Care and Care Workers: A Latin American Perspective (Latin American Societies) 303051692X, 9783030516925

Table of contents :
Foreword
Preface
Contents
Contributors
Chapter 1: Care Work: A Latin American Perspective
The Actuality and Centrality of Care
The Background of the Care Studies Field
Care Studies in Latin America: When Different (Intellectual) Voices Emerge on the Scene
Care Studies in Latin America: Results and Challenges
Conclusion
References
Chapter 2: The Care Deficit in Latin America: Structure, Trends and Policy Approaches
Introduction
Core Features of the Care Economy Globally: A Brief Overview
Provision of Care in Latin America
Demographic Trends and Pension Constraints
Policy Approaches and Frameworks to Address the Rising Care Demands in Latin America
Concluding Considerations: Positive Convergence, or Risk of a Rising Care Deficit in Latin America?
References
Chapter 3: The Social Inequality Matrix, Universal Social Protection Systems, and Care in Latin America
Introduction
The Latin American Social Inequality Matrix
Social Policies, Social Protection Systems, and Care as a Transversal Pillar
Recent Social Protection Trends in Latin America
Concluding Remarks
References
Chapter 4: The Centrality of Women’s Work and the Sexual and International Division of Care Labor: Brazil, France, and Japan
Introduction
Sexual and International Division of Labor and International Migration
Merging the Racial and Ethnic Division with the International Division
Migrants and Racialized
Inequality and Discrimination
France: Inequality and Discrimination in a Context of Migration
Japan: Inequality and Discrimination. Non-regular Work (Ringi or Haken)
Brazil: Wage Discrimination and Racism
Sexual and International Divisions of the Social Organization of Care. Brazil, France, Japan
France
Japan
Brazil
Points for Reflection to Conclude
References
Chapter 5: Reimagining Care and Care Work
Rethinking Care: Care as Practice
What Should Be Our Goals?
Some Directions for Change
Rethinking Social Citizenship to Include Care
Rethinking Paid Care
Worker Empowerment and Protection
Social Activism and Unionization
International Labor Conventions
Domestic Worker Self-Help, Education, and Advocacy Groups
Closing Thoughts
References
Chapter 6: Care Amongst Ourselves: Self-Care as a Therapeutic and Political Experience
At First, a Cultural Discomfort
Care vs. Justice: A Dilemma
The Struggle for Survival, a Never-Ending Quest in the Present
Busy Moms: Responsibility Beyond Love
From Care to Politics: “Caring for Each Other”
The Law and the Unthought About the Privilege of Care
Search for Any Lucrative Activity: “El rebusque” Between Resistance and Ethical Defeat
Feminism as a Therapy
Self-Care as a Social Praxis
Conclusion
References
Chapter 7: Care, Aesthetic Creation, and Anti-Racist Reparations
Introduction
AMAFROCOL: An Articulation of Black Women in Movement
Beauty, Aesthetics, and Anti-Racism
No More Chemicals and the “Big Chop”: Disidentification and Re-signification
The Care Work of the Godmothers: An Anti-Racist Sisterhood
Aesthetic Care Work in Virtual Natural Hair Communities: A Subaltern Public Sphere?
Final Thoughts
References
Chapter 8: The Circuits of Care: Reflections from the Brazilian Case
Introduction
Care as a Profession
A Long-Standing Activity in a Recent Profession
What Institutionally Counts as Work for Professional Caregivers in Brazil
Care as an Obligation
Care as Help
Revisiting Some Principles and Preventing a Short-Circuit
References
Chapter 9: Gender and Care in Uruguay: Ground Covered and Challenges to Current Policies
A Journey Through the Conceptualization of Care
Research in Uruguay
How Is Child Care Addressed?
How Is Elderly Care Addressed?
The Social Organization of Care and Public Policies from a Gender Perspective
Conclusions
References
Chapter 10: Social Organization of Care in Chile
Introduction
Care and Social Care Organization: Some Definitions
Social Care Organization
Welfare and Care Regime in Chile: Inequality by Class and Gender
The Hybrid State-Mercantile and “Familistic” Character of Care, Predominantly Female
Growing Demand for Care in Chile
Demographic Dimension
The Family and the Cultural Dimension
Care and Domestic Work Offer
Unpaid Domestic and Care Work in Chile
Paid Domestic and Care Work in Chile
Migrant Workers and the Existence of Global Care Chains
Some Conclusions and Suggestions
Policy Suggestions
For Further Research
References
Chapter 11: Migrations and Remunerated Eldercare in the City of Buenos Aires: A Subjective Perspective
Brief Aspects of Regional Migration and Its Legal Framework
Female Migrations and Work Trajectories in CABA (Autonomous City of Buenos Aires)
Paths Taken Before Working in CABA
Typical Work Trajectories in CABA
Migrant and Caregiver: Elements for Considering Stigmas and Affirmations
Assigned Otherness: Experiences and Resistance
“Us” vs. “Them”: About the Representations and Positioning of Migrant Caregivers
Work, Care, Self-Assessment, and Recognition
To Conclude
References
Chapter 12: Care Work: Professionalization and Valuation of Nurses and Nursing Assistants in Health and Old Age in Colombia
Introduction
The Conceptual Turn of Care
Healthcare Workers
Eldercare Workers
Conclusions
References
Chapter 13: Dialogues Between (Feminist) Studies of Care and (Critical) Disability Studies to Rethink Emerging Activisms
Caring for the Introduction
Research Fields
Care and (Feminist) Studies of Care
Disability and (Critical) Disability Studies
Right to Care, Caring Citizenship, and Activism
Social Right and Caring Citizenship
Classes of Activism
Emerging Activisms
Co-constructed Dialogues
Caring for the Conclusion
References
Index

Citation preview

Latin American Societies Current Challenges in Social Sciences

Nadya Araujo Guimarães Helena Hirata Editors

Care and Care Workers A Latin American Perspective

Latin American Societies Current Challenges in Social Sciences Series Editors Adrian Albala Instituto de Ciências Políticas (IPOL) University of Brasília Brasilia, Brasília, Brazil Maria Jose Álvarez Rivadulla Edificio Franco, Oficina GB 620 Universidad de los Andes Bogota, Colombia Alejandro Natal Department of Social Processes Universidad Autónoma Metropolitana Lerma de Villada, Estado de México, Mexico

​ his series aims at presenting to the international community original contributions T by scholars working on Latin America. Such contributions will address the challenges that Latin American societies currently face as well as the ways they deal with these challenges. The series will be methodologically agnostic, that is: it welcomes case studies, small-N comparative studies or studies covering the whole region, as well as studies using qualitative or quantitative data (or a mix of both), as long as they are empirically rigorous and based on high-quality research. Besides exploring Latin American challenges, the series attempts to provide concepts, findings and theories that may shed light on other regions. The series will focus on seven axes of challenges: 1) Classes and inequalities 2) Crime, security and violence 3) Environmental threats 4) Collective action 5) Cultural change and resistance 6) Migrations 7) Political inclusion and representation Both solicited and unsolicited proposals will be considered for publication in the series. More information about this series at http://www.springer.com/series/16592

Nadya Araujo Guimarães • Helena Hirata Editors

Care and Care Workers A Latin American Perspective

Editors Nadya Araujo Guimarães Department of Sociology University of São Paulo São Paulo, Brazil

Helena Hirata National Center for Scientific Research (CNRS) Center for Sociological and Political Research of Paris (CRESPPA) Paris, France

Copyright of Chapter 3, ‘‘The Social Inequality Matrix, Universal Social Protection Systems and Care in Latin America’’: © United Nations Economic Commission for Latin America and the Caribbean (UN-ECLAC) under an exclusive license to Springer Nature Switzerland AG, part of Springer Nature. ISSN 2730-5538     ISSN 2730-5546 (electronic) Latin American Societies ISBN 978-3-030-51692-5    ISBN 978-3-030-51693-2 (eBook) https://doi.org/10.1007/978-3-030-51693-2 © Springer Nature Switzerland AG 2021 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

We dedicate this book in memoriam to Luz Gabriela Arango Gaviria, an outstanding gender scholar and pioneer in Latin American care studies who helped us forge the journey that gave rise to this book.

Foreword

Sometimes a crisis provides us with the gift of insight. For more than a generation, feminist scholars around the globe have insisted that care and care work are central to life. The global coronavirus pandemic underscores what these scholars have said for decades. Despite its peripheral place in how social and political theories describe the world, care is at the center of human activity and at the center of our world. If we must now rethink, to use Harry Frankfurt’s phrase, “the importance of what we care about,” then this volume is a major contribution to our most important current efforts. After the pandemic is resolved, the stark reality will still exist: we focus too much on making, accumulating, and protecting wealth, and too little on the daily needs of people, infrastructure, institutions, and the natural world around us. In order to make care more central, we must first know how care now exists on the periphery of our understandings. It is no mistake that we have historically constructed society to marginalize care into an arena of life mainly occupied by women, people of color, migrants, formerly slaves and indentured servants, and mainly occurring in private homes and understudied and underfunded institutions for the vulnerable. Care is both highly personal and shaped by deep social structures. One can describe care workers, as do the authors here, by the nature of labor commodification practices or by their complications that arise from the texture of their hair. Care is both universal and particular at once, confounding the categories of social science and policy unless one starts from care itself. In these essays, the authors have done so by studying the critical cases in Latin America. Looking closely at care in Latin America allows us to understand many dimensions of past practices and difficulties of potential change. In this way, Latin America is both similar to other global sites of care and in some way remains distinctive. Children, the elderly, and those with different abilities and some kinds of infirmities are the people that we usually think about when we think about who needs care. Nevertheless, everywhere people also need to take care of themselves to participate in the market and to fulfill their basic physical needs every day. Latin American countries remain somewhat distinctive in how the affluent rely upon the personal services of female domestic workers in the household to manage everyday life. As vii

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the essays in this volume make clear, there are clear patterns of gender discrimination, histories of slavery and servitude, and forms of racial and ethnic domination that leave such workers in a state of great weakness against their employers. Yet it is largely in Latin America that creative changes also emerge to change this situation. When people despair of making change around caring practices, I point to the example of changes wrought in Latin America. In the first instance, scholars in Latin America were path-breaking in insisting that government agencies responsible for tracking labor trends focus not only on the formal and paid work force but also on unpaid work in households. Collecting the data, in country after country, revealed what everyone who thinks about it knows instinctively. Society cannot function without the unpaid (and poorly and informally paid) work of caregivers. Having the data—and this book presents this data—allows public policy to be based on the realities rather than on the prejudices, habits, or structural injustices of a previous time about gender roles, class, ethnicity, race, and migrant status. The data help us to see: Who does what care work for whom? Once that picture emerges, social inequality becomes visible in a new way, opening up possibilities for new solutions. This volume not only presents the data, then, but also shows how some countries have begun to innovate to provide solutions to the problem that some people are overburdened by care while others do little of it. From self-care practices to the creation of new state agencies to address the issues of care, to agitation for action by global institutions such as the ILO, scholars and activists in Latin American countries lead the way in showing both how resistance remains and how to innovate. So the rest of the world has much to learn from this volume. As I write this foreword, I am staying home in New  York City, watching the numbers of deaths in nursing homes and hospitals and homes increase as more and more people succumb to the COVID-19 disease. Finally people are beginning to see that the “essential workers” are disproportionately women and disproportionately people of color. There are reasons from the past why they are the essential workers and why they are the least well paid and the least well protected workers. We can glean some hope from how some Latin American countries have begun to change the discussion and improve the status of both the care workers and care receivers in their midst. We can hope that as we reflect upon the large care crisis we now all face that we can recognize the ongoing crises of care that occur everywhere every day. The experiences of Latin American scholars and the changes they have brought to their cultures serve as a source of inspiration and hope. The world will look different if we put care at its center rather than at the periphery. Perhaps now we have the wisdom to heed this lesson and move in more caring directions. Joan C. Tronto Department of Political Science University of Minnesota Minneapolis, MN, USA New York, NY, USA April 2020

Preface

Most societies are seeing a strong rise in the number of elderly people and are consequently feeling the effect of these aging populations, albeit at various paces and in response to different dynamics. This aging process generates new demands and reshapes traditional care activities. Thus, care services have become a significant area of paid work that is expanding the professional labor market. Additionally, new public policies for long-term elderly care, child care, and care for the disabled impact individual careers and the professional regulation of labor conditions and relations in care work. The growing demand for care services has been challenging academics internationally. Research lines expanded and diversified in different directions and at varying speeds. Theories and debates on care date back to the early 1980s in the United States and have developed much more recently in Europe. In France, for instance, publications on the subject only appeared in the 2000s. This phenomenon has also elicited a growing interest in Latin America where research soon spread among the countries, engaging social scientists in a field that had primarily been explored by geriatrists, gerontologists, and public health specialists. As in other parts of the world, professional care has also expanded dramatically in Latin America over the past 20 years. However, unlike in the USA, Europe, and Japan, it took place in a context of heterogeneous and poorly structured markets and in situations where recurrent gender and racial inequalities associated with high levels of extreme poverty overlap with slow government social protection initiatives. Recently, challenging experiments with social inclusion and wage redistribution policies, along with growing collective movements and intellectual mobilization in this field, created an attractive scenario for reflecting on the social organization of care in the region. On the other hand, although comparative studies are frequent, they cover mostly countries in the so-called Global North. Our analyses aim at enriching international comparisons on care labor and public policies related to care, offering solid results gathered by a new generation of research projects carried on in five Latin American countries—Argentina, Brazil, Chile, Colombia, and Uruguay, where intellectuals have been cultivating an intense dialogue with colleagues from France, Japan, and the US. ix

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Beyond academia, these fast and radical changes in the field of care services also challenge policy makers. This book is aware of this and responds with fresh, robust knowledge from both communities of readers. The authors are concerned with the specific nature and trajectory of the different social protection regimes and welfare systems in the five countries, as well as the particularities of the demographic and economic processes that shape the age and occupational structures of their populations. The five selected countries are also strategic cases for documenting public policy experiments with care. The 13 chapters that make up this book draw on secondary literature and statistical data and on the results of field research currently being undertaken by the authors. Nadya Araujo Guimarães and Helena Hirata open the volume with an overview chapter on Care Work: A Latin American Perspective. It is aimed at presenting the scenario of Latin American research on care and care work vis-à-vis the international debates in the field. Firstly, the authors situate the new empirical material vis-a-vis the broader pre-existing literature. Secondly, they explore how the Latin American experience transforms existing understandings on the social organization of care, especially on its relations with gender and race/ethnic inequalities, which ground the new experiences of care policies in the region. Anne Caroline Posthuma in The Care Deficit in Latin America: Structure, Trends and Policy Approaches shows structural changes are transforming both supply and demand of care in Latin America. The high rate of informal work in the region is a major factor leading to low coverage and insufficient benefits of contributory pension schemes which, in turn, raise dependence on family support or public services. The challenge to provide adequate supply and quality of care in Latin America is high, given these pressures on the existing care deficit in Latin America. The situation calls for a stronger and more proactive role of the public sector to support a vibrant and far-reaching care economy. Laís Abramo and Claudia Robles in The Social Inequality Matrix, Universal Social Protection Systems, and Care in Latin America argue that strengthening care policies in the region should consider their role as a pillar of evolving social protection systems and the principle of universalism that is sensitive to differences. The objective of universality, one of these systems’ basic principles, demands the recognition of the differences and acting on profound inequalities that continue to characterize societies in Latin America. For the authors, the building of comprehensive social protection systems in Latin America is one of the main challenges facing the rights agenda and the advancement of a development model that is focused on achieving equality. Helena Hirata in The Centrality of Women’s Work and the Sexual and International Division of Care Labor: Brazil, France, and Japan explores the sexual and international division of care work by comparing three countries profoundly different in terms of economic and technological aspects, but also in the particular ways they have been experiencing economic crisis. The chapter investigates the behavior of the crucial actors, namely the State, the market, and the family in order to document how they come together to impact the modalities of the sexual and international

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divisions of labor. Theoretical questions are discussed in the conclusion: theories of care and sociological paradigms, the theory of intersectionality, and the centrality of women’s work. Evelyn Nakano Glenn in Reimagining Care and Care Work addresses two inter-­ related issues: first, the care gap as it appears in many developed societies; second the often exploitative conditions under which paid caregivers work. She argues that these problems stem from care work’s historical entanglements with gendered divisions of labor in the family and coercive labor systems such as slavery, indenture, and colonial domination. Any attempt to address these issues requires rethinking care work in fundamental ways: define caring as a collective responsibility; distribute responsibility for caregiving more equitably across class, race, and gender lines; and make access to quality care available to all members of society. Pascale Molinier in Care Amongst Ourselves: Self-Care as a Therapeutic and Political Experience observes that in the feminist movements, self-care can be turned into a collective activity between women sharing one social destiny. Many women living in poverty experiencing social violence do not have the opportunity to benefit from the care of others, even if they themselves are caregivers. They do not know how to care for themselves. “Care Amongst Ourselves” mobilizes concrete practices that enable the discovery of how to value and respect oneself. By identifying with their peers, women experience a process of self-care that has a therapeutic value and constitutes a step in the direction of engaging themselves in political activism. Mara Viveros Vigoya and Krisna Ruette-Orihuela in Care, Aesthetic Creation, and Anti-Racist Reparations explore ways and means to analyze the actions of groups of women of African descent who have focused a major part of their struggle on combating the negative stereotypes associated with the hair of “black” women and on promoting aesthetic practices while they take care of their “naturalness.” The authors discuss how the activities undertaken by Afro-Colombian women can be related to promoting the aesthetic care of Afro hair with the practices associated with caring work and emotional work and how care practices can destabilize socio-­ racial orderings. Nadya Araujo Guimarães in The Circuits of Care: Reflections from the Brazilian Case departs from the idea that in societies marked by profound social inequalities, like Brazil, the multiple forms of care work challenge the exclusive focus on the so-called care professions. Thus she explores recent literature and field work to survey different native definitions for care (as a “profession,” as an “obligation,” or as “help”) in order to coin the concept of “circuits of care,” defined by the interlace of four dimensions: (1) the meaning bind to the work performed; (2) the actors deemed competent to carry it out; (3) the types of relationships (market or non-­ market relations); (4) the means of rewards (monetary or not). Karina Batthyány and Natalia Genta in Gender and Care in Uruguay: Ground Covered and Challenges to Current Policies present an overview of the conceptual framework of care in Uruguay and the empirical research conducted on the matter in order to discuss how care is organized in society. The different research lines generated knowledge that was used as input for public care policies and government

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agenda. The authors consider that the development of care policies entails a great challenge for Uruguay, as well as for Latin America, since it aims not only to design a public policy for the dependant but also to bring about a cultural transformation: that of a sexual division of labor under more equitable models characterized by solidarity and co-responsibility. Irma Arriagada and Francisca Miranda in Social Organization of Care in Chile begin with a brief review of the welfare and care regime in Chile, specifically observing the State provision of care for childhood, the elderly, and disabled people. The authors consider the demographic and sociocultural transformations affecting the crisis of the traditional model of care provision, mainly imposed on women. Lastly, they analyze the evolution of paid and unpaid domestic work together with the situation of migrant workers. They conclude with several recommendations for a further development of policies and research of social organization and care in Chile. Natacha Borgeaud-Garciandía in Migrations and Remunerated Eldercare in the City of Buenos Aires: A Subjective Perspective aims at analyzing the migrant women’s pathways, observing their labor experiences in this city based on research in qualitative sociology. Starting with the glance into and the comprehension of care that the female workers offer allow us to acquire a deeper understanding of immigration with regard to care, about the differences between employments and care settings for old adults, as well as the importance of taking into account the complexity of the work itself in the self-definition that women workers build, however socially so little valued. Javier A.  Pineda Duque in Care Work: Professionalization and Valuation of Nurses and Nursing Assistants in Health and Old Age in Colombia recognizes a “conceptual turn of care,” asking the extent to which institutionalized care and the advance in the processes of its professionalization have managed to value female care work, examining the case of caregivers in Colombia. In a context of high growth of employment in health care and its feminization, the author focuses on nurses and nursing assistants and investigates their working conditions, the devaluation of institutionalized care work, and the limits for the flourishing of an ethics of care. The growth and commodification of health care and eldercare reproduce gender injustices. Dora Inés Munévar M. in Dialogues Between (Feminist) Studies of Care and (Critical) Disability Studies to Rethink Emerging Activisms assumes that care is a domain placed at the intersection between feminist studies and studies on disability. Therefore, in this chapter she takes advantage of both fields to articulate the theme of care through common positions, and positions that distance them in patriarchal, familyists, androcentric, and capitalist societies. One of the common subjects is related to the activism that has arisen, either to rethink the issue of care, to demand policies on social organization, or to denounce the implications of their absence in the lives of women. The 13 chapters in this volume explore a wide range of themes and debates, in line with the analytical challenges found in the international field of care studies and following attentively the specificities of the Latin American reality.

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These chapters were originally prepared for being discussed at the International Workshop entitled “Labor, Care and Public Policies. Latin America in a Comparative Perspective,” held at the University of São Paulo (USP), Brazil, on October 15–17, 2018, sponsored by the Brazilian Center for Analysis and Planning and the Department and Graduate Program in Sociology at USP. Putting the book together required special commitment from all the authors, to whom we are very grateful. We also acknowledge the various institutions that sponsored the International Workshop and supported the publication of this book: • the University of São Paulo, College of Philosophy, Literature and Human Sciences, specially the Department of Sociology • the Brazilian Center for Analysis and Planning (Cebrap) • the French Laboratory “Genre, Travail, Mobilités,” affiliated to the Centre de Recherches Sociologiques et Politiques de Paris (CRESPPA), a research unit at the Centre National de la Recherche Scientifique (CNRS) • the University of São Paulo Agency for National and International Cooperation (AUCANI) • the Brazilian Coordination of Superior Level Staff Improvement (CAPES)/ PROEX Program at the Graduate Program in Sociology (USP) • the Economic Commission for Latin America and the Caribbean (ECLAC) • the French Consulate at São Paulo • the Research Support Foundation of the State of São Paulo (FAPESP)—Grant # 2018/14719-0 • the International Labor Office (ILO) in Brasilia—Grant # 40219557/0 We are grateful for administrative support from: Leci Reis, Kelly Almeida, Sandra Matos, Renata Braga, Evania Guilhon, Georgina Pinto Neta, Paula Braga, and Angela Ferraro. We also acknowledge the meticulous work of translation carried out by Jill Haring, who took care of nine of the 13 chapters, as well as Icleia Cury for her work of reviewing bibliographic references and formatting the manuscript. Finally, special thanks to Bruno Fiuza, Editor of Behavioral and Health Sciences at Springer-Brazil, whose enthusiasm and efficient supervision made the preparation of this manuscript so much easier. São Paulo, Brazil  Nadya Araujo Guimarães Paris, France   Helena Hirata May, 2020

Contents

  1 Care Work: A Latin American Perspective ������������������������������������������    1 Nadya Araujo Guimarães and Helena Hirata   2 The Care Deficit in Latin America: Structure, Trends and Policy Approaches����������������������������������������������������������������   25 Anne Caroline Posthuma   3 The Social Inequality Matrix, Universal Social Protection Systems, and Care in Latin America ����������������������������������   43 Laís Abramo and Claudia Robles   4 The Centrality of Women’s Work and the Sexual and International Division of Care Labor: Brazil, France, and Japan������������������������������������������������������������������������������������   61 Helena Hirata   5 Reimagining Care and Care Work ��������������������������������������������������������   77 Evelyn Nakano Glenn   6 Care Amongst Ourselves: Self-Care as a Therapeutic and Political Experience��������������������������������������������������������������������������   93 Pascale Molinier   7 Care, Aesthetic Creation, and Anti-Racist Reparations����������������������  107 Mara Viveros-Vigoya and Krisna Ruette-Orihuela   8 The Circuits of Care: Reflections from the Brazilian Case������������������  125 Nadya Araujo Guimarães   9 Gender and Care in Uruguay: Ground Covered and Challenges to Current Policies��������������������������������������������������������  149 Karina Batthyány and Natalia Genta 10 Social Organization of Care in Chile������������������������������������������������������  165 Irma Arriagada and Francisca Miranda xv

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11 Migrations and Remunerated Eldercare in the City of Buenos Aires: A Subjective Perspective��������������������������������������������  187 Natacha Borgeaud-Garciandía 12 Care Work: Professionalization and Valuation of Nurses and Nursing Assistants in Health and Old Age in Colombia ��������������  203 Javier A. Pineda Duque 13 Dialogues Between (Feminist) Studies of Care and (Critical) Disability Studies to Rethink Emerging Activisms ������������������������������  217 Dora Inés Munévar M. Index������������������������������������������������������������������������������������������������������������������  235

Contributors

Laís  Abramo  Social Development Division, Economic Commission for Latin America and the Caribbean (ECLAC), Santiago, Chile Nadya  Araujo  Guimarães  Department of Sociology, University of São Paulo, São Paulo, São Paulo, Brazil Irma Arriagada  Center for Woman Studies (CEM), Santiago, Chile Karina  Batthyány  Department of Sociology, Faculty of Social Sciences, University of the Republic (UdelaR), Montevideo, Uruguay Natacha  Borgeaud-Garciandía  National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina Institute of Social Research of Latin America (IICSAL) - Latin American Faculty of Social Sciences (FLACSO), Buenos Aires, Argentina Natalia Genta  Department of Sociology, Faculty of Social Sciences, University of the Republic (UdelaR), Montevideo, Uruguay Evelyn Nakano Glenn  Department of Gender & Women’s Studies and Department of Ethnic Studies, University of California, Berkeley, CA, USA Helena  Hirata  National Center for Scientific Research (CNRS), Center for Sociological and Political Research of Paris (CRESPPA), Paris, France Francisca  Miranda  Department of Education, Psychology and Family Studies, School of Family Studies, Finis Terrae University, Santiago, Chile Pascale  Molinier  Transversal Unity on Psychogenesis and Psychopathology (UTRPP), Sorbonne University of North Paris, Paris, France Dora  Inés  Munévar  M.  Departamento de Comunicación Humana, Escuela de Estudios de Género, Universidad Nacional de Colombia (UNAL), Bogotá, Colombia Javier  A.  Pineda  Duque  Interdisciplinary Center of Development Studies (CIDER), Universidad de los Andes, Bogotá, Colombia xvii

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Anne Caroline Posthuma  Inter-American Center for Knowledge Development in Vocational Training (CINTERFOR), International Labour Organization (ILO), Montevideo, Uruguay Claudia Robles  Social Development Division, Economic Commission for Latin America and the Caribbean (ECLAC), Santiago, Chile Krisna Ruette-Orihuela  School of Social Policy, Social Work and Social Justice, University College Dublin, Dublin, Ireland Joan  C.  Tronto  Department of Political Science, University of Minnesota, Minneapolis, MN, USA Mara Viveros Vigoya  Escuela de Estudios de Género, Universidad Nacional de Colombia (UNAL), Bogotá, Colombia

Chapter 1

Care Work: A Latin American Perspective Nadya Araujo Guimarães and Helena Hirata

The Actuality and Centrality of Care The coronavirus pandemic that has affected the world since the beginning of 2020 revealed the central role of care as both to give care (prendre soin, in French, cuidar, in Spanish and Portuguese) and to cure in the therapeutic sense (soin, in French, asistencia/cura, in Spanish, and assistência/cura in Portuguese1). In this context where everyone feels and acts vulnerable, even white upper-class men in the prime of life, certain controversial issues that have been unyieldingly argued among specialists have lost their meaning. This is the case, for example, in the debate on the range of the care field and in the discord that surrounds the scope of its key concept that questions whether care studies should focus only on dependent people or should it also equally cover so-called “autonomous” people? The reality of this pandemic has made it clear that care is what we do with the intention of meeting the needs and well-being of others. Thus, this is the sense of care we will use henceforth. Indeed, the idea conveyed by researchers such as Joan Tronto (1993) in the United States or Patricia Paperman (2005) in France that says we are all vulnerable 1  In this therapeutic sense, the Portuguese and Spanish terms also express status differences, suggesting distinction strategies. Only one term is used to refer the doctor’s work, which is cura (meaning “cure”). The therapeutic work done by nurses is never denoted as “cure,” referred to instead as assistência/asistencia (meaning “assistance”) to indicate the direct support they give to doctors and the indirect support they give to ensure prescriptions are implemented correctly. When it comes to their direct action with patients, the word would definitely be cuidado.

N. Araujo Guimarães (*) Department of Sociology, University of São Paulo, São Paulo, Brazil e-mail: [email protected] H. Hirata National Center for Scientific Research (CNRS), Center for Sociological and Political Research of Paris (CRESPPA), Paris, France e-mail: [email protected] © Springer Nature Switzerland AG 2021 N. Araujo Guimarães, H. Hirata (eds.), Care and Care Workers, Latin American Societies, https://doi.org/10.1007/978-3-030-51693-2_1

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at some point in our lives has become suddenly unanimous in this pandemic. This understanding has broken away from the restricted field of care theories to appear in broad daylight as a consensus on the conditions of human life in society. Thus, when we all desire care for each other, for ourselves and for others (prenez soin, cuídense, se cuidem), when self-care becomes as important as caring for the other, and in this extraordinary moment when we all feel and recognize our vulnerability, the actuality and centrality of care become clear. The pandemic has also exposed the centrality of women’s work and the importance of a gender perspective in understanding how to deal with this crisis situation. Women doctors, nurses, nursing assistants, physical therapists, caregivers, and domestic workers have been indispensable in caring for the sick and dependent people, whether in hospitals, long-term institutions for the elderly, or in homes. The pandemic has also revealed others that are equally crucial to our survival, like supermarket and store cashiers, pharmacy attendants, and those who clean public areas, whose work enables the rest of the population to remain in confinement. However, the crisis and compulsory lockdowns have also revealed the cruelty and intensity of the unpaid work required from women when activities that are essential for reproduction (i.e., teaching or leisure), which over time have been outsourced to other institutions, are once again concentrated in the home. Furthermore, care studies have documented that it is precisely women, black people, and the poorest populations (and frequently those with a mix of these characteristics) that are disproportionately represented when care work requires what is considered “dirty work.” These activities are undervalued, lack symbolic and material recognition, and have been kept “invisible” in different societies across all the continents. In today’s context, the urgent need to make sure this work gets done, the courage of the people who do it, and how much these workers are missed when they stop providing their services due to confinement or illness exposes them to the light of day, making their work and profiles visible and no longer forgotten. The urgency of the pandemic is currently challenging Humanities to consider the multiple dimensions of vulnerability. The field of care studies, which faithfully maintains a gender perspective, can contribute to this with the results and insights it has gathered on this phenomenon and whose actuality and centrality have become irrefutable. In this chapter, we will highlight several of these outcomes, which were produced first in the global North and then in the South. We seek to register a rich intellectual path, albeit irregular and not at all linear. Different institutional and national contributions have helped build this path throughout different circumstances, stimulated by feminist movements and debates. Understanding this construction allows us to reflect on how the specificities of contemporary societies like the Latin American ones address this accumulated knowledge and force us to develop new theoretical tools that can handle their singularities. In short, if it is true that we are all vulnerable, and if we agree that we must understand the multiple dimensions of this vulnerability, then identifying them and

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the specific configurations that produce them is sine qua non for consolidating this field.

The Background of the Care Studies Field The claim for care studies field dates back to the early 1980s in the United States. It was inspired by the feminist issues raised in social movements and was based on feminist epistemology. In 1982, Carol Gilligan began analyzing narratives of experiences, assuming that “the way people talk about their lives is of significance, that the language they use and the connections they make reveal the world that they see and in which they act” (Gilligan, 1982, p. 3). Centrality is thus given to concrete experiences and to ordinary situations. This leads to recognizing a different voice. “The different voice I describe is characterized not by gender but theme. Its association with women is an empirical observation, and it is primarily through women’s voices that I trace its development” (Gilligan, 1982, p. 2). Hence, Gilligan opposes an ethics of fairness founded on rational, abstract, and universal principles, and calls attention to a different way of solving moral dilemmas that is based on an ethics of care and grounded in unique and irreducible experiences and feelings, and in what is concrete and relational. Her interest in exploring the psychology that sustained the lives of men and women was not naïve. In her long “Letter to Readers, 1993” that introduces the second edition of her book, she recognizes that she was moved by the need to understand the reproduction of the political order, especially the important role of women’s voices in maintaining or transforming the patriarchal world (Gilligan, 1993, p. XII). Other authors such as Susan Moller Okin (1989, 1991) soon sought to place the care agenda in political theory debates. Based on ambiguities that had been previously identified by feminist political scientists, and as part of the discussion on the links between “public” and “private” (associated to state vs. society and domestic life vs. non-domestic life), Okim proposed the centrality of another dichotomy, the “public versus domestic.” In exploring this dichotomy, the author sought to reveal the political nature of family and the relevance of justice in people’s personal lives and in producing the inequalities that affect women (Okin, 1989, p. 69). She questioned the false division between care and justice and the idea of a “natural” or “unquestionable” justice in the sacrosanct family domain. Similarly, Joan Tronto, in two seminal works (Fisher & Tronto, 1990; Tronto, 1993), shifts reflections on the ethics of care toward understanding it as an activity, underscoring the unequal division of this type of work and its significant devaluation. The “different voice” alluded to by Gilligan would be the voice of people whose moral experience was built around a specific kind of work, that of care. The gender, racial, and class differences and the inequalities that intersect in a political dimension then become present at the heart of moral reflection. As Arango Gaviria and Molinier accurately recognized, Tronto operates a double denaturalization of this different voice: “first, when situating, without ambiguities, its emergence in an

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‘activity,’ in domestic and care work rather than in the supposed biological ‘nature’ (of women); and second, when establishing social divisions in the group of women, since care activities would not be related to all of them in the same way” (Arango Gaviria & Molinier, 2011, p. 17). Additionally, Tronto substituted the a­ utonomy/ dependence dilemma with the principle of vulnerability: we are all involved in a web of care that we depend on to exist. More recently (2018), she proposed making care a truly democratic value by advocating for “a democracy where care is a central part of political life” (Tronto, 2018, p. 26). Care as an activity was echoed in the advances that were simultaneously taking place in the domains of feminist economics, primarily in the English language (Ferber & Nelson, 1993; Folbre, 1982, 1994, 2001, 2006).2 This perspective was responsible for shedding light on the many nonmonetary types of economy that are generally performed by women in the invisible domains of their homes. Conceptualizing and measuring it gave value to the types of unpaid work of care. Instruments such as time-use surveys revealed the importance of unpaid domestic and care work in the gross domestic product of the countries that were studied and highlighted the links between gender, time use, income, and poverty. Additionally, it explored the connections between the economy of goods that is grounded in accumulating capital from markets and the economy of unpaid care, the anchor of social reproduction in the nonmarket domain. Analytical attention was also given to the care segment, growing especially in more advanced capitalist countries, and its capacity to generate employment for women, albeit often meant low wages and high turnover rates. Fervent criticisms were directed at Esping-Andersen’s new and challenging ideas on welfare regimes (1990, 1999) that identified his androcentric bias ((Daly and Lewis, 2000; Giullari & Lewis, 2005; Orloff, 2002). These advancements culminated with the consolidation of the “care economy” domain. In the mid-2000s, soon after care emerged as a field in the anglophone world, the so-called “French school of care” was formed, spearheaded by Patricia Paperman and Sandra Laugier (2005), Pascale Molinier, Sandra Laugier and Patricia Paperman (2009). Dialogues soon emerged in the sociology of work and gender in the sense that, the more the concept of domestic labor gave way to the concept of care work, the more attention was given to the moral, emotional, and symbolic dimensions involved (Arango Gaviria & Molinier, 2011, p. 18). In this respect, we must highlight the seminal contributions of Arlie Hochschild’s (1983, 2003) early works. In the mid-2000s, soon after care emerged as a field in the anglophone world, the so-called “French school of care” was formed, spearheaded by Pascale Molinier, Patricia Paperman and Sandra Laugier (Paperman and Laugier, 2005; Molinier, Laugier and Paperman, 2009). This added a new tone to the debate within gender studies. The concept of care made it possible to connect several themes that were part of the sex inequality agenda, which had long been explored by French

2  Razavi (2007, p. 32) stated ironically: What feminist economics has brought to this relatively new area of research are its distinct conceptual frameworks, which render visible critical areas of the economy that have escaped analytical and empirical scrutiny by ‘malestream’ economics, namely the production and maintenance of human beings.

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feminists.3 The scope of care was also understood as going beyond the merely therapeutic dimension expressed by the word soin, used repeatedly in health studies. Thus, borrowing the English word “care” filled this gap and better expressed the broader dimensions of the new field. They continued Tronto’s line of thinking, postulating the inseparability of politics, ethics, and work and underscoring care as an activity anchored in gender, racial, and class inequalities. The authors were interested in reflecting on ways of making these subaltern voices heard (Molinier, Laugier, & Paperman, 2009, pp. 7–31). Thus, they sought to identify the causes for the paradox seen in this type of work that is both invisible and yet so close to each of us. Specific factors are at the root of this invisibility. First is the naturalization of the capacities of women (the main providers) in providing care. Second is the nature of care work as “discrete know-how” (Molinier, 2005, p.  299). Third is the fact that emotional work and affectivity, which are intensely mobilized in care activities, are not recognized as dimensions of what is understood as work. Paperman (2017) introduced a thought-­ provoking slant to this, saying that the vulnerability and lack of citizenship experienced by dependent elderly and disabled people would also reflect on the status of those who cared for them. Thus, beneficiaries and providers share the stigma of “second-class” citizens in a vicious cycle between the devaluation of care work and the devaluation of those who receive care, who are the so-called vulnerable people and groups. Therefore, according to authors from the French school, recognizing care work means detemporizing and degenderizing it. It must be understood as an activity that involves men and women, not only official care workers or those who are paid to do it. Because society as a whole needs care, it is an activity that concerns everyone involved, even though it has typically been viewed as work that benefits specifically the elderly, people with disabilities, the sick, the dependent, etc., which goes against this feminist perspective. A definition shared in a colloquium of specialists in France provides a precise view of the contours of this concept of care: This kind of occupation, including its physical, technical, emotional, and affective aspects, occurs within a gender, class, and ‘racial’/ethnic based social relationship and is performed by distinctive protagonists (…) Care doesn’t only call for attentive behavior or vigilance, but also for care labor; it combines material and relational activities as a whole, and is occasionally related to highly specialized healing techniques in order to tangibly address the needs of others. It can also be defined as a relation of service, support, and assistance, thus implying a sense of responsibility towards the lives and well-being of others. (International Conference, 2013)

3  It is worth mentioning some of the pioneers that contributed to this field. For example, Geneviève Cresson (1995) reflected on studies conducted in 1987 about the unpaid domestic work performed by women, which she already qualified as de soin work, calling it soins profanes. Likewise, the research program on “domestic production” conducted by Christine Delphy and Yannick Lemel in the 1980s was also ground-breaking (Delphy, 1978).

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Defining care activities as such challenged the sociology of work and put the very notion of work into question. Thus, it had to expand its scope to include activities geared toward the “production of living” (Hirata & Zarifian, 2000, p.  232) since work could no longer be reduced to a mere social act that could be objectified and measured. French care studies thus contributed to expanding the concept of work, which had already been reconceptualized by feminists when they added social sex and domestic labor, given the need to include the production of living in society and thus question the separation between the private, salaried, and political spheres of life. Furthermore, this broader definition of care states, albeit inexplicitly, the importance of intersectionality/consubstantiality in the interdependence/intersection of the social relations of sex, class, and race. Danièle Kergoat, in a subsequent text, would define work as a “the production of living in society” and considers “care work as a paradigm of this production of living” (Kergoat, 2016, p. 12). According to her, “care work is relational work and supposes constant interactions where social trajectories, skin color, ethnicity, and age play important roles” (id. ibid.). This consubstantial definition of care echoes what had also been already identified by Joan Tronto when she stated, “In fact not just gender, but race and class, distinguish who cares and in what ways in our culture” (1993, p. 112). This was certainly motivated by the American debate where the emerging black feminism had been challenging academic feminists since the 1980s and 1990s.4 However, the international distribution of care research went hand-in-hand with what is now called the “crisis of care” or the “care deficit,” a concern that galvanized the agendas of the global North on two fronts. On one was the increased longevity of people with higher levels of dependence and/or physical or mental disabilities. On the other was the lack of free female labor within families because of the increasing number of women going to the labor market and because of their awareness of the costs of sacrificing themselves for the sake of others, the elderly, children, the disabled, and the ill. This crisis transformed care shortage into a social problem that questions the boundaries between what is private and what is public, and calls attention to the multiple actors involved in the production of care. This became a key subject in the 2000s, both in academic reflections and in the debates and documents produced by international organizations, which established the vitality of the economy of care field in so-called feminist economics. In 2007, Shara Razavi created a rhombus-­ shaped metaphor called the “care diamond,” which has been used extensively to represent the agents responsible for providing care. The four points of the

4  Indeed, the dimension of race and ethnicity has been on the political agenda of US social movements since 1977, when the Combahee River Collective (1977) postulated in their renowned declaration that their experiences with simultaneous oppressions made it hard for them to separate oppression from race, class, and sex. In a country marked by the commercial enslavement of afrodescendants such as the US, care work, especially domestic care work, carried the indelible mark of this multiple experience. Women were certainly not all equal, and care varied in terms of visibility, recognition, and retribution, depending on the class and race of the provider.

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diamond—state, market, families, community organizations—are interrelated to form various patterns in the different social realities that, depending on their weight, cause the diamond shape to change according to country, region, or social group. This debate inspired interest in another subject that soon became related—international migration (Michel and Peng, 2017). Over the last several decades, we have watched the globalization of care work. The current organization of this work is now based largely on transferring migrant workers that initially came from the global South to solve the “crisis of care” being experienced in the global North (Hochschild, 2000; Parreñas, 2001). However, while this helped reduce the care deficit in wealthy countries, it had the opposite effect in poor countries (Paperman, 2005, p. 292) that depended on the presence and work of women in their homes to care for their elderly or children, which in fact kept them from attaining paid work. This is primarily how the subject of care in the global South was placed on the international agenda. Empirical studies began considering these new circumstances, and the cases of some southern countries were added to increasingly frequent international comparisons. In the mid-2000s, the research outcomes coming from Latin America began circulating, asserting the region’s place in the field of care studies and extending the analyses being done in the United States since the 1980s, in England since the 1990s, and in France since 1995. The concepts developed in Northern countries were first echoed and then scrutinized as to their capacity to address Latin American reality. Care studies have thus maintained their relevance both in recent gender debates and in advancing reflections on subjects such as inequalities, racism, migrations, vulnerability, precarity, well-being, and policies, which are crucial to understanding contemporary societies. This will be discussed in the next section.

 are Studies in Latin America: When Different (Intellectual) C Voices Emerge on the Scene In a short 3-year span (2012–2015), two renown international care studies’ specialists, one in the United States and the other in Europe, reflected on the progress of ongoing research in Latin America and reiterated similar arguments. Joan Tronto stated: It is possible that I might not be convincing on the advantages of my proposal if you take into account that different academic and activist women in South America have developed noteworthy thinking on care in more economic terms. The commitment in this region to making care central to human life and to giving it political purpose has advanced more than in any other place I know. (Tronto, at the International Seminar “Gender and Care: theories, scenarios, and politics”, Bogotá, August 2015. In: Tronto, 2018, p. 24).

Just 3 years earlier, in her introduction to a publication entitled La economía feminista desde América Latina (Feminist Economics from Latin America) (Esquivel, 2012), Amaia Pérez Orozco wrote:

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N. Araujo Guimarães and H. Hirata We do not merely say feminist economics, but rather feminist economics in Latin America. Does that make a difference? First, it marks a contextual difference. Knowledge is not created in a vacuum, but is determined by social surroundings, thus it is worth thinking that, in this time of change, Latin America has become a much more favorable place than others (i.e. Europe or North America) for developing critical economic perspectives such as feminist economics […] Furthermore, doing feminist economics from Latin America implies breaking away from the tendency León summarizes in these words, “theoretical production is concentrated in the North and is ‘consumed’ in the South, where they seek to instrumentalize and apply it.” (Perez Orozco, 2012, p. 17)

Two ideas draw attention in these two keen views that are simultaneously internal and external—internal to the field and external to the region. First is the idea that there is a creative vitality in the Latin American thought being produced on the subject. Second is the idea that this vitality is nonsensical if we forget the challenges that local realities impose on care theorizing. It is precisely the combination of these two ideas that guides this revisit to Latin American thought on care: as we see it, the international debate in this field stands to gain thematic diversity, interpretational nuances, and consequently, more theoretical depth when it allows itself to be enriched by the analytical advancements produced in the Latin American context. The reason behind this is, if care is central to understanding contemporary societies, when we expand our gaze to incorporate new empirical realities, they and their specificities challenge accumulated knowledge and obligate us to develop new theoretical tools that can handle the singularity of the cases we add for observation. Furthermore, the intellectual history that forms thematic agendas is also inseparable from the realities in which they were built. It provides a lens through which we can capture, value, mobilize, and debate the analytical advancements and interpretative paradigms produced elsewhere. In the Latin American case, two starting points must be considered in order to correctly situate the “social surroundings” that Pérez Orozco alluded to above. The first is related to the particular configuration of the region’s socioeconomic inequalities that impact, as we will see later on, the reality of care and the study agenda built upon it. Substantial income inequality and high rates of extreme poverty are prominent traits that have been highlighted in literature over time (López-Calva & Lustig, 2010; Lustig, 1995; Salama, 2006; Tokman & O’Donnell, 1998). Their persistence, even in periods of growth (Economic Commission for Latin America and the Caribbean [ECLAC], 2016, 2019), gives us a clue as to how enduring the distances are between social classes. However, we must bear other dimensions in mind that configure these inequalities that are especially important to the studies in our field (ECLAC, 2016; Guimarães, 2019a; Jelin, 2014; Reygadadas & Gootemberg, 2010). For example, the increasingly powerful care services market would not make sense without understanding that formal and protected labor relations never became pervasive in the region, which caused different forms of informality to multiply (Nun, 1969; Silva, 2018 [1971]). Likewise, the fragile scope of care policies and their meager coverage and reversibility would lack meaning if we disregard the fact that the powerful welfare states seen in Europe have never been institutionalized in our countries, where the ruling elites have traditionally been miserly in terms of social

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protection policies (Filgueiras, 2013). This highlights the urgency of access to rights (Jelin, Caggiano, & Monbello, 2011), a historical constant on the agendas of the movements (feminist, but also union, indigenous, black, LGBT, special needs, and others). On the other hand, if women’s engagement in the labor market has increased, it has been at rates that are far from uniform and much lower than the level reached by societies in the so-called North (ECLAC, 2016, 2019). Additionally, in countries where women have engaged more quickly, the strength with which domestic employment structures the supply of household care is unprecedented in terms of international scale (International Labour Office [ILO], 2018). A colonial past and the legacy of commercial slavery make the ethnic-racial dimension crucial in configuring the unequal ways indigenous people and afro-descendants are represented among care providers and beneficiaries (ECLAC, 2016; see Chaps. 3 and 8 by Abramo and Robles and Guimarães). Furthermore, experiences with long-lasting local armed conflicts, acute political crises, and the different ways the lives of the poorest are managed under the guise of organized crime question the authority of nation-states, the legitimacy of their institutions, and the viability of their policies. This, in combination with economic reasons, makes the poorest even more vulnerable and heightens populational displacement within a country, within the region, and to countries outside the region (Arriagada & Todaro, 2012). In this sense, debates that were central to the history of care, for example, the debates about “care regimes” or about the so-called “care crisis,” can hardly be discussed in the same terms used by European and North American authors (see Chap. 2 by Posthuma). Thus, care ethics and ethos are inseparable from the scenarios and meanings that care work has acquired in Latin America. Not without reason, Tronto (as seen above) doubted that her ideas could convince South American academics and activists who, she thought, gave priority to the care economy lens. This leads us to the second starting point. Whatever discipline angle we take, we will see that these specificities never went unnoticed to interpreters of Latin American reality and that a powerful local capacity to autonomously theorize has accumulated over time. The trajectory of Latin American social sciences shows strong critical thought that is careful to resist merely transplanting knowledge formulated in different realities (Beigel, 2019). While Marxist inspiration often nurtured this critical capacity, it has also been placed under scrutiny, as exemplified by feminist and black feminist thought in the region. This ability to challenge canons has driven the vitality found in ECLAC’s thinking and in its criticism of economic orthodoxy (Prebisch, 1963), the creativity seen in dependence theories and in their rejection of unilinear hypotheses based on the functionalism of modernization theories (Cardoso & Faletto, 1969; Marini, 1973), and the novelty of emerging black feminism’s claim to “Amefricanity” (González, 1988; Rios, 2019), to name just a few authors. In all of these, no matter how different the interpretation paradigms, we have seen the urgency with which Latin American scholars throughout different generations have tried to understand the historical construction of structural inequalities and the particular configuration of social actors in the region. These two sets of determinants, whether those that come from structural inequalities or those that come from the way our intellectual history sought to understand

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them, also helped forge a plural and innovative agenda for Latin American care studies. In retrospect, the last 15 years have been marked by the subject’s increasing importance in regional academic production. In fact, similar to what happened in the United States and Europe, certain aspects of the care agenda had been addressed since the 1970s. When the concept of “care” entered the scene in the mid-2000s, intersecting several of these subjects and integrating them under a new perspective, it strengthened the domain of gender studies. However, few systematic efforts have been made to reflect on the way care studies establish a specifically Latin American agenda (Batthyány, n.d.; Esquivel, 2012).5 We believe that a good way to address the subject can be to look at the succession of initiatives that gave rise to the agenda. This would allow us to understand how the debate gained depth and to situate its main pillars. It is significant that all these initiatives were conducted in the wake of events that sought to bring together groups of researchers that were active in the field. This already allows a glimpse into the vitality of ongoing empirical production.6 The first was the International Seminar entitled “The Work and Ethics of Care” and held in Bogota in 2008, bringing together researchers from Colombia, France, and Spain. Luz Gabriela Arango Gaviria and Pascale Molinier, in a brief introduction to the book that later published the meeting’s material (Arango Gaviria & Molinier, 2011), presented interesting clues to the discussion about how the field of care as work was being constructed at the time and what new things it offered, especially in view of the findings of the multi-institutional group headquartered in Colombia in its interfaces with international literature and the challenges that produced. Shortly after, in 2010, another event was held in São Paulo that joined intellectuals from Brazil as well as France, 5  Borgeaud-Garciandia, Guimarães, and Hirata (2000), in discussing the subjects that catalyzed the interests of the countries in the so-called “South” and the Latin Americans it encompassed, highlighted three large domains. The first is about the diversity and complexity of care work in these societies, especially in terms of the links between its paid and unpaid forms. The second refers to social inequalities, which become severe when commodified types of care fill the void left by inefficient State action. The third refers to the relation between care and rights, which is urgent in societies where social protection from Welfare States was either non-existent or limited. Thus, the configurations of State and inequalities emerged as the two main beacons in the debate. 6  It can be observed that, at the same time, initiatives from international agencies exposed the care agenda to public policy formulators and managers in Latin America. Thus, in 2007, during ECLAC’s 10th Regional Conference on Women, the countries recognized in the “Quito Consensus” that care was a subject of public interest that should mobilize States, local governments, organizations, enterprises, and families. At the 11th Conference, held in Brasília in 2010, the subject gained even more importance and an entire chapter of the base document was dedicated to the subject of care economy. Almost simultaneously the notion of care appears as one of the articulating concepts in the text about work and family published by the United Nations Development Program and the International Labor Organization (International Labour Office [ILO]/United Nations Development Program [UNDP], 2009). Important researchers were present in these scenarios, as well as in seminars conducted by ECLAC in 2004 and 2005 that focused on family, seeking theorizations that were adapted to the reality and diversity of the region. The subject of care, of an economy of care, and of a culture of care was already on the table then (Arriagada, 2007; Arriagada, n.d.). However, these forums did not seem enough for spreading the new knowledge being produced in the region. Hence the place and growth of the strictly academic conduits referred to here.

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US, and Canada. In their introduction to the collection of the event’s papers, Helena Hirata and Nadya Araujo Guimarães (2012) situate how Brazilian studies were being constructed, according to the four subjects of the debate agenda: care, work, and emotions; social configurations of care; care, public policies, and professionalization; and care and international migration. Both the Colombian and the Brazilian initiatives demonstrate the emergence of relevant empirical production as well as close articulations with intellectual communities in the global North, as also underlined by Hirata (n.d.). However, it was also clear that the dialogue between Latin American researchers was still fragile. In 2013, the 7th Congress of the Latin American Association for Labor Studies (ALAST) held in São Paulo, formed the first Latin American working group (WG) to address the subject of care. The coordinators Bila Sorj (Brazil), Javier Pineda (Colombia), and Helena Hirata (France) were surprised by the large influx of papers. At the same time, ALAST held a symposium on the subject of care coordinated by Rosalba Todaro, from Chile. Later on, in 2014, another event took place in Brazil in both São Paulo and Rio de Janeiro, on the subject of “Work, Care, and Social Policy: Brazil-France in debate” (Guimarães et al., 2016). Although multi-institutional, the participants were still mostly from the host country, along with their partners from France, and French-­speaking Canada. Nevertheless, the subjects expanded under the four main topics of inequalities, professional careers, family dynamics, and social policies. There were also more researchers from other countries in the region, namely Chile and Colombia, indicating that Latin American dialogues were gradually consolidating. In August 2015, another event took place in Bogota. Luz Gabriela Arango Gaviria organized the International Seminar “Gender and Care: theories, scenarios, and policies.” Researchers from five different Latin American countries (Argentina, Brazil, Colombia, Mexico, and Uruguay) participated, along with speakers from France and the United States. The forward of the book that published the results (Arango Gaviria, Amaya Urquijo, Pérez-Bustos, & Pineda Duque, 2018) mapped the structure of the field in three main topics: the ethics and ethos of care; scenarios and meanings of care work; and the social organization of care and public policies. By October 2018, intellectual cooperation in this field had become even more solid. A network of Latin American care researchers had been established and two international events took place in different Latin American countries, Brazil and Uruguay. At the first one in São Paulo, Brazil, the network conducted a double seminar. Firstly, a work meeting was held to produce reports on the reality of care and its studies in five countries (Argentina, Brazil, Chile, Colombia, and Uruguay), which were later published as a collection (Guimarães & Hirata, 2020). Subsequently, a broad event open to the public mobilized the same group to present research advancements, which are collected here in this book. Once again international dialogue was salient and authors from the US, Japan, and France contributed to these debates alongside colleagues from Argentina, Brazil, Chile, Colombia, and Uruguay. The care studies field was most certainly becoming consolidated and institutionalized in Latin America. Initiatives multiplied almost simultaneously. Just 1 month after the events in São Paulo, an even broader International Seminar was promoted

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by the Research Group on Gender Sociology (GISG) from the Universidad de la República in Montevideo, Uruguay, joining again the network of Latin American specialists on care. The number and diversity of participating researchers was unprecedented, and another book was prepared (Batthyány, n.d.). A few months later, in 2019, new events took place in the United States (Latin American Studies Association Congress, March 2019) and at the Latin American Labor Studies Association in July 2019. At the latter event, the Latin American care studies network coordinated the most attended thematic seminar cycle at the Congress. All of this culminated in 2020, when a working group was institutionalized at CLACSO (Latin American Council of Social Sciences) and at the Latin American Studies Association. The area was definitively consolidated and duly instituted in the most important forums for intellectual exchange between Latin American researchers.

Care Studies in Latin America: Results and Challenges The empirical findings and conceptual contributions gathered throughout this trajectory can be grouped into seven major strands that document the density as well as the plurality of Latin American production.7 The first strand, at the origin of the care economy developed among Latin American authors, refers to the analyses of domestic and unpaid work and its place in producing well-being (Batthyány, n.d.; Esquivel, 2012; Todaro & Rodríguez, 2001). This is a tradition of studies that goes back to North American and European debates from the 1970s and 1980s, which initially focused on incorporating the subject of domestic work into Marxist framework (Himmelweit, 1999). The debate about the nature of domestic work had broad and somewhat different repercussions among gender scholars in Latin American countries. As reproductive work, it was considered necessary for reproducing the labor force, and in this sense it supported the organization of capitalism (Bilac, 1983; De Barbieri, 1984; De Barbieri & de Oliveira, 1987; Gálvez & Todaro, 1986; García, Muñoz, & de Oliveira, 1984; Oliveira, Lehalleur, & Salles, 1989; Saffioti, 1969). Its invisibility did not prevent recognizing its value, given the overlap between productive and unproductive spheres. Two important developments in this line of studies impacted the formulations that would later be produced in the domain of a Latin American care economy. On the one hand, and in line with Northern countries, it was necessary to measure it through time-use surveys (like what was documented by Aguiar, 2001, for Brazil; or Garcia & Pacheco, 2014, for Mexico) and even by incorporating it into national accounts to reveal its effect on GDPs (Antonopoulos & Hirway, 2010; Esquivel, 2012; Esquivel, Budlender, Folbre, & Hirway, 2008; Jesus, 2018). On the other hand, it was also necessary to think about paid work performed in the home. Given its enormous importance, Latin Americans

7  In presenting these strands, we use specific bibliographic references only as a way to illustrate the content of each one without any pretense for exhausting local production.

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produced a line of study on this type of employment early on (Saffioti, 1978), which gained depth over time (Brites, 2007; Chaney & Castro, 1989; Gálvez & Todaro, 1986, 1989; Guerra, 2017; Kofes, 2001).8 However, when Latin American literature shifts from the concept of “domestic labor” (paid or unpaid) to “care work,” this range expands even further as less importance is placed on the discussion about the location of work (if in the home or in the market) and more is placed on the content of this work and its place in producing well-being. The second important strand in Latin American care studies is embodied in the concept of the “social organization of care.” In fact, and as seen in an earlier section, feminist literature had coined the alternative notion of “care regimes” in European countries and in dialogue with Esping-Andersen’s reflections on “welfare regimes” (1990, 1999). The fact is that, in the Latin American context, neither work regulations, cash transfers, nor care services have become universal. Furthermore, it is difficult to operate under notions like care regimes in societies marked by interculturality. Anderson (n.d., p. 57) affirms that in Latin America, “Care systems vary significantly. They respond to extremely diverse cultural contexts and relate to different concepts of what a human is and should be, of what a valuable human life is and should be.” Thus, it stands to reason that Latin American literature would prefer to be aligned with the concept of the “social organization of care” rather than trying to identify a “care regime” that is unique, solid, and dominant in a given reality because of the region’s diverse contexts and the different nature of its social policies, less monolithic (in regimes), and more fragmented, fragile, and reversible than those implemented in Europe. The notion of “social organization of care” seemed more effective for handling a dynamic configuration, both in terms of services provided by different institutions, and the variable ways in which families and their members benefit from them, as Faur (2011, 2014) rightly emphasizes in her studies on child care.9 The third strand is also a tributary of the feminist economics agenda. It refers to the links between care and the international migration of women. Early on, Latin American production detached itself from the reflections based on Hochschild’s (2000) agenda that established the concept of “global care chains.” Instead it sought to document the diversity and complexity of migration flows in terms of their directions, as well as the links between paid and unpaid care, and local and outside care (Todaro & Arriagada, 2011; Borgeaud-Garciandía, 2017; Valenzuela, 2019). While it might be true, as Batthyány (n.d.) indicates, that the weaker links of the care chains are in Latin American countries, it did not drive Latin American authors to adopt Hochschild’s original argument about transferring affections from south to north, since new family configurations inside migrant groups played a decisive role. Thus, analytical interest turned instead to understanding the multiple symbolic and material dimensions of the organization of the so-called “transnational families” 8  This is especially true in Brazil’s case, where domestic employment is the main stronghold for female occupations. Hence the volume of production it has gathered on the subject. 9  Guimarães, Hirata, and Sugita (2011) explored an alternative concept of “modes of care provision” in a text comparing Brazil, Japan, and France.

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involving Bolivians, Ecuadorians, or Colombians that migrated to Spain, Peruvians to Chile, Paraguayans to Argentina, Nicaraguans to Costa Rica, and others (Arriagada & Todaro, 2012; Cerrutti & Gaudio, 2010; Cerrutti & Maguid, 2010; Herrera, 2013; Leiva, Mansilla, & Comelin, 2017; Leiva & Ross, 2016; Magliano, Mallimaci, Borgeaud-Garciandía, & Rosas, 2018; Magliano, Mallimaci, Rosas, & Borgeaud-Garciandía, 2019; Rosas, 2018). The fourth strand is developed around the subject of rights. The right to receive dignified care, the right to provide care in adequate conditions, and also the right to choose between providing care or not, which has been a central point in feminist literature. In a context where the sexual division of labor persists based on naturalizing women as caregivers, and where significant inequalities and poverty coexist with insufficient institutionalized protection structures, the subject of rights should be central to care studies, thus identifying another specificity of the Latin American agenda. Furthermore, analyzing care in such a context requires documenting the presence (or absence) of rights established by legislation, which, even though not defined as in spheres of care, they affect how it is provided. This is the case of work, family, and social rights legislation (Arriagada, 2007; Borgeaud-Garciandia, 2020; Pautassi, 2007). The right to dignified working conditions for care service providers has been another point underscored in the regional agenda and is especially relevant when considering the role of domestic employers in performing care activities and the precarity of the work relations and conditions these women are submitted to (Acciari, 2018; Guerra, 2017; Valenzuela & Mora, 2009). On the other hand, the high informality rates among care workers, especially those dedicated to home care, together with the precarity of those who work in institutions where subcontracting and outsourcing initiatives are increasing (Debert & Oliveira, 2015; Pineda Duque & Munévar, 2020) have added emphasis to the subject of accessing and ensuring rights for care providers. The fifth strand is related to the connection between state policies and the reproduction of inequalities. As we have mentioned, this is not about addressing the state as a mere point on the famous “care diamond” or evaluating the efficiency and/or efficacy of its policies. Here we find studies such as the 20 articles collected by Destremau and Georges (2017) or the pioneer work of Sorj (2016), which focus on the role of care policies as a modality for governing the poor. That is to say, the way these policies drive the moral content of the work conducted by social assistants, community agents, and social protection agents, who operate as the outward face of new government initiatives that address poverty and vulnerability. This strand also contains studies that seek, in the opposite sense, to understand the specificity and shape of community ways of providing care, which are repeatedly identified in Latin American literature, whether provided by community mothers (Pineda Duque, n.d.) or by reciprocity relationships and “help” (Faur, 2012; Guimarães & Vieira, 2020; Moreno, 2019). The sixth strand refers to the contexts, circuits, and meanings of care. It is a strand that has developed significantly in recent years and that places special emphasis on the subjective construction of care work. For this reason, it gives value to the voice of caregivers and the different types of care workers. These studies have

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explored different scenarios that range from homes to transnational families (Herrera, 2013), care institutions, aesthetic services (Arango Gaviria, 2018a, 2018b), and sexual work (Piscitelli, 2018). In order to capture and analyze the meanings care workers associate to the different types of activities they perform, some middle-range concepts have been mobilized and proven valuable, such as “scenarios” (Arango Gaviria et  al., 2018), “circuits” (Guimarães, 2019a), and “fields” (see, for example, Chap. 12 by Pineda Duque). In this way, the subject of self-care emerges in studies like Arango Gaviria (2018a) and Viveros Vigoya and Ruette-Orihuela (see Chap. 7 in this book) as interconnected with issues of ethnic identity, associating material reparations of the body (aesthetic services related to the black beauty industry) to emotional reparations (through self-esteem) and to symbolic reparations (of image). This strand also includes recent reflections on symbolic boundaries that separate the different types of care work: the work of domestic maids, caregivers, and nursing staff, to name a few (Guimarães, 2019b; Guimarães & Hirata, 2016). According to these authors, the boundaries demarcate the different meanings attributed to care work, while struggles for recognition are fundamental to understanding the processes of creating professional niches and gaining rights. The seventh strand is related to the subject that founded the field of studies as it emerged in the United States—the ethics of care. Latin American researchers have given emphasis to the transformative dimension of care as an ethical and political category. Examples of this can be found in the work of Meertens (2018) who reflects on transitional justice: before restoring rights, it reveals inequalities, discriminations, and structural violence and acts on them in order to reestablish dignity. In her study on gender, care, and justice in post-conflict Colombia, care appears as a recognition strategy, and community care, which is central to the region, appears as a way to repair the social fabric.

Conclusion The broad range of research paths that were pioneered in the Latin American trajectory of care studies documents the indisputable vitality achieved in the field. The challenges that remain are undoubtedly significant and can certainly propel new advancements. We will briefly list a few of them by way of conclusion. We begin with the very notion of “care crisis”, Since we have made so much progress in capturing the specificities of the Latin American context, is there any heuristic value in keeping this notion as an analytical tool, even knowing that it mobilized so much interpretative effort in the global North? What is the place of this crisis, when seen from the perspective of Latin American reality where extreme poverty and vulnerability are structural traits? Is there really a contemporary, situational crisis being exposed by social and demographic trends? What is its nature among us, and what have been the exit doors (domestic employment, the growing precarity of professional care, little emphasis on care in societies that believe they are experiencing a

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demographic dividend)? Several chapters in this book refer to the crisis of care, both in the global North and the global South. According to Evelyn Nakano Glenn (2009), this crisis is irrelevant in realities where women have always been faced with a lack of institutional or paid care, and yet have not spared their own efforts or allowed a crisis to set in that would be detrimental to themselves. The author states that this crisis only became a problem when it affected middle- and upper-class families (Glenn, 2009, p.  114), thus hiding its effects on black, lower income women, for whom the crisis was nothing new. Her approach underscores continuities in care provision without hiding behind the notion of “crisis” that evokes sudden and critical situations. In this way, if the notion of “care crisis” was mechanically transposed from research done in Northern countries, it would euphemize or hide other social realities where inchoate public policies make care the work of lower class women that prevent an outbreak of a “care crisis.” Nevertheless, despite the advances made in these last 15 years, there is still much to research in terms of gaining a better understanding of the care work modalities that are specific to Latin America. It is worth saying that the configurations of this work in the region and its new characteristics force us to create conceptual tools in order to capture them better. This brings up some elements for reflection, beginning with the place reserved for commodified care work in a context like the Latin American one where domestic employment geared toward care functions abound. In this sense, how should the boundaries between domestic employment and care work be treated, since this type of work is so essential in countries like Brazil, Chile, Argentina, Colombia, and Mexico? Thus, the community ways of caring seem especially important to us. In this sense, how should we treat the types of care that do not recognize themselves as such because they are on the border of solidarity against extreme poverty, where the state fails? How does this challenge us to think about the very notion of the care service market? What are its limits and its borders? To counter these questions, how to understand the weak institutionalization of care work, or the problems of recognizing, regulating, and protecting professional care work? What lessons can we glean from worthy experiences, like in the case of Uruguay, that institutionalized a National Integrated System of Care (SNIC), precisely on a continent where State governments are controlled by elites that hesitate to adopt social policies and are rarely pervious to pressure from organized groups from professional and corporative bases? Although Uruguay has a relatively small population, it was pressured by feminist and active student movements to create a coherent care system that worked systematically in all the fields of care (Batthyány and Genta, 2020). However, this is an exception in Latin America where governments manifest themselves primarily through their silence regarding social inequalities or poverty. The current role of several Latin American administrations raises a number of troublesome questions about the chances of multiplying good practices in the region.

