Category: Gender and Development

In the world’s largest democracy, with over 2698 registered political parties; 8 national parties, 52 state parties, numerous regional and local parties, and millions of members across party lines, political parties in India can be categorized as one of the largest unorganized sectors. From the lowest rung of volunteers to the office bearers at the highest level, the scale and strength of individuals involved is colossal. Women’s low participation in political organization and even lower representation in parliament and assemblies continues to remain a challenge not only in India but in most parts of the world. Politics has traditionally been promoted as the territory of men. When women attempt to enter the area of decision-making, including political decision-making by defying patriarchal norms, they face various forms of violence that includes casual sexism, harassment, bias, discrimination, psychological and physical violence etc.1 In many cases, these cases go unreported or unnoticed and don’t receive the attention that they should have received in the first place.

One of the most significant barriers to women in politics is the threat as well as the actual use of violence, and is seen as a common feature in South Asia2.  Various studies showcase that candidates and their families as well as voters have routinely faced violence during elections. For instance, Tamil Nadu’s five times Chief Minister Jayalalitha had faced severe backlash from her party members during her early years in politics. She was humiliated as MGR’s (then CM of the state and leader of AIADMK) body was lying in state in the heritage Rajaji Hall when a DMK leader tried to push her from the rostrum3

According to UN Women, gender-based violence (GBV) refers to “harmful acts directed at an individual or a group of individuals based on their gender. It is rooted in gender inequality, the abuse of power and harmful norms. The term is primarily used to underscore the fact that structural, gender-based power differentials place women and girls at risk for multiple forms of violence.” Violence against women and girls is defined as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women and girls, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or private life.”4

Sexual harassment is part of this gender-based violence. It permeates into the sphere of politics. Section 354A of the Indian Penal Code defines sexual harassment as a man committing any physical contact, advances involving unwelcome and explicit sexual overtures; or demanding or requesting sexual favours; or showing pornography against the will of a woman, or making sexually coloured remarks, shall be guilty of the offence of sexual harassment  (Indian Penal Code).

In 2013, the Indian Parliament enacted the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act (POSH) which is India’s first legislation specifically addressing sexual harassment of women at the workplace. It mandates employers to set up committees in the workplace, or local government officials in case of the informal sector, to hear complaints, conduct inquiries, and recommend action to be taken against perpetrators 5

In 2018, the sharing of stories about sexual harassment which began with the Me Too (or #MeToo) movement, also led to sexual harassment allegations against politicians in India. Several journalists had come forward to accuse MJ Akbar, the then Minister of State for External Affairs of sexual harassment. These and many other allegations brought the question of sexual harassment in political parties to the forefront. The Centre for Accountability and Systematic Change (CASC) had sent a legal notice to Maneka Gandhi, the then Union Minister of Women and Child Development, requesting for political parties to be penalised for failing to protect women as per the law 6. Taking cognizance of the same, Maneka Gandhi had urged all recognised political parties to take immediate action and form an internal complaints committee (ICC) to look into complaints of sexual harassment 7.

According to POSH, employers are bound to protect their employees from sexual harassment. This involves carrying out certain duties, one of which is setting up an Internal Complaints Committees (ICC). The Act mandates that workplaces with more than 10 employees need to set up an ICC8. In India, political parties which are registered under the Societies Registration Act and having more than 10 employees are thus mandated by law to have an Internal Complaints Committees (ICC) under the POSH Act9 .

Even in 2021, we continue to find that most political parties’ function without ICCs. While some parties have formed ICCs to address sexual harassment instances, many others deal with these cases either through their disciplinary committees or through informal mechanisms. According to a national party CPI(M)’s website, they have constituted an ICC that includes external members (the details of whom could be found on their website). In the past, the Aam Aadmi Party (AAP) has claimed to have established a committee10 but no description of such is available on their website. It had earlier been reported that functionaries of the BJP and the Congress had admitted that the parties did not have ICCs and sexual harassment complaints are generally handled by the disciplinary committee. Sometimes the case is registered at the state level and then referred to the party headquarters11. However, All India Professional Congress (the professional wing of Congress) has mandated the constitution of ICC for the organisation but it doesn’t cover the larger organisation of AICC.

If political parties take a stand against sexual harassment and violence against women in politics as a whole, it would be a step towards encouraging more women to join politics and attain leadership positions. People and party members need to recognise that political parties are workplaces and the implementation of POSH is essential. A massive number of volunteers are also part of the workforce of these parties and the parties need to acknowledge the volunteers’ rights under POSH.

The prevention of sexual harassment boils down to the fundamental right to live a dignified life, as enshrined in the Constitution of India. The political parties being an important factor in the democratic process of the nation, therefore, need to acknowledge the seriousness of the matter at hand and constitute an effective ICC with necessary provisions in place. They need to provide POSH training to all their membership cadres, volunteers etc about workplace violence, spread awareness about how people can file complaints and ensure accessibility to the process. 

This process of awareness generation, constituting the ICC, training etc could initially be taken up by the party headquarters and then spread to the local offices. Different parties could be encouraged to come together and adopt a joint code of conduct that would be followed by politicians and all-party workers and volunteers. Another approach to ensure that political spaces become safer spaces for women could involve a mandate by the Election Commission for political parties to constitute ICCs at the time of registration. 

Women continue to remain hesitant about entering politics. This can be seen in their low levels of representation in Indian politics. Currently, only 78 members out of 546 are women in the Indian Parliament. To ensure that women’s right to participate in politics is met, several activists across the globe have demanded legal reforms that formally acknowledge the threats that women face in politics and propose to close existing gaps. For instance, it was due to the efforts of the Association of Local Councilwomen of Bolivia, that Bolivia became one of the first countries to have passed a law that specifically prohibits and criminalises violence against women in politics12. The law covers physical and psychological violence and harassment and lays down various administrative, penal and constitutional sanctions13. This has bolstered action across the region and countries like Peru, Mexico, Costa Rica have proposed different laws in their parliaments, though they are yet to pass. It is time that Indian women leaders, women’s collectives and advocacy groups, gender-activists from across political parties and ideological spectrum come together to demand regulations that provide a safer environment to women and handle the issue of violence against women in politics in an equitable and just manner. 

The views expressed in the post are those of the author and in no way reflect those of the ISPP Policy Review or the Indian School of Public Policy. Images via open source.


  1. South Asia Partnership International. (2006). Violence Against Women in Politics: Surveillance System.
  2. Tuladhar, M. (2007). Unfolding the reality: Silenced voices of women in politics.
  3. Outlook India. (2016). Jayalalithaa: A Feisty Leader Who Dominated TN Politics for Three Decades. https://Www.Outlookindia.Com/.
  4. UN Women. (n.d.). Frequently asked questions: Types of violence against women and girls. UN Women. Retrieved 16 March 2021, from
  5. Human Rights Watch. (2020, October 14). “No #MeToo for Women Like Us”. Human Rights Watch.
  6. Hindustan Times. (2018, October 18). ‘Why should we exempt political parties?’ Maneka Gandhi urges for internal sexual harassment panel. Hindustan Times.
  7. The Economic Times. (2018b). Maneka Gandhi urges all political parties to immediately form sexual harassment committee—The Economic Times
  8. Ministry of Law and Justice, Govt. of India. (2013). The Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013|Legislative Department | Ministry of Law and Justice | GoI.
  9. Jayanthy, A. (2018, October 23). India’s #MeToo: Are Political Parties Legally Bound to Form ICC? TheQuint.
  10. Nath, D. (2018, October 22). Our ICC has taken action against harassers: AAP. The Hindu.
  11. The Economic Times. (2018a). Here is how political parties deal with sexual harassment charges—The Economic Times.
  12. Krook, M., & Restrepo, J. (2016). Gender and Political Violence in Latin America: Concepts, Debates and Solutions. Política y Gobierno, 23, 127–162.
  13. Saskia Brechenmacher. (2017). Fighting Violence Against Women in Politics: The Limits of Legal Reform. Carnegie Endowment for International Peace.

