Neoliberal Capitalism, Older Adult Care and Feminist Theory

Abstract

Classic feminist social theory highlights the exploitation of women’s labor in capitalist societies traditionally through an examination of how housework and childcare is perceived and organized, excluding an explicit analysis of older adult care work. In light of the surge in the demand for older adult caregiving over the last several decades, this paper uses older adult care work as a new lens to understand how gender, and its intersections with other critical identities such as race, ethnicity, and nativity, are a basis for continued exploitation and marginalization in modern capitalist systems. Building on Marxist feminism and Sylvia Wynter’s work on social value and domination, I argue that women’s care labor, both paid and unpaid, is an instrument of capital accumulation that differentially exploits women based on key intersectional identities. An examination of the system of older adult care work in the United States allows us to see the multilayered and complex system of exploitation that creates and reifies existing social hierarchies as capitalism seeks to expand. The paper ends with a discussion of two potential family care paths America could conceivably pursue in the coming years; one toward increased commoditization of care work in line with neoliberal capitalism, and the other toward more comprehensive social welfare policies that alleviate women’s reproductive labor burden and begin to break down gendered and racialized hierarchies.

Classic feminist critiques of social theory have both drawn on and criticized Marx’s theory of labor relations in capitalist societies. While some scholars build on Marx’s theory of labor relations under capitalism (Dalla Costa and James 1975; Mies, Bennholdt-Thomsen, and Von Werlhof 1988), other scholars have taken a post-structuralist approach, pointing to deeper layers of social arrangements that result in gender (and other) inequalities in societies (Wynter 2018). Many feminist scholars today also highlight the importance of identities that intersect with gender that are crucial in understanding exploitation and social relations in historic and modern societies (Folbre 2021; Wynter 1992; Glenn 1992; Hooks 2014; S. James 2021). While much classic feminist work on macro social theory focuses on exploitation of women and women’s labor, these works often consider housework and childcare, excluding an explicit analysis of older adult care work.

As the United States and other countries around the world, both developed and developing, continue to age, there is an increased demand for caregivers who provide physical, financial, and emotional support to this growing population of older adults. Due to social norms associated with paid and unpaid labor, family caregiving responsibilities continue to fall on women (Robinson 1997). The growing phenomenon of older adult caregiving provides us a new lens to understand how gender, and its intersections with other identities such as race, ethnicity, and nativity, are a basis for exploitation and marginalization in modern capitalist economic and political systems. In this paper, I will argue that focusing on older adult care work highlights the importance of labor, both paid and unpaid, in contributing to systems of gender domination and exploitation. Building on Marxist feminism, I argue that women’s care labor exploitation is an instrument of capital accumulation. However, in order to understand the exploitation of women’s labor as it relates to care work, we must also understand how race, class, and country of origin are key intersectional identities that are unequally exploited as capitalism spreads. Drawing on Sylvia Wynter’s theory of the general equivalent of social value (Wynter 1992) and Wynter’s discussion of the sociolinguistic foundation individuals are embedded within, we see the multilayered and complex system of exploitation in both unpaid and paid forms of older adult care work, creating and reifying existing social hierarchies. This allows women to simultaneously serve as the exploited and the exploiter of care labor. I argue that the underlying motivation for this unequal exploitation of women is rooted in the need for reproductive labor, especially as it relates to a seemingly “unproductive” segment of the population, in capitalist economies.

In order to move away from the reliance on the exploited and undervalued labor of women to support the United States’ aging population, the family institution and care work itself must be reimagined. New and creative para-familial institutions must be incorporated into the current model of intrafamily caregiving with the goal of improving work-family relationships for women. However, this cannot be accomplished with strictly marketized solutions. The U.S. is currently at a crossroads with its orientation to family care. One road continues down the path of increased commoditization of care work, while the other moves toward more comprehensive social welfare policies to support caregivers. Which path the U.S. will choose will be determined by whether women, those in the care work industry, and their families form political solidary or whether remain fragmented, acting on individual interests rooted in the social hierarchy.

Caregiving in the United States

The United States is in a period of unprecedented longevity with average life expectancy just shy of 80 years and approximately 16.5% of the population over the age of 65 (Population Reference Bureau 2020). This trend is projected to continue with the U.S. Census Bureau estimating that by 2035, there will be 78 million adults aged 65 and older in the U.S., representing approximately 21% of the population (U.S. Census Bureau 2018). Simultaneously, the share of the population under the age of 18 is decreasing. Census data projects that by 2035 there will be approximately 77 million children under 18 in the U.S. (U.S. Census Bureau 2018). This will mark the first time in U.S. history that the number of older adults will surpass the number of children.

An implication of the aging U.S. population is the increased demand for caregiving services to support this growing segment of the population. Traditionally, care for children, ill or disabled family members, and older adults has occurred within the family, done primarily by women. Social role theory suggests that deep-seated societal gender roles are the cause of women’s unequal adult caregiving burden. (Jenkins 1997; Montgomery and Datwyler 1990; Oliker 2011). Social role theory focuses on a non-marketized construction of identity, explaining that women are socialized to believe that their role is to be the primary caregiver for the family, while men internalize expectations about serving the role of male breadwinner, seeing paid employment as their primary family responsibility (Eagly and Wood 2012). Thus, women are likely to become caregivers for their elderly parents at some point during their adult lives. Even as paid employment has increasingly become an expectation for women as well as men, women are still bound to their social roles as family caretakers.

