WORLD BANK GROUP GENDER THEMATIC POLICY NOTES SERIES: EVIDENCE AND PRACTICE NOTE ADDRESSING CARE TO ACCELERATE EQUALITY TANIMA AHMED, AMANDA DEVERCELLI, ELENA GLINSKAYA, RUDABA NASIR, AND LAURA B. RAWLINGS OVERVIEW The care economy is essential in daily life and a driver of economic growth, human capital development, and employment. Gender is a defining characteristic of the care economy. Women spend 3.2 times more time on unpaid care work than men and constitute the majority of the care workforce. Disproportionate unpaid care responsibilities and a lack of access to quality, accessible, affordable care services impede women’s economic participation and affect their overall well-being. Investments in the care sector are essential to accelerate equality and could generate up to 299 million jobs worldwide by 2035. Globally, the need for care services is high. Worldwide, 43 percent of all children below primary-school-entry age—350 million children—need childcare but do not have access to it. The need for eldercare is also growing as the population continues to age and face chronic health conditions. The World Bank Group actively supports countries in addressing this care crisis. This thematic policy note reviews many of the issues, evidence, and lessons learned: • Investing in the care economy is a win-win-win for families, businesses, and economies. Affordable, accessible, and quality care services are a public good that benefits all. Care investment can generate jobs and yield multi-generational impacts by improving employment and productivity, child outcomes, family welfare, and overall economic development. • Ensuring access to well-designed, affordable, and quality care services can increase women’s economic participation. Designing care services that accommodate needs of caregivers—adjusting hours of operation and location—can boost caregivers’ labor market outcomes. • Addressing social and gender norms is essential for increasing the uptake of care services. Care is considered women’s work across societies. Interventions that simultaneously tackle multiple constraints, including normative barriers to outsourcing care, can increase the uptake of care services and, in turn, improve women’s labor market outcomes. • Employer-supported family-friendly initiatives can help employees manage their care responsibilities. This may include childcare support, paid family leave, paid and job-protected parental leave, and flexible working options. • Coordination and collaboration across the public and private sectors is required. Government ministries, the private sector, non-state organizations, and communities must work together to ensure access to quality care provision and maximize the return on such investments. AUGUST 2023 TABLE OF CONTENTS INTRODUCTION 1 THE NEED FOR CARE 4 UNPAID CAREGIVING AND CAREGIVERS’ ECONOMIC OUTCOMES 5 ECONOMIC RETURNS TO INVESTING IN CARE 8 CHALLENGES IN ACCESSING CARE SERVICES 9 WHAT WORKS? 11 WORLD BANK GROUP’S EFFORTS IN ADDRESSING CARE 15 CONCLUSION AND RECOMMENDATIONS 19 REFERENCES 21 This thematic policy note is part of a series that provides an analytical foundation for the World Bank Group Gender Strategy (2024–30). This series seeks to give a broad overview of the latest research and findings on gender equality outcomes and summarizes key thematic issues, evidence on promising solutions, operational good practices, and key areas for future engagement on promoting gender equality and empowerment. The findings, interpretations, and conclusions expressed in this work are entirely those of the author(s). They do not necessarily reflect the views of the World Bank Group or its Board of Directors. This note was prepared by Tanima Ahmed, Amanda Devercelli, Elena Glinskaya, Rudaba Nasir, and Laura B. Rawlings. Helpful comments are received from Hana Brixi, Anita Gurgel, Lauren Beth Gula, Ioannis (John) Arzinos, Charlotte Vuyiswa McClain-Nhlapo, Debbie Mei Si Bong, Ruchi Kulbir Singh, Samaneh Hemat, Farid M. Tadros, Felicia Norina Siegrist, Seemeen Saadat, Emcet O. Taş, Alessandra Heinemann, Ariana Maria Del Mar Grossi, Abhilasha Sahay, and Ito Peng. ii INTRODUCTION The care economy is a key driver of economic growth, Measuring the economic value of unpaid care work is human capital development, and employment. challenging due to the informal nature of the work, but The sector is highly influenced by gender dynamics available estimates suggest enormous monetary value. that demand women shoulder a disproportionate Globally, unpaid work consists of household chores (82 responsibility of care. While women carry out most of the percent), direct care work (13 percent), and volunteer work unpaid care work, they also constitute most of the care (5 percent) (ILO 2018a). Measuring these unpaid activities workforce (International Labour Organization (ILO) 2018a). is vital to realize a country’s overall economic output and Disproportionate unpaid care responsibilities impede progress. The valuation of these activities also underlines women’s economic participation and affect their overall the existing gender inequalities in labor market outcomes well-being. Addressing the issues of care and dramatically and unpaid work, which generally remain invisible to society. increasing and improving investments in the care sector Estimates based on time-use survey data in 64 countries are essential to accelerate equality and expand women’s suggest that globally, 16.4 billion hours are spent in unpaid ability to make strategic life choices. This brief focuses on care work every day, equivalent to 2 billion people working the care economy— primarily, childcare and care for older eight hours per day without pay (ILO 2018a). If this work is people and people with disabilities—and its impact on valued on an hourly minimum wage, unpaid domestic and women’s economic outcomes. It touches on the need for care work totals $11 trillion, equivalent to 9 percent of the care, economic returns and challenges of accessing care global Gross Domestic Product (GDP). services, care solutions, and World Bank Group initiatives in addressing care. Worldwide, women spend, on average, 272 minutes per day on unpaid care work and 181 minutes per day on paid The care economy consists of direct, personal, and work, compared to men spending 84 minutes on unpaid relational care activities, such as caring for children, care work and 321 minutes on paid work (see Figure 1). older people, people with disabilities, and adults. It also Even in high-income regions like North America, where includes indirect care activities that involve maintenance of household chores are largely automated and less time- home and communities, sometimes called domestic work, demanding, women spend 95 minutes more per day on such as cooking and cleaning. While unpaid care work is unpaid care work than men. The gap further widens in performed without a monetary reward, paid care work is South Asia and North Africa, where men spend 33 and 50 performed both formally or informally for pay or profit, minutes per day, respectively, on unpaid care work and mainly by domestic workers, nurses, doctors, childcare women spend 296 and 309 minutes per day, respectively. workers, and other personal care service providers. A comparison of the total work (unpaid care work and paid work) of women and men indicates that women regularly Women carry out three-quarters of unpaid care spend more time doing work than men in all the regions work. They spend, on average, 3.2 times more time of the world. Globally, while women spend 7 hours and 33 on unpaid care work than men (Charmes 2019). Family minutes daily (453 minutes) doing work-related activities, members, disproportionately women, often assume men spend 6 hours and 44 minutes (404 minutes). the responsibility of caring for young children and older people due to binding social norms and a lack of social services. Although this work is essential in daily life and a foundational contribution to human capital development and productivity, it largely remains unremunerated, unquantified, and unacknowledged. 1 FIGURE 1. PAID WORK, UNPAID CARE WORK, AND TOTAL WORK TIME (IN MINUTES PER DAY) BY REGIONS Notes: Unpaid care work consists of providing unpaid domestic services for own final use within households, providing unpaid caregiving services to household members, and providing community services and help to other households. Source: Charmes, Jacques.2019. The Unpaid Care Work and the Labour Market. An analysis of time-use data based on the latest World Compilation of Time-use Surveys. International Labour Office–Geneva: ILO. Women are typically time-poor due to their disproportionate participation in unpaid work. This lack of time impedes women from completing school, obtaining paid work, dedicating time to establish or grow businesses, and/or working as many hours for pay as men. This results in women being funneled into informal and lower-paying jobs. Working longer hours also affects women’s mental well-being, adding to emotional strain with increased stress. They have less time available to enjoy life and make choices to exercise, be creative, socialize, or relax. Crises, such as climate change and the COVID-19 pandemic, further increase women’s unpaid work, affecting their economic participation on a larger scale. The impact of climate change on growing food insecurity, decreasing access to clean water, and growing health risks all contribute to increasing the time women spend on unpaid care work. For instance, drought and scarcity may force women to travel longer distances to fetch water and firewood, potentially increasing their vulnerability to gender-based violence (GBV). Climate-change-induced disasters may reduce household income (Islam and Sharma 2021), leading to an increase in women’s unpaid work trying to compensate for the lost earning, which may further marginalize them. Health crises like the COVID-19 pandemic also markedly impacted women’s care responsibility, further reducing their opportunities for economic participation (see Box 1). 2 BOX 1. COVID-19 AND UNPAID CARE RESPONSIBILITY The global COVID-19 pandemic exposed women’s critical role in providing care. During the pandemic, the need for care and domestic work skyrocketed with the closure of schools, increased remote work, and disrupted health services. Although both women and men reported an increase in their time in unpaid work after the pandemic (60 percent for women versus 54 percent for men), women shouldered the bulk of this increased care responsibility (UN Women 2020) with severe consequences for their labor force participation and well-being. Women dropped out of paid employment at higher rates than men during the pandemic, largely due to increased care responsibilities for children, older people, and the ill (Bundervoet, Davalos, and Garcia 2021; Cucagna and Romero 2021; De Paz Nieves, Gaddis, and Muller 2021; Kugler et al. 2021; Taş et al. 2022). According to the ILO’s global estimates (2022a), around 2 million mothers left the labor market during the COVID-19 pandemic. Women who remained were under additional stress in managing increased care responsibilities (Goldin 2022). A Rapid Gender Assessment by UN Women (2021) finds that women who reported an increase in unpaid care and domestic work during the pandemic were 1.6 times more likely to have experienced increased mental and emotional stress than those who did not report an increase in such work. The increased care responsibility due to the closure of schools and childcare centers during the pandemic fell more heavily on working mothers than fathers (Collins et al. 2020; Del Boca et al. 2020). Women business leaders reported spending more time on domestic tasks during the pandemic than men business leaders. Nearly one- third of women entrepreneurs felt that increased childcare demands reduced their ability to focus on their businesses, which hurt their ability to generate income (Facebook, OECD, and World Bank 2020). The closing of schools, a major part of the care infrastructure, led to higher business closures for women business owners with children than for men business owners with children (Goldstein et al. 2022). 3 THE NEED FOR CARE Childcare is at the center of many critical issues that The need for care will grow with the increase in life governments face as they seek to fight poverty, build expectancy and chronic health conditions. In 2019, human capital, and increase productivity and equity. informal caregivers worldwide (primarily family members Worldwide, 43 percent of all children below primary- and friends) spent, on average, five hours per day providing school-entry age —350 million children—need childcare care and supervision for people living with dementia but do not have access to it (Devercelli and Beaton-Day (WHO 2023), 70 percent of which were done by women. 