Subject: Obstetrical and Gynaecological Nursing

ASSIGNMENT ON FAMILY
WELFARE SERVICES

INTRODUCTION:

The national family welfare program was launched in 1952 as National Family Planning
program. India was the first one to do so. It is 100% centrally sponsored program. The ministry
of Health and Family welfare was responsible for this program. In 1977 the Government re-
designated the National Family Planning Program as National Family Welfare Program. The
concept of ‘welfare is related with the quality of life’ of the family.
HISTORICAL BACKGROUND:

 During the 1950 Government of India introduced Maternal and Child health (MCH)
services as basic health services in Primary Health Centers because of their increased
vulnerability and morbidity and mortality.
 During 1952, National Family Planning Program was launched to control population
growth in India. The services were target oriented resulting in burden on health workers,
which ultimately affected the quality of work.
 During 1972, abortion was legalized due to increased maternal deaths following illegal
abortions.
 During 1975, emergency was declared in India by the Government.
 During 1976, the disastrous forcible sterilization campaign led to the defeat of congress
Government and the new Janatha Government during 1977, rule out compulsion and
 coercion of Family Planning Services and renamed the program as ‘Family Welfare
Program’ by providing a package of services to the mothers and children in integrated
manner, comprising maternity services ( antenatal, intra natal and postnatal care),
nutritional services (supplementary nutrition), immunization services and family planning
services, for the welfare of the entire family.
 During 1978, Government of India upgraded the immunization services and launched
WHO recommended expanded program of Immunization (EPI)
 During 1978-79, meanwhile Government of India became signatory to Alma-Ata
Declaration of achieving the Global Social Target ‘Health For All by 2000 AD’
 During 1985, Expanded program of immunization was renamed ‘Universal
Immunization Program (UIP)’ by concentrating the services to infants and expected
mothers.
 During 1992, to achieve the social target and to improve the quality of services to
mothers and children, the services were integrated into a single composite program called
the ‘Child Survival and Safe Motherhood Program (CSSM)’, a time bound and target
oriented National Program.
 The time bound was 2000 AD and the target population was all mothers and under five
children.

REPRODUCTIVE AND CHILD HEALTH PROGRAM (RCH)

It was formally launched by Government of India on 15th October, 1997 as per

recommendation of International Conference on Population and development held in Cairo in
1994.

RCH is defined as “a state in which people have the ability to reproduce and regulate
their fertility and are able to go through the pregnancy and child birth, the outcome of pregnancy
in successful in terms of maternal and infant survival and wellbeing, and couples are able to have
sexual relation free of the fear of pregnancy and of contracting diseases”.

Objectives:
  To improve the health of the mothers and children to ensure safe motherhood and child
survival.
 The intermediate to objective is to reduce IMR and MMR.
 The ultimate objective is population stabilization, through responsible reproductive
behavior.

Intervention:

 Prevention and management of un-wanted pregnancies.

 Maternal care (safe motherhood)
 Child survival
 Prevention and management of RTIs/STD
 Prevention of HIV/AIDS

Components of RCH:

Main components- Family planning, child survival and safe motherhood program
(CSSM), prevention and management of RTIs, STD and AIDS, client approach to health care.

Other activities:

 Providing counseling, formation and communication services on health, sexuality

and gender difference.
 Referral services for all above intervention
 Growth monitoring, nutrition education, reproductive health services for
adolescents etc.

RCH Package for various services:

1. For maternal services- Obstetric care, infection control and nutrition promotion.
2. For child services- The essential care of the newborn, including care of the at risk
newborn by prompt referral service. Infection control measures and nutrition promotion.
3. Reproductive health- fertility control, MTP services (for prevention and management of
un-wanted pregnancies), adolescent health, HIV/AIDS
RCH Program Phase-I

Under RCH program phase I, various provisions were made to improve the status of
maternal and child health. These include:

 Provision of essential and emergency obstetric care.

