Medical Termination Of Pregnancy Act 1971 And Pre Conception & Pre Natal Diagnostic Technique

3. INDUCTION OF ABORTION
•
•
• INDUCED
ABORTION
• SPONTANEOUS ABORTION
•

4. BEFORE 1971 (INDIAN PENAL CODE, 1860)
Before 1971, abortion was criminalized
under Section 312 of the Indian Penal
Code, 1860, describing it as
"causing miscarriage". Except in cases
where abortion was carried out to save
the life of the woman, it was a
punishable offense and criminalized
women/providers, with whoever
voluntarily caused a woman with child
miscarry facing three years in prison
and/or a fine, and the woman availing
the service facing seven years in prison
and/or a fine.
It was in the 1960s, when abortion was
legal in 15 countries, that deliberations
on a legal framework for induced
abortion in India was initiated. The
alarmingly increased number of
abortions taking place put the Ministry
Health and Family Welfare (MoHFW)
alert. To address this, the Government
India instated a Committee in 1964 to
come up with suggestions to draft the
abortion law for India. The
recommendations of this Committee
were accepted in 1970 and
the Parliament as the Medical
Termination of Pregnancy Bill. This bill
was passed in August 1971 as
the Medical Termination of Pregnancy
Act.

5. ABORTION INCIDENCE IN INDIA
•
•

7. THE MEDICAL
TERMINATION
OF
PREGNANCY
ACT, 1971
• THE MEDICAL TERMINATION OF PREGNANCY (MTP) ACT, 1971
PROVIDES THE LEGAL FRAMEWORK FOR MAKING CAC SERVICES
AVAILABLE IN INDIA. TERMINATION OF PREGNANCY IS PERMITTED FOR A
BROAD RANGE OF CONDITIONS UP TO 20 WEEKS OF GESTATION AS
DETAILED BELOW :-
• WHEN CONTINUATION OF PREGNANCY IS A RISK TO THE LIFE OF A
PREGNANT WOMAN OR COULD CAUSE GRAVE INJURY TO HER PHYSICAL
OR MENTAL HEALTH;
• WHEN THERE IS SUBSTANTIAL RISK THAT THE CHILD, IF BORN, WOULD
BE SERIOUSLY HANDICAPPED DUE TO PHYSICAL OR MENTAL
ABNORMALITIES;
• WHEN PREGNANCY IS CAUSED DUE TO RAPE (PRESUMED TO CAUSE
GRAVE INJURY TO THE MENTAL HEALTH OF THE WOMAN);
• WHEN PREGNANCY IS CAUSED DUE TO FAILURE OF CONTRACEPTIVES
USED BY A MARRIED WOMAN OR HER HUSBAND (PRESUMED TO
CONSTITUTE GRAVE INJURY TO MENTAL HEALTH OF THE WOMAN).

8. THE MTP ACT SPECIFIES
(i) Who can
terminate a
pregnancy
(ii) Till when a
pregnancy can
be terminated
(iii) where can
a pregnancy
be terminated.

9. WHO CAN TERMINATE A PREGNANCY ?
•
•
•
•

10. WHERE CAN A PREGNANCY BE
TERMINATED ?
•
DISTRICT LEVEL
COMMITTEE
•
•

13. WHOSE CONSENT IS REQUIRED FOR
TERMINATION OF PREGNANCY ?
•
•

15. METHODS OF TERMINATION OF
PREGNANCY

16. FIRST TRIMESTER TERMINATION OF
PREGNANCY
•
•
•
•
•
•

19. SURGICAL METHODS OF FIRST
TRIMESTER ABORTION

•
•
•
•
•
•

21. Done up to 12 weeks with minimal cervical dilatation.
Performed as an outpatient procedure using a plastic disposable
cannula (up to 12 mm size) and a 60 mL plastic (double valve)
It is quicker (15 minutes), effective (98–100%)
Less traumatic and safer than dilatation, evacuation and curettage.

22. •
•
1)
2)
3)
4)
5)
•
1)
2)

24. RAPID METHOD
SLOW METHOD
1. RAPID METHOD: DONE AS AN OUTDOOR
PROCEDURE WITH DIAZEPAM SEDATION AND
PARACERVICAL BLOCK .
• ADVANTAGES
I. DONE AS AN OUTDOOR PROCEDURE.
II. CHANCE OF SEPSIS IS MINIMAL.
• DRAWBACKS
I. CHANCE OF CERVICAL INJURY IS MORE.
II. UTERUS SHOULD NOT BE MORE THAN 6–8
WEEKS OF PREGNANCY. ALL THE DRAWBACKS OF
D&E.

