City’s shame in slums

While ICDS reports 15 tribal pockets with high incidence of malnutrition in Maharashtra, the scenario in Mumbai, the country’s financial capital, is no better. According to the World Health Organisation (WHO) estimates, malnutrition is responsible for more than one third of all child deaths globally, although it is rarely listed as the direct cause.

By definition, while malnutrition is a state where one’s regular diet is constantly deprived of essential nutrients, it includes several other aspects like improper sanitation, no toilets, early marriage, poor water supply and dearth in health care facilities. Further, while the word malnutrition might cast a skinny child’s image with bulging eyes, but there is much more to it. A Harvard study by researcher Janina R Galler, in 2013, said that malnutrition makes a person less sociable, less organised and affects his mental health. The ORF report says that 33 per cent children surveyed had headaches, a clinical sign of nutritional deficiency.

The report studied 300 children, aged 2-12 years, from two different kind of slums, including an authorised slum, Mata Ramabai Ambedkar Nagar, and  an unauthorised slum, Indian Oil Nagar.

While an authorised slum is registered and liable to receive amenities like water supply, sanitation and health services, an unauthorised slum, which is in the form of a squatter or resettlement colony, is bereft of even the basic facilities and lags far behind in human development index. As a result, health services have received a major blow in unauthorised slums. In Indian Oil Nagar, for instance, 70 per cent children surveyed were found undernourished and 51 per cent had stunted growth.

Missing toilets and sanitation

As per the 2011 census, the Brihanmumbai Municipal Corporation (BMC) has 41.3 per cent slum households, and 62 per cent live  in slums and slum-like habitats. But shockingly, there is an average of one toilet seat per 81 persons in these slums, says ORF’s report.
According to Rachel D’Silva, author of the ORF report, 56.04 per cent slum children, who opted for open defecation, had stunted growth and 69.23 per cent were underweight. “Access to a clean, maintained toilet and sanitation facilities makes a huge difference. In Indian Oil Nagar, children have almost no access to water and toilets,” she said.

Jockin Arputham, president of the Society for the Promotion of Area Resource Centres (SPARC), which works on the issue of public toilets in slums, said, “Individual toilets in a city like Mumbai are not possible, seeing that maximum people live in a house which ranges from 80 to 100-square-feet. According to our estimates, we have around 28,000 toilets in the public domain, of which 80 per cent are in slums. However, there is a projected need of 15,000-20,000 more toilet seats in these slum areas.”

Arputham further said that while there is a need for special toilets for children, as those below nine years cannot squat on ‘adult’ toilets, most children below nine end up going for open defecation on the side of the road, due to severe lack of facilities.

Coupled with the lack of toilet facilities, ignorance of proper sanitation plagues the slums. Vanessa D’Souza, chief executive officer of the Society for Nutrition, Education and Health Action (SNEHA), an NGO that is currently working on malnutrition in Dharavi, Govandi and Kandivali, said, “There are several sanitation and hygiene issues attached with slum-dwellers. They don’t wash hands at all, nor do they have a sense of drinking clean water and don’t even get  clean water supply. We are working towards sensitising them about proper hygiene, but not all slum-dwellers are receptive about such practices.”

According to Sitaram Shelar, programme director of Yuva, an NGO, the Bombay Port Trust land has over 30,000 unauthorised households with no access to water. Instead of buying cans for Rs 5-20 per litre, poverty-stricken people prefer not washing hands at all.

Mid- Day meal woes

Experts say that the government-funded scheme, that kicked off a decade ago, is a failure in several parts of the city. The ORF report reveals that as many as 41 per cent children consume half or less than their entire mid-day meal, with several citing poor quality and taste as the biggest causes for abandoning the ‘supposedly’ nutritious food.

Sayali Shinde, a class VII student of Mahatma Gandhi Vidya Mandir School, Bandra, said, “I have never liked the taste of any mid-day meal. It is too bland and the khichdi sometimes has excess salt or no salt at all.” Shinde skips her mid-day meals at school and eats after returning back home in the nearby slums if her mother, a domestic maid, is at home to cook food.

Currently, the civic body spends about Rs 3,000 per child per year, and the menu includes peas usal bhat, moong usal bhat, dal khichdi, chana usal bhat, moong bhat and biryani. Children, however, have claimed that neither the quality nor the taste is appeasing.

D’Silva, in her report, said that consumption of milk, fruits and vegetables were absent in their diet due to poor financial situation in almost all slum families.

Data released by BMC last year, following the death of 23 children in Bihar, who died after eating mid-day meal in school, indicated that around 80 per cent or 240 out of 328 self-help groups and NGOs providing such meals to children in Mumbai, offered poor quality food. There are 1,413 municipal and government-aided schools in the city covering over 4.2 lakh children. Of the 328 samples that BMC officials tested, 65 per cent fell short of the adequate calorie and protein content.

When contacted, a worker from the Mahila Bachat Gat, which prepares mid-day meals in Dharavi, who did not want to be named, said, “We have not been paid by the government for the last six months. To avoid loss, we have to cut down on quality and introduce money-saving mechanisms while cooking food. I accept that this may have affected quality.”

