DISABILITY :CHALLENGES VS RESPONSES
( By Ali Baquer; Anjali Sharma )

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a-Extent of Disability in India

Estimates of the number of disabled vary a great deal, depending on the definitions, the source, the methodology and the extent of use of scientific instruments in identifying and measuring the degree of disability. It is estimated that the population with disability in India is approximately over 90 million, of these 12 million are blind, 28.5 million are with low vision, 12 million are with speech and hearing defects, 6 million orthopaedically handicapped, 24 million mentally retarded, 7.5 million mentally ill, 1.1 million leprosy cured.

A comprehensive country-wide sample survey of persons with disabilities was undertaken by National Sample Survey Organisation (NSSO) in its 36th round in 1981 at the request of the Ministry of Welfare which indicated that 1.8 per cent of the total population of the country has physical and sensory disabilities. No survey on mentally retarded persons was done at that time. However, surveys done by various research organisations indicate that about 2 - 2.5 per cent of the total population of the country has mental retardation.

Another survey was conducted by NSSO in 1991 to estimate the magnitude of the persons with disabilities in India. The survey indicated the following important findings :-




  1. About 1.9 per cent of the total population of the country, i.e., 16.15 million persons have physical or sensory disabilities which include visual, speech, hearing and locomotor disabilities. There was thus a slight increase in disability over the previous decade both in terms of absolute numbers and percentage.


  2. In a separate survey of children (age 0-14 years) with delayed mental development, it was found that 29 out of 1000 children in the rural areas had developmental delays which are usually associated with mental retardation. Approximately 3 per cent of the children between 0-14 years of age have developmental delays associated with mental retardation.


  3. The prevalence rate for physical disability was observed to be significantly more amongst males (22.77/1000) than females (16.94/1000).


  4. As regards the State-wise distribution of physical disability, the States which have higher prevalence rate, than the national average, were Andhra Pradesh (24.98/1000), Himachal Pradesh (28.70/1000), Karnataka (21.31/1000), Madhya Pradesh (27/1000), Orissa (23.06/1000), Punjab (29.36/1000) and Tamil Nadu (23.72/1000). The national average is 19/1000.


  5. The rate of prevalence of physical disability in urban population was 16.75/1000 as compared to 19.75/1000 in rural areas.


  6. About 12.3 per cent of the disabled people identified were multihandicapped.


  7. 9.14 and 6.77 per cent of the total estimated households respectively in rural and urban India were reported to have at least one disabled person in the household. The average household size in urban and rural sectors was 5.8 persons.


  8. The incidence of physical disability (number born or otherwise rendered disabled) in the rural areas of the country was on an average 90 persons per 1,00,000 population during the past one year. The figure in respect of the urban areas was 83.


  9. The incidence rate, as is the case with prevalence rate, is higher in the case of males than females. There were significant inter-state variations. The rates among males were 99 and 90 in rural and urban India respectively as against 81 and 75 among females in rural and urban areas respectively.


  10. Among the physically disabled 25 per cent of the disabled people in the rural areas and 20 per cent in urban areas suffered from such severe disabilities that they could not perform activities of self-care and daily living even with aids/appliances.

Estimated number of disabled persons in the country, on the basis of the survey is as follows :


Table 1

Estimated Number of Disabled Persons in India - 1991



(in millions)










































































Type of Disability Rural Urban Total
  Male
(1)
Female
(2)
Persons
(3)
Male
|(4)
Female
(5)
Persons
(6)
(3)+(6)
Visual 1.539
(46.15)
1.796
(53.85)
3.335
(83.27)
0.308
(45.97)
0.362
(54.03)
0.670
(16.73)
4.005
Hearing 1.409
(54.76)
1.164
(45.24)
2.573
(79.36)
0.339
(50.67)
0.330
(49.33)
0.669
(20.64)
3.242
Speech 0.942
(62.84)
0.557
(37.16)
1.499
(76.25)
0.298
(63.81)
0.169
(36.19)
0.467
(23.75)
1.966
Hearing and/or Speech 2.009
(57.42)
1.490
(42.58)
3.499
(78.07)
0.557
(56.66)
0.426
(43.34)
0.983
(21.93)
4.482
Locomotor 4.396
(64.58)
2.411
(35.42)
6.807
(76.15)
1.370
(64.26)
0.762
(35.74)
2.132
(23.85)
8.939
Physical (at least one of the above) 7.442
(58.82)
5.210
(41.18)
12.652
(78.32)
2.078
(59.34)
1.424
(40.66)
3.502
(21.68)
16.154

Notes :




  1. Figures in brackets indicate percentages, and percentages shown in cols. (1) and (2), in cols (3) and (6), and in cols. (4) and (5) add up to 100.