On 21st Dec 2020, Makkal Needhi Maiam, the political party headed by South Indian superstar-turned-politician Kamal Hasan, in its “Seven point Governance & Economic Agenda”¹ promised remuneration to homemakers for their unpaid housework in a move to lend recognition and dignity to the labour of women at home. It may well be the first step towards formally monetizing women’s work and even the first step towards a universal basic income (UBI). 

As the country has never  seen such a proposal before, a good place to start may be to define who a “homemaker” is. Must the homemaker be defined as a “woman” who engages in unpaid care and housework or as a “person” who engages in such work? Using the latter definition may be a step towards normalizing such work as non-gender specific but also runs the risk of being gender neutral and hence, gender non-responsive by failing to adequately meet the needs of women. The dataset below shows us the percentage of men & women aged 15-59, who have participated in various activities in a day in 2019. The gap in unpaid domestic work between the genders is clearly seen below, and the fact that women take on so much more of it makes it necessary to emphasize the gender identity of the homemaker.

AreaGenderEmployment & Unpaid domestic workRelated activities 

Source- Time Use Survey,2019 (NSO) 

There is also the pertinent question of the number of hours of unpaid work that would suffice for remuneration. For instance, there are many women who are employed in part-time jobs (which do not have the same work contracts and commitments as regular employment). Would they also fall under this security provision that the policy envisions? Another consideration that must not be overlooked is rooted in the intangible manoeuvres that cost homemakers a lot of their time and mental energy. Time management, making sure everyone’s schedule is unaffected, agenda management, financial management, performing the role of a tutor for the children at home, assisting in school work, and care work for children and the elderly are time-consuming and energy-intensive tasks. One must also consider whether women with special children, children with disabilities, and those with bedridden senior citizens to care for must be compensated much higher than others. 

The task of working out the remuneration to be paid to homemakers is a massive one. The party will have to consider whether the amount can be calculated based on the size of the house, the size of the household, or both? Larger households require more labour and there are a variety of tasks that are taken on by homemakers every day. Does one then put a price tag on the various activities associated with homemaking like cooking, cleaning the house, doing the dishes, making the beds, grocery shopping, toilet cleaning and so many more after which one may add the value of the labour involved in each of these tasks? An alternative approach would be to pay based on the number of hours spent on “homemaking” regardless of the type of task that was performed. A careful cost and benefit analysis of these two approaches to payment must be undertaken to arrive at a justified figure. Western feminists made a model to monetize household work done by women by assigning each task a specific value derived from how much the household help charges when she’s appointed to do so, but in India, domestic work is an informal market and the “value” ascribed to each task is highly discretionary and ceases to be a practical way forward. 

The rural-urban divide among homemakers must also be accounted for while calculating costs as rural women’s responsibilities are very different from their urban counterparts. For rural women, walking long distances to fetch water and firewood will be additional tasks, as well as animal husbandry, livestock management and managing the family farm. The women in urban spaces spent 293 minutes on domestic work, while rural women spent 301 minutes running the house-hold. ² 

It is common knowledge among public policy professionals that even well-intended policies may have unintended consequences. It is possible to gain an understanding of the unintended effects by examining the socio-economic and cultural context in which this policy is implemented. Undoubtedly, remuneration for homemakers is one way of recognizing the value of their contribution to a well-functioning economy. It makes apparent their invisible labour and lends dignity to their work, in the best way that the post-globalization world knows how. However, one might wonder if this move may serve to incentivize women to remain homemakers. One of the reasons for the drop in Female Labour Force Participation in urban areas is the income-effect of households. ³ 

In several studies, it has been proven that as household income increases, an increasing number of married women withdraw from the labour force. This is exacerbated by a social phenomenon where women usually marry men who are more educated than they are. The increase in income and economic mobility of the household may discourage the wife from joining the labour market as she occupies herself with ‘status producing household work’. When there are monetary gains to such work, it could serve as an incentive for women to engage in more of it. On the flip side, evidence points to how men tend to enter traditionally “feminine” domains where there is monetary compensation involved, for instance most tailors who work outside the home as well as cooks at social gatherings are men. Urban Indian women spend 293 minutes each day on unpaid care work as opposed to urban men who spend only 29 minutes.⁴ If paid for, this care work that Indian women do would equal roughly 3.1% of the country’s GDP. It may be interesting to observe whether this policy actually encourages men to take to homemaking and whether the reluctance of men to do their fair share of housework so far is due to deeply entrenched patriarchal conditioning or lack of monetary recognition. It may also be worth studying if both these factors intersect to create such behaviour among men.

It is also important to examine the effect of this policy on women who are already engaged in work outside the household and who comprise the female labour force. The pandemic and the accompanying social distancing norms compelled middle-class working women to forfeit domestic help and this led to the re-emergence of gender roles within the household.⁵ When the benefits of the proposed policy start accruing to lower-middle class homemakers, they may choose not to seek employment as domestic workers in other households as they are now being paid for their labour in their own homes. Unless there is parallel work done on sensitizing Indian men to contribute equally to household labour, the entire burden of this would fall on working women and cost them time, energy and mind space that they had earlier employed in fulfilling job responsibilities outside the home. The opportunity cost of a woman’s time would emerge as an issue to contend with, both for the woman being paid for her unpaid care work at home and for the woman who is now doing without house help. 

Another possible social consequence could be that men may stop handing over their share of income for their wives to budget and spend for the household. It is possible that since the wife is now viewed by the husband as an “earning member”, he may cease to view the household as a single unit and take for granted the fact that he need not concern himself with household expenditure on the children’s education and healthcare as his wife’s income would suffice. Patriarchal dictates already construct childcare as a woman’s responsibility and a woman’s economic independence may unfortunately serve as the final justification that men may employ to absolve themselves even further of that responsibility. 

This situation may then lead women to feel that they may have been better off earlier. The possible consequences of policies have to be understood through the social hierarchies that frame behaviour as well. As an additive effect, men may withdraw from whatever little care work they were doing, as in their eyes, women are now being “paid for it”. In order to ensure that the policy generates the desired benefits and reduces a woman’s dependence on the man’s income, the amount given as remuneration must be larger than the husband’s income but this could lead to other social problems like alcoholism, domestic violence, etc. Intra-household resource allocation is rife with gendered power dynamics, especially in the socio-cultural context of India.⁶ According to the India Human Development Survey of 2018, less than two per cent of agricultural land is inherited by women.⁷ In studies on joint titles provided to married women in developing countries, it was found that yields in maize production increased by 56% in plots where women solely controlled the output as opposed to 15% where both owned the plot but men controlled the produce as de-facto heads of the household.⁸ This points to how land productivity can be boosted if women control the output of land rather than if they have to forfeit such control to the men of the household. Intra-household inequalities result in men controlling the output of land, even for “joint” titles that are awarded.

The India Human Development Survey (IHDS) 2011 survey, in its interviews with married women (15-49 years) found that one in five women in Delhi and half of the women in the sample taken in Uttar Pradesh revealed that they ate after the men in their family had finished. A phone based survey by Social Attitudes Research for India (SARI) conducted a similar study in 2016 in urban India, yielding shockingly similar results. It found that about four in ten women in urban Uttar Pradesh and three in ten women in Delhi ate after the men.⁹ These leftovers lack nutritional value required for maintenance of physical and mental health.¹⁰ Hence, when intra-household resource allocations of even basic items like food and income are so skewed¹¹, it is absolutely fair to pre-empt and check for the social consequence of men forcefully appropriating the remuneration of the homemaker. 

