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The Health and Nutrition Situation

of the Mother and Child

in Banswara

Introduction

Dear Supervisor,

Very often, data is collected, compiled sent up for reporting and the exercise is finished there. However, there is a need to use the data collected at your level for improving the service delivery and improving the use of services by the community for whom it is meant.

This is a booklet which sums up nine key indicators which are crucial in realizing Hajo Soru in the district of Banswara. Each of the indicators are explained and the data that you collected during the base line survey last year is explained.

This booklet has been prepared for your use. You can and must use this as a programme planning tool.

Go through it carefully and use the information provided in your sector level meetings, to make your AWWs and ANMs understand what the situation is and to discuss what needs to be done to improve the situation in your block. Many of the indicators are linked. For example, weighing and feeding during illness or diarrhoea.

To assess how well your block is functioning against each of the indicator look at Pg.31. The score given in the 2nd column shows how well each block has done against each indicator. If any of the indicator has a score less than 50% then it is time to act. You must decide which problem should be given priority and discuss with your workers as to how the problem can be addressed.

You can use your AWC/SHC records (Monthly reports) and see which sectors and which centres are showing improvement with regard to each of these indicators. Discuss what brought about this improvement and encourage your workers on the good work that they have done. In sectors and centres which are not showing improvement, spend more time with those workers and assist them.

You can also use this in the community, to explain to mothers, the importance of ANC, regularly weighing, feeding during illness, etc., along with the AWW booklet and posters that have been provided to each of AWCs and SHCs.

Facilitators Team
Hajo Soru Project 

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Only a Healthy Mother can have a Healthy Baby

Indicator 1 - Pregnancy at Risk

Among others, there, are two conditions that are crucial to reduce risk at birth which will also protect the mother from putting herself at risk.  These are: age of the mother and time interval between two consecutive deliveries.

Condition 1 - The Right Age

If a woman has a baby when she is over 18 years and below 35 years of age, there are more chances that she would have an easier pregnancy and delivery.

What did the baseline survey show?
From the above, it is clear that in both Anandpuri (27 out of 82) and Garhi (26 out of 80) blocks, there were a greater number of pregnant women who were either under age or over age.

Table 1: No. of Pregnant women at risk due to age

Blocks	Below 18 years	In the safe age group  (18 - 35 years)	Above 35 years	Total number of Respondents	Total number of women at risk
Anandpuri	8	55	19	82	27
Bagidora	9	62	13	84	22
Ghatol	6	62	11	79	17
Garhi	10	54	16	80	26
Kushalgarh	8	58	14	80	22
Pipalkhunt	3	56	14	73	17
Sajjangarh	4	65	12	81	16
Talwara	5	57	15	77	20

Condition 2 - Interval between two births

If a woman has another baby after a two year interval, then she would have recovered from her previous delivery and thus is stronger to cope with the next pregnancy and birth.

What did the baseline survey show?
The above shows that in both Bagidora (37 out of 84)  and Talwara (33 out of 77), there were a large number of pregnant women who had two children within 2 years.

Table 2: No. of Pregnant women having 2 babies within 2 years

Blocks	Pregnant Women having child <2 years and thus at risk	Total Pregnant women
Anandpuri	21	82
Bagidora	37	84
Ghatol	17	79
Garhi	21	80
Kushalgarh	10	80
Pipalkhunt	10	73
Sajjangarh	14	81
Talwara	33	77

To sum up:

ICDS and Health functionaries must counsel and talk to women, adolescents and families about family planning methods that are available and appropriate with respect to each case.  They must also discuss with the family the importance of taking the at risk mother for check-up and that special care must be taken during the entire period of the pregnancy.  Finally the family and the concern women must be prepared for safe delivery and arrangement must be made for transportation in case of need for emergency obstetric care.  Timely and appropriate counseling and along with building of trust can the problem of at risk be minimised in the future.  While all blocks need attention, specific attention must be paid to Anandpuri, Garhi, Bagidora and Talwara.

Indicator 2 - Ante- natal care

As soon as a woman knows that she is pregnant, both she and her family are vested with certain responsibilities. Safe motherhood is also a right and she has to be taken care of in an appropriate and fitting manner, by the service delivery system and by society.

