Improving Health Services For Street Chi

Improving Health Services for

Street Children in Mumbai City
The Missing Links

This policy brief is an effort to share the findings of a field study done through community survey,
interviews and group discussions to portray the health issues of street children in Mumbai city. It is
meant mainly for the policy makers i.e. State Government and Municipal Authorities. Academic
institutions working on public health and child rights; and organisations concerned and/or working
with street children will also benefit from the findings of this study.

@ Youth for Unity and Voluntary Action (YUVA)

Any part of this book maybe copied or adapted to meet local needs, without permission from the
authors or publishers, provided the material is distributed on a not-‐for-‐profit basis and the
contributions of the source are acknowledged. For any reproduction done commercially, prior
permission must be obtained from YUVA. We would appreciate being sent a copy of any material
that was used.
Published in January 2010

Improving Health Services for

Street Children in Mumbai City
The Missing Links
Street Children in India
Street children -
Hungry, tired,
Piteous children -
Looking for a place to sleep
Street children -
Roaming the streets at night
Sleeping in barrows and bins,
Longing for a home and a bed
Street children -
Children living in poverty
Eating any scraps,
No one picks and chooses
Street children
- C. Dipanjali, 2nd Grade

(Vidyodaya, India)

ACKNOWLEDGEMENTS

This document would not have been possible without the support of many individuals. We would

like to thank Dr R R Shinde, HOD & Professor and Dr Seema Bansode-‐Gokhe, Professor, of Preventive

and Social Medicine (PSM) Department, Seth GS Medical College & KEM Hospital, Mumbai for
facilitating workshop on street children issues at their department. We also thank the faculty
members of PSM Department of various medical colleges (Nair, Sion and JJ) for providing their
inputs during the participation in the workshops conducted.

We thank Mr. Denny John, Faculty, Institute of Public Health, Bengaluru, for conducting the study,

compiling the report and preparation of this document.

Our special thanks for the volunteers who facilitated and supported to ensure completion of field
study and meetings. We also thank the members who participated and expressed their views during
the interviews and workshops conducted as part of the study. We specially acknowledge the support
of the street children and homeless women who participated in the entire process. Without their
eagerness and enthusiasm the research study would not had been possible.

We are obliged to Dr R D Potdar, Paediatrician, Trustee & Hon Gen Secretary, Centre for Study of
Social Change (CSSC), Mumbai, for providing valuable inputs during the workshop held for discussing
the issues of street children in Mumbai.

We acknowledge the inputs from the staff members of Youth for Unity and Voluntary Action
(YUVA). A special thanks for the administrative department for providing the necessary support.

We would like to thank Novib for funding this study.

Mr K T Suresh, Executive Director
Mrs Arokia Mary, Coordinator (Child Rights)

FOREWORD

The fact that India is home to the world’s largest population of street children, estimated variously
from 10 to 18 million makes the need of such a brief at the present time. This brief was necessary to
highlight the (health) issues of street children since they do not constitute a vote bank; do not get
represented directly nor can they represent indirectly by their parents who most of the time are not

available, or capable.
‘Street children’ is an entity accepted by sociologists and anthropologists to be a socially created
category that in reality does not form a clearly defined, homogeneous population or phenomenon.
‘Street children’ covers children in such a wide variety of circumstances and characteristics that
policy-‐makers and service providers find it difficult to describe and target them. Essentially they are
individual girls and boys of all ages found living and working in public spaces, visible in the great
majority of the world’s urban centers.

The definition of ‘street children’ is contested, but many practitioners and policymakers use
UNICEF’s concept of boys and girls aged under 18 for whom ‘the street’ (including unoccupied
dwellings and vacant lands) has become home and /or their source of livelihood, and who are
inadequately protected or supervised.
Even as street children are subject to substance abuse, theft, commercial or otherwise sexual
exploitation of children, harassment by the city police and railway authorities, as well as physical and
sexual abuse, malnutrition, hunger, health problems, remain a primary concern for people who care.
Poor health is a chronic problem for street children.

Half of all children in India are malnourished, but for street children the proportion could be much
higher. These children are not only underweight, but their growth has often been stunted; for
example, it is very common to mistake a 12 year old for an 8 year old. On the other hand an element
of independence in eating food when available without sharing with the other members in poor
families could make some children better off than their peers in poor families.

