Mumbai: A Thane couple’s “distress” after approaching the Bombay high court to terminate a 31-week pregnancy, when a local medical board refused permission, has highlighted continuing gaps in India’s amended Medical Termination of Pregnancy (MTP) law.Abhaya, 37, and her husband Kiran (both names changed) said their experience at J J Hospital was “humane” compared with their first encounter with a medical board on MTP.Though the MTP Act was amended in 2021 to allow termination beyond 24 weeks, Form A, which grants non-govt hospitals permission, has not been updated. Private hospitals can still apply for licences only for MTP up to 12 weeks or up to 24 weeks.“Even the best-equipped non-govt hospital cannot do MTP beyond 24 weeks as a result. If the woman is insistent on a non-governmental hospital, then she has to move the high court for permission,” said gynaecologist Dr Nikhil Datar, who campaigned to raise the MTP limit from 20 to 24 weeks. He performed Abhaya’s MTP on March 30.Abhaya said she and Kiran decided to have a second child after their daughter turned 8. They had earlier lost their first-born immediately after birth due to meconium poisoning, and Abhaya also had an ectopic pregnancy.In the 30th week of her current pregnancy, her gynaecologist noticed abnormal skeletal development on a routine ultrasound and referred her to Wadia Hospital. Doctors diagnosed the foetus with skeletal dysplasia, a rare disorder affecting cartilage and bone growth. In severe forms, it can cause chest deformities leading to death soon after birth.Abhaya said doctors told her that the child would have brittle bones, suffer repeated fractures and severe pain. “I did not want my child to suffer so much pain,” she told TOI while recuperating after a C-section at Cloudnine Hospital, Malad, on March 30.The couple approached the medical board at Thane Civil Hospital on March 17 seeking permission for MTP. They received its opinion the next day: “…considering the advanced gestational age (31+ weeks) and the absence of lethal anomaly, the medical board is of the opinion that termination of pregnancy is not justified at this stage”.They then consulted Dr Datar and moved the Bombay high court, which directed them to J J Hospital’s medical board in Byculla. By then, it was March 26, and Abhaya was admitted for tests and specialist examination before the board submitted its report to the court the next day.According to Dr Datar, the J J Hospital board found that the foetal abnormality met the legal standard for termination beyond 24 weeks. It approved medical termination with foeticide in utero, and the court then allowed the procedure.The couple said the difference between the two boards was stark. Abhaya said doctors at J J Hospital were sympathetic and non-judgmental, unlike their experience in Thane. Her husband said that if the process was so difficult in Thane, which is so close to Mumbai, conditions in smaller cities could be worse.The case draws attention to two larger issues. The first is interpretation of the amended MTP Act. In 2021, India extended the gestation limit for certain abortions to 24 weeks and allowed termination beyond that in cases of substantial foetal abnormalities after review by a medical board. Dr Datar said the Thane board has not read the appropriate provisions of the MTP law to give such an opinion. He said the law also covers serious abnormalities likely to cause severe disability and suffering.The second issue is administrative. Datar said Form A, the registration form used by non-govt hospitals under the MTP framework, has not been updated since the law was amended.Because of that gap, private hospitals cannot formally obtain approval to carry out such procedures, effectively limiting them to govt hospitals. He raised the issue in several petitions; while the Maharashtra govt has said Form A is part of central law and must be amended by the Union govt, the Centre has maintained that no amendment is necessary. Dr Datar also said Mumbai should have multiple medical boards like Delhi does. Delhi has boards in eight govt hospitals and five private hospitals.
