POPULATION AND CONTROL

FAMILY PLANNING
 “A way of thinking and living that is adopted
voluntarily, upon the basis of knowledge, attitude
and responsible decision by individuals and couples,
in order to promote the health and welfare of the
family group and thus contribute effectively to the
social development of a country”. (WHO expert
Committee, 1971)
Objectives of the family planning:

Family planning refers to practices that help

individuals and couples to attain certain objectives:
 To avoid unwanted births

 To bring about wanted births

 To regulate the interval between pregnancies

 To control the time at which birth occur in relation

to the ages of the parent
 To determine the number of children in the family.
Scope of family planning services

 The proper spacing and limitation of

births
 Education for parenthood

 Sex education

 Screening for pathological conditions

related to reproductive system
 Genetic counseling
 Premarital consultation and examination

 Carrying out pregnancy tests

 Marriage counseling

 The preparation of couples for the arrival of

their first child
 Providing services for unmarried mothers

 Teaching - nutrition

 Providing adoption services

QUALITIES OF GOOD CONTRACEPTIVE:

 100% effective
 Free from side effects and complications
 Complete return to fertility when discontinued
 Cheap and low cost
 Long active power and easily available
 Simple to administer, requiring little or no medical
supervision
 Cultural acceptability.
HEALTH ASPECTS OF FAMILY PLANNING
 WOMEN HEALTH
Maternal mortality, morbidity of women of child
bearing age, nutritional status(wt changes, Hb level
etc), preventable complications of pregnancy and
abortion
 FOETAL HEALTH

Foetal mortality (early and late foetal death),

abnormal development
 INFANT AND CHILD HEALTH

Neonatal, infant and pre-school mortality health of

the infant at birth (birth wt ) vulnerability to
diseases
 Contraceptive Methods
Broadly classified into two classes
1)Spacing methods
2)Terminal Methods
I. Spacing Methods: II. Terminal Methods
A. Barrier methods A. Male sterilization
B. Intra-Uterine devices B. Female sterilization
C. Hormonal Methods
D. Post conceptional
methods
E. Miscellaneous
:
A. Barrier Methods

Barrier or “occlusive” methods, suitable for both men

and women are available.
Aim is to prevent live sperm from meeting the ovum.
 Non contraceptive advantages:
 Protection from STDs
 Reduction in the incidence of PID
 Protection from risk of cervical cancer
 i) PHYSICAL METHODS
1. Condom:

 Commonly used barrier device by males.

 Thin sheaths made of rubber, vinyl or natural products
 It prevents the semen from being deposited in vagina.
 Effectiveness of condom can be increased by using it in
conjunction with a spermicidal jelly.
 Trade name is “Nirodh”, a Sanskrit word
means prevention.
 Widely used in India as “Nirodh”
 Available in 3 types- dry Nirodh (sold at 25
paise for 3 pieces), Deluxe Nirodh
(lubricated condom, sold at price of Rs. 2 for
5 pieces) and Super Deluxe Nirodh (this of
thinner variety, lubricated and coloured, sold
at a price of Rs.3 for 4 pieces)
 Condoms are manufactured in India by the
Hindusthan Latex in Trivandrum and London Rubber
Industries in Chennai.

 Pregnancy rate varying from 2-3 per 100 women.

Advantages: Disadvantages:

 Easily available  It may slip or tear

 Safe and inexpensive  May cause allergy
 Easy to use, do not  May interferes with sex
require medical sensation
supervision
 Light and disposable
 No side effects
 Provide protection
against STD’s
 Is a vaginal barrier

 It was invented by a German physician in 1882 and also

known as “Dutch Cap”

 It is a shallow cup made up of synthetic rubber or plastic

material . It ranges in diameter from 5-10cm. It has a
flexible rim made up of spring or metal.

 Women should use diaphragm of proper size.

 Successful use vaginal tone
should be reasonable.

