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A study on women’s healthcare practice in urban slums: Indian scenario

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DOI: 10.1097/01.EBX.0000456499.60072.56

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 Original article 201

A study on women’s healthcare practice in urban slums:

Indian scenario
Sribas Goswami

Department of Sociology, Serampore College, Objective

Hooghly, West Bengal, India
Correspondence to Sribas Goswami, PhD, Department
of Sociology, Serampore College, Hooghly, West
Bengal 712201, India
Tel: + 91 943 454 5330; fax: + 91 332 652 9489;
e-mail: sribasgoswami@gmail.com
Received 15 May 2014
Accepted 13 October 2014
Evidence Based Women’s Health Journal
2014, 4:201–207
The aim of this study was to examine the factors that affect the health of women in the
slums of Raipur city.
Study design
This study involved a field-based empirical quantitative analysis.
Methods
Information about different levels of socioeconomic development and various
dimensions of the health conditions of women was collected from the participants
of slums in Raipur city, from 300 families across four slums. This study was based on
a microlevel survey, and information was collected through a structured interview
schedule.
Results
Social, economic, spatial, and cultural factors together determine the healthcare
behavior of women in slum areas. In the surveyed area, 31.33% of women breastfed
their children 1 day after delivery, 31% of women respondents purchased medicines
from local unrecognized shops, 6.67% of infant mortality cases have been reported,
and 32.33% of women used sterilization method to control reproductive health.
Conclusion
We suspect that there is an untapped demand for clean, habitable, and decent living
conditions among the slum dwellers that can positively impact women’s health.
Mentally and physically challenged girls are the worst victims of our social system;
thus, their condition is miserable in the surroundings they live. Therefore, girls in slums
need the urgent attention of their pathfinder.

Keywords:
breastfeeding, colostrums, contraceptive, immunization, malnutrition

Evid Based Women Health J 4:201–207

& 2014 Evidence Based Women’s Health Journal
2090-7265

of health services, traditional customs, sex status, etc.,

Introduction
which influence the use of reproductive health services.
Health is a major economic issue for slum residents,
However, the major limitation of most of these studies is
particularly for women. The unhealthy physical environ-
that they have been confined to specific cities, and
ment leads to sickness, demanding medical treatment,
therefore the findings cannot be generalized. The growth
which results in the reduction of workdays, followed by
of slum areas and the concentration of poor people in the
economic loss. Economic loss leads to inability to invest
slums is a rather depressing aspect of urbanization. The
in a clean environment. The vicious cycle continues.
majority of women slum dwellers belong to the lower
Slums have frequently been conceptualized as social
socioeconomic class and have migrated to the city with
clusters that produce a distinct set of health problems.
the hope of better means of livelihood. Having basically
The poor environmental condition coupled with high
low education, skill, and work experience, they have no
population density makes them a major reservoir for a
choice in the competitive job market and pick up low-
wide spectrum of adverse health conditions such as
paid jobs such as construction laborer, domestic servants,
undernutrition, delivery-related complications, postpar-
casual factory workers, and petty trading business. With
tum morbidity, etc. In India, there have been limited
their meager income, they are forced to live in slum areas
efforts to study the health of individuals, especially
in the most unsanitary and unhygienic conditions,
women living in slums. Of the few studies that exist,
carrying out their existence with the barest necessities
most have reported considerable differences in the
of life. Even if people have some money, they do not
situation of reproductive and women’s health between
invest it in home improvement because of the temporary
slum and nonslum areas.
status of their residence or because of illegal occupation
These disparities are probably the outcome of factors of public lands and the constant threat of eviction.
such as employment patterns, literacy levels, availability Therefore, the housing of the slum dwellers is of lower
2090-7265 & 2014 Evidence Based Women’s Health Journal DOI: 10.1097/01.EBX.0000456499.60072.56

