MATERNAL, CHILD & ADOLESCENT HEALTH SERVICES

AO 2008 -0029
 “Implementing Health Reforms for the Rapid reduction of Maternal and Neonatal Mortality”

MNCHN Strategy
 guides the development, implementation and monitoring or evaluation of various government programs aimed
at improving the health of women, mothers, and children, with the goal of rapidly reducing maternal and
neonatal mortality in the country.

The Maternal, Newborn, and Child Health & Nutrition (MNCHN) Strategy Ensures the following Results
1. Every pregnancy is wanted, planned and supported.
2. Every pregnancy is adequately managed throughout its course.
3. Every delivery is facility-based and managed by skilled birth attendants or skilled health professionals.
4. Every mother-and-newborn pair secures proper postpartum and newborn care with smooth transition to the
women’s health care package for the mother and child survival package for the newborn.

WOMEN’S HEALTH AND SAFE MOTHERHOOD PROJECT 2 (WHSMP2)

 shifted the emphasis from identifying and treating high-risk pregnancies to preparing all women for potential
obstetric complications
 aimed to strengthen the ability of the health system to deliver a package of interventions, including maternal
care, family planning, control of sexually transmitted infections, and adolescent health services – with a priority
on serving disadvantaged women.

SAFE MOTHERHOOD PROGRAM

 encompasses a series of initiatives, practices, protocols, and service delivery guidelines designed to ensure that
women receive high quality gynecological family planning, prenatal, delivery and postpartum care to achieve
optimal health for the mother, fetus, and infant during pregnancy, childbirth and postpartum.

Safe Motherhood Program Change in Design of Services

1. Shift in handling pregnant clients from risk approach to preparing all pregnant women for the complications at
childbirth.
RULE : there is no such thing as low or high-risk pregnant women, instead, all women are considered at risk for
pregnancy and complications
2. Improved quality of Family Planning counselling and expanded service availability of postpartum family planning in
hospitals and primary birthing centers; and
3. The integration of cervical cancer, syphilis, hepatitis B, and HIV screening among others into the antenatal care
protocols.

SUPPORT SYSTEMS FOR MATERNAL-NEWBORN SERVICE DELIVERY

 Anchored on PhilHealth accreditation of birthing centers and individual membership or enrolment into the
Sponsored Program.
 ensures sustainable financing of quality maternal-newborn services efficiently eliminating out-of-pocket
expenditures for antenatal, facility delivery and postnatal care.

RELATED LAWS AND POLICIES

1. AO 2018-0014 – “Strategic Framework and Implementing Guidelines for FOURmula OnePlus for Health (F1+)”
 aligned health initiatives into Four Strategic Pillars:
 a. Financing,
b. Regulation,
c. Service Delivery, and
d. Governance
2. RA No. 10354 – “Responsible Parenthood and Reproductive Health Act of 2012”
3. RA No. 11148 – The “Kalusugan at Nutrisyonng Mag-Nanay Act”
 National and Local health nutrition programs for pregnant and lactating women, adolescent girls, infants, and
young children in the first 1,000 days.
4. RA No. 11210 – The “105-Day Expanded Maternity Leave Law”
5. AO 2016-0035 –The National Policy on the Provision of Quality Antenatal Care in Birthing Centers and Health
Facilities Providing Maternal Care Services.
6. RA No. 10028 – “Expanded Breastfeeding Promotion Act of 2009”

MNCHN SERVICE DELIVERY NETWORK

 refers to the network of facilities and provider within the province-wide or city-wide health system offering the
MNCHN core package of services in an integrated and coordinated manner.
1. Community Level Service Providers or Community Health Team (CHT)
 comprise of out-patient departments, BHSs, RHUs, and private clinics which are manned by community health
volunteers and led by a midwife.
2. BEmONC-capable Facility (Basic Emergency Obstetric and Newborn Care)
 maybe a BHS, lying-in, or birthing home that provides the parenteral administration of oxytocin (3rd stage),
loading anticonvulsant, initial dose of antibiotic, assisted imminent breech deliveries, removal or=f retained
products and placenta, and emergency newborn interventions such as resuscitation, sepsis, and oxygen
treatment
3. CEmONC-capable facilities (Comprehensive Emergency Obstetrics andNewborn Care)
 provide all services rendered in BEmONC facilities with the addition of cesarean section, blood banking and
transfusion, highly specialized obstetric intervention, management of low birth weight and preterm babies, and
other newborn specialized services.

