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Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 1 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 2 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 3 ABORTION & LAW Operationalizing District Level Committees under the MTP Act IMPLEMENTERS GUIDE Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 4 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 5 Implementers Guide C ontents Foreword 3 Abortion Scenario 5 Project Implementation Framework 6 Introduction to Abortion and the Law 7 Salient Features of the MTP Act, Rules and Regulations 9 Tools for Operationalizing District Level Committees (DLCs) a) Reference Sheet: Activities for Operationalizing DLCs 20 b) MTP Site Verification Form 22 c) MTP Site Monitoring Form 25 d) Quarterly Reporting Format 27 e) Cover Letter for Site Certification 30 1 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 6 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 7 Implementers Guide Foreword T he Maternal Mortality Ratio (MMR) in India has declined substantially from 441 per 100,000 live births in 1997-98 to 212 in 2007-09. However, the current MMR is still high and the Government of India is committed to bringing it down. While most causes of maternal mortality are not predictable, unsafe abortion is predictable and easily preventable, if women have access to safe abortion care. Nationally, unsafe abortion alone accounts for approximately eight percent of these maternal deaths. Recognizing the present situation, the Government of India has included increasing access to safe abortion care as one of its strategies for reducing maternal mortality and morbidity in its program. The Departments of Health and Family Welfare Bihar, Jharkhand, Maharashtra, Rajasthan, Madhya Pradesh & Uttarakhand and Ipas are collaborating to implement the safe abortion component of RCH II to ensure increased access to safe abortion services, increased awareness in the community about abortion issues and thereby reduce the high incidence of unsafe abortions and their consequences. Since the private sector healthcare providers play a vital role in providing abortion services, it is important to involve them in this mission and the first step towards this will be to expand the number of legal private sector sites providing MTP services in India. The amendments to the MTP Act and Rules in 2002-03 have decentralized the power of site approval and regulation to a District Level Committee (DLC) chaired by the CMHO/District Health Officer/Civil Surgeon. This provides a good opportunity to the private sector clinics to get their sites registered and be approved to provide legal abortion services. Recognizing the present situation, the Government of India has included increasing access to safe abortion care as one of its strategies for reducing maternal mortality and morbidity in its program. To operationalize the DLCs and facilitate smooth functioning in all districts, the Government and Ipas are conducting a series of divisional/District level orientation workshops with CMHOs/DLC members and professional bodies like IMA and FOGSI. The workshop will provide participants with information on the MTP Act and subsequent amendments, setting up of DLCs, role of CMHOs & DLC members and the required formats & support material for operationalizing the DLCs. We look forward to your active participation in the workshop, and working closely with the DLCs in successfully certifying all the eligible private sector MTP sites in the country. July 2011 Vinoj Manning Country Director Ipas 3 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 8 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 9 Implementers Guide Abortion Scenario orldwide, W each year 46 million pregnancies end in abortion, with 20 million of these abortions taking place under unsafe conditions. 19 million unsafe abortions are contributed by the developing countries. Nearly 70,000 women die and millions more are injured every year because they lack access to safe abortion services and treatment for abortionrelated complications. Globally, abortion complications alone constitute 13% of all maternal deaths. Almost all the maternal mortality and morbidity related to unsafe abortion can be prevented by providing safe abortion services. Recognizing this, the Indian Parliament passed the Medical Termination of Pregnancy (MTP) Act in 1971. The MTP Act enables women to seek abortion for a number of indications. But in a sprawling country of over a billion, having a progressive law does not guarantee access to safe services. Though abortion has been legal in India for decades, illegal and unsafe abortions far outnumber legal and safe procedures. It is estimated that 8% of reported maternal deaths stem from unsafe abortions (Registrar General of India 2006). This translates to about 12 18,000 avoidable deaths every year or 20 25% of all global maternal deaths due to unsafe abortions. A range of factors contribute to the prevalence of illegal and unsafe abortions, including a dearth of trained providers; an inequitable concentration of certified providers and facilities in urban areas; inadequate and underutilized training facilities; illmaintained/non-functional equipment; and legal restrictions on who can provide abortion services. This situation is compounded by the fact that millions of Indian women remain unaware that abortions are legal and do not know where safe and legal services are available. The problem of unsafe abortions is like an iceberg. What we know or see is just the tip of the problem. Most of the abortions go unnoticed as there are no accurate records or reports of legal and illegal abortions. Worldwide, 46 million pregnancies each year end in abortion, with 20 million of these abortions taking place under unsafe conditions. Lack of availability and accessibility of trained providers is a major deterrent to safe abortion services in the public health system. Availability of trained providers varies significantly from District Hospitals to PHC's. The table clearly shows that women, particularly in rural areas, have hardly any option of accessing safe abortion services at a primary health centre (PHC) the first contact point between the rural population and a qualified medical doctor. Moreover, training of medical doctors is a challenging issue as it is difficult for the doctors to leave their work site for long duration for the training of MTP. Where the doctors are trained and are providing MTP services, outdated technology like D&C is still used. 5 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 10 Implementers Guide Comparative Accessibility of Safe Abortion Services in Public Health System State % of Health Facilities Providing MTP Services District Hospital FRU CHC PHC 73.0 48.0 31.0 6.1 All India Source: Calculated from the raw data of Facility Survey-II (2003). Comparative Availability of Trained Medical Providers State % of Health Facilities have at least one MTP Trained Doctor District Hospital FRU CHC PHC 68.8 54.4 44.4 14.6 All India Source: Facility Survey-II (2003). Maternal health is a high priority area . GoI has identified strategies to reduce maternal mortality and morbidity under the RCH II project which include increasing access to safe abortion care. Maternal health is a high priority area. Comprehensive Abortion Care GoI National Population Policy (NPP) (CAC) using new technology of 2000, has identified strategies to reduce Manual Vacuum Aspiration (MVA) maternal mortality and morbidity and Medical Methods of Abortion under the RCH II project which include (MMA). increasing access to safe abortion care. Ipas is assisting the state in operationalizing the safe abortion component by the following broad implementation stages: Service delivery of CAC using MVA and MMA for early abortions. Increase in the number of private sector sites approved to provide abortion services by effective Operationalizing training sites implementation of the MTP Act. Training of service providers in The figure details the project implementation framework. Project Implementation Framework Strengthening Training Site Monitoring Supportive Supervision Documentation IEC Campaign Training Providers & Support Staff ANMs & AWWs Community Groups Site Signage Private Provider Orientation & Site Certification 6 CAC SERVICE DELIVERY Client Information Material Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 11 Implementers Guide Introduction toLaw Abortion and the