Implementation of PNDT Act
The sex ratio in Maharashtra is 933 (2001 census) and in 0–6 years age group it is 917. This will have grave social implications for next generation, mainly for women’s status and their security.

Considering the tendency for male preference in Indian culture, it has become essential to initiate activities to reduce this tendency. This had lead to more no. of female foeticide cases affecting sex ratio, with special reference to sex ratio in –0–6 years age group.

The PNDT act provides important initiative for reduction of female foeticide and male preference. State has issued notification for implementation of PNDT act. All the centers providing facility of prenatal and pre–concept ional sex diagnosis have been registered under revised PNDT act.

IEC activities through media for community and medical profession are being conducted in the state. Special sensitization of doctors running/operating such facilities are conducted. State, and district level structures for monitoring PNDT activities have been set. Strict vigil over functioning of such facilities through quarterly and surprise monitoring visits are conducted in the state. Punitive action including sealing the machines and court cases has been taken in the state.

MTP Services
MTPs are mainly considered as a means of termination of unwanted pregnancy due to failure of contraception. Currently a large Number of maternal deaths occur due to aseptic abortions and other complications. An illegal abortion carried out at illegal institutes by illegal persons is the main cause. The state has following No. of registered MTP centers both in public and private sector.

Public MTP facilities: 473
Private MTP facilities: 2324
Total: 2797

Safe Abortion Services
Despite a liberal abortion law that encompasses a broader range of indications, illegal abortions far outnumber legal procedures in India. About nine percent of all reported maternal deaths could be attributed to unsafe abortions, which translates to about 12000 – 15000 deaths annually.

The causes of unsafe abortion are numerous and include unavailability of health centers providing these services in rural areas, dearth of trained providers and women who largely remain unaware of availability of service outlets and their rights to legal abortion.

Manual Vacuum Aspiration (MVA) technique
India’s National Population Policy 2000 delineates strategies to decentralize abortion services adopting new and easy technologies like Manual Vacuum Aspiration (MVA) and drug induced abortion simplifying "provider certification requirements" increasing the number of training centers and education communities.

Considering the success of the pilot and keeping in line with the policy of making all Reproductive and Child Health (RCH) services available to the people of the state, it is planned to introduce Safe Abortion Services in all health centers in the state.

Manual Vacuum Aspiration and Drug–induced abortion techniques will be introduced in a phased manner in all the health centers in the state. It is planned to initiate these services in all RH and Primary Health Center (PHC)s where 24 hr. EmOC services are to be provided.

Services to the Tribal Population and Underserved Areas
Pada worker scheme:(State funded activity)
In tribal areas the distance between villages and health institutions is more and the terrain is difficult, which leads to difficulty in reaching for medical care. Even the information of epidemics reaches the health institution very late leading to delayed actions. Hence State has initiated a Pada worker scheme (Link worker) in all the 15 tribal districts of the state from tribal funds. The pada worker is a local resident and interested in social work.

She/He is given sensitization in first aid, water disinfections and is expected to inform the nearest Primary Health Center (PHC) of any epidemic of water borne diseases or fever cases. She/He is paid an honorarium of Rs. 300/– per month. These pada worker will be involved in Reproductive and Child Health (RCH) activities, mainly in providing guidance for referral for EmOC, EmPC and helping in MCP sessions and nutrition demonstration. Currently a total of 10091 pada workers are engaged for 6 months during June to December every year.

The State is planning to appoint pada workers throughout the year considering morbidity and mortality of under five children in these areas. This being a state funded activity no budget is requested.

Matrutava Anudan Yojana for Tribal areas:(State funded activity)
Maharashtra state is implementing ‘Matrutava Anudan Yojana’ in tribal districts of Maharashtra under the auspices of "Nav Sanjivani"yojana, and is similar to National Maternity Benefit Scheme (JSY) of GOI. Every pregnant mother is provided with Rs. 400/– for improving nutrition and other needs. In addition Rs. 400/– are kept with nearest Primary Health Center (PHC)/Community Health Center (CHC) for necessary medical treatment i.e. cost of drugs.

Tribal Area activities through E.C. supported Sector investment prog.

The state of Maharashtra has a considerable tribal population spread across several district. The tribal people live in remoteareas in hamlets. All these tribals have their own taboos and customs. Usually during the illness of women & children, they approach the Bhagats. They immensely trust in Bhagats for all religious purposes including severely ill children and women.

Interventions for tribal areas

• Dai training.
• Dai training in the field.
• Provision of Dai kits to trained Dais.
• Female Pada Worker scheme.

In order to tackle the problem of maternal and child health, a female Pada worker will be selected and they will be suitably trained.

Training of healt staff on human approach regarding tribal issues
The training will be given to M.O.s and Paramedical staff working in Primary Health Center (PHC)s about the tribal culture and taboos at block level.

Training to Traditional Healers Traditional Medical Prcatitioners(TMPs/Bhagats)
Traditional healers/Bhagats Traditional Medical Practitioner(TMP) are very influential people in tribal population.In order to curb this tradition, it is necessary to involve the traditional healers in Reproductive and Child Health (RCH) Programme.

Referral incentives to TMPs
Compentency based training for Specialist MOs of FRUs in these areas
Basic Emergency Obstretic Care Training by FOGSI initiative to Doctor
M.O.s working at tribal Primary Health Center (PHC)s are supposed to conduct normal deliveries as well as refer high risk and obstructed labour cases to FRUs or District Hospitals. They are suppose d to handle cases as preacampcia and also PPH cases.Under the circumstances they need to be trained in handling such EmOC cases at Primary Health Center (PHC) level.

• Integrated Management of Neonatal and Child lllnesses(IMNCI) Training.
• Sensitization of Panchayat Raj Institutions personnel for supporting referral advocacy and demand generation.
• Management of paediatric asthma cases.
• Reimbursement of Travel Cost in ITDP Area.
• Maintenace & repaiors of vehicles (RH & PHCs).
• Pol for vehicles.
• Provision for repairs of opertion theatres and labour rooms at Primary Health Center (PHC)s.
• Provision of Motorcycles./Mopeds to Health Staff to increase mobility in Ttibal districts.
• IEC Activities.

Behavioral Change Communication (BCC)
It is a well–known fact that investment in health care improves well–being of the person directly affecting his capacity to work, production and thus helps in improving economic status of the person and community.

Health issues needing behavioral change

• Breast feeding.
• Complimentary feeding.
• Male preference leading to sex determination and female foeticide.
• Male sterilization.
• Early detection and treatment of RTI/STI.
• Responsible sexual behavior related to HIV/AIDS Immunization.