INDEX

PAGE NO

CONTENT
01. Introduction

02. Objectives

03. Definitions

04. Content on

 Epidemiological aspects of maternal and child health

 Aims of epidemiology
 Purposes
 Importance of epidemiology related to MCH
 Major elements related to MCH
 Areas of Maternal and child health
 Epidemiological tried related to mother and child
 MCH problem triad
 Maternal mortality and morbidity related
statistics
 Child related statistics (per 1000 live birth)
 Epidemiological approach
 Epidemiological methods

 Magnitude of Maternal and child health problems

 Introduction
 Concepts
 Definition
 Maternal morbidity problems
  Maternal mortality problem
 Prevention and control of mortality and
morbidity
 Concepts and importance of child health
 Child health problems

 Issues of maternal and child health

 Introduction
 Concept of maternal and child health
 Definition
 Issues of MCH Age gender sexuality psychological
05. factors socio cultural factors lifestyle pattern
 Emerging issues in MCH
06.
Summary
07.
Conclusion

Bibliography

MANISHA COLLEGE OF NURSING

SHEELA NAGAR, VISAKHAPATNAM

MASTER PLAN
Subject: Obstetrics and Gynaecological Nursing
Unit number: I
Topics:
 Epidemiological aspects of maternal and child health
 Magnitude of maternal and child health
 Issues of maternal and child health

Submitted to: Submitted By:

Prof: Mrs. Jyothi MSC(N) Mrs. Ratnakumari G
Associate professor MSC Nursing I st year
Dept. of Obstetrics and Department of obstetrics and
Gynaecological Nursing Gynaecological Nursing
Manisha college of nursing Manisha college of nursing

Submitted on :22/08/2022

INTRODUCTION

Maternal and child health is recognized as one of the significant components of Family
Welfare. Health of both mother and children is a matter of Public Health concern. It is also
being observed that the deaths of mothers and children are the major contributors to
mortality in any community in India. Maternal and Child Health care services are essential
and specialized services because mothers and children have special health needs which are
not catered to by general health care services.
OBJECTIVES:

General objectives

 At the end of the class students will gain in-depth knowledge about epidemiology
aspects of maternal and child health, Magnitude of maternal and child health and
Issues of maternal and child health and will be able to apply in the clinical setting
during their professional practice.

Specific objectives

 Introduce the epidemiology aspects of maternal and child health

 Define epidemiology and maternal and child health
 Enlist the areas of maternal and child health
 Describe epidemiological aspects of both mother and child
 Explain Epidemiological Tried Related to Mother and Child
 Specify the mortality and morbidity rate of maternal child health
 Enumerate the importance of epidemiology in the world and India

DEFINITION:

1. MATERNAL AND CHILD HEALTH Maternal and Child Health (MCH) refers to a package
of comprehensive health care services which are developed to meet promotive,
preventive, curative, rehabilitative health care of mothers and children.

2. DEFINITION OF MATERNAL HEALTH /REPRODUCTIVE HEALTH Maternal Health is now

referred as "Reproductive Health” (RH). According to WHO it is defined as a state of
complete physical, mental and social wellbeing and not merely the absence of
 disease or infirmity in all matters relating to the reproductive system and its
functions and processes.
-WHO
3. DEFINITION Epidemiology
“The study of the distribution and determinants of health related status or events in
specified population and the application of this study to the control and prevention
of health problems.”
- M. Last (1988)
This includes study of health services used by the population and to measure the
impact . It is more concern about society then individual.

4 .  Definition: Maternal and Child Health:

“Maternal and child health refers to the promotive, preventive, curative and
rehabilitative health care for mothers and children.”
- Park K. (2007)

Aim & Purposes of epidemiology

Prevention and control of diseases among women and children Purpose (a)Identify  trends
and emerging threats to the health of women on reproductive age and child  local impacts
on the prevention strategies (b)Targeting effective implementation (c)Appropriate
coordination with other agencies

AREAS OF MATERNAL AND CHILD HEALTH

 Maternal health
 Child health
 Family planning
 School health
 Handicapped children
 Adolescence health
  Health aspects of care of children in special settings such as day care.
 Mother and child one unit
 During antenatal period foetus is an integral part of mother
 Health of the mother and child are interrelated
 Mother can transmit certain diseases to the child during pregnancy
 Breast feeding is a regulatory process during early child hood
 Mother initiated primary socialization to the child
 Epidemiological Aspects of Maternal and Child Health
 The study of the distribution and determinants of health-related status or events in
mothers and children and the application of this study to the control and prevention
of health problems related to mother and child. It follows systematic assessment of
the health of the women in reproductive age and children in the community
including timely collection of data, analysis, interpretation, dissemination and use of
MCH related data.

