On 7-13 February 2018, Kuala Lumpur was host to the 9th World Urban Forum; at the event, on 8 February, ARROW organised a side event titled “Gender Responsive, Inclusive and Safe Space for Women for Resilient and Sustainable Cities,” where we highlighted the key issues in ensuring a gender-responsive urban development and planning that takes into account gender inequality, gender-based violence and affordable and universal access to health services, including sexual and reproductive health services. In continuation of that dialogue, Sivananthi Thanenthiran, the Executive Director of ARROW, has written an article on the multiple dimensions that make up a truly social inclusive city:

Cities –sprawling entities, shining beacons of the modern-day development – are often equated with the issues of over-crowding, pollution, marginalisation, and a lack of safety. However, cities also have tremendous potential: they can be safe, culturally rich, economically vibrant, creatively stimulating, and most of all – sustainable – consuming low levels of energy and resources. Cities are also able, to roll out services effectively and efficiently, to citizens in rapidly urbanising scenarios.

The concept of “the city” has fascinated people for a long time. The Greeks and the Romans were all deeply interested in the design, building and running of cities. In the Renaissance period, Shakespeare asked, “What is the city, but the people?”, striking right at the heart of the most important aspect of sustainable development of cities – understanding the people who populate it.

Cities are a melting pot of very diverse groups of people, possibly the most diverse representation of the population of a whole country. The lure of the bright, neon lights attracts hopefuls in search of a better life and future for themselves and their families, and to realize their full potential as human beings, like so many moths to a flame. It is safe to say that the citizens in any city will be comprised of men, women, children, migrants (both internal and external), the rich, the poor, the well-educated and the lesser educated, those employed both by the formal and informal sectors.

Hence, the first point we must take note of is that social inclusivity of cities is a critical aspect of human rights and city governance, and it will be a key determinant of how well cities will develop.

Subsequently, addressing social inclusivity entails the need to tackle poverty and inequalities in cities, in line with the central discussion of the post-2015. Even as cities generate income and wealth for economic growth, it is there that the disparities amongst individual citizens is at its starkest. The poverty amidst plenty is visible to all, and the juxtaposition of where and how the wealthiest live alongside the poorest has been immortalised in counter culture cartoons and images.

Hence, one of the key strategies to reduce poverty must be focused on the reduction of urban poverty. There are a few dimensions to urban poverty:

• Income: also tied to the types of income due to the work in the informal sector, which places workers at risk without social benefit coverage such as retirement and health insurance. This is especially true for jobs and workers that are seasonal in nature – different demands at different times of the year.
• Health: Many of the areas where most of the poor live in cities share the same characteristics; over-crowded, unhygienic living conditions (increasing exposure to diseases through air and water), and exposure to environmental hazards such as landslides and floods. In some countries which follow the centralised government system, internal migrants don’t have access to services due to their location and identification status. The hukou system in China is an example of this, where health and education services can only be obtained from the place you were registered and born in. This is a barrier for accessing critical health services for these migrant poor – antenatal health and safe delivery services comes to mind. One of the advocacy work that we did was in Shanghai, China; the country itself has a very low maternal mortality rate on the whole, but health indicators were showing that maternal deaths amongst migrant women were higher than the average. Through the data collection effort of our partner, the Shanghai Women’s Health Institute, an effective education and advocacy programme was made to make access easily available. The net result of this allowed the city to be more responsive to the needs of internal migrant women. Some of the other indicators we can measure to assess the health poverty of these marginalised groups are access to primary health services, share of household expenditure on health care, share of household expenditure on food, and access to nutritional safety net.
• Education: being able to register their children in schools, and the quality of the services accessed.
• Personal and tenure insecurity: these are forms of poverty which are overlooked. Often these groups leave well-established social and familial support systems behind, leading to a greater likelihood of gender-based violence, family breakdown and reduced support for children. Tenure insecurity is also a common feature of urban poverty; squatters are still expected to spend a large portion of their income on rent, and yet they are not guaranteed housing rights in any way, at risk of being evicted and forcibly moved elsewhere “at the drop of a dime”.
• Disempowerment: the direct result of the illegitimacy of residence, work, and the isolation of communities that are so far removed from access to services.

The convergence of these dimensions reinforces the importance of access to health services for poverty reduction strategies in cities, and this too refers to not just a generic and nebulous concept, but a comprehensive set of services, especially sexual and reproductive health services such as access to contraceptive services, access to maternal health services (antenatal, delivery, post-natal, abortion and post-abortion care, access to STIs and HIV screening, treatment and care, access to GBV services), health and legal services, as well as access to CSE and life-skills for marginalised groups (young people, women, migrants, LGBTIQ, sex workers). For specific economic groups it will be essential to make sure these services are affordable if not free, and there are social insurance schemes that take care of the poorest and most marginalised groups in society. Taking into consideration rural-urban migration, and inter-state migration, barriers such language and ethnic differences need to be catered for. In some societies which follow registration systems such as the hukou system in China – need to be updated and revamped – to ensure that migrant workers are able to procure services at cities they work in, and not just the villages they were born in.

Crucially, these strategies will also help break the vicious cycle of poverty and ill-health amongst the urban poor by reducing their out-of-pocket health expenditure, and reduce social inequalities between the different income groups and between migrants and residents.

The city is also a litmus test of whether the established frameworks (e.g. CEDAW, CRC, Beijing & Cairo) are realised. Is the city a place of equal treatement and equal opportunity for women as well as men? Is the city friendly and belong to its children? Is the city able to plan for its people and its future taking into account the inter-sections with different trends such as climate change & technology development? Agenda 2030 and the SDGs have a great potential to be the red ribbon that ties international framework and local implementation together – let us all ensure that it shall be so.