MAGNITUDE OF MATERNAL AND CHILD HEALTH PROBLEM:

Definition and concepts:

Maternal health is now referred as “reproductive health” (RH). According to WHO
it is defined as a state of complete physical, mental and social well being 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 a
satisfying and safe sex life; are informed about and 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 child birth and provide couples with the best
chance of having healthy babies. As such reproductive health is defined as under:
“people have the ability to reproduce and regulate their family, 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 fare of pregnancy and of contracting
diseases.”
The maternal health status differ tremendously from place to place and in the same
place. it is assessed in terms of maternal health problems (maternal morbidity) and
maternal mortality. The factors which are responsible for maternal health problems
i.e, maternal morbidity and maternal mortality include poverty, ignorance,
illiteracy, malnutrition, age at marriage and pregnancy, the number and frequency
of child bearing and the number of unwanted pregnancies and abortions, lower
status and worth of women in society, lack of access to quality maternal health /
reproductive health services, gender discrimination.
MATERNAL MORBIDITY PROBLEMS:
The common maternal health problems or morbidity conditions are discussed as
under:
1) Reproductive tract infection
2) Infection in general
3) Malnutrition
4) Anemia
5) Unregulated fertility
 6) Complications of deliveries
7) Puerperal sepsis
8) Abortions
9) Infertility
10)Uterine prolapse
11)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, as
compared 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 well
linked 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 to
inflammation of ovaries, fallopian tubes, endometrium, cervix and vagina. Many a
time leucorrhea may persist for years. Some time secondary sterility may follow
after 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 quit
especially when the women is young and unmarried or widowed. It is therefore
very 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 -3
storeys 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 skillful 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 have
declined 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 0-11
maternal deaths for every 100,000 live births. The maternal mortality rate is much
lower 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 checkups 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 checkups 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 and
development 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 infants
upto one year, care of toddler from one year upto 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.