There are many non-clinical, medicolegal aspects involved in terminating a pregnancy, ranging from acquiring the right certifications that have to be acquired to conduct an MTP to the finer details such as patient consent. In this second part of the medical abortions series, Dr. Kiran Kurtkoti has covered a list of important guidelines under the MTP act and rules.

As far as the medical termination of pregnancy with drugs is concerned, certain amendments enacted in this act are relevant. Under the MTP act section 5 was modified for the first time to legalise the use of drugs to terminate the pregnancy. Under the explanation to rule 5 of MTP rules 2003, first-time detailed guidelines were proclaimed for terminating a pregnancy with RU-486.

They are as follows :

1. The basic qualifications of a doctor for this purpose remain the same, namely:
   1. A medical practitioner who was registered in a State Medical Register immediately before the commencement of the act, experience in the practice of gynaecology and obstetrics for a period of not less than three years
   2. A medical practitioner who is registered in a State Medical Register-
      1. If he has completed six months of house surgency in gynaecology & obstetrics, or
      2. Unless the following facilities are provided therein if he/she has the experience at any hospital for a period of not less than one year in the practice of gynaecology & obstetrics; or
   3. If he/she has assisted a registered medical practitioner in the performance of twenty-five cases of medical termination of pregnancy of which at least five have been performed independently, in a hospital established or maintained, or a training institute approved for this purpose by the government.
      1. This training would enable the Registered Medical Practitioner (RMP) to do only 1st-trimester terminations (up to 12 weeks of gestation )
   4. A medical practitioner who has been registered in a State Medical Register and who holds a postgraduate degree or diploma in gynaecology & obstetrics and the experience or training gained during the course of such a degree or diploma.
2. The medical termination of pregnancy with RU-486 and Misoprostol may be carried on up to 7 weeks ie. 49 days of pregnancy. Such prescription for these drugs may be given either at a place registered under the MTP Act or at a clinic of such a recognised medical practitioner provided that he has access to a place approved under section ( 4) of MTP Act 1971 read with MTP (Amendment) Act,2002 and Rule 5 of MTP Rules.
3. When such a prescription is given by the said registered medical practitioner under the MTP act at his clinic, he/she should display a certificate to show that he/she has access to an approved place under the MTP act. The certificate is to be obtained from the owner of such an approved place, e.g. a qualified doctor who does not own his/her own nursing home is supposed to display a certificate showing that he/she has access to a place where a surgical abortion can be performed.
4. The consent and opinion forms should be filled as per any other procedures of MTP including the register which should also be maintained according to the MTP act.
5. It must be understood that all the obligations, liabilities and punishments are equally applicable to the medical termination of pregnancies with drugs, as they would be for any other first trimester MTP.

To read part one click here: Medical abortion: Stepwise guide & post-procedure care

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.

Dr Kiran Kurtkoti is a practising Obstetrician & Gynecologist with an experience of 28 years.