Street children live and work amidst trash, animals and open sewers. Not only are they exposed and
susceptible to disease like TB, Measles and Jaundice. A special campaign for vaccination for street
children is necessary. Child labourers suffer from exhaustion, injury, exposure to dangerous
occupational hazardous environment, plus muscle and bone afflictions due to postural reasons.
The rate of HIV/AIDS amongst children is lower, but because street children are far more sexually
active than their Indian peers and because many are even prostitutes they are hugely at risk of
contracting the disease. AIDS awareness, testing and treatment need to be fortified for street
children similar to other vulnerable demographic groups.
Most Government’s programs tend to deal with street children generally involve placing the children
in orphanages, juvenile homes or correctional institutes which can only be a temporary palliative
and not curative solution. The problem of street children needs to be tackled at the source itself.
The present policy brief by Mr. Denny John written for YUVA is not simply an analysis of a survey
done by the author himself but much more. I have no doubt that it will go a long way in advocacy,
motivation and action by its readers.

Dr R D Potdar, Pediatrician & Health Consultant, Mumbai

FEW WORDS....

YUVA as an organisation recognizes the vulnerability of street children. In the initial days the
organisation focused on safety, shelter and welfare; however, now since some of these issues have
been taken up in the main stream, YUVA is now looking at areas which have not yet caught the

attention of the policy makers, such as health, nutrition and social security. As part of this initiative a
research project with support from Institute of Public Health (IPH), Bengaluru, was initiated and the
research activity under the guidance of Mr Denny John, Faculty, IPH, had been carried out. This
policy brief is a result of this research activity.
YUVA’s experience has been that just institutionalizing street children will not rehabilitate and
mainstream them. There is a need to engage in empowerment processes with the children on the
streets to support themselves. This led us to initiate the formation of Self Help Groups with street
children across the city of Mumbai. The discussions with these SHGs (27 of them) health issues were
found to be foremost of the problems mentioned. Over 50% of our interventions through CHILDLINE
have been found to be related to health issues of street children. In the past many of our staffs have
experienced the issue of negligence and lack of cooperation in public hospitals as far as street
children are concerned. We strongly feel that population on the street is on high risk as far as
medical

issues are concerned.
The issue of street child’s health and nutrition requires support from a medley of actors; i.e.
government (municipal and state), public health department, medical colleges, NGOs, general public
and street children themselves. Also, there has been a lack of information of street child’s health
issues, especially as far as health services delivery is concerned. This brief intends to throw some
light on this issue.

Article 24 of The United Nations Convention on the Rights of the Child (1989), which came into force
in September 1990, recognizes the right of the child to the enjoyment of highest attainable standard
of health and to the facilities for the treatment of illness and rehabilitation of health. It also states
that the concern for children in difficult circumstances was no longer a matter of humanitarian and
charitable concern, but s a legal responsibility falling on a state as party to the Convention. Recent
publications concerning street children have explicitly referred to children’s rights and their best
interests as advocated in the Convention. For instance, UNICEF’s Implementation Handbook for the
Convention, which adopted a wider brief, considered those who live and work on the street under
the heading of “children deprived of their family environment” (UNICEF 1998). The Government of
India has ratified the Convention on the Rights of the Child on 12 November 1992. Article 47 of the
Directive Principles of State Policy of the Indian Constitution lays down the “duty of the State to raise the
level of nutrition and the standard of living and to improve public health”.
We hope that the findings and recommendations in this policy brief would find its takers in the
government, NGO and academic circles. We would also welcome any suggestions on the brief and
hope that the readers would be willing to extend their support towards the cause of street children
in Mumbai city.

Mr K T Suresh
Executive Director, YUVA

CONTENTS

Problem -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ 2

YUVA Study -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ 4

Findings

-‐ Street Children -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ 6
-‐ Pregnant Women and Women with Children less than six
years age living on streets -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ 11

Recommendations -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ 14

Conclusions -‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐-‐ 16

PROBLEM

The phenomenon of street children has come into existence because of the interplay between a medley of
factors such as industrialization, migration from rural to urban areas, poverty, a dearth of opportunities for
education, broken families, cruelty and abuse, neglect, natural calamities, etc. All these have led to an
escalation in the number of children running away from their homes or being left to fend for themselves.

DEFINITION OF STREET CHILD

United Nations defines street child as "any girl or boy . . . for whom the street in the widest sense of the
word, including unoccupied dwellings, wasteland, and so on, has become his or her habitual abode and/or
source of livelihood, and who is inadequately protected, supervised, or directed by responsible adults"
(Inter-‐NGO, 1994). Government of India uses the term “working child” as a “street child”. However, UNICEF
(1988) distinguishes between three categories of street children, namely: -‐ 1) Children on the Street; these
children return to their families at the end of their working day; 2) Children of the Street for whom the street
is their home where they seek shelter, livelihood, and companionship and have occasional or rare contacts
with their families;. 3) Abandoned Children are those with no contact with their families. They include
orphans, runaways and lost or destitute children.