Step 1 - Registration

All pregnant women must be registered at the AWC or the SHC. Registration helps her to seek the care she deserves and assists the functionary to provide her the services.

What did the baseline survey show?
The survey results show that in Pipalkhunt (26 out of 73), in Kushalgarh (20 out of 80), and in Anandpuri (20 out of 82), were not registered.

Table 3: No. of Registered Pregnancy

Blocks	Registered	Not Registered	No Response	Total number of Respondents
Anandpuri	61	20	1	82
Bagidora	69	14	1	84
Ghatol	63	8	8	79
Garhi	73	6	0	79
Kushalgarh	60	20	0	80
Pipalkhunt	47	26	0	73
Sajjangarh	64	13	4	81
Talwara	69	7	0	76

Step 2 - Regular check-up

During the period of pregnancy, the woman must have atleast 3 check-ups, to know that everything is going all right with her and her baby.

What did the baseline survey show?
The above shows that  many women in the following blocks did not have even one checkup. These were in Anandpuri (32 out of 82), Kushalgarh (29 out of 80) and Pipalkhunt (29 out of 73). Moreover, in almost all the blocks,  there was no response (blank ) to this indicator. There were a large number of women who received only one check-up.

Table 4: No. of Pregnant women who had at least 3 checkups during pregnancy

Blocks	At least 3 checkups	Only one	Never	No Response	Total number Respondents
Anandpuri	25	18	32	7	82
Bagidora	40	22	8	14	84
Ghatol	54	12	11	2	79
Garhi	51	20	8	1	80
Kushalgarh	25	24	29	2	80
Pipalkhunt	28	14	29	2	73
Sajjangarh	28	15	15	23	81
Talwara	52	12	11	2	84

Step 3 -Protecting against Tetanus

A pregnant woman must protect herself against tetanus. She must take two Tetanus Toxoid injections. This can be given by the ANM at the health centre or at the AWC.

What did the Baseline survey show?
The above shows that  while a large number of women had TT shots (either one or both), many responses were blank. This could mean that many women did not know or did not go for the TT shots. This was especially so in Anandpuri and Sajjangarh.

Table 5: No. of Pregnant women who had TT shots

Blocks	One Shot	Two Shots	No Response	Total number of Respondents
Anandpuri	12	21	49	82
Bagidora	29	30	25	84
Ghatol	39	22	18	79
Garhi	22	43	15	80
Kushalgarh	31	21	28	80
Pipalkhunt	22	24	27	73
Sajjangarh	24	16	41	81
Talwara	27	31	19	77

Step 4 - Combating Anemia

Most of our Indian women, especially from the poorer strata are prone to Anaemia. Lack of iron makes the woman weak  and impacts on safe motherhood. Therefore it is necessary that she must take atleast a 100 IFA tablets during the course of her pregnancy. These are available at the SHC and AWC.

What did the Baseline Survey show?
The results showed that in Anandpuri (26 out of 82), in Kushalgarh (22 out of 80) and in Pipalkhunt (19 out of 73) did not take IFA tablets. Here again there were a number of blank responses against this indicator in all the blocks.

Table 6: No. of Pregnant women who had taken IFA tablets

Blocks	Yes	No	No Response	Total number of Respondents
Anandpuri	33	26	23	82
Bagidora	65	9	10	84
Ghatol	60	4	15	79
Garhi	66	9	5	80
Kushalgarh	49	22	9	80
Pipalkhunt	33	19	21	73
Sajjangarh	50	13	18	81
Talwara	66	4	7	77

Step 5 - Care during Pregnancy

Together with the first four steps, the pregnant woman must take care of her diet and food intake, and also ensure that she takes sufficient rest (atleast two hours during the day) and not lift heavy weights or do heavy work. Proper care during pregnancy will ensure her strength, a healthier baby and a normal delivery.

What did the baseline survey show?
The results show that in almost all the blocks, except for Pipalkhunt (35 out of 65) and in Sajjangarh (31 out of 68)  pregnant women did not  take sufficient care with regard to adequate nutrition. In four out of the eight blocks, less attention was also being paid to taking a minimum of two hours rest during the day and ensuring that heavy work is not done.