2020). Nearly 8 out of 10 children who need childcare, but Worldwide, an estimated 55 million people were living with do not have access to it, are living in low and lower-middle- dementia in 2019, with over 60 percent living in low and income countries. A child living in a low-income country is middle-income countries. With life expectancy increasing nearly five times less likely to have access to childcare than in nearly every country, this number could increase to 139 a child living in a high-income country. million by 2050, indicating that without interventions, the care responsibility of informal family caregivers will also This need for care is also on the rise due to the aging increase substantially (Gauthier et al. 2022). The UN (2016) population. Countries worldwide are increasingly facing estimates that, worldwide, 48 percent of older people are aging-related challenges, and more countries are projected not covered by any type of long-term formal care services, to enter the aging phase of the demographic transition in and only 6 percent of them are covered by legislation that the coming decades. Many families rely on adult children provides universal coverage. (mostly younger women and girls) or older spouses to provide care in old age. This family care model is likely Gender and aging are intertwined in multiple ways, with to come under strain with the rising number of older longer life expectancy potentially worsening existing dependents. The number of people age 60 and older is gender inequality. First, women tend to live longer and expected to rise from 962 million in 2017 to 2.1 billion in make up a more significant percentage of the older 2050 (United Nations (UN) 2017), exceeding the projected population, especially for ages 80 and above. According population of adolescents and youth between the ages of to the World Development Indicators, in 2020, female life 10-24 (2 billion). The number of people age 80 and older is expectancy at birth was 75 years compared to 70 years for expected to increase even faster, tripling from 137 million men in 2020. Second, women’s labor force participation in 2017 to 425 million in 2050. is low worldwide (52 percent in 2019 compared to 80 percent for men).1 Older women typically face a higher Eldercare is different from childcare in terms of timelines, risk of poverty than older men because they are less likely predictability patterns, and level of intensity. The first to have retirement savings, such as pensions, and their five years of a child’s life demand large care needs, which employment is generally low-paid, part-time, or informal. diminish as the child grows. However, there is no such Women also experience frequent and more prolonged predictability in eldercare. The need to give care to an older career breaks due to childbirth and other life events. A 2021 person can come unexpectedly and can vary over time. report by the Organization for Economic Co-operation The care for older people can be complex, stressful, and and Development (OECD) suggests that across the OECD exhausting, especially when they require multifunctional countries, the gender pension gap (i.e., the difference in support for activities of daily living (ADLs), such as when the retirement income that women and men receive as they are bedridden, have a disability, or suffer dementia a ratio of men’s retirement income) averages 26 percent. or other conditions. Long-term care needs vary widely, Moreover, given the gender norms prevalent in many and the range of services provided needs to cover many societies, caring for older people predominantly falls on situations—from helping an older person with their basic women within households without relevant and accessible activities of daily living, such as bathing and dressing, to eldercare services. Worldwide, 70–80 percent of older much more complex demands that require services from people in need of care receive it from family caregivers at health care providers. home. Varying across countries, 57 percent to 81 percent of all caregivers are women (Sharma, Chakrabarti, and Grover 2016). In the OECD countries, women hold 90 percent of the jobs in the long-term care sector (OECD 2019). 1  The data is from the Gender Data Portal (https://bit.ly/3X1b0PH) for the indicator: Labor force participation rate, male and female (% of male and female population ages 15-64 years) (modeled ILO estimate). 4 UNPAID CAREGIVING AND CAREGIVERS’ ECONOMIC OUTCOMES Motherhood places a penalty on almost all women these mothers from going to work altogether (Alfers 2016). workers, inducing many to leave the workforce. Several During adverse weather or other disruptions, these women analyses find that the presence of young children in the may not be able to work due to inadequate shelter and household is associated with lower participation of women public infrastructure. Those who cannot take their children (including mothers and grandmothers) in economic to work may often need to leave them unsupervised or rely activities and employment (Taş and Ahmed 2021; Wang and on family members, including other children (Samman et Zhang 2018; Das and Žumbytė 2017). It also lowers women’s al. 2016). In a sample of low-income countries, 46 percent earnings (Cukrowska-Torzewska and Matysiak 2020). ILO of children age 5 or below were either left alone or in the and UN Women (2020) suggest that having children sets care of their siblings under 10 years old for at least an hour back women’s labor force participation more than getting per week (Samman et al. 2016). married. Their estimates show that, globally, the labor force participation of women ages 25 to 54 declines from Mothers who bring their children to the workplace 82 percent when they live alone to 64 percent when they experience a penalty due to loss of earnings. A study by live with a partner to 48 percent when they live with a UN Women (2015) estimates that 39 percent of mothers in partner and have a child under 6 years old. The opposite developing countries bring their children younger than 6 is observed for men in the same age group. Their labor years old to work. This practice is associated with earning force participation increases from 90 percent when they loss for the mothers. Delecourt et al. (2021) find that in live alone to 94 percent when they live with a partner to 97 Uganda, women business owners who bring their children percent when they live with a partner and have a child aged to work experience a baby profit gap, earning 48 percent under 6 years old. This motherhood penalty is particularly lower profits than women owners who do not bring their high for mothers caring for a child with a disability, which children to work. often turns out to be a lifetime occupation for a caregiver. The challenges of caring for children with disabilities This is particularly true for mothers with poor socio- can further weaken the labor supply and earnings of economic status. While the penalty reduces over time caregivers and family members. Families caring for (i.e., once the children leave home and care-responsibilities children with disabilities often face multiple barriers, reduce), the parental gender gap in earnings remains such as stigma and discrimination (McHatton and Correa substantial (Goldin, Kerr, and Olivetti 2022). 2005; Green et al. 2005). Families with children with Mothers working in the informal sector experience even disabilities also face greater caregiving challenges as they greater difficulty earning an income and raising a child. have fewer sources of reliable childcare than families Women who enter or re-enter the labor market after with typically developing children (Koliouli 2021). Children childbirth may end up in low-paying or informal jobs with disabilities themselves suffer from exclusion from that offer flexibility to balance paid and unpaid work at learning opportunities. The cyclical relationship between the expense of a pay gap (Alfers 2016, ILO 2018b). Many poverty and disability is often exacerbated by additional women working in the informal sector are forced to bring responsibilities associated with caring for children their children with them to work due to the lack of care with disabilities and likely further decreases family services. Lack of access to childcare and facilities for diaper income by reducing household members’, particularly changing, lactation, and breastfeeding can also constrain caregivers’, participation in paid work (Mooney-Doyle and Lindley 2019). 5 The findings are mixed on how caring for older people Unpaid caregiving to older people impacts men too. impacts family caregivers’ labor supply. The majority Men participate less in eldercare than women, but caring of studies find that providing care to older people for older people also reduces men’s probability of labor reduces the labor force participation and employment force participation and/or employment (Van Houtven, of caregivers, their paid working hours, and overall labor Coe, and Skira 2013; Butrica and Karamcheva 2014; Nguyen earnings (see Heger and Korfhage 2020; Johnson and Sasso and Connelly 2014; Heger and Korfhage 2020; Ahmed and 2006; Nguyen and Connelly 2014; Crespo and Mira 2014; Floro 2023a). Findings on the impacts of elder caregiving Bittman, Hill, and Thomson 2007; Fevang, Kverndokk, and on men’s labor supply are mixed. According to Fevang, Røed 2012; Kotsadam 2011; Van Houtven, Coe, and Skira Kverndokk, and Røed (2012), the impact of caregiving on the 2013; Butrica and Karamcheva 2014). Conversely, Meng employment rate is higher for women than men, but Van (2013) finds no effect. This ambiguous finding is due to the Houtven, Coe, and Skira (2013), Butrica and Karamcheva fact that there is great variation in the level and intensity (2014), Heger and Korfhage (2020), and Ahmed and Floro of unpaid caregiving to older people. As the level of (2023a) find that caring for an older person reduces men’s responsibility and time intensity of care increases, so does probability of labor force participation and/or employment the impact on caregivers’ labor force participation. Once a more than those of women. Nguyen and Connelly (2014), caregiver provides more than 15–20 hours of eldercare per however, conclude that caregiving to older people impacts week, her economic activity is compromised with fewer women and men equally by reducing women’s and weekly hours of paid work (Chen et al. 2017; Walsh and men’s employment rates by 12 percentage points. This Murphy 2018). Intense caregiving to an older person is also differential impact may suggest that, as women participate associated with a higher likelihood of retiring early (Jacobs more in part-time jobs than men, women can adjust their et al. 2014; Heger and Korfhage 2020).2 schedule for caregiving, whereas men leave the labor market altogether. 2  he employment participation and high earnings by women and men negatively impact the willingness to supply informal family care T to older persons (Carmichael, Charles, and Hulme 2010). The population aging and emerging employment opportunities will likely widen the gap between demand and supply of informal caregiving to older persons in the coming years, entailing a rapid extension of institutional care arrangements for ensuring the well-being of both the care recipients and the providers. 6 Those who are employed and care for older people also report experiencing productivity loss related to work interruptions. Andersson, Walker, and Kaskie (2019) and Peng et al. (2020) find that employed individuals caring for older people are more likely to experience work interruptions than non-caregivers. Wolff et al. (2016) suggests that caregivers of older people with disabilities are more than three times as likely to experience absenteeism-related productivity loss compared to those not providing care. These work interruptions also relate to women employees changing jobs and men employees exiting the labor market (Schneider et al. 2013). Caregiving to children, older people, and people with disabilities is also associated with caregivers experiencing stress and psychological distress. Box 2 highlights how unpaid caregiving is correlated with caregivers’ psychological well-being. BOX 2. UNPAID CAREGIVING AND CAREGIVERS’ PSYCHOLOGICAL WELL-BEING Unpaid domestic and care work is generally associated with multitasking and greater mental stress. Offer and Schneider (2011) find that in the U.S., mothers spend around 10 more hours per week than fathers multitasking, doing domestic chores, and caring for children. Caregivers who provide care to older people on a daily basis face long working days (Ahmed and Floro 2023b) and tend to multitask. Long periods of overlapping work activities diminish the caregiver’s well-being by reducing caregivers’ time for leisure, self-care, and other activities. High levels of multitasking activities are associated with higher stress levels, sadness, psychological distress, and work- life conflict (Lam and Garcia-Roman, 2017; Hammersmith and Lin, 2016). Intense caregiving responsibility of children and older people severely hurts caregivers’ psychological well- being (Wang et al. 2011; Feinberg 2016). Caregiving is mentally and emotionally draining, especially for those caring for children and older persons with disabilities (Roach, Orsmond, and Barratt 1999; Sheehan et al. 2021). Caregivers generally find eldercare more stressful and emotionally taxing than childcare due to its complexity and unpredictability (Dukhovnov, Ryan, and Zagheni 2022). Unpaid eldercare relates to caregivers experiencing physical and emotional strain, especially women and those with the financial responsibility of caring for older persons (Duxbury, Higgins, and Smart 2011; Kim and Gordon 2014; Ghaffar 2020). In some cultures, aging parents participate in household and care work, which can help free up their adult daughters to pursue paid work (Pagani and Marenzi 2008; Shen, Yan, and Zeng 2016; Kanji 2018). Many caregivers, however, do not have this support and are part of the sandwich generation: individuals who provide care to children and older family members. They face a high degree of difficulty balancing their caregiving responsibilities with their jobs (O’Sullivan 2015). Sandwich caregivers routinely experience extensive financial and emotional challenges as they juggle their dual care responsibilities (Lei, Legget, and Maust 2023; Pagani and Marenzi 2008). 