Supreme Court Upholds 24-Week Threshold for Medical Termination under MTP Act: X v. Union of India (2023 INSC 919)

Introduction

The Supreme Court of India delivered a pivotal judgment in the case of X v. Union of India (2023 INSC 919), addressing the complexities surrounding the medical termination of pregnancy under the Medical Termination of Pregnancy (MTP) Act, 1971. The petitioner, anonymized as "X," a 27-year-old woman with two children, sought permission to terminate her pregnancy at approximately 24 weeks. The crux of the case revolved around her late discovery of pregnancy due to lactational amenorrhea, coupled with mental health challenges and socio-economic constraints.

The Union of India contested the initial permissive order, leading to a split verdict and subsequent deliberations before a three-judge bench. This commentary delves into the intricacies of the judgment, exploring its legal underpinnings, reasoning, and implications for future jurisprudence.

Summary of the Judgment

Initially, a two-judge bench comprising Justices Hima Kohli and B V Nagarathna permitted the medical termination of the petitioner's pregnancy, citing risks to her mental health. However, subsequent communications from the All India Institute of Medical Sciences (AIIMS) raised concerns about the viability of the fetus and the necessity of feticide to prevent potential disabilities.

Upon reconsideration, the bench was reconstituted to include the Chief Justice of India, leading to a split verdict. Justice Kohli opposed the termination based on the new information, while Justice Nagarathna upheld the original order. Ultimately, a three-judge bench affirmed the necessity to adhere to the statutory 24-week limit, denying the petitioner's request for termination beyond this threshold in the absence of substantial fetal abnormalities or immediate threats to the mother's life.

Analysis

Precedents Cited

The judgment references several landmark cases that have shaped the interpretation of the MTP Act and the discretionary powers of the Supreme Court under Article 142 of the Constitution.

• State of Punjab v. Rafiq Masih (2014): Established that the benefits of Rule 3B of the MTP Rules are equally applicable to both single and married women, ensuring non-discriminatory access to pregnancy termination based on changing circumstances.
• State v. Kalyan Singh (2017): Affirmed the expansive power of Article 142, enabling the Supreme Court to ensure complete justice even beyond the confines of existing legal provisions.
• Delhi Administration v. Gurdip Singh Uban (2000): Highlighted the limited and exceptional nature of recall applications, emphasizing the need for finality in judicial decisions to maintain legal certainty.

Legal Reasoning

The Court meticulously analyzed the provisions of the MTP Act, particularly Section 3 and Section 5, concerning the permissible duration and conditions for medical termination of pregnancy.

• Section 3(2)(b): Allows termination up to 24 weeks with the concurrence of two Registered Medical Practitioners (RMPs) if there are substantial fetal abnormalities or significant risks to the mother's physical or mental health.
• Section 5: Empowers RMPs to bypass the gestational limits in cases where termination is immediately necessary to save the mother's life.

In the present case, the Court determined that:

• The pregnancy had exceeded the 24-week limit, reaching approximately 26 weeks and five days.
• No substantial fetal abnormalities were detected, as confirmed by AIIMS' medical board.
• The continuation of pregnancy did not present an immediate life-threatening risk to the mother.

Therefore, the Court concluded that the prerequisites for termination beyond 24 weeks were not met, necessitating adherence to the statutory framework.

Impact

This landmark judgment reinforces the sanctity of the 24-week threshold stipulated by the MTP Act, delineating clear boundaries for medical practitioners and judicial authorities. Key implications include:

• Clarification of Limits: Affirming that medical termination beyond 24 weeks remains unconstitutional unless specific stringent conditions under the MTP Act are satisfied.
• Judicial Restraint: Emphasizing the judiciary's role in interpreting rather than expanding legislative provisions, thereby maintaining legal predictability.
• Medical Protocol Adherence: Reinforcing the necessity for medical boards to adhere strictly to established guidelines when assessing termination requests.
• Protection of Fetal Rights: Implicitly recognizing the rights of the fetus post-viability, balancing maternal autonomy with fetal viability considerations.

Future cases involving late-term pregnancies will likely reference this judgment, ensuring that the MTP Act's provisions are upheld with fidelity.

Complex Concepts Simplified

Conclusion

The Supreme Court's decision in X v. Union of India (2023 INSC 919) underscores the judiciary's commitment to upholding legislative frameworks while navigating the nuanced challenges of reproductive rights. By reaffirming the 24-week limit for medical termination of pregnancy, the Court ensures a balanced approach that respects both the autonomy of the pregnant woman and the evolving considerations of fetal viability.

This judgment serves as a critical reference point for medical practitioners, legal professionals, and policymakers, guiding future deliberations on reproductive rights and the implementation of the MTP Act. It epitomizes the delicate interplay between statutory adherence and judicial prudence, paving the way for informed and equitable resolutions in complex medical-legal scenarios.