HOW TO ACHIEVE A GOOD HEALTH FOR A CHILD?

 Essential neonatal care

 Exclusive breast feeding for first 6 months of life
 Immunization
 Wearing
 Safety precautions to prevent accidents
 Play stimulation and emotional – social needs fulfilment
 Health supervision at regular interval
 Love and security
 Maintenance of nutritional requirements, hygiene, and safety measures
 Allowing recreational activities
 Explaining about sexual concerns and sexuality
 Avoidance of the children by their parents
 Health and immunization records
 Promotion of self- care activities
 Acceptance of the children by their parents
 Nutritional supplements if needed
 Emotional support
 Promoting coping ability
 Avoid humiliation
 Promote self – esteem by reward
 Encouraging independence
 Preventive education

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CURRENT STATUS OF CHILD HEALTH IN INDIA
INTRODUCTION
The term “paediatrics” is derived from the Greek words, ‘pedia’ means child, ‘
iatrike’ means treatment and ‘ics’ means branch of science. Thus pediatric means the science
of child care and scientific treatment of childhood diseases. Paediatrics is synonymous with
child health. Children are major consumer of the health care. In India, with 1.21 billion of
population is the world’s second most populous country after China. An estimated 26
millions of children are born every year. It is alarming that with an absolute increase in
population of about 181 million in the population during the census 2001 and 2011, there is a
reduction of 5.05 million in the child population aged 0-6 years during the same period.

According to 2011 census, the total number of children aged 0-6 years is 158.79
million which is reduced by 3.1 % compared to the child population in 2001 census.
According to the data available the share of children of the age group 0-6 years to the total
population is 13.1 % in 2011. The child health programme under the National Health
Mission (NHM) comprehensively integrates interventions that improve child survival and
addresses factors contributing to infant and under-five mortality. It is now well recognised
that child survival cannot be addressed in isolation as it is intricately linked to the health of
the mother, which is further determined by her health and development as an adolescent.
Therefore, the concept of Continuum of Care, that emphasises on care during critical life
stages in order to improve child survival, is being followed under the national programme.
Another dimension of this approach is to ensure that critical services are made available at
home, through community outreach and through health facilities at various levels (primary,
first referral units, tertiary health care facilities). The new born and child health are now the
two key pillars of the Reproductive, maternal, new born, child and adolescent health
(RMNCH+A) strategic approach, 2013.

DEFINITION OF CHILD HEALTH:

Child health is a state of physical, mental, intellectual, social and emotional well-
being and not merely the absence of disease or infirmity. Healthy children live in families,
environments, and communities that provide them with the opportunity to reach their fullest
developmental potential.

HISTORICAL BACKGROUND OF CHILD HEALTH

The continuance of any society depends on the succeeding generations. Since
primitive times, welfare of children has been a successful index of general welfare of people.

In India and abroad pediatric population includes children up to 12 years of age.

However in developed countries pediatric care is extended up to adolescent age. Previously
pediatrics was limited to curative care. Many citizens of child care are found in records of
ancient civilization.

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The historical background of pediatrics is as follows:-

 The first citation of qualities of breast milk and child hygiene was in 225 BC in Indian
‘Susruta Samhita’.
 Hippocrates, a Greek philosopher (370 – 460 B.C), also known as ‘Father of modern
Medicine’ has made significant contributions on diseases found in children.
 The first Indian pediatrics were Kashyapa and Jeevaka (6 th century). They worked on
children diseases and child care.
 The first manuscript on management of children diseases was written by Kashyapa
and Samhita. Thereafter, Susruta and Samhita wrote about Ayurvedic medicine that
can be used for children. It was the first written record of pediatrics anywhere in the
world. Susruta was known as ‘Indian Hippocrates’. He wrote on child rearing
practices, infant feeding and diseases of childhood.
 Charak, was the court physician of Peshawar. He wrote on ‘care and management of
newborn in his Sansthan and Ashtanga – hridaya.
 Arab physician Rhazes (850 – 923 AD) wrote the first book on the diseases of
children.
 In 1472 AD, first book written on pediatrics named ‘Bagallarders’ was printed in
Italian. This book was related to diseases of children.
 In 1545 AD, Thomas Phare wrote the first book in English on children’s diseases.
 In 1802 first pediatric hospital was opened in Paris. In USA children’s Hospital of
Philadelphia was opened.
 Pediatrics as speciality came into being in 1860, when Dr Abraham Jacob established
first child clinic in New York and started giving special lectures on diseases of adults.
 In the 9th century, antennal care and pediatric care developed. Slowly people started
realizing about children’s needs. The Lady Chemsford All India League for Maternal
and Child welfare was established in 1920. Efforts were made by the league to create
public awareness about health problems of children by putting exhibitions, publishing
a journal and celebrating and celebrating baby weeks.
 In 1923, the first crèche was opened in India to provide day care to children.

