According to a new report, ‘The ten and a half myths that may distort the urban policies of governments and international agencies’, this shift in the location of the poor needs to be reflected in how poverty is addressed, since the challenges and difficulties faced by those living in towns and cities are different to those of rural dwellers. For example, as families move away from the ties and community support of rural areas, the safety nets available to the poor are often much weaker. In addition, the access to services may appear to be better in towns and cities, but frequently the quality and availability is extremely uneven.
In Bangladesh, where the urban population increases by around 6% each year, the rapid expansion of slums has resulted in just such a situation. In Dhaka, large slum areas are now home to around two-fifths of the capital’s residents. But because officials refuse to recognise slums as official housing areas, basic facilities like water and electricity are not being extended there. And while an outreach healthcare network is in place across rural regions, the vast majority of Dhaka’s slum dwellers have to rely on services based in the city’s hospitals, which are already struggling to cope with demand.
With the inherent crowding of living conditions in slum areas and the lack of clean water, residents are more prone to the risk of communicable diseases. These urban poor also tend to buy a larger share of their food than rural dwellers, therefore hunger and malnutrition are more of a risk when food prices rise. Speaking to the news agency IRIN, a spokesperson for the local arm of the non-governmental agency BRAC, which runs a health programme in Dhaka’s slums, said “we’re seeing a lot of jaundice from polluted water sources, infants severely affected by poor sanitation and mothers severely malnourished”.
One of the greatest concerns is the lack of antenatal and child healthcare services available to the residents of Dhaka’s slums. Health experts worry that maternal and infant mortality levels may begin to rise again as urbanisation increases. To prevent this from happening, BRAC is providing women in the slums with maternal and newborn healthcare services. There is also a network of 6,000 volunteer healthcare workers who run maternity advice programmes in Korail, one of the capital’s largest slums.
Since its inception in 2007, the BRAC healthcare project has nearly halved the number of maternal deaths among slum patients. However, the organisation acknowledges how the urban environment brings extra challenges and echoes the conclusions of the new urbanisation report – “we will have to adapt...if we’re going to respond to the needs of millions of people”.