Indian Journal of Social Psychiatry

INVITED PERSPECTIVE
Year
: 2021  |  Volume : 37  |  Issue : 1  |  Page : 3--6

Safeguarding the Mental Health of Women of India in times of COVID 19: Challenges and ways forward


Mirai Chatterjee 
 Director, SEWA - Social Security, Gujarat, India

Correspondence Address:
Dr. Mirai Chatterjee
Director, SEWA - Social Security, Gujarat
India

Abstract

Self Employed Women's Association (SEWA) is movement of 1.8 million women workers in 18 states of India. This is an early narrative based report on how women have been affected by COVID 19 in India. There is description of loss of livelihood, malnutrition of children, increased responsibility of care giving, decreased access to health care and increased incidents of violence at home. The article also outlines how women have been resilient and have been active participants in supporting recovery. Mental Health awareness has been initiated by members of SEWA in 11 states.



How to cite this article:
Chatterjee M. Safeguarding the Mental Health of Women of India in times of COVID 19: Challenges and ways forward.Indian J Soc Psychiatry 2021;37:3-6


How to cite this URL:
Chatterjee M. Safeguarding the Mental Health of Women of India in times of COVID 19: Challenges and ways forward. Indian J Soc Psychiatry [serial online] 2021 [cited 2021 Jun 15 ];37:3-6
Available from: https://www.indjsp.org/text.asp?2021/37/1/3/312800


Full Text



 Introduction



Self-Employed Women's Association (SEWA) is a movement of 1.8 million informal female workers in 18 states of India. It organizes women into their own collectives such as unions and cooperatives for their economic empowerment. SEWA has worked with the female members and their communities through the last year to mitigate the mental health and psychosocial impact of COVID-19. Some of the narratives and lessons regarding the impact of COVID-19 and some of the solutions that have evolved are highlighted. All names of the people mentioned and the related identifying data have been changed.

 Case Vignettes



Premila is a domestic worker. She earned Rs. 15,000 a month and saved to take a loan for an autorickshaw for her son. She also helped her younger son set up a sandwich stall in the main market in Ahmedabad. The COVID-19 pandemic stymied her hopes for increasing the household income and saving for her grandson's education. She could not go out to work during the lockdown and her employer did not pay her for the time she was forced to stay away. Worse, she lost her job after the lockdown. Her employer did not feel safe having her coming and going from home. The sandwich stall had to shut down too and her son who drove the rikshaw saw his income plummet. They could no longer pay their loan installments. Premila says, “I cannot sleep at night worrying about mounting interest payments and how I can help my family get back on our feet.”

Ayesha is a small farmer and watched in dismay as her vegetables rotted as the supply chains were severely disrupted during the lockdown. “We work so hard on our land to feed ourselves and others. To see our produce lie unsold was heart-breaking. Later when the lockdown was lifted, we could sell our vegetables again. But people in the city have no work and no money and so are cutting back on food. We earned less for our vegetables. And when the time came to plant rice, I had no money to buy the seedlings. I borrowed from a money-lender and will have to pay back when I get a good harvest.”

 The Challenges



Premila, Ayesha, and lakhs of women and men who constitute the 500 million-strong informal sector in India are facing the devastation of their livelihoods and erosion of their well-being like never before in living memory. Leading precarious lives at the best of times, with little or no work and income security, food security, and social security such as health care, child care, and insurance, informal workers are facing challenges of all kinds due to the current COVID-19 pandemic. Female informal workers, the most exploited and vulnerable of workers in our country, face a level of hardship now that inevitably takes a toll on their mental health and overall well-being. Incomes have been severely affected. A study by SEWA's Cooperative Federation reported that the monthly income of households dropped by as much as 65% in the first 3 months of the pandemic and the lockdown.[1] Further, many women who migrate to the cities with their men-folk in search of work were forced to return to their villages, as their cash reserves quickly dwindled. Scenes of women, men, and children walking hundreds of kilometers to reach their villages will forever be etched in our memories of this pandemic, long after it is over. The stress and anxiety that this forced exodus resulted in, cannot even be imagined.

