The Sandwich Generation: Women bearing the burden

The great majority of family caregivers are women, many struggling to care for both children and elderly relatives. How can policymakers redress this imbalance?
Filipino women practise childcare on baby dolls during a caregiver course at a health care .../ Credits: Reuters
In America, the Department of Health & Human Services (HHS) reports that of the estimated seven million Americans who are informal caregivers, almost three-fourths are women, and notes that many of them are “sandwiched” between raising children and caring for a parent or older relative.

The same holds true in Europe, where the majority of caregivers are women; a 2011 OECD study showed that across several Europe countries surveyed, close to two-thirds of informal caregivers over 50 years old are women.

In developing countries, the prevalence of female caregivers is reportedly even higher, though the Sandwich Generation phenomenon seems limited to developing countries according to 1993 data from the U.S. Department of Commerce, which attributes the difference between developed and developing countries to the higher fertility rates of the latter group.

It appears that women as caregivers is a universally accepted paradigm, with the United Nations’ Division for the Advancement of Women noting in 2008 that “women bear a disproportionate burden, attempting to manage household consumption and production under conditions of increasing scarcity because of the gender division of labor and household responsibilities.”

Traditional gender roles contribute to a global problem

The origins of women as caregivers are deeply rooted in cultural gender roles and traditional concepts of family life. In Mexican society, for example, researchers Ann M. DiGirolamo of the Rollins School of Public Health, Emory University and Nelly Salgado de Snyder, Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública note that gender socialization within the culture expects that women’s highest priority is taking care of their families, while taking care of their own physical and mental health needs comes second – if at all. Furthermore, traditional gender roles assigned to women emphasize “passivity, dependence, submissiveness and self-sacrifice.”

Ironically, many argue that policies designed to support caregivers have exacerbated the problems for women. In their 2003 assessment of care leave policies in Western Europe, Kimberly J. Morgan, Associate Professor of Political Science and International Affairs at the George Washington University, and Kathrin Zippel, Associate Professor of Sociology, University of Wisconsin at Madison argue that due to the low benefits provided by these programs, “choices for parents remain deeply constrained by gender and class.

“These policies also are likely to reinforce the traditional division of care work in the home. Temporary homemaking is being institutionalized as the norm for many women, who face potentially negative consequences for their earnings and long-term employment trajectories.”

The negative long-term consequences are indeed troubling. In the U.S., the HHS reports that Social Security benefits for older women are often lower than for men due to lower wages, and extended absences from the workforce due to family caregiving. These absences contribute to gaps in employment history which can then make it difficult for women to establish pension eligibility – with the result that older women are only about half as likely as older men to be receiving pension income.

The United Nations also notes that caregiving interferes with women’s opportunities to acquire education and skills, especially in poorer countries, which again impacts future employment opportunities and the possibility to achieve economic independence.

The non-financial negative effects – the emotional and physical burdens of female caregivers – are equally alarming. In her analysis of health, stress, and coping among women caregivers, Christina Lee, Associate Professor in Psychology at the University of Newcastle, Australia states that family caregiving is associated with a high level of psychological stress as well as "reduced physical well-being", and points to documented evidence of, among other issues, increased psychiatric symptoms and illness, depression, back pain, headaches, and negative effects on the immune system resulting in increased viral illness.

Therefore, she concludes that “these documented effects of family caregiving justify arguments for the need for intervention and a more equitable division of this potentially arduous workload.”

Taking steps toward equality

The U.N. has come to a similar conclusion, but changing some of the most basic structures of society and embedded gender role concepts is clearly much easier said than done.

Speaking at a 2010 U.N. conference on the equal sharing of responsibilities between women and men, Carolyn Hannan, Director of the Division for the Advancement of Women of the United Nations Department for Economic and Social Affairs, remarked that engaging men in the process of social change is a critical factor.

As for addressing the existing state family policies which perpetuate gender roles and stereotypes –including parental leave, crèches and work-life balances that assume women bear sole responsibilities for caregiving – Hannan suggested “measures that facilitate more long-term transformation of attitudes and institutional arrangements that perpetuate unequal sharing and, at the same time, address the immediate challenges women and girls face in the current situation of unequal sharing.”

But what does such a broad statement actually mean? On a basic level, it means continued public support for caregivers, but with a focus on equality.

Opportunities for caregiver support should be equally available and incentivized for both men and women. For example, UK newspaper The Telegraph recently reported on the Swedish parliament’s decision to give couples where the father takes over caring for the baby a “gender equality bonus” of 3,000 Swedish Kronor (447 USD) each month. This new incentive is in addition to existing paternity benefits equal to 80 percent of salary.

Additionally, education and training for men should be made available to help overcome both the skills gap and any social stigma around male caregiving, while skills training for female caregivers to help them re-enter the workforce could potentially limit the negative impact on their long-term employment prospects.

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