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- Convenor:
-
Meera Tiwari
(University of East London)
Send message to Convenor
- Discussants:
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Giulia Greco
(London School of Hygiene and Tropical Medicine)
Mario Biggeri (Departiment of Economics and Management, University of Florence, Italy)
- Format:
- Thematic Panel
- Theme:
- Health inequalities, disability and aging
Short Abstract:
This panel examines how the health and wellbeing outcomes, equity and gender equality are anchored in the central pillars of the Capability Approach. The three papers in this panel engage with gender and youth related inequalities and inequities in the domain of health and wellbeing in two contexts in India and one in Uganda.
Long Abstract:
Grounded in the three ‘Cs’ of the conference theme, this panel examines how the Sustainable Development Goals 3 (Health and Wellbeing) and 5(Gender equality) are anchored in the central pillars of the Capability Approach. As marginalized communities worldwide navigate the multidimensional landscape of challenges, their lack of certain capabilities, the inequities, inequalities and deprivations they experience in several domains pose serious impediments to overcoming the problems. While the commitment of these communities, expressed and strengthened through individual and collective agency and empowerment is shown to improve their overall wellbeing (Anand et al., 2020; Datta, 2015; Tiwari, 2010), the relationship is complex. In some cases, there are externalities, while in others feeble conversion factors lead to sluggish progress in addressing inequalities, insecurities and lack of opportunities. Additionally, commitment is also manifested through targeted policy or intervention to address selected domains of deprivation.
The three papers in this panel engage with gender and youth related inequalities and inequities in the domain of health and wellbeing (SDG 3) in three contexts.
Cash transfer, privacy, and women’s empowerment: implications for intimate partner violence
The first paper draws on the research carried out in Uganda while the other two relate to different thematic situational frameworks in India. Prabhakar et al. examine the implications of cash transfer, privacy, and women’s empowerment for intimate partner violence (IPV). The study using a data set of 2000 refugee and host women residing in mobile phone-owning households in Uganda deployed RCT as the investigative tool. The findings reveal that combining privacy of information with mobile money transfers significantly enhances women's decision-making within the household and self-efficacy. Further, mobile money promotes their engagement in self-employment activities, and positively impacts women's labor supply outcomes when the husband is aware of the transfer. The study indicates the effectiveness of specific modes of cash transfer and the role of privacy in fostering women's economic empowerment and IPV reduction.
Gender and Equity: the analysis of Community-Based Rehabilitation program in India
The second paper is grounded in equity analysis literature using a capability approach lens, to examine the impact of a Community-Based Rehabilitation (CBR) program in India on health and non-health outcomes of children and youth with disabilities. Biggeri and Arciprete deploy impact analysis of the CBR after 4 and 7 years of implementation. The data is captured using a large-scale survey and a quasi-randomised trial design assessed across 7 dimensions of well-being via multilevel logit regressions. Equity analysis is then performed by intersecting personal characteristics, or identities, in order to simulate estimates for 8 profiles based on gender, caste, and severity of disability. Qualitative data were collected to triangulate quantitative findings. Results show that the coverage of the programme is inclusive, and that the program had positive impacts on the well-being of all beneficiaries. However, the magnitude of these effects varies according to specific dimensions and identities.
Women’s empowerment and health capabilities in Bihar, India
The third paper examines the relationship between women’s empowerment and health capabilities in rural Bihar in India. The state supported women’s Self Help Group (SHG) network Jeevika with over a million members, has been acclaimed for its empowering platform, strengthening both collective and individual agency of rural women (Tiwari, 2010; Dutta, 2015). Additionally, several studies (Anand et. al, 2020) link women’s empowerment to the wider wellbeing of the household including children, adults and the elderly. The Sustainable Development Goals (SDG) India Index Report (2018) though alerts to the slow progress the state has made in SDG 3 (wellbeing and health). The investigation draws on primary data using mixed methods from a sample of 1000 Jeevika SHG network women for quantitative analysis and in-depth interviews of 25 Jeevika SHG women. The inquiry focuses on capturing health and wellbeing functionings and capabilities of the SHG women. Both quantitative and in particular the qualitative data draws attention to whether there are other factors influencing health and wellbeing capabilities of the SHG women not captured SDG 3 index scoring. It is envisaged that the findings of this study will help in identifying wider thematic domains that are needed in addition to women’s empowerment to improve the progress of the SDG 3 targets in the state.
Accepted papers:
Paper short abstract:
This paper examines the relationship between women’s empowerment and health capabilities in rural Bihar in India. The research investigates why despite acknowledged progress in women's empowerment has not resulted in improvements in health outcomes and gender equality.
Paper long abstract:
This paper examines the relationship between women’s empowerment and health capabilities in rural Bihar in India. Since 2007 the state of Bihar has embraced livelihoods improvement strategies grounded in expanding women’s abilities to access better opportunities and public service provision. The state supported women’s Self Help Group (SHG) network Jeevika with over a million members, has been acclaimed for its empowering platform, strengthening both collective and individual agency of rural women (Tiwari, 2010; Dutta, 2015). Additionally, several studies (Anand et. al, 2020) link women’s empowerment to the wider wellbeing of the household including children, adults and the elderly. The Sustainable Development Goals (SDG) India Index Report (2018) though alerts to the slow progress the state has made in SDG 3 (wellbeing and health).
