The document discusses reproductive health and maternal and child health care in India. It defines reproductive health and outlines key milestones in MCH care such as establishment of training for birth attendants in 1880 and adoption of the family planning program in 1952. The document also summarizes the Reproductive and Child Health Program Phase 1 and 2, which adopted a holistic, community-based approach. The strategies of RCH-II aimed to reduce maternal and infant mortality through improved access to skilled care, immunization, and cash incentive programs like Janani Suraksha Yojana.

2. DEFINITION OF REPRODUCTIVE
HEALTH
 Reproductive health can be defined as:
 A state in which people have the ability to
reproduce and regulate their fertility,
 women are able to go through pregnancy and child
birth safely,
 The outcome of pregnancy is successful in terms of
maternal and infant survival and well being, and
 couples are able to have sexual relations free of
the fear of pregnancy and of contracting diseases

3. MILESTONES IN MCH CARE IN
INDIA
 1880 –Establishment of training of Dais in
Amritsar.
 1902 - 1st midwifery act to promote safe
delivery.
 1930 - Setting up of advisory committee on
maternal mortality.
 1946 - Bhore committee recommendation on
comprehensive & integrated health care.
 1952 –Primary health centre net work & family
planning program.

4. MILESTONES IN MCH CARE IN
INDIA
 1956 –Family planning program was adopted by govt. of India
 1961- MCH centers become integral parts of
PHCs.
 1971 – MTP act
 1974 – Family planning services incorporated
in MCH care.
 1977 – Renaming family planning to family
welfare.
 1978 – Expanded program of immunization.
 1985 – Universal immunization programme.
 1992 – Child survival & safe motherhood programme.

5. MILESTONES IN MCH CARE IN
INDIA
 1993 -National development committee report
 1994 -International conference on population
development (ICPD),Cairo, Egypt.
 1996 – Target free approach,
Review of safe motherhood component of
CSSM.
 1997 – RCH PROGRAMME PHASE-1
 2005 – RCH PROGRAMME PHASE-2

6. International conference on population
and development (ICPD)1994,Cairo.
RECOMMENDATIONS
 Holistic reproductive health care should be made
available through primary health care system.
 Efforts should be made by all the states to reduce infant
mortality by 50% by 2000AD
 Need assessment & need fulfillment as key elements
for improving reproductive health.

7. DEFINITION OF MATERNAL
MORTALITY
 Death of a woman while pregnant or
with in 42 days of termination of
pregnancy irrespective of duration &
site of pregnancy from any cause
related to or aggravated by
pregnancy or its management but
not from accidental or incidental
causes.

8. MAJOR CAUSES OF MMR
DIRECT CAUSES
 HEMORRHAGE – 29.6%
 PUERPERAL COMPLICATION – 16.1%
 OBSTRUCTED LABOUR – 9.5%
 ABORTIONS – 8.9%
 TOXAEMIA OF PREGNANCY 8.3%
INDIRECT CAUSES
 Anemia
 Pregnancy with TB
 Pregnancy with malaria
 Pregnancy with viral hepatitis

9. DISPARITY OF MATERNAL DEATH
BETWEEN DEVELOPED & DEVELOPING
COUNTRIES
 Barrier to receive timely & good quality care
 Barrier of availability and accessibility of
services
 Political barrier
 Geographical barrier
 Cultural barrier
 Women’s literacy and women empowerment
 Time barrier
 Economic barrier

10. DISPARITY OF MATERNAL DEATH
BETWEEN DEVELOPED & DEVELOPING
COUNTRIES
 Barrier to have health personnel at grass root
level
 Targets/Incentives distorted the program
implementation
 Top down approach which were never
appreciated by people and workers
 Gaps between infrastructure and in outreach
services
 The choice of contraceptives were limited.
 Training and reorientation program of staff is
not uniform through-out the country

11. EMERGENCE OF RCH PROGRAM
DEPARTMENT OF
FAMILYWELFARE
(SECTORAL REVIEW)
CHANGES IN IMPLEMENTATION
OF FAMILY WELFARE PROGRAM
(SHIFT ADDRESSED TO MCH
SERVICES)
NATIONAL FAMILY
WELFARE CHANGED TO
RCH (1997)

