disability in india _ statistical profile 2011 march mospi

8/13/2019 Disability in India _ Statistical Profile 2011 March MOSPI

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Disability in India

- A Statistical Profile

March 2 11

Central Statistics OfficeMinistry of Statistics & Programme Implementation

Government of India


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Foreword

In most parts of the World people with disabilities are subject to multiple deprivations with limitedaccess to basic services, including education, employment, rehabilitation facilities etc. Widespreadsocial stigma plays a major role in hindering their normal social and economic life. However in the last

three decades since the International Year of Disability in 1981, there has been a "paradigm shift" inattitudes and approaches to persons with disabilities. Worldwide the movement takes a new height fromviewing persons with disabilities as "objects" of charity, medical treatment and social protection totreating them as "subjects" with rights, capable of claiming those rights and making decisions for theirlives based on their free and informed consent as active members of society.

The Asia Pacific Region followed up the UN initiative with two consecutive disability specific regionaldecade initiatives since 1993 with approximately two-thirds of worlds 600 million disabled peopleliving in this region. It led to the formulation of Biwako Millenium Framework for action towards aninclusive, barrier free and rights-based society for persons with disabilities and its supplement, the

Biwako Plus Five for further efforts in this regard. In accordance with this convention, Governments areexpected to enhance their national capacities in data collection and analysis of disability statistics besidesother policy initiatives.

The Washington Group on Disability Statistics was formed by United Nations Statistics Division in 2001to allow the representatives from national statistical agencies of various countries to come together andaddress selected problems in statistical methods in compiling Disability Statistics.

However, there has been a major difference between the developed and the developing countries inunderstanding the disability types and formulation of their measures. In economically developedcountries these have been conceived in keeping with the greater scope of using measuring devicesduring disability surveys/ censuses or in the administrative records of the medical facility centres. Onthe other hand such advanced procedures are not feasible in developing countries for getting accuratemeasure of various disability related parameters. For this very reason, India, like most of the developingcountries, could not adopt the International Classification of Functioning, Disability and Healthframework for identification and measurement of disability types. In these countries disability statisticsis essentially based on the informants response to the simple, easily comprehensible disabilityquestionnaire and thus can capture only the most severe cases. This is reflected in the wide divergencein the estimates of prevalence of disability of the developed and the developing countries. In India theofficial statistics collected through both Population Censuses and the nationwide sample surveys put an

estimate of around 2% prevalence of disability as against nearly 20% in countries like Australia and NewZealand in the Asia Pacific region.

This publication has contextualized the analysis of existing official data on disability with reference tothe policy framework and the embedded principles of social justice followed in the country at present.

(T. C. A. Anant)Secretary, Ministry of Statistics & Programme Implementation


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Preface

In India, the enactment of the Persons with Disabilities (Equal Opportunities, Protection of Rights andFull Participation) Act, 1995 is a signal achievement of its disability movement. With increasingawareness of disability-based discrimination, explicit legal safeguards and major internationalcommitments as a signatory of United Nations Convention on the Rights of Persons with Disabilities(2006), India is attempting a multi-faceted approach to maximise the participation of these differentlyabled persons in the socio-economic progress of the country.

In order to work towards an inclusive, barrier free society through raising awareness and policy actions,there is a need to have comprehensive reliable statistics on people with disability and their socio-economic conditions. In India, the major sources of statistics on disability are the decadal PopulationCensuses and the regular large scale sample surveys on disability conducted by National Sample SurveyOrganisation (NSSO). Based primarily on the findings of the latest Population Census (2001) and NSSSurvey on Disability (2002), this statistical profile of the disabled persons in India along with discussionon relevant national and international issues makes the publication a comprehensive documentation onthe subject. It is expected to be a unique guide in analysing the issues of concern for deciding on thenature and locales of necessary policy interventions.

The detail discussion on the disability statistics in India available through multiple sources brings aboutthe issue of variation in the estimates of disability from different official sources due to differences inconcepts, definitions, methodology, type of questions etc. Thus one can find variations in the estimatesof prevalence of various types of disability as obtained from NSSO 2002 and Census 2001 mainly due to

different definitions used by these two agencies and hence leading to different coverage of thepopulation. A Technical Advisory Committee (TAC) on Disability Statistics was constituted by theMinistry of Statistics & Programme Implementation in the year 2005 to review the conceptualframework and definition for the measurement of disability. The Committee deliberated on the issue inconsultation with the various stakeholders and came up with standardized definition and questionnairefor collection of information on disability. However, subsequent progressive changes are yet to bereflected as the new Population Census 2011 is presently under way.

I wish to place on record my sincere appreciation for the dedicated effort put in by the team of officersled by Smt. S.Jeyalakshmi, Additional Director General, Social Statistics Division of my office in

bringing out this publication.

(S.K.Das)

Director General, Central Statistics Office


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Officers of Social Statistics Division, Central Statistics Office,

Associated with the Publication

Smt. S. Jeyalakshmi

Additional Director General

Shri S. Chakrabarti

Deputy Director General

Smt. Nivedita Gupta

Director


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CONTENTS

Chapter no. Topic Page no.

Snapshot of Disability Statistics viii - ix

Abbreviations x

1. Introduction A1 A9

2. Overview of Statistical Evidences on Disability B1 B5

3. Major Concepts and Definitions C1 C12

4. Dimension of Disability in India D1 D18

5. Nature and Causes of Different Types of Disability E1 E156. Socio-economic Profile of Disabled Persons F1 F22

7. International Scenario G1 G7

8. Government Initiatives for Redressal of Disability in India H1 H8

Appendix-I State-wise Tables and Maps on Disability S1 S11

Appendix-II Major References

State-wise Tables and Maps on Disability

Table S1: Total Number (in 000) of Disabled Persons in States/UTs in India for each PopulationCategory: Population Census 2001

Table S2: Total Number (in thousands) of Disabled Persons in States/ UTs in India and their PercentageDistribution by Type of Disability: Population Census 2001

Table S3: Number of Totally Disabled and their % distribution by type of disability in states/UTs ofIndia in 1981 Population Census 1981

Table S4: Percentage of disabled persons in the population of each State/UT: NSS Survey on Disability2002

Table S5: Prevalence of different types of disability per 100,000 persons in each state/UT : NSS Surveyon Disability 2002

Table S6: Percentage distribution of disabled persons of age 5 years and above by level of generaleducation for each state/UT: NSS Survey on Disability 2002

Page S7 to S11: Maps depicting prevalence of various types of disability in the states of India based onNSSO survey (2002) findings


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Snapshot of Disability Statistics

Item of information Census 2001 NSS Survey 2002

Proportion of disabled persons in population2.1% 1.8%

Estimated size of disabled population21 million 18.5 million

Sex ratio among the disabled (no. of females per 1000 males)738 698

Location of the disabled personsRural: 75%

Urban: 25%Rural: 76%

Urban: 24%

Decomposition of disabled population by type of disability49% in seeing7% in speech

6% in hearing

28% in movement10% mental

15% in seeing12% in speech

17% in hearing

57% in movement11% mental

Decomposition of disabled population by age-groupMore than 50% have age less than 30

and 25% were of age 50 or more44% have age less than 30 and35% were of age 50 or more

Literacy and completed educational level of disabled population51% not literate,

26% literate up to primary6% completed middle level

13% secondary level or above

55% not literate,25% literate up to primary

11% completed middle level9% secondary level or above

Percentage of disabled children attending schoolsIn age-group 6-10 years:

56% (rural) & 64%(urban)In age-group 11-14 years:64%(rural) & 69%(urban)

In age-group 5-18 years:48% (rural) & 55% (urban)


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Item of information Census 2001 NSS Survey 2002

Employment status of disabled population

Among males: 55% main workers,9% marginal & 36% non-workers.

Among females: 19% main worker,13% marginal & 68% non-workers.

Among males: 36% employed,1% unemployed & 63% out of

labour forceAmong females: 10% employed0.3% unemployed & 89% out of

labour force.

