The aim of this study was to examine the epidemiology of disability in India and assess access to disability support and rehabilitation services by people with disability (PWD).

This study is a secondary analysis of data from the 76th round of the National Sample Survey (2018), focusing on disability in India.

The survey employed a stratified two-stage sampling design based on Census 2011, covering all states and union territories of India. Villages and urban blocks were selected in the first stage, while households were chosen in the second stage across rural and urban areas.

The survey included data from a population of 576 796 individuals residing in 118 152 households from 8992 village/urban blocks (5378 rural villages and 3614 urban blocks). The analysis focused on 107 125 individuals (61 707 male and 45 305 female) who reported at least one disability.

The primary outcome was ‘any disability’. Secondary outcomes included access to disability support and rehabilitation services, which assessed difficulties in accessing public buildings and transport, loss of employment after disability, availability of government support, enrolment in special schools, and possession of a disability certificate.

The overall weighted disability prevalence was 2.2%, with significant disparities across sociodemographic characteristics. Among PWD, 45.9% of those who acquired disability after birth were aged between 15 years and 59 years, and 20.8% received no government aid. About 40% of PWD struggled to use public transport, and 57.7% had difficulties accessing public buildings. Additionally, 60.7% reported job loss due to disability, and 69.6% lacked a disability certificate.

This study highlights disparities faced by PWD in accessing disability support and rehabilitation services. There is an urgent need for concerted efforts to minimise such experiences. This will help us enhance the well-being and participation of PWD and empower them to contribute to society with their true potential.

Data are available in a public, open access repository. Data (Reference ID: DDI-IND-MOSPI-NSSO-76Rnd-Sch26.0-July2018 December 2018) is freely available on the website of the Ministry of Statistics and Programme Implementation (GOI) MOSPI’s https://microdata.gov.in/nada43/index.php/catalog/154/overview, and can be accessed as per standard protocols.

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As per the United Nations Convention on the Rights of Persons with Disabilities (CRPD), people with disability (PWD) include those who have long-term physical, mental, intellectual, or sensory impairments which, in interaction with various barriers, may hinder their full and effective participation in society on an equal basis with others.1 Disability is a global concern, impacting 1.3 billion people, or 16% of the population.2 The WHO and the World Bank’s World Report on Disability highlight that 80% of the global disabled population is of working age, with a substantial proportion residing in developing countries.3 India is one of the most populous countries, with a concerning proportion of PWD.4 With the increasing proportion of the geriatric population, the burden of disability has also proportionately increased (from 21.9 to 26.8 million) over the last two rounds of the national census (2001–2011).5 6 The reports from the 2011 Census and the 76th round of the National Sample Survey (NSS) estimate disability prevalence to be around 2.2%.7 However, the fifth round (2019–2021) of the Indian National Family Health Survey (a large-scale nationally representative survey with repeated cross-sectional design) estimates an overall disability prevalence of 4.52%.8 The discrepancy in available estimates is due to methodological differences, poor quality and inconsistent data, and lack of a standardised definition, which underscores the intricate nature of disability.9 10

