The document outlines India's maternal health programs initiated under the RMNCH+A framework, aiming to address mortality and morbidity among women and children. It introduces initiatives such as 'Sumalv' for quality maternity care and highlights goals like achieving a maternal mortality ratio of 100 by 2020, with significant improvements noted in recent years. Key strategies include enhanced antenatal and postnatal care, training healthcare providers, and legislations like the Medical Termination of Pregnancy (Amendment) Act, 2021 to provide safe abortion services.

1. Unit – I Maternal Health
Programmes
Mrs. Nirmala.M, M.Sc (N), MBA,
Associate Professor,
GRT CON

2. Maternal Health Care
Introduction
• Government of India adopted the Reproductive, Maternal, New-born,
Child and Adolescent Health (RMNCH+A) framework in 2013, It
essentially aims to address the major causes of mortality and
morbidity among women and children. This framework also helps to
understand the delays in accessing and utilizing health care
services.
• Based on the framework, comprehensive care is provided to women
and children through five pillars or thematic areas of reproductive,
maternal, neonatal, child, and adolescent health.

3. Maternal Health Care
• The programmes and strategies developed by various divisions are
guided by central tenets of equity, universal care, entitlement, and
accountability to provide ‘continuum of care’ ensuring equal focus
on various life stages.
• Ministry of Health & Family Welfare, Government of lndia has
launched a new initiative namely - SUMAlV - Surakshit Matritva
Aashwasan" with an aim to provide assured, dignified, respectful
and Quality healthcare at no cost and zero tolerance for denial of
services for every woman and newborn visiting the public health
facility in order to end all preventable maternal and newborn deaths
and morbidities and provide, a positive birthing experience.

4. Maternal Health Care
• The expected outcome of this new initiative
is "Zero Prevenlable Maternal and Newborn
Deaths and high qualily of maternity care
delivered with dignity and respect"

5. MMR: India’s MMR at 130 (SRS 2014-16) has
improved significantly from 167 (SRS 2011-13)
GOAL
INDICATOR
ALL INDIA STATUS
(Source of data)
NHM Goal
(2017)
Maternal
Mortality
Ratio (MMR)
254 (SRS
2004-06)
212 (SRS
2007-09)
178 (SRS
2010-12)
167 (SRS
2011-13)
130 (SRS
2014-16)
100
• According to the latest figure released by Registrar General of India -
Sample Registration System (RGI-SRS) Maternal Mortality Ratio
(MMR) for the period 2014-16 is 130maternal deaths per 100,000 live
births. With this, India has achieved the Millennium Development
Goal (MDG) 5 i.e. India have achieved a reduction in MMR by three
quarters between 1990 to 2015. The target was to achieve 139
maternal deaths per 100,000 live births.
• The table displays the trend in MMR over the years. The average
decline in MMR between 2007-09 and 2011-13 had been 11.3 points
per year, i.e. compound rate of annual decline was5.8% whereas
average compound rate of decline is 8% between 2011-13 and 2014-
16.

6. Maternal Health Indicators
S.
No
Indicator NFHS 3 NFHS 4
1
Mothers who had antenatal check-up
in the first trimester (%)
43.9 58.6
2
Mothers who had at least 4 antenatal
care visits (%)
37.0 51.2
3
Mothers who had full Antenatal
care(%)
11.6 21
4
Mothers who received postnatal care
from a doctor /nurse /LHV /ANM
/midwife /otherhealth personnel
within 2 days of delivery (%)
34.6 62.4
5 Institutional births (%) 38.7 78.9

7. Areas of Work
• Quality Service Provision:
• Quality Ante Natal care: Quality and comprehensive ANC
incorporates minimum of atleast four ANCs including early
registration and first ANC with first trimester.
• The ANC package includes physical and abdominal
examinations, Hb estimation, screening for Gestational
Diabetes Mellitus, Thyroid disorders, HIV/Syphilis and urine
investigation, T.T/Td, Immunization, distribution of IFA
tablets & Calcium (6 months during Antenatal period & 6
months during postnatal period) and counselling for nutrition
etc.
• Early detection of high-risk pregnancies, follow up and
management are important component of Antenatal care.

8. Areas of Work
• Essential Obstetric Care during Delivery: Government
of India provide free institutional delivery at its network
of health facilities including Sub-centre, primary health
centres, community health centres, sub-district
hospital, districts hospital etc, to reduce maternal
&neonatal morbidity and mortality.
• In order to provide essential obstetric care services,
Government of India is operationalizing the 24 X 7 PHCs
services and providing training to SNs/LHVs/ANMs
under Skilled Attendance at Birth.

