MATERNAL AND CHILD HEALTH

(MCH)

Dr. Shabnam Imam

Assistant Professor

Dept. of Community Medicine

BMCH
MATERNAL AND CHILD HEALTH CARE
(MCHC)

• MCH care refers to promotive,

preventive, curative and
rehabilitative health care for the
mother and children.
Components of MCH Service (Sub-areas):

 Maternal health.
 Child health.
 Family planning.
 School health service.
 Care of the handicapped children.
 Adolescent health care.
 Health care of the children in special
settings like day care centre.
 Specific objectives:
• Reduction of maternal, perinatal, infant and
childhood mortality & morbidity.
• Promotion of reproductive health.

• Promotion of physical, psychological & social

development of the children and adolescents
within the family.
 Ultimate objective:-

• To ensure life long health.

 What is MCH package?

• It is the strategy to provide an integrated

mother and child health service which is

based on the principles of primary health care

that is equity, intersectoral co-ordination and

community participation.
MCH Package MCH

Consists of

Promotive, preventive, curative and certain aspects of

rehabilitative services based on principles of PHC

Directed to the triad of

Malnutrition Infection Unregulated fertility

 Services of MCH package:
- Ante-natal service.
- Safe delivery.
- Postnatal care.
- Immunization.
- Vitamin –A capsule distribution.
- Distribution of oral rehydration salt.
- Health and family planning service.
- Follow up of the clients.
- Health education.
Why mother & child is in one unit?

 During the ante-natal period the

fetus the part of mother.

During this period the fetus gets all

the necessary supplies of nutrients
and oxygen from mother’s blood.
Why mother & child is in one unit?

 Child’s health is closely related to

maternal health. A healthy mother

gives birth of a healthy baby; there is

less chance of abortion, stillbirth and

premature birth.
Why mother & child is in one unit?

 Certain diseases and conditions of

mother cause deleterious effects to
fetus.

 Drugs to be prescribed for mother’s

also related to the health of the fetus
and infant.
Why mother & child is in one unit?

• After birth, the child is completely

dependent on mother for feeding.
• The physical growth, mental & social
development of the child is also
dependent on mother.
Why mother & child is in one unit?

 During the first few years of life, the

child usually accompanies the mother
during her visit to health facilities and
there are few occasions when services
to mothers and children are not
simultaneously called for.
 Why mother & child is in one unit?

• The mother is the first

teacher of child.
 Maternity Cycle:
Five stages:
• Fertilization.
• Antenatal period/Prenatal period.
• Intranatal period.
• Postnatal period.
• Inter-conceptional period.
 Periods of growth
• 1) Prenatal period :-
a) Ovum (0-14 days)
b) Embryo (14 days to 9 weeks)
c) Fetus ( 9th week to birth)

• 2) Premature infant :- From 28 weeks to 37 weeks

• 3) Full term birth :- avg. 280 days/ 40 weeks

/ 9 months and 7 days.
 Reproductive health:

• Reproductive health is defined as a state of complete

physical, mental and social wellbeing and not merely an

absence of disease or infirmity in all matters related to

reproductive system and its function and process.

Components of Reproductive Health:

• Safe motherhood
• Family planning services
• Prevention & control of RTI/STDs/AIDS.
• Maternal nutrition
• Menstrual regulation and unsafe abortion
• Infertility
• Adolescent care
• Neonatal care
 ANTENATAL CARE:

Antenatal care is the care of the mother

during pregnancy.
 OBJECTIVES OF ANC
1) To promote, protect and
maintain the health of the
mother during pregnancy.

2) To detect high risk mother and

give them special attention.
 OBJECTIVES OF ANC

3) To force complications and

prevent them.

4)To remove anxiety and dread associated

with delivery.
 OBJECTIVES OF ANC
5) To reduce maternal & infant mortality and morbidity.
6) To teach the mother about the elements of child care,
nutrition, personal hygiene and environmental
sanitation.

7) To sensitise the mother to the need for family

planning including advice to cases seeking medical
termination of pregnancy. 8) to attend the under-5
accompanying the mother.
 OBJECTIVES OF ANC
7) To sensitize the mother to the need for
family planning including advice to cases
seeking medical termination of
pregnancy.

8) To attend the under-5 accompanying

the mother.
 ANTENATAL VISITS:
• Regular visits:

- Once in a month upto first 7 months.

- Twice in a month for next one month.

- Once in a week for the rest of the

period.

• So, total regular visit = 14 in number.

 ANTENATAL VISITS:

• Minimum visits:

3 in numbers:
1. At 20 weeks,
2. At 32 weeks
3. At 36 weeks
 Components of ANC

1. Registration of pregnant woman.

2. History taking.

3. Examination .

4. Essential investigation.

5. Prenatal Advice.

6. Specific health protection.

 Registration of pregnant woman

• Includes enrollment of antenatal register in first

contact.
• Each woman is given a registration number to help in
retrieval of records and subsequent follow up.
• Date of first visit is particularly recorded.
 History taking
• Brief menstrual history including the 1st day of
LMP.

• Obstetrical history.

• Relevant medical history.

• Relevant family history.

 Prenatal Examination

• BP.
• Anaemia.
• Jaundice.
• Oedema.
• Cyanosis.
• Height.
• Weight.
• Fundal height etc.
 Examinations during subsequent visits
• BP, anaemia, oedema,

• Weight gain.

• Uterine size (in accordance with period of

amenorrhea or USG),
• Fetal movement, Fetal lie, presentation, and
engagement.
• Lab. tests e.g. Hb estimation ,Urine examination.
 Essential investigations
1. Hb. Estimation.
2. Blood grouping (ABO & Rh).
3. Total blood count if needed.
3. VDRL test.
4. Blood sugar estimation.
5. Blood for HbsAg.
6. Blood for HIV.
7. Complete urine analysis.
 Prenatal advice
• Diet
• Personal hygiene
• Drugs
• Radiation
• Warning signs
• Child care
 Diet
• A balanced & adequate diet.

• Total energy consumption (pregnancy): 80,000

kcal.

• Energy required during pregnancy: 285 kcal/day.

• Total weight gain: 12 – 15 kg; 3 kg in 1st 20 wks.

• Energy required during lactation: 550 kcal/day.

Prenatal Advice -- cont.

