Gender and Caregiving

This presentation is based on a position paper published last December by WHC which can be downloaded from our website ( 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 men and the state, the family and the market” (Daly and Rake, 2003).

Recent 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 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.

Care Policies

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.

  • 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.
  • Adoptive Leave is available to an adoptive father only in the case of the death of the adoptive mother.
  • 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.
  • 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 government’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, 2004).

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 two-fold (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 Feldman, 2000).

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.

Financial supports

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].