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Indien Frauen Massensterilisation 13.11.2014
Image: Reuters/M. Mukherjee

Bad for mothers and children

Murali Krishnan, New Delhi
May 6, 2015

Poor children in Indian cities are three times more likely to die before their fifth birthday than their affluent peers, says a recent report, which ranks India among the worst in the world in terms of health inequity.


India is one of the ten countries worldwide with the greatest survival divide between wealthy and poor urban children, according to the report "The Urban Disadvantage" released by the NGO Save the Children on May 5. It also stated that the quality of life of mothers and children in the urban slums of India's capital New Delhi is one of the poorest in the world.

The ten countries showing the greatest survival divide between affluent and poor urban children are: Rwanda, Cambodia, Kenya, Vietnam, Peru, India, Madagascar, Ghana, Bangladesh and Nigeria. Of the 189 countries surveyed for the report, India is ranked 140, behind countries like Rwanda, Iraq and Bangladesh.

The report - which, among other sources, uses data from UN agencies - ranks countries on five key factors: risk of maternal death, under-five mortality rate, educational status, economic achievement and political status.

"It is actually a tale of two cities. There is a wide difference of access between the urban rich and poor. The richest are the fittest and so it is the survival of the fittest in urban scenarios," Sudeep Gadok, director of programs of Save the Children, told DW.

Infant and maternal mortality rates in cities are on the rise and the situation would deteriorate further unless concerted efforts are made, said India's Minister for Minority Affairs Najma Heptulla. "Even today, over 760,000 children die in India every year and many of these deaths are due to preventable causes. We obviously need to do a lot more," Heptulla told DW.

Crumbling healthcare

It was found that 50,000 mothers die each year in India as a result of birth complications, as against 1,200 in the United States. But the poor bear the greatest burden everywhere irrespective of a nation's current state of economic development.

The other key finding of the report is that while great progress has been made in reducing urban under-five mortality around the world, health inequality is worsening. It emphasizes the issue of poor children and mothers in urban settings being deprived of lifesaving healthcare services.

The report found that public sector health systems are typically under-funded, and often fail to reach those most in need of basic health services. In many instances, the poor resort to seeking care from unqualified health practitioners, often paying for health services that are of poor quality, or in some cases, harmful.

"Overcrowding, poor sanitation and food insecurity make the poor mothers and children even more vulnerable to disease and ill health. And fear of attack, sexual assault or robbery limit their options when a health crisis strikes," said Devendra Tak, Save the Children's communications manager.

Investment needed

Given the rapid growth of urban populations and the increasing level of under-five mortality rates occurring among the urban poor, it was recommended that investments were needed for basic health services, water and sanitation, and improved nutrition for this under-served, and often neglected, population.

Globally every fifth child is born in India, and any improvement in infant mortality rate of even a single Indian state can positively impact the national situation.

A strong case has been made for investing in strengthened and expanded urban health systems designed to reach the poor, ensuring access to health workers able to provide quality care in slums and informal settlements, and removing financial barriers to accessing quality health services.

Employment generation, livelihood, housing and services should be the basis for urban renewal schemes, underlined Dunu Roy, an urban planner and director of the New Delhi-based Hazards Center. "Urbanization won't stop, it is only going to increase and that is why planners and city developers should focus on this issue on a war footing."

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