It’s time to talk about care. Or so says Melinda Gates. Last month while Bill was talking about climate change, Melinda announced in their agenda-setting annual letter that she’ll be focusing on unpaid care work and women’s time poverty.
Care work encompasses a great variety of tasks that promote the well-being of individuals, families and communities. It includes housework, growing food and grocery shopping, child rearing, nursing the sick and elderly, caring for the disabled, and teaching, among other things. Much care work is paid work — although much more of it is unpaid, occurring in households and community centers. Everywhere in the world, women do the majority of this work.
The notion of women’s time poverty stems from what feminist economists refer to as “the double shift”: paid work in the formal or informal economy, and unpaid care work in the household. There is also the “triple shift,” which includes often low-income women’s unpaid community labor, for example volunteer work in communal kitchens and social programs.
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Melinda’s announcement is a big deal. Why? First, because she’s not talking about Band-Aids and incremental changes to the status quo. She’s talking about changing the rules of the game that have held back gender equity, constraining some while others flourish. Tackling time poverty means transforming social and economic systems and institutions. Importantly, thanks to Melinda’s massive microphone, people are going to listen. And they are going to want to get on that rocket ship as it blasts off into funding a serious paradigm shift. This could be huge.
The to-do list in order to achieve the recognition, reduction and redistribution of care work is going to be a million miles long and diverse groups, voices, tools and efforts will be needed. From my work with women in rural Peru to analysis of current policy trends, here’s one suggestion that could be widely and immediately implemented: it’s about how we measure impact.
Measuring the impact of efficiency
Well-intended anti-poverty interventions often fail to account for women’s care work and, as a result, so do their evaluations.
Today, the global health and development community is besotted with measuring efficiency, mostly with quantitative (statistical) metrics: How many lives saved? How many vaccinations administered? How many girls in school? Speaking of microphones, this move towards efficiency metrics is in no small part attributable to Bill Gates’ 2013 annual letter on measuring progress.
To be sure, there is an important place for this kind of statistics-driven evaluation — it promotes accountability and transparency and reduces waste on interventions that don’t work. But this way of evaluating success (and failure) doesn’t provide a complete picture. The way we measure impact and efficiency often renders women’s care work invisible, but it doesn’t have to. Perhaps part of the solution is making care work visible, changing what we count.
Cash transfers and time poverty
A practical example of this is found in conditional cash transfer programs, which are at the forefront of efficiency-driven development interventions. Termed by The Economist “the world’s favourite new anti-poverty device,” CCTs provide cash incentives to low-income mothers on the condition that they seek prenatal care when pregnant and ensure their children attend school and receive regular health checkups. The programs began in Mexico and Brazil in the 1990s, and are now implemented in 52 countries worldwide. CCTs are widely evaluated using quantitative metrics that examine changes in school attendance, clinic visits, vaccinations and household savings. Overall, the numbers indicate positive results, at least in the short term. As a result, CCTs are widely lauded as being effective and efficient mechanisms for improving poor people’s access to health and education services.
It should go without saying that women receiving prenatal care and children attending school and getting vaccinated should be celebrated. But if we are to evaluate CCTs from the point of view of unpaid care labor, we get a different picture.
Starting with care
In the Andean mountains of rural Peru, a CCT program called “Juntos” intervenes in the poorest, most isolated corners of the country. Juntos has successfully compelled rural families to send their children to school and use health services: on average, 96 percent of CCT recipients comply with the program conditions. This is remarkable, given that the program intervenes in places where tiny health posts replace hospitals, schools do not have electricity, households do not have running water, roads and public transport are scarce or nonexistent, and health and education staff absenteeism is a chronic problem.
During the course of 11 months in 2012-2013, I carried out ethnographic research on Juntos’ impacts on women. Right from the start, it was obvious that surveys would not capture the ways in which Juntos shapes rural women’s everyday lives. Rather, it was in accompanying women as they attended community meetings and tended to their plots of land; observing at health clinics and schools; and walking between geographically dispersed villages that my research captured a different view of the program.
A program evaluation that accounts for care work will ask additional questions, for example: How many times did Maria walk to the clinic for her prenatal exam before she found it open? How many additional hours of work does Paloma put in on her plot of land because her teenage son is now in school? Who cared for Linda’s elderly father and three small children while she spent the day queuing for her cash payment at the village a four-hour walk away?
The answers to these questions can be quantified, but without ethnographic insights, program evaluators may not realize that there was anything to be quantified — or counted — in the first place.
My research found that the cash was indeed helpful, and that more children went to school and used health facilities. However, by accounting for women’s care work it also revealed that the realities women confronted in caring for their families were less optimistic: health clinics were often closed, schools were grossly understaffed, and the time it took to get to these places and find them open for service was significant. In a context where women’s unpaid care work isn’t supported by quality institutions and basic infrastructure, a well-intentioned CCT program increases women’s time poverty and burden of care work.
Making care visible
Metrics that prioritize efficiency and overlook care risk rendering invisible the difficulties women face in ensuring their families’ survival. A more comprehensive — and more just — approach to measuring impact accounts for care work, including the women who do it. Such an approach considers whether or not a given intervention exacerbates or reduces women’s time poverty. Crucially, this means also accounting for the availability and quality of resources that women need in order to do care work: running water, electricity, transportation, and access to health care, schools, medicine, daycare and doctors.
For policies and interventions to meaningfully address matters of time poverty, they must reflect the realities of women's everyday lives. To do this, policy and program designers and evaluators must account for all of the things women — and men — do to care for themselves and their dependants. This includes those tasks that are hidden from GDP counts, that quietly uphold the “formal” economy, and that ensure that the woman writing this piece has a clean shirt and a nice brown bag lunch.
Melinda Gates’ letter presents the development community with a real opportunity to realize gender equity and tackle poverty’s roots. I for one care enough to get on that rocket ship.
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