Maternal and child health programme
MR. INDRA MANI MISHRA
(M.Sc. Nursing , B.Sc. Biotech, Diploma in Hospital
Nursing Tutor in RIMSCON Ranchi
1. Mothers and children not only constitute a large
group, but they are also” vulnerable “ or special
group. They comprises 71.4 % of population of the
developing countries. 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 57.5% of population consists
of mothers and children. (current population of
India as on 22 march 2015 is 1.28 billion. And of
Jharkhand is 32,966,238 (32 Carores 9 lakh 66 thousand 2
2. Children are the foremost priorities of
community health program. Their aim is to
increase the nutrition level of mothers and
children to ensure the birth of healthy child.
3. MCH services started due to different reasons
in different countries. 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.
4. Various facilities and programme organized for
the purpose of providing medical and social
services for mothers and children.
5. Medical services include prenatal and postnatal
services, family planning care, and pediatric
care in infancy.
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”.
Thus maternal and child health service is an
important and essential service related to
mother and child’s overall development.
AIMS AND OBJECTIVES OF
• Reducing maternal (current status-2013: 190 per one
lakh live births) ,Perinatal ("number of stillbirths and
deaths in the first week of life per 1,000 live births)
infant (current status-2013: 41 per one thousand live
births) and child mortality and morbidity rates.
• Child survival
• Promoting reproductive health or safe motherhood
• Ensure birth of healthy child
• Prevent malnutrition
• Prevent communicable diseases
• Early diagnosis and treatment of the
• Health education and family planning
• The MCH services are rendered through the
infrastructure of primary health centres and sub-
centres, whose number are 24,049 (september 2013)
and 1,48,366 (september 2013) respectively. It is
proposed to set up one primary health centres for
every 30,0000 population, and one sub-centre for 3000
to 5000 population.
• Each sub centres are foundation of national
health system. Each sub-centres 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 following
Care of the children in special setting such as day
ACTIVITIES OF MCH PROGRAMME:-
Maternal and child health services are an
important part of primary health care.
Traditional activity areas of these
• Complete health check -up and care of the
child and mothers from conception to birth.
• Studying health problems of mothers and
• Providing health education to parents
for taking care of children.
• Training to professional and assistant
NEED FOR MCH PROGRAMME:-
• There are four main reasons why mother and child
health must be given top priority in health programme
1. Mother and child below the age of 15 years make up
the majority of the population in almost countries.
2. Mother and children constitute a “special risk’’ or
vulnerable group in the case of illness, deaths, in the
terms of pregnancy, childbirth of mothers, and growth
and development in the case of children.
3. By improving the health of mother and children we
can improve the health of the family and community.
4. Ensuring child survival is a future investment for the
family and community.
INDICATOR OF MATERNAL AND CHILD
Maternal and child health can be evaluated on the
basis of the following indicators:
1. Maternal mortality rate-below 1(for every 1000
2. Infant mortality rate-below 30 (for every 1000 live
3. Death rate of 1-4 year old age group-below 10.
4. Size of family- 2-3 members.
5. Perinatal mortality rate-30-35
6. Weight of minimum 90% of total children-
according to height/weight chart.
RECENT TRENDS IN MCH SERVICE
a. Integration of care:- Earlier maternal and child health
care services were divided into antenatal, child care and
family planning. Naturally it is helpful in increasing the
capability and effectiveness of service
b. Risk approach :- This new thought was born from the lack
of resources and their availability. As per this the risk
group among mother and infant is identified special care
is given to them.
c. Man power changes :- According to new concept,
maternal and child health services should be left to
traditional health workers(ANMs, health visitors) rather
than specialist of field and child volunteers and workers
d. Primary health care:- It makes available
information about protection and protection
and resources for mother and child health
e. Reproductive and child health :- As per the
decision taken in world women’ conferences,
Beijing(1995), maternal and child health
services have been included in reproductive
and child health services.
The guiding principle for the maternal and child health program me are:-
a) Consultation and participation:- consultation with, and
participation by, families is integral to the services. Services will be
informed by, and seek to meet, the young needs of young children
and their families.
b) Access and availability:- All families with young children should be
able to readily access the information, services and resources that
are appropriate for, and useful to, them.
c) Primacy of prevention:- Prevention of harm or damage is preferable
to repairing it later. Early detection of risk factors is required, and
intervention, where appropriate.
d) Capacity building:- Promotion of resilience and capacity is
preferable to allowing problems to undermine health or autonomy.
e) Equity:- All children should be able to grow up actively
learning,healthy,sociaable and safe-irrespective of their family
circumstances and background.
f) Family cantered- The identification and management
of child and family needs requires a family-
centered approach that focuses on strength.
g) Inclusion:- Inclusive practices are essential for all
children to get the best start, irrespective of their
family circumstances, differing abilities and
h) Partnership:- Quality services are archived through
integrated services delivery and partnership with
other early childhood and specialist services, and
i) Quality:- All families with young children must be
confident of the quality of information , services
and resources provided to them.
MATERNAL AND CHILD HEALTH SERVICE PROGRAMME STANDARDS
1.The maternal and child health services provides universal access to its services
for children from birth to school age and their families.
