Maternal and Child Health — MCQs

Maternal and Child Health Indian Medical PG Practice Questions and MCQs

Question 111: What is the primary function of the Kasturba Memorial Fund?

A. Relief work
B. Leprosy work
C. Tuberculosis work
D. Women development (Correct Answer)

Explanation: **Explanation:** The **Kasturba Gandhi National Memorial Trust (KGNMT)**, established in 1945 in memory of Kasturba Gandhi, is a pioneer voluntary organization in India. Its primary objective is the **upliftment and development of women and children**, specifically focusing on those residing in rural areas. **Why Option D is Correct:** The fund was created with the specific vision of empowering rural women through health, education, and literacy. It focuses on maternal health, vocational training, and social awareness, making "Women Development" its core functional pillar. **Analysis of Incorrect Options:** * **A. Relief work:** While many NGOs perform relief work during disasters, it is not the *primary* mandate of the Kasturba Fund. Organizations like the Indian Red Cross are more synonymous with primary relief work. * **B. Leprosy work:** Although the trust integrates general health services, specialized leprosy work is primarily associated with organizations like **Hind Kusht Nivaran Sangh** or the Gandhi Memorial Leprosy Foundation. * **C. Tuberculosis work:** TB control is the primary domain of the **Tuberculosis Association of India (TAI)** and the National TB Elimination Programme (NTEP). **High-Yield Facts for NEET-PG:** * **Target Population:** Rural women and children (not urban). * **Key Activities:** Balwadis (pre-schools), Arogya Seva (health services), and Gram Seva (village service). * **Historical Context:** It was established by Mahatma Gandhi to ensure that rural women lead a life of dignity and self-reliance. * **Related NGO:** Remember **SEWA** (Self-Employed Women’s Association) as another high-yield entity related to women's development in Community Medicine.

Question 112: When was the RCH programme launched?

A. 1993
B. 1995
C. 1997 (Correct Answer)
D. 1999

Explanation: **Explanation:** The **Reproductive and Child Health (RCH) Programme Phase I** was officially launched by the Government of India on **October 15, 1997**. This program marked a paradigm shift in India's public health strategy, moving away from target-based population control toward a client-centered, holistic approach. It integrated several existing programs, including the Child Survival and Safe Motherhood (CSSM) program and Family Planning services, into a single composite package. **Analysis of Options:** * **1997 (Correct):** The RCH Phase I was launched in 1997 following the recommendations of the 1994 International Conference on Population and Development (ICPD) in Cairo. * **1993:** This period was the peak of the **CSSM (Child Survival and Safe Motherhood)** program, which was launched in 1992. * **1995:** This year is significant for the launch of the **Pulse Polio Immunization (PPI)** program in India, but not RCH. * **1999:** This was during the implementation phase of RCH-I; however, the subsequent major milestone, **RCH Phase II**, was not launched until April 2005 (alongside the NRHM). **High-Yield Clinical Pearls for NEET-PG:** * **RCH Phase I (1997):** Focused on "Essential Obstetric Care," "Emergency Obstetric Care," and "Referral Services." * **RCH Phase II (2005):** Shifted focus to **Outcome-based monitoring** and introduced the concept of **Janani Suraksha Yojana (JSY)**. * **Components of RCH:** Includes Maternal Health, Child Health, Family Planning, and Adolescent Health (ARSH), along with the management of RTIs/STIs. * **Current Strategy:** The RCH program has now evolved into the **RMNCH+A** (Reproductive, Maternal, Newborn, Child, and Adolescent Health) strategy, launched in **2013**, emphasizing the "Continuum of Care."

Question 113: What defines an eligible couple?

A. A couple with two living children.
B. A couple who has had two children, regardless of whether they are alive.
C. A couple where the wife is between 15 and 45 years of age. (Correct Answer)
D. A couple willing to undergo sterilization.

