Chapter 1 People In Cities: Hope
Countering Desolation

The Unseen Dramas of the Urban Poor

Slums: Unparalleled Concentration of Poverty

The Persistent Disparities

Women's Empowerment and Well-being: The Pillars of Sustainable Cities

Social Contradictions in Growing Cities: Dialogue and Discord

The Changing Demographics of Growing Cities

Improving Urban Governance and Involving the Poor: The Right Thing to Do

As the developing world becomes more urban and as the locus of poverty shifts to cities, the battle to achieve the MDGs will have to be waged in the world's slums.(1)

The unprecedented urban growth taking place in developing countries reflects the hopes and aspirations of millions of new urbanites. Cities have enormous potential for improving people’s lives, but inadequate urban management, often based on inaccurate perceptions and information, can turn opportunity into disaster.

Conscious of this gap, the Programme of Action of the International Conference on Population and Development recommended that: “Governments should increase the capacity and competence of city and municipal authorities to manage urban development, to safeguard the environment, to respond to the need of all citizens, including urban squatters, for personal safety, basic infrastructure and services, to eliminate health and social problems, including problems of drugs and criminality, and problems resulting from overcrowding and disasters, and to provide people with alternatives to living in areas prone to natural and man-made disasters.”(2) This chapter addresses some of these concerns, particularly as they affect women, in light of expected future urban growth in developing countries.

The Unseen Dramas of the Urban Poor(3)

Until recently, rural settlements were the epicentre of poverty and human suffering. All measures of poverty, whether based on income, consumption or expenditure, showed that rural poverty was deeper and more widespread than in cities.(4) Urban centres on the whole offered better access to health, education, basic infrastructure, information, knowledge and opportunity.(5)Such findings were easy to understand in view of budgetary allocations, the concentration of services and the other intangible benefits of cities.

Poverty, however, is now increasing more rapidly in urban areas than in rural areas but has received far less attention. Aggregate statistics hide deep inequalities and gloss over concentrations of harsh poverty within cities. Most assessments actually underestimate the scale and depth of urban poverty.(6)

Hundreds of millions live in poverty in the cities of low- and middle-income nations, and their numbers are sure to swell in coming years. Over half of the urban population is below the poverty line in Angola, Armenia, Azerbaijan, Bolivia, Chad, Colombia, Georgia, Guatemala, Haiti, Madagascar, Malawi, Mozambique, Niger, Sierra Leone and Zambia. Many others have 40 to 50 per cent living below the poverty line, including Burundi, El Salvador, the Gambia, Kenya, the Kyrgyz Republic, Moldova, Peru and Zimbabwe. Many other nations would be included in this list if their poverty lines made allowance for the real costs of non-food necessities in urban areas.(7)

Urban mismanagement often squanders urban advantages and the urban potential for poverty reduction. Although urban poverty is growing faster than in rural areas, development agencies have only recently begun to appre­ciate that they need new interventions to attack its roots.

Slums: Unparalleled Concentration of Poverty

Poverty, begging and homelessness have been part of the urban scene since the first cities of Mesopotamia. Poor people are, for the most part, consigned to socially segregated areas generically called “slums” (see Box 4). Our concept of modern slums dates back to the industrial revolution as experienced in 19th-century London or early-20th-century New York.(8)



The term “slum” is used to refer to many types of housing, including those that could be upgraded. Terms such as “slum”, “shantytown”, “informal settlement”, “squatter housing” and “low-income community” are often used interchangeably.

According to UN-Habitat, a “slum household” is a group of individuals living under the same roof in an urban area who lack one or more of the following: durable housing, sufficient living area, access to improved water, access to sanitation and secure tenure.(1)

Not all poor people live in slums, and not all people who live in areas defined as slums are poor. However, for simplicity’s sake, this Report equates the urban poor with slum dwellers.

The basic features of slum life have not changed: The difference today is one of scale. Slum dwellers of the new millennium are no longer a few thousand in a few cities of a rapidly industrializing continent. They include one out of every three city dwellers, a billion people, a sixth of the world’s population.(9)

Over 90 per cent of slum dwellers today are in the developing world. South Asia has the largest share, followed by Eastern Asia, sub-Saharan Africa and Latin America. China and India together have 37 per cent of the world’s slums. In sub-Saharan Africa, urbanization has become virtually synonymous with slum growth; 72 per cent of the region’s urban population lives under slum conditions, compared to 56 per cent in South Asia. The slum population of sub-Saharan Africa almost doubled in 15 years, reaching nearly 200 million in 2005.

The United Nations Millennium Declaration recognized the importance of addressing the situation of slum dwellers in reducing overall poverty and advancing human development. Despite the strength of this commitment, monitoring progress on the situation of slum dwellers has been a challenge.(10)Proactive policy interventions are needed now if nations are to meet the spirit of Target 11 of the Millennium Development Goals(11)and ameliorate the lives of millions of the urban poor.

The Persistent Disparities

Nowhere are the disadvantages of the urban poor compared with other city dwellers more marked than in the health area.(12)Poor women are at a particular disadvantage. Although cash income is much more important in cities than in villages, income poverty is only one aspect of urban poverty. Others are poor-quality and overcrowded shelter, lack of public services and infrastructure such as piped water, sanitation facilities, garbage collection, drainage and roads, as well as insecure land tenure (see Box 5). These disadvantages increase the health and work burdens of the urban poor and also increase their risks from environmental hazards and crime.



Feryal El Sayed has called a tiny square room crammed with a bed and two seats, and a tinier cubicle containing a kitchen and a bathroom, “home” for the past 15 years. The makeshift roof is falling apart, and Ms. El Sayed, 62, had to install plastic sheeting under the ceiling to catch the debris. However, she is still better off than some of her neighbours in Ezbet El Haggana’s District 3, who have no roofs over their heads and who, on rainy nights, are forced to sleep under their beds.

