Ursula Barry, Emeritus Associate Professor, Gender Studies, School of Social Policy, Social Work and Social Justice, UCD
The propensity to care and the work of caring are the lifeblood of our social and economic systems. Care is central to the reproduction of society, part of the fundamental social infrastructure which holds society together. Occurring within gendered economic and cultural systems and structures, shaped by the policies – or lack of policies – pursued towards care at a societal level. Care encompasses looking after the physical, social, psychological, emotional, and developmental needs of one or more people. At a global level, women account for 70 per cent of frontline workers in the health and social care systems and carry out the large majority of unpaid care work in the home and in communities. All kinds of care work have been vulnerable to high rates of infection during the Covid-19 pandemic (European Parliament FEMM Committee, 2021).
This research study aims to examine the gendered nature of the EU care economy, the impact of Covid-19 on care and the care sector and the extent to which gender equality and care have been taken into account in the EU Covid-19 Recovery Plan (European Commission, 2020). By exploring the potential for a new EU strategy on care and the potential for a new model of care, this study argues that the care economy should be redefined as social investment and have a central place in the funding of the post-crisis EU Recovery Plan. Given that gender equality is a stated central objective of the EU, the long-term costs of persistently relying on women’s unpaid work to cover the failings of social protection systems and public services provision, are unacceptable. Urgent policies are needed to ensure continuity of care for those in need, that respect the choices of recipients and ‘recognise unpaid family and community caregivers as essential workers in this crisis (Power, 2020).
Gender inequality and care
Systems of care provision vary greatly across EU Member States (MS) and eight different countries are profiled in this report (Estonia, Finland, Germany, Greece, Ireland, the Netherlands, Poland and Spain). Selected countries are characterised by different care regimes and different relationships between the State, marketplace, family and communities in the provision of care. In some countries the State is the main provider, in others family and community are central and in yet others, the private market system dominates. Ireland heavily relies on the private marketplace and informal family and community networks to access care. While the State in Ireland funds a significant amount of formal child and long-term care, it is delivered mainly by private-for-profit services. Country profiles highlight the gendered nature of care, the reliance on women’s paid and unpaid work and the poor conditions in the care sector, as low-pay or unpaid work characterises care work. This research considers the potential for an EU strategy towards valuing the care economy.
Gender inequalities are at the heart of the care economy, directly linked to women’s position on the frontline of unpaid and low-paid work in the globalised care economy. Care encompasses the paid work of childcare, education, health and social care workers, those employed in institutional long-term care (LTC) settings, informal or unpaid work in the community as well as domestic work in the home (EIGE, 2020a). This pandemic has demonstrated the essential nature of care work and its central role in the functioning of economies and societies. Despite the critical role caring activities play in EU economies by contributing directly to economic and social well-being, care is undervalued, receives little recognition and has an invisibility that operates also at the level of public policy. At a global level, care work is often part of a hidden or underground economy and shaped by historical and persistent gendered inequalities. In practice, care is a spectrum of activities that reveals the critical, although largely unrecognised, interdependence and interconnectedness of society (EIGE, 2020b).
Gendered nature of care
At UN level, it is argued that women’s unpaid care work should be recognised as a ‘driver of inequality’ linked to ‘wage inequality, lower income, poorer education outcomes, and physical and mental health stressors (UN, 2020a). The unpaid and invisible labour of this sector has been significantly intensified by the Covid-19 pandemic. But the pandemic has also made starkly clear the way in which the daily functioning of families, communities, and the formal economy are dependent on this invisible work (UN, 2020a).
Covid-19 pandemic has shown the multiple ways in which both paid and unpaid care work are essential to sustaining both society and the economy. The pandemic has brought with it some greater recognition of the care economy as the care sector has been increasingly seen as composed of essential workers – these workers account for a significant amount of unpaid work globally. It is estimated that millions of 7.7 million women (compared to 450,000 men) are outside of paid employment across the EU because of unpaid work responsibilities. It has also been estimated that this involuntary underemployment accounts for €400 billion in lost additional GDP, based on a potential for 10 million additional paid jobs in the care economy (70 per cent of which would be taken up by women). It is further estimated that by 2050, if greater gender equality were to be attained, this could lead to an increase in EU (GDP) per capita by between 6.1 to 9.6 per cent which corresponds to €1.95 to €3.15 trillion (EIGE, 2017).
