Unit 1 FH

UNIT :1
FAMILY HEALTH AND

RESPONSIBLE PARENTHOOD
Dr Mamta Chhetri 1
Family health needs and
determinants of healthy family
Dr Mamta Chhetri 2
Structural Definitions of the Family
• A commonly used definition is that of the
Census Bureau, “a householder and one or
more other persons living in the same
household who are related to the householder
by birth, marriage, or adoption”
(Census 1990)
Dr Mamta Chhetri 3
• This definition includes many family types
commonly regarded as families including :
- Traditional families (breadwinner husband,

homemaker wife and their children)
- Remarried families
- Dual-earner families
- Single parent families
Dr Mamta Chhetri 4
Another frequently used structural definition:
“two or more persons related by birth, marriage, or
adoption”
(Ooms and Preister, 1988)
• This definition broadens the scope by counting as

“family” people who do not live together, but are
related biologically or through legal contracts
Dr Mamta Chhetri 5
Functional Definitions of the Family
According to most functional definitions:
A family is any unit in which there exists:
Sharing of resources and economic property™
A caring and supportive relationship
commitment ™
Preparation of children born to or raised by the
members to become adult members of the
society
Dr Mamta Chhetri 6
Family contd…..
• Family is a group of biologically-related

persons living together and sharing the
common kitchen and purse.”
Dr Mamta Chhetri 7
Family contd…
• Primary unit in all societies
• It is a group of biologically related individuals
living together and eating from common
kitchen
• Family differs from household in that all the
members of household may not be blood
related
Dr Mamta Chhetri 8
• As a biological unit ,the family members share
pool of genes
• As a social unit they share common physical
and social environment
• As cultural unit ,the family reflects the culture
of the wider society of which it forms a part
and determines the behavior and attitudes of its
members
Dr Mamta Chhetri 9
Characteristics of family
• Family as social group is universal and is
significant element in man‟s social life
• It is the first social group to which individual
is exposed
• The family is very close and intimate group
• It is the setting of most intense emotional
experiences during the life time of individual
Dr Mamta Chhetri 10
• The family effects the individual social value
and outlook in life
• The family has the unique position of serving
as link between individual and larger society
• Family is also unique in providing continuity
of social life
Dr Mamta Chhetri 11
FUNCTIONS OF FAMILY
As a social group and as an important social
institution, family performs various functions
that are as follows:
• Family is a unit through which procreation
takes place
• Marriage sanctions sexual relationships, and it
also establishes a family, which is further
reinforced with the birth of children
Dr Mamta Chhetri 12
• The process of reproduction is
institutionalized, regulated and controlled in a
family
• The family legitimizes the act of reproduction.
• Family helps in propagation of human species
and perpetuation of human race.
• Family provides an individual with an identity.
• It is through the family that every family
name is carried on from one generation to
another
Dr Mamta Chhetri 13
• Family is responsible for the production and
upbringing of children.
• Family is an important agent of socialization
- Primary socialization of any individual takes
place within the family
- Immediate family members teach all the basic
rules and norms of social life to a child
Dr Mamta Chhetri 14
• Family is also an important agent of cultural
transmission
-Culture is transmitted from one generation to
another through family
- All the aspects of culture are learnt within the
family structure
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• Family is a great source of strength, emotional
and psychological, for its members
• All the members are aware that they can
depend upon their family in the times of need
• Family provides an individual with a home,
and establishes enduring social relationships.
• The family is the basis of division of labor,
where all members have their duties and
obligations towards each other
Dr Mamta Chhetri 16
• Family fulfills the economic needs of its
members, function has undergone
transformation, with families moving from
being production and consumption units in
earlier times, to becoming more of consuming
units rather than a producing one
• Now-a-days, members of a family no longer
produce things themselves; rather, they go out
and work for some monetary remuneration or
wages
Dr Mamta Chhetri 17
• Family is traditionally responsible for education
of the children.
• Family also has a recreational function
- Earlier, most recreation was family- based
- Family gatherings during festivals, functions,
family reunions, marriages, brought entire families
together
-Now-a-days, taking family members out on
holidays or for movies, plays, dinners, or parties,
etc., perform the same function
Dr Mamta Chhetri 18
Murdock (1949)argued family performed four
basic functions :
1.Sexual :
• Provides stable sexual relationship for adults
and control sexual relationship of its members
2.Reproductive:
• Provides new members to society
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Economic:
• The family pools resources and provides for its
members
Educational:
• Teaches norms and values of society
Dr Mamta Chhetri 20
Family health
• Art and science of preventing diseases

prolonging life and promoting health and
efficiency of family through organized family
efforts
Dr Mamta Chhetri 21
FAMILY HEALTH NEEDS
Basic needs :
- Needs for survival (food , health , safe water
sanitation)
- Security : shelter ,peace , income ,livelihood
- Empowerment: basic education , literacy ,
community development , family and
psychological care
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Example of family needs in cancer
care
Diversity of family needs
Family:
• Group of individuals who are bound by strong
emotional ties, a sense of belonging
• Commitment to being involved in one another‟s
lives, and call themselves „family‟
• Different life stages / different needs
• Individuals within the family influence the other
members
• Strengths within a family often influence the
functioning of the family
Dr Mamta Chhetri 25
Importance of family
• Family has a strong influence on the health of

its members and understanding their needs
improves the family‟s ability to maintain
family functioning
• During adversity family members will often
experience challenges in their own health
• Family will often fail to seek help as they feel
lost in the health system
Dr Mamta Chhetri 26
Family functioning with cancer
• Families will aim to work together after the

diagnosis
• Family roles will change after cancer diagnosis,
particularly during treatment
• Not all families will deal constructively with the
change
• Communication within the family is the main
influencing factor for seeking help and doing well
Dr Mamta Chhetri 27
CONCLUSION
• Understanding family needs is important as

they may have more unmet needs.
• Families who can communicate openly about
their needs and distress are also more likely to
ask for help from health professionals
(Family who doesn’t ask, need even more
help)
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Determinants of family health
• Living and working condition
• Physical enviornment
• Psycho social enviornment
• Education and economic factors
• Health practices
• Cultural factors
• gender
Dr Mamta Chhetri 29
Living and working condition
Employment conditions:
• The most important factors shaping people's
social position include employment and
working conditions
• The health of workers and their families will
ultimately be improved by strengthening fair
access to employment and the other
dimensions of decent work
Dr Mamta Chhetri 30
• Work-related problems can affect our physical,
emotional and mental health
• Common issues include job dissatisfaction,
workplace injury, stress, discrimination and
bullying, violence, accidental death and
retirement
• Job loss, retrenchment or unexpected loss of
income can also cause distress and hardship
Dr Mamta Chhetri 31
The physical environment
• Includes land, air, water, plants and animals,
buildings and other infrastructure, and all of
the natural resources that provide our basic
needs and opportunities for social and
economic development
• A clean, healthy environment is important for
people's physical and emotional wellbeing
Dr Mamta Chhetri 32
• People tend to forget we live in a physical
environment that can influence health
• Human beings spend more than 88 percent of
their lives inside built environments where
they live, work and play
• The problem is that building materials such as
furniture and mechanical systems, such as
heating and air conditioning systems, can all
influence our health
Dr Mamta Chhetri 33
Psycho social environment
• Development in the field of social science