Level of Living of households reporting disability

-

Of households reporting disabilityof one or more of its members60% in rural areas and more than25% in urban areas had monthlyper capita consumptionexpenditure of Rs. 300.

Extent of disability

-

60% could take self-care withoutaid/appliance;

17% could take self-care only withaid/appliance;

9% had not tried appliance;

13% could not take self-care evenwith the help of aid/appliance.


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Abbreviations

BMF Biwako Millennium Framework

DISTAT United Nations Disability Statistics Database

ESCAP Economic and Social Commission for Asia and the Pacific

ICD-10 International Statistical Classification of Diseases and Related Health Problems

ICF International Classification of Functioning, Disability and Health

ICIDH International Classification of Impairments, Disabilities, and Handicaps

MoSPI Ministry of Statistics & Programme Implementation, Government of India

MSJE Ministry of Social Justice & Empowerment, Government of India

NSSO National Sample Survey Organisation (now National Sample Survey Office)

PWD Persons with Disabilities

PWD Act Persons with Disabilities (Equal opportunities, Protection of Rights and FullParticipation) Act 1995

SAARC South Asian Association for Regional Cooperation

SHO Self-help organizations of persons with disabilities

TAC Technical Advisory Committee on Disability Statistics

UNCRPD United Nations Convention on the Rights of Persons with Disabilities (2006)

UNSR United Nations Standard Rules on the Equalization of Opportunities for Persons withDisabilities

WHO World Health Organisation

WHO-FIC WHO Family of International Classifications


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Chapter 1

Introduction

1.1 What is Disability?

As defined by the World Health OrganizationDisability is an umbrella term, covering impairments, activitylimitations, and participation restrictions. Impairment is a problem in body function or structure; an activity limitais a difficulty encountered by an individual in executing a task or action; while a participation restriction is a pro

experienced by an individual in involvement in life situations. Thus disability is a complex phenomenon, reflecting aninteraction between features of a persons body and features of the society in which he or she lives."

The Convention on the Rights of Persons with Disabilities (2006), the first legally binding disability specifichuman rights convention, adopted by the United Nations gives two descriptions of disability. The Preambleto the Convention states that Disability results from the interaction between persons with impairments anattitudinal and environmental barriers that hinder their full and effective participation in society on an equal basis wothers. Again it emphasizes that Persons with disabilities include those who have long term physical, mentaintellectual or sensory impairments which in interaction with various barriers may hinder their full and effe participation in society on an equal basis with others. Both the expressions reflect a shift from a medical modelto social model of disability.

In the medical model, individuals with certain physical, intellectual, psychological and mental impairmentsare taken as disabled. According to this, the disability lies in the individual as it is equated with restrictionsof activity with the burden of adjusting with environment through cures, treatment and rehabilitation. Incontrast in the social model the focus is on the society, which imposes undue restrictions on the behaviourof persons with impairment. In this, disability does not lie in individuals, but in the interaction betweenindividuals and society. It advocates that persons with disabilities are right holders and are entitled to strivefor the removal of institutional, physical, informational and attitudinal barriers in society.

The WHO estimated that more than six hundred million people across the globe live with disabilities ofvarious types due to chronic diseases, injuries, violence, infectious diseases, malnutrition, and other causesrelated to poverty. People with disabilities are subject to multiple deprivations with limited access to basicservices, including education, employment, rehabilitation facilities etc. Widespread social stigma plays amajor role in hindering their normal social and economic life. To work towards an inclusive, barrier free

Science may have found a cure for most evils; but it has found no remedy for the worst of them all -the apathy of human beings." -Helen Keller


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society through raising awareness and policy actions, there is a need to have comprehensive reliablestatistics on people with disability and their socio-economic conditions.

1.2 Disability in India

While estimates vary, at the turn of the new millennium about 21 million people in India were found tohave disability as per the official statistics. These included persons with visual, hearing speech, locomotor ormental disabilities, who constituted about 2 percent of the population. However, some sources claim thatthe magnitude in actuality is more with at least 5 per cent of population suffering from one disability orother and the official statistics accounting for only the most severe ones. By and large, people with disabilityare further disabled through unequal treatment and denial of basic rights by the broader society. Thevoiceless disabled people are inseparable part of Indias growing population of marginal, weaker andvulnerable sections of society.

The roles and responsibilities of the Government of India are clearly identified in laws but there is a need to

study the gap between the law and the practice. This report aims at presenting a statistical profile ofdisability in India, especially in the new millennium.

1.3 Constitutional Provisions on Disability in India

Dignity of the individual is a fundamental notion behind all the fundamental rights guaranteed under part IIIof the Constitution of India. The Preamble to the Constitution of India & Part III of the Constitutionimposes a negative obligation on the part of the state, not to restrain the liberties and rights guaranteedunder the same part. Further the State has been directed under the various provisions of the constitution toextend similar treatment to all persons. Article 41 declares that, the State shall, within the limits of its

economic capacity and development make effective provision for securing the right to work, to educationand to public assistance in cases of unemployment, old age, sickness and disablement. Article 46 lays downan obligation on the State to promote with special care the educational and economic interests of theweaker sections of the people, and protect them from social injustice and all forms of exploitation.

Indian Constitution while distributing legislative powers between the Centre and States kept the disabilityissue in the State list. The Parliament of India gained competence to legislate on disability issues with thesigning of the Proclamation of Equality and Full Participation of People with Disabilities in Asian and PacificRegion. Article 249 of the Constitution empowers the Parliament to legislate on any subject falling in anylist in order to fulfill its international obligations. Being a signatory to a number of conventions, with a viewto implement the Proclamation, the Persons with Disabilities (Equal Opportunities, Protection of Rightsand Full Participation) Act, 1995 was enacted with effect from 1st January 1996.

The formal recognition of discrimination on grounds of disability is a recent phenomenon and laws enactedeven twenty years ago generally did not include disability in the list of prohibited discriminations. Forinstance, the Constitution in Articles 15 and 16 prohibits discrimination in the matter of employment andaccess to public facilities on grounds of religion, race, caste, sex and place of birth, but is silent on disability.


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In fact, the service rules until 1995 prevented entry of persons with disabilities in higher grades of service.These rules gave the employer the authority to force premature retirement in public interest and oftenemployees who acquired disability during service were either forced out of job or got their rank reduced. Inmost cases their opportunity for career enhancement was suspended forever.

With increasing awareness of disability-based discrimination, explicit legal safeguards have now been put inplace. The enactment of the Persons with Disabilities (Equal Opportunities, Protection of Rights and FullParticipation) Act, 1995 is a signal achievement of the Indian disability movement. Preamble to this Actclearly delineates its objective of promoting and ensuring equality and full participation of persons withdisabilities. The Act aims to protect and promote economic and social rights of people with disabilities.Though the words disability has not been defined under the Act, but it covers seven disabilities undersection 2(i) of the Act - blindness; low vision; leprosy-cured; hearing impairment; loco motor disability,mental retardation, mental illness etc.

1.4 Acts on Disability

In our Indian Constitution several Articles and Clauses provide ample opportunities for the development oflegal instruments to protect the rights of the disabled people. The first major legal advancement for theprotection of the rights of the disabled people after the constitutional guarantee took its shape as theRehabilitation Council of India Act, 1992 and it came into force on 31st July 1993. The Persons withDisabilities (Equal Opportunities, Protection of Rights & Full Participation) Act, 1995, came into forceafter a decade old lobbying by the activists working for the rights of the disabled. This Act classifies thecategories of the disabled and further identifies the duties of the Government of India, State Governmentsand local administration towards the welfare of the disabled people.

The Mental Health Act, 1987

This was an Act to consolidate and amend the law relating to the treatment and care of mentally ill persons,to make better provision with respect to their properly and affairs and for matters connected therewith orincidental thereto.

The Rehabilitation Council of India Act, 1992:

The Act was created to provide for the constitution of the Rehabilitation Council of India for regulatingtraining of the Rehabilitation Professional and maintaining of a Central Rehabilitation Register and for

matters related to these issues.

Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act,1995 :

The enactment of the Persons with Disabilities (Equal opportunities, Protection of Rights and FullParticipation) Act 1995 (referred to as persons with Disability Act) is guided by the philosophy of


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empowering persons with disabilities and their associates. The endeavour of the Act has been to introducean instrument for promoting equality and participation of persons with disability on the one hand, andeliminating discriminations of all kinds, on the other. The Act aims to protect and promote economic andsocial rights of people with disabilities.

The Act covers seven disabilities. The criteria for classification of each disability are embodied in a biomedical model. Section 2(t) of the Act proclaims that a person with disability means a person sufferingfrom not less than forty percent of any disability as certified by a medical authority. The disabilities thathave been listed in Section 2 include blindness, low vision, hearing impairment, locomotor disability orcerebral palsy, mental retardation, mental illness and persons cured of leprosy. In addition, autism andmultiple disabilities have been covered under the National Trust for Welfare of Persons with Autism,Cerebral Palsy, Mental Retardation and Multiple Disabilities Act, 1999.

The Act spells out responsibilities of the Government at all levels including establishments under its

control. It lays down specific measures for the development of services and programmes for equalisingopportunities for the enjoyment of right to education, work, housing, mobility and public assistance in caseof severe disability and unemployment. To execute the mandated responsibilities, a Central Co-ordinationCommittee and State Co-ordination Committees representing major development ministries, Members ofParliament and disability NGOs and having a woman with disability as a member have been envisaged in amulti-sector model. Furthermore, the institution of Chief Commissioner in the Centre and Commissionerfor Persons with Disabilities in States has been proposed. Their mandate is to redress individual grievances,provide safeguards to the rights of persons with disabilities, monitor implementation of disability relatedlaws, rules and regulations, and oversee utilisation of budget allocated on disability. These quasi-judicial bodies are vested with the powers of a civil court.

The PWD Act has an exclusive chapter entitled Non-Discrimination. Sections 45, 46 and 47 of this chapterprohibit discrimination on the basis of disability in the matter of public employment and in access to publicfacilities. It is another thing that corresponding reforms in service rules, building codes and motor vehiclestandards have been extremely slow. Consequently, disability litigation is on the rise but the redeemingfeature of the current scenario is efficient disposal of disability discrimination cases both by courts and quasi- judicial bodies.

This historic legislation is a corner stone of evolution of jurisprudence on the rights of persons with

disabilities in India. As a result, disability concerns have come into sharp focus. However, within a period often years of enforcement of this Act its weaknesses have also surfaced in the absence of a powerfulimplementing instrumentality. Unlike usual indifference the government soon realised these weaknessesand acceded to the demand of the disability movement for overall review of the Act. Towards this end acommittee was constituted which harmonised views of the disability sector and relevant bodies in itscomprehensive report.


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The National Trust for the Welfare of Persons with Autism, Cerebral Palsy, Mental Retardationand Multiple Disabilities Act, 1999:

The Government has also introduced a National Trust for the Welfare of Persons with Mental Retardationand Cerebral Palsy Bill, 1995. The trust aims to provide total care to persons with mental retardation and

cerebral palsy and also manage the properties bequeathed to the Trust.

As certain groups among the disabled are more vulnerable than others, a special enactment for theprotection of such persons, their property and well-being was felt necessary. The enactment of the NationalTrust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple DisabilitiesAct, 1999 (referred to as the National Trust Act) aims to fulfill a common demand of families seekingreliable arrangement for their severely disabled wards. The specific objectives of the Act are:

To enable and empower persons with disabilities to live as independently and as fully as possiblewithin and as close to the community to which they belong;

To promote measures for the care and protection of persons with disabilities in the event of death oftheir parent or guardian; and

To extend support to registered organisations to provide need based services during the period ofcrisis in the family of disabled covered under this Act.

1.5 Framework for Disability Statistics

The Disability Division in the Ministry of Social Justice & Empowerment, Government of India, through its

programmes and policy formulations facilitates empowerment of the persons with disabilities, includingpersons with visual, hearing, speech, locomotor and mental disabilities. They run a few schemes fordisabled persons and released the National Policy for Persons with Disabilities in the year 2006. However,there are inherent challenges in the implementation for MSJE as the nodal agency since disability has amulti-sectoral implication. For example, for early detection of disability or for special education needs ofthe disabled children Ministry of Health & Family Welfare and the Ministry of Human ResourcesDevelopment together with Ministry of Women and Child Development are the appropriate lead agencies.To address this issue, the PWD Act mandates central and state level Coordination and ExecutiveCommittees as key institutions in development of disability policy. Disability Statistics in India are capturedthrough decennial Population Censuses and periodic dedicated National Sample Surveys conducted byMinistry of Home Affairs and Ministry of Statistics & Programme Implementation respectively.

International Classification of Functioning, Disability and Health (ICF) has a comprehensive classification ofdisability which is found to be extremely difficult to canvass in census or surveys, particularly in developingcountries like those in the SAARC. It was therefore, felt necessary that an appropriate survey framework based on feasible concepts and definitions and classification of disability conditions is adopted in consultation


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taken through surveys and censuses in spite of their inherent limitations in netting rare personalcharacteristics. The Persons with Disabilities (Equal Opportunities, protection of Rights and FullParticipation) Act which came into force in 1995, imposes specific obligation on the government toundertake surveys, investigation and research concerning causes of disability. As already discussed in India,the major sources of statistics on disability are the decadal Population Censuses and the regular large scalesample surveys on disability conducted by National Sample Survey Organisation (NSSO).

i) Population Census: The history of collection of data on disability/ infirmity dates back to theinception of modern Indian Census in 1872. The questionnaire of the 1872 Census included questions notonly on physically and mentally infirm but also persons affected by leprosy. Collection of information oninfirmities in each of the successive decadal censuses continued till 1931. However, in view of the seriousdoubts expressed by the then Census Commissioners about the authenticity and quality of data collectedon infirm population, the enumeration of physically disabled persons was discontinued during the 1941Census. It was felt that question on disabled population did not lend themselves to a census enquiry since

these did not seem to provide accurate data due to variety of reasons particularly due to the social stigmaattached with this characteristic.

After a gap of 50 years, a question on disabilities was again canvassed at the 1981 Census. Since 1981 had been proclaimed as the "International Year for the Disabled" it resulted in inclusion of a question ondisability during censuses the world over and India was no exception to it. However, the question on onlythree broad categories of physical disabilities, viz. `Totally Blind', `Totally Dumb' and `Totally Crippled',was canvassed during the House listing Operations of 1981 Census. When the results of 1981 Censuswere finally available, it was felt that there was considerable under enumeration of physically handicappedpersons. The 1981 Census results also supported the views expressed by the earlier CensusCommissioners that the enumeration and determination of the physically handicapped and theircharacteristics were beyond the scope and capacity of Census Operations due to the complexity of thedefinition of disability and inherent reservations of the population to share this information with theenumerator usually a local government official. The question on disability was not canvassed again at the1991 Census of India.

The question on disability was again incorporated in census of India 2001 under the pressure from thevarious stakeholders and obligation under PWD Act, 1995, although it was generally felt that it wasdifficult to collect accurate information on disability during the census enumeration process. Further, the

concepts and definitions spelt out in the act were found to be difficult to canvass in the in the absence ofexpert investigator specifically trained for the purpose. However, considering its advantage ofcomprehensive coverage of population characteristics and scope to provide estimates at sub-state level thedecision to include the question on disability for all the members of the households was finally agreedupon.


