Underage children as domestic workers: Middle-class India’s greatest shame?

‘Behind the walls of Indian middle-class ­– and even many lower-middle-class – houses, unequal India is constantly produced and reproduced in the way employers treat their domestic help.’

In her extraordinary novel The Help, Katherine Stockett writes about the lives of black women domestic workers in a small town in Mississippi in 1962. At the time in which the novel is set, the civil rights movement was yet to alter the unequal social relations between races in this small, conservative settlement. Stockett observantly recreates the segregation, distrust and disrespect which African American women workers routinely endured while working in middle-class white households. In the novel, three women lead a secret rebellion by anonymously writing about their experiences with their employers.

What deeply troubled me after I read the book was that the humiliation and exploitation suffered by domestic workers in southern US half a century earlier was, in fact, in many ways less oppressive than the daily lived experience of an estimated three million domestic workers in middle-class homes across urban India in the second decade of the twenty-first century. And that this causes us so little outrage.

Behind the walls of Indian middle-class ­– and even many lower-middle-class – houses, unequal India is constantly produced and reproduced in the way employers treat their domestic help.

This is where children of relative privilege learn early to accept and normalize inequality, lessons they learn for life. When a small boy of four is asked to touch the feet of all his elders, how does he know so early that he is expected to touch the feet of all older people – except the domestic help? How does he learn that domestic workers are the only elders he can command, call by their first names, and speak rudely to without being corrected?

In the American novel, one African American help raises seventeen white children in her lifetime of employment. She has to sacrifice the care-time she wanted for her own son so that she can earn the money to tend to him. As long as they are babies, many white children love her more than their own mothers. Her heartbreak comes when they grow up, and treat her with the same casual disrespect and condescension, and acquire the same prejudices, as their mothers. How many of us urban, Indian, middle-class adults have been similarly raised by women who neglected their own children, women we have forgotten as we grow and they age?

In The Help, the ‘rebellion by writing’ of domestic workers in Mississippi is spurred by the decision of some employers to build segregated toilets for their helps, which they find insulting. But in middle-class Indian homes this is routine. A study in Delhi conducted by Jagori, an organization working primarily with women, found that in 30 per cent of the homes surveyed, part-time domestic workers had no access to toilets at all, and of those who did, used segregated toilets in 40 per cent of the homes.

In The Help, domestic workers ate at dining tables but at different times from their employers. But in Indian homes, there are often separate plates for the help to eat from, and they almost never eat at the same table as their employers. They are usually made to sit on the floor for their meals. They are not given the same food as the employers, but rationed quantities of coarser, cheap food, or leftovers.

The domestic help as portrayed in the book, in the 1960s, were modestly paid and worked eight hours with weekly off-days. Studies confirm that live-in Indian domestic workers today toil almost every waking hour, often seven days a week.

An official study estimated in 2004 that there were around 4.75 million domestic workers in the country.

Since domestic workers are mostly unregistered and are an invisible workforce, the actual numbers may be much higher. For instance, the study estimated that households in Delhi and Mumbai employ six hundred thousand domestic workers respectively, but activists place the numbers at one million in each city. There are three categories of domestic workers: residential workers who work 24x7, many of who are recruited through placement agencies; full-day workers who work from morning to evening for nine hours or more; and part-time workers who carry out specific tasks in more than one household and are normally recruited directly from and reside in slum areas.

Additional tasks range from washing and ironing clothes, walking the dog, cleaning cars, mopping floors and toilets, and many others. Wages paid to domestic workers tend to be very low and are arbitrarily fixed well below statutory minimum wages and paid in recompense for much longer hours than prescribed. They spend many hours, often without breaks, sweeping and swabbing floors, washing clothes, cooking and taking care of the aged and children.

Part-time helps are paid so little that they work in multiple houses, which adds up to inordinately long working hours.

Both full- and part-time helps have few, if any, paid holidays. They are protected by no labour law regulation and no social security contributions. Salaries are cut if they damage property, some workers report being denied their earnings by deceitful calculations, and they are often accused of stealing. Their work of sweeping, cleaning and cooking entail numerous health hazards, compounded by poor and irregular food and little rest and recreation. Aged domestic help are routinely dismissed from service to fend for themselves, with no question of any pension.