25. 
•
I.
II.
•
I.
II.
III.

26. 









27. 
•
•

28. 



•
•
•
•
•
•

30. HYSTEROTOMY

•
•
•
•
•
•

31. 
•
I.
II.
III.
IV.
•
I.
II.
III.
IV.

32. There is no universally
safe and effective
method which is
applicable to all cases.
Complications are
much less (5%) if
termination is done
before 8 weeks by
or suction
evacuation/curette.
The complications are
about five times more
in midtrimester
termination.
The complications are
either related to the
methods employed or
to the abortion

33. IMMEDIATE COMPLICATIONS
(1) Injury to the cervix (cervical lacerations).
(2) Uterine perforation during D&E.
(3) Hemorrhage and shock due to trauma, incomplete abortion, atonic uterus or
rarely coagulation failure.
(4) Thrombosis or embolism.
(5) Postabortal triad of pain, bleeding and low-grade fever due to retained clots or
products.

34. (6) Related to the methods employed:
Prostaglandins—intractable vomiting, diarrhea, fever, uterine pain and cervicouterine
injury. Oxytocin—water intoxication and rarely convulsions
 Hysterotomy :
1) Uterine bleeding.
2) Peritonitis.
3) Intestinal obstruction.
 Anesthetic hazards. Saline—hypernatremia, pulmonary edema, endotoxic shock,
Disseminated intravascular coagulation (DIC), renal failure, cerebral hemorrhag

36. PROPOSED AMENDMENTS TO THE MTP ACT, 2014
•
NATIONAL
CONSULTATION
MEDICAL TERMINATION OF
PREGNANCY AMENDMENT BILL 2014
•
•
•
•

37. •

38. •

39. • SAFE ABORTION: TECHNICAL AND POLICY GUIDANCE FOR HEALTH
SYSTEMS
•

40. It has been recommended to replace the term "registered medical
practitioner" with "registered health care provider". This would
the expanded provider base being suggested, by bringing in
and ANMs as well as Ayurveda, Unani, Siddha and Homoeopath
practitioners as legitimate providers of abortion service.
The MTP Act does not have a definition of termination of
For this purpose, it has been recommended to include a definition
for termination of pregnancy.

42. AMENDMENT TO MTP ACT WILL ALIGN THE REPRODUCTIVE
RIGHTS OF WOMEN WITH 21ST CENTURY MEDICINE



43.  A 2015 study in the Indian Journal of Medical Ethics has observed that 10-13% of maternal
deaths in India can be attributed to unsafe abortions. It roughly translates into at least six to
seven women losing their life due to unsafe abortions every day. Many of those who survive
such methods are compelled to live a life of pain compounded by infertility, sepsis and other
internal injuries. Studies have shown that the 20 week limit on abortion is based on outdated
medical concepts from the 1970s. Developments in medical science which include medical
abortion pills and vacuum aspiration which allow for safer abortions in advanced stages of
pregnancy have found no legal resonance in the MTP Act.
 By contrast Wednesday’s Cabinet decision to approve the MTP (Amendment) Bill, 2020, will truly
address the needs of gender justice through the prism of reproductive rights, providing a
which women in our country have sought for decades. The bill allows abortion up to 24 weeks of
gestational age for vulnerable categories of women and there is no limit of gestational age in
pregnancies with substantial foetal abnormalities, diagnosed by a medical board. This will
access of women to safe medico legal services and will thus reduce maternal mortality and
arising out of unsafe abortions.

44.  Worldwide, abortion is acknowledged as an important aspect of reproductive health of women. At
present, 26 countries including Egypt, Angola, Thailand, the Philippines, Madagascar and Iraq do not
permit abortion and 39 countries including Brazil, Mexico, Sudan, Indonesia and Sri Lanka permit
abortion when the woman’s life is at risk. Only some countries like China, Russia, Canada, Australia,
South Africa permit abortion on request mostly up to 12 weeks. India will now stand amongst nations
with a highly progressive law which allows legal abortions on a broad range of therapeutic,
humanitarian and social grounds. The new MTP (Amendment) Bill, 2020, is a milestone which will
further empower women, especially those who are vulnerable and victims of rape.

