Women's health

Maternity leave increases to 26 weeks – but only for a small section of Indian women

The amended law passed by Parliament this week excludes women from the unorganised sector.

A construction site worker, Tiniben, worked through fever in the seventh month of her pregnancy in Vadodara, Gujarat. She returned home with her husband to their village in Dahod district to deliver her baby. She got no paid leave and could not hold on to the job.

On August 11, Rajya Sabha passed amendments to the Maternity Benefit Act, 1961, increasing the period of maternity leave from 12 weeks to 26 weeks, which is over six months. The amended law also mandates a company to have a creche if they have more than 50 women employees.

But this covers only the organised formal sector of work and leaves out people like Tiniben.

As health experts note, it is crucial for mothers to be close to their babies for at least the first 24 months. The World Health Organisation recommends that every child should be breastfed within an hour of birth and given only breast milk for their first six months of life. Breastfeeding should ideally continue up to the age of two, along with complementary food. In India, proper breastfeeding could reduce thousands of child deaths and episodes of diarrhoea and pneumonia annually.

“We welcome this amendment,” said Sudeshna Sengupta of the Alliance for the Right to Early Childhood Development. “At least for the first time, some women would get the benefit of having six months paid leave. But this would apply only to 18 lakh women.” Sengupta said there are 2.97 crore pregnant women in the country any given time. “See how many women we are leaving out,” she added.

Activists working on the labour rights of women were disappointed with the amendments. Some of them ran a campaign in March and May this year lobbying for maternity benefits with the government. They held a public hearing in Delhi to document the issues related to the unorganised sector. Tiniben had deposed before them.

Narrow definition

Any woman working in agricultural, commercial or industrial establishments or shops with 10 persons or more is entitled to benefits under the Act. This leaves out many women who work from home – for instance, to roll bidis – or work at very small establishments, often without a fixed employer. “These women are left out and need the salary support,” said Jasodhara Dasgupta of Sahayog, a non-profit that works for the health rights of women in Lucknow. "They cannot keep the baby at home alone and go back to work." If a woman does not have a fixed employer, it should not mean that the woman is not entitled to benefits, the campaigners said.

In 2007, a report prepared by the National Commission for Enterprises in Unorganised and Informal Sector said that 96% of the women work in the unorganised sector.

Said Dipa Sinha, a right to food campaigner, who also looks at maternity rights and child nutrition: “The amendment should have expanded the definition of a working woman. Many working women do not even have an identified employer. Some women work on their own farms.”

Sinha said the campaigners were trying to work out a system where both the State and employers would take more responsibility for these women. The employers could be made to possibly contribute to a welfare fund and women could be given cash entitlements, she said.

Facing discrimination 

The amendment law has a peculiar rider. If a woman has two or more children, the maternity benefits remain just 12 weeks. This penalises women who have more children. “Women who have more than two children do not necessarily choose to get pregnant,” said Sinha. "Many have no reproductive rights, or have no access to contraception."

Besides, it penalises the third child too, who would be deprived of nutritional benefits of breastfeeding.

Dasgupta said that they will challenge this part of the amendment if it becomes a law.

Implementation of the law

Currently, labour inspectors are supposed to hold regular checks to see if the law is being implemented. For instance, under the new Factory Act, any establishment with more than 30 workers is supposed to maintain a creche.

“In reality, if you go to the creche, they will not keep more than 15 children,” said KR Jayaram, from the Garment and Textile Workers Union in Bengaluru. “Many also refuse to keep children under one year. These are unwritten restrictions.”

Women are often sacked or asked to leave during their pregnancy or after childbirth in contravention of the Act, activists said. They have been trying to get data on the action taken by labour inspectors against the employers who have contravened the provisions of the Act.

Sengupta said the Alliance had done a small study with garment workers at Gurugram. “We could not find a single pregnant woman in the entire area,” she said. “It is an unwritten rule that the women have to leave the company before delivering a child. There is no room for negotiation.”

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Removing the layers of complexity that weigh down mental health in rural India

Patients in rural areas of the country face several obstacles to get to treatment.

Two individuals, with sombre faces, are immersed in conversation in a sunlit classroom. This image is the theme across WHO’s 2017 campaign ‘Depression: let’s talk’ that aims to encourage people suffering from depression or anxiety to seek help and get assistance. The fact that depression is the theme of World Health Day 2017 indicates the growing global awareness of mental health. This intensification of the discourse on mental health unfortunately coincides with the global rise in mental illness. According to the latest estimates from WHO, more than 300 million people across the globe are suffering from depression, an increase of 18% between 2005 and 2015.

