Abortion after 20 weeks is now permitted. Hon. Bombay High Court in its landmark judgment has given great relief to needy Mothers and Doctors too..

Case Details :

XYZ V/s. State of Maharashtra (W.P. No.10835/2018) along with other petitions

Decided by Division Bench of Hon. Bombay High Court, 03/04/2019

CORAM : Hon. Abhay S. Oka & Hon. M.S. Sonak, JJ.

Facts of the case in short (the judgment runs in to 78 pages):

1. Various petitions were clubbed together to decide following moot questions :

a) Whether pregnancy can be terminated exceeding 20 weeks, i.e. the ceiling limit prescribed by Sec. 3(2) of MTP Act  and whether high Court has right to pass such order ?

b) If permission is so granted, then what should be the procedure and what safeguards to be taken ?

c) What is the legal status of the child born alive despite attempts   at   medical   termination   of   pregnancy   ­   the procedure   to   be   followed   in   such   cases   –   and   the responsibility of the State in such matters?

2. Hon. bombay high Court has dealt with all the issues in detail and has considered various cases, aspects of the matter and then it has passed the judgment.

Why MTP Act was passed ?

3)At the outset  The Bench considered the provisions of Medical Termination of Pregnancy Act (MTP), 1971 and its Statements of  Objects and Reasons (SOR) states why the law was enacted.  It relates back to the Sections 312 to 318 of IPC, 1860, and the Bench has also in detail considered these sections. The IPC had criminalized the medical termination of pregnancy (abortion). The mother as well as abortionist could be punished, except where abortion had to be induced in order to save the life of the mother. 

Who can perform MTP and where it can be performed  ?

4) The judgement has also emphasised  the definition of a Registered Medical Practitioner (sec.2(d)), only who is authorized to perform MTP. Rule 4 of the MTP Rules 2003 which provides   for   the   experience   and   training   which   ‘registered medical practitioner’  must possess before she can undertake termination of pregnancies under the MTP Act. Thus only a registered medical practitioner with proper experience and training can only perform MTP, if any one of the condition is lacking, then such Doctor cannot perform MTP. It is an offense under the Act with 2 to 7 years imprisonment plus fine if MTP is conducted by other than Registered medical Practitioner. The rule 4 is also very important and has been discussed in detail. 

Sec. 4 of the MTP Act is concerned with the  place where pregnancy may be terminated i.e. the registered Hospital under Act. It read with Rule 5 of the Act which talks about the conditions for approving a hospital as registered Hospital under this Act. 

It referred to the landmark judgment of hon. Supreme Court in the case of Surendra Chauhan vs. State of M.P. ­ AIR 2000 SC 1436,  the Supreme Court upheld the conviction of a Doctor, who had a degree in Medicine, but not the experience and training in the relevant discipline of Medicine for undertaking abortions. It was also held that conducting of abortions without proper facility and not keeping clinic registered, was itself a punishable crime

When MTP Can be performed as per law ?

The judgment revolves around these provisions. 

5) Section 3 (2) of the MTP Act provides, that sa pregnancy may be terminated by a registered medical practitioner,­  

a)  where the length of the pregnancy does not exceed twelve weeks, if such medical practitioner is, or  

(b)  where the length of the pregnancy exceeds twelve weeks but does not exceed twenty weeks, if not less than two registered medical practitioners are, of opinion, formed in good faith, that,­  

(i)  the continuance of the pregnancy would involve a risk to the life of the pregnant woman or of grave injury to her physical or mental health ; or  

(ii)  there is a substantial risk that if the child were born,   it   would suffer   from   such   physical   or   mental abnormalities as to be seriously handicapped.  

Explanation I.­ Where any, pregnancy is alleged by the pregnant   woman   to   have   been   caused   by   rape,   the   anguish caused by such pregnancy shall be presumed to constitute a grave injury to the mental health of the pregnant woman. 

Explanation II.­Where any pregnancy occurs as a result of failure of any device or method used by any married woman or her husband for the purpose of limiting the number of children, the   anguish   caused   by   such   unwanted   pregnancy   may   be presumed to constitute a grave injury to the mental health of the pregnant woman

6) Section   3   (4)   (a)   of   the   MTP   Act   provides,   that   no pregnancy   of   a   woman,   who   has   not   attained   the   age   of eighteen years, or, who, having attained the age of eighteen years, is a [mentally ill person], shall be terminated except with the consent in writing of her guardian. Section 3 (4)(b) provides, that save as otherwise provided in clause (a), no pregnancy. 

 “Life” of the pregnant woman.

7) This is the beauty of the judgment. Fine example of how law should be interpreted to achieve its aims and objects.  Section 5 of the MTP Act deals with the circumstances in which the provisions of sections 3 and 4 of the MTP Act will not apply. the provisions of Sec.3 and 4 shall not apply to the termination of a pregnancy by the registered medical practitioner, in a case where he is of opinion,  formed   in   good   faith,   that   the   termination   of   such pregnancy  is   immediately   necessary   to   save   the   life   of   the pregnant woman. 

