Reproductive child health Programme

REPRODUCTIVE & CHILD
HEALTH PROGRAMME
ANANDGOWDA.S
ASSISTANT PROFESSOR
COMMUNITY HEALTH NURSING
YENEPOYA NURSING COLLEGE
YENEPOYA UNIVERSITY ,
MANGALURU

DEFINITION
Reproductive health can be defined as a state in
which people have the ability to reproduce and
regulate their fertility, women are able to go
through pregnancy and child birth safely, the
outcome of pregnancy is successful in terms of
maternal and infant survival and well being, and
couples are able to have sexual relations free of the
fear of pregnancy and of contracting diseases.

MILESTONES OF THE RCH
 1983- National health policy-MCH and Family
Welfare Services were integrated
during this policy
 1992- Child Survival and Safe motherhood
Programme (CSSM) was lunched on
20th August to meet the total health
needs of both mother and the child.
 1997 –CSSM was replaced by the RCH
programme

 1983 - MCH
 1992 – CSSM
 1997 - RCH (Phase-I)
 2005 – RCH (Phase-II)

Goals of RCH
 The immediate objective is to address the unmet
needs of contraception, health care infrastructure,
health personnel and provide integrated service
delivery for basic reproductive and child health care.
 The medium term objective is to bring the total
fertility rate to replacement levels through
coordinated implementation of the inter sectoral
linkages.

 The long term objective is to achieve a stable
population by 2045 at a level consistent with
the requirements of sustainable economic
growth, social development and environmental
protection.
 Reduce the decadal rate of population growth
between 2001-2011 to 16.2%
 Reduce IMR to 45 per 1000 live births by 2007
and <30 per 1000 live births by 2010.
 Reduce total fertility rate to 2.1 % by 2010.

 Improve coverage of full antenatal care from 31.8% to
89% by 2010.
 Improve the coverage of institutional deliveries from
34% to 80 % by 2010
 Improve the coverage of fully immunized children from
54.2% to 100 % by 2010
 Improve the contraceptive prevalence from 48.2% to
65% by 2010
 Improve the quality ,coverage and effectiveness of the
existing family welfare and essential RCH services
with special focus on EAG STATES.

 The RCH Programme incorporates relating
child survival and safe motherhood and
includes two additional components, one
relating to sexually transmitted disease ( STD)
and other relating to reproductive tract
infection (RTI)

The CLIENT APPROACH
TO HEALTH CARE
PREVENTION AND MANAGEMENT O
F RTI’S AND STD/AIDS
CHILD SURVIVAL AND SAFE MOTHERHOOD COMPONENT
AND FAMILY PLANNING

COMPONENTS OF RCH
WOMEN’S
HEALTH
Mgt &
treatment
of RTI,
HIV/ADS
CSSM
FAMILY
PLANNING
CLIENT
APPROACH
TO HEALTH
CARE

MOTHERS:
1. All pregnancies to be registered by health workers.
2. Pregnant women must be given two doses of tetanus toxoid
immunizations.
3. Pregnant women must be given iron folic acid tablets for prevention
and treatment of anemia.
4. Pregnant women must be given three antenatal checkups, which
include checking their blood pressure and ruling out complications.
5. Deliveries by trained personnel in safe and hygienic surroundings
should be encouraged.
6. Institutional deliveries should be encouraged for women having
complications.
7. Referrals should be made to first referral units for management of
obstetric emergencies.
8. Three postnatal checkups should be given to mothers after the
delivery.
9. Spacing of at least three years between children must be encouraged

CHILDREN
1. Essential newborn care like keeping the baby warm, checking the baby's
weight and giving the baby mother's first milk is important. The
premature babies or low birth weight babies need special care. Babies
with any complications should be refereed to the nearest health center.
2. Exclusive breast-feeding must be encouraged for the first three months.
Weaning or starting the baby on semisolid food should start in the
fourth month.
3. BCG, DPT, Polio and Measles immunizations should be administered to
every child meticulously to prevent death and disabilities.
4. Vitamin A prophylactic for children is necessary to prevent blindness.
5. Parents must be informed about oral rehydration therapy and correct
management of diarrhea. The availability of ORS packets in the villages
should be ensured.
6. Acute respiratory infection in children should be detected early. They can
be treated by cotrimoxazole tablets. Acute cases should be refereed to
health center.
7. Treatment of Anemia.

