This document summarizes maternal and child health issues. It defines maternal mortality as death during pregnancy or within 42 days of termination from pregnancy-related causes. The main causes of high maternal mortality in India are anemia, lack of antenatal screening, 30% of women needing emergency care during delivery due to risk factors, and delays in reaching hospitals. It also defines perinatal morbidity and mortality, including neonatal mortality (death in first 28 days) and stillbirths (death after 28 weeks). The major causes of perinatal problems are maternal medical conditions, pregnancy complications, infections, and birth injuries. Developing countries have much higher rates of maternal death, around 1 in 11 women, compared to 1 in 5000 in developed

1. Epidemiological aspects of maternal & child hssealth
The role played by various studies and reports in developing a detailed plan foe
combating the different aspects of mortality and morbidity is invaluable .
1)Maternal Mortality
the WHO defines maternal death as.
The death of a woman while pregnant or within 42 days of termination of pregnancy,
irrespective of the duration and site of the pregnancy, fro many cause related to or
aggravated by the pregnancy or its management, but not from accident or incidental
causes.
Maternal mortality ratio :
Number of maternal deaths during a given time – period per 100 000 live births
during the same time period.
Maternalmortality rate :
Number of maternal deaths in a given time period per 100000 woman of
reproductive age during the same time period. Of the estimated total of 536000
maternal deaths world wide in 2005.
Causes of high maternal mortality in India
 Around 30% of all women need emergency care during delivery, due to
associated risk factors.
 Only 35% of all deliveries are conducted by a doctor
 Only 15% of all deliveries are conducted by a nurse, Auxiliary Nurse Midwife
(ANM), Midwife or lady health visitor.
 In urban arias more than 69% of deliveries take place in institutes , but in rural
areas only 30% of deliveries take place in institutes.
 Anemia.
 No antenatal screening.
 Delays in
 Taking decisions.
 Reaching hospital.

2. 2)Perinatal Morbidity
Perinatal Morbidity can be defined as an disorder affecting the neonate, child or
family, which occurs as a consequenceof adverse effects during pregnancy or due to
treatments given to the pregnant mother, which influence the fetus antenatally or
immediately after birth.
Perinatal Mortality
The term perinatal mortality includes both deaths in the 1st week of life (neonatal
mortality) and fetal deaths (stillbirths).
The perinatal mortality rate is determined by diving the number of perinatal deaths
(stillbirths and early neonatal deaths) by either the number of live births or by the sum
of live births and stillbirth
1) neonatalmortality
Number of deaths during the first 28 completed days of life per 1000 live births in a
given year or period.
Early Neonataldeaths may be subdivided into early neonatal deaths occurring
during the first 7 day of life,
late neonatal deaths occurring after the 7th day but before the 28 comletad days of
life
2)still births
A still birth is a birth of a newborn after 28th completed week when the baby does not
breathe or show any sign of life after delivery
Causes ofPerinatalMorbidity and Mortality
Perinatal morbidity and mortality could be a consequenceof maternal factors or
events at labour and delivery. Some of the important causes are enlisted below:
1. Maternal conditions include:

3. a. Medical conditions complicating pregnancy like anaemia, chronic
hypertension, chronicrheumatic heart diseases, chronic nephrities and
diabetes mellitus.
b. Pregnancy-related complications like hyperemesis gravidarum, preterm
labour, toxaemia of pregnancy, gestational diabetes and antepartum
haemorrhage.
c. Perinatal infections, including due to toxoplasma, rubella,
cytomegalovirus, herpes simplex and syphilis.
d. Subtance abuse and injury.
2. Events during labour and delivery including birth injury and birth asphyxia.
Magnitude of maternal & child health problems
One woman in 11 dies of pregnancy related complications in developing countries
,compared to 1 in 5000 in developed countries.
Magnitude of maternal proplems
classification
Direct indirect nonspecific
1) Direct obstetric deaths (75%)
Are those resulting from complication of pregnancy,delivery or their
management e.g .
-abortion
-ectopic pregnancy
-pre-eclampsia
-eclampsia
-antepartum & postpartum heamorrhage
-puerperal sepsis

4. 2) indirect obstetric deaths (25%)
Include conditions present before or developed during pregnancy but aggravated
by physiological effects of pregnancy& labour
-aneamia
-cardiac disease
-diabetes
-hepatitis
3)non –obstetric deaths
Accidents or other infectious diseases
Magnitude of child health problems
The major health problem in the developing country arises from the synergistic effect
of malnutrition , infection etc.
classification
Infections birth asphyxia preterm birth congenital malformations
1)Infections(33%)
-Sepsis
-Meningitis
-neonatal tetanus
-congenital syphilis
2) birth asphyxia(28%)
3)preterm birth & low birth weight (24%)
4) congenital malformation & others (15%)
It is the magnitude of maternal & child health problems