MATERNAL

AND CHILD
HEALTH CARE
INTRODUCTION:

In any community mother and children

constitute a priority group. The problems
affecting the health of mother and child are
multifactorial. The current trend in many
countries is to provide integrated MCH and
family planning services as compact family
welfare services.
 01 Reduce maternal mortality and morbidity.
Reduce per natal and neonatal mortality and
morbidity

02
Regulate fertility so as to have wanted and
healthy children when desired

03
Provide basic maternal and child health care to all
mother and children.
Promote and protect health of mothers

OBJECTIVES
04
Promote and protect physical growth and
psycho-social development of children.
OF MCH:
MATERNAL
HEALTH CARE:

Maternal health care include care of women during

pregnancy, child birth and after child birth. It also
includes treatment of child-less couples.
RISK FACTOR
Maternal risk is defined as the probability of dying
or experiencing serious injury as a result of
pregnancy or child birth.

Young primi i.e. below 19 years:

There is grave risk to both mother and the child because the
teenage mother. She still growing and is not adequately
equipped to cope with the pregnancy and labour & is not
psychologically prepared for the responsibilities of marriage.

Elderly primi i.e. 30 years and over:

Having babies too late in life, leads to increased risk of
complications in pregnancy and labour.

Having too many babies:

When the mother bears more than 3 babies, she is at high
risk of developing problems due to repeated pregnancies
and labour.
RISK FACTOR
Having too close pregnancies:
When the interval between the two pregnancies is less than
three years, it can create problems during the pregnancy

Other conditions of mothers

• Mothers with short height i.e. less than 145 cm, having a small and
inadequate pelvis.
• Mothers having less than 40kg of weight: usually underweight mothers are
malnourished and anemic.
• Mothers having more than 70kg of weight have difficulty during child-
birth.
• Mothers having malnutrition and anemia. These mothers are weak and find
it difficult to tolerate the stress and strain of pregnancy and child birth.
• Associated medical conditions: These include heart disease, high blood
pressure, kidney disease, tuberculosis, diabetes, repeated attacks of malaria,
hepatic disorder etc.
 MCH
COMPONENTS

