Abortion and MTP Act 1971, with amendment Bill 2014.

definition ,types of abortion

1. Abortion & MTP Act Dr M Balaji Singh , ACS medical college and hospital, Chennai

2. Definition of Abortion Abortion is expulsion of uterine contents of the gravid uterus before the full term. Medical definition for termination of pregnancy. when the contents expelled before 28 weeks - ABORTION Expulsion after 28 weeks is called as ‘ PREMATURE LABOUR . But legal definition is different.

3. Legal definition Legally, miscarriage, abortion and premature delivery are considered as synonymous terms indicating termination of pregnancy at any stage before confinement.

4. Types of abortion 1.Natural ( spontaneous) a spontaneous abortion. Occur in 10-20% of all pregnancies. Common at the gestational period of 2-3 months. 2. artificial / doctor induced- It may be of two types 1.legal abortion and 2. illegal abortion

5. Spontaneous abortion Causes Genetic ( 50%) Diseases of mother (HT, DM) Uterine abnormalities (retroverted/ submucous fibroids/hypoplasia) Hormonal insufficiencies Gross malformations of zygote Placental/Decidual diseases Infection

6. MEDICAL TERMINATION OF PREGNANCY ACT (1971) this act liberalized termination of pregnancy on various socio-medical grounds. it was brought into force on 1st April, 1972 and was aimed at eliminating abortion by untrained persons and in unhygienic conditions and saving lives of women who resorted to criminal abortion out of desperation, thereby succumbing to its complications.

7. According to Family Planning Association of India An estimated four million unsafe abortions are carried out every year in the country, and about 20,000 women die due to such abortions. Abortions carried out for the purpose of female feticide are generally ‘mid trimester’ and involve greater risk.

8. the Act provides the following grounds (indications) for termination of pregnancy: 1 . therapeutic ground 2. eugenic ground 3. humanitarian ground 4. socio-economic ground

9. 1.therapeutic ground where the continuance of the pregnancy would involve a risk to the life of the pregnant woman or of grave injury to her physical or mental health .

10. 2.eugenic ground where there is a substantial risk - child is born, it would suffer from such physical or mental abnormalities so as to be seriously handicapped. what may constitute grave injury to pregnant woman’s mental health.

11. Explanation 1: where any pregnancy is alleged by the pregnant woman to have been caused by rape , the anguish caused by such pregnancy shall be presumed to constitute a grave injury to the mental health of the pregnant woman (3. humanitarian ground ).

12. Explanation 2 where any pregnancy occurs as a result of failure of any device or method used by any married woman or her husband for the purpose of family planning , the anguish (suffering) caused by such unwanted pregnancy may be presumed to constitute a grave injury to the mental health of the pregnant woman (4. socio-economic ground ).

13. MTP AND DURATION OF PREGNANCY for a pregnancy of less than 12 weeks’ duration , one medical officer can take the decision of performing abortion. If the pregnancy is beyond 12 weeks but less than 20 weeks , opinion of two medical officers is required to terminate the pregnancy.

14. In case exceeding 20 weeks however, in case of an emergency situation, a pregnancy exceeding 20 weeks can be terminated even if only one doctor is available and the opinion to terminate pregnancy is formed in good faith. further, under such a situation, the specific experience or training in gynecology and obstetrics, i.e. holding of postgraduate degree or diploma, shall not be applicable.

15. PLACE FOR MTP the Act lays down certain requirements in respect of place where the MTP can be performed: Government and quasigovernment hospitals, MTP centers approved by the government, etc. ‘certificate of approval’ by the government must be conspicuously displayed at such approved centers.

16. EXPERIENCE AND TRAINING OF A DOCTOR the act describes ‘registered medical practitioner’ as one 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 such experience or training in gynaecology and obstetrics as may be prescribed by rules made under this act. the rules provide for the following experience and training

17. Up to 12 Weeks of Gestation If he has assisted a registered medical practitioner in performing 25 cases of medical termination of pregnancy, of which at least five have been performed independently, in a hospital established or maintained or a training institute approved for this purpose by the government.

18. Up to 20 Weeks of Gestations the medical practitioner who was registered in a state medical register immediately before the commencement of the act, having experience in the practice of gynaecology and obstetrics for a period of not less than 3 years .