MCH Problem triad:

The Problems in Women

 Early age of marriage—teenage pregnancies

 Unsafe abortion
 Unwanted fertility and infertility
 High fertility rate and rising population
 Unacceptably high mortality rate amongst women in reproductive age group
 Poor nutritional status—high level of anaemia
 Reproductive tract infections, sexually transmitted diseases and emerging problem
like HIV/AIDS
 Unfavourable sex ratio—gender discrimination
 Low level of literacy amongst females
 Low status of women and heavy work load and violence against women

Problems in Children & Adolescent Children

  Low birth weights
 Unacceptably high mortality rate during early childhood period
 Poor nutritional status—high level of anaemia
 Acute respiratory tract infections
 Diarrhoeal diseases
 High level of school dropouts
 Child labour and abuse
 Social problems of adolescents—Drug Abuse and Sexual problems
 Disabled children—Physical, Mental and also behavioural problems in street
children Adolescent
 Problem of adolescent girl –Teen age pregnancy, depression, malnutrition

Epidemiological Tried Related to Mother and Child

 Agent: Child Foetal Life –Nutrition, change in hormonal level, growth and
development Childhood – Nutrition, physical care, growth and development,
socialization & care during illness
 Host: Mother Nutrition, physical health, genetic inheritance & social status
 Environment: Physical, Biological and psychosocial.

MCH Problems Triad Health care delivery system factors Social Economic Cultural. Maternal
Mortality Rates (Per 1000 live births) Place MMR World 4.0 Developed country 1.3 India 2.9.
WHO review of maternal conditions most frequently reported Morbidity Number of studies
(%) Hypertensive disorders of pregnancy 885 Stillbirth 828 Preterm delivery 489 Induced
abortion 400 Haemorrhage (antepartum, intrapartum, postpartum) 365 Anaemia 267
Placenta anomalies (pravia, abruptio, etc.) 245 Spontaneous abortion 235 Gestational
diabetes 224 Ectopic pregnancy 146 Premature rupture of membranes 140 Perineal
laceration 139 Uterine rupture 116 Obstructed labour 102 Depression (postpartum, during
pregnancy) 96 Puerperal infection 86 Violence during pregnancy 77 Other conditions 1093
Overall 5933

Causes of maternal mortality in Asia (1997- 02) Morbidity Percentage Haemorrhage 30.8
Anaemia 12.8 Other indirect causes of deaths 12.5 Sepsis/infection 11.6 Obstructed labour
9.4 Hypertensive disorders 9.1 Unclassified deaths 6.1 Abortion 5.7 Other direct causes of
deaths 1.6 Embolism 0.4 Ectopic pregnancy 0.1 HIV/AIDS 0.0

Child related statistics(Per 1000 live births) Problems Developed country India World IMR
6.86 56 56.29 Underfives mortality 87 74 Early Neonatal mortality 33 Post neonatal
mortality 24 Total neonatal mortality 39 Birth rate 24 Malnutrition 470 Acute respiratory
infection 150-300 Others (Sexual harassment, adolescent. Still after various studies Exact
statistics not available

 Achievements related to Family planning programme in India (2007-08) Family

planning methods Achievement (in %) Sterilization 71 IUD 69 Oral pills 72 Couple
protection rate 47.8
 Achievements of National Immunization Programme (2004) Vaccine Achievement (in
%) Measles 56 DPT 64 Polio 70 BCG 73 TT 80
 National Health Indicators, Achievements & Strategies Indicators Achievement (2004)
Strategies (2015) MMR 2.9/1000 0.75/1000 IMR 56/1000 35/1000 Delivery by skill
birth attendant 43% 90% Access to reproductive health 100% Gender equity Poverty
Reduction Population growth Reduction Antenatal Coverage 60% 100% Couple
protection rate 47% 100% Total fertility rate 3.2% <2%

Epidemiological Approach Epidemiology deals with interaction of agent host and

environment which if operating in combination determine the – WHAT ? WHEN ? WHERE ?
WHO ? WHY ?
And also plans ;HOW TO PREVENT AND CONTROL THE PROBLEMS