Personal hygiene
• Personal cleanliness.
• Rest & sleep.
• Bowel.
• Exercise.
• Smoking.
• Alcohol.
• Dental care.
• Sexual intercourse.
 Drugs
• Thalidomide: Deformed hand & feet
• LSD: Chromosomal damage
• Streptomycin: 8th cranial nerve damage
and deafness
• Iodide content: Congenital goitre
• Corticosteroid: Impaired foetal growth
• Sex hormone: Virilism
• Tetracycline: Bone growth & enamel
formation of teeth
• Anaesthetic: Depressant effect
 Prenatal Advice -- cont.
Radiation

• X-ray abdomen or chest may be associated

with leukemia, other neoplasm, Microcephaly.
 Prenatal Advice -- cont.

Warning sign

(i)Swelling of the feet.

(ii)Fits.
(iii)Headache.
(iv)Blurring of vision.
(v)Per vaginal bleeding or discharge.
(vi)Any other unusual symptoms.
Prenatal Advice -- cont.

Child care
Need for special classes regarding:
• Nutrition education.
• Hygiene.
• Child rearing.
• Cooking demonstration.
• Family planning education
• Family budgets.
 Specific health protection

1. Anaemia:
Effects: Premature birth.
APH, PPH.
Puerperal sepsis.
Thromboembolic phenomena.

Prevention: Iron & Folic acid supplementation.

 Specific health protection
2. Nutritional deficiency :

• Protein, Vitamins and Minerals

( specially vitamin-A, Iodine).

• Prevention: Balanced and adequate diet

intake.
 Specific health protection
3. Toxaemia of pregnancy:

Pre-eclampsia:Hypertension, albuminuria & oedema.

Eclampsia : Addition of convulsion with the features

of PET.

Prevention: Proper antenatal care can minimize the

risk of this condition.
 Specific health protection

4. Tetanus :
2 doses of Tetanus toxoid
1st dose: 16-20 wks.
2nd dose: 20-24 wks.

2nd dose should preferably be given one

month before EDD.
 5. Syphilis :
Primary and secondary syphilis results in:
Spontaneous abortion.
Stillbirth.
Peri-natal death.
Child with congenital syphilis causes neurological
damage with mental retardation.

Fetus get the infection after 6th month of pregnancy.

Late syphilis usually does not infect the foetus.

 Treatment: Injection Procaine penicillin 6 lacs unit,

1 inj. daily for 10 days.

• Prevention: test for syphilis during 1st ANC (VDRL)

 6. German measles:
Rubella in 1st trimester cause :
Spontaneous abortion, Stillbirth, IUD,
Major defects like deafness, cataract and congenital
heart disease.

After 16th week: No major abnormalities.

Prevention :Vaccination of school aged children

women of child bearing age who are sero-negative.
Before vaccination pregnancy should be ruled out
After vaccination 8 weeks contraception is important.
 7. RH status:
Due to foetal haemolysis fetal red cell enter maternal
blood and cause immune response if the mother is
Rh-negative and fetus is Rh-positive.

Clinically haemolytic diseases like hydropes foetalis,

icterus gravis neonatorum & congenital haemolytic
anaemia occur.

Usually the first baby is unaffected.

Prevention: Rh anti-D immunoglobulin should be

given at 28 weeks of gestation & again within 72
hours of delivery.
 8. HIV infection:
The virus may pass to the newborn through placenta,
during delivery or during breast feeding;

About one-third of the children of HIV positive

mothers get infected.

Risk of transmission is higher in newly infected

mothers or in already developed AIDS cases.

Prevention: Prenatal testing for HIV infection for

those with HIV risk & motivation to choose
therapeutic abortion.
 9. Prenatal genetic screening:
 Screening for chromosomal abnormalities
associated with serious birth defects.
 Screening for direct evidence of congenital
structural anomalies, haemoglobinopathies.
 Screening for other inherited conditions e.g.
trisomy-21 (Down’s syndrome) & severe neural
tube defect.

Woman aged 35 years & above are at high risk.

 Ante natal diagnosis

•Alpha fetoprotein
•Ultra sound
•Amniocentesis
•Chorionic villi sampling
 Risk approach
• It is a managerial tool for improved MCH care.
Purpose:
• To provide better services for all.
• To give special attention to those in need most.
• To ensure maximum utilization of all resources
including some human resources.
 High risk mothers
• Elderly primi (35 years and above).
• Early primi (below 18 years ).
• Short statured primi (140 cm and below).
• Ante-partum haemorrhage.
• Threatened abortion.
• Toxaemias of pregnancy (Preeclampsia &
eclampsia).
• Malpresentation.
• Anaemia.
 High risk mothers (cont.)
• Multiple pregnancy.
• Hydramnious.
• Previous history of still birth, IUD, Mannual
removal of placenta.
• Elderly grand multipara.
• Prolonged pregnancy.
• H/o previous caesarean or instrumental delivery.
• Pregnancy associated with general diseases like
CVD, DM, Hypertension, Kidney disease, liver
disease, Tb etc.
 Intra natal Care
INC
Definition

It is the care of the mother during delivery.

The period extends from true labour pain to

delivery of the placenta.

Rooming-in

Keeping the baby’s crib by the side of the

mother’s bed is called rooming-in.
 Intra natal Care
Aim INC

(i) Thorough asepsis

(ii) Delivery without injury (prevention of injury) to the
infant & mother
(iii)Readiness to deal with complications e.g. prolonged
labour, APH, convulsions, malpresentation, prolapse
of the cord
(iv)Care of the baby at delivery.

Principles: 3 cleans

“clean hand – clean cut – clean surface”

 Intra natal Care INC

Domiciliary Care

When mothers with normal obstetric history

have their confinement in their own homes
conducted by the female health worker or trained
dai (TTBA), provided the home conditions are
satisfactory.
 INC
Domiciliary Care - cont.
Advantages

• Familiar surroundings in the home removes

the fear associated with delivery.
• No chance of cross infections.
• The mother is able to keep eye on the other
children & domestic affairs.
• Eases mental tension.
Domiciliary Care - cont. INC

Disadvantage

•May have less medical & nursing supervision

•May have less rest
•May resume her domestic duties too soon
•Her diet may be neglected.
 Institutional Care INC

This care is provided

When deliveries tend to be abnormal
and difficult requiring the services of
the doctor.
Where home conditions are unsuitable.

Usually Institutional Care is carried out at

different hospital settings, clinics, health
centers etc.
 Danger signals INC

a) Sluggish or no pain after rupture membrane.

b) Good pain after rupture membrane but no progress.
c) Prolapse cord or hand.
d) Meconium stained liquor.
e) Slow irregular or excessively fast foetal heart.
f) Excessive ‘show’ or bleeding during labour.
g) Placenta not separated within ½ hour after delivery.
h) PPH or collapse.
i) Temperature 38ºc or more during labour.
 Postnatal (partal) Care

Care of the mother along with the newborn after

delivery is known as Post natal care.

