1.Introduction to Maternaland Child health

2. 70% of the population of developing
countries
In India women of child bearing age (15-
44 Yrs) are 19%
Children under 15 years 40%
Together 59%
They are vulnerable or special risk group
Risk connected with childbearing for
women
Growth development and survival
-children
3. 50% of deaths are above 70 yrs of age
Same among under-five children
Maternal mortality rates vary from 13- 440 per
100000 live births
Sickness and deaths among mothers and children
are largely preventable
This have led to the formation of special health
services for mother and children all over the
world
The present strategy is to provide maternal and
child as an integrated package of Essential
health care also known as Primary health care
4. Mother and child as one unit- because
1. During the antenatal period , the fetus is part
of the mother development 280 days,
during this period fetus receives nutrition and
oxygen from the mother
2. Child health is closely related to maternal
health; a healthy mother brings forth a
healthy baby; there is less chances of
premature, still birth or abortion
5. 1. Certain diseases and conditions of the
mother during pregnancy ( eg. Syphilis,
German measles, drug intake) are likely to
have their effects on the fetus
2. After birth, the child is dependant on the
mother. Up to 6 - 9 months completely for
feeding. The mental and social
development is also dependant on the
mother, if the mother dies the child's
growth and development are affected
(maternal deprivation syndrome)
6. 1. In the care cycle of women, there are few
occasions when the service of the child is
simultaneously called for . For instance
post partum care is inseparable from
neonatal care and family planning advice
2. The mother is also the first teacher of the
child
7. Obstetrics, Pediatrics and PSM
In the past , maternal and child health services were rather fragmented and provided
piecemeal personal health services by
different agencies, in different ways and
separate clinics the current trend in many
countries is to provide integrated MCH and
family planning services as compact family
welfare service
8. This implies a close relationship of
maternity health to child health, of
maternal and child health to the health of
the family; and of family to the general
health of the community
In providing these services , specialists in
obstetrics and child health have joined
hands , and are now looking beyond the
four walls of hospitals into community to
meet health needs of mothers and children
aimed at positive health
9. In the process they have linked to
community medicine( preventive and
social medicine ) and as a result , terms
such as social obstetrics , preventive
pediatrics and social pediatrics have
come into vogue
10. Obstetrics
Obstetrics is largely preventive medicine
The aims are same, to ensure that throughout
pregnancy and puerperium, the mother will have
good health and that every pregnancy may culminate
in a healthy mother and healthy baby
The age old concept that obstetrics is now
considered as a very narrow concept, and is being
replaced by the concept of community obstetrics
which combines obstetrical concerns with the
concepts of primary health care
11. Social obstetrics
Gained usage in recent years
Defined as the study of the interplay of social
and environmental factors and human
reproduction going back to the
preconceptional or even premarital period
12. The social and environmental factors
which influence human reproduction are a
legion viz. age at marriage , childbearing,
child spacing , family size , fertility
patterns, level of education, economic
status , level of education, economic
status , customs and beliefs, role of women
in society , etc.
The social and obstetric problem in India
differs from other developed countries
13. While accepting the influence of
environmental and social factors on human
reproduction, social obstetrics has yet
another dimension, that is influence of
these factors on the organization, delivery
of comprehensive MCH services including
family planning so that they could be
brought within the reach of the total
community
14. Preventive pediatrics
Like obstetrics pediatrics has a large component of
Preventive and Social Medicine
There is no other discipline that teaches the value of
preventive medicine
Recent years have witnessed further specialization
within the broad field of pediatricsviz preventive
pediatrics, social pediatrics, neonatology,
perinatology, developmental pediatricspediatric
surgery, pediatric neurology
15. Preventive pediatrics comprises efforts to
avert rather than cure disease and
disabilities
It has been broadly divided into antenatal
pediatrics and postnatal pediatrics
The aims of preventive pediatrics and
preventive medicine are the same
prevention of disease and promotion
physical , mental and social well being of
children so that each child may achieve
genetic potential with which he is born
16. To achieve these aims , hospitals for
children have adopted the strategy of
primary health care to improve child
health care through such activities as
growth monitoring, oral rehydration,
nutritional surveillance, promotion of
breast feeding, immunization, community
feeding, regular health check ups etc.