ELIGIBLE COUPLES
1.Promoting use of contraceptive methods
among eligible couples is important to prevent
unwanted pregnancies. Couples should be
able to choose from various contraceptive
methods including condoms, Oral pills, IUDs,
male and female sterilization.
2. Safe services for medical termination of
pregnancies should be encouraged for women
desiring abortions.

OTHER NEW SERVICES
1. A large number of people suffer in silence due to
reproductive tract infections (RTIs) and sexually
transmitted diseases (STDs). RTIs and STDs can make
people infertile. If a pregnant woman has RTIs or
STDs, it can affect the health of her child. People
suffering from such infections should be referred to
the health center.
2. Adolescents are parents of tomorrow. It is
important to prepare them for the future by
counseling them on family life and reproductive
health. This can be a sensitive topic, as it has not
been addressed before. Therefore, the involvement of
parents, Anganwadi workers, and Mahila Swasthya
Sanghs should be ensured

The main highlights of RCH
programme are :
 The programme integrates all
interventions of fertility regulation,
maternal and child health with
reproductive health for both men and
women
 The services to be provided will be client
oriented, demand driven, high quality
based on the needs of community through
decentralized participatory planning and
target free approach.

 The programme envisages up gradation of the
level of facilities for providing various
interventions and quality of care. The FRU’s
(first referral units ) being set-up at sub-district
level will provide comprehensive emergency
obstetric and newborn care. Similarly RCH
facilities at PHC’S will be substantially
upgraded.

 It is proposed to improve facilities of
obstetric care, MTP and IUD insertion in
the PHC’s. Also for IUD insertion at sub
centers
 Specialist facilities for STD and RTI will be
available in all district hospitals and in a
fair number of sub-district level hospitals.

 The programme aims at improving the out-reach
of services primarily for the vulnerable group of
population who have been ,till now, effectively
left out of planning process, e. g special
programmes will be taken up for urban slums,
tribal population and adolescents; NGO’s and
voluntary organizations will be involved in much
larger way to improve the out-reach and make it

Interventions in All Districts
 Child survival interventions (immunization,
vitamin A ,oral rehydration therapy and
prevention of deaths due to pneumonia.
 Safe motherhood interventions e.g. antenatal
check up, immunization for tetanus, safe
delivery, anemia control programme)
 Implementation of target free approach

 High quality training at all levels
 IEC activities
 Specially designed RCH PACKAGE for urban
slums and tribal areas
 RTI’s/STD Clinics at district hospitals
 Facility for safe abortions at PHC’s by
providing equipment, contractual doctors etc.
 Enhanced community participation through
panchayat, women groups, and NGO’s
 Adolescent health and reproductive hygiene.

 Screening and treatment of RTI’s /STD at sub-
divisional level
 Emergency obstetric care at selected FRU’s
by providing drugs and having PHN/Staff
nurse at PHC’s
 Additional ANM at sub centers in the weak
districts for ensuring MCH care.
 Improved delivery services and emergency
care by providing equipment kits, IUD
insertions and ANM kits at sub-centers.

 Facility for referral transport for pregnant
women during emergency to the nearest
referral centre through panchayat in weak
districts.

MAIN RCH PHASE-1
INTERVENTIONS

ESSENTIAL OBSTETRIC
CARE
 Essential obstetric care intends to provide the basic maternity
services to all pregnant women through:
1. Early registration of pregnancy(within 12-16 weeks).
2. Minimum 3 ANC
3. Safe delivery
4. 3 PNC
5. Referral
6. More relevant for Assam, Bihar,Rajasthan, Orissa,UP, MP

EMERGENCY OBSTETRIC CARE:
 Complications associated with pregnancy are not
always predictable, hence, emergency obstetric
care is important.
 Under RCH programme the FRU’s will be
strengthened through the supply of emergency
obstetric kit, equipment kit and skilled manpower on
the basis of contract.
 Under CSSM programme Dai training is an uniform

24-HOUR DELIVERY SERVICES
AT PHC/CHC’s
 To promote institutional deliveries ,provision
has been made to give additional honorarium
to the staff to encourage round the clock
delivery facilities at health centers.