High levels of involuntary part-time work because of caring responsibilities have emerged in most of the selected countries, but in particular the Netherlands at 38.4 per cent, Germany at 31.3 per cent and Ireland 29.2 per cent – all above the EU average for 2019 of 28.4 per cent. Lower levels are evident in Greece 7.4 per cent, Finland at 12.9 per cent and Spain at 14.2 per cent. Research indicates that investing in the labour-intensive care economy generates a high level of return through growth in women’s employment and an increased level of social and economic well-being (European Commission, 2020). By funding quality diverse care services, women’s time spent on unpaid work would be reduced and new opportunities opened up for women in education and paid employment, particularly significant for those in low-income, migrant and lone parent households. New ways of thinking about care activities and enactment of different policies respecting the diverse needs of care recipients and care providers, a new model of care could be generated based on a more equal sharing of care work and a greater involvement by men with care activities. Societies based on enhanced gender equality and stronger social justice, this study argues, is in the interests of both men and women.
Provision for different forms of leave also varies hugely across Member States (MS), with high levels evident in Finland and Estonia for example, while much lower levels are evident in Greece and Ireland. The extent to which childcare costs are supported also varies enormously, from close to full publicly supported provision (for example, in Finland, Germany), to systems that operate to a maximum percentage of household’s income (in Estonia) and reliance on high-cost provision on the private marketplace (in Ireland). In some countries, the majority of care is provided for by families or communities within the informal sector (such as Greece) and in others there is an increasing reliance on migrant workers, both in the eldercare and domestic work sectors (for example, Spain and Ireland). New evidence is emerging that women have had to reduce their working hours or take a break from paid employment during the pandemic due to their primary involvement in home-schooling, child- and eldercare. Loss of seniority, lack of access to promotional opportunities and reduced entitlements to social protection and pension are all likely to suffer, to a greater or lesser extent between different member states. Women in households with children report higher levels of stress and significant increases in unpaid work according to recent Eurofound data, as well as intensified experiences of loneliness, isolation and depression. Work-life balance of women has been more negatively affected by the pandemic, highlighted by this new data which has shown that reduced working hours, loss of employment (in sectors such as retail, hospitality and tourism) and increased care responsibilities are common since the onset of Covid-19 (Eurofound, 2020).
Consequences of lack of visibility of care
Mainstream economics operates under an international system of measuring economic activity, which primarily values only market-based economic activities, that are paid for or that generate an income on the market. The majority of care work globally is unpaid, so therefore not measured and consequently is absent from, or marginal to, the concerns of economic policymaking. This renders a significant proportion of the work carried out by women on a global level uncounted, invisible and undervalued (UN Statistical Division, 2021). By using time use surveys, the UN has estimated that unpaid work accounts for between 20 and 40 per cent of GNP at global levels, and unpaid care accounts for most of this unpaid work (UN Department of Economic and Social Affairs, 2005). The Covid-19 pandemic has highlighted how women’s invisible work in the care sector is propping up economies at global, regional and national levels. Analysis of caring activities – paid and unpaid care work – reveals that it is highly gendered, whether in the formal or informal economy or whether carried out in homes, communities or in institutional settings (UN Women, 2020).
Making an extremely convincing case for the economic benefits of an investment strategy focused on the care economy, De Hanau and Himmelweit (2021) argue that the coronavirus pandemic has intensiﬁed the gender-equality case for investing in affordable, high-quality care and is simultaneously ‘a route to recovery from the employment crisis.’ By generating jobs in care, (and those industries supplying the care sector) it is argued, this would create more quality employment opportunities, further stimulating the economy through the spending of an expanded and high-quality care workforce. De Hanau and Himmelweit’s research argues that a set of positive employment effects would be generated by investment in the labour-intensive care sector – a sector that has historically suffered from under-investment. These include: direct employment effect by additional numbers employed in better quality jobs in care; indirect employment effects within companies that supply the care sector (including construction companies); and induced employment effects resulting from the increased spending by the expanded care workforce.
