गर्भ का चिकित्सकीय समापन अधिनियम, 1971 व पॉक्सो अधिनियम से संबंधित दिशा-निर्देश के सम्बन्ध में।

संख्या-05/2026/07/पांच-9-2026 अमित कुमार घोष, अपर मुख्य सचिव, उत्तर प्रदेश शासन। सेवा में, (॥) समस्त निदेशक/प्रमुख/मुख्य चिकित्सा अधीक्षक/अधीक्षिका, उत्तर प्रदेश। (2) समस्त मुख्य चिकित्सा अधिकारी, उत्तर प्रदेश। चिकित्सा अनुभाग-9 लखनऊ, दिनांक ॥3 जनवरी, 2026 विषय:-गर्भ का चिकित्सकीय समापन अधिनियम, i97. व पॉक्सो अधिनियमश्से संबंधित दिशा-निर्देश के सम्बन्ध में। महोदय/महोदया, अवगत कराना है कि स्वास्थ्य इकाईयों पर आने वाल्ले यौन*उत्पीड़न की उत्तरजीवी महित्राओं (सेक्सुअल एब्यूज सर्वाइवर) का उपचार किया जाता««है।क़तिपय मामल्रों में सेक्सुअल एब्यूज सर्वाइवर द्वारा स्वयं /उसके अभिभावकों/उसके Aertel के/साथ पुलिस में शिकायत किये बगैर या पुलिस में शिकायत के उपरान्त पुलिस द्वारा छढषचारू-हेतु स्वास्थ्य इकाईयों में सम्पर्क किया जाता है। 2- गर्भ का चिकित्सकीय समापन अधिनियम, 97 व पॉक्सो अधिनियम से संबंधित मामल्रों में गर्भवती लड़कियों/महिलाओं के गर्भ AAMT हेतु एक मानक संचालन प्रक्रियायें शासन के पत्रांक- 72/2025/632/पांच-9-2025 दिनांक..26 अगस्त 2025 के माध्यम से आपको प्रेषित किये गये हैं। 3- उक्त मामलों में आवश्यकंध्है कि सेक्सुअल एब्यूज सर्वाइवर/महिला /बालिका को अनचाहे गर्भ का सामना न करना पड़े और यदि feel कारणोंवश वह गर्भवती हो चुकी है तो शीघ्रातिशीघ्र गर्भ का चिकित्सकीय समाप्रन अधिनियम, 97 के अन्तर्गत सुरक्षित गर्म समापन की सुविधायें प्रदान की जायें। ऐसे मामलों, में घटना के साक्ष्य एकत्रित किये जाने के साथ-साथ अन्य विभागों/ एजेन्सियों (यथा Ao कल्याण विभाग वन स्टॉप सेन्टर आदि) से भी आवश्यकतानुसार समन्वय स्थापित किया जाये। 4- इस सम्बन्ध में मुझे यह कहने का निदेश हुआ है कि कृपया उक्त मानक संचालन प्रक्रियाओं (एस0ओ0पी0) के साथ ही संलग्न दिशा-निर्देशों का कड़ाई से अनुपालन करना सुनिश्चित करें। संलग्नक:यथोक्त। भवदीय, अमित कुमार घोष अपर मुख्य सचिव। I- यह शासनादेश इलेक्ट्रानिकली जारी किया गया है, अत: इस पर हस्ताक्षर की आवश्यकता नहीं है | 2- इस शासनादेश की प्रमाणिकता वेब साइट http://shasanadesh.up.nic.in से सत्यापित की जा सकती है |-2- AEAT:-05()/2026/07()/arg-9-2026 तददिनांक। प्रतिलिपि निम्नलिखित को सूचनार्थ एवं आवश्यक कार्यवाही हेतु प्रेषितः- सचिव, स्वास्थ्य एवं परिवार कल्याण मंत्रालय, भारत सरकार, निर्माण भवन, नई दिल्‍ली। () (2) प्रमुख सचिव, गृह विभाग, उ0प्र0 शासन। (3) महानिदेशक, पुलिस, उत्तर प्रदेश को इस आशय (4) (5) (6) (7) (8) (9) (40) () (2) से प्रेषित कि अपने स्तर से समस्त पुलिस कमिश्नर एवं वरिष्ठ पुलिस अधीक्षकों से उक्त निर्देशों का अनुपालन सुनिश्चित काायें। मिशन निदेशक, राष्ट्रीय स्वास्थ्य मिशन, उत्तर प्रदेश। समस्त मण्डलायुक्त, उत्तर प्रदेश। समस्त जिला-मजिस्ट्रेट, उत्तर प्रदेश। महानिदेशक, चिकित्सा शिक्षा एवं प्रशिक्षण, उत्तर प्रदेश। महानिदेशक, चिकित्सा एवं स्वास्थ्य सेवायें, उत्तर प्रदेश। महानिदेशक, परिवार कल्याण, उत्तर प्रदेश। महानिदेशक, प्रशिक्षण, चिकित्सा, स्वास्थ्य एवं GRA Hem, उत्तर प्रदेश। समस्त मण्डलीय अपर निदेशक, चिकित्सा, स्वास्थ्य' एबं. परिवार कल्याण, उ0प्र0। गार्ड फाईल। आज्ञा से, विनोद कुमार विशेष सचिव। I- यह शासनादेश इलेक्ट्रानिकली जारी किया गया है, अत: इस पर हस्ताक्षर की आवश्यकता नहीं है | 2- इस शासनादेश की प्रमाणिकता वेब साइट http://shasanadesh.up.nic.in से सत्यापित की जा सकती है |Standard Operating Protocol for medico-legal care for Sexual Assault Survivors (SAS)List of Abbreviations: Abbreviatio ns “Meaning © SAS Sexual Assault Survivors ‘Medical Officer’ ‘MO Protection. of children from sexual offence 20050 Medico Legal Certificate Juvenile Justice... Ju Sexual Assault forensic evidence SAFE Deoxyribonucleic Acid * * DNA ECP Emergency Contraceptive Pills First information Report FIR Medical Termination of Pregnancy MTP Urine Pregnancy Test UPT Bio Medical Waste BMW Personnel Protective equipment _ PPE Women and Child Department - WCD Child Care institute cc Ministry of Health and Family welfare MoHFWStandard Operating Protocol for medico-legal care for sexual Assault vs survivors (SAS) 4. Examination of a case of sexual assault (Sexual Assault Forensic Examination) It must be very meticulous, and it has far reaching consequences in the line of justice. 