The persistent erasure of marginalised women within systems that depend on their labour is not merely a policy failure, but a stark reflection of the deeper social hierarchies that continue to go unchallenged.
Published Mar 28, 2025 | 9:00 AM ⚊ Updated Mar 28, 2025 | 9:00 AM
ASHAs protesting in Thiruvananthapuram (X).
Synopsis: ASHAs form the backbone of India’s rural public health infrastructure, particularly under the National Rural Health Mission (NRHM) initiated in 2005. Spread across various states, ASHA workers have been consistently mobilising for better wages, formal recognition as employees, and access to social security benefits. Their protests have brought into sharp relief the structural inequities of India’s public health system, as well as the persistent undervaluation of feminised labour — especially when performed by women from marginalised caste and class backgrounds.
The mobilisation of Accredited Social Health Activists (ASHAs) can be seen as one of the most compelling contemporary social movements in India. It is a powerful grassroots resistance against the broader forces of globalisation, the erosion of the welfare state, neoliberal restructuring, and the systemic marginalisation of precarious labour.
Emerging from the ranks of community health workers situated at the very margins of India’s public health apparatus, ASHAs now stand at the forefront of a struggle that challenges not only their immediate working conditions but also the deeper political economy that has rendered essential care work invisible, undervalued, and expendable in an increasingly market-driven state.
Nowhere has this struggle been more intense and enduring than in Kerala, where the ongoing agitation in front of the state Secretariat in Thiruvananthapuram has emerged as the most determined expression of ASHA resistance so far, bringing their precarity and demands for recognition to the very centre of mainstream political and public debate.
ASHAs form the backbone of India’s rural public health infrastructure, particularly under the National Rural Health Mission (NRHM) initiated in 2005.
Officially designated as volunteers but functioning as frontline community health workers, ASHAs are tasked with a wide range of responsibilities, including maternal and child healthcare, disease surveillance, health education and the distribution of essential medicines.
They play a crucial role in accompanying pregnant women to hospitals, facilitating institutional deliveries, supporting antenatal and postnatal care, and promoting immunisation. Their tasks extend to raising community awareness on hygiene, nutrition, family planning, and disease prevention, as well as educating people about various government health schemes.
ASHAs are also central to grassroots-level disease surveillance, identifying and reporting communicable diseases such as tuberculosis, malaria and Covid-19, and assisting communities during health emergencies. In addition, they are involved in maintaining health records and assisting with data collection for national health programs.
Their contribution became particularly visible during the Covid-19 pandemic when they were instrumental in contact tracing, medicine distribution, monitoring home-isolated patients, and supporting the vaccination drive.
Spread across various states, ASHA workers have been consistently mobilising for better wages, formal recognition as employees, and access to social security benefits. Their protests have brought into sharp relief the structural inequities of India’s public health system, as well as the persistent undervaluation of feminised labour — especially when performed by women from marginalised caste and class backgrounds.
What has become increasingly clear through these struggles is that ASHA agitations are not merely demands for improved remuneration; they represent a deeper challenge to the neoliberal governance structures that have shaped health and welfare delivery in India since the early 2000s.
In Bihar, the intensity and duration of the ASHA agitation drew national attention. In July 2023, ASHAs undertook a 32-day strike — one of the largest women-led workers’ movements in the state. The agitation brought to the surface long-standing grievances related to unpaid and underpaid labour and demanded recognition beyond tokenistic praise.
As a result, the government conceded to an increment in their honorarium to ₹2,500 and agreed to recommend further benefits to the Union government.
However, the movement in Bihar was not just about economic rights — it was a potent expression of the demand for dignity, visibility, and structural reform in a system that has long thrived on the invisible labour of rural women.
At the national level, the scale of the movement further intensified. On 29 November 2024, thousands of ASHAs from 13 states gathered at Jantar Mantar in New Delhi, under the leadership of the ASHA Workers’ and Facilitators’ Federation of India (AWFFI), affiliated with the Centre of Indian Trade Unions (CITU).
Their demands included regularisation of employment, a minimum wage of ₹26,000 per month, and comprehensive social security, including pensions.
The national coordination of the protest signalled a maturing political movement — one that was no longer content with symbolic acknowledgement but demanded structural transformation. These workers, once considered mere adjuncts to the public health system, are now asserting themselves as a formidable collective voice, challenging both the patriarchal division of labour and the neoliberal logic that renders them disposable.
