Measuring the Drudgery and Time-Poverty of Rural Women - A Pilot Study from Rural Rajasthan.

CONTEXT: Women's hard-work toward family responsibility is rarely examined from a health perspective. Excessive physical work translates into musculoskeletal disorders (MSDs). It is essential to understand certain parameters of this burden. SUBJECTS AND METHODS: This was a cross-sectional study of 565 rural women. The participants were selected using a stratified random sampling method. A pre-tested questionnaire was used, focusing mainly on physical activities, durations, and health complaints.
RESULTS: The self-reported mean durations of various physical were quite high. On average, a woman spent around 11 h per day in domestic work-related physical activities. Older women (more than 50 years) spent similar durations for most of the physical activities compared to younger women (50 years or less). In the sample, 53.4% (n = 302) participants reported at least one Chronic MSD, and 16.99% (n = 96) took medication for the same in the last one year. Point prevalence of low back pain (LBP) was 29.2% (CI 25.5 to 33.1). Women worked even with MSDs as there was no significant difference in the mean durations among women with and without MSDs for most of the activity categories except for 'work in bending position' and 'work in farm'. General caste women spent higher time in domestic work.
CONCLUSIONS: Higher self-reported MSDs were likely to be contributed by continuous and repeated strenuous domestic work. Women had to continue working even with MSDs or higher age. Women got very less time for rest. Provision of basic amenities like electricity, water, cooking fuel, etc. at doorstep can help. Below poverty line women seem to have higher burden of MSDs. Copyright:

INTRODUCTION

From the times, since humans were hunters and gatherers, women have been given domestic responsibilities as those were relatively safe at that time. However, with a change in human life and development, work and physical activities in the domestic domain kept on increasing. With agricultural development, more grain and food came into the kitchen for processing. With increasing family size, water need increased; dependency on fire and firewood increased. Domestication of animals increased women’s work toward that. Women also got sucked-up in the seasonal labor-work in agriculture due to the sudden need to mass food production. Eventually, modernization reduced this workload on women as various appliances and amenities increased in the domestic domain. This saved women’s time and energy and their representation in other social roles is showing an increasing trend. However, some sections of society, especially the rural women, are still devoid of such amenities, and they remain burdened with tasks like fetching water, firewood, fodder, etc. For years, they work hard every day. There ought to be the cumulative stress and higher bodily wear and tear. This is super-imposed by malnutrition, various deficiencies like iron in the diet and other co-morbidities.[123] It is also true for adolescent girls.[4] In rural India, the birth order is also high.[5] All these factors affect the health of rural women in a synergistic manner. There are concerns raised toward women’s drudgery to some extent,[6] but very few scientific inquiries are made to understand the organization of this drudgery and its health impact. This busy schedule leads not only to time-poverty for women but also to various musculoskeletal disorders (MSDs).[6]

This study attempts to fragment and understand the domestic work in specific ways to capture the related durations and find its association with health complaints.

SUBJECTS AND METHODS

It was a community-based cross-sectional study among women from rural areas of Rajasthan state of India. All the villages were from the surrounding areas of Udaipur city from 50 to 100 kilometers, chosen conveniently. Out of 13 villages, ten were from Udaipur district, two from Rajasman and one from Banswara district. This study was conducted in March-April 2018. Stratified random sampling technique was used with village-areas as a stratum for approaching the participants. From each of the strata (areas of a village) at least ten, participates were chosen randomly for the study. The inclusion criteria were age above 16 years, not doing any formal job or any regular paid work, permanent resident of the village, and willing to participate in the survey. From each of the 13 villages, 40 to 60 participants were taken, making a total of 565 women participants. All the parts of each village were covered. Trained female field workers collected the data using a pre-tested structured interview schedule. The details of sociodemographic characteristics, their daily physical activities, health complaints, and health-seeking were captured using self-reports.

The study has gone through the review of the research committee of the organization. The Post Graduate Program Office of the local partner institute also reviewed the study before the data collection. Verbal informed consent was taken from all the participants after explaining the participant information sheet in detail. Due to very low literacy levels, there was fear of signing any document among these rural women and it may have affected the response rate, especially among the poorest and illiterate. Hence, written consent was avoided.

Ethical Clearance

Ethical approval for this study was approved by the Centre for Development Policy and Management, Indian Institute of Management- Udaipur (IIMU). on 20th January 2018.

RESULTS

Social and Demographic details of the sample

In total, 565 women were interviewed and the mean age was 38.07 years (range: 16–75 years). The baseline characteristics are presented in Table 1.

