Independent Researcher · Mumbai

Ananya
Sharedalal

12th grade student at a residential school. My research and projects examine historical narratives, grassroot development, and broader social issues.

Projects

Two long-form research projects

Cow Urine Chronicles
Digital Ethnography

Cow Urine Chronicles

An 18-month study of how cow-urine consumption is framed, defended, and historicised across 83 YouTube videos — how a contested practice is rebuilt as tradition in the digital public square.

Enter the archive
ASHA Workers of Annamayya
Field Study

The Nirasha of ASHAs

A field study of the invisible labour of India's frontline healthcare workers in Annamayya district — their schedules, their pay, and what the community really thinks.

Read the study
Ananya Sharedalal

About

I am a 12th grade student at a residential school with a deep interest in history and the social sciences. My research and projects focus on the construct of historical narratives, impact of developmental economics, and broader issues that affect communities.

ananyasharedalal@gmail.com
Cow at dusk
A Research Archive

Cow Urine
Chronicles

How has history been invoked in the ways gomutra gets talked about on the media, and how does the Indian public react to hearing what YouTube influencers claim history is?

Begin Reading →
About the Project

A digital ethnography of an unusual corner of Indian YouTube

This archive documents an 18-month study under the mentorship of Prof Joyojeet Pal along with a team of international researchers of how cow urine consumption is framed, defended, and historicised across 83 YouTube videos. It maps the recurring tropes, the appeals to antiquity, and the surprising appearances of Western science — tracing how a contested practice is rebuilt as tradition in the digital public square.

Ancient manuscripts
The Work

Research, Data
& Methodology

100 highly influential YouTube videos — classified manually and analysed using LLMs to examine how history is invoked, recast, and selectively remembered in the Gomutra discourse.

100
YouTube videos in corpus
83
Videos manually coded
28
Promoter videos
5–7
Explicit debunker videos
3.1M
Avg views per debunker video
680K
Avg views per promoter video


Methodology

The primary data source is YouTube. A video had to have at least 100 views to be included in the dataset — ensuring relevance and real audience reach.

All transcripts were translated to English using LLMs. Each translation was manually reviewed for accuracy — though some discrepancies may remain. Videos were then classified by stance (promoter, debunker, neutral), content style, narrative style, and speaker demographics.

A specific focus was placed on coding the historical imagination of each video: which time periods are invoked, which are absent, and how antiquity is used as a substitute for evidence.

Ethical Framing

All inferences and statements in this research are unbiased and based on observable patterns in the data — not on personal opinions. This subject is culturally and religiously sensitive, and that sensitivity has been central to how this research was conducted.

The goal is not to adjudicate whether Gomutra works or doesn't — the goal is to understand what historical and rhetorical frameworks are being deployed, and what that tells us about how Indians relate to their own past.



What the Data Shows

Preliminary Findings

Influencer content that invokes history and tradition is more likely to find an accepting audience. History is a powerful tool — and in this corpus, it is deployed with striking selectivity.

26 of 83

Videos cite ancient Ayurvedic texts by name — Charaka Samhita, Sushruta Samhita, Ashtanga Hridaya, Bhavaprakasha Nighantu.

13 videos

Invoke "thousands of years ago" or "since ancient times" as a stand-in for evidence.

13 videos

Mention rishis, sages, or ancestors as the source of authority.

0 videos

Mention the Mughal or British colonial period. The middle of Indian history is entirely absent.

9 videos

Reference America or Europe — not as colonisers, but as validators. "Even foreign science is now saying…"

Access the Data

The full dataset — 83 videos with transcripts, influencer metadata, classifications, and coded variables — is available for review. This includes the master dataset and three thematic breakdowns covering the Vedic frame, the role of the West, and the promoter-debunker divide.

View Full Dataset →
Rows of clay pots
Patterns in the Data

Recurring
Themes

Five patterns that surface repeatedly across 83 videos — from ancient texts as the only valid authority, to the remarkable absence of 2,000 years of Indian history.

01
Theme 01

Antiquity is the only "history" that matters

The historical imagination of this corpus is almost exclusively pre-classical — a deep, undifferentiated "Vedic past" treated as an unbroken tradition. 26 of 83 videos cite ancient Ayurvedic texts by name. Another 12 invoke "thousands of years ago" or "since ancient times." 13 mention rishis or sages. 13 cite the Vedas. Four different ways of pointing at the same period.

Named ancient texts as authority Sage / Rishi authority Time-distance / antiquity claims Cosmic / elevated terminology Sacredness, divinity, and "Mother Cow" Institutional credentials borrowed for ancient claims
"And in the Vedas, it is given the status of Amrit, Amrit means which does not let die, which is a life-saving drug." — Rakesh Agarwal
Analysis

The sentence quietly slides from myth to pharmacology. Amrit is the drink of the gods but by the end of the line it has become "a life-saving drug." Vedic theology, IIT credentials, and modern medicine — none of them are made to check each other, which is what makes the move work.

02
Theme 02

The West appears as a validator, not destroyer

When America or Europe appear (9 videos), they are not the colonisers who erased traditional knowledge. They are recent ratifiers of it. "America granted a patent on cow urine for cancer." "Germany and Singapore are importing our Ayurvedic beauty products." Modernity isn't framed as a rupture — it's framed as eventual catch-up. This is a quiet but important historiographical inversion: colonial trauma is replaced by Western endorsement.

The patent as final proof Big international names as proof Export markets as quality judges Western media as a quality stamp Shame as argument — Western respect converted into Indian guilt
"These are the countries that understand the power of India's centuries-old Ayurveda, but our people consider it a joke." — Sushant Sinha
Analysis

The speaker shifts the argument away from whether cow urine works to whether Indians are loyal. Doubting the substance gets framed as embarrassing your own country. The contradiction doesn't slow him down because the line is built to make you feel guilty.

03
Theme 03

Debunkers refuse to engage on historical terrain

This is the most consequential pattern in the dataset. Dhruv Rathee's strategy is to argue chemistry, not history — by performing the betadine trick with ordinary water and his own urine, he sidesteps the entire ancient-text argument. The skeptics treat history as irrelevant to whether chemistry works. The promoters treat chemistry as confirmation of what history already established. Because the two sides operate on different timescales, they almost never make contact.

Chemistry / experiment as rebuttal Modern medical authority as the only valid frame Politics and current affairs as critique The betadine experiment as shared battleground
"This is the first time that I will show you the experiment of betadine in my own urine." — Dhruv Rathee
Analysis

The move is deliberate. He is not attacking the ancient claim — he is bypassing it. By replicating the same "miracle" with his own urine, he shows the trick is basic chemistry, meaning the historical pedigree of cow urine isn't doing any of the work the promoters say it is. He never names a text or a sage. He doesn't need to.

04
Theme 04

Claims come in bundles, not alone

If a video says cow urine helps your liver, it almost always also says it helps your kidneys, your weight, your skin, and your digestion. Nobody promotes it for just one thing. Liver is the most common claim (23 videos), and it tends to drag the rest along with it. The promoted benefits cluster in a consistent hierarchy: mundane at the base, chronic disease claims in the middle, then grand claims at the top (cancer cure — 25 videos).

The "Ramdev formula" — personal anecdote + joint/liver/weight claims Claim escalation ladder from mundane to miraculous Cancer as the apex claim Bundle credibility — low-stakes claims lending authority to high-stakes ones
"Today's science proves what Baghbhatt ji said thousands of years ago." — Rajiv Dixit
Analysis

The hierarchy is what stands out. Science doesn't test the ancient claim — it confirms it. The ancient sage is positioned as already correct and modernity just catches up. So the speaker gets to claim scientific authority without ever being subject to scientific review.

