World Development 139 (2021) 105309

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World Development
journal homepage: www.elsevier.com/locate/worlddev

Incomplete transitions to clean household energy reinforce gender

inequality by lowering women’s respiratory health and household
labour productivity
Poushali Maji a,⇑, Zia Mehrabi a,b, Milind Kandlikar a,b
a
Institute for Resources Environment and Sustainability, The University of British Columbia, 2202 Main Mall, Vancouver, BC V6T 1Z4, USA
b
School of Public Policy and Global Affairs, The University of British Columbia, 6476 N.W. Marine Drive, Vancouver, BC V6T 1Z2, USA

a r t i c l e i n f o a b s t r a c t

Article history: India has over 800 million people without access to clean cooking fuel. A well-known, but under-
Accepted 17 November 2020 researched aspect of poor access to clean energy is its cost on woman’s health and well being. Here
Available online 14 December 2020 we use the nationally representative India Human Development Survey, tracking the same set of house-
holds from 2005 to 2011, to quantify the gender-related health and time-saving benefits of a shift in a
Keywords: household’s fuel and stove use patterns. We show that across India, the predicted probabilities of cough
Household energy transition in non-smoking women are 30%-60% higher than non-smoking men in solid-fuel using households, but
Gender inequality
that a complete transition from solid fuels to liquefied petroleum gas (LPG) for cooking reduces this
Fuel-stacking
Improved biomass cookstoves
gap to only 3%. Exclusive use of LPG is also accompanied by reduced cooking time (~37 min) and less time
for collecting fuels (~24 min) in rural households, together saving up to an hour in demands on women’s
labour each day. We also find electrification reduces the probability of developing cough by about 35–
50% in non-smoking men and women across both rural and urban households, and help close the gap
between men and women in rural households. Despite clean energy being a long-held policy goal of
Indian governments, between 2005 and 2011, only 9% of households made a complete transition to clean
energy, and 16.4% made a partial transition. We suggest that government efforts in India, and elsewhere,
should focus on improving affordability, supply and reliability of clean fuels in enabling a complete
household energy transition and help address key issues in gender inequality.
Ó 2020 Elsevier Ltd. All rights reserved.

1. Introduction Urpelainen, 2014). Although there have been significant efforts

In 2015, India had over 300 million people without access to
electricity and over 800 million people without access to clean
cooking fuel (Government of India, 2015), with the majority of this
group residing in rural areas (Ailawadi & Bhattacharyya, 2006;
Pachauri, 2014; Pachauri & Jiang, 2008). Total electrification and
access to clean cooking LPG has been a long-held policy goal of suc-
cessive Indian governments, though progress has been slow, par-
ticularly in cooking energy transition. The ongoing transition in
India from traditional solid fuels (such as wood fuel and dung)
for cooking towards LPG has been faster in urban India and among
middle and high-income households. The share of households rely-
ing on LPG for cooking rose from 5% to 58% in urban India between
1987 and 2009 but only from 4% to 8% in rural India (Cheng &
⇑ Corresponding author.
E-mail addresses: p.maji@alumni.ubc.ca (P. Maji), zia.mehrabi@ubc.ca
(Z. Mehrabi), mkandlikar@ires.ubc.ca (M. Kandlikar).
towards electrification in recent years, with the Government of
India claiming only about 19,000 un-electrified households as of
2019,1 even when households have access to modern energy sources
they often practice ‘fuel stacking’, wherein they continue to use bio-
mass for cooking after adopting LPG, and/or kerosene lamps along
with electricity (Davis, 1998; Kowsari & Zerriffi, 2011; Masera,
Saatkamp, & Kammen, 2000; Pachauri & Spreng, 2003; Rajesh,
Shukla, Kapshe, Garg, & Rana, 2003).
This slow progress has both direct and indirect impacts on pro-
longing gender inequality. Since women are responsible for cooking
in most households, it might be expected that women are particu-
larly more vulnerable to diseases caused by indoor air pollution
from polluting biomass fuels (Bruce, Perez-Padilla, & Albalak,
2002; Gordon et al., 2014). In addition to adverse health impacts,
clean energy transition can also have multiple impacts on reducing
gender inequality, through improving women’s labour productivity
1
https://saubhagya.gov.in/

https://doi.org/10.1016/j.worlddev.2020.105309
0305-750X/Ó 2020 Elsevier Ltd. All rights reserved.
P. Maji, Z. Mehrabi and M. Kandlikar
(Khandker, Samad, Ali, & Barnes, 2012) and girls’ education and lit-
eracy levels (Asian Development Bank, 2010; Khandker et al., 2012).
