MTP Act & MTP - Made simple Dr. Sharda Jain , Lifecare Centre 11 Gagan Vihar Delhi -51

Dr. Sharda Jain
Presented at centenary DMA conference
On 11th January 15 at Ashoka Hotel
MTP Act & MTP - Made simple

country wide Uproar by Doctors
forced
FOGSI & GOVT. of India
to take a step back
Proposed MTP Amendments
2014

Our
Aim
is
Safe
abortion
Safe Abortion

Indian Penal Code
(IPC, 1860)
SECTION 312
Any one voluntarily causing miscarriage to a woman
with child, other than in GOOD FAITH for the purpose of
saving her life is PUNISHABLE BY IMPRISONMENT
(simple or rigorous) &/or a fine
Sections 313 - 316 (for DEATH due to procedure)
Up to 10 years imprisonment and fine, extending up to
LIFE IMPRISONMENT where the abortion was conducted without
consent

A Protective Umbrella
THE MTP ACT if adhered to
completely offers complete
protection to the medical
practitioner from any of the
consequences of the IPC
However legal protection is only
available conditionalto
every requirement of the Act
being fulfilled
Sheriar, J Obs Gyn
India, 51(6):25, 2002

MTP Act, Rules, Regulations
MTP Act Is an Act of Parliament providing an
Overview of Safe abortions and delegating authority
to Central & State government
Rules are framed by the Central Government BUT
must be ratified by each house of Parliament
Regulations are framed by the State Government &
relate to issues involving Opinions , reporting and
maintaining secrecy
3 Things

MTP Act Specifies:
 1  The INDICATIONS for legal Terminations
 2  WHO can Terminate
 3  The PLACE where it can be terminated
 4  Last but most imp. CONSENT requirement

When Pregnancy can be terminated.. ???
1--continuation of pregnancy is a risk to the life of
pregnant woman
or it can cause grave injury to her physical and
mental health
2--Substantial risk that the child , if born ,would be
seriously handicapped due to physical or mental
abnormalities
3--pregnancy caused by rape
4--failure of contraceptive in
married woman
1

Who Can Terminate a Pregnancy?
2

Experience of RMP-
Up to 12 weeks Gestation only
PG Degree or Diploma in OB & Gynae
Who is registered in state medical register
---6months of house surgeon ship in gynae
Or experience of working in dept of gynae –1yr
1-- A Practitioner who has assisted RMP in 25 cases of
Medical termination of pregnancies ,at least 5 of which have
been performed independently in a hospital established or
maintained by govt or a training institute approved for this
purpose by the Govt

Experience and Training Required by a
RMP-upto 20 wks
PG Degree or Diploma in OB & Gynae
Completed 6 months as House Surgeon in OB &
Gynae
At least one yr experience in dept of ob & Gynae
at any hospital that has all facilities

Where pregnancy can be Terminated --
PLACE
Hospitals established or maintained by
the Govt
A Place approved by the Government
or DLC constituted by the Govt
3

Consent ----- Form C
1-- Only the
consent of a
women is
required
2-- If Age <18 yrs
or a mentally ill
patient consent of
guardian is reqd
4

Up to 12 wks --FACILITIES -
1-Gynecological examination /labor table
2-Resuscitation and sterilization Equipments
3-Drugs and Parenteral fluids
4- Backup facilities for treatment of shock
REQUIREMENT FOR APPROVAL OF
A PLACE – is done by D.L.C.

For Terminating 12 to 20 weeks of Pregnancy
FACILITIES
1-An operation table and instruments for performing
abdominal or gynecological surgery
2-Anesthetic Equipments, resuscitation and
sterilization equipments
3- Drugs and Parentral fluids for any emergency ,
notified by GOI from time to time
REQUIREMENT FOR APPROVAL OF
A PLACE – is done by D.L.C.

For Medical Abortion
1-up to 7 wks
An RMP does not need approval of place , can
display a certificate from owner of a approved
place
Only Registered doctor can prescribe
One needs to follow all rules and regulation
under MTP Act

MTP rules…..
Approval is applied - FORM A Annexure 1
Addressed to CMO
CMO does -- verification
inquiry or inspection
then recommends for approval of place to
DLC
 issues a certificate of approval in FORM B (annexure -1 )
APRROVAL PROCESS

Inspection of Place
Place should be inspected within 60 days of receipt
of approval
and approval within next 2 months or within 2 month
of any deficiency being rectified by applicant to
ensure safe and hygienic conditions
CMO may inspect the approved place any time if
necessary to reconfirm
You have to show and give all information's to CMO
anytime

Cancellation / Suspension
 CMO can suspend or cancel the approval , if he
suspects unsafe and unhygienic conditions .
After suspension can apply again after making
improvement within 60 days of order , during
suspension place is deemed as not approved govt can
modify or reverse the orders

Amendments to MTP rules
Key features :-
1. Detailed the composition and tenure of the DLC
2. Abortion sites approved for
A- up to 12 weeks
B- 12-20 weeks, facilities and equipments required for
two types were detailed
3. Allowed medical abortion using RU-486 and misoprostol
by RMP even from site not approved provided the RMP
has referral linkage access to an approved place
4.A non OB gynae provider who is trained and certified can
provide first trimester abortion
2003

