Progress towards achieving mch mdg

Progress towards
achieving Maternal and
Child Health – MILLENIUM
DEVELOPMENT GOALS
Dr. Sumaiya khatun
3rd year PGT, Community Medicine, CNMCH

• The Millennium Development Goals (MDG) was originated from the
Millennium Declaration adopted by the General Assembly of the
United Nations in September 2000.
• The MDGs helped in bringing out a much needed focus and pressure
on basic development issues, which in turn led the governments at
national and sub national levels to do better planning and implement
more intensive policies and programs.
• The MDGs consisted of eight goals, and these eight goals addressed
multiple development issues.

The eight (8) MDGs are as under:
 Goal 1: Eradicate Extreme Poverty and Hunger
 Goal 2: Achieve Universal Primary Education
 Goal 3: Promote Gender Equality and Empower Women
 Goal 4: Reduce Child Mortality
 Goal 5: Improve Maternal Health
 Goal 6: Combat HIV/AIDS, Malaria and TB
 Goal 7: Ensure Environmental Sustainability
 Goal 8: Develop Global Partnership for Development

• Eighteen (18) targets were set as quantitative benchmarks for
attaining the MDGs.
• The United Nations Development Group (UNDG) in 2003
provided a framework of 53 indicators (48 basic + 5
alternative) which are categorized according to targets, for
measuring the progress towards individual targets.
• India’s MDG framework is based on this framework, and it
includes all the eight goals, 12 out of the 18 targets which are
relevant for India and the related 35 indicators.

The respective goals, targets and indicators of MDG related
to Maternal and Child Health are as follows:

India’ s MDG framework: goals, targets and
indicators related to MCH
Goal 1: Eradicate extreme poverty and hunger
Target 2: Halve, between 1990 and 2015, the proportion of people who suffer
from hunger.
Indicator 4: Prevalence of underweight children under three years of age
Goal 4: Reduce Child Mortality
Target 5: Reduce by two-thirds, between 1990 and 2015, the Under-Five Mortality
Rate.
Indicator 13: Under-Five Mortality Rate
Indicator 14: Infant Mortality Rate
Indicator 15: Proportion of one year old children immunized against measles

India’ s MDG framework: goals, targets and
indicators related to MCH
Goal 5: Improve Maternal Health
Target 6: Reduce by three quarters, between 1990 and 2015, the Maternal
Mortality Rate.
Indicator 16: Maternal Mortality Ratio (MMR)
Indicator 17: Proportion of births attended by skilled health personnel
Goal 6: Combat HIV/AIDS, Malaria and other diseases
Target 7: Have halted by 2015 and begun to reverse the spread of HIV/AIDS.
Indicator 18: HIV prevalence among pregnant women aged 15-24 years

MDGs and Targets –Summary of Progress achieved by
India
MDG 1: ERADICATE EXTREME POVERTY AND HUNGER
Target 2: Halve, between 1990 and 2015, the proportion of
people who suffer from hunger
In progress
MDG 4: REDUCE CHILD MORTALITY
Target 5 : Reduce by two-thirds, between 1990 and 2015, the Under-
Five Morality Rate
Nearly achieved
MDG 5: IMPROVE MATERNAL HEALTH
Target 6 : Reduce by three quarters, between 1990 and 2015, the
maternal mortality ratio
In progress
MDG 6: COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES
Target 7 : Have halted by 2015 and begun to reverse the
spread of HIV/AIDS
Achieved

ELIMINATING EXTREME POVERTY AND HUNGER

Indicator 4:
 Prevalence of underweight children under three years of age

Indicator 4:
 Prevalence of underweight children under three years of age
33.7 % (2015-2016)

• Malnutrition refers to the situation where there is an unbalanced diet in
which some nutrients are in excess, lacking or in wrong proportion and
it can be under-nutrition and over-nutrition.
• The root cause of under- nutrition can be mainly hunger.
• Under-nutrition not only retards a child’s growth but also affects their
future productivity and capabilities.
• Highlighting the crucial importance of nutritional status of children, the
indicator ‘Prevalence of underweight children Under 5 years of age’ had
been kept as the indicator to monitor the MDG target relating to hunger

• It was estimated that in 1990, 52% of children below 3 years were
underweight and hence India had the MDG target as 26% by 2015.
• The NFHS showed that, the proportion of under-weight children below
3 year declined from 43% in 1998-99 to 33.7% in 2015-16.
• Thus, India could not achieve the MDG target for this indicator.