Table 7: No. of Pregnant women at risk due to age

Blocks	More Nutritious Food	Additional rest  totaling to  2 hours during  the day	Did not take care (food, rest)	No Response	Total number of Respondents
Anandpuri	46	13	19	4	82
Bagidora	63	16	2	3	84
Ghatol	43	21	7	4	75
Garhi	61	6	2	10	79
Kushalgarh	64	10	4	0	78
Pipalkhunt	30	4	26	5	65
Sajjangarh	37	14	3	14	68
Talwara	52	15	4	0	71

To sum up:

ICDS and Health functionaries must pay more attention to Ante-natal care services. They must:

• ensure that all pregnant women are registered and that there is no duplication of registration between departments;
• ensure that every pregnant woman has check-up at least thrice, and gains weight regularly
• ensure that all pregnant women receive both doses of  TT
• ensure that all women receive and consume their 100 IFA tablets
• build relationship with pregnant women and their families and counsel them, so that the woman has sufficient nutritious food intake during pregnancy, takes proper rest and does not engage in heavy work. These practices be discussed and workers must be encouraged to identify the problem and to workout solutions along with the concerned women and her family.

Special attention must be paid in these blocks, where the overall score for ANC is low:

• Pipalkhunt
• Anandpuri
• Kushalgarh
• Sajjangarh

ANC can be strengthened further in the remaining blocks of:

• Bagidora
• Garhi
• Talwara
• Ghatol

Safe Delivery Ensures Safety of Mother and Baby

Indicator 3 - Safe Delivery

Condition 1: Deliveries must take place at Institutions

In the earlier section, we saw  the importance of ante-natal care. Now , the mother is ready to deliver. Where she delivers her baby and how  and by whom the baby is delivered is extremely crucial for both the safety and health of the mother and her baby. If the delivery is carried out at a health centre or hospital, it is all the more safer and better.

The delivery can be conducted at home as long as the place of delivery is clean and hygienic and if the delivery is attended by a trained person (Dai or ANM).

What did the baseline survey show?
What the above shows is that in almost all the blocks more than one third of the deliveries take place in the home and not in institutions.  In Garhi almost all the deliveries 70 out of 80 took place at home. More than half of the deliveries took place at home in Pipalkhunt (51 out of 73), in Ghatol (51 out of 79), in Talwara (48 out of 77), and in Anandpuri (45 out of 82).

Table 8: No. of Pregnant women planning for Home versus Institutional Delivery

Blocks	Home	Institutional: PHC, Govt. Hosp.  Clinic	No response	Total number of Respondents
Anandpuri	45	21	16	82
Bagidora	42	29	13	84
Ghatol	51	16	12	79
Garhi	70	9	1	80
Kushalgarh	41	32	7	80
Pipalkhunt	51	5	17	73
Sajjangarh	36	19	26	81
Talwara	48	15	14	77

Condition 2: Deliveries must be attended by trained attendants

Since most of the deliveries tend to take place at home, it is important that those who attend the delivery are trained. This ensures that the five safety measures, i.e., safe, hygienic place, soap, clean hands, sterilized razor and clean strings are used.

What did the baseline survey show?
From the above, it is clear that except for Ghatol, all the blocks show a high number of deliveries attended by untrained Dais or family members. Kushalgarh, Sajjangarh and Talwara need attention in this regard.

Table 9: No. of deliveries were conducted by trained Personnel

Blocks	Family Member/  Untrained Dai	Trained Personnel	No Response	Total number of Respondents
Anandpuri	65	86	0	151
Bagidora	70	71	16	157
Ghatol	41	114	4	159
Garhi	65	94	0	159
Kushalgarh	91	65	0	156
Pipalkhunt	74	77	8	159
Sajjangarh	77	78	6	161
Talwara	82	76	8	166

To sum up:

The maternal mortality rate is 146 in Banswara as a whole, and the baseline survey also shows that  there is a definite need to increase the number of institutional deliveries.  secondly, even though Dais have been trained, women and their families tend to use the services of untrained Dais.  Therefore, ICDS and Health functionaries have to win the trust of pregnant women and their families, make them understand and use in practice the five essential safety measures.

