Submitted by: Group No.

9- Aashita Saini ( S213DSC02), Suchismita Deb

(S213DSC49), Meezan Anjum (S213DSC26) (MA. Sociology Batch)

Exploring the Gendered Experience of Healthcare and Health-Seeking

Behaviour among the Tea Garden Community of Assam

Introduction

Assam, the largest tea-producing state, contributes to over fifty percent of the total tea production

in India. Assam’s history with tea dates back to the Colonial period during the 1800s. They are

mostly known as the tea tribes and they belong to mostly the category of ST and some SC. The

tea garden labourers suffer from poor socio-economic conditions and lack of basic amenities like

clean drinking water, sanitary facilities, and ration and health services. The women labourers

form a massive proportion of plantation labourers not only in Assam but across the county. The

women labourers are doubly exposed to health issues along with the other socioeconomic factors

that influence the same due to their gender barriers both in their household and their work

environment. The socio-economic and cultural factors form the social determinants of health that

pattern the health and healthcare-seeking behaviour of this community.

Objectives of the Study

● To examine the nature of marginalisation experienced by women in tea garden communities

that influence their health-seeking behaviour and healthcare experiences.

● To understand the interplay between socio-economic factors, working conditions, and health

outcomes within tea garden communities.

● To examine the dynamics of gender relations to understand the systemic mechanisms of

domination that impact women workers within the tea garden community of Assam.
 Submitted by: Group No. 9- Aashita Saini ( S213DSC02), Suchismita Deb
(S213DSC49), Meezan Anjum (S213DSC26) (MA. Sociology Batch)

Research Questions

1. What are the socio-economic and cultural factors that enhance the marginalisation of the

women of the tea garden community in terms of seeking health care services and health

behaviour?

2. How does the process of seeking healthcare and the health-seeking behaviour become a

gendered experience among the tea garden community?

Study Area

The study aims to explore how the gendered experiences of healthcare-seeking behaviour among

tea plantation workers in India, here in Assam which are shaped by socio-economic conditions.

Specifically, the study will examine the extent to which traditional healing practices are used in

lieu of professional medical care, particularly for certain types of illnesses. Gender is a

significant factor in this investigation, as women are known to face greater discrimination and

barriers in accessing healthcare services, particularly in developing countries like India. The

study will seek to understand the underlying reasons behind the gendered difference in

healthcare-seeking behaviour in the tea garden community, including the role of cultural beliefs,

financial constraints, and social norms.

Methodology

This study employs a literature review and thematic discourse analysis as its methodology to

investigate the impact of socio-economic and cultural factors on the health status and health-

seeking behaviour of women in the tea garden community. Alhough health-seeking behaviour is

subjected to change given space and time, however, owing to the time-constraint field analysis

has not proved to be a viable option. Hence, the study uses the various existing literature and
 Submitted by: Group No. 9- Aashita Saini ( S213DSC02), Suchismita Deb
(S213DSC49), Meezan Anjum (S213DSC26) (MA. Sociology Batch)

theoretical understanding to examine the manifestation of health disparities as a discriminatory

social phenomenon, particularly among women in the tea garden community of Assam.

Literature Review

MacKian (2003) talks about health-seeking behaviour as a social phenomenon moulded through

social factors such as economic, geographic, cultural, religious, gender, caste, and other

cognitive factors. She suggests two approaches to understanding HSB better. One is healthcare-

seeking behaviour, which analyses what facilitates the utilization of health services and the

various social determinants of health that acts as barriers or facilitators of seeking healthcare

between the patients and the services, which includes factors like geographical location, social

and economic conditions, and cultural and organizational factors. The author suggests analysing

when and how healthcare is sought and in what form (traditional or professional). The second

approach is the health-seeking behaviour which looks at the complex process of sequential

remedial action and the factors influencing the decision of opting or rejecting certain healthcare

practices to rectify or cure a perceived ill health. She theorizes HSB through social capital and

“reflexivity” (Lash 200) and argues that it is imperative to take into consideration the complex

factors that influence an individual’s behaviour in given time and space. The widely used theory

that health inequalities are directly or indirectly linked with social, economic, and cultural

inequalities brings into focus the concept of social capital as a key theoretical idea to analyse

Health Seeking Behaviour. It is argued that higher social capital results in positive health impacts

and health-seeking behaviour.

Drawing from MacKian (2003), our research study examines the theoretical base through the

concepts of social capital and reflexivity which provide a framework for understand the health-
 Submitted by: Group No. 9- Aashita Saini ( S213DSC02), Suchismita Deb
(S213DSC49), Meezan Anjum (S213DSC26) (MA. Sociology Batch)

seeking behaviour as a social phenomenon among the community in a given social space and

time.