7 ECONOMIC RETURNS TO INVESTING IN CARE Investments in care are a win-win-win for families, Investing in the care economy can generate jobs, add to businesses, and economies. Primary caregivers can national income and yield multi-generational impacts. It reasonably expect to earn an economic benefit by entering improves women’s and men’s employment and productivity, or re-entering the labor force when they gain access to child outcomes, family welfare (including benefits to older quality, affordable, and reliable care services. Return- siblings by staying in school), business productivity, and on-investment estimates by Fraym, a preeminent global overall economic development. For women, access to care provider of hyperlocal population data, suggest that every services can enable labor market participation, increase $1 invested in quality childcare generates $3 in anticipated their work hours, productivity, and earnings and improve income in Nigeria and Indonesia, and $7 in South Africa their quality of work. For children, quality childcare can and Kenya. In addition, De Henau (2022) estimates that support holistic early childhood development, build providing high-quality, free, universal childcare to children foundational skills, promote school readiness, and improve ages 6 months to 5 years old in the United Kingdom their long-term education, health, and employment. A would result in an increase in women’s employment 2022 ILO report suggests that investing in a care economy by 3.4 percentage points at a 71 percent take-up rate of that promotes gender-equal leave, universal childcare, and the program and 4.6 percentage points at an 85 percent long-term care services could generate up to 299 million take-up rate. Cicowiez and Lofgren (2021) estimates that jobs worldwide by 2035, of which 234 million (78 percent) in South Korea, an increase in government investment in will be for women and 251 million (84 percent) will be eldercare of 0.15 percent of GDP each year from 2022–2030 formal jobs. This would require an annual investment of would result in a 1 percent increase in women’s total time $5.4 trillion (equivalent to 4 percent of global annual GDP), in production activities as a part of GDP, including goods which could be partially offset by increased tax revenue produced by households for their own consumption. generated from these additional care jobs and income. The 2015 Power of Parity report by McKinsey & Company posits that, globally, bridging the gender gap, especially ensuring progress in education levels, financial and digital inclusion, legal protection, and unpaid care work, could lead to an increase in GDP of $12 trillion to $28 trillion. 8 CHALLENGES IN ACCESSING CARE SERVICES Despite the economic benefits of investing in care, (Moussié 2020a). Globally, 58 percent of women workers care services are not widely accessible. Even when care are employed in the informal sector—a number that rises services are available, challenges related to social norms to 90 percent in Africa (ILO 2018c). Compared to formal and service affordability, convenience, and quality can workers in offices and other institutional settings, informal limit uptake. workers lack access to care services near their workplace (which could be near a marketplace, waste dump, or Affordable formal care options are often not available to recycling plant) or their residence often located in informal many unpaid caregivers due to lack of public or private settlements where care services are not well established care investments. The availability of childcare provision, (Moussié 2020b). especially free provision, is limited across economies. The World Bank’s Women, Business, and the Law (WBL) 2022 Underserved groups, such as lesbian, gay, bisexual, report shows that of the 55 economies where public sector transgender and intersex (LGBTI) people, also significantly childcare is regulated, about 80 percent do not mandate lack access to care services. LGBTI people are generally free provision. Surveys across countries of all income overrepresented in the bottom 40 percent of the levels show that families struggle to afford care services. population (Sexual Orientation and Gender Identity Task Household surveys from the European Union (EU) find Force (SOGI) and Koehler 2015). They face social stigma and that more than 40 percent of families consider cost to be discrimination that can limit their access to care services. a major barrier to using childcare (European Commission One U.S.-based study surveyed LGBT and non-LGBT adults 2016). One U.S.-based study finds that families with young living with children in two age groups: 5 years old and children spend approximately 10 percent of their income younger and 5 to 11 years old. Results show that 41 percent on childcare expenses. Families in poverty, however, spend of LGBT adults with younger children and 28 percent with around 30 percent of their income, with substantial gaps in older children were unable to attend childcare in the last their obtained quality of care (Morrisey 2020). four weeks, compared to 33 percent and 19 percent of non- LGBT adults living with children of the same age groups, In countries without long-term care insurance (LTCI) respectively (Godfrey, Cai, and Fremstad 2022). or other dedicated funding source, older people in need often cannot afford services as many have limited Even when care services are available, inconvenient retirement benefits (especially informal sector workers) locations and operating hours can limit access. Caregivers, or little to no private savings. At the same time, countries especially those who are working, need services located with LTCI and public investment in eldercare have been close by with operating hours that align with caregivers’ tightening eligibility and benefits in recent years, which will requirements. For instance, when the work commute is likely make care services for older people more costly (Gori long and exhausting, additional travel for childcare services and Luppi 2022). is extremely inconvenient and discourages use of formal care services (Alfer 2016). Also, available care services Access to affordable care services is limited for those may provide only partial support if operating hours are working in the informal sector. Informal workers cannot limited. For example, part-time preschool provision may easily afford formal quality care services and mostly rely temporarily relieve parents of their care responsibilities but on families or informal care services, such as neighbors does not fulfill working parents’ needs, particularly for those or home-based workers. Informal economy workers employed full-time (Devercelli and Beaton-Day 2020). The tend to work in non-standard formats, where employer- lack of extended operating hours can also impede access employee relationships are largely non-existent with no to care services when caregivers’ working times vary and do labor law protections or access to social benefits, such as not align with standard working hours (Hein and Cassirer pensions, health care, paid family leave, or parental leave 2010; Moussié 2020b). 9 The poor quality of care services also discourages take-up. Social norms exacerbate these challenges and influence Studies by Diaz and Rodriquez-Chamussy (2016) in Latin caregivers’ choice in accessing affordable, quality care America and Alfers (2016) in Ghana, South Africa, Brazil, services. Social norms govern personal relationships and Thailand, and India underline parents’ concern about commitments that are embodied in implicit contracts, with quality, particularly caregiver quality, in utilizing childcare women shouldering the caregiving responsibility more services. In Thailand, low-quality childcare and news about than men. Societal norms and discriminatory practices the mistreatment of children discouraged parents from make it harder for women with children and caregiving taking up childcare services (Kusakabe 2006). In Bangladesh, responsibilities to access employment if they want to, parents initially found it hard to trust childcare providers be paid equally, and access leadership opportunities. For and took a long time building enough confidence to enroll instance, mothers, as well as grandmothers, older sisters, their children in centers (Elsey et al. 2020). and other female household members, are expected to be the primary caregivers of young children, so caring for young Many countries lack a supply of qualified caregivers and children is an important issue in women’s employment a proper regulatory framework. An inadequate supply of and childcare decisions. qualified caregivers severely impedes countries’ capacity to provide and scale up quality service. In most countries, Where social norms are binding—with men considered especially developing countries, the childcare and early the breadwinners and women the caregivers—women learning workforce are underpaid, lack benefits, and work face severe constraints in freely exercising their choice in informally with no job protection and limited training. The accessing formal care services and participating in the labor low value attributed to these professions, high feminization, market. For instance, Caria et al. (2022) find that providing and low unionization relate to a high workforce attrition childcare subsidies with employment services has no rate, making investments in this workforce challenging impact on women’s job search behavior in Egypt. This (ILO 2018a). Licensing and accreditations, inspections, illustrates that social norms can be binding and removing reporting, and other parameters are crucial for ensuring the childcare constraints may not be sufficient for encouraging quality of care centers, but as countries work to formalize women’s economic participation. Globally, an estimated childcare, regulations must be crafted in a way that does 606 million working-age women consider themselves not penalize or exclude providers already working in the unavailable for employment or not seeking a job because sector informally. Several countries have established of their unpaid care responsibility, as opposed to only 41 care regulatory frameworks, especially for childcare million men (ILO 2018a). When institutional support is (World Bank 2022), but gaps between laws on the books, missing, quality public or private care is not available, or their implementation, and the inaccessibility of these resources to hire paid substitutes are limited, social norms frameworks and policies in the informal sector remain a are likely to be strongly enforced, restricting women’s ability significant concern in ensuring service quality. to freely exercise their life choices. 