Ezbet El Haggana, a sprawling slum in the north-east of Cairo, is one of the largest urban Ashwaiiyat, or “informal areas”, encircling this city. With more than a million inhabitants, it is among the few places where the poorest of Egypt’s poor can afford some sort of housing—a place where high-voltage cables hum constantly over their heads, sewage water seeps under their feet and the fumes of burning garbage fill their lungs.

“In addition to all sorts of diseases, we always have fires in these houses because of the high-voltage cables,” says Hazem Hassan, of the Al-Shehab Institution for Comprehensive Development, a grass-roots organization that has been assisting the residents of Ezbet El Haggana since 2001. Al-Shehab will soon construct new roofs for 50 of the most threatened dwellings in the district, including Ms. El Sayed’s.

Cairo’s population has exploded during the last three decades, doubling from 6.4 million people in 1975 to 11.1 million in 2005. The latest statistics of the Egyptian Ministry of Housing, Utilities and Urban Communities show that there are 1,221 “informal areas” similar to Ezbet El Haggana. They house 12-15 million of the country’s 77 million people. Sixty-seven of these are in Greater Cairo.

The Ministry has been diverting the flow of people from Egypt’s big cities through development projects and low-cost housing in “new cities”. Those in the Cairo area alone have absorbed 1.2 million people who would otherwise have ended up living in Ashwaiiyat. However, despite Government incentives, many still cannot afford to move there. People like Ms. El Sayed are sticking to Ezbet El Haggana. Despite her predicament, she remains optimistic, perhaps because she realizes that she is more fortunate than many of her neighbours—and that a new roof is on its way.

Poor people live in unhealthy environments.(13)Health risks arise from poor sanitation, lack of clean water, overcrowded and poorly ventilated living and working environments and from air and industrial pollution. Inadequate diet reduces slum-dwellers’ resistance to disease, especially because they live in the constant presence of pathogenic micro-organisms.(14)

The United Nations Development Programme’s Human Development Report for 2006 provides an excellent overview and analysis of the relations between power, poverty and water.(15)It highlights the fact that the stark realities of slum life defy statistical analysis. Frequently, many people live in compounds made up of several houses where one toilet serves all adults and children. Toilets may be reserved for adults, and children forced to go elsewhere in the compound or in the streets where they play.(16)Sharing three toilets and one shower with 250 households in a community is not at all unusual in cities of sub-Saharan Africa. Conditions like these increase stress on all inhabitants, especially women who are also subject to greater risks of gender-based violence.(17)In Latin America, only 33.6 per cent of the urban poor have access to flush toilets, compared to 63.7 per cent of their non-poor urban counterparts.(18)

Water is a scarce and expensive resource for the urban poor, often obtained in small quantities from street vendors. Bought this way, unit costs can be much higher than for people who have running water in their homes. If there is a piped supply, obtaining it may involve long journeys to the neighbourhood water post, long waits, tiring trips back home with full jerry-cans, careful storage to minimize wastage and reusing the same water several times, increasing the risk of contamination.(19)

Water chores take up a substantial part of women’s and girls’ time. A partial time-use study covering 10 sites in East Africa found that the waiting time for water increased from 28 minutes a day in 1967 to 92 minutes in 1997.(20)The physical and time burdens come not so much from long distances from the source of supply, as in villages, but from the large numbers who have to use the same source (see Box 6).



"Some say half a million people live there. Others put the figure at more than a million. No one really knows . . . Kiberans live in tin shacks or mud “houses” with no toilets, no beds and little water to speak of. Electricity is almost non-existent. Most of the pit latrines are full and locked up, so people use the aptly named “flying toilets” where they excrete into plastic bags and throw them in piles on the street. Children play on the heaps.

"Middle-aged Sabina sits by a standpipe to charge people for filling 20-litre containers with supposedly clean water. But the pipes, many of which leak, run through open sewerage ditches. When the pressure drops, as it does most days, the pipes suck in excrement. “I charge 3 shillings (4 cents) for a jerry can,” she explains. “But when there is less water, I put the price up to 5.5 shillings.” Sabina sits there 11 hours a day but doesn’t get paid. Standpipes are controlled by shadowy figures, rumoured to be government officials who make good money out of them."

The association between poverty, environment and housing in urban areas is critical because it indicates a key area for intervention. Policies directed to improving shelter in urban areas can have huge impacts on poverty reduction and on environmental well-being. Advances in health and mortality indicators depend very much on urban water and sewage treatment.

Women's Empowerment and Well-being: The Pillars of Sustainable Cities

As women are generally the poorest of the poor . . . eliminating social, cultural, political and economic discrimination against women is a prerequisite of eradicating poverty . . . in the context of sustainable development.(21)

The social and physical amenities of cities facilitate gender-equitable change. Indeed, the concentration of population in urban areas opens many possibilities for women—whether migrants or natives—to meet, work, form social support networks, exchange information and organize around the things of greatest importance to them. Cities tend to favour greater cultural diversity and, as a corollary, more flexibility in the application of social norms that traditionally impinge on women’s freedom of choice.

Compared with rural areas, cities offer women better educational facilities and more diverse employment options. They provide more opportunities for social and political participation, as well as access to media, information and technology. Cities offer many roads to decision-making power through community and political participation. Women can use urban space to project their voices, to participate in community politics and development and to influence social and political pro­cesses at all levels.

Women stand to benefit from the proximity and greater availability of urban services, such as water, sanitation, education, health and transportation facilities; all of these can reduce women’s triple burden of reproductive, productive and community work and, in so doing, improve their health status and that of their children and families.


Urbanization increases girls’ access to education and promotes cultural acceptance of their right to education. Primary, and especially secondary, education for girls has crucial multiplier effects that increase women’s social and economic status and expand their freedom of choice. Educated women tend to marry later and have fewer and healthier children.(22)In adulthood, they have greater employment potential, income-earning capacity and decision-making authority within the household.(23)Other benefits include knowledge and capacities to maintain and protect their health, including preventing unwanted pregnancies and sexually transmitted infections (STIs), including HIV/AIDS. All of these are helpful in the fight against poverty. 

