Making care work count

“Each day I fetch water. I put the barrel of water on my head. I also fetch firewood. I give my aunt baths, and after school I work in the houses of the neighbours or on their plots and they pay me whatever they can. Besides, the physical work, I cook for the family À“ that is when we have food to cook.À

These are the words of 12-year old Sarah* who takes care of her aunt who is dying of AIDS. Since her aunt became sick she goes to school much less than she did before as she takes care of her aunt and looks after her younger siblings and cousins.

But not many are aware of the burden of Sarah and the millions of women and girls like her around the world who are providing care to their families and communities. What we are aware of however is that in 2004 an estimated 3.1 million people in sub-Saharan Africa became infected with HIV while an estimated 2.3 million died of AIDS according to UNAIDS. At the end of 2003, the HIV prevalence rate amongst adults was estimated at 38.8 percent in Swaziland, 37.3 percent in Botswana, 24.6 percent in Zimbabwe and 21.5 percent in South Africa. The numbers are staggering.

But behind the statistics and estimates of infections and deaths as a result of HIV and AIDS lie another set of statistics that are less often cited. Their significance is only revealed when one asks: who is taking care of the sick and dying?

Studies show that approximately 90 percent of AIDS care takes place in the home and is primarily done by women and girls. It is also estimated that caring for someone with AIDS can increase the workload of a care taker by one third. Be this is it may, home based care has been seen as the solution for caring for people living with AIDS: notwithstanding that women already have a disproportionate amount of both productive and reproductive labour that they perform. After all, it women’s work to take care of others isn’t it? They put their families first, their communities first, and now, are being asked to put their nations first!

In a context which has seen cut-backs and privatisation in the public health sector in countries across the region, the provision of health services is being shifted to women’s unpaid care work. The responsibility of the state to provide care for its citizens has been shifted to women who are absorbing the costs of health care.

But who is bearing the cost of the care? And why is it that “women’s workÀ continues to be undervalued, invisible and taken for granted? Unless the economic value of “women’s workÀ is measured and quantified, their contribution to the economy will continue to go unrecognised. Significantly, the Protocol to the African Charter on Human and People’s Rights on the Rights of Women in Africa, which entered into force on November 25, 2005, emphasises the economic value of women’s work.

As the AIDS pandemic continues to wreak havoc on social structures, it is also operating to reinforce women’s traditional nurturing roles as care givers; emphasising women’s constructed role in the productive sphere   and giving new meaning to the “double shiftÀ of women’s work. Girl children and older women in particular, are bearing the primary cost of care. Research in Swaziland shows a 36 percent decline in enrolment rates as a result of children being taken out of school to care for parents, with girls being particularly affected.

The additional work of caring for family reduces the amount of time that care givers have available to engage in other productive and income-generating activities. This includes accessing information and services which could assist and support them in providing care; educational opportunities; and other work. Studies also point to links between women’ s care giving responsibilities and increased poverty in households, especially where women have become heads of households as a result of AIDS. UNAIDS found that household incomes in Zambia and South Africa fell by between 66 and 80 percent because of the need to cope with AIDS related illnesses.

Instead of being lauded as the panacea for Africa’s response to the ever increasing number people requiring care; home based care programmes need to be interrogated in terms of how it contributes towards shifting the responsibility of care from the state to women; while ignoring and not rewarding the economic value of this work.