In addition to the immediate loss of work and livelihoods, the working poor had to face the threat and risk of COVID-19 like the rest of their fellow citizens. However, the full and differential impact of the disease on people, taking into account nutrition and health status, immunity levels, age, gender, and ability to access timely and affordable health care is still to be assessed and understood. What is clear is that informal female workers and their families did not have access to information on the coronavirus, simple do's and don'ts and where and when to seek care. Moreover, they did not have money to pay for this nor have any insurance coverage. While care in public hospitals was free, there were several other costs that women had to bear, adding yet another cause of stress.

As a response to women's needs, at the SEWA, we organized health training for 800 grassroots level female frontline health workers across 11 states.[1] A common refrain was that just having accurate information on the coronavirus was a relief, and then, when women actually helped local people link up with referral care and treatment, they felt supported and somewhat relieved. Fear was widespread and information helped reduce this and the stress and anxiety that women reported. Sunita, a small farmer from Jodhpur district and one of the women trained in providing health education, said that “I think people became free of fear once they understood what the disease was about. We also saw that they were less stressed and tense. Also, the simple information we were able to give them helped.”

One of the emerging issues for women during this pandemic has been the marked increase in care work. While women have always been juggling their work outside and inside the home, the pandemic resulted in a much heavier load. The Integrated Child Development Scheme (ICDS) and the government-run crèches provide some support to working women. They normally leave their young children at the ICDS anganwadis or crèches and are assured that they get at least one meal a day. Since the pandemic, children of all ages are at home. The ICDS child care centers and crèches have been shut since the very first lockdown and are yet to open in most states. SEWA's own crèches have to adhere to these norms as well, and we are flooded daily with requests from women to open these up so that their children are taken care of while they go out to work and earn, and so that the children obtain a nutritious meal, perhaps the only one for the day, and some preschool stimulation and education, along with health care. In a survey of children reached out to by SEWA, there were reports of parents not being able to provide adequate or no food. This was corroborated by loss of weight amongst children. This survey was based on data of children's weights that are regularly maintained at the child centers. A larger study is currently underway to assess the health, nutritional, and mental health impact on young children and their mothers.

As providing for their children is one of the care responsibilities of women, the impact this has had on women's overall well-being can well be imagined but is yet to be assessed.

Concern for older children's education is another stressor. In our conversations with women, this comes up top of the list in their priorities. They worry how they can keep their children's schooling going as many do not have access to smartphones or tablets. And then, there are the costs associated with internet. When money for food is scarce, having cash to pay for internet is a challenge. And yet, women skip meals and tighten their belts as best as they can to ensure that their children's education does not suffer.

Other care works include caring for elders and even sick and coronavirus-affected family members, in situations where isolating and social distancing in a small ten foot by fifteen foot dwelling is virtually impossible. During this pandemic, support systems have been disrupted – whether a family member, neighbor, or even their solidarity group like a cooperative.

In addition, women have faced difficulties in obtaining care for other diseases and health conditions, as all health systems, public, and private, have been focused primarily and sometimes exclusively on COVID-19. Regular immunization of children, access to medicines for tuberculosis patients, and treatment for both communicable and noncommunicable diseases have suffered, especially in the early stages of the pandemic. This has also resulted in heightened stress and anxiety levels among women.

Yet, another challenge is that of rising levels of violence that women and their children have faced. This has been widely reported across the country and also by our frontline health workers. It prompted us to include sessions on gender-based violence, and suggesting ways women can obtain support, including mental health and psychosocial care. Victims of violence have told us that just having another woman to speak to on their experiences has been of support, and that they were grateful for the frontline female workers.

 Our Response



Given the nature and range of challenges that women are facing, and the toll these have taken on their mental health, the question before us is how we can support and assist women to safeguard their mental health and overall well-being. Our experiences at SEWA show us, time and again, that during crises such as the pandemic, it is not only that women are the worst affected, but also that they are part of the solution. Women in communities are expressing readiness to be a support system and want to ficus on rebuilding lives and livelihoods. They are ready to take risk, often at the cost of their own health, and assist their families and communities, and at low cost. They are ready to learn and take up new opportunities that come their way. This time too we saw how they fearlessly stepped up to support and serve others.

