1. HISTORICAL AND
CONTEMPORARY
PERSPECTIVES,ISSUES
OF MATERNAL AND CHILD
HEALTH

2. Introduction

3. History

4. Midwifery and nursing
 A midwife is a person who having been regularly
admitted to a midwifery education,but recognized by
the country in which it is located,has successfully
completed the prescribed course of studies in
midwifery and has aquire the requisite to be
registered and or legally licenced to practice
midwifery.

5. In India

6. IN KERALA
 Ancient Times- Untrained Dais
 1901-dais Given Skill Training For 1year
 1939-jphn Course Of 1 ½ Year Duration Started ,Later To
2year
 1972-bsc.Nursing Started In Kerala At Govt.Hospital
Trivandrum
 2011-1year Course Of Independent Nurse Midwifery
Practice/Training At Govt Hospital Trivandrum.

7. National programmes related to
mother and child health
 MCH PROGRAMME
 ICDS PROGRAMME
 CHILD SURVIVAL AND SAFE MOTHERHOOD
PROGRAMME
 RCH PROGRAMME
 JANANI SURAKSHA YOJANA
 NRHM

8. Development of maternity services
and obg nursing education…
In India
 1854-midwifery Course Started In School Of
Nursing In Madras
 1909-midwifery Programme Was Changed To 3yr
Programme

9. IN KERALA
 1906-2yr Prog Started In Govt Hosp Trivandrum
 1954-school Of Nursing Started In Govt Hospital
Trivandrum
 1972-school Of Nursing Upgraded To Bsc.Nursing
 1990-msc Nursing
 1996-msc Nursing In Obstetric And Gynecologic Nursing

10. CURRENT TRENDS IN OBG
NURSING

11. Gynecological nursing-recent
advancements

12. Obg nursing –global perspective

14. Maternal and children health.
HEALTH
SOCIETY
Healthy children need healthy mothers
CHILDMOTHER
Maternal and child health.

15. Maternal health
Health of women during pregnancy, childbirth and the postpartum
period.
Motherhood, for too many women it is associated with suffering, ill-
health and death.
Haemorrhage, infection, HBP, unsafe abortion and obstructed labour
still are major direct causes of maternal morbidity and mortality.

16. Maternal health care
 Is a concept that encompasses family planning,
preconception, prenatal, and posnatal care.
 Goals of preconception care can include
providing education, health promotion,
screening and interventions for women of
reproductive age to reduce risk factors that
might affect future pregnancies

17. Child health.
• Child's health includes physical, mental
and social well-being too.
• Each year more than 10 million children
under the age of five die.
• At least 6.6 million child deaths can be
prevented each year if affordable health
interventions are made available to the
mothers and children who need them.

18. Maternal & child health.
• There are birth-related disabilities that
affect many more women and go
untreated like injuries to pelvic
muscles, organs or the spinal cord.
• At least 20% of the burden of disease in
children below the age of 5 is related to
poor maternal health and nutrition, as
well as quality of care at delivery and
during the newborn period.

21. Maternal mortality.
• Maternal deaths are clustered around the
intrapartum (labour, delivery and the
immediate postpartum); the most
common direct cause globally is
obstetric haemorrhage.
• Other major causes are: obstetric
haemorrhage; anaemia; sepsis/infection
obstructed labour; hypertensive
disorders and unsafe abortions.

22. Children < 5 years mortality (2008).
• Globally, 80 percent of all child deaths
to children under five are due to only a
handful of causes:
• pneumonia (19 %),
• diarrhea (18 %),
• malaria (8 %),
• neonatal pneumonia or sepsis (10 %),
• pre-term delivery (10 %),
• asphyxia at birth (8 %),
• measles (4 %),
• HIV/AIDS (3 %).

24. CHILD AND MATERNAL
HEALTH ISSUES IN INDIA

25. Lack of Quality health care

26. Lack of national care

27. Malnutrition
 Most people in the developing countries are
malnourished
 Malnutrition has a significant impact on the vulnerable
groups – pregnant women, lactating women and
children
 It can result in maternal complications such as
 anemia
 post partum haemorrhage
 toxemia of pregnancy
 low birth weight in baby
 Children are most affected in utreo and during period
of weaning
 Malnourished children are more susceptible to
infections

28. Interventions to prevent malnutrition
can be direct and indirect
 Direct measures
 Food supplementation
 Food fortification
 Iron and folic acid supplementation
 Nutritional education
 Indirect measures
 Food hygiene
 Education
 Environmental sanitation
 Vaccination to prevent disease
 Provision for clean drinking water

