Quality Antenatal Care:- Quality and comprehensive ANC incorporates minimum of at least four ANCs including early registration and first ANC within 1st trimester. The ANC package includes physical and abdominal examinations, Hb estimation, screening for Gestational Diabetes Mellitus, Thyroid disorders, HIV/Syphilis and urine investigation, TT/Td vaccination, distribution of IFA tablets & Calcium (6 months during antenatal period & 6 months during postnatal period) and counselling for nutrition, family planning etc.

Pradhan Mantri SurakshitMatritva Abhiyan (PMSMA), one of the maternal health flagship programmes, provides fixed-day assured, comprehensive and quality antenatal care to all pregnant women in 2nd& 3rd trimesters on the 9th of every month. The service package includes - check up by Specialist doctor, essential blood investigations & USG. Early detection of high-risk pregnancies is an important component of antenatal care. Extended-PMSMA (E-PMSMA) has provisioned additional days for PMSMA clinic and 3 additional visits for follow up and management of high-risk pregnancies along with financial incentives.

Postnatal care for Mother and Newborn:- Ensuring postnatal care within first 24 hours of delivery and subsequently home visits as per following schedule:

• 3rd,7th,14th,21st, 28th and 42nd Day– 6 visits (incase of an Institutional Delivery )
• 1st,3rd,7th,14th,21st, 28th and 42nd Day – 7 visits (incase of Home Delivery -1st visit has to be within 24 hours)

For identification and management of high-risk conditions in mothers during postnatal period, a guidance note with financial provisions under “Optimizing Postnatal Care” has been disseminated. It aims for reduction of approximately one-third of maternal mortality which apparently happens after the delivery and discharge from hospital.

Provision of Emergency Obstetric and Neonatal Care at FRUs: - Provision of Emergency Obstetric and Neonatal Care at FRUs is being done by operationalizing all FRUs in the country. While operationalizing, the thrust is on the critical components such as manpower, blood storage units and referral linkages etc. Availability of trained manpower (Skill-based training of health care providers) is linked operationalization of FRUs. The initiative being under taken in this regard are:

Augmentation of Skilled human resources for Maternal Health - To overcome the shortage of skilled manpower particularly Gynaecologists and Anaesthetists, the following key skill-based training programs have been introduced:

• 6 months’ Training programme in Obstetric Management Skills including C-Section (CEmONC) for 3 years in-service MBBS Doctors
• 6 months’ Training Programme in Life Saving Anaesthesia Skills (LSAS) for Emergency Obstetric Care for 3 years in-service MBBS Doctors
• 10 days Training Programme in Basic Emergency Obstetric Care for newly recruited Medical Officers (BEmOC)
• 21 days Training Programme for ANMs/SNs/LHVs as Skilled Birth Attendants (SBA)
•  Skills Labs (Daksh training)– For improving the skills of healthcare providers and to enhance their capacity for providing quality RMNCH +A services, Government of India has established Skills Labs at National and State level.

Referral Services at both Community and Institutional level – Government of India has a thrust to establish a network for Basic patient care transportation through ambulances with an aim to reach to the beneficiary in rural area for quick service delivery. Presently, the states have been given the flexibility to establish assured referral systems to transport pregnant mothers and sick infants which includes different models including public-private partnership models.

Janani Suraksha Yojna (JSY): Janani Suraksha Yojna (JSY), a demand promotion and conditional cash transfer scheme, was launched in April 2005 with an objective of reducing Maternal and Infant Mortality. It is being implemented for reducing the maternal and neonatal mortality by promoting institutional delivery among poor pregnant women.

Janani Shishu Suraksha Karyakram (JSSK): The Government of India launched JSSK on June 2011, which entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery including Caesarean-section. This initiative stipulates free drugs, diagnostics, blood and diet along with free transport from home to institution, between facilities in case of a referral and drop back home. Similar entitlements were put for sick newborns accessing public health facilities for treatment till 30 days after birth, but it has been expanded to sick infants up to 1 year of age and antenatal & postnatal complications..

Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): It was launched in 2016 to provide Comprehensive and Quality antenatal care to the pregnant women in 2nd& 3rd trimesters of their pregnancy, on the 9th of every month at designated public health facilities (PHCs /CHCs /SDHs /DHs/Urban health facilities etc). The OBGY Specialists / Radiologists / Physicians working in private sectors are also encouraged to register and volunteer for the programme and provide services at the nearby public health facilities.

Further, focusing on the tracking high risk pregnancies, Extended PMSMA (e-PMSMA) strategy was launched in January 2022 to ensure quality ANC to pregnant women, especially to high-risk pregnancy (HRP) women and individual HRP tracking till a safe delivery is achieved by means of financial incentivization for the identified high risk pregnant women and the ASHA accompanying her for 3 extra visits over and above the PMSMA visit.

Labour Room Quality Improvement Initiative (LaQshya): In 2017, the Government of India launched “LaQshya” program to improve the quality of care in Labour room and Maternity OTs of public health facilities, for ensuring respectful and quality care to all pregnant women during delivery and immediate post-partum period. Its implementation involves improving infrastructure, ensuring availability of essential equipment, providing adequate human resources, capacity building of health care workers, and adherence to clinical guidelines and improving quality processes in labour room and maternity OT.

