sterilization within 8- Rs. 50,000/-
30 days from the date of discharge from
the hospital
3. Failure of sterilization Rs. 30,0001-

4. Cost of treatment in the hospital and Actual not
up to 60 days
..
ans mg out of exceeding Rs .
G complication following sterilization 25,000/-
operation (inclusive of complication
during process of sterilization
operation) from the date of discharge
5. Indemnity per doctor/health facilities Up to Rs. 2
but not more than 4 in a year lakh per claim
H
DEVIKA BISWAS v. UNION OF INDIA & ORS. 791
[MADAN B. LOKUR, J.]

The Union oflndia has given no clear-cut answer regarding audit A
of disbursal of the amounts, except to say that the States and the Union
Territories are required to follow the financial management system and
are required to submit statutory audit reports, utilization certificates,
quarterly summary on concurrent audits etc. Whether this is being
adhered to by the States and the Union Territories is not mentioned. It is
B
also not clear whether the accounts of the various organizations involved
in sterilization procedures are in fact open for inspection by the sanctioning
authority and audit including the Comptroller and Auditor General of
India and the internal audit of the Ministry of Health and Family Welfare
of the Government oflndia.
(iv) The Union oflndia has issued an advisory to all the States
c
and Union Territories on JO•h December 2014 to adhere to the standard
operating procedures at all levels to prevent and pre-empt incidents that
might adversely affect the health of clients due to sterilization procedures.
(v) In the high level meeting held on 15th May 2015 (pursuant to
orders passed by this Court) the following key action points were agreed D
upon:
(a) Sterilization services must be provided in a client friendly
manner in a conducive environment after taking informed consent.
Safety of those who opt for it should be ensured.
E
(b) A mechanism be put in place wherein service providers or
managers are not victimized or arrested without instituting a proper
enquiry by the district/State quality assurance committees.
( c) All States to conduct workshops on quality in sterilization
services orienting its programme managers and service providers
F
both at the State and district level on the updated manuals on
standards, male and female sterilization and family planning
indemnity scheme.
( d) All Government oflndia guidelines to be strictly ;:Jifered by
the States. '
G
(e) A periodic assessment ofall the facilities and fixed day camps
by 1-2 members of the sub-committees under the SQAC/DQACs
[State Quality Assurance Committee/District Quality Assurance
Committee] on implementation of the infection prevention
protocols as well as the efficacy of the services provided, should
H
792 SUPREME COURT REPORTS [2016] 5 S.C.R.

... _.,,,' ....,

A be carried out (as laid down in the Manuals).
(f) The issue of shortage of pool of providers for sterilization
could be addressed by resorting to compulsory training ofMBBS
medical officers when they join government service.
(g) Onsite Training/mentoring be initiated by identifying high
B caseload facilities (first) to undertake sterilization trainings. This
will ensure the service provider is available at the facility to
undertake their primary task of providing services to the clients in
addition to provide training to prospective trainees.
(h) Retraining of providers who are either short on confidence
c or have high failure rates.
(i) There should be more thrust on Minilap Sterilization as it
leads to fewer failures and complications.
U) The scope of increasing the basket of contraceptive choices
D like injectables/implants and weekly pills like 'Saheli' be explored
urgently to provide more choice.
(k) The idea of mobile teams or clinical outreach teams needs to
be encouraged to address the issue of shortage of surgeons.
(I) Every case of sterilization death must be audited as per format
E laid down and reported to the Government oflndia.
(m) Line listing of deaths and failures to be undertaken district/
facility wise and surgeon wise. Disbursal of claims for deaths,
failures and complications should be computerized.
(n) To address the issue of sterilization failures, sterilization
F certificates should be issued after at least one month in case of
female sterilization and after three months in case of male
sterilization.
(o) States to take urgent steps to rejuvenate the Family Planning
Programme with the ultimate aim of reducing the maternal and
G infant mortality and morbidity in addition to achieving population
stabilization.
(p) Government oflndia to conduct high level meeting like the
instant one with all States to acquaint them with the latest policies
and programmes of the Government of India on a yearly basis.
H
DEVIKA BISWAS v. UNION OF INDIA & ORS. 793
[MADAN B. LOKUR, J.]

(vi) In the high level meeting held on 171h November 2015 A
(pursuant to orders passed by this Court) the following key priority areas
were shared with the State Governments and Union Territories:
(a) Uniform consent forms should be available in all facilities
which should be duly filled in and the consent of the client should
be taken prior to the procedure in all cases. B
(b) State Quality Assurance Committee (SQAC)/District Quality
Assurance Committee (DQAC) and State Indemnity Sub
Committee (SISC)/District Indemnity Sub Committee (DISC) to
be constituted as per the GOI guidelines.
(c) All the Family Planning guidelines should be printed and c
disseminated at the State/district as well as facility level.
(d) State/District level orientation of all the program managers
and providers for the guidelines and protocols to be completed in
all States.
D
(e) Members of SQAC and DQAC should conduct periodic
supportive supervision visits as per quality protocols. The findings
of the same are to be documented and corrective actions should
be taken.
(f) Training calendar for training newly recruited doctors is to be E
prepared and updated in each State.
(g) Line listing of all the sterilization providers needs to be prepared
and periodically updated by all State.s.
(h) Every death attributable to sterilization should be audited.
(i) Sterilization certificates should be issued as per existing F
guidelines.
The aforesaid meeting was held through video-conferencing. The··
representative ofUttar Pradesh could not attend due to a State holiday
and since the office of the National Informatics Centre in the State was
closed. It may be mentioned that this is somewhat odd and suggests that G
responsible officers in the State of Uttar Pradesh seem to give more
importance to State holidays rather than issues relating to Family Planning.
This is most unfortunate, to say the least.
(vii) A National Summit on Family Planning was held on S'h and
H
794 SUPREME COURT REPORTS [2016] 5 S.C.R.

