CHAPTER 4
LEGAL PROVISIONS IN
MIDWIFERY PRACTICE IN
INDIA
HIMANI
INC/MOH AND FW REGULATIONS CHAUHAN
Definition
The ‘Midwifery Services Initiative’ aims to create a cadre of Nurse
Practitioners in midwifery who are skilled in accordance with ICM
competencies, knowledgeable and capable of providing
compassionate women-center, reproductive, maternal and
newborn healthcare services and also develop an enabling
environment for integration of this cadre into the public health system,
in order to achieve the SDGs for maternal and newborn health.
HIMANI
Objectives of Midwifery Service Initiative CHAUHAN
To provide access to quality maternal and newborn health services
and promote natural birthing by promoting a positive child birthing
experience.
To promote respectful maternity care throughout pregnancy and
childbirth.
To identify, manage, stabilize and/or refer as needed, women and
their newborns experiencing complications.
To provide higher levels of healthcare facilities.
HIMANI
Development of New Guidelines CHAUHAN
To propose an alternative model of service provision for
strengthening reproductive, maternal and neonatal health services
in India.
Introduction of the midwifery model of care for normal births
in midwifery-led units of public health facilities.
Serve as a cost-effective and efficient model to provide quality
care and reduce over-medicalization.
HIMANI
CHAUHAN
To support various states in the roll out of midwifery
services. These guidelines will cover all areas related to the
midwifery programme such as education, regulation, human
resources and career progression, support structures,
operational models in aspirational districts and urban areas,
and monitoring and research priorities.
HIMANI
ICM CODE OF ETHICS CHAUHAN
Definition
A midwife is a person who has successfully completed a midwifery
education programme that is based on the ICM Essential Competencies
for Basic Midwifery Practice and the framework of the ICM Global
Standards for Midwifery Education is recognized in the country where
it is located; who has acquired the requisite qualifications to be
registered and/or legally licensed to practice midwifery and use the title
‘midwife’; and who demonstrates competency in the practice of
midwifery.
—International Confederation of Midwives
HIMANI
International Confederation of Midwives: CHAUHAN
Code of ethics
HIMANI
Midwifery Relationships CHAUHAN
Midwives support the right of women/families to participate
actively in decisions about their care.
Midwives empower women/families to speak for themselves on
issues affecting the health of women and families within their
culture/society.
Midwives support and sustain each other in their professional
roles, and actively nurture their own and others’ sense of self-worth.
HIMANI
CHAUHAN
Midwives recognize the human interdependence within their
field of practice and actively seek to resolve inherent conflicts.
Midwives have responsibilities to themselves as persons of
moral worth, including duties of moral self-respect and the
preservation of integrity.
HIMANI
CHAUHAN
Practice of Midwifery
Midwives encourage the minimum expectation that no woman or girl should
be harmed by conception or childbearing.
Midwives use up-to-date, evidence-based professional knowledge to
maintain competence in safe midwifery practices in all environments and
cultures.
Midwives respond to the psychological, physical, emotional and spiritual
needs of women seeking healthcare, whatever their circumstances (non-
discrimination).
HIMANI
CHAUHAN
Professional Responsibilities of Midwives
Midwives hold in confidence client information in order to protect
the right to privacy, and use judgment in sharing this information
except when mandated by law.
Midwives are responsible for their decisions and actions, and are
accountable for the related outcomes in their care of women.
Midwives participate in the development and implementation of
health policies that promote the health of all women and childbearing
families.
HIMANI
CHAUHAN
Advancement of Midwifery Knowledge and Practice
Midwives ensure that the advancement of midwifery
knowledge is based on activities that protect the rights of
women as persons.
Midwives develop and share midwifery knowledge through
a variety of processes, such as peer review and research.
Midwives contribute to the formal education of midwifery
students and ongoing education of midwives.
HIMANI
Ethical Concepts and Ethical Issues in CHAUHAN
Maternal Care
Patient’s Autonomy
Issues
The right to life, the right to quality services, the right to get
information, respect for patient’s right.
Advocacy
Issues
Provide beneficence, informed consent, advocate patient’s
rights.
HIMANI
CHAUHAN
Justice
Issues
Priority service, equal health services, mental health women.
Confidentiality
Issues
Maintain patient confidentiality and avoid disclosing illness,
infectious diseases, or foetal abnormalities.
HIMANI
CHAUHAN
Beneficence
Issues
Quality of care, promote a good care, Beneficence of
intervention.
