THE MEDICAL TERMINATION OF PREGNANCY ACT, 1971

Year : 1971
Act : THE MEDICAL TERMINATION OF PREGNANCY ACT, 1971.ACT NO. 34 OF 1971.[10th August, 1971.] An Act to provide for the termination of certain pregnancies by registered medical practitioners and for matters connected therewith or incidental thereto.BE it enacted by Parliament in the Twenty-second Year of the Republic of India as follows:-
 
1. Short title, extent and commencement.
a. This Act may be called the Medical Termination of Pregnancy Act, 1971.
b. It extends to the whole of India except the State of Jammu and Kashmir.
c. It shall come into force on such, date 1 as the Central Government may, by notification in the Official Gazette, appoint.
 
2. Definitions
In this Act, unless the context otherwise requires,-
a. "guardian" means a person having the care of the person of a minor or a lunatic ;
b. "lunatic" has the meaning assigned to it in section 3 of the Indian Lunacy Act,1912; (4 of 1912)
c. "minor" means a person who, under the provisions of the Indian Majority Act, 1875 (9 of 1875) is to be deemed not to have attained his majority;
d. "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, (102 of 1956) whose name has been entered in a State Medical Register and who has such experience or training in gynaecology and obstetrics as may be prescribed by rules made under this Act.
   
3.When pregnancies may be terminated by registered medicalpractitioners.
(1) Notwithstanding anything contained in the Indian Penal Code, (45 of 1860) a registered medical practitioner shall not be guilty of any offence under that Code or under any other law for the time being in force, if any pregnancy is terminated by him in accordance with the provisions of this Act.

------------ 1 1st April 1972, vide Notification No. GSR 2857, dated 19-2-1972, see Gazette of India, Part II, Sec. 3 (i), p. 708.------------------------------------------- 172.
(2) Subject to the provisions of sub-section (4), a pregnancy may be terminated by a registered medical practitioner,-
  (a) where the length of the pregnancy does not exceed twelve weeks, if such medical practitioner is, or
  (b) where the length of the pregnancy exceeds twelve weeks but does not exceed twenty weeks, if not less than two registerd medical practitioners are of opinion, formed in good faith, that-
  (i) the continuance of the pregnancy would involve a risk to the life of the pregnant woman or of grave injury to her physical or mental health; or  
  (ii) there is a substantial risk that if the child were born, it would suffer from such physical or mental abnormalities as to be seriously handicapped.
  Explanation I Where any pregnancy is alleged by the pregnant woman to have been caused by rape, the angwish caused by such pregnancy shall be presumed to constitute a grave injury to the mental health of the pregnant woman.
  Explanation II Where any pregnancy occurs as a result of failure of any device or method used by any married woman or her husband for the purpose of limiting the number of children, the anguish caused by such unwanted pregnancy may be presumed to constitute a grave injury to the mental health of the pregnant woman.
(3) In determining whether the continuance of a pregnancy would involve such risk of injury to the health as is mentioned in sub- section (2), account may be taken of the pregnant womans actual or reasonably foreseeable environment.
(4) (a) No pregnancy of a woman, who has not attained the age of eighteen years, or, who, having attained the age of eighteen years, is a lunatic, shall be terminated except with the consent in writing of her guardian.
  (b) Save as otherwise provided in clause (a), no pregnancy shall be terminated except with the consent of the pregnant woman.
 
4. Place where pregnancy may be terminated.
No termination of pregnancy shall be made in accordance with this Act at any place other than-
  (a) a hospital established or maintained by Government, or
  (b) a place for the time being approved for the purpose of this Act by Government.
 
5. 173.5.Sections 3 and 4 When not to apply.
  (1) The provisions of section 4, and so much of the provision of sub-section
  (2) of section 3 as relate to the length of the pregnancy and the opinion of not less than two registered medical practitioners, shall not apply to the termination of a pregnancy by a registered medical practitioner in a case where he is of opinion, formed in good faith, that the termination of such pregnancy is immediately necessary to save the life of the pregnant woman.
  (3) Notwithstanding anything contained in the Indian Penal Code, (45 of 1860) the termination of a pregnancy by a person who is not a registered medical practitioner shall be an offence punishable under that Code, and that Code shall, to this extent, stand modified.
  Explanation For the purposes of this section, so much of the provisions of clause (d) of section 2 as relate to the possession, by a registered medical practitioner, of experience or training in gynaecology and obstetrics shall not apply.
 
