The document discusses India's Medical Termination of Pregnancy (MTP) Act of 1971. It provides information on the legal framework for abortion in India, including the MTP Act, Rules, and Regulations. Some key points covered include:
- The MTP Act aims to improve maternal health by preventing unsafe abortions and reducing mortality/morbidity. It legalizes abortion services and protects medical practitioners.
- Abortions are legal under 20 weeks gestation with consent and opinion of registered medical practitioners under certain circumstances.
- Abortions must be performed by approved practitioners at approved facilities and follow all legal requirements to be considered legal.
- The MTP Rules lay out practitioner training requirements, approval process for
Medical Termination of Pregnancy (MTP) Act,1971
Reasons for Abortion
Unwanted sex
Sexual violence
Unwanted pregnancy
Objectives
Aims to improve the maternal health scenario by preventing large number of unsafe abortions and consequent high incidence of maternal mortality & morbidity
Legalizes abortion services
Promotes access to safe abortion services to womenn
Offers protection to medical practitioners who otherwise would be penalized under the India Penall Code (sections 315-316)
Legal framework
MTP Act
Lays down when & where pregnancies can be terminated
Grants the central govt. power to make rules and the state govt. power to frame regulations
MTP Rules
Lays down who can terminate the pregnancy, training requirementss, approval process for place, etc.
MTP Regulations
Lays down forms for opinion, maintenance of records
Custody of forms and reporting of cases
Legal abortions
Termination done by a medical practitioner approvedd by the Act
Termination done at a place approved under the Act
Termination done for conditions and within the gestation prescribed by the Act
Other requirements of the rules & regulations are complied
Application
Risk to the life or grave injury to the physical or mental health of woman
Substantial risk of physical or mental abnormalities in the fetus as to render it seriously handicapped
Pregnancy caused by rape (presumed grave injury to mental health)
Contraceptive failure in married couple presumed grave injury to mental health
Medical Termination of Pregnancy (MTP) Act,1971
Reasons for Abortion
Unwanted sex
Sexual violence
Unwanted pregnancy
Objectives
Aims to improve the maternal health scenario by preventing large number of unsafe abortions and consequent high incidence of maternal mortality & morbidity
Legalizes abortion services
Promotes access to safe abortion services to womenn
Offers protection to medical practitioners who otherwise would be penalized under the India Penall Code (sections 315-316)
Legal framework
MTP Act
Lays down when & where pregnancies can be terminated
Grants the central govt. power to make rules and the state govt. power to frame regulations
MTP Rules
Lays down who can terminate the pregnancy, training requirementss, approval process for place, etc.
MTP Regulations
Lays down forms for opinion, maintenance of records
Custody of forms and reporting of cases
Legal abortions
Termination done by a medical practitioner approvedd by the Act
Termination done at a place approved under the Act
Termination done for conditions and within the gestation prescribed by the Act
Other requirements of the rules & regulations are complied
Application
Risk to the life or grave injury to the physical or mental health of woman
Substantial risk of physical or mental abnormalities in the fetus as to render it seriously handicapped
Pregnancy caused by rape (presumed grave injury to mental health)
Contraceptive failure in married couple presumed grave injury to mental health
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).
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:
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).
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:
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1. Medical Termination of Pregnancy
(MTP) Act
Dr Seema Mehrotra
Associate Professor
Dept Of OB&GYN
2. Induction of abortion
• Deliberate termination of pregnancy before the
viability of fetus is called induction of abortion.
• Induced abortion can be legal or illegal ( criminal )
• Up until the MTP act was passed, proving
abortion remained punishable under Indian law
• In case of death due to abortion procedure there
was punishment of upto 10 yers imprisonment
and fine.
3. • In India, abortion was legalised by medical
termination of pregnancy MTP act 1971 and
enforced in 1972 and provisions were revised
in 1975.
4. MTP Act: addressing a public
health priority
• Since legalization of abortion in India,
deliberate induction of abortion by RMP(
Registered Medical Practitoner) in interest
of mothers health and life is protected
under the MTP act
5. MTP Act:Aims
Aims to improve the maternal health scenario by preventing large
number of unsafe abortions and consequent high incidence of
maternal mortality & morbidity
Legalizes abortion services
Promotes access to safe abortion services to women
De-criminalizes the abortion seeker
Offers protection to medical practitioners who otherwise would be
penalized under the Indian Penal Code (sections 315-316)
6. Legal framework
• MTP Act
– lays down when & where pregnancies can be
terminated
– Grants the central govt. power to make rules and
the state govt. power to frame regulations
• MTP Rules
– lays down who can terminate the pregnancy,
training requirements, approval process for place,
etc.