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However, State governments matter when they fail to deter a monopoly of legitimate violence, to use Weberian terms. The reality of armed conflicts in Latin America is not just a challenge for theory and political analysis. It is also an open question for researchers in the field of care studies, since the region has seen the proliferation of armed solutions to conflicts. In fact, one of the specificities of care work concerns armed conflicts in countries like Colombia, which have forced the migration of domestic employees and care workers, as documented by Pineda Duque and Munévar (2020). Therefore, this requires facing the consequences of armed conflicts in terms of care needs. It is important to highlight that here we are talking about forced displacements, not migrations. Few studies in this field document that the victims of these displacements are mostly women, who usually gravitate toward domestic and care work, and who in recent decades have suffered banishment and violence as a result of these conflicts. Care work for victims of armed conflicts was also the goal of pioneer studies (like Pérez-Bustos, Olarte Sierra, & Díaz del Castillo, 2017) that have explored new and challenging analytical frontiers: care ethics have specific characteristics in the science and technology field, when they focus on the work of women scientists in the field of forensic medicine, as in this study about Colombia. Practicing forensic medicine with an ethics of care when the focus is on victims of armed conflict means exposing the articulation between emotional, rational, and practical work. The work of genetic identification provokes emotions and calls for subjectivity. A final point is related to international migrations and its prominent place on the research agenda for domestic employment and care work in Latin America. As we have seen, only recently has South-South migration been targeted by research that shows its importance in large Latin American cities. In more recent work, some of which is in this book, migration is analyzed as a biographical experience, as well as in terms of labor market participation, or as a factor that influences work and employment representations (see, for example, Chaps. 11 and 10 by Borgeaud-­Garciandia and Arriagada and Miranda). Countries such as Chile and Argentina benefit from South-South international migration for domestic and care work. However, countries like Brazil and Colombia have internal migrations between the regions of each one. The ethnic-racial dimension is directly associated to these internal and external migratory processes, and it makes up the inequality matrixes in the field of care. Research about South-South migration and, more generally, about the comparisons between countries in the global South in terms of care work are one of the originalities and strengths of Latin American care studies that challenge the findings that, until recently, had been losing the complexity of migratory flows because they had been based on studies of the South-North movements (cf. Avril & Cartier, 2019). In summary, Latin American production has already established its place in the international domain of care studies. Its inquiries bring new ways of theorizing

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about work, ethics, and care policies in countries of both the global South and the global North. Acknowledgment  This chapter was translated from its original Portuguese version to English by Jill Haring.

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Chapter 2

The Care Deficit in Latin America: Structure, Trends and Policy Approaches Anne Caroline Posthuma

Introduction The giving and receiving of care is central to nurturing and reproducing human life, from cradle to grave, and is a common global phenomenon. Care permeates a range of social and economic activities such as health, early childhood education, food preparation, food serving and cleaning of households. Despite its ubiquity and fundamental role, many dimensions of care are invisible, undervalued and often taken for granted. Furthermore, the economic role of care is not fully recognized, and indicators are not collected systematically as part of a “care economy”; rather, they must be compiled from other sectors. Furthermore, the lack of recognition and value of the care economy often result in a failure to translate into legal frameworks for the support and protection of care providers, or enforcement of labour rights for care workers, or public policies for provision of care services and subsidies for access to care. Where policies do exist, they are often the result of pressure from civil society. In Latin America, these policies tend to be fragmented, lacking an integrated framework, and may provide incomplete coverage or even fail to follow an individual’s needs as they evolve. Some international agencies have spoken of “… deficits in care service provision and its quality …”, for providers and recipients that need to be addressed properly (International Labour Organization [ILO], 2018a). Similarly, for Latin America, studies have called attention to a “… deficit for those who need care and the conditions in which it is provided …” which currently underpins the production of poverty and inequality (Economic Commission for Latin America and the Caribbean [ECLAC], 2016). The declining supply of non-paid family care provision in Latin America as women increase their labour market participation converges with a A. C. Posthuma (*) Inter-American Center for Knowledge Development in Vocational Training (CINTERFOR), International Labour Organization (ILO), Montevideo, Uruguay e-mail: [email protected] © Springer Nature Switzerland AG 2021 N. Araujo Guimarães, H. Hirata (eds.), Care and Care Workers, Latin American Societies, https://doi.org/10.1007/978-3-030-51693-2_2

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growing care-dependent population and the transformation of care needs (Benería, 2008; ECLAC, ibid). This chapter approaches the issue of the care economy from two vantage points. First of all, the chapter takes the Latin American region as a whole as its unit of analysis, with attention to the perspectives promoted by international organizations. Secondly, the chapter focuses upon policies for care, enabling the reader to better understand which care policies have been implemented, their key agents and care deficits in the region. The signs of care deficits in Latin America are visible, and future trends will exacerbate these deficits, if policy action is not taken. This chapter examines the structure, trends and policy approaches surrounding the care economy in Latin America and considers what transformations and pressures are likely to enhance the care deficit in the region. This text gives primary attention to care in relation to the demographic transition toward an ageing society in Latin America, and consequently the rising need for adequate attention to elder care, while also recognizing the important role of care for newborns and children and those with special needs. The first section of this chapter provides a brief overview of key global features of the care economy. The second section focuses upon the main forms of care provision in Latin America. The third section examines demographic trends in Latin America that are driving new and increasing care demands as well as the constraints on public resources and pensions to meet these needs. The fourth section examines different policy approaches and frameworks that could be part of a pathway to address the emerging care demands in Latin America in more integrated and transformative ways. The chapter ends with concluding considerations regarding some policy alternatives and frameworks.

 ore Features of the Care Economy Globally: A Brief C Overview Awareness has grown regarding the important role played by the “care economy” and the implications of its projected growth on a global scale in coming decades. An estimated 2.1 billion people (including 1.9 billion children under 15 years of age and 0.2  billion elderly) required care in 2015. That figure is forecast to rise to 2.3 billion people by 2030, due to increasing numbers of children, elderly and people with disabilities (ILO, 2018a). The role of care provider (both unpaid and paid) falls primarily to women around the world. A recent global report confirmed that in no country do men and women contribute equal shares of unpaid care work. It is estimated that, on average, women provide 76.2% of total unpaid care work (ILO, 2018a). However, the structure of households is changing, as the role of the extended family model weakens, leaving a larger proportion of nuclear families (comprising 43.5% of the world’s working age population), together with a rising number of differentiated household configurations. At the same time, as more women have entered the labour market, the need to reconcile the demands of both work and family responsibilities has grown worldwide.

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In more economically advanced countries, the paid care sector comprises a growing proportion of gross domestic product (GDP) and has become a significant employer of workers, primarily women. Subsequently, the economic dimensions of the care economy have drawn significant attention. However, there is also recognition that market provision of paid care work relies largely upon low-wage workers and is characterized by high labour turnover, which tends to undermine the quality of care services. Hence, while the need for care services is rising, the supply of care, in adequate quantity and quality and that is affordable, is a growing challenge. There is also recognition of the distinct characteristics of the care economy, in which human interaction is integral to care, defying conventional economic notions around raising productivity, creating a so-called “cost disease” in this sector (Figliuoli et al., 2018). In fact, a simplistic approach toward promoting greater productivity in the care economy leads to poor quality care and stressed care providers. A large proportion of social and economic activities are bound up in the care economy. Despite its importance, the care sector is often overlooked and is imbued with cultural and gender significance. On an economic level, the scale of care needs and care provision is poorly measured and is often included in other sectoral accounting. Compounding the situation, there does not exist a common definition of the care economy, complicating the ability to make comparative analyses.

Provision of Care in Latin America Caring in Latin America is widely perceived as rooted in the family and is framed as a female responsibility. A high percentage of women in the region do not participate in the labour market, due to family care responsibilities. For example, half of the women with children 0–7 years of age did not participate in the labour market in 2015; in comparison, only 10% of men were in this situation (ECLAC, 2016). A recent report on the care economy referred to this as a “motherhood employment penalty” which exists globally and across regions for women with young children (ILO, 2018a). In 2018, mothers with children 0–5 years of age displayed the lowest employment rates among workers at 47.6%. As a noteworthy counterpoint, fathers of children 0–5  years of age had higher employment rates (87.9%) than non-fathers (78.2%) (ECLAC, 2016). As a result, unpaid family care providers who remain outside of the labour market lack economic independence and may also lack social protection if they are not linked to the plan of a male or employed family member (ECLAC, 2016). When women performing unpaid care responsibilities also wish to engage in income generating activities, they are more likely to be self-employed, given the unpredictability and need for flexibility in order to balance care responsibilities with economic activities. Such women are less likely to contribute to social security than men. Furthermore, 62% of unpaid care-providers worked in the informal economy (versus 56.8% of non-care providers) and only 47.4% of unpaid care-­providers contributed to social insurance (versus 51.6% of non-carers) (ILO, 2018a).

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At the same time, Latin America has seen a rising rate of female labour market participation that rose from 20% in 1960 to 30% in 1980 and reached 50.3% in 2018, although this remains 20 percentage points below that for men (ILO, 2018b). This trend of increasing female participation in the labour market signals several intertwined shifts, including: working women who can afford to pay a domestic worker to assist with care tasks; women working out of economic necessity with uncertain care support; working women without children or other care responsibilities linked to the declining fertility rate and lower incidence of the nuclear household (Guerra, 2017). Importantly, the quality of women’s participation is poor overall; 87.1% of employed women work in low productivity sectors in which wages and social security coverage tend to be low and contact with technology and innovation is limited (ECLAC, 2019). Similarly, unemployment rates for women are systematically higher than for men in Latin America; the regional average in 2018 reached 10% for women and was only 7.3% for men (ILO, 2018b). Unemployment levels vary among women according to class: in 2013, unemployment rates were 15% for women in the first quintile; 7% among women in the third quintile and merely 3% among women in the highest-income quintile (ECLAC, 2019). Women’s labour force participation reduces time available for unpaid care provision to family members. The demographic shift toward an ageing population together with pressures regarding the cost, quality and availability of health care intensifies care demands of elderly family members (Razavi, 2007). Notwithstanding the importance of unpaid care work provided in the household, paid domestic work plays a large role in Latin America, as compared with other countries and regions in the world. As seen in Fig. 2.1, a large number of countries in South America stand out (along with South Africa), appearing in dark blue, designating “mid-to-high levels of employment in the care sector with a high proportion of domestic workers” and also green which refers to “low levels of employment in care sectors with a high proportion of domestic workers”. Roughly 14% of all employed women in the Latin American region is a domestic worker, providing care work in the household as a paid worker, in both formal and informal arrangements. Despite the important role they play for households and the economy, around 80% of domestic workers in the region are informal and lack social protection coverage paid by their employer(s). Domestic workers tend to be low-paid and only a small percentage contributes to public social insurance or to their own pension programme, placing these workers in vulnerable situations both during their working years and later in old age (ECLAC, 2016; ILO, 2018a). Paid domestic workers generally have low levels of formal education and rarely have any formal training to provide care services. Yet, domestic workers frequently fulfil multiple care roles for their employer(s). It is not uncommon for a domestic worker to clean the household, prepare and cook meals and possibly look after an infant or child, or elderly family member in the household (often while parents and adult family members are away, entrusting these care responsibilities to the domestic worker). While recognizing the great importance of care provided by domestic workers in many Latin American countries, as seen in Fig. 2.1, there is also a contingent of

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Fig. 2.1  Models of care employment, at a global level. (Source: Reproduced from the International Labour Organization (2018a). Care Work and Care Jobs for the Future of Decent Work. Global Report, ILO, Geneva, with permission from the International Labour Organization)

paid, professionally trained carers. Within this group, it is useful to recognize different categories of professional care providers and the relative proportions they comprise, although these vary across countries. For example, in Brazil, professional care providers numbered 1.28 million in 2010, of which 58% were nannies, while 24% worked in care institutions and 14% were home-based professional care providers. Despite their different categories, it should be observed that the overwhelming majority share common characteristics of being female, Afro-Brazilian and having low levels of formal schooling. In addition, considering that care work is not regulated, care providers generally end up as informal economy workers (roughly three-­ fourths have no formal work contract), intense working hours and low wages—with the exception of those working in care institutions that had higher levels of education and vocational training in their field (Guimaraēs & Hirata, 2016). These numbers are significant, but nevertheless overshadowed by the five million home-based domestic workers that are also paid care providers and work under vulnerable conditions (Guimaraēs & Hirata, 2016). The case studies of Argentina and Colombia in this volume discuss the conditions of these paid professional carers. Unsurprisingly, stress among professional paid care providers can become chronic, even raising mental health problems for providers. The physical and emotional workload of care is heavy, especially with the elderly and where illnesses such as Alzheimer’s and Parkinson’s diseases are involved. Symptoms of burnout include fatigue, anxiety and depression, often a restricted social network of support and sometimes leading to alcohol and/or drug consumption to cope. The “Statute of the Elderly” (2003) in Brazil includes recognition of the need to provide help for care providers1 (Grossi & dos Santos, 2016).

 http://www.planalto.gov.br/ccivil_03/leis/2003/l10.741.htm

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Community-based organizations and non-profit organizations also have emerged at the local level, in response to care needs of their community and to help fill care deficits which are not met by public agencies and alleviate the burden of unpaid mothers and family members. The costs of care work are handled in diverse ways, depending upon the organization, but often include forms of voluntary work, worksharing and solidarity work at a cost that is either free or lower than the market rate. Women’s neighbourhood associations, operating through voluntary work, are important organizations for strengthening family and community cohesiveness and identity. Examples such as Mothers’ Clubs, “Glass of Milk Committees” and community kitchens in Peru were created during the economic crisis in the 1980s and 1990s and helped to sustain the needs of families and their community (Blondet, 2002). Such community-based organizations are rooted in broad, collective goals and duties, and form a backbone for family and community care needs. Their services can be strengthened and expanded through collaborations. Governments may find it attractive to partner with these organizations for the provision of care at the local level, as they are often quite cost-effective, and public sector subsidies can help them upgrade facilities, support staff and scale-up activities. Such partnerships, however, must be developed on the basis of adequate and lasting support to enable these organizations to operate sustainably and effectively without undermining the quality of care that is provided (Razavi, 2007). Many Latin American women migrate, both internally and across borders (both South-South and South-North), in search of work as domestic and care workers. Paid migrant domestic workers in Latin America are typically female, from poor households, young and from historically discriminated groups (United Nations Development Programme [UNDP], 2017). They come in search of income opportunities and at other times to escape crisis situations such as in Venezuela or Haiti. The vast majority are unprotected and/or are undocumented and therefore live in fear of deportation, leaving them even more vulnerable to various forms of exploitation, abuse and human trafficking (International Domestic Workers Federation [IDWF], 2017). Important initiatives have been developed in the Latin America region, such as a mobile application for migrant workers in Argentina (but relevant for any domestic worker in the region), the creation of an independent monitoring group in El Salvador, changes in labour and migratory legislation in Argentina concerning Paraguayan domestic workers and a manual in Mexico developed for migrant domestic workers to know their labour rights (IDWF, 2017). As seen above, care needs in Latin America have traditionally been mostly provided by women, in the household and in community-based organizations and through paid care by domestic workers. However, important demographic transformations are underway in Latin America, shifting (albeit at different rates among countries) toward an older population and a declining fertility rate. These demographic transformations, together with changing household composition, weakening of extended family networks and increased female economic participation, raise important implications for growing care demands, the declining capacity of the family to handle these needs to the same extent as in the past, and, consequently, how growing and diverse care needs will be met in the future. The following section

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presents the main features of these transformations in care needs and provision in Latin America, and then considers the issue of pensions and whether the public sector in Latin America will be able to step up its role, as in other regions and countries such as Scandinavia, Western Europe, the United States and Australia provide a sufficient level of coverage for an ageing society and meet other care demands in the future.

Demographic Trends and Pension Constraints Overall, Latin America has a comparatively young population in relation to most advanced economies and regions. Between the period of 1950–2015, the median age in Latin America rose from 20 to 29 years (Caruso Bloeck, Galiani, & Ibarrarán, 2017), whereas the median age in the European Union already reached 42.6 years in 2016 (Caruso Bloeck et  al., 2017). However, in coming decades, ageing is expected to accelerate rapidly; according to some projections, the median age in Latin America will reach 49  years by the end of the century, as compared with 46  years in high-income countries (Caruso Bloeck et  al., 2017). Nevertheless, it must be recognized that, while strong common regional trends exist, there are also important intra-regional differences, such as divergences in the growth rate of female labour force participation rates, or also in fertility rates, which impact directly on the prominence and characteristics of care needs across different countries in the region. Taken as a whole, by 2030, elders over 60 years of age are projected to represent 17% of the total population in Latin America; by 2050, this average is estimated to rise to 25% (Aranco, Stampini, Ibarrarán, & Medellín, 2018). Nevertheless, strong differences exist within the region: countries with younger demographics such as Bolivia, Guatemala, Guyana and Haiti will have a profile similar to China, with around 15% of the population above 60 years in 2050; meanwhile, countries such as Brazil, Chile, Colombia, Jamaica and Uruguay will have a proportion comparable to that of Germany, Finland and Japan at around 30% (Aranco et al., 2018). Perhaps even more surprising, the share of those over 80  years (currently accounting for 11% of the elderly population) will reach 26% of elders by 2050 and even reach 30% in some countries such as Chile (Aranco et al., 2018). High rates of dependency among the elderly population imply greater needs for long-term care policies. In the absence of public care programmes provided by the State, this care has been traditionally provided by families, or by paid care services by domestic workers or in the market. However, the ability of families to continue providing unpaid and paid care on their own is likely to be increasingly limited, due to changes in the size and structure of households and family networks and women’s growing labour market participation as seen in the previous section. The ability to substitute unpaid family care with private paid care can be financially prohibitive, even for households in better socioeconomic conditions. Most elders in the region are unable to pay for private care, given their high rates of poverty and economic

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vulnerability. In countries such as Guatemala, Honduras and Nicaragua, around half of the elderly population lives in poverty. A large proportion of those over 80 years lives alone, particularly in countries such as Argentina, Uruguay and some Caribbean nations. Data from Uruguay indicate that 23.1% of adults over 65 years living alone have difficulties in realizing at least one daily task (Aranco et al., 2018). Given the various constraints, some families resort to private care services, yet many of these lack adequate levels of quality care. In Uruguay, most long-term care residences are not licensed to operate and cases of elder mistreatment or violence have been reported. Poor quality standards of such long-term residences also have been noted in Chile (Aranco et al., 2018). These various trends contribute to a growing care deficit. This rapid demographic transition for Latin America is due to two main trends. First of all, the fertility rate has fallen to an average of slightly more than two children per woman, roughly a threefold reduction from the 1950s. This pattern exists across the entire region, even among countries with the highest fertility rates, such as Guatemala and Bolivia. In addition, infant mortality rates have declined by 67% between 1990 and 2015 (from 53.8 to 17.9 infant deaths per 1000 live births, respectively), largely due to improved sanitation and maternal health services (Pan American Health Organization 2017). Second, longevity is rising. Improved living standards and wider access to health care in Latin America have increased average life expectancy to nearly 75 years. In some countries, such as Chile and Costa Rica, the life expectancy is above 80 years of age, slightly surpassing the United States average (Figliuoli et al., 2018). If this trend continues, by 2100 Latin America will have a higher share of elderly (32%) than advanced economies (27%) (Caruso Bloeck et al., 2017). This combination of lower fertility rates and rising life expectancy in Latin America is closing the so-called “demographic dividend” that has existed in the region since the 1970s, in which the population between 15 and 64 years of age grew faster than the population younger than 15 years and older than 64. This dividend already ended in 2015 in Chile and Costa Rica, while a few years remain in Brazil, Colombia and Uruguay, meanwhile countries with young populations such as Bolivia, Guatemala and Paraguay are projected to benefit from the demographic dividend until 2045 (Figliuoli et al., 2018). A crucial, twofold implication arises in this context: an expanding cohort of elderly with care needs, together with insufficient pension systems (constrained for those who are covered and roughly half the ageing population left uncovered) which will be explored below. Over time, fewer active people in the labour force will be contributing to support a growing number of dependants, thereby raising pressures on pension systems and restricting the financial resources required to support an ageing population.2 Pension systems across Latin America are already under pres2  The ratio of the number of working age people between 15 and 64 years per elder of 65 years and older (referred to as the old-age support ratio) has declined significantly in Latin America on average from 16.0 in 1950 to 8.9 in 2015. At this rate, the old-age support ratio in Latin America will be closer to that of high-income countries by 2050 (ILO, 2018b). In specific countries the situation

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sure to respond in terms of coverage (number of people reached), adequacy (benefit levels) and sustainability (capacity to guarantee coverage and benefits) (Figliuoli et al., 2018; ILO, 2018b). At present, approximately only 45% of active workers contributes to a pension system in Latin America and merely one-third of those over 65 years is entitled to pensions from a contributory scheme (Figliuoli et al., 2018). Some countries have expanded coverage through non-contributory pensions and special regimes, but coverage rates are lower than other regions. Even in countries where public pension systems cover a large share of the population, these systems often fail to provide adequate incomes for retirees, especially in cases of defined-­ contribution systems (ILO, 2018b). The high rate of informal work is a major factor underlying the low coverage and insufficient benefits of contributory pension schemes. Nearly half of Latin America’s labour force works informally, either in the informal economy or in formal enterprises which do not make statutory pension payments for workers (in some countries, such as Bolivia, informality is 76%) (ILO, 2018b). Informality is particularly high among domestic workers and the self-employed (which average one-third of the labour force in the region, although this may rise to 70% in some countries), for whom pension contributions are either voluntary or unenforceable (Figliuoli et al., 2018). As a result, 55% of the employed population makes no pension contribution (ILO, 2018b), despite important progress in employment-based pension contributions that increased from 36.6% to 44.6% between 2005 and 2015. Hence, 145 million workers in Latin American have no coverage through a contributory pension scheme (ILO, 2018b). This situation exacerbates income inequality and gender inequality because low-­ income workers are unlikely to receive a pension (or very limited one). These circumstances are particularly acute for women, who generally have lower coverage and benefits than men, due to their lower labour market participation rates, fewer years of salaried work due primarily to maternity and child care responsibilities, wage inequality which results in lower earnings than men during years of paid work, earlier retirement ages and longer life expectancy (Figliuoli et al., 2018). In 2015, 47% of women over 65 years received no pension or salary (versus 17% of men). These factors result in higher rates of old-age poverty among women (ILO, 2018b). These converging factors threaten to enhance the existing care deficit in Latin America, thereby requiring urgent policy action to fill the coverage gaps. A recent study produced three possible scenarios regarding future care needs of elders in Latin America (hence, not including persons with disabilities, infants and others requiring care). In the first scenario, the number of dependant elders 75 years and older would triple by 2050, totalling more than 27 million representing over 3% of the population (and around 14% of adults over 60 years). In the second scenario, the number of dependent elders would arise to 22 million (or 11% of the population

is even more extreme, such as Argentina and Chile whose ratio is 5.1 and 5.6 respectively, and Uruguay with 3.9 working age person per elder (Caruso Bloeck et al., 2017).

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over 60 years) versus a third scenario which would involve rates of up to 17% of the over-sixty population (Aranco et al., 2018). There exists a possibility that long-term care needs of elders in Latin America may be higher than in the advanced economies, due to the fact that life expectancy is increasing in Latin America but without the same improvements in quality of life and nutrition (Caruso Bloeck et al., 2017). Individual behaviour such as physical inactivity, tobacco use, poor eating habits and lack of proper preventive care (Luoto & Carman, 2014) has created a prevalence of chronic conditions such as obesity, hypertension, arthritis and high cholesterol, thereby raising the probability of premature ageing and early onset of care needs due to unhealthy lifestyles (Caruso Bloeck et al., 2017). These circumstances point toward a rising need for long-term care (LTC), but LTC raises important cost implications. While this may be an option for some households, the costs may require an additional supplement from the government (Caruso Bloeck et al., 2017). Among lower income households, the incidence of LTC needs could be met through poverty reduction programmes (Caruso Bloeck et al., 2017). Health care spending by governments in Latin America is reportedly higher than two decades ago, as many countries have sought to raise coverage and reduce inequalities. On average, public health spending in Latin America is 4.4% of GDP (Figliuoli et al., 2018). As health care costs rise in the future, it is important that States continue to finance necessary health care improvements, in terms of quantity and quality. If not, then there is a risk that many elders would be left either in conditions of neglect and vulnerability or would reinforce their reliance upon informal domestic workers for care. These trends indicate that, on the one hand, the demographic transition toward an ageing society, declining fertility rates and rising labour market participation of women have combined to put pressure on the traditional model of unpaid care in the home, signifying that this traditional model may be unable to meet care needs in the future to the extent it did in the past. On the other hand, the system of pensions is unprepared to meet these needs, confirming warnings about the emergence of a care deficit in Latin America. This context raises important implications regarding the type of care economy that will emerge as the Latin American region ages, whether these care needs will be met adequately, and how. The following section will consider what types of policies may be suitable for supporting the growing care economy in Latin America.

 olicy Approaches and Frameworks to Address the Rising P Care Demands in Latin America In earlier sections, this chapter touched upon different forms of care provision encompassing private/public, unpaid/paid and informal/formal configurations. These diverse ways of meeting care requirements have been conceptualized as a “care diamond”, as seen in Fig. 2.2.

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Families/ Households (Unpaid Care)

State Federal/ Local (Public Provision)

Markets (Paid Care)

Not-for-profit/ Community organizations (Voluntary, Solidarity and Paid)

Fig. 2.2  The “care diamond” of care provision. (Source: Razavi, 2007, p. 21)

Within the Latin American context, the care diamond is tipped heavily toward the top point of family and household-based care, counting primarily upon unpaid female labour. The reliance on paid care provision by domestic workers in Latin America was also seen to be among the highest in the world, which is the right-hand point of the diamond. Similarly, the role of not-for-profit and community-based organization, in the bottom point, plays a strong role in certain contexts, particularly in poorer and more vulnerable communities where pooling of labour and assets helps to manage care crises and is also tied with broader needs of families and the local community. The left-hand point, of State provision of care, is widely seen to be the weakest point of the diamond but is also the component with the greatest potential to offset the emerging care deficit in Latin America. Therefore, public policy approaches and frameworks are explored in this section. Public provision of care services is recognized to be limited in Latin America (Rico & Robles, 2017, p. 220). As seen in earlier sections, care has largely been relegated to the family and primarily women. However, with the changing demographics, structure of households, role of women in the labour force and weak pension coverage for a major share of the ageing population, the State cannot play a passive role. There is an urgent need for public policies to be proactive, scaled up and conceived in ways that will ensure the health, protection and care of society across all groups, particularly at both ends of age groups—infants/youth and the elderly— while maintaining awareness of the ongoing needs of people with disabilities. When considering public policies, the four components of care provision in the care diamond are best conceptualized within an integrated care framework. In this way, policies should contribute to strengthening and supporting these various components, and maintaining an effective equilibrium between them, thereby enabling each one to fulfil its respective role and scope of capabilities for care provision, in order to match up the diverse needs and financial means of different care recipients. This perspective is consistent with analyses by various international agencies and policy researchers who have examined the issue; they agree upon the need to promote coherence between care-related policies, in order to address the range of

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Table 2.1  Some components of an integrated care policy Population requiring care Monetary transfers for hiring care services (including cash-for-care benefits for people with disabilities, which can improve their independent living and enable employment of personal assistants). Day centres and long-term stay residences Home-based care Tele-care Care residences

Policy components Monetary resources

Services

Time

Quality standards for care services

Regulation and inspection

Care providers Monetary transfers for care providers Pension award in recognition of care responsibilities Training for care providers

Short-term care provision (hours or weekend) allowing unpaid care providers to rest and handle their personal needs Maternal and paternal leave, Parental leave and care Policies to balance work and family life Labour and social protection norms for paid care workers and care services

Source: Rico and Robles (2016, p. 149)

needs and circumstances more effectively. The ILO has called for transformative policies for a care economy, which are defined as policies that guarantee the human rights, agency and well-being of both unpaid and paid care providers (whether in employment or not) and care recipients (ILO, 2018a). Similarly, ECLAC promotes integrated care policies in its regional reports (ECLAC, 2016). A policy framework that is transformative and integrated must take into account elements related to monetary resources, services, time and regulation which are key components for meeting the needs of care recipients as well as unpaid and paid care providers, as depicted in Table 2.1. In recent years, care policies have emerged and expanded their reach in Latin America, but a review of these policies shows that they are most often implemented in a piecemeal way and not within a framework of integrated care economy policies such as called for by ECLAC and the ILO. ECLAC has criticized this piecemeal approach, arguing that states have done little to reduce inequalities or raise coverage of care policies and also have failed to challenge gender-based norms underlying the unequal distribution of care work and low levels of co-responsibility between women and men in the region. Instead, care must be seen as a “social function, public good and basic right” (Rico & Robles, 2017). Nevertheless, there are important trends and also emerging practices that can serve to point toward future policy priorities and approaches and also serve to contextualize the studies in this collected volume.

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A few countries in the Latin American region have started to implement more integrated public policies for long-term care of elders, thereby setting examples from which other countries can learn. Uruguay is the first country in Latin America to institutionalize an integrated policy for dependent care provision (Rico & Robles, 2016). This policy framework includes improved quality of care for dependent persons and also provides time freedom services for family members to reduce the burden of responsibility associated with care provision. Furthermore, visibility has been given to care tasks, promoting professionalization of these tasks and promoting co-responsibility of care between women and men, the State, private sector and families. Other policies that aim toward integrated elder care have been developed in Brazil, Costa Rica and Cuba (ibid). Argentina has recently begun to adopt such issues on the public agenda. Colombia is working to include indicators on non-­ remunerated care provision in the National Accounts of the country (a step toward recognizing how care demands place pressures on the family, especially women) (Aranco et al., 2018). Despite these examples of a rising number of care policies in Latin America, overall, the existence of broader, more integrated policy frameworks for care is limited. Instead, existing policies remain piecemeal and fragmented, rather than linked within integrated and transformative frameworks for care providers and care recipients. The transformations in the region create an urgent reality of a deepening care deficit in Latin America. More examples of country-level experiences and analyses are required to raise awareness and inform policymakers. The studies and analyses presented in this collected volume aim to contribute toward filling the empirical gaps and providing policy insights for a care economy in Latin America. Table 2.2 summarizes a review of care policies in Latin America in 2015, conducted by ECLAC, organized by policy type and frequency (by country, in parentheses). As can be seen, important strides have been made in the majority of countries to provide policies, programmes and services especially for caring of dependent elderly family members and for infants; along the same vein, leave for working adults (but particularly for women) is made available under different circumstances. When comparing Tables 2.1 and 2.2, we can see that countries performed best on time-related policies, related to provision of leave. Furthermore, monetary transfers were present in some countries, but limited. Services for care providers were present, and also a large number of countries offered care facilities for infants, persons with disability and dependent family members. The final category of regulation and inspection was not considered in Table 2.2. It is important to draw attention to the existence of such policies and their scope. However, at the same time, these operate mostly as stand-alone policies, rather than working in synergy with other related policies in a common framework of care. When policies operate in “silos”, they tend to deliver more limited coverage. Moreover, there is a risk that some needy individuals and families may lose coverage or “slip through the cracks” where gaps exist between different policies and when care needs change.

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Table 2.2  Summary of existing care policies in Latin America, frequency by number of countries, 2015 Policies, programmes and services Care of dependent elderly family member (20) Infant care (20) Training for care providers (10) Provide respite care services (downtime for family members and care givers to rest) (8) Monetary transfers for care provision (8) For care providers of persons with disability and dependency (6)

Family leave Maternity leave (20) Paternity leave (14) Adoption leave (8) Parental leave (4) Care for seriously or terminally ill family member (4) Care for a child with a disability (3)

Source: Rico and Robles (2017)

Furthermore, it is worth noting that many of the effective care policies have been put in place in response to pressure, mobilization, action and awareness-­raising by civil society. This highlights the effective role that can be leveraged through organization and representation among both care providers and care recipients, in drawing attention of policymakers to their activities and to the various needs for greater care policy support. This latter point has been underscored by some authors, who recommend that a “high road” of paid care provision should be supported by (1) strengthening coalitions among care workers (for example, nurses and teachers with less organized nurses’ aides and childcare workers) and including across different care sectors, (2) building upon areas of common interest for both care providers and care recipients (such as giving greater visibility to the connection between better working conditions and improved service quality) and (3) mobilization and unionization of care workers (and how unionization and mobilizing for better working conditions and improved care provision fit together) (Folbre, 2006). This point regarding the need to raise the organization and representation of care providers and care recipients is especially acute in Latin America, where paid care services are locked into a “low-road” strategy, reliant on the informal labour market (of paid domestic workers and nannies). This situation requires better regulation of domestic work (including formal employment relations, compliance with a minimum wage and payment of social benefits), such as outlined in Convention 189,3 the international labour standard that has been ratified by 25 countries worldwide and 14 Latin American countries to date (being the region with the highest number of ratifications of C189). These legal protections and rights for domestic workers must be implemented, enforced and monitored, but this is an especially challenging task, considering the special character of domestic work which takes place within private residences. Together with legal protection and enforcement, domestic workers must strengthen their voice and agency through representative organizations and trade

3  Convention 189 (2011) concerning “Decent Work for Domestic Workers” (https://www.ilo.org/ dyn/normlex/en/f?p=NORMLEXPUB:12100:0::NO::P12100_ILO_CODE:C189).

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unions, to demand recognition of their labour rights and to improve their pay and working conditions. Other strategies include coalition-building with other organizations of care workers, as well as with feminist and black consciousness movements (Mackintosh & Koivusalo, 2005). The transformative policies for a care economy described earlier can be summarized in a “5R Framework”, of policy goals and policy initiatives that can contribute to a “high-road” care economy (ILO, 2018a). As seen in Table 2.3, the policy guidelines in the 5R Framework address the needs and deficits of care provision in each of the four points on the “care diamond” (i.e. unpaid and paid care providers, community and voluntary organizations and the role of public services at the local, state and federal levels). In this way, it can be seen as an effort to provide guidelines toward a more balanced and integrated system of care, that is also more gender Table 2.3  The 5R framework for decent care work: “high road” care work with gender equality Policy goals •  Recognize the value of unpaid care work •  Reduce the drudgery of certain forms of care work •  Redistribute unpaid care responsibilities between women/ men and households/State

•  Reward paid care workers adequately

•  Representation of care workers

Policy measures: the “high road” to care work • Measure care work and consider unpaid care work in policymaking • Invest in quality care services, care policies and care-relevant infrastructure • Promote active labour market policies that support (re)integration of unpaid care workers into the labour force • Implement family-friendly working arrangements for all workers • Information and education for more gender-equal households, workplaces and societies • Guarantee the right to universal access to quality care services • Ensure care-friendly and gender-responsive social protection systems, including floors • Implement gender-responsive and publicly funded leave policies for all women and men • Regulate and implement decent terms and conditions of employment and achieve equal pay for work of equal value for all care workers • Ensure safe, attractive and stimulating work environment for care workers (women/men) • Enact laws and implement measures to protect migrant care workers • Ensure women’s participation and equal opportunities for leadership at all levels of decisionmaking in political, economic and public life • Promote freedom of association for care workers and employees • Promote social dialogue and strengthen the right to collective bargaining in care sectors • Promote alliances between trade unions representing care workers and civil society organizations representing care recipients and unpaid carers

Source: International Labour Organization (2018a). Care Work and Care Jobs for the Future of Decent Work. Global Report, ILO, Geneva, with permission from the International Labour Organization

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equitable and compliant with labour rights of care workers. Ultimately, policies that address the inequalities and lack of protection surrounding care provision by redistributing care work and guaranteeing the rights of care providers and care recipients will be promoting an agenda for sustainable development in the future (ECLAC, 2016). The policy approaches and frameworks that have been proposed by international and regional organizations and specialists on the care economy point toward feasible pathways for Latin American countries to prepare for the growing depth and range of care needs that are emerging in the region.

 oncluding Considerations: Positive Convergence, or Risk C of a Rising Care Deficit in Latin America? Care provision in Latin America has been traditionally rooted in the family, with women bearing the principle role as unpaid care providers for infants and young children, family members with disabilities and the elderly. Care work can be rewarding, but when excessive or without adequate time for rest, it can take a toll on care providers. Furthermore, a heavy and prolonged care burden without support can impact negatively upon women’s opportunities to seek paid employment outside the home and their earnings levels. Labour market participation rates, on average, have been low among women in the Latin American region (around 20% in the 1960s and slowly rising to 30% in the 1980s), while recognizing variations between individual countries. As a result, unpaid women carers tend to lack economic independence and social protection coverage (unless they are linked to the health and pension plans of a relative or spouse). In some cases, and particularly among lower income groups, community-based organizations play an important supporting role. Where financial conditions permit, paid care is provided largely by domestic workers, at a higher rate in Latin America when compared with other countries and regions. Meanwhile, public policies have been scarce for care provision or to support the work of unpaid care providers. Similarly, the labour rights, pay and working conditions of paid carers and domestic workers have been largely neglected. Thus, in the Latin American region, the four-pointed “care diamond” seen in Fig. 2.2 has been tilted toward the three dimensions of (1) unpaid family-based care; (2) paid care, primarily in the form of domestic workers and (3) community, voluntary and solidarity organizations, with a weak role of the fourth dimension played by public services for early childhood care, health and nursing care for the elderly and people with disabilities and promotion of good working conditions for workers in care sectors. However, unfolding structural changes are driving transformations in both the supply and demand of care in the Latin American region. On the one hand, the supply of unpaid family care is being impacted by a rising rate of female labour market participation (that surpassed 50% in 2018) and weakening of extended family ties. On the other hand, the demographic shift toward an ageing society, as well as needs

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of people with disabilities and childcare will unleash rising demand for a range of care including nursing, day care, personal assistance, health care services and hospitals. As seen in section “Provision of Care in Latin America”, the rising costs of care for the elderly will strain the coverage, adequacy and sustainability of pension systems for those who have coverage; meanwhile, the high levels of informal work mean that many ageing adults do not have coverage of pension and health plans and must rely upon either family support or public services. Thus, the Latin American region faces an expanding cohort of elderly with care needs together with insufficient pension coverage (roughly a mere one-third of those over 65 years is entitled to a pension from a contributory scheme). These circumstances exacerbate inequalities and vulnerabilities particularly for low-income workers and women who ­generally have lower coverage and benefits than men. In 2015, 47% of women over 65 years received no pension or salary, resulting in high rates of old-age poverty among women. It is estimated that 145 million workers in Latin America have no coverage through a contributory pension scheme and coverage rates through non-­ contributory pensions and special regimes are limited. Many elders in Latin America have poor health standards and a propensity toward disabilities as they age, meaning that the demand for long-term care (LTC) may tend to rise rapidly in the region (Caruso Bloeck et al., 2017). In contrast, most of the advanced economies in other regions have developed public social security systems because private markets are not well-prepared for providing coverage for LTC. As has been seen, the challenge to provide adequate levels of provision and quality of care in Latin America is high, given the structural changes underway which are adding further pressures on the existing deficit of care in Latin America. The situation calls for a stronger and more proactive role of the public sector in developing and implementing policies to support a vibrant and far-reaching care economy, operating in a framework of more integrated and transformative care policies.

References Aranco, N., Stampini, M., Ibarrarán, P., & Medellín, N. (2018). Panorama de envejecimiento y dependencia en América Latina y el Caribe (Policy Brief, IDB-PB-273). Washington, DC: Inter-American Development Bank. Benería, L. (2008). The crisis of care, international migration and public policy. Feminist Economics, 14(3), 1–21. Blondet, C. (2002). The “devil’s deal”: Women’s political participation and authoritarianism in Peru. In M. Molyneux & S. Razani (Eds.), Gender justice, development, and rights (pp. 277– 305). Oxford: Oxford University Press. Caruso Bloeck, M., Galiani, S., & Ibarrarán, P. (2017). ¿Cuidados de larga duración en América Latina y el Caribe? Consideraciones teóricas y de políticas (IDB Publications Working Paper No. 834). Washington, DC: Inter-American Development Bank. Economic Commission for Latin America and the Caribbean (ECLAC). (2016). Consolidar políticas integradas de cuidado: Un imperativo de igualdad (Infographic, Policy Brief No. 29). Santiago: Author. Economic Commission for Latin America and the Caribbean (ECLAC). (2019). Planes de igualdad de género en América Latina y el Caribe: Mapas de ruta para el desarrollo. Santiago: Author.

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Figliuoli, L., Flamini, V., Galdamez, M., Lambert, F., Li, M., Lissovolik, B., et al. (2018). Growing pains: Is Latin America prepared for population aging? (Departmental Paper Series No. 18/05). Washington, DC: Western Hemisphere Department, International Monetary Fund (IMF). Folbre, N. (2006). Measuring care: Gender, empowerment and the care economy. Journal of Human Development and Capabilities, 7(2), 183–199. Retrieved July 17, 2019, from https:// econpapers.repec.org/article/tafjhudca/v_3a7_3ay_3a2006_3ai_3a2_3ap_3a183-199.htm Grossi, P., & dos Santos, A. M. (Eds.). (2016). Envelhecimento e Cuidados: Relatos de experiências com cuidadores de pessoas idosas. Porto Alegre: EDIPUCRS. Guerra, M. d. F. L. (2017). Trabalhadoras Domésticas no Brasil: Coortes, Formas de Contratação e Famílias Contratantes. Unpublished doctoral dissertation in demography, Economy Faculty, Federal University of Minas Gerais, Belo Horizonte. Guimaraēs, N., & Hirata, H. (2016). La frontera entre el empleo doméstico y el trabajo profesional de cuidados en Brasil: Pistas y correlatos en el proceso de mercantilización. Sociología del Trabajo, nueva época, 86, 7–27. International Domestic Workers Federation (IDWF). (2017, June 11). Migrant domestic workers in Latin America. Retrieved March 28, 2020 from https://idwfed.org/en/updates/ latin-america-migrant-domestic-workers-in-latin-america International Labour Organization (ILO). (2018a). Care work and care jobs for the future of decent work. Global report. Geneva: Author. International Labour Organization (ILO). (2018b). Presente y Futuro de la Proteccion Social en América Latina y Caribe (Panorama Laboral Temático No. 4). Lima: Author. Luoto, J., & Carman, K. G. (2014). Behavioral economics guidelines with applications for health interventions. Washington, DC: Inter-American Development Bank. Mackintosh, M., & Koivusalo, M. (2005). Health systems and commercialisation. In search of good sense. In M.  Mackintosh & M.  Koivusalo (Eds.), Commercialisation of health care: Global and local dynamics and policy responses (pp. 3–21). Basingstoke: Palgrave. Pan American Health Organization (PAHO). (2017). Children’s health. Health in the Americas. PAHO.  Retrieved June 24, 2019, from https://www.paho.org/ salud-en-las-americas-2017/?tag=infant-mortality Razavi, S. (2007). The political and social economy of care in a development context: Conceptual issues, research questions and policy options (Gender and Development Programme Paper No. 3). Geneva: United Nations Research Institute for Social Development (UNRISD). Retrieved June 20, 2019, from http://www.unrisd.org/80256B3C005BCCF9/(httpAuxPages)/2DBE6A9 3350A7783C12573240036D5A0/$file/Razavi-paper.pdf Rico, M. N., & Robles, C. (2016). Políticas de cuidado en América Latina: Forjando la igualdad (Serie Asuntos de Género No. 140). Santiago: ECLAC. Rico, M. N., & Robles, C. (2017). Chapter 5: El cuidado, pilar de la protección social: Derechos, políticas e institucionalidad en América Latina. In R. Martínez (Ed.), Institucionalidad social en América Latina y el Caribe (pp. 219–248). Santiago: ECLAC. United Nations Development Programme (UNDP). (2017). Paid domestic workers in the Southern Cone of Latin America: A struggle to overcome a history of exclusion. New York: Author.

Chapter 3

The Social Inequality Matrix, Universal Social Protection Systems, and Care in Latin America Laís Abramo and Claudia Robles

Introduction Inequality “[…] is a historical and structural characteristic of Latin American and Caribbean societies that has been maintained and has reproduced itself even at times of growth and economic prosperity” (Economic Commission for Latin America and the Caribbean [ECLAC], 2016a, p. 14). Between 2002 and 2014, income inequality decreased in Latin America (ECLAC, 2016b, 2017a, 2018b, 2019a, 2019b) in a political context where the region’s governments prioritized the objectives of social development and promoted active redistributive and inclusive policies. The strengthening of increasingly universal social protection policies and systems from a rights perspective contributed to this (ECLAC, 2018b). In 2015, this tendency decelerated, while poverty and extreme poverty rates, which had dropped significantly in the previous period, rose once again (ECLAC, 2019a, 2019b). Furthermore, substantial gender, ethnic-racial, territorial, age, and other inequalities surface in all areas of accessing rights. Thus, high levels of inequality continue to deter development, people’s well-being, and democratic governance (ECLAC, 2017a). Care is one of the fundamental spheres where poverty and inequality is reproduced and intensified in the region (ECLAC, 2010a). On the one hand, it is strongly associated to care provision that is marked by unequal sexual division and

The data and reflections developed in this article are partly based on recent institutional publications by the Economic Commission for Latin America and the Caribbean (ECLAC), especially its Social Development Division. The authors wish to thank Amalia Palma for her support in writing this article, Daniela Huneeus for her editorial review, and Bernardo Atuesta for his comments on this article’s preliminary version. L. Abramo (*) · C. Robles Social Development Division, Economic Commission for Latin American and the Caribbean (ECLAC), Santiago, Chile © Springer Nature Switzerland AG 2021 N. Araujo Guimarães, H. Hirata (eds.), Care and Care Workers, Latin American Societies, https://doi.org/10.1007/978-3-030-51693-2_3

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feminization of labor. Paid care work is characterized by lower wages and higher precarity, when compared to other occupations (ECLAC, 2019b). Unpaid care work is marked by a sharp imbalance between men and women in terms of the time they dedicate to it. This tends to bar women from labor participation and better quality paid occupations, which impact their economic autonomy and the well-being of their families (ECLAC, 2016c, 2019b, 2019c). Thus, higher proportions of women are found in the low productivity sectors, and their average participation rate was 24 percentage points below men’s in the third quarter of 20171 (ECLAC, 2019b). In 2016, 41.7% of workers earned less than the national minimum wage. This proportion was higher among women (48.7%) than among men (36.7%) and was even more accentuated among young people (55.9%), especially young women (60.3%) (ECLAC, 2019b). Another important expression of this situation is the proportion of women in Latin America without their own income. Despite having dropped in recent years, in 2017, 29% of women aged 15 and over that were not exclusively studying did not have their own income, while among men it was only 10.5%.2 Complementary information gathered from time-use surveys3 reveals significant gender and socioeconomic gaps (ECLAC, 2017a) and shows that the amount of time women spend in domestic and unpaid care work oscillates between one-fifth and one-third of their daily or weekly time, while for men it is around 10% (ECLAC, 2017a). Around 2012, in seven countries (Argentina, Brazil, Colombia, Ecuador, Mexico, Peru, and Uruguay), it was observed that the amount of hours men dedicated to domestic or unpaid care work did not differ significantly according to socioeconomic levels. However, marked differences were found in the case of women: while women in fifth quintile (most resources) households spend an average of approximately 32 h a week on this type of work, those in the first quintile (least resources) spend around 46 h a week (ECLAC, 2017a), meaning they have much less available time for other activities such as education and paid work. This constitutes a situation of “time poverty” (Abramo & Valenzuela, 2016), which accentuates the insecurity they experience in other aspects of their lives. On the other hand, the situation in the region for those who require care such as children and people in situations of dependency due to disability, chronic illness, or age is quite complex and extremely vulnerable. There is a lack of public care policies (ECLAC, 2016c, 2019c), especially policies related to good-quality care services that ensure standards and supervision and allow access to any necessary care without compromising well-being (Rico & Robles, 2017). This exposes these

 Women’s participation rate was 50.2% while men’s was 74.4% (ECLAC, 2019b).  See online at: https://oig.cepal.org/es/indicadores/poblacion-sin-ingresos-propios-sexo 3  Time use surveys provide information on the activities people perform in a certain period and the amount of time assigned to them, as established by the Classification of Time-Use Activities for Latin America and the Caribbean (CAUTAL) (ECLAC/INEGI/INMUJERES/ONU-Mujeres, 2016 in ECLAC, 2017a). Currently 19 countries in the region have implemented at least one time use measurement. Although these surveys cannot be compared with each other due to their methodological differences, they provide very important information about the domestic and care work conducted within households as well as their distribution between men and women (ECLAC, 2017a). 1 2

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people to profound inequalities that intensify and reproduce poverty and social exclusion in the region. Therefore, care as a problem, social practice, and right directly influences the welfare regimes of countries and their internal arrangements for accessing it with greater or lesser participation of the State, families, communities, or the market. Care policies can be understood as actions that “guarantee the everyday physical and emotional well-being of people that have some level of dependence and that intervene in the social organization of care” (Rico & Robles, 2017, p. 223). They address care provided inside and outside the home and consider the situations of those that either require or provide care (Rico & Robles, 2017).  Comprehensive care systems include policies on time, resources, benefits and services (ECLAC, 2019c). Understanding the reality of care in Latin America requires taking into consideration its specificities. On the one side, it means explaining the interaction of care with the region’s social inequality matrix (addressed in the next section). On the other, it means analyzing the evolution of social protection and understanding it as a right that should be expressed in integrated social protection systems where care policies and institutions are both constitutive and transversal elements (addressed in the third and fourth sections). Finally, in the fifth and last section we will present some challenges and recommendations on how to move forward in building these systems and care policies.

The Latin American Social Inequality Matrix Although the debates and analyses regarding inequality in Latin America have focused on income disparities, its structural character, and its persistently high levels of concentration, it is increasingly recognized that inequality is a broader, more complex, and multidimensional phenomenon (ECLAC, 2016a, 2018c). In addition to income inequality, there are other inequalities, related to discrimination mechanisms, that are originated and reproduced in different areas, “[…] such as health, education, culture, and political and citizen participation. Those inequalities are determining factors of poverty and pose major barriers to overcoming it” (ECLAC, 2016a, p. 16). The notion of equality advocated by ECLAC does not allude to economic or resource equality4 alone. It includes equal rights and capacities (a set of acquired abilities, knowledge, and skills), autonomy, and the reciprocal recognition of actors (Bárcena & Prado, 2016; ECLAC, 2016a). In addition to being a necessary ethical principle, equality is also considered a key factor in increasing productivity,

4  This is an essential dimension of equality that includes both the distribution of current monetary incomes among people and households, as well as inequalities in the functional distribution of income between capital and labor, and inequality in owning financial and non-financial assets (Bárcena & Prado, 2016; ECLAC, 2017a, 2019b).

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innovation, and economic growth (ECLAC, 2018c).5 Equality of rights is considered the primary axis of equality and refers to the full entitlement of economic, social, and cultural rights and to the full inclusion of all people in development (ECLAC, 2016a). Understanding the phenomenon of inequality and being able to design, implement, and evaluate policies directed at overcoming it assumes reaching a deeper understanding about its nature and dynamics, especially about the axes that structure and perpetuate it. In Latin America, social inequality is conditioned by its productive matrix and by a culture of privilege (ECLAC, 2016a, 2018c). As ECLAC has shown, the productive matrix in the region’s countries is characterized by limited diversification and by elevated structural heterogeneity that is, to a large extent, at the base of the high indices of social inequality (ECLAC, 2012, 2014b, 2018c). Approximately 50% of employment is generated in low productivity sectors with high informality and the labor market is the link between this productive structure (and its inherent inequality in terms of productivity, access to quality employment, and social protection) and high household income inequality (ECLAC, 2012, 2014b, 2016a). The culture of privilege, on the other hand, exposes a historical trait that is entrenched in Latin American societies—a pattern inherited from the colonial and slavery period that continues until today in practices, customs, and institutions (Bárcena & Prado, 2016; ECLAC, 2018c). This culture is built on the denial of the other as rights holders; the other that, in the social configuration of the region, can be the poor, the worker, the woman, the indigenous person, the Afro-descendant, the migrant, or the homosexual. According to ECLAC, the culture of privilege is characterized by three basic elements. First, differences are understood as inequalities and become naturalized in people’s perceptions, whether they are in positions of privilege or subordination. Second, hierarchies are also naturalized and established to benefit whoever is in power (according to criteria based on class or blood, race or ethnicity, gender, birthright, culture, or a combination of these), which adds compelling inertia to power and inequality. Third, the culture of privilege is embodied and reproduced by actors, institutions, rules, and practices (ECLAC, 2018c). Latin America’s social inequality matrix (ECLAC, 2016a) is structured by a set of axes that intersect, reinforce, and connect with each other throughout the life cycle. It paves the way for multiple inequality and discrimination factors that interact simultaneously and emerge in the different areas of rights and social development and “characterize the ‘hard core’ of poverty, vulnerability,” and exclusion (ECLAC, 2016a, p. 17). The first axis of inequality is socioeconomic stratum (or the social class). Added to this are inequalities related to gender, ethnicity and race (especially those related  The development of ECLAC’s thinking on equality over the last decade has been summarized in the following institutional documents: Time for Equality: Closing Gaps, Opening Trails (ECLAC, 2010b); Structural Change for Equality: An Integrated Approach to Development (ECLAC, 2012), Compacts for Equality: Towards a Sustainable Future (ECLAC, 2014b), Horizons 2030: Equality at the Center of Sustainable Development (ECLAC, 2016d) and The Inefficiency of Inequality (ECLAC, 2018c). 5

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to indigenous people and Afro-descendants), territory, and life cycle. “What gives these axes the power to structure social inequalities is their constitutive and determining weight in the process of producing and reproducing social relations and people’s experiences; or, in other words, their impact on the depth of inequalities and their reproduction in different areas of development and the exercise of rights.” (ECLAC, 2016a, p.  16). Other significant expressions of inequality in the social relations configurations of Latin American countries are those associated to disability, migration status, sexual orientation, and gender identity (ECLAC, 2019d). The advancement of democracy and the rights agenda, the strengthening of recognition policies and social participation spaces and mechanisms limit and challenge the culture of privilege and allow for cementing a culture of equality (ECLAC, 2018c). However, this is not a linear process. The culture of privilege is very strong and predisposed to react. In certain settings, like those marked by significant social inclusion processes such as those experienced in Latin America in the last decade and a half, it can threaten democratic advancements and go against the rights agenda. Giving full attention to the characteristics, persistence, and operation of inequalities in all the abovementioned areas, as well as to the ways in which they intersect and reinforce each other, is fundamental to designing and implementing policies and institutions focused on ensuring rights, equality, and well-being for all. In this context, it is crucial to have social protection and care systems that aim for universality, acknowledging the inequalities in their access and closing these gaps (ECLAC, 2016a, 2016b).

 ocial Policies, Social Protection Systems, and Care S as a Transversal Pillar Social protection is a right upheld by multiple legal obligations and international instruments (Cecchini & Rico, 2015) and is a fundamental pillar in constructing welfare states. It can be understood as a set of policies and institutions focused on “[…] universal access to income that permits an adequate level of well-being, as well as universal access to social services (such as health, education, water, and sanitation), housing, labour inclusion policies and decent work” (ECLAC, 2020, p.  19). It includes four components: noncontributory social protection (or social assistance), contributory social protection (or social security), labor market regulations, and care policies (ECLAC, 2020). Its benefits include cash transfers (conditional and unconditional), social subsidies, grants, and various social security instruments (including pensions and unemployment, disability, and survival insurance) and care policies (ECLAC, 2018a). All of them contribute to people being able to exercise their economic, social, and cultural rights and their access to welfare, especially when their capacity to generate autonomous income is limited (ECLAC, 2018a). Latin America has made important progress in recent decades related to the legal recognition and constitutional inclusion of social rights, including the right to social protection (Cecchini & Rico, 2015). This perspective gained strength in the region

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in the first decade and a half of the 2000s, in a context where the State regained its role as regulator, overseer, and distributor; where commitment to the rights agenda was expanded, and where criticism escalated against targeted policies due to its reductionist approach as opposed to universal social policies (education, health, and social security) to combat poverty, commonly in use in the 1980s and 1990s (ECLAC, 2016b). There has been an increased understanding that social protection should adopt a systematic approach in its design and that social protection systems should respond to the needs of different life cycle events and of different population groups and articulate with social policy in the areas of health, education, housing, basic infrastructure, and others (Cecchini & Martínez, 2012; ECLAC, 2016b). Between 2002 and 2014, expanded coverage and the creation of new social protection policies and mechanisms played a key role in reducing poverty and inequality, as well as in containing the poverty increases and distribution drops that began in 2015 (ECLAC, 2019a, 2019b). Cash transfer programs deserve special mention for their central role in the social policies aimed at overcoming poverty in the region (ECLAC, 2016b) and for opening the door to social protection systems for some of the most excluded sectors of the population (Abramo, Cecchini, & Morales, 2019). These noncontributory programs are financed by general revenues and access is associated to needs-based criteria. In the region, they have come by way of conditional or unconditional cash transfers and family allowances (ECLAC, 2016b). Conditional cash transfer (CCT) programs deliver monetary and nonmonetary resources to families living in situations of poverty or extreme poverty. They generally target families with one or more children or adolescents, with the condition that they fulfill certain requirements associated to improving their human capacities, especially in the areas of health, education, and job training.6 Currently 20 Latin American and Caribbean countries in the region have CCTs, which in 2017 reached 20.7% of the region’s total population (133.5 million people in 30.2 million households), with disbursements that correspond to 0.37% of the regional GDP, or in other words, USD $148 per capita (Abramo et al., 2019). Figure 3.1 shows, on the one hand, the significant expansion of CCT coverage between 1997 and 2010 and then its subsequent drop after this year. This is worrying, especially in a context where, as indicated, poverty and extreme poverty rates are increasing after 12 years of reduction. As a consequence of these two trends, in 2017, the total number of people living in households that received CCTs corresponded to 71.3% of the total population living in monetary poverty (in other words, one in every three poor people were not covered by these transfers) (Abramo et al., 2019).7 Furthermore, the monetary payments disbursed by many countries through these programs are low in comparison to both the poverty line and the income shortfall of people living in poverty (i.e., the difference between their autonomous income and the poverty line), which means the transfers are not enough to overcome 6  For more information about these programs and their descriptions and components, see NonContributory Social Protection Programmes in Latin America and the Caribbean Database, Social Development Division, ECLAC, [online at]: https://dds.cepal.org/bpsnc/cct 7  Data for 20 Latin American and Caribbean countries that have CCTs.

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25.0

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Fig. 3.1  Percentages of the total population and percentages of GDP.  Latin America and the Caribbean (20 countries): individuals in recipient households of CCT programs and public spending on CCTs, 1996–2017. (Source: Reproduced from Abramo et al., 2019. Social Programmes, Poverty Eradication and Labor Inclusion: Lessons from Latin America and the Caribbean. ECLAC Books No 155 (LC/PUB.2019/5-P). Santiago: Economic Commission for Latin America and the Caribbean (ECLAC), on the basis of S.  Cecchini and B.  Atuesta, “Conditional Cash Transfer Programmes in Latin America and the Caribbean: coverage and investment trends,” Social Policy series, no. 224 (LC/TS.2017/40), Santiago, Economic Commission for Latin America and the Caribbean (ECLAC), 2017; Economic Commission for Latin America and the Caribbean (ECLAC), Non-contributory Social Protection Programmes in Latin America and the Caribbean Database, [online] https://dds.cepal.org/bpsnc/cct, “with” permission from the Economic Commission for Latin America and the Caribbean)

their situations of poverty (Abramo et al., 2019). Therefore, it is important to avoid additional decreases in CCT coverage and instead to expand cash transfers in order to reach everyone in situations of poverty and to ensure incomes that are able to at least surpass the extreme poverty lines (ECLAC, 2016b). Particularly key to these programs is mainstreaming a gender approach and giving attention to inequalities associated to the social organization of care so that they can, under the logic of integrating with the social protection system as a whole, foster co-responsibility in care and connection between program beneficiaries and care policies in the different countries (Rico & Robles, 2017). It is also fundamental to incorporate an ethnic-­ racial approach in these programs when thinking of the intersection of gender and ethnic-racial inequalities and the situation of greater poverty and exclusion experienced by indigenous and Afro-descendent women in the region (ECLAC, 2017a, 2017c). Along these lines, the region’s countries are still significantly indebted in terms of providing social protection that includes expanded coverage (especially for the most excluded and vulnerable groups), sufficient benefits, and adequate financing (ECLAC, 2018b, 2019d). Additionally, the core challenge is to integrate the many benefits into systems capable of coordinating different programs and State

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institutions, at different levels, which influences design, financing, implementation, regulation, monitoring, and evaluation (Campello, Falcão, & Costa, 2015; Cecchini & Martínez, 2012; ECLAC, 2018c). Thus, important institutional challenges in the countries are articulating between sets of interventions that serve different groups of the population requiring care (such as young children, persons with disabilities, and the elderly) or specific functions of social protection (such as care policies) that become subsystems of a universal social protection system. Likewise, because the region is characterized by deep and multiple structural inequalities, its social protection systems must be guided by a universal approach that actively identifies them and seeks for their overcoming. According to the Regional Agenda for Inclusive Social Development (ECLAC, 2020), this means that, besides a focus on universality, these systems must make specific efforts to close gaps and end the inequalities and discriminations that affect how different populations access social protection. This can lead to affirmative action measures and strategies to promoting a culture of equality within institutions and to recognizing different identities and demands (ECLAC, 2016a, 2020) by way of “rights-­ based, gender, ethnic and racial, life-cycle, territorial and disability approaches” (ECLAC, 2020, p. 29). This is a way to effectively advance toward universalizing the right to inclusive social protection, including in countries that have universal systems in some or many areas of social policies and services (e.g., health and education). Care policies form the fourth pillar in comprehensive social protection systems (Rico, 2014) and must intersect with the other three pillars as well as the different stages of the life cycle (ECLAC, 2019d). However, the axes that structure social inequality (ECLAC, 2016a) also intersect with the dynamics associated to care. When considering life cycle aspects, almost one-third (31.2%) of young women (between 15 and 29 years old) were neither in school nor occupied in the labor market in 2016. This means they faced considerable barriers when trying to access education and paid work, which are the main pathways toward social inclusion. For men, this proportion was almost three times less (11.5%) in the same year (ECLAC, 2019b). The fundamental reason for this situation is the high amount of domestic and unpaid care work that women do. According to data from around 2012, 70% of the young women outside the education system and the labor market were doing domestic and unpaid care work, which contrasts sharply with the 11% of young men in the same situation (ECLAC, 2014a). This type of dynamic establishes itself early on. Information gained from time-use surveys in six countries8 showed that while girls spent between 13.6 and 23.3 h a week doing unpaid work, boys spent between 6.6 and 15.2 h (ECLAC, 2017a). The inequalities related to care continue being linked to other axes that structure social inequality, which severely penalizes young Afro-descendent women: in five Latin American countries (Brazil, Ecuador, Panama, Peru, and Uruguay), and the 8  Chile (2015), Colombia (2012), Costa Rica (2011), Ecuador (2012), Mexico (2014), and Peru (2010). Children and adolescents are classified as anyone under the age of 18 and over 12, except in Colombia where the lower limit is 10 (ECLAC, 2017a, p. 200).

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average percentage of young Afro-descendent women that were not in school or occupied in the labor market in 2016 was 34%, compared to 26% young white women, 15% young Afro-descendent men, and 13% young white men (ECLAC, 2019b). Added to all this is consolidated evidence that more women are excluded from social security than men, and how this is a consequence of the inequalities that exist in the labor market as well as in reproductive spheres, which can be amplified by social protection system designs. In the majority of Latin American countries, women have less access to old-age pensions (ECLAC, 2018b, 2019c). Women also receive smaller average pension amounts9 (ECLAC, 2018b, 2019c). It is also important to consider that more women receive noncontributory pensions than men. Although this has allowed for greater coverage, the amounts are still substantially lower in comparison to contributory benefits (ECLAC, 2018b). Additionally, it must be kept in mind that even in this stage of life there are still considerable gaps between retired men and women in terms of time dedicated to unpaid work (ECLAC, 2017a). With regard to the populations that require care, we must consider the complex inequality machinery that is put into action when there is a lack of public policies targeting specific needs (ECLAC, 2016c). In the case of early childhood, for example, the deficit of public care services and early education and preschool programs is combined with the unequal capacities of families to hire care services on the market, which creates labor participation barriers for their home caregivers and thus heightens the household’s vulnerability (Rico & Robles, 2016). Sharp inequalities that exist in access to early education, health, and nutrition during early childhood (ECLAC, 2017b) partially show these inequalities that are later reproduced in the life cycle. Moreover, information on the effective access to care services among people who require them is still scarce. The elderly10 and people with disabilities11 experience considerable challenges in terms of sufficient pension amounts that they receive in the region. This is indicative of the deficiencies that these people and their families might experience when requiring care if they are in situation of dependency. This shows the importance of having public solutions for the region’s existing social organization of care. The challenge that care policies face is assuming the risks of those who need and provide care. This has led to debates about “integrated care policies,” or a set of

9  In 2016, the proportion of women aged 65 or older that received pensions below two poverty lines (44%) was 8% points higher than among men (36%) (ECLAC, 2018b). 10  Forty percent of the average monthly contributory pension benefits, usually higher than noncontributory pensions, were below the minimum wage threshold in eight countries of the region in around 2015 (ECLAC, 2018b). 11  For information on the non-contributory cash transfer and pension benefits received by persons with disabilities in countries of Latin America and the Caribbean, see Non-Contributory Social Protection Programmes in Latin America and the Caribbean Database, Social Development Division, ECLAC, [online at]: https://dds.cepal.org/bpsnc/cct. Also see Ullmann, Atuesta, Cecchini and Rubio (n.d.).

