It was during a reporting assignment that I found myself in a tribal village on the Bihar and Jharkhand border. It was inside the forests, an area once known for Maoist activities. I met Soni Murmu there who told me about her tryst with YouTube.

Soni, a madhu palak (bee keeper), lives in Rasuiya village with her husband, a farmer, and their son, who is in middle school. Soni herself has not gone to school. But that has in no way stopped her from running a flourishing honey business from her village in Banka district of Bihar and through an all-women FPO (farmer producer organisation). The honey she produces goes to clients as far as Mumbai.

Intrigued, I asked the Santhal Adivasi woman, who in the back of beyond village taught her bee-keeping and the business of honey.

“YouTube,” she replied. “Whenever I am free, I watch videos on the phone [smartphone] to learn new things. I used to watch videos on bee-keeping on YouTube, and during the pandemic when my husband had no work, I decided to try my hands at bee-keeping,” Soni smiled shyly.

I was surprised. Here was Soni, who was breaking down all preconceived notions of the tribal women living in remote corners of the country. She was strong, confident and efficiently running an enterprise, and had plans to add more bee boxes to her business.

Rural women constitute 48 percent of the country’s total rural population of 833 million (which is more than the total population of Europe at 742 million). But women from the villages in the country make it to mainstream media either when they are raped and murdered, or when a handful of them are picked to receive the Padma Awards. The rest of them live out their days in oblivion.

But time and again, as an environmental journalist, I have experienced something different. It is the rural and tribal women who have taught me some very important lessons in conservation and resilience, and what they know about ‘climate resilience’, would fill books.

In 2017, I travelled in north Bihar to report on floods. There, in Sahorwa village, in Ghongephur panchayat of Saharsa district, I saw what every other visitor to the Musahar (colloquially referred to as rat eaters) village of an extremely marginalised Mahadalit community saw. Poverty, open defecation, naked children running around on the kachcha lanes…

But, it was the women there who sat me down on a charpoy and it was there that I learnt all about the flood-compatible paddy variety, the indigenous desariya dhan, that they cultivated and ate. In that classroom under a tree, the ‘unlettered’ women of Sahorwa taught me about climate resilient crops that grew right there on their flooded fields not too far from my charpoy.

Sahorwa lies between the embankments of two major rivers in north Bihar – Kosi and Kamla Balan. Surrounded by water, its farmlands remain inundated under several feet of water levels for seven to eight months in a year making regular farming practices impossible.

This has led to the menfolk migrating in search of work. The community is so poor that buying foodgrains from outside is an expensive dream. But the women manage with the wisdom and lived experiences of a community that has lived in want for hundreds of years. They have lived with floods for centuries and have evolved their lifestyles, livelihoods and eating habits around it.

Desariya paddy, which they cultivate, is supposed to have evolved from the wild rice varieties grown in eastern Indo-Gangetic plains. It grows in flood conditions, and is hardy and nutritious. The coarse grains of desariya rice come in three varieties – white grain, black grain, and a mix of black-white grain. The latter is also known as cheeta or barogar dhan.

When I asked my teachers if they sold the desariya rice they grew, they laughed at my question. “Desariya dhan is a poor man’s rice. It is coarse and doesn’t look good. Why will anyone buy it? There are better rice varieties in the market. Also, we are able to grow only enough to feed our families.”

Rice aside, those women also have a local source of rich protein in their diet – ghongha (freshwater snail). The women stand in the chest-deep waters of their flooded fields and catch them.

Over 150 kilometres south of Saharsa district, across the Ganges in south Bihar, lies Kedia village in Jamui district. Here the women have helped turn their village into an organic village, and they also generate biogas which is used as a cooking fuel in their kitchens. Women feel strongly for organic farming as they are the ones, who do most farm labour work and are concerned about the health and nutrition of their children.

Those of us who churn out reports on climate change, climate vulnerability, adaptation and mitigation strategies from our comfortable offices and homes have much to learn from rural women. I know I learnt so much from the women of Sahorwa and Kedia and even Rasuiya. About preserving and cultivating indigenous and climate resilient varieties of crops, improving the health of soils and their families, and displaying remarkable resilience in the face of climate change and the ravages of floods.

