Mtp act

MTP ActMTP ActADVANCES IN MEDICAL SCIENCEADVANCES IN MEDICAL SCIENCE

Consequent Short comingsConsequent Short comings& &

Suggestion on ImprovementSuggestion on Improvement

Dr. Avinash BhondweDr. Avinash Bhondwe

President,President,

IMA, PuneIMA, Pune

GOOD ThingsGOOD Things

The The MTP ActMTP Act aims to regulate and ensure aims to regulate and ensure access to access to safe abortion caresafe abortion care and defines and defines ‘when’ ‘where’ and under ‘what’ conditions ‘when’ ‘where’ and under ‘what’ conditions abortion is permissible.abortion is permissible.

The recent amendment to The recent amendment to decentralisedecentralise regulation of abortion care to the district regulation of abortion care to the district

level serves to encourage registration of level serves to encourage registration of abortion facilities by minimising abortion facilities by minimising administrative delays administrative delays

MTP Act: ShortcomingsMTP Act: Shortcomings

MTPMTP ActAct permits women seek legal permits women seek legal

termination of an unwanted pregnancy for atermination of an unwanted pregnancy for a

wide range of reasons, the clause aboutwide range of reasons, the clause about

contraceptive failurecontraceptive failure applies only to applies only to marriedmarried

woman. This discrepancy needs to be woman. This discrepancy needs to be corrected corrected

Fast changing Social Culture & Scientific Fast changing Social Culture & Scientific developments have not been thought of.developments have not been thought of.

MTP Act: ShortcomingsMTP Act: Shortcomings

The default recognition of all public healthThe default recognition of all public health institutions as abortion facilities also impliesinstitutions as abortion facilities also implies the responsibility of the government to makethe responsibility of the government to make each public health institution each public health institution capable ofcapable of providingproviding abortion care and hence makes abortion care and hence makes

the statethe state accountable accountable for it. for it.

The training of The training of Non-MedicalNon-Medical & common but & common but educated people has to be plannededucated people has to be planned

MTP Act: ShortcomingsMTP Act: Shortcomings Another major critique of the abortion policyAnother major critique of the abortion policy is its lack of a is its lack of a link with good clinical link with good clinical

practicepractice and research. and research.

The The MTPMTP Rules define ‘person’ Rules define ‘person’ and ‘place’ requirements, but do not refer toand ‘place’ requirements, but do not refer to any any national or international technicalnational or international technical guidelinesguidelines for safe abortion care, in view of for safe abortion care, in view of

rapid scientific advancesrapid scientific advances

MTP Act: ShortcomingsMTP Act: Shortcomings

‘‘MTP” providers continue to use unsafe MTP” providers continue to use unsafe abortion practices like abortion practices like sharp curettage, sharp curettage, check curettagecheck curettage following a vacuum following a vacuum aspiration, general anesthesia, aspiration, general anesthesia, different drug different drug dosage schedulesdosage schedules and protocols for medical and protocols for medical abortion, etc. abortion, etc.

The scope of an abortion policy needs to be The scope of an abortion policy needs to be broad enough to internalize broad enough to internalize emerging emerging advances in reproductive technologyadvances in reproductive technology and and newer practices within the legal framework.newer practices within the legal framework.

MTP Act: ShortcomingsMTP Act: Shortcomings Comprehensive abortion care is integral to abortion Comprehensive abortion care is integral to abortion

services. This includes providing services. This includes providing pre-and post-pre-and post-counseling servicescounseling services for contraception, STI and HIV for contraception, STI and HIV counseling and voluntary testing, extended care up counseling and voluntary testing, extended care up to to six weekssix weeks after abortion and management of after abortion and management of abortion abortion complicationscomplications. .

Covert and overt coercion for Covert and overt coercion for post-abortion post-abortion contraceptive usecontraceptive use in public institutions often in public institutions often compels women to seek unsafe abortion compels women to seek unsafe abortion elsewhere. elsewhere.