Taking also into account the positive impact on tax revenue, De Hanau and Himmelweit’s calculations reveal that 1.6 per cent of GDP in net investment would be needed to generate 8.5 per cent increase in women’s employment growth in the care sector (linked to a 6 per cent increase in overall employment levels). In contrast, they argue, 5.3 per cent of GDP investment in construction would be needed to generate an equivalent positive employment result. By carrying out this comparative analysis of the construction and care sectors across nine selected countries (including the UK and US), they demonstrate that addressing low levels of wages in the care sector has the potential to generate a high level of investment return, increasing the value and recognition of care, improving conditions in the care sector and moving towards greater gender equality.
Working conditions in the care sector
Working conditions in the care sector are poor, frequently carried out by those in marginalised low-income households, including many migrant women in vulnerable situations. Many migrants find themselves in situations in which their formal qualifications are not recognised and, as a result, trapped in low pay and low-status precarious employment (ILO, 2016). Women continue to experience a significant care penalty that has been exacerbated during Covid-19, due to the sudden withdrawal of a range of educational and care services. Conditions during the pandemic meant that home-based working had to be combined with home-schooling and childcare, and those responsibilities are largely carried out by women, forcing many to reduce working hours or, in some instances, exit paid employment (EIGE, 2020b).
Increased training and educational qualifications need to be linked to the establishment of a career structure for each different cohort of carers, within a system of reciprocal recognition of qualifications at EU and global levels. Increased funding needs to be made available for training and education programmes for care workers in paid care, and also in informal systems of care. Provision of inclusive social protection for formal and informal, paid and unpaid caregivers needs to be resourced. An enhanced system of leave entitlements for parents and carers needs to be supported in a manner that has a significant impact on increased sharing of care responsibilities. Protections for migrant workers in home-based and institutional care need to be developed and clear lines established for access to residency rights and citizenship at MS level.
Crisis in Long-Term Care (LTC)
There is increasing evidence of a crisis in care, and particularly long-term care (LTC). An increasing proportion of the population of EU is in the older age groups and demand for all kinds of care has been increasing while simultaneously, the proportion of women in paid employment is growing. Unmet care needs are a feature of many EU countries, as traditional systems of extended family care are no longer available to meet household needs, and public investment has failed to fill the care gap. Underlying lack of investment, linked to often low-quality privatised care services, characterise long-term care (LTC) facilities in many countries. The crisis situation in LTC facilities has been heightened to a very significant extent by Covid-19, as infection and death rates among residents spiralled, and infections rates among mainly female staff rose dramatically. The extent of the crisis and failure to protect residents in LTC facilities has resulted in the call by the European Parliament for an enquiry into the failings and chronic underinvestment in LTC institutions, where the lack of support and investment has rendered the quality of care highly questionable (European Parliament FEMM Committee, 2021). This is reflected in the particular vulnerability to Covid-19 infection among both residents and staff of LTC facilities, and in many countries, enforced isolation of even those seriously ill and dying. It is estimated that 42 per cent of deaths from Covid-19 occurred in these institutional congregated settings, providing often poor levels of care for older people, people with disabilities and particularly isolated and marginalised asylum-seekers and refugees in some countries (International Long-Term Care Policy Network, 2020).
There is an urgent need at EU and MS levels to review provision of care for people with disabilities and older people, both in residential care facilities, community-based care and home-based settings with the objective of making greater resources available and increased funding for transitions to home- and community LTC. Funding for investing in de-congregation and creation of individualised spaces in LTC residential settings needs to be increased. Investment in forms of housing that creates independent living and supported housing spaces based on the principle of autonomy for people with disabilities and older people needs to be enhanced (EUGE, 2020c). Within the informal care sector, numbers of carers are reducing while demand is rising. A recent EU report estimated that the financial impact of a shift from informal to formal care by 2070 would mean an increase in the share of GDP dedicated to LTC by 130 per cent on average across EU (EU DG ECFIN, 2018) In practice, the economic value of informal care is rarely recognised, despite the growing needs of an ageing population. While investments in formal care remain the central priority, it is clear that strong measures are needed to support and retain informal carers, under much improved conditions. For countries to move away from institutional structures towards a system of family- and community-based care is a complex process requiring an interlocking system of quality care, networks and supports. Transfer of resources from institutional systems to effective community support systems is needed to enable quality and sustainable care (EUGE, 2020c). This means ensuring that the development of comprehensive social infrastructure encompassing core services such as healthcare, childcare, transport and housing as well as employment, education and training are accessible and available to everyone – a process defined as deinstitutionalistion (European Expert Group, 2020) .
