Health and Living Conditions in Eight Indian Cities

119 Pages·2009·3.46 MB·English

Ministry of Health and Family Welfare
Government of India
Health and Living Conditons
in Eight Indian Cites
Natonal Family Health
Survey (NFHS-3)
India
2005-06
Internatonal Insttute for Populaton Sciences
Deonar, Mumbai – 400 088
NATIONAL FAMILY HEALTH SURVEY (NFHS-3)
INDIA
2005-06

HEALTH AND LIVING CONDITIONS
IN EIGHT INDIAN CITIES

Kamla Gupta
Fred Arnold
H. Lhungdim

August 2009
Suggested citation: Kamla Gupta, Fred Arnold, and H. Lhungdim. 2009. Health and Living Conditions in
Eight Indian Cities. National Family Health Survey (NFHS-3), India, 2005-06. Mumbai: International
Institute for Population Sciences; Calverton, Maryland, USA: ICF Macro.

Acknowledgements
The authors are grateful to Ms. Y. Vaidehi, Ms. Bhawna Malik, and Ms. Kiran Agrahari for providing
support in generating the tables and preparing the graphs. We gratefully acknowledge comments
received from several reviewers.

For additional information about the 2005-06 National Family Health Survey (NFHS-3), please contact:
International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai - 400 088
Telephone: [phone]
Fax: [phone]
E-mail:
CONTENTS

ABSTRACT ………………………………….………………………………………………………......1
ABOUT NFHS-3 ……………………………. ………………………………………………………......3
CHAPTER 1 INTRODUCTION ………………………………………………………………......5
1.1 Urbanization and urban health in India ……………………………………….......8
1.2 Definition of slums. …………………………………………………….……...……10
1.3 Trends in the size of slum population…...…….……………………………….....12
1.4 The selection of eight cities in NFHS-3 for the study of
slum and non-slum areas ..……………………………………………………........12
1.5 Slums and urban poverty.…………………………………………………….........14
1.6 Sample ……………………………………………………………………….............15
1.7 Scope of the report …...……………………………………………………..............16

CHAPTER 2 THE URBAN POOR: WHO THEY ARE AND HOW THEY LIVE…...….......19
2.1 Poverty and slum/non-slum residence ………..………………………...…..........21
2.2 Demographic and socioeconomic characteristics of slum/non-slum
residents and the urban poor ……....…...……………….…………………...........24
2.3 Household living conditions……………………………………………………....35

CHAPTER 3 HEALTH AND HEALTH CARE OF THE URBAN POPULATION ………...43
3.1 Fertility and family planning ...……………...………………………………….....45
3.2 Infant and child mortality ……………………………………………………….....47
3.3 Child health ……………………………………………………………………….....48
3.4 Maternal care ………………..……………………………………………………....51
3.5 Nutritional status and anaemia among children…………..………………….....54
3.6 Nutritional status and anaemia among adults …………..……………………....55
3.7 Prevalence of diabetes, asthma, goitre or other thyroid disorders,
and tuberculosis ………………………………………………………………….....57
3.8 Knowledge of tuberculosis and HIV/AIDS ………..……………………..............59
3.9 Source of health care …………..…………………………………………………....60
3.10 Tobacco and alcohol consumption ……..………………………………………....61
3.11 Spousal physical or sexual violence ……………………………………………....62
3.12 Family life education …………….………………………………………………....63

CHAPTER 4 CONCLUSIONS ..……………………………………………………………….....65
REFERENCES ……………………………………………………………………………………….....69
TABLES …………...…………………………………………………………………………………....73
ABSTRACT
This report analyzes health and living conditions in eight large Indian cities (Chennai, Delhi,
Hyderabad, Indore, Kolkata, Meerut, Mumbai, and Nagpur). The report is based on data from
India's 2005-06 National Family Health Survey (NFHS-3). A special feature of NFHS-3 is that
the sample was designed to allow separate estimates of population, health, and nutrition
indicators to be generated for each of these eight cities, as well as for the residents of slum and
non-slum areas in these cities. In addition, a wealth index was constructed for households in
urban India as a whole, using NFHS-3 data on household assets and housing characteristics.
For the purposes of this report, the urban poor population is defined as those persons
belonging to the lowest quartile on this wealth index.