Epidemiological methods Observational Experimental Correlational Prevalence Case-control

Cohort Randomized controlled trials Field trials Community trials

Importance of epidemiology for MCH (INDIA)

 Mother and child constitute 70% of total population of which

women between 15 -44yrs of age is 19% and 40% are children
 Slow progress in the national MCH related programmes
 Newly emerging problems
 Un utilized funds
 Poor distribution system of skilled services and transport s
 Unmet needs of contraceptions
 Major Elements of PHC Related to MCH
 MCH including family planning
 immunization against major infectious diseases and education of the community about
health and nutrition These have direct bearing on the outcome of the Maternal and
Child Health related goals and objectives.
 Challenges in Collecting and Monitoring Data Data Related Information Systems Data
Capability Community Readiness
 Data access
 Data availability
 Quality of data
 Timeliness of data
 Problems with data collection
 Creating and maintaining information systems
 Availability of user-friendly hardware/software and manuals
 Recruitment and retention of skilled staff
 Lack of analytic capability
 Lack of data management skills
 Lack of interpretation skills
 Need for additional staff
 Training
 Community awareness
 Community interest
 Political will
 Communication
 CollaborationAgency’s
 readiness to change
Importance of epidemiology related to MCH (A) World

 Mother and child constitute around two third of the total population
 Most of the maternal and child hood mortality are due to preventable causes
 They are pillars of any of the developing or developed nation
 Though various strategies are made since many decades the progress seems to be very
slow
 They are vulnerable /special risk groups

MAGNITUDE OF MATERNAL AND CHILD HEALTH PROBLEMS

Maternal and child health. mortality morbidity risk factors. Factors affecting Health Diseases
In 2002, nearly 11 million children died before reaching their fifth birthday – 98% of these
deaths were in developing countries. 2006 World Health Organization.

MATERNAL AND CHILD HEALTH (MCH): A package of comprehensive health care services
which are developed to meet promotive, preventive, curative, rehabilitative health care of
mothers and children.

MATERNAL HEALTH, “Maternal health refers to the health of women during pregnancy,
childbirth and the postpartum period. While motherhood is often a positive and fulfilling
experience, for too many women it is associated with suffering, ill-health and even death.”

According to WHO”

REPRODUCTIVE HEALTH “People have the ability to reproduce and regulate their fertility,
women are able to go through pregnancy and child birth safely, the outcome of pregnancies
is successful in terms of maternal and infant survival and well-being and couples are able to
have sexual relations free of fear of pregnancy and of contracting diseases.”

"Reproductive and sexual ill-health accounts for 20% of the global burden of ill-health for
women” according to WHO”

OBJECTIVES OF MCH:
 To reduce maternal, infant and childhood mortality and morbidity.
 To reduce perinatal and neonatal mortality and morbidity.
  Promoting satisfying and safe sex life.
 Regulate fertility so as to have wanted and healthy children when desired.
 Provide basic maternal and child Health Care to all mothers and children.
 Promote and protect health of mothers.
 To promote reproductive health.
 To promote physical and psychological development of both mother and child.
GOALS OF MATERNAL AND CHILD HEALTH SERVICES:

 To ensure the birth of a healthy infant to every expectant mother.

 To provide services to promote the healthy growth and development of children up
to the age of under- five- years.
 To identify health problems in mother and children at an early stage and initiate
proper treatment.
 To prevent malnutrition in mothers and children
 To promote family planning services to improve the health of mothers and children.
 To prevent communicable and non- communicable diseases in mothers and children.
 To educate the mothers on improvement of their own and their children’s health.

MATERNAL MORBIDITY PROBLEMS:

The common maternal health problems or morbidity Condition are discussed asunder:
 Reproducti ve tract infecti on
 I n f e c ti o n i n g e n e r a l
 M a l n u t r i ti o n
 Anemia
 U n r e g u l a t e d f e r ti l i t y
 C o m p l i c a ti o n s o f   d e l i v e r i e s
 Puerperal sepsis
 A b o r ti o n s
  I n f e r ti l i t y
 Uterine prolapse
 Cancer of the cervix

REPRODUCTIVE TRACT INFECTIONS ( RTIs)

There are three types of RTIs which can occur. These are as under:

 Sexually transmitted diseases (STD) e.g; gonorrhea, syphilis, trichomonas,

Chlamydia, HIV/ AIDS and hepatitis B infection.
 Endogenous, due to over growth of existing bacteria e.g. candidiasis
during pregnancy.
 Infections caused by instrumentation, e.g. following pelvic examination ,septic
abortion etc.
A large number of women were unaware of the presence of any infection and were
asymptomatic. Young girls are more vulnerable to RTIs specially STD, ascompared to older
women. Women infected with HIV transmit it to their foetus. RTIs can cause pain, discharge,
infertility, ectopic pregnancy following inflammatory diseases etc.