05
Theme 05

Two camps, two vocabularies

Promoters talk about Vedas, Ayurveda, immunity, and "amrit/sanjeevani" — these words travel together. Skeptics talk about research, studies, experiments, and chemistry — those words travel together. The two sides barely share language. This linguistic divergence is not accidental. It reflects two entirely different epistemological frameworks that happen to be fighting over the same object.

Promoter vocabulary: sacred, ancient, divine, amrit Debunker vocabulary: experiment, research, chemistry, institution Wellness content as a third, neutral register Political vocabulary as a fourth lane — mostly avoided by mainstream content
The question is not whether Gomutra works — the question is what we mean when we say it does.
Analysis

When promoters say "it works" they mean it works spiritually, ancestrally, and chemically — all at once. When debunkers say "it doesn't work" they mean it fails a randomised controlled trial. These are not the same conversation.

Ancient Indian alley
From the Corpus

Videos &
Commentary

12 clips from the corpus — with close readings of what each reveals about how history, science, and authority are constructed in the Gomutra discourse.

DDhruv Rathee ► Watch on YouTube
Debunker 8.1M views · 28.5M subscribers
Dhruv Rathee · Dhruv Rathee

Cow Urine Magic! Hidden Secret in Gaumutra Explained

The move is deliberate. Rathee is not attacking the ancient claim — he is bypassing it. By replicating the same "miracle" with his own urine, he shows the trick is basic chemistry, meaning the historical pedigree of cow urine isn't doing any of the work the promoters say it is.

SSwami Ramdev ► Watch on YouTube
Promoter 10.4M views · 11.2M subscribers
Baba Ramdev · Swami Ramdev

Know the countless benefits of drinking cow urine

"Nectar-like medicine… offering of all the gods and goddesses." This isn't really a medical sentence at all. It's a religious one wearing medical clothes. By the time he's called the substance an offering to deities, he's left the realm of testable claims entirely.

RKintuParantuSAF ► Watch on YouTube
Debunker 3.3M views · 151K subscribers
Dr Ram Punyani · KintuParantuSAF

Is There Really Gold in Cow Urine? Debunking the Myth

"This has been glorified for a reason, and there's politics behind it too." Instead of arguing whether cow urine works, the speaker historicises the promotion. His critique is structural — about who benefits from the claim — rather than chemical or textual.

AAaj Tak ► Watch on YouTube
Neutral / News 55K views · 71.4M subscribers
Sudhir Chaudhary · Aaj Tak

Surprising benefits of cow urine, America has made medicine

"A patent has already been obtained for using cow urine to manufacture medicines for cancer…" The patent does all the work here. Just saying the word "patent" makes the claim sound officially approved, even though nothing was ever actually proved.

SSwami Ramdev HD ► Watch on YouTube
Promoter 32K views · 1.13M subscribers
Baba Ramdev · Swami Ramdev HD

Many people have experienced this and America has granted it a patent

Two unrelated things are stacked next to each other so that they reinforce each other. Personal anecdotes and an American patent get treated as if they're the same kind of evidence — but together they sound like a case.

STimes Now Navbharat ► Watch on YouTube
Promoter 621K views · 23.7M subscribers
Sushant Sinha · Times Now Navbharat

These countries understand India's centuries-old Ayurveda

"These are the countries that understand the power of India's centuries-old Ayurveda, but our people consider it a joke." The speaker shifts the argument away from whether cow urine works to whether Indians are loyal.

LLotus Pregnancy Care ► Watch on YouTube
Promoter 128K views · 29.7K subscribers
Lotus Pregnancy Care · Lotus Pregnancy Care

Benefits of cow urine (Gomutra) — home remedies

The speaker stacks three impressive names — NIH, AYUSH, an "International Journal" — into one breath. The volume of acronyms is meant to feel like institutional consensus. Nothing about what those bodies actually concluded is described, because the names alone are the argument.

BLEarning INDIA-BK ► Watch on YouTube
Promoter N/A views · 4.7K subscribers
B.K. Sahu · LEarning INDIA-BK

ANSI Herbal Gaumutra — certified by the World Health Organization

"The herbal cow urine by ANSI is certified by the World Health Organization." The WHO is one of the most over-cited authorities on Indian YouTube — partly because the audience won't go check. The certification claim is left vague, no document shown, no date given.

TTechnical Farming ► Watch on YouTube
Promoter 2.4M views · 3.24M subscribers
Rakesh Agarwal · Technical Farming

IIT Bombay PhD Dr. Rakesh Agarwal on cow urine

"And in the Vedas, it is given the status of Amrit, Amrit means which does not let die, which is a life-saving drug." Three different frames — Vedic theology, IIT credentials, and modern medicine — none of them are made to check each other.

WWe R Stupid ► Watch on YouTube
Neutral / Explainer 32K views · 1.2M subscribers
Akshay Chopra · We R Stupid

Truth about Gomutra (Cow Urine) — Science or Myth?

The speaker spreads the claim across continents on purpose. If the practice is only Indian, critics can call it Hindu pseudoscience. If it's universal, attacking it is like attacking all of human history. The vagueness is what makes the claim unfightable.

JJyovis Ayurveda ► Watch on YouTube
Promoter 5.2K views · 159K subscribers
Dr Raj Satpute · Jyovis Ayurveda by Dr. Raj

Cow urine benefits, precautions — complete information

"For thousands of years, cow urine has been used to prevent and eradicate incurable diseases from their root." The longevity of a practice is substituted for proof of its efficacy. Neither claim is defended in the sentence.

STimes Now Navbharat ► Watch on YouTube
Promoter 621K views · 23.7M subscribers
Sushant Sinha · Times Now Navbharat

Agenda-driven people attacked ancient practices

"Have the agenda-driven people specifically attacked the ancient practices by dismissing what Ayurveda says?" "Agenda-driven" lets him skip past the substance of any critique. "Attacked" changes intellectual disagreement into violence against a community.

Ancient Indian library
In the World

Talks &
Publications

This study has formed a part of talks and a peer-reviewed paper by my project mentor Prof Joyojeet Pal, University of Michigan, and his team of co-researchers.

No mentions yet.

This research is ongoing. More presentations and publications are expected as the project develops.

Old books and manuscripts
The Paper

The Role of History
in the Acceptance of Gomutra

How YouTube's gomutra discourse is quietly rewriting Indian history — one wellness video at a time.

Introduction

Introduction

Before getting into the analytics, it's worth discussing why cow urine of all things merits a whole paper. Gomutra sits at this unusual intersection where almost every faultline in contemporary India meets at once: Hindu religious practice (the cow is sacred), traditional medicine (it shows up in Ayurvedic texts), a multi-crore wellness industry (Baba Ramdev's company Patanjali alone sells huge volumes of bottled cow urine under the brand Godhan Ark), and pseudoscience claims that have reached cabinet ministers and prime-time news anchors. What makes it useful as a case study is that the same yellow liquid gets framed as scripture, medicine, product, identity marker, and political tool, sometimes in the same video. Few other Indian topics let you study religion, science, commerce, and politics together in one corpus.

As you enter the gomutra sphere on YouTube, there is something that catches your attention right off the bat. People are not just discussing the healing properties of cow urine, and whether or not it can actually cure cancer; they are debating what kind of history India has had, and whose historical authority should take precedence. A Patanjali wellness video and a debunker video by Dhruv Rathee (one of India's most followed YouTubers, known for political commentary and myth-debunking content with audiences in the tens of millions) both seem to be participating in the same discourse, yet their rhetoric and evidence couldn't be more different.

The actual purpose of this paper is narrower than it might sound. I'm not trying to settle whether cow urine works. I'm using gomutra as a small, somewhat manageable window into a much bigger thing: how Indian public memory is being shaped on YouTube in real time. What I care about is the historiography: which historical periods get amplified, which get erased, and who gets to be the authority on "what India was like" and what that means for Indians today. Cow urine is just a convenient case because that's one of the windows into a much larger pattern.