However, many scholars have pushed back against social role theory, arguing that women’s internalization of non-marketized ideals of gender identity is not a sufficient explanation for why women historically perform the lion’s share of care responsibility for the family. Rather, they argue that women’s labor within and outside of the home is a form of forced labor. Mies, Bennholdt-Thomsen, and Von Werlhof (1988) describe women’s work as a single form of labor that requires women to be available at all times for any task to serve the needs of others.

The ‘Bielefeld’ approach’ contends that in the modern society there is only one typical form of female labour which puts its stamp on both paid employment and domestic labour in equal measure: it comprises the compulsion of women to be available to meet the needs of others. This quality might be compared to that of the joker in a pack of cards: women’s special character is precisely that their activity is not fixed—they can be used for any function. (Mies, Bennholdt-Thomsen, and Von Werlhof 1988, 115)

Based on this definition of women’s labor, although women may be caring for children, working for pay, or balancing myriad other responsibilities, women are expected to take the lead on providing care for aging family members when such needs arise.

The expectation that women provide free labor to care for an older family member is especially salient in many capitalist countries, like the U.S., who offer little governmental support for older adult care needs. Evidence of this can be seen when examining the relationship between women’s employment and older adult caregiving needs in countries with various social welfare regimes. Kotsadam (2011) examined the parental care penalty in several European countries and found evidence that caregiving reduced average weekly work hours for women in a majority of countries, with hours reductions varying based on a country’s welfare regime. The largest negative employment effect was found in Southern Europe, where women caregivers experienced a 3% reduction in work hours. Kotsadam (2011) attributed the large negative effect found in Southern European countries to strong male-breadwinner norms paired with low levels of formal adult care. By contrast, in Nordic countries where eldercare is more formalized and gendered care norms are less prominent, Kotsadam concludes that eldercare is more of choice than a requirement for women, explaining why employment hours do not appear to be greatly affected by caregiving in those countries.

While the majority of family care needs, including physical, economic, and emotional support, are still expected to be the responsibility of the family (read women within the family), our society is at a point of transition (Bau and Fernández 2021). As the U.S. continues to move in the direction of a global, neoliberal capitalist economy, childcare and older adult care is becoming increasingly more difficult to manage solely within the institution of the family. While the lion’s share of family caregiving responsibilities continues to fall on women, what is different from previous generations is the prevalence of women in the workforce. According to the U.S. Bureau of Labor Statistics, women represented slightly over half of the U.S. labor force in 2020 (U.S. Bureau of Labor Statistics 2021). Women who are increasingly balancing work responsibilities with childcare responsibilities are finding it difficult to also support aging parents. Additionally, low fertility rates in the U.S. have contributed to a smaller pool of potential caregivers available within the family (Reznik, Shoffner, and Weaver 2007). Aging adults with few or no children will increasingly look for market-based solutions to meet their care needs (Wettstein and Zulkarnain 2019), moving care away from the family and into the marketplace.

While recent economic and demographic trends in the U.S. cause caregiving for both adults and children to be increasingly difficult, eldercare and childcare are not equivalent challenges. While families in the U.S. do not base the decision to have children on the expectation that their children will help support the national economy, it is true that child rearing is seen as more productive form of reproductive labor than caring for older adults. Nancy Folbre explains, “Children grow up to become taxpayers, helping repay public debt and directly or indirectly helping to support older generations. They are also perpetuate our species, our cultures, our communities, and our families” (Folbre 2021, 75). They are the future workers who will contribute to capital accumulation. Older adults on the other hand, are not viewed as a particularly economically or culturally productive segment of the population in capitalist societies, resulting in the deprioritization of older adult care work.

As evidence of this devaluation in capitalist societies, we can look to the dearth of workplace benefits and governmental supports for adult caregiving as compared with childcare. According to a recent Society for Human Resource Management report examining workplace benefits trends in the U.S., the percent of employers offering paid maternity leave rose from 26% in 2016 to 53% in 2020, while paid parental leave increased from 17% to 39% over the same time period (Society for Human Resource Management 2022). By contrast, the percent of employers offering eldercare leave above federal FMLA (Family and Medical Leave Act) standards only increased from 10% in 2016 to 16% in 2020. In fact, the percent of employers who offered eldercare leave benefits in 2020 was well below the percent of employers offering any form of parental leave, including paid paternity leave, paid adoption leave, and paid foster leave. While, in general, eldercare benefits in the public and private sector have become more prevalent over the years, they are far less common than childcare supports, and far less than what American families require.

Older adult care also presents unique challenges in that the type of care required can be more complex than childcare due to a variety of cognitive, emotional, and physical conditions older adults can experience. Additionally, the timeline of how long an older individual will require care is often ambiguous, ranging from less than a year to 10 years or more. These qualities make providing older adult care more challenging to plan for and anticipate for both families and policy makers.

