PREPARED BY

MRS.KAVITHA.S
ASST.PROF
ICON

HISTORY OF FAMILY WELFARE PROGRAMME

Family welfare programme is an important measures for the promotion of

maternal health. It enhances more benefits to the maternal health.

Objectives

Improve mother and young children condition. Provide facilities for prevention
and treatment of disease

Reduce the growth rate of population to achieve stable population rate at the
earliest

 To ensure good reproductive and child health. Contributory objectives

 To bring about wanted conception

 To develop wanted conception

 To avoid unwanted birth and to regulate the pregnancy

 To adopt small family norm

History

a) Mrs. Annie Besant Secretary of Malthusian league question about

uncontrolled league question of population explosion.

1912 - Margaret Sanger , public health nurse of USA needed the birth control
campaign

1921 - She formed Birth control control league.

1923 - Dr. Stopes popularized the birth Control movement in England.

1930 - Mysore started 1st Government sponsored Bir control clinic

1935 - Indian National congress given measures

1940 - Sai Rama Rao formed Family Association of India at Bombay

1951 - Planning commission started to formulate programme to check rapid
growth of the population.

1952 - Family planning programme was launched with 147 family planning
clinic.

Third Five Year Plan (1961 - 66)

During this period family planning was declared as "the very center of planned
development". This emphasis "clinical approach" for motivating people for
acceptance of small family norm.

1965 - Lippes loop introduction, major structural reorganization of programme

was done in 199 districts.

1966 - Leading to the creation of separation Department of family planning

(ministry of health)

1966-69 - Former root the infrastructure (Public Health center, Subcenter, urban
family center, district and state, subareas) was strengthened about small norm.

Fourth Five Year Plan (1969-74)

Government of India give "Top priority to the programme. It was made an

integral part of MCH activities to PHCS and their sub center.

1970 - All India Hospital postpartum programme was conducted.

1972 - Medical termination of pregnancy introduced

Fifth Five Year Plan 19751980

Major changes has taken place

1976 - National population policy were framed

1976 - Disastrous forcible sterilization campaign let to congress defeat in 1977

election.

1977 June New Janata Government came into power formulated a new
population policy and correlation for all times to come. The ministry of Family
planning was renamed "Family welfare"

1977-78 - The performance was very low.

January - It moved into new new health direction 42nd Amendment of the
constitution was made Manipulation control and family planning". The
acceptance of PRA gram me mainly on voluntary basis.

1977 - Rural health scheme launched involvement of local people [healthy

guide trained dais and opinion leader]

1978 - Alma Ata declaration acceptance primary health care for Health for all
by 2000AD.

1982 - Formulation of National health policy in 1982.

1983 - National Health Policy was approved NPR=1 by the year 2000 (2 child
family norm 2000AD.

SIXTH AND SEVENTH FIVE YEAR PLAN

Achieve goals of National health policy called reconstructing the health care
delivery system to achieve 2000AD and Family planning.

1985-86- Universal Immunization programme air reduce in mortality morbidity

among infant and younger children.

7TH FIVE YEAR PLAN

1992 - These programme was integrated By chid survival and safe motherhood
[CSSM]

1994 - International Conferences on population and development in

recommended implementation of unified reproductive and child health
programme [RCH]

NINTH FIVE YEAR PLAN

Integrated all programmes of 8 five year plan

In the 1" five year plan 0.65 crores and in 10th five year plan Rs. 27125 crores.

2000 - The government of India has enhanced more detailed and comprehensive
national population policy 2000 to promote family welfare

Components of family welfare

1. Administration and organization include recruitment of staff, getting

equipment, supplies
2. Training-medical, paramedical, social worker

3. Social and health education

4. Maintain supplies and services.

FAMILY WELFARE PROGRAMMES

As we know India has already crossed one billion mark in its population and
may soon become the first country in the world to have such huge population.
This will greatly strain the resources available in all spheres of daily life. We
have a health personnel must take more responsibility to help the country to
bring down the population growth.