Rural Indian households spend 1–2 h a day collecting firewood (in-
cluding traveling to the collection location) and about 3 h on cook-
ing, with women and girl children bearing most of the
responsibility (ESMAP, 2004; Laxmi, Parikh, Karmakar, & Dabrase,
2003). Although collecting firewood is often unpaid, the opportu-
nity cost of time spent collecting fuel is high, and has implications
for school hours missed by children, and significantly impacts qual-
ity of life for women as they regularly travel long distances and
have to carry heavy loads of fuelwood (Laxmi et al., 2003). Thus
switching to electricity and LPG is expected to save significantly
more time burden for women and girls than for men.
While a number of papers have quantified the patterns of
energy consumption across populations and the multidimensional
benefits of the energy transition using cross-sectional datasets
(Aguirre, 2014; Barnes, Kumar, & Openshaw, 2012; ESMAP, 2002;
Khandker, Barnes, & Samad, 2009, 2013), these data cannot easily
control for variation in the unobserved characteristics of a popula-
tion that influence the developmental indicator of interest, such as
respiratory health, or household labour. Panel datasets, which
allow us to track the energy transition in the same set of house-
holds over time, can isolate the health and developmental effects
of adopting clean fuels on individuals, while controlling for factors
which vary across households. In this study we use the India
Human Development Survey (IHDS) dataset collected in 2005
and 2011 to quantify both the progress of the clean energy transi-
tion in India, and the gender-related health and time-saving bene-
fits of energy transition at the household level.
The remainder of the paper is structured as follows. Section 2
provides a brief review of the literature on gendered direct and
indirect benefits of switching away from solid fuel and kerosene
use, including those related to health, and household time budgets.
Section 3 describes the panel dataset used and Section 4 outlines
the mixed effects regression methodology and models (4.1), with
a focus on health outcomes (4.2) and time spent collecting fuel
and cooking (4.3) for women. Regression results are presented in
section 5 and we conclude in section 6 with a discussion.
2. Gendered benefits of electrification and clean cooking fuel
As in many other parts of the developing world, women in India
spend a greater proportion of their time on household work than
men, almost 7 times as much (OECD, 2013), and bear much of
the responsibility for cooking, cleaning and childcare (ESMAP,
2004; Laxmi et al., 2003). Direct benefits of modern energy access
for women include increases in welfare, appliance use, longer
hours for home businesses in the evening, all enabled by electrifi-
cation, as well as time saved from collecting and cooking with solid
fuels when households switch to LPG. However, indirect benefits of
modern energy services such as improvement in education and
health can also be substantial (Laxmi et al., 2003). A key indirect
benefit is positive respiratory health impacts due to reduced expo-
sure to air pollutants as households’ transition away from solid
fuels and kerosene lamp. Other indirect benefits include improve-
ment in educational attainment due to lighting and reduced fertil-
ity levels as evidenced in rural Bhutan and Ivory Coast (Asian
Development Bank, 2010; Peters & Vance, 2011).
2.1. Smoke inhalation
Smoke from burning biomass and kerosene lamps indoors con-
tributes significantly to high particulate matter exposure in house-
holds and contains fine particles, also known as PM2.5 (particles
with aerodynamic diameter less than 2.5 mm) that are known to be
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World Development 139 (2021) 105309
respiratory irritants and carcinogenic by nature (Bruce et al., 2002;
Gordon et al., 2014; Lam, Smith, Gauthier, & Bates, 2012; Muyanja
et al., 2017; Naeher et al., 2010). Since women are responsible for
cooking in most households and children spend more time at home,
women and children are particularly vulnerable to diseases caused
by indoor air pollution (Bruce et al., 2002; Gordon et al., 2014). 24-
hour average exposure concentrations for respirable particulate
matter in wood-using households in a study conducted in rural India
was estimated at 226 lg/m3 for cooks, who are primarily women,
while for non-cooks it was 172 lg/m3 (Balakrishnan et al., 2002).
In LPG-using households in the same study, mean daily exposure
concentrations were similar for cooks and non-cooks at 76–79 lg/
m3. In the Global Burden of Diseases assessment of the impact of
household solid fuel exposure (Smith et al., 2014), estimated aver-
age national daily exposure to PM2.5 in solid fuel-using households
in India is higher in women, at 337 lg/m3 compared to 204 lg/m3 in
men. Switching to cleaner fuel like LPG improves indoor quality dra-
matically –personal exposure concentrations for cooks during cook-
ing time in wood-using households was measured at 1200–1307 lg/
m3, compared to 60–83 lg/m3 attributed to cooking with LPG
(Balakrishnan et al., 2002; Ellegard, 1996).
