Meerut City

Expanding Contraceptive Use in Urban UP

Meerut City Profile
Urban Health Initiative (UHI) is implemented by a consortium of partners working together to improve urban health in India. Meerut City is a priority city for urban health investments.

Meerut, the second largest city of the country in terms of urban poor population, is considered the sports capital of Uttar Pradesh. Meerut is located at a distance of 70 kms from Delhi. Meerut is famously associated with the Indian rebellion of 1857 against the British East India Company when chants of popular Hindi slogan "Dilli Chalo" (lets March to Delhi) were first raised here. Meerut is an important education centre for western U.P., catering to the city and the surrounding rural population.
Fig 1: Meerut Location Map

cold with temperatures dipping to 2 C. Meerut receives an average annual rainfall of 768 mm.
Table 1: District level indicators, Meerut Population District* 2,997,361 persons Urban population-District* 1,451,983 persons Slum population-District*** 369,505 persons SC & ST* 552,928 persons TV at home** 57.0 % Mobile Phone ownership** 49.2 %

Indicators based on DLHS-2 and DLHS-3

Indicator Women married <18 yrs Women 20-24 with 2+ births Institutional Births Family planning Use Any method Any modern method Female sterilization Male sterilization IUD Pill Condom Family Planning Unmet need Spacing Limiting Total DLHS-3 Total 10.9 55.3 38.8 49.5 36.6 17.7 0.2 2.5 2.8 13.4 DLHS-2 Total 9.5 27.6 45.0 37.7 18.2 0.1 2.4 3.3 13.4 DLHS-2 Urban

The district of Meerut spans across the coordinates 2898 North latitude to 770 7 East longitude. Meerut borders the districts of Ghaziabad in the south, Baghpat in the west, Muzaffar Nagar in the north and Bijnor and Jyotibaphule Nagar in the east. The city, which is spread over 142 sq km, is a junction of National Highways. By road and rail, Meerut is well-connected to major cities like Delhi, Noida, Hapur, Faridabad, Modinagar, Ghaziabad, Saharanpur, Haridwar, Indore and Jaipur. Meerut has two railway stations Meerut City and Meerut Cantonment. The city is well connected to Delhi, Ghaziabad, Agra, Dehradun and others by train. Some important places of tourist interest in the city include the Jama Masjid constructed in 1019 AD, the Jain temple, St. Johns Church, Augarnath temple, Shaheed Smarak and Company Garden. The climate of Meerut is extreme and tropical. The summers are extremely hot and the maximum temperature goes as high as 45 C, while the winter is

9.1 17.5 26.6

4.6 17.8 22.4

Source: * Census of India, 2001 ** District Level Household Survey-3, 2007-08 *** State Urban Development Authority, 2003-04

City Institutional Structure Meerut City is a Municipal Corporation. It is divided into th 80 wards. As per 2001 census, the city ranks 20 in terms of population and 6th in terms of population nd density in Uttar Pradesh. The city also ranks 2 in terms of population in NCR. Drinking water is mainly arranged by Municipal Corporation of Meerut, UP Housing and Development Board and Meerut Development Authority to the different parts of city. There are 102 tube wells, 20 overhead tanks, and 3 underground water tanks in Meerut city.

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Capacity of 20 overhead tanks is 20,500 KL and capacity of 3 underground water tanks is 16,000 KL. Municipal Corporation of Meerut supplies about 158.5 MLD of water from which only 4.8 MLD is supplied through canal. Water supply is provided in 87 wards of Meerut city covering 471 mohallas. As per the Municipal Corporation of Meerut; a) 230 mohallas have sufficient drinking water, b) 146 mohallas have partial water crisis, c) 95 mohallas have no piped water supply and are dependent on hand pumps and other water sources. These are mainly urban poor habitations. Data from reanalysis of NFHS-3 (UHRC, 2008) for urban low income population of Meerut shows that less than half (47.3 %) of the population has access to piped water supplies at home. Most of the households have toilet facilities with open drains near the settlement. Public toilets have been installed in some of the slums, but their maintenance has been grossly inadequate (e.g. Machheran). They remain in abysmal condition, and may be more unhygienic, in most cases, than open fields.
Fig 2: Meerut City Map

Meerut have resulted in a large slum-dwelling population, with a mixed socio-economic profile. 471,581 persons or 44.1% of Meeruts population resides in 102 l isted urban slums, recognized by the District Urban Development Authority (DUDA). As per UHRCs Meerut situation analysis summary report, 2009, there are 85 unlisted slums in the city as well.
Table 2: Distribution of slum population - Meerut City Slum Category Number Population Listed 102 455,923 Unlisted 85 216,935 Total 187 672,858
Source: Meerut City Situational Analysis, 2009, UHRC.