Left feminist economist Jayati Ghosh maintains that, ‘Inequality is the cause of lower wages for domestic workers in India. Inequality in India permits lower wages for domestic work.’ She observes that despite the huge contribution made by domestic workers in society, they remain largely invisible and undervalued, which reflects the low value India places on social reproduction. She affirms that domestic workers should have equal rights for reasonable hours of work, weekly rest of at least twenty-four consecutive hours, a limit on in-kind payment, as well as clear information on the terms and conditions of employment.

It is extraordinary that such a large and vulnerable workforce still lacks a specific protective legislative framework.

The majority are women – often children – and migrants, which anyway renders them especially vulnerable. Compounding this problem is the fact that workplaces are hidden away within people’s homes. As Ghosh observed, the greater part of the work performed by household help is underrated as work because, in most homes, it is considered unpaid and unacknowledged ‘women’s work’.

Since most middle-class enforcers of legal protections for domestic workers would themselves be employers – often on very similar exploitative terms – of domestic workers, there is built-in bias against domestic workers in enforcement.

In the high-profile run-in of Indian diplomat Devyani Khobragade with her domestic help, Sangeeta Richards, which made international headlines for many weeks during 2013 and even strained Indo-US diplomatic relations, it is remarkable how unanimous public sympathy—in the media, the diplomatic services, the bureaucracy and even across political parties—was for the employer rather than her domestic help. Few were concerned with Richards’s side of the story.

The dependence of urban middle-class households on domestic workers has grown further because of the entry of much larger numbers of educated women into the formal workforce. They depend critically on domestic carers to enable them to work and earn yet, as Sujata Ghotoskar again observes, contributions made by women domestic workers to the economy are grossly underrated, partly because domestic care-giving work by women is both devalued and taken for granted. The growing economic dependence on them has increased their bargaining power a little, but this is limited because they are mostly unorganized. Domestic help assert their power today mainly by changing employers more freely than they did in the past, and addressing their employers not as sahib and memsahib, but as uncle and aunty.

Middle-class India’s greatest shame is its employment of underage children as domestic workers.

This is an invisible and powerless category of workers and, therefore, there are no reliable estimates of child domestic workers. The official study conducted by the National Commission for Enterprises in the Unorganized Sector (NCEUS) estimates that 20 per cent of all domestic workers are under fourteen years of age. That is a shocking one in five. A quarter of all workers are between the ages of fifteen and twenty years. If you total both these figures, this means that an unconscionable two to three out of every five domestic workers are toiling for wages in homes when they should be studying and playing in schools and colleges.

Excerpted with permission from Looking Away: Inequality, Prejudice and Indifference in New India, Harsh Mander, Speaking Tiger.

We welcome your comments at
Sponsored Content BY 

Putting the patient first - insights for hospitals to meet customer service expectations

These emerging solutions are a fine balance between technology and the human touch.

As customers become more vocal and assertive of their needs, their expectations are changing across industries. Consequently, customer service has gone from being a hygiene factor to actively influencing the customer’s choice of product or service. This trend is also being seen in the healthcare segment. Today good healthcare service is no longer defined by just qualified doctors and the quality of medical treatment offered. The overall ambience, convenience, hospitality and the warmth and friendliness of staff is becoming a crucial way for hospitals to differentiate themselves.

A study by the Deloitte Centre for Health Solutions in fact indicates that good patient experience is also excellent from a profitability point of view. The study, conducted in the US, analyzed the impact of hospital ratings by patients on overall margins and return on assets. It revealed that hospitals with high patient-reported experience scores have higher profitability. For instance, hospitals with ‘excellent’ consumer assessment scores between 2008 and 2014 had a net margin of 4.7 percent, on average, as compared to just 1.8 percent for hospitals with ‘low’ scores.

