







































All articles are permanently available online to the public without restrictions or subscription fees. They are free to be used, cited, 

and distributed, provided that appropriate acknowledgment is included. Authors retain the copyright of their original contributions 

and grant the Canadian Online Publication Group (COPG) a license to publish the article and identify itself as the original 

publisher. CPOJ articles are licensed under the Creative Commons Attribution 4.0 International License. 

 

CPOJ Website: https://jps.library.utoronto.ca/index.php/cpoj/index 

Editorial Office: cpoj@online-publication.com    

ISSN: 2561-987X 

CPOJ is a member of, and subscribes to the principles of, the Committee on Publication Ethics (COPE).   

 

 

VOLUME 7, ISSUE 1 

 2024 
 

PROFESSIONAL OPINION 

 

Alam J, Joshi A, Mir N, Chawla N, Sagar S. Invisible struggles: Exploring challenges faced by women with amputation in India. Canadian Prosthetics & Orthotics 

Journal. 2024; Volume 7, Issue 1, No.5. https://doi.org/10.33137/cpoj.v7i1.44002 

https://jps.library.utoronto.ca/index.php/cpoj/index
mailto:cpoj@online-publication.com
https://publicationethics.org/about/our-organisation
https://publicationethics.org/members/canadian-prosthetics-orthotics-journal
https://doi.org/10.33137/cpoj.v7i1.44002


 

1 

Alam J, Joshi A, Mir N, Chawla N, Sagar S. Invisible struggles: Exploring challenges faced by women with amputation in India. Canadian Prosthetics & Orthotics 
Journal. 2024; Volume 7, Issue 1, No.5. https://doi.org/10.33137/cpoj.v7i1.44002 

 

 

PROFESSIONAL OPINION 

 

INVISIBLE STRUGGLES: EXPLORING CHALLENGES FACED BY WOMEN WITH 

AMPUTATION IN INDIA 

Alam J1, Joshi A1, Mir N1, Chawla N2, Sagar S1*    

1. Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India. 
2. Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.  
 
  
 

 

 

 

  

 

 

The 2019 Global Burden of Diseases (GBD) report 

highlighted that India sees about 23,500 new cases of 

people with amputation each year, with men making up the 

majority—around 20,200—while approximately 3,300 are 

women.1 Older women, especially those over 70, are at a 

heightened risk for traumatic amputations due to 

osteoporotic changes, according to GBD data.2 However, in 

our population, Road Traffic Injuries (RTIs) emerge as the 

leading cause of amputations, followed by train-associated 

injuries, attributed to lax laws and an increasing population.3 

Additionally, gender plays a role in prosthetic access and 

fitting, as fewer women (42.9%) successfully receive 

prosthetic limbs upon discharge compared to men (68.6%).4 

This disparity may stem from concerns related to the 

appearance of the prosthesis and its bulkiness. 

In patriarchal societies like India, there is often a tendency 

to prioritize men's comfort over women's needs, which can 

result in the dismissal of women's genuine concerns as 

"emotional" or "natural phenomena”.5 This societal bias may 

contribute to higher prosthesis rejection rates among 

women as compared to men. Additionally, women with 

disabilities face a dual form of discrimination—one based on 

gender and the other on their physical disability. This 

discrimination, combined with lower literacy rates, 

significantly reduces their job opportunities.6 The lack of 

empathy in Indian society towards individuals with 

disabilities is not a secret, especially if they are women, it 

creates a sense of insecurity in them about their future. 

They often fear abandonment by their husband or in-laws or 

have negative views on marriage prospects. In some 

instances, parents of unmarried daughters do not consent 

for amputation fearing their uncertain future. Consequently, 

women with amputations are seen as a "burden," making 

them more vulnerable than both able-bodied women and 

disabled men. 

Disability can either cause or result from poverty, creating a 

vicious cycle that is further exacerbated by stigma and the 

denial of basic rights and opportunities, particularly for 

women.1 In India, only a handful of organizations such as 

those supported by the Ministry of Social Justice and 

Empowerment and Ministry of Women and Child 

Development under the Government of India offers 

prosthetic devices at little or no cost to support individuals 

with disabilities. However, these prosthetic devices are 

often bulky, outdated in technology, and not well-suited to 

women needs.7 Apart from this, factors such as frequent 

volumetric changes in the residual limb, patient’s age, 

comorbidities, and the level of amputation often contribute 

to the rejection of prosthetic devices. Moreover, the side of 

the amputation can also play a role in this rejection, 

especially if it involves the dominant side, which is more 

relevant in case of upper extremity amputation. This can 

lead to a diminished sense of body perception, which 

significantly impacts performance, making individuals 

 
OPEN  ACCESS 

ABSTRACT 

Women in India, particularly those with amputation, face significant challenges, including but not 

limited to, unequal prosthetic access and satisfaction, societal discrimination, and the physical and 

emotional consequences of amputation. These challenges are further exacerbated by gender biases 

towards access to education and socioeconomic factors, which increases their vulnerability to 

unemployment and mental health issues. This article emphasizes the urgent need for affordable and 

customizable prosthetic options tailored to the unique needs of women with amputation, particularly 

those from low-income backgrounds who often face neglect. Thus, addressing these disparities 

would significantly enhance their overall well-being and independence. 