CHILD HEALTH GOALS / TARGET

The ministry of women and child development has prepared a National Plan of Action
for children, 2005 that has the following objectives:

a) To reduce IMR to below 30 per 1000 live births by 2010.

b) To reduce Child Mortality Rate to below 31 per 1000 live births by 2010.
c) To reduce Maternal Mortality Rate to below 100 per lakh live births by 2010.
d) Universal equitable access and use of safe drinking water by 2010.
e) To eliminate child marriages by 2010.
f) To eliminate disability due to polio by 2007.
g) To reduce proportion of infants infected with HIV by 20% by 2007 and by 50% by
2010.

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 h) 100% rural population to have access to basic sanitation by 2012.

Various measures have been initiated by the Government to achieve above goals.

1 Crude Birth Rate 18.2 births / 1000 population (2020)

2 Crude Death Rate 7.3 deaths / 1000 population (2020)

3 Neonatal Mortality Rate 17 deaths / 1000 live births (2019)

4 Early Neonatal Mortality Rate 25.4 deaths / 1000 live births (2020)

5 Post Neonatal Mortality Rate 41.67 / 1000 live births (2019)

6 Infant Mortality Rate 29.94 deaths / 1000 live births (2018)

7 Under – 5 Mortality Rate 34 / 1000 deaths (2019)

8 Life Expectancy Male – 68.4 years (2020), Female – 71.2 years (2020)

9 Total Fertility Rate 2.17 children born / woman (2020)

10 Perinatal Mortality Rate 29.848 deaths / 1000 live births (2020)

Status of children in Brand India

 With more than one third of its population below18 years, they constitute 19% of the
world’s children
 Only 35 % births are registered, impacting name and nationality
 Only out of 16 children die before they attain one year of age, and one out of 11 die
before they attain five years of age
 35% of the developing world’s low birth weight babies are born in India
 One in every 100 children, 19 continue to be out of school. Of those who enrol,
almost 53 drop out before completing class VIII
 46% children from schedule tribes and 38% from schedule castes continue to be out
of school
 Of every 100 children who drop out of school, 66 are girls
 65% of girls in India are married by the age of 18 and become mothers soon after
 India is home to the highest number of child labourers in the world
 India has the world’s largest number of sexually abused children with a child below
16 years raped every 155th minute, a child below 10 every 13th hour, and one in every
10th children sexually abused at any point in time.

CURRENT STATUS OF CHILD HEALTH IN INDIA

With 40% of its estimated 1.2 billion populations under the age of 18 India is home to
the largest number of children in the world. About half of the children from poor
families belong to disadvantage groups like Scheduled Castes and Scheduled tribes.

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India contributes to more than 20 per cent of the world’s child deaths, with
approximately 1.73 million children dying annually before completing their fifth
birthday.

The gross domestic product has grown at an average of 8.2 percent over the last five
years and the government’s commitment to inclusive growth has resulted in increased
allocations to the social sector. This combined with a progressive legislative policy
environment, numerous sector programs, protection schemes and local self-
governance through the Panchayati Raj systems- has helped improve the lives of
India’s children and women.

Economic growth has not yielded commensurate results in the reduction of poverty
and disparity, and as a result achievements have been uneven in meeting the targets of
the Millennium Development Goals. The under-five mortality rates for Scheduled
Tribes and Scheduled castes are 96 and 88 deaths per 1,000 live births, and among
girls there is a sharp drop in attendance between primary and secondary school. Eight
states with the highest under-five mortality rates contribute to 47 percent of the
population and carry the burden of almost 70 per cent of under-five and infant deaths.

Progress towards the Millennium Development Goals targets remains uneven. A 56%
decline in child mortality in the 1-4 year age group since 1990 not with-standing, the
overall decline in child mortality has been hindered by subdued progress in neonatal
survival, especially within the first week of birth. To meet the Millennium
Developmental Goals target on child survival, the health, nutrition and social status of
the mothers and infants needs to improve, as does early childhood feeding, care and
development. Equally important is to improve, as does access to, and use of, quality
services. The infant mortality rate declined 10 points since 2006, and average decline
of two points per year.

Progress towards the Millennium Development Goals targets remains uneven. 56%
decline in child mortality in the 1- 4 year age group since 1990 not with-standing, the
overall decline in child mortality has been hindered by subdued progress in neonatal
survival, especially within the first week of birth. To meet the Millennium
Development Goals target on child survival, the health, nutrition and social status of
mothers and infants needs to improve, as does early childhood feeding, care and
development. Equally important is to improve access to, and use of, quality services.
The infant mortality rate (IMR) decline 10 points since 2006, an average decline of
two points per year.

The large scale of maternal and child under nutrition poses a challenge for India in
reaching the Millennium Development Goals on child nutrition, survival and
development. Recent government efforts in reconstructing the Integrated Child
Development services and other initiatives exemplify national commitment to holistic
child development.

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 Progress is evident in universalizing primary education, and India is likely to achieve
this Millennium Development Goal. Enrolment and completion rates of girls in
primary school have improved and are catching up with those of boys, as are primary
and elementary completion rates. In light of the Right of Children to Free and
compulsory Education Act, the challenges now are sub-optimal learning achievements
and completion of upper primary education, particularly among girls, children in rural
areas and those belonging to minority groups and the poorest wealth quintiles.