 Provision of equipment and drug kits to selected PHCs and selected FRUs in all districts.
 Provision for additional ANM, staff nurse and laboratory technicians for selected
districts.
 Provision for 24 hours delivery services at PHCs and CHCs
 Referral transport in case of obstetric complication.
 Immunization and oral rehydration therapy.
 Prevention and control of vitamin A deficiency in children.
 Integrated management of childhood illness.
 District surveys for focused intervention to reduce IMR or MMR
 Setting up of blood storage units at FRUs.
 Training of MBBS doctor in anesthetic skill for emergency obstetric care at FRU.

RCH Phase II:

It was started from 1st April 2005 up to 2009. The RCH II vision articulates “improving
access, use and quality of RCH services, especially for the poor and underserved population.

Aims of RCH phase II :

 To reduce IMR, MMR, TFR, and to increase couple protection rate and immunization
coverage specially in rural areas.
 To improve the management performance
 To develop human resources intensively
 To expand RCH services to tribal areas also.
 To monitor and evaluate the services.
 To improve the quality, coverage and effectiveness of the existing family welfare
services and essential RCH services with a special focus on the EAG states.

Components of RCH phase II:

1. Population stabilization:
 By incorporating newer choices of contraceptive methods. Eg. Centchroman
 By increasing trained personnel
 By converging the services at grass root level
 By public private partnership
 Social marketing of contraceptives to be strengthened.
 Involving panchayti raj institution, urban, local bodies and NGOs
 By increasing incentives
2. Maternal health:
 Essential obstetric care-3 or more checkups, 2 doses of TT, Iron and folic acid
tablets, counseling
 Emergency obstetric care-first referral unit.
3. Newborn care and child health strategies:
 Skilled care at birth
 Strengthen IMNCI services
 Ensuring referral service of sick neonates and utilization of referral funds
 Permitting ANMs to administer selected antibiotics like gentamycin and co-
trimoxasole
 Availability of drugs and supplies
 Promoting breastfeeding practices
 Vitamin A, folic acid, iron supplementation
4. Adolescent health strategies:
 Enroll newly married couples
 Provision of spacing methods
 Routine antenatal care and institutional delivery
 Referral service.
5. Control of RTI/STI:
 HIV/AIDS/STI prevention education and counseling

6. Urban health
7. Tribal health
 8. Monitoring and evaluation

INTEGRATED CHILD DEVELOPMENT SERVICES:

It was launched in October 2nd 1975. It is one of the unique and largest programs for
early childhood development. The main beneficiaries of the program were aimed to be the girl
child up to her adolescence, all children below the age of 6 years, pregnant and lactating
mothers.

Objectives:

 To improve the nutritional and health status of the children in the age group 0-6 years.
 To lay the foundation for proper psychological, physical and social development of the
child.
 To reduce the incidence of mortality, morbidity, malnutrition and school drop-out
 To achieve effective co-ordination of policy and implementation amongst the various
departments to promote child development.
 To enhance the capability of the mother to look after the normal health and nutritional
needs of the child by giving health education to the mother.

Package of services include:

1. Supplementary nutrition
2. Immunization
3. Health check-ups
4. Referral services
5. Pre-school non-formal education
6. Nutrition and health education

Supplementary nutrition and periodic growth monitoring are done regularly through
Anganwadis. Severely malnourished children are given special feeding and medical referral
services. It includes Vitamin A syrup and IFA tablets distribution. Immunization against 6
vaccine preventable diseases are given.
 Health check ups, weight monitoring immunization, management of malnutrition,
treatment of diarrhea. De- worming and distribution of simple medicines are given to children
below 6 years of age.

Referral services anganwadi worker are trained to identify malnutrition, disabilities and
minor ailments and they will refer these cases to PHCs or sub centers.

Pre-school education is given to through anganwadi centers. If focuses on the overall

development of the child. They provide a natural, joyful and stimulating environment for the
children with special emphasis on necessary inputs for optional growth and development.

Nutrition and health education is one of the important work of the anganwadi worker.
This forms part of behavior change communication (BCC) strategy. This has the long term goal
of capacity building of women-especially in the age group of 15-45 years so that they can look
after their own health, nutrition and development needs as well as that of their children and their
families.

