Law on Paper, Delay in Practice: Can Delhi HC’s Guidelines Transform MTP Access for Minor Rape Survivors

 

The Delhi High Court recently issued crucial guidelines for police and hospitals, aiming to ensure the sensitive and timely handling of medical termination of pregnancy (MTP) cases, especially for survivors of sexual assault, including minors. These directives underscore the need for immediate action, thorough medical examinations, and prompt formation of medical boards when pregnancies extend beyond 24 weeks.

These essential guidelines emerged directly from a harrowing case in May 2025. A 17-year-old rape survivor was taken to AIIMS, Delhi, for medical examination and MTP. Despite being accompanied by police with a registered FIR, hospital authorities refused to conduct even an ultrasound, citing the absence of an identity document and a court order.

This delay had devastating consequences:

- The ultrasound was postponed by 13 days, during which the pregnancy was initially reported to have crossed the 24-week legal limit under the MTP Act.

- When the case reached court, AIIMS initially claimed the gestation had exceeded 25 weeks. However, a later court-directed medical board report contradicted this, stating the actual gestation was 23 weeks and 4 days—well within the permissible range for rape survivors.

- The court sharply noted this inconsistency and called out the “troubling picture of delay, miscommunication, and lack of clarity” on the hospital’s part.

- Even after the Child Welfare Committee (CWC) authorized the procedure, the hospital continued to demand an ossification test for age verification. It was only after the CWC's personal intervention that the ultrasound was finally performed, leading to the initial, later disputed, finding of 25 weeks and 4 days. Following a court directive, the medical board ultimately found the survivor fit for MTP.

In response to these systemic failures, the Delhi High Court issued sweeping guidelines to prevent such incidents in the future. These include:

- No ID required if the survivor is accompanied by police with an FIR.

- Immediate medical attention and ultrasound without waiting for court orders.

- Mandatory training for doctors and police on MTP and POCSO protocols.

- Immediate constitution of Medical Boards for cases beyond 24 weeks, without waiting for court intervention.

- The Delhi High Court has said that the right of a minor rape victim to undergo medical termination of pregnancy is protected under Article 21 of the Constitution and this right should not be infringed by judicial delay or bureaucratic inaction.

A Crisis of Numbers, A Call for Urgency  

The urgency of these guidelines is underscored by the persistent reality of sexual violence in India. According to NCRB 2021, India recorded 31,677 rape cases—an average of 86 per day—with about 10% involving minors under 18. In 2019 alone, 4,940 minor victims were reported under IPC Section 376. Moreover, a 2025 Lancet-backed report found that 30.8% of girls and 13% of boys in India faced sexual abuse before turning 18, highlighting significant underreporting and the true scale of vulnerability.

Cases involving minors—often defined as penetrative assault under the POCSO Act, 2012, and IPC Section 376—rose 96% between 2016 and 2022, with 36,381 cases in 2021 and 38,911 in 2022. These figures underscore the persistent vulnerability of children to sexual violence, making access to timely and sensitive MTP care critically important.

When Legal Rights Meet Institutional Roadblocks

Despite clear legal provisions, pregnant minor rape victims in India have frequently encountered significant hurdles in accessing timely medical termination of pregnancy (MTP), as tragically demonstrated by the AIIMS case. While the law now permits terminations for these vulnerable cases even beyond the 24-week limit, this is typically granted only through arduous court intervention on a case-by-case basis.

Judicial sensitivity in interpreting the MTP Act for minors has been evident in several landmark rulings that precede the Delhi High Court's recent directives. These cases often highlight how legal permissions are granted, but only after victims endure significant delays and trauma due to systemic issues:

- Supreme Court Allows Abortion at 30 Weeks (2024): The Supreme Court granted a 14-year-old rape survivor permission to terminate a 30-week pregnancy, overturning a previous Bombay High Court denial. The girl had gone missing in 2023 and was later found to be pregnant. The Court underscored the urgency, directing immediate medical intervention at Sion Hospital, Mumbai, emphasizing that "every hour was crucial" for the girl’s well-being.