Hence, a robust monitoring and evaluation framework of this policy must be put in place to check for and control factors that may potentially reverse the benefits that the policy hopes to deliver to women for their unrecognized house work. How would the policy ensure that the men in the household do not usurp the money? Can the policy check this undesirable tendency by putting in place a system of incentives where the male head of household also receives a certain type of social security? Should women who find themselves in such situations be given the option to use a helpline, or online registration of such grievances so they may be re-compensated for their loss? If this system were to work then what would be the policy pipeline for this and who would be the first points of contact for these women to approach? There may also be the risk of such monitoring frameworks enabling high-discretion actions. Policies that enable high discretionary power to be exercised by authorities are susceptible to corruption.¹² 

There are indeed numerous ethical dilemmas to consider, consequences to pre-empt and frameworks to be put in place to ensure that there are continued, sustainable benefits delivered to homemakers, lending dignity and recognition to their work which was hitherto unrecognized. If these conditions are addressed expertly, then there is much reason to be optimistic about this move to finally recognize the invisible work of our country’s women. This policy has the potential to reduce the poverty of many families that have the male as the only earning member and who may have lost their jobs amidst the pandemic. It would free women from a constant cycle of reliance on male family members, inspire them and enhance their individuality, their agency and their voice. The non-monetary and non-competitive perception of household work has diminished the position of homemakers in Indian society and if they are paid for their work, their social status would improve and their material freedoms would be broadened. Having financial resources of their own would empower women to leave abusive marriages and take themselves out of situations that are detrimental to their safety and well-being. It would make a significant difference to their overall status and place within the family and community. 

A final, interesting point to ponder would be the possibility of homemakers across the country being able to unite, much in the same way as a labor union. This sort of union would give women the collective strength and bargaining power to constantly ask for better and demand from the state what is rightfully theirs. Venezuela is the first country to have formed a homemaker’s union where the art of keeping house is accorded the status of a “profession” much like teachers, healthworkers, decorators, chefs, etc. Lizardi Prada, the founder of the Homemakers Union¹³ has managed to unite socialist women who are also homemakers and they collectively work to access education and information which they may need to improve their bargaining power vis-a-vis the state. In India, the caste-endogamous family is the unit of society and women are hardly a monolithic entity. Although organizations like the Self Employed Women’s Association (SEWA) is one of the earliest and most successful efforts at unionizing women, a more intricate network of women who are not necessarily involved in income generating activities outside the household (full-time homemakers) being able to unite and bargain for social protections would be a revolutionary thing to see unfold. Policies should not be a one-time top-down process and are more likely to generate sustained benefits through constant interaction between citizens and the state. As a long term goal, women being able to unite across caste and religious lines would send out a strong message that individuals are the unit of social organization, not the family. It is this position as individual citizens that women would be able to divorce themselves from roles like “wives” or “mothers” and raise their demands as workers who were keeping the wheels of the “productive” labor economy well-oiled with their own share of labor within the space of the home, no less productive than the conventionally understood labor economy. 


  1. Naig, U. (2020, December 21). Seven Point Governance & Economic Agenda. 
  2. Saha, D. (2017, May 4). Rising Income Levels, Stability Linked To Declining Female Workforce Participation In India. -participation-in-india-84594
  3. Oxfam, Roy, S. N., & Mukhopadhyay, P. (2019). What Matters for Urban Women’s Work. Oxfam.
  4. Ministry of Statistics & Programme Implementation. (2020, Sept 29). NSS REPORT: TIME USE IN INDIA- 2019 (JANUARY – DECEMBER 2019).
  5. Chauhan, P. (2020, October 24). Gendering COVID-19: Impact of the Pandemic on Women’s Burden of Unpaid Work in India.
  6. Dutta, D. (2018). Mind the Gap. 
  7. Pachauri, S. (2019, Feb 19). The invisibility of gender in Indian agriculture. 63290
  8. Agarwal, B. (2003). Agrarian Change, Gender and Land Rights. Blackwell Publishing. 
  9. Chakraborty, S. (2019, July 10). India Suffers Because Women Eat The Last And The Least.
  10. Coffey, D. (2017, January 03). When Women Eat Last. The Hindu.
  11. Bhattacharyya, R. (2019, March 7). Gender Pay Gap High in India. Economics Times. Gender pay gap high in India: Men get paid Rs 242 every hour, women earn Rs 46 less Read more at: ndia-earn-19-pc-less-than-men-report/articleshow/68302223.cms?utm_ 
  12. Kelkar, V., & Shah, A. (2019). In Service of the Republic. Penguin Books. 
  13. Prada, L., & Sugget, J. (2009, July 7). Venezuela’s Homemakers Union: An Interview with Founder and Coordinator Lizardi Prada.

The views expressed in the post are those of the author and in no way reflect those of the ISPP Policy Review or the Indian School of Public Policy. Images via open source.

The Government of India (GOI) defines Gender Budgeting as, “A process of identifying gender specific barriers across all sectors of development.”1 India began producing an annual Gender Budgeting Statement (GBS) as part of the Union Budget in 2005-06. A charter on Gender Budget Cells (GBCs) to be set up across GOI ministries was issued in 2007, and detailed guidelines to establish GBCs at state level were issued in 2012-13. The GOI’s Gender Budgeting Handbook (2015)2 makes mention of a sound understanding of gender equality, the involvement of each Department/Ministry, the effective utilization of GRB tools, and sex-disaggregated data as pre-requisites for efficient gender budgeting. In this context, our article provides an analytical framework to assess India’s progress on GRB, with particular emphasis on the GBS 2021-22. 

An analytical view of GRB in India

Numerous frameworks have been developed for effective GRB in developed and developing countries.  The Council of Europe applies gender budgeting principles on all European Union (EU) administered funds by conducting gender-based assessments of budgets and restructuring revenues and expenditures to promote gender equality at all levels of the government, across EU member states.3

The Overseas Development Institute advocates for a stronger focus on gender mainstreaming on the expenditure side of the Budget as opposed to the revenue side for developing countries in the early stages of GRB.4

The Governance and Social Development Resource Centre (GSRDC), an international think tank, highlights five key principles for GRB: (I) sex-disaggregated data collection and gender responsive analysis (ii) allocations as per strategic priorities/indicators (iii) performance monitoring (iv) civil society participation, and (v) the public disclosure of information.5

Drawing on these key principles, we analyse India’s Gender Budget 2021-22 along four parameters, evaluating the extent to which the GBS is transparent, responsive, evidence-based, and results-oriented. 

  • Clear
  • Detailed
  • Accessible
  • Uses Sex-Disaggregated data
  • Uses data collected across levels – National, State, District, Block, Village levels
  • Responsive to short and medium-term gender needs of the country
  • Dynamic and flexible
  • Follows a defined output-outcome-impact framework
  • Robust monitoring and evaluation methodology to measure impact

Parameter 1: Transparency

Over the last 16 years, India’s GBS has evolved into a comprehensive document, providing item-wise allocation and expenditure details in a clear, predictable format. The number of Ministries/ Departments included in the GBS has more than doubled, from 14 to 33. India’s GBS has been recognized as one of the most streamlined and detailed gender-responsive budgeting (GRB) documents in Asia.6

However, some challenges with the GBS remain. The GBS clearly delineates allocations into two parts:  Part A comprises women-specific schemes (100% allocation for women), and Part B for pro-women schemes, (30%-99% allocation for women). While this system allows policy makers to capture varying levels of the gender responsiveness in their schemes, the basis of the demarcation of schemes between parts A and B has been questioned on numerous occasions by public finance experts, such as Lahiri (2019)7 and Mehta (2020).8

Source: Union Budget Statements, 2005-06 to 2021-22

Moreover, in 2021-22, several ongoing schemes were compressed to create four new thematic umbrella schemes. Allocations have only been specified for these umbrella schemes. Though this approach allows for flexibility in allocation of funds within the umbrella, it reduces the detail around fund allocations and reporting on fund utilisation, not only in the current year, but also in subsequent years. 

