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BEHIND
THE
SCENES
A girl was
born; it was
not his child
Medicolegal aspects of
Pregnancy, Delivery
and Abortion
Medical Termination of Pregnancy Act
Pre-Conception & Pre-Natal
Diagnostic Techniques Act
Medicolegal Aspects
PREGNANCY
Civil cases
O Malicious persons

may allege either
verbally or in
writing, that an
unmarried woman
or widow is
pregnant, in which
case she would
definitely vindicate
herself

OMG! That
widow is
pregnant
Civil cases
O Concealed

pregnancy before
marriage by a
person other than
lawfully wedded
spouse constitutes
a valid ground for
divorce
Civil cases
O Duration of

pregnancy assumes
importance when
legitimacy of a
posthumous child
is questioned

She’s
pregnant?
??Her
husband
died a year
ago
Criminal cases
O Pregnancy is

positive proof of
sexual intercourse
in a trial for rape
Criminal cases
O Pregnancy may be

a motive for the
suicide of a married
or unmarried
woman, or for the
murder of a married
woman by her
husband, when it is
result of an explicit
relationship
Civil-Criminal cases
O Woman may feign

pregnancy, termed
pseudocyesis in order
to
O Avoid capital

punishment (Sec.416
Cr.P.C)
O Compel a person to
marriage
O Secure more
maintenance in case of
divorce
Civil-Criminal cases
O Superfetation –

Where 2 or more
pregnancies result
from the fertilisation
of 2 or more ova of
different ovulatory
periods

O Superfecundation

– 2 or more ova of
the same ovulatory
period are fertilised
by separate acts of
sexual intercourse
with same person
or 2 different
persons
Medicolegal Aspects
DELIVERY
Civil cases
O Feigned deliveryO Claiming property

of deceased
husband
O Child is called
suppositious child

Wish I could
speak, I
don’t think
she’s
mommy
Civil cases
O Affiliation cases
O Woman claims
O Child’s father is not

her lawfully
wedded husband
or
O Husband who
subsequently
divorced her
O Thus, he must
adopt the child as
his own
Civil cases
O Contested

legitimacy of
child- When as a
part of evidence
that child was born
of a particular
woman and her
husband

We’ll prove
that baby is
ours
Criminal cases
O Question of delivery assumes importance in

trials for
O Abortion and infanticide
O Concealment of a child begotten out of an

explicit relationship
O Affiliation case proceeding to blackmail
Medicolegal Aspects
of Abortion
MTP Act and PCPNDT Act
Medical Termination
of Pregnancy Act
1971 (Amended 1975 and 2002)
Introduction
Passed to liberalize abortions in India
Decided upon the idea of saving the lives of millions of women,
who would otherwise resort to criminal abortion out of desperation
Legalizes abortion services
De-criminalizes the abortion seeker
Offers protection to medical practitioners who otherwise would be
penalized under the Indian Penal Code (sections 315-316)
Legal framework
MTP Act

MTP Rules

MTP
Regulations

• lays down when & where pregnancies can be terminated
• Grants the central govt. power to make rules and the state
govt. power to frame regulations

• lays down who can terminate the pregnancy, training
requirements, approval process for place, etc.

• lays down forms for opinion, maintenance of records
• custody of forms and reporting of cases
When can pregnancies be
terminated?
Up to 20 weeks gestation
With the consent of the women. If the women is below 18
years or is mentally ill, then with consent of a guardian
With the opinion of a registered medical practitioner,
formed in good faith, under certain circumstances
Opinion of two RMPs required for termination of pregnancy
between 12 and 20 weeks
MTP rules: Who can
perform?
A medical practitioner (RMP)
O who has a recognized medical qualification

as defined in clause (h) of section 2 of
Indian Medical Council Act, 1956
O Whose name has been entered in a State
Medical Register and
O Who has such experience or training in
Gynecology and Obstetrics as prescribed
by Rules made under the Act
MTP rules: training
requirement - 1
For termination up to 12 weeks:
O A practitioner who has assisted a registered

