American Journal of Interdisciplinary Research and Development ISSN Online: 2771-8948 Website: www.ajird.journalspark.org Volume 18, July, 2023 96 | P a g e IMPROVED REFORMS IN UZBEKISTAN REGARDING MOTHER AND CHILD HEALTH CARE Abdurakhmon Abdumuminovich Abdukhalimov Andizhan State Medical Institute Work with Youth, Spirituality and Head of Education, History Doctor of Philosophy (PhD), Associate Professor. Abstract: The article analyzes the reforms carried out in the country during the years of independence in the field of maternal and child health care, medical services, birth rates and death rates. Keywords: Republic, mother and child, medical service, screening centers, health promotion, reproductive health. Introduction In the Convention "On the Rights of the Child", ratified in 1990, the Ministry of Health of the Government of the Republic of Uzbekistan and the entire health system have the following: - reducing the mortality rate of children under 5 years by 1/3; - Reduction of pronounced eating disorders and underweight in children under 5 years of age up to 1/2; - to support breastfeeding and completely eliminate micronutrient deficiency in the body; - maintaining a high level (at least 90 percent) of vaccination against controlled infections; - ending poliomyelitis, reducing the incidence and mortality from measles by 1/2; - It sets tasks such as reducing the death rate from enteric diseases by 1/2 and the death rate of children from acute respiratory infections by 1/3 [8:11]. RESEARCH METHODS At this time, more than 30 percent of the world's children under five were underweight for their age. 43 percent of children in developing countries, or 230 million children, are short for their age. As a result of iodine deficiency, at least 30,000 babies are stillborn in the world every year, and more than 120,000 babies are mentally retarded, stunted, deaf or paralyzed. A quarter of all children under the age of five in developing countries are at risk of vitamin A deficiency. In the developing world, more than 4 million children under the age of five die each year from acute respiratory infections, particularly pneumonia. Diarrheal diseases caused by lack of clean drinking water and poor sanitation and consumption of substandard food account for 3 million deaths among children under 5 years of age each year. That means one death every 10 seconds. American Journal of Interdisciplinary Research and Development ISSN Online: 2771-8948 Website: www.ajird.journalspark.org Volume 18, July, 2023 97 | P a g e RESULTS AND DISCUSSIONS Although the number of deaths among infants decreased somewhat, their number reached 35.5 per 1,000 newborns. Every year, on average, 24,000 children died under the age of one. Maternal mortality was also quite high, ie 65.3 per 100,000 women who gave birth to a live child [9:233]. At the end of 1992, maternal mortality in the republic decreased from 66.3 to 52.1 compared to the same period last year, but infant mortality increased from 35.5 to 36.8, respectively. Diseases of the perinatal period occupy the second place in the structure of infant mortality. Cases of delay in delivery of newborns to neonatal pathology departments of children's hospitals were observed. 24% of sick newborns were not transferred to these departments on time. At the same time, places for newborn babies worked only 210 days a year on average in the republic. One of the main reasons for the high death rate at home was the lack of primary medical and sanitary care provided by a pediatrician, and the lack of awareness among parents about the need to seek medical care in time. One of the main principles of reducing morbidity and mortality of children is breastfeeding. Only 52.7% of the population of the republic is fed with mother's milk up to 3 months. A lack of dry milk products is a serious nutritional concern if less than 20 percent of the requirement is met. Despite the direction of the Ministry of Health, the priority of protecting the health of the child's mother was that the pediatric service was lagging behind the general medical network. Among all doctors, the share of pediatricians is 16.8 percent, and the number of children in Uzbekistan is more than 41 percent. While the number of diseases in adults was more than 4.0 million, this situation was 3.9 million in children, and 1 pediatrician had to treat 326 diseases [10:140]. In society, women have equal opportunities with men to get education, acquire a profession, work, get paid for their work, and actively participate in political life, on the other hand, taking into account the place of women in the family, their physical capabilities, favorable conditions for them to work and maintain their health and special attention was paid to the creation of benefits. In relation to the number of the population, birth, death and natural growth processes began to be proportionate. The adoption of the program "For a healthy generation" and continuous efforts in this direction from the first period after independence showed its results. Research on improving the health of the nation, extending the life span of the population, reducing maternal and child mortality, and leaving healthy and talented offspring for future generations has proven that the right path has been taken in this area. In 1996, the maternal mortality rate decreased from 24.1 to 12 per 100,000 live births, and infant mortality decreased from 40.0 to 32.5. These improvements were made possible by the widespread promotion of family planning and antenatal care among women of reproductive age [11:11]. American Journal of Interdisciplinary