Gayatri Divecha, Mumbai Contributor
Perhaps the most shocking inequalities in growth and development between the elite and the marginalized play out in India's biggest metropolis — Mumbai, the country's economic and financial capital. In India's megacity, the "urban advantage" of the city's more developed socio-economic infrastructure eludes poor children, radically reducing their chances of pursuing healthy and economically productive futures. Nowhere are these disparities more apparent than in the difference in nutritional status between the poor and non-poor. In Mumbai, 36 percent of slum children are malnourished, posing a significant risk to their health and development.
Dasra, a Mumbai-based strategic philanthropic foundation, spent four months researching malnutrition amongst children aged 0-3 years in Mumbai's worst slums, such as Govandi and Dharavi. The research report surveyed 50 nonprofits intervening to tackle this often overlooked development challenge. Almost counterintuitively, we found that malnutrition rates in urban India are often higher than in rural India and are, in fact, intricately linked with rapid urbanization, poverty, and illiteracy, requiring the urgent attention of policy makers, development practitioners, and philanthropists.
Nutrition is a fundamental building block of a healthy and successful childhood, adolescence, and adult life. Studies have shown that the ages from birth to three years old are when a child develops the most, both physically and cognitively. For these children, therefore, malnutrition means compromising growth and development at the most crucial stage of human development and compromising the future of millions of children.
A challenging environment
Mumbai poses unique challenges to those tackling malnutrition amongst the urban poor: little or no knowledge of nor access to sound childcare practices; rural-to-urban migration that creates floating populations and slum pockets; poor living conditions in congested slum areas; and complex public health care systems that lack reach to vulnerable populations.
An estimated 50 percent of Mumbai's population lives in slums. This represents approximately 8 million people, of whom 33 percent earn an average monthly household income of US$60. Forthy percent of the slum population lives below the poverty line. The urban poor living in slums of all types in Mumbai consist mainly of migrants that have moved to cities in search of livelihoods. With skyrocketing real estate prices in cities, slums and shantytowns are de facto habitation for the urban poor.
Extremely harsh living conditions make the urban poor a highly vulnerable group in terms of economic and physical security. Mostly engaged in the informal sector, the incomes of slum dwellers are highly insecure. Serious illnesses and health-related expenses often lead to financial strains on households. Additionally, urban slums are characterized by their appalling lack of sanitation facilities and poor access to clean and safe drinking water, which increases the physical vulnerability of inhabitants to diseases. These living conditions are one of the main factors exacerbating susceptibility to diseases and placing young children at a much greater risk of being malnourished. In a physical environment where basic necessities and civic amenities are lacking, poverty cannot be fully captured by income alone. Other factors such as lack of access to health care facilities, inadequate water, and inadequate sanitation are major challenges in the lives of the urban poor.
Poverty and daily-wage earnings mean that the urban poor lack safety nets and are thus an extremely vulnerable group in dire need of a robust public health system, being unable to afford quality private health care. Unfortunately, slums in Mumbai are characterized by a shortage or total absence of health care infrastructure. In fact, due to complex issues of land ownership, some slums are not even officially recognized and are entirely excluded from the purview of municipal infrastructure. Moreover, the attitudes and behavior of the urban poor toward health care are shaped by the fact that the majority of the urban poor have had little or no exposure to any formal education. As a result, in many instances, they are simply unaware of correct and effective health care practices, such as the need for immunization or preventive steps against diseases such as diarrhea.
Child malnutrition is caused by an interplay of different factors in addition to poverty, such as inadequate public health systems and suboptimal child care practices. Mothers and caretakers (siblings and grandparents) are key influencers in the health and nutrition of children between 0-36 months. Malnutrition therefore is not only a public health issue but also depends in large part on the availability of the mother to breastfeed, the ability of the caretaker and household to provide nutritious meals, and overall community support.
Dasra's interactions with pregnant women and mothers in Dharavi revealed that challenges to child health and nutrition in urban slums are twofold: for each challenge there are specific supply-side (community) issues as well as demand-side (public health system) issues that need to be addressed. The poor in urban areas are particularly vulnerable to health risks as a result of degraded environments, lack of access to health care, irregular employment, widespread illiteracy and lack of awareness about effective child care practices, and lack of negotiating power to demand better public services.
Given the particularities of urban slums, Dasra's research revealed that critical interventions to overcome malnutrition must look beyond poverty and food availability but rather, as shown above, must address the lack of public health services and messages as well as inadequate child-care practices. Dasra found that training Community Link Workers and Public Healthcare Workers has the greatest impact on improving children's nutritional status in urban slums and has the largest potential to influence mothers to breastfeed, which the most effective way to reduce malnutrition rates.
This series of posts will explore further intervention opportunities to improve child malnutrition in Mumbai's slums, and will begin to weave together potential solutions to tackling this widespread and preventable problem.
Dasra is India's leading strategic philanthropy foundation working with philanthropists and social entrepreneurs to create large-scale social change.