A 61h April 2016. As a result of several workshops and summits held from
time to time on issues relating to family planning and the directions given
by the Court from time to time the following practical and pragmatic
measures were proposed by the Government in addition to the new
guidelines proposed to be undertaken:
B (a) Conducting annual review workshops of the programme in all
States of India with the State and district programme managers
and service providers.
(b) Monthly monitoring of at least 2 public health facilities and l
accredited private/NGO facility by SQAC/DQAC.
c (c) Replacement of operational 'Camps' by regular 'Fixed day
services' over the next three years.
(d) Further Strengthening of the State Quality Assurance
Committee (SQAC) and District Quality Assurance Committee
(DQAC) mechanism.
D
(e) Close monitoring, reviewing and collection of reports of deaths
attributable to sterilization by the Government ofindia.
(f) Conducting Client exit interviews of I 0% cases as per the
prepared checklist ..
E (g) Feedback from beneficiaries by Maternal and Child Health
Tracking Facilitation Centre (MCTFC).
(viii) Our country has adopted a comprehensive RMNCH+A
(Reproductive, Maternal, Neonatal, Child and Adolescent Health) strategy
under which the Family Planning program is being emphasized to promote
F reproductive health and reduce maternal, infant and child mortality and
morbidity.
(ix) The States of Tamil Nadu, Maharashtra, Sikkim and Goa
have already phased out the holding of sterilization camps. During the
course of submissions we were informed by the learned Advocate General
G for Chhattisgarh that that State has also phased out such camps. As far
as the Union oflndia is concerned, it proposes to ensure the phasing out
of such camps over the next three years.
(x) Several improvements have been made in the Family Planning
program and sterilization procedures. They are:
H
DEVIKA BISWAS v. UNION OF INDIA & ORS. 795
[MADAN B. LOKUR, J.]

(a) Decline in deaths following sterilisation from 140 in 2014-15 A
to 89 in 2015-16 (as per data available on the web based HMIS
till 31.3.2016);
(b) Decline in the number of failures from 5928 in 2014-15 to
2093 in 2015-16 (as per data available on the web based HMIS
till 31.3.2016); B
(c) The empanelled list of providers is available in every district;
(d) Surgeons are not performing more than 30 cases per day;
(e) Camps are being held only in public health facilities or
accredited private/NGO facilities. c
(f) Workshops relating to Family Planning programme have been
held in 28 out of29 States (as on 21st July, 2016). Unfortunately,
no such workshops were held after 24th August, 2015.
(g) The number of deaths attributable to sterilisation procedures
in 2014-2015 was 140 but it has come down in 2015-2016 to 113. D
(h) In 2015-2016 clients exit interviews have been conducted in
respect of 1,06,055 persons.
(i) Monitoring and supervision of facilities by SQAC/DQAC in
2015-2016 ih regard to public facilities is as high as 12,044 and
with regard to private accredited facilities it is as high as 2,984. E

U) The amount allotted for quality improvement which includes
training, family planning equipments, other service delivery
activities, human resource cost, infrastructure share, planning and
monitoring (including quality assurance) and family planning
commodities is as follows: F
.

Year 2013-14 2014-15 2015-16
Amount in Crores 1000.7 1648.07 1243.9
The sum and substance of the affidavits is that it is not as ifthe Ministry
of Health and Family Welfare of the Government oflndia is sitting idle G
and not taking adequate interest in the success of the Family Planning
program and particularly in sterilization procedures in public and private
health facilities. While deficiencies and faults have been pointed out,
there has also been considerable improvement in an ongoing exercise of
national importance.
H
796 SUPREME COURT REPORTS [2016] 5 S.C.R.

A Affidavits filed by the State of Bihar
33. The State of Bihar has filed two affidavits, a Status Report
and Written Submissions. '
34. The broad allegations ma~e by Devika Biswas have been
accepted and it is accepted that a sterilization camp was conducted by
B Jai Ambey Welfare Society (NGO) late in the evening of 7'h January
2012 in violation of the orders of the concerned Civil Surgeon. An FIR
has been lodged against the NGO not only for violating the directiv"es but
also for distributing expired medicine to the beneficiaries of the family
planning camp. ' · -'
c 3 5. It is further stated that the NGO has since been blacklisted
and steps have been taken for giving compensation to some of the women
who had developed complications during the surgeries.
36. The blacklisting is confirmed by respondent No. 4, that is,
Kumar Nath Choudhary, Secretary of Jai Ambey Welfare Society who
D filed an affidavit on l 4'h January 2013 in which it is stated that hue and
cry was made about the sterilization camp by anti-social elements and
as a result three FIRs, namely, Kursakanta P.S. Case No.03/2012, Case
No.05/2012 and Case No.14/2012 have been lodged against the NGO.
3 7. Two charge-sheets have been filed in respect of Kursakanta
E P.S. Case No.03/2012 and Case No.05/2012.
38. As regards Kursakanta P.S. Case No.03/2012, Charge Sheet
bearing No. 23 of2012 dated 09.03.2012 and supplementary Charge
Sheet No. 167 of2012 dated 31.12.2012 have been submitted. Cognizance
of the offence has been taken and thereafter Revision Application No.
F 44/369/12 has apparently been filed by the accused persons and that is
pending in the District Court in Araria.
39. As regards Kursakanta P.S. Case No.05/2012, Charge Sheet
No. 24 of2012 dated 12.03.2012 and supplementary Charge Sheet No.
87 of2013 have been submitted. Cognizance of the offence has been
G taken.on 28.06.2012 and a Revision Petition has apparently been filed
by the accused bearing No. 31/226/13 which is pending in the District
Court in Araria.
40. As regards Kursakanta P.S. Case No.14/2012 is concerned,
the details are not available on record.
H
DEVIKA BISWAS v. UNION OF INDIA & ORS. 797
[MADAN B. LOKUR, J.]

