issues of maternal and child in india. very knowledgeble and valuable topic for postgraduate nurses

1. DISCUSSION ON ISSUES OF
MATERNALAND CHILD
HEALTH
PRESENTED BY:-
MS.SANCHAYEETA DEY
M.SC NURSING 1ST YEAR
CPMS COLLEGE OF NURSING

2. ISSUES???

3. INTRODUCTION:-
• India Is One Of The Fastest Growing Economies In The World.
• India Is A Country Of Tremendous Diversity, Geophysical, Societal And Cultural.
• Healthcare Is A Neglected Issue In India.
• Lack Of Resources In Rural India Is A Major Concern Of The Day, Leading To
Most Of The Problems.
• 50% Of All Villagers Have No Access To Healthcare Providers.
• Infant Mortality Rate(IMR) Is 34 Per 1000 Live Births.
• 50% Of All Babies Having Lack Of Nutrition.
• 36% People Of India Have No Access To Toilets.

4. CONT..
• From The Increasing Poverty, To The Corruption At An All-time High, The
Increasing Violence Against Women Across The Nation, The Poor Health
Status Of The Women And Children Are Some Of The Most Scary Facts Of
This Fast Growing Economy, India.

5. MATERNAL AND CHILD HEALTH
• The Survival And Well Being Of Mothers Is Not Only Important In Their Own
Right But Are Also Central To Solving Large Broader, Economic, Social And
Developmental Challenges.
• Maternal Mortality Ratio Is One Of The Important Indicators Of The Quality Of
Health Services In The Country.
• India Has Made Remarkable Progress In Reducing Maternal Deaths In The Last
Two Decades.
• In 1990, MMR In India Was Very High With 600 Women Dying During Child
Birth/1000 Live Births, which Meant One And Half Lakh Women Dying Every
Year.

6. CONT..
• Globally MMR At That Time Was 400, Which Is About 5.4lakh Women Dying Every
Year, India Contribute To 27% Of The Global Maternal Deaths.
• In The Year 2010 Global MMR Was 210,against This India MMRWas Declined To
178/ 1000 Live Births In 2011.
• India Now Contributing Only 16% Of The Global Maternal Deaths.
• Globally There Has Been A 47% Decline Between 1990-2010.
• India Has Registered A Decline Of 70% Between 1990-2011.

7. CONT..
• Pace Of Decline In India Has Shown An Increasing Trend From-
-4.1% Annual Rate Of Decline During 2001-2003
- 5.5% In 2004-2006
- 5.8% In 2007-2009
- 5.7% In 2010-2012
• So Highest Rates Of Declines Are Evident From The Years 2004-2006, Which
Incidently Coincides With The Period Immediately After The Launch Of
NRHM(2005).

8. CONT…
• Currently, As Many As 1.66 Crore Women Are Reported To Deliver In Public
Health Institution.
• JSY ( Janani Suraksha Yojna) Has Launched In The Year 2005,which Has Resulted
In A Surge In Institutional Deliveries.
• Phenomenal Progress Of JSY Scheme, Janani Shishu Suraksha Karyakram(JSSK)
Launched In 2011 Provides Services Guarantees In The Form Of Entitlement To
Pregnant Women, Sick New Born And Infants For Free Delivery Including
Caesarean Section And Free Treatment In Public Health Institutions.

9. CONT..
• Still An Estimated 47,000 Mothers Continue To Die Every Year Due To Causes
Related To Pregnancy, Childbirth, And The Post-partum Period.
• The Major Causes Of Deaths Are Hemorrhage, Sepsis, Abortion, Hypertensive
Disorders, Obstructed Labor And Anemia.
• Socio-economic Cultural Determinants Like Illiteracy, Low Socio-economic Status,
Early Age Of Marriage, Low Women’s Empowerment, Traditional Preference For
Home Deliveries & Other Factors Contribute To The Delays Leading To These
Deaths.

10. CONT..
• The Term ‘Maternal And Child Health’ Refers To The Promotive, Preventive,
Curative And Rehabilitative Health Care For Mothers And Children. It Includes
The Sub-areas Of Maternal Health, Child Health, Family Planning, School Health,
Handicapped Children, Adolescence, And Health Aspects Of Care Of Children In
Special Settings Such As Day Care.
• Maternal And Child Health Is Recognized As One Of The Significant Components
Of Family Welfare.
• Health Of Both Mother And Children Is A Matter Of Public Health Concern.

