Reproductive Health of Women in Indian Slums:A Study of Slums in District Aligarh Thesis Submitted For the Award of the Degree of Doctor of Philosophy In Women’s Studies By Sameera Khanam Under The Supervision of Prof. Abdul Waheed Centre for Women’s Studies Aligarh Muslim University ALIGARH (INDIA) 2013 ACKNOWLEDGEMENTS I wish to thank many people who made this study an enthralling experience for me. First, I wish to thank Professor Abdul Waheed, my supervisor and mentor. The insight gained during the ‘discourses’ with him is beyond linguistic expressions. I would like to express my deep and sincere thanks to Prof. Shireen Moosvi for her constant encouragement and motivation. I also extend my sincere thanks to Dr. Azra Moosvi, Director, Advance Center for Women’s Studies, AMU, Aligarh for her help and invaluable support to this work. I am also extremely thankful to Prof. Nighat Ahmad for her support. I am also grateful to all my respected teachers at the centre for their constant encouragement, particularly Dr. Shadab Bano and Dr. Aziz Faisal for their thoughtful discussions and suggestions. My special thanks go to Prof. Mohd. Shahid, Dean Faculty of Social Sciences, MANUU Hyderabad who introduced me and drew my interest to the area of reproductive health. I am thankful to him also for his many insightful suggestions, advices and interesting discussions. I would also like to express my heartfelt thanks to Dr. Naseem Ahmed Khan, Chairman Dept. of Social Work, senior colleagues and students of Dept. of Social Work, AMU, Aligarh. My sincere thanks are due to Prof. S. Imtiaz Hasnain, Department of Linguistics and Prof. Shagufta Imtiaz, Women’s College for their genuine concern for my Ph.D. I am also grateful to the staff of Maulana Azad Library, A.M.U; Seminar, Advance Center for Women’s Studies; Seminar of Sociology and Social Work, A.M.U. V I would like to pay my sincere thanks to the staff of Aligarh Municipal Corporation and District Urban Development Authority, Aligarh for providing me the details of the slums in the city. I acknowledge Mr. Shamim, for his warm receptions that I was accorded with on each of my several visits to the Aligarh Municipal Corporation office. My sincere thanks are due to Dr. Kulshreshtra Chief Medical Officer, Aligarh and Dr. S.A Khan, Immunization incharge, Mr. Faiz Medical Social Worker at Malkhan Singh District hospital in reaching out the sites of data collection and Dr. Gyanendra Mishra for helping me at various stages of this research study. My thanks are also due to Mr. Shariq, Mr. Awez, Ms. Nighat, Ms. Samina Mr. Rizwan for their help and concern. I shall always be grateful to my friends Afzal, Idrees, Rifat, Tariq, Shuez and Fatima Apa for helping me at various stages of this study. My heartfelt thanks to all the participants who took part in this study, without them this study would not have been possible. I am indebted to my brother, father and mother-in-law for their compassion and dua. At this point of time I cannot stop thinking about two most important persons in my life my late grandfather and my late mother. They are no more but their encouragement and warmth has always inspired me. Finally, to my husband Syed Ghufran Hashmi, I will always remain grateful for all of his contributions in my studies and for the confidence he kept instilling in me. I am thankful to my wonderful and loving son Ali. This thesis would not have been possible without their support. VI International Conference on Population and Development (ICPD) at Cairo, Egypt (1994) is the paradigm shift that put an end to the demographically driven programs and policies. It has heralded a new dawn of individual and reproductive rights – client-centred, demand driven and target free approach. Later on World Conference on Women at Beijing, China (1995) explicitly recognized and asserted the rights of all women to control all aspects of their health, particularly reproductive health. The unabated growth of urban population in India has caused a huge increase in slum population and forced its inhabitants to live in absence of basic health and civic amenities. As a result people in slums are vulnerable to disease and poor health. Even the government policies and programs tend to neglect the problems of the slum population in India. NFHS 3 (2005-06) in its study of eight cities in India highlighted the differential status of people in slums on almost all the indicators of reproductive health, the situation is particularly disquieting in smaller cities and towns. This implies an urgent need to understand the reproductive health status of women in slums. It is in this background this study aims to analyze the reproductive health status of women in slums. The study has the following objectives. To examine fertility trend of women in slums. To investigate the nature and extent of ante natal care utilisation among women in slums To explore the extent of institutional and home delivery among women in slums. To understand the contraceptive practices among slum dwellers To analyze and assess the influence of socio-economic correlates namely caste, education of women and occupation of the husband on fertility, ante natal care utilisation, child delivery and contraceptive practices of women in slums. 