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Learn more: PMC Disclaimer | PMC Copyright Notice J Occup Med Toxicol . 2026 Apr 10;21:16. doi: 10.1186/s12995-026-00510-y Search in PMC Search in PubMed View in NLM Catalog Add to search Systematic review of health challenges experienced by Indian women engaged in informal labor Ankit Sheth Ankit Sheth 1 Health Sciences Division, ICMR – National Institute of Occupational Health, Ahmedabad, India Find articles by Ankit Sheth 1, # , Ankit Viramgami Ankit Viramgami 1 Health Sciences Division, ICMR – National Institute of Occupational Health, Ahmedabad, India Find articles by Ankit Viramgami 1, # , Mahendra Thakor Mahendra Thakor 1 Health Sciences Division, ICMR – National Institute of Occupational Health, Ahmedabad, India Find articles by Mahendra Thakor 1, ✉, # , Garima Lohra Garima Lohra 1 Health Sciences Division, ICMR – National Institute of Occupational Health, Ahmedabad, India Find articles by Garima Lohra 1 , Anushree Mohanan Anushree Mohanan 1 Health Sciences Division, ICMR – National Institute of Occupational Health, Ahmedabad, India Find articles by Anushree Mohanan 1 , Nisha Bhati Nisha Bhati 1 Health Sciences Division, ICMR – National Institute of Occupational Health, Ahmedabad, India Find articles by Nisha Bhati 1 , Zulekha Khalil Zulekha Khalil 3 Self-Employed Women’s Association (SEWA), Ahmedabad, Gujarat India Find articles by Zulekha Khalil 3 , Rakesh Balachandar Rakesh Balachandar 2 Occupational Medicine Division, ICMR – Regional Occupational Health Centre, Bengaluru, India Find articles by Rakesh Balachandar 2, ✉, # Author information Article notes Copyright and License information 1 Health Sciences Division, ICMR – National Institute of Occupational Health, Ahmedabad, India 2 Occupational Medicine Division, ICMR – Regional Occupational Health Centre, Bengaluru, India 3 Self-Employed Women’s Association (SEWA), Ahmedabad, Gujarat India ✉ Corresponding author. # Contributed equally. Received 2025 Dec 10; Accepted 2026 Apr 2; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13067567 PMID: 41964067 Abstract Background The informal economy encompasses all economic activities carried out by workers or economic units that are not adequately covered by formal legal or regulatory frameworks. National data from India indicate that 53.7% of the 308 million unorganized workers are women. Given the multifaceted occupational risks associated with informal employment, women workers in the informal sector are vulnerable to a range of adverse health outcomes. The present study aims to synthesise existing evidence on occupationally related health challenges experienced by Indian women employed in the informal sector. Methods Studies reporting health outcomes among Indian women engaged in informal labor were systematically searched in digital databases from their inception until September 09, 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Owing to substantial heterogeneity in outcome reporting and the limited availability of measures of dispersion, a pooled effect size could not be estimated. The risk of bias in included studies was assessed using the Newcastle–Ottawa Scale. Results Thirty-three studies involving women workers in the informal sector were included. Musculoskeletal disorders were the most frequently reported health outcome across occupations. The prevalence of upper limb and trunk discomfort (89–95%) was higher than that of lower trunk and lower limb discomfort (61–81%). High prevalence of cardiorespiratory (~ 73%), dermatological (32–78%), and ophthalmic (45–90%) symptoms was also reported. A small number of studies indicated that the odds of certain adverse health outcomes were higher among women compared with men in similar occupations. Overall, the majority of included studies were of low methodological quality and exhibited a high risk of bias. Conclusion The findings highlight the substantial occupational health burden faced by women workers in India’s informal sector. Although the evidence is largely derived from studies with high risk of bias, the growing participation of women in informal employment underscores the need for urgent, gender-responsive public health action. There is a pressing need to integrate informal women workers into primary healthcare systems and social protection programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12995-026-00510-y. Keywords: Occupational health, working women, India, Systematic reviews, Musculoskeletal system, Informal labor Key observations / summary at a glance • Informal women laborers experience multiple health challenges; most prevalent across all forms of informal sector is musculoskeletal discomfort, followed by cardio-respiratory related symptoms. • The odds of health challenges among the informal women workers are higher as compared to that of men. • Quality of existing studies are predominantly sub-optimal. Supplementary Information The online version contains supplementary material available at 10.1186/s12995-026-00510-y. Research in context Evidence before this study Added value of this study Implications of all the available evidence Women constitute a significant proportion of India’s informal workforce. Occupational health risks among informal women workers are multifaceted, influenced by a combination of physically demanding tasks, long work hours, poor ergonomic conditions, environmental exposures (dust, heat, pesticides, chemicals), and lack of personal protective equipment. Moreover, the absence of structured employment terms, social security, and health coverage further heightens their vulnerability to both acute injuries and chronic health conditions. Prior literature—largely fragmented and regionally focused—has reported a range of health complains, such as musculoskeletal pain, respiratory issues, dermatological problems, and heat-related symptoms among informal workers. However, a comprehensive synthesis of the health effects specifically experienced by women in informal occupations across India was lacking. No previous systematic review has holistically mapped the burden of health symptoms among this vulnerable group or critically evaluated the quality of the existing evidence. This is the first systematic review to consolidate and critically appraise the evidence on health problems faced by Indian women working in informal sectors. The study screened and included 33 primary research studies spanning 18 Indian states and diverse occupational settings. It revealed consistently high prevalence of musculoskeletal, cardio-respiratory, dermatological, and ophthalmic symptoms across different sectors. The findings underscore gendered health disparities, with several studies reporting significantly higher odds of adverse health outcomes among women compared to men. Furthermore, this review highlights substantial methodological weaknesses across the evidence base, including poor participant definition, non-random sampling, and underreporting of response rates. The evidence presented reinforces the urgent need to recognize informal women workers as a high-risk group for occupational health problems. Despite the methodological limitations of the included studies, the consistency of reported symptoms and their alignment with known occupational hazards point to a serious public health concern. These findings provide a rationale for immediate