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Nepal Leprosy Trust (NLT) runs Lalgadh Leprosy Hospital & Services Centre (LLHSC), which includes a referral hospital at Lalgadh in the Dhanusha District of Province 2 of Nepal, and community programmes in the eight districts of Province 2, which are highly endemic for leprosy. NLT-LLHSC began working with Self-Help Groups (SHGs) in 2002, through the Stigma Elimination Programme (STEP), initially to support the self-care aspect of the treatment of people affected by leprosy, and subsequently to empower the SHGs to influence the attitudes of communities and reduce the stigma against leprosy. The 10 original STEP SHGs established in 2002 were each formed around a nucleus of people affected by leprosy and then began to include people disabled and marginalized for other reasons, including poverty and gender. These SHGs are still functioning, and in most cases have become independent Non-Government Organizations (NGOs) in their own right.
As this work has progressed and grown, the original groups have gone on to support new groups as they have been established. An evaluation conducted in 2005 after the pilot project, conclusively demonstrated that people previously unable to participate in community life due to ostracism caused by leprosy, were almost fully integrated again after inclusion in the STEP.
In 2019, there are now 112 of these groups across Province 2, involving around 2500 people directly, and affecting many more than that indirectly; this study involves groups in only one District. In most groups, about 37% of the members do not have leprosy themselves and this makes the groups more accessible to people with other difficulties. In earlier years, a few leprosy affected people and some non-leprosy affected people were unwilling to join self-help groups for fear of exposure to the stigma of leprosy in the community. Some even believed that they might catch leprosy by joining a group. But now there is more understanding and support, and more involvement of the groups in community affairs, which encourages people not to be afraid to join.
This work has been a great success story, and continues to play a significant role in reducing the stigma of leprosy in the communities where these groups are active.
This analysis of women’s empowerment in mixed SHGs in Dhanusha District of Nepal is the first study of mixed male and female SHGs. Mixed SHGs in Dhanusha District were formed as part of NLT-LLHSC’s Stigma Elimination Programme (STEP) and its ‘Releasing the Energy and Capabilities of Leprosy Affected Individuals and other Marginalized people – Central Development Region’ (RECLAIM-CDR) project. The Dhanusha SHGs Federation is a registered local NGO formed in 2005, and consisting of 39 affiliated SHGs which include people affected by leprosy, people with disabilities, people with lymphatic filariasis (LF), and other marginalized people. It was formed initially with six SHGs but since then, 33 more groups have joined. In 2018, the federation had 760 members, with approximately 20 in each SHG. Sixty seven percent of the federation’s members are affected by leprosy, 19% are people with other disabilities, 13% are marginalized for various other reasons, and 1% are people with LF.
The SHGs of Dhanusha District are involved in leprosy services, including the prevention of disability, the referral of people with possible signs of leprosy, defaulter tracing and support, counseling, awareness raising, socio-economic empowerment, and the fight for their rights. They are also involved in community empowerment for the benefit of other poor and marginalized people as well as the community as a whole. Although women belong to these groups in the study area, we recognize that their participation in SHGs, their socio-economic status, their voice, leadership and presence in decision-making roles, continue to be poor. Nevertheless, women who are in a SHG setting are learning new things and are more involved in discussion and group work than they would be otherwise. This study therefore examines the benefits that these groups have brought to women, in particular their current self-efficacy levels (emotion, confidence, coping ability, optimism and work satisfaction).
Research hypothesis
There is a significant improvement in self-efficacy among women after joining a SHG, in comparison to women who are not part of a SHG (non-SHG women).
Literature review
The concept of empowerment
That women should be able to live their lives independently, fearlessly and with respect is “women’s empowerment”. Knowledge and capabilities, equal access to opportunities and resources, participation, independence and mobility, along with decision-making and leadership, are understood as elements of women’s empowerment.
Empowerment by way of participation in SHGs can bring meaningful changes and enhancements in the living conditions of women in poor and developing nations. The underlying principle of the SHG is to help improve the lives people living in conditions of poverty and to achieve empowerment.1 The full participation and partnership of both women and men are required in productive and reproductive life, including shared responsibilities for the care and nurturing of children and maintenance of the household.2
Cross and Choudhray3 explain that the process of empowerment is one in which identity is established, the value of life is enhanced, and the potential for a dynamic future is constructed. Kühhas et al.4 define women’s empowerment as the combined effect of changes needed for a woman to realize her full human rights. In these efforts, women must struggle to balance practical, daily, individual achievements with strategic, collective, long-term work to challenge biased social rules and institutions.
The World Bank defines empowerment as ‘the process of increasing the capacity of individuals or groups to make choices and to transform those choices into desired actions and outcomes.’
