Care Workers and Global Care Chains

How women migrate from poorer countries to care for children, the elderly and the sick in richer ones, and the economic and social effects on both ends.

Ageing populations and rising female employment in richer countries have increased demand for care: looking after children, older people and the sick. Much of this care is provided by migrant workers, many of them women. The sociologist Arlie Hochschild described the resulting links as global care chains.

How care chains work

A woman from the Philippines, India or Indonesia migrates to work as a nurse, nanny or domestic worker in the Gulf, Europe, Hong Kong or North America. Her earnings support her family at home, where relatives, often grandmothers or older daughters, or a lower-paid local worker, care for her own children. Care flows from poorer to richer places.

The scale

The Philippines has long been a major exporter of nurses and domestic workers, with government agencies managing overseas employment.
Kerala in India has a long tradition of nurses working abroad, especially in the Gulf, the United Kingdom and other countries.
Millions of domestic workers from South and Southeast Asia work in Gulf countries.

Economic effects

Remittances support families, education and health at home.
Care shortages in origin countries: when nurses emigrate, home health systems may face shortages. The World Health Organization maintains a list of countries with critical health workforce shortages where active international recruitment should be avoided.
Enabling work in destination countries: migrant care workers allow local women and men to work outside the home.

Risks for workers

Domestic workers, working inside private homes, are especially vulnerable to long hours, low pay, confiscation of passports and abuse. In some Gulf countries, the kafala sponsorship system has tied workers to employers, limiting their ability to change jobs, though several countries have reformed it. The ILO’s Domestic Workers Convention, adopted in 2011, sets standards for their rights.

A nurse's migration

A nurse from Kerala takes a job in a British hospital, earning several times her previous salary. She sends money home to pay for her children's education and her parents' health care. Britain's health service fills a staff shortage. Meanwhile, the hospital she left in Kerala must train or recruit a replacement. The same move creates gains and costs in different places.

Thinking care work migration only benefits rich countries

Migrants and their families often gain substantially through higher earnings and remittances. The challenges are protecting workers' rights and managing shortages in origin countries, not preventing migration altogether.

Key takeaways

Global care chains link migrant care workers from poorer countries with care needs in richer ones.
The Philippines and Kerala are major sources of migrant nurses and care workers.
Remittances help families at home, but origin health systems can face shortages.
Domestic workers face high risks of exploitation; the 2011 ILO convention sets standards for their rights.