In Haryana, too, ASHA workers have sustained visible and impactful forms of protest. From Rohtak to Hisar, sit-ins and public demonstrations have drawn attention to the negligence of the state government, particularly regarding timely disbursement of incentives, lack of protective equipment, and the absence of meaningful compensation for their extensive role during the Covid-19 pandemic.
In many cases, the response of the state has been apathy or repression — yet the resilience of these women has not waned. Supported by local trade unions and women’s rights groups, their resistance has become part of a larger feminist and anti-neoliberal assertion in contemporary India.
ASHAs are overwhelmingly women — who carry the weight of both productive and reproductive labour. Their work is essential to the health of the nation, yet it is consistently rendered invisible through the state’s classification of them as “volunteers”.
By demanding formal recognition as workers, ASHAs are not just seeking better pay — they are dismantling the caste-patriarchal and neoliberal frameworks that exploit their care work while denying them dignity and rights.
According to some of the recent government estimates, there are over 10 lakh ASHAs across the country, each typically assigned to serve a population of around 1,000 in rural areas, and up to 2,500 in tribal regions.
Most ASHAs hail from marginalised and economically disadvantaged communities, reflecting the structural inequalities embedded in Indian society. A significant proportion belong to Scheduled Castes (SCs), Scheduled Tribes (STs), and Other Backward Classes (OBCs).
Without fixed salaries, social security, or employment benefits, their status remains precarious, and their labour — despite being essential — is invisible. Performance-based incentives, which often arrive irregularly and inadequately, fail to compensate for the volume and intensity of their work. This under-compensation, coupled with the expectations placed on them during public health emergencies like the Covid-19 pandemic, has led to widespread physical and mental exhaustion.
In Northern Karnataka, for instance, a study recorded that violence against ASHAs was common and frequently emerged from their immediate social environment, adversely affecting their morale and effectiveness. Additionally, the lack of proper training, inadequate supply of materials, and the absence of sustained institutional support further compound the vulnerabilities they face.
This layered exploitation — rooted in caste, gender, and class — underscores the contradictions within India’s health governance and labour structures. While ASHAs are celebrated rhetorically as “health warriors”, their lived realities tell a different story — one of systemic neglect and caste-inflected marginalisation.
The persistent erasure of marginalised women within systems that depend on their labour is not merely a policy failure, but a stark reflection of the deeper social hierarchies that continue to go unchallenged.
In Kerala, one of the most sustained and politically charged labour struggles in recent years has been led by the Kerala ASHA Health Workers Association (KAHWA), reflecting not only the demands of a neglected workforce but also the growing political consciousness and determination of marginalised women.
Since 10 February 2025, ASHAs have been staging a continuous protest in front of the state Secretariat, demanding fair compensation and dignity for their work. In a further escalation of their struggle, they have now also launched a hunger strike.
Their primary demands include raising the monthly honorarium from the current ₹7,000 to ₹21,000, provision of retirement benefits amounting to ₹5 lakh, and the formalisation of their employment status. While these demands are not new, what is striking is the sustained, organised, and defiant manner in which they have been voiced — by women who are often positioned at the intersections of caste, class, and gender-based marginalisation.
This agitation has laid bare the contradictions in Kerala’s political landscape. The LDF government, which is often credited for its pro-welfare policies and progressive posturing, has responded to the ASHA protests with unjustifiable defensiveness and hostility.
Rather than acknowledging the legitimacy of the workers’ demands, senior ministers in the government have dismissed the movement as politically motivated, going so far as to label it a BJP-sponsored agitation.
This stance has sparked widespread criticism from civil society, Opposition parties, and feminist groups, who view such allegations as a tactic to delegitimise genuine grievances. The discourse quickly turned confrontational, with ASHA union leaders openly challenging ministers’ statements and refusing to allow the movement to be mischaracterised as partisan.
This is particularly unfortunate since the majority of ASHA workers in Kerala also belong to SC and ST communities, as well as other economically vulnerable sections of society, as pointed out by prominent feminist writers in Kerala, Professor Sarah Joseph and Dr J Devika.
The controversy also sparked a broader public debate around the interpretation of the LDF’s election manifesto, particularly its promises related to minimum wages and workers in the unorganised sectors.