2.2. Health outcomes
A number of studies show an association between high partic-
ulate matter exposure and adverse cardiovascular and pulmonary
health impacts (Gordon et al., 2014; Smith et al., 2014). Household
exposure to specifically biomass smoke is linked with higher risk of
chronic obstructive pulmonary disease (COPD) and acute lower
respiratory infection (ALRI) (Bruce et al., 2002; Dennis,
Maldonado, Norman, Baena, & Martinez, 2016; Ezzati & Kammen,
2001; Johnson et al., 2011; Liu et al., 2007; Naeher et al., 2010;
Smith, Rogers, & Cowlin, 2005), causing almost three million
annual premature deaths globally (Smith et al., 2014). The odds
of developing COPD due to biomass smoke is 20% higher for
women than men (Smith et al., 2014). Similarly, the likelihood of
ARI and ALRI incidence in women exposed to fuelwood smoke
indoors is twice as high as that in men (Ezzati & Kammen, 2001).
Household biomass usage also shows statistically significant asso-
ciation with cough, reduced lung function, and hypopharyngeal
and lung cancers (Ellegard, 1996; Mbatchou Ngahane et al.,
2015; Sapkota et al., 2008; Smith et al., 2014). Respiratory symp-
toms like cough are associated with carbon monoxide (CO) expo-
sure due to household air pollution (Naeher et al., 2010; Pope
et al., 2015). For example, the RESPIRE study, or Randomized Expo-
sure Study of Pollution Indoors and Respiratory Effects, shows that
ICS (with chimney) intervention in rural Guatemala reduced CO
exposure in households post-intervention by 50–60% and ICS
adoption is associated with a reduced risk of wheeze, a chronic air-
way symptom, in women (Smith-Sivertsen et al., 2009), but not
reduced incidence of pneumonia in children (Smith et al., 2011).
Kerosene wick lamps also contribute significantly to particulate
matter concentrations indoors (Apple et al., 2010; Lam, Chen, et al.,
2012; Muyanja et al. 2017), though there are fewer studies inves-
tigating the health impact of specifically using kerosene for light-
ing and cooking. Kerosene combustion generates known
carcinogens such as formaldehyde and polycyclic aromatic com-
pounds and studies indicate that kerosene use is linked with
reduced lung function and asthma in children and women (Lam,
Chen, et al. 2012), tuberculosis in women (Pokhrel et al., 2010)
and ALRI in children (Savitha et al., 2007).
2.3. Time spent by women
Surveys show that rural Indian households spend about 1–2 h a
day collecting firewood (including traveling to the collection
P. Maji, Z. Mehrabi and M. Kandlikar
location) and about 3 h on cooking, with women and girl children
bearing most of the responsibility (ESMAP, 2004; Laxmi et al.,
2003). The Asian Development Bank estimates that when rural
households in Bhutan switch from firewood to a clean alternative
like electricity, women are seen to benefit more than men, saving
27.6 min a day in firewood collection time compared to 21.6 min
for men (Asian Development Bank, 2010). Survey results show that
Indian households using LPG also spend about 24 min less on cook-
ing compared to households using firewood (ESMAP, 2004).
2.4. Education and economic benefits
Electrification has been shown to have a positive impact on
education outcomes such as school enrolment and study time at
home among school-going children (Aguirre, 2014; ESMAP, 2002;
Khandker et al., 2009; Martins, 2005), with a greater positive
impact for girls compared to boys (Asian Development Bank,
2010; Khandker et al., 2012). In general, economic benefits of
household energy transition, including those specific to women
are difficult to quantify, with a few studies showing increase in
income and employment with electrification (Khandker et al.,
2009, 2012), while others find no evidence of positive impact on
economic indicators (Aklin, Bayer, Harish, & Urpelainen, 2017).
The use of shadow wages for time saved on collecting fuels is
debatable since most of the collection work is done by women
and children in rural households, where employment opportuni-
ties are limited and time saved may not be used for income-
generating activity (García-Frapolli et al., 2010). Dijk (2012) con-
cludes that the impact of electrification on income depends on
the access to markets for rural businesses, and that energy is
Fig. 1. IHDS data: Household energy transition from 2005 to 2011 (Note: rural/urban households do not add up to 100% due to missing energy use data; urban households
account for 30% of total households interviewed in both years; ICS: Improved biomass cookstove; Not represented here: 1.4% rural households transitioned from using ICS in
2005 to traditional cookstoves in 2011).
3
World Development 139 (2021) 105309
necessary but not sufficient for increasing income-generating
activities.
3. Dataset and descriptive analysis
The IHDS is a nationally representative survey covering topics
within development including education, health, gender relations.