revealed that health is not only a biomedical
phenomenon but it is influenced by social
psychological , cultural , economic and political
factors of the people concerned
• All the factors should be taken into consideration
• Health is both biological and social phenomenon
Dr Mamta Chhetri 34
Education and economic factors:
• Major factor influencing health status is
education.
• The world map of illiteracy closely coincides with
the maps of poverty, malnutrition, ill health, high
infant and child mortality rates
• Health status improves with level of education
• Effective education for children and adults are
key contributors to health and prosperity for
individuals ,families , society , country and
ultimately for whole world
Dr Mamta Chhetri 35
Economic status:
• The economic status determines the
purchasing power, standard of living, quality
of life, family size and the pattern of disease
and deviant behaviour in the community
Occupation :
• The very state of being employed in
productive work promotes health, because the
unemployed usually show a higher incidence
of ill health and death
Dr Mamta Chhetri 36
Health practices
• Some people when they become sick first they

visit traditional healer which influence health
• Some treat with home remedies
• Purchasing drugs from pharmacy without
prescription of drugs
Dr Mamta Chhetri 37
Cultural factors
• Culture influence health status of people
which have positive impact and negative
impact in health
Example : - discarding of colostrum
- Chhaupadi pratha
- Alcohol consumption in some caste
Dr Mamta Chhetri 38
Gender
• Gender refers to array of society
• Gender norms influence the health systems
practice
• Many health issues are gender based health
status
• GBV ,male dominating society, lack of women
participation in every decision making process
will affect on family health
Dr Mamta Chhetri 39
• The 1990s have witnessed an increased
concentration on women's issues
• Global commission in 1993 drew up an agenda
on women's health covering nutrition,
reproductive health , ageing , life style related
conditions etc
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FUNCTIONAL AND DYSFUNCTIONAL
FAMILIES
Dr Mamta Chhetri 41
Dysfunctional Family
• “A Dysfunctional family
is one in which adult caregivers are unable to con
-sistently fulfill their family responsibilities”
• Any condition that interferes with healthy family
functioning is called as family dysfunction
• Family in which conflict , misbehavior and even
abuse on the part of individual member of the
family occur continually
Dr Mamta Chhetri 42
• Dysfunctional families are often result of
alcoholism , substance abuse or other
addictions of parents , parents untreated mental
illness
• Family that is not functioning according to
original design and also not working properly
• In dysfunctional family discourage open talk
about problems and also fails to provide
appropriate nurture for developing children
Dr Mamta Chhetri 43
• A dysfunctional family is one in which conflict
and instability are common
• Parents might abuse or neglect their children,
and other family members are often forced to
accommodate and enable negative behavior
• In some cases, dysfunctional families can be
the result of addiction, codependency, or
untreated mental illness of the family member
Dr Mamta Chhetri 44
Characteristics of dysfunctional families
Poor communication:
• Communication is one of the most important building
blocks of good relationships
• Dysfunctional families are unable to listen to one another,
so individual members often feel misunderstood or like
their voices aren‟t heard
• In addition, communication in dysfunctional families is:
- Disjointed rather than direct: “Family members talk
about each other to other members of the family, but don‟t
confront each other directly. This creates passive-aggressive
behavior, tension, and mistrust,”
Psychology Today says.
Dr Mamta Chhetri 45
Drug or alcohol abuse:
• When drug or alcohol abuse exists in a family,
“family rules, roles and relationships are
established and organized around the alcohol
and/or other substances, in an effort to …
maintain the family’s homeostasis and
balance,”
according to subject matter expert Marni
Low.
Dr Mamta Chhetri 46
• Family members also tend to fall into certain
well-defined roles, such as enabler and
scapegoat
• Enablers do whatever they can to ensure the
household runs smoothly in spite of the
substance abuse, while the scapegoat is usually
a child in the family who acts out to deflect the
negative experiences happening at home
Dr Mamta Chhetri 47
Perfectionism:
• In a dysfunctional family, one or more adults may
be perfectionists
• They have very high expectations for children or
other family members and don‟t accept failure
• This has a lasting negative effect, reducing
playfulness and assimilation of knowledge in
children
• Perfectionism creates a “steady source of negative
emotions” that causes individuals to constantly
feel inadequate
according to Psychology Today
Dr Mamta Chhetri 48
Lack of empathy:
• One of the hallmarks of a dysfunctional family is lack
of empathy
• Parents do not show unconditional love, instead
become judgmental
• Rather than attempting to understand a child‟s feelings
and point of view, a dysfunctional parent might rely on
anger or derision, making the child feel guilty or
demeaned
• Parents “lack the ability to emotionally tune in to their
kids,”
according to Psychology Today
• Causing children to internalize negative feelings
Dr Mamta Chhetri 49
Control:
• In dysfunctional family structure, one or more parents often
focus on controlling their children
• They might pit children against one another and make them
compete for affection, or constantly compare them
• Other important elements of control are dependence lack
of privacy
• “Researchers found that people who reported their parents
had intruded on their privacy in childhood or encouraged
dependence were more likely to have low scores in surveys
of happiness and general wellbeing,”
- The Independent reports.
• When children aren‟t allowed to make their own decisions,
they grow up without the confidence to excel in the
classroom or workplace
Dr Mamta Chhetri 50
Excessive criticism:
• Criticism and other verbal abuse are
particularly difficult for children to overcome
• Parents in dysfunctional families often criticize
a child‟s looks, intelligence, value, or abilities
• Some criticism might be direct, while other
forms are more subtle and relayed in the form
of teasing or put-downs
• Regardless of delivery, consistent criticism
from parents has a negative impact on self-
image and development
Dr Mamta Chhetri 51
The Effects of Growing Up in a
• Having dysfunctional parents or a dysfunctional
family dynamic can cause children to struggle
later in life
• According to the No Bullying campaign, “Some
of the impact, family dysfunction may have on
children is the development of various disorders
and negative behaviors
• Children involved with a dysfunctional family
unit could have study problems in school
• They could drift into drug or alcohol abuse.
Dr Mamta Chhetri 52
• Children from dysfunctional families are also more
likely to become withdrawn and socially isolated
• They often feel lonely and have difficulty expressing
their feelings, and they are at risk of developing
depression, low self-esteem, anxiety, and more
• Adult children of dysfunctional families “suffer
internally from self-rejection and self-criticism
• As children mature, these problems persist
• They can have depression, anxiety, and addictive

