Maternal And Child Health

Services
 Aims of MCH Services
• Reducing maternal mortality rate, infant mortality rate
and child mortality rate.
• Child survival.
• Promoting reproductive health or safe motherhood.
• Checking malnutrition in children and mothers.
• Protecting children and mother from infectious
diseases.
 Aims of MCH Services

• Early diagnosis and treatment of health problems of

mother and children.
• Ensuring physical and mental growth and
development of children and adolescents.
• Improving health levels of mothers and children
through family planning services and health
education.
 Target of MCH Services
• Target of MCH services as per National Health Policy 2017
• Reduction of TFR to 2.1 at National and sub National level
• Increase life expectancy at birth from 67.5 to 70 by 2025.
• Reduction of under five mortality to 23 by 2025.
• Reduction of IMR to 28 by 2019.
• Reduction of MMR to 100 by 2020.
• Reduction of neo-natal mortality to16,stillbirth rate to single
digit by2025.
 Indicators of MCH Services

• Maternal Mortality Rate - MMR

• Infant Mortality Rate- IMR
• Neonatal Mortality Rate -NNMR
• Under Five Mortality Rate –U5MR
• Total Fertility Rate - TFR
 ORGANIZATIONAL ACTIVITIES OF
MCH Services
• Complete health check-up and care of the child and
mother from conception to birth.
• Studying health problems of mother and children.
• Providing health education to parents for taking care
of children.
• Training to professional and assistant workers.
RECENT TRENDS IN MCH Services

• Integration of care

• Risk approach

• Manpower changes

• Primary health care

• Reproductive and child health

• RMNCH+A
RECENT TRENDS IN MCH Services
• Integration of care: maternal and child health services
(antenatal, family planning, child care etc)are provided in one
place in unified form.
• Risk approach: high risk mother and child are identified and
ensuring specialists care to them.
• Manpower changes: MCH services not left to traditional
health workers(ANM, TBA,HV) rather SBA/TBA, MPW,
ASHA, Anganwadi workers, specialists, child volunteers are
involved.
• Primary health care: achieving health for all through primary
health care should include services to mother and child.
RECENT TRENDS IN MCH Services

• RMNCH+A
Reproductive, Maternal, Newborn ,Child Health and
Adolescents( RMNCH+A)
• The main objective of the RMNCH+A program is to bring
about a change in three critical health indicators i.e. reducing
total fertility rate, infant mortality rate and maternal mortality
ratio
INTERVENTIONS UNDER MATERNAL HEALTH Services

Reproductive and child health services

• Janani Suraksha Yojana (JSY)
• Janani Sisu Suraksha karyakram (JSSK)
• Vandematharam scheme
• Accredited Social Health Activists (ASHA)
• Skilled Birth Attendants (SBA)
• Home Based Newborn Care (HBNC)
• Integrated Management of Neonatal Childhood
Illness (IMNCI)
 Janani Suraksha Yojana (JSY)

• The Janani Suraksha Yojana (JSY) is a Govt of India sponsored

Scheme which is being implemented with the objective of reducing

maternal and infant mortality by promoting institutional delivery

among pregnant women.

• Under the JSY, eligible pregnant women are entitled to cash

assistance irrespective of the mother's age and number of children for

giving birth in a government or accredited private health facility.

• Cash assistance to the mother is mainly to meet the cost of delivery, it

should be disbursed effectively at the institution itself.

 Janani Shishu Suraksha karyakram
• A scheme By MoHFW for pregnant women who access
government health facilities for their delivery, to absolutely
free and no expense delivery, including caesarean section.
• Essential care is provided to the mother and her neonate within
48 hours.
• Reasons like high out of pocket expenditure on
diagnostics/investigations, blood, drugs, food and user charges
institutional delivery JSSK was launched in June 2011 to
eliminate out-of-pocket expenses for institutional delivery of
pregnant women and treatment of sick infants.
• In 2014, the programme was extended to all antenatal &
postnatal complications of pregnancy and similar entitlements
have been put in place for all sick newborns and infants (up to
one year of age) accessing public health institutions for
treatment.
 Vande Mataram Scheme

• The launch of the Vande Mataram scheme in partnership with

private gynaecologists to provide safe maternity services.
• Under the scheme, free OPD services including ante natal
check up would be made available to all pregnant women.
• VMS would also extend family planning counselling to new
mothers regularly from the public and private health care
platform on the ninth day of every month.
 Accredited Social Health Activists
• Accredited Social Health Activist (ASHA) is a trained female
community health activist selected from the community itself
and accountable to it, the ASHA will be trained to work as an
interface between the community and the public health
system.
• ASHA must primarily be a woman resident of the village
married/ widowed/ divorced, preferably in the age group of 25
to 45 years.
• She should be a literate woman with due preference in
selection to those who are qualified up to 10 standard
wherever they are interested and available in good numbers.
This may be relaxed only if no suitable person with this
qualification is available.
 Skilled Birth Attendants

