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For a proud Dilliwala which I claim myself to be, it was nothing less than shocking to go through the pages of Save the Children’s recent State of the World’s Mothers 2015 report. The capital city, the report states, has least concern for poor women and children when it comes to providing healthcare services. And higher incidence of malnourished children born to poor parents is one of the consequences of the denial of such access. On these counts, the report reveals, Delhi fares worse than cities of Rwanda, Haiti, Senegal, Nigeria and Ethiopia.
The numbers should serve as a wakeup call for city planners. Only 27 per cent of women belonging to the poorest quintile have access to prenatal care and a mere 19 per cent are fortunate to have skilled attendant at the time of delivery. The corresponding numbers for the richest section are 93 per cent and 99 per cent respectively, the report reveals. Even cities like Kigali city, Lagos and Addis Ababa do not have such large gaps. In contrast, mumbai fares far better with 73 per cent of women belonging to the poorest quintile having access to prenatal care and 78 per cent have access to skilled attendant at the time of delivery.
Similarly, Delhi also ranks high with Dhaka and cities in Rwanda, Ethiopia and Honduras in child malnuturition gaps.In these cities, stunting rates are 29 to 39 percentage points higher among the poorest compared to the richest.
As has been the case in the past, the reaction to such a damning report will range from simple indifference to outright rejection. There may have been an element of exaggeration in reports of this kind. That is understandable because of paucity of reliable data and biases and prejudices of researchers. But the message is loud and clear: the capital city is very unfair to its underclass.
There is no denying that Delhi’s population growth rate has been very high. But scores of other cities around the world are in the similar situation. With growth came the challenge of providing basic amenities of all sections of society.
Cities like Addis Ababa (Ethiopia), Cairo (Egypt), Manila (Philippines), Kampala (Uganda), Guatemala City (Guatemala) and Phnom Penh (Cambodia) pretty much had the same set of problems so long ago but have made some amends recently.
The report calls them “ “positive deviant” cities that have reduced the gap between the haves and the have nots through “a variety of strategies to strengthen health systems, lower costs, increase health awareness and make care more accessible to the poorest urban residents.”
Just sample these facts from the report. In Addis Ababa, the poorest children were 3.6 times as likely to die as the wealthiest in 2000. In 2011, they were twice as likely to die.
Despite very high annual population growth of almost 4 per cent, under-5 mortality in Kampala declined at an annual average rate of 7 per cent from 2006 to 2011. The poorest section gained the most in this period.
Under-5 mortality in Guatemala’s metropolitan area dropped from 52 to 19 deaths per 1,000 live births from 1998-99 to 2008-09. Phnom Penh cut its under-5 mortality from 50 to 18 deaths per 1,000 live births in 10 years flat beginning 2000.
All these cities just focussed on fixing the basics. They ensured that mothers do have access to prenatal care, there is greater incidence of institutional delivery and children are vaccinated on time. They only differed on how to make people aware of such programmes. In Manila, for instance, Saturday has been designated as “Youth Day” when teenagers are allowed access to modern family planning methods. In Kampala, there are family health days organised at places of worship.
Community radio is being used to spread awareness. In Phnom Penh, health messaging is preferred mode of raising awareness. Such small steps have yielded rich dividend.
If these cities with very limited resource at their disposal can make a transition from the least concerned to caring cities, why cannot Delhi do the same? Delhi now has an aam aadmi chief minister in Arvind Kejriwal. Here is an opportunity for him to do something worthwhile for hitherto neglected aam aadmis.
In the meanwhile, I will keep praying that I regain my proud Dilliwala status, now slightly dented after going through this report, sooner rather than later.