2. Who will perform? A lady medical officer (not necessarily gynaecologist) will perform examination. w. ls consent needed or not? « Informed written consent is must, in prescribed format. « Incase of:a minor or intellectually disabled survivor, consent of parents or guardian is required. « In.case of minor or intellectually disabled survivor, if the parents /guardian refuse the examination, they must be counselled and the same should be documented clearly (as per thé mandate of Section-27, POCSO Aci). In case of destitute/orphan or intellectually disabled survivor, the Child Welfare Committee or Bal Kalyan Samiti must be informed and the survivor should be counselled by the concerned representative of the Bal Kalyan Samiti and the medical officer. च »र . W Ih no ca i ss e t to h eb e s ui rvn if vo or rm ie s d b? r ought directly to medical facility, then the neaक rा est police station must. » b Ie n ci an sfo er m te hd e. survivor does not want to pursue a police case, a MLC must be made and she must be informed that she has the right to refuse to file FIR. An informed refusal » m |nu cs at s b ee a cd co oc mu pm ae nn it ee dd bi yn as u pc olh i cc ea s pee rs s. onnel, the Personnel Number (CP Number) and name of the latter along with a copy of FIR are to be recorded in the case record and MLC report. 5, P Ir no o alf l cof a sa eg se under 70080 Act, where the age of the survivor, and cases where the age of t uh pe o nch i (l Sd e i cn t ic oo nnf -l 3i 4c ,t w Pi Oth C l Sa Ow a Ar ce t ma rt ee ar di a al, l ot nh ge wf io tl hl .o w Ji un vg e nd io lc eu m Jue sn tt is c/ e p (r Co ac re ed u ar ne d sh Pa rl ol t eb ce t ir oe nl ie od f Chil(di)r eAn )d aActte, o2f0 b0i0r.t)h certificate from the school, matriculation or equivalent certificate from t (ih i)e Bc io rn thc e cr en re tid f ie cx aa tem i gn ia vt ei no n b yB oa ar d c, o ri pf oa rv aa til ia ob nl e o; r a an d m uin n it ch ie p a alb s ae un tc hoe r ith te yr e oo rf , a Panchayat, G ( oi sio i s)v ie fA ir n cn adm t ie oon nn t l t y eH so tis np o i rtt ha ael n . ya ob ts he en rc me e do if c a( li) l ya pn rd o v{ eii n) aa nbo dv ie, m pra o g ve e ds h aa gll e db ee t ed re mt iee nr arm tmi ion ne d t esb ty . an (iv) A copy of identity proof (if available) may be attache:d in the case record and MLC documents. 6. Prerequisites « The examination should be carried out in a well-lit room, with onl y the nesded staff wearing proper PPE. ; ; \- ; [ie The Sexual Assault Forensic Evidence (SAFE) kit should be ready; Items like swab sticks, syringes and needle for drawing blood, lancets, nail scrappers, comb and nail cutters should be used only once for a case. e {i should then be disposed off and should not be used for any subsequent case, except instruments which should be disinfected or autoclaved. Usage of any used articles may lead to contamination of DNA samples. ~ हु है e Two identification marks (.0 Marks) on the exposed part like the face, upper and lower limbs. |.D marks are moles, scars, and tattoo marks etc. on the body should be documented. « The survivor should be asked to stand on white paper on the floor and undress. If possible, the examiner should look for fall-debris for evidence collection. « Outer and inner clothing should be preserved separately, and white paper should be kept on the floor. Clean clothing should be provided to the survivor. « Incase the survivor is not accompanied by any member of her family, the information about such crime.should be given immediately to her family and/or the Bal Kalyan Samiti. 