Abstract
Continued population growth and increasing urbanization have led to the formation of large informal urban settlements in many developing countries in recent decades. The high prevalence of poverty, overcrowding, and poor sanitation observed in these settlements—commonly referred to as “slums”—suggests that slum residence constitutes a major health risk for children. In this article, we use data from 191 Demographic and Health Surveys (DHS) across 73 developing countries to investigate this concern empirically. Our results indicate that children in slums have better health outcomes than children living in rural areas yet fare worse than children in better-off neighborhoods of the same urban settlements. A large fraction of the observed health differences appears to be explained by pronounced differences in maternal education, household wealth, and access to health services across residential areas. After we control for these characteristics, children growing up in the slums and better-off neighborhoods of towns show levels of morbidity and mortality that are not statistically different from those of children living in rural areas. Compared with rural children, children living in cities (irrespective of slum or formal residence) fare better with respect to mortality and stunting but not with respect to recent illness episodes.
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Notes
Numbers reflect list as of November 2012 (http://www.measuredhs.com).
Households are considered without access to safe water if the household does not have access to a private or public pipe, bore hole, or a protected well or spring. Households are defined as being deprived of basic sanitation if they either rely on open defecation or use an unimproved pit latrine. Shared sanitation facilities are considered as basic sanitation if they provide access to a flush toilet or ventilated improved pit latrine. A dwelling is considered as overcrowded if there are more than three persons per habitable room. If the floor material of a house is made of earth, dung, sand, or wood, its structure is considered inadequate. The information in the DHS thus allows us to closely approximate the UN Habitat criteria.
In some of the DHS, information on one of the four housing characteristics (mostly crowding) was missing. To maintain as large a sample size as possible, in such cases we imputed a positive value: that is, that the household was not overcrowded, or had good water supply or sanitation. As a result, we may have somewhat underestimated the share of slum dwellers. For our regression results (Table 2), this means that we might have underestimated the difference in health between urban nonslum areas and slum areas on the one hand, and nonslum urban areas and rural areas on the other hand.
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Fink, G., Günther, I. & Hill, K. Slum Residence and Child Health in Developing Countries. Demography 51, 1175–1197 (2014). https://doi.org/10.1007/s13524-014-0302-0
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DOI: https://doi.org/10.1007/s13524-014-0302-0