No One Will Let Her Live: Women's Struggle for Well-Being in a Delhi Slum

No One Will Let Her Live

The publisher gratefully acknowledges the generous support of the General Endowment Fund of the University of California Press Foundation.

No One Will Let Her Live

WOMEN’S STRUGGLE FOR WELL-BEING IN A DELHI SLUM

Claire Snell-Rood

Photographs by Mayank Austen Soofi

UNIVERSITY OF CALIFORNIA PRESS

University of California Press, one of the most distinguished university presses in the United States, enriches lives around the world by advancing scholarship in the humanities, social sciences, and natural sciences. Its activities are supported by the UC Press Foundation and by philanthropic contributions from individuals and institutions. For more information, visit www.ucpress.edu.

University of California Press

Oakland, California

© 2015 by The Regents of the University of California

Library of Congress Cataloging-in-Publication Data

Snell-Rood, Claire Natalie, author.

    No one will let her live : women’s struggle for well-being in a Delhi slum / Claire Snell-Rood.

        p.    cm.

    Includes bibliographical references and index.

ISBN 978-0-520-28480-7 (cloth : alk. paper)

ISBN 978-0-520-28482-1 (pbk. : alk. paper)

ISBN 978-0-520-96050-3 (ebook)

    1. Poor women—India—Delhi—Social conditions.    2. Poor women—Health and hygiene—India—Delhi.    3. Well-being—India—Delhi.    I. Title.

HQ1745.D4S64    2015

    362.83’985—dc23

2014045950

Manufactured in the United States of America

24  23  22  21  20  19  18  17  16  15

10  9  8  7  6  5  4  3  2  1

In keeping with a commitment to support environmentally responsible and sustainable printing practices, UC Press has printed this book on Natures Natural, a fiber that contains 30% post-consumer waste and meets the minimum requirements of ANSI/NISO Z39.48–1992 (R 1997) (Permanence of Paper).

To Dad

Contents

List of Illustrations

Acknowledgments

Note on Translation and Transliteration

Introduction: Well-Being and the Self

1. You Should Live for Others: Tensely Sustaining Families and Selves

2. Let the Dirtiness Go: Managing Relations with Neighbors to Protect the Self

3. Getting Ahead as Moral Citizenship in the Face of Demolition

4. To Know the Field: Shaping the Slum Environment and Cultivating the Self

Conclusion

Notes

Bibliography

Index

Illustrations

FIGURES

1. Big-City Loneliness

2. Mother India

3. Sense of Place

4. World-Class Dreams

5. Chicken Curry

6. Rajiv Gandhi Setu

TABLE

1. National Family Health Survey Data on Delhi, 2005–2006

Acknowledgments

There are times when saying thank you is met with recoil. My friends in India have taught me you’re not supposed to say thank you—at least not to the ones you hold dearest. It shows how little you expected from them and implies perhaps that you are eager to seal the exchange, rather than be there to give back. So as much gratitude as I have, here I will not say thank you, but instead explain how this project has been collaborative from start to finish. Despite the lone author’s name written on this book’s title page, it has grown, developed, and been pushed further through the generous labors of many people.

This project has been generously funded by a number of different sources. I am grateful to the U.S. Department of Education for Foreign Language and Area Studies (FLAS) grants in the academic year of 2005–2006 and summer 2006 that enabled me to study Hindi at University of Virginia and the American Institute of Indian Studies Intermediate Hindi Summer Program in Jaipur, India. The Anthropology Department at the University of Virginia funded a summer of pre–field research in 2007 and supported the final stage of writing and revising the dissertation that was the basis for this book. The U.S. Department of Education provided a generous Fulbright-Hays Doctoral Dissertation Grant that enabled me to conduct a year of fieldwork in Delhi and hire a research assistant. The financial support of Moriel Vandsburger, my husband, enabled me to write up my dissertation, making a critical difference when I did not receive other grants. And the University of Kentucky’s College of Medicine supported me and gave me a home during the final write-up of the book manuscript.