This is not to discount the biases and discrimination rural women face. I know that the women I spoke to in Sahorwa battled prejudice of class, caste and gender. But, they are not taking things lying down. They continue to be a repository of traditional knowledge. And, while it may not be widely acknowledged, they are the backbone of our rural agrarian economy. Solutions to many of the complex problems of climate change and ecological destruction will come from the lived experiences of these women and their cumulative learnings.

In December 2022, Gaon Connection released a report titled 50 Success Stories of Rural Women in the Pandemic, which has documented several such stories of women. The book is available for a free download. Go ahead, download and read it to celebrate International Women’s Day!

*Nidhi Jamwal is a journalist based in Mumbai. She writes on environment, climate, and rural issues.

Courtesy: Kashmir Times

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Savita Gaikwad’s husband committed suicide three years ago because of debt. Since then, she has been cultivating the land owned by her father-in-law. Women in India rarely own the land they till. This costs them access to government programmes and benefits, and leaves them economically and socially insecure.

With no money and no place to go, the then 20-year-old borrowed money from a neighbour in Thanapada village of Nashik district in Maharashtra, to take a shared taxi to her parents’ home in Gawandh village, 18 km away. Kadale was a farmer who cultivated the six acres her husband owned.

Now, she cultivates the two acres her father owns. Essentially, her situation is no different–she remains without a title to the land she tills, and, hence, without economic or social security.

“I worked all day at my husband’s farm in Thanapada. He did help me with the ploughing and selling the produce, but I did most of the work,” said Kadale, 32, listing out the relentless cycle of sowing, weeding and harvesting that farming entails. “If I had owned at least a part of the land, he would have thought really hard before abandoning me and my children. Also, it would have secured my children’s future.”

Pushpa Kadale, 32, with her daughter, 14, and son, 12. Kadale, a farmer from Gawandh village in Nashik district of Maharashtra, was abandoned by her husband 12 years ago. With no land to her name, she now looks after her children and her ailing parents by cultivating her father’s two acres of land.

Like Kadale, many women farmers in India do not own the land that they cultivate. In a country where 73.2% of rural women workers are engaged in agriculture, women own only 12.8% of land holdings. In Maharashtra, 88.46% of rural women are employed by agriculture, the highest in the country. In western Maharashtra’s Nashik district, women own only 15.6% of the agricultural land holdings, amounting to 14% of the total cultivated area, as per the Agricultural Census of 2015.

Research has long established that women who own land have better economic and social security. “By diminishing the threat of forced eviction or poverty, direct and secure land rights boost women’s bargaining power in the home and improve their levels of public participation,” said a 2013 report by the United Nations.

Land acts as a bargaining tool for women, said Anita Pagare, a women’s rights activist based in Nashik. “With no land to their name, women are completely at the mercy of their husbands or their family.”

Land transfer in India occurs mainly through inheritance and this is mediated through a series of religion-centric personal laws. As per the Hindu Succession Act (HSA), after a male Hindu’s death, the land has to be divided among the widow, the mother and the children of the deceased. HSA is also applicable to people following Sikhism, Buddhism or Jainism.

Muslim women under the Muslim personal law get one-third of the share in property, while men get two-thirds. This is not applicable to agricultural land, except in some states. As per the Indian Succession Act, 1925, Christian widows will get one-third of the property while the remaining two-thirds will be divided equally between the children of the deceased.

Despite the legal rights, social and cultural forces deny women ownership of land.

In Gawandh village, Jijabai Gawli, 40, has been cultivating her husband’s 10 acres for 20 years. However, after her husband’s death seven years ago, she was not given the primary ownership of the land. “The land is firstly owned by my sister-in-law, then my mother-in-law, then my children,” said Gawli, “And as their guardian, I am named last.”

Jijabai Gawli, 40, with three of her daughters. Gawli cultivates a 10-acre piece of land that her husband owned. After his death seven years ago, the farm was transferred to her mother-in-law and sister-in-law. She says she could have secured her children’s future had she owned a piece of the land.

“In our culture, women do not have the right to land,” said Gawli, “My eldest daughter got married two years ago and works on her husband’s land. They will not transfer their land to her. She is an outsider.”