Abortion policy also needs to explicitly link up with Abortion policy also needs to explicitly link up with national and national and international technical guidelinesinternational technical guidelines form form management of post-abortion complications.management of post-abortion complications.

Advances in Medical ScienceAdvances in Medical Science

Abortion Pill Abortion Pill Infertility TechniquesInfertility Techniques Developments in GeneticsDevelopments in Genetics Fetal Age for Viability Fetal Age for Viability International ScenarioInternational Scenario

Medical AbortionMedical Abortion

MTP using Mifepristrone (RU 486) & Misoprostol MTP using Mifepristrone (RU 486) & Misoprostol approved for up to 7 weeks terminationapproved for up to 7 weeks termination

Only an RMP (as defined by the MTP Act) can Only an RMP (as defined by the MTP Act) can prescribe the drugsprescribe the drugs

Has to follow MTP Act, Rules & RegulationsHas to follow MTP Act, Rules & Regulations Can prescribe in his/her clinic, provided he/she Can prescribe in his/her clinic, provided he/she

has access to an approved placehas access to an approved place Should display a certificate from owner of Should display a certificate from owner of

approved place agreeing to provide accessapproved place agreeing to provide access

Abortion PillAbortion Pill A medical abortion- taking a drug or a A medical abortion- taking a drug or a

combination of drugs orally, intramuscularly combination of drugs orally, intramuscularly and/or vaginally to terminate a pregnancy. and/or vaginally to terminate a pregnancy.

Combinations of Combinations of Mifepristone Mifepristone along with along with

MisoprostolMisoprostol are used after confirming that a are used after confirming that a woman is pregnant. woman is pregnant.

The drugs are considered quite effective in the The drugs are considered quite effective in the early stage of pregnancy early stage of pregnancy

Newer and recent research does indicate that the Newer and recent research does indicate that the drugs are effective almost up to the end of the first drugs are effective almost up to the end of the first trimester pregnancy.trimester pregnancy.

Table 1: Abortifacients Available with Chemists #

Drugs and Pharmaceutical

Company

Dosage MRP Rs.

Mifepristone Tablets

1 Mifegest (Zydus Alidac Ltd.)

1 325.50

2 Mifeprine (Sun Pharma)

1 325.50

3 MT Pill (Cipla Ltd.)* 3 930.00

4 Mifyron (German Remedies)

1 325.00

Misoprostol Tablets

1 Cytolog 100 (Zydus Alicac Ltd.)

4 31.00

2 Cytolog 200 (Zydus Alidac Ltd.)

4 60.00

3 Zitotec 200 (Sun Pharma)

2 30.50

4 Misoprost 100 (Cipla Ltd.)

4 31.00

5 Misoprost 200 (Cipla Ltd.)

4 60.00

6 Misogon 4 60.00

Sr.No. Brand Type Dosage MRP for the recommended dosage in Rs.

1 EP Forte (EN PA Forte) (Subina

Pharmaceuticals, Indore, MP)

Ayurvedic 3 14.00

2 CVK Forte Ayurvedic 6 30.00

3 Reglum Ayurvedic 10 50.00

4 Gynaforte Ayurvedic 3 50.00

5 CVP Forte (Sterling Lab, Hosur, TN)

Ayurvedic 10 110.00

6 Gynec Forte (Ankit Pharmaceuticals, Ahmedabad, Gujarat)

Ayurvedic 10 50.00

Sr.No. Brand Type Dosage MRP for the recommended dosage in Rs.

7 Gynolate Forte Ayurvedic NA NA

8 CV Forte (Ankit Pharmaceuticals, Ahmedabad, Gujarat)

Ayurvedic 6 15.00

9 Dyenaforte Ayurvedic 10 50.00

10 NK Capsule Ayurvedic 2 15.00

11 Emppea (Rekvina Pharmaceuticals)

Allopathic 10 45.00

12 Duibogen (Unichem

Laboratories Ltd.)