Primary health care with its potential for
vastly increased coverage through an
integrated system of service delivery is
increasedly looked upon as the best
solution to reach millions of children
17. Social pediatrics
Defined as the application of the
principles of social medicine to pediatrics
to obtain a more complete understanding of
the problems of children in order to
prevent and treat disease and promote their
adequate growth and development, through
an organized health structure
18. To study child health in relation to
community, to social values and to social
policy
This has given rise to concept of social
pediatrics it is concerned not only with the
social factors which influence child health
but also with the influence of these factors
on the organization, delivery and
utilization of child health care services
19. In other words , social pediatrics is
concerned with the delivery of
comprehensive and continuous child health
care services and to bring these services
within the reach of the local community.
Social pediatrics also covers various social
welfare measures local , national,
international aimed to meet the total
health needs of the child
20. Contribution of Preventive and Social Medicineto Social Obstetrics and Pediatrics
1. Collection and interpretation of community
statistics, delineating groups at risk for special
care
2. Correlation of vital statistics ( eg., maternal and
infant morbidity and mortality rates, perinatal and
child mortality rates )with social and biological
characteristics such as birth weight , parity, age,
stature, employment etc., in the elucidation of
etiological relationships
21. 1. Study of cultural patterns, beliefs and
practices relating to childbearing and
childrearing, knowledge of which might
be useful in promoting acceptance and
utilization of obstetric and pediatric
services by the community
2. To determine priorities and contribute to
the planning of MCH services and
programmes
3. For evaluating whether MCH services and
programmes are accomplishing their
objectives
22. Maternity cycle - stages
1. Fertilization
2. Antenatal or prenatal period
3. Intranatal period
4. Postnatal period
5. Inter - conceptional period
23. Fertilization takes place in the outer part of
the fallopian tube.
Segmentation of the fertilized ovum begins
at once and proceeds at a rapid rate
The fertilized ovum reaches the uterus in
8- 10 days.
Cell division proceeds at a rapid rate
By a process of cell division and
differentiation, all the organs and tissues of
the body are formed
24. Period of growth
1. Prenatal period
1. Ovum 0-14 days
2. Embryo - 14 days to 9 weeks
3. Fetus 9th week to birth
2. Premature 28 to 37 weeks
3. Birth, full term average 280 days
25. Antenatal care
26. Objectives
To promote, protect and maintain the health
of the mother during pregnancy
To detect high risk cases and give them
special attention
To foresee complications and prevent them
To remove anxiety and dread associated with
delivery
27. To reduce maternal and infant mortality
and morbidity
To teach the mother elements of child care,
nutrition, personal hygiene and
environmental sanitation
To sensitize the mother to the need for
family planning, including advice to cases
seeking medical termination of pregnancy
To attend to the under fives accompanying
the mother
28. Antenatal visits
Mother should attend AN clinics
Once a month during first 7 months
Twice a month during the next month
Thereafter once a week in the ninth month
If everything is normal
29. Minimum 3 antenatal visits
1. At 20 weeks or as soon as pregnancy is
known
2. At 32 weeks
3. At 36 weeks
4. At least 1 home visit by health worker
30. Preventive services for the mothers
Prenatal services ( before delivery)
First visit should include following
Health history
Physical examination
Laboratory examination
31. Lab tests
1. Complete urine analysis
2. Stool examination
3. Complete blood count, including Hb
estimation
4. Serological examination
5. Blood grouping and Rh determination
6. Chest x- ray if needed, pap tests, Gonorrhea
culture (Optional)
32. On subsequent visits
Physical examination( weight gain, Blood
pressure)
Laboratory tests should include
1. Urine examination
2. Hemoglobin estimate
33. Iron and folic acid supplementation
Tetanus Immunization
Group or individual instruction on
nutrition, family planning, self care,
delivery and parenthood
Home visiting by female health worker /
trained dai
Referral services , where necessary
34. Risk approach
Identify high risk cases from a large group of
antenatal mothers and arrange them for
skilled care, while continuing to provide
appropriate care for all mothers
35. At risk mothers
1. Elderly primi (30 years and over)
2. Short statured primi ( 140 cms and over)
3. Mal-presentations( breech, transverse lie)
4. Ante-partum hemorrhage, threatened
abortion
5. Pre eclampsia and eclampsia
6. Anemia
