Global Health & Gender Policy Brief No.

4 l December 2022

Photo courtesy of: Pressmaster / Shutterstock

Migrant Care Workers and

Their Families
OVERVIEW
The COVID-19 pandemic has brought into the open two things that much of the world has always
assumed but not fully acknowledged: women do the vast majority of caregiving, and caregiving is grossly
undervalued. Caregiving is also the fastest-growing economic sector in the world—projected to add 150
million jobs by 2030.1 Global societal changes, like low birth rates, demographic aging, and an increase in
female labor force participation, are basic drivers of the continued growth of this sector. But because in
many cultures care work is considered “instinctive” for women—a type of work not requiring skill—it has
remained virtually invisible, unpaid or underpaid and unregulated. It is also often stigmatized, especially
when relegated to already marginalized and underrepresented populations.

Migrant care work is a key component of this ongoing global care crisis. In recent decades, migrants
from poorer regions have performed much of the caregiving in wealthy regions of the world, forming
“global care chains.” Many caregivers have been compelled to migrate and work without documentation,

This brief was prepared by Sarah B. Barnes, Sonya Michel, Alyssa Kumler, and Deekshita Ramanarayanan through the generous
support of EMD Serono, the healthcare business of Merck KGaA, Darmstadt, Germany. This brief was informed by a larger white
paper that was developed through careful consultation with an expert advisory council and private roundtable with care work,
migration, and gender experts. (Expert advisory council is listed on the final page.)

Maternal Health
Initiative
but the pandemic has increased their risks, as it THE GLOBAL CARE ECONOMY,
has prompted national governments to tighten MIGRANT DOMESTIC WORK, AND
border restrictions. While the spread of COVID-19
GLOBAL CARE CHAINS
has greatly increased the need for care work
everywhere, it has also diminished the number The global care economy is critical to overall
of migrants available to perform it. Additionally, economic growth, and also affects gender, racial,
while migrant care workers are being applauded and class and caste equity and empowerment.
and elevated in stature as part of the “essential While much care work is provided in institutional
workforce” necessary for the overall health of a congregate settings, in-home care is a key
nation during the pandemic, they actually face component of the care economy. Even though
greater dangers from the disease than citizen there are some 75.6 million domestic workers,4
populations. Despite working closely with persons including in-home care workers, worldwide,
who may themselves be ill, migrant care workers they are less visible in research, as well as less
are often denied access to preventive measures protected and given fewer rights than high-level
such as vaccinations and personal protective care providers like doctors, nurses, and midwives.
equipment (PPE), or medical care if they contract Women make up more than three-quarters of the
COVID-19.2 At the same time, they must worry world’s domestic workers,5 and persistent gender,
about how members of the families who did not race, and class inequality adds to and reinforces
migrate with them are coping with the pandemic, the sector’s invisibility. Migrant domestic workers,
since they, too, are vulnerable and may lack an even less protected and researched population,
adequate care due to the absence of the migrant make up one-sixth (11.5 million) of all domestic
care worker.3 Migrant care workers are competing workers in the world, and roughly three-quarters
in a world that has historically undervalued (73.4 percent) of them are women.6
both care work as a sector and care workers as In rural and semi-industrialized economies,
people providing an essential service, and more women perform paid market work along with
recently a world that has become increasingly unpaid care work for their own family members
nationalistic and xenophobic. Thus COVID-19, at home, but when economies industrialize fully,
caregiving, and migration are intricately connected. this combination becomes less possible. As more
This brief serves as an overview of the effects of families have become dual-income and women
the pandemic on migrant care work, particularly have embraced paid employment opportunities
female caregivers and their own families. We also outside the home, the demand for non-familial,
propose ways for policymakers and practitioners to paid caregivers either in their homes or through
utilize the current spotlight on care work to garner outside services has increased sharply. Given
support to make lasting change in the status and the stigmas historically attached to caregiving,
working conditions of migrant care workers. The this market has been dominated by members of
information provided in this brief was informed lower-status populations with limited work options.
by a larger white paper that includes a section on More recently, these populations have demanded
activism among and in support of migrant care recognition, fair pay, and benefits—or have sought
workers and provides regional highlights on the to abandon caregiving occupations altogether,
response to COVID-19 in the Asia-Pacific and the leaving a gap for non-nationals—that is, migrants—
experiences of families of migrant workers in Sub- who often have grievously limited job options and
Saharan Africa. choice either at home or abroad.