Explanation: ### Explanation **1. Why the Correct Answer is Right:** In Community Medicine, an **Eligible Couple** refers to a currently married couple where the wife is in the reproductive age group, traditionally defined as **15 to 45 years**. These couples are considered "eligible" because they are at risk of conception and are the primary target group for family planning and maternal health interventions. In some contexts, the upper age limit is extended to 49, but 15–45 remains the standard definition for most national health programs and demographic surveys in India. **2. Why the Other Options are Incorrect:** * **Option A & B:** The number of children (living or deceased) does not define an "eligible couple." Instead, a couple with two or more living children is specifically termed a **"Target Couple."** Target couples are a priority subgroup of eligible couples prioritized for permanent sterilization methods. * **Option D:** Willingness to undergo sterilization is a behavioral intent, not a demographic definition. While eligible couples are the candidates for sterilization, the definition is based on biological reproductive potential and marital status. **3. NEET-PG High-Yield Pearls:** * **Eligible Couple Register:** Maintained by the ANM at the Sub-center level; it is updated annually and serves as the basic document for family planning work. * **Target Couple:** A couple with 2–3 living children who are actively encouraged to adopt permanent or long-term limiting methods. * **Eligible Couple per 1000:** In India, there are approximately **150–180 eligible couples per 1000 population**. * **Couple Protection Rate (CPR):** The percentage of eligible couples effectively protected against childbirth by one or the other approved methods of family planning.

Question 114: What is the name of the newer contraceptive program introduced in Family Planning?

A. Parivahana
B. Antara (Correct Answer)
C. Prerana
D. Indradanush

Explanation: **Explanation:** The correct answer is **Antara**. Under the revamped National Family Planning Program, the Government of India introduced two newer contraceptives to expand the "basket of choice": **Antara** and **Chhaya**. * **Antara:** This is an **Injectable Contraceptive (DMPA - Medroxyprogesterone Acetate)**. It is administered intramuscularly every 3 months (90 days). It works primarily by suppressing ovulation and thickening cervical mucus. * **Chhaya:** Introduced alongside Antara, this is a non-hormonal, non-steroidal once-a-week oral contraceptive pill (Centchroman). **Analysis of Incorrect Options:** * **Parivahana:** This is not a contraceptive program. It likely refers to transport-related schemes (e.g., *Mission Parivar Vikas* is the actual family planning mission, but "Parivahana" is a distractor). * **Prerana:** This is a strategy by the Jansankhya Sthirata Kosh (JSK) aimed at delaying marriage and spacing births among BPL families, but it is not the name of a specific contraceptive method. * **Indradanush (Mission Indradanush):** This is India’s flagship **immunization program** aimed at increasing full immunization coverage for children and pregnant women; it is unrelated to contraception. **High-Yield Clinical Pearls for NEET-PG:** * **Antara Dosage:** 150 mg IM every 3 months. * **Injection Site:** Deep intramuscular (Gluteal or Deltoid). Do not massage the site after injection. * **Common Side Effect:** Menstrual irregularities (amenorrhea or breakthrough bleeding) is the most common reason for discontinuation. * **Mission Parivar Vikas:** Launched in 146 high-fertility districts to accelerate access to these newer contraceptives.

Question 115: What are the functions of a female health worker?

A. Visit 4 subcentres per month for health assessment
B. Enlist dais of the sub-centre (Correct Answer)
C. Conduct 50% of deliveries
D. Perform chlorination of water

