Squatting before a brick walled shanty, from which pale green patches of paint is peeling out, in madrasi colony near the grain market Sector 26, Chandigarh is Uttara, who helplessly looks at her grandson as the motherless kid chases the mongrels, devouring on poultry waste, through the underbelly of the City Beautiful.
She haplessly smiles and with a heavy gasp said, “He is a true copy of his mother, but the poor child never really got to see his mother. She died within two hours of childbirth, due to excessive bleeding. Since then he thinks that this old hag is his mother. As a child he suckled at my dry breasts, I don’t know what he got by doing that, maybe he wanted to substitute someone for his mother.”
According to a study done by the Post Graduate Institute of Medical Education and Research, which was published in the year 2008, coverage of maternal health service was lowest in urban slums as compared to the rural and the urban areas. Maternal mortality is not a new thing in these dark alleys, housing workers who are the basic service providers and without whom the city might come to a screeching halt.
Uttara, 70-year-old is a migrant worker from Tamil Nadu used to work under a contractor at construction sites near Chandigarh till a few years back. She recalls the story of how Shahjahan, the Mughal Emperor hacked the thumbs of construction worker who built the Taj Mahal. Nothing much has changed since then. We are still marginalised and neglected by the society, she says.
There are more than two lakhs migrants residing in different slums, comprising 10 per cent of the total population of the city, which make them key to the electoral process. However, the irony is that even after lot of hue and cry about development which is made by most mainstream parties, development has failed to reach here.
A study conducted by Manoj Teotia, assistant professor, Centre for Research in Rural and Industrial Development (CRRID) says that first slum dwellers of Chandigarh were the construction workers who built the city, but one of the first planned cities of the country never had a place for them to reside.
Prabhawati spews venom against the healthcare services provided by the government as she washes clothes at a community tap. This bitterness sprouted after she lost her second child, a daughter, after just two months into her pregnancy. She never conceived after that. The pain shows as she talks about the lackadaisical attitude she encountered at the Government hospitals.
“Every time I complained to the doctors about my deteriorating condition, they used to write me a series of tests. After examining them, doctors sent me back by saying, “everything is normal, there is nothing to worry about.” Then one night when my condition worsened, I was rushed to General Medical College and hospital in Sector 16 and from there I was referred to Government Medical College Sector 32, but they failed to save the baby,” said Prabhawati, who resides with her husband, a daily wage worker, in Bapu Dham Colony.
Maternal health indicators among migrant women construction workers A study titled Maternal health indicators among migrant and women construction workers, conducted in the region states that disparity in maternal and child health indicator in this population is quite high when compared with the national and the state average. Dr Amarjeet Singh, Prof Department of Community Medicine PGI said, “The Government has made very good effort to tackle maternal mortality rate (MMR) and child mortality (CMR) in rural and urban areas, but still lot of work is needed to tackle the problem in the migrant workers’ population and especially among the workers dwelling in urban slums.”
Prabhawati is not the only one who has suffered this fate. There are many women residing in different colonies clustered around the city who have met neglect at the hands of the doctors during childbirth. The United Nations has set 2015 as the target year for meeting the millennium development goals, in which controlling MMR and CMR were two major factors. However, a tour around the slums of the city clearly depicts that as a country we are still far from fulfilling them.
In a study done by the department of community medicine PGI, titled Reproductive and Child Health Inequities in Chandigarh Union Territory of India, it was concluded that Reproductive and child health inequity exist in the Chandigarh Union Territory alongside the social and environmental inequity.
Maternal and child health coverage indicators were poor in slums as compared to urban and rural areas. After the study it was suggested that steps should be taken to breach this gap but not much has been done till date. The situation of construction workers, around the city is also not better. There are many migrant labourers who work at real estate sights at Zirakpur, Dera Bassi and Mohali. Most of the females who are in their reproductive age complained that they are not treated well when they visit Government hospitals.
A study undertaken by Manmeet Kaur of PGI shows that 54 percent migrant workers visit a government maternity facility as compared to only 20.6 per cent locals in their first trimester of pregnancy. But only 18 per cent migrant workers visit a government hospital as compared to 44 per cent locals more than four times during the course of their pregnancy. The study is still going on, but a look at the data clearly suggests that there is some anomaly that stops migrants from visiting Government hospitals during the course of pregnancy.
If Prabhawati is to be believed then it is the behavior of the health workers that prevent them from going to a government hospital after their visit during the first trimester of pregnancy. Similar tale of sorrow was narrated by Viva who was pregnant for the second time and when she reached the hospital, she was welcomed with scorn from the health workers attending on her.
“I was neglected by them, every time I visited the hospital. Some of the ladies even called me names. It was in August last year, when I started bleeding profusely and was rushed to a hospital. No one attended me for a very long time. Then they referred me to another hospital, where the foetus was removed through surgery. When I asked the doctor about the reason of the abortion, he shouted back at me by saying that when I was having complications, I should have visited a hospital earlier.”
This has been a common household story in most of the slums, in the city which has three topmost Government hospitals. But still only 15 per cent of migrant workers go for institutional deliveries and 18.5 per cent are attended by a trained midwife during deliveries. Rest 66.5 per cent are home deliveries which are assisted by midwives with almost little or no experience.
“Health workers are doing there job but one cannot rubbish all the claims of neglect,” said Dr Amarjeet. He added, “It is not always the fault of the health worker but at times slum dwellers are also at fault. Though in many cases I have seen that, to enhance the performance of their designated area in terms of MMR and CMR many health workers tend to neglect the migrant population.”
Also migrant workers have lesser community support. According to a PGI study published on January 16, 2008, only a few urban schemes have been implemented so far to meet the health care demands of the migrant population. These include the Urban Family Welfare Scheme, Urban Revamping Scheme, and Post Partum Centres. Recently, India Population Projects funded by the World Bank have attempted to provide health care services to the urban poor in the mega cities like Delhi, Mumbai, and Chennai.
However, coverage of these schemes has been far from complete and marked inequities in health still continue, as is also evident from better maternal and child health indicators in urban and rural area in comparison to the slums in Chandigarh UT. Not much has changed since 2008 and the one who have been wielding the dream homes for the social elite are lost in the oblivion of poor healthcare facilities.