# Care work

Care work includes all tasks directly involving the care of others. The majority of care work is provided without any expectation of immediate pecuniary reward. Instead, it is undertaken out of affection, social norms or a sense of responsibility for others. It can also be a form of paid employment.
It refers to occupations that provide services to help people develop their capabilities, or the ability to pursue aspects of their lives that they value. Examples include child care, all levels of teaching (from preschool through university professorship), and health care (nurses, doctors, physical therapists, and psychologists). Care work also includes unpaid domestic work that is often disproportionately performed by women.
Although it is frequently focused on providing for dependents such as children, the sick, and the elderly, care work also refers to work done in the immediate service of others (regardless of dependency) and can extend to "animals and things". The study of care work, linked to the fields of feminist economics and feminist legal theory, is associated with scholars who include Marilyn Waring, Nancy Folbre, Martha Albertson Fineman, Paula England, Maria Floro, Diane Elson, Caren Grown, and Virginia Held.

## Functions

Care work is essential to well-being. Without care and nurturing, it is thought that children cannot develop into high-functioning individuals and will have difficulty as adults maintaining (or expanding) their well-being and productivity. Actively-involved child care provided in the home or by the public or private sector contributes to the development of healthy, productive children. Effective care for the sick allows them to remain productive and continue contributing to society. Care work is related to the functioning of a society and its economic development of that society; well-cared-for people can more effectively contribute social and human capital to the market.
Caring for others is often costly, and care work is associated with a "care penalty"; work caring for others is often not financially compensated. It has been suggested that individuals who do not take care of others may not be capable of reproduction; receiving care is often necessary for individuals to reach the stage of life where they can care for others.
Although a popular belief in economics is that a household distributes wealth rather than creates it, it has been said that the household sector plays an important role in wealth creation. Unlike the business sector, wealth created by the household sector is not financial; much work done there is unpaid. The resulting wealth is social; care work by parents in raising a child increases the child's ability to perform in society later. Individuals who benefit from receiving care generally perform better in academic and social settings, enabling them to create financial wealth later in life and play a part in increasing social capital. According to Sabine O'Hara, "everything needs care"; she sees care as the basis of a market economy.

## History
### Family and community

Before the Industrial Revolution, care work (such as taking care of the household and raising children) was performed by the family and often involved the contributions of a community. The core sphere was not seen as separate from daily business interactions, because the concept of the market did not yet exist.

### Effects of industrialization

With the dawn of the industrial era, the core sphere became separate from jobs and business which were performed away from the home; men left home to work in factories and at other non-domestic jobs. Women, considered better suited to nurturing, were expected to provide child care and do housework. This familial hierarchy persisted in the American family with a breadwinner father, a homemaker mother, and their children. Not all families, however, were like this. Unlike white women, Black women and women of color were expected to work; almost 80 percent of single black women, compared to 23.8 percent of single white women, worked outside the home in 1880. The labor-participation rate of white women fell after marriage; labor-force participation remained stable for Black women, and Black men and women both contributed financially to the household.
Domestic work became an important element in a stable workforce. With the abolition of slavery in the U.S., Black women were increasingly hired as domestic workers. The history of domestic work in the United States is one of gender, race, citizenship, and class hierarchies. Although domestic work was a paid job, it was not recognized as such by the law or society. Because domestic work is in the private sphere and typically performed by women, it was often depicted as an "act of love" or rewarding in itself. This has been used to justify the lack of legal protection of domestic work, such as in the exclusion of domestic workers from the National Labor Relations Act guaranteeing the right to form labor unions. "Live-in" workers, such as nannies and housekeepers, do not have overtime protection under the Fair Labor Standards Act. Whether women worked or stayed in the home, their duties were believed to be unimportant and were largely ignored.
Work performed in the home often has a considerable replacement cost, but is not factored into productivity; paying others to perform care work is often prohibitively expensive. It is more cost-effective for families to substitute their time for the replacement cost. Paid care work is considered employment, but work done by family members is not counted as productive in the market and is overlooked when determining employment status.
More women participate in the labor force (at least part-time) than they did a century ago, and many believe that the "cult of domesticity" for women of the 19th and 20th centuries is obsolete. Women dominate caring professions such as teaching, child care, nursing, and social work, and most of these professions pay considerably less than jobs more frequently held by men. Women working outside the home are frequently still also expected to do housework and raise the children. Care work is still considered economically unimportant, and women have difficulty escaping gender roles.