IMMUNIZATION
 The universal Immunization programme
became a part of CSSM programme in 1992
and RCH programme in 1997.
 It will continue to provide vaccines for polio,
tetanus, DPT, DT, measles and tuberculosis.

MEDICAL TERMINATION OF
PREGNANCY
 MTP is a reproductive health measure that
enables a woman to opt out of an unwanted
pregnancy in certain specific circumstances
without endangering her life through MTP Act
of 1971.
 The aim is to reduce maternal morbidity and
mortality from unsafe abortions.
 The assistance from the central government is
in the form of training manpower, supply of
MTP equipment and provision for engaging
doctors trained in MTP to visit PHC’s on fixed
dates to perform MTP’s.

CONTROL OF REPRODUCTIVE TRACT INFECTIONS
(RTI) AND SEXUALLY TRANSMITTED DISEASES
(STD)
 Under RCH programme, the component of RTI /STD
control is linked to HIV and AIDS control. It has been
planned and implemented in close collaboration with
National AIDS control organization (NACO) .
 NACO will provide assistance for setting up RTI/STD
clinics up to the district level.
 The assistance from the central government is in the
form of the manpower and drug kits including disposable
equipment.
 Every district will be assisted by two laboratory
technicians on contract basis for testing blood, urine and
RTI/STD tests.

DRUG AND EQUIPMENT KITS:
 The drug and equipment kits supplied at various
levels are as follows: (DRUG KIT)
 At sub-centre level:
Drug kit A
Drug kit B
Midwifery kit
Sub centre equipment kit
 At PHC level:
PHC equipment kit
 At CHC/FRU level
Equipments kits from kit E to KIT P

 Kit-E – Laparotomy set
 Kit-F - Mini– Laparotomy set
 Kit-G – IUD insertion set
 Kit-H – Vasectomy set
 Kit- I – Normal delivery set
 Kit- J – Vacuum extraction set
 Kit- k – Embryotomy set
 Kit- L – Uterine evacuation set
 Kit-M – Equipment for anesthesia
 Kit-N- Neonatal resuscitation set
 Kit-O- Equipment and reagent for blood
test
 Kit-P – Donor blood transfusion set

ESSENTIAL NEWBORN CARE:
 The primary goal of essential new born care is
to reduce perinatal and neonatal mortality. The
main components are resuscitation of newborn
with asphyxia, prevention of hypothermia,
prevention of infection, exclusive
breastfeeding and referral of sick newborn.
 The strategies are to train medical and other
health personnel in essential newborn care,
provide basic facilities for care of low birth
weight and sick newborns in FRU and district
hospitals etc.

DIARRHOEAL DISEASE CONTROL
 India is the first country in the world to
introduce the low osmolarity oral rehydration
solution.
 Zinc is to be used as an adjunct to ORS for the
management of diarrhoea. Addition of zinc
would result in reduction of the number and
severity of episodes and the duration of
diarrhoea.
 De-worming guidelines have been formulated.
 The incidence of diarrhoea is reduced by
provision of safe drinking water.

ACUTE RESPIRATORY DISEASE
CONTROL:
 Standard case management of ARI and
prevention of deaths due to pneumonia is now
an integral part of RCH programme.
 Peripheral health workers are being trained to
recognize and treat pneumonia.
 Co-trimoxazole is being supplied to the health
workers through the CSSM drug kit.

PREVENTION AND CONTROL OF
VITAMIN A DEFICIENCY IN CHILDREN:
 It is estimated that large number of children
suffer from sub clinical deficiency of vitamin A.
Under the programme ,5 doses of vitamin A are
given to all children under 5 years of age.
 The first dose ( 1 lakh units) is given at nine
months of age along with measles vaccination.
 The second dose ( 2 lakhs units) is given after 9
months.
 Subsequent three doses ( 2 lakhs units each)
are given at six months interval upto 5 years of
age.