India launched a nationwide family planning programme in 1952; thought

record show that the control clinics have been functioning in the country since
1930.

Objectives

 Avoid unwanted births.

 Bring about wanted births.

 Regulate the intervals between pregnancies.

 Control the interval/time at which births occur in relation to the ages of

parents.

Scope of family welfare programme

 Proper spacing and limitation of birth.

 Advice on sterility.

 Sex education.

 Screening for pathological conditions related to the reproductive system.

 Genetic counselling.

 Carrying out pregnancy tests.

 Premarital consultation and examination.

  Marriage counselling.

 Preparation of parents for arrival of the baby.

 Preparation services to unmarried mothers.

 Teaching home economics and nutrition.

MATERNAL AND CHILD HEALTH PROGRAMMES

Mother and children are the special group for the following reason mother and
children are the consumers of the health services. Together they constitute
nearly 60% of the total population. These group are subjected to mark the
physical and psychological stress. If not cared for may cause serious deviation
from normal health.

The objectives are

1. To reduce the maternal, infant and childhood mortality and morbidity

2. To promote the reproductive health

3. To promote the physical and psychological development of children and the

adolescents

The policy guidelines for implementation of MCH programs are

1. Effective use should be made of existing resource and infrastructures

available in the community.

2. The services should be delivered as close to the homes of beneficiary as

possible.

3. Services for mother and children should be delivered in an integrated manner.

4. Child survival programs server for delivery of the family planning

programmes which in general are not popular.

5. Voluntary agencies working in the area should be involved in providing

MCH services

Child survival and safe motherhood programme

WHO in 1989 gave call for child survival and safe motherhood program which
was implemented by the government of India. This programme was initiated in
1992. The different incompetence of the CSSM programme are: advice on
breast feeding care of the new born, infant, resuscitation of the neonate, care of
the low birth weight infant and also services to the pregnant mother.

For pregnant woman

1. Essential care for all

 Registration by 12-16 weeks

 Antenatal checkup at least two times
 Immunization with TT
 Give IFA large to all (one tablet a day for 100 days)
 Deworm with mebendazole
 Safe and clean delivery practices
 Prepare the women for exclusive breast feeding
 Postnatal care including advice and services for
 limited and spacing of births

2. Early detection of complication

 Clinical examination to detect anemia

 Bleeding indication APH or PPH
 Weight gain or more than the 3 kg in the month or systolic BP of 40
mmHg or more ;diastolic BP of 90MM Hg or more
 Fever 39 degree and about after delivery or after abortion
 Prolonged or obstructed labour

3. Emergency care

 Early indication of obstetric emergencies

 Provided initial management and identified referral unit

4. Women in the reproductive age group

 Counseling on optimal timing and spacing of birth, small family norm,

use and choice of contraceptives
 Information on availability of MTP services, IUD and sterilization
services.

For children
1. Essential newborn care

 Birth weight for all the newborns

 Resuscitation of asphyxiated babies
 Care of the low birth weight babies
 Prevention of hyperthermia
 Exclusive breast feeding with in one hour of delivery
 Referral is newborns who show the signs of illness
 Advice to mother on essential newborn care.

2. Immunization

 BCG – One dose at the birth

 DPT – Three doses beginning six weeks at monthly intervals
 Polio - O dose at birth for all institutional deliveries three doses beginning
six week at monthly interval
 Measles - 1 dose at complication of nine months of the age
 Vitamin A - 1" dose (100,000IU) with measles vaccination at 9 month
 Children (1-3yrs)- DPV(OPV)-booster dose at 15 18 months, vitamin A 2
dose (200,00 IU) at 16-18 months along with DPV/OPV, third dose at 6
month interval

