Gender and Caregiving
This presentation is based on a position paper published last December by
WHC which can be downloaded from our website ( www.whc.ie
). It deals with the general concept of caregiving but many of the specific studies referred to tend to focus on caring for ill or ageing relatives rather than children. Many of the comments, however, would be also relevant in relation to childcare.
The importance of care
Caregiving is one of the most important aspects of our social identity as family and community members. Daly and Lewis (1998) define care as the activities and relations involved in meeting the physical and emotional needs of dependent adults and children, together with the economic and social frameworks within which these are assigned and carried out. Because of its social salience, care has been called “the signature piece of society, invoking and at the same time shaping the division of labour and responsibility between women and me n and the state, the family and the market” (Daly and
Re cent dramatic changes in the Irish social landscape have seen women’s participation in the labour market increase considerably, due to greater female education and emancipation, and the demise of the ‘family wage’. This trend is challenging the conventional division of labour in the home and is starting to promote a redefinition of gender roles to include caring and working for both men and women. Increased female participation in the workplace has also contributed to already falling fertility rates, and the parallel ageing of the population. This trend has caused the provision of care to become one of the most pressing issues on the public agenda not only at a national but also at
European level as evidenced by the publication of a Green Paper on the subject by the European Commission last year.
These demographic and social developments have also highlighted the role that the state can play in relation to care. Many European countries, including
Ireland, have explicitly or implicitly relied on the ‘private sphere’, meaning principally women, for the delivery of care to the population, stepping in with support services only when family members are not available to fulfil these functions. Now that women are not as readily available or willing to carry the full responsibility for the care of the nation, governments will have to reassess their traditional approach.
Gender and Care
Despite the fact that care is a quintessential part of all human relations, women have traditionally been the principal caregivers in Ireland, and care is often stereotypically seen as part of a ‘woman’s role’.
To quote Armstrong and Armstrong:
“Care work is women’s work. Paid and unpaid, located at home, in voluntary organisations or in the labour force, the overwhelming majority of care is provided by women. It is often invisible, usually accorded little value and only sometimes recognised as skilled” (2004: 4).
The reasons behind the greater propensity of women to care and to be involved in caregiving duties are usually explained in a deterministic way, linking women’s social roles to their biology and psyche. However, feminist scholars have highlighted the role that societal assumptions play in the gendered division of emotional and practical labour in the home and in the community.
The feminisation of care has not been contained within the family, but has also been reflected in paid care work. As the sector has grown, women have formed an ever larger majority of paid care workers (Daly and Rake, 2003). In keeping with the low value assigned to caregiving in the private sphere, this
sector is characterised by low pay and poor working conditions, devaluing the value of care in economic and employment terms.
Gendered Social Roles
As I have already mentioned, in recent decades women position in society has improved considerably thanks to increased education and emancipation, followed by legislative changes. Women in Ireland have seen their position as workers and consumers advance dramatically, especially through the influence of the European Union 1 . On the other hand, women’s principal responsibility as family carers has remained largely unchanged and relatively unchallenged. In fact, despite their greater work participation rates, women are still mainly responsible for the practical and emotional labour required to care for family members. Due to the current trend of delayed childbearing, women are also increasingly experiencing the burden of caring on two fronts at the same time, having to look after their young children while at the same time caring for ageing parents (Dex, 2003; Simoni and Trifiletti, 2005).
The need to fulfil multiple social roles has been found to affect women in a number of negative ways. I will cover the health and well being repercussions in more detail later in this presentation, but just to mention now that the constant struggle to balance their role as mothers, carers and workers causes women high levels of emotional and psychological distress (Women's Health
Council, 2004), as well as increasing the likelihood for physical exhaustion and illness (Conlon, 1999).
Caring also costs women financially. In order to fulfil their multiple roles, women are more likely to take leave from their jobs and reduce their working hours. For example, women with small children continue to show employment rates 13.6 percentage points lower than women without children, while men with small children show 10 percentage points higher employment rates than men without children across Europe (European Commission, 2005). These
‘reconciliation’ strategies have been documented to exert a major negative
1 For example, greater equality in the workplace was brought about by Directives 75/117/EEC,
76/207/EEC, and greater equality in access to goods and services by Directive 2004/113/EC.
effect on women’s careers and on their earnings throughout the lifecourse, representing what Daly has been called a wage penalty on caring (2002), and exposing women to a greater risk of poverty in their old age. The negative repercussions of the burden of care and its related financial consequences are felt even more strongly by women already experiencing economic and social disadvantage.