7. Treatment of survivor . « The survivor of such crime should be treated with dignity, empathy and sensitivity with psychosocial support by representative of Bal Kalyan Samiti. ° €mergency treatment.for MLC procedure and examination must not be deferred. Saving her life is as much a priority as for any other survivor (even if she gives negative consent for SAFE). है * The identity of the survivor must not be made public and due care must be taken not to reveal her identity in print and electronic media. ५. Admission shall be as MLC case and name will be Miss X (X IX MONTH MMXXIV). Photo of such survivor may be used in the case diary for the purpose of re-investigation. 8. Preventing long-term issues after assault The following protocol should be followed by the medical officer, based on consent, for preventing long-term issues post assault: » Emergency contraception should be offered to the survivor along with appropriate counselling if assault is reported within 72 hours. * The following emergency contraceptives shouid be offered and the survivor should be followed up till the next menstrual cycle: . a. Single dose of emergency contraceptive pill. (Levonorgestrel 7.5 mg) b. 4 tablets of combined oral contraceptive pills stat repeated after 72 hours. (If the survivor vomits within 7 hour of-taking ECPs the dose needs to be repeated) » - Incase she has not attained menarche, and if age is more than 7.5 years above pills can be safely administered, and survivor can be put under watch and ensure follow up as per « p ir fo tt ho ec o sl u. r vivor repo. rts after 72 hours of sexual assault, they should be followed up til their next menstrual period and tested for pregnancy using the urine pregnancy test kit and ». wu sil httt ohhr u ea t l s h dso e un br co v eog i nr v gca o ip er v h r ety n ne es w dti ts t h gh epi u on a os r pi0 d tt7 i ii av od e n na y (i oins fn to uchf a ne s d m e eUi r s rois gfni o en m i g i np n gt r oh ree a)gi n r n r ap e ane g br c a oi ry ro d td t i ie n osd g nta , t t ae ht. seh e i py m e p rs l h i po c ru a otह lै tid oo cnb ose l o sfc o upu nrn des g ee n rl a l n te c hd y e ,a Ml ao T* nn Pdg >.. A Cc ot n s2 e0 n2 t7 . o f the survivor and/or guardian (in case of minoन r or intellectually disabled) must be taken before undergoing medical termination of pregnancy. * « H PoV st t —es t ei xn pg o ss uh rou el pd r b ope h d ylo an xe i sb a shs oe ud l do n b ec o sn ts ae rn tt e. d within 72 hours: \ a 9. . T If L (D a) ( iT s e nn oo tf o av vi ar i, l aL ba lm e,i v Tu Ldi En e (, Te na on fd o vD io rl ,u t Le ag mr ia vv ui dr i) ne, and cf Ea fv ai virenz) NY e HBsAg testing should be done* Hep 8 vaccination should be administered (immunoglobulin only if perpetrator is’ known positive) * The survivor should also be counselled on mental health and should be encouraged to access mental health care servicés through the Tele MANAS helpline (i44(6 or 4- 800897446) or the district mental health clinic. है * Facility incharge must ensure regular social behavioural trainings of all cadres specially who are dealing: with sexual assault survivor. . ® Post the MTP procedure conducted (based on consent), the survivor should be followed up til next six menstrual cycles along with an ultrasonography. [Preventing long-term sues ater assaults long-term issues after assaults 4 ८. If reported within: 72 hours. lf reported after 72 hours a. Give a single dose of emergency | Follow up till their next menstrual cycle and contraceptive pill (Levonorgestrel 7.5 mg) test for pregnancy using the urine pregnancy b. 4 tablets of combined oral contraceptive test kit and ultrasonography within 7 days of pills stat repeated after 72 hours. missing the period date. If UPT report is positive There should be counselling of survivor along with the guardian (in case of minor) regarding the implications and should be given the option of undergoing an abortion as per protocols under the MTP Act 2027. Consent of the survivor and/or guardian (in case of minor or intellectually disabied) must be taken before undergoing medical termination of pregnancy. === HIV testing should be done based on