maternal health

Maternity benefits: There’s a yawning gap between women who work in the formal and informal sectors

Will Prime Minister Narendra Modi back his New Year’s Eve maternity benefits announcement with adequate budgetary support?

Despite protracted and valiant struggles for women’s rights as workers, the workplace as much as the home remains unequal, unjust and unsafe for the large majority of women. Women the world over work harder and longer on an average than men, yet they are paid a fraction of what men receive. They have had to wage long and hard battles even to be recognised as workers. They continue to fight for their rights to enter all fields of work on par with men, to receive equal pay for equal work, for safe and healthy conditions in the workplace, and for rules and conditions of work that accommodate the specific biological and social concerns of women relating to pregnancy, childbirth, and menstruation, which male workers do not have to bear.

One problem in approaching equality between genders in the workplace is that a substantial part of women’s work is not even recognised to be work, such as the bearing and care of children and of the aged, collecting water and firewood, cooking, cleaning and the unremitting drudgery of domestic work with no holidays or even recognition and respect.

According to one estimate (the National Sample Survey’s 2011-’12 data) nearly 44% of women of all ages were engaged solely in domestic work, while for men, participation in such work was negligible. If we take into account both unpaid domestic care work as well as work in the market, feminist economist Jayati Ghosh calculated for the year 2011-’12 that the total female work participation rate in India was as high as 86.2%, compared with 79.8% for men.

The even greater problem is the social idea that women are and should be subordinate to men, and that women are not capable of the kind of physical and intellectual work that men can accomplish. Combined with this is the vulnerability of women to sexual harassment by men at work, and the specific challenges faced by women in performing their reproductive functions while continuing as workers.

Rights of women

As far back as 1967, the International Covenant on Economic, Social and Cultural Rights explicitly laid down global norms that women should be treated as equal to men with respect to standards of employment. It affirmed that everyone has the right to enjoy just and favourable conditions of work, along several parameters.

This included fair remuneration, based on a minimum wage, which, for women, must equal that paid to a male worker for the same work, and be sufficient to provide a decent standard of living for the employee and their families. It also included a safe and healthy working environment where occupational accidents and disease have been minimised and specific safeguards have been put in place to protect the safety and health concerns of women, for instance, during pregnancy; opportunities for advancement, based on considerations of seniority and competence; and lastly, limitation of working hours to ensure time for rest, leisure and paid leave.

(Photo credit: Reuters).
(Photo credit: Reuters).

The case of India

In India, none of these objectives of fair and just work conditions for women have been accomplished. Women continue to be paid less than men for the same work. They have not achieved parity in numbers employed in most modern sectors of the economy (except those like teachers and nurses that are seen as predominantly female occupations), and women are the first to be laid off when work opportunities shrink.

Despite the Supreme Court guidelines, women widely continue to face sexual harassment in workplaces. But some of their hardest battles have been to ensure women’s rights as women workers in the specific context of their reproductive roles, for what are variously described as “maternity entitlements” or “maternity benefits”.

The Constitution of India included what it then called “maternity relief” in the Directive Principles of State Policy, calling upon the State to “make provision for securing just and humane conditions of work and for maternity relief”.

The International Labour Organisation looked upon maternity entitlements as essential to protect women against income loss and job discrimination while ensuring that they have adequate time “to give birth, to recover and to nurse their children”.

For women who work in the formal sector, this is accomplished mainly through the right to paid leave during and after pregnancy. The Government of India recently made many progressive amendments to the Maternity Benefits Act, 1961. For instance, it increased maternity leave for women from 12 weeks to 26 weeks. Women working both in the private sector and public sector are eligible for this full-pay leave. There are other excellent features in the law as well, including provisions for working from home (if the organisation opts for it) for nursing mothers even beyond the 26-week maternity leave period, as well as the setting up of crèches with nursing breaks for women with small children.

All of this must be welcomed. It is hoped the result of respecting these entitlements will be to ensure that more women will be retained in the workforce, as well as more will be enabled to rise to middle and senior levels of management. One major reason for women dropping out of work is that with the rise of nuclear families, family and social support for young parents is reducing, and women are being forced to give up or compromise on their careers.

