This document summarizes a lecture on the Medical Termination of Pregnancy (MTP) Act and MTP procedures in India. The key points covered include:
1) MTP cases account for 50-500 cases reviewed by the Delhi Medical Council annually, showing many doctors are unaware of MTP Act requirements.
2) The MTP Act of 1972 provides legal protection for doctors performing abortions as long as all Act rules are followed, including qualifications, gestation periods, facilities and consent.
3) Amendments to the Act and Rules in 2003 aimed to simplify procedures, expand access to early medical abortion, and clarify approval and record-keeping processes.
Legal aspects of abortion care By DR ALKA MUKHERJEE NAGPUR M.S. INDIAalka mukherjee
Provisions Under the MTP Act, Rules, and Regulations for Compliance The MTP Act enacted in 1971 and as amended in 2002; the MTP Rules, 2003; and the MTP Regulations, 2003 govern the provision of abortions or MTP in India. The MTP Act, and the Rules and Regulations framed thereunder provide an ambit under which legal abortion services can be provided up to 20 weeks of pregnancy. The MTP Act provides details about the following aspects of abortion services: l Conditions under which pregnancy may be terminated. [MTP Act: Section 3 (2)] l Who can provide abortion services. [MTP Act: Section 2 (d) and Rule 4] l Sites where abortion service can be provided. [MTP Act: Section 4] l Documentation and records for abortion services. [Rule 5, Rule 9, Regulation 3, Regulation 4 (5), and Regulation 5] l Punishments for violation of the MTP Act. [MTP Act: Section 5 (2), Section 5 (3), and Section 5 (4)] Legal Provider Currently, MTP can be legally provided only by a registered medical practitioner (RMP) – a medical practitioner who possesses any recognised medical qualification as defined in clause(h) of Section 2 of the Indian Medical Council Act, 1956, whose name has been entered in a State Medical Register and who has one or more of the following experience or training in gynaecology and obstetrics [MTP Act: Section 2 (d); and Rule 4]: 1. In the case of a medical practitioner, who was registered in a State Medical Register immediately before the commencement of the Act, experience in the practice of gynaecology and obstetrics for a period not less than three years. 2. In the case of a medical practitioner, who was registered in a State Medical Register after the commencement of the Act and: a. Has completed six months of house surgency in gynaecology and obstetrics; or b. Has experience at any hospital for a period of not less than one year in the practice of obstetrics and gynaecology; 23 for Service Providers GUIDANCE: Ensuring Access to safe Abortion and Addressing Gender Biased Sex Selection or c. Holds a post-graduate degree or diploma in gynaecology and obstetrics; or d. Has assisted an RMP in the performance of 25 cases of MTP of which at least five have been performed independently, in a hospital established or maintained by the Government, or a training institute approved for this purpose by the Government. This training will enable the RMP to do only first trimester terminations (up to 12 weeks of gestation). Site Approval l A private site has to be approved by the District Level Committee (DLC) for providing MTP services. There are separate requirements for approval for first and second trimester abortion services. [MTP Act: Section 4 (b) and Rule 5] l The certificate of approval by the DLC needs to be conspicuously displayed at the site to be easily visible to persons visiting the place. [Rule 5 (7)] l Public sector sites do not need separate approval for providing MTP services. [MTP Act:
Surrogacy Regulation Act 2021 has been notified in the Gazette on 25th December 2021 and there are important implications for all who practice surrogacy in India both for patients and clinics and ART Banks.