19. In other cases If he has completed 6 months of house surgency in gynaecology and obstetrics or if he had experience at any hospital for a period of not less than 1 year in the practice of obstetrics and gynaecology. In case of a medical practitioner who holds a postgraduate degree or diploma in gynaecology and obstetrics, the experience or training gained during the course of such degree or diploma

20. R OLE OF CONSENT the entire scheme of the act shows that the provisions thereof can be invoked only by the pregnant woman. an adult woman (18 years and above ) can give a valid consent. however, in case of a minor (below 18 years) or a mentally ill woman, consent of a guardian must be obtained . (it is the doctor’s responsibility to ensure the age of the patient and to take her guardian’s consent if she is a minor. a doctor got into trouble where a minor girl claimed herself to be a major and signed the consent form ). her spouse’s consent is not required . however, it is wise to get either husband or any other adult person’s signature as a witness to the woman’s consent.

21. Criminal / illegal abortion Termination of pregnancy without legal justification. The termination of pregnancy which ever is indicated beyond the provisions of M T P Act 1971. Methods used ◦ Abortificient drugs ◦ General violence ◦ Local violence

22. General violence Intentional  Severe pressure on abdomen  Violent exercise horse riding cycling skipping jumping  Cupping  Hot and cold hip bath Accidental

23. Local violence  Syringing  Syringe and aspiration  Vacuum aspiration  Rupturing of membrane  Abortion stick  Dilation of cervix  Air insufflations  Electric current  Paste

24. Abortion Stick  Bamboo stick 12-18 cm long wrapped at one with Cotton, Wool or Cloth  Soaked with juice of Marking Nut , Calotropis or  Paste made of Arsenous Oxide or Lead  Sticks can also be of  Plumbago Rosea ,  Calotropis,  Nerium Odorum

25. Criminal abortion

26. Complications (instrumentation, suction termination, higginson’s syringe) immediate:  vagal inhibition (without or inadequate anaesthesia).  anaesthetic deaths (dot) early:  embolism (air, amniotic fluid, fluid)  haemorrhage (tears in vag.wall , cervix, post.fornix , uterus, perf.abdominal organs)

27. Late complications …….. Effects of haemorrhage (shock, DIC, ARF )  infections  uterine (septic instruments, vulval /vaginal infection spreading through instruments, injuries to genital tract, rpoc -streptococci, coliform, clostridia)  pelvic (perforation of post. fornix, ut. wall)  abdominal (perforation of uterus, intestines, bladder)  tetanus & gas gangrene

28. Late complications sterility (due to salpingitis/ PID) pelvic vein thrombosis-> pulmonary thrombo embolism . DIC- disseminated intra vascular coagulation acute renal failure septicaemia

29. Criminal abortion , RUPTURED UTERUS

30. Uterine rupture

31. SEC. 312 IPC. Causing miscarriage whoever voluntarily causes a woman with child to miscarry, punished with imprisonment to three years , or with fine, or with both if the woman be quick with child, shall be punished with imprisonment seven years , and fine. explanation:- a woman who causes herself to miscarry, is within the meaning of this section

32. SEC.314 IPC. death caused by act done with intent to cause miscarriage whoever, with intent to cause the miscarriage of woman with child, does any act which causes the death of such woman , punished for a term may extend to ten years, and fine if act done with woman’s consent. and if the act is done without the consent of the woman punished either with imprisonment for life or with the punishment above mentioned.

33. SEC. 315 IPC . act done with intent to prevent child being born alive or to cause it to die after birth : - any act with the intention of there by preventing that child from being born alive or causing it to die after its birth, be punished with imprisonment of which may extend to ten years , or with fine, or with both

34. SEC. 316 IPC. causing death of quick unborn child by act amounting to culpable homicide:- whoever does any act under such circumstances, that if he thereby caused death he would be guilty of culpable homicide , and does by such act cause the death of a quick unborn child, shall be punished with imprisonment which may extend to ten years also be liable to fine .

35. SEC. 317 IPC . exposure and abandonment of child under twelve years, by parent or person having care of it .- whoever being the father or mother of a child under the age of twelve years, having the care of such child, shall expose or leave such child in any place with the intention of wholly abandoning such child , shall be punished with imprisonment extend to seven years ; or with fine, or with both. explanation.- this section is note intended to prevent the trial of the offender for murder or culpable homicide, as the case may be, if the child die in consequence of exposure.

36. SEC.318 IPC. concealment of birth by secret disposal of dead body . whoever, by secretly burying or otherwise disposing of the dead body of a child whether such child die before or during its birth, intentionally conceals or endeavors to conceal the birth of such child , shall be punished with imprisonment of either description for a term which may extend to two years , or with fine, or with both.

37. Abortion and laws in other countries

38. Sources/ courtesy to 1.Textbook of Forensic Medicine and Toxicology by Dr Krishan Vij MD LLB 2.(slide share ) Dr Kaleem Khan Assistant Professor JNMCH,AMU,ALIGARH 3. SLIDESHARE

39. Thanking you