 Prevents entry of sperm

 It is inserted before sexual

intercourse and must remain in
place for not less than 6 hours
after sexual intercourse. A
spermicidal jelly is always used
along with the diaphragm.
Advantages: is almost total absence of risks and
medical contraindications.
Disadvantages:
 Trained person will be needed initially to
demonstrate the technique.
 After delivery, can be used after involution of the
uterus is completed.
 Privacy needed to insert.
 If the diaphragm is left in vagina for an extended
period can lead to toxic shock syndrome.

 Failure rate is 1.9 per 100 women.

 Small polyurethane foam sponge
measuring 5cm x 2.5cm
 Saturated with spermicide, nonoxynol-9
 Commercially marketed in USA as trade
name “TODAY”
 Less effective than diaphragm
4. Cervical cap
 5. Female Condom:
 A pouch made of polyurethane which
lines the vagina
 Internal ring – close end – covers the
cervix
 External ring remains outside the
vagina
 Pre lubricated with silicone
 Advantages :- effective barrier to STD
infections
 Disadvantages:- high cost and
acceptability less
 ii) CHEMICAL METHODS
They are comprise in four categories:

 Foam

 Creams, jelly and pastes

 Suppositories

 Soluble films

Spermicides are “surface –active agents” which attach

themselves to spermatozoa and inhabit oxygen uptake and
kill sperms.
Demerits of chemical methods
 They have high failure rate

 They must be used almost immediately before

intercourse and repeated before each sex.

 They must be introduced into those regions of vagina

where sperms are likely to deposited.

 Cause mild burning or irritation

 Carcinogenic effect to vaginal skin or cervix

iii) Combined

 Combination of physical and chemical

methods
 Eg: ……….
Intra uterine device
 Types
 Mechanism of action of IUDs
 Change of IUD
 Advantages of IUDs
 Contraindications
 The ideal IUD candidate as a woman
 Timing of insertion
 Follow up
 Side effects and complications
 Medicated
 Non-medicated
 Inert IUDs
 They are first generation IUD’s
 Has different shapes-loops, spirals, rings
 Example- lippes loop
 Is double – S shaped
 Made of polyethylene, a plastic material that is
non-toxic, non tissue reactive and extremely
durable.
 Contains little barium sulphate to allow x-ray
observation
 Has attached threads or “tail” made of nylon
 It exist in four sizes A, B, C and D (A – large size)
 Side effects and expulsion rate was high-now
outdated.
 Bio-active IUD’s

It consist of:-

 2ND generation IUD’s (release metal ions-

copper) - Eg: COPPER-T
 3RD generation IUD’s (release hormones) -
Eg: Progestasert, Levonorgestrel)
 It is a small T-shaped flexible device,
 It releases copper ions which has anti-
fertility effect.
Earlier device
- Copper-7
- Copper T-200
Newer devices
 T Cu -220C
 T Cu-380
 Nova T
 Multiload devices – ML-Cu-250, ML-Cu-375
(more effective and effective life for 5 years)
 They are third generation IUDs
 Based on the principle of release of
hormones
 It is T-shaped Device
 It releases progesterone hormone at the
rate of 65gm daily.
 Direct local effect on the uterine lining ,
cervical mucus
Levonorgestrel / Mirena

 Another hormonal device LNG-20

(Levonorgestrel) is a T shaped IUD
releasing 20gm of levonorgestrel daily.
This is effective for 3-5 yrs.
IUD causes a foreign body reaction in the
uterus causing cellular and biochemical
changes in the endometrium and uterine
fluids and it is believed that these changes
impair the viability of gamete and thus
reduces its chances of fertilization and
implantation.
 Copper ions may affect sperm motility
and survival.