In child protection, issues like child marriage, child labor and gender-biased sex
selection threaten the environment in which children live. Forty three percent of
women in the 20-24 age group are married before the legal age of 18 years and an
figures show a continued decline in child sex ratios (0-6 age group), from 927 girls
per 1,000 boys in 2001 to 914 girls in 2011.

Another important area of concern is children’s rights affected by ethnic violence and
left wing extremism in some areas of states. There is growing concern on how this
affects children, both in terms of access and availability of basic services and a need
for challenging the protective environment.

THEORY APPLICATION FOR CHILD’S HEALTH

We can apply Maslow’s hierarchy of needs for children :

Maslow’s Hierarchy of needs Theory :

Maslow's hierarchy of needs is a motivational theory in psychology comprising a

five-tier model of human needs, often depicted as hierarchical levels within a pyramid.

Maslow (1943, 1954) stated that people are motivated to achieve certain needs and that
some needs take precedence over others. Our most basic need is for physical survival,
and this will be the first thing that motivates our behaviour. Once that level is fulfilled the
next level up is what motivates us, and so on.

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 This five-stage model can be divided into deficiency needs and growth needs. The
first four levels are often referred to as deficiency needs (D-needs), and the top level is
known as growth or being needs (B-needs).

Deficiency needs arise due to deprivation and are said to motivate people when they are
unmet. Also, the motivation to fulfilled such needs will become stronger the longer the
duration they are denied. For example, the longer a person goes without food, the more
hungry they will become.

Growth needs do not stem from a lack of something, but rather from a desire to grow as a
person. Once these growth needs have been reasonably satisfied, one may be able to reach
the highest level called self-actualization.

Every person is capable and has the desire to move up the hierarchy toward a level of
self-actualization. Unfortunately, progress is often disrupted by a failure to meet lower
level needs. Life experiences, including divorce and loss of a job, may cause an
individual to fluctuate between levels of the hierarchy. Therefore, not everyone will move
through the hierarchy in a unidirectional manner but may move back and forth between
the different types of needs.

The 5-stage model include :

1. Physiological needs -

The basic physiological needs are probably fairly apparent—these include the things
that are vital to our survival. Some examples of the physiological needs include:

 Food

 Water

 Breathing

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 Homeostasis

In addition to the basic requirements of nutrition, air and temperature regulation, the
physiological needs also include such things as shelter and clothing. Maslow also
included sexual reproduction in this level of the hierarchy of needs since it is essential to
the survival and propagation of the species.

2. Safety and security needs -

As we move up to the second level of Maslow’s hierarchy of needs, the requirements

start to become a bit more complex. At this level, the needs for security and safety
become primary. People want control and order in their lives, so this need for safety and
security contributes largely to behaviour at this level. Once a person's physiological needs
are relatively satisfied, their safety needs take precedence and dominate behaviour. In the
absence of physical safety – due to war, natural disaster, family violence, childhood
abuse, etc. – people may (re-)experience post-traumatic stress disorder or trans
generational trauma. In the absence of economic safety – due to economic crisis and lack
of work opportunities – these safety needs manifest themselves in ways such as a
preference for job security, grievance procedures for protecting the individual from
unilateral authority, savings accounts, insurance policies, disability accommodations, etc.
This level is more likely to predominate in children as they generally have a greater need
to feel safe.

Safety and security includes :

- Personal security

- Financial security

- Health and well-being

- Safety against accidents and illness.

3. Social belonging -

After physiological and safety needs are fulfilled, the third level of human needs is
interpersonal and involves feelings of belongingness. This need is especially strong in
childhood and it can override the need for safety as witnessed in children who cling to
abusive parents.

Deficiencies within this level of Maslow's hierarchy –

due to hospitalisation, neglect, shunning, ostracism, etc. – can adversely affect the

individual's ability to form and maintain emotionally significant relationships in general.

Social Belonging needs include:

- Friendship

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 - Intimacy

- Family

4. Esteem –

Esteem needs are ego needs or status needs develop a concern with getting
recognition, status, importance, and respect from others. All humans have a need to feel
respected; this includes the need to have self-esteem and self-respect. Esteem presents the
typical human desire to be accepted and valued by others. People often engage in a
profession or hobby to gain recognition. These activities give the person a sense of
contribution or value. Low self-esteem or an inferiority complex may result from
imbalances during this level in the hierarchy. People with low self-esteem often need
respect from others; they may feel the need to seek fame or glory. However, fame or
glory will not help the person to build their self-esteem until they accept who they are
internally. Psychological imbalances such as depression can hinder the person from
obtaining a higher level of self-esteem or self-respect.

Most people have a need for stable self-respect and self-esteem. Maslow noted two
versions of esteem needs: a "lower" version and a "higher" version. The "lower" version
of esteem is the need for respect from others. This may include a need for status,
recognition, fame, prestige, and attention. The "higher" version manifests itself as the
need for self-respect. For example, the person may have a need for strength, competence,
mastery, self-confidence, independence, and freedom. This "higher" version takes
precedence over the "lower" version because it relies on an inner competence established
through experience. Deprivation of these needs may lead to an inferiority complex,
weakness, helplessness etc. .