36. 1. Twins, hydramnios
2. Previous still birth, intrauterine death,
manual removal of placenta
3. Elderly grand multiparas
4. Prolonged pregnancy( 14 days after
expected date of delivery)
5. History of previous cesarean or
instrumental delivery
6. Pregnancy associated with general
diseases cardiovascular disease, kidney
disease, diabetes, tuberculosis, liver
disease
37. Risk approach is a managerial tool
Services for all but with special attention to
those who need them the most
Maximum utilization of all resources
including some which are not involved in
in such care traditional birth attendants,
community health workers, women groups
Improvements in coverage & quality of
health care
38. Maintenance of records
Antenatal card- in first examination, thick paper to
facilitate filing
Registration number. Identifying data, previous
health history, main health events
Record is kept at MCH/FP center
A link is maintained between the antenatal card,
postnatal card and under-fives card
Essential for evaluation and further improvement
39. Home visits
Home visiting is the backbone of all MCH
services
Even if the expectant mother is attending the
ante natal clinic regularly, she must be paid
one home visit by the health worker female or
public health nurse
More visits are required if the delivery is
planned at home
40. Prenatal advice
Mother s more receptive to the advice
concerning herself and her baby at this time
than at other times
The talking points should cover not only the
specific problems of pregnancy and childbirth
but also about family and child health care
41. Prenatal advice - diet
Reproduction costs energy
Pregnancy in total duration consumes
about 60000 k cal over and above normal
metabolic requirements
Lactation demands about 550 kcal / day
Child survival is correlated with birth
weight
Birth weight is correlated to the weight
gain of the mothewrww .dsimuilimar.ciomng pregnancy
42. On an average . A normal healthy women
gains about 12 kg of weight during
pregnancy
Average poor Indian women gains 6.5 Kgs
Thus pregnancy imposes extra calorie and
nutritional requirements
If maternal stores of iron are poor (as may
happen after repeated pregnancies) and if
enough iron is not available to the mother
during pregnancy, it is possible that fetus
may lay down insufficient iron stores
43. Such a baby may show a normal Hb. at
birth but will lack the stores of iron
necessary for rapid growth and increase in
blood volume and muscle mass in the first
year of life
Stresses in the form of malaria and other
childhood infections will make the
deficiency more acute, and many infants
become severely anemic during the early
months of life
Therefore a balanced diet is necessary
44. Personal hygiene
Personal cleanliness bathe, clean clothes,
hair
Rest and sleep 8 hrs sleep, 2 hrs rest after
midday meals
Bowels constipation should be avoided by
taking green leafy vegetables, fruits and extra
fluids purgatives like castor oils should be
avoided
45. Exercise light household work is advised
but manual physical labour during late
pregnancy may adversely affect the foetus
Smoking should be cut down, causes
Intrauterine growth retardation, low birth
weight babies.
Vasoconstrictor action produces placental
insufficiency.
Mothers who smoke heavily produces on an
average 170 g less weight babies at term.
The perinatal mortality amongst babies
whose mother smoked during pregnancy is
10-40% higher
46. Alcohol :alcohol causes fertility problems
in mothers, pregnancy loss, various
physical and mental problems in the child,
causes fetal alcohol syndrome in the child
includes IUGR, developmental delay
Dental care oral hygiene
Sexual intercourse should be restricted
especially in the last trimester
47. Drugs
Drugs which are not absolutely essential
should be discouraged
Can cause fetal malformations like
thalidomide more serious when taken 4-8
weeks of pregnancy
LSD produces chromosomal damage,
streptomycin causing deafness, iodide causing
congenital goitre
48. Corticosteroids may impair growth
Sex hormones virilism
Tetracyclines- growth of bones and enamel
formation
Anesthetics pethidine administered
during labour- can have depressant effect
and delay the onset of respiration
Certain drugs are excreted in breast milk
49. Radiation
Exposure to radiation, X ray during
pregnancy - mortality from leukemia and
other neoplasms are significantly higher
Congenital malformations such as
microcephaly
X rays should be avoided in the last 2 weeks
preceding menstrual cycle
50. Warning signs
Report immediately
1. Swelling of the feet
2. Fits
3. Headache
4. Blurring of vision
5. Bleeding or discharge per vagina
6. Any other unusual symptoms
51. Child care
The art of child care should be learnt
Special classes to be conducted
Mother craft includes nutrition education,
advice on hygiene and childrearing, cooking
demonstrations, family planning education,
family budgeting etc.