Research and Development ISSN Online: 2771-8948 Website: www.ajird.journalspark.org Volume 18, July, 2023 98 | P a g e The results of the study show that the total fertility rate in the country is 3.3 children per woman. Fertility rates vary among different population groups. For urban women, 2.7 children per woman is much lower than for women in rural areas, which is 3.7 children in rural areas. Uzbek women have an average of 3.5 children per woman, which is higher than women of other nationalities (2.5). The most important of the results achieved by republican medicine is the reduction of maternal and child mortality. As a result of the development and implementation of the national program on "Strengthening the health of pregnant women and children" and the "Complex program for the health of the young generation" developed by the government, maternal mortality in 1996 was 4.4 times higher than in the first year of independence, and infant mortality was 1.8 times higher. decreased [9:144]. As a result of measures to increase the efficiency of medical services for mothers and children, several changes have been made in the field. However, the lack of qualified personnel and poor material and technical capabilities of medical institutions was one of the main problems in the system. As a result of the prevention of pathological births and the birth of sick children, the birth rate per 1,000 population decreased from 25.2 in 1997 to 23.8 in 1998. Also, one of the important indicators that determine the level and quality of medical services for women, maternal mortality was 38.1 percent, compared to 27.3 percent in 1998. In 1998, 50 percent of infant deaths in the country were caused by respiratory diseases. 25% of the children died from conditions that occurred during the perinatal period, 9% were caused by infectious and parasitic diseases, and 4.5% by congenital diseases. 2000 "Year of a Healthy Generation" State program, the first direction was to create the necessary conditions for the formation of a healthy family and a high spiritual and moral environment in the family. Based on it, several programs such as "Maternity School", "Medical Work Foundation", "Puberty Period" were implemented. Also, in accordance with the Family Code, medical examination of young people before marriage, organization of dispensary control for young families during the first five years, more than 170 million soums were spent on this. As a result, under the marriage registration departments of every city and district, "Family Universities" was opened, which provides the necessary information and lessons to young people about the family, its sanctity, its responsibility, and the upbringing of children. More than 20 thousand young men and women participated in them in a short time owner Great efforts were also made to increase the attention and care of the state, society and family for the upbringing of healthy offspring. In particular, about 20,000 families, more than 30,000 young men and women who are getting married in the areas requiring special attention by the "For a Healthy Generation" International Charitable Foundation were given medical examinations and sponsored medical assistance. More than 5 million women of childbearing age, about 98 percent of children under 6 years of age underwent comprehensive medical examination, and those who needed treatment were taken to the dispensary and rehabilitated. American Journal of Interdisciplinary Research and Development ISSN Online: 2771-8948 Website: www.ajird.journalspark.org Volume 18, July, 2023 99 | P a g e The philanthropic assistance in the amount of 6 million US dollars through this fund aimed at continuously providing maternity hospitals and children's medical institutions with the most modern equipment and medicines was an important step in the birth of healthy offspring. This program is intended to be implemented for five years, and only this year 440 thousand US dollars were spent on it. Some work was done in other areas of the Healthy Generation program, including strengthening children's health, their education, all-round development, all-round assistance to disabled people suffering from congenital diseases [4:89]. Adoption of the program "For a healthy generation" and continuous struggle along the way to improve the health of the nation, prolong the life of the population, reduce maternal and child mortality, and leave healthy and talented offspring for the future generations proved that the right path was taken in this field. The measures defined in the state program adopted on the occasion of the Year of Mothers and Children in 2001 were a logical continuation of the work included in the programs developed in the previous years of Human Interests, Family, Women, and Healthy Generation. First of all, it should be said that the role and importance of this program in life today can be seen in the fact that the attitudes and views of people, the whole society, towards family problems, maternal and child health issues are fundamentally changing. First of all, the program focused on creating the necessary conditions for the formation of a strong and spiritually healthy family, strengthening the role of the mother and the family in raising a child and growing up in all aspects. Secondly, as a result of the implementation of these measures, it is especially important that the population's medical and general culture, attention to their own health, healthy lifestyle, which is the basis of family happiness, increased. A clear proof of this is the fact that thousands of young people getting married