Maternal and Child Health (MCH) Care 2024 Comprehensive Guide

Maternal and Child Health (MCH) care, as defined by the World Health Organization, encompasses the promotion, prevention, therapeutic, and rehabilitative services for mothers and children. The MCH field is essential due to the vulnerability of these groups and their significant impact on a country’s health status. This article delves into the components, objectives, and recent trends in MCH, aiming to provide a comprehensive understanding of this vital healthcare sector.

Understanding Maternal and Child Health (MCH) Care

Definition of Maternal and Child Health (MCH) Care

The World Health Organization defines maternal and child health services as “promoting, preventing, therapeutic or rehabilitation facility or care for the mother and child.” These services encompass a range of healthcare interventions aimed at ensuring the health and well-being of mothers and children.

Importance of MCH Care

Maternal and child health (MCH) is crucial as it involves two vulnerable groups—the mother and children. The health status of these groups significantly influences the overall health status of a country. In India, women of reproductive age (15-44 years) and children under five years constitute a substantial portion of the population, making MCH services essential.

Objectives of Maternal and Child Health Care

Reduce Morbidity and Mortality Among Mothers and Children

Addressing the major health challenges faced by these groups is a primary objective. Efforts focus on preventing and managing complications during pregnancy, childbirth, and early childhood to reduce illness and death rates.

Promote Physical and Psychological Development of Children Within the Family

Ensuring the holistic development of children involves providing appropriate healthcare, nutrition, and psychosocial support from infancy through adolescence. This includes regular health check-ups, vaccinations, and developmental screenings.

Promote Reproductive Health

Focusing on family planning and safe motherhood practices is essential to improve reproductive health. This includes access to contraceptives, education on reproductive rights, and services to ensure safe and healthy pregnancies and deliveries.

Provide Child Care in Special Settings

Addressing the needs of children with special needs and those in unique circumstances, such as orphans, children in foster care, and those with disabilities, is crucial. This includes specialized medical care, rehabilitation services, and support for families.

Ensure Lifelong Health

The overarching goal of MCH services is to promote lifelong health. This includes ensuring that children grow into healthy adults and that mothers maintain their health throughout their lives. Preventive healthcare, education, and early intervention play key roles in achieving this goal.

Sub Areas of MCH Components

Family Planning

Family planning services are essential in MCH as they help in spacing births, reducing the risk of maternal and child health issues. These services include access to contraceptives, education on reproductive health, and counseling on family planning options.

Child Health

MCH services focus on ensuring the health and development of children through immunizations, regular health check-ups, and nutritional support. This also includes addressing common childhood illnesses and promoting healthy behaviors.

School Health

School health programs aim to monitor and improve the health of school-going children, addressing issues like nutrition, hygiene, and disease prevention. These programs often include health education, screenings, and interventions to address health issues that can affect learning and development.

Physically Challenged Children

MCH includes services for children with physical challenges, ensuring they receive appropriate medical care and support for their development. This involves rehabilitation services, special education, and support for families to manage their child’s needs.

Trends in MCH

Historical Context of Maternal Mortality Rate

Before India’s independence, the maternal mortality rate was approximately 20 per 1000 live births, and 30% of babies died before their first birthday. These high rates reflected the lack of access to quality healthcare and the prevalence of poverty and malnutrition.

Post-Independence Trends in MCH Programs

Post-independence, the Indian government prioritized MCH programs, incorporating them into all five-year plans. These programs focused on improving access to healthcare, training healthcare workers, and addressing social determinants of health, resulting in significant improvements in maternal and child health outcomes.

Recent Trends in MCH

Integration of Care

An integrated approach in MCH care ensures comprehensive services where all health team members, from obstetricians to local health workers, collaborate for the well-being of mother and child. This holistic approach replaces conventional care, enabling mothers to receive all necessary services in one location.

Risk Approach

The risk approach focuses on identifying high-risk mothers and children to provide them with specialized care, ensuring efficient use of resources. This approach aims to prevent complications by providing targeted interventions for those at higher risk, while ensuring routine care for others.

Manpower Changes

Changes in manpower, including the introduction of multipurpose health workers and community volunteers, aim to enhance the quality of MCH services. Initiatives like “dai training” help rural women receive skilled assistance during childbirth, improving outcomes in areas with limited access to healthcare facilities.

Primary Health Care

Primary health care ensures that essential services, including MCH, family planning, and infection control, are accessible to all. This approach focuses on elements like nutrition, health education, and disease prevention, which have a significant positive impact on maternal and child health.