41. We have also been told that an FIR has been filed against the A
NGO Jay Am bey Welfare Society for distributing expired medicines to
the beneficiaries of the Family Planning camp held on 7'h January 2012.
A Charge Sheet has been filed in this regard and cognizance of this
offence has also been taken by the Trial Court, but again the details are
not available.
B
42. It is also admitted by the State ofBihar that inquiries into the
events that took place on 71h January 2012 have been concluded and
show cause notices have been issued to the Medical Officer in charge
in the Primary Health Centre in Bausa, Pumia as well as Kursakanta,
Araria and also to the Civil Surgeon, Purnia.
c
43. Thatthe situation in Bihar has not improved is clear from the
fact that in Saran district the accreditation of Gunjan Maternity and
Surgical Clinic at Chhapra to condupt sterilization procedures was
cancelled on 4'h March 2012, just a few months after the incident in
Araria district.
D
Affidavit filed by the State of Kerala
44. The State of Kerala has filed a Statement of Facts through a
letter dated l 51h March 2013. The Statement of Facts is not accompanied
by an affidavit and the first page of the Statement of Facts is not on the
record of this case. However, the letter states, inter alia, that "In Kerala E
sterilization camps are conducted only in well equipped centres (usually
in first referral units and above hospitals) where there are operation
theatre facility, lab facility, referral facility are in place." It is also stated
that "sterilization procedures are carried out in hygienic, well equipped
hospitals under the control and supervision of qualified empanelled
doctors." This is reiterated in an affidavit dated I" July 2013 filed by the F
State of Kerala.
45. In response to the submission made in the writ petition, the
State of Kerala states in paragraph 11 of its affidavit:
"[The] tribal population of Kera la State is accorded special
G
consideration for its dealing members. There is no compulsion of
promotion of-sterilization as part of Government policy. At the
same time family planning services are not denied to this segment
of the population if demanded. Felt need of the community is
assessed by the Health Worker and various options are put before
H
798 SUPREME COURT REPORTS [2016] 5 S.C.R.

·A them explaining the merits and demerits of each method and
encouraging to make right choice."
There is therefore no specific denial of the submission n:iade by
Devika Biswas in her writ petition.
Affidavit filed by the State of Madhya Pradesh
B
46. The State of Madhya Pradesh has filed only one affidavit
dated 7'h August 2013 and the allegations made by Devika Biswas have
not been denied in that affidavit.
47. However, the State of Madhya Pradesh denies coercive
c sterilizations and asserts that sterilization is undertaken only after informed
consent of the patient. The State further submits:
"The State Government has issued instructions for taking due
precautions for sterilization operations. The State Government has
formed Quality Assurance Committee in each District of the State
which is headed by the Chief Medical and Health Officer of the
D
district. The function of the Quality Assurance Committee is to
review all types of cases where there is some complication and
take necessary steps to rectify the same."
There is no specific denial of the events in Balaghat district.
E Affidavit filed by the State of Maharashtra
48. The State of Maharashtra has filed only one affidavit dated
14'h August 2012 in which it is generally stated that the family planning
program is being conducted satisfactorily and a large number of statistics
have been given in support of this submission. However, with regard to
F the sterilization camp held in Nagpur, Chandrapur and Gadchiroli districts
it is stated as follows:
"It is respectfully submitted that in the light of facts submitted in
the Petition by the Petitioner, detailed report has been called from
the Civil Surgeon, Gadchiroli, Chandrapur and Nagpur District
G which is marked and annexed as Annexure-1. However, keeping
in view the gravi_ty of such instances reported, State has taken
immediate corrective action and instructions have already been
issued to all the District Health Officers and Civil Surgeons to
perform the family planning operations as per the standards
prescribed by Govt. oflndia in hygienic conditions."
H
DEVIKA BISWAS v. UNION OF INDIA & ORS. ·799
[MADAN B. LOKUR, J.]

No detailed report has been annexed and no further affidavit was A
filed by the State of Maharashtra regarding any action taken against any
officer responsible for the mishap, any compensation paid or any further
action taken in this regard.
Affidavit filed by the State of Rajasthan
49. The State ofRajasthan in its affidavit filed on 23rct November B
2012 does not specifically contradict the contents of the report relating
to the sterilization procedures carried out in Bundi district but only affirms
that the standard operating procedures are being followed and that the
failure rate is in conformity with the failure rate prescribed by the
Government of India. c
50. The State ofRajasthan maintains that the proposed patients
are sufficiently instructed and advised with respect to both the sterilization
itself as well as post-sterilization care. The State further mentions that
continuous efforts are made by the health employees "to motivate females
to take up sterilization surgery". The failure rate at Bundi district "is in D
conformity to the failure rate prescribed by the Government oflndia".
The State submits that sufficient steps have been taken for implementation
of the directions in Ramakant Rai (/)as well as the guidelines of the
Government oflndia.
Affidavits filed by the State of Chhattisgarh E
51. The State of Chhattisgarh has taken up the issue of
mismanagement of the sterilization camps in Bilaspur district with due
promptitude and seriousness and has filed detailed affidavits that not
only specify the ameliorative steps taken but also the preventive steps
against recurrence of a similar tragedy.
F
52. Chhattisgarh has confirmed that sterilization camps were
organized in Sakri village ofBilaspur district on 8th November 2014 and
in Gore la, Pendra and Marwahi in Bilaspur district on 1Olh November
2014. In all 137 operations were conducted and many of those operated
upon complained of vomiting, pain and difficulty in breathing.
G
Consequently, all of them were admitted in nearby hospitals for treatment.
Unfortunately, 13 deaths took place despite relief measures including
bringing in a team of doctors from the All India Institute of Medical
Sciences in New Delhi. '0
53. Apart from these 137 persons, 37 persons who were not
H
800 SUPREME COURT REPORTS [2016] 5 S.C.R.

A operated upon also had similar complaints and 5 (five) of them died
thereby bringing the total number of deaths to 18. It appears that the
cause of death of these 5 (five) persons was not related to the sterilization
procedure but was due to consumption of Ciprocin 500 tablet.
54. By way of monetary compensation, the State Government
B has given Rs. 4 lakhs to the families of those who died and Rs. 50,000/
- to those who were discharged from medical institutions. The children
of the deceased have been adopted by the State Government which has
taken the responsibility of providing them free education and health care
till they are 18 years of age. The State Government has also put in an
amount of Rs. 3 lakh in a fixed deposit for children of the persons who
c died in the tragedy. The children would be entitled to the amount on
attaining the age of 18 years.
55. Departmental action has been taken against the doctors
involved in the sterilization camps. Two of them have been dismissed
from service while two others have been suspended pending a
D departmental enquiry. The Licensing Authority has also been suspended.
56. A Judicial Commission oflnquiry headed by a retired District
Judge Ms. Anita Jha was set up to give its findings on the criminal
culpability and accountability of the persons concerned. The report given
by the Ms. Anita Jha Commission has been accepted by the State
E Government and also acted upon.
57. Criminal proceedings in the form of Charge Sheet No.19/
2015 dated 15th February 2015 has been filed in the Court of Judicial
Magistrate, First Class at Bilaspur against Dr. R.K. Gupta, Ramesh
Mahawar, Sumit Mahawar (manufacturers of Ciprocin 500 tablets),
F Rajesh Khare, Rakesh Khare and Manish Khare (suppliers ofCiprocin
500 tablets). Rakesh Khare and Manish Khare have since been declared
proclaimed offenders and their property attached and a reward for their
arrest and information of their whereabouts has also been announced.
58. As regards measures taken to prevent the recurrence of such
G an incident, Chhattisgarh has begun placing greater emphasis on spacing
measures which will be more effective in population control. Greater
emphasis is being placed on vasectomy for gender equity. An advisory
has been issued that Ciprocin 500 should not be consumed and efforts
are being made to educate people about the importance, benefits, methods
and availability of services in health facilities. A mass awareness campaign
H
DEVIKA BISWAS v. UNION OF INDIA & ORS. 801
[MADAN B. LOKUR, J.]