3. Appropriate management of diarrhoea

 To give increased volume of fluids ORS for diarrhea

4. Appropriate management of ARI

 Prevention of death due to pneumonia or any severe illness

5. Vitamin A prophylaxis

6. Prevention of anemia

 Stool examination for hookworm infections

 Deworm with mebendazole in the area where prevalence rate
 IFA - Small tablets of child has clinical signs of anemia

7. ICDS (Integrated Child Development Services)

Initiated In 1971

Objectives
  To improve nutritional and health status of children in the age group 0-6
yrs.
 To lay the foundation for proper Psychological, Physical and
development of the child.
 To reduce mortality and morbidity, malnutrition and school dropout.
 To enhances the capability of the mother and nutrition needs of the child
through proper nutrition and health education.

Delivery of services :

Supplementary nutrition : Supplementary nutrition is given to children below

6 years and nursing and expectant mother from low income group.

They provide- 200 cal and 8-10 grams of protein below 1 year

- 300 cal and 15 grams of protein for 1-6 yrs

- 500 cal and 25 grams of protein - pregnant women

8. Applied nutrition programme

Implemented in nutritional status depends largely upon awareness and

knowledge as well as availability of food. The rest expanded programme of
nutrition and started in India in 1960. The rest expanded programme of nutrition
and started in India in 1960 with the assistance from UNICEF

The programme was launched in 1963 to compact malnutrition in vulnerable

groups, particularly mothers and children in rural area. The programme was
basically education oriented programme, operational at the village and family
level.

The main objective

To make people conscious of their nutritional needs

To increase production of nutritious foods and their consumptions

To provide supplementary nutrition to vulnerable groups through locally

produced foods

The main components

Production of protective aids

Training of the functionaries involved in the production of these foods

Nutrition education and demonstration of improved technique of cooking and

feeding were also used.

The programme is co-ordinate by the ministry of rural reconstruction

 Kitchen gardens, school gardens and community garden are set up to

promote the concept of balanced diet as well as increased production

 Fishery units and poultry units are set up to give employment, added
income and more production of food.

 Providing better seeds and cattle

 Supplementary feeding through local food production was given to

vulnerable pregnant and lactating mother and children

 Panchayats, yuvak and Mahila mandals were to be involved to promote

community participation

 Training for horticulture

NUTRITION PROGRAMME IN INDIA

1) Vitamin A prophylaxis programme: One of the main component of the

national programme for the control of blindness is to administer a single
massive dose of an oily preparation of Vitamin A containing 200,000 IU(110
mg of retinol palmitate) orally to all pre-school children in the community every
6 months through peripheral health workers. This programme was launched by
the Ministry of health and family welfare in 1970.

2) Prophylaxis against nutritional anaemia: For prevention of nutritional

anaemia government of India during 4 five year plan launched this programme.
The programme consist of distribution of Iron and folic acid tablets to pregnant
women and young children (1-12yrs)

3) Control of iodine deficiency disorders: The national goitre control

programme was launched by the government of India in 1962 in the
conventional goitre belt in the Himalayan region with the objective of
identification of goitre endemic areas to supply iodised salt in place of common
salt and to assess the impact of goitre control measures over a period of time. A
major national programme-IDD control programme was mounted in 1986 with
the objective to replace the entire edible salt by iodide salt.

4) Special nutrition programme: Started in 1970 for the nutritional benefit of

children below 6yrs of age, pregnant and nursing mothers. The supplementary
food supplies about 300 kcal and 10-12 grams of protein per children/day. The
beneficiary mothers receive daily 500 kcal and 25 grams of protein. This
supplement is provided for about 300day in a year. The main aim was to
improve the nutritional status of the target groups

5) Balwadi nutrition programme : This programme was stated in 1970 for the
benefit of children in the age group 3-6 years in rural areas. Voluntary
organizations which receive funds are actively involved in the day-to-day
management. This programme is implemented through Balwadis which also
provide pre primary education to these children. The food supplement provides
300 kcal and 10 grams of protein per child/day.