In India, the National Mental Health Survey of India, 2015-16, conducted by the National Institute of Mental Health and Neurosciences (NIMHANS) revealed the prevalence of mental disorders in 13.7% of the surveyed population. The survey also highlighted that common mental disorders including depression, anxiety disorders and substance use disorders affect nearly 10% of the population, with 1 in 20 people in India suffering from depression. Perhaps the most crucial finding from this survey is the disclosure of a huge treatment gap that remains very high in our country and even worse in rural areas.

According to the National Mental Health Programme, basic psychiatric care is mandated to be provided in every primary health centre – the state run rural healthcare clinics that are the most basic units of India’s public health system. The government provides basic training for all primary health centre doctors, and pays for psychiatric medication to be stocked and available to patients. Despite this mandate, the implementation of mental health services in rural parts of the country continues to be riddled with difficulties:

Attitudinal barriers

In some rural parts of the country, a heavy social stigma exists against mental illness – this has been documented in many studies including the NIMHANS study mentioned earlier. Mental illness is considered to be the “possession of an evil spirit in an individual”. To rid the individual of this evil spirit, patients or family members rely on traditional healers or religious practitioners. Lack of awareness on mental disorders has led to further strengthening of this stigma. Most families refuse to acknowledge the presence of a mental disorder to save themselves from the discrimination in the community.

Lack of healthcare services

The average national deficit of trained psychiatrists in India is estimated to be 77% (0.2 psychiatrists per 1,00,000 population) – this shows the scale of the problem across rural and urban India. The absence of mental healthcare infrastructure compounds the public health problem as many individuals living with mental disorders remain untreated.

Economic burden

The scarcity of healthcare services also means that poor families have to travel great distances to get good mental healthcare. They are often unable to afford the cost of transportation to medical centres that provide treatment.

After focussed efforts towards awareness building on mental health in India, The Live Love Laugh Foundation (TLLLF), founded by Deepika Padukone, is steering its cause towards understanding mental health of rural India. TLLLF has joined forces with The Association of People with Disability (APD), a non-governmental organisation working in the field of disability for the last 57 years to work towards ensuring quality treatment for the rural population living with mental disorders.

APD’s intervention strategy starts with surveys to identify individuals suffering from mental illnesses. The identified individuals and families are then directed to the local Primary Healthcare Centres. In the background, APD capacity building programs work simultaneously to create awareness about mental illnesses amongst community workers (ASHA workers, Village Rehabilitation Workers and General Physicians) in the area. The whole complex process involves creating the social acceptance of mental health conditions and motivating them to approach healthcare specialists.

Participants of the program.
Participants of the program.

When mental health patients are finally free of social barriers and seeking help, APD also mobilises its network to make treatments accessible and affordable. The organisation coordinates psychiatrists’ visits to camps and local healthcare centres and ensures that the necessary medicines are well stocked and free medicines are available to the patients.

We spent a lot of money for treatment and travel. We visited Shivamogha Manasa and Dharwad Hospital for getting treatment. We were not able to continue the treatment for long as we are poor. We suffered economic burden because of the long- distance travel required for the treatment. Now we are getting quality psychiatric service near our village. We are getting free medication in taluk and Primary Healthcare Centres resulting in less economic stress.

— A parent's experience at an APD treatment camp.

In the two years TLLLF has partnered with APD, 892 and individuals with mental health concerns have been treated in the districts of Kolar, Davangere, Chikkaballapur and Bijapur in Karnataka. Over 4620 students participated in awareness building sessions. TLLLF and APD have also secured the participation of 810 community health workers including ASHA workers in the mental health awareness projects - a crucial victory as these workers play an important role in spreading awareness about health. Post treatment, 155 patients have resumed their previous occupations.

To mark World Mental Health Day, 2017, a team from TLLLF lead by Deepika Padukone visited program participants in the Davengere district.

Sessions on World Mental Health Day, 2017.
Sessions on World Mental Health Day, 2017.

In the face of a mental health crisis, it is essential to overcome the treatment gap present across the country, rural and urban. While awareness campaigns attempt to destigmatise mental disorders, policymakers need to make treatment accessible and cost effective. Until then, organisations like TLLLF and APD are doing what they can to create an environment that acknowledges and supports people who live with mental disorders. To know more, see here.

This article was produced by the Scroll marketing team on behalf of The Live Love Laugh Foundation and not by the Scroll editorial team.