Rising trends in malnutrition among children under six here and in other cities have prompted the Maharashtra government to introduce an Urban Malnutrition Mission from next month, official sources said. A quarter of children below six years in the city weighed at anganwadis are underweight, according to the latest monthly progress report (MPR) of the Integrated Child Development Services (ICDS). Non-governmental organisations point to a severe crisis of primary health services and lack of adequate number of anganwadis in slum areas.
An ongoing anthropometric survey of children below six in the M-East Ward municipality of 20,000 families in slum and gaothan areas at Shivaji Nagar will be completed by month-end and will give an idea of the severity of the problem. Leena Joshi, director of the M-East Ward project of the Tata Institute of Social Sciences, feels malnutrition among children cuts across a large section of the city. The Human Development Report of the Greater Mumbai Municipal Corporation, 2009, said the M-East Ward with large slums in the northeastern part of the city had the highest infant mortality rate (IMR) of 66.47 per 1,000 live births, almost double the State's IMR of 34.57. Ms. Joshi has earlier headed an NGO Apnalaya, which traced the level of malnutrition and deaths at Rafi Nagar part II, a slum at Shivaji Nagar, since 2006. “Our claim is that Rafi Nagar is not an exception. Poor communities have little access to public health care and depend on quacks. For instance, in M-East Ward, there are 105 beds in maternity wards for a population of 12 lakh. Inadequate services lead to home deliveries or [women] going to private clinics which are expensive,” Ms. Joshi said.
Jahan Ara ekes out a living from a small shanty which also passes off as a grocery shop. In December 2010, her seven-month-old son died of prolonged diarrhoea. He was one of the 20 children who lost their lives in 2010-2011 at Rafi Nagar (part II).
“Asif was a sickly child and had low birthweight,” says Jahan Ara. At 29, she is very lean herself and hardly eats. Married at 15, she is left with a daughter and two sons, the oldest of the children being 12. Her husband doesn't work and ill-treats her. Her house was demolished three or four times and when Asif died, the family barely had a cover over its head. Her sister Anjum Sheikh, a social worker, had two deliveries at home, a common feature here. In addition, there is no food security. Anjum says that though 200 people were issued ration cards, there was no quota for them. She has been living here since 1996, and her house has been demolished at least five times. There is no sanitation and water comes from a tanker every afternoon to fill 50 large blue drums.
No basic amenities
Squeezed between a fenced-off kabrastan and a waste-dumping ground, residents of Rafi Nagar part II live under a constant threat of demolition. The settlement came up in 1996, some say earlier, on a waste-dumping ground. There are some 850 shanties here and activists have been demanding basic amenities and even filed a court case in the wake of the rising child deaths. Last year, the Bombay High Court appointed a committee to look into the basic question of rehabilitation of the slum but it did not function and some NGO representatives were added to it to advise the panel on basic amenities.
Home deliveries, low birthweight and lack of basic amenities were putting more and more women and children at risk. Ms. Joshi says the ICDS has to perform better and there is need to set up Child Development Centres in Mumbai on the lines of Melghat for special attention to the mother and the child.
Mumbai's malnutrition figures closely rival some really backward Adivasi regions of the State, like Amravati. According to the MPR for February for Mumbai as a whole, 26 per cent of the children are underweight. The total population of children under six is 4,45,209. Of these, 2,69,193 were weighed at ICDS centres and 1,99,180 were of normal weight. However, 64,735 (24 per cent) were moderately underweight and 5,278 (two per cent) severely underweight as per World Health Organisation guidelines. Of the severely underweight children, 589 are in the Shivaji Nagar area. For the city, there are a total of 5,153 anganwadi centres, which are not enough.
Dnyaneshwar Tarwade of Apnalaya, which has been monitoring the situation at Rafi Nagar part II since 2006, says the level of malnutrition was not as high seven years ago as it is now. After the December 2004 demolition of the slum, the situation took a turn for the worse and about 850 families, whose homes were razed to the ground, live precariously.
Apnalaya found that malnutrition levels were over 65 per cent in children under six at Rafi Nagar part II. Of the 220 children, at least 130 were malnourished based on the weight-for-age criterion. While it has set up crèches, a Nutrition Rehabilitation Centre and anganwadis at Rafi Nagar part II, the government-run anganwadis are barely working. The child deaths peaked to 20 during the period April 2010-March 2011. The 2005-2006 data for Rafi Nagar part II shows the number of deaths has been rising since, from four deaths that year. In 2011-2012, seven infants died till March.
Since April 2011, Apnalaya has also been monitoring eight bastis around the garbage dumping ground at Shivaji Nagar, where 7,500 families live. Only 25 anganwadis are there for a population of 50,000, when the number ought to be double that, says Mr. Tarwade. The latest data from February shows that of the 3,780 children below six years, 3,016 were weighed. Of these, only 217 had an above-normal weight. Forty-seven per cent, or 1,411 children, were normal weight, 901 were moderate underweight (30 per cent) and 487 were severe underweight (17 per cent). Almost half the children, Mr. Tarwade said, are below normal weight.