• Skilled Birth Attendant (SBA) is defined as "an accredited

health professional - such as midwife, doctor or nurse - who
has been educated and trained to achieve proficiency in the
skills needed to manage normal (uncomplicated) pregnancies,
childbirth and immediate postnatal period and in the
identification, management and referral of complications in
women and newborns."
 Home Based Newborn Care
• Home Based Newborn Care scheme for reduction of neonatal
mortality, has incentivized Accredited Social Health Activist
(ASHA) for making visits to all newborns and their mothers
according to specified schedule up to 42 days of life. The
incentive amounts to a total of Rs. 250 for six visits in case of
institutional delivery and seven visits in case of home delivery,
subject to the following:
– recording of weight of the newborn in Mother Child
Protection (MCP) card
– ensuring BCG , 1st dose of OPV and DPT vaccination
– both the mother and the newborn are safe till 42 days of
the delivery, and
– registration of birth has been done
 Integrated Management of Neonatal Childhood Illness
(IMNCI)

• The core of the IMNCI strategy is integrated case management

of the most common childhood problems, with a focus on the
most important causes of death.
• The clinical guidelines are designed for the management of sick
children aged from birth up to five years.
• They include methods for assessing signs that indicate severe
disease; assessing a child’s nutrition, immunization and feeding;
teaching parents how to care for a child at home; counseling
parents to solve feeding problems; and advising parents about
when to return to a health facility.
• The guidelines also include recommendations for checking the
parents’ understanding of the advice given and for showing them
how to administer the first dose of treatment.
 Maternal health services-Responsibilities
of community health nurse

1.Direct Care

Antenatal care

• Contact: Contacting every pregnant mother in the primary stage of

pregnancy.

• History : Taking history of general health, family environment, social

conditions, previous child births and present pregnancy.

• Antenatal Examination: Conducting general examination, physical

examination and obstetric examination, laboratory examination etc.

 Responsibilities of community health nurse

• Calculating expected date of delivery and informing mothers.

• Conducting antenatal clinics.
• Identifying high risk mothers.
• Providing counseling and health education.
• Helping mothers and other family members in planning the
delivery.
 Responsibilities of community
health nurse
Intranatal care
• Encouraging institutional deliveries.

• Preparing the place for delivery.

• Arranging necessary equipment and their sterilization.

• Giving mental support to mothers.

• Examining position of fetus, dilation of cervix, observing the position of

bladder and uterine contractions.

• Recording general condition of the pregnant mother, progress of pain and

time of membrane rupture.

 Responsibilities of community
health nurse
• Ensuring safe delivery, examining umbilical cord and noting

abnormalities.

• If necessary taking help of doctor or referring to a specialist.

• Taking care of the mother and newborn baby after the delivery.

• Maintaing asepsis during delivery.

• Proving skilled birth attendant at the time of child birth.

• Should ready to handle complications.

• Noting the correct time of child birth.

 Responsibilities of community
health nurse
Neonatal care

• Observing the respiration of newborn, immediately after birth

and if necessary proving resuscitation.

• Taking care of umbilical cord and tying it using proper

techniques.

• Taking notice of congenital defect and informing relatives.

• Assessing the physical condition of newborn by APGAR score.

 Responsibilities of community
health nurse
• Cleaning the Newborn child.
• Taking care of newborn’s skin and eyes.
• Keeping the newborn child on safe bed and providing
breastfeeding to baby at the earliest.
• Maintaining normal body temperature of the newborn. Give
kangaroo care
• Observe the crying, intestinal activity, urination, sleeping and
feeding pattern of the newborn child and accordingly giving the
treatment or nursing care.
 Responsibilities of community
health nurse
Home visit
• Home visit are the back born of maternal and community health
services.
• During home visit community health nurse should focus on

– Antenatal check up

– Anatomy, physiology and psychology of pregnancy.

– Diet during pregnancy.

– Plans of delivery.

– Neonatal care

– Family planning
 Responsibilities of community
health nurse
2.Managerial functions
• Organizing and managing the nursing homes.

• Playing role of liaison officer under referral system.

• Taking a part in community activities.

• Explaining the importance of reproductive and child health in community.

• Organizing and managing maternal clinics.

• Coordinating among doctor, family and patients.

