Chittorgarh, Pratapgarh (Rajasthan): It has been over two years since Goti Bai, 36, got her first cylinder of liquefied petroleum gas (LPG) under a three-year-old government scheme to promote clean cooking fuel.

A farmer from Khatlabor village in north Rajasthan’s Pratapgarh district, Bai is one of 80 million poor Indian women to benefit from the scheme titled Pradhan Mantri Ujjwala Yojana (PMUY).

On a scorching April afternoon when we arrived at her home, Goti Bai was busy with a weekly meeting of the local self-help group. How does she cook? we asked. She pointed to the chulha (earthen stove) on the floor of her one-room home. This windowless space serves as the living room, bedroom and kitchen for her family.

The steel gas stove that Goti Bai got as a part of the PMUY package sat on a high wooden beam, smothered in dust and cobwebs. She led us to her cowshed, her lavender odhni (stole) pulled firmly over her face as is the custom among the women of the region when they are in the presence of unknown men.

We were accompanied by volunteers of Prayas, a non-profit working on health, livelihood and gender in Rajasthan, as we investigated why PMUY has been unable to phase out chulhas in rural kitchens, as Factchecker reported on April 22, 2019.

Goti Bai’s LPG cylinder sat behind bales of cattle fodder. “We don’t have the money to buy a refill,” Got Bai explained.

The programme, started in 2016, gives women from below-poverty-line households their first gas cylinder, a regulator and a connecting tube. The government pays the security deposit for the cylinder, the cost of regulator and the installation charges--Rs 1,600 in all--as a kind of “loan” that is later deducted by the gas agencies from the LPG subsidies that beneficiaries get in their bank accounts.

After this, families have to buy their own refill cylinders that cost about Rs 800-850 each upfront. Even though an amount of Rs. 200 is deposited in their accounts after the loan amount is deducted, many beneficiaries cannot afford this price upfront, we found. Most homes in Khatlabor continue to cook on chulhas using firewood, dung and coal, breathing in noxious smoke, said Jawahar Singh, Prayas’ district coordinator in Pratapgarh.

We found this true of many villages we visited in Chittorgarh and Pratapgarh districts. Families that do use LPG to cook, do so sparingly--to brew a cup of tea, for example, or on a rainy day when firewood turns damp. This is despite the fact that Rajasthan ranks third in the number of LPG refill connections as per this December 2018 report from The Hindu BusinessLine.

Apart from the expenses involved in buying refills, there are widespread cultural factors as well: Food cooked on traditional stove is considered “healthier” and “tastier” by many. Also, in a society where gender skews are entrenched, the health risks women face from sustained use of solid fuels tend to be disregarded.

Our findings are supported by other studies as well: 73% of beneficiaries in rural Bihar, Rajasthan, Uttar Pradesh and Madhya Pradesh--where two-fifth of India’s rural population lives--still use solid fuels for cooking due to financial reasons and gender inequality, said a February 2019 study by Research Institute for Compassionate Economics (RICE), a non-profit research organisation. Further, researchers found 85% of Ujjwala beneficiaries still use solid fuels for cooking.

While 76% of households owned a LPG connection by 2018, an increase of one-third from 2014; 98% of household owned both chulha and a gas stove and 36% exclusively cooked on a chulha on the day before the survey.

‘Why buy cylinder when firewood is freely available?’

The scheme’s stated intention is to empower women by sparing them the discomfort of working in “smoky kitchens” or having to “wander in unsafe areas for firewood”, as per the official website. The government has claimed that till January 2019, 80 million households received free cylinders and 60 million received connections.

But these numbers do not reflect the reality of LPG use in the kitchens of beneficiaries, we found by listening to the stories of the women members of a local self-help group gathered in Goti Bai’s courtyard.

“I got a cylinder in 2017 but we had to pay Rs 200 [to middle men for documentation],” said Poorki Bai, 42. She has got three refills since, about one each year.

How did a single cylinder last that long? “I still cook on the chulha, the cylinder is for cooking in a hurry, to make chai when guests arrive or during the rainy season when the firewood is damp,” she said. Other women nodded their heads in agreement: An LPG cylinder at Rs 800-850 is about 13% of their average monthly earning of Rs 6,345, according to the Rajasthan Economic Survey, 2017-18.

