Strengthening RMNCAH+N: Broad Strategies

 To strengthen RMNCAH+N components, some strategies can be implemented:

1. Improving Access to Healthcare:

- Enhancing healthcare infrastructure and facilities.

- Expanding the reach of primary healthcare services.

- Implementing community-based healthcare programs.

- Ensuring transportation and logistics for healthcare delivery in remote areas.

2. Enhancing Maternal and Child Health:

- Promoting antenatal and postnatal care.

- Encouraging safe delivery practices.

- Increasing access to skilled birth attendants.

- Providing immunization services for children.

- Strengthening nutrition programs for mothers and children.

3. Addressing Reproductive Health Needs:

- Expanding access to family planning methods and contraceptives.

- Offering comprehensive sexual education.

- Providing safe and legal abortion services.

- Ensuring access to quality reproductive healthcare facilities.

4. Preventing and Managing Communicable Diseases:

- Implementing vaccination campaigns.

- Enhancing disease surveillance and outbreak response systems.

- Promoting hygiene practices and sanitation.

- Providing access to diagnostics, treatment, and care for infectious diseases.

5. Integrating Nutrition Interventions:

- Promoting breastfeeding and improving infant and young child feeding practices.

- Addressing malnutrition through targeted interventions.

- Implementing nutrition education and counseling.

- Strengthening micronutrient supplementation programs.

6. Strengthening Health Systems:

- Training and capacity building of healthcare workers.

- Enhancing health information systems.

- Improving supply chain management for medicines and healthcare commodities.

- Ensuring financial protection and health insurance coverage.

- Conducting research and monitoring evaluation to inform decision-making.

7. Engaging Communities and Partnerships:

- Involving communities in planning and implementation of healthcare programs.

- Partnering with NGOs, civil society organizations, and private sectors.

- Facilitating collaboration among stakeholders.

- Advocating for policy changes and mobilizing resources.

Remember, these are general strategies, and the specific actions may vary depending on the context and country-specific needs.

Midwifery Services in India

 Midwifery services play a crucial role in providing maternal and newborn care in India, particularly in rural areas where access to healthcare is limited. Midwives are trained healthcare professionals who specialize in childbirth and the postnatal period. They provide a range of services, including antenatal care, delivery care, postnatal care, and family planning services.

In India, the role of midwives has gained recognition in recent years, with the government launching initiatives to strengthen midwifery services. The National Health Policy (2017) recognizes midwives as an essential component of the healthcare workforce and aims to increase the number of midwives in the country.

The government has also launched several programs to improve midwifery services, such as the Janani Suraksha Yojana (JSY), which provides cash incentives to pregnant women who deliver in a health facility with the assistance of a skilled birth attendant, including a midwife. The government has also launched the National Rural Health Mission (NRHM), which aims to strengthen primary healthcare services, including midwifery services.

Despite these initiatives, there are still several challenges facing midwifery services in India. One major challenge is the shortage of trained midwives. According to a report by the International Confederation of Midwives (ICM), India has only 0.2 midwives per 1,000 population, which is significantly lower than the WHO-recommended ratio of 2.5 midwives per 1,000 population. This shortage of trained midwives leads to a high burden on existing midwives and limits access to quality maternal and newborn care in many areas.

Another challenge facing midwifery services in India is the lack of recognition and respect for midwives as healthcare professionals. Midwives are often viewed as less qualified than doctors and nurses, which limits their role in decision-making processes and restricts their scope of practice. This lack of recognition and respect also affects their remuneration and working conditions, leading to a shortage of qualified midwives and a high turnover rate.

In conclusion, while initiatives have been launched to improve midwifery services in India, there are still several challenges facing this critical aspect of maternal and newborn care. The government needs to address the shortage of trained midwives by increasing investment in midwifery education and training programs. Additionally, there is a need to recognize and respect the role of midwives as essential components of the healthcare workforce and provide them with adequate remuneration and working conditions. By addressing these challenges, India can ensure that all women have access to quality maternal and newborn care through skilled birth attendants, including midwives.