29. Infection
 Although infections have been controlled to a great
extend in developed countries, they continue to be a
major problem in developing countries
 Maternal infection can result in
 IUGR
 low birth weight
 abortions
 peurperal sepsis
 Upto 25 percent of pregnant women have urinary tract
infection
 Cytomegalovirus, herpes and toxoplasma infection are
also seen among mothers
 Children are at risk for diarrhoeal diseases, respiratory
tract diseases and skin conditions

30. Infections can be controlled by
 adequate nutrition
 sanitation
 immunization
 better primary health care services

31. Uncontrolled Reproduction
 Unregulated fertility has adverse effects
on both mother and children
 Decrease in birth spacing results in
inadequate care for the existing child and
risk of more complications during
pregnancy ( such as anemia, IUGR,
abortion)
 The risk increases greatly after the 4th
pregnancy

32. Interventions mainly include
 family planning services form an important
part of MCH programs
 Measures like Intrauterine contraceptive
device, oral contraceptive pills, long
acting injectable medroxy progesterone
acetate, female sterilisation and barrier
methods can be used.

33. Core interventions to prevent
child deaths.
• Preventive interventions:
• Vaccination
• Folic acid supplementation
• Tetanus toxoid
• Syphilis screening and treatment
• Pre-eclampsia and eclampsia prevention
(calcium supplementation)
• Intermittent presumptive treatment for
malaria in pregnancy

34. Core interventions to prevent
child deaths.
• Preventive interventions:
• Antibiotics for premature rupture of
membranes
• Detection and management of breech
(caesarian section)
• Labor surveillance
• Clean delivery practices
• Breastfeeding

35. Core interventions to prevent
child deaths.
• Preventive interventions:
• Zinc
• Hib vaccine
• Water, sanitation, hygiene
• Antenatal steroids
• Vitamin A
• Nevirapine and replacement feeding to
prevent HIV transmission
• Measles vaccine

36. Core interventions to prevent
child deaths.
• Preventive interventions:
• Prevention and management of hypothermia
• Kangaroo mother care (skin-to-skin contact)
for low birth-weight newborns
• Newborn temperature management
• Insecticide-treated materials
• Complementary feeding

37. Core interventions to prevent
child deaths.
• Treatment interventions:
• Detection and treatment of asymptomatic
bacteriuria.
• Corticosteroids for preterm labor.
• Newborn resuscitation
• Community-based pneumonia case management,
including antibiotics
• Oral rehydration therapy

38. Core interventions to prevent
child deaths.
• Antibiotics for dysentery, sepsis,
emerging and reemeging diseases.
• Antimalarials
• Zinc for diarrhea
• Vitamin A in respiratory diseases.

40. Female Infanticide And
Female Feticide
 Female Feticide is the act of aborting a baby
because it is of a female gender. Sex selective
abortion is a big problem in India. The number of
abortions by medical professionals have increased
so much that today it has become a industry even
though it is punishable by law.

41. Female Infanticide is the act of killing a
female girl either new-born or within the
first few years of life. It could be
actively, murdering through
suffocation, poisoning etc. Such acts can
also be passive, where no interest is
taken with regards to feeding or towards
her general health in affect total neglect.

42. Marriages

43. Education

44. Trafficking, slavery

47.  Within the framework of the World Health
Organization's (WHO) definition of health as
a state of complete physical, mental and
social well-being, and not merely the absence
of disease or infirmity. reproductive health, or
sexual health/hygiene, addresses the
reproductive processes, functions and
system at all stages of life.

48.  Reproductive health, therefore, implies that people are able to
have a responsible, satisfying and safer sex life and that they
have the capability to reproduce and the freedom to decide if,
when and how often to do so. One interpretation of this implies
that men and women ought to be informed of and to have
access to safe, effective, affordable and acceptable methods
of birth control; also access to appropriate health care services
of sexual, reproductive medicine and implementation of health
education programs to stress the importance of women to go
safely through pregnancy and childbirth could provide couples
with the best chance of having a healthy infant..

49. According to the WHO, "Reproductive
and sexual ill-health accounts for 20%
of the global burden of ill-health for
women, and 14% for men."

50. Sexual health

51.  An unofficial working definition for sexual health is that
"Sexual health is a state of physical, emotional, mental
and social well-being in relation to sexuality; it is not
merely the absence of disease, dysfunction or infirmity.
Sexual health requires a positive and respectful approach
to sexuality and sexual relationships, as well as the
possibility of having pleasurable and safe sexual
experiences, free of coercion, discrimination and
violence. For sexual health to be attained and
maintained, the sexual rights of all persons must be
respected, protected and fulfilled."