 Hormone releasing devices increases

the viscosity of the cervical mucus and
there by prevent sperm from entering
the cervix and level of progesterone
makes an endometrium unfavorable for
implantation.
 CHANGE OF IUD
 Development of side effect

 Occurrence of pregnancy

 PID

 Perforation of uterus

 Partial expulsion of IUD

 Life span of the IUD has passed

 When women reaches menopause

Change of IUD
 TCu -380 – for 10 years

 TCu-200 – for 4 years

 Nova T – for 5 years

 Progestasert – 1 to 2 years

 Levonorgestrol – for 10 years

 Advantages of IUDs

 Simplicity
 Insertion takes only a few minutes
 Once inserted IUD stays in place as long as
required
 Inexpensive
 Contraceptive effect is reversible
 Free of side effects when we compare with
hormonal pills
 CONTRAINDICATIONS
Absolute:
 Suspected pregnancy
 Pelvic inflammatory disease
 Vaginal bleeding
 Cancer of the cervix
 Previous ectopic pregnancy
RELATIVE:

 Anaemia
 Menorrhagia
 History of PID
 Purulent cervical discharges
 Distortions of the uterine cavity
 Unmotivated person
 The ideal IUD candidate as a woman:

 Who has borne at least one child

 Has no history of pelvic disease

 Has normal menstrual periods

 Is willing to check the IUD tail

 Has access to follow up

 Is in monogamous relationship
 Timing of insertion:

 The most ideal time for loop insertion

is during menstruation or within
10days of the beginning of a
menstrual period.
 The convenient time for loop insertion is
6-8 weeks after delivery (post
puerperal or postpartum insertion).
 Post abortion insertion: insertion of
IUD after 12 weeks after abortion.
Follow- up: After first menstrual period, after
third menstrual period, thereafter 6months or 1
year.

Objectives:
 To provide motivation and emotional support
 To confirm the presence of IUD
 To diagnose and treat the side effect or
complications
 Side effects and complications

 Bleeding
 Pain

 Pelvic infection

 Uterine perforation

 Pregnancy

 Ectopic pregnancy

 Expulsion

 Cancer

 Mortality.
3. Hormonal Contraceptives

Hormonal contraceptives are the most

effective, safe, easy and reversible
contraceptive for the young woman
wanting to delay her first pregnancy
or space the next child.
CLASSIFICATION:

A. Oral Pills
1. Combined pill
2. Progestogen only pill (POP)
3. Post coital pill
4. Once a month (long acting ) pill
5. Male pill
B. Depot (slow release) formulations
1. Injectables
2. Subcutaneous implants
3. Vaginal ring
 A. ORAL PILLS

1. Combined pill:
At present time combined pills contain 30-35mcg of
synthetic oestrogen and 0.5-1.0 mg of
progestogen.
The pills are available under two brands- MALA-N
and MALA-D.
It contains 28 pills ( 21 of oral contraceptive and 7
brown coated iron tablets).
 Mala-N:-
 contains Levonorgesterol 0.15mg and
Ethiniloestradiol 0.03mcg
 package of 28 pills
 is supplied free of cost at PHC’s

Mala-D :-
 contains Levonorgesterol 0.15mg and
Ethiniloestradiol 0.03mcg
 package of 28 pills (21- oral contraceptive pills
and 7 Brown film coated 60 mg ferrous fumarate
tabs)
 available in market at the rate of Rs.2
 Given orally for 21 days
 Beginning on the 5th day of menstrual
cycle
 A break of 7 days during menstruation
 Emergency Contraception

 Is recommended within 72 hrs of

unprotected sex, rape, contraceptive failure

 First tablet - 0.75mg of levonorgestrel with

in 72hours and second tablet after 12hrs of
first dose.
 Referred As “Minipill” Or
“Micropill”
 Contains Only Progesterone
 Commonly used are:
Norethisterone ,
Levonorgesterol
 It is long lasting pill
 Long-acting oestrogen is given in
combination with short-acting
progresterone
 Example- Quinesterol
 Made of gossypol- a derivative of
cotton-seed oil
 Ideal male contraceptive would
decrease the sperm count while
leaving the testosterone at normal
levels
 Preventing spermatogenesis
 Interfering with sperm storage and
maturation
 Preventing sperm transport in the vas
 Affecting the constituents of the seminal
fluid
MODE OF ACTION OF ORAL PILLS
 Prevent the release of the
ovum from the ovary – by
blocking the pituitary secretion
of gonadotropin (for
ovulation)

