Urban black holes

Most of the slums are devoid of sanitation and other basic amenities. As a result, for every 1000 infants born in these dwellings, 100 die, reports Nitin Jugran Bahuguna on the condition of the majority living in our cities.

About 1,70,000 children die in urban slums of India every year. For every 1,000 neo-natals, infants and under-fives born in the bastis (slums), approximately 100 die.

These were some of the disturbing facts brought to the fore at a recent meeting organised by the Urban Health Resource Centre (UHRC), a Delhi-based NGO in the Capital, to highlight the relationship between child morbidity and mortality and the growing marginalisation of the urban poor. Also released on the occasion was a compendium of articles by academicians, urban planners and health experts.

The data is even more shocking when one realises the magnitude of urban slums. About 55 per cent of the urban population lives in slums—areas largely devoid of proper sanitation and other basic civic amenities. Not surprising then that 64 out of every 100 babies—between the age group of 9-36 months in the slums of the Capital—are anaemic. However, more obvious to mothers would be the fact that 90 out of every 100 infants in the slums are underweight.

Unhygienic living conditions can only weaken a baby’s health. According to the compendium, mortality of children—with improved water supply and excreta disposal facilities—is 0 to 81 per cent lower than that of children without such facilities. The obvious solution of adopting better sanitation is easier said than done, when approximately 65 per cent of slum dwellers defecate in the open. Only 8 per cent use latrines in the slums of Delhi.

While there is a consensus among paediatricians, public health professionals and social activists that the prevailing child, infant and neo-natal mortality and morbidity can be substantially reduced by inexpensive technological interventions, it is clear that the urban poor have little access to these as well as most other perceived benefits of urban development.
Urban planners and healthcare experts say that the rapid growth of the slum population due to high levels of migration—at least a quarter of India’s poor now lives in the cities—renders the existing urban health infrastructure grossly inadequate.

Also, the illegal nature of slums deters government authorities from providing services because this would be seen as legalising their habitat, observes Dr Siddharth Agrawal, Executive Director, UHRC. "This, along with the fact that health is not a priority among slum-dwellers, who are bogged down in making ends meet, results in poor utilisation of healthcare services," he adds.
The health significance of this demographic trend is dramatic: the health status of urban poor children is as poor as that of the rural population and far worse than that of urban middle-and high-income groups. A lack of awareness amongst the women also contributes to high morbidity among the urban poor. Less than half of poor urban women avail of institutional deliveries or a skilled birth attendant at the time of childbirth. Unfortunately, ignorance does not even make them avail of whatever they can.

This data is gathered from areas recognised as slums. The number of unlisted slums is higher than listed and notified slums—as is the case in cities such as Dehradun and Indore. Thus government services usually do not reach the hidden and missing urban poor—such as brick-kiln workers and construction site workers—who live in pockets not mentioned on official slum lists.

There is a deep concern amongst urban planners and paediatricians about healthcare services not reaching the poor. "As a result, we find that about 200,000 child deaths, which are easily preventable, occur each year," says Dr H.P.S. Sachdeva of the Indian Academy of Paediatrics.

But there is a ray of hope as urban areas have the advantage of a number of stakeholders, including NGOs, who can be allies in dealing with this challenge. Sunita Kochar, a community leader from Indore, says that community volunteers, with help from UHRC, have succeeded in mobilising slum women to form forums. These women collectively negotiate with healthcare providers to extend them better service. "We can confidently state that this has helped improve the maternal and child health in our slums," she claims.

Corporate houses, as part of their corporate social responsibility activities, can play a key role, too. Unlike the villages, the crowded slums make a large number of people accessible for outreach activities. "With the country having committed to the Millennium Development Goals (MDGs) and to other population and health policies, we cannot afford to ignore the concerns of the poor," stresses Dr Agrawal.

A commitment to enhance efforts to make healthcare services available and accessible to the urban poor has been forthcoming from the government side, as well. Chaman Kumar, Joint Secretary in the Department of Women and Child Development, says that since children from urban slums experienced a higher level of malnutrition than their rural counterparts, his department has accorded a higher priority to the Integrated Child Development Services (ICDS) coverage in poorer localities of cities.

The Ministry of Housing and Urban Poverty Alleviation, which implements the Jawaharlal Nehru National Urban Renewal Mission (JNNURM), is said to be seized of this issue. "The JNNURM has made the delivery of basic services to the urban poor, such as water sanitation and housing, a sub-mission of the programme," says the Ministry’s Dr P.K. Mohanty. — WFS

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