behavior issues
- No Bullying says.
Dr Mamta Chhetri 53
• Most serious of all, these individuals can
continue the cycle by developing their own
parenting problems and perpetuating the
dysfunctional dynamic
• Psych Central notes that “Neural pathways
developed from childhood traumatic
experiences help shape how we respond to
others and adults often find themselves
repeating the same behaviors and patterns
throughout their lives.”
Dr Mamta Chhetri 54
How to overcome Negative Effect of
Seek Help
• Once you recognize your shortcomings, it is
important to seek professional help or help in
any form to deal with the issues from
childhood
• Dealing with low self-confidence can be a
difficult thing, and it always helps to have the
support of family and friends
Dr Mamta Chhetri 55
Get Creative
• Sometimes, conflicting situations can make
way for creativity and expression
• If you want to overcome the negative effect of
a dysfunctional family, express yourself in a
healthy way to your family and close ones
• Share your thoughts and discuss how you can
rebuild relationships
Dr Mamta Chhetri 56
Build Trust
• It is not easy to grow up in a place where trust
is hard to come by amongst the adults you
have seen around you
• As a child, if you have seen your parents be
mistrustful, their is a tendency that you will
carry the same into your adulthood
• With time and patience, learn to build trust
amongst your closest ones
Dr Mamta Chhetri 57
Build bridges with your family
• Families who are dysfunctional are
emotionally unstable, and as adults, you have
the choice to build or rebuild a relationship
that is broken
• Start with baby steps and try and forgive and
support your family wherever you can
• No matter what kind of an upbringing you
have had, there is always an opportunity as an
adult to reflect and improve yourself and to
have meaningful relationships with people
Dr Mamta Chhetri 58
Functional Family
• Known as healthy family
• Healthy families are not always perfect family
sometimes there may be conflict
,misunderstanding ,tension, anger but not all
the time
Dr Mamta Chhetri 59
• “A family that works and plays together- stays
together with a good communication and
interpersonal relationship, and often, the need
of the all members are fulfilled.”
• Can also be defined as family which has a
feeling of belongingness ,can also contribute to
their self esteem
Dr Mamta Chhetri 60
Features of functional families
• Functional families carry out effectively their
economic function, which means that their
members find the basic economic security they
need at home
• Apply a fair distribution of domestic activities
so that each member is responsible for its
implementation and does not overload a single
person with all duties.
Dr Mamta Chhetri 61
• Although there are well-defined rules and roles,
when problems surge, there is some flexibility
that facilitates arrangements and solutions based
on family well being
• There is an adequate distribution of hierarchy
levels
• The hierarchy between the parents is horizontal so
that both have the same power at home, but
exercise a vertical hierarchy on their children,
allowing them to set standards and apply them
Dr Mamta Chhetri 63
• Clear communication where all members can
express what they think and feel assertively
and without harming others.
• Each member feels accepted within the
family, where he finds an emotional security
source.
• The family grows alongside its members, so
the mistakes are learning experiences that
strengthen them.
Dr Mamta Chhetri 64
• The family is flexible enough to adapt to
circumstances, although this requires a change
of rules or roles
• If its members have no adaptation skills to
find a new balance in a crisis, the functional
family will eventually turn into dysfunctional
Dr Mamta Chhetri 65
Characteristics…..
Commitment:
• Each person cares for and is invested in the
well-being of the others
• They show this through respect, support, and
consideration
Dr Mamta Chhetri 66
Individuality:
• Individuality is respected
• Each member is encouraged to pursue their
interest and boundaries between them are honored
Spend Time Together:
• Make spending time with each other a priority:
even schedule time
• Do things together that you all find fun.
Examples: Games, Shopping, Cleaning the House,

etc.
Dr Mamta Chhetri 67
Trusting
• Trust is created by honesty
• Accurate expression of emotions, thoughts, and
desires is more important than agreement.
Needs fulfilled:
• Family needs are met
• Happy people are getting their needs
Met
• A functional family allows all of
its members to get their needs filled.
Dr Mamta Chhetri 68
Negotiating difference:
• To negotiate difference there must be
cooperation
• Negotiating difference skill is helpful in
creating intimacy among the members
Dr Mamta Chhetri 69
Flexible rules/laws
• The laws in functional families will allow for

Mistakes
• They can be, and are, negotiable.
• In a functional family the roles are open and
Flexible
• One can be spontaneous without fear
of shame and judgment.
Dr Mamta Chhetri 70
Accountability:
• Functional families are accountable.
• They are willing to acknowledge individual
problems, as well as family problems
• They will work to resolve those problems.
Dr Mamta Chhetri 71
REPRODUCTIVE HEALTH
Dr. Mamta chhetri

MBBS,MD(COM.MED)
Dr Mamta Chhetri 72
FAMILY AND RESPONSIBLE PARENTHOOD
DR MAMTA CHHETRI
MBBS,MD(COM.MED)
BPH 3RD YEAR
Dr Mamta Chhetri 73
Family:
Group of biologically related persons living
together and sharing same kitchen
Dr Mamta Chhetri 74
ESSENTIAL FUNCTIONS OF FAMILY
• Stable satisfaction of sexual needs

• Procreation and rearing of children
• Provision of home
• Socialization
Dr Mamta Chhetri 75
Dr Mamta Chhetri 76
SECONDARY FUNCTIONS OF FAMILY
• Economic functions
• Educational functions
• Religious functions
• Health related functions
• Recreational functions
• Social functions
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RESPONSIBLE PARENTHOOD
Concept:
• State of being parent is parenthood
• Parenthood is a broad concept including both
biological and socio cultural aspects of being
parent
• Being responsible towards your children is
responsible parenthood
Dr Mamta Chhetri 79
• Being a parent is both joy and challenge
• Parenting challenge is to raise confident,
respectful , happy and responsible child
• Responsible parenthood is the will ,ability and
commitment of parents to respond to the needs
and aspirations of family and children
• Responsible parenthood is a life long
commitment to be a parent
Dr Mamta Chhetri 80
FACTORS TO CONSIDER
• Ultimate goal of marriage is to raise family
• Implications depend on how parents assume
their responsibility in caring and supporting
children
• Nurturing and rearing pattern
Dr Mamta Chhetri 81
Preparing parenthood requires lot of
consideration such as:
• Parental role
• Emotional adjustment
• Family relationship
• Knowledge in child rearing
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PARENTING
• Process of promoting and supporting the
physical , emotional , social and intellectual
development of child.
Parenting may be influenced by many factors:
Social class
Economic status
Education
Dr Mamta Chhetri 83
Dr Mamta Chhetri 84
PARENTAL RESPONSIBILITIES
• Provide an environment that is SAFE

- Keep your child free from physical, sexual,
and emotional abuse
- Correct any potential dangers around the house
Dr Mamta Chhetri 85
• Provide your child with BASIC NEEDS
• Provide your child with SELF-ESTEEM
NEEDS
- Accept your child's uniqueness and respect his
or her individuality
- Notice and acknowledge your child's
achievements
- Use your child's misbehavior as a time to teach
Dr Mamta Chhetri 86
• Teach your child MORALS and VALUES
- Honesty
- Respect
- Responsibility
- Patience
Dr Mamta Chhetri 87
• Develop MUTUAL RESPECT with your
child.
- Use respectful language
- Respect his or her feelings
- Respect his or her opinions
- Respect his or her privacy
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• Involve yourself in your child's
EDUCATION.
- Communicate regularly with your child's
teacher
- Talk to your child each day about school
- Recognize and acknowledge your child's
academic achievements.
Dr Mamta Chhetri 89
• Get to KNOW YOUR CHILD
- Spend quality time together.
- Be approachable to your child.
- Ask questions
- Communicate and Communicate
Dr Mamta Chhetri 90
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AIM OF RESPONSIBLE PARENTHOOD
• To empower families so that couple can be

