With increasing urbanization in Africa concerns are emerging for the health of the urban population as cities sprawl beyond their boundaries, often filled with migrant populations from rural areas. Informal urban settlements are often crowded and do not have infrastructures such as waste disposal, plumbing, sewage roads, and reliable electricity. In addition, these areas lack regulated public or quality private health care, which negatively impacts maternal and newborn health (MNH).
The burden of maternal and neonatal mortality is heaviest among the lowest quintile in urban settings, and the health of the urban poor may even be worse than the health conditions in rural areas. Studies done in Kampala slums estimated the stillbirth rate to be 43/1000 live births, which is more than double the rate of 19/1000 estimated in rural Eastern Uganda.
While it may be logical to relate the high mortality to poor living conditions, studies from neighboring countries show that maternal and newborn health service provision in slums is poor despite optimal physical access and a multitude of private providers. The rhetoric of urban bias in development and better access to services in urban areas vis-à-vis rural areas has masked the real picture of the health conditions among the urban poor.