The study examines the living environment, socioeconomic characteristics of households and
the population, children's living arrangements, children's work, the health and nutrition of
children and adults, fertility and family planning, utilization of maternal health services,
knowledge of HIV/AIDS, attitudes of adults toward schools providing family life education for
children, and other important aspects of urban life for the eight cities by slum/non-slum
residence and for the urban poor

The analysis shows that more than half of the population in Mumbai lives in slums, whereas
the slum population varies widely in the other seven cities. Major differences in the estimation
of the size of the slum population are found depending on how slum areas are defined
(according to the 2001 Census designation or observation of the area by the NFHS-3 team
supervisor at the time of the fieldwork). The poor population in these cities varies within a
narrower range, from 7 percent in Mumbai to 20 percent in Nagpur. The analysis finds that a
substantial proportion of the poor population does not live in slums and that a substantial
proportion of slum dwellers are not poor (that is, they do not fall into the bottom quartile on
the NFHS-3 wealth index). In some cities, the poor are mostly concentrated in slum areas,
whereas the reverse is true in other cities.

Although slum dwellers are generally worse off than non-slum dwellers, this pattern is not
consistently true for all indicators in every city, and the differentials are quite small in some
cases. However, there are large disparities in health and living conditions between the poor
and the non-poor in these cities. Although there is an obvious need to improve living
conditions and the health of slum dwellers, it is equally apparent that programs that focus
solely on slum areas will not be able to address the urgent needs of the large poor population
not living in slums.
1
ABOUT NFHS-3
The 2005-06 National Family Health Survey (NFHS-3) is the third in the NFHS series of
surveys. The first NFHS was conducted in 1992-93 and the second (NFHS-2) was conducted in
1998-99. All three NFHS surveys were conducted under the stewardship of the Ministry of
Health and Family Welfare (MOHFW), Government of India. The MOHFW designated the
International Institute for Population Sciences (IIPS), Mumbai, as the nodal agency for the
surveys. Funding for NFHS-3 was provided by the United States Agency for International
Development (USAID), the United Kingdom Department for International Development
(DFID), the Bill and Melinda Gates Foundation, UNICEF, UNFPA, and the Government of
India. Technical assistance for NFHS-3 was provided by ICF Macro, Calverton, Maryland,
USA. Assistance for the HIV component of the survey was provided by the National AIDS
Control Organization (NACO) and the National AIDS Research Institute (NARI), Pune.

The survey provides trend data on key indicators of family welfare, maternal and child health,
and nutrition, and includes information on several new topics such as use of the Integrated
Child Development Services (ICDS) programme, HIV prevalence, attitudes toward family life
education for girls and boys, men’s involvement in maternal care, high-risk sexual behaviour,
and health insurance coverage. NFHS-3 collected information from a nationally representative
sample of 124,385 women age 15-49 and 74,369 men age 15-54 in 109,041 households.

A special feature of NFHS-3 is the provision of separate estimates of population, health, and
nutrition indicators for eight cities (Chennai, Delhi, Hyderabad, Indore, Kolkata, Meerut,
Mumbai, and Nagpur) and for the slum and non-slum populations in each of these cities.
Additional information on the security of tenure was collected in Kolkata and Mumbai. In
order to have a sample large enough to provide reliable information, in each of the eight cities
NFHS-3 selected a representative sample of approximately 2,000 households with about 1,000
households each from enumeration areas designated as slum and non-slum areas within the
municipal corporation limits of these cities according to the 2001 Census. State weights correct
for the oversampling, so that indicators based on these data are representative at the city level,
as well as for slum and non-slum areas within the cities.

More information about the definitions of indicators included in this report is contained in
Volume I of the NFHS-3 National Report, and the questionnaires and details of the sampling
procedure for NFHS-3 are contained in Volume II of the NFHS-3 National Report (available at
www.nfhsindia.org).
3
INTRODUCTION 1

Summary and Key Findings

 The urban population in India is expected to increase to more than 550 million by
2030.

 Currently, a sizable proportion of the population in most Indian cities lives in slum
areas. The increasing slum population in Indian cities is seen an indciation of
worsening living conditions and increasing poverty in cities in India.

 The increasing concentration of population in slums and urban poverty hvae

elicited a strong interest in urban health conditions in general and the health of
slum dwellers and the urban poor in particular.

 Because of a strong interest in urban health in general and because of then eed to
track progress on the Millennium Development Goal on improving the lives of
slum dwellers, NFHS-3 made special provisions to collect population, health, and

nutrition information for the population in slum and non-slum areas and for the
urban poor in Chennai, Delhi, Hyderabad, Indore, Kolkata, Meerut, Mumba,i and
Nagpur.

This report provides information on a variety of topics including:

 The extent of poverty in the eight selected cities by slum/non-slum residence
according to the census and NFHS-3 supervisor designation of these areas and by
wealth status

 Demographic and socioeconomic characteristics of slum/non-slum residents and
the urban poor

 Household living conditions

 Health and health care

5