• The proportion of under –weight children under 3 years of age is
highest in Jharkhand (44.9%) followed by Bihar (43.3%), Madhya
Pradesh (42%) and Uttar Pradesh (39.9%).
• The States of Chhattisgarh (36.7%), Rajasthan (36.2%), Gujarat
(34.5%) and Odisha (34.1%) also had the proportion of under-weight
children more than the national level estimate (33.7%).
• The lowest level of under - weight children (under 3 years of age) was
reported in Mizoram (14.3%) followed by Manipur (15.1%), Nagaland
(15.2%), and Sikkim (15.8%).
• As in the case of national level, all the States except Jammu & Kashmir
could not achieve their respective MDG target.

Proportion of Underweight Children(< 3yrs) (%)
States/UTs 1990est 1992-93 1998-99 2005-06 2015-16 Target 2015
West Bengal 56.11 53.2 45.3 37.6 32.6 28.05
India 52.01 51.5 42.7 40.4 33.7 26.00
Source: NFHS, M/o Health and Family Welfare (GoI)

Important Programme and policy initiative:
 Integrated Child Development Services (ICDS):
• Launched on 2nd October, 1975, the Integrated Child Development
Services (ICDS) Scheme is one of the flagship programmes of the
Government of India.
• It is the foremost symbol of country’s commitment to its children and
nursing mothers, as a response to the challenge of providing pre-
school non-formal education and breaking the vicious cycle of
malnutrition, morbidity, reduced learning capacity and mortality on the
other.
• The beneficiaries under the Scheme are children in the age group of
0-6 years, pregnant women and lactating mothers.

Objectives of the scheme are:
a) To improve the nutritional and health status of children in the age-
group 0-6 years;
b) To lay the foundation for proper psychological, physical and social
development of the child;
c) To reduce the incidence of mortality, morbidity, malnutrition and school
dropout;
d) To achieve effective co-ordination of policy and implementation
amongst the various departments to promote child development; and
e) To enhance the capability of the mother to look after the normal health
and nutritional needs of the child through proper nutrition and health
education.

The ICDS Scheme offers a package of 6 services,
viz,
1. Supplementary Nutrition
2. Pre-school non-formal education
3. Nutrition & health education
4. Immunization
5. Health check-up and
6. Referral services

• The Supplementary Nutrition Programme under ICDS has been made
as an entitlement under NFSA.
• The number of operational AWCs/ mini-AWCs increased is 13,49,153
and number of beneficiaries [Children (6 months to 6 years) and
pregnant & lactating mothers] for supplementary nutrition increased
1010.56 lakh in September 2016.
 Though significant progress has been achieved under MDG 1, eradication of
poverty and hunger continues to be a priority area of development in India.

Reduce Child Mortality:
TARGET 5 : Reduce by two-thirds, between 1990 and 2015, the Under-
Five Morality Rate
Indicator 13: Under five mortality rate (per 1000
live births)
43 (2015)
Indicator 14: Infant Mortality rate (per 1000 live
births)
34 (2016)
Indicator 15: Proportion of 1 year-old children
immunized against measles
81.1 (2015-16)

Indicator 13: Under- Five Mortality Rate

Under- Five Mortality Rate:
• The Under-Five Mortality Rate (U5MR) is the probability (expressed
as a rate per 1,000 live births) of a child born in a specified year
dying before reaching the age of five if subject to current age-
specific mortality rate.
• Majority of the under five deaths are neonatal deaths which are
mainly due to complications and infections happened during birth.
• In addition to this, the U5MR is sensitive to a wide variety of drivers
such as the nutritional status of mothers, level of immunization,
availability of child and maternal care services, economic
conditions in the family, etc.

• The Under - Five Mortality Rate (U5MR) was estimated at 125
deaths per 1000 live births in 1990.
• The MDG target for U5MR was 42 deaths per 1000 live births by
2015.
• As per SRS 2015, the U5MR was at 43 deaths per 1000 live
births and was very close to the target.
• The U5MR for rural areas is higher than of urban areas. In 2015,
the Rural U5MR was 48 whereas the Urban U5MR was at 28.
• The U5MR among females was higher than that of males at all
India level (female: 45, male: 40) as well as in rural (female: 50,
male: 46) and urban areas (female: 31, male: 26).

