Gender Equality in Caregiving: The United Nations Response
Can there be any doubt that women are the main caregivers for the sick, the elderly, the disabled, the young? This state of affairs is true not only in the US but in almost every country in the world. For the most part, we accept women's caregiving as the natural order of our culture, but when it comes to the urgency of HIV/AIDS and other global pandemics, the impact on women and girls highlights just how disastrous the disproportionate burden of caregiving can be. Caregiving affects women and girls socially, economically, physically, and mentally.
At the UN, the 53rd Commission on the Status of Women (CSW 53), focused on the theme of "equal sharing of responsibilities between men and women, including caregiving in the context of HIV/AIDS". The issues as I will describe them here are based on the two documents that guided the discussions and negotiations of the government delegations and the NGO's: The Expert Group Report, and the Secretary General's Report. These core documents were distributed to Commission members and NGO's several weeks before the commission met in March 2009.
Over 7 million AIDS patients need intensive long term care. Taking care of AIDS patients is a full time occupation which stresses the caregiver's body, mind, and finances. When health systems in developing countries do not have the capacity to undertake care, the burden is taken up by the family. In a Kaiser Foundation survey of South African households, 2/3 of the primary caregivers were women. Women and girls were also the primary caregivers of children who have lost both parents to AIDS.
The disproportionate burden on women is crushing. Fatigue can render caregivers more vulnerable to illness. The stress of caring for someone who is dying increases susceptibility to anxiety, depression and other psychological disturbances. Since caring for AIDS patients is a full time job, women and girls become disconnected from their communities, their work and their school…the very activities that could help relieve the stress of caregiving.
Girls orphaned by AIDS are particularly vulnerable, becoming heads of households during their childhood, struggling to feed their siblings and suffering from malnutrition. They are also removed from school, and so without skills they have diminished chances of obtaining a job. They become vulnerable to those who would take advantage of their plight, by subjecting them to prostitution and exposing them to HIV/ AIDS. It is a vicious cycle of misery, transmitted from one generation to the next. Causes of the problem: How did we get here? What are the underlying causes?
Gender norms: Gender norms across the world expect women to bear the burden of caring for the ill. Many men believe that caring is "women's work" and that it is beneath them, that their role as breadwinners should exclude them from domestic chores. It is important, however, to note that some men are willing to engage in caring. The Kaiser study reported that in 1/3 of households, men played a significant role in caregiving, although they were seldom acknowledged by their community. Other men and women, teachers, for example, find themselves providing emotional support for children affected by HIV/AIDS, without training in counseling and without the availability of other support services. Men, who would be willing caregivers, are deterred by gender norms and lack of confidence in their knowledge and skills.
In general, there is a need for research, training, attitude shift, and recognition for those providing care. Less education and literacy means less access to information and methods for coping with AIDS. The needs of and effects on caregivers are often ignored, especially the impact on elderly family members who are caring for the orphaned children and who may be sick themselves.
Government inaction on HIV/AIDS prevention and treatment, results in more people becoming ill and therefore more caring responsibilities for women. Governments lack the capacity and political will to help as evidenced by a decline in healthcare spending and a delay in making antiretroviral drugs available. Many NGO's point to the contributing fact that policy makers are men with little interest in female caregivers.
The Secretary Generals Report
Clearly, the unequal sharing of responsibility for caregiving is a problem. The issue of how to remediate it became the work of the 53rd Commission on the Status of Women, March, 2009. The Secretary General of the United Nations, Mr. Ban Ki-Moon, recommended certain actions to be taken by Governments (summarized here).
Ratify all the relevant treaties (Conventions), e.g., Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW, which has not yet been signed by the US); The Convention on the rights of the child ( not signed by the US).
Take appropriate measures to eliminate discrimination against women in relation to marriage, family law, inheritance and property rights.
Ensure care work is recognized, measured and valued.
Promote the sharing of carework by men and women.
Adopt gender sensitive policies to improve rights and protection of paid and unpaid care workers.
Ensure parental leave for men and women.
Increase flexible working conditions so that men and women can reconcile work and caregiving.
Adopt or review appropriate policies for caregivers, e.g., family and child care allowances, cash transfers, tax credits, minimum pensions, leaves.
Scale up efforts to fight HIV/AIDS: Universal access to prevention programs, treatment, care, and support.
Strengthen public health care services.
Increase resources to support home based caregivers: information on HIV/AIDS treatment, prevention, care, as well as equipment and training.
Informational campaigns to challenge gender roles and promote equal sharing of caregiving.
Take measures to increase the role of men in caring , through for example, fatherhood preparation courses.
Conduct research and collect sex and age disaggregated data to inform policy makers.
Increase women's participation in policy making.
The Outcome Document
The principal product of the 53rd Commission on the Status of Women, and indeed all Commissions, is the Outcome Document, which is a set of hard -won negotiated agreed upon conclusions. The Outcome document for CSW 53 urged governments to use policy to significantly scale up efforts to achieve access to prevention programs, treatment, care and support. Most of the Secretary Generals' recommendations were accepted but were subjected to hot debate and compromises. Governments recognized the feminization of the HIV/AIDs pandemic, and the need to review policies to ensure a reduction in women's vulnerability. On the main issue of the burden of caregiving and equal sharing of responsibility, they support a better quality of public health care services, greater access and programs designed to encourage men's responsibility for home based care.
The Outcome Document pushed for the social protection of home-based caregivers, including access to economic resources such as micro credit, pension and saving schemes, as well as education, affordable anti-retroviral drugs and nutritional support. It urged more research, data collection and allocation of financial services at the international level to implement the Beijing Platform for Action.
The UN cannot force governments who sign off on these outcome agreements to actually implement them. This is the major conundrum of the UN. Many good words are spoken, but fewer good deeds are carried through. However, the outcome documents do provide a resource for NGO's as summaries of the issues and material for advocacy efforts: "You signed off on this, now we expect you to carry through on your promises..."
In 2012, the Commission on the Status of Women will review each country's compliance and implementation of the CSW 53 Outcome Document. We expect, optimistically, that some progress will have been made.
For further information please see Women Watch. Ψ