Table 1

Sociodemographic details of participants

	n (%)
Religion
Hindu	551 (97.5%)
Muslim	10 (1.8%)
Jain	3 (0.5%)
Sikh	1 (0.2%)
Caste- category
General	121 (21.4%)
OBC	63 (11.2%)
SC	34 (6%)
ST	347 (61.4%)
Marital status
Unmarried	12 (2.1%)
Married	506 (89.6%)
Widowed	38 (6.7%)
Separated	7 (1.2%)
Divorced	2 (0.4%)
Class (as per Ration card)
Above poverty line	168 (29.7%)
Marginal poverty line	71 (12.6%)
Below poverty line	326 (57.7%)
Education
Never attended school	361 (63.89%)
Completed primary schooling	94 (16.64%)
Completed secondary schooling	87 (15.40%)
Junior college education	18 (3.18%)
Completed graduation	05 (0.88%)

Around 67% of households had agriculture as the primary source of income. The majority (521) of the households had agri-land with average land holding of 2.48 acres, whereas 44 (7.78%) reported no land. Only 161 (28.5%) had pakka house and 404 (71.5%) people lived in kachha house. An average number of rooms in a house were 1.9 per household. Among the participants, 387 (68.5%) had electricity connection, 323 (57.17%) had toilets, 271 (47.43%) had bathrooms, and 141 (24.96%) had drainage facility at the household level.

In the sample, only 95 (16.81%) women had a water tap in-house. This did not assure daily water supply and most of these women needed to fetch water from distances. Average distance to fetch water was 570 meters in regular days, and 780 meters in the dry season for every ferry. 198 (35.04%) rely on well, 92 (16.28%) on tube-well, 182 (32.21%) on hand-pump, 29 (5.13%) on tap.

Durations of various physical activities

Table 2 gives the mean self-reported duration of the respective physical activities. These activities are mutually exclusive in a category but not across typologies of physical activities. These typologies are based on the place, intention, and type of the physical movements.

Table 2

Duration of various physical activities per day

Physical activity	Average duration-in h (S.D.)	Range
Space of activity
Work inside the house	3.90 (2.81)	0-15
Work in house premises	3.05 (2.56)	0-13
Work outside of house premises	4.02 (2.58)	0-14
Type of physical activity
Total duration of walking	3.15 (2.50)	0-14
Total duration of carrying any sort of weight	2.07 (1.69)	0-12
Total duration you work in bending position	2.62 (1.78)	0-12
Reason for activity
Fetching water	1.10 (1.16)	0-10
Bringing fodder/preparing forage	1.17 (1.14)	0-11
Bringing firewood	1.70 (1.33)	0-8
Working in your farm	2.64 (2.18)	0-14
Leisure activities
Watching TV	0.23 (0.65)	0-4
Talking with friends/neighbors	0.76 (0.87)	0-8
Taking rest in day time	0.80 (1.18)	0-7

When women were asked “Which is the most strenuous task in your daily work?”, 45.13% reported it as agriculture-related work, 19.47% as bringing firewood, 8.5% as fetching water, 4.07% as animal husbandry related work, 2.66% as carrying any weight, and 2.47% as washing clothes. Only 5.13% reported no work as strenuous and 14.51% of women gave multiple tasks in combination as their responses, which mainly involves agriculture, fetching firewood and water.

Time-poverty

Time spent on various activities has been captured in various categories of related work, which are a place of work, type of physical activity, the reason for the activity, and leisure activities. Table 2 gives the respective timings of these categories which do not overlap within the category. On average, a woman works for around 11 h a day, within which around 7 h was strenuous physical work. Around three hours of strenuous work is contributed by lack of access to LPG and water. There are 87.26% of women who had animal husbandry, and if they get access to fodder 1.31 h per women per day can be saved. Women got slightly more than one and half hour on an average for their rest and recreational activities combined in day time.

It is important to see how this hardship on a daily basis affects the health of women as age advances. As seen in Table 3, women older than 50 years could not spend much time on the activities outside the house premises. However, this does not mean that the older women get much relief from strenuous physical activities as there is no significant difference in the mean duration for physical activities of “walking,” “carrying any weight,” “work in bending position,” and task like “fetching water,”

Table 3

Difference in mean duration between women <50 years and older

Physical activity	Mean duration (with SD) for “Women younger than or equal to 50 yrs” (n=495)	Mean duration (with SD) for “Women older than 50 yrs” (n=69)	P
Space of activity
Work inside the house	3.87 (2.72)	4.10 (3.38)	0.563
Work in house premises	3.11 (2.58)	2.62 (2.34)	0.137
Work outside of house premises	4.15 (2.56)	3.15 (2.52)	0.002
Type of physical activity
Total duration of walking	3.13 (2.40)	3.30 (3.14)	0.655
Total duration of carrying any weight	2.11 (1.71)	1.81 (1.52)	0.136
Total duration you work in bending position	2.65 (1.75)	2.40 (2.08)	0.274
Reason for activity
Fetching water	1.12 (1.19)	0.95 (0.88)	0.276
Bringing fodder/preparing forage	1.21 (1.17)	0.93 (0.93)	0.026
Bringing firewood	1.77 (1.35)	1.30 (1.16)	0.004
Working in your farm	2.76 (2.19)	1.82 (1.90)	0.000
Leisure activities
Watching TV	0.23 (0.65)	0.27 (0.62)	0.694
Talking with friends/neighbors	0.75 (0.89)	0.82 (0.75)	0.521
Taking rest in day time	0.74 (1.12)	1.25 (1.47)	0.001