Copyright © Evidence Based Women's Health Journal. Unauthorized reproduction of this article is prohibited.
 202 Evidence Based Women’s Health Journal
quality. Poor housing conditions, overcrowded environ-
ment, poor sanitation, occupational hazards, group
rivalries and clashes, stressful conditions together with
lack of open space for women’s recreation, etc. are
detrimental to the health of people in the slums. An
overview of women’s and children’s health status presents
a somber picture. Worldwide, death and illnesses are
highest among poor women, particularly among women in
developing countries [1]. In addition to the suffering of
women, yet another cause of concern is their almost
apathetic attitude towards their own health and its
management during illness. Women were found to seek
treatment only when their health problem caused great
physical discomfort or when it affected their work
performance. The situation with respect to women’s
and children’s health in the urban slums is not different,
rather their health is neglected the most. Insecurity
related to regular income, food, shelter, access to
healthcare, and other essential services, along with
poverty and difficult physical and social environments,
such as exploitation and abuse in the treatment of
women, have an adverse impact on the health of the
urban poor women [2].
Low education and ignorance of women lead to continua-
tion of wrong beliefs and unscientific attitudes toward
health. The outcome is incomplete immunization, insuffi-
cient gynecological checkup during pregnancy, unsafe
deliveries at home, and improper postnatal care of mothers
and children, especially in terms of diet and immunization.
Incomplete tuberculosis and malaria treatment leads to
recurrences and relapses. The unhealthy and polluted
environment, lack of immunization, malnutrition, and
absence of educational exposure affect children in slums.
Sadly, their physical, emotional, and intellectual growth is
stunted from a very early age. Access to community
facilities and health centers in these settlements is limited
and not adequate. Across all surveyed slums, it was found
that the health centers are not adequately equipped with
medicines and that the households have to procure
medicines from the open market. These health centers
are also not equipped to provide antenatal and postnatal
care. To overcome health problems, the corporation runs
three maternity hospitals: one government hospital and
several health centers located at various places in Raipur.
The corporation has also started reproductive and women’s
health project and it is being implemented through
nongovernmental organizations. With their participation,
many urban health centers have been established to
provide better health services to the women and children,
particularly in slums and the surrounding areas. There are
also government dispensaries that are visited by the poor.
There is a need to strengthen health infrastructure,
ensuring food and nutritional security; however, the
measures taken toward this end are not enough. There is
far too much vulnerability in the lives of the poor and those
just above the poverty line. Around 93% of our labor forces
work in the informal sector, without any form of social
protection, especially against old age [3]. Moreover,
vulnerability with respect to women’s health arises from
the underfunding of the public health system and its
Copyright © Evidence Based Women's Health Journal. Unauthorized reproduction of this article is prohibited.
inability to provide comprehensive care, which is a major
concern for the majority of the population. In India, the
public healthcare system has focused primarily on rural
areas. With the rapid urbanization that India has witnessed
over the past decades, the public health problems in the
country are increasingly assuming an urban dimension. This
is especially true for the estimated one-fourth of the urban
population who live in slums. There are growing indications
that this segment of urban India is more disadvantaged in
various aspects of health and well-being [4]. Low and
stagnating incomes among poor women have meant that
low purchasing power remains a serious constraint to
household food and nutritional security, even if food
production picks up as a result of interventions in the
creation of urban women lives in slums.
Objectives
The present study mainly focuses on the several aspects
of slum development in Raipur city. The following
objectives were framed for the present study:
(1) To examine the demographic characteristics of slum
dwellers.
(2) To know the living conditions available for women
in the slum areas.
(3) To study the health and nutrition level of women
slum dwellers.
(4) To explore the use of contraceptive by women
in slums.
(5) To see the various policy measures and programs
initiated by the government for women.
Methods
Sampling of the respondents
For the present study it was decided to use the purposive
sampling method to choose respondents from Raipur city
slums in India. Purposive sampling may involve studying
the entire population of some limited group or a subset of
a population. Here the sample size was 300 women from
four slums: 95 women were from Gandhinagar, 88 from
Moulipara, 100 from Kushalpur, and 17 from Kota Basti,
proportionately distributed. For the present study 10% of
the total number of families in each selected slum area
were taken. Ten percent of the total family size was 95.7
for Gandhinagar, 87.8 for Moulipara, 100.3 for Kushalpur,
and 16.6 for Kota. However, the figures have been
rounded off for the sake of convenience for calculation.
All individuals selected in the sample were asked to
provide informed voluntary consent.
Sources of data and technique
The data were collected from secondary and primary
sources.
(1) Secondary sources: Information was collected and
compiled from books, reports, published and
 Women’s healthcare practice in urban slums Goswami 203

