In 2018, the Care Work and the Economy (CWE-GAM) Project’s Understanding and Measuring Care (UMC) Working Group set out to gain a deeper understanding of the nature of care work and the well-being of caregivers in the context of South Korea. The group used a unique qualitative method combining in-depth interview and oral historical approach to investigate care as a continuously recurring activity throughout one’s life course and a necessary part of human existence. As part of the project’s qualitative field work and with the help of Gallup Korea, the UMC Working Group conducted 96 interviews between May – December 2018, bringing together 96 comprehensive narratives of care work in the South Korea context.
The CWE-GAM Project’s qualitative field work in South Korea conducted 96 in-depth interviews of paid and unpaid caregivers to provide useful care narratives based on the Korean context to inform macro-modelling. The qualitative research team interviewed 25 family caregivers of the elderly, 20 family caregivers of children, 20 paid care workers for elderly, and 31 paid care workers for children. The interviews of family caregivers focused on the decision-making process and evaluation of care arrangements for the elderly and children. In-depth interviews were combined with an oral historical approach to gain a deeper understanding of care work, emphasizing active listening to gain a more holistic understanding of the narrator’s life story on care. Interviewees were also asked about their experiences with caregiving. The interviews of paid caregivers focused on dual care burdens in terms of paid care work in addition to unpaid care work in the home. To learn more about the CWE-GAM Project’s qualitative field work in South Korea, read the Qualitative Methodology Report by the Care Work and the Economy UMC Working Group.
The following is one of the 96 stories. The respondent, Sung, lives with and cares for her mother, who was diagnosed with dementia about ten years ago.
Date: May 29, 2018
Interviewer: Hyuna Moon
Interviewee: Sung (pseudonym)
Sung, born in 1968, is 50 years old. She has a son and a daughter. They are both over 19 years old. One is attending college, and the other is studying for the college entrance exam. She is currently living with her children and her mother. As for siblings, she has one younger brother who is married. About ten years ago, Sung’s mother was diagnosed with dementia. Sung’s dad cared for her mom in the beginning, but her dad was also later diagnosed with Parkinson’s disease. Sung thus decided to move into her parents’ house to live together. It was by the time her first child entered middle school and her second child reached the upper grades in primary school. Her dad died four years ago, and she now looks after her mother. Her mother became a grade 3 beneficiary of the Long-Term Care Insurance (LTC) in her initial stage.
When Sung found out that her parents were ill, she didn’t think about passing the care duty to her brother. The siblings first considered making living arrangements so that each of them would live with one of their parents, for instance, Sung living with their dad and her brother living their mom, but their parents did not want this; they wanted to live together, not separately. Sung also felt that she ought to take care of her mother because of her ten years of experience living abroad, away from her parents. Sung has never thought that taking care of her frail parents is a son’s or a daughter-in-law’s duty. She didn’t think it was her brother’s duty to live with their parents and provide support. Nonetheless, her brother has taken up the role of financially supporting their parents. According to Sung, this was not negotiated but naturally happened. Sung and her brother also tried having their parents stay at her brother’s house during weekends, but it was always troublesome because he was not familiar with the situation, thus constantly calling up Sung for help. This weekday/weekend division of care duty did not work for them. Sung’s mother started going to the elderly daycare center from 2015 after her husband died. Her mother moved to a different center once because the center was located too far away from Sung’s place. Sung’s mother attended the first center for two years. When the center stopped running its shuttle bus to Sung’s house, Sung had to drive her mother to and from the center for a year. During that time, she had to hire a private caregiver who was responsible for driving Sung’s mother home in the evenings.
The hired caregiver also prepared meals and did some simple house chores for Sung. Sung paid her 1,000,000 KRW ($850 USD) every month, in addition to the monthly senior center fee of 300,000~400,000 KRW ( $250 – $335 USD). Other care-related expenses include Sung’s mother’s caregiver’s wage and other care services such as home-visit bathing service on weekends, food, medical bills and daily necessities such as diapers and etc., totaling about 2,000,000 KRW ($1,700 USD) per month. Sung’s brother helped to cover their mother’s care-related expenses, as Sung’s own income also had to cover her children’s education and living costs.
