Medical termination of pregnancy (MTP)

What is medical termination of pregnancy?

In plain words: MTP is an abortion brought about on purpose, as distinct from one that happens on its own. Indian law allows it on stated grounds, within time limits and by registered medical practitioners, under the MTP Act. Safe abortion care and the separate prohibition of sex selection should not be conflated.

How common MTP is

NCERT says that nearly 45 to 50 million MTPs are performed in a year all over the world, about 1/5th of all the pregnancies conceived in a year (page 46).

Beyond the NCERT text: the World Health Organization’s fact sheet on abortion now estimates about 73 million induced abortions worldwide each year, about 3 in 10 (29 per cent) of all pregnancies (WHO, “Abortion”). Learn NCERT’s figures for NCERT-based questions; the WHO estimate is the more recent one.

Why MTP is done

NCERT gives two kinds of reasons (page 46):

• to end unwanted pregnancies, whether due to unprotected intercourse, the failure of the contraceptive used during coitus, or rape;
• when continuing the pregnancy could be harmful or even fatal to the mother, to the foetus, or to both.

The MTP (Amendment) Act, 2021

NCERT prints a box on the law (page 46). In our words, it says that the Act was meant to reduce illegal abortion and the maternal deaths and illness that follow it; that a pregnancy may be terminated on certain grounds within the first 12 weeks on the opinion of one registered medical practitioner; that between 12 and 24 weeks, two registered medical practitioners must be of that opinion, formed in good faith; and that the grounds are (i) a risk to the life of the pregnant woman or of grave injury to her physical or mental health, or (ii) a substantial risk that the child, if born, would suffer from such physical or mental abnormalities as to be seriously handicapped.

NCERT slip (page 46): the box names the law as the “Medical Termination of Pregnancy (Amendment) Act, 2017”. The amending Act is the Medical Termination of Pregnancy (Amendment) Act, 2021, Act No. 8 of 2021, published in the Gazette of India on 25 March 2021. The box’s 24-week outer limit matches it, but its 12-week limit for one practitioner does not. In our own words, the Act as amended allows a registered medical practitioner to terminate a pregnancy:

• up to 20 weeks, on the opinion of one registered medical practitioner;
• from 20 to 24 weeks, only for categories of women prescribed by rules, on the opinion of at least two registered medical practitioners;
• in either case if continuing the pregnancy would risk the woman’s life or gravely injure her physical or mental health, or if there is a substantial risk that the child, if born, would suffer from a serious physical or mental abnormality (the Act’s 2021 wording; NCERT’s box says “seriously handicapped”);
• up to 20 weeks, the anguish of a pregnancy that follows the failure of a contraceptive device or method used by the woman or her partner may be presumed to be a grave injury to her mental health; for a pregnancy she alleges was caused by rape, it is presumed so, up to 24 weeks;
• the week limits do not apply where termination is needed because a Medical Board has diagnosed a substantial foetal abnormality.

Additional safeguards and exception: the Act protects the woman’s identifying information from unauthorised disclosure. Consent is required under section 3(4), with specified guardian-consent rules for those under 18 or covered by the Act’s mental-illness provision. Section 5 makes an exception to gestational-limit and two-practitioner requirements when a registered practitioner considers termination immediately necessary to save the woman’s life.

Sources: India Code, MTP Act sections 3–5A, and the 2021 amendment. NCERT’s box is not a statement of current legal thresholds. In a question on NCERT’s box, give 12 weeks (one practitioner) and 12–24 weeks (two); in a question on the 2021 Act, or on the law today, give 20 weeks (one) and 20–24 weeks (two, for prescribed categories). The 12 weeks of first-trimester safety (below) is about risk, not about how many practitioners the law requires.

Safety in the first trimester

MTPs are considered relatively safe during the first trimester, i.e., upto 12 weeks of pregnancy.

NCERT Biology (Class 12), Section 3.3, page 46

• NCERT adds that second trimester abortions are much more risky (page 46).
• Beyond the NCERT text: risk generally increases with gestational duration, but abortion can be safe beyond 12 weeks when the method, skills and setting are appropriate. WHO’s fact sheet says abortion is safe when a trained person uses a method suited to how far the pregnancy has gone (WHO, “Abortion”), so it is wrong to say that abortion is safe only before 12 weeks.
• Clinical trimester boundaries differ from NCERT’s shorthand; see pregnancy dating.
• NCERT calls it a disturbing trend that a majority of the MTPs are performed illegally by unqualified quacks, which are not only unsafe but could be fatal too (page 46). NCERT says that such practices, these and sex-selective MTP (below), should be avoided because they are dangerous both for the young mother and the foetus (page 47).
• Beyond the NCERT text: unsafe abortion can cause serious injury or death (WHO, “Abortion”); legal status and clinical safety are different concepts.