ICDS Team comprises of:

 Anganwadi workers, anganwadi helpers

 Supervisors
 Child development project officers
 District program officer
 Medical officers
 Auxiliary nurse midwife
 Accredited social health activist (ASHA)

MATERNAL AND CHILD HEALTH SERVICES:

According to WHO 1976, maternal and child health services can be define as
“promoting, preventing, therapeutic or rehabilitation facility or care for the mother and child”

Aims and objectives:

 Reducing maternal, perinatal, infant and child mortality and morbidity rates
 Child survival
  Promoting reproductive health or safe motherhood
 Ensure birth of a healthy child
 Prevent malnutrition
 Prevent communicable diseases
 Early diagnosis and treatment of health problems
 Health education and family planning services.

Component of MCH:

 Maternal health
 Family planning
 Child health
 School health
 Handicapped children
 Care of the children in special setting such as day care centers.

Package of services:

1. Complete health check-up of child and mother from contraception to birth

2. Studying the health problems of the mothers and children
3. Providing health education to the parents for taking care of children
4. Training to professional and assistant health workers.

Indicators of maternal and child health:

 MMR
 IMR
 Neonatal mortality rate
 Under five mortality rate
 Child survival rate

Maternal and child health services:

1. Antenatal care services

2. Intra-natal care services
 3. Postnatal care services
4. Under-five child health services

Antenatal services objectives:

 To detect high risk cases and give them special care

 To identify complications and prevent them
 To educate the mother
 To promote, protect and maintain health

Intra-natal services:

 To provide through asepsis

 To prevent injury to baby and mother
 To prevent complication
 To provide care to the baby

Postnatal services:

 To provide care to mother and baby

 To prevent complication
 To provide family planning services, basic education to the mother.

Child health services:

 Decreasing child death and infant mortality

 Complete protection of child
 Nutritious diet to children
 Overall growth of children
 Preserve and promote health of under-five children.

CHILD SURVIVAL AND SAFE MOTHERHOOD:

Aims:

 To reduce infant mortality

  Provide antenatal care to all women
 Ensure safe delivery services
 Provide basic care to all neonates
 Identify and refer those neonates who are at risk
Later in 1997, RCH included safe motherhood and family welfare as an integrated
approach.

Levels of maternal and child health care services:

Levels of MCH centers have been defined on the basis of MCH services delivery
package. They are as follows

Level I MCH centers ( Primary): They include sub-centers and primary health centers
providing skilled birth attendant level delivery care.

Level II MCH centers (secondary): The are the health facilities including the PHCs and CHCs.
They provide nutritional deliveries including management of complicated deliveries not
requiring surgeries. Facilities such as MTP, sterilization and care of sick newborn are also
available here.

Level III MCH centers (Tertiary): Health facilities (CHCs/DHs) providing critical emergency
obstetrical and newborn care (CEmONC) with fully functional operation theatre, blood bank,
sick newborn care etc.

Level I MCH care:

Services available a level I MCH care centers are as follows:

 Antenatal care package: Registration of pregnant woman within 12 weeks, physical

examination, identification of high risk for referral, and provision of iron and folic acid
(IFA) for pregnant and anemic woman.
 Delivery package: Normal delivery with use of partograph, active management of third
stage of labor (AMTSL), prevention of infection and pre-referral management of
obstetrical emergencies.
  Postnatal care package: Minimum 6 hours post delivery stay in health facility and home
visits for PNC check-up
 Newborn health care package: Newborn resuscitation, warmth, infection prevention,
support for breast feeding initiation, weighing the newborn, care of a low birth weight
newborn, and referral services of sick newborns.
 RTI/STI management
 Counseling and referral services
 Family planning services: Provision of emergency contraceptive pills, counseling and
motivation for small family norms, distribution of OCP, condoms and IUD insertion
follow up care
 “Assured” referrsl system to higher health facility
 Complete immunization
 Counseling for feeding, nutrition, family planning and immunization
 Human resources: Minimum two skilled birth attendants are available

Level II MCH care:

Level II care facilities are those to manage obstetrical emergencies or complications

arising from pregnancy or labor. Services available in level II MCH care centers are as follows.