made aware of their basic responsibilities as
parents
• To awake them for the life long commitment
towards family , community, society and
nation
Dr Mamta Chhetri 92
Components of responsible parenthood
• Children success is influenced by contribution
of parents as in terms of time , encouragement,
motivation
• Men has several roles as a father and as well as
bread winner , member of the family
• Therefore there is responsibility of individual
within the family, community and towards the
nation
Dr Mamta Chhetri 93
Parenting approach
• Overall emotional climate at home
1)Giving orders:
- Often called authoritarian style of parenting
- Parents are very rigid and strict but they are not
responsive towards child
- Sets lot of rigid rules and when these rules are not
followed punishment is most often to promote further
obedience
Dr Mamta Chhetri 97
What do children learn from this style of parenting?
- Children learn limit
- In 1983 Diana baumarind found that children raised
in this approach they were less cheerful, more moody
and vulnerable to stress
- Many cases they have also showed antisocial
behaviour
Dr Mamta Chhetri 98
2)Giving in :
- Also called permissive or indulgent parenting
style
- Set no limits
- A child freedom and autonomy is over valued
- Parents tend to rely mostly on reasoning and
explanation given by children
Dr Mamta Chhetri 99
What do children learn from this style of
parenting?
- Children are happy
- Society sets limits but children will have
difficulty in learning how to behave in society
- Children will have low level of self control
Dr Mamta Chhetri 100

3) Giving choices:
- Known as democratic style of parenting
- Most effective style of parenting
- Parents are aware of child‟s feelings and
capabilities

What do child learn from this style of parenting?

4)Neglectful style of parenting:
- They are not responsive to child‟s need
- Large gap between parents and children with
this parenting style

Importance of responsible parenthood ?????

STAGES OF RESPONSIBLE
PARENTHOOD

• Parenting is a process by which parents and
children grow and develop
• According to Galinsky 1981 there are six
stages of parenthood
• Parents with more than one child can be more
than one stage at the same time

Stage 1 : Image making stage
- Parents prepare for changes in themselves,
new relationship and responsibilities of new
life
- In this stage they have lot of queries in head

Stage 2:Nurturing stage :
- Birth to 18-24 months
- Major task at this stage is forming bonds
(attachment) with the baby
- Attempt to meet the needs of the baby and
balance this with other responsibilities
involving jobs , friends
- Parents make decision about child care and
they try to make work schedule flexible to take
care of the baby
Stage 3:authoritative stage:
- 2-4 or 5 years
- Parents nurture , guide and teach discipline to
their child
- Parents can teach and motivate their children
about maintaining personal hygiene

Stage 4:Interpretive stage
- Preschool years and ends with approach of
adolescence
- Parents teach their child about life and help him
or her to interpret the actions of others such as
their teachers and peers
- At this stage parents are concerned with the
increasing influences of peers and help their child
to understand consequences of his or her actions
Overview of parental decision to be
made
• Deciding what kind of life they want to and
can afford to provide
• Parents have to decide when to say yes and
when to say no to children request
• Deciding how they want children to behave
• Deciding when to let go ,to encourage the
children to do thing independently

• Deciding how to define the changing
relationship between parent and child
Example : physical relationship between parent
and child is changing .how much do parents and
children hug ,hold ,kiss as child continues to
grow and develop

Stage 5: Interdependent stage
- During adolescence
- Parents involve their teenager in more
decisions but ultimate responsibility rest with
the parent
- Stressful time for both parents and adolescence

• Stressful time for adolescence who is
searching for identity and independence from
parents
• At this time parents is also struggling to give
enough control to facilitate their teenagers
move towards independence and still support
and protect child

Stage 6: Departure stage
- Departure stage spans long period of time
- During the Departure Stage , parents search for
new ways to say they are still a family by
creating new rituals, habits, and traditions.
- Parents need to redefine their own identities
- New relationship emerge

Preparation for parenthood
• The process of preparing for parenthood

consists of a series of steps, each of which
presents unique challenges and dilemmas

• Preparing for parenthood begins with the
decision to become pregnant, or the discovery
of pregnancy in an unplanned circumstance
• In recent decades, the availability of effective
and reliable contraception and sterilization
techniques has given many the opportunity to
choose the timing of parenthood

Childbirth preparation

• One hundred years ago in the early 1900s
midwives attended most of the births
• As the training of physicians began to include
obstetrics, use of anesthesia, and other
advancing technologies, the place of delivery
moved from the home to the hospital

• Because obstetric care has become more
diverse and specialized, women can choose
their type of care according to their particular
needs and risks

Transition to parenthood

• Heath-care provider is generally in close
communication with a women throughout her
pregnancy and immediate postpartum period
• Once the event of birth has occurred new
parents are left to rely on family advice, past
experiences
• This advice is often conflicting and confusing

• When a baby is born, important developmental
changes occur in a family
• The marital relationship of the parents is
altered and the child becomes incorporated
into the family.
• Social support services or family counseling
may be necessary in cases of unresolved
conflict or crisis in the young family

Parenting and provision of child care

• Parent–child relationship is central to a child's
moral development, social behavior, and
ultimate attainment of adult independence
• In the 19th and early 20th centuries,
grandparents played an instrumental role in
religious training, education, and child care

• Parenting and child care are intimately linked
with the mother
• Traditionally, the mother was considered the
child rearer and the father the breadwinner
• women's movement, however, brought about a
social change in the family roles of men and
women, resulting in more shared childrearing

• Involvement of fathers in parenting has
changed dramatically in recent years
• This is due to an increase in the number of
working mothers and changes in family
demographics
• Today's fathers are much more involved in the
care and nurturing of their children
• Learning how to be an effective parent is a
challenging task
Parenting in unique
circumstances single parent
families

• Single-parent families are becoming more
common place
• Single-parent families can be divided into
three types:
(1) single parenting as a result of divorce or
death
(2) unplanned single parenting
(3) “elective” single parenting
Divorce:
• Stresses and difficulties in coping that are
experienced by families in which the parents
are divorced can lead to disturbances in
personal and social adjustment of the child
• Divorce may be a positive solution to
destructive family functioning

• long-term effects of divorce are still
controversial although evidence suggests that
children of divorced parents eventually were
functioning as well as non-divorce homes
• Effective social support systems must be
identified and developed that will help the
family adjust to the parental changes
associated with divorce

Unplanned parenting:
• Number of unplanned pregnancies continues to
escalate despite the availability of effective
contraceptive methods
• Adolescent pregnancy is a matter of great
public concern

• Parenthood at an early age, not only affects the
educational and social prospects for the
adolescent mother
• But also infants born to teenage mothers are at
risk for poor birth outcomes such as low birth
weight and preterm birth

• Research results have found that adolescent
parents have high levels of stress, inadequate
social support, poor knowledge of child
development, and inappropriate childrearing
attitudes
• Most teenage mothers live at home with a
parent or parents, the majority keeping their
babies

Elective single parenting:
• Elective single parenting has become more
acceptable and popular in the past decade
• concern about elective single mothers lack of
male role models for their children, believing
that these factors may stunt the child's social
and cognitive development.