12. PARADIGM SHIFT
 Govt. of India has brought paradigm shift
in the mother and child health policy and
accepted RCH program
LIFE CYCLE APPROACH

13. DEFINITION OF PARADIGM SHIFT
 It is a set of concepts ,methods, and
assumptions shared by the community of
scientists and guiding research in their
discipline.
 It shifted the program to quality , client
oriented , community responsive and
towards the overall development of
women and child securing their rights.

14. LIFE CYCLE APPROACH
CHILDHOOD
HEALTH
ADOLOSCENT
HEALTH
REPRODUCTI
VE HEALTH
HEALTHY
PREGNANCY
GOOD
HEALTH TO
NEXT
GENERATION

15. RCH-II - 1/4/2005

16. VISION FOR RCH-II
To bring about outcomes as envisioned in the :-
 Millennium Development Goals
 The National Population Policy 2000 (NPP 2000)
Goals
 The Tenth Plan Goals
 The National Health Policy 2002
 Vision 2020 India

17. COMPONENTS OF RCH
 Bottom-up planning
 Community need assessment approach
 Decentralized participatory planning &
implementation
 Strengthening infrastructure
 Integrated training package
 Improved management system
Interventions
 Monitoring & evaluation

18. STRATEGIES OF RCH-II
 Population stabilization:-
 TFR of 2.2
 Achieve universal coverage of contraceptives
 Promote an expanded basket of contraceptive
choice
 Focused & integrated BCC
 Expanded MTP facilities
 Increasing male involvement
 Easy access of services
 Encourage public-private partnership
 Intensified monitoring

19. STRATEGIES OF RCH-II
 Maternal health
 Goal:- MMR<100per lakh live births and
institutional deliveries to 80% by 2010
 OBJECTIVES:-
 Improve access to skilled care and
emergency obstetric care
 Improve coverage and quality of
antenatal care
 Increasing coverage of postpartum
care.

20. STRATEGIES TO REDUCE MMR
 Increasing number of facilities offering
safe delivery , emergency obstetric care
and demand for these services by two
levels of institutions :-
a) PHC & CHCs(basic emergency obstetric
care )
b) FRUs (Comprehensive emergency care)

21. STRATEGIES TO REDUCE MMR
 Operationalization of all CHCs and at
least 50% of PHCs to provide 24hr
services to provide 24hr delivery & basic
emergency obstetric care by 2010.
 Operationalization of comprehensive
emergency obstetric care at 2000 FRUs by
2010
 Ensuring access to safe blood at all
district hospitals and FRUs.

22. STRATEGIES TO REDUCE MMR
 Training of Medical officers in
Anesthesia for EmOC.
 Training MBBS medical officers in
caesarean section .
 Providing EmOC services to BPL
families at recognized private facilities.

23. Other recommendations to
reduce MMR:-
 Transfer specialists.
 Use telecommunication systems to improve
referral system
 Provide incentives to doctors & staff to work
at PHCs/ CHCs/ FRUs providing 24hrs
services.
 Untied funds to medical officers and ANMs.
 Encourage establishment of maternity
hospitals/ nursing homes in small towns and
private sectors.

24. FRUs (Package of services)
 Vacuum extractions
 Administration of Anesthesia
 Blood transfusion
 Caesarean section
 Manual removal of placenta
 Suction curettage for incomplete abortion
 Insert intrauterine devices
 Sterilization operation e.g. Vasectomy &
Tubectomy.

25. SAFE MEDICAL TERMINATION
OF PREGNANCY
COMMUNITY LEVEL:-
 Spread awareness of safe MTP and
availability of services thereof
 Enhance access to confidential counseling,
by ANM, AWW, and link volunteers
 Promote post-abortions care by ANM, link
volunteers and AWWs

26. SAFE MEDICAL TERMINATION OF
PREGNANCY
FACILITY LEVEL:-
 Provide quality Manual Vacuum
Aspiration (MVA) facility at all CHCs and
at least 50% PHCs that are being
strengthened for 24 hr delivery services.
 Provide comprehensive & high quality
MTP services at all FRUs
 Encourage private sector & NGO to
establish quality MTP services.

