On the Question of Access to Welfare and Health for Women During the Initial Phase of the Pandemic

The COVID-19 pandemic has exposed the fault lines of social inequality. Access to health, welfare, and well-being is unequal, and a large portion of our population lives in precarious conditions. As we begin to understand this global crisis, we see that it is standing on top of existing divides.

Women are half the world. But as images and reporting of migrant workers in crisis and travelling long distances poured in the initial phase of the pandemic, very few womens’ faces were visible. In fact, women workers only gained attention in the media when carrying children, seldom highlighted in their role as workers and people in their own right.¹ Millions of women workers in labour-intensive occupations, from domestic work, construction, to tailoring lost their jobs during the lockdown. Yet, we know very little about their lives during the pandemic. What effect has the pandemic had on the responsibility of care work, childbirth, household maintenance, and all the other forms of invisible labour women perform? 

Research Method

The methodology for this article involved in-depth semi-structured telephonic interviews with nine women, aged between 26–40 years, all of whom were working before the lockdown but lost jobs since March 2020.  The interviews assessed three major aspects of women’s lives in the initial days of the lockdown, between 25 March to 30 June 2020. First, the nature and sources (government, civil society) of dry ration and cooked food received and the condition of food intake in this period. Second, the impact of the lockdown on their work, wages received during this period, and any compensation of wage loss by employers or through direct cash transfers. Third, any health issues faced and steps taken, if any, to deal with them. Though the interviews focused on these aspects, other dimensions of their lives that came up during the interviews have also shaped the findings.

The Promise

In March and then subsequently in May, the government of India announced several welfare schemes under the Garib Kalyan Yojana package with the promise of providing dry ration to crores of poor. Under the Pradhan Mantri Jan Dhan Yojana (PMJDY), women Jan Dhan account holders were supposed to receive ex gratia ₹500 monetary assistance per month (MoHFW 2020).

The Pradhan Mantri Garib Kalyan Ann Yojana promised that the “government of India would allow nobody, especially any poor family, to suffer on account of non-availability of foodgrains due to disruption in the next three months” (PBI  2020). The same set of policy pronouncements also mentioned provisions for senior citizens, widows and Divyangjan (persons with physical impairments), amounting to a total of ₹3 crore for the latter two groups through direct cash transfers of ₹1,000 per month. The central government also promised rental relief. As per the Pradhan Mantri Awaas Yojana, the government aims to provide affordable rental housing for migrant labour and urban poor (MoHUA 2020).

The migrant women interviewed for this report belonged to Chhattisgarh, Delhi, Jharkhand, and West Bengal (“home states”) and worked in Tamil Nadu, Haryana, Rajasthan, and Delhi (“destination states''). Several of these states announced plans for migrants and low income workers. Among these, destination states like Tamil Nadu announced distribution of free ration and cooked food through Amma Canteens (Asianet 2020). The Delhi government started hunger centres and then allowed registration of electronic form for individuals without ration cards to avail PDS. The Rajasthan government announced food distribution, among other schemes. Haryana introduced a mobile app based helpline—Jan Sahayak App (Government of Haryana 2020). Announcements were also made by home states of West Bengal, Uttar Pradesh, and Jharkhand towards cash transfer of ₹1,000 for workers living outside the state. 

While several such welfare schemes were announced, the reality on ground seemed to indicate deep-rooted inequality and precarity exposed by the advent of the pandemic. 

The Reality of Welfare

As per the National Food Security Act, 2013, 75% of rural and 50% of urban population should be covered under the public distribution system (PDS) in India. But a large number of poor population, estimated 10 crore of them who otherwise should be covered, were excluded since the list has not been updated for years and statewise calculations are happening on the basis of the 2011 Census, while our population has far exceeded that (Hindu 2020).  Migrant workers in destination cities had been all the more excluded, given that no portability scheme has been in place till date. For those who did receive dry ration, the quantum would not be enough for a family to sustain themselves through the month, let alone receive adequate nutrition. The quantity varied from state to state, but on an average households received 5–10 kg of grains. This included cereal grains (rice and wheat) and not vegetables, milk, and other essentials. Interviews with women made it apparent that food scarcity impacted women in the household with greater intensity. 