Their Lordships posed the important and thought provoking questions :

Is the expression “life”to be construed narrowly as merely 

antithetic to the expression “death”?

Is the expression “to save the life of the pregnant woman” to be interpreted as “to prevent the death of the pregnant woman”? 

Is the expression “life” to be interpreted as “existence” or “mere animal existence” or “physical survival” ? 

Or is the expression “life” to be liberally construed so as to comprehend not only physical existence but also quality of life as is understood in its richness and fullness consistent with human dignity ?   

8) The expression “life” in section 5 of the MTP Act is to be construed narrowly as antithesis to death or physical survival or mere animal existence, then, it is perhaps possible to say that the exception carved out in section 5 of the MTP Act will apply only to termination of pregnancies to prevent the death of the pregnant woman. This would mean that the exception in section 5 of the MTP Act will operate only to cases where the registered medical practitioner forms an opinion in good faith that unless the pregnancy is terminated, the mother might die. Such   narrow   construction   would   then   mean   that   the exception in section 5 of the MTP Act will not operate even to contingencies where registered medical practitioners opine that the   continuance   of   pregnancy   involves   grave   injury   to   the physical health (not life threatening) or to the mental health of the mother. The exception will then not apply to cases where pregnancy   is   alleged   to   have   been   caused   by   rape.

Right to have a baby includes right not to have a baby. A woman has right to choose methods of birth control of their choice. 

9) The Court relied upon various judgments of Hon. Apex Court wherein MTP was permitted beyond 20 weeks where medical opinion established that continuance of pregnancy involved grave injury to the mental health of the pregnant woman or where there was substantial risk that if the child. This was despite the fact that there was no immediate danger to the life of the pregnant mother.

were born, it would suffer from such physical or mental abnormalities as to be seriously handicapped. Thus their Lordships did not give narrow interpretation to Sec.5

One of the important judgment  is that of  Suchita   Srivastava   vs.   Chandigarh Administration   –   2009   (9)   SCC  1. Wherein hon. Apex court held that   that  a woman’s right to make   reproductive   choices   is   also   a   dimension   of   ‘personal liberty’   as   understood   under   Article   21   of   the   Constitution. Even-though the Petitioner who was a rape victim was not permitted to undergo MTP as it could not be proved that she was Mentally Ill. But their lordships held that "It is important to recognize that reproductive choices can be exercised to procreate as well as to abstain from procreating.. Their dignity is very important.... there should be no restriction whatsoever on the exercise of reproductive choices such as a woman's right to refuse participation in sexual activity or alternatively the insistence on use of contraceptive methods."

"How she wants to deal with this pregnancy must be a decision she and she alone can make. The right to control her own body and fertility and motherhood choices should be left to the women alone. The basic right of a woman is the right to autonomy, which includes the right to decide whether or not to get pregnant and stay pregnant" -  High Court on its own motion vs. The State of Maharashtra – 2017 Cri.L.J. 218 has

Whether Hon. High Court has jurisdiction to order MTP beyond 20 weeks or it rests only with Hon. Supreme Court ?

10)  It was one of the argument advanced that only Hon. Supreme Court has constitutional powers to order MTP beyond 20 weeks. The reason was that it was observed in Tapasya Umesh Pisal vs. Union of India – (2018) 12 SCC 57, that MTP @ 24 weeks was permitted "in the interest of justice" after considering the opinion of Medical Board and thus the judgment ought to have been passed by exercising special powers Art. 142 of the Constitution and thus its not the binding precedent. 

However the High Court did not accpet this argument as there was nothing to suggest so. Moreover in another judgment of Sonali Kiran Gaikwad vs. Union of India – (Writ Petition © No. 928 of 2017 decided on 9th October 2017,) wherein it was held that such cases in future can be filed in respective High Courts. In another case of Z vs. State of Bihar – 2018 (11) SCC 572 Hon. Supreme Court was upset with Hon. High Court for not exercising its powers in allowing the needy woman to undergo MTP.

Why purposive interpretation of Law is essential and why Law should change as per times ?

11) Why there is a need to give proper interpretation to MTP, their Lordships turned to various judgment of Apex Courts. The MTP Act was enacted almost five decades ago, i.e., in 1971. There is sea change in the medical opinion looking to the advancement in medical science since then.

It has been held by their Lordships of Supreme Court that Law must not remain static but move ahead with the times keeping in mind the social context. In, Maganlal Chhaganlal (P) Ltd. v. Municipal Corpn. of Greater Bombay – (1974) 2 SCC 402, H.R. Khanna, J. rather pragmatically observed that as in life so in law, things are not static. Fresh vistas and horizons may reveal themselves as a result of the impact of new ideas and developments indifferent fields of life. Law, if it has to satisfy human needs. Nobody is so gifted with foresight that he can divine all possible human events in advance and prescribe proper rules for each of them. 

