4. How can social protection address women’s unpaid care work?

This chapter explores ways in which social protection policies can address women’s unpaid care work. It begins with a look at coverage gaps associated with significant underinvestment in social protection, such as in maternity leave and paid parental leave for men. There follows a discussion of policy options to redress women’s socio-economic disadvantage resulting from unpaid care responsibilities. Highlighted are the interventions of health and social insurance; cash transfer programmes; cash-for-care benefits; public works programmes; pensions; and leave benefits. The dynamics of such programmes are examined through examples from the focus countries: provision of welfare payments or transfers to enable families to care for vulnerable groups (Kenya); adapting social security and benefits to address the specific needs of unpaid care workers (Brazil); and expansion of the Social Security Fund to include informal workers and provide allowances to different categories of women, though not explicitly recognising their role in caring work (Nepal).


Connecting social protection and women’s unpaid care work

Social protection policies and programmes are designed to reduce and prevent poverty and vulnerability throughout the life cycle (Bastagli and al., n.d.[1]); (Devereux and Sabates-Wheeler, 2004[2]); (ILO, 2017[3]). They can take the form of cash transfers (e.g. childcare grants), public works (e.g. employment guarantee programmes), social security and social protection floors, pensions, disability benefits and income security for children and their families; they also include labour market policies, including paid maternity, paternity and parental leave (Corono and Gammage, 2017[4]; ILO, 2018[5]; UN Women, 2015[6]). As will be discussed in this section, these provisions and policies can all have the explicit goal of addressing unpaid care work.

Despite significant progress in the extension of social protection in many parts of the world, only 45% of the global population are effectively covered by at least one social protection benefit. The remaining 55%, equal to 4 billion people, are left unprotected (ILO, 2017[3]). Globally, social protection coverage is lower for women than for men (UN Women, 2015[6]), but pertinent gender-disaggregated data are often missing. This makes it difficult to make comparisons across countries or to have a clear picture of gender disparities in coverage.

Coverage gaps often stem from significant under-investment in social protection, particularly in Africa, Asia and Arab countries. In Africa for instance, effective coverage – combining contributory and non-contributory programmes – is as low as 18% of the total population, and there is a much greater reliance on informal support systems. In Latin America, the development of progressively comprehensive social protection systems over many years has resulted in 67% of the population being effectively covered by at least one cash social protection benefit (ILO, 2017[3]).

Regions also have different priority areas. In Africa and Asia, the extension of social protection to workers in the informal economy is one of the most pressing issues that governments need to deal with, along with developing social assistance programmes for those who cannot work (i.e. children, mothers with newborns, persons with disabilities, older persons, and the unemployed). In Latin America and the Caribbean one of the priorities is to extend social insurance programmes to groups difficult to cover, such as rural workers, the self-employed, domestic workers and migrant workers (see ILO, 2017 ([3]) for regional social protection priorities).

The vast majority of women lack maternity protection. Across the globe, only about 40% of women in employment are covered by maternity protection (57% if voluntary coverage is included, for example for self-employed women) (ILO, 2014 cited in ILO, 2017 ([3])). Currently, 830 million women are without adequate maternity protection1 and other social protection, such as maternal and child healthcare; the overwhelming majority are in countries in Africa and Asia (ILO, 2017[3]). Furthermore, most maternity cash benefit programmes only cover women in formal employment, placing workers who are self-employed, part-time or in other non-standard forms of employment at a disadvantage.

Meanwhile, relatively few countries offer paid parental leave to men and so reinforce the gender divide in parenting and childcare, although this is slowly changing. The lack of adequately paid care leave entitlements and the inadequate provision of affordable care services contributes to both gender inequality and overall inequality. Substantial gaps also exist in leave programmes to care for children, adults and older family members who are ill or disabled, as many countries do not have any relevant legislation. In those where leave exists, it is often unpaid or paid at a low rate (ILO, 2018[5]).

Due to women’s structurally different relationship to the labour market, they also have less access to employment-based or contributory social benefits. Having to combine unpaid care work with income generation often pushes women into vulnerable forms of employment and informal work, with very limited social protection in areas such as healthcare or insurance and lower rates of pension and retirement coverage. Existing data indicate that at the global level, 68% of people above retirement age receive a pension, either contributory or non-contributory (ILO, 2017[3]). In many low-income countries, however, where a large proportion of older persons depend heavily on family support, this figure falls to less than 20% (ILO, 2017[3]). Where sex-disaggregated data exist, statistics show that pension coverage for women in the majority of countries is lower than for men: in 15 out of 23 countries for which data are available the share of women that have pension coverage is lower than the share of men, while in 3 countries coverage is equal and in 5 countries, the share of women’s coverage marginally exceeds that of men.

Carers’ interrupted workforce histories cause gaps in their pension contributions, resulting in significantly lower retirement incomes and greater risk of poverty in old age (Hamilton and Thompson, 2017[7]). As women take on a greater portion of caring responsibilities than men do, they are more likely to have low incomes in old age (Hamilton and Thompson, 2017[7]). While a little over 40% of the global working-age population are currently covered by law with a pension once reaching the eligible age, this is the case for only one out of three women of working age (Bonnet and Tessier, 2014[8]). The gender gap in pension entitlements is particularly marked in countries with contributory pension systems, as women’s lower labour force participation and – due to their unpaid care responsibilities – intermittent formal employment patterns make them less able than men to make payroll contributions (ILO, 2014[9]).