Data was collected in 2005 (November 2004–October 2005) (Desai,
Vanneman, National Council of Applied Economic Research, 2010)
through interviews with households, and about 85% were re-
interviewed in 2011–12 (January 2011–March 2013) (Desai,
Vanneman, National Council of Applied Economic Research,
2015), providing a panel dataset to track changes in the same
households over time. The publicly available dataset covers
40,018 households in both years, with about 30% urban
households.
Fig. 1 shows the cooking and lighting energy transitions in
interviewed households between 2005 and 2011. The data confirm
that clean cooking energy transition has been faster in urban India
in comparison with rural India (as defined by Census of India
(2011)). About 50% of urban households exclusively used LPG for
cooking by 2011. While 6% of solid fuel-using urban households
partially adopted LPG/kerosene between 2005 and 2011, i.e. used
LPG and/or kerosene in addition to solid fuels, another 7% of urban
households reverted to solid fuel use – equal proportions moved
from exclusively using LPG to stacking solid fuels with LPG and
from stacking solid fuels with kerosene to only using solid fuels.
In the case of rural households, 87% used solid fuels in both years,
and only 5% of rural households exclusively adopted LPG/kerosene
between 2005 and 2011. In fact, 12% of rural households, moved
from stacking solid fuels with kerosene for cooking to exclusively
P. Maji, Z. Mehrabi and M. Kandlikar
using solid fuels. The IHDS dataset shows that kerosene use as a
primary cooking fuel is negligible, rather it is used to stack with
solid fuels for cooking. The Government of India has taken steps
to limit the availability of subsidized kerosene for household con-
sumption since a sizeable portion of it is estimated to be diverted
illegally, for further resale or to adulterate diesel (Gangopadhyay
et al., 2005; Ailawadi & Bhattacharyya, 2006). This has reduced
the appeal of kerosene as a primary cooking fuel option since larger
quantities are needed for cooking compared to lighting (Rao 2012).
Kerosene use for lighting, either as the sole lighting fuel or as
supplemental to electricity, is common in both urban and rural
households – 33% of urban and 64% of rural households used ker-
osene in 2011. Similar proportions of households transitioned from
using kerosene to exclusive use of electricity and from electricity to
using kerosene as a supplemental lighting fuel between 2005 and
2011 (about 14% urban and 11% rural households). About 40% of
urban and only 13% of rural households solely relied on electricity
for lighting in both years.
Cross-sectional datasets as used in previous studies capture a
snapshot in time of energy consumption patterns across a popula-
tion. On the other hand, panel data such as the IHDS can be used to
study changes in the same set of individuals or households over
time, treating each individual or household as their own control.
In this study, we restrict our analysis to the impact of household
energy transition, i.e. switch to cleaner fuels for cooking and the
use of electricity for lighting and appliances, on respiratory health
and time-savings, both of which have distinct indicators in the
IHDS dataset, such as occurrence of cough and time spent cooking
and collecting fuels, respectively. Other measures such as time
spent studying are confounded by changes in the ages of children
in a household making it harder to attribute educational outcomes
to electrification. We also restrict our analysis to household mem-
bers who were adults in 2005 and 2011, to control for changes in
periods of indoor exposure in children and young adults as they
transition into and out of school. Both measures – health and time
Fig. 2. Predicted probabilities of cough in men and women with 95% CI. *’Traditional’: traditional cookstove without chimney; ‘ICS’: Improved cookstove with chimney. Only
non-smoking individuals who are not exposed to passive smoke from other household members are included.
4
World Development 139 (2021) 105309
saved – are particularly significant for women who are primarily
responsible for collecting fuel and cooking in households.
The IHDS dataset shows that in rural households, where LPG was
used, 5% women (non-smokers) and 4% men (non-smokers)
reported having a cough in the previous 30 days; but if a traditional
biomass stove was used, 10% of women and 6% men reported a
cough. In urban India, 8% women (non-smokers) and 4% men
(non-smokers) reported a cough in households that used LPG,
whereas in traditional biomass stove-using households, 10%
women (non-smokers) and 6% men (non-smokers) reported a
cough (see SI Fig. S2). For studying time-saving effects, we analyze
the daily stove use time and time spent collecting solid fuels in
households. The mean reported daily stove use time in the survey
is 3 h and varies between 2 h and 50 min in LPG-using households
to 3 h and 20 min in households that use only solid fuels (see SI
Fig. S3). Most urban households that use solid fuels such as fire-
wood purchase it from markets - the IHDS dataset shows that in
2011 only about 4% of urban households collected it from their
own land and another 5% from locations apart from their own land.