• MTP Regulations
– lays down forms for opinion, maintenance of records
– custody of forms and reporting of cases
7. Legal abortions
Abortions are termed legal only when all the following
conditions are met:
– Termination done by a medical practitioner approved
by the Act
– Termination done at a place approved under the Act
– Termination done for conditions and within the
gestation prescribed by the Act
– Other requirements of the rules & regulations are
complied with
8. When can pregnancies be terminated?
• Up to 20 weeks gestation
• With the consent of the women. If the women is
below 18 years or is mentally ill, then with consent
of a guardian
• With the opinion of a registered medical practitioner,
formed in good faith, under certain circumstances
• Opinion of single RMP for termination upto 12
weeks
• Opinion of two RMPs required for termination of
pregnancy between 12 and 20 weeks
9. MTP Act: Indications
THERAPEUTIC OR MEDICAL
To save life of mother but limited and scarcely
justifiable except in :
1) Cardiac disease (NYHA gr III/ IV) with history of
decompensation I previous pregnancies or in
between pregnancies
2) Chronic glomerulonephritis
3) Malignant hypertension
4) Intractable hyperemesis gravidarum
5) Cervical and breast malignancies
6) DM with retinopathy
7) Epilepsy or psychiatric illness
10. Social indications
• This is almost sole indications to prevent grave
injury to physical and mental health of pregnant
woman
1) Pregnancy is caused by rape both in case of
major and minor girl and in mentally imbalanced
women
2) As a result of failure of contraception
3) In 80% cases it is limited to parous women
having unplanned pregnancy with low SE status
11. Eugenic indications
• Provision of substantial risk of child being born
with serious mental and physical abnormalties so
as to be handicapped In life
• 1) structural (anencephaly), chromosomal (
Downs syn) genetic ( haemophilia) abnormalties
in fetus
• 2) fetus likely to be deformed due to action of
teratogenic drugs or radiation exposure in early
pregnancy
• 3) rubella and viral infections in 1st trimester
12. MTP Act: Place for conducting MTP
A hospital established or maintained by
Government
or
A place approved for the purpose of this Act by a
District-level Committee constituted by the
government with the CMHO as Chairperson
13. MTP Act amendment 2002
• MTP amendment act was passed in 2002
• Term Lunatic was replaced by – Mentally ill
• MTP place to be approved by a district level
committee chaired by CMO / DHO
• Defaulters- rigorous punishment for 2-7 yrs
• Owner of the place also responsible if
defaulter
14. Medical Abortion
• MTP using Mifepristrone (RU 486) & Misoprostol
approved for up to 7 weeks termination
• Only an RMP (as defined by the MTP Act) can
prescribe the drugs
• Has to follow MTP Act, Rules & Regulations
• Can prescribe in his/her clinic, provided he/she
has access to an approved place
• Should display a certificate from owner of
approved place agreeing to provide access
15. Implications of amendments
• Simplifies registration of sites which can be done
at district level now
• Providers can get their sites approved for
providing abortions under the MTP Act for 1st
trimester only or up to 20 weeks and thereby
come under the protective cover of the MTP Act
16. Implications of amendments
• Approved providers can provide medical
abortions from their clinic, as long as they have
access to an approved site
• Offers potential to increase number of approved
sites, which would enable women to access safe
abortion services
• Effective implementation will help to bring all
abortions within legal frame work
17. MTP rules: what are they for?
• Enable proper implementation of the provisions of
the Act
• Ensure that MTP services are provided by
qualified persons in safe and hygienic settings
• Help to monitor quality of services
18. MTP rules: what do they cover?
• Experience & training required for providers
• Approval of a place for terminating pregnancy
under the Act
• Composition & tenure of District Level Committee
• Inspection, cancellation or suspension of
approval; review
• Consent form
19. MTP rules: Who can perform?
A medical practitioner (RMP)
– who has a recognized medical qualification
– Whose name has been entered in a State
Medical Register and
– Who has such experience or training in
Gynecology and Obstetrics as prescribed by
Rules made under the Act
20. MTP rules: training requirement - 1
For termination up to 12 weeks:
– A practitioner who has assisted a registered medical
practitioner in performing 25 cases of MTP of which
at least 5 were performed independently in a
hospital established or maintained or a training
institute approved for this purpose by the
Government
21. MTP rules: training requirement - 2
For termination up to 20 weeks (opinion of 2 RMPs
required)
– A practitioner who holds a post-graduate degree
or diploma in Obstetrics and Gynecology
– A practitioner who has completed six months
house job in Obstetrics and Gynecology
– A practitioner who has at least one-year
experience in practice of Obstetrics and
Gynecology at a hospital which has all facilities
– A practitioner registered in state medical register
immediately before commencement of the Act,
experience in practice of Obstetrics and
Gynecology for a period not less than three
years.