Sex-selective MTP and female foeticide

• Another dangerous trend is the misuse of amniocentesis to determine the sex of the unborn child; frequently, if the foetus is found to be female, MTP follows. This is totally against the law (page 46).
• Sex selection violates legal protections and sex equality. This is distinct from abortion undertaken for lawful medical grounds.
• Effective counselling on avoiding unprotected coitus and on the risks of illegal abortions, together with more health care facilities, could reverse these unhealthy trends (page 47).

Solved examples

Common mistakes to avoid

Quick revision summary

• MTP (induced abortion): intentional or voluntary termination of pregnancy before full term; legalised in India in 1971 with strict conditions.
• NCERT: 45 to 50 million MTPs a year worldwide, 1/5th of conceived pregnancies; WHO’s newer estimate is about 73 million, 29 per cent of pregnancies.
• Reasons: unwanted pregnancy (unprotected intercourse, contraceptive failure, rape) or danger to the mother or foetus.
• MTP (Amendment) Act, 2021: up to 20 weeks with one practitioner; 20–24 weeks for prescribed categories with two; no week limit where a Medical Board diagnoses a substantial foetal abnormality. NCERT’s box prints 2017 and 12/24 weeks.
• Risk depends on gestational duration, method and care; safe care is not restricted to 12 weeks. Sex selection is illegal, while the MTP Act permits abortion on specified grounds and includes an emergency life-saving exception.

Questions students ask

How did the 2021 amendment change India’s MTP Act?

Beyond the NCERT text, the 2021 amendment mainly raised the week limits: under the original Act one registered medical practitioner’s opinion sufficed up to 12 weeks and two were needed from 12 to 20 weeks (MoHFW guidance, 2015), whereas now one suffices up to 20 weeks and two are needed from 20 to 24 weeks, a window open only to categories of women the rules prescribe (Gazette of India, 2021). The contraceptive-failure ground, once limited to a married woman or her husband, now covers any woman or her partner. Two provisions are new: no week limit where a Medical Board diagnoses a substantial foetal abnormality, and a bar on practitioners revealing a woman’s identity.

Who is allowed to perform an MTP in India, and where?

Beyond the NCERT text, India’s MTP Act lets only a registered medical practitioner end a pregnancy, at a Government hospital or a place approved by the Government or its District Level Committee, though in an emergency to save the woman’s life an unapproved place is allowed (MoHFW guidance, 2015). Not every doctor qualifies: the practitioner needs the training or experience in gynaecology and obstetrics that the rules lay down, on top of a recognised medical qualification and a name on a State Medical Register (MoHFW, 2015). Since the 2021 amendment, rules also set which practitioners may give the opinion at each stage of pregnancy (Gazette of India, 2021).

What is the difference between female foeticide and female infanticide?

Female foeticide is the killing of a female foetus before birth, while female infanticide, a term from beyond the NCERT text, is the killing of a baby girl after birth: MeSH defines infanticide as “the killing of infants at birth or soon after”. NCERT discusses only foeticide, which it reports to be high in India and which the strict conditions on MTP are meant to help check (page 46). The ban on using tests to learn a foetus’s sex is explained with amniocentesis.

Is MTP a method of contraception?

No, MTP is not a method of contraception: contraceptive methods prevent a pregnancy from starting, and NCERT’s list of them, from natural and barrier methods to surgical ones, does not include MTP (page 43), while MTP is the termination of a pregnancy that has already begun (page 46). Even emergency contraception, which NCERT places among contraceptive methods, is used soon after coitus to avoid a possible pregnancy (page 45), not to end one. Beyond the NCERT text, the MTP (Amendment) Act, 2021 likewise treats termination as ending an existing pregnancy, with medicines or by surgery (Gazette of India, 2021).

Practice questions

Try each question first, then open the answer to check your working.

1. Q1. In which year did the Government of India legalise MTP?

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   1971 (NCERT page 46).

2. Q2. What interval does NCERT call relatively safe, and does it mean later care is always unsafe?

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   NCERT names up to 12 weeks (page 46). This emphasises earlier lower risk; later abortion is not inherently unsafe when appropriate methods and care are available.

3. Q3. Why is the use of amniocentesis followed by MTP of a female foetus against the law?

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   Amniocentesis is meant to test for genetic disorders; using it to find the sex of the foetus and then terminating a female foetus is sex-selective abortion, which is illegal and is checked by the statutory ban on amniocentesis for sex determination (NCERT pages 42 and 46).