“If he has education, there will not be any problem”: Factors affecting access to education for children with disabilities in Tamil Nadu, India

implementation [1]. For example, official data indicates an increase in the number of schools that have been upgraded for accessibility, but many have experienced faulty provision (e.g., installation of non-useable ramps) [20]. There has been an evolution in India’s policies towards inclusive education. Colonial and early post-colonial approaches to disability and inclusion, including in education, have focused predominantly on a policy of segregation [21]. In 1966, the Kothari Commission recognised the importance of including children with disabilities in the Indian education system [22]. It set up a dual approach that has been the dominant model of education for children with dis- abilities in India, in which there is an emphasis on both encouraging enrolment of some chil- dren with disabilities into mainstream schools while also focusing on the creation of special schools. More recently, there has been more of a shift to “inclusive education”, such as in the 2016 Rights of Persons with Disabilities Act and the 2016 National Education Policy, although segregated schools are still common [19]. There is some evidence that the enrolment of children with disabilities in India has increased in the past decade. For example, the proportion of children with disabilities in pri- mary schools increased by 50% between 2011 and 2016, from 0.8% to 1.2% of all children enrolled [19]. However, the proportion of children with disabilities in secondary school has remained unchanged (around 0.3%) over this time.

Further, these figures only capture children with official certifications of disability and do not provide information on the proportion of children with disabilities out of school. Even with increased enrolment, studies have highlighted persistent barriers to accessing and benefit- ting from education in different regions of India. These barriers include institutional chal- lenges, including inadequate teacher training, inaccessible facilities, insufficient adaptations, and specialist resources, and negative attitudes toward disability held by teachers and peers without disabilities [8, 23]. Other barriers at the community and household-level include pov- erty, lack of accessible and affordable transport, and caregiver attitudes about the ability of children with disabilities to learn and the value of education [8, 24]. Additional research is needed to explore the experiences of children with disabilities in accessing education in differ- ent contexts, including barriers and facilitators. Consequently, this study focuses on the per- spectives of children with disabilities and their families and caregivers in Tamil Nadu, India to understand the factors affecting decisions on if and where to enrol, how children got to school, their social and academic experience while at school, and learning outside the classroom. Materials and methods Study area and setting This study was carried out in two sites, a rural block in Ranipet district, Timiri (formerly Vel- lore district) and a tribal block in Tiruvannamalai district, Jawadhu Hills, both in Tamil Nadu

in southern India. These communities were chosen as this research was linked to an ongoing study in these areas with censused populations (DeWorm3 study) [25]. The ongoing DeWorm3 study is a multi-country, cluster-randomised controlled trial to test the feasibility of interrupt- ing transmission of soil-transmitted helminths using community-wide mass drug administra- tion in all ages compared to the standard of care (targeted deworming including pre-school and school aged children) [25]. As part of the DeWorm3 study, a baseline census (in 2017) of all individuals residing in the two study sites enumerated a population of 140,932 individuals [26]. During the DeWorm3 census update in 2019–20, children in the ages 5–17 years were screened for disability using the UNICEF/Washington Module on Child Functioning [27]. This module uses caregiver-reporting to identify children with functional limitations across a range of activi- ties (e.g., in seeing, hearing, walking, communicating, and cognition). For most activities, PLOS ONE Access to education for children with disabilities PLOS ONE | https://doi.org/10.1371/journal.pone.0290016 August 16, 2023 3 / 19