Prior to April 2005, the RCH programme was focused on demand generation viz. awareness and dissemination of IEC. There has been paradigm shift and now the RCH - II programme through the Mother NGO (MNGO) / Field NGO (FNGO) scheme will be focused on facilitating four service delivery components.
|Maternal & Child Health||Family Planning||Adolescent Reproductive and Sexual Health||Management of RTI / STI|
In India, women of reproductive age (15-49 years) and children (<15 years) constitute 60% of the total population. They comprise the vulnerable fraction of the population due to the risks connected with child-bearing in case of women; and growth, development and survival in case of infants and children. Improving child survival and maternal health indices is a priority area for policy makers, planners and various professionals. The socio-cultural determinants of maternal, newborn and child health have a cumulative effect over a lifetime. A correlation exists between the social inequity and maternal and child health. Examples are low literacy among women, son preference, sex –ratio being unfavorable to females and discrimination against the girl child.
About one third of women in India are married by the age of 15 years and two thirds by 18 years. The median age at first birth is 19.6 years (NFHS-2). Mothers who are younger than 20 years old at the time of first birth, were associated with a 1.7 times higher neonatal mortality rate and 1.6 times greater infant mortality rate than were mothers giving birth between 20-29 years. The links between pregnancy – related care and maternal mortality are well recognized. Over the last decade national programmes and plans have stressed the need for universal screening of pregnant women and operationalising essential and emergency obstetric care. Proper antenatal care can help ensure a favorable pregnancy outcome, a healthy mother and a healthy baby, but the coverage of antenatal care in India remains inadequate. Antenatal care, however, no matter how high the quality, must be backed up by the presence of a skilled health professional, a skilled birth attendant at the time of delivery. The distribution of skilled attendants and institutional births by states reveals an inverse relationship with maternal mortality ratios (MMRs), neonatal mortality rates (NMR) and infant mortality rates (IMR).
Postpartum care, both immediate and late is a major concern in India. Only 16.5% women received a post partum check up within two months of delivery (NFHS-2). Of these, less than one third were seen within the first post-partum week, a period associated with high complication rate.
Complications of pregnancy and childbirth are the leading cause of death and disability for childbearing women in many parts of the world. Comprehensive, high-quality maternity care can help prevent infant and material death and disability. No matter where they live, women should have access to the information and care that keeps them healthy and safe.
1. Understand the terms Essential Obstetric Care, Basic Obstetric Care and Comprehensive Obstetric Care
2. Discuss the different aspects of Essential Obstetric Care
3. Discuss the various interventions that FNGOs/MNGO can carry out to ensure that women in their project area are able to seek quality Essential Obstetric Care.
Essential Obstetric Care
üAntenatal Coverage and quality of Antenatal care
üEnsuring delivery with a Skilled Birth Attendant (SBA)
üEmergency Obstetric Care
üPost partum monitoring and care
Post partum care
üFirst post partum visit should take place within the first 24 hours after delivery
üSecond post partum visit in the first 7-10 days
üNew born care
The availability of family planning does more than enable women and men to limit family size. It safeguards individual health and rights and improves the quality of life for individual women, their partners and their children.
|Population Stabilization and Family
1.To understand the link of use of family planning methods and effect on fertility and unmet and met need.
2.To discuss the specific goals and strategies for fertility reduction as mentioned in the National Population Policy
Contextual Framework of Family Planning:
The National Family Welfare Programme in India has traditionally sought ‘to promote responsible and planned parenthood through voluntary and free choice of family planning methods best suited to individual acceptors’ (Ministry of Health and Family Welfare, 1998a). In April 1996, the programme was renamed the Reproductive and Child Health Programme and given a new orientation to meet the health needs of women and children more completely. The programme now aims to cover all aspects of women’s reproductive health throughout their lives. With regard to family planning, the new approach emphasizes the target-free promotion of contraceptive use among eligible couples, the provision to couples of a choice of contraceptive methods (including condoms, oral pills, IUDs, and male and female sterilization), and the assurance of high-quality care. An important component of the programme is the encouragement of adequate spacing of births, with at least three years between births (Ministry of Health and Family Welfare, n.d.).
The National Population Policy, 2000 (NPP 2000) adopted by the Government of India affirms the commitment of the government towards voluntary and informed choice and consent of citizens while availing of reproductive health care services and continuation of the target free approach in administering family planning services. The NPP provides a policy framework for advancing goals and prioritizing strategies during the next decade, to meet the reproductive and child health needs of the people of India, and to achieve net replacement levels (TFR) by 2010. It is based upon the need to simultaneously address issues of Child Survival, Maternal Health and contraception, while increasing outreach and coverage of a comprehensive package fo RCH services by Government, industry and the voluntary non-Government sector, working in partnership.
Of the 14 goals mentioned in the NPP document, three specific goals focus on family planning. These are:
1. Address the unmet needs for basic reproductive and child health services, supplies and infrastructure
2. Achieve universal access to information /counseling and services for fertility regulation and contraception with a wide basket of choices
3. Promote vigorously the small family norm to achieve replacement levels of Total Fertility Rate.
In addition, the NPP document also states twelve strategic themes, identified to address these goals:
About one fifth of India’s population is in the adolescent age group and yet to begin their reproductive lives. It is expected that this age group will continue to grow. All children in the age group of 10-19 years are adolescents. Focusing on this age group is critical for ensuring the health of future generations, and to achieve demographic transition and population stabilization in India. Furthermore, adolescents are more flexible to behavior change, and targeting this group can assist in changing future patterns of health problems and epidemics such as HIV/AIDS. Fostering and more importantly, sustaining an environment for gender equality and the empowerment of women is not possible without examining the attitudes and behavior of adolescents, especially adolescent boys. Adolescents are important as a target and as potential partners in population development planning and implementation. It has also been recognized that the health needs of adolescents are different and require separate attention.
Situation analysis of adolescents in India
Lack of education (low literacy levels among girls, % drop out from schools among boys and girls)
SRH is a taboo subject at home, school and in community settings
Low awareness and knowledge regarding SRH
Misconceptions and misinformation about SRH
Lack of skills to deal with peer pressure
Under pressure from parents and elders to marry young
Undernourished and underweight- fall prey to illness very often
Early marriage (before the legal age of marriage both for girls and boys)
Early pregnancy and childbirth
Unsafe sexual practices
Lack of knowledge on family planning usage
Exposure to substance abuse and drugs
Risk of exposure to RTI / STD and HIV / AIDS
Brainstorming on Adolescent Health needs and related interventions. The period of adolescence is very exciting part of a person’s life.
üThe body undergoes physiological changes due to puberty, resulting in changes in the reproductive system, gaining in height and weight.
üAt the same time, there is also an urge to try experimenting with different activities and take risks.
üTheir curiosity is also aroused and peer pressure and negative influencers easily mislead many adolescents.
üThis is further compounded by the fact that they lack Sexual health education.
üPeople often label this as ‘growing up’ and ignore the adolescent.
üMany adolescents adopt high risk behavior due to the numerous myths and there is a near total absence of credible resources to carry out the task either in the school system or in the community as such.
üAdolescents have a poor access to reproductive health information and services and mainly rely on peers- who themselves may be poorly informed- and the media to gain health related information.
to their prevalence and the suffering they cause, sexually transmitted
infections (STIs) are practically ignored in public health research,
interventions, and services.