## Care workers
### Women and unpaid work

Studies have indicated that women provide the majority of unpaid child care, and some have shown men to be more likely to support the elderly than to care for children. The comparative willingness of women to perform unpaid care work has contributed to the poor compensation received by people in care-based professions. The expectation that women would provide these services without assurance of financial compensation has devalued care work, leading to these professions being underpaid in comparison to professions requiring similar training and work but not equivalent to domestic tasks.
Women have a heavier burden of care work in the home than men do, largely due to differences in gender socialization and historical and cultural tradition. They are taught to be more caring and affectionate than their male counterparts. This does not imply that women are biologically predisposed to perform care work. Historical and cultural traditions explain the widely-held ideology of women's role in caring for others. In Nepal, women work 21 more hours each week than men; in India, women work 12 more hours. In Kenya, 8-to-14-year-old girls spend five hours more on household chores than boys do. Most of these extra work hours for women are spent on care work. This poses a problem for women; the extra hours of domestic care work create difficulty in balancing domestic and market work.
The creation of separate spheres, public and private, in the nineteenth century contributed to the belief that caring was incompatible with the workplace and belonged to the family only. The historical push of women into care work, combined with the contemporary dominance of women in these fields, accounts for the modern conception that care work is inherently feminine work. However, care work is socialized into a feminine sphere and is also done by males. Care work has become so feminized that there is a stigma against men who engage in it. This stigma may discourage men from entering care work and propagate the belief that it is inherently women's work. The conflation of women's work and care work can ignore cultural, political, racial, and ethnic differences among women.
Differences in earnings exist between high-school and college graduates, which are especially pertinent between males and females looking for work. Women tend to find more opportunities in unpaid care work if they are unable to enter the paid workforce. Individuals without a college degree may not meet the requirements of many jobs, and much of the world population is unable to attend school due to caring for elderly or sick family members.
An increasing number of companies claim to provide care, including airlines. According to its ad, Lufthansa provides "Service as dependable as a shoulder to lean on." The accompanying picture was of a woman leaning her head on a man's shoulder, with both sound asleep. British Airways had an ad with a similar message: "New Club World cradle seat. Lullaby not included." Its image showed a woman with a baby in her arms.

### Division by socio-economic class

Most paid care work is performed by members of the working class, predominantly women. The U.S. domestic workforce is about 2.2 million people, of which an overwhelming majority (91.5 percent) are women. Half identify as Black, Hispanic, or Asian American Pacific Islander, and Black and Hispanic women are over-represented in the domestic workforce. About 35 percent of domestic workers were not born in the U.S., many of whom are women of color. Scholars have described this phenomenon as the "international division of reproductive labor" or the "care chain". In this "chain", housework is commodified; women who can afford to do so pay other women, usually immigrant women of color, to do their housework. In their home country, other women do their housework. Care work is not necessarily face-to-face; in his study of Vietnamese transnational marriages, Hung Cam Thai considers migrant remittances a form of care work.

## Baumol effect

The market prices of items required for care increase and care work continues to be non-paid in what is known as the Baumol effect, described by William Baumol and William Bowen as a relative increase in the price of services without substitutes – for example, the costs of child care and sending children to college. People are living longer, and there are fewer siblings to share elder care than there were during the mid-20th century baby boom. The rising cost of items needed for care takes a toll on people who are generous and cooperative.