The period extends up to 42 days, from the

delivery of the placenta.

Perinatology

The combined responsibility of the obstetrician and

paediatrician (for mother & newborn) is known as
perinatology.
Objectives of PNC

a) To prevent complications of the postpartal period.

b) To provide care for the rapid restoration of the mother
to optimum health.
c) To check adequacy of breast feeding.
d) To provide family planning services .
e) To provide basic health education to mother & family.
 Complications of Postnatal period

1. Puerperal sepsis:
Infection of the genital tract within 3 weeks (21
days) after delivery.
• Features: rise in temperature & pulse, foul
smelling lochia, pain & tenderness in lower
abdomen, sub-involution of the uterus.
• Prevention: Thorough asepsis.
 Complications of Postnatal period
2. Thrombo-phlebitis: Infection of the veins of the legs
associated with varicose vein.

• Features: leg become pale, swollen, tender.

3. Secondary haemorrhage: Bleeding from vagina anytime

from 6 hours after delivery to the end of puerperium.

4. Postpartum (puerperal) psychosis.

5. Others: UTI, Mastitis.

 Restoration of mother to optimum health

(A) Physical Post natal examination

•Health check up: Twice a day during first 3 days, then

once a day till the umbilical cord drop off; at the end of
6 weeks check up for involution of uterus; Further visits
– once a month during first 6 months then 2-3 monthly
till the end of one year.
•Examinations: Temperature, Pulse, Respiration,
Breast, Involution of uterus, Lochia, Urine, Bowel,
Perineal toileting.
 Restoration of mother to optimum health -- cont.

Anaemia: Hb estimation routinely & should be corrected

Nutrition : Needs should be adequately met by diet

Extra calorie during lactation: 550 Kcal.

Exercise: Gradual routine house hold activities;

Easy exercises may be added to bring the
stretched abdominal & pelvic muscles back
to normal
 Restoration of mother to optimum health -- cont.

(B) Psychological

•Fear, Timidity, Insecurity for baby (puerperal psychosis)

•These can be eliminated by proper antenatal advice.

(C) Social

Mother, with her husband must develop her own methods to raise
& nurture the child in a wholesome family atmosphere
 Checking adequacy of breast feeding

•Feed the colostrum first

•It takes 2-3 days to start the flow of milk
•Daily secretion of milk : 500-600 ml .
•Exclusive breast feeding up to completion of 6 months
 Family planning services
• IUD
• Non-hormonal contraceptives
• Mini-pill
• Permanent methods ( Tubectomy) after 6
weeks of delivery
 Basic health education
• Health education on
• (a) Hygiene (Personal & Environmental)
• (b) Feeding of the mother & infant
• (c) Pregnancy spacing
• (d) Birth registration
(e) Immunization
 Care of the Newborn
• Objectives:

1) Establishment of cardio-pulmonary function

2) Maintenance of body temperature
3) Avoidance of infection
4) Establishment of satisfactory feeding regimen
5) Early detection and treatment of congenital and
acquired disorders, specially infection.
 Neonate: 0 days to 28 days (4 wks)

Early Neonate: (0 – 7 days)

+
Late Neonate : (after 7 days – 28 days)

Post Neonate: 28 days – 1 year

Infant = Neonate + Post Neonate

0 – 1 year = 0-28 days + 28 days-1 year
 Immediate care
1) Cleaning the airway
2) APGAR score
3) Care of the cord
4) Care of the eye
5) Care of the skin
6) Maintenance of body temperature
7) Establishment of breast feeding
 Cleaning the airway
• Positioning the baby with his head low

Help in drainage of secretion

• Assisted by gentle suction

• If fail, resuscitation by
* Suction * Oxygen mask
* Intubation * Assisted respiration
 APGAR SCORE
Virginia Apgar – an American anesthesiologist

Points to be noted for APGAR Score:

• Colour of skin
• Heart rate
• Respiration
• Tone
• Reflex
 A P G A R S C O R E

SCORE
SIGN
0 1 2
Heart Rate Absent Slow (<100) Over 100

Respiration Absent Slow Irregular Good-Crying

Muscle Flaccid Some flexion of Active

Tone extremities movements
Reflex No Grimace Cry
Response
Colour Blue-pale Body- Pink Completely
Extremity- Blue pink
 APGAR score

•This is taken in 1 minute & again at 5 minutes

after birth.
•Named after Virginia Apgar – an American
anesthesiologist

Interpretation •Severe depression: 0-3;

•Mild depression: 4-6;
•Satisfactory : 7-10.
•Score 4 or below needs intensive care
immediately
 Care of the cord
• Umbilical cord cut and tied after cessation
of pulsation ( So baby gets extra 10 ml of
blood ).

• Cord drops within 4 – 5 days

 Care of Eyes
• Any discharge is pathological
• Cleaning of eyes with sterile swab soaked with
normal saline from inner to outer side.
• Silver nitrate drop to prevent gonococcal
conjunctivities.
• Infection of mother must be treated during
pregnancy
• Care must be taken during face and breech delivery
 Care of eyes

• Causes of Ophthalmia Neonatorum:

- N. gonorrhoae & Cl. trachomatis (commonest)

- Staphylococcus
- Streptococcus
- Candida

• Infection by N. gonorrhoae if untreated cause

blindness.
 Care of skin
• Vernix caseosa , muconium and

blood clot are removed and washed

by warm oil.
Maintenance of body temperature

• Normal : 36.50 C to 37.50 C.

• The difference is between 100 to 200 C in

winter between womb and environment.

 Initiation of breast feeding
• Within half an hour after birth

• Establish the bonding of mother and child.

• Colostrum comes out first

• Full flow of milk come after 3rd day

• Demand feeding is preferable.

 Feeding of infant
• Breast feeding
• Artificial feeding
• Complementary feeding
 Breast milk is the ideal food for infant, explain?

•It is safe, clean, hygienic, cheap & available to the infant

at correct temperature.
•It fully meets the nutritional requirements to the infant
in the first months of life.
•It contains anti microbial factors e.g. macrophages,
lymphocytes, secretory IgA, anti streptococcal factors,
lysozyme, lactoferrin which provide considerable
protection against diarrhoea, enterocolitis & respiratory
infections.
•It protects baby from tendency of obesity
•It is easily digested & utilized by both the normal &
premature babies.
•It promotes bondage between the mother & the infant.

