Mother and Child Health Program

(National Health Intervention Program for Mother and Child)

Dr S Ponnusankar
Professor & Head
Dept. of Pharmacy Practice
 INTRODUCTION
• In India ,women of child bearing age (15-44 years) constitute 22.2% and children under 15 years of age
about 35.3% of total population, together a total of 57.5% of the population.
• According to WHO (1976) Maternal and child health services can be defined as ‘promoting, preventing,
therapeutic or rehabilitation facility or care for the mother and child’.
• Maternal and child health services were first organized in India in 1921 by a committee of ‘The lady
Chelmsford league’ which collected funds for child welfare and established demonstration services on
an all India basis.
• Aim- To increase the nutrition level of mothers and children to ensure the birth of healthy child..
• Various facilities are organized for the purpose of providing medical and social services for mothers and
children.
• Medical services include prenatal and postnatal services, family planning care, and pediatric care in
infancy.
 AIMS AND OBJECTIVES
• Reducing maternal ,perinatal, infant and child mortality and morbidity rates

• Child development

• Promoting reproductive health and safe motherhood

• Ensuring birth of healthy child

• Preventing malnutrition

• Preventing communicable diseases

• Early diagnosis and treatment of the health problems

• Health education and family planning service

 ISSUES
• Major health problems affecting mothers and children in India are:
1. Malnutrition 2. Infection 3. Unregulated fertility
• Malnutrition
- It is widely prevalent in pregnant and lactating women and in children
- Malnutrition during pregnancy can result in complications like maternal depletion, anemia, post-
partum hemorrhage, toxemia of pregnancy and low birth weight in baby.
- Severity of illness due to infections is more among the malnourished children as compared to the well
nourished. Hence improving, protection and promotion of the nutritional status is an essential element
of MCH care.
- The nutrition status can be improved by directly intervention by providing food and nutrients
supplements and also indirectly by practicing infection control through immunization, good food n
water hygiene, environmental sanitation and education.
 ISSUES
• Infection
- The risk of infections is low in developed countries but continue to be a major problem in developing
countries like India
- Infection during pregnancy can result in IUGR and low birth weight, congenital malformations in the
fetus and abortions. 25% of pregnant women in rural areas have at least one bout of UTI
- Children with infections have risk of diarrheal diseases, respiratory tract infection and skin infections
- Children in developing countries need to be immunized against the major six infections covered under
WHO’s EPI – TB, diphtheria, whooping cough, tetanus, measles and polio
- The mothers are educated to improve nutrition status, to practice good hygiene and to manage minor
ailments appropriately.
- Provisions of safe drinking water and sanitation are of great concern
 ISSUES
• Unregulated Fertility
- Unregulated fertility adversely affects the health of both the mother and the child
- Adverse effects include anemia, abortion, antepartum hemorrhage, low birth weight and perinatal
mortality.
- Different methods of family planning like new and safer intrauterine contraceptive devices, oral
contraceptive pills, long acting injectable medroxy progesterone acetate, female sterilization and
barrier methods are made easily available
 COMPOSITION
• The MCH services are rendered through the infrastructure of primary health centers and sub- centers.
It is proposed to set up one primary health centers for every 30,0000 population, and one sub-center
for 3000 to 5000 population.
• Each sub centers are foundation of national health system which is manned by a team of one male and
female health worker. In addition there is a team of one trained dai and one health guide in every
village.
• The components of MCH include the sub areas:-
- Maternal health
- Family planning
- Child health
- School health
- Handicapped children
- Care of the children in special setting such as day care centers
 FUNCTIONS
Complete health check -up and care of the child and mothers from
conception to birth