medical practitioner in performing 25 cases of

MTP of which at least 5 were performed
independently in a hospital established or
maintained or a training institute approved for
this purpose by the Government
MTP rules: training
requirement - 2
For termination up to 20 weeks
O A practitioner who holds a post-graduate degree

or diploma in Obstetrics and Gynecology
O A practitioner who has completed six months
house job in Obstetrics and Gynecology
O A practitioner who has at least one-year
experience in practice of Obstetrics and
Gynecology at a hospital which has all facilities
O A practitioner registered in state medical register
immediately before commencement of the Act,
experience in practice of Obstetrics and
Gynecology for a period not less than three years.
MTP Act: Indications
Continuation of pregnancy constitutes risk to the life or
grave injury to the physical or mental health of woman
Substantial risk of physical or mental abnormalities in
the fetus as to render it seriously handicapped
Pregnancy caused by rape (presumed grave injury to
mental health)
Contraceptive failure in married couple (presumed
grave injury to mental health)
MTP Act: Place for
conducting MTP
A hospital established or maintained by
Government

• OR
A place approved for the purpose of this Act
by a District-level Committee constituted by
the government with the CMHO as
Chairperson
MTP Act amendment 2002
Decentralizes site registration to a 3-5 member
district level committee chaired by the
CMO/DHO
Approval of sites that can perform MTPs under
the act can now be done at the district level
Stricter penalties for MTPs being done in a unapproved site or by a persons not permitted by
the act
Common Methods of terminating
pregnancy under MTP Act
Dilatation and curettege
Dilatation followed by oxytocin infusion
Vacuum aspiration technique
Intraembryonic instillation of prostaglandins
Extraembryonic instillation on hypertonic saline
With drugs: Mifepristone (RU486), and Misoprostol (early pregnancy)
Hysterotomy (after 12-14 weeks)
Common methods of
Terminating pregnancy

VAT
Common methods of
Terminating pregnancy

DC
MTP Regulations
O MTP Regulations, 2003 consists of all the

regulations:
O Forms to be required for making

opinion, admission register and
reporting of MTPs
O Custody of forms
O Prevention
of
disclosure
of
information
Pre-conception and
Pre-natal Diagnostic
Techniques (Prohibition of
Sex Selection) Act
1994, 1996 rules, 2003 amendment
What was the need for such
an Act?
O The Supreme Court, taking a serious view of

the onslaught of sex-selective
discriminatory practices by the medical
fraternity, and the connection it may have
with the use of pre-natal sex determination,
directed the Centre to implement the PC &
PNDT Act in all its aspects. The order came
following a public interest petition filed by the
centre for the Enquiry of Health and Allied
Themes (CEHAT), the Mahila Sarvangeen
Utkarsh Mandal (MASUM) and Dr. Sabu
George, who had done extensive research in
this area.
Dismal picture
PCPNDT Act, 2003
O To provide for the prohibition of sex selection,

before or after conception

O For regulation of pre-natal diagnostic

techniques for the purposes of detecting
abnormalities or metabolic disorders or
chromosomal abnormalities or certain
congenital malformations or sex-linked
disorders

O The prevention of their misuse for sex

determination leading to female foeticide and
for matters connected therewith or incidental
thereto
Salient Features
O Use of PNDT only allowed on medical

grounds & not for determination of sex
O PNDT can be conducted only by clinics
registered under the Act
O No person conducting prenatal
diagnostic procedure shall
communicate to pregnant women or
her relatives, the sex of the fetus by
words or signs or any other method
Salient Features
O Clinics involved in advertisement

(conducting sex determination) are
liable for punishment
O Declaration on each report that he/she
has neither detected nor disclosed the
sex of foetus to pregnant woman or to
any body
O Offence under PNDT are cognizable,
non-bailable and non compoundable
O Clients and their relatives asking for
sex determination are also punishable
Who is Appropriate
Authority under the Act?
O State Level: Additional Director (Family

Welfare)
O District Level: Civil Surgeon/Medical

Officer of Health
O Taluka Level: Medical Superintendent
Who can make the complaint?
O The Appropriate Authority concerned
O Any officer authorized in this behalf by the

