CM10.1-10 | Reproductive, Maternal, Newborn and Child Health — Graded Quiz

Correct. MMR uses 100,000 live births as denominator. IMR, NMR, and U5MR use 1,000 live births; PMR uses 1,000 total births.

Denominator rule: MMR = per 100,000 live births; IMR/NMR/U5MR = per 1,000 live births; PMR = per 1,000 total births.

Only MMR uses 100,000 live births. IMR/NMR/U5MR use 1,000 live births. PMR uses 1,000 total births (live + stillbirths ≥28 weeks).

Correct. India's U5MR is 41.9 per 1,000 live births (NFHS-5). The five canonical indicators: MMR=97 (SRS 2018-20), IMR=35.2, NMR=24.9, U5MR=41.9 (all NFHS-5).

NFHS-5 mortality indicators: NMR 24.9 < IMR 35.2 < U5MR 41.9 (ascending order, all per 1,000 LB). These are the standard figures tested in CM exams.

The canonical NFHS-5 set: NMR=24.9, IMR=35.2, U5MR=41.9 per 1,000 live births; MMR=97 per 100,000 live births (SRS 2018-20).

Correct. Primigravida aged 22 years with normal BMI carries no high-risk flags. High-risk criteria include: Hb <7 g/dL, height <145 cm, grand multipara, previous caesarean, hypertension, multiple pregnancy, prior bad obstetric history, and extremes of age (<18 or >35 years).

PHC high-risk ANC flags (any one triggers intensified monitoring/referral): Hb <7, BP ≥140/90, height <145 cm, age <18 or >35, grand multipara (≥4), previous caesarean, multiple pregnancy, prior baby >4 kg or <2 kg or malformed, prior 3+ spontaneous abortions.

High-risk criteria are specific and evidence-based. Normal young primigravida without any additional risk factors is NOT high-risk. Grand multipara, short stature, and severe anaemia are established high-risk flags.

Correct. JSSK (2011) provides entitlements in kind — free delivery, drugs, diagnostics, diet, and transport — to ALL pregnant women at government facilities regardless of income status. JSY gives cash (Rs 700-1,400) but only to BPL women.

JSY vs JSSK: JSY (2005) = cash to BPL rural mothers = Rs 1,400 (LPS) or Rs 700 (HPS). JSSK (2011) = free services to all = drugs + diagnostics + diet + transport. JSSK extended same benefits to sick newborns up to 30 days post-delivery.

Key distinction: JSY = cash transfer, income-restricted (BPL). JSSK = entitlements in kind, universal (no income criterion). Both aim to increase institutional delivery, but through different mechanisms.

Correct. MR vaccine is given subcutaneously at 9-12 months (first dose) and again at 16-24 months (second dose). The 9-month timing coincides with waning of maternal rubella antibodies.

UIP at 9-12 months: MR (subcutaneous right arm) + Vitamin A (first dose, 1 lakh IU oral) + JE (in endemic districts). The second dose of MR at 16-24 months corresponds to the DPT/OPV booster visit.

MR vaccine schedule under UIP: first dose at 9-12 months subcutaneous; second dose at 16-24 months. It replaced the measles monovalent vaccine in 2017.

Correct. The Dropout Rate is (BCG – MR) / BCG × 100, comparing the first vaccine of the schedule (BCG at birth) with the last age-appropriate vaccine (MR at 9-12 months). A dropout rate >10% triggers programme investigation.

Dropout Rate = (BCG – MR)/BCG × 100. Threshold >10% = investigation warranted. Causes: distance, seasonal migration, supply disruptions, health worker absenteeism, community hesitancy. Mission Indradhanush targets high-dropout districts.

The classic WHO/GOI dropout rate formula is (BCG – MR)/BCG × 100. Option B describes an alternative formula sometimes used (DPT1-DPT3) but the standard measure is BCG-to-MR. Option C is the coverage rate formula. Option D defines 'zero-dose' children.