Maslow states that while he originally thought the needs of humans had strict guidelines,
the "hierarchies are interrelated rather than sharply separated". This means that esteem
and the subsequent levels are not strictly separated; instead, the levels are closely related.

5. Self-actualization–

"What a man can be, he must be.” This quotation forms the basis of the perceived
need for self-actualization. This level of need refers to what a person's full potential is and
the realization of that potential. Maslow describes this level as the desire to accomplish
everything that one can, to become the most that one can be. Individuals may perceive or
focus on this need very specifically. For example, one individual may have the strong
desire to become an ideal parent. In another, the desire may be expressed athletically. For
others, it may be expressed in paintings, pictures, or inventions. As previously mentioned,
Maslow believed that to understand this level of need, the person must not only achieve
the previous needs, but master them.

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THE FACTORS THAT AFFECT THE CURRENT STATUS OF CHILD
HEALTH IN INDIA ARE:-
 SURVIVAL – The very survival of the Indian child is a matter of concern. 2.5
million children die in India every year ; accounting for one in five deaths in the
world, with girls being fifty percent more likely to die. 87 children of every 100 born
still have the probability of dying between birth and exactly 5 years of age. According
to report on the state of India’s newborn , the health challenge faced by the new born
child in India is bigger than that experienced by any other country. Although India’s
Neonatal Mortality Rate (NMR) witnessed a significant decline in the 1980’s ( from
69 % per 1000 live births in 1980 to 53 per 1000 live births in 1990), it has remained
static since then (only dropping four points from 48 to 44 per 1000 live births between
1995 and 2000).
 FOOD INSECURITY – MALNUTRITION AND STARVATION -

One in every three malnourished children in the world lives in India. Child
malnourished is generally caused by a combination of inadequate or inappropriate
food intake, gastrointestinal parasites and other childhood diseases, and improper care
during illness. Is it not incongruous that in a nation with soaring GDP rates and sensex
indices marking India’s entry into the global marker, children continue to die of
malnutrition and starvation? The major cause for such a tragedy is the lack of
availability of Public Health Services in remote and interior regions of the State, poor
access to subsidized health care facilities, the declining state expenditure on public
health and lack of awareness on preventive child health care.

According to Planning Commission 50% below poverty line families are out of the
preview of the targeted public distribution system. The identification of below poverty
line is in no way an indicator of purchasing power to provide for a minimum decent
standard of living.

It is almost ironic that the Supreme Court of India has had to intervene to ensure that
children in this country get adequate and nutritious food – the most basic of rights for
all citizens to stay alive and healthy.

 HIV / AIDS – India, with the official figure of 5.1 million HIV infected people, has
the second highest national total of persons living with HIV / AIDS after the republic
of South Africa.

While the National Aids Control Organisation has estimated 0.55 lakh HIV infected
children (0 – 14 years) in the country in 2003, according to UNAIDS, it is 0.16
million children. Clearly there is a confusion regarding actual number of HIV / AIDS
infected people in India with the UN agencies putting it much high than the official
figure, which is bound to have an impact on the implementation of any programme. A
report on children and HIV / AIDS released last year by Human Rights Watch has
once again drawn attention to the expediency of the situation.

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 To be born a Girl: Plummeting Sex Ratio – The very existence of the girls child is
under threat. Defying the normal male – female balance, and the higher survival
capacity of girl babies and greater life expectancy of women to men prevalent in
human populations, the female to male balance in India has been adverse to females
for at least the past 100 years.

Sex selective abortion, more commonly known as foeticide, and what appears to be a
re – emergence of infanticide, are taking a rising toll, while neglect of the ‘survivors’
of this weeding out also persist. Unlike all other social evils that are attributed to
poverty, killing of female foetuses through sex – selective abortion cannot be
attributed to poverty and ignorance. Almost all government’s health policies seem to
have an underlying family planning agenda. Health activists have analysed that with
its emphasis on population control, the Rural Health Mission is no different. Over the
years it has become quite clear that if people are forced to limit the size of the
families, they shall do so at the cost of the girl baby, even it means that they have to
“import” brides from outside their states or their community.

There is no guarantee that the girl child who escapes foeticide, infanticide and is in
the 0 – 6 age group, will escape the cycle of deliberate neglect that may even result in
death because she is less fed, less encourage to explore the world, more likely to be
handed jobs to do, given less health care and medical attention.

