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Termination of pregnancy

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2
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( F ard
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1. MTP Act
a
P 23
e
LAW
ls id • What empowers RMP to
cause miscarriage 2. IPC : [312, 315 & 316]
• What makes abortion
illegal
3. PCPNDT Act
 1
rt
Termination of pregnancy
Pa
 Termination of pregnancy
(Probable . common questions)

• Define, classify and discuss abortion, methods of procuring

MTP and criminal abortion and complication of abortion. MTP
Act 1971
• Describe evidences of abortion - living and dead, duties of
doctor in cases of abortion, investigations of death due to
criminal abortion
 Termination of pregnancy
(Learning objectives)
• Discuss the issues and general debate over abortion,
• Definition, types of abortion and what are the various stages of
pregnancy
• Describe relevance of legal expectations & MTP with examples
• Describe and discuss the examination of the victim of an alleged
case of abortion,
• Specimen & trace evidence one has to take from the victim.
Preservation and dispatch of fetus or the POC as evidences in such
cases
• Discuss significance of genital / extragenital injury in relation to
abortion. (Corroboration of victim’s story).
 is s n
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Unwanted pregnancies

• It is difficult for a woman to continue pregnancy,

• women’s choice is to get the pregnancy terminated.
• It is her individual problem,
• problem for the society, it is problem of the system.
 is s n
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Abortion needs
re Abo

• Widows, virgins and woman living adulterous life in order to

conceal birth commit such offence.
• The newly born child & killed as such is thrown in the drain,
canal & filth etc.
• What fails to meet the abortion needs of large number women
 is s n
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How mother can be Bête noire of her child

especially of unborn ?

• A person or thing which is strongly hated , disliked or avoided

is bugbear
• Woman can give birth to man. This distinct quality places her on
both advantageous and disadvantageous stance.
• She has right to motherhood but here bone of contention is
whether she has right to undergo abortion.
 is s n
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War is between woman & child who

has not taken birth ?
• Woman demands right over her body & child until who
has not taken birth
• Abortion is the subject of strong public debate.
 n f
ti o o
or nts
Ab one
p
Op

Abortion ban bill

• Alabamians believe
• that every life is precious
• and that every life is a sacred gift
from God.
 Abortion ban bill
t io he
or t t
ab ains
n
Ag

• The state of Alabama has now passed the nation’s

most restrictive abortion law
• – one with no exceptions for survivors of sexual
assault or any medical need less dire than
“immediate death or substantial physical
impairment” or any fetal anomalies that aren’t
lethal.
• Six months from now, when the law goes into
effect,
• a doctor who terminates a pregnancy at any point
after conception could face up to 99 years in
prison.
re Abo
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 Abortion
(miscarriage)
Types &
Causes
 Abortion
(miscarriage)
• Means the premature expulsion of the fetus
• From the mother’s womb at any time of pregnancy,
• Before full term of pregnancy is completed
 Abortion (miscarriage)
• Means the premature expulsion • Means the spontaneous or induced termination
of the fetus of pregnancy
• From the mother’s womb at any • before the fetus is independently viable, which
time of pregnancy, is usually taken as occurring after the 28th
• Before full term of pregnancy is week of conception.
completed

• < than 20 weeks &

• > than 20 weeks
• Are the important ages as laid down in MTP act.
 Spontaneous
Natural
Accidental

Abortion
Justifiable /
Legal /
Artificial Therapeutic

Criminal
 Stages of pregnancy

2
1 • 14th day ovulation takes
place
• 4 parts of FT
1. Intrauterine
2. Near uterus
3. Ampoule (dilated)
3 4. Fimbriae
4
 Stages of pregnancy

It’s not only complete fetus but other parts like as early as ovum,
embryo, yolk sac, chorionic villi etc that are important from the
point of view of identifying that there was pregnancy or early fetus

Fetus developing 13 week fetus

 Stages

• Life begins at the time of conception

• It takes 7-10 days before implantation of developing
ovum.
• 0 - 5 Post Menstrual Week
• Embryo goes on developing up to 9th week. i.e start of 6th
till 9th PMW
• From then onwards it is Fetus. i.e start of 10 PMW until
delivery
 Stages
• Fertilization takes place • Life begins at the time of
in ampoule. conception
• Fertilized ovum start • It takes 7-10 days before
migrating for implantation of developing ovum.
implantation • Embryo goes on developing up to
• It takes … days to reach 9th week.
uterus • From then onwards it is fetus.
 Stages

