Factors associated with persons with disability employment in India: a cross-sectional study

According to the 2001 Indian Census, there were 21.9 million people (2.1 % of the population) living with disability, the majority located in rural areas (75 %) and most unemployed (65.5 %) [1]. Understanding the differential employment of persons with disability (PwD) is especially relevant since in the last two decades the national government has adopted progressive disability law.

Indian disability legislation dates as far back as the 1987 Mental Health Act [2], followed by the 1992 Rehabilitation Council of India Act [3], which supported the growth of human resources within the disability rehabilitation sector. India was the first nation in South Asia to sign the Proclamation on the Full Participation and Equality of People with Disabilities in the Asian and Pacific [4]. This resulted in the 1995 Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act [5]. The Act was known to be one of most comprehensive pieces of legislation pertaining to persons with disabilities in the region. Specific to employment, it had provisions on non-discrimination in the built environment and in government employment. It gave statutory recognition to an employment reservation policy of 3 % in government and public education institutions. Specifically, a 1 % reservation is required for three disability categories combined: hearing, vision and locomotor. Further, an unemployment allowance exists for those registered with the Special Employment Exchange program (a national employment service) for more than two years without securing employment.

Since poverty is the greatest challenge before planners in India, and the incidence of disabilities is very high in rural (75 % of total) and poor families, the 1995 Act has mandated the government to include PwD in all its mainstream poverty alleviation programs. The Act states that, at all levels, the government shall reserve not less than 3 % of all funds in poverty alleviation programs for the benefit of PwD. Nevertheless, the 1995 Act has shortcomings, such as vague terminology, and gaps regarding the implementation, monitoring and evaluation of programs. Further, the Act states that reforms should only be adopted “within the limits of the state’s capacity”. There are no mechanisms empowering any authority or court to impose fines or levies in the case of the breach of the provisions relating to training and employment [6]. Overall, the Act has failed to improve the lives of persons with disabilities and protect their human rights [6].

In 2007 India signed and ratified the Convention on the Rights of Persons with Disability (CRPD), absent of the Optional Protocol (which provides an internationally recognized mechanism to ensure that rights are realized through systematic reporting and evaluation of countries by established international committees). Although it was enacted in 2008, comprehensive reforms are yet to take place [6]. Given the large discrepancies between the approach of the Indian government and the CRPD, there are debates about whether the previous disability legislation should be reformed or a new act should be created.

Although the legislation focused attention on disability, there has been a noted lag in implementation of services and programming for PwD [7–9]. This is especially true in rural areas, since the relatively few public rehabilitation services are mostly located in urban centers [10]. As governmental and non-governmental agencies begin to address this gap, it remains unclear what factors contribute the most to PwD employment, and whether their employment experiences differ geographically across India.

Considering labor market supply, PwD experience barriers of accessibility to and ability at the workplace. Productivity is largely dependent upon the characteristics of the type of disability and the requirements of the job. For example, a person with hearing impairment may find it difficult to do telecommunication work, but excel in mathematically-based accounting work. Overall, according to labor market theory, a higher reservation wage and a lower market wage make a PwD less likely to be employed than a person without disability [11].

Discrimination can play a role when PwD with equal productivity to those with no disability have unequal opportunities. There has been a dynamic shift from the medical model of disability to the social model [12]. The social model of disability draws a clear distinction between impairments and disability by clarifying that the degree of disability is a function of the societal barriers that fail to accommodate difference. A bio-pyschosocial definition of disability is reflected in the Preamble of the Convention on the Rights of Persons with Disability’s (CRPD) definition of disability as well [13]. Despite this conceptual shift, the official discourse continues to perceive disability as purely a medical condition, framing the individual on his/her own without engaging with the wider social and physical context [14]. Scholars argue that this has led to a “top-down” approach where blanket policies are applied to all PwD with a disregard for heterogeneity in experiences.

The International Labor Organization (ILO) has outlined two categories of factors which affect full participation of PwD in the Indian labor market [15]: environmental and social. Physical environment and public facilities and utilities have not been developed or designed with the requirements of each category of disability in mind and nearly all mainstream training programs and work sites exclude disability groups due to these barriers. For example there are over 100 regional sign languages, but there is no acceptable national sign language for use by all people with speech/hearing impairment during vocational training sessions [16]. Social barriers comprise a critical impediment in the process of full participation. Baldwin and Johnson [17] explain that employment discrimination can occur due to prejudice, differential information about the average productivity of persons with and without disabilities, or the exploitation of workers by employers [13, 17].

In India, research on disability has been limited by the availability of data. For example, the National Sample Survey has never collected data on employment across disability status. The 2001 Indian Census included multiple questions on disability, and also collected data on literacy, sex, and employment status. No detailed information on amount of education and level of income were included. This paper takes advantage of this information available on the Census to investigate the correlates of the proportion of PwD employed in India, accounting for geographic variation at the state and residential (rural and urban) levels. Results have direct implications for the planning of interventions targeted to PwD. To the best of our knowledge, this is the first study to investigate the differential determinants of employment among PwD in rural compared to urban areas in India, accounting for potential spatial effects.