has also been launched and several other pro-active measures have A
,been taken.
59. All in all, the State of Chhattisgarh has reacted positively to
the tragedy and has not sought to hide inconvenient facts under the
carpet.
B
Further submissions of Devika Biswas
60. Devika Biswas has pointed out in various affidavits filed during
the pendency of this writ petition that the campaign for sterilization is
effectively a relentless campaign for female sterilization. The web portal
of the Ministry of Health and Family Welfare of the Government of
India provides statistics on the number of sterilization procedures c
conducted in the country for 2012-13. The portal indicates that 97.4%
of all sterilization procedures during this period were of women.~ Devika
Biswas alleges that the entire family planning program ofChhattisgarh
focuses on female sterilization and the National Health Mission Project
Implementation Plan sets targets for female sterilization and allocates D
85% of the family planning budget exclusively to female sterilization.
61. More or less confirming the allegations made by Devika Biswas,
the affidavits filed by Madhya Pradesh, erstwhile Andhra Pradesh and
Goa reflect the fact that the over-whelming number of sterilization
procedures is targeted towards women and there is virtually no attention E
paid to male sterilization.
62. Devika Biswas has also pointed out that data released by the
Ministry of Health and Family Welfare during the period 20 I 0-13 shows
that at least 363 people have died as a result of sterilization procedures,
a very large number of such procedures have failed and that there have
F
been severe complications in respect of several persons who underwent
a sterilization procedure. This has resulted in payment of compensation
of at least Rs. 50 crores. 3
63. The principal problem pointed out by Devika Biswas is with
regard to the implementation of the various processes and guidelines
G
2
This has now gone up to 98, 1% for 2014-15
3
This information is in fact not very clear from the data on the website of the Ministry
but is available at: http://pib,nkin/newsite/PrintRelease.aspx?relid=I 06949: Press
Information Bureau, Government of India, Ministry of Health and Family Welfare,
18.07.2014,
H
802 SUPREME COURT REPORTS [2016] 5 S.C.R.

A issued by the Government oflndia from time to time. Mere issuance of
guidelines by the Government of India does not guarantee their
implementation. It is pointed out (for example) that the list of empanelled
doctors is not readily available; consent forms are not available in the
local language except in the Union Territory of Puducherry; unrealistic
targets have been set for sterilization procedures with the result that
B
non-consensual and forced sterilizations are taking place, including of
persons who are physically or mentally challenged. Some young persons
have been sterilized to meet targets and by and large illiterate persons
are sterilized. Devika Biswas is opposed to setting of targets and says
that she has the support of the Governme[lt oflndia in this regard, but
c unfortunately State Governments and Union Territories are still setting
informal targets for sterilization.
64. It is further pointed out that there is inadequate monitoring of
sterilization camps and facilities. There is little or no monitoring in most
camps and health centres, accountability measures are not in place and
D ,- the rights of thousands of women who undergo sterilization procedures
are violated. It is not enough for the Government ofindia to show that
it is merely playing a supportive and facilitative role since the campaign
is a national campaign and if it is not properly implemented, it merely
leads to passing the buck with the State Government blaming the
Government of India and vice versa.
E
65. The strengthening of the Quality Assurance Committees
(QAC) and the District Quality Assurance Committees (DQAC) is crucial
to the success of a family planning program of which sterilization
procedures is one of the elements. Details of the constitution ofQACs
and DQACs are not available on the website of the Ministry of Health
F and Family Welfare. There is also no indication of the steps and decisions
taken by them or the minutes of their meetings or reports submitted by
them. In other words, vital information is simply not available. Devika
Biswas doubts whether these Committees meet on a regular basis
although it would be appropriate for them to have at least quarterly
G meetings if not meetings every six months.
66. According to her, unless these existing institutions function
effectively and efficiently or are made to function effectively and
efficiently, it is very unlikely that any meaningful progress will be made
in the family planning program of the Government of India, of which
H sterilization is an important component.
DEVIKA BISWAS v. UNION OF INDIA & ORS. 803
[MADAN B. LOKUR, J.]

67. With regard to the Family Planning Indemnity Scheme, it is A
pointed out that regular reviews are not carried out; the utilization of
funds made available under the Scheme are mere figures since the details
of disbursements in case of death, failure, complication etc. are simply
not available anywhere. There is no indication of the number of claims
filed, the number of claims rejected and the reasons for the rejection and
B
the amount provided to each successful claimant. The Scheme requires
a death audit to be carried out but that is more or less missing in every
instance. It is stated that specialists who are conversant with the Scheme
are not available at sterilization camps and health centres to explain the
Scheme in detail so that there is no difficulty or complication faced in the
event of an unfortunate mishap. It should be the duty of such a specialist c
to ensure that each person proceeding to undergo a sterilization procedure
has a copy of all the required documents so that there is no difficultly
faced later on. This will also ensure that each person gives an informed
consent to the sterilization procedure in a language that he or she
understands. In fact, all information that is disseminated with regard to
D
the sterilization procedure should be made available in the local language
at all Government health facilities and accredited private facilities.
68. It is high time, according to Devika Biswas, forthe Government
of India to look at the quality of care made available to persons post a
sterilization procedure. As is clear from various documents on record
including the Ms. Anita Jha Commission Report, after-care facilities in
E
terms of counseling, assistance, follow-up etc. are totally absent.
Is it a public health issue?
69. The fundamental error that the Union oflndia is making (and
it has repeated that in its affidavits) is by asserting that the effective F
implementation of the sterilization program is the concern of each State
since it is a "Public health" issue covered by Entry 6 of List II in the
Seventh Schedule (the State List) of the Constitution. Apart from the
fact that the various entries in the Seventh Schedule relate to legislative
power, the error made by the Union oflndia is in completely overlooking
the more appropriate Entry in the Concurrent List that is Entry 20A G
which is "Population Control and Family Planning". This was inserted
by the Constitution (Forty-second) Amendment Act, 1976. If the
sterilization program is intended for population control and family planning
(which it undoubtedly is) there is no earthly reason why the Union of
India should refer to and rely on Entry 6 of the State List and ignore H
804 SUPREME COURT REPORTS [2016] 5 S.C.R.