 Elementary Education – While enrolment levels propelled by the flagship Sarva

Shiksha Abhiyan show an increase, the levels of retention in schools remain a matter
of concern. There has been a decline in the percentage of students who stay in school
till Class V from 61.2%, which is way below the global average of 83.3%. There is a
sharp decline in the enrolment ratio at the upper primary level. Also, the dropout rate
increases cumulatively as it proceeds towards higher levels. Although showing
improvements, the enrolment of girls is still below that of boys. The drop- out rates
for girls too is higher. Children belong to Scheduled tribe and Scheduled Castes
continue to face discrimination in schools and have lower enrolment and higher drop-
out rates. Despite the promise of education for all, 46% children from scheduled tribes
and 38% from scheduled castes continue to be out of school as against 34% in the
case of others. This is not surprising considering the discrimination that these children
face in the schools. The same can be said of the discrimination faced by disabled
children. In other words, the system of education is such- gender unfriendly, disabled
unfriendly, caste discriminatory, violent because of high degree of corporal
punishment- that children are forced to drop out of the system.
 Child Labour and Right to Education – A Contradiction - India continues to have
the highest child labour in the world. The existing law on child labour that allows
children to work in occupations that are not part of the schedule of occupations that it
considers harmful to children, contradicts the right of every child to the fundamental
right to free and compulsory education. Yet there seems to be no attempt being made
to resolve this contradiction.

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  Victims of violence and Abuse – There is an increase in reported crimes against and
by children. India has the dubious distinction of having the world’s largest number of
sexually abused children with a child below 16 years raped every 155 th minute, a child
below 10 every 13th hour, one in every 10 children sexually abused at any point in
time. An estimated 600,000 – 700,000 children are sexually abused in India. While
there is a fall in the reported cases of rapes, there is an increase in child rape and also
in incest rapes. Clearly, home and family are not always the safe haven they are
regarded to be. Child marriage, trafficking and corporal punishment continues.
Indeed, while child marriage earlier was merely a social evil, today children are
trafficked for marriage; especially into states that have either not allowed their girl
children to be born or prevented them from surviving.

Buying and selling of children within and across boarders for all kinds of purposes –
labour, marriage, entertainment and of course prostitution, continues unabated, even
as there is no comprehensive legal framework to address this problem in a holistic
manner.

GENERAL MEASURES OF IMPLEMENTATION

 Legal Framework for Implementation of CRC

The Indian Constitution, various national and policies and assorted laws concerning
children provide a legal framework for CRC implementation. There are certain policy
and other measures that directly concern children such as the National Charter for
Children, National Plan of Action and the National Commission for Protection of the
Rights of the Children. There are others that do not directly deal with children such as
the National Tribal Policy, the National Population Policy or the National Rural
Health Mission, but as citizens of this country, do have an impact on children also.

 Child Specific Interventions

National Charter for Children 2003

This chapter was published in the extraordinary Gazette of India, by the Ministry of
Human Resource Development through its Department of Women and Child
Development dated 9th February 2004.

The Charter reiterates the commitment of the Government of India to the cause of
children in order to see that no child remains hungry, illiterate or sick. However, this
Charter has come under criticism from child rights activists for a number of reasons.

 National Plan Of Action

Following the UN General Assembly Special Session (UNGASS) for Children in

2002 many countries of the world have decided to work on National Plan of Action
based on the Outcome Document. The Government of India has released the National
Plan of Action for Children 2005 on 20 August, 2005. The Plan has cited the UN

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 Convention as the guiding instrument for implementing all rights for all children up to
the age of 18 years. It also states, “The rights of the child as articulated in the
Construction of India and the CRC should work in synchrony to ensure all rights to all
children.”

 National Commission For The Protection Of Child Rights

The Government has been considering the setting up of a National Commission for
Children since 2000. In fact the draft bill for the National Commission for Children
and the Charter had been posted on the website of department of Women and Child
Development, inviting comments and suggestions.

The National Commission for Protection of Child Rights, on coming into force, shall
have the powers to uphold child rights and to take sue moto cognizance of child rights
violation.

 Non-Child Specific Interventions Affecting Children

Planning Commission of India Mid-term Appraisal(MTA) of the Tenth Plan

(2002-07)

In this approach to the mid - term appraisal, the Commission admits the following
areas of concern that reduce to children:

- Food security

- Right to Elementary and Primary Education

- Health and Family Welfare

 Special Protection Measures

Juvenile Justice

On July 24, 2003, a Bill seeking amendment to the Juvenile Justice Act 2000 was
introduced in Lok Sabha. Again later, the bill was presented in Rajya Sabha on 3
December 2004 to provide for the welfare measures to be undertaken by the State for
the neglected, exploited and underprivileged children such as street and vagabond
children, children born of pavement dwellers, sex workers, mentally challenged
mothers, jail inmates, etc.

Child Labour

The Child Labour Act, 1986, which distinguish between hazardous and non-
hazardous occupation allowing children below the age of 14 years are not allowed to
do any hazardous work. As the Act prevents children from working in hazardous
conditions but it has not been stop children from working.

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 Child Abuse

The Central Board of Secondary Education has drafted a Policy Paper for Help-Line
for Girl students for prevention of sexual harassment related to incidents in schools.

