Martha Sabar was 20 years old and pregnant. She lived and died in Odisha, India.
Martha came from a rural village, belonging to a marginalised tribal group. During her first trimester, her antenatal screening identified her as someone who would have a high risk pregnancy.
Throughout her pregnancy Martha experienced bleeding. She couldn’t move, remaining in bed. Despite being recognised as high risk, no health worker came to visit her.
Martha was eventually moved to a nearby government primary health centre, but they refused to provide her with treatment. Her family were forced to take to the District Headquarter Hospital. Rather than be transferred in an ambulance, her family had to take her on a public bus. A journey of 70 km.
Martha reached the District Headquarter Hospital at night where no medical officers were available to admit her. She was refused service in the morning on the grounds that she did not have the right identification papers – an Aadhaar card, issued to every pregnant woman to enable them to access free services in government facilities.
She sat outside on the road for 168 hours.
The family were forced to take her to a private clinic owned by the Obstetrics and Gynaecology specialist who worked in the government-run District Headquarter Hospital.
By the time Martha received medical attention, she had died.
In 2016 with the support of AmplifyChange, SLIC started auditing the maternal deaths in ten states across India. SLIC audited 45 maternal deaths. These deaths were shocking and shed light on huge gaps in government health services – especially access to care and the quality of care for pregnant women and lactating mothers.
Some of the incidents were heart-wrenching for the SLIC team. They showed the gross negligence of health care providers in providing basic antenatal and post-natal care. All of these deaths highlighted the need to stop obstetric violence and abuse which has been normalized by health care providers in India, and no punitive action till date has been taken against obstetric violence.
Martha Sabar was one such case. Martha and her family deserved justice for what happened to her. Left unchallenged, lessons cannot be learned from Martha’s case and the health system is left to repeat its failures.
The Government of India has introduced various schemes to reduce maternal mortality and infant mortality. Numerous rights to treatment should have been provided to Martha Sabar including free ambulance service for transportation of expectant mothers, critical post-natal care, nutritional care as well as a cash benefits and hospital care. However, none of these were provided to Martha before she died.
Human Rights Law Network took the state to court on 27th October 2022. They successfully filed a petition in the Odisha High Court.
In making his judgement, the judge Justice Murladharan stated:
There is a system in place that is designed to provide adequate care for pregnant women in each of these villages, and yet they are not properly administered. This is a direct violation of the basic fundamental right of a woman to survive pregnancy and childbirth. The government of India has created multiple schemes to help provide services that guarantee pregnant women that right. In this particular instance, there was a breakdown in the referral mechanisms which prevented antenatal care from being distributed, prevented the doctor from being able to understand his patient’s condition when she arrived, and a failure to get her to a hospital in time that could treat her in time. All of these resulted in a failure to avert a preventable maternal mortality, a violation of her right to survive pregnancy and child birth.Judge Justice Murladharan
The High Court directed the state to provide compensation to the family and take action against health workers and managers involved. Crucially, they also ordered that a maternal death audit is conducted for every maternal death moving forward to ensure that the cause of death is ascertained and institutional deaths are understood and prevented.
The judgment, albeit late, brought the family of Martha Sabar some closure. It has also strengthened understanding of the gaps in the health system and the need for the state to strengthen reproductive rights. By ensuring that government, the judiciary, and society in general look at health care through a justice lens, SLIC and many other civil society organisations are helping to use the law for good and to strengthen health systems.