Characterising access to healthcare and the health status of women domestic workers in Peru: a respondent-driven sampling study

Introduction: Domestic workers (DWs) worldwide face precarious and informal working conditions, including unstable employment, extended hours and insufficient labour protections, impacting their health. This study examines the health and healthcare access of women DWs in Peru, focusing on differences related to formal and informal employment. Methods: This participatory action research surveyed women DWs in Lima, La Libertad and Piura, Peru, from September 2023 to March 2024 using respondent-driven sampling (RDS). We gathered sociodemographic, healthcare access and health status data and reported counts and percentages with RDS-II estimators (95% CI). We compared health status and healthcare access by formal and informal employment using bootstrap RDS methods. Results: The study analysed data from 456 DWs. Most were between 19 and 45 years old (60.0%, 95% CI 50.1% to 70.0%), resided in Lima (69.8%, 95% CI 57.5% to 82.0%) and self-identified as Mestizo (54.8%, 95% CI 45.0% to 64.7%). Most respondents were precariously employed as informal DWs (90.5%, 95% CI 87.5% to 93.6%). A higher percentage of informal workers reported difficulty obtaining workplace permission for healthcare visits (32.2%, 95% CI 21.3% to 43.1% vs 21.2%, 95% CI 4.3% to 28.2%; p=0.187) and spent over 100 PEN (US$28) out of pocket on medical visits in the past year (21.2%, 95% CI 14.1% to 28.4% versus 10.5%, 95% CI 0.0% to 32.5%; p=0.249). Despite access to public health insurance, a higher percentage of informal workers visited private healthcare facilities (14.4%, 95% CI 8.3% to 20.5%) than formal workers (4.7%, 95% CI 1.5% to 7.8%) (p=0.084). A higher percentage of informal workers reported a diagnosis of depression (9.7%, 95% CI 5.1% to 14.4% vs 1.6%, 95% CI 0.0% to 4.4%; p=0.052) and anxiety (12.3%, 95% CI 6.1% to 18.5% vs 3.5%, 95% CI 0.0% to 9.1%; p=0.322). Obesity (43.0%) and depressive symptoms (41.4%) were prevalent across the DW population, regardless of employment status. Conclusions: Informal employment among women DWs in Peru may be linked to greater health challenges and barriers to care, despite public health insurance coverage. Addressing these inequities requires stronger labour protections.