People with disabilities are one of the most disenfranchised groups in India. Standardized measurements of disability in India and internationally have overlooked the linkages between the economy and disability. In recent decades, neo-liberal economic reforms imposed in developing countries, under pressure from international financial institutions, have downsized state role, privatized social goods, and encouraged export-led strategies and market-based economics. India's economic reforms, initiated in 1991, have led to rapid economic growth that is, however, increasingly mal-distributed.

This paper investigates the implications of economic restructuring in the arenas of social programs, education, employment, accessibility, health, agriculture and food security, and water and land acquisition from a disability perspective. Our analysis shows that while increased employment opportunities and accessibility have benefitted middle-class and highly-skilled disabled persons, the majority of people with disabilities have been left out of India's economic affluence. We contend that India's globalized economy and reduced state role necessitate renewed understanding of human rights, including disability rights.


Recent estimates suggest 85-90% of the global population of persons with disabilities resides in so-called developing countries. The United Nations estimated that more than 1.3 billion people live in abject poverty in the global South, 600 million of which are disabled (Yeo, 2005). Thus, the majority of people with disabilities in the South are not only poor, but they are among the poorest of the poor. In India, there are no clear estimates of the number of persons with disabilities. Concerns persist that, given the stigma surrounding disability, many individuals with severe impairments, mainly women and rural disabled, are excluded from census and surveys (Jeffery & Singal, 2008).

Moreover, large-scale government studies as well as most small-scale research in India has overlooked the impact of economic globalization in the form of changing roles of the state and the market on the lives of people with disabilities. The hype about India's recent economic growth obscures the lived realities of spiraling inequality, the declining welfare state, and the growing misery of the poor. As the state withdraws from the service sector, access to basic necessities such as education, health, employment, and food and water security has become increasingly difficult for vulnerable populations (Bhaduri, 2008). Little critical analysis of economic globalization and privatization exists from a disability rights perspective.

Using India as a case study, this paper assesses privatization and the state's abdication of responsibility for essential services and their implications for disability, specifically the propagation of chronic illnesses and impairments. Some of the ramifications of globalization and the privatization for human rights, including disability rights, are discussed, which underscores the need to re-visit the notion of human rights given the growing power of non-state actors in the globalized era.

Measuring Disability in India: Definition Dilemmas

Estimating the prevalence of disability in India has been hampered by complex and multitudinous factors. Deep-seated social stigma results in the exclusion and invisibility of individuals with disabilities. The lack of adequate definitions of disability further compounds the task of accurately assessing the prevalence of disability. There are two government sources of nationwide disability statistics in India: the Census and surveys of the National Sample Survey Organization (NSSO). The 58th round of the National Sample Survey (NSS) reported there were 18.5 million persons with disabilities in 2002 (NSSO, 2003) compared with 21.9 million reported by the Census of 2001 (Registrar General of India, 2001). The Census of 2001 did not adopt any particular definition of disability, rather it included a functional limitation question that asks respondents about their type of functional limitation (e.g., in seeing, hearing, movement). In contrast, the NSS considers a person as disabled if s/he has restrictions or lacks the ability to perform an activity in the manner or within the range considered normal for a human being. The NSS thus defines disability as an activity limitation.

Since the independence of India in 1947, a charity and medical model of disability has informed policymaking under the aegis of the welfare state. To date, these models are deeply embedded in the Indian society. Notwithstanding contemporary studies that have addressed poverty and social stigma, until recently, socio-political responses were focused mainly on medical intervention in the form of treatment and rehabilitation to cure the 'disease' or the 'problem' (Addlakha & Mandal, 2009). It was the ground-breaking Persons with Disabilities - Equal Opportunities, Protection of Rights and Full Participation (PWD) Act of 1995 that recognized the multi-faceted nature of disability and provided for education, employment, creation of a barrier-free environment, social security, etc. The Act articulated seven major kinds of impairments: blindness, low vision, leprosy-cured, hearing impairments, locomotor impairments, mental retardation and mental illness. Although the Act is guided by the philosophy of empowerment by addressing social attitudes, it is still premised on thresholds of physical and cognitive impairments defined largely in medical terms. Thus, even though the discourse in India's disability rights movement has advanced towards a social model, the policy environment remains "a hybrid between the medical and social models of disability" (World Bank, 2007, p. 124).

Lately, the conceptualization of disability has drawn from the International Classification of Functioning, Disability and Health (ICF) (WHO, 2001). This framework, termed as the biopsychosocial model of disability (World Bank, 2007), begins with a health condition that gives rise to an impairment leading to activity limitations, consequently affecting the ability to participate due to environmental, personal and institutional barriers. However, as Barile (2003) mentions, ICF standards and their earlier versions (ICIDH-1, ICIDH-2) ignore the historical and contemporary inequities between developing and developed countries and disparities within each country. Standardized definitions and measurements have overlooked the interactions between socio-cultural and economic factors in different regions that result in varying levels of impairment and opportunities for disabled persons. Barile aptly notes that in its attempt to attain a synthesis between different viewpoints of health from a medical, individual and social perspective, the ICF neglects the crucial link between economics and disability.

