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CASE COMMENT: POONAM SHARMA V. UNION OF INDIA

Case Comment, Publications

INTRODUCTION

The case of Poonam Sharma v. Union of India stands as a significant judicial landmark in India’s reproductive rights discourse, particularly concerning the termination of pregnancies beyond the statutory limit set by the Medical Termination of Pregnancy (MTP) Amendment Act, 2021 (hereafter, referred to as ‘the 2021 Act’). The Act is an amendment to the original Medical Termination of Pregnancy Act, of 1971 (hereafter, referred to as ‘the 1971 Act’). This new amendment extends the term limit for legal abortions in India. It allows abortion to be permitted up to 20 weeks on the opinion of just one Registered Medical Practitioner (hereafter, RMP) and also permits termination of pregnancies between 20 and 24 weeks in specific cases on the opinion of 2 RMPs. Poonam Sharma, a 27-year-old married woman experiencing severe postpartum depression, petitioned the Supreme Court under Art. 32 of the Indian Constitution to terminate her pregnancy at 25 weeks, despite the legal limit typically capped at 24 weeks. The Court, while deciding to grant her request, rightly took into consideration the maternal mental health, reproductive autonomy, and socio-economic circumstances of the plaintiff, highlighting broader implications for women’s rights and the interpretation of existing legal frameworks. 

FACTS

  1. The petitioner, Poonam Sharma, was a married lady aged twenty seven. She has 2 male children, aged 1 and 4 years respectively, suffering from post-partum depression. She had conceived the third child despite adopting Lactational Amenorrhea Method (LAM). LAM is a recognized contraceptive method that gives over 95% protection from pregnancy. She had no symptoms of pregnancy till the near end of her 2nd trimester, after which she started looking for medical termination of the unwanted pregnancy. But she and her husband were denied the request to do so as the 2021 Act, under normal circumstances, allows termination upto 20 weeks and rarely, upto 24 weeks, in the cases of forced pregnancies.
  2. They were rushed to the court, given the urgent nature of the matter, under Art. 32 of the Indian Constitution which grants every individual the right to move the SC for the enforcement of their fundamental rights. The petitioner and her husband filed the petition to permit them the medical termination of her ongoing pregnancy, which had reached 25 weeks 4 days by then, under § 3(2)(b)(i) and § 3(3) and 5 of the 2021 Act read with Rule 3B of the MTP Rules on a plea that she is in no manner prepared to continue with the unwanted pregnancy. 
  3. The matter was listed before a two-judge Bench on 5 October 2023. On the same day, the court had deemed it apt to obtain the opinion of the medical board, directed to be constituted by AIIMS (hereafter, referred to as ‘the institute’). The report suggested that though the baby is viable and has a reasonable chance of survival, there is a possibility of post-partum psychosis and complications due to hysterotomy. The options of prenatal care and delivery at the institute were given to the couple but they continued to seek permission from the court to terminate the pregnancy.
  4. By its order dated 9 October 2023, the Court allowed the petition and permitted the medical termination of the pregnancy on the ground that continuing with the pregnancy could seriously imperil the mental health of the petitioner.
  5. On the grounds that continuing with the pregnancy could seriously imperil the mental health of the petitioner, the Court allowed the petition and permitted the abortion on the order dated October 9th, 2023.

ISSUES RAISED

  1. Whether severe mental health issues, such as postpartum psychosis, be grounds for permitting an abortion beyond the 20-week gestational limit set by the 2021 Act?
  2. Whether the extent to which a woman’s reproductive autonomy and right to make decisions about her own body should be respected, especially in the context of an advanced-stage pregnancy?
  3. Whether socioeconomic conditions and practical difficulties faced by the petitioner should influence the Court’s decision on permitting an abortion?

CONTENTION OF THE PLAINTIFF

  1. The plaintiff, Poonam Sharma argued that she was suffering from postpartum psychosis and had been undergoing psychiatric treatment since October 2022. She contended that continuing the pregnancy would severely impact her mental health, posing a grave risk to her overall well-being.
  2. Sharma highlighted that she had already delivered two children via C-section, with the second child being born just a year prior. She argued that another pregnancy so soon after her last delivery could jeopardize her physical health, especially given her ongoing need for psychiatric medication.
  3. The plaintiff stated that the pregnancy was unplanned and occurred despite her using the Lactational Amenorrhea Method (LAM) as a contraceptive. She emphasized that the unexpected nature of the pregnancy, combined with her current health and socio-economic situation, made it untenable for her to carry the pregnancy to term.
  4. Sharma asserted her right to reproductive autonomy, arguing that she should have the freedom to make decisions about her own body. She stated that forcing her to continue with the pregnancy would violate her rights and lead to significant psychological and emotional distress.
  5. The plaintiff pointed out her challenging socio-economic circumstances, including the burden of raising two young children and her limited ability to provide for another child. She argued that adding another child to her family would exacerbate her financial and emotional strain.