 POP – render cervical mucus

thick and scanty -> inhibit
sperm penetration, also inhibit
tubal motility and delay the
transport of the sperm and the
ovum to the uterine cavity
Adverse effects

 Cardiovascular defects

 Risk for developing cervical cancer

 Metabolic effects – elevation of BP, alteration

in serum lipids, elevation in blood glucose and
plasma insulin
 Liver disorders

 Ectopic pregnancy

 Breast tenderness

 Weight gain

 Bleeding disturbances- miss the tablet

 Headache and migraine

ABSOLUTE
 Cancer of the breast and
genitals
 Abnormal uterine bleeding
 H/O thromboembolism
 Cardiac abnormalities
SPECIAL PROBLEMS
 Age over 40 yrs
 Smoking
 Mild HTN
 Epilepsy
 migraine
 Nursing mothers in first 6
months
 Amenorrhoea
 Chronic renal disease
 Hyperlipidemia
 Hypertension and DM
 Gall bladder disease
Advantages of OCP:
 Very effective when used
correctly
 Can be used at any age
 Fertility returns
 Prevents cancer and PID
 Easy to use
Disadvantages of OCP:
 Do not protect from STD
 Side effects and
complications
 Must be taken daily
 3. HORMONAL CONTRACEPTIVE

A. Oral Pills
1. Combined pill
2. Progestogen only pill (POP)
3. Post coital pill
4. Once a month (long acting ) pill
5. Male pill
B. Depot (slow release) formulations
1. Injectables
2. Subcutaneous implants
3. Vaginal ring
 B. Depot formulations (Slow
release formulations)
Three category:
1. Injectable contraceptives
2. Subcutaneous implants
3. Vaginal rings
 Depot formulations are highly
effective, long acting, reversible
and oestrgen free for spacing the
pregnancies.
1. Injectable Contraceptive
 Progestogen only injectable

- DMPA

- NET-EN

- DMPA-SC 104 MG

 Combined injectable contraceptives

DMPA (Depot-Medroxyprogesterone
Acetate)

Dose- 150mg, I.M every 3months

Safe, effective, acceptable
Minimum motivation
No affect on lactation
Action same as oral pills
NET-EN (Norethisterone enantate)
 Dose 200mg I.M every 60 days
 Both DMPA and NET-EN should be
given during the first 5 days of
menstrual period.
MERITS:

 Safe, effective, convenient and reversible.

 Long term pregnancy prevention.

 Does not interfere with sex, lactation

 Does not contain oestrogen

 Can be used by women of any age

 Prevent ovarian cancer

 Helps to prevent ectopic pregnancies.

Demerits:

 Menstrual cycles become irregular

 Changes in bleeding

 May cause weight gain 1-2kg per year

 Delayed return of fertility by 4-6 months.

 Injection to be taken once in 2-3 months

 May cause headache, breast tenderness,

mood changes.
 Contain both progestogen and an
oestrogen
Given at monthly interval
Eg. Cyclofem/cyclo-provera and Mesigyna
Contra Indications: Suspected pregnancy,
thromboembolic disorder, coronary artery
disease, breast cancer, diabetes, breast
feeding mothers.
Eg : Norplant
 NORPLANT

 Norplant is a long term contraceptive

 Contains 6 silicon capsules containing 35mg
each of levonorgestrel.
 Now available Norplant (R) -2 small rods.
 Inserted beneath the skin of forearm or upper
arm
 Start functioning within 24 hrs.
 Contraceptive for 5 years
Main Disadvantages:

irregularities in menstrual bleeding and

surgical procedures necessary to insert

and remove implants.