A Entry 20A of the Concurrent List. Population control and family planning
has been and is a national campaign over the last so many decades.
Therefore, the responsibility for the success or failure of the population
control and family planning program (of which sterilization procedure is
an integral part) must rest squarely on the shoulders of the Union of
India. It is for this reason that the Union of India has been taking so
B
much interest in promoting it and has spent huge amounts over the years
in encouraging it. It is rather unfortunate that the Union oflndia is now
treating the sterilization program as a Public Health issue and making it
the concern of the State Government. This is simply not permissible and
appears to be a case of passing the buck.
c 70. As regards Entry 20A of the Concurrent List, the Justice
Sarkaria Commission had this to say in Chapter II titled Legislative
Relations in paragraph 2.21.08:
"Only one State Government has suggested that this Entry should
be transferred to the State List. According to them family planning
D facilities should be an integral part of the health facilities which is
a State subject and the present dichotomy between the two facilities
hampers their adequate integration. Population control and family
planning are a vital part of the national effort at development.
This Entry was inserted by the Forty-second Amendment to the
E Constitution recognising the importance of this matter. It is well
known that a significant part of the fruits of development is
neutralised by the high growth in population. With more mouths to
feed, less savings are available for development. Large addition
to the population has its impact on every aspect of the nation's
life. Many of the ills of the society can be traced back to large
F numbers who are unable to find a rewarding employment. It is
necessary to recognise this inter-dependence between family
planning and other sectors. We are, therefore, of the view that
Population Control and Family Planning is a matter of national
importance and of common concern of the Union and the States."
G Notwithstanding the view of that one State Government, the Union
oflndia did not transfer Entry 20A to the State List, thereby making its
intentions quite clear and obvious.
71. When the Union of India formulates schemes of national
importance such as family planning, their implementation is undoubtedly
H
DEVIKA BISWAS v. UNION OF INDIA & ORS. 805
[MADAN B. LOKUR, J.]

dependent on the State Governments since they have the requisite A
mechanism for implementing the schemes and can also take into account
the needs that are particular to the State and its people. In this manner,
the cooperation of the Union of India and all State Governments is
indispensable to the success of such national programs. Adverting to the
provisions of the Constitution that allow for such coordination between
B
the Union and States, the Justice Sarkaria Commission held that these
provisions are not repugnant to but instead further the principle of
federalism.
72. In the same manner, it is imperative for both the Union of
India and the State Governments to implement schemes announced by
the Union of India in a manner that respects the fundamental rights of
c
the beneficiaries of the scheme. Given the structure of cooperative
federalism, the Union of India cannot confine its obligation to mere
enactment of a scheme without ensuring its realization and
implementation.
73. Apart from anything else, by not giving the sterilization program D
the importance it deserves (apart from other methods of population control
and family planning) and trying to pass the buck to the State Governments,
the Union oflndia is attempting to find an excuse for failure in its duty of
effectively monitoring a program of national importance. This game of
passing the parcel and treating a f)ational program as a public health E
issue has to stop and somebody must take ownership of the Population
Control and Family Planning program.
Draft National Health Policy
74. To compound the problem, and it is much more than a pity,
our country does not seem to have any health policy. The draft of a F
National Health Policy, 2015 was put up on the website on the Ministry
of Health and Family Welfare of the Government oflndia in December
2014 for comments, suggestions and feedback but even after more than
one and a half years, the website of the said Ministry shows that the
National Health Policy has not been finalized. G
75. The draft National Health Policy states that its primary aim is
to " ... inform, clarify, strengthen and prioritize the role of the Government
in shaping health system in all its dimensions ... " The draft recognizes
the correlation between health and development and also "recognizes the
high inequity in access to health care.
H
806 SUPREME COURT REPORTS [2016] 5 S.C.R.

A 76. With respect to sterilization, it states that sterilization related
deaths are a direct consequence of poor health care quality and is a
preventable tragedy. It also recognizes that female sterilizations are safest
if performed in an operation theatre which is functional throughout the
year and by a professional team with support systems which are in
constant use. Camp mode for such operations itself becomes a reason
B
for unsatisfactory quality. More monetary and human resource investment
is required for the National Rural Health Mission.
77. Increase in the proportion of male sterili~ation in the total
sterilizations from the existing 5% to at least 30% is stated to be another
policy imperative under the health policy. Coercive methods are not
c justified and are not even effective in meeting the goals of population
control. Improved access, education and empowerment should be the
aim.
78. Under the head of 'Governance' the draft National Health
Policy states:
D
"One of the most important strengths and at the same time
challenges of governance in health is the distribution of
responsibility and accountability between the Center and the States.
Though health is a State subject, the Center has accountability to
Parliament for central funding- which is about 36% of all public
E health expenditure and in some states over 50%. Further it has its
obligations under a number ofintemational conventions and treaties
that is a party to. Further, disease control and family planning are
in the Concurrent list and these could be defined very widely.
Finally though State ownership has been used by some states to
F become domain leaders and march ahead setting the example for
otbers, the Center has a responsibility to correct uneven
development and provide more resources where vulnerability is
more."
Surely, someone should be concerned that we do not have a
G national health policy or is it that we do not need.a national health policy
and ad hoc measures are good enough?
Female versus male sterilization
79. A perusal of the various affidavits on record indicates that the
sterilization program is virtually a relentless campaign for female
H
DEVIKA BISWAS v. UNION OF INDIA & ORS. 807
[MADAN B. LOKUR, J.]

