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Reportable
IN THE SUPREME COURT OF INDIA
CIVIL APPELLATE JURISDICTION
Civil Appeal No 5802 of 2022
(Arising out of SLP (C) No 12612 of 2022)
X ... Appellant
versus
The Principal Secretary,
Health and Family Welfare Department,
Govt. of NCT of Delhi & Anr. …Respondents
Digitally signed by
GULSHAN KUMAR
ARORA
Date: 2022.09.29
12:41:22 IST
Reason:
Signature Not Verified
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Reportable IN THE SUPREME COURT OF INDIA CIVIL APPELLATE JURISDICTION Civil Appeal No 5802 of 2022 (Arising out of SLP (C) No 12612 of 2022)

X ... Appellant

versus

The Principal Secretary, Health and Family Welfare Department, Govt. of NCT of Delhi & Anr. …Respondents

J U D G M E N T

Dr Dhananjaya Y Chandrachud, J

Table of Contents A. Background ................................................................................................... 4

B. Submissions ................................................................................................. 7

C. The Medical Termination of Pregnancy Act 1971 and the rules framed thereunder ............................................................................................................ 9

D. Barriers to accessing safe and legal abortions ....................................... 16

i. RMPs’ fear of prosecution...................................................................... 16 ii. Social stigma surrounding unmarried women ..................................... 20

E. Analysis ....................................................................................................... 22

i. The rule of purposive interpretation ..................................................... 22 ii. Transcending the institution of marriage as a source of rights ......... 27 a. Modern or atypical forms of familial relationships.................................. 29 b. The equal status of married and unmarried or single women ............... 30 iii. The object and purpose of the MTP Act ............................................... 32 iv. The MTP Act as an aid of interpretation: Understanding “injury to mental health” ................................................................................................ 39 v. Construing Rule 3B................................................................................. 43

F. Constitutional values animating the interpretation of the MTP Act and MTP Rules .......................................................................................................... 55

PART A

A. Background

  1. Leave granted.
  2. This appeal arises out of the judgment of a Division Bench of the High Court of Delhi dated 15 July 2022. The appellant invoked the writ jurisdiction of the High Court seeking its permission to terminate her pregnancy before the completion of twenty-four weeks on 15 July 2022. Other ancillary reliefs were sought. For convenience of reference, the reliefs claimed before the High Court are extracted below: “A.pregnancy through registered medical practitioners at any Permit the Petitioner to terminate her ongoing approved private or government center or Hospital before15.07.2022 as her relief will be infructuous after that as the pregnancy will be of around 24 Weeks by that time; B. Restrain the Respondent from taking any coerciveaction or criminal proceedings against the Petitioner or any Registered Medical Practitioner terminating the pregnancyof the petitioner at any approved private center or hospital registered by Govt NCT of Delhi; C. Direct the Respondent to include unmarried womanalso within the ambit of the Rule 3B of the Medical Termination of Pregnancy Rules 2003 (as amended on21.10.2021) for termination of pregnancy under clause (b) of sub-section (2) Section 3 of the MTP Act, for a period ofup to twenty-four weeks; D. Order an immediate Interim Relief of Stay during thecourse of proceedings”
  3. The appellant is an Indian citizen and a permanent resident of Manipur. She is currently residing in New Delhi. The appellant averred that she is the eldest amongst five siblings and that her parents are agriculturists. At the time of the

PART A

institution of the Writ Petition before the High Court of Delhi,^1 the appellant was carrying a single intrauterine pregnancy corresponding to a gestational age of twenty-two weeks. The appellant is an unmarried woman aged about twenty-five years, and had become pregnant as a result of a consensual relationship. The appellant wished to terminate her pregnancy as “her partner had refused to marry her at the last stage.” She stated that she did not want to carry the pregnancy to term since she was wary of the “social stigma and harassment” pertaining to unmarried single parents, especially women. Moreover, the appellant submitted that in the absence of a source of livelihood, she was not mentally prepared to “raise and nurture the child as an unmarried mother.” The appellant stated that the continuation of the unwanted pregnancy would involve a risk of grave and immense injury to her mental health.

  1. The appellant sought permission to terminate her pregnancy in terms of Section 3(2)(b) of the Medical Termination of Pregnancy Act 1971^2 and Rule 3B(c) of the Medical Termination of Pregnancy Rules 2003^3 (as amended on 12 October 2021). The appellant instituted a Criminal Miscellaneous Application^4 for grant of interim relief to terminate her pregnancy during the pendency of the Writ Petition.
  2. By its order dated 15 July 2022, the High Court issued notice restricted only to prayer C of the Writ Petition, and rejected the Criminal Miscellaneous Application, effectively rejecting prayers A and B. The High Court observed that Section 3(2)(b) of the MTP Act was inapplicable to the facts of the present case

(^12) WP(C) 10602/2022“MTP Act” (^34) “MTP Rules”CM Application 30708/

PART B

(ii) In the event that the Medical Board concludes that thefetus can be aborted without danger to the life of the petitioner, a team of doctors at the All India Institute ofMedical Sciences shall carry out the abortion in terms of the request which has been made before the High Courtand which has been reiterated both in the Special Leave Petition and in the course of the submissions before thisCourt by counsel appearing on behalf of the petitioner. Before doing so the wishes of the petitioner shall beascertained again and her written consent obtained after due verification of identity.”