Methodology

Methodology

I started with the 100 most-viewed gomutra-related videos on YouTube and ended up with 83 in the final dataset. The 17 that dropped out broke down roughly as follows: around 5 were duplicates or re-uploads of the same content on different channels, 6 weren't really about gomutra (it was mentioned in passing inside a longer wellness or religious video), 4 didn't have usable transcripts (no auto-captions, or in languages I couldn't reliably translate), and 2 were too short to code anything meaningful. The remaining 83 YouTube videos about gomutra mix promoter content (Patanjali ads, Ayurveda channels, wellness influencers, nightly-news segments) and debunker content (Dhruv Rathee, Dr. Ram Punyani, a couple of medical doctors). I went for the most-viewed videos in each camp rather than a random sample because the goal was to see what's actually shaping the conversation about gomutra.

For each video I got the auto-generated transcript, translated all of them into English using LLMs, and then verified the result of the translations myself. I subsequently coded the videos into categories like views, gender of channel, themes, content style, narrative style, claimed benefits, named ancient texts, mentions of rishis or sages, references to the West, political mentions, and any explicit historical periodisation.

Table 1: Sample description
Variable Category Total (n = 83)
Views Mean per video 1,027,214
Median per video 91,000
Total 84,231,546
Gender of channel Male 54
Female 9
Neutral / organisation 20
Content style Monologue 47
Interview 11
News report 10
Repurposed clips 8
AI-generated 5
Narrative style Promotional / testimonial 25
Explainer / factual 11
Devotional / faith-based 6
Opinionated / political 8
Not coded 33

Entire sample of YouTube videos available here.

Prior to starting my analysis, I read up on the basic methods of qualitative research analysis. Going through 83 transcripts line by line for qualitative analysis would have taken extremely long, so I used LLMs to pull out quotes, tag subthemes, and flag which historical references came up where. I then went back and manually verified every single quote against the original transcript myself, especially the ones I planned to actually use in the paper. Anything that didn't match got dropped.

One limitation worth bringing to attention is that I only looked at gomutra. I can't say yet whether the same historical pattern holds for yoga or general Ayurveda channels. That could be the next step.

Main Findings

Main Findings

A lot of patterns came out of the coding (claim-bundling, the "Ramdev formula," debunkers getting more views than promoters even though they're outnumbered 5:1, etc.).

One of the cleaner patterns in the data is that gomutra claims almost never travel alone. If a video tells you cow urine is good for your liver, it'll usually also tell you it's good for your kidneys, your weight, your skin, and your digestion in the same breath. Barely anyone out there is pitching cow urine for just one thing. And the bundling isn't random, it follows a reasonably predictable ladder.

At the base are the everyday, plausible-sounding claims: constipation and digestion (32 of 83 videos), skin and hair (21), obesity (16). The middle level is chronic disease — liver (23), kidney (14), immunity (14), joint pain (11), diabetes (7). As we notice most of these are chronic conditions for which there is no clear short-term cure, due to which is that someone may end up using these unproven 'medicines' for several months to find no results. And even then, they may be told that some or another aspect of how they used the medicine was incorrect causing it not to have a desired effect.

At the very top sit the grand claims: cancer (25 videos) and the "there's literally gold in cow urine" claim (only 2 creators say it, but debunkers love to attack it). The pattern is that promoters almost always lead with the small believable claims before escalating to the big ones. By the time a viewer has nodded along to "it helps with constipation," they're already several "yes"es deep when the cancer cure shows up. The structure is doing rhetorical work that no single claim could do on its own.

The single most revealing experiment in the whole dataset is that Baba Ramdev and Dhruv Rathee, the loudest promoter and the loudest debunker in the dataset, built entire videos around the exact same trick. Baba Ramdev's setup is short and visual. He pours a few drops of betadine into a glass with water, adds cow urine, and within seconds the dark colour disappears. He frames the colour change as proof that gomutra is neutralising toxins in real time. Dhruv Rathee runs the identical experiment, except with his own urine instead of cow urine, and gets the identical result. He doesn't need to argue with Baba Ramdev verbally, his experiment does the talking. The "miracle" becomes just a magic trick the moment the same trick works with his own urine.

Dhruv Rathee's betadine experiment
Image 1: Dhruv Rathee's 'betadine experiment' using his own urine (link to YouTube video)
Baba Ramdev's betadine experiment
Image 2: Baba Ramdev's 'betadine experiment' using gomutra (link to YouTube video)

I'm mainly going to focus on the two findings that have a direct implication for how history is being understood in India, because that's what I think is genuinely new here. Many gomutra videos are doing historiography without realising it. They're collectively writing a version of the Indian past where Vedic medicine flows uninterrupted to today's bottle of Godhan Ark, the Mughals and British never existed, and the West shows up only as verification. And the debunker side, by sticking strictly to chemistry, has let that historiography go unchallenged.

3.1 The Past Refers Only to the Vedic Period

The single most striking pattern in the dataset is how much of Indian history is missing. Out of 83 videos, more than half participate in a kind of ancient framing but it's always the same, ancient. There are zero references to the medieval, Mughal or colonial period and only one mention of cow slaughter being banned. The story jumps directly from rishis to today. The lines between history and mythology are often blurred. This is meant to imply that Indian history has been a black hole between the Vedic period and today, essentially suggesting that Indian history got pushed back by whatever happened in between.

Here's how the "Vedic" gets invoked, broken into subthemes:

Table 1. How videos invoke the Vedic past (out of 83 videos)
Subtheme Count Example
Named ancient texts (Charaka, Sushruta, Ashtanga Hridaya, Bhavaprakasha) 26 "we have three great texts… Sushruta Samhita, Charaka Samhita, and Bhavaprakasha Nighantu" — Rakesh Agarwal
"Thousands of years ago" / "since ancient times" 12 "For thousands of years, cow urine has been used…" — Dr Raj Satpute
Rishis / sages / ancestors 13 "Vagbhata Rishi has described the 'Mutravarg'…" — Dr Rupali Jain
Vedas referenced 13 "in the Vedas, it is given the status of Amrit" — Rakesh Agarwal
Sacred vocabulary (Amrit, Vishaghna, Rasayana, Shivambhu) scattered "urine is called Vishagna or killer of all poisons" — Akshay Chopra
Dr Rupali Jain discussing Mutravarg
Image 3: Dr Rupali Jain discussing the Mutravarg (link to YouTube video)

A reasonable pushback at this point is: if the Vedas actually do mention cow urine, how is invoking them a misrepresentation? They do mention it. But two separate things are going wrong, and they’re worth keeping apart. First, the medical part: the Vedas aren’t a scientific text, they’re religious literature, where medicine wasn’t separated from ritual. Citing a Vedic verse as clinical proof would be an error. The Vedas existing isn’t the misinformation, treating them as a peer-reviewed source is. Second, the historical part, which this paper cares about more: even if you grant the medical claim, what these videos do with the citations is a selective rewriting of Indian history. The 2,000-year intervening medical tradition gets collapsed into a flat “ancient times,” when Charaka and Sushruta Samhita’s were written centuries after the Vedas and routinely disagreed with earlier sources. There are two misrepresentations stacked on each other: one about what the text says, one about what Indian history was.

What’s interesting isn’t just that these speakers reach for antiquity, but how they do it. The vocabulary slides quietly between registers. Rakesh Agarwal, for example, says, “in the Vedas, it is given the status of Amrit, Amrit means which does not let die, which is a life-saving drug.” The sentence quietly slides from myth to pharmacology. Amrit is the drink of the gods but by the end of the line it has become “a life-saving drug.” There are different frames stacked in the video: Vedic theology, his IIT credentials, and modern medicine. None of them are made to check each other, which is what makes the move work. The same thing happens with sacred terminology more broadly: words like Vishaghna (“killer of all poisons”), Rasayana, Sanjeevani, Shivambhu show up scattered across promoter videos, and each one quietly lifts cow urine out of the medical register and into a metaphysical one. You can’t run a clinical trial on an offering to the gods.

