The Kerala High Court has delivered a significant judgment permitting medical termination of pregnancy (MTP) at 29 weeks gestation, where the fetus exhibited severe abnormalities incompatible with long-term quality of life. The Court relied on a Medical Board's report and precedent to direct a private hospital to perform the procedure, emphasizing the mother's right to terminate under such grave circumstances.
Background & Facts
The Dispute
The petitioners, Shereena K.S. (wife) and Arshad Anwar V. (husband), approached the Kerala High Court seeking permission to medically terminate the first petitioner's pregnancy. The pregnancy, at 29 weeks gestation, was diagnosed with multiple severe fetal abnormalities through periodic scans.
Key Facts
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1st Petitioner's Pregnancy Details: The first petitioner, aged 25, was pregnant with a fetus diagnosed with:
- Prominent lateral ventricles with ventricular wall irregularity
- Intraventricular synechiae
- Left ventricular cystic lesion
- Mild delay in cortical sulcation
- Mild fetal cardiomegaly
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Medical Reports: The abnormalities were documented in several medical reports:
- Exhibit P3: Second Trimester Obstetric Ultrasound Scan Report dated 07.05.2026 (20 weeks gestation)
- Exhibit P4: Second Trimester Obstetrics Scan Report dated 27.06.2026
- Exhibit P5: Neurosonogram Report dated 27.06.2026
- Exhibit P6: Radiology Report dated 01.07.2026
- Exhibit P7: Report dated 05.07.2026 from Medgenome Labs Pvt. Ltd., Bengaluru
- Exhibit P8: Letter from the treating doctor at the 6th respondent hospital dated 07.07.2026
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Medical Board Report: By order dated 09.07.2026, the Court constituted a Medical Board, which submitted its report on 13.07.2026. The Board's findings included:
- Continuation of pregnancy posed no grave injury to the mother's physical or mental health
- The fetal abnormalities were not incompatible with life but would likely result in:
- Sensory neural hearing loss
- Developmental delay
- Epilepsy
- Intellectual disability
- Risks associated with preterm induction of labour, including:
- Infection
- Haemorrhage
- Prolonged rupture of membranes
- Failure of medical methods necessitating preterm Lower Segment Caesarean Section (LSCS)
- Recommendation for intrauterine feticide prior to MTP
Procedural History
- 07.05.2026: First ultrasound scan conducted at Welcare Hospital, Ernakulam, revealing fetal abnormalities
- 27.06.2026: Follow-up scans conducted at Amrita Institute of Medical Sciences and Research Centre (6th respondent)
- 01.07.2026 - 07.07.2026: Multiple medical reports and consultations with treating doctors
- 09.07.2026: Kerala High Court directs constitution of a Medical Board
- 10.07.2026: 1st petitioner appears before the Medical Board
- 13.07.2026: Medical Board submits its report; Court delivers judgment
Relief Sought
The petitioners sought the following reliefs:
- Prayer (a): A writ of mandamus directing the respondents to allow the 1st petitioner to undergo MTP at the hospital of her choice, in accordance with Exhibit P9 (Guidance Note for Medical Boards for Termination of Pregnancy beyond 20 weeks of gestation) and other applicable laws
- Prayer (b): A writ of mandamus directing Respondents 3 to 5 to examine the 1st petitioner and permit her to undergo MTP at the earliest
The Legal Issue
The central question before the Court was whether medical termination of pregnancy at 29 weeks gestation could be permitted under Article 226 of the Constitution of India and Section 3(2B) of the Medical Termination of Pregnancy (MTP) Act, 1971, given the severe fetal abnormalities that would likely result in long-term neurodevelopmental disabilities for the child, despite not being incompatible with life.
