Introduction 

The Medical Termination of Pregnancy Act, 1971, was enacted as a breakthrough legislation to reduce unsafe illegal abortions and maternal mortality in India. With advances in ultrasonography and genetic technologies enabling diagnosis of foetal malformations and genetic disorders after 20 weeks of gestation, the need for legislative reform became evident. The MTP (Amendment) Act, 2021, which became law on March 25, 2021, addresses these contemporary challenges while balancing women's reproductive rights with medical safety and ethical considerations. This progressive legislation aims to provide universal access to comprehensive reproductive health services on therapeutic, eugenic, humanitarian, and social grounds. 

Historical Context and Pre-MTP Era 

• The journey of abortion laws in India can be traced back to the colonial era when the British-era Indian Penal Code, 1860 (IPC) criminalized abortion, considering it a serious offence except when done to save the life of the mother. 
• Section 312 of IPC declared abortion as culpable homicide under Sections 312-316, with imprisonment for three or more years and/or fine. Section 312 still criminalizes causing miscarriage, if such miscarriage be not caused in good faith for the purpose of saving the life of the woman. 
• The only exception was abortion performed to save the woman's life, leading to countless deaths from unsafe illegal abortions. 
• Abortion was not legal in India until 1971 when the Medical Termination of Pregnancy Act, 1971 (MTP Act) was enacted, marking a turning point in the legal stance on abortion. 
• The combination of high maternal mortality and increasing population pressure necessitated legislative reform in 1971. 

Medical Termination of Pregnancy Act, 1971 - Original Framework 

• The MTP Act was enacted to provide a legal framework for the termination of pregnancies and to address the health risks associated with unsafe abortions. 
• Section 3 originally permitted termination by registered medical practitioners up to 12 weeks based on one doctor's opinion, and up to 20 weeks based on two doctors' opinions. 
• The Act contains 8 Sections and mentions that pregnancy can be terminated by a registered medical practitioner only. 
• Termination of pregnancy by a person who is not a registered medical practitioner is a punishable offence. 
• The Act allowed for termination of pregnancies up to 20 weeks under specific conditions: when the pregnancy poses a risk to the mother's life or physical or mental health, in cases of fetal abnormalities, and if the pregnancy is a result of rape or contraceptive failure. 
• Section 4 mandated termination only by qualified registered medical practitioners in approved facilities. 
• The 2002 amendment allowed termination of up to 20 weeks to facilitate better implementation and increased access, especially in rural areas. 

MTP (Amendment) Act, 2021 - Comprehensive Reforms 

In 2021, the Indian government took a significant step by introducing amendments to the MTP Act. The proposed amendments sought to increase the gestational limit for abortion from 20 to 24 weeks, providing women with more flexibility in making reproductive choices. It provided benefits of the statute to all women, including single and unmarried women. Along with the Amendment Act, the Central government also notified MTP (Amendment) Rules, 2021. 

Section 3 - Enhanced Termination Provisions: 

• Single Doctor Opinion: Pregnancy may be terminated by one registered medical practitioner where length does not exceed 20 weeks (increased from 12 weeks). 
• Two Doctor Opinion: Required for pregnancies exceeding 20 weeks but not exceeding 24 weeks for special categories of women. 
• Medical Board Approval: Essential for termination after 24 weeks in cases of substantial foetal abnormalities diagnosed by State-level Medical Board. 

Key Amendments under Section 3: 

• Explanation 1: Pregnancy resulting from failure of contraceptive device or method - the anguish caused may be presumed to constitute grave injury to mental health (applies to both married and unmarried women). 
• Explanation 2: Pregnancy alleged to have been caused by rape - the anguish shall be presumed to constitute grave injury to mental health. 
• Section 3(2B): Provisions relating to length of pregnancy shall not apply where termination is necessitated by diagnosis of substantial foetal abnormalities by Medical Board. 

Special Categories for Extended Gestational Limits (20-24 weeks): 

• Rape Survivors: Including cases where pregnancy is alleged to have resulted from rape. 
• Incest Victims: Women who have suffered sexual assault by family members. 
• Minors: Pregnant girls under 18 years of age. 
• Differently Abled Women: Women with physical or mental disabilities. 
• Contraceptive Failure Cases: Both married and unmarried women experiencing contraceptive failure. 
• Vulnerable Women: Other categories as may be prescribed by rules under the Act. 

Section 5A - Confidentiality Provisions: 

• Enhanced Privacy Protection: No registered medical practitioner shall reveal the name and other particulars of a woman whose pregnancy has been terminated under this Act, except to a person authorized by law. 
• Penalty for Breach: Violation of confidentiality provisions attracts punishment with imprisonment up to one year, or fine, or both. 
• Comprehensive Protection: Ensures dignity and privacy of women seeking termination services. 

Medical Board Constitution and Functions: 

• Section 3(2C): Every State Government/Union Territory shall constitute a Medical Board for purposes of the Act. 
• Composition: Board may include specialists in obstetrics, gynaecology, paediatrics, and other relevant medical fields. 
• Powers and Functions: Exercise powers as prescribed by rules, particularly for cases involving substantial foetal abnormalities beyond 24 weeks. 
• Quick Decision Mechanism: Need for timely decisions to avoid procedural delays in critical cases. 

Punishment Provisions: 

• Section 6: Medical practitioners not complying with Act provisions face imprisonment up to 2 years or fine or both. 
• Section 7: Non-medical practitioners performing termination face imprisonment up to 7 years and fine. 
• Section 5A Violations: Breach of confidentiality provisions attracts imprisonment up to 1 year or fine or both. 

Conclusion 

• The Medical Termination of Pregnancy (Amendment) Act, 2021 marks a progressive shift in India's reproductive healthcare by extending gestational limits, including unmarried women, and addressing foetal abnormalities. It strikes a balance between reproductive autonomy and medical safety while aligning with evolving social and technological contexts. 
• Effective implementation, especially in rural areas, along with increased awareness, remains crucial for realizing its full potential. Though calls for greater autonomy persist, the Act positions India as a nation upholding women’s reproductive rights, advancing gender equality and maternal health.