 Management of all complication encountered by the woman during delivery including

provision of blood transfusion and surgery. Facilities are available for mothers for
episiotomy and suturing, repairing of cervical tears, management of obstetrical
emergencies, assisted vaginal delivery and any surgery that is required before referring
the patient to other health facility.
 Mothers can stay for 48 hour in this facility, stabilize their condition encountered during
delivery and post-delivery complication.
 Safe abortion services are available for women as per MTP act, with manual vacuum
aspiration up to 7 weeks of pregnancy and referral services, if required
 In case of preterm babies, antenatal corticosteroids are available here and also care of
newborn with low birth weight. Sepsis management and inj. Vitamin K for premature
babies are available and referral services for babies with complications are taken care of.
  Identification and management of RTI/STI is another service provided by this facility
 At this level, family planning services include male sterilization, NSV, tubectomy and
IUD insertion facilities. Referral services with transportation are assured to higher health
facility, if needed.
 Staffing pattern include one or two medical officers and 3-5 nurses or midwives with
SBA training.

Level III MCH care:

With the mother/infant is not able to recover from the treatment given in level II, they are
transferred to level III health facility. Skilled birth attendants, neonatologists/pediatrician,
professional nurses, anesthetists and laboratory and blood transfusion facilities are available here
for 24 hours, 7 days in a week. Services available at level III MCH care centers are as follows.

 Apart from the facilities for level I and level II MCH care services, level III has blood
storage facilities. This facility manages severe anemia and intra-partum and post-partum
complication including facility for blood transfusion.
 Facilities for patient requiring safe abortion services up to 20 weeks of pregnancy
 Facilities are available as per the MTP act and it manages all post abortion complication
 In this health facility, a low birth weight baby, and a high risk sick newborns are
managed.
 Mothers with RTI and STI requiring specialized care are managed in level III facility
 With regard to family planning services, in addition to such services included level I and
II along with management of complication, other family planning services available are
male sterilization, NSV, female sterilization, conventional tubectomy, mini lap and
laproscopic sterilization.
 Staffing pattern in level III MCH care includes an obstetrician, anesthetists, pediatrician,
technician/medical officer with skill for blood transfusion support, nine nurses, (available
in 24 hours services)

ORGANIZATION AND ADMINISTRATION OF FAMILY PALNNING:

Family planning program and related activities are managed at various levels-central,
state, district, block village levels- to ensure that they reach to maximum people.
Central level:

The central government controls the planning and financial management of the family
planning programs, the training involved and the evaluation. A population advisory council
headed by the Union Minister of Health and members of parliament and persons related to the
field of population control was set up to 1982. The hierarchy of this council is shown below.

Population council hierarchy

The central Minister of Health and Family Welfare

Secretary of health and Family welfare

Special secretary, department of Family Welfare

Joint Secretaries and Comimissioners

Additional Secretaries

 Policy division
 Aided program division
 Plan budget
 Organized operation media, media communication
 Mass and transport division
 Supply intelligence

State level:

The centre provides 1005 assistance to the state governments for services and education
for family planning. During the second five-year plan period, Family planning Bureaus were
established in each state, with their capital cities as the head quarters. The state head quarters was
headed by the additional, joint or deputy director of health services. The hierarchy in these
bureaus is shown below.
 State Health minister

Health minister

Health Secretary

Director of health services

Additional director- Family Planning

Deputy director Iimmunization Deputy director

(child health) cold chain (maternal health)

Research

Statistics

Health education

Mass education

District level:

In 1993, District Family Planning Bureau was established under the charge of the District
Family Planning Officers with facilities for publicity services, sterilization, and intra uterine
contraceptive application. The administration at the district level is highlighted below.

District Family Welfare officer-1

 Medical officers-2

Extension educators-2

Information officer

Statistician

Administrative officer-1

Clerk and ancillary staff-1

Block level:

There is rural family welfare centre with medical officers and supporting staff. Services
like sterilization, IUCD insertion are provided at the PHC’s. sub centers are the control of PHCs.
Each sub-center has one male and female health worker. They provide motivation for family
planning and also supply contraceptives.