  1. Counsel for the petitioner and the respondent stated that a Medical Board was constituted at the All India Institute of Medical Sciences.^5 The Board noted that the petitioner had consented to the termination of her pregnancy and the procedure could be undertaken without danger to her life. The report submitted by AIIMS indicates that the termination of the pregnancy was safely carried out.
  2. As the case involves a substantial question of law, this Court has taken it up for further consideration. The Writ Petition before the Delhi High Court shall stand transferred to this Court. The significant issue which comes up for determination in this appeal turns on the interpretation of Rule 3B of the MTP Rules.

B. Submissions

  1. Dr. Amit Mishra, learned counsel appearing on behalf of the appellant made the following submissions:

a. The appellant was an unmarried woman whose partner had refused to marry her. She did not wish to continue the pregnancy and have the child out of wedlock as she lacked the financial resources to do so. She was not employed and her parents were farmers;

(^5) “AIIMS”

PART B

b. She was also not mentally prepared to raise a child by herself. If she was compelled to do so, it would cause grave injury to her physical and mental health. The appellant was not prepared to face the social stigma surrounding unwed mothers; and c. Section 3(2)(b) of the MTP Act and Rule 3B of the MTP Rules are arbitrary and discriminatory because they exclude unmarried women from their ambit. They discriminate against women on the ground of marital status, in violation of Article 14 of the Constitution.

  1. Ms. Aishwarya Bhati, learned senior counsel and Additional Solicitor General has ably assisted this Court in the interpretation of Section 3(2) of the MTP Act and Rule 3B(c) of the MTP Rules. She made the following submissions in support of the argument that Rule 3B(c) extends to unmarried or single women who are in long-term relationships:

a. The interpretation of legislation must be guided by the text and context of a statute as well as the object it seeks to achieve. The Statement of Objects and Reasons of a statute must also guide its interpretation; b. Modern legislations ought to be read in view of the evolution of society from the time of enactment. The literal construction of beneficial legislations must be avoided, and they ought to be given a purposive interpretation; c. A subordinate legislation should give effect to the statute it is enacted under. If two constructions are possible, the interpretation in consonance with the statutory scheme ought to be adopted;

PART C

requirements to be fulfilled for terminating a pregnancy, including the persons who are competent to perform the termination procedure, circumstances when abortion is permissible, and places where the procedure may be performed.

  1. Section 3 of the MTP Act, as amended by the Medical Termination of Pregnancy (Amendment) Act 2021 (8 of 2021),^6 provides for when pregnancies may be terminated:

“Section 3 - When pregnancies may be terminated byregistered medical practitioners (1) Notwithstanding anything contained in the Indian PenalCode (45 of 1860), a registered medical practitioner shall not be guilty of any offence under that code or under anyother law for the time being in force, if any pregnancy is terminated by him in accordance with the provisions of thisAct. (^2) pregnancy may be terminated by a registered medical[(2) Subject to the provisions of sub-section (4), a practitioner,-- (a) where the length of the pregnancy does not exceedtwenty weeks, if such medical practitioner is, or (b) where the length of the pregnancy exceeds twentyweeks but does not exceed twenty-four weeks in case of such category of woman as may be prescribed by rulesmade 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 riskto the life of the pregnant woman or of grave injury to her physical or mental health; or (ii) there is a substantial risk that if the child were born, itwould suffer from any serious physical or mental abnormality. Explanation 1.--For the purposes of clause (a), where anypregnancy occurs as a result of failure of any device or method used by any woman or her partner for the purpose (^6) “MTP Amendment Act 2021”

PART C

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 thepregnant 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 thepregnancy shall be presumed to constitute a grave injury to the mental health of the pregnant woman. (2A) The norms for the registered medical practitionerwhose opinion is required for termination of pregnancy at differentprescribed by rules made under this Act. gestational age shall be such as may be

