2024 INSC 371 Page 1 of 22

Reportable

IN THE SUPREME COURT OF INDIA

CIVIL APPELLATE JURISDICTION

Civil Appeal No. 5194 of 2024

A (Mother of X) …Appellant

Versus

State of Maharashtra & Anr. …Respondents

J U D G M E N T

Dr Dhananjaya Y Chandrachud, CJI

Background

1. This appeal emanates from a judgment of a D ivision Bench of the High

Court of Judicature at Bombay dated 4 April 2024 which denied the minor

daughter of the Appellant (hereinafter referred to as ‘X’) permission to terminate

her pregnancy. ‘X’ is a minor, about fourteen years of age and is alleged to have

been subjected to sexual assault in September 2023. The incident did not come

to the fore till ‘X’ revealed the incident on 20 March 2024 by which time she was

Page 2 of 22

about 25 weeks into her pregnancy. ‘X’, it has been averred, always had irregular

periods and could not have assessed her pregnancy earlier.

2. An FIR was registered with Turbhe MIDC Police Station against the alleged

perpetrator on 20 March 2024 for offences punishable under Section 376 of the

Indian Penal Code and Sections 4, 8 and 12 of the Protection of Children from

Sexual Offences Act 2012. ‘X’ was taken to a hospital on 21 March 2024 for

medical examination and then transferred to the JJ Group of Hospitals, Mumbai

for termination of her pregnancy. On 28 March 2024 the medical board of the

Grant Government Medical College & Sir JJ Group of Ho spitals, Mumbai

constituted under the Medical Termination of Pregnancy Act 1971

1

opined that

‘X’ was physically and mentally fit for termination of her pregnancy subject to the

permission of the High Court.

3. The Appellant moved the High Court of Judicature at Bombay under Article

226 of the Constitution seeking the termination of pregnancy of her daughter. On

3 April 2024, the medical board issued a ‘clarificatory’ opinion, without re-

examining ‘X’. The report denied the termination of pregnancy on the ground that

the gestational age of the fetus was twenty-seven to twenty-eight weeks and that

there were no congenital abnormalities in the fetus.

2

By the impugned judgment

the High Court dismissed the writ petition on the ground that the pregnancy

exceeded the statutory period of twenty-four weeks.

1

MTP Act

2

There is an inexplicable inconsistency on the gestational age in the report of the medical

board of the Grant Government Medical College & Sir JJ Group of Hospitals, Mumbai dated

28 March 2024. Point 5 and 6 of the report mention the gestational age as 27 weeks, but the

opinion of the board in point 7 mentions the gestational age to be 28 weeks.

Page 3 of 22

4. The Appellant moved this court under Article 136 of the Constitution. The

Special Leave Petition was mentioned for urgent orders after the Court had risen

on the conclusion of normal working hours at 5:15 pm on 19 April 2024. The Bench

reassembled immediately thereafter and had the benefit of hearing the counsel

for the Appellant, the Standing Counsel for the State of Maharashtra and Ms

Aishwarya Bhati, Additional Solicitor General. While issuing notice, this Court took

note of the fact that the report of the Medical Board dated 3 April 2024, which

was relied upon by the High Court had not dealt with the impact of the pregnancy

on the physical and emotional well-being of ‘X’. Accordingly, a fresh Medical

Board was directed to be constituted under the Lokmanya Tilak Municipal

General Hospital and Lokmanya Tilak Municipal Medical College, Sion, Mumbai.

3

This Court directed that:

“5. From the material which has been placed on the

record, a striking feature which has emerged before

this Court, prima facie , is that the medical report does

not contain an evaluation of the physical and mental

status of the minor, particularly having regard to the

background leading up to the pregnancy, including

the alleged sexual assault. Moreover, it would be

necessary that this Court is apprised whether the

carrying of the pregnancy to the full term would

impact upon the physical and mental well being of

the minor who is barely fourteen years old. The

Medical Board shall also opine on whether a

termination of the pregnancy can be carried out at

this stage without any threat to the life of the minor.