10 WHAT WORKS? A range of interventions are effective in addressing the childcare explicitly to accommodate the needs of working care needs and improving the economic participation parents, such as adjusting service location and hours of of the caregivers, such as increasing access to affordable operation, increases positive impact on the maternal labor and quality care services; employer-supported family market outcomes. initiatives; paid family leave; paid parental leave; and addressing social norms. Solutions that are effective: Establishing childcare facilities near markets, waste dumps, and informal settlements is particularly helpful in covering Access to center-based childcare services, which is the childcare needs of informal workers. For example, affordable, easy-to-reach, and accommodates caregivers’ with the support from non-state organizations and work schedules: Global evidence suggests that the wide local government, the Asmare Waste Picker Cooperative availability of center-based childcare support, such (Associação dos Catadores de Papel, Papelão e Material as preschools, reduces women’s time constraints and Reaproveitável) in Brazil opened a community childcare improves women’s economic outcomes. For example, center to support the childcare needs of waste pickers. It Evans, Jakiela, and Knauer (2021) suggest that access to was later integrated into the public childcare service UMEI childcare and preschool is likely to increase women’s (Unidades Municipais de Educação Infantil) (Moussié 2017). employment and household income. A study by Ajayi, Dao, The center remains open from 7:00 am to 10:00 pm to and Koussoube (2022) finds that the availability of crèches accommodate the waste pickers’ early-morning and late- in Burkina Faso positively impacts women’s employment night schedules. outcomes (by spending more time in salaried employment and earning more income) and their financial resilience Other examples include, in Ghana, the Accra Metropolitan and savings. A forthcoming study by Donald and Vaillant Assembly (AMA) provided a childcare center in the new also concludes that the availability of community-based Makola Market to facilitate the childcare needs of the childcare centers in rural areas of the Democratic Republic women market traders and vendors. The center operates of the Congo helps increase women’s and their husbands’ from 6:00 am to 6:00 pm (Moussié 2017). In India, the Self engagement in commercial activities leading to improved Employed Women’s Association (SEWA), a trade union agricultural productivity and household income. Halim, representing around 2.5 million informal women workers Johnson, and Perova (2022) find that preschool availability across 18 states in India, opened childcare centers to has effectively increased mothers’ work participation in support its members (SEWA 2023). Each center provides Indonesia. Reviewing the rapid expansion of preschools full-day service for SEWA members. As a result, 64 percent in Indonesia between 2002 and 2014, Cali et al. (2022) of the working mothers using the SEWA childcare centers also find that the availability of preschools increases the reported increasing their work days and their incomes productivity of the manufacturing plants employing at (Moussié 2017). SEWA members pay a minimal monthly least 41 percent women employees fee for the childcare service, and the government and non- government organizations cover the remaining operating To effectively increase women’s labor supply, parents need costs to ensure these centers remain affordable to informal access to childcare that is affordable, easy to reach, and workers (Moussié 2017). covers the hours during which parents are working. For example, a field experiment in Uganda shows that childcare Access to well-designed, affordable long-term care subsidies making childcare services affordable are more services for older people: Studies also find that public effective in promoting child development, mother’s investments to make long-term care services for older business revenues, and father’s wage earnings than an people more affordable and accessible improve caregivers’ equivalent cash grant (Bjorvatn et al. 2022). Studies in Chile economic outcomes. Shimizutani, Suzuki, and Noguchi show that lengthening the duration of school hours and/ (2008) find that the introduction of long-term care or providing afterschool care can increase mothers’ labor insurance (LTCI) in Japan in 2000 helped raise women market outcomes (Contreras Sep’ulveda, and Cabrera 2010; caregivers’ probability of employment by 8 percentage Martinez and Perticara 2017; Berthelon et al. 2018). Halim, points and increased the number of days and hours Perova, and Reynolds (2023) also highlight that designing worked per week by 10–20 percent. Other studies in Japan 11 show that the introduction of LTCI was more effective in Improving quality of care services: Despite the lack of increasing men caregivers’ labor force participation than evidence on the impact of the quality of care services on women caregivers’ (15 percent compared to 3–6 percent). women’s labor market participation, it can be inferred This supports existing findings that labor market sensitivity that quality is important to care service uptake. A study to caregiving is more marked for men than women (Fu et by the World Bank (2013) on improving early childhood al. 2017; Sugawara and Nakamura 2014). A recent study by care and education finds a positive correlation between Costa Font, D’Amico, and Vilaplana-Prieto (2022) shows student enrollment rates and qualified teachers and that long-term care subsidies in Scotland, known as free better infrastructure, indicating that quality encourages personal care (FPC), have been effective in increasing service uptake among parents. The more care services the well-being (happiness) of unpaid caregivers (who are are embraced, the more effective they are in improving exposed to FPC and provide at least 35 hours of care per caregivers’ labor market outcomes. week) by 12 percentage points. The effect is larger among women and caregivers who are not actively employed. The Kidogo model of supporting affordable and high- quality childcare centers can be an effective solution for Some studies, however, find no effect of these long-term informal workers living in low-income communities. care investments on caregivers’ economic outcomes. This Kidogo, an innovative East African social enterprise, suggests that the design of programs and an understanding partners with informal, women-led childcare providers, of the context in which they operate matters in ensuring known as “Mamapreneurs”, in the urban slums of Kenya to the positive impact of LTCI on caregivers’ economic help them improve the quality of their childcare services participation. In Japan, the 2006 amendment to LTCI, and increase their profitability (see Box 3). Over the last 5 which removed housekeeping services and reduced other years, Kidogo’s network of Mamapreneurs grew from 24 benefits, caused the previous LTCI-enabled gains in labor to 800 centers serving 18,000 children, indicating high force participation to vanish completely (Fu et al. 2017). demand and usage of these quality childcare centers in Furthermore, at the macro level, Ando, Furuichi, and Kaneko low-income communities in East Africa. (Kidogo 2022). (2021) find no effect of LTCI on the labor force participation of middle-aged women in Japan. A study in Germany shows a negative impact of LTCI on older men caregivers’ labor supply (a reduction of around 16 percentage points) but no effect on women (Geyer and Korfheg 2018). LTCI in the form of a per capita cash transfer to eligible older persons may influence men caregivers to retire early and engage in caregiving instead of market work. 12 BOX 3 KIDOGO’S CHILDCARE WORK Kidogo is a non-profit social enterprise working in East Africa’s low-income communities to improve access to quality and affordable childcare. Kidogo uses a social franchising approach to support women childcare micro- business entrepreneurs, known as “Mamapreneurs”, in starting and growing their businesses (Kidogo 2023; Howard, Wilson, and Aliouche 2020). The social franchise model is scalable and fosters long-term sustainability. Kidogo provides franchisees with intensive business and early childhood training when they join the network, followed by ongoing professional development and community engagement to ensure parents and families understand the importance of early childhood development. Mamapreneurs are local community members who increase their income and have the right incentives to build and grow their childcare microbusinesses, ensuring the growth and longevity of Kidogo’s network of centers. To promote peer-to-peer support in a sector that is often dismissed as unimportant, Mamapreneurs form a community of practice and meet regularly to share challenges and successes. These forums also serve as a channel for Kidogo to provide ongoing guidance on operating and managing a childcare center. In response to the key business challenges reported by Mamapreneurs, Kidogo developed and introduced a phone-based app to easily track daycare attendance and payments, critical functions for increasing the returns of these microbusinesses. Kidogo’s quality standards ensure Mamapreneurs provide a minimum quality service. The standards focus on ensuring safe and stimulating environments and responsive caregiving; providing play-based activities; maintaining proper health, nutrition, water, and sanitation in the centers; engaging parents and the community in childcare; and upholding efficient business management (Howard, Wilson, and Aliouche 2020). Kidogo works closely with Mamapreneurs to improve the quality of their childcare services, scoring them on a red, yellow, and green scale. Once green, centers are eligible to become a Kidogo franchise and receive branded signage and a small renovation. This signals to the community that the childcare center provides quality care. Mamapreneurs must continue to maintain a green standard during regular quality assurance visits in order to stay in the network. 13 Access to employer-supported family initiatives: maternity leave (7 in 10 potential mothers live in the 98 Employers can help employees manage their paid work countries that are in line with the ILO maternity protection and family and care responsibilities and improve caregivers’ standard), access to paternity leave has remained limited labor market outcomes. Evidence suggests that offering (only 1 in 10 potential fathers live in countries with at least family-friendly initiatives, such as childcare support, training 10 days of paternity leave) (ILO 2022b). Amin, Islam, and for line managers on supporting new parents, and flexible Sakhonchik (2016), using firm-level data for a sample of work options, can enhance a company’s ability to attract 33,302 firms in 53 developing countries, find that women’s and recruit the best staff, improve retention, and reduce employment in the private sector is significantly higher in employee turnover (IFC 2017). Childcare support, such as countries that mandate paternity leave. Nepomnyaschy daycare, breastfeeding, and lactation facilities, reduce and Waldfogel (2007) find that fathers who take at least employee concerns about the safety and well-being of two or more weeks of leave at the birth of their child get their children. Employees are better able to concentrate more involved in childcare activities compared to fathers on work, improving their productivity and career prospects. taking no leave. Nonetheless, these leave policies are Flexible work arrangements are also correlated with only accessible to those working in the formal sector, and caregivers’ attachment to their job (Schneider et al. 2013). implementation varies. Kossek et al. (2019) find that increasing supervisors’ social support for work and nonwork roles and job control Rather than separate maternity and paternity leave in a results-oriented work environment can improve frameworks, a more comprehensive parental leave workers’ psychological well-being, especially for those framework delivers multiple potential wins. Job-protected caring for older individuals as well as children. Using a leave, primarily parental leave, for any employee to care for case study approach, Dembe and Partridge (2011) suggest a newborn or recently adopted child helps to recognize, that employers who sponsor assistance programs for reduce, and redistribute unpaid care work. A parental leave eldercare may also reduce worker absenteeism and framework can enable equitable sharing of newborn care improve work productivity. responsibilities between parents, including same-sex couples and adoptive and surrogate parents. In 2021, only Access to paid family leave: Other labor market policies, 68 of 185 countries offered a statutory right to parental such as paid family leave, are also effective in managing leave, and only 1 in 10 potential parents live in countries that care responsibilities that complement available care provide paid parental leave (ILO 2022b). Evidence suggests services. For instance, Cario et al. (2022) find that women in that parental leave can increase women’s paid working Egypt who received a childcare subsidy were significantly hours (Akgunduz and Plantenga 2013), lower the intra- more likely to want a job with paid leave to ensure they household gender wage gap (Andersen 2018), and promote would be able to take care of a sick child at home rather sharing of unpaid care work among women and men (Wray than rely on daycare. Care support and paid leave can be 2022; Tamm 2019; Kotsadam and Finseraas 2011). It also part of a broader package of support offered by employers, reduces fathers’ mortality rate (Månsdotter, Lindholm, and including lactation support and safe transportation. Winkvist 2007) and the divorce rate (Steingrimsdottir and Braga et al. (2022) find that a paid family leave policy Vardardottir 2014). Parental leave is the key to unlocking increases women caregivers’ probability of working by long-term changes in social norms toward greater gender 5.6 percentage points. It can be especially effective for equality (Unterhofer and Wrohlich 2017; Farré et al. 2022) caregivers who provide care to older parents in poor health and can potentially promote the inclusion of underserved who live nearby. When families experience disabilities or communities, such as LGBTI families. health shocks, job-protected paid leave mandates may help caregivers handle their increased care responsibilities Addressing social norms: Evidence on social norms without jeopardizing paid working hours (Anand, Dagur, indicates that interventions that successfully alter and Wagner 2022). conservative social beliefs improve female labor force participation (Bursztyn, Gonzalez, and Yanagizawa-Drott Access to job-protected paid parental leave: Job- 2020). While specific research is lacking on how changing protected paid maternity leave helps ensure the economic conservative social beliefs impacts the uptake of care protection of women and is a precondition to achieving services, from the available evidence it can be reasoned gender equality at work. ILO’s International Labour that well-designed interventions that simultaneously tackle Standards on Maternity Protection include safeguarding the multiple constraints to women’s labor market participation child’s and mothers’ health and protecting women against can influence uptake of care services and, in turn, improve job discrimination. Although many countries have offered women’s labor market outcomes. 