52. Specific health protection 1.anemia
About 50% to 60% of mothers in India of
low socio economic groups are anemic in
the last trimester of pregnancy
Etiology is iron and folic acid deficiency
Associated with high incidence of
premature births, postpartum hemorrhage,
peuerperal sepsis and thromboembolic
phenomena in the mother
IFA supplementation is done by Govt. of
India
53. Other nutritional deficiencies
Protein, vitamin and minerals
Especially vit A and iodine
Milk should be supplemented, or skimmed
milk should be given
Capsules of vitamin A and D also supplied
free of cost
54. Toxemias of pregnancy
Presence of albumin in urine and increase in
blood pressure
Their early detection and management
55. Tetanus
2 doses of adsorbed tetanus toxoid should be
given
First dose 16 20 weeks and second 20-24
weeks of pregnancy
Minimum interval between 2 doses should be
1 month
Second dose should be given at least 1 month
before the EDD
56. However , no dose of TT should be denied
to the mother even in late pregnancy
For a mother who have been immunized
earlier, 1 booster dose will be sufficient
When such booster doses are given it will
cover subsequent pregnancies in the next 5
years
It is advised not to immunize the mother in
every pregnancy in order to prevent hyperimmunization
57. Syphilis
Important cause of pregnancy wastage in
some countries
Pregnancies in primary and secondary
syphilis end in spontaneous abortion, still
birth, perinatal death or birth of a child with
congenital syphilis
Syphilitic infection in pregnant women is
transmissible to the foetus
58. Neurological damage with mental
retardation is one of the most serious
consequences of congenital syphilis
Infection of the foetus does not occur in 4th
month of pregnancy
it is most likely to occur after the 6th
month of pregnancy by which time the
Langhans cell layer has completely
atrophied
Infection of the foetus most likely in
primary and secondary stage of syphilis but
rare in late syphilis
59. German measles
In a long-term prospective study done in
Great Britain, when rubella is contracted to
the mother in the first 16 weeks of
pregnancy, foetal death or death during the
first year of life occurred in 17% of
offspring's
Among survivors who were followed up
the age of 8 years, 15 % had major defects
like cataract, deafness and congenital heart
diseases
60. Risk of malformations is about 20% up to
20 weeks of gestation
In some countries all school aged children
are vaccinated
Before vaccinating the women of child
bearing age should be made sure that they
are not pregnant and they follow
contraception for 8 weeks later to prevent
risk of rubella to the fetus
61. Rh status
The fetal red cells may enter the maternal
circulation in a number of difficult
circumstances, during labor, caesarean
section, therapeutic abortion, external
cephalic version and apparently
spontaneously in the late pregnancy
62. The intrusion of these cells, if the mother is
Rh ve and the child is Rh +ve, provokes
an immune response in her so that she
forms antibodies to Rh which can cross
placenta and produces fetal RBC
hemolysis
The same response may be seen by the
transfusion of Rh+ve blood
In a pregnant woman, iso-immunisation
mainly occurs in labour, so that the first
child although Rh+ve, is unaffected except
where the mother is already www.similima.com sensitized.
63. In the second or subsequent pregnancies, if
the child is Rh +ve, the mother will react to
the smallest intrusion of fetal cells, by
producing antibodies to destroy fetal blood
cells causing hemolytic disease in the fetus
Clinically hemolytic disease takes the form
of Hydropsfetalis, icterus gravis
neonatorum( of which Kernicterus is a
common sequel) and congenital hemolytic
anemia
64. Routinely test the blood for rhesus type
early in pregnancy
If the women is Rh-ve and the husband is
+ve , she is kept under surveillance for Rh
antibody levels during antenatal care
The blood should be further examined at
28 weeks and 34-36 weeks of gestation for
antibodies
Rh anti D immunoglobulin should be given
at 28 weeks of gestation so that
sensitization during the first pregnancy can
be prevented
65. If the baby is Rh +ve, the Rh anti D
immunoglobulin is given again within 72
hrs of delivery
It should also be given after abortion
Post maturity should be avoided
Whenever evidence of hemolysis in-utero
is suspected mother should be shifted to
special centers equipped to deal with such
problems
Incidence of hemolysis due to Rh factor in
India is 1 for every 400- 500 live births
66. HIV infection
HIV in child may occur through placenta,
delivery, breast feeding
1/3 of the children get infected through
above routes
Risk is higher if the mother is newly
infected or she had already developed
AIDS
Voluntary prenatal testing for HIV
infection should be done as early in
pregnancy for all wmww.simoilimtah.coemrs
67. Prenatal genetic screening
Prenatal genetic screening includes
screening for chromosomal abnormalities
associated with serious birth defects,
screening for direct evidence of congenital