Description of Care Arrangement
Sung’s mother goes to the senior daycare center on weekdays and receives a home-visit bathing service every Saturday morning. The current elderly care center runs a shuttle that arrives at Sung’s house at 8:20 am to pick up her mother and to ride her back home at 9 pm. Sung’s mother is using the center service fully, spending the whole day at the center. Sung takes care of her mother after 9 pm until she goes to bed. When her mother comes back home, Sung helps her take medicine and changes her clothes and diapers. Her mother sleeps before 10 pm. Sung said her mother usually gets home tired after engaging in a variety of programs and activities offered all day long at the center.
Sung thinks her mother’s enrollment at the day care center is better than her staying at home and being bored. Sung said the most difficult part in caring for her mother happens at night, when her mother wakes up due to defecation. In such instances, Sung has to respond quickly to avoid what would otherwise become an even longer night, with her having to clean up the remains that will be all over the place. It got worse since last year and called for the most attention when caring for her mother. Nevertheless, Sung said her mother’s situation of dementia is not too bad, considering that some people with dementia can be very aggressive and easily agitated. Sung’s mother is relatively well-behaved, but she has this stubbornness which makes it difficult for Sung to help her get washed and change her underwear for she finds these to be a shame.
Sung said weekend care is tougher than weekday care because she needs to prepare food for every meal. The LTC-funded caregiver visits every Saturday to provide bath support, which is of great help, but Sung also needs to partake in the bathing assistance, requiring her presence.
The Cost of Caregiving
For Sung, it was an overload of work when she started supporting her parents by living together, while also having to care for her two adolescent children and working for her job at the same time. Sung said she had suffered from depression a few years ago due to the high stress of managing all her responsibilities. She had to seek psychiatric and medical treatments to overcome her depression.
Sung is considering sending her mother to the 24-hour nursing home as her health status is gradually deteriorating. She has applied for the institution for her mother’s stay, but she faces a long waiting list with more than 200 people. Sung said the reason for such a long waiting list is because this is a public nursing home, which is believed to provide better quality care and facilities.
Two years, she said, is what she thinks as the maximum number of years that she would be able to live with her mother if the current situation holds. But if it worsens, that is, if her mother’s dementia symptoms get worse, Sung will also consider sending her mother to some other facility with a shorter waiting list but also with lower quality of care.
She said that she would have to set a deadline to her caregiving for her own sake. She does not want to spend the rest of her 50s trapped with the care duty to her mother. Her children are now independent adults. Sung wants to start living her own life. She also feels she has done enough for her mother, her families and relatives all know it, and nobody will blame her for making this decision. Sung said because she is also a human, she needs to have her life and has the right to pursue it instead of sacrificing for her family.
See the surveys utilized for conducting this research below:
The 2018 fieldwork for the CWE-GAM project aimed to understand and measure care work in the South Korean context in order to inform gender-aware care macroeconomic models. The fieldwork consisted of both quantitative and qualitative surveys. The quantitative surveys include two sets of questionnaires for paid care workers in eldercare and childcare (Paid Care Worker Survey) and two sets of questionnaires for the unpaid care providers in the households for eldercare and childcare (Care Work Family Survey). The qualitative component consists of two sets of in-depth interview questionnaires for care providers and care recipients.
PAID CARE WORK SURVEY
The Care Work and the Economy Paid Care Work Survey includes two sets of questionnaires for eldercare and childcare workers and a 24-hour time use diary. A purposive sampling method was used to sample 600 paid care workers, 300 eldercare workers and 300 childcare workers, because the exact size and distribution of paid care workers in Korea are unknown. Paid care workers are defined as those working in institutional settings, at the care recipients’ home, and informal workers working without formal contracts. The sample targeted those providing care of the elderly and children’s daily lives, excluding kindergarten teachers and health care workers at hospitals and medical eldercare facilities. The sample of paid care workers associated with institutions were allocated to reflect the national distributions of eldercare facilities and daycare centers, and the sample of informal care workers were equally allocated across regions.
The Paid Care Worker Survey collected detailed and comprehensive information on the care work provided by paid care workers. The stylized questions and time use diaries of paid care workers collect information on the type, intensity, duration, and evaluation of care work from the perspective of paid care providers. The survey aimed to investigate the characteristics and working conditions of paid care workers, including their background, condition of contract, working environment, task arrangement, and subjective evaluation of the working conditions, and their well-being. The 24-hour time use diaries were collected to provide insights on how the day of a care worker is constructed and how care work is associated with other domains of daily life and time use, which can be analyzed in tandem with the stylized questions on the well-being of care workers.