STREET CHILD POPULATION

-‐ India has the highest street children population in the world (UNDP, 1993)
-‐ India has nearly 20 million street children (approximately 7% of the child population) (Agrarwal, 1999)
-‐ Estimated that there are 100,000 to 125,000 street children each in Mumbai, Kolkata and Delhi, with
45,000 in Bangalore

There is no authentic data as to the number of street children (MWCD, 2007) as they constitute a floating
population, are neither counted nor subject to census. Rane (1994) based on her study throws a light on the
characteristics of street children in India. The majority of street children are boys (65 to 82%). A large
number of them (40 per cent) belong to the age group of 11-‐15 years, followed by the age group of 6-‐10
years (almost one-‐third of the total street child population).

STREET CHILDREN AND MUMBAI CITY

Most of the children ending up on Mumbai’s streets usually arrive through the crowded thoroughfare of
Mumbai CST, Bombay Central and Dadar Railway Stations. Most children from outside the city also end up in
the bus stations of Thane, and Kalyan. A study by Railway Children, Mumbai, conducted over two days at
Chhatrapati Shivaji Terminus (CST) in 2006 revealed the following that around 221 children live inside and
outside CST station.

Findings of Study done among 1359 street children by Shelter Don Bosco in 2002

-‐ Majority of children come to Mumbai from the West Zone i.e. states of Maharashtra, Gujarat and
Rajasthan; Maharashtra contributing to 49.64% of children (D’Souza Barnabe et al, 2002). Thus it
can be seen that intra-‐state migration is the predominant form of entry for street children in
Mumbai.
-‐ Most street children were found to fall in the 13-‐18 age group category (52.2%), followed by age-‐
group of 9-‐12 years (30.2%).
-‐ Most street children (approximately 34%) have spent around 5-‐10 years (M=7 years) in Mumbai city
streets

WHAT ARE THE FACTORS AFFECTING HEALTH OF STREET CHILDREN?

TYPE OF HAZARDS & FEATURES
RISKS
Health Hazards • Lack of proper nutritional intake of food, oily
food, and stale food resulting in malnourishment,
anemia, jaundice, diarrhoea, physical stunting etc
• Exposed to polluted environment resulting in
skin diseases, malaria, fever, frequent cough and
colds; skin rashes and boils, tuberculosis etc
• Odd and long working hours at young age
resulting in backache, headache etc
• Early pregnancy by several adolescent girls
resulting in poor maternal and neonatal health
Threats to Physical safety • Prone to street fights and bullying from bigger
youth
• Harassed by police and other law enforcers
• Many children sleep atop railway bridges,
pavements etc, making them prone to falling off
or being run over by vehicles
Poor health of street children

Exploitation by Adults • Forced to work, beaten up by own parents
• Victimized by syndicates/police
• Forced by police; sometimes to do work such as
lifting accident victims bodies from roads for
placing them in municipal transport vans
Sexual exploitation and • Street girls are particularly vulnerable to sexual
prostitution exploitation
• Street boys are the preferred victims of foreign
pedophiles and local homosexuals
Sexually Transmitted • Exposed to sexually transmitted diseases through
Diseases and AIDS early and unsafe sexual practices
• Young boys are exploited by pedophiles
• Adolescent boys and girls enter into informal
marriages and have sexual relations
Drug Addiction • Exposed to substance abuse
• Used by drug syndicates as drug runners/carriers
• Children in prostitution are also drug users
Other negative practices and • Create their own norms and speak their own
attitudes language
• Unhygienic living habits such as not having
baths for long periods, wearing dirty clothes, etc
• Early sexual maturity through exposure to blue
films, public display of sexual affection etc.
Threat to emotional well- • Influence of deviant behavior, deprivation of
being basic education, etc may find release in wild and
destructive behavior
• Stress of living in harsh environments may
sometimes result in mental health problems such
as depression, addiction to drugs etc

YUVA STUDY

WHY?

-‐ To understand the social support available to a child on the street.

-‐ To understand the factors affecting health issues of street children.

-‐ To identify the issues related to usage of health facilities by street children.
-‐ To understand obstetric, maternal and child health related issues of
women living on streets.
-‐ To understand the issues of health personnel in public hospitals with
regard to provision of health services to street children

WHERE?

