Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition

Improving the maternal and child health and their survival are central to the
achievement of national health goals under the National Health Mission (NHM). SDG
Goal 3 also includes the focus on reducing maternal, newborn and child mortality.

Government of India’s “Call to Action (CAT) Summit” in February, 2013, the Ministry
of Health & Family Welfare launched Reproductive, Maternal, Newborn, Child,
Adolescent Health and Nutrition (RMNCAH+N) to influence the key interventions for
reducing maternal and child morbidity and mortality.

The RMNCAH+N strategy is built upon the continuum of care concept-

Key features of RMNCAH+N Strategy:

The RMNCAH+N strategy approaches include:

o Health systems strengthening (HSS) focusing on infrastructure, human

resources, supply chain management, and referral transport measures.

o Prioritization of high-impact interventions for various lifecycle stages.

o Increasing effectiveness of investments by prioritizing geographical areas based

on evidence.

o Integrated monitoring and accountability through good governance, use of

available data sets, community involvement, and steps to address grievance.

o Broad-based collaboration and partnerships with ministries, departments,

development partners, civil society, and other stakeholders.
NUTRITION
Nutrition is fundamental to human health and development and child malnutrition is
a public health problem with major consequences for child survival, damaging the
cognitive and physical development of children and the economic productivity of
individuals and societies.

Malnutrition in children is represented by under-nutrition, characterized by stunting,

wasting, underweight, micronutrient deficiencies including iron deficiency anemia as
well as over-nutrition manifested as over-weight and obesity.
1. ANEMIA MUKT BHARAT (AMB): AMB launched in 2018 ,is implemented to
reduce the prevalence of anemia among children, adolescents and women in
life cycle approach.
 2. NATIONAL DEWORMING DAY (NDD): To reduce the soil transmitted helminth
(STH) infestation among children and adolescents (1-19 years) in the country,
albendazole tablets are administered in a single fixed day approach via schools
and anganwadi centres in two rounds (February and August) under National
Deworming programme
3. MOTHER’S ABSOLUTE AFFECTION(MAA): MAA programme focuses on
promotion of optimum Infant and Young Child Feeding (IYCF) practices including
early initiation of breastfeeding within one hour (EIBF), exclusive breastfeeding
up to six months, age appropriate and adequate complementary feeding after
six months and continuation of breastfeeding for two years
4. LACTATION MANAGEMENT CENTRES (LMC): LMCs are established at high
delivery load facilities to provide comprehensive support for lactation
management and ensure availability of safe pasteurized donor human milk
and/or expressed mother’s own breast milk suitable for feeding sick, preterm
and low birth weight babies.
5. NUTRITION REHABILITATION CENTERS (NRCs): NRCs are facility-based
interventions to provide medical treatment and nutritional management to
under-five year children suffering from Severe Acute Malnutrition (SAM) with
medical complications. adequate and appropriate feeding for children; on
improving the skills of mothers and caregivers on complete age-appropriate
caring and feeding practices and Counselling and support to mothers is
provided for identifying the nutrition and health problems in child.
6. VITAMIN A SUPPLEMENTATION: Under Vitamin-A Supplementation
programme, all children below five years of age (9-59 months) are given
Vitamin-A supplementation bi-annually.

ADOLESCENT HEALTH
There are 253 million adolescents in the age group 10-19 years in India. This age
group comprises of individuals in a transient phase of life requiring nutrition,
education, counselling and guidance to ensure their development into healthy adults.

1. Adolescent Reproductive and Sexual Healthprogramme (ARSH ): Adolescent

Reproductive and Sexual Health programme
a.Adolescent Friendly Health Clinics (AFHC ): Through Adolescent Friendly
Health Clinics, routine check-up
at primary, secondary and tertiary levels of care is provided on fixed day clinics

b. Facility based counselling services: Counselling services for adolescents on

important issues such as nutrition, puberty, RTI/STI prevention and
contraception, delaying marriage and childbearing, and concerns related to
contraception, abortion services, pre-marital concerns, substance misuse, sexual
abuse and mental health problems are being provided

c. Outreach activities: Outreach activities are being conducted in schools,

colleges, teen clubs, vocational training centres, during Village Health Nutrition
Day (VHND), health melas and in collaboration with self help groups to provide
adequate and appropriate information to adolescents in spaces where they
normally congregate

2. Menstrual Hygiene Scheme: promotion of menstrual hygiene among

adolescent girls in the age group of 10-19 years in rural
areas. This programme aims at ensuring that girls have adequate knowledge and
information about menstrual hygiene and have access to high quality sanitary
napkins along with safe disposal mechanisms.