6. In this view of the matter, we are of the view that the

petitioner’s daughter should be examined afresh by

a Medical Board to be constituted at the Lokmanya

Tilak Municipal General Hospital and Lokmanya Tilak

Municipal Medical College, Sion, Mumbai tomorrow

(20 April 2024). We request the Medical

Superintendent of the hospital to constitute a

Medical Board for that purpose.”

3

Sion Hospital

Page 4 of 22

5. A report has been submitted by the Sion Hospital. The minor was examined

by a team of six doctors constituted by the Dean. The composition of the team

was as follows:

(i) Dr Rajesh Dere, Prof. & Head Dept. of Forensic Medicine;

(ii) Dr Anagha Joshi, Prof. & Head Dept. of Radiology;

(iii) Dr Amarjitsingh Bawa, Additional Prof. Of Dept. of Gynecology & acting

Head of Department;

(iv) Dr Nilesh Shah, Prof. & Head Dept. of Psychiatry; and

(v) Dr Swati Manerkar, Prof. & Head Dept. of Neonatology;

6. After examining ‘X’, the medical board of the Sion Hospital opined that the

gestational age of the fetus was 29.6 weeks and continuation of pregnancy will

negatively impact the physical and mental well-being of ‘X’. Further, it opined that

the pregnancy can be terminated with a degree of risk not higher than if the

pregnancy was taken to term. The medical board reported as follows:

“1. Whether carrying of the pregnancy to the full

term would impact upon the physical and mental

well being of the minor who is barely 14 years?

Ans. Yes, continuation of pregnancy against her will

may impact negatively on physical and mental well

being of the minor who is barely 14 year old.

2. The medical board shall also opine whether

termination of pregnancy can be carried out at this

stage without any threat to the life of the minor?

Ans. Yes, termination can be carried out at this stage.

The threat of life to the patient if termination of

pregnancy carried out at this stage is not higher than

Page 5 of 22

the risk of delivery at full term of pregnancy. Also in

view of minor being barely 14 years, the chances of

surgical intervention (Abdominal Surgery) at term or

now may be there.”

7. While forwarding the report of the Medical Board, the Dean of Sion Hospital

has noted the opinion of the Board in the following terms:

“The opinion of the committee is forwarded herewith

for your perusal. The committee has opined that the

medical termination of the pregnancy can be done

with due risk and with appropriate counseling of the

patient and the relatives. The Psychiatrist also

contributed in evaluation of patient and assessing

the psychological state of the patient. According to

the committee report continuation of pregnancy

could cause psychological trauma to the patient.”

8. On 22 April 2024, this Court granted leave and pronounced its operative

order to set aside the judgment of the High Court of Judicature at Bombay. In view

of the urgency involved, while reserving judgment, this Court allowed ‘X’ to

terminate her pregnancy forthwith. This Court noted as follows:

“10 The following circumstances have been borne in

mind, at this stage:

(i) The medical termination of pregnancy is sought

in respect of a minor who is 14 years old;

(ii) The pregnancy is alleged to be an emanation

from a sexual assault which has resulted in the

registration of a First Information Report. The FIR was

recorded on 20 March 2024 beyond the period of 24

weeks envisaged in the MTP Act;

(iii) The minor was unaware of the fact that she was

pregnant until a very late stage;

(iv) The Medical Board at Sion Hospital has clearly

opined that the continuation of the pregnancy

against the will of the minor “may impact negatively

on physical and mental well being of the minor who

is barely 14 years old”; and

(v) While a certain degree of risk is involved in every

procedure for medical termination, the Medical

Board has opined that the threat to life of the patient

if termination of pregnancy is carried out at this stage

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is not higher than the risk of delivery at full term of

pregnancy.