Clearly older adult care provision in the U.S. is a highly complex issue; one that doesn’t appear to fit well within a capitalist framework driven by profit maximization and accumulation. To understand the role of care work, Marxist-feminists have built on Rosa Luxemburg’s theory of capital accumulation requiring exploited labor from the periphery of capital, arguing that capitalist societies are built on the devaluing of reproductive labor and the exploitation of women to perform that labor. Although women’s position is devalued and the reproductive labor they provide is unpaid or underpaid, this labor is essential to the success of capital accumulation. By examining both unpaid adult caregiving within the family and paid forms of care work that occur outside of the family, the following sections of this paper will demonstrate how older adult care work fits into this narrative, being shaped by systems of gender domination and exploitation within a capitalist framework. Additionally, examining unpaid caregiving and paid care work separately, allows for a more nuanced understanding of how race, class, and country of origin are key intersections with gender that are unequally exploited for reproductive labor; a concept Nancy Folbre (2021) describes as ‘intersectional political economy.’ I argue that the unequal exploitation of women to care for the growing older adult population exists as an instrument of capital accumulation in capitalist societies.

Unpaid Older Adult Care within the Family Institution

Women often shoulder the burden of unpaid adult caregiving responsibilities within their families (Jenkins 1997; Montgomery and Datwyler 1990; Oliker 2011). Recent American Time Use Survey (ATUS) data show that approximately 27% percent of women born between 1957 and 1964 provided care to an older adult compared with only 20% of men in the sample (Aughinbaugh and Woods 2021). Data using the Behavioral Risk Factor Surveillance System from 2015 to 2017 similarly showed that a majority of caregivers in the U.S. were women (Edwards et al. 2020). Women caregivers also tend to perform a higher volume of care, with higher complexity and intensity than male caregivers (Moen, Robison, and Fields 1994; Navaie-Waliser, Spriggs, and Feldman 2002; Neal, Ingersoll-Dayton, and Starrels 1997). On a global scale, women and girls provide approximately three-quarters of unpaid family care needs and domestic work (da Silva 2019).

By definition, this family care work is unpaid, and therefore, economically undervalued. This doesn’t mean that caring for older adults is trivial work however. Caregivers perform a variety of health-related activities for their care recipient, including activities of daily living, or ADLs (washing, dressing, feeding, mobility, toileting, etc.) and instrumental activities of daily living, or IADLs (shopping, making meals, laundry, transportation, medication management, etc.) (Spillman et al. 2014). In total, Reinhard et al. (2015) estimated the economic value of unpaid caregiving to adults in 2015 was approximately $470 billion, an amount comparable to the total combined sales of the four largest U.S. technology companies in 2013–2014 (Apple, IBM, Hewlett Packard, and Microsoft). Caregiving needs may arise at all hours of the day and women are expected to be available to address them at a moment’s notice.

Although recently men have taken on an increasing share of caregiving responsibilities for both children and adults, women still perform the large majority of caregiving (Lyttelton, Zang, and Musick 2020). Women also tend to perform more physically strenuous care tasks such as bathing, incontinence issues, and dressing (Kramer and Kipnis 1995). Maria Mies and colleagues (1998) would take this as evidence of women’s labor being a form of forced labor. Mies et al. describes the theory of women’s forced labor in capitalist societies as a labor relation in which women are involuntary forced into certain forms of labor that are seen as less meaningful than labor that directly contributes to capital accumulation. The authors suggest that “women have to do more work than men, and are allocated the dirtier, more disagreeable and more exhausting tasks” (Mies, Bennholdt-Thomsen, and Von Werlhof 1988, 119). Because of their sex, women are seen as the natural managers of family care needs and are assigned this status and societal expectation at birth. By demonstrating that women are exploited for their reproductive labor to the benefit of capital accumulation, Mies et al. (1988) extended Rosa Luxemburg’s groundbreaking critique of Marx which suggested that capital accumulation requires a “third group” of producers and consumers who primarily operate outside of capitalist production (Luxemburg 2003). Luxemburg argued that without exploiting this “third group” of consumers and producers whose daily lives operated outside of capitalism, achieving surplus value would be impossible (Henry 2021). Where Luxemburg mainly focused on individuals living in countries on the periphery of capitalist nations, Mies et al. (1988) also saw women as part of Luxemburg’s “third group”, essential to capital accumulation through their exclusion and exploitation. Mies et al. describe women’s peripheral but essential relationship to capitalism within the family: “She supplies capital with labourers and her owner (husband) with the means to reproduce his labor power. Through the transformation of her labour into the labour power of her husband—the wage labourer—she provides capital with a higher absolute surplus value than would otherwise have been possible” (Mies, Bennholdt-Thomsen, and Von Werlhof 1988, 22). This applies regardless of women’s employment status, as supporting and reproducing the family is still considered the primary responsibility of women.