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

(2C) Every State Government or Union territory, as thecase may be, shall, by notification in the Official Gazette, constitute a Board to be called a Medical Board for thepurposes of this Act to exercise such powers and functions as may be prescribed by rules made under this Act. (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 inthe Official Gazette by the State Government or Union territory, as the case may be. (3) In determining whether the continuance of a pregnancywould involve such risk of injury to the health as is mentioned in sub-section (2), account may be taken of thepregnant woman’s actual or reasonably foreseeable environment. (4) (a) No pregnancy of a woman, who has not attained theage of eighteen years, or, who having attained the age of

PART C

question (or in the case of pregnancies between twenty and twenty-four weeks, not less than two registered medical practitioners) is, in good faith, of the opinion that:

a. The continuance of the pregnancy would put the pregnant woman’s life at risk (Section 3(2)(i)); b. The continuance of the pregnancy would involve grave danger to the pregnant woman’s physical health (Section 3(2)(i)); c. The continuance of the pregnancy would involve grave danger to the pregnant woman’s mental health (Section 3(2)(i)); or d. There is a substantial risk that the child would suffer from a serious physical or mental abnormality, if it is born (Section 3(2)(ii)).

In determining whether the continuation of the pregnancy would involve grave danger to the pregnant woman’s physical or mental health, her actual or reasonably foreseeable environment may be taken into account.^13 We are of the opinion that significant reliance ought to be placed on each woman’s own estimation of whether she is in a position to continue and carry to term her pregnancy.

  1. The explanations to Section 3(2) provide for two legal presumptions indicating what constitutes a grave injury to the pregnant woman’s mental health. Explanation 1 stipulates that pregnancies which occur due to the failure of a contraceptive device or method used by a woman or her partner for limiting the

(^13) Section 3(3), MTP Act

PART C

number of children or preventing pregnancy shall be presumed to constitute a grave injury to the mental health of the pregnant woman, if the pregnancy has not exceeded twenty weeks. A similar legal presumption is provided for in Explanation 2, which stipulates that where a woman alleges that a pregnancy was caused as a consequence of rape, the anguish caused by the pregnancy shall be presumed to constitute a grave injury to her mental health. The legal presumption in Explanation 2 is applicable to all pregnancies which have not exceeded twenty-four weeks.

  1. Pregnancies may be terminated only in a hospital established or maintained by the government,^14 or any place approved for the purposes of the MTP Act either by the government or by a District Level Committee constituted in terms of Section 4(b). Further, the provisions of Section 4 and the provisions in Section 3(2) (which relate to the length of the pregnancy and the requirement for the opinion of at least two RMPs) shall not apply to the termination of pregnancies by an RMP, where the RMP is, in good faith, of the opinion that the termination of the pregnancy is immediately necessary to save the life of the pregnant woman.^15 The MTP Act also seeks to protect the privacy of a woman who has terminated a pregnancy – any RMP who reveals the name or other particulars of such a woman shall be liable to be sentenced to imprisonment which may extend to one year, or with fine, or both.^16 The MTP Act vests the Central Government with the power to enact rules to carry out its provisions^17 and the State Governments with the power to enact regulations in certain cases.^18

(^1415) Section 4(a), MTP ActSection 5(1), MTP Act (^1617) Section 5A, MTP ActSection 6, MTP Act (^18) Section 7, MTP Act

PART D

(disaster or emergency situations as may be declared by g ) women with pregnancy in humanitarian settings or the Government.” D. Barriers to accessing safe and legal abortions

  1. Despite the enactment of the MTP Act, a number of hurdles continue to prevent full access to safe and legal abortions, pushing women to avail of clandestine, unsafe abortions. These barriers include insufficient infrastructural facilities, a lack of awareness, social stigma, and failure to ensure confidential care. In some situations, unmarried women face particular barriers due to gender stereotypes about women’s sexual autonomy outside marriage. These barriers are a serious impediment and deter single women from seeking safe and legal abortions. Such barriers may contribute to a delay in accessing abortion services or a complete denial of such services, consequently negating women’s right to reproductive autonomy.

i. RMPs’ fear of prosecution

  1. It is not only the factors mentioned above which hinder access to safe abortion but also a fear of prosecution under the country’s criminal laws. Under the current legal framework, the MTP Act merely lays out exceptions to the provisions criminalizing abortion in Sections 312 to 318 of the IPC. Section 3(1) of the MTP Act begins with a non-obstante clause and stipulates that “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.” In terms of Section 3(1), the termination of a

PART D

pregnancy is a criminal offence under the IPC, unless it fulfils the conditions laid down in the MTP Act, including who can terminate a pregnancy, the place where termination can take place, and the specific conditions in accordance with which such termination is permissible. Section 5(2) provides penalties when termination of pregnancy is carried out by a person who is not an RMP. Section 5(3) provides penalties when termination of pregnancy is carried out in a place other than that mentioned in Section 4. RMPs and women seeking termination of pregnancy are exempted from any legal action under the provisions of the IPC mentioned above only when these conditions are fulfilled.