Self Help Groups and women’s empowerment
According to Sahu and Singh,5 participants in SHGs had economic security, easy credit accessibility, better decision-making in the family, improved family environment (relative freedom from domination), increased mobility, and improved political and legal knowledge. SHGs provided women with a common platform to discuss and solve their individual and community problems. Thangamani and Muthuselvi6 explain that women’s empowerment is a process in which women challenge the existing norms and culture, to effectively promote their well-being. Mahat7 states: ‘In the case of Nepal, the process of women’s empowerment involves many dimensions, including increasing access to economic opportunities and resources; strengthening political power through women’s organizations, solidarity, and collective action; raising consciousness about the symptoms and causes of prevalent oppressive religious, economic, cultural, familial, and legal practices; and strengthening women’s self-confidence.’
Methods
Study design and participants
Dhanusha District was selected for this study as it has the highest number of SHGs. The target population was women members of Dhanusha SHGs. Both qualitative and quantitative methods were used to explore women’s empowerment in mixed SHGs, comparing both members and non-members of SHGs.
Exclusion criteria
Self Help Groups having less than 8 women members were excluded, as were SHG members who were under the age of 18 years, or who had a hearing, speech or mental disorder.
Inclusion criteria
Disabled and marginalized men and women of SHGs were included in this study.
Limitation
The study has the following limitations:
1.
The study was confined to Dhanusha District.
2.
The data were collected from only six randomly selected SHGs.
3.
Women were not taken as key informants.
4.
Simple methods of analysis were used.
Study techniques
The list of SHGs and information relevant for the study were collected from the Community Development Department (CDD) of LLHSC. Simple random sampling was used for SHG selection. 19 of the 39 SHGs of Dhanusha District were excluded from the study for having less than 8 women members.
To select the sampled groups, the name of each group from the target population was written on a piece of paper and folded. These pieces of paper were placed in a container and thoroughly mixed, and then the 6 groups were selected by a counsellor of LLHSC who was not involved in the study. The composition of the six groups is shown in Table 1. A control group of women not in SHGs was recruited through the SHG participants who were asked to identify women of similar ages to those of the SHG women from the community.
Table 1
The male–female composition of the six randomly selected SHGs
| SN | Groups | Male | Female | Total |
| 1 | Sabaila | 9 | 8 | 17 |
| 2 | Yagyabhumi | 17 | 12 | 29 |
| 3 | Hariharpur | 5 | 16 | 21 |
| 4 | Mahua | 7 | 18 | 25 |
| 5 | Bengadavar | 13 | 11 | 24 |
| 6 | Kurtha | 7 | 10 | 17 |
| Total | 58 | 75 | 133 |
Sample size
The actual population from which the survey data were collected included 40 women from SHGs, 20 non-SHGs women, and 10 Key Informants – males from SHGs. The Key Informants were selected in order to help the researcher understand from a male SHG member’s perspective, the factors related to women’s lesser participation in SHGs, the barriers to women’s empowerment, and women’s under-representation in decision-making and leadership roles. Eight women leaders of Dhanusha SHGs who came for a review meeting at LLHSC, were also interviewed. A total of 78 participants were involved in this study.
Data collection instruments
The data collection instruments used in this study were:
1. Focus group discussion (FGD)
Individual interviews with the selected members and leaders were supplemented by group discussions with key participants. Accordingly, seven focus group discussions (with 8 to 10 members for each FGD) were held. The FGDs were made with three groups: women who were participants of SHGs (FGDs = 4), women who were not participants of SHGs (FGDs = 2) and women who were leaders of SHGs (FGD = 1). An experienced LLHSC staff member was assigned to take notes and the participants’ exact words were used in the paper to give a first-hand representation of the women’s emotions and experiences. In all the discussions the researcher was a facilitator and she was able to keep the discussion on track and made sure that every participant was heard. FGDs were recorded on a digital recorder to record the exact words of participants. Each FGD lasted one to one and a half hours. An FGD questionnaire was developed and translated into Maithili and Nepali. Themes covered in the FGD questionnaires were included in an interview guide which was used for the discussion with additional probing for deeper issues related to these themes. In addition, socio-demographic details of participants such as age, sex, education and occupation were collected.
2. In-depth interview
In-depth interviews were held with 10 male members of selected SHGs. The interviews consisted of open-ended questions based on interview guides used as checklists on the topics to be discussed. The questions were prepared in advance according to the context in which they were supposed to be used. The questionnaire was translated from English to Nepali and Maithili, to help participants who may have little or no education. Interviews were supported by written field notes, and each interview lasted between 25 and 30 minutes.