52. Childbearing and health
 Early childbearing and other behaviours can have health
risks for women and their infants. Waiting until a woman
is at least 18 years old before trying to have children
improves maternal and child health. If an additional child
is to be conceived, it is considered healthier for the
mother, as well as for the succeeding child, to wait at
least 2 years after the previous birth before attempting to
conception. After a fetal fatality, it is healthier to wait at
least 6 months.

53.  The WHO estimates that each year, 358 000 women die
due to complications related to pregnancy and childbirth;
99% of these deaths occur within the most
disadvantaged population groups living in the poorest
countries of the world.Most of these deaths can be
avoided with improving women's access to quality care
from a skilled birth attendant before, during and after
pregnancy and childbirth.

54. International Conference on Population and
Development (ICPD), 1994
 The International Conference on Population and Development
(ICPD) was held in Cairo, Egypt, from 5 to 13 September
1994. Delegations from 179 States took part in negotiations to
finalize a Programme of Action on population and
development for the next 20 years. Some 20,000 delegates
from various governments, UN agencies, NGOs, and the
media gathered for a discussion of a variety of population
issues, including immigration, infant mortality, birth control,
family planning, and the education of women.

55. 'Reproductive health' 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. Reproductive health therefore
implies that people are able to have a satisfying and safe
sex life and that they have the capability to reproduce and
the freedom to decide if, when and how often to do so.

56.  Implicit in this last condition are the right of men and
women to be informed [about] and to have access to
safe, effective, affordable and acceptable methods of
family planning of their choice, as well as other
methods of birth control which are not against the
law, and the right of access to appropriate health-care
services that will enable women to go safely through
pregnancy and childbirth and provide couples with the
best chance of having a healthy infant.”

57. The ICPD achieved consensus on four qualitative and
quantitative goals for the international community,
the final two of which have particular relevance for
reproductive health:
 Reduction of maternal mortality: A reduction of
maternal mortality rates and a narrowing of
disparities in maternal mortality within countries and
between geographical regions, socio-economic and
ethnic groups.

58.  Access to reproductive and sexual health services
including family planning: Family planning counseling,
pre-natal care, safe delivery and post-natal care,
prevention and appropriate treatment of infertility,
prevention of abortion and the management of the
consequences of abortion, treatment of reproductive tract
infections, sexually transmitted diseases and other
reproductive health conditions; and education,
counseling, as appropriate, on human sexuality,
reproductive health and responsible parenthood.

59.  Services regarding HIV/AIDS, breast cancer,
infertility, delivery, hormone therapy, sex
reassignment therapy, and abortion should be made
available.
 Active discouragement of female genital mutilation
(FGM)

60. Millennium Development Goals
 Achieving universal access to reproductive health by
2015 is one of the two targets of Goal 5 - Improving
Maternal Health - of the eight Millennium
Development Goals. To monitor global progress
towards the achievement of this target, the United
Nations has agreed on the following indicators:
 5.3: contraceptive prevalence rate
 5.4: adolescent birth rate
 5.5: antenatal care coverage
 5.6: unmet need for family planning

61.  According to the MDG Progress Report, regional
statistics on all four indicators have either improved
or remained stable between the years 2000 and
2005. However, progress has been slow in most
developing countries, particularly in Sub-saharan
Africa, which remains the region with the poorest
indicators for reproductive health. According to the
WHO in 2005 an estimated 55% of women do not
have sufficient antenatal care and 24% have no
access to family planning services.

62. MDGs and maternal/child health
• Millennium Development Goal 4 aims to
reduce child deaths by two-thirds
between 1990 and 2015.
• Millennium Development Goal 5 has the
target of reducing maternal deaths by
three-quarters over the same period.

63. MDGs and maternal/child health
• Unfortunately, on present trends, most
countries are unlikely to achieve either
of these goals.
• A recent review of MDG progress, show
that the world have only 32% of the way
to achieving the child health goal and
less than 10% of the way to achieving
the goal for maternal health.

64. Reproductive health and abortion
 An article from the World Health Organization calls
safe, legal abortion a "fundamental right of women,
irrespective of where they live" and unsafe abortion a
"silent pandemic".The article states "ending the silent
pandemic of unsafe abortion is an urgent public-
health and human-rights imperative.".