On the other hand, about 75% of rural households collected fire-
wood, with about 36% traveling to collect it (see SI Fig. S4). In house-
holds that did rely on collecting firewood, women spent more time
(32–43 min daily on average depending on the source of firewood)
collecting fuel than men (17–26 min daily), with negligible differ-
ence in reported time between the 2 survey years (see Fig. S5).
4. Methods
4.1. Regression analysis
We use hierarchical regression to estimate the developmental
impact of energy transition in households during the six years
between 2005 and 2011. Panel datasets such as the IHDS dataset
record observations for the same set of individuals and households
P. Maji, Z. Mehrabi and M. Kandlikar
at multiple points in time, allowing the comparison of develop-
mental outcomes of interest before and after energy transition. In
a panel dataset, observations within a group such as members of
a household are not independent, which can lead to inflated preci-
sion in parameter estimates. There are two common ways to deal
with this problem: the first is to proceed with fitting an ordinary
least squares (OLS) model which does not model these correlations
explicitly, then correct for the problem post-model, through the
use of clustering of the standard errors (Wooldridge, 2010). The
second is by fitting a hierarchical model that models the correla-
tion between the non-independent observations explicitly. The
IHDS data have individuals within households, and households
within districts/states. In this case hierarchical models are conve-
nient – they allow us to model both the dependence structure in
the error terms within a household, between households within
districts and between districts within states. In addition to dealing
with the dependent error structure, hierarchical models also carry
a number of other benefits depending on their application (Gelman
& Hill, 2007). In our case, in addition to accounting for non-
independence, we use the partial pooling benefits to estimate the
average individual level impacts of the energy transition on respi-
ratory health and time-savings, adjusting for household and regio-
nal differences in outcomes. We conduct all regression analysis
using Stata.
4.2. Respiratory health
A generalized linear mixed model was used to estimate the
probability that an individual i in household j in state k reports a
cough, or Prðyi ¼ 1Þ, as:
Prðyi ¼ 1Þ ¼ logit1 ðX i b þ aj½i þ ck½i Þ for i ¼ 1;    n observations
aj ¼ Nð0; r2a Þ for j ¼ 1;    :J households
ck ¼ Nð0; r2c Þ for k ¼ 1;    :K states
where,
X is a nX p matrix of p covariates, b is a vector of fixed effect
coefficients for p covariates (explanatory and control variables), a
and c are random effects to account for non-independence of indi-
viduals within a household, and households within states, respec-
tively. We expect State-level random effects to capture any
geographical variation in the incidence of cough (apart from
urban-rural disparity which is considered through a dummy vari-
able), either due to differences in ambient air quality or public
health provisioning.
Columns of X include the following variables and their interac-
tions: Cooking  Rural  Age_gender + Electricity  Rural + Quar
ter + Hours + log(Income) + Passive, which represent explanatory
variables and control variables, detailed below:
Explanatory variables:
 ‘‘Cooking”: a variable interacting fuel type (solid fuels, stack
solid fuels with LPG, or LPG), and stove type (improved with a
chimney (ICS), or traditional biomass cookstove (without chim-
ney)). This variable allows us compare the impacts of complete
and partial transition to modern energy services on outcome
variables, and whether a transition to improved biomass cook-
stoves provides a significant benefit for health outcomes.
 ‘‘Electricity”: a variable interacting kerosene for lighting
(kerosene + electricity), and electrification status of the house-
hold (electrified or not). This variable allows us to assess the
impact of electrification on health outcomes.
 ‘‘Rural” A two level indicator (1 = Rural, 0 = Urban): used to dis-
tinguish urban areas, which have higher ambient levels of pol-
lution, from rural locations.
5
World Development 139 (2021) 105309
 ‘‘Age_Gender” A two level indicator representing adult male and
females (1 = >15 female, 0 = >15 male). We restrict our analysis
to household members who were adults in 2005 and 2011, to
minimise changes in periods of indoor exposure due to transi-
tion into and out of school.
We assume that the impact of household energy transition on
respiratory health is different across categories of location, gender
and age through interaction terms: first, for urban and rural house-
holds, since urban areas can have higher ambient levels of pollu-
tion; second, for different gender and age categories since adult
women are responsible for most cooking activities and so exposed
to indoor smoke in greater numbers and magnitude. We expect the
impact of cooking energy transition on health to depend on age
and gender, but since kerosene lighting is not restricted to a speci-
fic location or activity such as cooking in the kitchen, we do not
consider the role of age and gender in determining the impact of
electrification on health. Cooking and lighting terms are not inter-
acted with each other since we do not expect electrification to
influence the impact of cooking energy transition on health.
Control variables:
 Quarter (1 = Dec-Feb (winter); 2 = Mar-May (spring/summer);
3 = Jun-Aug (monsoon); 4 = Sep-Nov (post-monsoon/pre-win
ter)) = season in which interview is conducted. Interviews were
conducted across the year in 2005 and 2011 and we account for
seasonal variation in cough by including the dummy season
variable.
