Integrating unpaid care work in gender transformative health programmes: Good practices and lessons

Introduction

Unpaid care work (UPCW) can be defined as caregiving that is undertaken in the absence of monetary compensation. This is broadly categorized into direct personal and relational care (such as caring for children, elderly, sick, etc.) and indirect care activities (cooking, cleaning, etc.). 

Globally, more than three quarters of UPCW is shouldered by women and girls and has direct implications for their health and wellbeing, including their sexual and reproductive health and rights and maternal newborn health (SRHR/MNH). For example, time poverty directly reduces women and girls’ access to essential health services, like antenatal care, which impacts their overall wellbeing. The stress of unpaid care work leads to poor prenatal and postnatal outcomes, increasing obstetric risks, mental health issues, and physical burdens, particularly during crises like the COVID-19 pandemic.

This blog calls for positioning UPCW as integral to gender transformative (GT) health programming, and presents select evidence-based good practices and lessons from multi-country SRHR/MNH programmes.

Integrating unpaid care work in gender transformative health programming

GT health programming addresses the root causes of gender inequalities at the individual, interpersonal, family/community and institutional levels, for optimal SRHR/MNH outcomes. Common strategies include building women’s and girls’ agency through access to accurate and empowering information, decision-making skills, and financial asset building. Male partners, women power holders and gatekeepers are trained to create an enabling environment for gender equality. Duty bearers are engaged to increase gender and age responsiveness of services, policies and laws. ADRA Canada’s TOGETHER and Plan International Canada’s SHOW projects, among others, offer examples that recognise gendered division of care work, rooted in unequal gendered power relationships as a key barrier to optimal health outcomes. Aligned broadly with the 5R framework and more directly with recognising, reducing and redistributing UPCW, the following examples outline how promoting equitable sharing of care responsibilities was integrated in SRHR/MNH programmes.

1. Recognizing the value of unpaid care work: 

This includes measuring time-use and the distribution of unpaid work within families, how care is provided and by whom. GT programmes typically gather sex and age disaggregated data at baseline on distribution of unpaid care work between different gender and age groups to map prevalent gender hierarchies and norms. For example, ADRA Canada documents time use among women and men in all its GT initiatives, including through routine project monitoring systems. Data on time use of participants, tracked in ADRA’s TOGETHER project which aims at bridging gaps in quality healthcare delivery in Kenya, Uganda, Cambodia and the Philippines, helped inform training content targeted at increasing awareness, acceptance and responsibilities among male partners to share household works. This in turn freed up women’s time enabling them to access critical life saving health services and participate in locally-led development initiatives. 

2. Reducing drudgery and hours spent on unpaid care work: 

This includes enabling women to access time and labour saving technologies and infrastructure to minimise their burden of care work. Examples include long-term infrastructural solutions such as safe piped water resulting in fewer water-borne diseases and short-term interventions like time-saving devices, such as smoke free solar cooking stoves, limiting indoor airborne diseases for women and children. At a minimum, GT programmes can promote adoption of labour saving technologies, for direct benefits towards health outcomes.

3. Redistributing the responsibility of care work more equitably: 

This includes shifting social and gender norms around distribution of care work and promoting gender-responsive social protection systems, including responsive child care infrastructure. Positive outcomes, documented as part of Plan’s SHOW project (Bangladesh, Ghana, Nigeria, Haiti and Senegal), demonstrate how engagement with women’s/girls’/boys’/men’s groups and women powerholders on unpacking unequal gender roles, and pushing for men’s accountability towards care responsibilities, led to  increased intra-household harmonious relationships, psychological and physical respite from care work and improved health of women and girls, especially during pregnancy and postpartum phases.

Similarly, ADRA’s TOGETHER project integrated male engagement strategies to promote redistribution of unpaid care work within families. Early monitoring results show that male and female community members in Uganda and Cambodia had stepped up to take childcare work, enabling their spouses to fully engage with the project activities. In both examples, communication strategies positioned male partners as not just partners of gender equality programming, but beneficiaries, who could gain exponentially from a shift towards healthier relationships and families. In support, project messages focused on rejection of shame and stigma associated with a shift in gender roles.

Project-level operational and compliance commitments are equally critical. Examples include child-friendly safe spaces or child care allowances to ensure inclusion of those with care responsibilities, as well as creating adequate capacity building for staff and intermediaries to eschew their own biases regarding UPCW.

4. Representing and responding to care workers’ rights: 

This includes creating opportunities for paid/underpaid healthcare workers, both facility-based and community-based, formal and informal, to be represented through mechanisms such as workers’ unions. It also includes efforts to respond to their rights. Examples of interventions include projects supporting local labour and women’s rights organisations to advocate towards strengthening healthcare, and domestic workers’ rights. Projects also train duty bearers on using gender-responsive budgeting and planning tools to design government interventions which redistribute UPCW through institutionalised and universal childcare systems and strengthen social protection and rights of workers in the care sector. 

In conclusion

Health and SRHR programmes that endeavour to be gender transformative should integrate interventions on recognizing, reducing, and redistributing women’s UPCW to optimise health outcomes. Programmes must include agency building of women and girls, sensitisation of men and boys, and women power holders to reduce women’s drudgery and increase redistribution of UPCW. They should also mitigate backlash against those women/girls and men/boys who reject gender stereotypical roles. Finally, GT approaches can be messy and complex. Often they are intentional in design, but require continuous reinforcement among rights-holders, intermediaries and staff. Programming should therefore include adequate funding for training staff,  regular support and monitoring.