14 WORLD BANK GROUP’S EFFORTS IN ADDRESSING CARE The World Bank Group addresses the care economy Women’s Social and Economic Empowerment project through operations, analytical work, and policy dialogue. includes providing childcare to support women’s livelihood Many World Bank Group projects have started to include activities. It also targets the availability of childcare for GBV care arrangements, particularly childcare, as a support survivors within a safe house. The intervention aims to help activity in project preparations and implementations children develop cognitive, social, and emotional skills in (Haddock, Raza, and Palmisano 2019). From 2017 to 2022, a safe environment and to enable women and adolescent approximately 102 World Bank projects included childcare girls to engage in productive economic activities. activities, with 74 percent intending to provide childcare solutions and 26 percent focusing on access to childcare in The World Bank Group is working with partners to build facilitating project participation, such as ensuring women’s the growing data and evidence base in the area of care. participation in skill training (authors’ calculation). Most of Over the years, the Bank Group has supported client these projects (68 percent) are in low-income countries countries in building a knowledge base for care needs eligible for International Development Association (IDA) and developing and implementing policy solutions. The financing, and they cover multiple sectors, such as social World Bank regional Gender Innovation Labs (GILs), Gender protection and jobs, education, and urban resilience, among Platforms, and several Global Practices have undertaken others. In 2023, around 45 country level diagnostics are analytical work to inform childcare policies. For example, the ongoing with World Bank support to understand the need Africa GIL conducted a study in Burkina Faso and a random for childcare support, cost out childcare arrangements, control trial (RCT) in rural areas of the Democratic Republic identify potential policy reforms, and prepare new projects of Congo to assess the impact of childcare services on to scale up access to childcare services. women’s economic outcomes. The East Asia and Pacific GIL conducted a similar study in Indonesia. A survey conducted Diverse work is ongoing across countries and regions by the Latin America and the Caribbean (LAC) GIL looks to address challenges related to childcare. For example, into the factors that explain fathers’ adoption of parental in Vietnam, the Inclusive and Sustainable Recovery leave in Uruguay. The Middle East and North Africa GIL has development policy operation supported the government partnered with the Jameel Poverty Action Lab (J-PAL) in in adopting entitlements for subsidized nursery and Egypt on an RCT to examine the effect of offering subsidized preschool care and education for children of workers in care for mothers on their labor force participation. The worker-populated areas, including industrial parks. The World Bank’s Social Protection and Jobs Global Practice is project aimed to make preschool and childcare subsidies assessing parental leave and long-term care policies across available for at least 50 percent of the industrial park countries to support improvement. The World Bank’s employees with children. Other operational examples Education Global Practice is working with partners to adapt include an ongoing WBG Enabling Childcare Services for and generate new tools to measure the quality of childcare Women Entrepreneurs in Uganda (ENCAWE-Uganda) settings and impacts on child development. In the fiscal project that incorporates a policy, regulatory, and space, the Poverty, Equity and Gender Global Practice institutional framework diagnostic and demand and have piloted a study on understanding the effects of the supply-side situation assessments of existing childcare fiscal system on gender disparities in Armenia using the services. These diagnostic exercises will inform a pilot Engendered Commitment to Equity (E-CEQ) methodology, on childcare centers to facilitate women entrepreneurs’ confirming that childcare and eldercare mostly constrain active participation in the labor market. In South Sudan, a women’s economic opportunities in the country (Tarlovsky medium-intensity conflict region, an ongoing South Sudan and Icaza 2023). 15 At the corporate level, the World Bank Group has made strong commitments to addressing care. The 20th replenishment of IDA (IDA20) committed to supporting at least 15 IDA countries in expanding access to quality, affordable childcare, with a special focus on low-income and vulnerable families. In 2022, the World Bank Group and partners launched the Invest in Childcare Initiative. This ambitious cross-sectoral work program brings together analytical and operational teams to strategically address childcare challenges in countries. The initiative is taking a whole-of-Bank Group and whole-of-government approach to help countries design and implement better childcare programs, improve policies, build capacity, generate data, and provide evidence on the impacts of childcare on women’s empowerment, early childhood development, and inclusive economic growth. With an initial funding level of $100 million, this initiative will catalyze up to $225 million in new funding to ensure quality and affordable childcare is available worldwide in low and middle-income countries. BOX 4. IFC’S GLOBAL TACKLING CHILDCARE PROJECT IFC’s Global Tackling Childcare project helped document and raise awareness of the business case for employer- supported childcare. It worked with more than 1,000 companies in 20 countries to accelerate the implantation of childcare and family-friendly initiatives. It also collaboratively engaged stakeholders on the topic. Through a series of reports, including the Guide for Employer-Supported Childcare developed in partnership with more than 30 organizations, as well as reports spanning Bangladesh, Cambodia, Fiji, India, Pakistan, Myanmar, Sri Lanka, Vietnam, and other countries, IFC showed that employer-supported childcare could result in a win-win-win for families, employers, and economies. Building on its research, the project also focused on improving the enabling environment for employer-supported childcare by working with governments, business networks, civil society, care providers, other international development institutions, and companies to facilitate the implementation of good childcare and family-friendly practices. The project used a variety of approaches to impact the childcare space in emerging markets, including firm-level advisory engagements, business case research, private-sector peer learning collaborations, and market research to address care demand and supply barriers and help inform childcare policies and identification of investment potential in the care economy. In 2020, IFC published Childcare in the COVID-19 Era: A Guide for Employers to support companies and other stakeholders in navigating childcare challenges during the pandemic. The Invest in Childcare initiative is financing work across the Bank Group, including International Finance Corporation’s (IFC’s) Care2Equal project and Women, Business, and the Law’s (WBL’s) data collection on legal frameworks of childcare. Care2Equal builds on the success of IFC’s Tackling Childcare project concluded in 2021 (see Box 4). Care2Equal will expand knowledge and understanding of the benefits of employer-supported childcare on businesses, economies, women, children, and families. It will examine the value of interventions that have the potential to lower barriers to quality childcare, including new technologies and partnership models. It will also increase awareness of childcare investment opportunities and accelerate the expansion of innovative childcare solutions in emerging markets. The Invest in Childcare initiative is also supporting the WBL’s standardized data collection of countries’ legal and regulatory framework around childcare availability, financing, and quality (see Box 5). 16 BOX 5: WOMEN, BUSINESS AND THE LAW (WBL) CHILDCARE DATA The Women, Business and the Law 2022 collected pilot data to assess the legal and regulatory framework on childcare availability, affordability, and quality in countries. It aims to continue this development in its future cycles of data collection. For this pilot stage of the project, WBL collected data on legal and regulatory frameworks for childcare provision in 95 economies. They were selected to represent at least 82 percent of the world’s population, with at least one economy from each income group chosen within each World Bank region. Under the availability pillar, WBL explored how governments make childcare available through regulatory interventions that support diverse types of provision and convenience. Under the affordability pillar, WBL measured regulatory interventions that increase affordability through government-provided free services and financial and non-financial support for families, private childcare providers, and employers. The regulation of fees was also measured. Finally, under the quality pillar, WBL collected data on regulatory interventions that improve the quality of services. In order to make the indicators more actionable, the concept of quality was broken down into three main categories: structural, process, and system quality. The WBL childcare pilot data were collected by desk research. Some questions on the availability and affordability of childcare services were also administered to current WBL experts in labor law. For future rounds of data collection, the team plans to build a solid base of legal contributors and survey childcare providers who have direct knowledge of country-specific legal requirements and acceptable standards. 17 Countries have benefited from the World Bank Group’s analytical work on eldercare. The World Bank Group’s analytical support has included review of existing long-term care systems, especially in high-income countries, and assessment of coverage, benefits, funding, and quality (World Bank 2021). The World Bank has also conducted situation assessments of the demand and supply of long-term care services, including financing and institutional arrangements in Chile, China, Thailand, Indonesia, Estonia, Poland, Romania, Greece, and Saudi Arabia (see Box 6). IFC’s Care2Equal project will also include the development of solutions and guidance for IFC staff, client companies, and partners on care for older people and mental health and well-being. It will document the business case for employers to support the care needs of employees caring for older parents and other dependent relatives, with the aim of identifying good corporate practices. BOX 6. WORLD BANK GROUP SUPPORT FOR AGED CARE IN CHINA In 2018, the World Bank conducted a study of the demand and supply of aged care in China. On the demand side, it assessed the determinants of demand for aged care in China, showing that they are driven primarily by the population’s age structure, family structure, and dynamics alongside health-related needs and income and asset situation of the households (Glinskaya and Feng 2018). On the supply side, family caregiving remains the dominant source of care for older people, while privately provided and privately financed services represent the fastest-growing segment in the aged care market. For sustainable long-term care supply, the report recommends building up government stewardship capacities while strengthening the private sector provision and extending the long-term care financing in a systemic way. The World Bank Group continues to support China in building its aged care system, providing investment loans for Anhui and Guizhou provinces. The Anhui Aged Care System Demonstration Project is helping to build government stewardship capacity, strengthening community-based and home-based care services, and improve the delivery and management of nursing care. The Guizhou Aged Care System Development Program seeks to improve the coverage and quality of basic aged care services and strengthen the efficiency of aged care financing for older people. In both provinces, the projects are helping to develop quality standards and train care professionals, setting up arrangements for purchasing basic home-based aged care services from private providers for eligible older people by the provincial and local governments, and strengthening community-based services by designing and upgrading the community service stations. The projects are also helping to develop skilled nursing homes and urban and rural welfare homes. 