RCH Scheme

The Reproductive and Child Health (RCH) Scheme is a flagship programme of the Government of India, launched in October 1997 under the Ministry of Health and Family Welfare (MoHFW). It aims to improve the reproductive health status of women and the health and survival of children through an integrated, client-centred, and decentralised approach. The RCH scheme represents a major shift from the earlier family planning-oriented approach to a holistic reproductive and child health care strategy, focusing on the needs of women, adolescents, and children.

Background and Evolution

Before the RCH initiative, India’s health policy on maternal and child welfare was largely guided by the Family Welfare Programme introduced in 1951, which focused primarily on population control. However, by the 1990s, there was growing recognition that improving reproductive health required a broader focus on maternal and child well-being, rather than merely limiting births.
In 1994, following India’s commitments at the International Conference on Population and Development (ICPD) in Cairo, the government adopted a Reproductive Health Approach, which included safe motherhood, child health, adolescent health, and reproductive rights.
To operationalise these goals, the Reproductive and Child Health (RCH) Programme was launched in 1997, integrating all earlier maternal and child health initiatives under one umbrella.

Objectives of the RCH Scheme

The broad objectives of the RCH Programme are to:

1. Reduce maternal and infant morbidity and mortality.
2. Provide comprehensive reproductive health services, including family planning, safe delivery, and management of reproductive tract and sexually transmitted infections (RTI/STI).
3. Promote child health and nutrition, ensuring full immunisation and disease prevention.
4. Encourage adolescent health education and counselling.
5. Empower women and couples to make informed reproductive and health-related decisions.
6. Ensure universal access to quality reproductive and child health services at the grassroots level.

Phases of the RCH Programme

The programme has evolved in phases, with each phase expanding its scope and improving service delivery mechanisms.

RCH Phase I (1997–2004)

The first phase aimed to provide integrated reproductive and child health services at the district and sub-district levels.
Key components included:

• Safe motherhood interventions (antenatal, natal, and postnatal care).
• Child survival initiatives (immunisation, control of diarrhoeal diseases, and acute respiratory infections).
• Family planning and contraception services.
• Management of reproductive tract infections (RTI) and sexually transmitted diseases (STD).
• Information, education, and communication (IEC) for behavioural change.

Under RCH-I, a target-free approach replaced the earlier family planning targets, emphasising quality of care and client satisfaction.

RCH Phase II (2005–2010)

Launched in April 2005, RCH Phase II was incorporated as a major component of the National Rural Health Mission (NRHM) (now part of the National Health Mission – NHM).
Its focus shifted to reducing maternal and infant mortality and ensuring quality healthcare services for women and children.
Major features of RCH-II included:

1. Institutional Deliveries:
   • Promotion of safe delivery practices through Janani Suraksha Yojana (JSY) – a conditional cash transfer scheme encouraging institutional births.
2. Emergency Obstetric Care (EmOC):
   • Establishment of First Referral Units (FRUs) and strengthening of Primary Health Centres (PHCs) and Community Health Centres (CHCs) to handle obstetric emergencies.
3. Skilled Birth Attendance (SBA):
   • Training of nurses, midwives, and auxiliary nurse midwives (ANMs) to ensure safe deliveries.
4. Child Health Interventions:
   • Focus on neonatal care, integrated management of neonatal and childhood illnesses (IMNCI), and universal immunisation.
5. Adolescent Reproductive Health:
   • Counselling and services for menstrual hygiene, nutrition, and prevention of early pregnancy.
6. Disease Control:
   • Screening and management of RTIs, STIs, and HIV/AIDS through convergence with the National AIDS Control Programme (NACP).

Components of the RCH Programme

The RCH Programme delivers an integrated package of services covering three main domains:

1. Maternal Health

• Antenatal care (registration, check-ups, tetanus immunisation, iron and folic acid supplementation).
• Skilled attendance at delivery and safe motherhood interventions.
• Institutional delivery under Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakram (JSSK).
• Emergency obstetric care (blood transfusion, caesarean section facilities).
• Postnatal care and family welfare counselling.

