Over the last few decades migration studies have fruitfully intersected with race, class and gender studies to foreground the gradual but steady marketisiation and commodification of migrant women’s reproductive labour from poor to richer countries. This ‘new international division of reproductive labour’ and/or ‘global care chain’, is constituted by transnational political economy of care which is based on historical inequalities of race, class and gender. Studies done on women migrating singly demonstrates the highly stratified and unequal world order where third world women labour in exploitative, ill-paid jobs, that privileged women from the first world refuse; this includes domestic labour, nursing in residential as well as in the formal health care system. The migration of nurses have been of particular concern; semi-skilled/skilled health care workers moving to the west in search of better employment opportunities has been termed as the ‘crisis of care’ or ‘care deficit’, as it has deeply affected the provisions of care in the host countries.

On the one hand, the intersection of care work, migration and employment regimes raises concerns of care demands/deficits in out-migration countries, on the other hand it brings in focus the policies and politics of labour which facilitates this migration.

Not much attention has been focused on the restructured labour market that struggles to meet this care deficiency in the sending countries. What has been the effect of large scale international nurse migration on the local economy; an economy that is already squeezed by larger processes of globalisation and informalisation. If I take the case of trained nurses for instance, the search for social and economic mobility has led many young, unmarried, trained nurses to migrate to U.K., U.S.A and more recently, to the Gulf— something that India has in common with other developing nations like Sub–Saharan Africa, Philippines and Malaysia. Though there has been a lot of concern raised by activists, academics and policy-makers regarding the adverse effect of the migration of skilled nurses on local health services, it has surprisingly not led to a commensurate increase in the local nurse’s bargaining power.

It is commonplace to assume that a squeeze in the supply of trained nurses in the health care labour market, would lead to nursing labour becoming a scarce commodity, thereby ensuring that the nurse located in the out-migration country would rise in the hierarchy of medical services which anyway peg her as an unskilled worker peripheral to the healing process. However, my research in the nursing labour market has pointed out that the low supply of trained nurses is offset by a hiring of un/semi-skilled, untrained nurses and attendants who work as nursing aides and do the lion’s share of care giving. The increase in nursing employment, what there has been of it, has been at the lower two tiers of untrained nurses and attendants in the regular and casual wage-work sector of the informal economy. Increasingly, the volume of trained nurses is decreasing vis-à-vis the increase in casually employed unskilled or semi-skilled nursing aides. The most recent trend in nursing employment is therefore, a reflection of wider processes in the economy, i.e., informal employment in the formal sector.

The fact that nursing remains structured as an ancillary service, figuring low in the priorities of health committees, state policies and public budgets renders it more vulnerable to casualisation and informalisation. Given the construction of women’s reproductive labour or ‘caring labour’ as unskilled and menial, nurses have not been able to resist these macro-labour processes, thereby losing critical bargaining advantages despite the supply crunch in trained nurses rendered more acute by large-scale immigration. The increasing numbers of casual workers in nursing has been fuelled by recent trends: the liberalisation of the Indian economy from the early 1990s and the informalisation within the formal sector. Thus, even government hospitals have grown more reliant on the category of ancillary nursing personnel, who represent the most informal and casual end of the workforce.

The relationship of migration with care work in the context of globalization and neo-liberalism has had profound implications for both receiving and sending countries of care workers. While destination countries have found poor immigrant women ready to take on reproductive labour at low costs, it has not necessarily led to her economic and social mobility. As for the host countries, the ‘care deficit’ created by the ‘care drain’ is met by the labour of poor women who are marginalized and too poor to migrate and further discriminated against through the politics of informalization within the labour market. The case of nursing also brings to focus the relationship between state policies, poverty and migration.

Health entrepreneurs, both in India and abroad, recognise the great economic benefit of placing nurses internationally, which has led to the expansion of what hospitals call ‘business process outsourcing’ i.e. educating nurses for emigration. The Government’s attempt to compete with ‘nurse exporting’ countries such as

Health entrepreneurs, both in India and abroad, recognise the great economic benefit of placing nurses internationally, which has led to the expansion of what hospitals call ‘business process outsourcing’ i.e. educating nurses for emigration. The Government’s attempt to compete with ‘nurse exporting’ countries such as Philippines has facilitated the up-gradation of private nursing schools and colleges, to meet international standards and qualities. While nurse migration is encouraged, there is no attempt to improve working conditions, wages, living conditions etc of nurses who work in various government and private hospitals in the country. Constituted as an ancillary service, it remains an ill-paid female-intensive occupation. Analysis of committee reports and organisational policies show that nursing services is pegged low in the priority of health budgets and nurses are considered as menial, semi-skilled workers. Moreover, the supply crunch of nurses has not increased their bargaining power; on the contrary, salaries continue to remain low and there is high unemployment among nurses after they have finished their training. Despite, a large number of nurses completing training every year, there are vacancies in government hospitals that are not being filled. Freshly trained nurses work in private establishments for dismal salaries waiting for postings. Studies done on nursing show the immense dissatisfaction that nurses feel regarding low wages, poor working and living conditions, lack of job prospects and low status of the nursing profession and thus aspire to migrate. The relationship between transnational migration of ‘care’ and a stratified social order constituted by inequalities of gender, class and caste produces employment regimes in the global South that incorporates women, informally as care givers. The interconnection between the feminization of migration, on the one hand, and ongoing change in the Southern ‘care regimes’, on the other hand is an area that demands further probing and research.

The Government’s attempt to compete with ‘nurse exporting’ countries such as Philippines has facilitated the up-gradation of private nursing schools and colleges, to meet international standards and qualities. While nurse migration is encouraged, there is no attempt to improve working conditions, wages, living conditions etc of nurses who work in various government and private hospitals in the country. Constituted as an ancillary service, it remains an ill-paid female-intensive occupation. Analysis of committee reports and organisational policies show that nursing services is pegged low in the priority of health budgets and nurses are considered as menial, semi-skilled workers. Moreover, the supply crunch of nurses has not increased their bargaining power; on the contrary, salaries continue to remain low and there is high unemployment among nurses after they have finished their training. Despite, a large number of nurses completing training every year, there are vacancies in government hospitals that are not being filled. Freshly trained nurses work in private establishments for dismal salaries waiting for postings. Studies done on nursing show the immense dissatisfaction that nurses feel regarding low wages, poor working and living conditions, lack of job prospects and low status of the nursing profession and thus aspire to migrate. The relationship between transnational migration of ‘care’ and a stratified social order constituted by inequalities of gender, class and caste produces employment regimes in the global South that incorporates women, informally as care givers. The interconnection between the feminization of migration, on the one hand, and ongoing change in the Southern ‘care regimes’, on the other hand is an area that demands further probing and research.