Time-distance claims do something a bit different. When Dr. Raj Satpute says “For thousands of years, cow urine has been used to prevent and eradicate incurable diseases from their root.” The hidden inference is, if it didn’t work, would people have used it for so long? “Incurable diseases” plus “from their root” also packs in two enormous claims: that cow urine handles what modern medicine can’t, and that it doesn’t just treat but eradicates. But, neither claim is defended in the sentence. Akshay Chopra does a related move when he says “a lot of yogis have shown the true use of urine therapy in our ancient Indian texts,” and then adds Chinese, African, and American traditions on top. The speaker spreads the claim across continents on purpose. If the practice is only Indian, critics can call it Hindu pseudoscience. If it’s universal, attacking it is like attacking all of human history. He doesn’t name a single non-Indian text, the vagueness is what makes the claim unfightable.

The implication is bigger than gomutra. If this is how a popular health debate is being historicised, where, from vedic times it directly cuts to the present, then a whole chunk of Indian history is being quietly edited out of public memory. The conventional script (Mughal destruction, British suppression, modern reclamation) doesn’t even need to be invoked here. The Vedic past, standing alone, is doing all the work.

The reason the Vedic-to-today jump actually matters is that this jump quietly decides what counts as “Indian” knowledge. If your only reference point for Indian medical tradition is the Vedas-and-now, then everything in between basically stops being part of “our tradition.” The medicine that came with the Mughals, Indo-Islamic medicine, colonial-era Indian doctors trained in Western medicine, post-Independence medical institutions, all of it becomes someone else’s history that happened to take place on Indian soil. The Vedic-to-today move isn’t just lazy storytelling, there is very specific political intent in it. It’s like a sorting mechanism: this is ours, that wasn’t. By extension, everything that happened between the Vedas and now is erased, and therefore, something to be ignored. And the political stakes of that sorting are obvious; it lines up with a much bigger conversation in Indian public life about who counts as authentically Indian. The Vedic past, standing alone, is doing all the work.

3.2 The West Shows Up as a Validator, Not a Destroyer

This finding cut against the paper's expectations. In most Indian discourse around cow protection and Hindutva politics, the West is cast as the destroyer of Indian local knowledge. Here, it isn't — it's the endorser.

Table 2: How the West is invoked
Subtheme Example What's doing the work
American patent as proof "America has granted it a patent." — Baba Ramdev, Sudhir Chaudhary The word "patent," with no detail on scope
Big-name institutions "NIH… AYUSH… International Journal…" — Lotus Pregnancy Care Stacking acronyms
WHO certification "Certified by the World Health Organization." — B.K. Sahu The brand of WHO
Export markets as judges "Singapore, Germany, America, Britain, UAE are buying." — Sushant Sinha Foreign markets = validation
Western media as quality stamp "Washington Post, New York Times, Guardian have praised…" — Sudhir Chaudhary Newspaper names as authority
Sudhir Chaudhary's video on gomutra insults
Image 4: Sudhir Chaudhary's video, "Do those who insult gomutra know this?" (link to YouTube video)

It’s worth being precise about what I am and am not claiming here. I’m not saying the West has to show up as a coloniser, or that validation from the West is inherently bad. People can cite whoever they want. What I’m flagging is two narrower things. First, the rhetorical function, phrases like “America has granted a patent” are being used to end the conversation rather than open one. None of the speakers describe what the patent actually covers, whether any medicine was approved, or what its legal scope is. There are 4 widely cited patents where cow urine, specifically gomutra or its distillate, is the core active ingredient or focus of the invention that have been granted by US courts. They are as follows: US Patent No. 6,410,059 (2002), US Patent No. 6,896,907 (2005), US Patent No. 7,235,262 (2007), and US Patent No. 7,297,659 (2007). The patents are presented as proof of medical efficacy whereas the patents are actually simply a legal test of novelty. The brand of “America” does all the work. That’s worth flagging regardless of whether you think the West is a hero or a villain in the story.

Second, the historiographical observation is that in most other Indian discourse (cow protection politics, Hindutva commentary, anti-secularist talk), the West is the destroyer of Indian local knowledge. Here, suddenly, it isn’t and that inversion is the finding, not a complaint.

Sushant Sinha’s quote is doing the most interesting work: “These are the countries that understand the power of India’s centuries-old Ayurveda, but our people consider it a joke.” Two things happen in that sentence. First, Western respect is treated as proof of value. Second, the argument is quietly shifted away from whether cow urine actually works to whether Indians are loyal enough to their own tradition. He’s also leaning on Western validation in the same line where he’s criticising Indians for caring about Western opinion, but the contradiction doesn’t hurt him because the line is built to make you feel guilty, not to make you think.

The Sudhir Chaudhary and Baba Ramdev patent claims work the same way. None of them actually describe what the patent covers, whether any medicine got approved, or what the legal scope is. Just saying “patent” carries weight.

Implications

4. Implications

4.1 What Does This Mean for Young People Who Grow Up Watching This?

The most striking structural feature of the gomutra content I analysed is not what it says, but what it leaves out. No videos in this dataset mention the British and none mention the Mughals. There is no story of loss, suppression, or reclamation — it is just a seamless jump from ancient rishis straight to today's bottle of Godhan Ark, with roughly 2,000 years of Indian history simply not spoken about. For a young person watching hours of this content, the picture of the past that gets formed is one where India had extraordinary medical knowledge in the Vedic period, this knowledge has existed uninterrupted ever since, and the only people who doubt it are those with an "agenda." Sushant Sinha, on a channel with 625,000 views, puts it plainly: "have the agenda-driven people specifically attacked the ancient practices by dismissing what Ayurveda says?" The word "agenda-driven" does the magic here — it bluntly discredits any critic, turning scepticism itself into evidence of bad faith.

The effect of this framing, when absorbed repeatedly, is a warped understanding of both history and science. Because the Mughal and British periods are simply absent from this discourse, young viewers are not learning that those periods produced their own contributions to medicine, scholarship, and science — that Mughal-era physicians translated and brought together Greek, Persian, and Indian medical traditions, or that the colonial period, for all its downsides, introduced scientific methodologies that modern medicine now relies on. Instead, the story they receive is that the Vedic period was when real knowledge existed, and the only science worth trusting is the science that confirms what the rishis already knew. Rajiv Dixit hints to this in a video with 78,000 views: “Today’s science proves what Baghbhatt ji said thousands of years ago.” Science here is not a method for testing ideas, it’s just a way of getting official-sounding approval for beliefs that were already decided long ago. Consequently, this suggests therefore that whatever came in with the Mughals and British – Islam, Westernization of certain kinds – were all things that were bad for India.

This matters because it does not just affect how young people understand gomutra, it shapes the entire category of what counts as “legitimate knowledge.” If Vedic science is always already correct, and modern beliefs are only now catching up, then there is no independent role for evidence and experiments only confirm the claim instead of testing it.

4.2 Implications for Understanding Medicine

One of the most disorienting features of this content is the genuine confusion it creates around authority. Rakesh Agarwal, introduced as an “IIT Bombay PhD”, tells viewers that Amrit means “a life-saving drug”, a switch from Vedic terminology into pharmacology that happens so quickly most viewers would not notice the shift. R.S. Chauhan, described as “the former Director of the IVRI”, is cited by Sushant Sinha as endorsing cow urine as “a truly remarkable substance.” These are not anonymous internet commentators, they are people with credible titles and their credentials are being used not to test ancient claims, but to vouch for them.