  2. Figures of hearing, speech and hearing and/or speech disability excludes the age-group below 5 years.

Source : Report No. 393. NSSO. A Report on Disabled Persons. 47th Round July - December 1991 & Report on Manpower Development. Rehabilitation Council of India, New Delhi, January 1996.

The age-wise distribution per thousand disabled has been found to be as follows:


Table No. 2

Type of Disability









































































Age group (Years) Visual Hearing Speech Locomotor Disability
  Rur. Urb. Rur. Urb. Rur. Urb. Rur. Urb. Rur. Urb.
0-4 4 5 N.A. N.A. 47 47 27 30    
5-14 24 21 85 80 262 261 224 223 150 165
15-59 255 304 387 377 539 513 487 503 425 458
60 and above 717 670 526 541 197 225 240 227 398 346

Notes :
Rur = Rural
Urb = Urban
N.A. = Not Available

Source : Report No. 393 NSSO A Report on Disabled Persons 47th Round July - December - 1991.

Amongst the visually handicapped, nearly 70 per cent are in the age-group 60+ and less than 3 per cent are in the age group of 0-14. For speech disability, nearly 26 per cent are in 5-14 age group. Nearly 50 per cent of the locomotor disabled and the speech disabled are in the age group 15-59.

The table below shows that after 45 years of age most of the people acquire all kinds of disabilities–visual, hearing, speech, locomotor.

Per 1000 distribution of physically disabled persons of age 60 years and above by age at onset of disability for each type of disability













































































































































All India
Age at onset (years)
Type of
disability
0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-44 45-59 60
and
above
Total
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12)
Rural
Visual 8 8 9 1 3 3 4 18 255 689 1000
Hearing 9 6 12 9 11 10 12 41 280 609 1000
Speech 42 23 24   10   12 25 262 594 1000
Locomotor 29 19 17 17 10 8 22 59 278 511 1000
Urban
Visual 12 15 7 3 6 5 5 18 236   1000
Hearing 7 13 10 11 9 14 13 55 215 651 1000
Speech 35 39 9   23   7 27 287 572 1000
Locomotor 21 16 15 9 12 8 13 41 280 586 1000

Source : Table (2.6.2) of Report No. 393. A Report on Disabled Persons, NSSO, 47th Round, July-December 1991.

Comparison with 1981 Sample Survey
The prevalence in 1991 has marginally gone up as compared to 1981. In 1991, the prevalence in rural areas is 1.99 per cent as against 1.84 per cent in 1981. The prevalence in urban areas in 1991 is 1.58 per cent as against 1.42 per cent in 1981. The tables below show that the prevalence as well as incidence of visual, hearing and speech disabilities have shown marginal to substantial decline and the prevalence of locomotor disability has shown substantial increase, although the incidence remains nearly the same.

Causes of disability as per NSSO survey
The survey has also estimated the causes of various disabilities. The findings can be summarised in the following tables:

Per thousand distribution of persons with a particular disability


Visual Disability



































































Causes of Disability Rural Urban
Sore eyes during first month of life 5 3
Sore eyes after the month 6 8
Severe diarrhoea before 6 years of age 11 13
Cataract 236 280
Glaucoma 34 42
Corneal opacity 13 16
Other eye diseases 130 107
Smallpox 29 35
Burns 2 5
Injuries other than burns 32 35
Medical/surgical intervention 18 38
Old age 362 273
Other reasons 49 74
Not known 72 71
Total 999 1000

The major share of cataract, old age and injuries are among the causes of visual disability.


Hearing Disability



















































Causes Rural Urban
German measles/rubella 9 14
Noise induced hearing loss 17 18
Ear discharge 175 143
Other illnesses 186 197
Burns 2 2
Injury other than burns 35 52
Medical/surgical intervention 10 21
Old age 310 316
Other reasons 77 88
Not known 179 149
Total 1000 1000

For about 31 per cent, the cause is old age. For a large number, the reasons are unknown. Ear discharge, too, is an important reason for this disability.


Speech Disability



























































Causes Rural Urban
Hearing Impairment 36 32
Voice disorder 90 63
Cleft palate 26 14
Paralysis 191 240
Mental illness/retardation 91 90
Other illness 221 207
Burns 4 6
Injury other than burns 32 47
Medical/surgical intervention 15 29
Old age 25 27
Other reasons 72 81
Not known 197 164
Total 1000 1000 1000


Locomotor Disability




























































Cause Rural Urban
Cerebral Palsy 48 43
Polio 328 346
Leprosy 30 19
Stroke 29 41
Arthritis 20 19
Cardio-respiratory diseases 4 5
Other illnesses 112 115
Burns 22 15
Injury other than burns 211 225
Medical/surgical intervention 22 34
Old age 62 49
Not known 60 44
Total 1002 999

Source : Report No. 393, Report on Disabled Persons, NSSO, 47th Round, July - December 1991.