Researchers at RICE found that since most rural households could gather free solid fuels--firewood, dung, agricultural residue--in their neighbourhood, an LPG refill is considered an expensive alternative. This was especially the case for those who live near forests where they could find firewood or owned animals that yielded dung.

At Katlabor village, Kali Bai, 18, with the stack of firewood she and her mother collected. This pile will last her family a year. It is usually the women who collect firewood in the dry season in Rajasthan.

“Why will we buy a cylinder when firewood is available free of cost?” asked Poorki Bai.

The 2019 RICE study asked respondents to name the fuel they used in their kitchens the day before they took the survey: Richest households had higher chances of exclusively using LPG to cook than those with fewer assets, it was found. The richest households also used solid fuels to cook at least one food item a day, as per the study.

Most houses in interior Rajasthan have two chulhas, one in the inner room/kitchen and other parked in the veranda. The outdoors one is used during summers and the indoors during winters and rains.

We found in our visits to local homes that the chulha is usually kept in a windowless room where the ceiling has turned black with soot. Women normally cook squatting in front of the stove, inhaling harmful smoke. During winters, families huddle around the chulha for warmth and this includes infants and small children.

Household air pollution led to 482,000 deaths in 2017

Solid fuel like firewood, cow dung and dry grass are highly damaging to health. Cooking on traditional chulhas leads to incomplete combustion, and emission of particles such as suspended particulate matter, carbon monoxide, polyaromatic hydrocarbons, polyorganic matter and formaldehyde. All these are harmful for respiratory health.

Household air pollution led to 482,000 deaths and 21.3 million disability adjusted life years (DALYs)--years lost due to ill-health, disability or early death--in 2017, according to a study published in The Lancet Planetary Health, a global journal, as IndiaSpend reported in December 2018.

The same study showed that even in 2017 more than half (55.5%) of India still used solid fuels--dung, coal, wood and agricultural residue--for cooking. The numbers were much higher--over 72.1% or about 486 million people--in Bihar, Jharkhand, Odisha, Chhattisgarh, Assam, Madhya Pradesh and Rajasthan. These states together suffered half the deaths caused by household pollution.

Particulate matter, known as PM 2.5, is 30 times smaller than human hair and has the ability to travel through the blood vessels to different organs causing lower respiratory infections, ischaemic heart diseases, stroke, chronic obstructive pulmonary disease, lung cancer and diabetes.

Krishna Bai, 32, an accredited social health activist from Keshavpura, Pratapgarh district, has not received an LPG connection despite filling the form and requesting the panchayat.

Women, children most vulnerable to household air pollution

Of all premature deaths caused by household air pollution, 44% were due to pneumonia, 54% due to chronic obstructive pulmonary disease (COPD), and 2% due to lung cancer. Women and younger children who spend the most time at home are the most vulnerable.

Exposure to air pollution during pregnancy leads to outcomes such as low birth weight and stillbirth.

COPD, typified by coughing, wheezing and breathlessness, is the second highest killer in Indians, responsible for death of almost 1 million Indians in 2017, IndiaSpend reported in March 2018. It is caused by the inflammation of airways in the lungs and results in the destruction of air sacs that extract oxygen and expel carbon dioxide.

In 2017, Rajasthan had the highest death rate due to air pollution--112.5, meaning 112 people in every 100,000 died due to air pollution impact. The state also ranks second worst after Chhattisgarh with 1,752 DALYS or disability adjusted life years per 100,000.

Switching from solid fuels to LPG cylinder can prevent these deaths and disability but PMUY’s implementation is riddled with many challenges.

Not enough awareness about health hazards

Another study on 550 PMUY households found most of the households lacked knowledge about health hazards of cooking with solid fuels. In their survey in Bikaner, Rajasthan, researchers from Delhi-based Institute for Economic Growth found 13% respondents considered serious health impact of solid fuels exist, 27% perceived no ill effects while 60% thought health effects were temporary like eye irritation, coughing etc. when cooking with solid fuels.