Studying health problems of mothers and children

Providing health education to parents for taking care of children

Training to professional and assistant workers

 RECENT STRATEGIES
• Integration of care - Earlier maternal and child health care services were divided into antenatal, child
care and family planning. Integration is helpful in increasing the capability and effectiveness of service
• Risk approach - Risk group among mother and infant is identified special care is given to them. This
tackles the lack of resources and their availability.
• Man power changes - Maternal and child health services are left to traditional health workers (ANMs,
health visitors) rather than specialist of field and child volunteers and workers of NGOs.
• Primary health care - Information about protection and resources for mother and child health care are
made available.
• Reproductive and child health - As per the decision taken in world women’s conference, Beijing(1995),
maternal and child health services have been included in reproductive and child health services.
 REFERENCE
• https://www.slideshare.net/INDRAMANIMISHRA/maternal-and-child-health-programme-46306252
• http://www.ihatepsm.com/blog/maternal-and-child-health-mch-problems-india
National Family Welfare Program
 INTRODUCTION
• Need: The increasing pressure of population on natural resources retards economic progress and limits
the rate of extension of social services, so essential to civilized existence.
• The National Family Welfare Program was launched in India in 1951 with the objective of reducing the
birth rate to the extent necessary to stabilize the population at a level consistent with the requirement
of the National economy. India is the first country in the world to formulate such a program.
• The Family Welfare Program in India is recognized as a priority and is being implemented as a 100%
Centrally sponsored program- The Ministry of Health and Family Welfare.
• In 1977 the ‘National Family Planning Program’ was re-designated as the ‘National Family Welfare
Program’.
• The concept of welfare is related to the quality of life which includes education, nutrition, health,
employment, women’s welfare and rights ,shelter, safe drinking water etc.
 EVOLUTION
• The First Five Year Plan (1951-1956):
The program initiated with a clinical approach to family planning.
• The Second Five Year Plan (1956-1961):
Large number of family planning clinics were opened. The NFWP entered a New technological era with
introduction of the Lippi's loop later replaced by copper T.
• The Third Five Year Plan (1961-1966):
An emphatic recognition was given to family planning
• The Fourth Five Year Plan (1969-1974):
The time and target oriented approach of family planning had been introduced in the fourth plan had
been continued in the fifth plan.
 EVOLUTION
• The Fifth Five Year Plan (1974-1979):
The fifth plan had also laid down a target for a birth rate of 25 per thousand and a population growth
rate of 1.4 percent by the end of the sixth plan period.
The Ministry of health and family planning had introduced a national population policy which
included raising the age as marriage, female education, spread of population values and the small
family norm, strengthening of research in reproductive biology and contraception, incentives for
individuals, groups and communities and permitting state legislatures to enact legislation for
compulsory sterilization.
• The Sixth Five Year Plan (1980-1985):
The sixth five year plan laid down the long term demographic goal of reducing the net reproduction
rate (NRR) to one.
 EVOLUTION
• Seventh Five Year Plan 1985-1990:
It planned a crucial role in human resources development and in improving the quality of the people
which stressed the need for promotion of family program on a voluntary basis as a people’s movement. It
placed more emphasis on the use of spacing methods between the births of two children.
• Eighth Five Year Plan 1992-1997:
It was towards human development that health and population control are listed as two of the six priority
objectives of the eighth plan. It was towards this end that population control. The priority objectives included
literacy, primary health care, provision of adequate food and safe drinking water employment generation and
basic.
• Ninth Five Year Plan 1998-2002:
There was a paradigm shift of objectives in the ninth plan. Centrally defined method specific targets for family
planning were abolished and was shifted to decentralized planning at the state and district level based on
assessment of community needs for maternal and child health and contraceptive care were worked out. A
massive pulse polio campaign was taken up to eliminate polio.
 EVOLUTION
• Tenth Five Year Plan 2002-2007:
The plan had fully operationalized efforts to assess and meet the unmet needs for contraceptives,
achieve reduction in the high desired level of fertility through programs for reduction in IMR and MMR
and enable families to achieve their reproductive goals.
• Eleventh Five Year Plan 2007-2011:
The plan continued to advocate fertility regulation through voluntary and informed consent and also
address the special health care needs of the elderly, especially those who are economically and
socially vulnerable.