• 9 weeks : It is fetus, limbs are there but are webbed

• Limb formation after 1st trimester
• Baby grows in 2nd trimester
• 1st & 3rd trimester will be risky
• There is risk of premature labor in 3rd trimester.
 Natural Abortion
• Incidence : 15 % among clinically
recognized pregnancies
• OH: Incidence is higher among women
with prior abortions.
• Fetal age : Most common at 2-3 months.
• Incidence increases with maternal age
from
• 12 % in women < 20 yrs
• Over 50 % in women > 45 yrs
 Causes of Natural
• Defect in Ova : Chromosomal defect.
(CC in 1st trimester).
• Developmental defect of fetus (common
cause).
• Low implantation of zygote
• Disease of decidua or placenta
• Rh incompatibility
• Retroverted uterus
• Submucous uterine fibroid.
• Malformed uterus
 2
rt
Pa

1. MTP Act
LAW
• What empowers RMP to
cause miscarriage 2. IPC : [312, 315 & 316]
• What makes abortion
illegal
3. PCPNDT Act
 Artificial Abortion
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Legal or therapeutic (MTP Act)

Abortion is justifiable only when it is done in good faith

to save life of the woman, if it is materially endangered
by the continuance of pregnancy
 Criminal abortion
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is induced destruction and expulsion of the fetus from womb

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of the mother unlawfully

i.e. when there is no therapeutic

indication for the operation

Resorted to mostly by widows and unmarried women

Usually carried out before the 3rd month.

A case of criminal abortion is investigated only when the woman dies
and rarely when some one gives the information to police
 MTP Act 1971
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Pregnancy can be terminated

Le

(1) Therapeutic
When the continuation of pregnancy endangers the life of woman or may cause serious
injury to her physical or mental health
 MTP Act 1971
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Pregnancy can be terminated

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(2) Eugenic
When there is risk of the child being born with serious physical or mental abnormalities. This
may occur
• If the pregnant woman in the first 3 months suffers from German measles, Small pox or
chicken pox, toxoplasmosis, viral hepatitis, any severe viral infection.
• If the pregnant woman was treated with drugs like thalidomide or she consumes
hallucinogens or antidepressants
• Pregnant woman was treated by X-rays or radio-isotopes.
 MTP Act 1971
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Pregnancy can be terminated

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(3) Humanitarian
When pregnancy caused by rape

(4) Social
Pregnancy resulted from failure of contraceptive methods in case of a
married woman.

(4) Environmental
When social or economic environment , actual or reasonably expected can
injure the pregnant woman’s health.
 MTP Act 1971
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Who is eligible to do ?

• Possessing PG degree or diploma in Ob &G or

• Who has assisted in performing 25 cases of MTP.
• Or has 6 months of experience as a house surgeon in Ob &G in a
recognized hospital.
• MTP (amendment) bill, 2014 allows homeopathy and ayurvedic
practitioner to conduct medical termination of pregnancy.
• A doctor ‘s training is to be certified by CMO
 MTP Act 1971
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Consent ?
• Consent of the woman is required before conducting abortion
• Written consent of the guardian is required if the woman is minor or a
mentally ill person
• Consent of the husband is not required.
• Abortion can’t be performed on the request of the husband, if the woman
herself is not willing
• The woman need not produce proof of her age, her statement is enough
• It is enough for the woman to state that she was raped
 MTP Act 1971
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Where MTP can be conducted ?

• in Government hospitals or in the hospital recognized by the government

for this purpose
• Non-governmental institutions if licensed from the the government or
district level committee constituted by government for this purpose
 MTP Act 1971
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Methods of Therapeutic abortion ?

1. Mifepristone inhibits the action of progesterone.
2. Electrical vacuum aspiration. Done during 1st three months of
pregnancy.
3. Dilation of Cx and oxytocic infusion
4. Dilation of Cx and evacuation of uterus by curettage during 1st
three months of pregnancy.
5. Low rupture of the membranes
6. Utus paste is injected through a cannula into the cervical cannula
 Methods of Therapeutic abortion ?