11. We will further elaborate on the guiding

parameters in a reasoned order which will be

delivered separately. However, bearing in mind the

exigencies of the situation, the welfare of the minor,

which is of paramount importance and her safety,

we pass the following order:

(i) The judgment and order of the High Court of

Judicature at Bombay dated 4 April 2024 shall stand

set aside for reasons to follow;

(ii) The Dean at Sion Hospital is requested to

immediately constitute a team for undertaking the

medical termination of pregnancy of the minor in

respect of whom the Medical Board has submitted its

report dated 20 April 2024;

(iii) Arrangements shall be made by the State for

transportation of the minor to the Hospital and for her

return home after the completion of the procedure;

(iv) The State has agreed to bear all the expenses in

connection with the procedure and all medical

expenses required in the interest of the safety and

welfare of the minor; and

(v) Post-termination if any further medical care is

required, this may be ensured in the interest of the

minor.”

9. The above direction requesting the Dean at Sion hospital to constitute a

team of doctors for undertaking the medical termination of pregnancy of ‘X’ was

based on the specific request of the appellant who is her mother.

10. Subsequently, a communication dated 26 April 2024 was addressed by the

Dean at Sion hospital to Ms Aishwarya Bhati, Additional Solicitor General. The

communication reads thus:

“Sub:-Guidance regarding Case No.9163/2024 order

dated 22.04.2024.

Ref:- Case No.9163/2024.

Respected Madam,

Order was given by Hon. Supreme Court of India to

Dean at LTMMC & LTMGH, Sion to immediately

Page 7 of 22

constitute a team for undertaking the Medical

termination of pregnancy of the minor in respect of

whom the Medical Board has submitted its report

dated 20.04.2024. On the basis of the order the

patient has been admitted at LTMMC & LTMGH, Sion

on 23.04.2024 under the expert care of Dr.

Amarjitsingh Bawa, Associate Professor & Unit Chief

Department of Gynecology.

The Team for undertaking the termination of

pregnancy is formed as below:-

1. Dr. Arun Nayak, Prof & Head, Department of

Obst & Gynecology.

2. Dr. Rahul Mayekar, Prof & Unit Chief,

Department of Obst & Gynecology.

3. Dr. Amarjitsingh Bawa, Asso. Prof & Unit Chief,

Department of Obst & Gynecology.

4. Dr. Swati Manerkar, Adhoc Prof & Head (I/C),

Department of Neonatology.

5. Dr. Nilesh Shah, Prof & Head, Department of

Psychiatry.

We request guidance of Hon. Supreme Court of India

before proceeding for termination of pregnancy in

the said case of minor girl in view of.

1. We would like to humbly bring to the attention of the

Honorable Supreme Court of India that the minor girl's

mother is changing her statements. On 24.04.2024

father and mother of the minor girl gave in writing

that they gave permission to stop the baby's heart in

utero by injecting medicine in the heart. They also

gave permission for attempting normal delivery of the

minor girl by giving medicine. During this, if the

pregnant minor girl suffers any problem, under such

circumstances cesarean section operation may be

needed, and they gave permission for the same. If

even after giving injection baby is born alive, then

they would like to give the baby for adoption.

2. On 25.04.2024 minor girl's mother said that she

wanted alive baby & she wanted to give live baby to

her relative for adoption. Thus we noticed that the

mother of the said girl was changing her statements.

3. On 26.04.2024 the mother of the girl said in front of

Medical team that she wants termination of

Page 8 of 22

pregnancy after the baby's heart is stopped by

injecting medicine in the heart.

4. Hence, due to the changing statements made by

the girl's parents and the fact that the sonography

done at our hospital on 25.04.2024 reveled 30.2 weeks

with baby weight of 1593grams, we humbly request

Hon. Supreme Court of India to guide us whether

(1) The baby should be delivered alive.

OR

(2) After injecting intracardiac injection KCL to end

the life of the fetus in utero as per

a. The Government of India guidelines MOHFW D.O No.

