TRIPTI SARNAAND ARCHANASHUKLA

A STUDY OF PHYSICAL-HEALTH AND NEUROTICISM AMONG WOMEN ENGAGED IN THE HOME-BASED PRODUCTION OF CHIKAN EMBROIDERY

(Accepted 10 January, 1994) ABSTRACT. The present study examinedphysical health and neuroticism among women(n = 200) engagedin the unorganizedhome-basedproductionof chikanembroidery. Physical health of women chikan workers was examined with the help of an abbreviated version of CMI, and neuroticism, with PGI Health QuestionnaireN-2 in easy paced, face to face personalinterviews. The results indicatedthat womenchikan workers in general were facing some serious health problems. Significantvariations were also obtained across groups of women associatedwith differentcentres of chikan production. The studypointstowardsthe stressfulnatureof environmentin whichthese womenchikan workers live and work.

In India, the unorganized home-based workers constitute an important part of the working population. A wide variety of income generating activities are carried out in this sector involving large number of workers most of whom are women. These activities include beedi making, textile, garment making, food processing, craft, coir work, dairy, chikan embroidery etc. Although, little is known about the magnitude of the unorganized industry both in rural and urban areas, there are indications that in the unorganized sector, working conditions are appalling, wages are incredibly low, and workers face great uncertainties and exploitations. Homebased industrial work is one of the least regulated, least supervised, and most hazardous, systems of industrial production. Yet, a large number of women workers are drawn into the unorganized sector mainly due to tack of personal resources, such as education and awareness, non-availability of employment opportunities, and normative practices
Social Indicators Research 32: 179-191, 1994. @ 1994 KluwerAcademic Publishers. Printed in the Netherlands.

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which restrict women's mobility outside home. Since most of the work is carded inside the home, it is known as home-based production. The present study focuses on one group of women engaged in homebased production of chikan embroidery. Chikan embroidery is a fine needle-craft done by hand mostly using white thread on a variety of fabrics from cotton and silk to synthetics. It is the most famous fine art of embroidery at Lucknow, the capital of Uttar Pradesh, and is famous not only in India, but also abroad. Chikan embroidery, being a fine craft requires crafts women to sit long hours in the same posture, resulting in problems with eye, back, shoulders as well as other psychosomatic problems depending upon the degree of unfavourableness of the physical environment in which these women live and work. Some background information about women chikan workers is available from previous sociological researches but little is known about their health. The present study, therefore, examined physical health and neuroticism among women engaged in the home-based production of chikan embroidery. Health is not assessed in the medical terms. Rather, women's perception of their health was assessed.

METHOD

Sample
There are four major centres for the production of chikan embroidery at Lucknow. These are U.P. Export Corporation (UPEC), Chikan Production Centre (CPC). All India Fabric Handloom Society (AIFHS), and Self Employed Women's Association (SEWA). The first three centres are run by the government and a large number of women chikan workers are officially registered with them. Women have to visit these centres to first get the raw material and then to return the finished goods and receive payment. From time to time various incentives are provided by the government to women chikan workers who are affiliated to these three centres. In contrast the SEWA centre is run by a voluntary non-government organization which has encouraged and guided women chikan workers to form a co-operative for production and marketing of chikan embroidery. At SEWA (which means 'service' in Hindi) educa-

PHYSICAL-HEALTH,NELrROTICISM,WOMENAND CHIKANEMBROIDERY 18 t

tional and medical facilities are also provided to women chikan workers and their families. Modes of payment as well as wages vary from centre to centre. Small samples of 50 women chikan workers were included from each of these four centres so as to make the overall sample a representative one and also to examine if health status of women varied from one centre to another. Sample selection was made following stratified nonrandom sampling procedures. Sample characteristics were as follows. Majority of these women workers (95.5%) were Muslim. All were married. Their age ranged from 20 years to 45 years with the mean age being 28.84 years. Only about 12% of the respondents had education ranging from Class III to Class X; others had no formal schooling. The income of these respondents ranged from Rs20.00 to Rs290.00 per month with the mean income being Rs114.80 per month.

Variables and Measures
Physical health and neuroticism were included for assessment in the context of women chikan workers.

