Medical termination of pregnancy act ,1971,

medical termination of pregnancy act,1971 for the pharmacy graduates.

1. Medical Termination Medical Termination
of Pregnancy act, 1971of Pregnancy act, 1971
ByBy
M.swethaM.swetha

2. PerspectivePerspective
26 million pregnancies are terminated annually legally.26 million pregnancies are terminated annually legally.
20 million terminated illegally.20 million terminated illegally.
78000 annual deaths. In India: 11.8% of MMR (GOI, 1990).78000 annual deaths. In India: 11.8% of MMR (GOI, 1990).
Abortion care centres are few & far between, Abortion care centres are few & far between,
accessibility is poor, training inadequate and do not meet accessibility is poor, training inadequate and do not meet
MTP Act requirements.MTP Act requirements.
Paramedics and quacks are involved more often than Paramedics and quacks are involved more often than
not. not.

3. Aims to improve the maternal health scenario by Aims to improve the maternal health scenario by
preventing large number of unsafe abortions and preventing large number of unsafe abortions and
consequent high incidence of maternal mortality & consequent high incidence of maternal mortality &
morbidity morbidity
Legalizes abortion servicesLegalizes abortion services
Promotes access to safe abortion services to Promotes access to safe abortion services to
womenwomen
De-criminalizes the abortion seekerDe-criminalizes the abortion seeker
Offers protection to medical practitioners who Offers protection to medical practitioners who
otherwise would be penalized under the Indian otherwise would be penalized under the Indian
Penal Code (sections 315-316)Penal Code (sections 315-316)

4. MTP Act MTP Act
lays down when & where pregnancies can lays down when & where pregnancies can
be terminatedbe terminated
Grants the central govt. power to make Grants the central govt. power to make
rules and the state govt. power to frame rules and the state govt. power to frame
regulationsregulations
MTP RegulationsMTP Regulations
lays down forms for opinion, maintenance lays down forms for opinion, maintenance
of recordsof records
custody of forms and reporting of casescustody of forms and reporting of cases

5. MTP RulesMTP Rules
lays down who can terminate the lays down who can terminate the
pregnancy, training requirements, approval pregnancy, training requirements, approval
process for place, etcprocess for place, etc. .

6. Legal abortionsLegal abortions
Abortions are termed legal only when all the Abortions are termed legal only when all the
following conditions are met:following conditions are met:
Termination done by a medical practitioner Termination done by a medical practitioner
approved by the Actapproved by the Act
Termination done at a place approved Termination done at a place approved
under the Actunder the Act
Termination done for conditions and within Termination done for conditions and within
the gestation prescribed by the Actthe gestation prescribed by the Act
Other requirements of the rules & Other requirements of the rules &
regulations are complied withregulations are complied with

7. When can pregnancies be When can pregnancies be
terminated? terminated?
Up to 20 weeks gestationUp to 20 weeks gestation
With the consent of the women. If the women is With the consent of the women. If the women is
below 18 years or is mentally ill, then with below 18 years or is mentally ill, then with
consent of a guardianconsent of a guardian
With the opinion of a registered medical With the opinion of a registered medical
practitioner, formed in good faith, under certain practitioner, formed in good faith, under certain
circumstancescircumstances
Opinion of two RMPs required for termination of Opinion of two RMPs required for termination of
pregnancy between 12 and 20 weekspregnancy between 12 and 20 weeks

8. Exemptions Exemptions
Continuation of pregnancy constitutes risk to Continuation of pregnancy constitutes risk to
the life or grave injury to the physical or mental the life or grave injury to the physical or mental
health of womanhealth of woman
Substantial risk of physical or mental Substantial risk of physical or mental
abnormalities in the fetus as to render it abnormalities in the fetus as to render it
seriously handicappedseriously handicapped
Pregnancy caused by rape (presumed grave Pregnancy caused by rape (presumed grave
injury to mental health)injury to mental health)
Contraceptive failure in married couple Contraceptive failure in married couple
(presumed grave injury to mental health)(presumed grave injury to mental health)

9. Cont……..Cont……..
““In determining whether the continuance of In determining whether the continuance of
pregnancy would involve such risk of injury to pregnancy would involve such risk of injury to
the health (as mentioned above), account may be the health (as mentioned above), account may be
taken of the pregnant woman’s actual or taken of the pregnant woman’s actual or
reasonable foreseeable environment”reasonable foreseeable environment”

10. MTP Act: Place for conducting MTP Act: Place for conducting
MTPMTP
A hospital established or maintained by A hospital established or maintained by
GovernmentGovernment
oror
A place approved for the purpose of this Act by a A place approved for the purpose of this Act by a
District-level Committee constituted by the District-level Committee constituted by the
government with the CMHO as Chairpersongovernment with the CMHO as Chairperson