Table 1: Umbrella schemes introduced in the Gender Budget, 2021-22

Total Allocation: INR 254 crores     Total Allocation: INR 582 crores
Total Allocation: INR 2,784.25 crores    Total allocation: INR 2,522 crores
      Total Allocation: INR 13,487.82      Total allocation: INR 20,105 crores

Note: These scheme allocations only pertain to the Gender Budget component, not the full allocation of the scheme. 

Source: GBS 2021-22 

Parameter 2: Responsiveness

Ideally, GRB should be dynamic, and evolve on an annual basis, with allocations reflecting both the short-term needs for women during the year, and a well-defined medium-term strategy for gender equality. The extent of the Indian Gender Budget’s responsiveness can be gauged by observing: (i) total magnitude of the gender budget; (ii) distribution of allocations across schemes and ministries; and (iii) diversion of funds towards emerging priorities. We analyse each of these below. 

First, the quantum of India’s Gender Budget between 2005-06 to 2020-21 has remained in the range of 4%-6% of the total expenditure, and less than 1% of GDP. The year 2020-21 was the only exception, when emergency spending on COVID-19 social protection schemes, like the Jan Dhan Yojana and Ujjwala Yojana drove the Gender Budget to 1.06% of GDP. In 2021-22, despite the disproportionate impact of COVID-19 on women9, the Gender Budget has fallen to 4.4% of the total budgetary expenditure and 0.7% of GDP. The paucity of the gender budget can be gauged from the example of gaps in allocations to support prevention of violence against women and girls (VAWG). Oxfam (2021)10  estimates an annual budgetary requirement of INR 10,000 to 11,000 crores for VAWG programming in India in 2018. However, budgetary allocations to support VAWG prevention stood at INR 797 crore, in the same year.

Source: Union Budget Statements, 2005-06 to 2021-22

Source: Union Budget Statements, 2005-06 to 2021-22

Second, for the past 16 years, India’s Gender Budget has been concentrated among five key Ministries and Departments: Rural Development, Women and Child Development, Agriculture, Health and Family Welfare, and Education.11 This trend has continued even in 2021-22, where these five Ministries account for 86% of the allocations. Further the top 10 schemes, which constituted about 65-80% of the Gender Budget between 2018-19 to 2020-21, were allocated 73% of the 2021-22 GBS.  

Source: Union Budget Statements, 2005-06 to 2021-22

Source: Union Budget Statements, 2005-06 to 2021-22

Third, several new areas of gender gaps emerged in 2021-22 requiring immediate priority including  social protection, prevention of domestic violence, skill training, public transport, digital literacy, and support for unpaid care work.12 While a small allocation was made for rural digital literacy and the introduction of the SAMBAL scheme resulted in nearly doubling the budget for tackling domestic violence, the total allocation for schemes in these areas comprised just 2% of the GBS 2021-22. 

Source: Union Budget Statements, 2005-06 to 2021-22

Parameter 3: Evidence-Based

GRB can be approached either through an ex-ante or ex-post lens. Under the ex-ante method, gender-gaps across sectors, geographies and social groups are identified, their demand is estimated, costs of intervention are estimated, and targets are set by undertaking a cost-benefit analysis. Based on set targets, budget allocations are made. On the other hand, the ex-post approach involves analysing existing schemes through a gender lens and identifying the extent to which they address gender gaps.13  The ex-ante approach is bottom-up, requiring extensive use of sex-disaggregated data for gender gap analysis, as well as data from various levels of government – village, block, district, state and national levels to formulate targets and under cost-benefit analysis. 

India’s experience of GRB has primarily been to follow the ex-post approach.14 While the Ministry of Women and Child Development’s Gender Budgeting Handbook (2015)15 urges the use of ex-ante GRB approaches such as participatory planning, spatial mapping and gender-sensitive checklists, Budget Circulars issued by the Ministry of Finance direct officials to identify allocations in existing schemes to be included in the GBS.16 Moreover, the gaps between budgeted and actual expenditures (which began being published in GBS 2019-20), indicate under estimation owing to lack of data driven, evidence-based gender needs analyses. 

Source: GBS 2019-20 to 2021-22

Parameter 4: Results-Oriented

Since 2017-18, the GOI has been producing an annual Outcome Budget, outlining measurable/quantifiable outputs and outcomes, against each scheme/project allocation across Ministries. The Outcome Budget 2021-2217 provides targets for 139 Central sector schemes and Centrally sponsored schemes. However, the GOI’s Outcome Budget does not report on the achievement of the targets in this Budget Statement, which makes it difficult to monitor results of government spending. 

This Outcome Budgeting approach has not yet been applied to the Gender Budget Statement. Moreover, the MWCD’s Gender Budgeting Handbook 2015 advocates for monitoring the utilisation of the funds allocated to different Ministries and schemes, however, post-budget monitoring and impact evaluation of the Gender Budget has not yet been undertaken in India.

Way Forward: Improving India’s Gender Budgeting Practices

In order to chart a gender-inclusive post-COVID-19 recovery, the Central government should undertake a gender-needs assessment study to recalibrate the total fiscal envelope available for the Gender Budget, broaden allocations across Ministries, as well as target finances towards emerging priority areas. 

Gender audits of Centrally sponsored schemes (CSSs) and flagship programs such as the Atmanirbhar Bharat Abhiyan should be undertaken to signal the importance of reporting gender impacts. In addition, the GBS should include measurable outcome and output indicators, and their annual progress should be reported. Most importantly, collection of gender-disaggregated data should be mainstreamed as a basic minimum requirement across dashboards of all CSSs, so as to normalize this practice. 

Akin to the ease of doing business ranking, NITI Aayog can consider developing a Gender Budget performance monitoring initiative, such that Ministries and even states can be ranked on the quality, results, and impacts of their gender budgets. 

And finally, capacity of GBCs which exist across 57 Central Ministries and 16 state governments should be enhanced through regular training. Central Ministries and states which are yet to adopt GRB should be supported through additional capacity building measures. 

We are grateful to Geetika Malhotra, Anushka Bansal, and Ishita Uppadhayay for their contributions to this piece.


  1. Ministry of Finance, Department of Economic Affairs, Government of India. (2021). Budget Circular 2021-2022.
  2. Ministry of Women and Child Development, Government of India. (2015). Gender Budgeting Handbook.
  3. European Institute for Gender Equality. (2017). Gender mainstreaming: gender budgeting. DOI: 10.2839/07916.,gender%20equality%20and%20women’s%20rights
  4. Welham, B., Barnes-Robinson, K., Mansour-Ille, D., and Okhandiar, R. (2018). Gender-responsive public expenditure management. Overseas Development Institute.
  5. Bosnic, M. (2015). Gender responsive budgeting. GSDRC Professional Development Reading Pack no. 14. Birmingham, UK: University of Birmingham.
  6. Chakraborty, L. (2016). Asia: A Survey of Gender Budgeting Efforts. International Monetary Fund. IMF Working Paper, Strategy, Policy, and Review and Research Departments.
  7. Lahiri, A. (2019). Fifteen years of gender budgeting in India: A Retrospective. Ideas For India. Retrieved 5 March 2021, from
  8. Mehta, A. K. (2020). Union Budget 2020–21: A Critical Analysis from the Gender Perspective. Economic and Political Weekly. Retrieved 5 March 2021, from
  9. Khan, P. R., & Nikore, M. (2021). It is time to address COVID-19’s disproportionate impact on India’s women. Asian Development Bank. Retrieved 5 March 2021, from
  10. Oxfam. (2021). Towards Violence Free Lives For Women. Oxfam India.
  11. The erstwhile Ministry of Human Resource Development was renamed Ministry of Education from 2021-22 under the New Education Policy 2020.
  12. UN Women Headquarters. (2020). Policy Brief: The Impact of Covid-19 On Women. United Nations.
  13. Chakraborty, L. (2014). Gender Responsive Budgeting, as Fiscal Innovation: Evidence from India on “Processes.” National Institute of Public Finance and Policy, New Delhi.
  14. Mehta, A. K. (2020). Union Budget 2020–21: A Critical Analysis from the Gender Perspective. Economic and Political Weekly. Retrieved 5 March 2021, from
  15. Ministry of Women and Child Development, Government of India. (2015). Gender Budgeting Handbook.
  16. Ministry of Finance, Department of Economic Affairs, Government of India. (2021). Budget Circular 2021-2022.