27. BEHAVIOURAL CHANGE
COMMUNICATION(BCC)
1. Social mobilization activities against female
infanticide and feticide by preventive
counseling.
2. Formation of Block, District level committees
for saving female babies.
3. Telecasting of TV serials, Radio broadcasts, wall
paintings, hoardings and glow signs for
popularizing health and reproductive health
messages in important places.

28. JANANI SURAKSHA YOJNA
Started under NRHM On 12th April 2005
with the objectives
 To reduce maternal mortality
 To reduce neo-natal mortality
AIM:_
To promote institutional deliveries by
cash incentives

29. ELIGIBILITY FOR CASH
INCENTIVES
 LPS:-All pregnant women delivering in
government health centers like sub-center
/PHCs/CHCs/FRUs/General wards of
district and state hospitals or accredited
private hospital
 HPS:-BPL pregnant women ,aged 19 years
and above.
 LPS & HPS:-All SC & ST women delivering
in a govt. health centers.

30. CASH ASSISTANCE FOR
INSTITUTIONALISED
DELIVERIES
CATEGORY RURAL AREAS TOTAL
RS.
MOTHERS’ PACKAGE ASHA’s PACKAGE
LPS 1400 600 2000
HPS 700 -- 700

31. CASH ASSISTANCE FOR
INSTITUTIONALISED
DELIVERIES
CATEGORY URBAN AREAS TOTAL
RS.
MOTHERS’ PACKAGE ASHA’s PACKAGE
LPS 1000 200 1200
HPS 600 600

32. ANTENATAL CARE
 Early registration of pregnancies (12 – 16
weeks)
 Minimum 3 antenatal visits (20,32,36 weeks)
 Anemia prophylaxis
 Two doses of TT
 Minimum investigations( Weight, B.P., Blood
group, Rh typing, Urine examination, VDRL,
HIV

33. ANTENATAL CARE
 Identification of high risk group, Early
detection of complication of pregnancy &
timely , safely referral to FRU
 Treatment of worm infestation with
Mebendazole
 Health education on diet, breast feeding, care
of breast, personnel hygiene during
pregnancy,& family planning

34. STRATEGIES OF RCH-II
RTI AND STD SERVICES
 Strengthening of laboratories for prompt
diagnosis and treatment.
 Preventive activities such as training
,awareness campaigns and drugs are
made available.
 Syndromic approach has been adopted for
diagnosis and treatment of RTI & STIs

35. STRATEGIES OF RCH-II
NEWBORN & CHILD HEALTH
 Reduce IMR to 30per 1000 live births and
neonatal mortality rate (NMR) to below 20
per 1000 live births by 2010.
 IMNCI approach
 Intrapartum and immediate newborn care .
 Early newborn care and
 Late newborn care
 Early diagnosis of dehydration
 Treatment with oral rehydration solution

36. STRATEGIES OF RCH-II
NEWBORN AND CHILD HEALTH
 Management of acute respiratory
infections
 Exclusive breast feeding for 6 months
 Introduction of complementary food
 Prophylactic vitamin A to prevent
blindness in children

37. STRATEGIES OF RCH-II
UNIVERSAL IMMUNISATION OF POLIO
 Routine immunization
 National immunization days
 Surveillance of acute flaccid paralysis
 Conduct extensive house to house immunization
mopping –up campaigns

38. STRATEGIES OF RCH-II
ADOLOSCENT HEALTH
 Counseling services regarding:
 Family planning methods
 Sexual health
 Nutrition
 Drug addiction

39. URBAN HEALTH
 To provide an integrated and sustainable
primary health care service delivery system
TRIBAL HEALTH
 The tribal population in India is
socioeconomically disadvantaged so basic
health and RCH services need to be
integrated in the overall development of
tribal areas.
 More emphasis is given to north-eastern
states

40. TRAINING
1. Skill up gradation training with focus on
improving/upgrading the skills of health care
providers.
2. Integrated skill training for peripheral health
functionaries such as LHVs, PHNs, medical officers
and health inspectors.
3. Improving managerial and communication skills
of health staff.