MTP Regulations
MTP Act empowers the state govt to form
regulations , maintain records , reports
Salient features
1-Form of certifying opinion or opinions
Form 1 Annexure - 2
RMP who terminate s, should certify it
in Form 1

MTP Regulations
2- Custody of forms
Form c the CONSENT FORM + Form 1 for
intimation of termination , shall be sealed &
kept in safe custody & given to head or owner
of approved place
A serial number is assigned to the pregnant pat
in the admission register ,name of the RMP, &
shall write SECRET
3- Head or Owner has to send monthly
statement of the MTP cases to the CMO
on FORM II ( Annexure -3 )

Maintenance Of Admission
REGISTER
Maintain records As per Form III ( Annexure -4 )
Record the detail

Keep in secret custody for 5years from the end
of calendar year it relates to; It is not disclosed
to anyone except under authority of law

Recommendations
to Overcome Shortcomings
Requirement of 2 opinions for second trimester
termination is now a formality and could be
dispensed – but doctors want no change in
view to curb sex selective abortion.
A qualified extension of up to 24 weeks to
accommodate terminations after prenatal diagnosis of
birth defects

Recommendations
Scope to simplify and streamline bureaucratic
procedures by amending MTP Rules and Regulations.
Registration of centres by meticulous application &
persistent follow up.
Valid case for bifurcating recognition
requirements for performing first & second
trimester MTPs, in view of the documented safety &
simplicity of early abortions

With medical methods administered on an
outpatient basis, the act needs to be updated to
keep abreast with future medical advances
Revisit documentation required. Admission
register could be replaced by MTP Register
Increase the number of trained persons performing
induced abortions by multiplying training facilities
Allow medical abortion by all MBBS doctors
(IMA/FOGSI)
Recommendations

Learning : is the powerful weapon we can use to
change the world

Please Remember
Violation of The ACT
Any PERSON doing MTP and not a RMP can be
punished with rigorous imprisonment for 2-7 yrs.
If terminating at a PLACE which is not approved
can be punished 2-7 yrs rigorous imprisonment.
The owner of unapproved place , performing
termination can also be punished with rigorous
imprisonment 2--7 yrs

“Please Remember”
Legal abortion means
Termination done at a place approved under the
Act
Termination done for conditions and within the
gestation prescribed the Act
Termination done by a medical practitioner
approved by the act
Other requirements of the rules and regulations
are complied with

Pre Abortion Information
for Patients & GP
Simple tips

for Patients & GP - Tips
Medical termination usually leads to vaginal
bleeding for 10 – 14 days – more like having a
heavy prolonged period.
 there may be a risk of congenital
malformation in your baby in case of
continuation of pregnancy
In case of heavy bleeding please report to
emergency immediately.

Next period may be delayed by one or two
weeks but subsequent periods should be
regularized as earlier.
Maintain a menstrual dairy.
Avoid intercourse during treatment and
preferably till the next menstrual periods

Please sign on the consent from after
being satisfied with information provided
and clarifying any doubts that you may
have
Note that you have the full option of
choosing suction evacuation for
termination of pregnancy.

Women desiring concurrent tubal
ligation should realize that surgical
abortion is preferable since it can be
combined with the tubal ligation
Any method of termination of
pregnancy may lead to future
INFERTILITY or pregnancy
mishaps!

Anti – D in Rh Negative patients
Take injection anti – D 50 mg of Rh D
on day one

“Absolute Contraindication to
medical abortion”
Previous ALLERGIC reaction to mifepristone /
misoprostol inherited porphyria
Chronic adrenal failure
Known or suspected ECTOPIC or heterotopic
pregnancy

Caution is required in a range of
circumstances including
Long term use of corticosteroids such as
for bronchial asthma
Coagulopathy
Severe anamia (must be treated at time of
abortion),
 Pre- existing heart disease or
cardiovascular risk factor (e.g
hypertension and smoking)

No Contraindication to medical
abortion
Adolescence age or >35 ,
anemia ,
insulin dependent diabetes mellitus,
thyroid disorders,
multiple pregnancies,
obesity, previous caesarean section,
smoking,
uterine malformation – congenital and acquired
and previous cervical surgeries

Medical Abortion is Not Advised
if
No quick access to 24 hrs emergency
service
Patents unable to take responsibility
excessive anxiety wanting quick abortion
language or comprehensive barrier not
willing for surgical abortion in case of
failure living alone

Take home message
• It is necessary to do register your nursing home
under the MTP act, if you are going to do MTP
• Must follow all the rules and regulations under
MTP strictly and correctly
• All paper work must be complete before you start
an MTP ,one never knows when an emergency
arises
• Cultivate good habits like keeping and preparing
documents well in time .
• Medical Abortion is safe & public awareness to be
created

ADDRESS
11 Gagan Vihar, Near Karkari Morh
Flyover, Delhi - 51
CONTACT US
9650588339, 011-22414049,
WEBSITE :
www.lifecarecentre.in
www.drshardajain.com
www.lifecareivf.com
E-MAIL ID
Sharda.lifecare@gmail.com
Lifecarecentre21@gmail.com
info@lifecareivf.com
&

MTP Act & MTP - Made simple Dr. Sharda Jain , Lifecare Centre 11 Gagan Vihar Delhi -51

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