9. Areas of Work
• Post natal care for Mother and New born: Ensuring
post-natal care within first 24 hours of delivery and
subsequent home visits on 3rd, 7th, 14th and 42nd day is
the important components for identification and
management of emergencies occurring during post-
natal period.
• The ANMs, LHVs, and staff nurses are being oriented
and trained for tackling emergencies identified during
these visits

10. Areas of Work
 Provision of Emergency Obstetric and Neonatal Care at FRU’s:
Provision of Emergency Obstetric and Neonatal Care at FRUs is
been done by operationalizing all FRUs in the country. While
operationalizing, the thrust is on the critical components such as
manpower, blood storage units and referral linkages etc. Availability
of trained manpower (Skill Based Training for health care providers)
is linked with operationalization of FRUs.
The initiatives being undertaken in this regard are:
 Augmentation of skilled human resources for Maternal Health:
 To overcome the shortage of skilled manpower particularly
Anaesthetists and Gynaecologists, the following key skill based
training programs are being implemented:
 18 Weeks Training Programme of MBBS Doctors in Life Saving
Anaesthesia Skills (LSAS) for Emergency Obstetric Care.
 16 weeks Training programme of MBBS Doctors in Obstetric
Management Skills including C-Section, in collaboration with
Federation of Obstetric and Gynaecological Society of India.(EmOC).

11. Areas of Work
• 10 days Training Programme in Basic Emergency Obstetric Care for Medical
Officers (BEmOC)
• 3 weeks Training Programme for ANMs/SNs/LHVs as Skilled Birth Attendants
(SBA) Referral
• Skills Labs (Daksh training)– For improving the skills of healthcare providers and
to enhance their capacity for providing quality RMNCH+A services, Government of
India established National and State Skills Lab.
• Referral Services at both Community and Institutional level
• Government of India has a thrust to establish a network for Basic patient care
transportation through ambulances with an aim to reach to the beneficiary in
rural area for quick service delivery.
• Presently, the states have given the flexibility to establish assured referral systems
to transport pregnant mothers and sick Infants, which includes different models
including public, private partnership models.

12. Training
• Capacity building programme for various categories
of health, works through various training
programme is as follows:
• Skilled Attendance at Birth: Government of India
has a commitment to provide skilled attendance at
every birth both at community and Institution
level.
• To manage and handle some common obstetric
emergencies at the time of birth, Staff Nurses (SNs)
and ANMs have been permitted to give certain
injections and also perform certain interventions
under specific emergency situations to save the life
of the mother.

13. Training
 DAKSHATA: Maternal Mortality and morbidity and perinatal
mortality are major public health problems. Majority have an
intra partum origin and are a consequence of interventions
carried out around the time of delivery.
 In light of this, the Government of India, in 2015, developed
‘Dakshata’ for rapidly improving the quality of care during
intrapartum and immediate postpartum period across
delivery points in the country.
 Currently, Dakshata is being implemented in more than 1500
facilities in seven states of the country.
 The package provides the complete set of resources to assist
the States in planning and implementing the Dakshata
programmes.
 For the realization of this, operational guidelines, learning
resource package, assessment tools, planning and budgeting
tools are included in the package.

14. Strategies and Interventions
Flagship Programmes
 Janani Suraksha Yojana (JSY): a demand promotion
and conditional cash transfer scheme was launched in
April 2005 with the objective of reducing Maternal and
Infant Mortality.
 It is being implemented with the objective of reducing
maternal and neonatal mortality by promoting
institutional delivery among poor pregnant women.

15. Strategies and Interventions
 Janani Shishu Suraksha Karyakram (JSSK): Government of India
has launched JSSK on 1st June, 2011, which entitles all pregnant
women delivering in public health institutions to absolutely free and
no expense delivery including Caesarean section.
 The initiative stipulates free drugs, diagnostics, blood and diet,
besides free transport from home to institution, between facilities in
case of a referral and drop back home.
 Similar entitlements have been put in place for all sick new-born
accessing public health institutions for treatment till 30 days after
birth.
 In 2013, this has been expanded to sick infants and antenatal and
postnatal complications.