Informal and formal sector divide

However, only an estimated 5% women workers are employed in the formal sector, and they indeed will, and should, benefit from this amendment. But it is easy to forget the reality of life and work for the remaining 95% of women workers. Even as we justly celebrate this amendment, its passage is also another harsh reminder of the enormous and unconscionable gaps that persist between the proverbial two Indias.

What is the lived experience of pregnancy, child-rearing and work for as many as 19 out of 20 women workers in India?

A recent study by the Delhi-based Centre of Equity Studies opened a sobering window to the realities of impoverished women workers in rural India.

In an article on their study in the Economic and Political Weekly, researchers Dipa Sinha, Shikha Nehra, Sonal Matharu, Jasmeet Khanuja and Vanita Leah Falcao wrote that most of the work women do is invisible and unrecognised because it is done outside the boundaries of the formal economy. As a result, laws pertaining to maternity entitlements reach a limited number of women.

In their study in 16 villages in eight districts in Bihar, Chhattisgarh, Jharkhand and Madhya Pradesh, they found that most women they interviewed were involved in multiple forms of long and arduous work that stretched through most of the day.

The report said:

“Besides daily tasks such as fetching water, collecting firewood, making dung cakes, cooking, cleaning, washing and taking care of the children and the elderly, women are also involved in agricultural work. In addition some women also earn a livelihood by performing daily wage labour under the Mahatma Gandhi National Rural Employment Guarantee Act.”

They also found women involved in home-based livelihood activities such as beedi rolling, minor forest produce collection, and basket making.

It was striking that almost every woman across the four states that they visited reported hard toil through their pregnancy right until the day of delivery, and they most often resumed work within a week post-delivery. For them, pregnancy entailed little change to the kind and quantum of work they did, right up to the day they gave birth.

The idea of paid rest – something that women working in the formal sector can consider a basic legal right – is like an impossible dream for these women.

Some women blamed their husbands and mothers-in-law for not allowing them to rest.

In the report, 27-year-old Bhago from Dhamtari district in Chhattisgarh “resentfully said that her mother-in-law did not let her rest. ‘Ek bhi din aaram nahi karne diya [I was not allowed to rest for a single day]’, she said”.

But most women said that they had no option but to work. There was no one who could take on their domestic work. And if they did not earn money from the market, how would their children eat?

(Photo credit: AFP).
(Photo credit: AFP).

This is the unforgiving reality for the large majority of 95% of women workers in India in the informal economy – no rest and escape from the drudgery and obligations of hard labour even as their bear, deliver and nurse their children. In most cases, women did not rest enough because there was nobody to share the work burden, be it within the household or outside. Women, including pregnant women, continued to perform strenuous work both in the fields and at the home, which adversely affects the health of the mother and child. They remained invisible and unprotected by the regime of labour laws that promised them equality and fair working conditions.

Brief history of maternity benefits

Impoverished women workers in informal employment remained entirely invisible to labour laws and social security policies in India until the lead was first taken – as in many social and food protection programmes – by the Dravidian parties of Tamil Nadu in the Eighties.

It was the All India Anna Dravida Munnetra Kazhagam government in 1987, under Chief Minister MG Ramachandran, that introduced the country’s first maternity benefit programme for pregnant women called the Dr Muthulakshmi Reddy Maternity Benefit Scheme. This scheme initially provided Rs 300 to every woman below the poverty line to help cover the expenses incurred during childbirth. The amount was increased to Rs 500 in 1995, and doubled 10 years later to Rs 6,000. In 2011, the government led by the late J Jayalalithaa raised the maternity benefits to Rs 12,000.

It is noteworthy that the state of Tamil Nadu has the lowest infant mortality rate after Kerala, with 20 deaths per 1,000 live births, half of the India average of 40. Tamil Nadu also has lower maternal mortality than most states in the country – 79 maternal deaths per 100,000 live births.

