Abortion &
Medical termination of
Pregnancy Act
1971
CEDAW and Right to Privacy- Art
21 Indian Constitution
Usual questions short
essays
Criminal abortion
MTP act 1971
MTP rules
MTP regulations
Confidentiality in MTP act
World Medical
Association
DECLARATION OF In India ,
OSLO 1970
NMC Considers
termination of pregnancy
Resolution on done by RMPS as a
therapeutic professional
abortion misconduct if done
beyond what is allowed
by MTP act.
Unsafe abortion is "a procedure for
terminating an unwanted pregnancy either by
persons lacking the necessary skills or in an
environment lacking the minimal medical
standards, or both" (WHO Definition).
Unsafe abortion remains the third leading cause of
maternal mortality in India.
Close to 8 women die each day due to
causes related to unsafe abortion.
Death - 21 /day before MTP act came into
power
Shantilal - Shah Committee was
formed in 1964 to study on unsafe
abortion found, doctors are hesitating
to provide MTP because IPC sections
penalized them if they provide
termination in circumstances when
there was no risk to the life of pregnant
person.
Before 1971, only these section existed in India,
related to MTP.
They exist now also. But after MTP act came, doctors
will not be penalized if they do termination of
pregnancy according to the act.
IPC/ Causing miscarriage of either description
BNS
312 Not in good faith up to 3 years +/- fine
/88
If quick with child- 7 years +/-
With consent fine
Pregnant woman also
punishable
313 Without consent 10 years +/- fine
/89 Life imprisonment +/- fine
314 Death of pregnant woman 10 years +/- fine
/90 Life imprisonment +/- fine
315 Act done with the intent to 10 years +/- fine
/91 cause it to die before or
after birth.
316 Causing death of a quick 10 years +/- fine
/92 unborn child by any act
62 BNS
Punishment for attempting to
commit offences punishable with
imprisonment for life or other
imprisonment be punished for a
term which may extend to one-half
of the imprisonment for life .
Medical Definition - SDL
Abortion
Miscarriage
Premature labour
In LEGAL SENSE
Abortion the premature expulsion of
the foetus from the pregnant person’s
uterus at any time of pregnancy, before
full term pregnancy is completed.
ie, abortion+ miscarriage+ premature
labour
Over all 10-15% abortion occurs naturally
CLASSIFICATION
NATURAL – spontaneous or accidental
INDUCED- therapeutic/justifiable, ie in
accordance with t he law of land; and
criminal abortion
NATURAL(SPONTANEOUS)- Modi’s Text
Maternal causes Foetal causes
Infections, Chromosomal
syphilis-late trimester anomalies
Diseases of blood Foetal anemia,
nervous system syphilis, hormonal
reproductive system imbalance
Accidents Diseases of placenta
Poisoning- As, Pb, Cu, Low implantation of
Hg ovum
Most common chromosomal abnormality
causing early natural abortion is Aneuploidy
Among this Trisomy is more common
Most common trisomy is trisomy 16
However Turnor’s syndrome, a monosomy is
the single most frequent specific
chromosomal abnormality
Therapeutic methods- 1st trimester medical
methods only in Intra Uterine pregnancy
400mg mifepristone orally followed after 36-48
hours by 800 microgram of misoprostol (PGE1)
vaginally
Medical abortion in early pregnancy acc to MTP
rules, allowed till 9 weeks
Criminal abortion is the unlawful
termination of a pregnancy
ie, Beyond the scope of MTP Act in India
Usually done by quacks when pregnant
persons have no access to legal abortion services
due many reasons- not affordable due to high cost,
no access to health care, social stigma in society
and among doctors, unware that MTP act legalizes
termination up to a certain gestational age.
Means to induce criminal abortion
Action MOA Called as Examples
on
Uterus Uterine Ecbolics Ergometrine, quinine
contractions
Uterus Increase menstrual Emmenagogu Borax, synthetic
flow es estrogen in larger
doses.
GUT Pelvic congestion Turpentine
Forming acute Irritants Castor, Ricin, Abrus,
localized punched Semicarpus
out ulcerations
Acting through GIT- tartar emetic,
Crotan oil- reflex uterine contractions.
Poisonous effects on systems-Heavy
metals (lead – direct toxic effect on
trophoblast)
animal and plant poisons abrus,
calotropis, marking nut as sticks
General violence
Intentional
Pressure on abdomen
Violent exercise
Cupping advanced preg
Role of papaya, pineapple- no specific
action on uterus but when
unripe ?????????