Table 1 Practices of breastfeeding after the birth of child

Total [N (%)]

Name of slums Within 1 h Above 1–12 h Within a day Above 1 day Total number of respondents [n (%)]

Kota Basti 2 (11.77) 4 (23.53) 6 (35.29) 5 (29.41) 17 (100)

Kushalpur 17 (17.00) 28 (28.00) 12 (12.00) 43 (43.00) 100 (100)
Gandhinagar 7 (7.37) 18 (18.95) 37 (38.95) 33 (34.73) 95 (100)
Moulipara 12 (13.64) 27 (30.68) 36 (40.91) 13 (14.77) 88 (100)
Total 38 (12.67) 77 (25.67) 91 (30.33) 94 (31.33) 300 (100)
Source: personal survey (2013).

Table 2 Healthcare status of women slum dwellers in Raipur city

Categories of
people Nature of health problems Treatment sought Probable causes

Adult women Ear bleeding Private doctors Do not know

Weak eyesight (irritation/watery eyes) None Work related – fine embroidery work
White discharge Medication RTI infection –complication in pre–postpregnancy
stage
Reproductive tract infection/urinary tract Medication Lack of bathing units and toilets for daily use
infection
Acute tiredness Standard pain killers Inadequate food intake/long working hours/heavy work
load
Rheumatism Medication Inadequate nutrition – vitamin and mineral deficiency
Female child Indigestion Private doctors (quacks) Weak immune systems
Malaria (dengue) Government hospitals/ Open garbage dumps/dirty open drains/stagnant
clinics water holes
Weakness/fainting None Inadequate food intake
Period pains Medication Natural
Tiredness None Heavy school/work load
Tuberculosis Government hospital Hereditary – weak immune systems
Indigestion Private doctors (quacks) Seasonal
Leukoderma Government hospital Skin disorder
Conjunctivitis Private doctors (quacks) Seasonal infections
Source: personal survey (2013).
RTI, respiratory tract infection.

unpublished papers, municipal records, and govern-
ment circulars.
(2) Primary sources: The primary source of data were
interviews from the field with respondents, word
counselors, and slum leaders, conducted to elicit
their opinions and experiences in slum life, with the
help of an interview schedule. This interview
schedule included all dimensions of the study and
was a combination of structured and unstructured
questions.
Results and discussions
Healthcare conditions of women in slums
Exclusive breastfeeding is recommended as the optimum
method of feeding for the first 6 months of life to meet
the physiological requirements of the infants. It has been
reported from the study that the practices of early
introduction of breastfeeding and late introduction of
semisolids are widely prevalent, more so in slum areas [5].
However, our study reveals a serious erosion of breast-
feeding practices (Table 1). The use of prelacteal feeds is
almost universal; the use of feeding bottles, animal milk,
and commercial milk formulae is very common [6]. It has
also been found that the introduction of complementary
foods is markedly delayed with this background.
The study was conducted to assess the breastfeeding
practices for children in slums and determine the factors
influencing it, if any. An overall 12.67% of mothers had
given colostrums within 1 h, 25.67% had breastfed their
children after 1 h but before 12 h of birth, 30.33% had
breastfed within the day, and 31.33% breastfed after 1
day. In Kushalpur and Gandhinagar slums, the majority of
respondents admitted that they breastfed their children
after a day. Mothers’ milk is very vital for the new-born
baby and new-borns should be breastfed as soon as
possible after birth.
Table 2 shows that men in slum areas have problems
related to chest pain, headaches, abdomen pain, etc. due
to smoking habits or consumption of alcohol and avail
medical facilities from government as well as private
hospitals for these conditions. As regards women in the
slum areas, they suffered from joint pains, mental stress,
white discharge, acute tiredness, etc., and most cases
were dealt through self-medication. The causes of these
health problems are generally overwork, inadequate food
intake, overall living conditions, etc. [7]. As regards girls
and boys, they suffered mainly from indigestion, cough,
fever, conjunctivitis, weakness, etc. and were often
treated by quack or home remedies.
The study shows that slum dwellers often neglect minor
sicknesses and do not consult a doctor for a remedial cure
unless they fall ill [8]. In this situation it becomes

