Castes-specific migration pattern into scavenging occupations

The findings of our study reinstate the existence of the caste-based occupation phenomena in India and show that almost 82% of Safai Karamcharis belonged to the SCs as compared to the 18% other castes (Table 1). Castes like the Mahar, Matang, Meghwal, Harijan, Valmiki, and Chambhar dominate in this occupation; others caste like Kathewadi, Kunbhi, Vadar, and Devendrakulathan are found in smaller numbers.

Safai Karamcharis in Mumbai mainly migrated from Rajasthan, Uttar Pradesh, Madhya Pradesh, Gujarat, Andhra Pradesh, and Maharashtra. At the beginning of the 19th century during the famine of 1803, these workers mainly migrated to Mumbai from the Konkan and Deccan seeking employment (Darokar, 2009). Migration during this period was exclusively based on caste and religion. People who migrated to Mumbai were available as cheap laborers to carry on dehumanizing and precarious conservancy work. Previous studies found that the British government forced SC people to migrate to clean urban areas (Darokar, 2009; Morris, 1960). Our findings confirm this migration trend; around 42% of Safai Karamcharis in Mumbai are migrants. A large number of Safai Karamcharis came from Marathwada and the Western Region of Maharashtra, followed by Vidarbha. Districts like Ahmednagar, Ratnagiri, Jalna, Beed, Nanded, and Sangli in Maharashtra represent the highest number of Safai Karamcharis in the Mumbai Municipal Corporation.

Spatial institutionalization of caste-based occupations

The conservancy work in many municipal corporations has become a hereditary occupation, continued from one generation to another through the municipal policy (Tripathi, 2012), for instance, the Warsa Hakka (a phrase that means “hereditary right” in Marathi language) system in the case of Mumbai Municipal Corporation. The Lad-Page Committee recommended in 1972 that Mumbai Municipal Corporations should adopt preferential treatment (PT case) in the recruitment of municipal workers in order to empower Safai Karamcharis. This system allows a worker to nominate his wife, son/brother, unmarried or widowed daughter/sister, or any other dependent to the post of Safai Karamchari after his retirement, death, or permanent disability. Another policy decision of the Social Justice Department of the Government of Maharashtra was sent to all of its municipal corporations for recruiting only Mehtar, Bhangi, Valmiki, and other Scheduled Caste community members as Safai Karamcharis under the Warsa Hakka policy (Government of Maharashtra, 2015). To secure housing facility under the scheme, one should serve for at least 25 years. Such policies have been fiercely debated on public forums. The proponents of Warsa Hakka endorse that this system secures Safai Karamchari’s social and economic welfare but social activists strongly condemn it as an age-old casteist and regressive move that perpetuates the caste system. The Warsa Hakka policy has been in place since 1975, resulting in generations of workers doing this stigmatized and hazardous work throughout Maharashtra and India. Our study highlighted that more than three-fourths (77.2%) of Safai Karamcharis are second or third-generation workers. Nine out of 10 workers (90%) have adopted this occupation after their father’s retirement or death and only 5% took their mother’s place (Table 2). This inter-generational policy has institutionalized caste-based occupations, and it will continue for many more generations due to the insecurity of housing in cities like Mumbai.

Cumulative risk of ghettoization

Cumulative risk is increased risk of harm when a group of individuals is forced into an environmentally toxic and unhygienic situation. These vulnerabilities further get complicated and result in increased morbidity as they become generational victims of caste oppressive structures, everyday discrimination, occupational segregation, and caste-specific ghettoization. The Ghetto may be defined as a spatially concentrated area which separates people involuntarily and limits some particular communities, for example, ethically or religious population groups, to be held and treated as inferior by the dominant society. The separation may be based on race/caste or ethnicity with combined spatially concentrated areas whose residents are excluded from the surrounding society (Darokar, 2009). As workers migrated to urban areas during British period, their housing settlement was largely based on caste. Our study also evidences and reinstates the argument that Safai Karamcharis are systematically isolated when considering their housing facility. There are Labor Residential Colonies in Mumbai exclusively for workers who forcefully settled in the unhygienic and vulnerable places. For instance, Labor Colonies such as Ramabai Colony aside of Chembur station are exposed to the railway track as well as one of the biggest fish market in Chembur. Similarly, a Bapti Labor Colony at Grand Road is close to the red-light area of Kamathipura, the Transit Camp which is near the Deonar dumping ground, and a Labor Colony near Deonar abattoir, etc. Many workers live in slum areas in Mumbai. The qualitative interviews substantiate our argument that colonies of Safai Karamcharis are deliberately settled in the less important areas of the city. For instance, one participant shared.