Economy and Disability

The linkages between disability and poverty have been increasingly recognized in international development literature (Yeo, 2005). Poor people are much more likely to live in unhealthy conditions without access to clean water or adequate nutrition. In times of illness, poor people are less likely to be able to afford treatment, often leading to chronic conditions or lifelong impairments. Conversely, impairment can lead to poverty and social exclusion by fostering financial dependency on handouts, the state and the extended family. Thus, disabled people are more likely to be poor than their non-disabled counterparts, and people living in poverty are more likely to become disabled than the non-poor. The relationship between poverty and disability has been referred to as a vicious circle (Elwan, 1999; Yeo, 2005).

However, just as disability is not simply a matter of bodily variations but is caused by social exclusion, poverty too is not merely a matter of inadequate incomes. According to the Poverty Assessment Study Report (1995) (cited in Dube and Charowa, 2005, p. 9), poverty is a symptom of structural inequities, social exclusion, powerlessness, and economic, political and socio-cultural deprivation. Poverty results from having limited or no access to basic services and is exacerbated by inadequate access to land, credit, technology and resources for sustainable livelihoods. Thus, poverty is an inevitable consequence of the way socio-economic systems are organized. However, hitherto most anti-poverty work has viewed poverty as a lack of individual or household incomes. As Sen (2007) emphasizes, a limited conception of poverty as lowness of personal income overlooks socio-political and economic processes that perpetuate poverty. Any efforts to eliminate poverty would, therefore, be unsuccessful if structural processes and socio-economic inequities are unaddressed. Sen cites the example of Europe where poverty was reduced by state provision of public health care, educational facilities, shared legal protections and other such common resources.

Yet, in the last two decades, under pressure from international financial institutions (IFIs) such as the World Bank and IMF, many countries in the global South have introduced economic reforms characterized by opening domestic markets to global competition, increasing transnational capital flows, and weakening the role of governments. These economic policies aimed at accelerated global economic integration ('globalization') (Razavi, 2008) believe in the ideology of neo-liberalism that maintains state intervention is an obstacle to economic growth because it creates inefficiency and market distortions. Therefore, government expenditures should be reduced, allowing provision of services through the private sector that is more efficient due to profit incentives (Gershman & Irwin, 2000). These principles have lead to privatization of health and social services, education, transport and, increasingly, water and food provision in many parts of the world. Neo-liberalism that underpins the current era of globalization has major implications for disabled persons; however, disability definitions and discourse have paid insufficient attention to this phenomenon. Given the virtual absence of literature on the impact of economic globalization for persons with disabilities in India, the next section explores this topic in greater detail.

Economic Globalization, Privatization and Disability: A View from India

A mounting burden of debt and balance of payments crisis led India to adopt economic reforms on the lines of IMF-World Bank structural adjustment programs. These reforms, known as the New Economic Policy (NEP), were introduced in July 1991. The NEP included standard measures including the devaluation of the rupee (India's currency); privatization of government-owned entities; reduction in public expenditure; cutbacks to food, agricultural and fertilizer subsidies; increase in imports and foreign investment in capital-intensive and high-tech industries; liberalization of trade regulations; and structural changes in the economy aimed at export-led growth (Upadhyay, 2000).

The NEP has resulted in far-reaching effects on the economy and society. While reforms have led to record economic growth, they have also led to unprecedented economic inequalities, environmental degradation, rise in food prices, and unrest in several states that has further hurt historically disadvantaged groups (Bidwai, 1995, 2000; Kumar, 2008). Bidwai (2000) observes as reform policies pry open India's markets to attract multinational telecommunications, information technology and automobile corporations, there is little dispute that economic globalization has benefited India's 40 million middle-class and elite; however, these policies have been ruthless to its 500- million-plus miserably poor.

Amidst these diverse forces impacting the lives of ordinary people in the country, the situation of people with disabilities is particularly concerning given that their exclusion from government census and surveys translates into denial of their citizenship rights and entitlements to existing state programs for the poor and disabled. In this section, we assess reform-induced changes in the arenas of social programs, education, employment, accessibility, health, water, agriculture and food security, and land acquisition from a disability perspective.

Social programs:

The central government's allocation of funding to the states, which constitutes a major resource to implement social programs in India, declined drastically in the post-reform period. For instance, funding for poverty alleviation programs operated jointly by the Center and states on 80:20 basis was drastically cut due to economic reforms (Teltumbde, 1996). Nevertheless, the range of social protection schemes that cover people with disabilities, such as below poverty line (BPL) ration cards for government-subsidized food grains and kerosene, social security pensions, scholarships, and reservations in government jobs, provide some hope for the destitute, although they are stingy and inadequate. Yet, as Mander's (2008) study reveals, access to these programs remains riddled with bureaucratic challenges, corruption and delays with the cumulative effect of denying benefits to those who need them most. Few disabled adults actually receive disability pensions. Neither they nor their caregivers have adequate information about their entitlements or how to apply. In order to avail of disability benefits, people with disabilities are required to undergo medical tests. Reports suggest given the large number of applicants, thousands of young and elderly disabled face grueling ordeals lining up at hospitals from morning to evening for registration, tests and the issuance of disability certificates (The Hindu, 2008). Moreover, in many states there is a lack of focus on social protection for people with disabilities, as the low rates of social pension coverage indicate (World Bank, 2007).