Explanation: In the Indian healthcare system, the **Female Health Worker (ANM - Auxiliary Nurse Midwife)** is the primary frontline worker at the **Sub-centre** level. Her role is pivotal in Maternal and Child Health (MCH) and Family Welfare. ### **Explanation of Options** * **Correct Answer (B): Enlist dais of the sub-centre.** One of the core responsibilities of the ANM is to identify and enlist **Traditional Birth Attendants (Dais)** within her catchment area. She is responsible for training them and involving them in the healthcare delivery system to ensure safer birthing practices and timely referrals. * **Option A (Incorrect):** Visiting 4 sub-centres per month is the duty of the **Health Assistant Female (LHV - Lady Health Visitor)**. The LHV acts as a supervisor for 6 sub-centres and is expected to visit each at least once a week. * **Option C (Incorrect):** While the ANM is trained to conduct deliveries, there is no fixed mandate to conduct "50% of deliveries." Her goal is to ensure **100% institutional delivery** or supervised delivery by a skilled birth attendant. * **Option D (Incorrect):** Chlorination of water and environmental sanitation are primarily the responsibilities of the **Male Health Worker (MPW-M)** and the Village Health Sanitation and Nutrition Committee (VHSNC). ### **High-Yield Facts for NEET-PG** * **Population Norms:** One ANM is posted at a Sub-centre (covering 5,000 population in plains; 3,000 in hilly/tribal areas). * **Supervision:** 1 LHV (Health Assistant Female) supervises **6 ANMs**. * **Key Duties:** Antenatal care (ANC), Immunization (Universal Immunization Programme), Family Planning counseling, and maintaining the **Eligible Couple Register**. * **The "Multipurpose" Concept:** Based on the **Kartar Singh Committee (1973)** recommendations, ANMs were designated as Female Health Workers.

Question 116: The National Iron Plus Initiative includes which of the following interventions?

A. Biweekly supplementation of iron and folic acid to children aged 6-60 months (Correct Answer)
B. Biweekly supplementation of iron and folic acid to pregnant and lactating women
C. Biweekly supplementation of iron and folic acid to adolescent girls
D. All of the above are part of the initiative

Explanation: The **National Iron Plus Initiative (NIPI)** was launched to address the high prevalence of anemia across the life cycle. The core strategy involves supervised Iron and Folic Acid (IFA) supplementation tailored to specific age groups. ### Why Option A is Correct Under NIPI guidelines, **children aged 6 to 60 months** are prescribed **biweekly (twice a week)** supplementation. The dosage is 1 ml of IFA syrup containing 20 mg of elemental iron and 100 mcg of folic acid. This frequent dosing is designed to build iron stores during a period of rapid growth and high nutritional vulnerability. ### Why Other Options are Incorrect * **Option B:** Pregnant and lactating women receive **daily** supplementation (100 mg elemental iron + 500 mcg folic acid) for 180 days during pregnancy and 180 days postpartum, not biweekly. * **Option C:** Adolescent girls (and boys) aged 10–19 years receive **weekly** supplementation (WIFS - Weekly Iron and Folic Acid Supplementation), not biweekly. * **Option D:** Since the frequencies for adolescents and pregnant women are incorrect, "All of the above" is false. ### High-Yield NEET-PG Pearls * **Age 5–10 years:** Weekly supplementation (45 mg Iron + 400 mcg Folic Acid). * **Adolescents (10–19 years):** Weekly supplementation (100 mg Iron + 500 mcg Folic Acid). * **Prophylaxis vs. Treatment:** NIPI focuses on prophylaxis. If a child is clinically anemic, the dosage shifts to therapeutic levels (3mg/kg/day). * **Color Coding:** IFA tablets for adolescents are **Blue**, while those for pregnant/lactating women are **Red**. Tablets for children (5-10 years) are **Pink**.

Question 117: All of the following are intranatal causes of perinatal mortality except?