6. Power to make rules.
  (1) The Central Government may, by notification in the Official Gazette, make rules to carry out the provisions of this Act.
  (2) In particular, and without prejudice to the generality of the foregoing power, such rules may provide for all or any of the following matters, namely:-
  (a) the experience or training, or both, which a registered medical practitioner shall have if he intends to terminate any pregnancy under this Act ; and
  (b) For the purposes of this section, so much of the provisions of clause (d) of section 2 as relate to the possession, by a registered medical practitioner, of experience or training in gynaecology and obstetrics shall not apply.
  (3) Every rule made by the Central Government under this Act shall be laid, as soon as may be after it is made, before each House of Parliament while it is in session for a total period of thirty days which may be comprised in one session or in two successive sessions, and if, before the expiry of the session in which it is so laid or the session immediately following, both Houses agree in making any modification in the rule or both Houses agree that the rule should not be made, the rule shall thereafter have effect only in such modified form or be of no effect, as the case may be ; so, however, that any such modification or annulment shall be without prejudice to the validity of anything previously done under that rule.
 
7. Power to make regulations.
  (1) The State Government may, by regulations,-
  (a) require any such opinion as is referred to in sub - section
  (2) of section 3 to be certified by a registered medical
  174. practitioner or practitioners concerned, in such form and at such time as may be specified in such regulations, and the preservation or disposal of such certificates;
  (b) require any registered medical practitioner, who terminates a pregnancy, to give intimation of such termina- as may be specified in such regulations ;
  (c) prohibit the disclosure, except to such persons and for such purposes as may be specified in such regulations, of intimations given or information furnished in pursuance of such regulations.
  (2) The intimation given and the information furnished in pur- suance of regulations made by virtue of clause (b) of sub-section (1) shall be given or furnished, as the case may be, to the Chief Medical Officer of the State.
  (3) Any person who wilfully contravenes or wilfully fails to comply with the requirements of any regulation made under sub-section
  (1) shall be liable to be punished with fine which may extend to one thousand rupees.
 
8. Protection of action taken in good faith.
No suit or other legal proceeding shall lie against any registered medical practitioner for any damage caused or likely to be caused by anything which is in good faith done or intended to be done under this Act.
 
Medical Termination of Pregnancy (MTP) Act Legal Update is it in conflict with PCPNDT?
Action Research and Training for Health (ARTH)
 
MTP Act : addressing a public health priority
MTP Act - an enabling act which
  (a) Aims to improve the maternal health scenario by preventing large number of unsafe abortions and consequent high incidence of maternal mortality & morbidity
  (b) Legalizes abortion services
  (c) Promotes access to safe abortion services to women
  (d) De-criminalizes the abortion seeker
  (d) Offers protection to medical practitioners who otherwise would be penalized under the Indian Penal Code (sections 315-316)
 
Legal Framework
  (a) 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
  (b) MTP Rules lays down who can terminate the pregnancy, training requirements, approval process for place, etc.
  (c) MTP Regulations lays down forms for opinion, maintenance of records custody of forms and reporting of cases
 
Legal Abortions
  (a) 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
 
When can pregnancies be terminated?
  (a) Up to 20 weeks gestation
  (b) With the consent of the women. If the women is below 18 years or is mentally ill, then with consent of a guardian
  (c) With the opinion of a registered medical practitioner, formed in good faith, under certain circumstances
  (d) Opinion of two RMPs required for termination of pregnancy between 12 and 20 weeks
 
MTP Act : Indications
  (a) Continuation of pregnancy constitutes risk to the life or grave injury to the physical or mental health of woman
  (b) Substantial risk of physical or mental abnormalities in the fetus as to render it seriously handicapped
  (c) Pregnancy caused by rape (presumed grave injury to mental health)
  (d) Contraceptive failure in married couple (presumed grave injury to mental health)
 
MTP Act : Indications
  (a) "In determining whether the continuance of pregnancy would involve such risk of injury to the health (as mentioned above), account may be taken of the pregnant woman's actual or reasonable foreseeable environment"
 
MTP Act : Place for conducting MTP
  (a) 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 Act amendment 2002
  (a) Decentralizes site registration to a 3-5 member district level committee chaired by the CMO/DHO
  (b) Approval of sites that can perform MTPs under the act can now be done at the district level
  (c) Stricter penalties for MTPs being done in a un-approved site or by a persons not permitted by the act
 
Medical Abortion
  (a) MTP using Mifepristrone (RU 486) & Misoprostol approved for up to 7 weeks termination
  (b) Only an RMP (as defined by the MTP Act) can prescribe the drugs
  (c) Has to follow MTP Act, Rules & Regulations
  (d) Can prescribe in his/her clinic, provided he/she has access to an approved place
  (e) Should display a certificate from owner of approved place agreeing to provide access
 
Implications of amendments
  (a) Simplifies registration of sites which can be done at district level now
  (b) Providers can get their sites approved for providing abortions under the MTP Act for 1st trimester only or up to 20 weeks and thereby come under the protective cover of the MTP Act
 