While specific attention needs to be paid in all the blocks, the critical ones are:

• Garhi
• Ghatol
• Pipalkhunt
• Kushalgarh
• Sajjangarh
• Talwara

Protect the Child and Strengthen Immunity

Indicator 4: Protection soon after birth

Condition 1: The new born must be Fed Colostrum

Soon after the baby is born, the baby is no longer protected by the mother's womb, but exposed to the world of infection. The first milk, Colostrum contains properties which will provide immunity to the child. Therefore, putting the child to breast within the first one hour and feeding Colostrum becomes extremely important.

What did the baseline survey show?
The above shows that in Garhi and Talwara nearly 50% of the mothers had fed Colostrum. In Anandpuri it was really low with only 6 out of 151 mothers who had fed Colostrum. The other blocks were Bagidora (20 out of 157) and Pipalkhunt (33 out of 159) and Sajjangarh (49 out of 166), Ghatol (58 out of 159) and Kushalgarh (59 out of 156.)

Table 10: No. of Mothers who fed colostrum and other fluids

Blocks	No. of Mothers who fed colostrum	Total Number of Respondents
Anandpuri	6	151
Bagidora	20	157
Ghatol	58	159
Garhi	78	159
Kushalgarh	59	156
Pipalkhunt	33	159
Sajjangarh	49	161
Talwara	72	166

Condition 2: Breast feeding must be initiated within 1 hour of birth

It is necessary that the mother initiates breast feeding within 1 hour of birth. This provides warmth to the baby and helps the baby to start the suckling process. Such a step also facilitates exclusive breast feeding.

What did the baseline survey show?
The baseline survey shows that only in Talwara did 50% of the mothers initiate Breast feeding within a couple of hours. It was lowest in Anandpuri (13) where around 111 mothers started breast feeding after 12 hrs.

Table 11: No. of Mothers initiating breast feeding within 1 hour of birth

Blocks	Within  1 hr.	Within  2 -4 hrs.	Within  12 Hrs.	After  12 hrs.	No Response	Total No. of Respondents
Anandpuri	7	6	22	111	5	151
Bagidora	37	23	48	39	10	157
Ghatol	29	28	38	57	7	159
Garhi	60	26	46	25	2	159
Kushalgarh	25	53	28	49	1	156
Pipalkhunt	24	28	23	69	15	159
Sajjangarh	46	24	34	41	16	161
Talwara	67	19	26	49	5	166

Condition 3: The newborn must be exclusively breast fed

It is common practice to feed the new born with all kinds of fluids (janam  ghutti), even goat milk and the baby is breast fed only after 12-24 hours. This is harmful practice. Breast milk is safe and meets all the fluid requirements of the new born.

What did the baseline survey show?
The results of the baseline survey shows that in all the blocks, a majority of the mothers gave goat's milk. They also gave ghuttis, jaggery or herbal solutions. In Anandpuri (144 out of 151) and in Bagidora (123 out of 157) in Kushalgarh (96 out of 156); Sajjangarh (98 out of 161), Pipalkhunt (106 out of 159), Ghatale (90 out of 159), Talwara (86 out of 166) and in Garhi (78 out of 159) gave goats milk and or other fluids.

Table 12:  No. of Mother fed other fluids after birth

Blocks	Herbal Solution and Ghutti	Goat Milk	Jaggery	No Response	Total No. of Respondents
Anandpuri	6	144	0	1	151
Bagidora	31	103	3	20	157
Ghatol	24	115	1	19	159
Garhi	37	105	9	8	159
Kushalgarh	6	130	19	1	156
Pipalkhunt	14	106	19	20	159
Sajjangarh	5	143	0	13	161
Talwara	14	137	7	8	166

To sum up:

ICDS and Health functionaries have to convince families and mothers the need for feeding Colostrum and to stop feeding the baby anything else except mothers milk.

In the overall, Colostrum feeding is poor in five out of the eight  the blocks. Initiation of breast feeding soon after birth and exclusive breast feeding has to improve in all eight blocks.

Specific attention needs to be paid in:

• Anandpuri
• Pipalkhunt
• Bagidora
• Ghatol
• Sajjangarh

Protect the Child and strengthen Immunity

Indicator 5 - Complete protection of Child upto 2 years

Condition 1  - Children must be completely immunized before they are 2 years old

Children are vulnerable and exposed to infection. They have to be specifically protected from 6 childhood diseases which are dangerous and can cause death. Every child must therefore receive all the necessary doses and booster shots before the age of 2 years, i.e. BCG, OPV, DPT, Measles, as well as Vit A prophylactics.