3. Generalized self-efficacy scale
The General Self-Efficacy scale was originally developed in Germany and translated into English by Jerusalem and Schwarzer,8 and into Hindi by Sud.9 The Hindi version of the scale was translated into Nepali and Maithili and used in this present study. It has a four point scale for identifying the subjects in categories of high and low self-efficacy. This scale has 10 items in which the scores range from a minimum of 10 to a maximum of 40. The scale is highly reliable and its psychometric precision has been tested in 25 countries.10 It yields internal consistencies between alpha 0.75 and 0.91 respectively. Its concurrent validity has also been established on the basis of appropriate correlations. This scale was used to compare the self-efficacy of 40 women participants of SHGs and 20 women who were not participants of SHGs, as well as 8 women leaders of SHGs. This scale was therefore applied to a total of 68 participants.
Data entry and analysis
The nature of the data collected was both quantitative and qualitative. Quantitative data were summarized into frequencies and percentages with the help of the Microsoft Excel 2007. The strength of association between variables was assessed in EPI INFO 7.0. Logistic regression and chi-squared tests were used for comparison of those subjects who were SHG members and those who were not SHG members. A P-value of less than 0.05 was considered as statistically significant.
Qualitative data were analyzed thematically based on the specific research objectives. This involved identifying major themes emerging from the data and relating them to the research objectives. The analysis focused primarily on textual data in the form of expanded field notes and transcripts of recorded interviews, which were ‘coded’ manually by the researcher. Then attempts were made to list the themes identified. The data from the focus group discussions and the in-depth interviews were categorized into themes and presented descriptively.
Finally, an overall interpretation emerged showing how thematic areas related to one another. Graphs were made on Grad Pad Prism 7.0.
Ethics statement
Research ethics approval was granted by the Nepal Health Research Council (NHRC). Permission to perform the study was obtained from the Director of LLHSC. For all participants, the nature of the study was explained at the beginning of the project to ensure written informed consent. Participation was on a voluntary basis, with all participants being informed of their right to withdraw at any time with no consequence or implication for their further treatment. Information provided in the course of the study has been kept in the strictest confidence.
Results
The analysis showed that women who were members of SHGs have higher self-efficacy than women who were not members of SHGs. They have good knowledge about their rights, higher participation in social programmes, and more employment through their engagement in income generating activities and saving schemes connected to SHGs. Some barriers were also found to women’s participation and empowerment in SHGs, and women’s representation in leadership roles. These barriers included male dominance, lack of assets and resources, social and cultural barriers, lack of capacity, domestic violence, and defamation.
The SHG women had a mean age of 45.05 years and SHG women leaders had a mean age of 47.78. The 20 non-SHG women included in the study had a mean age of 40.6 years. By contrast, the 10 male key informants had a mean age of 55.7. The education level of participants is shown in Table 2 and their occupations in Table 3.
Table 2
Education levels of participants
| Participants | 12 complete | School Leaving Certificate complete | Under SLC | Illiterate | Total |
| Non SHG women | 0 | 0 | 3 | 17 | 20 |
| SHG women | 1 | 1 | 4 | 34 | 40 |
| SHG women leaders | 1 | 0 | 1 | 6 | 8 |
| Key informants | 0 | 0 | 5 | 5 | 10 |
| Total | 2 | 1 | 13 | 62 | 78 |
Table 3
Occupations of the participants
| Participants | Business | Labor | Housewife | Farmer | Tailor | Total |
| Non SHG women | 2 | 1 | 14 | 3 | 0 | 20 |
| SHG women | 6 | 1 | 31 | 0 | 2 | 40 |
| SHG women leaders | 2 | 0 | 6 | 0 | 0 | 8 |
| Key informants | 3 | 4 | 0 | 3 | 0 | 10 |
| Total | 13 | 6 | 51 | 6 | 2 | 78 |
In all groups, the majority of the participants were illiterate and engaged in household work. The second most common occupation was business. Eighty-one percent of the participants were married, 18% were widows or widowers and 1% were unmarried. Most of the participants were Hindu and belonged to a low caste. Sixty-two percent of the SHG participants were leprosy affected, 5% were disabled, and 33% were others marginalized from societal activities. Those women not in SHGs were from the general population of the Dhanusha District SHG areas. The primary reason for women joining the SHGs was to empower themselves, and the second most common reason was leprosy. They liked the empowerment activities of the SHGs, and the SHGs increased their decision-making power, especially through rights-based activities (40%), programme exposure (20%), empowerment (training and income generation) (20%), advice (16%) and social issues (4%). Their involvement in these groups led to an improvement in their health and their economic status, and they received training, new skills and freedom. This came about mainly through the empowerment programmes, increased awareness, the income generating programmes, and the Government/NGO/INGO support in SHGs.