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No. 4 l December 2022
Editorial photo courtesy of: UN Women Asia and the Pacific. Attribution-NonCommercial-NoDerivs (CC BY-NC-ND 2.0)

Global migration patterns are vast, and many well-intended—may cause further hardship at
factors propel people to migrate for paid work. For home. In women’s absence, responsibility for the
some, migration allows for better job prospects, care they once provided may devolve onto other
higher pay, opportunities for job training and relatives, especially elders, or onto communities
advancement, and safer work conditions.7 But for that are already stretched thin.10 In this sense,
others, it is a reluctant choice, perhaps driven by care chains create a “care drain” in the sending
gender restrictions, civil war or ethnic conflict, countries. These gaps in the care available to
political instability, food insecurity, or a lack of the children and elders who remain in the sending
kind of educational and job opportunities potentially country are substantial, and connection through
available in receiving countries.8 new technologies can only begin to compensate
for them. This means that while migrants provide
But migration does not resolve all of these support and care to families at the receiving
problems. Female migrants may be prompted to end of the global care chain, this may come at
leave because of gender oppression at home, but the expense of their own children and extended
they do not necessarily escape discrimination once
families at the sending end of the chain.
they reach their destinations. The majority of those
with low socio-economic status become care or At the same time, the receiving countries (often
domestic workers because stereotypes based on wealthier than sending nations) experience a “care
sex, ethnicity, race, and nationality bar them from gain.” Families seeking care for children, elders
other occupations.9 or those with disabilities may now hire flexible
workers at low cost.11 This imbalance is further
The overriding need to support their own families intensified by a trend toward the commercialization
often supersedes women’s desire for personal of care services in wealthy countries. By
fulfillment. Nevertheless, their departure—however

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No. 4 l December 2022
offering lower wages and less favorable working affordable alternative care for young children and
conditions, these nations discourage citizens from the elderly, thereby heightening the demand for
taking jobs in this sector, thereby increasing the in-home care workers. But potential employers
demand for migrants. While care work agencies have found their efforts stymied by immigration
facilitate the recruiting and screening of potential regulations that, while always inhospitable to
employees, in this way, they perpetuate social “unskilled” workers, have been further tightened
inequality on a global scale. by travel restrictions and international policies
limiting migration in order to minimize the spread
Woman migrants are particularly invisible in of COVID-19. All of this has only exacerbated the
destination countries because they have restricted instability of care work and the vulnerabilities of
access to society and public spaces while employed those who provide it, particularly migrants.
in private homes.12 Often they experience social
and cultural isolation due to language and cultural For those care workers who had managed to
differences and, if undocumented, feel compelled migrate or were already living and working abroad,
to maintain a low profile. In many countries, the pandemic has brought additional stressors.14
all domestic workers are excluded from labor Migrant care workers have been particularly
protection laws, and in such places care workers affected by border closures and travel bans. In
who are migrants are especially susceptible to addition to closing down entry from outside, many
labor exploitation that leads to violations of their countries have also limited movement within
human and labor rights. These may include passport their borders through lockdowns and curfews,
and contract substitution—taking or replacing a forcing some migrant care workers to work on
personal passport or overriding a contract once rest days and beyond normal workday hours.15
These restrictions have also left migrant workers
a migrant has arrived and replacing it with a less
unable to access already limited health care
favorable one. Excessive fees charged by agencies
services as well as the money-transfer services
or traffickers, the absence of adaptive and protective
needed to send remittances to their families.
mechanisms needed in certain types of work, lack
In some places, care workers have been
of accurate information on terms and conditions
compelled to procure their own PPE, such
of employment, and restrictions on freedom of
as masks and gloves. Many migrant care
movement and association are also common
workers, concerned about the wellbeing of
examples of exploitation faced by migrant workers.13
families back in their country of origin, have
sought to return to their countries of origin,
CONTINUUM OF GLOBAL but the pandemic has impeded such efforts due to
RESPONSES TO MIGRANT threats and fears of job loss, the risk of contracting
DOMESTIC CARE WORK DURING COVID-19, and expired work visas.16
THE PANDEMIC: FROM JOB LOSS
Some countries have responded affirmatively
TO OVERWORK to the new challenges COVID-19 presented to
Even before the pandemic, the demand for care migrant care workers. Europe offers several
workers, in both homes and institutions, was examples of policies that helped support this group
growing in high-income regions/countries. Since during the pandemic. European countries have
its onset, however, disease outbreaks and closures some of the highest percentages of foreign-born
in child care centers, schools and long-term home-based caregivers in the world; on average,
13 percent of all essential workers responding
health facilities have made families desperate for

