Dhriti Jain v. State of Punjab and Others

IN THE HIGH COURT OF PUNJAB & HARYANA AT CHANDIGARH

CWP-4885-2024 (O&M). Re e!"e# $%& 0'.0(.2024. D)*e $+ ,!$%$-%.e/e%*& 00.0(.2024.

...Pe*4*4$%e!

5e! -

6TATE OF PUNJAB AND OTHER6

7Re ,$%#e%*

CORAM&   HON8B9E MR. JU6TICE 5INOD 6. BHARDWAJ

*****

Argued by

Mr. Gaurav Chopra, Sr. Advocate, with Mr. Shehbaz Thind, Advocate, Mr. Gagandeep Singh, Advocate, Mr. Jagraj Singh, Advocate, Mr. Buta Singh, Advocate, Mr. Rishabh Bajaj, Advocate and Ms. Sanjana Makkar, Advocate, for the petitioner.

Mr. Vivek Saini, Advocate, (Amicus Curiae).

Mr. Saurav Verma, Addl. A.G. Punjab with Mr. Aditya Sharda, DAG, Punjab.

integrity of this document 1

5INOD 6. BHARDWAJ.  J. Considering the nature of the case and the future prospects in the life of the young girl who is the petitioner before this Court, Registry is directed to conceal the identity of the petitioner and carry out appropriate steps to hide the details that would disclose or reveal her identity. For the facility of reference, the petitioner shall be referred to as 'X' and the case title be recorded as 'X' Vs. State of Punjab and others. 2 The present writ petition had been filed on 29.02.2024 for seeking directions to the doctors at Rajindra Hospital, Patiala, to carry out termination of pregnancy of the petitioner by constituting a Medical Board. 3 Briefly, the facts of the case are that the petitioner whose date of birth is (dd/mm/yy) and aged about 18 years 7 months, met a boy around an year ago and they fell in love with each other. As a result of their growing proximity, they entered into physical relations with each thother but both of them parted ways later. Petitioner is a student of 12 Standard and during her ongoing Board examinations, she felt pain in her abdomen for which she was diagnosed by the doctors of Rajindra Hospital, Patiala to be pregnant. Petitioner is under immense pressure for having conceived a child when she herself is of tender age and is a student appearing in her 10+2 Board Examinations. She is apprehensive that her entire career and future prospects shall suffer a huge set back in case the pregnancy is not permitted to be terminated at this stage. She is herself of a tender age and is not mentally prepared to give birth. The unwanted pregnancy shall subject her to enhanced social stigma and integrity of this document 2

incarceration. A prayer is thus made for being granted permission for termination of the pregnancy by relying on the judgment of the Hon'ble Supreme  Court in  the  matter  of Suchita  Srivastava  and  another  Vs. Chandigarh Administration, reported as (2009) 9 SCC 1. The relevant part of the judgment is extracted as under:- "There  is  no  doubt  that  a  woman's  right  to  make reproductive  choices  is  also  a  dimension  of  `personal liberty' as understood under Article 21 of the Constitution of  India.  It  is  important  to  recognise  that  reproductive choices can be exercised to procreate as well as to abstain from  procreating.  The  crucial  consideration  is  that  a woman's  right  to  privacy,  dignity  and  bodily  integrity should be respected. This means that 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. Furthermore, women are also free to  choose  birth-control  methods  such  as  undergoing sterilisation procedures. Taken to their logical conclusion, reproductive rights include a woman's entitlement to carry a  pregnancy  to  its  full  term,  to  give  birth  and  to subsequently raise children."

4    Considering that a legal issue is involved as to whether the permission  for  termination  of  the  pregnancy  can  be  granted  at  this juncture or not, counsel for the respondent-State  made a statement that there is no need to file reply and that they shall advance arguments on the petition itself.  Additionally, Sh. Vivek Saini, Advocate was also appointed as Amicus by this Court to assist in the matter. integrity of this document 3

5    When  the  matter  came  up  for  preliminary  hearing,  vide order dated 29.02.2024, the respondent-State of Punjab was directed to constitute  a  Medical  Board  to  carry  out  physical  examination  of  the petitioner  and  submit  its  report  as  regards  the  mental,  physical  and psychological status of the petitioner. 6    The petitioner appeared before the said Medical Board and a  report  was  received  from  the  Centre  Administrator.    The  same  is extracted as under:-

"Counseling  Report-  On  Dated  04-03-2024,  the  girl (name concealed) and the girl's father (name concealed) came to the Sakhi one stop Centre, Patiala for counseling as per the order case No.CWP-4885-2024 of the Hon'ble Punjab and High Court, Chandigarh.

In the Sakhi One Stop Centre, the girl was counseled in a comfortable  environment  away  for  her  father  in  the counseling room and was asked about food and drink.

During counseling session, the girl said that "My name is

(x) and father's name is (y), Mother's name is (z) address House  No.  (address  concealed),  Punjab.  My  age  is  18 years  and  7  months,  1  am  doing  twelfth  class  with Commerce  group  in  School  (name  concealed)  and  the girl was asked about her hobbies in which she said that I like  reading  and  cooking.  In  cooking  she  likes  making Rajmah and Chole Chawal.

During  Counseling  Session,  the  girl  told  that  a  few months ago she met a boy and they became friends and integrity of this document 4

came into a relationship with each other but now the girl neither  calls  the  boy  nor  wants  to  have a  relationship with him.

During  the  counseling  session,  the  girl  told  that  some time ago the girl started having pain in her stomach due to which she met the doctor and came to know about the girl's pregnancy and the girl is now six months pregnant.

During counseling session the girl told that she wants to have an abortion and does not want to have a child.

During counseling session, the girl told that she wants to have this abortion of her own free will, there is no family and social pressure on her.

During the counseling session the support of the girl's parents was asked, in which the girl told that her parents are giving her full support and there is no pressure on her to get an abortion.

This  Counseling  report  is  presented  to  you  for  further action and kind information.

Para legal Personnel-Cum-Centre Administrator, Sakhi one stop Centre, Patiala. 4/3/2024."

7    A  report  was  also  submitted  by  the  Medical  Board  of Rajindra Hospital, Patiala, which is extracted as under:-

"On Examination-integrity of this document 5

General  Condition  good,  well  built,  well  nourished,  well oriented to time, place and person. Temperature-  Normal Pulse-     84/min BP-      110/70 mm of Hg Per Abdomen-  30 weeks Fetal Movements- +ve Uterus-    Relaxed

Psychiatric Evaluation-

No  History  of  any  persistent  pervasive  sadness, anxiety, stress or any other mental Illness. No History of any substance abuse. On  mental  status  examination,  patient is  conscious and  co-operative.  No  abnormality  detected  in  her  mood, speech, thought, perception and cognitive function.

Ultrasound-   23/02/2024

Single  alive  Intrauterine  fetus  with  normal  cardiac  and somatic activity corresponding to 24 weeks 6 days seen at the time of examination.

Fetal Heart rate-   127/min Placenta -    Posterior upper Liquor-    Adequate No fetal congenital anamoly

On Counselling by Counsellor from the department of Social Security Women and child Development Ms. 'X', wants to terminate her pregnancy out of her on free will and consent without any social pressure.

integrity of this document 6

Medical Board has examined the patient and is of the opinion that 'X' D/O 'Y' aged 18 years 7 month does not have any mental, psychological or physical abnormality at time  of  examination.  Her  Ultrasound  report  dated  on 23/02/2024, shows she is 24 weeks 6 days pregnant without any fetal congenital abnormality.

Mrs. Rajmeet K?ur Centre Administrator Social Security WCD.

Dr. Rajesh Kumar Assistant Professor Radiodiagnosis Deptt.

Dr. Surinder Kaur Assistant Professor Paediatrics Deptt.

Dr. Jasmine Garg Assistant Professor Psychiatry Department

Dr. Preetinder Singh Assistant Professor Forensic Department

Dr. Shelly Khilan Assistant Professor Obst. & Gynae Deptt."

8    It was, however, noticed from a perusal of the above said medical report that the said Board merely reiterated the report of the ultrasound  conducted  earlier  on  23.02.2024  without  any recommendation  of  its  own.  In  view  of  incomplete    report  and recommendation  of  the  Medical  Board,  petitioner  was  referred  for integrity of this document 7

medical examination by the Medical Board of the Post Graduate Institute of Medical Education and Research, (PGIMER), Chandigarh, to make a recommendation as to whether it would be safe for her to undergo medical termination of pregnancy or not. In compliance of the said order dated 05.03.2024, petitioner was medically examined by the Board of Doctors of the PGIMER, Chandigarh and its report is extracted as under:-

"Subject. Regarding orders from court of Justice Vinod S Bhardwaj, Judge, Punjab & Haryana High Court, Chandigarh / UID No CWP-4885-2024 dated 05.03.2024 wherein Medical Superintendent, PGI has been requested to constitute a Medical Board immediately. The Medical Board to submit report about the medical condition of the patient and to give its opinion about the stage of her pregnancy and to report if it is safe for her to undergo the medical termination of her pregnancy or not. Details of patient

(X) 18 yrs female CR No (xxx xxx xxx)

The patient was evaluated by the Permanent Medical Board in its meeting held on 06/03/2024

Following observations were made:

¶1As per the ultrasound done on 06/03/202,at PGIMER, the period of gestation is 25 weeks+5 days with single live healthy intrauterine fetus with estimated fetal weight 763 113gms. No gross congenital malformation seen. integrity of this document 8

¶2The patient is medically and physically fit to undergo a procedure

¶3The detailed psychiatric evaluation done is suggestive of psychological distress due to her current situation She is expressing suicidal ideation in case of continuation of pregnancy. Hence, she will require further psychological assessments, monitoring and support.

¶4Keeping in view the current gestation of pregnancy, termination carries more than the usual risks for the patient.

¶5At this gestational age and condition of fetus, it is likely to be born alive. There is a likely neonatal survival of around 60-65%. The newborn will be very preterm and likely to have several complications related to prematurity and will require NICU admission and ventilation for prolonged period. All these will lead to significant morbidity including neurodevelopmental handicap in the long run.

¶6Hence, in view of the above, the Permanent Medical Board suggests that the pregnancy may be continued as per the natural course. The Board also recommends hospital admission of the patient for further psychiatric evaluation, psychological support and treatment. In the event of continuation of her pregnancy, she may be advised regular obstetric check-ups and institutional delivery.

