Toward Inclusive Primary Health Care: Understanding Health Needs of Informal Women Workers Through a Socioecological Framework

Background: Informal women workers (IWWs) face disproportionate occupational health risks due to hazardous work environments, poor social protection, and systemic inequities. However, limited research captures their lived experiences across multiple social-structural levels. The study was conducted to explore the physical, mental, and occupational health challenges of IWWs across five the most prominent informal sectors employing women workers, from Ahmedabad, India, and identify multi-level determinants using the Socioecological Model (SEM). Methods: We conducted five focus group discussions (FGDs) with 41 IWWs from agriculture, construction, street vending, waste recycling, and home-based work in Ahmedabad, India. Data were thematically analyzed and mapped across SEM levels—ranging from intrapersonal to policy-level determinants. Findings: Participants reported musculoskeletal disorders, dermatological conditions, stress, substance use, and heat-related illnesses —underscoring the need for integrated care. Delayed health-seeking behavior, inadequate sanitation, absence of maternity leave, and poor access to first aid reflecting critical service gaps. Structural barriers included limited access to welfare schemes and lack of formal contracts and mistrust in public healthcare leading to high out-of-pocket costs further restricted and shaped the care-seeking preferences. Interpretation: Our findings highlight the urgent need for gender-responsive occupational health integration into primary healthcare. The study informed a national policy roundtable that convened key stakeholders to co-develop actionable recommendations to improve occupational health coverage for informal women workers in India. Funding: Financial support was provided by Women in Informal Employment: Globalizing and Organizing (WIEGO) to cover minimal research expenses; the funder had no role in study design, data collection, analysis, or interpretation.