Nonmaleficence
Issues
Protect the women and fetus, not to do harm, neglected
care that impaired fetus development.
HIMANI
CHAUHAN
Neonatal Ethical Issues
Implications of Advance Directives for Nursing Clinical
Practice
Implications of Decision-Making at the Time of Birth for
Nursing Clinical Practice
Implications of Using Developmental and Family Centered
Care in the NICU for Nursing Clinical Practice
HIMANI
CHAUHAN
Critical Care Decisions in Fetal and Neonatal Medicine
Deliberately Ending Life
• Decision Making
• Decisions About Whether to Start Intensive Care unit for
Extremely Premature Babies
• Withdrawing Treatment and Palliative Care
HIMANI
CHAUHAN
ADOPTION LAWS
Definition
Adoption is the legal and permanent transfer of parental rights
from a person or couple to another person or couple. Adoptive
parents have the same responsibilities and legal rights as
biological parents.
HIMANI
CHAUHAN
Persons who can adopt the child
HIMANI
CHAUHAN
Adoption Eligibility Criteria
A child in India can be adopted by an Indian citizen, NRI or a
foreign citizen. The procedure of adoption is different for all three.
Any person is eligible to adopt irrespective of their gender or
marital status.
In case a couple is adopting a child, they should have completed at
least two years of stable marriage and should have a joint
consensus for the adoption of the child.
The age difference between the child and the adoptive parents
should not be less than 25 years old.
HIMANI
Conditions to be Fulfilled by Parents CHAUHAN
The prospective adoptive parents need to be physically, emotionally
and mentally stable.
They should be financially stable.
The prospective parents should not be suffering from any life-
threatening diseases.
Couples with three or more kids are not considered for adoption
except in case of special-needs children.
A single female can adopt a child of any gender.
However, a single male is not eligible to adopt a girl child.
A single parent cannot be more than 55 years of age.
A couple cannot have a cumulative age of more than 110 years.
HIMANI
CHAUHAN
Laws governing adoption
HIMANI
CHAUHAN
Hindu Adoption and Maintenance Act of 1956
An adoptive parent is allowed to ask for a child, as per
her preferences (age, gender, skin colour, religion,
specific features and health conditions).
Single parent or married couples are not permitted to
adopt more than one child of the same sex.
HIMANI
Procedure for Adoption of a Child in India CHAUHAN
Step 1- Registration
Step 2- Home Study and Counselling
Step 3- Referral of the Child
Step 4- Acceptance of the Child
Step 5- Filling of Petition
Step 6- Pre-Adoption Foster Care
Step 7- Court Hearing
Step 8- Court Order
Step 9- Follow Up
HIMANI
Guardian and Wards Act of 1890 CHAUHAN
A foreign national adopts an Indian child under the provisions of
the Guardian and Wards Act, 1890.
The adoptive parent is only the guardian of the child until she
reaches 18 years of age.
An adoptive parent is allowed to ask for a child, as per her
preferences (age, gender, skin colour, religion, specific features and
health condition).
Foreign citizens and NRIs are supposed to adopt according to the
adoption laws and procedures in the country of their residence.
HIMANI
CHAUHAN
Juvenile Justice Act of 2000
Children who have been abandoned or abused and not
those children who have been voluntarily put up for
adoption.
HIMANI
CHAUHAN
Adoption Regulations 2022
The following fundamental principles as shown below shall govern adoptions
of children from India, namely:
The child’s best interests shall be of paramount consideration, while
processing any adoption placement.
Preference shall be given to place the child in adoption with Indian
citizens with due regard to the principle of placement of the child in their
own socio-cultural environment, as far as possible.
All applications for adoptions shall be registered on the Designated Portal
and confidentiality of the same shall be maintained by the Authority.
HIMANI
CHAUHAN
MTP ACT
Medical Termination of Pregnancy Act, 1971
Medical Termination of Pregnancy (Amendment) Act,
2002
Medical Termination of Pregnancy (Amendment) Act,
2021
HIMANI
CHAUHAN
Medical Termination of Pregnancy Act, 1971
The Act was launched by the Government of India to provide
guidelines for the termination of certain pregnancies by
registered medical practitioners and for matters connected
therewith or incidental thereto.
The MTP Act. 1971 is divided into 8 sections, each section
dealing with a particular area of information regarding the
medical termination of pregnancy.
