Emigration of women domestic workers from Kerala : gender, state policy and the politics of movement

Restrictions imposed by the Government of India on the emigration of women in ‘unskilled’ categories such as domestic work are framed as measures intended to protect women from exploitation. Special protection for certain categories of emigrant women workers makes way for gendered conceptions of citizenship and sovereignty through the use of gender to assert control over space in ways that curtail women’s access to mobility and emigrant work opportunities. However, restrictions have directed potential migrants to the use of informal / illegal processes in connivance with state agencies. Whereas, intermediaries, including recruiting agents and government officials, profit from the use of informal / illegal processes by prospective emigrants and hence they have an interest in rendering these more effective than formal processes established by the state, we argue that the gender politics around movement provides an enabling condition for both state restrictions and the burgeoning of informal / illegal processes. To spell out the implications of state policy on emigrant women domestic workers, the paper compares their position and experience of migration with that of emigrant nurses on the one hand and outmigrant fish processing workers on the other. It also explores the nature of women’s agency involved when domestic workers resist state policy and social norms to emigrate through informal / illegal means. Key words: International Migration, Gender, Citizenship, State Policy, Domestic Workers. JEL Classification

Effects of Intracoronary Alteplase on Microvascular Function in Acute Myocardial Infarction

Background—Impaired microcirculatory reperfusion worsens prognosis following acute ST‐segment–elevation myocardial infarction. In the T‐TIME (A Trial of Low‐Dose Adjunctive Alteplase During Primary PCI) trial, microvascular obstruction on cardiovascular magnetic resonance imaging did not differ with adjunctive, low‐dose, intracoronary alteplase (10 or 20 mg) versus placebo during primary percutaneous coronary intervention. We evaluated the effects of intracoronary alteplase, during primary percutaneous coronary intervention, on the index of microcirculatory resistance, coronary flow reserve, and resistive reserve ratio. Methods and Results—A prespecified physiology substudy of the T‐TIME trial. From 2016 to 2017, patients with ST‐segment–elevation myocardial infarction ≤6 hours from symptom onset were randomized in a double‐blind study to receive alteplase 20 mg, alteplase 10 mg, or placebo infused into the culprit artery postreperfusion, but prestenting. Index of microcirculatory resistance, coronary flow reserve, and resistive reserve ratio were measured after percutaneous coronary intervention. Cardiovascular magnetic resonance was performed at 2 to 7 days and 3 months. Analyses in relation to ischemic time (<2, 2–4, and ≥4 hours) were prespecified. One hundred forty‐four patients (mean age, 59±11 years; 80% male) were prospectively enrolled, representing 33% of the overall population (n=440). Overall, index of microcirculatory resistance (median, 29.5; interquartile range, 17.0–55.0), coronary flow reserve(1.4 [1.1–2.0]), and resistive reserve ratio (1.7 [1.3–2.3]) at the end of percutaneous coronary intervention did not differ between treatment groups. Interactions were observed between ischemic time and alteplase for coronary flow reserve (P=0.013), resistive reserve ratio (P=0.026), and microvascular obstruction (P=0.022), but not index of microcirculatory resistance. Conclusions—In ST‐segment–elevation myocardial infarction with ischemic time ≤6 hours, there was overall no difference in microvascular function with alteplase versus placebo