Ministry of Finance, Government of India. (2021). Outcome Budget 2021-2022.

The views expressed in the post are those of the author and in no way reflect those of the ISPP Policy Review or the Indian School of Public Policy. Images via open source.

The COVID-19 pandemic has exacerbated pre-existing gender inequalities with its disproportionate impact on women. Even before the pandemic, women spent nearly 7 times more time on unpaid work compared to men1, which has surged further now.2 While lockdown restrictions and economic tensions are reported to have increased domestic violence,3 families are resorting to other negative coping mechanisms such as reducing food intake4, pulling children out of school5, child labour6 and child marriage7 – a major brunt of which is borne by women and girls. Women are also more likely to have lost jobs and less likely to rejoin the labour force8. These effects are compounded for rural, poor, marginalised, disabled and elderly women. 

Despite this, women remained largely absent from the Indian government’s COVID-19 policy response. The limited gender-targeted relief measures were not only inadequate9 but also excluded a majority of poor deserving women.10 11 Even the ‘pandemic budget’ failed to recognise the plight of women, as witnessed by the cuts in schemes for women.12 13 

Given this context, strengthening Social Protection (SP) is imperative, as explained in our previous article.14 Well-designed SP can reduce gender gaps in poverty, enhance women’s income and food security, empower them, and provide a lifeline for poor and vulnerable women. However, given that the failure to confront inherent gender norms makes a gender-neutral approach gender-blind, it is important that SP is also gender-responsive in order to build back fairer, not just better. This would entail a transition from the left end of the spectrum shown in Figure 1, towards its right. 

Figure 1: The Gender Integration Continuum

Source: Adapted from UNICEF Office of Research – Innocenti (2020)15 

Identifying the gaps 

To formulate truly inclusive Gender-Responsive Social Protection (GRSP), one must first understand the gaps in existing SP. This section focuses on two schemes – one gender-specific (Pradhan Mantri Matru Vandana Yojana (PMMVY)) and one gender-sensitive (Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS)).  

PMMVY is a conditional cash transfer (CCT) of INR 5,000 to a mother for her first live birth, paid in three instalments (see Figure 2). The problem with its design is that it looks at a woman primarily as a mother/caregiver, solely responsible for meeting the conditionalities, and not as an individual in her own right. 16 17 18 19 This reinforces the gender norm that a child’s health and well-being is the mother’s responsibility alone. By mandating Aadhaar cards for both parents20, it penalises single mothers in the process. Further, by restricting it to the first live birth, it also penalises women who face abortions, miscarriages, stillbirths and infant mortalities. PMMVY can be far more inclusive if all mothers, irrespective of age and marital status, are made eligible and it covers at least two births like Odisha’s Mamata scheme21. Furthermore, in times of crises, there should be considerations to increase the entitlement and remove conditionalities. 

There are problems in its implementation too: cumbersome application process, delays in disbursement, slow grievance redressal, etc. due to which coverage routinely falls short of the target.22 23 In 2018-19, only around 14% of all pregnant women received full entitlements while 22% received it partially.24 The government must address these issues at the earliest and make the scheme uncomplicated and more women-centric. 

Figure 2: How to avail PMMVY benefits

Source: Ministry of women and child development25 

MGNREGS, on the other hand, is a rights-based gender-sensitive public works program. The gender-sensitive provisions, some shown in Figure 3, appeal to women, attracting over 50% of their participation year after year26. Yet, the scheme is not gender-responsive as it does not address the socio-cultural barriers to women’s participation or intra-household power dynamics. The key feature of MGNREGS is that it guarantees 100 days of employment to rural households. With COVID-19 induced job scarcity and return of male migrants to their villages, it remains to be seen whether women will be pressured by men not to compete for these jobs. The physically demanding nature of work also discourages many women. One way in which the type of work can be diversified and women can be remunerated for their care work is by expanding the programme to include social sector activities. Additionally, it must be ensured that the gap between design and implementation is minimum.27 Putting women at the forefront in planning, supervision and monitoring while countering gender norms that restrict women’s voice and mobility will not only make MGNREGS more efficient and transparent, but also change societal perceptions about women’s capabilities. 

Figure 3: Gender Sensitive Provisions in MGNREGS

Source: Ministry of Rural Development28

Designing Gender-Responsive Social Protection

Once the limitations of existing SP are acknowledged, they can inform the design and implementation of future GRSP. The foundation of GRSP lies in Gender Mainstreaming, a strategy for making women and men’s concerns and experiences an integral dimension of any planned action, in all areas and at all levels29. It critically examines the gendered impact of the criteria (poverty or other forms of vulnerability) which necessitates SP intervention in the first place. Such an inquiry would reveal the major constraints faced by women (shown in Figure 4), which render the outcome of a gender-neutral approach gender-discriminatory. 

Figure 4: Constraints that limit opportunities for women and girls 

Source: Adapted from Kabeer (2008)30

These constraints are further intensified by their varying implications across the lifecycle of a woman31, which need to be accounted for in policy design. Lifecycle risks for girls necessitate addressing their nutritional, educational and health risks, for which CCTs (if designed properly and supported by supply-side institutions) can deliver strong outcomes. For older women, social pensions accompanied by access to affordable healthcare can prove to be most appropriate. For working-age women, reducing the unpaid work burdens of participating women through employment guarantee programs with gender-sensitive interventions like MGNREGS is expected to work best32. As demonstrated by PMMVY, programme targeting and conditionalities must be carefully considered and all components must be reviewed for their gender-sensitivity33. Moreover, approaches that address a single constraint and not the multidimensional deprivations faced by poor women are unlikely to deliver long-term gains. Thus, basic income support must be complemented with simultaneous interventions to empower women thereby improving their prospects for a sustainable exit from poverty.34

A gender-responsive framework builds on a gender-sensitive knowledge base. Responding to gender inequality as a source of risk and vulnerability in the intended SP requires a context-based understanding of the gender dynamics at play. A comprehensive Gender-Sensitive Poverty and Vulnerability Analysis (GSPVA) can generate evidence for the same (summarised in Figure 5).35 Such an analysis would enable policymakers to design the intervention in line with the gendered needs, priorities and perspectives of the population, by defining explicit gender-sensitive programme objectives, targets and indicators, to promote equitable outcomes. 