What did the base line survey show?
In Anandpuri (30 out of 151) , Kushalgarh (33 out of  156), Pipalkhunt (22 out of 159), and in Garhi (45 out of 159),  the number of children who had been completely immunized was very low. Moreover, the number of blank responses were high in Pipalkhunt, Sajjangarh, Bagidora and Anandpuri.

Table 13: Status of Child Immunisation

Blocks	Completely Immunised	Incomplete Immunisation	No Response	Total no. of Respondents
Anandpuri	30	86	35	151
Bagidora	68	58	31	157
Ghatol	81	65	13	159
Garhi	45	113	1	159
Kushalgarh	33	117	6	156
Pipalkhunt	22	105	32	159
Sajjangarh	63	53	45	161
Talwara	99	45	22	166

To sum up:

While the situation has to be improved in all the blocks, serious attention has to be paid to the following blocks:

• Anandpuri
• Kushalgarh
• Pipalkhunt
• Garhi
• Bagidora
• Sajjangarh

The workers have to be assisted so that they can encourage women to bring their children for immunisation. They must have discussions with mothers in different hamlets on what the problem is, how the women perceive the problem and what solutions they propose.

Proper Feeding and Care leads to Healthy Growth

Indicator 6 - Timely and appropriate complementary feeding

As the baby grows, more nourishment is needed. In addition to mothers milk, the baby needs food in the form of semi-solids. This has to be initiated between 4-6 months. It can be a part of the family diet, but has to be prepared in such a way that the baby can eat and digest easily.

Condition 1 - Complementary feeding must start between 4-6 months.

What did the base line survey show?
The above shows that in Anandpuri only (22 out of 84) and in Bagidora (23 only out of 81) blocks mothers were aware of when to start complementary feeding. In the remaining blocks, a little over half of the mothers knew about this. The highest awareness was in Garhi and Ghatol blocks.

Table 14: No. of Mothers who have knowledge about timely complementary feeding

Blocks	Yes	No	No Response	Total No. of Respondents
Anandpuri	22	55	7	84
Bagidora	23	28	30	81
Ghatol	55	20	5	80
Garhi	58	22	1	81
Kushalgarh	44	29	3	76
Pipalkhunt	45	22	7	74
Sajjangarh	41	22	14	77
Talwara	49	24	1	74

Proper Diarrhoea Management Prevents Death

Indicator 7 -Proper management of diarrhoea

Diarrhoea is still the largest single health problem which takes a heavy toll on children under 5 years. Diarrhoea not only makes the already under-nourished child weaker, improper management can lead to dehydration and ultimately death. Feeding of Oral Rehydration Solution (ORS) becomes extremely vital, so also continued breast feeding and of other fluids and semi-solids during illness and after  recovery.

Condition 1 - ORS must be administered at the onset of diarrhoea

What did the base line survey show?
The base line results show that less than half the children in Anandpuri, in Bagidora and Sajjangarh received ORS or Sugar Salt Solution (SSS) during diarrhoea. The general practice seems to be taking the child to the doctor. There could be two reasons for this, (1) diarrhoea is not managed at home properly and therefore the child gets worse and needs medical attention, or (2) the child is immediately taken to the doctor, as the mothers do not know/are not convinced that it can be managed at home.

Table 15: Treatment during diarrhoea

Blocks	No. of children suffering from Diarrhoea	Given Nothing	Sugar Salt Solution	ORS	Treated by Doctor
Anandpuri	44	3	4	11	29
Bagidora	47	8	2	9	29
Ghatol	44	5	12	34	20
Garhi	24	1	7	14	15
Kushalgarh	65	3	15	20	38
Pipalkhunt	27	4	12	11	27
Sajjangarh	21	2	3	7	13
Talwara	56	7	8	19	31

Condition 2 - Continue feeding during and after illness

Young children are prone to fall ill, get bouts of diarrhoea. It is extremely important that during illness nourishment continues and so also after recovery. This is important because, the body needs to be strong to fight the illness and its effects.

