MTP Amendment Act 2021: Key Changes in Gestation Limits
The MTP Amendment Act 2021 extended the upper gestation limit for termination of pregnancy from 20 weeks to 24 weeks for specific categories of women, while maintaining the 20-week limit for general cases. 1, 2
Major Changes in Gestation Limits
Extended Upper Limit to 24 Weeks
The amended Act allows termination up to 24 weeks of gestation for specific vulnerable groups, including survivors of rape, victims of incest, minors, women with disabilities, and cases where there is a change in marital status during the ongoing pregnancy (widowhood or divorce). 1, 2
For pregnancies with substantial fetal anomalies, termination is now permitted beyond 24 weeks with approval from a Medical Board, removing the previous absolute upper limit for such cases. 1, 2
Standard Limit Remains at 20 Weeks
- For the general population not falling into the special categories, the upper gestation limit remains at 20 weeks, unchanged from the original 1971 Act. 1, 2
Provider Requirements Based on Gestation
Single Provider Authorization
- Terminations up to 20 weeks of gestation require the opinion of only one registered medical practitioner, maintaining the previous standard. 1, 2
Two Provider Authorization
- Terminations between 20 to 24 weeks of gestation require the opinion of two registered medical practitioners for the special categories mentioned above. 1, 2
Medical Board Approval
- Terminations beyond 24 weeks for substantial fetal anomalies require approval from a Medical Board consisting of specialists as defined by state-level regulations. 1, 2
Clinical Implications
Safety Considerations Beyond 20 Weeks
Medical termination of pregnancy at or beyond 20 weeks carries specific maternal risks, including postpartum hemorrhage (11.1% of cases) and need for manual removal of retained placental tissue (16.0% of cases). 3
Severe maternal morbidity occurs in approximately 1.3% of cases when performing medical termination at or beyond 20 weeks, including complications such as amniotic fluid embolism, cardiac arrest, major obstetric hemorrhage, and uterine rupture. 3
These procedures should be performed in hospital settings with emergency support services available, not in outpatient facilities, particularly for high-risk cases. 4
Common Pitfalls and Caveats
Implementation Challenges
- The Amendment Act was passed in 2021, but full implementation depends on state-level rules and regulations being finalized, which may create temporary gaps in service availability. 1
Access Barriers
Legislative amendments alone are insufficient without addressing awareness, availability, accessibility, and affordability of quality MTP services across all levels of healthcare. 5
Women must be educated about the risks of unsupervised medical termination pills and the importance of seeking care from registered providers. 5