Medical Termination of Pregnancy - MTP in Hyderabad | Act & Cost

The Medical Termination of Pregnancy Act 1971 came into force on 10th august 1971. It is framed to allow registered or licenced medical professionals to end certain pregnancies and handle any other issues related to the procedure. 

The termination of pregnancy is allowed on the basis of a single registered obstetrician's opinion if the gestation period does not exceed twelve weeks, whereas if it exceeds more than 12 weeks and less than 20 weeks, it is good to take two registered obstetricians' advice. It is not allowed if it exceeds more than 20 weeks except in a few cases.

As per the Medical Termination of Pregnancy Act of 1971, a pregnancy may be terminated by a registered medical practitioner under the following provisions:

1. The continuation of the pregnancy would threaten the pregnant woman's life or seriously hurt her physical or mental health, that includes rape or failure of any contraceptive (device or medication) that a married woman and her partner used to avoid pregnancy; or
2. There is a significant probability that if the kid is born, it will be severely handicapped due to physical or mental defects.

In addition to this, According to Section 3 of the Medical Termination of Pregnancy (MTP) Act of 1971, the following need to be considered:

• When a doctor or other medical professional terminates a pregnancy in line with the law, they should not hold in violation (have or commit a crime) of any crime under the Indian Penal Code, 1860, or any other law in effect at the time.
• A minor girl (under age 18) and /or who is mentally ill or of unsound mind cannot get an abortion without the consent of her guardian or parent.

In the case where there is an immediate need for the termination in order to save a pregnant woman's life, the length of the pregnancy (less than 20 weeks) and the opinion from two obstetricians will not be applicable or mandatory.

This act expanded the indications for abortion, outlined the requirements for facilities and practitioners, and mandated training for obstetricians carrying out abortions.

No pregnancy terminations shall be performed under this act at places other than

• An established hospital or a hospital which is maintained by the government of India, or
• A place for the time being that the government has approved for the purposes of this act.
  

In order to ensure better and more general implementation and expanded access for women, especially in rural areas, the Medical Termination of Pregnancy Act 1971 was revised in 2002, where a committee was set up by the government at the district level, with the Chief Medical Officer or District Health Officer as the committee's chairperson. In addition to the 1971 act, the district-level committee can approve additional places where a legal termination of pregnancy could be done.



Unfortunately, the act has not kept pace with advanced technology in foetal health diagnostics and abortion access for malformed foetuses (identifying foetal abnormalities). 

In light of advancements in medical technology, such as genomics and ultrasonography, the MTP Act of 1971 and 2002 has become antiquated and inadequate in providing safe rights to women. A study was reported in 2015 where 1.56 crore abortions in India were reported, with 73% of those occurring in non-medical settings.

The medical Termination of Pregnancy Act 2021 act is an amendment to the Medical Termination of Pregnancy Act 1971 and 2002 as there is an advancement in technology, where ultrasonography and genetics enabled the prenatal (before birth or during pregnancy) diagnosis of having a variety of foetal abnormalities. These abnormalities can be identified after 20 weeks gestation period due to a variety of scientific and biological reasons, thereby highlighting the necessity to raise the gestational limit for abortion (more than 20 weeks). 

The Ministry of Health and Family Welfare has been pressured by the concerned medical professionals to amend the MTP Act and bring it in line with worldwide norms due to the increase in writ petitions requesting termination of pregnancy in cases of significant foetal defects. As a result, the MTP Act 2021 (which is currently law) substantially revises the MTP Act of 1971 and 2002. These changes have provided more time for obstetricians, gynaecologists, and other specialists in the field of foetal medicine to make accurate diagnoses of foetal abnormalities.

As per this, termination can be performed on a woman by a registered medical practitioner on the advice of one obstetrician for up to 20 weeks for women who had conceived due to the failure of any device or method used by her or her partner for the purpose of limiting or preventing pregnancy.

In cases of survivors of rape, victims of incest, minors, women with physical disabilities and women with a change of marital status during an ongoing pregnancy (widowhood and divorce), if the length of the gestation period is less than 20 weeks, the advice of one obstetrician is required, and in cases of more than 20 weeks and less than 24 weeks, a two obstetricians’ opinion is need to have a safe termination. For more than 24 weeks, the state-level medical board's opinion is required for the termination.