Social protection: reinforcing gender stereotypes by focusing on care deficits

In many cases, social protection policies and programmes are not gender- or care-sensitive but primarily target women in their roles as mothers, at best reinforcing gender stereotypes and at worst further driving the inequalities deriving from this ascribed caring role (UN Women, 2015[6]). Moreover, even where such social protection programmes have been designed with a consideration for care, the focus has been on keeping children, elderly and sick people or people with disabilities with their families, with the implicit expectation that women will provide any required care, either unpaid or in exchange for low levels of support, thus relieving the state of responsibility.

Social protection options to address unpaid care work

The combination of social protection and public services can be a powerful tool to redress women’s socio-economic disadvantage resulting from unpaid care responsibilities and related unequal employment opportunities (UN Women, 2015[6]). Social protection policies set a framework for the “most appropriate and desirable” types of care, care providers (“public, private or voluntary sectors”) and care funders (“through contributory, non-contributory or employer liability systems; by universal or means-tested benefits”) (ILO, 2018, p. 30[10]). Meanwhile, direct provision of care through investment in accessible and affordable public services, such as childcare centres or long-term care for older persons, directly reduces the unpaid care work primarily performed by women: provision responsibilities are transferred from households to the state (see Chapter 6 on public services for further discussion).

Despite the gaps highlighted in the previous section, unpaid care issues are increasingly being recognised in the design of broader social protection systems. Some measures more explicitly attempt to reduce and redistribute unpaid care work and ensure women’s representation in the delivery of policies and programmes addressing care, while others help expand access to care services through expansion of social insurance. Uruguay is unique in having established a National Integrated Care System (Sistema Nacional de Cuidados/SNIC) in 2015 and approved a National Care Plan (2016-20) to implement and co-ordinate care policies for adults with specific care needs, including persons with disabilities, the elderly and small children (see Box 4.1). The national care system aims to be the fourth pillar of the country’s social protection system, along with health, education and social security (Esquivel, 2017[11]).

Box 4.1. Uruguay’s National Integrated Care System

International and national feminist advocacy in the 1990s provided the initial impetus for measuring unpaid care work. In Uruguay, this advocacy led to the collection of data through time-use surveys to quantify unpaid care work, culminating in the creation of a National Integrated Care System (Sistema Nacional de Cuidados/SNIC) that mandates an integrated care system. The system’s success can be explained by the country’s enabling environment – which includes the existing feminist movement – its low female participation rates in the labour force, a rapidly ageing population, the quality of data and effectiveness in communicating data results, and motivation for policy change.

Uruguay’s national care system objectives include respect for caregivers’ rights, both paid and unpaid. The national care system is enshrined in a new law entitled the “legal right to care and be cared for”, and includes fiscal reforms to ensure its sustainability and universality (Esquivel, 2017[11])The Uruguayan care system also brings to light the situation of paid care workers, who are usually low waged but whose working conditions and levels of pay determine to an important extent the quality of care they provide (Esquivel, 2017[11]), and provides an example of a rights-based approach to care policies. Moreover, it reflects the importance of representation through a strong and long-standing feminist movement that provided the advocacy needed to assert women’s rights and measure all of women’s work, both paid and unpaid. The care system is based on the principle of co-responsibility of the state, the community, the market and families – including men as well as women – in the provision of care (Esquivel, 2017[11]).2

The Uruguay case both influences and is influenced by wider policies in the region. A rights-based approach to care policies has been progressively enshrined in the regional agreements that have emerged from the Regional Conferences on Women in Latin America and the Caribbean, namely in Santiago (1997), Lima (2000), Mexico City (2004), Quito (2007), Brasilia (2010), Santo Domingo (2013) and Montevideo (2016).

Source: (Buvinic and Blecker, 2017[12]), Uruguay's national care policy; (Esquivel, 2017[11]), The Rights-based Approach to Care Policies: Latin American Experience; (Omilola, 2014[13]), Social protection in Africa: A review of potential contribution and impact on poverty reduction.

A range of measures have been tried to recognise and, in some cases, reduce and redistribute unpaid care work. Table 4.1 provides an overview of intervention options.

Table 4.1. Approaches to social protection addressing unpaid care work across different intervention areas

Intervention area



Health and social insurance

Extending coverage to informal and unpaid workers

Including maternal health and other care entitlements in universal health insurance packages

Mutuelle de Santé, Rwanda

Cash transfer programmes

Combining financial support for families with essential nutrition, healthcare, childcare services and education

Providing crèche/childcare facilities as part of programme

South Africa Child Support Grant

Brazil Carinhoso (part of Bolsa Familia)

Mexico Prospera programme

Cash-for-care benefits

Benefits or vouchers for households with care responsibilities

Voucher programmes in France, Belgium, Chile

Asignación Universal por Hijo, Argentina

Public works programmes

Providing childcare at worksites

Extending access to paid care services through PWPs

Productive Safety Net Programme, Ethiopia; Mahatma Gandhi National Rural Employment Guarantee Act 2005, India