With four daughters and a son, Gawli said she would have been able to manage her expenses better and could have secured her children’s future had the land been in her name.

As many as 29% of the wives of indebted farmers who committed suicide were not able to get their husband’s land transferred to their names, said a 2018 study by Mahila Kisan Adhikari Manch (MAKAAM), an informal forum working to secure rights of women farmers in India. Of the 505 women that were covered in the study, 65% were not able to get their houses transferred to their names.

Savita Gaikwad, 31, has been cultivating the 15 guntha (0.375 acre) of land that her father-in-law owns in Nashik’s Songaon village since her marriage 13 years ago. Three years ago, her husband committed suicide because he could not pay back a Rs 1.5 lakh farm loan. Since then, she and her two sons, aged 12 and nine, have been dependent on her husband’s family and her father-in-law’s land.

After her husband’s death, Gaikwad asked her father-in-law to transfer the land to her name, but he refused. He asked her to make do with the yield from the land. “The farm requires an expenditure of Rs 10,000-Rs 11,000 annually and the returns depend on the yield. Last year, there was not much yield so I could not earn anything,” said Gaikwad, adding, “I need at least Rs 2,000 per month to take care of all the basic necessities for me and my sons.”

In order to make ends meet, Gaikwad takes up work as an agricultural labourer for a daily wage of Rs 150, in addition to working on her farm.

Savita Gaikwad’s husband committed suicide due to farm debt three years ago. Gaikwad and her two children are now dependent on her father-in-law’s land for survival.

Gaikwad also worries that someday she may be asked to vacate her house. Two years ago, her father-in-law took a loan on the land to build a new house where he, his wife, his son and daughter-in-law live. Gaikwad lives independently with her children in a house made with tin sheets held up with wooden beams.

Savita Gaikwad working on land that her father-in-law owns. Two years ago, her father-in-law took out a loan on the land to build a house (right). Gaikwad, who lives independently with her children in a house (left) made with tin sheets and wooden beams, worries that someday she will be asked to vacate the farm.

Gaikwad’s land was insured under the Pradhan Mantri Fasal Bima Yojana (Prime Minister’s Crop Insurance Scheme or PMFBY) last year, but the insurance amount was transferred to her father-in-law who owns the land. “Government schemes may have helped farmers. But since my father-in-law owns the land, he gets all the benefits,” says Gaikwad.

Women’s access to government schemes and other facilities is curtailed when the land they till is not in their name, said Seema Kulkarni, a member of the national facilitation team at MAKAAM.

The National Policy for Farmers, 2007 recommended a broader definition of a farmer, including labourers, tenants and other workers, but the government’s definition is based on ownership of land. The revenue department defines a farmer based on the land title records and the agriculture department follows the revenue department’s definitions, Kulkarni said. “Hence, most of the schemes require the submission of land title record, limiting the beneficiary base to landowners,” she said.

Access to institutional credit is also limited with no land ownership. The only funding options available to women with no land are self-help groups (SHG) and microfinancers, said Kulkarni, “With limited funding at SHGs, most women go with the microfinancers and accept their high interest rates and borderline inhuman recovery processes.”

In cases of farm suicides, access to institutional credit is of increased importance. After the death of the husband, the burden of paying off the debt falls on the widow. Most (58%) of these widows are younger than 45 and only a handful (1.7%) had other sources of income than agriculture, said the study by MAKAAM.

Gaikwad said she has not yet been able to repay her husband’s debt. “Some people had come to ask me for the money. But I told them of my situation. So they left,” said Gaikwad, “They might come back and I don’t know what I will do or how will I pay them.”

The Maharashtra government provides an ex gratia amount of Rs 1 lakh to the family of an indebted farmer who commits suicide. However, the death must be declared as farmer suicide for the family to get the money. “Documents stating the details of the loan have to be submitted to the committee constituted under the collector. After the committee approves it, the family gets the money,” said Raju Desale, working president of the All India Kisan Sabha (AIKS), a farmers’ union.

Gaikwad said she has not yet received the ex-gratia amount and that she has no idea about the procedure to get it.