1 Though the study is intended to study slums of Aligarh district but due to unavailability of data on slums of other urban agglomeration in Aligarh district, the study focused on slums of Aligarh city. The study is limited to a sample of 180 households collected from six slums of Aligarh city. In the collection of primary data, both survey method and qualitative techniques like FGDs and case studies are used. The intention was to extend the quantitative data with rich qualitative data. Secondary data is utilized to analyze facts and figures collected from Census and Aligarh Municipal Corporation. The data thus collected are analyzed and inferences are drawn accordingly with the help of percentages and mean averages, and to bring more clarity regarding subtleties and nuances it was complemented with the FGDs and case studies. The thesis is divided into seven chapters. The first chapter provides introduction to the research area and brings conceptual clarity to reproductive health. It discusses the debates centered around reproductive health, its various dimensions an objectives of the study. The second chapter is on reproductive health in policies and realities which discusses reproductive health in various policies and programs of government of India. The chapter also deliberates upon the major indicators of reproductive health and to put them in perspective these indicators were compared with national data on indicators of reproductive health. Chapter three is on reproductive health of women in Indian slums which discusses the concept of slums and proliferation of slums across India and also focuses on the review of the existing literature on reproductive health of women in Indian slums. Chapter four is on research methods, adopted in the present study. Chapter five provides descriptive profile of the selected slums, households and the participants. Chapter six contains data analysis of the present research and the discussions and inferences are drawn accordingly. The thesis ends with Chapter seven providing conclusion and the ways forward. The findings of the present study are summed up according to the objectives of the study. The study endeavored to examine fertility trend and how socio-economic correlates affect it. Upon the analysis of data fertility was seen to be affected by the socio-economic correlates. The data was collected on women’s education, their caste category and their husband’s occupation. Fertility was reported higher among women who were uneducated than those who were educated. 2 It is seen in this study that those women who have their husbands in self employment, had exorbitantly higher share in more than three children than any other occupational group. The women whose husbands were casual labourers also had higher fertility than women whose husbands were regular salaried employees either in private or in government sector. Women whose husbands were employed in the government sector are found to have the lowest fertility level. It was observed in this study that ANC utilization is quite high and majority of the women sought ANC services from the government sources – anganwadi centers, urban primary health centers and health camps organized by the district hospitals and the university medical college. However, it was also observed that three quarters of sampled women did not have 100 days consumption of IFA tablets. From the qualitative data it became clear that lack of proper counselling and information dissemination regarding anaemia and under supply of IFA tablets were the primary reasons for underutilization of the tablets. ANC utilization is found to be positively associated with women’s education and husband’s occupation. Women whose husbands were salaried class employed either in government sector or in private sector ANC utilization was substantially high among them. In the caste category ANC utilization was the highest among SC category and the lowest among OBCs. Majority of the women in the sampled population preferred home delivery over institutional one. Among women who had institutional deliveries, majority of them occurred in public health facilities. The study suggests a positive relationship between institutional delivery, women’s education and husband’s occupation. Among the caste category home delivery was the highest in SCs and the lowest in OBCs. Dais and her services in child delivery are considered valuable in the community. The study also found that majority of the women use contraception and among the contraceptive users majority of them use condoms followed by sterilization.