Women have undoubtedly suffered as a consequence of the definition of care as women’s responsibility and work. However, this situation has also disadvantaged men in relation to their ability to participate in family life
(O'Connor, 1998) as well as being discriminated against in terms of social welfare entitlements as carers (Kennedy, 2001). Hence a more equitable approach to care would highlight the rights of men to care as well as enable women to participate more equitably in the public sphere.
The gendered nature of caring is not only due to cultural tradition but is deeply entrenched in society through official laws and policies. The Irish
Constitution, as the fundamental law of the land, has served to embed a strict and inegalitarian gender framework in all government policies despite the major changes which have taken place in Irish society since its promulgation.
Last week the All Party Oireachtas Committee on the Constitution published its report on the articles that relate to the family. While many of its recommendations were disappointing, referring to the sexist stereotypes contained in the articles on the ‘Woman in the Home’, it recommended that they be made gender-neutral thus highlighting the role that both mothers and fathers play within the family for the greater social good. The Women’s
Health Council hopes that the government will act to see these amended implemented as soon as possible.
But at the moment most laws and social policies either prescribe women as being responsible for caring or expect this to be the case. There are many examples of this underlying gender framework but I will give you just a few. o Even despite the recent increases in maternity leave which will add up to 6 and ½ months paid and 4 months unpaid by 2007, fathers still are not entitled to even one day’s leave at the birth of their child. o Adoptive Leave is available to an adoptive father only in the case of the death of the adoptive mother. o The unpaid nature of Parental Leave ensures that is it the parent with the lesser income to avail of it, and this is most often the mother. o The Carer’s Allowance being means-tested assumes that there will be a head of household, whose income will be sufficient to support other family members.
In relation to healthcare, policies often refer to ‘care in the community’
(Department of Health and Children, 2000, 2001). However, this statement often stands for ‘care by the community’ (Bredin, 1994), which, again, mostly refers to care by women. The gove rnment’s expectations that women will deliver the necessary care, though, are in marked contrast with official policies in the economic sphere. So while women are still expected to fulfil familial caring duties, they are also encouraged and increasingly expected to join the labour market.
The Government is also concerned about the cost of care to the public purse.
However, even when not being funded by government, informal caregiving is still associated with costs, such as lost earnings, lost production, low geographical mobility in the economically active population slowing economic growth. There are also healthcare costs, in that, as we will see, the carer’s health is often negatively affected by care-giving (Batljan, 2005). So governments’ assumption that family care is cheaper than formal care can be sustained only if women’s labour and missed opportunities are not taken into account (Lee and Porteous, 2002). Society is therefore already paying, but
the financial burden is not equitably distributed, with women being disproportionately affected by the current system.
Gender Differences in Caregiving
While results from the Irish census in 2000 pointed to a significant proportion of men being involved in caring responsibilities (4 out of every 10), women still comprised two thirds of those carers who provided 43 hours or more of care a week (Cullen, Delaney and Duff, 2004). European research also identified
Irish women as 3 times more likely than Irish men to be involved in providing both child care and care for ill or elderly adults (Daly and Rake, 2003).
Comprehensive reviews of caring responsibilities carried out in Canada and the USA point to a great diversity in the type of duties women and men carers engage in and to the differential effect of these duties on their lives (Navaie-
Waliser, Spriggs and Feldman, 2000; Morris, 2001; Armstrong and Kits,
More women than men provide more demanding and intensive forms of daily caring, such as bathing and dressing, care with incontinence and walking, and with relatively complex tasks including dressing changes, assistance with medical equipment and the administration of multiple prescription medication.
Men’s contribution, on the other hand, is much more likely to be concentrated in care management or household maintenance, shopping or transportation.
So women are more likely to provide the care that is daily and inflexible while men provide care that can be more easily planned and organised around paid work. Women also more often have responsibility for more than one care recipient than men.
