175) "Mother’s Health is Child’s Health" was the theme of a five rupee coin issued by the Reserve Bank of India/India Govt. Mints in 1996:

175) "Mother’s Health is Child’s Health" was the theme of a five rupee coin issued by the Reserve Bank of India/India Govt. Mints in 1996:

World Population Day:

In 1968, World leaders met and resolved that “individuals had a basic human right to determine freely and responsibly the number and timing of having their children”.

Despite having asserted their commitment towards creating awareness towards this right, modern contraceptives have remained out of reach for millions of women, men and young people world-wide.

On 11.07.1987, when the World population was recorded at Five Billion, the World Population Day was first observed in 1989, as an awareness initiative. This initiative was started to build awareness on population related issues and the impact that a rapidly rising human population has on development, quality of life as well as the environment. As a corollary, of vital concern was the health of a mother, as well as, her newly born child particularly in large families, where not only the mother’s health was under severe strain but the quality of life of the family also underwent a severe setback in a majority of cases.

The driving point behind every one of these UNO initiatives was “Make every Mother and Child count”.

Therafter, World Population Day is observed by the United Nations on July 11 every year to reassert the human right to plan for a family, at the same time, to refocus on the problems arising out of a rising population.

The UNO encourages activities, events and information to help make this right a reality across the World. It aims at increasing people’s awareness on various population issues such as the importance of family planning, gender equality, poverty, maternal health and human rights. The Day is celebrated world-wide with several activities including seminar discussions, educational information sessions and essay competitions. World Population Day is a global observance and not a public holiday.

Focal points which go into creating an Environment for taking care of the health of Mothers and new born and young children:

-      There is a need for World Nations to set in place Public health programmes which should focus on all families having continuous care which extends from even before pregnancy through childbirth and on into childhood, instead of piecemeal health related services as are available at present. Mothers, the new born and children represent the well-being of a society and its potential for the future. Their health needs cannot be left unmet without harming the whole society. In many countries several mothers and children are excluded from even the most basic health care benefits – those that are important for their mere survival. Nevertheless, even today, in many countries, the situation is improving too slowly or not improving at all, while in some it is getting worse.

-      Universal access and financial protection is required for all mothers and children. This is required, so as to ensure that every mother, new born baby and child in need of care obtains it and no one is driven into poverty by the cost of that care.

-      There is an urgent requirement to build up a health workforce based on better funding and better organisation to respond to health needs  of mothers and new born and young children, on extremely affordable or no cost basis.

-      The Millenium Development Goals (MDGs) which have a target of being achieved by December 2015 have also emphasised the importance of improving health of mothers and children as an integral part of poverty reduction. The redefined buzz-word for this purpose not “MCH” (Maternal and Child Health) but “MNCH” (Maternal, Newborn and Child Health).

-      Every year more than 3.5 to 4.0 million babies are still-born, more than 5.0 million die with a month of their birth and around 7.0 to 8.0 million young children die before they reach the age of five. Maternal deaths at over half a million every year too are rather alarming – during pregnancy, during child-birth or after the child is born – often leaving behind families driven to poverty because of meeting the health care costs.

-      During the 1990s, several countries with the highest burdens of mortality and ill-health made little progress towards reducing this human cost. Even today a worrisome situation regarding reversal of newborn, child and maternal mortality exists in these countries.

-      Ante-natal care needs to be integrated with other health programmes such as HIV/AIDS/HINI, prevention and cure of sexually transmitted infections, tuberculosis and malaria etc. as well as, Family Planning through awareness created by dedicated teams of health workers.

-      There is an urgent need to reform the thinking in every society, political and legal environment, through Education and focussed programmes, in a way that violence against women, discrimination in the workplace or at school or even marginalisation is done away with. Usage and wider availability of contraceptives would go a long way too in Family Planning. These initiatives would do away with several millions of unwanted, unintended and mistimed pregnancies, as the women would have an equal say in the matter. This would help focus resources towards mothers who have planned to have a family.