Budget cuts in the post-reform period have not only compounded already existing bureaucratic challenges, they have also reduced government spending on disability programs. Between 1998 and 2003, the Ministry of Social Justice and Empowerment (MSJE), the nodal agency for promoting the welfare of disabled and other marginalized groups, accounted for only between 5 to 7% of total government spending, signifying the low priority placed by the government on core programs for people with disabilities (World Bank, 2007). Although funding for inclusive education under the education ministry has increased substantially in recent years, MSJE does not have consolidated figures for spending on disability across ministries. As such, a comprehensive picture about government spending on people with disabilities is lacking (World Bank, 2007). Budget cuts for social programs of the MSJE, however, have adversely affected non-governmental disability organizations that depended on government funding. NGOs have been encouraged by the government to seek philanthropic contributions from private wealthy donors and international aid organizations and by collecting fees from few elite clients who can afford to pay for services rather than receiving their funding from the central government (Erevelles, 2001).

Social protection in the form of social insurance interventions are not a reality for the vast majority. Most disability insurance in India is provided publicly in the form of a mandated benefit based on the retirement income scheme. However, disability insurance schemes cover only workers in the formal sectors. Public social protection system for people with disabilities outside of the formal sector is sketchy in most states and offers low coverage and limited financial protection. Disability insurance that covers employees in the private formal sector provides similar benefits; however, the private insurance market in India is still at an early stage of development without much experience in annuity products. In any case, public and private sector schemes together cover only one in 10 workers in the country. Thus coverage is low and concentrated in the top half of the income distribution, excluding most Indians with disabilities (World Bank, 2007).

The latest National Policy for Persons with Disability 2006 signals a further withdrawal of the state from its responsibility towards disability and a tendency to push that responsibility on civil society and communities. Although the policy includes extending rehabilitation services to rural areas, increasing employment opportunities, improving access to public services etc, the section on 'Responsibility for Implementation' states:

The community should take a leading role in generating resources within themselves or through mobilization from private sector organizations to maintain the infrastructure and also to meet running costs. This step will not only reduce the burden on state resources but will also create a greater sense of responsibility among the community and private entrepreneurs (quoted in Bhas, 2006, para 22).

The attempt to absolve the state of its obligation towards disenfranchised persons by placing the onus of generating resources on the private sector and the community draws from a global neo-liberal trend that, as studies elsewhere have shown, has led to disconcerting consequences for the poor and disabled (ex. see Hiranandani, 2002; Johnson & Woll, 2003; Maskovsky, 2000; Waitzkin & Iriart, 2000).


The Persons with Disabilities Act of 1995 emphasized free education for disabled children up to eighteen years of age, the development of teacher training programs specializing in disabilities to provide trained manpower for special schools and integrated schools for children with disabilities, equal access for disabled people to all levels of education including higher and vocational education, and reservation of a minimum of 3% in admissions to all levels of public educational institutions (Government of India, 1996). Yet, after more than a decade of the PWD Act, few persons with disabilities have access to education or training. Illiteracy is high across all categories of disability, at 52% compared to 35% for the general population. Ninety percent of India's disabled children — five times the general rate — do not attend school, totaling around 40 million (Chatterjee, 2003 cited in Gabel & Chander, 2008). Disabled children rarely progress beyond primary school, and only 9% have completed higher secondary education (World Bank, 2007).

The Sarva Siksha Abhiyan (SSA), a program formulated under the Education for All — National Plan of Action, has a special section on inclusive education; however, enrollment and retention rates remain poor. Similarly, only 2 to 3% of persons with disabilities receive vocational training in low-profile stereotyped non-engineering areas likely to deliver low income (Mishra &Gupta, 2006). While the poor utilization of these interventions can be attributed to multiplicity of factors, including low awareness and ritualistic implementation of programs with discrimination, privatization has not advanced the cause of education for children and youth with disabilities. Spending on inclusive education, although promoted under the SSA, is only 1% nationally (World Bank, 2007).

In addition, the quality of public schools has suffered immensely due to reduced government expenditure on education. In 2005, the government's Common Minimum Program promised a gradual increase in the education budget to at least six percent of GDP. However, the education budget continues to remain at 3% of GDP (D'Costa, 2008; Das, 2009). Several states (eg. Karnataka) have education budgets that are 2.25% lower than the national average. Private investors have established educational institutions ranging from kindergartens to universities offering more expensive education for the middle class and elites, motivated mainly by profit (Bagal, 2005). These changes have hardly benefited disabled students, as is evidenced by a survey of 89 schools by the National Centre for Promotion of Employment for Disabled People (NCPEDP), which found in 2004, more than a decade after liberalization and economic reforms, only 0.1% of disabled students were in mainstream educational institutions at the university level and 0.51% at the primary and secondary level, a negligible figure compared to the 3% reservation enacted by the PWD Act (NCPEDP, 2004). The NCPEDP survey further shows that 20% of the schools acknowledged they do not admit disabled students and 18% were not even aware of the PWD Act. Only 20 out of 55 schools that admit disabled children employ special educators. Moreover, pedagogical methods continue to be outmoded and rote-based, and the disempowering approach of the formal education system considers the needs of children with disabilities to be largely a non-issue (D'Costa, 2008).

Although the PWD Act encouraged equal access in higher education, NCPEDP's 2005 survey showed, out of the 119 universities that responded, 20% did not follow the 3% reservation rule. Only 15% of the universities reported providing appropriate desks and chairs for students with physical impairments. Only 16 universities provided assistive software to students with visual impairments and only 10 universities provided books in Braille and sign language interpreters (cited in Gabel & Chander, 2008).