18 CONCLUSION AND RECOMMENDATIONS Improving access to affordable and quality care services informal workers to ensure their access to care services. for children, older people, and people with disabilities This could be through promoting targeted investment in has far-reaching impacts on women’s and men’s human social insurance, undertaking innovative policies to ensure capital, economic outcomes and the overall economy. parental leave coverage for informal workers, and closing The active participation of women and men in society and the pension gap for older women. Demand-side subsidies the labor market is a key channel to help eradicate poverty (e.g., vouchers or cash allowances) can be used to increase and boost shared prosperity. Affordable, accessible, and the purchasing capacity of those with greater needs and quality care services are a public good that facilitates vulnerabilities and are compatible with promoting care- labor market participation, generates jobs, and provides in-place, for example, if vouchers can be redeemed for essential support to employers by attracting and retaining home- and community-based care. Financial incentives a high-quality workforce. In the case of childcare, quality to promote care-in-place can also include subsidies services can also provide the critical inputs that children for informal care provision (e.g., vouchers that can be need during their early years to build skills and succeed in redeemed by caregivers or respite care for older people). school and throughout life. Public policies that increase the Supply-side public financing to improve care systems and availability of care should have enough nuance and not seek make them accessible to low-income families and informal to substitute formal care for familial care when the latter is workers can include direct subsidies to providers, as well preferred. Policies should create choices for women, men, as incentivizing or mandating places for low-income or families, and underserved groups, such as LGBTI people otherwise vulnerable families. Promoting cost sharing and and persons with disabilities, to exercise their agency with private spending is also a critical component of sustainable respect to whether they want to provide care themselves long-term financing in care, as private spending can provide or seek it in the market from public or private providers. additional resources to publicly funded services and grow the market share served by the private sector. The following recommendations can help governments, World Bank Group teams, development partners and the Ensure access to quality care services and support the private sector develop and implement interventions that care workforce: Quality care services are crucial in ensuring consider and address varied care needs: uptake and reaping the benefits of available care provision. To support quality service, governments can promote Expand the availability of care services by making them supportive licensing, registration, and accreditation systems inclusive: To promote women’s and men’s economic of care facilities – but this should be done in a manner participation and ensure the well-being of care recipients, that considers feasibility and local context with caution investment in care services is needed to make care services to avoid overly punitive or onerous approaches that may widely available, accessible, affordable, and high quality. adversely impact existing providers. They can also set up These services must also be inclusive of persons with the domestic legal and regulatory frameworks and localize disabilities and other underserved populations, including good international practices for regular monitoring and LGBTI people, to ensure the special needs of these groups inspection of the services. For quality assurance, it is also and their caregivers are considered to maximize the essential to professionalize the care workforce with formal economic benefits of care service provision. For example, qualifications, career pathways, and suitable remuneration. public infrastructure should include care centers and Home-based providers and other entrepreneurs also need diaper-changing rooms in all public restrooms. Dedicated support through networks, training, coaching programs, spaces for children, older people, and persons with peer support, and access to learning resources. disabilities in public transportation are also essential for promoting an inclusive environment, and age-ready cities Strengthen institutional coordination and collaboration should be planned for inhabitants of all ages and needs. and ensure policy coherence: Ensuring accessibility to quality care provision and maximizing the return on such Invest public resources in care and ensure affordable care investments requires coordination and collaboration across is available for low-income and vulnerable households: many government ministries and departments and levels While governments work on making care services of government, as well as active participation from non- available, it is critical to target low-income families and state organizations, including the private sector, civil society, 19 and development finance institutions. Collaboration is Collect data and implement evidence-based solutions: needed to ensure effective and efficient interventions and Governments will need to put in place good data collection to share knowledge and experience among stakeholders. mechanisms to inform policy design, implementation, It is important to explore public-private partnerships in and effective monitoring and evaluation of care services. addressing care challenges, with the private sector creating To ensure continued improvement and sustained products, services, and business models and adopting investment in care solutions, building the evidence base corporate policies and practices that support employees is essential. This can include country-level demand and with care responsibilities. Promoting labor market policies supply assessments, business surveys to assess care to support caregivers is also key. Family-friendly initiatives, responsibilities of employees for employer-supported such as home-based work, flexible work, and family solutions, and evaluations of different interventions that leave policies, can help workers balance their work and assesses their impact on broader groups (e.g., caregivers, family responsibilities and help businesses achieve better children, older people, people with disabilities, LGBTI outcomes. It is important to look at family-friendly policies people, siblings, fathers, and other household members) holistically to include paid leave for those in caregiving and indicators (e.g., children’s development outcomes, roles, flexible work arrangements, safe transportation, and outcomes for older people and people with disabilities, care and mental health support, among others, to ensure women’s economic empowerment, time use, business increased diversity in the workforce and a more productive outcomes, and mental health). work environment. It is also critical to undertake analytical work in under- Increase public finance for care while also encouraging standing the impacts of public provision of care using non-state and private investment in care: There are a methodologies such as the Commitment to Equity variety of different pathways to finance an expansion in care (CEQ) assessment, which can provide a comprehensive services across countries. A substantial amount of childcare understanding of how fiscal policies in care can affect is provided through the non-state sector in many countries gender disparities, income inequality, and poverty in and financing to support social entrepreneurs or in the a country. Also, it is important to undertake country- context of skills or jobs programming is a viable pathway specific costing and return on investment analysis to in many countries. While considerations of human capital assess the longer-term fiscal implications of investment accumulation strongly support the case for public financing in care services. Systematic collection of time-use data of childcare, the case for public investments in long-term in valuing the unpaid care economy is also needed to eldercare is supported by considerations of efficient risk recognize, reduce, and redistribute women’s unpaid management and equity as long-term care for older people care responsibilities. has a stronger element of private consumption compared to childcare. In that case, strengthening diversified, innovative, and sustainable financing is critical. For eldercare, greater selectivity may be needed to determine eligibility and access to publicly financed care and specific services. Financing care from general tax revenue is sensible, with the view of moving to broad-based social insurance over time. Public funds should finance safety net programs that help those in need and promote healthy aging and human capital development. Both supply-side and demand-side financing can be employed. Explicit linkages between financing and delivery models are critical so that in-home, community-based, and institutional delivery of care are all supported. Long-term care financing for older people and people with disabilities needs to encourage integration in service delivery across health and social services. It is then more realistic to initiate the development of a basic package of long-term care services and pilot it to develop a robust understanding of the implied costs and benefits of such initiatives. 20 REFERENCES Ahmed, Tanima, and Maria S. Floro. 2023a. “Unpaid eldercare Bjorvatn, Kjetil, Denise Ferris, Selim Gulesci, Arne Nasgowitz, and its impact on the US labor supply.” The Philippine Review of Vincent Somville, and Lore Vandewalle. 2022. “Childcare, labor Economics 60 (1): 10-46. [Forthcoming] supply, and business development: Experimental evidence from Uganda.” G²LM|LIC Working Paper No. 67. Institute of Labor Ahmed, Tanima, and Maria S. Floro. 2023b. “Unpaid care to older Economics (IZA) and UKaid. https:/ /bit.ly/3JpFtkW persons and tradeoffs in time use: The experience of working-age women and men in the US.” Journal of Family and Economic Braga, Breno, Barbara A. Butrica, Stipica Mudrazija, and H. Issues: 1-17. https://bit.ly/3CEEyt0 Elizabeth Peters. 2022. “Impacts of state paid family leave policies for older workers with spouses or parents in poor health.” Ajayi, Kehinde F., Aziz Dao, and Estelle Koussoubé. 2022. “The Discussion Paper Series, no. 15007. IZA. https://bit.ly/46k4Crk effects of childcare on women and children: Evidence from a randomized evaluation in Burkina Faso.” Policy Research Working Bundervoet, Tom, Maria E. Dávalos, and Natalia Garcia. 2022. Paper 10239. Washington, DC: World Bank. https:/ /bit.ly/46ePqvn “The short-term impacts of COVID-19 on households in developing countries: An overview based on a harmonized Akgunduz, Yusuf Emre, and Janneke Plantenga. 2013. “Labour dataset of high-frequency surveys.” World Development: 105844. market effects of parental leave in Europe.” Cambridge Journal https://bit.ly/42VLHA1 of Economics 37(4): 845-862. https:/ /bit.ly/3pfiGRZ Bursztyn, Leonardo, Alessandra L. González, and David Alfers, Laura. 2016. Our children do not get the attention Yanagizawa-Drott. 2020. “Misperceived social norms: Women they deserve. Cambridge, Massachusetts: Women in working outside the home in Saudi Arabia.” American Economic Informal Employment: Globalizing and Organizing (WIEGO). Review 110(10): 2997-3029. https://bit.ly/42UI4KP https://bit.ly/3NGkTiJ Butrica, Barbara, and Karamcheva, Nadia. 