sterilization. This is more or less confirmed from the figures available A
on the website of the Ministry of Health and Family Welfare of the
Government oflndia which indicate thefollowing:
YEAR 2013 2014
Female sterilizations 1,57 ,431 1,49,262
Male sterilizations 8130 5085 B
Total sterilizations I ,65,561 1,54,347
% Female sterilizations 95.09% 96.7%
%Male sterilizations 4.91% 3.29%

80. The issue of male versus female sterilizations was debated
and discussed during the course of the hearings and it was conceded by
c
all the learned counsel that the sterilization program cannot be targeted
primarily towards women but must also actively include the sterilization
of men as well. It appears to us, without going into the merits and demerits
of the incentives given for undergoing the sterilization procedure, the
documents on record indicate that the incentive given to males for D
undergoing a sterilization procedure is less than it is for females and that
may perhaps be one of the reasons why the percentage of males being
sterilized is so remarkably low as compared to females. This is an area
that the Union of!ndia must address itself to, ifnothing else then at least
for reasons of gender equity.
E
Right to life
81. The manner in which sterilization procedures have reportedly
been carried out endanger two important components of the right to life
under Article 21 of the Constitution - the right to health and the
reproductive rights of a person. F
(i) Right to health
82. It is well established that the right to life under Article 21 of
the Constitution includes the right to lead a dignified and meaningful life
and the right to health is an integral facet of this right. In C.E.S. C.
Limited and Ors. v. Suhltash Chandra Bose and Or~ dealing with ·G
the right to health of workers, it was noted that the right to health must
be considered an aspect of social justice informed by not only Article 21
of the Constitution, but also the Directive Principles of State Policy and

'(1992) I SCC441 H
808
- [2016] 5 S.C.R.
SUPREME COURT REPORTS

A international covenants to which India is a party. Similarly, the bare
·minimum obligations of the State to ensure the preservation of the right
to life and health were enunciated in Paschim Banga Khet Mazdoor
Samity v. State of W.B.. ;
83. In Bandhua Mukti Morc/w v. Union of India & Others6
B this Court underlined the obligation of the State to ensure that the
fundamental rights of weaker sections of society are not exploited owing
to their position in society.
84. That the right to health is an integral part of the right to life
does not need any repetition.
c (ii) Right to reproductive health
85. Over time, there has been recognition of the need to respect
and protect the reproductive rights and reproductive health of a person.
Reproductive health has been defined as "the capability to reproduce
and the freedom to make informed, free and responsible decisions. It
D also includes access to a range of reproductive health information, goods,
facilities and services to enable individuals to make informed, free and
responsible decisions about their reproductive behaviour."' The
Committee on Economic, Social and Cultural Rights in General
Comment no. 22 on the Right to Sexual and Reproductive Health
E under Article 12 of the International Covenant on Economic, Social and
Cultural Rights 8 observed that "The right to sexual and reproductive
health is an integral part of the right of everyone to the highest attainable
physical and mental health. " 9

'(1996) 4 sec 37.
F '(1984)3sec161.
7
WHO, Sexual Health, Human Rights and the Law (2015) cited from Committee on
Economic. Social and Cultural Rights. General comment No. 22 (2016)on the right to
sexual and reproductive health (Article 12 of the International Covenant on Economic,
Social and Cultural Rights), May 2, 2016, E/C.12/GC/22 at paragraph 6, available at
https://documents-dds-ny. un. org/doc/UNDOC/G EN/G 16/089/32/PDF I
G G 1608932.pdf?OpenElement
'India ratified this Convention on April I 0, 1979.
9
General comment No. 22(2016) on the right to sexual and reproductive health (article
12 of the International Covenant on Economic, Social and Cultural Rights), E/C.12/GC/
22, available at https://documents-dds- ny,un.org/doc/UNDOC/GEN/G 16/089/32/PDF/
1608932.pdf? OpenElement
H
DEVIKA BISWAS v. UNION OF INDIA & ORS. 809
[MADAN B. LOKUR, J.]

86. This Court recognized reproductive rights as an aspect of A
personal liberty under Article 21 of the Constitution in Suc/1ita Srivastava
v. Cllandif(arll Administration. 10 The freedom to exercise these
reproductive rights would include the right to make a choice regarding
sterilization on the basis of informed consent and free from any form of
coercion. The issue of informed consent in respect of sterilization
B
programs was considered by the Committee on tile Elimination of
Discrimination Against Women in A.S. v. Hungary1 1, where the
Committee found Hungary to have violated Articles 1O(h ), 12 and 16,
paragraph l(e) of the Convention on the Elimination of Discrimination
Against Women 1c by performing a sterilization operation on A.S. while
she was brought in for a caesarean by making her sign a consent form c
that she did not fully understand. The Committee found that it was not
plausible to hold that, in the brief period of 17 minutes commencing from
her admission in the hospital to the completion of the surgical procedures,
that the hospital personnel provided her with sufficient counselling and
information about sterilization, as well as alternatives, risks and benefits,
D
to ensure that she could make a well-considered and voluntary decision

10
(2009J 9 sec 1
11
Ms. A. S. v. Hungary, CEDAW/C/36/D/4/2004. UN Communication No. 4/2004,
Committee on the Elimination of Discrimination against Women, Thirty-sixth session,
7-25 August 2006, available at http://www.un.org/womenwatch/daw/cedaw/protocol/ E
decisions-views/Decision%204-2004%20-%20English.pdf
11 Article 10 : States Parties shall take all appropriate measures to eliminate

discrimination against women in order to ensure to them equal rights with men in the
field of education and in particular to ensure, ori a basis of equality of men and women
- (h) Access to specific educational information to help to ensure the health and well-
being offamilies. including information and advice on family planning. F
Article 12 : 1. States Parties shall take all appropriate measures to eliminate discrimination
against women in the field of health care in order to ensure, on a basis of equality of men
and women, access to health care services, including those related to family planning.
2. Notwithstanding the provisions of paragraph I of this article, States Parties shall
ensure to women appropriate services in connection with pregnancy, confinement and
the post-natal period, granting free services where necessary, as well as adequate nutrition G
during pregnancy and lactation.
Article 16: 1. States Parties shall take all appropriate measures to eliminate discrimination
against women in all matters relating to marriage and family relations and in particular
shall ensure, on a basis of equality of men and women - (e) The same rights to decide
freely and responsibly on the number and spacing of their children and to have access
to the information, education and means to enable them to exercise these rights; H
810 SUPREME COURT REPORTS [2016] 5 S.C.R.

