Editorial 1: ​​Labour of care

Context

Better wages are essential for women driving rural health services.

Introduction

Anshakalin Stri Parichars (ASPs) in Maharashtra are the backbone of rural healthcare, performing vital yet undervalued labour. Despite decades of service, they endure stagnant wages, no job security, and systemic neglect shaped by gender and caste. Their protests echo those of ASHAs nationwide, exposing India’s dependence on underpaid women workers while denying them recognition, dignity, and rights.

Role of Anshakalin Stri Parichars (ASPs)

• Women serving as ASPs in Maharashtra perform some of the toughest and least acknowledged work in the rural health system.
• Their responsibilities span a wide range of health-related tasks.
• Despite their crucial role, recognition and compensation remain inadequate.

Wages and Employment Conditions

• Stagnant Pay:
  • Monthly wage stuck at ₹3,000 since 2016.
  • Fails to keep up with inflation.
• Lack of Benefits:
  • No job security or pension.
  • Absence of safety gear and travel allowance.
• Judicial Recognition:
  • In 2023, a Nagpur labour court acknowledged ASPs deserved protection under the Minimum Wages Act.
  • Left implementation to the State government.
• State’s Response:
  • Only verbal assurances so far.
  • Promise of ₹6,000 a month by December 2025 — still far less than multi-purpose health workers earn.

Systemic Neglect

• ASPs predate ASHAs (Accredited Social Health Activists) and anganwadi workers.
• They are easily ignored due to being poor, rural women.
• Their neglect reflects a gendered and caste-based hierarchy of labour within public health.
• Skilled work is undervalued because of who performs it.

Protests and Struggles

• ASPs’ protests part of a longer series of agitations across districts such as Kolhapur, Nagpur, Ratnagiri, and Yavatmal.
• Their struggles echo the experiences of ASHAs across India.

ASHAs’ Parallel Struggles

• Introduced in 2005 under the National Rural Health Mission.
• Serve as the community’s first link to the health system.
• Classified as “volunteers,” not employees.
• Paid only through delayed incentives, often below subsistence.
• Repeatedly demanded:
  • Fixed honoraria.
  • Recognition as government staff.
  • Social security benefits.

Structural Contradiction in Health System

• India relies heavily on women health workers for:
  • Maternal and child health care.
  • Immunisation drives.
  • Disease surveillance, especially in rural areas.
• Yet, these women are not recognised as workers with rights to wages, benefits, and dignity.
• Work is presented as “opportunity for service” but functions as exploitation.

Risks and Exploitation

• Daily threats include:
  • Snakebites while clearing hospital grounds.
  • Fatal accidents during vaccination duties.
• No insurance or compensation for such risks.

Call for Reform

• A health system that undervalues frontline workers weakens itself.
• Securing rural health requires:
  • Living wages.
  • Safe working conditions.
  • Stable, dignified employment for women health workers.

Conclusion

The struggles of ASPs and ASHAs highlight a deep structural contradiction: India’s health system relies on women frontline workers for maternal care, immunisation, and disease control, yet refuses to treat them as workers with entitlements. Ensuring living wages, safe conditions, and secure employment is not charity but essential to strengthening public health and upholding the rights and dignity of women.