Unionizing Care: Gender, Piety, and Labor Politics among Pakistan’s Lady Health Workers

• In Event: Organizing and Union Strategy

Abstract

Lady Health Workers (LHWs) occupy a paradoxical position within Pakistan’s public healthcare system. As frontline female health workers they are responsible for maternal and child health, disease surveillance, and national immunization campaigns, which are essential to the functioning of both state health governance and internationally funded health initiatives. Yet historically, LHWs have been treated as precarious workers positioned at the lowest rung of the public sector hierarchy. This paper examines labor organizing among female community health workers unionized under the National Program Health Employees Association Punjab (NPHEAP), asking how gendered workers in patriarchal social environments mobilize collective labor while maintaining the respectability necessary for community legitimacy and personal safety.

Drawing on qualitative interviews conducted between 2015 and 2025, focus groups with frontline workers, archival newspaper research, and ethnographic observation of sit-in protests (dharnas), the paper analyzes how collective identity is constructed through idioms of sisterhood, kinship, and Islamic piety. Rather than adopting confrontational repertoires associated with elite feminist activism, union leaders frame demands through service, sacrifice, and moral responsibility, allowing workers to claim dignity and negotiate publicly with the state.

Situated within Pakistan’s uneven labor landscape, where unionization remains limited and male dominated, NPHEAP demonstrates forms of social movement unionism shaped by bureaucratic hierarchies and shifting political opportunity structures. LHWs strategically leverage their indispensability to polio immunization campaigns and broader public health mandates to demand regularization, timely wages, promotions, and pensions. At the same time, internal class distinctions between supervisors and frontline workers complicate claims of sisterhood within the union itself. By foregrounding emotion work, moral legitimacy, and gendered respectability as labor strategies, the paper contributes to scholarship on public sector unions and demonstrates how care work becomes a site of collective bargaining and political negotiation in the Global South.

Author

• Sarah Ahmed, Providence College