Table 4 shows the scores on the Self-Efficacy Scale (SES), indicating a vast difference in the level of empowerment between SHG and non-SHG women.
Table 4
Scores on the Self-Efficacy Scale (SES) for SHG and non-SHG women
| SHGs | Non SHGs | |
| Number | 40 | 20 |
| Mean SES | 37.95 | 26.85 |
| Score > 30 | 38 | 6 |
| Score < 30 | 2 | 14 |
| Odd ratio 40 (95% CI 8-314) | ||
An odds ratio of 40 suggests a very strong association between SHG membership and women’s empowerment.
Qualitative analyses show similar differences between SHG women and non-SHG women with regard to their current self-efficacy levels.
“Before, I used to think whether to be alive or to die. But I am cured. Now I think to run a business or to raise goats, cows….” – 62 year old SHG participant
“Now, my husband earns money and gives it to me to spend as needed for the family. I do everything myself. When my husband is not there, I have to be the guardian….” – 35 year old SHG participant
“Before, I was afraid to ask the teacher about the progress of my children’s education. Now, I can ask confidently….” – 28 year old SHG participant
“The women of this group are very happy and moving forward in life by doing various occupations and arranging toilets and water facilities….” – 50 year old SHG male key informant
“The women have learned good things after joining this group, they are staying cleaner, and have become self-dependent by doing various income-generating activities. They have learned useful skills and are more able than other women in this community. ….” – 45 year old SHG male key informant
“A woman of this group is treasurer….” – 53 year old SHG male key informant
In contrast, 50 percent of non-SHG women were found less empowered as they were not invited to participate in community functions. In general, they were only included in marriages, feasts and helping in household work. Eighty-six percent of them said that they did not receive any skills development training. Fifty-five percent of non-SHG women reported that men take the household decisions, while 20% said that they and their husband shared the decisions at home (Figure 1). In this category, most of the women were of an older age. Sixty-three percent of non-SHG women reported that men take responsibility for the decision to spend money.
A 50 year old non-SHG participant reported, “I earn and my son-in-law takes the decisions to spend money.”
A 40 year old non-SHG participant reported, “there was a meeting in the school and we were not invited - then how could we know what happens in our society…?”
Another woman highlighted the situation of women in their society “when relatives arrive, only then are women sought to help in cutting vegetable and organizing household chores.”
The data from non-SHG participants revealed that in 57% of cases husbands and wives take the decision to go outside for purchasing things, whereas in 43% of cases only men go outside to purchase things. If they are widows and have no son, they have more troubles, as described by a 35 years old participant:
“I have no husband or son. When I go to ask or talk about anything to others, people say bad things about me. They come to my house and beat me. If I do a snack business and men come to drink or eat, people say that I am having an illicit relationship with those men. How can I be empowered?”
Figure 1.
Non-SHG women responses on who takes decisions at home.
Women’s Leadership is believed to be a “Route to Greater Empowerment” (USAID desktop study).11 Leadership gives legitimate power and authority to perform the tasks, opportunities to participate in the planning and decision-making tasks, and contribute to the development programme and activities individually.
The results from quantitative and qualitative data analysis explored the idea that women leaders of the mixed SHGs of Dhanusha District are more empowered because of their exposure to SHG activities (Table 5). This includes attending training, participating in programme exposure visits to other SHGs, participating in meetings, and involvement in government and NGO programmes. These activities had a transformative impact on them and equipped them with skills such as communication, critical thinking, collaboration, information management, leadership, and adaptability, all of which gave them the impetus to participate in community development initiatives with more confidence and skill.
Table 5
Main activities of SHG women leaders
| SHG women leaders activities | Frequency | Percentage |
| Group activities (organize meetings, sharing, self-care practice, saving, microcredit loan and discussions on personal and social issues) | 5 | 29 |
| Support to get assistive devices (footwear, eye glasses, crutches) for group members | 4 | 24 |
| Social support (Participate in community activities such as cleaning programmes, search for leprosy and LF cases, coordinate with government officials for their share in the budget or for development of poor communities) | 3 | 18 |
| Awareness on leprosy, LF, nutrition, immunization, sanitation and hygiene | 1 | 6 |
| Hygiene and sanitation activities | 2 | 12 |
| Patient referral (suspect leprosy or LF cases) to local health institutions or Lalgadh Leprosy Hospital and Services Centre | 2 | 12 |
As role models, these women have played a significant role in influencing their own spaces. These female leaders have paved the way for other women to assume leadership roles. Some of these women have created their own stories by standing for what they believe in and making major breakthroughs in different fields. Women in leadership positions have challenged their status in both their SHGs and in their community, and now they are more respected and valued.
