Urban poverty and malnutrition increase in Madhya Pradesh

Malnutrition in Madhya Pradesh is much higher than the national averages for India. And MP’s urban poor are worst-affected. This is the first in a series of articles, researched as part of the Infochange Media Fellowships 2009, that analyse the food security of the urban poor who reside in the slums of Bhopal.

The state of Madhya Pradesh has seen rapid urbanisation in the past two decades. The lack of livelihood opportunities, especially in sectors like agriculture, coupled with restrictions imposed on the use of forests, has resulted in the migration of the poor from rural areas to cities.

Urban areas have come to symbolise, and apparently seem to provide, better income and employment opportunities. However, the people who move in to access these opportunities tend to remain on the socio-economic margins, struggling to meet the most basic requirements of life and livelihood. One of the most intense struggles is for food. In recent times there has been some attempt to highlight the extent of malnutrition among the poor, but the focus has largely been on rural areas. The urban situation remains under-explored, but it is very relevant particularly in the context of the food security legislation the government is poised to introduce.

Bhopal, capital of Madhya Pradesh

Madhya Pradesh was formed in 1956 with Bhopal as its capital. From the time of its formation Bhopal has been predominantly urban. There are two occurrences in the more recent history of Bhopal which have ensured that it is remembered in history. The first was the century-long reign by Muslim women rulers, from 1819 to 1926. The foundation of the city was laid and developed during their reign. After independence, this older part of Bhopal has been neglected as almost all economic and infrastructural development and geographic spread shifted to the newer parts of the city.

The second event of importance was the dark tragedy that resulted from a leak of toxic gas from the Union Carbide factory in 1984, killing thousands and disabling several more. It has been designated one of the worst industrial disasters in the history of the world. As horrific as the disaster itself has been the 25-year-long struggle for justice that the people affected by the poisonous fumes have been forced to wage. Punitive action against the company and adequate compensation and health measures for the affected are still elusive. Population growth rates in the city were affected by the gas disaster but there has been a steady increase over the past decade reflecting trends similar to those at the national level.

An analysis of population growth trends recorded in the national census between 1991 and 2001 shows that the annual average growth rate of the country was 2%, that of its urban population 3%, while the slum population rose by 5-6% with more that 90 million people living in urban poor settlements. Most development professionals consider the census estimates extremely conservative, but even going by these estimates, the urban poor population in the next couple of decades would reach 200 million.

In Bhopal in recent times, a large number of settlements have come up on the periphery of the main slums and on the outskirts of the city. According to the Planning Commission, more than 42% of the urban population of Madhya Pradesh is designated Below Poverty Line (BPL), compared to 37% in rural areas. It must also be noted that urban poverty has actually increased in the five-year period between 2000 and 2005. Further, the nutritional status of people in urban areas by and large presents a dismal picture. According to the National Sample Survey (NSS) 61st round report, 70.1% of persons in urban areas of the country consume below the NSS intake calorie norm when compared to 61.3% of their rural counterparts.

According to the Census of India 2001, Bhopal has a population of approximately 14.34 lakh. Estimates show that more than one-third of this population is poor. According to a Situational Analysis of Poverty Pockets in Bhopal carried out by Water Aid, UN Habitat and Bhopal Municipal Corporation in 2006, Bhopal has a slum population of 1,28,170 households living in 380 slums. According to the Directorate of Food and Civil Supplies, Government of Madhya Pradesh, 1,22,076 families were issued BPL cards in keeping with their economic status in the year 1997-98. The average size of households in Bhopal city was 5.2 (Census 2001), putting the slum population at over 6 lakh according to either of the above estimates.

Nutritional status of the urban poor

The urban poor comprise a large segment of the urban population and their nutritional status is much worse than their richer counterparts. The disparity between the income levels of different socio-economic groups is so vast that an average would actually run the danger of under-reporting malnutrition. Secondly, in most urban surveys smaller slums and settlement clusters tend to get left out of the sampling owing to their unrecognised status, unless specifically targeted. It is these settlements that constitute the most vulnerable and poor populations of urban areas. In the few studies that have attempted to study the urban poor, it is evident that the nutritional status of people living here is as bad – if not worse – than the rural average. The same is apparent in comparisons based on states, gender, age and social groups within the urban population.

It must be noted that nutritional status in urban areas is closely linked to affordability of nutritious food, access to it and its timely consumption, and this varies according to income levels, gender and social groups. When we look at the urban areas it becomes relevant to segregate populations along these parameters to understand the actual magnitude of variation. In a reanalysis of the National Family Health Survey data (NFHS) of 1998-99, based on the Standard of Living Index it was found that at least 7 out of 10 children belonging to socio-economically deprived populations in urban Madhya Pradesh were underweight for age; about 6 of 10 children were undernourished and over 88% are anaemic.

Another factor relevant to malnutrition is its invisibility. This is both by virtue of the manifestations that go undetected as well as the population cohort that most suffers from it – women and children.

A leading indicator of a country’s health is the nutritional status of its population. Malnourishment in children and women is a major determinant of mortality and morbidity. It is important to remember that the body’s resistance to disease can be effectively developed through adequate nutrition. Food insecurity is an aspect of urban poverty spread across all people living in the slums of Bhopal, irrespective of their work or community. As in other cities of the country, there are many variations in the living conditions, facilities, social grouping, economic capacities, and access to education and health services.

According to the third NFHS (2005-06), Madhya Pradesh is one of the poorest performing states in the country with regard to the nutritional status of its urban children who are under five years of age. In almost all aspects of malnutrition they fare far worse than the national averages.