FAMILY CARE WORK SURVEY
The Care Work Family Survey also consists of two sets of questionnaires for main care providers in the household engaged in childcare and eldercare respectively. 1,000 cases of main care providers in the household were interviewed (500 cases for childcare, 500 cases for eldercare) using a stratified cluster sampling method. Because it is not possible to know the distribution of the population of people who provide unpaid care in a society, children aged below 10 and the elderly aged over 65 were treated as the target population from which to draw the sample. Based on the distribution of the 2018 National Resident Registration Data in Korea, we allocated the number of target households to each area, identified eligible households with elderly or children in need of care, and then selected eligible respondents within the selected households.
The Care Work Family Survey was developed to provide a detailed and comprehensive picture of the care arrangements in South Korea. The survey aimed to investigate how care provision is arranged for the children and the elderly and why it is arranged in such ways. Therefore, the survey collects information from the main care provider, not the care recipients themselves, as it is often the case that the main care provider is the one who knows most about the care arrangements.
After screening for eligibility, respondents were asked questions on their demographic characteristics and information on the respondent, care recipients and other household members. Respondents were asked about the specific activities involved with their care work including frequency, subjective intensity, preferences and willingness to engage in the activities. Information on care arrangements were collected as well including how the care work is shared within the household, whether there are any gaps of care provision, the history of caregivers, use of care services, and decision-making of using care services. Other information such as financial responsibility and burden, experience and evaluation of care work, dual care burdens and well-being of caregivers were collected.
The purpose of the in-depth interviews of paid and unpaid caregivers was to provide useful care narratives based on the Korean context to inform macro-modelling. The qualitative research team intervened 25 family caregivers of the elderly, 20 family caregivers of children, 20 paid care workers for elderly, and 31 paid care workers for children. The interviews of family caregivers focused on the decision-making process and evaluation of care arrangements for the elderly and children. Interviewees were also asked about their experiences with caregiving. The interviews of paid caregivers focused on dual care burdens in terms of paid care work in addition to unpaid care work in the home.
SIGNIFICANCE AND LIMITATIONS
The fieldwork for paid and unpaid care work in Korea was designed and conducted to investigate the nature and context of care work in Korea. The Paid Care Worker Survey and Care Work Family Survey have distinct characteristics that contribute to enhancing our understanding about the experience of caregiving in Korea. First, the set of questions that have been developed can be commonly applied to caregivers regardless of the type of care work or the subject of care to enable comparative analysis on the experience of caregiving. Second, not only the caregiving situation, but also the broader aspect of the caregiver’s life including the preferences and attitudes of the caregiver have been studied. Third, the surveys collect detailed information on how care is arranged. Lastly, a caregiver focused 24-hour time use diary has been developed to understand which activities could be considered as care.
This fieldwork only included certain types of caregivers due to the limited budget, time, and scope of the fieldwork. For instance, the sample did not include caregivers for the disabled, caregivers who work at hospital settings, and migrant care workers, despite their importance. Also, as the family survey for childcare limited the respondents to ‘mothers’, and consequently fathers and grandparents were excluded. We hope that the future rounds of surveys can be extended to have a larger sample size and to include a broader range of caregivers. Questions explored in this fieldwork provide important information about the experience of caregiving in Korea, and we hope the fieldwork in Korea can inform fieldwork in other countries.
Learn more about care arrangements and activities in South Korea based on our analysis on the 2018 Care Work and Family Survey here.
A growing concern in many countries is an aging population and an increase in the number of elderly in need of long-term care. However, the impact of elderly care on the well-being of care providers remains relatively understudied. One of the primary factors which complicate analysis is that a majority of elderly care is provided informally by family members, with adult children often comprising the largest share of care providers. The pervasiveness of unpaid care due to cultural or family ties has even limited the development of long-term care insurance in economically advanced regions like Europe. However, while children may provide an informal safety net, parental caregiving is a time-intensive task and must be met by adjustments in leisure or work hours on the part of the care provider. Hence, in order to understand the full macroeconomic implications of growing elderly care needs and the appropriate policy response, it is imperative to understand how households cope with these caregiving needs.
Economic models of elderly care have focused almost exclusively on inter-generational bargaining between parents and children or bargaining among siblings. However, little attention has been paid to the influence of care demands on the power dynamics between partners within a household (e.g. husband and wife). This is despite data showing that caregiving falls disproportionately on women and that some caregivers respond to increased parental care needs by reducing work hours, taking more flexible jobs, or by quitting paid work entirely. Moreover, caregiving may have spillover effects on the caregiver’s spouse or partner. For example, a spouse may work longer hours or reduce their spending to cope with fewer hours of paid work by the caregiver. So it is unclear to what extent partners reallocate their time and resources and share the burden of parental care needs when they arise.