3. Rashtriya Kishor Swasthya Karyakram (RKSK)- launched on 7th January

2014 to reach out to 253 million adolescents - male and female, rural and
urban, married and unmarried, in and out-of-school adolescents with special
focus on marginalized and undeserved groups .

The programme expands the scope of adolescent health programming in India -

from being limited to sexual and reproductive health, it now includes in its
ambit nutrition, injuries and violence (including gender based violence), non-
communicable diseases, mental health and substance misuse.

4. School Health & Wellness Programme- School Health & Wellness

Programme (launched in Feb 2020) is being implemented in government and
government aided schools in districts (including aspirational districts). Two
teachers, preferably one male and one female, in every school, designated as
“Health and Wellness Ambassadors” shall be trained to transact with school
children, health promotion and disease prevention information on 11 thematic
areas in the form of interesting joyful interactive activities for one hour every
week.
2.

NEWBORN AND CHILD HEALTH

In India, an estimated 26 millions of children are born every year. As per Census 2011,
the share of children (0-6 years) accounts 13% of the total population in the Country.

It is now well recognized that child survival cannot be addressed in isolation as it is

intricately linked to the health of the mother, which is further determined by her
health and development as an adolescent.

As per Cause of Death Statistics 2017-19 released by Office of the Registrar General &
Census Commissioner, India; major causes of child mortality in India are - Prematurity
& low birth weight (31.2%), Pneumonia (17.5%), Birth asphyxia & birth trauma (9.9%),
Other non-communicable diseases (9.6%), Diarrheal diseases (5.8%), Congenital
anomalies (5.7%), Injuries (4.9%), Ill-defined or cause unknown (4.3%), Fever of
unknown origin (4.1%), Acute bacterial sepsis and severe infections (3.8%) and All
other remaining causes (3.3%).

As per Cause of Death Statistics 2017-19 released by Office of the Registrar General &
Census Commissioner, India; major causes of new-borns deaths in India are
Prematurity & low birth weight (45.5%), Birth asphyxia & birth trauma (15.1%),
Neonatal Pneumonia (12.6%),

1. Facility Based Newborn and Child Care :Neonatal mortality is one of the major
contributors (2/3) to the Infant Mortality. Setting up of facilities for care of Sick
Newborn such as Special New Born Care Units (SNCUs), New Born Stabilization
Units (NBSUs) and New Born Baby Corners (NBCCs) at different levels is a thrust
area under NHM.
a. Special Newborn Care Units (SNCU)
States have been asked to set up at least one SNCU in each district. SNCU
is 12-20 bedded unit and requires 4 trained doctors and 10-12 nurses for
round the clock services. The minimum recommended number of beds
for and SNCU at all the district hospital is 12. However, if the district
hospital conducts more than 3000 deliveries per year, 4 beds should be
added for each 1000 additional deliveries.
b. Newborn Stabilization units (NBSUs)
NBSUs are established at community health centres /FRUs. These are 4
bedded units with trained doctors and nurses for stabilization of sick
newborns.
 c. New Born Care Corners (NBCCs)
These are 1 bedded facility attached to the labour room and Operation
Theatre (OT) for provision of essential newborn care. NBCC at each facility
where deliveries are taking place should be established. equipments like
radiant warmers, suction machines, self-inflating bag/AMBU bag including
masks of size 0 &1, Oxygen availability etc
2. Kangaroo Mother Care (KMC) is a simple method of care for low birth weight
infants that includes early and prolonged skin-to-skin contact with the mother
(or a substitute caregiver) and exclusive and frequent breastfeeding. KMC
satisfies all five senses of the infant. The infant feels the mother’s warmth
through skin-to-skin contact (touch), listens to her voice and heartbeat
(hearing), sucks breast milk (taste) has eye contact with her (vision) and smells
her odour (olfaction).
Minimum duration of a KMC session should be one hour because frequent
handling may be stressful for the infant. The duration of each KMC session
should be gradually increased for as long as the mother can comfortably
provide KMC.
3. Mother Newborn Care Unit (MNCU): A separate Step down/ KMC unit which is
existing in many units as per the existing guidelines can now be upgraded and
named as mother newborn care unit (MNCU) which will be an ideal available
space to keep the mother- baby dyad together to fulfill the following objectives:
a. Decongesting SNCU of newborns who do not require intensive care but
need observational care for their medical conditions.
b. Making provisions (Bed, diet and treatment) for the mothers of SNCU
admissions.
c. NO newborn deserving admission in SNCU will be shifted to the MNCU
4. Janani Shishu Suraksha Karyakram (JSSK): was launched on 1st June 2011and
has provision for both pregnant women and sick new born till 1 year after birth
are
a. Free and zero expense treatment,
b. Free drugs and consumables,
c. Free diagnostics & Diet,
d. Free provision of blood,
e. Free transport from home to health institutions,
f. Free transport between facilities in case of referral,
g. Drop back from institutions to home,
 h. Exemption from all kinds of user charges.
5. RBSK-Rashtriya Bal Swasthya Karyakram: This program involves screening of
children from birth to 18 years of age for four ds- defects at birth, diseases,
deficiencies and development delays, spanning 32 common health conditions
for early detection and free treatment and management, including surgeries at
tertiary level.
The program also offers flexibility to States to utilize services of private
empanelled hospitals which have entered MoU with the States governments to
provide treatment for conditions like cardiac cases, congenital defects
treatments, thereby ensuring provision of timely care to children.
To facilitate screening of children, there is a strong convergence with the
a. Screening children the age group 0 – 6 years enrolled at Anganwadi
centres
b. children enrolled in Government and Government aided schools.
c. newborns are screened for birth defects in health facilities by the doctors
at health facilities and during the home visit by ASHA
d. District Early Intervention Centres, with multitude of services offering
developmentally supportive care are being made operational at the
district level for follow-up management of referred and treated cases.
6. Integrated Management of Neonatal & Childhood Illnesses (IMNCI) and (F-
IMNCI)- The extent of childhood morbidity and mortality caused by diarrhoea,
AR1, malaria, measles and malnutrition is substantial. Most sick children
present with signs and symptoms of more than one of these conditions. This
overlap means that a single diagnosis may not be possible or appropriate, and
treatment may be complicated by the need to combine for several conditions.
An integrated approach to manage sick children is, therefore, necessary.