What did the base line survey show?
The baseline survey shows that in the overall, mothers were either continuing with breast feeding or providing fluids during diarrhoea. This is a good sign. However, it can be improved in Ghatol (27 out of 44) and in Pipalkhunt (11 out of 27).

Table 16: Feeding Pattern during diarrhoea

Blocks	No. of Children suffering from diarrhoea	Breast feeding continued	Liquid Diet
Anandpuri	44	5	29
Bagidora	47	1	29
Ghatol	44	7	20
Garhi	24	7	15
Kushalgarh	65	13	38
Pipalkhunt	27	0	11
Sajjangarh	21	2	13
Talwara	56	10	31

To sum up:

In all blocks, use of ORS has to improve. ICDS and Health functionaries have to ensure that supplies of ORS packets are available and that mothers and their families know how to make the ORS solution and use it.

While the situation has to improve in all the blocks, specific attention needs to be paid to:

• Anandpuri
• Bagidora
• Sajjangarh

With respect to continued feeding and fluid intake during diarrhoea, most of the blocks are better off in terms of this indicator. However, this should be strengthened even further in all the blocks.

Specific attention needs to be paid to:

• Ghatol
• Pipalkhunt

Regular Weighing helps to Assess Proper Growth of Child

Indicator 8 - Regular weighing and growth monitoring takes place

In the district, most children have low birth weight. A child must increase in weight according to age. This is a clear indicator that the child is growing properly. Any dip or plateau in weight between two recordings is a sign that things are not going well with the child.

Condition 1 - Every child must be weighed at least 10 times a year.

What did the base line show?
The survey showed that in five blocks: Anandpuri (35 out of 151), Talwara (39 out of 166),  Kushalgarh (64 out of 156),  Sajjangarh (70 out of 161) and in Pipalkhunt (58 out of 159), less than half the number of children were weighed in the last  3 months prior to the survey.

Table 17: No. of children weighed

Blocks	Yes	No	No Response	Total no. of Respondents
Anandpuri	35	113	3	151
Bagidora	74	73	10	157
Ghatol	91	66	2	159
Garhi	138	21	0	159
Kushalgarh	64	92	0	156
Pipalkhunt	58	100	0	159
Sajjangarh	70	72	19	161
Talwara	39	121	6	166

To sum up:

In all the blocks, ICDS and Health workers have to organize health days, and ensure regular weighing takes place. Mothers of children who are under weight, or are consistently losing or not gaining weight must be paid specific attention.

Specific attention needs to be paid in all blocks.

However intensive efforts are needed in:

• Anandpuri
• Bagidora
• Kushalgarh
• Pipalkhunt
• Talwara

The workers have to be assisted so that they can encourage women to bring their children for weighing. They must have discussions with mothers in different hamlets on what the problem is, why they do not bring their children for weighing and what solutions they proposed.

Frequent interaction with women Increases participation and involvement

Indicator 9 - Regular interaction between mothers and functionaries

There is a need for mothers to come to the AWC regularly and for the workers in turn to visit mothers in their homes. If women do not come to the AWC, it reflects their lack of interest which could also be because of poor interaction between worker and mothers.

What did the base line show?
Only in three blocks over half of the mothers tended to visit the AWC regularly. In Bagidora (45 out of 81), in  Ghatol (45 out of 80), Sajjangarh (45 out of 77) and in Talwara (44 out of 74), mother were rarely visiting the AWC.

Table 18: No. of mothers visiting AWC

Blocks	No. of mothers who visit AWC regularly			Numbers who do not go	No Responses	Total No. of Respondents
	Regularly	Sometimes	2-3 times in a month
Anandpuri	44	9	5	10	16	84
Bagidora	33	11	3	22	12	81
Ghatol	34	9	1	11	25	80
Garhi	51	12	2	5	11	81
Kushalgarh	40	7	2	7	20	76
Pipalkhunt	39	1	6	12	16	74
Sajjangarh	32	15	0	16	14	77
Talwara	29	10	1	19	15	74

To sum up:

ICDS and health functionaries have to improve relations with mothers and their families and build the necessary trust and friendship with the women, so that both the worker and the women see care of mother and child as a shared commitment. While all blocks need to pay attention, urgent attention is needed in:

· Bagidora

· Ghatol

· Sajjangarh

· Talwara

As the supervisor of ICDS and Health it is your responsibility to assist the AWW and the ANM to organised Health days on a fixed day at a fixed place. Such a regular activity if organised and conducted with proper planning (see guidelines), then women will definitely participate more actively. Mahila Mandals have to be strengthen as core participants and leaders who take initiative in the community.