Allopathic 10 47.00

13 Megestone (Wyeth Health Care)

Allopathic 10 38.00

MTP Act: ShortcomingsMTP Act: Shortcomings

A recent survey in Gujrath Shows Chemists A recent survey in Gujrath Shows Chemists have been prescribing ‘have been prescribing ‘Abortion PillsAbortion Pills' more ' more than doctors.than doctors.

US has allowed RU468 to be sold over the US has allowed RU468 to be sold over the counter counter

What about the What about the Recognized PlaceRecognized Place?? What about the What about the trained or authorized trained or authorized

Doctor?Doctor?

MTP rules: Who can perform?MTP rules: Who can perform?

A medical practitioner (RMP) A medical practitioner (RMP) – who has a recognized medical qualification as who has a recognized medical qualification as

defined in clause (h) of section 2 of Indian defined in clause (h) of section 2 of Indian Medical Council Act, 1956Medical Council Act, 1956

– Whose name has been entered in a State Whose name has been entered in a State Medical Register and Medical Register and

– Who has such experience or training in Who has such experience or training in Gynecology and Obstetrics as prescribed by Gynecology and Obstetrics as prescribed by Rules made under the ActRules made under the Act

MTP Act: ShortcomingsMTP Act: Shortcomings

The doctors have been prescribing to the The doctors have been prescribing to the patients more than 7 weeks pregnant up to patients more than 7 weeks pregnant up to 14 weeks14 weeks

Limits set by MTP Act?Limits set by MTP Act? Dosages? Doctors know it can be given per Dosages? Doctors know it can be given per

vaginally after 7 weeks to induce abortions.vaginally after 7 weeks to induce abortions.

MTP Act: ShortcomingsMTP Act: Shortcomings

More than 7 weeks Patient presents as More than 7 weeks Patient presents as Natural Incomplete Abortion and gets Natural Incomplete Abortion and gets treated by the Obstetrician-treated by the Obstetrician-

Dosages?Dosages? Abortion or preterm labour?Abortion or preterm labour? MTP Act Nowhere.MTP Act Nowhere.

Partial Birth AbortionPartial Birth Abortion

An An abortionabortion in which the person performing the in which the person performing the abortion, deliberately and intentionally vaginally abortion, deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside first presentation, the entire fetal head is outside the body of the mother, or, in the case of breech the body of the mother, or, in the case of breech presentation, any part of the fetal trunk past the presentation, any part of the fetal trunk past the navelnavel is outside the body of the mother, for the is outside the body of the mother, for the purpose of performing an overt act that the person purpose of performing an overt act that the person knows will kill the partially delivered living fetus; knows will kill the partially delivered living fetus; and performs the overt act, other than completion and performs the overt act, other than completion of delivery, that kills the partially delivered living of delivery, that kills the partially delivered living fetus. fetus.

What is Infertility treatment?

Case 1Case 1

32 years old woman seeks Gynecologist’s 32 years old woman seeks Gynecologist’s treatment for treatment for Infertility by IVFInfertility by IVF

After treating for few months woman gets pregnant After treating for few months woman gets pregnant with with quadrupletsquadruplets

Gynecologists decides unless 3 embryos are Gynecologists decides unless 3 embryos are ‘‘selectively killedselectively killed’ and one embryo is allowed to ’ and one embryo is allowed to develop, a viable pregnancy would not occurdevelop, a viable pregnancy would not occur

After the After the selective reductionselective reduction the dead embryos the dead embryos would be absorbed in the mother’s body and they would be absorbed in the mother’s body and they would not be would not be expelledexpelled from uterus from uterus

Case 1Case 1

Don’t you think the Don’t you think the Selective ReductionSelective Reduction causes encroachment of the MTP act ?causes encroachment of the MTP act ?

Should it be included in the act?Should it be included in the act? Is it necessary to take Is it necessary to take mother’s permissionmother’s permission?? What if she does not agree?What if she does not agree?

