Slums and Malnourishment: Evidence From Women in India

Abstract

More than 50% of the world population was classified as urban for the first time in 2009 and is expected to reach around 69% in 2050. 1 The proportion of the urban population in the developing world is expected to increase from 45% to 66% during the same period. One of the immediate consequences of population pressure in urban spaces is the growth of slums or urban communities that are characterized by poor access to civic services, inadequate housing, and overcrowding.2 It has been estimated that slum populations would double before 2035 in the low-and middle-income countries. 3One of the main concerns regarding the growth of slum populations is that the living conditions of the slum dwellers could become a public health issue. The attention gained by the relation between poor health outcomes and living conditions is neither new nor restricted to the developing world. As early as the 19th century, the Public Health Acts of Britain aimed to improve water systems and sanitation facilities in slums.2 This was also true of other developed countries-notably, France and the United States-which attempted to regulate residential dwellings to contain the spread of disease among other things. Although the pace of urbanization in India historically has been slow, it is increasing rapidly. India's urban population grew by about 230 million between 1971 and 2008, and it is estimated that 250 million more will swell the urban population within the next 2 decades. 4 This urban growth has led to a population explosion in cities, and India boasts of 2 cities with a population of at least 10 million (Delhi and Mumbai). Literature from the developing world suggests that both communicable and noncommunicable diseases are a major concern for urban populations, particularly the slum populations. Already malnourished slum dwellers may experience additional stress because of overcrowding and poor living conditions and are more likely to have poor health outcomes. However, India-specific research findings paint a mixed picture. A study on urban slums in Maharashtra in 1999 indicated that women living in slums were more disadvantaged with respect to antenatal care than were women not living in slums. 5 This was reaffirmed by another study that compared the health status of poor populations in slums and in resettlement colonies in Delhi and Chennai and found that slum dwellers had worse health outcomes than those in resettlement colonies. rates of all illnesses, morbidity rates, incidence of hospitalization, and other health indicators as various proxies of health status. Our study examined the distribution of women's malnutrition in 8 cities across slum and nonslum populations. Malnutrition is a significant problem among Indian women. According to several studies that used the NFHS-3, only 52% of the women were within the normal weight range for a given height. 8,9 Following the World Health Organization, we defined malnutrition to include the dual burden of undernutrition and overnutrition. Until recently, attention has been exclusivel...

Children's health in slum settings

“…Similar findings are present in Ethiopia, Niger and India 2 28 51. Malnutrition in slum children is closely associated with maternal education and breastfeeding practices 48. Mothers in informal settlements may not breast feed due to work, lack of knowledge or education, and breakdown of traditional practices 10 49.…”

“…Malnutrition makes a central contribution, up to 56%, to child mortality worldwide and is a recognised problem in informal settlements 47 48. Compared with their urban counterparts, children in slums are more likely to be undernourished and stunted 10 49.…”

“…It will be important to collect reliable and disaggregated urban data. Even disaggregated city data or census data that include slums may miss the most vulnerable ones that are frequently not counted 37 48. In one Indian study, malnutrition was more closely associated with slums not officially recognised in the census compared with those that were counted 48.…”

“…Even disaggregated city data or census data that include slums may miss the most vulnerable ones that are frequently not counted 37 48. In one Indian study, malnutrition was more closely associated with slums not officially recognised in the census compared with those that were counted 48. Methodologies, such as expanded or focused data collection, over-counting specific urban areas, and standardising measures or gradients of socioeconomic status in areas of generalised poverty must also be explored to capture these populations 74 75.…”

Slum Definitions in Urban India: Implications for the Measurement of Health Inequalities

“…First, the Census was conducted in 2001, but the NFHS was undertaken in 2005–2006, making it possible that slum areas changed significantly between Census enumeration and NFHS survey observation and respondent reports (Montana et al, forthcoming), an issue that has not been addressed in studies using these data (Swaminathan and Mukherji, 2012). A second reason for the definition discrepancy may be the significant variation in components that make up the four definitions.…”