Living conditions and the burden of daily wage work prevent young migrant mothers from availing state health services, including vaccination for their children
Amoolya Rajappa
Siddhartha Colony shelters workers from North Karnataka employed in construction, manufacturing, and domestic work in the nearby Peenya industrial area in Bengaluru. Amoolya Rajappa/The Migration Story
Bengaluru, Karnataka: Twenty-year-old Mahalaxmi got married three years ago. Last October, her daughter Rashmita, now 11-months old, caught a severe cough and chest infection. The eight day stay and treatment in a private hospital cost her Rs 10,000. She had to take an informal loan at a high interest rate to pay the bills.
Born in a family that migrated to state capital Bengaluru from Yadgir district in Karnataka, Mahalaxmi worked as a construction worker about a year ago. Due to lack of functional crèches at Anganwadi centres and no other support system, she had to quit her work to look after her daughter.
Her neighbour Parvathi, a mother of three children under 10, also migrated from Yadgir. She doesn’t really remember the vaccination details of her children. “I could only track the vaccination till they were nine months’ old. After nine months, neither the Government representative insisted nor did we follow up,” said Parvathi, who works as a domestic worker for a living.
Young mothers in the migrant communities of Bengaluru face a constant financial and logistical struggle to manage necessary vaccination and handle routine medical issues of their children amidst the grind of daily wage work and changing locations.
Mahalaxmi, 20, relies on Anganwadi workers who regularly visit their settlement, to ensure free vaccinations for her 11-month-old daughter. Amoolya Rajappa/The Migration Story
"Multiple problems complicate the case of migrant populations. In the neighbourhoods they stay, there is extreme ignorance of the benefits of essential vaccinations. And then they frequently relocate within the city which makes it difficult for them to navigate new neighbourhoods and find reliable guidance to access healthcare facilities. Language barrier further hinders their ability to seek the support they need,” says Venkatraman Iyer, founder of Swabhimaan, an NGO working with underprivileged communities in South Bengaluru.
“Better outreach programs are needed to ensure these services reach young mothers, as this can significantly improve their children’s overall health,” added Iyer.
Government health services v/s private clinics
Ashwathpura migrant colony is in Bangaluru's Dasarahalli area. It is located on government land along a storm water drain that falls into the nearby Chokkasandra lake. Packed in parallel lanes, there are 250-300 houses in the cluster, all inhabited by migrant labourers from North Karnataka and the nearby state of Tamil Nadu. People here earn a livelihood from construction work, housekeeping, domestic work and security services.
Designated government nurses and Accredited Social Health Activists (ASHA) visit the locality twice a month to administer vaccines besides keeping track of the vaccinated population in the area and advising mothers on maternal and child health. Mahalaxmi depends on the Anganwadi workers for Rashmita's vaccination but for other health issues, she is quick to turn to a private doctor. “The syrups given by Anganwadi nurses take too long to work,” she said.
Parvathi also visits private clinics nearby for minor illnesses of her three children. “Private doctors never insist on checking vaccination records. The government hospitals and Primary Health Centres (PHCs) are too far to reach on foot. Each visit costs between ₹300 and ₹1,000,” said the 26-year-old. Over the past six months, Parvathi has spent ₹5,000 to ₹6,000—about 15% of her family's income—on her son’s medical expenses.
Long waiting time, distance, overbearing documentation and relatively poor service quality are the reasons for not going to PHCs, concur women in Ashwathpura.
Essential child vaccination impacted in the flurry
The government recognises vaccination against 12 preventable diseases as (diphtheria, pertussis, tetanus, polio, measles, rubella, severe childhood tuberculosis, hepatitis B, Hib, pneumococcal infections, and rotavirus-induced diarrhoea) an essential component of child health and thus made these vaccines free under the Universal Immunisation Programme (UIP).
But the women in migrant colonies displayed a lack of interest, citing side effects of injections that makes parents hesitate to vaccinate their children.
The Anganwadi centre located next to the Ashwathpura Colony in Bengaluru. Amoolya Rajappa/The Migration Story
Mariyamma, 28, gave birth to her son at the Mallasandra Primary Health Centre, about three kilometres from Ashwathpura Colony. She benefited from the Thayi Bhagya scheme that provides comprehensive healthcare and financial aid to pregnant and lactating women from low-income families.
“Some children develop high fever after vaccination, forcing parents to skip work to care for them. This results in loss of daily wages for two to three days so young mothers don’t want to take that risk,” added Mariyamma, who quit her job as a domestic worker after her son’s birth. She said her son received all necessary vaccinations but could not recall the details of his last immunization.
