Maternal & Child Health / Reproductive Health Programs
1. What this chapter covers, and how NEET PG actually tests it
Questions here ask what a named scheme does, which age group it covers, or what a specific service package contains.
The organising principle is the continuum of care: every programme occupies one point in the life cycle, and a gap at any point undoes the work done at the others.
| Stage | Programmes |
|---|---|
| Pre-pregnancy | Family planning, adolescent nutrition |
| Pregnancy | Antenatal care, Pradhan Mantri Surakshit Matritva Abhiyan |
| Delivery | Janani Suraksha Yojana, Janani Shishu Suraksha Karyakram, LaQshya, SUMAN |
| Newborn | Home based newborn care, facility-based newborn care, kangaroo mother care |
| Childhood | Integrated management of neonatal and childhood illness, Rashtriya Bal Swasthya Karyakram |
| Adolescence | Rashtriya Kishor Swasthya Karyakram, weekly iron folic acid supplementation |
The whole set is now delivered under a single umbrella covering reproductive, maternal, newborn, child and adolescent health plus nutrition.
The umbrella exists precisely because the components used to be run separately, and a woman could receive excellent antenatal care and then deliver unattended, or a child could be immunised and remain undiagnosed for a congenital heart defect.
2. Antenatal care
2.1 The package
India's programme specifies a minimum of four antenatal visits, while the World Health Organization now recommends eight contacts, and Indian practice is moving toward the higher figure.
| Visit | Timing |
|---|---|
| First | Within 12 weeks, as soon as pregnancy is suspected |
| Second | 14 to 26 weeks |
| Third | 28 to 34 weeks |
| Fourth | 36 weeks to term |
Each visit includes weight, blood pressure, abdominal examination, fetal heart, haemoglobin, urine testing, and screening for syphilis and human immunodeficiency virus.
Iron and folic acid supplementation is 180 tablets during pregnancy and a further 180 in the postpartum period, each tablet containing 60 milligrams of elemental iron with 500 micrograms of folic acid.
Calcium supplementation of 500 milligrams twice daily is given from the second trimester to reduce pre-eclampsia risk.
Tetanus and adult diphtheria is given as two doses four weeks apart, or as a single booster if the woman was immunised within the preceding three years.
2.2 Reaching the high-risk pregnancy
Pradhan Mantri Surakshit Matritva Abhiyan provides free assured antenatal care by a specialist on the ninth day of every month.
The fixed-day approach exists because occasional specialist availability produced unpredictable attendance, whereas a known monthly date allows a woman to plan.
The extended version adds individual tracking of identified high-risk pregnancies, with financial incentives for the woman and for the accompanying community health worker across three additional visits, continuing until a safe delivery is achieved.
That shift from screening to tracking matters, because identifying a high-risk pregnancy achieves nothing if the woman is then lost to follow-up.
3. Delivery
Janani Suraksha Yojana is a conditional cash transfer introduced to shift deliveries from home to institutions, with the amount differentiated by state performance and by rural or urban residence.
Janani Shishu Suraksha Karyakram removed the remaining financial barrier, entitling every pregnant woman to free delivery including caesarean section, free drugs, diagnostics, diet, blood and transport, with the same entitlements for sick infants up to one year.
Cash transfer addressed the decision to come; free entitlements addressed the cost of having come, and the two together are what moved institutional delivery to close to ninety per cent.
SUMAN, launched in 2019, guarantees assured, dignified and respectful care at no cost with zero tolerance for denial of services, which addresses the quality and dignity gap that remained once access had improved.
LaQshya targets quality specifically in labour rooms and maternity operating theatres, because the intrapartum period concentrates both maternal and newborn mortality into a few hours.
3.1 Maternal death and its review
A maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by the pregnancy, but not from accidental or incidental causes.
Direct deaths result from obstetric complications of the pregnancy itself; indirect deaths result from pre-existing disease aggravated by pregnancy, such as rheumatic heart disease or severe anaemia.
A late maternal death occurs between 42 days and one year, and it is recorded separately rather than counted in the standard ratio.
| Leading direct causes in India |
|---|
| Haemorrhage, chiefly postpartum |
| Hypertensive disorders including eclampsia |
| Sepsis |
| Unsafe abortion |
| Obstructed labour |
Haemorrhage remains the single largest cause, which is why active management of the third stage of labour is the intervention with the greatest single effect on maternal mortality.
Maternal death surveillance and response requires every maternal death to be notified, reviewed and acted upon, whether it occurred in a facility or in the community.
The review is explicitly not a search for individual blame, because a blame-driven process leads simply to concealment, and a death that is hidden teaches nothing.
3.2 Safe abortion
Unsafe abortion remains an avoidable contributor to maternal mortality, and legal provision has been progressively widened to reduce it.
Termination is permitted on the advice of one registered medical practitioner up to twenty weeks and of two practitioners from twenty to twenty-four weeks for specified categories, including survivors of rape and women whose contraception failed.
Beyond twenty-four weeks, termination requires the approval of a state-level medical board and is confined to substantial fetal abnormality.
