14.4 Medical Termination of Pregnancy (MTP): Law & Methods
Key Takeaways
- The MTP Act 1971 (amended 2021) legalises abortion in India up to 20 weeks on the opinion of one registered medical practitioner (RMP), 20–24 weeks on the opinion of two RMPs, and beyond 24 weeks only for foetal abnormalities diagnosed by a Medical Board.
- Grounds for MTP include risk to the woman's life or physical/mental health, rape/incest (with gestational-tiered limits), contraceptive failure (married woman, up to 20 weeks), and substantial foetal abnormality at any gestation via the Medical Board route.
- Medical abortion (mifepristone 200 mg followed 24–48 hours later by misoprostol 800 µg buccal/vaginal) is approved up to 9 weeks (63 days) gestation; surgical methods (manual vacuum aspiration, D&C, D&E) are used for higher gestations and retained products.
- Only a registered medical practitioner with the prescribed training, at an approved facility, may perform MTP; consent of the woman (and guardian if minor/unable) is required, and confidentiality is protected.
- The PCPNDT Act 1994 prohibits sex-selective abortion; MTP for sex selection is illegal and a punishable offence distinct from lawful MTP.
14.4 Medical Termination of Pregnancy (MTP): Law & Methods
High-Yield Core Concept: The Family Planning syllabus names Medical Termination of Pregnancy as a distinct topic. CMS questions test the gestational tiers and practitioner numbers introduced by the 2021 amendment and the method appropriate to each gestation.
1. Legal Framework — the MTP Act
India's Medical Termination of Pregnancy Act 1971, substantially amended in 2021, is the governing statute. Lawful MTP requires a registered medical practitioner (RMP) with prescribed training, performed at an approved place.
Gestational tiers (2021 amendment):
| Gestation | Requirements |
|---|---|
| Up to 20 weeks | Opinion of one RMP |
| 20–24 weeks | Opinion of two RMPs |
| Beyond 24 weeks | Only for substantial foetal abnormalities — decision by a Medical Board (constituted at an approved facility) |
Grounds for termination:
- Risk to the woman's life or physical/mental health (failure to continue pregnancy endangers her).
- Rape or incest — gestational limits tiered (the 2021 amendment raised the upper limit to 24 weeks for survivors of rape/incest, beyond the general 20-week ceiling).
- Contraceptive failure — available to a married woman (and, per amendment, to any woman) up to 20 weeks; failure of any contraceptive method, including sterilisation.
- Substantial foetal abnormality — at any gestation, via the Medical Board route.
Emergency provision: where immediate termination is necessary to save the woman's life, one RMP may proceed.
2. Consent & Confidentiality
- Consent of the woman is required (written, informed).
- For a minor or a woman unable to give consent, consent of the guardian is required.
- Confidentiality of the procedure and the woman's identity is protected; unauthorised disclosure is an offence.
- A husband's consent is not required for an adult woman's MTP.
3. Methods of Termination
Medical abortion (first-trimester, up to 9 weeks / 63 days):
- Mifepristone 200 mg orally (antiprogestin) followed 24–48 hours later by Misoprostol 800 µg buccal/vaginal (prostaglandin analogue causing uterine contractions).
- Follow-up at 7–14 days to confirm complete abortion (clinical + ultrasound/β-hCG as needed).
- Contraindications: confirmed/suspected ectopic, IUD in situ (remove first), adrenal failure, anticoagulant use, porphyria.
Surgical methods:
| Method | Indication |
|---|---|
| Manual vacuum aspiration (MVA) / suction evacuation | Up to ~12 weeks; quick, outpatient |
| Dilatation & curettage (D&C) | Historically used; sharp curettage largely replaced by suction |
| Dilatation & evacuation (D&E) | 13–20 weeks; requires cervical priming (misoprostol/osmotic dilators) |
| Instillation / medical (mifepristone + misoprostol, or prostaglandins) | Second trimester; medical regimens increasingly preferred |
Cervical priming with misoprostol reduces cervical injury in surgical methods.
4. Complications of Unsafe Abortion
Unsafe abortion remains a major cause of maternal mortality and morbidity in India. Complications include haemorrhage, sepsis, uterine perforation, cervical injury, retained products, anaesthetic risk, and long-term sequelae (synechiae/Asherman syndrome, future pregnancy loss). Legal, safe MTP services and access to contraception are the public-health antidote.
5. MTP vs Sex-Selective Abortion — PCPNDT Act
The Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act 1994 prohibits using prenatal diagnostic techniques (ultrasound, amniocentesis, etc.) for sex determination and sex-selective abortion. Lawful MTP performed under the MTP Act is distinct from and unrelated to sex-selective abortion, which is illegal and punishable. A physician must not disclose fetal sex or perform termination on the basis of sex.
6. Post-Abortion Care & Contraception Linkage
Lawful MTP is incomplete care unless paired with post-abortion care and contraception — repeat abortion is common and preventable.
Immediate post-procedure care:
- Observe for bleeding, uterine cramping and vital signs after surgical evacuation.
- Confirm complete evacuation (clinical + ultrasound where indicated); retained products cause persistent bleeding and infection.
- Anti-D immunoglobulin (300 µg IM) within 72 hours if Rh-negative, to prevent isoimmunisation.
- Analgesia and antibiotics where indicated; counsel on warning signs (fever, foul discharge, heavy bleeding) requiring return.
Contraception linkage: a woman who has just had an abortion can conceive again within 2 weeks. Initiate contraception immediately:
- LARC (long-acting reversible contraception) — Cu-IUD or hormonal IUD inserted at follow-up, or implant, gives the most effective prevention of repeat unintended pregnancy.
- OCPs/POP can be started the same day (with backup for 7 days if started >5 days post-procedure).
- DMPA injection at the visit.
- Permanent methods (tubal ligation/vasectomy) for those who have completed family.
Counsel that MTP itself does not cause infertility when performed safely and legally; unsafe abortion is what carries the morbidity risk. Document the chosen method and arrange follow-up at 1–2 weeks.
Worked scenario: a 24-year-old woman has suction evacuation at 8 weeks; she is Rh-negative and does not want a pregnancy soon. The correct bundle is anti-D within 72 hours, immediate contraceptive counselling and insertion of a Cu-IUD at follow-up, and a written contraceptive plan before discharge.
Key Takeaways for the CMS Candidate
- MTP Act tiers: ≤20 weeks = 1 RMP; 20–24 weeks = 2 RMPs; >24 weeks = Medical Board for foetal abnormalities (amendment 2021).
- Medical abortion (mifepristone + misoprostol) is approved up to 9 weeks (63 days).
- Husband's consent is not required for an adult woman; guardian's consent is required for a minor.
- Always exclude ectopic before medical abortion.
- Sex-selective abortion is illegal under the PCPNDT Act and is separate from lawful MTP.
Under the MTP (Amendment) Act 2021, what are the requirements for terminating a pregnancy at 22 weeks on the woman's request following contraceptive failure?
Which regimen is the standard medical method for termination up to 9 weeks (63 days) of gestation?