India's efforts to increase attended birth rates in urban areas : a bridge too far?

Abstract

Rapid urbanization of India in recent years has increased the wealth of the country and along with it, raised the urban slum population. Slum dwellers typically live below the poverty line and have no or minimal access to clean water, sanitation, education and public health. The urban unattended birth rate is attributable mainly to women in slums in big Indian cities who face many hurdles in accessing public healthcare facilities. To deal with this issue, the government of India initiated the “National Urban Health Mission” (NUHM) in 2013, which focused on the reduction of maternal and infant mortality rate. This program was preceded by the “National Rural Health Mission” (NRHM) in 2005, which was implemented to rural areas of India with similar ideals, and managed to lower maternal and infant mortality rates.

This paper is a critical appraisal of the NUHM scheme by analyzing the achievements, loop holes and setbacks of the previously introduced NRHM upon which the NUHM is based. While the NRHM achieved improvement in attended birth rates, it did not consider various factors that play a key role in the care seeking behavior of women such as maternal education level, social factors and norms. The NUHM also excludes these factors from the scope of the program. The aim of this paper is to analyze the results of the NRHM in assessing whether the NUHM can meet its goals and expectations.

Method: Information was extracted mainly from government of India sources such as District Level Health Surveys 2 and 3 (DLHS-2 and DLHS-3), National Family Health Survey- 3 (NFHS-3) and the Census of India, 2011 until July 2013. Articles were searched from PubMed, Google and Google scholar using the key words unattended birth, skilled birth, India, urban, slum.

Conclusion of Abstract: A unified approach involving the ministry of health, ministry of education and communication and media is needed to deal effectively in implementing the NUHM and sustaining the NRHM.