A to be sterilized. The Committee held:
"Compulsory sterilization ... adversely affects women's physical
and mental health, and infringes the right of women to decide on
the number and spacing of their children." The sterilization surgery
was performed on the author without her full and informed consent
B and must be considered to have permanently deprived her of her
natural reproductive capacity."
87. It is necessary to re-consider the impact that policies such as
the setting of informal targets and provision of incentives by the
Government can have on the reproductive freedoms of the most
c vulnerable groups of society whose economic and social conditions leave
them with no meaningful choice in the matter and also render them the
easiest targets of coercion. The cases of Pasc/1im Banga Khet Mazdoor
Samity and Bandhua Mukti Morclut have emphasized that the State's
obligation in respect offundamental rights must extend to ensuring that
the rights of the weaker sections of the community are not exploited by
D virtue of their position. Thus, the policies of the Government must not
mirror the systemic discrimination prevalent in society but must be aimed
at remedying this discrimination and ensuring substantive equality. In
this regard, it is necessary that the policies and incentive schemes are
made gender neutral and the unnecessary focus on female sterilization
E is discontinued.
Supplementary directions
88. On the basis of the submissions before us, we have highlighted
some key issues that need active consideration. In addition, our attention
was repeatedly drawn to the guidelines given by this Court in Ramakant
F Rai (I) and while it is generally the case of the Union oflndia and all the
States that the guidelines are being followed, we find that at least in
respect of some of them, there is still much more that needs to be done
for their effective implementation not only in letter but also in spirit.
Some fine-tuning is also necessary in view of the passage of time, change
G in circumstances and the need to use technology to the optimum.
Accordingly, we find it necessary to issue the following supplementary
directions:
1. The State-wise, district-wise or region-wise panel of doctors
approved for carrying out the sterilization procedure, must be accessible
through the website of the Ministry of Health and Family Welfare of the
H
DEVIKA BISWAS v. UNION OF INDIA & ORS. 811
[MADAN B. LOKUR, J.]

Government oflndia as well the corresponding Ministry or Department A
of each State Government and each Union Territory. The list should
contain all necessary particulars of each doctor and not merely the name
and designation. This exercise should be completed on or before 31st
December, 2016 and thereafter the list be updated every quarter that is
by 3 i st March, 301h June, 30'h September and 31" December of every
B
year.
2. The contents of the checklist prepared pursuant to the directions
given in Ramakant Rai (I) should be explained to the proposed patient
in a language that he or she understands and the proposed patient should
also be explained the impact and consequences of the sterilization
procedure. This can be achieved by (a) ensuring that the checklist is in C
the local language of the State; (b) it should contain a certificate duly
signed by the concerned doctor that the proposed patient has been
explained the contents of the checklist and has understood its contents
as well as the impact and consequences of the sterilization procedure;
(c) in addition to the certificate given by the doctor, the checklist must D
also contain a certificate given by a trained counselor (who may or may
not be an ASHA worker) to the same effect as the certificate given by
the doctor. This will ensure that the proposed patient has given an informed ·
consent for undergoing the sterilization procedure and not an incentivized
consent.
E
Sufficient breathing time of about an hour or so should be given to
a proposed patient so that in the event he or she has a second thought,
time is available for a change of mind.
The checklist prepared pursuant to the direction given in Ramakant
Rai (I) with the aforesaid modifications should be prepared in the local
F
or regional language on or before 31st December, 2016.
3. The Quality Assurance Committee (QAC) as well as the
District Quality Assurance Committee (DQAC) has been set up in every
State and District in terms of the directions given in Ramakant Rai (/).
However, it is only the designation of its members that has been made
G
available. The details and necessary particulars of each member of the
QAC and DQAC should be accessible from the website of the Ministry
of Health and Family Welfare of the Government of India as well the
corresponding Ministry or Department of each State Government and
each Union Territory on or before 31st December, 2016 and thereafter
updated every quarter. H
812 SUPREME COURT REPORTS [2016] 5 S.C.R.

A 4. In addition to the six monthly reports required to be published
by the QAC containing of the number of persons sterilized as well as the
number of deaths or complications arising out of the sterilization procedure,
as already directed in Ramakant Rai (/), the QAC must publish an
Annual Report (on the website of the Ministry of Health and Family
Welfare of the Government oflndia as well the corresponding Ministry
B
or Department of each State Government and each Union Territory)
containing not only the statistical information as earlier directed, but also
non-statistical information in the form of a report card indicating the
meetings held, decisions taken, work done and the achievements of the
year etc. This will have a significant monitoring and supervisory impact
c on the sterilization program and will also ensure the active involvement
of all the members of the QAC and the DQAC.
The first such Annual Report covering the calendar year 2016
should be published on the websites mentioned above on or before 31"
March, 2017.
D 5. As many as 363 deaths have taken place due to sterilization
procedures during 20I0-2013. This is a high figure. During this period,
more than Rs. 50 crores have been disbursed towards compensation in
cases of death. Apart from steps taken by Bihar and Chhattisgarh during
the pendency of the writ petition to mitigate the sufferings of the patients,
E we have not been told of any death audit conducted by any State
Government or Union Territory in respect of any patient, nor have we
been informed of any steps taken against any doctor or anybody else
involved in the sterilization procedure that has resulted in the death of a
patient or any failure or any other complication connected with the
sterilization procedure. There is a need for transparency coupled with
F accountability and the death of a patient should not be treated as a one-
off aberration. Therefore, it is directed that the Annual Report prepared
by the QAC must indicate the details of all inquiries held and remedial
steps taken.
6. With regard to the implementation of the Family Planning
G Indemnity Scheme (FPIS),· there does not seem to be any definitive
information with regard to the number of claims filed, the claims accepted
and in which category (death, failure, complication etc.), claims pending
(and since when) and claiins rejected and the reasons for rejection.
The QAC is directed to include this information in the Annual Report
and the Ministry of Health and Family Welfare of the Government of
H
DEVIKA BISWAS v. UNION OF INDIA & ORS. 8I3
[MADAN B. LOKUR, J.]