• Studies indicate that children raised by their
mothers alone have no adverse effect on
mothers' parenting ability or the psychological
adjustment of the child

Parenting practices

Practices to promote physical health and
safety
Parents influence the health and safety of their children

in many ways
Breastfeeding:
• Has well-established short- and long-term benefits
for both babies and mothers
• Breast milk bolsters babies' immunity to infectious
disease, best source of nutrients to help babies grow
and develop
• Supports bonding between mothers and their babies
• Benefit mothers' health as well by lowering risk for
postpartum depression, certain cancers, and chronic
diseases such as diabetes

Nutrition and physical activity:
• Parents play an important role in shaping their young
children's nutrition and physical activity levels
• The presence of less nutritious food and beverage
items at home may increase children's risk of
becoming overweight
• Physical activity is a complement to good nutrition

• Even in young children, physical activity is
essential for proper energy balance and
prevention of childhood obesity
• Parents may encourage activity in young
children through play or age-appropriate sports
• Children who spend more time outdoors may
be more active

• Several cross-sectional and longitudinal studies on
younger children show an association between
television viewing and overweight and inactivity

Vaccination:
• Parents protect their children from potentially serious
diseases by making sure they receive recommended
vaccines
• Parental practices around vaccination may be
influenced by parents' knowledge

Preconception and prenatal care:
• Steps women take with their health care providers
before becoming pregnant can promote healthy
pregnancy and birth outcomes for both mothers and
babies
• Receipt of recommended prenatal care can help
parents reduce the risk of pregnancy complications

• Infants born to mothers who do not receive prenatal
care may be premature or LBW
• Women whose pregnancies are unintended also are

less likely to receive timely prenatal care

Injury prevention:
• Unintentional injuries are the leading cause of death
among children ages 1-9
• Parents can protect their children from injury through
various measures

Practices to support cognitive
development
• Children's first teachers, parents play an important
role in their cognitive development
• Example competencies as language, literacy, and
numerical/math skills
• Studies had suggest that children whose fathers are
more educated and use complex and diverse language
when interacting with them develop stronger
vocabulary skills relative to other children

Behavioral discipline practices
• Parental guidance or discipline is an essential
component of parenting
• As infants become more mobile and begin to
explore, parents need to create safe
environments for them
• Parents' use of corporal punishment as a
disciplinary measure is a controversial topic

• Parents' intentional use of physical force to
cause a child some level of discomfort,
corporal punishment is assumed to have as its
goal correcting children's negative behavior
• Physical punishment often results in
immediate cessation of behavior that parents
view as undesirable in young children

Important qualities of parents

Accept change
• As parents too might end up making mistakes
• Should know what you have to change within
yourself and when
• Nobody is perfect and being a perfect parent is also
just a myth
• Should know where you are going wrong and then
implement changes for yourself.

Patience:
• Patience is another important quality which every
parent must possess
• Dealing with kids can get stressful at times
• learn to calm down and handle situations
• Taking decisions in a haste may lead to problems

A good teacher:
• It is very well said that parents are the first teachers
• All that you teach your child from the childhood itself
nurtures their upbringing
• Have to teach everything to your child in such a way
that it makes them sensible enough to deal with odd
situations

• Be assertive and kind when pointing out what they
have done wrong
• Children should be very familiar with the
consequences of their actions
• Remember your values can be seen in your children ,
therefore be careful while handling them.

Loving:
• Parent‟s love and care determine eventually how a
child grows up and how a child will eventually be
parent
• Being loved by your parents make you feel important
and gives you the inspiration to do something
worthwhile in life

• Depriving your child from love they deserve is no
less than a criminal offense
• Love directs your children towards the right path
• Parents must keep it in mind to never let the child feel
unwanted or not loved, this might lead to show
behavioral changes in them

Encouraging:
• Encouragement is the first and foremost thing a
parent must do
• Life brings many failures but learning to cope with
them and being encouraged to move on is necessary.
• Encourage them to try new things and explore their
talents.
• Your encouragement may lead them to do great
things

Frankness:
• Parents are the first friends of children
• Should let them open up to you, should feel
comfortable in talking to you about anything that they
are curious about
• You should be the first ones they approach for any
kind of problem they face

Compromise:
• Is a unique as well as an important quality
• There comes a time when you have to accept
things as they are and compromise a bit to
move on in life
• Be it financially or in any other way to build a
secure future for your children you should be
that much responsible to give up what it takes

Supportive:
• Being parents you are the only support for the
children
• Children look up to their parents for
everything
• In whatever they do, you should stand by them
to let them not feel alone

• when children grow up, for their future
decisions too, parents must act supportive
towards them rather than imposing your own
decisions over them

Understanding:
• Understanding leads to a healthy and smooth
relationship between a parent and a child
• Should be so much approachable that your children
can talk their hearts out in front of you
• Many times it happens that parents don‟t understand
their children and simply make the child feel reluctant
in expressing themselves
• It affects the child mentally , therefore maintain a
balance in your relationship.

Trust:
• Trust is the threshold of every relationship
• Being parents must trust your children
• Lack of trust may lead to a lot of arguments or
misunderstandings
• When your child is in his or her teens, they are at a
phase where anything said or done against them
invokes them to fight back
• Therefore do not be suspicious of your children in
any situation , trust them freely

Responsible parenthood practices
contd(what parents should do)
They teach more with actions (and examples)
and less with words
• Various studies have proved children learn more
from observing and experiencing the world than
by taught words
• Responsible parents provide the right examples
and behavior to their children to learn from
Instead of saying „be polite‟, they demonstrate
politeness by being polite in their everyday life
They encourage more and criticize less
• Biggest responsibilities of parents is to instill
confidence in their children and this can be
achieved by being more encouraging and
motivating of the children‟s strengths and good
qualities
• Constant criticism can rip the children off their
self esteem and demoralizes them
• It can take them into withdrawal mode and
secretiveness, while regular appreciation helps in
building strong, confident and positive children
• Responsible parents reward good behavior

They spend quality time with their children
• Reports have suggested that when it comes to
spending time with kids
• We all would prefer an hour of peaceful,

undistracted, quality time with our loved ones
over four hours full of distractions, divided
attention and undue arguments

• They spend quality time with their kids that
helps in developing a deeper bond of love and
understanding between the parents and their
children

They encourage dialogues with the kids
• Encouraging dialogues with the kids have two
fold benefits: it makes them feel that they are
important to have their opinions heard and it helps
them in developing the art of self expression
• Lot of issues can be solved with open
communication and having a healthy, logical
dialogue
• Responsible parents listen actively to their kids
and set it as the stepping stone to a relevant and
useful discussion
They stay connected as a couple
• In a study done by Robert Epstein and
Shannon Fox, they reported „relationship
skills‟ as one of the most important „parenting
competencies‟
• According to the study, parents who show
great relationships skills as a couple raise
happier kids
• Responsible parents behave happy and
connected couples to give good example to
kids.

They understand their kids’ love language
• Responsible parents not only learn their kids‟
love language but also try to communicate
with them in the same language
• This helps immensely in addressing the
children‟s needs directly and filling any
emotional need gap in kids

They let their children take their own decisions
• Letting the children take their own decisions
helps them in self discovery
• should begin at young age but at the same time
what decisions are left upon them depends on
their age and maturity
• Instead of allowing children to decide whatever
they want, responsible parents give them choices
and let them choose
• Slowly as their sense of judgement grows, this
array of choice can be widened
They emphasize more on moral values and less
on materialistic things
• Time and again it has been proved that in end,
moral values stand taller than materialistic
possessions
• Responsible parents place more significance on
values like honesty, kindness, compassion and
integrity and less on materialistic aspects like
grades, competition, expensive things and
grooming
• They understand that a sound character goes a
longer way than a better grade.