Genetics ResearchGenetics ResearchMedical geneticsMedical genetics interventions can be interventions can be

performed in two ways. performed in two ways. First, genetic defects may be repaired (First, genetic defects may be repaired (gene therapygene therapy).).

Secondly, a possible future individual (an embryo or a Secondly, a possible future individual (an embryo or a possible combination of gametes) may be possible combination of gametes) may be preselectedpreselected because of its favourable genetic make-up (by using because of its favourable genetic make-up (by using genetic diagnostic methods and procedures from genetic diagnostic methods and procedures from reproductive medicine so called reproductive medicine so called Preimplantation Preimplantation Genetic DiagnosisGenetic Diagnosis). ).

Genetics ResearchGenetics ResearchThe first kind of intervention means that The first kind of intervention means that someone gets medical treatment in the someone gets medical treatment in the normal sense, however, normal sense, however, Second kind does not. Rather, in that Second kind does not. Rather, in that case, the potential patient is exchanged for case, the potential patient is exchanged for another individual who is in no need of another individual who is in no need of treatment. treatment.

Genetics ResearchGenetics Research Molecular biology scientists have developed a Molecular biology scientists have developed a

technique that enables parents to technique that enables parents to select the sex of select the sex of their future childtheir future child. This technique simply separates . This technique simply separates the X carrying sperms from Y carrying sperms and the X carrying sperms from Y carrying sperms and then inseminates females with the preferred sex then inseminates females with the preferred sex chromosomes. This procedure is banned in India. chromosomes. This procedure is banned in India.

Potential parents with Potential parents with sex-linked diseasessex-linked diseases may may choose to have a girl, avoiding the possibility of choose to have a girl, avoiding the possibility of having a boy with hemophilia, for example. having a boy with hemophilia, for example. Should Should sex selection for medical and non-medicalsex selection for medical and non-medical reasons be available for parents? reasons be available for parents?

Genetics ResearchGenetics Research

Pregnancy-associated plasma protein-APregnancy-associated plasma protein-A (PAPP-A) largest of the pregnancy associated (PAPP-A) largest of the pregnancy associated proteins produced by both embryo and placentaproteins produced by both embryo and placenta

( ( syncytiocytotrophoblastssyncytiocytotrophoblasts) during pregnancy ) during pregnancy This protein is thought to have several different This protein is thought to have several different

functions, including preventing recognition of the functions, including preventing recognition of the fetus by the maternal immune system, matrix fetus by the maternal immune system, matrix mineralization and angiogenesis. Levels of PAPP-mineralization and angiogenesis. Levels of PAPP-A rise from first detection in the first trimester until A rise from first detection in the first trimester until term. term.

Genetics ResearchGenetics Research

Detection of this protein is also used as a first and Detection of this protein is also used as a first and second trimester diagnostic test for Trisomy 21. second trimester diagnostic test for Trisomy 21. Down SyndromeDown Syndrome

Maternal serum concentrations are related to Maternal serum concentrations are related to subsequent fetal growth and this relationship has subsequent fetal growth and this relationship has suggested that it can be used as a diagnostic test suggested that it can be used as a diagnostic test for adverse pregnancy outcomes (intrauterine for adverse pregnancy outcomes (intrauterine growth restriction, premature birth, pre-eclampsia, growth restriction, premature birth, pre-eclampsia, and stillbirth). and stillbirth).

Prenatal Diagnostic MethodsPrenatal Diagnostic Methods

Prenatal testingPrenatal testing is is testingtesting for diseases or for diseases or conditions in a conditions in a fetusfetus or or embryoembryo before it is before it is born. The aim is to detect born. The aim is to detect birth defectsbirth defects such such as as neural tube defectsneural tube defects, , Down syndromeDown syndrome, , chromosomechromosome abnormalities, abnormalities, genetic diseasesgenetic diseases and other conditions. It can and other conditions. It can also be used to determine its also be used to determine its sexsex. .