Spotter for practical
exam 1. Identify the specimen
Wet mounted specimen of
cut open gravid uterus
(evident from increase
size)
and its appendages with
Abortion stick inside
perforating the fundus;
2. Medicolegal significance:
Criminal abortion method
3. Mechanisms of death:
heamorrgae, shock, vagak
inhibition, peritionitis
folllowing perforation to bowel
loops
Local violence Abortion stick-
rupture of membrane and contractions risk of
perforation
And irritant substance/ fluids used to
inject
Syringing mostly soap water detaches sac.
Placenta heamorrhage, contraction and
abortion, risk of perforation
Higginson syringe
Air embolism
Air insufflation
Electricity
Pastes-I2,KI,Hg. (Utus paste) detach
placenta and later necrosis and infection of
uterine wall
Laminaria tent (US)- seaweed used for
cervical dilatation
Differences
Natural abortion Criminal abortion
Cause Predisposing disease ‘Illicit’(???) pregnant
persons
Infection Rare Frequent
Marks of violence Nil May be
Toxic effects of drugs Absent May be present
Foreign body Absent May be present
Foetus Wounds absent May be found
Gangrene of uterus following
criminal abortion
Death due to criminal abortion
High index of Suspicion needed
to confirm if death happened
due to criminal abortion. Following questions
are to be assessed during autopsy
Was the woman pregnant?
What was the term of pregnancy?
Is there evidence of abortion?
How it was done? Method used?
Who induced? Self or others?
What were the complications?
What was the cause of death, if death
happened? opinion given as death
was due to abortion criminally induced
following complications if any, mention
it
What is the result of chemical analysis?
What are the histological findings?
Was the woman pregnant
Changes in the breast
and abdomen
Urine tests for pregnancy
Products of conception present?
Foetus
Placenta
membranes
Corpus luteum of pregnancy
2-5 cm
Size of uterus according to alleged
age of gestation
m of pregnancy from-
Developmental stage of foetus (from- length, appearance, internal organs, ossf c
centa, membranes
Size of corpus luteum of pregnany
Size of uterus
Evidence of abortion in cervix
Absence of mucus plus at ext os
Patent cervical canal
Dilated cervical canal
Other injuries locally or generally
How it was done? Method
used? Assessed from
Injuries
Foreign objects
Retained Instruments
Preservation of (routine) organs for
chemical analysis along with uterus and
appendages with vagina- half for chemical
analysis (special organs), half for
histopathology
Pelvic dissection method used
MUST foetal tissue preservation in
saturated saline for DNA identification
Scene examination to assess method used
Fabricated abortion
A women may claim that she had been
assaulted while pregnant and as a result
of violence had aborted. She may
acquire a human foetus or an animal
foetus to support the charge
Duty of a medical officer
Professional secrecy must be kept- if Breach of
privacy occurs punished with 1 year or fine or both
Ask to make a statement about the
induction of criminal abortion- if refuses –
informed refusal to be written
Must consult a professional colleague- record
Record all details
Treat to the best of ability
If the condition is serious- arrange for
dying declaration
If dies - Do not issue MCCD medical
certification of cause of death.
Should not release body to relatives
Intimate police
Mechanisms of death in criminal
methods
Immediate Delayed Remote
[Link]
1. Vagal inhibition 1. Jaundice
MC cause among
immediate a 2. Endocarditis
(sudden dilatation of 2. Peritonitis
cervix or 3. Renal failure
excruciating pain) 3. Tetanus
4. Pulmonary
2. Air embolism embolism
4. psychological
sequele
3. Haemorrhage
4. Fat embolism
5. Amniotic fluid
embolism
[Link]
MTP Act
MTP Rules
MTP Regulations
SDGs- 3.1, 3.7 and 5.6
CEDAW- UN
Abortions are legal only when
all the following conditions are met:
Termination done by an approved RMP by the Act,
in an approved centre
For conditions and within the gestational age
prescribed by the Act
Acc to procedure laid down.
ie, Acc to MTP act/ rules/ regulations
Central and State bu
Act Rule 2003 Regulation
1971 Experience and training of RMP Form I - Opinion Form of RMP/s with
list of indication
1972- started Approval of the place
Form II - MTP reporting Form
2002 Clinic related
amendment Form III - Admission Register with 14
Columns
2021 Forms A, B, C
amendment is Opinion of Medical Board in Form D
the latest Form A - Application Form for site
Approval, to chief DMO Form E opinion form of RMPs in 20-
24 weeks
General Form B - Certificate of Approval,
matters of the from District Level Committee, Custody of forms – by owner of
MTP act centre
discussed Form B to be displayed in centre
Monthly statement to DMO in form II
When and where Form C - Consent Form from
can termination pregnant person Maintenance of admission register
be done. for 5 years
INDICATIONS as given in textbooks
Therapeutic
Eugenic
Humanitarian
Social
Section 2 of act
pregnancy may be
terminated
Up to 20 weeks 1 RMP
20-24 weeks 2 RMPS : for special category of women
RMP of the opinion, formed in good faith, that—
(i) the continuance of the pregnancy risk to the life
of the pregnant woman or of grave injury to her
physical or mental health
(ii) foetus born with serious physical or mental
abnormality.