• As per the SRS results, the U5MR showed a declining trend both in rural and
urban areas and the rural – urban gap is also decreasing over the years.

• In 2015, the State of Kerala (13) reported the lowest level of U5MR
followed by Delhi (20), Tamil Nadu (20), and Maharashtra (24).
• The U5MR was highest in Madhya Pradesh (62) and Assam (62)
followed by Odisha (56), Uttar Pradesh (51).
• The States of Delhi, Jammu & Kashmir, Karnataka, Maharashtra,
Tamil Nadu and Uttar Pradesh and West Bengal have achieved their
respective MDG target.
• The States of Assam, Rajasthan, Odisha, Himachal Pradesh,
Haryana and Maharashtra are lagging behind in achieving their
respective targets.

Under 5 Mortality Rate:
States/UTs 1990 1998 2005 2012 2015 Target 2015
West Bengal 102 67.6 59.6 38 30 34
India 125 94.9 74.3 52 43 42

Indicator 14: Infant Mortality Rate:

Infant Mortality Rate:
• IMR is the number of death in children under 1 year of age per
1000 live births.
• High neo - natal (less than 29 days of birth) mortality still continues
to be a significant contributor to the infant mortality rate in India.
• In 2015, at national level, 67.8% of the total infant deaths were neo
- natal deaths.
• At national level, the neo – natal mortality rate is 25 and ranges
from 15 in urban areas to 29 in rural areas.

• Among the bigger States, neo – natal mortality ranges from 35 in
Odisha to 6 in Kerala.
• In India, IMR was estimated at 80 per 1,000 live births in 1990.
• As per SRS 2015, the IMR is at 37 vis -a -vis the target of 27 infant
deaths per 1000 live births by 2015.
• The recent results from SRS shows that, IMR has further declined
to 34 in 2016.

Source: Sample Registration System, Office of Registrar General of India

The latest
data show
that even in
2016 the rural
- urban gap in
IMR is
significant
(rural IMR:
38, urban
IMR: 23).

• During 1990 to
2015, female
IMR has
declined from
81 to 39 infant
deaths per
1000 live
births and
• the decline in
male IMR is
from 78 to 35
infant deaths
per 1000 live
births.

• There exists considerable variation in the level of IMR at the States
level in India.
• In 2016, among the bigger States, IMR is lowest in Kerala (10),
followed by Tamil Nadu (18) and Delhi (18).
• The highest IMR is in Madhya Pradesh (47) followed by Assam
(44), Odisha (44), and Uttar Pradesh (43).
• In addition to these States, Rajasthan (41) and Chhattisgarh (39),
Bihar (38) and Uttarakhand (38) reported IMR higher than the
national level estimate.

States/UTs 1990 2007 2010 20015 2016 Target 2015
West Bengal 63 37 31 26 25 21
India 80 55 47 37 34 27
Source: Office of Registrar General of India

Indicator 15: Proportion of one year old
children immunized against measles

Proportion of one year old children immunized
against measles :
• It is the percentage of children under one year of age who have
received at least one dose of measles vaccine.
• Measles is the leading cause of child mortality.
• The NFHS - 4 (2015- 16), showed that, at all India level, 81.1% of
children within 12-23 months have received measles vaccine and
thus India is lagging in the task of achieving universal coverage of
one year old children immunized against measles.
• However, there is substantial improvement in the coverage of one
year old children immunized against measles as the level was at
42% in 1992-93.

against measles :
Source: NFHS, M/o Health and Family Welfare

against measles :
• The NFHS - 4 (2015-16) showed that, in urban areas, 83.2%
children aged 12-23 months had received measles vaccination and
in rural areas, the same is 80.3%.
• In 2015-16, more than 90% children of age one year have received
measles vaccination in Delhi (90.5%), West Bengal (92.8%),
Punjab (93.1%), Sikkim (93.3%), Chhattisgarh (93.9%) and Goa
(96.5%),
• Whereas the percentage of such children was as low as 50.4% in
Nagaland, 54.6% in Arunachal Pradesh and 61.1% in Mizoram.

