This document discusses maternal and child health (MCH) care. It notes that the health of mothers and children are closely linked, and certain interventions like tetanus toxoid immunization jointly protect both. MCH care aims to reduce mortality and morbidity for mothers, newborns, and children under 15, who make up 60-70% of the population. Key challenges to MCH in India include lack of universal access to services, rural-urban differences, women's status, and lack of political will. The document outlines opportunities like continuum of care from pregnancy to early childhood through community-based services.

1. Maternal & Child Health
(MCH Care)
DR. Jagannath S Shete
Assistant Professor, Community Medicine,
DYPMC, Kolhapur

2. Mother and Child: A Single Entity
• Health of the child and the mother are so closely linked that
each has the capacity to influence the other. The outcome of
pregnancy in terms of a healthy newborn is dependent on the
physical, physiological, mental and nutritional state of the
mother during pregnancy. Some specific health interventions
jointly protect pregnant women and their babies for e.g.
Tetanus toxoid immunization and nutrition supplementation.

3. Why So Much Attention to
This Issue?
• Together, mothers (women 15-45 years of age) and children
(under 15 years of age) constitute 60%-70% of the population.
They also belong to the most vulnerable section of society in
terms of death, disease, disability and gender discrimination.
Women and Children represent economically dependent and
least empowered section of the society
• Most of the deaths and illnesses in these groups are avoidable
by cost effective interventions.

4. Scenario of Maternal and
Child Health
• Global Picture: 211 million pregnancies that occur each year,
about 46 million end in induced abortion.
• unpredicted deaths occur during pregnancy itself (as a
consequence of unsafe abortion), during childbirth, or after
the baby has been born due to blood loss and infections. The
5,29,000 annual maternal deaths, including 68,000 deaths
attributable to unsafe abortion.
• Each year 3.3 million babies are stillborn, more than 4 million
(neonatal deaths) are dying within 28 days of coming into the
world, and a further 6.6 million young children die before
their fifth birthday. Over 300 million women in the world
currently suffer from long-term or short-term illness brought
about by pregnancy or childbirth.

5. • India
• country has a falling low sex ratio of 933 female per thousand
male. Early marriage in women and universality of marriage
are important social issues. The median age at first marriage
among women is 17.2 years
• Poor knowledge about temporary contraceptive methods and
this coupled with poor availability affects ‘delaying the first
and spacing the second child’ doctrine adversely. Less than
half of women receive antenatal care during the first trimester
of pregnancy.
• Three out of every ten births in India take place at home.
More than one third were delivered by a Traditional Birth
Attendant. A Disposable Delivery Kit (DDK) is being used only
in 20%-30% of births taking place at home. Only 37 percent of
mothers had a postnatal checkup within 2 days of birth.

6. • Infant mortality is 77 per 1,000 for teenage mothers,
compared with 50 for mothers age 20-29. Infant mortality in
rural areas is 50 percent higher than in urban areas. Less than
half (44%) of children 12-23 months are fully vaccinated
against the six major childhood illnesses.
• only 46 percent of children under 6 months are exclusively
breastfed. Many infants are deprived of the highly nutritious
first milk (colostrum) as only 55 percent are put to the breast
within the first day of life. Among children between the ages
of 6 and 59 months, about 70 percent are anaemic including
three percent who suffer from severe anaemia.

7. Challenges in MCH
• The challenges include lack of universalisation of services,
rural urban differentiation, poor status of women in society,
lack of political/administrative will and acceptance of the
issue as a social priority.
• The main challenge to child survival is ensuring that the
services and education required for these solutions reach the
most marginalized countries and communities.

8. Opportunities in MCH
• Continuum of Care : The continuum consists of a focus on
two dimensions to provide essential primary-health-care
services:
• Time: There is a need to ensure essential services (for
mothers-ANC registration, Nutritional supplements, Delivery
services and for children-Breastfeeding, vaccination,
Nutritional supplements, Growth monitoring) for mothers and
children during pregnancy, childbirth, the postpartum period,
infancy and early childhood
• Place: Linking the delivery of essential services in primary-
health-care system that integrates home, community,
outreach and facility-based care.

9. Objectives

10. MCH Problems
• In developed countries congenital malformations, genetic and
behavioural problems .
• In developing countries like India, maternal and child mortality
and morbidity, spacing of pregnancies, family size,
communicable diseases, nutrition, acceptance of health
practices. Main triad malnutrition, infection, uncontrolled
reproduction
• 1) Malnutrition: like Iceberg. pregnant women, nursing
mothers, children are vulnerable. Maternal malnutrition results
in toxemia of pregnancies, anemia, PPH, LBW babies leading to
high maternal mortality & morbidity. Intrauterine period and
period of weaning are also imp time regarding nutrition and
have effects on both mother & baby.
• Nutrition promotion activities and protection essential activity

11. • Measures to improve nutrition:
• Direct interventions- supplementary feedings, Iron & folic acid
tablets, food fortification & enrichment, nutritional education
• Indirect interventions- not specifically related to nutrition,
control of communicable diseases, immunization, environmental
sanitation, clean drinking water, family planning, food hygiene,
education, primary health care.
• 2) Infection: maternal infection has adverse effects as foetal
growth retardation, LBW baby, abortion, anomalies, sepsis. Baby
may get infection during pregnancy/ delivery. Diarrhoea, ARI,
skin infections, TB, malaria. Infection precipitate PEM and
anemia.
• Prevention, early detection & treatment of infections,
immunization, TT during pregnancy, education of mothers
related to nutrition, hygiene, sanitation measures.

12. • 3) Uncontrolled reproduction: due to unregulated fertility,
increase no. of LBW babies, anemia, abortion, APH, PPH, high
MMR & IMR, high under 5 mortality.
• Measures are, Integrated family planning, new contraceptives,
safe MTP methods, OCPills, utilization of family planning
services, education.
• Maternal and child health: promotive, preventive, curative,
rehabilitative health care for mothers & children. It also
includes family planning, school health, handicapped children,
adolescence health.
• Objectives: 1.reduction of maternal, perinatal, infant,
childhood mortality & morbidity, 2. promotion of
reproductive health, 3. promotion of physical & psychological
development of child and adolescents in family.