At the University of California Press, I have been lucky to work with Naomi Schneider and Rob Borofsky, who first considered this project and gave it a chance. Their belief in this work has been vital. As I have gone farther in the process, Ally Power has given patient support to me as a confused, first-time author. I am grateful to Ted Lowe, editor of Ethos, for allowing me to publish a revised version of To Know the Field in this book as chapter 4. Finally, Mayank Austen Soofi’s photos of Delhi so well capture the range of feelings that Delhi provokes. I appreciate his participation in this project, knowing that his photos can bring readers closer to Delhi and its extraordinary residents.

My academic journey began with Dr. Alan Dundes, from the University of California, Berkeley, who is sadly no longer with us. I never would have begun graduate school and done this research if he had not told me I was a dummy not to. I ended my undergraduate career frustrated with anthropology and academia and convinced I would never return. He convinced me not to renounce the true pleasure of learning. I miss him, his desk piled with papers, and his grand, mischievous smile. I have been blessed with an amazing dissertation committee who guided me from the beginning of this project: R.S. Khare, Susan McKinnon, Kath Weston, Wende Marshall, and Norman Oliver. At the University of Virginia, R.S. Khare has been an incredible mentor from the beginning of my graduate career. He has prodded me to extend my explorations further, holding me to high standards, while accepting my ability to comprehend from a limited position at any point in time. His enthusiasm for this project has kept me inspired and made me believe it was possible for a naïve white woman to do this research; he never questioned it. Susan McKinnon has taught me the importance of careful argumentation, urging me to patiently understand how all the pieces fit together. When my tendency was to argue a point impatiently, she suggested thoughtful rearrangement that profoundly shifted meanings. Through fieldwork and analysis, Susie’s kind words have motivated me to find my own potential and have let me believe that indeed maybe there was something to all of this. Kath Weston pushed me to consider how my research might point in new directions. She encouraged me to pull this project beyond the walls in which I had micromanaged it. As intimidated as I have been at times by her theoretical precision, I am so grateful for it and know that I will only continue to learn from it. I appreciate her support for me to further develop my writing. Wende Marshall urged that learning must always occur in unexpected, intimate places. She has conveyed to me that scholarship must be passionately inspired—it should feel, not just know. Wende taught me to carefully consider the politics of research, both whom it is for and what it can and should do. Norm Oliver has been an ardent mentor, suggesting fruitful ways that I bring this research back off the paper and into the real, messy world. He has led me to believe that I can be honest about women’s lives in ways that also honor the political stakes of research. Philip McEldowney, the librarian for South Asia and anthropology at the University of Virginia’s Alderman library, taught me the true excitement of thinking historically and across disciplines. Nancy Schoenberg and Carl Leukefeld of University of Kentucky’s Department of Behavioral Science encouraged me to finish this project as even as the new demands of my postdoc emerged; without their backing, it would not have been possible. Claire Renzetti provided essential guidance as I put together the book proposal for this work.

At Delhi University’s Department of Sociology in the Delhi School of Economics, Rabindra Ray was my mentor during fieldwork. I could not have been luckier to have a guide who I have trusted since my first trip to India in 2003. For those who know the delight of working with Dr. Ray, we are blessed by his impassioned advice that is as incisive as it is far ranging. In Delhi, staff at the Centre for Women’s Development Studies, the National Institute for Urban Affairs, and the library at Jagori were generous in helping me access their collections. A steadfast group of people helped me in my continued study of Hindi: Griff Chaussee, Bimla Gaur, and Mehr Farooqi at the University of Virginia; Rakesh Ranjan, Bimla-ji, Reshmi-ji, and Upma-ji at the American Institute of Indian Studies Intermediate Hindi Summer Program in Jaipur (2006); and, during the write-up of the book, I have turned to friends and colleagues to help me in translation, including Anmol Arora, Bindu Sharma, Sonal Upadhyaya, and Nivedita Naresh.

