There is an obvious danger in drawing lessons about abortion from the trial of a woman accused of killing her three children. Lindsay Clancy is currently standing trial in Massachusetts for the deaths of her three young children in January 2023, with her defence arguing that she was suffering from severe postpartum mental illness, including postpartum psychosis, and relying upon her psychiatric treatment and the medications prescribed to her before the killings. The prosecution disputes the extent to which her mental condition affected her criminal responsibility and maintains that her actions were deliberate. That is ultimately a question for the jury. But the case has brought into focus a broader and difficult question about maternal mental health, and one that Indian courts have increasingly encountered at a much earlier point in a woman’s reproductive life: how seriously should the law take a woman when she says that she is psychologically incapable of continuing a pregnancy or raising another child?

It is here that India’s abortion jurisprudence becomes particularly interesting. In X v Union of India in 2023, the Supreme Court was approached by a 27-year-old married woman who already had two children, the younger approximately a year old. Lactational amenorrhea had delayed her discovery of another pregnancy and, by the time she sought termination, she had crossed the ordinary statutory limit. Her case was not one of foetal abnormality. Among the circumstances she placed before the Court were postpartum depression, her mental inability to raise another child and the financial constraints facing her family. The eventual result went against her: a three-judge Bench held that once the pregnancy had crossed 24 weeks, termination could be permitted in her circumstances only within the statutory exceptions concerning substantial foetal abnormality or an immediate necessity to save her life, neither of which was established. Yet the case also produced an important disagreement about what, precisely, the law should be measuring when a woman says that she cannot continue a pregnancy.

Justice B.V. Nagarathna would have allowed the termination. Her position placed the woman’s autonomy, socioeconomic circumstances and stated unwillingness to continue the pregnancy at the centre of the inquiry. Seen in isolation, that position could have remained simply the more expansive view in a divided Bench. Seen alongside what followed, however, it begins to resemble part of a wider shift in the Court’s approach to reproductive autonomy.

In February 2026, Justices Nagarathna and Ujjal Bhuyan permitted termination of a pregnancy of approximately 27-28 weeks where the woman had been a minor when she conceived. The Bombay High Court had refused permission, reasoning, among other things, that she had since turned 18 and that the child could be given up for adoption. The Supreme Court rejected that approach. Her subsequent attainment of majority did not change the fact that she had conceived as a minor, while foetal viability could not, by itself, determine whether she should be required to continue an unwanted pregnancy. Two months later, in S v Union of India, the Court went further in a way that assumes particular significance for the conversation around maternal mental health.

The case concerned a 15-year-old who was approximately 27 weeks pregnant. The Medical Board found no major psychiatric disorder. Ordinarily, such a finding could easily become shorthand for the absence of sufficient mental-health grounds for intervention. But the girl had attempted suicide twice after learning of the pregnancy. The Court refused to treat the absence of a clinical psychiatric diagnosis as the end of the inquiry, observing in substance that the absence of a diagnosed mental disorder did not negate the existence of severe psychological distress. It also considered the longer-term consequences that a compelled pregnancy could have for her mental health, education and development.

That distinction between a diagnosis and distress is where the Indian cases begin to speak, albeit from a very different legal context, to the questions raised by the Clancy trial. The evidence being examined in Massachusetts concerns not merely whether Clancy was mentally ill, but how her condition was identified, treated and understood before the killings. Her defence relies upon her psychiatric history and treatment; the prosecution disputes the conclusions that should be drawn from them. The criminal trial will determine the consequences of that evidence for criminal responsibility. It should not be pre-judged, and postpartum depression and postpartum psychosis should certainly not be treated as interchangeable. Nor does the existence of mental illness automatically extinguish responsibility for an otherwise criminal act.

The comparison with India is therefore not about culpability. It is about the point at which institutions begin listening. Indian reproductive jurisprudence has increasingly resisted the proposition that a woman’s mental suffering becomes legally relevant only when it satisfies a narrow diagnostic threshold. That development builds upon the Supreme Court’s 2022 decision in X v Principal Secretary, Health and Family Welfare Department, which located reproductive choice within dignity, privacy and bodily and decisional autonomy and refused to interpret the MTP framework in a manner that excluded unmarried women merely because their relationships did not conform to conventional marital categories. By 2026, the inquiry had moved further: foetal normalcy could not alone compel continuation of a pregnancy, delay could not necessarily extinguish autonomy and the absence of a psychiatric diagnosis could not erase lived psychological distress.

There is, of course, a tension within Indian law that should not be understated. The MTP Act continues to prescribe gestational limits and statutory conditions, and the 2023 decision demonstrates that those restrictions can decisively limit reproductive choice. At the same time, constitutional courts are increasingly being asked to deal with cases in which the statutory framework does not comfortably accommodate the reality confronting the pregnant woman. What has consequently evolved is not an unrestricted constitutional right to abortion, but a body of jurisprudence in which Article 21 has progressively widened the lens through which reproductive decisions are examined.

And perhaps that is the more useful connection to draw from the Clancy case. Criminal law encounters maternal mental illness at the most catastrophic end of the spectrum, after an act has occurred, and asks whether illness was sufficiently severe to affect criminal responsibility. Reproductive law encounters a woman much earlier, when she says that she does not want another child, cannot psychologically cope with another pregnancy, or believes that continuing it will fundamentally affect her mental, familial or material circumstances. The two inquiries are legally distinct and should remain so. But both ultimately require institutions to decide how much weight to give a woman’s account of her own mental state.

India’s recent abortion cases suggest that courts are becoming increasingly reluctant to wait for that distress to fit neatly within a diagnostic box before acknowledging it. That may be the more important lesson to take from the uncomfortable comparison with Massachusetts: a legal system should not have to wait for psychological distress to become catastrophic before it becomes real enough to be heard.

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