Evaluated Measles coverage data of West Bengal for
the children of age group 12-23 months
States/UTs
Measles immunization
NFHS 1
(1992-93)
NFHS 2
(1998-99)
NFHS 3
(2005-06)
NFHS 4
(2015-16)
West Bengal 42.5 52.4 74.7 92.8
India 42.2 50.7 58.8 81.1

Important Programmes and Policies:

Health programmes related to MDG 4:
1. National Policy on Children 2013: (by Government of India)
The policy emphasized that the right to life, survival, health and
nutrition is an inalienable right of every child and will receive the
highest priority.
2. National Policy on Early Childhood Care and Education: (By
Ministry of Women and Child Development, 2013) The policy lays down the
way forward for a comprehensive approach towards ensuring a
sound foundation for survival, growth and development of child
with focus on care and early learning of every child.
3. The Integrated Child Development Services (ICDS) Scheme:

4. National Health Mission:
• The child health programme under the NHM comprehensively
integrates interventions that improve child survival and addresses
factors contributing to infant and under-five mortality.
• This program follows ‘continuum of care’ that emphasizes on care
during critical life stages in order to improve child survival.
• It ensures that critical services are made available at home, through
community outreach and through health facilities at various levels.
• The newborn and child health are now the two key pillars of the
Reproductive, Maternal, Newborn, Child and Adolescent health
(RMNCH+A) strategic approach, 2013.

5. NEWBORN AND CHILD HEALTH INTERVENTIONS:
i. Facility based newborn care : Newborn Care Corners (NBCCs) are
established at delivery points to provide essential newborn care at birth, while
Special Newborn Care Units (SNCUs) and Newborn Stabilization Units
(NBSUs) provide care for sick newborns.
ii. Janani Shishu Suraksha Karyakram (JSSK): (1st June 2012) JSSK
has provision for both pregnant women and sick new born till 30 days after birth
are (1) Free and zero expense treatment, (2) Free drugs and consumables, (3)
Free provision of blood, (4) Free transport from home to health institutions, (5)
Free transport between facilities in case of referral, (6) Drop back from
institutions to home, (7) Exemption from all kinds of user charges.

iii. Ensuring Injection Vitamin K in all the births in the facility:
(2014) All the public and private health facilities should ensure single dose of
Injection Vitamin K prophylaxis at birth even at the sub center by ANM.
iv. Up scaling of Kangaroo Mother Care (KMC) in health facility:
v. Empowering frontline health service provider: The ANMs are now
empowered to give a pre referral dose of antenatal corticosteroid (Injection
Dexamethasone) in pregnant women going into preterm labor and pre-referral
dose of Injection Gentamicin and Syrup Amoxicillin to newborns for the
management of sepsis in young infants (upto2 months of age)

vi. National Training Package for Facility Based Newborn Care:
has been developed with participation of national neonatal experts in the
Country. This package will improve the cognitive knowledge and build
psychomotor skills of the medical officers and staff nurses posted in these units
vii. India Newborn Action Plan: INAP lays out a vision and a plan for India
to end preventable newborn deaths, accelerate progress, and scale up high-
impact yet cost effective interventions. It also articulates the Government of
India’s specific attention on preventing stillbirths.

viii.Home Based Newborn Care Scheme: for early diagnosis of danger
signs, prompt referral to an appropriate health facility with provision for newborn
care facility, saving lives.
ix. Child Death Review: (18th September 2014 by MoHFW)
x. Infant and Young Child Feeding: Promotion of optimal IYCF practices
and management of lactational failure/breast related conditions such as Home
Based New Born Care visitations, Village Health Nutrition Day (VHND),
Outreach sessions for Routine Immunization, RI sessions at facilities,
management of newborn and childhood illnesses at community level.

xi. Nutritional Rehabilitation Centres (NRC):
 Nutritional Rehabilitation Centers are facility based units providing medical and
nutritional therapy to children with Severe Acute Malnourished under 5 years of
age with medical complications.
 In addition special focus is on improving the skills of mothers on child care and
feeding practices so that child continues to receive adequate care at home.
Expansion of NRCs has been ensured in High Need Areas such tribal blocks. A
total of 875 NRCs have been established in the country as on September, 2014.
 ASHAs are now entitled to receive incentives for follow up visits after child is
discharged from facility or community based SAM management and till MUAC
(Mid -Upper Arm Circumference)is equal to or more than 125mm.