rior to the enactment of the MTP Act 1971, the issue of abortion or voluntarily causing miscarriage, was covered under Sections 312 316 of the Indian Penal Code. Under these Sections of the IPC, voluntarily causing miscarriage was an offense punishable with imprisonment of 3 10 years. The IPC provisions were drawn in 1860 and were in line with the then prevalent English Law. Both the abortion provider and the woman could be punished for causing the miscarriage. The only exception the IPC provided was when the termination was done in good faith to save the life of the mother. In other words, before the MTP Act, the only indication for which abortion was permitted was to save the life of the mother. What the MTP Act did was to expand the indications for which MTPs could be done, without attracting action under the IPC. The provisions of the IPC still exist but Section 3 of the MTP Act establishes the precedence of this Act over the IPC by stating that notwithstanding anything contained in the IPC a registered medical practitioner shall not be guilty of any offense under that code or any other law for the time being in force, if any pregnancy is terminated by him in accordance with the provisions of this Act. P 1 1 Developments leading to the enactment of the MTP Act The concern over the abortion issues came to the forefront in India in the mid-sixties especially from the Central Family Planning Board (CFPB). According to the CFPB meeting in August 1964, concerns were raised over the number of illegal abortions occurring in the country, in unsafe conditions, which put the lives of many women in danger. The Shantilal Shah Committee, constituting mainly of doctors, deliberated for more than 2 years. Consequently, the Government of India (GoI) set up an 11 member committee to study the question of legislation of abortion in its entire aspects legal, medical, social and ethical, and make recommendations for the same. The Shantilal Shah Committee, constituting mainly of doctors, deliberated for more than 2 years. The report submitted to the Government suggested a broadening and rationalizing of law pertaining to abortion. Recommendations of the Shah Committee The Report proposed that a qualified medical practitioner acting in good faith should be permitted to terminate a pregnancy, not only for the MTP: a user s guide to the law. The Lawyers Collective. Women s Rights Initiative 7 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 12 Implementers Guide sole purpose of saving a woman's life, but also for the following considerations: 1. Serious risk to the life, or grave injury to her health physical or mental, before or after the birth of the child; 2. Substantial risk of the possibility of a seriously, physically or mentally handicapped child being born; 3. Where the pregnancy resulted from rape or intercourse with a minor or mentally retarded girl; Based on the Shah Commission report, the Medical Termination of Pregnancy Act (MTP Act) was passed in the Parliament in 1971. 4. It also allowed the woman to opt for termination of pregnancy upon the failure of contraception. The Committee also recommended promotion of the small family norm and contraception, education on sex, marriage, parenthood and expansion of easily accessible family planning services that would aid in reducing the cases of pregnancy termination. It advised doctors to recommend sterilization methods to either spouse, in order to prevent repeat abortions. Based on the Shah Commission report, the Medical Termination of Pregnancy Act (MTP Act) was passed in the Parliament in 1971. With the passing of the MTP Act, India became one of the few nations of the world with liberal abortion laws. However, it may be noted that the Act still does not provide a right to abortion but liberalizes the conditions under which women may have access to abortion services provided by approved Medical Practitioners. Amendments to the MTP Act in 2002 The MTP Act of 1971 was amended in 2002, the key features of the amendments were: 8 1. The approval of place for performing abortions (site certification) was decentralized to a district level committee. 2. The punishment for offenses under the MTP Act was made stringent and 3. The term "lunatic" was replaced with the term "mentally ill". Amendments to the MTP Rules in 2003 The MTP rules were amended in 2003 and the key features of the amendments were: 1 Detailed the composition and tenure of the District Level Committee. 2 Abortion sites could be approved for 1st trimester (up to 12 weeks) only or for 1st and 2nd trimester (up to 20 weeks). The facilities and equipments required for the two types of sties were detailed. 3 Allowed prescription of medical abortion using RU-486 and Misoprostol by a Registered Medical Practitioner from even a site that is not approved, provided the RMP has referral linkage access to an approved place. 4 A non-Obgyn provider who is trained and certified can provide only 1st trimester abortions. The MTP Act of 1971 was one of the progressive Acts of its time. It was first time in the world that failure of contraception was an indication for which a woman could terminate an unwanted pregnancy. Though the indications are quite liberal, abortion is still not a women's right in India. It is the provider who decides if the woman seeking an abortion meets the indications mentioned in the Act. Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 13 Implementers Guide Salient Features of the MTP Act, Rules and Regulations MTP Act The Medical Termination of Pregnancy (MTP) Act of 1971, governs the provision of MTPs in the country. This legislation was enacted from the public health perspective, given the very high mortality and morbidity due to consequences of unsafe abortions. The MTP Act specifies the indications for which a pregnancy can be legally terminated, who could terminate the pregnancy and the place where the pregnancy could be terminated. It also covers the consent requirement for the MTP procedure. The MTP Act offers protection to a practitioner if she/he adheres to or fulfills all the recommended requirements under the Act. Salient features of the MTP Act A) Who can terminate a pregnancy? B) When can pregnancy be terminated? A pregnancy can be legally terminated only when the Registered Medical Practitioner is of the opinion formed in good faith that: Continuation of pregnancy is a risk to the life of the pregnant woman or it can cause grave injury to her physical or mental health Substantial risk that the child, if born, would be seriously handicapped due to physical or mental abnormalities The MTP Act specifies the indications for which a pregnancy can be legally terminated, who could terminate the pregnancy and the place where the pregnancy could be terminated. The pregnancy was caused by rape (presumed to constitute grave injury to mental health) Pregnancy caused due to failure of contraceptive in married woman or her husband (presumed to constitute grave injury to mental health) Only a Registered Medical Practitioner can terminate the pregnancy. He/she should: However, for termination between 12 20 weeks, the opinion of two Registered Medical Practitioners is required (Form I, Annexure-2) Possess a recognized medical qualification as defined in the Indian Medical Council Act, 1956 C) Places where pregnancy can be terminated Have her/his name entered in a State Medical Register MTP can be performed only in a hospital established or maintained by the Government Have such experience or training in gynecology and obstetrics as prescribed by the MTP Rules made under this Act. A place approved by the Government or a District Level Committee constituted by the Government 9 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 14 Implementers Guide D) Consent Only the consent of woman is required to terminate the pregnancy. (Form C, Annexure-1) In case of minor (less than 18 years) or a mentally ill person, consent of a guardian is required (Form C, Annexure-1) If termination is performed by a Registered Medical Practitioner in good faith to save a woman's life, it will not be treated as an offense. If termination is performed by a Registered Medical Practitioner in good faith to save a woman's life, it will not be treated as an offense even if it is done at a non-approved site or by a Registered Medical Practitioner who does not have the legal requirements to perform MTP. Violation of the Act Consequences of violating provisions of the Act can be quite severe: Any person terminating a pregnancy, who is not a Registered Medical Practitioner, can be punished with rigorous imprisonment for a minimum of two years and a maximum of seven years Anyone terminating a pregnancy at a place, which is not approved, can be punished with rigorous imprisonment for a minimum of two years and a maximum of seven years The owner of a non-approved place, performing termination of pregnancy can also be punished with rigorous imprisonment for a minimum of two years and a maximum of seven years. MTP Rules The MTP Rules cover the composition of the DLC, site approval process and experience and training requirement of MTP provider. 