Reproducing the state : women community health volunteers in north India

India’s community health worker program is the largest in the world. Its one-million strong, all-women workforce is a success story. Since their appointment in 2005, these women, called ASHAs (Accredited Social Health Activists), have spearheaded significant improvements in the country’s maternal and child health outcomes. However, ASHAs are an exceptionally precarious workforce. They are “paid volunteers”, who receive none of the benefits of staff, and get per-case “incentives” instead of salaries. These poor and mostly lower caste women work round-the-clock in an under-resourced and over-burdened health system, for an itinerant pay that is a fraction of minimum wage. Given these conditions, I ask, how do ASHAs succeed in delivering health services? And what does their success tell us about state power? I conducted 14 months of ethnographic fieldwork in North India, mostly in Punjab, including 80 interviews with ASHAs and ASHA program experts. I find that ASHAs reveal the productive power of an under-studied and gendered role in the state, that of a frontline bureaucrat. Frontline bureaucrats expand the reach of the state into communities. Although the gender, caste, and class marginality of ASHAs subsidizes the Indian state’s health system, ASHAs craft themselves into highly sought-after actors in service delivery. They do so by cultivating deeply intimate knowledge of women clients and their families, and by building networks among both public and private health care providers. In this way, they get not just intrinsic rewards—like skills, emotional fulfilment etc. usually associated with care work—but also extrinsic rewards, like commissions earned by referring patients to private clinics. I also find the care work of ASHAs comprises political socialization, that is, ASHAs educate their communities about the workings of the state, particularly welfare schemes, thus maintaining state legitimacy from below. In effect then, the very marginality that traps ASHAs into care work also unexpectedly allows them to maneuver into a social location of relative power within their communities.Sociolog

Globalisation of birth markets: a case study of assisted reproductive technologies in India

The escalation of Assisted Reproductive Technologies (ARTs) in India into a veritable fertility industry is the result of a multitude of reasons. This paper places the bio-genetic industry within the larger political economy framework of globalisation and privatisation, thus employing a framework that is often omitted from discussions on ARTs, but has direct and significant bearings on the ART industry in India. As markets for human organs, tissues and reproductive body parts experience unprecedented growth, the limits of what can or should be bought and sold continue to be pushed. As such, bodies have emerged as sale-worthy economic capital. Commercial flows of reproductive material create and deploy the division of the body into parts over which ownership is claimed, in the process following 'modern routes of capital' and raising issues of structural inequality

Wages of Liminality: How an in-between status lowers the earned wages of women health workers

Second Place Winner, Audre Rapoport Prize for Scholarship on Gender and Human Rights (2020). Vrinda Marwah is a doctoral candidate in the Department of Sociology at The University of Texas at Austin. Her primary research interests are in reproductive health issues, particularly in how they are translated into law and policy in contemporary India. Vrinda received her MSc in Gender and Social Policy from the London School of Economics, and her BA in Political Science from the University of Delhi.In this paper, I analyze the experiences of the world’s largest, all-women community health workforce through the lens of liminality. Originally used to describe transition from one state to the other, the concept of liminality in the study of work and organizations can frame workers’ experiences of being in-between established structures and roles in varying degrees, times, and/or places. India’s ASHAs, or Accredited Social Health Activists, are community women at the frontlines of the state’s health care provisioning. But the state does not categorize them as workers or employees. ASHAs are considered volunteers. Instead of salaries, they are paid task-based incentives. Based on 14 months of ethnographic fieldwork, including 80 interviews, I find that ASHAs’ liminal occupational status as ‘paid volunteers’ produces conditions of chronic underpayment and control for them, further lowering their already low wages. This has implications for how we understand the gender wage gap. I argue we need to consider not just how much women are paid, but how the amount is structured, and how that places women workers in relation to others in the workplace. Moving beyond whether liminality is a negative or positive experience, future research should delineate the conditions under which liminality is negative or positive, and for whom.La