Village level:

At the village level, there are village health guides and trained dais. Village health guides
are mostly women, one for each village or for a population of 1000. They provide motivation for
family planning and supply oral pills. Trained dais local birth attendants (females) who are
trained for conducting deliveries. They act as family planning counselors and motivators.

ROLE OF NURSE IN FAMILY WELFARE PROGRAM:

 The nursing personnel have various functions and responsibilities at different levels with
regard to family planning. These are as follows:

1. As a nurse administrator:
 Maintains an up-to-date and relevant knowledge about family planning services in
the country
 Make sure that all her nursing staff are aware of family planning measures during
their training or in-service education program
 Ensures that adequate educational material on family planning is available in the
ward library and all contraceptives methods for demonstration to patients are
made available in the wards.
 Formulate a policy on imparting knowledge on family welfare services to all
patients before they are discharged from the hospitals.
 Establishes a good referral system between each ward of the hospital and the
family planning department so that each eligible client gets required
contraceptives.
 Incentivizes nurses to make their best contributions to family planning services.
 Supervises nurses, ANMs, Anganwadi workers and multipurpose health workers
in relation to activities on family planning.
 Participation or conducts research on family planning.
 Plans and conducts in-service education programs for nursing personnel.
2. As a nurse educator:
 Integrates family planning component in nursing curriculum while teaching.
 Teaches family planning as a subjects.
 Selects and organizes learning experience both in theory and practice for student
nurses.
 Coaches ANM, health visitors, multipurpose health workers and Anganwadi
workers regarding family planning
 Help nurse administer to organize in-service education programs for nurses
 Also clarifies doubts of patients regarding family planning, during her supervisory
rounds
  Conducts or participates in nursing research on family planning
3. As a clinical nurse in hospital/community:
 Identifies eligible couples.
 Imparts information to the eligible couples regarding different methods of
contraception advantages, disadvantages and side effect
 Motivates the couple to adopt family planning methods
 Counsels the couple to identify their problems due to large family and take steps
to solve those problems
 Assist the doctor in surgical methods such as vasectomy and tubectomy
 Maintain the stock book and ensures adequate supplies in health care center
 Manage referral services and follow-up-care
 Maintain properly the documents and records of vital statistics.
4. As a research worker:
 Conducts surveys of eligible couples from different communities with varying
socio-economic data
 Studies the attitude of community toward the family planning
 Organizes surveys on knowledge of family planning among patients in hospital
setting
 Imparts sex education on adolescents
 Participate in or conducts studies on family planning and other related topics.

COUNSELING FOR FAMILY WELFARE:

Nurses plays an important role in counseling couples for family planning.

 Respect the couple and help them to now all the methods of family planning
 Listen and encourage them to explain their needs, concern, and problems
 Let the couple talk and lead the discussion
 Give correct information in simple language
 Give cafeteria approach in choosing the methods. (In cafeteria approach, all the methods
are demonstrated to the couple with the explanation of their advantages and
 disadvantages. The couple can then select a method according to their choice there is no
coercion) the way we choose a food item from the menu book in a restaurant.
 Inform the client about the effects and side effects of each method or the chosen method
 Respect and appreciate the client on their informed decision
 Check the client’s feedback and respond immediately
 Give proper referral health facility, if required
 Before the client’s leave ensure that they are statisfied
 Distributes supplies
 When a new client comes for the first time asking for contraceptive information, inform
demonstrate and motivate them use the appreciate method
 Give adequate time for the client to decide
 Ensure constant availability of counseling and maintain counseling record
 Give appointment for re-counseling and or follow up care and maintain documentation.

CONCLUSION:

The problems of maternal and neonatal mortality are complex, involving women’s status,
education, employment opportunities and the availability to women of the basic human rights
and freedom. So all the strategies to improve maternal and child health must be integrated with
and operated through existing health system.
BIBLIOGRAPHY:

1. NIKSY ABRAHAM. Text book of Midwifery & Obstetrical Nursing. Frontline

publication.2018;page no 822-36.