MAGNITUDE OF MATERNAL AND CHILD HEALTH PROBLEM: Definition and concepts: Materna

l health is now referred as “reproductive health” (RH). According to WHO it is d

efined as a state of complete physical, mental and social well being and not mer
ely the absence of disease or infirmity in all matters relating to the reproduct
ive 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 sa
fe, effective,affordable and acceptable methods of family planning as well as ot
her methods of their choice for regulation of fertility which are not against th
e law; are able to have access to appropriate health care services that will ena
ble women to go safely through pregnancy and child birth and provide couples wit
h the best chance of having healthy babies. As such reproductive health is defin
ed as under: “people have the ability to reproduce and regulate their family, wo
men are able to go through pregnancy and child birth safely, the outcome of preg
nancies is successful in terms of maternal and infant survival and well being an
d couples are able to have sexual relations free of fare of pregnancy and of con
tracting diseases.” The maternal health status differ tremendously from place to
place and in the same place. it is assessed in terms of maternal health problem
s (maternal morbidity) and maternal mortality. The factors which are responsible
for maternal health problems i.e, maternal morbidity and maternal mortality inc
lude poverty, ignorance, illiteracy, malnutrition, age at marriage and pregnancy
, the number and frequency of child bearing and the number of unwanted pregnanci
es and abortions, lower status and worth of women in society, lack of access to
quality maternal health / reproductive health services, gender discrimination. M
ATERNAL MORBIDITY PROBLEMS: The common maternal health problems or morbidity con
ditions are discussed as under: 1) 2) 3) 4) 5) Reproductive tract infection Infe
ction in general Malnutrition Anemia Unregulated fertility
6) 7) 8) 9)
Complications of deliveries Puerperal sepsis Abortions 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 ba
cteria e.g. candidiasis during pregnancy. • Infections caused by instrumentation
, e.g. following pelvic examination , septic abortion etc. A large number of wom
en were unaware of the presence of any infection and were asymptomatic. Young gi
rls 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 i
mportant to diagnose RTIs early. The treatment should be done for both the partn
ers. Personal and sex hygiene is to be practiced. INFECTION IN GENERAL: The wome
n during pregnancy, especially in underdeveloped areas and developing countries
are at risk of contracting infection. Many women get infected with herpes simple
x virus, cytomegalovirus, protozoon which causes toxoplasmosis, E Coli causing n
ephritis or cystitis. Infection during pregnancy can cause various harmful effec
ts e.g. retardation of fetal growth, abortion low birth weight baby and puerpera
l 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 antenat
al care
right from the beginning of conception of pregnancy so that mother get proper an
tenatal care and get well informed about these infections and participate in pre
vention and control of these infections. MALNUTRITION: Malnutrition is a very co
mmon problem among women who are discriminated and underprivileged. Pregnant and
nursing mother especially prone to the effects of malnutrition. Malnutrition ca
n cause poor resistance, abortion, anemia , miscarriage or premature delivery, l
ow birth weight baby(< 2.5kg), eclampsia, post partum hemorrhage etc. these cond
itions can cause fatal effects on mothers, unborn and new born babies. Malnutrit
ion in women needs to be prevented and treated by some of the direct measures su
ch 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 enrich
ment. Other measures which can help prevent malnutrition include prevention and
control of infections by improvement of environmental sanitation, safe water sup
ply, food and personal hygiene, immunization and treatment of minor ailments; re
gulation of fertility and practice of small family norm, and health education. A
NEMIA: Anemia is very common among women in India due to invariable reasons whic
h include malnutrition, infection especially hookworm infestation, repeated preg
nancies, abortions, antepartum and postpartum hemorrhage, discriminatory treatme
nt 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 h
igh maternal and perinatal mortality. It is being recognized to regulate fertili
ty by integrated and comprehensive approach in family welfare services which inc
lude 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 unhygien
ical environment and mostly by untrained dais lacking obstetrics skill. Often va
rious 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 worker
s, adequate facilities and well linked referral units where skilful and efficien
t emergency care can be given to save mother and baby. PUERPERAL SEPSIS: It is m
ainly due to infection during labor and after delivery because of lack of person
al hygiene, insanitary conditions, septic procedures etc. this may lead to infla
mmation of ovaries, fallopian tubes, endometrium, cervix and vagina. Many a time