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ii) NSS Surveys on Disability: The National Sample Survey made its first attempt to collect informationon the number of physically handicapped in its 15th round survey (July 1959-June 1960). The enquiry wasexploratory in nature and was confined to rural areas only. In its 16th round (July 1960-June 1961) thegeographical coverage was extended to urban areas. Thereafter the subject was again taken up fornationwide survey in its 24th round(July 1969-June 1970), 28th round (October 1973-June 1974), Thesesurveys (undertaken during 15th, 16th, 24th, and 28th rounds) were intended mainly to get a count of personsin the country who suffered from certain specified physical handicaps. However, the types of physicalhandicap covered were not always same. For reasons of economy information on physically handicappedwas collected in the early rounds in survey schedules meant for other subjects. Therefore, there was verylittle scope for collecting information on cause, specific nature and other details of physical handicap.

NSSO undertook a comprehensive survey on this subject for the first time in the NSS 36th round (July-December 1981) as 1981 was the International Year of the disabled persons. Detailed information relatingto magnitude of disability, type of disability, cause, age at onset, type of aid/ appliance used and other

socio-economic characteristics was collected in this survey. A decade later, at the request of MSJE, NSSOcovered this subject again in its 47th round (July-December 1991), with the same basic framework includingconcepts, definitions and operational procedures as followed in the 36th round. While the earlier surveyswere restricted to only the physically handicapped persons, in the survey conducted since NSS 36th round(1981) an extended definition was used to cover all persons with one or more of the three physicaldisabilities visual, communication (i.e. hearing and/ or speech) and locomotor. Also, data ondevelopmental milestones and behavioural pattern of all children of age 5-14 years were collected,regardless of whether they were physically handicapped or not.

Again, after a gap of eleven years, the survey on the persons with disabilities was carried out in the 58th round during July-December, 2002. This round also maintained the same definitions and procedures forphysical disabilities as were adopted in earlier two rounds. This round, however, extended the coverage by including the mental disability. Along with the particulars of physical and mental disabilities, the socio-economic characteristics of the disabled persons such as their age, literacy, employment, vocational trainingetc. were collected. Governing Council (GC) of NSSO through the working groups with National Expertsin different medical institutions, eminent professors, academicians and other important users includingMinistry of Social Justice and Empowerment, finalised the questionnaire, sampling design, tabulation planetc. for the survey.


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Chapter 2

Overview of Statistical Evidences on Disability

2.1 Size of Disabled Population At the turn of the new millennium about 21 million people in India were found to have disability asper official estimate obtained from the Population Census 2001. These included persons withvisual, hearing speech, locomotor or mental disabilities, who constituted about 2 percent of thepopulation. On the other hand, NSSO survey on Disability (July December 2002) estimated thedisabled population in the country as 18.5 million, who formed about 1.8 percent of thepopulation. Population Census and NSS surveys are the major two sources of official statistics. Butthe two differ substantially especially in respect of overall estimates of persons with various typesof disability and their age distribution, mainly due to differences in the concepts and definitions as

also the data collection methodologies.

2.2 Prevalence of Disability:

a) As per Population Census 2001 , of the persons with disability (PWD), about 75% belongedto rural areas and only 25% were from urban areas. For the population of the country as awhole, 2.13% were found to have one type of disability or the other. In rural India, theprevalence of disability was much higher (2.21%) as compared to that in its urban counterpart(1.93%). Among males, the prevalence of disability (2.37%) was significantly higher than thatamong females (1.87%). The prevalence rate among SC population (2.23%) was marginallyhigher as compared to the general population; while among ST population, it was noticeably

lower (1.92%). Among the major states of India the prevalence of disability (percentage ofdisabled in total population) was relatively much higher in J & K (3%), Orissa (2.8%), Kerala(2.7%), Tamil Nadu and H.P. (2.6% each) while it was quite low in Maharashtra (1.6%), Jharkhand, Punjab and Delhi (1.7% each), Karnataka & Andhra Pr.(1.8% each) etc.

b) In the NSSO Survey (2002) 8.4% of rural households and 6.1% of urban householdreported disability of one or more of their members in the survey. More than 90% of thesehouseholds reported disability of only one member, 6 to 8% in the rural areas and nearly 10%of households in the urban areas reported to have two disabled members. Only in 1% or less ofthe households, three or more disabled members could be found in both the sectors. For thepopulation of the country as a whole, 1.8% was found to have at least one type of disability.Again out of them 10.63 per cent suffered from more than one type of the disabilities. In ruralIndia, the prevalence of disability was more (1.85%) as compared to its urban counterpart(1.5%). Further, among males, the proportion of disabled (2%) was significantly higher thanthat among females (1.5%). Among the disabled persons, 7% were ST, 22% were SC, 41% belonged to OBC and 30% were categorized as others. The proportion of disabled persons inthe population was found to be relatively high (more than 2%) in H.P (2.6%), Orissa (2.5%)Kerala (2.2%), and Punjab (2%) and significantly low in Delhi (0.6%), Assam (1.0%),


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Jharkhand (1.2%), Rajasthan (1.5%) etc. In almost half of the states the prevalence was in therange of 1.7% to 1.8%.

The proportion of persons with any disability was found to be increasing steadily with age fromabout 0.5% for age less than 5 to more than 1.7% till age 20. It remains more or less samealmost till the age 50. Thereafter, it increases rapidly with age to about 3% for age-group 55-59and more than 6% after age 60 years.

2.3 Composition of Disabled Population:

a) As per Census (2001) findings, where not more than one type of disability was recorded foreach PWD, about half of them were found to have visual disability, more than a-fourth hadmovement disability, about 10% were having mental disability, 7% had speech disability and6% were with hearing disability. The proportions vary marginally across different sets ofpopulation categories. More than half of the disabled were of age less than 30 and only one-fourth of disabled persons were of age 50 or more.

b) In the NSSO (2002) survey a person with restrictions or lack of abilities to perform an activityin the manner or within the range considered normal for a human being was considereddisabled and information on one or more types of disability were collected from each personreported to have disability. The survey found out Loco motor Disability to be the mostprevalent type with more than 1% of population suffering from it. This was followed by hearingdisability, then visual disability and lastly speech and mental disability, prevalence of each ofwhich was relatively low (with less than 0.3% of population suffering from each of thesedisabilities).

2.4 Literacy of the Disabled Persons:

a) In the Population Census (2001) majority of disabled persons were found to be not literate only 37% of disabled females and 58% of disabled males were reported to be literate. Only3% were of level graduate and above and another 10% were of level secondary or highersecondary. Wide gap in literacy among disabled existed in the states from 37% in Bihar to67% in Kerala with almost half of the states having majority of their disabled persons notliterate. Among disabled children, 58% of age 6-10 years and 63% of age 11-14 years of werefound to be attending schools, as against 69% and 75% respectively in the general population.

b) NSSO survey estimated that about 55% of the persons having any disability were not literate,25% were literate up to primary level, 11% completed middle level and another 9% were ofsecondary level and above. 58% of disabled in the rural and 39% of disabled in urban (age 7years and above) were not literate, another 35% in rural and 43% in urban were literate but below secondary and only 7% rural disabled and 18% urban disabled persons were ofeducational level secondary and above. Among the major States, the highest percentage ofilliterates among disabled persons was found in Bihar (66%), Orissa and Andhra Pradesh (64%in both the states). The proportion of not-literate persons among the disabled of age 5 yearsand above was least in Kerala (33%).


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The proportion of disabled children currently enrolled was found to be low (less than 50%) ingeneral, and among mentally disabled and blind children in particular in both rural and urbansector. Proportion of disabled females (age 5-18 years) enrolled in either ordinary or specialschools were invariably lower than that of their male counterpart. Regarding reason for non-enrolment in special school, 32% identified disability itself as the main reason, another 15%

were not aware of special schools and for another 14% parents were not interested.