10 Salient features of the MTP Rules, 2003 A) Composition and tenure of District Level Committee (DLC) The District Level Committee is appointed by the Government and is responsible for approval/suspension of place for performing MTPs, and is chaired by the Chief Medical Officer or District Health Officer and consists of the following: 3 to 5 members Chairperson including member shall be a One Gynecologist/Surgeon/Anesthetist Other members local medical governmental Panchayati Raj district should be from the profession, nonorganization and Institution of the At least one member of the Committee should be a woman. The tenure of the Committee shall be for two calendar years and the tenure of the NGO member shall not be for more than two terms. B) Requirements for approval of a place Rules now segregate sites that offer only first trimester (up to 12 weeks) MTPs and sites that offer MTPs up to 20 weeks. A place can be approved for terminating pregnancies up to 12 weeks, if it has the following facilities: Gynecology examination/labor table Resuscitation and sterilization equipment Drugs and parenteral fluids Back-up facilities for treatment of shock Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 15 Implementers Guide Facilities for transportation. For terminating pregnancies up to 20 weeks the place should have the following facilities: An operation table and instruments for performing abdominal or gynecological surgery Anesthetic equipment, resuscitation and sterilization equipments. Drugs and parenteral fluids for emergency use, notified by Government of India from time to time. Medical (MMA) Methods of Abortion In case of termination of early pregnancy up to seven2 weeks using Mifepristone and Misoprostol, the Registered Medical Practitioner, as defined by the MTP Act, can prescribe the drugs at his/her clinic provided he/she has access to a place approved for terminating pregnancy under the MTP Act. The place where MMA is prescribed does not need approval. The clinic should display a certificate to this effect from the owner of an approved place. C) Approval process The approval for the place should be applied in Form A (Annexure-1) and addressed to the Chief Medical Officer of the district The Chief Medical Officer (CMO) shall verify information provided in the application or inspect the place to satisfy himself that the termination of pregnancy may be made under safe and hygienic conditions. If the CMO is satisfied after verification, enquiry or inspection, he/she recommends the approval of such place to the District Level Committee (DLC) The Committee after considering the application and the recommendations of the CMO may approve the place and issue a certificate of approval in Form B (Annexure-1) The place shall be inspected within 2 months of the receipt of application and certificate of approval may be issued within next 2 months or if there is any deficiency noted, within 2 months of the deficiency being rectified by the applicant. Other Rules The CMO may inspect the approved place as often as may be necessary to verify that MTPs are being performed under safe and hygienic conditions If the CMO has reason to believe that there has been death or injury to pregnant woman at the place or that the termination is not being done under safe and hygienic conditions, he/she can seek any information or seize any article, medicine, admission register or other documents The CMO may inspect the approved place as often as may be necessary to verify that MTPs are being performed under safe and hygienic conditions. If the CMO, after inspection, is satisfied that the facility is not being maintained properly and termination cannot be made in safe and hygienic conditions, he/she shall report this fact to the committee and the District Level Committee may suspend or cancel the approval after giving the owner an opportunity of making representation The owner of the place whose approval has been suspended or cancelled, can apply again for 2 Mifepristone + Misoprostol ( 1 tab of mifepristone 200 mg and 4 tab of misoprostol 200 mcg) combipack has been approved by the Central Drugs Standard Control Organisation, Directorate General of Health Services for medical termination of pregnancy (MTP) for upto 63 days gestation in December 2008 11 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 16 Implementers Guide approval after making additions or improvements to the place The owner whose approval has been suspended or cancelled can apply for a review within 60 days of the order The Government may confirm, modify or reverse the order D) Experience and training required by a Registered Medical Practitioner Up to 20 weeks gestation The MTP Act empowers the State Governments to form regulations, maintain records and report the MTP services to the state. A practitioner who holds a postgraduate degree or diploma in Obstetrics and Gynecology A practitioner who has completed six months as House Surgeon in Obstetrics and Gynecology A practitioner who has at least one year experience in the practice of Obstetrics and Gynecology at any hospital that has all facilities. Up to 12 weeks gestation only A practitioner, who has assisted a Registered Medical Practitioner in 25 cases of medical termination of pregnancy of which at least five have been performed independently in a hospital established or maintained by the government or a training institute approved for this purpose by the government. Essentials of safe and legal abortions Abortion is legal only when it fulfills the following conditions: A Registered Medical Practitioner who is allowed to terminate pregnancy as defined by the MTP Act performs it It is performed at an approved place under the Act 12 Other requirements of the Act like consent, opinion of Registered Medical Practitioner etc. are fulfilled. MTP Regulations 2003 The MTP Act empowers the State Governments to form regulations, maintain records and report the MTP services to the state. The salient features of the MTP Regulations 2003 are: 1. Form of certifying opinion or opinions When one RMP forms or two RMPs form an opinion to terminate the pregnancy he/she shall certify such opinion in Form I (Annexure-2). Every RMP who terminates any pregnancy shall certify such termination in Form I (Annexure-2). 2. Custody of Forms Form C with the consent of the woman and Form I for intimation of the termination shall be sealed in an envelope by the RMP(s) performing the termination and shall be kept in their safe custody until it is sent to the head of the hospital/owner of the approved place or CMO The serial number assigned to the pregnant woman in the admission register and the name(s) of the RMP(s) shall be noted on each envelope and shall be marked "SECRET" Every envelope shall be sent immediately after termination of pregnancy to the head of the hospital/owner of the hospital where pregnancy was terminated and will be kept in safe custody Every head of the hospital/owner of the approved place shall send a monthly statement of MTP cases to Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 17 Implementers Guide the Chief Medical Officer of the district on Form II (Annexure-3). 3. Maintenance of Admission Register Every Head of the hospital/owner of the approved place shall maintain a register as per Form III (Annexure-4) for recording the details of the women and keep in secret custody for five years from the end of the calendar year it relates to. It is a secret document not to be disclosed to any person authority of Law except under Entries in the Admission Register shall be made serially and a fresh serial started at the beginning of each calendar year. The serial no. will be distinguished by the year, e.g. SN 5/2006; 5/2007 No entry shall be made in any casesheet, operation theatre register, follow-up card or any other document other than the Admission Register. Reference to the woman in other records will be made by the S.No. assigned to her in the Admission Register. Every Head of the hospital/owner of the approved place shall maintain a register as per Form III (Annexure-4). 