Medico-legal responsibilities of obstetricians in caring for minor survivors of sexual assault with advanced pregnancy: key lessons from recent court judgments

Recent high court rulings have clarified how clinicians should manage pregnancies in minor survivors of sexual assault under the medical termination of pregnancy (MTP) act when read with the protection of children from sexual offences (POCSO). These rulings have clarified ambiguities in the acts and removed procedural barriers that delay essential care: when an investigating officer (IO) or child welfare committee (CWC) presents the survivor, ultrasound and other indicated evaluations should proceed without insisting on identity cards; termination within 24 weeks may be undertaken by the requisite registered medical practitioners with guardian consent and the survivor’s informed assent. The judgments also affirm the documentary first hierarchy for age proof under the Juvenile Justice Act and discourage non-essential radiological age estimation in pregnancy. For pregnancies over 24 weeks, the Delhi High Court has ruled for immediate constitution of a medical board to examine the survivor and place its opinion before the competent authority or court, enabling timely judicial decisions; the Gujarat High Court emphasized reproductive autonomy and a broad, lived-experience view of mental health harm. For obstetric services, these instructions read as plain functional requirements: standard operating procedure (SOPs) that codify the ≤24-week protocol, readiness to constitute a medical board only for >24 week cases, standardized dual-consent forms, complete records, coordinated communication with IO/CWC, and routine psychological counselling. Implementation of these directions can limit avoidable delays, align practice with law, and safeguard the dignity and safety of this vulnerable population.