Dr. Christa Wichterich (Senior Fellow, Independent Researcher, Bonn)

Who Cares? Care Extractivism, State and Gendered Subjectivities – The Case of Scheme Workers and Nurses in India

1 December 2018 – 1 March 2019

Social reproduction and care work have been at the centre of feminist political economics which is about unequal exchange and power relations based on gender and other categories of social inequality. Work is conceived as “site of gendering” which shapes the gender division of labour, gendered identities and performing subjectivities. Persistently, unpaid and paid care work are marked by low valuation and meagre remuneration assuming a female nature and its intersection with caste, class, ethnicity, race, migration and North/South.

The main findings of my recent research on care work in Germany were that neoliberal policies try to fix crises situations in social reproduction by resorting to care extractivism. Analogous to resource extractivism, I coined the term ‘care extractivism’ to analyse the intensification of commodification of care resources and its expansion into areas which were not commercialised until recently. Under the auspices of austerity policies, strategies of care extraction aim at managing crisis situations while reducing costs, intensifying efficiency, and foster economic growth. They construct reproductive
workers as a cheap low-valued labour force that supplies services in national and transnational care chains.

On this backdrop and in the overall political and economic context of further privatisation and neoliberalism in India, I explored two sectors of care giving, namely scheme work and nursing. The key research questions were: what mechanisms, strategies and discourses facilitate care extraction and the persistent low valuation of care work?

Government schemes with nearly 70 lakh anganwadi workers, mid-day-meal cooks and maternity related health workers (ASHAs) were introduced from the 1970s onwards to tackle the crisis of chronic malnutrion, ill-health and lack of child development in poor rural communities. Scheme work is “voluntary”, meaning to a large extent unpaid women’s work, remunerated with a small honorarium only. Though the work is not considered employment in the public sector but a gendered community service, sewa, it is the backbone of these internationally reputated poverty alleviation and so-called women’s empowerment schemes. The schemes represent the welfarism of the Indian state, and are supported by foreign development aid.

Voluntarism and the ongoing mobilisation of unpaid care work for public programmes is an appalling strategy of care extractivism. Without regular payment, the workforce that is deemed to combat poverty in the communities is impoverished itself. While struggling against the imposed voluntarism, the scheme workers construct a subjectivity of being ‘real’ workers doing a government job, and demand regularisation.

However, the low valuation of their work is sustained by a narrative of “corruption” and accusations of misuse of resources, irregularities and absenteeism delegitimise their struggle for recognition and fair pay. This stigmatisation facilitates care extraction of honorary work and discredits the scheme work. The stigma justifies the intensified use of control and bureaucratic documentation of the scheme workers which deepens the contradiction between voluntarism and mechanisms of force.

After liberalisation cost efficiency became the guiding principle of public services reforms. The state started to privatise and outsource provisions to corporations, private foundations and (commercial) NGOs, and to introduce direct cash transfers. All these measures undermine the schemes what suggests that the state plans to phase out the schemes as old-fashioned welfarism.

The acute shortage of around 2 million nurses is a key problem of the Indian health care system. Nursing is trapped between its historically double stigmatisation based on the brahmanic concept of pollution and accordingly low caste ascription, and the assumption of sexual permissiveness of nurses. At the same time, the job has a connotation of modernity based on professionalization, medical technology and migration. Since liberalisation, the political economy of nursing is largely determined by privatisation and corporatisation of training institutions, hospitals and recruitment agencies. The principle of cost efficiency leads to informalisation, contract labour and a further hierarchisation of nursing in the hospitals. Being indebted by an educational loan, nurses who migrate within India are forced into vulnerable situations of bonds. The inner differentiation and hierarchy of nurses in hospitals is a regime of extractivism along caste, class and ethnic lines, and a way of downloading “dirty” body work and stereotypes to the bottom of the pyramid. This hierarchisation is internalised and perpetuated by the nurses themselves. On this backdrop, being understaffed and overworked is the prevailing pattern of care extraction in private and public hospitals alike while competition and fragmentation of the labour force are advancing. Multiple stress often results in low quality of nursing.

Many of the nurses from Kerala who migrated in domestic care chains to metropolitan cities in India or in transnational care chains abroad are empowered as breadwinners vis-à-vis their less earning husbands. However, they stick to their Malayali identity of being a ‘good’ women even far away from home and try to raise the status of the family e.g. through paying excessive dowry, a deeply patriarchal structure.

Because of the bright prospects of a migratory and income career, men have entered the profession. While women as breadwinners are breaking up the gender division of labour, it is asserted by male nurses who are founders and leaders of new unions with a majority of female members.

Many indicators of modernisation and more fluid public-private boundaries are prevailing in a persisting or even strengthened patriarchy. New identities as care workers and caring subjectivities are constructed while the so-called welfarist state and the market are less and less caring about the care workers.

Nowadays, unionisation and struggles for equal pay, regularisation of contract workers and less workload. Anganwadi workers are coined the best organised group in the unorganised sector. Their strikes have got a lot of attention in public and led to a pay hike by the government – however still neither reaching the minimum wage nor recognition as regular worker. Under male leadership, nurses in Kerala finally achieved a victory: equal pay for equal work in private and public hospitals. Though still highly fragmented, alliances are formed to demand a change in neoliberal policies and in privatisation e.g. a higher health budget and a welfarism which does not shamelessly extract women’s care work.


Christa Wichterich, PhD. in sociology, worked as a lecturer at Gilan University in Iran, at Jawaharlal Nehru University in New Delhi and at various universities in Germany, Austria and Switzerland. Recently, she was a guest professor for gender politics at the universities of Vienna, Kassel and Basel. As researcher, journalist and author of books, her key interest is a feminist perspective on globalisation and development, women’s work, sexual and reproductive rights, women’s movements and international gender policies.