M. 12015/58/2017- MCH dated 14.08.2017, vide

section Ve (Copy attached).

b. जा.क्र. राकुकका/पीसीपीएनडीट�/ क� ८ ड/नस्ती क्र. ५०७/२०

आठवडयाप�लकडील वैद्यक�य गभर्पात/मा. उच्च न्यायालय आदेश

/ स्थायी वैद्यक�य मंडळ व मान्यता प्राप्त वैद्यक�य गभर्पात क� द्रांनी

अनुसरावयाची कायर्मागर्दशर्क तत्वे (SOPs) / �दनांक ०:-

१८.०१.२०२०. vide section IVc (Copy attached)

5. We are ready to do the termination of pregnancy as

per the directives of the Hon. Supreme Court of India.

If the baby is born alive, we are ready to keep the

baby in the Neonatal Intensive Care Unit if required

under the care of neonatologist.”

11. On the communication being drawn to the attention of the Registrar

(Judicial – I), the proceedings were listed before the Court on 29 April 2024, which

was the first available working day.

12. In view of the communication of the Dean at Sion hospital, we had the

benefit of hearing submissions of counsel again. We considered it appropriate to

thereafter interact with the parents of ‘X’ as well as with the medical team at Sion

hospital. We have had an elaborate discussion with the medical team consisting

of Dr Arun H Nayak, Professor and Head of the Department of Obstetrics and

Page 9 of 22

Gynecology and Dr Amarjeet Kaur Bava, Associate Professor and Unit Chief,

Department of Obstetrics and Gynecology , over the video conferencing

platform.

13. Dr Arun H Nayak has indicated that after the order of this Court dated 22

April 2024, the medical team followed requisite procedures by carrying out

medical investigations and seeking the consent of the parents. According to the

medical team, while initially the parents were agreeable to the stoppage of the

fetal heart on 24 April 2024, on 25 April 2024 the appellant stated that she desires

that the pregnancy be taken to term and that she would thereafter give the child

in adoption. Subsequently, on 26 April 2024, the appellant stated that she desired

a termination of pregnancy.

14. The doctors stated that in view of the changing views of the appellant and

her spouse and the above background, they had moved the Additional Solicitor

General with a communication dated 26 April 2024 of the Dean of the Sion

hospital, as extracted above. Dr Nayak and Dr Bava have stated that in terms of

the guidelines of the Union Government dated 14 August 2017, medical steps

would have to be taken by giving an intracardiac injection, KCL, to end the life of

the fetus in utero. An SOP has also been issued by the State Government on 18

January 2020. The doctors have stated that the pregnancy of the minor is at an

advanced stage. In terms of the applicable guidelines, an intracardiac injection

of KCL has to be administered and if the fetal heart is not detected to have

stopped after sonography following the administration of the injection, the

procedure would have to be repeated. Both the doctors have indicated that this

Page 10 of 22

may involve a certain degree of risk to the minor which cannot be ruled out

bearing in mind the late stage of the pregnancy.

15. The parents of ‘X’ have conversed with the doctors and with the Court on

the video conferencing platform in Hindi. Their primary concern was that they

should have been apprised a week ago by the medical team after the order of

this Court was passed of the inherent dangers in carrying out the procedure in an

advanced pregnancy. We appreciate the concerns of the parents and their

anguish, particularly having regard to the backdrop in which the pregnancy is

stated to have arisen. The issue is about the way forward at the present stage.

16. During the course of the conversation online, the doctors have deliberated

on whether a delivery can be induced at this stage. However, both the doctors

ruled out such a course of action bearing in mind that inducing a delivery at this

stage may have real risks of a deformed child as a result of the premature birth.

The situation has been duly explained to the parents of the minor.

17. It has emerged during the course of the discussion that both the parents of

‘X’ are averse to undertaking any risk to the life and well-being of their daughter

at this stage and would prefer to take her home and to readmit her to the Sion

hospital in time for her due date of delivery. During the course of the discussion, Dr

Bava indicated to the parents that Sion hospital is ready and willing to let ‘X’ be in

the care of the hospital from now until the date of the delivery. However, the

father of the minor has specifically stated the he would prefer to take the minor

home where she would be in more congenial surroundings with the members of

her family. The doctors have indicated to the father and the mother that they

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should bring the minor back to the hospital for regular antenatal checkups .