When they do provide care, men are more likely than women to get formal help. Women carers are more likely to report difficulty with care provision and to have unmet needs. These findings could be based on the assumption by support service providers that men must have jobs and that they may lack the necessary skills to provide care (Armstrong and Kits, 2004). Other studies have also shown that women caregivers are less likely to solicit support from other sources.
Similar gender differences have also been observed in care receiving, with women receiving fewer hours of care then men pointing to the fact that the needs of women often may go unmet due to the presumption that they might be better able to look after themselves (Morris, 2004) .
While no comparable gender-sensitive care research is available in Ireland, it can be argued that due to the enduring gendered expectations, the situation might be broadly similar here.
Caregiving and Health
Caring for other people often provides women with significant emotional benefits. Caregivers often experience satisfaction from their caring responsibilities and these help to establish a sense of importance, value and belonging. Carers also get joy from helping others and often feel rewarded through personal interaction and the very real support they receive in return
(Armstrong and Kits, 2004).
However, the role as primary carers has also been found to cause women significant negative health repercussions, such as an increased risk of mental and emotional distress, as well physical implications.
A study by Blackwell et al . in Ireland (1992), which focused on carers of older people, found that almost one third (29.5%) had a level of psychological distress that put them at risk of clinically diagnosable anxiety/depression and
this was a lot higher than in the general population (cited in Cullen, Delaney and Duff, 2004). Studies have also shown that women’s mental health is more likely to be adversely affected by caregiving than men’s as evidenced by greater feelings of burden, stress, anxiety and depression (Navaie-Waliser,
Springs and Feldman, 2000).
Caring duties also impact on the carer’s physical wellbeing and research has found that a significant proportion of carers report a deterioration in their health after taking on a caregiving role (O'Neill and Evans, 1999; Lane et al.
2000). Caregiving has been associated with chronic fatigue, sleeplessness, stomach problems, back pain, elevated blood pressure, poor immunitary system functions, viral illnesses, and increased health care use (Wilcox and
King, 1999; Navaie-Waliser, Spriggs and Feldman, 2000; Lee and Porteous,
2002; Lee et al.
, 2003; Forssén, Carlstedt and Mörtberg, 2005).
Data from a study on women carers also indicates that caring for a disabled or ill spouse for 9 hours or more a week increased the risk of CVD almost twofold (Lee et al.
, 2003). The authors attributed this result to the distress from seeing a loved one suffer, added to the stress from financial burdens and the pressures of juggling work with caregiving. This is particularly significant as
CVD is the highest cause of mortality in women in Ireland today (Women's
Health Council, 2003).
Finally, caregivers are also less likely to have time to engage in self-care and health promotion and they may also alter normal patterns of diet, exercise, and other health-related behaviours in response to the stress of providing care (Sisk, 2000; Lee et al.
, 2003). A study of Australian women carers found that despite poorer physical health, they were no more likely to seek medical attention than non-carers. The authors argued that the time pressures experienced by carers make it more difficult for them to attend to physical problems in their early stages and this may explain their greater rate of hospitalisation (Lee and Porteous, 2002). Finally, women have also be found to be more likely to forego respite activities (Navaie-Waliser, Spriggs and
In summary, international research has provided evidence that, due to the gendered patterns of caring duties highlighted in the previous section, caregiving primarily negatively affects the health of women more than men
(Morris, 2001) . This situation seems to be linked to women carers’ greater propensity to care for longer hours, be involved in more intensive and demanding activities and reduce their non-caregiving activities at the same time, such as employment and respite participation. These changes often result in increased stress caused by financial instability and social isolation.
An equality framework for caregiving
What is needed in order to improve the situation is a radical shift from the current framework to an effective system of care and work that is more gender balanced (National Women's Council of Ireland, 2003a, b). This model would entail everybody having responsibility for caring duties within families, as well this responsibility being more equitably shared with the state.
Revalorising Care Work
In order to achieve this, first and foremost, the importance of care work must be revalorised. Williams states that care should become as important to the notion of full participation in society as paid work (2004), and Sevenhuijsen asserts that a ‘caring attitude’ should not be confined within the private sphere but become integrated into public discourse (2002) . Thus, the ‘costs’ that care entails, in time, effort, as well as income foregone in the present and the future, should be rewarded in society. Not only must those who care not be penalised for their caring, but everybody should also be encouraged to care and this caring work should be emphasised as paramount for the well being of society and its members.