45. THANK YOU

47. PRE-CONCEPTION
AND PRE-NATAL
DIAGNOSTIC
TECHNIQUES ACT,
1994
By
Dr. Akshat Tiwari

48. Content :
 Objective of law
 Female Feticide
 Prenatal Diagnostic Test
 Main Provision of the Act
 Prenatal Diagnostic Techniques
 Imposed Restrictions
 Prohibitions
 Offences
 Implementation by Appropriate Authority
 Maintenance and Preservation of Records
 Public Information

50. OBJECTIVE OF THIS LAW
 Prohibit sex selection (before or after conception).
 Regulate pre-natal diagnostic techniques for detecting. Genetic or metabolic
disorders or chromosomal Abnormalities or certain congenital mal-formations or sex
linked disorders.
 Prevent misuse of such techniques for the purpose of Sex determination of female
feticide.

51. WHAT IS FEMALE FETICIDE ?
Female feticide-
 Aborting a female fetus after sex determination test.
Ultra-sonography, helps determine abnormalities in the fetus.
 Misused to find out sex of the fetus and abort it if it is a girl.

53. WHY IS FEMALE
FETICIDE A
PROBLEM ?
Increase in violence against women-
violation of their human rights.
Abortion due to family pressures to
have male child.
Effect on mental and physical health
of woman.
More men in society due to sex
selective abortions.

55. FEMALE FOETICIDE IN INDIA
 This process began in the early 1990 when ultrasound techniques gained
widespread use in India. There was a tendency for families to continuously
produce children until a male child was born. Foetal sex determination and sex
selective abortion by medical professionals has today grown into a Rs. 1,000
crore industry (US$ 244 million). Social discrimination against women and
a preference for sons have promoted female foeticide in various forms skewing
the sex ratio of the country towards men. According to the decennial Indian
census, the sex ratio in the 0–6 age group in India went from 104.0 males per 100
females in 1981, to 105.8 in 1991, to 107.8 in 2001, to 109.4 in 2011. The ratio is
significantly higher in certain states such as Punjab and Haryana (126.1 and
122.0, as of 2001).

56. WHAT WAS THE NEED FOR SUCH AN
ACT ?
The PNDT Act 1994and its subsequent amendment in 2003 as the PC &
PNDTAct(Prohibition of Sex Selection) Act were not brought into force because
common people were resorting to sex selection,but because the medical fraternity
made it possible and easy for them to do so.
Abandoning their moral responsibility to the tenets of our profession, a few
took advantage of the discriminatory social practice of son-preference and
aversion.

61. PRENATAL
DIAGNOSTIC
TEST
It includes:
 Ultrasonography(USG)
Test or analysis of :
 Amniotic fluid
 Chorionic villi
 Blood
 Any tissue
 Fluid
To detect:
 Genetic disorders
 Metabolic disorders
 Chromosomal abnormalities
 Congenital anomalies
 Haemoglobinopathies
 Sex-linked diseases

62. SEX SELECTION
 Sex selection includes:
1. Procedure.
2. Technique.
3. Test.
4. Administration.
5. Prescription.
6. Provision for the purpose of ensuring or increasing the probability that an embryo will be of a particular sex.

63. MAIN PROVISIONS IN THE ACT ARE
 It regulates the use of pre-natal diagnostic techniques, like ultrasound
and amniocentesis by allowing them their use only to detect :
1. Genetic abnormalities
2. Metabolic disorders
3. Chromosomal abnormalities
4. Certain congenital malformations
5. Haemoglobinopathies
6. Sex linked disorders.

64. PREVENTION OF MISUSE
Sex selection before conception
Prenatal Sex Determination
Female Foeticide

65. PRE-NATAL DIAGNOSTIC TECHNIQUES
INCLUDE
 Ultra-sonography,
 Fetoscopy,
 Taking samples of amniotic fluid, embryo, blood or any tissue or fluid of pregnant
women before or after conception,
 Testing samples in Genetic Laboratory to detect genetic disorders, abnormalities or
sex-linked diseases

66. A schematic representation of fetoscopic laser photocoagulation for twin-twin transfusion
syndrome. A fetoscope is percutaneously inserted into the recipient sac through a cannula.

