Reproductive and Child Health Care (RCH) - Comprehensive Overview

1. Definition and Concept

"People have the ability to reproduce and regulate their fertility; women are able to go through pregnancy and childbirth safely; the outcome of pregnancies is successful in terms of maternal and infant survival and well-being; and couples are able to have sexual relations, free of fear of pregnancy and of contracting disease."

• Family Welfare Programme
• Universal Immunization Programme
• Oral Rehydration Therapy (ORT)
• Child Survival and Safe Motherhood (CSSM) Programme
• Acute Respiratory Infection (ARI) Control Programme

2. Components of the RCH Programme

A. Family Planning

• Spacing methods, particularly Post-Partum IUCD (PPIUCD) at high case-load facilities
• Interval IUCD insertion at all facilities on fixed days
• Home Delivery of Contraceptives (HDC) and Ensuring Spacing at Birth (ESB) through ASHAs
• Pregnancy Testing Kits ("Nischay Kits")
• Comprehensive abortion care services
• Quality sterilization services
• IUCD insertion, oral contraceptive pills (OCP), and condoms at sub-centre level

B. Maternal Health

• Use of Mother and Child Tracking System (MCTS) for early pregnancy registration
• Detection and line-listing of high-risk pregnancies (including severe anaemia)
• Equipping delivery points with trained personnel
• Emergency Obstetric Care (EmOC) through First Referral Units (FRUs)
• MCH Wings at high case-load facilities
• Review of maternal, infant, and child deaths for corrective action
• Strengthening referral systems

C. Newborn Health

• Early initiation and exclusive breast-feeding
• Home-based newborn care through ASHA
• Essential Newborn Care (ENC) and resuscitation at all delivery points
• Special Newborn Care Units (SNCUs) with trained HR
• Community-level use of Gentamycin by ANM for neonatal sepsis

D. Child Health

• Complementary feeding, IFA supplementation, and nutrition promotion
• Diarrhoea management using ORS and Zinc at community level
• Management of pneumonia (ARI)
• Full immunization coverage
• Rashtriya Bal Swasthya Karyakram (RBSK) - screening of children for "4Ds":
  1. Birth defects
  2. Development delays
  3. Deficiencies
  4. Diseases

E. Adolescent Health

• Address teenage pregnancy and increase contraceptive prevalence
• Community-based services through peer educators
• Strengthening ARSH (Adolescent Reproductive and Sexual Health) clinics
• Roll-out of National Iron Plus Initiative including weekly IFA supplementation
• Promote menstrual hygiene

3. Antenatal Care (ANC)

Schedule and Minimum Requirements

• Early registration of pregnancy
• Minimum 4 antenatal check-ups (at least one by a doctor, preferably the 3rd visit)
• At least one check-up in each trimester

Minimum Laboratory Investigations

Key ANC Interventions

• Nutrition and health counselling
• Supplementation of folic acid and iron tablets
• Tetanus Toxoid (TT) immunization
• Brief advice on tobacco cessation (if applicable)
• Tracking of missed and left-out ANC cases
• Identification of high-risk pregnancies (hypertension, anaemia, multiple pregnancy, malpresentations)
• Referral to FRU for high-risk cases

4. Intranatal Care

Key Services

• 24-hour service for normal delivery
• Promotion of institutional delivery
• Assisted deliveries (forceps and vacuum)
• Manual removal of placenta when needed
• Prompt referral for specialist care
• Management of Pregnancy-Induced Hypertension (PIH)
• Pre-referral management in obstetric emergencies
• Minimum 48 hours stay after delivery
• Use of Partograph to monitor labour progress
• Skilled identification of PPH, eclampsia, sepsis and prompt referral

5. Postnatal Care (PNC)

Schedule of PNC Visits

Services Provided

• Early initiation of breast-feeding within one hour of birth
• Counselling on nutrition, hygiene, contraception, and immunization
• Essential Newborn Care
• Provision under Janani Suraksha Yojana (JSY)
• Tracking of missed and left-out PNC cases

6. Newborn Care

Essential Newborn Care (ENC)

• Immediate drying and stimulation
• Provision of warmth (Kangaroo Mother Care/KMC for LBW babies)
• Hygienic cord care
• Early initiation of breast-feeding
• Administration of Vitamin K (prevents haemorrhagic disease of newborn)
• Delayed cord clamping - reduces risk of anaemia and intraventricular haemorrhage