Causes of Maternal Mortality in India

Medical Causes

Obstetrical Causes

• Toxemias of Pregnancy: Conditions like preeclampsia and eclampsia that can lead to severe complications.
• Hemorrhage: Severe bleeding during or after childbirth.
• Infection: Postpartum infections that can become life-threatening.
• Obstructed Labor: Labor that does not progress, often requiring surgical intervention.
• Unsafe Abortion: Complications arising from unregulated and unsafe abortion practices.
• Anemia: Severe anemia can lead to complications during pregnancy and childbirth.

Non-Obstetrical Causes

• Associated Diseases: Conditions like cardiac, renal, and metabolic disorders that complicate pregnancy.
• Malignancies: Cancers that may be diagnosed during pregnancy.

Social Factors

• Age at Childbirth: Higher risks associated with very young or older mothers.
• Parity and Close Pregnancies: Increased risks with higher number of births and closely spaced pregnancies.
• Accidents: Traumas that can affect pregnancy outcomes.
• Family Size, Malnutrition, and Poverty: Poor socioeconomic conditions affecting maternal health.
• Illiteracy, Ignorance, and Prejudices: Lack of education and cultural practices that hinder access to healthcare.
• Lack of Maternal Services and Untrained Delivery Practices: Insufficient healthcare services and reliance on untrained birth attendants.
• Poor Communication and Transportation Facilities: Difficulties in accessing healthcare due to infrastructural barriers.
• Societal Customs: Practices and beliefs that negatively impact maternal health.

Preventive and Social Measures

Promote Early Registration of Pregnancy

Encouraging early and regular prenatal care to monitor and manage health issues is crucial in preventing complications. Early registration helps in identifying high-risk pregnancies and ensuring timely interventions.

Education and Awareness

Raising awareness about safe motherhood practices and available health services is essential. Educating women and communities about the importance of prenatal care, nutrition, and skilled birth attendance can significantly improve maternal and child health outcomes.

Improving Health Services

Enhancing the quality and accessibility of maternal health services, particularly in rural areas, is vital. This includes building healthcare infrastructure, training healthcare providers, and ensuring the availability of essential medicines and equipment.

Training Health Workers

Providing training to traditional birth attendants (dais) and other health workers to improve the quality of care. Skilled birth attendants can manage normal deliveries and identify complications that require medical attention, reducing maternal and neonatal mortality.

Community Involvement

Engaging communities in health education and support programs to address social determinants of health. Community involvement helps in creating supportive environments for pregnant women and new mothers, promoting practices that improve maternal and child health.

Antenatal Care

Definition

Antenatal care involves comprehensive health supervision provided to pregnant women before delivery. It encompasses planned examinations, observations, and guidance from conception until labor.

Objectives

• Promote, protect, and maintain the health of the mother and growing fetus.
• Identify and provide special attention to high-risk cases.
• Prevent complications.
• Reduce maternal mortality rates.
• Provide health education on child care, nutrition, hygiene, environmental sanitation, etc.
• Sensitize mothers on the need for family planning and advise on safe abortion and medical termination of pregnancy (MTP).
• Attend to under-five children visiting the outpatient department (OPD) with their mothers.

Principal Elements of Antenatal Care

• Early Registration: Ideally register all pregnancies in the first trimester before the 12th week. Late registrations should be accepted, with care given according to gestational age.
• Minimum Four Antenatal Check-ups: Ensure at least four visits and provide a complete package of services.
• Antenatal Visit Schedule:
  • 1st Visit: Within 12 weeks, preferably as soon as pregnancy is suspected.
  • 2nd Visit: Between 14 and 26 weeks.
  • 3rd Visit: Between 28 and 34 weeks.
  • 4th Visit: Between 36 weeks and term.
• Doctor Examination: At least one antenatal check-up (preferably the third visit) should be conducted by a doctor.
• Provision of Iron and Folic Acid: Supplementation and tetanus toxoid injection.
• Laboratory Investigations: Includes hemoglobin, urine albumin and sugar, RPR test for syphilis, blood grouping, and Rh typing.
• Nutrition and Health Counseling: Guidance on diet and overall health.
• Identification and Management of High-Risk Pregnancies: Monitor and refer to higher-level care if needed.
• Chemoprophylaxis for Malaria: In high malaria-endemic areas.

Intranatal Care

Definition

Intranatal care aims to prevent complications during delivery. This includes ensuring health centers and hospitals are equipped to prevent sepsis in delivery rooms and newborn care units. Home deliveries should be conducted by trained birth attendants (dais), taking necessary precautions to prevent sepsis and save the lives of mother and baby.

Postnatal Care

Definition

Postnatal or postpartum care involves caring for the mother and the newborn after delivery. Obstetricians and pediatricians play crucial roles during this period.