On the debunking side, Dr. Navin Agrawal says simply that “the chances of benefiting from this in the eyes of modern medicine are not acknowledged” — staying firmly in the present, citing institutional authority. It is also, according to my data, far less effective. His video has 8,400 views against Rakesh Agarwal’s 2.4 million.

The deeper problem is that people’s understanding of medicine is being shaped by their understanding of history. If you have already accepted that Vedic science is the foundation of all true knowledge, then a chemistry experiment performed by a YouTube creator using his own urine is not going to change your mind. The promoters have already answered the question on historical grounds and the debunkers are still trying to answer it at the level of chemistry. So, we see, they are not in the same conversation. This raises a difficult question: who do people learn to trust when they are sick? A doctor trained in modern medicine who dismisses traditional practice, or an influencer backed by ancient texts, IIT credentials, and an American patent? In my data, the influencers are winning; not because the claims are stronger, but because the historical frame that supports them has been left completely unchallenged.

4.3 Ayurveda in Indian Science Textbooks

What happens on YouTube might seem like a self-contained problem but it is not. Under India’s National Education Policy (NEP) 2020, the current government has introduced Ayurveda into NCERT science textbooks for Classes 6 to 8. The Class 6 Curiosity textbook now references the Ashtanga Hridaya Sutra Sthana, the very same ancient text that Dr. Rupali Jain cites on YouTube, with 726,000 views, to authorise the medical properties of cow urine. The same texts that lives on wellness channels now lives in the national curriculum.

NCERT Class 6 Curiosity textbook reference
Image 5: The NCERT Class 6 Curiosity textbook, chapter "Materials Around Us" (link to PDF)

The Class 8 textbook includes a chapter titled “Ayurveda: Balance of Body, Mind, and Environment,” covering daily routines and seasonal habits drawn from traditional practice. The University Grants Commission (UGC) is simultaneously developing course modules to bring Ayurvedic principles into higher education. This is a systematic, institutional movement.

The connection back to this study’s findings is not incidental. The gomutra videos in our dataset operate by treating ancient texts as given authority — “the Charaka Samhita says so” is used as a conversation-ender, not to invite inquiry. When that same logic enters the science classroom through state-approved textbooks, it is no longer just one influencer among people, it becomes the curriculum. The movement from imagination of history to imagination of science to imagination of medicine is no longer just a pattern in online content.

The long-run implication is serious. If what counts as scientific knowledge is shaped by what confirms India’s ancient greatness, and if that idea becomes standard in classrooms and eventually in medical training, then the medical establishment itself (who gets trained, what gets funded, what treatments get recommended) will increasingly reflect a vision of science defined by history rather than by evidence.

Conclusion

5. Conclusion

This paper set out to answer a specific question: if the medical properties of gomutra are largely unproven, why do so many people believe in them? The answer this study finds is that belief is not being carried by chemistry. It is being carried by history, or more precisely, by a very selective version of history.

Across all the promotional videos, the pattern is consistent: the ancient Vedic and Ayurvedic past is invoked relentlessly (26 videos cite named Sanskrit texts, 13 cite the Vedas, 13 mention rishis and sages), while everything that happened between that golden past and the present is simply absent. The West shows up not as a villain but as a validator, American patents, Washington Post articles, NIH name-drops, ratifying what "history" already established. And the debunkers, for all their reach (Dhruv Rathee's betadine video alone accumulated 8.1 million views), never actually engage with this historical frame. They argue about chemistry, the promoters argue on cultural grounds, and so the two sides never meet.

This study offers insight into how misinformation spreads in India. It's not through outright political dialogue — videos that name Prime Minister Modi or the BJP actually get fewer views. It works through cultural memory and of ancient authority, it works through what people hear that makes them feel good about themselves in a sense. Viewers feel like they're learning about their heritage, not being persuaded, but the ideas and messages they're taking in are one where scepticism is "agenda-driven" and modern science only counts when it agrees with what the rishis already knew.

Once that framework makes it into NCERT textbooks (which it already has, with Ayurveda entering the Class 6 and 8 science curriculum under NEP 2020) it's no longer just a YouTube problem. The same historical imagination that makes gomutra believable online will shape what a generation of Indian children understands as science, and eventually, as medicine.

What the gomutra case ultimately reveals is something larger than cow urine: it is a working model of how a society’s relationship with its past can be reshaped to serve its relationship with contested science. It happens one YouTube video at a time, in the same vocabulary of rishis and ancient texts and foreign endorsements, until it is simply the way things are.

ASHA worker walking through a village
The Field Study

The Nirasha of ASHAs

The Invisible Labour of India's Frontline Healthcare Workers

A qualitative field study based on interviews with three ASHA workers and fifteen community members in Annamayya district, Andhra Pradesh.

Abstract

ASHA stands for Accredited Social Health Activist, but it also means "hope" in Hindi. Since the introduction of the programme in 2005 under the National Rural Health Mission (NRHM), over nine lakh ladies have been recruited in India's rural areas, and there is limited documentation of their day-to-day working conditions. This report is based on qualitative studies conducted with three ASHA workers, fifteen community members, and observations from field rounds in a group of villages in Annamayya district, Andhra Pradesh. The findings reveal that the official narrative of ASHAs as "part-time volunteers" is highly inappropriate since their work is comparable to that of full-time workers on multiple fronts, including maternal health, disease surveillance, digital reporting, and social welfare. These ASHA workers are very modestly remunerated; they bear the cost of transportation, equipment, and communication personally, and despite that, receive their dues irregularly. Further, this paper brings forth the interrelated dynamic between poor pay, community perception and disproportionate workload. The paper requests for a permanent classification of ASHA workers, a simplified incentive system and meaningful representation of these ladies in health policy decisions.

Introduction

Introduction

Community health in rural India is, as a matter of fact, held up by people who live right next to the problem — women in villages, local midwives, and volunteers who know everyone in their area. They know which house has a pregnant woman, which child has still not been vaccinated, and which elderly man keeps forgetting his blood pressure medicine. In a country where many villages still do not have access to medical clinics and hospitals, these grassroots workers are the crucial first interface between these marginalised communities and the public healthcare system. They translate what doctors say into the local language, carry medicines over long distances, and build a kind of trust that the government itself has struggled to build.

The ASHA (an acronym for Accredited Social Health Activist) programme was started in 2005 under the National Rural Health Mission (NRHM) and rolled out from 2006. The intention is to have one trained female health worker for every one thousand people in a community or village. ASHAs, wearing white sarees with a blue border, are recruited from the village itself by women's groups, the Gram Sabha, and block officers, and they're generally supposed to be women between the ages 25 and 45 who have studied till class 10 at least. Literacy requirements may be relaxed if no suitable candidates are available. They work alongside the Anganwadi system that was established in 1975 under the Integrated Child Development Services Scheme and runs village centres for nutrition, pre-school education, and basic health check-ups for children less than 6 years in age, pregnant women, and new mothers. Thus, most of the rural maternal and child health in India is taken care of by the Anganwadi and ASHA systems. Today, there are over nine lakh ASHA workers across the country, making it one of the biggest community health worker programmes in the world.

The issue is, even though everyone talks about how important ASHA workers are, almost no one really looks at what their actual day-to-day routines are like. A lot of what is written about them is just quantitative data like the number of child deliveries they helped with, the number of vaccines administered, etc. There isn’t much discussion on the conditions they are working in, the challenges they face or how they think they can be more effective. Engaging with the ASHA workers in Annamayya district in Andhra Pradesh made it apparent that the way the government describes their role does not adequately reflect what they actually do and the real cost at which they do it. Honorariums fixed with little regard to performance, overtime work not being compensated, travel and conveyance costs having to be incurred personally, and absorbing patients’ stress as a normal part of the job, are all factors that are rarely mentioned in official reviews of this group of medical workers

An ASHA worker detailing her work
Image 1: Field visit shadowing ASHA worker

One specific rural area was therefore chosen as a sample for case study and the work done essentially focussed on exploring the ground realities of being an ASHA worker and developing a perspective on how they are perceived by the people they take care of. It is based on a cross section of interviews and field observations carried out in villages near the Rishi Valley Rural Health Centre, Kurabalakota Primary Healthcare Centre (PHC), and Madanapalle in Annamayya district of Andhra Pradesh. I spoke to ASHA workers, Anganwadi teachers, and patients from a mix of Hindu and Muslim households across different ages. Statistically, it is not a large survey since the focus is more on exploring ground realities: what is working, what better can be done, and where the trust isn’t really reaching.