South Africa Extended Public Works Programme


Contributing credits to compensate time spent in caring

Programmes in Uruguay, Chile, Plurinational State of Bolivia, Finland, Sweden

Leave benefits

Universal maternity leave coverage

Extending “use it or lose it” paternity leave benefits


Myanmar, Uruguay, Iceland, Sweden

Health and social insurance

Over the past two decades, several countries have started to roll out universal health coverage3 reforms, using a variety of approaches and funding sources to enhance affordability for the poor and workers in the informal economy. For instance, in rural areas of People’s Republic of China, the Rural Medical Co-operative Scheme had enrolled more than 830 million people by late 2009. Similarly, the Ghana government introduced the National Health Insurance Scheme (NHIS) in 2003 to attain universal health insurance coverage and ensure equitable health care. In 2010, 66% of the population was registered with the NHIS. Another example is found in a pilot project in Rwanda, the community-based health insurance Mutuelle de Santé, initiated in 1999/2000: by 2012, 90% of the population was covered (Holmes, 2016[14]).

Affordable health care is particularly important for women because they have less access to personal income, face costly health conditions such as pregnancy and childbirth, and are often responsible for the healthcare of other family members. A number of health and social insurance programmes have shown progress in covering life cycle events that put women in a more vulnerable position. These include health insurance programmes that specifically include family planning; cover pregnant women and/or childbirth and/or waive the premiums for pregnant women; and offer maternity insurance. There are also pension programmes that amend the calculation of pension benefits, which leads to women benefiting even when they live longer on average. In some instances, however, social insurance programmes do not cover reproductive healthcare (Holmes, 2016[14]) or require higher premiums for women. In Chile, for example, where the National Public Health Fund (Fonasa) reaches nearly universal coverage (96%) and includes low income workers, women have been subject to significantly higher premiums than men of the same age because of maternal care needs (Holmes, 2013[15]).

Cash transfer programmes

Cash transfer programmes, both conditional (CCTs) and unconditional (UCTs), as well as public works programmes (PWPs) currently cover 718 million people worldwide (World Bank, 2015[16]). Public works programmes are now implemented in 94 countries, many of which are in Africa. CCTs have expanded considerably in Latin America and the Caribbean, where they cover about 133 million people (Cecchini, Filgueira and Robles, 2014[17]). Such social protection programmes often target female-headed households for benefits or make women in jointly headed households the household’s transfer receiver; the aim is to facilitate women’s access to labour markets; increase their income and ability to own productive assets; enhance their control over income; and in some cases, increase investments in children’s education, nutrition and health.

Cash transfer programmes have facilitated girls’ access to education and can increase women’s bargaining power within households by putting cash directly into their hands and improving the intra-household allocation of resources. Beyond economic benefits, social protection programmes targeting women can also improve the well-being, health and nutrition of poor women, as well as enhancing their self-esteem, increasing their involvement in social networks, and enabling their community and political participation. Such programmes can also promote recognition of gendered economic and social risks linked to socio-cultural norms, especially when such norms may prevent women’s active engagement in economic and social activities (Holmes, 2009[18]).

However, existing evidence indicates that the cash transfer programmes are not always automatically empowering. Evaluations of Ghana’s Livelihood Empowerment against Poverty programme, for example, found that in spite of transfers directed to women, decision making remained with husbands, brothers and sons (UN Women, 2015[6]). In addition, transfer amounts are usually too low, and often too irregular and inconsistent to be effective in providing women with financial independence or a greater say in household decision-making. For CCTs, women are often assigned the responsibility to complying with requirements linked to children’s health, education or nutrition, thus reinforcing their responsibility for childcare (Molyneux, 2016[19]; Molyneux, 2007[20]) and jeopardising their ability to participate in paid work or skills development (Fultz and Francis, 2013[21]; Molyneux, 2007[20]). Therefore, while women may derive benefits from such approaches, these initiatives often fail to address structural causes of gender inequality linked to unpaid care work and can further entrench gender stereotypes and divisions (e.g. (Holmes, 2013[15]; Kabeer, 2008[22]; Sabates-Wheeler, 2003[23]).

Several countries have implemented child-sensitive social protection programmes that combine financial support for families with essential nutrition, healthcare, childcare services and education, while also ensuring that care workers have good working conditions. The Child Support Grant in South Africa, introduced in 1998, was designed as gender-neutral in its targeting, allowing for both male and female primary caregivers as recipients (Clulow, n.d.[24]). In practice, however, most beneficiaries of the CSG are female (Vorster, 2008[25]). Quantitative as well as qualitative studies show positive impacts of the CSG, which provides an important source of income for the whole family. That results in a reduction of financial stress through receipt of the cash transfer, improved child-carer and intra-family relationships, and greater engagement of women in decision making on finances and around children (Roelen, K.; et al., 2015[26]). Less is known about its impact on the division of care responsibilities in the home or on gender relations. Similarly, there is little evidence of these grants providing a transformative environment in relation to unpaid care work (van den Berg, 2015[27]) (see Chapter 2 for more on this issue).

Cash transfer programmes, particularly CCTs, are increasingly recognising that both mothers and fathers have responsibilities as breadwinners and caregivers. Many programmes, namely in Brazil, Chile and Mexico, now include services such as quality affordable childcare initiatives (see Chapter 5 on public services), as well as awareness raising to challenge the traditional division of paid work and unpaid care work between women and men (ILO, 2017[3]). In the case of Brazil, time spent complying with the conditions of Bolsa Familia’s cash transfers seems to account for a reduction of time spent on paid work by women beneficiaries, an effect not found among men. Acknowledging this effect, both Bolsa Familia and the Prospera programme in Mexico have begun to offer complementary crèche programmes to beneficiaries.