In the study detailed in the CWE-GAM working series paper published May 2020, we develop a theoretical model to explore how unpaid parental caregiving can affect the allocation of time and resources across partners under different household power structures. As parental caregiving disproportionately falls on daughters, we consider a model in which a woman’s parent is in need of time-intensive care. The provision of care across partners is then a bargained outcome between the couple. We not only examine how power dynamics and work arrangements impact caregivers and their partners but also how these factors may influence unmet care needs and care recipients.
After developing our model, we use cross-country data from the Survey of Health, Age-ing, and Retirement in Europe (SHARE) to illustrate our theoretical concepts with some numerical exercises. Broadly our results indicate caregivers may face a “triple burden” of market work, domestic chores, and caregiving. For example, our model predicts that for a duel-earning couple in France, the total cost of unpaid parental caregiving to the male is only about 57% that of their female partner—a skewed but shared burden. The higher cost to the female stems from two sources; (1) relatively fewer hours of leisure due to her provision of unpaid care; (2) the additional mental or emotional cost of leaving her parent with some level of unmet care needs.
Overall, our theoretical and numerical results show that ignoring bargaining power differentials across partners can misrepresent the true cost of unpaid parental caregiving by not taking into account the uneven distributional consequences. Moreover, our cross-country findings suggest that lower female bargaining power results in a larger burden on female caregivers and additional unmet care needs for their parents. If bargaining power is determined by relative earnings, government policies subsidizing long-term care could decrease the well-being gap within a household by providing financial relief and improving the bargaining position of the caregiver. This could further result in reduced levels of unmet care needs and improved outcomes for elderly care recipients. We further show that inflexible work arrangements also exacerbate the total cost of unpaid caregiving to the household as well as the unequal distribution of the burden. This implies policies that promote flexibility, such as caregiver leave or part-time options, could provide substantial relief, particularly to high-intensity caregivers.
This blog was authored by Ray Miller and Neha Bairoliya, who are both expert researchers for the Care Work and the Economy Project within the Rethinking Macroeconomics working group. To learn more read the CWE-GAM working paper upon which this blog was based here.
About half of all the time devoted to work in the U.S. is devoted to unpaid work in the home. The Institute for New Economic Thinking has created an adorable animation of some comments I made in an interview with them on this topic a while back.
It’s quite a lot of fun, and basically accurate. Just don’t pay too much attention to the numbers they inserted into my discussion of two families, each with a market income of $50,000–the animation seems to imply that leisure should be assigned a monetary valuation–not something I advocate. Still, the main point comes through just fine: conventional measures provide a misleading picture of living standards.
The animation provides a great introduction to the topic for students, and you can find a more academic version of the basic argument in a short briefing paper I wrote for the Washington Center for Equitable Growth.
Original blog published on CARE TALK: FEMINIST AND POLITICAL ECONOMY on June 11, 2020. See here for the original posting.
Reposted with permission from Dr. Nancy Folbre from University of Massachusetts Amherst and an expert researcher for the Care Work and the Economy Project within the Rethinking Macroeconomics working group.
The Unpaid Care Work and the Labor Market. An analysis of time use data based on the latest World Compilation of Time-use Surveys
How much time do people spend on doing paid and unpaid care work? How do women and men spend their time differently on unpaid care work? Are there any differences in time use among the regions? How do socioeconomic factors influence people’s choices to do paid and unpaid care work?
Jacques Charmes addresses these questions in recent ILO report by providing a comprehensive overview of the extent, characteristics and historical trends of unpaid care work. The report is based on the analysis of the most recent time-use surveys carried out at the national level across the world, revealing the differences in time spent on unpaid care work between women and men and among people with different socioeconomic characteristics, such as geographical location, age and income groups, education level, marital status and the presence and age of children in the household. An insightful discussion of the concepts and methodological approaches underlying the analysis of time-use data is also offered.
Chart 7 in the ILO Working Paper the Unpaid Care Work and the Labour Market. An analysis of time use data based on the latest World Compilation of Time-use Surveys illustrates the time spent by women and men in various categories of unpaid care work across Sub-Saharan African countries including Cameron, Ghana, Benin, Madagascar, South Africa, Tanzania, Mali, Mauritius, Ethiopia and Cabo Verde. As with the case around the world, women in Sub-Saharan African countries are providing significantly more unpaid care services in households and communities. Read the report to learn more about time-use analysis concepts and methodologies, gender variations in paid and unpaid work across the world and across various socio-economic levels:
When crisis hits, longer-term thinking can easily, and understandably, be cast as a distraction or a luxury—even when it relates to tackling critical issues like gender inequality, climate change, or extreme poverty.