undergo medical examinations, 50,000 young families receive medical protection, and the same number of young families receive relevant information in the "Fundamentals of Marriage" course. Thirdly, many new issues were solved during the preparation and implementation of the "Mother and Child" program. It is especially noteworthy that during the implementation of this program, 90 percent of women in our country underwent preventive medical examination. It should also be noted that new systems such as "Mother and Child Screening" have been introduced in all regions of the republic. The fact that more than 580,000 women have undergone preventive examinations and received qualified medical advice in these centers will undoubtedly have a positive effect on their health. Measures to protect pregnant women and fetuses from various diseases, to provide them with free of charge medicines against iodine deficiency and anemia, and to vaccinate children under the age of four against yellow fever and poliomyelitis are also having positive effects. According to the "Mother and Child" program, for the first time, girls' gynecology services were organized in all districts of the country. Also, the Republican educational and methodical center for the health of young and adolescent girls has started work. American Journal of Interdisciplinary Research and Development ISSN Online: 2771-8948 Website: www.ajird.journalspark.org Volume 18, July, 2023 100 | P a g e Fourthly, it should be noted that the system of treatment and health care institutions for mothers and children has expanded considerably, and their material base has been strengthened. We see this, first of all, in the example of newly built medical facilities equipped with the most modern equipment. For example, rehabilitation and rehabilitation centers established in the cities of Gulistan, Kuva and Namangan, maternity complex in Nurota district, "Mother and Child" sanatorium in Beshariq district and many other facilities are among them [5:192]. In the healthcare system, the role and importance of wide-ranging screening centers, which regularly monitor the health of expectant mothers and support the birth of healthy children, are great. If in the first year of independence, the rate of maternal mortality was 65 per 100,000 women, in 2007 this number decreased to 24, and infant mortality decreased to 14 out of 35 per 1,000 babies [6:52]. In recent years, the creation of a solid system of highly effective modern medical institutions for the protection of motherhood and childhood in the country was an important step in this direction. Screening centers were established in all regions and the city of Tashkent, and more than 4 million dollars were allocated for their operation in 2010 alone. This year, more than 116,000 expectant mothers underwent medical examinations at screening centers. At the same time, the network of perinatal centers also developed rapidly, and in 2010, more than 158,000 people, that is, 10 times more than in 2000, underwent medical examinations of mothers and children [7:114]. Adopted in 2009, the "Measures program to strengthen the reproductive health of the population in 2009-2013, the birth of a healthy child, and the raising of a physically and spiritually mature generation" is aimed at the following: 1) improvement of the system of strengthening the reproductive health of the population, a healthy child creating the necessary conditions for birth; 2) to further strengthen the material and technical base of maternity care, maternity and child care institutions, and primary health care institutions providing medical care to mothers and children; 3) to strengthen educational work among the population on the birth of healthy children and their upbringing, the formation of the desire to build a healthy and harmonious family and lead a healthy lifestyle in young people; 4) providing the necessary conditions for the physical and harmonious development of children and adolescents, the formation of a physically strong and intellectually mature young generation; 5) improving the qualification of medical workers working in the field of maternity and child protection, improving the quality of medical care provided to mothers and children. As a result of the medical and preventive work carried out in this regard, the rate of diseases among mothers and children, and the rate of congenital disabilities in the country has significantly decreased" [12:16]. The President of the Republic of Uzbekistan, Shavkat Mirziyoev, in his speech at the solemn ceremony dedicated to the 24th anniversary of the adoption of the Constitution of the Republic of Uzbekistan on December 7, 2016, said: "Improving reproductive health, which is an important condition for raising a healthy child, preventing births with birth defects and American Journal of Interdisciplinary Research and Development ISSN Online: 2771-8948 Website: www.ajird.journalspark.org Volume 18, July, 2023 101 | P a g e diseases, the material and technical base and human resources of medical institutions systematic works were carried out for further strengthening. A lot can be said about this, but I will only touch on some examples. This year, 80 million dollars worth of loans and grants were allocated to equip medical facilities in our country with modern diagnostic and treatment equipment. About 9 million women of childbearing age and about 10 million children were medically examined and treated according to the measures specified in the program. In particular, cochlear implantation operations were performed on more than 350 hearing- impaired children at the Republican Specialized Pediatric Scientific and Practical Medical Center. 