 

 

ARTICLE INFO 

Received: September 19, 2024 

Accepted: October 10, 2024 

Published: October 14, 2024 
 

CITATION 

Alam J, Joshi A, Mir N, Chawla N, Sagar S. 

Invisible struggles: Exploring challenges 

faced by women with amputation in India. 

Canadian Prosthetics & Orthotics Journal. 

2024; Volume 7, Issue 1, No.5. 

https://doi.org/10.33137/cpoj.v7i1.44002 

KEYWORDS 

Amputation, Rehabilitation, India, Women 

with Amputation, Prosthesis, Prosthetics, 

Quality of Life, Satisfaction, Disability 

 

 

* CORRESPONDING AUTHOR: 

Professor Sushma Sagar,  

Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, 
India. 

E-Mails: sagar.sushma@gmail.com; dr.sushma@aiims.gov.in  

ORCID ID: https://orcid.org/0000-0002-4700-9868   

Journal Homepage: https://jps.library.utoronto.ca/index.php/cpoj/index 

Volume 7, Issue 1, Article No.5. 2024 

 

 

https://doi.org/10.33137/cpoj.v7i1.44002
https://doi.org/10.33137/cpoj.v7i1.44002
mailto:sagar.sushma@gmail.com
mailto:dr.sushma@aiims.gov.in
https://orcid.org/0000-0002-4700-9868
https://jps.library.utoronto.ca/index.php/cpoj/index


 

2 

Alam J, Joshi A, Mir N, Chawla N, Sagar S. Invisible struggles: Exploring challenges faced by women with amputation in India. Canadian Prosthetics & Orthotics 
Journal. 2024; Volume 7, Issue 1, No.5. https://doi.org/10.33137/cpoj.v7i1.44002 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X CHALLENGES FACED BY WOMEN WITH AMPUTATION IN INDIA 

Alam et al., 2024 

slower and more self-conscious while limiting their overall 

function.8 

Moreover, in India, women from low socioeconomic 

backgrounds frequently engage in physically demanding 

jobs, such as domestic work, agriculture, and manual 

labour, which necessitate floor sitting, mobility, and stamina. 

Unfortunately, the affordable prosthetic options available to 

these women often fall short in providing the functionality 

required for these strenuous tasks. This inadequacy can 

lead to feelings of frustration, disappointment, and various 

health issues. 

The literature on people with amputation revealed that they 

often experience anxiety, depression, and post-traumatic 

stress disorder. However, women are particularly more 

vulnerable to depression following an amputation than men. 

If the amputation involves the upper limb, this risk doubles 

for women, as the upper limb is crucial for self-expression, 

self-care, and communication, leading to a greater 

functional loss compared to lower limb amputations. 

Moreover, if depression is diagnosed, the likelihood of 

unemployment increases tenfold. Even though men are 

more frequently subjected to amputations, women generally 

experience worse outcomes.9-11 

To address the specific challenges that women face in India, 

it is essential to provide affordable yet customizable 

prosthetic solutions that can support their unique physically 

demanding work schedules. The low-cost customizable 

prosthetic devices need to be less bulky and comparatively 

less in weight for improved functionality. A recent innovation 

by a prestigious Indian Institute offers a high-end prosthetic 

feature of cross-legged sitting in a low-cost above-knee 

prosthesis, holds promise in addressing this gap by not only 

making them independent but also allowing them to perform 

long periods of sitting, standing, or squatting, that are 

typically seen as a royalty for a non-affording person with 

amputation.12 

Furthermore, adopting a user-centered design approach 

that takes into account the experiences of women with 

amputations during the customization process can highlight 

essential details that might otherwise be missed. A more 

secure and snug-fitting suspension that minimizes 

bulkiness would also be particularly attractive from a 

cosmetic perspective for women. Additionally, addressing 

specific needs related to menstrual hygiene or pregnancy is 

vital, especially for those with higher levels of lower limb 

amputation where the proximal brim of the socket is a 

problem. Consequently, providing well-fitted and functional 

prosthetics is the way of empowering women, enhancing 

their physical and mental well-being, and reducing 

disparities in access to prosthetic use. This enables them to 

lead active, dignified lives, irrespective of their economic 

status or disability. 

DECLARATION OF CONFLICTING INTERESTS 

The authors have no conflicts of interest to disclose. The 

manuscript has been read and approved by all the authors. 

 

SOURCES OF SUPPORT 

None. 

REFERENCES 

1.Mishra S, Kumar D, Gupta AK, Yadav G, Ghosh S. A 

demographic study of lower limb people with amputation in a north 

Indian tertiary rehabilitation center. Indian J Phys Med Rehabil. 

