COVID-19: Socio-economic and healthcare impact in rural Bihar, Part – 1

In the aftermath of COVID-19 lockdown, a survey conducted by Human Liberty Network has revealed major challenges related to livelihood, healthcare, nutrition and basic needs in rural Bihar and Uttar Pradesh. In this first part, R&M brings in the key takeaways from Bihar

COVID-19: Socio-economic and healthcare impact in rural Bihar, Part – 1

In the aftermath of COVID-19 lockdown, a survey conducted by Human Liberty Network has revealed major challenges related to livelihood, healthcare, nutrition and basic needs in rural Bihar and Uttar Pradesh. In this first part, R&M brings in the key takeaways from Bihar. In the second part, the report will be on rural Uttar Pradesh.

Human Liberty Network (HLN), a network of Civil Society Organisations (CSOs) with a vision for a human trafficking free society, released the findings of a survey conducted in 15 districts of Bihar and 6 districts of Uttar Pradesh with over 1200 respondents revealing major challenges related to livelihood, access to health services, nutrition and basic needs post the return of migrant workers, which is strongly increasing their vulnerability to rural distress, debt bondage and human trafficking. The survey further reinforced targeted and coordinated efforts from the state governments and community based organisations, for rapid implementation of support mechanisms for the vulnerable.

Key takeaways

  • Prevalence of social stigma against returnee migrant workers leading to a higher incidence of trafficking. Ten percent of the workers representing 384,658 surveyed households are victims of social stigma.
  • Poor performance of Mahatma Gandhi National Rural Employment Guarantee Act (MNREGA) making individuals more economically vulnerable in districts such as Araria, Gopalganj and Nawada.
  • Prevalence of anaemia among children and women where Kishanganj (65.2 percent and 62 percent respectively) and Purnea (66.5 percent and 72.2 percent respectively) have reported the highest prevalence making them victims of debt bondage.
  • Difficulty in accessing benefits under Integrated Child Development Services (ICDS) where Katihar (57 percent) and Saharsa (58 percent) reported high proportions of children not enrolled in Andandwadi Centres (AWCs) leading to cases of malnourishment.
  • Only 29 percent of the population have active job cards.
  • Saharsa, Sitamarhi, and Gopalganj districts are underperforming in providing jobs.
  • Only 37 percent of Gram Panchayats have adopted special measures for the single women workers.


Bihar Migrant Labourers.jpg

Mushahar community is one of the most backward and oppressed caste groups in Bihar. Since they are usually landless, a large number of people from this community have to go to other states in search of work. They constitute a large percentage of the population of migrant workers who returned to Bihar during the lockdown.

Upon returning to Bihar, they are facing difficulties in finding employment under MNREGA. Since most of them have not worked under MNREGA in the past, they haven’t been issued job cards. Furthermore, MNREGA staff have not been helping them with documentation and enrollment. This has put them in a vulnerable position, where they have lost their incomes and savings without any alternate sources of livelihood.

COVID-19 impact on pregnant women and adolescent girls
Poor maternal health and child malnutrition have been perennial problems. Bihar has one of the highest rates of child stunting (48.3 percent) and child wasting (20.8 percent). Along with this, Bihar also has the highest rates of anaemia among children and pregnant women. The impact of these conditions compound over time, and often leads to high out of pocket healthcare expenditure and loss of livelihood due to sickness. The economic impact of these problems is significant for low income households and the resulting situation might push them into debt bondage, forced labour or child labour. Usually, during Village Health Nutrition Day (VHND), providing immunisation to children and disbursing Iron Folic Acid (IFA) tablets to pregnant and lactating mothers and adolescent girls are done to combat anaemia. However, due to the COVID-19 lockdown, only 79.8 percent of Gram Panchayats in the study area reported home visits by ASHAs. Furthermore, 79.53 percent of the Panchayats in the study area did not report any VHND conducted in the past two months. Those panchayats which did report in the affirmative, had very low participation.

Difficulty in accessing DBTs for Mid-Day Meal
The nutritional requirements of school children have also been hampered by the discontinuation of the midday meal scheme as the schools are shut due to the lockdown. The state government has disbursed Rs 114.21 per student for class I to V and Rs 171.17 per student for class VI to VIII via DBT. This amount is insufficient to meet the nutritional requirements for the children especially those from Above Poverty Line (APL) families who cannot purchase foodgrains at subsidised rates.