The rest of the report is structured as follows: a literature review of what has already been said about ASHA workers, followed by field observations and interview findings concluding with a discussion of what is missing in existing reportage.

Literature Review

Literature Review

This section reviews what has already been written about ASHA workers. It is organised into three themes: what studies say about their roles and how effective they are; their specific role in maternal, child, and nutrition-related health, and the problems and challenges they face. The section concludes with a brief discussion on what is missing from the existing research, which is the gap this report is trying to fill.

Most of the literature describes ASHAs as the "first port of call" for rural health needs, especially for women and children. Saxena, Kakkar, and Semwal (2012) looked at 150 ASHAs in Haridwar district and found that the majority saw antenatal care, vaccinations, and family planning as their main work, and a lot of them also saw the job as a way into future employment. The National Health Mission's own writing describes ASHAs both as service providers (they carry a basic drug kit that contains Oral Rehydration Salts, Iron & Folic Acid tablets, condoms, delivery kits and some basic Over The Counter medications) and as activists who spread awareness about health and push the community to actually use the health services that exist. What I saw in the field matches this almost completely: ASHAs in Annamayya district carry medicine and vaccine boxes between villages, pick up vaccines weekly from the PHC, run Non Communicable Disease (NCD) surveys door-to-door, and go with pregnant women to the PHC or district hospital. But what doesn't show up in the official description is how long their actual day is (usually a full 9am to 5pm day with no holidays) and how many additional duties they handle, like dengue checks, Tuberculosis (TB) follow-ups and registering participants for India's digital healthcare ecosystem, Ayushman Bharat Health Account (ABHA).

A lot of studies also look at how ASHAs affect maternal and child health specifically. Padda et al (2013) compared urban and rural Faridkot in Punjab and found that maternal and child health services in rural areas clearly improved after ASHA workers were introduced, with rural indicators sometimes doing better than urban ones. ASHAs are the ones making sure babies are exclusively breastfed for the first six months, that vaccinations are done at the stipulated 45 day, 75 day, 105 day, and 10 month intervals, and that high-risk pregnancies actually make it to the right hospital. They also work with the Anganwadi system, helping with monthly immunisation, handing out ‘Balamrut’ powder (an Ayurvedic immunity booster) and eggs for children between 3 and 5 years of age, and distributing iron syrup and deworming tablets in schools.

An ASHA worker detailing her work
Image 2: Saturday immunisation at the Anganwadi school

The interviews backed this up too. Patients in villages around Madanapalle said ASHAs were most helpful with anaemia, vaccinations, and calling the Emergency Response Service on 108 for ambulances. One ASHA worker had just spent three days, travelling 45 kilometres each way on each day to Punganur, to arrange for a tubectomy for a lady from her village. What was especially striking in this instance was that she had to personally bear the full cost of all this travel.

The literature is also consistent on the challenges. Gopalan, Mohanty and Das (2012) did a mixed-methods study of 386 ASHAs in Orissa and found that what demotivates ASHAs most is bad health infrastructure, too much workload, and how the incentives are structured, while what keeps them going is mostly internal, like a sense of social responsibility and self-efficacy. Across studies, ASHAs come across as overworked, under-resourced, and financially insecure. They don’t get a fixed salary, just a small honorarium and performance-based incentives, so what they actually earn varies from month to month. And all of this sits on top of gender. Every ASHA is a lady, and a lot of them are widowed or separated or from Below-Poverty-Line homes doing community health work over and above all the housework. Saxena et al (2012) also pointed out that even basic things like the age and education criteria are not always followed during selection, so even the small protections built into the programme do not always apply.

What the existing research doesn’t really evaluate is the actual economics of being an ASHA. How the ₹10,000 a month honorarium in areas like the ones investigated in this study actually plays out when each worker has to pay for transport costs, their mobile device and its data charges, and all the paperwork. Or what it is like when three ASHAs are doing the work of five because there aren’t enough workers. Or how women deal with the fact that the job is not permanent, there is no pension, and that many need to take microloans to manage cash flows. There is also not much research on how ASHA workers’ perception differs across communities and categories. Some families think they are extremely important, but others, especially in semi-urban Muslim or higher-income households, said they barely see them and just go to private clinics instead. The fieldwork and interviews in this report attempt to address these gaps by focusing on what the workers themselves say about their conditions and what the community actually thinks, in a part of Andhra Pradesh that has not really been written about much.

Table 2: ASHA Compensation Structure, Annamayya District (2025)
Compensation Component Details
Fixed Monthly Honorarium ₹10,000
Task-Based Incentives ₹2,000–₹4,000 (approx., often unpaid)
Gratuity on Retirement ₹1.5 Lakh (after 30 years of service)
Maternity Leave Benefit ₹60,000 for 180 days
Retirement Age 62 years
Employment Classification Honorary / Voluntary (not permanent govt. employee)
ANM (for comparison) ₹30,000/month + pension + 20 days leave/year

Source: careermeto.com — Annamayya ASHA worker salary 2025

Methodology

Methodology

This report uses a qualitative approach, which essentially means that the findings are developed from conversations and direct observation rather than from surveys or statistical data. This method was chosen because the answers sought (a day in the life of an ASHA worker, her community's perception and treatment of her, and what it feels like to do this job in the context of the money earned) are not the sort that a questionnaire can answer well. Individuals' relationships with the healthcare system are layered and personal. Every attempt was made to get the participants to describe these views in their own words. Statistics can tell you that an ASHA worker vaccinated sixty per cent of the women in her community, but they can't tell you why she walked two kilometres in the scorching heat to make that happen.

The fieldwork for this study was done in a cluster of small villages in a semi-arid rural region. Agriculture, mainly groundnut, paddy, tomatoes, and millets, is the principal economic activity in this region and it is essentially reliant on monsoon rains as only a small amount of the land is irrigated. Public health infrastructure is poor: the closest complete hospital is a long bus ride away and the roads often become unusable during the monsoon months.

Two villages were visited. One lay close to an all weather road and the other was at a distance away from it. This criteria was chosen because the ability to commute and the access to transport meaningfully changes a community's experience with the healthcare system and it was therefore relevant to hear both perspectives.

Two groups of people were interviewed. The first was the ASHA workers for the area, Chamundeshwari, Ammajan and Hemlata. These three ladies covered the chosen area collectively so all of them were interviewed. The second group comprised fifteen members from the local community recruited from people visiting the Rural Health Centre and from an immunisation drive under way during the field visit. A conscious effort was made to assemble a diverse group rather than the most convenient group available. The final sample included Hindu and Muslim families, women and men, young mothers and older women, Telugu-only and Telugu-Urdu speakers, and residents from both the more central as well as the more outlying parts of the villages. The aim was to hear voices from as broad a range as possible.

Three methods were used to collect data.

The first was interviews. All interviews were personally conducted in Telugu, the local language. Respondents were not given time limits, they could speak for as long or as little as they liked depending on their comfort and convenience. Consequently, some conversations ended in twenty minutes while some others went on for forty five minutes. Participants were asked about their routines, income, household circumstances, experiences with the healthcare system and how things had changed over time. Conversations did not follow a set question-answer format, the flow was a bit informal, like they were talking to a family friend.