Child Marriage

Child Marriage Restraint Act, 1956 has proved inadequate in containing child
marriage in the country is beyond doubt. The Government has recently announced its
intention of drafting the Prevention of Child Marriage Bill 2004. As per the Bill, child
marriage will be a cognisable offence and also provides for declaring the marriage
void, paying maintenance to the minor girl until a remarriage and taking into custody
and provide maintenance for children born of child marriage.

Trafficking

For a long time the Suppression of Immoral Traffic in Women and Girls Act (1956)
was the main law dealing with trafficking and sexual abuse of girls. It was enacted
primarily to prohibit trafficking in women and girls for the purpose of prostitution and
was later amended and renamed as the Immoral Traffic Act (1986).This law as well as
the Indian Penal Code (1860) makes the offences of child trafficking, prostitution of
children and their sexual abuse carry higher punishments than those against adults. It
provides for the presumption of guilt under certain circumstances when the victim is a
child who has been sexually abused.

NATIONAL POLICIES FOR CHILDREN WELFARE:

In India, several measures has been undertaken by the national government to
improve the health of the people. Now a days, much importance has been given for
the care of children because “ Today’s children are the citizen of tomorrow ”. so to
improve the health condition of the children and keeping in view the constitutional
provisions and the united nations declaration of the rights of the child, the Govt. Of
India adopted a “ National policy for children in august 1974”.

The policy declares: “it shall be the policy of the state to provide adequate services
to the children, both before and after birth and through the period of growth, to ensure
their full physical, mental and social development. the state shall progressively
increased the scope of such services so that , within a reasonable time , all children in
the country enjoy optimum conditions for their balanced growth.”

Principles of India’s national policy for children are as follows:

1. A comprehensive health program for all children & nutrition service for the children.
2. Provision of health care, nutrition and nutrition for expectant and nursing mothers.
3. Free and compulsory education up to the age of 14 years, informal education for pre-
schoolers and efforts to reduce wastage & stagnation in schools.
4. Out of school education for those not having access to formal education.

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5. Promotion of games, recreation, and extracurricular activities in school and
community centres.
6. Special programs for children from weaker sections.
7. Facilities for education, training and rehabilitation for children in distress.
8. Protection against neglect, cruelty and exploitation.
9. Banning of employment in hazardous occupations and in heavy work for children.
10. Special treatment, education, training ,rehabilitation and care for physically
handicapped, emotionally disturbed or mentally retarded children.
11. Priority for the protection & relief of children in times of national distress and
calamity.
12. Special programs to encourage talented and gifted children, particularly from the
weaker section.
13. The paramount consideration in all relevant laws is the “interests of children”.
14. Strengthening family ties to enable children to grow within the family, neighbourhood
and community environment.

A number of programs were introduced by the Govt. of India, after the declaration of
national policy for children. the important programs are ICDS scheme (Integrated Child
Development Services), programs of supplementary feeding, nutrition education,
production of nutritious food, welfare of handicapped children, national children’s fund,
CSSM program (Child Survival & Safe Motherhood), etc.

ICDS scheme: It is the most important scheme in the field of child welfare is the ICDS
scheme. It was initiated by the Govt. Of India in the ministry of social and women’s
welfare in 1975, in the pursuance of the national policy for [Link] provides an
integrated package of early childhood services. This consist of

 Supplementary nutrition.
 Immunization.
 Health check up & health records.
 Nutrition and health education
 Non-formal preschool education.

NATIONAL NUTRITIONAL POLICY:

Govt. Of India adopted the national policy on Nutrition in 1993. It aims to identify
vulnerable groups, who require immediate intervention to improve their nutritional status.
National nutritional policy includes nutrition intervention through:

 Fortification of essential foods.

 Control of micronutrient deficiency.
 Improvement of dietary pattern through production and demonstration.
 Land reforms.

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And It includes some programs:-

 Applied Nutrition Programme (ANP): The Applied Nutrition Programme (ANP)

was introduced as a pilot scheme in Orissa in 1963 which later on extended to Tamil
Nadu and Uttar Pradesh with the objectives of: a) promoting production of protective
food such as vegetables and fruits and b) ensure their consumption by pregnant and
nursing mothers and children.
 Supplementary nutritional program: Under the Indo-CARE Agreement of 1950,
CARE-India extends food aid so that supplementary nutrition can be provided to pre-
school children of age less than six years and expectant/nursing mothers. SFPs
comprise two different types:
 Targeted SFPs: The main aim of a Targeted SFP is to prevent the moderately
malnourished becoming severely malnourished and to rehabilitate them.
 Blanket SFPs: The main aim of a blanket SFP is to prevent widespread malnutrition
and to reduce excess mortality among those at-risk by providing a food/micronutrient
supplement for all members of the group (e.g. children under five or under three,
pregnant women and nursing mothers, etc.).

