10/3/23, 8:00 PM Home health care industry in India; an account of genderised labour in commercial health care economy - ScienceDirect

Women's Studies International Forum

Volume 88, September–October 2021, 102497

Home health care industry in India; an account of

genderised labour in commercial health care
economy ☆
Ritumoni Das

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Abstract

In India traditional care givers has provided care to family members and kith and kin. It is noteworthy that
when it comes to family providing care to ailing, elderly and children, care work has been genderised in
nature. There has been change in recent decade in Indian economy where many women have involved in
jobs outside home leaving a care gap. The other sociological shift is the breaking of traditional joint family
system making it difficult for the family members to carry the work of care-giver. This transition in family
and economic systems leaving a gap in care giving has enabled markets to enter in creating paid workforce.
This paper explores how care work has grown to become commercialized in nature and how it has shifted
from feminine unpaid work to paid and genderised nature of work in India.

Introduction

The transition from informal to formal care was dependent on many developments, primary being change in
family structures, and change of role for women. It is important to understand how and why the role of
women changed from household activities to wage earning. Apart from this, the transition from informal to
formal care giving for long-term care is also dependent on the factors of individual choice, absolute absence
of social support system and the ability to afford care. Social support is an important indicator in defining
whether one opts for formal or informal care giver. It implies if the ailing person can be supported by any
relative, spouse or any other person who can organise living arrangements. The transition of care giving
from informal to paid become easier for people who were financially much more stronger. The decision for
formal or informal care giving is also governed by the ability to buy care for a person. Following from the
theory on feminized nature of labour, it is discussed in conventional economic theories how labour outside
home and mostly performed by men or masculine labour is considered to be productive as opposed to
responsibilities shared by women (Mazurkiewicz, 2007). As Folbre and Nelson (2000) informs by 19th

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10/3/23, 8:00 PM Home health care industry in India; an account of genderised labour in commercial health care economy - ScienceDirect

century the women were considered as dependents. This was a result of change in economic production and
perception of neo-classical theories that women hardly could be part of economic systems with the advent
of industrialization. The whole conceptualization of care actually intimidates the basis of classical economic
theory which does not recognize the need to discuss people's welfare as indicated by Folbre and Nelson
(2000). Thus the one who discusses care having economic value actually proposes to follow alternative
school of thoughts that links economics of care to feminist theories.

The global care industry, where private for profit companies plays an important role in creating a care
industry also depicts unorganized, genderised and exploitative nature of the sector. The earnings of care
workers may vary due to the various kinds of skills they require, how labour market sets values for those
required skills (Misra & Buddig, 2008). Thus doctors and nurses have a higher wage levels in care work
industry as opposed to domestic care workers, specifically women (Misra & Buddig, 2008). As Stacey (2006)
also gives evidence that the skilled nurses who give post-operative care are highly paid. It is discussed that
the wages of home care workers in countries like USA varies based on region, employer and whether the
employees are unionized (Stacey, 2006). Moreover, the health care industry is often criticized as a way of
reducing public spending as the cost of care at institution has been transferred to unpaid care givers in
family or low paid care-givers available through this emphasis on home based care (Aronson & Neysmith,
1996).

