country, including in the rural pockets, due to various social, economic and logistical barriers. stigma is another dimension that prevents women from seeking abortions from approved facilities. despite india's extensive efforts to improve maternal and reproductive health, wide geographical disparities exist between its urban and rural population. interventions at various socio-ecologic and cultural levels, along with improved health literacy, access to improved health care and sanitation need attention when formulating and implementing policies and programs for equitable progress towards improved maternal and reproductive health. unsafe abortion, the third leading cause of maternal deaths in the country, contributes eight per cent of all such deaths annually with 13 women dying each day. several factors contribute to women opting for abortion outside the accredited abortion centers including: woman denied services as she is unable fulfil the requirement as per the mtp act, thus resorting to unsafe means shortage of providers/absence of competent health professionals and poor perceived quality of care in government facilities in rural areas, is another major reason, as many rural and poor areas lack registered medical providers, supplies and infrastructure high abortion cost at hospitals in the cities. private sector charges are huge and unaffordable for the poor reluctance to obtain services from known neighborhood clinics due to lack of confidentiality lack of awareness about the need to seek abortion early in pregnancy providers denying services because of biases or misinformation around how laws governing sex selection, child sexual abuse and abortion intersect profile of women seeking abortion a client profile study focusing on the socio-economic profiles of women seeking abortion services, and costs of receiving abortion services at public health facilities in madhya pradesh, india, revealed that "57% of women of who received abortions at public health facilities were poor, followed by 21% moderate and 22% rich. more poor women sought care at primary health level facilities (58%) than secondary level facilities, and among women presenting for postabortion complications (67%) than induced abortion." further, the study found that women admitted to spending no money to access abortion services as they are free at public facilities. poor women, it was reported, "spend inr 64 (usd 1) while visiting primary level facilities and inr 256 (usd 4) while visiting urban hospitals, primarily for transportation and food". the study concluded that the "improved availability of safe abortion services at the primary level in madhya pradesh has helped meeting the need of safe abortion services among poor, which eventually will help reducing the maternal mortality and morbidity due to unsafe abortion". safe abortion and pocso act the protection of children from sexual offences (pocso) act defines a child as any person below eighteen years of age, and defines different forms of sexual abuse, including penetrative and non-penetrative assault, as well as sexual harassment and pornography. the said act prescribes stringent punishment graded as per the gravity of the offence, with a maximum term of rigorous imprisonment for life, and fine. although the act safeguards the life and rights of children, it fails to differentiate between 'consensual sex' and offence and also does not address the grey area of 'early marriage'. any sexual activity with persons below the set age i.e. 18 years is deemed as statutory rape. as the act fails to differentiate between offense and consent, it poses a huge barrier to access to sexual and reproductive health services for adolescents. moreover, the act has the requirement of mandatory reporting and failing to do so can lead to penalty with imprisonment or a fine. this requirement impacts adolescents' sexual and reproductive health (srh), as it results in denial of variety of srh services such as contraception, medical help for sexually transmitted infections, etc. health professionals are playing safe not to get entangled in legal proceedings thereby impacting srh services. the mandatory reporting also hinders access to safe abortion services for adolescents. the conflation between pocso and mtp acts result in denial of services for consensual as well as sexual assault of minors. earlier the mtp act required the consent of a guardian for a minor and that still remains, but due to pocso act, the mandatory reporting complicates the issue, and providers are wary of delivering safe abortion services to minors, even in case of assault, ensuing many to seek unsafe abortions to avoid legal hassles; and to further complicate parents exploiting this to harass children or their partners with imprisonment of 7 to 10 years. safe abortion and gender-biased sex selection gender-biased sex selection and safe abortion are mutually exclusive issues within the purview of indian law. while the mtp act provides a framework for provision of abortion services, the pc&pndt act regulates the misuse of diagnostic techniques for determination of sex of the foetus. both the laws have a very clearly defined purpose, however, there is still conflation in the implementation of the two laws. due to the stringent implementation of the pc&pndt act, many doctors are fear or are reluctant to provide mtp services due to the possibility of undergoing inspection and facing legal issues, thus creating great hindrance for accessing safe abortion services. by conflating the two, confusion is being created in the minds of the public against a basic right of women. even government posters for "awareness generation" of the public with respect to sex determination have been found to use the terminology of "bhroon hatya" or "foeticide" rather than "abortion" – a term that indicates a homicidal criminal activity of taking "a life". these incorrect messaging and unawareness has serious implications on access to safe abortion services for women. for addressing this issue a group of organizations and individuals working on the issue came together to launch pratigya campaign for gender equality and safe abortion in 2013. the campaign provides a platform to address the issue of sex selection while protecting women's right to safe, legal abortion services in india. the campaign also created an information kit for the media on the subject. impact of covid-19 pandemic on access to safe abortion services the nationwide lockdown imposed from 25 march onwards in an effort to