IMNCI includes Pre-service and In-service training of providers, improving

health systems (e.g. facility up-gradation, availability of logistics, referral
systems), Community and Family level care.

F-IMNCI is the integration of the Facility based Care package with the IMNCI
package, to empower the Health personnel with the skills to manage new born
and childhood illness at the community level as well as at the facility. This
training is being imparted to Medical officers, Staff nurses and ANMs at
 CHC/FRUs and 24x7 PHCs where deliveries are taking place. The training is for
11 days.

7. HOME BASED NEWBORN CARE (HBNC) : A new scheme in 2011 has been
launched to incentivize ASHA for providing Home Based Newborn Care. ASHA
will make visits to all newborns according to specified schedule up to 42 days of
life. The proposed incentive is Rs. 50 per home visit of around one hour
duration, amounting to a total of Rs. 250 for five visits.

Six visits in the case of institutional delivery - Day 3, 7,14, 21, 28, and 42.
Seven visits in the case of home delivery (Day 1, 3, 7,14, 21, 28 and 42).
In cases of C- section delivery, five visits starting from Day 7, 14, 21, 28, 42

Works to be done by ASHA under HBNC

a. recording of weight of the newborn in MCP card
b. ensuring BCG, 1st dose of OPV and DPT vaccination
c. both the mother and the newborn are safe till 42 days of the delivery, and
d. registration of birth has been done
8. Home based care for young child (HBYC): Under National Health Mission,
MoHFW, GOI in 2018 has rolled out Home-Based Care for Young Child (HBYC)
Programme as an extension of the Home Based New Born Care (HBNC)
programme to promote evidence based interventions delivered in four key
domains namely nutrition, health, childhood development and WASH (Water,
Sanitation and Hygiene).

