The Kerala High Court has affirmed that the right to reproductive autonomy under Article 21 of the Constitution overrides rigid gestational limits when a fetus presents with severe, life-altering congenital abnormalities. This judgment reinforces the legislative intent behind Section 3(2-B) of the Medical Termination of Pregnancy Act, 1971, ensuring that medical boards and courts prioritize the physical and mental health of the pregnant person over procedural formalities.
Background & Facts
The Dispute
The petitioners, a married couple, sought termination of a 32-week pregnancy after multiple ultrasound and MRI scans revealed severe congenital abnormalities in the fetus, including microcephaly, irregular lateral ventricles, intraventricular synechiae, abnormal cerebral gyrations, and bilateral talipes. These findings, corroborated by specialists in neurology, pediatrics, and radiology, indicated a high probability of profound, lifelong neurological and physical disability if the child were born.
Procedural History
- The petitioners filed a writ petition under Article 226 seeking permission to terminate the pregnancy beyond the statutory 24-week limit.
- On 27 January 2026, the Court directed the Medical College Hospital, Kottayam, to constitute a Medical Board under Section 3(2-C) of the MTP Act.
- The Medical Board, comprising gynecologists, neurologists, pediatricians, and radiologists, submitted its report on 29 January 2026.
- The Board concluded that continuation of pregnancy posed a risk to the petitioner’s mental health and that the fetal abnormalities were substantial enough to qualify under Section 3(2-B).
Relief Sought
The petitioners sought a direction to the respondents to permit medical termination of the pregnancy without delay, invoking Section 3(2-B) of the MTP Act and the constitutional right to reproductive autonomy recognized in Suchita Srivastava v. Chandigarh Administration and A v. State of Maharashtra.
The Legal Issue
The central question was whether Section 3(2-B) of the Medical Termination of Pregnancy Act, 1971 permits termination of pregnancy beyond 24 weeks when a Medical Board confirms substantial fetal abnormalities, even if the pregnant woman’s physical health is not at immediate risk, and whether the court must defer to the Board’s assessment of mental health impact.
Arguments Presented
For the Petitioner
The petitioners relied on A v. State of Maharashtra [(2024) 6 SCC 327], arguing that Section 3(2-B) removes gestational limits for substantial fetal abnormalities and mandates that Medical Boards evaluate both physical and mental health risks. They emphasized that the Board’s finding of significant mental distress - supported by psychiatric evaluation - was sufficient to trigger the exception. They also cited XYZ v. State of Gujarat to assert that constitutional courts must not deny relief on technical gestational grounds when substantive harm is established.
For the Respondent
The State did not oppose the petition. The Government Pleader acknowledged the Medical Board’s unanimous opinion and submitted that the statutory requirements under Section 3(2-B) and Rule 3A of the MTP Rules, 2003, had been fully satisfied. No counter-arguments were advanced.
The Court's Analysis
The Court undertook a detailed review of the statutory framework, judicial precedents, and medical evidence. It held that Section 3(2-B) was enacted to remove arbitrary barriers for women facing pregnancies with severely abnormal fetuses, drawing a parallel to the presumption of grave mental injury in cases of rape under Explanation 2. The Court emphasized that the legislature’s value judgment was not based on viability or prognosis alone, but on the profound psychological burden such pregnancies impose.
"The legislation has made a value judgment in Section 3(2-B) of the Act, that a substantially abnormal foetus would be more injurious to the mental and physical health of a woman than any other circumstance."
The Court noted that the Medical Board’s opinion was not merely a formality but a mandatory, expert determination under Section 3(2-D). It found the Board’s conclusion - that continuation of pregnancy posed a risk to the petitioner’s mental health - was well-supported by psychiatric evaluation and consistent with the Guidance Note of 14 August 2017, which requires boards to assess quality of life and maternal well-being.
The Court further held that delays in decision-making, even for procedural verification, risk violating the fundamental rights to dignity and privacy under Article 21. It rejected any notion that termination must be denied because the fetus might survive birth, affirming that the law permits termination even if the child is born alive, provided the decision is made in good faith and with medical oversight.
The Verdict
The petitioner won. The Court held that Section 3(2-B) of the MTP Act permits termination beyond 24 weeks when a Medical Board confirms substantial fetal abnormalities and a risk to the pregnant woman’s mental health. The Court directed immediate termination of the pregnancy under medical supervision, with safeguards for the child’s care if born alive.
What This Means For Similar Cases
Medical Board Opinions Are Binding on Courts
- Practitioners must treat the Medical Board’s opinion under Section 3(2-B) as a conclusive medical determination, not a recommendatory opinion.
- Courts cannot substitute their own medical judgment; they must assess whether the Board followed due process and considered all relevant factors.
- Failure to constitute a Board or delay in its constitution may constitute a violation of Article 21 rights.
Mental Health Risk Is Sufficient Ground for Termination
- A finding of severe emotional distress, anxiety, or psychological trauma - supported by psychiatric evaluation - is sufficient to satisfy the "grave injury to mental health" threshold under Section 3(2)(i).
- The Court explicitly recognized that the anguish of carrying a fetus with severe abnormalities constitutes a distinct and valid form of mental injury, independent of physical risk.
Procedural Compliance Must Be Swift and Human-Centered
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Hospitals must constitute Medical Boards within 48 hours of a petition being filed.
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Final scans before termination are mandatory, but delays beyond 72 hours risk judicial intervention.
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Petitioners must be provided with legal and psychological support throughout the process.
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Practitioners should prepare affidavits from psychiatrists and fetal medicine specialists early in such cases.
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Courts should treat MTP petitions under Section 3(2-B) as priority matters, with hearings scheduled within 72 hours of filing.