• Twelfth Five Year Plan 2012-2017:
The health goals were to reduce infant mortality rate to 25, maternal mortality ratio to 100, total fertility
rate to 2.1, anemia cases in women (ages 15-49) to 28% and raising child sex ratio in age group 0-6 from
914 to 950.It was the last five year plan.
 EVOLUTION
• The Government of India adopted a new approach, which places a well-defined focus to the family
planning efforts under a larger and more comprehensive umbrella of RMNCH+A (Reproductive,
Maternal, Newborn and Child Health and Adolescents) program.
• This shift was adopted recognizing the need and long-term goal of addressing a target free approach
which is beyond the simple strategy of achieving population stabilization, under the larger view of
improving maternal and child (and adolescent) health in India.
 OBJECTIVES
• To promote the adoption of small family size norm, on the basis of voluntary acceptance
• To promote the use of spacing methods
• To ensure adequate supply of contraceptives to all eligible couples within easy reach
• To arrange for clinical and surgical services so as to achieve the set targets
• Participation of voluntary organizations/local leaders/local self government, in family welfare program
at various level
• Using the means of mass communication and interpersonal communication to overcome the social and
cultural hindrances in adopting the program or extensive use of public health education for family
planning
 STRATEGIES
• Integration with health services: Family welfare program (FWP) has been integrated with other health
services instead of being a separate service.
• Integration with maternity and child health: FWP has been integrated with maternity and child health
(MCH). Public are motivated for post delivery sterilization, abortion and use of contraceptives.
• Concentration in rural areas: FWP are concentrated more in rural areas at the level of subentries and
primary health centers. This is in addition to hospitals at district, state and central levels.
• Literacy: There is a direct correlation between illiteracy and fertility. So stress and priority is given for
girl's education. Fertility rate among educated females is low.
• Breast feeding: Breast feeding is encouraged. It is estimated that about 5 million births per annum can
be prevented through breast feeding. Raising the age for marriage: Under the child marriage restraint
bill (1978), the age of marriage has been raised to 21 years for males and 18 years for females. This has
some impact on fertility
 STRATEGIES
• Minimum needs program: It was launched in the Fifth Five Year Plan with an aim to raise the
economical standards. Fertility is low in higher income groups. So fertility rate can be lowered by
increasing economical standards.
• Incentives: Monetary incentives have been given in family planning programs, especially for poor
classes. But these incentives have not been very effective. So the program must be on voluntary basis.
• Mass media: Motivation through radio, television, cinemas, news papers, puppet shows and folk
dances is an important aspect of this program.
 IMPACT
• Nearly 98% of women and 99% of men in the age group of 15 and 49 have a good knowledge about
one or more methods of contraception.
• Adolescents seem to be well aware of the modern methods of contraception.
• Over 97% of women and 95% of men are knowledgeable about female sterilization, which is the most
popular modern permanent method of family planning.
• While only 79% of women and 80% of men have heard about male sterilization.
• 93% of men have awareness about the usage of condoms while only 74% of women are aware of the
same.
• Around 80% of men and women have a fair knowledge about contraceptive pills.
 REFERENCE
• http://pbhealth.gov.in/pdf/FW.pdf
• https://www.slideshare.net/Soumyaranjanparida/national-family-welfare-programme-2
• https://www.researchgate.net/publication/284467291_NATIONAL_FAMILY_PLANNING_PROGRAMME_
-_DURING_THE_FIVE_YEAR_PLANS_OF_INDIA
• https://www.slideshare.net/INDRAMANIMISHRA/family-welfare-programme-46691314
• https://en.wikipedia.org/wiki/12th_Five-Year_Plan_(India)
• https://humdo.nhp.gov.in/about/national-fp-programme/
National Tobacco Control Program
 INTRODUCTION
• India is the 2nd largest producer and consumer of tobacco and a variety of forms of tobacco use is
unique to India. Apart from the usual smoked forms that include cigarettes, bidis and cigars, a plethora
of smokeless forms of consumption exist in the country.
• The Government of India has enacted the national tobacco-control legislation namely, ‘The Cigarettes
and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce,
Production, Supply and Distribution) Act’ on May, 2003.
• India also ratified the WHO-Framework Convention on Tobacco Control (WHO-FCTC) in February, 2004.
• Further, in order to facilitate the effective implementation of the Tobacco Control Law, to bring about
greater awareness about the harmful effects of tobacco as well as to fulfill the obligations under the
WHO-FCTC, the Ministry of Health and Family Welfare, Government of India launched the National
Tobacco Control Program (NTCP) in 2007- 2008.
 OBJECTIVES
• To bring about greater awareness about the harmful effects of tobacco use and Tobacco Control Laws