13 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 18 Implementers Guide Annexure - 1 APPLICATION FORM FOR SITE APPROVAL FORM A [See sub-rule (2) of rule 5] Form of application for the approval of a place under clause (b) of Section 4 Category of approved place: A. Pregnancy can be terminated upto 12 weeks B. Pregnancy can be terminated upto 20 weeks 1 Name of the place (in capital letters) 2 Address in full 3 Non-Government/Private/Nursing Home/Other Institutions 4 State if the following facilities are available at the place Category A (i) Gynecological examination/labour table. (ii) Resuscitation equipment. (iii) Sterilization equipment. (iv) Facilities for treatment of shock, including emergency drugs. (v) Facilities for transportation, if required. Category B (i) An operation table and instruments for performing abdominal or gynecological surgery. (ii) Drugs and parenteral fluid in sufficient supply for emergency cases. (iii) Anesthetic equipment, resuscitation equipment and sterilization equipment. Place Date Signature of the owner of the place 14 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 19 Implementers Guide CERTIFICATE OF APPROVAL FORM B [See sub-rule (6) of rule 5] The place described below is hereby approved for the purpose of the Medical Termination of Pregnancy Act, 1971 (34 of 1971). As Read Within Upto Weeks Name of the place Address and other descriptions Name of the owner Place Date To the Government of the ............................................................................................................................ CONSENT FORM FORM C [See rule 9] I daughter/wife of aged about years of (here state the permanent address) at present residing at do hereby give my consent to termination of my pregnancy at (State the name of place where the pregnancy is to be terminated) Place Date Signature (To be filled in by guardian where the woman is a mentally ill person or minor) I son/daughter/wife of aged about years of (permanent address) at present residing at give my consent to the termination of the pregnancy of my ward who is a minor/lunatic at (place of termination of pregnancy) Place Date Signature 15 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 20 Implementers Guide Annexure - 2 RMP OPINION FORM FORM I [See Regulation 3] I (Name and qualification of the Registered Medical Practitioner in block letters) (Full address of the Registered Medical Practitioner) I (Name and qualification of the Registered Medical Practitioner in block letters) (Full address of the Registered Medical Practitioner) hereby certify that *I/we/am/are of opinion, formed in good faith, that it is necessary to terminate the pregnancy of (Full name of pregnant woman in block letters) resident of (Full address of pregnant woman in block letters) for the reasons given below**. * I/We hereby give intimation that *I/We terminated the pregnancy of the woman referred to above who bears the serial No. in the Admission Register of the hospital/approved place. Signature of the Registered Medical Practitioner Signature of the Registered Medical Practitioner Place : Date : Strike out whichever is not applicable. **of the reasons specified items (i) to (v) write the one which is appropriate :(i) in order to save the life of the pregnant woman, (ii) in order to prevent grave injury to the physical and mental health of the pregnant woman, (iii) in view of the substantial risk that if the child was born it would suffer from such physical or mental abnormalities as to be seriously handicapped, (iv) as the pregnancy is alleged by pregnant woman to have been caused by rape, (v) as the pregnancy has occurred as a result of failure of any contraceptive device or methods used by married woman or her husband for the purpose of limiting the number of children. Note: Account may be taken of the pregnant woman's actual or reasonably foreseeable environment in determining whether the continuance of her pregnancy would involve a grave injury to her physical or mental health. Place : Date : 16 Signature of the Registered Medical Practitioner/Practitioners Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 21 Implementers Guide Annexure - 3 MTP REPORTING FORM FORM II [See Regulation 4(5)] 1. Name of the State 2. Name of the Hospital/approved place 3. Duration of pregnancy (give total No. only) (a) Up to 12 weeks. (b) Between 12 20 weeks 4. Religion of woman (a) Hindu (b) Muslim (c) Christian (d) Others (e) Total 5. Termination with acceptance of contraception (a) Sterilization (b) I.U.D. (c) Oral Pills (d) Condom (e) Others (specify) 6. Reasons for termination: (give total number under each sub-head) (a) Danger to life of the pregnant woman. (b) Grave injury to the physical health of the pregnant woman. (c) Grave injury to the mental health of the pregnant woman. (d) Pregnancy caused by rape. (e) Substantial risk that if the child was born, it would suffer from such physical or mental abnormalities as to be seriously handicapped. (f) Failure of any contraceptive device or method. Signature of the Officer Incharge with Date 17 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 22 Implementers Guide Annexure - 4 ADMISSION REGISTER FORM III [See Regulation 5] (To be destroyed on the expiry of five years from the date of the last entry in the Register) 1 3 4 5 6 7 S.No. Date of Admission Name of the Woman Wife/ Daughter of Age Religion Address 8 9 10 11 12 13 14 Duration of Pregnancy 18 2 Reasons on which Pregnancy is terminated Date of termination of Pregnancy Date of discharge of Woman Result and Remarks Name of Registered Medical Practitioner(s) by whom the opinion is formed Name of Registered Medical Practitioner(s) by whom Pregnancy is terminated Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 23 Implementers Guide Tool for Operationalizing District Level Committees (DLCs) The DLC is empowered by the Government to approve the sites for providing MTP services and also monitor them to ensure that the services are being provided under safe and hygienic conditions. This section contains the following tools to facilitate the DLC in discharging its duties and ensuring improved reporting of MTP services in the district: a. Reference Sheet: Activities for Operationalizing DLCs b. MTP Site Verification Form c. MTP Site Monitoring Form d. Quarterly Reporting Format e. Cover Letter for Site Certification This DLC guide book is accompanied by a CD-ROM, MTP District Level Committee: Tool Kit which contains these aids and the statutory forms in soft copy for easy reproduction and further use. 19 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 24 Implementers Guide Reference Sheet: Activities for Operationalizing District Level Committees (DLCs) under the MTP Act, 1971 Sl.N0. Activity Sub-activity Step 1: Formation of DLC 1 Form DLC 1. CMO to identify 5 8 responsible persons from the categories specified under the MTP Rules 2003 2. CMO to select 3-4 persons (excluding CMO) representing the categories specified under the MTP Rules 2003 to be DLC members and get their written consent. 3. CMO to inform the list of the DLC members to Director, Directorate of Health Services, Government of India Step 2: Site Certification by DLC 1 CMO to depute a nodal staff at his office responsible for the following: a. providing application form for approval of sites to doctors requesting them b. maintain record of the applications received c. maintain a register of sites inspected and approved. CMO to plan or depute a representative from the DLC to conduct site verification visits 1. CMO/Representative to conduct site verification to assess adequacy of facilities for providing quality MTP services on the site verification form and recommend to the DLC for approval, if satisfied. 2. If CMO/Representative not satisfied during the visit, CMO to provide written information regarding the result of the verification visit to the DLC. The record of the visit to be maintained. 1. DLC to meet to review CMO/Representative's recommendations of site verification and decide on the site approvals to be made or if not satisfied the owner to be notified for hearing. 2. 20 CMO to ensure availability of adequate forms A, B, C, I, II and III (MTP Regulations 2003) at his office. 