Maternal healthcare component include

Antenatal care

Natal care

Postnatal care
.
 ANTENATAL CARE

ANTENATAL CARE:
Antenatal care is care during pregnancy.
Objectives of Antenatal Care:
• To promote, protect and maintain health
of mother during
pregnancy.
• To ensure the birth of mature and healthy baby.
• To identify high risk mothers and give the
appropriate attention to prevent complication.
• To prepare the mother for confinement.
• To prepare the mother to care for her baby
 Antenatal care services: Registration of
pregnant women:
The mother must be registered
within 12 weeks of pregnancy.
Antenatal visit:
Ideally the mother should attend the antenatal clinic once a month
during the first 7 months, twice a month during the second month, and
thereafter, once a week, if everything is normal.
Care during first contact:
Taking health history, Physical examination,
general medical examination, obstetrical examination. Laboratory
examination Immunization against Tetanus:
2doses of tetanus toxoid should be given. 1st dose at 16-20 weeks
and 2nd dose at 20-24 weeks of pregnancy.
Iron and folic acid tablet:
Mother is given one tablet of iron and folic acid twice a day for at
least 100 days to prevent anemia in mother & to promote proper growth
of fetus.
Health education during pregnancy:
Diet during pregnancy:
• A well balanced diet is required during pregnancy for the proper growth
and development of fetus & for optimum health of mother.
• A pregnant women should be educated regarding personal hygiene.
Smoking and drinking:
Mother should be advised to avoid smoking and drinking alcohol. It lead to low birth weight and retardation.
Drugs:
The mother should be advised not to take any medicine unless it is prescribed by the Doctor.
Radiation:
The mother should be advised to avoid abdominal X-ray it predisposes
child to the risk of leukemia and other cancers
Protection from infections and illnesses:
An expected mother should be instructed to protect herself from the risk of infection especially measles & syphilis
Sexual activities:
Avoid coitus during the first & last trimester.1st trimester it increases the risk of abortion & last trimester it
predisposes to infection
Travel:
Avoid travel during first and last trimester Reporting of untoward sign and symptoms:
The mother should be instructed to report to health personal if there is unusual pain, bleeding from vagina, swelling
in the feet, hand or face, headache, blurred vision, dizziness, high fever baby’s movement not being felt.
Child care:
The mother should be educated on various aspects of child care.
Follow up visits:
Mother must be educated about the need for regular visit and proper care during pregnancy.
Preparing for confinement:
The preparation for safe delivery is very important. It should be done well in advance to avoid any type of difficulty
or emergency which might occur at the time of delivery.
Psychological preparation of the mother
 INTRANATAL CARE:
Natal care refers to care during confinement /delivery/ birth of a
child.
Objective:
 To prevent infection,
 To Prevent injury to both mother and baby,
 To detect and deal with any complications
 To resuscitate the baby and to provide immediate care to baby. Care
during intra natal period
⦿ Preparation of place and surroundings of confinement.
⦿ Preparation of equipment and supplies required during delivery.
⦿ Physical and psychological preparation of the mother.
⦿ Examination of mother’s physical condition abdominal palpation, monitoring
fetal heart sound, observation of vital signs, labour
pain and uterine extraction etc.
⦿ Conducting delivery, watchful about any problem and helping mother in
taking pains.
⦿ Referral of mother immediately in case of any such problem.
⦿ Giving immediate care to mother and baby after delivery.
⦿ Giving instruction to the mother and family members.
Maintaining record and reporting of birth to authority
 POST NATAL CARE
POST NATAL CARE:
It refer to care which is
rendered to both mother and
the baby after delivery.
Objectives
To restore, promote and
maintain health of mother
and baby.
To promote breast feeding.
To prevent complications.
.
OBJECTIVES
•
To establish good nutrition's
of the baby.
• To prevent infection and
identify any health
problem/disorder in the
baby.
• To support and strengthen
the parents confidence and
their role within their
family and cultural
environment.
• To motivate for planed and
small family norms.
• To educate mother and
family on various aspects of
mother and child care
 POST NATAL VISIT
The health worker is expected to follow the under
mentioned schedule

◾ 1st visit - within 24 hours

During these visits, both mother and baby are given
(on the 2 delivery was conducted by her )
nd
care to meet their health needs.
◾ 2nd visit - 5th or 6th day
Care of the mother
• General observation of the mother and the
◾ 3rd visit - 10th day surrounding to assess overall health status of mother,
cleanliness etc.
• Observation temperature, pulse and respiration.
◾ 4th visit - 2nd to 4th week • Examination of breast, involutions of uterus, lochia,
perineum for any kind of abnormality.
◾ 5th visit -6th to 8th week • Observation of any abnormality in the
abdomen likes painful and hard abdomen
(the visit is done in the clinic).
Care of newborn:
 General observations of the baby and how
is he/she.

Observation of temperature, heart rate and
respiration.
 Observation of eyes for any kind of
abnormality such as watering of eyes or
any discharge etc.
 Observation of skin for change in colour.
 Observation of cord stump.
 The weight is checked and recorded.
 Observation of any sign of abnormality
of abdomen such as distension, tenderness
etc.
 RISK FACTOR

