No man's land

Photo: icddr,b

Rapid urbanisation has been taking place in Bangladesh since 1960. With the expansion of urban centres and increase in the urban population, the number of slums and slum dwellers has been rapidly increasing. Presently, Bangladesh has about 3.5 million people living in the 4000 slums of Dhaka, according to the Ministry of Local Government and Rural Development.
The slum dwellers are largely the distressed migrants from the rural areas and, more importantly, most of them live below the poverty line. The slum dwellers do not have sufficient access to education, employment and health facilities of the formal sector. The health and nutritional status, and contraceptive use of the urban poor are even worse than that of the rural poor.
Among the basic health amenities, the state of universal access to reproductive health is the worst. According to the study of International Society for Urban Health, family members rather than trained birth attendants assist most births in the slums. Only about 5-10% of births are attended by parsonnel trained in safe childbirth practices; even the most basic cleanliness is not observed, e.g. the umbilical cord is cut with an unsterilised razor or bamboo strip.
A cross sectional study conducted on married women residing in slums of Kamrangirchar shows that the unmet need was about 41.1%, which included about 21.5%, of women who wanted to limit the birth, and about19.6% wanted to delay childbirths. This rate is much higher than the national rate, which is about 12%. It is important to note that about 11% of the respondents with unmet contraceptive need mentioned that they did not know about any method or did not know where to get contraceptives from.
A baseline study undertaken by icddr,b and Population Council in the slums of Mohakhali, Mohammadpur and Jatrabari reveals high rate of child marriage and consistent violation of sexual and reproductive rights of the women and girls. According to the study, about 85% reported that their husbands restricted their access to health care.
Although the government has been implementing a structured health and family planning service delivery system for the rural poor it does not have any comparable structure for the urban poor particularly slum dwellers.
According to Gias Uddin, Deputy Director (Services), MCHS, DGFP, the best metaphor for a slum area is a 'no man's land'. Health issues of the slum areas are under the jurisdiction of city corporations and local government. But the local government is not strong enough to execute those roles. They give contract to NGOs to look after the issue.
Health and Family Planning Ministry looks after rural areas and a few health facilities of urban areas. They are not designated to provide service in slum areas. Md Giasuddin admitted the importance of a coordinated effort to ensure basic health services to slum dwellers under the leadership of Ministry of Health and Family Welfare.