Systematic review of health challenges experienced by Indian women engaged in informal labor

The informal economy encompasses all economic activities carried out by workers or economic units that are not adequately covered by formal legal or regulatory frameworks. National data from India indicate that 53.7% of the 308 million unorganized workers are women. Given the multifaceted occupational risks associated with informal employment, women workers in the informal sector are vulnerable to a range of adverse health outcomes. The present study aims to synthesise existing evidence on occupationally related health challenges experienced by Indian women employed in the informal sector.

Studies reporting health outcomes among Indian women engaged in informal labor were systematically searched in digital databases from their inception until September 09, 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Owing to substantial heterogeneity in outcome reporting and the limited availability of measures of dispersion, a pooled effect size could not be estimated. The risk of bias in included studies was assessed using the Newcastle-Ottawa Scale.

Thirty-three studies involving women workers in the informal sector were included. Musculoskeletal disorders were the most frequently reported health outcome across occupations. The prevalence of upper limb and trunk discomfort (89-95%) was higher than that of lower trunk and lower limb discomfort (61-81%). High prevalence of cardiorespiratory (~ 73%), dermatological (32-78%), and ophthalmic (45-90%) symptoms was also reported. A small number of studies indicated that the odds of certain adverse health outcomes were higher among women compared with men in similar occupations. Overall, the majority of included studies were of low methodological quality and exhibited a high risk of bias.

The findings highlight the substantial occupational health burden faced by women workers in India's informal sector. Although the evidence is largely derived from studies with high risk of bias, the growing participation of women in informal employment underscores the need for urgent, gender-responsive public health action. There is a pressing need to integrate informal women workers into primary healthcare systems and social protection programs.