To increase women farmers’ access to government schemes, the Maharashtra government on June 18, 2019 passed a government resolution to transfer the land title (called the 7/12 extract in Maharashtra) to the widow of the farmer who committed suicide. The resolution also states that widows will be given priority in access to government schemes and assistance cells shall be created at district level for the widows.

IndiaSpend tried contacting the officials at the Maharashtra revenue and forest department to know more about the implementation of the resolution but has not received a response yet. We visited the office of the principal secretary, Manu Kumar Srivastava, sent the office two emails and tried contacting him via the telephone five times. We will update this story if and when we receive a response.

(Reporting for this story was funded as a part of the Impact Journalism grant.)

Correction: An earlier version of the story erroneously said that the agriculture department defines farmers to include labourers, tenants and other workers. We have now corrected it to say that the National Policy for Farmers, 2007 recommended that definition.

(Shreya Raman is a data analyst with IndiaSpend.)

Courtesy: India Spend

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Yet feminist, minority and queer activists have argued that selfies can be a way for people to represent and take pride in their identity, sexuality and gender orientation. And recently, my own experiences researching gender, smart cities and urban citizenship in India have led me to see the value of selfies in a new and surprising way.

As part of a recent research project, my team and I were interested in understanding the lives of young women living in slum resettlement colonies on the outskirts of Delhi’s sprawling metropolis. To that end, we created a WhatsApp group, and asked 11 women to send in diary entries of their daily experiences in the form of images, text, audio or video as they travelled from their homes to the city over the course of six months.

Our participants turned out to be avid selfie takers. But there’s much more to this than a simple rendition of a millennial trend. Their selfies are digital, visual stories from the margins which capture their struggles and accomplishments as they step out from women’s traditional role in the home and navigate the largely male-dominated realm of the city.
 

Phones for fun and freedom

Getting a personal mobile phone is a significant event in the lives of these women. Families only permit the women to have their own phone after a series of difficult negotiations, as families are anxious that the phones could lead to what families perceive as “transgressive” behaviour, such as disobeying parents, breaking curfew, talking to men, or wearing Western clothes. Our participants convinced their families that having a phone is essential for keeping safe and staying in touch, when they have to go into the city for “legitimate” reasons such as work or education.

Smart phones usually come at a price which their families cannot afford, so when women start working they often spend their first salary to get one of the cheaper Android devices and pay off the full cost in monthly instalments. Data is affordable and connectivity can be instantaneous. Having a personal phone gives women the ability to leave the home and communicate with others away from the gaze of the family, so they see it as giving the gift of freedom.

Collage of fun selfies. WhatsApp diary entries.

Women celebrate this freedom using the phone’s front-facing camera. Of course, they take selfies for fun, using filters to transform their faces with amusing and outlandish templates.

But they also take selfies to record their visits to different places, celebrate their friendships and mark their coming of age as smart, connected young women, enjoying urban life – even when poor network connectivity means phones frequently crash and apps fail.
 

The city at arm’s length

Our participants didn’t really regard taking selfies as a political act. But when you consider how, when and where they take selfies the images are a barometer of their social, economic and political exclusion from the city. They speak to the paradoxes experienced by women living in Delhi’s urban peripheries, as both technology – and the city itself – can be at once liberating and dangerous.

In some ways, the selfies show that being in the city is liberating for women, as they represent a new-found freedom outside the home and the constraints of traditional gender roles. Through these selfies, women curate the city at arm’s length, placing themselves in the centre of the frame as they stage their own arrival in many different public places.

Collage of selfies in the city. WhatsApp diaries

But by recording women’s presence at a particular time and place, these selfies also give away what, when and where the women cannot be. For example, selfies are mostly taken during the day, or when they are with a group of friends, in places where there are fewer men, or in familiar neighbourhoods where they feel comfortable and confident. Very rarely do these women take selfies when they travel alone, – because sexually predatory male attention remains a constant feature of their journeys.

Uploading selfies to Facebook also exposes these women to the dangers of online and offline stalking, harassment and bullying. A disturbing picture entry in the WhatsApp diary, captioned “my selfie in a bus full of men”, evoked the Nirbhaya case of 2012 – when a young woman was fatally gang raped on a bus – and suggested that the selfie is also a way for these women to witness and record danger in their everyday life.
 