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 204 Evidence Based Women’s Health Journal

Table 3 Action taken during minor sickness by women

N (%)

Consult registered Consult nonregistered Self-

Names of the slum doctor doctor prescribed Did not take any action Total number of respondents

Kota Basti 8 (47.06) 7 (41.18) 1 (5.88) 1 (5.88) 17 (100)

Kushalpur 65 (65.00) 25 (25.00) 7 (7.00) 3 (3.00) 100 (100)
Gandhinagar 65 (68.42) 8 (8.42) 21 (22.11) 1 (1.05) 95 (100)
Moulipara 34 (38.64) 16 (18.18) 38 (43.18) – 88 (100)
Total 172 (57.33) 56 (18.67) 67 (22.33) 5 (1.67) 300 (100)
Source: personal survey (2013).

Table 4 Source of medicines

N (%)

Names of the slum Medicine center Local grocery/shop Other place Total number of respondents

Kota Basti 13 (76.47) 3 (17.65) 1 (5.88) 17 (100)

Kushalpur 80 (80.00) 20 (20.00) – 100 (100)
Gandhinagar 63 (66.32) 32 (33.68) – 95 (100)
Moulipara 50 (56.82) 38 (43.18) – 88 (100)
Total 206 (68.67) 93 (31.00) 1 (0.33) 300 (100)
Source: personal survey (2013).

imperative to know the medical practices of slum
dwellers of Raipur city. In the surveyed population
(Table 3), 57.33% of respondents said that they consult
a doctor. Government hospitals provide comparatively
cheaper treatment. Some of them (18.67%) consult the
local doctor or quack. The most dangerous practice was
self-prescription; 22.33% respondents self-prescribed
medicines without proper knowledge. An overall 1.67%
people have said that they do not take any medicine for
minor cases. Many people in Moulipara and Gandhinagar
practice this. Often, people neglect minor sicknesses in
slum areas, which is evident in the data given in the table,
in which Kota Basti has ranked first. In slum areas local
doctors such as those having a registered medical
practice, or quacks, operate. They often take advantage
of the ignorance of slum dwellers, which is also evident in
the Table 3. Such cases are common in Kota Basti.
Another most important factor indicates the health
concern of slum dwellers, which plays a vital role in
purchasing medicines [9]. Large pharmacies are located
in city hearts. Slums have very few shops and quacks are
indirectly involved with these shops. Only a few low-cost
medicines are generally available here. Medicines are sold
even in grocery stores without having any valid license.
Table 4 shows that 68.67% of respondents buy medicines
from the medical shop; however, 31% of women depend
on the local shop and 33% of women still buy medicines
from the roadsides. A field study revealed that people also
buy medicinal plants (Jaributi) from the local vegetable
market.
Although the informal means of obtaining medicines are
not genuine and safe, people spend money on such
medicines [10]. Local grocery stores preserve medicines
for a longer time period and may have medicines that
have exceeded the date of expiry. These kinds of
ignorance show the worse condition of health and medical
awareness among the slum dwellers, which brings far
reaching consequences.
It is ironically said that good medical treatment is
expensive. Indirectly it indicates to the private institu-
tions providing medical services across the country [11].
It is a fact that good health treatment is still unreachable
to many poor people living in slums. So far the
government hospitals are concerned they have tremen-
dous pressure, patients come from the various places
throughout the state. Here in Raipur, the number of
large/good hospitals is limited. The condition of local
hospitals and dispensary is miserable and are unable to
handle the critical cases due to lack of
infrastructure. Table 5 shows that 77% of women depend
on government hospitals; however, 23% of respondents
have said that they avail the facilities of private
institutions for health treatment. The right to good
health in many cases is unreachable to the urban poor.
The data show that maximum number of people are
dependent on government hospitals and a few among
them can afford private treatment as and when required.
All slums are projecting the same picture in this regard.
Table 6 shows that 14% of women or the partner use
condoms as a contraceptive measure. An overall 32.33% of
women have said that they use either cervical cap or other
traditional methods for contraception. Here it is clear
that the awareness level is yet to improve. Data show that
many people do not bother about the doctor’s reputation.
The study has shown that there are significant differ-
ences in the utilization pattern of reproductive health
services among women in the slum communities. The
findings of this study call for focused and sustained
efforts geared toward the promotion of the use of
reproductive services in the slum communities [12].
A multivariate analysis was conducted to identify the
factors that have an influence on the use of antenatal