21 billion soums were spent for this. But it is important for us not how much money was spent, but the health of hundreds of our children was restored. Among such activities, 700,000 children were vaccinated against pneumococcal infection and other infectious diseases" [1:112]. In this regard, the head of state said, "In our country, great attention is paid to women's recreation and health recovery. Speaking of which, I want to draw your attention to one number. Women make up 60 percent of the population that rests in sanatoriums owned by trade unions every year. In 2017, about 75,000 women were treated in such facilities on the basis of preferential referrals. At the same time, large-scale work is being carried out to further improve the activity of rural medical centers, prevention and patronage system. At the same time, as we all know, there are problems in this area as well. In particular, screening of pregnant women is not in demand. In order to eliminate the serious deficiencies in this regard, separate medical consultation rooms for our girls and women are being organized in family polyclinics and rural medical centers" [2:470]. The decision of the President of the Republic of Uzbekistan, Shavkat Mirziyoev, dated December 25, 2017, "On the State program for the early detection of congenital and hereditary diseases in children in the period 2018-2022", defines the important tasks to be carried out in the field of early diagnosis of genetic syndromes in children, mass screening of babies with genetic diseases. is also noteworthy. This Program ensures that people living in remote areas of the country can fully benefit from modern screening services. In the past short term, special importance was given to improving the quality of medical care for pregnant women, strengthening the health of mothers, and developing the modern infrastructure of high-tech specialized medical care for girls and teenage girls. For this purpose, there are "Girls' Health Centers" in the republic, regional and each district and city, and "Women's Consultation Centers" based on multidisciplinary central polyclinics, as well as the "Ishkonch phone" (1003) network of the Ministry of Health, which operates around the clock. activity has been launched. Republican and 12 regional screening centers are working [13]. Basic vaccination services are well established in the country. In 2020, 99 percent of infants received a dose of measles vaccine. This is higher than the average in the European region. Vaccination rates against diphtheria, tetanus, and polio are also high, reaching 95 percent of all infants in 2020. American Journal of Interdisciplinary Research and Development ISSN Online: 2771-8948 Website: www.ajird.journalspark.org Volume 18, July, 2023 102 | P a g e Due to historically high rates of infant and maternal mortality, maternal and child health has been considered one of the country's top priorities in the health sector. Several important government programs aimed at reducing maternal and child mortality have been developed. Maternal mortality in the country decreased by 12 deaths per 100,000 live births in 2020 compared to 2017. However, this was more than twice the average for the European region. Infant mortality also decreased to 15.6 per 1,000 live births in 2020. This was lower than the Central Asian average of 17.6 in the same year. However, it remains high compared to the European region average [14:11]. As the Honorable President noted, "Another main direction - national programs on protection of reproductive health, motherhood and childhood are being implemented. In children's treatment facilities in our regions, complex treatment practices are being conducted in new departments such as neonatal surgery, cardiosurgery, invasive surgery, girls' gynecology, which did not exist before. Such systematic changes are an important factor in improving women's health and reducing maternal and infant mortality in our country. Also, the patronage service was launched on a completely new basis. Unparalleled efforts are being made to fully cover single, elderly, chronically ill persons with disabilities, expectant mothers and children with patronage services. Due to the fact that nurses go from house to house and thoroughly study the health of each person, considerable progress is being made in terms of disease prevention and improvement of medical culture in families" [3:383]. CONCLUSION In conclusion, it can be said that after independence, the maternity hospital system was reorganized in Uzbekistan. Maternity units in general hospitals were closed and services transferred to primary care or to newly established central maternity units or units that provide all maternity and infant inpatient services for the covered population. Maternal and child health protection services are guaranteed by the state. The prospects of the system were defined by the Ministry of Health in order to prevent the existing problems in the country. In the early years of independence, the main causes of infant mortality were the poor health status of women, the unsatisfactory professional qualifications of medical personnel, the fact that parents do not know the signs of danger to the child's life, late turning to medical institutions, late assessment of the severity of the patient's condition, and a tool for providing resuscitation care to a critically ill child. - manifested in the lack of equipment and medicines. REFERENCES: 1. Мирзиёев Ш.М. 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