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The hidden debt of care

healthcare
Albertina is 15 and the oldest of three sisters. When her mother died she took over responsibility for raising her younger siblings.
Now she wants to become a nurse. CHRIS DE BODE/PANOS

It’s an essential ingredient for life. It keeps us fed, nurtured and healthy and enables social systems to function. It’s skilled, emotional, exhausting, rewarding work. Work that props up our lives, households, communities and economies. It’s ‘women’s work’, work for poor people, work for migrants. Without it we would have nothing.

Yet care is massively undervalued and ignored across the world, its contribution to economies invisibilized. While growth and profit remain the priority, care of people and the planet is relegated to the sidelines.

This continues, despite caregivers carrying the burden of Covid-19. Researcher Christine Berry summed this up when writing about the British government’s approach to childcare: ‘Privately, governments and employers both know that unpaid childcare is essential and demanding work, and that the scale of it has just exploded. Publicly, they must pretend this work does not exist, since they have no appetite to properly support it.’

Care work is too often treated as a private matter. It is ‘unproductive’ work, carried out ‘beyond’ the market and naturalized to certain groups of people to be performed out of love, virtue or duty. It’s not the business of the economy. While care work might be treated as a ‘gift’, and can be full of joy, its capacity has limits. Those carrying it out – paid or unpaid – are too often treated as expendable. Yet caregivers are the ghostwriters of economic success: their work subsidizes states, the private sector and households and the unpaid bill has been accumulating for many years.

A mammoth 12.5 billion hours of unpaid care work is carried out by women and girls each day – equivalent to 1.5 billion people working eight hours a day, without pay. It is estimated that women’s unpaid care work adds $10.8 trillion of value to the economy, while most of the financial benefit is felt by those who are already the wealthiest.

Still, public spending on care is treated as a cost rather than an investment. Paid care workers have seen their toil devalued, neglected and diminished and are paid significantly less than those in other sectors with similar levels of skill and equivalent qualifications. There are many places where caregivers would not be able to afford the care for themselves that they carry out for others.

Caregivers are the ghostwriters of economic success: their work subsidizes states, the private sector and households

Yet this work is not considered ‘real’ work. In its recently published Care Manifesto, the Care Collective writes: ‘It is perhaps reassuring for many to pretend that those who perform the jobs that most disgust us, perhaps literally cleaning up our own or another’s excrement, do so because “that is all they are good for”. This is another reason why caring has been traditionally relegated to the domain of women, servants or others deemed inferior, while simultaneously serving to reinforce the notion of that inferiority.’

The responsibility for getting through the pandemic has been externalized from the state to households and communities. The way to beat this virus is to stay at home and the consequences of that are ours to deal with. But realistically, the work of caring for each other’s health and wellbeing was never situated exclusively within the confines of the private household and nuclear family, particularly for the most marginalized. For example, lesbian, gay and feminist collectives around the world took matters into their own hands at the height of the HIV and AIDS epidemic, caring for each other and responding to practical needs.

Covid-19 has also shown that our interdependence is inescapable. As author D Hunter notes, reflecting on how neighbourhoods have organized to support each other: ‘It speaks to the fact that despite a decade or twenty of propaganda by the owning and ruling class, a large number of us maintain a level of recognition that we aren’t just individuals, that our entanglements with one another matter, and that we are both reliant on each other and responsible for one another.’

Nurses protest in Turin, Italy about the lack of safety at work during the Covid-19
pandemic. PACIFIC PRESS/ALAMY

The world’s ghostwriters

Behind every ‘great man’ (and plenty of ‘great’ people of all genders) there is an undervalued workforce of largely poorer women whose work supports the economies that make them richer and more powerful. Extreme poverty rates are higher for women than men across the world, rising to as much as 22 per cent when women are at reproductive age.

Women spend significantly more time doing unpaid care work. As Susan Himmelweit of the Women’s Budget Group has explained: ‘Caring for others is something which structures women’s lives… women end up in worse paid jobs with worse pensions, as a result of the way that they structure their lives around caring in a way that men neither do nor are expected to do.’