The members of the Medical Board shall consist of the following:

1. Gynaecologist
2. Paediatrician
3. Radiologist or Sonologist
4. Other members as may be notified in the State Government or Union territory's Official Gazette.

The termination shall not be subject to the restrictions with respect to the duration of the pregnancy by the medical practitioner when necessary due to the presence of the significant foetal abnormalities identified by a Medical Board.

The core objective of the Medical Termination of Pregnancy (MTP) Act was framed in its initial version (Act 1971). It states the following:

"An Act to provide for the termination of certain pregnancies by registered Medical Practitioners and for matters connected therewith or incidental thereto."

The objective focus on improving maternal health and reducing the mortality rate (death rate) in India caused by unsafe and illegal abortions. With this act, only certain pregnancies are allowed to be terminated by medical professionals.

Possible complications of medical termination in pregnancy can vary depending on the type of technique used. 

Medical termination:

• Incomplete abortion, which could necessitate a surgical abortion
• If the medical technique does not work, there will be a continuation of the pregnancy
• Serious complications such as heavy and prolonged bleeding
• Infection and increase in body temperature
• Discomfort in stomach

Surgical termination:

• Probability of cervical tear
• Uterine perforation
• Bleeding and infections
  

Medical termination is a common procedure to have a safe abortion, but it is not an option for everyone. Women with the following conditions are not allowed to have a medical termination of pregnancy:

• Presence of an intrauterine device in the uterus
• In the case of ectopic pregnancy (pregnancy outside of the uterus)
• Presence of bleeding disorders, serious liver, lung and kidney disease, and seizures (uncontrolled)
• Intake of blood thinning agents or steroids
• Complications of the heart or blood vessel
• Presence of an allergy to the medications involved in the technique.
  

Before initiating a medical abortion, the healthcare provider would like to know the following:

• Overall medical and medication history of the pregnant women.
• Pregnancy confirmation by undergoing a physical examination.
• Request for an ultrasound exam to rule out ectopic (suspecting of having pregnancy outside the uterus) and molar pregnancy (development of tumour in the uterus).
• Request for urine and blood tests.

The obstetrician will explain the complete procedure, how it works, the side effects, and possible risks and complications.

The patient needs to understand the entire process and how the MTP kit / medication work, the risks and complications involved and should be clear on all questions or concerns, if any, before the start of the process. Also, the patient needs to sign the consent form as a token of acceptance to have a medical termination.

This technique of abortion does not need anaesthesia as this is not a surgical procedure. This technique can be performed in clinics or in home premises under the supervision of an obstetrician or gynaecologist. 

The obstetrician will be providing safe medications / MTP kit in combination through the oral or different route of administration. This regimen is approved by the Food and Drug Administration (FDA), and medicines are typically given within seven weeks from the first day of the last menstrual period. The obstetrician might prescribe medicines at different intervals.

Medical abortion pills are used in a medical procedure resulting in cramping and bleeding in the uterus. It's also possible that they could lead to the following:

• Vomiting sensation
• Increase in body temperature
• Chills
• Loose and more frequent bowel movements
• Headache
  

The patients will be advised by the healthcare team that the occurrence of the following signs is expected after MTP, which may indicate a successful abortion. 

• Severe abdominal pain
• Increase in body temperature that lasts more than 24 hours
• Presence of foul-smelling vaginal discharge
• Heavy bleeding

Following a medical abortion, the patient should visit their obstetrician to ensure adequate healing and to examine the uterine size, bleeding, and any signs of infection. In order to prevent the risk of having infections, the patient should not insert anything vaginally up to two weeks after an abortion.

The obstetrician may ask about the patient's feelings about pregnancy, the regularity of bleeding, and other such questions during the follow-up visit. An ultrasound and, maybe, a surgical abortion may be necessary if the obstetrician detects an incomplete abortion or continued pregnancy.



The obstetrician might suggest having a counselling session if the patient is feeling low, sad and having mixed emotions (guilty, embarrassed and stigmatised).

The advantages of medical termination of pregnancy include the following:

• Non-invasive procedure until it fails 
• Safety and effective method for early pregnancy
• Done with privacy under medical supervision