Abstract
IntroductionThe tea estate sector of India is one of the oldest and largest formal private employers. Workers are dependent on plantation estates for a range of basic services under the 1951 Plantation Labour Act and have been subject to human rights violations. Ad hoc reports related to poor health outcomes exist, yet their determinants have not been systematically studied. This study in Assam, situated in Northeast India, sought to understand the Social Determinants of Health (SDH) of women plantation workers with an aim to offer directions for policy action.MethodsAs part of a larger qualitative study, 16 FGDs were carried out with women workers in three plantations of Jorhat district covering permanent and non-permanent workers. Informed consent procedures were carried out with all participants individually. Data were analyzed thematically using Ritchie and Spencer’s framework based on an adapted conceptual framework drawing from existing global conceptual models and frameworks related to the SDH.ResultsDeterminants at structural, intermediary and individual levels were associated with health. Poverty and poor labour conditions, compounded by the low social position of women in their communities, precluded their ability to improve their economic situation. The poor quality of housing and sanitation, inadequate food and rations, all hampered daily living. Health services were found wanting and social networks were strained even as women were a critical support to each other. These factors impinged on use of health services, diet and nutrition as well as psychosocial stress at the individual level.ConclusionYears of subjugation of workers have led to their deep distrust in the system of which they are part. Acting on SDH will take time, deeper understanding of their relative and/or synergistic contribution, and require the building of stakeholdership. Notwithstanding this, to have heard from women workers themselves has been an important step in visibilizing and building accountability for action on the health and SDH of women in plantation estates.
Highlights
The tea estate sector of India is one of the oldest and largest formal private employers
In the North Eastern state of Assam, nearly one in five persons is employed in the plantation sector [1], relying on estate for employment as well as a range of services including housing, water, health, education, and many facilities that affect the daily lives of worker [2]
Based on Ritchie and Spencer’s Framework Method [16], we created a priori codes according to structural, intermediary and individual factors described in relevant frameworks on social determinants of health that we identified in advance of the study that were relevant to women’s health [17, 18]
Summary
The tea estate sector of India is one of the oldest and largest formal private employers. In the North Eastern state of Assam, nearly one in five persons is employed in the plantation sector [1], relying on estate for employment as well as a range of services including housing, water, health, education, and many facilities that affect the daily lives of worker [2] This has been historically shaped by the practice, by British companies since the nineteenth century, of coercively bringing low Rajbangshi and Nambiar International Journal for Equity in Health (2020) 19:29 period, tea plantations continue to control the lives of their workers in a parallel governance structure, with little active involvement by the State [6]. Studies suggest that women in plantation estates are more likely to have severe anaemia, be married early and have high parity [11,12,13,14]
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