Contraceptive failure was extended from married women to any woman, which removed a provision that had forced unmarried women toward unsafe providers.
The identity of a woman undergoing termination must not be disclosed except to a person authorised by law, and this confidentiality provision exists to remove a major deterrent to seeking safe care.
4. Newborn care
4.1 Home based care
The community health worker visits the newborn on a fixed schedule: days 3, 7, 14, 21, 28 and 42 after an institutional delivery, with an additional visit on day 1 when the birth occurred at home.
Each visit weighs the baby, checks feeding, and looks for danger signs including poor feeding, lethargy, fever, hypothermia, fast breathing and chest indrawing.
Home based care of the young child extends the same principle with visits at 3, 6, 9, 12 and 15 months, focused on feeding, growth and development.
4.2 Facility based care
| Level | Facility | Function |
|---|---|---|
| Newborn care corner | Every delivery point | Resuscitation and immediate care |
| Newborn stabilisation unit | Community health centre | Stabilise before referral |
| Special newborn care unit | District hospital | Care of sick newborns, at least twelve beds |
The tiering exists because most newborn deaths occur in the first days, so a unit reachable within hours matters more than a distant tertiary centre.
Kangaroo mother care is continuous skin-to-skin contact with exclusive breastfeeding, used for low birth weight infants, and it reduces mortality, infection and hypothermia at essentially no cost.
Essential newborn care at every birth means warmth, cleanliness, initiation of breastfeeding within one hour, cord care and eye care, and delayed cord clamping.
Delayed cord clamping by one to three minutes transfers a substantial additional volume of blood to the infant and measurably reduces iron deficiency at six months, which links newborn practice directly to the anaemia programme.
The commonest causes of newborn death are prematurity with its complications, intrapartum events including birth asphyxia, and infection, and all three are addressed at the point of delivery rather than afterwards.
5. Child health
Integrated management of neonatal and childhood illness is the Indian adaptation of the global approach, and its distinguishing feature is that it includes the first two months of life, which the original did not.
It trains health workers to assess every sick child for a fixed set of danger signs rather than for a single presenting complaint, then to classify and treat by colour-coded severity.
The facility-based version extends the same algorithm into the hospital for children needing admission.
Diarrhoea is treated with low-osmolarity oral rehydration solution together with zinc for fourteen days, and the zinc is not a supplement but a treatment that shortens the episode and reduces recurrence for months.
Rashtriya Bal Swasthya Karyakram screens children from birth to eighteen years for the four Ds: defects at birth, deficiencies, diseases and developmental delays including disability.
It covers thirty conditions, uses mobile teams visiting anganwadi centres and schools, and links positive screens to free treatment at district early intervention centres.
Exclusive breastfeeding is recommended for six months with complementary feeding from six months alongside continued breastfeeding, and the national programme promoting it is Mothers' Absolute Affection.
5.1 The anganwadi platform
Integrated child development services deliver most nutrition and preschool interventions, and the anganwadi centre is the point at which they reach the village.
Six services are provided together: supplementary nutrition, immunisation, health check-up, referral services, nutrition and health education, and non-formal preschool education.
Three of the six are delivered in partnership with the health system rather than by the anganwadi worker alone, which is why coordination between the anganwadi worker, the auxiliary nurse midwife and the community health worker determines whether the platform functions.
Beneficiaries are children under six years, pregnant women and lactating mothers, with adolescent girls included in specified components.
Growth monitoring uses the mother and child protection card, which plots weight against the World Health Organization growth standards and is held by the family rather than the facility.
Holding the record with the family matters, because a card kept at a facility is unavailable at exactly the moment a sick child presents somewhere else.
6. Adolescent health
Rashtriya Kishor Swasthya Karyakram covers the ten to nineteen age group and was a genuine departure, because adolescents had previously been served only incidentally through school and maternal programmes.
It addresses six areas: nutrition, sexual and reproductive health, non-communicable diseases, substance misuse, injuries and violence, and mental health.
Delivery is through adolescent friendly health clinics and through trained peer educators, on the reasoning that adolescents will discuss sexual health and substance use with a peer long before they will with a clinician.
Weekly iron and folic acid supplementation targets adolescent anaemia, using a weekly rather than daily schedule because weekly dosing achieves comparable haemoglobin response with far better adherence.
6.1 Anaemia Mukt Bharat
The national anaemia programme uses a six-by-six-by-six structure: six beneficiary groups, six interventions and six institutional mechanisms.
| Beneficiary groups |
|---|
| Children 6 to 59 months |
| Children 5 to 9 years |
| Adolescents 10 to 19 years |
| Women of reproductive age |
| Pregnant women |
| Lactating women |
The six interventions are prophylactic iron and folic acid, deworming, behaviour change toward diet and delayed cord clamping, testing and treatment, mandatory provision in the public health system, and addressing non-nutritional causes such as malaria and haemoglobinopathies in endemic areas.
The target is a reduction of three percentage points in anaemia prevalence each year, and it has not been met, with the fifth National Family Health Survey recording a worsening rather than an improvement.