•Sucking is good for the baby – it helps in the

development of jaws & teeth.
•It prevents malnutrition & reduces IMR

•It helps parents to space their children by prolonging the

period of infertility.
•It prevents neonatal hypo-ca & hypo-mg
•A child who is breast-fed has greater chances of
survival than a child artificially fed.
•Prolonged breast-feeding does protect the infant from
early malnutrition & some infections.
•The data suggest that infant mortality rates in
developing countries are 5-10 times higher among
children who have never been breast feed or who have
been breast fed for less than 6 months

Energy content: Breast Milk

Calorie: 70 kcal/100 ml; Protein: 9 – 15%;

Fat: 35 – 45%; Carbohydrate: 45 – 55%
Anti infective agents in human milk

Secretory IgA,
Macrophages.
Lysozyme.
 Exclusive Breast Feeding (EBF)

EBF means that the baby should be given only

breast milk and nothing else – not even water. Its
usual duration is 6 months (180 days), although total
duration of breast-feeding may extend up to 2 years
and beyond.
 Importance of EBF

• It ensures optimum nutrition for the child.

• Ensures colostrum feeding.
• Lactation failure – less.
• Incidence of mortality & morbidity – less.
• Reduces chances of PPH.
• Helps in early involution of uterus.
• Helps in bondage with the mother.
• Averts pregnancy – 98%.
 Milk Injury

If a baby is fed only with milk over a long period of

time (2 years) without giving any supplementary food,
the baby becomes flabby and oedematous due to
deficiency of protein and anaemia (iron deficiency)
this is called milk injury.
INFANT AND YOUNG CHILD FEEDING (IYCF)

• Infant and Young Child Feeding means

Breast feeding plus complementary feeding.
Breast feeding
Initiation of Breast feeding:
• % of infants who put into the breast within
an hour of birth.
Exclusive Breast Feeding (EBF):
• New definition allow a child to receive ORS,
drops and syrup (vitamins, minerals and
medicine)

Complementary feeding:
• Complimentary feeding means giving extra
food to a child from completion of 6 months
along with breast milk.
Core indicators of IYCF
• Early initiation of breast feeding.
• EBF under 6 month.
• Continuation of breast feeding at 1 year.
• Introduction of semisolid, solid soft food
at 6-8 month.
• Minimum dietary diversity.
• Minimum meal frequency.
• Minimum acceptable diet.
• Consumption of iron rich food or iron fortified
Food.
Optional indicators of IYCF

• Children ever breast fed.

• Continuation of breast feeding at 2 years.
• Age appropriate breast feeding.
• Predominant breast feeding.
• Duration of breast feeding.
• Bottle feeding.
• Milk frequency of non breast fed children.
Minimum milk frequency
Breast fed children
• 6- 8 months age group needs at least 2
meal / day.
• 9- 23 months age group 3 meal / day.
Non breast fed children
• 6- 23 months age group 4 meal / day.
Minimum dietary diversity 6 - 23 months.

• Foods from 4 or more food groups are

recommended.
• 3 food groups (1 animal source + 1 fruit/
vegetable and 1 staple food) plus another 1
from remaining food groups as WHO
recommended.
Seven food groups:
1. Grains, roots and tubers.
2. Legumes and nuts.
3. Dairy products.
4. Flash food.
5. Eggs.
6. Vitamin A rich fruits and vegetables.
7.Other fruits and vegetables.
Composition of colostrum:
• Colostrum is the special milk that is secreted in
the first 2- 3 days after delivery.
• It is produced in small amounts about 40- 50 ml
on the first day.
• It is reach in white cells and antibody specially
IgA and it contains a larger % of protein, minerals
and fat soluble vitamins (A,E,K).
• Provides important immune protection to an
infant.
• Epidermal growth factor helps to prepare the
lining of the gut to receive the nutrient in milk.
Complimentary feeding:
Complimentary feeding means giving extra
food to a child from completion of 6 months
along with breast milk.
Importance:
Up to 6 months breast milk is a complete food for
adequate growth and development of the child.
If appropriate CF is not introduced the energy gap
would be at -
6-8 month: ¼ of the need.
9-11 month: ⅓ of the need.
1-2 year energy gap would be 58%.
If iron rich food is introduced, the iron gap would
be more > 90 % at 6 months.
In case of LBW the iron gap is higher and
starts before 5 months.

If appropriate CF is not introduced the

vitamin gap would be 10 % at 9- 11 month
and 16% at 1- 2 year.
How to introduce CF
• After birth each and every child knows how to
suck, drink and don’t know hoe to eat.
• Eating is a learning process and they learn
gradually.
• Their stomach is small but their demand is much
higher for rapid growth.
• Better to start liquid then gradually introduced
semi solid to solid forms.
• Food should soft be and mashed but not should
be blend.
• Gradually introduced new varieties of
food.

• With the increase of age the amount

should be increased.
 Quantity, frequency, texture and energy of CF

Age Energy/ day Texture Frequency Amount/

meal
6-8 months 200 kcal/ d Mashed 2-3 meal/ d 2-3 TBS full
food +1-2 and half cup
snacks / d (250 ml).

9-11 300 kcal/d Finely 3-4 meal/ d ↑ ½ Cup

months chopped + 1-2
and mashed snacks/ d
food
12- 23 550 kcal/ d Family food 3-4 meal/ d ⅔ Cup
months (chopped/ + 1-2
mashed) snacks/ d
Good Complimentary Foods are:
• Rich in energy/ protein and micronutrients
(particularly iron, zinc, calcium, vit A, C and
folate).
• Not spicy and salty.
• Easy for the child to eat.
• Liked by the child.
• Locally available and affordable.
Disadvantage of formula feeding:

• It is expensive.
• Artificial feeding is hazardous procedure because
of the dangers of contamination and over
dilution.
Guiding principles for complementary feeding of the
breastfed child:
1. Practise exclusive breastfeeding from birth to 6 months
of age, and introduce complementary foods at 6 months
of age (180 days) while continuing to breastfeed.
2. Continue frequent, on-demand breastfeeding until 2
years of age or beyond.
3. Practise responsive feeding, applying the principles of
psychosocial care.
4. Practise good hygiene and proper food handling.
5. Start at 6 months of age with small amounts of food and
increase the quantity as the child gets older, while
maintaining frequent breastfeeding.
6. Gradually increase food consistency and variety as the
infant grows older, adapting to the infant’s
requirements and abilities.
7. Increase the number of times that the child is fed
complementary foods as the child gets older.
8. Feed a variety of nutrient-rich foods to ensure that all
nutrient needs are met.
9. Use fortified complementary foods or vitamin-mineral
supplements for the infant, as needed
10. Increase fluid intake during illness, including more
frequent breastfeeding, and encourage the child to eat
soft, favorite foods. After illness, give food more often
than usual and encourage the child to eat more.
Baby friendly hospital initiative (BFHI)
• It is created and promoted by WHO and UNICEF has
proved highly successful in encouraging proper infant
practices starting at birth.
• The ten steps of BFHI includes :
 Helping the mother initiate breast feeding with in the first
hour of birth in normal delivery and four hours following
C/S.
 Encourage breast feeding on demand.
 Allow mother and infants to remain together 24 hours a
day, except for medical reasons.
 Give new born infants no food or drink, other than breast
milk unless medically indicated.
 Exclusive breast feeding should be promoted till 4- 6
months of age.
 No advertisement, promotional material or free
products for infant feeding should be allowed in
the facility.
 Baby friendly hospitals also expected to adopt
and practise guide lines for child survival including:
 Antinatal care.
 Clean delivery practices.
 Essential new born care.
 Immunization and ORT.
 Neonatal examinations

1st examination

Aim
(i) To ascertain that the baby has not suffered any birth
injury.
(ii) To detect malformations.
(iii) To assess maturity.
 Neonatal examinations –cont.
(1st examination)
Abnormalities
• Cyanosis of the lips.
• Difficulty in breathing.
• Imperforate anus.
• Persistent vomiting.
• Signs of cerebral irritation (e.g. convulsion).
• Neck rigidity.
• Twitching.
• Bulging of anterior fontanel.
• Temperature instability.
 Neonatal examinations –cont.
2nd examinations

Should be made by a paediatrician within 24 hours after

birth; including – Body size, Body temperature, Skin,
Cardio respiratory activity, Neuro-behavioural activity,
Head & face, Abdomen, Limbs & joints, Spine, External
genitalia.
 Infections of the Newborn

• Neonatal Tetanus:
• Congenital Syphilis:
• HBV positive mother:
• HIV positive mother:
 “At risk” infants
• LBW.
• Twins.
• Birth order 5 or more.
• Artificially fed baby.
• Weight below 70% of the expected weight
(2nd and 3rd degrees of malnutrition)
 At risk infants
• Failure to gain weight for three successive
months.

• Child with PEM and Diarrhoea.

• Working mother / One parent.

 Low birth weight
• Infants weighing 2.5 Kg or less at birth
preferably within the 1st hour of life.

Two groups of LBW;

1) Pre-term babies : born before 37 wks
2) Small for date : born at term or preterm.
< 10th percentile for the
gestational age (IUGR)
 Causes of LBW
• Maternal causes:

Malnutrition. Severe anaemia.

Heavy physical work. Hypertension.
Infection. Malaria.
Toxaemia. Smoking.
Alcoholism. Low economy.
Short statured. Very young age.
High parity. Close birth spacing.
Low education.
 Causes of LBW
• Fetal causes:

Fetal abnormality.
Chromosomal abnormality.
Intrauterine infection.
Multiple gestation.
 Causes of LBW
• Placental causes:

Placental insufficiency.
Placental abnormality.
 Risk factors of LBW
• Malnutrition
• Infection
• Unregulated fertility

• Poor socioeconomic condition

• Environmental condition
 Prevention of LBW

• Direct intervention:

- Increase food intake.

- Control of infection.

- Early detection and treatment of medical disorder.

 Prevention of LBW
• Indirect intervention
- FP.
- Avoidance of smoking & alcohol.
- Improve sanitation and hygiene.
- Improve adolescent health.
- Socioeconomic development.
- Better coverage by health and other sector.
 Treatment of LBW
• 1) wt. < 2 kg 2) wt. > 2 - 2.5 kg

Intensive care:
1) Incubatory care- adjustment of
temperature, humidity and oxygen supply.

2) Feeding - breast feeding / naso-gastric feeding

3) Prevention of infection
 Causes of death in LBW

• Atelectasis.
• Malformation.
• Pulmonary haemorrhage.
• Intracranial haemorrhage due to anoxia or birth
trauma.
• Pneumonia and other infection.
 Growth & Development
Growth:
Increase in physical size of the body

Development:
Increase in skills and functions

Growth & development include not only physical

aspect but also intellectual, emotional & social aspect
 Determinants of growth &
development
• Genetic inheritance.
• Nutrition.
• Age.
• Sex.
• Physical surroundings.
• Psychological factors.
• Infection & parasitic infection.
 Determinants of growth & development

• Economic factors
• Other factors:
- Birth order.
- Birth spacing.
- Birth weight.
- Education of parents.
 Determinants

Genetic inheritance
Related with height, weight, mental & social
development, personality etc.

Nutrition
• Improved nutrition (diet) improved growth & dev.
• Lack of nutrition (diet) growth retardation, malnutrition.

Age
• Foetal life, 1st year of life, puberty  maximum growth
• Other periods of lifeless growth
 Sex
Maximum female growth occurs during (10-11 years)
and male growth occurs during (12-13 years)

Physical surroundings
Sunshine, good housing, lighting, ventilation have
growth promoting effects.

Psychological
Love, tender care, proper child-parent relationship
affects social, emotional & intellectual development of
children.
 Infection, parasites
• Infection of the mother during pregnancy
affects intra uterine growth of the children e.g.
Rubella, Syphilis.
• Infection after birth slows down growth &
development e.g. Diarrhoea, Measles.
• Intestinal parasites hamper the routine growth
by consuming the host nutrition e.g. hook
worm, round worm.
 Economic
Children from well-to-do family better height, weight
(growth)

Others
Comprises e.g. birth order, birth spacing, birth weight,
parent’s education etc.
 Congenital Malformation

Congenital malformation: confined to structural

defects at birth.

Congenital anomaly: confined to all structural,

biochemical & functional disorders present at
birth.
 (a) Genetic factors Causes

• Chromosomal anomaly: The chromosome is either missing or

excess e.g. Down’s syndrome, Turner’s syndrome.
• Inborn errors of metabolism: Phenyl Ketoneurea (PKU),
Galactosaemia, Tay-sachs diseas.
• Possible genetic aetiology: Club foot, Congenital dislocation
of hip, Neural tube defect.
• Others: Single gene disorder e.g.
autosomal dominant – Huntington’s chorea.
autosomal recessive – Thalasaemia, Sickle cell anaemia.
sex linked disorder – Haemophilia.
 Environmental factors

• Intra uterine infection: infection with ‘TORCH’ agents.

