Imported to Care

Chances are if you live in the United States, you might know, work with or employ someone who has traveled from overseas to work in the United States. Many of these workers are women, and many of them work in “care” jobs such as housekeeping or child and elder care.

Quite often, your neighbor’s nanny, the people who take care of your kids, or the people who maintain your school gardens and clean your offices are from the Philippines, El Salvador, Nepal or Bangladesh. Nurses trained in Jamaica and Ghana, doctors from India and health technicians from the Philippines attend you or your loved ones in hospitals and in urgent care.

Across the world women are in motion, leaving families and communities behind to work elsewhere in wealthier nations. They leave because jobs are available elsewhere; they come because there is a growing demand for their services. As more women enter the labor force in wealthier economies they have less time to fulfill traditional caring roles, such as staying at home to care for children and aging parents.

The Migration Policy Institute reports that as of 2015, nearly one in three U.S. doctors (physicians and surgeons) were foreign born. In 2010, women accounted for three of every four foreign-born health care workers. Nearly one-third of foreign-born women employed in health care occupations in 2010 worked in health care support jobs as nursing, psychiatric or home health aides. Yet a 2010 study showed that almost one-quarter of foreign-born workers employed in these health care support jobs lack health insurance themselves, and worked without access to affordable health care when they, or a loved one, became sick.

Data tells us that in the U.S. immigrant workers make up 47 percent of the workforce in health care and social services. And the U.S. Census Bureau tell us that 25 percent of all immigrants—compared to 17 percent of all native workers—were in some type of service occupation in 2014. Many of these services are personal services in care work and the majority of these workers are women.

Care work is often seen as a women’s job, a natural extension of the role women have in society. In fact, it’s hardly questioned that care workers are disproportionately women. And because care work is perceived to require few skills, there is a belief that anyone can do it. As a result, care work commands little monetary value. In most cases, migrant workers in the ”care economy” work in jobs that earn low wages and that typically do not come with benefits and workplace protections—particularly when the work takes places in our own homes and communities.

Even when this care work is hired-in to the home, these jobs sit firmly in that blurry terrain between formal and informal work, and since much of the service rendered is about demonstrating care and affection, it is easy for the cared-for—and sometimes for the carers themselves—to devalue this work. And therein lies one of the biggest ironies of care work: so many of us depend on others who perform care work, who are increasingly migrants, that we do not question if they work long hours for low pay or that they have few opportunities to earn pensions and have paid vacation and lack the right to health care themselves.

This begs the question: How can we resolve this apparent conundrum that care work is valuable, important and increasingly in demand yet is too often is rewarded with low wages and associated with poor working conditions and long hours? It is a tough puzzle to solve, but not one that is impossible.

The Sustainable Development Goals (SDGs) provide an excellent opportunity for us to tackle this problem to ensure that care is valued and that care workers have the rights they deserve. The SDGs are a set of universal goals that the international community has signed on to in order to guide their investments in development assistance and to reduce poverty and inequality worldwide. To date they have been seen largely as commitments that are relevant for foreign aid to the poorer countries and not as universal principles that will need to be reported on and monitored within the national boundaries of the wealthier nations.

One of these commitments is to “recognize and value unpaid care and domestic work through the provision of public services, infrastructure and social protection policies and the promotion of shared responsibility within the household and the family as nationally appropriate.” This goal is acutely relevant to all countries where entrenched gender inequalities mean that women specialize in caregiving while men tend to specialize in paid work. This goal is also particularly relevant in contexts where migrants densely populate care work and the care sector in host countries, including right here in the United States.

These commitments provide a new opportunity to raise concerns about the need for better care options for families and more quality jobs in care for those seeking employment. They provide a new opportunity for citizens to ask the government to provide services such as after-school programs for children or to offer tax credits to put income in the hands of families so they can purchase in-home help or send an aging parent to senior care or a child to child care. This would make care options more affordable and accessible for many and would provide an opportunity to increase the value of care work. Further, it would ensure that caring jobs are good jobs and that minimum wages and legislation about hours and conditions of work are upheld.

After all, although we need care, we want good quality care for our loved ones and that usually goes hand-in-hand with good quality jobs.



Dr. Sarah Gammage is an economist with more than 25 years of experience as researcher and feminist economist, providing policy advice and supporting strategic advocacy on gender equality in Latin America, Africa and Asia. She is the senior director, Gender, Economic Empowerment and Livelihoods at the International Center for Research on Women.