2014. The impact Amin, Mohammad, Asif Islam, and Alena Sakhonchik. 2016. “Does of informal caregiving on older adults’ labor supply and paternity leave matter for female employment in developing economic resources. Washington, DC: The Urban Institute. economies? Evidence from firm-level data.” Applied Economics https://bit.ly/3XmAV4s Letters 23(16): 1145-1148. https://bit.ly/3NhYWFr Cali, Massimiliano, Hillary C. Johnson, Elizaveta Perova, and Anand, Priyanka, Laura Dague, and Kathryn L. Wagner. 2022. “The Nabil R. Ryandiansyah. 2022. “Caring for children and firms? role of paid family leave in labor supply responses to a spouse’s The impact of preschool expansion on firm productivity.” Policy disability or health shock.” Journal of Health Economics 83: Research Working Paper 10193. Washington, DC: World Bank. 102621. https://bit.ly/42XtDFE https://bit.ly/46gglH4 Andersen, Signe Hald. 2018. “Paternity leave and the motherhood Caria, Stefano, Bruno Crepon, Hala ElBehairy, Noha Fadlalmawla, penalty: New causal evidence.” Journal of Marriage and Family Caroline Krafft, Abdelrahman Nagy, Lili Mottaghi, Nahla Zeitoun, 80(5): 1125-1143. https://bit.ly/46k5zjl and Souraya El Assiouty. 2022. “Child care subsidies, employment services and women’s labor market outcomes in Egypt: First Andersson, Matthew A., Mark H. Walker, and Brian P. Kaskie. midline results.” Middle East and North Africa Gender Innovation 2019. “Strapped for time or stressed out? Predictors of work Lab (MNAGIL) Policy Research Working Paper. Washington, DC: interruption and unmet need for workplace support among World Bank. https:/ /bit.ly/3XmBeME informal elder caregivers.” Journal of Aging and Health 31(4): 631-651. https://bit.ly/46ePWJP Carmichael, Fiona, Susan Charles, and Claire Hulme. 2010. “Who will care? Employment participation and willingness to supply Ando, Michihito, Masato Furuichi, and Yoshihiro Kaneko. 2021. informal care.” Journal of Health Economics 29(1): 182-190. “Does universal long-term care insurance boost female labor https://bit.ly/3XrHxib force participation? Macro-level evidence.” IZA Journal of Labor Policy 11(1). https://bit.ly/3PHFDs7 Charmes, Jacques. 2019. The unpaid care work and the labour market. an analysis of time use data based on the latest world Berthelon, Matias, Diana Kruger, Catalina Lauer, Luca Tiberti, and compilation of time-use surveys. Geneva: International Labour Carlos Zamora. 2020. “Longer school schedules, childcare and the Organization (ILO). https://bit.ly/43SbDxA quality of mothers’ employment: Evidence from school reform in Chile.” GLO Discussion Paper 525. Global Labor Organization Chen, Lu, Na Zhao, Hongli Fan, and Peter C. Coyte. 2017. (GLO). https://bit.ly/3qO8pfY “Informal care and labor market outcomes: Evidence from Chinese married women.” Research on Aging 39(2): 345-371. Bittman, Michael, Trish Hill, and Cathy Thomson. 2007. “The https://bit.ly/449C7dQ impact of caring on informal carers’ employment, income and earnings: A longitudinal approach.” Australian Journal of Social Cicowiez, Martin, and Hans Lofgren. 2021. “Child and elderly care Issues 42(2): 255-272. https:/ /bit.ly/449vlEX in South Korea: Policy analysis with a gendered, care-focused computable general equilibrium model.” CWE-GAM Working Paper Series 21-05. https://bit.ly/3qXpFj9 21 Collins, Caitlyn, Liana Christin Landivar, Leah Ruppanner, Donald, Aletheia and Julia Vaillant. “Experimental evidence and William J. Scarborough. 2021. “COVID-19 and the gender on rural childcare provision.” Washington, DC: World Bank. gap in work hours.” Gender, Work & Organization 28: 101-112. [Forthcoming] https://bit.ly/3NIKS9x Dukhovnov, Denys, Joan M. Ryan, and Emilio Zagheni. 2022. Contreras, Dante, Paulina Sepúlveda, and Soledad Cabrera. “The impact of demographic change on transfers of care and 2010. “The effects of lengthening the school day on female associated well-being.” Population Research and Policy Review labor supply: Evidence from a quasi-experiment in Chile.” serie 41(6): 2419-2446. https://bit.ly/42NnFao Documentos de Trabajo 323: 1-28. https:/ /bit.ly/42RO8DI Duxbury, Linda, Christopher Higgins, and Rob Smart. 2011. “Elder Costa Font, Joan, Francesco D’Amico, and Cristina Vilaplana- care and the impact of caregiver strain on the health of employed Prieto. 2022. “Caring for carers? The effect of public subsidies caregivers.” Work 40(1): 29-40. https://bit.ly/3Xr8SRK on the well-being of unpaid carers.” Discussion Paper Series, no. 15369. IZA. https://bit.ly/42Rgkqf Elsey, Helen, Fariza Fieroze, Riffat Ara Shawon, Shammi Nasreen, Joseph Paul Hicks, Mahua Das, Rumana Huque, Izumi Hirano, Crespo, Laura, and Pedro Mira. 2014. “Caregiving to elderly parents Hilary Jane Wallace, and M. Saidur. 2020. “Understanding demand and employment status of European mature women.” Review of for, and feasibility of, centre-based childcare for poor urban Economics and Statistics 96(4): 693-709. https://bit.ly/42Xv8Ui households: A mixed methods study in Dhaka, Bangladesh.” BMC Public Health 20(1): 1-14. https://bit.ly/46fodJ2 Cucagna, Maria Emilia, and Francisco Javier Romero Haaker. 2021. The gendered impacts of COVID-19 on labor markets in Evans, David K., Pamela Jakiela, and Heather A. Knauer. 2021. “The Latin America and the Caribbean. LAC Gender Innovation Lab. impact of early childhood interventions on mothers.” Science 372 Washington, DC: World Bank Group. https:/ /bit.ly/3NiXJOg (6544): 794-796. https://bit.ly/46kOSUH Cukrowska-Torzewska, Ewa, and Anna Matysiak. 2020. “The European Commission. 2016. Eurostat- 2016 EU-SILC module motherhood wage penalty: A meta-analysis.” Social Science “Access to services” Assessment of the implementation. Research 88: 102416. https://bit.ly/3NjMyVp https://bit.ly/3XrIYgz Das, Maitreyi Bordia, and Ieva Žumbytė. 2017. “The motherhood Facebook, OECD, and World Bank. 2020. Global state of small penalty and female employment in urban India.” Policy business report: Reflections on six waves of data collection. Research Working Paper 8004. Washington, DC: World Bank. https://bit.ly/42ShXny https://bit.ly/3JqdCB3 Farré, Lídia, Cristina Felfe, Libertad González, and Patrick De Henau, Jerome. 2022. “Simulating employment and fiscal Schneider. 2022. “Changing gender norms across generations: effects of public investment in high-quality universal childcare in Evidence from a paternity leave reform.” BSE Working Paper, no. the UK.” International Journal of Child Care and Education Policy 1310. Barcelona School of Economics. https:/ /bit.ly/3JqtDac 16 (1): 1-27. https://bit.ly/3PooXW8 Feinberg, Lynn Friss. 2016. The dual pressures of family caregiving De Paz Nieves, Carmen, Gaddis, Isis, and Muller, Miriam. 2021. and employment. Washington, DC: American Association of “Gender and COVID-19: What have we learnt, one year later?.” Retired Persons (AARP). https:/ /bit.ly/3PpWPSt Policy Research Working Paper 9709. World Bank, Washington, DC. https://bit.ly/3CF2YCH Fevang, Elisabeth, Snorre Kverndokk, and Knut Røed. 2012. “Labor supply in the terminal stages of lone parents’ lives.” Journal of Del Boca, Daniela, Noemi Oggero, Paola Profeta, and Mariacristina Population Economics 25(4): 1399-1422. https:/ /bit.ly/3qOawQW Rossi. 2020. “Women’s and men’s work, housework and childcare, before and during COVID-19.” Review of Economics of the Fraym. “Calculating Return on Investment (ROI) for caregiving Household 18: 1001-1017. https://bit.ly/43Tx55m programs in Nigeria, Kenya, South Africa, and Indonesia.” https://bit.ly/449yq7W Delecourt, Solène, and Anne Fitzpatrick. 2021. “Childcare matters: Female business owners and the baby-profit gap.” Management Fu, Rong, Haruko Noguchi, Akira Kawamura, Hideto Takahashi, Science 67(7): 4455-4474. https://bit.ly/3CE0Yuy and Nanako Tamiya. 2017. “Spillover effect of Japanese long-term care insurance as an employment promotion policy Dembe, Allard E., and Jamie S. Partridge. 2011. “The benefits of for family caregivers.” Journal of Health Economics 56: 103-112. employer-sponsored elder care programs: Case studies and https://bit.ly/3CZy34x policy recommendations.” Journal of Workplace Behavioral Health 26(3): 252-270. https://bit.ly/3Xn377G Gauthier, Serge, Claire Webster, Stijn Servaes, José A. Morais, and Pedro Rosa-Neto. 2022. World Alzheimer Report 2022: Life after Devercelli, Amanda Epstein, and Frances Mary Beaton-Day. 2020. diagnosis: Navigating treatment, care and support. London: Better jobs and brighter futures: Investing in childcare to build Alzheimer’s Disease International. https:/ /bit.ly/42Rhy4P human capital. Washington, DC: World Bank. https://bit.ly/3NDcM6B Geyer, Johannes, and Thorben Korfhage. 2018. “Labor supply effects of long-term care reform in Germany.” Health Economics Diaz, Mercedes Mateo, and Lourdes Rodriguez-Chamussy. 27(9): 1328-1339. https://bit.ly/3NK4NVC 2016. Cashing in on education: Women, childcare, and prosperity in Latin America and the Caribbean. Washington, DC: Ghaffar, Abdul. 2020. “The impact of the financial cost of caring for World Bank Group and Inter-American Development Bank (IDB). greying on emotional exhaustion in the workplace: The mediating https://bit.ly/44bx6Bp role of stress.” Is Ahlakı Dergisi 13(1): 31-51. https://bit.ly/3CHHk0U 22 Glinskaya, Elena, and Zhanlian Feng. 2018. Options for aged care International Finance Corporation (IFC). 2017. Tackling childcare: in China: Building an efficient and sustainable aged care system. The business case for employer-supported childcare. Washington, DC: World Bank. https:/ /bit.ly/3NIR4yi Washington, DC: IFC. https://bit.ly/3LBi2Wn Goldin, Claudia. 2022. “Understanding the economic impact of International Finance Corporation (IFC). 2020. Childcare in the COVID-19 on women.” Working Paper, no. 29974. Cambridge, COVID-19 era: A guide for employers. Washington, DC: IFC. Massachusetts: National Bureau of Economic Research (NBER). https://bit.ly/3Nr22si https://bit.ly/42NQhQV International Labour Organization (ILO). “International Labour Goldin, Claudia, Sari Pekkala Kerr, and Claudia Olivetti. 2022. Standards on maternity protection.” https:/ /bit.ly/44vMOZo “When the kids grow up: Women’s employment and earnings across the family cycle.” Working Paper, no. 30323. Cambridge, International Labour Organization (ILO). 2018a. Care work and Massachusetts: National Bureau of Economic Research (NBER). care jobs for the future of decent work. https://bit.ly/46jc9Xi https://bit.ly/43RDaiV International Labour Organization (ILO). 2018b. Global wage Goldstein, Markus P., Paula Lorena Gonzalez Martinez, report 2018/19: What lies behind gender pay gaps. Sreelakshmi Papineni, and Joshua Seth Wimpey. 2022. “Childcare, https://bit.ly/3CGpFqd COVID-19 and female firm exit: Impact of COVID-19 school closure policies on global gender gaps in business outcomes.” International Labour Organization (ILO). 2018c. Women Policy Research Working Paper 10012. Washington, DC: World and men in the informal economy: A statistical picture. Bank Group. https:/ /bit.ly/46k8NmX https://bit.ly/46hzLv9 Gori, Cristiano, and Matteo Luppi. 2022. “Cost-containment long- International Labour Organization (ILO). 2022a. “Over 2 million term care policies for older people across the Organisation for moms left the labour force in 2020 according to new global Economic Co-operation and Development (OECD): A scoping estimates.” https://bit.ly/3n9KjLc review.” Ageing & Society: 1-24. https://bit.ly/3pfyN1U International Labour Organization (ILO). 2022b. Care at work: Green, Sara, Christine Davis, Elana Karshmer, Pete Marsh, and Investing in care leave and services for a more gender equal Benjamin Straight. 2005. “Living stigma: The impact of labeling, world of work. https://bit.ly/3NISfxm stereotyping, separation, status loss, and discrimination in the lives of individuals with disabilities and their families.” International Labour Organization (ILO) and UN Women. Sociological Inquiry 75(2): 197-215. https:/ /bit.ly/3phqMtq 2020. The impact of marriage and children on labour market participation. https://bit.ly/3CE3gd8 Godfrey, Julia, Julie Yixia Cai, and Shawn Fremstad. 2022. Lack of universal childcare and other family benefits hurts LGBT parents Islam, Faisal Bin, and Madhuri Sharma. 2021. “Gendered and caregivers. Center for Economic and Policy Research (CEPR). dimensions of unpaid activities: An empirical insight into rural https://bit.ly/3PjCs9I Bangladesh households.” Sustainability 13(12): 6670. https://bit.ly/3JqjQkH Haddock, Sarah Elizabeth, Amna Raza, and Giacomo Palmisano. 2019. Addressing childcare in the World Bank portfolio: Jacobs, Josephine C., Audrey Laporte, Courtney H. Van Houtven, Approaches, experiences, and lessons learned. Washington, DC: and Peter C. Coyte. 2014. “Caregiving intensity and retirement World Bank. https://bit.ly/44gPUQ1 status in Canada.” Social Science & Medicine 102: 74-82. https://bit.ly/3JqDywE Halim, Daniel, Elizaveta Perova, and Sarah Reynolds. 