Wage compensation for those reducing their working hours or giving up work in order to provide care would send a strong signal that caring is valued as highly as working in the labour market and, thus, helping to develop a dual
identity of carer-worker for all members of society, male or female. The state should also provide financial assistance to people who, for whatever reasons, are not in a position to combine work and care. At the moment there are scant provisions made for this through the Carer’s Allowance and the Carer’s
Benefit 2 .
A recent review of the these payments by the Equality Authority shows that only a third of all carers appear to be receiving these payments (2005), as they can only be accessed by people who do less than 10 hours paid work per week 3 , those who are not already receiving other social welfare payments or those who do not exceed the means test limit. Moreover, as the Carer’s
Allowance and Carer’s Benefit are less than one third of average weekly earnings, individuals and households solely dependent on such payments are at risk of living in poverty (Equality Authority, 2005). Hence, a variety of schemes to provide this financial support, such as tax benefits and social insurance payments and credits, should be put in place to address the financial needs of all those providing care and ensuring that they are not at risk of falling into poverty because of their caring responsibilities.
Furthermore, it is vital that people providing care are not penalised and do not suffer negative financial repercussions in their old age through pension allocations.
Different financial support schemes should also be available to carers who choose to avail of care services. Ideally, these services should be provided directly by the state, but where this is not possible, it is vital that these services are affordable for all people and do not discriminate against lowincome families.
2 Carer's Allowance is a means tested payment to full-time carers. The maximum weekly rate is
€153.60 for carers under 66 and €169.80 for those aged 66 and older, with up to 50% extra when caring for more than one person (these amounts are increasing to €180 and €200 respectively from January
2006). While claiming Carer’s Allowance recipients cannot receive any of the other social welfare income maintenance payments. However, they can receive other household benefits and a free travel pass. Carer's Benefit is a social insurance payment for up to 65 weeks to people who give up paid employment to become a carer (increasing to 96 weeks from May 2006). The maximum weekly rate is
€163.70 if caring for one person and €245.60 if caring for more than one person. (increasing to €180.70 and €262.60 respectively from May 2006).
3 Rising to 15 hours from June 2006.
Provision of services
Socio-economic differences in access to care are greatly emphasised where state-provided affordable care is lacking. In fact, making provision for care needs to focus not only on the availability of time and financial support, but also of services (Daly and Rake, 2003), otherwise care becomes the privilege of those who can afford to give up their time and earnings, or use them to pay for private care. Relying on markets means that gender equality is likely to be a privilege (nearly) attained by better off women only. More highly educated women pay for care and develop continuous careers whereas the less highly educated return after having fulfilled their caring duties to low paid part-time jobs and suffer a huge loss of income (Kilkey, 2004; Pascall and Lewis, 2004).
The Global Dimension of Care Work
Any consideration of care cannot ignore the current reliance on immigrant women for its provision either in the domestic or institutional sphere. The feminisation of migration is thus also significantly connected to the gender inequitable system of care in the Western world. While migration can have positive repercussions for these workers, many have been found to suffer grave discrimination in terms of pay and conditions of employment. Hence, it is particularly regrettable that these kinds of services were excluded from the provisions of the Equality Act 2004. Moreover, as shortages in this sector are rarely recognised, many of them are illegal migrants, and hence cannot avail of any formal protections.
Hence, care work is not only being shared unequally between the genders, but also between privileged and disadvantaged women globally (Ehrenreich and Russell Hochschild, 2002). A revalorisation of care work would also improve the pay and working conditions for those migrant women who are employed in this area and might help to reduce the number of years that they might have to spend apart from their families.
Current social commentaries frequently point to the decrease of social capital in society, and often associate its demise with women’s increased labour market participation (Putnam, 2000). However, the important question is whether women alone should be held responsible for the bonds that nurture society or rather whether this is the responsibility of all its members (Edwards,
Franklin and Holland, 2003). Caring has been highlighted as one of the most important aspects of social capital, and as such it should form part of everyone’s identity as well as being promoted as a desirable trait in every society.