The recent Right to Education (RTE) Act of 2009 promises free and compulsory education to all children between 6 and 14 years and requires public and private schools to reserve 25% seats for children from disadvantaged sections. However, the Act excludes children below six years from their fundamental right to pre-primary education - a shortcoming that was brought to the attention of the human resources minister by disability rights groups (EPW, 2009). Moreover, the Act does not specifically require disabled-friendly infrastructure in schools; rather, it uses the vague and undefined phrase of 'barrier-free access.' The minister assured that the Act would be amended later to include enabling provisions for disabled students and children under age 6, but pleaded that it be passed in its current form to avoid losing time. In its current form, the RTE Act covers only those impairments included under the PWD Act, with promises for amendments to incorporate impairments covered by the National Trust for the Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act, 1999. However, as EPW (2009) aptly notes, the fact that this law, hailed as 'historic' and 'revolutionary,' needed to be amended within a month of its passing and did not give sufficient attention to children from one of the most marginalized sections of India, is indeed intriguing. Moreover, the RTE Act augments the pace of commercialization in India's education sector by banishing the very idea of public-funded common school system and promoting public-private partnerships, which will ensure that India's poor continue to be relegated to sub-standard schools and excluded further from an increasingly elite-centered formal education system.


Privatization has led to mixed outcomes for people with disabilities in the employment sphere. On one hand, technological advances have reduced their job opportunities. ILO (2003) cites the example of jobs earlier available to visually-impaired people such as telephone operator, stenographer and typist that have declined due to changes in communication technology and introduction of computers. On the other hand, privatization has opened newer avenues for employment of people with disabilities in highly-skilled and service jobs, making them more mobile and competitive in the job market (B. Punani, Executive Director, Blind People's Association, personal communication, March 22, 2009). However, this is limited to those with access to higher education and adequate training. Most training programs do not match the demand of the service sector leaving most persons with disabilities unequipped to avail of highly-paid jobs in this transitional phase of the Indian economy (ILO, 2003). Furthermore, the vast population of the rural disabled is deprived of access to technology and jobs that involve its application (Sridhar, 2003).

Overall, employment of people with disabilities fell from 42.7% in 1991 to 37.6% in 2002 despite strong economic growth (World Bank, 2007). Since most organized sector jobs available to persons with disabilities were earlier available in government and public sectors, globalization has constricted job opportunities due to disinvestments by the government in the public sector (ILO, 2003). The PWD Act of 1995 provided for 3% reservation in all government and public sector employment. Although the Act provides incentives to private sector employers for promoting disabled persons' employment, the 3% reservation rule is not mandatory for private employers (Friedner, 2009; Mishra & Gupta, 2006). More than fifteen years after the reforms, disabled people have about 60% percent lower employment rates than the general population, a gap that has been increasing over the past fifteen years (World Bank, 2007). The World Bank report mentions in the late 1990s, employment of people with disabilities in large private firms was only 0.3% of the companies' workforce. In 1999, the National Centre for Promotion of Employment for Disabled People (NCPEDP) conducted a research study of the top 100 companies in India to examine employment practices in the corporate sector. Of the 796,363 total employees in 70 of the companies that responded, only 3,160 were disabled persons comprising 0.4% of the workforce. The percentage of employees with disabilities in public sector companies was 0.54, while in private companies only 0.28 percent employees were disabled (Abidi, 1999). The percentage of employees with disabilities in multinational corporations is only 0.05% (World Bank, 2007).

People with disabilities are often employed in the private sector under the rubric of corporate social responsibility and such initiatives are highlighted by corporations in their PR campaigns. Friedner's (2009) study cites the example of one data entry and processing company in Bangalore that employs only disabled people since, according to the company's chief operating officer, turnover of 'normal' people is persistent. Despite consistently paying less than minimum wages to its disabled workers, this corporate was awarded a leading disability and employment accolade in India and it prominently displays its employment of people with disabilities on its website utilizing this initiative as a unique selling point.


Although the PWD Act promotes accessibility in public buildings, evidence shows accessibility continues to be largely an unrealized goal in India (World Bank, 2007). No budgetary provisions are in place to provide accessibility features in transport, road and the built environment (Raturi, 2008). As such, ramps or lifts that accommodate wheelchairs, signs in Braille, audio commands at traffic signals, accessible toilets etc are rare. Due to resource constraints, courts often restrict the availability of state assistance to a few categories of people with disabilities (Addlakha & Mandal, 2009). Besides, as the PWD Act does not enforce accessibility in the private sector, most multinational and domestic businesses have ignored accessibility requirements in their buildings.