Families’ ability to enrol girls as well as boys in school, and to keep them there, strongly influences the extent and depth of urban poverty and the transmission of poverty from one generation to the next. Unfortunately, in countries with low overall enrolment, many girls in poor urban areas drop out before they are functionally literate. Demographic and Health Survey data point to four main reasons for this: lack of finances; early marriage and pregnancy; household responsibilities; and poor performance. School fees, uniforms and materials, loss of income or household help, expenditures on transport and other costs of sending children to school may be prohibitive for many poor families and reduce the urban educational advantage. If families are forced to choose, daughters are typically the first to do without or to be pulled from school. 

Data on within-city differentials reveal dramatic differences in access to education and levels of literacy between slums and wealthier neighbourhoods. In some countries, such as Bangladesh, Colombia, India and Pakistan, literacy of women living in slums is 30-50 per cent lower than those of non-slum communities.(24)Young people’s ability to continue in school is influenced by age at marriage, pregnancy and household headship. Young women and men in low-income households are more likely to have children, be married or head a household than their upper-income counterparts.(25)


Employment possibilities are far more diverse in urban areas for both men and women. Urbanization has significantly boosted women’s labour force participation.(26)Paid employment for women not only increases household income but can trigger transformations in gender roles and elevate women’s status in the family and society.

Worldwide, there has been a significant increase in women’s non-agricultural wage employment during recent years.(27)New opportunities have arisen, especially in tradable sectors(28)and in home-based businesses linked to global production networks.(29)For example, of the 50 million workers in export processing zones, 80 per cent are young women.(30)



The UNFPA Ethiopia country office supports the Good Samaritan Training Centre, an urban-based NGO providing vocational training to young women and girls, aged 18-25, with a view to enabling self-employment or finding paid work. The main target groups are street girls—girls from low-income families exposed to street life by economic deprivation, neglect, family break-ups, civil strife and war. Apart from training in different skills, such as leather handicrafts, weaving, knitting, sewing, embroidery and hairdressing, the Centre provides training on health, home management, nutrition and HIV/AIDS and family planning.

However, most growth of female employment is in the informal sector, which accounts for most new employment opportunities in the world,(31)and where women are a large majority, especially in Africa and Asia.(32)Informal employment is critical in enabling women to absorb the economic shocks that poor households experience. In this regard, women’s employment, paid and unpaid, is of fundamental importance in keeping many households out of poverty.(33)The downside is that much informal work is unstable, of poor quality and poorly paid.(34)


Physical and financial assets offer women more than economic well-being and security. Legal property tenure increases women’s opportunities to access credit, generate income and establish a cushion against poverty. It also empowers them in their relationships with their partners and their families, reduces vulnerability to gender-based violence and HIV/AIDS and provides a safety net for the elderly.

Women own less than 15 per cent of land worldwide.(35)In some countries, women cannot legally own property separately from their husbands, particularly in parts of Asia and sub-Saharan Africa. Lacking legal title to land and property, women have virtually no collateral for obtaining loans and credit, thus limiting their economic options. In some settings, although women can legally own and inherit property, custom dictates that men control it and that it passes only to male heirs on a man’s death. It is difficult or impossible in these circumstances for women to exercise their property rights in practice.

There is evidence that the difficulty of securing title to property in rural areas is prompting women to migrate to cities in hopes of securing property there, where prospects are assumed to be better.(36)Women may also have better access to legal information and support in urban areas. Because of the greater social dynamism and range of economic possibilities open to women, cities are likely to offer more opportunities to acquire property in the long run. 

Legal reforms are still necessary, however, to secure women’s equal rights to own property. Where laws are in place, cities continue to need programmes and recourse mechanisms to tackle informal barriers such as customary practices, low awareness of rights, the high cost of land and housing and discriminatory lending and titling policies. 

Property rights and access to credit are closely linked, so it is not surprising that women face difficulties in obtaining financial assets. Microcredit programmes have partially filled this need. Making its mark initially in rural settings, microcredit is also allowing poor urban women to leverage their capacities and improve their incomes.


Decision-making power is one of the main indicators of women’s empowerment. The prospects for women’s formal participation in politics are improving, despite the many challenges they face, including gender dis­crimination and prejudice, multiple poorly-rewarded responsibilities and calls on their time and energy, lack of support in crucial areas such as reproductive health and lack of resources.



Urban areas, with better-quality information, communication and technology, enable women to organize more quickly and more effectively, and allow groups that start off as small collectives to grow into larger networks and even international movements. The Huairou Commission, born out of the Fourth World Conference on Women in Beijing, is one such example. The presence of 35,000 non-governmental organization participants from around the world provided the momentum for the continued networking of these mostly women-led organizations, making it a true global movement that has influenced policymaking at the local, regional and international levels on issues of habitat and the environment.(1)

With increased ability to use news media, radio and television, messages can be disseminated instantaneously, encouraging learning in areas such as health, propelling specific causes of interest and advancing knowledge of women’s rights on a broad front. CEMINA (Communication, Education, and Information on Gender), for example, reaches thousands of listeners in some of the poorest communities across Brazil. With 400 radio programmes, the Women’s Radio Network brings education on gender equality, health and environmental issues into many homes.(2) 

From civic groups to savings groups, urban women have been active agents of change in their communities—working to meet shelter needs and improve essential services, upgrade slums and provide the backbone to economic security.(3)The Self-Employed Women’s Association, a trade union of 700,000 members in six Indian states, has set up facilities that provide health care, childcare and insurance services, research, training, communication and marketing, as well as housing and infrastructure for poor urban women working in the informal economy.(4)Such efforts often carry on without government or international support; however, when existing efforts of women are recognized and incorporated into programming, it has proven invaluable. The CAMEBA project is a vibrant demonstration of this: A slum upgrading project in Caracas, Venezuela, backed by the World Bank, it became more efficient and sustainable after the inclusion of the women’s groups which had already been working on the ground for several years.

