India’s massive second wave of Covid-19 hit women and families particularly hard.

The leaders of the Self-Employed Women’s Association (SEWA) watched as women lost their livelihoods – and the ability to feed their families.

“Even to make a cup of tea for the family…you need tea and sugar and milk and there would be no money,” Naimisha Joshi, a SEWA senior coordinator, said through a translator. “Children would ask for food,” and none would be available.

For women working in the country’s informal sector – vendors, artisans, garment workers – the toll was particularly bad, Joshi said.

Families sheltered in homes that had no running water and were too small for social distancing. Individuals developed mental health concerns. As tensions brewed, many women experienced intimate partner or family violence. Young couples separated, unable to handle the stress of the pandemic. As schools moved online, families who couldn’t afford electronic devices were forced to halt children’s education.

And all the while, Covid-19 was rampaging. In the urban slums, where running water is often unavailable and houses are close together, the situation grew particularly bad, said Reema Nanavaty, an Indian social worker and SEWA’s head. Although villages were heavily affected, lockdowns kept people safer and more rural families were able to help each other.

SEWA has a long history of advocating for Indian women and helping them access food, support services, health care, nutrition, and shelter. For each of the organization’s 1.8 million members, the goal is that “her work gets recognition, she’s able to speak up,” Nanavaty said. “It brings dignity and respect to these women.”

And even as Covid-19 killed untold numbers – the true death count is likely in the millions, according to both on-the-ground sources and authoritative estimates, although official numbers hover around 429,000 – and ravaged livelihoods, they swung into action.

“We go by what the needs of our members are, so the first and foremost need was to protect our members from getting further infected,” Nanavaty explained.

As SEWA works both to contain the spread of Covid-19 and to address its indirect impacts, such as increased mental health concerns and lost livelihoods, Direct Relief is supporting the organization’s efforts with a $250,000 grant. “Had it not been for Direct Relief, we would not have been able to [take action] immediately, as the need arose,” Nanavaty said.

The pandemic itself

SEWA’s members, drawing from a large-scale study conducted in rural Bangladesh, developed a program for distributing face coverings, providing information and education, and monitoring the correct use of masks in public spaces. More than 100 of the organization’s members were trained in stitching face coverings, and 300 trained health ambassadors distributed over 350,000 face coverings. (The goal is to distribute approximately 3.8 million across the country’s rural and urban areas.)

Documenting the use of face coverings, SEWA’s health ambassadors noted that approximately 50% of people were wearing masks correctly in April 2021. Those number increased to nearly 63% in July, a change that SEWA attributes to education and reinforcement efforts.

The health ambassadors have also visited over 150,000 households to discuss vaccination, address hesitancy or concern, and help people register for vaccination appointments. SEWA members coordinated with district health officials to arrange for Covid-19 vaccination camps, including in remote villages.

“The percentage of SEWA members who are fully vaccinated is much higher than the percentage of the country,” said Dr. Sahil Hebbar, a consulting physician with SEWA.

Nanavaty explained that many SEWA members with Covid-19 in their households were unsure of what to do and how best to access care. SEWA set up a helpline where members could get information about the availability of nearby hospital beds, oxygen suppliers, testing facilities, and other resources. The helpline has been used by more than 1,000 people with Covid-19-related symptoms.

And because many hospitals were overfull, and medications and oxygen hard to come by, SEWA converted a number of its district centers into 11 Covid-19 care centers., based on the World Health Organization’s home care guidelines for the disease. The centers are equipped with oxygen concentrators, oximeters, and other medical supplies, along with over-the-counter medication to manage patients’ symptoms.

One health ambassador, Nanavaty recalled, had no experience using oxygen concentrators, but she diligently trained so that she could provide support to a Covid-19 care center and even ended up training public health workers on using the equipment correctly. When people in her own village developed severe cases of Covid-19, she was able to administer oxygen and bring them to a nearby hospital.

Indirect effects

But SEWA also wanted to tackle the pandemic’s indirect effects. They established virtual group support sessions for women facing many of the same concerns, and worked with two psychologists to provide one-on-one sessions to women experiencing mental health symptoms. SEWA’s community leaders would loan a smartphone or tablet to women who otherwise wouldn’t have access.

And they set about mitigating the pandemic’s devastating economic impacts.

“This pandemic has been very, very damaging and destructive to women,” Nanavaty said. “It has completely destroyed their livelihood…after 18 months, their livelihood hasn’t really stabilized or picked up.”

So SEWA trained women to make snacks, such as cookies and breads, that could be sold locally. They taught women who could craft accessories or garments the digital, photography, and writing skills to market their work online. They connected rural farmers, who were in danger of having to destroy vegetables no one else had bought, with women vegetable vendors in the city.

Members were also taught digital skills, to enable them to participate in online trainings and credentials, handle financial transactions, and otherwise navigate professional life. SEWA even provided trainings in solar installation and maintenance. “These are the livelihoods where you don’t have to travel a lot. You can do it in the village and still earn,” Nanavaty said.

For SEWA, it’s not just about getting things back on an even keel. It’s about continuously working to improve the lives of women and families.

“Our goals are the full employment and self-reliance of our members,” Nanavaty explained. “We come together in our fight against poverty.”