structural anomalies, screening for
hemoglobinopathies and other inherited
conditions detectable by biochemical
assays
Universal genetic screening is generally
not recommended
www.similima.com 67
68. Screening for chromosomal abnormalities
and for direct evidence for structural
anomalies is performed in pregnancy in
order to take decisions regarding
therapeutic abortions
Typical examples are Downs syndrome
and severe neural tube defects
Women aged above 35 years and those
who are having afflicted child are at higher
risk
69. Mental preparation
It is also important
A free and frank talks on all aspects of
pregnancy and delivery
Removing the fears about confinement
The mother craft classes at the MCH centers
70. Family planning
Related to every phase of maternity cycle
Mothers are psychologically more
receptive to the advice on family planning
than at other times
Motivation and education should be done
during the antenatal period
If the mother has had 2 or more children
she should be motivated for puerperal
sterilization
All India post partum programme services
are available
71. Pediatric component
Pediatrician should be in attendance at all
antenatal clinics to pay attention to the under
fives accompanying the mother
72. Intranatal care
73. Childbirth is a normal physiological process, but
complications may arise
Septicemia may result from unskilled and septic
manipulationsand tetanus neonatorum from the
use of unsterile instruments
The need for effective in tranatal care is
indispensable
The emphasis is on cleanliness
5 cleans - clean hands and fingernails,a clean
surface for delivery, clean blade for cutting the
cord, clean cord tie, clean cord stump and care of
the cord
74. Keep the birth canal clean by avoiding
harmful practices
Hospital and health centers should be
equipped for delivery with midwifery kits, a
regular supply of sterile gloves and drapes,
towels, cleaning materials, soap and antiseptic
solution, as well as equipment for sterilizing
instruments and supplies
75. There are delivery kits available with the
items needed for basic hygiene for delivery
at home, where a midwife with a
midwifery kit is not likely to be present
76. AIMS
1. Thorough asepsis
2. Delivery with minimum injury to the
infant and mother
3. Readiness to deal with complications such
as prolonged labour, antepartum
haemorrhage, convulsions,
malpresentations, prolapse of the cord
4. Care of the baby at delivery- resusitation,
care of the cord, eyes etc.
77. Domiciliary care
Confinement can be in home if the conditions
are satisfactory
In such cases delivery may be conducted by
the health worker female or trained dai
This is called as domiciliary midwifery
service
78. Advantages of domiciliary care
1. The mother delivers in the familiar
surroundings of her home and this may
tend to remove the fear associated with
delivery in a hospital
2. The chances for cross infection are
generally fewer at home than in
nursery/hospital
3. The mother is able to keep an eye upon
other children and domestic affairs; this
may tend to ease her mental tension
79. Disadvantages of domiciliary care
1. The mother may have less medical and
nursing supervision than in the hospital
2. The mother may have less rest
3. May resume her duties too soon
4. Her diet may be neglected
5. Many homes in India may be unsuitable for
even a normal delivery
80. Since 74% of Indias population live in
rural areas, most deliveries will have to
take place at home with the aid of female
health workers and trained dais
Female health worker who is a pivot of
domiciliary care should be adequately
trained to recognize the danger signals
during labour and seek immidiate help in
transferring the motherto the nearest
Primary health center or hospital
81. Danger signals
1. Sluggish pains or no pains after rupture of
membranes
2. Good pains for an hour after rupture off
membranes but no progress
3. Prolapse of cord or hand
4. Meconium stained liquor or a slow irregular
or excessively fast fetal heart rate
82. 1. Excessive show or bleding during labour
2. Collapse during labour
3. A placenta not separated within half an
hour after delivery
4. Post partum hemorrhage or collapse
5. A temperature of 38 deg C or over during
labour
There should be a close liaison between
domiciliary and institutional delivery
services
83. Institutional care
About 1% of deliveries tend to be
abnormal and 4% difficult requiring the
services of a doctor
Recommended for all high risk cases and
where home conditions are unsuitable
The mother is allowed to rest in bed on the
first day after delivery, next day to be up
and about, discharge after 5 days of lying
period
84. Rooming in
Keeping the babys crib by the side of the
mothers bed is called rooming in
This arrangement gives an opportunity for the
mother to know her baby
Mothers interested in breast feeding usually find
there is a better chance for success
It also allays the fear in the mothers mind that
the baby is not misplaced in the central nursery
It also builds up her self confidence
www.