A. Birth injuries
B. Birth asphyxia
C. Antepartum hemorrhage (Correct Answer)
D. Obstructed labor

Explanation: ### Explanation The **Perinatal Mortality Rate (PMR)** includes late fetal deaths (stillbirths after 28 weeks of gestation) and early neonatal deaths (deaths within the first 7 days of life). Causes are categorized based on the timing of the insult: **Antenatal** (before labor), **Intranatal** (during labor/delivery), and **Postnatal** (after birth). **Why Antepartum Hemorrhage (APH) is the correct answer:** Antepartum hemorrhage (bleeding from the genital tract after 28 weeks but *before* the onset of labor) is strictly an **Antenatal cause**. While it significantly contributes to perinatal mortality by causing fetal hypoxia or preterm birth, the insult occurs prior to the intranatal period. **Analysis of Incorrect Options (Intranatal Causes):** * **Birth Injuries:** These occur due to mechanical trauma during the process of delivery (e.g., shoulder dystocia, forceps application), making it a classic intranatal cause. * **Birth Asphyxia:** This refers to the failure to initiate or sustain breathing at birth, usually resulting from hypoxia during labor (e.g., cord prolapse or placental insufficiency during contractions). It is a leading intranatal cause of death. * **Obstructed Labor:** This is a purely intranatal complication where the fetus cannot descend through the birth canal despite good uterine contractions. It leads to fetal distress, rupture of the uterus, or birth asphyxia. **High-Yield Pearls for NEET-PG:** * **Definition of Perinatal Period:** Starts at 28 weeks of gestation and ends 7 days after birth. * **Most Common Cause of PMR in India:** Low Birth Weight (LBW) and Prematurity. * **Intranatal Period:** Defined from the onset of labor until the delivery of the placenta. * **PMR Formula:** (Late fetal deaths + Early neonatal deaths) / (Total Live births + Stillbirths) × 1000.

Question 118: In GOBI, what does the letter 'O' stand for?

A. Oral hygiene
B. Oral rehydration (Correct Answer)
C. Oral drugs
D. None of the above

Explanation: **Explanation:** The acronym **GOBI** was introduced by UNICEF in 1982 as a part of the "Child Survival Revolution." It represents a selective package of low-cost, high-impact primary health care interventions designed to reduce infant and child mortality in developing nations. * **Why 'Oral Rehydration' is correct:** The 'O' stands for **Oral Rehydration Therapy (ORT)**. Diarrheal diseases are a leading cause of death in children under five, primarily due to dehydration. ORT (using ORS solution) is a simple, cost-effective intervention that prevents and treats dehydration, significantly reducing child mortality. **Analysis of Incorrect Options:** * **A. Oral hygiene:** While important for general health, it is not a life-saving emergency intervention prioritized in the GOBI framework for reducing under-five mortality. * **C. Oral drugs:** This is too vague. While specific drugs (like antibiotics for pneumonia) are vital, the GOBI strategy focuses on specific, standardized interventions rather than general pharmacotherapy. **High-Yield Facts for NEET-PG:** * **GOBI components:** * **G:** Growth Monitoring (using Road to Health charts to detect malnutrition early). * **O:** Oral Rehydration. * **B:** Breastfeeding (exclusive breastfeeding for the first 6 months). * **I:** Immunization (against the six vaccine-preventable diseases). * **GOBI-FFF:** Later, three more elements were added to form GOBI-FFF: **F**emale Education, **F**amily Spacing, and **F**ood Supplementation. * **Concept:** This represents the "Selective Primary Health Care" approach, focusing on specific medical interventions rather than the "Universal" approach of the Alma-Ata Declaration.

Question 119: "Baby-friendly hospital initiative" (BFHI), created and promoted by WHO and which other organization?