2.4 Employment of the Disabled Persons:

a) In Population Census (2001) more than a-third (36%) of disabled males and more than two-third (68%) of disabled females of age 15 to 59 years were found to be non-workers (noteconomically active) vis-a-vis only 19% of males and 60% of females as non-workers amonggeneral population. Majority of persons with speech or movement disability and almost three-fourth of persons with mental deficiencies were non-workers. On the whole 55% of disabledmales were main workers, 9% marginal workers and 36% non-workers. Among disabledfemales the respective percentages were 19% main worker, 13% marginal worker andremaining 68% non-workers. Out of the total disabled non-workers, about 50% of the non-workers were dependent, more than 20% were students, about 14% were engaged inhousehold duties, 2% were pensioners, 1% of them were beggars, vagrants, etc and 5% werecategorized as others.

b) The NSSO Survey (2002) estimated oonly 25% of the disabled population as employed, 1%were unemployed and the rest were out of labour force. Among males, 36% were found to beemployed while among females only 10% were employed and 89% were out of labour force.More than 90% of the disabled persons with mental retardation or blindness, 85% of personswith mental illness and about 80% of persons with low vision were out of labour force.Nearly 70% of the persons with speech or locomotor disability and about 65% of the persons

with hearing disability were also out of labour force.

Out of the persons employed, about 13% were self-employed in agriculture, 10% were casuallabourers, 5% were self-employed in non-agricultural activities and only 4% (5% forlocomotor disability, 3% in case of speech disability and less than 1% for the other types ofdisability) were regular employees. Among the disabled persons who were out of labourforce, 15% attended domestic duties and 5% attended educational institution. In general,nearly 55% of the disabled males working were involved in the primary sector, 17% insecondary sector and 28% in the tertiary sector. Out of the total disabled females, more than60% were involved in the primary sector, 16% in the secondary sector and 22% in thetertiary sector.

2.5 Marital Status of the Disabled Persons:

a) Population Census (2001) found out only 1% of the total disabled persons/males/femaleswere married at age below15 years. In the age-group 15-59 years, about 34% of the totaldisabled persons were reported to be never married, 60% were married, 5% were widowedand 1% were divorced or separated. About 50% of persons with disability in speech, mental


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(most prominent) and movement were never married even after age 15. But in case ofdisability in seeing and hearing, majority of age 15-59 years were married.

b) In NSS Survey, among the disabled males of all age, 47% were reported to be never married,45% were married, 7% were widowed and 1% got divorced or separated. Among thedisabled females, 39% were never married, 31% were married, 28% were widowed and 2%got divorced or separated. More than 90% of the persons with mental retardation never gotmarried. More than 70% of the males faced with speech disability and nearly 70% of thefemales having disability in hearing were not married. Even in the marriageable age category(15 years and above), almost a-third of disabled males and 22% disabled females remainedunmarried.

More than 90% of the disabled persons were not living alone, about 5% were living with theirspouse and only 3% were living alone.

2.6 Extent of Disability:

This information was collected in NSS Survey where it was found that in the year 2002, of thePWD about 60% could take self-care without aid/appliance and another 17% could take self-care only with aid/appliance and 9% had not tried or aid/appliance or those were not availableto them. But 13% of the disabled persons could not take self-care even with the help ofaid/appliance.

2.7 Cause of Disability and Age at Onset:

Again in the NSS surveys only detail information on cause of disability, age at onset of disabilityetc. were collected and tabulated separately for each type of disability. In more than 50% cases,mental retardation has been reported to be caused by serious illness or head injury in the

childhood. More than 85% of the persons with mental retardation were disabled since birth.The proportion was still higher in the rural areas (90%) as compared to the urban areas (about70%) and again more for females (90%) than for males (85%). More than 85% of the mentallyretarded persons showed a delay in the development of the combination of sitting, walking andtalking. Mental illness is more of an old age problem. For nearly 40% cases, the age at onsetwas 45-49 years and more than 30% acquired mental illness after the age of 60 years

Out of the total visually disabled persons , more than 70% were blind (of which 35% hadno light perception and more than 35% had light perception but could not count fingers from adistance of 1meter) and nearly 30% suffered from low vision. More than 60% of the personswith blindness and about 70% of persons with low vision acquired disability due to thefollowing three reasons - old age, cataract and other eye diseases. Again, more than two-thirdof persons with blindness and more than 70% of persons with low vision acquired the disabilityafter the age of 60 years.

Among the persons withhearing disability , in more than 30% cases the disability wasreported to be profound, another 40% had severe disability, and only 30% had moderatehearing disability. The three major reasons for hearing disability was old age, other illnesses and


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ear discharge. Nearly 60% of the persons with hearing disability acquired the disability after theage of 60 years and about 25% acquired it in the age-group 45-49 years.

Nearly 50% of the persons withspeech disability could not speak and nearly 20% of thespeech disabled spoke only in single words. Paralysis, mental illness or retardation and voicedisorders were reported, among other common causes, as major causes of speech disability. Formore than a-third of the speech disabled persons, the age at onset was after 60 years, about 20%acquired disability in the age-group 45-49 years and more than 35% of speech disabled personswere disabled since birth.

About 45% of the locomotor disability was attributed to deformity of limb, more than20% to dysfunction of joints of limb, another 15% to paralysis, 10% to any other deformity of body and 8% to loss of limbs. Polio and injury other than burns were the two major causes oflocomotor disability contributing more than 50% of cases. More than 50% of the persons withlocomotor disability acquired it after the age of 60 years, 28% in the age-group 45-49 years andonly 5% were disabled since birth. About a third of the persons with locomotor disability used

crutches, 11% used callipers, nearly 8% acquired support from wheelchair or artificial limbs,6% used tricycle, 5% had splint and only 1% had spinal brace.

2.7 Level of Living and Type of Assistances Received by the Disabled Persons:

In the NSSO Survey information was collected on the average monthly consumer expenditureof the households reporting one or more cases of disability. In both rural and urban areas, about25% of the households belonging to the lowest MPCE class reported disability although lessthan 3% of general households belonged to this poorest class. More than 50% of householdsreporting one or more disabled members were below poverty line in both rural and the urbansector. These households were put into disadvantage in respect of both disability and poor level

of living. Also the proportion of households reporting disability decreased steadily as one movesup along the higher MPCE classes.

In general, about 12% of the disabled persons of age 5 years and above had received some govt.aid or help. The disabled in the urban areas had a higher RGAH (received any Govt. aid/ help)rate as compared to the rural. Out of the total percentage of disabled persons receiving aid fromgovt., more than 20% received help for aid/ appliance, nearly 10% obtained help for educationand 5% for corrective surgery (more so in urban areas). The distribution of disabled males andfemales receiving any aid or help was nearly the same. Among the different types of disability, ahigher proportion of persons with blindness (16%) and locomotor disability (13%) received anygovt. aid or help, followed by low vision and speech disability (about 10% each), and finallymental and hearing disability (nearly 5%).


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Chapter 3

Major Concepts and Definitions

3.1 The Background

The Convention of Rights of Persons with Disabilities (UNCRPWD:United Nation, 2006 w.e.f. 8 May2008) and the Biwako Millenium Framework for Action and Biwako Plus Five (ESCAP 2003) reflect ashift from a medical to social model of disability . In the medical model, individuals with certain physical,intellectual, psychological and mental conditions (impairment) are regarded as pathologic or abnormal; itis simply the abnormality conditions themselves that are the cause of all restrictions of activities.According to the medical model, disability lies in the individuals, as it is equated with those restrictions ofactivity. Faced with the line of thinking, individuals would feel pressured to work on their restrictions, bearing the burden of adjusting to their environment through cures, treatment or rehabilitation.

In contrast, the social model shifts the focus to the society; undue restrictions on behaviour of personswith impairment are seen to be imposed by: a) dominant social, political, and economics ideologies; b)cultural and religious perceptions regarding persons with disabilities; c) paternalism in social welfaresystems; d) discriminations by society; e) the inaccessibility of the environment and information; and f) thelack of appropriate institutional and social arrangements. Thus in this model, disability does not lie inindividuals, but in the interactions between individuals and society. In the social model, persons withdisabilities are right holders, and are entitled to advocate for the removal of institutional, physical,

informational and attitudinal barriers in society. Thus it is a concept based on the consequences ofdiseases/ infirmity on functional capacity and/ or social participation. It locates the definition of disabilityat the most basic level of activity/participation in core domains defined as the ability or inability to carryout basic actions at the level of whole person (i.e. walking, climbing stairs, lifting packages, seeing a friendacross the room etc.).

