1. WOMEN AND CHILD HEALTH A REJIG OF POLICIES REQUIRED

2. Dr Harshindar Kaur,M.D. (Paediatrics ) Deputy Medical Superintendent Govt. Medical College and Rajindra Hospital, Patiala (Punjab ) Email-drharshpatiala@yahoo.com

3. PRESENT SITUATION IN INDIA More than a third of wasted children of world in India. More than a third of wasted children of world in India. 20 % of children less than 5 years suffer from acute malnutrition. 20 % of children less than 5 years suffer from acute malnutrition. 48 % children have stunted growth. 48 % children have stunted growth. Under nutrition more in rural areas,illiterate and undernourished mothers. Under nutrition more in rural areas,illiterate and undernourished mothers. Highest no. of LBW babies in world ( 7.4 Million every Year ) Highest no. of LBW babies in world ( 7.4 Million every Year ) Only 46 % of children <6 months are breastfed. Only 46 % of children <6 months are breastfed. 70 % of children < 5 Years are anemic. 70 % of children < 5 Years are anemic.

4. < 50 % households use iodized salt. < 50 % households use iodized salt. 200 Million women are in reproductive age group –benefits of Green Revolution not transformed into better maternal and child health. 200 Million women are in reproductive age group –benefits of Green Revolution not transformed into better maternal and child health. MMR in India,300-1000/100,000 live births accounts for 45 % of maternal deaths of world. In developed world it is 2 /100,000 live births. MMR in India,300-1000/100,000 live births accounts for 45 % of maternal deaths of world. In developed world it is 2 /100,000 live births. Out of 30 years of reproductive lifespan of average Indian female 16 years spent in pregnancy and lactation. Out of 30 years of reproductive lifespan of average Indian female 16 years spent in pregnancy and lactation.

5. INDIA -14% of population is calorie deficient. Average Female-deficiency of 100 Cal /Day. Average Maleexcess of 800 Cal /Day. Deficiency Statewise-AP (23%),UP(65%),Punjab (25-75% in privileged and underprivileged ) Difference magnified –Poverty, Low Socioeconomic status, floods and drought.

6. Nutritional stress in majority of females starts in childhood,aggravates in adolescence,pregnancy and lactation leading to premature deaths.

7. ROLE OF NUTRIENTS IN PREGNANCY VIT B COMPLEX AND FOLIC ACID –development of brain and spinal cord. VIT B COMPLEX AND FOLIC ACID –development of brain and spinal cord. VIT A –prevent developmental defects and maintain vision. VIT A –prevent developmental defects and maintain vision. IODINE-prevention of mental retardation,prematurity and stillbirth. IODINE-prevention of mental retardation,prematurity and stillbirth. IRON-deficiency leads to premature birth, defective brain development and medical problems in mother and child. IRON-deficiency leads to premature birth, defective brain development and medical problems in mother and child.

8. ZINC-deficiency leads to IUGR,congenital malformations and death in utero. ZINC-deficiency leads to IUGR,congenital malformations and death in utero. CALCIUM and VIT D –reqd. for strengthening bones of mother and child. CALCIUM and VIT D –reqd. for strengthening bones of mother and child. VIT B 12-deficiency causes growth retardation and IUD. VIT B 12-deficiency causes growth retardation and IUD. VIT C, K,Mg, Phosphorus – reqd. for growth of fetus and health of mother. VIT C, K,Mg, Phosphorus – reqd. for growth of fetus and health of mother. PROTEINS-reqd. for proper growth of fetus and health of mother. PROTEINS-reqd. for proper growth of fetus and health of mother.

9. MAJOR PROBLEMS IN MCH AND WAYS TO TACKLE A. LBW (weight <2500gm) Worldwide prevalence-14 % of all live births (93 % in developing world ) Prevalence in India-28 %,USA -8%. Target < 10 % in 2010. Causes a) Identify pregnancy at risk –maternal malnourishment, more workload, Infections and medical diseases and BOH.

10. INTERVENTIONS Supplementary feeding,FA supplementation,food fortification and enrichment. Supplementary feeding,FA supplementation,food fortification and enrichment. Controlling infections like –malaria,UTI and TORCH. Controlling infections like –malaria,UTI and TORCH. Early detection of medical diseases- DM,HT and PIH. Early detection of medical diseases- DM,HT and PIH. Indirect interventions like family planning,decrease smoking and improve health and nutrition of young girls. Indirect interventions like family planning,decrease smoking and improve health and nutrition of young girls.

11. B. INFANT MORTALITY I M R –World average 47/1000live births I M R –World average 47/1000live births India- 83/1000 (1990 ) India- 83/1000 (1990 ) 54/1000(2007 ) 54/1000(2007 ) USA-5/1000live births Target- <30/1000live births (by 2010 ) Target- <30/1000live births (by 2010 ) Causes-LBW, birth weight >4000gm,age of mother 30 yrs,high order of pregnancy and birth spacing 4000gm,age of mother 30 yrs,high order of pregnancy and birth spacing <1 year.

12. PREVENTION OF INFANT MORTALITY Birth spacing (>2 Years ) postponement of 1 st pregnancy, delaying age of marriage,free education to girls, improving health of mothers and girls,exclusive breast feeding for 6 months and immunization.