Central Government or State Government or
the Appropriate Authority

O A person who has given notice of at least 15

days to the Appropriate Authority of the
alleged offence and of his intention to make a
complaint in the court i.e. if the Appropriate
Authority fails to take action on the complaint
made by a person, on the lapse of 15 days,
that person can directly approach the court
Common Arguments
It is choice of individual clients, what is
wrong if couple choose to have a son?
Response: Strong desire to have a son, puts
tremendous psychological pressure on women.
Obsession for boys can lead to domestic violence,
with women bearing the brunt for her inability to
produce a male child. This can also lead to
desertion and/or bigamy.
Common Arguments
By Sex selection and elimination of Girls, I would
only be increasing their value and position in
society?
Response: With declining sex ratio, practices like
polyandry, selling of brides, violence against women,
denial of their basic rights, trafficking of girls, will
increase.
Declining Sex Ratio in other states have not led to
women’s empowerment, on the other hand,
instances of violence and crime against women are
steadily increasing.
Common Arguments
Only couples with two or more daughters go for
sex selection, therefore it does not affect overall
sex ratio?

Response: This is misleading.
Had this been true, sex ratio of girls would not
have gone down drastically.
Common Arguments
It is more humane to eliminate a female foetus rather
than subjugate her to life of discrimination?

Response: By this logic, it would be justifiable to
eliminate poor & handicapped people. The girl
child is not a problem, the practice of sex
selection is a problem.
Common Arguments
As a medical professional, I am not duty
bound to talk on social issues?
Response: Are we not part of society, and are
affected by good or bad practices of society?
HOW CAN YOU IMPACT SEX
SELECTION?
 Be vigilant towards misuse of technology and

morally pressurize doctors indulging in Sex
selection
 Take initiatives to break silence around this
issue
 Stop sympathizing with perpetrators
 Counsel vulnerable couples & link with local
NGO for community support

 Value and celebrate the girl child’s life in your

family and community
 Advocate to promote positive image of girl

child
 Strictly Abide by the PCPNDT Act
All the text is taken
from Textbook of
Forensic Medicine
and Toxicology by
V.V Pillay;
http://pndt.gov.in
;
http://dit.mp.gov.
in
All images are from
google images and
edited in paint or
powerpoint itself

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Medicolegal aspects of Pregnancy, Delivery and Abortion