leucorrhea may persist for years. Some time secondary sterility may follow afte
r acute or chronic salpingities. Chronic infection of cervix may predispose to c
ancer of the cervix. It require proper preparation for confinement by the mother
, conduct of deliveries by trained and skilful dais, midwives etc and availabili
ty of equipments and supplies etc. ABORTION: Twenty percent of maternal mortalit
y 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 rura
l 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 ur
ban areas, lack of information about the availability of safe abortion clinics,
lack of privacy and impersonal atmosphere in government run clinics and reluctan
ce of unmarried and widowed to go to the clinics/ hospitals for MTP services. Il
legally 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 ver
y important to improve the accessibility of MTP services in primary health centr
es and create awareness among the people about the availability of such services
. INFERTILITY: Infertility is both a medical and social problem. Even if the fau
lt/ defect is in the male partner, usually it is the women who is labeled as “ b
anjh” or “Barren” and is socially not treated properly by the family and the soc
iety. 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 g
round or climbing 2 -3 storeys with heavy weight are predisposed to prolapse ute
rus. Certain child birth practice such as pressing hard on the abdomen during la
bor, pulling the baby etc, lead to prolapse of the uterus, especially when the m
other 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 ski
llful dais and midwives, improvement of working conditions and education of wome
n. 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 cervi
x. These are; early marriage and early pregnancy, multiple child birth, poor hyg
iene 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 42day
s of delivery from puerperal causes. The Maternal Mortality Rate (MMR) is expres
sed as number of maternal deaths per thousand live births and is computed as und
er: Total no.deaths of women due to complications of pregnancy, child birth or w
ithin 42 days of delivery from puerperal causes in an area during a given year M
MR = ---------------------------------------------------------------------------
-- X 1000 Total number of live births in the same area and same year. The multip
lying 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 eve
ry 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 ma
ternal mortality rate is much lower in east Asian countries. The maternal mortal
ity 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 Oris
sa 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%), a
bortion (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 communic
able or non-communicable diseases which the women might be suffering before preg
nancy or develop during pregnancy e.g. tuberculosis (4.6%), viral hepatitis (0.4
%), malaria (0.4%), diabetes, rheumatic heart disease etc (12%). The maternal mo
rtality also high due to large number of deliveries being conducted at home by u
ntrained persons and also lack of adequate referral facilities to provide emerge
ncy obstetric care for complicated cases. The maternal mortality also affected b
y a wide range of socio-economic factors such as status of women, low level of f
emale 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 approp
riate and timely action as under: • Early registration of pregnancy ( within 12-
16 weeks) • Minimum three antenatal checkups by ANM or medical officer to monito
r the progress of pregnancy and to detect any risk/ complication so that appropr
iate care including referral could be given on time. • Dietary supplementation a
nd correction of anemia. • Early detection and treatment of medical conditions.
• Tetanus toxoid immunization. • Promotion of institutional deliveries. • Provis
ion of safe delivery at home. • Provision of three postnatal checkups and care t
o monitor the postnatal recovery of women and to detect any complication which i
ncludes appropriate referral. • Promotion of family planning to adopt small fami
ly norms. • Training of local dias / traditional birth attendants (TBA) and supe
rvision and guidance of female health workers. • Strengthening of infrastructure
. • Improving social status of women by alleviating gender discrimination, educa
ting and empowering them, providing supporting environment. CHILD HEALTH:
Concept and importance: Child health refers to a state of complete physical, men
tal 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 fetu
s during antenatal period which refers to antenatal pediatrics, health care of n
eonates from birth to 28 days, care of infants upto one year, care of toddler fr
om 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 s
tatus, health behaviour and life style thus form during child hood determines qu
ality of life during the following years of life. The health of the children dif
fer 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, malnu
trition, 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) • Mal
nutrition • Infectious diseases • Accidents and poisoning.