Cash-for-care benefits

Some states implement cash-for-care benefit systems, as a way of recognising and compensating the activities of unpaid carers, such as benefits and voucher systems in France, Belgium and Chile. These provide an incentive for unpaid carers to work for pay out of the household by enabling them to purchase public or private childcare services, or to hire domestic workers. However, the amount of benefits is often low compared with the market cost of good-quality care (ILO, 2018[5]). For example, Argentina offers a monthly family allowance for parents who are unemployed or work in the informal economy (Asignación Universal por Hijo) and income transfers of USD 45 to unemployed heads of household with dependants under the age of 18 or with disabled household members of any age (Plan Jefes y Jefas de Hogar Desocupados).

An example of targeted benefits for disabled carers is an EU-funded pilot project implemented in Kyrgyzstan by a co-operative of Kyrgyz women with disabilities. The project identified Kyrgyz families with newborn babies with disabilities, and with mothers with disabilities. These particularly vulnerable families received an in-kind maternity grant, in the form of a “baby box” that included essential items to take good care of their children during the lactation period. Clothes, blankets and other essential items for the baby box were produced by the tailoring co-operative of women with disabilities. This small demonstration project thus played an important role also in terms of employment creation for women with disabilities.

Public works programmes

PWPs, or employment-guarantee programmes, such as those established in Ethiopia, India and South Africa, can provide poor or unemployed women and men with an important source of income in the face of persistently high levels of unemployment, widespread rural poverty, and economic crisis. In addition, some programmes, such as the National Rural Employment Guarantee Scheme in India, may offer better conditions for women than available employment alternatives (UN Women, 2015[6]). However, women often end up being paid less, and women’s representation in public works‐related decision-making structures is often inadequate (Holmes and Jones, 2011[28]).

Moreover, the design of public works programmes has focused largely on the productive sphere of work and generally has not sought to redistribute the costs of social reproduction, thereby often reinforcing the existing gender‐based division of labour (ant). There is evidence that these programmes can exacerbate care issues in terms of children’s safety and care (on worksites) and the inter-generational transfer of care burden (often but not exclusively to girls), or lead to exclusion of women with heavy care responsibilities (for children, people with disabilities, elder care) (Holmes and Jones, 2011[28]).

A variety of public works and social protection programmes have begun to consider the implications of women’s unequal caring responsibilities in their design (see Box 4.2). Within public works programmes, investments have been made to ensure they do not further exacerbate women’s time poverty or the unequal sharing of care responsibilities, by expanding community social care services and offering day care for children and crèche services (Holmes, 2010[29]). In the north-eastern regions of Brazil, microcredit and skills training for women are supplemented by publicly funded childcare services for children under the age of six under Brasil Carinhoso (“Caring Brazil”), a sub-component of the cash transfer programme Bolsa Familia.

Box 4.2. Public works programmes and provision of childcare

In India, the Mahatma Gandhi National Rural Employment Guarantee Act mandates that rural households have the right to 100 days per year of unskilled employment, and established that childcare must be provided at worksites and organised by women workers. In practice, however, these requirements have been difficult to implement (Fultz and Francis, 2013[21]), and childcare facilities are not always of adequate quality.

Programmes in other countries, such as the Expanded Public Works Programme in South Africa, have incorporated training and job accreditation in early childhood development programmes and for home- and community-based care services, as a way of providing job opportunities to women (Parenzee, 2016[30]). This results in benefits for the care providers and an increased supply of affordable care services. However, the programme has also faced implementation challenges, namely being able to provide work opportunities at scale. Another example of efforts to make programmes gender sensitive is found in Ethiopia with the Productive Safety Net Programme, which provides childcare at programme worksites: one worker, paid the same as other participants, is appointed to care for the children (Omilola, 2014[13]).

Source: (Fultz and Francis, 2013[21]), Cash Transfer Programmes, Poverty Reduction and empowerment of Women; (Omilola, 2014[13]), Social protection in Africa; (Parenzee, 2016[30]) Who Cares? – South Africa's Expanded Public Works Programme in the Social Sector and Its Impact on Women.


Some contributory pension systems have recognised unpaid care work through adopting contribution credits for carers to improve women’s pensions and help redress women’s socio-economic disadvantage in old age. Contribution credits for caregivers are one way to address the adverse impact that (mostly) women’s time spent out of the labour force and dedicated to taking care of others can have on pension entitlements (Azra, 2015[31]). For some, but not all programmes, they are provided whether the care is for children, the elderly, the sick, or people living with disabilities.

The design and impacts of contribution credits for carers vary across countries. In some countries, pension amounts increase irrespective of whether work was interrupted or not, while in others contribution credits compensate for the period spent out of the formal labour market caring for children. In still others, credits for caring periods count only toward pension-qualifying years (Azra, 2015[31]); (also see Box 4.3).