## The market

An economy has four sectors: business, household, public, and non-profit. The business sector is typically considered paramount, but all four parts of an economy generate wealth and are interdependent. One reason that unpaid care work is largely ignored is because of the belief that a household does not create wealth, but the household prepares children for the other sectors of the economy.
Although care work has largely been associated with domestic unpaid work, it is more frequently paid. This shift has implications for care work and society as a whole. As care work is increasingly marketized, those who need care – the sick, the elderly, and children – will not be able to afford the care they need. The quality of care may decrease in response to the profit motive.
The marketization of care work is under public and academic scrutiny for its endemic low pay for care work, the effects of the market on the quality of care, and the implications of the market on care workers. Five theories (devaluation, public good, prisoner-of-love, commoditization of emotion, and love-and-money) have been explored by academics.

### Devaluation theory

Devaluation theory seeks to explain the low wages typical of care work by focusing on the fact that many care workers are women, and sexism persists. Decision-makers underestimate the contribution of female-dominated jobs to organizational goals (including profits), and underpay these workers.
The theory is supported by sociological studies. In 2002, sociologist Paula England conducted a study that revealed, after controlling for skill demands, educational requirements, industry, and gender, a net penalty of five to 10 percent for working in an occupation involving care; one exception was nursing, which did not seem to experience the pay penalty of other care work.

### Public-good theory

Care work has a number of indirect social benefits that are associated with public goods; goods with benefits that are impossible to deny to those who have not paid for them. Education, an example of care work, is an example of a public good. Care work is unique in the category of public goods in that receiving care helps recipients develop skills, values, and habits that benefit themselves and others.
This theory may explain the low wages characteristic of care work. The standard economic argument is that public goods will be under-provided by markets because there is no way to capture (and turn into profits) benefits of social interaction.

### Prisoner of love theory

Care work has been defined as work that provides services based on sustained personal interaction, and is motivated (at least in part) by concern about the recipient's welfare. This understanding affects the nature and wages of care work. If care workers are motivated by the intrinsic value of their work, economic theory holds that they will tolerate lower wages for their work. The connection these workers feel to their work places them in a poor bargaining position.

### Commoditization of emotion theory

Commoditization of emotion theory focuses on the effects of marketized care work on care workers' experiences and well-being. It holds that many jobs in the service economy require workers to display emotions they do not feel, which is harmful to them.

### Love-and-money theory

The "love-and-money" theory attempts to reconcile the perceived divide between work done for intrinsic motivation and work done for pay. Theorists assert that because men and women are seen as opposites and gender governs thinking, a dualistic view develops that "women, love, altruism, and the family are, as a group, radically separate and opposite from men, self-interested rationality, work, and market exchange." This belief has led to the idea that care work should not be performed for pay because pay will undermine the intrinsic motivations for this work; however, studies have shown that these divides may not be so stark. It has been found that acknowledging rewards sends the message that the recipient is trusted, respected, and appreciated. These results suggest that the more that pay is combined with trust and appreciation, the less it drives out genuine intrinsic motivation (especially important in care work). Theorists believe that the central problem with care work is under-demand, and it should be better compensated by the market.

## Public policy

The debate surrounding care work has policy implications: issues of market structure, work environments, incentive schemes, regulatory requirements, and adequate financial support for care. Another policy area related to care work involves gender analysis in economic policy.

