Maternal and child health" refers to the Promotive, Preventive, Curative and Rehabilitative health care for mothers and children.

4. The term "Maternal and child health" refers to the
Promotive, Preventive, Curative and Rehabilitative
health care for mothers and children.
It also 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.

5. Maternal and child health status is assessed through
measurements of mortality, morbidity and, growth and
development
Mortality rates are still the only source of information.
Morbidity data are scarce and poorly standardized

6. Maternal mortality ratio
Mortality in infancy and childhood
The commonly used mortality indicators of MCH
care are :

7. According to WHO, a maternal death is defined as ''the
death of a woman while pregnant or within 42 days of
termination of pregnancy, irrespective of the duration and
site of pregnancy from any cause related to or aggravated
by the pregnancy or its management but not from
accidental or incidental causes

8. Maternal mortality ratio measures women dying from
"puerperal causes" and is defined as
Total no. of female deaths due to complications of
pregnancy, childbirth or within 42 days of delivery from
"puerperal causes in an area during a given year
Total no. of live births in the same area and year
MATERNAL MORTALITY
RATIO

9. Complications of pregnancy or childbirth can also lead to
death beyond the six-weeks postpartum period.
It is defined as "the death of a women from direct or
indirect causes, more than 42 days but less than one year
after termination of pregnancy·•
Late Maternal Death

10. A pregnancy-related death is the death of a woman while
pregnant or within 42 days of termination of pregnancy,
irrespective of the cause of death
Pregnancy-Related Death

12. •Maternal mortality ratio : Number of maternal deaths
during a given time period per 100,000 live births during
the same time-period
•Maternal mortality rate : Number of maternal deaths
in a given period per 100,000 women of reproductive age
during the same time-period.

13. •Adult lifetime risk of maternal death : The probability of
dying from a maternal cause during a woman's
reproductive lifespan
•Proportion of maternal deaths of women of
reproductive age (PM) : The number of maternal deaths in
a given time period divided by the total deaths, among
women aged 15-49 years

21. 2015
Maternal Deaths
216
MMR
global adult life-time risk
of maternal mortality
1 in 180
303,000
211
MMR
1 in 190
global adult life-time risk
of maternal mortality
2017
295,000
Maternal Deaths

22. Nigeria and India
together account for
over one-third of all
global maternal
deaths in 2015, with
an approximate
58,000 and 45,000
maternal deaths
respectively

23. 44,000
Annual Deaths
causes related to pregnancy, childbirth
and the post-partum period

24. The major medical causes of these deaths are
haemorrhage, sepsis, abortion. hypertensive
disorders, obstructed labor and other causes
including anaemia and Illegal abortions

25. A host of socio-economic and cultural
determinants like illiteracy, low
socioeconomic status, early age of marriage,
low level of women's empowerment,
traditional preference for home deliveries
and other factors contribute to the delays
leading to these deaths.

27. •For the purpose of categorization, MMR is considered to
be high if it is 300-499, very high if it is 500-999 and
extremely high if it is >=1000 maternal deaths per 100,000
live births

28. The United Nations’ Sustainable Development Goal 3 of “ensuring
healthy lives and promoting well-being at all ages” provides a
number of key global health targets.
The first is to decrease the global maternal mortality ratio from 211
to below seventy maternal deaths per 100,000 live births by 2030.
In addition, no individual country should have a maternal mortality
ratio more than twice the global average

29. The strategy is a road map for the post-2015 agenda as
described by the Sustainable Development Goals and
seeks to end all preventable deaths of women, children
and adolescents and create an environment in which
these groups not only survive, but thrive, and see their
environments, health and wellbeing transformed
Global Strategy for Women's, Children's and
Adolescent's Health 2016- 2030

30. End preventable deaths
- Reduce global maternal mortality to less than 70 per
100,000 live births
- Reduce newborn mortality to at least as low as 12 per
1000 live births in every country
- Reduce under-5 mortality to at least as low as 25 per
1000 live births in every country
SURVIVE

31. -End epidemics of HIV, tuberculosis, malaria, neglected
tropical diseases and other communicable diseases
- Reduce by one third premature mortality from non-
communicable diseases and promote mental health and
well-being