integration of the informal women workers into primary healthcare services, occupational health surveillance, and social protection schemes. Addressing these gaps is essential to reduce gender-based health inequities and ensure inclusive growth, especially in light of India’s expanding informal economy and evolving climate-related vulnerabilities. Supplementary Information The online version contains supplementary material available at 10.1186/s12995-026-00510-y. Background The International Labor Organization (ILO) defines the informal economy as encompassing all economic activities carried out by workers or economic units that are, either de jure or de facto (in law or practice), not adequately covered by formal legal or regulatory frameworks or social security mechanisms [ 1 ]. For a sustainable livelihood in developing and underdeveloped regions, citizens are often forced to engage in informal work. However, in addition to the widely prevalent poverty associated with informal economies, these work environments are also recognized for substantial gaps in working conditions—such as unregulated employment conditions, limited access to social protection, weak institutional oversight, and low labor productivity [ 1 ]. Globally, it is estimated that over 61% of the workforce is engaged in informal employment, underscoring its scale and relevance. Notably, women are disproportionately represented in informal employment in low- and lower-middle-income countries, where they are more likely to occupy precarious roles with minimal protection or stability, often in the most marginalized sectors of the workforce [ 2 ]. The precise proportion of the informal economy in India is unclear, however about 74% of the Indian workforce is estimated to be involved in the informal economy, and 81% of working Indian women are employed in the informal economy [ 3 , 4 , 2 ]. National data reveal that women constitute 53.7% of the 308 million registered unorganized workers, likely an undercount due to limited registration [ 5 ]. These women are engaged across a diverse array of sectors including agriculture, construction, street vending, domestic work, beedi rolling, artisanal production, waste collection, and home-based manufacturing [ 6 ]. Occupational health risks among informal women workers are multifaceted, influenced by physically demanding tasks, long work hours, poor ergonomic conditions, and environmental exposures (dust, heat, pesticides, and chemicals), along with limited access to personal protective equipment. Moreover, the absence of structured employment terms, social security, and health coverage further heightens their vulnerability to both acute injuries and chronic health conditions [ 6 ]. Emerging evidence suggests that these women are at elevated risk for musculoskeletal disorders (MSDs), respiratory illnesses, dermatological conditions, eye strain, reproductive health issues, heat stress, and psychological distress [ 7 – 11 ]. However, the existing body of literature remains fragmented, with limited large-scale epidemiological studies or systematic synthesis of data. Much of the available evidence is confined to isolated case studies or region-specific assessments, often with methodological limitations such as small sample sizes, non-representative recruitment, and lack of longitudinal follow-up. Given this context, a systematic review is warranted to synthesize existing evidence on health outcomes specifically related to occupational hazards and working conditions experienced by Indian women in the informal sector. A secondary objective was to summarize reported gender differences between women and men working in similar informal occupations, where such data were available. This review aims to identify key health outcomes of women employed in the informal sector, assess the methodological quality of available studies, and highlight critical research and policy gaps. Such an effort is essential to inform targeted public health action, improve working conditions, and advocate for inclusive occupational health policies that address the needs of this often-overlooked women workforce. Methods The present systematic review aimed to systematically synthesize evidence on occupationally related health challenges experienced by Indian women engaged in the informal / unorganized sector, based on available literature. The “Preferred Reporting Items of Systematic review and Meta-analysis - (PRISMA)” guidelines were followed during the execution of this study (PRIMSA checklist – supplementary Table 1 ). The protocol was registered at PROSPERO (CRD42022382835) [ 12 ]. Scopus and PubMed were systematically searched for original studies reporting occupationally related health outcomes among Indian women workers in the informal sector available from their inception to September 09, 2024 (supplement Table 2 search terms). Additionally, explored grey literature such as government reports, ILO/WHO documents, non-indexed Indian journals and lateral search. Reviews, commentaries and methodology publications were excluded. Further studies reporting only socio-economic conditions such as domestic violence, gender discrimination, violence at workplaces without description of health challenges, or general health without associating it with their workplace / occupations were excluded. Table 1. Description of the original studies included in the present systematic review Citation (State) Outcome parameters Study population (Age, % of females) Details of occupation Remarks Studies reporting women laborers employed at construction and brick associated industry Sett et al. 2022 (West Bengal) [ 18 ] Body Part Discomfort Scale (neck, forearm, upper arm, thigh) N = 30 females; mean age brick molding ( N = 18) was 24.2 ± 3.51 years, that of brick carrying ( N = 12) was 21.7 ± 2.12 years Brick molding and brick carrying activities of brick manufacturing Brick molding and carrying tasks generated compressive forces of approximately 1800–2500 N and shear forces of 280–500 N, thereby increasing the risk of work-related musculoskeletal disorders and highlighting the need for immediate ergonomic interventions. Vaidya et al. 2015 [ 20 ] Complains / symptoms related to musculoskeletal disorders (backache, tremors in hands and legs), eye (poor vision), respiratory (cough, breathlessness), dermatological issues (skin irritation, burning sensations in hands and feet), non-specific (headache, sleeplessness), and nutritional deficiencies such as anemia. N = 103 females; aged between 18–40 years Brick kilns ( N = 40) and Construction ( N = 63). Over 22% of them with work experience of greater 5 years These workers were exposed to high CO (> 55.5 ppm) and dust (41.5 ppm), beyond the regulatory limit. Sett and Sahu 2014 [ 19 ] Cardiovascular outcomes including heat stress, peak heart rate, recovery time, and indicators of cardiac strain N = 40 females; Brick carriers ( N = 22) & brick moulders ( N = 18) were aged respectively 21.3 ± 1.3 & 26.5 ± 3.4 years Brick carriers with mean work experience of 4.3 ± 0.6 years and that of brick moulders was 8.1 ± 1.7 years. WBGT ranged 26.9–30.7 °C during summer Workers experienced increased cardiovascular and physical strain during summer, with resting heart rate elevated by approximately 5 beats per minute and walking speed reduced by 0.9–1.3 km/h, indicating reduced work capacity. Brick molders, in