Arguments Presented
For the Petitioners
- Right to Termination: The petitioners relied on the Supreme Court's judgment in S. v. Union of India [2026 KHC OnLine 7224], which held that no woman should be pressurised to continue a pregnancy against her will
- Medical Board's Findings: Emphasized the Medical Board's observations regarding the severe fetal abnormalities and the risks of continuing the pregnancy
- Guidance Note Compliance: Argued that the procedure should be carried out in accordance with Exhibit P9 (Guidance Note for Medical Boards), which permits MTP beyond 20 weeks in cases of substantial fetal abnormalities
For the Respondents
- Government Pleader's Submission: The learned Government Pleader, Smt. Pooja Surendran, appeared for the respondents but did not contest the petitioners' contentions. The respondents effectively conceded to the Medical Board's recommendations and the petitioners' request for MTP
The Court's Analysis
The Court analyzed the case on the following grounds:
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Medical Board's Report: The Court placed significant reliance on the Medical Board's report dated 13.07.2026, which detailed the fetal abnormalities and the potential long-term consequences for the child, including:
- Developmental delay
- Epilepsy
- Intellectual disability
- Sensory neural hearing loss
The Court noted that while the abnormalities were not incompatible with life, they would severely impact the child's quality of life.
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Precedent: The Court cited the Supreme Court's decision in S. v. Union of India [2026 KHC OnLine 7224], which emphasized a woman's right to terminate a pregnancy, particularly in cases involving grave fetal abnormalities. The Court observed:
"No lady is to be pressurised for continuing with the pregnancy."
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Balancing Risks and Rights: The Court balanced the risks associated with preterm induction of labour (infection, haemorrhage, surgical complications) against the petitioners' right to terminate the pregnancy under Article 21 of the Constitution of India (right to life and personal liberty). The Court concluded that the petitioners' request was justified given the Medical Board's findings.
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Intrauterine Feticide: The Court specifically directed the hospital to consider the Medical Board's recommendation for intrauterine feticide prior to MTP, ensuring that the procedure adhered to medical and ethical standards.
The Verdict
The Court allowed the writ petition and issued the following directions:
- The 6th respondent (Amrita Institute of Medical Sciences and Research Centre) was directed to carry out the Medical Termination of Pregnancy as suggested by the Medical Board in its report dated 13.07.2026
- The 6th respondent was specifically directed to adhere to the 5th opinion of the Medical Board, which recommended intrauterine feticide prior to the termination of pregnancy
- The writ petition was disposed of with the above directions
What This Means For Similar Cases
Medical Termination Beyond 20 Weeks: A Shift in Judicial Approach
- Fetal Abnormalities as Grounds for MTP: This judgment reinforces that severe fetal abnormalities, even if not incompatible with life, can justify MTP beyond 20 weeks under Section 3(2B) of the MTP Act. Practitioners should emphasize the long-term neurodevelopmental outcomes (e.g., developmental delay, epilepsy, intellectual disability) rather than mere survival of the fetus
- Medical Board's Role: Courts are likely to place high reliance on Medical Board reports in MTP cases. Ensure that the Board's report comprehensively documents:
- The nature and severity of fetal abnormalities
- Risks to the mother's physical and mental health
- Long-term prognosis for the child
- Recommended medical procedures (e.g., intrauterine feticide)
Procedural Compliance for MTP Cases
- Guidance Note Adherence: Always cite Exhibit P9 (Guidance Note for Medical Boards for Termination of Pregnancy beyond 20 weeks) in petitions. This document provides the legal and medical framework for MTP in advanced pregnancies
- Court-Ordered Medical Boards: In cases where the pregnancy is beyond 20 weeks, request the Court to constitute a Medical Board at the earliest. The Board's report should be submitted within 2-3 days to avoid delays in judicial proceedings
- Hospital Selection: The Court permitted the petitioners to choose the hospital for MTP. Petitioners should identify a well-equipped hospital capable of handling complex MTP procedures, including intrauterine feticide
Broader Implications for Reproductive Rights
- Right to Termination Under Article 21: The judgment reaffirms that the right to terminate a pregnancy is protected under Article 21 of the Constitution (right to life and personal liberty). Courts are increasingly recognizing that forcing a woman to continue a pregnancy against her will, especially in cases of severe fetal abnormalities, violates this right
- Precedent Reliance: Practitioners should cite S. v. Union of India [2026 KHC OnLine 7224] to argue that no woman should be pressurised to continue a pregnancy in cases involving grave fetal abnormalities or risks to her health
- Ethical Considerations: The judgment highlights the ethical duty of hospitals to comply with Court directions in MTP cases. Hospitals can no longer refuse MTP on grounds of advanced gestation alone if a Medical Board recommends it
