Legal Abortion in India in the Second Trimester (22–24 Weeks)

Abortion in the later stages of pregnancy — particularly between 22 and 24 weeks — remains one of the most debated aspects of reproductive healthcare in India. While early abortions are fairly accessible under Indian law, terminations in the second trimester involve higher medical risks, legal scrutiny, and emotional sensitivity.

Recent legal reforms and court rulings have broadened the scope for such procedures, yet practical challenges and moral dilemmas persist. This article explores the medical aspects, legal boundaries, and ongoing challenges associated with second-trimester abortion in India.

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Understanding Second-Trimester Abortions in India upto 24 weeks

The second trimester spans from the 13th to the 26th week of pregnancy. Abortions in this stage are usually more complicated, requiring hospital-based care and expert supervision.

Common Reasons for Abortions Between 22–24 Weeks

Abortions during this phase are typically not elective but result from serious circumstances such as:

• Severe fetal abnormalities detected during the Level-II or anomaly scan (18–22 weeks).
• Threats to the mother’s physical or mental health, including preeclampsia or psychological distress.
• Pregnancies resulting from sexual assault or contraceptive failure.
• Judicial permissions, when courts allow late-term abortions in exceptional cases.

In India, these late-term terminations are permitted only under strict legal and medical supervision.

Medical Procedures for 22–24 Week Abortions

At this stage, both medical and surgical methods may be considered, depending on the gestational age, health condition, and clinical setup.

1. Dilation and Evacuation (D&E)

A surgical method commonly used after 14–15 weeks. The cervix is carefully dilated, and fetal tissue is removed using suction and forceps. The procedure is usually performed under anesthesia and followed by ultrasound monitoring to ensure completeness.

2. Medical Induction

In certain cases, doctors may use a combination of Mifepristone and Misoprostol to induce uterine contractions and expel pregnancy tissue. However, medical abortions after 20 weeks are rare in India and must be closely supervised in a hospital setting due to higher risks of bleeding or incomplete expulsion.

3. Combined Method

Sometimes, a medically induced abortion is followed by surgical evacuation to ensure complete removal and prevent complications.

Potential Risks

• Heavy bleeding or hemorrhage
• Incomplete abortion requiring re-evacuation
• Uterine injury or infection
• Adverse anesthesia reactions
• Emotional or mental health distress

Nonetheless, when performed by trained professionals in licensed facilities, the risk of complications remains very low.

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Legal Framework in India

The Medical Termination of Pregnancy (MTP) Act, 1971

The MTP Act, 1971, was India’s first formal abortion law. It permitted abortion up to 20 weeks of pregnancy for specific reasons such as risk to the woman’s life, fetal abnormalities, or pregnancies due to rape.

The MTP (Amendment) Act, 2021

The 2021 amendment to the Act expanded the gestational limit for certain categories of women:

• Survivors of rape or incest
• Minors
• Cases of fetal abnormalities detected later in pregnancy
• Women whose marital status changes during pregnancy (e.g., divorce or widowhood)

Under this law:

• Abortions up to 24 weeks are allowed for approved categories with the recommendation of two registered medical practitioners.
• Terminations beyond 24 weeks may only be permitted by a Medical Board in cases of substantial fetal abnormalities.

Judicial Interpretations

In several cases, Indian courts have allowed abortions beyond 20 weeks on humanitarian grounds.
For example, the Delhi High Court (2024) permitted a 22-week abortion due to mental health risks to the mother, emphasizing that reproductive autonomy includes the right to preserve a woman’s mental well-being.

These judgments reflect a gradual shift toward recognizing reproductive rights as fundamental rights under Article 21 of the Indian Constitution.

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Challenges and Real-World Barriers

1. Limited Access to Late-Term Services

Although the law now allows abortions up to 24 weeks in specific cases, very few hospitals — especially in rural regions — are equipped or authorized to perform them. Many private clinics avoid late-term abortions due to legal uncertainty.

2. Awareness and Stigma

Many women remain unaware that second-trimester abortions can be legal. Social stigma, fear of judgment, and misinformation often lead to dangerous delays or unsafe procedures.

3. Legal Ambiguity

While the MTP Act is progressive on paper, the absence of uniform state guidelines and delays in setting up medical boards often create confusion among healthcare providers.

4. Cost and Accessibility

Second-trimester abortions are more expensive than early procedures. In India, private hospital costs may range from ₹45,000 to ₹80,000, depending on the method and duration of stay.

5. Emotional and Psychological Impact

Women undergoing late-term abortion often experience anxiety, guilt, or grief. Access to post-procedure counseling remains limited in most facilities.

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Ethical Considerations

Abortions between 22–24 weeks bring sensitive ethical debates:

• When does fetal viability begin?
• Should mental health be valued equally with physical health?
• How do we balance fetal rights with maternal autonomy?

Medical experts and legal scholars increasingly agree that a woman’s well-being — both physical and psychological — must remain the central focus of abortion care.

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Improving Access and Safety

To ensure safe and legal access to second-trimester abortion, India must:

1. Operationalize 24-week abortion guidelines in every state.
2. Establish medical boards swiftly for cases beyond 24 weeks.
3. Enhance medical training for gynecologists in late-term abortion care.
4. Integrate mental health support into abortion counseling.
5. Strengthen public hospital infrastructure to reduce cost barriers.
6. Raise awareness about women’s reproductive rights under the MTP Act.

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Abortion in India during 22–24 weeks remains a delicate balance between law, medicine, and human rights. While the 2021 MTP Amendment has extended hope for women facing late pregnancy complications, true progress depends on effective implementation, wider access, and continued public education.

Ultimately, reproductive freedom must mean more than legality — it should ensure that every woman, regardless of circumstance, has safe, confidential, and compassionate access to abortion care when she needs it most.