Young primi i.e. below 19 years

2017 2018 2019 2020

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 IMMEDIATE CARE OF NEWBORN
Clearing of airway:
Immediately after birth the baby should cry and breathe. In
order to promote breathing the airway needs to be cleared of
mucus and any other secretions.
Maintenance of baby temperature:
The new born baby has the risk of hypothermia because of
immature heat regulating system. The risk of hypothermia is
greatly reduced if the new born baby is immediately and carefully
dried with towel or clean cloth, wrapped in a clean cloth, kept
close to the mother for skin to skin contact and breast fed as soon
as possible preferably within an hour of birth.
Care of the eyes:
The care of eyes include, wiping of each eye from inside to
outside with boil cooled swabs, one for each eye as the child is
born before he opens the eyes.
Care of the umbilical:
The cord should be legated in two places, 6cms
and 9cms from the umbilicus and cut in between
with sterilized scissors/blade and tied with sterilized
cord tie to prevent tetanus. The cord should be kept
dry.
Apgar scoring:
It is determined by immediate observation of the
heart rate, respiration, muscles tone, reflex response
and colour of the infant. The observation is done at
1 minute and again at 5 minutes after birth.
Care of the skin:
The care of the skin is very important to protect
the child from any infection and keep the baby clean
and warm
Physical examination:
The physical examination of the baby should be
done by health worker assisting mother in delivery
soon after the birth to identify any birth injury,
malformations and general health condition of the
baby.
Breast feeding:
The breast feeding should be started as soon as
possible preferably within an hour of the birth .
 CHILD HEALTH CARE
CHILD HEALTH
CARE:
Child health Objective:
care refer to care ⦿ Every child receives adequate
care and proper nourishment.
of children from ⦿ Every child is immunized and
protected from diseases.
conception to ⦿ To monitor growth and
development.
birth till the age ⦿ To identify ailments and
treated without delay.
of five

To educate the mother and family members to

give proper care to their children
Care of child
Personal care of children:
Every child must get proper personal care to protect the child from
any kind of injury. It include maintenance of personal hygiene,
maintenance of body temperature, rest and sleep, exercise, training of
child regarding healthy habits etc.
Breast feeding:
For the first few month (6 month) of life, breast feeding is best food
which is made available by nature for healthy growth and development.
Supplementary food:
For the first six month, breast feed alone is sufficient for normal
growth and development. Beyond six month baby require additional
food to meet body requirements.
Monitoring growth and development:
It is very important to monitor growth and development of children
regularly. It indicates health and nutrition status of the child. It helps in
identification of any deviation from normal.
 Immunization of children:
The child needs to be protected from six infectious and vaccine
preventable diseases. There diseases include tuberculosis,
tetanus, diphtheria, whooping cough, measles and poliomyelitis.
It is very important that health workers must educate all the
mothers about the importance of immunization.
Safety and security of children:
Safety and security can be ensured by providing clean, safe
and comfortable physical environment.
Early recognition and treatment of ailments:
The most common ailments includes diarrheal diseases, acute
respiratory infection, vaccine- preventable diseases, and
nutritional deficiency problems
ROLE OF NURSE
Service Provider:
• Provision of ante natal care.
• Monitoring the growth of the fetus & its well being
• Supplementation of requisite vitamins & micro nutrients.
• Provision of health aspects related to new born Promotion
of good delivery practices.
• Promotion of breast feeding & maternal bonding.
• Promotion of optimal new born care
• Ensuring appropriate immunization services.
• Screening for mal formations, congenital
anomalies & other deviations.
• Promotion of child rearing practices.
• Periodic growth, development & mile stone monitoring.
• Promotion of good child rearing practices. Promotion of
school enrollment & Angan wadi enrollment.
Provision of de-worming services & nutritional
supplementation services
 Services for Mothers:
• Assess for feeding difficulties.
• Promote iron & calcium supplementation.
• Monitor & promote balanced diet & good
dietary habits.
•
Monitor for post-natal blues.
• Encourage plenty of fluids & roughage diet.
• Promote adoption of contraception & family
planning practices.
• Educate the mother on the importance of
child rearing & self-care practices including
diet, exercise & sleep.
 Role as an Administrator:
• Evolve policy related to MCH.
• Serve as an information provider to policy makers in relation to
MCH services.
• Serve as a liaison with the Govt, community & NGO in organizing
& implementing MCH services.
• Develop counseling & MCH assistance network in the state.
Educationist:
• Organize training programme for health care professionals.
• Conduct workshops & conferences relating to MCH care & sensitize
the community, health care professionals & policy makers.
• Design curriculum in medical & para medical curriculum
incorporating aspects of MCH services.
Design health education materials & distribute. Develop separate
channels in order to sensitize the public on MCH services
 Researcher:
• Identify researchable areas in MCH & conduct research.
• Pool grant in aids to support research activities in the
areas of MCH services.
• Support research scholars undertaking research
in the area of MCH.
• Co-ordinate & network research activities.
• Design models based on research findings.
 MTP ACT, FEMALE FETICIDE,
CHILD ADOPTION,FAMILY WELFARE
MTP ACT:
INTRODCTION:
Abortion is theoretically defined as termination of pregnancy before the fetus become viable.
This has been fixed administratively at 28 weeks, when the fetus weighs approximately 1000g. In India it has been
computed that about 6 million abortion takes place every year, of which 4 million are induced and 2 million
spontaneous.
REASONS FOR ABORTION:

Unwanted sex sexual

violence unwanted Desire for son
pregnancy

Abortion
0 HISTORY:
• The MTP act was passed by the Indian parliament in
1971 and came into force from April 1, 1972.
• Implementing rules and regulations initially were written in
1971 and were revised again in 1975.
• MTP act is a health care measure which helps to reduce
maternal morbidity and mortality resulting from illegal
abortions.
OBJECTIVES:
Aims to improve the maternal health scenario by
preventing large number of unsafe abortions and
consequent high incidence of maternal mortality &
morbidity
 Legalizes abortion services
 Promotes access to safe abortion services to women

Offers protection to medical practitioners who otherwise
would be penalized under the Indian Penal Code (sections
315-316)
 LEGAL FRAME WORK:
Medical termination of pregnancy act
was passed in the year of 1971.
It includes the following:
1. The condition under which pregnancy can
be terminated.
2. The person or persons who can perform
termination.
3. The place where termination can be
performed.
 The condition under which pregnancy can be
terminated:
Medical: Conditions of pregnancy may
threatens the mother's life. Eugenic: Child
being born with serious
physical or mental abnormalities.
Humanitarian: Pregnancy results in Rape.
Socio Economic: Social or economic
background will leads to the injury to the
health of the mother.
Failure of Contraceptive Device: Unwanted
pregnancy due to failure of contraceptive
devices can cause mental Injury to the mother
Person or persons who can perform abortion:
Registered medical practitioner having experience
in gynaecology and obstetrics to perform abortion
where the length of pregnancy does not exceed 12
weeks, however where the pregnancy exceeds 12
weeks and is not more than 20 weeks, the opinion of
two RMP is necessary to terminate the pregnancy.
Place where abortion can be done:
Abortion can be done Government hospital or
Hospitals approved by Government following this
act. Abortion can be strictly confidential where it can
be performed.
 MTP RULES:
The rules and regulations framed were altered in
October 1975,
 To eliminate the time consuming procedure involved
in MTP.
 To make more services readily available.
These changes have occurred in 3 administrative areas
• Approval By Board
• Qualifications Required To Do Abortion

The Place Where Abortion Can Be Performed

Approval by board:
 The CHIEF MEDICAL OFFICER of the district is empowered to certified
that the necessary training in Obstetrics and Gynecology to do abortions.
 Qualifications required to do abortion:
 The registered medical practitioner has involved in the performance of 25
cases of medical termination of pregnancy in an approved institution
 He also had much experience in old MTP rules.
 6 months house man ship in Obstetrics and Gynecology.
 PG qualifications in Obstetrics and Gynecology.
 3 years practice for Doctors in OBG following the MTP ACT passed in1971.

Place where abortion can be performed:

 Under the new rules the non-Governmental institution may also take up
abortions license from the chief medical officer of the district
 IMPACT OF LIBERALISATION OF ABORTION:

The legal abortions are about 6.1 in 1000 pregnancies.