3.2 Indian Context

In India different definitions of disability conditions have been introduced for various purposes, essentiallyfollowing the medical model and, as such, they have been based on various criteria of ascertaining

abnormality or pathologic conditions of persons. In absence of a conceptual framework based on the socialmodel in the Indian context, no standardisation for evaluating disability across methods has been achieved.In common parlance, different terms such as disabled, handicapped, crippled, physically challenged, areused inter-changeably, indicating noticeably the emphasis on pathologic conditions.

Persons with Disability Act, 1995: Through the Act is built upon the premise of equal opportunity,protection of rights and full participation, it provides definitions of disabled person following the medical


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model. According to the Persons with Disabilities (Equal Opportunities, Protection of Rights and FullParticipation) Act, 1995, "Person with disability" means a person suffering from not less than forty percent of any disability as certified by a medical authority (any hospital or institution, specified for thepurposes of this Act by notification by the appropriate Government). As per the act "Disability" means -(i) Blindness; (ii) Low vision; (iii) Leprosy-cured; (iv) Hearing impairment; (v) Loco motor disability; (vi)Mental retardation; (vii) Mental illness, which were defined as below.

"Blindness " refers to a condition where a person suffers from any of the following conditions,(i) Total absence of sight.(ii) Visual acuity not exceeding 6/60 or 20/200 (snellen) in the better eye with correcting lenses;(iii) Limitation of the field of vision subtending an angle of 20 degree or worse;

"Person with low vision " means a person with impairment of visual functioning even aftertreatment or standard refractive correction but who uses or is potentially capable of using vision

for the planning or execution of a task with appropriate assistive device; "Leprosy cured person " means any person who has been cured of leprosy but is suffering from-

(i) Loss of sensation in hands or feet as well as loss of sensation and paresis in the eye and eye-lid but with no manifest deformity;

(ii) Manifest deformity and paresis; but having sufficient mobility in their hands and feet to enablethem to engage in normal economic activity;

(iii) Extreme physical deformity as well as advanced age which prevents him from undertaking anygainful occupation, and the expression "leprosy cured" shall be construed accordingly;

"Hearing impairment " means loss of sixty decibels or more in the better ear in theconversational range of' frequencies;

"Loco motor disability " means disability of the bones, joints muscles leading to substantialrestriction of the movement of the limbs or any form of cerebral palsy;

"Mental retardation " means a condition of arrested or incomplete development of mind of aperson which is specially characterized by sub normality of intelligence;

"Mental illness " means any mental disorder other than mental retardation;

However, these definitions were not found to be useful even for enumerating the disabled population,particularly in Population Census process for a large population like that of India.


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3.3 Definitions adopted for Population Census

Census of India 2001 document mentioned "Defining and measuring disability is a complex issue and it isnot easy to communicate these concepts during the census process, in which only a limited amount ofquestioning time is possible to be spent with a household for obtaining detailed information on every

individual."

With regard to definitions adopted by PWD Act, Census of India stated "the concepts and definitions ofdisabilities coupled with measuring its extent and its types contained in the PWD Act, 1995 were found to be extremely difficult to canvass even in normal circumstances assuming people had time, were willingand forthcoming to share this information and there was an expert investigator to elicit this information."

Census therefore used its own version of definitions of disabilities. Census of India 2001 defined five typesof disabilities:- (i) seeing, (ii) speech, (iii) hearing, (iv) movement, and (v) mental.

Seeing disability : A person who cannot see at all (has no perception of light) or has blurred vision evenwith the help of spectacles. A person with proper vision only in one eye was also treated as visuallydisabled. A person may have blurred vision and had no occasion to test whether her/his eyesight wouldimprove by using spectacles - such persons were treated as visually disabled.

Speech disability: A person who is dumb or whose speech is not understood by a listener of normalcomprehension and hearing, was considered to have speech disability. Persons who stammer but whosespeech is comprehensible were not classified as disabled by speech.

Hearing disability: A person who cannot hear at all (deaf), or can hear only loud sounds was considered

to have hearing disability. A person who is able to hear using hearing aid, was not considered as disabledunder this category. If a person cannot hear through one ear but her/his other ear is functioning normally,she/ he was still considered to have hearing disability.

Movement Disability : A person, who lacks limbs or is unable to use the limbs normally, wasconsidered to have movement disability. Absence of a part of a limb like a finger or a toe was notconsidered as disability. However, absence of all the fingers or toes or a thumb make a person disabled bymovement. If any part of the body is deformed, the person was also treated as disabled and covered underthis category. A person, who cannot move herself/himself without the aid of another person or withoutthe aid of stick, etc., was treated as disabled. Similarly, a person who is unable to move or lift or pick upany small article placed near her/him was also treated as disabled in movement. A person who may not beable to move normally because of problems of joints like arthritis and has to invariably limp while moving,too was considered to have movement disability.

Mental disability: A person who lacks comprehension appropriate to her/his age was categorised asmentally disabled. This would not mean, however, that if a person is not able to comprehend her/his


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characterization of the behaviours like talking to self, laughing/crying, staring, violence, fear and suspicionwithout reason. As NSS definition seems to be more comprehensive/ inclusive, although NSS 2002 figureof number of mentally disabled was less than the Census 2001 figure. However, in contrast to othercategories of disability these figures obtained from two sources were close to each other.

Visual Disability:

Except including a person with proper vision only in one eye (Population Census) the definitions of Censusand NSS are similar in practical terms. NSS has used the counting of fingers as practical measure to verifythe blurred vision. Classifying person with proper vision only in one eye as disabled, is not in accordancewith the PWD Act. Besides, categorization of a person as disabled is primarily based on activity limitationin execution of usual task in environment relevant to the person and not the deviation from the acceptedstandard of biomedical status of the body of a person. Inclusion of person with proper vision only in oneeye under Visually disabled is not in accordance with this criterion. As expected, the Census 2001 figure(10.64 million visually disabled person) is higher than the NSS estimate (2.83 million). The high extent ofdifference is not justifiable due to inclusion of one eyed category only. It may be that many two eyedpersons also suffer from low or lack vision in one of the eye due to some internal injury/defect which is notnoticed by others from outside.

Hearing Disability :

Census and NSS definition differ in following respect

a) A person with only one ear functioning normally is classified as disabled in Census but not under NSSOsurvey.

b) Under Moderate disability NSS includes as disabled a person who would normally ask to repeat thewords spoken by the speaker or would like to see the face of the speaker while he/ she spoke or would feeldifficulty in conversations.

PWD Act does not classify a person as suffering from Hearing Impairment if he/ she has one earfunctioning normally. Here again Census definition has given undue weightage to the deviation of bodystructure from the accepted structure. On the other hand NSS definition of Moderate Hearing Disabilitymay be considered as covering more than what is required or intended under PWD Act. In spite of that, aCensus figure (1.26 million) was much less than the NSS estimates (3.06 million). Besides sampling error,inclusion of moderate category of hearing disabled, inclusion of persons having hearing disability in

combination with other disability (like speech disability) under both disability categories, may be otherreasons for NSS figure being higher than Census figure.

Speech disability

The definitions of Census and NSS are similar so far as a person having speech disability is concerned.Census definition is more simple and qualifies the listener also. It may be noticed that the PWD Act doesnot include speech disability under its purview. The reason for NSS figure being higher may be that some


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c) General Criteria for judging a disabled person

A person with restrictions or lack of abilities to perform an activity in the manner or within the rangeconsidered normal for a human being - this general definition of disability is based on activity limitation inexecution of usual task and not the deviation from the accepted standard of biomedical status of the body

of a person. This concept is followed in NSSO survey. The Census has recommended that the persons whoattended/are attending special institutions and those who attend/attending normal education institutionswill be treated as disabled if admitted to normal schools against the quota reserved for disabled students orotherwise.