Legal aspects of abortion care By DR ALKA MUKHERJEE NAGPUR M.S. INDIAalka mukherjee
Provisions Under the MTP Act, Rules, and Regulations for Compliance The MTP Act enacted in 1971 and as amended in 2002; the MTP Rules, 2003; and the MTP Regulations, 2003 govern the provision of abortions or MTP in India. The MTP Act, and the Rules and Regulations framed thereunder provide an ambit under which legal abortion services can be provided up to 20 weeks of pregnancy. The MTP Act provides details about the following aspects of abortion services: l Conditions under which pregnancy may be terminated. [MTP Act: Section 3 (2)] l Who can provide abortion services. [MTP Act: Section 2 (d) and Rule 4] l Sites where abortion service can be provided. [MTP Act: Section 4] l Documentation and records for abortion services. [Rule 5, Rule 9, Regulation 3, Regulation 4 (5), and Regulation 5] l Punishments for violation of the MTP Act. [MTP Act: Section 5 (2), Section 5 (3), and Section 5 (4)] Legal Provider Currently, MTP can be legally provided only by a registered medical practitioner (RMP) – a medical practitioner who possesses any recognised medical qualification as defined in clause(h) of Section 2 of the Indian Medical Council Act, 1956, whose name has been entered in a State Medical Register and who has one or more of the following experience or training in gynaecology and obstetrics [MTP Act: Section 2 (d); and Rule 4]: 1. In the case of a medical practitioner, who was registered in a State Medical Register immediately before the commencement of the Act, experience in the practice of gynaecology and obstetrics for a period not less than three years. 2. In the case of a medical practitioner, who was registered in a State Medical Register after the commencement of the Act and: a. Has completed six months of house surgency in gynaecology and obstetrics; or b. Has experience at any hospital for a period of not less than one year in the practice of obstetrics and gynaecology; 23 for Service Providers GUIDANCE: Ensuring Access to safe Abortion and Addressing Gender Biased Sex Selection or c. Holds a post-graduate degree or diploma in gynaecology and obstetrics; or d. Has assisted an RMP in the performance of 25 cases of MTP of which at least five have been performed independently, in a hospital established or maintained by the Government, or a training institute approved for this purpose by the Government. This training will enable the RMP to do only first trimester terminations (up to 12 weeks of gestation). Site Approval l A private site has to be approved by the District Level Committee (DLC) for providing MTP services. There are separate requirements for approval for first and second trimester abortion services. [MTP Act: Section 4 (b) and Rule 5] l The certificate of approval by the DLC needs to be conspicuously displayed at the site to be easily visible to persons visiting the place. [Rule 5 (7)] l Public sector sites do not need separate approval for providing MTP services. [MTP Act:
Surrogacy Regulation Act 2021 has been notified in the Gazette on 25th December 2021 and there are important implications for all who practice surrogacy in India both for patients and clinics and ART Banks.
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The Medical Termination of Pregnancy (MTP) Act 1971 — a law that was considered ahead of its times — legalized abortion in India up to 20 weeks of pregnancy, based on certain conditions and when provided by a registered medical practitioner at a registered medical facility. Conditions under the MTP Act under which a pregnancy may be terminated are continuation of the pregnancy would involve a risk to the life of the pregnant woman or cause grave injury to her physical or mental health. Also, substantial risk that the child, if born, would be seriously handicapped due to physical or mental abnormalities; pregnancy is caused by rape (presumed to constitute grave injury to mental health) and pregnancy is due to failure of contraceptive in a married woman or her husband (presumed to constitute grave injury to mental health).
Key words:
Medical termination rules, termination act, penalty of illegal's pregnancy termination, what is family planning, approval process, Application form for approval,Maintaince of admission register, circumstances for termination of pregnancy ,What is MTP act, objectives of MTP act, what is owner, what is minor,
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MTP Act & MTP - Made simple, Dr. Sharda Jain, Presented at Multispecialty Centenary conference of DMA At Ashoka Hotel On 11th Jan. 2015
1. Dr. Sharda Jain
MTP Act & MTP - Made simple
Presented at Multispecialty
Centenary conference of DMA
At Ashoka Hotel On 11th
Jan. 2015
2. Lecture was on public demand as 50/500
cases which come to Delhi Medical council
for redrassal – are related
to MTP alone
This means the doctors are over confident &
think it is petty procedure or totally unaware
of the MTP act 1972
3. country wide Uproar by Doctors
forced
FOGSI & GOVT. of India
to take a step back
Proposed MTP Amendments
2014
6. Indian Penal Code
(IPC, 1860)
SECTION 312
Any one voluntarily causing miscarriage to a woman
with child, other than in GOOD FAITH for the purpose of
saving her life is PUNISHABLE BY IMPRISONMENT
(simple or rigorous) &/or a fine
Sections 313 - 316 (for DEATH due to procedure)