The CRPD identifies disability as an evolving concept and highlights the constantly changing needs of PWD, which are largely unmet.1 11 12 The different articles of CRPD (6, 7, 9, 24 and 27) focus on key aspects such as gender, age, accessibility, education and employment to empower PWD by addressing specific needs. For instance, Article 6 caters to gender-related needs, which may include protections against gender-based discrimination and access to reproductive healthcare, while Articles 7 and 24 focus on the needs of children with disability and ensure inclusive education. Article 9 ascertains that older adults with disability have access to necessary social and healthcare services. These measures aim to enable independent living and full participation in all aspects of life, ensuring that PWD are not deprioritised compared with the general population.13–17 The limited priority given to the needs of PWD in society increases the existing disparities, leading to poorer health outcomes, lower educational attainment and reduced economic opportunities, thereby exacerbating social inequities.18 Addressing these disparities is a global priority as mandated by the second principle of the Sustainable Development Goals, ‘Leave no one behind’, which is the central, transformative promise of the Agenda 2030.19 International human rights law, including the CRPD, Convention on the Elimination of All Forms of Discrimination Against Women, Convention on the Rights of the Child, International Covenant on Civil and Political Rights, International Covenant on Economic, Social and Cultural Rights, collectively uphold the principles of equality and non-discrimination, obligate each country to address the inequalities faced by PWD, ensuring that they have equitable access to services, full participation in society, and protection from exclusionary practices.1 20 Between March 2007 and January 2025, 192 parties, including India, formally agreed to the CRPD. Despite progress, there remains a gap in fully recognising and upholding the rights and needs of PWD.18 The needs of PWD can span from personal functional assistance (daily activities and extent of disability), social integration (living conditions, caregivers and public accessibility), economic rehabilitation (impact on employment and finances) to service access (certification and receipt of government/non-government organisation (NGO) support) necessitating a comprehensive approach.21 However, access to such services is less studied, so it is crucial to highlight disparities that affect the disability care continuum and limit the efforts to minimise social exclusion of PWD and foster a social environment that is inclusive and accessible to all.21 22

Previous literature from India has primarily focused on the epidemiology of disability.10 The lack of disability-friendly infrastructure, affordable assistive technologies, support services, including personal assistance, therapy, aids and vocational rehabilitation, and comprehensive care perpetuates inequalities.23 However, it remains underexplored by the scientific community. Within this context, the 76th NSS collects data regarding disability and access of PWD to various disability support and rehabilitation services, thus providing an opportunity to study them.7 Thus, the primary aim of the study was to explore the epidemiology of disability and the accessibility of PWD to various disability support and rehabilitation services to provide insights for specific interventions.

Table 1 provides a comprehensive overview of the weighted prevalence of different types of disability across various sociodemographic characteristics in India. Of the participants, 107 125 (2.2%) had at least one form of disability. The majority of such participants had a locomotor disability 61 981 (1.36%), followed by hearing 15 294 (0.30%), visual 11 977 (0.23%), speech-related 12 661 (0.23), intellectual 8564 (0.16%), mental illness 6751 (0.16%), and other types 3121 (0.05%) of disability. The highest prevalence of any disability, locomotor, speech and ‘other’ disability was seen in those aged 50–65 years. However, the proportion of participants with visual and hearing disability was highest in the eldest age group, while intellectual disability and mental illness were highest in the 6–35 years age group. Disability prevalence was notably higher among older individuals, men, rural populations, and those from lower socioeconomic backgrounds with minimal or no educational attainment, and living in the southern part of India.

We further assessed the origin of disability as per the type (table 2). The most common cause of locomotor and speech disability was disease 28 673 (46.3%) and 1246 (61.9%), respectively, while ‘other causes’ were most commonly involved in visual 538 (46.5%) and hearing 637 (49.7%) disabilities. Around 11 488 (18.5%) of PWD had their disability from birth. Of the total participants, 2987 (6.1%) participants acquired their disability in the last year preceding the survey. The most common place of disability origin was road 5977 (41.9%), followed by home, 4693 (32.9%). Only 17 329 (28%) of PWD were consulting doctors and undergoing treatment.

Table 3 depicts the living conditions of PWD and access to crucial services, and online supplemental table 1 provides results in more detail for each type of disability. Overall, nearly half of the PWD who did not have disability since birth were 15–59 years old (45.9%), while nearly a fifth (20.8%) had received aid or help from the government. 57% of PWD lived with their spouses, and 62.8% reported that caregivers were available. About 40% reported an inability to use public transport, while 54.4% reported inaccessibility to public buildings. Further, 57.7% of PWD reported facing difficulties while accessing public buildings. Around 60.7% of PWD reported a loss of work due to disability onset, and 69.6% did not have any official document certifying their disability for administrative purposes. Figure 1 further depicts the geographical disparities in the PWD’s access to basic services.