Box 4.3. Contribution credits for carers in Latin America

Some countries in Latin America have recently adopted contribution credits for carers. In Uruguay for instance, women are credited with one year of contributions per child (up to a maximum of five) toward the qualifying conditions of social insurance pensions. In Chile, a child credit was introduced in 2008 to improve the pension benefits of women in the private defined contribution system. The credit consists of a contribution of 10% of a minimum wage for 18 months per child (plus interest), financed by the state and deposited into women’s individual accounts. In the Plurinational State of Bolivia, following a pension reform in 2010, mothers can also benefit from a contributory credit equivalent to one year of contributions per child, up to a maximum of three years. Women can use this credit either to get better benefits from the solidarity pillar or to anticipate retirement.

Source: (Azra, 2012[32]), Pension Reforms and Gender Equality in Latin America.

In many pension programmes, contribution credits are paid to the main caregivers independently of their sex. In practice, however, women accrue more credits than men do, given that women take on the larger share of caring work. In Finland and Sweden, contribution credits are linked with “use-or-lose” leave and cash benefits for fathers, thus encouraging men to take on a greater sharing of caregiving and enabling transformative change in gender relations (UN Women, 2015[6]) (see next section on leave benefits). By contrast, most of the newly created contribution credits in Latin America are targeted to mothers, excluding fathers or other caregivers and thereby not challenging gender stereotypes.

Leave benefits

The availability to both women and men of adequate maternity, parental and childcare leave benefits (including provisions in cases of children with illnesses and disabilities), is an important element of social protection systems that directly address unpaid care. Effective universal maternity coverage has been achieved in Ukraine and Uruguay, while Argentina, Colombia, Mongolia and South Africa, among others, have made significant progress (ILO, 2017[3]).

Reforms in leave policies facilitate a greater involvement of fathers in childcare through introducing or extending paternity leave, as well as (in some cases) providing incentives to increase men’s take‐up of parental leave (ILO, 2018[5]). Fathers’ involvement in childcare not only has positive effects on children’s health and parent-child interactions, but also contributes to gender equality, both in the home and at work. Today, paternity leave is mandated in 94 countries, compared to only 40 countries in 1994 (Socialprotection.org, 2018[33]). For example, Myanmar and Uruguay extended paternity leave, paid by social insurance. Other countries that have recently introduced or extended paid paternity leave include Bolivia, Lao People’s Democratic Republic, Mexico, Nicaragua, Paraguay and Portugal (ILO, 2017[3]), as well as Brazil. Although paternity leave is becoming common, the mandated leave period is often less than one week, or unpaid.

Ensuring take-up has been a challenge in some countries, especially among lower-income groups.4 Non-transferable quotas, commonly known as “use it or lose it” leave or “fathers’ quotas”, may be one of the most important factors to encourage men’s take-up of leave and equal participation in care work (Shand, 2018[34]). In Iceland, fathers averaged 39 days of leave in 2001. After the fathers’ quota was instituted, leave rose to 103 days in 2008 (Moss, 2014[35]). Additionally, in Sweden and Iceland, which both offer a non-transferable fathers’ quota, men’s take-up is much higher (90%) than it is in Denmark (24%) or Slovenia (6%), where quotas are transferable between parents (ILO, 2014[9]). Assigning leave as an individual entitlement for each parent can normalise men’s take-up by not requiring mothers to give up their leave days so that fathers can take leave, and better supports diverse family structures (Shand, 2018[34]).

Adequately paid leave, ideally paid in full through social security benefits, can also increase men’s take-up of leave and support new parents and families. Take-up of leave in Estonia increased from 14% of eligible fathers in 2007 to 50% in 2008 after paternity leave benefits were increased to 100% of previous wages (ILO, 2014[9]). Fathers across the European Union most frequently cited insufficient compensation as the reason for not taking leave (ILO, 2014[9]).

Elsewhere, there have been measures to extend maternity protection coverage to women who were previously unprotected. The introduction or extension of non-contributory maternity benefits, usually funded by taxes, is an important means of ensuring maternity protection for those women outside formal employment, or those in the formal economy who do not qualify for contributory benefits (ILO, 2017[3]). Non-contributory benefits are usually not directly associated with an interruption of employment in the form of maternity leave, but pursue a broader objective of providing pregnant women and new mothers with a predictable cash benefit during the final stages of their pregnancy and after childbirth. They therefore represent an important source of income security around childbirth in the absence of contributory benefits. In India, for example, to reach women without maternity protection, the Indian 2013 National Food Security Act established a maternity benefit over six months to support maternal and child nutrition and well-being. Yet the amount paid is less than the minimum wage, and far less than the average amount received by formally employed women.

Evidence from Brazil, Kenya and Nepal on how social protection can address women’s unpaid care work

A range of approaches to social protection were identified in Brazil, Kenya and Nepal, including cash transfer programmes, social security and pensions, some of which recognise or address care issues to a limited degree. Annex C provides a brief overview of the initiatives discussed in this section and their approaches to unpaid care work.

One approach is the provision of welfare payments or transfers to enable families to care for vulnerable groups, exemplified by Kenya’s Cash Transfer for Orphans and Vulnerable Children (CT-OVC) programme and Older Persons Cash Transfer programme (see Box 4.4). By providing a very small stipend to carers in the family or community, the CT-OVC initiative implicitly recognises and values the unpaid care work that family carers provide to vulnerable groups, by acknowledging that some resources are required for poor families to be able to continue providing adequate care, while still being able to undertake paid work. Box 4.4 explains how this initiative, as well as the subsequent Older Persons Cash Transfer, was developed; the latter is currently being extended into a universal pension. A drawback of such programmes, where women are often the majority of beneficiaries, is that they tend to transfer small sums, particularly when compared to contributory programmes where men are more likely to benefit.