11. For termination up to 12 weeks:For termination up to 12 weeks:
A practitioner who has assisted a registered A practitioner who has assisted a registered
medical practitioner in performing 25 cases of medical practitioner in performing 25 cases of
MTP of which at least 5 were performed MTP of which at least 5 were performed
independently in a hospital established or independently in a hospital established or
maintained or a training institute approved for maintained or a training institute approved for
this purpose by the Governmentthis purpose by the Government

12. For termination up to 20 weeksFor termination up to 20 weeks
A practitioner who holds a post-graduate A practitioner who holds a post-graduate
degree or diploma in Obstetrics and degree or diploma in Obstetrics and
GynecologyGynecology
A practitioner who has completed six months A practitioner who has completed six months
house job in Obstetrics and Gynecologyhouse job in Obstetrics and Gynecology
A practitioner who has at least one-year A practitioner who has at least one-year
experience in practice of Obstetrics and experience in practice of Obstetrics and
Gynecology at a hospital which has all Gynecology at a hospital which has all
facilitiesfacilities
A practitioner registered in state medical A practitioner registered in state medical
register immediately before commencement of register immediately before commencement of
the Act, experience in practice of Obstetrics the Act, experience in practice of Obstetrics
and Gynecology for a period not less than and Gynecology for a period not less than
three years.three years.

13. For termination of pregnancy at For termination of pregnancy at
any stageany stage
It can be done by medical practitioner when the It can be done by medical practitioner when the
life of mother is in danger.life of mother is in danger.
It is done only in hospitals with adequate It is done only in hospitals with adequate
facilities are there.facilities are there.

14. Methods of AbortionMethods of Abortion
A. Surgical: A. Surgical:
 By using mechanical device they r removing the By using mechanical device they r removing the
fetus fetus
Disadvantages of Surgical abortion:-Disadvantages of Surgical abortion:-
Requires highly skilled personnel, because:-Requires highly skilled personnel, because:-
Blind technique.Blind technique.
Pregnant uterus is very soft & prone to injuryPregnant uterus is very soft & prone to injury

15. Methods of AbortionMethods of Abortion
SurgicalSurgical….contd….contd..
Requirement of Anaesthesia: GA or localRequirement of Anaesthesia: GA or local
Higher chance ofHigher chance of septic abortion.septic abortion.
Mostly following illegal induced abortion Mostly following illegal induced abortion
(>90%). 6.5% from legal surgical abortion.(>90%). 6.5% from legal surgical abortion.
Very high mortality: 6-13%Very high mortality: 6-13%
Serious morbidity including fecal fistula.Serious morbidity including fecal fistula.

16. Methods of AbortionMethods of Abortion
Medical:-Medical:- also called “Chemical abortion”.also called “Chemical abortion”.
Advantages:-Advantages:-
Possible at earlier stage of pregnancy.Possible at earlier stage of pregnancy.
Private procedure.Private procedure.
No trauma to the utrus cevix and other organs.No trauma to the utrus cevix and other organs.
Post-abortal endometritis very rare.Post-abortal endometritis very rare.
No anaesthetic hazards.No anaesthetic hazards.

17. Methods of AbortionMethods of Abortion
Medical abortionMedical abortion….contd.….contd.
Disadvantages:-Disadvantages:-
Lengthy procedureLengthy procedure
UncertainUncertain
Unpredictable (timing).Unpredictable (timing).
Failure rate: 2-10%.Failure rate: 2-10%.
Psychological effect.Psychological effect.
Difficulty in diagnosing ectopic pregnancy.Difficulty in diagnosing ectopic pregnancy.
Side-effects of drugs.Side-effects of drugs.

18. Mifepristone, MisoprololMifepristone, Misoprolol
Antagonizes progesterone at target Antagonizes progesterone at target
tissue.tissue.

19. Approval of a place Approval of a place up to 12 up to 12
weeks MTPweeks MTP
Gynecology examination/ labor tableGynecology examination/ labor table
Resuscitation and sterilization equipment Resuscitation and sterilization equipment
Drugs & parental fluidsDrugs & parental fluids
B ack up facilities for treatment of shock B ack up facilities for treatment of shock
Facilities for transportationFacilities for transportation

20. Approval of a place Approval of a place up to up to
20weeks MTP20weeks MTP
All requirements for up to 12 weeks +All requirements for up to 12 weeks +
Operation table and instruments for performing Operation table and instruments for performing
abdominal or gynecological surgeryabdominal or gynecological surgery
Anesthetic equipment, resuscitation equipment Anesthetic equipment, resuscitation equipment
and sterilization equipmentand sterilization equipment
Drugs & parental fluids notified for emergency Drugs & parental fluids notified for emergency
use, notified by Government of India from time to use, notified by Government of India from time to
time.time.

