On Mother’s Day, a global report reminds us that poor, urban Indian mothers are struggling

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Urban India is a hard place for poor mothers and their children. That was made horrifying obvious in the Mothers’ Index, a global study released earlier this week ranking the well-being of the world’s women and children. India is at No 140 in the 179-country list, three places down from last year’s index.

More than half of India’s poor urban children are stunted, the index shows, compared to 20% or less of its wealthiest. India is also one of the 10 countries of the world with the deepest “survival divide” between poor and wealthy urban children, in the same category as Rwanda, Kenya, Ghana and Nigeria.

The index is contained in The State of the World’s Mothers: The Urban Disadvantage, a report commissioned by the NGO Save The Children that makes clear what social observers have always suspected: a slum is among the worst places in the world in which to be a mother.

In cities around the world, the poorest children are at least twice as likely to die as the richest, the report says.  In slums, “poverty, and the social exclusion that goes with it, leave the urban poor trapped in overcrowded, makeshift or decrepit housing, with few opportunities to stay clean or safe on a daily basis”, writes Dr. Margaret Chan, director-general of World Health Organisation, in her foreword to the report.

“Diets are poor,” she said. “Diseases are rife. Pregnancies occur too early in life and too often. Good health care, especially preventive care, is rare…These are the women and children left behind by this century’s spectacular socio-economic advances…Their plight is largely invisible.”

The price of inequality

Significantly, the report also links inequality in urban areas with the health of its poorest women and children, a relationship rarely deliberated upon. Developed countries with minimal inequality in their populations rank high up in the world’s Mothers’ Index. Norway, Finland, Sweden, Australia are among the top ten. Among India’s neighbours, Bangladesh is ranked 130 while Pakistan is 149. By way of comparison, the United States of America is ranked 33rd while China is placed at 61.

The key findings of the State of the World’s Mothers report are that inequality is worsening in many cities; the poorest children face alarmingly high risks of death in most cities; the poorest urban mothers (and children) are deprived of affordable healthcare; their high death rates are rooted in disadvantage, deprivation and discrimination.

It would be a mistake for the government to dismiss the report. These findings are a wake-up call in a rapidly urbanising India in which the poor and the slums they live in are being glossed over by official policies driven by business-friendly compulsions and big-ticket infrastructure projects. But these policies are leaving the India’s urban poor at a distinct disadvantage. (Though The State of the World’s Mothers report focusses on urban areas, it does not require great imagination to picture poor mothers in rural India as badly off as – perhaps worse than – their counterparts in urban areas.)

Rapid urbanisation

The five fast urbanising states – Tamil Nadu, Maharashtra, Gujarat, Punjab and Karnataka – will soon have more than half of their populations living in cities. These states already account for more than half of the country’s slum population.

That inequality in urban areas is on the rise has been well-documented. The Gini coefficient – an internationally accepted measure of inequality in which zero is perfect equality and 1 is perfect inequality – for urban India increased from 0.37 to 0.38 in five years from 2004-’05 to 2009-’10, according to a study by the erstwhile Planning Commission. This study, based on the National Sample Survey Organisation data, 68th Round, showed that the Gini coefficient for rural India in the same period declined from 0.30 to 0.29.

The trend of rising inequality with increasing urbanisation becomes clear in the long-term data. The Gini coefficient for urban India increased from 0.27 in 1977-’78 to 0.38 in 2009-’10.

Slum proliferation

For all the talk of rehousing slum-dwellers and the homeless, India’s slum population has been growing at a disturbing pace. It more than doubled in ten years, rising from 43 million in 2001 to more than 93 million in 2011, according to the government data. And it was projected to grow every year. It means inequality has hardened. In the slums and make-shift homes on pavements, it is the women who bear the brunt of the lopsided economic system.

In the context of fast urbanisation and rapid slum proliferation – itself an outcome of flawed urban land use policies – the findings of the State of the World’s Mothers report are significant. Among other instances, it talks about women in a Delhi slum. “Among the poorest 20% of women in this city, only 27% receive recommended prenatal care and only 19% have a skilled attendant at birth,” it says.

In slums across Mumbai, Delhi and other Indian cities, all indicators of pre-natal, delivery and post-natal care were consistently worse in slum areas than in non-slum areas, according to National Family Health Survey 3. It found that almost 45% of children under age five in Mumbai and 41% in Delhi slums were stunted.

These facts demonstrate that all boats have not been lifted by the rising economic tide. The poorest mothers are too feeble to ride the wave and require urgent interventionist strategies such as improved housing and healthcare, a living wage for women, enhanced nutrition and more.

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