Box 4.4. Care of vulnerable groups and social protection in Kenya

In 2007, Kenya launched a pilot project using internal “challenge funds” to respond to the devastating effects of HIV-AIDS. Two hundred people in two districts were given payments over a period of 100 days. The intention was to support the most vulnerable people, namely orphans, disabled and sick people, including but not limited to those affected by HIV-AIDS (which were heavily stigmatised), and keep them in the care of their families and communities. A rapid assessment was carried out, evidence of the positive impact of the pilot project was provided to the Treasury (Ministry of Finance), and the government decided to roll out the project nationally. By October 2017, 1.75 million orphans and vulnerable children (OVCs) (an estimated 40% of the total number) were enrolled in the programme.1 The initiative was one of the earliest examples of how social welfare policies could support those impacted by HIV-AIDS.

In 2011-12 a second programme was established, the Older Persons Cash Transfer. The OPCT was a response to the secondary effects of poverty on children living in households headed by older people. The OPCT targets poor and vulnerable older people aged 65 and over. The project covered approximately 24% of the population in the targeted age group in 2015-16 (HelpAge International, 2018[36]), and is fully nationally funded. As of May 2018, the government is on the point of extending the OPCT programme into a universal old age pension, for all persons aged 70 and above.

The gender ratio of beneficiaries differs between the programmes. For the CT-OVC, nearly four times as many women as men (3.7:1) are the payment recipients in the child’s or children’s household, whereas more men than women (1.4:1) receive the individual old age payment.

The level of individual payments is the same under the two projects, currently KES 2 000 (USD 19) per recipient per month, scarcely enough to cover an individual’s basic food basket, according to official poverty calculations. Nevertheless, both the first official post-pilot assessment and later independent assessments (HelpAge International, 2018[36])2 show many positive externalities, including conferring social capital on the beneficiaries; improving children’s vaccination rates and educational attainment; ensuring that vulnerable people can stay in the care of their families; older people sharing their food with grandchildren and other family members; and a regular payment that allows credit to be raised for family expenditures such as housing upgrades.

1. See the social protection section of the Summary Report on OECD Policy Dialogue on Women’s Economic Empowerment, 25 January 2018, http://www.oecd.org/development/gender-development/OECD-Policy-Dialogue-WEE-Summary-Note-Jan-18.pdf.

2. http://projects.worldbank.org/P111545/kenya-cash-transfer-orphans-vulnerable-children?lang=en&tab=results.

Source: Key informant interviews, Kenya.

A second approach consists of adapting social security and other benefits such as pensions, maternity leave and paid sick leave, so that they include or address the specific needs of unpaid care workers. This is observed in Brazil’s so-called Housewife Policy, where there is “formal recognition of unpaid care work in social protection through earlier retirement age and a voluntary social security scheme for housewives” (Key informant interview, Brazil). In 2005, policy makers changed the Constitution to ensure that the pension system included special coverage of certain workers who are low income and homemakers. Since 2006, Brazil has effectively included “housewives” in its social security provisions by reducing the rate of contributions made by low- or non-income earners, from 20% to 11% and then to 5% of national minimum wage. This is funded mainly through contributions made by micro entrepreneurs and low-income and no-income workers, although it is not clear how sustainable this coverage is, as no evaluation has been done.

These changes in the pension system are universal but particularly affect women – thus the nickname “Housewife Policy”. This initiative reflects the lessons learned by the Brazilian government from previous experiences of housewives having difficulties paying into contributory social security provisions, such as pensions. It was part of a broader set of measures implemented at around the same time, including the Simples Federal, which also simplified social security taxes for small and medium-sized enterprises (Berg, 2011[37]).

In Nepal, the government is expanding the Social Security Fund, which receives 1% of the monthly salary paid by formal employers to all employees to include informal workers. The funding initially comes from the government sector and a small proportion of formal sector employees, which is unlikely to be sufficient to extend the provisions of the programme, or provide adequate benefits. Unpaid care workers are not covered, however: while “home-based workers are included, no one is talking about housewives” (Key informant interview, Parliamentarian, Nepal). Challenges to the recognition of housewives in the country’s social security system include a lack of awareness by unpaid care workers themselves that they could be eligible to contribute; a lack of clarity on how to create provisions to include unpaid care workers in the coverage; and uncertainty about ways to measure and count housework.5

A few other social security programmes in Nepal provide benefits for particular categories of women, such as the elderly allowance with affirmative provision for women over 60 who are widows; the single women allowance for women over 40 who have never been married or are separated; and the disability allowance. None of these programmes, however, explicitly recognise women’s role in caring work. Moreover, the amounts transferred are typically too low to have any effective impact. Additionally, social norms within Nepal discourage those entitled from accessing them (Key informant interview, Women’s Rights Activist, Nepal), which suggests a need to raise awareness of the benefits of contributing to and accessing social security funds.