6. SUPPLEMENTATION WITH MICRONUTRIENTS:
i. Iron Folic Acid Supplementation and deworming to children
(6 months to 59 months) and children (6-10 years): (by mohfw in
Jan, 2013) Bi-weekly IFA syrup to children 6m – 5 years and weekly IFA tablets
to children (6-10 years) and bi-annual deworming to children 1-10 years is part
of the National Iron Plus Initiative.
ii. Vitamin A Supplementation in under-five children: 1st dose of
Vitamin A (1 lakh I.U.) is being given to the child at the time of immunization at 9
months of age, and thereafter, the child is administered doses of Vitamin A (2
lakh I.U. of Vitamin A) at 6 monthly interval, so that a child receives a total of 9
doses of Vitamin A till the age of 59 months.

7. REDUCTION IN MORBIDITY AND MORTALITY DUE TO ACUTE
RESPIRATORY INFECTIONS (ARI) AND DIARRHOEAL
DISEASES:
i. Childhood Diarrheal Diseases: every child treated for diarrhea should
get one/two ORS packets along with 14 tablets of Zinc and counselling for
feeding at the start of therapy
ii. Acute Respiratory Infections (ARI): Cotrimoxazole and Amoxicillin is
the drug at community level for non-severe pneumonia. Provisions for
equipments such as Nebulizers, Pulse Oximeters and relevant injectable
antibiotics at each level.

iii. Integrated Management of Neonatal and Childhood Illnesses
(IMNCI): Medical officers and staff nurses would be trained in facility based
IMNCI to provide care to sick children and newborns at CHCs/FRUs.
iv. Universal Immunization Program:
 With an aim of Measles elimination and Rubella control, Measles Rubella (MR)
vaccine is being introduced replacing measles vaccine in routine immunization,
preceded by a wide age range, (9 months< 15 years). So far more than 22 crore
children in India have been safely vaccinated in MR campaigns already
completed in 30 states/UT across the country (as on 7 January 2019)
 Mission Indradhanush (MI) was introduced in 2014 in low performing districts,
to achieve over 90% full immunization coverage among children in the country by
2020, by focusing on areas with the poorest immunization coverage.

7. RASHRTIYA BAL SWASTHYA KARYAKRAM (RBSK): (Feb,
2013)
 For early child health screening and early intervention services
through early detection and management of 4 ‘D’s i.e Defects at
birth, Diseases, Deficiencies, Development delays including
disability

Improve Maternal Health:
TARGET 6 : Reduce by three quarters, between 1990 and 2015, the
maternal mortality ratio
Indicator 16: Maternal mortality ratio (per
100,000 live births)
167 (2011-13)
Indicator 17: Proportion of births attended by
skilled health personnel
81.4% (2015- 16)

Indicator 16: Maternal Mortality Ratio

Maternal Mortality Ratio:
• The Maternal Mortality Ratio is the number of women who die from
any cause related to or aggravated by pregnancy or its
management (excluding accidental or incidental causes) during
pregnancy and childbirth or within 42 days of termination of
pregnancy, irrespective of the duration and site of the pregnancy,
per 100,000 live births.
• Such deaths are affected by various factors, including general
health status, education and services during pregnancy and
childbirth.
• Most maternal deaths are avoidable by improving access to ante
natal care in pregnancy, skilled care during childbirth, and care and
support in the weeks after childbirth will reduce maternal deaths
significantly.

• The number of maternal deaths per year has come down from
approximately 1,00,000 deaths (1991-01) to 44,000 deaths in 2011-
13.
• The present status shows that, even now, 120 women die of
causes associated with pregnancy, in a day, in India.
• There are various approaches for measuring maternal mortality like
Civil Registration System, household surveys, Census,
Reproductive Age Mortality studies etc.
• The Office of the Registrar General of India (ORGI) under the
Ministry of Home Affairs, Government of India provides estimates of
Maternal Mortality Ratio (MMR) using demographic data collected
through the Sample Registration System (SRS).

Source: M/o Health and Family Welfare

• Among the major States, the MMR ranges from 61 in Kerala to 300
in Assam in 2011-13.
• In the States of Bihar/ Jharkhand (208), Madhya Pradesh /
Chhattisgarh (221), Orissa (222), Rajasthan (244), Uttar Pradesh /
Uttarakhand (285) and Assam (300), the MMR estimates were
higher than the estimate at all India level (167).
• The Office of Registrar General of India (ORGI), also releases
estimates for Maternal Mortality Rate and Life Time Risk.
• MM rate was 20.7 in 2004 -06, it decreased to 11.7 in 2011-13.
• At all India level, the Life Time Risk is 0.4%

• As per the
Sample
Registration
System
estimates of
2011-13, 68% of
maternal deaths
were women in
the age group of
20-29 years.