1. Physical health. Physical health in the present study was conceptualized in terms of a continuum - the low end of which represents lot of physical health problems and the high end, as no complaints. Respondents were asked to describe their health problems with the help of a symptoms checklist adopted from Cornell Medical Index or CMI. The 195-item CMI has been shown to be a reasonably reliable indicator of health status, but its length and propensity for picking up on psychological symptoms make alterations in the index desirable and omit items obviously dealing with psychological symptoms. The 15-items dealing most directly with the physical health - eye, respiratory, cardiovascular, digestive, musculo skeletal, skin, genito urinary,, anemia and sugar were extracted and compiled as an abbreviated CMI. Normative data on the shortened, 15-items CMI is not available. 2. Neuroticism. Neuroticism, in the present study was assessed through PGI Health Questionnaire N-2 (Verma and Wig, 1976). It is a simple

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50-items measure of neuroticism (N) available in Hindi, as well as in English. It also has, in addition, a 10-items lie (L) scale. Test-retest reliability with an interval of one week was noted by the authors to be 0.91 for the N-scale and 0.84 for the L-scale. Evidence is also available regarding the high construct validity of the scale. Verma (1974) has earlier compared 17 tests of personality and adjustment in Hindi in terms of their level of difficulty and has shown that the Cornell Medical Index and the PGI Health Questionnaire N-2 are the two tests which have the lowest number of difficult words per sentence. Thus, these two tests were selected for use in the present study because these are simple, and therefore applicable to the relatively uneducated, unsophisticated sample of women chikan workers. Procedure Questionnaires were prepared in simple Hindi, interspersed with common Urdu words. Respondents were contacted at the places where they go to obtain work and/or to receive payment for the finished goods. Data were collected through slow-paced personal interview. The sampies were compared to find out if there were significant variations across the four subsamples of women chikan workers.

RESULTS

The present study obtained perceptions of women chikan workers regarding their physical health and neuroticism. In Table I are presented percentages of women saying 'yes', 'don't know' and 'no' to various physical health problems. The table lists nine sets of physical health complaints. An inspection of column' 1' presents insight into the health problems most frequently cited by women chikan workers. In this sample of women chikan workers, 53.5% reported having pain and swelling in the joints and 80.5% suffered from backache (#9 and 10, Musculo Skeletal). Eye problems are the next most commonly reported problems with 53% of the women reporting weak eyesight (#1) and 73% having eye infections (#2). Over half (60%) of the women reported that

PHYSICAL-HEALTH, NEUROTICISM,WOMEN AND CHIKANEMBROIDERY 183

TABLE I Physical health: Percentage of women reporting various problems (total sample) (1) Yes Weak Eyesight Eye Infection Asthma 2. Respiratory Cough Blood with catarrh 53.0 72.0 20.0 39.0 15.0 (2) Don't know 4.0 0.0 0.5 0.5 0.5 (3) No 43.0 28.0 79.5 60.5 84.5

Problems 1. Eye

3. Cardiovascular

Palpitation/ Breathlessness Gum Problems 47.5 36.5 60.0 0.0 0.5 0.5 52.5 63.0 39.5