2020;31(1):11–3. DOI: 10.5005/jp-journals-10066-0066 

2.Yuan B, Dong H, Gu S, Xiao S, Song F. The global burden of 

traumatic amputation in 204 countries and territories. Front Public 

Health. 2023;11. DOI: 10.3389/fpubh.2023.1258853 

3.Dar PMUD, Mir N, Katiyar AK, Sati HC, Priyadarshini P, Alam J, 

et al. Outcome predictors of patients who underwent limb 

amputation/s following trauma at a level I trauma center in North 

India. Eur J Trauma Emerg Surg. 2024;50(1):233-242. DOI: 

10.1007/s00068-023-02273-1 

4.Singh R, Hunter J, Philip A, Tyson S. Gender differences in 

amputation outcome. Disabil Rehabil. 2008;30(2):122–5. DOI: 

10.1080/09638280701254095 

5.Women’s pain is often not believed – here’s how to make your 

voice heard when seeking help [Internet]. Hindustan Times. 2023 

[cited 2024, Sep 19]. Available from: 

https://www.hindustantimes.com/lifestyle/health/women-pain-is-

often-not-believed-here-s-how-to-make-your- voice-heard-when-

seeking-help-101694585279987.html 

6.Perkins ZB, De’Ath HD, Sharp G, Tai NRM. Factors affecting 

outcome after traumatic limb amputation. Br J Surg. 

2011;99(S1):75–86. DOI: 10.1002/bjs.7766 

7.Not as good as real, but new prosthetics give confidence to live 

independent lives [Internet]. The Times of India. 2023; [cited 2024, 

Sep 19]; Available from: 

https://timesofindia.indiatimes.com/city/delhi/not-as-good-as- real-

but-new-prosthetics-give-confidence-to-live-independent-

lives/articleshow/97210838.cms 

8.Nico D. Left and right hand recognition in upper limb amputees. 

Brain. 2004;127(1):120–32. DOI: 10.1093/brain/awh006 

9.Kashani JH, Frank RG, Kashani SR, Wonderlich SA, Reid JC. 

Depression among people with amputation. J Clin Psychiatry. 

1983;44(7):256-8. 

10.Cheung E, Alvaro R, Colotla VA. Psychological distress in 

workers with traumatic upper or lower limb amputations following 

industrial injuries. Rehabil Psychol. 2003;48(2):109–12. DOI: 

10.1037/0090- 5550.48.2.109 

11.Hirsh AT, Dillworth TM, Ehde DM, Jensen MP. Sex differences 

in pain and psychological functioning in persons with limb loss. J 

Pain. 2010;11(1):79–86. DOI: 10.1016/j.jpain.2009.06.004 

12.IIT Guwahati creates affordable prosthetic leg for Indians that 

allows deep squatting, cross-legged sitting [Internet]. India Today. 

2022 [cited 2024, Sep 19]. Available from: 

https://www.indiatoday.in/education-today/news/story/iit-guwahati-

creates-affordable-prosthetic-leg-for-indians-that-allows-deep-

squatting-cross-legged-sitting-1965024-2022-06-21 

https://doi.org/10.33137/cpoj.v7i1.44002
https://www.hindustantimes.com/lifestyle/health/women-pain-is-often-not-believed-here-s-how-to-make-your-%20voice-heard-when-seeking-help-101694585279987.html
https://www.hindustantimes.com/lifestyle/health/women-pain-is-often-not-believed-here-s-how-to-make-your-%20voice-heard-when-seeking-help-101694585279987.html
https://www.hindustantimes.com/lifestyle/health/women-pain-is-often-not-believed-here-s-how-to-make-your-%20voice-heard-when-seeking-help-101694585279987.html
https://timesofindia.indiatimes.com/city/delhi/not-as-good-as-%20real-but-new-prosthetics-give-confidence-to-live-independent-lives/articleshow/97210838.cms
https://timesofindia.indiatimes.com/city/delhi/not-as-good-as-%20real-but-new-prosthetics-give-confidence-to-live-independent-lives/articleshow/97210838.cms
https://timesofindia.indiatimes.com/city/delhi/not-as-good-as-%20real-but-new-prosthetics-give-confidence-to-live-independent-lives/articleshow/97210838.cms
https://www.indiatoday.in/education-today/news/story/iit-guwahati-creates-affordable-prosthetic-leg-for-indians-that-allows-deep-squatting-cross-legged-sitting-1965024-2022-06-21
https://www.indiatoday.in/education-today/news/story/iit-guwahati-creates-affordable-prosthetic-leg-for-indians-that-allows-deep-squatting-cross-legged-sitting-1965024-2022-06-21
https://www.indiatoday.in/education-today/news/story/iit-guwahati-creates-affordable-prosthetic-leg-for-indians-that-allows-deep-squatting-cross-legged-sitting-1965024-2022-06-21