T V Mohandas Pai, whose Akshay Patra Foundation supplies mid-day meal in seven states across the country, including Maharashtra, said that while admissions in schools increased by 15-18 per cent after the introduction of mid-day meals and drop-outs declined by a similar percentage, it is unfortunate that half of the food is thrown away as children do not eat it.

Insufficient personnel &infrastructure

As per the Central government’s mandate, there needs to be one anganwadi centre (AWC) per 750 population, said Leena Joshi, who works with the Tata Institute of Social Sciences (TISS), in a project to improve the human development index in the M-East ward. But the 5,136 AWCs spread across the city’s slum pockets roughly convert into one anganwadi per 1,168 population. The city is not only reeling under lack of AWCs, it is also bearing the brunt of several that are defunct at any given point.

Anganwadi, a pre-school shelter, was launched to combat malnutrition and child hunger. It is responsible for nutrition counseling and healthcare facilities to children aged below five years. Several NGOs, however, claimed that most do not have space to set up infrastructure and operate out of the homes of slum-dwellers.

“Our estimate is that 20 per cent anganwadis don’t function either due to absence of teachers and helpers or due to space crunch. But on papers they are functioning properly,” said Joshi. Additionally, while several angandwadis are supposed to sensitise children about sanitation, very few have actually worked towards it, Joshi added.

In the ORF report, Rachel pointed out that the unauthorised slums have less access to anganwadis than authorised slums. In 2011, a report prepared under the National Commission for Protection of Child Rights on Mumbai, made a startling observation. It said, “All the AWCs visited are plagued with infrastructural problems of rented premises, inadequate space, leaking roofs, makeshift space for anganwadi worker, unavailability of potable water , lack of toilets and unhygienic surroundings.” The report was prepared after random visits to certain slum pockets in the city.

An official from the state’s Women and Child Development department, while admitting the issues plaguing the AWCs currently, said, “The AWC is set up after central government’s approval. The proposal for 7,000 new anganwadis in Maharashtra is pending with the Centre for the past one year.”
The official added that a provision has now been made to provide one room in the Slum Rehabilitation Authority’s (SRA) buildings for AWCs in the city.
Joshi, however, said, “An anganwadi is ideally a local programme. If it is set up in SRA structures, care must be taken that they are near slums, otherwise children below five years will not be able to access far-away located centers.”

Family set-up & social implications

The ORF report pointed out that 61.36 per cent children across both authorised and unauthorised slums, who were facing household food insecurity on certain days or weeks, were underweight.

Besides monetary constraints, D’silva said, “Mothers do not receive proper counseling on nutrition value. On several counts, they are ignorant about taking folic acid tablets for avoiding issues during pregnancy. These smaller things affect the child.”

D’Souza said that women in urban slums face multiple issues and their offspring face the consequences. “We have noticed that slum women, who work and have small children at home, fail to provide nutritious food to the kids. On several occasions, they prefer buying chips as an evening snack because it is easily available,” said D’Souza. She further said that marrying young and anaemia are two very common observations in girls dwelling in slums presently, though it is improving slightly.

“When they are not fit themselves, their children will be born weak. The first six months after birth must have special focus on breast feeding. But even now babies are not given breast milk properly. This directly affects their physical growth,” she added.

The road ahead

While efforts of several NGOs are directed towards addressing the malnutrition problem engulfing the urban slums, government intervention is necessary, said experts. Arputham admitted that while certain slums have toilets, their maintenance is often neglected. Ratna Jadhav, a domestic maid living in Mograpada slums, Andheri (East), said, “The toilets in our locality are cleaned properly only during the elections when local corporators visit us and ask us about our problems. Apart from that, we have to beg civic officials to clean the toilets, which cannot be used otherwise.”

Sudhendra Kulkarni, from ORF, said that sanitation and under-nutrition are directly linked and efforts towards clean and sufficient toilets will prevent open defecation.

D’Silva also proposed that more attention in unauthorised slums and increase in anganwadis will help in reaching out to more children. “Currently, the existing anganwadis are insufficient to accommodate the dense population,” she said.

D’Souza stressed on the need to pool in more local field workers for counseling women about importance of sanitation. “Washing hands, clean drinking water and maintaining cleanliness around helps in improving overall health. Campaigns towards this direction will help,” said D’Souza.

While nutrition is a state-subject, the civic body does not monitor it. But with the recently launched National Urban Health Mission (NUHM), the government now aims to focus on urban slums and related-health issues.

Dr Raju Manohar Jotkar, who works with the Directorate of Health Services, said, “We observed that in rural areas, the reach is better than in urban areas. For 1,000 people, there is one Accredited Social Health Activist or ASHA worker, but in urban slums, the ratio is skewed. Probably, there is one civic health worker for over 3,000 people.”

Joshi said that under NUHM, the concept of ASHA workers will now be replicated. “We will implement the concept of ASHA workers in urban slums so that every slum-dweller comes under the radar. Currently, we are thinking of having one ASHA worker for 2,000 population.”
tabassum.barnagarwala@expressindia.com