11. MEDICAL TERMINATION OF PREGNANCY ACT AND RULES

MEDICAL TERMINATION OF PREGNANCY (MTP) ACT AND RULES

The Medical Termination of Pregnancy Act, 1971, Rules and Regulation, 1975 set standards for certain cases of pregnancy termination by registered medical practitioners and related matters.

OBJECTIVES OF THE ACT

1. To prevent large number of unsafe abortions and subsequent high incidence of maternal mortality and morbidity by improving maternal health scenario.
2. To legalise abortion services.
3. To promote access to safe abortion services to women.
4. To provide protection to medical practitioners who otherwise would be penalised under the Indian Penal Code sections 315-316.

DEFINITIONS UNDER THE ACT

• Registered Medical Practitioner (RMP): Person possessing recognised medical qualification under Indian Medical Council Act, name entered in State Medical Register, with prescribed experience/training in gynaecology and obstetrics.
• Hospital: Hospital established and maintained by Central Government or Government of Union Territory.
• Guardian: Person having care of a minor or a lunatic.
• Lunatic: Person who is mentally ill, dangerous, foolish, or unpredictable (as defined in Indian Lunacy Act).
• Minor: Person under the age of adulthood (usually 18, 20, or 21 years).

BACKGROUND: INDIAN PENAL CODE, 1860

Before 1971, abortion was considered illegitimate in India. Section 312 to Section 318 of IPC, 1860 dealt with “Offences related to newborn or unborn children.” Section 312 stated: “Whoever voluntarily tries to cause miscarriage to a woman except in good faith or where woman’s life is in danger shall be liable for imprisonment which may extend to three years and shall also be liable to fine.”

TERMINATION OF PREGNANCY – PROVISIONS

Up to 12 Weeks

One RMP can terminate pregnancy if continuance of pregnancy will risk woman’s life or her mental/physical health, or child will be handicapped due to physical/mental abnormality. Pregnancy caused by rape or failure of family planning devices may pose serious mental health injury.

12 to 20 Weeks

Two RMPs must suggest that termination is required due to complications.

Any Length of Pregnancy

If two RMPs suggest immediate termination or else woman’s life would be at risk, termination can be done even by RMPs without experience/training in gynaecology and obstetrics.

Qualifications of RMP (Post-Commencement of Act)

• Completed at least 6 months of house surgery in gynaecology and obstetrics, OR
• Possess experience of 1½ years, OR
• Have assisted an RMP in not less than 25 pregnancy termination cases, OR
• Hold postgraduate degrees in gynaecology and obstetrics.

Consent Requirements

• Woman 18 years or more: Written agreement of the woman.
• Woman less than 18 years or lunatic: Written agreement of woman’s guardian.

PLACE WHERE PREGNANCY MAY BE TERMINATED

• A hospital founded or maintained by the government.
• A location temporarily designated for this purpose by the government.
• A District Level Committee established by the government (chaired by Chief Medical Officer or District Health Officer).

APPROVAL OF A PLACE – REQUIREMENTS

• Operation table and instruments required for abdominal or gynaecological surgery.
• Anaesthetic equipment, resuscitation equipment, and sterilisation equipment.
• Drugs and parenteral fluids required during emergencies.

The District CMO can inspect the approved place whenever required. Approval certificate should be displayed visibly at the place.

ADMISSION REGISTER

The hospital head or owner of approved place should maintain a register to keep records of women admitted for terminating pregnancies. Entries should be in serial order year-wise (e.g., 5/97). The register is a SECRET document and information should not be revealed to anyone.

Persons Authorised to Inspect Admission Register

• Chief Secretary to the Government of a Union Territory (departmental enquiry).
• Magistrate of first class (investigation into an offence).
• District Judge (suit or other action for damages).

OFFENCES AND PENALTIES

Offence	Penalty
Physician intentionally killing pregnant patient by performing unlawful abortion (with consent)	Imprisonment up to 10 years + fine
Doctor performing illegal abortion without consent, killing the patient	Imprisonment up to 10 years + fine
Non-registered medical professional performing abortion	Imprisonment 2-7 years
Physician conducting abortion at location not approved by government	Imprisonment 2-7 years (both doctor and owner/in-charge)

SALIENT FEATURES OF MTP ACT, 1971

1. Applies to married women.
2. Permits termination of pregnancies up to 20 weeks of gestation under certain circumstances.
3. Allows abortions to be carried out exclusively by licensed medical professionals in accredited hospitals.
4. One RMP required for termination up to 12 weeks.
5. Two RMPs required for termination up to 20 weeks.
6. Aims to lower maternal mortality and morbidity rates and prohibit unsafe/illegal abortions.
7. Has set of offences and penalties for RMPs or medical institutions.

MEDICAL TERMINATION OF PREGNANCY (AMENDMENT) ACT, 2021

On 16 March 2021, the Rajya Sabha passed the MTP (Amendment) Bill, 2021 (Lok Sabha passed on 17 March 2020). The Delhi High Court recently allowed termination at 22 weeks due to foetal abnormalities.

Needs for Amendment

1. Women faced legal problems after 20 weeks – Bill proposes extension to 24 weeks.
2. Hundreds of women die due to unsafe/illegal abortions – aims to provide safety and protection.
3. 1971 Act outdated with modern technologies – requires amendment.
4. Guardian’s approval for minors/lunatics provision excluded.
5. Rationalises complicated legal provisions for easier and more effective termination.

Key Provisions of MTP Amendment Act, 2021

• Contraceptive Failure: Married and UNMARRIED women may terminate pregnancy up to 20 weeks if contraceptive method/device fails.
• Opinion Requirements:
  • Up to 20 weeks: One RMP opinion required.
  • 20-24 weeks: Two RMPs’ opinions required.
  • After 24 weeks (significant foetal abnormalities): State-level medical board’s opinion required.
• Upper Gestation Limit for Special Categories: Increased from 20 to 24 weeks for rape victims, incest victims, disabled women, girls under 18 years.
• Confidentiality: Identity and particulars of woman shall be revealed only to person authorised under present law.

Salient Features of Amendment Bill, 2020

1. Proposes amendment of MTP Act, 1971.
2. For pregnancy termination with gestation >20 weeks: only one RMP required instead of two.
3. New provision: two or more RMPs’ advice required for 20-24 weeks gestation.
4. Broadens scope – includes disabled women, rape victims, under 18 girls, incest victims.
5. Increases maximum gestation period from 20 to 24 weeks.
6. Protects privacy and confidentiality of women terminating pregnancies.

SUMMARY TABLE

Particular	Details
Act Passed	1971
Rules Framed	1975
MTP Amendment Act	2021
Pre-1971 Legal Position	Section 312 IPC – abortion criminalised
Up to 12 weeks	One RMP opinion
12-20 weeks (Original Act)	Two RMPs opinion
20-24 weeks (Amendment)	Two RMPs opinion (special categories)
Beyond 24 weeks	State-level medical board opinion