URBAN SLUM WOMEN HEALTH

ISSUES AND CHALLENGES

Dr . Shaila Parveen

Associate professor

Department of social work

M.G.K.V.P. Varanasi

“ WOMEN HOLD UP HALF THE

SKY”

DOES NOT APPEAR TO GIVE

THEM A POSITION OF DIGNITY

AND EQUALITY.

URBANIZATION: TRENDS AND PATTERNS

• Movement of people from rural to urban areas with

population growth equating to urban migration

• A double edged sword• On one hand- Provides people with varied opportunities and

scope for economic development

• On the other- Exposes community to new threats

• Unplanned urban growth is associated with• Environmental degradation

• Population demands that go beyond the environmental service

capacity, such as drinking water, sanitation, and waste

disposal and treatment

Source: UN, Urbanization prospects, the

1999 revision

Year Urban

Population

Total Population in

million

1800 2% 140

1950 30% 360

2000 47% 1027

2008 50% 1060

2030 60% 2050

URBANIZATION TRENDS IN INDIA

URBANIZATION: TRENDS AND PATTERNS

331 million people in India live in urban areas (around 30.31% of the population)*

The proportion of urban population in India is increasing consistently over the years From 11% in 1901 to 26% in 1991 and 28% in 2001 to 30.31% in

2011

Estimated to increase to 357 million in 2011 and to 432 million in 2021*

After independence

• 3 times growth - Total population

• 5 times growth - Urban population*

* Census of India 2011

4.26 crore people live in slums

A large number of slums are not notified*- around

50%

Urban growth has led to rapid increase in the

number of urban poor

In-migration and a floating population has worsened

the situation * NSSO Report No. 486

URBANIZATION: TRENDS AND PATTERNS

MIGRATION -CAUSES

Increased family size-limited agricultural property

-Land use Pattern

-Irrigation facilities

Better income prospects

Better educational facilities

Better “Life style”

Basic amenities – health, transport,water, electricity.

Victims of natural/manmade calamities-Refugees

CONSEQUENCES

Overcrowding

Mushrooming of slums

Unemployment

Poverty

Physical & mental stress

Family structure- Nuclear families

-Single males

According to the World Health Organization,

“Health is a state of complete physical, mental,

and social well-being and not merely the absence

of disease or infirmity”.

“Good health requires provision of health care for

prevention and treatment of disease and injury,

good nutrition and a safe environment. The health

of populations has many links with other sectors,

such as economic, education, water and

sanitation and gender” (Health, 2010).

SOCIAL DETERMINANTS OF HEALTH (SDH)

Social Determinants of Health are the conditions in

which people live and work, and these conditions

affect their opportunities to lead healthy lives. In

March 2005, the World Health Organization set up

a Commission on the Social Determinants of Health

(WHO, 2005).

THE LIST OF DETERMINANTS OF HEALTH

Child development

Gender

Urban setting

Employment

Health system

Measurement and evidence

Globalization

Social exclusion

THE IMPORTANCE OF WOMEN’S HEALTH

Moreover, many believe that the health of families and

communities are tied to the health of women. The illness

or death of a woman has serious and far reaching

consequences for the health of her children, family and

community (The Importance of Women’s Health, 2005).

The realities of women's lives remain invisible to men

and women a like and this invisibly persist at all level

begning from the family to the nation . Although

geographically men and women share the same space,

they live in different worlds. Sprawling inequalities

persist in their access to education, health care ,physical

and financial resources and opportunities in the political,

economic, social and cultural sphers.

Finding from the world economic forum

indicate that India is one of the worst

countries in terms of inequality. The 2014

UNDP human Development Report ranked

india135 out of 187 in terms of gender

inequality. Gender is one of many social

determinants of health which includes

Social, Economic and political factors that

play a major role in the health outcomes of

women in India.

HEALTH ISSUES OF URBAN SLUM WOMEN

Housing: Rapid growth of urban centers has led to substandard

housing on marginal land and overcrowding

Clean water : Due to increasing urbanization coupled with existing un-

sustainability factors and conventional urban water management

Sanitation/ Hygiene :

It exacerbates health risks related to insufficient and poor water supply

and poor sanitation systems Nearly 1.1 billion people worldwide who

do not have access to clean drinking water and 2.6 billion people i.e.

over 400 million people, lack even a simple improved latrine can lead

to increased episodes of diarrhea and economic burden

Social Security

HIV/AIDS :Lack of Education ,lack of access to contraceptive such

condom

Access to Health Facilities: Despite the concentration of health-care

facilities in urban areas, the access of the urban poor to basic health

services is hampered by several factors. The cost of travel may be

prohibitive, women may not have anyone to leave young children with

and/or slum dwellers may be treated shabbily or overtly discriminated

against in health centers. Where free health services are not available,

the cost of care may be unaffordable.

Anemia

Reproductive health: As a nation India contribute nearly 20% of all

maternal deaths between 1992-2006. It is directly related to socio

economic condition and cultural constraints and limiting access to care.

Mal Nutrition: 70% of non pregnant and 75% pregnant women are

anemic ( distribution of food.