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public and private intersectoral actions that are brought together to provide care services and help families (Salvador, 2011). These policies include a series of instruments12 such as cash transfers for hiring care services or for crediting care work provided within the home; care services for young children and persons in situations of dependency due to age, illness, or disability (which can include everything from day care or long-term facilities to homecare, telecare, or foster families), as well as respite and training programs for caregivers; leaves of absence and time off for caring for children or dependent family members; and finally, rules and regulations related to care that include quality standards and labor laws, among others (Rico & Robles, 2017). In a comprehensive and integrated approach, these instruments would allow simultaneous progress in covering the different risks associated to care by ensuring coherence with the set of social protection instruments and between their design and their goals to protect against vulnerability and reduce the inequalities found in the current social organization of care (Rico & Robles, 2017). Nevertheless, a review of care policies in the region shows unequal access to a fragmented situation (ECLAC, 2016c; Rico & Robles, 2017). On the one hand, maternity leaves and childcare and eldercare services operate in all the countries of the region, although coverage is unequal, not universal, and often highly commodified. For example, around 2014, preschool assistance for children between 3 and 5  years old in eight countries (Brazil, Chile, Colombia, Costa Rica, Honduras, Mexico, Peru, and Uruguay) oscillated between 86% in Uruguay and 37.6% in Honduras, reaching an average of 64.8% (ECLAC, 2017b). On the other hand, of 17 countries in Latin America, 15 provide paternity leaves and only two provide parental leaves (Tromben & Podestá, 2019). Some areas have less coverage, like leaves to care for children with disabilities, care for a gravely or terminally ill family member, or for adoption (Tromben & Podestá, 2019). Cash transfers for care, that might play a crucial role in ensuring households have an adequate level of income, are also less frequent in all the countries, along with other benefits such as “respite services” for caregivers and home care services, and regulated quality standards (Rico & Robles, 2016). Also, although there has been significant progress in labor laws for domestic workers, they still address specific and more precarious regulations than the rest of the waged workers in the region (ECLAC, 2017a). Thus, advancement toward integrated care policies or systems is still in its early stages. The strongest experience in the region is the National Integrated Care System in Uruguay, which regulates the right to care and defines benefits for those who require and provide care. Chile has created the Support and Care System, Chile Cuida. Similar initiatives with their own particularities are being discussed in Ecuador, El Salvador, and Paraguay (ECLAC, 2019b, 2019c). Similarly, the experiences of the National Child Care and Development Network (Red Nacional de Cuido y Desarrollo Infantil—REDCUDI) and the Progressive Care Network for Comprehensive Care of Older Persons (Red de Atención Progresiva para el Cuido

12

 A detailed review of these instruments can be found in Rico and Robles (2016, 2017).

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Integral de las Personas Adultas Mayores) in Costa Rica are relevant points of reference when analyzing integrated policies for specific populations (ECLAC, 2019b). In short, moving toward integrated care policies and systems that address the care needs of those that require them along the life cycle as well as gender inequalities associated to the sexual division of labor and the regulation problems of care work within the framework of social protection is a considerable challenge that requires integrated actions that are comprehensive and inclusive. It is crucial to consolidate their institutionality in a way that considers the intersecting inequalities that characterize Latin American society and its labor markets.

Recent Social Protection Trends in Latin America Contributory and noncontributory social protection increased significantly in Latin America between 2002 and 2015, in a context of accelerated demographic transition. This increase was related to both the positive evolution experienced by the labor market until 2014 (low unemployment rates, higher wages, increased formality) and the legislative and political changes that facilitated expanding the contributory base of the social security systems (ECLAC, 2018b). It was also due to the rise and development of new noncontributory social protection instruments such as cash transfer programs for poor families and noncontributory pensions (Abramo et al., 2019). However, critical challenges persist in terms of coverage, adequacy, financing, and articulation (ECLAC, 2018b), issues that interact decisively with the axes of the matrix of social inequality described in the second section, as well as with contextual factors that should be considered in the discussion about care policies. An increasingly aging population is a key challenge to social protection systems and care policies in the next decades (ECLAC, 2010a). Latin America and the Caribbean foresee that the number of people aged 60 or older will, for the first time, surpass the number of children and adolescents under the age of 15 by approximately 2036, a trend that will continue until 2080 (United Nations, 2017 in ECLAC, 2018b).13 Consequently, the demand for care, health, and pensions will increase while the demand for primary and secondary school and maternal and child health will decrease (ECLAC, 2018b), which challenges the welfare regimes of the region, demands their strengthening in order to meet the emerging requirements, and mandates a fluid articulation between the many components of social protection. Furthermore, aging has become feminized: “excess male mortality, which means that women enjoy higher life expectancies, has increased from between 3 and 4  years in 1950–1955 to a current level of more than 7  years” (ECLAC, 2018b, p. 25). A complex situation is found at the intersection between women’s higher widowhood rates and their more limited economic participation, which increases

 For a more detailed analysis of these tendencies, including the heterogeneity found between Latin American and Caribbean countries, see ECLAC (2018b).

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their risk of having lower contributory social protection coverage and being in poverty (ECLAC, 2018b). Thus, social protection policies should give special attention to older women that are in highly vulnerable situations and who are only partially, if at all, recognized for the unpaid care work they performed throughout their lives, even in their old age. Once again, we can see the need for interfacing care and social protection policies and the need to build integrated care systems. Current migration trends in Latin America have also created new challenges for social protection (ECLAC, 2018a, 2019a) and care systems. It is necessary to consider the risks that especially impact migrant women that incarnate global care chains (ECLAC, 2019a), the care needs of migrant children, as well as the many specific vulnerability factors found in each stage of the migration cycle (origin, transit, destination, and return) (Maldonado, Martínez, & Martínez, 2018). These include high levels of irregular and informal labor, which lead to difficulty accessing contributory social protection. Added to this is the insufficient response capacity of social protection and care systems to address the set of related challenges. Furthermore, the profound transformation underway in the world of work led by the fourth industrial revolution brings new dilemmas to social protection linked to possible increments in informality and to crucial aspects of social security functions (ECLAC, 2017b; International Labour Organization [ILO], 2018). It is especially important to follow up on the situation of women in new types of employment, such as employment on digital platforms, which, while it can provide an opportunity to conciliate paid and unpaid work, it also can reinforce gender roles and lead to precarious and unprotected participation if there are no pertinent public policies and social dialogue and collective bargaining mechanisms among employers and trade unions (ECLAC, 2019c).

Concluding Remarks Over the last two decades, Latin America has made progress in building social protection systems that use different approaches and mechanisms to protect people from the many circumstantial, structural, and emerging risks that affect the region. These advances have allowed expanding contributory and noncontributory social protection coverage and their instruments and reducing some of the inequalities that have historically characterized social protection in the region. However, significant gaps still persist. In fact, recent analyses (ECLAC, 2018b, 2019b, 2019d; ILO, 2018) have shown that social protection systems have several debts, as seen in the numerous gaps related to accessing different coverage instruments and adequate benefits. Important sectors of the population are still excluded, which means that these systems are still far from achieving universality. The discussion on expanding care policies must be situated in this context as one of the pillars of these systems and must address the emerging challenges that question social protection as a whole.

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In this sense, this chapter draws attention to how this goal can be supported by a careful analysis of the axes that structure the social inequality matrix in Latin America. It also addresses the call to intervene the associated gaps and recognize the differentiated needs in the design of social policies, including social protection and care policies. This can be expressed in various elements that can be considered in the design, implementation, monitoring, and evaluation of these systems. First, designing instruments and benefits with this approach requires actively identifying inequalities related to coverage, access, and adequacy that affect the different population groups, particularly those that face the multiple and intersecting dimensions of these inequalities and exclusions, as well as persistent and emerging risks. This refers to the need to strengthen social information systems and national statistical capacities, especially in terms of disaggregating information in order to reveal these inequalities (ECLAC, 2017b), an issue that also extends to the expanding care demands in the region. Second, giving attention to differences implies considering the specific identities, needs, and demands of the people and collectives in situations of greater inequality and exclusion in the program’s design. In the case of care policies, it means addressing both the inequalities and risks faced by those requiring care and the gender inequalities that build up throughout the life cycle produced by the current social organization of care in the region (ECLAC, 2019b). Special attention should be given to indigenous people, Afro-descendants, migrants, and disabled women who live in poorer territories and who require and provide care. In this sense, it is fundamental to integrate care policies with policies that target early childhood, adolescence, and youth as well as policies associated to social security, social protection for elderly women, and promoting ethnic and racial equality. In addition to the necessary mainstreaming of a gender perspective, it is necessary to concretely mainstream ethnic/racial, territorial, life cycle, and disability perspectives in the design and implementation of social protection policies according to the Regional Agenda for Inclusive Social Development (ECLAC, 2020), which can also be extended to care policies. Another important element to advance in this direction is recognizing the region’s recent rich experience in developing new strategies, instruments, and programs in different areas of social policy that are focused on closing socioeconomic, interethnic, territorial, and other gaps and that have not been sufficiently registered, systematized, or analyzed. An example of this is the participation of organizations, indigenous authorities and communities, Afro-­ descendants, and small farmer communities in the design and implementation of conditional cash transfer programs (Campello et al., 2015; ECLAC, 2017c; Robles, 2009), and affirmative action policies that allow indigenous people, Afro-­ descendants, persons with disabilities and lower income people to have access to technical and higher education. These examples address the significant gaps faced by these groups when trying to access different areas of social development (Campello & Gentili, 2017; ECLAC, 2017c; Mercadante, 2019). Third, clear orientation on how to address the inequalities involved in accessing and operating social protection instruments could consider the most pressing needs of certain groups as a way of prioritizing efforts to expand coverage. This demands

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a decided social investment commitment in public services of care and even in the search of collective insurance mechanisms in this matter, including care insurances. Finally, this orientation could also involve a careful examination of the numerous risks that affect the diversity of the population. Here, it is fundamental to consider the surge of emerging questions (ECLAC, 2019d) that directly challenge social protection systems and their claim to universality. These challenges include the growing incidence of disasters and their greater impact on the population groups that are most affected by the structural axes of social inequality; migration as an important factor in reproducing the inequalities in countries of origin and those of destination, which claims social protection mechanisms associated to the different stages of the migration cycle (Maldonado et al., 2018); the changes in the world of work associated to the fourth technological revolution; and the demographic shifts that account for an increasingly aging population, the feminization of this aging, and other expressions (ECLAC, 2019d). The risks associated to these dynamics complicate the responses that should be shaped by social protection, especially care policies. Care policies within the framework of social protection intersect each of these aspects and require specific attention. As described in the first section of this chapter, although these policies have been garnering increased attention in the region’s countries, challenges remain in terms of the coverage, financing, articulation, and response capacity of the existing instruments in different contexts for addressing the different needs of care givers and care receivers. Exposing the risks faced by these groups and designing appropriate responses for their social protection are thus core aspects that must be strengthened. Likewise, this implies that such policies must consider the necessary relevance of their instruments and pay careful attention to the gaps and inequalities experienced by specific populations like indigenous peoples, Afro-descendants, persons with disabilities, and those living in rural areas far from existing care services. And finally, they must consider the different stages in the cycle of life. At the same time, these considerations refer to the double integration challenge faced by care policies: on the one hand, the possibility of articulating their instruments in order to respond to different needs and move toward universality; on the other hand, coordinating with the other components of the social protection systems (Rico & Robles, 2017). Advancing along these lines means recognizing the true reach and importance of universality and comprehensiveness in building and strengthening social protection and care systems, emphasizing the central role of these policies in overcoming poverty, inequality, and the culture of privilege, and making steady progress toward achieving the Sustainable Development Goals and the imperative of leaving no one behind, as indicated by the Agenda 2030 for Sustainable Development (United Nations, 2015). Acknowledgment  This chapter was translated from its original Spanish version to English by Jill Haring.

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Salvador, S. (2011). Hacia un sistema nacional de cuidados en el Uruguay. In M. N. Rico (Ed.), El desafío de un sistema nacional de cuidados para el Uruguay (Serie Seminarios y Conferencias No. 66, LC/L.3359). Santiago: Economic Commission for Latin America and the Caribbean (ECLAC). Tromben, V., & Podestá, A. (2019). Las prestaciones familiares públicas en América Latina (Documentos de Proyectos, LC/TS.2018/97/Rev.1). Santiago: Economic Commission for Latin America and the Caribbean (ECLAC). Ullmann, H., Atuesta, B., Cecchini, S. & Rubio, M. (n.d.). Las transferencias monetarias no contributivas: Un instrumento para promover los derechos y el bienestar de la población infantil con discapacidad en América Latina y el Caribe (Serie Políticas Sociales). Santiago: Economic Commission for Latin America and the Caribbean (ECLAC), United Nations Children’s Fund (UNICEF). United Nations. (2015, October). Transforming our world: The 2030 agenda for sustainable development (A/RES/70/1). New York: Author. United Nations. (2017). “World Population Prospects: The 2017 Revision” [online] https://esa. un.org/unpd/wpp/.

Chapter 4

The Centrality of Women’s Work and the Sexual and International Division of Care Labor: Brazil, France, and Japan Helena Hirata

Introduction In spite of national differences between Brazil, France, and Japan, a study of care work in different societal contexts shows that employment conditions, employee profiles, and lack of recognition/remuneration are similar in all three countries. Although the different actors of care—state, market, family, and community— act unequally and asymmetrically, care work is still primarily done by women in the three countries and will likely continue as such since the work is mostly precarious, pays low wages, is mostly unrecognized, and is poorly valued. Therefore, it is important to take into consideration the gender, class, and racial inequalities that permeate the growing internationalization and institutionalization of care work. In Brazil and France, care workers are mostly poor, black women who are often immigrants (internal or international migrants). Because it is a set of material and psychological practices that consist in giving concrete answers to the needs of others (Molinier, Laugier, & Paperman, 2009, p. 17), care work had long been done by women, usually inside the domestic space, the so-called “private” sphere, given for free and “out of love” to the elderly, the children, the sick, and the physically and mentally disabled. The rise of care-related professions and the commodification and outsourcing of this type of work were consequences of an aging population and the mass influx of women into the labor market in countries as different as Brazil, France, and Japan. These factors, added to migration flows in a context of increasing globalization, generated not only a new international labor division but also reconfigured care work. H. Hirata (*) National Center for Scientific Research (CNRS), Center for Sociological and Political Research of Paris (CRESPPA), Paris, France e-mail: [email protected]

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With commodification, free and invisible female care work became visible and was finally considered work with corollaries such as professional training, wages, promotions, and career. It has even become a work a man does, as seen in long-term institutions for the elderly in Japan where, according to our field work,1 almost 40% of care workers are men. The heterogeneous profiles of the interviewed care workers stand in contrast to the fact that care work in all three countries is similarly undervalued, underpaid, and socially underrecognized. These similarities, despite the unequal profiles and trajectories, seemingly find their explanation at the very heart of care activities, which is that it has traditionally been provided by women, free of charge, in domestic and familial scenarios. This hypothesis, which is framed by gender and care theories, was confirmed by our international comparative research.2 In this chapter, we introduce different modalities of the current sexual and international division of care work that highlight the central role of women in this type of activity. In the first part, we discuss international migrations in a context of growing globalization and the significant increase of women immigrating on their own and without family to find paid domestic and care work, especially in northern countries. In the second part, we underscore how the racial and ethnic division of labor, and the discrimination it entails, cannot be separated from the sexual and international divisions, which we illustrate using specific cases from Brazil, France, and Japan. In the third part, we present the different configurations of the social organization of care using the “care diamond” model (Razavi, 2007), focusing specifically on cases from Brazil, France, and Japan. While the multiple actors of care (state, market, family, NGOs, non-profits, associations, philanthropy, volunteer work, etc.,) mix and act very unequally in different social contexts, the central role of women’s work remains true in all cases. In the conclusion, we review the more theoretical aspects of this text in a discussion on the predominant social sciences paradigms that are challenged by gender and care perspectives.

1  The research entitled Theory and Practice of Care, comparing Brazil, France, and Japan, was conducted in 2010 and 2011. In the Brazilian field, we worked with Myrian Matsuo, a researcher from FUNDACENTRO—Ministry of Labor, and in the French field with Efthymia Makridou, at the time a PHD student of sociology at CRESPPA—GTM-University of Paris 8 laboratory (cf. Hirata et al., 2017). 2  For the field work of the project “Theories and Practices of Care from a Compared Perspective: Brazil, France, Japan”, we conducted a total of 330 interviews in 2010 and 2011:

• 235 at establishments (three EHPAD (Etablissements d’Hébergement pour les Personnes Agées Dépendantes, Long Term Facilities) in France, three ILPI (Instituições de Longa Permanência para os Idosos, Long-term Institutions for the Elderly) in Brazil, three TOYO (Tokubetsu Yogo Rojin Home, Nursing Home for the Elderly in Japan)): 10% men in France, 3% in Brazil, almost 40% in Japan. • 95 home care workers (zaitaku homon kaigo, cuidadoras, aide à domicile pour personnes âgées) in all three countries (100% women).

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 exual and International Division of Labor S and International Migration Joan Tronto, an American political scientist that has considerably influenced care studies in France, combined perspectives of political science, economy, and ethics to highlight the fact that care workers are often proletarian, women, and migrants: “In fact not just gender, but race and class, distinguish who cares and in what ways in our culture” (Tronto, 1993, p. 112). My own research on care work shows that its current expansion is directly correlated to international migration movements. Today, it is impossible to address the subject of care and ignore the increase of female international migration in the 2000s. Migration flows and the globalization of care and reproductive work outline the general contours of a new international division of service work (“global chain of care and assistance”) (cf. Carrasco, 2001; Ehrenreich & Hochschild, 2003, Introduction). The international division of labor among migrants from the South in cities of the North matches the sexual division of labor where women occupy the lower circuits of capital (invisible informal work) and men occupy the higher circuits of capital (financial flows): “The dominant discourse on globalization concerns itself with the upper circuits of global capital, not the lower ones, and with the hypermobility of capital rather than with capital that is bound to place” (Sassen, 2003, p. 254). The specificity of care work is undeniable: it cannot be transported like the industrial production of multinational companies. Instead, care requires migration (caregivers and nannies from Asia, Africa, Latin America, the Caribbean, and Eastern Europe) to the United States, Canada, Western Europe, and Japan. More recently, South-South migration can be seen, such as Filipino nannies in Brazil. However, we must also point out that there is capital moving toward profitable areas that have potential beneficiaries (dependent seniors) who are place-bound. For example, international groups that manage care companies that provide care to dependent seniors are opening branches in Europe and Latin America.

 erging the Racial and Ethnic Division M with the International Division A new kind of international labor division can be identified if we merge it with the racial/ethnic dimension. See, for example, the international and ethnical labor division that produces prepared foods in England (Glucksmann, 2010). Likewise, a comparison between Brazil, France, and Japan’s care sector shows the importance of integrating the racial and ethnic dimension with the international division in order to understand the social distribution of care work. In France, more than 90% of caregivers are migrants living in Paris and Ile-de-France. Japan, despite having economic cooperation agreements with Indonesia and the Philippines, has few migrant caregivers in its institutions due to the high language proficiency

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requirements imposed by Japanese authorities. In Brazil, the presence of international migrants in the care sector is still very recent, although there is an internal migration of caregivers from the north and northeastern regions of the country to, for example, the São Paulo—Rio de Janeiro area (similar to internal migration of domestic workers in contemporary China) (Shuang, 2009).

Migrants and Racialized Our sample of home caregivers in the Paris region consisted of 39 wage earners employed by an association that intermediates between the families of elderly people and caregivers.3 The professional and personal trajectories of these caregivers we interviewed in France have been significantly affected by migratory movements. Of the 39 interviewees, 36 were immigrants (34 female immigrants, two children of immigrants) and only three (7.6%) were of French origin: a nursing assistant, a nurse, and a home caregiver. Of the same 39, only four were men (10%). The same phenomenon was observed in institutions. Of the 32 caregivers interviewed at a long-term institution for dependent seniors (EHPAD, établissement de hébergement des personnes âgées dépendantes), 28 were immigrants (23 immigrants, five children of immigrants), four (13%) were of French origin, and four (10%) were men. The immigrant home caregivers in France came from different countries: 11 from Algeria, one from Morocco, nine from Sub-Saharan Africa (Togo, Senegal, Mali, Cameroon), six from the Caribbean (Martinique, Guadalupe), one from Réunion,4 four from Haiti, one from Lebanon, and one from Portugal. The caregivers at institutions (EHPAD) also come from various different countries. Eight come from Maghreb (Algeria, Morocco, Tunisia, two children of immigrants), eight from Sub-Saharan Africa (Mali, Cameroon, Guinea, Zaire, Benin, Gabon, Nigeria, two children of immigrants from these countries), four from the Caribbean (Martinique and Guadalupe), one from Haiti, three from Madagascar, one from Réunion, one from Mauritius, one from Lebanon, one from Portugal, one from Belgium, and one child of German immigrants. In Brazil, I did not find any immigrant workers, whether in institutions or among home caregivers, with the exception of one Bolivian woman whose status and profile were very atypical (one of 130 interviewees in homes and institutions). However, internal migration is very high in the country, with only 14% of our sample being 3  A French characteristic should be noted: 90% of care work in Paris and its surrounding areas is done by immigrants or French-born children of immigrants. In other regions of France there are fewer immigrants, and care workers are normally French employees. 4  Although Martinique, Guadalupe, and Réunion are part of France as overseas departments and territories (départements et territoires d’outre-mer- DOM-TOM), and although these workers have French nationality, as workers they are considered immigrants and are racialized/discriminated against due to skin color, accent, and origin from outside continental France.

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workers born in the state of São Paulo and working there. Therefore, one of Brazil’s unique characteristics is that care activities, whether at home or in eldercare institutions, are done by Brazilians. Even though domestic work was performed by African slaves and their descendants until the end of the nineteenth century, and Brazil experienced a significant influx of European and Japanese migrants for agricultural and industrial labor between the end of the nineteenth century and the beginning of the twentieth, paid domestic employment today is supplied by salaried Brazilian nationals, most often from the Northeast, but also from the states of Minas Gerais, Paraná, and Santa Catarina. Hence, these are internal migrations.5 The inequalities produced by racial and ethnic differences must be highlighted. Discrimination (racism) is the outcome of this large contingent of immigrants found among the care workers in France. Racist speech and behavior were reported by many of the care workers interviewed in the association. Unequal employment also drives discrimination. We will report cases found in care institutions for the elderly and in homecare work in France, Japan, and Brazil.

Inequality and Discrimination France: Inequality and Discrimination in a Context of Migration Immigrants that come from northern or Sub-Saharan Africa that have medical or nursing degrees, which are not recognized in France, are systematically recruited by the EHPADs to be caregivers or nursing assistants, professions that generally do not require more than 1 year of training. Having highly qualified professionals working, for example, the night shift when management and doctors are absent is a significant advantage for any institution. In our research, we found six doctors, half of them hired as nurses and half as nursing assistants. M. is a 33-year-old night caregiver working as a nursing assistant at an EHPAD who came from Guinea in 2004. His medical training in his country allowed him to do internships at the National Institute of Health and Medical Research (INSERM) and get a master’s degree in public health in Paris, specializing in tropical medicine. His monthly net salary was 1500 euros,6 sometimes slightly more when he worked overtime. He reported that some elderly people refused his care because he is black, saying, “Leave me alone.” He got his job through the National Employment Agency (ANPE), and his plan is to return to his country in the future and work as a medical doctor. Many caregivers mentioned the racist discourses of care receivers. Particularly touching is the story of a foreign male caregiver. He expressed the suffering and 5  In the three ILPIs surveyed, only 43% of the workers were from the state where they worked (São Paulo), while 57% were migrants from other regions in the country (30% from the Northeast, a significant source of labor for south-central Brazil). 6  The minimum wage was around 1100 euros in France at the time of the interview.

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revolt he felt at the racism shown by elderly people living at a public French institution, who said things like: “What are you doing in my country? When are you leaving?” He talked about an elderly person who told a black, French-born caregiver, “Go back to your country,” and the case where an elderly woman went to a white intern to give her advice: “Don’t do this work, leave it for the ‘others’.” The same woman also hid her box of chocolates so she could share them with white caregivers only. Japan: Inequality and Discrimination. Non-regular Work (Ringi or Haken) The coexistence of workers that have regular employment status with non-regular workers (haken, ringi, part-timer) in the same institution leads to discriminatory practices toward the latter, especially in terms of wages and benefits. Thus, we were able to interview non-regular workers in Japan that receive very low wages compared to their regular status counterparts, particularly because they did not benefit— except symbolically—from the bonus, which is a variable part of the salary that is very important in Japanese companies. (In the Japanese institutions that we studied the bonus was equivalent to 4–5 times the monthly salary, paid out twice a year.) F. is a 28-year-old male caregiver (“helper”) working at a Japanese institution for dependent seniors. Although he has a university degree in economics and 6 months of care training, being a ringi, or non-regular worker without the rights of a permanent employment worker, means he receives a monthly salary of 120,000  yen, which is less then women’s salaries that are traditionally lower than men’s salaries in Japan. He talked about his current employment situation, the low wages, the intense work, and the human relations problems at the heart of the institution, all reasons why he intends to look for another job. Brazil: Wage Discrimination and Racism The vast majority of the caregivers interviewed in both long-term eldercare institutions and in homecare situations were black, mixed-race (pardas), or immigrants from the northeast of Brazil. They recalled situations of racist verbal violence and racist, sexist, and classist behavior. Sometimes he would humiliate me a little (…) sometimes he’d yell saying I was impertinent, a stupid Baiana (Deise, 43  years old). Occasionally verbal violence insinuated physical violence: “I’m going to kick you in the face” (Joana, 64 years old). A domestic worker interviewed by Lousa Acciari (2016, p.  133) shared an account of racism and humiliation that goes along the same lines: For example, he doesn’t let me drink water from the house. Every day I have to take my own water… I take care of his mother, and then one day he had to go out to buy more toilet paper. When he came back, he said, ‘Next time I’ll buy black paper for your black butt!’ His mother always called me ‘that black woman’…. This account shows, according to

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Acciari (2016), the overlap of gender, race, and class, or the “matrix of oppression,” according to Patricia Hill Collins and Sirma Bilge (2016). Added to these forms of racism are situations of wage discrimination that does not recognize qualifications. The number of nurses and nursing assistants that are hired and remunerated as caregivers is very high in Brazil, meaning their qualifications are not acknowledged. Similar situations can be found in France and Japan. It is a management practice to reduce payroll costs. Long-term care institutions for the elderly try to hire competent and well-trained employees for the work of caregiving. However, because the training available in Brazil for this type of work is weak, the establishments prefer hiring nursing assistants or technicians that have a high school diploma and 1 or 2 years of training to care for the elderly, thus allowing them to pay the lower wage of a caregiver.

 exual and International Divisions of the Social Organization S of Care. Brazil, France, Japan The multiple actors of care in society combine in quite unequal and asymmetrical ways in different social contexts. The State (central and local structures), market, family, NGOs, NPOs, associations, philanthropy, volunteer work, and community all come together in different ways to ensure the social organization of care (Hirata & Guimarães, 2012). The multiple configurations of the so-called “care diamond” made up of State, market, family, and community (volunteer work or non-profits) (Ochiai, 2015; Razavi, 2007, pp. 20–23).

France In the case of France, public policies play a central role in elderly care and provide a large number of tools.7 The personalized allocation of autonomy, or APA (allocation personnalisée d’autonomie) created in 2002, is the main instrument in France for people over the age of 60 who are in situations of autonomy loss. Their case is evaluated by a medical-social team according to a classification of levels of dependency called AGGIR,8 which goes from 1 to 6. People classified as level 5 and 6 are considered autonomous and cannot receive the benefit, while people classified between levels 1 and 4 can become beneficiaries. The allocation is given to everyone who is 60  years old or more, independent of income, although the total 7  This does not mean that the government finances elderly care institutions. In fact, the protests conducted by care workers from EHPAD across France in 2017 and 2018 against the Ministry of Health because of budget cuts related to the sector resulted in a heavier workload and poor quality care for the elderly (cf. Pelletier, 2019, pp. 276–280). 8  AGGIR: Autonomie, Gérontologie, Groupes Iso-Ressources.

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allocation is greater or lesser depending on it. The benefit is to help pay for expenses so the person can stay at home, or to pay for part of the cost of staying at a long-term facilities. Family members who care for elderly relatives can also benefit from the APA. According to Florence Weber’s research (Weber, Trabut, & Billaud, 2014), 16% of family members receive a small stipend to care for elderly family members at home. There is nothing similar to this type of measure in Japan or Brazil, where family members provide nonpaid care. The APA reinforces local authority in that it is administered by Community Centers and the Department Councils.9 The associative sector and the NGOs are equally very active in providing elderly care. They are structured to truly mediate between care beneficiaries and the different care providers. Volunteer work and philanthropy are also well-structured and have been active for at least 20 years. As for the market, an informal labor market has emerged on one side, while government-authorized structures (private businesses) have developed on the other.

Japan In Japan, eldercare is the responsibility of the family, specifically the women. Thus, non-remunerated informal care plays a central role. The public sector has also been very active in recent years, especially since the “institutional recognition of care” (Ito, 2010, p. 139) and the enactment of the LTCI (Long-Term Care Insurance) in 2000. This public policy, like the APA in France, covers homecare as well as long-term care or day care expenses for people aged 65 or older. According to the Japanese government, this is a flexible policy so the elderly can choose different modalities of care. There is considerable cash flow from the public sector to the market as well as to NGOs. The LTCI is financed by a compulsory tax paid by all residents in Japan that are 40 years old or more (including foreign residents). When care is needed, the resident pays 10% of the costs and the government pays the remaining 90%. As in France, the market assists care beneficiaries by way of para-public or private companies that are authorized by the government to operate in the sector. More recent programs like the Economic Partnership Agreement, enacted in 2007 with Indonesia and in 2008 with the Philippines (cf. Ito, 2010, p. 138), try to introduce immigrant labor to the care sector. According to Ito (2010, p. 141), in 2004 “13.6% of the seniors receive care in long-term facilities and 75% are cared for by family members. Of the family caregivers, 75% are women: wives, daughters, sisters in-­ law, and daughters in-law.”

9  The dossiers to benefit from the APA are taken from the Centre Communal d’Action Sociale (CCAS) and sent to the Conseil Départemental.

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Brazil Brazil has nothing similar to the French APA or the Japanese LTCI in terms of public policies for eldercare. Brazil lacks public financing for care as well as institutional ways of protecting the elderly. As Anna Bárbara Araujo (2018) says when referring specifically to São Paulo, “The supply of public care equipment is significantly lower than the demand, in that the number of elderly people in São Paulo is 1,733,664 (14.75% in 2018 according to SEADE, the State Data Analysis System Foundation), and the number of openings at different public agencies that give shelter to the elderly (day care centers, ILPI, and PAI, the Program to Serve the Elderly, community centers, special centers, etc.,) is only 19,660”. The ILPIs, for example, receive only 1% of the country’s elderly population (Camarano & Barbosa, 2016), while in Japan the same type of institution received almost 14% of its elderly population in 2004 (Ito, 2010, p. 141). Two examples of municipal public policies can be presented. One is the Day Center where elderly people can spend the day and then go home at night. According to a person responsible for one of these, there were 16 Day Centers in the city in 2017. All Center employees considered themselves caregivers, and the dimension of care is what structured the operation of the Center: “We are all caregivers. We all see ourselves as caregivers” (interview R. Katz, 2017). Second is PAI (Program to Serve the Elderly) that mobilizes government, NGOs, and associations. Their teams are multi-professional and they provide care services that include taking the elderly to and from several activities when they can no longer do it on their own. However, there were not enough teams (39 by the end of 2017) to meet the needs of the elderly population in the city. One of those responsible for the program told us in November 2017, that she assists 121 seniors in a region where there are approximately 60,000 people over the age of 60. The city of São Paulo was also innovated by creating the first public ILPI in Brazil. It is especially geared toward highly dependent elderly people and works with a multi-professional team. In all these cases, what stands out is the disproportion between the number of elderly people that potentially need assistance and the resources available to manage such initiatives (more details about PAI in Araujo, 2018; Paschoal, 2013). In the Brazilian case, the main care providers are found in social networks made up of families, neighborhoods, or broader social networks (cf. Guimarães et  al., 2018). Family is still the predominant place for care, which is not only the responsibility of its members, primarily the women but also of the domestic workers that, in addition to housework, are called upon to care for the elderly and the children in the family. In this way, the market is a care provider especially because it supplies domestic work services as well as homecare businesses and agencies. The state, despite systematic efforts, particularly in the 1990s, still has no effective, financially viable care program for the elderly. However, agencies that intermediate between caregivers and families develop quickly in Brazil. Differently from France and Japan, these agencies do the job of training home caregivers, since Brazil has no training program that offers a

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state-recognized diploma. France has the DEAVS (Diplôme d’Etat d’Auxiliaire de Vie Sociale)10, a diploma given to assistantes de vie sociale after they complete a 1-year training course at a public Center, and Japan has the kaigo fukushishi diploma, awarded after completing secondary school and a 2-year training course. Employment agencies and service companies that offer family care planning proliferate in Brazil. These businesses provide training and certification for caregivers, albeit informally. In our current field work, we were able to capture the organizational dynamics of one of these businesses, in the context of an unstable economy, based on our analysis of consecutive interviews with the person responsible for a caregiver employment agency specialized in homecare for the elderly that was inaugurated in 2012.11 Although the research is still ongoing, it has already provided some interesting results about the characteristics and perceptions of the home caregivers.12 Their accounts of racism and sexism corroborate what the director of the agency herself has said about experiencing numerous situations where black or overweight caregivers were refused by the family-clients. The person responsible for the company observed that the families initially tend to rely on their domestic workers to provide care for an elderly person during their early stages of decline. However, as their dependence increases, they look for a caregiver and consequently, an agency, whose greatest appeal is its portfolio of professionals with reliable references. In the case of the agency in question, for example, its database in 2016 contained approximately 300 professionals. According to the owner, 30% of them would be employed by the end of that year, in a context of crisis. From the point of view of the caregivers, our interviews suggest that what attracts them to the agency is the possibility of obtaining the coveted training that can set them on a path to a new profession. The range of possibilities for accessing courses, certification, and job placement is quite broad and varied. Some agencies, like the one being studied, intermediate and offer courses. Others do only the intermediation and do not offer courses (such as Home Angels, Guardiões da Vida, or Right at Home). There are also courses  This name changed to DEAES (Diplôme d’État d’Accompagnement Éducatif et Social) in 2016.  Since 2015, H. Hirata and N.A. Guimarães have been conducting systematic observations of an important private employment and care services agency in São Paulo that trains and certifies caregivers and then places them in homes. They also help the families, especially if they have very high incomes, plan the care services for the person in need in the home. Getting to know the agency better has allowed accompanying the training provided for the caregivers, conducting and repeating long interviews with the caregivers who completed the course and with the agency staff, and having access to internal documents about the agency’s registered professionals. After 2016, the research has focused on understanding the dynamics of the business (re)organizing itself due to the impact of growth and retraction crisis experienced by the Brazilian labor market in a highly unstable context. 12  Until now, we have accompanied a group of 13 caregivers in the agency (eight women, four men, and one trans) by way of semi-structured consecutive interviews. In some cases, we have re-interviewed them up to three times. 10 11

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without intermediation that are offered at churches, parishes, and convents, especially on the outskirts of São Paulo. It is worth mentioning some of the non-intermediated courses like the one offered by an NGO called Olhe13 led by Marilia Berzins, or the ones offered by the Red Cross and SENAC. Not to mention the ILPIs that provide caregiver courses (e.g., “Ikoi no Sono,” in Guarulhos). Such diversity shows how entering and performing in this market is poorly regulated in terms of overseeing people (caregivers) and companies (their intermediaries). The training offered by the agency we are researching is highlighted because it allows us to compare what we could observe. The course started by offering 80 h (60 theory classroom hours and 20 practical hours at an ILPI). At one point it had reached 190 h, which was reduced to 100 in 2017 due to the need to cut costs and make it more accessible to their clientele that was primarily made up of low-income women. This is noteworthy, since specific care training is virtually non-existent, and where many courses in the care market either give diplomas after a mere 25 h of theory classes or are practically inaccessible to most candidates because of their competitive and selective requirements. (Such is the case of the courses offered by the Public School of Health14 at the University of São Paulo in the past, by PUC of Belo Horizonte,15 or by the Oswaldo Cruz Foundation (Fiocruz) coordinated by Daniel Groisman in Rio de Janeiro16). Thus, the context of economic crisis and unemployment puts the income of the course at risk, seeing as the agency’s clients have decreased resources that make it hard for them to afford their monthly fees. In fact, although the national statistics  Olhe’s course is 12 years old and began with a website, The Aging Portal, in 2006, and a course associated to the master’s program in gerontology from PUC (Pontifical Catholic University) led by Professor Beltrina Corte (for this information, cf. Berzins, 2018). The course was first financed by Danone, which believed caretakers should be trained to buy ingredients for elderly consumption, and which was part of Danone’s program “Caring is Living.” The partnership ended due to differences about whether or not to transform the NGO into an employment agency. The course lasts 3 months, meets twice a week for a total of 120 classroom hours, followed by 16 h in internships at an institution (“practical experience”). The criteria for entering the course is knowing how to read and write and filling out a form. Classes are held at the City Hall of S. Bernardo, at centers against violence, at CIP, in communities, in favelas, etc. Originally a nominal fee of R$ 150.00 was charged for the 120 h of classes, but once Danone left the project the fee went up to R$ 650.00, paid in three installments. Currently, 1300 students have gone through the course. 14  According to Helena Watanabe (2018) (interviewed by the author on October 9, 2018), a professor at this institution, there were two or three awareness courses for caregivers that had around 20 students at the end of the 1990s. They were taught by a nurse and a psychologist specialized in aging. There were no classes about care techniques. 15  According to Marilia Berzins (2018) in an interview conducted by the author on October 9, 2018, this was a non-diploma course of Cultural Diffusion offered between 2005 and 2007 coordinated by Ieda Duarte from the Nursing School. 16  Fiocruz offers a free professional training course on caring for the elderly since 2007. It requires 240 h (around 100 internship hours). The current class has 35 students, the result of a selection process that 3000 candidates applied to, of which 1600 enrolled and 200 were interviewed. Because the students are low-income, Fiocruz provides help for transportation and meals to reduce dropout rates (Daniel Groisman, 2018) (interview conducted by the author on September 21, 2018). 13

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show that caregiving jobs continue to increase, albeit slower, despite the crisis (cf. Guimarães et al., 2018) this experience of a well-established agency in the largest job placement market in Brazil shows how economic crises can have a strong, destabilizing effect on the business of intermediation.17 This speaks to how families deal with limited resources and, at the same time, how they approach providing care for their dependent elderly. The story told by the agency leader is expressive because it suggests adjustment strategies that alter the margins for maneuvering in a service that is strongly commodified. According to her, middle-class families that had kept their elderly in ILPIs were taking them out due to high costs. In addition to the crisis that cut into family incomes, new employment laws about maximum work hours for home caretakers drove families to reduce their eldercare expenses by paying for only 6–8 h. To make up the time their elderly still needed, families redistributed the work, especially the night shift (the most expensive) among their own members. Furthermore, the crisis and unemployment increased the number of men seeking care training and certification,18 which tends to gradually modify the sexual division of care work (cf. as already noted by Hirata, Makridou, & Matsuo, 2017, in the Japanese case).

Points for Reflection to Conclude A first point of reflection is about the theory of care and the critiques it can produce regarding predominant paradigms. The paradigm of a hierarchy where reason and cognition are placed above emotions and affect, and the paradigm of disciplinarity that elevates sociology as a privileged field of analysis and reduces interdisciplinarity to being questionable and looked down on. The relationship seen in care work between reason and feelings, the individual and the collective, the social and the moral, and the fluid lines between affect, love, and emotion on one side and the cognitive, technical, and material on the other side puts into question one of the paradigms of general sociology that creates hierarchies and internalizes emotions and feelings related to reason and cognition (cf. Paperman, 2013, pp. 24. et seq.). Additional reflection can be made regarding interdisciplinarity. The decidedly interdisciplinary focus of care theories (sociology, psychology, political science, philosophy, etc.,) challenges one of general sociology’s greatest paradigms—disciplinarity (mistrust of interdisciplinary or multidisciplinary approaches). Gender

 Indeed, the person responsible for the agency reported that since 2016 she has been forced to reduce the company’s hours and cut courses because of low enrollment. She moved the company’s location to reduce rent expenses but managed to stay in the same building (very well-located close to a key metro station). She has also cut staff (an intern), and even her business partner decided to leave the company in July 2016, fearful of the company’s future in light of the crisis. 18  The same phenomenon was observed by the Fiocruz course coordinator. 17

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sociologists, considered outliers or on the “margins” (Crenshaw’s expression), are the ones that have been able to advance firm inter- and multidisciplinary approaches. A second point of reflection is about the centrality of the work performed by women. Analyses of caregiving confirm the notion that women’s work plays a central role in institutions as well as in the home, whether paid or unpaid. In spite of societal differences, care work is performed primarily by women in Brazil, Japan, and France and will probably continue as such since the work is unstable, underpaid, under-recognized, and undervalued. Homecare, given the need to simultaneously perform domestic work and care work, is also done by women in all three countries. In the case of France, it is done by migrant, often undocumented women, and in Brazil, by informally employed domestic workers. In Japan, the work is also done primarily by women, albeit almost 40% of the caretakes in long-term eldercare institutions are men. The social organization of care ascribes a central role to women and family in all three countries we studied.19 A third point of reflection is about the racial and class inequalities that, together with gender inequalities, define an elder caregiver, independent of the country being studied. The theory of intersectionality20 can be a powerful analytical instrument when reflecting on relationships of race, class, and gender as one and the same with power relationships. The interdependence of race, gender, and class relations as power relations and the non-hierarchization of these three dimensions are the main characteristics of the intersectional paradigm. While intersectionality can be considered a tool for knowledge, it can also be a weapon for political action. The limitations of a gender-based approach that does not take into account belonging to a social class or race is that it does not consider the oppression that overlaps the different social relations. A final point of reflection is about ways to overcome the current sexual division of care work by highlighting the roles of public policies and feminist movements. In contemporary societies, feminist mobilizations for the equal division of domestic work and care, and the social and family policies enacted by some states in favor of greater equality between women and men, have pointed out possible ways for overcoming today’s sexual division of labor. There certainly will not be more professional equality between men and women as long as there is asymmetry in performing domestic and care work, which continues being the almost exclusive responsibility of women. The importance of a theoretical discussion centered on “degenderizing” care (cf. Tronto, 1993) is undeniable when considering a new sexual division of care work where men and women are both responsible for giving attention to dependent people. Caring for dependent beings—children, the elderly, the physically and mentally disabled, the sick, etc.—must be the duty of all humans  This situation is not exclusive to the three countries we studied, as shown in the research conducted in Belgium by Degavre and Nyssens (2008) about innovation in the field of care. 20  Cf. dossier about gender and intersectionality presented by Guimarães and Hirata (2014), in Tempo Social. 19

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without distinction of sex because we are all vulnerable at some point in our lives (Molinier et al., 2009; Tronto, 1993). Research on care can contribute to making this definition of vulnerability more widespread in society as a whole and can challenge today’s sexual segregation of care work. Acknowledgment  This chapter was translated from its original Portuguese version to English by Jill Haring.

References Acciari, L. (2016). “Foi difícil, mas sempre falo que nos somos guerreiras” – O movimento das trabalhadoras domésticas entre a marginalidade e o empoderamento. Mosaico, 7(11), 125–147. Araujo, A. B. (2018, October). As políticas de cuidado de idosos no Brasil, subsídios ao relatório Brasil (Relatório para o Taller Inaugural de la Red Latinoamericana de Investigacion, USP). Berzins, M. (2018, October 9). Interview by H. Hirata. Camarano, A. A., & Barbosa, P. (2016). Instituições de longa permanência para idosos no Brasil: Do que se está falando? In A. de O. Alcântara, A. A. Camarano, & K. C. Giacomin (Orgs.), Política nacional do idoso: Velhas e novas questões (pp. 479–515). Rio de Janeiro: IPEA. Carrasco, C. (2001). La sostenibilidad de la vida humana: ¿un asunto de mujeres? Mientras Tanto, (82). Degavre, F., & Nyssens, M. (2008). L’innovation sociale dans les services d’aide à domicile: Les apports d’une lecture polanyienne et féministe. Revue Française de Socio-Economie, 2, 79–98. Ehrenreich, B., & Hochschild, A. R. (2003). Introduction. In B. Ehrenreich & A. R. Hochschild (Eds.), Global woman: Nannies, maids, and sex workers in the new economy (pp.  1–14). New York: Metropolitan Books. Glucksmann, M. (2010). Les plats cuisinés et la nouvelle division internationale du travail. In J. Falquet et al. (Eds.), Le sexe de la mondialisation (pp. 85–98). Paris: Presses de Sciences Po. Groisman, D. (2018, September 21). Interview by H. Hirata. Guimarães, N. A., & Hirata, H. (Orgs.). (2014). Dossiê Trabalho e gênero. Tempo Social, 26(1). Guimarães, N. A., Hirata, H., & Posthuma, A. (2018, October). O trabalho de cuidado. Balanço e primeiras reflexões a partir do caso brasileiro (Relatório para o Taller Inaugural de la Red Latinoamericana de Investigacion, USP). Hill Collins, P., & Bilge, S. (2016). Intersectionality. Cambridge: Polity Press. Hirata, H., & Guimarães, N. A. (Orgs.). (2012). Cuidado e cuidadoras: As várias faces do trabalho do care. São Paulo: Atlas. Hirata, H., Makridou, E., & Matsuo, M. (2017). Trajectoires professionnelles et rapports sociaux: Le travail du care dans une perspective comparative. In A. Damamme, H. Hirata, & P. Molinier (Orgs.), Le travail entre public, privé et intime. Comparaisons et enjeux internationaux du care (pp. 33–53). Paris: L’Harmattan. Ito, R. (2010). Immigration et travail de care dans une société vieillissante: Le cas du Japon. In J. Falquet et al. (Eds.), Le sexe de la mondialisation (pp. 137–150). Paris: Presses de Sciences Politiques. Katz, R. (2017, November 22) Interview by N. Araujo Guimarães, & H. Hirata. Molinier, P., Laugier, S., & Paperman, P. (2009). Qu’est-ce que le care? Souci des autres, sensibilité, responsabilité. Paris: Payot & Rivages. Ochiai, E. (2015). Changing care diamonds in Europe and Asia: Is Europe becoming Asia? Paris: Center for French-Japanese Advanced Studies in Paris, EHESS. Paperman, P. (2013). Care et sentiments. Paris: PUF (Coll. Care Studies).

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Paschoal, S. (2013, June). Elderly caregiver program. In Actes du Colloque international Théories et pratiques du care: Comparaisons internationales (pp.  75–82). Paris: Université Paris Descartes. Pelletier, A. S. (2019). EHPAD, une honte française. Paris: Plon. Razavi, S. (2007). The political and social economy of care in a development context: Conceptual issues, research questions and policy options (Gender and Development Programme Paper No. 3). Geneva: United Nations Research Institute for Social Development (UNRISD). Sassen, S. (2003). Global cities and survival circuits. In B.  Ehrenreich & A.  R. Hochschild (Eds.), Global woman: Nannies, maids, and sex workers in the new economy (pp. 254–274). New York: Metropolitan Books. Shuang, L. (2009). Employées domestiques dans la Chine actuelle: Le service domestique au croisemen des rapports sociaux de sexe et de la hiérarchie urbain/rural. Unpublished doctoral thesis, University Paris 8 Vincennes-St. Denis. Tronto, J. (1993). Moral boundaries. A Political argument for an ethic of care. New York; London: Routledge. Watanabe, H. (2018, October 9). Interview by H. Hirata. Weber, F., Trabut, L., & Billaud, S. (Eds.). (2014). Le Salaire de la confiance. L’aide à domicile aujourd’hui. Paris: Éditions rue d’Ulm.

Chapter 5

Reimagining Care and Care Work Evelyn Nakano Glenn

I want to start by briefly reviewing the circumstances of the “care crisis” as differentially experienced in different countries and regions depending on their position in the global economic system. In my country, the USA, as well as in Europe and other developed societies is the so-called “care deficit.” The number of those needing care—the elderly, disabled, children, and other dependents—has risen sharply in recent decades. Simultaneously, the ranks of those who have traditionally provided the lion’s share of care—relatives and friends—have thinned. The employment of paid caregivers to fill the gap has grown accordingly. Nonetheless, limited resources to pay for care, and the high turnover by workers out of care work, have meant that the supply of available paid care falls far short of the demand. As a result, many of the most vulnerable citizens of affluent countries are not receiving the amount—or quality—of care they need and deserve. Simultaneously, those who provide care are stretched thin, struggling to provide care without adequate support or compensation. In certain so-called Third World nations, the lack of well-paying jobs has led to men and women migrating to the USA, Europe, and the Middle East for work that pays enough to support their families. As we know from the ample literature on the global care chain, more and more women have been migrating to take domestic and caring jobs. Their remittances help to support and, in some cases, elevate the economic status of their families. When they go abroad, however, the burden of care of children and other dependents typically falls to their female kin. Moreover, remittances help maintain individual families, but they do not solve the underlying problem of “underdevelopment,” thus, labor migration becomes a long-term intergenerational pattern. How this situation came about: the care crisis has grown out of long-standing structural and ideological factors; I refer to these structural and ideological underpinnings E. N. Glenn (*) Department of Gender & Women’s Studies, and Department of Ethnic Studies, University of California, Berkeley, CA, USA © Springer Nature Switzerland AG 2021 N. Araujo Guimarães, H. Hirata (eds.), Care and Care Workers, Latin American Societies, https://doi.org/10.1007/978-3-030-51693-2_5

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under the general rubric of the social organization of care. Three general features have characterized caring, especially in Western societies. First, caring has been organized around spatial and conceptual separation between public and private realms. The public sphere of the market (economy and politics) and the private sphere of family and household are imagined to be discrete spheres that serve different purposes, perform different functions, and operate according to different principles. Success/survival in the public sphere is thought to require people to be independent so that they can engage in competition and pursue self-interest; this conception requires the exclusion of dependency needs from the public sphere and their sequestration within the socalled private sphere. Thus, the family is viewed as the proper institution for meeting dependency needs, and family members are charged with responsibility for taking care of one another. This principle is embedded in everyday mores as well as in law and social policy. The principle is internalized as a status obligation, such that individuals feel morally obligated on the basis of a parental, child, or spousal relationship. It is also incorporated into law and social policy, which, for example, has denied the right to compensation for caring for family members and withheld state subsidized care for those who have close kin nearby. Because kin are assumed to be fulfilling strictly personal responsibility, kin care labor is not considered real work and the lack of monetary compensation means that it does not fulfill one’s citizenship duty to earn and support oneself. Thus, to the extent that individuals reduce paid employment in order to take on more unpaid caring for relatives, they forgo benefits and recognition that are tied to working and earning. A second feature is that gender, class, race, and citizenship status are central axes in the social organization of caring. Concretely this means that the burden of care (including both the responsibility for and the actual labor) is differentially distributed according to gender, class, race, rural-urban residence, and citizenship status. The pattern of women taking disproportionate responsibility for care is so well established that it is largely taken for granted, often not noticed, and when noticed, seen as natural. Also taken for granted is the pattern of poor people, people of color, and migrants providing care for more affluent native-born whites. Further, as with other types of labor, caring is subject to division into higher and lower levels: more spiritual versus more menial tasks, more intellectual versus more physical duties, and more supervisory versus more hands-on work. Poor people, people of color, and noncitizens are charged with a greater share of the menial, physical, and hands-on work of care. Thus, the low status of caring work and the low status of care workers are mutually constituted and reinforced. The third feature is that care and non-care labor have different relationships to freedom and coercion. Recruitment into caring has historically relied on coercion, either direct or indirect. Historically, caring has been associated with lack of freedom, with caring labor drawn from those restricted by slavery, indenture, colonialism, caste, social and spatial segregation, and other systems of exclusion and containment. While not denying intrinsic rewards of caring, the first two dynamics have meant there was little material incentive to do this work. Moreover, demand does not increase the price of care labor. In this sense, paid caring labor is expected to operate outside of the vaunted market principles valorized by economists. In the

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absence of significant material benefits, there is little to attract people into care work; instead, restrictions that cut off other options and “tracking” mechanisms seem to be the primary impetuses for entry into care work. All three areas of social structure and ideology reinforce one another. For example, economic restructuring has displaced men and women from subsistence activities in the Global South, impelling them to migrate to the Global North in search of work; once in the north, legal, educational and labor market barriers severely limit immigrants’ occupational options. Simultaneously, ideology constructs immigrant women of color as naturally subservient due to gender, race, and culture. Historically, social and legal restrictions on middle-class married women kept them out of the public realm of politics and the professions and constrained them to the private sphere of the family, while ideologies of home, motherhood, and respectable womanhood exalted their role as caregivers. During the nineteenth and early twentieth centuries, American territorial expansion and subjugation of Native Americans and colonial subjects were premised on an ideology that posed a dichotomy between civilized and uncivilized peoples. A cornerstone of so-called civilized societies was the “Christian family,” with its clearly differentiated masculine and feminine roles, with men acting as household heads and economic providers and women dedicating themselves to domesticity, including care for children and the elderly. Thus, part of the aim of civilizing subject peoples was to reform their domestic practices by inducting their women into domestic service. Remnants of these older ideologies of servitude and entitlement tied to social status cling to caring relationships today. These prevalent patterns in social structure and ideology are pervasive and deep-­ seated and are not easily reformed.

Rethinking Care: Care as Practice In order to develop alternatives to the present inequitable (and ultimately unworkable) situation, we need to rethink the concept of care. Because care is so closely associated with womanhood, feminist philosophers and social theorists have subjected care to close analysis. A reading of several theorists of care, including Joan Tronto, Dietmut Bubeck, Emily Abel and Margaret Nelson, and Sara Ruddick, suggests the usefulness of thinking of care as a practice that encompasses feeling (caring about) and activity (caring for). “Caring about” engages both thought and emotion, including awareness and attentiveness, concern about and feelings of responsibility for meeting another’s needs. “Caring for” refers to the varied activities of providing for the needs or well-being of another person (Abel & Nelson, 1990; Bubeck, 1995; Ruddick, 1998; Tronto, 1993). These activities include physical care (e.g., bathing, feeding), emotional care (e.g., reassuring, sympathetic listening), and direct services (e.g., driving a person to the doctor, running errands). These definitions are not free of ambiguity, but they do establish some boundaries. For example, defining caring in terms of direct meeting of needs differentiates caring

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from other activities that may foster survival. Thus, economic provision would not be included, even though it may help support caregiving.1 Within these definitions three features are important. First, it is recognized that everyone requires or needs care, not just those we consider incapable of caring for themselves by reason of age, disability, or illness. Often only children, the elderly, the disabled, or chronically ill are seen as requiring care, while the need for care and receiving of care by so-called independent adults is suppressed or denied. As Sara Ruddick notes, “most recipients of care are only partially ‘dependent’ and often becoming less so; most of their ‘needs’, even those clearly physical cannot be separated from more elusive emotional requirements for respect, affection, and cheer.” (Ruddick, 1998, p. 11). At the same time, even those we see as fully independent, that is, able to care for themselves in terms of “activities of daily living,” may for reasons of time or energy, or temporary condition, need or desire care to maintain their physical, psychological, and emotional well-being. They may turn to a family member, friends, a servant or a service provider for hot meals, physical touch, or a sympathetic ear. The difference is that independent adults may preserve their sense of independence if they have sufficient economic or social resources, so as to command care from others rather than being beholden to relatives or charity. A second aspect of these definitions is that care is seen as creating a relationship; as Sara Ruddick puts it, “(caring) work is constituted in and through the relationship of those who give and receive care.” The relationship is one of interdependence. Generally, we think of the caregiver as having the power in the relationship, but the care receiver, even if subordinate or dependent, also has agency/power in the relationship. Focusing on relationships brings into relief the influence of the recipients of care on caring work. Tronto notes that for the work of care to be successful, its recipients have to respond appropriately, e.g., a screaming child or a moaning elderly person betokens failure. In some situations, where the care receiver employs the caregiver or has social authority (e.g., due to the norm of respect toward elders) the care receiver may have more power than the caregiver (Ruddick, 1998, p. 14; Tronto, 1993). Third, it is recognized that caring can be and is organized in a myriad of ways. The paradigmatic care relationship is the mother–child dyad, which often serves as the template for thinking about caring. In this model, caring (mothering) is viewed as natural and instinctive and as women’s natural vocation. However, this idealized model is deceptive in that it ignores the actual diversity in the ways mothering/caring is actually carried out in within and across cultures. Caring can and does take place in the household or in publicly organized institutions and can be carried out individually or collectively, as paid or unpaid labor. Much caring takes place in the family, usually as the unpaid work of women, but it is also done as paid work (e.g., 1  Thus, Men are often said to be “taking care of their family” when they earn and bring money into the household. Despite the use of the word “care” in this phrase, breadwinning would not be considered as “caring”; in fact, economic support has historically been seen as men’s contribution in lieu of actual caregiving; simultaneously, caregiving has been viewed as women’s responsibility, an exchange for not being the primary breadwinner.

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by baby sitters, home health aides). It also takes place in the community as unpaid volunteer work, as in the case of church or charitable organizations that run day care or senior activity centers. It also takes place in institutions organized by the state, corporations, or individuals as commodified services using paid caregivers. Care can also be “fragmented,” divided among several caregivers and between “private” and “public” settings. Thus, a parent may take ultimate responsibility for ensuring that a child has care after school but delegate the actual work of caregiving to a babysitter, a relative, a paid home care worker, and/or an after-school program. Barrie Thorne found in her study of childhoods in an urban multicultural community that parents often have to patch together several of these arrangements (Thorne, 2000).

What Should Be Our Goals? To build societies in which caring work is valued in all spheres of social life, all of the elements—the caring relationship, the work of caregiving, and the people involved (care receivers and caregivers)—should be recognized and valued. Hence, a society in which caring is valued would be one in which: 1. Those who need or require care (including children, the elderly, disabled, and chronically ill) are recognized as full members of the society and accorded corresponding rights, social standing, and voice. This would mean that care receivers are empowered to have influence over the type of care, the setting, and the caretaker and that they have access to sufficient material resources to obtain adequate care. 2. Caring is recognized as “real work” and as a social contribution on a par with other activities that are valued, such as paid employment, military service, or community service, regardless of whether caring takes place in the family or elsewhere or as paid or unpaid labor. 3. Those who do caring work are accorded social recognition and entitlements for their efforts similar to those who contribute through other forms of work or other activities. These entitlements include working conditions and supports that enable them to do their work well and an appropriate level of economic return, whether in wages or social entitlements. For these ideals to be achieved, certain preconditions must be put in place: 1. Caring is recognized as a community and collective (public) responsibility rather than as purely a family (private) responsibility. 2. Access to care and to “high-quality” care is relatively equally distributed and not dependent on economic or social status. Ultimately the ideal would be a society in which there is an adequate amount and quality of care for all who need it, i.e., care that is individualized, culturally appropriate, and responsive to the prefer-

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ences of those who are cared for. (A similar goal involving access to medical care for all members of society has gained widespread political support.) 3. The responsibility and actual work of caring are relatively equitably shared so that the burden of care does not fall disproportionately, as it does now, on disadvantaged groups—women, racialized minorities, and immigrants. Why is the goal of achieving a society that values caring and caring relationships important? It seems inherent in the definition of a good society that those who cannot care for themselves are cared for, that people can trust that if they become dependent, they will be cared for, and that they will feel able to care for those they care about. Additionally, valuing care and caring relationships would contribute to building a more just society. Since caregiving is disproportionately carried out by women and by people of color, the devaluing of caring contributes to the marginalization, exploitation, and dependency of these groups. Conversely, valuing and recognizing caring and caring relationships would expand the boundaries of equality to many currently excluded from social equality. Although these goals and aspirations might appear almost utopian, in fact they are not. A number of European countries—albeit smaller, more racially homogeneous, and with lesser degrees of income inequality, and lower rates of poverty than the United States and Brazil—have chosen precisely these societal goals—and have moved dramatically toward achieving them.2 Thus, we know that the objectives are not really utopian; they require leadership, commitment, and reallocation of resources.

Some Directions for Change Rethinking Social Citizenship to Include Care One important step is to redefine “social citizenship” to make care central to the rights and entitlements of citizens. This will involve a reversal of the present situation where care is defined as a private responsibility and therefore outside the realm of citizenship. Making care central to citizenship will entail three elements: first, establishing a right to care as a core right of citizens; second, establishing caregiving as a public social responsibility; and third, according caregivers’ recognition for carrying out a public social responsibility. These elements are interrelated. If citizens have a right to receive care, then there is a corresponding responsibility on the part of the community to ensure that those who need care get it. Further, if caregiving is a public social responsibility, then those who perform caregiving fulfill an obligation of citizenship and are thus entitled to societal benefits comparable to those accorded to those fulfilling the obligation to earn (for example, social security, seniority, and retirement benefits).  http://www.oecd.org/social/inequality.htm

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There are some additional considerations, however, because of the gendered organization of caring and the “secondary dependence” of unpaid caretakers who forgo earning to undertake care. Regarding the gendered organization of care, Joan Tronto warns that policies have to be carefully crafted so as not to reinscribe gender inequities in caring. Cancian and Oliker, reworking Hobson’s concepts of citizen worker and citizen mother, identify several types of welfare policies: carer citizen, worker citizen, and carer-worker citizen (Cancian & Oliker, 2000; Tronto, 1993). Worker citizen policies provide entitlements for breadwinners and their dependents through programs such as unemployment insurance and survivor benefits. These policies encourage men, who are generally able to earn more than women, to specialize in earning and women to focus on unpaid caregiving. Worker citizen policies exist in all countries but it is the principal approach used by the U.S. welfare system (Cancian & Oliker, 2000; Tronto, 1993). In most European countries, carer citizen policies complement worker citizen policies by providing direct benefits to caregivers through programs such as mother’s allowances and caregiver pensions. Carer citizen policies reinforce the gender division of earning versus caring by encouraging women to specialize in caring. However, it also supports them for doing so through payments and services that are treated as entitlements and are not means tested. Carer-worker citizen policies provide supports and benefits for citizens who combine caring and earning through such programs as paid parental leave, employment-­based child care, and crediting years spent in caring and in earning equally toward retirement. Such policies are most prevalent in Scandinavian welfare systems. Cancian and Oliker note that carer-worker policies “are least likely to reinforce full-time caregiving for women and are most supportive of women and men sharing earning and caring.” Carer-worker policies have not succeeded in degendered caring work, but they have encouraged some shifting. For example, Norway’s parental leave policy, which sets aside a portion of total leave that can only be taken by fathers, has encouraged men’s involvement in caring (Cancian & Oliker, 2000). An additional constraint that is specific to caring (in contrast to earning) and that needs to be addressed is what Eva Kittay (1995) has called the “secondary dependence” of the caregiver. By taking on the care of a dependent and forgoing earning, unpaid caregivers become dependent on a third party—a breadwinner or the state— for resources to sustain both those they care for (primary dependents) and themselves (secondary dependents). The USA has been particularly backward in failing to recognize caregivers’ need for support, particularly in the case of poor women of color. Indeed, the U.S. Congress passed the Personal Responsibility and Work Opportunity Reconciliation Act in 1996, which abolished a long-standing program, Aid to Families with Dependent Children program, replacing it with Temporary Assistance to Needy Families, devolving welfare back to individual states, requiring employment after 2 years of

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receiving benefits, and restricting lifetime benefits to 5 years. Most states have mandated stringent workfare to get single mothers off welfare.3 In contrast to the U.S. welfare system, European welfare systems have generally provided some forms of family allowance for citizens with children. Most countries support caregivers with child allowances, and some even give small pensions for those who engage in unpaid care work. In countries with relatively conservative welfare regimes, such as France and Germany, the rationale for maternal allowances typically has been framed in terms of child welfare and promoting natalism, so as to ensure the size and well-being of the future population, rather than in terms of the value of caring and social citizenship rights and responsibilities in caring. Nonetheless, the allowances have been designed as universal entitlements not tied to income or means testing, unlike U.S. welfare programs. In more progressive social democratic countries, such as Sweden, support for caregiving is extensive, including allowances, subsidies, and direct services, such as childcare and home aides (Pedersen, 1993; Sainsbury, 1996). In short, what is called for is a three-pronged expansion of social citizenship rights to: (a) make caretaking allowances and support universal rather than means tested; (b) have such support explicitly framed as entitlements for carrying out an important citizenship responsibility, not as charity or replacement of a breadwinner’s contribution; and (c) provide support for combining employment/earning and caregiving, so as to equalize the costs and benefits of caregiving versus earning. The latter feature is important both not to penalize women for caregiving and to avoid reinforcing the gender division of labor in which men earn and women care. Transforming social citizenship to make care central to rights and entitlements would require tremendous mobilization, particularly in the case of the United States, which hews tightly to the ideologies of individual independence and family responsibility that I have described earlier. Whatever social citizenship rights we currently have in the USA—social security, unemployment relief, minimum wage, and job creation were responses to the political mobilization of millions of Americans

3  During the Progressive Era, most states (46 out of 48) instituted “Mother’s Pensions” to help “deserving” widows to keep their children instead of placing them in orphanages. Such support was deemed to be “deserved” only when a mother lost the support of a male breadwinner through no fault of her own; thus benefits were denied to women who were deemed to be single by choice. In any case, funding was always inadequate and contained no caretaker’s grants, forcing women receiving mothers’ pensions to also work. The New Deal Era Aid to Dependent Children, which became Aid to Families with Dependent Children, was designed to provide a modicum of support for children of in families without a male breadwinner. In the South and Southwest, Black and Latina single or widowed mothers were often deemed ineligible, because the demand for their labor in the fields or in domestic service made them “employable.” The successor program, AFDC, operated according to a “man in the household” rule whereby only single-parent female-headed households were eligible for benefits. Various workfare programs were instituted in the 1970s and 1980s, without, however, removing numbers of single-parent households from the welfare rolls. The Personal Responsibility and Work Opportunity Reconciliation Act therefore extended the “employable mother” concept to all mothers, regardless of the age of children or the availability of jobs.

