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The Urban Newborn1
Last Updated : 2012-02-19 19:37:56 (5306 read)
The Urban Newborn
Siddharth Agarwal, Urban Health Resource Centre , February 2012

Urbanization and its fall-out on India’s city dwellers: Along with remarkable technological advances, unprecedented economic growth and rapid urbanization, India faces a major problem, the rapid increase in urban poverty. According to provisional totals from Census 2011, 377.1 million people (31.2%) of India’s 1.2 billion population reside in urban areas. According to the Planning Commission of India, which declares official estimates of poverty, 25.7% (96.91 million) of India’s urban population is ‘poor’ i.e., living below the official poverty cut-off line. The urban poor reside in slums, squatters, pavements, constructions sites, urban fringes amidst problems such as poverty, lack of awareness, poor living conditions, poor family support system, low access to basic water, sanitation, health and nutrition services as many of them have evolved as encroachments and are not notified in official records. The glitter of today’s growing cities typified with multiplexes, malls, shopping plazas masks the less visible reality of the city’s unseen and unheard poor most of whom contribute as the informal sector workforce to the urban component of India’s GDP (estimated to be 70% of India’s total GDP). An unfortunate paradox of cities is that even though most cities have several hospitals and doctors, a large proportion of urban poor are unable to access these health facilities owing to social and economic barriers.

Current scenario of neonatal health among urban poor: Annually, about 2.74 million births take place among the urban poor in India [calculated based on Crude Birth Rate 27.4 for the urban poor (lowest quartile by the wealth index) and 100 million urban poor populations]. Despite proximity to specialty hospitals, 56% of slum children are born at home. In such an environment, the neonate born in an urban poor family is more vulnerable to illness, sub-optimal survival, growth and development. Different slum based studies conducted in Mumbai, Indore, Nagpur, Hyderabad have shown that between 30 and 54% babies in slum settings are Low Birth Weight (birth weight <2,500 grams).Neonatal Mortality Rate (NMR) among the urban poor is also much higher (34.9 per 1,000 live births) compared to NMR among the urban average (28.7 per 1,000 live births) and urban non-poor (25.5. per 1,000 live births). This continues to compromise India’s march towards the Millennium Development Goals and National goals.

There is wide disparity in neonatal health and survival across different Indian States. NMR is far worse in certain states as compared to other States. Uttar Pradesh, Madhya Pradesh and Jharkhand, Orissa,
Rajasthan, Chattishgarh and Bihar together are home to over 40% of India’s urban poor and are States where Home deliveries and NMR is comparatively higher as compared to all-India urban poor and substantially higher than NMR and home deliveries among the urban poor in Tamil Nadu and Maharashtra. The data shown in these figures is based on re-analysis of urban sample of NFHS-3 data for All-India and the identified States based on wealth quartiles.

Why are we talking about this: India’s urban population is expected to increase further to 535 million (38%) by 2026. Out of the total population increase during 2011-2026, the share of increase in urban population is expected to be 168 million i.e., 87% of total population increase. The urban poor estimated to be increasing at about 6-7% per annum across the country (with certain cities having faster growth) constitute the fastest growing segment of India’s population. There is a need to enhance health care systems to provide equitable basic healthcare on the maternal and neonatal front at the minimum from and equity, rights and ethical perspective as well as the standpoint of the urban poor’ s sizable Contribution to the bulk of the count4ry’s informal sector works-force.

Urgent need to address the inequities among urban newborns: More than 52,500 babies are born every week among the urban poor segment of India’s population. This number is expected to increase nearly two-fold by 2020. There is an urgent need for preparedness to gear up the weak maternal-neonatal health care system in India’s cities. The urban poor newborns are more vulnerable to many health and nutrition problems compared to the non poor urban counterparts. Among nearly half of the urban poor population of India, about 70% deliveries take place at home. It is critical that all government, non-government stakeholders and academia acknowledge this reality and work towards a phased approach to make these deliveries safer than the present situation and gradually work towards near cent percent deliveries in hospitals. The pregnant woman and fetus are symbiotic, and interventions to improve outcomes of one are intricately linked to the outcomes of the other. Hence maternal and neonatal health improvement efforts will need to go hand in glove. Intensified efforts towards reducing neonatal mortality and ensuring concerted focus on urban poor newborns through both facility and community level actions proposed in this paper can help reduce neonatal mortality and thus help our nation progress towards attaining Millennium Development Goal-4 and the goals set forth in the Indian policies and programs.

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