Source: The Indian Express 

Introduction 

The recent Bombay High Court judgment allowing a 35-year-old woman to terminate her 25-week pregnancy at a private hospital reveals significant gaps in India's abortion laws. The case brings to light the urgent need to update the Medical Termination of Pregnancy Rules, 2003 (MTP Rules), particularly regarding procedures at private hospitals for pregnancies beyond 24 weeks. This landmark decision sets a crucial precedent while raising important questions about reproductive rights and healthcare accessibility. 

What is the Law on Abortion in India? 

• Under Section 3 of the Medical Termination of Pregnancy Act, 1971 (MTP Act) pregnancy termination up to 20 weeks requires approval from one registered medical practitioner. 
• For pregnancies between 20-24 weeks, approval from two registered medical practitioners is mandatory. 
• Rule 3B of MTP Rules (2003) allows abortion between 20-24 weeks for specific categories including rape victims, minors, and women with changed marital status during pregnancy. 
• For pregnancies beyond 24 weeks, state governments must establish medical boards in each district to evaluate cases of substantial fetal abnormality. 
• Medical practitioners must assess if continuing pregnancy risks the woman's life or could cause grave physical/mental harm. 
• They must also determine if there's substantial risk of serious physical/mental abnormality in the child if born. 
• The law requires evaluation of both maternal health risks and fetal abnormalities in decision-making. 

What are the Regulations for Abortion in Private Hospitals? 

• Section 4 of the MTP Act permits pregnancy termination at government hospitals or approved private facilities. 
• Private hospitals must obtain approval from a District Level Committee headed by Chief Medical Officer/District Health Officer. 
• Under Rule 5(6) of MTP Rules, the committee can review applications and issue approval certificates to private hospitals. 
• Private hospitals must submit 'Form A' for approval, which currently only includes two categories: termination up to 12 weeks and up to 24 weeks. 
• The facility must have the necessary equipment and meet all requirements specified under MTP Rules. 
• The hospital must possess valid licenses for conducting sonography and other related procedures. 
• Regular monitoring and compliance with government regulations is mandatory for maintaining approval status. 

What was the Background of the XYZ v State of Maharashtra Case? 

• The petitioner was a 35-year-old woman seeking termination of her 25-week pregnancy. 
• Medical examination revealed the fetus had skeletal dysplasia, a genetic disorder affecting bones and neurological functioning. 
• The condition had high postnatal morbidity and would require multiple corrective surgeries. 
• The Medical Board at JJ Hospital had recommended termination. 
• Despite the recommendation, she couldn't proceed due to legal limitations regarding private hospitals. 

What Issues were Raised Before the High Court? 

• The primary issue was the ambiguity in MTP Rules regarding Form A for private hospitals. 
• Form A only provided categories for terminations up to 12 weeks and up to 24 weeks. 
• There was no category in Form A for terminations beyond 24 weeks. 
• The chosen private hospital couldn't perform the procedure despite having necessary facilities. 
• The petitioner's advocate argued for the need to add a third category to Form A for pregnancies beyond 24 weeks. 

What were the Court's Observations and Decision? 

• The court recognized the "utmost urgency" of the case given the advanced stage of pregnancy. 
• The bench considered the petitioner's right to reproductive freedom and bodily autonomy. 
• They verified that the chosen private hospital met all necessary conditions under MTP Rules. 
• The court permitted the termination while keeping the larger issue of Form A's limitations open for future consideration. 
• A similar precedent from April 2024 was cited where a 27-week termination was allowed at a private hospital. 

Conclusion: 

The Bombay High Court's decision not only states an immediate medical necessity but also exposes critical gaps in India's abortion regulations. The case underscores the urgent need for updating the MTP Rules to better accommodate exceptional cases while ensuring safe and accessible abortion services. As India continues to evolve its healthcare policies, this judgment serves as a crucial stepping stone towards more comprehensive and inclusive reproductive healthcare regulations.