Agency through Devalued Work: The case of Health Care Workers in Palliative Care in Kerala

Women are at the center of palliative home-based care in Kerala; however the labour in which this care is produced is undervalued, insecure, and deeply gendered. This paper explores working conditions, gendered hierarchies and forms of agency adopted by community nurses, secondary nurses and Accredited Social Health Activist (ASHA) workers working in palliative care. Using purposive sampling method and multiple modes of data collection including 12 Key informant and 105 in-depth interviews the research draws upon qualitative primary data collected from four palliative care units in rural, urban and coastal parts of Thiruvananthapuram district to analyze the experiences of women in the working places. Unequal conditions existed among the women in terms of compensation, security of contracts, work load, recognition as well as interpersonal relationships at work. While women spend time for home visits, documentation and care responsibilities, they share informal, unfunded, and unpaid domestic and familial care work at home. Besides unequal working conditions and a mix of other factors such as gender stereotyping, harassment, insecurity during home visits and lack of institutional recognition shaping women's work experiences and relations. However, work that has low social value does not create women disempowerment. The paper argues that agency of women should be situated within the structure not as proof that exploitation is already ended and it is seen that among the palliative care workers women overcome exploitation by negotiating, asserting and acquiring power even within structures which deny them rightful recognition. Hence the paper highlights that feminized caring labour need to be recognized, protected and dignified.