67. IMPOSES RESTRICTIONS ON
 Clinics, medical personnel and sale of machines
 Only registered genetic clinics can use prenatal diagnostic techniques
 By qualified medical practitioner
 Prohibition of sex-selection
 Prohibition on sale of ultrasound machine to unregistered laboratories, clinics &
persons

68. WHEN CAN PNDT BE CONDUCTED ?
 Techniques can be used or conducted only when any of the following conditions exist:
 Pregnant woman is above 35 years.
 Pregnant woman has undergone ≥2 spontaneous abortions or foetal loss.
 Pregnant woman has been exposed to potentially teratogenic agents such as drugs/ radiation/ infection or
chemicals.
 Pregnant woman or her spouse has a family history of mental retardation/ physical deformities such as spasticity
or any other genetic disease.
 Any other condition specified by central supervisory board.
 It is mandatory that the person conducting USG on a pregnant woman to keep complete record in the clinic.

69. ESSENTIAL COMMUNICATIONS
Explanation of all known side/ after effects & test procedures.
Written consent in prescribed form & its copy given to her.
Not to disclose sex of the fetus by words, signs etc.
Display prominently in local language that disclosure of sex of fetus
prohibited under law.
Registration certificate to be displayed prominently in the clinic.

70. PROHIBITIONS : ON PERSONS
No person will open any genetic
counselling centre, clinic or laboratory
including clinic, laboratory or center
having any technology capable of
undertaking determination of sex of
foetus and sex selection unless such
centre, clinic or laboratory is duly
registered separately or jointly.
No person including a relative or
husband of the pregnant woman will
seek or encourage the conduct of any
pre-natal diagnostic techniques/ sex
selection technique on her except for
medical reasons.

71. CONT..
 No person including the
person conducting a pre-
natal diagnostic procedures
will communicate to the
pregnant woman or her
relatives or any other person
the sex of the foetus by
words, signs or in any other
manner.

72. PROHIBITION OF ADVERTISEMENT
 No person, organization including Genetic Counselling Centre,
Laboratory or Clinic will :
 Issue
 Publish
 Distribute
 Communicate any advertisement regarding pre-natal determination or
pre-conception sex selection by any means even if its scientific.

73. PROHIBITION ON SALE OF ULTRASOUND
MACHINE
 Prohibition on sale or otherwise transfer of ultrasound machines to
persons, laboratories, clinics, not registered under the PC and PNDT
Act.
 The Act further says that no person shall sell or in any other manner
transfer any ultrasound machine or imaging machine or scanner, or any
other equipment capable of detecting sex of the foetus to any genetic
counselling centre, laboratory, clinic or any person not registered under
the Act.

74. AN OFFENCE
UNDER THIS
LAW
 Cognizable – A police officer
may arrest the offender
without warrant.
 Non-bailable – Getting bail is
not the right of the accused.
The courts have discretion to
grant bail
 Non-compoundable - Parties
to the case cannot settle the
case out of court and decide
not to prosecute.

75. OFFENCES : BY
PERSONS
1. If any person acts contrary to
the prohibitions listed in the
act, he will be liable to be
punished with:
 Upto 3 years imprisonment
and
 UptoRs.10,000fine.
 Any subsequent conviction
entails:
 Upto5 years imprisonment
and
 UptoRs.50,000 fine.

76. 3. In case of a doctor his name will be
reported by the appropriate Authority to the
State Medical Council for taking necessary
action:
 Suspension of the registration if charges
are framed by the court and till the case is
disposed of and
 Removal of his name from the register of
the council on conviction for the period of:
 Five years for the first offence.
 Permanently for the subsequent offence.
2. In case of a person seeking the aid of
the bodies or persons for sex selection or for
conducting pre-natal diagnostic techniques
on any pregnant woman for the purposes
other than those specified in the act, he
shall be liable to be punished with:
 Imprisonment up to 3 years; and
 Fine which may extend to Rs.50,000/-
 Any subsequent conviction entails:
 Imprisonment which may extend to
5 years and
 Fine which may extend to Rs.1 lakh.