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No. 4 l December 2022
Photo courtesy of: Sharon Mollerus / Flickr. Attribution 2.0 Generic (CC BY 2.0)

to the pandemic in Europe are migrants.17 Those (including care providers) faced food, job, and
from member countries move freely through housing insecurity as well as barriers to accessing
the European Union (EU), but a large proportion health care.21 Spain’s strict lockdowns made it
come from outside that system. And while non- almost impossible for their informal economy,
EU migrants are clearly a prominent component including care work, to function. In response
of the care cadre, they have historically been less to the situation, the government extended
supported by immigration policies and host-country temporary permits to migrants with temporary
citizens.18 During the pandemic, however, the value residence status enabling them to access their
of migrant care workers gained recognition in social rights, but discarded calls for policies and
several European countries, prompting the creation protections for those who lacked proper work
of policies to support them. The Italian government and residency status, leaving many without
granted temporary legal status to migrants in the access to health care and social service programs
care sector in spring 2020,19 and Austria, Germany, specifically intended to support those who had
and Switzerland exempted migrants providing in- lost employment due to the pandemic.22
home care from international travel bans.20
In the Caribbean, lockdowns strained already
At the same time, in countries both in Europe precarious conditions for migrant domestic
and elsewhere, migrant domestic workers workers. Some were dismissed without pay,
who already lacked support experienced a received inadequate or no PPE, were given
continuation of the same policy environment— increased levels of work and reduced wages,
and sometimes even an escalation of hostility faced housing instability, and had limited access
during the pandemic. In the Netherlands, to medical services.23 Similarly, migrant care
undocumented migrant domestic workers workers throughout Latin America often face

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No. 4 l December 2022
additional barriers in accessing health services a large minority suffered from high levels of mental
due to lack of legal protections and inclusion in distress, primarily due to lack of confidence or
health care policies, limited accurate information, resources (like PPE and adequate nutrition) to care
and insufficient culturally appropriate care.24 properly for themselves or those they were looking
Migrants in this region also experienced reduced after.30 In general, research on the mental health of
access to asylum and resettlement schemes, migrant care workers is hard to come by, but what
leaving them particularly vulnerable to job, exists has shown that migrant workers have a higher
housing, and food insecurity, as well as violence incidence of common mental issues, particularly
and trafficking.25 depression, than local workers due to stressors
such as finances, lack of access to healthcare,31 job
In Canada, some provinces that experienced a instability, and social isolation.32 In the best of times,
large number of COVID-related deaths in long-term care workers are susceptible to burnout due to the
care institutions, such as Quebec, introduced paid high physical and emotional demands of the work;
training programs for care workers with assured currently, this sector has become more pressured
employment upon obtaining a certificate and and strained, leading to an increase in burnout and
invited students, immigrants, and refugees and stress among care workers.33
asylum seekers to take the training.26 This was
matched by the federal government’s new “health- RAMIFICATIONS OF THE PANDEMIC
care workers permanent residence pathway” FOR THE FAMILIES OF MIGRANT
initiative to recruit and retain potential care workers
CARE WORKERS
in the health-care sector, including nurses, nurse
aides, orderlies, and home-support workers. How have these transnational families been
Under this new policy, refugee claimants who affected by COVID-19? To understand this,
had worked 120 hours or more between March we must look at both halves—at the migrant
13 and August 14, 2020 (during the height of the caregivers abroad and their children and other
COVID-19 pandemic deaths in Canada) could apply relatives remaining in the sending country.
for a special pathway to permanent residency. Separation from family, lack of social and legal
Unfortunately, this special pathway was closed at supports in the host country, and gender
the end of August 2021, when the pandemic crisis differences greatly affect the mental health of
appeared to be over.27 parents who are also migrant workers.34

