The document discusses maternal health and efforts to improve it. It notes that while maternal mortality has declined globally in recent decades, it remains high in many developing countries. It outlines several indicators of maternal health in India that have improved between 2005-06 and 2014-15, such as antenatal care and institutional births. However, maternal mortality still varies greatly between states. The document proposes strengthening maternal health through expanding programs that provide antenatal, delivery and postnatal care, especially in rural areas, as well as improving infrastructure and monitoring systems.

1. MATERNAL HEALTH CARE:
NEW HORIZON

2. Maternal health has been becoming a global concern because the lives of millions
of women in reproductive age can be saved through maternal health care services.
Despite efforts that have been made to strengthen maternal health care services,
maternal mortality is still high in most of the developing countries.
Women who remain healthy during pregnancy and after birth are more likely to
stay healthy later in life and have better birth outcomes, influencing infancy,
childhood and adulthood.
Therefore, the health and well-being of women matter to every person, society and
country and are essential for the achievement of the Sustainable Development
Goals (SDGs).
INTRODUCTION

3. Maternal health is the health of women during pregnancy, childbirth, and
the postpartum period. It encompasses the health care dimensions of family
planning, preconception, prenatal, and postnatal care in order to ensure a
positive and fulfilling experience, and reduce maternal morbidity and
mortality.
MATERNAL HEALTH

4. Every day in 2017, approximately 810 women died from preventable causes related
to pregnancy and childbirth.
Between 2000 and 2017, the maternal mortality ratio (MMR, number of maternal
deaths per 100,000 live births) dropped by about 38% worldwide.
94% of all maternal deaths occur in low and lower middle-income countries like
Afghanistan, Benin, Burika Faso, Burundi Bangladesh, Bhutan, Cambodia, etc.
Young adolescents (ages 10-14) face a higher risk of complications and death as a
result of pregnancy than other women.
INDICATORS OF MATERNAL HEALTH

5. Sr.No Indicator
NFHS 3
(2005-06)
NFHS 4
(2014-15)
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/other health personnel
within 2 days of delivery (%)
34.6 62.4
5 Institutional births (%) 38.7 78.9
Maternal health indicators

6. MMR/ 1lakh live births
(2017)
• 130India
• 122Punjab
• 130Ludhiana
• 63Tamil Nadu
• 42Kerala
• 87Gujarat
• 140Jammu &
Kashmir
• 229Assam
• 55Maharashtra

7. Maternal
Health
Poverty
Limited
access to
healthcare
HIV/AIDS
Oral
problems
Obesity
FACTORS AFFECTING MATERNAL
HEALTH

8. Hemorrhage (PPH)
Hypertension (eclampsia)
Consequences of unsafe abortion
Improper health seeking behavior
Unskilled birth attendants
Obstructed labor
CAUSES OF MATERNAL MORTALITY

9. •Government of India adopted 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 :
PROPOSED SOLUTION

10. REPRODUCTIVE
HEALTH
MATERNAL
HEALTH
NEONATAL
HEALTH
THEMATIC AREAS/ 5 PILLARS
CHILD
HEALTH
ADOLESCENT
HEALTH

11. Quality
service
provision
Technical
guidelines &
Service
delivery
guidelines
Strategies/
Intervention
Newer
intervention
AREAS OF WORK

12. Quality
service
provision
Quality
antenatal
care
Essential
obstetric
care
during
delivery
Postnatal
care of
mother
and
women
Provision
of
emergency
care at
FRU
Referral
services at
both
community
and
institutional
level
Quality service provision

13. Skilled birth attendant at birth
Dakshata
TECHNICAL GUIDELINES & SERVICE DELIVERY
GUIDELINES

14. Launched In: 30 April, 2015
Aim: Improving the quality of care during intrapartum and immediate postpartum
period across delivery points in the country.
Implemented: Currently, Dakshata is being implemented in more than 1500
facilities in seven states of the country.
Facilities: 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.
States: Jharkhand, Kerala MP, Orissa, Rajasthan.
DAKSHATA

15. DAKSHATA
5 DAYS PROGRAMME

16. Day-3
Assessment of cervical dilatation and effacement,
Normal delivery, essential newborn care
Active management of 3rd stage of labor, newborn
weighing, neonatal resuscitation,
Day-2
Pregnancy detection test, hb test, urine test, RDD for
malaria, Using bag and mask
Abdominal palpation, Auscultation of FHS, plotting
Partograph, organizing LR
Day- 1
PPE, Hand washing, EDD calculation,
Ht., Wt., BP monitoring & recording Processing of
equipment

17. Day- 5
Administration of Magnesium Sulfate
for severe eclampsia and pre- eclampsia
IUCD
Day- 4
Management of Shock, Bf, KMC Using a nebulizer Management of PPH

18. DAKSHATA

19. Resources
availability
Improved
monitoring
and
accountability
Strategy for
transfer of
learning
Focused
customized
training
PILLARS OF
DAKSHATA

20. LaQshya
Janani
suraksha
yojana
Pradhan
Mantri
Shurakshit
Matritva
Abhiyan
Comprehensi
ve abortion
care services
Janani Shishu
Suraksha
Karyakaram
Provision of
RTI/STI
services
Village health
and nutrition
day
STRATEGIES/ INTERVENTIONS
(Flagship Programme)