HIMANI
CHAUHAN
Medical Termination of Pregnancy
(Amendment) Act, 2002
The MTP Act, 1971 was first amended in 2002, and was called
as the Medical Termination of Pregnancy (Amendment) Act,
2002. It came into action on 1st April, 2003.
HIMANI
CHAUHAN
• Salient features of the MTP (Amendment) Act, 2002:
MTP (Amendment) Act, 2002 allows termination of pregnancy up to 20
weeks of pregnancy, with the consent of the pregnant woman.
The word “Lunatic” in the act of 1971 is replaced by “Mentally ill
patient”.
The MTP (Amendment) Act, 2002 decentralizes site registration to a
district-level committee consisting of 3-5 members.
Approval of sites for MTP procedure can be done at district level as well.
Penalties were made stricter in case of MTP done by unapproved person at
an unapproved site.
HIMANI
Medical Termination of Pregnancy CHAUHAN
(Amendment) Act, 2021
• The MTP Act, 1971 was amended and came into action on 25th March, 2021.
• The amendment provides provisions for safe and legal abortion services
based on therapeutic, eugenic, social and humanitarian ground.
• Salient features of the MTP (Amendment) Act, 2021:
The upper gestational limit was increased from 20 to 24 weeks.
Opinion of 2 medical practitioners is required if pregnancy exceeds 20 weeks.
The medical board can make decisions regarding MTP even after 24 weeks of
gestation in case of fetal anomalies.
HIMANI
PRE-CONCEPTION AND PRE-NATAL CHAUHAN
DIAGNOSTIC TEST (PROHIBITION OF SEX
SELECTION) ACT, 1994; PNDT ACT
The PNDT Act, 1994 was enacted for the prohibition of sex
selection before or after conception, and for regulation of pre-
natal diagnostic techniques for the prevention of their
misuse for sex determination that may lead to female
feticide.
This Act came into action on 1st January 1996.
HIMANI
CHAUHAN
Objectives of PCPNDT Act, 1994
To improve sex ratio.
To reduce female feticide.
To enhance the valuation of girl child.
To decrease the male gender preference in the community.
HIMANI
CHAUHAN
Functions of the Board Under PNDT Act
To advise the government on policy matters related to the use of
prenatal diagnostic techniques.
To review and monitor the implementation of the rules made.
To create public awareness against the practice of preconception
sex selection and female feticide.
To formulate a code of conduct to be observed by persons working
at genetic counseling centers and laboratories.
To perform board meetings at least once in six months.
HIMANI
CHAUHAN
SURROGATE MOTHERS
Surrogacy is defined as “the practice by which a woman (called
a surrogate mother) becomes pregnant and gives birth to a baby
in order to give it to someone who cannot have children.”It is
one of the types of Assisted Reproductive Technologies,
commonly referred to as ART.
Types of Surrogacy
Surrogacy
Traditional Surrogacy Gestational Surrogacy
Legally, there are two types of surrogacies
Surrogacy
Altruistic Surrogacy Commercial Surrogacy
HIMANI
CHAUHAN
Surrogacy Regulation Act (SRA) 2021
The Surrogacy (regulation) Bill 2019 was introduced by the Minister
of Health and Family Welfare, Dr. Harsh Vardhan in Lok Sabha on
July 15, 2019 and passed on August 2019 but referred to Rajya
Sabha.
On 8th December 2021 Surrogacy Regulation Act was passed by
the Rajya Sabha.
25th December 2021 SRA was notified in the Gazette of India.
HIMANI
CHAUHAN
Not Eligible for Surrogacy Under Surrogacy
Regulation Act 2021
Single/Widow/Divorced Men
Single unmarried women
Couples in “Live In” Relationships
GBTQ intending parents
Intending couple who have a child already either biologically or
through adoption or surrogacy except if the child is
mentally/physically challenged/ suffers from a life threatening
disorder or fatal illness with no permanent cure
HIMANI
Conditions for a Surrogate Mother CHAUHAN
Ever married woman.
Age 25 to 35 years on the day of implantation.
Has a child of her own.
Willing woman” (not necessarily relative).
Only for altruistic purposes not for commercial purposes
Certificate of medical and psychological fitness.
Must possess an Eligibility certificate issued by the appropriate
authority (AA).
Only once in lifetime (number of attempts maybe as prescribed).
Not to provide own gametes.
HIMANI
CHAUHAN
Termination of Pregnancy during Surrogacy
Written consent of the surrogate mother.
Authorization of the same by AA subject to and in compliance
with the MTP Act 1971.
No person/person/organisation/clinic/Lab/Clinical
Establishment of any kind shall force the surrogate mother to
abort at any stage of pregnancy except in such conditions as
may be prescribed.