6) Supplementary Programme: Started in 1975. There is a strong nutrition

component in this programme in the form of supplementary nutrition, vitamin A
prophylaxis, iron and folic acid distribution the beneficiaries are preschool
children below 6 years, pregnant and lactating mothers.

7) Mid-day meal programme: The mid-day meal programme(MDMP) is also

known as school lunch programme, started in 1961.

In formulating midday meals for school children the following broad principles
should kept in mind;

The meal should be a supplement and not a substitute to the home diet.

The meal should supply at least 1/3. The total energy requirement and half of
the protein need.

The cost of the meal should be reasonably low.

The meal should be such that it can be prepared easily in schools; no

complicated cooking process should be involved.

As far as possible, locally available foods should be used; this will reduce the
cost of the meal and monotony

8. Applied nutrition programme

Implemented in nutritional status depends largely upon awareness and
knowledge as well as availability of food. The rest expanded programme of
nutrition and started in India in 1960. The rest expanded programme of nutrition
and started in India in 1960 with the assistance from UNICEF

The programme was launched in 1963 to compact malnutrition in vulnerable

groups, particularly mothers and children in rural area. The programme was
basically education oriented programme, operational at the village and family
level.

The main objective

To make people conscious of their nutritional needs

To increase production of nutritious foods and their consumptions in

To provide supplementary nutrition to vulnerable groups through locally

produced foods

The main components:

 Production of protective aids

 Training of the functionaries involved in the production of these foods
 Nutrition education and demonstration of improved technique of cooking
and feeding were also used.
 The programme is co-ordinate by the ministry of rural reconstruction
 Kitchen gardens, school gardens and community garden are set up to
promote the concept of balanced diet as well as increased production
 Fishery units and poultry units are set up to give employment, added
income and more production of food
 Providing better seeds as well as well bored cattle
 Supplementary feeding through local food production was given to
vulnerable pregnant and lactating mother and children.
 Panchayats, yuvak and Mahila mandals were to be involved to promote
community participation
 Training for horticulture

REPRODUCTIVE AND CHILD HEALTH PROGRAMME

DEFINITION
Reproductive and child health approach has been defined as people have the
ability to reproduce and regulate their fertility, 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 couple are able to
have sexual relations free of fear of pregnancy and of contracting disease.

RCH was launched on 15th October 1977, by integrating strengthening

interventions under CSSM, of fertility regulation and adding components of
reproductive tract infections and STD. Based on international conference on
population and development held at cairo in 1994. It was planned and delivered
by Department of family welfare.

Aims

 To improve health status of young women and children

 To reduce the cost input to some extent because of overlapping of
expenditure would not be necessary.
 Integrated implementation in RCH would optimize outcome at field level.

Components of RCH

 Family planning
 Child survival and safe motherhood component
 Client approach to health care
 Prevention/management/STD,AIDS/ RTD

Main highlights

 The programme integrates all interventions of fertility regulation,

maternal and child health with reproductive health for both men and
women.
 The services to be provide will be client oriented, demand driven, high
quality and based on needs of community through decentralized
participatory planning and target free approach.
 The programme envisages up gradation of the level of facilities for
providing various intervention and quality of care. The 1" referral units
(FRUs) being set up at sub-district level will provide comprehensive
emergency obstetrics care and newborn care.
 It is proposed to improve facilities of obstetric care. MTP and IUD
insertion in the PHC's also for IUD's insertion at sub-centers.
  Specialist facilities for STD and RTI will be available in all district
hospital and in a fair number of sub-district level hospital.
 The programme aims at improving the outreach of services primarily for
the vulnerable group of population who have been, till now, effectively
left out of planning process.

Eg : Urban slums, tribal population and adolescent.

RCH Phase - I

 Essential obstetrical care

 Emergency obstetric care
 24 hour delivery services at PHC/SC
 Control of reproductive tract infection and sexually transmitted diseases
(SID)
 Medical termination of pregnancy
 Immunization
 Essential newborn care
 Oral rehydration therapy
 Acute respiratory disease control
 Prevention and control of vitamin A deficiency in children.