22. Launched On: April 2005 a demand promotion and conditional
cash transfer scheme
Objective: To reducing the Maternal and neonatal Mortality by
promoting institutional delivery among poor pregnant women.
JANANI SURAKSHA
YOJANA

23.  Facilities:
 special dispensation for states having low institutional delivery rates namely the states
of Uttar Pradesh, Uttaranchal, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam,
Rajasthan, Orissa and Jammu and Kashmir.
Tracking Each Pregnancy: Each beneficiary registered under this Yojana should have
a JSY card along with a MCH card. ASHA/AWW/ any other identified link worker
under the overall supervision of the ANM and the MO, PHC should mandatorily
prepare a micro-birth plan. This will effectively help in monitoring Antenatal Check-
up, and the post delivery care.
Eligibility for Cash Assistance: BPL Certification – This is required in all HPS
states. However, where BPL cards have not yet been issued or have not been updated,
States/UTs would formulate a simple criterion for certification of poor and needy status
of the expectant mother’s family by empowering the gram Pradhan or ward member.
JANANI SURAKSHA
YOJANA

25. Launched on: 1st June, 2011
Objective: To provide free institutional deliveries (normal as well as Cesarean) for
all pregnant women all pregnant women.
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.
JANANI SHISHU
SURAKSHA YOJANA

26. PMSMA

28. Launched in: 2016
Aim: to ensure quality antenatal care and high risk pregnancy detection in pregnant
women on 9th of every month.
Initiatives: Antenatal checkup services would be provided by OBGY specialists /
Radiologist/physicians with support from private sector doctors
•A minimum package of antenatal care services (including investigations and drugs) would be
provided to the beneficiaries on the 9th day of every month at identified public health facilities
(PHCs/ CHCs, DHs/ urban health facilities etc) in both urban and rural areas in addition to the
routine ANC at the health facility/ outreach.
•While the target would reach out to all pregnant women, special efforts would be made to
reach out to women who have not registered for ANC (left out/missed ANC) and also those
who have registered but not availed ANC services (dropout) as well as High Risk pregnant
women.
PMSMA

29. OBGY specialists/ Radiologist/physicians from private sector would be encouraged to provide
voluntary services at public health facilities where government sector practitioners are not available
or inadequate.
Pregnant women would be given Mother and Child Protection Cards and safe motherhood booklets.
One of the critical components of the Abhiyan is identification and follow up of high risk
pregnancies. A sticker indicating the condition and risk factor of the pregnant women would be added
onto MCP card for each visit:
 Green Sticker- for women with no risk factor detected
 Red Sticker – for women with high risk pregnancy
•A National Portal for PMSMA and a Mobile application have been developed to facilitate the
engagement of private/ voluntary sector.
•‘IPledgeFor9’ Achievers Awards have been devised to celebrate individual and team achievements
and acknowledge voluntary contributions for PMSMA in states and districts across India.
PMSMA

30. Aim: In order to further accelerate decline in MMR in the coming years, MoFHW has
recently launched 'LaQshya - Labor room Quality improvement Initiative.
LaQshya program is a focused and targeted approach to strengthen key processes related
to the labor rooms and maternity operation theatres which aims at improving quality of
care around birth and ensuring Respectful Maternity Care.
LaQshya

31. LAQSHYA

33.  Comprehensive and safe abortion services are provided at public health facilities including 24*7 PHCs/ FRUs
(DHs/ SDHs /CHCs) including the Delivery Points.
 Supply of Nischay Pregnancy detection kits to sub centres for early detection of pregnancy is undertaken .
Capacity Building of Medical officers is being carried out routinely in safe MTP Techniques. ANMs, ASHAs and
other field functionaries are trained to provide confidential counselling for MTP and promote post-abortion care
including adoption of contraception.
Routine orientation and training of ASHAs to equip them with skills to create awareness on abortion issues in the
community and facilitation of women's access to services.
District Level Committees (DLCs) have been framed and empowered for accreditation the facilities for conducting
safe abortion services under MTP Act including approval of private and NGO sector facilities for conducting MTPs.
Regular monitoring and evaluation of the services are being conducted.
COMPREHENSIVE ABORTION CARE
SERVICES

35. Strategy: to prevent HIV transmission and to promote sexual and
reproductive health services in all the FRUs, CHCs and at 24 X 7 PHCs.
PROVISION OF RTI/STI SERVICES

36. VILLAGE HEALTH AND NUTRITION DAY

37.  Village Health & Nutrition Day (VHNDs) are being organized at
Anganwadi center at least once every month.
It is a platform to provide ante natal/ post partum care for pregnant
women, promote institutional delivery, immunization, Family Planning
& nutritional counseling.
VILLAGE HEALTH AND NUTRITION DAY

38. • Delivery
Points
• Obst.
HDU/ ICU
• MCH
Wings
Infra-
structure
• MCP Card
• RCH
Portal
• MDSR/
MCIS
Portal
Information
system for
maternal
health
NEWER INTERVENTIONS

39. Delivery Points
Obstetric
HDU/ICU
MCH Wings
INFRASTRUCTURE

40. MDSR
RCH
portal
MCP
card
INFORMATION SYSTEM FOR
MATERNAL HEALTH