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Mara D’Angelo: Structural Barriers to Women’s Health: Preventing Infant Mortality in Delhi

April 8, 2010

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The April 7-10 health conference Cities and Women’s Health: Global Perspectives, the 18th Congress of the International Council on Women’s Health Issues, is underway at the University of Pennsylvania. Next American City is hosting a liveblog of the event.

By **Mara D’Angelo**

The concurrent session titled “Structural Barriers to Urban Women’s Health” touched on the influence of economic factors on the plight of street children in Kenya, and Belgian research on the impact of gender relations on contraceptive use rates. But the topic area that generated the most interest from the audience was a presentation about the institutional barriers to hospital care for pregnant women in Delhi.

In Delhi’s urban slums, it is common for women to pay a nominal fee to an untrained birth attendant to assist with delivery. While untrained attendants are often competent with by-the-book deliveries, breach births and other complications are much more likely to result in stillbirths, and women are sometimes offered inappropriate over-the-counter drugs or given poor information about postnatal care that threatens their health.

It is for these reasons that Indian government officials have set a goal of increasing the percentage of hospital births from 40 percent to 80 percent. To help achieve that goal, Delhi has constructed new urban healthcare facilities, and conducted community outreach to encourage urban slum dwellers to use those facilities during delivery. But poor women are facing a variety of barriers to accessing healthcare institutions that must be addressed if the government’s goals are to be realized.

For one thing, initial outreach efforts may have worked a bit too well; Delhian facilities have become overwhelmed and now a full quarter of poor women are turned away from hospitals for a host of reasons, exacerbating a feeling of distrust in slum communities. Difficulties with transportation access, inhospitable hospital staffs and other challenges also abound. Likewise, while the government offers to pay poor pregnant patients between 600 and 1200 rupees to incentivize use of healthcare facilities, impoverished migrant women can’t “prove” that they’re living below the poverty line, or even that they have residency in the city at all, making them ineligible for the benefit.

During the session’s discussion period, audience members from developing countries around the world related similar stories, and offered some solutions, such as: training “patient advocates” who can help poor women understand the processes and rights associated with a hospital visit ahead of time, or working with unskilled birth attendants, who have traditionally been reluctant to lose customers to hospitals, shift to a “birth companion” role, where they help women get to a skilled attendant, and stay to provide comfort to her during the birthing process.

So while infant mortality is undoubtedly a troubling problem in India, today’s session suggests that lessons from elsewhere, and the persistence of practitioners in Delhi, may be the keys to the city’s success.

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This post originally appeared at Next American City.


Mara d'angelo.jpgMara D’Angelo is currently a Policy Analyst with Smart Growth America, a nonprofit advocacy organization dedicated to creating more livable communities. There, she works on urban policy issues including revitalizing older industrial cities, redeveloping vacant properties, and preserving affordable housing. You can read her contributions to SGA’s blog here.

To read more blog entries from others at GUERNICA click HERE .

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