ASHA workers are the backbone of India's healthcare, yet they fight for recognition and fair pay. These women are now trying to transform the narrative around labor and dignity in the healthcare system.

The word ‘ASHA’ means hope in Hindi, and refers to an Accredited Social Health Activist, a crucial link in the healthcare system of India. Against the systemic devaluation of their labour, ASHAs across India opted for collective action and formed one of the largest feminist workers resistance movements in India.
In 2005, the Indian Government launched the National Rural Health Mission (NRHM) to address the health needs of under-served communities in India. As part of the mission, ASHAs were to be women community health workers employed by the Ministry of Health and Family Welfare. ASHAs would serve the village they were from and help the community access healthcare at their doorstep. The government aimed to have “one ASHA in every village”.
As of June 2022, there were over 1.05 million ASHAs in India, making them the largest volunteer workforce in the world. However, in the last few years, ASHAs across the country, thousands of women on whom the functioning of the healthcare system rests, have begun to strike in protest against the government. At the core of all their demands is a simple one – to be recognised as workers and to be given their fair due for their work.
“When we were first recruited, we were told the work would be very little, we would just have to document the births in our neighbourhoods, but now our work has expanded to cover most of the community’s healthcare needs”, says Rita, an ASHA from Delhi who has been working since 2005. While ASHAs carry the burden of full-time workers, they receive none of the basic benefits of employment.
“While the government relies so much on our labour, it cannot provide even a night’s stay or a toilet for us when we visit the district government office. We have to wait in a government school building all night to attend a meeting in the morning”, says Rekha, an ASHA from Bamrauli in Uttar Pradesh. According to a survey conducted by All India Central Council of Trade Unions, most dispensaries where ASHAs report to in Delhi, do not have a working toilet for the ASHAs to use.
ASHA Workers Are the Difference Between Life and Death for a Majority of the Population in India
According to the NRHM, ASHAs are the ‘first port of call’ for any health-related demands of the deprived populations of their village. They are responsible for promoting health awareness, guiding communities on hygiene, sanitation, and nutrition, and supporting maternal and child health by facilitating immunizations, safe deliveries, and family planning. They provide first-contact care, administer basic medicines, counsel women on issues like birth preparedness and breastfeeding, and help connect the community to health services at local centres. Additionally, ASHAs distribute essential items such as oral rehydration solutions, iron tablets, and contraceptives.
ASHAs are responsible for such a wide range of duties that their centrality in the Indian healthcare system cannot be refuted. In India, ASHAs are the difference between life and death for a majority of the population.
However, despite the reliance of the healthcare system on their work, the government classifies them as ‘volunteers’. As a result, in most of the 28 states and 8 union territories of the country, except Andhra Pradesh, Kerala, Karnataka, Haryana, West Bengal and Sikkim, ASHAs are not entitled to a fixed pay. From the central government, ASHAs receive a payment of 2000 rupees (23.73 USD) a month for completing a set of eight tasks that include collecting data and promoting child and maternal health in the village. The rest of their payment system is incentive-based. ASHAs receive small additions for different tasks, such as 300 rupees (3.56 USD) for each institutional birth they facilitate.
To point out further the disproportionality of the work and compensation, ASHAs work for 8-12 hours a day, travelling across villages, often in extremely harsh climates, with no protective gear, and no healthcare support when they suffer from illness due to their job, while the honorarium received for their work is far from enough for their family’s livelihood.
Layers of Patriarchy: Devaluation of women’s labour
The patriarchy and caste system in India work together to devalue women's labour by assigning it a lower social status, often framing it as natural or obligatory rather than skilled or deserving of fair compensation. For upper-caste women, this often results in symbolic or domestic restrictions that devalue their contributions outside traditional roles, while lower-caste women face both economic exploitation and caste-based stigmatization. This dynamic is evident in the treatment of ASHA workers, whose critical healthcare roles are undervalued as extensions of gendered and caste-based service expectations, leading to poor pay and exploitative conditions.
“I am afraid that though I am forced to rush if any woman in the village goes into labour, if something happens to my child at home, I might not be able to help”, says Rekha.
ASHA workers critical healthcare roles are undervalued as extensions of gendered and caste-based service expectations.
Due to their incentive-based payment system, each time an ASHA does not respond to a healthcare call, they lose their payment. More importantly, they understand that if they do not respond, the patient who is calling them may not have access to any other healthcare. As Shashi Yadav, the State President of the Bihar Asha Workers Union points out, this simultaneous burdening of ASHAs through over-reliance on their labour and the devaluation of this very labour, has its roots in the patriarchal devaluation of women’s labour. It underlines the understanding that since women ‘take care’ of their households and families already, their care should extend to their communities and hence their country. The devaluation of the ASHA’s labour adds another facet to the devaluation of women’s labour in all walks of life – according to a 2023 report by the State Bank of India, the value of women’s unpaid domestic labour is equivalent to almost 7.5 per cent of India’s GDP.