Pregnancy resulted due to contraception
failure by married woman or her husband
Pregnancy resulted due to contraception
failure by her or partner (2021)
pregnancy resulted due to rape
anguish caused by such pregnancy may be
presumed to constitute a grave injury to the
mental health of the pregnant woman.
Most important clause
To assess the risk of injury to
health
Person’s actual or reasonably
foreseeable environment can be
taken into consideration
Category of women specially allowed for 20-24 wks of
termination
a) survivors of sexual assault or rape or incest
(b) minors
(c) change of marital status during the ongoing pregnancy
(widowhood and divorce)
(d) women with major physical disabilities
(e) mentally ill women including mental retardation;
(f) the foetal malformation that has substantial risk of being
incompatible with life or if the child is born it may suffer from
such physical or mental abnormalities to be seriously handicappe
(g) women with pregnancy in humanitarian settings or disaster or
emergency situations as may be declared bythe Government.
What about unmarried women? – added to the
category by special verdict by supreme court
Qualificati (d) PG/ diploma in OBG
on of RMP
a Before the Experience in the practice of OBG for a period of not less
act, SMR than three years.
entry
RMP is
MBBS
b RMP is :- (i) If they have completed 6 months of house surgery in
MBBS OBG; or
(ii) Unless the facilities are provided therein, if they had
experience at any hospital for a period of not less than
one year in the practice of OBG
c RMP is If they have assisted a registered medical practitioner in
MBBS the performance of 25cases of medical termination of
pregnancy of which at least 5 have been performed
Up to 12 independently, in a hospital
weeks only
By Medical Methods alone
c RMP is (i) experience at any hospital for a period of not less
a MBBS than 3 months in the practice of OBG
Up to 9 (ii) has independently performed ten cases of pregnancy
weeks only termination by medical methods of abortion under
Special clause in emergency to save
life of pregnant person
• Even single RMP, at any week of pregnancy
of the person, without training, in
unapproved place.
• RMP’s form I inside an envelop marked as
“Secret”, with name and address of
doctor, date of procedure sent to owner of
the place, if in unapproevd place DMO
soon.
CONSENT
More than 18 years can give consent their own.
Less than 18 years/mentally incapacitated to give
consent GUARDIAN’s consent
Suchita v Chandigarh admin, 19 yr old mentally
retarded survivor of rape
Consent of partner NOT needed.
Proof of age is necessary??? Yes . Very much needed
to avoid future legal complications. If less than 18,
mujst intimate police as POCSO case
Rape need not be complained by the
pregnant person to the police, in order
to plead for abortion from doctors.
BUT? Rape should be intimated to
police by doctor in case of both minors
and adults.
Forms to be downloaded-
regulations
Approved places, keep Register fro 5 years
Custody of forms RMP/ owner
Emergency if hospital, if not
Monthly statement in form II by owner of
hospital; safe custody of forms
Employed women, certificate of termination for
leave, employer
What are the mechanisms to ensure
Confidentiality in MTP act?
Name of pregnant person to be there
only in register. Form III- ie in register
Owner should have the custody.
No other persons to have access to it.
If breach of privacy occurs, 1 year or fine or both
as punishment. Previously it was 1000 rs only.
Punishment
If quack 2-7 years imprisonment
A doctor performs termination of preg in an
unapproved place 2-7 years ; exception?
Owner also punished.
Regulations if violated 1000 Rs/-
Medical board if substantial foetal anomaly detected after
24 weeks
a) a Gynaecologist;
(b) a Paediatrician;
(c) a Radiologist or Sonologist; and
(d) A govt doctor/ member nominated
by state govt or union territoty
1971 2021 amendment
Indication of Married woman Any woman
contraceptive failure
20 weeks 20-24 wk special category
Max gestational age 24 weeks substantial
foetal anomaly
Up to 12 weeks 1 Up to 20 wks 1
12-20 wks 2
RMP opinion required 20-24 wks 2
> 24 wks medical board
within 5 days termination
be done.
Breach of Fine up to 1000 rs 1 year imprisonment or fine
confidentiality or both