 3. Vaginal Rings

•Containing levonorgesterl
•Hormone slowly absorbed through
the vaginal mucosa
•The ring is worn in the vagina for 3
weeks of the cycle and removed for
the fourth.
 Menstrual regulation
 Menstrual induction
Menstrual regulation
 It consists of aspiration of the
uterine contents 6 to 14 days of
missed period.
 Immediate complications are
uterine perforation and trauma.
 Late complications include
premature labor, infertility,
menstrual disorders, ectopic
pregnancy, abortion
Menstrual induction

 This is based on disturbing the normal

progesterone – prostaglandin balance
by intrauterine application of 1-5 mg
of prostaglandin F2. Within a few
minutes of the prostaglandin impact,
performed under sedation, the uterus
responds with a sustained contractions
continuing for 3-4 hours. The bleeding
starts and continues for 7-8 days.
Oral abortifacient
 Mifepristone (RU 486) cominbation with misoprostol
is 95% successful in terminating pregnancies of upto
9 wks duration
 Regime (I) :- day 1- mifepristone 200mg orally
followed by misoprostol 800 mcg vaginally either
immediately or within 6-8 hrs
 Regime (II) :- mifepristone 600mg on day 1
followed by misoprostol 400 mcg orally on day 3
 .
1 Abstinence
2. Coitus interruptus
3. Safe period
4. Natural family planning methods
5. Breast feeding
6.Birth control vaccines
Coitus interruptus
 Old method of voluntary fertility control.
 It is widely practised method.

 The males withdraws before ejaculation,

and tries to prevent deposition of semen
into the vagina.
 Failure rate may be high as 25 percent

(withdrawal may lead to the deposition of

a certain amount of semen)
Safe period

 Rhythm method or Calendar method

 The shortest cycle minus 18 days gives the
first day of fertile period.
 The longest cycle minus 10 days gives the
last day of fertile period.
For example:

 If a woman’s menstrual cycle varies from

26 to 31 days, the fertile period during
which she should not have intercourse
would be from the 8th day to 21st day of
the menstrual cycle, counting day one as
the first day of the menstrual period
 26-18= 8

 31-10 =21
For example:
Drawbacks

 Woman’s menstrual cycles are not regular

 High degree of motivation is required
 Method is not applicable in postnatal
period
 Compulsory abstinence of sexual
intercourse for nearly one half of every
month
Natural family planning methods

A) Basal body temperature method (BBT)

B) Cervical mucus method ( Billings
method or Ovulation method)
C) Symptothermic method
Basal body temperature method
(BBT)
 At the time of ovulation, as a result of an increase in the
production of progesterone.

 Rise of temperature is very small, 0.3 to 0.5 degree C.

 The temperature is measured preferably before getting

out of bed in the morning.
Cervical mucus method ( Billings
method or Ovulation method)
 This method is based on the observation of changes
in the characteristics of cervical mucus.

 At the time of ovulation, cervical mucus becomes

watery clear resembling raw egg white, smooth,
slippery.

 After ovulation under the influence of progesterone

, the mucus thickens and lessens in quantity.
Symptothermic method

 Combination of calendar techniques,

temperature and cervical mucus.
Breast feeding

 Lactation prolongs postpartum

amenorrhoea and provides some degree
of protection against pregnancy.
Birth control vaccines

 Immunization with hCG (human chorionic

gonadotropin) would block the
continuation of pregnancy. The immunity
can be boosted by a second injection.
B.TERMINAL METHODS ( STERILIZATION):

 Also called as permanent method.

