Mother-and-child healthcare facilities: Urban slums are worse off than rural areas, says study

A slum in the outskirts of a Gujarat city
A slum in the outskirts of a Gujarat city

By Rajiv Shah

A recent study suggests that healthcare facilities in Gujarat’s urban slums, as in the rest of India, are worse than those the rural areas. Though the study is confined to one of Gujarat’s richest districts, Anand, which has lately considerable urbanization, it is indicative of the fact that there is a complete failure on the part of the officialdom to provide basic healthcare facilities to the deprived sections of population, who come from the rural areas and settle down in slums in the hope of eking out a better livelihood.  

Titled “Urban slums in Gujarat Newborn Care Practices and Health Seeking Behavior in Urban Slums and Villages of Anand, Gujarat”, the study was jointly carried out by Archana S Nimbarkar and Vivek V Shukla from the Department of Pediatrics, Pramukhswami Medical College, Karamsad, and Ajay G Pathak and Somashekhar M Nimbalkar from the Central Research Services, Charutar Arogya Mandal, Karamsad, Anand district.

A major conclusion of the study is that “infant and neonatal mortality rates have declined in India but are relatively higher in urban slums and rural areas.” It underlines, “About one-third of India’s urban population resides in slums and squatters and this is expected to rise. Urban health care indicators are better than rural areas but these numbers disregard the differences between urban rich and poor slum dwellers. The Government of India has an elaborate and variably functioning healthcare delivery system in the rural areas. Urban slum areas lack such healthcare systems.”

The scholars compared the urban slums in Anand district with surrounding rural areas for aspects related to newborn care and care seeking. This comparison was done in order to “put in context the poor status of newborn health and health seeking in slums of even smaller cities and give direction to policy making in the future”, the scholars say. Families with infants less than 9 months were included in the study. In all, 156 families (more than 90% of eligible families) in slums were approached. Village survey followed and 160 families were recruited across 6 villages selected by random process from eligible 27 villages with more than 30 estimated deliveries per year.

To carry out the study, the scholars say, “Families were contacted a day prior to survey to ensure completeness of data.” The study was conducted from May 2011 to September 2011. It was carried only after the Institutional Human Research Ethics Committee granted approval for it. Gender distribution of participants was similar across study areas. There was a clear distinction even in the educational status of women between slum areas and rural areas. While 44.2 per cent of mothers from slums were illiterate, things were not as bad in the urban areas. In urban areas, 83.7 per cent of mothers from villages had at least primary education.

Similarly, the study says, the socioeconomic status and living conditions of the village participants were better than the slum participants. “Healthcare utilization, antenatal care (ANC), hospital delivery, neonatal follow up, health seeking behavior was better in village participants. Harmful cultural practices like administration of non-essential syrups, and Kajal application in eye were more common in slum participants, whereas substance application over umbilicus was more common in village participants. Bathing baby at birth was equally prevalent (31.2 per cent vs 32.5 per cent) whereas bottle feeding was not very common (8.6 per cent vs. 12.5 per cent)”, the study says, adding, “Early essential newborn care and exclusive breast feeding were better followed in village participants.”

The study reveals wide socioeconomic gap between slums and villages. “This gap exists even for a smaller town with a population smaller than the national average for a city. There is lack of properly functioning and structured healthcare delivery system in urban slums vis-à-vis affluent urban and rural areas. Proximity of the slums to two multispecialty hospitals and smaller private hospitals did not improve utilization of services. Urban slum dwellers are ignorant about their health needs and also lack attitude for seeking healthcare. There is lack of basic sanitation (72 per cent) and water supply facility (44.8 per cent) in most slum residents”, it says.

The study points out that neonatal follow-up and care of infants requiring medical attention was provided by unqualified personnel or not taken in 72 per cent of slum areas. Exclusive breastfeeding till 6 months was given in 6.5 per cent of slum participants versus 85.6 per cent in village participants. Education of immediate health care providers and mothers in basic neonatal care is required in urban slums as similar provisions exist in villages under various government efforts.

The scholars conclude, “The study describes a wide gap in newborn practices in slums of a smaller town with better practices in surrounding villages. Slum dwellers were 6 times less likely to seek care. Not taking ANC and being illiterate was associated with home deliveries. A single district study is a limitation of this study but similar gaps between rural and urban health settings are likely in rest of Gujarat as well as India. Detailed assessment of reasons for poor health care seeking behavior is required. Policy planners need to plan for urban slums while allocating funding for health in urban areas.”

MOTHER AND CHILD HEALTH CARE DETERMINANTS

 Variable Name    Slum  Village  
 No: 154  No: 160
 No (%)  No (%)
 Home delivery  27 (17.5)  10 (06.3)
 ANC taken  123(79.9)  151(94.4)
 Neonatal follow up:
 Not done  62 (40.3)  6 (03.8)
 To unqualified practitioner  49 (31.8)  28 (17.6)
 To pediatrician  43 (27.9)  126(78.8)
 Hospital delivery in:
 Government hospital  29 (22.8)  41 (27.3)
 Non govt. hospital  98 (77.2)  109(72.7)
 If ANC taken from
 Government hospital  26 (21.2)  25 (16.5)
 Non-government hospital  97 (78.8)  126(83.4)
 Bottle feeding  13 (08.6)  20 (12.5)
 Kajal application in eyes  55 (35.7)  36 (22.5)
 Bathing baby at birth  48 (31.2)  52 (32.5)

ESSENTIAL AND GENERAL NEWBORN CARE

 Variable and Response    Slum    Village
 No: 154  No: 160
 No(%)  No(%)
 Baby dried immediately  132(85.7)  153 (95.6)
 When was breastfeeding started
 — within half hour  90(58.4)  113 (70.6)
 — 1 h to 2 h  38(24.7)  21 (13.1)
 — 3 h to 6 h  3(01.9)  1 (0.6)
 After 6 h  0  3 (1.9)
 — 2nd day onwards  13 (8.4)  16 (10.0)
 — 3rd day onwards  10 (6.5)  6 (3.8)
 Baby recieved Kanagroo
 mother care  1 (0.6)  28 (17.5)
 Handwashing done before
 handling baby  5 (3.2)  118 (73.8)
 Mother and child kept together  150(97.4)  148 (92.5)
 Baby was clothed properly  131(85.1)  137 (85.6)
 Baby exclusively breast fed
 for 6 months  10 (6.5)  137 (85.6)
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