Different dimensions of care need to be supported to ensure that longevity is linked to the highest attainable standards of health – not merely the absence of disease or infirmity – but also quality care that supports physical, mental and social well-being. Deinstitutionalisation of care for older people and people with disabilities has been shown to be a preferred option, promoting social inclusion of older people, preventing isolation and improving quality of life. Investment in more high-quality models of care would generate more options that promote independence and autonomy. These could include for example, community-based complexes of supported housing with individualised spaces, communal facilities and access to support services (European Platform for Rehabilitation, 2020).
Covid-19 and gender-based and sexual violence
Covid-19 brought with it a dramatic rise in reports of gender-based sexual and domestic violence across the EU, as family and community networks were dismantled and many homes became places of danger. Services provided by both statutory agencies and NGOs have been curtailed and emergency help has not been available or been restricted to on-line services. Vulnerability of women restricted to homes, families and domestic settings have created circumstances in which gender-based sexual and domestic violence has systematically increased while critical service and supports systems have been seriously curtailed or withdrawn (European Parliament FEMM Committee, 2021). Calls to helplines, demand for refuge spaces, reports to police – all have seen a marked rise over the past 12 months and more. Similar patterns are evident where research is available, for example in Finland, Spain and Ireland. Domestic violence levels have increased by 14 per cent in Finland and by 20 per cent in Spain. Calls to the Women’s Aid Helpline in Ireland increased by 41 per cent by December 2020, nine months into the pandemic. At a global level, UN data has highlighted reports on increased level of abuse in confined home settings, as well as vulnerable street, transport and other public spaces, in the particular conditions generated by the pandemic. Full and partial lockdowns to deal with the spread of Covid-19 have been introduced in many countries, which has meant temporary unavailability of maternity, sexual and reproductive health services, of particular importance to women. In some countries, restricted access to contraception and abortion services, together with restrictions on travel has forced many women with crisis pregnancies into highly vulnerable situations (UN, 2020a).
While high levels of violence within the home have been revealed by the UN report on The Shadow Pandemic (2020) other forms of violence are also recorded, such as against female health workers, as well as against women migrant and domestic workers. Both public spaces and on-line abuse has intensified as ‘xenophobic-related violence and harassment’ has increased. Specific groups of women, including women journalists, politicians, human rights defenders, LGBTQ+ women, ethnic minority, indigenous women and women with disabilities have been particularly targeted in on-line abuse. At the same time, the limited investments in systems of support towards women victims/survivors of violence have become even more restricted, as the demands on health, social and NGO resources have been stretched – at times to their limits (UN, 2020b).
There is a need for MS to develop systems to link into new structures and policies at EU level, based on the recognition of sexual and domestic violence as a Eurocrime, and the Istanbul Convention needs to be resourced and fully implemented at EU and MS levels. Training and education programmes for volunteers and staff need to be funded on a multi-annual basis and investment in second stage housing to facilitate households exiting emergency systems. Particularly vulnerable communities in emergency congregated settings, such as refugees, homeless, asylum seekers and those suffering from gender-based sexual and domestic violence should be housed in appropriate and safe community-based settings and, at a minimum, with private, individualised and family spaces with autonomous cooking and catering facilities and specific supports to integrate adults and children with the wider communities. Funding also needs to be provided at EU and MS levels to address the restriction on sexual and reproductive care services (including maternity care services) during the pandemic (European Parliament FEMM Committee, 2021).