• Storing and maintaining the records of maternal and child health services.
 Responsibilities of community
health nurse
3.Educational Functions
• Providing health education to TBAs, mothers and family.
• Educating(demonstrations) pregnant mothers and relatives about
maternal nursing.
• Community health nurse should discuss following topics.
– Importance of regular antenatal check up.
– Importance of rest, sleep and exercise.
– Personal hygiene and proper diet.
– Clean environment.
– Utility of maternity clinic
– Plans of delivery.
– Cutting and tying umbilical cord.
– Taking care of infants.
 Maternal clinic and care
• Maternal services are essential constituents of primary health care.

• The latest trends on MCH services is to stress on conducting

coordinated schemes and programmes on motherhood, child,
nutrition and family planning.
• Maternal services can be divided in to

– Prenatal /antenatal care

– Intranatal care

– Postnatal care
 Maternal clinic and care
Antenatal care
• Antenatal care means looking after the women during pregnancy.
• Start before the pregnancy (b/r the conception) in planned
manner.
• Aims
– Protecting and promoting the health of mother.
– Maximum care to the mother
– Identification of high risk mothers and treat them.
– Ensure safe delivery and healthy child
– Physical and mental preparation for mother
– Educating mother
– Reduce maternal mortality
– Informing about FP and MTP
 ACTIVITIES OF ANTENATAL CLINIC
• Collection of facts-present/past obstetrical history, h/o abortion ,
social history
• Antenatal examination

• Identifying the high risk women and treating them

• Prenatal counseling

– Diet, hygiene, EDD, care of nipple ,family planning and signs

that need medical attentions.
• Immunization and health protection

• Mentally prepare the mother for pregnancy and motivating her for
family planning.
 Functions of community health nurse in
Antenatal clinic
• Selection of place for clinic.
• Fixing clinic days
• Informing mothers about time and days of clinic.
• Ensure presence of specialists
• Contacting and motivating mothers to came for clinic.
• Prepare antenatal cards
• Take history and general examinations (ht,wt,BP,Hb,Urine
test).
• Identifying high risk group and counseling
• Assist specialists
• Educating mothers and family.
• Visiting homes
• Maintaining records,
 Maternal clinic and care
• Intranatal care: care required at the time of delivery.
• Delivery may be arranged at home or at hospital.
• Institutional delivery is safe.
• SBA is essential.
• Aims
– Maximum possible care during delivery.
– Minimum harm to mother and child.
– Prevention of complications
– Immediate neonatal care.
 Maternal clinic and care
• Responsibilities of Community health nurse
– Maintenance of delivery room.
– Preparing for emergencies.
– Maintain asepsis and cleanliness during delivery.
– Appropriate care in all stages
– Proving all health intervention for safe delivery.
– Managing complications
– Mental support to mothers.
– Keeping delivery kit ready for home delivery.
– Acquiring specialists when needed and appropriate
referral of cases.
 Maternal clinic and care
• Postnatal care/postpartal care
• Care given after delivery to both mother and baby.
• Aims
– Taking care of mother and reestablishing optimum level of
health as early as possible.
– Protecting from complications.
– Encouraging breast feeding.
– Health education mother and family.
– Family planning services.
 Maternal clinic and care
Responsibilities of community health nurse
• Prevention of complications.
• Postnatal examination
• Preparation of mother mentally and socially.
• Health education.
• Preparing mother for breast feeding.
• Family planning
• Postnatal home visit
 Causes of maternal mortality in
India
• Medical causes
– Obstetrical causes
– Non Obstetrical Causes
• Social factors
1. Obstetrical causes are
– Hemorrhage
– Infection
– Obstructed labor
– Unsafe abortion
Non Obstetrical Causes
• Anemia
• Associated disease – cardiac, renal, metabolic
• Malignancy
• Accidents

Social Factors
• Age at child birth, parity, too close pregnancies
• Family size, Malnutrition, Poverty, Illiteracy and ignorance
• Lack of maternal services, delivery by untrained dai
• Poor communication and transportation facilities
 Prevention of MMR
• Promote early registration of pregnancies.
• Four antenatal visit
• Supplementation of diet and anemia correction.
• Preventing hemorrhage and infection in puerperium.
• Prevent complication (PIH,Uterine rupture etc,)
• Ante malaria and tetanus prophylaxis.
• Clean delivery practices by training dais
• Promote family planning
• Safe abortion services.
• Identify maternal death and its causes.
Child health services
 Child health services

• Child health services are a part of maternal health

services.
• According to WHO 15 lack children die before
attaining the age of 1 month.
• In developing countries infant mortality is very high.
 Causes of child death
• Premature birth

• Diarrhea or other diseases leading to dehydration

• Acute respiratory infections(pneumonia)

• Malnutrition

• Diseases which could be prevented by vaccination.