-‐ Interviews with street children and homeless women were conducted
around railway stations in Western, Central and Harbour areas

The rationale was that most street children and homeless women tend to live in
and around railway stations. A YUVA staff who had been on the streets as a child
for many years facilitated the visits to these areas. For interviews with street girls
and women support of a female interviewer were taken.

-‐ Group discussions with selected street children were conducted in a closed
environment (i.e. hall)

This was to ensure that the street children were available throughout the
discussion period.

WHEN?

The entire field study through interviews, observations and group meetings with
street children and homeless women; and experts working with child rights
issues were conducted from the period of December 2007-‐ March 2008.

2 consultative meetings were conducted (one in December 2007 and one in May
2008) with participants from PSM faculty of medical colleges, NGO personnel,
street children, and public health professionals.

WHO?

-‐ Interviews were conducted among 128 street children in and around

various railway stations in Mumbai city

-‐ Interviews were conducted among 33 pregnant women or women with

children less than 6 years of age who were homeless or living on streets

-‐ Meetings with experts working on child rights issues

-‐ Workshops conducted were attended by faculty of PSM departments of

various medical colleges of Mumbai, JAPU, NGO personnel, street

children and public health professionals

-‐ Meetings and observations of CHIDLINE staff (at Central office and NGO

office)

-‐ Meetings with youth who had spent time on streets as a child

WHAT?

Interviews with street children
-‐ Social support available (e.g. family, elder member, friend etc)
-‐ Morbidity episodes in past year
-‐ Usage of health facilities during morbidity episodes
-‐ Support available for usage of hospital facilities
-‐ Experiences at the health facility
-‐ Expenses (including bribes) in public health facility

Interviews with women on streets
-‐ Child age
-‐ Marital status of woman
-‐ Husband/partner support for child rearing expenses
-‐ Usage of health facility for obstetric and maternal care
-‐ Experience and expenses incurred during visit to health facility
-‐ Visits by public health personnel during pregnancy and/or post-‐
pregnancy period

Consultative meeting
-‐ Sharing of field experiences of public hospital staff, NGOs and street
children regarding access in public hospitals
-‐ Suggestions for improving health conditions of street children

FINDINGS

SURVEY AMONG STREET CHILDREN

We interviewed 128 street children in and around railway stations in Western, Central and Harbour lines.

LOCATION OF THE STREET CHILDREN

AGE-‐GROUP OF THE STREET CHILD

-‐ Most of the children found on the streets were in the category of 15-‐18 years. This find is consistent
with other studies (Rane, 2004 & D’souza 2002).
-‐ It is worrying that children less than 6 years of age are found on the streets, of which some of them
were less than 2 years. These could be children who were abandoned by parents or had lost their
parents.
(Kindly note that for children aged less than 6 years the data was collected from the members with
whom the child was residing, such as guardian, older children etc)

LIVING STATUS OF THE STREET CHILD

-‐ Most of the children were found living on the pavements along the streets. These children are
usually on the streets for most part of the day, due to lack of living spaces.
-‐ Almost 25% (n=33) of the children were found living alone on the streets.
-‐ 31% (n=40) of children were living with family members in the city.

LIVING STANDARDS OF THE STREET CHILD

-‐ Only 10% (n= 13) of the street children were found living for most part of the day with some shelter
with NGOs.
-‐ Most of them were found to be living near railway stations. Due to recent crackdowns by Mumbai
Police on living on platforms very few children were found living on railway platforms. But, few
children mentioned that they slept in areas such as near the sea on beaches or under the bridge
exposing them to various hazards.
-‐ For sleeping, most street children preferred areas near the railway stations. Some of them had
access to night shelters run by NGOs. Some street children are used to sleeping under railway
bridges, which could result in deaths or accidents in case the child happens to fall below.
-‐ For bathing and ablution activities, most children mentioned that they frequented railway stations
(such as railway sheds, Shulabh Shauchalayas etc). Very few street children used facilities available
at shelters for such purposes.

UTILIZATION OF HEALTH SERVICES DURING MORBIDITY EPISODE(S) IN PAST 1 YEAR*
*-‐ From date of survey

-‐ Of the 128 street children interviewed for the study, around 98 children mentioned that they had
suffered with some kind of illnesses in the past year. The common illnesses they suffered were fever,
back pain, ear pain, cold, cough, diarrhoea, and breathing problems, with some of them having dog
bites, injury (head and legs), and headaches.
-‐ Of these 98 children, 92 of them visited any type of health facility.
-‐ Only 6 children did not attend any health facility. The higher number of reasons was related to lack
of money to pay for expenses; followed by no elder person to accompany, or receiving no leave from
employer.