• To facilitate effective implementation of the Tobacco Control Laws

• The objective of this program is to control tobacco consumption and minimize the deaths caused by it.
The various activities planned to control tobacco use are as follows:

- Training and Capacity Building

- IEC activity

- Monitoring Tobacco Control Laws and Reporting

- Survey and Surveillance

STRUCTURE OF NTCP
 WHO TOBACCO FREE INITIATIVE IN
INDIA
• World Health Organization (WHO) led the negotiation of the Framework Convention on Tobacco
Control (FCTC), the world's first public health treaty in 2003
• FCTC provides a framework to ‘protect present and future generations from the devastating health,
environmental & economic consequences of tobacco consumption and exposure to tobacco smoke.’
 ACHIEVMENTS OF NTCP
Year Achievements under NTCP
2012 -13 • Issued notification to regulate the depiction of tobacco products or its use in films and TV programmes.
• Issued the packaging and labelling Rules 2012 vide notification G.S.R. No. 724 (E) dated 27-09-12.
• Launched Public awareness campaign using electronic media as well as outdoor media like Bus panels, bus queue
shelters, unipole, back light display at railway station, metro rail display etc.
• Several people were challaned, tobacco users counselled,school programs were conducted and people were trained
through workshops
2013-14 • Up-scaled the coverage of National Tobacco Control Programme (NTCP) from existing 42 districts of 21 states to 53
districts of 29 states in 2013, subsumed under the National Health Mission (NHM) Flexi-pool for Non-Communicable
disease (NCD’s).
• Organized “National Consultation on Tobacco Economics” which dwelt on three issues of economics of tobacco (i)
Health Cost of Tobacco Use, (ii) Alternative livelihood to tobacco farmers and bidi rollers and (iii) tobacco taxation.
• Launched Public awareness campaign launched using electronic media and Radio and outdoor (train wrap-up & bus
panels).
2014-15 • Issued notification of new Rules on tobacco pack pictorial warnings on 15th October, 2014, which mandate display of
pictorial health warnings on 85% of principal display area of tobacco packs and on both sides.
• Launched Public awareness campaign using electronic media and Radio.
• Funds released for setting up/ upgradation of State Tobacco Control Cells in 35 States/UTs and for setting up district
tobacco control cells in 56 districts.
• Initiated the process of setting up national quit line and strengthening violation helpline.
 CURRENT SCENARIO
• Although India’s overall consumption of bidis and cigarettes declined between 1999–2000 and 2011–
2012, these observed reductions were not significantly different between NTCP and non-NTCP districts.
This highlights the importance of strengthening the implementation and enforcement of tobacco
control policies in LMICs to achieve SDG mortality reduction targets for children and adults.
 REFERENCE
• http://vikaspedia.in/health/nrhm/national-health-programmes-1/national-tobacco-control-
programme?content=normal
• https://www.slideshare.net/vinip3012/tobacco-control-laws-in-india
• http://pib.nic.in/newsite/PrintRelease.aspx?relid=124551
• http://www.searo.who.int/entity/noncommunicable_diseases/events/ncd-bengaluru-tobacco-
control-india.pdf?ua=1
• https://tobaccocontrol.bmj.com/content/early/2019/02/13/tobaccocontrol-2018-054621
 ROLE OF A PHARMACIST
• Explaining the importance and necessity of the program to masses.
• Using various techniques of teaching and communication to propagate the message to common man.
• Coordinating between doctor, family and the patient
• Motivating the eligible couple to use contraceptives and educating them about its uses.
• Motivating people for family planning operation or permanent contraception.
• Organizing family planning camps
• Arranging family planning operations ( sterilization male/ female ) through special camps
• Maintaining records and research work related to family planning
• Analyzing the goals, impacts and outcomes of the program in the society