consent « Post - exposure prophylaxis should be started within 72 hours a. TLD (Tenofovir, Lamivudine, and Dolutegravir) b. if a is not available, TLE (Tenofovir, Lamivudine, and Efavirenz) «« HH eB ps A Bg vt ae cs ct ii nn ag t is oh no u sl hd o ub le d d bo en e a dministered (, immunaglobuti; n only if perpetrator is known positive) 4 ५ i) > \a \ After MTP procedure, (based on consent), the survivor should be followed up till néxt six menstrual cycles along with ultrasonography. - fy Liwa > ic9, SAFE KIT The SAFE kit should include the following: - Forms for documentation Large sheet of paper to undress over Paper bags for clothing collection Catchment Paper Sterile cotton swabs and swab guards for biological.evidence collection Comb Nail Cutter Wooden stick for finger nail scrapings . . cos Small scissors ; an , : Urine sample container ~ : Tubes/ vials/ vaccutainers for blood samples [Ethylenediaminetetraacetic acid (EDTA), Plain, Sodium fluoride] . Syringes and needle for drawing blood Distilled water Disposable gloves Glass slides _ Envelopes or boxes for individual eviderice samples Labels Lac(sealing wax) Stick for sealing _ : Clean clothing, shower/hygiene items for survivors use after the examination Other items for a forensic/medical examination and treatment that may be included are Woods lamp/Good torch : Vaginal speculums हु - Drying rack for wet swabs &/or clothing Survivor gown, cover sheet, blanket, pillow Post-It notes to collect trace evidence Camera (35mm, digital with colour printer) Microscope Colposcope/ Magnifying glass Toluidine blue dye 4% Acetic acid diluted spray Urine Pregnancy test kit Surgilube Medications Instruments should be disinfected (washed with ‘soap and water then autoclaved) before reuse as per BMW rules 2076. ; 40. Medicolegal examination Thorough medical and incident history should be recorded (menstrual, vaccination and s Ge ux au ra dl i av nio l /e n rc ee p, r ep sh ey ns ti ac ta il v ev i oo fl é Bn ac le ) Kalyan Samiti in case of minor can be present if SAS w Ni os h te ws o-finger test must be done, and no comment should be made on vaginal laxity o Nar t s ue rx eu a ofl sh ea xb ui at l violence, time lapsed and whether survivor has b athed and changed her clothing should be recorded lain white sheet of paper to collect any loose evidence as 4. Survivor will undress o n a p है * pubic hair etc “ fj \wr All clothing must be folded inside out and kept in paper bags if a sanitary pad is there the sticky side is covered with’ butter paper and kept in paper bag Pore Note and draw any bite or injury marks, swelling, haemorrhage or laceration Head hair sample must be plucked and placed in paper envelope Pubic hair must be combed after laying survivor on white paper to collect loose hair which is sent 7. Survivor's pubic hair is plucked and packed 8. Vulval swab is taken by separating the labia and smearing a wet swab stick over inner aspect of labia minora and navicular fossa 9. Vaginal'swab is taken from anterior and posterior fornixes by speculum examination 0. Cervical swab is similarly sent 44. Anorectal swab is collected and packed 2. Survivor's blood samples in lavender, red, grey and green vials 43. Oral swab is taken where theré is suspected oro-genital trauma i4. Breast swabs 5. Slides prepared from vulval, and vaginal smears are prepared and sent in slide cases or with another slide on top 6. Nail cutting and scrapings 7. Urine sample is sent in sterile container 8. Vaginal washing is also needed SAFE to be Collected Specimen . : Purpose Preservation Chain of Custody ale saline Seal, label, hand over to |O with MLC हि * container number Products of conception |’ DNA profiling (avoid - हे (etal nay membranes, ‘0 establish DNA) for Tissue to be pacer patem’y transported ; DNA of maintaining cald Fetal tissue sample foetus Saline or dry chain. DNA . ; comparison/ EDTA & plain Blood sample of survivor toxicology vials Buccal swab of survivor DNA (if blood unavailable) comparison Air Dry swab Seal, label, hand over to Buccal swab of accused Reference !0 with MLC number. (if available) . DNA . Air Dry Swab 44. Drafting the report and dispatching the report and specimens ७. The report of sexual assault survivor examination should be prepared immediately after examination and handed over to investigating officer. e 'Acopy of the receiving must be attached in the case record with the name and personal number of the official e Acopy of medical report should be made available to the survivor 42. Important instructions « Documentation should be thorough. * Packing and labelling should have name not Miss X. * Proper PPE should be used to avoid contaminating DNA samples. y @ (im fs é* Acopy of the record must be kept in the case record. 43. Follow-up , The importance of follow up should be explained and emphasized to the survivor. follow up to be done by WCD DEPTT (ONE STOP CENTRE, ७08 & Bal Kalyan Samiti). It should be -ensured that in whole process of follow up confidentiality of the survivor should not be compromised. The survivor can be called for re-examination 02 days after the assault to note the development of bruises and other injuries. * Every case should be followed ‘up at 02 weeks, 04 weeks, 03 months and 08 months. » 9 The 02 weeks. follow ~ up visit: i. Test for pregnancy if indicated. 2,. Check if survivor has completed course of STI medication. 3. Assess the survivors emotional and mental status; if required support and counselling. ह co The 04 Weeks follow — up visit: 4. 274 dose of Hepatitis B vaccination. 2. Repeat pregnancy test. 3. Assess the survivors emotional and mental status: if required support and counselling. , ; ० The 03 Month follow — up visit: 4. HIV and syphilis testing, Pre and post - test counselling to be ensured. 2. Assess the pregnancy status. . हैं हु 3. Assess thé survivors emotional and mental status; if required support and counselling. o The 06 Month follow — up visit: Rona 03” dose of Hepatitis B vaccination. Test for HIV, Pre and post - test counselling to be ensured. Assess the survivors emotional and mental status and refer as necessary. Assess for psychological sequelae and re-iterate need for psychological support as per; Section 5 of the guidelines. ¢ All follow-ups should be documented. ¢ If pregnancy positive, abortion services as per the provisions of MTP Act should be offered upto 09 weeks under supervision of medical officer, Product of Conceptus for DNA testing can be éollected in-sterile saline vial/container with proper labelling, and if the pregnancy is more than 09 weeks to up to 20 weeks can be terminated at CHC level under supervision of trained RMP as per MTP act. « Incase of more than 20 weeks and up to 24 weeks case should be referred at appropriate facility has up to two Obstetricians and Gynaecologists. In case-of minor, if menarche has not occurred, then the child should also be tested for pregnancy through UPT in subsequent follow-up visit. * For details on the above, refer guidelines and protocols for medico-legai care for survivors/survivors of sexual violence, MoHFW, 2074. Important Helpline Numbers: : 4. One Stop Center: 784 - 2, Bal Kalyan Samiti (Child3. Women Helpline: 4090 4. Telemanas: 74446 or 4 -8008944446 Steps for comprehensive healthcare response to sexual violence Consent Age Estimation History for comprehensive healthcare response to sexual violence Hand-over fo Police = “Physical " Dental | Radiological 4 Exarninati Dry xarnination ayo. Pack of injuries ST Seal testand prophylaxis, HIV ' Evidence Collection test and prophylaxis, L. emergency contraception, I } UPT and ultrasonography (applicable), counseting —— Treatment Documentation information and referral : Tepe " * to other services Lay Discharge - Follow-up