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2. Medical Termination of Pregnancy (Abortion)
What is MTP/ Abortion ?
Abortion is a procedure that enables a woman to opt out of an unwanted pregnancy. Medical procedure for ending a pregnancy at any time before the foetus has attained the stage of viability is called Medical Termination of Pregnancy (MTP) or abortion. It is not a family planning method but it is a reliable method of terminating unplanned and unwanted pregnancy.
An abortion can be induced or spontaneous. A spontaneous abortion occurs when a pregnancy terminates without any medical or surgical intervention, as in the case of a miscarriage. Induced abortions involve surgical or medical procedures for termination of the pregnancy.
Is abortion legal ?
Discontinuation of pregnancy has been practiced from time immemorial. The procedure was known to practitioners of Gynecological Medicine but because of society’s attitude it has resulted in unnecessary complications. Our Government recognized this silent need in society and passed a legislation called ‘The Medical Termination of Pregnancy Act in 1971’ which came into force from 1st April, 1972. This act makes the termination of pregnancies legal for doctors and for clients. India is among the first few countries to legalize termination of unwanted pregnancy.
What does the Act say ?
Under MTP Act of 1971, any woman, married or unmarried can terminate an unwanted pregnancy through abortion.
Reasons for ending pregnancies can be numerous. Some well-known reasons are:
- The continuance of pregnancy involves a risk to the life of the pregnant woman or grave injury to her physical or mental health.
- There is substantial risk that if the child were born, it would suffer from such physical or mental abnormalities as to be seriously challenged.
- Pregnancy occurs as a result of failure of any contraceptive device or method used by any married woman or her spouse.
- Pregnancy occurs due to rape.
- If the pregnant woman is suffering from any kind of mental disorder or mental illeness.
Under the MTP Act, the following are strictly specified:
• Maternal/ Fetal conditions under which MTP can be done
• Place where it can be done
• Persons who can do it
Does a woman require a written consent of her husband to get an MTP done?
A woman can give her own consent if she is above 18 years of age, she does not require the consent of her husband. However a girl below 18 years need the consent of her guardian in writing.
Where should abortion be performed and by whom ?
Since making termination of pregnancy legal in 1971, Government has given license to a few well qualified doctors and institutions to conduct termination of pregnancy. Abortion should always be done by these trained and qualified doctors at MTP registered clinics.
Note – It is dangerous and sometimes FATAL to get an abortion done by quacks, nurses, untrained dais or unskilled doctors. This is also illegal apart from leading to serious medical complications and these doctors and dais can be imprisoned under the MTP Act.
When should abortion be done ?
Although the MTP Act allows termination up to 20 weeks of pregnancy, it is advised that the sooner the termination is done the better. As soon as menstrual date is missed, a urine test to confirm pregnancy should be done.
How abortion is done in the first trimester of pregnancy ?
The first trimester methods of abortion include:
(i) Cervical dilatation followed by evacuation of uterus by Curettage /Suction evacuation / vacuum aspiration / Dilatation and evacuation
(ii) Menstrual aspiration (MR)
(iii) Medical Methods
What is cervical dilatation followed by evacuation?
It is a kind of Surgical abortion done in the early pregnancy, that is before 12 weeks by first dilating the cervix, which is done by introducing hollow metal rods of increasing diameters and then evacuating the contents of the uterus mechanically by scraping or by suction or both. The procedure takes about 15 minutes.
What is menstrual aspiration or regulation?
Menstrual aspiration also called minisuction, miniabortion, vacuum aspiration, lunchtime abortion that is done between 1 to 3 weeks after the failure to menstruate. This procedure is done as an outpatient. A thin plastic tube is inserted into the uterus and its contents sucked out by negative pressure created in a syringe. The procedure takes about 10 minutes to complete.
What are medical methods of aborting first trimester pregnancy?
The main drugs in use today are a group of drugs known as prostaglandin which can be used through various routes namely by mouth (referred to as the Abortion Pill), by injection intramuscularly /intravenously or vaginally. These drugs are used by themselves or in combination with other drugs.
1] The Methotrexate – Misoprostol method: A woman receives an injection of methotrexate. Between five to seven days later she returns and inserts suppositories of misoprostol into her vagina. The pregnancy usually ends at home within a day or two. The embryo and other tissue that develops during pregnancy are passed out through the vagina.
2] The Mifepristone – Misoprostol method: Mifepristone also known, as RU-486 is antiprogesterone. A woman swallows a dose of mifepristone. She returns in five to seven days and inserts suppositories of misoprostol into her vagina. The pregnancy usually ends at home within four hours. The embryo and other tissue that develops during pregnancy are passed out through the vagina.
Does the Abortion Pill always have to be taken under medical supervision ?
Yes, the Abortion Pill must always have to be taken under medical supervision. Under no circumstances it should be taken
What are the methods employed for MTP in second trimester ?
The methods may include medical methods and surgical methods .
What is done in case of using medical methods for aborting second trimester pregnancy?
Medical methods involve the use of Prostaglandin related drugs, which may be given orally or intravaginally or injected directly into the uterine cavity.
What are the surgical methods for aborting second trimester pregnancy?
The surgical methods include:
- Aspirotomy: Similar to Dilatation and Evacuation
- Hysterotomy: Opening the uterus and removal of foetus
- Hysterectomy: Removal of the entire uterus.
What are the long-term effects of an abortion ?
Women who have had an abortion worry that it may affect their ability to conceive or bear a child in the future. They will be relieved to learn that now it is generally believed that a single abortion performed in the first 12 weeks of pregnancy does not pose a threat to future childbearing potential. However, a recent World Health Organization study has shown that women who underwent two or more abortions had a two-to-three times greater chance of miscarriage, premature delivery, or low birth weight infants.