Background

It is estimated that about 335 million people inhabit India’s cities, of which about a fourth (80.8 million) are poor. Uttar Pradesh (UP), which is the second largest state in terms of urban poor population, houses nearly 11 million urban poor. The state’s urban poor have a high Neonatal, Infant and Under-5 Mortality Rates.

Of the 340,000 pregnancies every year among this group, only 2% receive complete antenatal care. More than 80% deliveries are conducted at home. Only 15% children receive complete immunization. (Source: National Family Health Survey (NFHS)-3 data for UP, reanalyzed on the basis of wealth index.)

It is a challenge for the Government to provide quality and affordable healthcare services to the urban poor. Effective program strategies require in-depth insight into the health related problems faced by this population, especially with regard to maternal, neonatal and child health.

To enhance understanding in this regard, a study was conducted on the Maternal, Neonatal and Child Health Scenario among the urban poor, in the slums of Meerut, Uttar Pradesh, in 2008. Meerut was selected for the study in view of being one of the largest cities in the programmatically high priority state of Uttar Pradesh, with a population of 1.07 million persons. It also has the highest slum population among cities in the state and is second highest after Mumbai in terms of slum-population ratio.
The study was conducted jointly by Urban Health Resource Centre, Johns Hopkins Bloomberg School of Public Health, and Chatrapati Sahuji Maharaj Medical University. It was funded by United States Agency for International Development.

A Workshop was organized in New Delhi to share the findings of the study on Maternal, Neonatal and Child Health Scenario in the slums of Meerut: Implications for Program and Policy”, on 14th April 2009, at India International Centre.

The workshop brought together officials from the Ministry of Health and Family Welfare, Government of India, State Governments of UP and Delhi, Meerut District Health Department, faculty from Meerut Medical College, King George Medical University (KGMU), Johns Hopkins University, and members of the National Neonatology Forum, who shared their experiences at the event.

Workshop Sessions

Dr Marta Levitt Dayal, MCH Star, presented an Overview of the Workshop, laying out the sessions for the day.

Professor Robert Black, Chair of the Dept of International Health, Johns Hopkins University, gave a presentation on the Global Overview of Maternal Neonatal and Child Health – Need for an Urban Focus.

Dr Gajraj Prasad, Additional Director, Maternal and Child Health (MCH), Directorate of Family Welfare, Government of UP, delivered the Special Remarks. He gave a presentation on Urban Health in Uttar Pradesh: Challenges and Opportunities.

Technical Session I
The session was chaired by Prof. Arvind Pande, Director, National Institute of Medical Statistics, Indian Council of Medical Research.

Dr Abdullah Baqui, Johns Hopkins University, presented an overview of the Meerut MNCH Study and Methodology. He outlined the study rationale and objectives, key aspects covered and methodology including study design, sampling process, field data collection and quality control measures.

Technical Session II
The session was chaired by Dr A.K. Mishra, DGM, MCH & Family Welfare, State Programme Management Unit, NRHM, Government of UP.

The Maternal Health Scenario in the slums of Meerut, UP, as per the study, was presented by the UHRC team, which showed that the indicators representing the status of maternal health in the slums covered by the study faired poorly.
• Only 53.2% of the pregnant mothers received any antenatal check-up and only 27.2% received the recommended 3+ check-ups.
• Overall 68% of the mothers delivered at home. Only 32% of the deliveries were conducted in a health facility

Technical Session III
The session was chaired by Dr Sushma Nangia, Secretary, National Neonatology Forum. The study findings on Neonatal Care Scenario in the slums of Meerut, UP, presented by the UHRC team, revealed poor knowledge and practices of essential newborn care.

• Only 50% of the newborns received complete cord care (new blade, new thread and nothing applied to the cord).

• Only 4.6% of women initiated breast feeding within the first hour after delivery.

• Postnatal preventive care was low in the slums with only about a third of the mothers (32.5%) reporting that their newborn received a postnatal check up.

Technical Session IV
The session was chaired by Dr Baya Kishore, Assistant Commissioner, Child Health, Ministry of Health and Family Welfare, GoI.

A presentation by UHRC team on the Child Health Scenario in the slums of Meerut, UP, showed poor performance on indicators related to vulnerability to child morbidity and mortality.
• The infant mortality rate (IMR) in the surveyed slums was 59.8.
• Immunization coverage rates were low and complete immunization among children aged 12-23 months was dismal at 12%
• Almost 43.0% of the children <3 were underweight and 68.2% stunted (indicative of chronic malnutrition). The extent of severe stunting was about 44.5%.

Valedictory Session cum Discussion
The last session was followed by an interactive panel discussion, chaired by Prof. Amitabh Kundu, JNU. The participants included Prof R.C. Ahuja (King George Medical University), Dr Shally Awasthi (KGMU), Dr S.C. Maheshwari (CMO, Meerut), Dr Monika Rana (Delhi State Health Society), Dr Harivansh Chopra (Meerut Medical College) and Prof. Black.

Participants brought forth several concerns relating to improving health and healthcare for slum dwellers in urban areas, such as coordinated delivery of services, strengthening convergence at higher levels and improving quality of care to the poor. Summing up the discussion, Prof. Kundu said that at the grassroots level, the Meerut study allows us to have a dispassionate view of the functioning of health programs, and how the system can be influenced to improve delivery of services.

Closing Remarks
Dr Sanjeev Upadhyaya, USAID, delivered the closing remarks. He pointed out the importance of this study in understanding the maternal and child health needs of the slum population and expressed the hope that the findings will be utilized for the larger good by researchers and policy makers.

Key Findings- Maternal Health Scenario in the slums of Meerut, UP

Key Findings- Neonatal Care Scenario in the slums of Meerut, UP

Key Findings- Child Health Scenario in the slums of Meerut, UP