A. UNICEF (Correct Answer)
B. USAID
C. UNDP
D. FAO

Explanation: **Explanation:** The **Baby-Friendly Hospital Initiative (BFHI)** was launched in **1991** as a joint global effort by the **World Health Organization (WHO)** and the **United Nations Children's Fund (UNICEF)**. The initiative was established to implement practices that protect, promote, and support breastfeeding, based on the **"Ten Steps to Successful Breastfeeding."** **Why UNICEF is correct:** UNICEF is the primary UN agency dedicated to the welfare and health of children. Since BFHI focuses on improving neonatal outcomes through optimal feeding practices, UNICEF partnered with WHO to mobilize health facilities worldwide to become "Baby-Friendly." **Why other options are incorrect:** * **USAID (B):** An independent agency of the US government focused on international development; while they fund health programs, they did not co-create the BFHI. * **UNDP (C):** Focuses on poverty eradication and sustainable economic growth rather than specific clinical maternal-child health protocols. * **FAO (D):** The Food and Agriculture Organization focuses on global hunger and food security, not hospital-based clinical practices. **High-Yield Clinical Pearls for NEET-PG:** * **The Ten Steps:** These are the core of BFHI. Key steps include initiating breastfeeding within **30 minutes** of birth, practicing **rooming-in** (keeping mothers and infants together 24 hours a day), and giving no food or drink other than breast milk unless medically indicated. * **Innocenti Declaration (1990):** The BFHI was a direct outcome of this declaration, which set global goals for breastfeeding. * **Prohibition:** Baby-friendly hospitals are prohibited from accepting free or low-cost breast milk substitutes (formula) or promoting pacifiers/artificial nipples.

Question 120: What is the recommended prophylactic iron and folic acid content according to the RCH program during pregnancy?

A. 500mg iron + 100 meg folic acid
B. 100mg iron + 500mcg folic acid (Correct Answer)
C. 100 mg iron + 100 meg folic acid
D. 20 mg iron + 100 meg folic acid

Explanation: ### Explanation The correct answer is **B. 100mg elemental iron + 500mcg folic acid.** **Underlying Medical Concept:** Iron deficiency anemia (IDA) is the most common nutritional deficiency during pregnancy in India. To combat this, the Reproductive and Child Health (RCH) program—now integrated under the **Anemia Mukt Bharat (AMB)** strategy—recommends prophylactic supplementation. The goal is to meet the increased physiological demands of the fetus and placenta and to compensate for the expansion of maternal blood volume. The standard prophylactic dose for pregnant women is **100 mg of elemental iron** (usually as 335 mg of Ferrous Sulphate) and **500 mcg (0.5 mg) of folic acid** daily for at least **180 days**, starting from the second trimester (after the first 12–14 weeks). **Analysis of Incorrect Options:** * **Option A & C:** 500 mg of iron is an excessively high daily dose that would lead to severe gastrointestinal toxicity. Conversely, 100 mcg of folic acid is insufficient; while 100 mcg may prevent megaloblastic anemia, 500 mcg is the standard to ensure adequate fetal neural development and maternal stores. * **Option D:** 20 mg of iron is the dosage used for **prophylaxis in children** (6 months to 5 years) under the AMB guidelines, not for pregnant women. **High-Yield Clinical Pearls for NEET-PG:** * **Therapeutic Dose:** If a pregnant woman is diagnosed with anemia (Hb < 11 g/dL), the dose is doubled to **100 mg iron + 500 mcg folic acid twice daily** for 180 days. * **Postpartum:** The same prophylactic dose (100mg Fe + 500mcg FA) should be continued for **180 days postpartum** (lactating period). * **Pre-conception:** To prevent Neural Tube Defects (NTDs), 400 mcg of folic acid is recommended daily starting 3 months before conception. * **IFA Tablet Color:** The adult IFA tablet (for pregnant women) is **Red**, while the pediatric tablet is **Pink**.

Practice by Chapter

Maternal Mortality: Causes and Prevention

Practice Questions

Antenatal Care

Practice Questions

Intranatal Care

Practice Questions

Postnatal Care

Practice Questions

High-Risk Pregnancy Management

Practice Questions

Infant Mortality: Causes and Prevention

Practice Questions

Under-Five Mortality

Practice Questions

Integrated Management of Neonatal and Childhood Illness

Practice Questions

School Health Services

Practice Questions

Adolescent Health

Practice Questions

Reproductive and Child Health Programs

Practice Questions

International Maternal and Child Health Initiatives

Practice Questions

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