Several Middle Eastern countries, including Under the conditions of care drain, the pre-
Bahrain, Saudi Arabia, Qatar, and Lebanon, have pandemic status of transnational families
in place the kafala system which, by tying the was precarious at best. Many lived in low- or
legal residency of migrant workers (including care middle-income economies where jobs were
providers) to their employers, has led to significant scarce and business opportunities virtually non-
abuse.28 The Lebanese government, for example, existent. Social safety nets were inadequate,
has not taken any actions to protect workers, and access to education and health care limited.
despite proof of increased violence and abuse.29 For some families, migrants’ remittances
While Israel does not deploy the kafala system, it were supplementary but essential for helping
has imposed lockdown during the pandemic. members, especially children, achieve upward
mobility, while for others, they constituted the
A study of the psychosocial status of migrant sole source of income.35
workers in the country during this period found that

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No. 4 l December 2022
Photo courtesy of: Eric Parker / Flickr. Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0)

Accompanying the flow of cash were the children (LBC) find varied results, a strong
emotional and psychological side effects of long- reminder that migrants and their families are not
term separation. Prevented from returning home homogeneous. Some studies of LBC found that
with any regularity, female migrants, in particular, they have more emotional and behavioral problems
sought to close the distance between themselves than non-LBC, particularly mental health disorders,
and their children via “Skype mothering”36 and hyperactivity, and peer relationship issues,40,41
other uses of modern technology.37 However while others have found that remittances from
this option was not always available to family abroad improve the education and well-being of
members at both ends of the global care chain. family members remaining at home.42
Whether or not households are fortunate enough
Further, the complexity of family dynamics, level
to have internet, mothers, whether present or
and quality of care received by LBC, economic
working abroad, become involved with assisting
variance between receiving and sending
with lessons.38 One Filipina mother employed as
countries, and prevalence of emigration in a
a caregiver in Taiwan told an interviewer that she
sending country can also be associated with
spent her evening hours on the telephone with her
the overall well-being of those remaining in the
daughter back home, helping her especially with
sending country.43 At the same time, migrant care
her English homework.39
workers who want to bring family members with
In families where this type of engagement was them are prevented from doing so because they
not possible, and long distances and restrictions would lack needed child or elder care services in
prevented return visits, mother-child relationships receiving countries.
could become attenuated. Studies of left-behind

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No. 4 l December 2022
RECOMMENDATIONS TO UNDERSTAND MIGRANT CARE WORK AND
IMPROVE CONDITIONS FOR WORKERS
Reform immigration laws and regulations:

• Reform immigration policy and selection to include workers who are in high demand but not
considered “high-skilled” workers

• Increase labor-market-specific skill-based immigration policies

• Utilize existing evidence on the value of migrant care work to establish new structures for work visas

Implement tailor-made policies for migrant care workers: 44

• Address particular challenges experienced by women due to their intersectional identities

• Develop programs to highlight the value of migrant caregivers’ services to citizen families

• Create health care supports, including mental health, and education programs for migrant care workers

Develop health workforce governance to connect health system needs, health labor markets, and
individual migrant caregivers: 45

• Ensure that migrant workers have access to health care services, including vaccinations, sexual and
reproductive health, and mental health services

• Ensure that migrant workers have access to unemployment benefits, housing subsidies, and other
emergency funding resources

• Suspend employment-based visa programs and deportation for migrant workers dismissed due
to pandemic

Include migrant care workers in public health and health workforce research to help inform
immigration policy and reform: 46

• Invest in further research on migrant care workers, their families, and their experiences returning to
their home country

• Collect disaggregated data that clearly defines migrant care workers separately from domestic
workers, and clearly distinguishes women migrant care workers

• Create a systematic review of restrictions that legally prevent migrant workers from reaping benefits
designed for domestic workers

• Increase focus on under-studied regions and patterns of migration, like Sub-Saharan Africa, Latin
America, and Global South to Global South migration, as well as studies focused on women and
vulnerable populations

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No. 4 l December 2022
ENDNOTES
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can Behavioral Scientist, 65(10), 1287–1301. https://doi.org/10.1177/00027642211000396
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137–150. https://doi.org/10.1111/gwao.12509
4 10 years on, domestic workers still fight for equality and decent work (2021, June 15). International Labour Organization. http://www.ilo.org/global/
about-the-ilo/newsroom/news/WCMS_802516/lang--en/index.htm
5 10 years on, domestic workers still fight for equality and decent work (2021, June 15). International Labour Organization. http://www.ilo.org/global/
about-the-ilo/newsroom/news/WCMS_802516/lang--en/index.htm
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7 King-Dejardin, A. (2019). The Social Construction of Migrant Care Work: At the intersection of care, migration and gender (p. 171). International
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eurpub/ckaa126

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