Lack of gender analysis and gender budgeting
Responses to Covid-19 by EU countries has lacked a gender analysis of the impacts of Covid-19 and consequently lacks a gender perspective to inform policy-making and strategies to combat the pandemic (Dowling, 2021). There is evidence of the establishment of emergency committees or structures to address the Covid-19 pandemic in all MS. Emergency structures and teams tend to be headed up by men, drawn from senior levels of health authorities or central government who, in the main, have not prioritised a gender-informed analysis in their response to Covid-19 and their recovery plans (EIGE (2020). Gender and age disaggregated data on contraction of the disease and on mortality rates are collected across the EU, however there is less attention to other key variables, such as ethnicity and social class. While gender disaggregated data are collected, there is little to no evidence of a gender perspective on the pandemic or the recovery process, and only limited research and policy analysis of the specific ways in which Covid-19 has impacted on women and men (OECD, 2020).
A new funding system
The EU has established an unprecedented new funding system to which Member States can apply and criteria for funding highlight two specific funding strands: digital transition and green transformation which together are expected to account for two-thirds of approved funding. While these two funding strands may benefit both women and men, there is no mention of the care economy as a priority for funding, despite the recognition of the role of care services during the pandemic. Unless a specific strand of funding, to the value of 30 per cent of total funding, is allocated to the care economy, the EU Recovery Plan for Europe will reinforce or exacerbate gender inequalities in the post-crisis period (Masselot, 2019). Specifying the substantial and diverse investments needed in the care economy is necessary so that the essential care economy can be put on an equal footing with digital and green economies. Based on research evidence, the care economy needs to be designated a public investment in social infrastructure with a recognised capacity to generate enhanced economic activity, as well as economic and social well-being, which is in the interests of greater gender equality and social justice (UK Women’s Budget Group, 2020).
A twin track approach is needed that on the one hand, targets the care economy and on the other, builds gender equality criteria horizontally across the new Resilience and Recovery Facility (RRF), as the newEU funding system is named under the EU Recovery Plan for Europe. References are made to gender mainstreaming and gender equality, under the RRF but crucially these are not reflected in the proposed allocation of resources. Firstly, significant RRF funds need to be ring-fenced and allocated to supporting the care economy. Secondly, gender equality budgeting should be applied to all the stages and levels of the budgetary process in the EU – and in the future to ex-ante and ex-post funding strategies. Gender impact assessment should be carried out in advance on all expenditure and investment proposals and actual spending should be monitored. Gender mainstreaming approaches should be applied to social investments in care, as well as digital and green investments (European Commission, 2020).
Fiscal stimulus packages and emergency measures to address public health gaps have been put in place in many countries to mitigate the impact of Covid-19. But there has been little to no focus on the more broadly-based care economy, both paid and unpaid, that is urgently in need of transformative change to bring about greater gender equality and social justice. It is crucial that national responses place gender equality at the core of social and economic change, based on inclusion, representation, rights and protection. This is about addressing long-term systemic gender discrimination, but it is also about a new model of care and making social well-being an objective for all of society, recognising the close interconnection to economic well-being (Nesbitt-Ahmed and Subrahmanian, 2020).
Time use surveys should be centrally managed and produced by Eurostat, drawing on a data template completed at MS level, ensuring that complex time use data is available in each MS on a gender, age, ethnicity and nationality and disability basis and that generates estimated values of unpaid work. Such data on care and time use should be used in the development of an EU Care Strategy, with a focus on the care economy as social investment and encompassing a strategic approach towards care providers and care recipients. Gender and equality budgeting should be systematically implemented at central European Commission (EC) level, and at all stages of the budgetary process of the EC. Gender impact assessments and gender mainstreaming need to be resourced and carried out by the EC on its own central EC budgets and within all EC funding systems, both ex ante and ex post assessments. EC should apply gender equality indicators to the process of reviewing RRPs submitted by MS, to each programme of funding included in RRPs for EC funding (including proposals for matching funding)(EIGE, 2020a).