As many women can attest, women often have little choice in whether or not they provide care or manage care needs for older family members. Typically, an adult daughter or female spouse is the default source of care for older adults. While the caregiving role is often forced upon women when a health issue arises in the family, some women see this type of unpaid labor as their family responsibility. Studies examining why women seemingly choose to take on family caregiving roles cite a sense of family obligation, responsibility toward the care recipient, and a sense of self-sacrifice (Sharma, Chakrabarti, and Grover 2016). Some scholars might attribute these feelings to women’s socialization into the role of primary caregiver, resulting in more caring and nurturing skills and abilities (Witt 1994). However, socialization theories would suggest that women voluntarily take on the primary caregiving role. In the case of adult caregiving, there is often more nuance in terms of how family members negotiate the assignment of care responsibilities. In a focus group study of how decisions about the provision of care are discussed within families, Brewer (2001) found that gender role assumptions played a prominent role in assigning care responsibility. One participant described the decision-making process, “In my family, I am the only daughter so when my mother became ill, there was the expectation by my brothers that I would be the caregiver. I think it falls on the women the majority of the time. It’s the traditional attitude” (Brewer 2001, 218). In this instance, the adult daughter did not express having a say in whether or not she would provide care for her mother. The male family members decided that this difficult, strenuous, and time-consuming task would be best suited for the woman in the family. While women may feel a sense of responsibility and devotion to their care recipient, that does not mean that women voluntarily and consciously take on this role. In capitalist societies supported by women’s unpaid reproductive labor, women have little choice in determining their role in adult caregiving relations.

While women have always provided the bulk of childcare and older adult care in the U.S., what is different from previous generations is the prevalence of women in the workforce. While women still handle the majority of caregiving for both children and adult family members, they are also now balancing employer expectations and responsibilities (National Academies of Sciences, Engineering, and Medicine 2016). A recent study by the Bureau of Labor Statistics found that female caregivers, were more likely to be employed and hold full-time positions than adults who did not provide eldercare (U.S. Bureau of Labor Statistics 2021). Women’s dual roles as paid employee and family caretaker can cause work-family conflict as women try to navigate the expectations and demands of both roles (Gignac, Kelloway, and Gottlieb 2010; Gordon et al. 2012; Kayaalp, Page, and Rospenda 2021; Marks 1998).

This highlights another element of Marxist-feminist theories of women’s labor—that women’s full responsibility for reproductive labor contributes to their subordination to men in the workplace (Dalla Costa and James 1975; Mies, Bennholdt-Thomsen, and Von Werlhof 1988). Maria Dalla Costa and Selma James warned that simply absorbing women into the paid labor market would not result in the true liberation of women and equality with men. Regardless of their employment status, women still bear primary responsibility for childcare, housework, and older adult caregiving, resulting in their duel exploitation at home and in the office (Dalla Costa and James 1975). Under the current capitalist model, women’s employment does not equal freedom, but rather a greater ability to be exploited through both wage- and non-wage labor.

Prior research shows that employed women often pay a hefty price when transitioning into a childcare or older adult caregiving role. In relation to childcare, the motherhood penalty is described as a phenomenon whereby mothers experience employment disadvantages compared to women without children and men (Yu and Hara 2021). Prior research has demonstrated the motherhood penalty with a variety of employment outcomes including wages (Jee, Misra, and Murray-Close 2019; Gough and Noonan 2013), occupational attainment and prestige (Stone and Lovejoy 2019; Kahn, Garcia-Manglano, and Bianchi 2014; Baker 2019), and labor force participation (Sandler and Szembrot 2020; Hook and Pettit 2016). The gendered nature of how parenthood influences employment outcomes is so stark that evidence suggests fathers may actually experience an employment bonus compared to non-fathers, while mothers are almost always penalized for their childcare responsibilities (Correll, Benard, and Paik 2007; Fuegen et al. 2004). The situation is similar for older adult caregiving, though considerably less research exists on the topic. The current state of evidence suggests that women who assume a parental caregiving role may be more likely to exit the labor force than men or women without adult caregiving responsibilities (Boaz and Muller 1992; Ficker 2010). However, women more commonly attempt to balance employment and caregiving responsibilities by maintaining their level of labor force participation while simultaneously caring for an aging family member. These women can expect to face a gendered wage penalty when taking on a caregiving role for an adult family member (Glauber 2019; Van Houtven, Coe, and Skira 2013). Nancy Folbre describes this reproductive tax women often pay in the labor market when caring for family:

[Women’s] specialization in care provision is not entirely voluntary, and its benefits redound not only to care recipients but also to society as a whole. The economic penalties caregivers pay are not legislatively stipulated, officially measured, or even widely acknowledged, but they are nonetheless significant. There incidence helps explain the persistence of gender inequality. (Folbre 2021, 186)

This statement illuminates the fact that a gendered caregiving penalty is intricately woven into the fabric of capitalist societies.

Early Marxist-feminists called for recognition and fair payment of women’s unpaid reproductive and household labor, a movement called Wages for Housework (Toupin 2018). Mariarosa Dalla Costa’s classic essay “Women and the Subversion of the Community” (Dalla Costa and James 1975) became a founding document for this international movement aimed at shedding light on the unpaid but essential labor women are forced to provide in capitalist societies (Federici and Austin 2017). The movement called for the liberation of women through the provision of wages for reproductive labor (housework, childcare, and eldercare work) (S. James 2021).