Of course, poorer women have always done paid work and an increasing number of women have now joined them, on top of taking the lion’s share of household care and responsibility. Even for people whose ideals are of equality, breaking free of gender roles can be tough. Studies around the world have shown that even when the responsibility for paid labour is redistributed between genders, roles continue to be reinforced when it comes to the amount and type of care and domestic work that men take on.

Across the world, women and girls living in poverty, unable to outsource their domestic labour or make use of technology that might alleviate their burden, spend significantly more time on unpaid care work than those from wealthier families. Many are also providing similar services to others as carers, cleaners, nannies or other domestic workers, particularly in countries where there is a high level of inequality.

This work, 80 per cent of which is done by women, is precarious and sometimes deeply unsafe. Just 10 per cent of domestic workers are covered by labour laws to the same extent as other workers; only half have equal minimum-wage protection and a majority are working in places where there are no legal limits on their work hours. Sometimes trafficked, or with precarious immigration status, domestic workers are vulnerable to abuse.

Covid-19 saw many plunged into poverty as they were suddenly let go by employers. Those that were kept on faced risk of infection, particularly when not provided with adequate protective equipment and safety measures. In March, 63-year-old housekeeper Cleonice Gonçalves was the first person to die from the virus in Rio de Janeiro, Brazil. Her employer had recently returned from a holiday in Italy.

Crisis by design?

Heavy care workloads limit people’s ability to participate in education or social, economic and political life, or even to have a rest. The work can start young. Girls from the poorest households spend an average of seven hours a week more on care work than girls in less-poor households and they are subsequently spending less time in school – five hours fewer each week than those from better-off households.

As public services and social protection systems around the world are gutted, the capacity for families and communities to fulfil their care responsibilities and needs is simultaneously diminished, stretched to breaking point.

Covid-19 has escalated the care workloads for women and men across the world. A report published by Oxfam in June found that women living in poverty, single mothers, essential workers and ethnic minorities were being ‘pushed furthest to the margins’. People of all genders in the US, Britain, Canada, the Philippines and Kenya were found to be struggling physically and emotionally thanks to the impacts of the pandemic. Women are particularly feeling the strain: almost half said they were feeling more anxious, depressed, overworked, isolated or physically ill because of increased unpaid care and domestic duties.

Behind every ‘great man’ (and plenty of ‘great’ people of all genders) there is an undervalued workforce of largely poorer women

The crisis of care is not an unfortunate set of circumstances that just ‘happened’; austerity, classism, privatization and the extraction of wealth from the Global South all play a part. There’s also growing demand for care, fuelled by climate change and changing demographics. In high-income countries around 20 per cent of the population is aged 60 or above, predicted to rise to 30 per cent by 2040. An estimated 2.3 billion people will be in need of care by 2030.

Some are turning to technology to try to fill the void. In Rwanda, human-sized robots have been used in clinics to screen people for Covid-19 and deliver medicine and other supplies. Some of Britain’s care homes have plans to deploy robots that make human-like gestures, hold conversations and offer practical help, after a trial found that they helped reduce loneliness. The Guardian newspaper reported that the trial was intended ‘to help fill lonely periods when, because of a stretched social care system, staff do not have time to keep residents company.’

Is this a crisis by design? ‘It’s always difficult to establish what the difference is between design and default, but it’s definitely by neglect,’ says Jerome De Henau, Senior Lecturer in Economics at the Open University.

‘There is a care crisis in most countries – even in Scandinavian countries that are known to be much more advanced,’ he adds. Privatization has not only reduced access to affordable care but deepened inequality, particularly as two-thirds of health-sector jobs globally are held by women. Only half of countries have enough health workers to deliver quality care services and the International Labour Organization estimates that this coverage will get worse, along with working conditions of care workers, unless investment in paid care services increases by six per cent of global GDP.

As a report published by the Women’s Budget Group in September highlighted, many businesses are becoming ‘rentiers’, focused on short-term gains, instead of long-term investment, including in their workers. Assets like care homes can be used to ‘extract rent, interest payments, fees, dividends, and capital gains, while seemingly making only small profits’. In the UK, an estimated £1.5 billion ($1.9 billion) leaks out of this industry each year in this way, described as ‘transfers to the world’s richest through the servicing of vulnerable people’s basic needs, financed by taxes and lifetimes’ savings.’