Although Illegal abortions are about 13. 5 in 1000
pregnancies.
Recent amendment of the MTP in the year of 2003
includes,
1) Spread awareness regarding MTP in the community
and available services.
2) Enhance confidential counseling regarding for safe
MTP, train ANM, AWW, and ASHA health workers.
FACILITIES IN MTP:
• To provide vacuum aspiration facilities in CHC.
•
To provide comprehensive and high quality of
MTP services in FRUs

• Encourage private and NGO sectors to establish

MTP services.
FEMALE FOETICIDE ACT

INTRODUCTION:
• Female foeticide is the aborting of a girl fetus in
the womb before its complete growth. Female
foeticide has become a disgraceful and shocking
truth of our nation. In India, there is a strong
fondness for sons over daughter. Several
religious, social, financial and emotional factors
are the reason for female foeticide. It is one of the
main motives for declining sex ratio.
• Ultrasonography and foetoscopy helps to
determine abnormalities in the foetus. But it is
misused to find out sex of the foetus and abortion
is done if it is a girl child.
DEFINITION:
• It is defined as aborting a female foetus after sex
determination test.
• Female foeticide is the procedure of abortion to terminate
female fetus from the womb of the mother before taking
birth after the sex recognition.
CAUSES:
• Obsession for son
• Fear of Dowry
• Money: Girls are considered a financial obligations
• Advancement in technology to determine sex
• Poverty
• Illiteracy
• Gender discrimination
• Female is considered as greater responsibility
• Religious faith: Only male child can perform last rites for
their parents
EFFECTS:
•
Decrease in the female sex ratio
• Adverse effect on women’s
health physically, mentally
and emotionally
• Women are abused and sexually
exploited
• Women trafficking
• Increased suicide among women
 MEASURES TO OVERCOME FEMALE
FOETICIDE:
Legal Initiatives:
• Pre-Conception and Pre-Natal Diagnostic
Techniques (PCPNDT) Act, 1994
• The Dowry Prohibition Act, 1961
• The Medical Termination of Pregnancy
(Amendment) Bill, 2020
• Immoral Traffic
Prevention Act
Government
Schemes:
• Central Government
Schemes:
• Beti Bachao, Beti
Padhao
• Sukanya
Samriddhi Yojna
• Balika Samridhi
Yojna
 National Girl Child Day:
Pre-conception and pre-nataldiagnostic techniques
(pcpndt) act, 1994(amended in 2003):
• Pre-Conception and Pre-Natal Diagnostic Techniques
(PCPNDT) Act, 1994 is an act of the parliament of India
enacted to stop female foeticide and arrest the declining sex
ratio in India. The act banned prenatal sex determination.
• The main purpose of enacting the act is to ban the use of sex
selection techniques after conception and prevent the misuse
of prenatal diagnostic technique for sex selective abortions.
The Act provides for the prohibition of sex selection, before or after
conception
• It regulates the use of pre-natal diagnostic techniques, like
ultrasound and amniocentesis by allowing them their use only
to detect :
• Genetic abnormalities
• Metabolic disorders
• Chromosomal disorders
• Certain congenital malformations
• Hemoglobinopathies
• Sex linked disorders.
• No laboratory or center or clinic will conduct any test
including ultrasonography for the purpose of determining the
sex of the foetus.
 No person, including the one who is conducting the
procedure as per the law, will communicate the sex of
the foetus to the pregnant woman or her relatives by
words, signs or any other method.