CONTENTION OF THE DEFENDANT

  1. The defendants emphasized that the petitioner was seeking termination of her pregnancy at an advanced stage, which posed significant medical and ethical challenges. At the time of the court’s consideration, the pregnancy had reached approximately 26 weeks, well beyond the standard 20-week limit set by the 2021 Act, for most cases.
  2. The defendants argued that medical reports indicated the fetus was healthy and viable. They stressed that the termination of such an advanced pregnancy could result in a live birth, necessitating intensive medical care for the premature baby, with uncertain long-term outcomes.
  3. The defense highlighted the existing legal framework under the 2021 Act, which provides clear guidelines on the conditions under which pregnancy termination is permitted. They argued that granting permission for termination at such a late stage could set a problematic precedent and potentially undermine the established legal thresholds.
  4. The defendants noted that the petitioner had support available, particularly from her mother-in-law, who was willing to help care for the children. This support network was presented as a mitigating factor that could potentially alleviate some of the petitioner’s concerns about her ability to manage another child.
  5. While acknowledging the petitioner’s mental health concerns, the defense raised questions about the actual risk to her physical health if the pregnancy continued. They suggested that with appropriate medical care and adjustments to her treatment, it might be possible to manage her condition without necessitating termination of the pregnancy.

JUDGEMENT

In the case of Poonam Sharma case, the Supreme Court of India ruled in favour of the petitioner, allowing her to terminate her pregnancy. The court was liberal and considered a broader approach while dealing with this case. It not only took into consideration her mental and physical condition but also the socioeconomic situation of her husband. The Court recognized an important ground for the termination of pregnancy which is when the pregnant woman’s mental health is in serious danger because of it. It used the precedent of X vs. Principal Secretary, Health and Family Welfare Department, Govt. of NCT of Delhi and Another to use the expression ‘grave injury to her physical and mental health’ in § 3(2)(b) of the 2021 Act in an overarching and all-encompassing sense. The court was also liberal in interpreting § 3 of the 2021 Act which permits the RMPs to terminate the pregnancy beyond 20 weeks in extreme and special circumstances such as where continuing with pregnancy would cause grave injury to her physical or mental health or risk her life. 

The court had gone another mile to recognize unwanted pregnancies of a married woman and rape within marriage that results in forced pregnancies with the forced pregnancies that are caused by rape or sexual assault. It said that like the petitioner in the present case, who took the plea of LAM, there could also be other medical conditions that might lead to unwanted conception for a married woman. It also rightly recognized the bodily autonomy of a woman because the child from an unwanted pregnancy would have a major toll on the mental, physical, and financial condition of the primary caregiver, ie. the mother. 

Looking at these circumstances the court saw it fit to grant permission to the petitioner to terminate her unwanted pregnancy in her 26th week. The Court directed the institute to immediately take the necessary steps to admit Sharma and proceed with the termination of her pregnancy.

DEFECTS OF THE LAW

The 1971 Act and the 2021 Act grant great relief to pregnant women who are suffering from unwanted pregnancies. The Amendment did increase the termination limit upto 20 weeks in normal circumstances and upto 24 weeks in extraordinary situations, listed in the act, but there are still loopholes that have failed to provide complete justice to all. In the present case, the petitioner was not allowed to terminate her pregnancy by the hospital because she was a married woman who had exceeded the cap of 24 weeks. The law should broaden its criteria for abortion in terms of the circumstances in which a woman could do it as well as the 20 and 24-week limit. Though the 24-week cap is sufficient in most of the cases some provisions should be put in place to deal with unwanted hazardous pregnancies that have unfortunately crossed the threshold but are taking a heavy toll on the pregnant woman. 

INFERENCE

In the case of Poonam Sharma case, the Supreme Court addressed several critical legal issues. The Court underscored the importance of considering mental health alongside physical health when evaluating requests for pregnancy termination, recognizing that severe mental health issues, such as postpartum psychosis, can be significant grounds for permitting an abortion beyond the gestational limit of 20 weeks set by the 2021 Act. This decision reinforced the idea that women should have the right to make independent decisions relating to their reproductive health, particularly when continuing the pregnancy poses significant personal health risks. The Court also considered the socio-economic circumstances of Poonam Sharma, acknowledging the practical difficulties she faced in raising another child. This holistic approach suggests that socio-economic context is a relevant factor in judicial decisions related to reproductive health.

The case also highlighted the need for clearer and more uniform application of the 2021 Act. The ambiguity in the current legal framework and the potential for inconsistent interpretation across different jurisdictions can lead to unequal access to reproductive rights, indicating a necessity for legislative reforms to provide clearer guidelines, especially for late-term abortions. The requirement for court approval in advanced-stage abortion cases can result in procedural delays, potentially exacerbating health risks. Thus, the case illustrates the importance of streamlining legal processes to ensure timely access to medical procedures, thereby protecting women’s health and rights more effectively. Additionally, the judgment points to the importance of increasing awareness and education about reproductive rights and the provisions of the 2021 Act among both the public and healthcare providers, empowering women to make informed decisions and seek timely medical and legal assistance.

ISHITA GUPTA

B.A. LL.B (2023-28)

O.P. JINDAL GLOBAL UNIVERSITY