How Women Provide an 'Invisible Subsidy' to the World’s Health Care Systems

Caregiving has long been thought of as women's work—and thus unpaid.
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Community health care worker in Bangladesh. (Photo: The United States Agency for International Development)

Community health care worker in Bangladesh. (Photo: The United States Agency for International Development)

The world over, the work that women do is often undervalued. As University of Maryland sociologist Philip Cohen put it, "The pay in jobs that women hold is lower because women hold them." One crucial field where that's true? Health care. In 2010, women in 32 countries did so much work caring for sick folks that it should have been worth $3 trillion—but about half of that work went unpaid, according to a new report commissioned by the journal the Lancet.

Governments should come up with programs that better pay or otherwise support female health care workers, the report's authors, an international team of public-health researchers, argue. Better pay and benefits wouldn't only be fair, it would improve the level of care provided by nurses, midwives, and community health workers—positions held mostly by women worldwide. As an example, the report notes that Finnish nurses were more motivated and provided better quality of care after their union earned them benefits such as more predictable hours and guaranteed time off between shifts.

Better pay and benefits wouldn't only be fair, it would improve the level of care provided by nurses, midwives, and community health workers—positions held mostly by women worldwide.

Who is performing all this underpaid—sometimes unpaid—health work? One major contingency is comprised of positions that are often considered less prestigious than "doctor," such as the community health worker or midwife. In remote or low-income regions, these types of workers are often the only health care experts locals have access to. And studies show that, when well supported, such workers indeed do improve the health of their neighbors.

One survey found that only seven percent of community health workers in six African countries receive a stipend, even though high local demand often pushes such workers to put in long hours. Paying workers, the researchers argue, would likely improve community health programs. Payment also reduces turnover in the positions, which makes programs less effective, one recent World Health Organization review found.

In addition, women are more likely than men to take on the responsibility of caring for a disabled or aging relative or friend at home. That's true in high-income and low-income countries. And regardless of these home caretakers' gender, they mostly end up being an "invisible subsidy to health systems and societies," the researchers write. But it doesn't have to be this way. The report highlights programs in Costa Rica, Turkey, and the United Kingdom that pay home caregivers.

Can we prove that this kind of work goes unpaid because it's mostly women who do it? That's a difficult question to study, but the research that exists suggests professions end up undervalued because more women work in them. In general, "caregiving" has long been thought of as women's work, and long gone uncompensated. But what could be more important—and better worth cold, hard cash—than health care and healing?

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