Due to recent social changes, the traditional model which saw women solely responsible for care work is no longer sustainable. Moreover this situation was never desirable for women, having caused them significant negative repercussions both in terms of their well being and their economic, cultural and political position. Thus, a new caregiving policy needs to be promoted and implemented. This framework must ensure greater gender equity in the provision of care within families as well as highlighting the crucial role that the state should play in this field. It is only by emphasising the value of care for society that its contribution will be truly supported and cherished.
In order to ensure that caregiving becomes valued in society in general and does not contribute to gender inequality in Irish society, the Women’s Health
Rebalancing the care responsibilities of women and men
Wage compensation and other relevant financial benefit for all
carers who give up work because of the caring responsibilities.
Both parents to be entitled to paid leave upon the birth of a
Both parents to be entitled to family-friendly working patterns.
Affordable childcare services to be provided for all parents.
All carers to be able to combine caring and working without negative financial repercussions.
Appropriate services, including health and social support services, to be provided to support all carers in their duties.
Providing gender-sensitive services for carers and those they care for
All services to be based on needs-assessment rather than gender stereotyped expectations.
Carers’ health to be promoted and monitored in order to prevent negative repercussions.
Reforming official laws and policies which perpetuate gender inequality
Amend the Irish Constitution to remove gender stereotypes
and promote caring roles regardless of gender.
Amend all care related laws to promote gender equality in care.
Reform the current system of benefits and entitlements to promote gender equality in care.
Minimising the global inequalities of care
Adopt a gender-sensitive approach to immigration policies.
Amend the Equality Act (2004) to include domestic workers
Protect the family and caring rights of migrant workers.
Conducting gender-sensitive research into caregiving
Document the current gender difference in caregiving in terms of time, type, support needs and repercussions.
Armstrong, P. and Armstrong, H. (2004) Thinking It Through: women, work and caring in the new millennium. Halifax, Nova Scotia: Dalhousie University. http://www.healthyb.dal.ca/thinking.pdf
Armstrong, P. and Kits, O. (2004) 'One hundred years of caregiving' In Caring for/Caring about: women, home care and unpaid caregiving.
K.). Aurora, Ontario: Garamond Press Ltd.
Batljan, I. (2005) 'Presentation to NESF Plenary Session on Care for Older People' at
NESF Plenary Session on Care for Older People . Dublin, 28th September
Bredin, K. (1994) 'Women and dementia care in the community' In Women, the State and Mental Health . (Ed, Toft, C.). Bradford: University of Bradford Press.
Conlon, C. (1999) Women: The Picture of Health. A Review of Research on Women's
Health in Ireland. Dublin: Women's Health Council. http://www.whc.ie/publications/pic-heal.pdf
Cullen, K., Delaney, S. and Duff, P. (2004) Caring, working and public policy.
Dublin: The Equality Authority.
Daly, M. (2002) 'Care as a Good for Social Policy'. Journal of Social Policy, 31 (2), pg. 251-270.
Daly, M. and Lewis, J. (1998) 'Introduction: conceptualizing social care in the context of welfare state restructuring' In Gender, Social Care and Welfare State
Restructuring in Europe . (Ed, Lewis, J.). Aldershot: Ashgate.
Daly, M. and Rake, K. (2003) Gender and the Welfare State: care, work and welfare in Europe and in the USA. Cambridge: Polity Press.
Department of Health and Children (2000) The National Health Promotion Strategy
2000-2005. Dublin: The Stationary Office.
Department of Health and Children (2001) Health strategy: Quality and fairness - A health system for you. Dublin: Stationery Office. http://www.doh.ie/pdfdocs/strategy.pdf
Dex, S. (2003) Families and Work in the 21st Century. York: Joseph Rowntree
Edwards, R., Franklin, J. and Holland, J. (2003) Families and Social Capital: exploring the issues. London: South Bank University. http://www.lsbu.ac.uk/families/workingpapers/familieswp1.pdf
Ehrenreich, B. and Russell Hochschild, A. (Eds.) (2002) Global Woman: nannies, maids and sex workers in the new economy. London: Granta Books.
Equality Authority (2005) Implementing Equality for Carers. Dublin: The Equality
European Commission (2005) Report on Equality Between Women and Men (2005)
44 final. Brussels: Commission of the European Communities. http://europa.eu.int/eurlex/lex/LexUriServ/sits/en/com/2005/com2005_44en01.pdf
Forssén, A., Carlstedt, G. and Mörtberg, C. (2005) 'Compulsive Sensitivity - a consequence of caring: a qualitative investigation into women carers' difficulties in limiting their labours'. Health Care for Women International,
26 , pp. 652-671.