It is very important to diagnose RTIs early. The treatment should be done for both the
partners. Personal and sex hygiene is to be practiced.
INFECTION IN GENERAL:
The women during pregnancy, especially in underdeveloped areas and developing countries
are at risk of contracting infection. Many women get infected with herpes simplex virus,
cytomegalovirus, protozoon which causes toxoplasmosis, E Coli causing nephritis or cystitis.
Infection during pregnancy can cause various harmful effects e.g. retardation of fetal
growth, abortion low birth weight baby and puerperal sepsis. It is very important that
women during pregnancy need to be alert and careful regarding prevention and control of
infection. They need to seek antenatal care right from the beginning of conception of
pregnancy so that mother get proper antenatal care and get well informed about these
infections and participate in prevention and control of these infections.
MALNUTRITION:

Malnutrition is a very common problem among women who are discriminated and

underprivileged. Pregnant and nursing mother especially prone to the effects
of malnutrition. Malnutrition can cause poor resistance, abortion, anemia ,miscarriage or
premature delivery, low birth weight baby(< 2.5kg), eclampsia, post partum hemorrhage
etc. these conditions can cause fatal effects on mothers, unborn and new born babies.

Malnutrition in women needs to be prevented and treated by some of the direct measures
such as nutrition education, modification and improvement of dietary intake before, during
and after pregnancy, supplementation of diet, distribution of iron and folic acid tablets,
subsidizing of food items and their fortification and enrichment. Other measures which can
help prevent malnutrition include prevention and control of infections by improvement of
environmental sanitation, safe water supply, food and personal hygiene, immunization and
treatment of minor ailments; regulation of fertility and practice of small family norm,
and health education.

ANEMIA:

Anemia is very common among women in India due to invariable reasons which include
malnutrition, infection especially hookworm infestation, repeated pregnancies, abortions,
antepartum and postpartum hemorrhage, discriminatory treatment of women etc.

About 85 percent of the women during pregnancy are known to be anemic. Anemia in

pregnancy result in premature labour, low birth weight babies, post partum hemorrhage
and perinatal mortality. Twenty percent of the maternal mortality is directly related to
anemia related causes.

UNREGULATED FERTILITY:

 Unregulated fertility has been recognized to cause many maternal health hazards. These
include abortions ,miscarriages , premature deliveries, low birth weight babies, antepartum
hemorrhage etc. all these health hazard are responsible for high maternal and perinatal
mortality. It is being recognized to regulate fertility by integrated and comprehensive
approach in family welfare services which include effective measures related to
reproductive health, child health and family planning. These services should be accessible
and acceptable to all and utilized by all the women, children and couples throughout
the countries.

COMPLICATIONS OF DELIVERIES:

In India most of the deliveries take place at home under unhygienical environment and
mostly by untrained dais lacking obstetrics skill. Often various health hazards result in such
as perineal tears, cervical damage, prolapse and displacement of uterus, fetal distress, post
partum hemorrhage etc. thus it is very important to have properly trained, skilful and
qualified health workers, adequate facilities and welllinked referral units where skilful and
efficient emergency care can be given to save mother and baby.

PUERPERAL SEPSIS:

It is mainly due to infection during labor and after delivery because of lack of  personal
hygiene, insanitary conditions, septic procedures etc. this may lead toinflammation of
ovaries, fallopian tubes, endometrium, cervix and vagina. Many atime leucorrhea may
persist for years. Some time secondary sterility may followafter acute or chronic salpingities.
Chronic infection of cervix may predispose to cancer of the cervix. It require proper
preparation for confinement by the mother ,conduct of deliveries by trained and skilful dais,
midwives etc and availability of equipments and supplies etc.

ABORTION:

Twenty percent of maternal mortality is directly related to abortion related causes. The

number of abortions is on the increase because of unwanted pregnancies. Medical
termination of pregnancy (MTP) has been legalized under the MTP Act of 1971, under
certain conditions.