18. This Court by its earlier order had authorized the medical team at the Sion

hospital to carry out the termination of pregnancy. The reasons on the basis of

which such a course was adopted have been elaborated upon in the earlier

order, which is extracted above. Even when the Court passed the order on the

previous occasion, the minor was in the thirtieth week of her pregnancy. She is

now nearing the end of the thirty first week of pregnancy.

19. The sole and only consideration which must weigh with the Court at this

stage is the safety and welfare of the minor. We are conscious of the trauma which

the minor will face in having to continue the pregnancy for approximately five

weeks, if the course of action which has been suggested by her parents is

accepted. The Court has been informed that the minor is ready and willing to

accept the decision of her parents which is in her best interest. Performing a

procedure for termination of an advanced pregnancy at this stage is subject to

risks involving the well- being and safety of the minor as explained by the medical

team at Sion hospital. Bearing in mind the detailed discussion which took place,

the parents of the minor have chosen not to press ahead with the termination of

the advanced pregnancy at the present point of time. This decision, should, in our

view, be accepted bearing in mind all that has been set out in the earlier part of

this order. As a consequence, the earlier order of this Court dated 22 April 2024

shall stand recalled.

20. Before parting with this judgment we would like to shed light on two issues

which have caught our attention in these proceedings. First, the opinion of the

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medical board constituted under the MTP Act must reflect the effect of the

pregnancy on the pregnant person's physical and mental health. Second, the MTP

Act and the reproductive right of a pregnant person gives primacy to their

consent.

Role of the RMP and medical board under the MTP Act

21. In X v. State (NCT of Delhi),

4

a three-judge bench of this Court had

recognised that the fear of prosecution among registered medical practitioners

5

is a barrier for pregnant persons

6

to access safe and legal abortions. The opinion

of the RMP is decisive in matters of termination of pregnancy under the MTP Act.

The purpose of the opinion of the RMP borrows from the legislative intent of the

MTP Act which is to protect the health of a pregnant person and facilitate safe,

hygienic, and legal abortion. The right to abortion is a concomitant right of dignity,

autonomy and reproductive choice. This right is guaranteed under Article 21 of

the Constitution. The decision to terminate pregnancy is deeply personal for any

person. The choice exercised by a pregnant person is not merely about their

reproductive freedom but also about their agency as recognised by this court in

X v. State (NCT of Delhi).

7

It is therefore imperative that the fundamental right of a

pregnant person is not compromised for reasons other than to protect the physical

and mental health of the pregnant person.

4

(2023) 9 SCC 433

5

“RMP”

6

We use the term ‘pregnant person’ and recognize that in addition to cisgender women,

pregnancy can also be experienced by some non -binary people and transgender men

among other gender identities.

7

(2023) 9 SCC 433

Page 13 of 22

22. Section 3(1) of the MTP Act protects the registered medical practitioner

from penal provisions against abortion, under the Indian Penal Code,

8

if it is carried

out as per the MTP Act. Moreover, no penalty may be attracted to a RMP merely

for forming an opinion, in good faith, on whether a pregnancy may be terminated.

This is because the MTP Act requires and empowers the RMP to form such an

opinion. Its bona fide assured, no aspersions may be cast on the RMP. The same

applies to medical boards constituted under Section 3(2-C) and Section 3(2-D) of

the MTP Act.

23. The opinion of the RMP or the medical board, as the case may be, is

indispensable under the scheme of the MTP Act. This inadvertently gives the power

to the RMP or the medical board to stand in the way of a pregnant person

exercising their choice to terminate the pregnancy. When there is fear or

apprehension in the mind of the RMP or the medical board it directly jeopardises

the fundamental freedoms of pregnant persons guaranteed under the

Constitution. However, the scheme of the MTP Act and the steady line of

application of the law by the courts has made it clear that the RMP or the medical

board cannot be prosecuted for any act done under the MTP Act in good faith.