None of the nine women we spoke to were receiving dry ration regularly, and cooked food services were also not known or available to all. Most women did not have ration cards.² All those who managed to receive ration without cards were only able to do so once, not on a monthly or regular basis. Prior to the lockdown, the women were dependent on meagre incomes for buying basic food and cereals from private providers, since their ration cards were not applicable in destination states. In case of even short disruptions to their daily wages, they were unable to feed themselves and their families adequately, as became amply clear through the lockdown. Food intake and nutrition had reached abysmally low levels through the lockdown for all respondents. 

Rashida, 40 years, lives in Yamuna Vihar, Delhi, with her husband, two children and widowed sister. She worked in an LED company in Anand Vihar. Rashida and her husband lost their job in March 2020. Rashida's sister got some work in April 2020, but only for a short while. She received a ration kit only once in the three months between March to June. She did not know where it came from. Her landlord told her to go and collect dry ration that was being distributed in the gali. She also received ₹500 from somewhere, but was not sure of the source of the cash either. In many cases, such as that of Rashida, beneficiaries were not aware of the exact source of relief since there were several sources of distribution, including civil society actors and local residents. Information about relief traveled via word-of-mouth in neighbourhoods. Rashida did not have a ration card. When asked whether she knew about the announcement of the state and central governments which indicated that even people without ration cards could get ration/foodgrains at regular intervals during the lockdown, she said that she did not have any information about this. Her widowed sister also did not receive any monetary assistance promised for widows.

Sushma, 20 years old, unmarried, from Jharkhand, works in a cloth factory in a tailoring job in Coimbatore, Tamil Nadu. She lost her job in March 2020 and came back to her village on 1 June. While staying in Coimbatore, she did not get any ration. She said she had filled what she referred to as the “Hemant Soren” form on mobile. She could be referring to the Chief Minister’s Special Assistance Scheme mobile app started by the government of Jharkhand in 2020 for providing assistance to migrant workers. She was not aware of the details of the assistance that was being offered but that some relief was available. But she informed us that she did not receive anything. She got ration and foodgrains, from the PDS, after returning to her village. While in Coimbatore, Sushma managed by pooling resources with others, “We are women, we have a habit. We used to pool together and manage. Eight of us, women lived together in a building and worked in nearby factories.” She added, “We had to come to the village because we were not getting work.” It is noteworthy how women who have travelled independently, living outside their households, create their own informal collectives in neighbourhoods or workplaces. 

The respondents either spoke of getting no ration at all, or had received some dry ration sporadically and were not sure of its source. When received outside PDS shops or government schools, they would assume it came from non-governmental organisations (NGOs). A recurring feature was women trying to get their names enlisted in “lists” circulating in neighbourhoods, or trying to call helpline numbers circulating on WhatsApp groups. 

They were left in a position where they were always “seeking help,” rather than being able to claim food security as a fundamental right. During the lockdown, low-income women were dependent on civil society or charitable individuals for food security despite an excess of foodgrains in the PDS, suggesting a systemic failure in fulfilling the provisions of the National Food Security Act, 2013 (Scroll 2020).

Farhana Bibi, a 46-year-old domestic worker in Delhi, sought help and support for food from all possible avenues—NGOs, individuals, civil society organisations, owners of the apartments where she worked, and her local member of legislative assembly (MLA). She received help a couple of times by a support group which distributed ration in her basti twice, once in April and then in mid-May of 2020. By the end of May, they too stopped taking her calls. She did not have a ration card. She knew of the e-coupon being issued by the Delhi government to access dry ration, and sought the help of her landlord to fill it out. But when she tried registering, the link failed. She tried opening the link multiple times over two consecutive days, but it failed each time. She also knew of a scheme announced by the West Bengal government through which she could get ₹1,000 as a migrant worker.³ She tried to register herself but failed in this as well because of some issues in her bank account details. She did not know what was wrong with her bank account because of which she could not get the cash transfer. She usually relied on her son to do any bank-related work. She has a daughter who has studied till fourth standard and was also not able to handle such official work. When I spoke to her, she was continuing to call all possible numbers in her phonebook for help as she has been refused work by all the residents of the apartments she had been working in before the lockdown.

