Supreme Court Upholds Reproductive Choice: A (Mother of X) vs. State of Maharashtra (2024)

Introduction

Date of the Judgment: April 29, 2024

Citation: 2024 INSC 371

Judges: Dr Dhananjaya Y Chandrachud, CJI; J B Pardiwala, J; Manoj Misra, J. The judgment was authored by Dr Dhananjaya Y Chandrachud, CJI.

Can a minor’s decision regarding her pregnancy be overruled by her parents or the state? The Supreme Court of India recently addressed this critical question in a case involving a 14-year-old rape survivor, emphasizing the paramount importance of a pregnant person’s autonomy and reproductive rights. This case highlights the complexities of balancing legal frameworks with individual rights, particularly in the context of medical termination of pregnancy.

Case Background

In September 2023, a minor, referred to as ‘X’, was allegedly subjected to sexual assault. The incident came to light on March 20, 2024, when ‘X’ revealed the assault. By this time, she was approximately 25 weeks pregnant. It was stated that ‘X’ had irregular periods, which is why she could not assess her pregnancy earlier. An FIR was registered on March 20, 2024, at Turbhe MIDC Police Station against the alleged perpetrator under Section 376 of the Indian Penal Code and Sections 4, 8, and 12 of the Protection of Children from Sexual Offences Act 2012.

On March 21, 2024, ‘X’ underwent a medical examination and was subsequently transferred to JJ Group of Hospitals, Mumbai, for the termination of her pregnancy. On March 28, 2024, a medical board from Grant Government Medical College & Sir JJ Group of Hospitals, Mumbai, formed under the Medical Termination of Pregnancy Act 1971 (MTP Act), stated that ‘X’ was physically and mentally fit for termination, subject to the High Court’s permission.

The Appellant, ‘X’s mother, filed a writ petition in the High Court of Judicature at Bombay under Article 226 of the Constitution, seeking permission for her daughter’s pregnancy termination. On April 3, 2024, the same medical board issued a ‘clarificatory’ opinion without re-examining ‘X’, denying termination because the fetus was 27-28 weeks old and had no congenital abnormalities. The High Court dismissed the petition, citing that the pregnancy exceeded the statutory 24-week limit.

Timeline

Course of Proceedings

The Appellant initially approached the High Court of Judicature at Bombay seeking permission for her minor daughter, ‘X’, to terminate her pregnancy. The High Court dismissed the petition on the ground that the pregnancy exceeded the statutory period of twenty-four weeks as prescribed under the MTP Act. This decision was based on the medical board’s report which stated that there were no congenital abnormalities in the fetus.

The Appellant then moved the Supreme Court under Article 136 of the Constitution. The Supreme Court, while issuing notice, noted that the High Court had not considered the impact of the pregnancy on ‘X’s physical and emotional well-being. The Supreme Court directed a fresh Medical Board to be constituted at Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Sion, Mumbai.

Legal Framework

The primary legal framework in this case is the Medical Termination of Pregnancy Act 1971 (MTP Act).

• Section 3(1) of the MTP Act:

  This section protects registered medical practitioners (RMPs) from penal provisions under the Indian Penal Code (IPC) for carrying out abortions as per the MTP Act. It states that, “Notwithstanding anything contained in the Indian Penal Code (45 of 1860), a registered medical practitioner shall not be guilty of any offence under that Code or under any other law for the time being in force, if any pregnancy is terminated by him in accordance with the provisions of this Act.”

• Section 3(2-B) of the MTP Act:

  This section stipulates that there is no limit on the gestational age for terminating a pregnancy if the fetus has substantial abnormalities.

• Section 3(3) of the MTP Act:

  This section mandates that the opinion of the pregnant person must be given primacy in evaluating the foreseeable environment of the person.

• Section 3(4)(a) of the MTP Act:

  This section states that for a minor, the consent of the guardian is prescribed under the MTP Act.

• Section 5 of the MTP Act:

  This section allows termination of pregnancy at any gestational age if the medical practitioner believes it is immediately necessary to save the life of the pregnant person.

