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Crisis In Family Care Demographics, Women Pay The Price

Women have the most to lose if governments don't start investing more in quality care services, the International Labour Organization warns.

Four elderly men ride the bus home from their day jobs in Hong Kong
Four elderly men ride the bus home from their day jobs in Hong Kong
Megan Clement

When it comes to care provision, the world faces something of a perfect storm as populations age, family structures shrink and more women enter the workforce. It's a crisis in the making, the International Labour Organization (ILO) warned in a recent report. And unless governments start properly investing in care services, gender inequality will increase and economies will suffer.

The demand for care work is set to increase significantly in the next decade, with 2.3 billion people needing care by 2030, the ILO report concludes in its report released in late June. What remains to be determined is whether this work will be high quality and well remunerated, or low quality and exploitative. The answer to that question, lead author Laura Addati explains, will determine in large part how the crisis plays out.

Addati says government spending on child care, elderly care and early childhood education will have to double by 2030 to avoid a "race to the bottom" on care work. If we continue on current investment trajectories, she says, women will end up taking on more and more unpaid care, leading to higher poverty and a waste of human capital.

"Women will lose their talent and the investment that has been put into educating more women, pushing them to have careers, climbing the ladder and breaking the glass ceiling," she says. "It's all these costs in terms of equality and in terms of impoverishment."

The ILO researcher says it's not just unpaid carers who will suffer in this scenario, but paid carers and domestic workers as well as nurses, midwives and doctors who will have to step in to care for more clients and patients, and do so on lower salaries, as investment fails to keep up with the demand for care.

"Care work cannot be forfeited," she says. "The demand is there to be met."

This is what Addati calls the "status quo" scenario for 2030. But if governments take "the high road" scenario and double investment in care work, it's estimated that 475 million extra care jobs will be added to the global economy. She says this approach will not just stave off the care crisis, but also ensure that the UN's Sustainable Development Goals on health and education will be met.

Changing family dynamics

Much of the looming care conundrum is due to the changing structure of families worldwide. While in the past, the burden of unpaid care work has been split across extended families, the rise of nuclear families and single-parent households has intensified the responsibilities that fall to primary caregivers, who, more often than not, are women. There are 300 million single parents leading households worldwide, and 78% of them are women.

Worldwide, women are responsible for 76.2% of all unpaid care work.

"This idea of the traditional role of extended families helping out with child care — it's not the norm any more," Addati says.

Mayra Buvinic, a senior fellow at the Center for Global Development, says this dynamic applies to the elderly as well, and that the developing world will be affected just as much as the developed.

"In the developing world, you're still under the notion that families will take care of their elderly, but that's not the case anymore in a lot of places," she says. "And then what do you do with your elderly?"

The report also reveals that the burden of unpaid care shouldered by women is higher than previously thought. While earlier calculations found that, on average, women carry out two and a half times more unpaid care work than men, the new report puts that figure at 3.2 times more. Worldwide, women are responsible for 76.2% of all unpaid care work, and there is not a country on earth where men do more of this work than women.

Adatti says the overall value of this work is $11 trillion, or 9% of global GDP, the equivalent of "two billion people working every day for eight hours."

The gender gap in time spent on unpaid care narrowed by a mere seven minutes between 1997 and 2012; on that trajectory it will take 210 years for the gap to close. This is in line with other gender equality measures. Last year, the World Economic Forum found that the overall economic gender gap would not close for another 217 years at current rates.

2018 Children's Day celebrations are at capacity in Montevideo, Uruguay — Photo: Jimmy Baikovicius/Flickr

Sharing the burden

Addati says we have to speed up progress on closing the care gender gap. Part of that involves encouraging men to take on more unpaid care work. The report points to progressive parental leave policies as a key driver of men""s ongoing involvement in child care, which can lead to a better life for children too.

"We see that when men are more involved, children's outcomes improve in development and health," she says.

Addati and Buvinic agree that care work also needs to be redistributed from families to the state, to ease the burden on women. Buvinic says the private sector cannot be responsible for providing the majority of care.

