AIIMS Board Submission on 28-Week Pregnancy Termination

In early 2024, the All India Institute of Medical Sciences (AIIMS) expert board submitted a report to the Delhi High Court highlighting the serious medical risks involved in terminating pregnancies beyond 24 weeks, specifically at 28 weeks gestation. The board emphasized increased maternal complications including hemorrhage, infection, and mortality risks. This submission comes amid petitions seeking permission for abortion beyond the statutory 24-week limit under the Medical Termination of Pregnancy (MTP) Act, 1971 (as amended in 2021). The case underscores the tension between expanding reproductive rights and safeguarding maternal health within India's legal and healthcare frameworks.

Legal Framework Governing Abortion in India

The MTP Act, 1971 regulates abortion in India, originally permitting termination up to 20 weeks gestation. The MTP Amendment Act, 2021 extended this limit to 24 weeks for specific categories such as survivors of rape, minors, and fetal anomalies (Section 3(2)(b)). Terminations beyond 24 weeks require approval from a state-level MTP Board under strict conditions, per the MTP Rules, 2021. The Indian Penal Code (IPC), Sections 312-316, criminalize unlawful abortions, imposing penalties for illegal procedures. The Supreme Court's ruling in Suchita Srivastava v. Chandigarh Administration (2009) affirmed reproductive autonomy as part of the right to life under Article 21 but upheld medical safeguards.

• Section 3(2)(b) of MTP Act permits abortion up to 24 weeks for special categories
• MTP Board approval mandatory for terminations beyond 24 weeks
• IPC Sections 312-316 penalize illegal abortions
• Supreme Court recognizes reproductive rights but balances with health safeguards

Medical Risks of Late-Term Pregnancy Termination

Terminating pregnancies at 28 weeks involves substantial maternal health risks. AIIMS experts report increased incidence of hemorrhage, sepsis, uterine rupture, and long-term reproductive complications. The viability of the fetus at this stage also complicates clinical decisions. India's healthcare infrastructure and trained personnel for safe late-term abortions remain inadequate, increasing the likelihood of adverse outcomes. The National Family Health Survey-5 (NFHS-5, 2019-21) records a maternal mortality ratio (MMR) of 103 per 100,000 live births, with unsafe abortions contributing approximately 8-9% of maternal deaths (WHO, 2022).

• 28-week terminations increase risks of hemorrhage, infection, and mortality (AIIMS report, 2024)
• Limited infrastructure and trained staff for late-term abortions in India
• Unsafe abortions cause 8-9% of maternal deaths nationally (WHO, 2022)
• MMR at 103 per 100,000 live births (NFHS-5)

Economic Implications of Expanding Late-Term Abortion Services

India’s healthcare expenditure on maternal and neonatal care is approximately 1.3% of GDP (Economic Survey 2023-24). Expanding late-term abortion services would necessitate increased resource allocation for specialized care, including intensive monitoring, surgical expertise, and post-procedure rehabilitation. AIIMS data indicates that managing high-risk pregnancies demands higher costs and infrastructure investments. Without adequate funding and capacity-building, scaling late-term abortion services could strain public health budgets and exacerbate disparities in access and outcomes.

• Maternal and neonatal care expenditure: 1.3% of GDP (Economic Survey 2023-24)
• Late-term abortions require specialized, costly medical care
• AIIMS reports increased resource needs for high-risk pregnancy management
• Potential strain on public health budgets without infrastructure scaling

Institutional Roles in Abortion Policy and Implementation

The Ministry of Health and Family Welfare (MoHFW) formulates reproductive health policies and oversees implementation through the National Health Mission (NHM), which runs maternal health programs at the grassroots. The MTP Boards at state levels evaluate and approve abortion requests beyond 24 weeks. AIIMS, as a premier medical institution, provides expert opinions influencing judicial and policy decisions. Coordination among these institutions is critical to balancing legal provisions, medical safety, and rights-based approaches.

• MoHFW: Policy formulation on reproductive health and abortion laws
• NHM: Implements maternal health programs nationwide
• MTP Boards: Approve abortions beyond 24 weeks under exceptional conditions
• AIIMS: Provides expert medical opinions on maternal health risks

Comparative Analysis: India vs United Kingdom on Late-Term Abortion

Critical Gaps in India’s Abortion Framework

India’s legal framework permits abortion up to 24 weeks for select cases but lacks clear, accessible guidelines and adequate infrastructure for safe terminations beyond this period. This results in inconsistent MTP Board approvals and elevated health risks. Policy debates often focus narrowly on gestational limits without addressing systemic healthcare capacity, training, and resource constraints. The AIIMS board’s report highlights these gaps, calling for a calibrated approach that integrates legal reform with healthcare strengthening.

• No standardized protocols or infrastructure for safe abortion beyond 24 weeks
• Inconsistent and opaque MTP Board decisions across states
• Healthcare capacity and trained personnel shortage for late-term procedures
• Policy focus on gestational limits neglects systemic healthcare challenges

Way Forward: Balancing Rights and Risks

• Develop clear, uniform guidelines for MTP Boards to evaluate late-term abortion requests transparently
• Strengthen healthcare infrastructure and train personnel for managing high-risk pregnancies and late-term terminations
• Integrate reproductive rights with maternal health safeguards in policy and judicial frameworks
• Increase public healthcare expenditure on maternal and neonatal care to support specialized services
• Promote awareness and counseling to prevent unsafe abortions and reduce maternal mortality

Jharkhand & JPSC Relevance

• JPSC Paper: Paper 2 - Health and Social Welfare Policies
• Jharkhand Angle: Jharkhand’s maternal mortality ratio is higher than the national average, and unsafe abortions contribute to maternal health challenges in tribal and rural areas.
• Mains Pointer: Frame answers highlighting the need for strengthening healthcare infrastructure in Jharkhand, ensuring legal access to safe abortions, and improving awareness to reduce unsafe practices.