The MTP Act is designed to protect the health of pregnant persons and facilitate safe, hygienic, and legal abortions. The right to abortion is considered a concomitant right of dignity, autonomy, and reproductive choice, guaranteed under Article 21 of the Constitution.

Arguments

The arguments in this case revolved around the interpretation and application of the MTP Act, particularly concerning the rights of a minor seeking termination of pregnancy and the role of medical boards.

Arguments on behalf of the Appellant:

• The Appellant argued that the High Court erred in dismissing the petition without considering the impact of the pregnancy on the minor’s physical and mental health.

• It was contended that the medical board’s initial report, which recommended termination, should have been given more weight than the subsequent ‘clarificatory’ report, which did not re-examine the minor.

• The Appellant emphasized the minor’s right to reproductive autonomy and the trauma she would face by continuing the pregnancy, especially given the circumstances of the sexual assault.

Arguments on behalf of the State of Maharashtra:

• The State initially relied on the High Court’s decision, which was based on the medical board’s second opinion that the pregnancy was beyond the statutory limit for termination and there were no fetal abnormalities.

• The State also highlighted the medical guidelines and SOPs regarding the procedures for late-term abortions, particularly the use of intracardiac injections to stop the fetal heart.

Arguments before the Supreme Court:

• The Supreme Court also considered the conflicting statements of the minor’s parents regarding the termination of pregnancy, which led to the medical team seeking guidance from the court.

• The Court also discussed the risks involved in both terminating the pregnancy at a late stage and carrying it to term, particularly for the minor’s health.

Innovativeness of the Argument:

The innovativeness of the arguments lies in the emphasis on the pregnant person’s autonomy and the need for medical boards to consider the physical and mental health of the pregnant person, not just the gestational age or fetal abnormalities. This approach challenges the traditional interpretation of the MTP Act, which often prioritizes fetal health over the pregnant person’s well-being.

Issues Framed by the Supreme Court

The Supreme Court did not explicitly frame issues in a separate section. However, the following issues were implicitly addressed:

1. The role and responsibilities of medical boards under the MTP Act, particularly in cases involving late-term pregnancies and minors.
2. The primacy of a pregnant person’s consent in decisions regarding termination of pregnancy.
3. The interpretation of Section 3(2-B) of the MTP Act regarding the termination of pregnancies with substantial abnormalities of fetus.
4. The balance between the rights of the pregnant person and the state’s interest in protecting potential life.
5. The impact of a change in the opinion of the medical board on the pregnant person’s mental health.

Treatment of the Issue by the Court

The following table demonstrates as to how the Court decided the issues:

Authorities

The Supreme Court relied on several cases and legal provisions to arrive at its decision.

Cases:

Legal Provisions:

• Section 3(1), Medical Termination of Pregnancy Act, 1971: Protects RMPs from penal provisions for abortions done as per the Act.
• Section 3(2-B), Medical Termination of Pregnancy Act, 1971: No gestational age limit for terminating pregnancies with substantial fetal abnormalities.
• Section 3(3), Medical Termination of Pregnancy Act, 1971: The opinion of the pregnant person must be given primacy in evaluating the foreseeable environment of the person.
• Section 3(4)(a), Medical Termination of Pregnancy Act, 1971: Consent of the guardian is required for a minor.
• Section 5, Medical Termination of Pregnancy Act, 1971: Allows termination at any stage if necessary to save the pregnant person’s life.
• Article 21 of the Constitution of India: Guarantees the right to life and personal liberty, which includes reproductive autonomy.

Judgment

How each submission made by the Parties was treated by the Court?

How each authority was viewed by the Court?