In Badshah v. Urmila Badshah Godse – (2014) 1 SCC 188, the Supreme Court reaffirmed the need to shape law as per the changing needs of the times and circumstances by observing that the law regulates relationships between people. 
In a situation where the continuance of pregnancy poses grave injury to the physical or mental health of the mother or in a situation where there is substantial risk that if the child were born, would suffer from deformities and diseases, the pregnant mother is forced to continue with her pregnancy merely because the pregnancy has extended beyond the ceiling of 20 weeks, there would arise a serious affront to the fundamental right of such mother to privacy, to exercise a reproductive choices, to bodily integrity, to her dignity.

Right to life includes right to live with human dignity.

The right to life includes the right to live with human dignity and all that goes along with it, namely, the bare necessaries of life such as adequate nutrition, clothing and shelter and facilities for reading, writing and expressing oneself in diverse forms, freely moving about and mixing and commingling with fellow human beings. Every act which offends against or impairs human dignity would constitute deprivation pro tanto of this right to live and it would have to be in accordance with reasonable, fair and just procedure established by law which stands the test of other fundamental rights.(See Fransis Coralie Mullin vs. UT of Delhi – (1981) 1 SCC 608).

Therefore, when it comes to interpretation of the expression “life” in section 5 of the MTP Act, we cannot construe the same as restricted to mere physical existence or mere animal existence or mere survival of the pregnant mother. The scheme of the MTP Act, even otherwise, places the interests of a mother on a higher pedestal than the interests of a prospective child. This is based on the logic that the fetus cannot have independent extra uterine existence and the life of the mother who independently exists, is entitled to greater consideration.

"Many anomalies cannot be detected until 20 weeks."

( These Words, the Doctors were eagerly waiting to listen, don't they ? )

14) Many Doctors were suggesting this observation that many anomalies cannot be detected earlier i.e. prior to 20 weeks. But the MTP Act was not allowing needy women to terminate pregnancy only because anomalies were detected after 20 weeks. 

Their Lordships on this point rightly observed that It is not as if all contingencies express themselves only within the first 20 weeks of pregnancy. Even in cases where a pregnant mother is regularly following up with her gynecologist, double marker test is undertaken between 10th and 13th week; triple marker test between 18th and 20th week and the crucial Anamoly scan, in or around the 20th week. Many serious fetal anamolies may not even be diagnosable until twenty weeks as many pregnant mothers may not even have access to suitable diagnostic tools, particularly in rural parts. In many cases, complications can develop as the pregnancy advances. In many cases, complications may be detected at some advanced stage. In such cases, as long as the medical opinion does not suggest that medical termination of pregnancy at the advance stage is itself a serious risk to the physical life of the pregnant mother, the law cannot plead helplessness particularly where

circumstances set in clauses (i) and (ii) of section 3 (2)(b) of the MTP Act manifestly exist

15) Conclusion :
In its 78 pages judgment, after touching to various aspects of MTP Act, the Division bench concluded its judgment by passing order and same may be summarised as under   :
a) a registered medical practitioner may medically terminate pregnancy which has exceeded 20 weeks, without permission from the High Court, only where he is of opinion, formed in good faith, that the termination of such pregnancy is immediately necessary to save the life of the pregnant woman, else she might die.
b) If there is no immediate danger of the pregnant woman succumbing, in case the pregnancy is not terminated, the registered medical practitioner is not entitled to terminate pregnancy beyond 20 weeks.
c) where a pregnant woman, the length of whose pregnancy has exceeded 20 weeks seeks to terminate such pregnancy on the ground that its continuance would involve grave injury to her physical or mental health or where there is a substantial risk that if
the child were born, it would suffer from such physical or mental abnormalities as to be seriously handicapped, such pregnant woman will have to seek permission from the High Court and unless such permission is granted, no registered medical practitioner can terminate such pregnancy as per Sec.5
d) The High Court has every power under Art. 226 of the Constitution to direct MTP beyond 20 weeks.
e) Within 3 months from this order, State government should establish medical boards in every District to examine pregnant women whose pregnancy is to be terminated beyond 20 weeks. 
f) Govt. should establish such authorsied places for MTP in every districts and inspect them periodically.
g) Govt. should emphasis on rural areas and pregnant women have access to safe and hygienic facilities and there is avoidable wastage of mother’s health, strength and sometimes, life.
h) If inspite of MTP, a child is born alive, the registered medical practitioner and the hospital/clinic concerned will have to assume full responsibility to ensure that such child is offered best medical treatment available in the circumstances, in order that it develops into a healthy child and a special policy is to be formed for treating such cases.
i) If the parents of such child are not in a position to or not willing to look after such child, then State the State and its agencies will have to assume full responsibility for such child and offer such child medical support and facilities.

I sincerely feel its a great piece of judgment. Their Lordships have considered all the aspects of  MTP Act. It has given great relief to all those parents who have to take unpleasant decision of MTP. The Court has also recognized the important role of Doctors and have made their job easy. 

Thanks and Regards

Adv. Rohit Erande
Pune. ©