4. Digestive

Indigestion and Stomach Upset Pain and Swelling

5: Musculo Skeletal

in Joints Backache

53.5 80.5 27.0

0.0 0.0 0.0

46.5 19.5 73.0

6. Skin

Skin Diseases

7. Genito Urinary

Kidney Problems Menstrual Problems

31.5 58.5 47.0 4.0

1.0 0.0 3.5 5.5

67.5 41.5 49.5 89.5

8. Anemia 9. Sugar

Anemia Diabetes

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they suffer from indigestion and stomach upsets and 36.5% have gum problems (#8 and 7, Digestive). 58.5% have menstrual problems and 31.5% have kidney problems (#13 and 12, Genito Urinary). A little less than half (47.5%) of the women have cardiovascular problems (#6) and about the same said that they are anemic (#14). An inspection of column '3' (% 'no' responses) suggests that problems related to respiratory, skin and sugar are among the tess often cited ones by the present sample. Another important finding is that very few women (0% to 6.5%) in the sample replied 'don't know' to various physical health problems (column '2'). This indicates that women chikan workers, by and large, are well aware of their health problems, except for a few women who are uncertain regarding some of the problems such as weak eyesight, anemia, sugar etc. In Table II are presented percentages of women in each of the four subsamples reporting 'yes' for the nine physical health problems. The eye and musculo skeletal problems are reported more often by the SEWA and the AIFHS groups, while digestive problems are reported more often by the CPC and the genito urinary by the AIFHS group. Besides, the AIFHS group also reported respiratory problems (88%), skin problems (58%) and anemia (82%) and the SEWA workers reported cardiovascular problems (60%). Sugar was reported by only a small percentage of women (0-10%) in the four groups. In addition to the frequency analysis the physical health data was also analysed by scoring three response alternatives - 'yes', 'don't know', 'no' as 2,1 and 0 respectively and then Computing ANOVA and Tukey's test of multiple comparisons. These values are contained in Table III. An inspection of this suggests that on the whole there are significant variations in the physical health complaints across the four groups, i.e. different groups scored more on different problems. This could therefore be broadly suggestive of individual variations regarding physical health among the present sample of women chikan workers. Next, data relating to neuroticism among the four groups of women chikan workers as well as the total sample were analysed. These are presented in Table IV. An inspection of the means, in general, shows that those who obtained a high score on neuroticism were also the ones who obtained a high score on lie scale as well and vice versa. For

PHYSICAL-HEALTH,NEUROTICISM,WOMENANDCHIKANEMBROIDERY 185 TABLEII Physical health: Percentageof women in each of the four subsamples saying 'yes' for the nine physicalhealth problems UPEC I II III IV V VI VII VIII IX Eye Respiratory Cardiovascular Digestive Musculo Skeletal Skin Genito Urinary Anemia Sugar 66 38 40 72 88 32 54 48 10 CPC 86 66 38 82 76 26 70 14 4 SEWA 100 24 60 72 90 4 68 32 0 AIFHS 100 88 42 54 90 58 88 82 2

example, the UPEC women have the highest and the AIFHS women the lowest scores on both neuroticism and lie scale. Such findings of a high score on neuroticism accompanied by a similar high score on lie scale may perhaps arise due to respondents' attempt to gain sympathy by presenting an exaggerated version of their mental health problems. The obtained F ratios for neuroticism and lie scale, as well as for the total score on the questionnaire are significant, suggesting that there are significant between group variations. The Tukey's test of multiple comparisons revealed three significant differences between pairs of means involving the AIFHS group on the one hand, and the UPEC, CPC and SEWA groups on the other with the former having lowest neuroticism and lie scores in comparison to the brpEC, CPC, and SEWA workers. Correlations of physical health with neuroticism were also computed separately for the four groups of women chikan workers. These are presented in Table V. As can be seen from this table significant correlations between the two measures are obtained for three out of four groups. The SEWA women are the only exception. This confirms the expected relationship between physical and the psychological health.

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T. SARNA AND A. SHUKLA TABLE III Physical health: Mean, SD and F ratios (1) Variables UPEC (2) CPC (3) SEWA (4) AIFHS F ratio Tukey's Test

I

Eye Mean SD Respiratory Mean SD Cardiovascular Mean SD Digestive Mean SD Musculo Skeletal Mean SD Skin Mean SD

2.04 1.67 1.24 1.80 0.80 0.99 2.04 1.54 2.80 1.40 0.64 0.94 1.30 1.34 1.06 0.96 0.26 0.63 12.16 4.44

2.70 1.36 1.84 1.49 0.76 0.98 2.22 1.28 1.92 1.34 0.52 0.89 1.46 1.01 0.36 0.72 0.20 0.49 11.98 3.11

3.00 0.97 0.68 1.32 1.20 0.99 2.14 1.57 2.72 1.33 0.08 0.40 1.44 1.07 0.64 0.94 0.08 0.27 11.99 2.69

2.40 0.81 2.52 1.33 0.84 1.00 1.92 1.89 2.96 1.35 1.16 1.00 2.56 1.34 1.64 0.78 0.04 0.28 16.04 5.86

