Abortion - Medical termination of Pregnancy-MTP- A Female Perspective. Abortion clinic for safe and confidential abortion at Mumbai India.
The Medical Termination of Pregnancy Act, 1971
The MTP Act (Act No. 34 of 1971) has been defined in its opening lines as ‘An Act to provide for the termination of certain pregnancies by registered medical practitioners and for matters connected therewith or incidental thereto’. Passed by Parliament on August 10, 1971, this is a Central Act that extends to the whole of India except the state of Jammu and Kashmir, which adopted it in 1980.
The purpose of this act was to define the situations and circumstances in which safe abortion could be legally performed and to empower medical practitioners and institutions delivering this service. All practice of induced abortion medical or surgical has to be conducted against the all-pervading backdrop of the MTP Act. The MTP Act – A Protective Umbrella
Even today, voluntarily ‘causing miscarriage’ to a woman with child – other than in ‘good faith for the purpose of saving her life’ is a crime under Section 312 of the Indian Penal Code, punishable by simple or rigorous imprisonment and/or fine. Consequent sections (IPC Sections 313 – 316) relating to causing miscarriage without a pregnant woman’s consent or causing maternal death due to the procedure are stricter, with punishments ranging from up to 10 years imprisonment, and extending up to life imprisonment.
The MTP Act is an empowering legislation, which if adhered to completely, offers protective umbrella allowing clinicians to offer legal safe abortion services within well-defined limits. The use of medical methodsfor early abortion is also completely covered by the MTP Act. MTP Act, MTP Rules and MTP Regulations
The MTP Act is an Act of Parliament providing a broad overview of the methodology of safe abortion practice and defining and delegating authority to central and state governments to make rules and regulations.
The MTP Rules are framed by the Central Government, but must be placed before each House of Parliament.
The MTP Regulations are framed by State Governments and relate to issues involving opinions for termination, reporting and maintaining secrecy.
The importance of this distinction is the possible flexibility in introducing or modifying rules and regulations within the ambit of the Act without having to steer amendments through Parliament.
The potential for appropriate changes in rules and regulations to encompass medical methods is particularly significant, since this new development is not adequately reflected in the present rules and regulations.
When Pregnancies may be Terminated
A registered medical practitioner (RMP) is protected under law if a pregnancy is terminated in accordance with Section 3 of the MTP Act, based on opinion formed in good faith.
Duration of Pregnancy
According to Section 3 (2), pregnancies not exceeding 12 weeks may be terminated based on a single opinion formed in good faith. Since the use of medical methods governed by clear guidelines issued by Drug Controller is presently up to 49 days, the single clinical opinion is necessary and sufficient. Grounds for Termination
According to Section 3 – Sub section (2) of the MTP Act, a pregnancy may be terminated for the following indications :
1. If the pregnancy would involve a risk to the life of the pregnant woman or of grave injury to her physical and mental health.
2. If there is a substantial risk that if the child was born, it would suffer physical or mental abnormalities as to be seriously handicapped.
Explanations I and II further clarify the following indications
Pregnancy alleged by the pregnant woman to have been caused by rape.
Pregnancy resulting from a failure of any device used by any married woman or her husband for the purpose for limiting children.
It is important to note that the MTP Act does not permit induced abortions on demand. The responsibility rests with the medical practitioner to opine in good faith regarding the presence of a valid legal indication. These indications are also mandatory with medical methods. Valid Legal Consent
Section 2 – Sub section (4) of the MTP Act mandates the presence of a valid legal consent.
1. Termination of pregnancy in minors (under 18 years age) or lunatics (as defined in Section 3 of Indian Lunacy Act, 1912) only with consent in writing of guardian.
2. Termination of pregnancy in adult women over 18 years age permissible with their valid consent.
The consent must be informed and recorded in Form C recommended in Rule 8 of MTP Rules. This is also a requirement every time a medical method is used for early abortion. An adult woman requires no other person’s consent except her own. Where Pregnancies may be Terminated
According to Section 4 of the MTP Act, pregnancies may only be terminated in the following settings.