  1. Presently, under the MTP Act, the opinion of an RMP (in accordance with the restrictions and grounds laid down in the Act) is decisive. It is on the basis of the opinion formed by RMP(s), either under Section 3 or under Section 5, that a woman can terminate a pregnancy under the MTP Act. This makes the MTP Act a provider-centric law. Since women’s right to access abortion is conditional on the approval by an RMP, the denial of services by an RMP compels women to approach courts or seek abortions in unsafe conditions.^24 A fear of prosecution under this complex labyrinth of laws, including linking of the MTP Act with the IPC, acts as a major barrier to safe abortion access, by having a chilling effect on the behaviour of RMPs. The chilling effect — historically associated with protection of freedom of speech and expression under Article 19^25 — has an impact on the decision-making of medical professionals acting under the MTP Act and

(^24) Review 2 (2019) (^) Dipika Jain, Time to Rethink Criminalisation of Abortion? Towards a Gender Justice Approach, 12 NUJS Law (^25) S. Khushboo v. Kanniammal, (2010) 5 SCC 600; Shreya Singhal v. Union of India, (2015) 5 SCC 1

PART D

  1. These extra-legal requirements have no basis in law. As noted above, it is only the woman’s consent (or her guardian’s consent if she is a minor or mentally ill) which is material. RMPs must refrain from imposing extra-legal conditions on women seeking to terminate their pregnancy in accordance with the law. They need only ensure that the provisions of the MTP Act (along with the accompanying rules and regulations) are complied with.
  2. Before the MTP Amendment Act 2021 was enacted, the petitioners in a number of cases before the High Courts also sought permission to terminate pregnancy where the gestation was below twenty weeks.^28 The unamended MTP Act clearly stated that termination of pregnancy between twelve and twenty weeks was permissible when two RMPs opined that the request for termination of pregnancy meets either of the four grounds mentioned in Section 3(2).^29 Thus, there was no legal requirement to refer cases within the legal limit of twenty weeks to the courts. These cases represent the barriers faced by women in accessing safe and legal abortions, even when their decision to terminate their pregnancy is permitted by the law.
  3. This Court has recognized the disastrous effects of unnecessary delays and lack of promptitude in the attitude of authorities when dealing with termination of pregnancies. In Z v. State of Bihar ,^30 this Court found that the state authorities, including Patna Medical College and Hospital, had erred in failing to terminate the

(^28) Maharashtra, 2021 SCC Online Bom 9339; ABC v. State of Maharashtra, (2018) 4 Mah LJ 374, 2018 SCC Online (^) See XYZ v. State of Maharashtra, 2018 SCC OnLine Bom 13751; Prabhavati Dattatray Jadhav v. State of Bom 144; A v. State of Maharashtra, 2022 SCC OnLine Bom 1361; D. Rajeswari v. State of Tamil Nadu, 1996 CriLJ 3795; X v. Govt. of NCT of Delhi, 2013 SCC OnLine Del 4929; Puja Kumari v. State of West Bengal, 2019 SCC Online Cal 1277; Velunatchiyar v. Govt. of Tamil Nadu, 2021 SCC Online Mad 5047; M. Kala v. The Inspector ofPolice, 2015 SCC OnLine Mad 7767 (^2930) Section 3(2)(b), MTP Act 1971(2018) 11 SCC 572

PART D

pregnancy before the passage of twenty weeks, despite the woman seeking an abortion on the ground that she was a victim of rape. This Court also rebuked the “negligence and carelessness” of the authorities in failing to terminate the pregnancy as permitted by law. It noted that the proceedings in the High Court were unduly delayed, leading to a situation where the pregnancy could not be terminated without endangering the life of the woman in question. Compensation was awarded to the petitioner (i.e., the pregnant woman).

ii. Social stigma surrounding unmarried women

  1. An RMP’s decision to provide medical termination of a pregnancy is also influenced by social stigma surrounding unmarried women and pre-marital sex, gender stereotypes about women taking on the mantle of motherhood, and the role of women in society.
  2. Due to a widespread misconception that termination of pregnancies of unmarried women is illegal, a woman and her partner may resort to availing of abortions by unlicensed medical practitioners in facilities not adequately equipped for such medical procedures, leading to a heightened risk of complications and maternal mortality. In Surendra Chauhan v. State of Madhya Pradesh ,^31 a two- Judge Bench of this Court upheld the Madhya Pradesh High Court’s order to convict the accused under Section 314 read with Section 34 of the IPC for causing a woman’s death by miscarriage. According to the facts of the case, the accused was in an “illicit relation” with the deceased, an unmarried woman of twenty-four years. The deceased woman had become pregnant as a result of this relationship.

(^31) (2000) 4 SCC 110