Phones between the home and the city

Selfies inside the home are largely absent in the WhatsApp diary entries. Although home is valued by their families as private – and therefore safe for women, our participants often viewed it as a place of confinement.

Home is where the women’s daily struggles with poor infrastructure for drinking water, sanitation, waste collection and transport take place. More significantly, family control over women’s bodies – through strict curfew hours and restrictions on where they can go – highlight older and younger generations’ very different understandings of freedom and danger.

While older generations who grew up without mobile phones are mainly concerned about women’s physical safety, the young women in our research have to deal with daily invasions of privacy, sexual harassment and abuse both at home and in the city, online and in real life. Their selfies tell a story about what it’s like to navigate the journeys between home and the city, as the boundaries between public and private, freedom and danger become increasingly blurred in these “smart times”.
 

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Sustained high economic growth since the early 1990s has led to improved education and health indicators among India’s women. Yet, women accounted for no more than 25% of the labour force in 2011-12, declining from 33% in 2005, according to national sample survey report (2014) on employment, a rate worse than neighbouring Bangladesh (29%), Nepal (52%) and Sri Lanka (34%), IndiaSpend reported on May 4, 2017

But this decline is more marked for rural women, according to data from the ministry of statistics and programme implementation’s National Sample Survey (NSS), 2014.

The aspirations of rural women, increasingly educated and exposed to paid labour opportunities under the Mahatma Gandhi National Rural Employment Guarantee scheme (MGNREGS), have shifted away from unpaid agricultural work on family farms toward more formal, paid work.

There are, however, not enough formal sector jobs available in rural areas. MGNREGS, a labour demand-driven programme, is limited to providing only 100 days of paid labour on public works projects per year. The few paid, formal jobs available, besides MGNREGS, tend to go to men and women with degrees, leaving women educated till the secondary school level in limbo–with skills that qualify them for non-agricultural work, but with few such jobs available, according to a 2018 study by the University of Maryland.

This lack of formal jobs, coupled with shrinking availability of agricultural work, has led to declining numbers of women in the rural workforce.

Labour force participation rate (LFPR) is a measure of the number of persons in the labour force per 1,000 persons. The NSS data recording the change in female LFPR in rural and urban areas over 18 years to 2011 show that the female LFPR has declined in both.

However, a closer look at the NSS data shows that the decline is steeper in rural areas. Whereas female LFPR in urban areas has declined from 165 per 1,000 in 1993 to 155 in 2011, in rural areas the female LFPR has fallen from 330 to 253 over the same period.

Fewer agricultural work opportunities are partly responsible for this decline. The size of agricultural landholdings has shrunk with concomitant divisions within families, according to agricultural data.

The average farm size fell from 1.23 hectares in 2000-01 to 1.15 hectares in 2010-11, according to the ministry of agriculture’s Agricultural Census 2011. Increasing mechanisation has also possibly led to a decline in the demand for agricultural wage labour, according to a 2018 joint study by the National Council of Applied Economic Research (NCAER) and the University of Maryland.

Decline is greater in lower income classes
The decline in labour force participation among rural women is also greater among the lower income sections, NSS data show. The first three income classes–representing the lowest earners in rural India–have the lowest female workforce population ratio (WPR) (defined as the number of people who are currently employed per 1000 of the population), according to NSS data. The lowest representation of 198 per 1,000 females is in the third lowest income class of 20%-30%, while the highest of 288 is in the third highest income class of 70%-80%.

The increasing workforce population ratio is higher income classes in rural India clearly indicates rural women’s changed aspirations towards more formal, paid work. Where alternatives for remunerative employment are provided, such as by MGNREGS, rural women prefer these over unpaid labour, according to a 2015 study conducted by the Indian Institute of Management, Ahmedabad for the NITI Aayog. The decline in female WPR in the lower income classes may be attributed to a number of factors, the study said. Increased income may have led to women withdrawing from distress employment, preferring instead to do family farm work. Some formal sector work done by women in lower income rural families is also going unrecorded. For instance, women and girls contribute labour to the recorded wages earned by male relatives, particularly in jobs such as construction work, the study added.  