Illiteracy among working-class women in both urban and rural settings has been a major concern over the past decades, with high drop-out rates, especially among younger girls after secondary levels (Taneja 2020). This is set to exacerbate by the pandemic-driven push towards digital education and online classes, given the gender gap in digital access (Singh 2020).  Access to welfare schemes is also, to a great extent, determined by how women can access information and communication devices. Although access to smartphones at the household level has increased, including among the labouring class, access for women in the household is still limited with men mostly controlling family-owned digital devices (GSMA 2016). Further, having access to a phone is not a direct pathway to being online. Even when there is a phone available in the household, women tend to depend upon husbands, fathers and sons to use the internet. During the pandemic, women even relied on owners of internet cafes and more literate landlords, shopkeepers in the neighbourhood to fill e-forms to access government schemes.

Aseema Khatun, 37 years, got her Delhi government e-coupon for ration filled out by someone in her neighbourhood. After receiving the form, she thought she had got a regular ration card. According to Aseema, she was not getting the ration card initially, but then she was told that the ration card was available through a link on the computer. She paid ₹100 to the person to fill out the form on the computer. She said, “Then the ration card was issued to me. Then I got gehu and rice. That too I did not get the entire amount due for 4 people.” Aseema had been looking for government relief measures since her household was in misery. She did not receive any monetary help or cash transfer, but was told that if she makes a labour card, she will get some monetary support. She got to know that some woman in Meer Vihar makes “labour cards,” and tried to get herself registered for one. She had already tried to make a “labour card” thrice even before the lockdown. Once, someone took ₹200 from her for making a card, but it got cancelled, and another time someone took ₹300 after promising the registration, but never returned her calls after. Aseema said, “Now this lady is saying she will make it hand to hand. I said okay, let’s try.” It is not clear which identification document or scheme Aseema was referring to by “labour card.”

Aseema lives with her husband and two children. When asked whether she works, she responded with a “no.” Then she revealed that she did cleaning jobs in three households before the lockdown, but said that “that is not what we can call work.” Aseema’s husband did assistant mistry jobs, but according to Aseema, he was not regular, had drinking issues, which is why she had to take up domestic work to take care of children.

Aseema's desperation to access any document or card to get enrolled in a welfare programme is indicative of the desperate position women workers were left in. The pandemic surfaced several layers of systemic lack of information and the curtailing of women’s access to social security as a result. State institutions failed to make themselves easily available to ones who need them the most, as has become painfully apparent through the pandemic. 

Health and Nutrition

The food crisis had its health effects over and above the virus itself. In India, women's health is generally neglected, with rampant malnutrition and anaemia. According to the National Family Health Survey, 2015-16, 53%–54% of Indian women in the age group of 15–49 years are anaemic (MoHFW  2017).

The dietary intake of most women in India lacks essential nutrients, due to a social norm of women eating after feeding others in the household. In poorer households, deficient food intake becomes even more severe (Sethi et al 2020). Food items containing essential nutrients like protein and calcium are often consumed first by other members of the family, before the younger woman whose responsibility is to care for members of the household. Practices of women eating at the end, eating leftover food, or not getting a share of protein-rich items like milk and egg are common (Chakraborty 2019).

With such practices, the COVID-19 lockdown and unavailability of proper food had adverse effects on the nutrition intake of women in poorer households. Most women I spoke to said that their staple diet through the lockdown was chatni roti and namak roti. Having three meals in a day was almost impossible for many of the respondents. Even with the gradual opening up of the economy following the strict lockdown in June, support through welfare fell short and employment opportunities continued to be scarce, with very little improvement in the food crisis. The cumulative effects of the lockdown and the COVID-19 crisis on nutrition and the general well-being of women will be long term, and much exceeding what is immediately conceivable.