Dutta and Samanta (2022) in their paper, question the patriarchal and capitalist socio-economic

set-up of the tea gardens by critiquing the narrative of ‘two leaves and a bud’ as a driving factor

for the deteriorated and marginalised status of the women of the tea gardens. The articles delve

into the history of this marginalisation from the colonial times to the present times and argue that

the systematic subjugation of women as exploited bodies continue owing to the capitalistic

mentality which subjects them to low wages and hazardous work conditions as well as the

patriarchal socio-cultural set up both within and outside their homes. Thus, despite being a

financial contributor to the family, they are deprived of basic decision-making power. The article

also talks about the dual role and burden of female workers as both homemakers and earners and

questions the very idea of women’s primary responsibility as caregivers. The article argues that

the primary role of women is confined to unpaid domestic work, hence they act as a reserve of

cheap labour. The concept of tea-plucking only being associated with women and their delicacy

makes room for appointing women workers for only the peak seasons as casual workers for

maximum profit making. Thus, the irregularity of income increases the tendency of overworking

among women in the garden to meet ends financially.

Dutta and Samanta (2022) work is relevant for our research study as it examines the

unavailability and inadequacy of the medical facilities within the garden, despite the introduction

of the Labour laws (1951) and health benefits and there is an absence of even the most basic

health requirements. It also highlights that the women are extensively unaware of their rights

which adds up to their systematic marginalisation by men both within families and outside which

we are exploring in our research study. The factors mentioned in this study are relevant to our
 Submitted by: Group No. 9- Aashita Saini ( S213DSC02), Suchismita Deb
(S213DSC49), Meezan Anjum (S213DSC26) (MA. Sociology Batch)

research topic as the above factors like, dual labour responsibility, over-working, domestic

exploitation, lack of decision-making power, and the lack of implementation of the health

facilities as mentioned in the Act 1951, lead to poor health conditions and behaviour among the

women labourers.

Sutradhar (2013) explores the structural and systematic marginalisation of the women of the

Cachar tea gardens from all aspects since the colonial period. The author discusses

marginalisation under 4 factors, viz, immigrant status, gender, class, and caste. The author argues

that the socio-economic exclusion of women is not solely culturally embedded but also produced

systematically by legal, structural, and economic imperatives. Gender itself becomes the sole

representative of patriarchy and sexism leading to the subordinated position of women within

homes and communities (social), workplace (economic), and state (political). Women in the

patriarchal social construct inherently have been seen as the secondary class which further aids

the structural exclusion. Such discrimination and systematic exclusion lead to a lack of

education, decision-making power, and awareness of rights. These negatively impact not only

the social positioning as a woman but also impacts health in a negative light. In our research

study, we are analysing the impact of such exclusions on the health-seeking behaviour of women

labourers in our study.

Rajbangshi and Nambiar (2020), in their study of the health status and determinants of health

among the women labourers of Assam tea plantation talks specifically about how women are

victim of larger social and health discrimination, despite forming the backbone for social

reproduction and regeneration of workforce in the tea plantations. The paper states that women

form more than 50% of the labour force and yet continue to remain in poor health conditions

which are influenced by the social determinants of health (SDH) like hazardous work conditions,
 Submitted by: Group No. 9- Aashita Saini ( S213DSC02), Suchismita Deb
(S213DSC49), Meezan Anjum (S213DSC26) (MA. Sociology Batch)

lack of education awareness, and health care services. This study is relevant to our research as it

explores the instances where women are reluctant to use government health services due to

delays and a lack of doctors and health providers. Additionally, there is also an exclusionary

factor of upper caste practitioners not willing to mindfully attend to the patients. There is an Out

of pocket expenditure that comes in as the labourers seek health care from private pharmacies.

Women also delay seeking health care due to the fear of wage deduction and other private issues

like gynaecological problems. Other than that low social position and dual pressure of paid and

unpaid labour induces anxiety and depression among women on the plantation. This study is

relevant as it highlights the various SDHs that impact the health status and health-seeking

behaviour among the women of the concerned community.

Das and Dhanaraju's (2019) investigation delves into the socio-economic history of women

workers within the tea garden industry, with a particular focus on the pervasive marginalisation

of women in Assam. The study explores how women's subordination in this sector is shaped by

the interplay of the forces of production and societal norms. By examining the gendered division

of labour in the tea gardens, Das and Dhanaraju (2019) identify the dependence of women on

men and their precarious living conditions as contributing factors to their marginalisation.