In nutritional anthropometry, underweight for age indicates long- and short-term nutritional status. One-third of urban children in India (33%) suffer from this condition. In urban Madhya Pradesh more than half (51%) are underweight. The percentage of children among the urban poor would be far more. Even if we were to consider just this average, it is still very high. Though the number of underweight children may have reduced over the past five years in most states, what is troubling for states like Madhya Pradesh is that this percentage has actually increased.

In India, the percentage of urban children under age five whose height-for-age (stunting) is less than normal is as high as 40%, and 17% are wasted. Stunting is used as an indicator of long-term nutritional status, and acute short-term undernutrition is indicated by the weight for height (wasting) criterion. In urban Madhya Pradesh over 44% of children under age five are stunted, or too short for their age and 32% are wasted, or too thin for their height, which may result from inadequate recent food intake or a recent illness.

Prevalence of anaemia is another important indicator of deprivation of important nutrients in food intake. At a young age anaemia results in a negative impact on various aspects of cognitive, behavioural and motor development in children. It also increases their susceptibility to infectious diseases. The level of anaemia among urban children between 6 to 59 months is a serious cause for concern. In India, 63% of urban children are anaemic while in urban Madhya Pradesh 69% suffer from some form of anaemia of which 27.5% are mildly anaemic (10.0-10.9 g/dl), 37% are moderately anaemic (7.0-9.9 g/dl), and 4% are severely anaemic (less than 7.0 g/dl). Data from the third NFHS with regard to prevalence of anaemia among urban women falling in the age-group 15 to 49 years shows that at least 51% of women are anaemic. Compared to this, 47% of women in urban Madhya Pradesh have anaemia and this too is quite high.

The Sample Registration System is a large-scale demographic survey which provides estimates of Infant Mortality Rate in the country and its states. In 2004 urban India is estimated to have had an IMR of 40 deaths per 1,000 live births. In Madhya Pradesh the IMR was one of the highest in the country at 56, second only to Orissa where 58 children out of every 1,000 below the age of one year died.

The lack of adequate nutrition and food security is affected by a number of factors. The issues of availability, access, distribution, consumption and food preference have distinct and different qualitative dimensions in the city and a study and analysis of these is critical to understand the situation, impact, and any planned intervention. In order to understand and highlight issues of nutrition and food security among the urban poor, three bastis or slums in Bhopal have been studied in some detail. These are Ganga Nagar, Gautam Nagar and Indra Nagar. The first two are large heterogeneous, regularised slums and the last is a small homogeneous settlement of about 60 households residing on a private plot. Besides this, in order to build an understanding about the problems faced by people whose bastis have been relocated, experiences from two other bastis – Banjara and Gehu Kheda – have also been recorded.

Bhopal’s slums

Ganga Nagar is located in the Kotra Sultanabad area of Bhopal. It is a large heterogeneous slum consisting of approximately 600 households. Located on the periphery is a small pocket of about 120 Gond adivasi households who settled here about 30 years ago. The people from this community are daily wage earners and perhaps the most marginalised in the slum. Till recently they felt diffident even in accessing the toilet located in the neighbouring lane due to the discriminatory remarks and treatment by their neighbours and the service providers. Some of them still have a problem understanding and conversing in Hindi, the language widely used in most government offices and for any official work. It was only 12 years ago that children from the cluster began formal learning at an alternative learning centre run by an NGO. In this cluster all households have Antyodaya cards (meant for the poorest families).

In the Gautam Nagar area of Bhopal is a small basti of about 50-60 households of the Ojha (Gond) adivasi community who have settled on a small private plot of land of about 2,500-3,000 square feet. This basti is one of the most vulnerable in terms of access to any government service or basic amenity like drinking water, sanitation, housing and food security. All the houses in this slum are kachcha or rough, temporary structures. The members of this community came to Bhopal from Betul when restrictions on the use of forests were imposed. Traditionally, they were bards and storytellers who travelled and narrated stories and performed their folk songs at weddings or special occasions in different villages. They also collected and gathered forest produce. In Bhopal they mostly pick scrap and ask for money for a living. In this cluster some households do not have ration cards. The rest have Antyodaya cards.

Indra Nagar is a large heterogeneous basti of about 1,300 households. Among the various communities living here is a cluster of about 60 households belonging to other backward castes that moved here from Khandwa over time when their small land holdings were no longer able to sustain them. All the women belonging to this cluster are domestic workers in the city and have fairly regular incomes. The men are either self-employed, selling plastic ware on thelas, or take up painting, small engineering and repair work. Their income is more erratic. Several of the men do not work. Over 90% of the houses in this cluster are pucca (finished, permanent structures) and have access to most basic amenities. Most of the houses use LPG for cooking. In this cluster all the households have BPL cards.

This study has been enriched by experiences and conversation with several of the people residing in all the abovementioned bastis. An attempt was made to include experiences of the urban poor from diverse socio-cultural backgrounds engaged in different livelihoods to understand how these affect their access to nutrition and food security.

The findings of the study and an analysis of issues pertaining to urban areas in general and to specific communities in particular have been presented in the articles to follow. In-depth interviews, observation, discussions and conversations were held with members of the communities to determine the factors that affect availability, access, provisioning and consumption of food. An attempt has also been made to evaluate government policies related to food and nutrition from the perspective of the community, and build a critique of the interventions constructed at the national and international level, the impact and price of which is paid directly by them.