Neonatal Resuscitation

Facility-Based Newborn Care (FBNC) Levels

Key Newborn Programmes

7. Care of the Child

Integrated Management of Neonatal and Childhood Illness (IMNCI)

• Integrated assessment of common childhood illnesses
• Appropriate treatment protocols
• Counselling for caregivers

Key Child Health Services

• Emergency care of sick child (IMNCI approach)
• Routine childhood illness care
• Breast-feeding promotion for 6 months (exclusive)
• Full immunization under UIP against vaccine-preventable diseases
• Vitamin A prophylaxis (prevents blindness and reduces infection mortality)
• Growth and development monitoring
• Management of Severe Acute Malnutrition (SAM)
• ORS and Zinc for diarrhoea management

Immunization (Under UIP)

8. Adolescent Health

Key Challenges in Adolescent Reproductive Health

• Teenage pregnancy and early marriage
• Anaemia (especially among girls)
• Poor menstrual hygiene
• Sexually transmitted infections
• Lack of awareness about sexual and reproductive health

Key Programmes

• ARSH clinics at CHCs provide friendly services for adolescents
• Services include counselling, STI management, nutrition advice
• Peer educators for community-based outreach

• Target: Adolescent girls and boys (10-19 years)
• Dose: 100 mg elemental iron + 500 mcg folic acid weekly
• Biannual de-worming with Albendazole 400 mg
• Covers 10.25 crore adolescents across India (rural and urban)
• Goal: Break the intergenerational cycle of anaemia

• Target: Girls aged 10-19 years in rural areas
• Key activities:
  • Community health education on menstrual hygiene
  • Regular availability of sanitary napkins
  • Training of ASHAs and nodal teachers
  • Safe disposal of sanitary napkins

9. Pre-conception and Antenatal Care Package

Essential Preconception Interventions

• Peri-conception folic acid supplementation (prevents neural tube defects)
• Prevention and management of STIs and RTIs
• Counselling on nutrition and healthy behaviours
• Management of pre-existing conditions (diabetes, hypertension, epilepsy)

Prevention of Parent-to-Child Transmission (PPTCT)

• HIV testing for all pregnant women
• ARV prophylaxis to HIV-positive mothers and newborns

10. RCH Interventions - Summary by Life Stage

11. Health System Strengthening under RCH

Community/Family Level

• ASHAs for home-based care and counselling
• AWWs for supplementary nutrition
• Community-based distribution of contraceptives
• Women's self-help groups and Panchayat involvement

Facility Level

• Sub-centres (SC) - first contact point
• Primary Health Centres (PHC) with 24x7 delivery services
• Community Health Centres (CHC) with specialist care
• First Referral Units (FRU) for emergency obstetric and newborn care
• District/Divisional Hospitals for comprehensive care
• MCH Wings: 30/50/100 bedded comprehensive units with antenatal waiting rooms, labour ward, ENBC room, SNCU, OT, blood storage, postnatal ward

Health Information Systems

• Mother and Child Tracking System (MCTS) for individual tracking of pregnant women and children
• HMIS-based dashboard monitoring
• Survey-based score cards with 19 outcome and coverage indicators

12. Six Key Strategic Packages (RMNCH+A)

1. Pre-conception and Antenatal Care - starts before pregnancy
2. Care during Labour and Childbirth - skilled birth attendance, EmOC
3. Immediate Newborn Care - ENC, resuscitation, warmth, Vitamin K
4. Care of Small and Sick Newborn - KMC, SNCUs, antibiotics
5. Care of the Healthy Child - immunization, nutrition, IMNCI
6. Adolescent Health - ARSH, WIFS, menstrual hygiene

• ~75% of newborn deaths
• ~33% of stillbirths
• ~50% of maternal deaths by 2025

13. RTI/STI Prevention and Management

• RTI/STI clinics at District Hospitals
• Health education for prevention
• Screening and treatment at sub-divisional level
• Integration with family planning services

14. Monitoring and Evaluation

Score Card Indicators Include:

• Proportion of pregnant women < 19 years (to detect teenage pregnancy)
• HBNC visit by ASHA to planned visits ratio
• Children 9-11 months fully immunized
• Children with diarrhoea treated with ORS
• Children with diarrhoea treated with ORS + Zinc
• Children discharged live from SNCUs
• Children with ARI who received treatment