65.  It also states "access to safe abortion improves women’s
health, and vice-versa, as documented in Romania
during the regime of President Nicolae Ceaușescu" and
"legalisation of abortion on request is a necessary but
insufficient step toward improving women’s health" citing
that in some countries, such as India where abortion has
been legal for decades, access to competent care
remains restricted because of other barriers

66.  WHO’s Global Strategy on Reproductive Health, adopted
by the World Health Assembly in May 2004, noted: “As a
preventable cause of maternal mortality and morbidity,
unsafe abortion must be dealt with as part of the MDG on
improving maternal health and other international
development goals and targets." The WHO's
Development and Research Training in Human
Reproduction (HRP), whose research concerns people's
sexual and reproductive health and lives, has an overall
strategy to combat unsafe abortion that comprises four
inter-related activities:

67.  to collate, synthesize and generate scientifically sound
evidence on unsafe abortion prevalence and practices;
 to develop improved technologies and implement
interventions to make abortion safer;
 to translate evidence into norms, tools and guidelines;
 and to assist in the development of programmes and
policies that reduce unsafe abortion and improve access
to safe abortion and high quality post-abortion care
 This strategy does not involve studying the possible
effects of abortion on aborted fetuses

68. Sexual education
 Burt defined sex education as “the study of the
characteristics of beings; a male and female. Such
characteristics make up the person's sexuality. Sexuality is an
important aspect of the life of a human being and almost all
the people including children want to know about it. Sex
education includes all the educational measures which in any
way may of life that have their center on sex. He further said
that sex education stands for protection, presentation
extension, improvement and development of the family based
on accepted ethical ideas.”

69.  Leepson sees sex education “as instruction in
various physiological, psychological and sociological
aspects of sexual response and reproduction.”
 Kearney also defined sex education as “involving a
comprehensive course of action by the
school, calculated to bring about the socially
desirable attitudes, practices and personal conduct
on the part of children and adults, that will best
protect the individual as a human and the family as a
social institution

70.  sex education may also be described as "sexuality
education", which means that it encompasses education about
all aspects of sexuality, including information about family
planning, reproduction(fertilization, conception and
development of the embryo and fetus, through to
childbirth), plus information about all aspects of one's sexuality
including: body image, sexual orientation, sexual
pleasure, values, decision
making, communication, dating, relationships, sexually
transmitted infections (STIs) and how to avoid them, and birth
control methods. Various aspect of sex education are to right
in school depending on the age of the students or what the
children are able to comprehend at a particular point in time.

71.  Rubin and Kindendall expressed that sex education
is not merely a unit in reproduction and teaching how
babies are conceived and born. It has a far richer
scope and goal of helping the youngster incorporate
sex most meaningfully into his present and future
life, to provide him with some basic understanding
on virtually every aspect of sex by the time he
reaches full maturity.

72.  Sex education may be taught informally, such as
when someone receives information from a
conversation with a parent, friend, religious leader, or
through the media. It may also be delivered through
sex self-help authors, magazine advice columnists,
sex columnists, or sex education web sites. Formal
sex education occurs when schools or health care
providers offer sex education.

73.  Slyer stated that sex education teaches the young
person what he or she should know for his or her
personal conduct and relationship with others.
Gruenberg also stated that sex education is
necessary to prepare the young for the task ahead.
According to him, officials generally agree that some
kind of planned sex education is necessary.

74.  Sometimes formal sex education is taught as a full
course as part of the curriculum in junior high school
or high school. Other times it is only one unit within a
more broad biology class, health class, home
economics class, or physical education class.

75.  Some schools offer no sex education, since it remains a
controversial issue in several countries, particularly the
United States (especially with regard to the age at which
children should start receiving such education, the
amount of detail that is revealed, and topics dealing with
human sexual behavior, e.g. safe sex practices,
masturbation, premarital sex, and sexual ethics).

76.  The existence of AIDS has given a new sense of
urgency to the topic of sex education. In many
African nations, where AIDS is at epidemic levels
(see HIV/AIDS in Africa), sex education is seen by
most scientists as a vital public health strategy..

77.  Some international organizations such as Planned
Parenthood consider that broad sex education
programs have global benefits, such as controlling
the risk of overpopulation and the advancement of
women's rights (see also reproductive rights). The
use of mass media campaigns, however, has
sometimes resulted in high levels of "awareness"
coupled with essentially superficial knowledge of HIV
transmission

78.  According to SIECUS, the Sexuality Information and
Education Council of the United States, 93% of adults
they surveyed support sexuality education in high school
and 84% support it in junior high school. In fact, 88% of
parents of junior high school students and 80% of
parents of high school students believe that sex
education in school makes it easier for them to talk to
their adolescents about sex. Also, 92% of adolescents
report that they want both to talk to their parents about
sex and to have comprehensive in-school sex education

79.  Sexual Education In India
In India, there are many programs promoting sex
education including information on AIDS in schools
as well public education and advertising. AIDS clinics
providing information and assistance are to be found
in most cities and many small villages.