In many cases, women’s organizations are able to do things other social movements cannot. Some of the disadvantages women face can be turned into strengths of sorts. Women and their organizations are less of a threat, not only to governments but to local gangs and the like. Thus, there are situations where men’s organizations would quickly be either corrupted or disrupted by the powers that be, whereas women’s organizations can gain power and support.(5)

Some governments have enacted quotas or parity laws to address these barriers and ensure that women have a critical level of participation in city councils and local governments.(37)Nevertheless, women make up only 16 per cent of members of national parliaments in Africa and Asia and 9 per cent in the Arab States.(38)These percentages are well below what is believed to be a “critical mass” for women to influence policy and spending priorities.

Despite this bleak picture in the capitals of nations, women’s participation in decentralized governance has increased. Local spheres of government offer greater opportunities for women’s empowerment and political participation, a situation that reflects positively on women’s prospects as urbanization increases. Moreover, countries with a higher percentage of women councillors are likely to have a higher number of women parliamentarians, which may, in turn, benefit women at the municipal level.(39)

Urbanization can thus be a powerful factor in creating the conditions for women’s empowerment. Turning this potential into reality is one of the most effective ways of promoting human rights, improving the living conditions of the poor and making the cities of developing countries better places in which to live.

Cities lend themselves to women’s social and political participation at many levels. For poor women whose lives have been confined to home, family and work, the act of joining an organization immediately broadens their prospects. When women actively participate in an organization, or take on leadership roles, they gain self-confidence, new skills, knowledge and a greater understanding of the world. Organizing can address many of the limitations that poverty imposes on poor women; it can begin to counter the costs and risks of informal work. It can also help to reduce poor women’s vulnerability, insecurity and dependence, including a lack of knowledge about the outside world and how it works.

Organizing also helps women who have few assets to pool resources, thereby increasing their economic power. Savings and credit groups may help the working poor access microfinance services, and producers with little capital may buy raw materials at wholesale prices by combining their resources.(40)

Such advantages could be enhanced with more support. Poor women need a representative voice in the institutions and processes that establish social and economic policies in a global economy, in order to continue improving the living and working conditions of the poor. International, regional and national negotiations regarding free trade agreements, the Millennium Development Goals and poverty reduction strategies all need to include the voices and concerns of the urban poor and, in particular, informal workers, the majority of whom are women. Ensuring a voice for poor urban women at the highest level requires that government and international organizations support the growth of their organizations and build capacity for leadership.


Access to health care is particularly critical for women, because of their reproductive functions, because they are disproportionately burdened with providing care for the elderly and the sick and because they do more to relieve poverty at the community level.(41)Better access to education and employment for women contributes to their overall empowerment, their capacity to exercise their right to health, including reproductive health, and, overall, improves their life chances.

These services and opportunities tend to be more readily available to women in urban than in rural areas. But for poor women, lack of time and money, as well as the lack of freedom to make household decisions, or even to move about the city, can negate these advantages. In urban areas, inclusive health policies and programmes, accompanied by better targeting of services and resources, could rapidly improve women’s health, in particular their reproductive health.

Gender relations and poverty condition how couples and families approach sexual and reproductive behaviour. Poor urban women are exposed to higher levels of reproductive health risks than other urban women. They are also less likely to obtain good-quality services. They are more likely to face gender-based violence in the home and on the streets and continue to be subject to harmful traditional practices.

Total fertility rates are lower in urban than in rural areas throughout the world.(42)But this does not mean that all urban women have the same access to reproductive health care, or even that they can all meet their needs for contraception. Poor women within cities are significantly less likely to use contraception and have higher fertility rates than their more affluent counterparts. At times their reproductive health situation more closely resembles that of rural women(43)(see Figure 4).

Figure 4: Total Fertility Rate for Residents of Urban Slum and Non-slum Areas and for Rural Areas: Selected African Countries, 2003-2004

zoom Click here to enlarge image


Source: Based on data provided by: UN-Habitat. Urban Indicators, Phase III.

Unmet need for contraception among women predictably varies according to relative poverty. Surveys covering Asia, Latin America, North Africa and sub-Saharan Africa show generally higher levels of unmet need among the rural population when compared to the urban population, with poor urbanites midway between the rural and the urban population as a whole.(44)In South-East Asia, for example, estimated unmet need is 23 per cent among the urban poor, compared to only 16 per cent among the urban non-poor.(45)

Overall, poverty may be a better indicator of fertility patterns than rural or urban residence. For policymakers concerned with the rate of urban growth, it will thus be especially important to look at the interactions between population and poverty, and increasingly within urban settings.(46)Prioritizing women’s empowerment, augmenting their access to education and employment and providing good quality sexual and reproductive health information and services to both women and men leverages their choices and is conducive to smaller, healthier families. This helps meet the needs and rights of individuals, while simultaneously improving prospects for economic growth and human well-being.


Gender-based violence, with its tremendous physical, psychological and financial damage inflicted on women and society, is a feature of urban life, regardless of income or educational status. Violence in its various forms, from intimidation to sexual assault, restricts the ability of women to move in and around the city,(47)reducing their freedom to seek work, social services and leisure activities. Physical and sexual abuse is also a factor in unwanted pregnancies, sexually transmitted infections (including HIV) and complications of pregnancy.(48)

Women in urban settings are far more likely than their rural counterparts to report having ever experienced violence, in part because of the breakdown in cultural mores that govern relations between the sexes.

Women in urban settings are far more likely than their rural counterparts to report having ever experienced violence.(49)Part of this can be ascribed simply to better possibilities in urban areas for denouncing violence. Yet, women may, in fact, be at greater risk of gender-based violence in urban areas, because of the breakdown in cultural mores that govern relations between the sexes and the lower likelihood that neighbours would intervene. Poverty, the move to a new environment (in the case of migrants), unemployment, inadequate wages, social exclusion and racism can produce frustration among men and vulnerability among women. The most deprived are the most likely to be affected.(50)Street children and sex workers are especially vulnerable.(51)

Rapidly shifting norms regarding male and female roles can also increase domestic violence. Research in the Philippines found that poverty and urban residence are associated with a higher likelihood of intimate-partner violence.(52)A study of urban women in Moshi, United Republic of Tanzania, found that 21.2 per cent had experienced an incident of intimate partner violence in the year preceding the survey, and more than a quarter had experienced it at some time in their lives.(53)


Maternal mortality remains astoundingly high, at about 529,000 a year, more than 99 per cent in developing countries, and much of it readily prevent­able.(54)Four out of five deaths are the direct result of obstetric complications,(55)most of which could be averted through delivery with a skilled birth attendant and access to emergency obstetric services.