11. DEFINITION OF ISSUE-
• A Point Or Matter Of Discussion, Debate Or Dispute.
• A Point In Debate Or Controversy On Which The Parties Take Affirmative And
Negative Positions, A Presentation Of Alternatives Between Which To Choose Or
Decide.

12. ISSUES OF MATERNAL AND CHILD HEALTH-
• India Is A Lower-middle-income Country With One Of The Fastest Growing
Economies In The World.
• India Has A High Child Mortality Rate.
• Poverty, Malnutrition And Poor Sanitation Are Major Problems And Major
Contributor To Child Mortality.
• More Than 40% Children Are Malnourished And Stunted.
• Healthcare Provision Is Poor, And Many Families, Especially In Rural Areas, Have
Major Difficulties In Accessing Healthcare.

13. MATERNAL AGE
• Maternal Age Is Term Used To Donate The Age Of A Pregnant Women.
• Maternal Age Is Closely Related To The Outcome Of The Child’s Health.
• Pregnant Before 18years And After 35years Is Considered As High Risk Pregnancy.
• In Both Cases The Health Of The Mother And Child Can Be Affected.

14. TEENAGE PREGNANCY- Early Pregnancies Among Teenage Girls Have Major Health
Consequences For Teenage Mothers And Their Babies
• Teenage Mothers Aged Less Than 19 Years Face Higher Risk Of-
-Eclampsia
-Puerperal Endometritis
-Systemic Infection
-Anemia
• Babies Born To Mothers Under 20years Of Age Gave Higher Risk Of-
-Low Birth Weight
-Preterm Delivery
-Congenital Malformation
-Severe Neonatal Condition

15. ADVANCED AGED PREGNANCY- Womens Who Are Pregnant At Age 35 Or Older Are
Often Referred To As “Advanced Maternal Age’. Various Risks Occur In Advanced Aged Pregnancy.
• It May Take Longer Time To Get Pregnant.
• Multiple Pregnancy.
• Gestational Diabetes.
• High Blood Pressure.
• Birth Defects.
• Pregnancy Loss.
• Preeclampsia.
• Premature Birth And Low Birth Weight.

16. It may take longer to get pregnant

17. Multiple pregnancy

18. Gestational diabetes

19. High blood pressure

21. Pregnancy loss

23. Premature birth and low birth weight

24. MULTIGRAVIDA AND CHILDBIRTH-
•A Multigravida Has Been Pregnant More Than Once.
•A Grand Multipara Is A Woman Who Has Already Delivered Five Or More Infants Who Have
Achieved A Gestational Age Of 24 Weeks Or More, And Such Women Are Traditionally Considered To
Be At Higher Risk Than The Average In Subsequent Pregnancies.
•A Grand Multigravida Has Been Pregnant Five Times Or More.
•A Great Grand Multipara Has Delivered Seven Or More Infants Beyond 24 Weeks Of Gestation.

25. • RISKS ASSOCIATED WITH MULTIGRAVIDA-
-Abnormal Fetal Presentation.
-Precipitate And Preterm Delivery Although Higher Age Is More Significant.
-Uterine Atony.
-Placenta Praevia.
-Uterine Rupture.
- Amniotic Fluid Embolism.
-Postpartum Hemorrhage.
-Stress Incontinence And Urinary Urgency Symptoms.

26. GENDER
• Gender refers to the characteristics of women, men, girls and boys that are socially
constructed.
• This includes norms, behaviors and roles associated with being a woman, man, girl
or boy, as well as relationships with each other.
• Gender is hierarchical and produces inequalities that intersect with other social and
economic inequalities.
• Gender-based discrimination intersects with other factors of discrimination, such as
ethnicity, socioeconomic status, disability, age, geographic location, gender identity
and sexual orientation, among others. This is referred to as
INTERSECTIONALITY.