5.63**

1< 3

II

13.96"*

3 < 2,4

III

2.10

IV

0.33

V

5.87**

2 < 1,4

VI

13.97"*

1,2,3 < 4 3< 1 1,2,3 < 4

VII Genito Urinary Mean SD VIII Anemia Mean SD IX Sugar Mean SD Grand Total Mean SD

11.80"*

21.19"*

1,2,3 < 4 2< 1

2.62

11.26"*

1,2,3 < 4

** Significant at 0.01 level

PHYSICAL-HEALTH,NEUROTICISM,WOMENAND CHIKANEMBROIDERY 187 TABLE IV Neuroticism: Mean, SD and F ratios (1) UPEC (2) CPC (3) (4) SEWA AIFHS (5) Total Sample

Variables

F ratio

Tukey's Test

Neuroticism Mean SD Lie Mean SD Grand Total Mean SD

25.20 4.73 3.30 1.23 28.50 5.16

24.44 6.18 3.02 1.15

23.92 9.48 2.98 0.89

16.62 6.11 2.16 0.58 18.78 6.49

22.55 7.61 2.87 1,08 25.41 8.15

16.91 ** 4 < 1,2,3

12.11"*

4< 1,2,3

27.46 26.90 6.29 10.09

19.01"*

4 < 1,2,3

** Significant at 0.01 level

TABLE V Correlations of physical health with neuroticism UPEC 0.26! CPC 0.24! SEWA 0.08 AIFHS 0.64"*

Significant at 0.10 level ** Significant at 0.01 level

Finally an attempt is m a d e to c o m p a r e health status o f w o m e n chikan workers with those o f the other groups. For this, data f r o m two previous studies b y V e r m a et al. (1974) and Verma and W i g (1976) are utilized. The c o m p a r i s o n s presented in Table V I for the physical health items o f C M I clearly demonstrate that w o m e n chikan workers report m o r e p h y s ical health p r o b l e m s not only in c o m p a r i s o n to normals but also those

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T, SARNAAND A. SHUKLA TABLE VI Percentage of physical health items from CMI endorsed by various groups of respondents Verma et al. (1974) Present Study*

Normal WomenChikan Psychiatric Cardiac Chest (n=60) (n=111) (n=103) (n = 116) Workers (n = 200) Physical Health Items (n = 144)

52.08

46.52

35.42

13.89

43.07

* Percentage for the present study is calculated on 15 items version of CMI.

TABLE VII Mean neuroticism (N) and lie (L) scores for various groups of respondents Verma and Wig (1976) Normals Male Female (n = 47) N L 7.86 2.45 (n = 15) 8.06 3.67 Neurotics (n = 35) 28.51 4,94 Present Study

Women in Women Chikan Stressful Situation Workers (n = 60)* 9.50 2.02 (n = 200) 22.55 2.87

* Awaiting medical termination of pregnancy.

suffering from chest diseases. A similar set o f comparisons involving neuroticism and lie scores in Table VII further demonstrate that w o m e n chikan workers obtained a higher score on neuroticism in comparison to normals as well as w o m e n in stressful situation, but only a little less in comparison to neurotics. The lie score o f w o m e n chikan workers was approximately equal to those o f normal individuals. The fact that w o m e n chikan workers score more unfavourably on the two measures in comparison to various normal and patient samples is noteworthy.