21. Regulatory bodyRegulatory body
District level MTP CommitteeDistrict level MTP Committee
Minimum of 3 & Maximum of 5 membersMinimum of 3 & Maximum of 5 members
including chairperson (CM H O)including chairperson (CM H O)
Composition of the committee:Composition of the committee:
One medical person (Gynic /Surgeon/ One medical person (Gynic /Surgeon/
Anesthetist)Anesthetist)
One member from local medical profession; One member from local medical profession;
NGO & Panchayati Raj Institution of the NGO & Panchayati Raj Institution of the
district.district.
At least one member shall be a woman.At least one member shall be a woman.

22. Tenure 2 calendar yearsTenure 2 calendar years
NGO members shall not have more than NGO members shall not have more than
22termsterms

23. Approval ProcessApproval Process
Application in Form A to be addressed to CMHO Application in Form A to be addressed to CMHO
by place seeking approvalby place seeking approval
CMHO verifies or inspects the place to satisfy CMHO verifies or inspects the place to satisfy
that termination can be done under safe & that termination can be done under safe &
hygienic conditionshygienic conditions
CMHO recommends approval to the committeeCMHO recommends approval to the committee
Committee considers application & Committee considers application &
recommendation and approve and issue recommendation and approve and issue
certificate of approval in Form Bcertificate of approval in Form B

24. Cont……..Cont……..
Place to be inspected within 2 months of Place to be inspected within 2 months of
receiving applicationreceiving application
Certificate to be issued within 2 months of Certificate to be issued within 2 months of
inspectioninspection
If deficiency found, within 2 months of deficiency If deficiency found, within 2 months of deficiency
having been rectifiedhaving been rectified

25. Inspection/cancellationInspection/cancellation
CMHOs to inspect to ensure safe & hygienic CMHOs to inspect to ensure safe & hygienic
conditions for conduction of MTPs.conditions for conduction of MTPs.
Call for information and seize in case found Call for information and seize in case found
otherwise CMHO to report the committee for otherwise CMHO to report the committee for
unsafe and unhygienic conditions.unsafe and unhygienic conditions.
Committee can suspend or cancel approval after Committee can suspend or cancel approval after
giving the owner an opportunity for giving the owner an opportunity for
representationrepresentation
Owner can reapply to the committee after making Owner can reapply to the committee after making
additions and improvements.additions and improvements.
During suspension the place be deemed as non-During suspension the place be deemed as non-
approvedapproved

26. MTP regulationsMTP regulations
Power to states to make regulations regarding Power to states to make regulations regarding
MTP servicesMTP services
Regulations for Union Territories by Central Govt.Regulations for Union Territories by Central Govt.
Application of central govt. regulations in the Application of central govt. regulations in the
absence of state regulationsabsence of state regulations
Forms to be required for making opinion, Forms to be required for making opinion,
admission register and reporting of MTPsadmission register and reporting of MTPs
Custody of formsCustody of forms
Prevention of disclosure of informationPrevention of disclosure of information

27. MTP regulations: opinion formsMTP regulations: opinion forms
F or an MTP, opinion of an approved RMP F or an MTP, opinion of an approved RMP
(2 RMPs for 2(2 RMPs for 2
ndnd
trimester) is required. trimester) is required.
The provider(s) is required to certify his/her The provider(s) is required to certify his/her
opinion in Form I within three hours of opinion in Form I within three hours of
terminating a pregnancy.terminating a pregnancy.

28. Declining sex ratios…Declining sex ratios…
•Census 2001 confirmed apprehensions of Census 2001 confirmed apprehensions of
declining juvenile sex ratios. declining juvenile sex ratios.
•Parallel with steep increase in availability of Parallel with steep increase in availability of
ultrasound machines and use during pregnancyultrasound machines and use during pregnancy
•Sex determination testing followed by second Sex determination testing followed by second
trimester abortion- major pathway for sex trimester abortion- major pathway for sex
selectionselection
•Public interest litigation triggered amendments in Public interest litigation triggered amendments in
Act of 1994Act of 1994
•Focus on “female feticide” as having attained Focus on “female feticide” as having attained
endemic proportionsendemic proportions

29. Safe Abortion and Sex Selection Safe Abortion and Sex Selection
PathwaysPathways
Sexual violenceSexual violence
Unwanted pregnancyUnwanted pregnancy
Unwanted sex Unwanted sex
Desire for sonDesire for son

Sex determinationSex determination

AbortionAbortion

30. Choices along the thin edge separating Choices along the thin edge separating
the two are:the two are:
◦Restricting access to abortion to prevent sex Restricting access to abortion to prevent sex
selectionselection
◦Dealing with the two issues separatelyDealing with the two issues separately
◦Developing a integrated strategy to address Developing a integrated strategy to address
both sex selection and unsafe abortion both sex selection and unsafe abortion
together together