Lessons learned in Brazil, Kenya and Nepal on addressing unpaid care work in social protection

While the social protection policies or programmes identified recognise unpaid care work in different ways, few have any explicit intent to reduce or redistribute it. For example, the main objective of Bolsa Familia in Brazil is to recognise and address poverty. As such, “unpaid care work is not necessarily a priority” (Key informant interview, Former Staff, Bolsa Familia, Brazil). Similar points were echoed around the Child Grant in Nepal, where the primary objective is supporting better nutrition for children under five years of age in the Karnali region and Dalit households in the rest of the country.

As the social protection initiatives identified in the selected countries do not directly monitor changes in unpaid care work, it is difficult to ascertain long-term impacts from this perspective, although some negative, immediate outcomes could be identified. The CT-OCV project in Kenya, for example, may increase women’s unpaid care work by maintaining beneficiaries within the household. In fact, where evidence exists it suggests that failure to consider unpaid care work adequately may undermine the whole intent of initiatives. For example, an independent assessment of the Karnali Employment Programme, a major public works programme in Nepal, revealed three factors that negatively affected women’s participation in the programme: lack of childcare provision; long distances to the worksites; and long working hours with no provision of drinking water, toilets or safety equipment (IDS, 2017[38]). Lack of childcare provision either discourages women with small children from continuing to work or forces them to take small children to the worksite – which on the one hand slows down their work and on the other puts children’s health at risk.

The extent to which these social protection policies and programmes recognise unpaid care work is primarily driven by concern about the consequences of care deficits for particular social groups, rather than about the impacts on carers themselves. In Kenya for example, the rapid assessment showed that inadequate care was being provided to vulnerable groups, which provided the Treasury with evidence that led to the national roll-out of the pilot social pension system (see Box 4.4). This suggests that instrumental arguments, recognising the role of unpaid care work to fill in gaps in care services, can also be beneficial if they result in getting unpaid care work onto the policy agenda.

Social protection can reinforce restrictive gender stereotypes

In routinely targeting women as mothers or carers, social protection initiatives frame societal expectations on unpaid care work, reinforcing stereotypes around who provides care. This challenge was identified in Kenya, where women make up the majority of the CT-OVC programme beneficiaries, and “people notice that unpaid care work is mostly done by women” (Key informant interview, Kenya, Social Pension). Similarly, women are the main recipients of social assistance services in the public system in Brazil, which also reinforces the view of women as natural carers.

In Brazil, there were recent signs of more openness to addressing social norms around unpaid care in social protection programming. Starting in 2016, Bolsa Familia looked into addressing the critiques by “many liberal feminists … that it naturalises women’s care role” (Key informant interview, Former Staff, Bolsa Familia, Brazil). This had the initial aim of “increasing communication with men to deconstruct hegemonic masculinities”. Specifically, this sought to change the image of who receives social assistance, as well as to train social workers on how to talk to men and women about their roles in the programme. Discussions in Brazil since then have also led to an increase of paternity leave from 5 to up to 20 days, again underlining a broadening of the policy agenda to address gender stereotypes and social norms surrounding care. Due to wider changes in the policy environment, the scope for further innovation is increasingly limited. Yet, as indicated in Box 4.5, and with the Kenya pilot (see Box 4.4), innovation is crucial to getting unpaid care work onto the social protection agenda.

Box 4.5. Advocating to get unpaid care onto the agenda in Brazil

Women’s movements in Brazil have lobbied governments to pass legislation that would provide basic labour and social rights for paid care workers, such as minimum wage legislation and coverage in terms of health insurance. Brazil provides an example of how recognition of paid domestic work enabled unpaid care to become more visible, as “until recently domestic work was not considered a job” (Key informant interview, Brazil). The policy process involved the creation of a specific working group in 2010 including civil society, a domestic worker and union membership, which worked with actors within government including the Secretariat of Women, various ministries and the Presidency. The working group initially focused on changing the constitution to align Brazil with ILO Convention 189 on domestic workers. In 2015, a law came into force that made paid domestic work equal to other private sector work. The discussions in this forum then provided the opportunity for women’s groups to push for recognition of the work of unpaid care workers. Specifically, the aim was “supporting informal unpaid domestic work by trying to get it into the social security system”. The scope for further work in this area was however limited by the excessive number of advisory councils (thus stretching the capacity for civil society engagement in policy processes), as well as the gap between policy makers (who are mainly men) and those councils, which according to key informants has grown since 2016.

Source: Key informant interviews, Brazil.

In fact, getting unpaid care issues onto the policy agenda requires time and energy, for political mobilisation and for the detailed technical work of designing policy. For the “Housewife Policy” in Brazil, discussions leading to its creation in 2015 started in 2004 within the Secretariat for Women’s Policy in collaboration with CSOs and women’s rights organisations (Box 4.5). In Nepal, women’s movements have also played a key role in having unpaid care work recognised in the Constitution, which – over time – could enable consideration of including unpaid care work in the Social Security Fund.

A number of actors working together are instrumental in designing and implementing care-sensitive social protection policies. Buy-in from policy makers and ownership of their design and implementation by national government is important. In the Kenya social pension’s case, the Head of Community Development at the Ministry of East African Community, Labour and Social Protection had a particular interest in ensuring that the carers of vulnerable groups were recognised. The roll-out of a universal pension plan for older people in May 2018 that partially recognises care issues resulted from collaboration among the government, donors (e.g. DfID, WFP, World Bank) and specialist agencies (UNICEF) to provide technical assistance in the payments system and evaluation of the plan. Implementation of the social pension has involved working through banks to ensure that payment kiosks are within 5 to 6 kilometres of beneficiaries. The proximity of payment outlets to communities is critical to ensure that receiving pensions does not add to beneficiaries’ time poverty.

