WORLD OF WORK
No. 45, December 2002

Women in the informal economy:
Urgent need for maternity protection

For millions of women in the developing world, maternity health care is almost unavailable. For millions more, other maternity benefits are even harder to get. Through an ILO research initiative, innovative ways of providing maternity protection to poor women in the informal economy are being promoted, Anne Sieger reports.

BUHWEJU, Uganda - For the women workers of this mountainous tea-growing area of southwest Uganda, the lack of adequate maternity care can be a matter of life and death.

There are many stories about the tenuous nature of maternity here. One concerns a woman and her child who may owe their lives to a solar-powered radio transmitter.

Buhweju is a small village. Taxis don't come around here often and the closest hospital is in Busheny, 52 kilometres away down a bumpy road.

Feeling that her baby was about to be born and worried that there might be complications, the woman rushed to the nearby satellite clinic. The clinic had been established by a local community health insurance scheme to which she belonged. The nurse on duty realized the woman needed hospital treatment, and used the solar-powered transmitter to contact a private taxi service.

The taxi arrived quickly and the woman was taken to a hospital, where she received help in time.

In this Ugandan case, a solar-powered radio transmitter has made all the difference. And it is these kinds of innovative examples which the ILO is using to promote ways to improve pregnant women's safety worldwide.

In many developing countries, women face a high risk of dying during pregnancy or childbirth. Poor hygiene and the lack of access to quality medical care are often to blame.

More and more developing countries have recognized the urgent need for maternity protection. In the Philippines, the Government is providing free prenatal checkups at public hospitals. For deliveries with complications, Bangladesh offers free treatment. Government hospitals in India provide vaccinations for newborns. And Tanzania has developed a "Safe Motherhood" programme.

Still, for many women, especially in rural areas, such vital public services are almost unavailable, either due to financial reasons such as transportation costs, or cultural traditions such as giving birth at home. For millions more, other maternity benefits are exclusively for wage earners.

Maternity protection has been a priority in the ILO since its founding in 1919, when the first Maternity Protection Convention was adopted. Its latest Maternity Protection Convention, adopted in 2000, reached a new level of quality. For the first time, the Convention also applies to women in "atypical" forms of employment, found mostly in the informal economy. This refers to women who often have no legal employer, regular income or little if any access to statutory health-care services. They may be street vendors, home workers or part-time labourers in the garment or agriculture sector. A vast majority suffer from social exclusion and poverty.

To extend maternity protection to women in the informal economy, the ILO Global Programme, STEP^* - Strategies and Tools against Social Exclusion and Poverty - and the Conditions of Work Branch (CONDIT) have started an initial research effort.

The current focus is on community-based health financing schemes which provide limited, demand-driven benefit packages of health services at affordable prices. Next to delivery with complications, normal delivery, pre- and postnatal care, many schemes also engage in preventive and maternity care training, recruit local traditional birth attendants, and organize awareness-raising activities including HIV/AIDS.

Including maternity protection in the benefit package meets an urgent need among poor women. One lesson learned so far is that schemes are most successful when they reflect specific maternity needs articulated by their members. Installing the radio transmitter is the solution which the scheme in Buhweju uses to cope with the transportation problem. In other communities, women may choose to receive benefits not in cash but in food, clothes or medicine, thus avoiding the risk of a family member spending the money. Some schemes also cover the health care needs of the woman's husband.

Still, to the ILO, the sheer existence of maternity protection within health micro-insurance schemes is not an end in itself. Rather, to effectively promote maternity protection, the ILO wants to encourage links between schemes at the community level and national policies and programmes, especially with social security institutions.

With all the cultural and regional differences characterizing the schemes, there is no "one size fits all" solution. A set of provisional guidelines is currently being developed by the ILO, based on the information gathered in nine countries in Africa, Asia and Latin America. These guidelines can be used by the ILO's tripartite partners as well as by social organizations and other parties active in the health sector. The guidelines, as well as selected country working papers, will be published online and on paper in early 2003.

The provisional guidelines are just a first step in the promotion of maternity protection for women workers in the informal economy. Further research and analysis of existing and developing schemes is necessary. It can then be discussed whether a solar-powered radio transmitter could also make a difference in Asia or Latin America. To some families in Uganda it already has.

^* STEP is part of the Social Security and Development Branch in the social protection sector.