Figure 5: Components of Gender-Sensitive Poverty and Vulnerability Analysis (GSPVA) 

Source: Adapted from FAO Technical Guide (2018)36

Translating intent into impact 

As demonstrated by MGNREGS, gender-sensitive design does not always deliver gender-equitable results due to improper implementation. Embedding a gender lens at each step of implementation is necessary to acknowledge the impediments like cultural resistance to women’s empowerment, lower literacy rate, digital gender divide, digital and financial illiteracy, that restrict women’s equal access to SP. Implementation should therefore be guided by a conscious effort to avoid exclusion on grounds of any disadvantage. Once participation has been ensured, the next step is to set up gender-friendly delivery mechanisms, institutional arrangements and grievance redressal.37

Any policy intervention must necessarily be complemented by routine evaluation throughout its lifecycle. It is perhaps even more important to ensure that the tools used for evaluation adopt a gender lens to map the intended outcomes with the actual impact. This is where the final component of GSPVA can assist implementers in assessing progress and redressing any shortcomings in programme design38. GSPVA can also provide a baseline to track the impact of the programme on gender-related issues.39 Gender audits can therefore provide important insights for course-correction as well as augment the evidence base for future interventions. Leveraging Self Help Groups for such audits can concurrently improve accountability and empower women collectives40

Finally, an overarching element critical to the success of GRSP is the active participation of women throughout the design, implementation and evaluation stages. Women should be systematically represented within all the institutional bodies in the programme, from steering committees to frontline staff. A commitment to gender balance in program staffing can boost women’s participation in SP programs41. This in turn requires sufficient and sustained financing.42

COVID-19 has presented an opportunity to reset everything. It has brought the multidimensional deprivations faced by women to the fore, thereby stressing the need to revisit SP and evaluate them from a gendered lens. Women and their perspectives must cut across all stages of decision-making rather than merely emerging as an afterthought or being left out altogether43. While making SP gender-responsive requires immediate action, the long-term objective of rendering SP systems gender-transformative by redistributing power relations should be kept in mind. The ultimate aim, therefore, is to make socio-economic structures more equitable in the household and beyond.


  1. OECD Stat. (2021). Employment: Time spent in paid and unpaid work, by sex.
  2. Chauhan, P. (2020) Gendering COVID-19: Impact of the Pandemic on Women’s Burden of Unpaid Work in India. Gend. Issues. 
  3. Rukmini, S. (2020, April 18). Locked down with abusers: India sees surge in domestic violence. Al Jazeera.
  4. Azim Premji University. (2020). COVID-19 Livelihoods Survey. 
  5. Seethalakshmi, S. (2020, August 16). Out-of-school children likely to double in India due to coronavirus. Mint.
  6. Ellis-Peterson, H. and Chaurasia, M. (2020, October 13). Covid-19 prompts ‘enormous rise’ in demand for cheap child labour in India. The Guardian.
  7. BBC News. (2020, September 18). India’s Covid crisis sees rise in child marriage and trafficking.’s%20coronavirus%20lockdown%20has%20had,reports%20the%20BBC’s%20Divya%20Arya.&text=It%20is%20illegal%20for%20girls,18%20to%20marry%20in%20India.
  8. Rukmini, S. (2020, June 11). How covid-19 locked out women from jobs. Mint.
  9. Dhawan, V., Pande, R., Rabinovich, L., et al. (2020, April 24). Getting by on Rice and Salt: Rural Women’s Coping Strategies during India’s Coronavirus Lockdown. Yale Economic Growth Center
  10. Pande, R., Schaner, S., Troyer Moore, C., et al. (2020, April 17). A Majority of India’s Poor Women May Miss COVID-19 PMJDY Cash Transfers. Yale Economic Growth Center
  11. Somanchi, A. (2020, May 22). Covid-19 relief: Are women Jan Dhan accounts the right choice for cash transfers? Ideas for India.
  12. Gupta, S., Ghosh, P. and Bindal, S. (2021, February 17). Budget 2021: No Lessons Learnt From the Disproportionate Impact of the Pandemic on Women? The Wire.
  13. Chadra, J. (2021, February, 1). Budget for Women and Child Development shrinks, poshan slashed by 27%. The Hindu.
  14. Shrivastava, S. and Sanyal, R. (2021, February 1). Making India’s Social Protection Shock Responsive: Lessons from PDS amid COVID-19. Policy Review.
  15. UNICEF Office of Research – Innocenti. (2020). Gender-Responsive Age-Sensitive Social Protection: A conceptual framework.
  16. Cookson, T. (2018). Unjust Conditions: Women’s Work and the Hidden Cost of Cash Transfer Programs. California: University of California Press. DOI: 
  17. Poverty Insights. (2009). Cash transfers: To condition or not to condition? Institute of Development Studies.
  18. Plagerson, S. (2024, September 8). Do Social Protection Programmes That Impose Conditionalities on Women Fail to Confront Patriarchy as a Root Cause of Inequality? Social protection and human rights.
  19. Ladhani, S, Sitter, KC. (2020). Conditional cash transfers: A critical review. Dev Policy Rev.; 38: 28– 41.
  20. Ministry of Women and Child Development. (2017). PMMVY Scheme Implementation Guidelines. Government of India.
  21. Department of Women & Child Development and Mission Shakti. (n.d.). Revised MAMATA Guidelines. Government of Odisha.
  22. PTI. (2018, January 15). Less than 2% beneficiaries get aid under maternity scheme. Hindustan Times.
  23. The Wire. (2019, November 29). Latest Data on PMMVY Coverage Shows Only Marginal Improvement in All-India Figures.
  24. Dreze, J. (2019, November 19). The mother of non-issues: on maternity entitlements. The Hindu.
  25. Ministry of Women and Child Development. (2017). PMMVY Scheme Implementation Guidelines. Government of India
  26. Ministry of Rural Development. (2018, December 13). Women Participation Under MGNREGS. PIB.,%2D19%20(as%20on%2007.12.
  27. Chopra, D. (n.d.) Gendering the design and implementation of MGNREGA. UNICEF Office of Research-Innocenti.
  28. Ministry of Rural Development. (2013). Mahatma Gandhi National Rural Employment Guarantee Act, 2005 Operational Guidelines. Government of India.
  29. UN Women. (2000). Gender Mainstreaming.
  30. Kabeer, N. (2008). Mainstreaming gender in social protection for the informal economy. Commonwealth Secretariat.
  31. International Labour Office. (2003). Extension of Social Security.
  32. Antonopoulos, R. (2013). Expanding social protection in developing countries: a gender perspective. Levy Economics Institute at Bard College Working Paper, (757).
  33. FAO. 2018. FAO Technical Guide 1 – Introduction to gender-sensitive social protection programming to combat rural poverty: Why is it important and what does it mean? Rome. 76 pp.
  34. FAO. (2018). Meeting Our Goals.
  35. FAO. 2018. FAO Technical Guide 2 – Integrating gender into the design of cash transfer and public works programmes. Rome. 88 pp.
  36. FAO. 2018. FAO Technical Guide 2 – Integrating gender into the design of cash transfer and public works programmes. Rome. 88 pp.
  37. Hidrobo, M., Kumar, N., Palermo, T., & Pe, A. (2020). Why gender-sensitive social protection is critical to the COVID-19 response in low- and middle-income countries.
  38. FAO. 2018. FAO Technical Guide 2 – Integrating gender into the design of cash transfer and public works programmes. Rome. 88 pp.
  39. FAO. (2018). Meeting Our Goals.
  40. The Quantum Hub. (2020). Women’s Economic Empowerment in India.
  41. FAO. 2018. FAO Technical Guide 3 – Integrating gender into implementation and monitoring and evaluation of cash transfer and public works programmes. Rome. 48 pp.
  42. Gulati, N. (2021). Budget 2021-22: A gender lens. Ideas For India.
  43. Holmes, R., & Jones, N. (2013). Gender and social protection in the developing world: beyond mothers and safety nets. Zed Books Ltd.

The views expressed in the post are those of the author and in no way reflect those of the ISPP Policy Review or the Indian School of Public Policy. Images via open source.