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d­ isplaced by the Great Depression.4 In the second half of the twentieth century, the second Civil Rights Movement and second wave Feminism impelled legal, political, and social changes that dramatically expanded employment, education, and legal rights for racial minorities and women. An important recent example of expanding citizenship is the success of the disability rights movement in establishing federal laws and policies that require schools and universities, employers, and public entities to provide facilities and programs that enable differently abled citizens to work, study, travel, and otherwise participate in the social and cultural life of the society. The disability rights movement comes quite close to addressing the issues central to caring and social citizenship. It focuses the rights of citizens who have physical and mental conditions that limit their physical and economic independence to receive services and accommodations that allow them to achieve social and political independence.5 There is thus a precedent for claiming the right to receive care as essential for meaningful citizenship. What has been more difficult is to make the case for rights and entitlements for those providing care to disabled citizens. In the next section, I argue for the need to rethink the family as the primary site of care and describe some alternatives, such as intentional communities. If we adopt the principle that the community or the state, not the family, should be the first resort in caring, there would be two good outcomes: under such a system, it is more likely that family members who do undertake care will be doing so voluntarily and freely and makes it clearer that they are undertaking work that contributes to the public and not just private good. In turn, if family caregivers are seen as undertaking work that contributes to the public good, it is more likely that the public will agree that family caregivers deserve economic support and services.

Rethinking Paid Care As noted at the beginning of this chapter, the sheer demand for care, the inability of families to provide all or even most care, and some economic incentives have together brought about a shift of care work toward a higher proportion involving paid caregivers. A significant portion of marketized care work takes place in institutional settings, assisted-living facilities, nursing homes, hospitals, and residential facilities, where the intensive face-to-face caring is done by nursing aides and other nonprofessional workers under the supervision and authority of administrators and medical and nursing professionals. This is especially the case for those needing physically demanding, around-the-clock care, such as children and adults with severe mental and physical disabilities and the elderly with advanced dementia or

4  Similarly, veterans’ benefits, the G.I bill, hospitalization, and other social welfare benefits, came about in part because of veterans’ political organizing efforts to further their interests. 5  There has been a recent movement to franchise citizens with mental illness.

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Alzheimer’s. Nonetheless, the overall trend has been to keep dependents out of institutions by caring for them at home, so a great deal of marketized care is done in private households by home care workers employed by nonprofit or for-profit agencies, or by care recipients themselves (or their relatives). The biggest issue raised by marketized care is whether economic motives and caring motives are compatible. Returning to our earlier definition of caring work as involving on the one hand “caring activities” and on the other hand “caring feelings,” we can ask whether, when people are paid for caring, they focus on caring activities and give short shrift to caring feelings. Marketized care has been decried by people on both the left and the right. On the left, there is suspicion of capitalism and its tendency to turn everything into a commodity, so that care becomes an impersonal “product,” produced at least cost and sold to the highest bidder to generate profit (Folbre, 2002, p. 128). On the right, social conservatives exalt traditional “family values,” see family care as invariably superior and want to preserve the private Dad/Mom/Child household as a protected sphere of altruism and love. In the USA, there has been considerable resistance to allowing those eligible for Medicare-­ funded home care services to hire and pay relatives. The concern is that being paid would erode the sense of family responsibility. Spouses, parents, and children would be providing care for the “wrong reasons” or perhaps relatives who would otherwise be unwilling to provide care for free would take on care for monetary reasons. In either case, it is feared, the quality of care would suffer. This reasoning assumes a dichotomy between paid and unpaid work: that those who work for money are motivated purely by materialism, self-interest, and greed while those who work without pay are motivated by altruism, spiritual values, and affection. In short, it assumes that people work either for money or love. However, there are many more complex meanings and intentions involved in monetary exchanges other than materialism, for instance, a parent paying child support based on concern for the child and not as an economic exchange. In a similar fashion, allowances or wages for caring for family members can be viewed as acknowledgment of the loving care they provide, not as a “bribe” to do what they would not otherwise do. Thus, as shown in Chap. 6, family caregivers who receive admittedly meager payments from disabled or elderly programs look at the pay they receive not as a quid pro quo, but as social recognition and validation of their contributions. (The amount in any case is not enough to support themselves fully, but enables them to contribute to their own support and to get by with additional assistance from other family members.) Similarly, work for pay involves more than material self-interest or greed. The working man is assumed to be an independent and self-interested actor in the market. However, a married working man is commended as “breadwinner” for providing for the needs of his wife and children. Indeed, the argument that working men are breadwinners was used historically to argue for a family wage for men. The notion of the male breadwinner acknowledges that as a worker he is not acting strictly as an autonomous individual but as a connected human being enmeshed in social relations and concerned about his family’s well-being. Ideally, the b­ readwinner is acting altruistically when he shares/uses his earnings to provide for his wife and children’s maintenance.

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Working for pay does not therefore necessarily negate the intrinsic aspects of work. Philosopher Margaret Radin makes a distinction between the “laborer,” who is motivated solely by money and thus experiences labor as separate from the real self and the “worker,” for whom work has a more complex meaning. She notes, Workers make money but are also at the same time givers. Money does not fully motivate them to work, nor does it exhaust the value of their activity. Work is understood not as separate from life and self, but rather as a part of the worker, and indeed constitutive of her. Nor is work understood as separate from relations with other people (Radin, 1996, p. 105).

I do not want to make the distinction between work and labor in the way Radin does; however, I do want to hold on to the idea that there is a range of orientations that workers can have toward work that go beyond that of economic exchange. This idea, that paid workers have non-economic orientations, complements the earlier stated idea that family carers retain their “intrinsic” (non-economic) motivation to care even when they are compensated monetarily for their care. Too often, low wages for care workers are rationalized on the grounds that care work offers intrinsic rewards that compensate for lack of material rewards or even, especially in the case of family caregivers, that too much monetary compensation would undermine altruistic feelings. Thus, any scheme to create a society in which caring is valued in all spheres of society must address the growing commodification and defamilialization of care. We need to think about the implications of changes that take place in caring work when “strangers” rather than family members provide care, when it is paid rather than unpaid and most importantly when it is regulated and controlled by impersonal rules and hierarchy. Deborah Stone (2000) found that home care workers faced a conflict between bureaucratic rules and their own ethic of care. They often stretched or evaded rules and supervisors to provide personal care or spent off-work time or money to provide extra services. Giving workers latitude to attend to social and emotional aspects of care would increase the intrinsic rewards of the job. Because direct care workers are in a position to assess firsthand what the needs of the care recipient are, empowering them to take initiatives in shaping services would also be salutary. At the same time, empowering caregivers without also empowering care recipients poses the risk of exacerbating the already unequal relationships between caregivers and care receivers. Caregivers may feel that they understand the needs of care receivers and that they are acting in their best interests. However, care receivers might have different values and priorities. To the extent that care receivers are emotionally and physically dependent on their caregivers, they may feel they have no choice but to defer to the caregiver’s judgment. Thus, an additional concern should be to ensure that care receivers are given voice and influence over their care. Mentally competent adults requiring home care assistance, for example, might be given grants to hire their own caregivers rather than being assigned a helper by a social service agency. One of the 50 disabled women interviewed by Jenny Morris in England said that only when she started employing her own helper, did she feel she could pay attention to her own appear-

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ance. She had her paid helper assist her with clothing and make up, which she felt justified in doing because “They need to be patient and I’m paying for that patience so I feel OK about expecting it.” (Cancian & Oliker, 2000, p. 99). In the USA, one major group already has long had direct access to government grants with which to hire care workers. The Department of Veteran’s Affairs has a program called Universal Aid and Attendance Allowance that gives direct unrestricted cash payments to 220,000 veterans to pay for home care workers or “attendants” (Cancian & Oliker, 2000, p.  155). The right of veterans to be paid for hiring their own care workers is acknowledged because of their service to the country. What is needed is a more universal approach that extends the right to non-familial paid care for all categories of citizens. In short, both paid caregivers and receivers of paid care need to be empowered. Sometimes, when the interests of caregivers and care recipients intersect, it makes sense for them to organize together. For example, when social service agency budgets are cut and home care and other services are reduced, caregivers may be forced to serve more clients less well and clients do not get the care they need. During the 1980s and 1990s, coalitions of home health care workers and receivers and community leaders were formed to improve wages and benefits for care workers. Since services are paid from Medicaid and other public funds, care receivers will support wage increases for care workers, especially if it means that their caregivers will continue providing care rather than leave for higher paying jobs in other fields (Cobble, 1996; Service Employees International Union [SEIU], 1999).

Worker Empowerment and Protection Care workers have not simply complained about their working conditions and pay; they have increasingly mobilized to organize, speak out, and get laws changed. These efforts have occurred at the local, national, and international level. They have formed worker centers and cooperatives at the local level to provide education, support, and legal help to members. They have formed national and international coalitions. In this final section, I turn to a small sample of efforts by paid care workers and their allies to improve their working conditions and gain legal rights and protections, especially minimum wage, maximum hours, rest time, vacation days, and protection from harassment and abuse.

Social Activism and Unionization One route has been to form labor unions for caregivers. One example is in my home state of California. The state runs a program, In-Home Supportive Services that is partly funded by federal Medicare funds and partly funded by the state. Since federal Medicare would not allow its funds to be used to pay for family members to

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provide care, the state or county provided the portion of funds for paying family caregivers. Begun in the 1970s, IHSS employed more than 200,000 caregivers by the 1990s. They were paid minimum wage and had few benefits. In the meantime, organizers and planners had set up IHSS programs in Los Angeles, San Francisco, and Alameda County that were to be administered by local bodies—county or regional boards to oversee the program and act as “employees of record” in their localities. Having a local board as the employee of record allowed care workers both family and non-family to unionize. As a result, family and non-family caregivers worked together to improve pay and conditions. Moreover, care receivers were granted rights to choose their own caregivers and pay them. This arrangement thus protected and harmonized the interests of care receivers and caregivers. The result of a successful effort of the Service Employees International Union is to organize more than 100,000 home care workers at the end of the 1990s. While the actor, Arnold Schwarzenegger was governor of California (2003–2011) the state was in deep financial trouble. His administration applied for and received an exemption to use Medicare funds for an “experimental program” to pay family caregivers, an exemption that continues to this day.6

International Labor Conventions Another kind of effort is to work to get care workers, particularly those who work in private homes, included in national labor laws. In 2011, the United Nations International Labor Organization surveyed legal protections for domestic workers in 117 countries, finding substantial exclusion of household employees from basic labor rights that are accorded to other workers. Focusing on work hours, minimum wage, and maternity protections, the survey found that only 10% of the estimated 53–100 million domestic workers worldwide are covered by general labor laws to the same extent as other workers; 29% are completely excluded, while the remaining 61% have partial or special coverage but are excluded in key areas. The ILO also adopted a Convention on Domestic Work, which states that workers who care for families and households must have the same basic labor rights as other employees. This Convention recognizes the prevalence of especially vulnerable groups—children and migrant women—among domestic workers worldwide. Whether internal rural to urban migrants or transnational Global South to Global North migrants, domestic workers are especially vulnerable to abuse because they are often isolated in the household and lack support networks. They are in danger of being abused and denied freedom by middleman brokers, recruitment agencies, and employers. Indeed, migrant domestic work is one of the sectors most often implicated in human trafficking for labor. By February 2018, 25 countries (seven of them in Europe,

6  https://ca.db101.org/ca/programs/health_coverage/medi_cal/ihss/faqs.htm#_q705. September 23, 2018.

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Belgium, Finland, Germany, Ireland, Italy, Portugal, and Switzerland) had ratified the Convention. The momentum has come to a standstill as only two have ratified since 2015 and neither Canada, Mexico nor the Unites States have done so.7

Domestic Worker Self-Help, Education, and Advocacy Groups Domestic workers in many cities and regions have formed Worker Cooperatives and Support Groups. Various domestic workers organizations (many organized around ethnicity) have simultaneously worked to exert political and moral pressure on state, county, and city governments to pass bills mandating minimum wage, overtime, and other protections for home care workers. In 2003, at the instigation of domestic worker organizations, the New York City Council passed a bill requiring placement agencies to obtain signed promises from employers to follow minimum wage, overtime, and Social Security regulations. In 2008, a worker organization, CASA de Maryland, helped pass a bill to require employers in Montgomery County, Maryland, to provide employees with written contracts setting out wages and benefits. In another closely watched 6-year campaign in New  York state spearheaded by Domestic Workers United (an organization of Caribbean, Latin, and African housekeepers, nannies and elderly caregivers) and the New  York Domestic Workers Justice Coalition, succeeded in getting the state legislature to pass a Domestic Workers’ Bill of Rights (DWBR) in 2010. Coalitions in other states worked to get their states to pass some version of a DWBR.  According to Domestic Workers United, “The Bills (would) ensure (that) domestic workers are provided a limited number of paid sick days, personal days, and vacation days; notice and severance pay; yearly raises tied to inflation; full overtime pay for any work over 40 h/week; 1  day of rest per week; protection from employment discrimination; and health benefits.” The California Coalition for Household Worker Rights announced in 2010 that it was working to pass a domestic worker rights bill. Passed by the California legislature in 2012, Assembly Bill 889 would have required overtime pay, paid breaks, and other protections to over 200,000 caregivers, nannies, and housecleaners, but Democratic Governor Jerry Brown vetoed the bill. In explaining his veto, Brown directed his concern toward those receiving care and their families, while ignoring the plight of paid caregivers. He asked: “What will be the economic and human impact on the disabled or elderly person and their family of requiring overtime, rest and meal periods for attendants who provide 24 h care?” “What would be the additional costs and what is the financial capacity of those taking care of loved ones in the last years of life.” Ironically, he describes the families who employ caregivers as 7  The 25 ratifying countries are: Argentina, Belgium, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, Finland, Germany, Guinea, Guyana, Ireland, Italy, Jamaica Mauritius, Nicaragua, Panama, Paraguay, the Philippines, Portugal, South Africa, Switzerland, and Uruguay (International Labour Organization – ILO, 2013).

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“those taking care of loved ones” while referring to paid caregivers as “attendants.” A year later, the legislature passed a watered-down domestic bill of rights that specifically excludes personal attendants—i.e., care givers of the elderly and disabled who provide services through the state’s In-Home Health Services (IHHS) program. Governor Brown signed it and the law went into effect in 2014. Between 2012 and 2018, six other states, Hawaii, Massachusetts, Illinois, Oregon, Connecticut joined New York and California, and several cities: Seattle, Washington, DC, and New York City, passed ordinances to grant rights and protections to domestic workers.8

Closing Thoughts Achieving the kinds of changes needed to achieve a society that values caring will require transforming the ways we think about ourselves, our relationships with others, the family, civil society, the state, and the political economy. Ultimately the transformation of caring must be linked to changes in political economic structures and relationships. Perhaps most fundamentally, the concept of “society” as made up of discrete, independent, and freely choosing individuals will have to be updated to include notions of interdependence among not wholly autonomous members of society in large part because the unquestioned demographic trajectories of the twenty-first century are leading to larger numbers of elderly and others in need of care. The recent history of the United States and of advanced democracies in Europe has shown that such changes are achievable and that they can lead to more just societies in which all individuals, regardless of age, gender, race, or beliefs can lead more fulfilling lives.

References Abel, E., & Nelson, M. (Eds.). (1990). Circles of care. Albany: State University of New  York Press. Bubeck, D. E. (1995). Care, gender, and justice. Oxford: Clarendon Press. Cancian, F. M., & Oliker, S. J. (2000). Caring and gender. Thousand Oaks, CA; London: Pine Forge Press. Cobble, D.  S. (1996). The prospects for unionization in a service economy. In C.  MacDonald & C.  Siriani (Eds.), Working in a service economy (pp.  333–358). Philadelphia: Temple University Press. Folbre, N. (2002). For love or money - or both? Journal of Economic Perspectives, 14(4), 123–140. International Labour Organization (ILO). (2013, September 5). Ratifications of C189 - Domestic workers convention, 2011 (No. 189). Genève: Author. Retrieved September 23, 2018, from,

 https://www.domesticworkers.org/national-affiliates, states. Accessed September 23, 2018.

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Text at: https://www.ilo.org/dyn/normlex/en/f?p=NORMLEXPUB:12100:0::NO::P12100_ ILO_CODE:C189, Ratifications at: https://www.ilo.org/dyn/normlex/en/f?p=NORMLEXPU B:11300:0::NO::P11300_INSTRUMENT_ID:2551460 Kittay, E. F. (1995). Taking dependence seriously: The family and medical leave act considered in light of the social organization of dependency work and gender equality. Hypatia, 10(1), 8–29. Pedersen, S. (1993). Family, dependence, and the origins of the welfare state, Britain and France, 1914-1945. Cambridge: Cambridge University Press. Radin, M. (1996). Contested commodities. Cambridge, MA: Harvard University Press. Ruddick, S. (1998). Care as labor and relationship. In J. G. Haber & M. S. Halfon (Eds.), Norms and values: Essays on the work of Virginia held (pp. 3–25). Lanham, MD: Lanham, Rowman and Littlefield. Sainsbury, D. (1996). Gender, equality and welfare states. Cambridge: Cambridge University Press. Service Employees International Union (SEIU). (1999). Drive to improve L.A. homecare takes big step forward. Washington, DC: Author. Stone, D. (2000). Care as we give it, work as we know it. In M. Harrington-Meyer (Ed.), Care work: Gender, labor and the welfare state. New York: Routledge. Thorne, B. (2000). Pick-up time at Oakdale elementary school: Work and family from the vantage points of children. In R. Hertz & N. Marshall (Eds.), Work and family. Berkeley: University of California Press. Tronto, J.  C. (1993). Moral boundaries: A political argument for an ethic of care. New  York: Routledge.

Chapter 6

Care Amongst Ourselves: Self-Care as a Therapeutic and Political Experience Pascale Molinier

In this chapter,1 I will use a narrative approach to describe how the issue of “concern for self,” or in French le souci de soi, presented itself to me: a phrase that corresponds to the Foucauldian concept of “the care of the self” (Foucault, 1988/1984), but that is different from the feminist perspective of care.2 Several years ago, French sociologist Liane Mozère, who first introduced the work of Joan Tronto in France (Tronto, 2009 [1993]), sought to bring the two perspectives closer together (Mozere, 2004). However, it seems, the differences between the two are so great that it would be better to critically discuss the Foucauldian concept and conceptualize self-care based on data gained from the framework of care (Molinier, 2018). Self-care, for its part, is problematic in that it refers to neoliberal and individualistic models of well-­ being, which I will also depart by proposing the notion of “care amongst ourselves.” However, before that, I will situate my proposal on accounts taken from many stages in my research.

1  This text is largely related to the numerous conversations I had with Luz Gabriela Arango Gaviria, María Fernanda Cepeda, Mira Younes, Priscila Cuellar, Mariana Luciano Alfonso, Anne Loyal, and Antonio Morales Riveira. 2  By feminist perspective of care, I mean a way of looking at the social world from the needs of care while taking into account the needs of the caregivers (mostly women).

P. Molinier (*) Transversal Unity on Psychogenesis and Psychopathology (UTRPP), Sorbonne University of North Paris, Paris, France © Springer Nature Switzerland AG 2021 N. Araujo Guimarães, H. Hirata (eds.), Care and Care Workers, Latin American Societies, https://doi.org/10.1007/978-3-030-51693-2_6

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At First, a Cultural Discomfort I arrived in Colombia for the first time in 2001. It was not a work trip, as had been my trips to Brazil and Argentina, but rather one I took for personal reasons. Since then, my stays there have multiplied to the point where today I have two countries and two homes, one in Paris and one in Bogota. When I began living in Colombia, I was quite bothered by the presence of domestic help in everyone’s homes, whether urban or in the country, and even in my own home. The role of the Colombian domestic worker is very different from the role of the femme de ménage, or cleaning lady, in France who comes a few hours a week to do predetermined fixed tasks and whose work is part of a service. She is not required to do anything outside of that, unless she wants to. The Colombian domestic worker often comes for entire days and does everything the head of the household asks: cleans, cooks, irons, serves meals, prepares coffee at a moment’s notice, opens doors, etc. In general, her work is a kind of servitude. I mention details as facts that I will not substantiate here. To describe this experience, I will talk about my “cultural discomfort” (to paraphrase Freud in Civilization and its Discontents, 2002/1929). I felt like I was participating in a way of life that I did not agree with, a kind of “close domination” (see Memmi, 2003) that silently permeates Colombia’s entire society like a completely banalized specter of ancient colonialist structures (Drouilleau-Gay, 2019). It seemed possible to do a political interpretation of inequalities and types of domination based on the omnipresence of domestic employment and that this interpretation was missing in Latin American theories about the “coloniality of power.”3 My discomfort was clearly eccentric (in the sense of De Lauretis, 1990), according to Colombian society: being from outside, yet at the same time on the inside. In others words, an accomplice. I began writing wildly and without any research framework in a field notebook where I described all the situations I found intolerable. One of these “scenarios” occurred on a family-owned country estate, a colonial mansion so disproportionate it was shocking. We were seated around a large table near a fireplace where a fire we had not lit burned, when the maid entered with a platter of food. Behind her walked her daughter carrying the bread, a girl of eight, proud to be participating in her mother’s work. According to the ILO, 11 generations are needed before Colombians can escape poverty, but how many to break away from servitude? I realized that I would not be able to overcome my discomfort without doing something more active. I decided to do research with some domestic workers and explore the difference between service and servitude. I took a sabbatical year from 2008 to 2009, and along with María Fernanda Cepeda, a young anthropology student, conducted a “workshop” about domestic work at an association of female heads of household in a low-income neighborhood of Bogota (Molinier & Cepeda, 2012). The women agreed to meet because they realized that all of them, both leaders and participants, had worked as domestic workers but had never reflected on the subject. 3  Maruja Barrig’s book, El mundo al revés (2001) exceptionally addresses this subject, and her interpretation, for me, provided very important confirmation of my first hypotheses.

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Care vs. Justice: A Dilemma What were the results of this investigation? We collected a significant amount of data on the notion of servitude. The most difficult situation we found in this context was that of the young peasant women doing live-in work in urban homes. Additionally, all of the participants admitted that it was common for them to be submitted to humiliating situations like washing undergarments (especially women’s) or finding dirty dishes that had accumulated over several days and smelled bad. But the most astounding situation was linked to their ambiguous work relationship. The women complained that most of their employers did not provide benefits (health and pensions). This is an important point, since it demonstrates that the women know they have rights, but yet they seem very passive in the process of claiming them. For example, they spend years working in homes where their rights are disrespected, and even violated. In fact, they push their own benefits aside to make way for other considerations. The most important thing to them becomes being “well-treated” by employers they define as “good people.” The women used narratives that value respect, niceness, support in sensitive situations (e.g., paying for an abortion), or holiday invitations. They do not say they feel part of the family, meaning they do not use the idiom of the family, as studied by sociologist Grace Esther Young, but valued their friendship instead (Younes & Molinier, 2016; Young, 1987). One of the women said of the family she worked for (that did not pay benefits), “Our relationship was good, even though it was unfair.” All the women agreed with that paradox. In these narratives, the women made many comparisons between their employers and their own families. The importance of being well-treated reflected situations of domestic violence. They talked about how their parents, grandparents, spouses, and even their children (drug users) would beat them. This domestic violence, and the fact that they had been live-in domestic workers since they were teenagers, is the opposite of care. Generally speaking, we can say that these women did not receive care from their own families. Therefore, any kind gesture is interpreted as a precious sign of care. So precious that unpaid benefits become secondary and their complaint about it is more an expression of regret with a touch of sadness.

 he Struggle for Survival, a Never-Ending Quest T in the Present Another very important element in their definition of being well-treated is having free access to good and abundant food. An empty refrigerator is much more a reason for complaint than not being paid benefits. This background allows us to better understand their psychological strategies. Benefits are associated to a distant future. They refer to the possibility of getting

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sick or of retiring at some point in time. Some research shows that the body is the sub-proletariat’s most important property and tool (Dejours, 1993). While they are afraid of losing their health and strength, which would prevent them from working, they defend themselves from this fear by forgetting their bodies. Not thinking about it, not going to the doctor, not caring about the risks of getting sick—these defense mechanisms can, to some extent, explain the behavior of these domestic workers. From this perspective, it is difficult for them to fight for their benefits because it implies acknowledging their vulnerability. Along those same lines, none of them gave their age, which we can connect to the fact that aging is an obstacle to getting a job or to doing heavy work such as washing clothes by hand with cold water. Another key element is associated to the constant search for extra work. This constant search is understood as looking for any opportunity to bring in money, even if informally or illegally. An important part of “paid” domestic work is done as side jobs. For example, occasionally washing clothes for a neighbor, caring for a child, etc. This constant search for extra work is part of a survival rationale, or of a very short-term logic. In this way of thinking, nothing is discarded. For example, one of the women was better off than the others because she lived with two of her working children and had an employer that paid well, including benefits and free access to food. We were very surprised when she said she had taken on extra work while her employers were on vacation. The work was physically demanding and the pay was low. Why did she take it? We can say that it was because she had never lost the habit of looking for work: anything is valid. The psychology behind the incessant search for work is that “we don’t know what tomorrow will bring.” The time of action is the present and only the present. In this short-term time of searching and surviving, having food in abundance is more important and desirable than having future social benefits like pensions, disability, or retirement. Lack of food is a more legitimate reason for complaining and quitting than the omission of benefits.4 Thus, these women’s behavior is in no way irrational, but rather corresponds to a logic of hunger. The incessant search for lucrative activities becomes a specific form of subjectivity, a real social drive that directs all intelligence and personality toward this single goal.

Busy Moms: Responsibility Beyond Love Our second finding is related to the particularities of motherhood. The women described their peasant upbringing as having been very hard, often including physical punishment. Thus, they want to raise their own children differently, in ways that include care and providing an education (which some of them had already achieved). Motherhood concerns stood out strongly in their narratives. During the introductions

 On their part, employers regularly complain that employees steal or eat too much food.

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of our first session, two of the women recounted domestic accidents involving their children that occurred in their absence. It is highly significant that their focus was not on their paid domestic employment, but rather on the fact that it caused them to neglect their children. They are mothers and heads of households committed to their jobs and finding extra work. They do not have much time for care and tenderness. When they talk about their children, their tone is quite cold. Moreover, besides their own households, they are responsible for taking care of their extended families, which often include their parents, adult children, and grandchildren. This role of main caretaker is quite heavy and the feelings they express toward their relatives are very ambivalent, mixing irritation, anguish, and sometimes guilt. Two of them described resentmentfilled family conflicts, one case involving a daughter-in-­law, and another, a mother. However, we were very surprised to hear that, despite this resentment, they still support these family members financially, which means that they have to work even harder. Despite their bitter and contradictory feelings, they assume their responsibility as the main providers, as the ones everyone can turn to and rely on. It would be hard to say that they always do what they do “out of love,” which suggests a certain autonomy between relational responsibility (ethics) and feelings.

From Care to Politics: “Caring for Each Other” The third outcome we found is care as a way of life. In a discussion with the association leaders, they underscored the importance of care amongst themselves. “It is very important, caring for each other; it’s a way of life.” This sentence was a very important key to our understanding. We knew the association had begun with a concern for care, specifically of creating a space for their children to eat. But besides caring for their children, the association is a place where the women take care of each other. What does this way of life mean? Here, I should mention some simultaneous discussions I had with leftist Colombian intellectuals. The women in the association frequently debated the subject of self-esteem, and they used behavioral techniques like applauding when someone shared a moving personal experience. The word “self-esteem,” not to mention the techniques to achieve it, brings up connotations associated to right-wing charity movements and individualism. This made my intellectual friends quite ­skeptical of my stories on the subject. Thus, I understood that ideologically, the subject of self-esteem was often silenced. Likewise, the association women often rejected feminism, which was strange because many of their actions in favor of women and against domestic violence were feminist, from my point of view. I understood from them that feminism was associated to middle-class and academic women. In other words, the patronas, or employers. Some of my academic feminist colleagues from the university contradicted me, arguing that these women were not “politicized.” As proof, they referred to the fact that the employees did not assert their right to benefits. I asked myself, “When did ‘the political’ begin? And who has the right to define it?”

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Those discussions brought about a second “cultural discomfort”: “What right did I, a foreigner, have to not share in the hegemonic ideologies of a country? Was it possible that I had been completely mistaken in my understanding because I was an outsider? What was the relevance of knowledge from an outside?” Today, 10 years later, I am still trying to construct and elaborate on this understanding.

The Law and the Unthought About the Privilege of Care What does it mean to be a subject of rights? The subject of rights does not lack care, which theoretically implies that all subjects benefit from care from the day they were born. This situation does exist, albeit belongs to a privileged group of people. It is difficult for this particular social group, as subjects of rights, to understand that care is in fact a primary need because they have always benefitted from it. In the same way, they cannot understand that when care has been absent, it becomes more important than any law. The subject of the relentless search for work, on the other hand, does not stay within the boundaries of legality. Does that make it immoral? The women’s sense of relational responsibility would demonstrate that it does not. But its ethics are driven by survival, and because survival outweighs anything else, there is always the risk of doing something illegal like stealing or causing harm to others. That is what happens when this persistent search truly becomes an ethos, or “second nature.” It is why a domestic worker with a good salary and paid benefits might scrounge (i.e., steal) food from her employers. In the 1950s, French psychiatrist Louis Le Guillant emphasized envy as the driving force behind the small crimes committed by domestic workers (robberies, broken objects, and so on), also motivated by humiliation and disrespect. Stealing food is a way of calming their envy and the aggressiveness generated by servitude and of establishing a kind of secret, but jubilant justice (Le Guillant, 2006 [1957]; Molinier, 2011). Indeed, we can never forget that because they work amongst the “rich,” domestic workers are directly confronted with the injustice of inequality and know firsthand that the rich are not morally better than the poor. Especially because they work directly with the less noble aspects of intimacy and bodily functions. The women at the association described the rich as dirty, asserting that cleanliness was a value of the poor. This moral judgment is the result of the disgust they experience when they come into direct contact with the filth of the rich.

 earch for Any Lucrative Activity: “El rebusque” Between S Resistance and Ethical Defeat Here we can introduce the issue of the centrality of work and the discussion about morality and the political value of this kind of relation to work. For many people, the incessant search for lucrative activities—el rebusque, as the Colombians say—is

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a short-term individualistic stance that seems to ruin opportunities to use work appropriately, for both individuals and society.5 There is no mediation of the collective or of social rules and laws lose an opportunity to seem legitimate. Of course, Colombians believe the situation is improving and that the rights of domestic workers are increasingly respected. However, in 2018, Priscila Cuéllar, a student at the Universidad Nacional, studied eight professional, educated, single, middle-class men. They all had domestic workers and yet none paid their benefits (Cuellar, 2018). Let us now look at work from the perspective of the association women. In comparison to servitude, which appears to be a passive attitude in the service of others, their incessant search for work (rebusque) is a reactive attitude because it is about taking advantage of every opportunity, of moving, of being shrewd, of adapting to different situations, of risking illegal activities, etc. The moral world and values of the “responsible” women of the association are very different from the “democratic” image that prevails in moral and work theories. If there is an ethic linked to this type of search, would it be an individualist or a group that depends on a provider? Is this search, after all, political? There are many opinions about el rebusque. To some, it is precisely the consequence of what is non-political, or in other words of not being part of organized, salaried work. It is being on the lumpen proletariat marginality as opposed to having “decent” and legal work. To others, many of whom practice it, el rebusque is a kind of resistance, of collective organization as opposed to just individual because it is not merely for short-term survival. It is a way to fight against hegemony. In one way or another, the cause of this constant search is structural unemployment, which is faced by an enormous portion of the population, cynically sacrificed for the benefit of privileged minorities. While these two perspectives oppose each other ideologically, psychosocial analysis suggests that these contradictions are part of the same subjective world—I mean the hard world of this incessant search for survival—and are often experienced by the same people. Understanding the connections of this incessant search for ethics as well as politics cannot be undervalued and must consider the subjective dimensions of this kind of search as well as the tensions between survival and resistance. Let us go back to our friends and their words: “It is very important, caring for each other; it’s a way of life.” The women described how they gained self-­confidence when they were able to identify with leaders; women who had been through the same situations of violence or extortion at work, but who had prevailed and were now capable of helping others. They described, for example, learning how to speak in public and the pride their children felt when they listened to them. In terms of politics, we can say that the association is a learning space where women learn to care for each other. This experience is the first step toward being political.

5  In Colombia, this frenetic search of any activity—often in the informal sector—seemingly pertains to local culture goes by the Spanish term el rebusque, from the verb, rebuscar. In the political debate, el rebusque designates a set of activities in tension between the values of resistance and the complete loss of ethics (or the common version of elite corruption).

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Through “selfcare amongst themselves” they learn the meaning of what is collective and an ethics of “each other.” Of course, these ethics are still limited, even though they are about peer groups rather than family. They are women and heads of households from the same low-income neighborhood (equal to a city of 400,000 inhabitants), and they care for each other in terms of a common destiny. In other words, based on the ties that come from shared experiences and interests. One could object, arguing that the group is too limited to implement a democratic process. But what is an oligarchy other than a limited group? I would like to develop or at least suggest the idea that, for some people who have not experienced being cared for, care amongst each other takes on the role of “political therapy.” In other words, it is also a preamble to finding their own voice in the political arena. Now, what brought me to this idea?

Feminism as a Therapy In 2015, I became interested in two outsiders, two women from the realm of psychoanalysis: Bertha Pappenheim, also known as Anna O and the patient of Josef Breuer, Freud’s friend (Ellenberger, 1995); and Marie Langer, an Austrian psychoanalyst that developed her career in Argentina and Mexico. Bertha Pappenheim is known in Germany as a pioneer in social work who fought against prostitution and other issues. As a young woman she became ill, exhibiting serious symptoms of “hysteria.” She began treatment under Josef Breuer, who was in constant dialogue with Freud. Anna O became famous for being the inventor of the “talking cure” that Freud later transformed into psychoanalysis therapy. We know from Breuer’s reports that young Anna was very intelligent, cultured, and spoke several languages. However, as a female she did not have the right to study at university and her sole bourgeois destiny was to marry and have children. Her therapy with Breuer ended under obscure circumstances. There is much debate about Anna’s “false pregnancy,” which caused Breuer to panic. Some historians say it was a story invented by Ernest Jones, Freud’s first biographer. Regardless, Breuer was not able to cure her, and we know that she was institutionalized several times at the Binswanger clinic in Switzerland, which also did not provide a cure. Later on, Bertha reappears sane and full of energy in Frankfurt, her mother’s hometown, where she begins a social career caring for vulnerable women, orphans, and prostitutes. This was made possible because of the charitable tradition amongst the city’s Jewish women. In the following year, and until her death, she committed herself to the feminist movement and to Judaism. She translated a book written by Glückel Von Hameln from Yiddish to German. Von Hameln was a strong and active Jewish woman from the eighteenth century, and Bertha so identified with her that she put a portrait of herself dressed in clothing from the past century on the cover of the translated book, as if she were Von Hameln. Although we do not know how Bertha was cured, we do know she was well when she identified with maternal women that were strong and active like the Jewish

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shekel and when she poured her capacity for care into the work of caring for other vulnerable women. We can risk hypothesizing that Bertha was cured when she rejected the social destiny that defined being a woman (hers as a bourgeois Victorian, and the prostitutes as victims). As Daniel Boyarin said, “The hysterical woman grew as a feminist, because feminism cures hysteria” (Boyarin, 1997). Boyarin is not talking about the structure of hysteria, but of the “disease,” which he puts in quotes not to deny the suffering involved, but to emphasize the effects of the social context of the “disease.” The hysteria of “situation” could be resolved by political awareness and action. Breuer had noted that, even while sick, Bertha Pappenheim cared for others. However, there is a gap between care in the private sphere, which does not protect against setbacks, and care in the public sphere, which combines social work with political action. Domestic care corresponds to what Virginia Woolf and Carol Gilligan call “the angel in the house” (Gilligan, 2013), which proposes a feminine ethic of care based on self-sacrifice and abnegation, or as Boyarin says, on self-aggression or masochism (see the reference to Story of O in the chapter’s title). Public care corresponds to all the characteristics of sublimation, including aggressivity against men that is sublimated toward political action. Bertha Pappenheim’s social and political work is a feminist care ethic. Her cure suggests that public care is a healing praxis that joins self-care and caring for others into a common destiny that implies being aware of class, gender, and race relations. One hundred years ago, experts argued about the appropriate diagnosis for Anna O. However, her life as Bertha Pappenheim invites us to discuss a “situational hysteria.” By fighting against her social oppression and the oppression of her peers, she did not need to return to psychological therapy. Feminism is where women work to improve their conditions and way of life for themselves and for other women that share their social destiny. Or in other words, feminism is a form of sublimation to overcome the social destiny of being a woman. Can it also be a form of political therapy? In this case, even if the women of the association reject academic feminism—and do not call themselves feminists—their way of life is distinctly feminist, in a radical sense. Marie Langer was also a Jewish woman from Vienna’s bourgeois. She was born in 1904 and began studying medicine, which she did not complete in order to fight in Spain’s civil war as a communist. Later, she could not return to Austria because of the Nazi regime, so she went to Argentina where she became a psychoanalyst. Then, during Argentina’s military dictatorship, she moved to Mexico, returning to Argentina just 1 year before her death in 1988. In an interview at the end of her life, Marie Langer stated why collective therapies were invented in the hospitals of low-­ income neighborhoods in Buenos Aires (Langer, Del Palacio, & Guinsberg, 1981). It was to combat the social asymmetry between the patients (working class) and the therapists from privileged backgrounds. They discovered that a therapeutical group allowed more horizontal identifications. Marie Langer thought that while psychoanalysis should cure symptoms related to patients’ psycho-infantile history (in line with Freud), it should also cure symptoms related to social suffering. Group therapy had a political purpose, where identification made participants aware of their social class or gender destiny and enabled them to change it.

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The women from the association suffer from traumas caused by intrafamilial violence. This produced a lack of self-confidence, to the point that they saw no possibility of having a public voice. I am not saying they do not need psychotherapy to overcome their traumas. But more than anything, they need to overcome a destiny inscribed in patriarchy, or in other words, understand that this destiny is not at all natural. Their social suffering (to quote Veena Das) requires collective treatment before anything else. Gonçalves Filho (1998) states that political barriers and objectification are the elements that structure social humiliation. Gender inequality causes women to experience both these phenomena: the political barriers that constantly prohibit them from acting and speaking and the objectification that often causes them to be treated as things and reduced to available bodies that are vulnerable to abuse. We can also mention the feminist work done by a Guatemalan group called Las Poderosas Teatro that moves between the theater of the oppressed and Mayan healing. Their goal is to help women overcome family violence and acts of aggression committed by members of the military and police officers, or in other words, violence committed by the state itself (Loyal, 2018).6 In the Bogota association of peers, identifying with authority figures is probably more banal than Bertha identifying with Gluckel, but that does not keep it from mutating or from being dynamic. “The unattained self,” to use Emerson’s words, can only be attained through interactive relationships between women. The victims identify as survivors of violence and as initiators of subversive, non-submissive models of femininity. From their own point of view, for the women in the Bogota association to identify themselves as “feminist” could be a form of submission to the models of dominant women. (Black feminism helps us to think about these gaps.)

Self-Care as a Social Praxis Therefore, it is about responding to criticisms of depoliticization and understanding how these experiences differ from mutual help organizations like Alcoholics Anonymous or Weight Watchers. This is where therapy is both ethical and political. How does it become political therapy? Identifying with similar people and self-­ transformation take on important roles not only on individual levels but also in the process of transforming the world, work, and actions. What is this work about? It is 6  “Theater that is specifically part of the performing arts has been important not only to my personal and emotional development, but also professionally. Before, I couldn’t look in their eyes, I didn’t know how to speak in public, really. I did it, but I was, you know, very scared. But now, since participating in the theater, I understand that we have the opportunity to speak, to express what we feel, to scream … without anyone telling you to stop. Typically they teach us, or raise us to be women that have to stay in the background, to be fearful. We don’t have to be that way, we have to evolve … There are many stereotypes, stigmas, constructions about us. But of course, when we do theater and go on stage, we know we have all the possibilities to transform ourselves” Interview with a Poderosa by Anne Loyal (2018).

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about repressing social determinations of suffering, whether one’s own or of others. The association is founded on care as a social praxis. Caring for yourself—thinking of yourself, developing a self that freely chooses how to identify—is essential in the psychological-to-political transition for women who have been victims of multiple kinds of oppression, women who have stifled their voices, silent women that have been identified by the more powerful as merely victims only good for beating, or to appear as beautiful ornamental flowers … “A way of life,” say the women at the Bogota association, designing a process of self-­ care that is not individual, according to the neoliberal mandates of well-being, nor ascetical, like the Foucauldian perspective, but rather the fact of self-care amongst themselves. This kind of self-care with others resonates with the sanación (healing) theorized by Lorena Cabnal, a Maya-Xinca7 feminist, and with the Poderosas, in that they are simultaneously therapeutic and political actions where sanación designates and marks a process of reciprocity: If I heal myself, it heals you; if you heal yourself, it heals me. In the context of another tradition, Stanley Cavell writes that “Emersonian perfectionism” does not go from brute to sophisticated, or from the common to the higher, but rather from lost to recovered. Or, with a loose interpretation of Thoreau’s words, “from desperation to interest” and Kierkegaard, Heidegger, Wittgenstein, and Lacan, “from chatter to words” (Cavell, 2003). Words are inscribed in a relationship: self-reliance, voice (as a unique and political expression). Talk needs collective elaboration to discover and affirm one’s own tone (claim) based on one’s own ethic. In other words, an awareness of what matters, or of the importance of what counts, what matters (Laugier, 2015, 2018). I use this concept of care amongst ourselves to designate a collective practice that does not go through a psychotherapist as such, but through what people say has brought about positive self-transformation, an escape from “sickness,” and empowerment, but not in the overused sense. In other words, a more powerful being emerges by conciliating and reinforcing relationships with those who are important and with what matters. A being that is able to use her “different voice” in public and, in doing so, transform it.

Conclusion In conclusion, I would like to show that understanding the moral lives of subordinate groups implies that the researcher must experience the anguish of “losing your concepts” (Diamond, 1988) and renounce epistemic privileges. The psychology that is implicit in hegemonic political theory considers care “a given.” But care, in reality, is a social privilege (Tronto, 2009 [1993]). That means that the kind of politics that recognizes care requires an intersectional analysis (of class, race, and gender)

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of its social conditions as well as of the ways of thinking and subjectivities that are mobilized by survival. In French, the semantic proximity between the syntagmas related to the Foucauldian concept of “care of the self” and “care,” or souci de soi and souci des autres8 need to be clarified when speaking of “cares amongst ourselves” or le souci entre nous, which carries a precise difference from Foucault’s souci de soi. Unlike Foucault, the care of the self from the feminist perspective of care does not originate from stoicism and a(n) (idealized) subject’s desire for self-control and freedom from pleasure, but rather from an experience of annihilation, suffering, or individual and/or collective disaster (see also Ortega, 2008). Langer is right to insist on the dimension of reparation, which was equally important in the healing processes of Mayan women and in the “care amongst ourselves” experience of the women in the Bogota association. Without intersubjective mediation, there can be no transition from experiences of “sickness” or disaster to political expression, and neither can one go from being a victim of violence to being a survivor of that violence or of being silent to having a public voice. Western, academically trained, psychologists (especially if they work in the West) must learn to respect and favor—political therapies. This has become the challenge for my discipline: allowing ourselves to listen to distinct and/or different voices. Acknowledgment  This chapter was translated from its original Spanish version to English by Jill Haring.

References Barrig, M. (2001). El mundo al revés: Imágenes de la mujer indígena. Buenos Aires: CLACSO-ASDI. Boyarin, D. (1997). Unheroic conduct. The rise of heterosexuality and the invention of the Jewish Man. Berkeley: University of California Press. Cavell, S. (2003). Emerson’s transcendental etudes. Stanford, CA: Stanford University Press. Cuellar, P. (2018). Contratando domesticidad. Estudio de caso de varones y su relación con lo doméstico. Unpublished doctoral thesis, en estudios de género, Universidad Nacional de Colombia, Colombia. De Lauretis, T. (1990). Eccentric subjects: Feminist theory and historical consciousness. Feminist Studies, 16(1), 115–150. Dejours, C. (1993). Travail usure mentale. Paris: Bayard. Diamond, C. (1988). Losing your concepts. Ethics, 98(2), 255–277. Drouilleau-Gay, F. (2019). Secrets de familles. Parenté et emploi domestique à Bogota (Colombie, 1950-2010) (Series, Intersections). Paris: Editions Pétra. Ellenberger, H. F. (1995). Médecines de l’âme. Essais d’histoire de la folie et des guérisons psychiques. Paris: Fayard. Foucault, M. (1988). The history of sexuality: The care of the self (Vol. 3). New York: Vintage Books. (First published 1984). 8  First translation of “care” in the book directed by Paperman and Laugier, Le souci des autres, 2005.

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Freud, S. (2002). Civilization and its discontents. London: Penguin. (First published 1929). Gilligan, C. (2013). Résister à l’injustice: Une éthique féministe du care. In C.  Gilligan, A. Hochschild, & J. Tronto (Eds.), Contre l’indifférence des privilégiés. À quoi sert le care. Paris: Payot. Gonçalves Filho, J. M. (1998). Humilhação Social – Um problema político em Psicologia. Revista Psicologia USP, 9(2), 11–67. Langer, M., Del Palacio, J., & Guinsberg, E. (1981). Memoria, Historia y Dialogo psicoanalítico. Mexico: Folios Ediciones. Laugier, S. (2015). Voice as form of life and life form. Nordic Wittgenstein Review, 4(Special Issue), 63–81. Retrieved from https://www.nordicwittgensteinreview.com/article/view/3364 Laugier, S. (2018). What matters: The ethics and aesthetics of importance. In G. L. Hagberg (Ed.), Stanley cavell on aesthetic understanding (pp. 167–195). London: Palgrave MacMillan. Le Guillant, L. (2006). Incidences psychopathologiques de la “condition de bonne-à-tout-faire”. In L.  Le Guillan (Ed.), Le drame humain du travail. Essais de psychopathologie du travail (pp. 37–90). Toulouse: Éres. (ré-ed 1957). Loyal, A. (2018). Le théâtre comme outil d’articulation du thérapeutique et du politique au Guatemala, à travers l’analyse des pratiques de la compagnie Las Poderosas (Master 1 Etudes de genre). Paris: Université Paris 8. Memmi, D. (2003). Une situation sans issue? Le difficile face à face entre maîtres et domestiques dans le cinéma anglais et français. Cahiers du Genre, 35(2), 209–235. Molinier, P. (2011). Empleadoras y empleadas domésticas. ¿Las feministas son mejores patronas? In L. G. Arango & P. Molinier (Eds.), El Trabajo y la Ética del Cuidado (La Carreta Social) (pp. 229–256). Bogota: La Carreta Editores. Molinier, P. (2018). Le care monde. In Trois essais de psychologie morale. Lyon: Ed. ENS. Molinier, P., & Cepeda, M.-F. (2012). Comme un chien à carreau. des employées domestiques colombiennes entre care et justice. Travailler, (28), 33–56. Mozere, L. (2004). Le «souci de soi» chez Foucault et le souci dans une éthique politique du care. Le Portique, 13–14. Retrieved September 14, 2018, from http://journals.openedition.org/ leportique/623 Ortega, F. (Ed.). (2008). Veena Das: Sujetos del dolor, agentes de dignidad (Colección Lecturas CES). Bogotá: Universidad Javeriana, Universidad Nacional de Colombia. Paperman, P., & Laugier, S. (Eds.). (2005). Le souci des autres. Éthique et politique du care. Paris: Éditions de l’EHESS. Tronto, J. (1993). Moral boundaries: A political argument for an ethic of care. London; New York: Routledge. (French translation by Hervé Maury Un monde vulnérable. Pour une politique du care. Paris: La Découverte, 2009). Younes, M., & Molinier, P. (2016). “El lenguaje de la familia”: ¿ideología patriarcal, falsa conciencia o ética del cuidado? Un análisis a partir de relatos de trabajadoras domésticas (Colombia, Líbano). Papeles del CEIC, 2016/1(147). https://doi.org/10.1387/pceic.15211 Young, G.  E. (1987). The myth of being like a daughter. Latin American Perspectives, 14(3), 365–380.

Chapter 7

Care, Aesthetic Creation, and Anti-Racist Reparations Mara Viveros-Vigoya and Krisna Ruette-Orihuela

Introduction In recent years, the struggle against negative stereotypes associated to “black” women’s hair has increasingly become a focus on the collective agendas of women descendants from the African diaspora in various parts of the world. In some Latin American and Caribbean countries, particularly Colombia, aesthetic care practices for the “natural” hair of black women have become a collective “empowerment” mechanism to transform and re-signify the many racist representations associated to their bodies. In this chapter, we are especially interested in how the efforts employed by Afro-Colombian women to promote aesthetic care for Afro-textured hair can be related to the practices associated to care work and emotional work (Hochschild, 1979). Moreover, we explore how and to what extent the subjective “displacement” processes generated by these (aesthetic) care practices can destabilize social-racial orders, erode the political and symbolic economy of white and mixed-race beauty, and symbolically repair the racist grievances inflicted upon women’s bodies. At the same time, different studies and empirical evidence indicate that discussions about the use of emotions in the work environment of aesthetic services have multiplied, as shown in the literature review conducted by the Colombian sociologist, Luz Gabriela Arango Gaviria (2018a). A less frequent reflection has been the possible relationship between aesthetic care demands that form a specific type of clientele (e.g., women with Afro-textured hair) and the emotionally reparative and therapeutic dimensions that aesthetic care services can provide, particularly in a M. Viveros-Vigoya (*) Escuela de Estudios de Género, Universidad Nacional de Colombia (UNAL), Bogotá, Colombia e-mail: [email protected] K. Ruette-Orihuela School of Social Policy, Social Work and Social Justice, University College Dublin, Dublin, Ireland © Springer Nature Switzerland AG 2021 N. Araujo Guimarães, H. Hirata (eds.), Care and Care Workers, Latin American Societies, https://doi.org/10.1007/978-3-030-51693-2_7

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hairdressing or beauty salon, or even in virtual communities or events such as Tejiendo Esperanzas (Weaving Hope), which we will describe later on. We also show that the reparative aspects of this type of work can be expressed individually, collectively, materially, emotionally, and symbolically. Thus, at the same time the individual materiality of a client’s hair is repaired, her self-esteem increased, and her insecurities and frustrations related to the prevailing aesthetic norms are alleviated (Villarreal Benítez, 2017). Events such as Tejiendo Esperanzas seek not only to address and repair the individual suffering of black women in terms of their appearance but also to use collective, politicized aesthetic care to redress the suffering and pain provoked by the cultural violence of narratives that define African hair as ugly (Oyedemi, 2016). The LAPORA Project1 team had the opportunity to participate in a Tejiendo Esperanzas event that took place in Cali, on Colombia’s Pacific coast, in September 2017. The event had been sponsored by the Association of Afro-Colombian Women (AMAFROCOL) since 2004 with the goal of promoting traditional hairstyling competitions, as well as Afro fashion and beauty. The event featured young “black” women, many of whom were small business owners and university students, proudly and beautifully parading their abundant “natural” hair while enthusiastically selling their beauty products. There were also 17 hairstylists braiding artificial hair extensions imported from China and ribbons in the colors of the Colombian flag onto the heads of their models in sessions that lasted over 6  h. To the sound of booming amplifiers playing “salsa brava,” “salsa choke,” and other Pacific ethnic and Hip-­ Hop genres were vendors selling tamales, shampoos, cheese breads, and other regional food; a Brazilian dance group; journalists, and anthropologists; all mingling among hair stations piled with synthetic hair, colorful hair decorations, makeup kits, combs, and hair ties. On plastic folding tables, small business owners displayed jars of oils made of Amazonian seeds and almonds, hair-shaping products made of Pacific fruits, collections of accessories in the shape of the Department of Chocó, traditional aphrodisiac liqueurs, and t-shirts that read “I love my afro.” Group photos and selfies were part of most interactions to be later uploaded onto the Facebook and Instagram pages of the collectives and small businesses with comments on how aesthetics and beauty are part of the political debates of black women in Colombia. The body and hair have been recognized as productive fields for anti-racist actions in the Black Atlantic. Critical studies on aesthetics analyze how beauty standards reproduce racial, gender, and class inequalities and produce stereotypes that both attach and divest meaning to and from black women’s bodies. In Colombia, organizations like the Association of Afro-Colombian Women, also known by its Spanish acronym AMAFROCOL, in Cali, and their collective allies have included 1  LAPORA stands for “El Anti-Racismo Latinoamericano en Tiempos ‘Post-Raciales’”, or “Latin American Anti-Racism in a ‘Post-Racial’ Age” and is financed by the Economic and Social Research Council (ESRC). The Colombian team was formed by Krisna Ruette-Orihuela (University of Manchester), Danny Ramírez (Universidad Nacional de Colombia), and Mara Viveros Vigoya (Universidad Nacional de Colombia).

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in their political agendas affirmative actions and entrepreneurial projects that have ethno-racial, cultural, gender, and generational perspectives. These actions are mobilized in different cities of Colombia in order to fight the negative stereotypes associated to black women’s hair. This chapter examines how the different activities of these Afro aesthetics collectives produce subjective “displacements” that challenge racist practices and forge intra-ethnic and intergenerational solidarity among women, at the same time that they generate anti-racist actions focused on economic empowerment to erode the boundaries between culture and political economy (Álvarez, Dagnino, & Escobar, 1998; Wade, 1999). These processes of subjective displacement produce not only memories of “racial melancholy and grief” (Tate, 2007) but also quests for wholeness and well-being, which have been translated into aesthetic hairdressing services for Afro women that correspond with their desire for physical and emotional welfare (Arango Gaviria, 2018a). These processes have also led to the rise of virtual communities where young women assert black identity, advocate the beauty of “natural” curly hair, and exchange information about how to care for their hair, thus encouraging changes in their appearance and improving self-esteem. The reflections we present here are based on collective ethnographic research we did under the LAPORA2 project. The empirical material is based on 12 in-depth interviews with women from AMAFROCOL and their different allied collectives conducted between July and November 2017, and on participant observations made in four different contexts: (a) a workshop/meeting on self-recognition and empowerment for black women, (b) the Tejiendo Esperanzas public forum, (c) the Annual Hairstyling Competition, and (d) an open group interview with 13 women of different ages at a small hairstyling business called Makeda located in a low-income neighborhood in Cali. These different ethnographic situations gave us the opportunity to share meaningful experiences with the participants that formed ties of ethno-racial solidarity and/or sisterhood. The group interview that took place at different times of the day3 at the Makeda hair salon was particularly challenging because it allowed us to ask the participants about their relationship with their hair. Talking about this subject in a group of black women generally brings up subjective and painful experiences, often from their childhood, and stimulates emotions and memories that expose the effects of racism on their self-perception (Gomes, 2002). Furthermore, the subject tends to be ignored by social sciences because it is considered fatuous, superficial, and intrinsically depoliticized. Nevertheless, this exchange allowed us to ascertain that, unlike decades ago when the subject was considered trivial, private, and familial—as was the case for some of us, today many young Colombian black women are sharing and politicizing their reflections on beauty and hair care. 2  An early partial version, which is more an analysis of the role played by small, Afro-textured hair product businesses in anti-racist actions, was presented at the LASA Conference in Barcelona in May 2018, “Aesthetic creation, subjective affirmation, and micro-economy in the anti-racist struggles of black women. The Amafrocol case in Cali, Colombia” (Ruette-Orihuela & Viveros, 2018). 3  Interview conducted on September 2, 2017, in Cali, Colombia.

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It is important to emphasize that although our conversations took on dimensions of mutual therapy, they were always from a political perspective, whether latent or manifest, that emerged when we associated aesthetic practices with the struggles against social injustice and racism. When we situated our conversations about the particularities of black women’s bodies and hair within the social relational context of gender, race, and class, our dialogues gained a political density that traversed the past, present, and future of each woman, of the collective and of the Afro population in general. Furthermore, assuming a continuous reflective position in these exchanges not only meant allowing emotions into the conversations, which sometimes challenged our capacity to listen, but also guided the course of the conversations with the interviewees. In this sense, the way in which hair, technical knowledge, know-how, care work, feelings, and reflections on the racist social order came together enabled us to understand how subjectivities are closely tied to the cultural and political responses produced in these aesthetic experiences.

AMAFROCOL: An Articulation of Black Women in Movement The Association of Afro-Colombian Women, or AMAFROCOL, was created in 1996 in the city of Cali with the participation of displaced women from rural areas living in precarious economic conditions. According to Emilia Eneida Valencia, AMAFROCOL’s founder and current president, the association was initially organized to support poor black women, especially those affected by violent situations. The group currently has 20 regular participants who are women of different ages, many being educators or businesswomen in the beauty, hairdressing, sewing, and bags and accessories manufacturing sectors. Since 2004, AMAFROCOL has held an annual event called Tejiendo Esperanzas, a project intended to reaffirm the cultural identity of the black Afro-Colombian populations living in Cali and in the Valle del Cauca department. It gives visibility and value to their own aesthetics and beauty, which is uniquely expressed in hairstyles and cuts. The event includes seminars, hairstyling competitions, and photo exhibits on the subjects of beauty, bodily care, and racism. It has also supported the creation and articulation of several small businesses led primarily by young black women from Cali, Medellín, Buenaventura, Cartagena, Putumayo, and Quibdó. These businesses produce and sell care cosmetics (creams, oils, balms, shampoos) for Afro-textured hair, accessories (turbans, earrings, necklaces, wallets, bags), and clothing (shirts, skirts, tunics) inspired by Afro-diasporic aesthetics. These young entrepreneurial leaders see themselves as part of a broad movement of Afro-Colombian women that integrate productive projects with very different ideologies: those that want their unique ethnicity recognized in a multicultural context, those made up of young black women who identify as de-colonialist and anti-­ capitalist activists, and those that bring together business initiatives and evangelical

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Christian platforms that are compatible with the goal of the event. Despite these differences, they all agree that aesthetics is a field of action for empowering black women and for denouncing racism and sexism.

Beauty, Aesthetics, and Anti-Racism Numerous studies have analyzed how beauty reproduces racial, gender, and class inequities that create and reify polarized positions among black, white, and mixed-­ race women (Bordo, 1993; Caldwell, 1991; Candelario, 2000; Coleman & Figueroa, 2010; Craig, 2006; Jha, 2015; Moreno Figueroa, 2013; Tate, 2007; Villarreal Benítez, 2017). The hegemonic and global paradigms of beauty give privilege to light skin tones, straight hair, and European facial and body features and exclude black women, considering them aesthetically inferior and representing them as hypersexualized objects that incite both desire and repulsion (Craig, 2006, p. 168). Nevertheless, some studies have revealed that aesthetic work can produce a certain capacity for emancipatory agency that helps transform or re-signify the ideas and practices of beauty (Arango Gaviria, 2018a, 2018b) that can be associated to pleasure, identity, enjoyment, and to forming solidary political networks (Cahill, 2003; Gimlin, 2002). Mónica Moreno Figueroa (2013) seeks to go beyond the dichotomy of agency and oppression, suggesting that beauty can be understood as a fragile aesthetic feeling, an ambivalent resource that is negotiable, incomplete, and relational. Like Shirley Tate (2007), Moreno Figueroa suggests approaching beauty as a process and proposes focusing on its performative effects. In other words, on what beauty “does” rather than just on what beauty “is” at its essence. From this perspective, when a black woman rejects beauty practices associated to hair straightening, she positions herself on the side of the multiple meanings of Afro-textured hair, which are not just aesthetic but also political (Craig, 2006, p. 170). According to Shirley Tate (2007), this process is marked by situations of disidentification and melancholy that are produced by the kind of beauty that cannot be loved or recognized because of emotional pain. On the other hand, the author believes that black anti-racist aesthetics produces its own normalized racial standards and its own exclusions between natural4 and not natural (Tate, 2007, pp. 306, 307, 309). Afro aesthetics is an important language in the identity politics of emancipation and subjective affirmation. It is not only an expression of individual choice and positioning but also a way to re-signify a part of the body that has been the object of significant physical and symbolic violence associated to sexist racism, in a way that is collective and positive, and undeniably political. To black women, affirming 4  It is worth noting Jocélio Teles dos Santos, quoted by Arango Gaviria (2018c, p. 124), who states that “the discourse about what is natural does not imply the absence of ‘external interferences’ like creams or oils, but rather about the symbolism of straight Western hair and breaking the hierarchy between “good” hair and “bad” hair.”

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black aesthetics means challenging the “white gaze” that produces the “double consciousness” coined by Du Bois in the beginning of the twentieth century. This double consciousness carries with it the strange feeling of “always looking at one’s self through the eyes of others, of measuring one’s soul by the tape of a world that looks on in amused contempt and pity …” (Du Bois, 1903, p. 2). It also means resisting an “awareness of one’s own body in the third person” that is produced by the warp and weft of “a thousand details, anecdotes, and stories” that form the fabric of the white gaze (Fanon, 1975 [1952], p. 90). As we will see later on, many of the activists from the collectives associated to AMAFRACOL  share melancholic stories among themselves about childhood beauty—painful and often nostalgic memories about hair they could not love. At the same time, they create new ways of looking at themselves and presenting themselves, as well as different processes of disidentification. Moreover, all these subjective and affective processes are translated into and associated to political projects through practices of mutual care.

 o More Chemicals and the “Big Chop”: Disidentification N and Re-signification During our ethnographic participation with AMAFROCOL, we had many conversations that reveal the multiple subjective movements associated to abandoning hair-­ straightening chemical products and going through with the so-called “big chop.” The initial decision to “go natural” usually starts as an attempt to repair the significant physical damage caused to hair and scalp by the frequent use of peroxide and caustic soda–based chemicals. During the 2017 Tejiendo Esperanzas event in Cali, we talked to Jessica, a 24-year-old Cali woman, publicist, business administrator, and founder of a small company called Afronía. She told us that she began thinking about going natural when she realized how badly the chemicals were damaging her hair. Wearing a turquoise turban and selling “alternative” afro hair products from her colorful stand (decorated with flowers, jute fibers, pallet shelves, and sophisticated ethno-vintage designs), she narrated the following: … they burned the back part of my head with the straightener … they did quite a job on my head! It was horrible! That’s when I started asking what my hair was like when I was little, because I couldn’t remember. And [even though] I had never really identified with straight hair, I kept doing it because my hair had been straightened since I was a child, it was the norm. But I kept asking my mom, “What was my hair like when I was little?” I loved it when my hair was washed, and I could walk around with it all kinky. Then one day I started asking, “Why do I straighten it?” At first, I thought it was because of my mom, or because of my friends, or my boyfriend. Then one day I decided to start from zero to see what my hair was like; I would explore this part of me. So, I buzzed it off. As my hair grew back, I realized that I didn’t want chemical products anymore, but also, that there weren’t any products for Afro hair on the market. In other words, we black people were not even taken

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into consideration. There were no products for us, much less natural products or products that represented the Pacific. So, I said to myself, I’m going to launch these products.

Jessica expressed instances and concerns that led her to explore caring for her hair and to associate it to an anti-racist stance. First, she shifted from being passive to active. It was no longer about her hair being burned and straightened by “others,” including her mother. It was no longer about giving in to school rules, where she was teased and excluded because of her hair. It was about identifying the fact that the chemicals damaged her scalp and about questioning the practice of hair straightening—which she described as something normal in the social context for any black woman in certain stages of life. Jessica tries to recuperate her “original” identity by tracing memories of her “childhood” hair and by asking her mother about her “real” hair. From this active position, she asserts herself as a subject that asks questions, raises doubts, and defends opinions and beauty choices. Her decision to start over and re-signify her identity materialized when she removed the guard from the hair clippers and executed the “big chop,” removing all her straightened hair to make way for her natural hair to grow back. It is from this new position that she notices that there are no products for Afro-textured hair and so decides to produce some. As we will see further on, this subjective movement that allows one to question the hair-straightening practice imposed by mothers and society and to embrace the “big chop” that physically creates a distance from the practice, allows Jessica and other activists to imagine and start small businesses that involve beauty products for Afro-­ textured hair. Malle, a 38-year-old woman from Bojayá, Chocó, who had moved to Cali in the 1990s, had a similar experience. An awareness of her hair’s particular care needs and the lack of adequate and specific products on the market led her to start a small business called Bámbara, which produces cosmetics for women’s “natural” black hair. She told us, “At the time I didn’t know of any black movement or organization,” although she later joined one. Her interest in hair was more personal, such as “wanting my hair back the way it was,” than political. She experienced the process of transitioning to “natural” hair by herself, shaving her head at a time when there were no social networks and when women her age and in her social sphere were wearing extensions and straightening their hair. She describes the experience as one of rediscovering her hair and of learning how to care for it, and especially of searching for “the woman she wanted to be, or the woman she wanted to see in the mirror.” Malle focuses her narrative on the subject of hair care and health. She talks about the “damage she did to herself” and expresses the pleasure she has in the abundance and volume of her “natural” hair. She refers to “natural” or original beauty as a kind of “state” to be discovered, but she is also open to the possibility of reinventing herself as a woman by caring for her hair, which becomes a metaphor for femininity. As Moreno Figueroa (2013) points out, beauty, like the condition of being a woman, is not a state, but rather a process that can be invented and produced. Malle’s story also shows how the process of disidentifying from the white beauty standards produces an anti-racist subjectivity that is anchored in the binary and normalizing tension between natural and not natural beauty (Tate, 2007).