Skilled attendance and access to emergency care explain why maternal mortality is generally lower in urban areas, where women are three times more likely to deliver with skilled health personnel than women in rural areas.(56)However, poor urban women are less likely to deliver with a skilled birth attendant.(57)For example, only 10-20 per cent of women deliver with skilled health personnel in the slums of Kenya, Mali, Rwanda and Uganda, compared to between 68 and 86 per cent in non-slum urban areas.(58)

There are a number of reasons why poor urban women do not seek maternal care. These include poverty and the more pressing demands of other household expenses, other demands on their time given their many other responsibilities and the absence of supporting infrastructure such as transport and childcare.(59)

Shelter deprivation increases mortality rates for children under five. In Ethiopia, the mortality rate in slums (180 per 1,000 live births) is almost double that in non-slum housing (95). Similar differentials prevail in Guinea, Nigeria, Rwanda and the United Republic of Tanzania. Countries such as the Philippines and Uzbekistan, with much lower levels of child mortality, also show a relationship between shelter deprivation and child survival.

Although poor children born in cities are closer to hospitals and clinics, and their parents are generally better informed, they still die at rates comparable to rural children.(60)Overcrowded and unhealthy living conditions, without adequate water and sanitation, provide a rich breeding ground for respiratory and intestinal diseases and increase mortality among malnourished urban children.(61)



The number of slum dwellers in India is estimated at 40.3 million in the 2001 census, that is, about 14.2 per cent of the total urban population. A UNFPA project in the State of Maharashtra operates in five municipalities which have experienced rapid growth of urban slum populations. 

In remote and inaccessible slum areas, the project upgraded basic emergency obstetric care centres to provide comprehensive services. It is working with women’s groups to strengthen women’s knowledge and capacities in the area of reproductive health as well as the institutional and community mechanisms to address gender-based violence.

The project also provides spaces for adolescents to discuss their sexual and reproductive health issues in a safe and accepting environment; it fosters improved access to reproductive health information and services; and it provides opportunities for adolescents to build their life skills.

In addition, the project has set up voluntary community-based depots for non-clinical contraceptives. The value of this approach is that it links communities with health institutions, increasing accessibility.

In Kenya’s rural areas, almost twice as many infants or children under five years of age die per 1,000 live births compared to Nairobi, the capital city. However, mortality rates are much higher in the capital’s informal settlements, where around half of Nairobi’s population lives. In Kibera, one of Africa’s largest slums, nearly one child in five dies before its fifth birthday. Surveys in many other cities have also shown under-five mortality rates of 100-250 per 1,000 live births in particular settlements. 


In urban settings, the risk and prevalence of HIV/AIDS increases, but the longer-term possibilities of reducing the epidemic appear to be better there. Currently, the situation is bleak. Rural-to-urban migrants leave behind not only partners and family but often customary restrictions on sexual behaviour as well. Cash dependency, coupled with poverty and gender discrimination, may increase transactional sex; at the same time, it reduces opportunities for negotiating safe sex, especially for women and girls but also for younger men and boys. Injecting drug use tends to be higher in urban settings. Sexually transmitted infections and tuberculosis, which increase the acquisition and transmission of HIV, are also more common in urban areas.

Some rural people living with HIV migrate to cities for better treatment and care, including antiretroviral drugs. As a result, HIV prevalence is generally higher in urban than rural populations in sub-Saharan Africa, the epicentre of the AIDS epidemic.(62)Botswana and South Africa both have high urbanization levels and extremely high HIV prevalence. 

Urban poverty is linked to HIV transmission and reduces the likelihood of treatment. Street children, orphans, sex workers and poor women in urban areas are particularly vulnerable to HIV infection. Poor urban women are more likely to become victims of sexual violence or human trafficking, increasing their risk; moreover, they are less likely to know how to protect themselves.(63)Women threatened with violence cannot negotiate safe sex. 

There is, however, some good news. Recent evidence of a downturn in HIV prevalence in urban areas of some countries suggests that urbanization may have the potential to reduce the epidemic. Condoms—key for HIV prevention—and information about HIV transmission may be more readily available in urban areas. Stigma and discrimination may also be lower in urban areas, because of better education and more exposure to people living with HIV/AIDS. 


Social Contradictions in Growing Cities: Dialogue and Discord


Since the 1950s, rapid urbanization has been a catalyst of cultural change. As globalization proceeds, the urban transition is having an enormous impact on ideas, values and beliefs. Such transformations have not been as uniform or seamless as social scientists predicted. The widening gaps between social groups make inequal­ity more visible. In this atmosphere, large cities can generate creativity and solidarity, but also make conflicts more acute.(64)

Rapidly growing cities, especially the larger ones, include various generations of migrants, each with a diversity of social and cultural backgrounds. Urban life thus exposes new arrivals to an assortment of cultural stimuli and presents them with new choices on a variety of issues, ranging from how their families are organized to what they do with their leisure time. In this sense, urbanization provides opportunities for broad cultural enrichment and is a prime mover of modernization. Through interaction of new urbanites with rural areas, it also accelerates social change across different regions.

At the same time, urbanites may lose contact with traditional norms and values. They may develop new aspirations, but not always the means to realize them. This, in turn, may lead to a sense of deracination and marginalization, accompanied by crises of identity, feelings of frustration and aggressive behaviour. Many people in developing countries also associate the pro­cesses of modernization and globalization with the imposition of Western values on their own cultures and resent them accordingly.(65)


The revival of religious adherence in its varied forms is one of the more noticeable cultural transformations accompanying urbanization. Rapid urbanization was expected to mean the triumph of rationality, secular values and the demystification of the world, as well as the relegation of religion to a secondary role. Instead, there has been a renewal in religious interest in many countries.

