‘Care’ being historically relegated to the sphere of the domestic and performed by women and other marginalised subjects without remuneration, itself assumed a marginalised position in the academic discourse on labour. The labour that produces humans has not received nearly enough attention when compared to the labour that produces ‘commodity’ in a capitalist system. This trend is upset whenever the world enters a crisis and the worlds of production (of commodities) and social reproduction (of humans) fail to maintain a strict bifurcation. The COVID-19 pandemic presented another such moment when care labour could no longer be ignored. Medical, nursing and community care work received unprecedented attention and applause, albeit only in that form- of applause. As care labour continues to reel under devaluation and invisibilisation, the new publication from Zubaan Books (2023) – Who Cares? Care Extraction and the Struggles of Indian Health Workers edited by Maya John and Christa Wichterich, does the crucial and timely task of providing a comprehensive account of care labour in the form of nursing labour in India. Divided into two parts of six chapters each, the book deals with the working conditions, segmentations, challenges and collectivisation efforts of nurses working in India and of migrant Indian nurses.

In the first part of the book, we learn through the experiences of nurses in Kolkata, Siliguri and Punjab the effects of stratification and hierarchisation on different aspects of work. The three accounts by Panchali Ray, Hemantika Basu and Sneha Makkad respectively, highlight that the hierarchies created within nursing are both a result of the neoliberal character acquired by the healthcare sector, and the existing hierarchies in society (re)produced within forms of nursing labour. Differentiation among nurses arises out of existing differences of caste, class, ethnicity, language, region, religion and so on, leading to varied experiences of work and collective bargaining among workers. Ray particularly argues that the devaluation of nursing labour is a direct result of it being historically performed by women from lowered castes. The work gets separated into menial/corporeal labour that requires attending to bodily fluids and is thus constructed as dirty/impure, and the medical/managerial labour that acquires a language of ‘curing’ and warrants greater respect. Expectedly, women from backward castes are overrepresented in the former category. The separation between doctors, supervisors, nurses, ayahs, trainees,attendants etc. is similarly reflective of the caste, regional, and language background of the workers.

Another crucial way nurses’ working conditions are shaped is by the nature of their employment- in private vs public healthcare facilities, central vs state government health departments, the permanent vs contractual and registered vs unregistered nature of employment, the nature of certification they hold, etc. At the bottom lie the ‘volunteer’ workers in government schemes for whom any claim to worker rights and entitlements is offset by their situation as volunteers, activists, or social workers as opposed to being employees of the state. Seemi Zafar makes this amply clear through the examination of ASHA workers’ conditions. These distinctions are often secularised through the language of skills and efficiency and act to prevent any possibilities of coming together as a unified nursing labour force. Makkad’s essay on the break in the unionisation of permanent and contract nurses in Punjab is a lucid account of this phenomenon. Maya John further argues that it is the differential access to education that reproduces stratification in the nursing labour market.

As different chapters focus on specific ways in which nursing labour comes to be segmented and hierarchised, a connected reading of the book presents a complex picture of the devaluation of healthcare work. It is co-constructed through the caste-bound notions of purity and pollution, ethnic constructions of female subjectivities, religious notions of care and piety, as well as the broader shifts in terms of the privatisation of the healthcare sector, the global crisis of care, underfunding of government programmes, and so on. This is a theme that connects the experiences of nursing in India to the experiences of migrant nurses, who are discussed in detail in the second part of the book.

The second part delves deep into the working as well as everyday lives of Indian migrant nurses. The fact of being a migrant worker puts them into a space of constant negotiation with the gendered, racist, religious and cultural aspects of this identity. As in the case of Indian nurses, the social realities manifest in their working lives. For example, Catholic institutions that have played a pivotal role in the migration of nurses to Gulf and Western countries play the dual role of constructing the imagination of a gendered, pious, acquiescent caregiver, as well as providing support systems for the nurses and their families sustaining themselves in an unfamiliar environment. Ester Gallo’s and Urmila Goel’s essays provide a succinct description of these intertwined dynamics. In negotiating the circumstances that migration brings, new forms of solidarities, social networks, and care circulation among families emerge. These could be in the form of performing care through ICTs as reflected in Tanja Ahlin’s essay or community building through cultural exchanges as brought out by Philomina Chakkalakkal. The world of work for migrant nurses also depends on the educational/professional requirements in the receiving countries, the visa regimes, migratory regulations and financial considerations. Margaret Walton-Roberts and Irudaya Rajan discuss some of these mechanisms to reflect on whether nurse emigration constitutes brain circulation that empowers the workers, or it traps the workers in debt fixing them in their location. The exploration of migrant nurses’ lives is completed through a series of rich life stories (by Vinayan and Elsy Vadakumcherry), an auto-ethnographic account (by Philomina Chakkalakkal) and a photo essay exhibiting the diasporic lives of Indian nurses in Germany (by Manoj Kurian).

This book has successfully captured the complex lives of nursing workers- registered and unregistered, public and private, permanent and contractual, as well as ‘voluntary’ workers, through rich field accounts and life stories. It strongly establishes that the value accrued to work is socially constructed, even when it is professionalised and institutionalised. The singular gripe from the edited volume is that the introductory chapter identifies nursing labour as a component of the care economy and social reproduction, but the book does not return to these themes later in the chapters. Christa Wichterich does analyse the mechanisms of care extraction through various state actions, but she places care work in a moral economy that is in a conflictual position vis-a-vis a capitalist labour market. In doing so, an affectual component is necessarily associated with care work, which might not always be the case. Social reproduction as a theoretical paradigm often attempts to analyse the domain of care from within the ambit of capitalist production. In this sense, a theoretical inquiry into the nature of the care economy itself could have provided further conceptual rigour to the rich empirical contributions of this volume.

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Shiva Singh is a PhD Scholar at the Department of Social Sciences and Humanities, Indraprastha Institute of Information Technology (IIIT) Delhi.