Apprehension of contracting the disease and concurrent nationwide lockdown created uncertainty among millions of laborers compelling them to migrate from cities. Migrant workers are spine of unorganized workforce in Indian economy (1). An estimate by (Geetika et al., 2020) states that 90% of women workforce is engaged in informal sector in which 70% come from rural areas who migrate seasonally. Gross estimate of women migrants and their reproductive health needs have largely remained underreported, undocumented and politically unattended. Hence, the term emergence of “shadow epidemic” as a negative outcome of pandemic, for their inability to access sexual and reproductive health care needs (3). Exodus of laborers went back to rejoin their works again after the Government declared “Endgame of pandemic in India” in early March 2020 (4) but with the upsurge of devastating second wave of COVID-19, the plight of migrant women amplified exposing their vulnerability and status of Universal Health Coverage of India.
The spread of COVID in rural areas created a state of emergency due to ill-equipped infrastructure in Public Health system to handle spike in cases. This directed the Government to shift its priority deeming SRH activities as non-emergency, to respond to the needs of pandemic (5), consequently sidelining the reproductive health needs. Above that, seasonal migration disrupts the access to health care services in actual place of origin and also simultaneously creating missing and duplicity in public health records of antenatal, family planning and vaccination.
Siddiah et al. reports that most women migrants are in their reproductive age group and face huge inadequacy in antenatal care services in terms of reduced contact with formal health care providers, antenatal checkups, receipt of IFA tablets, contraceptives and managing medical emergencies (6). With strict protocols of social distancing in COVID, uncertainty in availability of medical doctors, suspended transportation and heavy charges applied for medical services pushed pregnant women in higher risk of unsafe home delivery and abortion leading to further dependence on informal providers. The idea of Universal Health Coverage through flagship programs of National Health Mission like: Janani Suraksha Yojana (JSY), Rashtriya Kishori Swasthya Yojana (RSKY), partial insurance coverage was breached during COVID crisis. Jahan (2020) explores the predicament of adolescent girls for non availability of sanitary pads during menstruation days that risked with Reproductive Tract Infections. Migrant women returning back to their villages had been through specially imposed quarantine that increased stigmatization and put them in seclusion (7). State lacked prior planning or disaster mitigation strategies and curtailed medical services during pandemic. While the Reproductive health services are also combined with nutrition and other maternal health services, haste management of COVID crisis brought their unexpected close down resulting in falling rate of tetanus vaccination for pregnant women, rising malnutrition, maternal mortality and still births.
The suffering was double folds, one from exposure to COVID and other was adverse outcomes as a result of measures taken to contain the viral Pandemic. The Lancet, observes this as inefficiency of India’s Public Health system to mitigate with the pandemic and to deal with avoidable maternal and child deaths (8). India struggles with high maternal mortality rate of 113 (9) and heavy burden of reproductive tract diseases, anemia and malnutrition among pregnant women (10). Other than maternal health, other treatable reproductive tract infections also remain untracked, undiagnosed and underestimated due to deficient robust Health Management and Information Services (HMIS) which fails to map the trajectory of migrant women. COVID made the matter cluttered and worse for the health care system to handle and added to many health disadvantages to women. Priority of the public health system remained curbing COVID-19 pandemic with relocation of the health machinery and directing National funds into COVID related activities deeming reproductive health needs and services as “non-essential”.
To address, the exact strength of unorganized women migrants should be tracked with support of community health workers along with strong interpersonal communication to disburse information related to SRH services. Adequate funding and flexibility in approach for SRH services integrated in a strategic manner with National programs especially to deal with emergency situations. SRH services should give enough flexibility that their access to institutional deliveries and family planning can be made possible in their place of work. Geographic Information System (GIS) Mapping and HMIS could be utilized to avoid duplicacy of MCH records owing to their movable nature. Above all, strong political commitment to accommodate the need of women migrants acknowledging them as equal citizens of India.
- National Commission for Enterprises in the Unorganised Sector. Government of India. The challenge of employment in India. An informal economy perspective. 2009. http://dcmsme.gov.in/The_Challenge_of_pdf. Accessed 26 May 2021.
- Geetika, Singh T. & Gupta A. (2011). “Women Working in Informal Sector in India: A Saga of Lopsided Utilization of Human Capital.” International Proceedings of Economics Development and Research 4: 534–538.
- COVID-19 and new gender equations, Response, Recover and Thrive, UN Global Compact Network, India. March 2021. https://www.globalcompact.in/uploads/knowledge-center/1615216821GES%202021%20Knowledge%20paper_spread.pdf , Accessed 30th May 2021.
- Awasthi P.(2020). “The Life of ASHA Workers in the Time of COVID-19,” This Week, https://www.theweek.in/news/india/2020/04/10/the-life-of-asha-workers-in-the-time-of-covid-19.html, Accessed 26th May 2021
- Siddaiah A., Kant S., Haldar P., Rai S.K. and Misra P. “Maternal health care access among migrant women laborers in the selected brick kilns of district Faridabad, Haryana: mixed method study on equity and access”. International Journal for Equity in Health, 17(171), 1-11.
- Jahan N. (2020). “Bleeding during the pandemic: the politics of menstruation” Sexual and Reproductive Health Matters; 28(1), 525–527.
- The Lancet. India’s COVID-19 emergency. Lancet 2021; 1683.https://doi.org/10.1016/S0140-6736 (21) 01121-1 (accessed May 23, 2021).
- https://censusindia.gov.in/vital_statistics/SRS_Bulletins/MMR%20Bulletin%202016-18.pdf. Accessed 30 May 2021
- National family health survey, India. Mumbai: International Institute for Population Sciences (IIPS) and Macro International; 2015-16. http://rchiips.org/nfhs/pdf/NFHS4/India.pdfAccessed 30 May 2021
Courtesy Counter Currents