They take parenting easily by giving good
memories
• They do not follow helicopter parenting and
nor are they completely lousy parents
• They are right there ,raising better kids by
giving them the happy home to live in
• They create good memories for their children
that often last a lifetime

As responsible parents what they
should not do
They don’t fake their attention to kids
• They are genuine parents and so when they
spend time with the kids, they actually do
• They do not just pretend to be there physically
• They are mindful of their kids‟ presence and
give undivided attention to their kids

They don’t compare their kids with others
• They don‟t fall in comparison trap to make their
child feel inferior
• They believe in the individuality of their kid and
stay away from unnecessary comparisons and
judgements.
They don’t stop their kids from voicing their
opinions
• They value what their kids have to say and let the
children have a thinking process of their own
• They also do not judge their kids based on their
differing opinions.

They don’t thrust their decisions upon their
kids
• They treat their kids as individuals and hence
do not thrust their own choices and decisions
upon the kids
• They first let their kids choose and then
depending upon the choice decide whether or
not to follow the kids‟ decisions

They don’t “act” as great parents
• They do not act or pretend
• Whatever they are, they are in reality
• They do not shower compliments upon their
kids in front of others and criticize them when
alone and nor they act too goody-goody to gain
appreciation from others
• Responsible parents learn to become great
parents by doing the above mentioned things
and they do so heartily.
Effects on family health/health
• Countless colds, sleepless nights, may not sound
like a healthier lifestyle
• Yet, children often boost the health of moms and
dads everywhere
• Choosing a life with children is an extremely
personal, lasting decision
• The childless tend to have more freedom
• With that independence, time and money can be
dedicated to whimsical(unpredictable) vacations,
spontaneous plans

• Statistics prove if you opt for the adventure of
parenting, there are healthful benefits
• Kids tend to be the ultimate motivator for a
healthier lifestyle
• Those considering conception often take steps
toward improved health by eating well,
quitting cigarettes, and eliminating caffeinated
and alcoholic drinks
• Couples who embark on the parenthood
journey tend to take team approach to improve
their physical condition

• The birth, and pending birth, of a child is a
large motivator for couple to get in better
physical shape
• Along with thoughts of saving for everything
from the latest baby gear to college tuition,
parents want to be around to see their families
grow and prosper
• Many people, credit their children as
motivation to improve their health

• It is not only pregnant parent who requires a
body in optimum shape
• The dream of playing and growing with
children well into old age, and providing for
them, has shed countless unwanted pounds,
reduced cholesterol, lowered blood pressure,
and strengthened joints and muscles
• Perhaps this is one reason parents have a

lower rate of heart disease and suicide

• Research has proven an increase in the brain
size of post-partum mothers
• A study published in Behavioral Neuroscience
examined brain scans of women at two to four
months after birth
• Their mid-brain and prefrontal cortex regions
showed growth, which respectively involve the
experience of pleasure and ability to reason,
plan, and make judgments

• Researchers believe it is strong indication that
these women got smarter during new motherhood
• This study did not involve new fathers
• However, the concept is likely the same
• The child‟s brain is nurtured and developed from
a mother‟s input, who in turn experiences her own
brain growth.
• An expanded social circle, and increased social
interaction, is known to have a positive impact on
health.
• Surprisingly though, when children get sick,
parents do not always contract the illness
• One study, which followed almost 800 adults,
proved parents were less likely to develop a
new cold virus than their childless peers
• It did not indicate parents contracted less
colds than non-parents; rather, parents were
less likely to catch new cold virus when
exposed.

• The more kids, the stronger immunity: Parents
with one or two children were 48 percent less
likely to get sick than non-parents
• Parents with three or more children jumped to
61 percent less likely
• The finding held true for parents with adult
children who no longer lived in the same
household
• Psychological factors, such as decreased
loneliness and increased sense of purpose, may
also be responsible.

THANK YOU

• A state of complete physical, mental, and social well
being and not merely the absence of disease or
infirmity, in all matters related to the reproductive
system and to its functions and process
International Conference on Population and

Development, Programme of Action, 1994.

The WHO International Conference on Population and
Development, held in Cairo in 1994, arrived at a consensus
view of reproductive health that was endorsed by 165
countries
Definition suggests that reproductive health encompasses:
• The ability to reproduce

• Freedom to control reproduction
• The ability to go through pregnancy and childbirth safely, with
successful maternal and infant survival and outcomes
• The ability to obtain information about and access to safe,
effective and affordable methods of family planning
• The ability to have a satisfying, safe sex life, free from fear of
pregnancy and disease
• The ability to minimize gynecologic disease and risk
throughout all stages of life

There are certain implicit rights of
both men and women:
• To be informed of safe, effective, affordable and
acceptable methods of fertility regulation
• To have access to safe, effective, affordable and
acceptable methods of fertility regulation of their
choice
• To have access to appropriate health care services
that will enable women to go through pregnancy
and childbirth safely, and provide couples with
the best chance of having a healthy infant
Reproductive health includes
• Satisfying, safe sex life
• Ability to reproduce
• Successful maternal and infant survival and
outcomes
• Freedom to control reproduction
• Information about and access to safe, effective,
affordable methods of family planning
• Ability to minimize gynecologic disease
throughout life

IMPORTANCE OF REPRODUCTIVE
HEALTH

General
• Reproductive health is a human right stated in
international law
• Reproductive health plays an important role in
morbidity, mortality and life expectancy
• Reproductive health problems are the leading
cause of women‟s ill health and mortality
worldwide

• There is a long history of recognizing reproductive
health among the essential human rights
• Acknowledgements of reproductive health from a
human rights perspective are embedded in:
- The Universal Declaration of Human Rights, 1948;
- The Convention on the Elimination of All Forms of
Discrimination Against Women, 1979
- The Programme of Action, from the International
Conference on Population and Development, Cairo
1994
- The Platform for Action at the Fourth World
Conference on Women, Beijing 1995

– Crucial part of general health and central feature
of human development
• Reflection of health during childhood, and crucial
during adolescence and adulthood, sets the stage for
health beyond the reproductive years for women
• State of health in reproductive years affects the health
of next generation
• Health of the newborn is largely a function of the
mother's health and nutrition status and of her access
to health care

• Reproductive health is prerequisite for social,
economic and human development
• Addresses the human sexuality and
reproductive processes, functions and system
at all stages of life
• Men and women have the right to be informed
and have access to safe, effective, affordable
and acceptable methods of their choice for the
regulation of fertility

• Right of access to appropriate health care
services for safe pregnancy and childbirth
• Reproductive health is life-long, beginning
even before women and men attain sexual
maturity and continuing beyond a woman's
child-bearing years

GLOBAL INDICATORS OF
REPRODUCTIVE HEALTH
• Fertility
• Life Expectancy
• Perinatal Mortality
• Low birth weight
• Maternal Mortality

HISTORICAL DEVELOPMENT OF
CONCEPT

• During the 1960s, UNFPA established with a
mandate to raise awareness about population
“problems”
• Concern about population growth coincided
with the rapid increase in availability of
technologies for reducing fertility

• WHO established the Special Program of
Research, Development and Research Training
in Human Reproduction (HRP) in 1972
• Modern contraceptive methods were seen
reliable for controlling unregulated fertility

• Population policies became widespread in
developing countries during the 1970s and
1980s
• Supported by UN agencies and a variety of
NGOs
• Planned parenthood federation (IPPF) is
perhaps the most well known.

