National Policies and Programs on Reproductive, Maternal, Newborn, Child and Adolescent Health

The Reproductive, Maternal, Newborn, Child, and Adolescent Health Plus Nutrition (RMNCAH+N) framework forms the core of healthcare interventions under the National Health Mission in India. Introduced originally as RMNCH+A in 2013, the policy strategy expanded to incorporate ‘Nutrition’ (+N) to address lifecycle health requirements through a continuum of care approach. This strategy targets the key causes of mortality and morbidity among women and children across different stages of life.

Historical Evolution of Maternal and Child Health Care

India transitioned through several institutional frameworks to arrive at the current comprehensive policy architecture.

Key Developmental Milestones

• National Family Welfare Programme (1977): Shifted the policy orientation from strict population control to broad family welfare services.
• Child Survival and Safe Motherhood (CSSM) Programme (1992): Integrated vertical maternal and child health programs into a single framework.
• Reproductive and Child Health (RCH) Phase I (1997): Incorporated the Cairo International Conference on Population and Development (ICPD) principles. Added management of Reproductive Tract Infections (RTIs) and Sexually Transmitted Infections (STIs).
• RCH Phase II (2005): Launched under the National Rural Health Mission (NRHM) to strengthen First Referral Units (FRUs) and 24-hour delivery facilities.
• RMNCH+A Strategy (2013): Formally recognized adolescence as a distinct life stage and emphasized a continuum-of-care model.

Core Components of RMNCAH+N Framework

The strategy organizes health interventions across five distinct life stages alongside overarching nutritional support.

Key Maternal and Reproductive Health Initiatives

Janani Suraksha Yojana (JSY)

Launched in 2005 under NRHM, JSY is a conditional cash transfer scheme aimed at reducing maternal and neonatal mortality by promoting institutional deliveries among poor pregnant women.

Janani Shishu Suraksha Karyakram (JSSK)

Launched in June 2011, JSSK guarantees completely free and cashless services to pregnant women delivering in public health institutions. Benefits cover free drugs, diagnostics, blood transfusion, diet during hospital stay, and free transport from home to facility and back. The scheme extends free care to sick infants up to one year after birth.

Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)

PMSMA provides fixed-day, assured, comprehensive, and quality antenatal care free of cost to all pregnant women in their 2nd and 3rd trimesters. Specialized health check-ups occur on the 9th of every month across designated public health facilities.

Surakshit Matritva Aashwasan (SUMAN)

Introduced in 2019, SUMAN assures dignified, respectful, and quality healthcare at zero cost for every woman and newborn visiting a public health facility. It mandates zero tolerance for denial of services.

Key Newborn and Child Health Initiatives

India Newborn Action Plan (INAP)

Launched in 2014, INAP aligns with the global Every Newborn Action Plan. It aims to achieve single-digit Neonatal Mortality Rate (NMR) and single-digit Stillbirth Rate per 1,000 live births by 2030.

Rashtriya Bal Swasthya Karyakram (RBSK)

RBSK conducts systematic child health screening and early intervention services for children from birth up to 18 years. It targets the 4 Ds:

1. Defects at birth
2. Diseases in children
3. Deficiency conditions
4. Development delays including disability

Mothers’ Absolute Affection (MAA)

MAA is a nationwide program targeting intensified promotion of breastfeeding and complementary feeding practices. Frontline health staff counsel mothers to ensure initiation of breastfeeding within one hour of birth and exclusive breastfeeding for the first six months.

Nutrition Rehabilitation Centres (NRCs)

NRCs operate inside public health facilities to provide in-patient medical and nutritional care for children under five years suffering from Severe Acute Malnutrition (SAM) with medical complications.

Adolescent Health and Nutrition Programs

Rashtriya Kishor Swasthya Karyakram (RKSK)

RKSK targets adolescents aged 10 to 19 years across six priority areas: nutrition, sexual and reproductive health, non-communicable diseases, substance abuse, mental health, and gender-based violence. The scheme works through Adolescent Friendly Health Clinics (AFHCs) and peer educators (Saathis).

Anemia Mukt Bharat (AMB)

AMB implements a 6x6x6 strategy to accelerate the reduction of anemia across six target age groups using six interventions and six institutional mechanisms.

• 6 Beneficiary Groups: Children (6-59 months), children (5-9 years), adolescents (10-19 years), pregnant women, lactating mothers, and women of reproductive age (15-49 years).
• 6 Interventions: Prophylactic Iron and Folic Acid supplementation, periodic deworming, intensified behavior change communication, digital testing and point-of-care treatment, mandatory fortification of food in public programs, and management of non-nutritional causes of anemia in endemic areas.

Important Facts and Trivia for Exams

• The RMNCH+A framework introduced the ‘5×5 Matrix’ to prioritize high-impact interventions across five life stages and five structural pillars.
• High Priority Districts (HPDs) were identified based on a composite index of health indicators to receive 30% additional financial allocation under RMNCH+A.
• Under Home Based Newborn Care (HBNC), Accredited Social Health Activists (ASHAs) conduct 6 home visits for institutional deliveries and 7 visits for home deliveries during the first 42 days of life.
• The target replacement level Total Fertility Rate (TFR) set under national health policies is 2.1.
• The recommended duration for exclusive breastfeeding under the MAA program is the first 6 months of life.
• Sick Newborn Care Units (SNCUs) are established at District Hospitals and tertiary facilities to care for neonates weighing less than 1,800 grams or experiencing severe health complications.
• Deworming under national health programs uses Albendazole tablets administered biannually on National Deworming Day.
• First Referral Units (FRUs) are upgraded community health centers or sub-district hospitals equipped to handle emergency obstetric and newborn care 24/7.