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Paper short abstract

Drawing on longitudinal qualitative data from India, this paper examines how families facing precarity negotiate health and nutrition amid unstable livelihoods. Using Strong Structuration Theory, it shows how limited resources and moral reasoning shape trade-offs that reproduce vulnerability.

Paper long abstract

This paper examines how families living in conditions of precarity and socio-economic uncertainty negotiate health and nutrition within limited resources and structural constraint. We draw from longitudinal qualitative data conducted in Uttar Pradesh and Goa over three phases between December 2022 and May 2025. Drawing on repeated interviews with multiple members across 40 households, the study interrogates how health and wellbeing are continuously negotiated within intersecting regimes of food insecurity, labour precarity, and care. We show that while food insecurity exacerbated ill-health, health concerns were often deprioritised in favour of securing food and livelihoods. Adversities in one domain often compounded vulnerabilities in the other, revealing their interdependence within constrained socio-economic contexts. Health conditions—both sudden and chronic—were negotiated through difficult trade-offs. Drawing on Strong Structuration Theory (Stones, 2005), the study conceptualises family responses to health needs as situated within a dynamic interplay between external and internal structures. External conditions—such as unstable work, dependence on the informal economy, low wages, food inflation, marital transitions, seasonality and barriers to healthcare—constrain what forms of choices are materially possible. At the same time, internal structures—families’ interpretations, moral reasoning, and dispositions—mediate how these constraints are understood and acted upon. This leads to actions that have short and long-term outcomes. Together, these interactions produce a recursive loop in which health-related choices both emerge from and further reinforce/strain the very structural conditions that shape them.