By and large abortion are still done by quacks and unauthorized persons in the rural areas.
This is mainly due to lack of access to safe abortion clinics, non-availability of such clinics,
poor financial resources to reach to clinics in urban areas, lack of information about the
availability of safe abortion clinics, lack of  privacy and impersonal atmosphere in
government run clinics and reluctance of unmarried and widowed to go to the clinics/
hospitals for MTP services.

Illegally induced abortion and uncared spontaneous abortions may cause sepsis and severe
bleeding which may become fatal. There is also a sense of shame and quite specially when
the women is young and unmarried or widowed. It is there for every important to improve
the accessibility of MTP services in primary health centres and create awareness among
the people about the availability of such services.

INFERTILITY:

Infertility is both a medical and social problem. Even if the fault/ defect is in the male
partner, usually it is the women who is labeled as “ banjh” or “Barren” and is socially not
treated properly by the family and the society. Therefore this problem is to be considered
medically as well as socially. There is need to have empathetic attitude towards
childlessness of women by the society.

UTERINE PROLAPSE:

Uterine prolapse is a major problem in women of hilly areas. Women working at

construction sites, climbing heights, or digging hard ground or climbing 2 -3storeys with
heavy weight are predisposed to prolapse uterus. Certain child birth practice such as
pressing hard on the abdomen during labor, pulling the baby etc lead to prolapse of the
uterus, especially when the mother is malnourished and weak. Uterine prolapse may cause
lot of inconvenience to mother and predispose her to infection. Hence the need is for
trained and skill full dais and midwives, improvement of working conditions and education
of women.

CANCER OF THE CERVIX:

Cancer of the cervix is very common among Indian women. There are various factors which
contribute to the prevalence of cancer of cervix. These are; early marriage and early
pregnancy, multiple child birth, poor hygiene by the male partner, multiple partners,
repeated infections. Most of these factors are pertaining to sociocultural aspects of a
community and families and imply involving attitudinal change in these practices to prevent
the occurrence of cancer of the cervix.
MATERNAL MORTALITY PROBLEMS:

The maternal mortality refers to mortality (deaths) of women due to complication of

pregnancy, child birth or within 42days of delivery from puerperal causes. The Maternal
Mortality Rate (MMR) is expressed as number of maternal deaths per thousand live births
and is computed as under: 

Total no. deaths of women due to complications of pregnancy, child birth or within 42 days
of delivery from puerperal causes in an area during a given year 
MMR = ----------------------------------------------------------------------------- X 1000 

Total number of live births in the same area and same year.

The multiplying factor can also be 10,000 or 100,000, if the number of death haved eclined
considerably like in UK and USA.

Globally there are 430 maternal deaths for every 100,000 live births. In developing
countries there are 27 maternal deaths for every 100,000 live births.

The highest maternal mortality figures are found in Eastern and Western Africa, where in
some countries more than 1000 women die for every 100,000 live births. The lowest
recorded figures are in northern Europe, where they range from 0-11maternal deaths for
every 100,000 live births. The maternal mortality rate is muchlower in east Asian countries.

The maternal mortality rate in India is 408 per 100,000 live births. This means that around
125000 women die each year due to pregnancy related causes. The maternal mortality rate
also varies from state to state. The maternal mortality rate is highest in Orissa and lowest in
Kerala.

The major causes of maternal mortality in India are anemia (19%), antenatal and postnatal
hemorrhage (29.6%), puerperal sepsis (16%), obstructed labor (9.5%),abortion (8.9 -12%),
toxemia, sepsis (8.3%) and other.

 
Besides these causes related to pregnancy, there are many other causes which are not
directly related to pregnancy and childbirth. These causes include communicable or non-
communicable diseases which the women might be suffering before pregnancy or develop
during pregnancy e.g. tuberculosis (4.6%),viral hepatitis (0.4%), malaria (0.4%), diabetes,
rheumatic heart disease etc (12%).

The maternal mortality also high due to large number of deliveries being conducted at home
by untrained persons and also lack of adequate referral facilities to provide emergency
obstetric care for complicated cases.

The maternal mortality also affected by a wide range of socio-economic factors such as
status of women, low level of female education, economic dependency, lack of access to
services and gender bias.