- Andhra Pradesh Gang-Rape Case (2025): In Sri Satya district, a 15-year-old Dalit girl endured repeated rape over two years and became eight months pregnant. Thirteen men were arrested in connection. This case also brought to light serious caste-based apathy and suppression, including community pressure to marry one of the accused. The survivor is currently under medical care, with rehabilitation efforts underway.

- Numerous Supreme Court and High Court Interventions: Across India, higher courts frequently hear petitions from minor rape victims (and their guardians) seeking MTP for pregnancies exceeding 20 or 24 weeks. In almost all such cases, the reason they reach court is because hospitals either refused the MTP, demanded a court order, or delayed the process until the pregnancy advanced beyond legal limits of acceptable medical risk thresholds.

It is crucial to note that even with these judicial permissions, the process was rarely automatic. Courts typically relied on medical board assessments and, for minors, parental consent, which often introduced further delays. Each of these cases involved medical boards, court petitions, and bureaucratic stumbling blocks—despite the survivor’s right to access timely termination.

How Bureaucratic Inertia Violates Survivors’ Rights

The aforementioned cases, particularly the AIIMS incident, starkly illustrate the critical gap between progressive legal provisions and rigid institutional protocol. 

Despite clear legal entitlements to minor rape survivors and the presence of police with a registered FIR, institutions have, in the past, insisted on procedural formalities such as identity documents and explicit court orders before even performing basic medical assessments like an ultrasound. Such hesitation was not legally necessary under the Medical Termination of Pregnancy Act (MTP) Act, 2021, especially after its amendment to better accommodate survivors of sexual assault.

Several systemic issues contribute to this problematic scenario:

- Outdated Protocols: Hospital staff often follow internal Standard Operating Procedures (SOPs) that have not been updated in line with the MTP Act's amendments and Protection of Children from Sexual Offences (POCSO) Act provisions.

- Risk Aversion: Many hospitals interpret rules conservatively to avoid potential legal liability, even if it goes against the spirit of the law and the urgency of the patient's condition.

- Lack of Coordination: Poor legal awareness and insufficient inter-departmental coordination often lead to "cover-your-back" behavior—a systematic tendency to delay action unless there's explicit court-backed permission.

- Prioritizing Documentation Over Care: Most crucially, compassion is often not explicitly integrated into administrative training, leading officials to prioritize documentation and procedure over the urgent, trauma-informed care that survivors desperately need.

- Insistence on Guardian Consent: Even with the MTP (Amendment) Act, 2021, guardian consent for minors remains mandatory. In situations where the guardian is unsupportive, the perpetrator is a family member, or the guardian is simply unaware or hesitant due to social stigma, this can become a significant barrier, causing delays.

- Resource Constraints and Geographical Barriers: In rural areas or smaller towns, the lack of approved MTP facilities, trained doctors, or functional Medical Boards (especially for late-term abortions) further compounds the problem, forcing victims to travel long distances, leading to inevitable delays.

The Delhi High Court unequivocally addressed these failures in its recent judgment. It explicitly noted that the refusal of care and delayed ultrasound directly compromised the girl’s fundamental right to timely medical relief, to which she was legally and ethically entitled.

Conclusion: A Shift Towards Compassion and National Standard?

The Delhi High Court's new guidelines are a direct and vital response to these recurring problems, aiming to bridge the critical gap between progressive legal frameworks and the ground reality of their implementation in healthcare settings. The goal is to ensure that no minor rape victim is denied timely and sensitive MTP care due to bureaucratic hurdles or misinterpretations of the law.

Can these guidelines become a national standard? 

Will this finally shift the culture of care from suspicion to support across India? 

Will AIIMS, district hospitals, and rural health clinics rewrite their protocols in the language of empathy?

Will survivors stop needing a judge’s signature for the dignity of medical care?

Change begins not just with a new law, but with a shift in mindset. And that’s a verdict the country must deliver together. These are the crucial questions as the nation strives to truly protect its most vulnerable.

Author’s Note: I’ve spent the past few years writing about the hidden cracks in our systems—legal, medical, social—that often fail the very people they’re meant to protect. But some stories, like that of a minor survivor denied care despite the law being on her side, don’t just stay on the page. They stay with you. This piece isn’t just about a court judgment—it’s about what happens when compassion gets lost in paperwork. 

---