Speaking personally, I’ve felt a bit silly trying to push forward projects that focus on gender lens investing or women’s economic empowerment in the last few weeks, given that my colleagues’ and collaborators’ attention, and frankly much of my own, lies elsewhere, and with something that seems much more pressing.
But for those of us who are in the position of privilege to continue thinking long term, it’s our responsibility to do so. Working towards structural changes that will take longer to come to fruition, especially those that relate to reducing global inequality, is the only way to radically decrease the extent of harm caused by moments of crisis, especially for vulnerable populations.
Dismantling unequal power structures, and in turn ensuring that every individual—regardless of gender, age, income level, national origin, and so on—has a safety net protecting them from vulnerability to health scares, income loss, and threats of increased violence, will allow us to focus on crisis without fearing fallout across every dimension of life.
In times of pandemic, the economically vulnerable cannot afford to stay home. Women in quarantine are facing increased risks of intimate partner violence. Girls staying home from school in some parts of the world may not have the opportunity to return. And none of this would be the case if we more effectively tackled the forms of inequality that underlie these realities. Then a virus could be a virus — assuredly deadly and destructive from a health perspective – but without inciting increased abuse, poverty, and lost prospects.
My colleague David Evans, drawing upon work by Claire Wenham, Julia Smith, and Rosemary Morgan in The Lancet, recently highlighted a range of problems stemming from the COVID-19 pandemic that disproportionately impact women and girls. In hopes of continuing to move the conversation forward, I propose some solutions to those problems here, and welcome others to add to this initial list. To be clear, these actions should not distract from immediate measures to address the pandemic. But we also can’t afford to risk forgetting about them when the focus on COVID-19 has faded; otherwise history is doomed to repeat itself.
1. Promote a Gender-Equal Health Workforce
Because the health workforce is disproportionately women (67%), women are at a higher risk of exposure to the virus within medical facilities.
More doctors worldwide are still men. But the vast majority of the global health workforce consists of nurses, community health workers, and others who are less highly compensated. All health workforce jobs need to become increasingly well-compensated, high-quality jobs. Not only will this incentivize men to seek these positions, destigmatizing their current positioning as “feminine” and dismantling occupational sex segregation within the healthcare sector, but it will also ensure that those on the frontlines of protecting populations from pandemics don’t also have to fear economic fallout on a day-to-day basis.
The number of women doctors is rising. Research from other sectors tells us what works to combat occupational sex segregation, including men acting as mentors supporting women to “cross over” into higher-paying occupations. These efforts will have to be paired with those that increase the perceived (and actual) value of work in sectors, including nursing and other frontline health work, where women dominate. More research is needed on this front, both on what works to incentivize men to take up traditionally “feminine” roles and how to avoid unintended displacement of women from those occupations.
2. Protect (and Expand) Existing Health Resources
With all hands on deck to fight COVID-19, particular groups of women and girls face other health risks.
Health facilities should not have to choose between providing lifesaving care in the face of pandemics and continuing to provide support for those in need in other areas, including pregnant women, adolescent girls (who have the highest prevalence of HIV infection, and in need of life-saving medication to keep their immune systems strong), and all women and girls in need of contraceptive access.
Increased investments in health are needed to ensure critical day-to-day care is not compromised during times of crisis. Establishing a Global Health Security Challenge Fund would help ensure countries are prepared to balance day-to-day needs with additional burdens in the face of pandemic, and evidence-based prioritization strategies are needed for when resources cannot be expanded.
3. Reduce and Redistribute Unpaid Care Work Burdens
As schools close and people fall ill, women and girls will assume increased unpaid care work burdens.
Under business-as-usual scenarios, women and girls do more than their fair share of unpaid care work, which limits their educational attainment, workforce participation and advancement, and leisure time. To lessen these burdens in times of crisis and more generally, we need increased investments in child and elder care, and in the poorest countries, gender-responsive energy, water, and sanitation infrastructure that would reduce the time women and girls must spend collecting water and fuel, as well as cooking and cleaning. We also need shifts in household norms that mean men assume more unpaid care responsibilities. Initiatives focused on promoting women’s economic empowerment, such as 2X Challenge and the Women’s Global Development and Prosperity (W-GDP) initiative, as well broader investments in gender equality and economic growth, must prioritize reducing and redistributing women and girls’ unpaid care work.
