Ms. Z v. The State of Bihar and Others (2017)

Introduction 

This landmark judgment addresses the constitutional and statutory rights of rape survivors seeking medical termination of pregnancy, establishes the distinction between mental illness and mental retardation for consent purposes under the Medical Termination of Pregnancy Act, 1971, and affirms the State's liability to provide compensation when administrative negligence causes irreversible harm to a victim's reproductive autonomy and mental health. 

Facts 

• Ms. Z, a thirty-five-year-old destitute woman abandoned by her husband and family, was living on the footpath in Patna when she was brought to Shanti Kutir, a government shelter home, on January 25, 2017.  
• Medical tests revealed she was pregnant. On February 8, 2017, an ultrasound at Patna Medical College Hospital (PMCH) showed she was 13 weeks and 6 days pregnant. 
• On March 4, 2017, Ms. Z expressed her desire to terminate the pregnancy and revealed she had been raped.  
• An FIR under Section 376 IPC was registered on March 18, 2017. On March 14, 2017, she was taken to PMCH for termination, and her father and brother were called to sign a consent form. However, hospital authorities did not proceed with the termination despite their consent. 
• By April 3, 2017, her pregnancy was 20 weeks old, but termination was still not carried out. Ms. Z was also found to be HIV positive. Unable to secure termination at PMCH, she approached the Patna High Court seeking directions for pregnancy termination. 
• The High Court constituted a Medical Board at IGIMS, Patna, which examined her and reported that she was 20-24 weeks pregnant with mild mental retardation and schizophrenia, but mentally alert and oriented. On April 26, 2017, the High Court declined to permit termination, stating that her conduct of not disclosing rape earlier did not suggest grave injury to mental health. 
• Ms. Z appealed to the Supreme Court, which arranged for examination by a Medical Board at AIIMS, New Delhi. The AIIMS Board concluded that termination at that advanced stage (approximately 25 weeks) was risky to both mother and foetus. 

Issues Involved 

• Whether hospital authorities are required to obtain consent from the father or husband of a major woman who is a rape survivor and suffers from mild mental retardation before terminating her pregnancy under the MTP Act, 1971? 
• Whether the distinction between "mental illness" and "mental retardation" under Section 3(4) of the MTP Act is material in determining whose consent is required? 
• Whether delay and negligence by State hospital authorities in proceeding with pregnancy termination entitles the victim to compensation under public law remedy? 
• Whether the High Court's approach of requiring extensive procedural formalities was legally justified and sensitive to the statutory framework? 

Court's Observations 

• Statutory Framework: The Court emphasized that the MTP Act, 1971 was enacted to liberalize abortion on health, humanitarian (rape), and eugenic grounds. Section 3(2) permits termination up to 20 weeks when continuation would cause grave injury to physical or mental health. Explanation 1 creates a statutory presumption that pregnancy alleged to be caused by rape constitutes grave injury to mental health. 
• Mental Illness vs. Mental Retardation: The Court distinguished between "mental illness" and "mental retardation," holding that Section 3(4)(a) requires guardian consent only for minors or those with mental illness, not mental retardation. Relying on Suchita Srivastava v. Chandigarh Administration, the Court affirmed that persons with mild mental retardation retain personal autonomy and can provide valid consent for pregnancy termination. 
• Hospital Negligence: The Court found that Ms. Z had given clear consent, alleged rape (triggering statutory presumption), and was brought by a government shelter home. Hospital authorities' insistence on obtaining father's and husband's consent was legally unwarranted and caused fatal delay. By the time the case reached the Supreme Court, termination had become medically risky, making the situation irreversible due to State negligence. 
• High Court's Errors: The Supreme Court held the High Court's approach was "completely erroneous" and showed "total lack of sensitivity." The High Court wrongly treated it as adversarial litigation, unnecessarily impleaded family members who had abandoned her, and misunderstood trauma responses. The emphasis on "compelling State interest" was misplaced when statutory requirements were clearly met. 
• Public Law Compensation: The Court held that when State functionaries fail to perform statutory duties, causing grave and irreversible injury to fundamental rights, compensation under public law remedy is appropriate. Citing Nilabati Behera and other precedents, the Court affirmed that mental torture often has more grievous impact than physical torture. 
• Reproductive Rights: The Court reaffirmed that reproductive choice is a dimension of personal liberty under Article 21. Noting India's CEDAW obligations, the Court emphasized that time is critical in pregnancy cases—hospitals must act with sensitivity and promptitude. 
• Ratio Decidendi: 
• When a major woman who is a rape survivor seeks medical termination of pregnancy and suffers from mild mental retardation (but not mental illness), her own consent is sufficient under Section 3 of the MTP Act, and hospital authorities are not required to obtain consent from her guardian, father, or husband. The statutory presumption that rape-caused pregnancy constitutes grave injury to mental health is mandatory. When State authorities negligently delay pregnancy termination despite statutory entitlement, causing irreversible harm, the State is liable for compensation under public law remedy for violation of Article 21 rights. 
• Judgment: 
• The Supreme Court allowed the appeal and set aside the High Court's order. The Court directed the State of Bihar to pay Rs. 10,00,000 as compensation to Ms. Z for negligence and mental injury, to be kept in fixed deposit, in addition to Rs. 3,00,000 already paid under Section 357A CrPC. The Court directed the State to provide proper treatment, nutrition, and medical aid to the child to be born, and granted liberty to approach the High Court for future grievances. 

Conclusion 

This judgment establishes crucial precedents for reproductive rights in India, particularly for vulnerable women. It clarifies that mental retardation does not trigger guardian consent requirements under the MTP Act, reinforces the statutory presumption that rape-caused pregnancy constitutes grave mental injury, and holds the State accountable through public law compensation when administrative negligence transforms a protected reproductive choice into irreversible trauma, emphasizing that timely, sensitive action is essential as every day of delay can cause irreparable harm to constitutional rights.