Fieldwork was the toughest thing I have ever done. It required extreme independence and fierce self-questioning that rocked me daily—and I could not have done it without an amazing community of friends and family. Whenever I visit India, my mother feels compelled to write to Pallavi and Adit Tandon to thank them for being my family in India. There is not enough room here to recount all of the times they have saved me. The Arora family in Jaipur were wonderful hosts during my language study in Jaipur. I am so grateful that their son Anmol has become my watchful brother in Delhi or wherever I am. There were so many times where I showed up on the front doorstep of Eileen Kelly and Sanjay Pahuja, sweaty and depressed. I’m so grateful for all of the times that Eileen reminded me of how much fieldwork demanded and that it was okay to acknowledge our limits and frustrations. During my time in Delhi, Bindu Sharma came to know everything about my fieldwork struggles. Bindu offered me her wonderful home for the majority of my fieldwork and is responsible for the fact that I stayed healthy and mentally sound. I counted on our daily counseling of each other and the personal standards for which we held each other accountable. There is no way to imagine the fieldwork experience—and my life afterwards—without her. Susan Johnson-Roehr was there for me every single day leading up to demolition and in the months afterwards, calling me to check up on me. A fellow Fulbrighter, Susan reminded me of all the life beyond the extreme things I got caught up with from day to day.

Numerous researchers and activists in Delhi were the impetus that pushed this project into being and made vital conceptual contributions to the project as a whole. Sadre Alam, of the Centre for Community Support and Social Development, helped me from the very beginning of this project, explaining the foundations of poverty in Delhi and the political landscape. He connected me to my fieldsite and never stopped checking up on my progress. He had faith in this project, no matter how far it seemed at times from his deeply important, grounded activist work in Delhi. Pushpa Pandey, quite possibly the sweetest and most determined activist in Delhi, has explained so much to me about Delhi in slow, deliberate Hindi with kind pauses ensuring that I understand everything. She and her family have welcomed me into their home so many times. Pushpa and her colleagues at the Bhaleswa Resettlement Colony Shakti Manch repeatedly opened the doors of their valuable work to me as a visitor, kindly answering all of my questions and sharing their very personal experiences. The staff at the Navjyoti Development Society—Rajinder-ji, Sonu, Kanta, Sadhna, and Pushpa—graciously introduced me to members of the community in Ghaziapuram. They ensured I did not get lost and answered so many of my questions as I got to know members of the community. I was lucky to meet several compassionate individuals who facilitated health and social services for my interlocutors, including Barbara Spencer at Kamalini; Sangeeta Sindhwani at Lady Hardinge Medical Institute; Dunu Roy and the staff at the Hazards Centre; Amita at the Delhi Shramik Sangathan (DSS); Anil Kumar Verma, a graduate student at Jawaharlal Nehru University; and V. Ramana Dhara, of the Centers for Disease Control and Emory University.

Numerous scholars throughout Delhi shared their individual and institutional work that provided essential background on this research project: Madhvi Misra and Krishna Rao at Public Health Foundation of India; Bertrand Lefebrve and Cyril Robin at the Centre de Sciences Humaines; Rajesh Chandra of the National Institute for Urban Affairs; Arup Mitra and Indrani Gupta at the Institute of Economic Growth; Meera Chatterjee, Jerry LaForgia, and Genevieve Connors at the World Bank; Purnima Menon of the International Food Policy Research Institute; Dr. Nandini Sharma at Maulana Azad Medical College; Geeta Gupta at UNIFEM; Anita Khokhar at Sardarjung Hospital; Renu Khosla at CURE; Isher Judge Ahluwalia; Sunita Reddy at Jawaharlal Nehru University’s Community Health and Social Medicine; Harish Naraindas in Jawaharlal Nehru University’s Centre for the Study of Social Systems; Dr. Savyasaachi of Jamia Milia University; Roma Chatterji and Deepak Mehta of the Department of Sociology in the Delhi School of Economics; Veena Das of Johns Hopkins University; and Dr. Shalini Grover of the Institute of Economic Growth, who was a consistent source of encouragement from the project’s conception through fieldwork. Government officials also helped me, including Mr. Kundan Lal and Mr. Maggu at Delhi’s Slum and JJ Department; and Mr. P.K. Jha of the Monitoring Committee for Sealing Commercial Establishments in Residential Areas. I had valuable conversations with other scholars doing research in Indian slums that helped generate new interesting questions: Adam Auerbach; Rityajyoti Bandyopadhyay; Alekya Baba Das; Shankar Ramaswami; and Richa Dhanju.