MNCHN PACKAGE OF SERVICES

I. REPRODUCTIVE HEALTH & RESPONSIBLE PARENTHOOD
 REPRODUCTIVE HEALTH
- is the sate of complete physical, mental, and social well-being and not merely the absence of infirmity in all
matters relating to reproductive health and to its functions and processes, (WHO, 2008).
 RESPONSIBLE PARENTHOOD
- refers to the will and ability of a parent to respond to the needs and aspirations of the family and children
 R.A. 10354 - “Responsible Parenthood and Reproductive Health Act of 2012” (RPRH) Law

13 SEXUAL REPRODUCTIVE HEALTH RIGHTS

1. The Right to Life
2. The Right to Liberty and Security of the Person
3. The Right to Equality, and to be free from all Forms of Discrimination
4. The Right to Privacy
5. The Right to Freedom of Thought
6. The Right to Information and Education
7. The Right to Choose Whether or Not to Marry and to Find and Plan a Family
8. The Right to Decide Whether or When to Have Children
9. The Right to Health Care and Health Protection
10. The Right to the Benefits of Scientific Progress
11. The Right to Freedom of Assembly and Political Participation
12. The Right to be Free from Torture and Ill Treatment
13. The Right to development

FAMILY PLANNING
 refers to a program which enables couples and individuals to decide freely and responsibly the number and
spacing of their children and to have the information and means to do so, and to have access to a full range of
safe, affordable, effective, nonabortifacient modern natural and artificial method of planning pregnancy.

FOUR PILLARS OF FAMILY PLANNING

1. Responsible Parenthood
2. Child spacing
3. Respect for life
4. Informed choice

II. MATERNAL-NEWBORN HEALTH

A. PREPREGNANCY PACKAGE
1. Micronutrient Supplementation
2. Iron & Folate: 60mg elemental iron with 400 microgram folic acid tablet daily for 3-6 months
3. Iodized oil capsule with 200mg iodine 1 capsule for 1 year (women ages 15 – 45)
4. Promotion of the use of iodized salt
5. 5. Nutrition counseling
6. Promotion of healthy lifestyle including advice to smoking cessation, healthy diet, regular exercise and moderation of
alcohol intake.
7. Advice on family planning and provision of family planning services.
8. Prevention and management of life-style related diseases like diabetes and cardiovascular diseases.
9. Counseling, prevention, and management of infection including STIs and HIV/AIDS,
10. Adolescent health services.
11. Deworming women of reproductive age to reduce other causes of iron deficiency anemia.
12. Provision of oral health services.

B. ANTENATAL CARE SERVICES (First 270 Days)

1. Pregnancy Tracking and Enrollment to Antenatal Care
 Antenatal Care (ANC) – the care provided by skilled health professionals to pregnant women and adolescent
girls to ensure the best health conditions for both mother and baby during pregnancy.
- it helps reduce maternal and perinatal morbidity and mortality directly, through detection and treatment of
pregnancy-related complications and indirectly through the identification of women ad girls at increased risk of
developing complications during labor and delivery
- ensures referral to an appropriate level of care

Components of ANC
 risk identification
 prevention and management of pregnancy-related or concurrent diseases
 health education and health promotion

AO 2016-0035 – “The National Policy on the Provision of Quality Antenatal Care in Birthing Centers and Health facilities
Providing Maternal Care Services”
Role of the BHW in ANC
 tracking of pregnancies in the community
 assist pregnant women in developin birth plans
 help families facilitate access to critical health services

“Bantay Buntis” – a practice at the regional level by organized communities with indigenous people, ensure pregnant
women avail of professional assistance throughout pregnancy, delivery and postpartum
- the service extends to ensuring the provision of basic health services to newborns up to their childhood

DOH Recommende Prenatal (ANC) Visits in the Country

Prenatal Visits Period of Pregnancy
st
1 Visit As early as possible
2nd Visit 2nd Trimester
rd
3 Visit 3rd Trimester
th
4 Visit After 8th month until delivery – every 2 weeks