The second method was observation. Over the course of a field visit with the ASHA workers, homes and families on the call sheet were visited, prenatal checks and evaluations were attended and documentation completed was considered. Insights were gained from discussions that the ASHA workers engaged in with the people being met. This method added perspective to the information gained from the interviews. The patience and perseverance required to communicate effectively with patients given the modest levels of literacy and awareness; the physical resilience required for all the walking, every day, and the application of judgement and experience in situations that were not standard.

The third method was the study of relevant documents. Some very useful sources of information were government websites like the National Health Mission pages about the ASHA programme; various research papers and news articles about ASHA workers in different states, and brochures available at the rural sub-centre. These documents all provided context and awareness.

Analysis followed. Repeated scrutiny of interview notes and observations recorded in the field resulted in the discovery of insightful comments, helpful feedback and recurring patterns. These patterns were then grouped into four broad themes: what ASHA workers actually do day to day, the pay and financial conditions of the role, the community’s perceptions of them, and the structural problems built into the wider system. These themes structure the findings section that follows.

Table 1: Weekly and Monthly Schedule of ASHA Workers
Day / Frequency Activity
Monday – Tuesday Village rounds: antenatal follow-ups, household surveys, NCD screenings
Wednesday Thettu subcentre — immunisation session + village rounds
Thursday School and Anganwadi visits: iron tablets (6+yrs), Vitamin A, height/weight, deworming
Friday Dry Day survey: larva/dengue checks, sanitation inspections, drain monitoring
Saturday Anganwadi immunisation (rotating across four villages each month); iron syrup for ages 3–5
Sunday Emergency standby; early finish if no urgent cases
3rd Friday All pregnant women are escorted to Kurabalakota PHC
Twice monthly All pregnant women to Madanapalle District Hospital; Village Health Nutrition Day; Village Health Sanitation Day
1st Tuesday Compulsory ASHA meeting, Kurabalakota PHC
Monthly Gram Sabha meeting
Findings

Findings

What ASHA workers really do

An ASHA worker detailing her work
Image 3: An ASHA worker, in the white saree, detailing the nature of her work

A typical working day for the ladies spoken to begins around nine in the morning and does not have a clear end. Officially, ASHA workers are classified as part-time volunteers and are only required to work for a few hours, but in practice, they are on duty from 9am to 5pm and, in case of emergencies, are on call around the clock. Chamundeshwari described being reachable at any hour – when a lady in her area goes into labour at two in the morning, she is the person who gets the phone call. Hemlata reiterated this. Weekends too are rarely free, especially during immunisation drives or surveys.

The range of work that each of them is expected to handle is striking. Based on interview learnings and field visit observations, responsibilities include prenatal check-ups and follow-ups, escorting pregnant women to hospital when labour begins, post-delivery home visits, newborn weighing and the administration of the full schedule of childhood vaccinations, TB screening and follow-up with patients on long courses of treatment, household-level dengue and malaria surveys (that involve walking from door to door checking for stagnant water), distributing iron tablets, family planning counselling, contact tracing during outbreaks, and a substantial amount of register-keeping. Ammajan also mentioned tasks that fall outside any official remit, such as helping families apply for disability certificates and personally following up on patients who have stopped taking their TB medication.

Each ASHA worker is responsible for about a thousand people, and sometimes more. When asked whether this caseload was too high, all three ladies laughed. Hemlata pointed out that the official one-ASHA-per-thousand guideline does not account for the fact that the villages are physically spread out, so reaching a single household can take half an hour on foot; many times, if there is no one else in the village willing to take up the job of being an ASHA worker, they have to cover larger populations. As she put it, the number on paper does not capture what the job actually demands.

Pay and money problems

Pay was the single issue that came up in every interview, with all three ASHA workers and with most of the community members too. ASHA workers do not receive a fixed salary. Their income consists of a small monthly honorarium of roughly ₹10,000 (the exact figure varies by state) together with an incentive. The incentive structure looks reasonable on paper, but payment is often delayed by months or never given. Chamundeshwari told me she was still waiting on incentives from work she had done five months earlier and others, regardless of the effort they put in, never received incentives at all.

In addition to the compensation being meagre, ASHA workers absorb a significant amount of out-of-pocket expenses. They use their personal phones for work, making calls to patients, sending photos of registers, navigating government apps, and they pay for their own mobile data. During the first months of the COVID-19 pandemic, they bought their own Personal Protective Equipment (PPE). They buy their own registers, pens, and at times even bus tickets when they have to travel to the block office to submit reports.

Their personal financial situations makes these costs much harder to bear. Chamundeshwari’s husband has been unwell for years and cannot work consistently, which means her ASHA income is essentially what keeps the household running. Ammajan, whose husband has passed away, is the sole earner for children still in school, and she described having to choose between paying her phone bill and paying their school fees. Hemlata’s situation was a little easier because her husband works, but she was still firm that the income did not match the hours she put in. None of the three women has any form of pension, leave entitlement, or job security to fall back on.

School security pledge event attended during fieldwork
Image 4: An ASHA worker describing her living conditions outside her house

What the community thinks

The community’s views were more divided than expected. Some respondents spoke about their ASHA worker in genuinely warm terms. One young mother credited the ASHA worker with saving her baby’s life: she had had a complicated pregnancy, and the ASHA worker had visited her again and again, pushing her to attend her scans and accompanying her to hospital when labour began. An older woman said the ASHA worker was the only person in any official capacity who had ever come to her door simply to ask whether she was alright.

Other respondents had little or no contact with their ASHA worker at all, and a few did not know who their ASHA was. When probed further, the explanation usually came down to one of two things. Either the household lived in one of the more outlying hamlets that were difficult to reach regularly, or there was a quiet social distance, usually along religious or caste lines, that no one quite stated openly, but was clearly present.

A subset of respondents preferred to go to private hospitals or clinics, despite the cost. Their reasoning was partly about trust – they felt the government sub-centre was understaffed and rushed – and partly about status. One man indicated that government services were “for the poor” and that he did not want to be perceived in that way.

COVID-19 came up in nearly every community interview. Several respondents felt that ASHA workers deserved greater recognition and compensation for their work during that period, and expressed frustration that their conditions had not improved since. Respondents reported dissatisfaction with compensation relative to workload.

Problems in the system

There is more to the story than what we see every day. The principal issue with ASHA workers is that they are not permanent employees. The government states their employment status as “voluntary”. This means ASHA workers do not get a salary that they can count on. They do not get time off when they need it or a pension when they are old. ASHA workers don’t have any of the things that come with a real government job. Many ASHA workers have been in the role for two decades and still not classified as permanent. A few of the women spoken to had been doing this work for over twelve years and still had no job security, no pension, and no real path forward. They are still waiting for something that will give them security. Given the critical role they play, the issue of ASHA workers is a problem that needs to be solved.

This becomes especially visible when ASHA workers are compared with Auxiliary Nurse Midwives (ANMs), who do overlapping work in the same villages. ANMs are formally employed by the government, with a fixed monthly salary, leave entitlements, and a pension. In practice, the ASHA worker often does the legwork (visiting houses, identifying patients, bringing them in) while the ANM handles the clinical portion. The ASHA worker is then paid a fraction of what the ANM earns. All three ASHA workers raised this comparison without prompting, and it was clear that the disparity stung.

School security pledge event attended during fieldwork
Image 5: an ANM comparing her job details and compensation with that of ASHAs

A specific case made the unfairness particularly clear. A woman in one of the villages had undergone a tubectomy and developed complications afterwards. The ASHA worker had been the one to counsel her, bring her in for the procedure, and follow up at home for weeks. The incentive for the whole episode was small. When complications arose however, it was the ASHA worker the family blamed, not the doctor and not the ANM. She absorbed the social cost without receiving either the professional standing or the pay that would have come with it.