Prenatal Diagnostic MethodsPrenatal Diagnostic Methods

Diagnostic prenatal testing can be by Diagnostic prenatal testing can be by invasiveinvasive or or non-invasivenon-invasive methods. methods.

Invasive methodsInvasive methods involves probes or needles involves probes or needles being inserted into the placenta,. being inserted into the placenta,.

AmniocentesisAmniocentesis, which can be done from about 14 , which can be done from about 14 weeks gestation, and usually up to about 20 weeks gestation, and usually up to about 20 weeks, weeks,

ChorionicChorionic VillusVillus Sampling Sampling, which can be done , which can be done earlier (between 9.5 and 12.5 weeks gestation) earlier (between 9.5 and 12.5 weeks gestation) but which is slightly more risky to the fetus. but which is slightly more risky to the fetus.

..

Prenatal Diagnostic MethodsPrenatal Diagnostic Methods

Non-invasive methods, called "screens", can only Non-invasive methods, called "screens", can only evaluate risk of a condition and cannot determine evaluate risk of a condition and cannot determine 100% if the fetus has a condition. Non-invasive 100% if the fetus has a condition. Non-invasive techniques include examinations of the woman's techniques include examinations of the woman's womb through womb through ultrasonographyultrasonography and and

maternal serum screens (i.e. maternal serum screens (i.e. Alpha-fetoproteinAlpha-fetoprotein). If ). If an abnormality is indicated by a non-invasive an abnormality is indicated by a non-invasive procedure, a more invasive technique may be procedure, a more invasive technique may be employed to gather more informationemployed to gather more information

Prenatal DiagnosticsPrenatal Diagnostics

Non-invasive methodsNon-invasive methods, called "screens", can , called "screens", can only evaluate risk of a condition and cannot only evaluate risk of a condition and cannot determine 100% if the fetus has a condition. determine 100% if the fetus has a condition.

UltrasonographyUltrasonography : : Alpha-fetoproteinAlpha-fetoprotein :Examinations of the woman's :Examinations of the woman's

womb through maternal serum screens. womb through maternal serum screens. If an abnormality is indicated by a non-invasive If an abnormality is indicated by a non-invasive

procedure, a more invasive technique may be procedure, a more invasive technique may be employed to gather more informationemployed to gather more information

Prenatal DiagnosticsPrenatal Diagnostics

Most often this is performed to test for Most often this is performed to test for birth defectsbirth defects. .

Common procedures include Common procedures include amniocentesisamniocentesis, , sonogramssonograms, , nuchalnuchal translucency translucency testing, or testing, or genetic screening. genetic screening.

The tests can be used to check for conditions such The tests can be used to check for conditions such as as Down syndromeDown syndrome, , spinaspina bifida bifida, , cleft palatecleft palate, , TayTay Sachs disease Sachs disease, , sickle cell anemiasickle cell anemia, , thalassemiathalassemia, , cystic fibrosiscystic fibrosis, and , and fragile x syndromefragile x syndrome. .

In some cases, the tests are administered to In some cases, the tests are administered to determine if the fetus will be determine if the fetus will be abortedaborted..

Reasons for prenatal diagnosis Reasons for prenatal diagnosis

There are three purposes of prenatal diagnosis: There are three purposes of prenatal diagnosis: (1) to enable timely medical or surgical treatment (1) to enable timely medical or surgical treatment

of a condition before or after birth, of a condition before or after birth, (2) to give the parents the chance to abort a fetus (2) to give the parents the chance to abort a fetus

with the diagnosed condition, and with the diagnosed condition, and (3) to give parents the chance to "prepare" for a (3) to give parents the chance to "prepare" for a

baby with a health problem or disability, or for the baby with a health problem or disability, or for the likelihood of a stillbirth.likelihood of a stillbirth.

Having this information in advance of the birth Having this information in advance of the birth means that healthcare staff can better prepare means that healthcare staff can better prepare themselves and parents for the delivery of a child themselves and parents for the delivery of a child with a health problem.with a health problem.

