This document discusses key indicators used to measure maternal and child health (MCH) care. It defines indicators such as maternal mortality ratio, maternal mortality rate, perinatal mortality rate, neonatal mortality rate, post-neonatal mortality rate, infant mortality rate, under-5 mortality rate, and 1-4 year mortality rate. It provides formulas for calculating each indicator and discusses their importance for monitoring MCH programs and outcomes. The document also reviews current statistics on MCH in India, identifying preterm birth, sepsis, and pneumonia as leading causes of neonatal death.

1. Indicators of MCH care
Dr Nishant Kumar
Assistant Professor
Department of Community Medicine
Madhubani Medical College , Madhubani , Bihar

2. MCH Indicator Classification
Mortality
indicators
Morbidity
indicators
Growth and
development.

3. Indicators
MCH Indicator
Maternal Indicators
Maternal mortality ratio and rate
Late Maternal death
Pregnancy related death
Indicator during
Infancy
Perinatal mortality rate,
Neonatal mortality rate
Post Neonatal mortality rate
Infant mortality rate
Indicators during
childhood
1 to 4 year mortality rate
Under 5 mortality rate

4. Maternal mortality Ratio
• Ratio- A ratio is quotient in which the numerator is not a part of
denominator
• Maternal Death : A maternal death (as cited in International
Classification of Disease or ICD-10, [WHO, 1992]) is the death of a
woman while pregnant or within 42 days of termination of pregnancy,
irrespective of the duration and the site of the pregnancy, and can stem
from any cause related to or aggravated by the pregnancy or its
management, but not from accidental or incidental causes.

5. Maternal Mortality Ratio
Total number of female death, due to complication of pregnancy ,
child birth or within 42 days of delivery from puerperal causes
an area during a given year.
Total number of live births in the
same area and year
1000

6. Maternal Mortality Ratio
• Live Birth : It refers to the complete expulsion or extraction from
its mother of a product of conception, irrespective of the duration
of the pregnancy, which, after such separation, breathes or shows
any other evidence of life - e.g. beating of the heart, pulsation of
the umbilical cord or definite movement of voluntary muscles -
whether or not the umbilical cord has been cut or the placenta is
attached. Each product of such a birth is considered live born.

7. Maternal Mortality Rate
• Rate : A rate is a quotient in which the numerator is a part of
denominator.
Total number of female death, due to complication of pregnancy ,
child birth or within 42 days of delivery from puerperal causes
an area during a given year.
Number of women in reproductive age group during the same period
1000

8. Other Maternal Mortality Indicators
• Late maternal death Death of a woman from direct or indirect
obstetric causes more than 42 days but less than one year after
termination of pregnancy
• Pregnancy –related death :Death of a woman while pregnant or
within 42 days of termination of pregnancy irrespective of the
cause of death

9. Causes of Maternal MortalityMaternalmortality
Direct Cause
Obstetric complications of the
pregnant state interventions,
omissions, incorrect treatment, or
from a chain of events resulting
from any of the above.
Toxemias of
pregnancy,
Hemorrhage
Infection,
Obstructed labour,
Abortion,
Indirect Causes
Previous existing disease or
disease that developed during
pregnancy, and which was not
due to direct obstetric causes,
but which was aggravated by
physiologic effects of pregnancy
Anaemia,
Associated diseases e.g
cardiac, renal
,Infectious,
Malignany

10. Social Determinants of Maternal Mortality
Age at child birth
Shortage of
health
manpower
Delivery by
untrained
midwives
Poor
environmental
sanitation
Poor
communications
Social
customs…
Parity
Too close
pregnancies
Family size Malnutrition
Poverty Illiteracy Ignorance
Lack of
maternity
services