Supplementary food can be distributed in two ways:

 On-site feeding or wet ration: The daily distribution of cooked food/meals at

feeding centres. The number of meals provided can vary in specific situations, but a
minimum of two or three meals should be provided per day.
 Take-home or dry ration: The regular (weekly or bi-weekly) distribution of food in
dry form to be prepared at home. It may be necessary to increase the amount of food
to compensate for intra-household sharing
 Mid-day meal programme: it is also known as school lunch programme. This
programme has been in operation since 1961 throughout the country. The objectives
of the programme is to attract more children for admission to schools and retain them
so that literacy improvement of the children could be brought about.
 Balwadi nutritional programme: The Balwadi Nutrition Programme is a
healthcare and education programme launched by the Govt. Of India to provide food
supplements at balwadis to children of the age group 3–6 years in rural areas. This
program was started in 1970 under the Department of Social Welfare, Government of
India. Four national level organizations including the Indian Council of Child Welfare
are given grants to implement this program. The food supplement provides
300 kilocalories of energy and 10 grams of protein per child per day.
Others National programmes related to child care and welfare are

 National malaria eradication programme, 1953, to reduced the incidence of malaria on

country.
 National goitre programme, 1962 which is directed towards control of iodine
deficiency disorders and working to ensure that iodized salt is used in India.

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  Vitamin A prophylaxis program, according to this programme, infants who are not
breast fed should receive a 500000 supplement of vitamin A by 2 months of age (or
two doses of 250000 IU each with one month interval in between) in areas of endemic
vitamin A deficiency.
 National anemia control programme, under the programme , anemic mothers and
children are given iron & folic acid tablets. Tablets contain 60 mg elements iron &
500µg folic acid each. For children , contain 20mg iron and 100µg folic acid. Tablets
are given to the mothers and children’s if their haemoglobin is below 10 gms or 8gms
respectively.

NEWLY LAUNCHED SCHEMES ARE:-

 Mother and child tracking system: The Mother and Child Tracking System
was launched in 2009, helps to monitor the health care system to ensure that all
mothers and their children have access to a range of services, including pregnancy
care, medical care during delivery, and immunizations. The system consists of a
database of all pregnancies registered at health care facilities and birth since 1
December 2009.

 Pradhan mantri matritva vandana yojana:- Indira Gandhi Matritva Sahyog

Yojana (IGMSY), Conditional Maternity Benefit (CMB) is a scheme sponsored by
the national government for pregnant and lactating women age 19 and over for their
first two live births. The programme, which began in October 2010, provides money
to help ensure the good health and nutrition of the recipients. As of March 2013 the
program is being offered in 53 districts around the country.

 Rajiv Gandhi scheme for empowerment of adolescent girls:- The Rajiv

Gandhi Scheme for Empowerment of Adolescent Girls – Sabla is an initiative
launched in 2012 that targets adolescent girls. The scheme offers a package of
benefits to girls between the age group of 10 to 19. It is being offered initially as a
pilot programme in 200 districts. It offers a variety of services to help young women
become self-reliant, including nutritional supplementation and education, health
education and services, and life skills and vocational training.

 CSSM program:- India launched a major programme in 1992 called the

Child Survival and Safe Motherhood (CSSM) programme with assistance from World
Bank, UNICEF and other donors. The child survival component of the programme
was a continuation and expansion of previous child survival activities such as
immunisation, ARI and diarrhoea management.

 Rashtriya Bal Swastha Karyakram (RBSK):- Under National Rural Health

Mission, significant progress has been made in reducing mortality in children over the
last seven years (2005-12). Whereas there is an advance in reducing child mortality
there is a dire need to improving survival outcome. This would be reached by early

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 detection and management of conditions that were not addressed comprehensively in
the past.
According to March of Dimes (2006), out of every babies born in this country
annually, 6 to 7 have a birth defect. This would translate to around 17 lakhs birth
defects annually in the country and accounts for 9.6% of all newborn deaths. Various
nutritional deficiencies affecting the preschool children range from 4% to 70%.
Developmental delays are common in early childhood affecting at least 10% of the
children. These delays if not intervened timely may lead to permanent disabilities
including cognitive, hearing or vision impairment. Also, there are group of diseases
common in children viz. dental carries, rheumatic heart disease, reactive airways
diseases, etc. Early detection and management diseases including deficiencies bring
added value in preventing these conditions to progress to its more severe and
debilitating from and thereby reducing hospitalization and improving implementation
of Right to Education.
Rashtriya Bal Swasthya Karyakram (RBSK) is an important initiative aiming at early
identification and early intervention for children from birth to 18 years to cover 4 ‘D’s
viz. Defects at birth, Deficiencies, Disease, Development delays including disability.

 Janani Shishu Suraksha Karyakram (JSSK):- Janani Shishu Suraksha Karyakram

(JSSK) was launched on 1st June 2011 and has provision for pregnant women and sick
new born till 1 year after birth are:-
- Free and zero expense treatment
- Free drugs and consumables
- Free diagnostics and diet
- Free provision of blood
- Free transport from home to health institutions
- Free transport between facilities in case of referral
- Drop back from institutions to home
- Exemption from all kinds of user charges.
The initiative would further promote institutional delivery, eliminate out of pocket
expenses which act as a barrier to seeking institutional care for mothers and sick new
born and facilitate prompt referral through free transport.
 Facility Based Integrated Management of Neonatal and Childhood illness (F-
IMNCI)

F-IMNCI is the integration of the Facility based Cared package with the IMNCI
package, to empower the health personnel with the skills to manage new born and
childhood illness at the community level as well as at the facility. Facility based
IMNCI focuses on providing appropriate skills for inpatient management of major
causes of Neonatal and Childhood mortality such as asphyxia, sepsis, low birth weight
and pneumonia, diarrhoea, malaria, meningitis, severe malnutrition in children. This
training is being imparted to Medical officers, Staff nurses and ANMs at CHC/FRUs
and 24x7 PHCs where deliveries are taking place. The training is for 11 days.