DEVELOPMENT OF
REPRODUCTIVE HEALTH

Before 1978 Alma-Ata conference:
- Basic health services in clinics and health
centers
Primary health care declaration 1978:
• MCH services started with more emphasis on
child survival
• Family planning was the main focus for
mothers

Safe motherhood initiative in 1987:
• Emphasis on maternal health
• Emphasis on reduction of maternal mortality
Reproductive health, ICPD in 1994 :

• Emphasis on quality of services
• Emphasis on availability and accessibility
• Emphasis on social injustice
• Emphasis on individuals woman's needs and
rights

Millennium development goals and reproductive
Health:
• MDGs are directly or indirectly related to
health
• MDG 4, 5 and 6 are directly related to health
• World Summit 2005, declared universal access
to reproductive health

SDG 3: Ensure healthy lives and
promote wellbeing for all at all ages

TARGETS
• 3.1 By 2030, reduce the global maternal
mortality ratio to less than 70 per 100 000 live
births.
• 3.2 By 2030, end preventable deaths of
newborns and children under 5 years of age,
with all countries aiming to reduce neonatal
mortality to at least as low as 12 per 1000 live
births and under-5 mortality to at least as low
as 25 per 1000 live births.

• 3.3 By 2030, end the epidemics of AIDS,
tuberculosis, malaria and neglected tropical
diseases and combat hepatitis, water-borne
diseases and other communicable diseases
• 3.4 By 2030, reduce by one third premature
mortality from non-communicable diseases
through prevention and treatment and promote
mental health and well-being

• 3.5 Strengthen the prevention and treatment of
substance abuse, including narcotic drug abuse
and harmful use of alcohol.
• 3.6 By 2020, halve the number of global
deaths and injuries from road traffic accidents

• 3.7 By 2030, ensure universal access to sexual
and reproductive health-care services,
including for family planning, information and
education, and the integration of reproductive
health into national strategies and programmes.
• 3.8 Achieve universal health coverage,
including financial risk protection, access to
quality essential health-care services and
access to safe, effective, quality and affordable
essential medicines and vaccines for all.

• 3.9 By 2030, substantially reduce the number
of deaths and illnesses from hazardous
chemicals and air, water and soil pollution and
contamination.
• 3.a Strengthen the implementation of the
WHO Framework Convention on Tobacco
Control in all countries, as appropriate

• 3.b Support the research and development of
vaccines and medicines for the communicable and
non-communicable diseases that primarily affect
developing countries, provide access to affordable
essential medicines and vaccines, in accordance
with the Doha Declaration on the TRIPS
Agreement and Public Health, which affirms the
right of developing countries to use to the full the
provisions in the Agreement on Trade-Related
Aspects of Intellectual Property Rights regarding
flexibilities to protect public health, and, in
particular, provide access to medicines for all.

• 3.c Substantially increase health financing and
the recruitment, development, training and
retention of the health workforce in developing
countries, especially in least developed
countries and small island developing States.
• 3.d Strengthen the capacity of all countries, in
particular developing countries, for early
warning, risk reduction and management of
national and global health risks

PROGRESS OF GOAL 3 IN 2018
• Many more people today are living healthier
lives than in the past decade
• Nevertheless, people are still suffering
needlessly from preventable diseases, and too
many are dying prematurely
• Overcoming disease and ill health will require
concerted and sustained efforts, focusing on
population groups and regions that have been
neglected

Reproductive, maternal, newborn
and child health
• The maternal mortality ratio has declined by
37 per cent since 2000
• Nevertheless, in 2015, 303,000 women around
the world died due to complications during
pregnancy or childbirth
• Over the period 2012–2017, almost 80 per
cent of live births worldwide occurred with the
assistance of skilled health personnel, up from
62 per cent in 2000–2005

• Globally, from 2000 to 2016, the under-5
mortality rate dropped by 47 per cent, and the
neonatal mortality rate fell by 39 per cent.
Over the same period, the total number of
under-5 deaths dropped from 9.9 million to 5.6
million
• Even in the region facing the greatest health
challenges, progress has been impressive.
Since 2000, the maternal mortality ratio in sub-
Saharan Africa has been reduced by 35 per
cent, and the under-5 mortality rate has
dropped by 50 per cent
• In 2018, the global adolescent birth rate is 44
births per 1,000 women aged 15 to 19,
compared to 56 in 2000. The highest rate (101)
is found in sub-Saharan Africa

NOTE:
“Sexual and reproductive health is fundamental
to the social and economic development of
communities and nations, and a key component
of an equitable society”

CORE COMPONENTS OF
REPRODUCTIVE HEALTH

Family planning:
Key facts:
• 214 million women of reproductive age in developing
countries who want to avoid pregnancy are not using
a modern contraceptive method
• Some family planning methods help prevent the
transmission of HIV and other sexually transmitted
infections.

• Family planning reduces the need for abortion,
especially unsafe abortion.
• Reinforces people‟s rights to determine the
number and spacing of their children.
• By preventing unintended pregnancy, family
planning prevents deaths of mothers and
children.

Benefits of family planning
• Preventing pregnancy-related health risks in
women
• Reducing infant mortality
• Helping to prevent HIV/AIDS
• Empowering people and enhancing education
• Reducing adolescent pregnancies
• Slowing population growth

Global unmet need for contraception
• 214 million women of reproductive age in
developing countries who want to avoid
pregnancy are not using a modern contraceptive
method
Reasons are:
• limited choice of methods
• limited access to contraception, particularly
among young people, poorer segments of
populations, or unmarried people
• Fear or experience of side-effects
• Cultural or religious opposition
NEPAL:
• The main aim of family planning is to have
babies by choice not by chance
• Main aim of the National Family Planning
Program is to ensure that individuals and
couples can fulfill their reproductive needs by
using appropriate family planning methods
based on informed choices
• Family planning information and services are
provided through the government, social
marketing, NGOs and the private sector

Family planning spacing methods
Annual report Current user (2074/75)

Annual report 74/75 New acceptor

SAFE MOTHERHOOD AND
NEWBORN HEALTH

Global scenario
• Countries with the highest burdens of mortality
and illness have made the least progress
• Each year there are at least 3.2 million
stillborn babies, 4 million neonatal deaths and
more than half a million maternal deaths

• HIV/AIDS and malaria in pregnancy are
having an impact on maternal mortality
• 11–17% of maternal deaths occur during
childbirth itself; 50–71% occur in the post-
partum period
• A total of 98% of stillbirths and newborn
deaths occur in low- and middle-income
countries