Mental Health: With the high incidence of depression, anxiety, neurosis

psychosomatic disorder, increasing rate of suicides among clearly

shows that in keeping of the projections of world mental health report

this is emerging as a major causes of morbidity. Lack of privacy leading

to depression, anxiety, stress etc

Marriage & Fertility

Maternal health

Child survival

Family planning

Environmental Conditions, Infectious Diseases and

Access to Health Care

URBAN SLUM WOMEN’S KEY

ELEMENTS OF HEALTH

Indicators Urban

Poor

Urban

Non

poor

Overall

Urban

Overall

Rural

All

India

Urban

Poor

NFHS 2

Women age 20-24 married by age 18

years (%) 51.5 21.2 28.1 52.5 44.5 63.9

Women age 20-24 who became

mothers before age 18 (%) 25.9 8.3 12.3 26.3 21.7 39.0

Total fertility rate (children per

woman) 2.8 1.8 2.1 3.0 2.7 3.8

Higher order births (3+ births) (%) 28.6 11.4 16.3 28.1 25.1 29.5

Birth Interval (median number of

months between current and

previous birth)

29.0 33.0 32.0 30.8 31.1 31.0

MARRIAGE & FERTILITY INDICATORS OF URBAN

POOR IN INDIA: NFHS 3

Indicators Urban Poor Urban

Non

Poor

Overall

Urban

Overall

Rural

All

India

Urban Poor

NFHS 2

Mothers who had at least 3

antenatal care visits (%) 54.3 83.1 74.7 43.7 52.0 49.6

Mothers who consumed IFA for 90

days or more (%) 18.5 41.8 34.8 18.8 23.1 47.0

Mothers who received tetanus

toxoid vaccines (minimum of 2) (%) 75.8 90.7 86.4 72.6 76.3 70.0

Mothers who received complete

ANC (%) 11.0 29.5 23.7 10.2 15.0 19.7

Births in health facilities (%) 44.0 78.5 67.4 28.9 38.6 43.5

Births assisted by a doctor/nurse

/LHV/ANM/other health personnel

(%)

50.7 84.2 73.4 37.4 46.6 53.3

Women age 15-49 with anaemia

(%) 58.8 48.5 50.9 57.4 55.3 54.7

MATERNAL HEALTH INDICATORS OF URBAN WOMEN IN INDIA: NFHS 3

FAMILY PLANNING INDICATORS OF

URBAN POOR IN INDIA: NFHS 3CIndicators Urban

Poor

Urban

Non

Poor

Overall Urban Overall

Rural

All

India

Urban

poor

NFHS 2

Any modern

method (%) 48.7 58.0 55.8 45.3 48.5 43.0

Spacing

method (%) 7.6 19.8 16.9 7.2 10.1 4.6

Permanent

sterilization

method rate

(%)

41.1 38.2 38.9 38.1 38.3 38.4

Total unmet

need (%) 14.1 8.3 10.0 14.6 13.2 16.7

Unmet need

for spacing

(%)

5.7 4.1 4.5 6.9 6.2 8.5

Unmet need

for limiting

(%)

8.4 4.2 5.2 7.2 6.6 8.2

Indicators Urban

Poor

Urban

Non

Poor

Overall

Urban

Overall

Rural

All

India

Urban

poor

NFHS 2

Households with access to piped water supply

at home (%)18.5 62.2 50.7 11.8 24.5 13.2

Households accessing public tap / hand pump

for drinking water (%)72.4 30.7 41.6 69.3 42.0 72.4

Household using a sanitary facility for the

disposal of excreta (flush / pit toilet) (%)47.2 95.9 83.2 26.0 44.7 40.5

Prevalence of medically treated TB (per

100,000 persons)461 258 307 469 418 535

Women (age 15-49) who have heard of AIDS 63.4 89.1 83.2 50.0 60.9 42.1

Prevalence of HIV among adult population

(age 15-49)0.47 0.31 0.35 0.25 0.28 na

Children under age six living in enumeration

areas covered by an AWC (%)53.3 49.1 50.4 91.6 81.1 na

Women who had at least one contact with a

health worker in the last three months (%)10.1 5.8 6.8 14.2 11.8 16.7

Environmental Condition, Infectious Diseases and

access to Health Care in Urban Poor : NFHS 3

SOCIAL DETERMINANTS WHICH EFFECTS

WOMEN HEALTH

Preference to son

Female feticide

Once born daughters are prone to being fed less than sons.

In adulthood many barriers prevent them from achieving equitable level of health

Superior rights to men.

Under reporting of illness

lesser visits to doctors.

Of all health workers in country nearly 2\3 are men

only 6% female doctors.

CRIME ASSOCIATED WITH WOMEN HEALTH

Female feticide

Rape

Incest

Sexual harassment

Child sexual abuse

Importation of girls /Trafficking

Kidnapping

Dowry related murder

Acid attacks

Domestic violence

Suicide

SUGGESTION

Empowerment Measures

Improving Living Conditions

Popularizing Regular Medical Checkups

Cluster Services & Child Care Centers:

Elimination of Gender Disparities:

Bringing Convergence:

Access to Safe & Legal Abortions

Redefining Standards

WHO, the Indian government and

health/municipal authorities, women’s

organizations, the NGOs, and the community

groups need to work in tandem. More

importantly, men and women need to become

aware of the equality of sexes and need to

respect the same. Both sexes need to learn

how to live in co-operation and harmony,

which is often difficult to secure in

traditionally very patriarchal parts of the

world.

THANK YOU