7. Prostaglandins : induce labor and abortion

8. Amniotic fluid replacement therapy : useful after 12th week of
pregnancy or in case of IUD.
9. Manual vacuum aspiration : A handheld vacuum syringe and
flexible plastic canula are used.
10. Abdominal hysterotomy : preferred after 14 weeks of
pregnancy.
 The methods of procuring criminal
abortion ?
1. Abortifacient drugs
2. Drugs acting directly on Uterus : Ecbolic & Emmenagogues.
3. Irritants of the Genitourinary tract
4. Irritants of the Genitourinary tract
 in an emergency ?
• Pregnancy can be terminated by a single doctor
• even without required training
• Even after 20 weeks
• Without consulting a second doctor, in a private hospital which
is not recognized.
 MTP Act 1971
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If < 12 week
Single doctor
Up to 20 weeks
If 12 to 20 week
Abortion 2 doctors

After 20 weeks Permission of the court

 1

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The Niketa Mehta case: does the right to abortion
tio g
or Ille
Ab l &

threaten disability rights ?

ga
Le

https://ijme.in/articles/the-niketa-mehta-case-does-the-right-to-abortion-threaten-disability-rights/?galley
=html
• The secular public discussion on abortion in India has generally been
centered around the need to prevent sex selective abortion because of its
social consequences.
• Abortion has also been discussed in the context of maternal health, where
it is feared that contraception use is substituted by repeated induced
abortions.
• Another concern has been that induced abortions are resorted to by
unmarried girls. In all the above circumstances, the key ethical issues are
related to gender inequality and the presence of subtle or overt coercion.
• It needed a person like Niketa Mehta to initiate the ethical discussion
surrounding the question of abortion per se in India.
 The Niketa Mehta case:
on
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=html
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• Coercion does not seem to be an issue in the case of Niketa Mehta. An educated,
middle-class woman, with a supportive husband, having a much longed-for first
pregnancy, she was arguably better placed than most women to take a decision
about her pregnancy. She was equipped with sufficient information on the foetus`
health
us had a serious heartcondition
defect and apparently did not face any coercion from her family.
d the defect• been
Shelearnt
wanted to terminate
before 20 weeks. a pregnancy whichhave
Abortion would had abeen
highdone
probability of resulting in
a miscarriage or the birth of a child with a serious heart defect. This could have
mally & in routine.
was learnt when been a routinehad
pregnancy decision,
advancedhadbeyond
it not been for the fact that Niketa`s pregnancy had
20 weeks
ting MTP at theadvanced beyond
age of 23 weeks, thewithout
20 weeks during
court’s which medical
permission, was termination of pregnancy is
sible but wouldpermitted
have beenin India
illegal act.
er 20 weeks
• MTP can’t
Rather beresort
than done without the permission
to an illegal of court.
abortion, Niketa and her husband, along with the
specialist who diagnosed a congenital anomaly in the foetus, filed a petition in the
Mumbai High Court asking for permission for an abortion in the 23rd week,
which was when the problem was detected
2

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Rules for conducting Abortion :
Ex

• Up to 12 week : single doc

• 20 Yrs old pregnant mother
• Pregnancy was of 21 weeks & 3 days
• Wanted both termination of her
pregnancy and divorce.
• Bombay HC denied permission
• 12 to 20 weeks : team of 2 docs or
more
• Beyond 20 weeks one can’t do
without court’s permission.
Probably because quickening starts
at this age.

Doctor Can Medically Terminate Pregnancy Exceeding 20 Weeks Without HC's Permission
If Mother's Life Is In Danger: Bombay HC [Read Judgment]
https://www.livelaw.in/top-stories/medically-terminate-pregnancy-exceeding-20-weeks--144064
 HC
• Marital dispute,
• didn’t grant permission for the
abortion of her 21 weeks
pregnancy.
Supreme court
dismissed her petition for the
abortion of 25 weeks.
• 2 views on the issue of
Abortion
• The one from the point of view of the
mother
• The other from the point of view of
unborn baby. (i.e. viewpoint of the
honorable courts)
Next lecture is on 25.5.2020

LAW
• What empowers RMP to
cause miscarriage 2. IPC : [312, 315 & 316]
• What makes abortion
illegal
3. PCPNDT Act