Decline in Total Fertility Rate and India at 2050

The total fertility rate (TFR) is the average number of children born to a woman during her reproductive years. In India, the TFR has declined significantly over the past few decades, from 5.0 in 1950-55 to 2.2 in 2015-20, according to data from the National Family Health Survey (NFHS). This decline in TFR is a result of various factors such as increased access to education and employment opportunities for women, improved access to family planning services, and changing social norms and attitudes towards family size.

The decline in TFR has significant implications for India's population dynamics in 2050. With a lower TFR, India's population growth rate is expected to slow down significantly. According to projections by the United Nations, India's population is expected to reach 1.7 billion by 2050, but the annual population growth rate is projected to decline from 1.3% in 2020 to 0.3% by 2050. This slower population growth rate will have several benefits for India, including reduced pressure on resources such as water, food, and housing, and lower healthcare and education costs per capita.

However, a lower TFR also presents some challenges for India. With a smaller workforce relative to the elderly population, there could be a greater burden on the working-age population to support the elderly through pensions and healthcare services. The government will need to ensure that there are enough jobs and economic opportunities for the working-age population to support this demographic shift.

Moreover, a lower TFR could also lead to a shrinking workforce relative to the dependency ratio (the ratio of dependents - children and elderly - to working-age individuals). This could put pressure on the working-age population to support a larger number of dependents, potentially leading to lower economic growth rates and higher taxes for working individuals.

In conclusion, the decline in TFR presents both opportunities and challenges for India's population dynamics in 2050. While slower population growth rates will have several benefits for India, such as reduced pressure on resources and lower healthcare and education costs per capita, there could also be challenges such as a greater burden on the working-age population to support the elderly and a shrinking workforce relative to the dependency ratio. The government will need to implement policies that cater to these demographic shifts and ensure that there are enough jobs and economic opportunities for all individuals in society.

Mental Health Counselling: An inseparable part of modern method of treatment

 Mental health counselling has become an integral part of modern healthcare, as it addresses the emotional, psychological, and social well-being of individuals. Mental health issues are becoming increasingly prevalent in today's society, with stress, anxiety, depression, and other disorders affecting people of all ages and backgrounds. Counselling provides a safe and supportive space for individuals to explore their thoughts, feelings, and behaviours, and develop coping strategies to manage their mental health.

The benefits of mental health counselling are numerous. Firstly, it helps individuals understand the root causes of their mental health issues and develop a greater sense of self-awareness. This understanding can lead to improved self-esteem, self-confidence, and a greater sense of control over one's life. Secondly, counselling provides individuals with practical tools and techniques to manage their mental health symptoms, such as relaxation techniques, cognitive-behavioural therapy (CBT), and mindfulness meditation. Thirdly, counselling can help individuals build resilience and develop coping strategies to manage future challenges and stressors.

Counselling is also beneficial for individuals who have experienced trauma or adversity. Trauma can have a profound impact on an individual's mental health, leading to symptoms such as anxiety, depression, and post-traumatic stress disorder (PTSD). Counselling provides a safe space for individuals to process their traumatic experiences and develop coping strategies to manage the associated symptoms.

Moreover, counselling is essential for individuals who are struggling with relationships or life transitions. Relationship issues can lead to feelings of isolation, low self-esteem, and anxiety. Counselling provides a supportive space for individuals to explore their relationship dynamics and develop communication skills to improve their relationships. Similarly, life transitions such as retirement, divorce, or the loss of a loved one can be challenging and lead to feelings of uncertainty and grief. Counselling provides a safe space for individuals to process their emotions and develop strategies to manage the associated challenges.

In conclusion, mental health counselling is an inseparable part of modern healthcare as it addresses the emotional, psychological, and social well-being of individuals. Counselling provides a safe and supportive space for individuals to explore their thoughts, feelings, and behaviours and develop coping strategies to manage their mental health symptoms. It is essential for individuals who have experienced trauma or adversity, are struggling with relationships or life transitions, or are experiencing mental health issues such as anxiety or depression. By providing practical tools and techniques to manage mental health symptoms and build resilience, counselling plays a crucial role in promoting overall well-being and improving quality of life.