 Hours = daily stove use hours
 Passive = (0 = not exposed to passive smoke due to other house-
hold members; 1 = exposed to passive smoke)
 Log(Income) = logarithm of per capita income
We use this model to estimate mean predicted probabilities of
cough and corresponding 95% confidence intervals (CI) for explana-
tory variable of interest (see Fig. 2). For graphical presentation we
present the cases of individuals not exposed to passive smoke from
other members in their household since our regression results
show that passive smoking is associated with a 14% (95% CI: 9%
19%) increase in odds of developing a cough. The mean predicted
probabilities are calculated considering both the fixed effects of
explanatory variables and random variability across households
and states, while estimated confidence intervals reflect the uncer-
tainty in fixed effects estimations. There are less than 10 observa-
tions in the following groups: only LPG-using non-electrified rural
or urban households; and ICS-using non-electrified urban house-
holds (see SI Section A for the number of interviewed individuals
by group). We exclude these groups in our discussion of impacts
of household energy transition.
We also conduct simultaneous post-hoc pairwise comparisons
(t-tests) across categories of interest. The results indicate which
categories of individuals have a statistically significant difference
(at 95% confidence level) in terms of the predicted probability of
cough. Results from pairwise comparison and post-estimation
diagnostics can be found in the SI Section B.
4.3. Time savings
4.3.1. Time spent cooking
More than 98% of interviewed households, rural or urban, have
female cooks. Daily stove hours recorded in the dataset include
total stove use time, which includes boiling water, making tea,
and other minor uses.
A linear mixed model was used to estimate the daily stove use
hours woman i in household j in state K spend cooking, or yi , as:
P. Maji, Z. Mehrabi and M. Kandlikar
yi ¼ X i b þ aj½i þ ck½i þ i for i ¼ 1;    n observations
aj ¼ Nð0; r2a Þ for j ¼ 1;    :J households
ck ¼ Nð0; r2c Þ for k ¼ 1;    :K states
i ¼ Nð0; r2 Þ
Columns of X include the following variables and their interac-
tions: Cooking  Rural + Meals + Quarter + Hhsize + log(Income).
The variables ‘‘Hhsize” = number of household members; and
‘‘Meals” = number of meals cooked per day. i are residuals associ-
ated with observation i. All other variable descriptions are as
above. The explanatory variables of interest include cooking energy
transition within a household, including transition in stove type as
described above. We account for possible cultural and dietary dif-
ferences between urban and rural households and consequent dif-
ferences in cooking time through the interaction term with cooking
energy transition. The number of meals cooked daily, interview
month and household size are control variables in the regression.
As in Section 4.2, we present the predicted daily stove use hours
(estimated as the outcome of the regression equation) and the 95%
confidence intervals reflecting the uncertainty in fixed effects in
Fig. 3. We also conduct post-hoc pairwise comparisons (t-tests)
across categories of interest to test for statistical significance (at
95% confidence level) in differences in stove use time. Results of
statistical tests are included in SI Section C.
4.3.2. Time spent collecting fuel
Spending time to collect firewood is specifically a rural chal-
lenge and we focus our analysis of this burden in rural households.
Fig. 3. Predicted daily stove use in households and 95% confidence interval *’Traditional’ = traditional cookstove without chimney; ‘ICS’ = Improved cookstove with chimney
(ICS used by less than 5% of urban households interviewed in both years).
6
World Development 139 (2021) 105309
A linear mixed model was used to estimate the fuel collection
time in minutes for woman i in in household j in district, or yi , as:
logðyi Þ ¼ X i b þ aj½i þ i for i ¼ 1;    n observations
aj ¼ Nð0; r2a Þ for j ¼ 1;    :J households
ck ¼ Nð0; r2c Þ for k ¼ 1;    :K districts
i ¼ Nð0; r2 Þ
Columns of X include the following variables and their interac-
tions: Cooking  Age_gender + Source + Hhsize + Hours + log(Inc
ome). Where Source = Firewood source (Collect from own land, Col-
lect from other places, Both purchase and collect). All other vari-
able descriptions are as above. The explanatory variables of
interest are, as described above, cooking energy transition within
a household, including transition in stove type. The gender-
specific burden of collecting firewood is considered by including
an interaction term with cooking energy transition. In rural house-
holds that collect solid fuels in both years, women spend almost
twice as much time as men, and on average 37 min daily, collecting
fuel (while the average time spent by children in interviewed
households is only 3–7 min per day).