Health and symptom analysis

In this sample, 302 (53.45%) reported some form of MSD. LBP was the most common complaint in this category with point prevalence 29.2% (CI 25.5–33.1) followed by knee pain- 12.92% (CI 10.3-16.0), headache- 10.27% (CI 7.9-13.1) and shoulder pain 3% (CI 1.8- 4.8). Another set of 56 women (9.91%) said that they have pain at multiple joints or other non-specific MSDs. It is clear from Table 4 that musculoskeletal problems are one of the major reasons for seeking health care.

Table 4

Causes for health seeking

Reason/type of health complaint	Visited doctor in last 1 year [n (%)]	Taken medication in last 1 year [n (%)]
Musculoskeletal problem	70 (12.39)	96 (16.99)
Gynecological problem	42 (07.43)	30 (05.31)
Obstetrics reasons	18 (03.19)	14 (02.48)
Other	223 (39.47)	215 (38.05)
Total	353 (62.48)	355 (62.83)

It was seen that 2.83% of women were ever hospitalized for MSDs out of total 29.91% ever admitted. Other reasons for ever hospitalization included 8.14% obstetric, 6.19% for infective diseases, 4.25% for hysterectomy, and rest were various other causes. There was no significant difference across caste-categories and self-reported MSDs.

As seen in Table 5, there was no significant difference among women with or without MSDs in the mean duration of work inside the house, house premises, or outside house premises. This indicated that women had to continue working even with chronic pain. Also, there is no difference in their leisure activities, further establishing that they have to endure the pain and keep on working without any rest toward the daily chores. The only significant difference was in “agriculture-related activities” and in “work in bending position,” which are also the top rated “most strenuous tasks.”

Table 5

Difference in mean durations among women with and without MSDs

Physical activity	Mean duration (with SD) for “Women without MSDs” (n=263)	Mean duration (with SD) for “Women with MSDs” (n=302)	“P” for the difference in mean durations
Space of activity
Work inside the house	3.72 (2.84)	4.05 (2.77)	0.170
Work in house premises	3.11 (2.66)	3.00 (2.47)	0.630
Work outside of house premises	3.98 (2.58)	4.07 (2.58)	0.669
Type of physical activity
Total duration of walking	3.15 (2.61)	3.14 (2.41)	0.977
Total duration of carrying any weight	1.96 (1.65)	2.17 (1.72)	0.151
Total duration of working in bending position	2.46 (1.68)	2.76 (1.88)	0.045
Reason for activity
Fetching water	1.11 (1.11)	1.08 (1.20)	0.785
Bringing fodder/preparing forage	1.18 (1.21)	1.17 (1.09)	0.863
Bringing firewood	1.69 (1.34)	1.72 (1.33)	0.813
Working in your farm	2.39 (2.01)	2.86 (2.30)	0.010
Leisure activities
Watching TV	0.26 (0.68)	0.22 (0.62)	0.519
Talking with friends/neighbors	0.72 (0.89)	0.75 (0.86)	0.412
Taking rest in day time	0.75 (0.89)	0.85 (1.17)	0.352

Caste and class aspect

As seen in Table 6, there was significant difference across caste categories for total duration of working hours and the General category women were working longer. This could be due to higher agricultural land and related work responsibility among General category families. No such association was found in class- categories.

Table 6

Caste and mean duration of total work

Caste	Mean duration of total work (in Hrs)	SD	n	P (for ANOVA test)
General	12.276	7.72	121	0.015
OBC	9.667	5.12	63
SC	10.515	4.63	34
ST	10.806	4.83	347

The BPL class women found to report higher MSDs, as seen in Table 7. There was no significant difference in MSDs across caste categories.

Table 7

Class and self-reported MSDs

Class	BPL	MPL	APL	P
Women with MSDs (%)	191 (58.59)	39 (54.93)	72 (42.86)	0.004

In caste-wise analysis, there was significant difference in percentage of women consumed medication for MSD in last 1 year. Among these women OBC consumed higher (76.19%) medicines compared to General (65.29%), SC (70.59%), and ST (58.79%) women.