Prof. Y.S. Bansal (Member) Dr Shalim Naik (Member) Prof Rashy Bagga (Chairperson)

integrity of this document 9

Prof. KanyaMukhopadhyay (Member) Prof Shefali Sharma (Member) Nidhikabhoker br Or Nidhi Prabhakar (Member) Dr Navin Pandey (Convener)"

9 The above said report was shown to the counsel representing the respective parties as well as the learned Amicus along with suggestions/recommendations of the Permanent Medical Board of the PGIMER, who opined that pregnancy be continued as per natural course. 10 Learned Senior counsel appearing on behalf of the petitioner has placed reliance on the judgment of the Hon'ble Supreme Court in the matter of ' Vs. $rincipal Secretar% (ealth and )amil% *el+are  ,epartment  and  another-  reported  as  (202.)  9  SCC  /.., where termination of pregnancy beyond a period of 24 weeks was allowed by the Hon'ble Supreme Court. It was held that a woman's right to reproductive choice is an inseparable part of her personal liberty under Article 21 of the Constitution of India. She has a sacrosanct right to bodily integrity and a woman's right to reproductive autonomy is a dimension of Article 21 of the Constitution of India, which such right already stands recognized in the case of Suchitra  Srivastava  Vs. Chandigarh  Administration (supra) and reiterated in the matter of 0ustice 1.C. $uttas2am% ( etd.) and another Vs. &nion o+ 3ndia and others, reported as (2014) 10 SCC 1. It was held in the judgment of 0ustice 1.C. $uttas2am% ( etd.) that privacy of the body entitles an individual to the integrity of the physical aspects of personhood. The integrity of this document 10

intersection between one's mental integrity and privacy entitles the individual to freedom of thought, the freedom to believe in what is right, and the freedom of self− determination. When these guarantees intersect with gender, they create a private space which protects all those elements which are crucial to gender identity. The family, marriage, procreation and sexual orientation are all integral to the dignity of the individual. Above all, the privacy of the individual recognises an inviolable right to determine how freedom shall be exercised. It was noticed that the petitioner had moved the High Court before she had completed 24 weeks of pregnancy and that delay in judicial process cannot work to her prejudice. An interim order was accordingly passed for carrying out abortion of the foetus without danger to the life of the petitioner. 11 Reliance is also placed on the judgment of Bombay High Court in A5C Vs. State o+ 6aharashtra, *rit $etition (S7) 8o.1.94 o+

202. decided on 20.01.202. wherein it was held that the decision to continue with the termination or not has to be that of the petitioner and the same is not to be substituted by an opinion of the Medical Board. 12 Further, reliance was also placed on the judgment of the Hon'ble Supreme Court in the matter of Sarmishtha Cha:ra;ortt% and another Vs. &nion o+ 3ndia Secretar% and others, reported as 201< (1.) SCC ..9, wherein a 26 week pregnancy was allowed to be terminated by recognizing the right of a woman to have reproductive choice as an integrity of this document 11

13 Reliance was also made on certain other single bench and Division Bench Judgments of the High Court of Punjab and Haryana, Rajasthan as well as Madhya Pradesh High Court which reiterated the said principles, however, the same are not being extracted since they are not applicable to the facts of the present case and even otherwise, the right of a woman to make reproductive choices is not even disputed. 14 Emphatic reliance was placed on the judgment in the matter of Shai:h A%esha 1hatoon Vs. &nion o+ 3ndia, reported as 201< SCC !nline 5om. .0./, wherein a 27 week pregnancy was permitted to be terminated considering freedom of a pregnant woman of making choice of reproduction is an integral part of personal liberty. 15 Relying on the aforesaid judgments and the position in law espoused through the same, learned Senior counsel appearing for the petitioner emphatically argues that the law and the Courts have recognized the right of a woman to make a reproductive choice and to determine whether she would want to give birth to a child or not and that the said decision of the woman cannot be overruled by an opinion of a Medical Board. He further submits that the report of the Medical Board of PGIMER, Chandigarh suggests that the petitioner has expressed suicidal ideation in case of continuation of pregnancy and as such, denial of permission of medical termination of pregnancy to the petitioner would set in motion a severe psychological impact on the petitioner. He further contends that the petitioner herself being of tender age at 18 years is not in a position to bring up a child on her own. Besides this, she is yet to appear in her 10+2 Board Examination and that her entire integrity of this document 12

future, career and matrimonial prospects shall be gravely hampered if termination of pregnancy is denied. He laid emphasis that the permission for medical termination should not be denied solely because the petitioner was in a consensual relationship and has become pregnant due to un-protected sex. A woman cannot be discriminated with respect to her reproductive choices and determination which are integral and insegregable part of Article 21 of the Constitution of India under the Medical Termination of Pregnancy Act and the rules framed thereunder. Giving birth to an unwanted child would not only be harmful for physical and psychological well-being of the mother but is also not in the well-being of an unwanted child who is likely to suffer social stigma, desertion and unacceptability. The feeling of a void of such a child cannot be filled up. Thus, it would be in the larger welfare of the mother as well as the unborn child that permission for medical termination be granted. 16 A specific query was also put to the learned Senior counsel representing the petitioner as to whether in an eventuality where the Court may not agree to the grant of permission for medical termination of pregnancy, the petitioner would be willing to bring up the child or she would like to surrender the child to the State with no objection to the child being given in adoption. Counsel for the petitioner, on instructions, submits that the petitioner does not intend to and is not willing to keep the child and in such an eventuality, would rather surrender the child to the Care and protection of the State and would have no objection for the integrity of this document 13

17 Learned counsel for the respondent-State of Punjab has, on the other hand, contended that the provisions of the Medical Termination of Pregnancy Act and the rules framed thereunder stipulate termination of pregnancy for a period upto 24 weeks and that such right has been made available to the women who are survivors of sexual assault or rape or incest; minors; change of marital status during pregnancy; women with physical disability; or women suffering from mental challenges; or on account of fetal malformation which has substantial risk of being incompatible with life or due to severe physical or mental abnormalities/handicap or in situations where due to disaster, emergency or humanitarian setting, the Government may so declare. The case of the petitioner does not fall under any of the said categories. 18 He relies upon the report submitted by the Medical Board of the PGIMER as per which the foetus is of 26 weeks and there is no congenital malformation and that the patient as well as the child were both healthy. It was also contended by the Medical Board that chances of neo-natal survival are around 60 to 65 % and that the foetus is likely to be born alive and a pre-mature forced delivery is likely to cause severe neuro-development handicap in the long run rendering the child dependent for the rest of his life. He further submits that such a forced medical termination of the pregnancy at such advance stage would thus disregard the well-being of the child who is likely to be delivered, pursuant to an order passed by this Court. He further contends that the petitioner did not approach the Court for seeking termination of the pregnancy at any time prior to 24 weeks and that she has in fact integrity of this document 14

approached this Court on 29.02.2024 when she was already pregnant for 26 weeks. He submits that the benefit of the time lapse during the process of Court could be extended only when a patient has approached the Court prior to 24 weeks of pregnancy but where the statutorily prescribed period for termination of pregnancy had already expired, such benefit cannot be extended. Adverting to the judgments relied upon by the learned Senior counsel appearing for the petitioner, he submits that after the judgment in the matter of ' Vs. $rincipal Secretar%, (ealth and  )amil%  *el+are  ,epartment,  reported  as  (202.)  9  SCC  /.., a similar issue came up before the Hon'ble Supreme Court in the matter of ' Vs. &nion o+ 3ndia, reported as 202. 38SC 919, where a married woman had approached the Court for seeking the termination of pregnancy after 24 weeks and that when the matter came up for hearing before the Hon'ble Supreme Court, she had been pregnant for 26 weeks, it was recommended by the Medical Board that considering the duration of the pregnancy, it will not be a case of medical termination of pregnancy and would rather be a pre-term delivery and that a directive would rather be required for carrying out a feticide (stopping the fetal heart) before the termination. Such feticide is although recognized, where a foetus has abnormal development, but the same is usually not resorted to for a normal foetus. The said matter was put up before a medical board of 09 doctors of AIIMS and its report was received, which reported that there was no abnormality in the foetus and that the medical complications faced by the mother could be tackled and taken care of by proper medication. After consideration of the scenario and also the judgments relied upon by the petitioner as extracted above, the Hon'ble integrity of this document 15

Supreme Court denied the medical termination of the pregnancy. The operative part of the said judgment reads thus:- "24.  As  noticed  above,  the  length  of  the  pregnancy  has crossed twenty-four weeks. It is now approximately twenty-six  weeks  and  five  days.  A  medical  termination  of  the pregnancy cannot be permitted for the following reasons:

a. Having crossed the statutory limit of twenty-four weeks, the  requirements  in  either  of  Section  3(2B)  or  Section  5 must be met; b.  There  are  no  "substantial  foetal  abnormalities" diagnosed  by  a  Medical  Board  in  this  case.  in  terms  of Section  3(2B).  This  Court  called  for  a  second  medical report from AllMS to ensure that the facts of the case were accurately placed before it and no foetal abnormality was detected; and c.  Neither  of  the  two  reports  submitted  by  the  Medical Boards  indicates  that  a  termination  is  immediately necessary  to  save  the  life  of  the  petitioner,  in  terms  of Section 5.

25. Under Article 142 of the Constitution, this Court has the power to do complete justice. However, this power may not be attracted in every case. If a medical termination were to be conducted at this stage, the doctors would be faced with a viable foetus. One of the options before this Court, which the email from AIIMS has flagged, is for it to direct the doctors to stop the heartbeat. This Court is averse to issuing a direction of this nature for the reasons recorded in the preceding paragraph. The petitioner, too, did not wish for this Court to issue such a direction. This was communicated by her to the court during the course of the hearing. In the absence  of  a  direction  to  stop  the  heartbeat,  the  viable integrity of this document 16

foetus  would  be  faced  with  a  significant  risk  of  lifelong physical and mental disabilities. The reports submitted by the Medical Board speak for themselves.

26. For these reasons, we do not accede to the prayer for the medical termination of the pregnancy.

27.  The  delivery  will  be  conducted  by  AIIMS  at  the appropriate time. The Union Government has undertaken to pay all the medical costs for the delivery and incidental to it.

28. Should the petitioner be inclined to give the child up for adoption,  the  Union  Government  has  stated  through  the submission  of  the  ASG  that  they  shall  ensure  that  this process takes place at the earliest, and in a smooth fashion. Needless to say, the decision of whether to give the child up for adoption is entirely that of the parents."

