Maternal health services, particularly
antenatal care and postnatal care services, require special
attention to reduce both maternal and infant mortality.
A large proportion of women in both urban and rural areas
are anaemic and are not protected against tetanus. The
proportion availing of postnatal care services are also
very low. Prophylaxis against nutritional deficiency would
be able to save many lives.
ANMs
will register all pregnant women in rural areas
in the first trimester with the help of periodic
surveys
Pregnant
women will be given two doses of TT injections and
100 tablets of iron and folic acid (IFA) twice a
year, following the special campaign approach in
addition to the regular services at all service
delivery points
Logistic
systems related to the procurement and distribution
of TT injections and IFA tablets will be streamlined
Antenatal
check-ups will be conducted to identify pregnant
women at risk and the referral system will be strengthened
to serve these women
Supplementary
nutrition will be provided to all pregnant and lactating
women and an IEC campaign will be launched to promote
healthy food habits
Postnatal
check-ups will be done by ANMs at both subcentres
and also during home visits
Infertility
clinics will be opened in all district hospitals
and services will be provided to couples having
infertility problems
Maternal
health care centres will be set up in all villages
with more than 1,000 people, initially by involving
community members and mobilizing resources from
the community
Facilities
and trained personnel will be made available at
the CHC level to treat women with reproductive tract
infections
Deliveries by Trained Personnel
Deliveries conducted by trained personnel
are extremely low in UP. Most of the deliveries take place
at home and are attended by untrained personnel. This
has led to high infant mortality, particularly neonatal
mortality and also maternal mortality. To reduce infant
and maternal mortality, added emphasis will be placed
on increasing institutional deliveries and the proportion
of deliveries attended by trained personnel.
The proportion
of institutional deliveries will be increased substantially
by encouraging women to avail of the facilities
available at block PHC, CHC, and health institutions
above the CHC level
In a
phased manner, round-the-clock service centres will
be opened in all health institutions with facilities
to conduct deliveries
Panchayats
will be provided funds to provide transport and
other facilities for emergency delivery.
Traditional
birth attendants will be trained in all villages
in conducting safe deliveries, and innovative approaches
will be initiated to provide safe delivery kits
to trained dais.
Refresher
training programmes will be conducted for trained
traditional birth attendants on a regular basis.
Child Health Services
The reach of child health services and
their acceptability have to be considerably increased
in order to reduce infant mortality. Immunization of children
against vaccine-preventable diseases, proper management
of diarrhoea, treatment of acute respiratory infection
and improved nutrition are the important measures that
need to be strengthened further. There has been considerable
improvement in the recent past in immunization coverage
and in the use of ORS packets or home-made solutions in
the case of diarrhoea.
IEC campaign
will be launched to create awareness about vaccine-preventable
diseases and to encourage utilization of immunization
services
Complete
immunization of children will be given the highest
priority and services of NGOs, community leaders,
and other civil society organizations will be utilized
to achieve complete immunization coverage of children
Mothers
will be educated about the use of oral rehydration
and home-made solutions, and social marketing of
ORS packets will be encouraged
Facilities
at PHCs and CHCs will be augmented to detect and
treat children having acute respiratory problems.
Supplementary
nutrition will be provided to all children, particularly
those from below the poverty line to eliminate all
forms of nutritional deficiencies
Sterilization Services
Sterilization services have a major
role to play in the reduction of fertility. Demand for
sterilization services is extremely high and has increased
over time. The sterilization performance in the state
has declined in the recent past, particularly after the
introduction of the target-free approach. Health workers’
visits to villages and their contacts with women to promote
informed choice have also declined. There is an urgent
need to streamline the service delivery systems to provide
services to voluntary acceptors of sterilization methods.
Integrated RCH camps conducted in select
districts of UP have helped to improve access to and quality
of services. RCH camps planned in advance and publicised
through various media have substantially improved access
to services. The camp approach may not be the best approach
to provide high-quality services on a regular and continuous
basis but, given the current service delivery situation
in the state, is the best suited to reach those in need
of services. The RCH camp approach will be further strengthened
and expanded to cover the entire state.
Sterilization
camps, in addition to RCH camps, will be conducted
in a systematic and planned way in the entire state
throughout the year
CHCs
and PHCs will be upgraded to provide quality counselling
and sterilization services
Visits
of health workers to villages and households, particularly
pregnant women, will be monitored and strict action
will be initiated against those who are not making
regular visits
All women
who availed of medical termination of pregnancy
(MTP) services and desired to limit their families
will be counselled to adopt permanent methods
Panchayat
members, NGOs, and personnel from other departments
will be involved to mobilize additional resources
to improve the quality of sterilization camps and
to make each camp conducted in the state a major
success
The frequency
of camps will be increased and systems in place
to organize camps will be streamlined
A pool
of medical officers consisting of surgeons would
be created at both the divisional and district levels
to provide services at RCH and sterilization camps.
This will enable Chief Medical Officers (CMOs) to
ensure availability of clinical services at camps
on an assured basis as per a predetermined calendar
Measures
will be initiated to ensure follow-up services to
all clients who received services at RCH/sterilization
camps
A periodic
review of the RCH/sterilization camp approach will
be undertaken to identify areas that need to be
strengthened, and all attempts will be made to strengthen
the quality of services provided in the camps
Involvement of Men
Involvement of men in family planning
has sharply declined in the past two decades. Vasectomy,
once the most accepted method, has hardly any users now.
Male participation is essential not only to increase the
use of contraceptives but also to reduce the enormous
burden the non-participation of men imposes on women.
UP has already trained several medical officers to conduct
no-scalpel vasectomy operations.
More
medical officers will be trained in conducting no-scalpel
vasectomy operations, and male sterilization services
will be made available in all CHCs and block PHCs
in a phased manner
Special
IEC campaigns will be launched to educate men about
responsible parenthood and to encourage them to
use family planning methods
Training
curricula of health workers, supervisors, and medical
officers will be modified to include material on
involvement of men
Facilities
will be provided at CHCs and PHCs to treat men having
reproductive tract infections, and effective counselling
services will be provided to prevent the spread
of infection