Up to 10 years imprisonment and fine, extending up to
LIFE IMPRISONMENT where the abortion was conducted without
consent
8. A Protective Umbrella
THE MTP ACT if adhered to
completely offers complete
protection to the medical
practitioner from any of the
consequences of the IPC
However legal protection is only
available conditionalto
every requirement of the Act
being fulfilled
Sheriar, J Obs Gyn
India, 51(6):25, 2002
9. MTP Act, Rules, Regulations
MTP Act Is an Act of Parliament providing an
Overview of Safe abortions and delegating authority
to Central & State government
Rules are framed by the Central Government BUT
must be ratified by each house of Parliament
Regulations are framed by the State Government &
relate to issues involving Opinions , reporting and
maintaining secrecy
3 Things
10. MTP Act Specifies:
1 The INDICATIONS for legal Terminations
2 WHO can Terminate
3 The PLACE where it can be terminated
4 Last but most imp. CONSENT requirement
11. When Pregnancy can be terminated.. ???
1--continuation of pregnancy is a risk to the life of
pregnant woman
or it can cause grave injury to her physical and
mental health
2--Substantial risk that the child , if born ,would be
seriously handicapped due to physical or mental
abnormalities
3--pregnancy caused by rape
4--failure of contraceptive in
married woman
1
13. Experience of RMP-
Up to 12 weeks Gestation only
PG Degree or Diploma in OB & Gynae
Who is registered in state medical register
---6months of house surgeon ship in gynae
Or experience of working in dept of gynae –1yr
1-- A Practitioner who has assisted RMP in 25 cases of
Medical termination of pregnancies ,at least 5 of which have
been performed independently in a hospital established or
maintained by govt or a training institute approved for this
purpose by the Govt
14. Experience and Training Required by a
RMP-upto 20 wks
PG Degree or Diploma in OB & Gynae
Completed 6 months as House Surgeon in OB &
Gynae
At least one yr experience in dept of ob & Gynae
at any hospital that has all facilities
15. Where pregnancy can be Terminated --
PLACE
Hospitals established or maintained by
the Govt
A Place approved by the Government
or DLC constituted by the Govt
3
16. Consent ----- Form C
1-- Only the
consent of a
women is
required
2-- If Age <18 yrs
or a mentally ill
patient consent of
guardian is reqd
4
17. Up to 12 wks --FACILITIES -
1-Gynecological examination /labor table
2-Resuscitation and sterilization Equipments
3-Drugs and Parenteral fluids
4- Backup facilities for treatment of shock
REQUIREMENT FOR APPROVAL OF
A PLACE – is done by D.L.C.
18. For Terminating 12 to 20 weeks of Pregnancy
FACILITIES
1-An operation table and instruments for performing
abdominal or gynecological surgery
2-Anesthetic Equipments, resuscitation and
sterilization equipments
3- Drugs and Parentral fluids for any emergency ,
notified by GOI from time to time
REQUIREMENT FOR APPROVAL OF
A PLACE – is done by D.L.C.
19. For Medical Abortion
1-up to 7 wks
An RMP does not need approval of place , can
display a certificate from owner of a approved
place
Only Registered doctor can prescribe
One needs to follow all rules and regulation
under MTP Act
20. MTP Rules…..
Approval is applied - FORM A Annexure 1
Addressed to CMO
CMO does -- verification
inquiry or inspection
then recommends for approval of place to
DLC
issues a certificate of approval in FORM B (annexure -1 )
APRROVAL PROCESS
21. Inspection of Place
Place should be inspected within 60 days of receipt
of approval
and approval within next 2 months or within 2 month
of any deficiency being rectified by applicant to
ensure safe and hygienic conditions
CMO may inspect the approved place any time if
necessary to reconfirm
You have to show and give all information's to CMO
anytime
22. Cancellation / Suspension
CMO can suspend or cancel the approval , if he
suspects unsafe and unhygienic conditions .
After suspension can apply again after making
improvement within 60 days of order , during
suspension place is deemed as not approved govt can
modify or reverse the orders
23. Amendments to MTP rules
Key features :-
1. Detailed the composition and tenure of the DLC
2. Abortion sites approved for
A- up to 12 weeks
B- 12-20 weeks, facilities and equipments required for
two types were detailed
3. Allowed medical abortion using RU-486 and misoprostol
by RMP even from site not approved provided the RMP
has referral linkage access to an approved place
4.A non OB gynae provider who is trained and certified can
provide first trimester abortion
2003
24. MTP Regulations
MTP Act empowers the state govt to form
regulations , maintain records , reports
Salient features
1-Form of certifying opinion or opinions
Form 1 Annexure - 2
RMP who terminate s, should certify it
in Form 1
25. MTP Regulations
2- Custody of forms
Form c the CONSENT FORM + Form 1 for
intimation of termination , shall be sealed &
kept in safe custody & given to head or owner
of approved place
A serial number is assigned to the pregnant pat
in the admission register ,name of the RMP, &
shall write SECRET
3- Head or Owner has to send monthly
statement of the MTP cases to the CMO
on FORM II ( Annexure -3 )
26. Maintenance Of Admission
REGISTER
Maintain records As per Form III ( Annexure -4 )
Record the detail
Keep in secret custody for 5years from the end
of calendar year it relates to; It is not disclosed
to anyone except under authority of law
27. Recommendations
to Overcome Shortcomings
Requirement of 2 opinions for second trimester
termination is now a formality and could be
dispensed – but doctors want no change in
view to curb sex selective abortion.