Some governments have taken action toward the movement’s goal, for example, in the Netherlands older adults and other individuals in need of long-term care, are able to pay relativities (or professionals) for care tasks through a personal budget provided by the government. While the primary goal of this program was to allow for a broader range of caregivers due to professional caregiving shortages, the policy was also seen as a way to provide women with compensation for the care work they were already providing. Family caregiving was now able to be marketized through contracts and payments between family members. In an interview study investigating how family caregivers experienced and perceived the new contractual care relationship with their family members, Grootegoed, Knijn, and Roit (2010) found that cash for care did not necessarily lead to the empowerment of women caregivers. While many participants had some positive feelings toward the policy, many also noted that most family caregivers in a paid care arrangement in the Netherlands did not receive the same employment benefits as other workers in the economy, highlighting that payments for family caregiving actually led women into a more precarious labor situation. The authors note, “Our findings support the idea that women who become paid family care-givers are led into a cul-de-sac of reduced labour-market value and limited employment rights” (Grootegoed, Knijn, and Roit 2010, 486). While on its face this move by the Dutch government signals a recognition of unpaid labor that occurs among women within the family, it was a half-hearted attempt at renumeration that only sustained women’s subordinated and less financially independent position in society.

The Netherlands example suggests that simply repositioning unpaid reproductive work into a market system will not entirely eliminate women’s exploitation. In fact, this study suggests that in some cases providing wages for family care work may actually contribute to women’s subordinated labor market position. This would not be surprising to Mies et al. who described the purposive patriarchal structure that keeps women in precarious and involuntary labor situations; “women are accorded this status [as housewife] in order to make them work without pay as housewives and work in paid employment in unprotected and underpaid jobs” (Mies, Bennholdt-Thomsen, and Von Werlhof 1988, 113). Even if women’s family care work is compensated, evidence suggests that this labor will continue to be undervalued, keeping women in less stable employment conditions, a necessary condition for capital accumulation.

The situation of unpaid family caregiving for older adults in the U.S., demonstrates that the unpaid and undervalued reproductive work of women is a necessity. In absence of a strong government supported welfare system for care in the U.S., women will continue to shoulder the burden of older adult care work so that capital accumulation can advance. However, examining only unpaid care work within the family institution does not paint the entire picture of reproductive labor exploitation. Looking at the paid older adult care labor market reveals a more nuanced view of how labor exploitation operates not solely on the basis of gender, but at the intersection of gender with race, class, and country of origin.

Paid Older Adult Care in the Labor Market

While the prior section demonstrated how women are exploited for their care labor within families, a look at the paid care work sector highlights that not all women are equally exploited. Due to changing demographics, cultural norms, and a more challenging economic climate favoring dual-income households, care for older family members is becoming increasingly difficult to manage solely within the family. Therefore, care for older adults in countries with weak social supports has become increasingly marketized. Because of this trend, the eldercare industry is in a period of rapid expansion. Employment in direct care services for older adults has grown from 3 million workers in 2009 to approximately 4.6 million workers in 2019 (Campbell et al. 2021). The composition of the direct care workforce is overwhelmingly composed of women (86%), and the majority of employees are persons of color (59%) (Campbell et al. 2021). Additionally, the direct care workforce relies heavily on immigrant workers to meet increasing care demands, with every one in four direct care workers being born outside of the U.S. (Campbell et al. 2021). Direct care work is economically undervalued compared to other occupations, with home health and personal care aides making a median salary of $29,430 in 2021, compared the national average of $51,896 (Bureau of Labor Statistics 2022). While wages for direct care are relatively low, women of color are offered the lowest hourly wages in this industry on average, followed by White women, men of color, and finally White men with the highest salaries (Campbell et al. 2021). These labor force statistics show that women, and especially women of color, are exploited for their reproductive labor, not only within the family, but also in the paid adult care industry. In this way, reproductive labor is clearly undervalued, underpaid, and is composed of exploited labor from women, especially non-White and immigrant women.

Although most women in patriarchal capitalist societies are exploited for their reproductive labor to some extent, women who are part of socially and economically dominant groups are better able to pass on their own exploitation to other women. Nancy Folbre (2021) describes how differences in class, race, and citizenship serve as axes of exploitation to keep care work undervalued to allow for capital accumulation and reproduction among dominant groups of women.

Care penalties in wage employment are sharply crosscut by differences in bargaining power based on class, race, and citizenship. Relatively cheap domestic servants have always been available to the very wealthy; cheap service-sector employees replicate their effects, often in similarly racialized ways. In the United States, a large supply of low-wage immigrant women keeps the cost of childcare and eldercare services—as well as restaurant meals—relatively low. Native-born, college-educated, high-earning women reap many of the benefits. (Folbre 2021, 199)

This exploitation and othering of women by women is not just based on race, class, or nativity. Rather, exploitation is rooted in the intersection of many of these identities. In an increasingly global capitalist economy, reproductive labor becomes progressively undervalued as the pool of workers increases, while at the same time care work becomes increasingly essential. Women who have the social and financial means to pursue capital accumulation in the paid labor market can pass off a portion of their own exploitation to women who are perceived as other; i.e., those with fewer financial and political resources. In this way, the exploitation of women by other women is not necessarily inherent of human nature, rather it is inherent in patriarchal capitalist systems.

In Ain’t I A Woman, Bell Hooks discusses the situation of Black and White women in the U.S., explaining that popular discourse “perpetuat[es] the myth that the social status of all women in America is the same” (Hooks 2014, 121). By examining the history of reproductive labor in the U.S., Hooks illuminates the social differences between White and Black women’s situations, suggesting that while White women are in a subordinated position to men, they are also able to act as oppressors of Black women. Hooks writes, “white racial imperialism granted all white women, however victimized by sexist oppression they might be, the right to assume the role of oppressor in relationship to black women and black men” (Hooks 2014, 123). To oppress other women in a patriarchal capitalist society is to displays one’s own privilege and social status. In relation to reproductive labor, Hooks explains, “In the white community, employing domestic help was a sign of material privilege and the person who directly benefitted from a servant’s work was the white women, since without the servant she would have performed domestic chores” (Hooks 2014, 155). Here Hooks shows the complex relationship between gender, race, and power in pursuit of capital accumulation and social status.