(i) Disability in Seeing/ Visual Disability

A person who does not have any light perception both eyes taken together or a person who has lightperception but can not count fingers of a hand (with spectacles/contact lenses if he/she usesspectacles/contact lenses) from a distance of 3 metres (or 10 feet) in good day light with both eyes open is

considered as visually disabled. The visually disabled persons may be categorized into two broad groups viz;those with Blindness & those with Low Vision.

Blindness: A person who does not have light perception and a person who has light perception but cannotcount fingers at a distance of 1 metre even with spectacles is taken as Blind.

Low vision: A person who has light perception but cannot count fingers up to a distance of 3 metres evenwith spectacles is taken as a person with Low Vision.

The core question which will decide whether a person is having absolute blindness/incurable/noncorrectable blindness is the following:

(i) Can you perceive light? Yes/ NoIf the answer is no, then the person will be treated as an absolute blind person. If the answer is yes, thenit means that the person is not absolutely blind and there is scope for improvement of vision aftertreatment.

If the answer to question 1 above is yes then the following question may be asked:

(ii) Can you perceive my hand movements? Yes/ No

(iii) Can you count fingers of my hand? Yes/ No (the hand is to be kept one metre to three metresaway from the person)

The questions (ii) and (iii) are to be asked to the person whose sight is already corrected with the bestpossible spectacle or lens. Normally, during the survey questions are asked assuming that the person hasthe best possible correction in the spectacle/lens he is wearing. If the person suffers from low vision evenafter taking corrective measures, she/he will be recorded as visually disabled under category Low Vision.Persons with blurred vision who did not have occasion to test their eyesight would improve by using


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spectacles would be treated as having Low Vision. (The question (i) can be used for assessing prevalence ofabsolute blindness through census whereas in sample survey further detailed questions may be asked.)

(ii) Disability in speech/speech disability

A person will be classified as having speech disability if he/she is unable to speak like normal persons. Thecore question which will identify a person having speech disability is as under:

Is there any one in the house who is unable to speak like others (normal persons)? (This questionshould not be canvassed for children up to 3 year of age)

Does he/she not speak at all?

Further probing question may be asked in order to categorise the speech disability:

Does he/she speak only in single words?

Is her/his speech not understood easily by others?

Does he/she stammer?

Does he/she have any voice problem like hoarse voice or nasal voice?

Does he/she have any other speech defect such as articulation defects etc.?

Persons who stammer but whose speech is comprehensible will not be classified as disabled by speech.

(iii) Disability in hearing/hearing disability

A person will be classified as having hearing disability if he/she has any problem in hearing day to dayconversational speech when hearing aid is not used. A person who has problem only in one ear will not beconsidered as having hearing disability.

A person may have the following degrees of hearing disability:

A person, who does not hear at all or can only hear very loud sounds like thunder and crackers, isconsidered to haveprofound disability.

A person who can hear speech only when spoken to very loudly, near the ear is considered to havesevere disability.

A person often asks for repetitions when spoken to or needs to see the face of the person who isspeaking is considered to havemoderate disability.

A person who has difficulty in hearing but it does not interfere in day today conversation isconsidered to havemild disability.

Core questions to identify the persons with hearing disability are as under:


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Is there any one in house who has difficulty in hearing day today conversational speech?

Does he/she hear only very loud sounds like thunder/crackers?

Does he/she hear speech only when it is spoken very loudly near the ear?

Does he/she ask for repetitions when spoken to or needs to watch the face of the person who isspeaking?

Does he/she have difficulty in hearing but it does not interfere in day today conversation?

(iv) Disability in movement/ locomotor disability

Persons with (a) loss or absence or inactivity of whole or part of hand or leg or both due to amputation,paralysis, cerebral palsy, deformity or dysfunction of joints which affects his/her normal ability to moveself or objects and (b) those with physical deformities in the body (other than limbs), such as, hunch back,deformed spine, etc. regardless of whether the same caused loss or lack of normal movement of body areconsidered as disable with locomotor disability.

Thus, dwarfs and persons with stiff neck of permanent nature who generally do not have difficulty in thenormal movement of body and limbs are also to be treated as disabled.

(v) Mental disability

A mentally disabled person is defined as the one who has difficulty in understanding routine instructions,who does not carry out his/ her activities like others of similar age or exhibited behaviours like talking toself, laughing/crying, staring, violence, fear and suspicion without reason. The activities like others

(normal) of similar age includes activities of communication (speech), self-care (cleaning of teeth, wearingclothes, taking bath, taking food, personal hygiene, etc.), home living (doing some household chores) andsocial skills. The mentally disabled are categorized into two groups viz. mentally retarded and mentally ill.If persons with mental disability manifests this behaviour since birth/ childhood but before 18 years of ageand the person was late in talking, sitting, standing or walking, they are classified as mentally retarded.The remaining mentally disabled persons are classified as mentally ill. The normal time for attaining themilestone after birth in the case of sitting is before 1 year, for walking it is before 2 years and fortalking it is before 3 years.

In the category of mental disability, both the mental retardation and mental illness should be elicited

separately. As in the PWD Act both are listed as separate disability. Core Questions to identify a personwith Mental Retardation are as under:

1. Is there anyone in family who has difficulty in understanding instructions, and who does not carry outhis/ her activities like others of his age/ her age, such as;

Motor activities, head holding, sitting, standing, walking, grasping, manipulation

Activities of speech and communication


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Activities of self care, brushing teeth, dressing, bathing, feeding, toileting etc.

Personal hygiene

Activities of household chores

Activities of play and socialization

2. Is he/ she late in sitting, standing, talking or walking?

3. Is the abnormal behavior of the person was observed since birth or developed before 18 years of age?

If the responses to these three questions are in affirmative it suggests that person may be suffering frommental retardation.

Core Questions to identify persons withMental Illness are as under:

1. Is any one in family does not look after his/her personal hygiene like brush his teeth, take a bath,

have regular meals and dresses properly.2. Is he/ she show abnormal behaviour like violence, laughing and weeping without reason, suspicious,

talking to self, hearing voices when alone and irrelevant talks

3. Is he/ she has problems in communication and understanding the verbal and non-verbal messages.

4. Does he/ she has problems related to work and social relationship.

If the answer is in affirmative to all four questions then it suggests that person may be suffering from mentalillness. Persons, who show signs of mental fatigue, lack of understanding and depend on others for dailyroutine on account of being old, will not be considered as mentally disabled.

(vi) Leprosy Cured Persons

Any person who has been cured of leprosy but is suffering from-

(i) Loss of sensation in hands or feet as well as loss of sensation and paresis in the eye and eye-lid butwith no manifested deformity;

(ii) Manifest deformity and paresis; but having sufficient mobility in their hands and feet to enablethem to engage in normal economic activity;

(iii) Extreme physical deformity as well as advanced age which prevents him from undertaking any

gainful occupation, and the expression "leprosy cured" shall be construed accordingly;Only the persons who have been cured of leprosy and are having type (iii) (as mentioned above) kind ofdisability will be considered as disabled. The other two types given above will not be considered as disabled.


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Chapter 4

Dimension of Disability in India

4.1 Estimates of Disabled Persons

The official estimates of disabled persons in India, obtained through the latest Population Census andNational Sample Survey Organisation s comprehensive surveys on disability,put the figure as about 21million (roughly around 2 percent of the population) at the beginning of the new millennium. However,estimates vary across sources and a new World Bank Report1 on disabled persons in India, has observedthat there is growing evidence that people with disabilities comprise between 5 and 8 per cent of theIndian population (around 55 90 million individuals).

There is a common concern that disabled persons are among the most excluded ones in the developmentprocess of the country. For an effective and efficient policy intervention to improve the lots of thedisabled persons, it is of utmost importance to get a clear idea of the dimension of disability in India.Although government and the public sector would have to play a key role in this endeavour, it may beneither feasible, nor desirable for them to do it all. Further, there is wide heterogeneity in the situationand the policy requirements of different groups of disabled persons in India. There are major differencesin social attitudes to different types of disability, coupled with variations due to gender, class, place ofresidence (rural / urban) etc.