PREVENTION AND CONTROL
OF ANAEMIA IN CHILDREN
 Iron deficiency anaemia is widely prevalent in
young children.
 To manage anaemia, infants from the age of 6
months onwards up to the age of 5 years are to
receive iron supplementations in liquid formulation
in doses of 20 mg elemental iron and 100 mcg
folic acid per day for 100 days in a year.
 Children 6 to 10 years of age will receive iron in
the dose of 30 mg elemental iron and 250 mcg
folic acid for 100 days in a year.

Initiatives taken after adoption of
national population policy 2000.
 RCH CAMPS:A scheme for holding camps to
make the services of specialists like
gynecologist and pediatricians to people living
in remote areas.
 RCH Out Reach Scheme: The RCH out-reach
scheme was initiated to strengthen the
delivery of immunization and MCH services in
weaker districts and urban slums.

BORDER DISTRICT CLUSTER
STRATEGY (BDCS)
 Under this initiative 49 districts spread over 17 states have
been selected for providing focused interventions for reducing
the infant mortality and maternal mortality rates by at least 50
percent over the next 2 to 3 years.
 It is a UNICEF assisted activity. UNICEF releases funds
directly to the states.
 The activities of the project are:
 Development and training of health and nutrition teams.
 Physical up-gradation of primary health centres and sub-
centres

 Additional supply of drugs and equipments
 Support for mobility of staff
 Development of local IEC
 Training of medical officers
 Up-gradation of first referral units and filling of
vacant posts through contractual appointments

INTRODUCTION OF HEPATITIS B
VACCINATION
 Introduction of Hepatitis B in the national
immunization programme has been approved
by the Government.
 Under this project hepatitis B vaccine will be
administered to infants alongwith the primary
doses of DPT vaccine.

TRAINING OF DAIS
 A scheme for training of dais was initiated during
2001-02.
 The scheme is being implemented in 156 districts
in 18 states/UTs of the country based on safe
delivery rates.
 The aim was to train at least one dai in every
village.

DISTRICT SURVEYS
 There is no regular source of data to indicate
the reproductive health status of women.
 The RCH programme conducts district based
rapid household surveys to assess the
reproductive health status of women.

EMPOWERED ACTION GROUP
(EAG)
 An empowered action group has been constituted in the
Ministry of health and family welfare , with union Minister for
health and family welfare as chairman on 20th march 2001.
 As 55 percent of the increase in the population of India is
anticipated in the states of UP, Bihar, MP, Rajasthan, Orissa,
Chhattisgarh, Jharkhand and Uttaranchal , these states are
perceived to be most deficient in critical socio-demographic
indices.
 Through EAG, these states will get focused attention for
different health and family welfare programmes

The key indicators are:
 % of pregnant women with full ANC
 % of institutional deliveries and home deliveries
 % percentage of home deliveries by trained birth
attendant
 Current contraceptive prevalence rate
 % of children fully immunized
 % of unmet need for family planning
 % of household reported visits by health worker in
previous 3 months

 RCH –phase II began from 1st April 2005.
 Objective of RCH-II
 To reduce maternal morbidity & mortality
 To child morbidity & mortality
 Focus on rural health care

STRATEGIES OF RCH-
PHASE-II
 Essential obstetric care
a. Institutional delivery
b. Skilled attendance at delivery
 Emergency obstetric care
a. Operationalzing first referral units
b. Operationalzing PHCs & CHCs for round the
clock delivery services.

 Strengthening referral system
 All other strategies of RCH-I in addition
implementation of manual vacuum aspiration
services under safe abortion services at PHC
level.

 The government of India has given some
broad guidelines and strategies for achieving
the reduction in maternal mortality rate and
infant mortality rate.
The initiatives are :-

ESSENTIAL OBSTETRIC CARE
 Institutional deliveries: CHCs would be made operational as
24 hour delivery centres–in phased manner by the year 2010.
These centres would be responsible for providing basic
emergency care, essential new born care & basic new born
resuscitation.
 Skilled attendance at delivery: guidelines for normal delivery &
management of obstetric complication at PHC & CHC for MOs &
for ANM & skilled attendance at birth for ANM /LHVs.
 The policy decision: ANM /LHVs /SNs have now been
permitted to use drugs in specific emergency situation.

