Urban health under serious stress
Cultural factors surrounding care during pregnancy, childbirth and care of the newborn exert a significant influence on health of the mother and newborn. Knowledge of such practices is helpful in promoting beneficial practices and restraining the harmful practices in larger programmatic settings.
A study: Maternal and Newborn Care Practices Among the Urban Poor in Indore, was undertaken in the slums of Indore, after implementation of the Indore Urban Health Program for one year. Factors facilitating and hindering optimal practices and potential programme options derived from them were also studied. The study was conducted through in-depth interviews with 312 mothers and 37 traditional birth attendants in 11 slums of the city (population 24,395). The study assumes added significance in the present context with about 2.5 million births taking place annually among the urban poor in India. India has about 100 million urban poor, a number which is likely to increase to about 200 million by 2020. It is therefore important to address the health needs of this large population. According to the study 82% women received two tetanus injections during pregnancy while 86.2% received iron and folic acid tablets and 11.5% consumed them. Though 76.6% mothers received at least one antenatal checkup, only 40.1% mothers received the recommended three or more checkups. Despite physical proximity of health facilities, 72% deliveries were conducted at home, of which 66.5% deliveries were conducted by trained birth attendants. Seventy percent women had identified a birth attendant during pregnancy and 76.9% women saved some money to incur delivery related cost. The study brought out some harmful practices during childbirth and newborn care and feeding practices. Un-sterilised but new cotton thread dipped in water was used to tie the cord in most cases. Vermillion, oil, turmeric or talc was applied to the cord by almost half of the families. Forty six percent newborns were left uncovered during the time between delivery and cord tying and 62.5% babies were washed with lukewarm water after delivery. Fifty five percent newborns were breastfed within the first one hour of birth. Prelacteals such as jaggery water, weak tea, honey and water were given to 38.1% newborns. Fifty eight percent infants were exclusively breastfed till two months of age. Economic status and cultural practices were found to be the main determinants of the behavior and practices. The findings suggest a need to engage in collective dialogue with elder women of the slum community and traditional birth attendants as they have significant influence on practices during pregnancy and childbirth. The study recommends enabling slum community women to analyse the benefit of optimal behaviors through discussions using case narratives and the use of pictorial material by trained slum based health volunteers. Urban Heath in Delhi Along with rapid urbanisation in India, there has been an explosive growth of the urban poor population. Nearly one-fourth of India’s urban population or about 100 million persons resides in slum or slum-like conditions with very limited access to health and other civic services. The health status of the urban poor population is considerably worse off than the rest of the urban population and is as bad as the rural population.
The report says that over half of the city’s population or 72 lakh persons reside in slums and other urban poor locations such as resettlement and unauthorised colonies. Reanalysing the National Family Health Survey data of Delhi, the study brings out the poor status and sharp disparities, which exist in healthcare and health conditions of the urban poor in the nation’s capital. The poor health situation of the urban poor in Delhi is reflected in the fact that one in ten urban poor children in Delhi die before reaching the age of one (94.4 infant deaths per 1,000 live births) and one in seven children die before reaching the age of five (135.5 deaths per 1,000 live births). Only one in four urban poor children are fully immunised and 70% of urban poor mothers in the capital deliver at home contributing to high maternal and neonatal morbidities. The prevalence of communicable and vector borne diseases is also high with one in seven persons in Delhi’s slums being infected with tuberculosis. The national capital also reports a high incidence of dengue, malaria and chikungunya. An in-depth situation analysis of slums and health facilities in two large administrative zones of Delhi housing a large urban poor population revealed the inadequacy of public sector primary health services to the urban poor in Delhi. Government hospitals are not accessed by the poor owing to difficulty in reaching them, long waiting times and poor quality of services. The analysis also brought out the presence of a large number of slums, which are not listed in official records. These slums are deprived of civic services and other benefits of slum improvement activities by virtue of being illegal and unofficial. The study recommends that a spatial mapping of all slums is essential and emphasises the importance of bringing unlisted slums under service coverage. The study also found that all slums are not alike and it is necessary to categorise slums and focus on the most needy slums. Improving the health status of the large and rapidly growing urban poor population in a megalopolis like Delhi is a challenge for health program managers and policymakers. The city has been growing at over 40% over the past two decades and Delhi’s population of 1.37 crores as per the Census conducted in 2001 would double to reach 2.79 crores by 2026. Source: UHRC |
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