5. Site approval Inform private doctors & nursing homes regarding DLC and invite applications for approval of their sites to provide MTP services through: a. representatives of the DLC b. communication to FOGSI and IMA chapters c. press release in local media d. notice at CMO office notice board 4. 3. CMO to chair a meeting of the DLC members to plan and agree on the activities and their process during the term of two years 3. Site verification visit 1. 2. 2. Preparation for site verification and approval CMO to communicate to the owner of the sites the DLC approval (refer suggested covering letter) with the Certificate of Approval (Form B, MTP Rules) Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 25 Implementers Guide Sl.No. Activity Sub-activity 4. Site re-verification 1. visit CMO/Representative to revisit the site on receiving an application from the owner after his/her hearing in #3 above and site verification to be conducted, if satisfied recommend the site for approval to the DLC. 5. Approved site monitoring visits 1. CMO/Representative to conduct monitoring visit to the approved sites to assess adequacy of facilities for providing quality MTP services are maintained, using the site monitoring form. 2. Maintain records of the monitoring visits. Step 3: Reporting Activities of DLC 1. Meetings of DLC 1. 2. Compiling MTP 1. data received from private sites CMO to maintain a register capturing the MTP data received from the approved sites in Form II. 3. Reporting to Directorate of Health Services CMO to send quarterly activity report to the Nodal Officer MTP, Family Welfare, Directorate of Health Services on the Quarterly Reporting Form for information. 1. Hold at least one meeting every quarter to review recommendations for site approval, progress of the DLC activities, and reporting of MTPs from the service providers. 21 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 26 Implementers Guide District Level Committee under MTP Act 1971 (Name of District) MTP Site Verification Form Name of the owner Name of the site Address of the site Type of Clinic (Tick the appropriate box) NGO Private Clinic Applied for provision of MTP Services (Tick the appropriate box) Nursing Home Other Institutions upto 12 weeks upto 20 weeks Date of verification visit (d/m/y) Note: the appropriate response for each item assessed. Enter any special observation in the column of Remarks. Sl.No. 1. Item Essential equipment present and functional as required for the duration of pregnancy to be terminated Upto 12 weeks: a. Gynecological examination table/labour table b. Resuscitation equipment c. Sterilization equipment d. Drugs and parenteral fluids (Refer annexure 'A') e. Backup facilities for treatment of shock (IV fluids & referral linkage) f. Facilities for transportation Upto 20 weeks: a. Operation table b. Instruments for performing abdominal or gynecological surgery c. Anaesthetic equipment d. Resuscitation equipment e. Sterilization equipment f. Drugs and parenteral fluids for emergency use as notified by GoI (Refer annexure 'A') 2. Instruments & items for performing per-speculum and pelvic examination in the OPD 3. Instruments for performing MTP upto 12 weeks present and functional Instruments and drugs for performing MTP from 12 20 weeks present and functional (tick as applicable) 22 Yes No Remarks Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 27 Implementers Guide Recommendation to DLC: A. The site is suitable to perform MTP services upto Committee may approve the site to perform MTP services upto weeks. The District Level weeks. B. The site is assessed and found not suitable to perform quality MTP services due to: (List specific details of deficits identified): Signature of CMO/Representative District Seal of CMO Date: District Level Committee Considering the recommendations of the CMO/Representative, the District Level Committee, (Name of District), is of the opinion to approve the site (Name and address of the site) (name of owner) Signature Chairman (DLC) of to perform MTPs upto weeks. Date of DLC Meeting 23 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 28 Implementers Guide Annexure - A3 Ministry of Health and Family Welfare (Department of Family Welfare) NOTIFICATION New Delhi, the 30th December, 2004 S.O. 50(E). In exercise of the powers conferred under (c) of Rule 5 of the Medical Termination of Pregnancy Rules, 2003, to notify the drugs and parenteral fluids for emergency use, Central Government hereby notifies that places approved for conducting termination of pregnancy, under Section 4 of the Medical Termination of Pregnancy (Amendment) Act, 2002 (64 of 2002), shall provide for the following drugs and parenteral fluids for emergency use: (i) Drugs and parenteral fluids a. Antibiotics Ampicillin, amoxicillin trihydrate, cephalexin or a suitable alternative. b. Analgesic paracetamol, pentazocine, dicylomine or a suitable alternative. c. Local anaesthetic Injection Lignocaine 1 per cent. d. Injection Diazepam. e. Uterotonics Injection Oxytocin and Injection Methylergometrine maleate. Injection Prostaglandins are optional. f. Injection Atropine sulphate. g. 5 per cent dextrose and Ringer lactate solution with IV sets and cannulae or scalp vein sets. (ii) Facilities for treatment of emergencies a. Injection Adrenaline b. Injection Aminophylline c. Injection Sodium bicarbonate 7.5 per cent d. Injection Calcium gluconate 10 per cent. e. Antiemetics-Injection Metaclopramide or a suitable alternative. f. Antihistaminics-Injection Promethazine hydrochloride or a suitable alternative. g. Steroid-Injection Hydrocortisone succinate. h. Injection Frusemide. i. Injection Dopamine. Additional drugs and parenteral fluids: (i) Ethacridine lactate solution with Foley's catheter for instillation (ii) General Anaesthetic drugs [F. No. M-12015/59/2003-MCH] S. S. BRAR, Jt. Secy. 3 Attach with MTP site verification form. 24 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 29 Implementers Guide District Level Committee under MTP Act 1971 (Name of District) MTP Site Monitoring Form Name of the owner Name of the site Address Type of Clinic (Tick the appropriate box) NGO Applied for provision of MTP Services (Tick the appropriate box) Private Clinic Nursing Home upto 12 weeks Other Institutions upto 20 weeks Date of monitoring visit (d/m/y) Note: the appropriate response for each item assessed. Enter any special observation in the column of Remarks. Sl.No. Item 1. Remarks Confidentiality and privacy of woman maintained in the OPD, OT and post-operative ward 3. No Admission register maintained as per standard format 2. Yes Essential equipment present and functional as required for the duration of pregnancy to be terminated Upto 12 weeks: a. Gynecological examination table/labour table b. Resuscitation equipment c. Sterilization equipment d. Drugs and parenteral fluids (Refer annexure A ) e. Backup facilities for treatment of shock f. Facilities for transportation Upto 20 weeks: a. Operation table b. Instruments for performing abdominal or gynecological surgery c. Anaesthetic equipment d. Resuscitation equipment e. Sterilization equipment f. Drugs and parenteral fluids for emergency use as notified by GoI (Refer annexure A ) 4. Instruments & items for performing per-speculum and pelvic examination in the OPD 5. Instruments for performing MTP upto 12 weeks present and functional 25 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 30 Implementers Guide Sl.No. Item 6. RMP Opinion Form (Form-I) and MTP Reporting Form (Form-II) available at the site and being used 9. Standard precautions for infection prevention practiced 10. Remarks Consent Form C maintained 8. No Instruments and drugs for performing MTP from 12 20 weeks present and functional 7. Yes Records being sent to CMO regularly Recommendation to DLC: A. The site is performing and reporting quality MTP services as per standards and can continue providing services upto weeks. B. The site is not able to perform quality MTP services due to lack of: (List any specific details of deficits identified) Signature of CMO/Representative District Seal of CMO 26 Date Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 31 Implementers Guide District Level Committee The Medical Termination of Pregnancy (Amendment) Act, 2002 QUARTERLY REPORTING FORMAT From (Month/Year): to (Month/Year): District: Date of reporting: Submitted to: Nodal Officer (MTP), Department of Public Health & Family Welfare, Govt. of India Reporting indicators Status for the quarter Number of applications received for site approval on Form A Number of sites approved by DLC Upto 12 weeks: Upto 20 weeks: Number of approvals pending at the end of reporting period Total number of MTP sites registered Upto 12 weeks: in the district till date Upto 20 weeks: Remarks/Comments: Name of CMO: Signature: Seal Enclose: 1. List of health facilities approved in this quarter 2. Summary of MTP cases. 