78. IMPLEMENTATION BY APPROPRIATE
AUTHORITY
 Role:
 To grant, suspend or cancel registration.
 Enforce standards.
 Investigate complaints of breach of provisions.
 Complaints:
 Can be made by any person/social organisation.
 The chief medical officer to investigate.
 Can approach court if chief medical officer does not take action.
 Court:
 Judicial Magistrate First Class or Metropolitan Magistrate

79. ADVISORY COMMITTEE
The advisory committee shall consist of :-
Three medical experts from gynaecologists, obstetricians, paediatricians and medical geneticist;
One legal expert
One officer to represent the dept. dealing with information and publicity of the State govt.
Three eminent social workers, at least one from the women’s organisations.

80. THE ADVISORY COMMITTEE MAY MEET
For consideration of any application for registration and to give advice thereon; provided
that the period intervening between any two meetings shall not exceed sixty days (rule 15)
On the request of the Appropriate Authority.
As necessary

81.  Every registration shall be renewed in such manner and after such period and on payment of such
fees as may be prescribed.
 The certificate of registration shall be displayed by the registered Genetic counselling center, Genetic
clinic, Genetic Laboratory, Ultrasound clinic or imaging center in a conspicuous place at its place of
business.
 Validity of Registration-Every certificate of registration shall be valid for a period of five years from
date of issue.
 Cancellation or suspension of registration The A.A. on complaint, issue a notice to the Genetic
counselling center, Genetic clinic, Genetic Laboratory to show cause why its registration should not be
cancelled or suspended for the reasons mentioned in the notice.

82. MAINTENANCE
AND
PRESERVATION
OF RECORDS
Genetic Counselling , Genetic
Laboratory, Genetic Clinic or
ultrasound clinic or imaging
center shall maintain a register
showing, in serial order, the
names and addresses of the men
or women given genetic
counselling, subjected to pre
natal diagnostic procedure
or test, the name of their spouse
or father and the date on which
they first reported for such
counselling, procedure of test.

84.  The record to be maintained by every Genetic counselling center, in respect
of each women counselled shall be specified in Form D
 The record to be maintained by every Genetic Laboratory, in respect of each
man or woman subjected to any pre-natal diagnostic
procedure/technique/test, shall be as specified in Form E.
 The record to be maintained by every Genetic counselling center, in respect
of each women counselled shall be specified in Form D
 The record to be maintained by every Genetic Laboratory, in respect of each
man or woman subjected to any pre-natal diagnostic
procedure/technique/test, shall be as specified in Form E.

85.  Before conducting pre implantation genetic diagnosis, or any pre-
natal diagnostic technique/test/procedure such as amniocentesis, chorionic villi
biopsy, fetoscopy, fetal skin or organ biopsy or cordocentesis, a written consent, as
specified in Form G, in a language the person undergoing such procedure
understands, shall be obtained from her/him.
 Person conducting ultrasonography on a pregnant woman shall keep a complete
record thereof in the clinic in such manner as may be prescribed and any deficiency
or inaccuracy found therein shall amount to contravention of provisions of sec.5 or
sec.6 unless the contrary is proved by the person conducting such ultrasonography.

86. INTIMATION OF
CHANGES IN
EMPLOYEES,
PLACE OR
EQUIPMENT
 Genetic Laboratory/Genetic
Clinic/ Genetic Counselling
centre shall intimate every
change of employee, place,
address and equipment
installed, to the A.A. with in a
period of thirty days of such
change. (Rule 13)

87. PUBLIC INFORMATION (RULE 17 )
Prominently display of notice of its premises in English and in the other local
language or language for the information of the public, to the effect that
disclosure of sex of foetus is prohibited under law.
At least one copy of the act and the rule shall be available.
The A.A., and the state govt. may publish periodically lists of registered centers
and findings from the reports and other information in their possession, for the
information of the public and for use by the experts in the field.

89. CHALLENGES AND FUTURE PROSPECTS
The two main challenges faced by the State in implementing this Act include
(a) the difficulty of monitoring cases of illegal scanning to determine the sex
of the foetus and (b) the larger societal issue of changing mindsets of the
people.
However, online registration, geo-tagging and vigilant monitoring of
scanning centres coupled with the fast tracking of registration facilities in
Urban Primary Health Centers (for instance, online Form-F) and continuous
advocacy efforts to generate awareness in society will help in the future.

90. Reference :-
Preventive and Social Medicine by K Park
www.wikipedia.org
www.google.co.in

91. Thank You