particular, demonstrated approximately 5% higher cardiac strain in summer compared to winter. Lakhani 2004 (Maharashtra) [ 16 ] Complains / symptoms related to respiratory (73%), dermatologic (78%), ophthalmic (68%), otology (30) and musculoskeletal (76%) including accident and injuries (56%) N = 1052; 49.4% females; aged between 26–35 years Construction sector for 11–20 years; most work for 10–12 h / day 3/4th’s of women gender specific job overload & skill underutilization. Such, discrimination were associated with their recurrent psychological symptoms Sahu et al. 2010 (West Bengal) [ 17 ] Body part discomfort scale; % prevalence of discomfort ranged 12.2 (headache) to 78.8 (low back ache) in the last 12 months N = 230; 39% females; aged 36.27 ± 7.85 years Construction with mean work experience of 12.73 ± 5.08 years. REBA assessment revealed action level 3 & 4, i.e. suggestive immediate action. Longer employment was significantly associated with higher prevalence of musculoskeletal discomfort Studies reporting women laborers employed at Artisans, weavers and textile industry Sahu et al. 2022 (Chattisgarh) [ 23 ] Musculoskeletal discomfort assessed using Modified Nordic questionnaire and Body Part Discomfort Scale (neck, shoulder, fore arm, upper arm, wrist, elbow, hand, lumber, buttocks, thigh, knee, lower leg, ankle and feet pain) N = 120; 50% females; mean age 34.8 ± 13.1 years Dhokara artisans with mean work experience of 16.53 ± 10.42 years, working on average 6.73 ± 1.12 h per day and 6.03 ± 0.72 days per week. Artisans were exposed to poor ergonomic conditions, with RULA scores > 3, REBA scores > 6, and OWAS scores predominantly > 2, indicating high-risk postures. These exposures were associated with a > 50% prevalence of lower limb MSDs, underscoring the need for immediate ergonomic interventions. The unorganized nature of work further contributed to adverse postures and excessive workload. Hanumegowda et al. 2021 (Andhra Pradesh & Karnataka) [ 22 ] Musculoskeletal discomfort assessed using Body Part Discomfort Scale N = 177; 19.77% females, aged between 24–60 years, Artisans (toy makers), Work-related and lifestyle factors were significantly associated with MSDs, particularly affecting the lower back and shoulders. These symptoms interfered with daily activities in > 25% of workers, with higher prevalence observed among individuals aged > 35 years and those with ~ 10 years of occupational exposure, indicating a cumulative burden of risk. Gangopadhyay et al. 2015 (West Bengal) [ 21 ] Body Part Discomfort scale and musculoskeletal including wrist pain, forearm pain, tingling and numbness N = 200 females; mean age 27.1 ± 2.8 years Artisans (Chikan embroidery), with mean work experience of 12 ± 2.8 years, working on average 6 ± 1.9 h / day The median nerve conduction velocity among embroiderers (55.9 ± 6.7) was significantly lower than that of the control group (65.1 ± 8.6), suggestive of CTS. Studies reporting women laborers engaged in farming and agriculture allied industry Dutta and Bahadur 2019 (West Bengal) [ 25 ] Acetylcholinesterase (AChe) & ButyrylCholinEsterase (BuChe) activity, and risk assessment N = 95; 37% females; mean age 35.37 ± 9.48 years. Tea garden farmers exposed to pesticides Tea garden farmers by virtue of their exposure to pesticide exhibited significantly lower AChE (6.43 ± 1.85 units) and BuChE activity (3.5 ± 1.89 units) compared with controls, who exhibited higher AChE (11.81 ± 3.4 units) and BuChE (4.73 ± 1.84 units) activities. Pal and Dhara 2018 (West Bengal) [ 26 ] Prevalence of regional musculoskeletal pain / discomfort using Nordic questionnaire and Body part discomfort scale (perceived rate of discomfort) N = 166 females; mean age 34.85 ± 10.78 years Farmers; typically worked for 6 h / day with 30 min break Postural analysis of the workers revealed MSD prevalence as high as 91% (hips) suggestive of high risk and recommended immediate interventions Patel et al. 2018 (Arunachal pradesh) [ 15 ] Accidents, injuries, animal bites, Injuries N = 50,614; age and sex of study participants was unavailable in the primary study Farming Reported 127 women had work related injuries / accidents. Estimated that 1 lakh women workers have work related injuries every year in this region Subasinghe et al. 2014 (Andhra Pradesh) [ 10 ] Chronic energy deficiency and anemia N = 1178; 55% of females; aged > 18 years Farming and livestock labors and small scale cottage industries Study observed women engaged in farming and livestock rearing activities had significantly higher odds of chronic energy deficiency [OR 2.2 95% CI 1.39–3.49] and anemia [OR 1.6 95% CI 1–2.54] as compared to the women employed in formal economy Sarkar et al. 2012 (Karnataka) [ 27 ] Workplace injuries accidents and animal bites (~ 85%), and heat stroke (51%) N =- 480; 50% females; aged 16–44 years Farming, exposed to heat stress with ambient temperature crossing 40 °C, pesticides, vector borne diseases and zoonosis. Women farm laborers faced greater risk of undernutrition as compared to male counterparts Chitra et al. 2006 (Tamil Nadu) [ 24 ] Complains / symptoms related to ophthalmic (Burning/stinging/ itching eyes, Blurred vision), ENT (dry/sore throat) dermatologic (excessive sweating, redness, white patches, scaling, burning), musculoskeletal (Numbness/ muscle weakness/ muscle cramps), respiratory (chest pain, Shortness of breath, wheezing cough), gastrointestinal (nausea, vomiting, Stomach pain, cramps, diarrhea) and pesticides exposure (fatigue, dizziness, Runny/ burning nose, Excessive salivation, Tremors), N = 625; 14.7% females; aged above 20 years. Farming, exposed to pesticides Farmers demonstrated low awareness and use of protective measures during pesticide handling, with > 50% reporting no precautions, including handling pesticides with bare hands and not using protective clothing during spraying, indicating a high risk of exposure. Singh et al. 2005 (Haryana) [ 28 ] Workplace injuries and general fatigue N = 52; 13.5% females mean age of 29.9 ± 10.63 Patients visiting the tertiary health care center for injuries due to wheat threshing (process to separate the grains) Workplace injuries were associated with poor lighting (25% attributed to inadequate lighting; 49% occurring after dusk), insufficient training (21% due to lack of skill in machine operation), and suboptimal ergonomics, indicating multiple modifiable risk factors. Studies reporting women laborers employed at Beedi and tobacco processing industry Basu et al. 2018 (West Bengal) [ 29 ] Percentage prevalence of complains related to musculoskeletal disorders (low backache, weakness of hands), ENT, eye (difficulty in vision, headache), respiratory (cough, breathlessness), cardiovascular diseases (palpitation), gastrointestinal (epigastric pain, hyperacidity) and general health (B.P., BMI, pallor), N = 103 females; mean age 38.69 ± 8.53 years Beedi rolling, with mean work experience of 15 ± 1 years, working on average 5 ± 0.14 h / day. Study observed statistically significant association between ocular symptoms and work duration ( p = 0.026) and work hours ( p = 0.007). Rout et al. 2017 (Andhra Pradesh) [ 32 ] Symptoms such as breathing difficulty, increased salivation, increased sweating, poor appetite, sleeplessness, tiredness/weakness, nausea/vomiting, itching, body ache N = 2880; 53.1% females; aged between 15–60 years Beedi rolling