MEMBERS ACCOMPANYING STREET CHILD TO HEALTH FACILITY

“Uncle (NGO staff)

Hospital mein le jate
hai phir didi log (NGO
staff) sab karte hai,
phir thik ho jate hai”
-‐ A Street Child

-‐ Significant percentage of street children was accompanied by a NGO member.
-‐ Most street children also mentioned the use of 1098 as a method to receive help from NGOs.
-‐ Most street children had utilized public health facilities; with Nair, Bhabha and Bhagwati Hospitals
being the most frequented.

EXPERIENCES AND EXPENSES AT THE PUBLIC HEALTH FACILITY

-‐ Almost 70 street children mentioned having spent some money during their visit to a public health
facility. Most amounts spent ranged between Rs 55-‐ 300.
-‐ Many of the street children mentioned that they had paid bribes to receive treatment at public
hospitals. All the bribes paid were to lower-‐level staff such as ward-‐boys, ayahs etc.
-‐ Many of the children visiting a health facility were prescribed follow-‐up treatment in form of
laboratory tests, diagnostic tests (X-‐ray, MRI etc), hospitalization and medicines. Some of the
reasons mentioned by street children for discontinuing the follow-‐up treatment were not having
enough money, lack of attention from doctors, uncomfortable in staying in hospital, medicines were
lost and lot of medicines were prescribed.

ISSUES AND EXPECTATIONS FROM PUBLIC HEALTH FACILITIES BY STREET CHILDREN

 Good behaviour from all hospital staff.
 Free medicines and food (including biscuits and milk) to be provided.
 Clothes during stay in the hospital should be given.
 Clear directions to be given while visit to hospital.
 Children with parents are given more attention, and street children are ignored.
 Faster check-‐up, admission and discharge process for all children.
 Extra facilities, such as no queues for street children, should be made available.
 Asking for Bribes for providing special treatment (such as making case paper, jumping OPD
queue etc), should be stopped.

 Creation of a help-‐desk for facilitating the care process at public hospitals through

involvement of JAPU.
 Maintenance of registrar at public hospitals for recording of number of street children
visiting health facility.

ISSUES RELATED TO STREET CHILDREN WITH REGARDS TO ACCESS TO PUBLIC HOSPITALS

a) Difficulty in gaining access to public hospitals-‐ The main reasons are due to:

- Fear of going to hospitals by street children due to their own superstitious beliefs and knowledge
about uncaring attitude of medical personnel from other street peers.

- Lack of availability of adult or NGO member to accompany the child to the hospital.

- Lack of finances to pay for medical services.
- Lack of support from police personnel where NC is needed in case of sick or injured street child
found near railway stations emergency medical admissions.
- Not knowing about the need for health services due to lack of education and familial support.
- On reaching the public hospitals on his own the street child finds it difficult to receive care due to
unfamiliarity of hospital systems and unavailability of hospital personnel support.
- Not allowed leave from employer in case the street child is working.

b) Issues related to care and support within hospital

- Delay in receiving medical attention where there is need for NGO staff intervention for providing
consent for surgical operations on street child.
- Lack of cleanliness and hygiene has prompted many doctors to ask the street child to get bath first
and then receive care. The street child if he feels a bit alright, then he rarely comes back to the
hospital to receive treatment. In certain cases, it was left to accompanying NGO staff to clean up the
child since Class IV staff refused to clean the child.
- Cleaning up of wounds without providing proper counselling or anaesthesia exposes the street child
to pain and suffering. The experience leaves a negative impact and the street child is apprehensive
about receiving care in the future.
- Lack of familial support results in early discharges or treatment on OPD basis which otherwise
warranted further treatment and/or inpatient admission.
- Ill-‐treatment through scolding and/or being beaten by Class IV staff in case the street child soils bed
sheets, vomits, needs commode or support to pass urine or stools, or asks for more milk or food.
When the ill-‐treatment becomes unbearable, the street child at most times runs away from the
hospital, thus being left out of receiving complete treatment.
- Street children have been found to be lying on the hospital floor if hospital bed is needed for other
patients.
- Lack of psycho-‐social support since the street child, unless accompanied by adult or NGO staff, is
alone in the hospital.
- There is lack of knowledge and provision of appropriate care by medical personnel with regards to
most street child being under-‐nourished and need specialized and personal care.