​2020 has been a year of immense learning for policymakers across the globe. As Covid-19 unfolded, new social, political, healthcare, and economic challenges came to the forefront. W.r.t healthcare challenges, older adults remained disproportionately affected.1 The problems of the old have not received adequate attention in a young country like India. India is home to 134 million older people and by 2026,  this number is expected to rise to 173 million.2 The share of people above 60 years of age in India’s population stands at nearly 10% today and is rapidly growing.3 As fertility rates fall and a large proportion of the population ages, policymakers will increasingly face new challenges in terms of delivery of healthcare.

The government of India launched the National Programme for the Health Care of Elderly (NPHCE) in 2010-11.4 The NPHCE recognizes the deficiencies of the primary healthcare system and its inability to meet the long-term care needs of older people. It also recognizes the importance of the availability of care closer to the place of residence for older people given high levels of disability. Nevertheless, the policy limits healthcare provision for older people mainly to the existing healthcare settings. The proposal for home visits by trained healthcare workers is constrained by limited personnel. Besides, the regional diversity in demographics, economics, socio-politics is vast enough to call in question a universal policy solution. This clearly calls for policy debate on how to get effective solutions in place before the health of older adults turns from being a problem to a crisis. A decentralized policy option with an underlying principle of intergenerational solidarity is more likely to be efficient. A rural community-based, women-led, low-cost model, like the ones facilitated by Self-Help Groups (SHGs), can potentially be integrated with long-term healthcare services. We examine the healthcare needs of older people in India through the lens of demography and propose utilizing India’s social capital, in form of Self Help Groups (SHGs), to deliver significant components of healthcare to older adults.     

Key demographic trends in relation to healthy ageing in India

The policy challenges of the changing demographic structure of the world vary sharply between regions. For more affluent countries, where the problem of population ageing was detected earlier and social security nets were put in place, the key challenge remains allocation of resources fairly between and within generations. For the rapidly ageing developing regions though, resources are scarcer and institutions have a shorter time frame to adapt to the changing population pyramid. India is a case in point. 

“India has traditionally relied on multigenerational families to provide for the needs of older people.”5 Sathyanarayana et al draw attention to the increasing reversal of this trend. Particularly, rural and illiterate elderly women are likely to age alone, raising concerns about policy responses for their welfare.6 Also, analysis of morbidity shows an expansion of morbidity with ageing, starting as early as 45 years of age. 

Changing Living Arrangements

The Census (2011) showed that three out of four elderly people reside in rural areas. However, most of the health infrastructure is situated in urban areas.7 This creates a barrier to healthcare access for older adults. Sathyanarayana et al (2014) compared data from two National Family Health Surveys – first (1992-1993) and third (2005-2006). The proportion of single-member older adult households went from 2 percent to 5 percent and two member households with at least one older adult went up from 8 percent to 15 percent. Thus, more older persons are living alone or with a single caregiver. This increase accompanies a reduced proportion of total households with older adult members, which means that a lesser proportion of older people live with their family. The percentage of older adults living alone has gone up from 2.6 to 5 percent; with wide regional disparities. These trends indicate a disintegration of the multigenerational household, the legally obligated care-providers for older people in the country.8 A legal obligation to care falls short of addressing the capacity to care for the family. The care providers of old people are part of the 22.5 percent of the population living on less than 1.90 dollars a day.9 Financial constraints on providing long term care to older adults is significant. Moreover, India’s labour market is predominantly informal. The sector lacks comprehensive social security nets like old-age pensions and job security, which restricts time and finances for care provision. With a high prevalence of unskilled, high physical intensity, low-paying jobs, both the caregiver and the elderly workforce become disadvantaged in the present and the future. This also creates a vicious cycle of poor health and unhealthy ageing. Healthcare policies designed for rural areas, with a specific focus on the marginalized social classes, will thus be more helpful especially given the expansion of morbidity with ageing. 

Expansion of morbidity

Arokiasamy and Yadav draw attention to the exceptional rise in the non-communicable disease prevalence in older adults.10 Prina et al (2020) corroborate these findings with their assessment of Disability Free Life Expectancy.11 The lowest estimates for India were 11.5 years in men and 11.7 years in women. “With the concomitant increase in life expectancy at age 60 to 16.7 and 18.9 years for males and females respectively, older adults will thus live longer with chronic diseases”.12 The demographers also highlight early onset of morbidity, soon after 44 years of age.

While developed countries have seen a clear shift from infectious to chronic diseases, India faces a dual burden of disease.13 The pattern is reflected in the older adults’ disease patterns too, with significant morbidity associated with infectious diseases and their sequelae.  In the face of high morbidity, questions about availability, affordability, and access to long-term care services for older adults in India beg discussion. 

Availability, access, and affordability of healthcare in India 

In addition to physical barriers to healthcare access, mobility issues and distance to the healthcare system; older adults in India face significant social barriers. As Dey et al highlight in their study, gender, religion, caste, socioeconomic status, stigma impede access to healthcare for older adults.14 While availability and quality of care vary widely among regions; older people, in general, receive less care commensurate to their level of morbidity even where available. Affordability of healthcare was an additional access barrier. With only 15 percent of the population covered under insurance, resulting in 62 percent expenditure on health coming from out of pocket payments.15 Such over-reliance on out of pocket payments creates impediments for access to quality healthcare, especially for the marginalised sections of communities.  Let’s take the health of older women for instance. ‘Feminization of the older population’ is a prevalent phenomenon across the globe. This is more apparent in rural India. The rate of homebound older people is approximately 70 per 1000 persons in India, and even higher for women.16 Despite reporting worse health, older women are less likely to be hospitalized. A patriarchal society, accumulation of malnutrition, and life-long poverty compounded by high morbidity pose challenges to healthy ageing of Indian women. 

While many have to continue working in their old age, their incomes remain meagre. One in three elderly people lives below the poverty line, with another one living just above the cut-off of the poverty line.17 Social security in India is inadequate. The state pension scheme is not universal. Even among expected beneficiaries, less than 10 percent receive assistance.18 Moreover, rural to urban migration of youth leaves older parents more vulnerable. As Sinha and Batniji point out, “At times of illness, people on low-incomes in general often respond by foregoing their children’s education, selling limited assets (including those used to make a living), borrowing from informal sources at exorbitant rates, or foregoing medical treatment.”19 An average rural older adult can thus expect to live with higher morbidity and multiple chronic conditions miles away from quality healthcare, which also happens to be out of her budget. 

Trends in Policy Response to Ageing in India

India first formulated a National Policy for Older Persons in 1999.20 The NPOP aims to ensure healthcare, financial, and social well-being of older people. It also focuses on the feminization of ageing and the importance of intergenerational solidarity. It puts the onus on individuals and families to ensure “healthy” ageing with minimal state intervention. While the policy document quotes the changing demographic structure to emphasize the importance of population ageing, it fails to look beyond aggregate numbers or take into account major factors which interact with demography and shape the experience of ageing. 

The policy attributes challenges of ageing to the breakdown of families. The homogenization of ageing and its challenges forecloses a proper role for the state to take in designing welfare policies. To quote from the policy, “Welfare is intended primarily for the extremely vulnerable elderly who are disabled, infirm, and chronically sick and without any familial support” (NPOP, 1999). The national policy centres on the highly debated idea of successful ageing, putting the onus of care on individuals and extending it to families. The concept of “successful ageing” has been heavily criticized as it fails to account for differences in socioeconomic status and gender disparities, thus decontextualizing individual choices towards “healthy ageing”.21 With the breakdown of multigenerational households and a vicious cycle of poverty, neglect and poor health in old age, this approach of completely relying on families without offering extensive state support seems more and more unfeasible. 