Rural-urban disparities persist in the accessibility of transportation services. In rural areas, people with stigmatized conditions, such as leprosy-cured, are not allowed to use public transport even if they can afford it (Mander, 2008). Although, most buses and trains continue to be inaccessible for people in wheelchairs (PACS, 2005), in urban areas, privatization has had a positive impact in a way. For instance, Samarthyam, an organization that advocates accessible environment and universal access for all, was able to convince the New Delhi Municipal Council (NMDC) to make 197 new bus shelters barrier-free and accessible. The contract for construction was given to the multinational, J. C. Decaux, which is well-versed with accessibility requirements as these are mandatory in Western countries. NDMC agreed to incorporate accessibility features in these new bus shelters only if the bidders agreed to do so at no extra cost. Advocacy with J. C. Decaux successfully led to the addition of universal design features in the new bus shelters (A. Agarwal, Executive Director, Samarthyam National Centre for Accessible Environment, personal communication, March 30, 2009). Likewise, the Ministry of Railways has undertaken an initiative to upgrade accessibility in all 'A' category stations in larger cities followed by category 'B' and 'C' stations in a phased manner (World Bank, 2007). However, as the World Bank Report indicates, provisions of the PWD Act concentrate mainly on end-point access issues: consultations with people with disabilities could go a long way to prioritize investments to promote access and monitor access outcomes. Moreover, grievance redress procedures are weak and penalties for non-compliance are non-existent. Orders from the Commissioner of Persons with Disabilities are often not implemented unless the litigation reaches the High Courts (Raturi, 2008). Addlakha & Mandal (2009) note that although the PWD Act is rooted in a rights discourse, its application in concrete cases shows various government agencies and departments are either unaware and/or refuse to implement clauses of the disability act passed by the very same government. Checks and balances as well as mechanisms to empower people with disabilities to undertake long and complicated litigation processes are urgently needed to ensure that the law does not "remain a paper tiger" (Addlakha & Mandal, 2009, p. 68).

Health and health care:

In the first decade of the reforms, state spending on health care as percentage of Gross Domestic Product (GDP) fell from 1.3% in 1990 to 0.9% in 1999 (Gupta, 2005). During 1990-1999, with the introduction of user fees in public health care, the proportion of people unable to access any health services has doubled, primarily among disadvantaged castes, religious minorities and low-income people with disabilities. Currently, only 2% of the national budget is spent on health care, compared to 13% on defense (The Globe and Mail, 2009). Public health spending accounts for less than 20% of the total health spending, while out of pocket expenses amount to 98% of the total private health expenditure, signifying unequal access (Duggal, 2009). Duggal further notes, ironically, the central government's attempt to increase spending on public health by boosting allocations to its National Rural Health Mission has been unsuccessful because states have responded by reducing their expenditures. Instead of decentralizing health expenditures, the central government has taken greater control of available health sector resources that have not been adequately utilized even for priority programs such as immunization and rural child health, which in turn has affected health outcomes.

Moreover, the National Health Policy of 2002 legitimizes the ongoing privatization of health care. While domestic and foreign private insurance companies, health care management organizations, and medical technology and pharmaceutical companies have proliferated — often with government support — already poorly-funded public health care that has traditionally cared for the poor has collapsed (Sengupta & Nundy, 2005).

Additionally, privatization and deregulation have resulted in rising drug prices. The number of drugs under price control decreased from 347 in 1979 to only 35 in 2004, which is about 22% of the total market (Gupta, 2005). In 2005, under pressure from the World Trade Organization's (WTO) Trade-Related Intellectual Property Rights (TRIPs) agreement, the Indian government changed its Model Patent Act of 1970, thereby raising the cost and reducing the availability of essential drugs. The increased cost of medical care is the second most common cause of rural indebtedness in India (People's Health Movement - India, 2007). Given that almost 40% of India's population lives in poverty, the health of the poor and disabled population is threatened.

Under the liberalization regime, India has become one of the world's leading exporters of pharmaceuticals, with the U.S. its largest customer (Gupta, 2005). As European countries and the U.S. protect their environment by importing drugs, populations in India such as villagers in Patancheru in Medak district in Andhra Pradesh are forced to consume a slew of toxic residues dumped in the local streams by numerous drug factories (Mason, 2009). With the government's drive to industrialize 'backward' areas, Medak district has seen a sharp rise in morbidity rates, from 10% in 1991 to 25% in 2004. Orthopedic and skin problems have escalated. Increased levels of heavy metals have been detected in blood, urine, hair and nail samples of local people, due to consumption of industrially contaminated water and vegetables grown in contaminated soils (Greenpeace India, 2004). Although it is evident that ill-health is on the rise in Medak, country-wide environment and health impact assessments to investigate the relationships between rapid industrial growth, unchecked pollution, and chronic health conditions and impairments have been lacking.

There is limited research on the use of health services by people with disabilities in India (World Bank, 2007). The 58th National Sample Survey Organization's (NSSO) conducted in 2002 shows that most states which lag in the provision of health care services to the general population also fall behind in the use of those services by people with disabilities. The exception is Delhi, which has adequate health services overall, but where less than 50% of people with disabilities sought any treatment. Overall, around 16% of people with disabilities reported negative attitudes of providers as a reason for not seeking treatment. While it can be contended that privatization has increased access to assistive devices and rehabilitation technology for at least some sections within the disabled population, data from 2002 NSSO shows less than 16% of people with disabilities had actually acquired aids and appliances (NSSO, 2003).

Overall privatization has not improved the health of the majority. Indeed, death, ill-health and impairment of the poor have become collateral damage in the cause of economic growth and profit maximization (Baviskar, 2008). Baviskar reports that hundreds of migrant adivasis1 from Madhya Pradesh have died from acute silicosis (caused by inhaling silica) while working in quartz crushing factories in Gujarat.

Furthermore, Western countries, particularly the US, Canada, Britain, Australia and Germany, are increasingly disposing their recycled and hazardous waste by shipping them to the 'Third World', where they pose substantial threats to human health and environment (Pucket et al, 2002; Stebbins, 1992). To liberalize the economy, the Indian government abolished regulatory licensing in most industry groups. Consequently, India has quickly become a major dumping ground for the West's hazardous waste. Greenpeace reports that India imported 5 million kilograms of metal waste, 346,000 kilograms of used lead-acid batteries and 2.85 million kilograms of metal scrap from Australia in the first half of 1994 (cited in Bidwai, 1995). Although World Bank's (2007) report states "[t]he medical causes of impairments are rapidly changing in India - from communicable disease to non-communicable disease and accidents" (p. xii), the report is silent on health conditions and impairments induced by the processes of economic globalization, liberalization and privatization.