Unfortunately, competing policy agendas and political processes often relegate the unpaid care issue to a back seat, even among organised women’s groups. Similarly, while there are provisions for women’s rights and the Constitution has recognised household work, “some people don't want to hear the word feminism – not only the men, even some women’s rights groups” (Key Informant Interview, Nepal).6

What emerges, particularly in Brazil and Nepal, are competing agendas where limited human resources within both civil society and government ministries constrain their capacity to address this issue in addition to their other commitments and priorities. There is also ongoing tension between those who see giving money to women as an empowerment strategy versus those who see it as naturalising women as caregivers. Finally, even when unpaid care issues do get onto the policy agenda, challenges or reversals are likely, as experience with Bolsa Familia in Brazil indicates. While some see the programme as a major step forward to create a more just system, others challenge the dependency that the programme might create, which may also have an impact on any scope for further recognition of unpaid care work.

Key findings

Constituting the majority of unpaid carers, women in low-income countries heavily rely on social protection yet have worse access to and lower adequacy of benefits. Additionally, a vast majority of women lack maternity protection, as it often covers only women in formal employment. Women also face challenges in accessing pensions and other social security programmes, due to lower participation rates and their over representation in jobs (self-employed, unpaid family workers) or sectors not covered by existing social security laws, such as agriculture.

The design of social protection programmes and policies often adopts an instrumental approach, which focuses on “care deficits” and the impact on vulnerable groups and sees unpaid care work as a means to fill gaps in care services. Social protection programming largely targets women in their role as mothers or carers, with the intent to increase welfare outcomes for children or other vulnerable groups, or more broadly to reduce poverty. However, this risks reinforcing existing stereotypes of women as “natural” caregivers. Only a handful of initiatives have attempted to address or transform stereotypes around unpaid care in this domain. Efforts have included offering adequate parental leave to men and incentives to increase men’s take‐up, which challenges norms around household responsibilities and promotes the gender divide in parenting and childcare. Unfortunately, few policies or programmes have the explicit intent to recognise, reduce or redistribute, and few monitor changes in unpaid care work. There is limited evidence of other policies managing to achieve the 3Rs in social protection; that points to a need for better monitoring and more research.

Social protection policies and programmes can be reframed with the explicit goal of recognising, reducing and redistributing unpaid care work. Ensuring the representation of unpaid care workers in discussions of priorities is key to policy formulation. Some measures, such as care credits in contributory pension systems, maternity leave and medical support (e.g. paid sick leave), address the specific needs of women as unpaid care workers or their unequal access to benefits. Others help expand existing entitlements and access. Cash transfer plans, particularly CCTs, are increasingly recognising that both mothers and fathers have responsibilities as breadwinners and caregivers.

The “right to care and be cared for” has only very recently been recognised, mainly in Latin American countries. Alliances among actors with common interests are key to making care visible and getting it onto the social protection policy agenda. Having women’s movements work closely with other CSOs, trade unions and parliamentarians is vital to raising the profile of the issues. There is potential also for building alliances with advocates for the elderly, the disabled, and other groups with specific care needs. Committed individuals within ministries can be key to innovation in this area and to achieving buy-in from policy makers. Technical capacity to support the design and implementation of care-sensitive social protection policies by national government is also required.

Finally, despite some advances, particularly in a few middle-income countries, there is insufficient investment in social protection to extend coverage to those providing unpaid care. Shifts in demographic, family and household structures, are taking place globally with implications for women’s income and, in turn, care-sensitive social protection and care provision. Many parts of the world have seen growing numbers of single-parent households with women often raising children on their own, while the migration of both women and men raises additional challenges for the care of children or elderly parents (UN Women, 2015[6]). Many households cannot afford to extend support to others for long periods, while community-based support is frequently minimal and precarious. Social policies in general, and social protection policies in particular, need to adapt to the reality of population ageing, single parenthood and migration (UN Women, 2015[6]; ILO, 2018[5]) and address growing care deficits in this context.


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← 1. The Maternity Protection Convention No. 183 (2000), which is the most up-to-date international labour standard on maternity protection, provides for 14 weeks of leave and entitlement to a cash benefit that ensures the women can maintain themselves and their child in proper conditions of health and with a suitable standard of living; it shall be no less than two-thirds of their previous earnings or a comparable amount.

← 2. For further analysis of the connections between unpaid care and paid care work, and the experiences of care workers both unpaid and paid.

← 3. The World Health Organisation defines universal health coverage as “ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship” (https://www.who.int/health_financing/universal_coverage_definition/en/).

← 4. See the social protection section of the Summary Report on OECD Policy Dialogue on Women’s Economic Empowerment, 25 January 2018.

← 5. A total of NPR 550 million (USD 4.9 million) was allocated for initially setting up the Social Security Fund. Subsequent administration has been financed by the government from its budget.

← 6. A total of NPR 550 million (USD 4.9 million) was allocated for initially setting up the Social Security Fund. Subsequent administration has been financed by the government from its budget.

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