Seasonal Work, Interrupted Care: Maternal and Child Health Gaps of Brick Kiln Migrants in Bihar, India

Abstract

In India nearly 40% of the population is considered a migrant, yet migration is poorly understood and not prioritized in government policy. Seasonal migrants represent a particularly vulnerable category of people who come from the poorest sectors of society, often from scheduled castes and scheduled tribes. As seasonal migrants move between their home and work locations, continuity of care is interrupted and the portability of benefits denied. Working under what are often exploitative or slave-like conditions, they are systematically excluded from social services, as existing policies have largely failed to provide protection to this population, especially with regard to state-provided services such as healthcare. This project explores the challenges seasonal migrant workers face in identifying, accessing, and receiving maternal and child health services through the lens of seasonal brick kiln workers. As many as 50 million women and children could be residing as seasonal migrants at brick kilns in India. A literature review and expert interviews were conducted to provide an overview of the migration landscape in India. This research informed a qualitative study, which was carried out at brick kilns in Bihar through in-depth interviews and focus group discussions with brick kiln workers, brick kiln managers, and healthcare workers. Thematic analysis was used to synthesize findings, which were placed within the Three Delays Framework. System level barriers to maternal and child healthcare arising from the exploitative nature of the employment system, the power the manager has over his employees, the social segregation brick kiln workers experience from the local population, stigma and discrimination, and the delivery mechanisms of government community health schemes were identified. There is a need for systematic investments in knowledge and data around seasonal migrants. Surveying methods need to be improved to better count the number of seasonal migrants and understand their health status. The development of pilot projects involving community health workers to ensure maternal and child health programs are accessible is important. Finally advocacy with state and national government, as well as convening of key stakeholders, in order to bring about changes in labour laws is needed.