24. In the present case, the medical board of the Grant Government Medical

College & Sir JJ Group of Hospitals, Mumbai had prepared a report dated 28

March 2024 stating that the pregnancy may be terminated in view of the physical

and mental health of ‘X’. The report however sought the permission of the High

Court since the gestational age of the fetus was above twenty four weeks, which

8

“IPC”

Page 14 of 22

is the permissible age for termination of pregnancy under the MTP Act. What is

inexplicable is the diametrically opposite view taken by the medical board in its

‘clarificatory’ opinion dated 3 April 2024. As we have noted above, the medical

board issued a clarification without re-examining ‘X’. Moreover, the opinion did

not elaborate on the change in circumstances which prompted the board to issue

a clarification on its earlier opinion.

25. From a perusal of the MTP Act, its statement of object and reasons as well

as the recommendation of the Shah Committee which examined the issue of

liberalising abortion laws in India,

9

two clear postulates emerge as to the legislative

intent of the MTP Act. Firstly, the health of the woman is paramount. This includes

the risk avoided from the woman not availing unsafe and illegal methods of

abortion. Secondly, disallowing termination does not stop abortions, it only stops

safe and accessible abortions. The opinion of the RMP and the medical board

must balance the legislative mandate of the MTP Act and the fundamental right

of the pregnant person seeking a termination of the pregnancy. However, as

noticed above and by this Court in X v. State (NCT of Delhi)

10

the fear of

prosecution among RMPs acts as a barrier for pregnant people in accessing safe

abortion. Further, since the MTP Act only allows abortion beyond twenty four

weeks if the fetus is diagnosed with substantial abnormalities, the medical board

opines against termination of pregnancy merely by stating that the threshold

under Section 3(2-B) of the MTP Act is not satisfied. The clarificatory report dated

3 April 2024 fell into this error by denying termination on the ground that the

9

Report of the Committee to Study the Question of Legislation of Abortion, Ministry of Health

and Family Planning, Government of India, dated December 1966.

10

(2023) 9 SCC 433

Page 15 of 22

gestational age of the fetus is above twenty-four weeks and there are no

congenital abnormalities in the fetus.

26. The report failed to form an opinion on the impact of the pregnancy on the

physical and mental health of the pregnant person. If a pregnant person meets

the condition under Section 3(2-B) of the MTP Act then there would be no need

for any permission by the courts. Therefore, whenever a pregnant person

approaches the High Court or this Court, it is imperative for the medical board to

opine on the physical and mental health of the pregnant person. This court in XYZ

v. State of Gujarat,

11

held 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. In light of the peculiar circumstances of that case

where the pregnancy was detrimental to the physical and mental health of the

pregnant person, this Court held that:

“10. We find that in the absence of even noticing the

aforesaid portion of the report, the High Court was

not right in simply holding that “the age of the foetus

is almost 27 weeks as on 17.08.2023 and considering

the statements made by the learned advocate fo r

the petitioner-victim and the averments made in the

application the petition for medical

termination of pregnancy stands rejected”, which, in

our view is ex facie contradictory...

…

19. The whole object of preferring a Writ Petition

under Article 226 of the Constitution of India is to

engage with the extraordinary discretionary

jurisdiction of the High Court in exercise of its

constitutional power. Such a power is vested with the

constitutional courts and discretion has to be

exercised judiciously and having regard to the

facts of the case and by taking into consideration

the relevant facts while leaving out irrelevant

considerations and not vice versa.”

