MEDICAL TERMINATION OF PREGNANCY ACT 1971 .ppt

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.


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

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)
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

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 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

To save life of mother but limited and scarcely justifiable except in :
Cardiac disease (NYHA gr III/ IV) with history of decompensation I previous pregnancies or in between pregnancies
Chronic glomerulonephritis
Malignant hypertension
Intractable hyperemesis gravidarum
Cervical and breast malignancies
DM with retinopathy
Epilepsy or psychiatric illness


This is almost sole indications to prevent grave injury to physical and mental health of pregnant woman
Pregnancy is caused by rape both in case of major and minor girl and in mentally imbalanced women
As a result of failure of contraception
In 80% cases it is limited to parous women having unplanned pregnancy with low SE status
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

1. Medical Termination of Pregnancy
(MTP) Act
Mr. Abhinav Bhatt

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 upto10 yersimprisonment
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
Aimstoimprovethematernalhealthscenariobypreventinglarge
numberofunsafeabortionsandconsequenthighincidenceof
maternalmortality&morbidity
Legalizesabortionservices
Promotesaccesstosafeabortionservicestowomen
De-criminalizestheabortionseeker
Offersprotectiontomedicalpractitionerswhootherwisewouldbe
penalizedundertheIndianPenalCode(sections315-316)

6. Legalframework
•MTPAct
–laysdownwhen&wherepregnanciescanbe
terminated
–Grantsthecentralgovt.powertomakerulesand
thestategovt.powertoframeregulations
•MTPRules
–laysdownwhocanterminatethepregnancy,
trainingrequirements,approvalprocessforplace,
etc.
•MTPRegulations
–laysdownformsforopinion,maintenanceofrecords
–custodyofformsandreportingofcases

7. Legal abortions
Abortionsaretermedlegalonlywhenallthefollowing
conditionsaremet:
–Terminationdonebyamedicalpractitionerapproved
bytheAct
–TerminationdoneataplaceapprovedundertheAct
–Terminationdoneforconditionsandwithinthe
gestationprescribedbytheAct
–Otherrequirementsoftherules&regulationsare
compliedwith

8. When can pregnancies be terminated?
•Upto20weeksgestation
•Withtheconsentofthewomen.Ifthewomenis
below18yearsorismentallyill,thenwithconsent
ofaguardian
•Withtheopinionofaregisteredmedicalpractitioner,
formedingoodfaith,undercertaincircumstances
•OpinionofsingleRMPforterminationupto12
weeks
•OpinionoftwoRMPsrequiredforterminationof
pregnancybetween12and20weeks

9. MTP Act: Indications
THERAPEUTIC OR MEDICAL
Tosavelifeofmotherbutlimitedandscarcely
justifiableexceptin:
1)Cardiacdisease(NYHAgrIII/IV)withhistoryof
decompensationIpreviouspregnanciesorin
betweenpregnancies
2)Chronicglomerulonephritis
3)Malignanthypertension
4)Intractablehyperemesisgravidarum
5)Cervicalandbreastmalignancies
6)DMwithretinopathy
7)Epilepsyorpsychiatricillness

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 parouswomen
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 1
st
trimester

12. MTP Act: Place for conducting MTP
Ahospitalestablishedormaintainedby
Government
or
AplaceapprovedforthepurposeofthisActbya
District-levelCommitteeconstitutedbythe
governmentwiththeCMHOasChairperson

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
•Simplifiesregistrationofsiteswhichcanbedone
atdistrictlevelnow
•Providers can get their sites approved for
providing abortions under the MTP Act for 1
st
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?
•Enableproperimplementationoftheprovisionsof
theAct
•EnsurethatMTPservicesareprovidedby
qualifiedpersonsinsafeandhygienicsettings
•Helptomonitorqualityofservices

18. MTP rules: what do they cover?
•Experience&trainingrequiredforproviders
•Approvalofaplaceforterminatingpregnancy
undertheAct
•Composition&tenureofDistrictLevelCommittee
•Inspection,cancellationorsuspensionof
approval;review
•Consentform

19. MTP rules: Who can perform?
Amedicalpractitioner(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
Forterminationupto20weeks(opinionof2RMPs
required)
–Apractitionerwhoholdsapost-graduatedegree
ordiplomainObstetricsandGynecology
–Apractitionerwhohascompletedsixmonths
housejobinObstetricsandGynecology
–Apractitionerwhohasatleastone-year
experienceinpracticeofObstetricsand
Gynecologyatahospitalwhichhasallfacilities
–Apractitionerregisteredinstatemedicalregister
immediatelybeforecommencementoftheAct,
experienceinpracticeofObstetricsand
Gynecologyforaperiodnotlessthanthree
years.

22. Approval of a place by trimester
For sites up to 12 weeks (1
st
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 (1
st
and 2
nd
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
•DistrictlevelMTPCommittee
–Minimumof3&Maximumof5members
includingchairperson(CMHO)
•Compositionofthecommittee:
–Onemedicalperson(Gyne/Surgeon/Anestheist)
–Onememberfromlocalmedicalprofession;NGO
&PanchayatiRajInstitutionofthedistrict.
–Atleastonemembershallbeawoman.
•Tenure2calendaryears
–NGOmembersshallnothavemorethan2terms

25. Approval Process
•Application in Form A to be addressed to CMHO
by place seeking approval
•CMHOverifiesorinspectstheplacetosatisfy
thatterminationcanbedoneundersafe&
hygienicconditions
•CMHO recommends approval to the committee
•Committee considers application &
recommendation and approve and issue
certificate of approval in Form B

26. Application form for Approval (Form A)

27. Certificate for Approval ( F orm B )

28. Approval Process
•Placetobeinspectedwithin2monthsof
receivingapplication
•Certificatetobeissuedwithin2monthsof
inspection
•Ifdeficiencyfound,within2monthsofdeficiency
havingbeenrectified

29. Inspection
•CMHOstoinspecttoensuresafe&hygienic
conditionsforconductionofMTPs.
•Callforinformationandseizeincasefound
otherwise

30. Cancellation/ Suspension
•CMHOtoreportthecommitteeforunsafeand
unhygienicconditions.
•Committeecansuspendorcancelapprovalafter
givingtheowneranopportunityfor
representation
•Ownercanreapplytothecommitteeafter
makingadditionsandimprovements.
•Duringsuspensiontheplacebedeemedasnon-
approved

31. Multiple choice Questions

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

33. •A1) 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

39. A5) Husband consent is required

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

41. •A6) Legalizes contraceptive services

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

43. •A7) 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

45. •A8) Can be done upto 24 weeks

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

47. •A9 ) All of the above

48. THANK YOU