In 1995, nearly 50 years after Independence, the Government of India first introduced the earliest limited maternity entitlement for women in the unorganised sector. Called the National Maternity Benefit Scheme, it provided Rs 500 to women officially identified to be poor for each of their first two live births.

This was replaced a decade later by a modified Janani Suraksha Scheme. The amount was raised to Rs 1,400, but the scheme transformed from a maternity entitlement to an incentive scheme for women to undertake family planning and institutional deliveries.

Finally in 2010, the government introduced a conditional maternity benefits scheme implemented on a pilot basis in 53 districts called the Indira Gandhi Matritva Sahyog Yojana. This provided lactating and pregnant women with Rs 4,000, which was raised in 2014 to Rs 6,000, for their first two live births if they fulfilled certain conditions.

Modi’s announcement

Given this, the New Year’s Eve announcement by Prime Minister Narendra Modi of a nationwide near-universal scheme of maternity benefits should have ordinarily been welcomed warmly.

The prime minister announced that Rs 6,000 will be transferred directly to the bank accounts of pregnant women who undergo institutional delivery and vaccinate their children. The scheme, he said, would reduce maternal mortality, and help ensure nutrition before and after delivery.

However, for many reasons, I could barely cheer for this announcement.

My first reservation was that the prime minister used the occasion of his 2016 year-end speech to address widespread dismay about the suffering caused by demonetisation by trying to take credit for a scheme that would benefit millions of impoverished women. He even tweeted about this measure as a new scheme of his government. This is a falsehood, one of many that the government regularly circulates particularly when it is confronted with criticisms about failing its poor and disadvantaged citizens.

The prime minister did not acknowledge that he was only implementing after unexplained and illegal delays what the law required his government to do much earlier.

The truth is that the National Food Security Act, passed by Parliament in September 2013, already had placed a binding legal obligation on the Union government to create a scheme for universal maternity benefits of Rs 6,000 a month. The law bound the government to roll out all the entitlements created by it within 365 days.

However, the government refused to make budgetary provisions for this in its succeeding budgets. The People’s Union for Civil Liberties challenged this delay in the Supreme Court. In November 2016, a large number of scholars and activists wrote in protest to Prime Minister Narendra Modi, demanding that his government implement without further delay the maternity benefit mandated by the law under the National Food Security Act.

They wrote, “The nation is paying a heavy price for this violation of the Act…Maternity entitlements are essential to address India’s staggering problem of low birth weights, poor maternal health and severe hardship during pregnancy.”

Modi did not explain why his government had failed to implement the law for universal maternity benefits.

Following the prime minister’s December 31 announcement, Kavita Srivastava of the People’s Union for Civil Liberties stated aptly,

“The Prime Minister on 31 December 2016 has announced a cash entitlement of Rs 6,000 for pregnant women across the country; presenting it as an original idea and also as if it is somehow to mitigate the hardships caused by demonetisation. However this is far from the truth”.

No budgetary allocation

Universal maternity benefits were incorporated in the National Food Security Act not as a labour right of working women, but as an entitlement that was critical also for food and nutrition security, especially of children.

For the first six months, a child’s nutrition is best secured with exclusive breastfeeding. After childbirth, an impoverished woman worker in the informal sector has no option but to return to work and leave her child in the care, usually, of an older sibling. The infant child then suffers a double nutritional whammy of being deprived both of breastmilk and becoming vulnerable to repeated infections through insanitary oral intakes.

An underweight mother is likely to give birth to an underweight child, and the toll this takes is difficult to reverse later in the child’s life. Therefore also to support the nutrition of the newborn child, the mother requires maternity benefits to enable her to rest, get better nutrition and stay at home, as well as crèches near her workplace that would allow her to regularly breastfeed her child after she returns to work. This is why experts and activists wished to write both these into the food security law.

The final law contained provisions of near-universal maternity benefits for the first time in the country, but the second requirement of workplace crèches was not incorporated.

I have further misgivings about the prime minister’s announcement because even this belated proclamation is still not backed by adequate budgetary provisioning.