If a genetic disease is detected, there is often no If a genetic disease is detected, there is often no treatment that can help the fetus until it is born. treatment that can help the fetus until it is born. This does give parents the option to consider This does give parents the option to consider abortionabortion..

If abortion isn't an option for a particular couple If abortion isn't an option for a particular couple (because of their own beliefs or the laws of their (because of their own beliefs or the laws of their country), invasive prenatal diagnosis of such a country), invasive prenatal diagnosis of such a condition is unhelpful as the test puts the fetus at condition is unhelpful as the test puts the fetus at risk, and knowing the result doesn't help the fetus.risk, and knowing the result doesn't help the fetus.

Non-invasive methodsNon-invasive methods

Examination of the woman's Examination of the woman's uterusuterus from outside from outside the body. the body.

Ultrasound detectionUltrasound detection - Commonly - Commonly dating scansdating scans (sometimes known as (sometimes known as booking scansbooking scans) from 7 weeks ) from 7 weeks to confirm pregnancy dates and look for to confirm pregnancy dates and look for twinstwins. The . The specialised specialised nuchalnuchal scan scan at 11-13 weeks may be at 11-13 weeks may be used to identify higher risks of Downs syndrome. used to identify higher risks of Downs syndrome. Later Later morphology scansmorphology scans from 18 weeks may check from 18 weeks may check for any abnormal development. for any abnormal development.

Listening to the fetal heartbeat (see Listening to the fetal heartbeat (see stethoscopestethoscope) ) often known as a non-stress test often known as a non-stress test

False Positives False Positives andand

False NegativesFalse Negatives

Ultrasound of a fetus, which is considered a Ultrasound of a fetus, which is considered a screening test, can sometimes miss subtle screening test, can sometimes miss subtle abnormalities. For example, studies show that a abnormalities. For example, studies show that a detailed ultrasound, also called a level 2 detailed ultrasound, also called a level 2 ultrasound, can detect about 80% of ultrasound, can detect about 80% of spinaspina bifida bifida. . Ultrasound results may also show "soft signs," Ultrasound results may also show "soft signs," such as an Echogenic intracardiac focus or a such as an Echogenic intracardiac focus or a Choroid plexus cyst, which are usually normal, but Choroid plexus cyst, which are usually normal, but can be associated with an increased risk for can be associated with an increased risk for chromosome abnormalitieschromosome abnormalities

False Positives False Positives andand

False NegativesFalse Negatives Other screening tests, such as the AFP triple Other screening tests, such as the AFP triple

test, can have false positives and false test, can have false positives and false negatives. Even when the AFP triple test negatives. Even when the AFP triple test results are positive, usually the pregnancy is results are positive, usually the pregnancy is normal, but additional diagnostic tests may be normal, but additional diagnostic tests may be offered. Both false positives and false offered. Both false positives and false negatives will have a large impact on a couple negatives will have a large impact on a couple when they are told the result, or when the child when they are told the result, or when the child is born. is born.

Diagnostic tests, such as amniocentesis, are Diagnostic tests, such as amniocentesis, are considered to be very accurate for the defects considered to be very accurate for the defects they check for.they check for.

False Positives False Positives andand

False NegativesFalse Negatives A higher maternal serum AFP level indicates a A higher maternal serum AFP level indicates a

greater risk for greater risk for AnencephalyAnencephaly and open and open Spina Spina bifidabifida. This screening is 80% and 90% . This screening is 80% and 90% sensitive for spina bifida and anencephaly, sensitive for spina bifida and anencephaly, respectively.respectively.

Amniotic fluid acetylcholinesterase and AFP Amniotic fluid acetylcholinesterase and AFP level are more sensitive and specific than level are more sensitive and specific than MSAFPMSAFP in predicting neural tube defects. in predicting neural tube defects.

