1. The Medical Termination of Pregnancy Act, Rules, Amendments -by Dr Sayan Das DMCHO, South 24 parganas

2. Background (1/2) IPC 312: Any one voluntarily causing miscarriage to woman with child, other than in good faith for purpose of saving her life is punishable by imprisonment (simple or rigorous) up to 3 years, with /without fine. Women who caused her self to miscarry are also counted. IPC 312: Any one voluntarily causing miscarriage to woman with child, other than in good faith for purpose of saving her life is punishable by imprisonment (simple or rigorous) up to 3 years, with /without fine. Women who caused her self to miscarry are also counted. IPC 313 (Abortion without consent): Punishable by life imprisonment or up to 10 years with fine IPC 313 (Abortion without consent): Punishable by life imprisonment or up to 10 years with fine IPC 314 (death due to procedure): Imprisonment up to 10 years with fine, may be extended to life imprisonment if with out consent. IPC 314 (death due to procedure): Imprisonment up to 10 years with fine, may be extended to life imprisonment if with out consent.

3. Background (2/2) In 1964: Maternal mortality increases In 1964: Maternal mortality increases Married women under no socio-cultural pressure – seeking abortion service Married women under no socio-cultural pressure – seeking abortion service Abortion is illegal- opted for unsafe method- maternal mortality Abortion is illegal- opted for unsafe method- maternal mortality The Shah Committee appointed by GOI-recommended legislation in 1966- some state wants it to decrease population The Shah Committee appointed by GOI-recommended legislation in 1966- some state wants it to decrease population Committee denies it Committee denies it In 1971, The Medical Termination of Pregnancy (MTP) Act passed- applied all over India except Jammu & Kashmir in 1972 In 1971, The Medical Termination of Pregnancy (MTP) Act passed- applied all over India except Jammu & Kashmir in 1972 Jammu & Kashmir and Mizoram adopted in 1980 Jammu & Kashmir and Mizoram adopted in 1980 GOI: Government of India

4. The MTP Act, Rules, Amendments The Medical Termination of Pregnancy Act, 1971 (Act No. 34 of 1971) The Medical Termination of Pregnancy Rules, 1975 The Medical Termination of Pregnancy (Amendment) Act, 2002 (Act No. 64 of 2002) The Medical Termination of Pregnancy Rules, 2003 The (Amendment) Act 2021 The Medical Termination of Pregnancy (Amendment) Act 2021 (Act No. 8 of 2021)

5. The MTP Act (no 34 of 1971) Can be terminated up to 20 weeks of pregnancy Can be terminated up to 20 weeks of pregnancy Requires a second doctor’s approval- if beyond 12 weeks Requires a second doctor’s approval- if beyond 12 weeks When Conducted - When Conducted - o To save the life of mother or it cause grave physical or mental illness o When pregnancy is due to rape o Contraceptive failure in married women o Substantial risk that if child born, would be seriously affected with mental and/or physical disability o Written Consent:  By the woman  By legal guardian, if women is lunatic or minor

6. The MTP Act (no 34 of 1971) Who can Conduct- Who can Conduct- o Registered Medical Practitioner with recognize medical qualification in Clause(b) Section 2 of The Indian Medical Council Act, 1956 o Registered in any State Medical Register o Have training experience as per MTP rules

7. Experience required as per the MTP rules,1975 o Up to 12 weeks 1 years experience in G&O department 1 years experience in G&O department 6 months of House Surgeon ship in G&O 6 months of House Surgeon ship in G&O Worked with an RMP- 25 cases done 5 of which by own Worked with an RMP- 25 cases done 5 of which by own Before commencement of act- minimum 3 years of experience Before commencement of act- minimum 3 years of experience o From 12 weeks to 20 weeks PG degree or diploma in G&O PG degree or diploma in G&O Completed 6 months of House staff ship in G&O Completed 6 months of House staff ship in G&O At least one year experience in G&O at any Government Hospital have all facilities At least one year experience in G&O at any Government Hospital have all facilities RMP: Registered Medical Practitioner, G&O: Gynecology & Obstetrics

8. Abortion in 1970-2000 1972 to 1986: 10% increase in abortion 1972 to 1986: 10% increase in abortion In 90s: shows decline trends In 90s: shows decline trends 2/3rd facilities are urban 2/3rd facilities are urban Less than 10% of estimated abortion reported Less than 10% of estimated abortion reported 2-11 illegal abortion performed per single legal case 2-11 illegal abortion performed per single legal case Thus all are not unsafe, when done at unapproved place Thus all are not unsafe, when done at unapproved place In most states: less 20% PHC provide abortion services In most states: less 20% PHC provide abortion services Both public & private: poor technique, counselling, privacy Both public & private: poor technique, counselling, privacy Dilatation & Curettage preferred than vacuum aspiration Dilatation & Curettage preferred than vacuum aspiration

9. Abortion law reform since 2000 Act amended - 2002, Rules and Regulation amended – 2003 Act amended - 2002, Rules and Regulation amended – 2003 Power shift to district level from state level Power shift to district level from state level Provision of punishment 2-7 year for provider & owner of unapproved place Provision of punishment 2-7 year for provider & owner of unapproved place Approval with in 60 days with inspection by CMO/DLC or with in 60 days after rectification of any deficiency found Approval with in 60 days with inspection by CMO/DLC or with in 60 days after rectification of any deficiency found Facilities dose not requires onsite management of emergency Facilities dose not requires onsite management of emergency Allow medical abortion facility (up to 7 weeks) Allow medical abortion facility (up to 7 weeks)  RMP dose not need approval from DLC for place  Only registered doctor can prescribe  Need to follow all rules and regulation under MTP Act Rules and Regulations formed in 1975 previously, CMO: chief Medical Officer, DLC: District Level Committee

10. The MTP (Amendment) Act, 2021 (1/2) Allows abortion for up to 20 weeks based on the judgement of one medical practitioner. 2 doctor’s consent required - pregnancies between 20-24 weeks. The District Level Medical Board - evaluate whether abortions after 24 weeks are permissible based on significant foetal abnormalities only The writ petition has to be filed - rape and a gestation period of more than 24 weeks. Up to a period of 20 weeks by a married woman if a contraceptive method or device fails. The amended act has also allowed unmarried women to terminate a pregnancy under such circumstances.

11. The MTP (Amendment) Act, 2021 (2/2) No registered medical practitioner shall reveal the name and other particulars of a woman whose pregnancy has been terminated under this Act except to a person authorized by any law for the time being in force No registered medical practitioner shall reveal the name and other particulars of a woman whose pregnancy has been terminated under this Act except to a person authorized by any law for the time being in force

12. How to apply for MTP License & Reporting Pre-requisite: CE License Pre-requisite: CE License Apply in Form No A Apply in Form No A Inspection from CMOH Office Inspection from CMOH Office District Level License committee meeting District Level License committee meeting Issuance of License in Form No B Issuance of License in Form No B Quarterly reporting to RCH section of CMOH Office Quarterly reporting to RCH section of CMOH Office Note: Mandatory consent from mother to be taken in Form C for each case

13. Safer abortion – Better reproductive health Thank You