  • 1.
  • 2.
  • 3.
  • 4.
  • 6.
  • 7.
  • 8.
  • 9. A girl was born; it was not his child
  • 10. Medicolegal aspects of Pregnancy, Delivery and Abortion Medical Termination of Pregnancy Act Pre-Conception & Pre-Natal Diagnostic Techniques Act
  • 11.
  • 12.
  • 13.
  • 15. Civil cases O Malicious persons may allege either verbally or in writing, that an unmarried woman or widow is pregnant, in which case she would definitely vindicate herself OMG! That widow is pregnant
  • 16. Civil cases O Concealed pregnancy before marriage by a person other than lawfully wedded spouse constitutes a valid ground for divorce
  • 17. Civil cases O Duration of pregnancy assumes importance when legitimacy of a posthumous child is questioned She’s pregnant? ??Her husband died a year ago
  • 18. Criminal cases O Pregnancy is positive proof of sexual intercourse in a trial for rape
  • 19. Criminal cases O Pregnancy may be a motive for the suicide of a married or unmarried woman, or for the murder of a married woman by her husband, when it is result of an explicit relationship
  • 20. Civil-Criminal cases O Woman may feign pregnancy, termed pseudocyesis in order to O Avoid capital punishment (Sec.416 Cr.P.C) O Compel a person to marriage O Secure more maintenance in case of divorce
  • 21. Civil-Criminal cases O Superfetation – Where 2 or more pregnancies result from the fertilisation of 2 or more ova of different ovulatory periods O Superfecundation – 2 or more ova of the same ovulatory period are fertilised by separate acts of sexual intercourse with same person or 2 different persons
  • 23. Civil cases O Feigned deliveryO Claiming property of deceased husband O Child is called suppositious child Wish I could speak, I don’t think she’s mommy
  • 24. Civil cases O Affiliation cases O Woman claims O Child’s father is not her lawfully wedded husband or O Husband who subsequently divorced her O Thus, he must adopt the child as his own
  • 25. Civil cases O Contested legitimacy of child- When as a part of evidence that child was born of a particular woman and her husband We’ll prove that baby is ours
  • 26. Criminal cases O Question of delivery assumes importance in trials for O Abortion and infanticide O Concealment of a child begotten out of an explicit relationship O Affiliation case proceeding to blackmail
  • 28. Medical Termination of Pregnancy Act 1971 (Amended 1975 and 2002)
  • 29. Introduction Passed to liberalize abortions in India Decided upon the idea of saving the lives of millions of women, who would otherwise resort to criminal abortion out of desperation Legalizes abortion services De-criminalizes the abortion seeker Offers protection to medical practitioners who otherwise would be penalized under the Indian Penal Code (sections 315-316)
  • 30. Legal framework MTP Act MTP Rules MTP Regulations • lays down when & where pregnancies can be terminated • Grants the central govt. power to make rules and the state govt. power to frame regulations • lays down who can terminate the pregnancy, training requirements, approval process for place, etc. • lays down forms for opinion, maintenance of records • custody of forms and reporting of cases
  • 31. When can pregnancies be terminated? Up to 20 weeks gestation With the consent of the women. If the women is below 18 years or is mentally ill, then with consent of a guardian With the opinion of a registered medical practitioner, formed in good faith, under certain circumstances Opinion of two RMPs required for termination of pregnancy between 12 and 20 weeks
  • 32. MTP rules: Who can perform? A medical practitioner (RMP) O who has a recognized medical qualification as defined in clause (h) of section 2 of Indian Medical Council Act, 1956 O Whose name has been entered in a State Medical Register and O Who has such experience or training in Gynecology and Obstetrics as prescribed by Rules made under the Act
  • 33. MTP rules: training requirement - 1 For termination up to 12 weeks: O A practitioner who has assisted a registered medical practitioner in performing 25 cases of MTP of which at least 5 were performed independently in a hospital established or maintained or a training institute approved for this purpose by the Government
  • 34. MTP rules: training requirement - 2 For termination up to 20 weeks O A practitioner who holds a post-graduate degree or diploma in Obstetrics and Gynecology O A practitioner who has completed six months house job in Obstetrics and Gynecology O A practitioner who has at least one-year experience in practice of Obstetrics and Gynecology at a hospital which has all facilities O A practitioner registered in state medical register immediately before commencement of the Act, experience in practice of Obstetrics and Gynecology for a period not less than three years.
  • 35. MTP Act: Indications Continuation of pregnancy constitutes risk to the life or grave injury to the physical or mental health of woman Substantial risk of physical or mental abnormalities in the fetus as to render it seriously handicapped Pregnancy caused by rape (presumed grave injury to mental health) Contraceptive failure in married couple (presumed grave injury to mental health)
  • 36. MTP Act: Place for conducting MTP A hospital established or maintained by Government • OR A place approved for the purpose of this Act by a District-level Committee constituted by the government with the CMHO as Chairperson