19    He  further  submits  that  in  so  far  as  the  reliance  by  the learned  Senior  counsel  for  the  petitioner  on  the  Division  Bench judgment of the Bombay High Court in the matter of Shaikh Ayesha Khatoon Vs. Union of India, reported as 2018 SCC Online Bom. 3034, is  concerned,  the  said  judgment  is  not  applicable  to  the  facts  of  the present  case  since  the  petitioner  therein  established  by  making  a reference  to  the  sonology  examination  that  the  foetus  suffered  from several fetal anomalies including a congenital malformation. As many as 07 different anomalies were reported by the Sonologist, on examination, and the chances of the independent intact neo-natal survival appeared to be less. It was under the said circumstances that the Division Bench of integrity of this document 17

the Bombay High Court gave precedence to the preference of the mother vis-à-vis medical report since the child was to suffer serious physical and mental abnormalities and had to be brought up as a dependent for the rest of his life. The said circumstances do not exist in the case in hand. 20 While referring to the judgment in the matter of A5C Vs. State o+ 6aharashtra, *rit $etition (S7) 8o.1.94 (supra), it is again reiterated that there were serious substantial fetal abnormalities noticed in the said case as well. Even though the pregnancy was of 32 weeks and foetal condition was assessed among the anomalies in relation to their microcephaly and lissencephaly along with mild uteroplacephaly which added the possibility of intellectual disability though not life threatening. It was also noticed that the petitioner therein belonged to a humble background with severe financial constraints and that the additional financial resources required to meet the expenses of an infant born with such conditions were not available with them. Hence, medical termination of pregnancy was allowed in peculiar facts of the said case. Further, while responding to the judgment of the Hon'ble Supreme Court in the matter of Sarmishtha  Cha:ra;ortt%  and  another  (supra), 36 weeks pregnancy was permitted to be terminated again on the basis of the medical report, which revealed that there was danger to life of both the woman and the baby to be born, if the pregnancy was not terminated. He thus contends that reliance on the said judgment is misconceived as the judgments have to be seen on the basis of the facts brought before the Court and the said facts are not applicable or attracted in the present case. Termination of pregnancy beyond 24 weeks in all these cases has integrity of this document 18

been allowed only in such exceptional circumstances where the child was suffering from severe mental and physical abnormalities or where giving birth to the child was dangerous to the life of both the mother and the child. None of the said circumstances exist in the current circumstances. Hence, there is no justification for allowing termination of the pregnancy. 21 Learned Amicus has also taken this Court through the judgments of the this Court in  Vs. State o+ (ar%ana and others, C*$ 8o.1.29=>202. decided on 19.4.202. wherein when the Medical Board of the PGIMER did not recommend termination of pregnancy, but certain directions were issued by this Court which are extracted as under:- "3! Accordingly# the prayer of the petitioner for termination of pregnancy is thus dismissed as not pressed at this stage 5owever# in the larger interest of the petitioner as well as the minor unborn child# it is directed as are underK%

i.  The  Civil  /urgeon=Chief  8edical  (fficer#  ;ewari  is directed to ensure that all necessary medical facilities are made available to the petitioner# without the payment of fee# charges or e"penses of any nature and to ensure that the delivery takes place in a safe environment!

ii. The privacy of the petitioner shall be maintained at all stages and identity of the petitioner be not divulged in the course of hospitali9ation and treatment!

iii. The child# on birth# may be handed over to the Child 2elfare  Committee  of  )istrict  ;ewari  and  the  petitioner shall  fulfill  all  such  necessary  documentation  and integrity of this document 19

formalities as may be so re&uired in law for handing over custody of the said child to the Child 2elfare Committee!

iv. The said Child 2elfare Committee# ;ewari shall take care of all needs and facilities of the child!

v. The petitioner has no ob6ection to the said child to be given in adoption by the /tate agency to the willing parents in  accordance  with  law!  0ermission  is  thus  granted  for giving  the  child  in  adoption  to  the  willing  prospective parents# in accordance with law!

vi. The above said directions are without pre6udice to any other  rights  and  entitlement  of  the  petitioner  under applicable  policies=guidelines  for  financial  assistance= rehabilitation! The petition is accordingly disposed of!'

22 No other argument has been raised. 23 I have heard learned counsel appearing for the respective parties and have also gone through the documents appended along with the present petition with their able assistance. 24 The twin issues which arise for consideration are firstly, as to whether an unmarried girl/woman or a single mother is entitled to seek termination of pregnancy when such pregnancy is a result of consensual sexual relationship and the child does not suffer from any physical, mental or psychological deformity and poses no danger to the mother as well. The second aspect is whether the petitioner should be granted permission for seeking termination of medical pregnancy under the current peculiar circumstances noticed above. For the purposes of integrity of this document 20

consideration of the said aspect, it is necessary to extract the relevant statutory provisions of the Medical Termination of Pregnancy Act, 1971 and the MTP Rules of 2003 (hereinafter referred to as the Act of 1971 and  the  Rules  of  2003  (as  amended  on  12.10.2021).  The  same  are extracted as under:- Section 3 of the Medical Termination of Pregnancy Act, 1971 "3.  When  pregnancies  may  be  terminated  by  registered medical practitioners.

(1)Notwithstanding anything contained in the Indian Penal Code (45 of 1860), a registered medical practitioner shall not be guilty of any offence under that Code or under any other law for the time being in force, if any pregnancy is terminated by him in accordance with the provisions of this Act.

(2) Subject to the provisions of sub-section (4), a pregnancy may be terminated by a registered medical practitioner,--

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

(b) where the length of the pregnancy exceeds twenty weeks but  does  not  exceed  twenty-four  weeks  in  case  of  such category  of  woman  as  may  be  prescribed  by  rules  made under  this  Act,  if  not  less  than  two  registered  medical practitioners are, of the 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 integrity of this document 21

(ii) there is a substantial risk that if the child were born, it would  suffer  from  any  serious  physical  or  mental abnormality. Explanation 1.--For the purposes of clause (a), where any pregnancy  occurs  as  a  result  of  failure  of  any  device  or method used by any woman or her partner for the purpose of limiting the number of children or preventing pregnancy, the anguish caused by such pregnancy may be presumed to constitute  a  grave  injury  to  the  mental  health  of  the pregnant woman. Explanation  2.--For  the  purposes  of  clauses  (a)  and  (b), where any pregnancy is alleged by the pregnant woman to have  been  caused  by  rape,  the  anguish  caused  by  the pregnancy shall be presumed to constitute a grave injury to the mental health of the pregnant woman.

(2A)  The  norms  for  the  registered  medical  practitioner whose opinion is required for termination of pregnancy at different gestational age shall be such as may be prescribed by rules made under this Act.

(2B) The provisions of sub-section (2) relating to the length of  the  pregnancy  shall  not  apply  to  the  termination  of pregnancy  by  the  medical  practitioner  where  such termination is necessitated by the diagnosis of any of the substantial  foetal  abnormalities  diagnosed  by  a  Medical Board.

(2C)  Every  State  Government  or  Union  territory,  as  the case may be, shall, by notification in the Official Gazette, constitute a  Board  to  be  called  a  Medical  Board  for  the purposes of this Act to exercise such powers and functions as may be prescribed by rules made under this Act. integrity of this document 22

(2D)  The  Medical  Board  shall  consist  of  the  following, namely:

(a) a Gynaecologist;

(b) a Paediatrician;

(c) a Radiologist or Sonologist; and

(d) such other number of members as may be notified in the Official Gazette by the State Government or Union territory, as the case may be.]

(3) In determining whether the continuance of a pregnancy would  involve  such  risk  of  injury  to  the  health  as  is mentioned in sub-section (2), account may be taken of the pregnant  woman's  actual  or  reasonably  foreseeable environment.

(4) (a) No pregnancy of a woman, who has not attained the age of eighteen years, or, who having attained the age of 2eighteen  years,  is  a  [mentally  ill  person],  shall  be terminated  except  with  the  consent  in  writing  of  her guardian.

(b) Save as otherwise provided in clause (a), no pregnancy shall be terminated except with the consent of the pregnant woman." xxx  xxx  xxx MTP Rules of 2003. "3. Composition and tenure of district level Committee.-

(1) One member of the district level Committee shall be the Gynaecologist/Surgeon/Anaesthetist  and  other  members from  the  local  medical  profession,  non-governmental organisations, and Panchayati Raj Institution of the district Provided that one of the members of the Committee shall be a woman. integrity of this document 23

(2) Tenure of the Committee shall be for two calendar years and the tenure of the non-government members shall not be more than two terms.

3-A.  Powers  and  functions  of  Medical  Board.-For  the purposes of Section 3,-

(a) the powers of the Medical Board shall be the following, namely-

(i)  to  allow  or  deny  termination  of  pregnancy  beyond twenty-four weeks of gestation period under sub-section (2-B)  of  the  said  section  only  after  due  consideration  and ensuring that the procedure would be safe for the woman at that gestation age and whether the foetal malformation has substantial risk of it being incompatible with life or if the child  is born it  may  suffer  from such  physical  or  mental abnormalities to be seriously handicapped;

(ii) co-opt other specialists in the Board and ask for any additional  investigations  if  required,  for  deciding  on  the termination of pregnancy;

(b)  the  functions  of  the  Medical  Board  shall  be  the following, namely –

(i)  to  examine  the  woman  and  her  reports,  who  may approach for medical termination of pregnancy under sub-section (2-B) of Section 3;

(ii) provide the opinion of Medical Board in Form D with regard  to  the  termination  of  pregnancy  or  rejection  of request for termination within three days of receiving the request  for  medical  termination  of  pregnancy  under  sub-section (2-B) of Section 3;

(iii) to ensure that the termination procedure, when advised by  the  Medical  Board,  is  carried  out  with  all  safety integrity of this document 24

precautions along with appropriate counselling within five days of the receipt of the request for medical termination of pregnancy under sub-section (2-B) of Section 3.

3-B. Women eligible for termination of pregnancy up to twenty-four weeks. The following categories of women shall be considered eligible for termination of pregnancy under clause  (b)  of  sub-section  (2)  Section  3  of  the  Act,  for  a period of up to twenty-four weeks, namely-

(a)ksurvivors of sexual assault or rape or incest;

(b)kminors;

(c) change of marital status during the ongoing pregnancy (widowhood and divorce);

(d) women with physical disabilities [major disability as per criteria  laid  down  under  the  Rights  of  Persons  with Disabilities Act, 2016 (49 of 2016)];

(e) mentally ill women including mental retardation;

(f) the foetal malformation that has substantial risk of being incompatible with life or if the child is born it may suffer from such physical or mental abnormalities to be seriously handicapped; and

(g)  women  with  pregnancy  in  humanitarian  settings  or disaster or emergency situations as may be declared by the Government."

25     A perusal of the same shows that the pregnancy may be terminated by a registered medical practitioner subject to the provisions contained under the Act and the rules framed thereunder after obtaining opinion  from  the  medical  practitioners/medical  board.  Section  3  (2) entitles termination of the pregnancy where continuance thereof involves integrity of this document 25

risk to the life of the pregnant woman or grave injury to her physical or mental health or that the child suffers from substantial risk of physical or mental abnormality. It further recognizes right of a woman to exercise a discretion where the pregnancy is an outcome of failure of contraceptive devices adopted or where such pregnancy is an outcome of rape or physical assault or under circumstances as elaborated in Rule 3 B of the Rules of 2003 as amended. 26 The Medical Termination of Pregnancy Act, 1971, was enacted to expand access of safe and legal abortion services to all women. It was perceived as an important step towards safety and well being of women. Prior to enunciation of the above said Act¸ there were numerous hurdles that stood in the way of women securing full access to safe and legal abortions thereby pushing women to avail discreet and unsafe abortions under deficient infrastructure facilities propelled by fear of social stigma. The problems compounded for pregnancies contracted on account of exercise of sexual autonomy outside or without marriage. The fear of social reprimand and harassment compelled the women to make choices which were violative of their right to reproductive autonomy. The law recognizes the exercise of sexual autonomy by an individual as an integral part of an inviolate right conferred under Article 21 of the Constitution of India and is embodied in her right to life and for protection of her bodily integrity. Women who engage in pre-marital sexual relations were forced to suffer social stigma, even though pregnancy may have had occasioned on account of insufficient or inadequate knowledge about their own bodies escalated by lack of integrity of this document 26