4. Address Gender-Based Violence
With quarantine measures imposed and stress heightened, women are at increased risk of violence committed by their partners and family members, and essential support services are absent.
Early reports suggest that gender-based violence rates are increasing in light of COVID-19 quarantining, consistent with evidence documenting increased violence in other crisis settings. Gender-based violence needs to be elevated as its own public health crisis, and resourced accordingly.
We’re far from meeting this objective, considering that all OECD donors combined allocated less than $200 million to addressing violence against women according to 2016-17 data, and over half of this financing came from just three countries (Australia, Canada, and Norway). Increased resources should target evidence-based approaches, such as Promundo’s MenCare program.
In pandemic contexts, preparations for social distancing should include considerations of how individuals will be able to access social services when faced with violence in their households. The World Bank has taken a step in the right direction in positioning interpersonal and gender-based violence as priorities to address in its new Fragility, Conflict, and Violence Strategy, though time will tell how the bank and other donor institutions finance this priority.
5. Guarantee Girls’ Education
With schools closing as part of social distancing measures, girls who already face pressure to drop out of school may not return.
Even absent crisis, tens of millions of girls globally face pressures to drop out of school to care for siblings and do other unpaid domestic work, contribute to supporting their households financially, and/or marry and have children when they are still children themselves. These pressures may be heightened due to interruptions in their education, as observed when Ebola hit West Africa. School closures, especially those impacting adolescent girls, should be weighed against longer-term risks related to girls’ school drop-out and limited school-to-work transition prospects as a result. Where possible, efforts should be made to incentivize parents to allow their children to return to school and to ensure consistent access to sexual and reproductive health services in the interim, as unintended pregnancy is cited as a reason for girls’ failure to return to school.
6. Promote Women’s Economic Opportunities
Across the globe, women are more likely to work jobs that are low-paid, informal, and lacking in benefits.
In large part due to the disproportionate unpaid care work women take on, they are less likely to be employed full-time, in the formal workforce, or in jobs that provide paid sick leave, unemployment insurance, and other protections.
We must continue to invest in evidence-based programs and policies that improve women’s economic opportunities and support organizations such as the Self-Employed Women’s Association and Women in Informal Employment: Globalizing and Organizing—organizations that are well-positioned to provide and advocate for dignified work.
Cash transfers should be considered as a means of ensuring a social safety net for those most in need. Critical to transfers’ success will be (1) ensuring that delivery mechanisms (through digital technology or otherwise) are properly designed and implemented and (2) that those in need, including low-income populations and workers vulnerable to economic backslides because of the virus, are prioritized.
7. Ensure Women’s Representation in Decision-Making and Critical Research
Women are not equally represented in decision-making roles responding to the COVID-19 pandemic.
The White House Coronavirus Task Force is over 90 percent men, and the team Prime Minister Johnson just assembled to lead the United Kingdom’s COVID-19 response is all men. As in the contexts of peace and security, international trade, and climate change, an exclusionary approach to decision-making will yield inferior decisions: those that don’t account for the needs and constraints of populations absent from the table.
Going forward, decision-making teams should be equally representative of men and women, and also prioritize other forms of inclusion, such as those based on race and ethnicity, as called for by Women in Global Health’s Operation 50/50 campaign.
Women must also be equally represented in clinical trials as biomedical treatments and other interventions are developed. As my colleague Carleigh Krubiner has noted speaking to the context of Ebola, women who are pregnant or breastfeeding are typically excluded from experimental studies, and in some high-fertility contexts, this means up to 80 percent of reproductive age women are virtually invisible in trial samples. Lack of representation means a lack of essential data on the types of prevention methods, treatments, and other interventions that work for women, risking higher fatality rates and other complications.
Times of crisis magnify the cracks in our systems and highlight disproportionate risks to the most vulnerable among us. COVID-19’s impacts, those already felt as well as those still anticipated, should serve as a wake-up call. They should spur action to address underlying inequalities, including those that disadvantage women and girls worldwide and make the consequences of a pandemic even worse than they would otherwise be. Increased prioritization of women and girls’ health, education, economic opportunity, safety, and decision-making power can help create a world where no one falls through the cracks. Decision-makers should realize this is inextricably linked to today’s pandemic response.