Most of the slums of Meerut are areas of extreme poverty and severe environmental degradation. These conditions place residents at an aggravated risk of disease and mortality. Where legal or social security is ensured, one also sees improved housing structures and better access to services. Poverty is reflected in the selective access to services and infrastructural facilities. As per NFHS-3, 85.5 % of slum families in the city have access to toilet facility but within the most vulnerable groups most of the toilets are open drain toilets. So far as private water tap connection is concerned, 50% of the slum dwellers have such a facility. Slums vary in several aspects like size, duration of residence, population density, service facilities, employment status, access to Anganwadi centres (AWCs), schooling opportunities, infrastructure and social recognition. These factors impact the quality of life of the residents. From a health perspective, about one-third of the total number of slums could be considered vulnerable. In poor areas, access to health facilities is poor and dependence on local healers is found to be very high. Prevalence of public and private health services (Urban Health Centres, qualified doctors, NGOs and charitable hospitals) within the poor slum population is negligible. As per the data available with DUDA and Municipal Corporation out of 102 listed slums 50.9% slums have piped water supply, 6.8% slums have partial water supply, 15.6% slums have public toilet and most of the slums have tube wells. Majority of the slum population are daily wage earners, with a few engaged in business related activities, i.e., manufacturing of sports goods (cricket bats, wickets, etc.). Most women who work outside home are domestic maids in the surrounding areas. Living conditions vary from illegal settlements with kutcha houses, to low rent dwellings, or owned concrete houses. The slum areas are characterized by high population density and extremely poor sanitation and hygiene conditions. Urban Health Resource Centre conducted a vulnerability study to identify and geographically map, from a health perspective, the vulnerable population in Meerut, and to then identify the key internal and external factors that predispose certain urban populations to vulnerability. Key factors that increase vulnerability, as identified by

Demographic & Social Profile Meerut city, spanning across 335 sq km, has a population of 1,068,772 persons as per 2001 census. Decadal growth rate of Meerut during the last decade was quite high at 42.5%. The population density of the area falling within the Meerut Municipal Corporation is 7532 people per sq/km. As per census 2001 there are 193,000 households and about 15 % of total population is below 6 years of age. Males constitute about 53 % of the population and 47 % are females. The sex ratio of the city is 881, which is quite alarming. The sex ratio for population less than 6 years old is even lower at 861. The literacy rate of Meerut city is also relatively low at 68.0%. Meerut has one of the largest Muslim populations among the districts of India (32.5%). Vulnerable Population Migrations from its vicinity and other states of India to

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slum residents, NGOs, public sector functionaries and other urban stakeholders are: 1. 2. 3. 4. Economic conditions - nature of occupation, unemployment, access to fair credit Social conditions - alcoholism, gender inequities, education, access to facilities Living environment water & drainage systems, sanitation facilities, type of houses Access and usage of public health services Integrated Child Development Scheme (ICDS) & Department of Health and Family Welfare (DHFW) Poor health status and high disease incidence Presence/absence of collective or organized community-based organizations (CBOs)

The population is fast outgrowing the existing health facilities. The heavy workload on the limited outreach staff (predominantly ANMs) results in insufficient contacts or interactions at the community level. Some of the health centres cover over 150,000 population with very minimum staff.
Table 3: Distribution of Health Facilities Type of Facilities Government Health Facilities First Tier (Primary Health Care Facilities) Urban Family Welfare Centre / Urban RCH Health Post Municipal Dispensary Second Tier Facilities District / Joint Hospital District Women Hospital Postpartum Centre Medical College ESI Railway Defence Other public hospitals (Municipal, Police etc.) Private Health Facilities Private for Profit Health Post Clinics Maternity / Nursing Homes NGO/ not for profit/ Charitable Clinics Clinics
Source: Office of Chief Medical Officer, 2009

Number

5. 6.

14 1

Meerut slums are lacking community level processes such as community based organizations. This results in less voices of community among service providers and decision makers. 14 DWACUA (Development of Women and Children of Urban Areas) groups, nurtured by DUDA exist and are mainly engaged in Income Generation Activities (IGA). Apart from this some women groups (Matri Samittee) are also there with ICDS who are mainly assisting AWWs in food distribution. In general, those groups promoted by government agencies have tended not to flourish or to develop a strong independent identity. Health System and Infrastructure Health services in Meerut are provided by the public sector (Department of Health and Family Welfare) and private sector agencies (hospitals, nursing homes and clinics). For MCH services communities prefer to go to private facilities. First Tier facilities Primary health care in the city is provided through 14 first tier centres located in various parts of the city, which include Urban Family Welfare Centres (UFWCs) and Urban RCH Health Posts. Their main job involves OPD Services, ANC registration, ANC check-ups, family welfare services and routine immunization. Second Tier Facilities Medical college hospital, district male and female hospitals play an important role in providing secondary care facilities to the entire district. PL Sharma and Dufferin hospitals are catering to the needs of urban as well as rural population. In addition, the defence and railway hospitals and their network of dispensaries provide services to the city population. Private Health Service Providers Meerut has numerous private clinics, maternity centres, nursing homes and hospitals catering to the health needs of the general population. There are four charitable hospitals, accessed to a large extent by the poor population.