c) Issues after receiving medical care

- If the street child is provided with prescription to buy medicines from outside and the child does not
have money to buy them, in most instances the child forgoes treatment.
- Certain instances where the child has bandages or plaster, there are chances that these can get
soiled and dirty since the street child does not have a place of his own to go back to. This leads to
higher chances of getting infections. This is also due to the fact that there are no after-‐care facilities
in the city to handle such cases where hospital stay is not warranted to receive care.
- The compliance of follow-‐up care by the street child is poor, due to missing on follow-‐up dates,
losing the OPD or discharge card, lack of money, lack of availability of adult or NGO staff, and
previous hospital experiences.

COMMON REASONS WHY STREET CHILDREN DO NOT SEEK HEALTH SERVICES

a) Fear
- Children may not want to appear feeble among their peers.
- They do not trust health and welfare services as they feel that these services are a cover by police or
other government agencies out to put them in remand homes

- Some children who are part of a gang comprising of either adults or older street child, might be

forced not to go to a hospital. These adults or older street children feel that the child might attract
government authorities to their nefarious activities.

b) Low self-‐esteem
- Many of them feel that they will be not be attended by the doctors there. In Mumbai, most children
for minor illnesses tend to use private dispensaries, mostly at times when the dispensaries are
devoid of many patients, so that they can avoid prying eyes of other patients.
- Many of the street children resign themselves to the health condition and may not indulge in any
sort of mechanism to cure themselves, since they feel that the suffering is part of their destiny.
- Most street children for minor cold, fever and cough; and injuries resort to self-‐care, through
purchase of medicines from local dispensary or on advice of their peers.

Report of “CHILDLINE in India-‐ An Analysis of Calls to 1098 (April 2003-‐March 2005)” reveals around
12119 calls comprising 17% of total calls were made for issues related to street child to CHILDLINE, out of
which 5607 calls were for medical assistance comprising of 50% of total calls. The nature of CHILDLINE’s
response to calls for medical assistance range from providing first aid, taking the child to the outpatient
department (OPD) or casualty department and supporting children who require to be admitted into
hospital.

“What would be the value of a 100 rupee note if it was crumbled and
crushed and thrown away? What if it is soiled with mud and dirt? It
would still be the same 100 rupee note. So is the value of a child and a
human being whose worth does not shrink under any circumstances.”
Dr R D Potdar, MD (Paediatrics)
Hon Secretary & Trustee
Centre for Study of Social Change, Mumbai
Workshop Participant

SURVEY AMONG PREGNANT WOMEN or WOMEN WITH CHILDREN LESS

THAN SIX YEARS LIVING ON THE STREETS

A semi-‐structured questionnaire administered by a female trained volunteer was used to elicit the responses
in this study. The study was conducted in and around railway stations of Mumbai city and slum areas (Colaba
and Nariman Point) during Nov-‐Dec 2007.

Number of women interviewed (n) = 33

Age Profile: Age range = 18 years – 28 years
Median age= 22 years
Average age= 22.29 years

GEOGRAPHICAL LOCATION OF RESPONDENTS

MARITAL STATUS OF RESPONDENTS

-‐ 11 women were found to be legally married; of which 2 women did not have their male partners
staying with them
-‐ 25 women were found to be staying with a male partner; of which only 9 women were found to be
legally married

It is quite common that many times the male partner/husband is not found to be staying with them since
these males tend to have multiple partners. Some girls or early youth women also tend to have multiple
male partners.

FINANCIAL SUPPORT FROM PARTNER/HUSBAND

Frequency of financial support

Only 14 women (42.4%) mentioned the financial support to be sufficient for the pregnant woman or for
both mother and child for purchase of food

MATERNAL STATUS OF RESPONDENTS

-‐ 30 women were found to be having children

-‐ 3 women were found to be currently pregnant

Age-‐group of children

ANC CARE DURING PREGNANCY PERIOD

- 23 women (69.69%) had visited health facility during pregnancy for ante-‐natal care
- Most women (n=22) mentioned use of public facility for ANC

Reasons cited by women for not visiting health facility during pregnancy

One of reasons for women not knowing or did not bother for ANC is the fact that only 1 woman mentioned
that she was visited by a health worker (such as Anganwadi worker).It is necessary to conduct frequent
checks by AWW and CHVs in the ward area to know the presence of such women and ensure proper health
education regarding maternal and child health is provided to them.