The other aspect that was severely impacted during the lockdown was essential healthcare facilities for conditions other than COVID-19, which were almost suspended during this period. Women who were dependent on the public health system due to their inability to afford private facilities faced the brunt of this, even though private facilities were not operating either. Needless to say, the shortage in public hospitals was more than evident during the pandemic. A large proportion were converted into exclusive COVID-19 hospitals, and even if this was not the case, they were either closing down due to the spread of the virus, or the need to necessarily test every incoming patient for the virus combined with a shortage of tests resulted in denial of treatment. Pregnancy and maternity-related facilities were also severely affected.

Radha, 26 years, living in North Delhi, was eight months pregnant in March 2020, when the lockdown began. She had been visiting a general hospital in the Shastri Park area in North Delhi. When Radha went there during the lockdown, the hospital was unwilling to see her. They asked her to get an ultrasound from a private facility. Despite a  lack of finances, she was forced to do an ultrasound from a private lab. Then, after her admission to the hospital, she was told that she needed blood and needed to be shifted to another hospital. She was then admitted to another hospital, where too, she had to wait for two and a half days while being shifted in and out of the COVID-19 testing ward. Finally, she gave birth to a child who was infected with jaundice within a few days. Given the COVID-19 situation, she was advised to leave the hospital, although the newborn child, and the mother, both, needed extensive postnatal care and treatment. But staying back at the hospital was not possible. While jaundice is common among newborns, it does need care and can lead to complications. The public health system in India has failed to provide postnatal care to most women in India who cannot afford expensive care and treatment. The pandemic only showed the existing fault line. Radha had to come back home and was dependent on a doctor from a local clinic which too was closed due to the lockdown but the doctor agreed to see Radha.

The interviews also revealed that many other ailments, including life-threatening diseases such as cancer, could not be treated and many patients did not receive post-operative care during the COVID-19 pandemic with health facilities nearly collapsing. 

Nazma, a 35-year-old woman, from Delhi, living with her husband and four kids, used to work from home stitching buttons on garments provided by a contractor, earning ₹3,000–₹5,000 per month. With the start of the lockdown, she lost her work. She also had to take care of her cousin who was diagnosed with cancer immediately before the countrywide lockdown was announced. But she was not yet registered for treatment at any public hospital, and the treatment had not started when the pandemic hit. According to Nazma, the hospital at which she was seeking treatment had turned into a COVID-19 hospital. Nazma told me, “Now people have to go to the private. But if someone has no money, how will they do that?” Meanwhile, her cousin simply continued to take the pills that were prescribed to her before the lockdown and was unable to start treatment for cancer.

With the collapse of official infrastructure, women were only able to rely on community-level support for survival. From shopkeepers at local medicine shops taking up the job of paramedics to women having to gather support from each other, the pandemic clearly demonstrated the neglect of the well-being of marginalised groups in urban geographies.

Unemployment

As per the census and other official statistical systems, migration among women is mostly attributed as being tied to marriage. As per  Census  2011,154 million out of 221 million women migrants attributed “marriage” as the reason for migration, 69.6% of all women who migrated (MoHUA 2017). However, these numbers do not capture the entry of women into the workforce even if their primary trigger for migration was marriage, which also gets missed out in public debates around migration. Many women are also migrating primarily to join the workforce.

Sundari, a 27-year-old from Chhattisgarh, worked as a checker in a company called DMS in Neemrana, Rajasthan. DMS is a vendor company of Maruti Suzuki that manufactures nuts and bolts. She has been staying alone in Neemrana for many years. She lost her job in March 2020 when the lockdown started. She received her salary only till April 2020. She knew of no welfare scheme or forms for which she could apply. She said that not much information reaches where she lives, a few kilometres away from Neemrana. She had been staying by herself for very long and had gotten used to it. She did not go back to her village when the lockdown was announced because she did not have her Aadhaar card. Her Aadhaar card remained with the thekedar of the company at the time of speaking as well.⁴ She was no longer sure if she would get the chance to go back. 

All women interviewed lost their jobs during the lockdown. Some waited till they could sustain themselves with the hope they would get their jobs back, and returned home eventually. Once home, they became dependent on their husbands or in-laws.