• Drugs: Thalidomide, Stilbosterol, Anti convulsant,

Steroid, Anaesthetics.

• Maternal disease complicated by pregnancy: Diabetes,

Cardiac failure.

• Irradiation

• Dietary factors: Folic acid deficiency.

 Risk factors

• Maternal age: When advanced; the risk rises

sharply with age, 1:67 for aged 40-45.

• Consanguinity: High incidence of mental

retardation & congenital malformation with first
cousin, uncle-niece marriage.
 Ante natal diagnosis

• Alpha fetoprotein.
• Ultra sound.
• Amniocentesis.
• Chorionic villi sampling.
 Prevention

• By discouraging further reproduction after the birth of a

malformed child.

• The avoidance of pregnancy in circumstances where

malformations are likely to occur.

• The identification & removal of certain teratogens --

(i) Drugs: Thalidomide, Steroid, Anticonvulsants, Folate
antagonist.
(ii) Infective agents: Rubella, CMV, Herpes simplex, Varicella
zoster, Toxoplasma gondii.
(iii) Physical agents: X-ray, Radiation.
 Parameters for physical growth assessment

• Weight for age.

• Height for age.

• Weight for height.

• Head and chest circumference.

 Weight for age (%)

Weight for age = Weight. of the child × 100

Weight of a normal child of same age

Birth weight doubles by 5 months

Birth weight tripples by 1st year
Birth weight quadruples by 2nd year

Use: To classify malnutrition.

To identify underweight children.
 Height for age (%)

Height for age = Height. of the child × 100

Height of a normal child of same age

• Length of baby at birth is about 50 cm.

• It is increased by 25 cm during 1st year and by
another 12 cm during the 2nd year.
• Low height for age is also known as Nutritional.
stunting or dwarfing.
• It reflects past or chronic malnutrition.
 Weight for height (%)

• Weight for height Weight. of the child × 100

Weight of a normal child
of same height

• Low wt for ht. indicates nutritional wasting or acute

malnutrition (emaciation).

• < 70% wt for ht. means severe wasting.

 Head & Chest circumference

• Head circumference > Chest circumference at

birth ( 2 cm greater).
• Head circumference at birth : 34 cm.
• Head circumference = Chest circumference
by 6 to 9 months.
• After 6 to 9 months Chest circumference
overtakes the head circumference.
• In severe malnutrition overtaking may be delayed
by 3 to 4 years due to poor development of
thoracic cage.
 Growth Chart

The growth or “Road to health” chart is a

visible display of the child’s physical growth
& development designed primarily for the
longitudinal follow up or growth monitoring
of a child, so that changes over time can be
interpreted.
 Growth Chart --cont.

It is designed to simplify growth monitoring

(weight for age) of children from birth to 5
years of age.

Originally designed by David Morley and later

modified by WHO.

The card is almost widely used in most of the

developing countries of the world.
 Components of Growth Chart

• Growth monitoring chart ( 0 to 60 months )

• Personal information (registration details) of the child.
• Immunization records.
• Vitamin A capsule – preventive & therapeutic measures.
• Recording common diseases and ailments.
• Pictorial and health education messages on breast
feeding, complementary feeding, ORS, interpretation of
growth curve, immunization and VAC schedule.
 Uses of Growth Chart

• Growth monitoring.
• Diagnostic tool: For identifying high-risk
children.
• Educational tool: Mother can be educated in
the care of her own child.
• Tool for action: Helps the health worker on
the type of intervention that is needed.
 Uses of Growth Chart
• Tool for teaching: e.g. importance of breast
feeding, deleterious effects of diarrhea.
• Planning & policy making.

• Evaluation: Provides a good method to evaluate

the effectiveness of corrective (intervention)
measures.
 MCH Problems

• Malnutrition.

• Infection.

• Consequences of uncontrolled fertility.

 Malnutrition

Maternal depletion
Anaemia
Toxaemia of pregnancy
PPH
Abortion, IUD, Still birth
Low birth weight

High mortality and morbidity

• Pregnant women, nursing mothers and
children are the vulnerable to the effects of
malnutrition.

• Most crucial period from nutritional point of

view:
Intrauterine period of fetus
Period of weaning
&
also adolescent period of mother.
 Prevention of Malnutrition
• Direct Intervention:

 Supplementary feeding programme.

 Iron & Folic acid distribution.
 Fortification & enrichment of food.
 Nutrition education.
Prevention of Malnutrition ( cont.)
• Indirect Intervention:
Immunization.
Improvement of environmental sanitation.
Safe drinking water.
Family planning.
Food hygiene.
Education.
Primary health care etc.
 Infection
Maternal infection
May cause

Retarded fetal growth

LBW
Embryopathy
Abortion
Puerperal sepsis
 Infection

• Some of the maternal infections can be

transmitted to mother.

• ToRCH infection, Hepatitis B, HIV infection,

Syphilis etc.
 Childhood Infection
• Diarrhoeal diseases.
• ARI.
• Skin disease.
• Infections from EPI diseases.
• Parasitic diseases.

Infections are aggravated by chronic diseases/conditions

like:
Malaria, Tuberculosis,
PEM, Anaemia.
 Effects of Uncontrolled fertility

• High prevalence of LBW.

• Severe anaemia.
• Abortion.
• APH.
• High MMR, IMR, PNMR, under-5 mortality.
 Interventions to reduce MCH problems

1. Early detection of malnutrition and

infection in pregnant women and in
children.

2. Treatment of malnutrition and infection.

3. Supplementary feeding program.

4. Iron and folic acid supplementation.

Interventions to reduce MCH problems (Cont.)

5. Food fortification.

6. Immunization of mother and children.

7. Strengthening GOBI-FFF strategy.

8. Health education on nutrition, childcare,

hygiene, oral rehydration, family planning,
sanitation etc.
 Indicators of MCH Care

(i) Maternal mortality rate.

