Reproductive rights in India: Inequality, access, and bodily autonomy

India was one of the first countries in the world to develop legal and policy frameworks, giving women access to abortion and contraception. Key legislations include: 

The Medical Termination of Pregnancy (MTP) Act, 1971 

The MTP Act, most recently amended in 2021, expanded the permissibility of abortions from 20 weeks up to 24 weeks of gestation. In addition to the consent of the pregnant woman, the MTP Act allows termination of pregnancy only on the advice of doctors. 

Between 20 and 24 weeks, only certain women — minors, survivors of rape, mentally ill, and differently abled — are eligible to terminate their pregnancies. After 24 weeks, the MTP Act requires a medical board to be set up in “approved facilities”, which may allow termination of pregnancy only if there is a substantial foetal abnormality. 

The confidentiality of the woman’s identity is protected, and only minors need consent from others (guardians) for termination. 

The Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994

The PCPNDT Act was enacted to prohibit prenatal diagnostic techniques for the determination of the sex of the fetus, leading to female feticide.

The Assisted Reproductive Technology (Regulation) Act, 2021, and the Surrogacy (Regulation) Act, 2021

These laws prescribe the legal framework for surrogacy and lay down age limits on those intending to have a child through surrogacy. Each of these laws emerges within a specific historical context and serves distinct social functions.

The Surrogacy (Regulation) Act, 2021, permits altruistic surrogacy for married Indian couples, non-resident Indians (NRIs), and Overseas Citizens of India (OCIs) facing proven infertility. It bans commercial surrogacy and prohibits financial compensation to the surrogate, except for medical expenses and insurance.

Along with these laws, the judiciary has played an important role in advancing reproductive autonomy. 

Role of the judiciary 

In Justice K S Puttaswamy (Retd) and Anr versus Union of India and Ors (2017), the Supreme Court affirmed privacy as a fundamental right under the Constitution. It specifically recognised the constitutional right of women to make reproductive choices as part of personal liberty under Article 21 of the Constitution of India. 

In Suchita Srivastava & Anr v. Chandigarh Administration (2009), the Supreme Court refused to allow forced abortion involving a woman with intellectual disability who had become pregnant after being raped in a government run welfare institution. 

The apex court held that reproductive choices are inherent to a woman’s right to privacy, dignity, and bodily integrity, which are covered under Article 21 of the Constitution. The case also highlighted the issue of reproductive autonomy in the context of women with intellectual disabilities. 

In this context, Sundarnag Ganjekar et al., in an article Reproductive rights of women with intellectual disability in India (2022), note that the judicial system often seeks psychiatric opinion regarding the “capacity to consent” of women with intellectual disability to procedures such as medical termination of pregnancy and permanent sterilisation. 

Nevertheless, despite constitutional protections and judicial interventions, reproductive rights remain unevenly accessible. Legal frameworks do not operate in isolation but within a broader socio-cultural context. Women face several barriers in accessing fair and equitable reproductive healthcare. 

Unequal landscape of reproductive healthcare

Women face several barriers in accessing fair and equitable reproductive healthcare. In an edited volume, Negotiating Sexual and Reproductive Justice: Voices from the Margins (2025), T K Sundari Ravindran et al. highlight women’s experiences of surveillance over mobility, limited control over marital choices, or sexual autonomy.

Drawing on case studies from Delhi, Gujarat, Tamil Nadu, Maharashtra, and Odisha, the authors also underline women’s lack of awareness about contraceptive methods and sexual intimacy, and very limited access to disease diagnosis. 

For poor, Dalit, and Adivasi women, reproductive rights continue to be shaped by structural inequalities, state intervention, and cultural regulation. In Understanding Reproductive Health Services in Eastern Uttar Pradesh, India: A Dalit Feminist Approach (2021), Priti Chandra shows how Dalit women face denial in accessing reproductive health services owing to caste and gender biases. 

Similarly, Adivasi women face several barriers in accessing fair reproductive healthcare facilities. They are underweight, anaemic, and lack knowledge about contraceptive methods and require better nutrition. 

Medical boards, surrogacy, and reproductive control

Apart from structural challenges, there are also concerns about the laws. The involvement of medical professionals in the MTP Act raises questions over women’s right to decide on their bodies. In the 15-year-old case, for instance, the Delhi High Court denied permission for abortion based on the recommendation of a medical board at All India Institute of Medical Sciences (AIIMS).

Moreover, the Act also excludes transgender and non-binary persons. Similarly, while the Surrogacy (Regulation) Act, 2021 bans commercial surrogacy, the outsourcing of reproductive labour to women of the Global South remains a concern.

Madhushree Jana and Anita Hammer’s 2021 study, Reproductive Work in the Global South: Lived Experiences and Social Relations of Commercial Surrogacy in India, highlights how the weak bargaining power of surrogates and the greater power of fertility clinics and agents are increased by the lack of effective regulation and the state’s prohibitionist policy.

Moreover, assisted reproductive technologies have an unequal impact on women from lower classes who are primarily used as surrogate labour in the global reproductive market.

India’s reproductive rights in comparative perspective

Situating the debates around reproductive rights within a broader global context also offers some insights into differences in reproductive rights. In the US, the legal right to abortion varies across states. In the UK, abortion is legal under certain conditions up to 24 weeks in most cases. 

Canada, on the other hand, has decriminalised abortion with no federal gestational limit. In China, abortion is legal and generally accessible, which is historically linked to population control policies. By contrast, countries such as Poland and Saudi Arabia maintain restrictive abortion laws. 

Against this backdrop, one can see that India has a fairly progressive reproductive rights framework, especially when it comes to abortion. At the same time, the reproductive rights framework in the country needs to be addressed more holistically. 

Towards ensuring reproductive justice

This requires greater awareness and training among medical professionals about women’s reproductive rights. Access to safe abortion facilities needs to be expanded, particularly in rural primary healthcare centres where private healthcare is expensive. 

Also, rather than a total prohibition on commercial surrogacy, creating a balance between bodily autonomy, dignity, labour rights, and healthcare access may help. A reproductive justice approach, which mandates counselling for all parties and provides mental health support for the surrogates, needs to be adopted. 

To mitigate the social stigma faced by women who seek abortion, there needs to be trauma-sensitive care systems and sensitisation of medical professionals to become more gender-aware. Social stigma cannot be fought in isolation and requires both medical and legal support.

Post read questions

Reproductive rights are integral to the right to life and personal liberty under Article 21 of the Constitution. Discuss in the light of recent judicial interpretations and legislative developments in India.

The legal recognition of reproductive rights does not necessarily translate into equitable access to reproductive healthcare. Critically examine.

How does reproductive justice differ from reproductive rights? Discuss in the Indian context.

Discuss the socio-cultural barriers that hinder women’s reproductive autonomy in India.

Examine the Surrogacy (Regulation) Act, 2021 in the context of bodily autonomy, labour rights, and reproductive justice.

(Rituparna Patgiri is an Assistant Professor at the Indian Institute of Technology (IIT), Guwahati.)

Share your thoughts and ideas on UPSC Special articles with ashiya.parveen@indianexpress.com.

Gear up for UPSC Prelims 2026—Practice smarter, revise faster, and succeed with our Special Quiz Magazine. (Click Here)

Click Here to read the UPSC Essentials magazine for May 2026. Subscribe to our UPSC newsletter and stay updated with the news cues from the past week.

Stay updated with the latest UPSC articles by joining our Telegram channel – IndianExpress UPSC Hub, and follow us on Instagram and X.