Mumbai: Thirty-one-year-old Usha Gautam went into labour almost a month before her scheduled due date. The government-run hospital she had enrolled herself in was over six kilometres away from her residence in the Mandala slums located in the city’s ‘M East’ municipal ward, called ‘M/E’ for short. It was March 27, only a few days into the nationwide lockdown that was imposed to contain the spread of the novel coronavirus. The state administration had forced the entire city into a “curfew-like” situation. With no public transport or ambulance service available in the neighbourhood, Usha’s family was forced to go looking for a Dai Ma, a local midwife, to help with the process of delivery.
Usha’s baby boy was born amid acute uncertainty. The infant weighed just over 2 kilos. He was frail, so was Usha. But Usha says she is grateful that they both survived. “My second child was born at home too. I had vowed after that delivery (of her second child) to never risk my or my child’s life by giving birth at home again. But here I was again, with my life in the hands of a midwife, just hoping to stay alive,” she says.
Dai Mas are an integral part of the slum ecosystem in the M East ward, located in the northern edge of the metropolis of Mumbai, where government facilities are scarce. Most lives here survive on the handouts offered by different non-governmental organisations (NGOs), which try to fill the gaps left by government apathy.
Non-institutional births, experts say, have been minimised in the past few years but the lockdown pushed many towards the dangerous, unattended birthing methods once again. “From 60% in 2010, the institutional birth had been increased to almost 99% in areas like Shivaji Nagar. But with the pandemic, all our efforts have gone down the drain,” Arun Kumar says.
Considered to be the poorest part of Mumbai, the M East ward is spread over a large expanse of Chembur East, Govandi, Deonar, Mankhurd, and Shivaji Nagar. It covers over 256 slums and as many as 13 resettlement colonies, and the 132-hectare Deonar dumping ground that processes 4,500 tonnes of garbage every day. Amid refineries, an atomic energy plant and several illegal chemical plants, most families here live in crammed one-room tenements that serve as a kitchen, living space and bedroom all rolled into one.
M East Ward: One of the poorest areas in Mumbai
The M East ward, one of the twenty-four administrative divisions of Mumbai and home to over 8,07,720 (Census 2011) residents, is also one of the poorest areas in the city. And in the past decade, experts say the population has doubled.
Government and NGO data shows that close to 78% of the ward’s population live in abject poverty, deprived of the most basic government facilities. From housing, water and electricity, every facility is questionable and citizens spend their life trying to prove they are “legal beings”.
Aisa Bano Khan, a woman in her mid-50s, is the go-to person for most expecting mothers. Khan, a class three dropout, has been delivering babies for the past three decades. She doesn’t have any formal training but relies on her experience.
The lockdown brought about an unprecedented crisis for expecting mothers, she says, one like never before. “I would receive one call every week, sometimes even two or three. Most of them could not travel to government hospitals. Their husbands and other earning members were rendered jobless. It was a desperate situation,” she says, adding that she must have delivered at least 30 children in just the Mandala slums since March.
Khan charges Rs 2,000 per delivery. This money, she says, is for the risk involved and the post-delivery cleaning she has does all by herself. “People trust me and my sole focus is to save the mother and her child,” she says.
But when 21-year-old Hina Shaikh could not afford Khan’s fees, she agreed to accept some food that the family offered to pay in lieu of cash. “I did not want to add to her distress. The family paid a little in cash and gave me dry food packets that some NGO gave them. I agreed,” Khan says.
Tata Institute of Social Sciences’ field action project ‘Transforming M Ward’ points out that the human development index of the ward is the lowest in the city, with an infant mortality rate of around 66.47 per thousand live births, out-of-school children between the ages of 6 to 14 years is 1,490, more or less equally divided between boys and girls. More than 50% of children in the ward are malnourished according to HDR, 2009.
A midwife in every alley
Almost in every alleyway, there is a Hina or a Usha seeking help to deliver their babies. In a recent study conducted in close to 12 slums of the M East ward (of which Mandala is a part) by Apnalaya, a well-regarded NGO, it was found that out of the 534 deliveries, 32 were at home. Of them, seven were stillborn.
Midwives use their experience to handle the birthing process, but the overwhelming squalor and lack of appropriate surgical devices make it challenging.
The survey further states out of the 126 deliveries which took place in private hospitals, at least 81 women were those who were registered in a government hospital but had to be taken to a close by private hospitals due to the lockdown. Another 201 pregnant women (38% of the 534) had to move back to their village because they had no faith in the city health system.
“Lives here are difficult, more so for women. But the situation has got exacerbated further in the past five months,” Poornima Nair, director (health & disability) at Apnalaya, says.