PHYSICAL-HEALTH, NEUROTICtSM, WOMEN AND CHIKAN EMBROIDERY DISCUSSION

189

Very few studies are available which have focused on women engaged in the unorganized sector of home-based production. Those that have studied such women point toward the poor psychosocial environment that surrounds them. The present study has demonstrated that one such group of women chikan workers do not only have much more health problems but also exhibit greater neuroticism than other segments of population. Numerous studies utilizing cross sectional samples have similarly found a significant association between physical and psychological health (e.g. Hendrie, 1981). Such a correlation might arise from several sources and overall causal interpretation is difficult. However, there are several reasons for expecting reduced psychological health to follow from physical impairment and vice versa. Chronic pain, restriction of mobility, sleeping or eating problems, reduced ability to cope with work and other demands, uncertainty about the future, and possibly reduced standard of living have earlier been reported to be associated with distress and psychiatric morbidity. Wan" (1987) has also pointed out that an indirect influence on psychological health may occur through job related deterioration in physical health. Previous researches have often addressed consequences of poor living conditions, providing empirical evidence and plausible inference of negative physical effects. It appears likely that indirect psychological deterioration will in many cases accompany the direct physical consequence. However, the question that arises is 'why does the present sample of women chikan workers face so many health problems?' Answer to the question may partly lie in the nature of their work. Chikan embroidery as an income generating activity is physically strenuous and economically unrewarding. Almost all of the women reported either weak eyesight and/or certain types of eye infections (such as pain, redness or watering of eyes). Most women also reported suffering from indigestion, stomach upsets, and menstrual problems possibly because of not being able to consume nutritive food and living in unhygenic conditions. These women also reported severe backache, pain and swelling in the joints

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perhaps because they are required to sit long hours in the same posture for embroidery. Other frequent health problems characterizing the life of women chikan workers appeared to be problems of heaviness of eyes, wind formation in the stomach, feeling of thirst, lack of proper sleep, heaviness of head, sinking of the heart, forgetfulness. Most of the women have also reported that they cannot tolerate loud noise, and that they get irritated easily. Such symptoms may be broadly suggestive of heightened anxiety, nervousness apprehension, stress, and lack of self-confidence (Sarna and Shukla, 1992). In a number of studies utilizing similar samples various types of occupational hazards have been reported. Miyashita et al. (1980) conducted a study on female sewing machine operators in a small scale industry and reported that occupation of operating a sewing machine may cause cervicobrachial disorder. These machine operators experience physical and mental fatigue because of being seated in a stationery position and being continuously engaged in static and repetitive exertion of hand and arm muscles. Thus, the results of the present study are in tune with the findings of other studies which reveal that the disadvantaged groups are more anxious, high on neuroticism and rigid (Rath, 1974; Hassan, 1977; Misra and Tripathi, 1977). Such a disadvantage may be caused by low education and income, lack of social emotional support and an impoverished work and home environment as seems to be the case in the context of women chikan workers.

REFERENCES

Hassan, M. K.: 1977, 'Social deprivation, self image and some personality traits', Indian Journal of Personalityand HumanDevelopment1, pp. 42-56. Hendrie, H. C.: 1981, 'Depressionin the courseof physicalillness', in G. Salvendyand M. J. Smith (eds.), Machine Pacing and OccupationalStress (Taylorand Francis, London). Misra, G. and Tripathi, L. B.: 1977, 'The concept of prolongeddeprivation and its measurement',Indian Journalof Behavior 1, pp. 48-60.

PHYSICAL-HEALTH,NEUROTICISM,WOMENAND CHIKANEMBROIDERY 191

Miyashita, K., Shiomi, S., Kasamatsu, T., Itoh, N., and Iwata, H.: 1980, 'A study on occupational cervicobrachial disorder among female sewing machine operators in a small scale industry', Wakayama Med. Rep. 23, pp. 81-88. Rath, R.: 1974, 'From social isolation to stagnation: A study ofscheduledcaste groups', Social Action 24, pp. t01-116. Sama, T. and Shukla, A.: 1992, 'Sources of stress among unorganized home based women workers. Paper presented at Vlth National Annual Conference of Behavioral Medicine Society of India and NIMHANS Workshop on Stress (June, 28-29), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India. Verma, S. K.: 1974, 'The difficulty levels of some personality tests in Hindi', Indian Journal of Clinical Psychology 1, pp. 15-18. Verma, S. K., Wig, N. N., and Pershad, D.: 1974, 'A comparative study of medical and psychiatric patients in India on Comell Medical Index', Indian Journal of Clinical Psychology 1, pp. 104-108. Verma, S. K. and Wig, N. N.: t976, 'PGI Health Questionnaire N-2: construction and initial tryouts', Indian Journal of Clinical Psychology 3, pp. 135-142. Wail, R: 1987, Work, Unemployment, and Mental Health (Clarendon Press, Oxford).

Lecturer cum Community Organiser, Training and Orientation Centre, Literacy House, P.O. Alambagh, Lucknow-226005, U.P., India