Mental health: a new challenge

 Young people today face an increasing number of challenges to their mental health, and systems worldwide are insufficient to meet the large and growing demand.

Depression, anxiety and behavioural conditions are the leading cause of illness for young people and suicide is the fourth most prevalent cause of death amongst 15- to 19-year-olds. Meanwhile, around 50 per cent of mental health conditions begin by the age 14 and 75 per cent by age 24. So, if youth mental health challenges and their environmental factors aren’t addressed, they extend into adulthood. Conversely, having good mental health means being better able to cope, connect and function, leading to more fulfilling and productive lives.

Quality access to support and education remains a challenge in all countries, while stigma and discrimination prevents many young people from reaching out for support when it is available. However, access to support is not the only challenge. So too are the social determinants which influence mental health including poverty, social inequality, marginalization, exposure to war, increasing uncertainty and access to quality employment and training, with girls being disproportionately affected.

Low Sex Ratio at Birth: a major concern for Odisha

 Sex Ratio at Birth and Child Sex Ratio denotes the number of girls per 1000 boys, whichare considered as strong indicators of social health. The adverse sex ratios not only indicate poor social health, but also a barrier to attaining sustainable social development.

The child sex ratio of Odisha has been showing a declining trend since 1961. In the 1961 census, Odisha’s ratio was 1,035 which declined to 1,020 in 1971, 995 in 1981, 967 in 1991, 953 in 2001 and 941 in 2011.The National Family Health Survey-5 (2019-2021) had estimated Odisha's child sex ratio at 894, a sharp decline from 932 in NFHS-4 (2015-2016). The SRS statistical report estimated a fall of 23 points by Odisha in five years from 948 in 2014-16 to 925 in 2018-20. Odisha’s child sex ratio has plummeted to its lowest ever, according to the National Family Health Survey-5 (NFHS-5) that reported 894 female children for every 1000 males despite central and state government initiatives for the girl child. In 2015-16, the child sex ratio in Odisha was estimated at 932.Although, the overall sex ratio in Odisha has increased from 1,036 in 2015-16 to 1,063 in 2020-21, the child sex ratio has decreased to 894, which is the lowest it has ever been in the state.

The sex ratio at birth in Odisha in 2013 was 956 which decreased to 925 in 2020 (SRS 2018-20). The decline of SRB is a major concern for the State.  

The Department of Health and Family Welfare, Government of Odisha, in collaboration with the United Nations Population Fund (UNFPA), organized a State Level Consultative Workshop on Addressing Low Sex Ratio at Birth in Odisha on 5th December 2023 at Hotel ITC Welcom, Bhubaneswar.

The workshop was conducted in view of the decline of Sex Ratio at Birth (SRB) in the state to find out strategies to improve the sex ratio at birth in our State. Some of the reasons commonly put forward to explain the low levels of Sex Ratio at Birth are preference for sons, sex selective abortions, and female foeticide.

The objective of the workshop was to discuss the causes and consequences of the low SRB in the state and to develop a comprehensive action plan to improve the situation. The workshop also aimed to sensitize the district health officials and build their capacities on strengthening the implementation of the Pre-Conception and Pre-Natal Diagnostic Techniques (PC & PNDT) Act, 1994, which prohibits sex selection and regulates the use of diagnostic techniques.

The workshop was attended by around 100 participants, including the Additional District Public Health Officers (Family Welfare)-cum-District Nodal Officers, PC & PNDT and Assistant Managers-LAIS of all districts, state level health officers and concerned consultants, legal and medical experts, social scientists, members of civil societies and other stakeholders.

The workshop was inaugurated by the Mission Director, NHM Odisha in presence of Dr. Bijaya Kumar Panigrahi, Director, Family Welfare, Odisha, Md. Nadeedm Noor, Head of Office, UNFPA, Odisha, Director, I &PR Dept., Director, Social Welfare, W&CD Department, Director, Health Services of the State. The workshop generated a fruitful dialogue and paved a way to develop an action plan to address the issue of low SRB in Odisha and to ensure the survival, protection, and empowerment of the girl child.

Read more at:

https://pragativadi.com/state-level-workshop-on-low-sex-ratio-at-birth-in-odisha/ 

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