Farzana, 39 years, a single mother of four, had to return to her in-laws’ house in Gorakhpur, Uttar Pradesh when she failed to get her job back in Gurgaon, Haryana. She lost her job in March 2020 with the lockdown. The company reopened but did not call her back. She said, “I am staying with my in-laws. You know how it is with family. Now I have no money in hand, what can I do. They only do all the things and feed me and my children. I cannot say anything … I have to totally depend upon them. How much will I ask, so whatever is there, I have to do with that. I can work only when I go back to work outside. It has also now been two– months that the rent is piling, plus all my kids are in school.”

Farzana worked in Gurgaon for 15–16 years. For Farzana, a single earning mother, the loss of livelihood and lack of social security has meant going back to a life of dependency. For a woman who earned her living and took care of four children with little support, this dependence was very distressful. There was also no certainty about how she would be able to break out of this dependence.

The COVID-19 crisis will have far-reaching consequences for the question of women’s employment. Women have largely joined the unorganised and informal sector, and the precarity of work and sporadic job loss has been key to the poor condition of working women during the pandemic. The impact of the pandemic will make way for even more flexible work relationships and compressed wages. Further, to the extent that employment is linked to the question of women’s empowerment and social independence, the COVID-19 pandemic has created long-term adversity. More and more women will be pushed to do unpaid care work and shoulder greater responsibility of household chores, increasing structural dependency.

Conclusions

This article aims to bring out economic, social, and health dimensions of the pandemic’s impact on women. Several factors have contributed to the crisis: the near collapse of the non-COVID-19 public health infrastructure (which was already inadequate for the health needs of low income women), precarity of women’s work in the informal economy combined with job loss, and inadequacy of welfare schemes and social support. There has been a severe impact on women’s nutrition and health, stemming from the crisis in household-level food security and their status as caregivers within the household. 

Women’s lack of access to digital technology and poor digital skills (GSMA 2016), have further created barriers in accessing critical information and registering themselves for emergency welfare schemes, including those specifically targeted towards women beneficiaries. This meant that the women included in this study were all dependent and vulnerable on various sources for survival. The issues they raised are often dismissed as “implementation issues” in policy discourse. What their stories reveal, instead, are fundamental concerns regarding the vision of “digital India” for welfare delivery and what its implementation is actually achieving for women on the margins.

Health and nutrition came up as important aspects during the interviews. The lack of even minimum care due to the pandemic, particularly for non-COVID-19 cases, brings attention to the urgency of directing more funds towards India’s failing public health system. The poor state of infrastructure also meant that women were downplaying or failing to report health conditions to not cause “further trouble” to families amidst economic hardship. The inadequacy of state infrastructure to address the reproductive and sexual health of women also came up as a serious concern.

As all the women I interviewed worked in the informal economy with no job security, they faced immediate loss of employment during the lockdown. This had disastrous consequences for single mothers and other women supporting their families in particular. The women I spoke to were employed in sectors that are overrepresented by women workers, such as domestic work, construction, and contractual work in garment manufacturing. These are sectors with little protection in labour law, with domestic work still to be recognised as “work”. These women were completely bereft of provident funds or pensions, with no safety net during this crisis. 

Though my interviews were mostly focused on questions of access to welfare benefits and health, several other issues also came up in conversations with women. Constraints on physical mobility, increased burden of household work due to extended stay at home, prolonged hours of childcare with closure of schools and anganwadis, and increase in domestic violence together led to a general sense of unfreedom among my respondents.

What also emerged were bonds of solidarity forged among migrant women to fight the crisis, particularly when they were living by themselves in distant cities with few social networks. These bonds were critical to ensure survival at points when no other support was available.

The impact of a pandemic is assessed by not just how many it infects but in deeper societal effects. Existing structures of social inequality are not just deepened but also constitute and shape the crisis. Lessons from previous epidemics like Ebola, SARS, and Zika (Conversation 2016) in other parts of the world, or natural disasters in our own country, suggest that women remain among the most systematically disempowered when dealing with crises. While we failed to learn from these lessons in the past, it is critical to carry them into the future.