22. Approval of a place by trimester
For sites up to 12 weeks (1st trimester)
• Gynecology examination/ labor table
• Resuscitation and sterilization equipment
• Drugs & parental fluids
• Back up facilities for treatment of shock
• Facilities for transportation
23. Approval of a place by trimester
For sites up to 20 weeks (1st and 2nd trimester):
• All requirements for up to 12 weeks +
• Operation table and instruments for performing
abdominal or gynecological surgery
• Anesthetic equipment, resuscitation equipment
and sterilization equipment
• Drugs & parental fluids notified for emergency
use, notified by Government of India from time to
time
24. Regulatory body: D L C
• District level MTP Committee
– Minimum of 3 & Maximum of 5 members
including chairperson (CM H O)
• Composition of the committee:
– One medical person (Gyne/Surgeon/Anestheist)
– One member from local medical profession; NGO
& Panchayati Raj Institution of the district.
– At least one member shall be a woman.
• Tenure 2 calendar years
– NGO members shall not have more than 2 terms
25. Approval Process
• Application in Form A to be addressed to CMHO
by place seeking approval
• CMHO verifies or inspects the place to satisfy
that termination can be done under safe &
hygienic conditions
• CMHO recommends approval to the committee
• Committee considers application &
recommendation and approve and issue
certificate of approval in Form B
28. Approval Process
• Place to be inspected within 2 months of
receiving application
• Certificate to be issued within 2 months of
inspection
• If deficiency found, within 2 months of deficiency
having been rectified
29. Inspection
• CMHOs to inspect to ensure safe & hygienic
conditions for conduction of MTPs.
• Call for information and seize in case found
otherwise
30. Cancellation/ Suspension
• CMHO to report the committee for unsafe and
unhygienic conditions.
• Committee can suspend or cancel approval after
giving the owner an opportunity for
representation
• Owner can reapply to the committee after
making additions and improvements.
• During suspension the place be deemed as non-
approved
32. Q1) All are the indications of therapeutic
termination of pregnancy except
• Cardiac disease in NYHA Gr IV
• Chronic severe glomerulonephritis
• Cervical malignancy
• Thyroid disorder
34. Q2) Following are the social indications for
termination of pregnancy
• Pregnancy caused by rape
• Unwanted pregnancy due to contraceptive
failure
• Parous women having unplanned pregnancy
• All of the above
35. Q3 ) Eugenic indications for termination of
pregnancy include all except
• Anencephalic baby
• Radiation exposure (>10 rads)
• Rubella infection in first trimester of
pregnancy
• SLE in mother
36. Q4 ) MTP can be performed by all except
• Person who has degree /diploma in OB &GYN
• Who has done 6 months house job in OB
&GYN
• Who has assisted in at least 10 MTPs in
authorized center
• Who has assisted in at least 25 MTPs in an
authorized center
37. A4) Who has assisted in at least 10 MTPs in
authorized center
38. Q5) All are true regarding MTP except
• Written consent of woman is required
• Husband consent is required
• Termination is permitted up to 20 weeks
• In case of minor girl/mentally retarded woman
written consent of the parents or legal
guardian is to be taken
40. Q6) Following are true regarding MTPact except
• MTP act came into force in 1972 and revised
in 1975
• Legalizes contraceptive services
• Offers protection to medical practitioners
• Improves maternal health by preventing large
numbers of unsafe abortions
42. Q7 The MTP law specifies
• Conditions under which pregnancy can be
terminated
• Person who can perform MTP
• Places where MTP can be performed
• All of the above
44. Q8) Regarding MTP following are true except
• Can be done upto 24 weeks
• Opinion of two RMPs is required for
termination between 12-20 weeks
• Should be conducted in a hospital established
or maintained by government
• Can be done if pregnancy results from
contraceptive failure
46. Q10) Medical abortion is done
• Up to 7 weeks
• Using Mifepristone and Misoprostol
• Drugs are prescribed only by Registered
Medical Practitioner
• All of the above