The growth of new religious movements is primarily an urban phenomenon,(66)for example, radical Islam in the Arab region, Pentecostal Christianity in Latin America and parts of Africa and the cult of Shivaji in parts of India. In China, where cities are growing at a breakneck pace, religious movements are fast gaining adherents.

Increased urbanization, coupled with slow economic development and globalization, has helped to increase religious diversity as part of the multiplication of subcultures in cities. Rather than revivals of a tradition, the new religious movements can be seen as adaptations of religion to new circumstances.

Research has tended to focus on extreme religious responses—which have indeed gained numerous followers—hence the tendency to lump them all under the rubric of “fundamentalism”. Yet religious revivalism has varied forms with different impacts, ranging from detached “new age” philosophy to immersion in the political process. Along this continuum, there are many manifestations of religious adherence. Together, they are rapidly changing political dynamics and the social identities of today’s global citizens.(67)


Inter-personal violence and insecurity is rising, particularly in urban areas of poorer countries. This exacts an enormous toll on individuals, communities and even nations, and is fast becoming a major security and public health issue.Violence tends to be greater in faster-growing and larger cities.

The daily living conditions of the urban poor have been strongly correlated with social exclusion and inequality, which tend to be more blatant and resented in cities.(68)They can heighten the potential for the emergence of conflict, crime or violence. The inadequacy of state institutions, particularly police and the justice system, affects the poor most severely. Women are the principal victims, particularly of sexual and domestic violence.

Increased violence is also associated with globalization and structural adjustment, which have aggravated inequality while reducing the capacity of the state to take remedial action. Criminal organizations have taken advantage of open markets to create a global criminal economy, promoting new forms of electronic fraud and international trafficking.(69)Globalization of the illicit drug industry, in particular, has a multiplying effect on violence and criminality.

Violence triggers a wide array of direct and indirect impacts on economic, political and social organization and has a huge impact on development: For instance, if the Latin American region had a crime rate similar to that of the rest of the world, its per capita gross domestic product might be “an astounding 25 per cent higher”.(70)

The organization of urban space is also affected by crime and violence. The affluent middle and upper classes wall themselves in and pay for private security. But the privatization of security itself can be a source of increased violence and disrespect for human rights.(71)

The impacts of crime, robbery, rape and assault on poorer communities are much more severe. The most damaging is perhaps the erosion of social capital—long-standing reciprocal trust among neighbours and community members—which is itself an effective protection against crime.(72)

It is particularly important to note that young people aged 15 to 24 commit the largest number of violent acts and are also the principal victims of violence. The coming “youth bulge” could signal an upsurge in violence unless preventive measures are taken now. Although women are vulnerable, especially to sexual violence and harassment, men are much more likely to become victims of violent crime (Figure 5). Young men are both the main perpetrators and the main victims of homicides.

As with many of the situations this Report describes, dealing effectively with urban violence calls for a longer-term outlook. The root causes of crime cannot be eliminated overnight. Policymakers must address violence not simply as an issue of social path­ology, but as a fundamental constraint on poor people’s livelihoods.(73)Altering the trend towards increasing violence calls for effective responses to poverty, inequality and social exclusion.

The Changing Demographics of Growing Cities


A clear youth bulge marks the demographic profile of cities in developing countries; this bulge is particularly large in slum populations. The individual successes and failures of young people as they ride the wave of urban growth will be decisive for future development since these drastic demographic changes, combined with persistent poverty and unemployment, are a source of conflict in cities across developing countries. Yet political processes rarely reflect the priorities of youth, especially the hundreds of millions of urban children who live in poverty and in conditions that threaten their health, safety, education and prospects.

Young people are typically dynamic, resourceful and receptive to change: But if they are uncared for, unschooled, unguided and unemployed, their energy can turn in destructive, often self-destructive, directions. Investing in urban children and youth, helping them to integrate themselves fully into society, is a matter of human rights and social justice. It is also the key to releasing potential economic benefits and ensuring urban security.

It is estimated that as many as 60 per cent of all urban dwellers will be under the age of 18 by 2030.(75)If urgent measures are not taken in terms of basic services, employment and housing, the youth bulge will grow up in poverty. The number of children born into slums in the developing world is increasing rapidly. Figure 6 shows that slums generally have a much higher proportion of children. The health problems associated with such environments have already been described.

A particular concern is the proliferation of street children and homeless orphans. In villages, the extended family or the community will normally adopt or foster orphaned or homeless children. Urban children and youth who have lost their parents to AIDS lack extended families who could take them in or keep a watchful eye on them. They are vulnerable to abduction and trafficking for sexual purposes. STIs, including HIV/AIDS, and the risk of being involved in or victimized by crime are high among these marginalized groups.

Figure 5: Estimated Global Homicide and Suicide Rates, by Age: World, 2000

zoom Click here to enlarge image


Source: WHO. 2002. World Report on Violence and Health. Geneva: WHO.


Young people need literacy, numeracy and an adequate level of formal schooling in order to function in complex urban settings and take full advantage of urban opportunities. School enrolment may be higher in cities because schools are closer to where people live, but again, the poor and, in particular, poor girls, have fewer opportunities. The transition from primary to secondary school is especially problematic since, at this stage, many young people have to start working to help support their families. Girls are often taken out of school to help with household work or to be married off, a practice still prevalent in many cities of sub-Saharan Africa. Schools may refuse to register slum children because their settlements have no official status. Many families cannot afford the indirect costs of “free” education, such as uniforms, textbooks and other supplies. Finally, the quality of education in slum schools is, with few exceptions, significantly inferior, thereby negating the urban advantage.