combat the covid-19 pandemic, has adversely impacted contraceptive and safe abortion access. ministry of health and family welfare, government of india suspended essential contraception services a week before the lockdown and issued a guidance advising that sterilizations and intrauterine contraceptive devices (iucd) services should not be resumed until further notice. as a fallout of lockdown due to covid-19, over 20 million couples in the country were deprived from availing contraceptives and terminating unintended pregnancies. according to a report by idf, around 1.85 million abortions, i.e. 50 percent of the number of abortions that would have taken place in this period normally, may have been compromised as a result of restriction on travel due to the lockdown from march to june in 2020. this would have resulted in a large number of unwanted pregnancies being seen through, as well as unsafe abortions that can result in maternal deaths. a report by frhs india estimates that the pandemic situation could lead to an additional 834,042 unsafe abortions and 1,743 maternal deaths in india. with limited mobility, increased reports of intimate partner violence, changes in living patterns of migrants, delays in accessing contraception and safe abortions, and potential changes to decisions about parenting, there is an increased need for safe abortion services in india due to the pandemic. expanding telehealth to include information, support, and services around medical abortion can be a safe and revolutionary way to expand access to safe, legal abortion. although according to who guidance, abortions in the first trimester can be safely self-managed as long as there is access to information and support, and to a facility in case of complications,40 in indian law, abortions outside of health facilities without prescription from an rmp are currently illegal. offering abortion through telehealth can provide clients a legal, safe, and supported experience: expanding the use of telemedicine for abortion can provide legal protection to those self-managing without a prescription, without having to meet physically with an rmp. given the need for medical abortion in india and the already existing self-use in large numbers, the openness of clients and providers alike to use technology for health, and the established safety of abortion via telemedicine from global models, it is clear that there is appetite for abortion provision using telemedicine. public sector provision of abortion has several challenges – lack of trained staff, equipment and supplies, and nonjudgmental care up to the legally permitted extent, to name a few.38 telemedicine for abortion can not only help address gaps in the public sector provision of safe abortion but can also serve as a viable choice even when quality services are available since it would reduce the burden on the health infrastructure by reducing in-person visits and enhancing privacy and confidentiality needs of clients. by expanding telemedicine to include medical abortion, india can forge the way ahead for safe abortion access not just during the pandemic, but also creating an opportunity for long-lasting impact. recent court cases for late-term termination of pregnancy the mtp act allows for termination of pregnancy up to 20 weeks of pregnancy. in case termination of pregnancy is immediately necessary to save the life of the woman, this limit does not apply (section 5 of the mtp act). there are however cases of diagnosed foetal abnormalities and cases of women who are survivors of sexual abuse who have reached out to the court with requests for termination of pregnancy beyond 20 weeks. a report by the center for reproductive rights analyzed some of these cases that have come to court in a comprehensive report. another report by pratigya campaign assesses the role of judiciary in access to safe abortion. the report highlights the growing increase in the number of cases reaching courts for permission. while a number of orders permitting termination are based on the opinion of the medical board and the jurisprudence already laid down in previous cases, there have been some groundbreaking judgments in the past years also, which have been highlighted. this lays emphasis on the necessity for the law to keep up with the changing times. it is imperative that access to abortion becomes a legal right for pregnant women at least in the first trimester. it is necessary that the opinion of the doctor, that the woman is consulting should be considered as primary and the only one required. the setting up of medical boards which has been done by the courts while dealing with cases of this nature has only created further obstacles for women in accessing safe and legal abortion. media has covered many of these cases actively. listed below are some of the significant cases with requests for late term termination that have come to the court for permission. in december 2017, a 13-year-old rape survivor's father approached the bombay high court seeking permission for the termination of 26-week foetus. the girl was repeatedly raped by her cousin. considering the report of the medical board which claimed that there was greater risk to the pregnant girl's life if continued., the court held that the girl was physically incapable to deliver a child, and granted permission for termination. a 15-year-old girl who had eloped to marry, sought permission from the delhi high court to abort her 25-week pregnancy. the medical board assigned to examine her case, however, reported that termination would pose serious risks to the lives of both the foetus and the mother. subsequently, the high court denied the girl permission to undergo an abortion. a woman from thane approached the bombay high court in december 2017, seeking permission to terminate her 22-week-old foetus that was diagnosed with various infirmities. the report of the medical committee ascertained that the child, if born, may have an intellectual disability, while admitting that terminating the pregnancy at this stage would be risky. after the petitioner expressed her willingness to take the risk, the court permitted her to undergo abortion. after the foetus of a 24-year-old woman from pune was diagnosed with a cardiac anomaly, she approached the bombay high court seeking permission to abort her 24-week foetus. the medical board asked to examine the woman advised abortion while reporting that the child, if born, may have to undergo multiple surgeries. the court consequently, granted