Which doctors Can Perform AN MTP: New Rules give some relaxations on eligibility but put limits of gestation criteria
New Delhi: Defining the operations of the new The Medical Termination of Pregnancy (Amendment) Act, 2021, the central government has recently notified Medical Termination of Pregnancy (Amendment) Rules, 2021 in order to clear the operational ambiguity related to the new Act
The fresh rules, which are effective from 12th October, 2021, not just requote the elements of the act defining which patients are eligible for the MTP under the new Act but also amend the previous rules of 2003 adding on the elements on who can perform MTP, how the newly defined board is going to function and the extra forms that doctors need to fill to perform MTP in certain cases.
One of the important points that the new rules define is the expansion of eligible medical practitioners who can perform an MTP. The original MTP rules 2003, clearly specify that an MTP, whether medical or surgical can be performed by doctors registered under the state medical register. In addition, the 2003 rules lay down the requirements for various kinds of MTP. Now the new rules, expand these and under Section 4 of the rules that define Experience and training required for perfoming MTP add a new clause (ca)
"(ca) A Registered Medical Practitioner shall have the following experience and training for conducting termination of pregnancy upto nine weeks of gestation period by medical methods of abortion, namely:-
(i) experience at any hospital for a period of not less than three months in the practice of obstetrics and gynaecology; or
(ii) has independently performed ten cases of pregnancy termination by medical methods of abortion under the supervision of a Registered Medical Practitioner in a hospital established or maintained, or a training institute approved for this purpose, by the Government
Simplifying the rules, now, those doctors who have experience of three months in obstetrics and gynaecology in any hospital or have independtly performed more than 10 cases of MTP under the supervision of another doctor in a government setup can also perform medical MTPs.
However, there is a limit also attached to these doctors performing Medical MTP, as the doctors falling under the newly added clause can only perform Medical MTP till 9 weeks of pregnancy
The new set of rules have firstly demarcated gestation stages separately with substantiated methods of MTP i.e., medical or surgical.
Therefore, the following is the new requirement of the opinion of a Registered Medical Practitioner for termination of pregnancy at different gestation stages:
1. Till 9 weeks of gestation period- by way of MEDICAL METHODS-
Following doctors can perform MTP under the new rules
- (a) In the case of 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;
- (b) In the case of a medical practitioner, who is registered in a State Medical Register:-
- (i) If he has completed six months of house surgency in gynaecology and obstetrics; or
- (ii) Unless the following facilities are provided therein, if he had experience at any hospital for a period of not less than one year in the practice of obstetrics and gynaecology; or
- (c) if he 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.
- (i) This training would enable the Registered Medical Practitioner (RMP) to do only 1stTrimester terminations(up to 12 weeks of gestation).
- (ii) For terminations up to twenty weeks the experience or training as prescribed under sub rules(a), (b) and(d) shall apply .
- (ca) A Registered Medical Practitioner shall have the following experience and training for conducting termination of pregnancy upto nine weeks of gestation period by medical methods of abortion, namely:-
(i) experience at any hospital for a period of not less than three months in the practice of obstetrics and gynaecology; or
(ii) has independently performed ten cases of pregnancy termination by medical methods of abortion under the supervision of a Registered Medical Practitioner in a hospital established or maintained, or a traininginstitute approved for this purpose, by the Government."
- (d) In case of a medical practitioner who has been registered in a State Medical Register and who holds a post-graduate degree or diploma in
gynaecology and obstetrics, the experience or training gained during the course of such degree or diploma.
2. Till 12 weeks of gestation period- by way of SURGICAL METHODS only
Following doctors can perform MTP
- (a) In the case of 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; - (b) In the case of a medical practitioner, who is registered in a State Medical Register:-
- (i) If he has completed six months of house surgency in gynaecology and obstetrics; or
- (ii) Unless the following facilities are provided therein, if he had experience at any hospital for a period of not less than one year in the practice of obstetrics and gynaecology; or
- (c) if he 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.
- (i) This training would enable the Registered Medical Practitioner (RMP) to do only 1stTrimester terminations(up to 12 weeks of gestation).
- (ii) For terminations up to twenty weeks the experience or training as prescribed under sub rules(a), (b) and(d) shall apply .
- (d) In case of a medical practitioner who has been registered in a State Medical Register and who holds a post-graduate degree or diploma in
gynaecology and obstetrics, the experience or training gained during the course of such degree or diploma.
3. Beyond twelve weeks till twenty weeks of gestation period
Following doctors can perform an MTP from the 12 weeks to 20 weeks period
(a) In the case of 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;
(b) In the case of a medical practitioner, who is registered in a State Medical Register:-
(i) If he has completed six months of house surgency in gynaecology and obstetrics; or
(ii) Unless the following facilities are provided therein, if he had experience at any hospital for a period of not less than one year in the practice of obstetrics and gynaecology; or
(d) In case of a medical practitioner who has been registered in a State Medical Register and who holds a post-graduate degree or diploma in gynaecology and obstetrics, the experience or training gained during the course of such degree or diploma.
20-24 weeks of gestation period
As the new MTP act, 2021 set out to increase the gestation limit for an MTP, now one can get an MTP done till 24 weeks. Thus, for this purpose, the new set of rules have introduced a new "form E" for this purpose. Under Form E opinions of 2 RMPs are needed. Such RMPs should be eligible as per clauses (a), (b) and (d) of the earlier rules.
Beyond 24 weeks-
The new MTP Act had brought in the role of a medical board for the purpose of MTPs to be conducted beyond a period of 24 weeks. Therefore, the new rules, 2021 for MTP have gone ahead and talked about a medical board which is to be constituted by respective state governments or Union Territories Administration. The approval of such a board with the opinions of the 2 medical practitioners talked about above ( that is (a), (b) and (d) of the Rule 4) is needed in order to carry out an MTP beyond 24 weeks.