Midwifery Initiative: With a vision to provide Midwifery-Led-Care Services in public health facilities, the Government of India (GoI) launched the Guidelines on Midwifery Services in December 2018. Through this initiative, GoI aims to create a cadre of Nurse Practitioners in Midwifery (NPM) who are skilled in accordance with International Confederation of Midwives (ICM) competencies, knowledgeable and competent in providing skilled, compassionate, respectful, women-centered care. Midwifery Initiative is focused on providing respectful and positive birthing experiences to all pregnant women by promoting natural birthing. For the training of Nurse Practitioners Midwifery Educators (NPME) and Nurse Practitioners in Midwifery (NPM), National Midwifery Training Institutes (NMTIs) and State Midwifery Training Institutes (SMTIs) have been established in the country.

Surakshit Matritva Aashwasan (SUMAN): The Ministry of Health and Family Welfare launched the SUMAN initiative in October 2019. The aim of the initiative is to provide assured, dignified, respectful and quality healthcare at no cost and zero tolerance for denial of services for every woman and newborn visiting public health facilities. Under SUMAN, all the existing schemes for maternal and neonatal health have been brought under one umbrella in order to create a comprehensive and cohesive initiative, which goes beyond the entitlements and provides a service assurance. It is envisaged that such an approach will accelerate the rateof decline of maternal and neonatal mortality and pave the way for achieving Zero Preventable Maternal and Newborn deaths.

Optimizing Postnatal Care: One of the resolutions of the Chief Secretaries Conference held in January 2023 was, to emphasize the post-natal care for reduction of maternal mortality. Subsequently, this initiative was launched in June 2023 and a guidance note along with financial provisions was disseminated to all States/UTs. It aims to strengthen the quality of post-natal care to mothers, by laying emphasis on detection of danger signs and incentivization of ASHAs for prompt detection, referral & treatment of such high-risk postpartum mothers. Complimentary to the HBNC programme, ASHA conducts 6 home visits in case of an institutional delivery and 7 visits if it is a home delivery, not only for early detection of high-risk mothers but also for healthy outcome at 45th day post-delivery.

Comprehensive Abortion Care

Comprehensive abortion care is an important element in the reproductive health component of the RMNCH+A strategy as 8% (2001-03 SRS) of maternal deaths in India are attributed to unsafe abortions, thereby this is indeed a very important component of RNMCH+A program. This program is implemented as per the mandates of the Medical Termination of Pregnancy Act.

Medical Termination of Pregnancy (Amendment) Act & Rules, 2021: The MTP Act, 1971 recognized the importance of providing safe, affordable, accessible and legal abortion services to women who need to terminate a pregnancy due to certain therapeutic, eugenic, humanitarian or social grounds. The Act was amended for expanding the base of beneficiaries to provide safe abortion services.

Upon the approval of The Medical Termination of Pregnancy (Amendment) Bill, 2021 in Lok Sabha and Rajya Sabha and further assent received from Hon’ble President of India, the Medical Termination of Pregnancy (Amendment) Act, 2021 had been published in the official gazette on 25th March 2021, followed by its notification for commencement on 24th September 2021. The Rules were formulated and notified for commencement on 12th October 2021.

The Medical Termination of Pregnancy (Amendment) Act, 2021 provides for:

• Requirement of opinion of one registered medical practitioner for termination of pregnancy up to twenty weeks of gestation.
• Requirement of opinion of two registered medical practitioners for termination of pregnancy of twenty to twenty-four weeks of gestation.
• Enhancing the upper gestation limit from twenty to twenty-four weeks for vulnerable groups of women.
• Non-applicability of the provisions relating to the length of pregnancy in cases where the termination of pregnancy is necessitated by the diagnosis of any of the substantial foetal abnormalities diagnosed by a Medical Board.
• Strengthening the protection of privacy of a woman whose pregnancy has been terminated.
• Failure of contraceptive clause extended to the woman and her partner.

Key components of the program

Comprehensive abortion care services are available across the country at the public facilities along with approved private facilities with availability of RMP, as per the purview of law (mainly at MC, DHs, SDHs and FRU CHCs along with approved private health facilities). The facility providing abortion care services are strengthened in terms of the availability of drugs, equipment and trained provider for ensuring the safety of procedure. Capacity building of MBBS doctors

Capacity building is regularly done for MBBS doctors and OBGYNs on safe abortion techniques. ANMs, ASHAs and other field functionaries are also trained for providing safe abortion counselling while keeping women privacy on forefront along with post abortion contraception counselling .

Manuals, training packages, booklets and other IEC materials are developed from time to time for strengthening the implementation of the program such as CAC Training & Service Deliver Guidelines, CAC Training Package, Handbook for ASHA, videos, leaflet & booklet for field intermediaries, and posters for community awareness generation.

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Guidelines-MH	(314 MB)
IEC-Material	(7.30 MB)
Video-Material	(23.5 MB)