16. Strategies and Interventions
 Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): Carrying
forward the vision of our Hon’ble Prime Minister, the Pradhan
Mantri Surakshit Matritva Abhiyan was launched in 2016 to ensure
quality antenatal care and high risk pregnancy detection in
pregnant women on 9th of every month.
 LaQshya: In order to further accelerate decline in MMR in the
coming years, MoFHW has recently launched ‘LaQshya - Labour
room Quality improvement Initiative’.
 LaQshya program is a focused and targeted approach to strengthen
key processes related to the labour rooms and maternity operation
theatres which aims at improving quality of care around birth and
ensuring Respectful Maternity Care.

17. Other Programmes
• Comprehensive Abortion Care: is an important element in the
reproductive health component of the RMNCH+A strategy as 8%
(2001-03 SRS) of maternal deaths in India are attributed to unsafe
abortions, thereby this is indeed a very important component of
RNMCH+A program. This program is implemented as per the
mandates of the Medical Termination of Pregnancy Act.
• Medical Termination of Pregnancy (Amendment) Act & Rules,
2021: The MTP Act, 1971 recognized the importance of providing
safe, affordable, accessible and legal abortion services to women who
need to terminate a pregnancy due to certain therapeutic, eugenic,
humanitarian or social grounds. The Act was amended for expanding
the base of beneficiaries to provide safe abortion services.

18. Other Programmes
• Contd..
• Upon the approval of The Medical Termination of
Pregnancy (Amendment) Bill, 2021 in Lok Sabha and
Rajya Sabha and further assent received from Hon’ble
President of India, the Medical Termination of
Pregnancy (Amendment) Act, 2021 had been published
in the official gazette on 25th March 2021, followed by
its notification for commencement on 24th September
2021.
• The Rules were formulated and notified for
commencement on 12th October 2021.

19. Other Programmes
• The Medical Termination of Pregnancy (Amendment)
Act, 2021 provides for:
• Requirement of opinion of one registered medical
practitioner for termination of pregnancy up to twenty
weeks of gestation.
• Requirement of opinion of two registered medical
practitioners for termination of pregnancy of twenty to
twenty-four weeks of gestation.
• Enhancing the upper gestation limit from twenty to
twenty-four weeks for vulnerable groups of women.

20. Other Programmes
• Contd…
• Non-applicability of the provisions relating to the length of
pregnancy in cases where the termination of pregnancy is
necessitated by the diagnosis of any of the substantial foetal
abnormalities diagnosed by a Medical Board.
• Strengthening the protection of privacy of a woman whose
pregnancy has been terminated.
• Failure of contraceptive clause extended to the woman and
her partner.

21. Infrastructure
• Delivery Points: All the States & Union Territories have
identified DPs with certain minimum benchmark of
performance in order to prioritize and direct resources
in a focused manner to these facilities.
• All delivery points are strengthened with trained and
skilled human resources, infrastructure, equipment,
drugs and supplies, referral transport etc. for providing
quality & comprehensive RMNCH (Reproductive,
Maternal, and Neonatal& Child Health) services.

22. Infrastructure
• Obstetric HDU/ICU: Operationalization of Obstetric
ICU/HDU in a high case load tertiary care facilities is being
conducted across country to handle complicated
pregnancies.
• MCH Wings - State of the art Maternal and Child Health
Wings (MCH wings) have been sanctioned at District
Hospitals/District Women’s Hospitals and other high case
load facilities at sub-district level, as integrated facilities
for providing quality obstetric and neonatal care.

23. Information to Maternal Health
• Maternal Death Surveillance and Response
(MDSR): The process of maternal death review (MDSR)
has been implemented & institutionalized by all the
States since 2017.
• Guidelines and tools for conducting community based
MDSR and Facility based MDSR have been provided to
the States. The States are reporting deaths along with
its analysis for causes of death.
• Maternal near miss review is also being conducted at
premier institutions.

24. Information to Maternal Health
• RCH portal/MCTS Portal: Name Based Tracking of Pregnant
Women and Children has been initiated by Government of
India as a policy decision to track every pregnant woman,
infant & child upto 5years of age by name for provision of
timely ANC, Institutional Delivery, and PNC along-with
immunization & other related services.
• MCP Card: Ministry of Health & Family Welfare and Ministry
of Women and Child Development (MOWCD) has been
launched as a tool for documenting and monitoring services
for antenatal, intranatal and postnatal care to pregnant
women, immunization and growth monitoring of infants.