Table 4 demonstrates the multivariable binary logistic regression analysis results to present the sociodemographic variables affecting the likelihood of living with any disability. We found a significantly higher likelihood of living with disability with increasing age (adjusted OR: 58.4; 95% CI 55.4 to 61.5 in >65 years vs up to 5 years), urban residence (1.3; 1.2–1.3) versus rural, social castes (1.3; 1.3–1.3 in general caste) versus scheduled tribes, and living in the southern region of India (1.1; 1.1–1.2) compared with those from North India. However, female sex (0.6; 0.6–0.6), more years of education (0.3; 0.3–0.3), Islam followers (0.9; 0.9–0.9), currently married/widowed versus never married (0.3; 0.3–0.3), and higher socioeconomic status (0.5; 0.5–0.5) depicted significantly lower likelihood of living with disability. Online supplemental table 2 provides results from the more detailed regression analysis for each type of disability.

We report an investigation that assesses the epidemiology of PWD and their access to disability support and rehabilitation services in India using nationally representative data. Our key findings have profound policy implications. First, we identify concerning disparities in disability prevalence across sociodemographic groups. Second, a fifth of PWD reported acquiring their disability at birth. Third, the most common place of disability origin was the road, followed by home. Fourth, approximately half of PWD reported challenges in using public transport and buildings. Lastly, the majority of PWD reported a loss of work due to disability onset and lacked official certification of their disability.

Disability prevalence was notably higher among older individuals, men, rural populations and those from lower socioeconomic backgrounds. Despite a modest 2.2% prevalence rate, this figure represents around 30 million people in India, and it is expected to rise, indicating an urgent need for attention. While there was a preponderance of men with locomotor disability, speech and language disabilities were significantly higher in women. As per the estimates obtained from the previous 36th, 47th and 58th rounds of NSS, there is a constant rise in disability prevalence in rural (1.8% in the 36th round to 2.3% in the 76th round) as well as urban (1.4% in the 36th round to 2.0% in the 76th round) areas, with the overall increase from 1.6% in the 36th round in year 1981 to 2.2% in the 76th round in the year 2018.7 Secondary analysis of another national survey (National Family Health Survey round 5, 2019–21) depicts an overall disability prevalence of 0.95%, with a higher proportion of locomotor disability (0.4%), followed by mental illness (0.2%).9

We observed that a high proportion of survey participants had their disability from birth. However, the available data limit our further understanding of such disability, whether the onset was intrauterine or acquired during the birthing process. Such limited information still necessitates mitigation strategies targeting pregnant women by ensuring accessibility to screening for intrauterine pathologies causing disability, such as Down’s syndrome and intellectual disability, and later extending the access to screening for auditory and visual disability.36 Further, adopting more rigorous screening toolkits and investigations for newborns at the primary healthcare level through the expansion of the Rashtriya Bal Swasthya Karyakram, Indian national programme that involves screening of children from birth to 18 years of age, for 4 Ds—Defects at birth, Diseases, Deficiencies and Development delays, spanning 32 common health conditions for early detection and free treatment and management, including surgeries at the tertiary level would help in increasing the scope for early psychological or therapeutic interventions that would impact the quality of life of children with disability.37 In addition, the Pradhan Mantri Jan Arogya Yojana offers free healthcare for children with disability who are not covered under the Rashtriya Bal Swasthya Karyakram (RBSK) scheme.38 39