Crisis of vaccination and nutrition
While new births have been one of the primary concerns in the region, Dr Vaishali Venu of Doctors for You (DFY), an NGO working in M East ward, points to the after-birth crisis as a bigger challenge. Venu says since the lockdown, the immunisation work carried out under the Integrated Child Development Services (ICDS) has virtually come to a halt.
Usha’s five-month-old baby has not yet been vaccinated, not even the first three vaccines—zero polio dose, perinatal Hepatitis B vaccines and BCG injections for tuberculosis—which are commonly administered soon after the child’s birth. Her three other children, all under five years of age have also missed their vaccines in the past months. Her husband, a daily wager, lost his painting job and the family has since been dependent on local NGOs for support. This also means that the nutritional requirements of Usha and her children have taken a backseat.
DFY, along with the local civic body, works actively in the M East ward and focusses on the immunisation work. Their data shows, the organisation was able to reach out to just 2,000 children in the past seven months. In 2019 and 2018, the coordinating figures were over 5,000. The earlier years’ figures, Venu says, is over and about the work carried out by the municipal corporation. But this year, since March, the civic body has entirely stopped its work.
Within days after the nationwide lockdown was imposed, the centre’s National Health Mission released an analysis of its first quarterly data. As per the NHM, nationwide, at least one lakh children did not receive their BCG vaccination for tuberculosis in March, and another two lakh children missed out on their immunity building ‘pentavalent and rotavirus’ that helps fight meningitis, pneumonia, Diptheria and tetanus, among other diseases impacting children.
There is a dire need to keep these vaccines within the reach of the population of M East, says Dr Arun Kumar, chief executive officer of Apnalaya. “The state administration has focussed on the ‘legality’ of where poor live as against their fundamental right to life. In this process, even the most basic citizenry rights are denied,” Arun Kumar points out.
The region comprises of Bahujan population who have migrated from various parts of India; among Muslims too, Arun Kumar says, it is mostly the Pasmanda (low caste) Muslims who live here. The state government, terming the region “unauthorised” or “illegal” has shirked its responsibilities. “When you term them illegal, what you are actually doing is legalising their exclusion,” Arun Kumar says.
Nair says the problem in the area can’t be looked at as something that suddenly cropped up with the outbreak of COVID-19. “Children and their health concerns have remained a neglected issue forever. Like, for instance, the number of anganwadis is disproportionate to the number of children living here,” she points out.
Anganwadi, a government-sponsored child and mother care centre, play a crucial role in areas where families aren’t able to provide essential care. Across the country, children between age 3-6 are provided with one hot cooked meal every day, and babies and toddlers are provided with “take-home rations”.
In the several slum clusters that this reporter visited, anganwadis were either shut; in some cases, they were never functional. Most children in the area accessed services made available by NGOs or survived on whatever their families could provide. Anganwadi workers are mostly from the community or nearby areas. The government, besides expecting them to take care of the child and mother development, also forces them to carry out several auxiliary works.
Sharifa, an anganwadi sevika in Rafi Nagar’s slums, says that her centre had to be shut down by the end of March. Instead of cooked meals, she and other angandwadi workers and helpers went door to door, handing over take-home rations. “Bread earners in most families had lost their jobs. The take-home ration for children became meals for most families,” she says.
According to the DFY’s data, in the few slum clusters that they are active, around 1,079 children were found to be malnourished in 2019. Among them, as many as 568 children fell in the severe acute malnutrition (SAM) category and the rest were affected by moderate acute malnutrition (MAM). The organisation fears that most children under MAM could have slipped into SAM in the past months.
Sakina Khan, a community worker associated with DFY, says that they have intensified their outreach program and have tried to cover as many children and lactating mothers as they can—providing them with ready-to-cook food mixes that are required to be fortified with specific micronutrients to tackle malnutrition. She says, “No amount of supplement would help if you are deprived of basic food, sanitation and healthcare.”
Failure of Centre’s decisions
Although senior civic health officials agree that Mumbai city, particularly the M East ward, was deeply impacted by the lockdown, they, however, attribute the failure to the Central government’s decisions. “March and April, we had to stall the work, since all our focus was to be shifted to COVID-19 related measures. Since public transport wasn’t available, our staff members could not report to work,” a senior health official on the condition of anonymity.
The official further added that since May onwards, they have shifted their focus back to the immunisation work and as compared to the past years, they have managed to cover more grounds this year. “As against 3500-3700 immunisation camps, just in June, we managed to set up over 4000 camps in the city. The M East ward has always remained a sensitive area and we are trying our best to rework plans to address the issue here,” the official added.