Basically, the Bapti Colony was constructed as the residential apartment for municipal officials but due to the closed red-light area of Kamathipura, officials rejected that housing societies and then that were allocated to our Safai Karamcharis. Now more than 70 percent of workers living there are from second to third generation of Safai Karamcharis, I don’t know how many more years this will continue [38 years old; 3rd generation Safai Karamchari]

Respondents/Safai Karamcharis are unknowingly trapped under ghettoization in the urban areas. In this proximity, workers are relegated to live here together for generations with no opportunity for socioeconomic mobility.

Substance use

The nature and places of work have negatively affected the physical and psychological well-being of Safai Karamcharis and they have resorted to multiple substances to cope with their work environment. The consumption of tobacco (smoking and chewing) and alcohol was found to be common among Safai Karamcharis. The study found the prevalence of substance use among Safai Karamcharis to be around 46% consuming tobacco and 45% consuming alcohol. Consumption of tobacco and alcohol is very high among Safai Karamcharis and the majority begin their day by consumption of alcohol. They reported that two-thirds (61%) of Safai Karamcharis consume alcohol daily, followed by chewing tobacco (85%) (Table 3). The Karamcharis who participated in in-depth interviews proposed that alcohol consumption work as an anesthetic during the working hours. For instance:

The alcohol consumption is necessary for us before engaging in our work; otherwise it is not possible to work continuously in the filthy environment [45 years old; Karamchari]

Participants also reported that Karamcharis tend to become alcoholic after joining this occupation; for instance, a Safai Karmachari narrates that:

My husband died due to excessive alcoholism, he was never used to have alcohol before engaging in cleaning work but over the period of years he become addicted to the alcohol as continue the work of waste collection. I use to confront him daily but it resulted in violence on me. He died due to the liver failure at the age of 47 years; doctor said that he died due to the excessive use of alcohol which causes liver failure. After three years of his death I continued his job as a Safai Karamchari in municipal corporation [40 years old; widow of Safai Karamchari]

Substance use not only influences the health outcome of Safai Karamcharis but at the same time determined workers treatment-seeking behavior for fatal illnesses. Workers addicted to substances frequently dropout from the course of medication to treat chronic diseases, which subsequently resulted in the fatal events. For instance, one respondent shared:

My husband worked for 18 years as a Safai Karamchari in Mumbai. He was diagnosed with Tuberculosis when he worked more than 40 years as a Safai Karamchari. He was severely alcoholic. The treatment of Tuberculosis required continuous follow-up for the medication. Due to his drinking habit he used to ward off the follow-up and medicine which increases the ineffectiveness of medicine during the treatment seeking. He died because of Total Drug Resistance-Tuberculosis (TDR-TB) before getting retirement of his service. I started working as a Safai Karamchari after his death [40 years old; widow of Safai Karamchari]

Subsequently over the generations, the substance use including alcohol consumption decreases among the Safai Karamcharis. For instance, another respondent said:

Earlier it was like if you want to work you have to drink the alcohol but now this has been changing over the time period. This new generation of workers are not much alcoholic, there are changes in alcohol brands also. Previously, workers used to consume the local alcohol including “country liquor” but now drinking beer and other brands which are less alcoholic are common [38 years old; supervisor of Safai Karamchari]

Morbidity

The substance use and nature of work leave Safai Karamcharis vulnerable to communicable and noncommunicable diseases. Previous studies highlighted that workers associated with solid waste management have higher prevalence of morbidity compared to the general population (An et al., 1999; Athanasiou, Makrynos, & Dounias, 2010; Gellin & Zaυon, 1970; Issever, Gul, Erelel, Erkan, & Gungor, 2002; Thorn, 2002). Safai Karamcharis are exposed to bacterial infections that lead to the skin, eyes, limbs, respiratory, and gastrointestinal illness. At the same time, long hours of repetitive working posture resulted in musculoskeletal disorders among workers. The present study reported that the Safai Karamcharis frequently suffered from pain in the lower back, shoulders, wrists/hands, and hips/thighs. Subsequently, our study revealed that the Safai Karamcharis also suffer from tuberculosis, heart disease, cancer, and liver diseases. The study found the nature of work, irregular food habits, and alcoholism enhance the risk of tuberculosis and life style–related diseases. The Safai Karamchari begin work early in the morning. They hardly get time for breakfast and start working with just a glass of water or tea. Without having adequate breakfast, Safai Karamcharis continuously work until afternoon. Supervisors explain below that such uncertain working conditions affect them in the long run over the years:

In early morning around 6.00 AM all Safai Karamcharis have to report at office, wherefrom they resume their assigned work without having breakfast. Our work begins at early morning around 6.30 AM to 01.30 PM because we have to finish it as early as possible because of the low density on road at early morning. We start at early when people are in their sleep and finished it before they leave for their work, so they cannot face problem due to our cleaning work. I think our Safai Karamcharis do hard work then the others workers, they do dirty job for others, so they can live in healthy and clean environment [43 years old; supervisor of Safai Karamchari]

The work nature and insufficient food intake has adverse effects on the health and nutrition of workers deteriorating their health further.