Copyright © Evidence Based Women's Health Journal. Unauthorized reproduction of this article is prohibited.
 Women’s healthcare practice in urban slums Goswami 205

Table 5 Preference for medical treatment

N (%)

Names of the slum Government hospital Private treatment Total number of respondents

Kota Basti 15 (88.23) 2 (11.77) 17 (100)

Kushalpur 69 (69.00) 31 (31.00) 100 (100)
Gandhinagar 75 (78.95) 20 (21.05) 95 (100)
Moulipara 72 (81.82) 16 (18.18) 88 (100)
Total 231 (77.00) 69 (23.00) 300 (100)
Source: personal survey (2013).

Table 6 Modern contraceptive methods adopted by women

N (%)

Names of the slum Use of pills Use of condoms Cervical cap/sterilization Total number of respondents

Kota 7 (41.18) 5 (29.41) 5 (29.41) 17 (100)

Kushalpur 59 (59.00) 8 (8.00) 33 (33.00) 100 (100)
Gandhinagar 48 (50.53) 24 (25.26) 23 (24.21) 95 (100)
Moulipara 47 (53.41) 5 (5.68) 36 (40.91) 88 (100)
Total 161 (53.67) 42 (14) 97 (32.33) 300 (100)
Source: personal survey (2013).

Table 7 Infant mortality incidents in the family of the respondents

1 case [N (%)] More than 1 case [N (%)]

Total number of cases Total mortality case Total number of respondent

Names of the slum Male Female Male Female [N (%)] [N (%)] [N (%)]

Kota Basti – 1 (5.88) – – 16 (94.12) 1 (5.88) 17 (100)

Kushalpur 1 (1.33) 3 (3.00) – – 96 (96.00) 4 (4.00) 100 (100)
Gandhinagar 1 (–) 4 (4.21) – – 90 (94.74) 5 (5.26) 95 (100)
Moulipara 4 (4.54) 4 (4.54) 2 (2.27) – 78 (88.64) 10 (11.36) 88 (100)
Total 6 (2.00) 12 (4.00) 2 (0.67) – 280 (93.33) 20 (6.67) 300 (100)
Source: personal survey (2013).

services among slum women. It was also found that less
than half of the women from the slum areas are currently
using any contraceptive methods, and discontinuation
rate was higher among these women. Sterilization was the
most common method of contraception (32.33%).
The use of contraceptives depended on age, level of
education, parity, and knowledge of the contraceptive
method. In Moulipara, almost 40% of people could not
answer the question and in some cases they avoided the
question.
The present study Table 7 shows that in some families
either boys (2%) or girls (4%) died after birth. An overall
67% of respondents have reported more than one infant
death incident, whereas 93.33% of respondents have
reported no such incident. The total number of infant
mortality recorded was 6.67%. Infant mortality is not a
single problem with a single solution. Multiple and inter-
related determinants interact, demanding a chain of
approaches and policies that need to be evolved to deal
with and bring down the mortality rates. Mostly the health
of women and children is often neglected, resulting in poor
health and development. Overpopulation and poverty are
pervasive and cause health hazards such as mortality.
Infants are naturally innocent, vulnerable, and dependent
on their parents’, mainly mother’s, nutrition status and
child feeding practices, and often suffer from viral and
infectious diseases. The smaller number of infant mortality
cases demonstrates a greater level of awareness. It is seen
that among the four slums, Moulipara has the maximum
number of infant mortality cases. However, the overall
scenario is encouraging in this regard.
Sociodemographic factors for healthcare among
women in the slums
In addition, poverty, lack of literacy, widespread ignor-
ance, and the low social status of women result in
malnutrition, low immunization rates, low maternal and
child care, and neglect of health, thus further contribut-
ing to the ill-health of the poor [13]. The problem is
further aggravated by the absence of a user-friendly
healthcare system. Clinics and hospitals are often far from
poor settlements and entail a long and expensive trip.
The hospitals are also often overcrowded and staffed by
unfriendly, unsympathetic doctors. Therefore, despite
good number of highly subsidized government hospitals,
dispensaries, and maternal/child health centers in Raipur,