"The private sector, if they're going to be made by the government to provide child care, they need to absorb the cost. So, the answer is, you need the government, you need all of us, to pay for child care," she says.

Buvinic points to Uruguay as a case of the government leading by example on care.

"Uruguay is a small country, very urban, not very rich. But it regulates in terms of elder care, child care, it builds more child care centers," she says. "It has a philosophical statement and value statement that care is something that all society is involved in, that men and women are involved in, and that the government should provide."

Addati says that's precisely the type of investment that is required to stave off a care crisis globally.

"It boils down to what type of society we want to live in," she says. "What future are we designing? Is it a future where care will be central, and taken into account in our daily life and policymaking, or a future where there is no space to care?"

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Coronavirus

Where Lockdowns For LGBTQ Meant Moving Back In With Homophobic Relatives

The confinement experience could turn brutal for those forced to live with relatives who would not tolerate a member of the family living their sexual orientation openly as a young adult. Here are stories from urban and rural India.

At a Rainbow pride walk in Kolkata, India

Sreemanti Sengupta

Abhijith had been working as a radio jockey in the southern Indian city of Thiruvananthapuram when the COVID-19 pandemic hit in March, 2020. When the government imposed a nationwide lockdown, Abhijith returned to the rural Pathanamthitta district , where his parents live with an extended family, including uncles, cousins and grandparents.

Eighteen months later, he recalled that the experience was "unbearable" because he had to live with homophobic relatives. "Apart from the frequent reference to my sexual 'abnormality', they took me to a guruji to 'cure' me," Abhijith recalled. "He gave me something to eat, which made me throw up. The guru assured me that I was throwing up whatever 'demon' was possessing me and 'making' me gay."


Early in 2021, Abhijith travelled back to Thiruvananthapuram, where he found support from the members of the queer collective.

Inspired by their work, he also decided to work towards uplifting the queer community. "I wish no one else goes through the mental trauma I have endured," said Abhijit.

Abhijith's story of mental distress arising from family abuse turns out to be all too common among members of India's LGBTQ+ community, many of whom were trapped in their homes and removed from peer support groups during the pandemic.

Oppressive home situations

As India continues to reel from a pandemic that has claimed more lives (235,524) in three months of the second wave (April-June 2021) than in the one year before that (162,960 deaths in March 2020-March 2021), the LGBTQ community has faced myriad problems. Sexual minorities have historically suffered from mainstream prejudice and the pandemic has aggravated socio-economic inequalities, instigated family and institutionalized abuse, apart from limiting access to essential care. This has resulted in acute mental distress which has overwhelmed queer support infrastructure across the country.

Speaking to queer collective representatives across India, I learned that the heightened levels of distress in the community was due to longstanding factors that were triggered under lockdown conditions. Family members who are intolerant of marginalized sexual identities, often tagging their orientation as a "disorder" or "just a phase", have always featured among the main perpetrators of subtle and overt forms of violence towards queer, trans and homosexual people.

Calls from lesbians and trans men to prevent forced marriages during lockdowns.

Sappho For Equality, a Kolkata-based feminist organization that works for the rights of sexually marginalized women and trans men, recorded a similar trend. Early in the first wave, the organization realized that the existing helpline number was getting overwhelmed with distress calls. It added a second helpline number. The comparative figures indicate a 13-fold jump in numbers: from 290 calls in April 2019-March 20 to 3,940 calls in April 2020-May 2021.

"Most of the calls we have been getting from lesbians and trans men are urgent appeals to prevent forced marriages during lockdowns," said Shreosi, a Sappho member and peer support provider. "If they happen to resist, they are either evicted or forced to flee home. But where to house them? There aren't so many shelters, and ours is at full capacity."

Shreosi says that the nature of distress calls has also changed. "Earlier people would call in for long-term help, such as professional mental health support. But during the pandemic, it has changed to immediate requests to rescue from oppressive home situations. Often, they will speak in whispers so that the parents can't hear."