EMERGENCY OBSTETRIC
CARE
 All FRUs are made operational for providing, Essential Obstetric
care, Emergency obstetric care, it includes
1. 24 hour delivery services including normal & assisted deliveries
2. Emergency obstetric care includes surgical intervention – Caesarian
Section
3. New born care
4. Emergency care of sick children
5. Full range of family planning services –Laparoscopic
6. Safe abortion services
7. Treatment of RTI /STI
8. Blood storage facility
9. Essential laboratory services
10. Referral transport services.

STRENGTHENING REFERRAL
SYSTEM
 •During RCH I –funds were given to
Panchayats for providing assistance to poor
people -----no active involvement of
Panchayats.
 •In RCH II : to involve Local Self Group, NGOs
women groups.
 •New initiatives taken under RCH II

NEW INITIATIVES TAKEN UNDER
RCH -II
 Training of MBBS doctors in life saving anesthetic
skills for emergency obstetric care
 Setting up a blood storage centres at FRUs
according to of India guidelines.
 Janani Suraksha Yojana.
 Vandemataram scheme
 Safe abortion services
 Integrated Management of Childhood illnesses.

JANANI SURAKSHA YOJANA
 The national maternity benefit scheme has
been modified into a new scheme called
Janani Suraksha Yojana (JSY).
 It was launched on 12th April, 2005.
 The objectives of the scheme are-
 Reducing maternal mortality
 Reducing infant mortality
 Focusing at institutional care among women in
below poverty line families

SALIENT FEATURES OF JSY
 It is a 100 percent centrally sponsored scheme
 Under NRHM , it integrates the benefit of cash
assistance with institutional care during
antenatal, delivery and immediate post-partum
care.
The benefits will be given to all women,
both rural and urban, belonging to below
poverty line and aged 19 years or above, up to
first two live births.
The ASHA would work as a link
health worker between poor pregnant women
and public health institution.

The scale of assistance under the
scheme from June 2010
CATEGORY RURAL AREA URBAN AREA
Mother’s
package
ASHA’s
package
Total
(Rs)
Mother’s
package
ASHA’s
package
Total
(Rs)
LPS 1400 600 2000 1000 200 1200
HPS 700 200 900 600 200 800

The eligibility of cash assistance is :-
 In low performing states (LPS)-
all women, including those from SC and ST
families, delivering in government health
centre
 In high performing states (HPS)-
Below poverty line women, aged 19 years
or above and the SC & ST pregnant women.

The limitation of cash assistance
for institutional deliveries is
 In LPS-:- all births, delivered in health centre,
government or accredited Private
health institutions will get the benefit.
 In HPS :- the benefit is only up to 2 live births

VANDEMATARAM SCHEME
 This is a voluntary scheme wherein any
obstetric and gynaec 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
‘Vandematarm doctors/Clinics’ for free
distribution to beneficiaries.

 The cases needing special care and treatment
can be referred to the government hospitals,
who have been advised to take due care of the
patients coming with vandemataram cards.

SAFE ABORTION SERVICES
 In India, abortion is a major cause of maternal
mortality and morbidity and accounts for nearly
8.9 percent maternal deaths.
 Majority of abortions take place outside
authorized health services or by unauthorized
and unskilled persons.
 Whether spontaneous or induced, abortion is a
matter of concern as it may lead to
complications.

 Under RCH phase II following facilities are
provided-
a. Medical method of abortion-
 Termination of early pregnancy with two
drugs-Mifepristone (RU 486) followed by
Misoprostol.
 They are considered safe under supervision,
with appropriate counseling.
 Currently its use in India is recommended
upto 7 weeks (49 days) of amenorrhea in a
facility with provision for safe abortion
services and blood transfusion.

Reproductive child health Programme

 Termination of pregnancy with RU 486 and
Misoprostol is offered to women under the
preview of the MTP Act,1971.
b. Manual vacuum Aspiration (MVA)-
 The department of family welfare has
introduced Manual Vacuum Aspiration (MVA)
technique in the family welfare programme.
 MVA is a safe and simple technique for
termination of early pregnancy, makes it
feasible to be used in primary health centres

Reproductive child health Programme

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