1. A hospital established or maintained by the Government.
2. A place approved for the purpose of the Act by the Government.
For approval Rule 4 of the MTP Rules further elaborates on the Clause 2 mentioned above as follows
1. The Government should be satisfied with safety and hygiene.
2. The following facilities should be provided.
• An OT table and instruments for abdominal and gynaecological surgery.
• Anesthetic, resuscitation and sterilisation equipment.
• Drugs and parenteral fluids for emergency use.
Any procedure performed in a centre which does not have government approval is deemed illegal. Medical methods have difficulty in fulfilling this particular requirement, since the administration of one or both drugs or the actual process of abortion may take place outside a clinic or hospital setting. Suggested Changes in Explanations in MTP Rules
Medical methods for termination of pregnancy not exceeding seven weeks, may be prescribed by a registered medical practitioner as prescribed under Section 2 (d) and Rule 3, having access to a place approved by the Government under Section 4 (b) and Rule 4 (1), for surgical and emergency back up when such is indicated.
By Whom Pregnancies may be Terminated
The necessary qualifications of a medical practitioner registered in the State Medical Register are broadly defined in Section 2 – Clause (d) of the MTP Rules.
1. Postgraduate degree or diploma in gynecology and obstetrics.
2. Registered before commencement of the Act with over 3 years experience in the practice of obstetrics and gynecology.
3. Registered after commencement of the Act if
• Six months of house surgeonship in gynecology and obstetrics.
• Experience in any hospital of over 1 year in the field of gynecology and obstetrics.
• Assisted in performing 25 MTPs in a government hospital or a recognised training institute.
While medical practitioners with postgraduate training or qualifications in gynecology and obstetrics stand automatically recognised, there is great scope to train registered medical practitioners in safe abortion techniques at recognised training centres. This could dramatically increase the access to and availability of safe abortion nationwide.
The training and registration of a cadre of registered medical practitioners exclusively for medical methods with links to a recognised centre, would be the final step in decentralizing safe abortion services. Documentation and Records
According to Regulation 5 of the MTP Regulations all approved centres are required to maintain an Admission Register in the format prescribed in Form III. A fresh register is started each calendar year, with new serial numbers generated by mentioning the year against the serial number.
The Admission Register is a secret document and should be kept in safe custody. The Admission Register should be maintained for at least 5 years from the last entry.
The importance of documentation is mandatory with medical methods to underline legality to benefit from protection of the MTP Act. Prompt and sincere reporting is important since it also contributes to databases.
Terminology changes will also have to be considered, since no admission is necessary for medical methods. The Admission Register could be called the MTP Register.
Protection of Action taken in Good Faith
The MTP Act in Section 8 protects the registered medical practitioner from suits or other legal proceedings for any damage caused or likely to be caused by anything done in good faith under the act. Section 52 of the IPC defines good faith as adequate and due care.
This last section of the MTP Act has far reaching implications as it is the foil protecting a medical practitioner diligently functioning within the boundaries set by the MTP Act, MTP Rules and MTP Regulations, from being prosecuted under the IPC or even potential civil or consumer court action. Of course, this protectionis conditional to judicious fulfilment of all the legal and statutory mandates and requirements. Conclusion
The MTP Act of 1971 has been the beacon of landmark social and medical legislation with farreaching positive benefits for the Reproductive Health of Women. It is an empowering act for the healthcare system and its beneficiaries, setting aside the application of the Indian Penal Code in certain welldefined situations.
Unfortunately, many of the traditional assumptions of the MTP Act, Rules and Regulations are out of step with contemporary medical methods. Even so, the MTP Act in its present form, with some fine tuning of MTP Rules and Regulations, is quite adequate to cover the introduction of this recent development which offers one more technique to achieve our goal of Safe Abortion.
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