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During her transition, Malle nurtured herself with memories and experiences from where she was born, and with how they contrasted with her experience at a university in Cali where women straightened their hair and wore extensions. She told us, “I was forced to look for my own reference as a woman, to build my own beauty reference, you know? It was a difficult time, I think. I was able to forge ahead with my natural hair, to wear it in many different situations, even at work where, surprisingly enough, it was quite admired. And I worked in an exclusive sector of Cali.” In Malle’s case, it is interesting to identify how her countercurrent aesthetic choice qualifies her subsequent participation in university collectives that debated topics related to racism, which she associates to her own experiences of exclusion and marginalization as a rural black woman. It is also important to point out that Malle, along with other friends, began questioning the exclusive leadership of men in these collectives, and how hard it was to include gender issues on their political agenda. This led them to form independent groups of black women where they studied black feminist thought, especially American and Brazilian authors, and where they also formed new leaderships and political participation methods.5 When she returned to Bogotá, Malle could only participate in the group virtually. So she created Entre Chontudas, a social media meeting platform for black women. The discussion on natural hair became very important on this platform, and Malle was able to share her experiences and thoughts. According to her, “The participants began changing on the inside, but they also transformed their bodies. One of these important changes was to let their hair go natural.” This comment shows “the bodily and emotional dimensions of hair care work” (Arango Gaviria, 2018c, p. 133) but also the collaborative work that develops through these platforms where people offer advice, information, and encouragement in order to consolidate a network of ethno-racial solidarity, albeit they do not call it that. In her interview, Malle points out the difficulties involved in taking on the process of subjective recognition alone and therefore the importance of having a support group. This awareness is what drove her to start the Entre Chontudas platform and Bámbara—one to provide online support for black women who decide to wear their hair natural and the other to offer the proper products to care for it. Caring for Afro-textured hair is Malle’s way of simultaneously helping black women and participating in the aesthetic care market. Many of the accounts we heard seemingly described individual experiences and subjective displacements that include dynamics of disidentification, pain and melancholy, and the many emotions that come with rediscovering a possible identity when asserting “natural” black beauty. However, we will see below how these experiences become collective processes that that take on political aspects when joined through social networks, activist sisterhoods, and aesthetic godmother relations.

5  It is also worth mentioning the difficulties faced by afrodescendant women to assert the fact that their particular experience with sexism, which is always connected to racism, merits a different agenda in women’s organizations and in the feminist movement (Viveros Vigoya, 2007).

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The Care Work of the Godmothers: An Anti-Racist Sisterhood Entre Chontudas is part of the collectives associated to AMAFROCOL and many of their activist participate in the annual Tejiendo Esperanzas events. It reclaims beauty not only as a sphere for individual enjoyment and pleasure but also as a collective practice of exchanging experiences that encourages solidarity, support, and empowerment. The political dimension of this project rests on building an affective network between women so that they do not have to “stand alone” in the process of disidentification (Cruz, 2013). The organizational structure of Entre Chotundas includes, for example, so-called madrinas, or godmothers, who accompany women that are transitioning6 to natural hair in practical ways and in affective and solidary terms. This personage is inspired by Colombian Pacific traditions that, in addition to family members produced by matrimonial alliances, also contain godmother and godfather relations that establish ritualistic bonds and create “godchildren” relations between the Ego and its godparents. In our case, the madrinas support their “goddaughters” by giving them advice about the steps they should take and the products they should use in their transition to “natural” hair. Madrinas generally take on women that have the same hair type and texture in order to ensure better closeness, understanding, and empathy. Thus, an aesthetic and subjective change becomes an intersubjective and collective process supported by the social relationships that emerge inside the group. For example, Lina (an accountant, beneficiary of the Martin Luther King scholarship, and cofounder of Bámbara) decided to be madrina to Karina (born in Tumaco and Economy student at the Universidad Nacional). They met when they were part of a mixed Afro-Colombian student organization. Karina decided to let her hair go natural after learning about black feminism and listening to Lina’s stories about AMAFROCOL, Entre Chontudas, and Bámbara. After a year of not straightening her hair, Karina began cutting off the parts that had been chemically treated. Lina accompanied the entire process, showing her how to cut, wash, hydrate, shape, braid, and comb her hair. She answered her questions via WhatsApp and encouraged her to face the anxieties and fears engendered by not straightening her hair. We had the opportunity to talk to both activists during a styling session at the San Antonio guesthouse in Cali. Karina had opted for the big chop just 3 days earlier and told us this was the first time she was out in public with her natural hair. Lina patiently explained how to apply the shaping cream (Chontu, the star product of her small business) and how to tie her coils into little knots that would later be removed to release her natural curls. Meanwhile, Karina told us about how she had given herself permission to go “natural” because she lived in Bogotá. With sadness, anger,

6  Transitioning is the term used in Afro-Colombian groups of women to refer to the time span between the moment a black woman decides to stop straightening her hair and begins wearing any kind of natural hairstyle without chemical or heat treatments to straighten it. It is a term that alludes to both the time span as well as the political act of the decision.

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and some disappointment, she commented that her family did not approve of her decision, and that she could not go back to Tumaco without straightening her hair because she was afraid of being criticized or rejected. This detailed description of Lina’s support is to emphasize that being a godmother is a job, in all its dimensions (Dejours & Molinier, 1994). It is concrete because it provides orientation for cutting, washing, shaping, braiding, and/or styling Afro-textured hair, and it gives the technical and emotional tools to help the goddaughter deal with problems that come up in practice. It is social, in that it means constant coordination between godmother and goddaughter based on shared values and norms. This dyad of care is also connected to a larger network of women who work together and share common bodily experiences. It is also subjective because it means the godmother must know how to emotionally listen and respond to the issues involved in accompanying her goddaughter throughout the process of changing and rebuilding a new public image. With these characteristics in mind, we can say that the caring, upkeep, and growth of Afro-textured hair while transitioning to natural, whether done in hair salons, at home, among friends, or in virtual communities, can be considered care work that corresponds to the physical and emotional well-being needs of Afro women. It is work that primarily seeks to restore the materiality of Afro-textured hair that has been damaged by multiple chemical or heat treatments used to adapt it to the aesthetic norms of straight hair, which is characteristic of the dominant social groups within a socio-racial pigmentocratic order (Telles, 2014). However, it is also work that seeks to repair the self-esteem of Afro women and to strengthen solidarity among them. The well-being that care work seeks to provide must always be situated in historical and social terms (Arango Gaviria, 2018a). While aesthetic services for Afro-­ textured hair address important issues like restoring the dignity and self-esteem of Afro women and eroding the hierarchies between good hair and bad hair, we cannot ignore the fact that they also reproduce, accentuate, or cause socioeconomic, ethno-­ racial, gender, sexuality, and other inequalities (Arango Gaviria, 2018a, p. 14). At the same time, we must keep in mind that the different meanings of hair vary depending on the intersections of race, class, and gender that shape the experiences of women in their social circles. Understanding that aesthetic norms condition the social values of appearance, and consequently the special privilege that separates and hierarchizes people according to their physical characteristics, allows us to better grasp what is at stake in caring for appearance. It plays an important part in the opportunities that open or close for certain positions in the labor market, in social and public life, and even in erotic-affective exchanges (Cruz, 2013). Caring for women’s hair is not an anodyne activity. In fact, while it contributes to preserving the social status of women in dominant groups, it can also allow women in dominated groups to achieve social respectability. Likewise, it can adapt the appearance of working women to the requirements of the labor market or help them express their individuality. It allows them to either affirm or transgress the norms of gender, age, race, and sexuality.

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Being straightened, brushed, or combed is a symbol of adhering to modernity of incorporating the aesthetic values and models associated to social ascent and to being part of the labor market (Arango Gaviria, 2018c; Villarreal Benítez, 2017). The prescriptive and imposing aspects of Eurocentric aesthetics in determining upward social mobility cannot be ignored. It is the reason Karina showed a certain ambiguity between pride and anxiety when “going natural.” However, the care work performed by Lina and the entire organization to provide support and a collective reference point served to ease the uncertainty and anxiety generated by processes of bodily disidentification.

 esthetic Care Work in Virtual Natural Hair Communities: A A Subaltern Public Sphere? In contrast to what happened in the United States at the end of the 1970s when Afro hair became a symbol of the political struggle against oppression and black pride and beauty, Colombia’s ideology of miscegenation that prevailed until the 1990s diffused this type of initiative. Even though Afro hair styles could be seen in different scenarios such as the arts, modelling, beauty trends, intellectualism, and activism in the 1970s, particularly toward the end of the decade, as shown by magazines like Cromos (Pisano, 2019), they were individual choices that corresponded to different demands associating the style with identity discourses that were disconnected from anti-racist agendas, which were not widely known or accepted in the Colombian context of the time. Furthermore, Afro hair was not used as a political stance by the groups that led the fight against racism at the time, who did not see individual and personal aspects of appearance as part of the public domain of politics and law (Wade, 2010). Only in the last decade has American and Brazilian black feminism begun spreading political reflections on using natural curly hair (Figueiredo, 2002; hooks, 2005; Pinho, 2002) as a form of resistance against imposed and reiterated beauty ideals. Although young women claiming a black identity in Colombia today are treading the same path African American women forged in the 1970s, they do so in a much different social and political context. Today, social networks have a predominant position as tools that allow sending emotional and direct messages without the intermediation of journalists, and feminism has reached a respectable degree of institutionalization. Furthermore, they can create their own space that is independent from men and white and mixed-race people. In this new sociocultural environment, the social movements created in virtual spaces are designed as collective attempts for changing hair care practices and their meanings. The virtual natural hair communities formed by young women in Colombia emerged at the end of 2013 and gave birth to projects like Pelo Bueno, AfroPower, or Entre Chontudas. Their primary goal has been to encourage Afro-descendant women to stop straightening their hair and learn about the characteristics of natural

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curly hair, how to care for it using special treatments, and how to adopt hairstyles that suit it. These networks perform care work by exchanging knowledge and information about hair routines, providing tutorials and advice on caring for natural hair that are geared toward positively re-signifying Afro-textured hair, changing how Afro women see themselves, and awakening an identity awareness that challenges predominant beauty standards and the criteria that determines what is good hair and what is bad hair. In spite of their differences, these networks share in their conviction to use aesthetics in these public spaces to “bother” people, to do political activism focused on social, racial, and gender issues (see http://cartelurbano.com/causas/ ellas-ya-tienen-corona). These virtual communities are being used by women like Malle Beleño to fight racism with a gender perspective, where they can share reflections, proposals, and discourses that accompany their aesthetic and political resignification and stories with chonto or chontudo hair, which are derogatory words used to describe “kinky” hair. On their Facebook page, the Entre Chontudas describe themselves as a study group and support network where they can share “the little tricks we use to style our hair with products found on the Colombian market, preferably the most natural and least expensive. We also teach each other how to use the different accessories we can wear in our hair. This, in addition to all the analyses, creates a space where we can claim our ancestral beauty.7” Villarreal Benítez (2017) points out an important aspect in these proposals: the fact that many virtual communities have become brands in the symbolic and economic market. Several of the women that lead them sell products and have business plans focused on the subject of hair and their messages and how they transmit personal experiences are not what one expects from social movements, but rather from the guidebooks of market strategies. These bloggers are seeking not only to build a good reputation online to gain trust and followers but also to obtain economic revenue. Here we can also see how Entre Chontudas is careful to not become a publicity platform for other pages or groups that do not share lessons that “reaffirm black aesthetics,” and states its objective of promoting products that are within the geographical and economic reach of the women who interact on the network, and that use as little damaging chemicals as possible. Entre Chontudas is also a support network focused on the political dimension of black aesthetics and of the emotional care work and preparation required for the women who want to support the transition to natural hair. Social networks like Facebook have allowed these women to meet in virtual spaces that are not always watched or controlled by men or non-white people. Additionally, they allow collective identities to generate commitments, rights, demands for immediate answers, and duties toward the virtual community. In fact, Entre Chontudas establishes strict mechanisms for verifying the identity of anyone who participates on its digital platform in order to ensure that the debates, care, and emotional work are directed and managed by black women members only.

 see: https://www.facebook.com/groups/Chontudas/

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From the intimacy of their homes, from different modes of transportation, or from work, black women (primarily urban) can use their mobile phones and social networks for new kinds of social interactions, like the godmother activities or accessing anti-sexist and anti-racist empowerment discourses. The movements and groups that are joined by social networks on the subject of transitioning to “natural” hair and of promoting different Afro-diasporic and African-inspired hairstyles as alternatives to straight hair have many followers (Entre Chontudas has over 6000) and have had an important effect on reducing prejudice against afro hair. These networks enable the bloggers to propose new ways of wearing Afro-textured hair and attribute political meaning to “natural hair” that makes it an anti-racist aesthetic stance. Now, while the hair advice shared on these networks generates unity because there are common interests about appearance, it is important to consider that the group of women that consult them are highly heterogeneous and that black beauty can be interpreted in many different ways and according to different discourses on what is black, which often coexist in the stories of the women we interviewed. Therefore, the beauty of Afro hair can be defined as the bond with African ancestry and aesthetic African cultures, or even as an expression of a traditional cultural identity with African roots, but connected by global phenomena related to Afro-­ diasporic youth culture and music such as rap, hip-hop, and new ways to express “Black is Beautiful” (Arango Gaviria, 2011, p. 38). Or it can be defined as a modern feminine look tied to the rise of black middle classes (Figueiredo, 2002; Pinho, 2002; Viveros Vigoya, 2015). Today, it is easier for black women to publicly assert their power and freedom to consume beauty products and techniques that diversify Afro-textured hair and disrupt the idea of a single black identity (Viveros Vigoya, 2015). Thus, black beauty can be defined as an appearance that transgresses and challenges the current norms of respectability in the middle classes, or as a softened ethnic identity that does not deny its origins, like adopting a wavy hairstyle (Arango Gaviria, 2018b, p.  179; Cruz, 2013). At the same time, once hairstyles are politicized, it is inevitable that they generate debates and separate black women into different sides, depending the scope of their political commitment. On the one side are those who can be understood as activists who resist social stigma by wearing their Afro hair naturally, and on the other side, those who straighten their hair and are seen as alienated for going against their physical traits (Craig, 2006; Villarreal Benítez, 2017). Even though AMAFROCOL and its partners say they do not judge black women who straighten their hair, in practice the community participants think differently. While some understand these are places for female complicity (hooks, 2005) where women can meet to collectively challenge beauty standards, others say the messages shared there by some of the movements are merely new ways of exerting power to coerce women (Villarreal Benítez, 2017). For example, it is commonly agreed that at some point in their lives, women who identify as black believed, or still believe, that to access femininity and everything that it implies (marriage, children, beauty, sensuality, and recognition) means they

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must straighten their hair. The women who chose to go “natural” take on new aesthetic practices that assimilate different ways of belonging in society, consequently some of them judge those who keep straightening their hair as women with low self-esteem and lost in terms of identity. Different studies, such as those conducted by Cruz (2013) and Villarreal Benítez (2017), raise the importance of taking a more complex approach to the hair-straightening phenomenon. Their investigations show that many women see it as a form of survival and adaptation, a way of being assimilated as women in a context where they are denied access to the benefits of femininity. The requirement to straighten hair says more about the racialized way in which femininity has been established in Colombia than about the desire, expectations, and racialized expressions of those who do it.

Final Thoughts As we have shown in this chapter, there are different scenarios that can serve as backdrops for black women developing the physical, emotional, and symbolic care work involved in styling, maintaining, and growing Afro-textured hair, both during the transition and in its natural state. They can include the women’s homes where they meet with friends to mutually exchange this type of aesthetic attention, or hair salons like Makeda, the place where we conducted the interviews that enabled these reflections. But they can also be associations like AMAFROCOL that seek to empower black women through education, community work, and support networks and by tending to their emotional and physical well-being needs that include caring for their type of hair that has been stigmatized as bad and ugly. Nowadays, this type of work is often developed within virtual communities like Entre Chontudas, which are led by young Afro women that are politically committed to anti-racist and gender struggles. In Colombia, these communities are particularly relevant because they represent the first opportunity to use the advantages of virtual space to give a positive meaning to black aesthetics and to give a political perspective to hair as a symbol of memory, strength, power, and resistance. Each of these scenarios seeks to, first, repair the physical aspects of Afro-textured hair that have been damaged by invasive treatments, and second, to provide emotional and symbolic reparations for the suffering and pain provoked by the cultural violence that treats Afro hair as ugly. However, this care work can also operate at the microphysical level of power to erode racist stereotypes, to assert other aesthetics that demand being valued and respected in Colombian public spaces, and to help black women be independent of beauty standards and their related services. Nevertheless, despite the explicitly political and anti-racist nature of some of these proposals, several questions remain unanswered: To what point is the aesthetic value produced by black women accumulated and kept in cities, in digital activism spaces, and in student feminist niches, and not redistributed to women living in low-­ income sectors or rural areas? To what point do these young, urban women’s

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subjective empowerment processes concern women who do not have the chance of using these social networks or products? We have been able to verify that there is an aesthetic market that provides African-style clothing, accessories, and jewelry that allows its consumers to incorporate an Afro-descendant identity that many are just now starting to explore. It also provides lines of care that are adapted to the specific needs of each kind of curly hair texture. However, the cost and the time required for this type of care dissuades many women, who decide to go back to straightening their hair because, in the end, it is cheaper and more efficient, or better suited to their lifestyles. It is worth asking how the added value acquired from these virtual communities is returned to cooperatives and raw material producers, when young women like Karina says it is easier to exhibit her “natural” hair in a city environment than where she grew up, where she would be the object of scorn. On the other hand, we can question whether the importance of the economic factor in the Colombian movement detracts from these processes of re-signifying and claiming natural hair. Although the answer must be contextual according to each case, we agree with Cintia Tamara Pinto da Cruz (2013) when she says the process of expanding these initiatives into profit-seeking businesses is also something that cultivates, reinforces, and reproduces the shared experiences of Afro-descendant women getting it touch with their self-esteem as women. We would add that the new aesthetic practices for Afro-textured hair are expanding the repertoire of what it means to be feminine in Colombia and are weakening the socially constructed contradictions between being feminine and having curly hair. It is equally important to question the scope of what black beauty projects can offer to existing gender and class orders, and how they might be producing new internal hierarchies and differences within Afro communities based on their aesthetic consumption. Here we can provide a preliminary answer. It is very likely that the scope is limited and that the personal satisfaction obtained from these collective and individual processes hides the persistently asymmetrical social relations between sex and race, even within the group of women that wear their hair “natural.” There is no doubt that the digital activism surrounding Afro hair has contributed to increasing the number of Afro-descendant women in advertisements where their hair and faces are symbols of beauty, all of which is new in Colombia. They have won the right to assert the individuality and uniqueness they had been denied for being members of a dominated group. Finally, it is very important to note that the visibility of “natural” hair care has removed black women from the position typically reserved for them as a group of care providers focused on the well-being of other social groups and who cannot be beneficiaries of care actions, gestures, and intentions. Now some of them can collectively enjoy and “consume” some of the privileges of social care. Furthermore, the dynamics involved in Afro hair care are collective acts that are not always economic transactions. The experiences do not end with the act itself but are prolonged through knowledge exchanges and by creating emotional ties and spaces for political and affective empathy. They are care practices that can be thought of as

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experiences that associate the well-being of black women to the quality of their social relationships. Acknowledgment  This chapter was translated from its original Spanish version to English by Jill Haring.

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Chapter 8

The Circuits of Care: Reflections from the Brazilian Case Nadya Araujo Guimarães

Introduction Care is a rich domain that can be used to analyze labor commodification processes. It is about commercializing a service provided in intimate spheres, which frequently involves manipulating the body of the other. Understanding care allows us to expand the concept of work and will certainly lead to analytical gains for sociological traditions. The paid work of giving intimate attention by way of home care, for example, calls into question certain long-standing beliefs about the boundaries between the public and the private (Okin, 1991). It especially challenges restricting the dwelling place to the sphere of private, intimate, familial, sentimental, and noncommercial relations. After all, today, our households have become one more locus for establishing monetary arrangements and multiple forms of hiring through specific employment regimes. Studies have long shown that the multiple forms of the social relations of care are based on a quasi-universal fact: the agents are primarily female. The “ladies of the house” and the “house help” are the ones who enable this social relation, irrespective of the various beneficiaries that depend on them (the elderly, the infirm, the disabled, children, etc.). Thus, the strategies used by caregivers to legitimize their work are a target of high analytical interest. What draws attention is their struggle for differentiation and their efforts to create new and alternative names for their activities in an effort to distinguish themselves from other stigmatized forms of female work. Such is the case in Brazil, where there is a tense (and very fine) line between home care workers (cuidadoras) and domestic help (domésticas). Additionally, caregivers resist the (de)classification strategies of other female workers whose care activities have already been socially recognized as professions, such as nurses and their professional subordinates. In fact, the nursing profession long N. Araujo Guimarães (*) Department of Sociology, University of São Paulo, São Paulo, Brazil e-mail: [email protected] © Springer Nature Switzerland AG 2021 N. Araujo Guimarães, H. Hirata (eds.), Care and Care Workers, Latin American Societies, https://doi.org/10.1007/978-3-030-51693-2_8

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ago attained occupational closure, ensuring that only nurses and trained helpers are considered “care” agents. Hence, verbs such as “classify” and “dispute” are crucial when trying to break into the material and symbolic practices established by actors that already recognize themselves as professional care workers. However, in societies marked by profound social inequalities like Brazil, the plurality of the forms and social relations found within care work is broader than the plurality found in contemporary studies on the so-called “care professions.” In the three main sessions of the chapter, I will try to explore this spectrum and expand its scope to include the different ways of defining the same concrete activity: “profession,” “obligation,” and “help.” I aim to show that varying the way in which a (same) concrete activity is defined not only alters those that are socially recognized as their agents, but (more interestingly) also creates (or not) the conditions for such agents to identify the activity they perform as part of a circuit of care, whether or not they call it “work” or “care.” Thus, differentiating the social relations (commercial or non-commercial) that support the exercise of this activity, and establishing boundaries and hierarchies between these and other similarly concrete activities, varies the forms of retribution for work performed and the means of retribution (that may or may not be monetary): Thus, besides presenting the configurations under which care is described as a “profession,” I will address a circuit where the activities, although self- and hetero-­ recognized as “care,” are not characterized as “work,” but as the fulfillment of an “obligation.” In this case, “love” and “family responsibility” are the definitions that give meaning to work and structure the social recognition and subjective identity of those who do it. Understood in this way, such activities do not receive monetary remuneration. Hence, the women who are the main agents in this circuit of care are commonly recognized as “housewives” or “mothers” rather than as “caregivers.” Subsequently, I will address a third circuit where the activities are also unrecognized as “work.” However, different from the latter, the agents do not identify themselves as fulfilling any “care obligation,” but rather as providing “help.” These different forms of help are supported (and reproduced) within social relations and are based on group or community reciprocity. The configuration of this circuit does not require establishing monetary relations. Money may never circulate here as a form of retribution, although when it does (rarely in a fixed manner), it is always welcomed, given the social privation experienced by both the providers and the beneficiaries of this type of care. This provides a glimpse into another relevant dimension: inequalities, especially class inequalities, inform both the chances of opting for professional care (circuit 1) and the way circuits 1 and 2 (care as obligation) work together and intermix. But above all, we see the power of circuit 3 (care as help) in promoting care alternatives (under different and new types of activities) for people in situations of extreme poverty and scarce (or ineffective) social protection policies. In order to understand the modalities of care work, I will focus on the Brazilian case. Brazil’s profound social inequality allows us to clearly grasp the many configurations found in these circuits. I adopted two criteria for selecting such modalities. First is their relevance to the socio-economic configuration of care in Brazil, as indi-

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cated in recent fieldwork findings and in related secondary literature.1 Second is how each of these modalities was defined natively and analytically: whether as care, as work, or as a profession. This allowed me to isolate the three mains circuits in order to explore the heterogeneity and complexity of the social organization of care in Brazil. The first conceptual tool I use is the notion of circuits. Like Zelizer (2004, 2005, 2006) when she conceptualized “circuits of commerce,” I understand that “circuits of care” must be based on the different forms of relational work involved in exercising care. In this sense, I would say that the process of commodifying a service— which happens so quickly in care work—can be thought of, like any other economic action, as a movement where individuals engage in permanent relational work. Furthermore, this understanding of relational work is far from being a vague allusion to the idea that “everything is relational” in social life. In the precise definition given by Zelizer (2012), relational work corresponds to the permanent effort to differentiate meaningful social relationships. In other words, individuals try to create barriers and outline boundaries that become visible when they name and classify activities (theirs or others) and when new practices are established. I argue that a circuit of care is the product of a kind of relational work that involves efforts to differentiate meaningful social relations. Thus it is defined by the confluence of: 1. certain modalities of social relations of care, 2. characterized by certain meanings attributed to them, 3. which correspond to certain economic transactions, 4. and certain ways of payment (including types of currency, when payment is monetary). I believe that the notion of circuits of care helps us sharpen analytical tools and grasp the nuances of building social relations within the work domain. These nuances, which I exemplify next using the Brazilian case, are found at the intersections of four analytical dimensions: the meanings attributed to the work, the actors considered able to do the work, the types of social relations (commodified or non-­commodified), and the forms of retribution (monetary or not). Since meanings are analytical starting points, I organized the following sections around the three configurations of meaning: care as a “profession,” care as an “obligation,” and care as “help.”

Care as a Profession Reflecting on professional care work in light of the Brazilian case requires having at least two key points in mind. First, although care is a long-established social activity, professional work has been only recently implemented in Brazilian social 1  The wealth of the data and Brazilian literature used here was only possible because of my participation in a group that prepared a balance sheet to show the reality of care in Brazil (Guimarães, Hirata, & Posthuma, 2020), to whom I am most grateful.

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life. Therefore, identifying the how and why of the hiatus between the longevity of an activity and the novelty of the social existence of the agent that performs it is an analytical challenge. Here it is worth making some clarifications. The notion of profession used henceforth to refer to care professionals is in line with the concept coined by Hughes (1994), where the term “professional” is understood as a category that gets its meaning from day-to-day life, from given definitions, and from values and judgements formulated by the actors themselves. In Brazil, home care workers (cuidadoras) had little chance of being considered professionals in the strict sense defined by American sociology (Freidson, 1994). Not only they did not have university credentials or formal recognition but also they lack what Freidson called “theoretically based discretionary specialization” (as opposed to “craft”). According to mainstream sociology, their occupation lacked regulations and was unable to achieve professional closure (Parkin, 1979), unlike, for example, nursing. However, because home care workers see themselves as professionals, they demand (Brazilian-style, from the State, Coelho, 2003) a license to exercise what they understand as their professional work. Thus, once they have a legitimate mandate to care for dependent individuals, they want to differentiate themselves from other workers like domestic employees (domésticas), since current regulations (at least in the case of home caregivers) see them as the same. In line with the perspective of the French sociology of professions, their subjective connection with the work fosters an “identity form” (Dubar, 1991) that supports their self-identification as professionals and defines their actions as bearers of a knowledge they consider socially useful. But there is a second key element when analyzing care in the Brazilian case. It would be impossible to understand the reality of paid care work without considering how it is part of a plurality of care approaches that mostly go unrecognized as “work” and/or unrecognized as “care.” This opens the door to a fertile field where relevant questions about (in)visibility and (self)recognition emerge, which leads us to the subject of measurement. Who are the Brazilian care professionals? How many are there? Where and how do they work?

A Long-Standing Activity in a Recent Profession Less than 15  years ago, in 2002, a new Brazilian Classification of Occupations (CBO—Classificação Brasileira de Ocupações) was published officially listing “professional caregivers.” This was the first time that the nature and content of their work was defined. Thus, the occupational family group defined as “caregivers for children, young people, adults, and the elderly” (Ministério do Trabalho e Emprego [MTE], 2018) was described as being composed by individuals that care for babies, children, young people, adults, and the elderly according to objectives established by specialized institutions or people directly responsible and that watch over the well-being, health, food, personal hygiene, education, culture, recreation, and leisure of the person being assisted (MTE, 2018).

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The broad spectrum of “care” is immediately visible.2 The CBO states that their work is exercised in homes or care institutions for children, young people, adults, and the elderly. The activities are exercised under some form of supervision, as independent or salaried workers. The work hours vary: full-time, rotation shifts, or predetermined periods. Caregivers working with individuals suffering from behavioral alterations are subject to dealing with situations of aggression (MTE, 2018).3

Once again, we notice the breadth (and consequent lack of definition) that characterizes the conditions of care work, in terms of not only location but also work hours and types of contracts. Including the caregiver occupation on the CBO list meant it was recognized by the (now defunct) Ministry of Labor and Employment. However, it was not enough for the State to regulate it as a professional activity. In fact, Brazil does not provide any employment guarantees or worker rights related to the exercise of professional care work, despite years of caregiver mobilizations.4 The main goal of these mobilizations was to ask the State to control the forms of exercising professional care work, enable it with rights, and create protection rules that would remove caregivers (especially those working in homes) from the common pool of remunerated domestic employment, from whence most of them came. Their insistence in advocating for a caregiver identity, a term (cuidadora) that has only recently entered the Portuguese language in Brazil (see Guimarães, 2016), shows the importance of their claim, as well as the social relevance of the activity itself in being officially recognized as a new occupation by the revised national classification. Attempts to regulate the caregiver profession faced strong opposition from health profession representatives, especially nursing5 and was intensely criticized by the

2  Nevertheless, the Brazilian Classification of Occupations (CBO) was careful not to confuse caregivers with other occupations it considered related but different. For example, the occupations of “nanny” and “foster mother” are listed separately in the CBO in order to make their differences clear. 3  The passage ends with a significant affirmation: this [occupational] group does not include 3222—nurse technicians and aides. This denotes that nurses achieved a professional closure that kept even the least qualified occupations within the nursing field. Additionally, the nursing profession is responsible for regulating access, training, credentials, and remuneration for nurse technicians and aides. Needless to say, the struggle of caregivers in Brazil to achieve professional labor regulations has faced strong resistance from associations and councils that represent the field of nursing. After all, nurses gained legitimacy when they carved out their professional niche as those who “give care,” thus distinguishing themselves from doctors who “cure.” How to accept, then, professionals that “give care” but who remain outside the field of nursing? 4  Indeed, President Jair Bolsonaro vetoed, on July 8, 2019, a proposal (PLC 11/2016)—the first attempt to regulate skill requirements and working conditions for the exercise of the profession (called “Caregiver for the Elderly, Children, and People with Disabilities and Rare Diseases”) that had already been approved by the Brazilian Congress. Mr. Bolsonaro considered it unconstitutional, stating it restricted free professional practice. 5  For a more detailed discussion, see Debert and Oliveira (2015).

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press, which helped discredit their petition and demoralized them in public opinions (Guimarães, 2016), thus paving the way for the Presidential veto. However, it is ironic that the domestic worker profession managed to be regulated through Constitutional Amendment 72, of April 2, 2013.6 Henceforth, minimum worker rights were guaranteed to at least those home caregivers that wanted (or were able) to be formally registered as “home workers.” Among the rights acquired as the result of their (paradoxical) incorporation into the world of domestic work were: work hours limits, a minimum wage, overtime pay for working nights, retirement, and unemployment insurance. Thus, in Brazil, we can see there are different levels that constitute the progressive institutional recognition of care activities as professional work. There is the level of statistics and sociodemographic registries, which is separate from the level of worker rights regulations, which in turn is different from the formal recognition of a profession. But there is a fourth level that is especially interesting—that of language. Assuming that the trajectory and the intense use of certain words signal what is going on in the social conscience, tracking the progression of creating categories and names can help us gauge the presence and social topography of remunerated care work and allows us a glimpse into the strategies used to self-identify, recognize, and be recognized. Guimarães (2016), for example, used word counting to track the trajectory of how the words “caregiver” and “caregivers” were used by a large Brazilian press agency since the nineteenth century. By tracking this information, the author documented that while the activity of care in Brazil is long-standing, the rise of a term to name the professional work of care has been very recent. Seemingly only in the last decade has the term been consolidated in Brazil’s social conscience, as seen by its recurrent use in the press. A new type of specialized work had emerged, bringing with it a need to name those who exercised it—the “caregiver” (cuidadora). Of the 1,080 references recorded by Guimarães (2016) between 1875 and 2014, almost all (92%) were found in the last two decades; and no less than two-thirds of them were found between 2010 and 2014. Therefore, we can say that these two words only became widely used in the 2000s. However, when the author conducted the same type of exercise with the word “care” she identified a completely different trajectory: 102,876 references were found between 1875 and 2014—100 times more than “caregiver(s).” The word has been in use for almost as long as the source used to track it. Since the middle of the last century, the word “care” was already recurrent in daily Brazilian life, suggesting that such activity had been perfectly legitimized in press narratives and in society since the 1950s. The material basis for this new symbolic expression was found in the movement to commodify care in Brazil, which is only one of the facets of the intense occupa-

6  That Constitutional Amendment Proposal (PEC) was referred to in Brazil as “the domestics’ PEC” because of the long fight waged by domestic workers to achieve it. The underlying belittlement contained in this term cannot be ignored, since the amendment includes all types of work in homes, not just “the domestics.”

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tional engagement women were involved in. In fact, women entering the labor market almost quadrupled over the last 50 years in Brazil. This movement, as documented by Guimarães, Brito, and Barone (2019), grew much faster in Brazil than in capitalist countries that experienced development first (like France and Germany) or that experienced industrialization later (like Argentina or Mexico). This trend was also due to a remarkable drop in fecundity during that period, meaning women had less children, the second structural marker. There were, however, more dependent elderly people to be taken care of, as pointed out by Guimarães, Hirata, and Sugita (2011), which is the third important element that configures the empirical scenario. Over the next decades, this increase will put Brazil on the same level as France as an “aged society.” Throughout the course of these changes, the provision of care diversified. On the one hand, the professional, remunerated, and public work of the caregiver emerged. On the other, this emerging circuit interacted with the previous dominating way that was (and still is) exercised in the private sector and in homes where women, whether housewives or domestics, felt responsible for the well-being of dependent people, especially children, the elderly, and the disabled.

 hat Institutionally Counts as Work for Professional Caregivers W in Brazil As we have seen, recent institutional recognition in Brazil by way of producing statistics did not imply legal recognition that ensured labor protection rights for professional caregivers. Furthermore, the many manifestations of this type of work affect measuring both the workers and their working conditions. Taking the category of “care worker” as measured by the Brazilian Classification of Occupations, we can say that it is formed by a triad of profiles, which, according to the last census (2010), encompasses 95% of those occupied in the segment: caregivers for children (58% of those occupied in care service), caregivers in institutions (24%), and caregivers in homes (14%). The information in Table 8.1 shows, nonetheless, that care workers made up only one-fourth of domestic workers. It is worth noting that in 2010, the five million domestic workers (or as defined in the census, “general domestic service workers”) formed the largest remunerated care provider group in Brazil and yet were made statistically invisible by the classification system as caregivers. A quick reference to these numbers immediately highlights how care is commodified in Brazil. Professional care work, in addition to being recently recognized by society, is immersed within a much broader set of different types of paid domestic work. In other words, when the term domestic caregiver appeared on the scene 20 years ago, other women had already been doing paid care work in homes under the guise of domestics (domésticas). They worked a variety of jobs such as cooks, washerwomen, ironing women, nannies, cleaners, etc. Each cared for one aspect of the daily lives of upper- and middle-class families. However, although these domes-

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Table 8.1  Brazil 2010: Who does the census include in care work? Categories Infant care service directors Elderly care service directors Private companions and helpers Child caregivers Personal care workers in institutions Personal care workers in households Personal care workers in health services not previously classified Care workers (cf. Census definition) Workers in domestic service

Frequency 6,518 657 1,455 741,745 307,047 174,979 45,158 1,277,559 4,949,965

Source: IBGE. 2010 Demographic Census (IBGE, 2012)

tic workers in effect provided care, they were neither seen nor counted, and did not feel like caregivers. This disconnection between the concrete activity (of care) and the professional recognition they deserve (as domestics), not only pervades and organizes their place in official statistics and everyday interactions (including with those who can call themselves caregivers) but also shapes the very way they represent the meaning of their work to themselves. Thus, as domestics (domésticas) they were not recognized as caregivers (cuidadoras). In addition to being excluded from the category by official statistics, there was an identity dispute at play. Becoming a caregiver (cuidadora) in a context without formal recognition, or in other words, without access (boundary) rules, or rules to control performance or allocate rights, means that the category’s strength and meaning (with Hughes, 1994) emanates from daily life, from given meanings, and from value judgments formulated (and enacted) by the actors themselves. Thus, the women who led this identity reconversion movement used the overlooked qualifications they had gained from domestic work, whether paid (as domestics) or unpaid (as housewives), to recreate themselves as caregivers (cuidadoras). After all, care was paradoxically what they had done their entire lives (as we hear repeatedly in field work). However, and herein lies the paradox, they used the new name to create a new image for their work, transforming their overlooked knowledge into systematized professional knowledge somehow legitimized (through more or less quick training) in order to distance themselves from the stigma of domestics (domésticas). This leads to another step in understanding how the circuit of care as a profession is configured in Brazil. It requires not only recognizing the central role of both caregivers (cuidadoras) and domestics (domésticas)7 but also exploring the fluidity of the boundary that differentiates these two configurations in professional home care

7  It is interesting to observe that official statistics include only “nannies” (babás) in the care worker category, even though neither those who hire them nor they themselves define their position as “caregiver,” but rather continue using the term “nanny.” Not even the expansion of daycare centers and preschools, and the subsequent re-division of child care work was able to remove the image of nanny and the inferiority it carries in wage hierarchies and in professional responsibilities from daily institutional scenarios (Moreno, 2019).

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work. This is evident when comparing their profiles in light of the last Demographic Census data gathered in Brazil in 2010, which is demonstrated in detail by Guimarães and Hirata (2016) in the data that follows. Similar to other countries that have been compared to Brazil (Guimarães et al., 2011), an initial characteristic stands out in home care work: it is a task undertaken almost exclusively by women. This is also true for paid domestic work. In each group, women make up no less than 94%. However, in the Brazilian case these workers are predominantly black or mixed-race, forming at least two-thirds of each group in 2010. This differentiates them from the average, where blacks did not make up even half (46%) of those employed in 2010. Once again, these women describe Brazil’s reality where racial differences coexist with common national origins. In other countries (see Guimarães et al., 2011), although care work is a female niche, it is occupied by foreign women and/or descendants of foreigners. This is not the case in Brazil. Yet it is significant that white women are proportionally better represented among caregivers occupied in institutions as opposed to in homes and that they are also the ones who have positions of authority in care services (in whatever type of institution). This suggests a prevalent commonality in Brazil between a caregiver’s race and her place in job hierarchies (if in a position of authority) or of prestige (if working outside the home). Domestics and caregivers have similarly low levels of education. Half of the home caregivers had not finished primary school in 2010. Among Brazilian domestics, this characteristic is even stronger: 63% of them either had never gone to school or had dropped out of primary school without ever finishing. Only caregivers in institutions had better formal education, which underscores the difference between caregivers working in homes and caregivers working outside homes. This difference increases when looking at only those who work in homes as caregivers or domestics.8 Furthermore, the lack of professional regulations exposes these workers to all sorts of work relations and conditions. This is evident when observing how many of them are covered by formal protection. According to the 2010 census, only 27% of Brazilian caregivers had access to labor rights, which are necessarily enjoyed by those who have formal contracts. This lack of protection is one more aspect where they were similar to domestic workers at the time, seeing as only 34% of them had formal contracts.9 In terms of remuneration conditions, Brazilian caregivers, especially those dedicated to home care, are almost as poorly paid as domestics. Slightly over half of them earned at most a minimum salary in 2010; this proportion was higher among 8  Furthermore, these low levels of schooling present a challenge to incrementing professional qualifications for this group. As we stated elsewhere (Guimarães et al., 2011), professional education requirements also differentiate Brazilian caregivers from those in other countries like France and Japan. 9  However, it should be noted that since Constitutional Amendment 72 of 2013, was enacted to regulate the rights of those working in homes, both caregivers and domestics experienced a process of formalization, which was recently affected by the post-2015 crisis.

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the domestics at just over 70%. This starkly contrasts with average occupied ­workers in Brazil, of which only 30% had such low wages. Additionally, low pay was combined with workload that was heavier for caregivers than for domestics: half of the caregivers worked over 40 h a week, compared to less than a third of the domestics. In summary, the observed indicators reiterate the convergence between the two main characters of care work in Brazil: the domestics (domésticas) and the emerging group of caregivers (cuidadoras), especially home caregivers. The common ground between these two actors is expressed in important individual attributes (like sex, race, schooling) and the characteristics of their employment and working conditions (hours, salary, type of contract). This overlap identifies two apparently contradictory movements. On the one side is the need to differentiate (and thus give a unique name—cuidadoras) this new type of work, even if it is only a new way of conducting the old, well-known activity of care (at home) that is now commodified, public, and disassociated from family roles and obligations, or from the roles of servitude that domestic workers had been submitted to. Yet, on the other side, the important movement of home care workers (cuidadoras) towards symbolic differentiation occurs in a labor market that is structurally marked (and equally long-standing) by the massive presence of paid women workers in homes to supply the needs and well-being of families. These domestics (domésticas) were relegated to a kind of work, albeit paid, that deprived them of the same rights given to other salaried workers until 2013 and placed them in a social position that disqualified them from being salaried. The conditions in which they worked (unlimited work hours, no employer obligation to pay a minimum wage, being subject to harassment and humiliation, as well as to being fired for no reason and without compensations) was a modern version of the servitude experienced by most of their black and mixed-race ancestors. Most importantly, it was care—for employers, children, and homes—that defined these workers’ job descriptions. It was, however, a kind of care that never qualified them as caregivers. For this reason, others claimed this new name, arguing that it defined a new form of work that was specialized and different from what domestic workers (empregadas domésticas) did. This complex amalgam of movements (symbolic, economic, political) combines the desire for autonomous recognition on the one hand, and the reality of the market and work conditions on the other, thus creating fluid boundaries that affect the workers involved in providing professional care in Brazil. This leads us to conclude that, in order to understand the circuit of professional care work in Brazil, we would need to consider not only the configuration of health care workers as nurses and nursing assistants but also the field of home care. Indeed, familism is a central feature in Brazilian social protection institutions and in Brazil’s collective conscience. Even the 1988 (post-dictatorship) Constitution establishes the family as the expected space where children, elders, and persons with special needs shall be cared for (Alcântara, Camarano, & Giacomin, 2016; Debert, Guimarães, & Hirata, 2020). This explains the reduced importance of long-term care facilities (especially public ones) as well as institutional care work in Brazil and consequently the high relevance of home caregivers (cuidadoras). Nevertheless, there is a third configuration inside this professional care circuit that is even more relevant in numerical terms: the domestic workers (domésticas). Their activities are

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also important in terms of caring for beneficiaries and/or their surroundings. However, a symbolic barrier does not give them the title of caregiver. From a social point of view, it is as if what they do is not exactly an act (or work) of care. Not without reason, government statistics recognize the economic value of this type of work (as part of the economically active population) and are aware of its commodified nature, even if exercised within the privacy of the home. Yet they place it in a category entitled “domestic work” not “care occupation.”

Care as an Obligation In order to understand how activities that are both social and institutionally recognized as occupations of care are structured and how they indicate the emergence of professional home care work in Brazil, it is useful to situate them in a context of another circuit of care that is also exercised in the day-to-day lives of families. This second circuit is about unpaid care work in the home, where acts of care are not socially recognized (and thus not institutionally codified) as occupations of care. Although care activities exist, the work is obscured and embedded in other notions such as “love” and “responsibility.” It materializes in a series of social obligations and behavioral expectations associated to gender and generational hierarchical relations inside the family group. Therefore, although these forms are socially recognized as ways of providing care to beneficiaries, official statistics do not classify them as economically relevant activities; their nonmonetary characteristics prevent recognizing any direct link to the market. Thus, the people who perform these activities are not included in the economically active population. This type of care has long been an object of interest in the field of gender and labor studies, which has highlighted both its notable economic, social, and symbolic invisibility (or maybe better said, invisibilization) and its unequal divisions according to sex, age, and racial origins (in Brazil), or ethnicity (in other Latin American countries). Care is not performed in a work relation, but within a (hierarchical, unequal) family relation. Although the debate regarding domestic work and its nature, invisibility, and unequal distribution has been on the agenda of Brazilian sociology since the last century10 (Saffioti, 1969; Souza, 1976), its belated inclusion in official statistics would indicate that this invisibility extends to its measurement. Even later came the recognition of unpaid care activities in the home, which was only recently officially measured. In fact, it was only in 2001 that the Brazilian Institute of Geography and Statistics (IBGE) added the subject of average weekly time dedicated to domestic duties to its National Household Sample Survey (PNAD). Two questions are now

 Saffioti’s (1969) had a strong theoretical bias regarding women’s subjections under capitalism, and Souza’s (1976) equally pioneering empirical work measured the use of time and its division among family members in homes in the former state of Guanabara. Using different theories and methodologies, the two studies identified gender divisions in household duties that left the work of reproduction almost exclusively to women.

10

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regularly asked in surveys: whether domestics duties were done on a part-time or full-time basis and how many hours per week were dedicated to that.11 The definition of domestic duties adopted by PNAD in 2001 in its “Interviewer Manual” (apud Jesus, 2018, p. 38) includes a list of activities introduced by a suggestive statement: “Domestic duties are understood as tasks performed in the home of residence (that do not fit the concept of work), of (…)” (emphasis added). Thus, the official recognition of such duties made it clear that they were not considered “work.” Hence, the official measurement did not name domestic work, reproductive work, work in the domestic unit, or even unpaid domestic work, like gender sociology, or even the feminist literature that was in vogue in Brazil at the time, did. To the contrary, it used the term “duties” to designate activities that were exercised as an “obligation,” or as being responsible for other members of the home in a division of roles that have always been naturalized in official statistics. Another aspect can be identified in how the types of activities that make up domestic duties were defined. The manual listed five duty categories: (a) tidy or clean all or part of the home; (b) cook or prepare food, iron clothes, wash clothes or dishes using, or not, home appliances to perform these tasks for oneself or others in the home; (c) guide or direct domestic workers in executing domestic duties; (d) take care of children or underage residents; and (e) clean the yard or lot that surrounds the home (emphasis added). Although care emerges among these five dimensions, it is only counted when directed at “children or underage residents,” who are thus treated as the only beneficiaries of care duties.12 The data released by PNAD generated significant research in the 2000s that was for the first time based on national statistics. Soares (2008) revealed that women spent twice as many hours performing domestic duties than men. Soares and Saboia (2007) showed that a person’s position in the home was associated to the amount of duties they assumed. Married women took on three times more tasks than their spouses, while sons spent the least amount of hours doing domestic tasks. Melo and Castilho (2009) demonstrated that the variations of schooling levels also made a difference in the distribution of responsibilities between gender groups. Poorly educated women spent 54% more time than poorly educated men. This difference dropped to 37% among groups with higher education. Even more interesting were

 In 1982, IBGE made its first attempt to measure the subject. Because it was a special module on education, the two questions (if you normally help with domestic duties, and for how many hours a week) were asked only to children between the ages of 4 and 18 (cf Jesus, 2018). A 1996–1997 pilot survey (IBGE-World Bank) called the Living Standards Measurement Study (LSMS) again tested two questions to measure the time dedicated to domestic duties in the 7 days prior to the survey, which was then applied to a representative sample of the population. Bruschini (2006) used these findings to underscore gender inequality (women spent 36 h on domestic duties, while men spent 14). 12  But the problem cannot be solved by merely adding the time spent on the ill and aged to item (d) in order to complete the triad of beneficiaries repeatedly referred in caregiving. The other four types of domestic duties are also clearly types of care work, in the sense that they ensure the wellbeing of others; which, in the words of Nieto (2014), encompass the activities that are necessary for the home to function and for the well-being of its members. 11

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the reflections presented by Ramos (2011) who also used PNAD to explore gender and racial differences. She found a higher proportion of Afro-descendant women performing domestic duties along the period 2001–2008 (1 h more per week than white women), while there was only a very small difference between white and black men. In summary, solid findings showed that, in Brazil, factors such as available time for domestic duties, income, and the variables related to life cycles (such as having children, how many, and their ages; marital status; and age, especially of women) were strongly associated to time spent doing unpaid domestic work. But it was also clear that gender differences were primarily responsible for other factors related to the burden of unpaid care work. Even if unemployment increased the availability of all home members to perform domestic duties, employed women still spent 10 h more on such duties than unemployed men. And even if time spent doing unpaid work tended to drop as income increased, women in non-poor homes still spent twice the amount of time on domestic duties than men in poor homes. (Bruschini, 2006; Instituto de Planejamento Econômico e Social [IPEA], 2012; Ramos, 2011). Two important developments took place in the 2000s. The first was the result of a certain discomfort with PNAD’s methodology to measure unpaid home care work. Brazilian authors began echoing international criticisms against surveys that used only a few questions about something in the past, which risked underestimation. Hence, in 2001, a pilot survey was conducted in three neighborhoods in Rio de Janeiro using retrospective interviews and field diaries, which adhered to international classifications for the performed duties. As a result, care activities were better differentiated from general domestic duties, which were also better classified. The findings showed that the group of 25- to 34-year-olds exhibited greater differences between men and women doing unpaid domestic work. Furthermore, such differences became greater when comparing hours allocated to general duties and to care duties. In the first, women spent 90% more time than the men, while in the second the difference reached 134% (ENCE, 2001, p. 28). Later, in 2009, IBGE conducted a sample survey in 12,000 homes spread across five Brazilian states in order to test a possible future methodology using field diaries that followed international directives to collect data. This produced other interesting regional results (Jesus, 2018, p.  37), that showed a significant variation in domestic work in the Northeast (in Pernambuco only 31% of the men performed this kind of work) and the South (56% of the men in Rio Grande do Sul).13  These changes to PNAD are the result of international debates and directives, especially those that came from the 4th United Nations Conference on Women (Beijing, 1995) that identified the need for governments to produce time-use statistics because they are crucial to examining gender inequalities. Brazil’s response was the slowest among Latin American countries, many of which had initiated these efforts in the 1980s. Brazilian academia had, however, developed some studies on the subject, albeit with more limited samples. The most striking was produced by Aguiar (2001, 2011), who surveyed 400 homes in Belo Horizonte between 2001 and 2002, and who had already been calling attention to the importance of time-use studies to help understand unpaid domestic work in Brazil.

13

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The second important development was part of the methodological changes to PNAD, which was then called Continuous PNAD that consolidated improvements to measuring domestic responsibilities and their allocations. Thus, since 2016, treatment of the subject gained new dimensions. Domestic and care activities became part of a category called “other types of work.” In this way, the category of work began including unpaid work, which had previously been called “duties.” Today, the four main types of work being investigated are own-consumption production, caring for people, domestic duties, and volunteer work. Care has become the focus of meticulous attention and is being measured in greater detail. This places us in a broad scenario where the variant of unpaid care work performed in the home becomes especially interesting. As we have seen, it is a modality that has always been strongly connected to the idea that certain activities are “obligations” to be performed within households for some of its members. The continuities, as can be seen in Fig.  8.1, are nevertheless disquieting. Comments made by Pinheiro and Medeiros (2016, p. 9) in PNAD 2009 correctly explain the reality of PNAD 2017. The authors said that women continue being responsible for routine activities that are less optional or discretionary, and with less possibility of postponement (such as washing clothes and dishes, ironing clothes, cleaning the house, caring for children, cooking), which are also tasks that consume the most time. Men, on the other hand, are responsible for more sporadic and flexible activities that, to a certain extent, have also been understood as more pleasurable than the others, for example, doing small household repairs, yard work, taking care of the cars, or paying bills (Pinheiro & Medeiros, 2016, p. 9).

Figure 8.1 demonstrates the persistence of the unequal distribution of responsibilities between sexes and also between races, with Afro-descendant women being more likely to perform unpaid home care work. These inequalities are even more pronounced when caring for people, as opposed to caring for the home. But the 2017 Continuous PNAD data also show that inequalities prevail between age groups; girls are given the most important care duties, which increase the size of the group classified as those “who neither study nor are engaged in the labor market.” Nevertheless, PNAD’s continued inability to capture certain care activities being documented by qualitative studies, especially those conducted in poor areas, draws our attention. The questionnaire addresses only modalities of care exercised outside one’s own home, vaguely entitled “care of a non-resident relative” (4.8% of women) and “domestic tasks at a relative’s home” (3.2% of women). It can be observed that in both cases the definition of this “external” type of caregiving is conditional: it presupposes a family relationship with the beneficiary and misses the chance to capture care activities extended to nonrelatives. Furthermore, nothing is captured about the care that can be given in one’s own home to benefit nonresidents and/or nonrelatives. Could we be reaching the limit for this type of instrument used to ascertain informal, transitory, and negotiated relations that are redefined in circuits that often go beyond family and operate mostly to handle emergencies, founded on group or community reciprocity? Thus, the central issue addressed in the next section is the

8  The Circuits of Care: Reflections from the Brazilian Case

Other unpaid care tasks (non-relative and non-resident)?

40%

27%

19%

14%

Care –non-resident relative

15%

Care –read or play?

11%

Care –transport or accompany to school, doctor, etc.?

22%

Take care of pets

19%

Do small repairs or maintenance?

28%

23%

0%

5%

White women

10%

15%

Black men

27%

20%

31%

30%

22% 27%

21% 19%

Did other domestics tasks in your home?

31%

28%

22%

20%

34%

27%

21% 19%

Take care of household organization (pay bills, hire services, direct employees, etc.?)

35%

26%

22%

19%

36%

33%

21%

18%

Shop for or research prices of household goods?

36%

25%

19% 17%

Clean or tidy the house, garage, yard, or garden?

36%

25%

22%

16%

Other care tasks?

37%

31%

17%

16%

Care –monitor or keep company in the home?

38%

31%

18%

14%

Prepare or serve food, set the table, or wash dishes?

38%

27%

20%

16%

Clean or maintain clothes and shoes?

39%

33%

15% 14%

Care –help with school activities?

41%

33%

13% 14%

Care –help with personal care?

Black women

139

32% 36%

24%

25%

30%

35%

40%

45%

White men

Fig. 8.1  Brazil 2017: Percentage of black women, white women, black men, and white men that perform domestic and care tasks, according to type of task. Source: IBGE Continous PNAD 2017 (IBGE, 2018)

third circuit of “care as help,” based on research results anchored in a qualitative methodology.

Care as Help The third circuit understands the specificities of care work in the conditions of extreme poverty that affect a large portion of the Brazilian population. It encompasses different forms of activities that, in addition to not being classified as occupations of care (because they are neither socially nor institutionally recognized), are not defined as care work, or even as work, by those who perform it. Instead, they are socially codified by the actors themselves as “help.” Different from the first two, this circuit extends beyond the circle of those who live under the same roof, sometimes even the family group, since its execution involves efforts and forms of solidarity that are part of broader networks that range from the extended family (with whom they do not live) to networks of local and/or community friendships.

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By invoking the role of family and community networks for providing care in situations of (extreme) poverty, we intend to fully capture the class differences that configure the Brazilian reality. Indeed, this side of care is the par excellence form found among poor and vulnerable populations. It is reproduced in conditions marked by insufficient social assistance and by the impossibility (or difficulty) of turning to the service market for care. Because they cannot access the State (through assistance policies) or the market (through purchasing power), they turn to reciprocity networks that are supported by the community or extended family. The invisibility of help does not differ from what characterizes unpaid domestic work. Only since 2016 has the national household survey (Continuous PNAD) provided data regarding the division of care responsibilities, whether performed without pay by members of the same household or performed for the benefit of others that are not relatives or coresidents.14 However, the numbers obtained are almost negligible. The 2017 PNAD registered only 0.2% of women and 0.1% of men in this modality of care provision. The fear significant underestimations are founded on the salient visibility of help in qualitative studies that investigate the day-to-day lives of social groups in situations of poverty. For this reason, and in order to come closer to this variant of care, qualitative research has been extremely valuable in understanding how care work is performed and represented in these contexts in Brazil. Guimarães and Vieira (2020) explored the characteristics of the help circuit based on Vieira’s (2017) ethnographic work in the periphery of the city of São Paulo. This ethnography collected individual discourses and observed experiences of poverty in order to analyze practices and discover categories of interpretation. It is significant that care, albeit not the focus of the original survey design, became a fundamental analytical element for understanding the experiences of poor individuals and their families in terms of work and of ensuring income and well-being, which is a key dimension in the symbolic constructions of what is (or is not) considered work among the poor.15 The neighborhood in question has many families, mostly black, with migrant origins, especially from the Northeast of Brazil, that have lived in São Paulo for at least two generation. Their family compositions are frequently single-parent homes where mothers raise and support their children without any help, financial or otherwise, from the fathers. Extended family members commonly live on the same plot of land, or at least in the same neighborhood, sharing daily activities in intense, and close proximity to each other.  In 2016 and 2017, PNAD introduced a yes/no question about help when performing care: In the week being referred to … did you work voluntarily and without pay for people who were not relatives and who did not live in this home, performing domestic tasks or caring for children, elderly, or other people who need special care? 15  This ethnographic study was conducted over a 15-month period between January 2016 and March 2017, in a neighborhood on the far east side of the periphery of São Paulo that is characterized by high social vulnerability and a large number of families living below the governmentestablished line of poverty. The ethnography accompanied nine families and individuals that received conditional cash transfers and investigated the dynamics of the relations they established with structural circuits of survival: markets, State, family, and friends and neighborhood networks. The analytical dimensions focused on family composition and dynamics, origin, gender, and generation. 14

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The neighborhood is far from areas in the city where employment can be found. Although the intensity and nature of individual relations with the labor market ­varies, the lack of formally registered employment is recurrent. Hence, individuals rarely have access to labor rights and other benefits associated to work, such as healthcare plans and/or daycare. In other words, the engagement of the poor in the labor market seldom comes with access to rights or benefits associated to care and well-being. Access to care provision mechanisms is also difficult in terms of public policies. Government social assistance primarily provides and monitors conditional cash transfer programs and scattered productive inclusion actions. The neighborhood being studied had no assistance program of any type that provided care, whether for children, the elderly, or the chemically dependent. Public facilities for seniors— such as adult day centers or long-term care institutions—are far away and require long waits in endless lines. The people who work at these facilities barely know the procedures or eligibility criteria for registering, which leads people to believe these services ineffective because they seem so scarce and inaccessible. It is true that Brazil’s public health system (SUS—Sistema Único de Saúde) is inefficient. Long waits for appointments and exams, insufficient hospital beds, and serious medical negligence means untreated and often serious health problems are common. Precarious and restricted services mean patients—when seen—are kept in health institutions for as short a time as possible. As a result, most of the recuperation process occurs at home, which frequently requires families to incorporate caring for someone sick into their routines. This is an important specificity found in the configuration of care beneficiaries among the poor. In addition to ensuring the well-­ being of children and dependent seniors, families must also care for active adults that are temporarily ill and have no health insurance to cover medical appointments and in-hospital recovery. The same goes for chemically dependent young adults. In other words, care needs vary significantly when controlling for class and when observing from the point of view of the poor. Nevertheless, public education and childcare facilities such as daycare centers do in fact meet the needs of local communities in terms of available openings, although not necessarily in terms of quality. However, public daycare centers, by law, can only stay open up to 10 h a day, making the most common operating times from 7 am to 5 pm or 8 am to 6 pm. Furthermore, tardiness is permitted at drop-off times, but not at pick up times.16 This situation especially affects parents working outside the neighborhood because their long commute requires leaving home very early and returning very late, making their schedules incompatible with the operating hours of the daycare centers. Public primary schools have even more restricted schedules, in addition to classes being only half period (mornings or afternoons), making is difficult to care for children during after-school hours. School holidays, which total 3–4  months a year, are also problematic and affect family routines because they require full-time childcare. Vacation activities offered by schools and other public

 This means families that exceed the formally established limit of tardy pick-ups per semester are at risk of being reported to Child Services and can lose the guardianship of their children, which generates substantial fear.

16

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facilities are sporadic and scarce. These characteristics and limitations found in the public system of education and childcare force adults responsible for children to make private arrangements. Solutions for these gaps in government services are not found on the market. The financial and material conditions of these families are limited and often prevent access to market-supplied care, whether through institutions or independent service providers. In emergencies, they might hire the services of a nanny or private daycare center, but this tends to be infrequent and temporary. As a rule, family budgets cannot afford long-term spending on paid care services at market prices. In short, paid care, as observed in our literature and described in the earlier circuits, is far from being a solution. Philanthropic institutions can play a meaningful care role in contexts of poverty, depending on time and space. In this particular community, charity organizations had provided childcare activities. Today, traditional and primarily religious groups offer free treatment for chemically dependent people, which is a critical and recurrent problem in the families being studied, who cannot afford private rehabilitation treatment. Charity organizations can also provide care for needy seniors, although there were none in this neighborhood. Nevertheless, because philanthropy depend on donations, it is uncommon and intermittent. In this context of limited government care, financially unviable market services, and fragile charity institutions, most care arrangements are established within families and/or communities. They often make private arrangements to pick up and drop off children at schools and daycare centers, take care of them during the intervals between beginning/end of the institutions’ schedules and the coming/going to work of family members, in addition to providing full-time care during school vacation periods. It is common for either older siblings or nonworking grandparents or great grandparents to be responsible for the younger children during these intervals. Another possibility is for relatives of children requiring care to find work that has alternative or flexible hours, is part-time, or within the neighborhood (in the case of self-employment or service provision). Another type of family arrangement is where the adults responsible for childcare find work at alternating times so that the one who starts later assumes care in the morning and the one who leaves early assumes care in the afternoon. The responsibility for childcare tends to be shared within families, not only between mother and father (when present), grandparents, and older siblings but also between aunts and cousins (not only next of kin) in a way that mobilizes almost all possible family ties. Childcare can enter the arena of family duties and obligations in many different ways, through reciprocity (for example, sisters sharing the care of each other’s children), exchanging favors, or even through material retributions that may or may not involve money, food donations, gifts, and financing for various needs. The agreements and negotiations are specific to each situation, need, and relationship. However, family arrangements alone are often unable to meet all the demands of care. Thus, important liaisons are formed between neighborhood women who organize themselves into an informal network of shared care. This type of community arrangement takes on two main forms. In one, the neighbor women that have flexi-

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ble hours organize themselves so that each day, or each period of the day, one of them cares for the children while the other mothers work. This allows for complementary shifts based on reciprocity. In the other, neighborhood women that have available time care for the children while the others work, receiving in exchange some kind of material retribution (monetary or not) or another service or favor. Similar to the family arrangements, these agreements and negotiations are specific to each situation, need, and type of relationship. But even when it involves monetary retribution, the agreed upon amounts tend to be flexible and far below market prices. Such activities are recognized as “help” or “favors” rather than as work. In practice, it is very common to mix several of these strategies that mobilize family members and neighborhoods depending on the day, time, or situation, without discarding any of the government or charity services that might be available, and in cases of emergencies, turning to commercial services. Thus, these family, community, and neighborhood networks play the decisive role in these arrangements, even when state, market, and philanthropy services are included to some degree. This modality of care takes on collective and community characteristics. Complex and well-connected networks are built on affection, obligation, reciprocity, and material exchanges wherein communication and trust are indispensable due to the constant need to establish or reformulate agreements and negotiations. Similar arrangements are created to care for the elderly or the ill that can (or not) override childcare arrangements, making the network web even more dense. Within these complex informal networks that involve numerous family and neighborhood participants, it is important to identify who can (or should) play a role and why, seeing as the responsibility for care is distributed unequally. It is worth reiterating that these care arrangements are built primarily by adult and adolescent women who are responsible for caring for younger generations (children, grandchildren, nieces, and nephews) and/or older ones (grandparents, parents, aunts, and uncles), in addition to those who are sick or chemically dependent of any age. However, emergency situations can call upon even children and seniors of both sexes, as in the cases of older siblings caring for the younger ones, and nonworking, healthier seniors caring for small children; or older children caring for sick or severely dependent seniors. As a rule, adult men have little participation. When they do play a role in these arrangements, it is to occasionally pick up or drop off children at school or daycare, or to conduct recreational activities on the weekends. Men’s participation in ordinary tasks that involve things like food, hygiene, and medication is limited, if not nonexistent. Contexts of poverty imply high rates of single-mother households, and it is very common for men to not assume fatherhood and family obligations, relegating the entire weight of material support and care to women. High rates of male mortality because of urban violence and frequent stays in prison are also important elements in understanding the absence of men in these arrangements. Furthermore, men who are involved in crime, drug trafficking, or other illegal markets are generally excluded from care arrangements. They are seen as inappropriate for security reasons—whether because they bring risks inherent to illegal activities, or because they are judged as immoral, irresponsible, or bad influences. Women that are involved in

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illegal markets or in sex work are not usually seen in the same manner, and thus are not always considered unsuitable for care work. To the contrary, sometimes these women are given central roles in informal care networks because they spend more time in the neighborhood and are closely tied to the community. It is significant that when such women are seen by families and neighborhoods as reliable, careful, affectionate, and as satisfactorily playing the role of a “good mother” or “good daughter,” the stigmas that surround their illegal or immoral work are lessened, allowing them to take on leadership positions. When this is not the case, they are given helping roles and are called upon only in emergencies. As already said, paid or unpaid care work performed within the family or community network is regularly called “help.” The term accentuates the dimension of affection, zeal, and attention toward the needs of those who require the service, product, or information; to the detriment of the idea of economic transactions. In the same way, the term shows the dimension of reciprocity and distinguishes donations without the need for compensation. Yet it also pushes aside the sense of work to the extent that the women who are active in family and community networks and zealously provide care on a permanent basis neither see themselves nor are seen by others (family, neighborhood, social services) as workers. In other words, the meaning of work is reserved for market dimensions. Furthermore, “help” is seen as a broad notion that encompasses a varied set of activities that are fundamental to survival, reproduction, and well-being and which shape the systems of solidarity and reciprocity within and among families. These diverse activities have an important characteristic in common: they are performed between and for individuals that maintain strong personal ties. There is no obligation except close relationships and affection.