The most common place of disability origin was the road, followed by home. Trauma is an important cause of locomotor disability, and in India, it is the second most common cause of locomotor disability.40 Previous estimates suggest that road crashes maximally impact the poorest quintiles. A lack of appropriate safety gear while on the road is often a factor in road trauma. People who experience road trauma often have inadequate access to medical and social safety nets after injury.41 42 Anecdotal evidence from Chandigarh, a Union Territory of India, suggests that strict compliance with traffic rules can mutually benefit the public and the administration. On one side, it reduces morbidity due to road traffic accidents, while on the other side, penalties due to non-compliance generate revenues and raise awareness. An increasing number of domestic accidents is equally concerning.43 Domestic accidents may be under-reported as most of the domestic injuries are considered minor, often neglected, and may be easily forgotten and subject to recall bias. This changing trend is similar to many developed nations where more accidents happen at home than anywhere else. We expect an increase in such incidents with increasing population and population density. Domestic accidents depend on the physical and social environments and also on the functional capacity of the individual. While road traffic accidents are unforeseen and unexpected, it is generally accepted that domestic accidents can be prevented and minimised by taking adequate safety measures well in time.44

We observed that there is scope for improving the accessibility of public buildings and transport for the PWD; these facilities must accommodate the PWD’s needs. Various schemes and initiatives demonstrate the Indian government’s commitment to securing the rights and welfare of disabled populations in the country. India’s commitment to the CRPD is embodied in the Rights of Persons with Disabilities Act of 2016 (RPWD Act, 2016). It emphasises dignity, autonomy and non-discrimination for PWD.45 The Act further mandates inclusive education, vocational training and self-employment opportunities without discrimination. To increase the accessibility of public buildings, the RPWD Act, 2016 and the National Building Code of India 2016 outline expanded guidelines for building accessibility.46 Compliance with these standards has been made compulsory, with responsibility falling on those involved in commissioning, designing, constructing or managing built environments. The building design must adhere to relevant legislation, including equality and safety regulations. This focus on accessibility has fostered the adoption of universal design concepts, leading to numerous best practices for creating inclusive environments. These encompass accessible buildings, parking areas, parks and recreational facilities, reflecting a concerted effort to ensure equal access and inclusion for PWD in the built environment.

While previous research has primarily emphasised individual heterogeneity among PWDs, our study indicated that a large proportion of PWD experience systemic disparities in accessing disability support and rehabilitation services. The high prevalence varies significantly as per the studied sociodemographic characteristics, reinforcing the urgent need for targeted interventions. We acknowledge that while individual differences exist, these do not negate the common challenges faced by PWDs in securing equitable access to essential services. Despite government initiatives, there remain gaps in accessibility, public awareness and enforcement of disability rights. There is an urgent need for concerted efforts to minimise these disparities, enhance the well-being and participation of PWD, and empower them to contribute meaningfully to society. Furthermore, our findings underscore that many disabilities originate from birth or early childhood, yet the availability of early screening, diagnostic services and timely interventions remains inadequate. Strengthening antenatal and neonatal screening, particularly for intrauterine conditions and birth-related complications, could significantly improve early detection and management of disabilities. As a society, we must work towards reshaping societal and institutional perceptions of disability, shifting the focus from viewing disability as a personal deficit or burden to recognising it as a societal construct that can be addressed through inclusion, accessibility and policy-driven structural changes. A more inclusive and disability-friendly society is essential not only for ensuring the dignity and rights of PWD but also for achieving socioeconomic development and social justice. These efforts align with India’s commitment to the CRPD and contribute to the global vision set by the 2030 Agenda for Sustainable Development, which recognises the promotion of PWD’s rights, perspectives, and well-being as a fundamental prerequisite for a more sustainable and inclusive world.

Data are available in a public, open access repository. Data (Reference ID: DDI-IND-MOSPI-NSSO-76Rnd-Sch26.0-July2018 December 2018) is freely available on the website of the Ministry of Statistics and Programme Implementation (GOI) MOSPI’s https://microdata.gov.in/nada43/index.php/catalog/154/overview, and can be accessed as per standard protocols.

This study used the National Sample Survey (NSS), 76th round Person with Disability in India Survey 2018. The authors thank members of the study field team, including those who were involved in mapping/listing/segmentation and the primary survey during data collection. The authors also thank all the respondents for their active participation in this study.