While race is a critical dimension by which women are exploited in a U.S. caregiving context, it is not the only salient dimension. In her analysis of the history of paid reproductive labor and care work in the U.S., Evelyn Nakano Glenn describes this complex system of othering; “White women’s lives have been lived in many circumstances; their “gender” has been constructed in relation to varying others, not just to Black women. Conceptualizing white womanhood as monolithically defined in opposition to men or to Black women ignores the complexity and variation in the experiences of white women” (Glenn 1992, 35). Glenn goes on to discuss how conceptions gender, class, and race intersections resulted in more complex systems of othering, rather than bringing women together to challenge gender-based exploitation of reproductive labor, especially in relation to care work. More economically and socially advantaged groups of women were able to “slough off the more burdensome tasks onto more oppressed groups of women” (Glenn 1992, 7). Glenn describes how various groups of women were constructed as others based on the demographic composition of a particular geographic location and time period.

Who was to perform the “dirty work” varied by region. In the North-east, European immigrant women, particularly those who were Irish and German, constituted the majority of domestic servants from the mid-nineteenth century to World War I (Katzman 1978, 65–70). In regions where there was a large concentration of people of color, subordinate-race women formed a more or less permanent servant stratum. Despite difference in the composition of the populations and the mix of industries in the regions, there were important similarities in the situation of Mexicans in the Southwest, African Americans in the South, and Japanese people in northern California and Hawaii. Each of these groups was placed in a separate legal category from white, excluded from rights and protection accorded full citizens. (Glenn 1992, 8)

Exploitation of paid reproductive labor does not just have implications for the capitalist country in which the care work takes place. As Rosa Luxemburg articulated, capital accumulation requires global exploitation (Luxemburg 2003). Today, the U.S. relies on the cheap and undervalued labor of immigrant women to care for both children and older adults (Folbre 2021). While the care workers themselves are exploited for their care labor, the situation often requires these women to pass on their own family care responsibilities to friends and family members. Nancy Folbre (2006) refers to this as “care drain”, a situation where women “leave their families and possibly also migrate to provide low-paid care work to others, therefore moving their own unpaid care responsibilities onto other family members, such as grandparents or older children” (Power 2020, 70). Mies et al. (1988) would describe this exploitation of women from developing countries for their low-paid reproductive labor as an essential and inherent element of capitalist growth and accumulation.

Hierarchies of Power and Exploitation

To understand why and how this complex system of exploitation occurs among women in relation to care work, we can first look to Sylvia Wynter’s discussion of the roots of inequality using a post-structuralist lens (Wynter 2018). Wynter explains that all social systems have a semio-linguistic foundation in which individuals are embedded. These semio-linguistic foundations include a ‘self’ and require its ‘other’. The imaginary institution of society creates a model of the human that is based on this binary logic. Wynter refers to these binaries as ‘dominant signifiers’ and ‘subordinate signifiers’. One cannot exist without the other. Under the current system of signifiers, men are one form of dominant signifier while women are their subordinate. But there are many dominant and subordinate signifiers. White, middle-class women who are exploited for their reproductive labor in our society, may see their other as Black women, or working-class women, or immigrant women. By locating an other, women in more socially dominant positions are able to pass on their exploitation to other women—women who are “unlike” themselves.

Taking Wynter’s viewpoint of the semio-linguistic foundations of binary othering, we see that both Marx and Mies et al. (1998) were limited in their conceptions of class and labor relations. Marx saw two primary classes in capitalist societies, capitalists and proletariats (Tucker 1978). Building on Luxemburg’s critique of Marx, Maria Mies believed, “There are at least three tiers in the capitalist pyramid of exploitation: capitalists, wage workers (mostly white and male) and non-wage workers (mostly female), housewives and subsistence producers in the colonies (male and female)” (Mies, Bennholdt-Thomsen, and Von Werlhof 1988, 7). However, Mies et al. (1998) did not deeply examine the heterogeneity of experiences in this “third” class/social tier. Evidence from unpaid and paid eldercare systems in the U.S. clearly show that there is more nuance in this system of exploitation. An analysis of social dominance and subordinance in the care work labor market suggests that there is a continuum of social positions based on the binary logics of linguistics.

But how are these social hierarchies and binary logics decided? Why is it that White males are more likely to be physicians, who are paid more than White female nurses who are more likely to be registered nurses (RNs), who in turn are paid more than non-White or immigrant women who are more likely to be licensed practical nurses (LPNs) (Glenn 1992)? In her analysis of C.L.R. James’ work, Sylvia Wynter suggests that current social hierarchies present in the labor market are not labor-centric, as Marx would suggest. Rather, they are based on conceptions of human value that are rooted in “the cultural categories of the colonial social orders” (Wynter 1992, 67). Wynter explains that individual value is based on a system of comparison against the White, male, middle class reference group. In this way an individual’s value is determined not by one binary classification, such as Black or White, or male or female, but by a pluri-dimensional system of social status. Wynter stresses the complex nature of this classification system saying, “To single out any of these factors was to negate the complex laws of the functioning of the social order, the multiple modes of coercion and power relations existing at all levels of the social system” (Wynter 1992, 69). These hierarchies are not necessarily fixed, but they are accepted and reified in daily life through exercises of power in the home and in the workplace. These exercises of power allow dominate groups to maintain their perceived social value and identity in relation to the middle-class reference group.