PREVENTION AND CONTROL OF MORTALITY AND MORBIDITY:

Most of these causes can be prevented and controlled and maternal mortality can be
lowered by taking appropriate and timely action as under:

 Early registration of pregnancy ( within 12-16 weeks)

 Minimum three antenatal check up by ANM or medical officer to monitor the
progress of pregnancy and to detect any risk/ complication so that appropriate care
including referral could be given on time.
 Dietary supplementation and correction of anemia.
 Early detection and treatment of medical conditions.
 Tetanus toxoid immunization.
 Promotion of institutional deliveries
 Provision of safe delivery at home.
 Provision of three postnatal check ups and care to monitor the postnatal recovery of
women and to detect any complication which includes appropriate referral.
 Promotion of family planning to adopt small family norms.
 Training of local dias / traditional birth attendants (TBA) and supervision and
guidance of female health workers.
 Strengthening of infrastructure.
  Improving social status of women by alleviating gender discrimination, educating and
empowering them, providing supporting environment.

CHILD HEALTH:
Concept and importance:
Child health refers to a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity in matters relating to growth of fetus during
antenatal period and from birth of the baby till five year of age. It implies health care of the
fetus during antenatal period which refers to antenatal pediatrics, health care of neonates
from birth to 28 days, care of infant supto one year, care of toddler from one year up to two
years, care of preschool child from two years to five years of age.

The health of the children is also very important not only because they are the asset and
future of their families and nation but also because health status, health behaviour and life
style thus form during child hood determines quality of life during the following years of life.

The health of the children differ from place to place and in the same place. It is assessed in
terms of child morbidity and mortality. The factor which affect the health of children include
poverty, ignorance, illiteracy, age, sex, environment, size of the family, malnutrition, lack
of access to maternal and child health services etc.

CHILD HEALTH PROBLEMS:

 Problems of neonates
  Low birth weight 
 Pre-term babies
 Small for date (SFD)
 Malnutrition
 Infectious diseases
 Accidents and poisoning
ISSUES OF MATERNAL AND CHILD HEALTH

INTRODUCTION

Safe motherhood begins before conception with good nutrition and a healthy lifestyle. It
continues with appropriate prenatal care and preventing problems if they arise. The ideal
result is a full-term pregnancy without unnecessary interventions, the delivery of a healthy
baby, and a healthy postpartum period in a positive environment that supports the physical
and emotional needs of the mother, baby, and family.

Pregnancy and childbirth have a huge impact on the physical, mental, emotional, and
socioeconomic health of women and their families. Pregnancy-related health outcomes are
influenced by a woman's health and other factors like race, ethnicity, age, and income.
CDC's Division of Reproductive Health conducts research and supports programs to improve
women health before, during, and after pregnancy to reduce both short- and long-term
problems. CDC collaborates with partners to reduce the higher rates of poor outcomes
experienced by some racial and ethnic groups, to improve the pregnancy and delivery
experiences of all women. Our goal is to help ensure that all women have a safe and healthy
pregnancy.

MATERNAL AND CHILD HEALTH:

Maternal health now referred as reproductive health”. According to WHO, it is defined as a

state of complete physical, mental and social wellbeing and not merely the absence of
disease or infirmity in all matters relating to the reproductive system and its functions and
processes. It implies that people are able to have satisfying and safe sex life, are informed
about to have access to safe , effective , affordable and acceptable methods of family
planning as well as other methods of their choice for regulation of fertility which are not
against the law, are able to have access to appropriate health care services that will enable
women to go safely through pregnancy and childbirth.

Maternal health is the health of women during pregnancy, childbirth, and the postpartum
period. It encompasses the health care dimensions of family planning, preconception,
prenatal, and postnatal care in order to reduce maternal morbidity and mortality.
Four elements are essential to maternal death prevention. First, prenatal care. It is
recommended that expectant mothers receive at least four antenatal visits to check and
monitor the health of mother and foetus. Second,skilled birth attendance with emergency
backup such as doctors, nurses and midwives who have the skills to manage normal
deliveries and recognize the onset of complications. Third, emergency obstetric care is to
address the major causes of maternal death which are hemorrhage, sepsis, unsafe abortion,
hypertensive disorders and obstructed labour. Lastly, postnatal care which is the six weeks
following delivery. During this time bleeding, sepsis and hypertensive disorders can occur
and newborns are extremely vulnerable in the immediate aftermath of birth. Therefore, a
follow-up visit by a health worker is to assess the health of both mother and child in the
postnatal period is strongly recommended.