Better education not leading to increased employment
One of the main factors identified as hindering women’s participation in the workforce is low education.

With education levels improving with incentives for female education, higher levels of literacy (22% in 1983 to 55% in 2011) and primary education (10% in 2005 to 17% in 2011) have been recorded among women in rural areas, according to NSS data.

However, better education is not leading to increased employment for rural women. The NSS data on workforce population rates by education level show a decline in the WPR despite increased education levels among rural women.

Increases in education–from none to completed secondary school (up to class 12)–are associated with a decline in women’s participation in the rural labour force, from 53.3% to 22.4%.

The WPR drops with rise in education levels: From 445 per 1,000 rural women who are not literate to 121 for women who have completed secondary education and above.

While most girls in rural India have received primary education, secondary school enrolment has also increased. This may account for the withdrawal of younger women of secondary school-going age from the rural workforce.

For women beyond this age–from 20-64 years–school enrolment is not a factor in work participation. The decline in WPR for rural women, however, affects women at all ages, the NSS data show. This suggests a deeper problem than that implied by the trade-off between the time spent in school and the time spent working.

For women past secondary school-going age, workforce population has increased for urban women, while it has declined for rural women, reflecting the greater availability of formal jobs in urban areas.

Among rural women, only women with higher educational qualifications are finding non-agricultural jobs. Beyond secondary school-going age, the decline in women’s workforce population ratio is not as much as it is for women with intermediate education.

Up to 28.1% of rural women who are college graduates are employed, according to a 2018  study by the University of Maryland. “Educated women look mainly for better quality jobs, especially salaried work,” said the study. “The inference might be that if all or most available jobs were salaried, Indian women would show the usual positive relationship of higher rates of employment with more education.”

“However, such jobs are limited and are accessible mainly with higher levels of education,” said the study. “If appropriate jobs were available for women with intermediate levels of education, we might expect higher levels of their labor force participation.”

Improved transport infrastructure increases rural women’s work participation
Most salaried jobs are in the cities, towns and big villages. Hence, availability of transport and allied infrastructure has an impact on women’s participation in the workforce, according to a 2017 study by University of Maryland that looked at data from India Human Development Survey (IHDS) rounds of 2004-05 and 2011-12, jointly conducted by the University of Maryland and NCAER.

“The conditions of transportation infrastructure have also changed dramatically during the survey interval, particularly because of the strong push by the central government through the PMGSY [Pradhan Mantri Gram Sadak Yojana],” the study said. “Many more villages were accessible by kutcha (unpaved) and pucca (paved) roads in 2012 than in 2005. The percentage [of villages] with “no road access” dropped from 6% to 1% during the seven-year interval.”

“Regarding the frequency of bus service, the percentage of villages with no bus services also dropped from 47% in 2005 to 38% in 2012,” said the study. “More villages had bus services one to six times a day in 2012 than in 2005, but slightly fewer villages had bus services seven times or more a day in 2012 compared to 2005.”

The IHDS surveys found that the construction of either a kutcha or a pucca road increased the odds of women’s participation in non-farm work by 1.5 and 1.4 times, respectively. Their gains were higher than that of men, who also benefited from road construction by 1.2 times for kutcha roads and 1.4 times for pucca roads, according to the study, reflecting the long-standing gender gap in employment. With men outnumbering women in the workforce, more women than men stand to gain from improved transport infrastructure.

The non-agricultural employment rate has also increased significantly for both men and women over the seven years to 2012, though the rate has remained much lower among women than among men. Only 10% of women participated in non-agricultural work in 2005, wḣich increased to 17% in 2012. The non-agricultural employment rate for men increased from 47% in 2005 to 55% in 2012.

MGNREGS work increases market wages for men, but not women
Another factor that has had an impact on women’s workforce participation is the MGNREGS. IHDS data suggest that fewer (46%) women reported having ‘no work’ in 2011-12 than in 2004-05 (50%). The Mahatma Gandhi National Rural Employment Guarantee Act was enacted in 2005.