I was lucky to benefit from an extremely supportive community of graduate students during the research and write-up process, in particular Lydia Rodriguez, Holly Donahue Singh, Roberto Armengol, SherriLynn Colby-Bottel, Beth Bollwerk, Todne Chipumuro, Tal Shamur, and Sibylle Lustenberger. Lu Ann Williams will always be my scholarly knight in shining armor. She has picked up me when I am down, taught me much about the values of collegiality, and worked me through the dirty nitty-gritty of my theoretical arguments. Jennie Doberne gave me strength and sass to push this manuscript into a book when I thought it was not possible, and Na’amah Razon helped me focus on how we can define our own meaningful worlds of anthropology within the larger disciplinary world from which we sometimes feel alienated. Many friends, colleagues, and family members dedicated time to reading, commenting, and editing many different iterations of these chapters: Malini Sur, Uday Chandra, Ajay Gandhi, Julia Kowalski, Susan Johnson-Roehr, Abby Lowe, and Sarah Stefanos. My aunt Mary Ann Rood gave impeccable editing for versions of several chapters. I also received helpful feedback at conferences and presentations. Thanks to discussant Dr. Ritty Lukose and the participants of the 2009 AAA Panel on Transforming South Asian Publics, participants of the 2011 Yale University Modern South Asia Workshop, the University of Haifa sociology-anthropology department, participants of the 2011 Israeli Anthropological Association meetings (particularly Pnina Motzafi-Haller), Donald Seeman, and members of Nurit Vandsburger’s professional women’s group in Herzliya for all of their helpful comments.

I was lucky to have family and friends who not only encouraged me in my efforts, but were interested in learning about my research, and some even visiting me. I found inspiration in the excited questions of my dear friends Abby Lowe, Sarah Stefanos, and Jessie James, my Aunt Karen and Aunt Mary Ann, Uncle John, Uncle Sandy, Aunt Betty, Uncle Ricky, Cousin Melissa, my late great Uncle Alex, and the entire Vandsburger family. As I’ve crossed back and forth between India and the United States, they reinforced the connections between these worlds that I have felt so intimately.

My sister Emilie has been my graduate school guardian angel from before I even started this process. Her no-nonsense passion for learning has been a great inspiration to remind me what matters through all of this and cautioned me not to let academic drama ever get the best of me. With her butterfly net swinging and her refusal to be bored, Emilie will always be my role model. I am so grateful that my parents have shared so many of the mundane moments throughout these last years, letting me drop by their offices throughout the weeks, feeding me dinner, and welcoming so many of my graduate school friends into their lives. Listening to my mother talk with other scholars and her former students, I’ve also learned so much about the kind of colleague, teacher, and researcher I want to be: dedicated, empathetic, and passionate. My dad has been a great source of calm. When I grew frustrated with grant writing, communication, or the research process, he would always chuckle and assure me that everything was proceeding exactly on schedule. I appreciate the confidence that he had in me through all of these trips to India, never questioning my aims and always trusting my judgment. When I defended my dissertation in 2011, my dad made it clear that he was excited for me to turn it into a book. When he passed unexpectedly later that year, I was not sure if I would ever be able to do it. With him on my shoulder, I finished this. And for this reason, I dedicate this book to him. I miss you, Dad, and wish you could read this.