The proposed study revisits the literature on the associations between women’s empowerment and health and wellbeing in the context of rural Bihar. The investigation draws on primary data using mixed methods from a sample of 1000 Jeevika SHG network women for quantitative analysis and in-depth interviews of 25 Jeevika SHG women. The inquiry focuses on capturing women’s perceptions of transformative changes in their lives they have experienced by becoming active participants of the collective network. A more specific domain of examination is then framed to capture health and wellbeing functionings and capabilities of the SHG women. Additionally, the research tool also gathers information on both the actual public health and/or alternative healthcare provision and how these are accessed or not by the SHG women. Further, both quantitative and in particular the qualitative data draws attention to whether there are other factors influencing health and wellbeing capabilities of the SHG women not captured SHG 3 index scoring.
It is envisaged that the findings of this study will help in identifying wider thematic domains that are needed in addition to women’s empowerment to improve the progress of the SDG 3 targets in the state. Additionally, the findings will also enable mapping the indicators deployed in the SDG India Indexing methods to the data and the rich narrative gathered from the field study to locate gaps and missing factors. The findings thus offer policy implications in designing SHG platforms to address weak health capabilities in different socioeconomic contests int the world with the necessary contextualisation.
Paper short abstract:
The objective of this paper is to provide a contribution to equity analysis literature by assessing, from a capability approach perspective, the impact of a Community-Based Rehabilitation (CBR) program in India on health and non-health outcomes of children and youth with disabilities.
Paper long abstract:
Equity analysis is taken into account to evaluate and guide health programs and policies as it allows a more flexible and effective response to health inequities especially in lower- and middle-income countries (LMICs) (Sen, 2002; Briggs and Nugent, 2016; Griffiths et al., 2016). The notion that the intersection of multiple identities matters for accessing opportunities is increasingly recognized allowing policymakers to identify better interventions to improve equity and reduce chronic outcomes’ disadvantages (Sen et al., 2009; Sen and Iyer, 2012; Deepak et al. 2013; Larson, et al. 2016). Several authors identify the capability approach as a suitable theoretical frame for this type of multidimensional analyses (Sen, 2002; Coast et al., 2008b; Lorgelly et al., 2010; Greco et al., 2016).
The objective of this paper is to provide a contribution to equity analysis literature by assessing, from a capability approach perspective, the impact of a Community-Based Rehabilitation (CBR) program in India on health and non-health outcomes of children and youth with disabilities.
Overall, in India CBR programs have been promoted as the most practical and viable solution for improving the well-being of persons with disabilities (O'Keefe, 2009). The CBR program in the districts of Mandya and Ramanagaram in Karnataka (India) constitutes our illustrative case study. This CBR program began in 1997 and by 2010, it had reached 2,045 villages in the 2 districts of involving around 22,000 persons with disabilities.
The impact analysis - after 4 and 7 years the CBR started - is based on a large-scale survey and a quasi-randomised trial design and is assessed across 7 dimensions of well-being via multilevel logit regressions. Equity analysis is performed by intersecting personal characteristics, or identities, in order to simulate estimates for 8 profiles based on gender, caste, and severity of disability. Qualitative data were collected to triangulate quantitative findings.
While caste membership does not significantly affect the magnitude of any improvement, the severity of disability and gender status play a determinant role. Overall, evidence suggests that the CBR program should strive to improve services for persons with severe disability, considering some complex social and cultural factors such as those related to gender roles.
Paper short abstract:
This study represents one of the pioneering Randomized Controlled Trials (RCTs) examining the effects of cash and mobile money delivery mechanisms, along with privacy of information, on women's economic empowerment and intimate partner violence (IPV) reduction.
Paper long abstract:
This study represents one of the pioneering Randomized Controlled Trials (RCTs) examining the effects of cash and mobile money delivery mechanisms, along with privacy of information, on women's economic empowerment and intimate partner violence (IPV) reduction. The study targeted 2000 refugee and host women residing in mobile phone-owning households in Uganda, employing randomization to allocate participants into four treatment groups and a control group. Two treatment groups received cash transfers, while the remaining two received mobile money transfers. In one cash transfer group and one mobile money group, the transfer information was privately provided to the target woman, while in the other two groups, the information was shared with both the target woman and her spouse, following the current practice of many cash transfer programs.
The findings reveal that combining privacy of information with mobile money transfers significantly enhances women's decision-making within the household and self-efficacy. Mobile money promotes their engagement in self-employment activities, and positively impacts women's labor supply outcomes when the husband is aware of the transfer. Moreover, it is observed that cash transfers effectively reduce IPV when the information regarding the transfer is known to both the woman and her spouse. These findings contribute to the growing body of evidence on the effectiveness of specific delivery mechanisms and the role of privacy in fostering women's economic empowerment and IPV reduction within the context of cash transfer programs.