27 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 32 Implementers Guide Attachment to Quarterly DLC Activity Report District Level Committee The Medical Termination of Pregnancy (Amendment) Act, 2002 From (Month/Year): to (Month/Year): District: Date of reporting: Submitted to: Nodal Officer (MTP), Department of Public Health & Family Welfare, Govt. of India List of health facilities approved during the reporting quarter Sl. No. Name of Health Facility Name of Owner Approved for providing MTP upto (Plz. One) 12weeks Signature of CMO: Seal 28 20weeks Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 33 Implementers Guide Attachment to Quarterly DLC Activity Report Summary of MTP cases From (Month/Year): to (Month/Year): District: Date of reporting: Submitted to: Nodal Officer (MTP), Department of Health & Family Welfare, Govt. of India Summary of MTP Cases reported in FORM II by Approved MTP Sites Sl No Name of approved site Total MTPs performed in the Quarter 12 weeks 20 weeks Signature of CMO: Seal 29 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 34 Implementers Guide Cover Letter Format for Site Certification under MTP Act, 1971 Date Dr./Mr./Ms. (Address of the Owner's Clinic/Nursing Home/Hospital) Dear Dr./Mr./Ms. With reference to the site verification visit dated (d/m/y) at your NGO/private clinic/Nursing Home/other institution (Name and address of the site) been approved to provide MTP services upto you are informed that your site has weeks w.e.f. (Date-d/m/y) Site approval certificate on standard Form B of MTP Regulations 2003 is attached. You are expected to provide safe and quality MTP services to women at the above mentioned site in conformance to MTP Act 1971, its amendments 2002, Rules 2003 and Regulations 2003. As part of provision of MTP services, you shall maintain records in privacy and safe custody at your clinic and report the same by completing the forms C, I, II and III specified in the MTP Act Rules and Regulations 2003. It is mandatory to take the informed written consent of the woman seeking abortion services on Form C prior to the procedure. You should ensure that all information required on the form is completed in detail. In case the woman is neither a minor nor mentally ill, only her consent is sufficient for the registered medical practitioner to provide MTP. Send Form C and Form I within three days of performing the MTP to the office of the undersigned in a sealed envelope marked with the serial number of the woman as per the admission register and the name/s of the doctor/s who performed the procedure. At the end of each month, send the completed Form II to the office of the undersigned. Also provide the summary of the MTP cases as per the format below: Month & year of reporting Total MTPs performed in the month 12 weeks 12 20 weeks All the records related to MTP services are confidential and should not be open to any person other than you or those assigned the duty to maintain them except under the authority of the law. No entry shall be made in any case-sheet, operation register, follow-up card or any other document or register other than the admission register maintained at your approved place indicating therein the name of the pregnant woman. If you willfully contravene or willfully fail to comply with the requirements of the above mentioned regulations, you shall be liable to be punished with fine which may extend to one thousand rupees. You may expect monitoring visits from the Office of the CMO to assess the quality of services from time-to-time. I encourage you to maintain the essential equipment and supplies required to perform quality MTP services in functional order to provide services to a woman in privacy and with dignity. Failing which the approval provided to the site could be withdrawn. Chief Medical Officer (District) CC: DLC record files. Attachment: Form B 30 (Seal) Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 35 Implementers Guide LokLF; vkSj ifjokj dY;k.k ea=ky; ifjokj dY;k.k foHkkx vf/klwpuk ubZ fnYyh] 13 twu] 2003 lk- dk- fu- 485 v -&dsUnzh; ljdkj] xHkZ dk fpfdRlh; lekiu vf/kfu;e] 1971 1971 dk 34 dh /kkjk 6 }kjk izn k 'kfDr;ksa dk iz;ksx djrs gq,] fuEufyf[kr fu;e cukrh gS] vFkkZr%& 1- laf{kIr uke vkSj izkjaHk-& 1 bu fu;eksa dk laf{kIr uke xHkZ dk fpfdRlh; lekiu fu;e] 2003 gSA 2 ;s jkti= esa izdk'ku dh rkjh[k dh iz;Ir gksaxsaA 2- ikfjHkk"kk,a-& bu fu;eksa esa] tc rd fd lanHkZ ls vU;Fkk visf{kr u gks d ^^vf/kfu;e** ls xHkZ dk fpfdRlh; lekiu vf/kfu;e] 1971 1971 dk34 vfHkizsr gS( [k ^^eq[; fpfdRlk vf/kdkjh** ls ftys dk eq[; fpfdRlk vf/kdkjh vfHkizsr gS] pkgs og fdlh Hkh uke ls Kkr gks( x ^^iz:i** ls bu fu;eksas ls layXu iz:i vfHkizsr gS( ?k fdlh LFkku ds laca/k esa ^^Lokeh** ls ,slk O;fDr vfHkizsr gS tks fdlh ,sls vLirky vFkok LFkku dk] pkgs og fdlh Hkh uke ls Kkr gks vkSj tgka bl vf/kfu;e ds v/khu xHkZ dk lekiu fd;k tk ldrk gks] iz'kklfud iz/kku gks vFkok tks vU;Fkk :i esa mlds dk;Zdj.k vFkok O;oLFkk ds fy, m kjnk;h gks( M ^^lfefr** ls fu;e 3 ds lkFk ifBr /kkjk 4 ds [k.M [k ijUrq ds v/khu ftyk Lrj ij xfBr dh xbZ lfefr vfHkizsr gS( 3- ftyk Lrjh; lfefr dh lajpuk vkSj dk;Z vof/k-& 1 ftyk Lrjh; lfefr dk ,d lnL; L=h jksx foKkuh@ ltZu@ ,usLFkfVLV gksxk vkSj vU; lnL; LFkkuh; fpfdRlk o`fr] xSj 'kkldh; laxBuksa vkSj ftys dh iapk;rh jkt laLFkk ls gksaxsa% 1 ijUrq lfefr ds lnL;ksa esa ls ,d efgyk gksxh] 2 lfefr dh dk;Z vof/k nks dSysaMj o"kksZ ds fy, gksxh vkSj xSj&'kkldh; lnL;ksa dh dk;Z vof/k nks o"kZ ls vf/kd ugha gksxhA 4- /kkjk 2 ds [k.M ?k ds v/khu vuqHko vkSj izf'k{k.k-&/kkjk 2 ds [k.M ?k ds iz;kstu ds fy;s] jftLV h r fpfdRlk O;olk;h ds ikl L=h jksx foKku vkSj izlwfr foKku esa fuEufyf[kr esa ls ,d ;k vf/kd dk vuqHko ;k izf'k{k.k gksxk] vFkkZr~%& d ,sls fpfdRlk O;olk;h dh n'kk esa] tks bl vf/kfu;e ds izkjaHk ls Bhd iwoZ jkT; fpfdRlk jftLVj esa jftLV h r gqvk Fkk] L=h jksx foKku vkSj izlfr foKku ds O;olk; w esa rhu o"kZ ls vU;wu dk vuqHko( [k ,sls fpfdRlk O;olk;h dh n'kk esa tks jkT; fpfdRlk jftLVj esa jftLV h r gqvk gS( i ;fn mlus L=h jksx foKku vkSj izlwfr foKku esa N% ekl dh gkml ltsZlh iwjh dj yh gS( vFkok ii tc rd mlesa fuEufyf[kr lqfo/kkvksa dh O;oLFkk ugha gS] ;fn mlds ikl fdlh vLirky esa L=h jksx foKku vkSj izlwfr foKku ds O;olk; dk ,d o"kZ ls vU;wu dk vuqHko gks( vFkok x ;fn mlus ljdkj }kjk LFkkfir vFkok lapkfyr vLirky easa vFkok blh iz;kstu ds fy, vuqeksfnr izf'k{k.k laLFkku eaas] xHkZ ds fpfdRlh; lekiu ds iPphl ekeyksa esa] fdlh jftLV h r fpfdRlk O;olk;h dh lgk;rk dh gks ftuesa ls mlus de ls de ik p ekeyksa dks Lora= :i ls fd;k gksA 31 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 36 Implementers Guide i ;g izf'k{k.k igyh frekgh ds xHkkZof/k ds 12 lIrkg rd xHkZ dk lekiu djus ds fy, jftLV h r fpfdRlk O;olk;h vkj- ,e- ih- dks leFkZ cuk,xkA ii chl lIrkg rd ds xHkZ dk lekiu djus ds fy, mi&fu;e d ] mi&fu;e [k vkSj mi&fu;e ?k ds v/khu ;Fkkfofgr vuqHko vkSj izf'k{k.k ykxw gksxkA ?k ,sls jftLV h r fpfdRlk O;olk;h dh n'kk esa tks fdlh jkT; fpfdRlk jftLVj esa jftLV h r gks pqdk gks vkSj L=h jksx foKku vkSj izlwfr foKku esa Lukrdks kj fMxzh vFkok fMIyksek /kkjh gks] ,slh fMxzh vFkok fMIyksek ds nkSjku izkIr vuqHko vFkok izf'k{k.kA 5- LFkku dk vuqeksnu-& 1 /kkjk 4 ds [k.M [k ds v/khu dksbZ Hkh LFkku rc rd vuqeksfnr ugha fd;k tk,xk]& i tc rd ljdkj dk ;g lek/kku ugha gks tk, fd ogka ij xHkZ dk lekiu fujkin vkSj LokLF;dj n'kkvksa esa fd;k tk ldrk gS( vkSj ii tc rd ml LFkku ij fuEufyf[kr lqfo/kkvksa dh O;oLFkk u dh xbZ gks] vFkkZr~%& izFke frekgh ds xHkZ dh n'kk esa vFkkZr~ xHkkZof/k ds 12 lIrkg rd%& L=h jksx foKku ifj{k.k@izlo ihM+k] iVy] iqu:Tthou vkSj futZehdj.k miLdj] vkS"kf/k;ka vkSj tudh; rjy] vk?kkr ds mipkj ds fy, iwfrZdj lqfo/kk,a vkSj ifjogu dh lqfo/kk,a% rFkk( nwljh frekgh ds xHkZ dh n'kk esa vFkkZr~ xHkkZof/k ds 20 lIrkg rd%& d 'kY;f ;k ds fy, iVy vkSj mnjh; ;k L=h jksx fo"k;d ltZjh ds fy, midj.k( [k fu'psrd miLdj] iqu:Tthou vkSj futZehdj.k miLdj( x Hkkjr ljdkj }kjk le;≤ ij vf/klwfpr vkikfrd mi;ksx ds fy, vkS"kf/k;ka vkSj tudh; rjyA 32 Li"Vhdj.k-&felksizksLVy ds lkFk vkj;w&486 dk mi;ksx djds lkr lIrkg rd ds izkajfHkd xHkZ ds lekiu dh n'kk esa mls vf/kfu;e dh /kkjk 2 ds [k.M ?k vkSj xHkZ dk fpfdRlh; lekiu fu;e ds fu;e 4 ds v/khu rFkk ifjHkkf"kr jftLV h r fpfdRlk O;olk;h vkj- ,e- ih }kjk mlds Dyhfud ij fofgr fd;k