### Unremunerated care

The Unremunerated Work Act of 1993 would require the Bureau of Labor Statistics to conduct surveys that would measure unpaid labor and include it in the GDP. The bill was supported by many, but not all, feminist economists. Critics said that it would romanticize care work and propagate gender biases in the field, believing that care work could be performed more efficiently outside the home. Other critics said that efficiency would be valued over affection and the quantity and quality of care.
Accounting for time spent in unpaid care is difficult because it is often an emotionally-involved activity. A "social desirability" bias exists, with husbands reporting more time spent on care work than their wives would report for them (and vice versa); providing care is considered praiseworthy. Problems with reporting can be minimized through a time diary, in which respondents describe activities performed the previous day; responses are then standardized for analytical purposes.
Women in 32 countries provide an estimated annual $1.5 trillion in health care, according to a study published in The Lancet. According to a McKinsey Global Institute study, global economic output would increase by $12 trillion if unpaid care work performed by women were compensated at minimum wage around the world – 11 percent of global economic output, equivalent to China's annual economic output.

### Wage parity

A second policy relating to care work is the push for higher wages. Advocates of this policy believe that individuals who respect and fulfill norms of care will be seen as economic losers if wages are not increased, and some economists believe that the supply of unpaid care services may gradually erode.

### Gender

A number of models surrounding care work involve its feminization, and focus on an attempt to make care work more gender-neutral or less disproportionately-burdensome to women. The universal-breadwinner model aims to achieve equity through female employment and parity with men. The caregiver-parity model promotes increased support for informal care work and forms of employment for women (such as part-time employment) which would increase their time available to perform domestic care work. The first model shifts care work to the market and the state, and the second keeps care work within the household with public support. Both models, to some extent, lift the burden of care work from women and transfer it toward the state or toward men.
Another model is the shared earning/shared parenting marriage, which does not transfer public money to women for care work; men are responsible for half the care work, and women take half the financial responsibility for the family's basic needs. This model focuses on removing developmental distortions from feminization of care, such as symbiotic mothering or paternal neglect.
A 2020 meta-analysis by Jenny Young et al. found that research on care work under-reports male care workers, and the experience of men is understood less well. In 1989, Sara Arber et al. referred to men as "the forgotten carers" and found that they have a larger share of care work than is often recognized.

#### Gender analysis

Care work, disproportionately performed by women and often unpaid, highlights the importance of gender in economic policy. A number of economists say that gender analysis should be part of the consideration of any economic policy.

### Global economic policy

Care work is manifested differently around the world due to differences in the availability of domestic service, the extent of the informal economy, and international migration. Economists say that differences exist between Northern and Southern countries which would affect certain policies in the Global South. Public policies suggested for these regions include increased availability of daycare centers, greater access to schools and health care, improved public transportation, and increased access to telephones.

## Care penalty

Care penalty describes sacrifices made in performing care work, and Nancy Folbre explores the care penalty in depth in The Invisible Heart. Care penalties may be an array of sacrifices, such as a loss of personal time, money, or experiences while providing care. The care work in question can be provided to children, animals, the elderly, the sick, the mentally challenged, the learning-incapable, and others with similar disabilities. Care work limits a person's ability to compete with those who do not have to provide such care.
Folbre says that the care penalty leads to distributional struggles which are relevant to gender roles. When two people have a child, in most cases one parent sacrifices more than the other so the other can provide for the family. Most of the time, the parent who stays home and cares for the children is the mother. According to the 2012 U.S. Census Bureau report, there were 189,000 homes with stay-at-home dads and 5,091,000 homes with stay-at-home moms. By taking time off from the workforce, these women are at a disadvantage for years to come.
This long-term decline in earnings is called by Folbre the family gap, or the motherhood gap. The reduction in compensation is not attributable to working fewer hours; mothers with families are often overlooked for advancement opportunities. The motherhood penalty has been increasing, in part, due to the increased parity of pay for men and women. In 1991, it was estimated that the motherhood gap accounted for 60 percent of the difference between men's and women's compensation.
Parenthood evokes the most significant, and most common, care penalty. The cost of raising a child increases, and sacrifices made to raise children are increasing at the same rate. Being responsible for a child can dictate decisions on where to live, what to do in one's free time, and what jobs to take.
Parenthood may be the most common source of the care penalty, but elder care also imposes costs on the caregiver. Unlike parenthood (which entails choice to some extent), an individual cannot choose whether to have elderly members of a family such as parents. Caring for elders is not legally required of a son or daughter, unlike legal parental responsibility to care for children. There is a societal expectation, however, that adult children will care for their parents. The possibility of an inheritance may also affect the behavior of adult children.
The care penalty received by caregivers of the elderly can be as costly as that received by parents of young children. Penalties can be emotional and economic. Research has shown that over 60 percent of caregivers for the elderly experience depression. Brandeis University research demonstrated that about 66 percent of caregivers lost career opportunities, such as training, due to care obligations.
The care penalty, to some degree, is shaped by public policy. In the United States, the Family Medical Leave Act provides that mothers are entitled to 24 weeks of leave and must be permitted to return to their previous position. The act, however, only provides unpaid leave and does not address long-term reduction in earnings or career advancement. The prevalence of part-time employment often influences the severity of the care penalty; it is more severe in the United Kingdom, since part-time employment is more common.
Raising successful children benefits society; employers benefit from productive employees, and the elderly benefit from the Social Security taxes paid by young workers. Parents benefit because of reciprocity, with the child giving care and the parents receiving it.