13. C MATERNAL MORTALITY LIFE TIME RISK 1/92 PREGNANCIES (WORLDWIDE ) 1/92 PREGNANCIES (WORLDWIDE ) 1/76 (DEVELOPING COUNTRIES ) 1/76 (DEVELOPING COUNTRIES ) 1/8000 (DEVELOPED COUNTRIES ) 1/8000 (DEVELOPED COUNTRIES ) MATERNAL MORTALITY RATE- MATERNAL MORTALITY RATE- India 301/100,000 live births India 301/100,000 live births USA 2/100,000 live births USA 2/100,000 live births Target -30/100,000 live births (by 2010 ) Target -30/100,000 live births (by 2010 ) Causes-obstetrical (80 % ) like bleeding, infections,eclampsia etc.

14. AT RISK PREGNANCIES 1. Anemia 2. Bad Obstetrical History. 3. Wt <35 Kg 4. DM, HT,UTI, Heart Disease 5. Parity >5 6. Age >30 and 30 and <19 years 7. Height <140cm 8. Low socioeconomic status

15. PREVENTION 1. At least 3 antenatal visits (37 % at present ) 2. Early registration of pregnancy 3. Control of infections 4. Early treatment of medical diseases. 5. Correction of malnutrition. 6. Clean delivery practices or by trained Dais (47 % present rate, target by 2010 was 100 % ) 7. 7.Institutional deliveries for high risk cases (39 % present rate,target was 80 % by 2010 )

16. POLICY MODIFICATIONS 1.MATERNAL NUTRITION- Micronutrient rich food by food enrichment and fortification,e.g. flour, bread,oil, ghee,sugar and salt.(Iodine in salt, Iron in flour,Vit. D and A in Ghee and cooking Oil) Micronutrient rich food by food enrichment and fortification,e.g. flour, bread,oil, ghee,sugar and salt.(Iodine in salt, Iron in flour,Vit. D and A in Ghee and cooking Oil) 2. Adolescent young girls-targets of nutritional intervention programs like supplementary nutrition, protective and functional foods in rural areas,iron and FA tablets,propagation of egg intake as good source of proteins and vitamins (NECC board )

17. 3. Free and compulsory education to girls –most effective way to delay age of marriage and conception,postponement of 1 st pregnancy. Illiterate mothers have twice the fertility rate and more IMR (145-Illiterate mothers,101-some education and 71 –Primary education ) Illiterate mothers have twice the fertility rate and more IMR (145-Illiterate mothers,101-some education and 71 –Primary education ) 4. National awareness programs aimed at rural mothers to inculcate healthy and nutritious dietary patterns amongst them as supplementation alone cannot be a permanent solution. 5. All dietary interventions should be started <3 years of age because disturbed homeostasis like growth retardation starts at 3 years age.

18. 6.Full coverage through mid day meals in schools and anganwaadis,food supplementation started at home for children <3 Years age and adolescent girls. 7. To tackle childhood obesity awareness programs and changing KAP for healthy dietary habits as drastic shifts in diet patterns and activity levels are leading to adult disease in pediatric age group. 8.Iodised Oil injection to pregnant and young girls to tackle endemic iodine deficiency (effective for 5 Years ) 9. Increase public spending on health to 3 % of GDP (Present 1 % )

19. EFFECT OF MOTHER EMPLOYMENT 10. Income of mother leads to better nutritional status of family especially the daughters. Off Season employment of women and food for work programs like MNREGA need to be strengthened and made corruption free. Off Season employment of women and food for work programs like MNREGA need to be strengthened and made corruption free.

20. 11. Food availability needs to be increased and be made affordable by Direct market interventions by Direct market interventions and and Promoting FDI in retail. Food expenditure INDIA-49.5% WORLDWIDE-38 % Below Poverty Line INDIA-68.7% WORLDWIDE-29.5% India ranks 66/105 countries in terms of food availability. lINDIA-68.7 % WORLDWIDE-29.5 % India ranks 66/105 countries regarding food availability

21. FAST FOODS 12.Banning fast foods and junk foods in school canteens and around school premises,no advertisements of fast foods around schools along with teaching healthy nutrition to children will aid in fighting childhood obesity. Children not to feature in ads of fast foods. 13. All fast food joints be legally liable to include nutritionally balanced recipes in menu. 14. Ingredients along with calorie content displayed in all fast food joints.

22. 14. Usage of child care facilities Prevalence of Kwashiorkor is 4 times in girls than boys,still 50 % admissions of these patients are of boys Prevalence of Kwashiorkor is 4 times in girls than boys,still 50 % admissions of these patients are of boys Girls –taken to less qualified doctors while more money spent on boys. Girls –taken to less qualified doctors while more money spent on boys. Improvement in educational status and income levels would remove this bias against girls. Improvement in educational status and income levels would remove this bias against girls. KERALA-Ideal example of women emancipation – literacy, people participation and responsive government. KERALA-Ideal example of women emancipation – literacy, people participation and responsive government.

23. CONCLUSION Maternal and Child Health targets have been accepted since 1990 (World Summit for Children) and revised again and again –India still a laggard. Preventive strategies like Balanced diet,promotion of exclusive breast feeding under 6 months of age,Immunization,avoidance of addictions,good sanitation, availability of clean water and air along with universal education are more effective measures than interventions later on. Preventive strategies like Balanced diet,promotion of exclusive breast feeding under 6 months of age,Immunization,avoidance of addictions,good sanitation, availability of clean water and air along with universal education are more effective measures than interventions later on.

24. THANK YOU