By Raghu Rai:
‘Slum dog millionaire may have been a hit, books on slums may have become best sellers, and a couple of children may escape poverty and misery. But the inequality and the injustice remain. These pictures goad us to ask relevant and critical questions, and push the wheel of change, mired in the inability to perceive and act. In a celebrated fable, a child’s voice once stated starkly that the Emperor was naked, dispelling the illusion that he was dressed in grand clothes. The children in these pictures fundamentally question the myth that India shines.The pictures ask questions that are pertinent and critical. Questions that we need to address urgently, to shape a more just India.’
– Aruna Roy, Social Activist
Crowded living spaces in Sanjay Colony, North-West Delhi. In this slum, a single room usually serves as the kitchen and bedroom. Indoor cooking-fires can cause pneumonia and other respiratory diseases among children. India has the highest number of childhood pneumonia cases in the world. It accounts for over 19% of all newborn deaths.
According to UN data, 1.65 million children under the age of five die every year in India from easily preventable diseases – more than any other country in the world.
Salma’s three-year-old daughter Nagma is in danger of becoming malnourished. She lives in Bhagwan Pura in North-West Delhi. The National Family Health Survey-3 (2005-06) data shows that 41% of urban children below five years in Delhi are chronically undernourished, i.e., they have low height for their age, which is also called being ‘stunted’ and is a consequence of long-term food deprivation and frequent infections.
An analysis of the NFHS-3 shows that among the urban poor, who constitute 15.2% (2.23 million) of its population, the proportion of children less than five years who are chronically undernourished is much higher (58%). This means that nearly 7 out of every 10 children less than five years of age residing in deprived urban settlements of Delhi are chronically undernourished.
A pregnant woman being diagnosed by a health worker. Nearly half of women in India give birth without a skilled birth attendant. According to Save the Children report, State of the World’s Mothers (May 2012), a woman in India is almost 8 times more likely to die during pregnancy or child birth than her counterpart in Sri Lanka.
Evidence shows that children are five times more likely to survive if there is a health worker within reach.
Families living near the railway track near Okhla Flyover that gives no protection against harsh weather conditions. The open sky is the roof for those living here and the railway track serves as children’s playground. They live under most perilous and unhygienic conditions.
They are uncounted and invisible and do not have access to basic services like home, health, hygiene and education.
Urbanization leaves hundreds of millions of the poor living in cities and towns around the world, excluded from vital services. The same cities the world over are also the setting for some of the greatest disparities in health, education and opportunities for the poor.
Babies being weighed at the Palika Maternity Hospital in Lodhi Colony, New Delhi. More than half of the babies are delivered at home even when it is critical that they receive care at a facility.
High urban child mortality rates tend to be seen in places where significant concentrations of extreme poverty combine with inadequate services, as in slums. Cramped and unsanitary conditions lead to the spread of diseases while immunization levels for children remain much lower in urban slums. Health services for the urban poor tend to be of much lower quality, often forcing people to resort to unqualified health practitioners, or pay for premium health care.
Sheila’s child was only 1.7 kilograms at birth. The main underlying cause of child mortality in India can be directly or indirectly attributed to malnutrition. Save the Children’s report A Life Free from Hunger (February 2012) points out that a third of children under the age of five who die lose their lives because they can’t get the food they need.
The high level of malnutrition in Delhi has a severe impact on child survival, which is evident by high child mortality rates (74 per thousand) among urban poor children below five years of age.
Children and families camping at the New Delhi railway station. Thousands from the neighbouring states of Bihar, Uttar Pradesh, and West Bengal flock to the city in search of a better future.
While the agriculture base continues to dwindle, city life provides the poor with no respite. On the contrary, families are pushed to abject poverty and a grinding experience in the urban landscape.
Families living under the Nehru Place flyover, Delhi. Nehru Place is a business district located in arguably Delhi’s richest locality, South Delhi. Under-five mortality is 300% higher in the poorest 20 %of the population compared to the richest 20 %.
Kamar Jehan is having her fifth baby. She is being cared for by Sangeeta, a community worker supported by one of Save the Children’s partner organisations in India. Previously, Kamar Jehan lost a one-year-old baby girl, Tarannum, to diarrhoea. There is evidence to show that children are five times more likely to die in countries affected by health workers crisis. Health workers are crucial for bringing much-needed care and counseling for mothers and their babies.
Save the Children is advocating for the Government of India to increase investment in healthcare, to recruit, train and deploy more health workers in the poorest and most marginalised areas.
The 1,000 days window from the start of a woman’s pregnancy to a child’s second birthday is critical. Low-cost nutrition solutions like exclusive breastfeeding for the first six months can make the difference between life and death for children in developing countries.
For instance, breastfed children are at least six times more likely to survive in the early months of life than non-breastfed children.
Save the Children is advocating for ‘life-saving six’ package of interventions – iron folate, breastfeeding, complimentary feeding, vitamin A, zinc and hygiene. The entire package can be delivered at a cost of less than 1000 INR (20 dollars) for the first 1000 days.