Activities During the Prenatal Visit

a. Health History – done to determine obstetric profile like the Gravida, Parity, Term, Preterm, Abortion, and Living
(GPTPAL), Expected Date of Confinement (EDC), and Age of Gestation (AOG) and potential risk factors:
 Age below 18 years old or above 35 years old
 Height less than 45 cm or 4’9”
 Multiparous women (having a fourth or more baby)
 one or more of the following: a previous cesarean section, 3 consecutive miscarriages or stillborn baby,
and/or postpartum hemorrhage
 one or more of the following medical conditions: tuberculosis, heart disease, diabetes, bronchial asthma
or goiter
b. Prenatal Assessment
 Physical examination ; GPTPAL, EDC, AOG, weight and height, fundic height measurement, Leopold’s
maneuver, fetl heart bat and fetal movement
 laboratory examinations : CBC with platelet, blood typing and Rh factor determination, urinalysis
(Bendict’s sugar and acetic acid tests – albumin), screening test for STI’s, blood sugar screening (FBS,
OGTT, HbA1c), pregnancy test, ultrasound, cervical cancer screening using acetic acid wash, and
Papanicolau Smear (PAPSmear)
Identify the danger signs of pregnancy and instruct to seek medical attention as soon as possible
 headache
 blurring of vision
 dangerous fever (Temp above or equal to 38C)
 severe difficulty of breathing
 abdominal pain
 vaginal bleeding
c. Birth Preparation and Emergency Plans
- focuses on promoting birth planning and facility-based delivery

Basic Contents of the Birth Plan

 place of delivery and method of transportation
 person or personnel to assist her during delivery
 expectations during labor and delivery
  materials to prepare and estimated cost of delivery
 possible blood donors and where the mother will be referred in case of emergency
2. Diphtheria Tetanus Toxoid Immunization
- a mother who received the complete five (5) doses of diphtheria tetanus is called a Fully Immunized Mother
3. Consumption of Iodized Salt
4. Micronutrient and Macronutrient Supplementation
- focus on addressing nutrient deficiencies: iron deficiency anemia, vitamin A deficiency, iodine deficiency
disorder, and macronutrient deficiencies

Iron deficiency Anemia – risk factor for neural tube defect such as spina bifida and anencephaly
- prevented through ingestion of both supplemental iron and folic acid with vitamin C rich food ; natural
sources of iron: red meat, liver, and green leafy vegetables
S/E of Iron: teeth and stool discoloration

Recommended dose of Iron and Folate Acid Supplementation

Pregnant Women 60mg elemental Iron with 400mcg folic acid 1 tab/day for 6 months or 2 tabs/day if
prenatal consultation starts on the 2nd
or 3rd trimester of pregnancy
Lactating Women 60mg elemental Iron with 400mcg folic acid 1 tab/day for 3 months or 90 days

Vitamin A Deficiency – Vitamin A supplementation must be started at the 2nd trimester until postpartal period
- Vit. A is not given at the first trimester since it is a teratogen

Recommended dose of Vitamin A Supplementation

Pregnant Women 10,000 IU 1 cap 2X/week (4 months until delivery)
Postpartum Women 200,000 IU 1 cap once after delivery (may be given within 4 weeks)

Iodine Deficiency Disorder – may lead to congenital hypothyroidism and cretinism

Recommended dose of Iodine Supplementation

Children of School Age 200 mg of Iodized oil capsule 1 cap per year
Women 15 – 25 years old 200 mg of Iodized oil capsule 1 cap per year
Adult Males 200 mg of Iodized oil capsule 1 cap per year

Macronutrient Deficiencies
- Calcium supplementation is recommended for the prevention of preeclampsia in pregnant women,
particularly those at risk of developing hypertension
- taken at mealtime from 20 weeks gestation until the end of pregnancy

