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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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Parenthood And The Pressure Of Always Having To Be Doing Better

As a father myself, I'm now better able to understand the pressures my own dad faced. It's helped me face my own internal demands to constantly be more productive and do better.

Photo of a father with a son on his shoulders

Father and son in the streets of Madrid, Spain

Ignacio Pereyra*


When I was a child — I must have been around eight or so — whenever we headed with my mom and grandma to my aunt's country house in Don Torcuato, outside of Buenos Aires, there was the joy of summer plans. Spending the day outdoors, playing soccer in the field, being in the swimming pool and eating delicious food.

But when I focus on the moment, something like a painful thorn appears in the background: from the back window of the car I see my dad standing on the sidewalk waving us goodbye. Sometimes he would stay at home. “I have to work” was the line he used.

Maybe one of my older siblings would also stay behind with him, but I'm sure there were no children left around because we were all enthusiastic about going to my aunt’s. For a long time in his life, for my old man, those summer days must have been the closest he came to being alone, in silence (which he liked so much) and in calm, considering that he was the father of seven. But I can only see this and say it out loud today.

Over the years, the scene repeated itself: the destination changed — it could be a birthday or a family reunion. The thorn was no longer invisible but began to be uncomfortable as, being older, my interpretation of the events changed. When words were absent, I started to guess what might be happening — and we know how random guessing can be.

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