Correct. India's TFR reached 2.0 (NFHS-5 2019-21) — just below the replacement level of 2.1, a landmark achievement. However, eight states still have TFR ≥ 2.1, indicating uneven progress.

TFR progression: NFHS-3 (2005-06) = 2.7 → NFHS-4 (2015-16) = 2.2 → NFHS-5 (2019-21) = 2.0 (below replacement 2.1). Unmet need = 9.4% (NFHS-5). mCPR = 56.5%, dominated by female sterilization (37.9%).

India's TFR (NFHS-5) = 2.0, below replacement level of 2.1. This is a significant milestone — the country average has crossed replacement fertility, though inter-state variation persists.

Correct. ECP (levonorgestrel 1.5 mg) is approximately 85% effective when taken within 72 hours of unprotected intercourse. Efficacy falls to approximately 58% between 72-120 hours. It can be taken up to 120 hours but with reduced efficacy.

ECP facts: Levonorgestrel 1.5 mg single dose; within 72 h = ~85% effective; 72-120 h = ~58% effective; mechanism = delay/inhibit ovulation (NOT abortifacient if taken before fertilisation); available over-the-counter in India; does not protect against STIs; not for regular contraception.

ECP is most effective within 72 hours (approximately 85% effective). It can still be taken up to 120 hours but efficacy declines significantly. The phrase 'within 72 hours' is the standard counselling message.

Correct. The cafeteria approach (post-1996) means all contraceptive methods are offered like items on a menu — the client chooses freely after counselling, without targets or pressure. This replaced the coercive target-based system abandoned after the Emergency-era backlash.

Family Welfare Programme phases: (1) 1952-1976 = target-based; (2) 1975-77 = Emergency coercive (forced sterilisation); (3) 1978-1995 = post-emergency liberalisation; (4) 1996-present = target-free cafeteria approach + informed consent mandatory + National Population Policy 2000.

The cafeteria approach is a policy principle: no targets, no coercion, client-driven selection from the full range of temporary and permanent methods. 'Cafeteria' refers metaphorically to choosing from a menu of options.

Correct. RKSK was launched in 2014, replacing the earlier Adolescent Reproductive and Sexual Health (ARSH) initiative. It covers 10-19 years with six health domains and uses a peer educator model.

Adolescent health programme timeline: ARSH (2005, RCH-II) → WIFS (2012) → RBSK (2013) → RKSK (2014). RKSK peer educator model: 1 peer educator per 40 adolescents; covers 6 domains including nutrition, SRHR, NCDs, mental health, injuries, substance use.

RKSK = 2014 launch. ARSH (its predecessor) was part of RCH-II from 2005. WIFS (Weekly Iron and Folic Acid Supplementation) was launched in 2012. RBSK was launched in 2013.

Correct. PMSMA is conducted on the 9th of every month at government health facilities. It provides a comprehensive ANC package including specialist examination (obstetrician/MBBS doctor) for all pregnant women in their second or third trimester.

PMSMA = monthly comprehensive ANC camp on the 9th. Services: specialist examination, full blood work, USG if indicated, high-risk identification and referral, TT and IFA provision. LaQshya monitors labour room quality; PMSMA monitors ANC quality.

PMSMA date = 9th of every month. This is a frequently tested operational fact. PMSMA targets all pregnant women at ≥4 months gestation, not just BPL, ensuring at least one quality ANC contact with a doctor.

Correct. NFHS-5 reports that 23.3% of women aged 20-24 were married before age 18 years — reflecting persistence of child marriage despite legal prohibition under the Prohibition of Child Marriage Act 2006.

NFHS-5 gender indicators: Child marriage (women 20-24 married <18 years) = 23.3%; Sex ratio at birth = 929 girls per 1,000 boys; Adolescent girls anaemic = 59.1%. These three figures are the standard CM10.9 exam data points.

The NFHS-5 child marriage statistic for women 20-24 = 23.3%. This figure also applies to the Beti Bachao Beti Padhao programme target group in high-prevalence districts.