With recommendations made in the National Policy on Older Persons (NPOP) as well as the responsibility of the Government under the Maintenance & Welfare of Parents & Senior Citizens Act, new changes were suggested. It stated that older individuals in rural areas and older women require more attention and medical technology needs to be factored into the ageing policy. The suggestions fall short of addressing challenges of the feminization of the older population, and an increasing role of the state. Besides, medical technology and assistive devices have influenced the population ageing much less than the existing gender, regional, income, and class disparities. The National Program for Health Care of the Elderly (NPHCE) is based on the objectives of the National Policy for Older People. Similar biases are thus reflected in the  NPHCE model. The NPHCE clearly outlines promoting “healthy” or “active” ageing in a “society for all ages” as its vision. Its specific objectives include easy access to health promotion, disease prevention, and curative and rehabilitative health services for older people. Its proposed strategy includes home health visits, dedicated services for elderly at all levels of the healthcare system, training of healthcare workers, and Information, Education and Communication (IEC).  However, there are some serious limitations to the stated objectives.

First, the policy fails to account for existing patterns of healthcare-seeking in rural India where most older people live. As Das et al. identify most of the healthcare in villages is provided by informal, untrained private providers.22 Second, even if the existing healthcare workforce is trained, the urban-rural ratio of health workers remains 3:1 with three doctors in urban areas for each one in a rural area.23 The policy thus fails to address the basic problem of access to healthcare, which is further complicated in the case of older adults as explained previously. Third, if the problem of access is solved, the challenge of affordability remains. The limited budget allocated to healthcare focuses more on maternal and child-care services.24 Households with older adults thus spend 3.8 times more out of their pocket to meet healthcare needs. This spending is catastrophic for poorer elderly households).25 Alternative approaches can thus be explored to deliver healthcare to older people, especially in rural areas. We suggest Self-Help Groups, already existing in rural areas, as possible delivery points of healthcare for older adults. 

We base our proposition on harnessing the principle of social capital in rural India, which has been effective in successful microfinance interventions for decades. Self-Help Groups can provide an alternative to deliver parts of the NPHCE in rural areas under the budgetary, social, and geographical constraints. The suggested policy response does not come without limitations, which are also discussed below. 

Self-Help Groups for Rural Healthcare Delivery: A Possibility

Microfinance is the provision of capital in the form of small loans, savings opportunities, insurance, and similar products designed explicitly for the poor has been a debated strategy to reduce poverty. The Ministry of Finance supports providing microfinance to self-help groups of older persons so that they can undertake income-generating activities.26 Microfinance programs in several instances have bundled health education or insurance towards better public health and increased profits. No program has tested health promotion or basic healthcare service delivery to older adults through microfinance groups. Self-Help Groups (SHGs) of younger people can be trained and supported for rural healthcare delivery tailored towards older people. Moreover, as Sinha and Batniji point out microfinance is more suited to address basic health and disability care needs; two of the most important healthcare needs of older people. 

Haldar and Stiglitz provide a theoretical basis to the debate, experiences, and a way forward for microfinance. The concepts of “social capital” and “institution” are of specific value.27 The economist duo looks at institutions as “emergent and localized reactions to collective action problems”. Designing long term care is heterogeneous and it needs local responses.  In this scenario, microfinance can be looked at as a potential  opportunity for policymakers. The confidence in the effectiveness of microfinance for successful rural ageing stems from its reliance on “social capital” to be successful. Social capital sees individual well-being “closely related to connectedness, and maintaining the affection and respect of those with whom one is closely connected, as an essential aspect of advancing an individual’s own sense of well-being”. The authors trope that non-reliance on social capital played a major role in the failure of microfinance institutions to help broadly define how microfinance can be utilized for healthy rural ageing. We emphasize on Self-Help Groups as women provide most of the caregiving needs across the world. 

Incorporating SHGs in rural ageing is in line with the social trends of a rural area. A strong sense of community, relatively strict divisions between social classes and social capital as described above can ensure effective delivery of healthcare interventions. Lorenzetti et al. state, “The leading microfinance institution Grameen Bank’s preconditions for loaning under microfinance include- all members must be “poor”, live close to one another in the village, have no blood-ties, and be from roughly similar economic conditions.28 Achievement of such homogeneity can help deliver culturally appropriate and accepted healthcare.” For instance, health promotion in older adults is a major focus of the NPHCE.29 Based on the Census (2011), the literacy rate is 39.8 percent for the oldest age cohort. This varied from 22.2 percent in Jammu and Kashmir to 76.9 percent in Kerala. As younger cohorts have higher literacy rates and are embedded in the social fabric of the community, health promotion interventions through SHGs will likely be more effective for older cohorts. Indeed, interactive sessions on HIV/AIDS, prevention of non-communicable diseases, water, and sanitation have been effective through this approach in India, Ghana, and Peru. Sessions for fall prevention, urinary incontinence, and information regarding available social schemes can be accomplished through the SHGs. Thus widening the availability of healthcare for rural older adults. 

The largest proportion of healthcare expenditure in India relates to the purchase of drugs. With the expansion of morbidity mostly driven by non-communicable diseases, long-term medical management of the condition is an essential and costly affair for progressively impoverishing rural older adults. Micro-franchise distribution of affordable, essential drugs can address some of these access to healthcare challenges. With the potential to be adapted to each setting and the decentralized nature of microfinance, it can increase the uptake of healthcare in the most marginalized of older adults. Approach to healthcare for older adults has traditionally been “holistic” and “team-based”. The same approach, supported by the principle of social capital in rural communities, can help provide appropriate healthcare to older adults. 

Critique of microfinance stems from the evaluation of interventions failing to demonstrate growth in income or gender empowerment. The microfinance crisis in the state of Andhra Pradesh in India,30 where  57 microcredit debtors committed suicide in 2010, is not lost on the writers.31 As Haldar and Stiglitz’s (2014) analysis of the failure of the model of microfinance points out, the flaws can be overcome with adherence to limited profit margins, the essentiality of social capital, and strong vertical and horizontal ties at all levels of the institution. With the Malegam committee’s proposal for a regulation of the microfinance sector, the risks of another crisis can be reduced.32 The essay does not advocate decontextualized use of microfinance; for example, the bundling of health insurance with a separate loan.33 It rather advocates a community-based approach to rural healthy ageing, delivered not by a single healthcare worker under a state-dependent structure, but developed, financed, and led by the community itself. If designed properly, microfinance backed Self-Help Groups may change the healthcare of rural older adults for the better. Especially in current times, given the restrictions to healthcare access and employment opportunities the Covid-19 pandemic has imposed, traditional financing and healthcare setups need the support of non-traditional ones, like microfinance to protect the interests of  the most disadvantaged. 


Population ageing is a process and will continue to pose a challenge to income security, work and retirement, health, and social care policymaking. This is magnified in the context of ageing in India, which is heavily populated with a predominantly informal economy, near absence of social security, and wide disparities in public health and healthcare systems. With the constraints on the younger population, a more responsive rather than punitive system will likely benefit the ageing population most. With changing family structures, the country needs to expand social security for an ageing population with context-relevant, decentralized measures. Foremost, it is important to collect and analyze good quality data on demography to facilitate policy making. To reverse trends in the expansion of morbidity, the newly introduced healthcare program for older adults needs to redirect its resources where the morbidity lies – in rural, feminized, deprived populations of older adults. Provision of healthcare for healthy rural ageing through Self-Help Groups can be explored as a contextually relevant, decentralized, low-cost option for better health outcomes.

The views expressed in the post are those of the author and in no way reflect those of the ISPP Policy Review or the Indian School of Public Policy. The picture on the header for this article has been clicked by Umesh Jadhav. Other images via open source.


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