Copyright © Evidence Based Women's Health Journal. Unauthorized reproduction of this article is prohibited.
 206 Evidence Based Women’s Health Journal
the poor remain unattended and untreated. Most urban
poor women, when they fall ill, prefer to consult a private
practitioner, and, as these doctors charge a heavy fee, the
tendency is to avoid consulting a doctor until the illness
becomes very serious. Housing in slums is a major health
concern because the residents of slums live in over-
crowded situations. One-fourth of the households are
simple one-room structures, a majority of them with dirt
floors and poor ventilation. Such overcrowding can lead to
a rapid spread of respiratory and skin diseases [14]. It is
estimated that over one-third of slum households have no
access to bathroom facilities, promoting open defecation,
which in turn leads to the spread of fecal-oral disease and
parasitic infestation [15]. Awareness regarding health
requires more attention in these areas. Some major
aspects are given for detailed study. It was also found
there was a difference in the two populations based on
the age of marriage and number of living children. Women
from slum areas were more likely to marry before the legal
age of marriage and also had higher number of
children [16].
In the study, it was found that irrespective of the place of
residence, a large proportion of our respondents had the
knowledge of contraceptive methods. However, it was
found that a significantly lower proportion of women
from the slum areas have never used contraceptives.
In fact, it was found that less than half of the women from
the slum areas are currently not using any contraceptive
methods.
Conclusion
Victimization of women is very common in slums and the
usual situation is one of women enduring it. A
Participatory Impact Assessment Study on the status of
women was carried out in the four slums using a number
of Participatory Rapid Assessment/Participatory Analysis
and Learning Methods exercises such as Focus Group
Discussions and Semi-Structured Interviews; before and
after the exercise, social mapping, livelihood analysis,
matrix scoring and cause-effect analysis were performed.
The factors responsible for bringing changes to the lives
of the slum women, which have also affected their status,
are analyzed by the women themselves and this helped
them greatly in becoming independent and further
helped their development. However, according to most
slum dwellers such activities take place in very small
selective areas. There is a need for expanding such
activities. In this context the role of NGOs is very
important.
It is extremely important to invest in more services such
as reorienting and sensitizing doctors/nurses, additional
beds in government hospitals, well-equipped dispen-
saries, and maternity clinics near slums and settlements
inhabited by the poorer sections. For the poor, private
doctors are approachable for small ailments or coughs/
cold, but free services at government hospitals are always
the option in case of severe health problems. Being close
to government hospitals and dispensaries is a positive
Copyright © Evidence Based Women's Health Journal. Unauthorized reproduction of this article is prohibited.
factor, but more information regarding health, reproduc-
tion, availability of better government resources for
illnesses for both men and women need to be appro-
priately addressed. Education can play a vital role in
influencing women’s knowledge about nutrition, hygiene,
and health. Sometimes respondents are found to be
conscious about food habit but cannot afford healthy
food, which is expensive for them. As most slum dwellers
do not own any land and stay in public and private land,
they cannot cultivate food crops and are dependent on
the market price for food. Still many women (33%)
breastfeed after 1 day of the birth of the child. An overall
74% of respondents do not have any complaint against the
quality of the water and 57% of people consult doctor
during minor sickness. Slum dwellers purchase medicines
(68%) from drug stores; 77% of people depend on
government hospitals for treatment. An overall 53% of
slum women use condoms as contraceptive. In slum areas
infant mortality is very low (6.67%). In these slums only
6% of people are found either physically or mentally
challenged. The health-related problems faced by women
in general comprise chest pain, headache, mental stress,
joint pain, fever, cough, conjuctivitis, indigestion, etc.
Sometimes they go to the government hospital and
sometimes to private clinics. An important finding from
the study is the dependence of slum women on the
public health system for reproductive health services.
This is not only encouraging but is also a concern as in
Raipur, it is widely recognized that urban health facilities
are marred by inadequate medical and nonmedical
manpower.
Acknowledgements
Conflicts of interest
There are no conflicts of interest.
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