proper sexual health education, safe sex education, lack of easy access to contraceptives or lack of proper advise and consultation. The lack of family and parental support further aggravated the agony and subjected the woman to seek discreet and unsafe abortions from unqualified persons and expose themselves to greater harm thereby and/or may also compel the woman to resort to seek registration of cases under sexual offences so as to claim benefit of seeking medical termination of pregnancies under the applicable statutory provisions. The Act of 1971, takes into consideration the pregnancies which are either a result of sexual assault/incest or on the basis of sexual activity between married adults. The same is silent with respect to the pregnancies as a result of consensual sexual relationship between consenting adults, who may not intend to get married and/or enter into a long lasting relationship but are in the process of exploring and exercising their sexual autonomy. A Court of law is required to fill the gap by judicial intervention and interpretation, without legislating, till such time that the legislation makes an appropriate arrangement or takes a conscious decision for such a situation. 27 The Hon'ble Supreme Court interpreted the provisions of the Act of 1971 and the Rules framed theruender i.e. the Rules of 2003 in Civil Appeal 8o.9<02 o+ 2022 decided on 29.9.2022 in the matter o+ ' Vs $rincipal Secretar% (supra) and also noticed that marriage as a pre-condition to the rights of an individual vis-a-vis, the objects and purposes of the Act needs to be interpreted taking into consideration the social and societal demands. Turning a blind eye to a social reality only integrity of this document 27

acts as a bedrock for the illegality and subjects individuals to hardships neither contemplated nor desired by the Statute. The perception of an age old society has to evolve with the changed social context mandating readjustment of the laws. Law cannot live in the past and remain static or act as an impediment which blocks the changing social requirements and fails to advance the cause of social justice. An unmarried girl or a woman, who exercises her right to sexual autonomy, cannot be put to prejudice and be denied her consideration for seeking medical termination of pregnancy which such right is recognized for a married woman. The Court cannot be indifferent to the plight of single woman/mother's exercising a right recognized in law and to force them to live with the consequences of exercises of such right with no respite. The statutory provisions are thus required to come to the aid of such women without doing violence to the statute as well as the statutory objectives. It could not have been the intent of law that a woman should be compelled to foist or to register a criminal case under Section 376 of the Indian Penal Code or any other sexual offences which she would not resort to if the law recognises her entitlement to seek termination of pregnancy. An interpretation that would compel the people to resort to an illegality for avoiding a relief would even otherwise be not desirable either by the Statute or by a Court of law. 28 The right of a woman and the constitutional values emanating from the interpretation of the Act of 1971 and the Rules of 2003 were extensively gone through by the Hon'ble Supreme Court in the matter of Civil Appeal 8o.9<02 o+ 2022 decided on 29.09.2022 in integrity of this document 28

the matter of X Vs. Principal Secretary, Health and Family Welfare Department,  Govt  of  NCT  of  Delhi  and  another.  Some  of  the significant excerpts thereof are reproduced hereinafter below.

"33.  In  Principles  of  Statutory  Interpretation  by  Justice G.P. Singh, it is stated that a statute must be read in its context  when  attempting  to  interpret  its  purpose.  [37] Context includes reading the statute as a whole, referring to the previous state of law, the general scope of the statute, surrounding  circumstances  and  the  mischief  that  it  was intended to remedy. [38] The treatise explains that:

37  JUSTICE  G.P  SINGH,  G.P.  SINGH:  PRINCIPLES OF  STATUTORY  INTERPRETATION,  (LexisNexis, 2016), at page 35

[38 Union of India v. Sankalchand Himatlal Sheth, (1977) 4  SCC  193.  Reserve  Bank  of  India  v.  Peerless  General Finance and Investment Co. Ltd, (1987) 1 SCC 424]

"For  ascertaining  the  purpose  of  a  statute  one  is  not restricted to the internal aid furnished by the statute itself, although the text of the statute taken as a whole is the most important  material  for  ascertaining  both  the  aspects  of 'intention'.  Without  intending  to  lay  down  a  precise  and exhaustive list of external aids, Lord Somervell has stated: "The  mischief  against  which  the  statute  is  directed  and, perhaps  though  to  an  undefined  extent  the  surrounding circumstances  can  be  considered.  Other  statutes  in  pari materia and the state of the law at the time are admissible." These  external  aids  are  also  brought  in  by  widening  the concept of "context" "as including not only other enacting provisions of the same statute, but its preamble, the existing state  of  the  law,  other  statutes  in  pari  materia,  and  the integrity of this document 29

mischief which the statute was intended to remedy." In the words of Chinappa Reddy, J.: "Interpretation must depend on  the  text  and  the  context.  They  are  the  bases  of interpretation. One may well say if the text is the texture, context is what gives colour. Neither can be ignored. Both are important. That interpretation is best which makes the textual interpretation match the contextual. A statute is best interpreted when we know why it was enacted."

34. The rule of purposive interpretation was first articulated in Heydon's case (1584) 3 Co Rep 7a in the following terms:

"for  the  sure  and  true  interpretation  of  all  statutes  in general (be they penal or beneficial, restrictive or enlarging of the common law) four things are to be discerned and considered:

1st. What was the common law before the making of the Act. 2nd.  What  was  the  mischief  and  defect  for  which  the common law did not provide. 3rd. What remedy Parliament hath resolved and appointed to cure the disease of the commonwealth. And, 4th. The true reason of the remedy; and then the office of all the  Judges  is  always  to  make  such  construction  as  shall suppress  the  mischief,  and  advance  the  remedy,  and  to suppress subtle inventions and evasions for continuance of the mischief, and pro privato commodo, and to add force and life to the cure and remedy, according to the true intent of the makers of the Act, pro bono publico"

35. In Bengal Immunity Co. v. State of Bihar, (1955) 2 SCR 603  the  Constitution  Bench  applied  the  mischief  rule  in Heydon's  case  in  the  construction  of  Article  286  of  the integrity of this document 30

Constitution. In Kehar Singh v. State (Delhi Admn.), (1988) 3 SCC 609 a three-judge Bench of this Court held:

"231. During the last several years, the "golden rule" has been given a go-by. We now look for the "intention" of the legislature  or  the  "purpose"  of  the  statute.  First,  we examine the words of the statute. If the words are precise and cover the situation in hand, we do not go further. We expound those words in the natural and ordinary sense of the words. But, if the words are ambiguous, uncertain or any doubt arises as to the terms employed, we deem it as our  paramount  duty  to  put  upon  the  language  of  the legislature rational meaning. We then examine every word, every section and every provision. We examine the Act as a whole. We examine the necessity which gave rise to the Act. We look at the mischiefs which the legislature intended to redress. We look at the whole situation and not just one- to-one relation. We will not consider any provision out of the framework of the statute. We will not view the provisions as abstract principles separated from the motive force behind. We  will  consider  the  provisions  in  the  circumstances  to which they owe their origin. We will consider the provisions to ensure coherence and consistency within the law as a whole and to avoid undesirable consequences.

233. For this purpose, we call in external and internal aids:

"External aids are: the Statement of Objects and Reasons when the Bill was presented to Parliament, the reports of the Committee, if any, preceding the Bill, legislative history, other statutes in pari materia and legislation in other States which pertain to the same subject matter, persons, things or relations.

integrity of this document 31

Internal aids are: Preamble, scheme, enacting parts of the statutes,  rules  of  languages  and  other  provisions  in  the statutes." Xxx  xxx  xxx ii. Transcending the institution of marriage as a source of rights

38.  While  much  of  law's  benefits  were  (and  indeed  are) rooted  in  the  institution  of  marriage,  the  law  in  modern times is shedding the notion that marriage is a precondition to  the  rights  of  individuals  (alone  or  in  relation  to  one another).  Changing  social  mores  must  be  borne  in  mind when interpreting the provisions of an enactment to further its  object  and  purpose.  Statutes  are  considered  to  be "always speaking."[48"]

148 Dharni Sugars and Chemicals Ltd v. Union of India,

(2019) 5 SCC 480

39. In Badshah v. Urmila Badshah Godse, (2014) 1 SCC 188 this Court reaffirmed that the law should be interpreted in  terms  of  the  changing  needs  of  the  times  and circumstances. AK Sikri, J. speaking for a two-judge Bench of this Court, observed that it is the duty of courts to bridge the gap between law and society by advancing a purposive interpretation of statutes:

"16.  The  law  regulates  relationships  between  people.  It prescribes patterns of  behaviour.  It  reflects  the  values  of society. The role of the court is to understand the purpose of law in society and to help the law achieve its purpose. But the law of a society is a living organism. It is based on a given factual and social reality that is constantly changing. Sometimes change in law precedes societal change and is integrity of this document 32

even  intended  to  stimulate  it.  In  most  cases,  however,  a change in law is the result of a change in social reality. Indeed, when social reality changes, the law must change too.  Just  as  change  in  social  reality  is  the  law  of  life, responsiveness to change in social reality is the life of the law. It can be said that the history of law is the history of adapting  the  law  to  society's  changing  needs.  In  both constitutional  and  statutory  interpretation,  the  court  is supposed to exercise discretion in determining the proper relationship between the subjective and objective purposes of the law. (Emphasis supplied)

40. In Navtej Singh Johar (supra), this Court emphasized the  transformative  nature  of  our  Constitution. Transformative  constitutionalism  promotes  and  engenders societal change by ensuring that every individual is capable of  enjoying  the  life  and  liberties  guaranteed  under  the Constitution.  This  Court  observed  that  transformative constitutionalism places a duty on the judiciary to "ensure and uphold the supremacy of the Constitution, while at the same  time  ensuring  that  a  sense  of  transformation  is ushered  constantly  and  endlessly  in  the  society  by interpreting and enforcing the Constitution as well as other provisions  of  law in  consonance  with  the  avowed  object. [50]"

[50 Navtej Singh Johar v. Union of India, (2018) 10 SCC 1, at paragraph 1221]

a. Modern or atypical forms of familial relationships

41. The law must remain cognizant of the fact that changes in  society  have  ushered  in  significant  changes  in  family structures. In S. Khusboo v. Kanniammal, (2010) 5 SCC 600 a three-judge Bench of this Court acknowledged that live-in integrity of this document 33

relationships and pre-marital sex should not be associated with the lens of criminality. The Court observed:

"46. [..] While there can be no doubt that in India, marriage is an important social institution, we must also keep our minds open to the fact that there are certain individuals or groups who do not hold the same view. To be sure, there are some indigenous groups within our country wherein sexual relations  outside  the  marital  setting  are  accepted  as  a normal occurrence. Even in the societal mainstream, there are a significant number of people who see nothing wrong in engaging in premarital sex. Notions of social morality are inherently subjective  and  the  criminal law  cannot  be used  as  a  means  to  unduly  interfere  with  the  domain  of personal  autonomy.  Morality  and  criminality  are  not coextensive."

42.  In  Deepika  Singh  v.  Central  Administrative  Tribunal, 2022  SCC  OnLine  SC  1088  a  two-  Judge  Bench  of  this Court (of which one of us, Dr. DY Chandrachud, J. was a part) recognized that family units may manifest in atypical ways:

"26.  The  predominant  understanding  of  the  concept  of  a "family" both in the law and in society is that it consists of a single, unchanging unit with a mother and a father (who remain  constant  over  time)  and  their  children.  This assumption  ignores  both,  the  many  circumstances  which may lead to a change in one's familial structure, and the fact that many families do not conform to this expectation to begin  with.  Familial  relationships  may  take  the  form  of domestic, unmarried partnerships or queer relationships. A household may be a single parent household for any number of reasons, including the death of a spouse, separation, or integrity of this document 34

divorce.  Similarly,  the  guardians  and  caretakers  (who traditionally  occupy  the  roles  of  the  "mother"  and  the "father")  of  children  may  change  with  remarriage, adoption, or fostering. These manifestations of love and of families may not be typical but they are as real as their traditional counterparts. Such atypical manifestations of the family  unit  are  equally  deserving  not  only  of  protection under law but also of the benefits available under social welfare legislation. The black letter of the law must not be relied  upon  to  disadvantage  families  which  are  different from traditional ones. The same undoubtedly holds true for women who take on the role of motherhood in ways that may not find a place in the popular imagination."