Colonial conceptions of human value are ever present today, working to support capital accumulation and advancement. The care work labor market provides a direct look at how the exploitation of labor based on the social hierarchy continuum is at the service of capital accumulation, in some cases subordinating quality of care to profit. Othering based on where a group falls on the “social totem pole” (Wynter 1992, 69), is a necessary instrument labor exploitation to further capital accumulation and capitalist advancement. Evelyn Nakano Glenn provides an example of how exploitation and the complex social hierarchies of women in the healthcare system are directly tied to profit maximization when a healthcare institution operates in the private sector. Glenn writes:

That these nurse’s aides are performing reproductive labor on behalf of other women (and ultimately for the benefit of households, industry, and the state), becomes clear when one considers who would do it if paid workers did not. Indeed, we confront the situation frequently today, as hospitals reduce the length of patient stays to cut costs. Patients are released “quicker and sicker” (Sacks 1988, 165). This policy makes sense only if it is assumed that patients have someone to provide interim care, administer medication, prepare meals, and clean for them until they can care for themselves. If such a person exists, most likely it is a woman—a daughter, wife, mother, or sister. She may have to take time off from her job or quit. Her unpaid labor takes the place of the paid work of a nurse’s aide or assistant and saves the hospital labor costs. Her labor is thereby appropriated to ensure profit (Glazer 1988). Thus, the situation of women as unpaid reproductive workers at home is inextricably bound to that of women as paid reproductive workers. (Glenn 1992, 31)

In this way, men exploit women to provide care work for the country’s older population, while women look to pass on their own exploitation to low-paid, undervalued, exploited care workers, who are primarily women of non-dominant social and economic groups. In turn, the care institutions themselves, pass off as much exploitation as they can onto their employees and women family members of patients in order to maximize profits. In the end, someone’s labor must be devalued to provide care for older adults in order for capitalism to thrive and expand. In a patriarchal capitalist society, this overwhelmingly falls on women.

Ultimately, women in the family are typically responsible for the care of their older family members, whether that means providing direct unpaid care or managing and coordinating care purchases through the marketplace. However, patriarchal capitalist societies can tolerate more women entering the workforce and taking on increasingly prestigious roles in the labor market, as long as these women find substitute caregivers with lower social value than themselves to shoulder their caregiving responsibilities. This mechanism operates at all levels of the “social totem pole”, across race, gender, nativity, income and education levels. In her examination of reproductive labor, Evelyn Nakano Glenn highlights how labor relations in patriarchal capitalist societies necessitated the creation of current conceptions of the social hierarchy based on gender, race, ethnicity, and nativity stating, “specific ideas about racial-ethnic womanhood were invented and enacted in everyday interactions between mistresses and workers. Thus ideologies of race and gender were created and verified in daily life” (Glenn 1992, 32).

The Path Forward

The United States is at a critical juncture in regards to family care. Traditionally, care for both children and older adults occurs within the institution of the family. Women continue to be the primary caregivers for family members. However, as more women enter the workforce, take on more demanding and prestigious employment roles, families become smaller and more geographically distanced, and the population of older adults in the country continues to grow, care for older adults is becoming increasingly difficult to accomplish strictly within the family. In light of these changes and the rise in neoliberalism in the U.S. over the past several decades, care work has become increasingly commoditized, occurring outside the family and increasingly by for-profit care organizations who aim to keep costs low and efficiency high (Polivka and Luo 2019). Today, the rapidly expanding direct care employment sector is primarily privatized, with little or no financial or political support for solutions from federal or state governments. As discussed, these market-based solutions do not eliminate or even reduce the exploitation of women for their reproductive labor. The burden of family caregiving is still placed squarely on women in the family. However, these market-based solutions allow women with social and financial capital to pass their own reproductive labor exploitation onto groups with lower perceived social value (Wynter 2018), causing the most difficult and demanding care work to fall on racialized and immigrant women. Looking through the lens of older adult care work allows us to see the social hierarchy among the unpaid and underpaid female care workers, leading to varying levels of exploitation, allowing capital accumulation to progress while preventing the development solidarity among care workers (Folbre 2021).

One solution to the care crisis in the U.S. calls for the increased participation of men within the family. By promoting gender equity in the private sphere, women may become freer to pursue career-oriented and family-oriented (e.g., having children) endeavors to the benefit of society. The United Nation supports this solution making it one of the organization’s Sustainable Development Goals for 2030. Sustainable Development Goal 5, Target 5.4 reads, “Recognize and value unpaid care and domestic work through the provision of public services, infrastructure and social protection policies and the promotion of shared responsibility within the household and the family as nationally appropriate.”, with the primary indictor being “the proportion of time spend on unpaid domestic and care work, by sex, age, and location” (United Nations 2022). However, this solution masks the inherently exploitative nature of reproductive labor in capitalist systems and minimizes the responsibility of the state to intervene by focusing primarily on individual actions within families.