-      Skilled mid-wifery professionals can help in providing first-level maternal care, as back-up care is necessary for only a minority of mothers and newborn children who may need the intensive care provided at well-equipped hospitals.

-      Even after child-birth, the days following the birth can be dangerous for mothers and their babies. There exists an urgent need to develop effective ways of organising continuous care during the first few weeks after birth. Health programmes to tackle vaccine preventable diseases, malnutrition, diarrhoea or respiratory infections still have a huge unattended/unfinished agenda.

-      The Integrated Management of childhood Illness (IMCI) programme has a three-fold initiative: improving the skills of health workers to treat diseases and to counsel families, strengthening the health system’s support and helping households and communities to bring up their children in a healthy manner and to deal with ill-health if and when it occurs. The emphasis is on health care closer to the mother and child’s home. The magnitude and scaling up of services towards universal access is, nevertheless, a very tall order.

-      Seventy million mothers and their new-born babies, as well as countless children are excluded from the health care to which they are entitled. Even more numerous are those mothers and children who remain without protection against the poverty that ill-health can cause.

-      Channelling increased funding flows through National Health Insurance Schemes, which may be tax-based, social health insurance or mixed systems offers an avenue to meet the finances required for building up the supply of services towards universal access, building up financial protection systems after the supply of services is put into place as well as having a dedicated and motivated work-force.

-      Above all, there is to be an overriding focus which places the mother, newborn and child health as the overriding concern for all these efforts and providing universal access to the entire target group. This will ensure that no mother, newborn or child’s health needs remain unattended and that “every Mother and Child counts”.

Millenium Development Goals (MDGs):

In September 2000, World leaders met at the UN Headquarters in New York where they adopted the United Nations Millennium Declaration, committing their nations to a new global partnership to set out a series of time-bound targets, with a deadline of December 2015.

The Millennium campaign aimed at eradicating extreme poverty which continues to be one of the main challenges today and is a major concern of the international community. The MDGs also targeted reducing hunger, disease, lack of adequate shelter and exclusion, while promoting gender equality, health, education and environmental sustainability which embody the basic human rights for every person on Earth.

The following eight initiatives are encompassed in the MDGs:

-      To eradicate extreme poverty and hunger

-      To achieve universal primary education

-      To promote gender equality and empower women

-      To reduce child mortality

-      To improve maternal health

-      To combat HIV/AIDS, Malaria and other diseases

-      To ensure environmental sustainability

-      To develop a global partnership for development

Each goal has specific targets and dates for achieving those targets. Till date, the progress in attaining the set goals has been unsatisfactory. Some countries have achieved many goals while been alarmingly slow.

Millenium Development Goals (MDG) Programme initiative – Improving the health of mothers and children:

These goals underline the importance of improving health, particularly of mothers and children as an integral part of poverty reduction around the Globe.

The health of mothers and children is a priority which had emerged long before the 1990s – it builds upon a century of programmes, activities and experience.

The nature of the priority status of maternal and child health (MCH) has now over the years also undergone a sea-change – previously, mothers and children were thought of as targets for focussed programmes, but now they are increasingly asserting their right to access of quality care as an entitlement to be guaranteed by the State. Today, maternal and child health issues have gradually transformed from a perceived concern into a moral and political imperative.

Nevertheless, universal access to the care provided to mothers and children which they are entitled to is still far from realisation. It is therefore necessary to refocus/ revisit strategies within maternal and child health programmes and give importance to the often overlooked health problems of newborn children. In other words, the term MCH (Maternal and Child Health) has now been recoined as MNCH (Maternal, Newborn and Child Health).

The proper strategies to improve MNCH can be put in place effectively only if they are implemented across programmes and service providers, throughout pregnancy and childbirth through to childhood. Placing MNCH at the core of this refocused initiative will provide a platform for building sustainable health systems where existing systems have hitherto failed to deliver satisfactorily.