Food security, globalized agriculture and the rural sector:

Although 80% of India's disabled persons live in rural areas, most government and NGO programs and rehabilitation centers are located in urban areas (D'Costa, 2008; Klasing, 2007). World Bank's (2007) study shows that the rural disabled have lower access to health care, not only due to the poorly functioning current system of disability identification and certification, but also because of poor awareness about disability issues among providers, as well as community and provider attitudes that act as constraints in the provision of health care for people with disabilities. Government schemes for the disabled, whether in education or employment, rarely reach rural people. Ninety percent of India's children with disabilities reside in rural areas where even non-disabled children find access to education difficult. The lack of services, such as accessible transportation, and the distance between home and school in rural areas further push children with disabilities to the margins (D'Costa, 2008; World Bank, 2007).

People with disabilities in rural areas are largely excluded from mainstream poverty alleviation programs due to attitudinal and physical barriers. The PWD Act requires governments to reserve not less than 3% in all poverty alleviation programs for people with disabilities. However, different poverty alleviation programs have interpreted the 3% reservation rule differently. As World Bank (2007) noted, the Sampoorna Grameen Rojgar Yojana (SGRY) (The Complete Rural Employment Scheme) mentioned parents of children with disabilities (CWD) rather than adult workers with disabilities, assuming that disabled people are unable to work. Yet, there is no specific quota mentioned for parents of CWD, unlike other groups such as women and other minority groups. The Indira Avaz Yojana (subsidized housing program named after the late prime minister Mrs. Indira Gandhi) mentions people with disabilities as a priority category among other groups; however, no specific quantitative targets are mentioned. In contrast, the Swaranjayanti Gram Swarozgar Yojana (SGSY) (The Centennial Rural Self-Employment Scheme) provides specific guidelines and requires that 3% of beneficiaries annually must be people with disabilities. However, the World Bank (2007) observes that data reported by various poverty alleviation programs do not clarify the share of beneficiaries who are persons with disabilities. Wherever clear data is available, people with disabilities are well below the 3% reservation rule in all schemes. For instance, the share of disabled beneficiaries in SGSY was below 1% between 1999 and 2004. In SGRY, a much bigger program in total spending than SGSY, data are reported for works completed for the benefit of disabled people rather than the number of days of employment generated for people with disabilities. However, the Comptroller and Auditor General Report (2004) shows the share of disabled beneficiaries in SGRY was below 1.7% during the reporting period 1998-2003 (cited in World Bank, 2007). More recent data from various states compiled by the World Bank report demonstrates even lower percentages. For instance, in the state of Orissa, people with disabilities accounted for only 0.3% of total employment days generated under SGRY during 2001-2005.

The new National Rural Employment Guarantee Act (NREGA) of 2005 in principle provides every person who is willing to work with a statutory right to 100 days of guaranteed wage labor at minimum wages. However, Dalal (forthcoming) reports disabled people constituted only 0.1% (167,934 persons) of the 16 million total NREGA beneficiaries in January 2007. Furthermore, NREGA recently deleted provisions for reservations for disabled people (World Bank, 2007).

Roughly 700 million (70%) of India's 1 billion people depend on the agricultural sector for their livelihoods (Coleman, 2003). International rules that encompass agricultural trade liberalization and the use of genetically engineered seeds have transformed agricultural practices and rural livelihoods everywhere. Recent free trade and seed patenting policies, such as the Agreement on Agriculture (AoA) and the Trade-Related Aspects of Intellectual Property Rights (TRIPs) instituted by the World Trade Organization (WTO), have required developing countries, such as India, to open their agricultural sector to global agribusinesses and to replace traditional farm-saved seeds with genetically engineered seeds (which are non-renewable and thus require re-purchasing for each growing season). The bulk of empirical evidence suggests that trade liberalization has led to unprecedented crisis in the agrarian sector as small-scale farmers are unable to compete in international markets (see Hiranandani, 2008). Declining rural credit, rising farm input prices and decreasing prices for agricultural produce have forced small-scale and subsistence farmers, including disabled farmers, off the land. India, home to 557 million subsistence farmers, has experienced an epidemic of farmer suicides since 1997 (Sainath, 2007). FAO (2004) notes that disabled farmers with inadequate access to means of production such as land, water, inputs and improved seeds, appropriate technologies and farm credit are particularly hard-hit. Given the decline of the rural economy, nearly 40% of rural households have no land of their own and it is estimated that the rural unemployment is as high as 30% (Dalal, forthcoming).

For India's 380 million officially-recognized poor, neo-liberalism has meant spending more money to buy less food, reducing calorie intake and facing starvation in many cases (Patnaik, 2004). Cereal consumption declined by 12% in rural India after a decade of reforms initiated in 1991 (Shiva, 2001). Economic reforms have slashed government spending for the public distribution system (PDS) that provides basic necessities such as food grains and pulses to the poor at subsidized rates. Prices of food items offered by the PDS have increased manifold. Unsurprisingly, the National Family Health Survey (NFHS-3) of 2005-06 reported that almost half of the children under age five are too short for their age, 20% are too thin for their height and 43% are under weight due to chronic malnutrition (IIPS & Macro International, 2007). While malnutrition has been recognized as a major cause of preventable impairments in India (World Bank, 2007), the association between agricultural trade liberalization, rising hunger and malnutrition-induced impairments in the post-reform period have been ignored.