My husband, Moriel, has helped me through most of this process, since we met after the second year of graduate school. Moriel helped me to realize that work did not have to consume all of life and indeed that it should not. From our first date to now, he has always made every effort to understand why learning all of this is important to me and has told me to take myself more seriously than I knew how. In all of my own crises of faith, Moriel has always calmly made me believe that it will get done and I’m doing something valuable—all while taking care of me, feeding me, and giving me strength.

My gratitude is greatest for Saraswati, Neetu, Durga, Geeta, Sunita, Mrinalini, Padma, Jyoti, Shaista, Mohan, and their families—you have been my amazing gurus. As far away as I am from you now, I remember you every single day. You gave me everything, shared everything, and without hesitation. As different as I am, you took a chance on me, heard me, took care of me, explained to me, understood me, made me laugh, and made me your own. You taught me to recognize my mistakes and you forgave them. These are all things that, no matter what you say, cannot ever be forgotten.

Note on Translation and Transliteration

During my continued process of learning Hindi, I have found it useful to compare Hindi words with their English translations to gain a better sense of the nuances of different words and phrases. For this reason, where possible, I have included the Hindi transliteration of interview quotes. I have tried my best to translate the quotes to colloquial English that captures the sentiment of the conversations and have consulted numerous native Hindi speakers to verify and improve my translations. However, in some cases, Hindi speakers may find that they would have translated these quotes differently.

I have transliterated most of the Hindi words in this text according to the U.S. Library of Congress standards. However, I depart from these conventions with my transliterations of nasal sounds. For the ease of reading, I have indicated the nasal sounds (indicated in devanagari script through a dot or crescent above the letters) simply as n within the words where they appear. (One exception is the word gaov for village, in which I have removed the nasal in the transliteration to follow the more common transliteration of this word.) All Hindi words are written in italics throughout the text. However, proper names of people and places are indicated without italics. I have given pseudonyms to all of my interlocutors.

A few guidelines for the non-Hindi speakers eager to try sounding out Hindi words: vowels with a line over the top (like a- or ī) should be pronounced as a long vowel; letters with a dot underneath (like t. or d.) should be pronounced with the tongue against the palate of the mouth; the r., reserved for those brave enough to try, should be attempted by flapping the tongue forward; c is pronounced as ch; the presence of n at the end of a word should be pronounced as a nasal rather than a hard n; and any consonant followed by an h (as in bh or ch) should be aspirated, or pronounced with an extra push of air.

Introduction

WELL-BEING AND THE SELF

I have my hands—that is what the midwife Durga said, smiling, when I asked her if she was scared the night before the government demolished her home. Durga was used to uncertainty. She had built a life here in the Delhi slum of Ghaziapuram twenty-five years earlier, after fleeing an abusive husband. Living on her own as a single woman meant that it was written that she would have to earn for herself, she explained, while tracing a finger across her forehead—the place where destiny is inscribed. When business was slow, she grew anxious. When it was not, she counted her blessings. Even as she kept helping her family in the village, she was never sure what she could count on in return. The clunky government tankers that delivered water to her neighborhood were known to come days late and were hardly guaranteed to fill all the buckets of those who scrambled around their base. Now, even the home around her was about to be bulldozed.

Durga’s neighbor and friend Neetu emphasized the vulnerability that women like the two of them shared: God has given women such a fate that she has to depend on someone or another. The miserly care they received from family and neighbors, their homes that the Delhi government had demolished, and the poor environment they endured—their health was tied to their relationships, no matter how fragile. Research on the social production of health over the last few decades has focused on how social conditions shape health. Relationships, from the microscale of the family to the macroscale of community and politics, establish the social conditions in which health is forged. The inequalities that structure these relationships have left the health of women like Durga chronically vulnerable. But for women in contemporary India, especially those living in slums, there is no other option but to depend on others. And if women tried to do without these relationships, no matter how precarious? Then, Neetu contended, No one will let her live. Women needed family, neighbors, and the powerful classes. Without these ties, Durga had no hope that politicians might intervene to stop demolition, she had no one to help her haul water, and she had no family to bolster her identity as a mother. Maintaining these ties was a social and cultural imperative.

