Maternal healthcare and perinatal mortality among brick kiln migrant workers: A case study.

ABSTRACT

The National Sample Survey Organization defines migrants as those for whom the last usual place of residence, where the person had stayed continuously for a period of 6 months or more, is different from the present place of enumeration. Short-duration migration is defined as persons staying away from their usual place of residence for 60 days or more for better employment or in search of employment.1 According to the 2001 Census of India, the proportion of migrants was 30%.2 More than 90% of the workforce in India is in the unorganized sector, also consisting of migrants.3 These migrant labourers make enormous contribution to the Indian economy through sectors such as construction, textiles, brick-making, stone quarries, mines, etc.4 The brick kiln industry in India is large and second only to that of China in terms of global production with over 100 000 brick kilns, employing about 10 million workers.5 Brick kilns serve as a source of livelihood for thousands of unskilled workers. A large number of these workers are also interstate migrants, with people from Uttar Pradesh being the largest from a state.6 Brick kilns are situated mainly in rural and in semi-urban areas, the work is predominantly seasonal and informal, attracting migrant labourers who are often landless farmers. The labourers are paid on a piece rate with average daily wages varying from `200 to `400 (US$ 2–4).7 The monthly income of over half (52%) the unskilled migrants was < `3000 according to a study conducted in Bengaluru, Karnataka.8 The Unique Identification Authority of India, an agency of the Government of India responsible for implementing the AADHAR scheme, requires migrants to be present in their home town to get enrolled.9 Enrolment with this authority scheme has been the basis of determining eligibility for various government schemes. Therefore, it is possible that migrant workers are excluded from government schemes to varying degrees such as voting rights, subsidized food and fuel, and even healthcare. A brick kiln owner typically provides water facilities to the workers in the form of a bore well. Usually no sanitation facility, even of the most rudimentary kind, is provided, and labourers defaecate in the open.10 Facilities such as a crèche, medical firstaid and transportation are not available to the workers. It is known that migrant workers in the brick kiln industry suffer many health hazards.11,12 They have to travel long distances to reach government hospitals; they are often unable to visit these facilities during illness. A study by Garg et al. found that among slum women, mostly migrants, who had not received antenatal care, 79% of their husbands were unskilled labourers. The perceived barriers for utilization of healthcare services were lack of knowledge, no