India as well as the State Governments should make this information A
accessible on the website, including the quantum of compensation paid
under each category and to the number of persons.
We have mentioned above that the learned Solicitor General had
assured us on 201h March, 2015 that full details of the funds utilized
under the FPIS would be furnished but that information has not been B
given as yet, necessitating the direction that we have passed.
In addition to the direction relating to the FPIS, the Ministry of
Health'and Family Welfare should conduct an audit to ensure that the
funds given by the Government oflndia have been utilized forthe purpose
for which they were given for the period from 2013-14 onwards.
c
7. The quantum ofcompensation fixed under the Family Planning
Indemnity Scheme (FPIS) deserves to be increased substantially and .
the burden thereof must be equally shared by the Government of India
and the State Government. The State of Chhattisgarh has shown the
way in this regard and it would be appropriate if others follow the lead.
Every death or failure or complication related to the sterilization procedure D
is a set-back not only to the patient and his or her family but also in the
implementation of the national campaign. We decline to fix the quantum
of compensation but would suggest, following the example of the State
· ofChhattisgarh, that the amount should be doubled and shared equally.
8. The Union of India is directed to persuade the State E
Governments to halt the system of holding sterilization camps as has
been done by at least four States across the country. In any event, the
Union oflndia should adhere to its view that sterilization camps will be
stopped within a period of three years. In our opinion, this will necessitate
simultaneous strengthening of the Primary Health Care centres across F
the country both in terms of infrastructure and otherwise so that health
care is made available to all persons. The significance of having well
equipped Primary Health Centres across the country certainly cannot
be over-emphasized. Therefore, we direct the l)nion of India to pay
attention to this as well, since it is absolutely important that all citizens of
our country have access to primary health care. G
9. The Union oflndia should make efforts to ensure that sterilization
camps are discontinued as early as possible but in any case within the
time frame already fixed and adverted to above. The Union oflndia and
the State Governments must simultaneously ensure that Primary Health
Centres are strengthened H
814 SUPREME COURT REPORTS [2016] 5 S.C.R.

A 10. Although the Union of India has stated that no targets have
been fixed for the implementation of the sterilization program, it appears .
that there is an informal system offrxing targets. We leave it to the good
sense of the each State Government and Union Territory to ensure that
such targets are not fixed so that health workers and others do not compel
persons to undergo what would amount to a forced or non-consensual
B
sterilization merely to achieve the target.
11. The decisions taken in the high level meetings held on 15'h
May 2015 and I 7'h November 2015 as well as the National Summit on
Family Planning held on 5"' and 61hApril 2016 should be scrupulously
implemented by the Ministry of Health and Family Welfare of the
c Government of India. The said Ministry should also ensure effective
implementation of the decisions taken keeping in mind thatthe sterilization
program is a part of a national campaign.
12. The Union of India is directed to ensure strict adherence to
the guidelines and standard operating procedures in the various manuals
D issued by it. The Sterilization program is not only a Public Health issue
but a national campaign for Population Control and Family Planning.
The Union oflndia has overarching responsibility for the success of the
campaign and it cannot shift the burden of implementation entirely on
the State Governments and Union Territories on the ground that it is only
E a public health issue. As the Justice Sarkaria Commission put it
"Population Control and Family Planning is a matter of national importance
and of common concern of the Union and the States."
13. We are pained to note the extremely casual manner in which
some of the States have responded to this public interest petition. What
F stands out is the response of the States of Madhya Pradesh, Maharashtra,
Rajasthan and Kerala in respect of which States allegations were made
concerning mismanagement in at least one sterilization camp. None of
these States have given any acceptable response to the allegations and
we have no option but to assume that the camps that have been referred
to in the writ petition were mismanaged as alleged by Devika Biswas.
G However, the matter should not end here. We direct the Registry of this
Court to transmit a copy of th is judgment to the Registrar General of the
High Court in the States of Madhya Pradesh, Maharashtra, Rajasthan
and Kerala for being placed before the Chief Justice of the High Court.
We request the Chief Justice to initiate a suo moto public interest petition
H to consider the allegations made by Devika Biswas in respect .of the
,,
DEVIKA BISWAS v. UNION OF INDIA & ORS. 815
[MADAN B. LOKUR, J.]

sterilization camp(s) held in these States (the allegations not having been A
specifically denied) and any other similar laxity or unfortunate mishap
that might be brought to the notice of the Court and pass appropriate
orders thereon. We also direct the Registry of this Court to transmit a
copy of this judgment to the Registrar General of the Patna High Court
for being placed before the Chief Justice of the High Court. We request
B
the Chief Justice to ensure speedy,completion of the investigations and
proceedings relating to the mishap on 7"' January 2012 in the sterilization
camp in Kaparfora Government Middle School, Kursakanta, Araria
district as well as the mishap in Chhapra in Saran district that led to
cancellation of the accreditation ofGunjan Maternity and Surgical Clinic
on 24'h March 2012. c
14. The State of Chhattisgarh is directed to implement the
recommendations given in the Ms. Anita Jha Report at the earliest and
with all sincerity.
15. We have already expressed our sadness at the fact that the
National Health Policy has not yet been finalized despite the passage of D
more than one and a half years. We direct the Union oflndia to take a
decision on or before 3 1" December, 2016 on whether it would like to
frame a National Health Policy or not. In case the Union of India thinks
it worthwhile to have a National Health Policy, it should take steps to
announce it at the earliest and keep issues of gender equity. in mind as E
well.
Conclusion
89. With the above supplementary directions, the writ petition is
disposed of. We must record our appreciation for the efforts putin by
Devika Biswas in bringing this vital issue to the notice of this Court and F
to all the learned counsel and concerned officers of the Ministry of Health
and Family Welfare of the Government oflndia in not treating the public
interest litigation as an adversarial proceeding but as a collaborative effort
to find a remedy to some problems and improve the well being of the
citizens of the country. G
Nidhi Jain Writ Petition disposed of.

H