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As per the India: Urban Poverty Report 2009, the total urban homeless population in India is 7,78,599 people (Census 2001 figures). Their condition is clearly linked to their lack of adequate shelter. Though governments in few cities have made efforts to provide temporary shelters, the people having access to these are far from adequate. For example, in Delhi less than 3% of the homeless people have access to night shelters.
According to the government guidelines for cash assistance under Janani Suraksha Yojana (JSY), a pregnant woman is eligible only if she is able to present a BPL card or SC/ST card. However, only a fraction of the homeless population in urban areas possesses Below Poverty Level (BPL) cards. A 2008 survey conducted by NGO The Calcutta Samaritans showed only 3.69% of Kolkata’s homeless population possessed BPL cards.
The author had conducted a study in 2007 using a semi-structured questionnaire among 33 women who were either pregnant or having children less than 6 years of age and were living on the streets of Mumbai city. Around 69.69% women mentioned of visiting any health facility during pregnancy for antenatal care, with a majority of them using public health facilities. Lack of knowledge about ANC was cited as one of the reasons for not utilizing ANC services. The average cost per delivery among the 27 women who had delivered in the past 2 years was Rs 439.22, though most of the deliveries were conducted in a public health facility. None of the women were aware of the JSY scheme.
In India since the state governments ask applicants to provide various documents, such as electoral roll number, copy of electricity bill and house rent bill to receive a BPL card; most of the homeless population remains left out of the process of possessing one. For the homeless women the lack of BPL cards results in maternity related expenses, even in a public health facility.
What can be done? Since BPL category is not a criterion for accessing the ICDS, Anganwadi workers (AWW) need to undertake periodic surveys in their designated areas for identifying homeless pregnant women. The women identified by the AWW could be provided with the benefits of the Antyodaya Scheme (Schedule VI of the Draft Food Entitlements Act, 2009 identifies urban homeless households as a priority group for the eligibility to the Antyodaya card). Once identified, these women can be linked to the ANM attached to a health post for counseling regards ANC services. Further linkages for delivery in urban maternity home or municipal hospital can be established through these Antyodaya cards for utilizing entitlements under the JSY scheme.
As per the Joint UN-Habitat/WHO 2010 Report ‘Hidden Cities: Unmasking and Overcoming Health’, half of poor urban women in India will continue to lack access to skilled birth attendance in 2015. If access to conditional cash transfers for maternal health such as JSY is improved for homeless pregnant women then such inequities can be minimized in the future.
Author: Mr. Denny John is a NZAID Commonwealth Scholar currently doing his MPH course at University of Auckland, New Zealand. This study was conducted as part of his involvement as Research Consultant with YUVA (Youth for Unity and Voluntary Action), Mumbai, in 2007-08.