In one section, the manifesto pledged to raise the minimum daily wage to ₹700, and while ASHA workers were mentioned in passing, no direct commitment was made to their honorarium or employment status. However, ASHA workers and their unions interpreted this mention as an opening — a political and moral entry point — to demand their inclusion in the promise.
They framed their struggle around a two-pronged slogan: First, recognise ASHAs not as “volunteers” but as actual workers, and second, extend to them the promised minimum wage of ₹700 per day to all workers, which would amount to ₹21,000 per month based on a standard 30-day work cycle.
This demand, far from being opportunistic, stems from the reality of their daily labour, which includes surveillance, field visits, data collection, patient care, and crisis management, often exceeding the workload of many formally designated workers.
Notably, the CPI(M)’s own trade union wing, CITU, has long recognised ASHAs as workers and advocated for their labour rights, including demands for wages, job security, and social protection.
By positioning themselves within the framework of the state’s own commitment to minimum wages, ASHAs have advanced an argument that is at once moral, economic, and deeply political — challenging the hypocrisies of a system that relies on their labour while continuing to erase their status as workers.
The contention between the state and Union governments over the rights and welfare of ASHAs is rooted in a blurred division of responsibilities, which has allowed both to evade accountability by shifting the burden onto the other. The ASHA programme, launched under the National Rural Health Mission (NRHM) in 2005 and now a key component of the National Health Mission (NHM), is formally a centrally sponsored scheme.
The Union government is responsible for setting the broad policy framework and guidelines, determining the structure of the programme, and allocating funds for specific task-based incentives. It also funds training and capacity building, creating a national infrastructure that guides how the ASHA system is meant to function.
However, the Union government stops short of guaranteeing a fixed wage, employment benefits, or formal recognition of ASHAs as government workers. By limiting its commitment to incentives for predefined services, the Union government maintains a distance from the actual conditions under which these women work and live.
The state governments, meanwhile, are tasked with implementing the programme on the ground. They control key aspects such as the disbursement of honorariums, coordination of field-level responsibilities, and grievance redressal mechanisms. Critically, states have the discretion to supplement the central incentives with a fixed monthly honorarium, which explains the wide variation in ASHA payments across the country.
States like Kerala, Tamil Nadu, and Maharashtra have historically provided higher honorariums and better support infrastructure, while others have consistently underinvested in the scheme. This discretion gives states significant autonomy to address the concerns of ASHAs, should they choose to do so. Moreover, as health is constitutionally a state subject, the primary responsibility for ensuring fair employment conditions within public health lies with state governments.
This dual structure creates a governance grey zone. The Union government claims that it provides the funds and overall design, implying that implementation failures lie with the states. Conversely, states argue that they are constrained by the limited financial and structural support from the Centre.
The result is a pattern of mutual deflection, where neither level of government assumes full responsibility, and ASHA workers remain trapped in precarious, undervalued labour arrangements.
ASHAs are acutely aware of the institutional ambiguity that defines their position within the Indian public health system. They know that while the Union government provides the overall framework, guidelines, and partial funding — mainly through task-based incentives — it does not ensure job security, minimum wages, or recognition as formal workers. They also recognise that the state governments, which are directly responsible for implementing the programme, disbursing payments, and setting additional honorariums, possess the administrative authority and constitutional mandate to address many of their immediate concerns.
Guided by this knowledge, they agitate against the Union government for a more just and inclusive institutional framework — one that moves beyond the exploitative “volunteer” model and ensures comprehensive resource sharing, stable employment structures, and universal protections. Their movements are therefore not misinformed or politically misled, but rooted in an informed critique of a system that benefits from its own lack of clarity.
In this light, any attempt — by political actors or commentators — to opportunistically delegitimise ASHA agitations by labelling them as premeditated attacks on either the states or the Union government is both intellectually dishonest and politically unacceptable.
ASHAs, as frontline agents of public health and as political subjects, are fully justified in holding both the state and Union governments accountable. Their struggles are a demand for justice within a system that has long relied on their labour while denying them basic rights.
To dismiss these movements as partisan or misplaced is to overlook the structural failures of misgovernance — and to silence the voices of some of the most vital yet undervalued contributors to India’s healthcare system. It also means discrediting a powerful intersectional feminist workers’ movement that challenges neoliberal governance, caste-based exclusion, and systemic marginalisation.
(Views expressed here are personal.)
