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Learning About Motherhood
in an Indian Slum
department formed partnerships with “lying-in
clinics” (modest, single-purpose facilities for
pregnancy and childbirth care). Through this
partnership, staff of private birthing clinics are
trained in essential newborn care, emergency
obstetric care, health and nutrition data collection
and other health protocols. For 4Ps
recipients who are also enrolled in PhilHealth,
the national insurance program, maternal and
newborn packages in accredited private birthing
clinics are free. 96
In Manila, a city within the National Capital
Region with a large population and high urban
poverty, a local nongovernmental organization
Likhaan Center for Women’s Health, Inc., helps
complement reproductive health and family
planning services offered by the city. At present,
Likhaan is in partnership with Save the Children
on a European Union-funded project. Through
this project, Likhaan is helping to reach more
than 90,000 poor urban mothers, fathers,
adolescents and children through consultations,
counseling, face-to-face meetings, home
visits and via mobile phones. The project also
advises local health providers and local government
officials on the best ways reach the urban
poor with other health and family planning
services. Saturday is designated as “Youth Day”
when teenagers can access adolescent sexual and
reproductive health services, including modern
family planning methods.
“I really like it here at Likhaan because the
services are free, unlike in some other hospitals,”
said Irene. “For poor people like me, it
is important that we are not paying for family
planning services. In hospitals, you have to pay
a lot for family planning.” 97
What challenges remain? In Metro Manila,
while health facilities and obstetric care are
physically more accessible, the poor and young
people still have to compete for limited resources.
Many poor people do not access health
services because they lack financial capacity to
do so. Also, the cost of health care continues
to rise despite policy reforms in the health
financing system. 98 Some mothers still prefer
delivering at home because fees for traditional
Chotti lost three babies shortly after they were born. During her
pregnancies, she did not receive any prenatal care and the deliveries
took place at home without a skilled attendant. “I didn’t know … I
didn’t get check-ups, nothing,” she said. “All three children were born
and then they died.”
In the slums of Delhi, India, her story is sadly commonplace.
Among the poorest 20 percent of women in this city, only 27 percent
receive recommended prenatal care and only 19 percent have a
skilled attendant at birth. In a city where the affluent enjoy a very
high standard of living, statistics like these make Delhi one of the
most unequal cities in the developing world. 99
When Chotti became pregnant a fourth time, her neighbors told
her to go see Rima, a Save the Children community health volunteer
in the VP Singh Camp where both women live. Rima became like
a wise older sister to Chotti, coaching her on when and where to
go for prenatal check-ups, how to have better nutrition, and danger
signs to watch for. Rima accompanied Chotti to the hospital and
helped her register so she could have her birth there.
“In the hospital, the baby was born properly,” Chotti said. “I liked it
there. The people helped me. They made me lie down and after that
the baby was born and everything was fine. If I had gone to the hospital
before, my other children would have survived.”
Rima visits Chotti at home now and helps her care for her new
baby boy, whom she named Naveen. Rima advises Chotti about
breastfeeding, cleanliness and vaccinations. Chotti has been following
Rima’s advice and Naveen is doing well.
“I used to feel sad earlier,” Chotti said. “But now my baby is fine.
My heart is happy.” 100
Delhi, India
34 Saving Lives in Slums