THE MEDICAL TERMINATION OF PREGNANCY ACT, 1971

Presented by:Divya Sridharan

PGD-HCM(2011-2013)Welingkar institute of

managemnt, development and research

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

LEGAL ABORTIONSAbortions 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

DEFINITIONS UNDER THE ACT

"guardian" means a person having the care of the person of a minor or a lunatic.

"lunatic" has the meaning assigned to it in Section 3 of the Indian Lunacy Act, 1912

"minor" means a person who, under the provisions of the Indian Majority Act,1875, is to be deemed not to have attained his majority;

"registered medical practitioner" means 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 such experience of training in gynaecology and obstetrics as may be prescribed by rules made under this Act.

When Pregnancies Can 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 two RMPs required for termination of pregnancy between 12 and 20 weeks

MTP ACT INDICATIONS Continuation of pregnancy constitutes 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)

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.

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

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. Consent form.

DEFINITIONS UNDER RULES

Definitions - In these rules, unless the context otherwise requires,-

"Act means the Medical Termination of Pregnancy Act, 1971 (34 of 1971);

"Chief Medical Officer of the District" means the Chief Medical Officer of a District, by whatever name called;

"Form" means a form appended to these rules "Owner" in relation to a place, means any person who is the

administrative head or otherwise responsible for the working or maintenance of such hospital or clinic, by whatever name called

"Place" means such building, tent, vehicle, or vessel, or part thereof, as is used for the establishment or maintenance therein of a hospital or clinic which is used, or intended to be used, for the termination of any pregnancy.

"Section" means a section of the Act.

Who Can Perform MTP ?

A medical practitioner (RMP) who has a recognized medical qualification as

defined in clause (h) of section 2 of Indian Medical Council Act, 1956

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

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

MTP RULES: Training Requirement - 2

For termination beyond 12 weeks and up to 20 weeks 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.

APPROVAL OF A PLACE No place shall be approved under clause (b) of

Section 4, unless the Government is satisfied that termination of pregnancies may be done therein under safe and hygienic conditions and unless the following facilities are provided therein namely:-

An operation table and instruments for performing abdominal or gynaecological surgery:

anaesthetic equipment, resuscitation equipment and sterilisation equipment

drugs and parenteral fluids for emergency use.

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 Place to be inspected within 2 months of receiving

application. Certificate to be issued within 2 months of inspection.

APPROVING COMMITTEE

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

INSPECTION CMHOs to inspect to ensure safe & hygienic

conditions for conduction of MTPs. If the place is found unsatisfactory for safe and

hygienic termination the CMHO can Call for information and seize any article, medicine, ampule, admission register or other document, maintained, kept or found at the place.

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.

FORM A-APPLICATION FOR APPROVAL OF A PLACE

Name of the place (in capital letters) Address in full Non-Governmental/Private/Nursing Home/Other Institutions* State, if the following facilities are available at the place - An operation table and instruments for performance

abdominal or gynaecological surgery. Drugs and parental fluid in sufficient supply emergency

cases Anaesthetic equipment, resuscitation equipment and

sterilisation equipment. Place : Date : Signature of the owner of the place

FORM B-CERTIFICATE OF APPROVAL

It states that the place described below is hereby approved for the purpose of the Medical Termination of Pregnancy Act, 1971 (34 of 1971).

Name of the Place Address and other descriptions Name of the owner Place : Date : to the Government of the ...................

FORM C - CONSENT I ............................................................... daughter/wife of ............................................... aged

about ............................................ Years of ........................................................................ (here state the permanent address) at present residing at ............................................................... do hereby give my consent to be

termination of my pregnancy at ............................................... (State the name of place where the pregnancy is to be terminated). Place : Date : Signature

(To be filled in by guardian where the woman is a lunatic or minor). I ................................................. son/daughter/wife of ...................................................... aged

about ......................................... Years of ............................................. at present residing at ............................................................................................. (permanent address) ............................................... do hereby give my consent to the termination of my pregnancy of my ward ......................................... who is a minor/lunatic at ................................................

(Place of termination of pregnancy). Place : Date : Signature

MTP REGULATIONS: What Do They Cover?

Forms to be required for making opinion, admission register and reporting of MTPs

Custody of forms Prevention of disclosure of information

DEFINITIONS UNDER REGULATIONS

"Act" means the Medical Termination of Pregnancy Act, 1971 (34 of 1971);

"Admission Register" means the register maintained under regulation 5

"Approved place" means a place approved under rule 4 of the Medical Termination of Pregnancy Rules, 1975;

'Chief Medical Officer of the State" means the Chief Medical Officer of the State, by whatever name called

"Forms" means a form appended to these regulations; "Hospital" means a hospital established or maintained

by the Central Government or, the Government of Union territory.

"Section" means a Section of the Act.

What The Regulations Include….????

Forms of certifying opinion or opinions Custody of forms Maintenance of admission register Admission register not to be open to

inspection Entries in registers maintained in hospital

or approved place. Destruction of Admission Register and

other Papers

FORMS OF CERTIFYING OPINION

Every registered medical practitioner who terminates any pregnancy shall, within three hours from the termination of the pregnancy certify such termination in Form 1.

CUSTODY OF FORMS The consent and the certified opinion given by the

medical practitioner will be sealed in an envelope and kept in safe custody until it is sent to the head of the hospital or owner of the approved place of the Chief Medical Officer of the State.

Every such envelope should contain the serial number assigned to the pregnant woman in the Admission Register and the name of the registered medical practitioner or practitioners by whom the pregnancy was terminated and such envelope shall be marked "Secret".

Every head of the hospital or owner of the approved place shall send to the Chief Medical Officer of the State a weekly statement of cases where medical termination of pregnancy has been done in Form II.

MAINTENANCE OF ADMISSION REGISTER

Every head of the hospital or owner of the approved place shall maintain a registered in Form III for recording therein the admissions or woman for the termination of their pregnancies.

The Admission Register shall be a secret document and the information contained therein as to the name and other particulars of the pregnant woman shall not be disclosed to any person.

DESTRUCTION OF ADMISSION REGISTER AND OTHER PAPERS

Every Admission Register shall be destroyed on the expiry of a period of five years from the date of the last entry in that Register and other papers on the expiry of a period of three years from the date of termination of the pregnancy concerned.

THANK YOU

No woman can call herself free until she can choose consciously whether she will or will not be a mother.A choice is only possible if there are genuine alternatives and MTP act provides this choice to every woman.