Hidden in plain sight: Sexual violence against community health workers in India

Ensuring the safety and well-being of women in the health workforce is a critical but underexamined dimension of health system functioning. In India, Accredited Social Health Activists (ASHAs) serve as frontline community health workers. They often operate in challenging and insecure conditions, and they are vulnerable to multiple forms of violence due to factors including night work, financial insecurity, and power dynamics in communities. This commentary contributes to our understanding of violence within the health system by analyzing diverse instances of sexual violence against ASHAs. These examples highlight ASHAs’ systemic intersectional vulnerabilities, rooted in their marginal status within the health system. By approaching this issue through a health-systems lens, we aim to highlight practical opportunities to enhance coordination, accountability, and workforce well-being across multiple levels of the health system. Recommendations include the need for robust institutional support, protective legislation enforcement, and broad community engagement. This paper advocates for the reimagining of ASHAs’ roles in the health system, emphasizing the need for: safety and dignity, inclusive policies that protect all health workers, and situating ASHAs’ struggles within the broader global context of health worker vulnerabilities.