The additional five home visits will be carried out by ASHA with support from
Anganwadi workers. ASHA will provide home visits on 3rd, 6th, 9th, 12th and
15th months to promote early initiation of breast feeding, exclusive breast
feeding till 6 months and continued breast feeding till 2nd year of life along with
adequate complementary feeding, prevention of childhood Pneumonia and
Diarrhoea and to ensure age-appropriate immunization and early childhood
development. ASHAs will be provided incentive of Rs. 250 for completion of 5
home visits under HBYC for each young child (Rs. 50 per visit)

9. Strengthening Facility based Paediatric Care:

The vision for paediatric care at District Hospital is to set up a comprehensive
unit comprisingof the following sub-units:
 I. Paediatric Outpatient Facility (including immunisation and
counselling services)
II. Emergency Triage Assessment and Treatment (ETAT) Facility
III. Paediatric Inpatient Facility
1. a) High Dependency Unit
2. b) Paediatric Ward
3. c) Diarrhoea Treatment Unit
4. d) Isolation Room
IV. Ancillary (eg;laboratory, imaging, pharmacy) & Auxiliary
Facilities (eg; play area,

The general paediatric care facility will function in close coordination with specialised
units that already have approved guidelines for operationalization and include the
following:

o Newborn care facilities (Newborn Care Corners, Newborn Stabilisation Unit,

Special Newborn Care Unit)

o Nutrition Rehabilitation Centre

o District Early Intervention Centre

10. Family Participatory Care: Family-participatory care (FPC) for newborn

essentially provides a setting in which family is empowered, encouraged and
supported as the constant care-provider, in addition to available nursing staff, to
complement care of their sick newborn in nursery, from admission until discharge
and continue in home settings too.
11. Navjat Shishu Suraksha Karyakram(NSSK): NSSK is a programme aimed to train
health personnel in basic newborn care and resuscitation, has been launched to
address care at birth issues i.e. Prevention of Hypothermia, Prevention of
Infection, Early initiation of Breast feeding and Basic Newborn Resuscitation.
12. Intensified Diarrhoea Control Fortnight -IDCF: Promotion of zinc and ORS
supplies is ensured during pre-monsoon/ monsoon season, with the aim of ‘zero
child deaths due to childhood diarrhoea’ since 2014 for under 5 children
13. MUSQAN : The goal of MUSQAN initiative to ensure provision of quality child
friendly services in public health facilities to reduce preventable newborn and
child morbidity and mortality.
Assessment methods under GoI MusQan, Observations (Ob), Staff Interview (SI),
Record Review (RR), Patient Interview (PI)
 MUSQAN rapid improvement (RI) cycles:
1. timely initiation of emergency treatment of sick newborn and children and
referral.
2. improvement in breastfeeding, hypothermia (temperature maintenance), kmc
practices in eligible neonates and developmentally supportive care.

O Ensuring Improvement In Infection Prevention Practices And Reduction In

Hospital Acquired Infections (HAIs)
1. Improving documentation and record management practices. This RI cycle
include timely recording and updation of information.
2. Ensuring implementation of clinical protocols ex. Rational use of antibiotics,
oxygen, fluid etc.
3. Respectful care and improving engagement of mother / attendant in newborn
care and ensuring enhancement of parent/ attendant’s satisfaction who are
seeking care in public healthcare facilities.
14. National Newborn Week: National Newborn Week is being observed by the
Ministry of Health and Family Welfare (MoHFW), Government of India from
15th through 21st November to reinforces the importance of newborn health as a
key priority area and reiterates its commitment steered at the highest level.
15. India Newborn Action Plan (INAP) was launched in 2014 to make concerted
efforts towards attainment of the goals of “Single Digit Neonatal Mortality Rate”
and “Single Digit Stillbirth Rate”, by 2030.
16. SAANS-Social Awareness and Actions to Neutralize Pneumonia Successfully:
Initiative was launched on 16th November 2019 to accelerate action to reduce
deaths due to Childhood Pneumonia. SAANS Campaign is rolled out in the States/
UTs every year with the aim of accelerating action against Childhood Pneumonia
by generating awareness around protect, prevent and treatment aspects of
Childhood Pneumonia and to enhance early identification and care seeking
behaviours among parents and caregivers.
17. Universal Immunization Programme:
Maternal Health
Based on the framework, comprehensive care is provided to women and
children through five pillars or thematic areas of reproductive, maternal,
neonatal, child, and adolescent health. The programmes and strategies
developed by various divisions are guided by central tenets of equity, universal
care, entitlement, and accountability to provide ‘continuum of care’ ensuring
equal focus on various life stages.
1. JANANI SURAKSHA YOJANA : It is being implemented with the objective of reducing
maternal and neonatal mortality by promoting institutional delivery among poor
pregnant women. The scheme, launched on 12 April 2005 . It is a 100 per cent
centrally sponsored scheme