A qualified extension of up to 24 weeks to
accommodate terminations after prenatal diagnosis of
birth defects
28. Recommendations
to Overcome Shortcomings
Scope to simplify and streamline bureaucratic
procedures by amending MTP Rules and Regulations.
Registration of centres by meticulous application &
persistent follow up.
Valid case for bifurcating recognition
requirements for performing first & second
trimester MTPs, in view of the documented safety &
simplicity of early abortions
29. With medical methods administered on an
outpatient basis, the act needs to be updated to
keep abreast with future medical advances
Revisit documentation required. Admission
register could be replaced by MTP Register
Increase the number of trained persons performing
induced abortions by multiplying training facilities
Allow medical abortion by all MBBS doctors
(IMA/FOGSI)
Recommendations
to Overcome Shortcomings
30. Learning : is the powerful weapon we can use to
change the world
31. Please Remember
Violation of The ACT
Any PERSON doing MTP and not a RMP can be
punished with rigorous imprisonment for 2-7 yrs.
If terminating at a PLACE which is not approved
can be punished 2-7 yrs rigorous imprisonment.
The owner of unapproved place , performing
termination can also be punished with rigorous
imprisonment 2--7 yrs
32. “Please Remember”
Legal abortion means
Termination done at a place approved under the
Act
Termination done for conditions and within the
gestation prescribed the Act
Termination done by a medical practitioner
approved by the act
Other requirements of the rules and regulations
are complied with
34. Pre Abortion Information
for Patients & GP - Tips
Medical termination usually leads to vaginal
bleeding for 10 – 14 days – more like having a
heavy prolonged period.
there may be a risk of congenital
malformation in your baby in case of
continuation of pregnancy
In case of heavy bleeding please report to
emergency immediately.
35. Pre Abortion Information
for Patients & GP - Tips
Next period may be delayed by one or two
weeks but subsequent periods should be
regularized as earlier.
Maintain a menstrual dairy.
Avoid intercourse during treatment and
preferably till the next menstrual periods
36. Pre Abortion Information
for Patients & GP - Tips
Please sign on the consent from after
being satisfied with information provided
and clarifying any doubts that you may
have
Note that you have the full option of
choosing suction evacuation for
termination of pregnancy.
37. Pre Abortion Information
for Patients & GP - Tips
Women desiring concurrent tubal
ligation should realize that surgical
abortion is preferable since it can be
combined with the tubal ligation
Any method of termination of
pregnancy may lead to future
INFERTILITY or pregnancy
mishaps!
38. Anti – D in Rh Negative patients
Take injection anti – D 50 mg of Rh D
on day one
39. “Absolute Contraindication to
medical abortion”
Previous ALLERGIC reaction to mifepristone /
misoprostol inherited porphyria
Chronic adrenal failure
Known or suspected ECTOPIC or heterotopic
pregnancy
40. Caution is required in a range of
circumstances including
Long term use of corticosteroids such as
for bronchial asthma
Coagulopathy
Severe anamia (must be treated at time of
abortion),
Pre- existing heart disease or
cardiovascular risk factor (e.g
hypertension and smoking)
41. No Contraindication to medical
abortion
Adolescence age or >35 ,
anemia ,
insulin dependent diabetes mellitus,
thyroid disorders,
multiple pregnancies,
obesity, previous caesarean section,
smoking,
uterine malformation – congenital and acquired
and previous cervical surgeries
42. Medical Abortion is Not Advised
if
No quick access to 24 hrs emergency
service
Patents unable to take responsibility
excessive anxiety wanting quick abortion
language or comprehensive barrier not
willing for surgical abortion in case of
failure living alone
43. Take home message
• It is necessary to do register your nursing home
under the MTP act, if you are going to do MTP
• Must follow all the rules and regulations under
MTP strictly and correctly
• All paper work must be complete before you start
an MTP ,one never knows when an emergency
arises
• Cultivate good habits like keeping and preparing
documents well in time .
• Medical Abortion is safe & public awareness to be
created