Maternal and child health care indicator
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maternal and child health indicators list WHO 2024
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Maternal and Child Health (MCH) Indicators
MCH indicators are quantifiable measures used to assess the health status and service coverage of mothers and children. They serve three functions: monitoring health trends, evaluating program effectiveness, and guiding resource allocation. Below is a detailed breakdown organized by category.
A. Family Planning Indicators
These reflect population-level reproductive behavior and contraceptive use.
| Indicator | Definition |
|---|---|
| Crude Birth Rate (CBR) | Number of live births per 1,000 mid-year population per year |
| Total Fertility Rate (TFR) | Average number of children a woman would have in her lifetime at current age-specific fertility rates |
| Couple Protection Rate (CPR) | Percentage of eligible couples (wife aged 15-44) effectively protected against pregnancy by a contraceptive method |
| General Fertility Rate (GFR) | Number of live births per 1,000 women aged 15-44 per year |
| Sex Ratio | Number of females per 1,000 males (or vice versa) |
India target (NHP 2017): TFR of 2.1 by 2025; SDG 2030 target for MMR <70/100,000 live births.
B. Mortality Indicators
1. Maternal Mortality
Maternal Mortality Ratio (MMR)
- Defined as the number of maternal deaths per 100,000 live births in the same time period
- Quantifies the obstetric risk per pregnancy
- India (2016-18): 113/100,000 live births; SDG 2030 target: <70
Maternal Mortality Rate (MMRate)
- Number of maternal deaths divided by person-years lived by women of reproductive age
- Captures both risk per pregnancy and the fertility level of the population
Adult Lifetime Risk of Maternal Death
- Probability that a 15-year-old girl will eventually die from a maternal cause
- Takes into account competing causes of death
Proportion of Maternal Deaths (PM)
- Number of maternal deaths / total deaths among women aged 15-49 years
(Source: Park's Textbook of Preventive and Social Medicine, pp. 649-650)
2. Child Mortality Indicators
| Indicator | Definition | Formula |
|---|---|---|
| Infant Mortality Rate (IMR) | Deaths under 1 year per 1,000 live births | Deaths <1 yr / Live births × 1,000 |
| Neonatal Mortality Rate (NMR) | Deaths in first 28 days per 1,000 live births | Deaths 0-28 days / Live births × 1,000 |
| Post-neonatal Mortality Rate | Deaths from 28 days to 1 year per 1,000 live births | - |
| Under-5 Mortality Rate (U5MR) | Deaths under 5 years per 1,000 live births | Deaths <5 yrs / Live births × 1,000 |
| Perinatal Mortality Rate | Stillbirths + deaths in first 7 days per 1,000 births | - |
| Stillbirth Rate | Fetal deaths at ≥28 weeks gestation per 1,000 total births | - |
India targets (NHP 2017):
- IMR: <28 by 2019 (Current: 32/1,000)
- NMR: 16 by 2025 (Current: 23/1,000); SDG target: <12
- U5MR: 23 by 2025 (Current: 36); SDG target: ≤25
(Source: Park's Textbook, Table 11, p. 648)
C. Service Coverage (Process) Indicators
These are the most practically useful indicators to assess ongoing programme interventions.
Antenatal Care (ANC) Indicators
- % mothers registering pregnancy in first trimester - India: 58.6% (NFHS-4)
- % receiving at least 4 ANC visits - India: 51.2% (urban 66.4%, rural 44.8%)
- % receiving full antenatal care - India: 21.0% (huge urban-rural gap: 31.1% vs 16.7%)
- % protected against neonatal tetanus - India: 89.0%
- % consuming Iron-Folic Acid for ≥100 days - India: 30.3%
- % receiving Mother-Child Protection (MCP) card - India: 80.3%
Delivery Care Indicators
- Institutional birth rate (%) - India: 78.9% (urban 88.7%, rural 75.1%)
- Births attended by skilled health personnel (%) - Globally key SDG indicator (Goal 3.1)
- Caesarean section rate (%) - India: 17.2% (urban 28.3%, rural 12.9%)
- Home delivery by skilled personnel (%) - India: 4.3%
Postnatal Care (PNC) Indicators
- % mothers receiving PNC within 2 days of delivery - India: 62.4%
- % newborns receiving health check within 2 days of birth - India: 24.3%
- % children born at home taken to facility within 24 hours - India: 2.5%
Financial Protection Indicators
- % receiving JSY (Janani Suraksha Yojana) financial assistance - India: 36.4%
- Average out-of-pocket expenditure per delivery in public facility - India: ₹3,198
D. Child Health Service Indicators
| Indicator | Definition |
|---|---|
| Immunization coverage | % children fully immunized (BCG, OPV, DPT, Measles) |
| Measles immunization rate | India: 80% (NHP 2017 target: >90%) |
| Exclusive breastfeeding rate | % infants exclusively breastfed up to 6 months |
| Vitamin A supplementation coverage | % children 6-59 months receiving Vitamin A |
| ORS use rate for diarrhea | % children with diarrhea receiving Oral Rehydration Salts |
| Wasting / stunting / underweight prevalence | Nutritional status indices (weight-for-height, height-for-age, weight-for-age) |
E. SDG Health Indicators for MCH (Goal 3)
The WHO SDG indicator framework maps MCH to specific targets:
| SDG Target | Indicator |
|---|---|
| 3.1 - Reduce MMR <70/100,000 | Maternal Mortality Ratio |
| 3.1 - Skilled birth attendance | % births attended by skilled personnel |
| 3.2 - End preventable child deaths | Neonatal Mortality Rate; U5MR |
| 3.7 - Universal reproductive healthcare | Adolescent birth rate; contraceptive prevalence |
| 3.8 - Universal health coverage | UHC service coverage index (RMNCH sub-index) |
(Source: Park's Textbook, Table 3, p. 646)
F. Nutritional & Socio-economic Context Indicators
These are important determinants used alongside direct health measures:
- Low birth weight rate (<2,500 g at birth)
- Anaemia prevalence in pregnant women and children
- Female literacy rate (strongly correlated with IMR and MMR)
- Sex ratio at birth
- Gender Development Index (GDI)
- Poverty headcount ratio
Summary: Why MMR + IMR are the Core MCH Indicators
As stated in Creasy & Resnik's Maternal-Fetal Medicine (p. 3164): "Maternal mortality is a summary indicator of maternity care, and combined with infant mortality it is a measure of the quality of a country's maternal-child health care."
However, MMR alone is insufficient - process indicators (ANC, skilled delivery, immunization) are needed to identify gaps in the continuum of care from preconception through postnatal life. The national average of these key indicators from NFHS-4 (India 2015-16) reveals persistent urban-rural and socioeconomic disparities, guiding targeted public health interventions.
Sources:
- Park's Textbook of Preventive and Social Medicine (23rd ed.), Chapter on MCH, pp. 648-655
- Creasy & Resnik's Maternal-Fetal Medicine, p. 3164
- WHO Global Dashboard on Child Health, 2024
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