tk,] ijUrq ,sls jftLV h r fpfdRlk O;olk;h dh xHkZ dk fpfdRlk lekiu la'kks/ku vf/kfu;e] 2002 ds lkFk ifBr xHkZ dk fpfdRlh; lekiu vf/kfu;e] 1971 dh /kkjk 4 vkSj xHkZ dk fpfdRlh; lekiu fu;eksa ds fu;e 5 ds v/khu vuqeksfnr LFkku rd igqap gksA igaqp ds iz;kstu ds fy, jftLV h r fpfdRlk O;olk;h dks vuqeksfnr LFkku ds Lokeh ls bl izHkko dk ,d izek.k&i= iznf'kZr djuk pkfg,A 2 LFkku ds vuqeksnu ds fy, izR;sd vkosnu iz:i ^d* gksxk vkSj ftys ds eq[; fpfdRlk vf/kdkjh dks lacksf/kr gksxkA 3 mifu;e 2 esa fufnZ"V vkosnu izkIr gksus ij ftyk eq[; fpfdRlk vf/kdkjh mlesa varfoZ"V tkudkjh dk lR;kiu dj ldsxk ;k mlds ckjs esa viuk lek/kku djus ds fy, ml LFkku dk fujh{k.k dj ldsxk rkfd mifu;e 1 esa fufnZ"V lqfo/kkvksa dh O;oLFkk dh xbZ gS vkSj ogka ij fujkin vkSj LokLFkdj n'kkvksa esa xHkZ dk lekiu fd;k tk ldrk gSA 4 ftl LFkku dk fujh{k.k ftyk fpfdRlk vf/kdkjh }kjk fd;k tkrk gS] mldk izR;sd Lokeh ml LFkku ds fujh{k.k ds fy, lHkh ;qfDr;qDr lqfo/kk,a iznku djsxkA 5 ftys dk eq[; fpfdRlk vf/kdkjh lfefr ls rc ,sls LFkku ds vuqeksnu ds fy, flQkfj'k dj ldsxk ;fn ,sls lR;kiu] iwNrkN vFkok fujh{k.k ds i'pkr~] ftls og vko';d le>rk gks] mldk ;g lek/kku gks tkrk gS fd LFkku ij LokLF;dj n'kkvksa esa xHkZ dk lekiu fd;k tk ldrk gSA 6 vkosnu vkSj ftyk eq[; fpfdRlk vf/kdkjh dh flQkfj'kksa ij fopkj djus Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 37 Implementers Guide ds i'pkr~ lfefr ,sls LFkku dk vuqeksnu dj ldsxh vkSj iz:i ^[k^ esa vuqeksnu dk izek.k&i= ns ldsxhA 7 lfefr }kjk tkjh fd, x, vuqeksnu dk izek.k&i= ml LFkku ij lgtn`'; :i ls iznf'kZr fd;k tk,xk ftlls fd os O;fDr tks ml LFkku es tk,a mls vklkuh ls ns[k ldsaA 8 vkosnu izkIr djus ds 2 ekl ds Hkhrj ml LFkku dk fujh{k.k fd;k tk,xk vkSj vxys 2 ekl ds Hkhrj ;k fdlh deh dks uksV fd, tkus dh n'kk esa] ml deh dk lq/kkj djus ds 2 ekl ds Hkhrj vuqeksnu izek.k&i= tkjh fd;k tk,xkA 9 bu fu;eksa ds izkjaHk gksus ij xHkZ dk fpfdRlh; lekiu vf/kfu;e] 1975 ds vuqlj.k esa vuqeksfnr LFkku dks bu fu;eksa ds v/khu vuqeksfnr le>k tk,xkA 6- LFkku dk fujh{k.k%& 1 ftyk eq[; fpfdRlk vf/kdkjh fu;e 5 ds v/khu vuqeksfnr LFkku dk fujh{k.k tc Hkh vko';d gks] ;g lR;kiu djus dh n`f"V ls dj ldsxk fd ml LFkku ij xHkZ dk lekiu fujkin vkSj LokLF;dj n'kkvksa esa fd;k tkrk gS ;k ugha( 2 ;fn eq[; fpfdRlk vf/kdkjh ds ikl ;g fo'okl djus dk dkj.k gks fd ml LFkku ij fdlh xHkZorh L=h dh e`R;q gks xbZ gS ;k mls {kfr igqaph gS vFkok ml LFkku ij xHkZ dk lekiu fujkin vkSj LokLF;dj n"kkvksa es ugha fd;k tk jgk gS rks og dksbZ Hkh lwpuk ekax ldsxk vFkok fdlh Hkh oLrq] vkS"kf/k] ,EI;wy] izos'k jftLVj vFkok vU; nLrkost dk] tks ml LFkku ij vuqjf{kr gks] j[kk tkrk gks ;k ik;k tk,] vfHkxzg.k dj ldsxk( tk, fd fu;e 5 esa fofufnZ"V lqfo/kk,a mlesa leqfpr :i ls ugha nh tk jgh gSa vkSj ,sls LFkku ij xHkZ dk lekiu fujkin vkSj LokLF;dj n'kkvksa esa ugha fd;k tk ldrk gS rks og ml ckr dh fjiksVZ lfefr dks nsxk ftlesa ml LFkku ij ikbZ xbZ dfe;ksa ;k nks"kksa dk C;kSjk nsxk vkSj ;fn lfefr dk lek/kku gks tkrk gS rks og vuqeksnu dks fuyafcr ;k jnn~ dj ldsxh ijUrq lfefr fu;e 5 ds v/khu tkjh izek.k&i= dks jnn~ djus ls igys ml LFkku ds Lokeh dks vH;kosnu djus ds fy, volj nsxhA 2 tgka fu;e 5 ds v/khu fn, x, fdlh izek.k&i= dks jnn~ vFkok fuyafcr fd;k tkrk gS ogka ml LFkku dk Lokeh ml LFkku esa ,sls ifjorZu ;k lq/kkj dj ldsxk vkSj mlds i'pkr~ og lfefr dks fu;e 5 ds v/khu vuqeksnu fn, tkus ds fy, vkosnu dj ldsxkA 3 vuqeksnu ds izek.k&i= ds fuyafcr gksus dh n'kk esa ml LFkku dks ,sls fuyacu ds vkns'k ds lalwfpr fd, tkus dh rkjh[k ls] xHkZ ds lekiu ds iz;kstuksa ds fy;s vuqeksfnr LFkku ugha le>k tk,xkA 8- iqufoZyksdu% 1 fdlh LFkku dk Lokeh tks fu;e 7 ds v/khu fd, x, vkns'k ls O;fFkr gS] ,sls vkns'k dh rkjh[k ls 60 fnu dh vof/k ds Hkhrj ljdkj dks ml vkns'k ds iqufoZyksdu ds fy, vkosnu dj ldsxk% ijUrq ljdkj fdlh foyac ds fy;s ml ekeys esa ekQh ns ldsxh tgka mldk ;g lek/kku gks tkrk gS fd vH;FkhZ le; ds Hkhrj vkosnu djus esa i;kZIr dkj.k ls fuokfjr gks x;k FkkA 2 ljdkj Lokeh dks lquokbZ dk volj nsus ds i'pkr~] vkns'k dh iqf"V dj ldsxh] mikarfjr dj ldsxh ;k myV ldsxhA 3 naM izf ;k lafgrk 1973 1974 dk 2 ds vfHkxzg.k laca/kh mica/k tgka rd gks lds] mifu;e 2 ds v/khu fd, x, vfHkxzg.k dks ykxw gksaxsaA 9- lEefr dk iz:i%&/kkjk 3 dh mi/kkjk 4 esa fufnZ"V lEefr iz:i&x esa nh tk,xhA 7- vuqeksnu ds izek.k&i= dk jnn~ vFkok fuyafcr fd;k tkuk%& 1 ;fn fu;e 5 ds v/khu vuqeksfnr fdlh LFkku ds fujh{k.k ds i'pkr~ ftyk eq[; fpfdRlk vf/kdkjh dk ;g lek/kku gks 10- fujlj vkSj O;ko`fr%&xHkZ dk fpfdRlh; lekiu fu;e] 1975 mu ckrksa ds flok,] fujflr fd;k tkrk gS] ftUgsa ,sls fujlu ls iwoZ fd;k x;k gS ;k fd, tkus dk yksi fd;k x;k gSA 33 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 38 Implementers Guide iz:i&d [fu;e 5 dk mifu;e 2 nsf[k,] /kkjk 4 ds [kaM [k ds v/khu LFkku ds vuqeksnu ds fy, vkosnu dk iz:i% vuqeksfnr txg dk izoxZ v 12 lIrkg rd ds xHkZ dk lekiu fd;k tk ldrk gSA vk 20 lIrkg rd ds xHkZ dk lekiu fd;k tk ldrk gSA 1- LFkku dk uke Li"V v{kjksa esa 2- iwjk irk 3- xSj&ljdkjh@izk;osV@uflZx gkse@vU; laLFkk,a 4- i;k crkb, fd D;k bl LFkku ij fuEufyf[kr lqqfo/kk,a miyC/k gSa& izoxZ v i ijh{k.k ds fy, VscyA ii Resuscitation iii futhZok.kqdj.k ds midj.kA (Sterilization) dh lkexzhA iv 'kkWd ,oa vkikr fLFkfr ds fy, lqfo/kk,a ,oa vkS"kf/k;kaA v ifjogu ds fy, lqfo/kk,a] ;fn visf{kr gksaA izoxZ vk i 'kY; f ;k gsrq Vscy vkSj 'kY;&fpfdRlk djus ds fy, midj.k ii vkikr n'kkvksa ds fy, i;kZIr ek=k esa vkS"kf/k;ka iii fu'psrd iv Resuscitation v futhZok.kqdj.k ds midj.kA (Sterilization) dh lkexzhA LFkku% Rkkjh[k% LFkku ds Lokeh ds gLrk{kj 34 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 39 Implementers Guide iz:i&[k [fu;e 5 dk mifu;e 6 nsf[k,] vuqeksnu dk izek.k&i= uhps of.kZr LFkku dks xHkZ dk fpfdRlh; lekiu vf/kfu;e] 1971 1971 d 34 ds iz;kstukFkZ lIrkg ds xHkZ lekiu ds fy, vuqeksfnr fd;k tkrk gSA LFkku dk uke irk rFkk vU; o.kZu Lokeh dk uke LFkku% rkjh[k% lsok esa ljdkj Consent Form iz:i&x eSa iq=h@iRuh vk;q yxHkx o kZ tks bl le; ;gka LFkk;h irk fyf[k, esa fuokl djrh gw ml LFkku dk uke fyf[k, tgka xHkZ dk lekiu fd;k tkuk gS eSa vius xHkZ ds lekiu ds fy, viuh lgefr nsrh gwa LFkku% rkjh[k% gLrk{kj tgka L=h ekufld :i ls vLoLF; ;k 18 o kZ ls de mez dh gks] ogka mlds laj{kd }kjk Hkjk tk, eSa iq=@iq=h@iRuh vk;q yxHkx o kZ tks bl le; LFkkuh irk esa fuokl djrk@djrh gwa viuh izfrikY; tks vo;Ld@ekufld :i ls vLoLF; ;k 18 o kZ ls de mez dh gS xHkZ dk lekiu djus dk LFkku LFkku% rkjh[k% esa xHkZ ds lekiu ds fy, viuh lgefr nsrk@nsrh gwaA laj{kd dk gLrk{kj 35 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 40 Implementers Guide ifjokj fu;kstu foHkkx vf/klwpuk ubZ fnYyh] 13 twu] 2003 lk- dk- fu- 485 v -&dsUnzh; ljdkj] xHkZ dk fpfdRlh; lekiu vf/kfu;e] 1971 1971 dk 34 dh /kkjk 6 }kjk izn k 'kfDr;ksa dk iz;ksx djrs gq,] fuEufyf[kr fofu;e cukrh gS] vFkkZr%& 1- laf{kIr uke vkSj izkjaHk-& 1 bu fu;eksa dk laf{kIr uke xHkZ dk fpfdRlh; lekiu fu;e] 2003 gSA 2 ;s lHkh la?k jkT;{ks=ksa ij foLrkfjr gksxsaA 3 ;s jkti= esa izdk'ku dh rkjh[k dks izo` k gksxsA 2- ifjHkk"kk,a-& bu fu;eksa esa] tc rd fd lanHkZ ls vU;Fkk visf{kr u gks d ^^vf/kfu;e** ls xHkZ dk fpfdRlh; lekiu vf/kfu;e] 1971 1971 dk 34 vfHkizsr gS( [k ^^nkf[kyk jftLVj** ls fofu;e 5 ds v/khu j[kk x;k jftLVj vfHkizsr gS( x ^^eq[; fpfdRlk vf/kdkjh** ls fdlh ftys dk eq[; fpfdRlk vf/kdkjh vfHkizsr gS] pkgs ftl fdlh uke ls Kkr gks( ?k ^^izk:i** ls bu fofu;eksa ls layXu iz:i vfHkizsr gS( ^^vLirky** ls dsUnzh; ljdkj ;k la?k jkT;{ks= }kjk LFkkfir ;k vuqjf{kr vLirky vfHkizsr gS( p ^^/kkjk** ls vf/kfu;e dh dksbZ /kkjk vfHkizsr gS( 3- jk; ;k jk;ksa dks izekf.kr djus okyk iz:i& 1 tgk ,d jftLV h r fpfdRlk O;olk;h dh ;k de ls de nks jftLV h r fpfdRlk O;olkf;;ksa dh jk; ,slh gS] tks /kkjk 3 dh mi/kkjk 2 ;k /kkjk 5 esa fufnZ"V gS] rks og ;k os ,slh 36 jk; dks iz:i 1 esa izekf.kr djsxk@ djasxsA 2 izR;sd ,slk jftLV h r fpfdRlk O;olk;h] tks fdlh xHkZ dk lekiu djrk gS] xHkZ ds lekiu ls rhu ?kaVs ds Hkhrj ,sls lekiu dks iz:i 1 esa izekf.kr djsxkA 4- izk:iksa dh vfHkj{kk& 1 xHkZorh efgyk }kjk vius xHkZ ds lekiu ds fy, nh xbZ lEefr vkSj ;FkkfLFkfr] /kkjk 3 vFkok 5 ds v khu vfHkfyf[kr izekf.kr jk; rFkk xHkZ ds lekiu dk izKkiu ,d fyQkQs esa j[ks tk,axs tks ml jftLV h r fpfdRlk O;olk;h vFkok mu jftLV h r fpfdRlk O;olkf;;ksa }kjk eksgjcUn fd;k tk,xk ftUgksaus xHkZ dk lekiu fd;k gS vkSj tc rd og fyQkQk vLirky ds iz/kku vFkok vuqeksfnr LFkku ds Lokeh vFkok jkT; ds eq[; fpfdRlk vf/kdkjh ds ikl ugha Hkst fn;k tkrk gS rc rd mls] ;FkkfLFkfr] lacaf/kr jftLV h r fpfdRlk O;olk;h vFkok O;olkf;;ksa dh lqjf{kr vfHkj{kk esa j[kk tk,xkA 2 /kkjk 3 ds v/khu xHkZ ds lekiu ls lacaf/kr mifu;e 1 esa fufnZ"V izR;sd fyQkQs ij nkf[kyk jftLVj esa ml xHkZorh L=h dks nh xbZ e la[;k rFkk ml jftLV h r fpfdRlk