Job Insecurity and Infection Prevention Practices Among Female Domestic Workers After COVID-19 Pandemic in Karachi

Objective: The objective of the study was to determine the extent of job insecurity and infection prevention practices among domestic workers in different parts of Karachi Pakistan. Methodology: A cross sectional survey was carried out from July 2020 to November 2020. Snowball sampling was done, and interviews were carried out on phone of 302 female domestic workers consenting to participate. Questionnaire was formed after extensive literature review with major emphasis on infection control measures. Analysis was done in SPSS 20. Logistic regression was applied to associate the preventive measures with socio-demographic factors and work pattern. Results: Nearly half 144 (47.7%) were given only partial leave and 64 (21.2%) were not given leave at all during the lockdown. Less than one third 26.4% were provided masks by employers and nearly half of the women experienced runny nose 43.7% and body aches 43.3% during their work. Significantly higher OR of symptoms was observed in women using same mask in all houses of work 2.74 (1.36-5.52) *** and not maintaining three feet distance 0.04 (0.01-0.16) ***. Also, as the number of employers increased and the hours of work in the OR of using same mask OR 2.24(1.16-4.31) *, not maintaining three feet distance 0.43 (0.20-0.90) * and not washing hands also increased. Conclusion: There is a dire need of recognizing the women domestic working industry and provide them with financial and social support along with protective wear in the current pandemic situation.

and use sanitizer, which in many cases are not provided by the employers [6]. The situation reported in India and Pakistan which comprises of many part-time as well as full-time domestic workers is even worse, where many domestic workers have lost their jobs in the epidemic and the ones still employed have to walk long distances as there is no public transport, risking their health for the meager money they earn [7,8]. Most of the domestic workers are sole earners of their home as noted from previous surveys and reports [9]. Therefore, there is a need to document the current situation of domestic workers in Karachi as the only available information is through print media. The objective of the study was to determine the prevalence of job insecurity and infection prevention practices among domestic workers in different parts of Karachi Pakistan.

Methodology
This was cross-sectional study conducted on female domestic workers residing in different squatter settlements of Karachi from July 2020 to November 2020. Due to the scattered nature of the domestic workers, their privacy and confidentiality concerns and the pandemic situation of COVID-19 the data was collected through phone calls. All adult female domestic workers above 18 years of age consenting to participate in the study were included. The study started immediately after the lockdown was removed and was completed in four months.
Sample size was calculated using the Open Epi calculator, sample size determination in health studies of world health organization.
As there was no statistical data available on the frequency of working pattern and use of preventive measure during COVID-19 of female domestic workers, we used the anticipated frequency to be 50%. At confidence level of 95% and bound of error of 5%, the sample size came out to be 384. Due to pandemic situation, we were able to collect data of 302 domestic workers.
Structured questionnaire was used to obtain detailed information on socio-demographics, job characteristics and work patterns after the pandemic (working hours, type of work, nature, salary, job benefits), and infection prevention practices (provision of masks, maintain three feet distance and washing hands at work).
Data was collected on phone by female data collectors from medical field in local language. After training, the questionnaire was piloted

Data Analysis
Data was analyzed using SPSS version 21. Descriptive variables were presented as mean and standard deviation or frequency percentages. Comparison of preventive measure with sociodemographic variable and work pattern was done using logistic regression. Odds Ratio was calculated with 95% confidence interval.

Job Characteristics During the Pandemic
The mean age of the study participants was Mean=30, SD=8.  (Table 1).

Infection Prevention Practices During the Pandemic
Nearly one third 55 (26.4%) of the female domestic workers started work without washing hands in any of the houses and more than one third 72 (34.6%) meet their employers by shaking hands.
One third 65 (31.3%) were not able to maintain three feet distance at work. More than half of the female domestic workers experienced Covid-19 symptoms 159 (52.6%) with nearly one third 69 (22.8%) experiencing cough and nearly half 131 (43.4%) experiencing body ache and runny nose 132 (43.7%). Majority 153 (73.6%) of the participants were not provided masks at work and more than two third 133 (63.9%) of the female domestic workers used the same mask at all places of work with nearly half 95 (45.7%) using same mask for more than one day ( Table 2). and increased working hours 0.56 (0.19-1.63) but the results were not significant. However, women experienced greater symptoms who did not was their hands at work and a significant negative association was observed 0.10 (0.03-0.31) *. Age and Education did not have any significant association to any of the outcome variables.  No extra benefits like clothes or food were also provided to those working during the lockdown. This is consistent with findings from Hong Kong where female domestic workers experienced extra hours of work and hardships as their employers were working from home [5].
According to ILO, COVID-19 threatens the livelihoods of more than 55 million people engaged in domestic work, including 37 million women. Working during the COVID-19 also puts women in a highly contagious environment and as shown by the findings of the study half of the female domestic workers experienced runny nose, body ache and weakness while working for their employers. The study also highlights the other symptoms of COVID-19 like fever, cough also been experienced by women domestic workers. This not only poses a risk for the families of domestic workers but also for the employers they work for as many of them work in more than 3-4 houses on daily basis. These risks have already been highlighted in the United Nations Economic Commission for Latin America and the Caribbean, 2020 [10].
Less than one third of the women were provided masks by their employers highlights the deprivation of these women to basic preventive measures. Majority of the women used the same mask at all places of work and nearly half of them used the same mask for more than one day. This is again in line with the study in Hong Kong and Ethopia where women have expressed the lack of provision of preventive material from employers [5,11].
The association of preventive measures showed that as number of employers and hours of work increased the chances of wearing (0.20-0.90) * maintain less distance and also showed significant higher Odds of having symptoms 0.04 (0.01-0.16) ***. Also, when washing hands was compared, we found that women who worked in 3 and above houses and longer working hours was significantly associated with less hand washing and also higher symptoms.
All these findings indicate that number of employers has a high influence on the usage of preventive measure and the occurrence of symptoms and is in line with the study in India [7]. The finding again reinforces the guidelines of WHO to prevent COVID-19 and highlights the vulnerability of the Female domestic workers to infection [10,12].
Based on the findings, we propose a few recommendations.
First, data that documents female domestic worker's care roles and economic status is essential in understanding the intersecting dimensions to women's care labor both during and after COVID-19. Second, workers in the informal sector will continue to need protection, with explicit attention required to inequities in access to personal protective equipment and work-site safety. Lastly to ensure women's perspectives are addressed, the voices of informal sector especially women should be central to developing short-and long-term responses to COVID-19. This study has a few limitations and is only the first step in the direction of highlighting the situation of female domestic workers during a pandemic situation in Karachi.
The sample size could not be achieved as many of the women are poor and have limited access to technology such as mobile phones which was a major hindrance in the collection of data.

Conclusion
As the pandemic has reshaped the entire economic, social and legal framework of the world. There is a need to recognize the female domestic workers' industry, providing them with social and financial protection along with protection at work so they do not have to risk their health and lives to bread their homes.