India, with the estimated population of 1.16 billion has the greatest burden maternal, newborn and child health. As per the Lancet in 2008, 1.8 million children below the age of five years including one million one million neonates' dies and 68000 mothers died.
As per National Family Health Survey the estimated maternal mortality ratio showed a 36% reduction from 398 per 100 000 live births in 1997-08 to 254 per 100 000 live births in 2004-06. However, this decrease is not sufficient to achieve a maternal mortality ratio of less than 100 per 100 000 live births to meet national goals or the Millennium Development Goal (MDG) 5 by 2015. According to the National Family Health Survey (NFHS), the mortality rate for children age 5 years in India was 74 per 1000 live births in 2005-06. The Institute of Health Metrics and Evaluation estimated a mortality rate of 62·6 per 1000 live births for 2010. At the current rate of progress, India will not be able to achieve the MDG target of 38 per 1000 live births by 2015. In 2008, infant mortality rate in India was 53 per 1000 live births. The national goal is to attain a rate of less than 30 per 1000 live births by 2010. Most states, and rural areas as a whole, will not achieve this even by 2015. In 2008, a neonatal mortality rate of 35 per 1000 live births meant that more than two-thirds of infant deaths happened in the first 28 days of life. More than 48% of children age 5 years are stunted, 43% are underweight, and about 20% have wasting Between 1998−99 and 2005−06, stunting showed a steady but slight reduction in the prevalence of 1% per year India consists of 28 states and seven union territories with diverse social, demographic, economic, geographic, and health systems. Wide differentials exist across states in the indicators for reproductive health, and child health and nutrition.
The leading causes of maternal deaths in India are hemorrage, sepsis, complications of abortion, and hypertensive disorders .More than half of deaths in children age 5 years occur in the neonatal period; infections including sepsis, pneumonia, diarrhea, and tetanus, prematurity, and birth asphyxia are the three major causes of death in this period.The remaining 45% of deaths occur in children aged between 1 month and 59 months, and the major causes are pneumonia and diarrhea. The immediate causes of poor reproductive health, and child health and under nutrition have underlying social, economic, and environmental determinants literacy, women's status, socio-cultural beliefs, caste, taboos, and, above all, income level. Analysis of data showed that illiteracy, low wealth index, rural habitat, and perceived small size at birth were significantly associated with neonatal and infant mortality. Maternal death is a measure of quality of health care in a community as it continues to remain higher than developed countries. It was observed that maximum numbers of deaths were recorded in the age group of 21-25 years (52.38%). Hemorrhage remains the leading cause of death followed by indirect causes, sepsis and postpartum pre-eclamptic shock. In 19.04% cases, no cause of death could be deter-mined. The forensic pathologist plays a crucial role in identifying maternal deaths and labeling cause of death. As the main focus of Millennium Development Goals 6, is for the better health for Maternal, new born and child health mainly focusing on vulnerable, marginalized and underprivileged population the comprehensive health should emphasize by addressing major gaps in child survival ,because women and infants are at utmost risk of death in the first few hours and days around birth.
The importance of maternal and child health services, In preventive medicine, MNH is defined as field of work related to the physical, mental and emotional health of women immediately before, during and after childbirth and of infants and young children. Health services begin at the time of conception pre-natal, intra-natal and post-natal supervision of the mother promotes and periodically supervises her nutritional state. Avoidable complications of pregnancy are prevented or treated. Intra-natal services provide skilled care and attention by trained midwives during childbirth. A post-natal check on the mothers health after delivery, which includes family planning services, make it possible for a gynecologist to diagnose and prevents some of the chronic and disabling conditions common in women. Child health services aim for the preventions of acute illness and disease that will disrupt the child`s early years. Child health development programs now include the promotion of and healthy growth and development in children. MCH seeks to address the high risks that women in many contexts face in relation to child bearing. MCH programs emphasize the need for pregnant women to receive adequate prenatal care that protects them against the avoidable complications of pregnancy, and allows them to undergo a safe delivery, and to receive adequate postnatal care. Maternal health is significantly associated with the health status of children, which can be measured in the form of a reduction in either mortality or risks to child survival childhood immunization is a most important facet of MCH. Success in child immunization programs leads to child survival however; the utilization of MCH mainly depends on the socioeconomic characteristics of the community.
State wise IMR - As per the data from Registrar General of India 2008, the highest infant mortality rate is in Madhya Pradesh - 70 per 1000 live births, Orissa - 69 per 1000 live births, Uttar Pradesh - 67 per 1000 live births, Assam - 64 per 1000 live birth.
State Wise MMR - Assam - 480, Uttar Pradesh- 440, Rajasthan-388, Chhattisgarh - 335
CHAI with wide range of experience working community health in northern states of India along with the member institutions caters the need of the marginalized and under privileged population in state by providing awareness on health using resources through collective effort. The media will be an important partner in advocacy work, both for the larger maternal and newborn health programme.