Dipa Sinha, of the Right to Food Campaign pointed out that, “The government, in complete violation of the Act, has failed to provide the required budget for its implementation”.

Sejal Dand of the Right to Food campaign said that the figures just don’t add up.

India’s birth rate is around 20 per 1,000. The current population is around 1.3 billion. So the number of births per year must be around 26 million. Thus, at Rs 6,000 per birth, universal maternity entitlements (assuming, optimistically, that 10% births are already covered under the formal sector) would conservatively cost Rs 14,000 crores per year.

However, in the plan presented in the government press release, the central government’s contribution for the next three financial years is only Rs 7,348 crores, or Rs 2,449 crores per year. With a 60:40 ratio for Centre and state contributions, this means a total of barely Rs 4,000 crores per year, a little over a quarter of the budget required.

It also appears very likely that the entitlement will not extend to all women in the informal sector. Reports suggest that it would be restricted to mothers over 19 years, for only two births and for those who opt for ante-natal and post-natal health examinations, vaccinations and institutional deliveries.

The purpose of maternity benefits is to provide some form of social security to pregnant women, to enable them to access better nutrition during pregnancy. It is not a reward for good behavior, as pointed out by activist Jashodhara Dasgupta, it is a matter of women’s rights.

Anaemia is prevalent among a higher percentage of women who have more than three children than among women who have fewer children, indicating that they require more nutritional support. Malnutrition, including anaemia, contributes to a significant number of maternal deaths.

Field evidence, including research by the Centre for Equity Studies, suggests that cash transfers to pregnant women, if provided in time, were used in many cases towards food and health expenses during pregnancy, something that is otherwise not considered a high priority in household budgets.

Excluding women who already have two children or more would deprive 60% of poor pregnant women from the scheme. This would have been tantamount to putting their lives at risk and contributing further to the unconscionably high rate of maternal mortality. Furthermore, these conditions penalise the mother, who is most often powerless in making decisions about her reproductive health. There may also be constraints of available public health infrastructure, for which it is unfair to penalise pregnant women.

The prime minister announced that women would receive their entitlements though bank accounts. However, in common with its larger accelerated voyage to a cashless economy, the government remains indifferent to the high human costs to the poor, especially rural women, for who the rural banking system in India is still largely inaccessible.

The research by the Centre for Equity Studies describes the predicament of Sangeeta from Bastar district, who “had to climb a hill and walk for about 25 kilometres in the third trimester of her pregnancy, to open her account at the post office in Bastanar. She required the help of her village’s AWW [Integrated Child Development Services centre worker] since she is illiterate, does not know her age, and speaks only Gondi and Halbi”.

The study found that banks were between four km and even 25 km to 30 km distant, the roads often poorly maintained, and public transport thin and expensive. They also had to factor in the opportunity costs for women and those who accompanied them, in terms of time, stress and lost wages. Although these were in theory zero-deposit banks, most women in the four states said they were forced by bankers to deposit some money before they could open and access their accounts.

Massive injustice

Even if all of these problems are resolved, the injustice of massive differences between what women in the formal and informal sectors of the economy receive as maternity entitlements would persist.

For the 5% women workers employed in the formal sector, they would receive 26 weeks of paid leave on full salary. For 95% women in the informal sector, even if we factor in just the minimum wages for unskilled labour, they should get much more money than the prescribed Rs 6,000. For instance, if we take an average of just Rs 150 daily minimum wage (although it is much higher in some states), and we look at six days payment with unpaid Sundays, even then 26 weeks of rest would require that women receive Rs 23,400 as maternity entitlements, nearly four times higher than what is provisioned.

No wonder then that the Centre for Equity Studies survey showed that the money women received as maternity benefits in the pilot districts went into health costs, food and household expenses, but never was it seen as compensation to allow a woman to stay at home, rear and nurse her baby, and rest. This is something that women employed in the formal sector can take for granted.

It is well known that India lives simultaneously in many worlds. The distance between conditions of work for women and men is vast. But the gulf between women who work in the formal and informal sectors is also immense. How many more generations will it take us to bridge these chasms between people who are after all equal in every way?

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