Sixty-three percent of women leaders of SHGs confirm that their leadership role has impacted the empowerment of women in SHGs. They have found that the number of female participants in their groups is higher at 50 percent, than in SHGs led by men. The women SHG members feel confident, and talk openly and share their problems with women SHG leaders. Leadership by women has increased the empowerment of women, and has contributed to leprosy elimination, cleanliness and environmental sanitation, work with Neglected Tropical Diseases (NTDs), detection of new patients, and improving girls’ education.
A 55 year old woman SHG leader reported how she had progressed in her life after becoming a SHG leader:
“After taking 24 months of medication, I became cured. I have started income generation activities effectively. Initially, we were given Nrs. 20,000/-. Now we have about 500,000/-profit. People are happy with me to see my progress and that I repaid loans as well…..”
Another 52 year old SHG woman leader reported that how she helps other women of her group: “when a woman is mistreated by her husband because of leprosy, I go to help that woman to show somebody is there to care for her, and I counsel her husband as well…”
A woman leader described how her community changed after SHG formation:
“Rights are equal now. Before, women used to be kept in under pressure in the house. There was no trust towards them. Always a question was put around them such as how can someone’s wife or daughter go out? How could a daughter or daughter-in-law be engaged in self-employment? How could they talk with other men? People think badly of them but now they are more open. Now they can talk and have less criticism directed towards them. Even their guardians could not criticize them because they understand that going out can make them knowledgeable, and help them learn about the environment, as I did when I went out.”
A 55 year old SHG male key informant reported:
“A woman listens to another woman and is influenced by them.”
Barriers in participating in mixed SHGs
Despite women’s increased empowerment in SHGs, it turns out they are still doing more household chores than men, which is limiting their ability to act on an equal footing within the SHGs. All respondents reported that women are mainly responsible for the housework. Their husbands do not help them in completing household chores. They are also responsible for fetching water, shopping and gardening. The responses (below) of SHG women show how women are not able to participate in group activities due to entanglement in household chores;
“Women have many things to do like cooking, household chores, and childcare. And men come and order food at home.”
“Women continue with various household chores, cooking meals, looking after the cattle and cutting grass. They just work all the time.”
It was also found that even when women are working outside and earning money, they are still compelled to do household chores because in the study area the roles of men and women are classified based on the local Maithili cultural context. While men are usually the breadwinners, women are traditionally responsible for most domestic chores. Qualitative analysis shows that age, education, having children, lack of energy, lack of support, lacking an independent source of income (being dependent, or tied to labour work), and caste are all significant barriers to women’s participation in SHGs. Coralynn Davis, an associate professor of women and gender studies at Bucknell University, has found through her research that ”Maithili women are generally economic dependents in their families – first as daughters, then as wives and mothers, and often as widows.”13
Overall, women reported that lack of time was a barrier to participating in SHGs. They have to stay for children’s bed time, family meal times and accommodating work schedules. When they go out to labour for the landowner, the landowner will not allow them to travel anywhere away from the work area. They are therefore unable to get any other work done that might benefit them. Health issues, and lack of support from family, government and NGOs, were barriers for participation in group activities reported by the SHG participants.
“The main barrier is that people stop us from participating in the groups led by leprosy-affected people. They said that leprosy will transmit to us as well…” – 32-year old disabled participant
“I was greatly traumatized by the community members because my husband was affected by leprosy. People were not receiving vegetables from me or sitting together with me. My husband and son were not allowed to eat in the village. When my husband was sitting in a chair, people pulled the chair from behind and asked ‘how he could sit on the chair because he had leprosy?’ My husband wanted to die that day, so we started crying loudly. Everyone was looking from outside but no one came near….” – 55-year old SHG participant
Barriers to women’s empowerment in mixed SHGs
The barriers to women’s empowerment experienced by the participants in mixed SHGs were classified into 4 main themes: (1) Male dominance (domestic violence), (2) Lack of assets and resources, (3) Social cultural barriers (defamation), (4) Lower level of capacity.
1. Male dominance
In Nepal, there are equal rights for men and women but in reality equality does not exist in rural areas where Maithili people live. Women are being neglected in many spheres of life. Women are not treated equally to men. People have a set attitude that women are only for household work. Their participation in SHGs needs the approval of their husbands or the head of the family. In focus group discussions, women unanimously named male dominance as the key hurdle in women’s empowerment. The women’s characters were criticized if they went out to be involved in the programme, and they had to bear domestic violence as well. Because of these fears, most SHG women did not dare to come forward for leadership roles. Hence, there was always male dominance in the groups. These issues were a barrier to women’s empowerment. Below are some statements of respondents:
“When we attend other meetings then men comment on us and say that now men have no value, only women have…” – 35 year old SHG participant
“If a woman participates in group meetings, people in the community suggest that she is having illicit relationships with other men…”. – 55 year old SHG participant.