Objectives

• Prevent complications that may occur during the postnatal period.
• Help in the rapid restoration of the mother’s optimal health.
• Assess breastfeeding adequacy.
• Educate on family planning services.

Complications of the Postpartum Period

• Puerperal Sepsis: Genital tract infection occurring within 3 weeks of delivery, characterized by fever, increased pulse, foul-smelling lochia, and lower abdominal pain.
• Thrombophlebitis: Infection of the leg veins, often associated with varicose veins.
• Secondary Hemorrhage: Vaginal bleeding occurring any time after 6 hours of delivery up to 6 weeks postpartum.
• Other Complications:
  • Urinary tract infection.
  • Mastitis.

Restoration of Mother’s Health

• Postnatal Assessment: Includes physical and psychosocial evaluation.
• Psychological Support: Provided as necessary.
• Breastfeeding: Ensuring proper breastfeeding practices.
• Anemia Prevention: Through appropriate supplementation.
• Nutrition and Postnatal Exercises: Promoting adequate diet and physical activity.
• Family Planning and Health Education: Educating mothers on available family planning options and overall health education.

Ensuring comprehensive care throughout the antenatal, intranatal, and postnatal periods is essential for the health and well-being of both mothers and children.

FAQs

What is Maternal and Child Health (MCH) care?

Maternal and Child Health (MCH) care includes services aimed at promoting, preventing, and treating health issues in mothers and children.

Why is MCH care important?

MCH care is crucial as it targets the health of mothers and children, two vulnerable groups that significantly impact a nation’s health status.

What are the components of MCH services?

Components of MCH services include family planning, child health, school health, and care for physically challenged children.

What are the recent trends in MCH care?

Recent trends in MCH care include the integration of care, risk approach, manpower changes, and emphasis on primary health care.

What are the causes of maternal mortality in India?

Causes of maternal mortality in India include obstetrical complications, non-obstetrical diseases, and social factors such as poverty and lack of maternal services.

How can maternal mortality rates be reduced?

Maternal mortality rates can be reduced through early pregnancy registration, skilled birth attendance, and improving maternal health services.

Medical Termination of Pregnancy (MTP)

Aims of the MTP Act

• Improve Maternal Health: Prevent unsafe abortions and reduce maternal mortality and morbidity.
• Legalize Abortion Services: Ensure legal access to abortion services.
• Promote Safe Abortion Services: Make safe abortion services accessible wherever applicable.
• Protect Medical Practitioners: Shield practitioners from penalization under the Indian Penal Code (Sections 315-316).

Legal Framework of the MTP Act

Legal Abortion Conditions

Abortions are considered legal when they meet the following criteria:

1. Approved Medical Practitioner: Termination must be performed by an approved medical practitioner.
2. Approved Conditions and Gestation: Abortion must adhere to the conditions and gestational limits prescribed by the Act.
3. Approved Place: Procedure must be carried out in a place abiding by all rules and regulations set forth by the Act.

Permitted Conditions for MTP

1. Medical: If continuation of the pregnancy poses a risk to the life or causes grave injury to the physical or mental health of the woman.
2. Eugenic: If there is a substantial risk of the child being born with serious physical or mental abnormalities.
3. Humanitarian: If the pregnancy is caused by rape, presumed to cause grave injury to mental health.
4. Contraceptive Failure: In married couples, presumed to cause grave injury to mental health.
5. Socioeconomic: If the environment could lead to injury to the mother.

Who Can Perform MTP?

A Registered Medical Practitioner (RMP) who:

• Holds a recognized medical qualification as defined in clause (h) of section 2 of the Indian Medical Council Act, 1956.
• Is registered in a State Medical Register.
• Has the prescribed experience or training in gynecology and obstetrics.

Eligibility Criteria for Medical Practitioners

• For Pregnancies up to 12 Weeks:
  • Practitioner who has assisted in 25 MTP cases, with at least 5 independently performed in an approved hospital or training institute.
• For Pregnancies up to 20 Weeks:
  • Practitioner with a postgraduate degree or diploma in obstetrics and gynecology.
  • Practitioner who has completed a 6-month house job in obstetrics and gynecology.
  • Practitioner with at least 1 year of experience in obstetrics and gynecology at a hospital with all facilities.
  • Practitioner registered in the state medical register before the commencement of the Act, with at least 3 years of experience in obstetrics and gynecology.

Guidelines for Terminating Pregnancy

• Consent: Must obtain the woman’s consent. If the woman is below 18 years or mentally ill, consent from the guardian is required.
• Gestational Limit: Only up to 20 weeks of gestation.
• Medical Opinion: One RMP’s opinion required for termination up to 12 weeks; opinion of two RMPs required for termination between 12 and 20 weeks.
• Place: Must be conducted in a government hospital or a place approved by a district-level committee constituted by the government.