As mentioned above, we were able to train women across the country in primary health care, including scientific knowledge of the coronavirus. We included reproductive and sexual health and basic information on mental health in the training modules prepared with the help of the World Health Organization. We also included sessions on where to go for primary, secondary, and tertiary care and how to access the services and entitlements, health, and others that were their due. During the review of the training and its outcome, women shared testimonies and experiences.

Ramkali, a tribal woman from Dhar district of Madhya Pradesh, told us that “Women said that in addition to messages and information on COVID-19, they learnt about sexual and reproductive health for the first time, and also about issues around mental health and domestic violence. Women put their phones on speaker so the whole family was learning together. This was a new experience for us. Then women shared the information with their neighbours also and forwarded the health education messages to everyone.”

Meherunissa from Delhi explained how along with training she helped women obtain referral care. “One woman whom I was in touch with developed symptoms of COVID-19. I referred her to the mohalla clinic and arranged conference calls with the doctors and other authorities. She was treated for COVID-19 and is fine now. Another woman said, had she known about laws pertaining to sexual harassment of women at the workplace, she would have known what to do and would not have left her job. She learned about sexual and reproductive health in our training.”

A special feature of this training of grassroots female health workers was that all of it was done online, using zoom, video calls, voice messages, and WhatsApp. The team of 800 women then used the same digital tools to spread the health messages across their communities, both urban and rural. Of course, it took some time to adapt to this new type of training. We had to repeat and practice with these tools, and with patience and persistence. Another issue was that many women did not have smartphones. However, they met this challenge by borrowing a neighbor's or using their husband's phones. Internet connectivity was a major gap in some states such as Nagaland and the desert districts of western Rajasthan. Fortunately, the virus had not spread to these areas and so women went door-to-door instead. Women were given modest, performance-based, financial incentives of about Rs. 2000 per month to encourage them to provide high-quality services. Later, women told us that this amount was critical at the time of the lockdowns, enabling them to buy food and other essential items.

 The Way Forward…



One of the ways in which we can reduce women's stress and anxiety on the economic front is providing livelihood support through their own collective enterprises like cooperatives. Seventy-one percent of women interviewed in the SEWA Cooperative Federation study said that they obtained support from their cooperative to re-start their businesses. Of course, women cannot go back to work, whether inside or outside of their homes, without key support services like child care. Hence, government and civil society will have to think of creative ways of taking care of children of all ages – perhaps through child care with social distancing and even opening up ICDS centers in areas with no coronavirus. A livelihood restoration fund to provide low or no interest loans to micro-entrepreneurs and women's collective businesses has been one of our suggestions to policy-makers.

In parallel to strengthening the support systems through strengthening the cooperatives, the need for providing health insurance for COVID 19 and continuing the same thereafter cannot be overemphasized. Through our insurance cooperative, VimoSEWA, we were able to negotiate with large insurance companies for a COVID-19 cover for women and their families not covered by the Pradhan Mantri Jan Arogya Yojana (PMJAY). PMJAY offers health insurance coverage to about 40% of the population. However, we need universal coverage, including for mental health, and as soon as possible.

Finally, and importantly, we need to invest in and develop programs for mental health and psychosocial care, with women at the grassroots playing a key role as counselors, identifying mental health issues early, and referring these to appropriate levels of care. Psychiatrists, and other mental health professionals, can join hands with women and their organizations at the grassroots levels in our villages and towns, to see that no one is left behind. It will require much training, hand-holding, and continuous support. However, women are ready to learn and play this role as best as they can. This may be the best opportunity we have had so far to plan for a mental health program that is tailored to local context and needs, and also will finally reach the last mile.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Muralidhara H, Salonie, Chetri N. Women's Cooperatives and COVID-19: Learnings and the Way Forward. Research Paper, SEWA Cooperative Federation, November; 2020. p. 3.