2 1 1 1 1 1 2 5

Utilization of Healthcare by the Urban Poor Different studies conducted by UHRC (such as qualitative survey, nutrition survey, vulnerability study etc) showed that, for outpatient care, most of the patients in urban areas sought treatment from the private/non-government sector, rather than from public hospitals or Primary Health Centres. FGDs with slum dwellers revealed that most illnesses are first reported to local healers and then to private health facilities. Slum residents seek medical care from private practitioners as a result of easier access, availability of credit/instalment payment, seemingly quick cures and personalized treatments. Though there is a high availability and dependence too on the private sector for curative services, women usually prefer charitable hospitals and dispensaries, and they also prefer a female attendant for gynaecological care. Awareness on health care facilities is negligible among the slum dwellers. Health Indicators As per the recent District Level Household and Facility Survey (DLHS-3) 2007 2008, only 36.6% of currently

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married women are using a modern method of contraception. The DLHS 3 estimates unmet family planning need in Meerut at 26.6%, comprised of 9.0% unmet need for spacing methods and 17.5% unmet need for limiting methods. The Ministry of Health and Family Welfare, Family Planning Division has recognized Meerut as a high priority district for family planning program in Uttar Pradesh. Reanalysis of NFHS-3 data (UHRC, 2008) shows a 50.5% usage of modern contraceptive methods among the low SLI (urban poor) group, of which 26.6% utilize permanent sterilization. This would indicate that there is only a minimal effort in delaying the first pregnancy or extending the gap between two successive pregnancies. Discussions in the slums also revealed a lesser acceptance of any temporary birth spacing method (pills, condoms, etc.) which is very much associated with their religious beliefs, especially in the slums of Meerut. It should also be noted that in Muslim communities (who constitute about 80% of the slum population in Meerut) tubectomy/vasectomy is also not considered an option due to strong religious beliefs. Slum health programs in Meerut should therefore consider: Enabling the families to plan and control their number and gap in children by increasing awareness and dispelling myths related to modern contraceptive methods. Ensuring easy availability of contraceptives through a variety of channels while respecting community customs and norms BCC efforts to influence the behaviour of communities in this regard. The situation analysis study by UHRC in Meerut shows that the infant and under-five mortality rates are higher in low income groups. FDGs conducted among slum communities also revealed that pregnant women go to obstetricians or to health workers only when there is an obvious problem such as bleeding and less or no foetus movement. Economic Base Meerut is famous as an industrial city. Being in the proximity of Delhi, it is ideal for industry. Existing industries include textiles, transformers, sugar, distillery, chemicals, pharmaceuticals, engineering, paper, musical instruments and sports goods manufacturing. Meerut is in fact the largest supplier of sports goods. The gold market of Meerut is one of Asias largest and employs over 25,000 skilled craftsmen. Uttar Pradesh State Industries Development Corporation (UPSIDC) already has two industrial estates in Meerut, namely Partapur and Udyog Puram. Mohkampur industrial area is a private initiative. Paschimanchal Vidyut Vitran Nigam Ltd provides unrestricted power supply to these industrial areas. Newer industrial areas are being developed across the district, especially along the DelhiMeerut expressway. Infrastructure in Meerut is developing rapidly, with many road projects and upcoming malls, shopping centres, residential and commercial complexes.

Contributors: Contributors: The Meerut City Profile is an updated version of the original profile published by Urban Health Resource Centre / Environmental Health Project finalized by Siddharth Agarwal, in 2004. Updated information was incorporated by Mukesh Kumar Sharma and Sainath Banerjee. Layout and formatting: Aradhana Srivastava, Madhwaraj Ballal The Meerut City Profile would not have been possible without the significant contribution of Urban Health Resource Centre. Urban Health Initiative is supported by the Bill and Melinda Gates Foundation, and by Family Health International, in collaboration with a consortium of partners committed to improving urban health. The contents of this paper do not necessarily reflect the views and policies of Urban Health Initiative, Family Health International, or Bill and Melinda Gates Foundation.

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