Valuing the care economy
The care economy needs to be made an urgent priority at global, EU and MS levels and no longer treated as deserving of only marginal or residual attention within EU economic and social strategies. A fundamental rethinking of care activities and the care sector is urgently needed (Folbre, 2020). This study concludes that the EU should develop a clear policy framework that designates funding and supports to the care economy as public investments in social infrastructure that are defined as key priority areas in European Commission (EC) economic and budgetary policies (OECD, 2020). The core recommendation of this Report is that funding for the care economy should account for at least 30 per cent of the expenditure under the EC Recovery Plan for Europe to create equal standing with the 37 per cent already allocated to green transformation investments and 30 per cent to digital transition investments. In order the enable this process, Eurostat needs to put in place a system to collect disaggregated data on care, including provisions of different types of care and profiling the composition of both formal and informal carers, paid and unpaid care workers in relation to gender, age, nationality, disability and ethnicity in different care settings (Oxfam, 2021).
Migrant women, who make up significant proportions of care workers in both formal and informal settings, experienced crises in maintaining paid work, accessing accommodation and establishing residency rights through the pandemic. Women and men experiencing homelessness found day centres and other services closed or restricted during the pandemic with increased risks on the streets of assault, racist abuse and gender-based violence. In some countries, the LGBTQ+ communities have seen critical supports systems, such as NGOs and mental health services severely restricted or closed for stretches of time. Women in precarious situations, including homeless women and women in prostitution, lacked access to health and hygiene facilities during COVID-19, as well as safety and protection systems. Traveller and Roma people and ethnic minorities have also been particularly vulnerable to abuse as the pandemic saw fear and hostility expressed more openly and dangerously towards specific minorities. COVID-19 has seen a rise in gender-based sexual and domestic violence but with little emphasis on policies to address the rise in gender, ethnic and racial violence or to strengthen support systems that have experienced funding crises as well as COVID-19 restrictions impacting negatively on service provision (Oxfam, 2021).
Other sectors have faced particular needs and challenges during the pandemic. Lone parents have faced particular stresses with the restriction and closures of early childcare and education programmes, leaving many, mostly women lone parents to face tasks of continuously providing education and care in situations of complete isolation. Many homecare and domestic workers carried out care responsibilities through the pandemic without adequate protective equipment and supports while others lost paid work without warning and without a safety net in social protection. Many of those with disabilities, including those who have daily care or high support needs, often living in closed settings, have been unable to access their usual support networks or had difficulties accessing services because of physical distancing restrictions (Barry, 2020).
Women are the hardest hit by this pandemic but they will also be the ‘backbone of recovery’ (UN, 2020a) in every country and policies that recognise this reality will be more effective (UN, 2020a). It is critical that post-Covid 19 gender equality policies recognise that inequalities are experienced differently and to a greater extent by specific groups of women. For instance, research has revealed that unpaid care work is disproportionately carried out by non-EU born women and young women (EIGE, 2017). As women’s employment rates have increased, demand for cheap domestic and care labour, a pattern in pre-Covid-19 likely to re-emerge in post-Covid-19. An intersectional policy framework is needed that takes into account experiences of racism, differences in ethnicity, social class and dis/ability (Folbre, 2020).
The challenge now is to shift the EU recovery plan towards a more care-centred perspective, based on the principle of gender equality. This involves putting the care economy on an equal footing with green and digital investments, the latter are already highlighted in the EU Recovery Plan, reinforced by a definite ring-fencing of resources (Women’s Policy Group Northern Ireland, 2020). This is not the case for the care economy – which benefits from only passing references. What is needed is an immediate change of focus, the development of a more complex strategy for recovery, one which places the care economy and gender equality at its centre (The Care Collective, 2020). There is an urgent need to rethink the lack of focus on the care economy and to place it centrally on the agenda of EU policies and funding strategies, with the specific objective of enhancing gender equality (Fineman, 2004). It is incontestable that investments in care would create new jobs in care and related sectors, as well as providing much-needed additional quality services (Dowling, (2021). A transformative approach needs to go further, by shaping policies that embed value in care, re-evaluate the care sector, build on qualitative care services and generate a restructuring of care activities within and between households – based on an ethical, gender equality and social justice perspective (UK Women’s Budget Group, 2020).
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1 This study was commissioned by the European Parliament, Dept for Citizens’ Rights and Constitutional Affairs Femm Committee. The full Report is available from: https://www.europarl.europa.eu/RegData/etudes/STUD/2021/694784/IPOL_STU(2021)694784_EN.pdf Research assistance provided by Ciara Jennings.