REPRODUCTIVE & CHILD HEALTH

Reproductive & Child Health Program

The rapidly growing population had been a major concern for health planners and
administrators in India since independence. The result was the launching of National Family Planning Programme by the Government of India. India was the first country to have taken up the family planning programme at the national level. A CHANGED POLICY named as TARGET FREE APPROACH came into existence from 1.4.96. Thereafter, following the recommendations of the International Conferenceon population and Development (ICPD) held in Cairo in 1994, the Govt of India introduced the Reproductive & Child Health (RCH) package to supplement the MCH services in the country. Reproductive and Child Health Program is a major initiative in 9th Five year Plan from April, 1999 following the International Conference of Population Development in Cairo.

Poor health status of women and children in terms of high mortality and morbidity was another health priority in this country. Health facilities like hospitals and health centres were established for providing Maternal and Child Health (MCH) care through antenatal, intra-natal and post-natal services. In addition, a number of special programmes and schemes like immunization against vaccine preventable diseases, nutrition interventions like iron and folic acid distribution and vitamin A supplementation, diarrhoeal disease control through Oral Rehydration Therapy (ORT), Acute Respiratory Infection (ARI) control programme etc. were implemented over the past. In order to ensure maximum benefit from these programmes and to provide services in an integrated manner to these vulnerable group, the Child Survival and Safe Motherhood (CSSM) programme was implemented in India since 1992.

•    Accountability to children and communities – making sure community members are able to give feedback and complain about the services they receive from Donors.
•    Transparency – improving accountability reporting and disclosure of information on operations and finances.
•    Protection from Sexual Exploitation and Abuse (PSEA).
•    Anti-corruption.

Despite all these efforts, desired impact on the population growth, health and development of women and children could not be achieved in the country and the need for a new approach to the problem was well felt. In 1994, during the International Conference on Population and Development (ICPD), held in Cairo, it was recommended that a new approach needs to be adopted to tackle the problem. Under this approach, it was decided that family planning services should be provided as a component of the comprehensive reproductive health care.

Reproductive health approach implies that men and women will be well informed about and will have access to safe and effective contraceptive methods, women can go through pregnancy and child birth safely and that couples are provided with best chance of having a healthy infant.

Being one of the 180 participating countries of the ICPD conference, India also agreed to the decision taken during the conference to adopt the ‘Reproductive Health’ approach to the population issues. Accordingly, as a follow-up action to this conference, the Government of India launched the Reproductive and Child Health (RCH) programme in October, 1997.

Reproductive and Child Health (RCH) has been defined as a state in which “People have the ability to reproduce and regulate their fertility; women are able to go through pregnancy and childbirth safely, the outcome of pregnancy is successful in terms of maternal and infant survival and well being; and couples are able to have sexual relations free of the fear of pregnancy and contract diseases”. This means that every couple should be able to have child when they want, that the pregnancy is uneventful, that safe delivery services are available, that at the end of the pregnancy the mother and the child are safe, well and that contraceptives by choice are available to prevent pregnancy and of contracting diseases.

For rendering the above stated services, the new approach under the RCH

•    Because people with untreated HIV tend to burn more energy, the total number of calories should be around 10% higher than the usual guideline amounts, and up to 30% higher during recovery from illness. The balance of fat, protein and carbohydrates should remain the same.
•    Many experts recommend a daily multivitamin (usually without iron, except in menstruating women or people with iron deficiency).
•    The World Health Organisation recommends vitamin A supplements every 4-6 months for young children living with HIV in resource-poor settings. HIV positive people suffering loss of appetite may need to make an extra effort to ensure they are eating enough. Helpful suggestions include eating several small meals per day, taking exercise to stimulate appetite, possibly mashing or liquidizing food to ease swallowing, and seeking advice from a health provider or dietician. If other approaches have failed to reverse wasting then doctors may recommend a liquid food supplement, an appetite stimulant, or resistance exercise to build muscle. Other possibilities include steroids and hormone treatments, though these can be expensive and have serious side effects.

With the new approach of the programme, it is expected that health personnel, including you, will be able to understand more easily and completely the needs of the population and deliver the services accordingly. The RCH programme is envisaged to provide an integrated package of services, which will include the following:

•    Services for mothers during pregnancy, child birth and post-natal period, and also safe abortion services, whenever required.
•    Services for children like newborn care, immunization, Vitamin A prophylaxis,
•    Oral Rehydration Therapy (ORT) for diarrhoea, management of Acute
•    Respiratory Infections (ARI), anaemia control etc.
•    Services for eligible couples through availability and promotion of use of
•    contraceptive methods, and infertility services when required.
•    Prevention and management of Reproductive Tract Infections (RTIs) and
•    Sexually Transmitted Infections (STIs).
•    Adolescent health services including counselling of family life and reproductive health.

For rendering the above stated services, the new approach under the RCH
programme places emphasis on client-oriented, need-based, high quality, integrated services to the beneficiaries. There has been major shift/change in the approach from the past and some of these important changes are:

Target Free approach Based on Community Needs

In the past, the workload of the health functionaries was based on the centrally determined, contraceptive method-specific targets. Under the RCH programme, this method is withdrawn and in its place, you yourself can estimate your workload by using Community Need Assessment Based Approach (CNAA).

Since 1996, the Government of India has started the implementation of this approach.

Participatory Planning

The estimation of needs of services is required and its planning is to be actually undertaken by the health workers under your guidance with active involvement of and consultation with community members including women’s groups, members of the Panchayat institutions etc.

Emphasis on quality of care and client satisfaction

Under the RCH programme, special emphasis is placed on good quality of care.

Therefore, you have to ensure that all services provided are of good quality and acceptable to the clients. This can be achieved by ensuring practice of technically correct procedures while rendering various services. It also need better interpersonal relationship between clients and service providers. clients are to be informed them about causes and seriousness of their health problems, types of services currently available and place of service delivery.

Counselling services are to be provided, whenever needed, so that the clients are able to take correct decisions for accepting the services. This, in turn, is expected to increase satisfaction about with the services received. This will increase acceptance of the services further.

In RCH Programme, the contour has broadened with major emphasis on:

•    Integrated delivery of services for fertility regulation
•    Maternal health
•    Child health
•    Safe abortions
•    Nutrition
•    Communication for behavior changes
•    RTIs / STIs
•    Adolescent health

The essential elements of reproductive and child health services at the community and subcentre level are given below, this will help you to understand how the reproductive and child health services are to be provided at the community level.

The different services provided under RCH programme are mentioned hereunder.

For the mothers:

•    Tetanus Toxoid Immunization
•    Prevention and treatment of anaemia
•    Antenatal care and early identification of maternal complications
•    Deliveries by trained personnel
•    Promotion of institutional deliveries
•    Management of obstetric emergencies
•    Birth spacing

For the children:

•    Essential newborn care
•    Exclusive breast feeding and weaning
•    Immunization
•    Appropriate management of diarrhoea
•    Appropriate management of ARI
•    Vitamin A prophylaxis
•    Treatment of Anemia

For eligible couple:

•    Prevention of pregnancy
•    Safe abortion



Prevention and treatment of reproductive tract infection (RTI) and sexually transmitted diseases (STD).