Health and Living Conditions in Eight Indian Cities

2005-06 National Family Health Survey (NFHS-3), India

Objective

To examine the intercity and intracity differentials in the health and living conditions of population by slum/non-slum residence and economic status in eight big cities of India

NFHS-3, India

Contents

• Need to focus on urban health by slum/non-slum residence and by economic status

• Differentials in living conditions

• Differentials in health status

• Spousal violence

NFHS-3, India

Need to Focus on Urban Health The urban population in India is expected to increase to

more than 550 million by 2030

Currently, a sizable proportion of the population in most Indian cities lives in slum areas

The increasing slum population is seen an indication of worsening living conditions and increasing poverty in Indian cities

The increasing concentration of the population in slums and urban poverty have drawn a strong interest in urban health in general, and the health of slum dwellers and the urban poor in particular

NFHS-3, India

Data on slum/non-slum areas in NFHS-3

Due to the growth of the urban population and a strong interest in urban health, as well as the Millennium Development Goal on improving the lives of slum dwellers, in NFHS-3 eight cities (i.e. Chennai, Delhi, Hyderabad, Indore, Kolkata, Meerut, Mumbai, and Nagpur) were selected for providing slum/non-slum estimates

NFHS-3, India

Proportion of Slum Population

According to 2001 Census, these eight cities together possessed nearly 30 percent of the total enumerated slum population of the country

NFHS-3, India

Sample

Slum/non-slum areas in cities are defined according to the census definition and supervisor’s observation

The poor in these cities include those belonging to the lowest quartile of the wealth index, which is calculated on the basis of ownership of a number of household assets, housing quality and important housing facilities for the urban sample as a whole at all India level. This definition of the poor is not the same as the population living below the poverty line.

NFHS-3, India

Contents

• Need to focus on urban health by slum/non-slum residence and by economic status

• Differentials in living conditions

• Differentials in health status

• Spousal violence

NFHS-3, India

Proportions of Slum Households and Poor Households in Selected Cities, India, 2005-06

Delhi Meerut Kolkata Indore Mumbai Nagpur Hy-der-abad

Chennai

20

4333

20

56

34

18 1814 16 14 12 821

13 17

Slum Poor

In every city there are many more slum households than poor households.

NFHS-3, India

Percentage of Poor Households in Slum/Non-slum Areas

Delhi Meerut Kolkata Indore Mumbai Nagpur Hy-der-abad

Chennai

42

23 23

9 10

29

17

32

510 8 12

3

15 11 12

Slum Non-slum

• Poverty is more prevalent in slum areas than in non-slum areas in every city except Indore

• Disparity in the proportion of poor between slum and non-slum areas is largest in Delhi followed by Chennai

NFHS-3, India

Distribution of the Poor between Slum and Non-slum Areas

Delhi Meerut Kolkata Indore Mumbai Nagpur Hy-der-abad

Chennai

68 66 61

16

79

53

2437

32 35 40

84

21

47

7663

Non-slum Slum

NFHS-3, India

Household Living Conditions

As expected, slums have poorer housing quality than non-slum areas whether we consider construction material, residential crowding or ventilation. However, the poor have the worst housing conditions on all counts.

There is not much difference between slum and non-slum households in the accessibility of piped water supply

NFHS-3, India

Household Living Conditions The use of improved toilet facilities is not very high

in most of these cities. In almost all cities, the accessibility to proper sanitation facilities is much worse in slum areas than in non-slum areas. A higher proportion of slum dwellers and members of poor households defecate in the open.

A majority of households in these cities use clean fuel (LPG, electricity or bio gas) for cooking. Differentials in the use of clean cooking fuels between slum and non-slum households are large in most cities.

NFHS-3, India

Delhi Meerut Kolkata Indore Mumbai Nagpur Hy-der-abad

Chennai

52 47

65

13

3244

33

55

1020

3015 15 20 25 25

8492 98

73

9689 88 92

Slum Non-slum Poor

Percentage of Households Using Kerosene and Solid Fuels

NFHS-3, India

Percentage of Poor Households Possessing a BPL Card

Hyderabad

Nagpur

Indore

Kolkata

Delhi

Chennai

Mumbai

Meerut

34

24

16

12

6

5

2

1

Except for Hyderabad (24%) and Nagpur (16%), only a small proportion of households (6% or less) have a BPL card

NFHS-3, India

Contents

• Need to focus on urban health by slum/non-slum residence and by economic status

• Differentials in living conditions

• Differentials in health status

• Spousal violence

NFHS-3, India

Infant and Under-five Mortality Rates

Delhi Meerut Kolkata Indore Mumbai Nagpur Hy-der-abad

Chennai

4163

41 4230

43 35 2849

78

49 5137

50 41 35

Infant mortality Under-five mortality

Deaths per 1,000

•The infant mortality rate (IMR) varies widely across these cities•Differentials by slum/non-slum residence do not show a consistent pattern