THE CURRENT RCH PROGRAMME

a. Essential obstetric care:

 It intends to provide the basic maternity services to all pregnant women

Through
 Early registration of pregnancy (within 12-16 weeks)
 Provision of minimum 3 antenatal check ups to detect risk factors.
 Provision of safe delivery at home or in an institution.
 Provision of 3 postnatal delivery check ups to monitor the postnatal
recovery and to detect complication.

b. Emergency obstetric care:- Complication associated with pregnancy are not

always predictable, hence emergency obstetric care is an important intervention
to prevent maternal mortality and morbidity. Under the RCH programme the
FRU's will be strengthened under supply of emergency obstetric kit, equipment
and provision of skilled manpower on contract basis.

c. 24-hour delivery services at PHC / CHC:

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.

d. Medical termination of pregnancy

MTP is a reproductive health measure that enables a woman to opt out of an

unwanted or unintended pregnancy in certain specified circumstances without
endangering her life, through MTP act 1971. The aim is to reduce maternal
mortality and morbidity from unsafe abortion. The assistance from the central
government is in the form of training of manpower, supply of MTP equipment
and provision for engaging doctors trained in MTP to visit PHCs on fixed dates
to perform MTP.

e. Control of reproductive tract infection(RTI) and sexually transmitted

diseases(STD)

Under the 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 clinic upto the district level. The
assistance from the central government is in form of training of the manpower
and thus kits including disposable equipment. Each district will be assisted by 2
laboratory technicians on contract basis for testing blood, urine and RTI / STD
tests.

f. Immunization

The universal immunization programme (UIP) became a part of CSSM

programme in 1992 and RCH programme in 1997. it will continue to provide
vaccine for polio, tetanus, DTP, DT. Measles and tuberculosis. The cold chain
established so far will be maintained and additional items will be provided to
new health facilities.

g. Essential newborn care

The primary goal of essential newborn care is to reduce perinatal and neonatal
mortality. The main components are resuscitation of newborn with asphyxia,
prevention of hypothermia, prevention of infection, exclusive breast feeding 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 new born in FRU and district hospitals etc.

h. Oral rehydration therapy:

Diarrhea is one of the leading causes of child mortality. ORT programme

started in 1986-87 is being implemented through RCH programme. Twice a
year 150 packets of ORS are provided as part of drug kit supplied to all sub-
centers in the country. Adequate nutritional cares of the child with diarrhea and
proper advice to mother on feeding are 2 important areas of this programme.

i. Acute respiratory disease control:

The 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. Cotrimoxazole is
being supplied to the health workers through CSSM drug kit.

j. Prevention and control of vitamin A deficiency in children:

It is estimated that large number of children suffers from subclinical deficiency

of Vitamin A. under the programme, 5 doses of vitamin A are given to all
children under 3 years of age. The first dose ( 1 lakh units) is given at 9 months
of age along with DTP/ OPV booster. Subsequent 3 doses ( 2 lakh units each)
are given at 6 months interval.

Initiatives taken after adoption of National population policy 2000

a. RCH camps: In order to reach the services offered by RCH to remote people,
a scheme for holding camps has been initiated in 102 districts covering 17 states
from January 2001

b. ARCH outreach scheme : During 2000-2001, an RCH out-reach scheme

was initiated to strengthen the delivery of immunization and other maternal and
child health services in remote and comparatively weak districts and urban
slums.

c. Operationalization of district new born care:

Home based neonatal care: the department of family welfare has approved 2
proposals for introducing home based neonatal care

...Gadchiroli model

..Proposal for ICMR the objective is to evolve a national programme for

provision of neonatal care at the grass root level.

d. Border district cluster strategy (BDCS): The activities of the project are

 Development and teaching of health and nutrition teams.