2. Child Health

• Universal immunisation (BCG, DPT, OPV, measles, hepatitis B, etc.).
• Newborn care through Home-Based Newborn Care (HBNC) and facility-based neonatal care.
• Management of childhood illnesses (pneumonia, diarrhoea, and malnutrition).
• Nutrition supplementation through coordination with the Integrated Child Development Services (ICDS) scheme.

3. Reproductive Health and Family Planning

• Access to a range of contraceptive methods and counselling.
• Prevention and treatment of RTI/STI.
• Infertility management and reproductive health education.
• Safe abortion services under the Medical Termination of Pregnancy (MTP) Act.

Special Initiatives under RCH

Several important sub-programmes and initiatives were launched under the RCH umbrella:

• Janani Suraksha Yojana (JSY):
  • Introduced in 2005 to promote institutional deliveries and reduce maternal and neonatal mortality.
• Janani Shishu Suraksha Karyakram (JSSK):
  • Launched in 2011 to provide free medical care, medicines, diagnostics, and transportation for pregnant women and sick newborns.
• Mother and Child Tracking System (MCTS):
  • Developed to digitally monitor maternal and child health services.
• Facility-Based Integrated Management of Neonatal and Childhood Illness (F-IMNCI):
  • Integrates neonatal and child health management at healthcare facilities.
• Rashtriya Bal Swasthya Karyakram (RBSK):
  • Introduced in 2013 for early identification and intervention for health conditions among children from birth to 18 years.
• Menstrual Hygiene Scheme (MHS):
  • Promotes awareness and access to hygienic products for adolescent girls.
• Mission Indradhanush (2014):
  • Launched to ensure full immunisation coverage for all children and pregnant women.

Institutional Framework and Implementation

The RCH programme is implemented through the National Health Mission (NHM), involving multiple levels of governance:

• Central Government: Policy planning, funding, and technical support through MoHFW.
• State Governments: Programme implementation, recruitment of healthcare staff, and monitoring.
• District Health Societies: Local execution, training, and reporting.
• Community Involvement: Village Health Sanitation and Nutrition Committees (VHSNCs) promote local participation.

Funding follows a flexible pool system, allowing states to adapt interventions to local needs.

Achievements of the RCH Programme

Over the years, the RCH programme has contributed significantly to improving maternal and child health outcomes in India:

• Maternal Mortality Ratio (MMR): Reduced from 398 per 100,000 live births (1997–98) to 97 per 100,000 (2018–20).
• Infant Mortality Rate (IMR): Declined from 72 per 1,000 live births (1998) to 27 per 1,000 (2023).
• Institutional Deliveries: Increased from around 39% in 2005 to over 89% in 2023 (as per NFHS-5).
• Full Immunisation Coverage: Improved significantly through Mission Indradhanush and related initiatives.
• Adolescent Health: Integration of adolescent-friendly health services (AFHS) under RCH strengthened health education and awareness.

These improvements reflect India’s progress toward achieving the Sustainable Development Goals (SDGs) related to maternal and child health.

Challenges and Limitations

Despite remarkable progress, the RCH programme continues to face certain challenges:

• Regional disparities: States like Uttar Pradesh, Bihar, and Madhya Pradesh still have higher MMR and IMR.
• Infrastructure gaps: Shortage of skilled healthcare professionals and inadequate facilities in rural and remote areas.
• Socio-cultural barriers: Early marriage, low literacy among women, and gender bias affect utilisation of healthcare services.
• Quality of care: Need for improved monitoring, accountability, and client satisfaction.
• Adolescent and reproductive health: Requires greater focus on mental health, sexual education, and menstrual hygiene.

Significance and Way Forward

The Reproductive and Child Health (RCH) Programme represents a cornerstone of India’s public health policy, combining maternal, child, and reproductive health services under a single comprehensive framework. It has shifted the focus from population control to health rights, quality care, and empowerment of women.
Moving forward, the focus areas include:

• Strengthening healthcare infrastructure and human resources.
• Expanding digital monitoring and telemedicine.
• Enhancing adolescent and reproductive health awareness.
• Ensuring equity in access across states and socio-economic groups.