11

2023 SCC OnLine SC 1573

Page 16 of 22

27. The powers vested under the Constitution in the High Court and this Court

allow them to enforce fundamental rights guaranteed under P art III of the

Constitution. When a person approaches the court for permission to terminate a

pregnancy, the courts apply their mind to the case and make a decision to

protect the physical and mental health of the pregnant person. In doing so the

court relies on the opinion of the medical board constituted under the MTP Act for

their medical expertise. The court would thereafter apply their judicial mind to the

opinion of the medical board. Therefore, the medical board cannot merely state

that the grounds under Section 3(2-B) of the MTP Act are not met. The exercise of

the jurisdiction of the courts would be affected if they did not have the advantage

of the medical opinion of the board as to the risk involved to the physical and

mental health of the pregnant person. Therefore, a medical board must examine

the pregnant person and opine on the aspect of the risk to their physical and

mental health.

28. The MTP Act has removed the restriction on the length of the pregnancy for

termination in only two instances. Section 5 of the MTP Act prescribes that a

pregnancy may be terminated, regardless of the gestational age, if the medical

practitioner is of the opinion formed in good faith that the termination is

immediately necessary to save the life of the pregnant person. Section 3(2-B) of

the Act stipulates that no limit shall apply on the length of the pregnancy for

terminating a fetus with substantial abnormalities. The legislation has made a value

judgment in Section 3(2-B) of the Act, that a substantially abnormal fetus would

be more injurious to the mental and physical health of a woman than any other

circumstance. In this case, the circumstance against which the provision is

Page 17 of 22

comparable is rape of a minor. To deny the same enabling provision of the law

would appear prima facie unreasonable and arbitrary. The value judgment of the

legislation does not appear to be based on scientific parameters but rather on a

notion that a substantially abnormal fetus will inflict the most aggravated form of

injury to the pregnant person. This formed the basis for this Court to exercise its

powers and allow the termination of pregnancy in its order dated 22 April 2024.

The provision is arguably suspect on the ground that it unreasonably alters the

autonomy of a person by classifying a substantially abnormal fetus differently than

instances such as incest or rape. This issue may be examined in an appropriate

proceeding should it become necessary.

29. Moreover, we are conscious of the fact that the decision to terminate

pregnancy is one which a person takes seriously. The guidelines to terminate

pregnancy as well as the scheme of the MTP Act show the seriousness attached

to the well-being of the pregnant person throughout the process envisaged under

the MTP Act. Change in the opinion of the medical board may cause undue

trauma and exertion to a pregnant person whose mental health is understandably

under distress. While we understand the need for a medical board to issue a

clarificatory opinion based on the facts and circumstances of each case, the

board must explain the reasons for the issuance of the clarification and, in

particular, if their opinion has changed from the earlier report. Pregnant persons

seeking termination of pregnancy seek predictability for their future. The

uncertainty caused by changing opinions of the medical board must therefore

balance the distress it would cause to the pregnant person by providing cogent

and sound reasons.

Page 18 of 22

30. The opinion of the pregnant person must be given primacy in evaluating

the foreseeable environment of the person under Section 3(3) of the MTP Act.

12

In

Z v. State of Bihar,

13

this Court found that the state authorities had failed in not

terminating the pregnancy before the passage of twenty weeks which was

permissible under the law. While a pregnancy beyond the statutory prescription

would require the intervention of a constitutional court, the vitality of time

sensitivity was recognised by this Court. ‘X’ was taken for termination of her

pregnancy at the gestational age of twenty-five weeks in the present case. The

passage of time in seeking the permission of this Court after being unsuccessful

before the High Court matured the gestational age of the fetus to almost twenty-

nine weeks. This increased the risk involved in ending the pregnancy of ‘X’

inducing the voluntary change of opinion by ‘X’ and her parents to take the

pregnancy to term.

31. This highlights the need for giving primacy to the fundamental rights to

reproductive autonomy, dignity and privacy of the pregnant person by the

medical board and the courts. The delays caused by a change in the opinion of

the medical board or the procedures of the court must not frustrate the

fundamental rights of pregnant people. We therefore hold that the medical board

evaluating a pregnant person with a gestational age above twenty-four weeks

must opine on the physical and mental health of the person by furnishing full

details to the court.

12

X v. State (NCT of Delhi), (2023) 9 SCC 433.