for more than 10 years Predominantly women depend on Beedi rolling to augment household income. Hence, women are commonly the victims of this occupational hazard Dhotre et al. 2017 (Maharashtra) [ 31 ] Total Cholesterol (TC), Low Density Lipoprotein (LDL)-cholesterol, High Density Lipoprotein (HDL)-cholesterol and Triglycerides, Atherogenic Index of Plasma (TC/HDL-c, LDL-c/ HDL-), CBC N = 100 females (50 beedi rolling & 50 matched participants not engaged in beedi rolling); aged between 28–60 years Beedi rolling, The biochemical (lipid profile & atherogenic index) and hematological (Hb, RBC, WBC & platelet counts) parameters were significantly poor among beedi workers as compared to non-beedi workers Chattopadhyay et al. 2014(West Bengal) [ 30 ] Respiratory related symptoms (Cough, Breathlessness, Morning cough and chest tightness) and signs (restrictive & obstructive impairment) N = 107; 52.34% females; mean age 35.64 ± 8.29 years Beedi rolling / binding for over 10 years. About 5.45% of them exhibited either obstructive or restrictive respiratory impairment, which was twice as compared to matched controls (2%) Studies reporting women laborers engaged as commercial sex workers Biswas et al. 2020 (Manipur, Mizoram & Nagaland) [ 33 ] HIV prevalence 1327 female sex workers; aged 15 years and above, Commercial sex workers, exposed to STD HIV prevalence in the study group was 11.83%. Medhi et al. 2012 34 (Nagaland) Sexually transmitted disease – HIV (13.4%), Chlamydia (22.3%), Gonorrhea (4.5%) & Syphilis (24.1%) N = 426 females with mean age 25.7 years Sex workers; about 80% of them engaged for > 2 years. The risk of sexually transmitted diseases were higher, in view of lower condom usage by the clients Shahmanesh et al. 2009 (Goa) [ 35 ] % prevalence of HIV (25.7%) and sexually transmitted diseases, i.e. Chlamydia (7.3%), Gonorrhea (8.9%), trichomonas (9.4%). 326 female sex workers with wide age range (15 - >40 years), Commercial sex workers, exposed to sexually transmitted diseases (STD) Quarter of them had HIV, and over one fifth of them had sexually transmitted bacterial infections. Studies reporting women laborers (multiple groups) involved at various individual workplaces Richardson et al. 2017 (Rajasthan) [ 43 ] Mental health as assessed by general health questionnaire − 12 N = 3177 females; mean age 29.39 ± 6.9 years. Daily waged labor at farms, household work and other informal chores, with average 9.5 h / day at work Positive association between work demand and mental stress Nag et al. 2016 (Gujarat) [ 9 ] Complains / symptoms related to musculoskeletal (including injuries), respiratory, ophthalmic, ENT (hearing loss, giddiness, vomiting), dermatologic and headache Powerloom weavers ( N = 224; 53% females; mean age 40 ± 13.4 years), Handloom weavers ( N = 293; 53% females; mean age 39.6 ± 22.1 years), Tobacco processing ( N = 453; 66% females; mean age 37.5 ± 11 years), Fish processing ( N = 52 females; mean age 20.4 ± 2.3 years) and construction ( N = 49, 23% women; mean age 28 ± 11 years) Workers from powerloom weavers (mean work experience of 17.6 ± 12.9 years, working on average 9.8 ± 2.9 h / day, Handloom weavers (mean work experience of 19.6 ± 11.4 years, working on average 8.6 ± 3.1 h / day, Tobacco processing (mean work experience of 19.7 ± 11.4 years, working on average 7.1 ± 2.1 h / day, Fish processing (mean work experience of 3.6 ± 2.8 years, working on average 12 h / day and construction (mean work experience of 9.2 ± 8.1 years, working on average 8 ± 2.3 h / day. The odds of respiratory, eye symptoms and workplace injuries was 80–100% higher among women as compared to men. Further, the prevalence of non-specific health symptoms was higher among women engaged in the construction sector. While the prevalence was similar to that male in other workplaces Venugopal et al. 2015 (Tamil Nadu, Karnataka, Maharashtra) [ 42 ] Heat related Impacts, Heat stress, hypertension and diabetes N = 442; 29% females; mean age 35.8 ± 12.7 years 18 different workplaces broadly within, agriculture, Transport, Hotel, Auto industry, Metal industry, Food industry, housekeeping Leather works, and construction. 82% of workers were exposed to WBGT profiles higher than the threshold during summers and 42% of them during winter. Extended work hours during heat stress (i.e. WBGT higher than TLV recommended by ACGIH) conditions were associated with fatigue/ exhaustion, sickness/ hospitalization and wages lost Studies reporting women laborers employed at others outdoor workplaces Ravindra et al. 2016 (Chandigarh) [ 39 ] Complains / symptoms related to respiratory (cough, breathlessness), dermatological (allergies), musculoskeletal including injuries, cuts and lacerations, and non-specific (vomiting and bodyache) N = 227; Majority of the participants were aged > 30 years. The precise proportion of females wasn’t available. However, the proportion of females was 53.2% among the rag pickers Community solid waste handling; including sweeping, collection of waste, processing / segregation of waste and rag picking. Majority of them work for > 5 h per day Solid waste workers are at higher risk for respiratory disorders (17–17.6%), injuries (10–44.4%) and allergies (35.3–48.9%). Prasad & Subhashini 2019 (Andhra Pradesh) [ 36 ] Custom-designed structured questionnaire for recording Stress (physical – 75.65%, physiological – 6.95%) and pre-existing hypertension (17.39%), diabetes (7.83%) and thyroid (17.39%) N = 115 females; aged 21–60 years with majority around 41–50 years, Street vendors; over 72% with more than 5 years of work experience; over 83% spend more than 5 h at outdoors per day, Study emphasized on the economical vulnerability of the work group. Studies reporting women laborers employed at others indoor workplaces (hairdressing, footwear manufacturing, fish processing, rice mill, salt processing and homebased incense stick) Mishra and Sarkar 2021 (Delhi and Gujarat) [ 8 ] Musculoskeletal disorders N = 384; 22.9% females, mean age 34.23 ± 10.96 years Salon & hairdressing Female hairdressers had higher odds of MSD (OR 2.63 with 95% CI 1.25–2.73) as compared to the male counterparts Salve and Jadhav 2019 (Maharashtra) [ 41 ] Prevalence of regional musculoskeletal pain / discomfort using Nordic questionnaire and Rapid Upper Limb Assessment (RULA), additionally prevalence of disruption of activity due to symptoms N = 51 females; mean age 42.61 ± 14.21 years Footwear Manufacturing with mean work experience of 14.7 ± 8.2 years, working on average 7.7 ± 1.6 h/ day Study reported musculoskeletal symptoms prevalence ranging from 88.5% − 25.7% affecting their activities, attributed to poor work postures as assessed by RULA. Tripathi et al. 2017 (Karnataka) [ 11 ] Complains pertaining to musculoskeletal disorders, respiratory, dermatological and headache N = 171; 42% females; mean age 37.2 ± 10.31 years Fishing, cleaning, sorting and selling, with majority engaged in this activity for over 15 years, working on average greater than 10 h / day Study reported the prevalence of symptoms and discomfort was significantly higher among females (63.9%) as compared to males (48.5%), further age beyond 40 years was significantly associated with higher prevalence of symptoms. Prasanna Kumar et al. 2008 (Arunachal pradesh) [ 37 ] Subjective irritability and headache N = 339; 42% females; mean age 42 (26–56) years Rice mill