Indian Health Heroines Fight to Unionize

Suraiyya Terdale sensed the danger, but she did not stop. During the peak of India’s deadliest COVID-19 wave in May 2021, when the country was reporting over 400,000 new cases daily, Terdale went door to door in her village of Ganeshwadi in western India’s Maharashtra state to ask people to get vaccinated.

“One man suddenly lost his calm and started abusing me,” she told OZY. She was used to people misbehaving when she arrived at their doors during the pandemic.

Yet, ASHAs — who have traditionally worked on public health campaigns, often involving women and children — had been given the responsibility of ensuring that rural Indians overcame vaccine hesitancy to receive their shots. So, she tried to explain the importance of inoculation to the increasingly hostile man.

This time, though, things were getting out of hand. “Within a minute, the man first threatened to beat me and then even brought a stick,” she recalled.

The 36-year-old knew she was at risk, so she dialed the local police and an elected village official. But they dismissed her concerns. She then called fellow ASHAs, and six of them arrived within four minutes. Seeing them, the abusive man went back inside his home.

That instinctive sense of unity and the readiness to stand by each other are now formalizing into a unique effort by the ASHAs to unionize and demand better conditions from a country that rarely acknowledges their impact.

In March 2020, as India’s health ministry devised a plan to contain the pandemic, it made ASHAs in charge of contact tracing, surveying and finding suspected COVID patients, along with monitoring them and performing other tasks. The vaccine advocacy was added once shots were available last year. Yet these women were sent to the front lines without any safeguards.

“For the first few weeks, we weren’t even given masks,” said Terdale. After protesting several times, they were each given a single-layered cotton mask and a mere 200 milliliters of sanitizer. “Every day, family members asked me to quit because they were scared of catching COVID.”

She didn’t. Instead, she and many other ASHAs worked for more than 400 days without a break.

Terdale would discuss her concerns with fellow ASHA Netradipa Patil from Maharashtra’s Kolhapur district. “During COVID duty, every day I would get several calls from ASHAs of at least ten states regarding verbal, physical abuse, delayed payment and much more,” said Patil, an activist who leads a group of 3,000 ASHAs.

Patil herself was overworked and mentally tired, but she started meeting these ASHAs and eventually unionized them in the city of Kolhapur, Maharashtra. ASHAs have led previous protest campaigns demanding better working conditions, “but during COVID, things got much worse,” Patil said. “So we had no option other than to protest on a larger scale to fight back.”

In Kolhapur district alone, these ASHAs have since staged over 10 protests, drawing almost all of the district’s healthcare workers. Meanwhile, their counterparts in other parts of the country were also protesting. On Aug. 7, 2020, roughly 600,000 ASHAs across India went on a two-day strike demanding better wages and working conditions, and the legal status of full-time workers. ASHAs, instituted under India’s National Rural Health Mission of 2006, are formally termed volunteers, which means that the government is not required to pay them a minimum wage.

In fact, ASHAs don’t have any regular wages — they are paid different rates for each specific task, whether it’s helping with vaccinations or working on a sanitation campaign. That means a fluctuating monthly income, though in many states, the government offers a minimum stipend. Yet even with these stipends and such relatively better-paying tasks as COVID-19 relief work, ASHAs were often making less than $100 a month.

After protests took place in the nation’s capital of New Delhi, the city’s police registered cases against several dozen ASHAs for “violating social distancing norms” by gathering together. “In Kolhapur too, several cases were registered against ASHAs, but our union ensured the government took back these cases,” said Terdale.

On June 15, 2021, around 70,000 ASHAs across Maharashtra — India’s wealthiest state — went on an indefinite strike. This was called off after nine days when the government partially agreed to their demands and promised to increase the pay by $19 monthly, up from between $44 and $64 a month, said Patil. That raise will include an increased allowance for COVID-19 tasks, which, as this article went to press, still paid around $13 a month, or 43 cents a day.

ASHAs begin every protest with the slogan: “Our strength is our union.” It truly is, said Terdale.

“Even if the pay hasn’t increased much, we at least have a primary support group,” she said. “Tomorrow, if something happens to me, I know my union will fight, and this gives me a sense of safety.”