  • 37. MTP Act amendment 2002 Decentralizes site registration to a 3-5 member district level committee chaired by the CMO/DHO Approval of sites that can perform MTPs under the act can now be done at the district level Stricter penalties for MTPs being done in a unapproved site or by a persons not permitted by the act
  • 38. Common Methods of terminating pregnancy under MTP Act Dilatation and curettege Dilatation followed by oxytocin infusion Vacuum aspiration technique Intraembryonic instillation of prostaglandins Extraembryonic instillation on hypertonic saline With drugs: Mifepristone (RU486), and Misoprostol (early pregnancy) Hysterotomy (after 12-14 weeks)
  • 41. MTP Regulations O MTP Regulations, 2003 consists of all the regulations: O Forms to be required for making opinion, admission register and reporting of MTPs O Custody of forms O Prevention of disclosure of information
  • 42. Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act 1994, 1996 rules, 2003 amendment
  • 43. What was the need for such an Act? O The Supreme Court, taking a serious view of the onslaught of sex-selective discriminatory practices by the medical fraternity, and the connection it may have with the use of pre-natal sex determination, directed the Centre to implement the PC & PNDT Act in all its aspects. The order came following a public interest petition filed by the centre for the Enquiry of Health and Allied Themes (CEHAT), the Mahila Sarvangeen Utkarsh Mandal (MASUM) and Dr. Sabu George, who had done extensive research in this area.
  • 45. PCPNDT Act, 2003 O To provide for the prohibition of sex selection, before or after conception O For regulation of pre-natal diagnostic techniques for the purposes of detecting abnormalities or metabolic disorders or chromosomal abnormalities or certain congenital malformations or sex-linked disorders O The prevention of their misuse for sex determination leading to female foeticide and for matters connected therewith or incidental thereto
  • 46. Salient Features O Use of PNDT only allowed on medical grounds & not for determination of sex O PNDT can be conducted only by clinics registered under the Act O No person conducting prenatal diagnostic procedure shall communicate to pregnant women or her relatives, the sex of the fetus by words or signs or any other method
  • 47. Salient Features O Clinics involved in advertisement (conducting sex determination) are liable for punishment O Declaration on each report that he/she has neither detected nor disclosed the sex of foetus to pregnant woman or to any body O Offence under PNDT are cognizable, non-bailable and non compoundable O Clients and their relatives asking for sex determination are also punishable
  • 48. Who is Appropriate Authority under the Act? O State Level: Additional Director (Family Welfare) O District Level: Civil Surgeon/Medical Officer of Health O Taluka Level: Medical Superintendent
  • 49. Who can make the complaint? O The Appropriate Authority concerned O Any officer authorized in this behalf by the Central Government or State Government or the Appropriate Authority O A person who has given notice of at least 15 days to the Appropriate Authority of the alleged offence and of his intention to make a complaint in the court i.e. if the Appropriate Authority fails to take action on the complaint made by a person, on the lapse of 15 days, that person can directly approach the court
  • 50. Common Arguments It is choice of individual clients, what is wrong if couple choose to have a son? Response: Strong desire to have a son, puts tremendous psychological pressure on women. Obsession for boys can lead to domestic violence, with women bearing the brunt for her inability to produce a male child. This can also lead to desertion and/or bigamy.
  • 51. Common Arguments By Sex selection and elimination of Girls, I would only be increasing their value and position in society? Response: With declining sex ratio, practices like polyandry, selling of brides, violence against women, denial of their basic rights, trafficking of girls, will increase. Declining Sex Ratio in other states have not led to women’s empowerment, on the other hand, instances of violence and crime against women are steadily increasing.
  • 52. Common Arguments Only couples with two or more daughters go for sex selection, therefore it does not affect overall sex ratio? Response: This is misleading. Had this been true, sex ratio of girls would not have gone down drastically.
  • 53. Common Arguments It is more humane to eliminate a female foetus rather than subjugate her to life of discrimination? Response: By this logic, it would be justifiable to eliminate poor & handicapped people. The girl child is not a problem, the practice of sex selection is a problem.
  • 54. Common Arguments As a medical professional, I am not duty bound to talk on social issues? Response: Are we not part of society, and are affected by good or bad practices of society?
  • 55. HOW CAN YOU IMPACT SEX SELECTION?  Be vigilant towards misuse of technology and morally pressurize doctors indulging in Sex selection  Take initiatives to break silence around this issue  Stop sympathizing with perpetrators  Counsel vulnerable couples & link with local NGO for community support  Value and celebrate the girl child’s life in your family and community  Advocate to promote positive image of girl child  Strictly Abide by the PCPNDT Act
  • 56. All the text is taken from Textbook of Forensic Medicine and Toxicology by V.V Pillay; http://pndt.gov.in ; http://dit.mp.gov. in All images are from google images and edited in paint or powerpoint itself