The final structural issue is the move to digital reporting. The government has been steadily shifting registers, reports, and surveys onto smartphone applications. None of the three ASHA workers I spoke to had been given a phone by the government, and none had received meaningful training on the apps. They were navigating the software on their personal handsets, often with help from their children, while still being held to the same deadlines as before. Chamundeshwari said she had been pulled up for late submissions even though her phone was old and the application kept crashing. The system, in short, is asking these women to function as digital workers without giving them the tools or the instructions to do so.

Discussion

Discussion

The three themes that came up across the interviews – workload, pay, and community perception – don’t really stand on their own. They are interrelated and point to deeper issues in the system. The ASHAs spoken to were doing substantially more than what their original job description covered: maternal health visits, COVID follow-ups, NCD screening, TB tracking, election duty, distributing iron tablets to young girls, and even helping fill out Ayushman Bharat and Aadhaar-linked beneficiary lists. But the incentive structure hasn’t expanded with the workload. So they end up doing more work for the same unpredictable pay, which then affects how their families and neighbours view the job. A few women mentioned that their husbands or in-laws kept asking why they were “running around” so much for so little money, and this constant questioning seemed to tire them more than the physical work itself. The community perception piece isn’t separate from the pay piece either. When people in the village see that the government doesn’t pay you a proper salary, they don’t take the role as seriously, and that makes it harder to do the actual work of convincing women to get safe deliveries in the hospital or vaccinate their children. So pay shapes perception, perception shapes how much cooperation an ASHA gets, and that in turn shapes how heavy her workload feels. It’s a loop, not three separate problems.

School security pledge event attended during fieldwork
Image 6: Parent-Teacher Meeting event on a Thursday at Zila Parishad High School where ASHA workers were checking height and weight and distributing iron and deworming tablets

The issue with the system is underlying to all of this. The ASHA programme was designed in 2005 as a “voluntary” scheme to bridge the gap between communities and the public health system, but two decades later the same framing is being used to justify keeping wages low even though the role has completely transformed. The experiences documented in this field site raise concerns that these ASHA workers are doing what would, in any other country, be considered the work of a community health nurse, but they’re being paid like part-time volunteers and managed like government employees, expected to attend meetings, fill forms, meet targets, and answer to multiple supervisors (ANM, PHC medical officer, block coordinator). This in-between status is what creates most of the day-to-day friction.

These findings mostly line up with what researchers have documented in other states. Ved et al (2019) and Saprii et al (2015) both pointed out the mismatch between the scope of ASHA work and the volunteer framing, and that came through clearly in interviews conducted for this research. The delays in compensation mentioned (some women said they hadn’t received incentives for almost five months) match the patterns Bajpai and Dholakia (2011) have written about, and also what came up during the ASHA strikes in Maharashtra, Karnataka, and Haryana between 2020 and 2023. Scott’s (2018) global review of community health workers brought up similar issues: unclear job descriptions, weak supervisory support, and the gendered devaluation of “care work”. This suggests this isn’t just an Indian problem.

However, the findings of this research differ a little in the sphere of community perception. A lot of the literature, especially from Kerala and Tamil Nadu, talks about ASHAs being respected in their community, but in the villages visited for this research, the impression was a lot less consistent. Some women were admired, but others described feeling judged or looked down upon within their communities. This tracks more with studies from Bihar and UP and therefore suggests that the “ASHA experience” is really shaped by state-level investment, training quality, and local caste/gender dynamics. The Kerala model works in Kerala partly because the basic public health system is stronger due to their education system, higher gender equity, and less rigid social structures.

It is readily acknowledged that the sample for this research was small and so the findings cannot be substantially generalized. The dynamics could be really different in another district and there would definitely be differences in another state. The ladies interviewed were also the ones willing to talk. For example, it was not possible to talk to ASHAs who had quit so their perspectives are missing from this data, and their reasons might also be the most important ones to state. Lastly, as a school-student researcher, an ‘outsider’ not fluent in the local language, and someone from a different class background than most of the ladies interviewed, the responses received could possibly have been impacted for their depth and candour. A longer fieldwork period would likely have provided a better picture. Thus, what is put together here is really a starting point rather than a final piece.

Policy Recommendations

Policy Recommendations

Permanent employment. The most fundamental shift the government could make is to stop calling ASHAs "volunteers" and recognize them as permanent health workers with a fixed monthly salary. Right now, their pay is split between the centre and state and is unpredictable, which means in some months, an ASHA might earn ₹5,000 while doing the same amount of effort as someone earning ₹10,000 in a different state. Several state-level commissions and the 45th and 46th Indian Labour Conferences have already recommended that ASHAs be classified as regular workers, but nothing has actually moved at the central level. A guaranteed minimum monthly salary, even ₹15,000, with incentives layered on top, would give these ladies some financial stability and also signal that their work is taken seriously by the state.

Incentives. Even if permanent employment takes time, the incentive structure itself needs fixing. Currently there are over 60 different incentive heads, each with its own paperwork and verification process, which is part of why payments get delayed for months. Consolidating these into approximately 8–10 broader categories tied to outcomes (maternal health, child health, NCDs, etc.) would reduce the administrative work for both ASHAs and the PHC staff who process payments. Linking payments to a direct digital transfer system with a public dashboard where ASHAs can see what they're owed would also reduce dependence on supervisors who sometimes hold up payments. The ladies interviewed were upset about the amount and equally about the unpredictability and the running around required to actually receive their dues, if at all they do.

Social security. ASHAs currently fall through almost every social security net in the country. They don’t get EPF, ESIC, gratuity, or a pension, even though many of them have been doing this work for over a decade and treat it as their primary occupation. Extending these benefits would acknowledge the long-term nature of the role. At the very least, health insurance for the ASHA and her immediate family can be provided along with maternity benefits (which is almost ironic given that they are the ones promoting institutional deliveries), and a retirement amount that pays out after 10+ years of service. Some states, like Kerala, have piloted small pension schemes for ASHAs, and the results have been encouraging in terms of retention. This would give these ladies something to fall back on when they retire

Workplace safety. Safety came up again and again in the interviews and is almost completely missing from current policy. The ASHAs spoken to described doing night visits during deliveries, walking alone through fields and unlit roads, dealing with aggressive male relatives during household surveys, and, during COVID, being sent into infected homes without proper PPE. A basic safety protocol needs to be put in place: a transport allowance or arrangement, especially in rural and tribal areas, and PPE supply during emergencies.

Representation in decision-making. The last thing to push for is giving ASHAs an actual seat at the table when health policy gets made. Right now, they’re treated as the people who implement decisions made by people who have never done a household visit. Mandating ASHA representation (with voting rights, not just attendance) would change this. They have ground-level knowledge that no bureaucrat or consultant has, and using that knowledge would probably make health programmes work better, not just be fairer to the ladies doing the work.

Conclusion

Conclusion

This study found that ASHAs in the villages visited are carrying a workload that has expanded far beyond their original role, while their pay remains unpredictable and their position in the community is more uncertain than the official narrative suggests. The three themes of workload, pay, and community perception are deeply tied together, and they all point to a system that depends on ladies' labour without giving them the recognition, security, or voice that the work deserves.

What this implies is that surface-level fixes like a small incentive raise here, a one-time bonus there, are not going to solve anything. Findings from this case study suggest: permanent employment, a fixed incentive structure, real social security and safety provisions, and actual decision-making power for ASHAs themselves. Future research could push this much further. A larger, multi-state sample would help show how much of what is found in this work is specific to this region versus a national pattern. A longitudinal study following the same ASHAs over a few years would capture how burnout and changing policy actually play out in their lives. And a comparative study across states with very different ASHA outcomes (say Kerala vs. Bihar) could help figure out which policy choices actually make a difference.

References

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