Furthermore, the study underscores how the feminization and undervaluation of women's labour

in tea gardens are perpetuated by the limited tasks associated with the industry, primarily the

plucking of tea leaves, which are traditionally considered suitable only for women and children.

Drawing from Das and Dhanaraju's (2019) seminal work, our research study aims to elucidate

the nature of marginality that women experience in tea garden communities and the factors that
 Submitted by: Group No. 9- Aashita Saini ( S213DSC02), Suchismita Deb
(S213DSC49), Meezan Anjum (S213DSC26) (MA. Sociology Batch)

shape their health-seeking behaviour and healthcare experiences. Additionally, we are borrowing

Das and Dhanaraju's (2019) concept of systematic and structural marginality, along with the

structural domination of the state and patriarchy, as a framework to explore the complex

challenges that women face in accessing healthcare services in tea garden communities. Through

this approach, we seek to contribute to a deeper understanding of the underlying dynamics of

gendered experience and health disparities among women.

Rasaily (2014) study employs case studies in the tea-growing regions of Jalpaiguri and

Darjeeling in West Bengal to establish that women have effectively negotiated and emerged

from the structures of power and authority, both in the workplace and in their domestic spheres.

The study is pertinent to our research as it pertains to the small tea grower sector, which has

remained largely unexplored, particularly with respect to the socio-economic dynamics of

women small growers and workers.

Rasaily (2014) argues that plantation societies are characterized by the pervasive influence of

patriarchal norms and practices, as well as the social structures that reinforce them. Women's

engagement in tea plantations is higher owing to the gendered attributes associated with tea leaf

picking and the steady reproduction of labour. Our research paper is exploring the effects of the

intersection between production forces and patriarchal norms on women's labour, which is a

critical site where these forces converge and potentially conflict. Drawing from Rasaily's (2014)

analysis, our research study is exploring the complex interplay between socio-economic

conditions, working circumstances, and women's health in the context of the tea industry. By

exploring the experiences of women in this industry, our study seeks to provide insights into the
 Submitted by: Group No. 9- Aashita Saini ( S213DSC02), Suchismita Deb
(S213DSC49), Meezan Anjum (S213DSC26) (MA. Sociology Batch)

ways in which gender and work intersect to shape health outcomes (both physical and mental)

and opportunities for women in plantation societies.

Bora (2022) explores the gendered facets of the tea garden community in Dibrugarh and

Tinsukia, Assam, with an exclusive focus on the economic and health status of female labourers.

She examines the different structures of gender hierarchy that prevail in tea gardens, along with

the representation of women workers in trade unions. Bora (2022) argues that traditional healers

continue to remain the primary healthcare providers for women in the tea garden community,

especially for those who encounter financial constraints and limited access to modern healthcare

resources. Drawing from Bora (2022) analysis, our research study examines the entrenched

influence of traditional practices in cultural and gender norms that often assign the burden of

household duties on women, thereby leaving them with meagre time and resources to avail

medical facilities.

The study is relevant for our research project to understand the engenders of a hierarchical

structure within the workforce, conditioned by various intersecting factors, such as gender,

employment type, and healthcare access. Additionally, our study aims to contextualize the

compounding effects of social stigma, limited access to education, and inadequate resources on

women's gendered experiences, ultimately undermining the health and well-being of women

workers.

Joyashri Dey et al. (2020) examines how gendered experiences and dynamics shape women's

health-seeking behaviour and their perceptions and utilization of healthcare services under the
 Submitted by: Group No. 9- Aashita Saini ( S213DSC02), Suchismita Deb
(S213DSC49), Meezan Anjum (S213DSC26) (MA. Sociology Batch)

National Rural Health Mission (NRHM). The scholars argue that the concept of women's health

is multifaceted, comprising physical, psycho-social, spiritual, and environmental aspects, which

are all interrelated. Women's health is also considerably impacted by the stress of work and

family obligations, as well as gender-based societal constraints. Communication barriers and low

levels of patient literacy further constrain effective communication with healthcare practitioners

and the understanding of treatment modalities and instructions.

Dey et al. argue that women in Cachar experience reluctance to engage with male healthcare

professionals, but they expect better treatment for issues related to reproductive health. Medical

practitioners also fail to provide adequate information to patients belonging to the Scheduled

Tribes group. Our research study examines women's inferior status in the family and society

curtails their access to healthcare, decision-making, education, and financial resources, rendering

them uninformed about health issues, unable to recognize illness, or dependent on older family

members or men for medical care.