Then, the researchers explained the ill-effects of solid fuel use--from childhood pneumonia to heart disease. They gave the households a discount voucher and found that informed households had a 36% higher rate of using the voucher than the others.

When researchers asked households to quote the maximum price they were willing to pay for an LPG cylinder, the answer was Rs 352. This is 40% of the market price of a cylinder (around Rs 850) and even after subsidy of Rs 200, it would be 50% of the cost.

Medical fraternity too is unaware of air pollution hazards

There were three-to-four COPD patients each in the 50-bed male and female wards at the district hospital in Chittorgarh. Mangal Lal, 70, a farmer from Achalpura village had been hospitalised three days ago after a bout of acute breathlessness. A widower, he has been living alone since his daughter got married. Lal was a beedi smoker all his life but quit three years ago. “I cook my own food on the chulha,” he told IndiaSpend, struggling to breathe.

70-year-old Mangal Lal suffers from chronic obstructive pulmonary disease. He has been beedi smoker all his life but quit three years back. He still cooks his food on a chulha.

“We do get COPD patients but most of them have a history of smoking and most of them are male,” said Madhup Bakshi, principal medical officer at the district hospital, Chittorgarh. Since COPD takes a few decades to develop, most of his patients are older. “There are very few women who come to us with COPD symptoms, they may have a natural resistance to the disease,” he said.

In the female ward, we met Shankari Bai, 70, who sat on her bed unable to breathe. Every word she spoke was followed by a long struggling breath. After a while, her granddaughter started answering the questions for us.

Shankari Bai (right) has been suffering from COPD for the last five to six years and cannot walk long distances. She has not been prescribed inhalers.

Shankari Bai has cooked on the traditional chulha all her life even though she received a cylinder two years ago. About 5-6 years ago, she started complaining of breathlessness. Under treatment for last 3-4 years, she has never been prescribed inhalers, only tablets.

The best treatment for patients with COPD is inhalation therapy using bronchodilators that relax the muscles around the airways and corticosteroids that prevent the inflammation of airways or a combination. But patients we met were given drugs, injections and syrups.

There was also lack of awareness among chest specialists about the prevalence of COPD in the region. “Smoke from chulha is not a big risk factor for COPD,” said Rakesh Bhatnagar, chest physician, at the hospital. “Women do come for respiratory illness but COPD is not common among them.”

But data show this is not true: COPD was responsible for 8.59% of all deaths in Indian women, almost equal to 8.71% in men in 2016, as per the Global Burden of Disease, 2017 data.

About 90,000 patients died due to air pollution in Rajasthan, about 39,000 were due to household air pollution, stated The Lancet Planetary Health, as we mentioned earlier.

There are cultural and gender-related reasons why the chulha is not disappearing from rural kitchens. Since women do most of the work involved in organising and using solid fuels, families do not even think of the opportunity cost of the time spent collecting firewood or cow dung.

Food cooked on chulha is ‘tastier’, ‘healthier’

Also even though people agreed that cooking on gas was easier and better for the health of cook, most also believe that the use of solid fuels made food “tastier” and “healthier”.

“I remember sitting with a Jain family in Madhya Pradesh and their daughter, who was studying for BSc in biology, explaining to me that wood-smoke improves eyesight because it washes away impurities,” said Aashish Gupta, co-author of the paper and research fellow at RICE. “Another Brahmin old man explained that carrying loads and cooking with solid fuels involves substantial kasrat (exercise) which improves women’s health. We heard 'Gas ka khane se gas hoti hai (food cooked with LPG induces stomach gas) in rich as well as poor households.”

Households that owned an LPG thought it is easier to cook using it (77.4%) but food tastes better when cooked on chulha (92.2%). Further, 86.5% thought cooking on chulha is better for health of the person who eats it though 69.8% thought it is worse for the person cooking it in the RICE study.

These findings show how many women knowingly sacrifice their own health and comfort for the comfort of their children, husbands, and other family members.