Maternal and child health (MCH) refers to a package of comprehensive health care services
which are developed to meet promotive, preventive, curative, rehabilitative health care of
mothers and children. It includes the sub areas of maternal health, child health, family
planning, school health and health aspects of the adolescents, handicapped children and
care for children in special settings.

OBJECTIVES OF MATERNAL AND CHILD HEALTH:

 To reduce maternal, infant, and childhood mortality and morbidity.

 To reduce perinatal and neonatal mortality and morbidity. \
 Promote satisfying and safe sex life.
 Regulate fertility so as to have wanted and healthy children when desired.
 Provide basic maternal and child health care to all mothers and children. 
 Promote and protect health of mothers. 
 To promote reproductive health.
 To promote physical and psychological health of adolescents and infants in the
family.

Issues related to MCH:

1. AGE: As maternal age advances, the result is increased rates of pregnancy loss and birth
of infants with chromosomal anomalies. Most women and women are aware that
advanced maternal age (older than 35 years) may affect a pregnancy adversely. This
awareness is the direct outcome of the adoption of practice standards that obligate
obstetricians, gynecologists, and women’s health. Nurses appropriately disseminate this
information and the considerable media exposure about this issue through public
service campaigns, news programs, and storyline s in popular entertainment. Conversely
the general public health care providers are less aware of that. Advanced paternal age
(older than 45 years at conception) unfavorably affects fetal growth and development.
People of advanced reproductive age require information about the possible outcomes
for a child conceived with their genetic gametes. The nurse should offer education and
counseling using incidence tables for chromosomal anomalies associated with advanced
maternal age and review characteristics of disorders that may occur through paternal
transmission of spontaneous new mutation as a result of advanced paternal age.
2. GENDER: In some societies there may be the discrimination between male and female
baby. If the mother is having a male baby the family will provide more care and
attention towards the mother and baby. And if the mother is having a female baby, the
family members will provide her less care and attention towards the mother and baby.
So the gender also influences the maternal and child health.
3. SEXUALITY: Both the client and her partner may express concerns about sexually and
intercourse during pregnancy. Although there is no reason why the healthy women need
abstein from intercourse or orgasm during pregnancy, some sources suggest that
women should avoid coitus and orgasm in the last four weeks of pregnancy. Regardless
of suggestions studies have found that the frequency of coitus decreases as pregnancy
progresses. Intercourse or orgasm is contraindicated in cases of known placenta previa,
or ruptured membranes. Nipple stimulation, vaginal penetration, or orgasm may cause
uterine contractions secondary to the release of prostaglandins and oxytocin. Therefore
women who are predisposed to preterm labour or threatened abortion may choose to
avoid intercourse. Development of sexuality is an important part of each person’s
psychological identity, integrated sense of self, reproductive capacity and ability to fulfill
role functions in society.
4. PSYCHOLOGICAL: Virtually all culture emphasizes the importance of maintaining a
psychological and agreeable environment for pregnant women. An absence of stress is
important in ensuring a successful outcome for the mother and baby. Harmony with
other people must be fostered, and visits for extended family members may be required
to demonstrate pleasant and no controversial relationships. If discord exists in a
relationship, it is usually dealt with a culturally prescribed ways. Certain environmental
factors such as emotional stress, anxiety, fears, frustrations, broken homes, poverty and
many others can lead to mental illness. The psychosocial environment at home or school
is an essential factor for health. Children exposed to happy and healthy homes make
them physically and mentally healthy. Other factors affecting the health status of
children including community and social support measures etc.
Pregnancy is the gestational process. Comprising the growth and development with a
woman of a new individual for conception through the embryonic and fetal periods to
birthing environment. However, an increasing amount of social science and midwifery
research has explored the issue of social support for child bearing women and the role
that the maternity services might play in offering or facilitating rather than
undetermining such support to women. Support must be individualized and tailored to
the women’s changing needs during labour. Emotional support includes physical
presence and words of affirmation, reassurance, encouragement and praise. Comfort
measures are any hands on activity aim at decreasing the physical discomfort (pain,
hunger, and thirst) of labour. Information and advice ensure that the women are aware
of what is happening and of techniques that may help her to cope.