“Women are not allowed to talk. They are not informed about anything. If they participate in any village meetings, men do not let them talk….” – 35 year old non-SHG participant
2. Lack of assets and resources
Like many parts of Nepal, women in the SHGs of Dhanusha District continue to face discrimination in access to land, housing, property and other productive resources and have limited access to technologies and services that could alleviate their work burdens. Unequal access to resources limits their capacity, security of livelihood and food security, which increases poverty and the risk of violence. These women have unequal access to and control over resources, and their continued responsibility for unpaid domestic and care work curtail their productivity and restrict their capacity to be empowered and participate fully and effectively in public life. Lack of education and training opportunities, employer biases, and limited mobility due to social responsibilities combine to keep them at these lower echelons. Many women of the study area were unable to insure themselves against contingencies arising from old age, ill-health, disability, unemployment and other life crises.
Even skills development training for women in SHGs was very traditional and concentrated on cutting, sewing, candle making, etc. However, in these employments they have generally been unable to receive a fair wage for their labour and have therefore subsequently abandoned the activity. There is still a general tendency to assume that women’s work is to participate in marriage activities and feasts as free help. Hence, low-return activities are forced on women, and they eventually lose interest in them.
“Men do not allow women to go out. We have to talk and fight for women’s rights. If we won’t talk, we will not get rights…” – 67 year old SHG participant.
“When she was a labourer, her landowner always blamed her for not doing work properly…” – 35 year old SHG participant.
“When the local government’s budget passes, we are kept separate, now we have to fight for our right to access to information about the public budget and be able to fully participate in decisions about the formulation and implementation of the budget.” – 45 year old SHG participant.
3. Social and cultural barriers
Social norms and culture also play a part in influencing women’s empowerment in mixed SHGs because Maithili cultural beliefs do not support the idea of women going out of their homes to participate in programmes where men are also present. This is viewed as a man’s role and women who do not adhere to this are ostracized in the community. The conversations below in FGDs showed how women’s opinions are not listened to, they are not respected, and they limit women’s ability to move freely. Married women cannot travel outside the home in the same way as married men. They are supposed to veil themselves before moving around outside. In these communities, mostly the men go out and to an extent do the shopping for the families while the women just stay at home.
The situation of the widow is particularly difficult as they face extreme neglect. A study on ‘gender, masculinity and son preference in Nepal and Vietnam’13 also reported that not a single widow received support from family, friends or neighbours. Those women who have no sons with only daughters are considered ‘unfortunate’ and not having a son reflects bad karma and lack of moral virtue.
“If anything happens in the village, women are not allowed to go – only men can go…” – 35 year old SHG participant
“There were restrictions on newly married women; they were not allowed to show their faces. It used to be a big problem at that time. Their parents-in-law used to beat them…” – 32 year old SHG participant.
Another conversation exposed the pitiable condition of women:
“If I would go to a meeting ignoring my husband, then he would not let me come inside the house. He would tell me to stay out of the house and to stay where I had come from. He keeps a big stick to beat me…”
The community people raise questions and criticize widows on their dressing and mobility as reported by a young widow:
“I don’t have a guardian so if I go out alone then they comment; ‘look at her wearing a nice sari, she has no husband why does she go out?’…” – 35 year old SHG participant
4. Lower level of capacity
Rural women generally have lower levels of human capital in terms of inadequate formal schooling and poor nutritional status as compared to men (World Bank 2001).14 Literacy levels and technical skills amongst women in Nepal remain much lower than their male counterparts. Dhanusha District is one of the districts of Nepal where women are often denied opportunities for education. Each day one can hear and read news about the incidences of gender-based violence and discrimination against women. There are deep-rooted social and cultural practices like child marriage, the dowry system, gender discrimination and many more. It was found that women spend 12 to 15 hours a day engaged in household chores; hence it is unlikely for women to be released to participate in any programme or paid employment which limits their capacity to do chores.
Women’s participation in paid employment is also constrained by the existing social norms restricting women’s mobility and by low women’s educational attainment. Women are working outside either as agricultural wage laborers or in the vulnerable informal sector which is more exploitative in nature and lower paid (UN Women, 2015).15 Women do not get better employment opportunity outside because of lack of education and skills. They have no knowledge of legal rights and women’s rights such as ancestral property, the right to representation, employment, etc. In FGDs, they reported:
“We could not understand or recognize these things because of our illiteracy…. We don’t have minds…” – 65 year old SHG participant.