Population Census and NSS surveys are the major two sources of official statistics in India. But the twodiffer substantially in respect of overall estimates of persons with various types of disability and theircomposition, mainly due to differences in the concepts and definitions as also the data collectionmethodologies. Therefore in this section dimension of disability reflected by these two sources would betaken up separately.

A. Findings of Population Census

In recent years a question on disability was canvassed during the House listing Operations of 1981Census where there was considerable under enumeration of physically handicapped persons. The 1991

Population Census did not cover disability. Again in Census 2001, question on disability was included forall the members of the households at the time of detail population enumeration. The findings of latestPopulation Census of 2001 on disability have been discussed here in detail with a brief mention of theobservations based on 1981 Census, although the two sets of results were not quite comparable.

1 People with Disabilities in India: From Commitments to Outcomes, by Human Development Unit, South AsiaRegion, The World Bank.


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4.2 Number of Disabled Persons and their composition: Census 2001

Table 4.1: Total Number (in thousands) of Disabled Persons in India and their Percentage Distribution by Typeof Disability

PopulationCategory

Total disabledpersons (no. in

thousand)

% of disabled intotal population

% distribution of disabled persons by type of disabilityseeing speech hearing movement mental

Total 21907 2.13 49 7 6 28 10Rural 16388 2.21 48 8 6 28 10Urban 5518 1.93 50 7 4 26 12Male 12606 2.37 46 8 5 31 11Female 9301 1.87 53 8 6 24 10SC 3711 2.23 49 7 6 29 9ST 1618 1.92 50 8 8 26 8Source: Population Census (2001).

In the year 2001, of the persons with disability (PWD) about 75% belonged to rural areas and only 25%were from urban areas. About 58% of disabled were males while only 42% were females. For thepopulation of the country as a whole, 2.13% were found to have one type of disability or the other.

49%

7%

6%

28%

10%

Fig. 4.1: Per cent distribution ofdisabled persons by type of disability

seeing

speech

hearing

movement

mental

As per Census (2001) findings, where not more than one type of disability was recorded for each PWD,

about half of them were found to have visual disability, more than a-fourth had movement disability,about 10% were having mental disability, 7% had speech disability and 6% were with hearing disability.The proportions vary marginally across different sets of population categories. Although the overallestimates of total number of PWD obtained through NSS survey (2002) were not wide off the mark,there were significant variations from Population Census findings with respect to their composition bytype of disability.


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4.3 Prevalence of disability: Census 2001

Fig. 4.2 Prevalence Rate (%) of Disability in Various Categoriesof Population

2.13

2.21

1.93

1.87

2.23

1.92

2.37

0.00 0.50 1.00 1.50 2.00 2.50

Total

Rural

Urban

Male

Female

SC

ST

prevalence (%) of disability

STSC

Female

Male

Urban

Rural

Total

In rural India, the prevalence of disability was much higher (2.21%) as compared to that in its urbancounterpart (1.93%). Again, among males, the prevalence of disability (2.37%) was significantly higherthan that among females (1.87%). The prevalence rate among SC population (2.23%) was marginallyhigher as compared to the general population; while among ST population, it was noticeably lower(1.92%).

3.0

2.8

2.7

2.6

2.6

2.5

2.3

2.3

2.3

2.3

2.2

2.1

2.1

2.1

2.0

1.8

1.8

1.7

1.7

1.7

1.6

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5

Jammu and Kashmir

Orissa

Kerala

Tamil Nadu

Himachal Pradesh

Rajasthan

Madhya Pradesh

West Bengal

Uttaranchal

Bihar

Haryana

India

Uttar Pradesh

Gujarat

Chhattisgarh

Andhra Pradesh

Karnataka

Punjab

Delhi

Jharkhand

Maharashtra

% of disabled persons

Fig. 4.3: Prevalence of disability in major states of India


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12.00

20.57

44.75

32.7128.48

23.7118.38 19.19

12.32

4.761.47 0.73

05

101520253035404550

T o

t a l n o .

o f d i s

a b l e d

p e r s o n s

Age group (years)

Fig. 4.4: Estimated total no. of Disabled Persons in each age-group

Table 4.3(b): Total Number of Disabled Persons in Different Age-Groups and their Percentage Distribution byType of Disability

Age-groupNo. of PWD (inthousands)

% distribution of disabled persons by type of disability in eachage-group

seeing speech hearing movement mental0-4 1200 69 3 2 20 65-9 2057 48 13 4 27 910-19 4475 40 11 4 33 1220-29 3271 45 9 4 30 1430-39 2848 50 8 4 25 14

40-49 2371 51 6 5 26 1250-59 1838 51 5 8 28 960-69 1919 52 4 11 28 670-79 1233 52 3 14 27 480-89 476 51 2 16 27 390+ 147 49 2 16 28 4

No. of PWD (in 000) 21907 10635 1641 1262 6106 2264Source: Population Census (2001).

In table 4.3(b), it can be seen that in age-group 0-4 years percentage of children with visual disabilitywere more(70%) and those with all other disabilities were much less compared to other age-groups.Proportion of PWD with hearing difficulty increased steadily in higher age-groups while movement,mental and speech disabilities were relatively more prevalent between age 5 to 39 years.

4.5 Findings from Population Census 1981

Prior to the year 2001, count of totally blind, totally crippled and totally dumb persons were attemptedin the Population Census 1981. In general, out of 0.12 million population reported to be disabled, about45% were found to be totally blind, 32% were totally crippled and 25% were totally dumb. In


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comparison to the rural areas, the percentage of totally blind persons was lesser and that of crippledpersons was higher in the urban areas.

Table 4.4(a): Total number of disabled persons and their % distribution by type of disability

Population Category Total no. ofdisabled

% distribution of disabled by type of disability

Totally blind Totally crippled Totally dumbTotal 1118948 43 32 25Rural 969401 44 31 25Urban 149547 36 39 24

Table 4.4(b): Prevalence of disability (% population)

Population Category Total disabled Totally blind Totally crippled Totally dumb

Total 0.16 0.07 0.05 0.04Rural 0.19 0.08 0.06 0.05Urban 0.09 0.03 0.04 0.02Source: Population Census 1981

Only 0.16% of the total population was found to be totally disabled in India in the year 1981. Theprevalence of disability was much higher in rural areas as compared to that in urban. Among the threetypes of severe disability, blindness was most prevalent for the population as a whole. However, ingeneral it was felt that there has been severe under estimation of disabled persons in Census 1981.

As shown in state table S3 in Appendix-I there was a high prevalence of disability in 1981 in UP,followed by Andhra Pradesh, MP and West Bengal and low in HP, J&K and Haryana. The percentageof totally blind was higher in Rajasthan, U.P. and M.P. and the proportion of totally dumb was high insome of the north eastern states.

0.16

2.13

0.19

2.21

0.09

1.93

0.00

0.50

1.00

1.50

2.00

2.50

1981 2001 1981 2001 1981 2001

Fig. 4.5: Prevalence of Disabil ity in Census 1981 andCensus 2001


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B. Findings of NSSO Surveys on Disability

4.6 Size of Disabled Population : NSSO survey (2002)

National Sample Survey Organisation has been conducting comprehensive nation-wide large scale samplesurveys on disability almost once in 10 years. The third and the latest survey on the disabled persons wascarried out in the NSS 58th round (July-December 2002), where the coverage was extended to includemental disability also.

According to the survey estimates, in 2002, there were 18.5 million disabled persons in the country andthey formed about 1.8 per cent of total population. Again out of them 10.63 per cent suffered frommore than one type of the disabilities. The types of disability covered were (i) mental disability in theform of (a) mental retardation or (b) mental illness, (ii) visual disability in the form of (a) blindness or(b) low vision, (iii) hearing disability, (iv) speech disability, and (v) locomotor disability. In the case oflocomotor disability, more than one type of locomotor disability was considered as multiple disabilities.

Table 4

disability in india _ statistical profile 2011 march mospi

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