 Home base care for young child (HBYC):

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 India witnessed a higher decline in material and child mortality compared to global
average since the inception of National Health Mission (NHM). With the National
Health Policy, 2017 in place, there is an unprecedented opportunity to build upon the
gains made in the last ten years and achieve Sustainable Development Goals.

Malnutrition continues to be underlying cause of death 35% of under 5 mortality

reported in India. The interaction between under nutrition and infection can create a
vicious cycle of worsening illness and deteriorating nutrition status. Intervention
promoting infant and young child feeding are known to improve child survival growth
and intellectual development. Numerous gaps and barriers are observed in the
delivery and practice of IYCF recommendations. Research points to the benefits of
integrated delivery platforms, notably combining nutrition interventions with support
for parents in promoting play-based learning.
Under National Health Mission, Child Health division, MoHFW, GOI has rolled out
home-based care for young child (HBYC) Programme as an extension of the home
based new born care (HBNC) programme to promote evidence based interventions
delivered in four key domains namely nutrition, health, childhood development and
wash (water, sanitation and hygiene). An operational guideline for home based care
for young child (HBYC) programme was released by Hon’ble Prime minister of India
on 14th April, 2018 in chhattisgarh.
Under home based care of young child (HBYC) programme, the additional five home
visit will be carried out by ASHA with support from Anganwadi workers, ASHA will
provide home visits on 3rd, 6th, 9th, 12th, and 15th, month to promote early initiation
of breast feeding till 2nd year of life along with adequate complementary feeding
prevention of childhood pneumonia and diarrhoea and to ensure age appropriate
immunisation and early childhood development. The quarterly home visits schedule
for low birth weight babies, SNCU & NRC discharged will be harmonized with the
new HBYC schedule.
ASHAs will be provided incentive of Rs 250 for completion of 5 home visits under
HBYC for each young child (Rs 50 per visit) as per the recommended schedule and
additional commodities namely ORS packet and Iron Folic Acid syrup will be
provided in the kit National Deworming Days, newborn care, IYCF & IDCF material
reports,IEC material to be shifted from old website under child section. Important
letters and DO’s of Child Health need to be updated on new website.

RIGHTS OF THE CHILD:

On 20th November ,1959, the 14th general assembly of the United Nations approved the
declaration of the rights of the child:

1. The right to affection, love and understanding.

2. The right to adequate nutrition and medical care.
3. The right to free education
4. The right to full opportunity for play and recreation.
5. The right to a name and nationality.

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 6. The right to special care if the child is handicapped.
7. The right to be among the first to receive relief in times of disaster.
8. The right to learn to be a useful member of society and to develop individual abilities.
9. The right to be brought up in a spirit of peace and brotherhood.
10. The right to enjoy this rights, regardless of race, sex, colour, religion, national or
social origin.

HEALTH MAINTENANCE ORGANIZATION ACT 1973: This act is to assist and

encourage the local & state Govt. On profit organization, insurance companies, & agencies to
change the health delivery system so that improved care could be provided.

EDUCATION FOR ALL HANDICAPPED CHILDREN ACT 1975: A state mandated

divisional special education within the department of education within the department of
education, provides services based on children need & special program services through their
division of maturation.

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CONCLUSION
The need for interventions are clearly felt two decades ago. Whatever be the
nomenclature used, what is clear is that the young child needs a multi-pronged initiative that
ensures survival and development. What has also been log established and accepted is that
any initiatives for this age group is closely linked to those for the mothers. The present child
labour law, allowing children to work in certain occupations continues to stand in
contradiction to the promise of compulsory elementary education, which is a fundamental
right. Discrimination faced by children based on caste and ethnicity violates their rights
against discrimination. Rights of children of refugees and illegal immigrants on Indian soil
too remain a matter of concern.

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REFERENCE
 Hockenberg MJ, Wilson D. Wong’s nursing care of infants and children.8th ed.
Missouri: Elseiver publications; 2009
 Park k. Textbook of Preventive and Social Medicine. 28th ed. India. Jabalpur:
Bhanot Publishers; 2015. 12-30
 Thukral EG. HAQ:Centre for Child Rights, Malviya Nagar. Available from:
[Link] of Children in India/
[Link].
 [Link] Nations-World Population Prospects. Available from:
[Link] >IND > India Infant Mortality Rate 1950-2020.

MARKS OBTAINED:-

SIGNATURE:-

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