In Pratapgarh, we found similar barriers. Women weren’t taught how to use LPG cylinders and men were okay with that. “I am afraid of lighting the gas stove, I may burn down the house,” said Kesari Bai, 45, whose husband went to Pratapgarh to get the cylinder. Only her sons were confident about turning on the gas stove.

“I know chulha smoke is bad for us, it leads to burning of eyes, cough and itching but what to do?” said Kesari Bai. She wasn’t alone, three of the other women especially older women in the village express fears about lighting a gas stove. Having heard of such incidents, they were also worried the cylinder would explode.

Not everyone who wants a cylinder gets one

At the anganwadi (childcare) centre in Kesavpura village in Pratapgarh, the sahayika (helper) was cooking sooji halwa (semolina porridge) over a chulha, surrounded by children. The centre did not have an LPG cylinder connection. The local ASHA (accredited social health activist) worker Krishna Bai, 32, had filled a form and put in a request for a cylinder with the panchayat but hadn’t heard back.

Sumitra Bai from Acchoda village has yet to get a gas connection despite many requests.

“Please get me a cylinder,” Sumitra Bai pleaded with us when we were interviewing villagers about Ujjwala. A labourer who works in the mines at Acchoda village in Chittorgarh district, she was tired of cooking on a chulha after an exhausting day at work, she said. “I have gone to the [district] collectorate and to the gas agency but they keep saying that your name is not in the list,” she said, showing us her Aadhaar card and bank account, both required for PMUY benefits.

In a random survey conducted by volunteers and staff of Prayas, the percentage of households without cylinders showed up thus in three villages across Pratapgarh and Chittorgarh districts--42% (12/28) in Khatlabor, 45% (33/72) in Kesarpura and 20% (10/50) Sowani.

60% Ujjwala households claim they did not get subsidies: study

Also there seemed to be a very low awareness about the LPG subsidy that is deposited in bank accounts linked with Aadhaar. “We didn’t get any subsidy in our bank account,” was a common complaint across the villages we visited.

Under PMUY, as we explained, beneficiaries get a gas connection, stove, regulator and one LPG cylinder at a subsidised rate. This is either provided to the beneficiaries as a loan or gas agencies deduct the amount over time from the subsidies that the beneficiaries get.

The RICE study also found 35% of all LPG-owning households, and 60% of households that received LPG through Ujjwala, reported not receiving the subsidy at all.

A substantial portion of these households are likely to be those that have not yet paid the "loan" component of the Ujjwala but “most of these households were not aware that this was the reason”, said the study which added that the Ujjwala guidelines have not been explained to most households. Additionally, some of these households have paid the loan component, and are still not getting the subsidy, for various reasons. Most of these could be due to glitches in the usage of Aadhaar, said Aashish Gupta of RICE.

“We have provided gas connections to over 3,000 beneficiaries since April 2016,” said Rakesh Badala, owner of Priyanka gas agency in Gandhinagar locality of Pratapgarh. He said in Pratapgarh, the gas agencies are recovering the initial Rs 1,600 they waived off from the subsidies. “After the initial 6-7 refills, the subsidy amount reaches the beneficiaries,” he told IndiaSpend.

Acchoda village is populated by Kanjars, a marginalised community branded “criminal” by the British and now denotified later. They still struggle for social acceptance and have few avenues to earn and live with dignity. Most Kanjars here work in the mines and only Salagram Kanjar’s family has bought refills, about six. “I don’t know if I received any subsidy,” he told IndiaSpend. “I can’t read and the bank official said I didn’t receive anything.”

In order to effectively promote the use of LPGs, the government will have to reduce the cost of the cylinders and explain the benefits of cooking with LPG while breaking the myths around it, experts believe. “Larger subsidies for cylinder refills, informational campaigns that educate about the harms of air pollution exposure, and behavioural campaigns that change attitudes:” These are some of the recommendations of the researchers at RICE.

Further, Ujjwala is emphasised as a project for women but if men were encouraged to take on household tasks like cooking through a public campaign, the use of LPG cylinders may accelerate at a faster pace.

Reporting for this article was supported by the REACH Lilly Media Fellowship Programme on Non Communicable Diseases.

(Yadavar is a principal correspondent with IndiaSpend.)

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