 Any person who puts an advertisement for pre-natal and pre-

conception sex determination facilities in the form of a notice,
circular, label, wrapper or any document, or advertises through
interior or other media in electronic or print form or engages in any
visible representation made by means of hoarding, wall painting,
signal, light, sound, smoke or gas, can be imprisoned for up to three
years and fined Rs. 10,000
Dowry prohibition act:
• Dowry Prohibition Act, Indian law, enacted on May 1, 1961,
intended to prevent the giving or receiving of a dowry. Under
the Dowry Prohibition Act, dowry includes property, goods,
or money given by either party to the marriage, by the parents
of either party, or by anyone else in connection with the
marriage.
• If any person, gives or takes or abets the giving or taking of
dowry, he shall be punishable with imprisonment which may
extend to six months, or with fine which may extend to five
thousand rupees, or with both.
• If any person, demands, directly or indirectly, from the
parents or guardian of a bride or bridegroom, as the case
may be, any

dowry, he shall be punishable with imprisonment which may

extend to six months, or with fine which may extend to five
thousand rupees, or with both.
The medical termination of pregnancy (amendment)
bill, 2020:
• The Bill amends the Medical Termination of
Pregnancy Act, 1971 which provides for the
termination of certain pregnancies by registered
medical practitioners.
• Under the Act, a pregnancy may be terminated
within 12 weeks, if a registered medical
practitioner is of the opinion that: (i) continuation
of the pregnancy may risk the life of the mother,
or cause grave injury to her health, or (ii) there is
a substantial risk that the child, if born, would
suffer physical or mental abnormalities. For
termination of a pregnancy between 12 to 20
weeks, two medical practitioners are required to
give their opinion.
Immoral traffic (prevention) act, 1956:
The Immoral Traffic (Prevention) Amendment
Bill, 2006 amends the Immoral Traffic (Prevention)
Act, 1956 to combat trafficking and sexual
exploitation for commercial purposes.
 GOVERNMENT SCHEMES AND POLICIES
FOR GIRL CHILD EMPOWERMENT:
Central Government Schemes:
• Beti Bachao, Beti Padhao
• Sukanya Samriddhi Yojna
• Balika Samridhi Yojna
Sivagami Ammaiyar Memorial girl
child protection scheme by
Government of Tamilnadu.
Beti Bachao, Beti Padhao
• Launched with initial funding of ₹100 crore the
scheme aims to address the issue of the declining
child sex ratio image (CSR) and is a national
initiative run jointly by the Ministry of Women
and Child Development, the Ministry of Health
and Family Welfare and the Ministry of Human
Resource Development.
Aims at generating awareness about the importance of
girl children and improving the efficiency of welfare
services intended for girls in India
 • Sukanya Samriddhi Yojna:
• Part of the ‘Beti Bachao, Beti Padhao’ campaign, the Government of
India backed saving scheme is targeted at the parents of girl children.
• The programme encourages them to build a fund for future
education and marriage expenses for their female child. Parents can start
saving early as the minimum amount of investment required is small, and
the account is active for 14 years from the date of opening the account.
Balika Samridhi Yojna
• This scheme was launched by the Government of India on 15th August
1997 and covered all girls born on or after 15 August 1997 who are
below the poverty line.
Aimed at offering financial aid to girl children born on or after 15
August 1997, the schemes key objectives include improving the enrolment and
retention of the girl child in schools and helping raise daughters until their legal
age of marriage
 Sivagami ammaiyar memorial girl child
protection scheme:
• Sivagami Ammaiyar Memorial girl child
protection scheme is being implemented
by the Social Welfare and Nutritious
Meal Programme Department,
Government of Tamil Nadu to provide
financial assistance to the girl children in
poor families.

Objectives of the scheme are:

• Promote Family Planning
Eradicate Female Infanticide Promote the
welfare of girl children in poor families and to
raise the status of girl children
 National girl child day:
• The National Girl Child Day is
celebrated in India every year on January
24. It was started by the Ministry of
Women and Child Development and the
Government of India in 2008.
Objectives:
• To spread awareness among people
about all the inequalities faced by
girls in the country.
•
To promote awareness about the
rights of a girl child.
To increase awareness on the importance of
girl education, health, and nutrition
THANK YOU