Figure 1. Big-City Loneliness. Photo by Mayank Austen Soofi.

Yet here was Durga displaying her hands that would remain, alongside her panic over what to do next and her frustration that it was all so fragile. Durga’s last patient for the day sat on her bed in the back room. Her work continued as if on any other day, though by now she had gotten her neighbors to remove and sell her roof. Leaves, dust, and chunks of building material from the surrounding commotion of an uprooting community fell onto her floor. While I stood trying to make sense of her calm, she continued, As long as I have my hands, I can keep eating. God gives everything. Why worry? There is no reason to be sad.

Based on fourteen months of intensive fieldwork with ten families in a Delhi slum, this book argues that women respond to the inequalities that threaten their health by fostering inner well-being. Exploring the centrality of the moral self, this book considers how cultural strategies of resilience buoyed women’s mental health while enabling them to navigate their dubious relationships. Like Neetu, women accepted these conditions as their fate. But there were things beyond fate. What was in their hands, what God saw, the strength of their bodies, how they got ahead, the purity of their hearts: these were words that women used to describe what they made of themselves in spite of their dependencies. I move beyond the reasons that no one will let [them] live to the ways that women living in slums continue to do so.

Contemporary advocates for health have endorsed widespread change through attention to the social conditions of health. Yet the large scale and policy orientation of this approach are less concerned with how women negotiate their social relationships every day. This book explores women’s relationships with family, community, state, and the environment. While relationships were necessary channels to obtain the dāl-roṭī (lentils and bread) needed for survival, women remarked on their hidden consequences. Haphazardly played, relationships yielded disastrous effects on social reputation, piled on long-term obligation, and whittled away one’s self-respect. Women could be left with no one to depend on and no moral reserve to sustain them. What was in their hands, they explained, were the boundaries they drew within relationships to maintain their independence and their capacity to define their meaning.

Attention to their moral selves left women with a form of well-being beyond the reach of those on whom they depended. Women intertwined spiritual values of asceticism and endurance with the values of mobility and citizenship endemic in contemporary urban India. Inner well-being did not ease physical ache or mental tension. But when women illuminated the personal strength they used to endure their suffering, they articulated inner well-being as a resource that outlasted present pain. In so doing, women reinterpreted the priorities that both biomedical and political-economic experts have elaborated for their health.

STARTING WITH SURVIVAL

Durga’s hands, and the other things she intended to last, were not what I thought I would find when I met her. I came to her twenty-five-year-old slum settlement in the Ghaziapuram Industrial Area first in the summer of 2007 and then returned in November 2008 for a full year of research. I was fixated on Durga’s neighbor who kept walking casually through the door, her sari tucked at the top of a pregnant belly that seemed too small on a body that seemed even smaller. Her son who trailed beside her was always sick. Rather than Durga’s strong hands, I had pictured someone with her weak body when I first planned to come to Ghaziapuram.

In an atmosphere of such chronic structural violence, how women managed to continue surviving burned as the most urgent issue. The 2011 census figures estimated that 15 percent of Delhi’s population lived in slums (Dash 2013), but other estimates pose that 50 percent of Delhi’s population lives in slums (Hindu News Group 2009). By 2030, 550 million people in India—more than half the population—are predicted to be living in urban areas (Dhar 2009; Gupta, Arnold, and Lhungdim 2009). The people living in this increasingly common urban form have worse health than those living in the urban areas surrounding slums, often comparable to—or even worse than—the health of the extremely poor rural regions from where they originally migrated (Islam, Montgomery, and Taneja 2006). For the urban poor, there is a dual burden of risk: all of the classic illnesses of underdevelopment that haunted them in the village as well as diabetes and obesity that came from being cooped up in crowded communities (Gupta, Arnold, and Lhungdim 2009).