 Procedure for couples desiring no more
children
Advantages:
 One- time method

 Does not required sustained motivation

 Effective protection against pregnancy

 Risk of complications are less

 Cost effective
Guidelines for sterilization:

 Age of the husband should not be less than 25years

nor should it be over 50years.
 The age of wife should not be less than 20 years or
more than 45 years.
 Couples must have two living children at the time of
operation
 If the couples has 3 or more children, the lower limit
of the age of the husband or wife may be relaxed at
the discretion of the operating surgeon
 Obtain the consent
 A. Male sterilization

 Vasectomy is simpler, safe, effective, faster,

less expensive operation (cost effective).
 Removal of piece of vas (1cm) under local
anesthesia, under aseptic technique by
trained doctor.
 Acceptor is not immediately sterile after
the operation, until approximately 30
ejaculations have taken place
 Following vasectomy sperm production
and hormone output are no affected.
Post operative advice:

 To use contraceptive until aspermia has been

established
 To avoid taking bath atleast 24 hours after
operation
 To wear T- bandage for 15 days
 To keep the site clean and dry
 To avoid cycling or lifting heavy weight for 15
days
 No need for complete bed rest
 To have the stitches removed on the 5th day after
operation.
Merits of male sterilization

 Simple, safe, highly effective,

permanent
 Less expensive compared to tubectomy
 Does not require hospitalization
 Can be done clinic or PHC
Complications:

1. Operative – pain, scrotal

haematoma and local infection
2. Sperm granules
3. Spontaneous recanalization
4. Autoimmune response
5. Psychological- headache, fatigue
 B. FEMALE STERLIZATION

Laproscopic


Minilap operation

 Laparoscopy:

 Is a technique through abdominal approach

 Abdomen is inflated with gas (CO2,N2O, or
air) and the instrument is introduced into the
abdominal cavity to visualize the tubes
 Once the tubes are accessible the Falope rings
or clips are applied to occlude the tubes.
 Should be carried out by expert.
Avantages are:
 It is simple/small incision
 Easy to perform
 Done in a short time
 Hospitalization is limited
 Scar will not be visible
Patient selection:

 Not advisable for postnatal mother for 6 weeks

after delivery.
 Can be done as a concurrent procedure to MTP.
 Haemoglobin should not be less than 8%.
 Free from any associated medical illness like heart
disease, HTN, DM, respiratory diseases.
 Patient should be kept in hospital for minimum 48
hours.
Follow up by the health personnel
 Between 7- 10 days after operation

 And 12 – 18 months after operation.

Complications:
 Puncture of internal organ
 Minilaparotomy operation:

 It is a modification of abdominal tubectomy

 Incision size 2.5-3cm
 Conducts under local anaesthesia
 The tube is blocked by removal of small piece of the
tubes on both sides.
 After operation should not carry heavy work for
atleast one month
 Should take adequate rest
 She can resume sexual intercourse when feels well
enough.
1) Barrier methods
1) Physical
- Condom
- Diaphragm

- Vaginal sponge

2) Chemical
- Foams

- Creams, jellies, pastes

- Suppositories

- Soluble films

3) Combined
 2) IUD’s
- First generation IUD’s (non medicated / inert
IUD’s)
Eg: Lippes loop
- Second generation IUD’s (medicated /

Bioactive IUD’s - metal ions)

Eg: Copper T
- Third generation IUD’s (medicated / Bioactive

IUD’s – Hormone releasing )

Eg: Progestasert
Levonorgestreal (LNG-20/ Mirena)
 3. Hormonal Contraceptive
A. Oral Pills
1. Combined pill
2. Progestogen only pill (POP)
3. Post coital pill
4. Once a month (long acting ) pill
5. Male pill
B. Depot (slow release) formulations
1. Injectables
2. Subcutaneous implants
3. Vaginal ring
 Menstrual regulation
 Menstrual induction
 .
1 Abstinence
2. Coitus interruptus
3. Safe period
4. Natural family planning methods
5. Breast feeding
6.Birth control vaccines
Evaluation of contraceptive methods:
 Contraceptive efficacy is generally
assessed by measuring the number of
unplanned pregnancies that occur during
a specified period of exposure and use of
contraceptive method
Methods of evaluation:
 Pearl index

 Method failure

 User failure
 The Pearl index is defined as the number of “failure
per hundred woman per years of exposure (HWY)”.
Total accidental pregnancy
Failure of HWY= x1200
Total months of exposure

1200 means number of months in 100 years

 Unmet need for family planning:
 First explored in 1960s

 Many women who are sexually active

would prefer to avoid becoming
pregnant, but nevertheless are nor using
any method of contraception these
women are considered to have an
“unmet need” for family planning.
Reasons for unmet are:
 Inconvenient or unsatisfactory services

 Lack of information

 Fears about contraceptive side effect

 Opposition from husband or relatives.