“When we have skills then we can be empowered. Without skills and ability, how can we make progress…?” – 40 year old SHG participant.
Similarly, women have limited and restricted access to leadership roles which restricts their influence over SHG governance and policies. Women’s leadership is present in the mixed SHGs of Dhanusha District; however, the number of women represented is not yet satisfactory as only around 20% of women are in this position. When it was asked in FGDs how many SHG women members want to become leaders of SHGs, only 22% of respondents reported that they want to become leaders, and 78% were reluctant to be a leader. The reasons were: illiteracy, lack of technical skills, socio-cultural barriers, discomfort with public speaking, time-constraints due to family obligations, male dominance, lack of assets and resources, and non-paying jobs.
‘Women’s Participation in Decision-Making and Leadership: A Global Perspective’16 also confirms the finding of this study that women are marginalized in decision-making and leadership by a variety of processes that begin in infancy. In most societies, women lack the experience of decision making and leadership in the public arena because girls, in contrast to boys are only allowed and encouraged to play passive roles and are given little opportunity to make decisions or develop leadership skills outside the family context. In most traditional societies girls are kept largely within the confines of the household and family where they are protected and taught to accept the decisions that others, parents, teachers, brothers, make on their behalf. As a result of this lack of experience in a public context, girls tend to be lacking in self-confidence and the skills needed to function effectively in positions of formal leadership. An article: Women and the Labyrinth of Leadership (Harvard Business Review)17 also confirmed that Women are associated with communal qualities, which convey a concern for the compassionate treatment of others. They include being especially affectionate, helpful, friendly, kind, and sympathetic, as well as interpersonally sensitive, gentle, and soft-spoken. In contrast, men are associated with agentic qualities, which convey assertion and control.
“We cannot be a leader because we are illiterate, so we cannot understand the things that are said or written” – 50 year old SHG participant
“Women hesitate to become the leader of self-help groups because they have to leave their chores and go out of their village, learn a new language, and feel embarrassed….” – 56 year old SHG male key informant.
Discussion
This study sheds light on the difference between SHG and non-SHG women, in the areas of self-efficacy, feelings of freedom, confidence, and decision-making. The findings confirm that most of the SHG participants learned about leprosy and self-care in group meetings. They have become health-conscious, aware of leprosy, self-dependent and ulcer free. Similar results were reported in a study by Cross et al.18 in which SHG members were generally enriched by participation in the project. Successful self-care groups in Ethiopia reported that belonging to a self-care group increased their confidence to participate in society. Membership also affected the restoration of dignity, self-respect and a sense of belonging within their community.19 The ‘Report on Status of Women and Youth Leadership’20 highlighted the exclusion of women from any active or productive roles in local development or governance in their own communities. This is directly related to the lack of awareness and understanding, but the ubiquitous exclusion in all areas, as demonstrated by the survey data, is extremely detrimental, not only to the individuals but to entire communities, as it directly undermines the entire concept of representative local governance and inclusive democracy.
Conclusion
This study explores the hypothesis that the SHGs have helped women to participate in community affairs and contributed towards developing women leaders at the community level, allowing them to participate in local governance activities. Men and women as a part of SHGs have also worked towards eliminating some of the cultural barriers to participation. Initially, the women from high caste were reluctant to sit with the Dalit women or with men. However, the SHGs, along with LLHSC staff, persistently addressed this issue through training, and participating in community feasts and community awareness programmes.
The women members have taken steps to encourage education for girls. They now set an example by sending their own daughters to schools and then encouraging other families to send their girls to school. One of the most significant changes has been in the attitude of SHG men towards women’s rights and empowerment. The SHG men have come forward to support SHG women.
The intervention led by the SHGs has created a long-lasting impact on the lives of the targeted population. The changes seen are in livelihood generation, social transformation and above all towards empowering the women. The SHG women themselves have realized the transformation that they have undergone and experienced. Not only has their standard of living changed, but the quality of life has also been affected by the initiative. It is evident that the women have taken a lead in decision-making; they are no longer silent listeners but are instead voicing the need for rights.
On the whole, this study confirms that though barriers persist, these mixed gender SHGs significantly enhance the empowerment of women compared to women who do not participate in SHGs. But more efforts are needed to overcome the barriers shown above.
In light of the conclusions drawn above, a few suggestions can be made. It is said that if a woman is educated and empowered, the entire family and society will be developed. So the most imperative need is to provide women with the skills and knowledge to take advantage of the many opportunities available to them, and help them improve their living standards. Providing women with the opportunities of education, job training, and basic services to ease household responsibilities, are the good ways to empower them. When women become more knowledgeable and acquire skills, they can accomplish a great deal. Women’s empowerment leading to effective leadership is required for the well-being of women as well as for the well-being of the mixed SHGs. Creating a balanced society is possible only by giving equal status and opportunities to all the people.
