The COVID-19 pandemic has significantly impacted the livelihoods, health, pay disparity and well-being of women workers in the unorganised sector, particularly in fields such as agriculture, fisheries and handloom. These women are especially vulnerable to exploitation, gender inequality and human rights violations, as they lack institutional support welfare measures and are poorly organised. The pandemic has only worsened their situation. A field survey was conducted using structured questionnaires with 769 women workers from five districts in Tamil Nadu and Kerala states of India to understand the magnitude and different dimensions of their experiences related to pay disparity and health during pandemic times. The study was conducted after both waves of COVID-19. The study focuses on their livelihoods, health, pay disparity, well-being, working conditions, household dynamics, health scenarios and authorities’ support during the pandemic. The data were supplemented with qualitative inputs with in-depth interviews with women workers across these districts. The results indicate that pay disparity and livelihoods were significant issues faced by women workers during the pandemic, along with financial difficulties, health issues and increased workloads. 84.65 per cent of women workers are aware of wage discrimination, while 48 per cent reported pay disparity at their workplace, 78 per cent were unpaid for overtime, and 88 per cent worked without training or safety measures. However, it was found that 99.7 per cent of women workers had been vaccinated. Based on the study results, there is an urgent need for national and state-level policies and support specifically aimed at women workers in the unorganised sector in India. Failure to address these issues will result in ongoing problems related to pay inequality, poverty, health risks and social marginalisation.