Definitions used in the survey
The NSSO survey defined disability as ‘any restriction or lack of abilities to perform an activity in the manner or within the range considered normal for human being’.

The definitions used by the NSSO were :

Visually disabled:
A person who had no light perception, and also who had light perception but could not count the fingers of a hand correctly (using glasses if ordinarily used) from a distance of three metres in good daylight with both eyes open.

Hearing disability :
A person was treated as having hearing disability if he/she could not hear at all or could hear only loud sounds or could hear only shouted words or could hear only when the speaker was sitting in the front, or would usually ask to repeat the words spoken or would like to see the face of the speaker.

Speech disability :
Speech disability speech of a person was judged to be disordered if the persons’s speech was not understood by the listener, drew attention to the manner in which he/she spoke than to the meaning, and was aesthetically unpleasant.

Locomotor disability :
Locomotor disability was defined as the loss or lack of normal ability of an individual to move both himself/herself and /or objects from one place to another. It may occur due to



  1. paralysis of the limb or body;
  2. deformity in the limb (s);
  3. loss of limb (s);
  4. dysfunction of joints of the limb (s); and
  5. deformity in the body other than that in the limb (e.g. deformity in the spine, or in the neck or dwarfing or stunting).

Additional Estimates of The Disabled

In most populations all over the world approximately two to three per cent of the population is expected to be mentally handicapped, mental handicap being defined as a condition characterised by significantly sub-average general intellectual functioning existing concurrently with deficits in adaptive behaviour and manifested during the developmental period.

On this basis it can be estimated that there are nearly 24 million individuals in India with mental retardation, out of which approximately six million are moderately, severely or profoundly handicapped. Out of the 24 million, 0.8 million are adults over 20 years of age whereas 15 million are children below 10 years of age.

A National Survey on Blindness conducted during 1986–89 under the aegis of the Ministry of Health & Family Welfare by Dr. Madan Mohan estimated that 11.92 million persons are blind as against 3.47 million estimated by the NSSO survey in 1981. The NSSO Survey conducted in 1991 reports that there has been marginal decline in the incidence of blindness. It has also been observed in the report (NSSO : 1991) "experts are of the opinion that with greater pace of development and urbanisation the disability prevalence rate is also likely to rise". On the other hand, owing to better health care and advancement of medical sciences during the decade (1981–91), the incidence of some types of disabilities may show a decreasing trend, although, as the survey reveals, the overall impact of these factors is a marginal rise in the prevalence rate of physical disability of all types, taken together, during the decade 1981–91.

According to the National Programme for Control of Blindness (WHO Report : 1989) about 28.56 million persons are with low vision. A study conducted by Indian Council for Medical Research (ICMR) estimated that 6.8 per cent in urban areas and 10.8 per cent in rural areas had significant hearing losses.

Conclusions :

From the above discussions, it is clear that the estimates on disability very a great deal. For policy formulation and provision of services it is imperative that reliable estimates of the incidence and prevalence of various disabilities be made in accordance with accepted definitions of various categories of disabilities.

With the strengthening of preventive measures and coordinated efforts at their universal application the rate of disability should get reduced. But, tragically, the reverse is true. New modes of living, a dramatic increase in accidents at home and outside, on agricultural farms and in industrial units, misuse and abuse of drugs and other chemicals, failure of health services to considerably reduce mortality of mothers and new–born children and a host of other factors associated with advanced, modern and industrialised societies are adding to the partial or total disabilities caused by fatal and non-fatal accidents. Furthermore, there is every likelihood that the disabled are going to live upto retirement age and beyond. Incidence of violence – domestic, ethnic, communal etc. is on the rise and keeps adding to the numbers of disabled people.

Disability can be prevented and controlled to some extent but can not be totally eradicated. The expectations of disabled people in India, like in other progressive countries of the world, are rising and instead of pity and charity they demand and get their civil rights. They are not second class citizens and can not be treated as such.

The logical answer to this new trend for rights and dignity of disabled people can be responded to by planning and implementing a range of services aimed at making them independent in all respects. These services cover all aspects of an individual’s life from before birth to death – from health to education to nourishment/nutrition to leisure to employment to housing to transport to others. Together, these services must help disabled people to fully participate in all activities of the society.

A cost benefit analysis should, however, convince us that by undertaking the task of providing an adequate level of services and goods the country would be able to generate productive forces, hitherto untapped. It is an opportune time to avoid the wastage caused by excluding disabled people from the productive activities of the society and at the same time by making them dependent on existing resources. But, the greatest benefit of the active participation of disabled people in mainstream activities of the society, however, is the improvement in the quality of their lives which can not be calculated in monetary terms.

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