workers About quarter (25%) of the workers were exposed to noise levels > 85 dBA Rajashekar et al. 2007 (Karnataka) [ 38 ] Description of symptoms related to respiratory (asthma), dermatological (skin infection) and musculoskeletal (body aches and pains) N = 303 females; aged > 17 years Small scale home based manufacturing incense (agarbatti) sticks ( N = 152) and Garment industry ( N = 151). The health challenges may be attributed to the raw materials used for preparing incense sticks, and their working conditions Sachdev et al. 2006 (Rajasthan) [ 40 ] Complains / symptoms related to ophthalmic − 60.7% (dryness, watering, redness, burning), dermatologic – 43.8% (dermatitis, thickening, traumatic ulcer) and 52.1% had musculoskeletal and non-specific (headache, dizziness) complains N = 865; 15.5% female; mean aged 32.17 ± 10.78 years Salt manufacturing industries with mean work experience of for 10.12 ± 7.37 years Study listed various direct and indirect health hazards of the occupation. Recommended frequent periodic health screening programs & PPE usage Open in a new tab Briefly, all citations were pooled and the study authors independently screened the title and abstract for their inclusion (A, GL, NB, ZK) using cloud based application “Rayyan intelligent systematic review” [ 13 ]. Thereafter, the full text of screened articles was reviewed for their final inclusion in the systematic review. Relevant data from the included articles were extracted into the pre-validated data extraction sheet (A, GL & NB). All conflicts during the independent review were resolved by mutual consensus. Study details such as title, authors, publication year, period and site of data collection, participant details such as sample size, age, gender, location, occupation, health and workplace environment are extracted from included studies, wherever available, and recorded using Google Sheets. Duplicates were identified and excluded by verifying study details viz. authors, study site, period of participant recruitment and sample size. In view of heterogeneous reporting and non-availability of data dispersion (e.g., standard deviation, confidence intervals) for the outcome parameters and usage of non-standardized questionnaire tools, the results were synthesized descriptively. The variability in outcome definitions, tools and assessment methods precluded meaningful data pooling, thereby limiting the feasibility of conducting a meta-analysis. The Newcastle Ottawa quality assessment scale was adapted for the current study and employed independently for assessing the risk of bias among the included studies [ 14 ] (description available in supplement material). Briefly, the tool was used for rating the risk of bias in the participant selection, exposure and outcome assessment. Individual studies were rated with star(s) based on description and clarity on the definition of participants, their representativeness and ascertainment of exposure and outcome. Finally, the certainty of evidence for each of the outcome parameters was attempted using the “Grading of Recommendations Assessment, Development, and Evaluation” (GRADE) framework. In the absence of pooled estimate and comparative groups, the GRADE assessment was restricted to available parameters. Results The systematic search retrieved 4366 citations for the review. After removing duplicates and screening titles and abstracts, 107 articles were selected for full-text review, and 33 studies met the inclusion criteria for data extraction. Step wise exclusion of studies along with reasons are described under Fig. 1 . Fig. 1. Open in a new tab PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers and other sources. From : Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/ Details of the included studies The systematic search identified studies conducted across 18 Indian states, with notable geographic representation from West Bengal, Maharashtra, Andhra Pradesh, and Karnataka. Notably, several regions including Kerala, Odisha, Madhya Pradesh, Chhattisgarh, Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Himachal Pradesh, several North-Eastern states, and Punjab were underrepresented, limiting the geographic generalizability. Sample sizes ranged from as few as 30 participants in ergonomic assessments to over 50,000 in large-scale injury surveillance [ 15 ]. Fourteen studies exclusively enrolled women, while the remainder included female participation ranging from 13% to over 50%. Most participants were adults aged 18–60 years, with the mean age typically falling between 30 and 40 years. Details of individual studies is described under Table 1 . The heterogeneity in assessment tools, non-standardized questionnaires, inconsistent case definitions, lack of standardized assessments and incomplete reporting of dispersion measures precluded meaningful quantitative synthesis of pooled estimates. Informal work sectors described in the included studies The included studies reflect the occupational diversity of the female informal workforce in India, encompassing roles such as beedi (local variant of cigar) rolling, brick moulding, construction, agriculture, street vending, garment and toy making, sex work, and waste collection. However, representation of each sector was uneven, with most evidence deriving from tobacco-related home-based work, construction, and brick kilns. The included studies demonstrate that health challenges among informal women workers varied by type of work, reflecting differences in task demands, environmental exposures, and workplace conditions (Table 2 ). Table 2. Major informal occupations and predominant occupational risk factors/exposures Major occupational group Key tasks/activities* Major risk factors / exposures* Dominant exposure type* Construction & brick kilns [ 16 – 20 ] Brick moulding, carrying, masonry, manual loading Heavy manual load, awkward postures, repetitive lifting, dust, carbon monoxide, high heat (WBGT up to 30–31 °C), long work hours, poor lighting, lack of PPE Physical, thermal and airborne pollutants Artisans, weavers & textiles (embroidery, toy making, metal casting) [ 21 – 23 ] Prolonged sitting, fine hand work, repetitive movements Poor ergonomics, sustained static posture, repetitive wrist/hand movements, inadequate workstations Ergonomic or repetitive strain Farming and agriculture allied work [ 10 , 15 , 24 – 28 ] Ploughing, weeding, spraying, harvesting, threshing, livestock care Pesticide exposure, extreme heat (> 40 °C), prolonged standing, manual labor, animal contact, poor lighting/training Chemical, thermal and physical Beedi & tobacco processing [ 29 – 32 ] Rolling, binding, sorting tobacco Tobacco dust/aerosols, indoor air pollution, prolonged seated work, repetitive hand movements Airborne particulates and ergonomic Commercial sex work [ 33 – 35 ] Transactional sex Low condom use, exposure to STIs, limited access to healthcare Biological/infectious risk Urban outdoor work (waste pickers, street vendors) [ 36 , 39 ] Sweeping, waste sorting, vending outdoors Bioaerosols, sharps/cuts, dust, traffic pollution, prolonged outdoor heat exposure Biological, airborne and thermal Indoor small-scale industries (salons, footwear, fish processing, rice mills, salt, incense) [ 8 , 11 , 41 ] Hairdressing, stitching, fish cleaning, milling, salt raking, incense rolling Repetitive upper-limb work, chemical irritants, salt/brine