 Physical up gradation of PHC and sub-centers
 Additional supply of drugs and equipments
 Support for morbidity of staff
 Training of medical officers
 Up- gradation of FRU
 Filling of vacant post through contractual appointments.

e. Integrated management of childhood illness (IMCI): The extent of

childhood mortality and morbidity caused by diarrhea, ARI etc is substantial.
Most children present with signs and symptoms of more than one of these
condition which in turn diagnosis will not be accurate. IMCI is a strategy for an
integrated approach to the management of childhood illness as it is important
for child health programme to look beyond the treatment of single disease.

f. Introduction of hepatitis B vaccine project: A pilot project for 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 along with the primary doses of DTP vaccine. Implemented in 38
districts.

g. Training of dias: A scheme for training of dias was initiated during 2001-02.
This scheme is being implemented in 156 districts in 18 states.

RCH phase II

RCH phase II was launched on 1" April 2005. The main

objective of the program is to bring at a change in mainly

three critical health indicators

1. Reducing total fertility rate

2 Reducing infant mortality rate,

3. Maternal mortality rate with a view of realizing the outcomes envisioned in

the millennium development goals ,the National Policy 2000, and the Tenth
Plan Document, the National Health Policy 2002 and vision 2020 in India

The major strategies are

1. Essential obstetric care

2. Emergency obstetric care

Essential obstetric care

a. Institutional delivery

To promote institutional delivery in RCH phase-II PHCs and CHCs would be

responsible for providing basic emergency care and essential newborn care and
basis newborn resuscitation services round a clock.

b. Skilled birth attendance

The WHO has emphasized that skilled attendance at every birth is essential to
reduce maternal mortality in any country. Guidelines for normal delivery and
management of obstetric and complications at PHC/ CHC for medical officers
and for ANC and skilled attendance at birth for ANM/LHVs have been
formulated and disseminated to the states.

c. The policy decision

ANMs, / LHV/SNs have now permitted to use drugs in specific emergency

situations to reduce maternal mortality. They are now permitted to use drugs in
specific emergency situations to reduce maternal mortality. They have also been
permitted to carry out certain emergency intervention when the life of the
mother is at stake.

Emergency obstetric care

a. Operationalising FRU

 A minimum bed strength of 20-30

 A fully functional operation theater
  A fully functional labour room
 An area equipped with new born care in the labour room and in the ward
 A functional laboratory
 Blood storage facility
 24 hour water supply and electrical supply
 Arrangement for waste disposal
 Ambulance facility
 24 hours delivery services at PHCs and CHCS
 Medical termination of pregnancy

New initiatives

1. Training of MBBS doctors in Anesthetic skills for emergency obstetric care

at FRU

2. Obstetric management skill: Introducing MBBSNdoctors in obstetric

management skills. Federation of Obstetric and Gynecological society of India
has prepared the training for 16 weeks in all obstetric management skills
including caesarian section operation and is present under consideration.

3. Setting up of Blood storage Centers at FRUS

4. Developing a cadre of community level skilled birth attendant: A

community level skilled birth attendant is a person who is trained in midwifery
to provide maternal care at the community level. She will be selected from the
community where she will set up her practice after completion of her training
for one year midwifery. The community level skilled birth attendant will not be
financial or administrative obligation to the health system. They will serve in
the

community for a minimum period of three years and will not be given
government services. They will be given special stipend for the training period
and hostel facility will be given at ANM training centers.

5. Janani Suraksha yojana: The scheme is a modification of National

maternity Benefit scheme, referral transport

Objective

 Reduction in MMR and IMR

 Focus on institutional delivery
Features

 Encouraging small family norm

 Provision for caesarean section
 Encouraging pregnant women to undergo Tubectomy/laparoscopy
 Trained birth attendant to be an effective link between field level health
functioning at the BPL women
 Payment of incentive to Dai / ASHA
 Fund to be released through state SCOVAS/state department of family
welfare
 Benefit to be disbursed by ANM through imprest.