Revisiting Some Principles and Preventing a Short-Circuit Analytical exploration on the diversity and various facets of “caring for the other” can provide a rich domain for reflecting on commodification processes. The terrain of care has proven to be especially challenging and elucidating because it is, after all, about commodifying an intimate service, an activity that frequently involves manipulating the body of the other. When accepting the challenge of using the subject of care to reflect on this phenomenon, we must pay attention to a primary aspect: commodification is a process of attributing cultural brands, which drive individuals to recognize goods or services as merchandises (Kopytoff, 1986). But it could be relevant to add another idea: that the process is also responsible for making individuals recognize themselves as providers of the good or service being commodified (Guimarães, 2016). Going even further, and explicitly relating with the subject of care, we can argue that the commodification process can be considered, like any other economic action, as a movement where individuals are engaged in permanent relational work that is characterized by a permanent effort to differentiate meaningful social relations, (re)

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establishing barriers, and defining boundaries that become visible when named and classified and when new practices are established (Zelizer, 2012). Observing care work circuits and exploring their different configurations reveals how such relational work is exercised. Finally, it is important to understand that these circuits are by no means exhaustive or mutually exclusive. This notion is only useful if it is capable of capturing the continuous remaking and transitory nature of the social relations of care, or in other words, the permanent negotiations that characterize it. For example, Redondo (2018), analyzed au pair programs, capturing the experience of young Brazilian middle-class migrants who, despite their continuous immersion in the paid work of home childcare, did not believe they were working (but were rather in an exchange program), even though they received monetary compensation. They did not see themselves as nannies (or nounous), even though their contracts defined childcare as an obligation. Instead they described themselves as students trying to enter the European job market. In other words, work was in the future. Care was defined as caring for oneself, a transitory investment in the experience of entering the market, while a profession was something that would be enjoyed in the future after entering the market. Expanding the scope of studies about circuits and their complex and changing configurations will certainly allow us to better understand this special form of relational work, the work of care. Acknowledgment  This chapter was translated from its original Portuguese version to English by Jill Haring.

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Redondo, M. F. (2018). Trajectoires du care; de jeune fille au pair à nounou. Unpublished doctoral dissertation in sociology, Unicamp and Université Paris 8, Campinas and Paris. Saffioti, H. (1969). A mulher na sociedade de classes. Rio de Janeiro: Ed. Quatro Artes. Soares, C. (2008). A distribuição do tempo dedicado aos afazeres domésticos entre homens e mulheres no âmbito da família. Revista Gênero, 9(1), 9–29. Soares, C., & Saboia, A. (2007). Tempo, trabalho e afazeres domésticos: Um estudo com base nos dados da Pesquisa Nacional por Amostra de Domicílios de 2001 e 2005 (Textos para Discussão No. 21). Rio de Janeiro: IBGE. Retrieved August 25, 2018, from https://biblioteca.ibge.gov.br/ visualizacao/livros/liv35740.pdf Souza, A. (1976). As 24 horas do dia de um carioca. Rio de Janeiro: IUPERJ. Vieira, P. (2017). Trabalho e pobreza no Brasil entre narrativas governamentais e experiências individuais. Unpublished doctoral dissertation in sociology, USP, São Paulo. Zelizer, V. (2004). Circuits of commerce. In J. C. Alexander, G. T. Marx, & C. Williams (Eds.), Self, social structure, and beliefs. Explorations in sociology (pp. 122–144). Berkeley: University of California Press. Zelizer, V. (2005). Circuits within capitalism. In V. Nee & R. Swedberg (Eds.), The economic sociology of capitalism (pp. 289–322). Princeton, NJ: Princeton University Press. Zelizer, V. (2006). Circuits in economic life. Economic Sociology: The European Electronic Newsletter, 8(1), 30–35. Zelizer, V. (2012). How I became a relational economic sociologist and what does that mean? Politics and Society, 40(2), 145–174.

Chapter 9

Gender and Care in Uruguay: Ground Covered and Challenges to Current Policies Karina Batthyány and Natalia Genta

A Journey Through the Conceptualization of Care For the past 40  years, gender studies have shown how crucial and indispensable domestic work is for both the operation of the economic system and social well-­ being. However, only since 10 or 15 years ago has specific knowledge about care been developed. One of the explanations for the “discovery” of care is the existence of tensions arising from the new roles played by women in the labour market since the late twentieth century, and as a result, the trend towards outsourcing domestic tasks (Carrasquer, 2013). Based on gender studies, the analysis of care evidences the sexual division of labour and renders visible the contribution of women to reproduction and to the sustainability of human life, yet at the same time opens a window of opportunity for a critical analysis of contemporary welfare states (Carrasco, Borderías, & Torns, 2011; Carrasquer, 2013). While care is widely explored in social science these days—and not just from a gender perspective—there is not a theoretically rounded, agreed upon concept of care, but rather conceptualizations and empirical studies focused on specific aspects of care. The differences in conceptualization mainly stem from whether the definition places emphasis on relations or family bonds, which in turn brings into question its connection with the concept of labour (Himmelweit, 2011) and with the professionalization of care (Carrasquer, 2013). The different conceptualizations of care can be analytically interpreted by means of at least two approaches or “journeys”. The first approach to the definition and reformulation of care goes back to the early conceptualizations in Anglo-Saxon literature. In the 1970s and 1980s, the concept of care was brought up by such authors as Graham (1983) and Ungerson (1990). Initially, care was, by definition, the K. Batthyány (*) · N. Genta Department of Sociology, Faculty of Social Sciences, University of the Republic (UdelaR), Montevideo, Uruguay © Springer Nature Switzerland AG 2021 N. Araujo Guimarães, H. Hirata (eds.), Care and Care Workers, Latin American Societies, https://doi.org/10.1007/978-3-030-51693-2_9

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support provided by women within the family. After subsequent reformulations, the definition incorporated care provided by other agents (Carrasquer, 2013; Thomas, 2011). Graham (1991) defined care as a mix of love and labour which, given its emotional implications, could only be provided within the family, and particularly through tasks only women could perform as a result of their socialization. In the 1980s, in contrast to authors whose definition of care was associated with women, other authors (Ungerson, 1990) claimed that care could be provided in institutional settings (state services, private centres, community networks, etc.) and that care relations could be established by means of paid labour agreements. This concept was based on the idea that limiting care to the family made it impossible to unveil family situations characterized by lack of affection and even abuse or ill treatment. Thus, while it recognized the existence of an emotional aspect, such aspect was to be analytically subordinated to the labour-related aspects of care. In the 1990s, a significantly influential conceptualization of care was that of Thomas (2011), who attempted to sum up the previous decade’s debates about Graham’s and Ungerson’s views. She defined care as both the paid and unpaid support involving work activities and emotional empathy, mainly, but not exclusively, provided by women to both able-bodied and dependent adults and children in either public of domestic spheres, and in a variety of institutional settings (public services, private agents, volunteers, and family). Also in the 1990s, the Anglo-Saxon scholarship introduced the concept of social care through the ideas of Daly and Lewis (2000), pioneering authors in a new field of studies aimed at analyzing welfare schemes, which partially steered interest in care towards the study of social politics. Social care was defined as the activities and relations involved in meeting the physical and emotional requirements of dependent adults and children, and the normative, economic and social framework within which these are assigned and carried out. This useful definition has helped understand the regulatory frameworks within which care is provided in our days, that is, the obligations and responsibilities assigned to actors and also measure the economic, time, and emotional costs involved in caring. It further steered the early discussion centred on “labour and love” towards one more focused on interrogating welfare states and on how they distribute care among the various agents (the state, the market, the family, the community). A second approach to the conceptualization of care largely stems from the early Marxist and Socialist feminism’s analyses of work, sexual division of labour, reproductive system, and domestic chores. This is the path taken in Uruguay (Aguirre, Batthyány, Genta, & Perrotta, 2014)1 and in other Latin American nations. During the 1970s and 1980s, caring was part of what was known as “domestic work”. The study of domestic work sought to emphasize its similarities with those activities developed in the public sphere. In its association with the sexual division of labour, care was one of the tasks performed by women which contributed to

1  For an approach to the link between the knowledge gained about gender and caring and the introduction of care in the national agenda, see Aguirre et al. (2014).

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well-being. These early papers did not focus specifically on care, but on the non-­ paid work done by women at home (Recio, 2010). The key aspect of this second conceptual approach was the identification of care as labour. One of the core concepts in this approach is the sexual division of labour. This means that gender relations are the principle by which work is organized, leading to an uneven distribution of tasks between men and women. The sexual division of labour is apparent in qualities and skills naturally associated with women, as opposed to those naturally associated with men, with care being one of the tasks typically assigned to women in society. Though at a basic level, this concept was originally developed by Marxist feminist literature and linked to the social division of labour. Based on the distribution governed by the sexual division of labour, women were assigned domestic chores, and as a result, capital benefitted from both men’s paid work at factories and women’s non-paid work at home. In these early developments, the analysis of women’s position was based on their relation to the economic system, not to men. Later on, Marxist feminists claimed not only capital but also proletarian men benefitted from women’s contribution and denounced the existence of “patriarchy” as a separate system, different from capitalism, where women were oppressed by men (De Miguel, 2005; Hartman, 1973). Beyond the historical account, the concept of the sexual division of labour has become increasingly complex, casting light on the current distribution of tasks in both paid and unpaid labour. Within the household, the sexual division of labour is also evidenced by the tasks assigned to men and women, as shown by the time-use survey (EUT) in Uruguay (Batthyány, 2015). The link between paid and unpaid labour runs parallel to that between the productive and reproductive system, a key issue brought up in the early Marxist feminist discourse. It is essential for the capitalist system to conceal the link between production and reproduction, so that capitalist production costs can be transferred to the domestic sphere by reproducing the labour force and maintaining the population. Such costs and reproductive tasks performed within the home include the provision of care. From a more emotional perspective (Hochschild, 2003), care not only reproduces individuals biologically but also aims to reproduce individuals with certain characteristics that are essential for joining the workforce. A major merit of the reproductive approach, further deepened by feminist economics, is the analysis of its connection with production, shedding light on a heretofore veiled issue: since the advent of industrialization, women “have suffered a constant tension by joining both spheres of activity in a world governed by the logic of capital” (Carrasco et al., 2011). In Uruguay’s journey, care was initially understood as one of the various types of unwaged labour. The early research on the matter was intended to identify the different unpaid activities as components contributing to social well-being, just as paid work did. However, in the process of recognizing and visualizing unwaged labour, it became apparent that the provision of care played a key role among other types of unpaid work (Aguirre et  al., 2014). Thus, a turning point along this journey was

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reached when care was conceptualized as separate from domestic work. This resulted from an in-depth study of household activities aimed at describing and understanding their specific characteristics. Indeed, the emphasis of research shifted from non-waged versus waged labour, to gaining greater insight into the activities developed within the home, among which the provision of care was of the utmost importance. This led to differentiating the various activities theretofore collectively identified as domestic or unpaid work. While care is similar to household work in that it is invisible and associated with female skills, it differs significantly in that care has a relational component (Carrasco et al., 2011).

Research in Uruguay Uruguay has been a pioneering nation in the second conceptual journey described above and also in the field of care policies. As already mentioned in other studies (Aguirre et al., 2014), a key factor leading to the introduction of care in the public agenda was the role of sociological insight as a driving force for the design and implementation of public policies. Gender-related sociological research has historically sought to strengthen this link, based on the critical theory’s principle that the ultimate goal of generating knowledge is to transform society. The central role played by care in Uruguay is reflected in the empirical research undertaken on diversified dimensions of care. With a view to deepening the quantification of care, we conducted a specific survey on unpaid care (Batthyány, Genta, & Perrotta, 2017). One of the main results of our survey was that the provision of care is extremely time-demanding throughout the course of a disease, whether chronic or temporary. This type of care is largely provided by family members, especially women, who account for 76.6% of caregivers. Only 18% of the homes surveyed have resorted to some kind of outsourced care (whether paid or not) to cover their members’ care needs, as the time they would have to hire someone during their disease would entail too hefty a cost for middle- and low-socioeconomic-­ level families. Furthermore, female caregivers assist other homes more than men do, playing a central role in the care strategy of, for instance, their elderly parents. The survey also evidenced there was a group of women who devoted a significant share of their time to providing care on an unpaid basis and did not access paid jobs, which in turn had a negative impact on their economic independence (Batthyány et al., 2017). As for the profile of those who provide unpaid care, most of them are 46–65 years old. This is probably due to the fact that, during that stage of life, a larger proportion of the population do not have regular full-time jobs and can devote time to caring for their elderly parents and also their grandchildren in extraordinary circumstances where the daily care strategy adopted proves insufficient, such as a temporary disease or an accident. The survey further evidences the limited participation of young people in these tasks as compared with adults and elder adults. Indeed, only 11% of caregivers were under 30 years of age (Batthyány et al., 2017).

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In our research journey on gender and caring in Uruguay, we sought to go beyond the mere quantification of care time measured by means of time-use surveys (TUS). In a pioneering move, we sought to delve into the social representations of care, that is, gain practical knowledge that would help portray the social reality shared by our community. The importance of the study of gender-based social representations lies in the fact that it casts light on those beliefs, values, and ideological assumptions which, based on biological differences, lead to inequalities between men and women when it comes to care. Our research sought not only to quantify gender mandates, as well as the most desirable conditions for caring, but also to understand the meanings attributed to quality care. The results of the National Survey on Social Representations of Care (ENRSC), conducted in 2011, evidenced a strong presence of “familism” in Uruguay (Batthyány, Genta, & Perrotta, 2013). According to the data gathered, the mainstream opinion is that the most desirable setting for care is the home, and that care should ideally be provided by family members. As for “familism”, the lower the socioeconomic level, the more it prevailed. Findings further showed the sexual division of labour persisted and was perceived as righteous. Men were considered responsible for indirectly guaranteeing care in their role as breadwinners. Women, on the other hand, were associated with the direct provision of care, which involved ties of kinship. The findings also evidenced that women tend to flexibilize their status in the labour market according to the needs of dependent relatives in their care. This research contributed to public policies as it helped identify the cultural barriers that hamper the acceptance of alternative care services. Though only a few studies place emphasis on the cultural aspects of care, they play a significant role in unveiling the community’s reluctance to accept care policies intended to shift care away from the family and transform the sexual division of labour. In the case of Uruguay, these studies provide guidelines for the design of public policies involving effective, truly transformative actions. In addition to the population’s social representations, research sought to explore expert knowledge on the matter (Batthyány et al., 2013). Based on the remarkable influence of such knowledge (i.e., who, how, and where care should be provided) on social representations and on the decisions adopted by individuals and families, as well as on those shaping public policies, we examined expert discourse on child and elderly care. The central hypothesis posited that, rather than being neutral as regards the roles assigned to men and women, expert discourse was part of the overall gender system’s mechanisms and institutions which laid down the very foundations of the sexual division of labour. The analysis of expert discourses on older people and children showed the importance placed on the promotion of social responsibility in care. In particular, expert knowledge asserted that the presence of the state was essential for providing the various modes of care to all sectors of society, and that it was the state’s duty to support families, so that they could perform their role under more favourable conditions. The research on care focused on dimensions hardly ever explored up to then. Along this line, over the past few years, researchers have examined what has changed and what has remained the same with regard to the sexual division of

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labour and the roles of men and women in caring. To this end, they conducted the project Políticas de cuidado en Uruguay, impactos en la relaciones de género (Care Policies in Uruguay—Impact on Gender Relations) (2015–2017), which probed into the discourses of three generations of men and women on child care. The findings of this research showed that the 1950s pattern of women as caregivers and housewives transitioned into the current model where women have entered the labour market and articulate the provision of care in different ways according to their socioeconomic level. Those women who had cared for their young children in the 1950s had not joined the workforce nor had they ever considered joining it, and would only do so if needed for economic reasons. Family life was perceived as mutually incompatible with working life, and women’s economically dependent role affected their personal development endeavours. The generation of women who cared for their young children in the 1980s had largely joined the workforce and in general assumed the dual responsibility of their paid job plus caring and household tasks. Thus, these women entered the labour market with no change in the sexual division of work at home. Even though they shouldered the added burden, they did not complain or get into arguments with their partners. This generation was characterized by the coexistence of different work-care models, as well as various representations and projects women could engage in, becoming a “hinge” between the traditional model and the different ones we see in our days (Batthyány, Perrotta, & Scavino, 2020). Today’s generation of women care for their young children and have personal and career endeavours beyond motherhood, though in three distinct scenarios. The first group consisting of lower class women with hardly any opportunities to get stable, quality income, care for their children but would like to share this responsibility with their partners and other care services. The second group, made up of middle-class women with full-time jobs, would like to have access to a wider range of free or low-cost care services, and actually share the responsibility of care with their partners more than the first group. In this regard, while the research findings showed that women’s paid work is a factor of change that favours a more equitable distribution of housework and care within couples, its mere existence does not guarantee such fair share of responsibility. The type of job, how both partners perceive female work and its importance for personal endeavours, the income generated by the female job for the home, and the shorter distance between men’s and women’s jobs as far as earnings and hierarchical status are concerned appear to be determining factors when it comes to transforming gender relations in the household (Batthyány et al., 2020). The third group surveyed high socioeconomic level women who have part-time jobs with no impact on household income and choose to care for their children because they value direct maternal presence in care. This group in particular represents a trend that poses a risk for women’s autonomy from a gender perspective. According to their discourse, the decision of these high-income women who have pursued university studies to partially withdraw from the market is based on biologicist literature that prioritizes maternal care and extended breastfeeding on demand, placing no emphasis on men’s role in caring. From this perspective, fathers

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play a secondary role, thereby reinforcing the leading, irreplaceable role of women in this domain. This type of contemporary motherhood calls into question what women have achieved in the labour market and their capacity to generate enough income to sustain their economic independence. It marks a new trend in the educated sectors that had heretofore taken a less traditional stance on gender roles. At the same time, the research findings evidenced the presence of a group of middle-class women who share care with their partners in a more equitable manner. This group promotes gender co-responsibility in caring and women’s economic autonomy, which entails multiple and often heated negotiations within the household. In line with the idea that research should work as input for the design of public policies, we implemented the survey Uso de licencias parentales y roles de género en el cuidado (Use of Parental Leave and Gender Roles in Caring) (2017). This survey sought to cast light on how decisions were made on whether or not to make use of parental leave and reduced working hours under the newly implemented Act 19.161 (2013) and on which factors have an impact on the use of such child care benefits. Under the newly passed legislation, for the first time in Uruguay men and women with 3- to 6-month-old babies are entitled to make use of a partial parental leave in an alternate, transferable manner. We examined the factors favouring or hindering the use of reduced working hours by mothers and fathers and the reasons why it is mostly women who make use of this half-time benefit (Batthyány, Genta, & Perrotta, 2018). The research outcomes provided evidence for guiding the design of public policies and favour greater gender co-responsibility in care. They showed an unmet demand for extended leave, as the vast majority of those surveyed consider it should last longer—what is more, quite a number of workers make use of their annual leave in order to extend their stay at home to care for their babies. The study evidenced inequalities regarding access to parental leave, which differs according to the socioeconomic level and the job quality. Hence, formal progress as far as rights are concerned not necessarily translates into actual exercise of such rights. It is basically women who make use of half-time for caring, but only those in higher social positions. Poorly educated, low-socioeconomic-level women who have elementary occupations and work in microenterprises or male-oriented businesses tend not to make use of it. As for men, while only 4.5% make use of reduced workdays as compared with 30% of women, they do so for different reasons. The main reasons mentioned by women are the loss of income and difficulties associated with their absence from the workplace. Men, on the other hand, mention breastfeeding and the importance of maternal care at a very early age, a claim that comes as no surprise considering this benefit is granted during an exclusive breastfeeding period and that the context is characterized by a familist, maternalist attitude regarding child care (Batthyány, Genta, & Perrotta, 2018). The study reveals lower socioeconomic and educational level women show higher rates of job abandonment at the end of their maternity leave. This should be analyzed taking into consideration the scarce access to full-time care services for babies, as will be discussed later on. Furthermore, according to the research

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findings, men make little use of half-time, evidencing that, because of the current characteristics of this benefit (it is transferrable to the other parent and coincides with the 6-month exclusive breastfeeding period), men are unlikely to make greater use of it. At the same time, there is evidence of a favourable context for additional child care measures for men, as the population surveyed understands they are useful for male involvement in caring (Batthyány, Genta, & Perrotta, 2018). All in all, the information obtained shows the need to articulate time policies (such as parental leave) with service policies, on the understanding that the extension of the former does not necessarily make up for the inexistence or scarcity of the latter. Thus, the knowledge gained informs and helps modify time policies so as to achieve a better impact on gender co-responsibility in care. At present, the cluster GISG, a gender research group leading the development of this novel perspective, faces a new challenge arising from the need to rely on previous research data, which will also become essential for informing the formulation of care policies. The project Necesidades y estrategias de cuidado en Uruguay (Care Needs and Strategies in Uruguay) (2018–2020) aims to generate useful primary information on care needs and the strategies developed by homes to meet those needs, with the added work and costs involved in them. Based on this survey, we will create a care strategy typology, as well as summary measures that may inform decision-making with regard to public policies on care, based on the sound assessment of the costs involved in the strategies implemented by the households. The research outcomes are intended to tailor policies to the needs of the recipients of care. Moreover, it will be a key source of information for measuring the impact of public policies on care in Uruguay.

How Is Child Care Addressed? In order to analyze how child care needs are addressed, we drew upon a recent study (Batthyány, Genta, & Scavino, 2018) which, on the basis of the secondary sources available, aimed at creating a typology that would help articulate in a single measure the different care arrangements available. In this study, care typologies were developed taking into account the degree of involvement of the private sector, the state, and families in child care by recording the hours of use of public and private centres, hired caregivers’ paid work, and family members’ unpaid work. The typology developed is shown below: • Familist Strategy: No State or private sector participation. • Low State Participation Strategy: Public child care services participate up to 20 h a week. • High State Participation Strategy: Public child care services participate more than 20 h a week. • Low Private Sector Participation Strategy: Private child care services and/or a hired caregiver at home for up to 20 h a week.

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• High Private Sector Participation Strategy: Private child care services and/or a hired caregiver at home for more than 20 h a week. • Strategy Combining State and Private Sector Participation: Households using both public services and paid caregivers at home. Source: Batthyány, Genta, and Scavino (2018)

The distribution of strategies according to the above typology evidences practically six out of ten children under 4 years of age (58.1%) are under the exclusive care of female family members, though this varies according to their age. While at 3, 32.1% fall into a familist strategy, this rate decreases to only 15% in 4-year olds and to 5.7% in children between 5 and 6 years of age. Low private sector participation strategies show an upward trend up to the peak age of 3 and then decrease. It is the strategy of choice for caring for 7% of 1-year olds, 10% of 2-year olds, and up to 14.6% for 3-year-old children. It goes down to 11.2% for 4-year olds and to 8.2% for 5-year-old children. This might evidence there is a group of families who hire half-time care centre services or caregivers at home for their children of up to 3 years of age, and then replace such private service with a public child care service that is only universally available, free of charge, on a 4-h-a-day basis, from this age on. As for high private sector involvement, it increases up to the age of 3 and then remains steady at approximately 15%. This suggests there is a group of families who resort to the public sector to complete full-­ time care from early ages, most notably from 3. Each one of the child care strategies adopted has different implications on the hours of unpaid work it entails. The more familist the strategy, the more hours mothers will devote to unpaid care work. For 0–3-year-old children, in the familist strategy mothers devote 86 h a week to caring for their children. This number decreases by an average of 5  h when there is part-time state support. When the strategy involves a private service or a paid caregiver for up to 20 h, it goes down to 70 h a week. The sharpest reduction in unpaid hours of work occurs in high private sector and high state participation strategies where mothers respectively devote 58 and 68 h a week to unpaid child care work. Households’ purchasing power has an impact on services accessibility, hence, on the strategy choice. For younger children the familist strategy prevails, though it increases for lower income households (70% in the first tertile as compared with 43.9% in the third tertile). While the low state participation strategy ranks second, it varies as it is adopted by 21% of families in the first tertile, but by only 85 of families in the third tertile. This is probably related to the institutional public offer of child care specially focused on early ages for lower socioeconomic-level persons. As for those strategies involving both low and high market participation, they tend to prevail more in the third tertile as compared with the other two. The reasons given for resorting to child care services vary depending upon the strategy adopted. Among those who opt for a low state participation strategy, the main reason is that it benefits children (82.6%). Among those who choose a high private sector participation strategy, on the other hand, the main reason is the need

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to work or study (58%). This has to do with the greater flexibility and wider time frame offered by private care centres or hired caregivers at home as compared with public institutions. In fact, those who adopt state participation strategies claim there are lower levels of compatibility between the child care centre’s coverage and their own working hours. While 65% of those who adopt low-state participation strategies express child care centres are compatible with their jobs, this rate rises to 83.8% among those adopting low private sector participation, and to 84.9% of those opting for high market participation. This brings into question once again public child care services’ capability to adapt to the work requirements of the adult members of the family. Regarding their labour status, 74% of non-working mothers adopt the familist strategy against 48% of those who have jobs. Among the latter, 19% arrange their children’s care by hiring private services with significant variations depending on the number of hours of paid work. Those women who work up to 20 h/week tend to adopt a familist (62.6%) and a low state participation strategy (24.6%), thereby behaving in a similar way as non-working mothers. This evidences that with the existing half-time public child care services, women cannot have full-time jobs. Women who work more than 20  h a week, on the other hand, largely tend to resort to high market participation strategies accounting for 21.7% of their children’s care. Only 13.1% of children whose mothers work more than 20 h a week are cared for within the framework of low-state participation strategies, i.e. the universal public offer for children in this age range. Therefore, women’s entry in the labour market and regular working hours are likely to promote the development of private sector participation strategies, which in turn brings into question the role of the state (through its free of charge, universal child care offer) as guarantor of women’s right to have paid jobs.

How Is Elderly Care Addressed? As regards older persons’ care, the services offered by the state are remarkably fragmented price- and also quality-wise. Since the state fails, or takes too long, to meet ever-increasing older persons’ care needs, the private sector has become a key provider of services for this age group and the development of its normative framework is currently underway. Of particular interest are Companion Services, private organizations created for the purpose of providing support to families during hospital stays. They were first established in the 1990s, driven by the reduction in personnel at medical centres and the increasing incorporation of women into the labour force, to respond to the need to accompany ill family members, many of them older adults. Since their inception, these services have gained legitimacy in the eyes of Uruguayan families. As a result, they are massively hired, especially by older persons and women. The fact that mostly women hire companion services evidences they take on greater responsibility when it comes to caring for male family members and need to outsource care

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services to fulfil such duty. At the same time, Companion Services have widened their coverage to include companionship at home, reflecting the market’s fast, efficient response to this ever-increasing demand. Another mode of care for the elderly consists of Extended-Stay Residential Institutions. According to the 2011 Census data, there were a total of 903 extended-­ stay board and care homes throughout the country with around 416 (just under 50%) located in Montevideo (Ministry of Social Development [MIDES], 2014, p. 31). In 2011, extended-stay facilities hosted 13,817 people, 11,560 of them over the age of 65 (MIDES, 2014, p. 31). The inter-census period shows a slightly upward trend. While in 1996, 1.6% of people aged over 60 lived in extended-stay board and care homes and by 2011, 2.2% of people over 60 and 3% of seniors 65 and above did so (Cabella, Soto, & Prieto, 2015). Six out of ten people residing at those facilities are 80 or older, most of them (8 out of 10) women. It is especially within this age range that women residing at extended-stay board and care homes are twice as many as men. This explains the rise in the institutionalization of the elderly over the 1996–2006 period (27.6% for women and 16.6% for men) (Cabella et al., 2015). This phenomenon is associated with a growing number of very old women who outlive their male partners and have special needs that cannot be met by their own families. Regardless of the upward institutionalization trend, the rate of elderly people living at residential institutions continues to be low, reflecting the desirable scenarios of care, as 90% of those under 70 state it is most desirable for older people to be cared for at their own home, especially by family members (43%), and only 8% of the population surveyed sees institutionalized care as the ideal (Batthyány et al., 2013). Another mode of care in which family and institutional care can be combined consists of Day Care Institutions where the elderly can stay for a number of hours during the day. In Uruguay, few centres offer this type of services, and it can be asserted that the Uruguayan society has not massively adopted this mode of care for older persons. Contrary to what occurs with the demand for care in Uruguay, which largely comes from the elderly, both female and male family members’ involvement in child care is greater than in that of elderly and handicapped people. As for the number of hours, women devote 22 h a week to caring for older people, while those men who do participate in care do so for 17 h a week. This difference between elderly and child care might be related to difficulties with the EUT instrument used for surveying the tasks performed by the population (the questions refer to irrelevant types of tasks), or for surveying the older adult, dependent population. This poses a challenge which may call for fine-tuning the quantification tool over the next few years.

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 he Social Organization of Care and Public Policies T from a Gender Perspective This section discusses the social organization of care as it relates to the sexual division of labour and in particular, the distribution of paid work and provision of care between men and women. While we acknowledge paid work and care-giving behaviours cannot be analyzed as linear effects of public policies, we can assert such policies do establish the terms for a more or less equitable distribution between men and women. When public policies are restrictive in terms of the cash and services offered for the provision of care, they indirectly promote the “familization” of care and low female activity rates where women either do not join the workforce or only do so part-time. Conversely, when policies provide or facilitate care mechanisms covering the entire workday, they generate favourable conditions for female employment and dual-income couples. Just like other nations in Latin America, Uruguay’s social organization of care is characterized by the family as key provider of care and fragmented access to public and private services and benefits. However, over the past few years, this country has advanced in the development of policies related to the gender agenda and the provision of care due to a series of factors, among them, the existence of academic studies that have contributed conceptualizations and evidence on men’s and women’s involvement in care, official statistical information about care times, feminist social organizations’ efforts, and the political determination to revisit the welfare model. The programmes that make up the new public policies regarding care seek to cover dependants’ care, yet focus on socioeconomically vulnerable families, children, and dependent adults, and provide very limited coverage. Therefore, while the state has incorporated care into public policies, since the 1990s it has always prioritized the most vulnerable sectors of the population. This approach leaves other large sectors with no availability of full-time public care services and difficulties to afford private institutions or outsourced caregivers at home. In the case of children, the scarce existing services for the most part fail to cover the entire workday. As claimed by feminist literature, care policies offering public, full-time services tend to promote more equitable gender relations (Fernández & Tobío, 2006), most importantly because they allow men and women to devote their time to remunerative work on equal terms. However, since there is no evidence that such policies have any impact on the distribution of household chores, from this perspective de-familizing care through extended external care services alone may not be enough. Rather, another transformation should accompany them, so that men also participate in the tasks performed at home. Anyway, the existence of these services generates the need to address child care, which at least helps reduce the time devoted by women to caring, gives the opportunity to engage men in this activity, and, above all, questions the traditional sexual division of labour. As suggested by De Henau and Himmelweit (2013), who analyzed the effects of the different types of care policies in 15 European nations, even when men take on care tasks, to the extent women have the opportunity to have a job and gain access to good care

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services, their financial status improves, bringing about positive changes within the household. Therefore, according to these authors, the availability of quality, affordable care services is one of the few policies that can potentially contribute to intra-­ household gender equality. Furthermore, there are no public services available for 0- to 36-month-old children. The absence of alternative care mechanisms during this period has to do with the generally accepted view that, at this very early stage, babies must be cared for by their families, especially their mothers. In fact, according to the initial documents issued by the National Integrated Care System (SNIC) experts agree and recommend that, until they turn one, babies should be cared within their homes (Etchebehere, 2011). Along this line, a recent study conducted in Uruguay contributes evidence on the content of good child care based on expert knowledge (Batthyány et al., 2013). Research showed there is a type of discourse known as the medical discourse, which has a very strong influence in the representations, practices, and decisions of families regarding care, as well as in public policies. Such view, especially but not exclusively expressed by paediatricians, defines and recommends that babies at this early stage should be cared for at home, in particular by their mothers. On the other hand, a second type of discourse known as the psychological-­educational discourse, questions and challenges mothers and homes as the ideal for providing quality care in all cases. This discourse is closer to the gender perspective, as it admits other agents as providers of care and questions women’s natural abilities in this regard. However, it does not elicit as much support nor is it as influential in public policy decision-making as the medical discourse. Therefore, the absence of institutional mechanisms for this age group is associated with the prevalence of a medical discourse that emphasizes certain aspects related to breastfeeding or prevention of diseases. Yet it fails to prioritize, as does the psychological-educational approach, the care quality link between the provider and the recipient of care. This aspect is essential for the gender perspective and for guaranteeing the right to care. This discourse might promote the development of care services available for children of all ages because quality would be the first priority. From this perspective, options would not be limited to home care, as even if they were provided at home by mothers, care quality could not be guaranteed. Therefore, the development of different care mechanisms for all ages would allow families to choose the best option for their specific needs, thereby promoting quality care bonds. As for policies regarding time, at present there are leave benefits for mothers and fathers and work-time reduction for providing care, as shown in the above section. A change in the leave policy appears to suit the demands of the Uruguayan population. According to the data obtained, most Uruguayans see the home, and especially the family, as the most desirable setting for child care (Batthyány et al., 2013). At the same time, however, historical data evidence the gender mandate regarding the role of women as providers of care is strong, so the most desirable situation for babies up to 1-year old is to be cared for by their mothers (Batthyány et al., 2013). It is precisely at this stage of children’s life that the new legislation seeks to favour co-responsibility in care through greater participation of men. Therefore, the

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possibility to impact care practices through the new legislation depends to a large extent on the social representations of men’s and women’s duties regarding care. The data available to date on the use of half-time for providing care evidences that mostly women (around 87%) make use of this benefit. The massive campaign promoting breastfeeding for newborns up to 6-month old is another factor to be considered (Batthyány, Genta, & Perrotta, 2015). The right to transfer the benefit to the other parent during the 6 months promoted as exclusive breastfeeding period deters fathers from making use of this benefit themselves. Studies on the impact of half-time leave for child care on the sexual division of labour (Morgan & Zippel, 2003) show that, in most cases, it is women who make use of this benefit. Because men see little advantage and abide by gender mandates, they use this subsidy far less than their female counterparts. In fact, they even state that this kind of policies brings about a reduction in women’s employment while their children are young and is likely to reproduce the traditional sexual division of work pattern at home. As for cash and services for older people, these merely consist of regulating the already existing day care and extended-stay centres, which are focused on socioeconomically vulnerable persons. Probably the main innovation in the past few years is the Personal Assistants program, which still offers limited coverage. Through the National Integrated Care System (SNIC), Uruguay seeks to increase the number of care services/benefits offered. One of its goals is to promote co-­ responsibility with regard to care between men and women, and between the state, the market, the family, and the community. Consequently, it aims to generate a change in the current social organization of care and in the sexual division of labour. However, the mechanisms developed up to now are still fragmented and reflect the prevailing familist approach.

Conclusions This chapter started by describing the conceptualizations and the empirical research on gender and care in Uruguay and their permanent connection with policies, which explains why, among other factors, the theme has been incorporated into the public and government agenda. One of the great challenges faced when producing expert knowledge was—and continues to be—to accrue scientific evidence in research while translating it into relevant input for public policies, on the understanding that scholarship must be made available for bringing about transformations that may lead to gender equality. While at the beginning of our journey, we focused on the material aspects of care, particularly on the basis of the quantification of time through time-use surveys  (TUS) and the specific conceptualization of care led to the development of various lines of research on different aspects and dimensions of care. At the same time, each one of these lines of research generated knowledge that was used as input for public care policies. While this connection is not free of tensions, it can potentially be used by the SNIC, especially to generate changes in the sexual division of

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labour. The research findings provided evidence of familism and gender inequalities in care practices and representations, which become apparent in the way policy beneficiaries use and conceive the different services and benefits offered to them. Such findings turn into input that allows policies to implement new actions and modify current ones.2 The development of care policies entails a great challenge for Uruguay, as well as for the entire Latin American region. It aims not only to design a public policy for the dependant but also to bring about a cultural transformation: that of the sexual division of labour, which is currently in line with a familist approach, into more equitable models characterized by solidarity and co-responsibility. There is a risk that the gender perspective may be just a statement of principles explicitly described as the guiding principle of policies, but which fails to translate into actions leading to the transformation of the sexual division of work through the cash and services offered to each target population. Otherwise, we will run the risk of implementing actions that may go against gender equality or maintain the current status quo. In order to avoid this risk, it is necessary to devise other innovative policies so as to redistribute tasks within families. Such policies not only should target families but also should have an impact within the household.

References Aguirre, R., Batthyány, K., Genta, N., & Perrotta, V. (2014). Los cuidados en la agenda de investigación y en las políticas públicas en Uruguay. Íconos, 50, 43–60. Batthyány, K. (Ed.). (2015). Los tiempos del bienestar social. Género, trabajo no remunerado y cuidados en Uruguay. Montevideo: Inmujeres, MIDES. Batthyány, K. (Coord.), Genta, N., & Perrotta, V. (2013). La población uruguaya y el cuidado. Análisis de representaciones sociales y propuestas para un Sistema de Cuidados en Uruguay. Montevideo: Ministry of Social Development (MIDES). Retrieved January 27, 2018, from http://209.177.156.169/libreria_cm/archivos/pdf_36.pdf Batthyány, K., Genta, N., & Perrotta, V. (2015). Avanzando hacia la corresponsabilidad en los cuidados: Análisis de las licencias parentales en el Uruguay (Serie Asuntos de Género No. 128). Santiago: CEPAL. Batthyány, K., Genta, N., & Perrotta, V. (2017). El aporte de las familias y las mujeres a los cuidados no remunerados en salud en Uruguay. Revista Estudos Feministas, 25(1), 187–213. Batthyány, K., Genta, N., & Perrotta, V. (2018). Uso de licencias parentales y roles de género en el cuidado. Sistema de Cuidados. Montevideo: MIDES. Batthyány, K., Genta, N., & Scavino, S. (2018). Cambios y permanencias en las estrategias de cuidado infantil en el curso de vida: Un análisis de género (Documento de trabajo).

2  At present, we face new challenges related to the need to develop knowledge that may contribute to the update of public policies, that is, the need to create a specific tool, different from EUT, which may help measure care, gain an insight into the strategies developed by households to meet care needs, and into the institutional, cultural, gender, and economic factors that play a role in the adoption of such strategies. At the same time, this tool will generate knowledge about the care-related costs incurred by households and women, in order to improve their tool for surveying the population benefitted by the policy and offer services/benefits to better suit their needs.

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Batthyány, K., Perrotta, V., & Scavino, S. (2020). El trabajo remunerado de las mujeres madres a lo largo de tres generaciones: ¿un camino hacia la igualdad de género? Dados. Cabella, W., Soto, M.  F., & Prieto, V. (2015). Las transformaciones de los hogares uruguayos vistas a través de los censos de 1996 y 2011 (Calvo, J. J. (Coord.)). Montevideo: INE UNFPA. Carrasco, C., Borderías, C., & Torns, T. (2011). Introducción. El trabajo de cuidados: Antecedentes históricos y debates actuales. In C. Carrasco, C. Borderías, & T. Torns (Eds.), El trabajo de cuidados: Historia, teorías y política. Madrid: Catarata. Carrasquer, P. (2013). El redescubrimiento del trabajo de cuidados: Algunas reflexiones desde la Sociología. Cuadernos de Relaciones Laborales, 31(1), 91–113. Daly, M., & Lewis, J. (2000). The concept of social care and the analysis of contemporary welfare states. British Journal of Sociology, 51(2), 281–298. De Henau, J., & Himmelweit, S. (2013). Examining public policy from a gender intra household perspective: Changes in family-related policies in the UK, Australia and Germany since the mid-nineties. Oñati Socio-Legal Series, 3(7), 1222–1248. Retrieved January 27, 2018, from http://ssrn.com/abstract=2296683 De Miguel, A. (2005). La articulación del feminismo y el socialismo: El conflicto clase-género. In A. De Miguel & C. Amorós (Eds.), Teoría Feminista: De la ilustración a la globalización (Vol. 1, pp. 295–332). Lisbon: Minerva. Etchebehere, G. (2011). Documento base de población infancia. Montevideo: Ministry of Social Development (MIDES). Retrieved January 27, 2018, from http://www.sistemadecuidados.gub. uy/innovaportal/file/13381/1/documento_de_infancia_-_sistema_de_cuidados.pdf Fernández, J.  A., & Tobío, C. (2006). Conciliar las responsabilidades familiares y laborales: Políticas y prácticas sociales. Madrid: Fundación Alternativas. Graham, H. (1983). Caring: A labour of love. In J. Finch & D. Groves (Eds.), A labour of love: Women, work and caring (pp. 13–30). London: Routledge. Graham, H. (1991). The concept of caring in feminist research: The case of domestic service. Sociology, 25(1), 61–78. Hartman, H. (1973). El infeliz matrimonio entre marxismo y feminismo: Hacia una unión más progresista Entre teoría y práctica. Teoría y Práctica, 12/13, 1. Retrieved February 15, 2018, from https://www.scribd.com/document/138100718/ Hartman-El-Infeliz-Matrimonio-Entre-Marxismo-y-Feminismo Himmelweit, S. (2011). El descubrimiento del trabajo no remunerado: Consecuencias sociales de la expansión del término trabajo. In C. Carrasco, C. Borderías, & T. Torns (Eds.), El trabajo de cuidados: Historia, teorías y política (pp. 199–224). Madrid: Catarata. Hochschild, A. (2003). The commercialization of intimate life: Notes from home and work. Berkeley: University of California Press. Ministry of Social Development (MIDES). (2014). Cuidados como sistema. Montevideo: SNC MIDES. Morgan, K., & Zippel, K. (2003). Paid to care: The origins and effects of care leave policies in Western Europe. Social Politics: International Studies in Gender, State and Society, 10(1), 49–85. https://doi.org/10.1093/sp/jxg004 Recio, C. (2010). Familismo, asistencialismo y precariedad. La configuración del empleo en el sector de atención a las personas. Alternativas. Cuadernos de Trabajo Social, (17), 19–43. Retrieved February 14, 2018, from http://rua.ua.es/dspace/handle/10045/14295 Thomas, C. (2011). Deconstruyendo los conceptos de cuidados. In C. Carrasco, C. Borderías, & T. Torns (Eds.), El trabajo de cuidados: Historia, teorías y política (pp. 145–176). Madrid: Catarata. Ungerson, C. (1990). Gender and caring, work and welfare in Britain and Scandinavia. London: Harvester Wheatsheaf.

Chapter 10

Social Organization of Care in Chile Irma Arriagada and Francisca Miranda

Introduction Care and Social Care Organization: Some Definitions In the specialized literature and in the current political debates, care refers to all the activities necessary for the well-being of people, whether they are remunerated or not. In a broad sense, care refers to the generation and management of the resources required to support life on a daily basis and health and to the daily provision of physical and emotional welfare of people throughout the life cycle. It is assumed that during the life cycle, there are circumstances or stages in which intensive and/ or specialized care is required, for example, in early childhood, during illness, when a disability is experienced and in situations of elderly dependency. On the other hand, it is considered that in general, all people are or will be, at some point in their lives, caregivers as well as care recipients (García-Calvente, Mateo-Rodríguez, & Eguiguren, 2004). There has also been some progress in distinguishing the different components of care: (a) material, which implies the time spent in carrying out the task and its subsequent economic cost involved; (b) cognitive, which concerns the necessary knowledge and skills in order to perform it; (c) relational, which refers to the bonds between the person who cares and the one being cared; and (d) emotional, which alludes to a certain management of the expression of emotions (caring people and caregivers) (Aguirre, 2009, 2011, p. 91; Batthyány, Genta, & Perrota, 2014). Other authors distinguish between direct and indirect care. The direct one implies its I. Arriagada Center for Woman Studies (CEM), Santiago, Chile F. Miranda (*) Department of Education, Psychology and Family Studies, School of Family Studies, Finis Terrae University, Santiago, Chile © Springer Nature Switzerland AG 2021 N. Araujo Guimarães, H. Hirata (eds.), Care and Care Workers, Latin American Societies, https://doi.org/10.1007/978-3-030-51693-2_10

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material provision, the response to physical and biological needs, that involves transferring time and face-to-face interactions between the people who grant and those who receive care. The indirect care involves activities of monitoring the services received and other support services such as cleaning or cooking that provide preconditions for direct care (Arriagada & Todaro, 2012). In its varied forms, care has analogous characteristics to salaried work, as it requires spending time and energy to be performed (here an opportunity cost is appointed), it is also a part of the division of labor (the contributions of women and men to the household are different) and produces goods and services (food, cleaning) which are independent from the person who executes care; hence, it can be produced by the market, although under different production relationships (Carrasco, 2006). Carol Thomas (1993) raises the epistemological status of care and the need to specify what types of care are we referring to when starting a research. She proposes seven components within a multidimensional concept of care. These are: (1) Social identity of the caregiver, which refers to his or her defining social characteristics, either in terms of family or professional roles; (2) Social identity of the recipient, which refers to the social characteristics of the person receiving care, and their level or situation of dependency; (3) Interpersonal relationships between the caregiver and the care recipient; (4) Nature of care; (5) Social domain in which the relationship of care is located, namely the distinction between public and private spaces, since the care provided in these two areas have different characteristics; (6) Economic nature of the relationship of care, to distinguish whether it is a wage-­ earning or unpaid relationship; and (7) Institutional framework and physical location in where care is provided. Following these broad definitions of care, the text will refer to care as the goods, services, and activities that allow people to eat, educate, be healthy, and live in an adequate habitat (Arriagada & Todaro, 2012). Care is considered not only as an individual need but also as a socially constructed responsibility and, therefore, as a public policy problem beyond the private and family sphere fulfillment. Therefore, in order to address the current social organization of care in Chile, the care necessities of Chilean population and the services, institutions, and people who provide them will be analyzed. This chapter will conclude with research and public policy recommendations to improve the current gender and class inequality in the model of care present in Chile.

Social Care Organization The social organization of care refers to the way of distributing, understanding, and managing the need for care, which is at the base of how the economic system and social policy operates. In order to define the social organization of care it is necessary to consider both the existing demand for care and those who provide the services to cover that demand and how the welfare regime handles the need for care as well as how much corresponds to the market and to the families (Arriagada & Todaro, 2012).

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In general, societies have the need to distribute goods and services in order to ensure the delivery of welfare and proper social protection to members. The dilemma of care refers to the weight and importance given to each of the systems that provide care (State, market, families, community) and to what criteria is that balance based on. This care dilemma has adopted different forms at different historical moments or models of social organization (O’Connor, 1996), in our society the burden lies heavily in women. The organization of care in Chile has a mixed character, as care can be provided by public and private organizations, inside and outside homes and families. At home, domestic and care work are carried out mainly by women without any payment, there are also paid caregivers, such as domestic workers, nannies, and babysitters, among others, and in-home medical and nursing services, aimed at higher income sectors. Outside home, in the modalities of the State and the market, activities include private services for childcare: daycare centers/nurseries, preschool care, and primary education. Also there are residential services for seniors and clinics, usually with very high costs. State-run public services also offer child and elderly care: daycare centers, kindergartens, daily care of the elderly centers, long-stay centers, hospitals, and health posts. Finally, community organizations also include services offered by volunteer caregivers, community organizations with international support, charities, and others. All these activities involve complex organization and planning and frequently maintain flows between them depending on sufficiency and opportunity of the provision. Thus, if the State-run public offer does not provide enough coverage or schedules, it becomes indispensable to go to the market, for paid or unpaid care within the home or/ and to informal care. Similarly, if the State’s offer is residual and income is insufficient to hire the services in the market, the non-State public offering available will be the one to go to: NGOs, religious institutions, and volunteers (Rodríguez, 2007).

 elfare and Care Regime in Chile: Inequality by Class W and Gender In Chile, the development of social policies related to care for children, elderly, and diseased has a long tradition that began in the last century. From the 1990s, until the current period, post-dictatorship governments sought to correct the inherited socioeconomic model and improve the living conditions of the population, reducing and regulating market action as a way of allocating and providing goods and services. Two fundamental reforms can be outlined in this line: the AUGE health program during the administration of Ricardo Lagos and the pension reform during the first government of Michelle Bachelet. They allowed access to health and retirement benefits for the poorest population. In spite of the improvements, at present, there is no articulated system of care that coordinates the diverse existing policies of education, health, and social security. It is important to highlight, however, the efforts to promote public, private, and family co-responsibility and the challenges that exist for the achievement of “de-feminization” of care, which faces deep cultural barriers.

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 he Hybrid State-Mercantile and “Familistic” Character T of Care, Predominantly Female The Chilean model corresponds to a model of private care with public support. It sustains itself through a systematic dependence on the family, namely, on women for the provision of care work and services, based on the principles of subsidiarity. Faced with growing demands, the level of public offer, although it has increased since the 1990s onwards, still is not enough to cover all the care needs of the population. Meanwhile, private provision is expensive and there are neither structures of care compatible with the multiple needs of families and people who require care nor alternatives to informal care. It is also observed an increase of dynamics of commodification of care, without an adequate or sufficient and proper design of social services for individuals and families, a situation that can be intensified with the new government in charge. A Social Protection System based on rights was created in 2012 (law 20.595) during the second government of Michelle Bachelet, which aims to cover the most pressing needs of 60% of the poorest population. Within this scheme, the following subsystems are running: (a) Child Protection Subsystem;1 (b) the Subsystem of Securities and Opportunities for families in poverty and extreme poverty that replaced the Chile Solidario program and the Ingreso Ético Familiar program; and (c) the recently created Subsystem of Supports and Care that is oriented to people with special long-term care needs: elderly and dependent people, and their caregivers. However, the proportion of the budget allocated in 2018 to the three subsystems is very different: Subsystem of Securities and Opportunities (79.3%; Child Protection Subsystem: 17% and Subsystem of Supports and Care, 3.7%) (Table 10.1). Along with ratifying the Convention on the Rights of the Child in 1990, the State and public offer of childcare, specifically preschool education, increased very significantly under the two governments of President Bachelet. More than half of the children between 0 and 5 years old attend preschool education, while those between 4 and 5  years old reach coverage of 90.1%. The main deficit lies in those under 3 years old (29%) and in the lowest income quintiles. Care-oriented policies have been developed in a partial manner, such as the case of the 6-month parental leave, which includes the possibility of transferring 6 weeks to the father (or 12 weeks of part-time). However, in 7  years of surveillance of the law 20.545 of 2011, only 0.2%2 of the fathers3 have taken this permit, making evident the necessity to encourage the use of this permission, perhaps by a modality in which the one who does not take it loses it. 1  The three Subsystems are: Chile Crece Contigo, Seguridades y Oportunidades y Apoyos y Cuidados. 2  Data from Superintendence of Social Security. 3  However, there has been an increase in fathers leave to care for ill children under 1  year old, which increased from 107 to 6744 between 2007 and 2017, that is from 0.09% to 8.9% of total licenses (Superintendence of Health).

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Table 10.1  Chile 2018: Offer of services of the National Subsystem of Supports and Cares Scope of action of the subsystem Home care

Services of the national subsystem of support and care Home Care Program Home Care Service—“Breathe” Home Care for People with Severe Dependence Support Devices Functional Housing Adaptation Program—“ADAPTA” Family Heritage Protection Program Transit to Independent Life Technical Aids Guidance and “Educational Action” Program Information Services Mental Disability Subsidy Basic Solidarity Pension (Old Age and Disability) Solidarity Pension Contribution (Old Age and Disability) Family Subsidy (DUPLO) Transfers (income and/ Stipend for caregivers of people or goods) with severe dependence. Specialized Service—Local Network of Supports and Cares. Residential Care Long-Stay Establishments for (Institutionalized) Older Adults (ELEAM) and ELEAM Funds Residences and Protected Homes Social and Community Senior Adult Day Centers Care Dementia Day Centers

Institutional dependence Elderly National Service (SENAMA) Ministry of Health (MINSAL) National Disability Service (SENADIS)

Ministry of Labor (MINTRAB)

Social Development Ministry (MIDESO) Ministry of Labor (MINTRAB) Ministry of Housing and Urbanism (MINVU) Elderly National Service (SENAMA) Social Development Ministry (MIDESO) Elderly National Service (SENAMA) National Disability Service (SENADIS)

Source: Chile, Social Development Ministry

Chile has signed the Inter-American Convention on the Protection of Human Rights of the Elderly and has an Integral Positive Aging Policy (2012–2025) that represents a turning point in the care offer for aged adults, as it embodies a long-­ term model in order to meet the functionality and autonomy of the elderly in the country. This policy was translated into three fundamental social programs, differentiated according to the dependence level: (1) daycare centers for the elderly with low dependency level; (2) homecare for the elderly with moderate or severe dependency who can continue residing in their homes, and (3) a subsidy to long-stay establishments administered by nonprofit institutions for the elderly with severe dependence (Fernández, Herrera, & Caro, n.d.). Despite these efforts, which include interministerial coordination (Ministries of Health, Social Development, Labor, Housing and Urbanism, and National Services for the Elderly (SENAMA) and the Disabled (SENADIS)), coverage is insufficient for the existing demand. Moreover,

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there is a shortage of medical and support staff: during 2018, there was approximately one geriatrician per 20,000 inhabitants while it is estimated that the demand for geriatricians reaches only 300 people, all these in a population that in 2030 will reach more than three million of elderly. The same critical situation is seen in relation to trained nurses and assistant personnel specialized in geriatrics. Chile has ratified the United Nations Convention on the Rights of Persons with Disabilities and its Optional Protocol and has a National Policy for the social inclusion of persons with disabilities 2012–2020. In it, various areas of action in health, education, job training, access to justice, culture, recreation and sports, and promotion of rights are defined. Studies from 2013 show that the disability reached 19% of the population, which is very unevenly distributed in the Chilean population, as lower income families are the ones who need more support to cover the care of the disabled population.

Growing Demand for Care in Chile The crisis of the care model has a twofold dimension: on the one hand, it refers to the social reproduction due to the increase in demand and the complexity of the care. This occurs simultaneously with the offer reduction of potential caregivers, which hinders the daily reproduction of people. On the other hand, we can speak of a crisis of long-term social reproduction, such as the difficulty of ensuring the reproduction of a large part of households. Along with the few possibilities, they have to reach satisfactory levels of well-being in multiple dimensions, including care (Pérez Orozco, 2009). The growing demand for care in Chile is due to both demographic and sociocultural factors, including the incorporation of women into paid work and family transformations, among others.

Demographic Dimension Chile is positioned as a country in advanced demographic transition within Latin America, along with Argentina, Cuba, and Uruguay, with a substantial aging of population, that is, with low birth and mortality, which establishes a reduced natural growth of the population. Only recently has the immigrant population explosively increased. The total fertility rate according to the latest census data for 2017 reached 1.6% below the replacement level. Even though Chile is not among the countries with the greatest aging in the Latin American region, a remarkable aspect, unlike the developed countries, is the rapidity of the demographic variations as can be seen in the changes in the population age pyramid (Fig. 10.1). In this way, the age pyramid has been modified, indicating a reduction among minors and an increase in the elderly population.

10  Social Organization of Care in Chile 1990 97

Men

171 2050

2018 Men

Women

Men

Women

85

97

97

73

85

85

61

73

73

61

61

49

49

37

37

49 37 25

25

25

13

13

13

0

0

-2,00,000 -1,00,000

0

1,00,000

2,00,000

-2,00,000

Women

0 -1,00,000

0

1,00,000

2,00,000

-2,00,000

-1,00,000

0

1,00,000

2,00,000

Source: INE, Estimates and projections of the population of Chile 1992-2050. Total country Summary of Results National Statistics Institute December 2018

Fig. 10.1  Chile 1992, 2018 and 2050: Pyramids by sex and age. (Source: Instituto Nacional de Estadísticas (INE). (2018a). Estimaciones y proyecciones de la población de Chile 1992-2050. Síntesis de resultados. or INE (2018a). Estimates and projections of the population of Chile 1992– 2050. Total country Summary of Results, December 2018) 2,00,000 and 1,00,000

In 2017, the population over 65 years old reached 11.4% of the total, the latest projections of INE indicate that by 2050 this group will double, reaching 25%. According to this projection, in 2031, the proportion of older people would exceed that of those below 15 years old. In 1992, the aging index, that is the proportion of people aged 65 and over compared to the group between 0 and 14 years old, was 21%; in 2031, it is expected that for every 100 children under 15 years old there will be 102 older adults, reaching 177 by 2050 (Instituto Nacional de Estadísticas [INE], 2018a). Accordingly, the life expectancy of the population has been growing and currently reaches 79.7  years: 77  years for men and 82  years for women. In the future, there will be a larger population to care for and fewer caregivers. In summary, it is possible to observe an accelerated aging of the total population, with aging of old age (increase of those older than 75 years) and the feminization of it, more women in those age segments.

The Family and the Cultural Dimension Another important aspect to consider when analyzing care is the reduction of people available to care, given the changes within the family: the size of the household has been reduced, the mobility of its members has increased, families have adopted more diverse and complex forms of coexistence, there has been a reduction of extended families and two-parent families where there were more people to care for, and single-parent families have increased (85% were female heads of households, as per the 2017 census). Accordingly, there is an absence or a weak presence of the father, increasing family financial difficulties and care. Similarly, the expansion of women’s labor participation is growing: in 2010, the economic participation rate was only 45%, and in 2017, it reached 48%, whereas the highest rates were among women of childbearing age between 25 and 45 years old. There are important gender gaps in participation, in unemployment, in informal

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employment, and in salaries (the average salary of women is between 20% and 30% lower than the average salary of men and the gap is greater among workers with higher education). The participation of women in the labor market takes place in service occupations (women are also the ones who care for them in a remunerated way) but many occupations are precarious and involve low incomes. The increase in participation in the labor market does not occur with a redistribution of tasks within the home, so it usually means for women a double working day, a situation often aggravated when they have small children or aged adults with disabilities that need to be taken care of. The social imaginary that serves as the basis for public policies—and the opinion of the majority of the population—considers women mainly in their role of mothers and caregivers, to a detriment of their role as workers. The scenario is still more complex, as there is a high inequality in the distribution and provision of care according to age, gender, class, kinship, and groups that require care and territory (the most unprotected are rural areas). In other words, those who most require it do not receive the corresponding care. Pensions and care benefits associated with retirement tend to depend on the time intervals spent on paid employment, particularly in the formal sector of the economy, and on the income received, which in the case of women periods of unemployment are present when dedicated to the upbringing, have social security gaps, informal jobs, and smaller incomes. This situation exacerbates the disparities between the rich and poor households and between women from different socioeconomic strata, since those with lower incomes cannot purchase care services to replace them in their domestic work, reproducing inequality patterns. This, in turn, leads to women in the same society who can resort to receive remunerated care and others, with low income, who are restricted in matters of time and income. In Chile, care inequalities observed among different socioeconomic groups are due to the different public–private combinations and to the quality of the care services received. There is a continuum among families whose extreme goes from the complete lack of access to care, as in the case of the population in extreme poverty who does not access the benefits of public policies oriented towards it (called hard poverty), until the population of higher income levels that can access private and quality care. Between both extremes, different situations can be distinguished: among the poorest sectors, care is mainly carried out by mothers, and among those who work, there is combination with family support (grandmothers, sisters) or neighbors (“comadres,” neighbors) who carry out this care work with and without payment. In some cases, there is also coordination with the use of daycare centers, kindergartens, and open care centers for the elderly of a public nature. In the intermediate levels, the kindergartens and the care centers for the elderly are combined with domestic work paid by days and/or hours. In the upper income levels, families have access to nurseries, kindergartens, and private adult care centers, which are combined with domestic work paid by working days in the form of outdoors domestic work. It is also in these sectors where they are able to hire paid domestic work indoors (Arriagada, 2013, pp. 103–104).

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Care and Domestic Work Offer Unpaid Domestic and Care Work in Chile In Chile, according to data from the 2015 Time-Use Survey, the distribution of paid and unpaid work was very highly unequal by gender and socioeconomic stratum. Domestic and reproductive work in the household, as well as the care responsibility for dependents, continue to be culturally recognized as the female functions. In terms of hours, men spend a total of 2.7 h on unpaid work in a typical day, while women spend 5.9 h (INE, 2016). This translates into gender inequalities that undermine opportunities and conditions for women’s labor insertion, generating a double pressure on them—as a family care and as a worker—that increases among those who are living in poverty. The data indicates that when women enter the labor market, they continue to adapt their paid and personal working time to the demands of family care, which not only implies facing a “double working day” but also makes them the main responsible for the reconciliation of the domestic sphere with the productive sphere, along with mental burdens and worrying concerns for their health and quality of life (INE, 2016). When analyzing the total workload (which measures unpaid and paid work, together with transportation time), it is possible to verify that Chilean women perform a greater proportion of paid and unpaid activities than men (see Figs. 10.2 and 10.3). In the employed population of 15  years old, the total workload presents Time in hours, Day type Occupied Men

Occupied Women

Unemployed Men

Unemployed Women

Inactive Men

Inactive Women

4.5 3.84

4 3.5

3.08

3.05

3 2.5 2

1.84

1.75

1.5

1.2

1 0.5 0

Men

Women Occupied

Men Women Unemployed

Men

Women Inactive

Source: National Survey on Use Time, 2015.

Fig. 10.2  Unpaid Care Work in the population aged 15 and over by sex labor market: Time in hours, day type. (Source: INE, National Survey of Use Time, 2015)

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Unpaid work

Paid work & transportation

120.0

100.0

80.0

27.6 41.8

47.6

53.7

56.0

46.3

44.0

Quintile 4

Quintile 5

46.0

60.0

40.0

72.4 58.2

20.0

0.0

Quintile 1

Quintile 2

52.4

Quintile 3

54.0

Total

Source: INE, National Survey of Use Time,2015 Fig. 10.3  Chile, 2015: Distribution of the time allocated to the global workload in the population aged 15 and over, according to the income quintile. (Source: INE, National Survey of Use Time, 2015)

p­ ronounced gender differences: 9.78 h for men and 11.46 h for women on a weekday, and on a weekend day the load of hours is lower but still an important difference is maintained by sex; moreover, the participation of women in domestic work and care intensifies during the weekends. By observing the distribution of activities of men and women it is possible to verify that whatever the employment relationship (employed, unemployed, or inactive), women allocate more hours to care work than men. It is striking to observe that even if men are unemployed or inactive, the time spent on caregiving does not change (Fig. 10.2), confirming the cultural attribution of that work to women. When examining the distribution of the population separated by income quintiles and disaggregating the time allocated to the global workload in its components: occupational work and associated transport journeys, along with unpaid work, it is observed that as the socioeconomic level increases, the proportion of time invested in unpaid work decreases, and in quintiles 4 and 5, these proportions are inverted. So, if in quintile 1 the population allocates 72.9% of time to unpaid work and 27.1%

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to occupational work and transport journeys, in quintile 5 unpaid work demands 44% while paid work 56% of the time (Fig. 10.3).

Paid Domestic and Care Work in Chile Paid domestic work is a decisive strategy for family domestic organization and a key link in the social organization of care, in contexts of limited public supply of care services and lack of family co-responsibility models that ensure an equitable distribution of work in homes. According to Economic Commission for Latin America and the Caribbean (ECLAC, 2018) in Latin America, 10.7% of women find in domestic work a gateway to the labor market. It is a feminized activity that concentrates 95% of the female workers in this type of services. As shown in the previous sections, it is expected that in the upcoming years the demand for domestic service will increase exponentially, given the demographic, family, and socio-­ cultural factors outlined. In recent decades, in Chile, the proportion of domestic work in female occupation has decreased, although it is necessary to emphasize that the true magnitude of this occupational category is underestimated. This is mainly due to the way in which labor statistics are collected, having difficulties to circumscribe the tasks that are carried out in private homes, either because there are workers who work per day and are counted as self-employed workers and not as domestic workers or due to a misclassification during coding (due to the wide variety of tasks they perform) (International Labour Office [ILO], 2012). According to data from the National Labor Survey of INE (ENE), from 1990 to 2016, domestic employment in Chile has been reduced by 10 percentage points, and the domestic employment category in 1990 was 19.3% and in 2016, it reached 8.9%. Data from the INE New Labor Survey (INE, 2014, 2018a, 2018b), available under its new measurement methodology4 for a more recent period (2010–2018), also show that the proportion of women employed in domestic service decreased by 11.6% to 8.2% (Fig. 10.4), which in absolute terms corresponds to a decrease from 322,447 domestic workers in 2010 to 283,253  in 2018 (including outside and inside doors). The decrease in domestic employment is associated with the expansion of employment opportunities in other economic sectors for Chilean women (mainly commerce and services) causing the supply of domestic workers to diminish, most of whom work in the outdoors modality (Fig. 10.5). Foreign domestic workers have

4  In 2010, the National Institute of Statistics implemented a change in the methodology for measuring employment, shifting from the National Labor Survey (ENE) to the New National Labor Survey (NENE). As the employment series that link both methodologies are not available, for this study the decision was to present only the data for the period 2010–2018.