A large corpus of health and economic survey research on slums emphasizes how the social conditions of poverty intertwine with sexism, racism, and other forms of inequality to generate health disparities. Such inequalities, writes Paul Farmer, are embodied as differential risk for infection and, among those already infected, for adverse outcomes including death (Farmer 2004: 305). Local manifestations of poor health are linked to broader geopolitical inequalities (Nguyen and Peschard 2003).

The residents of Ghaziapuram had seen the wealth of Delhi, like other Indian cities, surge with the onset of globalization. Yet urban planning decisions did little to alleviate slum conditions (Fernandes 2006). Two-thirds of Delhi’s slums remained non-notified. Unrecognized by the government, these slums had poorer water supply, sanitation, and power, and flimsy legal standing. Not only do they barely count as part of the city, their health needs are not counted within health policy needs (Gupta and Mondal 2014). People often lacked access to toilets yet their neighborhood was forced to accommodate a disproportionate amount of the city’s waste. They fought and waited and strained their backs to get water, and the air they breathed was more likely to carry industrial pollutants (Shukla, Kumar, and Ory 1991; Tewari et al. 2004; Tovey 2002). The gleaming malls that rose up and highways that kept expanding cloistered the poor into smaller, more segregated spaces.

Before, the courts had ruled that rural migrants to India’s cities deserved to have their homes protected in order to preserve their right to pursue a basic livelihood. Now, demolition had become the preferred method of urban development, encouraged by the public interest court settlements of middle-class people. They found slums threatening to their businesses, an eyesore to their aspirations of a green Delhi, and an obstacle to their city’s efforts to polish its shine as a world-class city (Bhan 2009; Ghertner 2010). Only a quarter of those whose homes are destroyed are resettled. People found themselves dumped on the edge of the city in settlements without electricity or water (Menon-Sen 2006; Bhan 2009: 128). To continue working, they rose before dawn to accommodate the ride to a now-distant Delhi. Those who were not resettled scrambled for a new roof over their heads, after their biggest financial asset was destroyed.

Life had always been difficult for migrants, but the present posed new frustrations. As Aamir sighed to me, The average man runs after money for every single thing.¹ After all, now there was less work to be had. Since the 1990s, India’s economic liberalization made secure factory jobs scarcer (Joshi 1999). For rural migrants who sought work in cities far wealthier than their rural villages, there were few options outside factory work. Their village homes had offered few opportunities for education, but now without education, what could they do (Joshi 1999; Papola 2007)? There was little room for negotiation with bosses who demanded more and gave less (Ramaswami 2006). So men sought casual labor and brought home little (Papola 2007), and the women in their households increasingly ventured out into middle-class homes as domestic servants, covering up their contributions in order to make the peace with underemployed husbands (Das 1994; Grover 2011).

Poor people in India have suffered as the state has pulled back its social welfare resources since economic liberalization. Geeta’s experience trying to get help for a rash modeled a pattern of how poor Delhi residents tried to get help these days. To get a doctor’s advice, she woke up early to battle through Delhi’s waves of traffic to get to the hospital. Through the throng of bicyclists to the industrial area, across a maze of cars, to an overflowing bus, down through busy streets, she arrived at a hospital and pulled up her sari to show a nurse the huge rash that extended from her stomach to her back, legs, arms, and neck. Come tomorrow at nine, the nurses said confidently. The doctor you need to see will be here then, for sure. There was a vision for what should be available, but often it was not available when it was needed.

The large-scale infrastructure for public health was largely fractured, with urban health care facilities for the poor few and far between, environmental infrastructure woefully inadequate, and few preventive health programs. State welfare programs that were at the core of India’s project of development since its independence were now just skeletons of their former robust selves (Gupta 2012). Public health programs that in past decades had been charged with eliminating epidemics had diminished, as if satisfied with extinguishing the outbreaks that threatened the middle class but apathetic about the environmental conditions that sustained health disparities (Chaplin 1999; Gupta 2005). There was room in public services for reproductive and child health and the essential disease control programs for HIV/AIDS, tuberculosis, and malaria (Qadeer 2009),