Kalita (2016) examines the tea plantation serves as a social center for the workforce as well as a

place for economic output and profit-making. The labour force on tea plantations is largely made

up of women. However, gender norms and the resulting hierarchies affect how they live, which

results in oppression, privation, and misery for them. This article aims to comprehend the lived

experiences of women working on tea plantations and the conceivable role that social workers

can play in emancipating the lives of these labourers, based on the Durrung tea estate in Assam.
 Submitted by: Group No. 9- Aashita Saini ( S213DSC02), Suchismita Deb
(S213DSC49), Meezan Anjum (S213DSC26) (MA. Sociology Batch)

Drawing from Kalita's (2016) research findings, we aim to explore the intersection of ethnicity

and identity, the living and working conditions of women tea plantation labourers, gender

discrimination in tea plantations, and the invisibility of women's work, where their economic

contribution is acknowledged but their household contribution is not.

Rajput et al. (2021) reveals the frequency of disease and the way in which Assamese tea garden

workers use medical services, including their awareness of and reliance on health insurance. The

study examines the associated enabling elements and impediments to the use of healthcare

services. In terms of everyday living and working circumstances, uniformity of minimum

salaries, and provision for better healthcare facilities, which is relevant for our study as it

produces evidence to reinforce the Indian Plantation Labour Act, of 1951. These can be achieved

by having well-funded tea garden hospitals, combining health and other social services, and

coordinating on multiple levels between state, federal, and local health agencies and tea boards.

Drawing from Rajput et al. (2021) work, we are investigating and identifying solutions for the

gendered experiences of healthcare and health-seeking behaviour among Assamese tea garden

residents.

Sahoo et al. (2011) examines the health practices of the tea workers at the Beesakopie tea estate

in the Tinsukia district and provides comprehensive details about the socioeconomic and cultural

background of the group. The study examines the dietary customs and practice that results in

people regularly eating without getting enough nourishment. There is a paucity of protein in the

diets of the sample size studies because all the participants are vegetarians. Other factors that

contribute to community illness include alcoholism and cigarette use. The study also identifies a

discrepancy between the number of calories consumed and those that are needed. The pattern of
 Submitted by: Group No. 9- Aashita Saini ( S213DSC02), Suchismita Deb
(S213DSC49), Meezan Anjum (S213DSC26) (MA. Sociology Batch)

food intake thus plays a crucial influence in the ongoing malnutrition and sickness linked to food

inadequacies among the tea community of this Location. Sahoo et al. (2011) study is relevant for

our study as it demonstrates the extent to which these tea industry workers are not mindful of

their own health, mainly from underrepresented groups, particularly women and tribal people.

Das et. al. (2018) explore the underlying perceptions influencing disparities in the treatment

choices made by men and women living in an urban slum in Kolkata, India. Women's behaviour

in combining formal and informal care shows that they are interested in maintaining their socio-

cultural ethos while caring for their disease. Additionally, their behaviour in seeking health care

is related to the fact that they are seen as having a lesser social status than men, which forces

them to overcome sociocultural barriers relating to mobility, morality, upholding the status of

their families, and maintaining health privacy. Women frequently turn to unofficial health care

when they can't convince their spouses to change.

The study explores how women occasionally switch between informal and formal health care or

use both when it comes to male and female preferences for doctors and therapies. Additionally,

the study is relevant to our research as it explores how men experience economic stressors,

whereas women have greater cultural expectations, social obligations, and economic

implications. In comparison to males, women give more justifications for choosing therapeutic

interventions to account for these various characteristics. Drawing from Das et. al. (2018), we are

examining the socio-cultural and economic factors that contribute to the gendered experiences of

healthcare-seeking behaviour among men and women.

References
 Submitted by: Group No. 9- Aashita Saini ( S213DSC02), Suchismita Deb
(S213DSC49), Meezan Anjum (S213DSC26) (MA. Sociology Batch)

Bora, M. D. (2022). Structures Of Gender Hierarchy In the Tea Gardens of Assam: Listening To
a Few Narratives of Tea Garden Women Workers. Changing Status of Women in Post
Independence India, 176-181.

Das, G., & Dhanaraju, V. (2019). Issue of Marginality and Tea Garden Women in Assam, India.
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Dey, J., Ramanathan, C., & Dutta, S. (2020). Issues and concerns of women’s health in India: A
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Dukhabandhu Sahoo, Konnaki Konwar, and Bimal Kishore Sahoo (2010). Health Condition and
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 Submitted by: Group No. 9- Aashita Saini ( S213DSC02), Suchismita Deb
(S213DSC49), Meezan Anjum (S213DSC26) (MA. Sociology Batch)

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