More women (9%) reported being engaged in non-farm work than the 6% involved in farm work from 2004-05 to 2011-12, according to the IHDS data. This suggests that the expansion of opportunities due to MGNREGS draws those women into paid labour who might have otherwise continued to work only on family farms. Further, research on IHDS data shows that nearly 45% of women MGNREGS workers worked as unpaid labour on family farms during the first wave of IHDS in 2004-05.

Higher allocation of MGNREGS work has been found to raise market wages (for formal work beyond MGNREGS) for male MGNREGS workers, but a similar increase is not statistically significant for women, according to a 2018 study by the NCAER. This underscores the gender bias in access to formal work. Where formal jobs beyond MGNREGS become available in rural areas, these go mostly to male MGNREGS workers, leaving women MGNREGS workers restricted to the informal sector.

(Salve is a senior policy analyst with IndiaSpend.)

Courtesy: India Spend
 

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Overall, there was a 6% rise in dependence on public healthcare for out-patients and 7% for in-patients over the decade ending 2014, said the Brookings report, which analysed National Sample Survey Office (NSSO) data over this period.
 
An in-patient is formally admitted for at least one night to a hospital, while an out-patient visits a hospital, clinic, or associated facility for diagnosis or treatment.
 
For out-patient care, 74.9% of ailing patients (who sought care) exclusively accessed a private facility in 2014, compared to 79.7% in 2004. The biggest decrease was seen among rural women, as we said. While 78.2% of them sought private care in 2004, 70.4% did in 2014.
 

Source: Brookings India, based on National Sample Survey Office data
 
In-patients depend less on the private sector than do out-patients, the data reveal.
 
The percentage of in-patients seeking public care increased from 42.3% in 2004 to 45.4% in 2014;  the percentage of rural women accessing public care rose from 45.1% in 2004 to 56.1% in 2014.
 

Source: Brookings India, based on National Sample Survey Office data
 
“The number of people seeking private healthcare, however, might be an underestimation, as NSSO surveyors are instructed to mark all those who went to both government and private facilities as “only going to government facilities,” said the Brookings report.
 
Indians spend eight times more in a private hospital than a government hospital, according to this analysis of National Health Accounts (NHA) 2013-14 data by The Hindu.
 
Quality of care biggest constraint for not accessing public hospitals
 
Despite the decline in exclusive dependence on private care, 29 of every 1,000 Indians pointed to the unsatisfactory quality of healthcare, the most commonly cited reason for not accessing a public hospital.
 
Long waiting periods at government health services appears to be an increasing bottleneck in seeking public care. In 2004, 6.8 of every 1,000 cited this as a reason for not using a public hospital; it rose to 18.6 in 2014.
 
Of 930,000 doctors in India, 11.4% (106,000) work for the government. This means there is one government doctor for every 11,528 people, according to the National Health Profile 2015, IndiaSpend reported in November 2016.
 
Public-health centers across India’s rural areas–25,308 in 29 states and seven union territories–are short of more than 3,000 doctors, the scarcity rising 200% (or tripling) over 10 years, IndiaSpend reported in February 2016.

Source: Brookings India
 
More people required medical care over a decade
 
The number of people not using medical services fell from 15.1 in every 1,000 in 2004 to 12.4 in 2014, which implies an 18% increase in Indians seeking some form of healthcare.
 
There was an increase, however, in the proportion of people not seeking services, as they felt their ailment wasn’t serious enough, and more women than men report not using healthcare due to the same reason–the gender gap has widened over the decade.
 
More Indian men are likely to be admitted to hospital during the last moments of life than women–62.5% to 37.5%, IndiaSpend reported in November 2016. For every 1,000 men whose death is certified by medical professionals, the corresponding figure for women is 600.

Source: Brookings India
 
The number of people not using healthcare due to financial reasons reduced from four of every 1,000 in 2004 to 0.7 in 2014, said the Brookings report, possibly a result of rising incomes or use of publicly funded health-insurance schemes implemented over the last 10 years by the central and state governments.
 
About 12% of the urban and 13% of the rural population got health insurance through the Rashtriya Swasthya Bima Yojana (National Health Insurance Scheme) or similar plans, IndiaSpend reported in July 2015.
 
(Saha is an MA Gender and Development student at Institute of Development Studies, University of Sussex.)

This article was firs published on India Spend
 
 

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