USE OF HEALTH FACILITY AND EXPENDITURE FOR DELIVERY EXPENSES

27 women mentioned that they had conducted a delivery in the last 2 years.

Type of health facility Number of respondents Average expenditure (in Rs)
Public Facility 24 1459
Private facility 1 10000
Home Delivery 2 400
TOTAL 27 439.22

 Most of the women had utilized public health facility for their delivery. But only 4 women (9%)
mentioned that they were satisfied with services provided in the public health facility
 Lack of BPL cards result in expenses by these women even in a public facility. Home delivery
expenses include payment of dai, material cost etc.
 None of the women mentioned the awareness of JSY scheme. This can be due to the lack of visits by
public health worker during pregnancy period.

 Significant number of women (n=27) mentioned use of savings for financing delivery expenses

followed by contributions from friends/relatives.

EXPECTATIONS FROM GOVERNMENT REGARDING HEALTH SERVICES

RECOMMENDATIONS

The reality of the street child is the vicious face of poverty, sickness and exploitation. The sad thing about
this is that those who bear it are innocent, lonely and frightened young children. Large-‐scale migration of
families from rural to urban areas has resulted in severe overcrowding, degrading work conditions,
homelessness, deprivation of basic services and appalling living conditions in the city. It is quite obvious that
the current system of public healthcare delivery has fallen short of the requirements of these children. Some
of the key recommendations to ensure overcoming these “missing links” are:

SHORT TERM RECOMMENDATIONS

CONDUCT MUMBAI CITY-‐WIDE SURVEYS OF HOMELESS POPULATION, INCLUDING STREET CHILDREN
Government funds from MWCD and Integrated Programme for Street Children can be used for this
purpose. Reputed organisations such as International Institute of Population Sciences (IIPS), Mumbai,
can be contracted to conduct these surveys. It is also necessary to ensure dissemination of survey
results to government, NGOs and general citizens.

PROVISION OF FREE HEALTHCARE SERVICES TO ALL UNACCOMPANIED CHILDREN IN PUBLIC HOSPITALS

In the past attempts were made by NGOs to provide identity cards to street children for improved
access to public hospitals. However, the reach of these cards will be highly inadequate due to limited
number of NGOs working with street children. The fact that most NGOs working with street children are
situated and/or working in South Mumbai areas would leave out the children living on streets in far-‐
flung areas such as Mira-‐Bhayander, Mankhurd etc. The lack of space restricts the safety and availability
of these identity cards at all times by the street children.

LINKAGES TO HEALTH AND NUTRITION SERVICES TO HOMELESS POPULATIONS THROUGH AWW, ANMS AND
CHVS

There has been a very limited coverage of the ICDS programme for homeless women and street
children. The AWW at the Anganwadi Centre and the ANMs and CHVs should ensure periodic surveys
(atleast once a year) to enumerate the number of homeless populations in their area. These
populations being less mobile as compared to street children can be ensured access to anganwadi
services through mobile vans.

ESTABLISHMENT OF KIOSKS AT MAIN RAILWAY STATIONS (CST, DADAR, THANE ETC) AND BUS STATIONS
(BOMBAY CENTRAL, DADAR ETC)

Most children enter Mumbai city through conduits such as railway stations and bus stations. Kiosks can
be established by government in collaboration with police and railway authorities to ensure that such
children are taken into care. These children can be counselled and arranged for repatriation back to
their homes after proper check and meeting with parents. Children unwilling to go back to their homes
should be ensured access to proper shelter facilities run by government or NGOs.

“We do not posses any proof of

identity. What do we do?”
-‐A Street Child

LONG TERM RECOMMENDATIONS

ESTABLISHMENT OF PATIENT FACILITATION CENTRES AT PUBLIC HOSPITALS IN MUMBAI CITY

The visit to a public hospital for a street child or a women living on the streets is a daunting task. The
lack of education and fear make the process of visit to a public hospital a harrowing experience to these
populations. The establishment of patient facilitation centres for these populations (also for general
populations) will ensure timely and proper usage of these facilities.

TRAINING AND SENSITIZATION OF HEALTH PERSONNEL TOWARDS STREET CHILDREN AND HOMELESS
POPULATIONS

The medical and nursing students to be exposed to street child health issues during their formal
training. There can be refresher courses related to street children for all in-‐service personnel (such as
resident doctors, nurses, and Class IV staff).