Even in countries where MDGs are not fully achieved by 2015, moving towards universal access will be a positive step.

India’s progress in achieving the MDGs:

The Ministry of Statistics and Programme Implementation (MoSPI) is of the view that while India has made remarkable progress in several sectors, achieving all the MDGs is unlikely.

On the issue of reducing poverty by half, India has achieved the target well ahead of time n 29.9 percent of the population living below the poverty line in 2011 (Of course, India’s systems of collecting data are still quite “primitive”, so this figure may at best be an educated “approximation”). The Ministry has further stated that India has achieved this target ahead of time.

The Ministry has further stated that India has successfully eliminated gender disparity in primary and secondary education.

 Also, that India has successfully managed to control the spread of deadly diseases such as AIDs, malaria and tuberculosis etc.

(What is alarming is that) the country is unlikely to meet the target of reducing the proportion of underweight children by half.

India has also increased the forest cover and has halved the proportion of population without access to clean drinking water.

Nevertheless, India lags behind on targets of empowering women through wage employment and political participation. Also, on the issue of maternal mortality India is unlikely to reduce mortality by 75% and under-five mortality by two-thirds, both of which issues are highlighted on this coin as early as 1996.

Issuing a coin with a social message by the Government of India/India Givernment Mints to highlight the issue of Mother and Child Health:

For the purpose of reducing mother/infant mortality rate in India, the Government of India brought out this slogan/coin which emphasises that a healthy mother’s health has a direct bearing on her child’s health.

This coin was released on World Population Day on 11.07.1996 to raise awareness among the citizens of India.

 On the Reverse of the Coin there is a triangle, representing the symbol of Family Planning, within which is shown a mother holding her baby/child. On the upper periphery is mentioned “Swastha Maa se Swasth Shishu” in Hindi and on the lower Periphery is mentioned “Mother’s Health is Child’s Health”. The Year of issue is mentioned as “1996” on top of the Family Planning Triangle, below which is the “Diamond” mint mark of the Mumbai Mint.

 On the Obverse of the Coin on the upper – centre is the Lion Capitol of Emperor Asoka with the legend “Satyameva Jayate” in Hindi meaning “Truth always Prevails” which is the emblem of the Government of India. On the left periphery is mentioned “Bharat” (in Hindi) and on the right periphery is mentioned “India” (in English). The denomination of the coin “Rs.5” is at the extreme bottom.

The specifications of this coin are as under:

Year of issue: 1996; Metal Composition: Copper-Nickel; Weight: 8.97 gms. Diameter: 23 mm; Thickness: 2.85 mm; Edge: Security; Shape: Round.

As a matter of interest – a Mother’s and Newborn’s Health Insurance Plan enacted in 1996 in the USA:

In 1996, the USA brought out “The Newborn’s and Mother’s Health Protection Act of 1996, which was a piece of legislation relating to the coverage of maternity by health insurance plans in the USA which was enacted on 26.09.1996.

This act requires a health plan or an employee health benefit plan that provides maternity (including childbirth) benefits to provide coverage for a minimum in-patient length of stay for a mother and her newborn following delivery. The Act mandates timely post-delivery care when mother and newborn are discharged prior to those lengths of stay.

The Act prohibits the Plan from using certain types of penalties or inducements regarding participants, beneficiaries, policy-holders or providers.

This Act also encompasses plans that offer maternity coverage to pay for at least a 48-hour stay following childbirth or a 96 hour hospital stay following a caesarean section except under certain clauses i.e. where the attending medical physician or midwife decides in consultation with the mother to discharge the mother or new-born child earlier and that health plans and insurance issuers may not restrict a mother’s or newborn’s benefits for a hospital length of stay as prescribed.

Also, a mother cannot be encouraged to accept less than the minimum protections available to her under the Act and an attending provider cannot be induced to discharge a mother or newborn earlier than 48 or 96 hours after delivery.

(This coin has been contributed for my collection by Rohit Tingre and his mother Manda Tingre.)