There is increased pressure by international financial institutions (IFIs) such as the World Bank and the Asian Development Bank to export natural resources critical to the lives of local communities. IFIs claim that these exports are essential in order to generate revenues to repay outstanding external debt and to finance future development programs (Asia Pacific Civil Society Forum, 2003). The World Bank-driven policies espouse a shift from social goods to a commercial orientation. While the gift of free water to the thirsty has been a core part of India's culture, privatization policies have commodified water. Water fees have doubled, thereby diverting water from the poor to the rich and from rural to urban areas. In Delhi alone, tariff increases have generated Rupees (Rs.) 30 billion, generating super profits of Rs. 26.66 billion to corporations (Shiva, 2005). While water parks abound for rich tourists, privatization of water has created undue hardships for the poor and disabled. Even homes for people with disabilities and orphanages have not been spared of spiraling tariff increases.

Besides, local agriculture has borne the brunt of water privatization. In Plachimada in Kerala, Coca-Cola extracted 1.5 million liters of deep well-water, bottling and selling them for profit. Depleting ground water levels have affected thousands of communities creating water shortages and destroying agricultural livelihoods. The poor, including disabled people, have to travel farther to fetch water. The remaining ground water has become contaminated with high chloride and bacteria levels, leading to scabies, eye problems and gastro-intestinal diseases. The company also sells the plants' industrial waste to farmers as fertilizers, despite high levels of hazardous waste and cadmium (Global Exchange, 2005). Yet, comprehensive assessments of water privatization for disease, impairment and environmental degradation have been lacking.

Land acquisition for Special Economic Zones:

To pursue the export-led growth strategy under the liberalization regime, India adopted the idea of Special Economic Zones (SEZs) to provide government-financed infrastructure to developers (Skeers, 2006). A Special Economic Zone (SEZ) is a geographical region with favorable economic laws more liberal than a country's typical regulations. The goal of SEZs is to promote rapid industrialization and economic growth by using tax and business incentives to attract foreign investment and technology. The Special Economic Zone (SEZ) Act 2005, passed with little parliamentary or public debate, facilitated the forceful acquisition of land with meager compensation thereby provoking determined protests by thousands of displaced farmers (Skeers, 2006). Prime agricultural land has been acquired in several areas with serious implications for food security and aggravating regional disparities. Following the brutal manner of state-sponsored land acquisition efforts in Nandigram in West Bengal that left 11 people dead and hundreds injured, a National Policy on Rehabilitation and Resettlement was adopted in 2007 (Kazi, 2007). This policy provides for land-for-land compensation and life-time monthly pensions to vulnerable persons, such as the disabled, destitute, orphans, widows, unmarried girls, abandoned women, and elderly persons without alternative livelihoods.

However, anecdotal evidence suggests that promises of resettlement and rehabilitation have not materialized. For instance, many acres of coastal land in Vishakhapatnam in Andhra Pradesh have been acquired for the SEZ program and the Indian Navy, thereby displacing thousands of people. Persons with disabilities in particular have been adversely affected. Not only have they received less compensation than the non-disabled, their houses are re-located further away in remote areas creating accessibility problems (M. Chandrasekar, Advocacy Coordinator, Community-Based Rehabilitation Forum, personal communication, March 22, 2009). People with disabilities have been left out of vocational training programs set up by the state government in SEZs. Although NGOs in these areas have been appeased by promises of employing trained persons with disabilities in textile industries of the SEZ, there are no job reservations for them in these private sector industries (Mishra & Gupta, 2006; World Bank, 2007). Recently, Gitanjali Gems, a Mumbai based diamond and jewellery maker established the 'Saksham' training centre in the Rajiv Gems Special Economic Zone in Hyderabad in the state of Andhra Pradesh. The training centre aims to empower people with disabilities and is expected to generate 1000 jobs for them within the next three years (Business Standard, 2010). While such initiatives are welcome, it remains to be seen whether the precedent set by Gitanjali Gems will be followed by other private companies in India's SEZs.

Moreover, as Murayama & Yokota's (2009) review of labor and gender issues in SEZs in Bangladesh, India and South Korea observes, workers in Indian SEZs are in a disadvantaged position not only against capital but also in comparison to their Bangladeshi and South Korean counterparts. Although wages and working conditions in Indian SEZs vary, Mazumdar's (2001) study showed 80% of workers in Noida SEZ in North India receive less than the minimum wage (cited in Murayama & Yokota, 2009). Young women who form the bulk of SEZ workforce receive wages well below the minimum wage (PRIA, 1999) and working conditions are similar to those prevailing in the urban informal economy (Neetha & Varma, 2004). Widespread malpractices are common, including unrecorded workers on company payrolls, lack of health insurance or workers' provident funds, and denial of leave stipulated by law. While studies have documented working conditions and employment practices for women workers in SEZs, systematic data on employment trends and working conditions of people with disabilities in SEZs is lacking.