The scheme focuses on poor pregnant woman with a special dispensation for states
that have low institutional delivery rates, namely, 10 states Uttar Pradesh,
Uttarakhand, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Assam, Rajasthan,
Orissa, and Jammu and Kashmir. While these states have been named Low Performing
States (LPS), the remaining states have been named High Performing states (HPS).
2.Vandemataram Scheme: This is a voluntary scheme wherein any obstetric and
qynaec specialist, maternity home, nursing home, lady doctor/MBBS doctor can
volunteer themselves for providing safe motherhood services. The enrolled doctors
will display ‘Vandemataram logo’ at their clinic. Iron and Folic Acid tablets , oral pills,
TT injections etc, will be provided by the respective District Medical Officers to the
‘Vandemataram doctors/ clinics’ for free distribution to beneficiaries.

3. PRADHAN MANTRISURAKSHIT MATRITVA ABHIYAN (PMSMA): The Pradhan

Mantri Surakshit Matritva Abhivan (PMSMA ) has been launched by the Ministry in
June, 2016. Under PMSMA, all pregnant women (in 2nd and 3rd trimester) in the
country are provided fixed day, free of cost assured and quality antenatal care.

a minimum package of antenatal care services ( including investigations an Irugs is

being provided to the beneficiaries on the 9th and 23rd day of every month. The
Abhiyan also involves private sector’s health care providers as volunteers to provide
specialist care in government facilities.

4. SUMAN–Surakshit Matritva Aashwasan with an aim to provide assured, dignified,

respectful and Quality healthcare at no cost and zero tolerance for denial of services
for every woman and newborn visiting the public health facility in order to end all
preventable maternal and newborn deaths and morbidities and provide a positive
birthing experience. The expected outcome of this new initiative is "Zero Preventable
Maternal and Newborn Deaths and high quality of maternity care delivered with
dignity and respect."

5. Labour Room Quality Improvement Initiative (LaQshya):((2017) It is estimated

that approximately 46% maternal deaths, over 40% stillbirths and 25% of under-5
deaths take place on the day of the delivery. Half of the maternal deaths each year
can be prevented if we provide higher quality health care. Its implementation involves
improving infrastructure upgradation. ensuring availability of essential equipment,
providing adequate human resources, capacity building of health care workers, and
adherence to clinical guidelines and improving quality processes in labour room and
maternity OT

o Reduce maternal and newborn morbidity and mortality

o Improve quality of care during delivery and immediate post-partum period

o Enhance satisfaction of beneficiaries, positive birthing experience and provide
Respectful Maternity Care (RMC) to all pregnant women attending public health
facilities.

6. Midwifery Services Initiatives: To create a cadre of Nurse Practitioners in

Midwifery who are skilled in accordance to competencies prescribed by the
International Confederation of Midwives (ICM) and are knowledgeable and
capable of providing compassionate women-centered, reproductive, maternal
and newborn health care services”. As of now 14 National Midwifery Training
Institutes have been identified.

7. MTP (Amendment) Act, 2021: The MTP Act, 1971 recognized the importance of
providing safe, affordable, accessible and legal abortion services to woman who
need to terminate a pregnancy due to certain therapeutic, eugenic, humanitarian
or social grounds.

 Requirement of opinion of one registered medical practitioner for termination

of pregnancy up to twenty weeks of gestation.

 Requirement of opinion of two registered medical practitioners for termination

of pregnancy of twenty to twenty-four weeks of gestation.

 Enhancing the upper gestation limit from twenty to twenty-four weeks for
vulnerable groups of women (such as minors, differently abled women, victims
of violence etc.).

REPRODUCTIVE HEALTH
Reproductive health services include the provision for contraceptives, access to
comprehensive and safe abortion services, diagnosis and management of sexually
transmitted infections, including HIV.

Priority interventions (52)

1. Community-based promotion and delivery of contraceptives.

2. Promotion of spacing methods (interval IUCD).

3: Sterilization services (vasectomies and tubectomies).

4. Comprehensive abortion care (includes MTP Act).

5. Prevention and management of sexually transmitted and reproductive infections

(STI/RTI).
1. Mission Parivar Vikas (MPV): The Government has launched Mission Parivar
Vikas for substantially increasing access to contraceptives and family planning
services in146 high fertility districts with Total Fertility Rate (TFR) of 3 and above in
seven high focus states. These districts are from the states of Uttar Pradesh, Bihar,
Rajasthan, Madhya Pradesh, Chhattisgarh, Jharkhand and Assam that itself
constitutes 44% of the country’s population.