States/UT
s
1997-
98
2001-03
2004-
06
2010-
12
2011-
13
2014-
16
Target
2015
West
Bengal
303 194 141 117 113 101 167
India 398 301 254 178 167 130 109

Indicator 17: Proportion of births
attended by skilled health personnel

Proportion of births attended by skilled health
personnel:
• The proportion of births attended by skilled health personnel is the
percentage of deliveries attended by personnel trained to give the
necessary supervision, care and advice to women during
pregnancy, labor and the post-partum period; to conduct deliveries
on their own; and to care for newborns.
• Skilled health personnel include only those who are properly
trained and who have appropriate equipment and drugs.
• The NFHS - 4 showed that at all India level, 81.4% births were
assisted by a doctor/ nurse/ LHV/ ANM/ Other health personnel.

personnel:
Source: NFHS -4

Births assisted by a doctor/nurse/LHV/ANM/other
health personnel(%) (2015-16):
States Urban Rural Total
West Bengal 88.5 79 81.7
India 90 78 81.4
Source: NFHS-4, M/o Health and Family Welfare

1. Promotion of institutional deliveries through Janani Suraksha
Yojana, (April 2005): For bringing pregnant women to health facilities for
ensuring safe delivery and emergency obstetric care
2. Janani Shishu Suraksha Karyakaram (JSSK), (1st June, 2011):
 The entitlements include free drugs and consumables, free diagnostics, free diet
during stay for normal delivery and C-section and free blood whenever required.
 This initiative also provides for free transport from home to institution, between
facilities in case of a referral and drop back home.
 Similar entitlements were put in place for all sick newborns accessing public
health institutions for treatment till 30 days after birth.
 In 2013, the scheme was expanded to cover complications during ante-natal and
post-natal period and also sick infants up to 1 year of age

3. Pradhan Mantri Surakshit Matritva Abhiyan
 The objective is a special ANC checkup to all pregnant women by a private
doctor on 9th of every month to detect any risk factor in the pregnant women with
its timely management and birth planning for a safe delivery.
4. Pradhan Mantri Matru Vandana Yojana (PMMVY): (2016)
 The scheme will help in improving health seeking behavior and nutrition among
the Pregnant Women and Lactating Mothers (PW&LM) to reduce the effects of
under-nutrition namely stunting, wasting and other related problems.
 PMMVY envisages cash incentive amounting to Rs. 5000/- directly to the
Bank/Post Office Account of PW& LM during pregnancy and lactation in response
to individual fulfilling specific conditions

5. Antenatal, Intranatal and Postnatal care including Iron and
Folic Acid supplementation to pregnant & lactating women for
prevention and treatment of anemia
6. Maternal Death Review
7. Comprehensive Abortion Care Services to reduce maternal death
due to unsafe abortions. “YUKTI YOJNA” in Bihar.

8. New guidelines have been prepared and disseminated to the states for
Screening for
 Diagnosis & Management of Gestational Diabetes Mellitus,
 Hypothyroidism during Pregnancy,
 Training of General Surgeons for performing Caesarean Section,
 Calcium supplementation during pregnancy and lactation,
 Deworming during pregnancy,
 Maternal Near Miss Review,
 Screening for Syphilis during pregnancy,
 Prevention of Post-partum Hemorrhage through Community Based Distribution of
Misoprostol.

9. A policy decision has been taken for universal screening of HIV and syphilis in
pregnant women to diagnose and treat Sexually transmitted infections (STIs)
and reproductive tract infections (RTIs) in pregnant women.
10.Human Resource:
i. Capacity building of MBBS doctors in Anesthesia (Life Saving Anesthesia Skills
- LSAS) and Emergency Obstetric Care including C-section (EmOC) skills
particularly in rural areas and Skilled Birth Attendants training of
SNs/ANMs/LHVs for improving quality in care during pregnancy and child birth
ii. Quality of training of nurses, training institutions for nursing – midwifery are
being strengthened by upgrading Govt. college of nursing in some areas into
National Nodal Centers and 6 weeks customized training of ANM/GNM and
faculty nurses.