The mode of firewood collection (whether collected from the
household’s own land or from other places or both purchased
and collected), hours of stove use daily, income per capita and
household size are control variables in the regression. We consider
variability due to household-level characteristics as well as local
geographical variation in firewood availability on a smaller spatial
scale than State-level by nesting household-level random effects
within district level random effects (instead of the larger spatial
scale of States as used in the previous regression models).
P. Maji, Z. Mehrabi and M. Kandlikar
We back-transform the output from logarithmic form to collec-
tion time in minutes by multiplying the output with the calculated
Duan’s estimator (=1.3; see SI Section D). We present the predicted
mean daily fuel collection time in minutes for household groups of
interest and the 95% confidence intervals reflecting the uncertainty
in fixed effects estimates in Fig. 4 (see SI Section D for intra-class
correlation values).
5. Results
5.1. Respiratory health
i) Cough in women vs. men: Predicted probabilities of cough in
women are 30–60% higher than men in solid-fuel using
households, with the differences between gender categories
statistically significant at 95% confidence level across electri-
fied and non-electrified households. Predicted probabilities
of cough in LPG-using rural households are similar for men
and women. In urban electrified households, male members
of solid fuel-using households have similar predicted proba-
bility of developing a cough compared to women in LPG-
using households, implying the health risk posed by solid
fuels specifically to women.
ii) Complete transition to LPG: A complete transition away
from solid fuels is associated with a 40–60% reduction in
the probability of developing a cough in non-smoking adult
men and women. We observe the effect in electrified rural
Fig. 4. Predicted daily fuel collection time (minutes) for men and women in rural households *‘Traditional’ = traditional cookstove without chimney; ‘ICS’ = Improved
cookstove with chimney.
7
World Development 139 (2021) 105309
and urban households – in non-electrified households that
exclusively use LPG there are less than 5 data points for
adult males or females in both rural and urban groups.
iii) Partial transition from solid fuel use to LPG: There is no pos-
itive health impact associated with stacking solid fuels with
LPG, compared to using only solid fuels (see SI Section B for
significance testing) – predicted probabilities of developing
a cough are similar in households that stack fuels and house-
holds that use only solid fuels, implying that even using solid
fuels as secondary fuel is harmful for women. This implies
that 6% of households who transitioned into partial LPG
adoption, along with 2% of households that reversed from
using only LPG to stacking it with solid fuels, are likely to
experience adverse health impacts in spite of using LPG.
Although not statistically significant, mean predicted proba-
bilities of cough are lower for the ‘stacking’ group compared
to ‘only solid fuels’ in non-electrified rural and urban house-
holds. However, there are fewer than 30 observations in
non-electrified ‘stacking’ groups.
iv) Switch from traditional stove to improved cookstove with
chimney (ICS): Overall, adoption rates of improved cook-
stoves with chimneys are low - about 4.5% of rural house-
holds and 1.2% of urban households transitioned from
traditional to improved cookstoves between 2005 and
2011, while 1.4% of rural households transitioned back from
ICS to traditional cookstoves. In rural and electrified urban
households, switching the primary stove type from tradi-
tional without chimney to improved cookstove with chim-
P. Maji, Z. Mehrabi and M. Kandlikar
ney reduces the probability of cough in women by about 30–
40%. We see a similar effect in men in rural India but only in
electrified households.
v) Switch from kerosene for lighting to electricity: Electrifi-
cation reduces the probability of developing cough by
about 35–50% in both men and women in rural and
urban households, either through a complete or partial
transition away from kerosene for lighting. The recorded
quantity of kerosene used for lighting is not a statistically
significant factor and use of kerosene for supplemental
lighting is not associated with an increased probability
of cough.
5.2. Time savings
Partial transition to LPG is associated with only a small reduc-
tion in stove use time (about 6 min in rural and urban households),
whereas a complete transition to LPG either from solid fuels
reduces stove time by 18% (about 37 min) and 12% (about
24 min) in rural and urban households respectively. Use of
improved cookstoves is not associated with any change in stove
use time compared to traditional cookstove in in urban house-
holds, while in rural households they lead to an increase in daily
stove use time by about 6 min.
Full transition to LPG from a traditional cookstove saves, on a
daily basis, 32 min of fuel collection time for women and 22 min
of fuel collection time for men. A partial transition to LPG or a tran-
sition from traditional to improved cookstoves saves about 6–
9 min daily in fuel collection time for adult men and women in
rural households.
6. Discussion
A household’s decision to rely solely or partially on modern
energy services is expected to affect women’s health and time dis-
proportionately since women are responsible for most cooking and
fuel collection activities. The 2011 IHDS dataset shows that more
than 98% of cooks in both urban and rural households are women.