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14.0 11.6

12.0

11.7

11.2 10.0

10.0

9.8

9.1

8.9

2015

2016

8.4

8.2

2017

2018

8.0

6.0 4.0 2.0

0.0 2010

2011

2012

2013

2014

Source: INE, New National Survey of Labor. Fig. 10.4  Chile, 2010–2018: Employed women in domestic service in relation to the total of women employed. Source :Instituto Nacional de Estadísticas (INE). (2014, 2018). New National Labor Survey (NENE) quarter. July-August- September 2014 and 2018. Or INE, New National Survey of Labor, 2014, 2018 Or INE (2014, 2018). Outdoors

Indoors

400000 350000 300000 57788.75

58107.5 53714.25 53346.5 49370.75 38975.25 41271.5 42541.75 44119.33333

250000 200000 150000

264658.25

289989.5 286839.75

100000

261006 266408.25 260076.5 254274 243611.5 239133.6667

50000 0

2010

2011

2012

2013

2014

2015

2016

2017

2018

Source: INE, New Survey of Labor Fig. 10.5  Chile, 2010–2018: Number of Women Occupied in Domestic Service by Type. (Source: INE, New Survey of Labor). Source: Instituto Nacional de Estadísticas (INE). (2014, 2018). New National Labor Survey (NENE) quarter. July-August- September 2014 and 2018. Or INE, New National Survey of Labor, 2014, 2018 Or INE (2014, 2018)

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fulfilled the demand for domestic service, especially in the “indoors” modality (Ministerio de Desarrollo Social, 2015). According to the 2015 CASEN Survey of the total number of women working in this sector (271,345  in 2015), 92% are Chilean nationals and 8% are from other nationalities. Of the latter, 13% do it in the indoors modality, a higher proportion than the one presented by the domestic workers of Chilean nationality (Bravo & Órdenes, 2016, p. 11). In recent years, in Chile, paid domestic work has been part of a labor agenda that seeks to progress towards gender equality and eradicate discrimination in the realm of work, under the auspices of ILO Convention 189 on “Decent Work for the workers and the domestic workers.” The struggle for labor rights sustained by workers’ organizations, with the support of state and political actors, has allowed a series of legislative improvements (Table 10.2).5 Paid domestic work in Chile is regulated by the Labor Code which stipulates that for legal purposes “private household workers are those who commit in a personal, continuous, and full or part time service to one or more individuals or a family, in cleaning and assistance work that is inherent to a home. Persons dedicated to the caring of people with special assistance needs and drivers are also subject to these special provisions” (Article 146 of the Labor Code) (authors translation). Regardless of improvements to the working conditions of domestic workers that the legislative progress involves, the legislation is not being fully complied. Particularly in the case of outdoor female workers, who despite of having improved their situation in the period, do not have access to vacations, to days paid for illness, to social security, to health coverage, to unemployment insurance, to parental leave, and to daycare centers (Table 10.3). A strategy of administrative simplification was implemented in Chile (Compulsory Labor Contract Registration, applied since 2015 for domestic workers) to streamline the procedures for registering the work contract, allowing the monitoring of the working conditions of domestic workers and to identify irregularities of the employer (for example, in relation to the salary amount, giving a period of 15 days to amend it).6 Despite these improvements, still the informality of the sector and the difficulties to perform inspection tasks has a non-compliance impact, especially in matters of health and social security. While 83% of indoors domestic workers were affiliates to social security by 2018, only 38.8% of outdoors workers were in the same condition (Table 10.3). However, it should be noted that Chile registers higher levels in relation to the Latin American average, which reaches 26.9% (ECLAC, 2018, p. 195). Another source of information (Ministerio de Desarrollo Social, 2015) states that 48% of domestic workers declare not having signed any employment contract, 5  However, the organizations of domestic workers in Chile evidence a weak participation, a limited contribution (some do not charge fees in order to expand their actions or other times payment is scarce), the need to strengthen the regional/local representation of the unions, difficulties in developing a common membership strategy in international participation structures (CONLACTRAHO, FITH) and a limited collective bargaining capacity due to the lack of organization of employers. 6  http://www.dt.gob.cl/portal/1627/w3-article-104689.html

1991

1968

Law 19.010

Law 16.744

After 1 year of work: 15 working days. After 10 years of work: 1 additional day of vacation for every 3 new years worked. The Labor Inspection has the faculty to visit the domicile of contracts registered from March 1st, 2015 onwards.

Paid annual holidays

Inspection

Occupational risks

Compensation

Weekly rest (outdoors regime)

Maternity rights

Conditions of dismissal

Remuneration

Social Security

Inclusion of domestic workers in compulsory social insurance against risks of Occupational Accidents and Illnesses, at the employer’s expense.

Compensation is financed by the employer through a contribution equal to 4.11% of the remuneration.

For the outdoors workers, the weekly rest will be governed by the general norms of the Labor Code that sets the days of Sunday and the holidays as days of rest.

Extension of maternity rights.

Indicates that the dismissal carried out without having the payment of pension contributions up to date makes it null and void.

Extension of the minimum monthly income, applicable to 100% of the sector starting from March 2011.

Minimum tax base for contribution to the social security system (pensions)

Extension of the right to holidays.

1st, 2015 onwards.

As of November 2015, workers indoors will have the right to rest on Saturdays, Sundays, and holidays. Previously the rest was of a full day per week in addition to national holidays.

Weekly rest (indoors regime)

Legal holidays

Not lower than the general minimum wage excluding food and room expenses, paid by the employer.

Remuneration

Additional working Up to 15 extra weekly working hours with a minimum 50% surcharge on the hour value corresponding to a regular day. hours

Reduces the weekly working time from 72 to 45 h for the workers outdoors, which can be distributed in a maximum of 6 days/week. For indoors workers, the working time is not subject to hours, but they will be entitled to absolute rest every day for 12 continuous hours.

Limitation of the working time

Description Compulsory written contract for indoors and outdoors regime, with registration within the 15 following days to its conclusion in the Labor Inspectorate, without which the employer will be fined.

Normative

Contract

Source: Prepared by the authors based on Órdenes (2016), Donaire (2014), Bravo and Órdenes (2016), Barros and Barrueto (2007) and data from the Ministry of Labor and Social Security of the Government of Chile

1998

1993

Law 19.591

Law 19.250

2008

1999

2008

Law 20.255 Article 98

Law 20.279

2009

Law 20.336

Law 19.631

Year

2014

Law

Law 20.786 (In force since January 1, 2015 and with different application phases)

Table 10.2  Legal reforms made in Chile in favor of paid domestic work

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Table 10.3  Chile, 2014 and 2018: Employee and domestic service benefits (In percentages) Employee Private Benefits 2014 2018 Annual holidays 75.5 78.5 Days paid for illness 81.4 82.1 Social Security/AFP, INP, others 83.8 83.7 Health Insurance (ISAPRE, FONASA) 84.1 84.3 Unemployment insurance 80.5 82.2 Parental leave 74.3 76.1 Children care centers 26.5 28.8

Public 2014 2018 84.2 88.9 87.2 89.9 87.2 88.4 87.2 88.7 56.4 57.1 83.1 86.7 50.3 53.0

Domestic Service Indoors Outdoors 2014 2018 2014 2018 86.2 78.1 39.2 41.6 87.5 83.1 35.1 39.5 85.0 83.1 35.7 38.8 85.0 83.6 35.8 39.8 77.6 76.4 31.0 36.2 63.8 59.5 24.5 28.8 2.5 0.2 1.2 1.0

Source: Own elaboration based on the INE (2014, 2018a, 2018b)

which leads to substantial shortcomings in terms of social protection, as coverage for health issues, work accidents, and pensions for advanced age. The inexistence of employment contracts is explained due to the unawareness of rights of domestic workers, especially of those who work sporadically or only some days per week; due to the will of the worker, who in some cases prefers to continue being dependent of the husband, to have access to cash in the face of domestic or financial emergencies; or due to the imposition of some employers, and the consent by the workers, because of their imperative need to work without any access to other formal sources of work (Grupo Nous, 2010).

Migrant Workers and the Existence of Global Care Chains The feminization processes of intraregional migration have contributed to transform the modalities of domestic work and care in Chile. The provision of domestic workers is increasingly associated with migratory processes that have ceased to be rural-­ urban to become intra-regional migration, including the formation of migratory corridors between bordering countries (Soto, Soto, González, & Dobrée, 2016). Facing the insufficiency of policies to reconcile work and family, together with the anxiety generated by the pressure to care for, the response of Chilean households in middle- and high-income sectors has been the hiring of foreign domestic workers, giving rise to bi-national care. The chains of care link homes with similar needs in the reproductive sphere, but with different capacities to cope with them. At one extreme, migrant workers are hired to solve the daily burden of domestic work. At the other extreme, migrant workers transfer responsibilities to other women in the home or environment of origin (Soto et al., 2016). In Chile, there is a substantial increase of female immigration oriented to domestic work and care, especially from Peru and Bolivia, including Ecuadorians and Colombians. Currently, the spectrum has been diversified with migrants from more distant places such as Venezuela, Haiti, Dominican Republic, and even Philippines.

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Peru

6,299

Colombia

3,626

Venezuela

1,979

Haiti

1,530

Ecuador

737

Bolivia

625

Argentina

14

Brazil

14 0

1000

2000

3000

4000

5000

6000

7000

Source: Based on data from Department of Immigration and Migration of the Ministry of the Interior and Public Security. Fig. 10.6  Chile, 2017: Number of visas granted to women domestic workers by country of origin. (Source: Based on data from Department of Immigration and Migration of the Ministry of the Interior and Public Security)

Information from the Ministry of the Interior displays that the visas granted in 2017 to female domestic workers (14.7% of total visas) were mostly given to Peruvian women, followed by Colombians and Venezuelan (Fig. 10.6).7 The information also revealed the presence of a group of Filipino women who would occupy a very specific niche of care within the very high-income households, where their command of English is valued due to its relevance in the support of school tasks of the children they care for. The majority of Peruvian domestic workers in Chile can be explained by the positive image of Chile in Latin America, in a context of closed borders in most countries of the world, especially in the United States and Europe; the geographical proximity from Chile, which keeps the workers near to their families; the differences in economic indicators between both countries (Stefoni, 2009), and the legal advances related to domestic work in Chile (Peru ratified only in June 2018, ILO Convention 189). On the other hand, Peru and Chile have a Free Trade Agreement and within that framework have signed a Memorandum of Understanding (2009) on labor and migration cooperation to develop policies and practices that improve

7  In 2018 in Chile it is estimated that there is a total of 1,251,225 people of other nationalities, representing 6.6% of the total population. Venezuelan is the predominant foreign nationality, which represents 23% of the total, followed by 17.9% of Peruvian, the Haitians represent 14.4% of all foreigners. Of the total of immigrants, 646.128 (51%) are men and 605.097 (49%) are women (INE, 2018b).

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migrants’ quality of life.8 Currently, there is also a Transit Agreement of Persons in the Chilean-Peruvian Border Zone of Arica Tacna (Soto et al., 2016, p. 59).9 In relation to Bolivian domestic workers, particularly those who live in adjacent departments to Chile, some authors have observed a circular migration pattern, characterized by the temporary and repetitive entry and exit of the country, from workers who visit their children in Bolivia, and that want to avoid the high costs of a Chilean work permit (Leiva Gómez, Mansilla Agüero, & Comelin Fornes, 2017). In this case, domestic work has specific characteristics, such as the work contract waiver (even when the workers are in a regular migratory condition) and the predilection for indoors modality. This situation exposes the workers to precarious employment conditions, extended working hours, and mistreatment. It is worth noting that the age profile of paid domestic workers in Chile (mostly between 25 and 45 years old, according to ECLAC) refers to women who have family responsibilities or who are mothers, a situation that also characterizes migrant domestic workers. For example, 85% of Peruvian domestic workers in Chile are mothers (Martínez, 2007). Migratory phenomena redistribute care work in homes and families, giving rise to “transnational” maternity phenomena, in which the worker assumes the remote care of her children while she cares about the children of her employer in a daily basis (León, 2007). The impact of the mother’s absence can have a double effect: due to her financial support her children may access to better opportunities, but at the same time family issues may be triggered (problems of discipline, drugs, and others). Comparatively, migrant women often enter the labor market from a position of disadvantage, with lower salaries, exposed to precariousness, abuse, and violence of various kinds due to the nonlegal status in the countries of destination. This vulnerability is accentuated in relation to domestic workers who have historically belonged to disadvantaged communities, such as Afro-descendant groups or ethnic minorities. It is also relevant to note that in Chile, domestic work is the only job that in the short term provides them with legal stability, “since obtaining a residence permit is subject to an employment contract, a situation that is hindered by the search for other jobs of greater social value” (Stefoni, 2009, p. 126). An attempt is being made to modify migration law, with a new project that has already passed the Deputies Chamber, in the process of being approved by the Senate in March 2019, and whose objectives are: (a) to establish clear entry requirements and an effective administrative procedure to prevent irregular entry and to also prevent people with criminal records from entering Chile; (b) to establish a Migration Policy Council, whose task will be to formulate and to periodically  Between Peru and Chile there is pension portability.  There is special legislation for Bolivian citizens, established in the Agreement on Residence for Nationals of the States Parties of MERCOSUR, Bolivia and Chile. Since 2009, this agreement was implemented in Chile, providing citizens of the members of MERCOSUR, Bolivia, Argentina, Brazil, Uruguay and Paraguay the possibility to obtain a temporary visa for 1 year, without the need of a work contract, extendable for the same period (Tapia, 2015 cited in Leiva Gómez et al., 2017). 8 9

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update a clear and transparent migration policy for our country; (c) to create a National Migration Service, which will have the structure and capacity to apply the migration policy and will act as the state channel to interact with migrants in order to establish a flexible system of migratory categories; (d) to decriminalize irregular residence and eliminate criminal penalties for immigration violations; and (e) to simplify and expedite the expulsion process for those foreigners who have violated the migratory law. Meanwhile until April 2018, an extraordinary regularization process was performed, in which all irregular immigrants (with an expired tourism permit or residence visa) have been urged to register and have been granted a temporary residence permit for a year, those who fail to register would be expelled.

Some Conclusions and Suggestions Throughout the text, we analyzed the social organization of care in Chile and the factors that contribute to increase the demand for care together with the reduction of supply of paid and unpaid caregivers, such as the demographic change, sociocultural transformations, and the lessening of the remunerated domestic work offer that tend to create an increase in demand for care. In a context in which public services do not cover the growing demand for care of the population, the shortage of caregivers has been mitigated by the influx of migrants who work as domestic workers preferring the “indoors” modality. Nevertheless, the possibility of hiring paid domestic work is only available to high-­ income families, which is why the majority of women who do not count with these resources must deploy different strategies to coordinate paid work with the time and effort that demands care. The agenda for the redistribution of care in Chile is still under construction: an unfair social organization still persists in which the responsibility for care is mostly attributed to families and, within them, to women. The different policy instruments differentially redistribute care responsibilities between the State and families, whereas the presence or absence of these policies “leaves a gap” filled by the market for those who have enough income to pay for it. Existing care policies, although not articulated in a comprehensive care system for sectors and actors coordination, have progressively moved towards universality starting with the most vulnerable groups, nonetheless it becomes necessary to integrate additional principles of equity and quality.

Policy Suggestions The first recommendation is the establishment of coordinate guideline for all policies and programs related to care, especially to ensure the coordination of programs and policies developed by public entities towards population groups that require specific care such as infants, elderly dependent, and the disabled. It is essential to count with a good public-private articulation in order to implement actions that foster the cultural change necessary for an awareness of care as a right and towards

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expanding State and men obligations in the provision of care. Additionally, the development of evaluation and control mechanisms for policies and programs is also central to ensure their quality and in this way, the assistance bias that predominates in many of them can be avoided. Secondly, it is essential to increase the coverage of services for children—especially those under 3 years old—for older people who are not autonomous, and for the disabled. Together with this, measures to eliminate the high socioeconomic inequities, regional and local, in access to services become fundamental. It is also necessary to widen the spectrum of modalities in which the supply of services is materialized, taking into account the diverse reality of the people who require care. Services targeting prevention, mental health care, and physical rehabilitation, among others, need to be developed with greater scope and national coverage (Acosta, Picasso, & Perrota, 2018). Thirdly, it is noteworthy to consider that progress towards co-responsibility in domestic work and unpaid care is still limited by cultural barriers that cross the social imaginary and that ground public policies: still in the opinion of the majority of the population and in policy design, women are situated as mothers and caregivers at the expense of their role as workers. It is crucial, therefore, to implement policies that allow women’s unpaid work within the home to be visualized, valued, and redistributed. Focused on access to time, resources, and care services, these policies should be synergistically articulated with employment policies that favor the economic autonomy of women and that are properly aware of the existing gender biases in the labor market, particularly regarding social protection models. In order to formulate these policies, it is necessary to continue performing data collection that allows the estimation of women’s workloads and their contribution to the economy, such as time-use surveys and satellite accounts of unpaid work. In relation to paid domestic work, this activity continues to be socially and economically undervalued, associated with informality, and with a deficit in regulations, particularly concerning the right to have early retirement, to additional remunerations such as holiday bonuses, and the right to have compensation for years of service (acquired only in compensation for any event, since 1991). Besides strengthening oversight functions of the Labor Inspection to invigorate the application of existing legislation, in the current care crisis context in Chile, it will become necessary to develop professionalization plans to meet the increasing demand for specialized care (especially care of the elderly), these plans could likely become an employment source for paid domestic workers, especially immigrants. From the point of view of paid domestic work salary agenda, this will constitute a challenge for the State and the domestic workers organizations, which will have to claim more precise regulations regarding the corresponding pricing of greater physical effort tasks and preparation, in a context of limited collective bargaining. On the other hand, it will be essential to move towards a greater articulation and coordination of care policies that ensure access of domestic workers to services and resources to care for their own children and towards decent work policies that promote formalization, regulation, and supervision of the modalities of domestic work and paid care. Finally, given the importance of migrant domestic workers in the country, it is essential to improve legislation and coherence between labor and migration poli-

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cies. Effective protection of migrant domestic workers’ rights involves the implementation of measures designed not only to promote better integration into the labor market in the countries of destination but also to resolve specific situations of vulnerability that affect them, such as greater exposure to abuse and, in particular, the lack of pension portability.

For Further Research Regarding a care research agenda in Chile, it is essential to generate more precise measuring instruments to produce better information on the impact of migration on family care. The care crisis has given rise to a plurality of ways in which care is provided, here, the biggest challenge is the standardization of definitions and the possibility to distinguish statistically the care functions of domestic work. For example, paid caregivers in the field of health are more likely to be detected by existing surveys than independent workers who perform this work per day or hourly. As for paid domestic work, it is fundamental to produce comparative statistics that provide disaggregated information by age, ethnicity, migratory status, and methods of paid domestic work (with retirement and without retirement), in order to account for the different aspects of this type of activity. On the other hand, the impact of gender inequalities in parental leave and in the time spent on care by mothers and fathers should be tracked and evaluated as often as possible. This will allow measuring and monitoring these inequalities and their evolution and surveys of time-use and well-being should continue to be carried out. In Chile, it is still imperative to build a decent work agenda and co-responsibility for care through intersectoral dialogue, as well as the participation of different political actors (in particular, women from different income strata) who are able to “politicize” care not as a naturally feminine but as a dimension of well-being that must be guaranteed in a framework of equality (Esquivel, 2015). Redistributing care more fairly involves guaranteeing a series of rights to women. This, in turn, entails a benefit for society in general because, among other things, investing in care generates jobs and ensures a better quality in the care provision for those who need it (boys and girls, adults and older adults, people with disabilities, and sick people). Thus, a redistribution of care tasks will benefit both men and women.

References Acosta, E., Picasso, F., & Perrota, V. (2018). Cuidados en la Vejez en América Latina. Los casos de Chile, Cuba y Uruguay. Santiago: Observatorio de Políticas Sociales Comparadas sobre Cuidados, Familia y Bienestar en América Latina, CUIFABI-SOPLA Fundación Konrad Adenauer.

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Aguirre, R. (2009). Uso de tiempo y desigualdades de género en el trabajo no remunerado. In R.  Aguirre (Ed.), Las bases invisibles del bienestar social. El trabajo no remunerado en Uruguay (pp. 23–85). Montevideo: UNIFEM, Doble Clic Editoras. Aguirre, R. (2011). El reparto de cuidado en América Latina. In M. A. Durán (Ed.), El trabajo de cuidados en América Latina y en España (Documento de trabajo No. 54). Madrid: Fundación Carolina. Arriagada, I. (2013). Desigualdades en la familia. Trabajo y cuidado en Chile. In C. Mora (Ed.), Desigualdad en Chile: La Continua Relevancia del Género (pp. 91–112). Santiago: Universidad Alberto Hurtado. Arriagada, I., & Todaro, R. (2012). El papel de las migrantes peruanas en la provisión de cuidados en Chile. Santo Domingo: ONU Mujeres-CEM. Barros, M., & Barrueto, C. (2007). La mujer como sujeto del contrato de trabajo (Memoria para optar a grado licenciado en ciencias jurídicas y sociales). Santiago: Facultad de Derecho, Departamento de Derecho Laboral, Universidad de Chile. Batthyány, K., Genta, N., & Perrota, V. (2014). Las representaciones sociales del cuidado infantil desde una perspectiva de género. Principales resultados de la Encuesta Nacional sobre Representaciones Sociales del Cuidado. Revista de Sociología, 99(3), 335–354. Bravo, D., & Órdenes, C. (2016). El Mercado laboral del Servicio Doméstico en Chile. Santiago: Centro UC, Encuestas y Estudios longitudinales. Carrasco, C. (2006). La economía feminista: Una apuesta por otra economía. Madrid: Akal. Retrieved November 20, 2018, from http://obela.org/system/files/CarrascoC.pdf Donaire, C. (2014). Situación actual y demandas de las trabajadoras de casa particular en Chile. Documento presentado al GTAS, Grupo de Trabajo sobre Autorreforma Sindical de CSA, Santiago, Chile. Economic Commission for Latin America and the Caribbean (ECLAC). (2018). Social panorama social of Latin America 2017. Santiago: Author. Esquivel, V. (2015). El cuidado: De concepto analítico a agenda política. Nueva Sociedad, 256, 63–74. ISSN: 0251-3552. Fernández, M.  B., Herrera, M.  S., & Caro, S. (n.d.). Desafíos públicos en la provisión de cuidado de las personas mayores dependientes en Chile. Santiago: Escuela de Trabajo Social UC, Centro Estudios de Vejez y Envejecimiento UC.  Retrieved September 18, 2018, from www.sociedadpoliticaspublicas.cl/archivos/septimo/Salud/ Desaf_os_p_blicos_en_la_provisi_n_de_cuidado_de_la.pdf García-Calvente, M. M., Mateo-Rodríguez, I., & Eguiguren, A. P. (2004). El sistema informal de cuidados en clave de desigualdad. Gaceta Sanitaria, 18(Suppl 1), 132–139. Grupo Nous. (2010). Trabajadoras de Casa Particular (Documentos de Trabajo, Dirección de Estudios Previsionales). Santiago: Subsecretaría de Previsión Social. Instituto Nacional de Estadísticas (INE). (2014, 2018). New National Labor Survey (NENE) quarter. July-August - September 2014 and 2018. Set of tabulations of quality of employment. Santiago: Author. Retrieved December 15, 2018, from www.ine.cl Instituto Nacional de Estadísticas (INE). (2015). Encuesta de Uso del tiempo 2015. Santiago: Author. Retrieved September 10, 2018, from www.ine.cl Instituto Nacional de Estadísticas (INE). (2016). Documento Principales Resultados Encuesta Nacional Sobre Uso del Tiempo ENUT 2015. Santiago: Departamento de Estudios Sociales del INE. Retrieved September 10, 2018, from www.ine.cl Instituto Nacional de Estadísticas (INE). (2018a). Estimaciones y proyecciones de la población de Chile 1992-2050. Síntesis de resultados. Santiago: Author. Retrieved December 15, 2018, from www.ine.cl Instituto Nacional de Estadísticas (INE). (2018b). Estimación de personas extranjeras. Santiago: Author. Retrieved December 15, 2018, from www.ine.cl International Labour Office (ILO). (2012). Panorama laboral de América Latina y el Caribe. Lima: ILO Regional Office for Latin America and the Caribbean.

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Leiva Gómez, S., Mansilla Agüero, M. Á., & Comelin Fornes, A. (2017). Condiciones laborales de migrantes bolivianas que realizan trabajo de cuidado en Iquique. Si Somos Americanos, 17(1), 11–37. León, M. (2007, August). Invisibilidad y discriminación del trabajo doméstico remunerado en América Latina. In 10 Conferencia Regional sobre la Mujer de América Latina y el Caribe. Quito, Ecuador, CEPAL. Martínez, J. (2007, July). Feminización de las migraciones en América Latina: Discusiones y significados para políticas. In Conferencia Regional sobre Migración (CRM) (Ed.), Seminario Mujer y Migración, El Salvador (pp. 125–131). Retrieved December 7, 2018, from https://oig. cepal.org/sites/default/files/jm_2007_feminizacionmigracionesal.pdf Ministerio de Desarrollo Social. CASEN. (2003, 2006, 2014, 2015, 2017). Encuesta de Caracterización Socio-económica. Santiago: CASEN. Retrieved October 15, 2018, from www. ministeriodesarrollosocial.gob.cl O’Connor, J. (1996). From women in the welfare state to gendering welfare state regimes. Current Sociology, 44(2), 1–130. Órdenes, C. (2016). Servicio Doméstico en Chile: Caracterización, evolución y determinantes de su participación laboral. Unpublished doctoral thesis en Políticas Públicas, Facultad de Economía y Negocios, Universidad de Chile. Santiago. Pérez Orozco, A. (2009). Miradas globales a la organización social de los cuidados en tiempos de crisis. I: Qué está ocurriendo? (Documento de trabajo n. 5, Serie Genero, Migración y Desarrollo). Santo Domingo: Instraw. Rodríguez, C. (2007). La organización del cuidado de niños y niñas en Argentina y Uruguay (Serie Mujer y desarrollo No. 90). Santiago: CEPAL. Soto, C., Soto, L., González, M., & Dobrée, P. (2016). Panorama regional sobre trabajadoras domésticas migrantes en América Latina. Asunción: Centro de Documentación y Estudios (CDE). Stefoni, C. (2009). Migración, género y servicio doméstico. Mujeres peruanas en Chile. In M. E. Valenzuela & C. Mora (Eds.), Trabajo doméstico: Un largo camino hacia el trabajo decente (pp. 191–231). Santiago: OIT. Tapia, M. (2015). Frontera, movilidad y circulación reciente de peruanos y bolivianos en el norte de Chile. Estudios Atacameños, 50, 195–213. Thomas, C. (1993). De-constructing concepts of care in British Sociological Association. Sociology, 27(4), 649–669.

Chapter 11

Migrations and Remunerated Eldercare in the City of Buenos Aires: A Subjective Perspective Natacha Borgeaud-Garciandía

Analyzing the meanings attributed to care work and some of its characteristics through the voices of workers and their experiences is highly significant to reaching a better understanding of care and its potential approaches (Borgeaud-Garciandía, Hirata, & Makridou, 2010; Paperman, 2015). This chapter situates itself where migration studies associated to care converge with analyses of the many dimensions of care work. Migration, be it a biographical experience, a key element of labor force participation or a factor that determines representations of work and employment, is an important part of the analysis. However, linking migration to the participation of women in sectors that are highly constrained by the dominating relations of class, sex, and “race,” as well as to the subjective relations they have with their work is a delicate task. While in some cases, migration stories leave clear marks; in others, different factors beyond the origin of the workers—even if only backdrops to their stories—affect the evaluation of the work they perform. In other words, there is a risk of inferring causalities or of overestimating or underestimating relations. Thus, beginning with the voices of the care workers and following their reasoning help avoid such pitfalls. The proposed analysis here is based on different field work conducted over the last decade on the subject of remunerated care work for dependent elderly people performed by migrant (and non-migrant) workers in the city of Buenos Aires. The largest study was done with care workers that worked long hours or as “live-in” help in the homes of elderly people whose physical and psychological health was deteriorating. More recently, another study began looking at female migrant workers working in geriatric institutions, usually after having worked in homes and receiving care training. They follow different circulations between types of care jobs. Biographical interviews were conducted with women who were mostly from Peru N. Borgeaud-Garciandía (*) National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina Institute of Social Research of Latin America (IICSAL) - Latin American Faculty of Social Sciences (FLACSO), Buenos Aires, Argentina © Springer Nature Switzerland AG 2021 N. Araujo Guimarães, H. Hirata (eds.), Care and Care Workers, Latin American Societies, https://doi.org/10.1007/978-3-030-51693-2_11

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and also from Paraguay and the northeast of Argentina (internal migrants). Although these last two groups do not face the same problems related to immigration status, they do share similar stories and trajectories. This chapter is divided into four parts. In an attempt to provide a brief explanation of the current panorama, the first part reviews some of the characteristics of regional migration development and the most recent laws related to the subject. The second part schematically reconstructs the types of trajectories experienced by both internal and regional migrant workers interviewed. It is important, even if briefly, to portray some elements of their life stories before they began working in homes and in care work. The third part looks at the tensions that are generated between an assignment and searching for a place, based on power relations and assigned stereotypes. The fourth part investigates how elements involved in both work environments (homes and institution), or in passing from one to the other, influence the relationships that the care workers develop with their work and with themselves.

Brief Aspects of Regional Migration and Its Legal Framework Argentina was and still is a country of immigration. It has welcomed regional migrants throughout its history and was the destination of Europeans until the first decades of the twentieth century. Latin American immigrants, who primarily participate in the most precarious and informal sectors of the economy, have historically represented between 3% and 4% of the country’s population, although there are factors that make them seem more visible. For example, the decrease of European migrations caused regional migrations to move up to 80% of total immigrants, or an increase in their presence in urban conglomerates. The three largest and most dynamic migrant groups come from Bolivia, Paraguay, and Peru.1 One of the most significant migratory transformations seen between 1990 and 2000 has been its feminization. In the case of Paraguayan migrations, male/female ratios went from 102 in 1960 to 85 in 1980 and 73 in 2001. In the case of Peruvian migrants, feminization came later and exponentially, with indexes going from almost 200 to just under 70 between 1980 and 2001 (Courtis & Pacecca, 2010). Both are often migration pioneers who enter care and domestic services in the bigger cities of Argentina. Likewise, a large portion of women are seen early on internal migration (Jelin, 1976). The presence of migrants varies significantly in Argentina. In the greater Buenos Aires area, 54.7% of the domestic workers were born in other provinces and 19.4% were born in other countries (Groisman & Sconfienza, 2013). In the beginning of the 2000s, 69% of Peruvian women and 58% of Paraguayan women worked as domestic help (Cerruti, 2009).

1  Argentina has begun receiving more migrants from Venezuela as a result of its political, economic, and social crisis. Between January and August 2018, Venezuelan migrants formed the largest group of migrants in the country (25%), more than Paraguayans (24%) and Bolivians (19%).

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Between the mid-2000s and the next decade, Argentina made regulatory changes to its migration legal framework and to domestic employment, both in the sense of giving greater recognition to national realities and to basing itself on the discourse of rights. The Videla Law, considered restrictive, repressive, and against the fundamental rights of migrants, was replaced in 2004 by the new Migrations Law (Ley 25,871, regulated in 2010). The new law stipulates migration as a right that includes equal access to education, social assistance, health (regardless of immigration status), employment, social security, justice, family reunification, and participation in public life. Likewise, in 2006, the Patria Grande regulation program was implemented specifically to regulate the situation of migrants from MERCOSUR countries who were already living in Argentina. Although criticisms of the new law question the political will of the government administration in power (Rodríguez Enríquez & Sanchís, 2010) and see the regulatory changes as “control policies with a human face” (Domenech, 2013), it unquestionably represents a new level in terms of formally recognizing the rights of migrants. However, in terms of work, especially in sectors like the domestic one that is marked by extremely high levels of unregistered workers (approximately 75% of female workers), migration regulations do not necessarily mean labor regulations (even when its absence served to justify informality) or better employment and work conditions (Baer, Benítez, Contartese, & Schleser, 2011). The issue of work regulations is particularly noteworthy because during the first decade of the millennium, the government implemented a number of actions to increase the registration of female workers in the sector. In 2013, Law 26,844 entitled Special Work Contract Regime for Private Home Personnel was approved to seek equate workers in private homes were given the same rights as other workers. Among its many changes, the new regime also included the nontherapist caregiver. Nevertheless, migrant and nonmigrant women continued to inflate the high rates of unregistered workers. Furthermore, although registered female workers have better legal protection and theoretically benefit from labor rights, registration does not substantially change the precarious state of their work nor does it protect them from the numerous abuses that mark domestic employment. Finally, it is worth highlighting a change in migration policy implemented by Mauricio Macri, who governed from 2015 to December 2019. Using the rhetoric of fighting narcotraffic and transnational crime, his administration focused on migration from the perspective of security and control, thus criminalizing migrants. Among other measures, the president used the Decree of Necessity and Urgency 70/2017 (a DNU is theoretically a tool to be used by the executive branch in extreme cases) to modify Law 25,871 in order to make Argentinian citizenship more difficult for immigrants, restrict access to residency, make deportation easier, and hinder access to a defense.2 This direction was taken at the same time that anti-immigration 2  See S. Caggiano (2017) “La nueva política migratoria argentina: control y exclusión” (The New Argentinian Migration Policy: control and exclusion). The said decree was declared unconstitutional in March, 2018, because of how it was employed (unjustified use of DNU) and its content

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policies were being implemented in central countries and within a national context of economic and employment decline, which increases the fragility and uncertainty of the population (Caggiano, 2017). This creates favorable conditions for generating and designating scapegoats.

 emale Migrations and Work Trajectories in CABA F (Autonomous City of Buenos Aires) Paths Taken Before Working in CABA The mobility3 of Paraguayan and internal migrant women has been part of Argentina’s migration history for decades. In fact, the mobility of four out of every six women that we interviewed from these regions had family and community histories of migration. Migration was especially part of the lives of poor girls from rural areas4 who, from a very young age, were seen as “part of the universe of available resources” (Miranda, 2013, p.  21). Doris, from the northeast of Argentina, recalled that none of her schoolmates stayed in their hometown. Marina, a woman from Paraguay who has worked since she was a young girl, said that from a very young age children understood that they had to leave. “We couldn’t even think about staying; we had to go somewhere.” Half of the women we interviewed, especially from Paraguay and Argentina, had combined more or less important mobilities with domestic and care work early on in life. Their experiences varied in terms of the dynamics of their labor incorporation (which usually began with live-in jobs), employment conditions, and interpersonal work relations. Schematically, the experiences of the paid “girl maids” are different from the experiences of the “niece maids”5 who work in exchange for lodging and “care.” They can work close to their homes, and/or go through successive mobilities that can take them through several towns and capital cities in their provinces or countries before arriving in Buenos Aires.

(against the rights of migrants). The Macri administration appealed, which means the decree remains in effect until the decision of the Supreme Court. The president-elect in late 2019 has expressed interest in its repeal. 3  According to Catarino and Morokvasic (2005), mobility includes, in addition to the more classic image of a migrant, different and varied forms of displacement (circulatory, back and forth, etc). Here it is used to identify the specificity if internal and Paraguayan female migrants straddling the two worlds of Buenos Aires and their place of origin. 4  Other girls experienced different types of mobility and work that are not necessarily part of their family or community histories, but rather were generated from biographical accidents such as the loss of their affective point of reference. 5  In line with M. Jacquemin (2009) who categorized the “petite bonne” (little maid) as girls from outside the family nucleus who were paid for their work, and the “petite nièce” (little niece) as family domestic helpers. He specifies that the latter suggests ties of proximity, not of kinship.

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These types of displacements create a kind of migratory gear train that is difficult to reverse. It sets into motion a long-term mobility made up of comings and goings that are highly dependent on the situation of the original family until the person settles in a host city (once their parents pass away or migrate). More than turning points, these mobilities form a long migration process that can be understood as a double presence6 that requires female migrant workers to be both in their place of origin and in their host city. The distance, the communications, the movements of family members, and the remittances feed a strong sense of presence from a distance. This type of mobility tends to be different from the experiences of the Peruvian women we interviewed, who came from social sectors that are socioeconomically less relegated and somewhat settled, and whose basic needs were covered. In line with the data published by migration specialists (Maguid, 2011; Rosas, 2010), and different from the Argentinian and Paraguayan migrants, all the Peruvian workers we interviewed had completed secondary school and most of them had begun tertiary or higher education before migrating. These characteristics distinguish them from their peers, even though their childhood was marked by significant biographical ruptures. In general, the Peruvian women had relatively protected childhoods and adolescences. When they migrated, some were homemakers and others had jobs, formed families, and had children. While their situations varied, what drove them to leave their countries and families were the effects of the economic crisis experienced in Peru in the early 1990s and the neoliberal policies that impacted the work and economic stability of the nuclear family. These women see migration as the only solution to their daily problems, the debt they accumulated because of devaluation, and the unemployment or underemployment that impoverished their family nucleus. At the time, Argentina was an attractive migratory destination due to its geographic proximity (compared to other destinations like Spain, the United States, or Japan), shared language, relational networks, and currency convertibility (peso-dollar). To them, being employed in domestic services goes hand-in-hand with migration (Magliano, Perissinotti, & Zenklusen, 2013).

Typical Work Trajectories in CABA The analysis of the life stories of these women allows us to highlight the variability that, as observed by authors like Destremau and Lautier (2002), characterizes the trajectories of domestic and care workers, especially when they are marked by migration. However, accessing and participating in work fields that are tightly controlled by lines of exploitation that articulate the social relations of sex, social class, and “race”/ethnicity/nationality tend to organize work trajectories that are less 6  Alluding to A. Sayad’s “La double absence” (1999). The use of the term here differs from the definition given by Laura Balbo (1978) in that it highlights a mobility that implies the migrant is present in her place of origin and in a new place.

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heterogeneous. If we begin with their jobs at the time of our investigation, we have to understand how their different paths merged and confused in the niches we looked at. The cases we analyzed show that once the migrants arrive in Buenos Aires, there are three employment patterns that intimately integrate their work situations with the problems of housing and configuring or regrouping their families. These can be schematized into typical trajectories: • Specialization in “live-in” care jobs: When they arrive in the capital of Argentina, some women take on more than one per-hour jobs or do “live-in” work before creating a work trajectory that is specialized, like providing “live-in” care for (highly) dependent elderly people. They are able to do this because of the trust and recommendations of their network and employers. The work paths of these women in Argentina are less dependent on their families. Separated, older (they were over 50 when they arrived in Buenos Aires), they have no dependent children and they dedicate themselves to this type of assistance. Their children either were almost adults when they migrated, did not migrate with them, or came later as adults. While “live-in” jobs can solve both employment and lodging issues in the early stages of migration, they are also part of the trajectories of older migrant women who are more independent and who dedicate themselves exclusively to caring for the elderly people they live with. Different from the next employment pattern that transitions from live-in to outside work, this pattern reaches a point of stability; it is the culmination of a set of disparate, shifting, and precarious experiences. • Trajectories to outside hourly or part-time work: The second migrant employment pattern includes female workers who were younger when they arrived and either formed families in Buenos Aires or brought their partners and children with them. This trajectory takes the women from “live-in” work, when they are alone, to often part-time outside domestic and care work once they stabilize their families and housing situation. They are gradually able to separate family (and eventually other activities) and work spaces, and reach a certain level of employment stability. The possibility of transitioning to outside work means they have some conditions that compensate the instability of the job, such as other family members contributing to the household income or secure housing. When outside work is combined with lack of housing and loneliness, their situations can become extreme, as seen in some of the migrants’ trajectories. • Leaving employment in private homes: This pattern is made up of women that leave domestic employment to start their own businesses (as in the case of the Peruvian woman who started a glassware store with her Bolivian husband) or to work as caregivers at institutions for adult seniors. It is worth noting that neither their previous trajectory nor their new situation—at least not until they reach stability—are automatically more advantageous. In other words, leaving domestic employment does not imply being able to achieve better living and working conditions, or even more capital. In fact, leaving the work of home care can mean facing several stumbling blocks in the process reaching greater work stability. Finally, while these trajectories seemingly lead to new professional horizons,

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nothing allows us to affirm that these workers would not have to one day go back to domestic work in cases of economic, employment, or family crises. Women who find work at institutions as geriatric assistants have generally taken public or private training courses that require a varied number of hours. The presence of foreign women from Paraguay, Peru, and Bolivia in the training courses and in institutional jobs7 extend the scope of the transitions and circulations between different types of care work and appear in less analyzed areas that, although minorities, are not considered “niches.” Similarly, Mallimaci (2018) shows the presence of migrant women that arrived as young girls with their families or that had family support that allowed them to get nurse training. In many of these cases, they get training after or while (or even thanks to) their domestic jobs. The institutional jobs, which are more controlled and (theoretically) based on collective agreements, involve more protective ways of hiring and are less subject to private agreements, even though the work is not always easier. At the time of the interviews, the women had spent between 10 and 35 years in Buenos Aires. They rarely considered the (remote) possibility of going back to their place of origin. They had “created their own place” in the city. However, we will see that their first experiences reveal the many problems they had to face and the efforts they made to try and gain some form of recognition.

 igrant and Caregiver: Elements for Considering Stigmas M and Affirmations The first employment, housing, and existential experiences of these migrant women working in the capital of Argentina are marked by profound fragility that require a long stabilization process that is at times relative and at other times more consolidated. Initially, they live in boarding houses with others from their country, go directly to the home of an employer they do not know, or live with a relative or acquaintance temporarily. They carry the weight of the needs of their children and family members who stayed behind in their country of origin. They are able to enter into the domestic work sector in because of its specific characteristics (high rates of informality and lack of requirements such as diplomas and legal migration status) and by the existence of compatriots’ and employers’ networks that guide them towards these jobs. In general terms, it is a sector that offers few mobility opportunities and is typically precarious, underpaid, and socially unrecognized both in terms of the work and the workers. The intersectoral perspective that integrates relations of sex, class, 7  For example, according to statistics from a foundation in Buenos Aires that trains caregivers within the framework of a national public program, between 2006 and 2011, an average of 20% of the graduates were foreigners, although that average varied between 5.5% and 50%. Seventy percent of them were Peruvian (personal document).

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race, and ethnicity is able to analyze the connections between female migration and domestic work (Falquet, Lada, & Rabaud, 2006) while “the articulation of [these] social classifications (…) produces subordination with respect to work in that they justify and naturalize their participation in concrete activities that are generally unstable, poorly paid, and informal” (Magliano, 2018, p. 37). In other words, most migrant women from Paraguay and Peru are in the domestic and care sectors of Argentina and that conversely, these jobs are seemingly reserved for women that are poor and/or national or foreign migrants. As Kergoat demonstrates, these are paradigmatic examples of how the social relations of sex, class, and “race” are consubstantial (Kergoat, 2009, 2016). On another occasion, we contemplated the possibility of integrating these structural dimensions (with real and daily concrete effects) with the complexity they acquire from the biographies and subjective perspectives of these women. Thus, the accounts told by the caregivers give meaning to the apparent contradictions between trajectory, occupied place, and personal assessment (Borgeaud-Garciandía, 2015b). From another point of view, we will now analyze the discriminations the migrants suffered when they arrived, wherein they looked to assert themselves in a play of oppositions between nationalities and work qualities (“social utility”).

Assigned Otherness: Experiences and Resistance The women’s accounts of their early experiences as migrants, told from a “present” perspective of self-recognition, tell how they are placed by their employers in a precise symbolic status of “foreigners” and “strangers”, and the micro-struggles and resistance that identification can generate. These struggles and acts of resistance are vital, insofar as the objections are directed toward the identity of uprooted people who are transitioning between their premigration lives and the trajectory they are creating in a new place. Without establishing equivalence, we can propose two types of situations. One that affects the experiences of adult foreign women performing home care and another that affects young girls from rural areas that go work for urban families as “live-in” help. Although these women usually suffer banal forms of racism and discrimination, especially those with more Andean physical traits (darker skin and straight black hair), during their time in Buenos Aires, their first work experiences were particularly rich in that they include elements for thinking about the actors’ positions, defended and assigned, dynamic and changing. While migrants see live-in care as an “ethnic work niche” and an entryway to the local job market, for employers it is an Argentinian work niche that supposes a certain transparency from its workers. Dorlin’s (2009) critical reading of “whiteness” reminds us that white does not refer to a chromatic notion, but rather to having a certain “social transparency” that presupposes not having to bear any disgraceful brand (such as skin color, accent) and being addressed as a person and not a metonymy associated to an otherness “entity”. In our case here, the migrant is required to

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take on a kind of invisibility and transparency at work that dispossesses her of her identity. Thus, until she is able to achieve a certain subjective stability in her host country, the caregiver tries to create and safeguard a place for herself on the margins of the place she is assigned, while neither denying nor accepting it. Live-in work often involves elderly people who are suspicious and upset at being forced by their children into having a live-in caregiver. In an effort to minimize this disruptive visibility, they frequently reprimand the caregivers about little things like, for example, how they talk. “Don’t say Aló! Say Hola! We’re in Argentina!” was a common rebuke. The caregivers both acquiesce and resist these types of requirements, depending on how they are said and the intentions behind them. They see it as questioning their identity in a period of biographical transition and subjective fragility. Thus, in spite of the pressure, they try to find ways to assert themselves. I didn’t want to lose my identity. I said, “I will never speak like an Argentinian, using words like “Che” […], no. I will always speak my own way because I’m not going to change anything.” (…) But then what happened? Mr. Pedro made me, his daughter and everyone else obligated me (…) you never knew who was in favor of foreigners coming and who wasn’t … [In the end] I started saying Ché like an Argentinian, so I passed [unseen]. Nobody noticed me. (…)” (Lucia, Peruvian caregiver). The guy was dreadful! (…) he was neurotic about wanting me to talk the way he wanted me to. And I didn’t want to talk like he wanted me to (…) He said it was for my good, but the more he corrected me, the more I spoke in my own way. See, it was like going against him (Olga, Peruvian caregiver).

Another example of this type of treatment involved food. The workers were told to cook “the Argentinian way,” not the “Peruvian way.” They were supposed to unlearn years of knowledge, abandon their habits, and learn local cooking customs. However, occasionally they were able to share dishes from their country in the caregiving context, which seemed like both a victory and revenge. Then I made lunch, and I started making Peruvian food for her. And she ate it! She ate Peruvian food! [Did she like it?] Yes, she did, she liked it (…) So much that once I told her daughter, “She eats …” “Mama, you eat that?” “Yes, she said, I do.” She ate, for example, chicken chili, not spicy, of course, but well-prepared. Things she could eat. I worked there almost exactly five and half years! And I never missed a day of work. (Olga, Peruvian caregiver).

These same feelings were evident in the experiences of the people receiving the care, and people had to recognize (although maybe not in those terms) the caregiver’s contributions to their improvement. (…) She was really neglected (…) Even her friends noticed when they went to visit her after I was there for 2 months. They couldn’t believe what they saw; she was brimming with health (…) She was really beautiful. Everyone commented on how her appearance had improved, both inside and outside, her way of being (Estrella, Peruvian caregiver).

Despite their differences, both foreign and domestic workers experience “othernisation”, through forms of degradation and/or infantilization in their relationships with their employers. In the case of migrant girls who leave rural areas to do live-in work

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for urban families, the combination of being underage, peasants, and female exposes them to all sorts of abuse, generating everything from care behavior and maternalistic-paternalistic physical and moral control, to cruel forms of belittlement that accentuate otherness based on the rural-ignorant versus urban-modern dichotomy. What Sofia experienced 20 years before we met is all the crueler because her body and intimacy was disparaged. I showered, dressed, and changed my clothes, but at the time I didn’t know that we had to wear deodorant because we smelled bad or something (…) And one day the lady came and brought me some, saying: “Here, use this because …” I don’t remember what it was like, but she said it in a rude way. She said, “I can’t stand your smell.” Well, after that, deodorant became part of my life, you know? Well, then it was like I didn’t feel comfortable anymore. That was the second or third day (Sofia, Argentinian migrant, 13–14 years old, second job, provincial capital, several hours by public transportation from her house).

Despite the long hours of work requires, these young home care workers are not considered autonomous and independent beings, and have little margin to negotiate their labor relations. They retrospectively value the maternalistic attitudes of their employers, even if accompanied by abuse because they feel like they have found shelter in a time of loneliness. In some cases, when the belittlement cannot be opposed, it becomes a permanent scar.

“ Us” vs. “Them”: About the Representations and Positioning of Migrant Caregivers An analysis, in terms of coproducing social relations, highlights the struggles between employers and employees regarding work by focusing on the productive subordination of the employee (who helps produce and feed the employer’s position and attributes). Nevertheless, the movement between differentiation and assertion includes a broader universe of actors and positions. The opposition between the Argentinian employer and Peruvian caretaker, for example, along with the caretaker’s subjective apprehension, becomes more complex due to a number of factors. Perhaps one of the main factors is care relations, which different from domestic work, often contain a triangulation between the care receivers, the children-­ employers, and the caregivers. This triangulation, in the case of caring for dependent elderly people and the “crossed” relations of domination (between work dependence, physical or mental dependence, and affective dependence) make for complex interactions (Borgeaud-Garciandía, 2012). From a subjective point of view, the caregivers (especially the Peruvians in the cases we studied) might have experienced different positions during their trajectories, or recount situations that become acceptable because of those same migratory trajectories. For example, Olga, a home care worker we met, when asked if she would do the same kind of work in her country, answered: “With the abuelas? The cleaning? Is that what you mean? [She shakes her head.] It’s not the kind of work I would do there. No. There, we are very biased. We are biased and even proud. I would say I wouldn’t do it. No,

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I wouldn’t do it.” This shows how the connections and negotiations between her experience and social positions are structured as “here” and “there.” Even though her status in Argentina is reserved for Latin American immigrants according to a “racialized” social division of labor, it is acceptable, while a similar position in her country would be inconceivable (Borgeaud-Garciandía, 2015b). In this same sense, the social and labor position of the caregiver, even when moving down the social ladder, is mediated by her migratory story and the impact it has on her understanding of space (between here and there), time, and experience (Ibid.). Another element that affects the dynamics of relative relations and positions has to do with seeing oneself as part of a unique collective in terms of the qualities and stereotypes that are appropriated, rejected, or assigned. These specific and stereotypical dynamics are often more apparent among nationals who essentialize foreign groups on the basis of supposed, negative, or positive-infantilizing qualities. However, migrants can also appeal to the same mechanism in their own process of affirmation and self-recognition. Although this stereotyping mechanism of distinction has less real effect and can be analyzed from a defensive position, they exist. Thus, totalizing categories (“the Argentinians,” the “Peruvians,” the “Paraguayans,” etc.) emerge, which can be feminized in a context of care activities and which the migrants assume and interpret according to how they place and assert themselves. For example, Amadea, a gerontology assistant in a geriatric institution, says that Peruvians are seen by Argentinian society as lawbreakers. She accepts and even validates this image, but adds that Peruvians are “hard workers” and Argentinians “don’t like to work,” which is why Argentinian employers like to hire Peruvians. She goes on to illustrate this: She (Peruvian) never says “no” and always stays at work past her shift, while the Argentinian gerontology assistants are always ready to leave when their shift is over. Amadea does not relate their attitude to their rights but to disinterest and laziness. Olga supports the same stereotypes but to distinguish herself from the other communities of foreign workers says, “The Peruvian men and women are very hard workers; they don’t sit around. Maybe that’s what makes them different from other communities. We are about working.” This stereotype (hard workers) that both women associate to “Peruvians” is also true for female caregivers and their greater “affective capacity.” According to Estrella, “[people who’ve had Peruvian caregivers] always say that they are very sweet, very pleasant, and very kind, maybe because they have another kind of culture.” A representation that she shares with Olga, for whom “They look for Peruvians to work with their elderly. (…) Because Peruvian women are kinder (…) they love their older people much more, I think, than others [workers of other nationalities], and they are more patient and affectionate.” These assertions, albeit in different contexts, echo observations made by Hochschild (2003) about American employers who value the supposed affective and family culture of Southern countries that can alleviate the deficiencies of globalized cities in developed nations. Except for the distances, this double argument is taken up by (some) migrant caregivers that assert themselves by being different from their employers: we are kinder, we care for our elderly, we do not abandon them to the care of others, and we do not place them in geriatric institutions. The naturalization of these affective qualities

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serves to identify, from the perspective they defend, a central issue of care and of performing it: the responsibility, its distribution, and its “coercion” (BorgeaudGarciandía, 2017a). Both of the claimed characteristics (hard worker and kindness) are focused on work, the second one being an essential part of care according to the interviewed caregivers, even when essentialized as feminine (capacity for love and patience). These qualities are considered typical of Peruvian caregivers and are the same ones that are socially valued in caring for the elderly. While on one hand, they participate in recognizing the caregiver’s contribution (by the employer family and themselves) and on the other hand, they feed a vicious cycle that does the opposite that actually undermines the recognition of what care work is—with its knowledge, difficulties, and efforts—and consequently undermining the contributions of caregivers. Recognition of their contributions, and thus of themselves, is the backdrop for these affirmations in situations where the only witness is sometimes the dependent elderly person, whose state of health does not always allow him or her to evaluate the caregiver’s performance.

Work, Care, Self-Assessment, and Recognition If migration is central (in different ways according to the type of mobility) in the life stories of these workers, it is a delicate matter to measure its impact on their subjective relationship with work, avoiding falling back on causal presuppositions. To what point does it have an impact on the understanding of work? And to what extent does it influence its performance? These are questions that still need to be closely analyzed with intellectual tact. However, a brief look at the examples of care that we analyzed (live-in home care and care in geriatric institutions) highlights some interesting points that can already be used to think about the meanings of work. It goes without saying that the differences between these workspaces (home/institution, isolated work/work with colleagues, only one assisted person/several assisted people, organization of personal work/outside organization, continued presence/ absence of hierarchies, etc.) weigh on the perceptions and representations of these women. We have highlighted the relationship between gender/sex, migration stories, and doing care work. The live-in jobs are “racialized” subniches in which migrant women are over-represented. They are particularly tough jobs that imply living with highly dependent people who, in many cases, suffer from more or less advanced senile dementia that progressively deteriorates over time. The caregiver and care receiver spend long hours of the day together, sometimes during both day and night. The caregiver is dedicated to caring for a single person who she accompanies at all times and in all their activities until they die (or are institutionalized). The work conditions (caring for one person or a couple, their high level of dependency, sharing a home, isolation, dependence on the timing, and requirements of the illness) influence how the caregiver perceives her work. From their accounts, we notice an amplified sense of affection, a reinterpretation of the extreme isolation, the

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presentation of the care performed as a personal creation, the way they give themselves to care the other, not only because of contractual obligations but because of the “consuming” characteristics of their care. Their stories, shared in defensive mode, coexist with the suffering produced by the other’s dependence, lack of privacy, and confinement. Schematically, their accounts express a certain tension between the risk of losing themselves and depersonalization and building themselves up (creatively and defensively) through the work.8 In the case of care at institutions, which requires from the applicant a training certificate,9 a certain affective distance is necessarily created by the number of people that have to be cared for, in addition to how the work is organized “from the outside,” the physical and time separation between work and personal-familial space, the coworkers who participate in the same care, and an outside structure that assumes the responsibility of care. This does not presume the feelings of the caregivers, which can be contradictory as well as ambivalent in both types of care. The institutions are valued especially for being formal jobs that offer a continuity that does not exist in home care (where caregivers lose their jobs every time an elderly person dies). In terms of the work itself, caregivers in institutions say they do not have enough time to give attention to all the elderly in their care, albeit they also value the affective protection that keeps them from suffering. Numerous investigations have revealed how the subjective impact of caregiver training10 is greater than its concrete impact in terms of improving their work and gaining recognition (Borgeaud-Garciandía, 2015a; Borgeaud-Garciandía & Georges, 2016; Findling & López, 2015). The training formalizes knowledge, requires real learning efforts, and creates a distance from the naturalization of skills that takes the worker from “natural know-how” (which to the caregivers and others amounts not knowing) to specific knowledge. Furthermore, the experience of the training itself includes personal and family efforts, long classroom hours, exchanges with teachers and other students, sharing doubts and difficulties, the presence and recognized need for a psychologist to help, and the interaction with public care institutions about their practices, all of which contribute to establishing a strong personal assessment. The caregivers see the training as very positive and as having helped them see their work differently from the perspective of recognized knowledge that is unattached and independent from the object of their work (the care receiver). The caregivers underscore how training played a key role in helping them obtain the tools for addressing the issues of their work, especially managing affective and relational issues (including with the family members of the people they care for). This repositioning permeates their vocabulary: they refer to themselves as gerontological assistants and to the care receivers as “patients” rather than “abuelitas.”  Abou these different points, see Borgeaud-Garciandía (2012, 2017a, 2017b), among others.  This hasn’t alway been the case and it probably still is not in many places, although it is becoming more generalized. In the capital, it is required by the laws that regulate the activities conducted by establishements for the elderly. 10  We are referring to the public training courses that provide a diploma. 8

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Based on these observations, it would seem that, in the first case, self-assessment and subjective relationships at work are associated to care itself, the care provided and its outcomes and effects on the other, who represents both the object of care and the objectivation of their work and of themselves (themselves in the other, where “putting oneself in the place of” takes on a literal meaning, and where the other is their own creation). In the second case, training in combination with hourly home employment or, even more so, with institutional jobs, allows assessing oneself on the basis of denaturalized knowledge. It establishes a certain distance or detachment from the object of care that comes from a sense of pride in themselves (that is necessary, protective, and healthy) and in their skills, which exist regardless of who receives the care at any given moment. While these perceptions are not reserved for migrant caregivers, it is important to note that, considering the place socially assigned to migrant women, getting training and a diploma and attaining formal work at institutions shows a certain shift in the highly undervalued place that is typically reserved for them, which can be crudely summarized as Bolivian-vegetable vendors, Paraguayan-domestic workers (or caregivers), and Peruvian-caregivers (or domestic workers).

To Conclude In Argentina, like in many other countries, providing care services in private homes is a privileged entryway to the labor market for migrant women from poorer provinces and other South American countries, especially when they arrive alone or are first-time migrants. They are dedicated to caring for homes and people, especially helping dependent elderly people remain in their homes and thus alleviating their families in a national context that lacks public policies on the subject. Their migration stories and Argentina’s employment market structure are reflected in their work trajectories and in the different pathways and circulations they engender. Some of the women we interviewed specialize in “live-in” care, while others combine part-time jobs with caring for their children and/or organized activities in their communities, and still others did training courses to either become better prepared for home care employment or to achieve other types of more stable and recognized jobs. There are several aspects involved in how these caregivers see their work and how they relate to it (Borgeaud-Garciandía, 2017a). Their migration stories and their personal and family lives (which recapture historical and cultural elements that pertain to both their country of origin and their adopted country), intertwine with how they interpret their labor participation and their work. Their experience of creating a reason for being, even by mobilizing attributed naturalizations and stereotypes, is less about Bourdieu’s (1986) teleological illusion than about recognizing themselves in their present situation and valuing their contributions as well as their participation in collectives that are socially discredited and potentially suspect.

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In a labor market that is structured by significant social inequality, home care jobs represent a work niche for migrant women. However, more detailed qualitative studies show the types of pathways, circulations, and even displacements that occur in the trajectories of migrant caregivers, as well as the relations, tensions and aspirations regarding the work niches they are “assigned”. Some of the migrants seek out professions of greater relative social prestige despite the practical difficulties, tensions, and oppositions involved. In this sense, training and institutional work, even in care sectors, can offer a certain level of displacement and denaturalization, thus creating new spaces in local society. Acknowledgment  This chapter was translated from its original Spanish version to English by Jill Haring.

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Domenech, E. (2013). Las migraciones son como el agua: Hacia la instauración de políticas de “control con rostro humano”. La gobernabilidad migratoria en la Argentina. Polis, 12(35), 119–142. Dorlin, E. (2009). Vers une épistémologie des résistances. In E. Dorlin (Dir.), Sexe, race, classe. Pour une épistémologie de la domination. Paris: PUF, Coll. Actuel Marx. Falquet, J., Lada, E., & Rabaud, A. (2006). (Re)articulation des rapports sociaux de sexe, classe et «race» [introduction]. Les Cahiers du CEFREF, (14). Findling, L., & López, E. (Coord.). (2015). De cuidados y cuidadoras. In Acciones públicas y privadas. Buenos Aires: Biblos. Groisman, F., & Sconfienza, M. E. (2013). El servicio doméstico en Argentina. Particularidades y desafíos de un sector relegado (2004-2012). Carta Económica Regional, 25(111-112), 151–172. Hochschild, A. R. (2003). Love and gold. In B. Ehrenreich & A. R. Hochschild (Eds.), Global woman: Nannies, maids, and sex workers in the new economy (pp. 15–30). New York: Henry Holt and Company. Jacquemin, M. (2009). «Petites nièces» et «petites bonnes» à Abidjan. Les mutations de la domesticité juvénile. Travail, genre et sociétés, (22), 53–74. Jelin, E. (1976). Migración a las ciudades y participación en la fuerza de trabajo de las mujeres latinoamericanas: El caso del servicio doméstico (Estudios Sociales No. 4). Buenos Aires: Centro de Estudios de Estado y Sociedad. Kergoat, D. (2009). Dynamique et consubstantialité des rapports sociaux. In E. Dorlin (Dir.), Sexe, race, classe. Pour une épistémologie de la domination. Paris: PUF. Kergoat, D. (2016). Le care et l’imbrication des rapports sociaux. In N. Guimarães, M. Maruani, & B. Sorj (Orgs.), Genre, race, classe. Travailler en France et au Brésil (pp. 11–23). Paris: L’Harmattan. Magliano, M. J. (2018). Mujeres migrantes y empleo doméstico en Córdoba: Luchas y resistencias frente a formas de explotación y violencia laboral. In N. Borgeaud-Garciandía (Ed.), El Trabajo de Cuidado (pp. 33–57). Buenos Aires: Fundación Medifé Edita. Magliano, M.  J., Perissinotti, M.  V., & Zenklusen, D. (2013). Mujeres bolivianas y peruanas en la migración hacia Argentina: Especificidades de las trayectorias laborales en el servicio doméstico remunerado en Córdoba. Anuario Americanista Europeo, (11), 71–91. Maguid, A. (2011). Chapter 3: La migración sudamericana en la Argentina: Cambios recientes y perfil de sus protagonistas. In MTEySS, & OIT (Ed.), La inmigración laboral de sudamericanos en la Argentina (pp. 75–107). Buenos Aires: MTEySS y OIT. Mallimaci, A. (2018). Mujeres migrantes y la gestión de los cuidados. La enfermería en el horizonte laboral. In N. Borgeaud-Garciandía (Ed.), El Trabajo de Cuidado (pp. 119–138). Buenos Aires: Fundación Medifé Edita. Miranda, A. (Comp.). (2013). Ahata Che: Juventud, migración y género en el corredor paraguayo-­ argentino. Buenos Aires: Ediciones de la Flacso Argentina. Paperman, P. (2015). L’éthique du care et les voix différentes de l’enquête. Recherches féministes, 28(1), 29–44. Rodríguez Enríquez, C., & Sanchís, N. (Coords.). (2010). Cadenas Globales de Cuidados. El papel de las migrantes paraguayas en la provisión de cuidados en Argentina. Buenos Aires: ONU Mujeres. Rosas, C. (2010). Implicaciones mutuas entre el género y la migración. Mujeres y varones peruanos arribados a Buenos Aires entre 1990 y 2003. Buenos Aires: EUDEBA. Sayad, A. (1999). La double absence. In Des illusions de l’émigré aux souffrances de l’immigré. Paris: Le Seuil.

Chapter 12

Care Work: Professionalization and Valuation of Nurses and Nursing Assistants in Health and Old Age in Colombia Javier A. Pineda Duque

Introduction Modernization processes have conveyed a constant need to expand markets. While this has led to removing women from domestic spaces in order to expand job offers in labor markets, it has also simultaneously socialized and commodified many activities that had previously been done in domestic and home care contexts (Carrasco, Borderías, & Torns, 2011). Although several phenomena began in the first half of the twentieth century, since the 1970s Latin America has seen a growing participation of women in professional education and in labor markets, increased State socialization of some care services, especially childcare and care for the elderly, and also a growing commodification of these and other care services such as those related to body and beauty (Arango & Pineda, 2018; Hirata & Guimarães, 2012). These shifts have also facilitated and occurred within the framework of a growing movement to assert and value the work of women in both the domestic sphere as well as in public and market spheres, and more recently within a concept of care as work in an effort to expose its subordination and to value care and the feminine (Arango & Molinier, 2011; Hirata & Guimarães, 2012). The concern with care has also included the way to reconfigure what has been called the social organization of care. This organization is understood as the way in which care services are provided in a society and how they are distributed among families, the State, civil society, community organizations, and markets (Batthyány, 2018; Esquivel, Faur, & Jelin, 2012; O’Connor, 1996). A stronger State influence in socializing certain care activities has led especially health and social protection services to experience intense professionalization and J. A. Pineda Duque (*) Interdisciplinary Center of Development Studies (CIDER), Universidad de los Andes, Bogotá, Colombia e-mail: [email protected] © Springer Nature Switzerland AG 2021 N. Araujo Guimarães, H. Hirata (eds.), Care and Care Workers, Latin American Societies, https://doi.org/10.1007/978-3-030-51693-2_12

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institutionalization processes, which today, along with commodification and a greater market presence in care services, reconfigure the social organization of care. In view of the traditional naturalization and invisibility of care work, its professionalization has been understood and used as a mechanism that values care work in that it highlights the skills and knowledge involved in care services and denaturalizes them as the “innate” qualities of women (Arango, 2011). While institutionalization has facilitated professionalization, it has also cast doubt on valuing care work and on implementing an ethic of care (Pineda, 2018). This chapter presents aspects of the professionalization and institutionalization of women caregivers working with health and the elderly in Colombia with the objective of analyzing the ways care work is devalued and the impact of exercising and developing an ethics of care. This is done based on two research projects about care work: the first is called Old Age and Care Work in an Aging Society, conducted between 2014 and 2015 and the second one, currently being developed, is called Women Health Care Workers: resistance and care ethics. Both projects have had the support of research funds from CIDER at the Universidad de los Andes and other entities. A mixed research methodology was used, the first one being a representative survey conducted at gerontological centers in Bogota and semi-structured interviews of care workers, center administrators, and elderly people. The second one involved consulting the human resources of health database at the Ministry of Health in Colombia and interviewing with nurses at health centers in Bogota.

The Conceptual Turn of Care Feminist criticism of the world of work presents different disciplinary sources and conceptual contributions that have led, in recent decades, to what I have called the “conceptual turn of care” (Pineda, 2019).1 On the one hand, there are approaches based on the sexual division of labor concept that contributed to: economy, in identifying the invisibility of women’s work concentrated in reproductive and unpaid spheres (Benería, 1979); sociology, and its materialist tradition centered on domestic production and its socioeconomic analysis of the patriarchy (Delphy, 1982); anthropology, with the cultural and situated character of work in premodern societies (Comas d’Argemir, 1995); and history, with the modern construction of an ideology of domesticity (Scott, 1993). On the other hand, in the 1990s Anglo-Saxon feminist economy developed a criticism of the predominant economic theories and how those theories understand economic circuits exclusively from the point of view of what was involved in the market. Not considering what was outside the market not only impeded understanding the economic dynamic itself but also obstructed economic development and social well-being, and created a male bias that renders the contributions of women’s

 This conceptual part continues in summary what was said in the cited text of Pineda (2019).