CONCLUSION
India has made several national commitments towards children by way of constitutional provisions, legislation,
policies and programmes. Article 15 of the Indian Constitution states that “The State shall not discriminate against any
citizen (3) nothing in this article shall prevent the State from making special provision for women and children”;
whereas Article 47 of the Directive Principles of State Policy of the Indian Constitution lays down the “duty of the
State to raise the level of nutrition and the standard of living and to improve public health”. It goes on to add: “The
State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of
public health as among its primary duties”. Article 24 of the Convention on the Rights of the Child underlines the
child’s right to enjoyment of the highest attainable standards of health. The Government of India has ratified the
Convention on the Rights of the Child on 12 November 1992.
The YUVA study has shown that the current public health system in Mumbai city has fallen short to ensure
access and availability of adequate healthcare services to vulnerable populations, such as street children and
homeless populations. Thus, it can be seen that the “right to health” as far as street children and homeless
populations are concerned has not been met.

In the end we would like to highlight some of the issues so that some of them can be taken by the Municipal
and State authorities as points for improvement:

 Conduct Mumbai city-wide surveys of homeless population, including street children
 Provision of free healthcare services to all unaccompanied children in public hospitals
 Linkages to health and nutrition services to homeless populations through AWW, ANMs and CHVs

 Establishment of kiosks at main railway stations (CST, Dadar, Thane etc) and bus stations (Bombay
Central, Dadar etc)

 Establishment of patient facilitation centres at public hospitals in Mumbai city

 Training and sensitization of health personnel towards street children and homeless populations

“I shall give you a talisman. When faced with a

dilemma as to what your next step should be,

remember the most wretched and vulnerable
human being you ever saw. The step you

contemplate should help him!”

Mahatma Gandhi

ABBREVIATIONS

ANM-‐ Auxiliary Nurse and Midwife
AWW-‐ Anganwadi Worker
CHV-‐ Community Health Volunteer
CST-‐ Chattrapati Shivaji Terminus
IIPS-‐ International Institute of Population Sciences
IPH-‐ Institute of Public Health
JAPU-‐ Juvenile Aid Police Unit
MRI-‐ Magnetic Resonance Imaging
MWCD-‐ Ministry of Women and Child Development
NGO-‐ Non Governmental Organisation
OPD-‐ Outpatient Department
PSM-‐ Preventive and Social Medicine
UNDP-‐ United Nations Development Programme
UNICEF-‐ United Nations Children’s Fund
YUVA-‐ Youth for Unity and Voluntary Action

REFERENCES
Agrawal R (1999), Street Children, Shipra Publications, New Delhi
D’Souza B, sdb, Larissa C, Madangopal D (2002), A Demographic Profile of Street Children in Mumbai, Shelter
Don Bosco Research & Documentation Centre, Mumbai
Inter-‐NGO (1994), cited in Swart-‐Kruger & Donald p 108
Ministry of Women and Child Development (2007), National Report on ‘A World Fit for Children’,
Government of India
Rane A & Shroff N (1994), Street Children in India, Emerging Need for Social Work Intervention, in Rane A
(Ed)
UNDP (1993), Human Development Report, Oxford University Press, New York
UNICEF (1988), A Background Paper on Street Children, submitted at National Workshop on Street Children,
29-‐30 Aug, New Delhi

Youth for Unity and Voluntary Action (YUVA) was founded in 1984 as a voluntary

development organisation with a goal to intervene in issues of social justice. Our mission is

to “to empower the oppressed and the marginalized by facilitating their organisations and

institutions towards building equal partnerships in the development process ensuring the

fulfilment of their human right to live in security, peace and dignity.”

We are a registered voluntary development organisation taking up issues of the poor and

the marginalised in urban and rural areas.

We are a non-‐profit making organisation funded by external and Indian funding

organisations as well as Government of India, Government of Maharashtra, other

governmental bodies and UN agencies.

YUVA is accredited as an NGO with General Consultative Status with the United Nations

Economic and Social Council (ECOSOC)

Registered Office: Field Office:
YUVA Centre New Naigaon Municipal School
Plot No 23, Sector 7 Room No 5 & 6
Kharghar Opp Saraswati Vidyalaya
Navi Mumbai-‐410210 Dr Ambedkar Road
Maharashtra (INDIA) Dadar, Mumbai-‐400014
Telefax: 91-‐22-‐27740970/80 Tel: 91-‐22-‐24116393/94
91-‐ 22-‐27740990 91-‐ 22-‐24143498

Email: info@yuvaindia.org Fax: 91-‐22-‐24135314

Website: www.yuvaindia.org

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