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Manila, Philippines
treatment and discrimination by health personnel,
which deters them from seeking care. 42 And
some are unwilling to go to facilities they find to
be poorly equipped and poorly staffed. 43
Home births not accompanied by a trained
medical professional are commonplace in many
urban slums. 44 This contributes to late recognition
of newborn illness, inadequate postnatal
care, and delays in seeking appropriate medical
services. Newborn deaths (deaths within the
first 28 days of life) are also common in many
slums and are often caused by premature birth,
birth complications and infections. 45 Recent
studies in Brazil and India found newborn
mortality rates up to 50 percent higher in slum
compared to non-slum areas. 46
Beyond the newborn period, infants and
young children frequently die of diarrheal
disease and respiratory infections. 47 Many slum
children are malnourished, which increases
their susceptibility to illness. In Bangladesh,
for example, 50 percent of children under age
5 living in slums are stunted and 43 percent
are underweight. In non-slum areas of cities,
these percentages are 33 percent and 26 percent,
respectively. 48 The national average rate of stunting
for children under 5 is 42 percent. 49
Inadequate Health Systems in Slums
In order to meet the goal of universal health
care, tremendous investments are needed
to address deficiencies in the health systems
serving the urban poor. Public sector health
systems are typically under-funded, and often
fail to reach those most in need with basic
health services. Private sector facilities are more
plentiful in urban areas, but the urban poor
often lack the ability to pay for care – and may
face discrimination or even abuse when seeking
care. In many instances, the poor resort to seeking
care from unqualified health practitioners,
often paying for care that is poor quality, or in
some cases, harmful.
In Nairobi, Kenya, for example, a study of
women giving birth in slums found the majority
were served by privately owned, substandard,
often unlicensed clinics and maternity homes.
An audit of 25 facilities concluded “the quality
of emergency obstetric care services in Nairobi’s
slums is unacceptably poor, with inadequate
essential equipment, supplies, trained personnel,
skills, and other support services.” There
was little supervision or adherence to standards.
Health personnel were found to be
often unfriendly, unresponsive to questions
STATE OF THE WORLD’S MOTHERS 2015 19