MTP (Amendment) Act & Rules 2021

& its implications

DR SUMITHA KS
JUNIOR RESIDENT
JMMC THRISSUR
Objectives:

• What is new in the MTP law?

• What are the MTP rules and policies ?
MTP ACT
• 10 th August 1971
• Came into force in 1 st April 1972
• MTP rules 1972 &1975
• MTP Amendment -2002 ->25 th march 2021
• When is Abortion considered SAFE?

WHO definition Safe Less Safe Unsafe

of (both criteria met) (only one criteria (both criteria not
Safe Abortion met) met)

By appropriate
methods

By trained persons
Person
who can conduct MTP?

MANDATORY QUALIFICATIONS
Any recognized medical qualification as defined in section (2)of the
Indian Medical Council act 1956 which recognizes degrees
• Name has been entered in State Medical Register
• who has such experience or training in OBG by rules made under this
act
Additional training and experience for a RMP as per
MTP ACT rules 4
1-RMP CONDUCTING MTPs WITHIN 12 WEEK PERIOD
Experience of assisting atleast 25 MTPs of which he must have performed atleast 5
MTPs independently,In a Govt Hospital or training institute approved by the Govt
2 RMPs CONDUCTING MTPs FROM 12-24 WEEKS
RMP with completion of 6 months of house surgency in OBG
• in the event if such facilities are not available then experience of atleast 1 year in
OBG practice at any hospital
• degree or diploma holder and registered under State Medical Register
(experience or training gained during the course will be considered)
TRAINING AND EXPERIENCE FOR A RMP(ORAL PILLS)

• A registered Medical Practitioner shall have the following experience and

training for conducting termination of pregnancy upto nine weeks of gestation
period by medical methods of abortion namely
1)experience at any hospital for a period of not less than three months on the
practice of OBG
2)Has independently performed ten cases of pregnancy termination by medical
methods of abortion under the supervision of a RMP in a hospital established or
maintained or a training institute approved for this purpose by the Govt
Place

1) a hospital established or maintained by government or

2) a place approved by government or a district level committee
Salient Features: MTP Amendment 2021
Modification in requirement of Provider:

One RMP Upto 20 weeks of gestation

Two RMP 20 – 24 weeks of gestation

Medical Board Beyond 24 weeks

Rules under MTP Amendment 2021

Composition of the Medical Boards:

For composition of the Medical Boards, following suggestive points are as
follows:
• The head of the department of Obstetrics and Gynaecology of that institution
will be the chair of the Board
• It should have at least one women member, and One member from the
Government Hospital
• Specialists from any other department may be included in the Board as per
the requirement of the case
• Any Board Member, if not available at the point of time of discussion on a
case, may be suitably substituted by another member by the Chair
Salient Features: MTP Amendment 2021
Modification for vulnerable group of women:
Previous Act
MTP is permissible beyond 20 weeks only when it is
immediately necessary to save the life of the
Pregnant Woman.
2021 Amendment
 Enhanced the upper gestation limit from 20 to 24
weeks for special/ vulnerable categories of
women.
 Further enhancement for birth defects not
compatible with life on medical board consensus
Modification for birth defects and congenital anomalies:

Previous Act 2021 Amendment

 The Act had provision for termination of such Upper gestation limit does not apply in cases of
pregnancies only up to 20 weeks. pregnancies with substantial foetal abnormalities
diagnosed by a Medical Board as may be prescribed
under the Rules made under this Act.
Modification related to marital status:

2021 Amendment
Previous Act

 The condition of failure of contraceptive was  Condition of failure of contraceptive to be

applicable for only married women or her extended for any woman or her partner.
husband.
Insertion of new clause of strengthening
privacy
Previous act
The Medical Termination of pregnancy
Regulation 2003 mentioned that
information shouldn’t disclosed except
under the authority of law
New insertion in 2021
Name and other particulars of a woman
whose pregnancy has been terminated
shall not be revealed except to a person
authorized by any law for the time
being in force
For minors-consent by guardian
simplified
RECORD KEEPING
1 Consent form-FORM C
2 Opinion of RMP(Upto 20weeks)- FORM I
3 Opinion of 2 RMP(20-24 weeks)-FORM E
4 Report of medical board(> 24 weeks)-FORM D
5 Maintenance of ad register –FORM III
6 Monthly reporting to CMO-FORM II
Salient Features: MTP Amendment 2021
Previous Act
 Requirement of opinion of one provider for MTP
up to 12 weeks
 Requirement of opinion of two providers for MTP
for 12-20 weeks.
 MTP is permissible beyond 20 weeks only when it
is immediately necessary to save the life of the
Pregnant Woman.
 The condition of failure of contraceptive was
applicable for only married women or her
husband.
2021 Amendment
 Requirement for opinion of one Registered
Medical Practitioner (RMP) for termination of
pregnancy up to 20 weeks of gestation
 Requirement of Opinion of two RMPs for
termination of pregnancy 20-24 weeks of
gestation.
 Enhanced the upper gestation limit from 20 to 24
weeks for special/ vulnerable categories of
women.Further enhancement for birth defects
not compatible with life on medical board
consensus.
 Condition of failure of contraceptive to be
extended for any woman or her partner
THANK YOU
Process of Developing/Adapting Forms

Forms introduced/revised in 2021 Amendments: Forms adapted and shared as model forms by
MoHFW:

1. Form A 1. Form I
2. Form B 2. Form II
3. Form C 3. Form III
4. Form D
5. Form E
FORM A
1)NAME OF FACILITY
2)ADDRESS
3)NONGOVERNMENT/PRIVATE/
NURSING HOME ETC
4)STATE
FORM B- CERTIFICATE FOR APPROVAL
FORM C-CONSENT FORM
FORM D-REPORT OF MEDICAL BOARD
(BEYOND 24 WEEKS)
FORM E-OPINION FORM OF RMP
FORM I-OPINION OF RMP UPTO 20 WEEKS
Requirements for MTP
• Place : identified as proper for conducting MTP by CMO,DMO ie,place should be
registered
• Person : qualified .ie,enough qualified as required
• Patient : justified in asking for MTP ,ie,should be fitting into the list of given
indications
• Papers : documentation should be as required
FORM II
FORM III-NADMISSION REGISTER
Documentation of Other Types of Abortions

• Spontaneous, Inevitable, Incomplete, Missed, Septic • Opinion Form not required

and Molar Pregnancy
None of these come under the purview of the MTP • Consent as taken for any other procedure and not
Act on Form C

• Procedure not recorded in Admission Register

(Form III) but in Labour Room Register, OT
Procedure Register or Evacuation Register (ER)
2. Norms for the RMP opinion required MTP at
different gestational age

• RMP defined as MBBS or more with any:-

• Medical practitioner assisted in 25 cases of MTP, of which at least five done
independently in a hospital
• Medical practitioner who has completed 6 months of house surgency in obstetrics
and gynaecology
• Medical practitioner who holds a post-graduate degree or diploma in obstetrics
and gynaecology
• Medical practitioner who has experience of at least 1 year in the practice of
obstetrics and gynaecology