NFHS-3, India

Nagpur

Mumbai

Meerut

Kolkata

Indore

Hyderabad

Delhi

Chennai

57

69

35

63

74

53

52

89

76

73

50

71

76

62

67

74

Non-slum Slum

Percentage of Children Age 12-23 Months Who Received All Basic Vaccinations

In every city, at least 90 percent of children age 12-23 months have received some vaccinations

The proportion of children who have received all basic vaccinations is not very high in any of these eight cities, ranging from 43 percent in Meerut to 78 percent in Chennai

NFHS-3, India

Percentage of Women Who Had Three or More Antenatal Care Visits

Delhi Meerut Kolkata Indore Mumbai Nagpur Hy-der-abad

Chennai

58 6181 84

9081

91 9980

61

90 8593 94 91

100

4132

68 66

92

7382

99

Slum Non-slum Poor

NFHS-3, India

Percentage of Women Who Received All Recommended Antenatal Care

Delhi Meerut Kolkata Indore Mumbai Nagpur Hy-der-abad

Chennai

14 1625 29

18 1729

4135

26 29 3222

40 4152

4 412 13 13

7

2530

Slum Non-slum Poor

Although the utilization of all antenatal care services differs substantially across the cities,

between their slum and non-slum areas, in almost all cases poor women are the least likely to receive

every antenatal care serviceNFHS-3, India

Place of Delivery

Delhi Meerut Kolkata Indore Mumbai Nagpur Hy-der-abad

Chennai

42 43

81 80 82 81 90 99

7161

9376

93 87 95100

25 18

62

31

7463

80100

Slum Non-slum Poor

At least 60 percent of deliveries in these cities took place in health facilities, except in Meerut

where only 46 percent of deliveries were conducted in health facilities. Institutional

deliveries were nearly universal in Chennai and Hyderabad.

NFHS-3, India

Maternal CareAll indicators of delivery and postnatal care

are consistently better in non-slum areas than in slum areas in all cities except Indore and Chennai, where there is essentially no difference in the utilization of postnatal care

The utilization of delivery and postnatal services is lowest among poor women in all cities except Chennai. The differences are particularly striking in Meerut and Delhi.

NFHS-3, India

Percentage of Children Under Age Five Years Who Are Underweight

Delhi Meerut Kolkata Indore Mumbai Nagpur Hy-der-abad

Chennai

35

26 27

50

3642

2632

2430

16

37

26 28

18 21

46 44

32

57

46 4537

43

Slum Non-slum Poor

NFHS-3, India

Percentage of Children Age 6-59 Months Who have Anaemia

Delhi Meerut Kolkata Indore Mumbai Nagpur Hy-der-abad

Chennai

71 6955 60

50

7159

72

5267

55 5347

58 5360

67 7366 72

52

7864

83

Slum Non-slum Poor

There is not much variation in the anaemia status of children ranging from

49% in Mumbai to 68% in MeerutNFHS-3, India

Percentage of Children Age 0-71 Months Who Received Any Service from An Anganwadi Centre

Indore

Nagpur

Chennai

Kolkata

Mumbai

Delhi

Meerut

Hy-der-abad

31

30

21

19

17

10

7

4 The percentage of children that are covered by an AWC varies substantially across these cities, ranging from 12% in Meerut to 95% in Chennai

NFHS-3, India

Nutritional Status of Women

Delhi Meerut Kolkata Indore Mumbai Nagpur Hy-der-abad

Chennai

14 20 1625 22

3121 16

58 50 5453 50

50

4645

27 30 30 22 27 1933 39

Thin Normal Overweight

NFHS-3, India

Anaemia Among Poor Women

Meerut Mumbai Indore Hy-der-abad

Delhi Chennai Nagpur Kolkata

42 44 50 51 51 54 5665

Percentage

Anaemia is widespread among women in every city, ranging within a narrow band

from 40% in Indore to 55% in Kolkata

NFHS-3, India

Contents

• Need to focus on urban health by slum/non-slum residence and by economic status

• Differentials in living conditions

• Differentials in health status

• Spousal violence

NFHS-3, India

Spousal Violence Among Ever-married Women

Delhi Meerut Kolkata Indore Mumbai Nagpur Hy-der-abad

Chennai

28

49

36 3523

34 30

62

12

27 22

38

15 1726

3637

67

49

64

2533

42

68

Slum Non-slum PoorPercentage

NFHS-3, India

Conclusions and RecommendationsIn general, most, but not all, of the selected

indicators of living environment and health status of the population in eight cities are better in non-slum areas than in slum areas. Nevertheless, the

urban poor in every city are in the most disadvantaged position with respect of almost all of the selected indicators. Since a large proportion of the poor population in every one of the eight cities does not live in slums, there is an imperative need

to have a more inclusive policy that extends services to all poor people in addition to slum dwellers.

NFHS-3, India

Contd…Since inter-city disparities in most indicators

are much sharper than the intra-city disparities by residence or economic status, for evidence-based planning, it is important to have reliable

disaggregated data on environmental and health conditions in individual cities and for different groups within these cities similar to the information provided in NFHS-3 for eight

selected cities.

NFHS-3, India

THANK YOU