11.Initiatives taken to strengthen health systems
 To sharpen the focus on the low performing districts, 184 High Priority Districts(HPDs)
have been identified.
 Engagement of Accredited Social Health Activists (ASHAs) to facilitate accessing of
health care services by the community.
 Strengthening of over 20,000 delivery points in terms of infrastructure, equipment,
and trained manpower under RMNCHA services.
 Operationalization of sub-centres, Primary Health Centres, Community Health
Centres and District Hospitals for providing 24x7 services.
 Under NHM, 100 / 50/ 30 bedded MCH Wings are being established in District/ Sub-
District Hospitals/ CHC-FRUs
 Web Enabled Mother and Child Tracking System (MCTS)
 A joint Mother and Child Protection Card of Ministry of Health & Family Welfare and
Ministry of Women and Child Development (MOWCD)

Improve Maternal Health:
TARGET 7 : Have halted by 2015 and begun to reverse the spread of
HIV/AIDS
Indicator 18: HIV Prevalence among pregnant
women aged 15-24 years
0.25% (2015)

COMBATING LIFE THREATENING DISEASE

Indicator 18: HIV prevalence among
pregnant women aged 15-24 years (%)

HIV prevalence among pregnant women aged
15-24 years (%)
Source: HIV Sentinel Surveillance 2015, D/o AIDs Control
• The
prevalence of
HIV among
pregnant
women aged
15-24 years
is showing a
declining
trend from
0.89 % in
2005 to
0.25% in
2015.

HIV prevalence among pregnant women aged 15-24
years (%)
• In the HIV Sentinel Surveillance 2015, ‘nil’ HIV prevalence (%)
among pregnant women aged 15-24 years was reported from the
State/ UT's of Andaman & Nicobar Islands, Arunachal Pradesh,
Chandigarh, Dadra & Nagar Haveli, Daman & Diu, Delhi, Goa,
Himachal Pradesh and Kerala.
• Nagaland reported the highest HIV prevalence among pregnant
women aged 15-24 years (1.63%)

HIV prevalence among pregnant women aged
15-24 years (%)
States 2004 2005 2007 2010-11 2015
West Bengal 0.36 0.81 0.38 0.11 0.1
India 0.86 0.89 0.49 0.39 0.25
Source: HIV Sentinel Surveillance

National AIDS Control Programme- Phase IV:
• Launched in 1992, is being implemented as a comprehensive programme for
prevention and control of HIV/AIDS in India
• NACP Phase-IV aims to accelerate the process of reversal and further strengthen
the epidemic response in India through a cautious and well-defined integration
process
• The NACP-IV objective is to reduce new infection by 50% (2007 baseline of
NACP-III) and comprehensive Care, Support and Treatment to all persons living
with HIV/AIDS.
• Preventive services:
 Prevention of Parent to Child Transmission (PPTCT) under NACP involves free
counseling and testing of pregnant women, detection of HIV positive pregnant
women, and the administration of prophylactic ARV drugs to HIV positive pregnant
women and their infants to prevent the mother to child transmission of HIV.

Summary of Progress of MDG indicators related to
MCH
Indicator Year 1990 Latest status
MDG Target
2015
MDG 1: ERADICATE EXTREME POVERTY AND HUNGER
TARGET 2: Halve, between 1990 and 2015, the proportion of people who suffer from hunger
Status: In progress
Proportion of under-weight children below 3
years (%)
52 33.7 (2015) 26
MDG 4: REDUCE CHILD MORTALITY
TARGET 5 : Reduce by two-thirds, between 1990 and 2015, the Under- Five Morality Rate
Status: Nearly achieved
Under five mortality rate (per 1000 live births) 126 43 (2015) 42
Infant Mortality rate (per 1000 live births) 80 34 (2016) 27
Proportion of 1 year-old children immunized
against measles
42.2 81.1 (2015-16) 100

Summary of Progress of MDG indicators related to
MCH
Indicator Year 1990 Latest status
MDG Target
2015
MDG5 5: IMPROVE MATERNAL HEALTH
TARGET 6 : Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio
Status: In progress
Maternal mortality ratio (per 100,000 live
births)
437 167 (2011-13) 109
personnel (%)
33 81.4 (2015-16) 100
MDG 6: COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES
TARGET 7 : Have halted by 2015 and begun to reverse the spread of HIV/AIDS
Status: Achieved
HIV Prevalence among pregnant women
aged 15-24 years ( % )
0.25% (2015)
Reversal of
trend

Progress towards achieving mch mdg

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