Care and Support: Persisting Challenges in the Region

Why was an International Day of Care and Support established?

All people require care and support at some point in their lives. As defined by UN Women and ECLAC (2020), care encompasses various daily tasks that sustain life. This includes maintaining the household, caring for bodily needs, education, managing social relationships, and providing psychological support to the family. On July 24, 2023, the UN General Assembly approved the proposal of 13 countries to officially establish the International Day of Care and Support, to be celebrated every October 29.

This milestone contributes to ending the invisibility of essential work that benefits families, individuals and communities. Care work plays a significant role in national, regional and global economies. It is estimated that the economic value of hours spent on unpaid care worldwide represents 9% of the global Gross Domestic Product. This is equivalent to US$11 trillion per year. In OECD countries, this proportion amounts to 15% of GDP. The International Labor Organization suggests that the value of care represents between 10 and 39% of GDP, depending on the country. In Mexico, this figure reached 24.7% of GDP in 2021, with 18% contributed by women.

In the region, demand for care is expected to increase rapidly. By 2050, IDB estimates project that this demand will reach 14 million paid caregivers. They will mainly be located in long-term care services for the aging population.

Persistent challenges in the care economy

Despite the above, there are persistent challenges to ensuring gender-sensitive access to quality care.

Care overload is a gender issue

In the region, the unequal burden of care work, whether paid or unpaid, is a gendered problem. Gender norms are a major cause that assigns girls and women the responsibility for caregiving. There is little evidence that these norms are changing over time. Approximately half of respondents to the 2018 World Values Survey stated that preschool children suffer when their mothers work, with little or no difference between genders (IDB, 2023). The latest Social Institutions and Gender Equality Index (SIGI) report, which measures discrimination against women in social institutions, highlights that 56% of respondents agreed with the statement “When a woman works, the children suffer.”

At the same time, according to ECLAC time use figures (2021), women in the region dedicate, on average, two thirds of their time to unpaid work and one third to paid work, with variations among countries. Other IDB estimates for Chile, Colombia and Costa Rica show that between 63% and 84% of unpaid workers who provide long-term care for their family members are women. Their work represents between 72% and 88% of the hours dedicated to long-term family care. At the same time, the gender gap in participation is among the highest and most persistent, standing at about 32 percentage points in 2022. This contrasts with Latin American averages of 23 percentage points and OECD averages of 16 percentage points.

Why does unpaid care work matter?

The time women spend on domestic and unpaid care work directly influences the time they are able to devote to paid work. The ENASIC (2022) conducted an analysis of non-economically active women who provide care. Of these, 39.7% said they “would like to work for an income,” and 26.5% said they “could not go to work”. The main reason for not working, even if they wanted to, was that “they had no one to care for their children” (68.4%) or “they had no one to care for the elderly or sick” (78.4%). Other documented effects are on the health and well-being of women caregivers. In the case of Mexico, 35.4% of women caregivers stated that for this reason they “felt tired” or “decreased their sleep time”. Furthermore, 16.3% responded that they “felt depressed” and 12.7% “had their physical health affected”.

Paid opportunities are scarce and when they do exist, they are precarious.

Despite its contribution to the economy, the provision of paid care in the region is still limited. Even when paid, it traditionally offers low wages, often in the informal economy and with few social protections and precarious working conditions. Jobs in the care economy have lower status, pay and benefits than other types of work.

A recent IDB publication estimated the number of paid caregivers for 17 countries in the region. It highlights that 95% of paid caregivers are women and that there are approximately 8.9 million paid caregivers in the region. Of these, 5.8 million care for children, and 3.1 million care for the elderly and people with disabilities. However, only 27% of paid caregivers are formally employed, when the average formal employment rate is around 43%. In addition, paid caregivers earn below the minimum wage, averaging US$249 per month.

Opportunity to transform this reality

Women’s care overload perpetuates gender inequalities in the region, creates barriers to women’s economic empowerment, and reduces their potential to pursue careers. Initiatives supported by the Bank have taught us that caregiving issues must be approached with a systemic perspective. This implies considering the needs of both the care recipient and the care provider. This approach includes aspects such as institutional governance, financing, quality and standards, rights, monitoring and evaluation, as well as human resources.

There are opportunities to promote gender equality in the region through the design and investment in Integrated Care Systems as a pillar of social protection. Below, we list some of them:

• Integrated Care System: A Comprehensive Care System can be defined as a set of policies aimed at implementing a new social organization of care with the purpose of caring for, assisting, and supporting people who require it, as well as recognizing, reducing, and redistributing care work -which today is mostly performed by women- from a human rights, gender, intersectional and intercultural perspective. Furthermore, given the level of informal work in the region, access to some services and benefits should be separated from formal work.
• Formalization of care work: The growing demand for care work, particularly for long-term services, has the potential to increase formal employment rates of professionals in the sector and improve their working conditions. The quality of care can be improved by recognizing care as a profession, developing curricula, encouraging training and strengthening social protection systems.

Much remains to be done to achieve true equity in the distribution of time and care responsibilities in the home.

What about you? What policies or actions do you consider a priority in responding to the growing demands and needs for care?