41. HEALTH MANAGEMENT
INFORMATION SYSTEMS
 Introduction of IT-enabled HMIS for
planning and monitoring health services at
the State/District /Block levels

42. STRENGTHENING OF
TEACHING INSTITUTIONS
 Strengthening the facilities at teaching
institutions for providing optimum obstetric,
family welfare, neonatal child health
services.

43. ESTABLISHING URBAN
HEALTH POSTS
 To provide an integrated and sustainable
system for primary health care service
delivery catering to the requirements of
urban slum population and other vulnerable
groups

44. PUBLIC- PRIVATE PARTNERSHIP
 NGOs , private practitioners, hospitals,
and other health institutions are
involved for providing MCH services.
e.g. VANDAE MATRAM SCHEME

45. VANDAE MATRAM SCHEME
 The scheme is continuing under Public Private
Partnership with the involvement of
Federation of Obstetric and Gynecological
Society of India and Private Clinics.
 Aim of the scheme :- Reduce the maternal
mortality and morbidity of the pregnant and
expectant mothers
 The scheme intends to provide free antenatal
and postnatal check, counseling on nutrition,
breastfeeding, spacing of birth etc. through
public private partnership.

46. VANDAE MATRAM SCHEME
 A voluntary scheme wherein any OBG specialist, maternity
home, nursing home can volunteer themselves in joining
the scheme
 Any lady doctor/MBBS doctor providing safe motherhood
services can also volunteer to join this scheme. The
enrolled ‘Vandematram’ doctors will display
‘Vandematram’ logo in their clinic, Iron and Folic Acid
Tablets, oral pills, TT injections etc. will be provided by the
respective District Medical Officers to the ‘Vandematram’
doctors/clinics for free distributions to beneficiaries.
 Referral services are also provided for special cases to
govt. hospital.

47. COMMUNITY PARTICIPATION
 Elected representatives and the civil
societies are involved for planning and
monitoring of RCH services.

48. ROLE OF A NURSE

49. ROLE OF NURSE IN RCH SERVICES
1. Assessment of the community.
2. IEC services regarding :-
 Prevention of complication and promotion of health
of mother and child.
 Various services provided by the govt.
 Awareness about different diseases.
3. Gathering data regarding:-
 New births or conceptions in the village
 Surveillance of cases of measles, diarrhea and
pneumonia ,RTI/STIs and other diseases
 Cases of polio or a neonatal death

50. ROLE OF NURSE IN RCH SERVICES
 ANC registration
 Early registration (less than 16 weeks)
 Providing complete immunization during antenatal
period
 Providing IFA prophylaxis to avoid complications.
 Ensuring minimum 3 antenatal visits
 Conduction of ANCs clinics
 Performing ANCs examinations

51. ROLE OF NURSE IN RCH SERVICES
 Enforcing Institutional deliveries
 Deliveries by trained person
 Providing postnatal care by giving
minimum 3 visits
 MTPs referral services

52. ROLE OF NURSE IN RCH SERVICES
ASSESSMENT OF INFANT /CHILD ACCORDING
TO IMNCI
 Special care to birth weight below 2.5 kg
 High risk newborn referred
 Conduction of immunization session
 Ensuring Children should be fully
immunized as per age.

53. ROLE OF NURSE IN RCH SERVICES
REFERRAL SERVICES
 RTI/STD referred
 Gynecological problems referred
 Infertility cases referred

54. ROLE OF NURSE IN RCH SERVICES
MAINTAING OF RECORDS
 Records of Vital events
- Live births
- Neonatal deaths (under 28 days)
- Infant deaths (under 1 year)
- Child (1-5) death
- Maternal deaths
- Marriage
- Marriage of girls below 18 years