Not surprisingly, hazards related to the school system are much higher for girls. Factors such as the risks of travel to and from school, inadequate toilet facilities, overcrowding and sexual harassment deter parents from enrolling their daughters in school. Sexual abuse by teachers and other students has been documented in several countries and increases the dropout rates. Such obstacles combine with cultural and social practices that militate against girls’ education and favour child or early marriage. In some countries of sub-Saharan Africa, such as Benin, Côte d’Ivoire, Guinea and Mali, only half the school-age girls are registered in urban schools. In most others, between 20 and 30 per cent of girls living in slums are out of school. Geographically targeted education policies and programmes matter as much as shelter deprivation in increasing girls’ levels of school enrolment. Informal and flexible educational systems are needed in order to accommodate these situations.

Figure 6. Percentage of Male and Female Population, Aged 0-12, by Slum and Non-slum Residence, in Selected Countries

zoom Click here to enlarge image


Source: UN-Habitat. 2007. Urban Indicators Database.

Adolescence is the time when most young people initiate sexual activity. Lack of access to sexual and reproductive health information and services can lead to unwanted pregnancies and to unsafe abortions. The fact that young people, even in urban areas, do not have adequate information or services in sexual and reproductive health is a greater cause for concern in the era of the HIV/AIDS pandemic. About half of all new HIV infections occur among young people aged 15-24, in particular among girls.(76)

Unemployment and underemployment are major concerns for urban youth trying to provide for themselves and their extended families in cities. Young people living in urban poverty are more likely to be married, have at least one child and be heads of household, requiring greater financial resources at an early age.(77)Young women without education are more likely to find only temporary and informal work.



UNFPA Senegal supports a project for adolescent girls, in partnership with the UN Foundation, that combines reproductive health with livelihoods and life-skills activities within the framework of poverty-reduction strategies. UNFPA also supports voluntary HIV testing and counselling services for youth centres in urban areas where young people are more at risk from precocious sexuality, undesired pregnancies and sexually transmitted infections. Prevention activities target populations such as migrants and truck drivers who may put young people at risk.

Young men’s frustration at being unable to find adequate work, or to construct productive, decent livelihoods, contributes to violent behaviour on the streets or at home. Young unmarried women faced with uncertain financial futures may resort to early marriage or involvement in prostitution to provide for themselves and their children, increasing their risk of sexual violence and exposure to HIV/AIDS. 

Programmes offering job-skills training and mentoring and increasing access to capital and microenterprise support can help young people fulfil their economic potential. The ability of cities to absorb young people’s labour will be a key determinant in the future success of cities and their people.

Urban life greatly increases the exposure of young people to new technologies, mass media and global culture. The Internet is, in most developing countries, an exclusively urban phenomenon. It could be used more effectively in training young people and linking them to jobs.


The importance of involving the young in improving their neighbourhoods is being increasingly recognized. Young people have a right to a voice in matters that concern them. They are also experts on their own environments, well placed to identify not only the problems that confront them but also possible solutions. The Internet has greatly multiplied communication among young people; it could become an important tool in reaching out to them and promoting their effective participation in city governments.

Recognition of the need to involve young people in city governments has spawned such initiatives as the “Child-Friendly Cities” movement (a loose network of city governments committed to involving children in the process of making them better places for children) and the “Growing Up in Cities” programme (that has supported children in low-income urban neighbourhoods all over the world to assess their local environments and to work with local officials to improve them).(78)


The number and proportion of older persons is increasing throughout the world. Urbanization in developing countries will concentrate an increasing proportion of the older population in urban areas. In Africa and Asia, older persons still live predominantly in rural areas, but it is expected that this situation will be reversed before 2020.(79)

Given the context of limited access to social services, high incidence of poverty and low coverage of social security in many countries, this increase in the numbers of older people will challenge the capacity of national and local governments. In principle, urban areas offer more favourable conditions: better health facilities, home-nursing services and recreational facilities, as well as greater access to information and new technologies.(81)Urban areas also favour the rise of associations of older persons, as well as the development of community-based services to support the sick and the frail.



In the city of Barra Mansa, more than 6,000 children have been involved in discussions about how to improve their city. They take part in neighbourhood assemblies where they debate pressing issues and elect district delegates who, in turn, elect child councillors. All children aged between 9 and 15 can participate, nominate candidates and vote in the assemblies, but only those who attend school are eligible for election. Such initiatives improve the quality of neighbourhood responses to children’s priorities and provide children—both those elected and those who meet to discuss their concerns—with a genuine chance to apprentice in the skills of active citizenship.

However, to benefit from these theoretical advantages, older persons need economic security, strong social support systems, access to good transportation and unimpeded access to urban space free of charge.(82)In most cities of the developing world, these potential advantages are undermined by poverty and by physical or institutional restrictions. Moreover, older persons are often invisible, “lost” among other priorities. Urbanization tends to erode traditional sociocultural norms and values and the social networks and family support structures favouring the support of older persons by communities and families.

Three main areas need to be addressed: helping older persons to preserve their autonomy and independent living for as long as possible; providing health and other social services, including long-term care; and assuring higher levels of economic security through social protection systems for those who are more socially and economically vulnerable.

Particular attention must be given to the situation of women who are less likely to have lifetime earnings or full-time employment and who tend to live longer, thus losing spousal support. They are more likely to have worked in the informal sector and thus are not entitled to pensions and social security nor to have accumulated savings. Moreover, given the lack of state protection, the burden of care is likely to rest entirely on the shoulders of women and girls.

The data needed to analyse and monitor these issues have to be improved and updated, including mapping the situation of older persons and their social and spatial segregation.(83)In order to maximize the development benefits of urbanization for older persons while minimizing its possible negative impacts, new approaches will be needed. Box 12 offers a case example of tackling the issues of ageing populations in Asia.



By 2050, fully 24 per cent of China’s population will be 65 and over, compared with 8 per cent today; seven per cent will be 80 and over, compared with 1 per cent today. People live longer and have fewer children today, largely because technology allows them to do so. But there is no easy technological answer to the sudden arrival of large numbers of elderly people. Population ageing is happening fast in developing countries; ingenuity will be needed to meet its challenges.