Acknowledgements
I would like to thank the participants and the organizations - American Leprosy Missions (ALM), Nepal Leprosy Trust (NLT), LLHSC, and NLT UK, for their funding, technical and administrative support in the conducting this research study. Ethical approval was obtained from Nepal Health Research Council- Reg. No. 14/2019.
Conflict of interest
The author declares that there is no conflict of interest.
References
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Annexes A
List of abbreviations used in this paper
ALM
American Leprosy Mission
ACWF
The Asian Women in Co-operative Development Forum
CDD
Community Development Department
FGD
Focus Group Discussion
GSE
General Self –Efficacy Scale
ICAROAP
International Co-operative Alliance Regional Office for Asia and the Pacific
ICPD
International Conference on Population and Development
IOSR-JBM
International Organization of Scientific Research Journal of Business and Management
INGO
International Non Government Organization
ISSN
An International Standard Serial Number
KII
Key Informant Interview
LF
Lymphatic Filariasis
LLHSC
Lalgadh Leprosy Hospital and Services Centre
NHRC
Nepal Health Research Council
NGO
Non Government Organisation
NLT
Nepal Leprosy Trsut
NTDs
Neglected Tropical Diseases
POA
Programme of Action
RECLAIM-CDR
Releasing the Energy and Capabilities of Leprosy Affected Individuals and other Marginalized people – Central Development Region
SES
Self-Efficacy Scale
SHG
Self Help Group
STEP
Stigma Elimination Programme
UK
United Kingdom
UNFPA
United Nations Population Fund
USAID
The United States Agency for International Development
Annexes B
Questionnaires for FDGs, KII
1.
FGD questionnaire with SHG female members
1.
What are the reasons for joining SHGs ?
2.
What do you like best about SHGs ?
3.
What results have you observed from helping others through SHGs?
4.
If you could change anything about your experience with this SHG, what would it be?
5.
What do you think about that SHGs enhanced women’s decision-making in the group and family?
6.
Would you tell me what barriers hold you to participate in group activities?
7.
How many of you want a leadership role?
8.
Can you tell me how women in leadership role help in women empowerment?
9.
What barriers are there for women to not come forward in a leadership role?
10.
What do you believe could improve women’s empowerment?
11.
Would you like to say what is women’s rights?
12.
Are there other things you would like to say before we wind up?
2.
FGD questionnaire with non SHG female members
1.
What is a woman’s right?
2.
What kind of community functions do you attend?
3.
Can you read and write your name?
4.
What kind of skill development training you received?
5.
Did you participate in any specific training?
6.
Who take decisions at your home?
7.
Who takes the decision to spend money?
8.
Who goes outside to purchase things?
9.
In your opinion, What are the barriers for women to be not empowered?
10.
What do you believe could improve women’s empowerment?
3.
FGD Questionnaire for SHG female leaders
1.
Tell me more about your position in this SHGs.
2.
Please describe your leadership activities.
3.
Can you tell me what expectation members have from you as a leader?
4.
Would you like to share what issues female members feel comfortable to raise or discuss with you?
5.
How male members react to your leadership?
6.
Would you tell me that in your leadership male and female members get equal opportunity in training, education and economic development?
7.
Do you believe your gender has played a role in how you exercise leadership, please explain?
8.
How do you lead, and does it differ from the way male SHG leaders lead?
9.
What is women’s rights?
10.
What do you believe could improve women’s empowerment?
4.
Key Informants questionnaire
1.
Please tell me what is Women’s rights?
2.
In your opinion, has health and empowerment of women improved after joining SHG, stayed the same, or declined over the past few years?
3.
Why do you think it has (based on the answer from the previous question: improved, declined, or stayed the same)?
4.
What other factors have con/ Atributed to the (based on the answer to question 2: improvement, decline or to health and empowerment of life staying the same)?
5.
How have women members given equal opportunity for training and decision making role?
6.
How do you find changes among SHG and non SHG women?
7.
In your opinion, if women become the leader of SHG Women’s issues discussed more openly and addressed?
8.
How many in your group do you think like to be a leader?
9.
What are the reasons for women holding a leadership role?
10.
In your opinion, What are the barriers for women to be not empowered?
11.
What needs to be done to address these issues? Possible probe: What specific actions, policy or funding priorities would you support because they would contribute to women empowerment?
Annexes C
Hindi Self Efficacy Scale