Our results showed that disability type, gender, and illiteracy were associated with PwD employment, and that the magnitude and direction of the association was not the same for urban and rural areas. Being a female and being illiterate results in less PwD employment in urban areas, while having mental disability results in fewer PwD employed in rural areas. Having movement and sight disability (holding all other variables constant) resulted in increased PwD employment in urban and rural areas. This is expected because most public programs target movement and sight disability [29]. The presence of spatial effects underscores the need to properly address local idiosyncrasies in policies and programs aimed to improve employment of PwD.

Regarding policy and programmatic issues, strategies implemented in urban areas need to address gender and illiteracy discrimination. While these results align with previous research [30–33], it is important to identify if there are fewer jobs available for female PwD and for illiterate PwD, if these people lack the proper training to undertake the job, or if they are qualified but do not have equal job opportunities. Moreover, it is crucial to assess the extent to which these issues vary across districts and states. The fact that in rural areas gender and illiteracy is not associated with fewer PwD employment could be a result of the prominence of agricultural labor [7, 11, 23, 34].

Current disability rights legislation for employment assumes homogeneity of experiences. Most efforts target PwD with vocational training and employment services through Federal mandates of “one size fits all” type of policy. There are although a few state-government initiated pilot programs which challenge this approach. For example, the state of Andhra Pradesh and the city of Pune have explored the utility of disability self-help groups that provide more autonomy to local leaders for rural development [7]. Self-help groups take the form of neighborhood-based collectives, which actively participate in problem solving and in the development of local programming. Self-help groups have been widely employed for women, but its application to PwD is less prevalent [35–39]. They mostly take the form of microcredit-based interventions that provide entrepreneurial opportunities. Their applicability beyond economic empowerment has although been the most salient feature. They allow for PwD communities to systematically organize around issues that are pertinent and pressing to them, allowing for programming to be more local and therefore more contextualized.

Regarding disability type, mental problems seem to be a major barrier for PwD employment in rural areas. This could be a result of lack of jobs suitable to persons with mental disabilities, of discrimination, or of lack of minimum training to conduct the job. This has important implications for targeted initiatives. The Rural Health Commission and the National Rural Employment Guarantee Act target persons in rural areas, without attention to specific disability types. For example, in the state of Andhra Pradesh, the Society for the Elimination of Rural Poverty has piloted microcredit schemes for PwD in rural areas, targeting all PwD, with no differential interventions for particular disability types. Also, a governmental agency based in south eastern India called the National Institute for the Mentally Handicapped has developed extensive vocational training for PwD, which has proven effective in increasing employability [40], but their scope is limited to urban areas. Another, non-governmental organization called Maharogi Sewa Samiti based in central India has developed a vocational training center for rural school drop outs and youth with disabilities. Although they target PwD in rural areas, all of the training occurs in the urban centers causing low retention rates. A similar initiative has been initiated by one governmental agency, the Society for the Elimination of Rural Poverty in Hyderabad. But they face similar issues with the context of an urban-based training approach.

This study has some limitations. Our data do not allow making conclusions about causality. Nevertheless our modeling approach and results shed light into factors associated with PwD employment, and make it clear that programmatic efforts designed to improve the wellbeing of PwD must account for disability type and spatial differences. In addition, we had a limited set of variables to include in our models. For example we would expect age and socioeconomic status to play a role in employment. Yet, the models had a high explanatory power, for both urban and rural areas. Another limitation is that the definition of disability varies across different surveys, and therefore caution is needed when attempting to establish comparisons between our results and others previously published [14]. Further, the decision of the Census of India to not include multiple disabilities as a category has implications for the interpretation of results. Mainly, caution should be used when extending these results to the small percentage of people with multiple disabilities. A recent article on disability estimates from the 2001 Census and the 2002 58th round of the National Sample Survey (NSS) concluded that “prevalence estimates in the census and the NSS are clearly not comparable… and it is unsure what aspects of disability are captured by the census and NSS current disability definitions” [11]. Lastly, the analysis was limited to district-level number of PwD; thus, due to the lack of individual-level data, the model predicts the likelihood of having lower or higher proportion of (percentage point increase or decrease in) PwD employed within a district, based on the type of disability and other variables.

Persons with disability have different employment experiences depending on their disability type, literacy, gender, and on whether they live in rural or urban areas. Although India has achieved significant progress regarding disability legislation, and has recently made an effort to implement poverty alleviation strategies targeting PwD, failure to account for these differences may hinder the benefits of the efforts.

Policies implemented at the national level without considering local idiosyncrasies are not likely to result in equitable improvements for the livelihood of PwD. There is a need to better understand the barriers to PwD employment, and how those barriers may vary by disability type across different districts in India. Such knowledge would provide much needed evidence that could be translated in more effective local policies. The results presented here are a first step towards building this knowledge by unveiling significant differences across urban and rural areas, type of disability and gender.