Causes of death

The occupation of municipal waste collection is placed in the world’s most hazardous employment, and it is one of the top five hazardous types of work in America (Lam, 2016; Tibbetts, 2013). In developing countries, where over 90% of municipal solid waste is dumped in open space, it affects the workers associated with its management (World Bank, 2018). The nature of work and the health behaviors of workers in low-income countries make them vulnerable to fatal diseases. In order to assess the causes of death of Safai Karamcharis in Mumbai, we obtained the official data of deaths during service from the Municipal Corporation of Mumbai. The official mortality data show that 2039 Safai Karamcharis died during service in 14 out of 24 municipal wards between 1996 and 2006 (Nair, 2006). And, Table 4 shows 1940 deaths of Karmacharis from 2007 to 2014. Thus, over 18 years, 3,979 Safai Karamcharis died before their retirement from service in Mumbai. The mean age of workers at the time of death was recorded as 58 years. In the past decade, the absolute number of deaths of Safai Karamcharis has been decreasing over the years but it is still higher than for other occupations. For instance, the death rate of Safai Karamcharis is 9 per 1,000 compared to the 6.7 death per 1,000 of the general population in Mumbai (Table 4) (Registrar General, 2016).

This study found out that among 100 respondents, 51% of Safai Karamcharis died due to noncommunicable diseases, whereas 42% died due to communicable disease. Seven percent of deaths occurred due to road accidents while working and because of intentional self-harm (Suicide). In particular, more than one-third (34%) of Safai Karamcharis died because of tuberculosis (TB) followed by cardiovascular disease (21%), liver disease (10%), cancer (10%), and stroke (7%) in the past 3 years (Table 5). Tuberculosis was found to be the leading cause of death of Safai Karamcharis which could be because of many contextual factors (sweeping the dust, food habits, alcoholism, and lack of treatment seeking).

There are free health services for Safai Karamcharis in a condition that they have to access only civil health facilities for the health treatment. In this case, municipal hospitals are supposed to give priority attention to Safai Karamcharis, but this does not happen on the ground. The lack of proper health facilities and overcrowding at these hospitals resulted in delayed provision of healthcare. The in-depth interviews revealed the actual profile of these facilities, for instance:

We go to the municipal hospital for treatment, but the doctors don’t pay attention to us as they think we don’t have any other option. Anyhow there is no use of going to these facilities because we often have to buy all the medicines from external pharmacies and get the diagnostic tests done from an external lab. Why should we go there? Only to save the doctor’s fee? [42 years old; Safai Karamchari, recovered from tuberculosis]

Even when Karamcharis seek medical treatment for illness in these facilities, they have to produce the medical fitness certificate when resuming the job. If they fail to produce it, then the municipal corporation will ask them to take unpaid leave until they provide the certified document indicating they are fit for work. Due to this condition, many workers do not seek treatment in a civil facility and go to private hospitals where the services are costlier. The Brihan Mumbai Municipal Corporation used to organize annual medical check-ups for Safai Karamcharis, but more than half (54%) of karamcharis we surveyed reported not having gone for any medical check-up organized by the corporation over the previous 5 years (Table 6).

We also observed that the Warsa Hakka scheme was primarily used by Safai Karamcharis, and other medical aid, scholarship, has hardly reached this population (See Table 7).