The 2019-21 National Family Health Survey says that 76% of children aged 12–23 months are fully vaccinated, which is a sizable increase from 62% in 2015–16. However, studies indicate that there was a significant decline in child immunizations in India during the pandemic. A report by the WHO and UNICEF says that India recorded the second-highest number of unvaccinated or "zero-dose" children in 2023, with nearly 16 lakh children missing out on essential vaccines. The report also highlighted a decline in India's diphtheria, pertussis, and tetanus (DPT) vaccine coverage, which dropped from 95% in 2022 to 93% in 2023, exposing gaps in the country’s immunization efforts.
Praveena Kumari, an ASHA worker, visits multiple high-risk areas in Bengaluru’s Dasarahalli ward every month to monitor immunizations. “We do our best to follow up and remind young mothers about these crucial vaccines but some remain fixated on side effects like fever and fail to see the long-term benefits of life-saving vaccines,” Praveena told The Migration Story. “Some parents say, ‘What’s the point of vaccinating if children still fall sick?” she added.
But the ASHA workers’ hard work pays off at times. Anita, 30, has four children, all under 12 years. “My husband’s legs do not function properly and they say it is because of wrongful polio vaccination. I was initially scared to vaccinate my children, but then the nurses convinced us,” shared Anita, a resident of Siddhartha Colony, home to around 240 migrant families. Residents of Siddhartha Colony work in the nearby Peenya industrial area.
While fear of losing work days is one reason behind the indifference towards vaccines, the other is navigating the complex web of government health services which sometimes requires furnishing past vaccination records and other formalities.
A resident of Rajendra Nagar in Koramangala, 29-year-old Arpita Biswas found it hard to track her toddler’s vaccinations after the local PHC relocated. “The alternative PHC frequented by the other women in our neighbourhood is located in Audogudi and is quite far. With my husband away at work all day, I did not feel confident taking my child alone since I was not familiar with the locality,” said Biswas who hails from Nadia district in West Bengal.
Biswas could not access a PHC for almost a year after her child’s nine-month vaccinations, causing her son to miss several crucial vaccines between 9-18 months of age. "After he turned two, an ASHA worker guided me to the new location of the PHC which is right across the main road, less than a kilometre away," she said.
Lack of records
Vaccinations for infants are generally provided until the age of one; however, for certain diseases, additional and booster doses must be given up to the age of five. This necessitates that parents and healthcare professionals maintain accurate records of these immunizations.
But when asked about vaccination records of her children, Anita admitted she did not remember where she misplaced the Thayi card, which contained the vaccination records of her youngest daughter.
Siddhartha Colony is located right next to a sewage drain and is prone to flooding. Diseases like malaria and typhoid are common here. As she and her friends Akkamahadevi (25) and Shantha (22) sat outside their house talking to The Migration Story, it was evident that it is a big deal for them to preserve records, not just vaccination but also identity documents like Aadhar and ration cards.
“We store important documents in large drums to protect them from floodwaters that enter our homes. But when the water rises suddenly, saving our lives becomes the priority over saving documents," said Shantha.
The tightly packed, one-room hutments lined in parallel rows in Siddhartha Colony, Bengaluru. Amoolya Rajappa/The Migration Story
Parvathi from Ashwathpura stores vaccination records of her children in a plastic folder to protect them from rats. "We use conventional fire stoves for cooking, so the documents get blackened due to smoke," said Parvathi who lives in a two-room house, with the larger room serving both as a kitchen and living space.
Migrant workers’ children often receive essential vaccines away from their birthplace. Inappropriate vaccination records makes these children susceptible to less or even excess booster doses of vaccines.
“In the absence of vaccination records, we are forced to rely on people’s verbal description to guess which vaccines a child may have received to further decide on administering booster doses,” said Sunita M.L, 31, a nurse working in Bengaluru’s Thippenahalli ward. Sunitha regularly visits Siddhartha Colony as part of her duties.
After each visit, Sunita diligently updates the vaccination records for every young child in Siddhartha Colony. On her part, she ensures the records are accurate and up-to-date by entering the details in the U-WIN app, her physical register, and the Reproductive and Child Health portal.
The Health care network needs to be more sensitive in planning the delivery of crucial healthcare services to floating populations like migrant workers, says Geeta Menon, a woman rights activist and co-founder of Stree Jagruti Samiti, a non-profit working with domestic workers for three decades now.
“Young mothers often tell me about their struggle to access healthcare, unsure of which PHC to visit for vaccinations or the operating hours of Anganwadis and Namma clinics run by the Karnataka Health Department. They need to be guided on how to navigate the urban healthcare system, stages of vaccination, schemes and how medical staff can assist them in emergencies,” said Menon.
Edited by Ravleen Kaur
Amoolya Rajappa is a Bengaluru-based independent journalist and reports on labour, internal migration, climate change and displacement in India.
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