Benefit

 Assistance to mother increased to Rs.700 in rural areas of low performing

states and Rs 600 to urban areas of LPS and rural areas of HPS
 Assistance package of RS.600 in rural area for institutional delivery in
low performing states to meet Dai/ASHA fee, transport cost and food and
incidental charges during delivery
 In urban areas of LPS ,the assistance package is limited to RS 200.

6. Accredited social health activist (ASHA)

Government of India announced a National Rural Health Mission with a clear

goal of addressing the health needs of rural population especially vulnerable
sections of the society. Such community level links workers may be called as
Accredited social health activities. ASHA is a link between among beneficiary
at village level, Anganwadi worker and ANM. The scheme is under
consideration. Initially it is planned to give this helper (ASHA) to
villages( Assam, Jammu and Kashmier). She will help and guide women to
assess the health facilities antenatal care, institutional delivery, postnatal car and
counseling on nutrition and family planning services.

7. Vande Matram scheme:

 This scheme is continuing under public private partnership with the

involvement of Federal of Obstetric And Gynecological society of India
and private clinics
  The aim of the scheme is to reduce the maternal mortality and morbidity
of the pregnant and expectant mothers involving and utilizing the vast
resources of specialist /trained work available in the private sector.
 The scheme intends to provide free antenatal and postnatal checkup,
counseling on nutrition, breastfeeding, spacing of birth etc.
 This is a voluntary scheme where in OBG specialist. maternity home,
nursing home can volunteer themselves in joining the scheme.
 The enrolled vandemataram doctors will display vande mataram logo in
their clinic, iron ,folic acid tablets, oral pills, TT injections etc will be
provide by the district Medical Officer for free distribution to the
beneficiaries.

8. Safe Abortion Services

Under RCH II following facilities are provided

a. Medical method of abortion : Termination ofNpregnancy with two drugs -

Mifepristone followed misoprostol. Termination of pregnancy with RU 486 and
Misoprostol is offered women under the previe of the MTP Act, 1971

b. Manual Vacuum Aspiration : The department of family welfare has

introduced manual vacuum aspiration technique in the family welfare
programme Manual vacuum Aspiration is a simple safe technique for
termination of early pregnancy.

9. Integrated management of child hood illness (IMCI)

 Inclusion of 0-7 days age in the programme

 Incorporating national guidelines on malaria, anemia,Bvitamin A
supplementation and immunization schedule
 Training of health personnel begins with sick youngNinfants up to 2
months
 Proportion of training time devoted to sick young infant and sick child is
almost equal.

SAFE MOTHERHOOD PROGRAMMES

Safe Motherhood programmes are designed to reduce the high numbers of

deaths and illnesses resulting from complications of pregnancy and childbirth.
In too many countries, maternal mortality is a leading cause of death for women
of reproductive age. Most maternal deaths result from haemorrhage,
complications of unsafe abortion, pregnancy-induced hypertension, sepsis and
obstructed labour. Safe Motherhood programmes seek to address these direct
medical causes and undertake related activities to ensure women have access to
comprehensive reproductive health services.

Safe Motherhood Indicators

Indicators to be collected from the health-facility level

 Crude birth rate

 Neonatal mortality rate
 Stillbirth ratio
 Coverage of antenatal care
 Coverage of syphilis screening
 Coverage of trained delivery services
 Coverage of postpartum care
 Incidence of obstetric complications
 Indicators collected at the community level
 The knowledge of the community regarding safe motherhood
 Interventions should be assessed periodically.
 Indicators concerning training and quality of care

Supervisors should periodically assess the skills of health care providers to

ensure quality of care of Safe Motherhood interventions

Checklist for Safe Motherhood Services:

a) In Emergency Phase:

 Provision of delivery kits: UNICEF midwifery kits for health centres and
clean delivery kits for home use.
 Identification of referral system for obstetric emergencies
 One health centre for every 3000040000 people
 One operating theatre and staff for every 150,000 to 200,000 people
 Skilled health care providers trained and functioning (one midwife for
2000030000 people, one CHW/ TBA for 20003000 people)
 Community beliefs and practices relating to delivery are known
 Refugee women are aware of service availability

b. Antenatal Services are in place:

  Record systems in place (clinic and home-based maternal records)
 Maternal health assessment routinely conducted
 Complications detected and managed
 Clinical signs observed and recorded
 Maternal nutrition maintained
 Syphilis screening in pregnancy undertaken routinely
 Educational activity related to antenatal care provision in place
 Preventive medication given during antenatal services:
 Iron folate for anaemia, Vitamin A, tetanus toxoid, others as indicated
(malaria)
 STD prevention and management undertaken
 Materials available to implement antenatal care services

c. Delivery services are in place:

 Protocols for managing and referring complications in place and transport

system functioning Training and supervision of TB As and midwives
undertake
 Complications are detected and managed appropriately
 Awareness of warning signs of complications in pregnancy is widespread
 Standard protocols are used to manage deliveries
 Breastfeeding is supported

d. Postpartum services are in place:

 Educational activities undertaken (especially family planning and

breastfeeding)
 Complications managed appropriately
 Iron folate and Vitamin A provided
 Newborn weighed and referred for under-five services
 (e.g., EPI, growth monitoring)

ORGANIZATION AND ADMINISTRATION AT NATIONAL

(CENTRAL) STATE, DISTRICT, BLOCK, & VILLAGE LEVEL IN
FAMILY WELFARE PROGRAMME.

1. Central Government: The family welfare programme is 100% centrally

sponsored programme. Central government controls, plans and manages
befinancial matters. There is separate department of family welfare which was
created in 1966. The secretary to the government of India in ministry of health
and family welfare in overall in charge of department of family welfare. For
technical expertise and advise there is an apex institute i.e National institute of
health and Family welfare to promote health and family welfare through
education, research, training and evaluation.

2. State level: In the state there is state family welfare Bureau, which is part of
the state health and family welfare directorate.

3. District Authorities: In the district family welfare Bureau consisting of 3

divisions headed by district family welfare officer, mass education and media
division in charge and district mass education and media officer.

4. Primary health centre: There are 3 medical officers at PHC level to provide
essential health care and family planning services. The activity of sub-centre is
supervised by health assistant (male) and female. The activities at the sub-centre
are managed by health worker female and male. Family planning services to the
women is responsibility of health worker (female) whereas for female, health
worker (male) is responsible.

5. Village level: There is one village health guide for every 1000 population.
They are responsible for educating and informing the people about family
planning and also to supply Nirodh and oral pills. Trained dias also work for
1000 population, who act as a counsellor for family planning and motivate
mother to adopt family planning methods.

6. Role of Non Governmental agencies: The role of NGO and private

practitioner is well organised and government has created a nationwide social
market for Nirodh through them.

ROLE OF NURSE IN FAMILY WELFARE PROGRAMME

1. Counsellor's role

As a nurse she will come across with different couples requiring special care
and advises. She needs to clear their doubts and assist them in making decision
for themselves.

2. Administrative roles
As a nurse she is called to participate at national, regional, local level services.
She has to set-up clinics and manage the administrative activities.

3. Supervisory roles

She is responsible for practical supervision and in service education of their

health workers and professionals

4. Functional role

As a community health nurse she is responsible in finding eligible couples and

helping them the choose a suitable method of contraception. She may run a
clinic or assist the doctor for various other activities related to family planning.

5. Educational role

The main role of a nurse is to educate people about family planning. The health
education can be held in the health centers, hospitals, clinics, schools, homes etc.

6. Role in research

The nurse should have an enthusiastic mind to answer the questions and find the
solution of it. She keeps accurate records to analyse the facts to help in further
planning of the family planning activities in her area of assignment.