State policies

Including the public policies of the municipal corporation, the state and union government looks unfavorable to Safai Karamcharis. In 1952, a committee was appointed under the chairmanship of V. N. Barve for enquiry of the scavenger’s living condition. In the year 1953, the first backward class commission recommended that states should raise funds to improve the standard of the quarters for municipal workers and quarters should be in different regions rather than placing them in restricted areas. In addition, they suggested the need for mechanization for cleaning purposes which would prevent the manual handling of municipal waste. The Central Board of Harijan Welfare studied the living and working conditions of Safai Karamcharis and recommended the need for center-sponsored schemes for the welfare of Safai Karamcharis in 1956. Subsequently, the inquiry committee under the chairmanship of Prof. N.R. Malkani suggested for improving the working and living conditions of municipal workers and argued for discouraging the use of dry latrines in India. Government reports show that there are around 2.6 million dry latrines in India which requires Safai Karmacharis to clean them (Office of the Registrar General & Census Commissioner, 2011). The Employment of Manual Scavengers and Construction of Dry Latrines (Prohibition) Act was constituted in 1993 for abolishing the practice of manual scavenging and banning the construction of dry latrines. However, this law does not consider one’s job manual as scavenging if protective gear is used. The National Safai Karamchari Finance and Development Corporation under the Ministry of Social Justice and Empowerment provided financial loans at concessional rates to the target group of Safai Karamcharis in 2004–05. Over 336 million Rupees were disbursed for implementation of a national scheme for liberation and rehabilitation of scavengers up to 2002–03 (Lok Sabha Secretariat, 2013). The budgetary allocation under, “Self-Employment for the Rehabilitation of Manual scavengers,” was 4.48 billion Rupees in 2014–15, and was reduced to a mere 50 million Rupees in 2017–18. Despite the early efforts to improving the condition of Safai Karamcharis, the majority of schemes actually increased bureaucratic hurdles rather than uplifting the Safai Karamcharis who were deprived from accessing socioeconomic and public resources.

Clean India campaign

In 2014, the prime minister of India, Narendra Modi said, “My identity is of a Hindutvawadi [one who promotes the Hindu religion], but I say build toilets before you build temples.” His government emphasized the importance of modernizing India’s sanitation system. The Swachh Bharat Mission (SBM) is one of the most well-known programs of government since 2014 which aims to end open defecation in the country. The government substantially increased the allocation of the financial budget for SBM from 42.6 billion (INR) in 2014 to 162.48 billion (INR) in 2018. While billions of rupees have been spent on improving the cleaning and sanitation status in the country, little has been done to ensure the health and safety of those who continuously work to clean throughout the country. SBM has missed the point that cleanliness has more to do with the cultural notions of purity and impurity than with the other aspects, including spreading awareness. As long as these cultural notions prevail, the stigma attached to Safai Karamcharis will continue. The field responses reflect that the SBM have contributed to increasing the consciousness of cleanliness in society, but it has not changed the government’s indifference to the Safai Karamcharis. For instance, one respondent shared that:

Nothing has changed after Swachh Bharat Mission and media highlighted it just because of the involvement of prime minister with broom in hand. We have been working in this filthy occupation for decades in this country. Have you ever seen us on the media? Our occupation is stigmatized and this stigma needs to be cleaned first. Safai Karamcharis are barred from entering in hotels and not allowed to drink water. People taunt and abuse us, you will find many cases of Karamcharis being beaten up by people. We expected that our occupation might be recognized and respected after SBM [43 years old; second generation Safai Karamchari]

Indebtedness

Financial literacy is a major component of socioeconomic development of an individual in a society. Although Safai Karamcharis receive a regular salary from the municipal corporation, they often fail to manage their expenditure. Substance use and episodes of morbidity resulted in high rates of absenteeism at work, which means less salary to workers. To meet their family and social commitments, workers often take loans from formal (banks) or informal (moneylenders) sources. In addition, to maintain their basic living status in the community, Safai Karamcharis have to spend more than their income. Hence, they borrow from the Makadwallas or any local moneylender. These financial loans from nonregistered sources push workers into debt. For instance, almost 39% of Safai Karamcharis reported to have borrowed money for marriage from the nonregistered sources popularly known as the Makadwallas (see Table 8). Makadwalla is a community of moneylenders which provide financial loans to Safai Karamcharis. Neither the Makadwallas nor the workers maintain any written records of these transactions. In-depth interviews revealed that workers were frequently harassed (verbal/physical) by moneylenders due to the delays in repayment and sometimes the situation turns life-threatening. One respondent said:

After the accidental death of my husband at the workplace, my 22-year-old son assumed his place as Safai Karamcharis. My son was continuously threatened and harassed by the Makadwallas as he was failing to repay the loans taken by his father. My husband had multiple loans from Makadwalla. I told two Makadwallas that only if this give us time will we be able to repay it. My son worked hard for more than six months, but he was troubled by them every day. One day my son had dispute at the workplace with these Makadwallas, I am sure that because of this trouble only he committed suicide [40 years old; widow of a Safai Karamchari]

The workers were not only harassed but many times these Makadwallas create hostile situations for Safai Karamcharis by abducting their official documents if they fail to repay loans on the due date.

This Makadwallas harasses Safai Karamcharis, I have frequently observed that Makadwallas take off the official documents such as ATM, PAN card, Bank Pass Book, salary slip from workers if they could not make loan repayment on due date [Leader of Labor Union of Safai Karamcharis]

The economic instability and financial burden due to multiple factors including frequent health problems and continued indebtedness affect the overall socioeconomic development of Safai Karamcharis.