It is well established that there is a global trend towards urbanisation. The World Health Organisation estimate that by 2050, 70% of the world’s population will be living in towns and cities and one in three urban dwellers will live in slums, a total of one billion people worldwide. City life can have its freedoms and pleasures, such as leisure opportunities, new relationships, anonymity and alternate ways of organising households.
However, low-income urban settlements also intensify certain risk factors for ill health and introduce new hazards. The environment is often less than adequate, with overcrowded and substandard housing, patchy provision of water and sanitation services, and poor access to affordable quality food, and safe spaces for recreation. Women may be restricted in terms of their ability to move within urban spaces, either because they are confined to the home and expected to carry out care or other household work or because they do not feel able to move freely in the urban environment. The risk and fear of violence may prevent them from moving safely in public spaces.
In Africa attention has been directed particularly to the epidemic of HIV and pressing concerns remain around the vulnerability of women and girls to infection and the affects of an HIV positive diagnosis and the poor condition of their sexual and reproductive health more generally. The recent push toward the attainment of MDG 5 on maternal health has led to a renewed interest in sexual and reproductive health and rights.
Migration to, and residence in, low-income urban settlements is associated with particular health challenges for women and girls. Communicable diseases such as HIV, sexual and reproductive ill-health and, increasingly, non-communicable diseases related to poor diet, tobacco and a sedentary lifestyles, are an issue. There is also concern about the mental health burden arising from the stresses of surviving on the economic margins in large cities characterised by high levels of crime and violence, and more fragmented access to social support.
In some instances, access to health care and commodities might be better in urban areas. But residents are also likely to be exposed to the problems associated with negotiating a more diverse healthcare market, evidenced by an array of private and informal health providers of variable cost and quality.
Donors and the governments have made political commitments to tackle ill-health amongst the poorest women. However, these commitments and targets tend to be siloed and to pay insufficient attention to intensified urbanisation and the urban environment. We know little about what approaches to improving the health of women and girls are currently working in these settings, and less about efforts to tackle emerging and significant health conditions such as injury, violence, cardiovascular disease and neuropsychiatric disorders.