Lack of spaces

Like many of his fellow queer community members, life for Sumit P., a 30-year-old gay man from Mumbai, has taken a turn for the worse. The lockdown has led to the loss of safe spaces and prolonged residence at home.

"It has been a really difficult time since the beginning of the lockdown. I am suffering from a lot of mental stress since I cannot freely express myself at home. Even while making a call, I have to check my surroundings to see if anybody is there. If I try to go out, my family demands an explanation. I feel suffocated," he said.

The pandemic has forced some queer people to come out

Sumit is also dealing with a risk that has hit the community harder than others – unemployment and income shortage. He's opened a cafe with two other queer friends, which is now running into losses. For others, pandemic-induced job losses have forced queer persons from all over the country to return to their home states and move in with their families who've turned abusive during this long period of confinement.

Lockdowns force coming out

According to Kolkata-based physician, filmmaker and gay rights activist Tirthankar Guha Thakurata, the pandemic has forced some queer people to come out, succumbing to rising discomfort and pressure exerted by homophobic families.

"In most cases, family relations sour when a person reveals their identity. But many do not flee home. They find a breathing space or 'space out' in their workspaces. In the absence of these spaces, mental problems rose significantly," he said.

Not being able to express themselves freely in front of parents who are hostile, intolerant and often address transgender persons by their deadname or misgender them has created situations of severe distress, suicidal thoughts and self-harm.

Psychiatrist and queer feminist activist Ranjita Biswas (she/they) cites an incident. A gender-nonconforming person died under suspicious circumstances just days after leaving their peer group and going home to their birth parents. The final rites were performed with them dressed in bangles and a saree.

"When a member of our community asked their mother why she chose a saree for someone who had worn androgynous clothes all their life, she plainly said it was natural because after all, the deceased 'was her daughter,'" Biswas recalls.

The Indian queer mental health support infrastructure, already compromised with historical prejudice, is now struggling

David Talukdar/ZUMA

"Correctional" therapy

In India, queer people's access to professional mental healthcare has been "very limited," according to community members such as Ankan Biswas, India's first transgender lawyer who has been working with the Human Rights Law Network in West Bengal.

"A large majority of the psychiatrists still consider homosexuality as a disorder and practice 'correctional therapy'. It's only around the big cities that some queer-friendly psychiatrists can be found," Biswas said. "The pandemic has further widened the inequalities in access to mental health support for India's LGBTQ community."

Biswas is spending anxious days fielding an overwhelming amount of calls and rescue requests from queer members trapped in their homes, undergoing mental, verbal and even physical torture. "We don't have the space, I just tell them to wait and bear it a little longer," he said.

Medical care is dismal

Anuradha Krishnan's story, though not involving birth family, outlines how the lack of physical support spaces have affected India's queer population. Abandoned by her birth family when she came out to them as a trans woman in 2017, Anuradha Krishnan (she/they), founder of Queerythm in Kerala who is studying dentistry, had to move into an accommodation with four other persons.

Isolation triggered my depression

"I am used to talking and hanging around with friends. Isolation triggered my depression and I had to seek psychiatric help." Living in cramped quarters did not help with quarantine requirements and all of them tested positive during the first wave.

What is deeply worrying is that the Indian queer mental health support infrastructure, already compromised with historical prejudice, is now struggling, placing more and more pressure on queer collectives and peer support groups whose resources are wearing thin.

During the 10 months of the first wave of the pandemic in India in 2020, Y'all, a queer collective based in Manipur, received about 1,000 distress calls on their helpline number from LGBTQ+ individuals. In May 2021 alone, they received 450 such calls (including texts and WhatsApp messages) indicating a telling escalation in the number of queer people seeking help during the second wave.

As India's queer-friendly mental health support infrastructure continues to be tested, Y'all founder, Sadam Hanjabam, a gay man, says, "Honestly, we are struggling to handle such a large number of calls, it is so overwhelming. We are also dealing with our own anxieties. We are burning out."

Sreemanti Sengupta is a freelance writer, poet, and media studies lecturer based in Kolkata.

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