43. Societal reality, as observed by this Court in Deepika Singh (supra), indicates the need to legally recognize non-traditional  manifestations  of  familial  relationships.  Such legal recognition is necessary to enable individuals in non-traditional family structures to avail of the benefits under beneficial legislation, including the MTP Act.

b. The equal status of married and unmarried or single women

44. Over the years, the Parliament has enacted legislation bringing about a congruence between the rights of married and unmarried women. The Maternity Benefit Act 1961 was enacted to provide maternity benefits to women employed in any establishment. In terms of section 5 of the Maternity Benefit  Act  1961,  the  payment  of  maternity  benefits  is extended to all women (including unmarried women) by the use of the phrase "every woman."

Xxx  xxx  xxx integrity of this document 35

48.  In  the  evolution  of  the  law  towards  a  gender  equal society, the interpretation of the MTP Act and MTP Rules must  consider  the  social  realities  of  today  and  not  be restricted by societal norms of an age which has passed into the archives of history. As society changes and evolves, so must our mores and conventions. A changed social context demands a readjustment of our laws. Law must not remain static  and  its  interpretation  should  keep  in  mind  the changing  social  context  and  advance  the  cause  of  social justice.

iii. The object and purpose of the MTP Act

49. The purpose or object of an enactment is the mischief at which the enactment is directed and the remedy which the lawmakers have devised to address the mischief. A number of decisions, such as Chiranjit Lal Chowdhury v. Union of India  1950  SCR  869,  A.  Thangal  Kunju  Musaliar  v.  M. Venkatachalam Potti (1955) 2 SCR 1196, State of Himachal Pradesh v. Kailash Chand Mahajan, 1992 Supp (2) SCC 351  and  National  Insurance  Co.  Ltd.  v.  Swaran  Singh

(2004) 3 SCC 297 lay down that it is desirable to look into the  legislative  history  and  the  Statement  of  Objects  and Reasons of an enactment to appreciate the background and state  of  affairs  leading  up  to  the  legislation  and  the circumstances which were prevalent at the time the statute was enacted

xxx  xxx  xxx

52. The MTP Amendment Act 2021 intended to extend the benefits of the statute to all women, including single and unmarried women. The MTP Amendment Act 2021, which integrity of this document 36

came  into  force  from  24  September  2021,  introduced  a major change in Section 3 of the MTP Act by extending the upper limit for permissible termination of pregnancy from twenty  weeks  to  twenty-four  weeks.  In  terms  of  the unamended MTP Act, a pregnancy could only be terminated under Section 3(2) if it did not exceed twenty weeks. The MTP  Amendment  Act  2021  extended  the  upper  limit  and allowed termination of pregnancy up to twenty-four weeks for specific categories of women based on the opinion of two RMPS.

53. The MTP Amendment Act 2021 also extended the benefit of  the  legal presumption  of  a  grave  injury to  the  mental health  of  a  woman  on  account  of  the  failure  of contraception, to all women and not just married women. In the unamended MTP Act, Explanation II provided that the anguish caused by a pregnancy resulting from a failure of any device or method used by any "married woman or her husband" for the purpose of limiting the number of children may be presumed to constitute a grave injury to the mental health of the woman. After the MTP Amendment Act 2021, Explanation  I  provides  that  the  anguish  caused  by  a pregnancy (up to twenty weeks) arising from a failure of a contraceptive device used by "any woman or her partner" either for limiting the number of children or for preventing pregnancy can be presumed to constitute a grave injury to a woman's mental health. By eliminating the word "married woman or her husband" from the scheme of the MTP Act, the legislature intended to clarify the scope of Section 3 and bring  pregnancies  which  occur  outside  the  institution  of marriage within the protective umbrella of the law.

integrity of this document 37

54.  The  Statement  of  Objects  and  Reasons  of  the Amendment Act locates the purpose within the framework of reproductive rights:

"With  the  passage  of  time  and  advancement  of  medical technology for safe abortion, there is a scope for increasing upper  gestational  limit  for  terminating  pregnancies especially for vulnerable women and for pregnancies with substantial  foetal  anomalies  detected  late  in  pregnancy. Further, there is also a need for increasing access of women to  legal  and  safe  abortion  service  in  order  to  reduce maternal mortality and morbidity caused by unsafe abortion and its complications. Considering the need and demand for increased  gestational  limit  under  certain  specified conditions and to ensure safety and well-being of women, it is proposed to amend the said Act. The proposed Bill is a step  towards  safety  and  well-being  of  women  and  will enlarge the ambit and access of women to safe and legal abortion  without  compromising  on  safety  and  quality  of care.  The  proposal  will  also  ensure  dignity,  autonomy, confidentiality and justice for women who need to terminate pregnancy." (emphasis supplied)

55. The Statement of Objects and Reasons indicates that the MTP  Amendment  Act  2021  is  primarily  concerned  with increasing  access  to  safe  and  legal  abortions  to  reduce maternal mortality and morbidity. The increase in the upper gestational limit for terminating pregnancies under "certain specified conditions" was considered necessary to fulfil the goal  of  ensuring  "dignity,  autonomy,  confidentiality  and justice for women who need to terminate pregnancy."

integrity of this document 38

56.  The  unamended  MTP  Act  of  1971  was  largely concerned  with  "married  women",  as  evident  from paragraph 1 of its Statement of Objects and Reasons, which stated  that  most  of  the  women  seeking  abortions  were married, and thus "under no particular necessity to conceal their  pregnancy."  Significantly,  the  2021  Statement  of Objects and Reasons does not make a distinction between married  and  unmarried  women.  Rather,  all  women  are entitled to the benefit of safe and legal abortions.

Xxx  xxx  xxx iv.  The  MTP  Act  as  an  aid  of  interpretation: Understanding "injury to mental health"

60. When interpreting a sub-clause or part of a statutory provision, the entire section should be read together with different sub-clauses being a part of an integral whole. [69] In terms of Section 3(2)(b) of the MTP Act, not less than two RMPs  must,  in  good  faith,  be  of  the  opinion  that  the continuation  of  the  pregnancy  of  any  woman  who  falls within the ambit of Rule 3B would involve (i) a risk to her life; (ii) grave injury to her physical health; or (iii) grave injury to her mental health. Alternatively, not less than two RMPs must, in good faith, be of the opinion that there is a substantial  risk  of  the  child  suffering  from  a  serious physical or mental abnormality, if born. Women who seek to avail  of  the  benefit  under  Rule  3B  of  the  MTP  Rules continue to be subject to the requirements of Section 3(2) of the MTP Act.

[69 Balasinor Nagrik Co-operative Bank Ltd. v. Bababhai Shankerlal  Pandya,  (1987)  1  SCC  606,  Madanlal Fakirchand  v  Shree  Changdeo  Sugar  Mills  Ltd,  1962 Supp (3) SCR 973) integrity of this document 39

61. One of the grounds on the basis of which termination of pregnancy may be carried out is when the continuance of a pregnancy would involve risk of injury to the mental health of the woman. The expression "grave injury to her physical or  mental  health"  used  in  Section  3(2)  is  used  in  an overarching  and  all-encompassing  sense.  The  two explanations  appended  to  Section  3(2)  provide  the circumstances  under  which  the  anguish  caused  by  a pregnancy may be presumed to constitute a grave injury to the mental health of a woman.

62.  Courts  in  the  country  have  permitted  women  to terminate  their  pregnancies  where  the  length  of  the pregnancy exceeded twenty weeks (the outer limit for the termination of the pregnancy in the unamended MTP Act) by  expansively  interpreting  Section  5,  which  permitted RMPs  to  terminate  pregnancies  beyond  the  twenty  week limit when it was necessary to save the life of the woman. In X v. Union of India (2017) 3 SCC 458, Mamta Verma v. Union of India (2018) 14 SCC 289, Meera Santosh Pal v. Union of India (2017) 3 SCC 462, Sarmishtha Chakrabortty v. Union of India, (2018) 13 SCC 339 this Court permitted the termination of post twenty week pregnancies after taking into account the risk of grave injury to the mental health of a pregnant woman by carrying the pregnancy to term.

63. The grounds for approaching courts differ and include various reasons such as a change in the circumstances of a woman's  environment  during  an  ongoing  pregnancy, including  risk  to  life,  [74]  risk  to  mental  health,  [75] discovery  of  foetal  anomalies,  [76]  late  discovery  of pregnancy in case of minors and women with disabilities, [77]  and  pregnancies  resulting  from  sexual  assault  or integrity of this document 40

rape.[78]  These  are  illustrative  situations  thrown  up  by cases  which  travel  to  the  court.  Although  the  rulings  in these  cases  recognized  grave  physical  and  mental  health harms and the violation of the rights of women caused by the denial of the option to terminate unwanted pregnancies, the relief provided to the individual petitioner significantly varied.

[74 A v. Union of India, (2018) 14 SCC 75, X v. Union of India, (2017) 3 SCC 458. Meera Santosh Pal v. Union of India, (2017) 3 SCC 462. Tapasya Umesh Pisal v. Union of India,  (2018)  12  SCC 57,  Mamta  Verma  v  Union  of India, (2018) 14 SCC 289]

[75*  X  v.  Union  of  India,  (2017)  3  SCC  458,  Meera Santosh  Pal  v.  Union  of  India,  (2017)  3  SCC  462, Sarmishtha Chakraborty v. Union of India, (2018) 13 SCC 339, Mamta Verma v. Union of India, (2018) 14 SCC 289, ? v. State of Bihar, (2018) 11 SCC 572]

[76" A v. Union of India, (2018) 14 SCC 75. Sarmishtha Chakraborty  v.  Union  of  India,  (2018)  13  SCC  339. Tapasya Umesh Pisal v Union of India, (2018) 12 SCC 57, Mamta Verma v. Union of India, (2018) 14 SCC 289]

[77" X v. Union of India, (2020) 19 SCC 806]

[78 ? v. State of Bihar, (2018) 11 SCC 572, X v. Union of India, (2020) 19 SCC 806)

64. The expression "mental health" has a wide connotation and  means  much  more  than  the  absence  of  a  mental impairment  or  a  mental  illness.  The  World  Health Organization  defines  mental  health  as  a  state  of "mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to  their  community."[79] The  determination  of the status of one's mental health is located in one's self and experiences  within  one's  environment  and  social  context. integrity of this document 41

Our  understanding  of  the  term  mental  health  cannot  be confined to medical terms or medical language, but should be  understood  in  common  parlance.  The  MTP  Act  itself recognizes the need to look at the surrounding environment of the woman when interpreting injury to her health. Section 3(3)  states  that  while  interpreting  "grave  injury  to  her physical  or  mental  health",  account  may  be  taken  of  the pregnant  woman's  actual  or  reasonably  foreseeable environment.  The  consideration  of  a  woman's  "actual  or reasonably  foreseeable  environment"  becomes  pertinent, especially when determining the risk of injury to the mental health of a woman.