• X v. State (NCT of Delhi), (2023) 9 SCC 433: The Court reiterated the observations made in this case that the fear of prosecution among registered medical practitioners is a barrier for pregnant persons to access safe and legal abortions.
• XYZ v. State of Gujarat, 2023 SCC OnLine SC 1573: The Court reiterated that the medical board or the High Court cannot refuse abortion merely on the ground that the gestational age of the pregnancy is above the statutory prescription.
• Z v. State of Bihar, (2018) 11 SCC 572: The Court recognized the vitality of time sensitivity and noted that the state authorities had failed in not terminating the pregnancy before the passage of twenty weeks which was permissible under the law.
• Suchita Srivastava v. Chandigarh Admn., (2009) 9 SCC 1: The Court reiterated that the right to make reproductive choices is a facet of Article 21 of the Constitution and that the consent of the pregnant person in matters of reproductive choices and abortion is paramount.

The Supreme Court ultimately recalled its earlier order allowing the termination of pregnancy. This decision was based on the parents’ informed choice to carry the pregnancy to term, which the Court recognized as a valid exercise of their reproductive autonomy. The Court emphasized that the MTP Act does not allow interference with the personal choice of a pregnant person in terms of proceeding with the termination.

The Court observed that, “The MTP Act does not allow any interference with the personal choice of a pregnant person in terms of proceeding with the termination.”

The Court further stated that, “The choice to continue pregnancy to term, regardless of the court having allowed termination of the pregnancy, belongs to the individual alone.”

The Court also noted that, “The consent of a pregnant person in decisions of reproductive autonomy and termination of pregnancy is paramount.”

What weighed in the mind of the Court?

The Supreme Court’s decision was primarily influenced by the following factors:

• Primacy of the Pregnant Person’s Autonomy: The Court emphasized that the decision to continue or terminate a pregnancy is a deeply personal one, and the pregnant person’s choice must be respected. This is particularly crucial in cases involving minors, where their views should be given significant weight.
• Informed Consent: The Court acknowledged the parents’ decision to carry the pregnancy to term was made after they were fully informed of the risks involved in both termination and continuing the pregnancy.
• Role of Medical Boards: The Court stressed that medical boards must provide comprehensive opinions that consider the physical and mental health of the pregnant person, not just the gestational age or fetal abnormalities.
• Time Sensitivity: The Court recognized that delays in the legal process can increase the risks associated with late-term abortions, potentially influencing the pregnant person’s decision.
• Protection of RMPs and Medical Boards: The Court clarified that the MTP Act protects RMPs and medical boards when they form an opinion in good faith regarding the termination of pregnancy, thereby reducing the fear of prosecution.

Sentiment Analysis of Reasons Given by the Supreme Court

Fact:Law Ratio

Logical Reasoning:

Key Takeaways

• The consent of a pregnant person is paramount in decisions regarding the termination of pregnancy.
• Medical boards must consider the physical and mental health of the pregnant person, not just the gestational age or fetal abnormalities.
• The MTP Act protects registered medical practitioners and medical boards when they act in good faith.
• Delays in legal processes can negatively impact the pregnant person’s health and decision-making.
• The reproductive rights of minors must be given due consideration, and their views should be an important factor in the decision-making process.

Directions

The Supreme Court issued the following directions:

• Sion Hospital shall bear all expenses related to the minor’s hospitalization.
• If the minor and her parents decide to give the child up for adoption, the State Government shall facilitate the process per applicable laws.

Development of Law

Ratio Decidendi: The ratio decidendi of this case is that the consent of a pregnant person is paramount in decisions regarding the termination of pregnancy, and medical boards must consider the physical and mental health of the pregnant person, not just the gestational age or fetal abnormalities. The Court also emphasized the importance of reproductive autonomy and the need to protect the rights of pregnant persons, especially minors.

Change in Previous Positions of Law: This judgment reinforces the position of law that the pregnant person’s autonomy is paramount and that the medical board has to consider the mental and physical health of the pregnant person and not just the gestational age of the fetus.

Conclusion

In conclusion, the Supreme Court’s judgment in A (Mother of X) vs. State of Maharashtra reaffirms the importance of reproductive autonomy and the primacy of a pregnant person’s consent in decisions regarding the termination of pregnancy. The Court emphasized that medical boards must consider the physical and mental health of the pregnant person, not just the gestational age or fetal abnormalities. The judgment highlights the need for a balanced approach that respects individual rights while ensuring the safety and well-being of all parties involved.