Toward inclusive primary health care: understanding health needs of women in India’s informal economy through a socioecological framework

Women in India’s informal economy face significant occupational health risks that remain largely undocumented and unaddressed. With limited labour protections and inadequate access to health services, informal women workers (IWWs) experience overlapping vulnerabilities related to gender, work conditions, and environmental exposures. This study explored the multi-level determinants of health among IWWs in Ahmedabad, India, to inform gender-responsive integration of occupational health within primary health care systems. A qualitative study was conducted using focus group discussions (FGDs) guided by the Socioecological Model (SEM). Five FGDs were held with 41 women representing key occupational groups—agricultural workers, construction workers, street vendors, home-based workers, and waste recyclers. Discussions were recorded, transcribed, translated, and thematically analysed. Themes were organized across SEM domains: intrapersonal, interpersonal, organizational, community, and policy levels. Participants reported multiple, intersecting health risks such as musculoskeletal disorders, respiratory problems, skin irritation, and heat-related illnesses. Psychological stress, economic insecurity, and work-family conflict were pervasive, compounded by gendered expectations and absence of social protection. Poor workplace infrastructure, including lack of sanitation and shade exacerbated illness and fatigue. Many women avoided drinking water due to lack of toilets, leading to dehydration and urinary problems. Health-seeking behaviour was shaped by trust and convenience; private clinics were preferred over public facilities despite higher costs. Awareness of government schemes such as Ayushman Bharat and e-Shram was limited. Participants expressed demand for pensions, maternity protection, and home-based livelihood support. Findings underscore the urgent need for gender-responsive occupational health integration into primary health care system. The study informed a national policy roundtable that convened key stakeholders to co-develop actionable recommendations to improve occupational health coverage for women in India’s informal economy.