27. • Gender interacts with but is different from sex, which refers to the different
biological and physiological characteristics of females, males and intersex persons,
such as chromosomes, hormones and reproductive organs.
• Gender and sex are related to but different from gender identity.
• Gender identity refers to a person’s deeply felt, internal and individual experience of
gender, which may or may not correspond to the person’s physiology or designated
sex at birth.
• Gender influences people’s experience of and access to healthcare. The way that
health services are organized and provided can either limit or enable a person’s
access to healthcare information, support and services, and the outcome of those
encounters. Health services should be affordable, accessible and acceptable to all,
and they should be provided with quality, equity and dignity

28. • Gender inequality and discrimination faced by women and girls puts
their health and well-being at risk
• Women and girls often face greater barriers than men and boys to
accessing health information and services.
• These barriers include restrictions on mobility; lack of access to
decision-making power; lower literacy rates; discriminatory attitudes of
communities and healthcare providers; and lack of training and
awareness amongst healthcare providers and health systems of the
specific health needs and challenges of women and girls.

29. • Consequently, women and girls face greater risks of unintended pregnancies,
sexually transmitted infections including HIV, cervical cancer, malnutrition,
lower vision, respiratory infections, malnutrition and elder abuse, amongst
others.
• Women and girls also face unacceptably high levels of violence rooted in gender
inequality and are at grave risk of harmful practices such as female genital
mutilation, and child, early and forced marriage.
• WHO figures show that about 1 in 3 women worldwide have experienced
either physical and/or sexual intimate partner violence or non-partner sexual
violence in their lifetime.

30. • Consequently, they are at higher risk of HIV and mental health
problems, including suicide.
• Harmful gender norms – especially those related to rigid notions of
masculinity – can also affect boys and men’s health and wellbeing
negatively.
• For example, specific notions of masculinity may encourage boys and
men to smoke, take sexual and other health risks, misuse alcohol and not
seek help or health care.

31. GENDER IDENTITY
• Gender identity is the personal sense of one's own gender. Gender identity
can correlate with a person's assigned sex at birth or can differ from it.
• While a person may express behaviors, attitudes, and appearances
consistent with a particular gender role, such expression may not
necessarily reflect their gender identity.
• The term gender identity was originally coined by Robert J. Stoller in
1964.
• Gender identity is usually formed by age three. After age three, it is
extremely difficult to change and attempts to reassign it can result in
gender dysphoria.

32. CONT…
1. Age of formation.
2. Factors influencing gender identity:
a) Nurture Vs Nature
b) Intersex people
c) Transgender and trans-sexuality
e) Social and environmental factors
f) Parental establishment of gender roles

33. SEXUALITY
Sexuality is about sexual feelings, thoughts, attractions and
behaviours toward other people. When a person finds other people
physically, sexually or emotionally attractive and all those things are
a part of one’s sexuality.
Sexuality refers to habits and preferences in terms of sexual behavior.
People express it in many ways. Sometimes, people feel confusion or
distress about their sexuality or sexual identity. Human sexuality is
complex and personal.

34. A person's own definitions of sexuality may include:
•Feelings of attraction toward others
•Intimacy with others
•Feelings related to body image
•Personal values
People express and experience sexuality in many ways. Some ways people
express their sexuality include:
•Thoughts
•Fantasies
•Behaviors
•Roles
•Through a relationship

35. • Gender, orientation and identity can influence sexuality. But
these are distinct concepts.
• Sex refers to the sex determined at birth.
• Physical anatomy determines sex at birth.
• Gender refers to someone's knowledge of being male, female,
non-binary, or other gender.
• Sexuality is also different from sexual orientation.
• Orientation refers to the type of sexual attraction a person
feels.

36. Many factors influence mainstream views on sexuality. Some
of these factors include religion, philosophy, and history.
No single culture views sexuality the “right” way.
 Problems can emerge when someone’s sexuality does not fit
the norms of their culture.
For example, people with same-gender attraction may feel
shame in a culture that sees heterosexualuality as the norm.
This can cause inner conflict.