(70*  World  Health  Organization,  "Promoting  mental health: concepts, emerging evidence, practice (Summary Report)" (2004))

65. There have been numerous decisions of the High Courts where  a  purposive  interpretation  is  given  to  the  phrase mental health as used in the MTP Act. In High Court on its Own Motion v. State of Maharashtra, 2016 SCC OnLine Bom 8426 the High Court of Bombay correctly held that compelling a woman to continue any unwanted pregnancy violates a woman's bodily integrity, aggravates her mental trauma and has a deleterious effect on the mental health of the woman because of the immediate social, financial and other consequences flowing from the pregnancy.

xxx  xxx  xxx

v. Construing Rule 3B

68. By framing Rule 3B, the legislature intended to solve the mischief,  so  to  speak,  of  women  being  unable  to  access abortions  when  their  lives  underwent  significant  changes impacting  their  physical  and  mental  health,  and  their integrity of this document 42

decision to have a child was impacted after the length of the pregnancy  exceeded  twenty  weeks.  The  Minutes  of  the Meeting of the Expert Committee held on 22 June 2021 for deliberating upon and drafting the MTP Rules dealt with, inter alia, category of women under Rule 3B. The members of the Expert Committee suggested different categories of women such as "survivors of sexual violence/ rape; mentally challenged women, minors, women with disabilities; foetal anomalies;  conception  in  lactational  amenorrhea  period; single women (such as unwed women (major), divorced and widowed,  separated  women);  women  who  are  facing difficulties in contexts of humanitarian setting/ emergencies and/or  natural  disasters;  women  victims  of  domestic violence/gender-based  violence  etc."  The  members  of  the Expert Committee urged the inclusion of women in Rule 3B, who  often  delay  revealing  the  pregnancy  or  making decisions as to its continuance, for various reasons.

69. The common thread running through each category of women  mentioned  in  Rule  3B  is  that  the  woman  is  in  a unique and often difficult circumstance, with respect to her physical, mental, social, or financial state. All the different categories  in  Rule  3B  represent  women  who  seek  an abortion  after  twenty  weeks  either  due  to  a  delay  in recognizing  pregnancy,  or  some  other  change  in  their environment  impacting  their  decision  on  whether  the pregnancy is wanted or unwanted. The law recognizes the myriad ways in which a pregnancy may cause distress in such situations and cause grave injury to her physical and mental health. It gives such women latitude in seeking out the termination of an unwelcome pregnancy by extending the gestational period up to which the termination is legally permissible.

integrity of this document 43

70.  Rule  3B(a)  is  based  on  an  acknowledgement  of  the reality that survivors of sexual assault, rape, or incest may face immense stigma if and when they share the fact of their assault  with  others,  including  family  members.  It  is  no secret that a culture of shame surrounds sexual violence in India.  Survivors  are  often  hesitant  to  speak  about  the violence inflicted upon them. This is doubly the case with victims of incestuous sexual assault or rape, whose close relatives  abuse  their  power  and  authority  over  the woman and  other  family  members  oftentimes  being unwilling to believe that the perpetrator (that is to say, their relative)  is  guilty  of  sexual  violence.  Many  survivors, including minors, may not even be aware that pregnancy is a  possible  consequence  of  rape.  Hence,  the  delay  in revealing the fact that a man has raped them may lead to a delay  in  discovering  the  pregnancy.  Alternatively,  the woman  in  question  may  be  unable  to  access  medical facilities in a timely fashion and may therefore find herself unable to terminate the pregnancy before the completion of twenty weeks.

xxx  xxx  xxx

81. To ensure that the benefit of Rule 3B(b) is extended to all women under 18 years of age who engage in consensual sexual activity, it is necessary to harmoniously read both the POCSO Act and the MTP Act. For the limited purposes of providing medical termination of pregnancy in terms of the MTP Act, we clarify that the RMP, only on request of the minor and the guardian of the minor, need not disclose the identity and other personal details of the minor in the information  provided  under  Section  19(1)  of  the  POCSO Act. The RMP who has provided information under Section 19(1) of the POCSO Act (in reference to a minor seeking medical termination of a pregnancy under the MTP Act) is integrity of this document 44

also  exempt  from  disclosing  the  minor's  identity  in  any criminal  proceedings  which  may  follow  from  the  RMP's report  under  Section  19(1)  of  the  POCSO  Act.  Such  an interpretation  would  prevent  any  conflict  between  the statutory obligation of the RMP to mandatorily report the offence under the POCSO Act and the rights of privacy and reproductive autonomy of the minor under Article 21 of the Constitution. It could not possibly be the legislature's intent to deprive minors of safe abortions.

Xxx  xxx  xxx

90. Rule 3B(c) is based on the broad recognition of the fact that a change in the marital status of a woman often leads to  a  change  in  her  material  circumstances.  A  change  in material circumstance during the ongoing pregnancy may arise when a married woman divorces her husband or when he  dies,  as  recognized  by  the  examples  provided  in parenthesis  in  Rule  3B(c).  The  fact  that  widowhood  and divorce are mentioned in brackets at the tail end of Rule 3B(c) does not hinder our interpretation of the rule because they are illustrative.

91. A change in material circumstance may also result when a woman is abandoned by her family or her partner. When a woman separates from or divorces her partner, it may be that she is in a different (and possibly less advantageous) position financially. She may no longer have the financial resources  to  raise  a  child.  This  is  of  special  concern  to women who have opted to be a homemaker thereby forgoing an  income  of  their  own.  Moreover,  a  woman  in  this situation may not be prepared to raise a child as a single parent or by coparenting with her former partner. Similar consequences may follow when a woman's partner dies.

integrity of this document 45

92.  Women  may  undergo  a  sea  change  in  their  lives  for reasons  other  than  a  separation  with  their  partner  (Rule 3B(c)), detection of foetal "abnormalities" (Rule 3B(f)), or a disaster  or  emergency  (Rule  3B(g)).  They  may  find themselves  in  the  same  position  (socially,  mentally, financially, or even physically) as the other categories of women enumerated in Rule 3B but for other reasons. For instance, it is not unheard of for a woman to realise that she is pregnant  only after  the  passage  of  twenty  weeks, [88] Other  examples  are  if  a  woman  loses  her  job  and  is  no longer  financially  secure,  or  if  domestic  violence  is perpetrated  against  her,  [89]  or  if  she  suddenly  has dependents to support. Moreover, a woman may suddenly be diagnosed with an acute or chronic or life- threatening disease, which impacts her decision on whether to carry the pregnancy to term. If Rule 3B(c) was to be interpreted such that its benefits extended only to married women, it would perpetuate the stereotype and socially held notion that only married  women  indulge  in  sexual  intercourse,  and  that consequently, the benefits in law ought to extend only to them. This artificial distinction between married and single women is not constitutionally sustainable. The benefits in law extend equally to both single and married women.

[88" Siddhi Vishwanath Shelar v. State of Maharashtra, 2020 SCC OnLine Bom 11672]

[89 Sidra Mehboob Shaikh v. State of Maharashtra, 2021 SCC OnLine Bom 1839]

93. A recognition of the fact that there may be a change in a woman's material circumstance animates Rule 3B(c), Rule 3B(g)  and  Rule  3B(f).  However,  Rule  3B  does  not enumerate  all  the  potential  changes  that  a  woman's material  circumstances  may  undergo.  It  merely  specifies some  of  the  potential  changes  to  a  woman's  material integrity of this document 46

circumstances, in sub-rules (c), (f) and (g). From the object and purpose of the MTP Act, its overall scheme, and the categories of women specified in Rule 3B, it is evident that it  was  not  the  intention  of  the  legislature  to  restrict  the benefit of Section 3(2)(b) and Rule 3B only to women who may  be  confronted  with  a  material  alteration  in  the circumstances  of  their  lives  in  the  limited  situations enumerated in Rule 3B. Rather, the benefit granted by Rule 3B  must  be  understood  as  extending  to  all  women  who undergo a change of material circumstances.

94. It is not possible for either the legislature or the courts to list each of the potential events which would qualify as a change of material circumstances. Suffice it to say that each case must be tested against this standard with due regard to the unique facts and circumstances that a pregnant woman finds herself in.

95.  Certain  constitutional  values,  such  as  the  right  to reproductive autonomy, the right to live a dignified life, the right to equality, and the right to privacy have animated our interpretation of the MTP Act and the MTP Rules. A brief discussion of these values is undertaken below.

i. The right to reproductive autonomy

96. The ambit of reproductive rights is not restricted to the right of women to have or not have children. It also includes the constellation of freedoms and entitlements that enable a woman to decide freely on all matters relating to her sexual and  reproductive  health.  Reproductive  rights  include  the right  to  access  education  and  information  about contraception and sexual health, the right to decide whether and what type of contraceptives to use, the right to choose integrity of this document 47

whether and when to have children, the right to choose the number  of  children,  the  right  to  access  safe  and  legal abortions, and the right to reproductive healthcare. Women must also have the autonomy to make decisions concerning these rights, free from coercion or violence.

97.  Zakiya  Luna  has,  in a  2020  publication, argued that reproduction  is  both  biological  and  political.  [90] According  to  Luna,  it  is  biological  since  physical  bodies reproduce, and it is political since the decision on whether to  reproduce  or  not  is  not  solely  a  private  matter.  This decision is intimately linked to wider political, social, and economic structures. A woman's role and status in family, and  society  generally,  is  often  tied  to  childbearing  and ensuring the continuation of successive generations.

[90  ?AKIYA  LUNA,  REPRODUCTIVE  RIGHTS  AS HUMAN RIGHTS: WOMEN OF COLOR AND FIGHT FOR REPRODUCTIVE JUSTICE (NYU Press, 2020))

98. To this, we may add that a woman is often enmeshed in complex notions of family, community, religion, and caste. Such  external  societal  factors  affect  the  way  a  woman exercises autonomy and control over her body, particularly in  matters  relating  to  reproductive  decisions.  Societal factors  often  find  reinforcement  by  way  of  legal  barriers restricting a woman's right to access abortion. The decision to  have  or  not  to  have  an  abortion  is  borne  out  of complicated life circumstances, which only the woman can choose on her own terms without external interference or influence.  Reproductive  autonomy  requires  that  every pregnant  woman  has  the  intrinsic  right  to  choose  to undergo or not to undergo abortion without any consent or authorization from a third party.

integrity of this document 48

99.  The  right  to  reproductive  autonomy  is  closely  linked with  the  right  to  bodily  autonomy.  As  the  term  itself suggests,  bodily  autonomy  is  the  right  to  take  decisions about  one's  body.  The  consequences  of  an  unwanted pregnancy on a woman's body as well as her mind cannot be understated. The foetus relies on the pregnant woman's body for sustenance and nourishment until it is born. The biological  process  of  pregnancy  transforms  the  woman's body to permit this. The woman may experience swelling, body ache, contractions, morning sickness, and restricted mobility, to name a few of a host of side effects. Further, complications may arise which pose a risk to the life of the woman.  A  mere  description  of  the  side  effects  of  a pregnancy cannot possibly do justice to the visceral image of  forcing  a  woman  to  continue  with  an  unwanted pregnancy. Therefore, the decision to carry the pregnancy to its full term or terminate it is firmly rooted in the right to bodily autonomy and decisional autonomy of the pregnant woman.

