|Priorities in Health and Nutrition of the Urban Poor: The Case of the Calcutta Slums (CRED, 1991, 18 p.)|
Information was collected on a total of 14.999 persons and 2.603 families. The age distribution of both sexes were significantly in favour of young adults in their reproductive years. The distribution of religion by occupation groups is displayed. The predominant religion was Hindu accounting for 68% of the population, followed by Muslims accounting for about 30%. There were practically no other religious groups. Among the Hindus, over two-thirds were of low castes or tribes. The average family size was 5.8 with a crude birth rate of 55.3 per 1,000 population. Occupations varied among religions. Muslims were typically in wage labour or petty business whereas the Hindus were typically on salary. Overall, wage labour was the most frequent occupation, accounting for nearly one quarter of the total, most of the families cited economic reasons for moving to the city and 38.4% had moved within the last ten years. Income was very difficult to estimate, especially because the respondents were rarely able to vouch for the husbands income. A rough estimate from the reported figures would place the majority of the families within a range of 400 to 800 rupees a month.
Over half of the families surveyed lived in temporary or semi-temporary shelters. The housing consisted either of improvised roofs with one or more anchored walls or entirely improvised structures. The majority of the families (79.6%) lived in spaces with one or more anchored walls which had a thatched or unattached roof. Over half of the families (55.1%) lived in one room and 60.2% cooked in their living/sleeping quarter. Among those who did not have separate kitchens, the majority used either kerosene or biomass fuels (both cheaper fuels), while coal and gas users generally had more than one room and separate kitchen areas. The average number of persons per room was 4.2. Almost all drinking water was drawn from public taps and the main source of light was electricity, principally drawn from illegally tapped lines.
Health Status and Health Services Use
Approximately 70% of the surveyed slums had a health centre or hospital in the vicinity, of which less than half were Integrated Child Development Centres (ICDS). Based on a CMDA report (1983), there were 163 general and specialised hospitals with 26,365 beds available in the Calcutta Metropolitan area. The total number of hospitals in the State of West Bengal in 1988 was 412. Nearly 40% of the hospitals in the State are within the Calcutta Metropolitan area. Thus there about 307 persons per bed in the city compared to 1,161 state wide (Statistical Handbook of India, 1991). It should be noted that the presence of these institutions does not reflect services actually provided or used.
The rates of immunisation were hogh, over 70% of children had at least one dose of an Expanded Program of Immunisation (EPI), with the exception of measles. Only 22% of the male children and 19% of the female children were vaccinated against measles. The majority (80%) of the immunisations were provided by government hospitals. Very few immunisation were administered through the primary health care (anganwadi) structure. The type of medical care used by the population varied among allopathic, homeopathic, ayurvedic, and other lesser known forms of traditional medicine. Allopathic services accounted for 70.2% of all those who were ill in the previous year. Of the remaining percentage, homeopathy was a significant alternative, representing 14.1% of the total. Non-allopathic forms of medicine were used more frequently by females than males. Average monthly health care expenditure for the family was a little over 60 rupees, of which nearly 80% was spent on medicines and tonics. These results correspond to findings from other studies. For example, the average monthly health care expenditure in Delhi was observed to be 40 rupees per household (Sinha and Ghosh, 1988). Data from the CMDA survey (1988) similarly indicates an expenditure proportion of nearly 90% of the health expenditure per episode for medicines. Gender differences were significant in patterns of health expenditures, where the proportion of females decreased as levels of expenditure per episode of illness increased.
Maternal and Nutritional Characteristics of Women
Table 3 presents general maternal and nutritional characteristics of married women included in the survey. The average age at marriage for females was 17 years compared with the national average of 18 years. More than 31% of the women were married before the age of 16 years and 20% of the first pregnancies occurred before 16 years. By the age of 20, nearly 75% of these women had been pregnant at least once. Childbirth occurred almost entirely at hospitals with nearly 80% in Government hospitals. Less than 10% were delivered at home or in non-institutional surroundings. Similar statistics were observed by Yosudesian in a study of Bombay slums (ORD, 1991).
The age-specific fertility rates ranged from 641 per 1,000 women 16 to 19 years of age, 400 for women 20 to 24 and 254 for women 25 to 29 years of age. The general fertility rate was 312 per 1,000 women 15 to 44 years of age and the total fertility rate (expected births per woman through her entire reproductive period) was 8.54. Although this last figure is an overestimation dur to the sampling design of the survey, it should be remembered that the majority of the slum women are young and this rate is probably fairly close to reality. Twelve per cent of the births occurred within 18 months of the previous delivery and 39% within 24 months. More than a third of the women had one child under one year of age and 7% were pregnant at the time of the survey.
Nutritional deficiencies were calculated for calorie, fat, and proteins. Distribution of observed calorie intake (adjusted for age, weight, and maternal status). Severe calorie deficiency was defined as intake < 2 standard deviations of the mean requirement for age, weight, and maternal status (assuming moderate activity). The calorie deficits were the highest in lactating women and among the younger age groups, particularly among women with one child under two years. Significant deficiencies were also observed in pregnant women. Fat deficiency was the second most prevalent condition. Both calorie and fat deficiencies increased with parity and family size indicating the vulnerability of this group to competing demands for food. Protein deficiencies were the least compared to calorie and fats. Among occupation groups, domestic servants displayed large nutricional deficiencies although the chisquare statistic was significant only for protein deficiency. Muslim women, women with higher parity, and women whose husbands worked as wage labourers all displayed significantly higher nutritional deficits (chisquare statistics of 7.7 and 7.03, respectively, significant at the p < 0.05 level). Odds ratios (OR) revealed higher risks for women with children under two years (OR = 5.11), for women in families with over four members (OR = 6.8) and for mothers working outside the home (OR =5.7).