This clearly indicates that good customer service in hospitals boosts loyalty and goodwill as well as financial performance. Many healthcare service providers are thus putting their efforts behind: understanding constantly evolving customer expectations, solving long-standing problems in hospital management (such as long check-out times) and proactively offering a better experience by leveraging technology and human interface.

The evolving patient

Healthcare service customers, who comprise both the patient and his or her family and friends, are more exposed today to high standards of service across industries. As a result, hospitals are putting patient care right on top of their priorities. An example of this in action can be seen in the Sir Ganga Ram Hospital. In July 2015, the hospital launched a ‘Smart OPD’ system — an integrated mobile health system under which the entire medical ecosystem of the hospital was brought together on a digital app. Patients could use the app to book/reschedule doctor’s appointments and doctors could use it to access a patient’s medical history, write prescriptions and schedule appointments. To further aid the process, IT assistants were provided to help those uncomfortable with technology.

The need for such initiatives and the evolving nature of patient care were among the central themes of the recently concluded Abbott Hospital Leadership Summit. The speakers included pundits from marketing and customer relations along with leaders in the healthcare space.

Among them was the illustrious speaker Larry Hochman, a globally recognised name in customer service. According to Mr. Hochman, who has worked with British Airways and Air Miles, patients are rapidly evolving from passive recipients of treatment to active consumers who are evaluating their overall experience with a hospital on social media and creating a ‘word-of-mouth’ economy. He talks about this in the video below.


As the video says, with social media and other public platforms being available today to share experiences, hospitals need to ensure that every customer walks away with a good experience.

The promise gap

In his address, Mr. Hochman also spoke at length about the ‘promise gap’ — the difference between what a company promises to deliver and what it actually delivers. In the video given below, he explains the concept in detail. As the gap grows wider, the potential for customer dissatisfaction increases.


So how do hospitals differentiate themselves with this evolved set of customers? How do they ensure that the promise gap remains small? “You can create a unique value only through relationships, because that is something that is not manufactured. It is about people, it’s a human thing,” says Mr. Hochman in the video below.


As Mr. Hochman and others in the discussion panel point out, the key to delivering a good customer experience is to instil a culture of empathy and hospitality across the organisation. Whether it is small things like smiling at patients, educating them at every step about their illness or listening to them to understand their fears, every action needs to be geared towards making the customer feel that they made the correct decision by getting treated at that hospital. This is also why, Dr. Nandkumar Jairam, Chairman and Group Medical Director, Columbia Asia, talked about the need for hospitals to train and hire people with soft skills and qualities such as empathy and the ability to listen.

Striking the balance

Bridging the promise gap also involves a balance between technology and the human touch. Dr. Robert Pearl, Executive Director and CEO of The Permanente Medical Group, who also spoke at the event, wrote about the example of Dr. Devi Shetty’s Narayana Health Hospitals. He writes that their team of surgeons typically performs about 900 procedures a month which is equivalent to what most U.S. university hospitals do in a year. The hospitals employ cutting edge technology and other simple innovations to improve efficiency and patient care.

The insights gained from Narayana’s model show that while technology increases efficiency of processes, what really makes a difference to customers are the human touch-points. As Mr. Hochman says, “Human touch points matter more because there are less and less of them today and are therefore crucial to the whole customer experience.”


By putting customers at the core of their thinking, many hospitals have been able to apply innovative solutions to solve age old problems. For example, Max Healthcare, introduced paramedics on motorcycles to circumvent heavy traffic and respond faster to critical emergencies. While ambulances reach 30 minutes after a call, the motorcycles reach in just 17 minutes. In the first three months, two lives were saved because of this customer-centric innovation.

Hospitals are also looking at data and consumer research to identify consumer pain points. Rajit Mehta, the MD and CEO of Max Healthcare Institute, who was a panelist at the summit, spoke of the importance of data to understand patient needs. His organisation used consumer research to identify three critical areas that needed work - discharge and admission processes for IPD patients and wait-time for OPD patients. To improve wait-time, they incentivised people to book appointments online. They also installed digital kiosks where customers could punch in their details to get an appointment quickly.

These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the marketing team and not by the editorial staff.