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work invisible (Elson, 1995; Folbre, 1994, 1995). Elson (1995) indicates that the male bias in development processes leads to considering homes as merely units of consumption and not as producers of goods and resources that are valuable for the economic system. These contributions fostered what would be later called care economy, defined as work performed and value created, primarily in the domestic sphere (England, 2005). A third feminist tradition that introduces the concept of care more explicitly is based on moral psychology and philosophy. Carol Gilligan’s (1982) work opened a new study agenda, particularly in American feminism, to analyze the emotional and ethical characteristics of women’s work, especially the direct care of people, and to challenge the positivist, rationalist, and individualist theories of work. The notion of “ethics of care” coined by Gilligan in her opposition to Kohlberg’s moral theory also opened the discussion to taking the concept of care beyond the home and placing it in the center of social organization with multiple economic and political repercussions (Tronto, 2013). Joan Tronto (2013) criticizes the liberal concept that prioritizes the market as an adequate system for distributing resources according to the logic of rational agents that pursue their own interests. She states that markets are built by power arrangements and relations between care providers inside and outside the market and care receivers, and they are not concerned about the devaluation of care services or its quality or how privileged and non-privileged citizens access it. She points out the need to move toward a “caring economy” that would discuss the responsibilities of care in society and consider who is exempted from such responsibilities because of class, race, or gender. The different sources that contribute to the conceptual turn of care make it multidimensional and interdisciplinary. Thus, the contributions of the care perspective and its ethical, subjective, emotional, corporal, and identity dimensions are added to the analysis in terms of the sexual division of labor. While Luz Gabriela Arango (2015) brings back these dimensions, she also emphasizes care as work. When stating that care includes personal aptitudes related to the ethics of care, which are generally associated to love and concern for the well-being of other, care is above all a set of physical and emotional activities that must be conducted in order to meet the needs of other people and provide for their well-being. The psychodynamics of the work approach driven by Molinier (2011) seeks to articulate several of the aforementioned sources of care’s conceptual turn and debates with moral philosophy and American feminists on the ethics of care. In this, she places emphasis on care as work, on the social and power relations in which it occurs, and on the cultural and material conditions where the ethics of care emerge and operate. However, the contributions of the psychodynamics of work are to the study of subjective mechanisms that drive women to defend themselves from the suffering and humiliation that this type of work can produce. Care work has been explored as a broad concept of work that incorporates feminist production that includes the concept of emotional work, as seen in Hochschild’s (1983) seminal contribution and in the different sources about the ethics of care (Paperman, 2011). Care work has also expanded with the concept of corporal work,

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understood as having direct contact with the body of the other (personal hygiene, carrying, massage, etc.) while doing emotional work. Caring for the bodies of dependent people requires caregivers to manage their feelings about the corporality of their work as they provide care. Corporal work supposes physical work where the body is subject to work and simultaneously the place or object where the services are conducted (Adkins & Lury, 2000; Blood, 2005; Kang, 2010; McDowell, 2009). Anglo-Saxon literature introduces the concept of social care in the work of Julia O’Connor (1996) and Mary Daly and Jane Lewis (2000), who link care work to well-being regimes and social policy. This facilitates understanding the regulatory frameworks for conducting care, or in other words, the obligations and responsibilities assigned to the actors, and also connects measuring time use and the economic costs of care activities. This opens the analysis to how care is distributed among the different providing agents in society, which is called the social organization of care. This establishes the “care diamond,” a care regime produced by the interrelation between the State, market, families, and community (Razavi, 2007). In Latin America, analyses of the social organization of care have demonstrated not only its profound gender inequities but also how State and market participation has increased in the so-called processes of socialization and commodification of care, like professionalizing and institutionalizing care outside the home (Arango & Pineda, 2018; Batthyány, 2018; Esquivel et al., 2012; Vega & Gutiérrez, 2014). This chapter seeks to analyze these gender inequities from the perspective of the devaluation of the care work performed by thousands of women, which occurs in institutional contexts and in the growing professionalization of care services. This is done with the largest group of healthcare workers (nurses and nursing assistants) and eldercare workers (nursing assistants and general service workers).

Healthcare Workers The health sector in Colombia has experienced far greater growth than the national economy. The average annual growth of spending between 1996 (2 years after the reform enacted by Law 100 of 1993) and 2014 was around 8% in real terms, which led to doubling the spending as a percentage of the GDP in the same period. In 2014, total public spending on health alone was 4.7% of the GDP, which made it the second largest public spending category, surpassed only by the debt service (Gutiérrez, 2018). Therefore, in recent decades, greater coverage of social security for health has enabled effective access to services for a growing population. The total coverage went from 61% of the population in 2003 to 95% in 2016. The subsidized regime in particular went from covering 28% of eligible individuals in 2003 to covering 50% of the total population in 2009, and later stabilized at around 45% in 2016. The spending per member increased 74% between 2004 and 2014. The latter increased not only because of the benefits added to the package but also because of more frequent use. For example, the number of procedures per person increased by 37% between 2010 and 2015 and the number of consultations by 35% (Gutiérrez, 2018, p. 33).

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This dynamic of Colombia’s health sector is reflected in an important growth of employment rates in the sector, especially for professional and technical women. While this growth has favored employment in the sector, it has presented some problems related to processes of intermediation, hiring, and guaranteeing labor rights. Health occupation analyses generally differentiate between two types of occupations, each one made up of a set of related positions: administrative occupations and assistance occupations. On the other hand, there are many healthcare professionals that work for or are hired directly by other sectors and are counted as such. Additionally, according to the World Health Organization, health personnel should include family caregivers working in homes, whether informally or as volunteers, that contribute to improving health (WHO, 2006). Here we seek to include all those who work in institutional contexts outside the home. Thus, defining employment in the sector is clearly neither easy nor precise. There are two sources of information: home surveys designed to provide information about the labor market and the sector’s registration systems and controls that, in Colombia, are managed by the Observatory of Human Talent in Health of the Ministry of Health and Social Protection—OTHS (Ministerio de Salud y Protección Social [Minsalud], 2015).2 Based on the registration of all health personnel in the different territorial health areas that make up OTHS, we can observe an increasing supply of health assistants, technicians, technologists, and professionals throughout the entire twenty-first century (Fig.  12.1). Health workers experienced an average of 7% growth per year. Seventy-nine percent of these workers are women, whose participation remains steady in recent years and reveals the very high feminization of healthcare work. Considering the 28 occupations in a health assistance area that includes all health assistants, technicians, technologists, and professionals (doctors, dentists, nurses, therapists, nutritionists, bacteriologists, etc.), the occupation that has the most work-

900 800 700 600 500 400 300 200 100 0

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Fig. 12.1  Workers in Colombia’s health sector 2000–2018 (Thousands of people). (Source: Osorio (2004) and ReTHUS data from OTHS) 2  OTHS relies on the National Single Registry of the Human Talent in Health (ReTHUS), where everyone with assistance, technical, or professional health training is registered.

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ers is nursing assistance that makes up 34% of the total health workforce. Added to the professional nurses, who make up 11% of the total, we can say that the two groups form 45% of the direct healthcare personnel. However, these statistics do not include those that provide logistic support and that collaborate in all health entities, especially in personal hygiene activities, in other words, indirect care providers. These workers are almost exclusively women, and they are not included because they do not have health training. As we will see in eldercare, this group is key to understanding the continuities and devaluation of women involved in direct and indirect care. The most relevant issue in characterizing the work conditions of health caregivers is the type of work ties or contracts, which is related to the way the health system and labor regulations function. Although the health sector’s institutional design is highly complex due to Colombia’s Social Security System reform (Law 100 of 1993), it suffices to say that the health security system, similar to other countries in the region undergoing neoliberal reforms, functions according to market mechanisms where the State takes on the role of regulator and operates subsidy mechanisms on demand, where insurance is mandatory, where service packages are established for members, and where intermediary entities (Health Promotion Enterprises, or EPSs) are created to manage and hire services. The different ways of hiring workers in this context can be grouped into three categories: direct work contracts, different types of employment intermediation, and service provider contracts. The anti-labor bias present in Colombian development meant that until the early 1990s, the percentage of workers without a direct contract, including subcontracts via third parties, was negligible. However, “from that year on began an intensive process of outsourcing productive activities and workers” (Pineda, 2015, p. 116). The health sector did not escape this process. On the contrary, it was one of the most affected because of its own institutional restructuring. The delaborization process of the work relations in the health sector occurred because of the growing use of service provision contracts and the associated work cooperatives (also known by their Spanish acronym, CTA). These are widely used by EPSs (Spanish acronym for Health Promotion Enterprises) to hire workers as associated cooperatives with commercial contracts, which allows EPSs to evade labor relations. In addition to violating cooperative principles, a worker being hired as a CTA when it was not of their own volition contributes to a framework of unequal power relations because the EPSs (Health Promotion Enterprises) are the same ones that promote the cooperatives and condition the workers to become cooperative members. It is generally agreed that this phenomenon is one of the most powerful producers of job insecurity in several sectors of the economy (Urrea, 2010).3 Despite their decline in recent years, many female caregivers remain associated to CTAs.

3  Once the free trade agreement with the United States was negotiated, the situation generated by the CTAs entered the public agenda, which made the government intervene as of 2010 and somewhat revert the growth of outsourced labor through CTAs.

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Service provision contracts are not regulated by labor laws and have been widely used in the health sector, thus contributing to the delaborization process of work relations. According to OTHS (ReTHUS) information, workers that make direct contributions to the social security system, like self-employed workers, form more than one-third of the registered workforce. Although many health professionals have traditionally been self-employed, service provision contracts have increased in the sector to the point that it has become a mechanism to reduce costs by transferring social benefit payments directly to the worker and to prevent collective actions. Finally, the different types of employment intermediation in the health sector have been used primarily by the temporary service companies (also known by their Spanish acronym, EST). Acting as third parties, the ESTs manage human resources for health service companies in order to make them more efficient. However, in many cases they violate legal conditions such as not paying benefits to workers and preventing them from participating in labor unions. This is the case of one of the most important private clinics in Bogota and its temporary services company. In 2016, they were fined over one million dollars by the Ministry of Labor for systematically violating fundamental worker rights, creating parallel payrolls, and keeping direct labor relations from their personnel list by using outsourced labor. Many nurses had gone 10 or 15 years renewing their contracts every year with the temporary service company, often without rights to vacations and other benefits. This legal victory took 2 years of work by the clinic’s labor union, one of the few in the sector, and made up primarily of nursing assistants. Several of the testimonies provided by the clinic’s nursing assistants, 2  years later in 2018, showed numerous parallel processes generated by the commutation of the fine imposed by the Ministry of Labor.4 First, the clinic did indeed directly hire these female workers, but not according to the conditions of the collective work agreement negotiated with the labor union, but rather by putting personal and intimate pressure on the newly contracted individuals to not affiliate themselves to the union. Second, it created an organizational environment to terrorize the unions that included negotiations to remove the older ones and then blaming and stigmatizing all their affiliates for being “against the company.” This not only generated an environment of stress that made some of the employees sick but also affected the organization’s ethos, the interpersonal work relationships between the different groups of workers, and the care work itself with the patients. The situation of delaborization and intermediation that these institutional arrangements generated in health care reached a point that even the national government recognized it: This dynamic between employers, intermediaries, and types of work contracts has influenced the autonomy and decision-making capacity of health professionals, making the ethical and civil responsibilities required by their profession vague and more complex (Minsalud, 2018).

4  A fine imposed by the Ministry of Labor can be commuted or forgiven if the punished company commits to directly hire its outsourced workers. This clinic made this commitment.

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Fig. 12.2  Undergraduate Health Education Programs 1974–2018. (Source: based on the National Ministry of Education, 2018)

Lastly, it is important to highlight that the devaluation process of care work in the health field occurs in parallel with a process of professionalization of male and female health workers. One of the indicators of this is the growth of higher education programs in the sector. For example, in 1990, there were only 19 nursing programs and a total of 95 programs for health in general. In 2018, those numbers reached 66 and 288, respectively (Fig. 12.2).

Eldercare Workers Latin America’s context of demographic transitions and increasing life expectancy has pushed the growth rate of its older population to between three and five times higher than its total population. Although this aging population has generated a large demand for care, the discussions have generally focused on pension systems, assuming that care is the responsibility of the family or family networks. However, this is a highly problematic assumption because families tend to be smaller and more diversified and care is highly feminized and its responsibility rests on the women, who have less time because of their increasing participation in the labor market (Pineda, 2010, 2011; Robles, 2006). The aging population and the demand for care have produced in the market a variety of commercial establishments like eldercare homes that target middle- and upper-class families, who can afford it. Thus, the aging process has reconfigured the “care diamond” in the eldercare field so that it has greater market participation. I have analyzed how the commodification of eldercare has occurred by institutionalizing the elderly. This model, on the one hand, has segregated and isolated seniors, while on the other, has proven unsustainable and has led to devaluating older people and robbing them of their dignity in their final days (Pineda, 2014, 2018).

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In a study conducted in Bogotá city, I found that there were 521 eldercare homes with valid registrations, most of them grew during the first decade of the twenty-first century (Pineda, 2018). This same survey also provided organizational information about the employees working in these homes that included schedule distribution, work hours, positions, training, etc. We also interviewed caregivers as well as administrative staff and some of the elderly. Eldercare in gerontology centers in Bogota is performed mainly by two groups of women: nursing assistants and general services employees, who are highly demanded in all the homes to handle personal hygiene and to support the care services. Eighty-five percent of them are women. These two female caregiver groups have different profiles. The nursing assistants have a 2-year technical training course and are usually younger. The general services staff do not have qualified training, are usually older, and in many cases have been domestic workers. A number of factors make their work precarious. First, instability is very high, especially among nursing assistants, because their precarious working conditions are not what they expected. The main concern of the center managers and owners is, consequently, the high turnover rates of the young nursing assistants. This, in turn, undermines care ethics, affects the quality of the services, and prevents a life of dignity for the seniors (Pineda, 2018). Many care homes have limited logistic and infrastructure resources and are understaffed, which means they are overloaded both emotionally and in terms of work. I found that many care homes keep both a legal payroll and an informal one for workers that are neither registered nor receive benefits. While some nursing assistants are on the informal payroll, it consists mainly of general service caregivers, even though they have less turnover. This shows the caregivers’ precarious conditions of high instability and constant turnaround, excessive work hours, low wages, and inferior quality of life. The devaluation of care is thus a kind of vicious cycle where precarious conditions affect stability, which in turn affects both formality and care itself at the same time. Workers in the homes that have the greatest difficulties show the most distress when having to deal with the needs of the elderly without the proper resources or minimum care conditions, which is augmented by delays in their wages and their own personal and health needs. As mentioned earlier, care work is also subjective and emotional. Care work tends to include being overworked and emotionally overburdened. The tasks not only require the normal physical efforts of bathing, carrying, feeding, etc., highly dependent elderly people but also demand significant emotional efforts. Some homes require workers to set their personal problems aside and focus exclusively on the physical and emotional well-being of their patients. Few places attend to the emotional and psychological needs of the caregivers. This burden syndrome along with shift issues involved in caring for highly dependent seniors are often blamed for what some center administrators call a lack of “vocation” among caregivers, especially young nursing assistants. But what is a lack of “vocation” and what causes it are questions that invite deconstructing this management concern that places the responsibility of care on the “nature” of the caregiver. They associate this lack of “vocation” to abuses of the elderly people in their care, which can range

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from seating them in front of a television for a whole shift to ignoring their personal hygiene needs all night so that the caregiver from the next shift has to do it. This lack of “vocation” is, rather, a lack of what I call developing an ethic of care. This lack of “vocation” is not exclusively the outcome of the aforementioned labor conditions and precarious employment, and neither is it a typical characteristic of family care. Many women are able to develop an ethic of care and still preserve the dignity of their patients, despite limited conditions. Nevertheless, precarious employment conditions certainly do nothing to contribute to the motivations and requirements of care that enable caregivers to become involved with their elderly patients and develop responsible care. The lack of motivation seen among young caregivers seems more related to the sense of depersonalization that comes from not envisaging their professional lives in these care organizations. To speak about developing an ethic of care means it is not an innate feminine quality or an “essential” quality that belongs to women who have a “vocation” for care. While it is certainly connected to cultivating values at the deepest level of culture, it can still be molded and developed at different times in people’s lives by the institutional and organizational context they find themselves in. Therefore, words like patience, tolerance, understanding, love, affection, happiness, as well as emotional descriptions are highly frequent in the caregivers’ narratives about the relationships they establish in the process of caring for their elderly patients. These narratives are precisely the ones shared by women who had worked longer at a care home, who had built their careers there, and had developed a caregiver identity. It is easier to find an ethic of care, a sense of responsibility for the well-being of the other, among the women working in general services. They are the ones who do the “dirty,” least appreciated part of care work. They are the ones who bear up the dignity of the elderly, and the ones who develop an ethic of care. Reflecting on the ethics of care gives care work a central place in humanizing social relations (Arango & Molinier, 2011). This is seen in the potential this type of work has to generate reflections on the position of the other, of considering the other, and of experiencing the other. Reflections about otherness are part of the ethical dimension of work and form a key element not only for reconceptualizing work but also for building new social relations that are much broader. Work as a space for constructing identities continues being highly relevant in the configuration of contemporary identities in Latin American societies. But this process of changing identities also implies a transformation of attitudes, behaviors, and relationship patterns based on the social-labor context in which they interact.

Conclusions This chapter has analyzed the work of care in two specific fields: health care and eldercare. These fields have been experiencing a double process of professionalizing and institutionalizing care through different mechanisms that have led to devaluating the care provided by thousands of female care workers.

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Analyzing these cases in the context of the “conceptual turn of care” has been important to validate not only the concepts this turn has brought but also the persistent gender injustices that motivated the first conceptual efforts focused on the sexual division of labor. Undervaluing feminized care work and women’s care work persists when, first, full rights are denied to healthcare workers and second, when the work of eldercare employees is devalued. Thus, care work is undervalued by the socialization of health care and by the commodification of eldercare. The ethics of care tends to be undermined by the work conditions and employment markets the care workers find themselves in. The growing demand for care in health services and elder homes has led to the growth of institutional and commercial care with high supply segmentation and possible deterioration of care quality. The market influence on care work in a context of a growing demand raises serious questions about whether or not care work health centers and in elder homes devalue ethics in favor of growing markets. Acknowledgment  This chapter was translated from its original Spanish version to English by Jill Haring.

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Chapter 13

Dialogues Between (Feminist) Studies of Care and (Critical) Disability Studies to Rethink Emerging Activisms Dora Inés Munévar M.

Caring for the Introduction Studies about care and disabilities are part of academic research, although as marginal knowledge and practices. This marginalization is the consequence of the inferior place given to care and is related to how a good number of care subjects are relegated to situations of dependency because of age, sickness, or disability, which is true for all disabled subjects whose lives narrate individual experiences and collective stories of pathologization, medicalization, and institutionalization. According to Beatriz Mena and Dora Inés Munévar (2010), care work can prepare care receivers to be seen and heard in a common world that ignores or is unaware of the lives of disabled people. While knowledge and practices can serve to denaturalize the familial characteristics of care and its patriarchal imposition on women, relatives emphasize its emotional aspects and ignore its remuneration as work. As a social right, it establishes a sense of citizenship and structures new activisms. Care receivers share experiences that are interconnected by age, generation, gender, and everyday community life, again according to Beatriz Mena and Dora Inés Munévar (2013). This allows for situated understandings and space for reflecting on transformations that can be collectively reconstructed by deliberating together other ways of experiencing activisms for the purpose of care. In this sense, understanding some of the contributions made by (feminist) studies of care and (critical) disability studies and dialoguing with investigative care-based perspectives imply rethinking how experiences of care can produce, experience, and increase different activisms. These activisms emerge in the everyday experiences of caring for disabled relatives in neighborhoods or in new care niches that are not seen as work. They are also D. I. Munévar M. (*) Departamento de Comunicación Humana, Escuela de Estudios de Género, Universidad Nacional de Colombia (UNAL), Bogotá, Colombia e-mail: [email protected] © Springer Nature Switzerland AG 2021 N. Araujo Guimarães, H. Hirata (eds.), Care and Care Workers, Latin American Societies, https://doi.org/10.1007/978-3-030-51693-2_13

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in the narratives of mothers with disabled children who move through health programs where they are treated as eternal children, rehabilitation services that only see the needs, or educational institutes that have no place for their ways of understanding. In the end, the dialogues between these two fields of study conjugate the meaning of the activisms that emerge in academic research in Colombia.

Research Fields Care as a subject debated by academic feminists and members of social disability movements, according to Anahí Guedes de Mello, “involve[s] women, usually mothers, who care for disabled people most of the time, from whence they derive the main political features of feminist theories on disabilities” (2014, p. 178). This approach enables analyzing the transnational and racialized relations that overlap with everyday experiences, according to Christine Kelly (2016). Both sides experience marginalization, devaluation, domination, and resistance, which is inscribed in a care that naturalizes, colonizes, and constructs women as being responsible for care per se. Because care is a social subject embodied in the lives of women, understanding it implies that both care receivers and caregivers should reflect on it together. Although Anahí Guedes de Mello points out that “the dichotomy of sex/nature and gender/culture are part of feminist studies, while the dichotomy of lesion/nature and disability/culture are part of disability studies” (2014, p. 178), the effects of racializing and genderizing care operate in all the fields. In addition, according to Juliana Quecan, “this type of work is strongly tied to low wages, precariousness, and low social status, [which] fosters new work niches related to care work that are especially reserved for foreign women” (2017, p. 11). The subjectivities of resistance have emerged in both areas. In the case of disability, they seek to “understand the meaning of the body in the experience of pain, driving the discussion about what it means to live in a [different] body,” according to Débora Diniz (2007, p. 4), and in the case of feminist thought, they reveal its foundations. Here we see tensions and contradictions between what feminists reveal as the expropriation of time, or the appropriation of the wealth contributed by women, and what the social movement sees as the basis for infantilizing women and men and for disposing their decision-making agency regarding their own lives. Although these fields do not have similar focuses or agendas, they address the same subjects. Karen Soldatic and Helen Meekosha (2012) have explored the neoliberal politics of care and the effects that a weak welfare state have on inequalities, social rights, and the labor market. Thus, the precarious care work conditions in the South, the care crisis in the North, and the transformation of the caregiver profiles due to South-North migrations have intensified. Care has also been part of (feminist) studies of care and (critical) disability studies, both of which claim, like Christine Kelly (2016), processes of transformation in how we give and receive care in order to resignify our understanding and practices of it.

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According to Bill Hughes, Linda McKie, Debra Hopkins, and Nick Watson (2005), feminist debates about care lean toward rethinking the situation of those who provide care (usually women), while those who receive care (women and men) occupy a place of interest in the critical disability studies field. According to Teppo Kröger (2009), the theoretical focuses of care in both perspectives are a platform for interdisciplinary learning based on emancipatory practices. Finally, Christine Kelly (2016) states that the theoretical discussions that revolve around care imply debates between those who do feminist research and those who work with disabilities, since they explore policies more deeply and expand their effects on everyday experiences. The Independent Life Movement founded by Edward Roberts in the 1960s with the goal of incorporating care criticism into a center for theory, investigation, and policies, demanded the guarantee of direct financial resources to facilitate a life of dignity in community environments. These claims reject care approaches and their effects on everyday life; demand political discussions about the vocabulary used in regulations, laws, publications, and debates such as normal, deficiency, dependence, independence, and autonomy; and introduce the concept of personal assistance. The movement prefers to use the term personal assistance because it is socially more acceptable than caregiver, which evokes the idea of sickness and comes from the health sector. Laura Viñuela’s statement that emphasizes “the historical conceptualization of women as disabled [that] has been vitally important in joining the two fields” (2009, p. 35) of disability and feminism outlines two scenarios. Studies about care have been cultivated as part of human sciences, health, and political and social research, while feminist studies of care have been collaborative and interdisciplinary constructs that articulate concerns about disability studies. The feminist studies of care give more attention to bodies living in ableist contexts that are mediated by appearance policies, ideologies of beauty, the medicalization of different bodies, and privileges granted to normality or to identity construction.

Care and (Feminist) Studies of Care Endorsed by different feminisms, studies about care evoke the ethics of care, considering that it seeks socio-political, legal, economic, familial, and interpersonal transformation in relational and reciprocal terms. According to Victoria Camps, as quoted by Iris Comins (2015), this ethic is related to people, is interested in being applied situationally, considers the views adopted by rationality when mixed with emotion, is centered on direct and close commitment to the other, and proclaims a specific approach rather than an abstract, general approach to the ethics of universal justice. These studies call to mind the limitations of the “I” that self-identifies as autonomous and rational, and governed by abstract, universal laws. They also involve the practices of individualism that demean the social relations that form identities and incorporate the lives of subjects attached to an individualism that seeks only their

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own good. This normative image hides the vital dynamics of interdependent beings that live in concrete, historical contexts. It frustrates the transformation of abstract justice that, by not considering its complexity, or not being sensitive to a broad range of ethical considerations, addresses different circumstances with the same principles. It also mediates an equality that is limited to a legal dimension or to the dichotomic power struggle between majorities and minorities. Care studies were brought together to reclaim social justice. Its proponents began by recognizing the subordination of care work and of those who perform it without pay, meaning women with family ties to the care receiver. The alternative would be to defend care as a job in order to identify its ties to the State and expose whether caregivers are remunerated or non-remunerated, working formally or informally, or in decent or dirty conditions. Care has found a place for macro as well as micro analyses with contributions from the economy. In terms of the macro-level of care, the main infrastructure issues are subsidies, services, the relations between the different participating sectors (e.g., the division of care work, the distribution of responsibilities and costs between families, the market, the government, communities and volunteers), and the contributions of each sector according to the particularities of the social organization of care. In terms of the micro-level of care, what emerges is both the work of the women who perform the care and the experiences of the individuals who receive the care. In other words, the distribution of care among women, men, and families, as well as in the labor spaces or spheres, and in the work variations and conditions, which, in the words of Juliana Quecan: … are distinguished according to the social position occupied by the caregivers as well as the patients or clients, in terms of gender, class, race, ethnicity, age, sexuality, and other. […] there are other categories […], that must be understood as closely connected to it, and which also naturalize the position of certain social groups as destined to serve or be served. (2017, p. 52)

In addition to their economic contributions, women caregivers were politicized, their chores were denaturalized, and their transformation potential was valued because of reciprocity, something that is not part of patriarchal social spaces. The notion of independence gave way to interdependence as a central aspect of human life, which according to Dora Inés Munévar and Yency Cardozo (2018), affects children, seniors, the disabled, the chronically ill, and others. Interdependence, in an ethical sense, accompanies the relations of giving and receiving and maintains the dynamics of mutual care. Care is an object of feminist research that was incorporated into public policies and social organization studies based on the relations between care, vulnerability, and mutual dependence. These experiences influence the definition of what is political, which is understood as the order of power in everyday life. They are also influenced by care policies structured on the non-remunerated work of women (family members of not) and affect the care received and the social context in which the care is given, which specify the institutions responsible for providing and distributing formal and informal care.

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Demographic and financial factors, such as statistical mechanisms, have been the basis for incrementing the supply of care services, while social factors, such as family configurations and the responsibilities of women in the public sphere, have contributed to transforming social organization. This is where feminist research focuses in order to reveal the relations established between who performs care work and who receives it because care does not end with mechanical tasks, and not all the tasks are gratifying or dignified. Some care tasks, like those considered dirty work, are the least gratifying due to what Luz Gabriela Arango and Pascale Molinier say, as quoted by Juliana Quecan: The more social stigma they have, the less symbolic value they have because they are associated to contamination and impurity […], even though they are vital to maintaining the wellbeing of people, they incur more social disapproval, are badly paid, and the people who generally do the work are in socially inferior positions (confining specific groups to these chores). (2017, p. 49)

The reflections of different feminists in different geographic locations have created tension between the dominant concepts of independence and autonomy (with their legal, social, political, and ideological dimensions), which are deeply rooted in individualism, capitalism, and the patriarchy. They brought to light racialized discourses that prioritize normatively built and reproduced whiteness and the legacy of a social regime based on pigmentocracy, as well as the repercussions of gendered and normalizing discourses that maintain their foundation of heterosexual and cisgender masculinity and ableism. Hence, the analyses of (feminist) studies of care are an open challenge to the merely binary or dichotomous concept that is inherent to the action of giving and receiving. They also refer to the asymmetries of these experiences in everyday life. The research indicates that the gendered, racialized, and classist nature of care regimes maintain existing social inequalities, and affirm that the materialization of care as work, with its structural, cultural, and ideological characteristics, re-situates the involved parties.

Disability and (Critical) Disability Studies Disability studies began in the heart of disability organizations toward the end of the 1960s, at which time its members shared the same ideas as other historically excluded groups such as African Americans, black populations, ethnic nations, women, lesbians, and gays. Later on, critical disability studies, along with debates about ableism1 and disablism (i.e., discrimination against disabled),2 revealed that

1  Derogatory attitudes toward people with disabilities that contribute to forming subjects, subjectivities, and representational practices used to legitimize their oversight and care. 2  The belief that disabled people are inferior to others conduces to discriminatory, oppressive, or abusive behavior.

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the hegemonic norm operates as a process and product that is inscribed on bodies, lives, and identities. Now researchers understand how its expressions, rooted in an idea of deviation, are supported by the social systems of classification and simultaneously contribute to exploring the issue of corporality, the incorporation of subjectivities, discourses and institutions, the rise of resistances and activisms, and the configuration of alliances that bother the system.3 Débora Diniz (2003, 2007) highlighted the theoretical contributions made to care studies in the field of disabilities by way of generations. The first generation led by professional men with spinal injuries introduced the social model of disability. Their members reproduced the dominant discourses on gender and class and denied the dimension of care in their lives. Based on a critical review of the same social model, those who advanced the second generation included the feminist perspective and proposed the notion of interdependence as a human value to drive debates about the embodied experience, discussions about pain, and the everyday lives of people living with multiple disabilities. Thus, the lives of girls and boys and young people dealing with intellectual disabilities or severe disabilities in a world governed by rationality, autonomy, independence, self-sufficiency, and productivity soon appeared in these academic debates. Criticisms of care arose early on in the social disability movement as expressions against oppression and oppressive regimes. Consequently, care and its relationship with disability became associated to institutional confinement, imposed social absence, partial civic responsibility, and being silenced. Care was depicted as participating in the naturalization of disabled bodies and in the disregard for different gender experiences. According to Bill Hughes et  al. (2005), the political debates take into account that care contributes to defining life with disabilities as a dependent life, but do not consider the gender relations that affect it. Care in the lives of disabled people is equivalent to confinement, institutionalization, and control based on the biopower exercised by professionals in the areas of medicine, nursing, rehabilitation, social work, and psychology; by entities that provide formal care; and by informal female caregivers. Thus, based on the institutional, personal, and interpersonal foundations that are inherent to ableism and experiences of oppression, disabled people launched two inevitable political acts: the conceptualization of disability and the recognition of disabled people as being targeted by social discriminated and living in disadvantaged situations, according to debates promoted by early disability studies. This alternative became the basis for politicizing disabled people and for creating new alliances with people from different cultural contexts. This feminist-driven phase challenged the weight of securitist discourses, or instruments that intentionally manipulate popular beliefs; the discourses of dependence, due to the lack of the  Disability studies emerge in the Anglo-Saxon world as the struggle of disabled people against the normalization, segregation, and stigmatization that underly medical discourses and understandings, rehabilitation activities, special education, wellbeing, and integration. In Latin America, this perspective of socio-political analysis of disability has included the contributions of critical theory and is supported by decolonial theory and the voices of those whose bodies and subjectivities have been labeled as disabled. 3

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necessary abilities to make decisions in a rational world; and the discourse of personal assistance, mediated by contracts or contractual relationships presented by disabled men. Disabled women also established themselves in the struggle and committed to feminist ideas. Their leaders used social oppression to name the social disadvantages they experience as a collective. Once they were made visible, the concept of disableism came into being, which is shared by Rachel Hurst and Tony Manwaring: “Why talk about another ‘ism’?” (2004, p. 15). Disablism exists and must be named. Thus, after reflections and deliberations, disabled women chose to name their own experiences with discrimination, similar to what feminist activists did with sexism or Afro activists did with racism. Care as a research subject in disability studies has been questioned by some feminist research on disabilities. Jenny Morris (2001) points out that this research ignores the conditions experienced by disabled women and colludes with a patriarchal system that does not guarantee people the right to control their own lives or to have the required support. It sees the provision of care as conditioned upon dependence or eligibility. The author emphasizes that neither the research nor the disability policies are designed with the care receivers in mind, but only considers those who directly provide the care, whether formally or informally. In any case, the conceptual ties that underly care and disability studies have been determining factors in revealing the socio-political way of construing subjects that are dependent and unable to make decisions. Being considered passive subjects is nothing more than a consequence of the normative and normalized protection imposed by the system. This situation has led different activists from social disability movements to denounce the concept of care that grants total power to caregivers and foments increasingly unfavorable attitudes toward care receivers. On the one hand, the historical invalidation of the lives and bodies of disabled people comes from the work of some care receivers, and from the way public policies tied the term care burden to consumption of scarce but available resources, which included the lives of the caregivers. On the other hand, research on the infantilization of the disabled subject and the erasure of disabled men and women’s civic rights has intensified this construct and generated feelings of resistance toward care. These forms of resistance produced new concepts with alternative options and practices contained in a phrase: We do not want to be cared for because care is oppressive. With a specific desire: Our political goal is to have personal assistance. And a new focus of the independent life movement: It is indispensable to seek and enjoy good care in order to foment the debates about autonomy and to respect diversity. The renewal of these postulations brought into effect the legitimate right to direct representation and to hear the plurality of their voices without the intervention of third parties. These practices promoted personal assistance or support. Teppo Kröger (2009, p.  405) illustrates these alternatives with three proposals and three authors: Vic Finkelstein’s (1998) idea of support as a way to meet people’s needs, an idea of help through reciprocal relationships between peers based on Tom Shakespeare’s (2000) solidarity, and the sharing of these ideas because of the advantages they offer in

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creating a distance from personal subjects and because they are based on a contractual relationship removed from emotions, according to Nick Watson, Linda McKie, Bill Hughes, Debra Hopkins, and Due Gregory (2004). These options allow a pragmatic and immediate stance: that disabled people have material control over the work relations they support or establish with their assistants. Personal assistance and assistants emerged for the purpose of guaranteeing “the active presence of a third party [who is] important in conducting [our] decisions,” according to Julián Sánchez (2017, p. 31). However, they maintain their connection with rationality and independence, which undermines the rights of people with intellectual disabilities, multiple disabilities, severe disabilities, or who cannot communicate in conventional ways. In any case, going from a dependent relationship in family or community contexts to having the advantages provided by personal assistants produces new situations described by Christine Kelly as “an abusive interaction between individuals rooted in specific situated power dynamics, an institutionalized approach to disability, and an unjust social organization” (2016, p. 35). Under these circumstances, what happens to autonomy and independence as principles and rights embodied in the national constitutions of each country? Although independence, self-control, and control can be found in the conceptual and political foundations that support the idea of emerging activisms in these critical spheres of care, independence does not mean self-sufficiency. Rather, it expresses the desire to have control over decision-making and of being able to define how help is provided in concrete situations within the sphere of rights and citizenship.

Right to Care, Caring Citizenship, and Activism In both fields of research, caring for disabled relatives constitutes understandings and practices rooted in generational order and family relations. Both contribute to rethinking the foundations of the right to care as sine qua non conditions for revealing the structural inequalities that support the standard care regime in a country. Its materialization has been produced by different emerging activisms in everyday life.

Social Right and Caring Citizenship Care means being entitled to a right, is a citizen issue, and involves social responsibility that competes with the State and requires social recognition. Care is therefore problematized when it is not an individual subject that family women have to solve according to their economic possibilities, even though, according to Karina Batthyány, a “significant part of this load has fallen, and still falls, on the families, which is the same as saying, in most cases, on the women in the families” (2015, p. 11).

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For this reason, defining, discussing, and implementing all the necessary measures to exercise citizen care, as proposed by Selma Sevenhuijsen (1998, 2003), begins with redistributing and re-signifying care and implies rethinking the activisms that have emerged in the everyday lives of women caregivers or of disabled women and men who receive care, as summarized by Anahí Guedes de Mello: To my activist colleagues, the category of caregiver is “degrading,” [even though] the “caregivers” are women and men – most of the time mothers, and in some cases fathers or other family members – that assume the tasks related to the personal care of their disabled children or siblings. (2014, p. 257)

Therefore, self-reflective and critical mobilization, along with the exercise of one’s sense of citizenship and rights, intensify the desire for social transformation. And reorganizing care work shows the reach of some international pacts and agreements (such as the Santo Domingo Consensus, 2013, the Brasilia Consensus, 2010, and the Quito Consensus, 2007), which recognize care as a social right guaranteed by the State. Karina Batthyány states that it is “a universal right for all citizens, from the double circumstances of people who need care and provide care, to the right to give and receive care” (2015, p. 11). This configures the multiple practices that are part of the citizen care described by Irene Comins, which are: Practices where people can make their own choices to be caregivers and/or care receivers, dialogue with each other, be concerned for their own wellbeing and that of others and of nature. It is seeing new ways of democratic actions that include care as a driving principle and make care a political practice that is participative and global. (2015, p. 172)

These are practices that create space for citizen interaction with symbolic, physical, and geographic places that, according to Avtar Brah, “are experienced in terms of neighborhood […] especially through daily encounters” (2011, p.  26). These interactions can be reconsidered through activisms that emerge in the everyday lives of girls and adult and elderly women. This same understanding also requires listening closely to the situated experiences of boys and adult and elderly men, considering that social reality is deepened by regimes of inequality in terms of race/ethnicity, gender, and class.

Classes of Activism The academic debates of both fields have produced several activist dynamics that are derived from politics. The cross-questioning between them, in addition to configuring different expressions of activism, also calls for leadership from situated experiences and reiterates that care work involves knowledge and practices that are recreated in everyday struggles. This implies people involved in social, legal, political, or bureaucratic activisms. Social activism  Social activism addresses several themes and strategies because it does more than draw attention to different social groups in civil society making

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demands for change or using mechanisms to guarantee their entitlement to exercise social rights. It also requires measuring the reach of social organizations and those who defend them publicly. According to José Santana, João Afonso Batista, and Patrícia Costa, defending the rights of disabled people means: Creating community awareness in order to reduce discriminatory attitudes, preconceived ideas, and practices; applying pressure to establish policies that truly and totally remove architectural barriers or to implement quotas that enable access to jobs in companies and institutions; collaborating in the development of people’s skills and abilities. (2006, p. 28)

Legal activism  Legal activism occurs though constitutional provisions and has led to judges taking actions that sometimes go beyond their responsibility, which tend to be consulted to support other activisms. According to Pilar Arcidiácono and Leticia Barrera, it is necessary to go “before the judicial branch with a repertoire of actions and strategies for changing public policies that other branches of power deny or do not enact” (2018, p. 58). While its central issues refer to the nature of the Fundamental Rights Charter established in each country, it also follows the relation between law, society, politics, and legal culture. Political activism  Political activism emerges as a specific type of social action that involves a collective political process guided by a coalition. This activism is an expression of citizenship in social participation that stimulates collective actions, which indicate the formation of self-reflective political subjects that are committed to change. In addition to emerging from a social process of political subjectivity, its goal is to covert its interactions into practices so that its participants recognize their own contradictions and thus, create collective solutions for their common issues called for their presence, word, and organization. Bureaucratic activisms  Bureaucratic activisms address the overcrowded relations between public administration and different social groups. They observe how the rationality of these relations plays out in everyday life, and try to understand how it multiplies. According to Lina Buchely, they are not “something discreet, unitarian, or determined [to reveal] the negotiations where gender and the fragile citizen rights of women find solutions through struggles within the legal power structures of the state” (2015, p. 143). These activisms have the need to identify both the institutions and the actors that want to be involved in concrete actions, while also being aware of the possible reactions of the system. These types of activisms can bring together the different situated experiences according to the research intentions of each field. These dialogues, in addition to communicating different individual ways of being and doing resistance, also seek to understand the relational foundation of the care established between the subjectivities involved. In all cases, the collective mobilization inherent to women’s social organizations and to feminist collectives has been an anti-exploitation political strategy shared by disabled women. In turn, disabled men have turned to formalized mechanisms that allow them to strengthen their dialogue with the State.

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Emerging Activisms This topic includes a set of public actions intended defend the rights and interests of people, groups, and collectives that have historically been excluded. Thus, care knowledge and practices become their core principle when accompanying the transformation of care, strengthening collective possibilities for action, reflecting as a group, and recognizing together the right to care. Gladys Parada (2018) and Julián Sánchez (2017) show different actions in disability studies, Ana Lucía Giraldo (2018) in political science, and Nora Pava (2016) in social sciences. Being an activist means being committed to understanding oppressive situations in order to accompany a group’s actions or to improve the organization of other, less effective political efforts. For that reason, recreating the everyday care practices implemented in the socio-­ political and economic-political dynamics that surround caregivers, care receivers, and care supporters requires looking at the multiple political, economic, social, cultural, ideological, and generational factors that characterize it. This was done, for example, in the gender studies conducted by Juliana Quecan (2017) and Dora Inés Munévar, Ana Yineth Gómez, and Myriam Morales (2015). Two situations arise from this double approach. First, caregiver activism grows as social power structures expand, or in other words, as oppression structures their experiences, as documented by Gladys Parada. Second, the situated and everyday experiences of those who fight for care rights contribute to consolidating parallel activisms conducted by women and men caregivers and care receivers and become a component of collective mobilization. This is similar to the findings of Dora Inés Munévar et al. While shared experiences differ from care experiences, they both conjugate the personal and the political in order to interweave different ways of doing activism, thus creating resistance and mobilizing “anti” stances, as pointed out by Juliana Quecan (2017, p. 159). Women can use all their ways of expression to bring together the many processes they experienced in order to intensify their claims, which Gladys Parada reiterates as, The voices of the protagonists unite and empower when they show how understandings and practices are socially built. They enrich, mobilize, transform, and adapt, subverting the knowledge of the experts. These other forms of knowledge are important because when they are built collectively on subjectivities, and they produce a new knowledge that enables recognition and positioning as subjects. (2018, p. 2)

The social and political activism of women who are mothers of disabled children or sisters of disabled siblings has emerged slowly. It involves homemakers and professional women from the areas of health and rehabilitation, law, care—all of whom care for their disabled children, as seen in Ana Lucía Giraldo’s study. The author highlights the women’s active participation, and how they share “what happens in their lives and in the lives of other caregivers, [which] allows them to reflect on what they experience [in order to] make decisions” (2018, p. 157).

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To understand how mothers and fathers of disabled children find their place in the world of disability, we must refer to the situated knowledge described by Jhonatthan Maldonado as “tools that produce awareness maps in the subjects that have been marked by exclusion, inequality, and violence” (2017, p. 143). Nora Pava approaches the kind of knowledge and expertise shared by professionals in workshops and training courses with the desire to think about care to provide care, since: The care of their children becomes another expert knowledge, especially when parents maintain their work, family, and couple lives. This involved an emotional mobilization that makes them reflect on their decision-making process, the inherent responsibilities of raising children, and the motivations behind these decisions, which are related to the magnitude of the responsibility they feel. (2016, p. 137)

Men caring for disabled relatives want to have their own place in these activisms. This desire reflects the personal assistance described in Julián Sánchez’s thesis in the questions about the social integration programs exposed by Dora Inés Munévar et al., and in the emotional capital explored by Nora Pava. Julián Sánchez describes his father as his caregiver and how much he appreciates his companionship in public, their mutual emotional support, and their affectionate collaboration. He adds that social activism allows claiming a personal assistant because, besides counting on their hands and legs, the disabled person enjoys the support of an assistant in a way that is relational and emotional. This challenges the separation between the autonomous and rational “I” of individualism and human beings that are aware of their interdependencies. Dora Inés Munévar et al., highlight the configuration of political activism in their observations of how some women want to be publicly recognized because they want to contribute their experiences to making changes, and how many women have disclosed their daily unpaid work. The men in their study that were caring for their children at home were willing to co-construct a beautiful life based on affection and feelings, since it was possible to co-construct social and bureaucratic activism. Along the lines of social activism, Juliana Quecan wants men to become involved because “it would allow them to understand how they are different […] that they are also racialized and also occupy a specific social position” (2017, p.  161). Furthermore, based on the conviction that within the giving and receiving of care, there operates an interpretative relation mediated by bodies and corporalities, Nora Pava suggests an affective intentionality in social activism: Combining these factors [forms] greater emotional capital, [which, albeit] cannot be quantified as economic capital, appears in achievements, actions, reflections, wellbeing, and peace of mind, […]; in other words [observing it requires] understanding that the capacity for political action is built in the mix between social structure and feelings. (2016, p. 175)

Dora Inés Munévar et al., identify some mobilization attempts narrated by caregivers that evoke the experiences of “madres comunitarias” (or community mothers) described by Lina Buchely. They expressed ways of configuring bureaucratic activism based on the work of these mothers as street bureaucrats, which involves: An understanding of local processes of the state and public spheres that occur when private subjects resolve public interest matters. […], when negotiating and dividing the social dis-

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tribution of childcare work with mothers and state institutions in the privacy of their homes, these temporary substitute mothers become a sort of street bureaucrat. (2015, p. 138)

Legal activism has two manifestations that constitute an immediate demand, especially because, according to Pilar Arcidiácono and Leticia Barrera, “it affects the ‘harmonization’ process of regulatory frameworks [because] it recognizes a scheme of resistances and regulatory ‘translations’ on the part of the bureaucracies that condense several approaches and expert understandings (or not)” (2018, p. 74). The first manifestation, suggested in the work of Ana Lucía Giraldo, follows the tracks left by the Constitutional Court since 2003 with Sentence T-191 of 2015, “the first legal reference where the State recognizes the importance of its attention […], without this implying work overload or a failure to comply with part of the family responsibility” (2018, p. 182). The second manifestation is in line with the work of Julián Sánchez, a researcher interested in the Independent Life Movement.4 He claims policies based on a relational encounter because, as Kelly Fritsch states, “it is not what you can do for me, but what we can create together” (2010, p. 11). In his investigation it is decisive to “discuss how the Constitutional Court interprets the rights of autonomy and independence and the experiences of a group of peers, while keeping in mind the philosophy of the Independent Life Movement” (2017, p.  20). These interpretations show that neither the paternalistic attitude inscribed in care work nor the infantilization that restricts autonomy can be maintained in daily life. Likewise, substituting desires in decision-making cannot continue. These citizenship care practices in academic research have involved new interrelations between care, research, and disability activism. While women who provide care have already crossed over from the private sphere to the public sphere, ­according to Ana Lucía Giraldo (2018), both disabled women and men continue showing who they are and what they want from their entitled rights, according to Julián Sánchez (2017).

Co-constructed Dialogues (Feminist) studies about care have enriched the epistemological debates about supporting life and living beings and have created an own place in the academic organization of knowledge. (Critical) disability studies have involved subjects that are omitted or deleted from canonical studies on human disabilities because its advocates refuse to be under any care at all, or even the object of care.

4  Julián Sánchez wrote, “Disability leaders lean toward bringing the Independent Life Movement to Latin American. They have found that it is a way to comply with article 19 of the Convention [of the Rights of Persons with Disabilities, UN] and to begin closing inequality gaps. They have defended this alternative to achieve material and real equality […]” (2017, p. 81).

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Both fields of study have been part of different debates on the activisms unleashed by care work. Even though the debates are not always connected or do not have the same origin or reach in their resistance practices (their own or incorporated), both perspectives seek to accompany the denaturalization of the body, the incorporation of the identity dimension, and the adoption of a feminist ethic. Although the groups of women and men bring together their experiences as activists, the two perspectives see care relations as formed by different dynamics that create a certain tension. This tension includes ways of providing care, ways of moving between public and private spheres, ways of relating with otherness in affective, emotional, and rational terms, and ways of transiting through spaces with little or no social, symbolic, or economic value. In addition to generating political and social changes in the everyday lives of women and men that receive care, there has been an in interest within critical disability studies to do empirical research and restructure the theoretical reach of care. Its proponents have encouraged analyses of care relations and how it connects with public policies. They have also insisted that personal assistance is far from being merely a contractual or instrumental issue devoid of emotions, since there is an awareness that it is rooted in and structured by independent-interdependent interactions. The activism involved in (critical) disability studies has begun to register symbolic effects that have added new topics to the public agenda. It has enhanced the political gist of the practices it shares with other movements, has considered other academic discussions, and has shown that other subjectivities are willing to move through “a field of tension, where that same tension is what feeds the production of new understandings and, in turn, new tensions,” according to Natacha Borgeaud-­ Garciandía (2018, p. 18). (Feminist) disability studies have opted to incorporate alternatives focused on re-appropriating different bodies through creativity. Thus, the work of re-­ signification conducted by artists with or without disabilities has been dedicated to challenging the individualist, capitalist, and patriarchal logic inscribed on the bodies of disabled women and men. Eventually, the goal is to bring, navigate, and understand the paths of an activism that involves, in the words of Luis Berraquero, Francisco Maya, Joan Vidal and Francisco Escalera, (2013, pp. 5, 6), “the body and everyday life as mainstays of political action [to] generate new networks.” This requires rethinking the affirmation made by Laura Jaffee and Kelsey John: Activists without disabilities have their own ways of conceptualizing activism – and the language it uses – that relegate or set aside many bodies. [For this reason], disabled activists have turned to more creative ways of fighting that come from their body experiences and understanding. (2018, p. 1426 nota 12)

In this double sense, reorganizing the care derived from the activisms of caregivers and care receivers is based not only on its worldview but also on its possibilities of giving and receiving, concern for others, and being responsible for caring for others, which includes the idea of caring more for oneself. Furthermore, it requires thinking how the lives of disabled people are transforming the co-construction of

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care as lived experiences become the critical source for “some ways some getting to know multiplicity, differences, and a sense of the provisionality of place,” as supported by Carmen Luke (1989, p. 13). Thus, what has been experienced by more women caregivers than men providers, a fact that has kept it invisible in statistics as well as in languages, cannot be ignored when adopting critical approaches for activisms. These approaches require understanding the notion of interdependence between subjects in order to identify how intergenerational relations are structured. These structures reveal the asymmetrical relations of gender, ethnicity, age, class, and generation that can “communicate with personal narratives, performance art, or cinema more than with the objective purposes of research,” as suggested by Sharon Snyder and David Mitchell (2006, p. 4). Apart from questioning expert discourses about care, situated experiences bring together the understandings and practices shared by women and men providing and receiving care within family spheres in different ways. This enables approaching the processes of care recognition in order to expand the multiple pedagogical purposes of the tasks related to research within and without academia, to the politization of care work, and to gender influences on familiarity. Raquel Guimarães stated that: Care work occupies an inferior position in the gender hierarchy that organizes life in society, […]. Understanding the issue of disability without the transversal approach of gender has significant impact on the lives of people who do care work. (2010, p. 208)

The research desired by professional women and mothers of disabled children is one that continues their own knowledge, their intense resistance practices, and their emerging activisms, as experienced by Gladys Parada et al., (2018). They want to contribute to the social transformation of care work with actions that begin with their social, cultural, and political experiences as professional women more than as mothers. This includes the re-signifying proposed by Christine Kelly (2016), intensifying the “anti” position suggested by Juliana Quecan (2017), and understanding the conditions in which this type of gendered, racialized, and precarious work occurs. In other words, keeping in mind the importance of revealing the oppressive aspects of care to the care receivers, as well as accentuating its transformative potential. Thus, according to the political proposals of Jhonatthan Maldonado, they are listening more closely to their voices but not “in the paternalistic way of talking for or over their life trajectories like an ableist ventriloquist” (2017, p. 145).

Caring for the Conclusion Considering the academic literature and research about care in the (feminist) studies of care and in (critical) disability studies, emerging activisms speak of two groups of people or components of a dichotomic relation: caregiver, the women in the families; and care receivers, more men than women. Both perspectives challenge many situated experiences and shape the dynamics experienced by the women who care and the disabled men and women who receive care.

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Both fields subscribe to principles in line with a life of dignity and tend to accommodate asymmetrical relations that are typical of feminized social spaces. Both configure the actions of the caregivers in the same way as the mobilizations of the people with disabilities. These debates also include and recognize the implications derived from formal and informal care work and its uses, abuses, costs, and ways to materialize its supply in the market. In both fields, the analysis of care work involves breaking away from naturalizations and familiarizations to embrace the emotional components that are so closely tied to kinship. It requires incorporating power structures in order to rethink the interdependence between subjects, counting time in terms of days and years dedicated to care, the intergenerational and gender relations, and the lack of economic, social, and symbolic recognition. It also involves rethinking the distribution of responsibilities within homes, which is a place of not only leisure and consumption but also work and producing goods and services. Within the (feminist) studies of care, it is essential to deeply examine the critical stance of those doing critical disability research in terms of the concepts and practices of care. Within (critical) disability studies, it is fundamental to consider criticisms against what felt like claims that perpetuate patriarchal privileges. In the interrelation between both fields, fully caring citizenship is part of the pending debates on new questions about available care services, social organization processes, and strengthening complaint mechanisms through emerging activisms. These prospects will occupy a fundamental place in care studies whether to emphasize its political characteristics or to understand the contributions of unpaid female caregivers and how caregivers and care receivers configure activisms. In other words, incorporating the multiple situated experiences from both fields of research will activate political awareness in care givers and care receivers and will contribute to complexify the understanding of activisms produced by care work. Acknowledgment  This chapter was translated from its original Spanish version to English by Jill Haring.

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Index

A Activism bureaucratic activisms, 226 legal activism, 226 political activism, 226 social activism, 225 Aesthetics for Afro-textured hair, 116 beauty standards, 108, 110 black anti-racist, 111 care market, 114 “displacement” processes, 107, 109 emancipation and subjective affirmation, 111 Eurocentric, 117 fragile aesthetic feeling, 111 hairdressing/beauty salon, 108 hegemonic and global paradigms, beauty, 111 “natural” hair, black women, 107 racism, 114 social values, 116 and subjective change, 115 in virtual natural hair communities, 117–120 work environment, 107 Afro-Colombian women aesthetic care, 107 AMAFROCOL, 108, 110–111 Aging population, 53, 56 Aid to Families with Dependent Children program, 83 Anti-exploitation political strategy, 226 Anti-racism, 108, 109, 113, 117, 119, 120 Association of Afro-Colombian Women (AMAFROCOL), 108–111

Attendance Allowance, 88 “Autonomous” people, 1 B Beauty and hair care, 109 hair straightening, 111 “natural” black hair, 113 of “natural” curly hair, 109 racial, gender and class inequities, 111 standards, 108 Bertha Pappenheim, 100–102 Big chop, 112, 113, 115 Brazil “caregiver” and “caregivers”, 130 in care work, 132 CBO, 128 domestic and care tasks, 139 familism, 134 family and community networks, 140 home care workers, 128 international criticisms, 137 Portuguese language, 129 professional care work, 127 (see also Care) public health system, 141 racial differences, 133 remuneration conditions, 133 social inequality, 126 C Care actuality and centrality, 1–3 analytical attention, 4 concept, 5

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236 Care (cont.) coronavirus pandemic, 1, 2 democracy, 4 doctor’s work, 1 domestic, 4 ethics, 3 as help, 139–144 labor commodification processes, 125 in Latin America (see Latin America) and non-care labor, 78 nursing profession, 125 as an obligation, 135–139 as a profession institutional recognition in Brazil, 131–135 long-standing, 128–131 notion of profession, 128 nursing, 128 occupational family group, 128 self-identification, 128 self-care, 2 social and economic activities, 25 social relations, 125 ubiquity and fundamental role, 25 Care activities, 4–6, 14 Care crisis, 77 Care deficit, 6, 77 Care diamond, 6, 14, 40 Care economy, 25, 26 care provider, 26 care services, 27 GDP, 27 households, 26 implications, 34 “motherhood employment penalty”, 27 recognition, 27 transformative policies, 36, 39 Care employment, 29 Care of the self feminist perspective, 93 Care policies, 8, 14, 47, 50 aging population, 53 challenge, 51 comprehensive social protection systems, 50 ECLAC, 36 everyday physical and emotional well-­ being, 45 “high road”, paid care provision, 38 inequalities and risks, 55 integrated, 51–53 integrated policy, 37 in Latin America, 36, 37 program beneficiaries, 49

Index public policies, 35 social protection, 47, 55, 56 transformative policies, 36, 39 Care professions, 126, 128 Care provision care diamond, 35 care economy, 27 caring, 27 costs, care work, 30 domestic workers, 28 female participation, 28 home-based domestic workers, 29 households and economy, 28 paid domestic work, 28 unemployment levels, 28 unpaid care responsibilities, 27 women’s participation, 28 Care research, 6 Care services, 27 Care studies field, 3 Care vs. justice, 95 Care work actors of care, 61 in Brazil, 128, 135 Brazilian Classification of Occupations, 131 caregiver mobilizations, 129 commodification, 62 commodifying a service, 127 description, 6 domestic labor, 4 domestics and home caregivers, 134 as “discrete know-how”, 5 familism, 134 female niche, 133 5R framework, 39 “help”, 144 home care workers and domestic help, 125 illegal activities, 143 immigrants, 61 labor market, 134 long-established social activity, 127 paid domestic work, 133 poverty, 139 production of living, 6 professional care circuit, 131, 134 sexual and international division (see Sexual division) social inequalities, 126 social topography, 130 societal contexts, 61 types, 15 unpaid, 135, 137, 138

Index Caregiver mobilizations, 129 Carer citizen policies, 83 Carer-worker citizen policies, 83 Caring, 78, 80 Caring work access to care, 81 caring relationship, 81 caring relationships, 82 people involved, 81 preconditions, 81 as “real work”, 81 responsibility and actual work, 82 work of caregiving, 81 Cash transfer programs, 48 Cash transfers for care, 52 Centrality, 3 Chemicals, 112, 113, 116, 118 “Christian family”, 79 Circuit of care in Brazil, 134 care as a profession, 132 day-to-day lives of families, 135 exercising care, 127 as “housewives”/“mothers, 126 notion, 127 social relations, 127, 145 Citizenship status, 78 Class, 78 Colombia “cultural discomfort”, 94 domestic help, 94 domestic worker, 94 lucrative activities, 98 self-esteem, 97 society, 94 Coloniality of power, 94 Community-based organizations, 30 Conditional cash transfer (CCT) programs, 48, 49 Contributory pension schemes, 33 Contributory social protection, 47 Coronavirus pandemic, 1, 2 Cost disease, 27 “Crisis of care”, 6 Cultural discomfort, 94, 98 Culture of privilege, 46 “Cure”, 1 D Democracy, 4 Disability rights movement, 85 Discrimination (racism), 65

237 Disidentification, 111–114 Domestic employment, 94 Domestic labor, 4 Domestic violence, 95, 97 Domestic workers, 94–96, 98, 99 Domestic Workers’ Bill of Rights (DWBR), 90 E Economic restructuring, 79 Eldercare, Buenos Aires affective and relational issues, 199 Argentina, 189 migrant and non-migrant, 187 migrant caregiver Argentina, 193 experiences and resistance, 194–196 female migration and domestic work, 194 representations and positioning, 196–198 migrant women (see Work trajectories) migration stories, 200 racial, 198 regional migration, 188–190 self-assessment, 200 subjective relationship, 198, 200 work and employment, 187 work and gaining recognition, 199 work conditions, 198 Equality of rights, 46 Ethics of care, 3, 15, 205 Exploitation, 82 F Familism, 134 Family actors of care, 62 in Brazil, 69, 70, 72 “care diamond”, 67 elderly people and caregivers, 64 in France, 68 in Japan, 68 incomes, 72 place for care, 69 private sphere, 78, 79 social organization of care, 73 Female care work, 62 Femininity, 113, 119, 120 Feminism, 97, 100, 101 Feminist care ethic, 101 Feminist epistemology, 3

Index

238 Feminist studies activism (see Activism) care, 219–221 care receivers, 217 co-constructed Dialogues, 229–231 disability and critical disability, 221–224 emerging activisms, 227–229 Laura Viñuela’s statement, 219 marginal knowledge and practices, 217 resistance, 218, 222, 223, 226, 227, 229–231 social disability movements, 218 social right and caring citizenship, 224–225 tensions and contradictions, 218 transversal approach, 231 “5R Framework”, 39 “French school of care”, 4 G Gender, 3, 6, 78, 135, 137 Gender and care, Uruguay care concept economic system, 149 labour and renders, 149 Marxist and Socialist feminism’s analyses, 150 Marxist feminists, 151 productive and reproductive system, 151 social care, 150 social well-being, 149 unwaged labour, 151 care policies, 152 care strategy typology, 156 child care, 156–158 co-responsibility (see Gender co-responsibility) educational level women, 155 elderly care, 158–159 familism, 153 female caregivers, 152 motherhood, 154 public policies, 153, 160–162 roles of men and women, 154 social organization, 160–162 socioeconomic level women, 154, 155 time-use surveys (EUT), 153 Gender co-responsibility, 155, 156 Gender inequality, 33 “Global care chains”, 13 Globalization, 61 Gross domestic product (GDP), 27

H Home Supportive Services, 88 Humanities, 2 I Independent Life Movement, 219 Inequalities and discriminations, 50 employment, 46 and exclusion, 55 gender, 53 labor market, 51 and poverty, 43, 48 social inequality matrix, 45–47, 55 social organization of care, 49 socioeconomic stratum, 46 Informality, 33 In-Home Health Services (IHHS) program, 91 Integrated care policies, 36, 51–53 Intensive face-to-face caring, 85 Intentional communities, 85 International comparison caregivers at institutions, 64 immigrant home caregivers, 64 inequality and discrimination Brazil, 66–67 France, 65–66 Japan, 66 internal migration, 64 international migrants in care sector, 64 migrants and racialized, 64–65 racial and ethnic dimension, 63 International Labor Conventions (ILO) Convention on Domestic Work, 89 legal protections, domestic workers, 89 migrant domestic work, 89 self-help, education and advocacy groups, 90–91 International migrations, 7, 62 L Labor market, 47, 51 Latin America administrations, 16 care diamond, 35 care economy, 12 care needs, 30 care policies, 14 care systems, 13 CCT program, 49 contexts, circuits and meanings of care, 14 “demographic dividend”, 32

Index demographic transformations, 30 demographic transition, 32 domestic labor, 13 effect on GDPs, 12 employment, 13 existing policies, 38 health care spending, 34 inequalities (see Inequalities) labor force, 12 legal recognition, 47 life expectancy, 34 median age, 31 migration trends, 54 paid migrant domestic workers, 30 pension systems, 32 rights, 14 social inequality matrix, 45, 46, 55 social organization of care, 13 social protection trends, 53–54 Latin American care chains, 13 Longevity, 32 Long-term care (LTC), 34, 41 Lucrative activities, 98 M Mother–child dyad, 80 Motherhood, 96 Mutual therapy, 110 N National Child Care and Development Network, 52 National Integrated Care System, 52 “Natural” haircare, 108, 113, 115 Noncontributory social protection, 47 Nora Pava approaches, 228 Nurses and nursing assistants, Colombia childcare, 203 eldercare, 210–212 ethics of care, 205 health and social protection services, 203 healthcare, 206–210 modernization processes, 203 moral psychology and philosophy, 205 psychodynamics, 205 sexual division of labor, 204 social care, 206 social organization, 206 women caregivers, 204 Nursing, 125, 128, 129

239 O Orientation, 55, 56 P Paid caring labor, 78 Paid care work, 44 Pension systems, 32–34, 41 People with disabilities, 5 Personal Responsibility and Work Opportunity Reconciliation Act in 1996, 83 Poverty, 4, 8, 14, 16 Private sphere, 61, 78, 79 Psychoanalysis, 100, 101 Public care, 101 Public care policies, 44 Public care programmes, 31 Public policies, 25, 35, 37, 40, 67–69, 73 Public vs. domestic, 3 R Race, 3, 6, 135, 137 Race and ethnicity, 6, 78 Racism, 109–111, 114, 117, 118 Research Group on Gender Sociology (GISG), 12 Re-signification, 118 Responsibility, 97, 98 Rethinking care “caring about”, 79 “caring for”, 79 care as practice, 79–81 paid care, 85–88 S Secondary dependence, caregiver, 83 Self-care and caring for others, 101 problematic, 93 process, 103 “selfcare amongst themselves”, 100 as a social praxis, 102–103 Self-esteem, 97 Self-reliance, 103 Self-transformation, 103 Sexual divisions and international (see International comparison) labor and international migration, 63 social organization Brazil, 69–72

Index

240 Sexual divisions (cont.) France, 67–68 Japan, 68 Social activism, 88, 89 Social assistance, 47 Social care organization, Chile and care, 165–166 care work paid domestic, 175–179 unpaid domestic, 173–175 demand care model, 170 demographic dimension, 170–171 family and cultural dimension, 171–172 description, 166–167 migrant workers, 179–182 policy suggestions, 182–184 “politicize” care, 184 welfare and care regime, 167–170 Social citizenship carer-worker citizen policies, 83 caretaking allowances and support universal, 84 constraint, 83 disability rights movement, 85 elements, 82 European welfare systems, 84 responsibility, 82 rights, 84 “secondary dependence”, unpaid caretakers, 83 worker citizen policies, 83 Social inequalities, 8, 50, 126, 138 Social inequality matrix, 45–47 Social networks, 117–119, 121 Social organization of care, 13 Social policies, 48, 78 Social protection care policies, 50, 51 care services, 51 cash transfer programs, 48 cash transfers for care, 52 CCT program, 48, 49 components, 47 comprehensive and integrated approach, 52

contributory, 47 integrated care policies, 52, 53 noncontributory, 47 policies and mechanisms, 48 public policies, 51 structural inequalities, 50 systems, 48 universal access, 47 Social security, 47, 51, 53, 54 T Transformative policies, 36, 39 Transitioning, 113, 115, 116, 119 Transnational families, 13, 15 U Unionization, 88, 89 United Nations Development Programme (UNDP), 30 Universal Aid, 88 Unpaid care work, 44 Unpaid work of care, 4 V Virtual natural hair communities, 117, 118 W Women’s work “degenderizing” care, 73 in institutions, 73 labor market, 61 and migrants, 63 professional equality, 73 salaries, 66 social organization of care, 73 Work, 6 Work trajectories, CABA paths taken before working, 190–191 typical work trajectories, 191–193 Worker empowerment, 88 Worker protection, 88