The Reproductive and Child Health (RCH) programme initiated under NRHM in Telangana emphasised public health measures essential for enhanced maternal and child survival and lower RCH morbidity. The performance audit of Reproductive and Child Health under National Rural Health Mission was conducted (during April to August 2017), covering the period from 2012-13 to 2016-17. Annual Facility level surveys for identification and fixing of decentralised monitorable goals, indicators and gaps/deficiencies in the existing healthcare facilities and areas of interventions were not conducted. Bottom-up and community owned approach to public health planning was also not followed in preparation of State Program Implementation Plans (SPIPs). The Department had not utilised fully the funds released in any of the years under review. Utilisation ranged between 38 and 44 per cent only during 2012-14 and between 39 and 46 per cent only during 2014-17. Shortfall in spending on maternal health ranged between 31 to 50 per cent during 2014-17. The expenditure on child health component did not exceed 26 per cent of the approved outlay in any year during the period 2014-17. The institutional deliveries declined from 69 per cent (2013-14) to 42 per cent (2016-17) in public health facilities as compared to deliveries in private health facilities which registered an increase from 31 to 58 per cent. Telangana had a very high rate of Caesarean-section deliveries at 45 per cent out of the total deliveries reported in the State. In private health institutions it was higher at 67 per cent. Adequate attention on availability of required physical as well as human infrastructure in the health facilities was not accorded. Maternal Death Review (MDR) and the Infant Death Review (IDR) were largely not conducted. In other cases, these Reviews were ineffective. The State had achieved 100 per cent immunisation of children of 0 – 1 year age group. Maternal Mortality Ratio and Total Fertility Rate was satisfactory at State level.