13

(2018) 11 SCC 572

Page 19 of 22

Primacy of the pregnant person’s consent in abortion

32. As noted above, the order of this court allowing ‘X’ to terminate her

pregnancy is recalled. This decision is made in light of the decisional and bodily

autonomy of the pregnant person and her parents. The MTP Act does not allow

any interference with the personal choice of a pregnant person in terms of

proceeding with the termination. The Act or indeed the jurisprudence around

abortion developed by the courts leave no scope for interference by the family

or the partner of a pregnant person in matters of reproductive choice.

33. As stated above, the role of the RMPs and the medical board must be in a

manner which allows the pregnant person to freely exercise their choice. In the

present case, the guardians of ‘X’, namely her parents, have also consented for

taking the pregnancy to term. This is permissible as ‘X’ is a minor and the consent

of the guardian is prescribed under Section 3(4)(a) of the MTP Act.

34. In Suchita Srivastava v. Chandigarh Admn.

14

, a three-judge Bench of this

Court has held that the right to make reproductive choices is a facet of Article 21

of the Constitution. Further, the consent of the pregnant person in matters of

reproductive choices and abortion is paramount. The purport of this Court’s

decision in Suchita Srivastava (supra) was to protect the right to abortion on a firm

footing as an intrinsic element of the fundamental rights to privacy, dignity and

bodily integrity as well as to reaffirm that matters of sexual and reproductive

choices belong to the individual alone. In rejecting the State’s jurisdiction as the

parens patriae of the pregnant person, this Court held that no entity, even if it is

14

(2009) 9 SCC 1

Page 20 of 22

the State, can speak on behalf of a pregnant person and usurp her consent. The

choice to continue pregnancy to term, regardless of the court having allowed

termination of the pregnancy, belongs to the individual alone.

35. In the present case the view of ‘X’ and her parents to take the pregnancy

to term are in tandem. The right to choose and reproductive freedom is a

fundamental right under Article 21 of the Constitution. Therefore, where the

opinion of a minor pregnant person differs from the guardian, the court must

regard the view of the pregnant person as an important factor while deciding the

termination of the pregnancy.

Conclusion

36. In the facts and circumstances of this case, we issue the following directions:

(i) The Sion hospital shall bear all the expenses in regard to the

hospitalization of the minor over the past week and in respect of her re-

admission to the hospital for delivery as and when she is required to do

so; and

(ii) In the event that the minor and her parents desire to give the child in

adoption after the delivery, the State Government shall take all

necessary steps in accordance with the applicable provisions of law to

facilitate this exercise. This shall not be construed as a direction of this

Court binding either the parents or the minor and the State shall abide

by the wishes as expressed at the appropriate stage.

Page 21 of 22

37. In light of the issues which arose before this Court we record our conclusions

as follows:

(i) The MTP Act protects the RMP and the medical boards when they

form an opinion in good faith as to the termination of pregnancy;

(ii) The medical board, in forming its opinion on the termination of

pregnancies must not restrict itself to the criteria under Section 3(2-B)

of the MTP Act but must also evaluate the physical and emotional

well being of the pregnant person in terms of the judgment;

(iii) When issuing a clarificatory opinion the medical board must provide

sound and cogent reasons for any change in opinion and

circumstances; and

(iv) The consent of a pregnant person in decisions of reproductive

autonomy and termination of pregnancy is paramount. In case there

is a divergence in the opinion of a pregnant person and her

guardian, the opinion of the minor or mentally ill pregnant person

must be taken into consideration as an important aspect in enabling

the court to arrive at a just conclusion.

38. In view of the above, the appeal is disposed of. There shall be no order as

to costs.

Page 22 of 22

39. Pending application(s), if any, disposed of.

….…...…...….......………………….....…CJI.

[Dr Dhananjaya Y Chandrachud]

…….……...…...….......………………....… ..J.

[J B Pardiwala]

…….……...…...….......………………....… ..J.

[ Manoj Misra]

New Delhi;

April 29, 2024.