Given the number of school children relying on the midday meal scheme as a critical component of their nutritional requirements, this situation aggravates the out of pocket expenditure for many households with precarious financial health. This could again be a major contributor towards debt bondage, child labour or forced labour. Further, lack of access to education drives child labour. Experts have stated that the economic hardship and lack of employment in the households will result in older children dropping out of school to get work to supplement the family income.

Bihar, number of children eligible for DBT under midday meal.jpg

Impact on accessing nutrition under ICDS
The Integrated Child Development Service (ICDS) machinery is instrumental in improving child and maternal health, and hence preventing debt bondage, child labour and forced labour. However, the coverage of ICDS is not absolute, as only households of lower socio-economic strata are generally enrolled at the local Anganwadi Centre (AWC). The enrollment status of the children (3-6 years) in the AWCs of the study districts where districts such as Katihar (57 percent) and Saharsa (58 percent) have more children not enrolled in AWCs and the poor coverage of Take Home Ration (THR) and Direct Benefit Transfers (DBT) allotted to the pregnant and lactating mother during the lockdown by the state government. Districts such as Khagariya (40 percent) and West Champaran (48 percent) have witnessed more cases of pregnant and lactating mothers not receiving the THR and DBT.

The AWCs provide nutritional supplementation to pregnant and lactating mothers and children of those households which have registered for its services. However, due to the lockdown and the subsequent loss of livelihood, many households which would have not required these services earlier, would be in dire need of them at the moment. However, since such households are not registered, they are unable to avail the services. These households would include the unregistered local families which require support in providing proper nutrition for the pregnant and lactating mothers and children as well as the families of migrant workers, who have returned to Bihar during the lockdown, due to loss of livelihood at the destination state.

Poor coverage of institutional deliveries during the lockdown
In Bihar, 93 percent of childbirths happen in rural areas, and thus providing adequate healthcare facilities to rural women becomes a priority for the state. Further, it has been found that the share of institutional deliveries for Bihar stands at 25 percent, low among the populous states. With the onset of the pandemic, the coverage has fallen down by 46 percent in the state. This fall in institutional deliveries has led to an increase in unattended home births and consequently, a surge in the out of pocket expenditure among rural households; thus increasing the risk of debt bondage among them.

Purnea and Katihar have witnessed the highest fall in institutional deliveries at 80 percent and 74 percent respectively. It was found that health seeking behaviour and access to medical facilities have been poor in these districts. With the additional pressure on families, there is a possibility that marginalised communities will become victims to different forms of trafficking as this region (Koshi) already reports a high incidence of child labour.

Difficulty in accessing rations
With the advent of the lockdown, the Central government under Pradhan Mantri Garib Kalyan Yojana (PMGKY), announced free 5 kg rations for the marginal communities. In addition to this, the state government announced free rations and Rs 1000 for all ration card holders. However, based on the study conducted in the 15 districts, it was found that 12 percent of the rural households did not possess ration cards. Districts such as Nawada (50 percent), Begusarai (21 percent) and Kishanganj (16 percent) have registered the highest number of households without ration cards. This lack of access to free rations makes the community vulnerable to borrowing to meet the basic needs, making them a victim of debt bondage and other forms of trafficking.

Difficulty in accessing Rs 500 under PMGKY
The Central government announced the allocation of Rs 500 under PMGKY to all woman Jan Dhan account holders seeking to provide an immediate financial cushion amidst the lockdown. The majority of rural households have bank accounts under Pradhan Mantri Jan Dhan Yojana (PMJDY). However it was observed that 9 percent of the women account holders in the studied districts did not receive the amount in their accounts. At the same time, 33 percent of these women account holders received the amount only through verification of Aadhaar and passbook in absence of Know Your Consumer (KYC). Purnea (29 percent) and Nawada (25 percent) districts show the highest gaps in receiving the DBT money during the lockdown.

Way ahead
The COVID-19 lockdown has created unprecedented challenges for the societal and economic health of Bihar. Besides the increasing cases of COVID-19 and the influx of returnee migrants, the state and district agencies are struggling to ensure holistic implementation of the central and state welfare schemes for marginalised communities. This calls for joint action between the CSOs and the government machineries to implement the policy interventions better. Such collaboration will help the government administration understand the distress faced by such communities and implement support mechanisms for the vulnerable. Finally, this will also help the administration prevent the cases of trafficking in these regions.

(The survey report on rural Uttar Pradesh will be published in the second part.)

The Changing Face of Rural India