85. Post natal care
86. Care of the mother and the newborn after
delivery is known as postnatal care or post
partal care
Broadly this care falls into 2 areas - care of
the mother ( primarily the responsibility of
the obstetrician), care of the
newborn( combined responsibility of the
pediatrician and the obstetrician)
The combined area of responsibility is also
called perinatology
87. Care of the mother
The objectives of postpartal care are
1. To prevent the complications of postpartal
period
2. To provide care for the rapid restoration of the
mother to the optimum health
3. To check the adequacy of breast feeding
4. To provide family planning services
5. To provide basic health education to mother/
family
88. Complications of the post partumperiod
Should be recognized early and dealt with promptly
1. Puerperal sepsis ; this is infection of the genital
tract within 3 weeks after delivery
2. This is accompanied by rise in temperature and
pulse rate, foul smelling lochia, pain and
tenderness in lower abdomen
Prevented by asepsis before, during and after
delivery
89. 2. Thrombophlebitis: infection of the veins of
the legs, frequently associated with
varicose veins
The leg may become tender, pale and
swollen
3. Secondary hemorrhage : Bleeding from
vagina anytime from 6hrs after delivery to
the end of peurperium(6weeks ) is called
secondary hemorrhage, and may be due to
retained placenta or membranes
4. Others UTI, mastitis
90. Restoration of the mother to optimumhealth
Physical
Psychological
Social
91. Physical
Postnatal examinations- health check ups must be
frequent- twice a day during first 3 days and
subsequently once a day till the umbilical cord
drops off. At each of these examinations, the FHW
checks temperature, pulse and respiration,
examines the breasts, checks progress of normal
involution of uterus, examines lochia for any
abnormality, checks urine and bowels and adviseson perinatal toilet including care of the stitches, if
any
92. The immidiate postnatal complications, viz
peurperal sepsis, thrombophlebitis
secondary haemorrhage should be kept in
mind
At the end of 6 weeks , an examination is
necessary to check up involution of uterus
which should be complete by then
Further visits should be done once a month
during the first 6 months, and thereafter
once in 2-3 months till the end of 1 year
93. In rural areas only limited postnatal care is
possible
Efforts should be made by the FHWs to
give at least3-6 postnatal visits
The common conditions seen during the
postnatal period are subinvolution of
uterus, retroverted uterus, prolapse of
uterus and cervicitis.
94. 1. Anemia to be detected and treated
2. Nutrition breast feeding mothers should
be given nutritious diet
3. Postnatal exercises are necessary to bring
the stretched abdominal and pelvic
muscles back to normal as quickly as
possible
95. Psychological
Fear and insecurity which is generally born of
ignorance to be eliminated by prenatal instruction
Timidity and insecurity regarding the baby
To endure cheerfully the emotional stresses of
childbirth, she requires the support and
companionship of her husband
Postpartum psychosis - rare
96. Social
Women to have a baby part of the truth
To nurture and raise the child in a
wholesome family atmosphere
She with her husband should develop her own
methods
97. Breastfeeding
Breast milk provides the main source of nourishment
first year of life and in India up to 18 months of
life
Feeding bottle is nutritionally poor and
bacteriologically dangerous
Indian mothers feed up to 2 years
They secrete 400- 600ml of milk /day during first
year
98. Exclusive breast feeding up to 6 months
Complementary or supplementary foods
thereafter
weaning
99. Family planning
Related to every phase of maternity cycle
Motivate mothers when they attend maternity clinics
Spacing or terminal
Post partum sterilization generally recommended on
the second day
Lactational amenorrhea cannot be relied on for
contraception
100. To ask the mother to come at first
menstrual cycle may be too late
Contraceptive should not affect lactation
IUD and non hormonal are choice in first
6months
Oral pills to be avoided
DMPA- successful without suppressing
lactation, but causes irregular bleeding and
prolonged infertility- so not recommended
for general use
101. Basic health education
Hygiene personal and environmental
Feeding mother and infant
pregnancy spacing
Importance of check up
Birth registration