When her mother noticed her 15-year-old’s distended belly, she sat her down to ask a few questions. The teenager couldn’t remember when she had her last period. A quick visit to the doctor confirmed a pregnancy, 27 weeks, or nearly seven months. Because it had advanced beyond the legal limit of 24 weeks, her mother filed a petition before the Delhi high court on April 13 for permission for what’s known in medical terms as a late-stage termination.

Three days later, under orders from the high court, an eight-member board of specialists including a gynaecologist, paediatrician and psychiatrist from the All India Institute of Medical Sciences (AIIMS) was set up.

Not advisable, the board concluded. Termination at this stage carried “significant dangers to the mother and baby”. There was a good chance of a live neonatal birth that would require “active resuscitation”. There was a good chance also that a baby born so prematurely could be left with severe disabilities. Going by that advice the Delhi high court denied permission for an abortion.

The mother then went to the Supreme Court. Solicitor general Tushar Mehta argued that since the medical report indicated a threat to the life of both the 15-year-old and the foetus, adoption would be a better alternative.

Justices B.V. Nagarathna and Ujjal Bhuyan were firm: No woman can be forced to continue an unwanted pregnancy on the grounds that her unborn child could be given up for adoption after birth. “What is relevant here is the choice of the pregnant woman rather than that of the child to be born,” the judges said.

Moreover, the judges continued, the constitutional right to liberty and privacy under Article 21 included the right to make decisions concerning one’s body, particularly in matters of reproduction. It’s a right that “cannot be rendered ineffective by imposing unreasonable restrictions, especially in cases involving minors and unwanted pregnancies.”

If the girl was forced to continue the pregnancy and give birth, “the consequence would be adverse.” Permission to carry out a late-stage termination was given.

That might have been the end of the matter. It was not.

Now it was AIIMS that came to court with a curative petition against that permission. Additional solicitor general Aishwarya Bhati argued that the abortion of the foetus, now 30 weeks old, would not be a conventional D&C (dilation and curettage) but a preterm delivery of a normally growing, viable foetus. What if it resulted in a live birth? What of the risk of lifelong disabilities and prolonged care? And, yes, it would also put the young mother at risk in future child bearing.

But chief justice Surya Kant and justice Joymalya Bagchi refused to entertain the petition saying the court “will not allow the institution to choose for the parents”. An unwanted pregnancy “cannot be burdened on the woman”. At stake was not just the fate of the unborn foetus but “also the trauma of the minor girl”.

The chief justice also observed that in cases of minor rape survivors, the law ought to remove the time limit altogether.

Body of evidence

In 2021, the Medical Termination of Pregnancy (MTP) Act of 1971 was amended to allow abortion up to 20 weeks and, in certain cases including rape, up to 24 weeks. Since the age of consent is 18, the pregnancy of the 15-year-old through a consensual relationship with a 17-year-old boyfriend can only be classified as rape in legal terms.

The MTP act allows abortion under specific circumstances: As a health measure when continuing a pregnancy poses a threat to the woman’s life, including her physical or mental health; in cases where the pregnancy is a result of rape or incest; and if the foetus has significant abnormalities or genetic disorders.

Such framing, finds a 2025 study by the Centre for Health, Equity, Law and Polity (C-HELP), “does not take into account the varied needs and circumstances of women.” For instance, there could be underlying medical conditions, changes in relationship status, domestic violence or systemic barriers that prevent timely access to abortion within the legal window.

“As a result, women are often forced to approach courts, both due to the law’s limitations and because healthcare providers frequently deny abortions for fear of prosecution—especially in cases involving minors or survivors of sexual violence,” finds the report.

The study looks at 1,114 judgments on abortion jurisprudence from 2019 to 2024 and finds that 85% of these allowed abortion; in 180 cases, beyond the 24-week limit.

But late-stage abortion comes with its own problems. In 2025, the outcome of a late-stage termination at AIIMS was a live neonatal birth born with severe abnormalities because it was so premature. A year later, the child continues to live in a hospital ward on assisted medical support.

To avoid that risk, there are established medical procedures to stop the foetal heartbeat through an intrauterine injection before terminating the pregnancy, points out Anubha Rastogi, a lawyer at the Bombay high court who works on issues of access to abortion. Stopping the foetal heartbeat is also accepted by the Royal College of Obstetricians and Gynaecologists before a late-stage termination. And between 2017 and 2018, the ministry of health and family welfare issued guidelines recommending a stopping the foetal heartbeat prior to induction.

The MTP Act makes no mention of a “viable foetus” but concerns around it are often correlated to pregnancies that cross the 24-week mark. In 63 cases examined by the C-HELP study, a “viable foetus” was cited as one of the grounds for denying abortion. And in 18 of these cases the fundamental rights of the unborn child were discussed.

So, who decides who is permitted a late-stage abortion and who isn’t? Much depends on the woman/girl. What were the circumstances under which she got pregnant? Why is she seeking an abortion, is it because she was raped or is it because foetal abnormalities have been detected? Or have her circumstances changed, which means she can no longer bring up a child. Crucially which bench is hearing her case makes all the difference.

The Medical Termination of Pregnancy law intersects with the laws against child sexual abuse where 18 is the age of consent and with the law against pre-natal sex determination, making it a minefield for doctors to negotiate. For some doctors there is a conflict between their duty to the patient, their duty to neonatal life and a very real legal fear around ‘foeticide’.

Judges too have been loath to issue orders to stop a foetal heartbeat. In 2023, a three-judge Supreme Court bench rescinded permission given to a 27-year-old married woman seeking to end her 26-week pregnancy noting, “we cannot kill a child” in response to an email sent to court by a doctor clarifying on the need to stop foetal heartrate.

Whose right, whose choice?

Reproductive rights activists estimate that 22% of abortions in India occur in unsafe environments. Among adolescents, the figure is as high as 78%. Unsafe abortions account for 8% of all maternal mortality.

The Supreme Court ruling granting permission to a 15-year-old to abort a 30 week plus pregnancy is significant because it affirms abortion not just as a reproductive choice but as part of a broader constitutional framework of autonomy, dignity and bodily integrity.

It places the mother’s right as paramount. At its core lies a simple proposition. No woman or girl can be compelled to complete a pregnancy she does not want.

The ruling, says Neha Srivastava, member of the Pratigya campaign for safe abortion, “Underscores that the right to make decisions about one’s body is not conditional—it cannot be limited by gestational timelines.” The court, she adds, has “reinforced the primacy of individual agency.”

Earlier this year, in February the same Supreme Court bench overturned a previous Bombay high court ruling that denied permission to an 18-year-old to terminate her 30-week pregnancy. Even then, justice Nagarathna acknowledged the “moral and legal questions”.

Ultimately, abortion jurisprudence must answer one central question: who has the final authority over a pregnant woman or girl’s body? This time around, the court is unequivocal. It must be the woman, or the girl. Her wish to carry the pregnancy, or not, is what is paramount. Only she must be in charge of her body.