exposure, dust, noise (> 85 dBA in rice mills), long shifts Ergonomic, chemical and noise Open in a new tab Women engaged in construction and brick-related work consistently experienced high burdens of MSDs (12.2–78.8% with low backache the most common), heat stress, and workplace injuries, alongside frequent respiratory (up to 73%), dermatological, and ophthalmic complaints (68–78%) attributable to dust, carbon monoxide, and poor ergonomics [ 16 – 20 ]. Among artisans, weavers, and textile workers, the dominant health issue was chronic MSDs (74.28%). Which was linked to repetitive tasks, prolonged sitting, and awkward postures [ 21 – 23 ]. In farming and agriculture-related work, health outcomes were more heterogeneous, encompassing pesticide-related cholinesterase suppression, heat illness (~ 51%), MSD (70–90%) and workplace injuries (including animal bites) accounting up to 589 per 100,000 workforce [ 10 , 15 , 24 – 28 ]. Women involved tobacco-processing (beedi) industry predominantly reported respiratory, ocular, ear, nose, throat (ENT) symptoms along with MSDs [ 29 – 32 ]. Among commercial sex workers, the primary health burden was a high prevalence of sexually transmitted infections [ 33 – 35 ]. In urban outdoor work (e.g., waste handling and street vending), respiratory symptoms (12.3–17.6%), allergies (35.3–48.9%), and injuries (up to 44.4%) were common, while indoor small-scale industries were characterized mainly by MSDs (52.1–88.5%), dermatological (43.8%) and ophthalmologic problems (60.7%), related to chemical or physical dust exposures [ 8 , 11 , 36 – 41 ]. Overall, while sector-specific patterns were varied, MSDs respiratory symptoms, and dermatological complaints emerged as the cross-cutting outcomes across most informal occupations. Health outcomes A wide range of outcome parameters were reported, with many studies focusing on musculoskeletal disorders (MSDs), often assessed using the Modified Nordic Questionnaire or Body Part Discomfort Scales. Additionally, studies documented symptoms related to respiratory symptoms, dermatological conditions, gastrointestinal symptoms, vision and ENT-related conditions, fatigue, heat stress, and mental health outcomes. Few studies also assessed biomarkers of exposure or disease, including cholinesterase activity, lipid profiles, and hematological parameters. Musculoskeletal Twelve of the included studies reported musculoskeletal discomfort / disorders [ 8 , 9 , 11 , 17 , 20 – 23 , 26 , 29 , 41 ]. Broadly, the participants were engaged in artisanal, beedi (tobacco), construction and brick industries. Notably, the prevalence of musculoskeletal discomfort was highest in the trunk/axial regions—including the neck, upper, middle, and lower back—with reported prevalence often exceeding 80% and reaching above 90% in worker groups engaged in outdoor and physically intensive nature of job. Discomfort in upper limbs (shoulder, arm, wrist, elbow) ranged from approximately 70–90% while lower limb discomfort (thigh, calf, ankle, feet) ranged from 60 to 90%. Additionally, two studies observed 2.63 times higher odds (OR: 2.63; 95% CI: 1.25–2.73) of musculoskeletal disorders among women compared to their male counterparts in similar occupational settings [ 8 , 11 ]. Cardiorespiratory Twelve of the included primary studies reported cardiorespiratory associated symptoms [ 9 , 11 , 16 , 19 , 20 , 24 , 29 , 30 , 38 – 40 , 42 ]. Prevalence of cough, breathlessness, and shortness of breath reached as high as 70–75%. These studies reported of involving women engaged in occupations such as beedi rolling, fish processing, agriculture, heavy machinery operation, waste handling, and construction. Notably, two studies observed 80–100% higher odds of respiratory symptoms among women compared to their male counterparts, highlighting a significant gender disparity in occupational health vulnerability [ 9 , 11 ]. ENT, Ophthalmic, dermatology, gastrointestinal and neuropsychology Seven studies reported ENT and Ophthalmic symptoms / complains with prevalence ranging 45–90% 9,16,20,21,24,29,40 . Frequently reported symptoms included blurred vision, tearing, photophobia, headache, hearing impairment, and dizziness These symptoms were observed among workers in beedi production, fish processing, farming, artisanal work, brick-making, and construction. Dermatologic symptoms / complaints were reported in eight studies [ 9 , 11 , 16 , 20 , 24 , 38 – 40 ], with prevalence ranging between 32 and 78%. Dermatological complains included itching, redness, skin scaling, and rashes. Studies highlighted a higher prevalence of dermatological and ophthalmic symptoms in construction and fish processing sectors, reiterating gender-based vulnerability in certain high-risk occupational environments [ 9 , 11 ]. In contrast, gastrointestinal symptoms were by Basu et al. (2018) and Chitra et al. (2006) [ 24 , 29 ]. Likewise, neuropsychological complaints—including fatigue, tremors, and stress-related symptoms—were reported in three studies [ 16 , 20 , 43 ]. Heat stress, workplace accidents and injuries Four studies documented occupational heat stress at farming, construction, brick manufacturing, and large-scale indoor industries, reporting Wet Bulb Globe Temperature (WBGT) values exceeding 30 °C 19,27,42 . Heat-related symptoms—tachycardia, sweating, fatigue—were common, with heat-related illness prevalence reaching as high as 51% in them. Seven studies reported occupational injuries across farming, salt production, construction, waste management, and heavy machinery [ 9 , 15 , 16 , 27 , 28 , 39 , 40 ]. Injury prevalence ranged from 55 to 85%. Notably, Nag et al. (2016) reported 100% higher odds (OR 2 with 95% CI of 1.5–2.7) of workplace injuries among female workers, particularly those in the construction sector, highlighting a critical gender-specific occupational vulnerability [ 9 ]. Workplace assessments Only a subset of studies systematically assessed workplace conditions [ 17 , 19 – 21 , 23 , 26 , 37 , 38 , 41 , 42 ]. Reported hazards included poor ergonomics, excessive work hours, dust, chemical exposures, high heat, noise, and inadequate lighting. Most studies documented the absence of personal protective equipment. Evidence on workplace conditions, although limited, consistently supports the mechanistic plausibility of the health outcomes reported. Risk of bias A detailed evaluation of the risk of bias across included studies—specifically regarding participant definition, selection, exposure assessment, and outcome reporting—is presented in Table 3 . Only one study adequately defined its sampling frame; the remaining studies showed substantial ambiguity in participant eligibility criteria, a limitation strongly tied to the absence of formal registries for informal-sector occupations [ 29 ]. This is primarily attributed to the absence of formal registries for most categories of informal women workers, limiting the ability to apply uniform inclusion criteria across studies. Although certain subgroups—such as beedi workers, construction workers, farmers, and solid waste handlers—are included in occupational registries, none of the included studies reported using such sources to define or verify participant eligibility. Table 3. Newcastle Ottawa scale for assessing the risk of bias in the included studies Citation Participant definition Participant representativeness Exposure assessment