By Dr Sapna Raina, Senior Consultant, Clinical Lead, Obstetrics & Gynaecology, Narayana Health City, Bengaluru.
The Protection of Children from Sexual Offences (POCSO) Act, 2012, was enacted with the noble intent of shielding children under 18 years of age from sexual abuse. For us, gynaecologists—particularly those engaged in adolescent health and high-risk obstetrics—this law is both a powerful ally and a serious responsibility. It challenges us to walk a tightrope between compassion and compliance, medical confidentiality and mandatory legal duty.
The Act criminalises all forms of sexual offences against children, including both penetrative and non-penetrative acts. Importantly, it makes reporting of such offences mandatory for everyone, including healthcare professionals. Not reporting a suspected or confirmed case of abuse is itself punishable under the law.
Where Medicine Meets the Law
In our clinics and emergency rooms, we often encounter children and adolescents who are vulnerable—those facing unwanted pregnancies, unsafe abortions, or reproductive tract infections. In these moments, we’re not just doctors—we’re protectors, listeners, and sometimes the first and only support a young girl might have.
However, the POCSO Act leaves no room for discretion when it comes to reporting:
- All pregnancies in girls under 18
- All abortions involving minors
- Any suspicion of sexual abuse or exploitation
Even when a minor claims the relationship was consensual, the law treats it as statutory rape. This is where our biggest ethical challenge arises:
Mandatory Reporting vs Confidentiality
Adolescents often come to us scared and seeking help, sometimes in a consensual relationship and sometimes not. Under the Act, we are bound to report all such cases—even if the child or her family begs us not to. While our instinct as caregivers may be to protect the young patient’s privacy, we are also legally bound to inform the authorities.
This tight spot can erode the trust a young patient places in us, but it’s important we explain that our actions are rooted not in judgment, but in law.
Medico-Legal Examination and Consent
When abuse is suspected or disclosed, a medico-legal examination is often warranted. This, too, must be approached sensitively.
- For children under 12, consent must be taken from a parent or guardian.
- For those between 12 and 18, the minor’s assent and the parent’s consent are both needed.
- If a child resists or refuses, we must respect that—unless there’s a specific court directive.
Respectful communication, gentleness, and having a trusted female attendant during the examination go a long way in reducing trauma.
Teen Pregnancy: A Legal and Emotional Challenge
Teenage pregnancies come with layers of complexity. Even if the relationship was consensual, the pregnancy of a minor is automatically treated as a case under POCSO.
As gynaecologists, our approach must include:
- Offering non-judgmental, safe medical care
- Mandatory reporting to the local police or Child Welfare Committee
- Coordinating with legal guardians and authorities
- Providing mental health support to the child and family
Families often request silence, citing social stigma or rushing into marriage. But we must remind them—and ourselves—that failure to report is not an option. Section 21 of the Act makes it punishable.
What Can We Do as Gynaecologists?
- Be compassionate, always – Use gentle, age-appropriate language. Create a safe space.
- Know your legal duty – Be familiar with reporting protocols, coordinate with your hospital’s legal team, and document everything with care.
- Work as a team – Collaborate with child protection units, mental health professionals, and law enforcement as needed.
- Educate and counsel families – Explain the law and reassure them that reporting is for the child’s safety, not to shame them.
The Way Forward
The POCSO Act is a necessary legal tool. However, in its current form, it doesn’t always account for the grey areas—especially in the case of consensual relationships among older adolescents. Many medical professionals and child rights advocates are now calling for nuanced legal reforms.
Until then, we must continue to practice with both legal clarity and emotional intelligence. Because at the heart of this legislation—and the core of our profession—is the child. Her safety, her dignity, her voice.
Let us be that voice as well as the strength she needs when she feels most vulnerable.