32. Ensure health and well-being
- End all forms of malnutrition , and address the nutritional
needs of adolescent girls, pregnant and lactating women
and children
- Ensure universal access to sexual and reproductive
health-care services (including for family planning) and
rights
THRIVE

33. Ensure that all girls and boys have access to good quality
early childhood development
- Substantially reduce pollution-related deaths and
illnesses
- Achieve universal health coverage including financial risk
protection and access to quality essential services,
medicines and vaccines

34. Expand enabling environments
- Eradicate extreme poverty
- Ensure that all girls and boys complete free , equitable and
good quality primary and secondary education
- Eliminate all harmful practices and all discrimination and
violence against women and girls
TRANSFORM

35. -Achieve universal and equitable access to safe and
affordable drinking water, and to adequate sanitation and
hygiene
- Enhance scientific research, upgrade technological
capabilities and encourage innovation
- Provide legal identity for all, including birth registration
- Enhance the global partnership for sustainable development

37. Women's age: The optimal child-bearing years are
between the ages of 20 and 30 years. The further away
from this age range, the greater the risks of a woman dying
from pregnancy and childbirth.
Birth interval: Short birth intervals are associated with an
increased risk of maternal mortality.
Parity: High parity contributes to high maternal mortality

38. Economic circumstances,
Cultural practices and beliefs,
Nutritional status,
Environmental conditions and
Violence against women
OTHERS
The social factors often precede the medical causes and
make pregnancy and child-birth a risky venture

39. Determinants
Of Maternal
Mortality

40. From year 2000 onwards, SRS (Central registration
system) included a new method called the "RHIME"
or Representative, Re-sampled, Routine Household
Interview of Mortality with Medical Evaluation. This is
an enhanced form of "verbal autopsy" which is the
key feature of a prospective study of 1 million deaths
within the SRS.
THE SRS INTERVENTION

41. RHIME include random re-sampling of field-work by an
independent team for maintaining quality of data.
For comparability with WHO estimates for India and for
other countries, the WHO's "Global Burden of Disease“
categorization of maternal deaths have been used,
which includes various categories with their ICD-10 codes
such as: hemorrhage, sepsis, hypertensive disorder,
obstructed labour, abortion. and other conditions.

44. Antenatal check-up
Institutional delivery and
Delivery by trained personnel
The estimates of maternal mortality can only be used as a rough
indicator of maternal health situation in any given country. They
Include:
These indicators also reflect the status of the ongoing
programme interventions and the situation of maternal health

47. Early registration of pregnancy;
At least four antenatal check-ups;
Dietary supplementation , including correction of anaemia
Prevention of infection and haemorrhage during
puerperium;
Prevention of complications, e .g., eclampsia,
malpresentations, ruptured uterus;
Any attempt to lower MMR must take into consideration the
following measures

48. Treatment of medical conditions, e.g.
hypertension, diabetes, tuberculosis.
Anti-malaria and tetanus prophylaxis;
Clean delivery practice;
In India, a large number of maternal deaths could
be prevented with the help of trained village level
health workers

49. Institutional deliveries for women with bad
obstetric history and risk factors;
Promotion of family planning - to control the
number of children to not more than two, and
spacing of births;
Identification of every maternal death and
searching for its cause; and
Safe abortion services.

50. Park's Textbook of Preventive and Social Medicine
•https://www.gatesfoundation.org/goalkeepers/report/2021-report/progress-
indicators/maternal-mortality/
https://www.google.com/search?
q=maternal+mortality+rate&tbm=isch&ved=2ahUKEwiB8cLJidD4AhWE_TgGHepbBpU
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cCegQIABAA&oq=maternal+&gs_lcp=CgNpbWcQARgGMgQIIxAnMgQIIxAnMgQIABBD
MgQIABBDMgsIABCABBCxAxCDATIECAAQQzIICAAQgAQQsQMyBAgAEEMyBAgAEE
MyBQgAEIAEOgYIABAeEAg6CggAELEDEIMBEEM6BwgAELEDEENQixVYwkhg1GVoA
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REFERENCES

51. Thanks!