(ii)Infant mortality.
(iii)Neonatal mortality rate.
(iv)Post neonatal mortality rate.
(v)Perinatal mortality rate.
(vi)1-4 year mortality rate.
(vii)Under 5 mortality rate.
(viii)Child survival rate.
 Maternal Mortality Rate (MMR) / Ratio

It is the total number of maternal death per 1000

live births in the given area & given year.
MMR =
Total No. of female death due to complicati on of pregnancy,
child birth or within 42 days of delivery from puerperal causes
in an area during a given year
 1000
Total No. of live births in the same area & year

MMR= 1.94/ thousand live births

 Maternal Death

The death of a woman while pregnant or 42 days

of termination of pregnancy, irrespective of the
duration & site of pregnancy, from any cause
related to or aggravated by the pregnancy or its
management but not from any accidental or
incidental causes.
 Late maternal death

Death of a woman from direct or indirect causes more

than 42 days but less than 1 year after termination of
pregnancy.

Pregnancy related death

A Pregnancy related death is the death of a woman

while pregnant or within 42 days of termination of
pregnancy, irrespective of the cause of death.
 Causes of MMR

A. Medical causes
Obstetric causes Non obstetric cause

a. Anaemia.
a. PPH (26%).
b. Toxaemia of pregnancy(16%). b. Systemic diseases e.g.
c. Infection (11%). Cardiac, Renal,
d. Obstructed labour (8%). Hepatic, Metabolic,
e. Unsafe abortion (21%). Infectious
f. Other obstetric causes (18%).
c. Malignancy.
d. Accidents.
 MMR in Bangladesh
Obstructed
labour, 8%

PPH, 26%
Toxaemia, 16%

1
2
3
4
Others, 18% 5
Unsafe 6
abortion, 21%
Infection, 11%
 Causes : MMR --cont.

B. Social factors

• Age at child birth. • Lack of maternity service.

• Parity. • Shortage of health manpower.
• Too close pregnancy. • Delivery by untrained dai.
• Family size. • Poor environmental sanitation.
• • Poor communications &
Malnutrition.
transport.
• Poverty. • Social customs.
• Illiteracy.
• Ignorance & prejudice.
 Prevention of MMR

• Early registration of pregnancy.

• Regular or at least 3 antenatal check ups.
• Dietary supplementation with correction of anaemia.
• Prevention of complication e.g. Eclampsia, Malpresentation,
ruptured uterus, APH, PPH , obstructed labour etc.
• Treatment of medical conditions e.g. hypertension, diabetes,
TB, liver and kidney disease etc..
• TT vaccination.
• Institutional deliveries for women with bad obstetric
history & high risk mothers.
 Prevention of MMR --cont.
• Clean delivery practice at home or institutes and home
delivery must be in trained hand.
• Timely referral of the cases with complications and proper
functioning of EOC.
• Prevention of infection & haemorrhage during puerperium.
• Promotion of family planning.

• Identification of every maternal deaths & search for its

causes (Death review).

 Prevention of MMR --cont.
Other social measures:
• Gender equity & valuation of women in the society.
• Female education.
• Activation of marriage law (stop early marriage).
• Improvement of nutritional status of mothers.
• Improvement of quality of life.
• Family planning.
• Accessibility to the health care facilities.
• Social awareness and motivation.
 Infant Mortality Rate (IMR)

It is the number of the infant deaths in a given year to the

total number of live births in the same year.
It is usually expressed as a rate per 1000 live births

No. of deaths below age 1 during a year

IMR= × 1000
No. of live births during the same year.

IMR= 41/ thousand live births

 Causes: IMR
Neonatal mortality

a. Low birth weight.

b. Birth injury, difficult Post neonatal mortality
labour .
c. Congenital anomaly. a. Diarrhoeal disease.
d. Diarrhoeal disease. b. Acute respiratory
e. Acute respiratory infection (ARI).
infection (ARI)
c. Other communicable
f. Tetanus.
diseases.
g. Haemolytic disease of the
d. Malnutrition.
newborn.
e. Congenital anomaly.
h. Conditions of placenta &
cord.
f. Accidents.
 Factors affecting IMR

(A) Biological factors

• Birth weight: Babies of LBW (<2.5 kg) & high birth

weight (>4 kg).

• Age of the mother: Mother of very young age (<20

years) and very old age (>35 years).

• Birth order: Highest mortality1st born+5th & later

child; lowest mortality2nd child.
 Biological factors --cont.

•Birth spacing.

•Multiple births.

•Family size.

•High fertility.
 (B) Cultural & social factors
• Inadequate breast feeding: Early weaning & bottle fed
infants.

• Religion & cast: IMR is attributed to various socio

cultural patterns of living, age-old habits, customs,
traditions, cleanliness, eating, clothing etc.

• Early marriage:
• Sex of the child:
 Cultural & social factors --cont.

• Quality of mothering.

• Maternal education.

• Quality of health care.

• Broken family.

• Illegitimacy.
 Cultural & social factors --cont.

• Brutal habit & custom: e.g. depriving the baby from

colostrum, branding the skin, application of cow dung
to the umbilical cord, faulty feeding practice, early
weaning.
• Indigenous dai: Untrained midwife service

• Bad environmental sanitation: e.g. lack of safe

water, poor housing, bad drainage, overcrowding, insect
breeding.
 (C) Economic factors

Nonavailability & poor quality of health care, nature of

the child’s surroundings, all are related to the
socioeconomic status.
 Prevention of IMR
• Antenatal nutrition: To improve the state of maternal
nutrition i.e. supplementation of small amount of extra
food to the mother’s basic diet.
• Prevention of infection: Immunization of the infants
against the EPI & other infectious disease +
Immunization of the mother against infectious diseases
e.g. Rubella, Tetanus, Hepatitis-B.
• Breast feeding: It safeguards against many diseases e.g.
gastro-intestinal & respiratory infections, PEM etc.
• Family planning: Family limitation & spacing of
births.
 Prevention of IMR --cont.

• Growth monitoring: All infants should be weighed

periodically (once a month), also growth chart should

be systematically used for promotion of health of the

children.
• Sanitation: To improve the overall sanitation.

• Provision of primary health care:

• Socio economic development:

 Prevention of IMR --cont.

• Education: Women & adult education in general.

• Health education: On breast feeding,

immunization, hygiene, child care, family
planning etc.
 Neonatal Mortality Rate (NMR)

Neonatal Mortality Rate is the total number of

neonatal deaths in a given year per 1000 live births.

(Neonatal period = Birth to 28 days of age)

No. of death of children under

28 days of age in a year
NMR   1000
Total live births in the same year
 Post Neonatal Mortality Rate (PNMR)

It may be defined as the total number of deaths

from 28 days to below one year of age per 1000
live births in a given year.

