A society that venerates health, youth and individual autonomy will not much enjoy thinking about birth or death. We are born helpless and need years of care until we reach the happy state of health and autonomy. At the other end of life, the same often applies: the Alzheimer’s Society tells us there are some 850,000 dementia patients in the UK and that this will rise to over a million by 2025 as life expectancy continues to rise.
If we are reluctant to dwell on the reality of human vulnerability at either end of life, we are unwilling to give much thought to its corollary: that (somewhere safely hidden from the more exciting business of being healthy, youthful and autonomous) there must be people caring for those who are unable to do it themselves. Someone is wiping those bottoms.
Traditionally, this job of caring for the very old and the very young has been “women’s work”. To a great extent, it still is: the OECD reports that, worldwide, women do between two and ten times as much caring work as men.
In the UK, this tends in statistics to be framed as “unpaid work”, a sort of poor relation of the economically productive type that happens in workplaces and contributes to GDP.
Carers UK suggests there are around 9 million people caring for others in the UK part or full-time, of whom up to 2.4 million are caring for both adults and their own children. Women carry out the lion’s share of this work: 60% according to the ONS. Full-time students do the least and, unsurprisingly, mothers with babies do the most. Older working women carry the heaviest load of people in employment, with those in the 50-60 bracket being twice as likely as their male counterparts to be carers whether of a vulnerable adult, a partner or a child or grandchild.
Second-wave feminism pushed hard against the pressure women experience to take on this work of caring. Within this variant of liberalism, caring work is routinely framed as a burden that imposes an economic “penalty” while harming the economy by keeping skilled women away from the workplace. The OECD report cited above states: “The gender gap in unpaid care work has significant implications for women’s ability to actively take part in the labour market and the type/quality of employment opportunities available to them.”
The implication is that, once freed of this obligation, women can then pursue more fulfilling activities in the workplace.
So what does this liberation look like in practice? According to a 2017 report by the Social Market Foundation, women in managerial and professional occupations are the least likely to provide care, as are people with degree qualifications. The number working in routine occupations who also donate more than 20 hours a week of care in their own homes is far higher than those in intermediate or professional occupation.
In other words, higher-earning women are to a far greater extent able to outsource the wiping of bottoms to less well-off people, who are themselves typically women: 90% of nurses and care workers are female.
These women are then too busy to wipe the bottoms of their own old and young, who are sent into institutional care. Such institutions are typically staffed by women, often on zero hours contracts, paid minimum wage to care for others all day before going home to do so for their own babies and elderly. The liberation of women from caring is in effect a kind of Ponzi scheme.
This is a problem for our liberal society, for two interlocking reasons. Firstly, the replacement of informal family-based care with a paid, institutional variety renders caring impersonal, in a way that invites cruelty. Indeed, cases of care home abuse are well documented – see here, here or here – and the number is rising: the CQC received more than 67,500 in 2018, an increase of 82 per cent over the already too high 2014 figure of 37,060.
It is difficult to see how this could be otherwise. Caring for those who are physically or mentally incapacitated is emotionally testing even when we love those we care for. An exhausted worker on a zero-hours contract, paid the minimum wage to perform more home visits than she can manage in the allotted day, is unlikely to have a great store of patience to begin with, let alone when faced with a refractory “client”. The entire system militates against kindness.
Secondly, and relatedly, it turns out that the informal, traditionally female networks in which caring for the young and old once took place were actually quite important. Those networks also ran church groups, village fetes, children’s play mornings – all the voluntary institutions that form the foundation of civil society.
When caring is treated as “unpaid work” and we are encouraged to outsource it in favour of employment, no one of adult working age has time for voluntary civil society activities any more. If the number of people caring informally for relatives is waning, replaced by institutional care, so is voluntarism: between 2005 and 2015 alone there was a 15% drop in the number of hours donated (ONS).
The result is loneliness. Almost 2.5m people aged between 45 and 64 now live alone in the UK, almost a million more than two decades ago. Around 2.2 million people over 75 live alone, some 430,000 more than in 1996. In 2017, the Cox Commission on loneliness described it as “a giant evil of our time”, stating that a profound weakening of social connections across society has triggered an “epidemic” of loneliness that is having a direct impact on our health.
Several generations into our great experiment in reframing caring as a burden, we are beginning to count the cost of replacing mutual societal obligations with individual self-fulfilment: an epidemic of loneliness, abuse of the elderly and disabled in care homes, substandard childcare. A society liberated from caring obligations is, with hindsight, a society liberated from much that was critically under-valued.
What is the alternative? Some would prefer a more communitarian approach to caring for the old and the young. Giles Fraser recently wrote on this site that caring for the elderly should be the responsibility of their offspring:
“Children have a responsibility to look after their parents. Even better, care should be embedded within the context of the wider family and community. […] Ideally, then, people should live close to their parents and also have some time availability to care for them. But instead, many have cast off their care to the state or to carers who may have themselves left their own families in another country to come and care for those that we won’t.”
These are strong words and there is much to agree with, but the barest glance at the statistics shows that in practice what that means is “women have a responsibility to look after their parents”.
If we are to count the costs of liberating society from mutual caring obligations, we must also count the benefits, as well as who enjoyed them. Society once encouraged men to seek worldly success, underpinned by the imposition of an often-suffocating domestic servitude on women.
Liberalism blew this out of the water by declaring that in fact both sexes were entitled to seek some form of worldly activity and fulfilment. It is not enough to point to negative side effects of this change and say: “Someone needs to be resuming these mutual caring obligations or society will disintegrate.”
To women well-accustomed to the widespread tacit assumption that it is they who will pick up those underpants, wash up that saucepan, pack that schoolbag and so on, this sounds a lot like a stalking-horse for reversal of societal changes that, on balance, most of us greatly appreciate. In truth no one, whether liberal or post-liberal, wants to confront the enormous elephant that liberal feminism left in society’s sitting room: the question of who cares. Who, now that we are all self-actualising, is going to wipe those bottoms? There are no easy answers.