37. Mental health issues that may cause sexual issues include:
• Anxiety
• Depression
• Post traumatic stress (PTSD)
• Issues with body image
• Trust issues
Physical issues that can impact sex or sexual expression
include:
• Bowel or urinary problems
• Diabetes
• Heart and vascular issues
• Medication side-effects
• Hormone imbalance

38. • ISSUES LINKED TO SEXUALITY-
Some common concerns of people seeking therapy include:
• Impotence
• Lack of sexual desire
• Anxiety or uncertainty about sexual orientation
• Conflicting sexual desires between partners
• Recovery from sexual abuse or assault
• Loneliness
• Body image issues
• Sexual impulses or compulsions that cause distress
• Promiscuous behavior

39. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists
three sexual disorders for females. It also lists four for males.
 Female sexual disorders:
• Sexual interest/arousal disorder
• Orgasmic disorder
• Genitopelvic pain/penetration disorder
 Male sexual disorders:
• Hypoactive sexual desire disorder
• Delayed ejaculation
• Electile dysfunction
• Premature ejaculation

40. SEXUAL ORIENTATION:
• Sexual orientation is the emotional, romantic, or sexual attraction that a
person feels toward another person.
 TYPES OF SEXUAL ORIENTATION
1. Heterosexual.
2. Homosexual.
3. Bisexual.
4. Asexual.

41. • Heterosexual:- People who are heterosexual are romantically and physically attracted to
members of the opposite sex. Heterosexual males are attracted to females, and
heterosexual females are attracted to males. Heterosexuals are sometimes called
"straight."
• Homosexual:- People who are homosexual are romantically and physically attracted to
people of the same sex. Females who are attracted to other females are lesbian; males who
are attracted to other males are often known as gay. (The term gay is sometimes used to
describe homosexual individuals of either sex.)
• Bisexual:- People who are bisexual are romantically and physically attracted to members
of both sexes.
• Asexual.:-People who are asexual may not be interested in sex, but they still feel
emotionally close to other people.

42. WHAT IS LGBT?
• You may see the letters "LGBT" or ("LGBTQ") used to describe sexual
orientation. This abbreviation stands for "lesbian, gay, bisexual, and
transgender" (or "lesbian, gay, bisexual, transgender, and questioning").
• Transgender isn't really a sexual orientation — it's a gender identity. Gender
is another word for male or female. Transgender people may have the body
of one gender, but feel that they are the opposite gender, like they were born
into the wrong type of body.
• People who are transgender are often grouped in with lesbian and gay as a
way to include people who don't feel they fit into the category of being
"straight."

43. SEX EDUCATION
• Sex education is the instruction of issues relating to human
sexuality, including emotional relations and
responsibilities, human sexual anatomy, sexual activity, sexual
reproduction, age of consent, reproductive health, reproductive
rights, safe sex, birth control and sexual abstinence. Sex education
that covers all of these aspects is known as comprehensive sex
education. Common avenues for sex education are parents or
caregivers, formal school programs, and public health campaigns.

44. PSYCHO SOCIO CULTURAL FACTORS:
• Meaning: Psychosocial factors are influences that affect a person psychologically or
socially.
• Definition: Social factors include general factors at the level of human society
concerned with social structure and social processes that impinge on the , individual.
Psychological factors include individual- level processes and meanings that influence
mental states. Sometimes these words are combined as ‘psychosocial’.
• Cultural psychology is the study of how cultures reflect and shape the psychological
processes of their members.
• The term socio culture is something that involves the social and cultural aspects. An
example of socio culture is to know about the people around us and their family
background.

45. THE PSYCHO SOCIO CULTURAL FACTORS AFFECTING
MATERNALAND CHILD HEALTH
• Education: Education level can have an effect on how healthy we are. Education
gives us the tools we need to make good decisions about our health. People with
more education are more likely to live longer.
-Mothers with better education tend to take better care of their children and are
more likely to seek medical care, such as immunization, than those who lack
schooling etc.
• Income: The amount of money we make has an effect on our health. People with
higher incomes tend to be healthier and live longer than the people with low
incomes.
-There are countless women in a low income country dying from maternal
related causes. Every day in 2017 about 808 women died due to complications of
pregnancy and child birth.

46. • Housing: Because of poor housing condition the mother and child are in a
high risk of developing health issues. Poor housing leads to poor hygiene,
poor drainage, poor water supply, more sources of infection.
• Employment: Because of poor condition even a 10 year old child also need
to work to feed the family which effect the child’s health. So the pregnant
woman and lactating mothers also have to work.
• Domestic violence: The more there is a issue of education, income there is a
chance of having domestic issues which leads to domestic violence to a child
or to a woman.
• Girl trafficking: Due to the need of money as a way of easy money girl
trafficking takes place. This is great hazard to the girl’s health.
• Prostitution: To fulfill the need of food the young girls and even the women
choose this profession to earn money.