Kennedy, F. (2001) Cottage to Creche: family change in Ireland. Dublin: Institute of
Kennedy, P. (2004) 'Women, autonomy and bodily integrity' In Theorising Irish
Social Policy . (Ed, Quin, S.). Dublin: University College Press.
Kilkey, M. (2004) 'The 'Citizen-Worker' Model and Assumptions About Men, Work and Care' at European Social Policy: meeting the needs of a new Europe .
University of Oxford, Oxford, 9th - 11th September. http://www.apsoc.ox.ac.uk/Espanet/espanetconference/papers/ppr%5B1%5D.
Lane, P., McKenna, H. P., Ryan, A. and Fleming, P. (2000) Listening to the Voices of
Carers: an exploration of the hatlh and social care needs and experiences of informal carers of older people. Waterford: South Eastern Health Board.
Lee, C. and Porteous, J. (2002) 'Experiences of family caregiving among middle-aged
Australian women'. Feminism and Psychology, 12 (1), pp. 79-96.
Lee, S., Colditz, G. A., Berkman, L. F. and Kawachi, I. (2003) 'Caregiving and risk of coronary hearth disease in U.S. women: a prospective study.' American
Journal of Preventive Medicine, 24 (2), pp. 113-119.
Morris, M. (2001) Gender-sensitive Home and Community Care and Caregiving
Research: a synthesis analysis. Ottawa: Women's Health Bureau, Health
Morris, M. (2004) 'What research reveals about gender, home care and caregiving' In
Caring for/Caring About: women, home care and unpaid caregiving.
Willson, K.). Aurora, Ontario: Garamond Press Ltd.
National Women's Council of Ireland (2003a) Valuing Care Work. Dublin: The
National Women's Council of Ireland. http://www.nwci.ie/documents/vcw.doc
National Women's Council of Ireland (2003b) A Woman's Model for Social Welfare
Reform. Dublin: National Women's Council of Ireland.
Navaie-Waliser, M., Spriggs, A. and Feldman, P. (2000) 'Informal Caregiving: differential experiences by gender'. Medical Care, 40 (12), pp. 1249-1259.
O'Connor, P. (1998) Emerging Voices: women in contemporary society. Dublin:
Institute of Public Administration.
O'Neill, S. and Evans, D. (1999) Informal Care in the Western Health Board: a study of carers, people receiving care and non-carers. Galway: Western Health
Pascall, G. and Lewis, J. (2004) 'Emerging Gender Regimes and Policies for Gender
Equality in a Wider Europe'. Journal of Social Policy, 33 (3), pg. 373-394.
Putnam, R. (2000) Bowling Alone: the collapse and revival of American community.
New York: Simon & Schuster.
Sevenhuijsen, S. (2002) 'A Third Way? Moralities, Ethics and Families' In Analysing
Families: morality and rationality in policy and practices.
(Ed, Edwards, R.).
Simoni, S. and Trifiletti, R. (2005) 'Caregiving in Transition in Southern Europe: neither complete altruists nor free-riders.' In Overstretched: European families up against the demands of work and care.
(Ed, Sipilä, J.). Oxford: Blackwell
Sisk, R. (2000) 'Caregiver burden and health promotion'. International Journal of
Nursing Studies, 37 , pp. 37-43.
Wilcox, S. and King, A. C. (1999) 'Sleep complaints in older women who are family caregivers'. Journals of Gerontology Series B: Psychological Sciences and
Social Sciences, 54 (8), pp.189-198.
Williams, F. (2004) 'Rethinking Families, Rethinking Care' at Families, Children and
Social Policy - 10 years on from the Year of the Family . Croke Park, Dublin,
16 - 17th September. http://www.ispa.ie/documents/160904fwilliams.doc
Women's Health Council (2003) Women and Cardiovascular Health. Dublin: The
Women's Health Council. http://www.whc.ie/publications/31658_WHC_Cardiovascular.pdf
Women's Health Council (2004) Women's Mental Health: promoting a gendered approach to policy and service provision. Dublin: The Women's Health