Besides the lack of resources for their burden of responsibilities, ASHAs must also navigate caste and patriarchal norms in their work with little to no support. For instance, Shashi Yadav shares that in many cases, ASHAs are called to faraway villages at night under the pretence of a medical emergency. When they reach the house, they face harassment or even rape. ASHAs face harassment for distributing condoms and promoting sex education as well. Notably, during the COVID-19 pandemic, though ASHAs formed a crucial part of India’s pandemic response, they worked without any additional resources, protective gear, or support from the government. “I have had doors slammed on my face, even slapped by some residents due to stigma during the pandemic”, says Rita. Yadav writes about their working conditions during the pandemic, “In 2020, they received Rs 3000 for 3 months from the Central government at the rate of Rs 1000 per month, which was not sufficient even for their rickshaw fare”. Hundreds of ASHAs were infected by the coronavirus and many died due to the lack of oxygen cylinders. However, their families did not receive the insurance promised by the government. While carrying out their duties, ASHAs faced verbal and physical abuse from their communities. “It is not fair, but we have continued to do this work, and done it with complete sincerity because we don’t have any other choice”, says Rekha.
Power of protest: ASHAs are on strike
Since the COVID-19 pandemic, ASHAs have increasingly collectivised and intensified protests in various states. In the last few years, ASHAs have gone on strike in Maharashtra, Uttar Pradesh, Odisha, Delhi, and West Bengal. Yadav, an organizer of ASHAs, says that almost 80 per cent ASHAs are now collectivised, and through each others’ support are able to negotiate for better working conditions and safety. She points out that while ASHA workers are given the burden of both regular and emergency services and are ‘on call’ almost 24 hours a day, the government’s continuous neglect of their needs and refusal of their demands shows that the government is interested in extracting forced labour from the ASHAs. In this context, ASHA workers withdrawing their labour through the form of strikes forces the government to take note of their demands. In Bihar, through two major strikes in 2018 and 2023, ASHA workers were able to negotiate their demands with the government through indefinite strikes.
On December 1st 2018, ASHAs went on an indefinite strike which ended with negotiations with the government after 38 days. Through the 2018 strike, ASHAs were able to secure a fixed monthly honorarium of 1000 rupees (11.85 USD). However, after the agreement between the government and the ASHAs, the word ‘honorarium’ was changed to ‘reward’ by the then BJP Health Minister Mangal Pandey. This emphasised the State’s devaluation of ASHAs work, and further reinforced the idea that the ASHAs do not deserve to be paid for their labour. On July 12, 2023, ASHAs in Bihar went on another indefinite strike to improve on the negotiations made in 2018.
The ASHA movement is working towards worker status and permanent employment benefits in the future.
This 32-day strike, which was one of the largest women workers movements in Bihar in recent times, resulted in a negotiation on various demands of the ASHAs. The government acknowledged the ASHAs demand to term their payment as an ‘honorarium’ rather than the patronising terminology of a ‘reward’. The honorarium was also increased to 2,500 rupees. The Bihar government agreed to send recommendations to the Central government of India to increase incentive rates, implement a retirement scheme and other job benefits, and clear past dues of the ASHAs. “This is the first victory in our battle for the rights of ASHA workers”, says Yadav, one of the chief organisers of this strike. The ASHA movement is working towards worker status and permanent employment benefits in the future. However, ASHAs protests have been criminalised and punishable in various states, as police cases have been filed against protesting ASHAs and many have been threatened with dismissal.
A strike at the intersection of the workers movement with the feminist movement
On August 9, 2024, a medical student in Kolkata was raped and murdered in the R.G. Kar Medical College and Hospital when she went to rest during a night shift. After this incident, medical students and doctors across the country came out in protest with the rallying cry ‘Take back the night’. Though ASHAs' needs for workplace safety were not included in this movement, ASHAs across the country joined the protests to demand safety for women in medical fields.
Shashi Yadav says that the demands of the ASHAs do not usually feature in popular feminist movements, because their demands are seen as being more relevant to the workers’ movement. At the same time, due to the patriarchal blind spot of the workers movements, ASHAs demands were neglected in the beginning. However, ASHAs represent the intersection of the feminist and workers movements, as their struggle against the devaluation of their labour must tackle class, caste and patriarchal systems. According to Yadav, in recent times the strength of the ASHA movement ensures that the ASHAs’ needs cannot be .sidelined.
ASHAs represent the intersection of the feminist and workers movement.
When asked how the healthcare system will change if the ASHAs demands are all met, Yadav says that the changes will be immense. Even under the present conditions, ASHAs across the country have made such incredible contributions to the healthcare system that under fair working conditions, ASHAs may transform the healthcare system, making it more accessible and inclusive for patients from all backgrounds.
The ASHA workers’ movement is a stark reminder of the strength of collective organising and a powerful symbol of resistance against the systematic devaluation of women’s labour. Despite their indispensable role in improving public healthcare, these workers remain marginalised, underpaid, and unrecognised as formal employees. The withholding of their labour is a radical expression of resistance against a system that sees their work as ‘duty’. Recognizing and supporting ASHA workers is not just a matter of justice for them, but a crucial step toward building a more equitable healthcare system that serves all.