Original blog published on Center for Global Development website March 18, 2020, see here for the original post
Reposted with permission from Megan O’Donnell Assistant Director, Gender Program and Senior Policy Analyst at Center for Global Development
Who, exactly, are care workers, other than the people we need most right now, as the covid-19 pandemic overlays the division of labor with a new division of risk?
I’ve long been an advocate of using the term “care worker” rather than “caregiver” even though the work can be and often is, at least in part, a gift. Because care–whether performed for pay, or not–is at the crux of any sustainable economic system. All work depends on the successful production and maintenance of workers themselves. Yet because this very notion of care-as-work is relatively new, there is little agreement on its exact boundaries.
When I first started pursuing this issue with Paula England, we emphasized hands-on or face-to-face work that develops the capabilities of the care recipient, an essential aspect of the services that health care providers, workers, child care and elder care workers provide. This emphasis could be translated into a specific list of Census-designated occupations, grounding empirical research on the relative pay of care workers that has revealed significant pay penalties for both women and men in such occupations, controlling for many other variables such as education, experience, and unionization.
I liked this broad definition because it spanned paid and unpaid work, low-wage and relatively high-wage occupations, women and men, creating potential for new political alliances. Sociologists initially embraced the definition with some enthusiasm. Not so, economists, and Robert Solow, who attended some meetings of the Russell Sage Foundation Network on Care Work, pushed us for more specificity.
I felt some affinity with Kenneth Arrow’s insistence on the limits of markets and with efficiency-wage theories pointing to the difficulty of monitoring worker productivity, so added another twist to the definition: work in which concern for the welfare of the care recipient is likely to affect the quality of the service provided. In other words, work not performed entirely for money, akin to what some economists have termed “public service motivation” but more…personal.
Still not quite right. Sociologist Mignon Duffy has argued eloquently in Making Care Count that this definition privileges what she calls “nurturant care,” deflecting attention from the drudgery of menial care tasks–the emptying of bed pans, cleaning of toilets, and mopping of floors often performed by the most disempowered members of society. “Dirty” work itself is devalued. Duffy’s work has nudged me to focus more on industry–the economic consequences, for instance, of being employed in health care, education, or social services, regardless of occupation.
The pandemic, however, has pushed me over a cliff, because it is redefining the meaning of “dirty” work–now, any work that increases the risk of exposure to a potentially deadly virus: not just health care, child care, and elder care and unpaid care for family members, but also food services, package delivery, police protection, home repair services, garbage collection…the list goes on. We rely heavily on the motivations of such workers to minimize our own–as well as their own–chances of infection.
The entire sequestration/shelter-in-place/social distancing strategy relies heavily on good will and voluntary compliance. The very invisibility of covid-19 blurs the boundaries between love and money, us and them. The healthy now may later be sick, the sick now may later be dead. When risk is shared, the overlaps between solidarity and self-interest expand.
Yet so many boundaries, however blurry, remain in place. Whether because of who they are or what they do, some workers face much greater risks than others. It’s not enough to cheer them on, to offer them applause or a bit of extra cash.
If we are all care workers now we should do everything in our power to protect our own.
Original blog published on CARE TALK: FEMINIST AND POLITICAL ECONOMY on April 4, 2020. See https://blogs.umass.edu/folbre/
Reposted with permission from Dr. Nancy Folbre from University of Massechusetts Amherst and an expert researcher for the Care Work and the Economy Project
The world outside my study is churning and whirling… as it is engulfed with the fast-evolving health situations in communities around the globe. There are many unknowns about the
COVID-19 illness that has spread rapidly in every continent and the presence of uncertainty—big time—has rattled governments, shaken markets, and upended our daily routines, to say the least.
While I join the hundreds of millions of people who constantly check the news online and in newspapers, radio and/or tv, I also take time to pause. These moments allow me to reflect on
what this difficult time that we are all experiencing means and what it says about us—as
individuals, as members of communities, and as citizens of the world.
For one, I find that:
- each individual action has multitudes of rippling effects, large and small, on others;
- the real world oscillates between predictability and unpredictability; it requires each of us to constantly assess the balance between taking caution and taking risk;
- the distinction between self-interest and altruism (promoting others’ interests) becomes more blurred given the pervasive interconnectedness of our lives;
- adaptation and flexibility are vital life skills that we need to have not just now but at all times;
- we have the ability to change as we obtain more information and as conditions around us change; the notion of fixed tastes and preferences is outmoded;
- the skills that we must hone and develop should prepare us not only to live in a competitive world but also to be able to work together, coordinate and cooperate with one another; for the greater good requires collective action.