Non- Response Total^ Sett et al. 2022 [ 18 ] - - - - - Sahu et al. 2022 [ 23 ] - * * - 2 Hanumegowda et al. 2021 [ 22 ] - * - * 2 Mishra and Sarkar 2021 [ 8 ] - - - - - Biswas et al. 2020 [ 33 ] - * - - 1 Prasad & Subhashini 2019 [ 36 ] - - - - - Salve and Jadhav 2019 [ 41 ] - - * - 1 Dutta and Bahadur 2019 [ 25 ] - - - * 1 Basu et al. 2018 [ 29 ] * * - - 2 Pal and Dhara 2018 [ 26 ] - * * * 3 Patel et al. 2018 [ 15 ] - * - - 1 Rout et al. 2017 [ 32 ] - * - - 1 Tripathi et al. 2017 [ 11 ] - - - - - Dhotre et al. 2017 [ 31 ] - - - - - Richardson et al. 2017) [ 43 ] - * - * 2 Nag et al. 2016 [ 9 ] - - - - - Ravindra et al. 2016 [ 39 ] - - - - - Venugopal et al. 2015 [ 42 ] - - * - 1 Vaidya et al. 2015 [ 20 ] - * * * 3 Gangopadhyay et al. 2015 [ 21 ] - * * - 2 Sett and Sahu 2014 [ 19 ] - - * - 1 Subasinghe et al. 2014 [ 10 ] - * - - 1 Sarkar et al. 2012 [ 27 ] - - - - - Medhi et al. 2012 [ 34 ] - - - - - Sahu et al. 2010 [ 17 ] - - * - 1 Shahmanesh et al. 2009 [ 35 ] - - - - - Chattopadhyay et al. 2014 [ 30 ] - * - * 2 Prasanna Kumar et al. 2008 [ 37 ] - - * - 1 Rajashekar et al. 2007 [ 38 ] - - * - 1 Sachdev et al. 2006 [ 40 ] - - - - - Chitra et al. 2006 [ 24 ] - - - - - Singh et al. 2005 [ 28 ] - - - - - Lakhani 2004 [ 16 ] - * - - 1 Percent of studies carrying high risk of bias 97% 61% 70% 82% Open in a new tab ^ Total number of stars obtained by each study Furthermore, most studies relied on convenience sampling, contributing to high risk of bias in representativeness. Only a few studies employed robust sampling strategies. Similarly, while a few studies conducted workplace hazard assessments, most did not systematically measure occupational exposures, even where relevant hazards were described narratively. Finally, non-response rates or recruitment losses were seldom reported, further introducing potential bias in outcome interpretation. The overall quality of evidence is therefore limited by inconsistent methodological rigor across studies, particularly in domains critical to the internal validity of occupational health research. In summary, ~ over 60% of the included studies carried risk of bias related to participant definition, participant representativeness, insufficient exposure assessment, and incomplete reporting of non-response or recruitment rates. Certainty of evidence The GRADE evaluation was restricted to available parameters. The overall certainty of evidence was judged to be low to very low. This reflects substantial risks of bias and methodological limitations. A comprehensive evidence profile along with the summary of findings is provided in Supplementary Table 3 . The low certainty primarily reflects high risk of bias, methodological limitations, and potential publication bias. Furthermore, the reliability of the evidence was weakened by non-availability of pooled estimate, wider % prevalence reported by individual studies, indicating variability and imprecision across the studies. Taken together, these limitations highlight the pressing need for more rigorous, high-quality research to better substantiate the observations. Discussion Current systematic review synthesizes findings across 33 primary studies on occupational health outcomes among Indian women in informal labor. The studies reflected significant occupational diversity including construction, brick moulding, beedi rolling, farming, vending, and waste collection. Across occupations, a consistent pattern emerged: high prevalence of MSDs, respiratory symptoms, dermatological and ophthalmic complaints, heat stress, and workplace injuries, underscoring a substantial and under-addressed occupational health burden. However, given the methodological limitations across the studies, these findings should be interpreted cautiously. Overall pattern of health outcomes Musculoskeletal disorders (MSDs) consistently emerged as the most frequently reported health problem, particularly among workers performing repetitive, forceful, or posture-intensive tasks. Across occupations such as brick molding, beedi rolling, and construction, MSD prevalence frequently exceeded 80%, aligning with global evidence that informal workers, particularly women, experience disproportionate ergonomic strain due to task allocation and inadequate mechanization [ 44 ]. Two studies further quantified the risk, highlighting that female workers had higher odds of MSDs compared to males [ 8 , 11 ]. However, variability in symptom definitions, recall periods, and measurement instruments limits cross-study comparability. Cardiorespiratory symptoms such as cough, breathlessness, and fatigue were reported in twelve studies, with a maximum prevalence of 73%. Notably, studies observed significantly higher odds of respiratory complains among female workers, especially in occupations with dust or chemical exposure, such as construction, fish processing, and solid waste handling [ 9 , 11 ]. Few studies indicated heightened respiratory vulnerability among women compared with male workers in similar roles. ENT, ophthalmic, dermatological gastrointestinal and neuropsychiatric symptoms were reported sparingly in these studies. Importantly, the co-occurrence of multiple health symptoms was common, reflecting the cumulative physiological toll of ergonomic, chemical, psychosocial, and environmental exposures commonly present at informal work environments. Heat stress and injuries Few studies documented the burden of occupational heat stress, with WBGT values exceeding 30 °C, contributing to physiological strain and reduced work productivity. These findings are particularly relevant given the increasing frequency of extreme heat events in India. Additionally, literature suggest of higher prevalence of workplace injuries, particularly among female construction workers, where a single study reported higher odds of injury among women compared to men. These findings hint the compounded vulnerability of informal female workers who are often excluded from occupational safety frameworks. Workplace conditions Very few studies systematically assessed workplace environments. Where available, reports linked adverse health outcomes to poor ergonomics, environmental exposures (dust, heat, and chemicals), and the absence of protective infrastructure. These studies call for urgent implementation of preventive interventions—ranging from workplace redesign and safety equipment provision to education and access to health services. Key observations include the absence of a registry to document the presence of a particular informal economy, so as to draft occupational safety and health guidelines around it. Although certain subgroups—such as beedi workers, construction workers, farmers, and solid waste handlers—are included in occupational registries, none of the included studies reported using such sources to define or verify participant eligibility. Current observations on Indian women in informal labor have relevance globally, particularly among other low- and middle-income countries (LMICs) with large informal economies. The consistent associations between physically demanding work, poor ergonomics, heat exposure, and high prevalence of musculoskeletal disorders, respiratory symptoms, and workplace injuries are likely applicable to informal workers in regions where similar working conditions prevail. However, the direct generalizability is limited due to the unique mix of informal