Maternal and Child Health Worldwide

Maternal Mortality - Global Grim Reaper

• Definition: Death of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by the pregnancy or its management (excluding accidental/incidental causes).
• Key Metric: Maternal Mortality Ratio (MMR): No. of maternal deaths per 100,000 live births during a specific time period.
• Major Global Causes:
  • Severe hemorrhage (esp. Postpartum Hemorrhage - PPH)
  • Infections (sepsis)
  • Hypertensive disorders (pre-eclampsia, eclampsia)
  • Unsafe abortion
  • Obstructed labor
• Three Delays Model (Thaddeus & Maine):
  • Delay 1: Deciding to seek care.
  • Delay 2: Reaching health facility.
  • Delay 3: Receiving adequate care at facility.
• 

⭐ SDG Target 3.1: Reduce global MMR to <70 per 100,000 live births by 2030.

Child Mortality - Tiny Targets, Big Threats

• Metrics (per 1000 live births):
  • NMR (<28 days)
  • IMR (<1 year)
  • U5MR (<5 years)
• Top Threats (U5s):
  • Pneumonia (top infectious cause)
  • Diarrhea
  • Malaria
  • Prematurity/LBW
  • Birth Asphyxia, Neonatal Sepsis
• Defenses:
  • IMNCI (Integrated Management of Neonatal & Childhood Illnesses)
  • EPI (Expanded Programme on Immunization)
  • ORS & Zinc (diarrhea)
  • Exclusive Breastfeeding (first 6 months)
  • SBA (Skilled Birth Attendance)

⭐ Pneumonia is the single largest infectious cause of death in children worldwide.

MCH Nutrition - Fueling Futures

• Key Deficiencies:
  • Iron: Anemia. Prophylaxis: 100mg Fe + 500µg folic acid/day x 100 days (preg).
  • Iodine: IDD (cretinism). Salt iodization ≥15 ppm.
  • Vit A: VAD (xerophthalmia). Prophylaxis: 1L IU (9m), then 2L IU q6m to 5yrs.
  • Zinc: Growth, immunity. 10-20mg/day x 14 days with ORS for diarrhea.
• Breastfeeding (BF):
  • Exclusive (EBF): First 6 months.
  • Colostrum: "First vaccine", rich IgA.
  • Continue BF with complementary foods up to ≥2 years.
• Maternal Diet:
  • ↑Energy: Preg +350 kcal/d (2nd/3rd tri); Lactation +600 kcal/d (0-6m).

⭐ Exclusive breastfeeding for the first 6 months reduces infant mortality from common childhood illnesses.

Global MCH Initiatives - Worldwide Warriors

• Key Global Actors:
  • WHO: Norms, standards, research agenda.
  • UNICEF: Child health, nutrition, WASH, education.
  • UNFPA: Reproductive health, family planning, maternal health.
  • World Bank: Financial & technical aid for health systems.
• Core Strategies:
  • RMNCAH+N Framework: Integrated care continuum (Reproductive, Maternal, Newborn, Child, Adolescent Health & Nutrition).
  • Global Strategy for Women's, Children's and Adolescents' Health (2016-2030).
• Relevant SDGs:
  • SDG 2: End hunger, achieve food security, improved nutrition.
  • SDG 3: Ensure healthy lives, promote well-being (targets MCH).
  • SDG 5: Achieve gender equality, empower women/girls.

⭐ The RMNCAH+N strategy emphasizes a life-course approach to health, addressing needs from pre-conception through adolescence and linking to nutrition explicitly (+N).

High‑Yield Points - ⚡ Biggest Takeaways

• Major causes of maternal mortality: Hemorrhage, hypertension, sepsis.
• Leading neonatal death causes: Preterm birth, asphyxia, infections.
• Key interventions: Antenatal care (ANC), skilled birth attendance, postnatal care (PNC).
• IMNCI is a vital strategy for child survival.
• SDG 3 targets reducing MMR and preventable newborn/child deaths.
• Malnutrition is a critical factor in maternal and child health.
• India's JSSK & PMSMA aim to improve MCH services.