O;olk;h vFkok O;olkf;;ksa ds uke] ftUgksaus xHkZ dk lekiu fd;k gks] fy[ks tk,axs rFkk ,sls fyQkQs ij ^^xqIr** vafdr fd;k tk,xkA 3 mi fofu;e 2 esa fufn"V izR;sd fyQkQk] xHkZ dk lekiu ds rRdky Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 41 Implementers Guide i'pkr~ ml vLirky ds iz/kku vFkok ml vuqeksfnr LFkku ds Lokeh ds ikl tgk xHkZ ds lekiu fd;k x;k gks] Hkst fn;k tk,xkA 4 mi&fofu;e 3 fufnZ"V fyQkQs dh izkfIr ij] vLirky dk iz/kku vFkok vuqeksfnr LFkku dk Lokeh mls lqjf{kr vfHkj{kk esa j[kus dk izca/k djsxkA 5 vLirky dk izR;sd iz/kku vuqeksfnr LFkku dk izR;sd Lokeh jkT; ds eq[; fpfdRlk vf/kdkjh dks mu ekeyksa dk] ftuesa xHkZ dk lekiu fd;k x;k gks] lkIrkfgd fooj.k iz:i 2 esa HkstsxkA 6 /kkjk 5 ds v/khu xHkZ ds lekiu ls lacaf/kr mi&fofu;e 1 esa fufnZ"V izR;sd fyQkQs ij ml jftLV h r fpfdRlk O;olk;h dk uke vkSj irk ftlds }kjk xHkZ dk lekiu fd;k x;k Fkk rFkk og rkjh[k tc xHkZ dk lekiu fd;k x;k Fkk] fy[ks tk,axs rFkk ,sls fyQkQs ij ^^xqIr** vafdr fd;k tk,xkA Li"Vhdj.k&/kkjk 5 ds v/khu fd, x, xHkZ lekiu dh fLFkfr esa iz:i 1 esa vLirky vFkok vuqeksfnr LFkku ls lacaf/kr LraHk rFkk nkf[kyk jftLVj esa xHkZorh L=h dks fn, x, e la[;kad dks [kkyh NksM+ fn;k tk,xkA 7 tgk xHkZ dk lekiu fdlh vuqeksfnr LFkku vFkok vLirky esa u fd;k x;k gks] ogka mi&fofu;e 6 eas fufnZ"V izR;sd fyQkQ+k jkT; ds eq[; fpfdRlk vf/kdkjh ds ikl jftLV h Mkd }kjk mlh fnu] ftl fnu xHkZ dk lekiu fd;k x;k gks ;k ml fnu ls] ftl fnu xHkZ dk lekiu fd;k x;k Fkk] Bhd vkxkeh dk;Zfnol dks Hkstk tk,xkA ijUrq tgk xHkZ dk lekiu fdlh vuqeksfnr LFkku vFkok vLirky esa fd;k x;k gks ogk mi&fofu;e 1 ls 6 esa micaf/kr izf ;k dk vuqlj.k fd;k tk,xkA 5- nkf[kyk jftLVj dk j[kk tkuk& 1 vLirky dk izR;sd iz/kku vFkok vuqeksfnr LFkku dk izR;sd Lokeh iz:i 3 esa ,d jftLVj j[ksxk] ftlesa xHkZ ds lekiu ds fy, fL=;ksa ds nkf[kyksa ds C;kSjs vfHkfyf[kr fd, tk,axs vkSj os ,sls jftLVj dks ml dys.Mj o"kZ dh] ftlls og lacaf/kr gS] lekfIr ls ikap o"kZ dh vof/k ds fy, j[ksxkA 2 nkf[kyk jftLVj esa izfof"V;k ekuqlkj dh tk,axh vkSj izR;sd dys.Mj o"kZ ds izkjaHk esa u;k e vkajHk fd;k tk,xk vkSj fdlh fof'k"V o"kZ dh e la[;kad dk vU; o"kksZa dh e la[;kadksa ls izHksn ml e la[;kad ds lkFk o"kZ dk mYys[k djds fd;k tk,xk] mnkgj.kkFkZ 1972 dh e la[;kad 5 vkSj 1973 dh e la[;kad 5 dks 5@1972 vkSj 5@1973 ds :i esa mfYyf[kr fd;k tk,xkA 3 nkf[kyk jftLVj ,d xqIr nLrkost gksxk rFkk mlesa of.kZr xHkZorh L=h ds uke vkSj vU; fof'kf"V;ksa ds ckjs esa tkudkjh fdlh Hkh O;fDr ij izdV ugha dh tk,xhA 6- nkf[kyk jftLVj dk fujh{k.k ds fy, [kqyk u gksuk&nkf[kyk jftLVj vLirky ds iz/kku vFkok vuqeksfnr LFkku ds Lokeh vFkok ,sls iz kku vFkok Lokeh }kjk izkf/k r fdlh O;fDr dh lqjf{kr vfHkj{kk esa j[kk tk,xk] rFkk fofu;e 4 ds mi&fofu;e 5 esa vU;Fkk micaf kr ds flok;] ;g fof/k ds izkf/kdkj ds v/khu ds flok;] fdlh O;fDr }kjk fujh{k.k ds fy, [kqyk ugha gksxk% ijUrq jftLV h r fpfdRlk O;olk;h fdlh ,slh efgyk deZpkjh ds vkosnu ij ftlds xHkZ dk lekiu fd;k x;k gks] mls bldk izek.k&i= nsxk ftlls fd og vius fu;ksDrk ls NqV~Vh izkIr dj 37 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 42 Implementers Guide lds% ijUrq ;g vkSj ,slk dksbZ Hkh fu;ksDrk bl tkudkjh dks fdlh vU; O;fDr ij izdV ugha djsxkA 3 naM izf ;k lafgrk 1973 1974 dk 2 ds vfHkxzg.k laca/kh mica/k tgka rd gks lds] mifu;e 2 ds v/khu fd, x, vfHkxzg.k dks ykxw gksaxsaA 7- vLirky ;k vuqeksfnr LFkku esa j[ks x, jftLVjksa esa izfof"V;k &fdlh Hkh 38 vLirky vFkok vuqeksfnr LFkku esa j[kh xbZ fdlh dsl 'khV] 'kY; deZ'kkyk jftLVj] vuqijh{k.k dkMZ vFkok fdlh vU; nLrkost ;k nkf[kyk jftLVj ls fHkUu fdlh vU; jftLVj esa ,slh dksbZ Hkh izfof"V ugha dh tk,xh ftlesa fd xHkZorh L=h dk uke minf'kZr gks rFkk mlesa ml xHkZorh L=h ds izfrfunsZ'k] mls nkf[kyk jftLVj esa nh xbZ e la[;kad }kjk fd;k tk,xkA Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 43 Implementers Guide izk:i&1 fofu;e 3 nsf[k, eSa jftLV h r fpfdRlk O;olk;h dk uke vkSj vgZrk,a Li V v{kjksa esa jftLV h r fpfdRlk O;olk;h dk iwjk irk eSa jftLV h r fpfdRlk O;olk;h dk uke vkSj vgZrk,a Li V v{kjksa esa jftLV h r fpfdRlk O;olk;h dk iwjk irk izekf.kr djrk gwa@djrs gSa fd esjh@gekjh jk; esa] tks ln~HkkoiwoZd cukbZ xbZ gS xHkZorh L=h dk iwjk uke Li V v{kjksa esa fuoklh fuoklh dk iwjk irk Li V v{kjksa esa ds xHkZ lekiu djuk fuEufyf[kr dkj.kksa ls vko ;d gSA *eSa@ge ;g lwpuk nsrs gwa@nsrs gSa ds *eSaus@geus fufnZ V L=h ds] ftldh vLirky@vuqeksfnr LFkku ds nkf[kyk jftLVj esa e la[;kad gSa] xHkZ dk lekiu fd;k gSA LFkku% rkjh[k% jftLV h r fpfdRlk O;olk;h@O;olkf;;ksa ds gLrk{kj *tks ykxw u gks mls dkV nsaA **en i ls v rd dh enksa esa fofufnZ"V dkj.kksa esa ls og ,d fyf[k, tks leqfpr gksA i xHkZorh L=h ds thou dh j{kk ds fy,A ii xHkZorh L=h ds 'kkjhfjd ;k ekufld LokLF; dks gksus okyh xaHkhj {kfr ds fuokj.k ds fy,A iii bl n`f"V ls fd bl ckr dk i;kZIr tksf[ke gS fd ;fn cPpk iSnk gqvk rks og ,slh 'kkjhfjd ;k ekufld vilkekU;rkvksa ls ihfM+r gksxk fd og xaHkhj :i ls fodykax gksA iv blfy, fd xHkZorh L=h dk ;g vfHkdFku gS fd xHkZ cykRlax }kjk gqvk gSA v blfy, fd xHkZ] cPpksa dh la[;k lhfer j[kus ds iz;kstu ls] fookfgr L=h ;k mlds ifr }kjk iz;ksx esa ykbZ xbZ fdlh xHkZ fujks/kd ;qfDr ;k rjhds dh foQyrk ds QyLo:i gqvk gSA fVIi.kh&;g vo/kkj.k djus ds fy, fd D;k mlds xHkZ ds cus jgus ls xHkZorh L=h ds 'kkjhfjd vFkok ekufld LokLF; dks xaHkhj {kfr igqapsxh] ml L=h dh okLrfod ;k ;qfDr;qDr iwoZ ifjfLFkfr;ksa dks /;ku esa j[kk tk,A LFkku% rkjh[k% jftLV h r fpfdRlk O;olk;h@O;olkf;;ksa ds gLrk{kj 39 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 44 Implementers Guide izk:i&2 fofu;e 4 5 nsf[k, 1- jkT; dk uke 2- vLirky@vuqeksfnr LFkku dk uke 3- xHkZ dh vfLrRokof/k dsoy dqy la[;k nhft, d 12 lIrkgksa ds chp [k 12&20 lIrkgksa ds chp 4- L=h d [k x ?k dk /keZ fgUnq eqlyeku blkbZ vU; dqy 5- xHkZ fujks/ku dh Loh fr nsrs gq, lekiu d ulcaUnh [k vkbZ- ;w- Mh- ywi x xHkZ fujks/kd xksfy;k ?k fujks/k daMkse vU; ]6- lekiu ds dkj.k izR;sd mi&'kh"kZ ds vUrxZr dqy la[;k nhft,a d xHkZorh L=h ds thou dks [krjk [k xHkZorh L=h ds 'kkjhfjd LokLF; dks xaHkhj {kfr x xHkZorh L=h ds ekufld LokLF; dks xaHkhj {kfr ?k cykRlax }kjk gqvk xHkZ bl ckr dk i;kZIr tksaf[ke gS fd ;fn cPpk iSnk gqvk] rHkh ,slh 'kkjhfjd ;k ekufld vlkekU;rkvksa ls ihfMr gksuk 'kkjhfjd og xaHkhj :i ls fodykax gks p fdlh xHkZ fujks/kd ;qfDr vFkok rjhds dh foQyrk izHkkjh vf/kdkjh ds gLrk{kj vkSj rkjh[k 40 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 45 Implementers Guide izk:i&3 fofu;e 5 nsf[k, nkf[kyk jftLVj bl jftLVj esa vafre izfof"V dh rkfj[k ls ikap o"kZ dh lekfIr ij bls u"V dj fn;k tk, 1 2 3 4 5 6 7 -la- nkf[kys dh rkfj[k efgyk dk uke iRuh@iq=h vk;q /keZ irk 8 xHkZ dh vof/k 9 xHkZ lekiu ds dkj.k 10 11 xHkZ lekiu efgyk dks dh rkjh[k NqV~Vh nsus dh rkjh[k 12 ifj.kke vkSj fVIi.k 13 jftLV h r fpfdRlk O;olk;h dk@ O;olkf;;ksa ds uke ftlds@ ftuds }kjk jk; dk;e dh xbZ gS 14 ml jftLV h r fpfdRlk O;olk;h dk@ O;olkf;;ksa ds uke ftlds@ ftuds }kjk xHkZ dk lekiu fd;k x;k gS 41 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 46 Implementers Guide References Hyman, Alyson G. and Laura Castleman, Woman-centered abortion care: Reference manual, Ipas, Chapel Hill, NC (2005). Turner, Katherine, Teresa McInerney and Jeannine Herrick, Woman-centered post abortion care: Trainer's manual, Ipas, Chapel Hill, NC (2004). Woman-centered abortion care: Trainers manual, Ipas, India, (2007). World Health Organization (WHO), Safe Abortion: Technical and Policy Guidance for Health Systems, Geneva, WHO (2003). MTP: A user's guide to the law, The Lawyers Collective, Women's Rights Initiative, Universal Law Publishing Co. Pvt. Ltd., New Delhi (2004). The Medical Termination of Pregnancy (Amendment) Act (2002), The Gazette of India (June 2003). The Medical Termination of Pregnancy Rules & Regulations (2003), The Gazette of India (June 2003). Maternal Mortality in India, Federation of Obstetric and Gynecology Societies (1993). Sample Registration System Bulletin, 1999 & 2000, Registrar General, India. Special Survey of Deaths using RHIME (2001 2003), Registrar General, India. Sample Registration System, MMR in India: 1997 2003, Trends, Causes & Risk Factors, Registrar General, India (2006). International Institute for Population Sciences (IIPS) and ORC Macro, 2000, NHFS-2 (1998-99). IIPS (2005), India Facility Survey-II (2003). 42 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 47 Ipas India P.O. Box 8862, Vasant Vihar, New Delhi -110 057 Tel.: 91-11-41662006 Fax: +91-11-41661711 Website: www.ipas.org IIICO-TRG/O:4-8/Rev:8-11/Rp:0--(500)-#1 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 48 Abortion and Law_Guide 10.qxd 8/17/2011 5:09 PM Page 49

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