Nepal
• The goal of the National Safe Motherhood
Programme is to reduce maternal and neonatal
morbidity and mortality and improve maternal
and neonatal health
• Evidence suggests that three delays are
important factors for maternal and newborn
morbidity and mortality in Nepal
• Safe Motherhood Programme has made
significant progress since it began in 1997

Major activities:
Safe abortion services:
• Global and national evidence shows that many
women face unwanted pregnancy including
due to limited access to family planning
information and services
• Need to make safe abortion services available,
accessible and affordable to all women with
unwanted pregnancies

• Four key components of comprehensive
abortion care as:
- Pre and post counseling on safe abortion
methods and post abortion contraceptive
methods
- Termination of pregnancies as per the national
protocol

• Diagnosis and treatment of existing
reproductive tract infections
• Provide contraceptive methods as per informed
choice and follow-up for post-abortion
complication management

Nyano jhola programme:
• Launched in 2070/71 to protect newborns from
hypothermia and infections and to increase the use of
peripheral health facilities
• Two sets of clothes for newborns and mothers, and
one set of wrapper, mat for baby and gown for mother
are provided for women who give birth at birthing
centers and district hospitals
• Programme was implemented in all 75 districts in
2072/73

Aama and newborn program:
• Maternity Incentive Scheme, 2005 provided
transport incentives to women to deliver in
health facilities
• 2009, user fees were removed from all types
of delivery care under the Aama Programme
• 2012, the separate 4ANC incentives
programme was merged with the Aama
Programme
Provisions of the Aama and Newborn
Programme in Nepal (Revised)
For women delivering their babies in health

institutions:

Transport incentive for institutional delivery:
• Cash payment to women immediately after
institutional delivery (NPR 3,000 in mountains,
NPR 2,000 in hills and NPR 1,000 in Tarai
districts)
Started from FY 2075/76 )
(Transportation incentives doubled from budget
speech)
• Incentive for 4 ANC visits: A cash payment of
NPR 800 to women on completion of four ANC
visits at 4, 6, 8 and 9 months of pregnancy,
institutional delivery and postnatal care

Free institutional delivery services:
• A payment to health facilities for providing
free delivery care
• For a normal delivery health facilities with
less than 25 beds receive NPR 1,000 and
health facilities with 25 or more beds receive
NPR 1,500
• For complicated deliveries health facilities
receive NPR 3,000 and for C-sections
(surgery) NPR 7,000
• Ten types of complications
- (antepartum haemorrhage (APH) requiring blood
transfusion
- postpartum haemorrhage (PPH) requiring blood transfusion
- or manual removal of placenta (MRP) or exploration
- severe pre-eclampsia, eclampsia
- MRP for retained placenta
- puerperal sepsis
- instrumental delivery
- management of abortion complications requiring blood
transfusion)
- admission longer than 24 hours with IV antibiotics for
sepsis
included as complicated deliveries

• Anti-D administration for RH negative is
reimbursed NPR 5,000
• Laparotomies for perforation due to abortion,
indicated or emergency C-sections, laparotomy
for ectopic pregnancies and ruptured uterus are
reimbursed NPR 7,000

For newborns:
• A payment to health facilities for providing free
sick newborn care
• Facilities are reimbursed for set packages of care:
Packages 0, A, B and C costing nothing, NPR
1,000, NPR 2,000 and NPR 5,000 respectively.
• Health facilities can claim a maximum of NPR
8,000 (packages A+B+C), depending on
medicines and diagnostic and treatment services
provided

Incentives to health workers (to be arranged
from health facility reimbursement amounts):
• For deliveries: A payment of NPR 300 to
health workers for attending all types of
deliveries.
• A payment of NPR 300 to health workers for
providing all forms of packaged services.

Achievements
ANC:
• WHO recommends a minimum of four
antenatal check-ups at regular intervals to all
pregnant women
• During these visits women should receive the
services and general health check-ups

Delivery care:
• Nepal is committed to achieving 70 percent of
all deliveries by SBAs and at institutions by
2020 (2076/77) to achieve the SDG target
• Deliveries attended by SBA is 52% in the year
074/75

Postnatal care:
• The proportion of mothers attending three
PNC visits as per the protocol is slightly
declined in 2074/75 (16%)

Issues
• Referral mechanism needs to be established
• Availability of quality maternity care services
at hospitals and birthing centers
• Low use of institutional delivery and C-section
services in mountain districts
• High demand for free surgery for uterine
prolapse cases
• Increasing the number of birthing centres ,the
inadequate use of some birthing centres
Prevention and Management of
HIV/STI
• 2016, 1.0 million people died from HIV-
related causes globally.
• Approximately 36.7 million people living with
HIV at the end of 2016 with 1.8 million people
becoming newly infected in 2016 globally

• 54% of adults and 43% of children living with
HIV are currently receiving lifelong
antiretroviral therapy
• It is estimated that currently only 70% of
people with HIV know their status
• In mid-2017, 20.9 million people living with
HIV were receiving antiretroviral therapy
globally

NEPAL
• Nepal began its policy response to the HIV epidemic

through its first National Policy on Acquired
Immunity Deficiency Syndrome (AIDS) and Sexually
Transmitted Disease (STD) Control (1995)
• New National HIV Strategic Plan (2016-2021) was
recently launched with the ambitious 90-90-90 goal,
that by 2020

• HIV in Nepal evolved into a concentrated
epidemic among key populations
• Heterosexual transmission is the major route
of transmission in the total pool of HIV
infection in Nepal
• Nepal started its PMTCT programme in 2005
by establishing PMTCT sites

Note
• Concentrated HIV epidemic: HIV has spread
rapidly in one or more defined subpopulation
but is not well established in the general
population.
• Numerical proxy: HIV prevalence is
consistently over 5% in at least one defined
subpopulation but is less than 1% among
pregnant women in urban areas

• The national strategy structures the PMTCT
programme around the four-prong approach of
i) The primary prevention of HIV transmission
ii) Preventing unintended pregnancies among
women living with HIV
iii) Preventing HIV transmission from women
living with HIV to their children
iv) Providing treatment, care and support for
women living with HIV and their children and
families

CHALLENGES IN HIV/STI MANAGEMENT
• Large data gaps in HIV reporting, especially

from regional, sub-regional, zonal and district
hospitals that are yet to be covered by
electronic HMIS
• All NGO testing sites are not covered under
the HMIS database system
• Inadequate staff, especially trained HIV
counsellors in government sites, especially
PMTCT sites

ISSUES IN PMTCT
• Inadequate laboratory personnel at PMTCT
sites
• Tracking of HIV-positive mothers and
exposed babies for early infant diagnosis

THANK YOU

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UNIT :1

FAMILY HEALTH AND

- Traditional families (breadwinner husband,

• This definition broadens the scope by counting as

• Family is a group of biologically-related

• Art and science of preventing diseases

• Family has a strong influence on the health of

• Families will aim to work together after the

• Understanding family needs is important as

• Development in the field of social science

• Some people when they become sick first they

• They can have depression, anxiety, and addictive

Examples: Games, Shopping, Cleaning the House,

• The laws in functional families will allow for

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• Stable satisfaction of sexual needs

• Provide an environment that is SAFE

• To empower families so that couple can be

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• The process of preparing for parenthood

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Parents influence the health and safety of their children

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• Women whose pregnancies are unintended also are

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