Ageing in Asia is increasingly an urban phenomenon. The tradition that children support their parents in old age survives, but many young people have left the countryside for the city. A growing number of elderly people are following them, in search of a way to live. They do not always find it: In China, the city of Wei Hai is building homes for some 10,000 “abandoned elderly” who have no direct family support.

Adapting for an ageing future requires organizational ingenuity. In Chennai, India, for example, where the total fertility rate has already fallen to below replacement level, the city is closing 10 maternity clinics, retraining staff and reopening them as geriatric units.

Organizational change is also part of the response in East and South-East Asia, where ageing is already more advanced. Wei Hai is proposing itself as the site for a pilot programme in which the national family planning board’s mandate will be extended to include the aged. Such creative reorganization will be necessary to prepare for the challenge of urban ageing.

Improving Urban Governance and Involving the Poor: The Right Thing to Do

This chapter has highlighted some of the potentialities and the contrasting realities of the cities. Specifically, it discussed many of the problems faced by the rapidly growing population of urban poor. Large gaps between the access of poor and better-off urban residents to what the city has to offer can be observed with respect to gender, child mortality, reproductive health, education, income, housing and security. The conclusions are that the rights of the poor to the city and to its benefits are often severely restricted and that the advantages of the urban poor over rural populations are surprisingly small in many developing countries.

This is disappointing: Urban economies of scale and proximity should translate into access to better services for all urban dwellers. Extending services to poorer neighbourhoods costs much less than reaching the same numbers of people in remote and scattered rural settlements.(84)It thus stands to reason that much of the discrepancy between potential and reality has to do with urban management.

How can these patterns be improved? What would it take? This Report stresses that accepting the inevitability and potential advantages of urban growth is a crucial starting point. Unfortunately, prohibitionist approaches still prevail in managing urban and slum expansion. Many politicians and planners regard slum formation as temporary: the less intervention, the better.(85)

Instilling among leaders a more positive approach to urban growth and to slum dwellers calls for advocacy concerning the benefits of preparing effectively for urban growth. Ultimately, political commitment to feasible solutions is essential; that issue will be discussed in the next chapter. Policymakers and civil society both need solid information on who the poor are, how their numbers are expanding, where they live, what their needs are and what the obstacles are to accessing what the city has to offer. Chapter 6 looks at this aspect in some detail.

Another critical strategy in efforts to reduce poverty and fulfil the rights of individuals is to involve people in shaping the policies and programmes that affect their lives. The benefits of participation have been widely acknowledged and encouraged in national poverty reduction strategies, as well as in local-level approaches. Although involving this large and growing population in development processes would seem an obvious necessity, anti-urban prejudices in many cities still prevent it.(86)

In response to day-to-day realities, the urban poor themselves have set up formidable groups, associations and federations. Large or small, Organizations of the Urban Poor (OUPs) have come together to identify the social and economic conditions that they face; to find practical solutions to these problems; to struggle against marginalization; and to ensure access to the goods and services to which they are entitled. They have had success on a variety of fronts: slum upgrading, impeding relocations and evictions, providing affordable housing and infrastructure and building capacities for the stable livelihoods of their members.(87)

A few illustrative cases demonstrate this. The South African Homeless People’s Federation and the People’s Dialogue on Land and Shelter boast a combined membership of over 80,000 households. Through their community groups, the organizations work on local mapping and data gathering for planning; savings and credit schemes; acquisition of housing and land; income generation; and empowerment of individuals through networking and exchange.(88)

In approximately 80 cities around Afghanistan, community groups, mostly women-led, were providing education, health and business services even during the challenging times of Taliban rule. Today, UN-Habitat is working to fold such community initiatives into the development and infrastructure rebuilding process.(89)In the Philippines, a federation of neighbourhood organizations (ZOTO) led a successful effort to secure title and leasehold rights and community upgrading from the Philippine Government, in an area of Manila that had been slated for land conversion and the displacement of the masses of urban poor residing there. This effort, along with others, has brought new laws which make forced evictions nearly impossible without consultation of those affected and which assure relocation in properly serviced areas.(90)

Many OUPs eventually have an impact on the policies and practices of governments. In Pune, India, nearly 2 million inhabitants were supplied with public toilet blocks by the local Government. This was the result of a concept pioneered jointly by the Society for the Promotion of Area Resource Centres and by the National Slum Dwellers Federation, Mahila Milan—a network of savings and credit groups formed by women.(91)In Thailand, more than 1,000 organizations and community groups are linked into a national project to make locally based improvements to the urban environment in poor areas.(92)And in several Brazilian cities, participatory planning and budgeting has allocated a greater portion of the municipal investment budget to priorities determined by neighbourhoods and community groups.(93)

In other instances, small groups have grown into larger national federations and even into international networks.(94)Shack/Slum Dweller’s International, possibly the largest of such international movements, and the Huairou Commission (see Box 8) are two examples of how networked organizations have been effective in raising the profile of issues important to the urban poor.(95)Their pressure has influenced the international agenda in areas such as housing rights, protection against evictions, women’s rights and the responsibilities of government and civil society with regard to the plight of the urban poor.(96)

In such ways over the years, their creativity and lively action have demonstrated that OUPs are capable and motivated to take responsibility for their needs and to claim their rights to living a dignified and quality life. The UN Millennium Project’s Task Force on slums recommended that governments “acknowledge the organizations of the urban poor wherever they exist and to work with their strategies”.(97)Civil society participation and the country-driven approach are among the World Bank’s core principles in the poverty reduction strategy process.(98)

With proper governmental support these organizations can make an even greater impact in attacking material poverty, in harnessing their rights as citizens and city dwellers and in building their own capacities as active agents of change. Governments only stand to gain, since the inclusion of OUPs in city management increases its effectiveness. Needs and demands are better identified, while responsiveness and efficiency in urban service delivery are enhanced. Such collaboration also improves learning and understanding by combining technical expertise with local knowledge. Empowering civil society deepens democracy.(99)