The Silent Struggles of Migrant Women: A Hidden Crisis in Reproductive Health

The Silent Struggles of Migrant Women: A Hidden Crisis in Reproductive Health

Ann Maria Anil, Researcher

In Kerala, a state often lauded for its progressive social and health indicators, a silent yet significant crisis affects migrant women workers. They face major barriers in accessing sexual and reproductive health (SRH) services. Despite migrant women making up nearly half of the migrant population, as indicated by the 2011 Census, whether due to employment, marriage, or associational migration, their specific experiences and challenges remain largely undocumented and overlooked. This invisibility deepens their vulnerability, hindering effective interventions in SRHR services, including access to safe abortion.

As part of the Safe Abortion For Everyone (SAFE) Fellowship with The YP Foundation, in-depth interviews were conducted with women migrant workers from West Bengal, Odisha, and Bihar, employed in sectors such as beauty and wellness, tailoring, and more. These interviews were followed by a focus group discussion with healthcare professionals and ASHA workers at a government hospital in Pathanamthitta. The goal was to understand the significant challenges migrant women face in accessing safe abortion services, contraceptives, and reproductive health information in Kerala. Below are some key findings from the study. For reasons of privacy and confidentiality, the names of all respondents have been changed.

Swastha, a beauty salon worker in Pathanamthitta, married and became pregnant as a minor. Despite the pregnancy being unplanned, cultural stigma and family pressure prevented her from seeking an abortion, ultimately forcing her to give up her aspirations. Her experience reflects the struggles faced by many migrant women, who have limited autonomy over their reproductive choices and are often pressured into continuing pregnancies they neither planned nor wanted. Nadia, a Muslim migrant worker, faces similar challenges, compounded by language barriers and cultural and religious norms. Unable to easily access reproductive healthcare, she stocks up on six months’ worth of contraceptives from her home state of West Bengal or relies on acquaintances to procure them. This workaround highlights the systemic barriers migrant women encounter in accessing basic healthcare services, deepening their vulnerability.

The Medical Termination of Pregnancy (MTP) Act of 1971 stipulates that only the consent of the person seeking the abortion is required. However, even in government hospitals, family consent is often demanded, fostering a judgmental environment and increasing the risk of family members becoming aware. While private clinics offer more discretion, they remain largely unaffordable for many. Societal taboos around reproductive rights further limit access to essential healthcare. Most migrant women lack access to rights-based information on reproductive health and safe abortion services, often relying solely on their mothers or close female friends for guidance. As a result, many resort to self-administering abortion-inducing medications, which frequently leads to health complications such as heavy bleeding, incomplete abortions, and in extreme cases, death.

In conversations with nurses at a government hospital in Pathanamthitta, it became apparent that they mistakenly believed abortion in India was only legal for minors or survivors of sexual violence. Despite Kerala’s high literacy rates, healthcare providers often misunderstand or are reluctant to adhere to the provisions of the MTP Act. Personal and religious biases frequently lead healthcare professionals to deny abortions, even when legally permissible. This highlights the urgent need for gender-sensitive and diversity-focused training for healthcare providers, ensuring they can better support vulnerable populations across caste, gender, religion, and including migrant women.

It was also found that ASHA workers, who play a critical role in bridging healthcare gaps and delivering services, engage directly with migrant families to provide essential health information and build trust. However, due to being overworked, underpaid, and burdened with multiple responsibilities, ASHAs are often unable to make SRHR information—especially regarding abortion—easily accessible.

Language barriers, systemic challenges, lack of proper documentation, and unfamiliarity with healthcare laws and schemes further isolate migrant women from Kerala’s otherwise robust public health system, increasing their vulnerability to unsafe abortion practices and other sexual and reproductive health issues.

Although Kerala has introduced initiatives like the ‘Athidhi Portal’ for migrant worker registration, ‘Apna Ghar’ for safe, affordable housing, and the ‘Awaz Health Insurance Scheme’ (AHIS), awareness of these programs among migrants remains low. To address this gap, targeted interventions such as SRHR-focused local health camps, multilingual IEC materials, and integrating SRHR into local governance structures are essential. Additionally, promoting gender-sensitive and diversity-focused training for healthcare professionals is crucial to ensuring inclusive healthcare access.

In conclusion, for Kerala’s policies and healthcare system to be truly effective, they must prioritize reproductive justice and safe abortion access, especially for marginalized groups like migrant women. Expanding awareness and embedding SRHR within these frameworks will foster a more equitable and comprehensive approach to healthcare.