Confidentiality

• The process should be conducted in strict confidence to protect the privacy of the woman.

Ensuring the above conditions and guidelines helps promote safe and legal abortion services, contributing to improved maternal health outcomes

Female Foeticide Act

Introduction

The Preconception and Prenatal Diagnostic Techniques (PCPNDT) Act was enacted by the Government of India in 1994 to address the issue of female foeticide and the declining sex ratio. It aimed to curb the practice of prenatal sex determination and its consequent impact on the female population. In 2003, the Act was amended and renamed as the Preconception and Prenatal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994.

Important Features of the Act

1. Prohibition of Sex Selection:
   • Before or After Conception: The Act prohibits sex selection procedures, both pre-conception and pre-natal.
   • No Sex Determination Tests: No laboratory, clinic, or center can conduct tests, including ultrasonography, for determining the sex of the fetus.
   • Communication Ban: It is illegal for anyone to communicate the sex of the fetus to the pregnant woman or her relatives by any means.
2. Penalties for Violation:
   • Advertising: Any person advertising for sex determination services in any form (notices, circulars, labels, etc.) can face imprisonment for up to three years and a fine of ₹10,000.
3. Permitted Uses of Prenatal Diagnostic Techniques:
   • Genetic Abnormalities: Detecting genetic disorders.
   • Metabolic Disorders: Identifying metabolic conditions.
   • Chromosomal Abnormalities: Detecting chromosomal disorders.
   • Congenital Malformations: Identifying certain congenital defects.
   • Hemoglobinopathies: Detecting hemoglobin disorders.
   • Sex-linked Disorders: Identifying disorders linked to the sex chromosomes.

Child Adoption Act

Overview

Adoption is a legal process where a child is placed with a married couple or a single female who agrees to raise the child as their own. The legal framework for adoption in India is governed by various acts, including the Adoptions and Maintenance Act of 1956, which outlines the process for adopting children, particularly for Hindus. It also extends to provide maintenance to family members.

Laws Related to Adoption

1. Hindu Adoption and Maintenance Act of 1956:
   • Applies to Hindus, Jains, Sikhs, and Buddhists.
2. Guardian and Wards Act of 1890:
   • Applies to Muslims, Christians, Jews, foreign citizens, and NRIs.
3. Juvenile Justice Act of 2000:
   • Addresses the adoption of children by non-Hindu parents.

Criteria for Adoption

1. Eligibility to Adopt:
   • Indian Citizens: Can adopt within India.
   • Non-Resident Indians (NRIs): Can adopt from abroad.
   • Foreign Citizens: Can adopt as per specific regulations.
   • Single Females: Unmarried, widowed, or divorced.
   • Married Couples: Can adopt together.
2. Eligibility to Give the Child for Adoption:
   • Parents or Guardians: Father or mother or guardian with legal capacity.
   • Special Cases: If both parents are deceased, have renounced the world, or are declared mentally unsound, the guardian with court permission can give the child for adoption.
3. Eligibility Criteria for Adoptive Parents:
   • Medical and Financial Fitness: Must be medically fit and financially able to care for the child.
   • Age Requirements: At least 21 years old. No legal upper age limit, but it may be relaxed for older children or children with special needs.
   • Gender-Based Limitations: If adopting a son, must not have a living son; if adopting a daughter, must not have a living daughter.

Adoption Preferences

• Under the Hindu Adoption and Maintenance Act of 1956, adoptive parents can specify preferences such as age, gender, skin color, religion, specific features, and health condition of the child. However, single parents or married couples cannot adopt more than one child of the same sex.

Family Welfare

Historical Background

After independence, India introduced various plans and policies to improve health, education, and economic status. The National Planning Program of 1951 aimed to stabilize the population by reducing the birth rate.

Evolution of Family Welfare Programs

1. Initial Approach (1951-1961): Clinical approach to family planning.
2. Extension and Education Approach (1961-1977): Promoted small family norms through slogans.
3. Voluntary Approach (1977-1985): Shifted focus to voluntary participation and community involvement.
4. Family Welfare Program (1985-1997): Emphasized voluntary methods and community participation.

Reproductive and Child Health Strategy

• 1997 Onwards: The Reproductive and Child Health (RCH) Program was introduced, integrating maternal, child, and adolescent health into primary health care. This approach continued through the ninth five-year plan (1997-2002) and aimed at providing comprehensive services and wider coverage.

Integration with Other Programs

The RCH Program included family planning, maternal and child health, universal immunization, diarrhea control, acute respiratory tract infection control, and nutritional deficiency control, all under one umbrella to enhance service delivery and population control