Eligible couples

 Refers to a currently married couple

where the wife is in the reproductive
age , which is generally assumed to lie
between the ages of 15 – 45.
Target couples

 It refers to couples who have had 2 -3

children, and family planning was
largely targeted to such couples.
Couple protection rate (CPR)

 Defined as the percent of eligible

couples effectively protected against
childbirth by one or the other approved
methods of family planning like
sterilization, IUD’s, condom or pills.
 Theortically defined as termination of pregnancy
Before the fetus becomes viable (capable of
living independently)
 Fixed administratively at 28 wks, when fetus wt
appox 1000g
 Categorized as spontaneous

induced
Abortion hazards
 Early complications :
 haemmorrhage
 Shock
 Spesis
 Uterine perforation
 Cervical injury
 Thromboembolism
 Anaesthetic and psychiatry complications
 Late complications :
 Infertility
 Ectopic gestation
 Increased risk of spontaneous abortion
 reduced birth wt
MTP ACT
 The act was passed in the year 1971
 Health care measure which helps to reduce
maternal morbidity and mortality resulting from
illegal abortions
 Its lays down :
1) The conditions under which the pregnancy can
be terminated
2) The person or persons who can perform such
terminations
3) The place where such terminations can be
performed
The conditions under which the pregnancy
can be terminated
 Medical – endanger the mother’s life
 Eugenic – risk of the baby being born
 Humanitarian- where pregnancy is the result of
rape
 Socioeconomic- socio or economic environments could
lead to risk of the injury to the health of the mother
 Failure of contraceptives
The person or persons who can perform
such terminations

 Registered medical practitioner having experience in

gynaecology and obstetrics to perform abortion
where as the length of the pregnancy should not
exceed 12 weeks.

 If exceeds 12 weeks , suggestions from 2 medical

practitioner is required.
 A post graduate qualification in OBG

 3 years experience in OBG for those doctors

registered before 1971 MTP Act

 1 year experience in OBG for those doctors

registered on or after the commencement of 1971
MTP Act
The place where such terminations can
be performed

 Hospital established or maintained by

government or a place approved by the
purpose of this act by government.
MTP RULES

 Rules and regulations framed initially

were altered in October 1975 to
eliminate time-consuming procedures
involved in MTP and to make services
more readily available
 MTP RULES
 3 administrative areas:
1. Approval by board: chief medical officer of district is empowered to
certify that a doctor has the necessary training in gynecology and
obstetrics to do abortion
2. Qualification required to do abortion :
 Assisted RMP in 25cases
 6months housemanship in OBG
 PG in OBG
 3 yrs of practice in OBG for those who registered before 1971 MTP
act
 1 yr practice in OBG for those registered on or after the date of
commencement of the Act

3. The place where abortion is performed : non govtal institutions also – licence
from CMO of district
Impact of liberalization of abortion
 Amendment of MTP 2003 includes decentralization of
power for approval of places as MTP centres- aims- to
enlarge the network of safe MTP centres, MTP services
providers
 Strategy at community level:
a) Spread awareness
b) Enhance access to confidential counselling for safe MTP
;through train ANMs, AWWs link workers/ASHA
c) Promote post abortion care
 Facility level
a) To provide manual vacuum aspiration facility at all CHCs and
PHCs strengthened for 24hr deliveries
b) Comprehensive high quality MTP services at all FRUs
c) Encourage pvt and NGO sectors to establish quality MTP
services