• Neonatal causes: insufficient maternal or neonatal care.

Objectives of child health services
Aims of infant or child health services have been
unified with maternal and child health services. It
includes
• Decreasing child death and infant mortality rate.
• Complete protection of child.
• Nutritious diet to children(including treatment and
checking of vitamin A deficiency)
• Overall growth of children
• Special effort to preserve and promote health of
children below 5 years of age.
• Increasing the health level of children through school
health services and other programmes.
 Responsibilities of community
health nurse
• Assessment of growth an development
• Immediate care of newborn.
• Care of nutritional status.
• Prevention and treatment of childhood accidents.
• Immunization
• Educational functions
• Other functions
 Responsibilities of community
health nurse

Other functions
• Providing remedies to check diarrhea,
vomiting and dehydration.
• Conducting child health clinic
• Helping in registration of births.
• Rehabilitation for disabled children.
• Participating in school health programmes.
 Responsibilities of community
health nurse
• Opposing child labor.
• Health check-up in crèches and orphanages.
• Contacting various health care organizations
• Participating in IMNCI,HBNC and child
health clinic programmes.
• Checking the entries in mother, child
protection card.
 Programmes under child health
services

1. Integrated Management of Neonatal and Child

hood illness (IMNCI)
• Integrated management of child hood illness
(IMCI) is developed by WHO in collaboration
with UNICEF and many other agencies working
in the field of child care.
• It encompasses a range of intervention to prevent
and manage five childhood illnesses namely
ARI,diarrhea,malaria, measles, and malnutrition.
 Programmes under child health
services
2. Home based Newborn Care(HBNC)

• It is mainly to reduce the IMR on the basis of work done by

NGOs, ASHA will be trained in the aspects of Newborn care.

3. Child clinics

• Child clinic play an important role in the child health services.

• It include

– Under Five Clinic

– Child Guidance Clinic

 Programmes under child health
services
1.Under Five Clinic
• Earlier these were known as “Well Baby Clinics”.
• These clinics are run in association with antenatal
clinics.
• Pediatrician play an important role in this.
 Programmes under child health
services
1.Preventive care
• Timely physical examination of children.

• Immunization

• Nutritional care

• Oral rehydration therapy

• Health education and family planning

2.Growth monitoring
3.care in illness
4.Family planning
 Programmes under child health
services
2. Child Guidance Clinic
• Some children suffer from abnormal behavior or
psychological problems.
• Child guidance clinic are organized to solve such
problems.
• Psychiatrists, pediatricians, community health nurse and
other auxiliary workers are include in this clinics.
• Cooperation of parents is essential in these clinics.
 Programmes under child health
services
Child suffering from following problems attent clinics

• Bedwetting/enuresis

• Refusing to go to school

• Complaints of being ignored/neglected

• Not behaving as per age

• Cruel behavior toward other children and animals

• Stealing the objects.

ASSESSMENT OF MCH SERVICES

• MCH services are evaluated on the basis of following

indicators
• IMR
• MMR
• NNMR
• Child Survival Rate
• In that IMR and MMR are main indicators.
ASSESSMENT OF MCH SERVICES

• The Maternal mortality rate (MMR) is the annual

number of female deaths per 100,000 live
births from any cause related to or aggravated by
pregnancy or its management (excluding accidental
or incidental causes).
ASSESSMENT OF MCH SERVICES

• Infant mortality is the death of an infant before the

infant's first birthday. The occurrence of infant
mortality in a population can be described by
the infant mortality rate (IMR), which is the
number of deaths of infants under one year of age per
1,000 live births.
Preventive measures to reduce Child mortality rate

• Explain importance of family planning.

• Taking care of antenatal and postnatal diet.
• Protecting children from infections and appropriate
vaccinations.
• Immediate diagnosis and treatment of illness.
• Monitoring growth and development.
• Encourage breast feeding and explain its advantages.
 Preventive measures to reduce
Child mortality rate
• Providing safe and healthy environment.

• Making health education as an integral part of general

education.
• Training of TBA, ensuring safe delivery.

• Making adequate arrangement for the treatment of

children.
• Effective implementation of IMNCI,HBNC,Baby friendly
hospital and child nutrition programme etc.
 FOR YOUR KNOWLWDGE

• Current IMR-26.9 Death per 1000 live births.

• Current MMR-97 per lakh live births in
2018-20