Implications of amendments
  (a) Approved providers can provide medical abortions from their clinic, as long as they have access to an approved site
  (b) Offers potential to increase number of approved sites, which would enable women to access safe abortion services
  (c) Effective implementation will help to bring all abortions within legal frame work
 
MTP rules : what are they for?
  (a) Enable proper implementation of the provisions of the Act
  (b) Ensure that MTP services are provided by qualified persons in safe and hygienic settings
  (c) Help to monitor quality of services
 
MTP rules: what do they cover?
  (a) Experience & training required for providers
  (b) Approval of a place for terminating pregnancy under the Act
  (c) Composition & tenure of District Level Committee
  (d) Inspection, cancellation or suspension of approval; review Consent form
 
MTP rules : Who can perform?
  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
  (a) For termination up to 20 weeks
  (b) A practitioner who holds a post-graduate degree or diploma in Obstetrics and Gynecology
  (c) A practitioner who has completed six months house job in Obstetrics and Gynecology
  (d) A practitioner who has at least one-year experience in practice of Obstetrics and Gynecology at a hospital which has all facilities
  (e) 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 by trimester
For sites up to 12 weeks (1st trimester)
  (a) Gynecology examination/ labor table
  (b) Resuscitation and sterilization equipment
  (c) Drugs & parental fluids
  (d) Back up facilities for treatment of shock
  (e) Facilities for transportation
 
Approval of a place by trimester
For sites up to 20 weeks (1st and 2nd trimester) :
  (a) All requirements for up to 12 weeks +
  (b) Operation table and instruments for performing abdominal or gynecological surgery
  (c) Anesthetic equipment, resuscitation equipment and sterilization equipment
  (d) Drugs & parental fluids notified for emergency use, notified by Government of India from time to time
 
Regulatory body : D L C
  (a) District level MTP Committee Minimum of 3 & Maximum of 5 members including chairperson (CM H O)
  (b) 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.
  (c) Tenure 2 calendar years NGO members shall not have more than 2 terms
 
Approval Process
  (a) Application in Form A to be addressed to CMHO by place seeking approval
  (b) CMHO verifies or inspects the place to satisfy that termination can be done under safe & hygienic conditions
  (c) CMHO recommends approval to the committee
  (d) Committee considers application & recommendation and approve and issue certificate of approval in Form B
 
Application form for Approval (Form A)
 
Certificate for Approval ( Form B )
 
Approval Process
  (a) Place to be inspected within 2 months of receiving application
  (b) Certificate to be issued within 2 months of inspection
  (c) If deficiency found, within 2 months of deficiency having been rectified
 
Inspection
  (a) CMHOs to inspect to ensure safe & hygienic conditions for conduction of MTPs.
  (b) Call for information and seize in case found otherwise
 
Cancellation/ Suspension
  (a) CMHO to report the committee for unsafe and unhygienic conditions.
  (b) Committee can suspend or cancel approval after giving the owner an opportunity for representation
  (c) Owner can reapply to the committee after making additions and improvements.
  (d) During suspension the place be deemed as non-approved
 
MTP regulations
  (a) Power to states to make regulations regarding MTP services
  (b) Power to states to make regulations regarding MTP services
  (c) Regulations for Union Territories by Central Govt.
  (d) Application of central govt. regulations in the absence of state regulations.
 
MTP regulations : What do they cover?
  (a) Forms to be required for making opinion, admission register and reporting of MTPs
  (b) Custody of forms
  (c) Prevention of disclosure of information
 
MTP regulations : opinion forms
  (a) F or an MTP, opinion of an approved RMP (2 RMPs for 2nd trimester) is required.
  (b) The provider(s) is required to certify his/her opinion in Form I within three hours of terminating a pregnancy.
 
Declining sex ratios....
  (a) Census 2001 confirmed apprehensions of declining juvenile sex ratios.
  (b) Parallel with steep increase in availability of ultrasound machines and use during pregnancy
  (c) Sex determination testing followed by second trimester abortion- major pathway for sex selection
  (d) Public interest litigation triggered amendments in Act of 1994
  (e) Focus on "female feticide" as having attained endemic proportions
 
Safe Abortion and Sex Selection Pathways
  (a) The thin edge......
 
The recent incidents in Rajasthan have shown that the distinction between two public policy issues – sex selection ("female feticide") and safe abortion - have become extremely blurred
Choices along the thin edge separating the two are :
  (a) Restricting access to abortion to prevent sex selection
  (b) Dealing with the two issues separately
  (c) Developing a integrated strategy to address both sex selection and unsafe abortion together