Human Rights, Privatization and Disability

Disability rights have been increasingly addressed in the international development discourse since the 1980s. The International Year of Disabled Persons in 1981, followed by the United Nations Decade for Disabled Persons declared by the United Nations in 1983, put disability into a global context (Yeo, 2005). However, the basic assumption that underpins all United Nations human rights agreements, including disability rights, is governments' responsibility to attain these rights. The underlying premise of globalization, however, is the abdication of government responsibility for essential services (Naim-Ahmed, 2007). This paradox complicates progress towards human rights declarations in an era of unfettered global market economy since international human rights obligations apply to government organizations and not to the private sector. Privatization has reduced the power of governments to ensure access to services that are essential to the enjoyment of human rights (Amnesty International, 2005).

Disability is an arena that is particularly susceptible to the shifting boundaries between the public and private domains. The consequences of dismantling the welfare state are severe, especially for poor and disabled people in developing countries who depend on state provision of basic needs such as education, health care etc. With disability still treated as a 'special interest' issue in India — that is, not of interest to the general population - the risks of privatization are high. Fortunately, India has a large, varied and active movement of NGOs working on disability issues, though many still have a welfare-led approach and are mainly urban-based (Thomas, 2004). However, in the era of privatization and liberalization, large companies, seeking to create reputations of 'corporate social responsibility,' have initiated in-house NGOs, especially as the state dismantles its public provision of basic services (People's Health Movement - India, 2007). The implication of this civil society transformation for disabled people is yet ambiguous. It is clear, nonetheless, that one of the most salient elements in the globalization process, the explosion of information and communication technology such as the Internet, has enabled people with disabilities from different regions and countries to communicate and access information quickly and across great distances. Albeit of benefit to urban-based populations, this has fostered increased dialogue between disabled persons across the globe and facilitated the formation of extensive support and advocacy networks.

However, people with disabilities in India still remain a weak political constituency without full citizenship rights. Although political party workers conduct house-to-house surveys to register voters, homelessness especially among the urban destitute and disabled combined with social stigma and family shame perpetuates the invisibility and isolation of many persons with disabilities and their consequent absence from lists of voters (Jeffery & Singal, 2008; UNNATI & Handicap International, 2004; World Bank, 2007). Even when disabled people are registered, inaccessible pooling booths, inadequate transport facilities and lack of information in accessible formats hinder their ability to vote. Thus, persons with disabilities are politically disenfranchised. This is despite the fact that in addition to ratifying international human rights instruments, India has one of the strongest rights-based constitutions in the world that holds the government primarily responsible for the well-being of historically disadvantaged populations (Thomas, 2004).

The failure of the rights-based legislation to promote full inclusion and increase disabled people's employment rates exposes the contradictions of promoting equal opportunity within the paradigm of economic growth in an unequal society (Russell, 2002). Economic reforms have led to increasing mal-distribution of growth. While currently India has the world's fourth highest number of billionaires (36 billionaires) with total wealth equaling one-fourth of the country's GDP, poverty reduction has been the slowest in the neo-liberal years; in fact, poverty and destitution has been aggravated by reform-induced dispossession and displacement (Bidwai, 2007).

Neo-liberal globalization, with its emphasis on privatization of services, threatens universal access to basic services. Privatization has re-defined education and agriculture as 'industry' and has commodified basic necessities such as health care, education, food and water (Shiva, 2005). Free trade agreements have jeopardized the health and human rights of the majority and undermined social policies aimed at promoting employment and full inclusion for people with disabilities (PSAC, 2005). Privatization and the globalized economy thus compel the re-envisioning of the concept of human rights to ensure that state and non-state actors, such as corporations, are held accountable to human rights agreements. Hitherto, civil rights and disability rights, conceptualized in an individualist framework, do not address structural barriers and health abuses caused by business practices, the economic system and class power relationships (see Russell, 2002). Human rights for persons with disabilities across all sections of the society cannot be achieved until the very system that lavishes wealth on a few and impoverishes the masses is brought under scrutiny.

Concluding Remarks

People with disabilities have been excluded from most evaluations of economic reforms in India. Our analysis shows that while increasing employment opportunities and accessibility has benefitted a few persons with disabilities, the majority, particularly the poor and rural disabled, have been left out of India's economic boom. It is questionable whether unbridled market reforms are sustainable given their human and environmental costs. Furthermore, the implications of the current economic downturn for India's urban and rural disabled populations are yet unknown.

Due to constraints of space, this analysis has included class differences and urban-rural disparities within the disabled population, where data permit. However, given India's enormous diversity, intersectionality based on gender, caste, religion, age and marital/family status differences among people with disabilities merit further investigation to provide a more comprehensive picture of reform-induced changes.

The importance of including people with disabilities in the development agenda has been increasingly recognized. The former president of World Bank, James Wolfensohn stated "… if we are to achieve the Millennium Development Goals (MDGs) of halving poverty by 2015, dealing with education for all, halving the rates of birth and child mortality, it is simply impossible to conceive of doing that without the inclusion of the disabled community" (quoted in Yeo, 2005, p. 13). Yet, the Bank's well-intentioned efforts towards full inclusion do not address the health, impairment and disability effects of global economic processes. Neo-liberalism, with its tenets of market economy and reduced state role, necessitates renewed understanding of human rights, including those of disabled persons. It is difficult to imagine how the MDGs will be achieved unless poverty and disability, and indeed impairment itself, are recognized as manifestation of the ways in which society and economy are organized.

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  1. Adivasis refer to indigenous peoples who have been identified as disadvantaged by the Government of India.

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