5. SOCIOCULTURAL FACTOR: culture and family must be viewed simultaneously for,

regardless of the family type, it remains the basic unit of society and influences human
development or the life span. The older adults in these families often have significant roles
in health and childcare, household maintenance, and decision making. Multiple caretakers
are available to help with child rearing and discipline. Socialization is an early but family
functioning. Socialization includes all the learning experiences of early life. Home remedies
and folk care practices for prevention of illness, maintenance of health, and curative
purposes remain primary sources for most families, regardless of ethnic and cultural
backgrounds. Communication patterns are influenced by a family’s culture.religous beliefs
and practices are part of cultural and familier heritage and influence health care behaviors.
Within the neighborhood and community, health families tend to associate freely with
community groups and institutions to identify resources and receive services as needed by
them. The ability of the healthy family to seek health through contact with others appears
related in part to the family’s perception of itself as a part of a whole and to their successful
dealings with the larger community in meeting physical, psycho logic, and social
requirements. The value of the children varies greatly, depending on the meaning each
society attaches to children. Health values and beliefs are also important in understanding
reactions and behavior. If a culture views pregnancy as a sickness, certain behaviors can be
accepted, whereas if pregnancy is viewed as a natural occurrence, other behaviors may be
accepted. Prenatal care may not be a priority for women who view pregnancy as a natural
phenomenon. Many cultural variations in prenatal care exist. Some practices may conflict
with the beliefs and practices of a subculture group to which she belongs. Because of these
and other factors such as lack of transportation, and poor communication on the part of
health care providers, women from many such groups don’t participate in the prenatal care
system. Such behavior may be misinterpreted lifestyle factors.

6. LIFESTYLE PATTERN: Individual has a direct relationship to the lifestyle. It is nothing but
just a way of living. A person who has healthy practices of day to day living will remain
healthy. Those people who follow the healthy life styles are much healthier than those who
follow injurious lifestyles. The way of life of people in a community and their individual’s life
style also has a significant impact on life. Health is deeply related to lifestyle which includes
ways of living, personal hygiene, habits and behavior. A healthy lifestyle helps to promote
health and poor lifestyle has ill effects on health. Lifestyles are the most critical modifiable
factor influencing the health today. Lifestyle refers to a person’s general way of living,
including living conditions and individual patterns of behavior that are influenced by
sociocultural factors and personal characteristics. Life style choices may have positive or
negative effects on health. Practices that have potentially negative effects on health are
often referred as risk factors. E.g. Overeating, getting insufficient exercise, overweight are
closely related to incidence of heart diseases, diabetes and hypertension. Excessive use of
tobacco is clearly implicated in lung cancer, emphysema and cardiovascular diseases. These
lifestyle risk factors have gained increased attention because it is known that many of the
leading causes of death. This also presents a huge impact on the economics of the health
care system. Therefore it is important to understand the impact of lifestyle behaviors on
health status. Nurses can educate their clients and the public on wellness- promoting
lifestyle behavior.

Emerging Issues in Maternal and Child Health:

Recent efforts to address persistent disparities in maternal and child health have employed
a “life course” perspective to health promotion and disease prevention. At the start of the
decade, fewer than half of all pregnancies are planned. Unintended pregnancy is associated
with a host of public health concerns. In response, preconception health initiatives have
been aimed at improving the health of a woman before she becomes pregnant through a
variety of evidencebased interventions.

The life course perspective also supports the examination of quality of life, including the
challenges of male and female fertility. An estimated 7.3 million American women ages 15
to 44 have received infertility services (including counseling and diagnosis) in their lifetime.
Infertility is an area where health disparities are large, particularly among African American
women and may only continue to increase as childbearing practices change over time

SUMMARY

As we learned about introduction of MCH and epidemiological aspects of maternal and child
health, as well problems of both mother and child and causes and mortality morbidity ratio
by statistical phenomenon, issues of MCH can use our day today care practice to provide
productive work output.

CONCLUSION
Mother and child are one unit and most vulnerable to the morbidity and mortality. Hence it
is essential to protect them through appropriate action at each level. MCH epidemiology
programme emphasizes the analytical skills to address the health problems of the mothers
and children through surveillance, assessment, planning, implementation, monitoring and
evaluation. Nurse as team member of the health can contribute her skill for the promotion
of health of mother and children.

BIBLIOGRAPHY:

1. J B Sharma, “A text book of Midwifery And Gynaecological Nursing 1 st Eddition 2018

avichal publication company. Pge no :03, 06, & 08-11
2. DC Dutta, “Atext book of obstretrics including Perinatology and contraception, 6 th
Eddition 2004, New central Book Agency (P) LTD Page no: 599-608
3. https://www.slideshare .net
4. www.google .com