100. In K. S. Puttaswamy v. Union of India, (2017) 10 SCC 1 a nine-judge bench of this Court recognized the right to privacy as a constitutionally protected right under Article 21 of the Constitution. In Puttaswamy (supra), this Court held that the right to privacy enables individuals to retain and  exercise  autonomy  over  the  body  and  mind.  The autonomy of the individual was defined as "the ability to make decision on vital matters of concern to life.[92] The judgement delivered on behalf of four judges described the right to privacy in the following terms:

[92 KS Puttawamy Union of India (2017) 10 SCC 1, at paragraph 298 (Puttaswamy"]

integrity of this document 49

297. Privacy postulates the reservation of a private space for the individual, described as the right to be let alone. The concept is founded on the autonomy of the individual. The ability of an individual to make choices lies at the core of the human personality. The notion of privacy enables the individual to assert and control the human element which is inseparable  from  the  personality  of  the  individual.  The inviolable nature of the human personality is manifested in the ability to make decisions on matters intimate to human life.  The  autonomy  of  the  individual  is  associated  over matters which can be kept private. These are concerns over which there is a legitimate expectation of privacy. The body and  the  mind  are  inseparable  elements  of  the  human personality. The integrity of the body and the sanctity of the mind  can  exist  on  the  foundation  that  each  individual possesses  an  inalienable  ability  and  right  to  preserve  a private space in which the human personality can develop. Without the ability to make choices, the inviolability of the personality would be in doubt." (emphasis supplied)

101. Importantly, Puttaswamy (supra) also deals with facets of  reproductive  autonomy.  Chelameshwar,  J.  held  that  a "woman's  freedom  of  choice  whether  to  bear  a  child  or abort her pregnancy are areas which fall in the realm of privacy."  [93]  This  Court  recognized  the  right  to  bodily integrity  as  an  important  facet  of  the  right  to  privacy. Puttaswamy  (supra)  considered  Suchita  Srivastava  v. Chandigarh  Administration  (2009)  9  SCC  1  to  reiterate that the statutory right of a woman to undergo termination of  pregnancy  under  the  MTP  Act  is  relatable  to  the constitutional  right  to  make  reproductive  choices  under Article 21 of the Constitution. [95]

integrity of this document 50

[93 Puttaswamy, at paragraph 373] [95 Puttaswamy, at paragraph 82]

102.  In  Suchita  Srivastava  (supra)  this  Court  explicitly recognized the  concept  of reproductive autonomy.  In  this case, the victim, an orphaned woman of around 19 years, with mental retardation, became pregnant as a result of a rape  that  took  place  while  she  was  an  inmate  at  a government-run welfare institution. After the discovery of her pregnancy, the Chandigarh Administration approached the High Court of Punjab and Haryana seeking approval for  the  termination  of  her  pregnancy.  The  High  Court constituted an expert body to conduct an enquiry into the facts.  The  expert  body  recorded  that  the  victim  had expressed her willingness to bear the child and accordingly recommended the continuation of the pregnancy. However, the High Court directed the termination of the pregnancy on the ground that the victim was mentally incapable of making an informed decision on her own.

103. A three-judge Bench of this Court disagreed with the High  Court's  decision.  In  a  judgment  authored  by  K  G Balakrishnan, C.J., this Court emphasized that the consent of  the  pregnant  woman  is  an  essential  requirement  to proceed with the termination of a pregnancy under the MTP Act. It was held that the state administration cannot claim guardianship  of  the  woman  as  she  was  a  major.  It  was further  held  that  the  woman  only  had  "mild  mental retardation"  and  was  therefore  competent  to  give  her consent in terms of Section 3(4)(a) of the MTP Act. This Court concluded that the state must respect the reproductive rights of women with "mental retardation" with regard to decisions about terminating their pregnancy. In the process, this Court recognized that a woman's right to reproductive autonomy is a dimension of Article 21 of the Constitution: integrity of this document 51

"22.  There  is  no  doubt  that  a  woman's  right  to  make reproductive  choices  is  also  a  dimension  of  "personal liberty" as understood under Article 21 of the Constitution of  India.  It  is  important  to  recognise  that  reproductive choices can be exercised to procreate as well as to abstain from  procreating.  The  crucial  consideration  is  that  a woman's  right  to  privacy,  dignity  and  bodily  integrity should be respected. This means that 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. Furthermore, women are also free to  choose  birth  control  methods  such  as  undergoing sterilisation procedures. Taken to their logical conclusion, reproductive rights include a woman's entitlement to carry a  pregnancy  to  its  full  term,  to  give  birth  and  to subsequently  raise  children.  However,  in  the  case  of pregnant women there is also a "compelling State interest" in protecting the life of the prospective child. Therefore, the termination  of  a  pregnancy  is  only  permitted  when  the conditions  specified  in  the  applicable  statute  have  been fulfilled. Hence, the provisions of the MTP Act, 1971 can also  be  viewed as reasonable  restrictions  that  have  been placed on the exercise of reproductive choices."

104. Suchita Srivastava (supra) rightly recognised that the right of women to make reproductive choices is a dimension of  personal  liberty  under  Article  21.  It  held  that reproductive rights include a woman's entitlement to carry the pregnancy to full term, give birth, and raise children. More  importantly,  it  also  recognised  that  the  right  to reproductive choice also includes the right not to procreate. integrity of this document 52

In doing so, it situated the reproductive rights of women within the core of constitutional rights.

105. Decisional autonomy is an integral part of the right to privacy.  Decisional  autonomy  is  the  ability  to  make decisions  in  respect  of  intimate  relations  [96]  In Puttaswamy (supra) this Court held that personal aspects of life  such  as  family,  marriage,  procreation,  and  sexual orientation are all intrinsic to the dignity of the individual. 1971  The  right  to  privacy  safeguards  and  respects  the decisional autonomy of the individual to exercise intimate personal choices and control over the vital aspects of their body and life. In Common Cause v. Union of India, (2018) 5 SCC 1 this Court observed that right to privacy protects decisional autonomy in matters related to bodily integrity:

[96 Purtaswamy, at paragraph 248] [97 Puttaswamy, at paragraph 298]

"441. The right to privacy resides in the right to liberty and in the respect of autonomy. The right to privacy protects autonomy  in  making  decisions  related  to  the  intimate domain of death as well as bodily integrity. Few moments could be of as much importance as the intimate and private decisions  that  we  are  faced  regarding  death.  Continuing treatment  against  the  wishes  of  a  patient  is  not  only  a violation of the principle of informed consent, but also of bodily  privacy  and  bodily  integrity  that  have  been recognised as a facet of privacy by this Court."

106.  The  right  to  decisional  autonomy  also  means  that women  may  choose  the  course  of  their  lives.  Besides physical  consequences,  unwanted  pregnancies  which women  are  forced  to  carry  to  term  may  have  cascading integrity of this document 53

effects for the rest of her life by interrupting her education, her career, or affecting her mental well-being.

107. In High Court on its Own Motion (supra), an under-trial  prisoner  requisitioned  for  obtaining  permission  to terminate  her  4-month  pregnancy  to  a  judge  of  the  City Civil  &  Sessions  Court  visiting  the  prison.  The  woman stated  that  it  would  be  too  difficult  for  her  to  maintain another child in addition to her five-month-old child, who was  suffering  from  various  malaises  such  as  epilepsy, hernia  and  other  illnesses.  In  such  circumstances,  the woman stated that it was difficult for her to maintain and take care of another child. The judge forwarded a letter to the  High  Court  of  Bombay  along  with  the  woman's requisition for information and further action, which was converted into a suo moto PIL.. The High Court referred to the  relevant  provisions  of  the  MTP  Act  to  observe  that mental health can deteriorate if the pregnancy is forced or unwanted:

"14. A woman's decision to terminate a pregnancy is not a frivolous one. Abortion is often the only way out of a very difficult situation for a woman. An abortion is a carefully considered decision taken by a woman who fears that the welfare of the child she already has, and of other members of the household that she is obliged to care for with limited financial and other resources, may be compromised by the birth  of  another  child.  These  are  decisions  taken  by responsible women who have few other options. They are women  who  would  ideally  have  preferred  to  prevent  an unwanted pregnancy, but were unable to do so. If a woman does not want to continue with the pregnancy, then forcing her to do so represents a violation of the woman's bodily integrity of this document 54

integrity and aggravates her mental trauma which would be deleterious to her mental health."

108. A woman can become pregnant by choice irrespective of her marital status. In case the pregnancy is wanted, it is equally shared by both the partners. However, in case of an unwanted  or  incidental  pregnancy,  the  burden  invariably falls  on  the  pregnant  woman  affecting  her  mental  and physical  health.  Article  21  of  the  Constitution  recognizes and protects the right of a woman to undergo termination of pregnancy  if  her  mental  or  physical  health  is  at  stake. Importantly, it is the woman alone who has the right over her body and is the ultimate decision-maker on the question of whether she wants to undergo an abortion.

ii. The right to dignity

109.  The  right  to  dignity  encapsulates  the  right  of  every individual to be treated as a self- governing entity having intrinsic value. It means that every human being possesses dignity  merely  by  being  a  human,  and  can  make  self-defining  and  self-determining  choices.  Dignity  has  been recognized  as  a  core  component  of  the  right  to  life  and liberty under Article 21.

110.  If  women  with  unwanted  pregnancies  are  forced  to carry their pregnancies to term, the state would be stripping them of the right to determine the immediate and long-term path their lives would take. Depriving women of autonomy not only over their bodies but also over their lives would be an affront to their dignity. The right to choose for oneself-be it as significant as choosing the course of one's life or as mundane as one's day-to-day activities-forms a part of the right to dignity. It is this right which would be under attack integrity of this document 55

if  women  were  forced  to  continue  with  unwanted pregnancies.

111. In Kesavananda Bharati v. State of Kerala, (1973) 4 SCC 225 it was held that dignity forms a part of the basic structure of the Constitution. Such is its fundamental value in our legal system the concept of dignity forms the very foundation to the Constitution and the rights enshrined in it. Dignity  inheres in  every individual  and is an inalienable aspect of one's humanity.

112.  In  Francis  Coralie  Mullin  v.  Administrator,  Union Territory of Delhi, (1981) 1 SCC 608 a two-judge bench of this Court was dealing with the rights of detenus under the Conservation  of  Foreign  Exchange  and  Prevention  of Smuggling  Activities  Act.  This  Court  recognized  that  the right to dignity is an essential part of the right to life under Article 21 of the Constitution. It was observed:

"8.... We think that 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. Of course, the magnitude and content of the components of this right  would  depend  upon  the  extent  of  the  economic development of the country, but it must, in any view of the matter, include the right to the basic necessities of life and also the right to carry on such functions and activities as constitute the bare minimum expression of the human-self. 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 integrity of this document 56

and just procedure established by law which stands the test of other fundamental rights."

