MTP approval for a private clinic: the process Section 4 site approval, Form A and Form B, who may perform, and what the owner answers for.

To offer MTP, a private clinic needs two things: an approved place and a qualified doctor. Section 4 of the Medical Termination of Pregnancy Act, 1971 says no termination "shall be made in accordance with this Act at any place other than" a hospital established or maintained by Government, or "a place for the time being approved for the purpose of this Act by Government or a District Level Committee constituted by that Government with the Chief Medical Officer or District Health Officer as the Chairperson". Separately, the person doing it must be a registered medical practitioner (RMP) with the experience or training in obstetrics and gynaecology that rule 4 of the MTP Rules prescribes. Your clinical establishment registration does not replace either.

Who approves a private place for MTP?

The District Level Committee (DLC) approves it, on the recommendation of the district Chief Medical Officer (CMO). The Act says the DLC has three to five members including the chairperson. Rule 3 of the MTP Rules, 2003 adds that one member must be a gynaecologist, surgeon or anaesthetist, the others come from the local medical profession, non-governmental organisations and the district's Panchayati Raj institutions, and "one of the members of the Committee shall be a woman". The committee's tenure is two calendar years. The name of the CMO post differs by state; the rules define it as the Chief Medical Officer of a district "by whatever name called".

How does a clinic apply?

1. Decide the category. The Form A substituted by the MTP (Amendment) Rules, 2021 asks which category you seek: "(A) Pregnancy can be terminated upto twelve weeks" or "(B) Pregnancy can be terminated upto twenty-four weeks".
2. Fill Form A: name of the place in capital letters, full address, whether it is non-government, private, a nursing home or another institution, and which of the listed facilities are available. The owner of the place signs it.
3. Address it to the Chief Medical Officer of the District (rule 5(2)).
4. Expect verification. The CMO "may verify any information" in the application or inspect the place (rule 5(3)), and the owner "shall afford all reasonable facilities for the inspection" (rule 5(4)).
5. The CMO, if satisfied that terminations can be done there "under safe and hygienic conditions", recommends the place to the committee (rule 5(5)).
6. The committee considers the application and the CMO's recommendation and may "approve such place and issue a certificate of approval in Form B" (rule 5(6)).
7. Display the Form B certificate "conspicuously" so it is "easily visible to persons visiting the place" (rule 5(7)).

Rule 5(8) sets the clock: the place "shall be inspected within 2 months of receiving the application", and the certificate may be issued within the next two months, or within two months of a deficiency being put right. The central rules we read do not prescribe a fee for approval; ask the CMO's office whether your state charges one, and keep the acknowledgement of your application with its date.

What facilities does Form A ask about?

Rule 5(1) says no place shall be approved unless the Government is satisfied terminations can be done there under safe and hygienic conditions and the listed facilities are provided. The 2021 Form A lists them by category:

The 2021 amendment also added a separate list in rule 5 for termination beyond twenty-four weeks, which the Act allows only on the opinion of a state Medical Board and, under rule 4A(3), "at approved facilities". That is hospital territory and outside the scope of a small clinic.

Which doctors may perform it?

Only an RMP as defined in section 2(d): a recognised medical qualification, a name on a State Medical Register, and "such experience or training in gynaecology and obstetrics as may be prescribed". Rule 4 sets the qualifying routes and rule 4A, added in 2021, sets which routes cover which stage. In summary:

Between twenty and twenty-four weeks the Act needs the opinion of two RMPs, only for the categories of women listed in rule 3B, and rule 4A(2) limits those two to routes (a), (b) and (d), with the opinion recorded in Form E. Keep a copy of each doctor's registration and the certificate proving their route in the clinic file; the inspecting CMO can ask for it. Gestation limits and methods are clinical questions; read rules 3B, 4 and 4A in full.

Can a doctor prescribe early medical termination without an approved clinic?

Only with access to an approved place. The Explanation to rule 5 lets a qualified RMP prescribe early termination by medical methods "at his clinic, provided such a Registered Medical Practitioner has access to a place approved under Section 4", and adds: "For the purpose of access, the RMP should display a Certificate to this effect from the owner of the approved place." The 2021 amendment changed the limit in that Explanation from seven weeks to nine weeks. So a clinic without its own approval needs a written tie-up with an approved place and that owner's certificate on the wall.

What does the owner answer for after approval?

• Inspection: the CMO may inspect an approved place "as often as may be necessary" and, if there is reason to believe a woman has died or been injured there or conditions are unsafe, may seize "any article, medicine, ampoule, admission register or other document" (rule 6).
• Suspension or cancellation: the committee may suspend or cancel the approval on the CMO's report, after giving the owner a chance to make a representation. During suspension the place is not an approved place (rule 7). A review application lies to the Government within sixty days (rule 8).
• Records: the central MTP Regulations, 2003 extend to the Union territories; states make their own under section 7. They require an Admission Register in Form III kept for five years as "a secret document", a monthly statement in Form II to the CMO, and no other register naming the woman. Ask your CMO for your state's version.
• Confidentiality: section 5A, added in 2021, bars an RMP from revealing the name and particulars of a woman whose pregnancy was terminated except to a person authorised by law, with up to one year, a fine, or both.

The penalties sit on the owner as well as the doctor. Section 5(4) punishes "any person being owner of a place which is not approved" with rigorous imprisonment of two to seven years, and section 5 defines owner as the administrative head or anyone "otherwise responsible for the working or maintenance" of the place. For the separate licence most states need for any clinic, see our clinical establishments list by state.