Perfect company? The popularity of
robot caregivers is growing.
BSIP SA/ALAMY

May all be mothers

The way our economies entrench the binary between autonomous self-sacrificing caregiver and dependent care recipient is not a true reflection of real life, or of most people’s capacities and contributions to society. It also fails to recognize the level to which many, particularly men, also benefit from work, largely carried out by women, in order to maintain their standard of living. We all deserve more.

‘People like to disavow their own dependency and their own needs,’ says Lynne Segal, Anniversary Professor of Psychology and Gender Studies at Birkbeck College and co-author of the Care Manifesto. ‘In fact, those whose needs are being most met and who are most dependent on others are the very rich, because they are being serviced at every level from cradle to grave. What’s more, those who are doing the servicing jobs are often looked down on because people don’t want to admit their own dependency.’

A more caring society, as described by Nancy Fraser, Professor of Philosophy and Politics at the New School for Social Research, would be one that ‘assumes every adult is a person with care responsibilities, community engagements, and social commitments – as much as their physical capacity allows’. It would value the essential work of caring for people and the planet, as well as the wellbeing and safety of those they care for, regardless of their economic ‘productivity’.

The two things that capitalism relies on – the reproduction of the workforce and the extraction of the world’s natural resources – are exhaustible. As Fraser has pointed out, ‘neither nature nor social reproductive capacities are infinite; both of them can be stretched to the breaking point.’

There needs to be a radical shift at every level of economic policy to strengthen gender equality and redistribute resources and power.

For De Henau, better training, pay and conditions for paid caregivers is key, alongside the redistribution of care between genders and different age groups. In a caring economy people would be able to spend less time doing paid work and more time caring for each other. ‘It’s one where the success of an economy is measured in terms of the quality of life and the way that people are looked after, rather than income or economic growth,’ De Henau explains. ‘It’s the idea that kindness and quality of life need to be prime measures of success.’

Decent and affordable housing, public transport and education need to be part of the package. ‘Care isn’t just hands-on care; it absolutely depends on the infrastructures that enable the care to happen that we are all dependent on: transport, schools, hospitals and so on. You can’t really have adequate interpersonal care for each other – unless you’re very, very rich – unless all the supports are in place.’

Too many people have little to no choice about how their own care needs, or those of people close to them, are met. An economy that has care at its centre would need to start with the most marginalized and oppressed and not privilege the heteronormative nuclear family more than other households. Expanding state services alone is not going to be enough; even people in professional ‘care’ roles can be just another tool in an oppressive system. It needs to be part of wider action, including at the grassroots, in order to address the structural causes of inequality.

The care challenge is one for all of us. So, where do we start? The words of activist Jasmeen Patheja stand out for me:

‘May all persons be mothers

Regardless of gender, sexuality or life choices

May all build capacity to care and nurture

May we be mothers to the earth, trees, to strangers, to ourselves, our friendships.

To those like us and unlike us.

Known and unknown.’

The answer couldn’t be closer to home.

Action and INFO
Global Women’s Strike: International network campaigning for a living wage for mothers and other carers.
Women’s Budget Group: UK-based network working to build knowledge on feminist economics.
The Leap: Campaigning for systemic change in the face of climate change, racism and inequality.
National Nurses United: Campaigning union of registered nurses with more than 150,000 members across the US.
Global Nurses United: Federation of nurse and healthcare worker unions in 29 nations.
United Voices of the World: UK-based trade union supporting precarious, low-paid and predominantly migrant workers.
Women in Informal Employment: Globalizing and Organizing (WIEGO): Global network focused on empowering the working poor, especially women, in the informal economy to secure their livelihoods.
Pilipino Workers Center: Organizes the low-wage Filipino community in Southern California, and elsewhere, to demand better living and working conditions.

New Internationalist issue 528 magazine cover This article is from the November-December 2020 issue of New Internationalist.
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