DISCUSSION

In recent years, mainstreaming and empowering rural women is a major focus of development agencies. However, most of the interventions are around maternity or financial assistance. In order to achieve the mainstreaming, one has to understand avoidable contributors to the time-poverty of these women. After this understanding only, effective interventions can be planned. There is limited literature focusing on domestic work as a contributing factor to rural women’s ill-health and time-poverty.

As per the census 2011, 5.19% elderly (above 60 years) were disabled and 76.19% of those were living in rural areas. For women, their neglected MSDs could be one of the reasons for disability. Compromised health access aggravates the health problems making treacherous routine further difficult.[6] The results show that older women continue the hardship even after 50 years of age. Also, women with chronic MSDs continue most of the routine tasks, which is tragic. It proves the compelling nature of domestic work for women.

Women contribute to agricultural activities significantly and their tasks are the most difficult and strenuous ones. In various surveys related to women’s contribution toward agriculture, mostly time and monetary part is calculated.[7] The health effects are focused rarely. Mechanization of various agricultural activities will help women significantly to save their time and energy as well as to promote their health. Unfortunately, there is no penetration of better agricultural tools in rural India. Use of traditional methods adds to the drudgery as these are effort-intensive processes.

As the amenities like LPG or water are not available at household, women have to go outside to meet the ends. One of the factors contributing to the hardship is the lack of basic amenities related services in the public sphere. Public systems like LPG distribution, which incur cost on the consumer are almost absent from rural areas due to the low paying capacity of the beneficiaries. It is well established through various studies that use of traditional solid fuel for cooking leads to respiratory and other diseases among rural women and children.[8910] There are fewer studies which explore the effects on other systems like musculoskeletal due to firewood fetching.[6]

Another example is the unavailability of electricity. Among the study participants, only 68.5% of women had an electricity connection at household. In 2018, the electricity coverage of rural Udaipur District was at 56.79%.[11] And the electricity connection does not mean constant power supply. This unavailability of electricity affects work done by women and their hardship.[12] Many tasks related to cooking and water fetching can be made easy with sustainable electric supply. To meet the ends, women have to solely work, whereas their husbands are away from home to earn money. It is evident from the results that women are working in excess to any work-related norm in occupational set-ups. As per the Factories Act- 1948, work hour limit is nine hours per day for any adult, male or female, and it should not exceed 48 h a week.[13] Ideally, the maximum weight which an Indian woman worker should carry is 15.4 KGs.[14] But in reality, women in this part of India are working much harder and beyond these norms leading to compromised health. It is evident from the results that MSDs are in excess in the study population. This is in line with the findings of global studies indicating women are having a higher prevalence of chronic MSDs.[1516]

Access to health is not optimal in villages. There are not many registered medical practitioners in villages and quacks treat many. The primary treatment given here is mainly symptomatic, which give temporary relief. There is no easy access to higher health centers neither rural poor afford those. This leads to exacerbation of health ailments rather than cure. All of this is adding to the disability among rural women, especially in older age.

Even today in rural areas, people do not think beyond the domestic application of woman’s energy and time, which leads to the continuation of age-old drudgery of women, untouched with technological advancement. From the labor-economic perspective, the opportunity costs of women’s labor, as well as time, are the significant factors affecting the daily activities. If there are options available to utilize women’s time in economically positive ways, then only the adaptation of certain domestic amenities is more so that women’s time can be saved there and utilized at a better paying job. In the absence of it, the energy of women is used in traditional, work-intensive manner. For example, among the study participants, 75.22% use firewood, 15.75% use LPG for cooking, and 8.67% use firewood even though they have LPG. Even though some subsidy was given for LPG to the rural poor, its complete adaptation is lacking as women do not have anything monetarily important and they continue fetching firewood which is free of cost.[1718]

As long as women do not have time, energy, and health, they cannot be brought to the mainstream, and at present, these things are consumed by their laborious daily schedule.[61718] Similarly, provision of electricity can help in the mechanization of various tasks of women in domestic and agricultural activities.[12]

Lack of these basic facilities make women slave of a very harsh and laborious life. This also leads to time poverty and affect their health. There can be economical ways to provide basic amenities, and there is room to explore options like biogas, solar energy, wind energy, and muscle-energy optimizing technology. Currently, there is negligible penetration of such technologies in or around study areas. If employment can be generated for women around such solutions, then uptake of the intervention will be much better. It was seen that improving access of very basic facilities will reduce the duration of the drudgery by 4 h or so on a daily basis and it will give the women time and energy to engage in other developmental activities. Lower cast and class should be given priority as data indicate higher time poverty and burden of MSDs among them. Without this saved time and energy, it is difficult to think about their mainstreaming and better health.

Financial support and sponsorship

The fieldwork was supported by Indian Institute of Management- Udaipur. Apart from that there was no financial engagement with any organization

Conflicts of interest

There are no conflicts of interest.