113.  In  Puttaswamy  (supra)  one  of  us  (Dr.  D.  Y. Chandrachud,  J.)  emphasized  the  interlinkage  between privacy, dignity, and liberty as follows:

"298.  Privacy  of  the  individual  is  an  essential  aspect  of dignity.  Dignity  has  both  an  intrinsic  and  instrumental value. As an intrinsic value, human dignity is an entitlement or  a  constitutionally  protected  interest  in  itself.  In  its instrumental  facet,  dignity  and  freedom  are  inseparably intertwined,  each  being  a  facilitative  tool  to  achieve  the other.  The  ability  of  the  individual  to  protect  a  zone  of privacy enables the realisation of the full value of life and liberty. Liberty has a broader meaning of which privacy is a subset.  All liberties may  not  be exercised  in privacy. Yet others can be fulfilled only within a private space. Privacy enables the individual to retain the autonomy of the body and mind. The autonomy of the individual is the ability to make decisions on vital matters of concern to life. Privacy has  not  been  couched  as  an  independent  fundamental right.... The intersection between one's mental integrity and privacy  entitles  the  individual  to freedom  of  thought,  the freedom to believe in what is right, and the freedom of self-determination.  When  these  guarantees  intersect  with gender, they create a private space which protects all those elements which are crucial to gender identity. The family, marriage,  procreation  and  sexual  orientation  are  all integral  to  the  dignity  of  the  individual.  Above  all,  the privacy of the individual recognises an inviolable right to determine how freedom shall be exercised... Dignity cannot exist  without  privacy.  Both  reside  within  the  inalienable integrity of this document 57

values of life, liberty and freedom which the Constitution has recognised. xxx  xxx  xxx

121. The object of Section 3(2)(b) of the MTP Act read with Rule  3B  is  to  provide  for  abortions  between  twenty  and twenty-four weeks, rendered unwanted due to a change in the material circumstances of women. In view of the object, there  is  no  rationale  for  excluding  unmarried  or  single women (who face a change in their material circumstances) from the ambit of Rule 3B. A narrow interpretation of Rule 3B,  limited  only  to  married  women,  would  render  the provision  discriminatory  towards  unmarried  women  and violative  of  Article  14  of  the  Constitution.  Article  14 requires  the  state  to  refrain  from  denying  to  any  person equality before the law or equal protection of laws.

Prohibiting  unmarried  or  single  pregnant  women  (whose pregnancies  are  between  twenty  and  twenty-four  weeks) from accessing abortion while allowing married women to access them during the same period would fall foul of the spirit  guiding  Article  14.  The  law  should  not  decide  the beneficiaries  of  a  statute  based  on  narrow  patriarchal principles about what constitutes "permissible sex", which create invidious classifications and excludes groups based on their personal circumstances. The rights of reproductive autonomy,  dignity,  and  privacy  under  Article  21  give  an unmarried woman the right of choice on whether or not to bear a child, on a similar footing of a married woman."

29     It  is  evident  from  a  perusal  of  the  same  that  rule  3  B provides for abortion within a period of 24 weeks, due to change of material (including marital) circumstances and that the said provision has  to  be  read  to  extend  also  to  an  unmarried  woman  and  that integrity of this document 58

disallowing the same access to an unmarried woman/girl under Rule 3 B, would be discriminatory to her and she too deserves the reproductive autonomy and right of her choice whether or not to bear a child. The said provisions are, however, not a means to dilute the provisions of Pre-Conception and Pre-Natal Diagnostic Techniques Act, 1994. 30 Hence, I am of the view that law needs no further elaboration. An unmarried girl/a single mother cannot be made to suffer social, physical, psychological and financial trauma merely for having exercised her rightful autonomy. Changed circumstances/material alterations as available to a married woman under Rule 3 B of the Rules of 2003, as amended, would also subsist in favour of an unmarried consenting adult and that when a consensual sexual relationship between adult parts away or is mutually closed, the same would have certain callings equivalent to the scenario contemplated by the Legislature akin to divorce/widowhood for the purpose of seeking medical termination of pregnancy. A changed scenario, in terms of requirement has to presume a legal recognition of a relationship with her partner at par with a spousal relationship stipulated under Rule 3 B of the Rules of 2003 and that on existence of such circumstances which permit a married woman to seek termination of pregnancy, the Court may exercise its power to grant approval to medical termination of pregnancy even in case of an unmarried girl. 31 Further, during the course of hearing, a question was also posed to the petitioner herein as to whether she would like to name or disclose the identity of the person who is the father of the child, integrity of this document 59

however, she expressed her unwillingness to disclose the name. Her right of privacy and dignity empowers her to make a choice as to whether she would like to disclose the name of the partner or not and that the law cannot compel a woman to make public the name of the person who is the father of the foetus and/or the child. 32 Having recognized the right of the petitioner to seek medical termination, this Court now proceeds on the factual aspects of the case and to determine as to whether such permission needs to be granted in the facts of the present case. 33 I have gone through the judgments that have been cited by the petitioner where pregnancy has been permitted to be terminated after expiry of 24 weeks, however, in all the said judgments cited by the senior counsel for the petitioner, the child/pregnancy posed grave risk to the lives of mother as well as the child or the child suffered from serious physical and mental abnormalities. While it is recognized that the foetus in the present case is an unwanted pregnancy and the possible social stigmatic fall out for the petitioner cannot be entirely ruled out, however, the legislature has prescribed the time frame within which such termination may be permitted, after due consideration of the medical condition and the status of the foetus. It is also seen that while the law may confer a right to be exercised by the mother for seeking a termination of pregnancy on occurrence of the circumstances stipulated thereunder, the above said right is recognised by law till such time that the pregnancy completes 24 weeks. The mandate of Article 21 of the Constitution of India guarantees life and personal liberty to an individual integrity of this document 60

in accordance with the procedure established by law. Hence, when such a right is subject to certain procedural restrictions and on occurrence of an event (i.e. the pregnancy beyond 24 weeks), an individual cannot claim an unbridled right yet in her favour and to claim that notwithstanding the mandate of the Act of 1971 and the Rules of 2003, yet, she is entitled to seek medical termination. The legislative wisdom of confining the time line is not a subject matter of challenge and is also not confronted by any medical jurisprudence to the contrary. Invariably, in the process of carrying out a termination of the pregnancy, post expiry of 24 weeks, when a child is healthy and is grown, the implications and consequences have been segregated and consciously confined by the Legislature. The law leaves it to the discretion of the constitutional Courts, to exercise on case to case basis, as to whether such circumstances exist as would necessitate issuance of directions for termination of pregnancy. Hence, the Court is required to take into consideration the admissible evidence. 34 Even though the Medical Board cannot substitute a decision of a person to exercise his right, however, once it is held that such right is circumscribed by the legal provisions, the opinion of the expert Medical Board of an Institution of Eminence, would not ordinarily be disregarded. 35 It is also noticed herein that it is not a case where delay has occasioned on account of delay in adjudication, rather, the petitioner herself approached this Court after expiry of the statutory period. The present writ petition was listed for the first time before this Court on integrity of this document 61

29.02.2024 and as per the ultrasound report of 23.02.2024, she was pregnant by 24 weeks and 06 days i.e. 25 weeks. Hence, she was pregnant by 26 weeks when she approached the High Court. Further, the report of the Medical Board of PGIMER, even though notices that the patient is medically and physically fit to undergo a procedure and expressed a suicidal ideation of the petitioner and recommends psychological assessments and support, also states it to be a case of pre-term delivery and not a medical termination as ordinarily understood. For carrying out a termination in such circumstances, the doctors are required to carry out a feticide as per which the heartbeat of the child have to be forcibly stopped, failing which the survival rates of the pre-mature delivered child would be more than 65%, having numerous neuro-developmental handicaps and increasing the morbidity of such child. It seemingly is on account of the aforesaid circumstances and to avoid committing of a feticide that the legislature decided a 'cut off' for pregnancy period before any such right/authority ought to be exercised. 36 While pleading her circumstances, the petitioner is seeking a direction from this Court to authorize the doctors to carry out a feticide failing which it would be an instance of a pre-term delivery which is likely to add to the hardships of the child himself. The Court cannot be oblivious to the possibility of a pre-term delivery and the consequences which its order may have to a child or to assume a role where it takes upon itself to decide that the child ought not be allowed to be born alive. While ordinarily under general circumstances, this Court may have approved of the medical termination if the foetus or the mother would integrity of this document 62

have suffered a grave physical or mental harm or the child was likely to be born with serious physical, mental or psychological deformities, however, a mental shock or stigma as a result of a pregnancy not approved, but on account of a consensual relationship, cannot at this juncture be seen as an event which would have an irreversible mental hazard. Exercise of a right of sexual autonomy also at times comes along with the responsibility to discharge duties that arise on exercise of such an option. A person may be called upon to live with the consequences of the option exercised, when such consequences cannot be erased and are required to co-exist. The desirability of a circumstance cannot outweigh the reality of the circumstance. 37 The report of the Medical Board of the PGIMER having been perused, the same refers to the eventuality of a pre-term delivery with a survival rate of 60 to 65% along with significant morbidity and neuro-developmental handicaps. However, the said aspect may be specifically determined, before proceeding further, yet again. Taking into consideration the peculiar circumstances of this case, it is deemed appropriate to issue following directions for balancing the equities and to prevent continued incarceration, stigma and embarrassment to the petitioner:-

(i) The petitioner shall appear before the Medical Board of the Rajindra Hospital, Patiala which such Board will carry out a re-determination as to whether the termination of the pregnancy can be carried out, without a feticide, and shall explain the said consequences to the petitioner, including integrity of this document 63

the enhanced risk to which the petitioner might be exposed in the event of being subjected to such medical termination of pregnancy. In the event, the Medical Board is of the opinion that the medical termination of the pregnancy would not be possible and it would rather lead to a pre-term delivery or would call upon the Medical Board to carry out a feticide, the procedure shall not be carried out any further.

(ii) The State shall take all appropriate steps to ensure an institutional delivery of the child of the petitioner along with necessary medical facilities without payment of any fee, charges or expenses of any nature whatsoever, and shall ensure that delivery takes place in a safe environment;

(iii) The privacy of the petitioner shall be maintained at all stages and her identity be not divulged during the course of hospitalization, treatment, delivery or thereafter;

(iv) The petitioner may be called upon to exercise an option of the institutional facility where she intends to get the treatment and delivery and also as to whether she intends to keep the child and to bring up the said child.

(v) In the event, the petitioner exercises her option against bringing up the child, the same may be handed over to the Child Welfare Committee of the said District where delivery is to take place and the petitioner shall execute all such documents and procedural formalities mandated in law integrity of this document 64

for custody of the said child to the Child Welfare Committee.

(vi) The above said Child Welfare Committee shall thereafter take care of all the needs and facilities of the child; and

(vii) The petitioner shall thereafter have no objection to the said child being given in adoption by the State agencies to the willing parents/persons in accordance with law. The Child would be deemed to be free for being given in adoption.

38 The aforesaid directions are without prejudice to any other right and entitlement of the petitioner under the applicable policy/guidelines for financial assistance and rehabilitation. 39 The present petition is disposed of accordingly. 40 A copy of the order be given to the learned counsel for the respective parties under the signatures of the Bench Secretary.

M)!.: 00> 2024.                (5INOD 6. BHARDWAJ) !)@ )!$!)                              JUDGE 2hether speaking=reasoned   K Fes=1o 2hether reportable     K Fes=1o

integrity of this document 65