2.The maternal and child health services promotes optimal health and
development outcomes for children from birth to school age through a focus
on the child, mother and family.
3.The maternal and child health services builds partnership with families and
communities and collaborates and integrates with other services and
4.The maternal and child health services is delivered by a competent and
5.The maternal and child health service ,supported by local government or the
governing authority, provides a responsive and accountable se
• Service for the child, mother and family
through effective governance and
• The maternal and child health services
delivers a quality and safe services.
OF MCH SERVICES
• Complete health check up and care of the
child and mother from conception to birth
• Studying the health problems of mothers
• Providing health education to parents for
taking care of children
• Training to professionals and assistant
Responsibilities of community health
nurse in MCH services
The function of community health nurse
1.Direct care provider:
A. Antenatal care:-
i. Contact: Contacting every pre-gnant mother in the primary
Stage of pregnancy.
ii. History:- taking history of general health, previous child birth
and pres-ent pregnancy.
iii. Antenatal examination:- Conducting physical birth and
iv. Antenatal Examination:-
a. Calculate obstetric examination etc.
b. Calculating the expected date of delivery
c. Identifying high risk of mothers
d. Providing counselling and health education.
e. Helping mother and other family members in planning
B. Intranatal care:-
• Preparing the place for delivery.
• Arranging necessary equipment.
• Giving mental support to mothers.
• Preparing mother for delivery.
• Examine position of foetus, dilatation of cervix, and
heart of foetus, observing the position of bladder and
• Noting general condition of the pregnant mother,
process of pain and time of membrane rupture.
• Ensuring safe delivery, examining umbilical cord and
• If necessary, taking help of doctor or referring patient
to a specialist.
• Maintaining through asepsis during delivery.
• Should be ready to handle complications like bleeding,
malpresentation, cord prolaps etc.
• Noting the correct time of birth.
C. Postnatal care:-
• The week immediately after the child birth is called
postnatal period. The responsibilities of community
health nurse are.-
• Observing the blood pressure, temperature and pulse
of mother immediately after the delivery and then
during the following period.
• Collecting information about the general condition
of mother, food, sleep, pain and elimination etc. and,
accordingly the nursing care.
• Observing fundus, perineum, lochia, bladder etc.
• Observing breast and nipples.
• Protecting the mother from complications like
puerperal sepsis, breast inflammation, postpartum
hemorrhage,urinary incontinence, urinary retention
and thrombophlebitis and providing required
D. Neonatal care
• Observing the respiration of newborn, immediately
after birth and if necessary providing resuscitation.
• Taking care of the umbilical cord and cutting the
• Cord and tying it using proper techniques.
• Taking notice of abnormalities or congenital defects and
informing the relatives.
• Assessing the physical condition of the newborn by his
apgar score ( 9 or 10 is ideal score )
• Cleaning the newborn child ( giving bath to the newborn
has become less popular.
• Taking care of the newborn skin and eyes.
• Keeping the newborn child on safe bed and providing
breast feeding to baby at the earliest.
• Maintaining normal body temperature of the new
• born. Give kangaroo care.
• Function related to maternal clinics :-
• Home visits:- During home visit, community
health nurse should try to focus the attention of
mother of mother on the following points:-
• Antenatal check up and its importance.
• Anatomy, physiology, and psychology of
• Diet during pregnancy
• Plans of delivery
• Neonatal care
• Family planning
2. Managerial functions:-
• Organizing and managing the nursing homes.
• Playing the role of liaison officer under referral system,
for sending the mother to hospital for safe delivery.
• Taking part in community activities.
• Explaining the importance of reproductive and child
health in community.
• Supervising the work of midwives and female health
workers and giving them appropriate suggestions.
• Organizing and managing maternal clinics.
• Coordinating between the doctor, family and patients.
• Storing and maintaining the records of maternal and
child health services.
• Assisting the research work in the field of maternal and
child health services.
3. Educational functions:-
• Providing health education to mother and family either
individually or in the group.
• Educating (using demonstration) pregnant mothers and
relatives about maternal nursing.
• Community health nurse should discuss following topics
with pregnant mothers :
• Importance of regular antenatal check up.
• Personal hygiene and proper diet.
• Clean environment ( including mental environment)
• Importance of hospital delivery or delivered or delivery by
• Taking care of infant.
• Thus, community health nurse has a multifaceted role
in maternal services. It is only through proper discharge
maternal and infant mortality can be reduced to targeted
• Introduction of maternal and child health
• Aims of maternal and child health programmes.
• Sub areas of MCH.
• Activities of MCH programme.
• Need for NCH programme.
• Principles of MCH programme.
• Indicators of MCH programme.
• Recent trends in MCH
• Role of nurse in MCH.
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2013,published by premnagar,Jabalpur, pg no.-481,514.
• Park. K, Essential of community health nursing,4th
edition2014, published by premnagar,Jabalpur,pg,no,- 278-
• Rao sundar kasthuri Mrs.Dr.,An introduction to community
health nursing,4th edition(reprint) 2005,published
byB.I.publication pvt.ltd, chennai, pg.no.-446
• Swarnkar Keshav,Community health nursing, 2nd edition
2007, published byN.R.Brothers,indore,pg.no-83-87