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The 2011 India Human Development Survey found that in about a quarter of Indian households, women are expected to have their meals after men have finished eating. This study investigates whether this form of gender discrimination is associated with worse mental health outcomes for women. Our primary data source is a new, state-representative mobile phone survey of women ages 18–65 in Bihar, Jharkhand, and Maharashtra in 2018. We measure mental health using questions from the World Health Organization’s Self-Reporting Questionnaire. We find that, for women in these states, eating last is correlated with worse mental health, even after accounting for differences in socioeconomic status. We discuss two possible mechanisms for this relationship: eating last may be associated with worse mental health because it is associated with worse physical health, or eating last may be associated with poor mental health because it is associated with less autonomy, or both.
Solid fuel use is an important contributor to air pollution and disease burden in India. We present survey evidence documenting LPG ownership and cooking fuel use in rural north India. LPG ownership has increased rapidly, substantially driven by the Ujjwala Yojana. Three-quarters of rural households in Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh now have LPG. Almost all of these households also have a stove that uses solid fuels, and among those owning both, almost three-quarters used solid fuels the day before the survey. Household economic status, relative costs of cooking fuels, gender inequality, and beliefs regarding the ease, food taste, and health impacts of cooking with solid fuels versus LPG are important contributors to high solid fuel use despite LPG ownership. Households that continue to use solid fuels continue to expose themselves and their neighbours to harmful air pollution. To realize the full health benefits of Ujjwala’s expansion in LPG ownership, attention must now be turned towards discouraging the use of solid fuels and promoting exclusive use of LPG. This is an urgent priority for research, policy, and action.
The Swachh Bharat Mission has turned out to be a top-down programme in which villagers are often coerced into building latrines, with relatively little focus on latrine use. A field survey challenges the official narrative that the SBM is a "people's movement".
In high-income countries, population health surveys often measure mental health. This is less common in low- and middle-income countries (LMICs), including in India, where mental health is under-researched relative to its disease burden. The objective of this study is to assess the performance of two questionnaires for measuring population mental health in a mobile phone survey. We adapt the Kessler-6 screening questionnaire and the World Health Organization’s Self-Reporting Questionnaire (SRQ) for a mobile phone survey in the Indian states of Bihar, Jharkhand and Maharashtra. The questionnaires differ in the symptoms they measure and in the number of response options offered. Questionnaires are randomly assigned to respondents. We consider a questionnaire to perform well if it identifies geographic and demographic disparities in mental health that are consistent with the literature and does not suffer from selective non-response. Both questionnaires measured less mental distress in Maharashtra than in Bihar and Jharkhand, which is consistent with Maharashtra’s higher human development indicators. The adapted SRQ, but not the adapted Kessler-6, identified women as having worse mental health than men in all three states. Conclusions about population mental health based on the adapted Kessler-6 are likely to be influenced by low response rates (about 82% across the three samples). Respondents were different from non-respondents: non-respondents were less educated and more likely to be female. The SRQ’s higher response rate (about 94% across the three states) may reflect the fact that it was developed for use in LMICs and that it focuses on physical, rather than emotional, symptoms, which may be less stigmatized.
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