Child survival and Safe
Motherhood
Dr. Babita
Maternal and child health (MCH)
services
• In India women in reproductive age group (15-49 year)
&
Children below 15 year constitute 54% of population.
• Vulnerable due to
• Risks connected with child bearing in women
• Growth, development and survival in infants & children
Presentation title 2
MILES STONE IN MCH CARE
•1880 – Establishment of Training of Dais in Amritsar
•1902 - 1st Midwifery Act to Promote Safe Delivery
•1930 - Setting Up Of Advisory Committee on Maternal Mortality.
•1946 - Bhore Committee Recommendation on Comprehensive &
Integrated Health Care
•1952 – Primary Health Center Net Work & Family Planning Programme
•1956 – MCH Centers Become Integral Part Of PHCS
•1961 - Department Of Family Planning Created
•1971 – MTP Act
•1974 – Family Planning Services Incorporated In MCH Care
•1977 – Renaming Family Planning To Family Welfare
•1978 – Expanded Programme on Immunization
•1985 – Universal Immunization Programme
•1992 – Child Survival& Safe Motherhood Programme
•1996 – Target Free Approach
•1997 – RCH Programme Phase-1 (15.10. 1997)
•2005 – RCH Programme Phase-2 (01-04-2005) 3
•2013 – RMNCH+A
Evolution of MCH services in India
• MCH services were just minimal to begin with 1952
• ANC, delivery and PNC was mainly through TBA
• Family planning program and MCH were running vertically and during
4th five year plan officially integrated
• 1978 EPI for children upto 5 year and pregnant women
• 1983 National Health Policy focused on high morbidity/mortality in
children/mothers and formulated 17 goals to achieved by 2000. (13 were
related to MCH)
• Child survival and safe motherhood (CSSM) started in 1992 to integrate
UIP + family planning+ MCH
Presentation title 4
Child Survival and Safe Motherhood
(CSSM)
• Launched on Sadbhavna Diwas on 20th August 1992 by President of India
• High priority for states and central governments
• The major reasons for high child and infant deaths are
• ARI
• Diarrhoeal diseases
• Vaccine preventable diseases
• Inadequate maternal and newborn care
• The major reasons for high maternal deaths are
• Anaemia
• Toxaemia
• Septicaemia
• Haemorrhage
• Obstructed labour
• Illegal abortions
• The CSSM Programme attempts to deliver the maternal and child health services as a package
programme
Presentation title considering the total needs of mothers and children during health and disease. 5
Child Survival and Safe Motherhood
(CSSM)
• The Child Survival and Safe Motherhood Programme jointly funded by
World Bank and UNICEF was started in 1992-93 for implementation up
to 1997-98. The Child Survival and Safe Motherhood Programme was
implemented in a phased manner covering all the districts of the country
by the year 1996-97.
• CSSM program is directed at achieving 9 of the 17 goals of National
Health Policy (1983) which are related to maternal and child health
• The Programme yielded notable success in improving the health status of
pregnant women, infants and children & also making a dent in IMR,
MMR and incidence of vaccine preventable diseases.
Presentation title 6
National Health Policy (MCH)GOALS CSSM
A) Reduction of mortality rate
1. IMR – 79 to <60
2. Perinatal mortality rate – 48.4 to 35
3. Child (0-4) mortality rate – 26.3 to 10
4. Maternal mortality ratio – 4 to 2
B) Reduction in proportion of LBW
5. LBW – 30 to 10
C) Services coverage
6. Immunization – infant 85
7. Pregnant women – 79.4 to 100
8. Deliveries by trained personnel – 44.1 to 100
9. Antenatal care – 79 to 100
D) Prevention of blindness due to vitamin A deficiency – 03%
Presentation title 7
Specific objectives of the program
1.To reduce infant mortality rate from 80 to 75 by 1995; and to 50 by 2000.
2.To reduce child (1-4 years) mortality rate from 41.2 to 10.
3.To reduce maternal mortality rate from 5 to 2 per 1000 livebirth.
4.To achieve polio eradication by 2000 A.D.
5.To eliminate neonatal tetanus by 1995.
6.To prevent 95% measles deaths and 90% cases of measles by 1995.
7.To ensure prevention of 70 % diarrhoea1 deaths and reduce diarrhoeas
cases by 25 %.
8.To prevent 40 % deaths due to Acute Respiratory Infections.
Presentation title 8
Subcentre drug kits – under CSSM
• Drug kit B
• Drug kit A
• Methyl ergotamine – 500 tablets
• IFA (Large) – 15000tablets • Chlorphenaramine – 400 tablets
• IFA (Small) – 13000 tablets • Paracetamol – 500 tablets
• Vitamin A solution – 6 • Anti-spasmodic tablets – 250 tablets
• Inj. Methyl ergotamine – 5 ampoules
bottles
• Mebendazole – 300 tablets
• Cotrimoxazole – 1000 • Chloramphenicol – 500 eye
tablets applicaps
• ORS packets – 150 packets • Cetrimide powder – 5 packets
• Povidine ointment – 5 tubes
• Cotton bandage – 120 rolls
• Cotton absorbent – one roll
Presentation title 10
Activities of CSSM
• Children • Mother
1. Essential newborn care
1. Anaemia prophylaxis and therapy (100%).
• Resuscitation of newborn with asphyxia
• Prevention of hypothermia 2. Antenatal check-ups, at least 3 check-ups (100%).
• Prevention of infection 3. Immunization
• Exclusive breastfeeding
• Referral of sick newborn
4. Delivery by trained personnel
2. Primary Immunisation by 12 months 5. Promotion of institutional deliveries
(100%) 6. Training of birth attendants
3. Appropriate management of diarrhea 7. Referral of those with high risks and complications.
4. Appropriate management for acute
respiratory infections 8. Care at birth and promotion of clean delivery.
5. Vitamin “A” prophylaxis
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9. Birth time and spacing. 11
RCH - 1
CSSM
+
2 components (STD & RTI)
Presentation title 12
RCH – 2
1. Essential obstetric care
a) Institutional delivery
b) Skilled attendance at delivery
2. Emergency obstetric care
a. Operationalizing First Referral Units
b. Operationalizing PHCs and CHCs for round the clock delivery
3. Strengthening referral system
Presentation title 13
Presentation title 14
Thank
you