(Post neonatal period = 28 days to below 1 year of age)

No. of deaths of children between

28 days & 1 year of age in a given year
PNMR   1000
Total live births in the same year
 Perinatal Mortality Rate (PMR)

It is the total no.of the perinatal deaths in a given year

per 1000 live births in the same year.
Perinatal death =
Late foetal death (Still birth) + Early neonatal death

Late fetal deaths (stillbirth)  early neonatal deaths

(weighing over 1000 gm at birth)
PMR   1000
Total live births (weighing over 1000 gm at birth)
 Perinatal mortality includes -

• Foetal deaths after 28 weeks of gestation when the

fetus becomes viable.
• Those above a minimum birth weight, i.e. 1000 gm at
birth.
• Deaths within 7 days of neonatal life..
Causes: PNMR A. Antenatal cause

1. Maternal disease e.g. Hypertension, CVS disease,

diabetes mallitus, TB, Anaemia.

2. Pelvic disease e.g. Uterine myoma, Endometriosis,

Ovarian tumour.

3. Anatomical defect e.g. Uterine anomaly, Incompetent

cervix.

4. Congenital defect.
 A. Antenatal cause --cont.

(i) Endocrine imbalance.

(ii) Blood incompatibility.
(iii)Malnutrition.
(iv)Toxaemia of pregnancy.
(v) Antepartum haemorrhage.
(vi)Advanced maternal age.
 B. Intranatal cause C. Postnatal cause

(i) Birth injury. (i) Prematurity.

(ii) Asphyxia. (ii) Respiratory distress syndrome.
(iii) Prolonged effort / labour. (iii) Respiratory & GIT infections.
(iv) Congenital anomaly.
 Prevention

• Women with medical problems should avoid pregnancy

till health improves.
• Birth spacing.
• TT immunization.
• Control of anaemia; supplementation of iron & folic acid
tablet.
• Early treatment of maternal complications.
 Prevention --cont.

• Institutional delivery for woman at high risk.

• Immediate referral & appropriate care of emergency

obstetric complications.

• Safe & clean delivery practice.

• Essential newborn care.

• Resuscitation of newborns without spontaneous cry

at birth.
 1-4 Year Mortality Rate (Child Mortality Rate)

It may be defined as the number of deaths of children

aged 1-4 years per 1000 children in the same age group in
a given year. (It excludes IMR); it is calculated by the
formula:
No. of deaths of children aged 1 - 4 year during a year
  1000
Total No. of children aged 1 - 4 years at the middle of the year

Importance

(i) It reflects the economic, educational & cultural

characteristics of the family
(ii) It also reflects adverse environmental health hazards
e.g. malnutrition, poor hygiene, infections,
accidents.
 Causes

(i) Developing countries: Diarrhoeal diseases,

Respiratory infections, Malnutrition, Infectious
diseases e.g. Measles, Pertussis, febrile diseases,
accidents, injuries.
(ii) Developed countries: Accidents, Congenital
malformations, Malignant neoplasms, Influenza,
Pneumonia .
 Under-5 Mortality Rate

It may be defined as the number of deaths of children

aged under 5 years, per 1000 live births in a given year;
it is calculated by the formula:

No. of deaths of children less than 5 years of age duringa year

  1000
Total No. of live births in the same year
 Child survival index

• Child survival rate per 1000 births is calculated by

subtracting the under-5 mortality rate from 1000.
• Dividing this figure by ten shows the percentage
of those who survive to the age of five years.

1000 – under 5 mortality rate

Child survival rate =
10
 EOC

EOC refers to ability to recognize, stabilize

and manage the complications that arise and
threatens the life of the mother and her unborn
child.

There are life saving obstetric services that can be

performed at various levels of the health system.
 EOC
Types of EOC

1. Obstetric First Aid.

2. Basic EOC.
3. Comprehensive EOC.
 EOC

Functions used to define Obstetric First Aid

• Administer Parenteral oxytocic drugs (ergometrine).

• Administer Parenteral antibiotics.
• Administer Parenteral sedatives / anticonvulsants.
 EOC

Functions used to define Basic EOC

• Administer Parenteral antibiotics.

• Administer Parenteral oxytocic drugs (ergometrine).
• Administer Parenteral sedatives / anticonvulsants.
• Perform manual removal of placenta.
• Perform assisted vaginal delivery (vacuum extraction,
forcep).
 EOC
Functions used to define Comprehensive EOC

• All of those included in basic EOC.

• Surgery e.g. caesarean section, curettage etc.
• Blood transfusion.
 EOC
Factors affecting
utilization & outcome Phase of Delay

• Economic status Phase 1

• Educational status Decide to Seek Care
• Women status

• Distance Phase 2
• Transport Reach Medical
• Roads Facility
• Cost
Phase 3
Quality of Care Receive adequate
treatment
 EOC
Programme level Programme activity

District Comprehensive EOC.

• Basic EOC.
Thana • Vacuum extraction.
• Refer & arrange transport.
• Obstetric first aid.
Union • Menstrual regulation.
• Refer & arrange transport.
• Community education.
Community • Community mobilization.
 EOC
Strategy that could substantially reduce maternal deaths:
(Meeting the community halfway)

Delay in Delay in Delay in

Problem receiving reaching an deciding to
EOC at EOC facility seek EOC
facility
Upgrade Decentralization Community
Solution EOC of EOC education
Service

   
Community
mobilization
 MCH Programme in Bangladesh
 MCH care is provided by both govt and Non-govt
agencies.

 Health division and population division under the

Ministry of health and family welfare provide MCH
and family planning services.

 Services are provided at national ,district , thana,

union, ward and village level.
 At Community / Village level
• HA & FWA, TBAs work.

• FWA: Distributes contraceptives, motivational

work for F.P.
• TBAs: Prenatal care, attend deliveries at home,
postnatal care.
 At union level

• USC, FWC, UH & FWC.

• At FWC: FWV are trained to provide

antenatal care, contraceptive service,
health and family planning education and
motivation for mothers, essential health
care for under-five children.

• FWC do not provide intranatal services.

 At Thana Level

• THC and its MCH units provide care of the

pregnant women and under fives, family
planning services.

• Manpower : Medical officer, Family planning

officer, two FWVs, Family planning assistant.
 District level
• District general hospital.
• MCWC.
 National level
• Medical colleges.
• Postgraduate institute.
• Specialized institute.
 Services from NGOs
• Services from private hospital/Institute
• MCH and FP service based NGOs
• Bangladesh Women’s Health Coalition.
• Kumudini welfare trust of Bangladesh.
• Bangladesh Association of Maternal and
Neonatal Health.
• Concerned women for Family Planning.
• ICMH (Institute of Child and Maternal Health).
Thank You