occupations (e.g., beedi rolling, brick kilns, salt manufacturing), regional climatic variability, labor practices, and social protection systems. Therefore, patterns observed in this review provide broadly relevant insights for informal worker health globally necessitating remedial public health actions. The results of the review need to be interpreted under the limitations carried by the individual studies. First, the heterogeneity in study designs, outcomes assessed, and reporting practices precluded meta-analysis and limited comparative interpretation. Most studies relied on cross-sectional designs and convenience sampling, with high risk of bias in participant selection and exposure assessment. The high risk of bias could overall affect the magnitude and reliability of the health estimates reported in primary studies. The selection bias and cross sectional design could potentially overestimate the symptomatic cases. Conversely, under-recruitment of highly vulnerable or transient workers, may have resulted in underestimation of severe outcomes, including heat illness and occupational injuries. Second, the lack of registries to define the population and standardized tools for measuring outcomes and underreporting of response rates further compromises generalizability. Further, the absence of data from several Indian states restricts geographic representativeness. The informal nature of work among women—often invisible in national registries presents challenges in systematically capturing and addressing occupational health risks in this group. Finally, the certainty of available evidence is low to very low considering the high risk of bias, varied percentage prevalence and the tools used to report the outcome parameters. Despite the limitations, the review offers critical insights into the health vulnerabilities of female informal workers in India and highlights the urgent need for inclusive occupational health policies and targeted research (Fig. 2 ). These findings provide strong evidence for developing policy responses that prioritize the health and well-being of women in informal employment, particularly in light of compounding challenges such as climate change and economic precarity. Importantly, this review underscores the necessity of integrating the occupational health needs of informal women workers into India’s primary health care system to ensure accessible, equitable, and continuous care for this underserved and disproportionately affected population. Fig. 2. Open in a new tab Conceptual framework linking informal employment, gendered work conditions, and occupational health outcomes among women in the informal sector Conclusion This systematic review highlights the significant occupational health risks among Indian women in the informal sector. The sectors included a wide range of occupations—including construction, brickwork, beedi rolling, farming, street vending, artisanal production, and waste handling. The findings reveal a high prevalence of musculoskeletal disorders, cardiorespiratory symptoms, dermatological and ophthalmic conditions, heat stress, and workplace injuries. These health outcomes are compounded by unsafe working environments, long hours, inadequate protective measures, and the lack of institutional support. However, findings must be interpreted cautiously due to pervasive methodological limitations, including high risk of bias, heterogeneous methods, low certainty of evidence and lack of standardized outcome measurement. Given the growing female participation in India’s informal economy and the increasing impacts of climate and occupational stressors, this evidence calls for urgent and inclusive action. There is a pressing need to strengthen research frameworks, improve workplace assessments, create registries to map their health and challenges and integrate informal women workers into either national occupational health and social protection programs or primary health care programs. Public health policies must prioritize gender-responsive strategies that address both environmental and occupational determinants of health for this underserved population. Supplementary Information Below is the link to the electronic supplementary material. Supplementary Material 1 (24.6KB, docx) Acknowledgements None. Author contributions Ankit Sheth: Conception, Data collection, Execute, Review and approval of final draft Ankit Viramgami:Conception, Data collection, Execute, Review and approval of final draft Mahendra Thakor: Conception, Execute, Review and approval of final draft Rakesh Balachandar: Conception, Execution, Data cleaning, Drafted first version & final version Zulkeha Khalil: Screening title-abstract, Review and approval of final draft Anushree Mohanan: Screening title-abstract and full text, data extraction, approval of final draft Nisha Bhati: Screening title-abstract and full text, data extraction, approval of final draft Garima Lohra: Screening title-abstract and full text, data extraction, approval of final draft. Funding The authors being full time research faculties of the non-profit occupational health research institutes, conducted and reported this study within their independent capacity. AS (Author) received a small grant from WIEGO (Women in Informal Employment: Globalizing and Organizing, UK) to generate evidence on health challenges faced by informal women workers in India, and part of this grant is planned to offset the article processing charges. WIEGO had no role in the conceptualization, study design, search strategy, data extraction, analysis, interpretation, or manuscript preparation for this systematic review. Data availability The data that support the findings of this study are available on request from the corresponding author. The data is systematically collected from various literature sources. Code availability Not applicable. Declarations Ethical approval Not applicable, the study was conceived from secondary data available from various literature sources. Informed consent Not applicable, the study was conceived from secondary data available from various literature sources. Research involving human participants Not applicable, the study was conceived from secondary data available from various literature sources. Consent for publication The authors have approved and obtained necessary permissions from respective institutions towards publishing this document. Consent to participate Not applicable, the study was conceived from secondary data available from various literature sources. Competing interests The authors declare no competing interests. Footnotes Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Mahendra Thakor and Rakesh Balachandar contributed equally and deemed as corresponding authors. Ankit Sheth and Ankit Viramgami contributed equally and deemed as lead authors. Contributor Information Mahendra Thakor, Email: [email protected]. Rakesh Balachandar, Email: [email protected], Email: [email protected]. References 1. ILO. Informal Economy. 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Supplementary Materials Supplementary Material 1 (24.6KB, docx) Data Availability Statement The data that support the findings of this study are available on request from the corresponding author. The data is systematically collected from various literature sources. Not applicable. 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