80.  “India has a strong prevention program which goes
hand in hand with care, support and treatment. We
have been able to contain the epidemic with a
prevalence of just 0.31 %. We have also brought
about a decline of 50% in new infections annually.”
As per the words of Shri Gulam Nabi Azad, Hon’ble
Minister of Health and Family Welfare, 2011.

81. Other countries
 Indonesia, Mongolia, South Korea have a systematic
policy framework for teaching about sex within
schools. Malaysia and Thailand have assessed
adolescent reproductive health needs with a view to
developing adolescent-specific training, messages
and materials.
 Bangladesh Myanmar, Nepal and Pakistan have no
coordinated sex education programs.
 In Japan, sex education is mandatory from age 10 or
11, mainly covering biological topics such as
menstruation and ejaculation.

82.  In China and Sri Lanka, sex education traditionally consists
of reading the reproduction section of biology textbooks. In
Sri Lanka young people are taught when they are 17–18
years old. However, in 2000 a new five-year project was
introduced by the China Family Planning Association to
"promote reproductive health education among Chinese
teenagers and unmarried youth" in twelve urban districts
and three counties. This included discussion about sex
within human relationships as well as pregnancy and HIV
prevention.

83.  The International Planned Parenthood Federation
and the BBC World Service ran a 12-part series
known as Sexwise which discussed sex
education, family life education, contraception and
parenting. It was first launched in South Asia and
then extended worldwide

84.  Morality

85. Lesbian, gay, bisexual, and
transgender youth

86. REPRODUCTIVE & SEXUAL
HEALTH IN INDIA
 Reproductive health implies that people are able to
have a responsible, satisfying and safer sex life and
that they have the capability to reproduce and the
freedom to decide if, when and how often to do so.
According to the WHO, “Reproductive and sexual ill-
health accounts for 20% of the global burden of ill-
health for women and 14% for men. The WHO
estimates that each year, 3, 58, 000 women die due
to complications related to pregnancy and childbirth.

87. Challenges Facing
Reproductive and Sexual Health
in India

88. Illiteracy
In India, the problems related to reproductive and
sexual health among women is highest amongst the
rural population. Illiteracy is the leading cause of this
situation. Ensuring literacy of the girl child can help
delay the age at which a woman gets married and
thereby reduce other disparities.

89. Gender Inequality
Women in India for years have been exposed to
gender inequality that has been the root cause of
sexual and reproductive diseases. Optimum sexual
and reproductive health can be attained by health
and social interventions.

90. Lack of Proper and Adequate
Nutrition

The lack of proper nutrition has a profound effect on
the health of a woman as she advances into
motherhood. “When it comes to reproductive
health, pregnancy care is very crucial. During
pregnancy, the nutritional deficiency has a negative
impact on the heath of both mother and the baby. In
this period, women are vulnerable to problems like
anaemia, post-delivery bleeding, low birth weight
babies, etc

91.  . Also, in developing countries, Tetanus remains as a
leading cause of maternal and neonatal morbidity
and mortality,” said Dr Amita Shah, obstetrics &
gynaecologist, Columbia Asia Hospital, Gurgaon.
She adds that the Reproductive and Child health
programme mandated by the Ministry of Health and
Family Welfare that promotes the concept of health
of women from womb to tomb is taken seriously

92. Lack of Decision-Making Power
The lack of power to decide how and when to have a child has
amounted to the increase in maternal mortality. “The women should
have the right to have safe sex, to decide on when she wants to get
pregnant or opt for a legal abortion. Women empowerment can be
successful only when societal norms enable the women to access
these rights and empowers them to take right decisions. There
should be an advanced health system in place to deal with
pregnancy related complications, which is also very important,” adds
Dr Shah.

93. Spread of STDs

Generally, women don’t have any access to
contraceptives, thereby increasing the number of
unwanted and unplanned pregnancies and severe
sexually transmitted diseases.

94. REPRODUCTIVE AND
HEALTH SERVICES
 Family Planning Services
 Counseling to enable couples to make an informed
choice
 Prenatal care
 Safe delivery and post natal care
 Prevention and appropriate treatment of infertility
 Prevention of spontaneous abortion and management of
consequences of induced abortion
 Treatment of reproductive tract infections, sexually
transmitted diseases and other reproductive health
conditions
 Education on responsible parenthood

95.  Other Specific Health Services pertain to:
 HIV/AIDS
 Breast cancer
 Delivery
 Hormone therapy
 Sex reassignment therapy
 Abortion

96. Thank you…