“My husband says that taking care of these matters is a woman’s job. He asks me, do you want to make me look unmanly by using a condom?” Those were the words of Suman (name changed), 26, who lives in a resettlement colony near Delhi’s Rajouri Garden, and who supplements her family’s income by working in middle class homes in the neighbourhood.
She was one of the women I spoke to while researching maternal health issues of domestic workers living in urban clusters and shanty towns across India’s capital city of Delhi. The field work covered select patches near Budhella, Keshopur and Hasthsal villages (near Vikaspuri in South West Delhi); slum settlements near Rajouri Garden and Mayapuri; and resettlement colonies near Tughlakabad and Sangam Vihar (South Delhi). The paper that emerged, entitled ‘Living On the Edge: Maternal Health Issues of Domestic Women Workers’, revealed the clear lack of a well-defined and workable system of maternal and neo-natal health for domestic women workers in the informal economy, and the critical need for such support.
Largely migrants, most of these women lived in makeshift homes and led extremely vulnerable lives. While Delhi was the site of my research, the findings that emerged could hold true for any big city in India. Rural distress and poor access to paid labour in the hinterland ensure that there is a constant flow of women and men in search of unskilled employment into the urban centres of the country. Simultaneously, there is also a sharp increase in the numbers of middle class women pursuing professional careers and looking to shift the household workload that inevitably falls on their shoulders, on to the poor women employed in their homes as domestic workers.
These “housemaids” had few support structures, little education and almost no bargaining power. To add to their many deprivations was their lack of access to affordable and quality contraception and maternal health care. Even their partners failed them, as we saw in Suman’s case. According to my research, 73 per cent of the male partners of the respondents did not concern themselves with family planning in any way and the use of the condoms was very low.
Pregnancy brought its own share of traumas. A majority of respondents – 77 per cent – continued to work almost until the time came for them to give birth. This was because most of the women bore the sole responsibility of taking care of their household. They could neither afford hired help nor forgo their monthly or daily wages. Being in the informal sector, they, of course, received no paid maternity leave. So they carried on at their hard grind even in the advanced stages of pregnancy.
A woman from Sangam Vihar near Tughlakabad Fort spoke for many when she said, “My husband doesn’t earn anything. He is a useless drunkard. How can I, the sole bread earner for the family, stop working for so many months? Who will support us?”
What was striking about the findings of the investigation was that although most of these women went to a hospital or saw a doctor during their pregnancy, a large number of them – 66.6 per cent – had delivered at home as opposed to a hospital (23.3 per cent) or a clinic (10 per cent). Talking to the women provided insights into why this was the case in a major metropolis like Delhi with innumerable health facilities.
The reasons varied. In some cases, it was the lack of financial resources. Revealed Laxmi (name changed), who lives near Budhella village, “We don’t have enough money to have a vehicle ready for us at all times. If there is no means of transport, we have to give birth at home.” In other cases, it was the lack of education and the inability to make an informed choice. Savita (name changed), said she conformed to family diktat by delivering at home. As she put it, “My in-laws told me that it was tradition to call the ‘dai’ (traditional birth attendant) home for helping with the delivery. What is the need for wasting money in hospitals?” In fact, 53.33 per cent of respondents revealed that the decisions on healthcare during pregnancy were made by the “elders” of the family, who were more likely than not to hold conservative views on such issues. The pregnant woman herself contributed little or no inputs in this decision making process.
The lack of personal agency when it came to contraceptive and maternal healthcare manifested itself in different ways. During the focus group discussions, some housemaids shared how they often requested their “memsahibs” (women employers) for morning-after pills after they had had sexual relations with partners without having used contraception of any kind.
This appeared to be a fairly widespread phenomenon and again underlined the lack of access to information and contraceptive services among migrant domestic women workers in urban clusters. This pointed to the larger reality of a health delivery system that had several inherent weaknesses. Even in something as basic as information generation, there were many gaps. The core behaviour change messages of the much acclaimed strategic health communication campaigns run by the government, that focus on maternal health and family planning, appeared to be very poorly accessed or even understood by the women from this section of society and their male counterparts. Either these messages are wrongly conceived or the media chosen to transmit them is proving ineffectual. For instance, most respondents accessed private FM radio stations, but public interest messages on maternal health and family planning were rarely broadcast through them.
These are women who spend their best years on an unrelenting double shift – working furiously to clean up other people’s homes, cook other people’s food, and look after other people’s children, even as they struggle to feed their own families, clean their own homes and keep their own children in schools. And their numbers are growing by the day. Yet, they do not figure in government policies or benefit from social welfare initiatives and programmes. It is time that India’s domestic workers they are given a fairer compensation for their work and provided with adequate support structures, including quality health and contraceptive care.