As the impacts of the COVID-19 spread intensify, there is growing recognition among governments and the public that traditional efforts for dealing with shocks and managing risks through conventional emergency responses are inadequate. Strategic thinking is needed as much as the ability to respond quickly and to take proactive measures. There is an urgent need to build the adaptive capacity and longer-term resilience of communities and societies.
One striking fact about the current global pandemic is its tremendous effect on the care sector. This includes not only the health care systems employing doctors, nurses, aides, and other health professionals but also the unpaid care labor provided by family members, neighbors, and kin.
Many are changing their daily life patterns to provide further assistance and care support for those who are vulnerable such as their parents or grandparents and for those who are self-quarantined. Many more are willing to take the risk of exposure to care for those who have tested positive and are ill but are staying at home because the healthcare system is inadequate, inaccessible, and/or overwhelmed. The shutdown of schools and daycare centers further adds demand for unpaid care. Parents are struggling to care for their children while at the same time trying to tele-work from home.
“How can I write or have meetings with my six-year old around?”
The cloak or mantle that hides the emerging crisis of social reproduction, or the under- provision of care for people who depend on it, is removed. This global pandemic exposes the heavy demand on those who carry the responsibility for providing care for the sick, the young and the frail elderly, the vast majority of whom have been women. It has upended preconceived notions such as: each individual is a ‘Robinson Crusoe’ in families that can find their own solutions to provide care, and that one’s ability to pay should determine who accesses care in the private sector.
The Care Work and the Economy Project joins the efforts of other organizations, research institutions and advocacy groups towards making the care sector visible to policymakers. The heavy care burden that is now being shouldered by health care systems, households, communities and countries throughout the world makes it imperative to bring care work out of statistical shadows and to remove the veil of ignorance in economic policymaking.
Let us hope that this time is truly different and that the jolt brought about by the current pandemic leads to more openness in the academic community and among policymakers towards a paradigm shift and policy change.
Providing care for others, especially for the frail elderly and young children, is one of the most important forms of human work that sustains our existence. However, caregiving is also often challenging and strenuous. Many informal caregivers are known to suffer negative physical, emotional, and social outcomes, and are at risk of losing their own health and well-being. Fengler and Goodrich, for example, refer to the wives of frail elderly men as ‘the hidden patient,’ warning the negative consequences of caregiving on informal caregivers. Since the 1980s, several instruments have been developed to measure the strain of caregiving among informal caregivers. Some measurements such as the Zarit Burden Interview and the Caregiver Strain Index have been applied more widely, while other measurements have been used for more specific groups of caregivers (e.g., who takes care of the elderly with cancer). Although these measures provide valuable information on various dimensions of caregiver strain, they are not sufficient to assess the overall level of strain experienced by caregivers. In most cases, these measurements consist of a list of questions or statements about the caregiver’s burden; the sum of the answers is then used to indicate the level of burden/strain experienced by the caregiver. Although useful, a simple non-weighted sum of answers may not be an accurate representation of the overall strain. For instance, two groups of caregivers may have the same average total strain score, but one group may consist of all caregivers who suffer strain in some statements, while the other group may have half of the care givers who suffer strain in all statements and the other half who do not suffer strain at all. While the marginal distribution may be the same, the joint distribution may not, and this has an important policy implication.
Adapting the Alkire-Foster method developed to measure multidimensional poverty, Jun et al (2019) propose a threshold-based approach to measuring overall caregiving strain that accounts for the multidimensionality of the caregiving experience. The approach is based on the premise that as in the case of poverty, the negative consequences of multiple strains attached to caregiving would be greater than the sum of their individual effects. The authors first identify the dimensions and indicators that are known to be important consequences of caregiving, such as physical, psychological, financial and relational strains, and daily life constraints. They then count the overlapping strains a care giver experiences under different indicators of caregiver strain. Next, they identify caregivers who are experiencing strains above a specific cut-off point as multi-dimensionally strained. This measure is tested using the data from the newly collected Survey of Eldercare and Childcare in Korea 2018, exploring whether receiving support, help and appreciation may be associated with reduced chance of being multi-dimensionally strained. By providing an overall measurement that identifies caregivers with multiple strains, the authors examine 1) which group of caregivers are more likely to be at risk; 2) which dimensions do most caregivers suffer strain; and 3) what may be potential buffers for caregiving strain.
This paper will be available December 2019