Health and wellbeing experiences of women informal workers during the COVID-19 pandemic: a qualitative systematic review

Background: Lacking social safety nets, women informal workers were adversely affected during the COVID-19 pandemic, particularly with their over-representation in hard-hit sectors and poor prospect of alternative employment. Differential needs of women informal workers during the pandemic must be explored to address health inequalities and inform pandemic preparedness. This systematic review aimed to synthesise qualitative evidence on the health and wellbeing experiences of women informal workers during the recent pandemic.

Methods: MEDLINE, Web of Science, Scopus and PsycINFO were systematically searched in November 2024, along with supplementary searches in Google Scholar and WHO COVID-19 research database. Citation tracking of included studies and grey literature search were also performed. Eligible studies explored first-person accounts of women informal workers about their health and wellbeing during the pandemic, and collected data using interviews, focus groups, or observations. Quality assessment of included studies was completed using Mixed Methods Appraisal Tool. Drawing from the concept of determinants of health, thematic approach was used to synthesise findings, taking a holistic perspective of health and wellbeing experiences during the pandemic.

Results: Fifty-three studies were included, majority conducted in low-and middle-income countries. Studies explored the experiences of women in various forms of informal work including sex workers, domestic workers, traders/vendors and home-based workers. Four themes were generated: (1) exacerbation of existing vulnerabilities; (2) negotiation of risks and resilience; (3) interconnectedness of health and wellbeing stressors; and (4) variable experiences across social locations. Financial strain from livelihood loss was the primary stressor during the pandemic, and through cascading effect impacted other health and wellbeing domains. Stressors experienced were deeply interrelated and shaped by structural determinants – socioeconomic, political and cultural – as well as pandemic response policies. The experiences of women informal workers were mediated by intersecting social identities such as occupation type, caste/class and migration status, which influenced both their vulnerabilities and capacities to respond, resulting in diverse and unequal outcomes.

Conclusions: The COVID-19 pandemic has taken a toll on the health and wellbeing of woman informal workers. In the groundwork for future development and pandemic planning, equity-centred approach informed by intersectionality must be applied.