In line with the debate on care economy being unpaid and informal in nature and mostly led by women
there is a need of looking at the condition of informal women workforce in India. Palriwala and Neetha
(2010) have given a detailed understanding of the present network of informal and unorganized work which
centres around a large number of sections of women being in low paid informal workforce. The GDP has
grown to 6% annually in the period of 1991–2005. However even with that growth rate, there is a very
minimal participation of women in the economic activity has been extremely on lower side with only 29%
(Palriwala & Neetha, 2010). The study reiterates the gender inequality that exists in Indian context
specifically in relation to informal work both in rural and urban context with a 61% of women being a part of
unpaid family work in the year 2004–05 (Palriwala & Neetha, 2010). As there is evidence of extensive female
participation in the context of unpaid or lowly paid care work, it is noteworthy that a large portion of such
workforce also works as domestic help mostly performing household chores. The recent NSSO data
showcases that the statistical figure for domestic worker has increased from 1.62 million in the year 1999–
2000 to 2.52 million in the year 2005–2010 (Ganesh, 2013). The aspect of feminization surely finds its
presence in the context of domestic worker as 75% of increase in domestic workforce is surely accounted for
women (Ganesh, 2013). Historically women have been performing household tasks. The shift of such work
from being unpaid informal household based tasks to paid work has not however changed its key feature of
being women oriented. In recent times the care economies which have stepped out of the realms of the
households and have entered the markets involving self-employed domestic workers especially in the
context of developing nations (Mehrotra, 2010). The availability of labour force for enabling growth of such a
care economy also has been possible due to rapid migration to urban centers. In Indian context a large
number of women have entered into the cities and have been working as domestic workers (Mehrotra,
2010).

Section snippets

Methodology

The broad objective of the study is to explore growth of care- giving as an industry in terms of its structure,
stakeholders, demand and supply, the nature of such work, the type of workforce and issues associated with

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10/3/23, 8:00 PM Home health care industry in India; an account of genderised labour in commercial health care economy - ScienceDirect

this workforce in urban context in India. It is primarily qualitative and the development of paid home health
care work in Delhi, India is studied. The primary reasons for taking Delhi is that it is one of the largest
growing metro centers in India and also as is depicted through …

Historical evolution of care work

The questions that rise are how this need of external caregivers in families have originated in India and who
have been the primary stakeholders in turning this development into an opportunity to create and reinforce
a market. Referring to this, it is noteworthy that the oncoming of the care industry in Indian context is very
nascent hence the transition in care system may have been a recent phenomenon.

In the present study this transition is assessed based on discussion with family care givers…

Genderised nature of care work

The collected data during the study indicates the very genderised nature of the industry, in which
economics of care draws from the social and cultural understanding of care being an inherent quality of
women, easy to perform and bearing “a very low value skill sets” required. In private network of agencies
both for profit and not for profit sector shows the presence of more female health care aides than male.
Indeed the supervisor at Max Hospital one of the noted pioneers in the field of…

Conclusion

Home health care work is still in a very nascent stage in the context of India. But as one may derive from the
accounts and evidences the transition from informal to formal home health care work is ingested with a
notion of care work being a feminine labour. Notably the stakeholders in the industry agree to the existing
need of male care givers but at the same time recruited mostly female care workers. The absence of men is
corroborated with the fact that the work of care giver is low paid and…

Declaration of competing interest

None.…

References (11)

Anon., n.d.. Minimum standard of operation for home health agencies, s.l.: Missisipi State Department of
Health....

J. Aronson et al.
You’re not just in there to do the work; depersonalizing policies and the exploitation of home
care workers’ labor
Gender and Society (1996)

N. Folbre et al.
For love or money or both
The Journal of Economic Perspectives (2000)

U. Ganesh
Domestic work in India
https://www.sciencedirect.com/science/article/abs/pii/S0277539521000613?via%3Dihub 3/5
10/3/23, 8:00 PM Home health care industry in India; an account of genderised labour in commercial health care economy - ScienceDirect

Searchlight, South Asia (2013)

D. Khosla et al.
Palliative care in India: current progress and future needs
Indian Journal of Palliative Care (2012)
There are more references available in the full text version of this article.

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10/3/23, 8:00 PM Home health care industry in India; an account of genderised labour in commercial health care economy - ScienceDirect

☆ I hereby confirm that I have taken ethical approval from Institutional Ethics Review Board of Jawaharlal Nehru University. I
also want to confirm I have conducted this study for the partial fulfillment of PhD degree from Centre for Social Medicine and
Community Health, Jawaharlal Nehru University located in India. I state that I have given due acknowledgement in the final
dissertation to my university, home health care attendants from NGO St Stephens Society, Can Support, Max Hospital,
Verghese Placement Cell, Globe Bonitus and National Institute of Social Defense. The university provided no fund for this study.

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