No prenatal test can detect No prenatal test can detect allall forms of birth forms of birth defects and abnormalitiesdefects and abnormalities

Imposing QuestionsImposing Questions

These types of research work has lead to These types of research work has lead to few questions-few questions-

1.1. Is the mother’s health and woman’s right Is the mother’s health and woman’s right have to be considered?have to be considered?

2.2. Is there any place for the child’s future Is there any place for the child’s future health & life?health & life?

3.3. If the fetal defects are detected after 20 If the fetal defects are detected after 20 weeks?weeks?

Imposing QuestionsImposing Questions

Who is more important, the Who is more important, the MotherMother or or the the FetusFetus?? The crux is, can we force a The crux is, can we force a mother tomother to

(i) carry an unwanted fetus to term, with (i) carry an unwanted fetus to term, with possible medical complications to the possible medical complications to the mother during delivery or childbirth,mother during delivery or childbirth,

(ii) endure postpartum blues, and(ii) endure postpartum blues, and (iii) post-birth, force her to care for an (iii) post-birth, force her to care for an

infant that she does not want,infant that she does not want,

Fetal ViabilityFetal Viability

Imposing QuestionsImposing Questions

If the If the Fetus Fetus is an independent entity is an independent entity and an and an IndividualIndividual, can this individual , can this individual live outside the mother? live outside the mother?

No, of course not. Fetus born prematurely, No, of course not. Fetus born prematurely, i.e. before 37 weeks, may suffer i.e. before 37 weeks, may suffer complications even if treated in pre-natal complications even if treated in pre-natal intensive care. intensive care.

Absent pre-natal care, they cannot survive Absent pre-natal care, they cannot survive as their organs aren’t developed yet. as their organs aren’t developed yet.

Imposing QuestionsImposing Questions

by compelling a mother to complete her by compelling a mother to complete her pregnancy for a fetus she doesn’t want, we pregnancy for a fetus she doesn’t want, we are are forcing herforcing her to provide prenatal care to provide prenatal care (using her own body) which is (using her own body) which is not not of her of her own choice, and for which she is obviously own choice, and for which she is obviously not being compensated either. The not being compensated either. The question is, is that a question is, is that a fair and justfair and just in the in the terms of law? terms of law?

United KingdomUnited Kingdom

Abortion was illegal before 1968 actAbortion was illegal before 1968 act In 1971 The act made abortion legal in the UK up In 1971 The act made abortion legal in the UK up

to 28 weeks gestation. to 28 weeks gestation. In 1990, the law was amended by the In 1990, the law was amended by the

Human Fertilisation and Embryology Act: abortion : abortion became legal only up to 24 weeks except in cases became legal only up to 24 weeks except in cases where it was necessary to save the life of the where it was necessary to save the life of the woman, there was evidence of extreme fetal woman, there was evidence of extreme fetal abnormality, or there was a grave risk of physical abnormality, or there was a grave risk of physical or mental injury to the woman.or mental injury to the woman.

International ScenarioInternational ScenarioIn In EuropeEurope, abortion is usually only allowed up to 12 weeks, abortion is usually only allowed up to 12 weeks1.1. SwedenSweden 18 weeks, 18 weeks, 2.2. NetherlandsNetherlands 21 weeks,21 weeks,3.3. Great BritainGreat Britain 24 weeks in 24 weeks in 4.4. FranceFrance, unless the fetus is severely deformed or the , unless the fetus is severely deformed or the

woman's health is directly at risk, any abortion after the woman's health is directly at risk, any abortion after the first twelve weeksfirst twelve weeks is illegal. is illegal.

5.5. CanadaCanada - no laws or restrictions regulating abortion,- no laws or restrictions regulating abortion,6.6. AustraliaAustralia-places heavier restrictions on the procedure. -places heavier restrictions on the procedure.

Every Abortion needs permission. Ban on Abortion Pills.Every Abortion needs permission. Ban on Abortion Pills.7.7. US:US: Up to 26 Weeks Up to 26 Weeks