11. Burden of Problem
• Every day in 2015, about 830 women died due to complications of pregnancy and
child birth.
• The MMR in India has dropped from 212 per 100,000 live births in the period
2007-09 to 167 per 100,000 live births in the period 2011-13, as per the latest
report of the registrar general of India, sample registration system (RGI-SRS).
"India's rate of decline of MMR between 2007-09 and 2011-13 is 5.7 per cent.
• Highest in Assam (300) and lowest in Kerala (61)

12. Indicators during Infancy
• A stillbirth is the death of a fetus weighing 1000g or more, or of
28-weeks gestation or more if weight is unavailable.
SBR
Foetal death weighting over 1000 gm at birth during the
year
Total Birth( total live birth+ still births weighting over
1000gram
1000

13. Indicator During Infancy and Childhood
7 days
28 days
1 year
5 year
 ENMR
 NMR
 IMR
 U5MR
Expressed as per 1000 live birth

14. Indicator During Infancy
• Perinatal Mortality rate
‘Number of stillbirths and deaths in the first week of life per 1,000 total births, the
perinatal period commences at 22 completed weeks (154 days) of gestation and ends
seven completed days after birth’.
• It measures the wastage of pregnancy both before and after delivery
PMR No of Still births + No of early neonatal death weight over 1000 g at birth
Total number of live birth , weighting over 1000 grams
1000

15. Perinatal Mortality Rate
• The PMR is a key outcome indicator for newborn care and
directly reflects prenatal, intrapartum, and newborn care
• Spontaneous preterm delivery and hypertensive disorders were
the most common obstetric events leading to perinatal deaths
(28.7% and 23.6%, respectively). Prematurity was the main
cause of early neonatal deaths

16. Indicator During Infancy
• Post Neonatal Mortality rate
Number of Death of infants between 29 days
and up to one year of age in a given year
Total number of Live birth in the same year
1000

17. Current Situation
Week 1
73%
Week2
13%
Week 3-4
14%
Figure : Distribution of neonatal
Death by time since birth
50%
10%
14%
9%
7%
5%
5%
Figure :Propotion of infants dying in first
week of life
Day 0 Day 1 Day 2 Day 3 Day 4 Day 5 Day 6

18. • 46% of Maternal deaths
• 40% of Neonatal Death
• 40% of Still birth
Day of Birth is Most dangerous for Mother
and Newborn
Intervention targeting day of birth – Triple benefit

19. Current Situation
Preterm
35%
Sepsis
15%
Pneumonia
16%
Birth asphyxia
20%
Malformation
9%
Diarrhea
2%
Others
3%
Figure : Causes of Neonatal Mortality in India
Source :Liu et al , Lancet 2012
Statistical Report

20. Causes of Post neonatal Mortality
• Diarrheal diseases
• ARI
• Communicable diseases
• Malnutrition
• Congenital anomalies
• Accidents.

21. Current Situation
Trends of Child Mortality Rates.

22. Current Situation
Difference between rural & urban NMR of major states.

23. Current Situation
64 63 63 62
59 58 58 57 56 56 54 54 54 53
49
39
0
10
20
30
40
50
60
70
Contribution of Neonatal deaths to Under Five Mortality (%)
Data source – SRS 2012

24. Indicators During Childhood
Child death rate (1-4 year
mortality rate)
Number of deaths of children aged 1-4 years
during a year
Total number of children aged 1-4 years at the middle
of the year
1000

25. Child Survival Index
• This indicator is calculated by subtracting the Under Five Mortality from
1000 and dividing this figure by 10
• It is a measure of social development and attention given to the care of
under-five children
• This Index is much better in developed countries as compared to
developing country like India
• India 49.7% in 2013 while Japan 99.6% in the same year

26. Causes of Under 5 Mortality
• Acute Respiratory infections
• Measles
• Diphtheria
• Pertussis
• Acute diarrhoeal diseases

27. Summary
Birth 7 days 28 Days 1 year28 weeks
Still Birth
Neonatal Death
Early
neonatal
death
Perinatal Death
Late
neonatal
death
Post Neonatal Death
Infant Death

28. Thank You