That failure is instructive: anaemia has multiple simultaneous causes, and a supplementation-led programme cannot fix a problem driven equally by diet, infection and repeated pregnancy.
7. Targets
| Target | Value | Deadline |
|---|---|---|
| Sustainable Development Goal maternal mortality | Below 70 per 100,000 | 2030 |
| Sustainable Development Goal neonatal mortality | 12 or fewer per 1000 | 2030 |
| Sustainable Development Goal under-five mortality | 25 or fewer per 1000 | 2030 |
India has already met the under-five target nationally and is close on neonatal mortality, while maternal mortality at 88 requires a further substantial fall.
The national picture conceals wide state variation, and several states have already achieved all three targets while others remain far behind, which is why programme effort is now concentrated in specified high-priority districts.
Concentrating effort geographically is defensible arithmetically as well as ethically, because a national average improves fastest when the worst-performing districts improve, not when the best ones improve further.
The national health policy sets its own domestic targets alongside the international ones, covering maternal, infant and under-five mortality together with total fertility, and these are the figures against which state programme implementation plans are assessed.
Judging a programme requires separating three different questions: whether the service was delivered, whether it reached the people who needed it most, and whether the health indicator actually moved.
A programme can score well on the first and badly on the second, which is the usual pattern when coverage is measured as a state average rather than by district or by wealth quintile.
That distinction between coverage and equity is what the current generation of programme evaluation is built around, and it is why survey data disaggregated by district and by social group has become as important as the national figure.
8. Worked examples
Example 1. A child with acute watery diarrhoea is prescribed oral rehydration solution alone. What is missing?
Zinc, given for fourteen days. It shortens the current episode and reduces the incidence of further episodes for two to three months, and omitting it is one of the commonest departures from protocol.
Example 2. A woman delivers at home. On which days should the community health worker visit?
Days 1, 3, 7, 14, 21, 28 and 42. The day 1 visit is added specifically for home deliveries, because an institutional birth already provides observation during the first day.
Example 3. Which programme screens a five-year-old for a congenital heart defect, and what else does it cover?
Rashtriya Bal Swasthya Karyakram, which screens birth to eighteen years for defects at birth, deficiencies, diseases and developmental delays, covering thirty conditions and linking positive screens to free treatment.
Summary
Place every programme on the continuum of care, because each exists to close a gap at one point in the life cycle.
The reproductive, maternal, newborn, child and adolescent health plus nutrition umbrella exists because separate programmes left gaps between them.
India specifies a minimum of four antenatal visits while the World Health Organization recommends eight contacts.
Iron and folic acid is 180 tablets in pregnancy and 180 postpartum, at 60 milligrams elemental iron with 500 micrograms folic acid.
Calcium 500 milligrams twice daily from the second trimester reduces pre-eclampsia risk.
Tetanus and adult diphtheria is two doses four weeks apart, or one booster if immunised within three years.
Pradhan Mantri Surakshit Matritva Abhiyan gives free specialist antenatal care on the ninth of every month.
The extended version tracks identified high-risk pregnancies individually until safe delivery, with incentives.
Janani Suraksha Yojana is a conditional cash transfer; Janani Shishu Suraksha Karyakram makes delivery and newborn care free.
SUMAN guarantees dignified respectful care with zero tolerance for denial of services.
LaQshya targets quality in labour rooms and maternity theatres, where mortality concentrates.
Home based newborn care visits are on days 3, 7, 14, 21, 28 and 42, with day 1 added for home births.
Newborn care corners sit at every delivery point, stabilisation units at community health centres, and special newborn care units at district hospitals.
Kangaroo mother care is skin-to-skin contact with exclusive breastfeeding for low birth weight infants.
The Indian adaptation of integrated management of childhood illness added the first two months of life.
Diarrhoea is treated with low-osmolarity oral rehydration solution plus zinc for fourteen days.
Rashtriya Bal Swasthya Karyakram screens birth to eighteen years for defects, deficiencies, diseases and developmental delays.
Rashtriya Kishor Swasthya Karyakram covers ten to nineteen years across six areas, using peer educators.
Weekly rather than daily iron dosing is used in adolescents because adherence is far better.
Anaemia Mukt Bharat is a six-by-six-by-six strategy targeting a three percentage point annual reduction, which has not been achieved.
Sustainable Development Goal targets are maternal mortality below 70, neonatal mortality at 12 and under-five mortality at 25 by 2030.
A maternal death is one during pregnancy or within 42 days of its termination from a related cause; beyond that and up to a year it is a late maternal death.
Direct deaths arise from obstetric complications and indirect deaths from pre-existing disease aggravated by pregnancy.
Haemorrhage is the largest single cause, so active management of the third stage has the greatest single effect on maternal mortality.
Maternal death review is deliberately blame-free, because a blame-driven process produces concealment rather than learning.
Termination is permitted up to twenty weeks on one practitioner's advice, to twenty-four on two for specified categories, and beyond that only by medical board for substantial fetal abnormality.
Integrated child development services deliver six components through the anganwadi centre, three of them jointly with the health system.
The mother and child protection card is held by the family, so that the growth record travels with the child.