In order to move away from the reliance on the exploited and undervalued labor of women to support the country’s aging population, the family institution needs to be reimagined. New and creative para-familial institutions must be incorporated into the current model of caregiving, with the goal of supporting work-family relationships for women while also valuing the paid care workforce. After several decades of neoliberal policy orientation, the U.S. has progressively moved toward more conservative welfare policies, especially as it pertains to women and older adult health and well-being. If we are to combat the exploitative nature of capitalism that grows as care work is commoditized and transferred to the free market, it is essential for the state to intervene and articulate the values of care, compassion, and equality. This will only happen when women, those in the care work industry, and their families come together and articulate these values to policymakers through their vote.

Historically, support for greater governmental control and more comprehensive social welfare policies in the U.S. has ebbed and flowed based on the successes or failures of the free-market. Following economic and political crises in the 1970s, neoliberal ideology began to take hold in the U.S. calling for greater privatization and deregulation paired with reductions in welfare policies and redistribution programs. When the free-market and deregulation failed in 2008 causing the Great Recession, support for neoliberalism began to crack, paving the way for more extreme right-wing (Donald Trump) and left-wing (Bernie Sanders) political candidates (Gerstle 2018). Since then, we have seen political agendas emerge that aim to combat the increased commonization of care work and increase social welfare policies to support caregivers. For example, as a turn against neoliberalism, 2016 presidential candidate Hillary Clinton proposed one of the most comprehensive family care packages in recent history, calling for a cap on childcare expenses, universal preschool access, paid family leave, increased pay for childcare workers, increased Social Security benefits for family members who take time away from paid employment for caregiving, and a tax break for family caregivers of older adults (The Office of Hillary Rodham Clinton 2022). But women and care workers did not overwhelmingly come together for Clinton in the 2016 presidential election, especially White women who favored Donald Trump with approximately 53% of their vote (Rogers 2016). While the rejection of Clinton’s family care reform plan may appear surprising, recent research suggests that experiencing even a few years of high neoliberalism in a country increases individuals’ tolerance of and preference for income inequality (Goudarzi, Badaan, and Knowles 2022), translating to less support for welfare expansion.

More recently in 2021, president Biden campaigned and won with his Build Back Better Framework which included expanded access to long-term care services, lower costs of healthcare for older adults, a national paid family leave program, and an increase in wages for home care workers (The White House 2021). While this plan offered an alternative to neoliberalism and a step in the direction toward offering support to women who comprise the majority of family caregivers and paid care workers, it represented only a small step toward the type of comprehensive support families require. However, once elected, the Build Back Better Framework was rejected for being deemed unnecessarily expensive by the Senate. In 2022, a slimmed down version of Biden’s original framework, the Inflation Reduction Act, was signed into law, but conspicuously missing from this version are measures to expand the social safety net in regards to childcare and older adult caregiving burdens.

The birth and death of these social policy frameworks illustrate both that neoliberalism as a dominant economic system is in crisis, and the complexity and uncertainty of the current period. The ongoing COVID-19 pandemic has further exposed cracks in neoliberal capitalisms’ approach to family care, with childcare and eldercare shortages highlighting the already existent gendered caregiving crisis (Htun 2022). It feels as though the nation is at a crossroads with respect to its family care policy orientation. Will the U.S. continue on the path toward increased commodification of care work, exploiting and devaluing reproductive labor within the family and in the care work labor market? Or will the pendulum swing back to embrace more comprehensive social welfare policies that alleviate women’s reproductive labor burden, especially for racialized and immigrant woman? In an interview, C.L.R. James said, “People don’t promote the revolution. The revolution takes place because an instinctive mass of the population feels that it can’t live as it’s been living so it breaks out” (C.L.R. James 1986, 33–34). The current question is, have women who provide unpaid care to family members and women who work in the care work industry reached their breaking point?

In the 1970’s Selma James and Mariarosa Dalla Costa believed that women were prevented from organizing because they were tied exclusively to the home and the family (Dalla Costa and James 1975). Today, women are juggling work responsibilities with childcare and older adult care responsibilities in a neoliberal individualist environment, making it difficult for them to recognize their subordinated position and align with women and care workers of various classes, races, and nationalities. In fact, many women do not even consider themselves to be caregivers (i.e., as unpaid reproductive laborers)—seeing the care they provide as their inherent responsibility to their family (Lu 2015). However, recent research suggests the COVID-19 pandemic may have catalyzed an greater alignment of the goals and interests of women across a variety of identities who perform reproductive labor (Htun 2022). It remains to be seen if the current economic, political, and caregiving crises will lead to greater support for family care policy expansions or if the trend of increased commonization of caregiving will continue.

The question of who will care for the increasing population of older adults, and how that care will be performed will only become more urgent and socially costly as the U.S. continues to age and inequality remains at an all-time high. Only time will tell if we are able to reach an equitable and sustainable solution to our caregiving crisis. But, one thing is almost certain—purely market-based solutions in a global capitalist economy that continue to unequally exploit women for their reproductive labor are unlikely to be the solution.