Conclusion

What is the conclusion?
All the 9 indicators show that there is a need to improve the delivery of services quantitatively and qualitatively. For this the relationship between ICDS and Health functionaries and the women has to be strong and based on trust.

The 9 indicators can be looked at together to understand the overall situation. For this purpose, points have been allocated to each indicator.
This is given in the table alongside.

Indicator No.	Conditions	Points
1.	At Risk: -    The right age  -    Interval between two births	5
2.	Ante-natal Care -    Registration  -    Regular check-up  -    Protecting against Tetanus  -    Combating Anaemia  -    Care during Pregnancy	25
3.	Safe Delivery -    Deliveries must be attended by trained attendants	10
4.	Protection Soon after Birth -    The new born must be Fed Colostrum  -    Breast feeding must be initiated within 1 hour of birth  -    The new born must be exclusively breast fed	15
5.	Complete Protection of child upto 2 years -    Children must be completely immunized before they are 2 years old	5
6.	Timely and appropriate complementary feeding -    Complementary feeding must start between 4-6 months	10
7.	Proper management of Diarrhoea	10
8.	Regular Weighing and Growth monitoring takes place -    Every child must be weighed atleast 10 times a year	10
9.	Frequent interaction with women increases participation -    Number of mothers regularly visiting the AWC	10
Total		100

Now if we add up the points scored by each block, the picture for all the nine indicators would be as follows:

Indicators	Maximum Score	Blocks
		Anandpuri	Bagidora	Ghatol	Garhi	Kushalgarh	Pipalkhunt	Sajjangarh	Talwara
At Risk	5	2	2	5	2	3.5	5	5	2
Ante-Natal Care	25	8	14	18	23	14	4	13	18
Safe Delivery	10	0	0	8	8	0	0	0	0
Protection Soon after birth	15	0	0	0	8	4	0	0	4
Complete Protection of child upto 2 years	5	0	0	4	0	0	0	0	4
Timely and appropriate  complementary feeding	10	2	2	8	8	8	8	8	8
Proper management of Diarrhoea	10	5	4	9	10	9	5	4	4
Regular weighing and Growth monitoring	10	2	2	8	10	2	2	2	2
Number of mothers regularly visiting the AWC	10	8	2	2	8	8	8	2	2
Total	100	27	26	62	77	48.5	32	34	44

From the above, it is clear that all the 8 blocks have unacceptably low scores in terms of total scores or with respect to different single indicators.

How did we get the score?

Method for scoring

In each block, against each indicator, grading has been done depending on the number among the targeted group who has not received the service, or not followed the correct practice, or not been aware etc. For example under indicator 1- At Risk, for condition 1 and 2, a block can score a maximum of five points. If there are over 50 women out of 100 who are at risk by age and spacing, then point scored would be 0. But if there are 25-50 women out of 100, then the score would be 3.33 out of 5. If there are less than 25 women out of 100 who are at risk by age and spacing, the block would score 5 out of 5.

This method has been used only for

• indicator 1 — at risk pregnancy

However, with respect to indicator 2, Ante-natal care, the method is reversed. The total score is 25. In each block against this indicator if for condition 1 i.e. registration, only 50 or less number of women out of a 100 are registered that block will get 0 out of 5 or 2 out of 10, as the case may be. If the number of women who have been registered is between 51 to 75 out of a 100 then the block will score 4 points out of 5 or 8 out of 10. If there are more than 75 women out of a 100 who have been registered then the block would score 5 out of 5 or 10 out of 10.

This method has been used for the following indicators.

• indicator 2 — Ante-natal care,
• indicator 3 — safe delivery,
• indicator 4 — protection soon after birth
• indicator 5 — Complete Protection of child upto 2 years,
• indicator 6 — Timely and appropriate complementary feeding,
• indicator 7 — Proper management of Diarrhoea
• indicator 8 — regular weighing and growth monitoring takes place.
• indicator 9 — Number of mothers regularly visiting the AWC.