Our analysis indicates that the greatest benefits to health are made
possible from a full conversion to LPG for cooking in rural India,
which can reduce the likelihood of developing a cough by almost
60% in women. Similarly, electrification has significant positive
impact on respiratory health – it can reduce the probability of
developing a cough by up to 50% in households. However, this find-
ing is predicated on the assumption that electrified households pri-
marily rely on electricity for lighting, with little or no kerosene use
for lighting.
The exposure–response relationship curve between PM2.5
exposure and cardiovascular disease mortality risk is steep at
levels of exposure corresponding to 0–20 mg PM2.5 inhaled daily
and flattens out at higher levels of exposure (Pope et al., 2009).
Grieshop et al. (2011) estimate the intake from LPG stoves at less
than 1 mg/day, while that from traditional cookstoves is almost
two orders of magnitude higher. Exposure to PM2.5 when solid
fuels are used along with LPG is thus sufficient can cause adverse
health impacts. Our findings are consistent with this – the partial
adoption of LPG (i.e. stacking solid fuels with LPG) does not reduce
the probability of developing a cough.
Our study also finds a reduction in the occurrence of cough as a
result of transition to ICS, and contributes to an emerging picture
of the effect of ICS on human health. Modelling studies (Grieshop
et al., 2011) show that relative to traditional stoves ICS can reduce
exposures by 75% and 94%, with and without chimneys respec-
tively. A number of recent field trials (for e.g. Aung et al., 2016;
Dutta, Shields, Edwards, & Smith, 2007; Sambandam et al., 2015)
8
World Development 139 (2021) 105309
also show reductions in PM2.5 exposure, though usage of ICS tends
to drop over time (Pillarisetti et al., 2014), so the benefits might be
short-lived (Hanna, Duflo, & Greenstone, 2012). For our analysis
there are two points to consider: first, the IHDS dataset only
includes ICS with chimneys, which result in considerably lower
PM2.5 emissions than ICS without chimneys and thus might pro-
vide greater respiratory health benefits; two, the dataset does
not provide information on which year ICS were adopted in house-
holds, and we might be observing the short-term health benefits
ICS may provide.
This work shows that LPG for cooking is associated with sig-
nificantly less cooking time (37 min) compared to using solid
fuels in traditional rural cookstoves. When this is combined with
the average reduction in time for collecting fuels (24 min), rural
women stand to gain roughly an average of an hour every day
from a complete transition to LPG. A partial transition to LPG
offers far lower time saving benefits during cooking, and only
a ~30% reduction (~10 min) in a household’s firewood collection
time. The potential time saving benefits of improved cookstoves
are not evident in terms of reducing actual cooking time – in
fact, rural households spend 6 extra minutes on switching from
traditional to ICS. ICS reduces household fuel collection time by
about 30% (~10 min), implying lesser use of firewood. In labora-
tory settings and under proper usage conditions, ICS are known
to reduce fuel requirements but evidence from actual usage con-
ditions is disputed - in rural India and Ghana, there is no evi-
dence that ICS reduce firewood requirements (Aung et al.,
2016; Burwen & Levine, 2012; Hanna et al., 2012), while in
Senegal, ICS are associated with a 15–30% reduction in firewood
usage per meal compared to traditional stoves, but no statisti-
cally significant reduction in fuel collection time (Bensch &
Peters, 2012).
Continued use of firewood either through stacking with LPG or
in cleaner improved cookstoves offers women only minor incre-
mental time savings and marginally lower exposure to particular
matter. A complete transition to clean fuels is needed to mitigate
the gender inequities in household cooking. Making the supply of
clean fuel more affordable, accessible and reliable will go a long
way in meeting this goal.
7. Research data/data statement
The data used in this study is publicly available from the India
Human Development Survey website.
CRediT authorship contribution statement
Poushali Maji: Conceptualization, Methodology, Software, For-
mal analysis, Writing - original draft. Zia Mehrabi: Methodology,
Writing - review & editing. Milind Kandlikar: Conceptualization,
Writing - review & editing, Supervision.
Declaration of Competing Interest
The authors declare that they have no known competing finan-
cial interests or personal relationships that could have appeared
to influence the work reported in this paper.
Acknowledgements
This research was supported by the University of British Colum-
bia’s Four-Year Doctoral Fellowship and the Canadian Institutes of
Health Research-Bridge Fellowship Program. We are grateful to
Prof. Hadi Dowlatabadi (University of British Columbia) for his
insightful comments and valuable feedback.
P. Maji, Z. Mehrabi and M. Kandlikar
Appendix A. Supplementary data
Supplementary data to this article can be found online at
https://doi.org/10.1016/j.worlddev.2020.105309.
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