Recommended dose of Calcium Supplementation

Pregnant Women 1.0 – 2.0 g elemental calcium three divided doses

5. Early Identification and Management of Nutritionally at – Risk Pregnant Client

- different anthropometric measurements are evaluated among patients:
 weight-for-age
 height-for-age
 BMI
 mid-upper arm circumference
  skin fold thickness
6. Counselling on Maternal Nutrition, breastfeeding and rooming-in, appropriate infant and young child feeding
practices.
7. Assessment of risk for parasitism and provision of anti-helminthic medicines
8. Provision of oral health services including oral health assessment
9. Counselling on proper handwashing, environmental sanitation and personal hygiene
10. Counselling on nutrition, smoking cessation and adoption of healthy lifestyle practices
11. PhilHealth Insurance enrollment and linkages to facility and community-based health and nutrition workers and
volunteers
12. Social welfare support
3. Maternity protection during pregnancy
14. Counselling and support to parents and caregivers on parent/caregiver-infant/child interaction
15. Provision of counselling and psychosocial support to parents and caregivers

C. INTRAPARTAL SERVICES
 The DOH advocate facility-based delivery to ensure safe labor, availability of intrapartum interventions and to
safeguard the welfare of women and newborns.
 The establishment of a network of public and private healthcare providers of emergency obstetric and newborn
care is integral to safe intrapartum interventions.
 These networks are centers capable of providing BEmONC and a referral hospital that can provide CEmONC.
 A BEmONC must be reached within 30 minutes from home using the most common mode of transportation
while a CEmONC should be reached within an hour from each BEmONC –capable facility.
NOTE: For Intrapartal services, please refer to your EINC lectures.

D. POSTPARTAL SERVICES
1. Postpartum Visit
1st Visit – within 24 hours
2nd Visit – within one week after delivery

Postpartum Assessment
 breast – engorgement, inverted nipples
 uterus – involution, contracted
 bladder – void within 4 – 6 hours
 bowel – may be given laxative especially if with deep laceration
 lochia – rubra, serosa, alba
 episiotomy
 Homan’s Sign – (+) calf pain – deep vein thrombosis
 Emotion : Taking-in, Taking-Hold, Letting-go

2. Micronutrient Supplementation – Vitamin A, Iron and Folate

3. Birth Registration
4. Lactation Support and Counselling from birth up to 2 years and beyond
5. Nutrition assessment and counselling to meet the demands of lactation in health facilities and workplace
6. Identification and management of malnutrition of chronically energy deficient (CED) and nutritionally-at-risk
postpartum and lactating women and provision of Ready to Use Supplementary Food (RUSF) in addition to dietary
supplement as appropriate
7. Organization of community-based mother support groups and peer counsellors for breastfeeding in cooperation
with other health and nutrition workers
8. Lactation breaks for women in workplaces including micro, small and medium enterprises
9. Availability of lactation stations in workplaces both in government and in the private sector, informal economy
workplaces, and in public places and public means of transportation as stipulated in RA No. 10028
10. Organization of breastfeeding support groups in workplaces, in cooperation with occupational health workers and
human resource managers trained in lactation management for the workplace
11. Provision of micronutrient supplements as deemed necessary
12. Promotion of the consumption of iodized salt and foods fortified with micronutrients deemed necessary
13. Provision of oral health services
14. Counselling on and utilization of modern methods of family planning and access to reproductive health care
services
15. Social welfare support to improve access to health and nutrition services
16. Assurance of women-friendly and child-friendly spaces where mothers and their infants will be able to continue
breastfeeding during calamities, disasters and other emergencies
17. Provision of support to fathers and caregivers to ensure their commitment to support the mother and the child on
proper health and nutrition care and provide necessary counselling and positive parenting support interventions
18. Counselling and support to parents and caregivers on parent/caregiver-infant/child interaction for responsible care,
and early stimulation for early childhood and development

E. BIRTH AND NEWBORN SERVICES (TWENTY-EIGHT DAYS)

 RA 8980 – also known as the “Early Childhood Care Development”
- refers to the full range of health, nutrition, education and social services programs that provide for the holistic
needs of young children from birth to 6 years of age, to promote their optimum growth and development
 AO 2005-0014 - National Policies on Infant and Young Child Feeding
Early initiation of breastfeeding
Exclusive breastfeeding for the first 6 months
Extended breastfeeding for 2 years and beyond
Appropriate complementary feeding
Micronutrient supplementation
Universal Salt Iodization
Food Fortification