## Over-representation of women

Evolutionary biology explains female investment in care as a rational response to ensure their pregnancy and child; men need to diversify their opportunities by distributing their seed widely enough to ensure that their genes are promulgated by invested females. Institutional economics emphasizes that this ignores the power of social institutions which exaggerate biologically-explained male power, including strength and freedom from childbearing and child-rearing activities. The social arrangements perpetuated by these institutions are considered to be internalized as individual preferences.
Gerda Learner's research on the history of women has identified patriarchy (institutionalized male dominance) as a human-devised social institution which originated during the Bronze Age. Learner says that the "production of the idea system", including our recorded history, was constructed within and imbued with a patriarchal system that under-emphasizes female contributions to society. She writes that this misrepresentation of women in history under-emphasizes their role beyond domestic work and dampens their future ambitions outside the home, reinforcing this misrepresentation.
Patriarchy has excluded women from written history and has limited their political representation, education, and property rights. Law and public policies have reinforced the patriarchal structure. Until the Nineteenth Amendment to the United States Constitution gave women the right to vote, female interests were thought to be represented through male political participation. Women only began to secure property rights on a state-by-state basis after the American Civil War, although women continued to lack any legal claim to their husband's income at that time.
Institutionalized patriarchy has limited female agency in the public sector by concentrating political and economic power among men. Braunstein and Folbre cite Gary Becker's rotten-kid theorem as refuting the idea that a woman's interests can be adequately represented by her husband. If individual family members consistently acted in the collective interest of the family, it would be in the interest of individual family members to act in coordination with the family; this is not always the case, as demonstrated by the rebellion of children. Recognition of what they call the "non-benevolent patriarch" debunks the idea that women can be adequately represented by a single head of household; families have a myriad of interests not always manifested in one member's actions.
According to Braunstein and Folbre, the hierarchical relationship produced by the patriarchal system allocates care work to women. Understanding that economic resources increase bargaining power, they say that men – who have historically controlled the resources – encourage female specialization in care work to limit their economic activity (and bargaining power) to preserve male authority. The individual controlling financial resources is seen as more interested in preserving their power than in preserving the well-being of the family. Braunstein and Folbre demonstrate that more egalitarian families, where men and women have comparable economic resources, distribute care work more efficiently than patriarchal structures with asymmetrical concentrations of power.
Public policy can be interpreted as covertly enforcing patriarchy by discriminating against single-parent households and encouraging a patriarchal family structure based on a primary income earner and an unpaid care laborer. The 1996 Personal Responsibility and Work Opportunity Act in the U.S. cites, among its goals, ending pregnancy outside marriage and promoting two-parent households. The United States tax code imposes a lower tax rate on families of earners with a wide income disparity than that applied to families with adults earning similar incomes.