Performing MTP Beyond 24 Weeks: What Doctors need to know

New Delhi: After much anticipation, the Medical Termination of Pregnancy Act 1971 has been amended by the parliament to be in force from 24th September 2021. The amendments in this act have not only provided some much-needed relaxation in the existing norms of abortion but also tried to form a safer environment for availing abortion services by all women. It aims at providing a safe environment for the termination of unwanted pregnancies by all women by being more inclusive and open-minded. Provisions like an extended period of gestation or making even unmarried women eligible for an MTP are just some steps towards it.

Providing major relief in cases of medical anomalies, the new Medical Termination of Pregnancy (Amendment) Act, 2021 has specified that the various rules of MTP limiting to 24 weeks will not apply in case of substantial foetal abnormalities. The Act ads that this diagnosis has to be done by a Medical Board in this case, stating 

The provisions of sub-section (2) relating to the length of the pregnancy shall not apply to the termination of pregnancy by the medicalpractitioner where such termination is  by the diagnosis of any of the substantial foetal abnormalities diagnosed by a Medical Board

With this the act has laid down the requirement of a board to be set up in every state, UT for this purpose

Every State Government or Union territory, as the case may be, shall, by notification in the Official Gazette, constitute a Board to be called a Medical Board for the purposes of this Act to exercise such powers and functions as may be prescribed by rules made under this Act.

AS per the Act, The Medical Board shall consist of the following, namely:—

(a) a Gynaecologist;

(b) a Paediatrician;

(c) a Radiologist or Sonologist; and

(d) such other number of members as may be notified in the Official Gazette by the State Government or Union territory, as the case may be.

Further defining the operations of the new The Medical Termination of Pregnancy (Amendment) Act, 2021, the central government has recently notified  The Medical Termination of Pregnancy (Amendment) Rules, 2021. The rules reiterate that In order for one to be able to get a termination of pregnancy beyond 24 weeks of the gestation period, approval from a state-wise established medical board is necessary. The board will also give its opinion in a new  FORM D which has been definied for this purpose 

The recently released rules have gone ahead to explain all the powers as well as functions of such a medical board.

The Powers of the board are as follows:

1. To allow or deny termination of pregnancy beyond 24 weeks of gestation period only after due consideration and ensure that the procedure would be safe for the woman at that gestation age. It also has to investigate in case of a foetal malfunction that whether such malformation has a substantial risk of it being incompatible with life or if the child is born it may suffer from such physical or mental abnormalities to be seriously handicapped.

2. To co-opt other specialists in the Board and ask for any additional investigations if required, for deciding on the termination of pregnancy.

The Functions of the board are as follows:

1. To examine the woman and her reports, who may approach for medical termination of pregnancy.

2. To provide the opinion of the Board in Form D with regard to the termination of pregnancy or reject the request for termination within 3 days of receiving the request for medical termination of pregnancy.

3. To ensure that the termination procedure, when advised by the Medical Board, is carried out with all safety precautions along with appropriate counselling within 5 days of the receipt of the request for medical termination of pregnancy.

With such powers and functions well listed, a 'Form-D' has also been introduced. Such a form is required to be duly filled in case one wishes to carry out a procedure of MTP after 24 weeks. 
This form talks about the Report of the Medical Board for Pregnancy Termination Beyond 24 weeks. It seeks:

1. Details of the woman seeking termination of pregnancy like name, age, registration/case number, her available reports and investigations as well as any additional investigations that might have been carried out. 

2. Opinion of the medical board. Whether the termination has been denied or allowed. 

3. Justification for the decision of the board. In case the request has been denied reasons need to be provided and in case the request has been approved reasons are still needed to be specified. 

4. Whether the woman in question met the physical fitness level needed for the procedure, yes/no.

5. details of the members of the medical board who reviewed the case like name, signature etc. 

6. The date and time of filling up the form-D. 

The form has been provided below for clear reference:

10                                                                   THE GAZETTE OF INDIA: EXTRAORDINARY                                                                             [PART II—SEC. 3(i)]

"Form D

(See sub-clause (ii) of clause (b) of rule 3A)

Report of the Medical Board for Pregnancy Termination Beyond 24 weeks

Details of the woman seeking termination of pregnancy:

1. Name of the woman

2. Age:

3. Registration/Case Number:

4. Available reports and investigations:

S.No.                                                                                                  Report Opinion on the findings

5. Additional Investigations (if done):

S.No.                                                                                                 Investigations done Key findings

6. Opinion by Medical Board for termination of pregnancy:

a) Allowed

b) Denied

Justification for the decision:

7. Physical fitness of the woman for the termination of pregnancy:

a. Yes

b. No

Members of the Medical Board who reviewed the case:

S.No.                                                                                                             Name Signature  

Date and Time:………….