2023. “Childcare and mothers’ labor market outcomes in lower-and Johnson, Richard W., and Anthony T. Lo Sasso. 2006. “The impact middle-income countries.” The World Bank Research Observer of elder care on women’s labor supply.” INQUIRY: The Journal of 38(1): 73-114. https://bit.ly/3qT0aiS Health Care Organization, Provision, and Financing 43(3): 195-210. https://bit.ly/3PqbJIK Halim, Daniel, Hillary C. Johnson, and Elizaveta Perova. 2022. “Preschool availability and women’s employment: Evidence from Kanji, Shireen. 2018. “Grandparent care: A key factor in mothers’ Indonesia.” Economic Development and Cultural Change 71(1): labour force participation in the UK.” Journal of Social Policy 47(3): 39-61. https://bit.ly/3JsE7WO 523-542. https:/ /bit.ly/3qOclgK Hammersmith, Anna M., and I-Fen Lin. 2019. “Evaluative and Kidigo. 2022. 2022 Highlights: A poster of our Top 10 Highlights in experienced well-being of caregivers of parents and caregivers 2022. https://bit.ly/44ayl42 of children.” The Journals of Gerontology: Series B 74(2): 339-352. Kidigo. 2023. https://bit.ly/3JpJy8O https://bit.ly/46euEfo Kim, Najung, and Judith R. Gordon. 2014. “Addressing the stress Heger, Dörte, and Thorben Korfhage. 2020. “Short-and medium- of work and elder caregiving of the graying workforce: The term effects of informal eldercare on labor market outcomes.” moderating effects of financial strain on the relationship between Feminist Economics 26(4): 205-227. https://bit.ly/3NEGbNI work-caregiving conflict and psychological well-being.” Human Hein, Catherine, and Naomi Cassirer. 2010. Workplace solutions Resource Management 53(5): 723-747. https:/ /bit.ly/43TzvAY for childcare. Geneva: International Labour Office, (ILO). Koliouli, Flora, Stéphanie Pinel-Jacquemin, and Chantal Zaouche https://bit.ly/3qXyNnX Gaudron. 2021. “Barriers and facilitators in inclusive daycare Howard, Jill, Fiona Wilson, and E. Hachemi Aliouche. 2020. facilities: Mothers’ perspectives.” International Journal of Inclusive “Kidogo: Addressing the childcare needs of low-income families Education: 1-15. https:/ /bit.ly/3JrFrJc in East Africa.” Carsey School of Public Policy White Paper. University of New Hampshire. https:/ /bit.ly/3JqOKJB 23 Kossek, Ellen Ernst, Rebecca J. Thompson, Katie M. Lawson, Todd Moussié, Rachel. 2017. “Women Informal Workers Mobilizing for Bodner, Matthew B. Perrigino, Leslie B. Hammer, Orfeu M. Buxton, Child Care.” International Labour Organization (ILO) and Women David M. Almeida, Phyllis Moen, David Hurtado, Brad Wipfli, Lisa in Informal Employment: Globalizing and Organizing (WIEGO). F. Berkman, and Jeremy W. Bray. 2019. “Caring for the elderly at https://bit.ly/3Xk6Sui work and home: Can a randomized organizational intervention improve psychological health?” Journal of Occupational Health Moussié, Rachel. 2020a. “Quality childcare services for workers Psychology 24(1): 36. https://bit.ly/3phI0Xz in the informal economy.” Policy Brief, no. 1. ILO and WIEGO. https://bit.ly/46k9DjE Kotsadam, Andreas. 2011. “Does informal eldercare impede women’s employment? The case of European welfare states.” Moussié, Rachel. 2020b. “Extending childcare services to Feminist Economics 17(2): 121-144. https://bit.ly/3XgM1It workers in the informal economy: Policy lessons from country experiences.” Policy Brief, no. 3. ILO and WIEGO. Kotsadam, Andreas, and Henning Finseraas. 2011. “The https://bit.ly/3pfomLN state intervenes in the battle of the sexes: Causal effects of paternity leave.” Social Science Research 40(6): 1611-1622. Nepomnyaschy, Lenna, and Jane Waldfogel. 2007. “Paternity leave https://bit.ly/3JqPUor and fathers’ involvement with their young children: Evidence from the American Ecls–B.” Community, Work and Family 10(4): Kugler, Maurice, Mariana Viollaz, Daniel Duque, Isis Gaddis, David 427-453. https://bit.ly/446Uwry Newhouse, Amparo Palacios-Lopez, and Michael Weber. 2021. “How did the COVID-19 crisis affect different types of workers Nguyen, Ha Trong, and Luke Brian Connelly. 2014. “The effect of in the developing world?” Policy Research Working Paper 9703. unpaid caregiving intensity on labour force participation: Results Washington, DC: World Bank. https:/ /bit.ly/3NHdgIQ from a multinomial endogenous treatment model.” Social Science & Medicine 100: 115-122. https://bit.ly/3CEEj1l Kusakabe, Kyoko. 2006. Reconciling work and family: Issues and policies in Thailand. Geneva: International Labour Organization Offer, Shira, and Barbara Schneider. 2011. “Revisiting the gender (ILO). https://bit.ly/43XyQyz gap in time-use patterns: Multitasking and well-being among mothers and fathers in dual-earner families.” American Lam, Jack, and Joan Garcia-Roman. 2017. “General and proximal Sociological Review 76(6): 809-833. https:/ /bit.ly/3CHf9is associations between unpaid eldercare, time constraints and subjective well-being.” International Journal of Care and Caring O’Sullivan, Ann. 2015. “Pulled from all sides: The sandwich 1(1): 83-96. https://bit.ly/3qVCPx4 generation at work.” Work 50(3): 491-494. https:/ /bit.ly/3Pvm6el Lei, Lianlian, Amanda N. Leggett, and Donovan T. Maust. 2023. Pagani, Laura, and Anna Marenzi. 2008. “The labor market “A national profile of sandwich generation caregivers providing participation of sandwich generation Italian women.” Journal of care to both older adults and children.” Journal of the American Family and Economic Issues 29(3): 427-444. https://bit.ly/42Sl5Qk Geriatrics Society 71(3): 799-809. https://bit.ly/3qXEcLP Peng, Yisheng, Steve Jex, Wenqin Zhang, Jie Ma, and Russell A. Månsdotter, Anna, Lars Lindholm, and Anna Winkvist. 2007. Matthews. 2020. “Eldercare demands and time theft: “Paternity leave in Sweden—Costs, savings and health gains.” Integrating family-to-work conflict and spillover–crossover Health Policy 82(1): 102-115. https://bit.ly/3XofH6n perspectives.” Journal of Business and Psychology 35(1): 45-58. https://bit.ly/3NnWehP Martínez, Claudia, and Marcela Perticará. 2017. “Childcare effects on maternal employment: Evidence from Chile.” Journal of Roach, Mary A., Gael I. Orsmond, and Marguerite S. Barratt. 1999. Development Economics 126: 127-137. https:/ /bit.ly/3qYqW9G “Mothers and fathers of children with Down syndrome: Parental stress and involvement in childcare.” American Journal on Mental McHatton, Patricia Alvarez, and Vivian Correa. 2005. “Stigma Retardation 104(5): 422-436. https://bit.ly/3XmxoU7 and discrimination: Perspectives from Mexican and Puerto Rican mothers of children with special needs.” Topics in Early Childhood Samman, Emma, Elizabeth Presler-Marshall, Nicola Jones, Tanvi Special Education 25(3): 131-142. https://bit.ly/3panKHx Bhatkal, Claire Melamed, Maria Stavropoulou, and John Wallace. 2016. Women’s work: Mothers, children and the global childcare McKinsey & Company. 2015. The power of parity: How crisis. London: Overseas Development Institute (ODI). advancing women’s equality can add $12 trillion to global https:/ /bit.ly/3CDKVwW growth. https://bit.ly/449dzm7 Schneider, Ulrike, Birgit Trukeschitz, Richard Mühlmann, and Ivo Meng, Annika. 2013. “Informal home care and labor-force Ponocny. 2013. “”Do I stay or do I go?”—Job change and labor participation of household members.” Empirical Economics market exit intentions of employees providing informal care to 44(2): 959-979. https://bit.ly/3NEIeRU older adults.” Health Economics 22(10): 1230-1249. https://bit.ly/3Nj1WBy Mooney-Doyle, Kim, and Lisa C. Lindley. 2019. “The association between poverty and family financial challenges of caring for Sexual Orientation and Gender Identity Task Force (SOGI) and medically complex children.” Nursing Economics 37(4): 198-208. Dominik Koehler. 2015. “LGBTI people are (likely) overrepresented https://bit.ly/3JpL5vw in the bottom 40%.” In Blog on Governance for Development. World Bank. https://bit.ly/3pjMT2r Morrissey, Taryn. 2020. Addressing the need for affordable, high-quality Early Childhood Care and Education for all in Sharma, Nidhi, Subho Chakrabarti, and Sandeep Grover. 2016. the United States. Washington Center for Equitable Growth. “Gender differences in caregiving among family-caregivers of https://bit.ly/3JspTFn people with mental illnesses.” World journal of Psychiatry 6(1): 7. https://bit.ly/3qYrOuY 24 Sheehan, Orla C., William E. Haley, Virginia J. Howard, Jin Huang, J. UN Women. 2020. “Whose time to care? Unpaid care and David Rhodes, and David L. Roth. 2021. “Stress, burden, and well- domestic work during COVID-19.” Gender and COVID-19 Brief. being in dementia and nondementia caregivers: Insights from UN Women. https://bit.ly/3Nj2OGk the caregiving transitions study.” The Gerontologist 61(5): 670-679. https://bit.ly/3pkSC87 UN Women. 2021. Women and girls left behind: Glaring gaps in pandemic responses. UN Women. https:/ /bit.ly/46fsKew Shen, Ke, Ping Yan, and Yi Zeng. 2016. “Coresidence with elderly parents and female labor supply in China.” Demographic United Nations (UN) Department of Economics and Social Affairs. Research 35: 645-670. https:/ /bit.ly/44gSSnD 2016. “The growing need for long-term care: Assumptions and realities.” Briefing Paper. UN. https://bit.ly/3CFcpC7 Shimizutani, Satoshi, Wataru Suzuki, and Haruko Noguchi. 2008. “The socialization of at-home elderly care and female labor United Nations (UN). 2017. World population ageing 2017. New market participation: Micro-level evidence from Japan.” Japan York: UN. https://bit.ly/44ehBsm and the World Economy 20(1): 82-96. https:/ /bit.ly/43PLMXp Van Houtven, Courtney Harold, Norma B. Coe, and Meghan M. Steingrimsdottir, Herdis, and Arna Vardardottir. 2014. Domestic Skira. 2013. “The effect of informal care on work and wages.” equality and marital stability. Does paternity leave affect Journal of Health Economics 32(1): 240-252. divorce risk. Copenhagen Business School Working Paper. https:/ /bit.ly/3CGmsab https://bit.ly/3PmjxuL Walsh, Edel, and Aileen Murphy. 2018. “Investigating the causal Sugawara, Shinya, and Jiro Nakamura. 2014. “Can formal elderly relationship between employment and informal caregiving of the care stimulate female labor supply? The Japanese experience.” elderly.” BMC Research Notes 11(1): 1-6. https://bit.ly/3CDMk6G Journal of the Japanese and International Economies 34: 98-115. https://bit.ly/3paoTPl Wang, Yafeng, and Chuanchuan Zhang. 2018. “Gender inequalities in labor market outcomes of informal caregivers Tamm, Marcus. 2019. “Fathers’ parental leave-taking, childcare near retirement age in urban China.” Feminist Economics 24(2): involvement and labor market participation.” Labour Economics 147-170. https://bit.ly/3Pq1zYl 59: 184-197. https://bit.ly/42TawfR Wang, Yu-Nu, YeaiIng Lotus Shyu, Min-Chi Chen, and Pei-Shan Tarlovsky, Alan Fuchs, and Maria Fernanda Gonzalez Icaza. 2023. Yang. 2011. “Reconciling work and family caregiving among adult- Assessing the effects of the fiscal system on gender disparities child family caregivers of older people with dementia: Effects in Armenia: Pilot-study for the Engendered CEQ methodology. on role strain and depressive symptoms.” Journal of Advanced Washington, DC: World Bank. https:/ /bit.ly/3Xn7LCE Nursing 67(4)829-840. https:/ /bit.ly/3NFdNey Taş, Emcet O., and Tanima Ahmed. 2021. “Women’s economic Wolff, Jennifer L., Brenda C. Spillman, Vicki A. Freedman, and participation, time use, and access to childcare in urban Judith D. Kasper. 2016. “A national profile of family and unpaid Bangladesh.” Policy Research Working Paper 9735. Washington, caregivers who assist older adults with health care activities.” DC: World Bank. https:/ /bit.ly/44vrcLV JAMA Internal Medicine 176(3): 372-379. https:/ /bit.ly/3Nkb1Ki Taş, Emcet O., Tanima Ahmed, Norihiko Matsuda, and Shinsaku World Bank, 2013. Republic of Uzbekistan: Improving Early Nomura. 2022. “Gender impacts of COVID-19 on the labor market Childhood Care and Education. Washington, DC: World Bank. and household well-being in Pakistan.” Review of Economic https://bit.ly/3NnXp0J Analysis 14(2): 221-252. https://bit.ly/3CNb9gh World Bank. 2021. World Bank support to aging countries an The Organisation for Economic Co-Operation and Development independent evaluation. https://bit.ly/3qZWXOm (OECD). 2019. Women are well-represented in health and long-term care professions, but often in jobs with poor working World Bank. 2022. Women, Business and the Law 2022. conditions. https://bit.ly/3pe81al Washington, DC: World Bank. https://bit.ly/3CHEAAz The Organisation for Economic Co-Operation and Development World Development Indicators. https://bit.ly/44gY3nv (OECD). 2021. Pensions at a glance 2021: OECD and G20 Indicators. https://bit.ly/3XlO1ir World Health Organization (WHO). 2023. “Dementia.” https://bit.ly/3NHfmsc Unterhofer, Ulrike, and Katharina Wrohlich. 2017. “Fathers, parental leave and gender norms.” Discussion Paper Series, no. 10712. IZA. Wray, Dana. 2022. “How do work-family policies shape parents’ https://bit.ly/3Ni4RKF time with children?” Ph.D. Dissertation, Department of Sociology, University of Toronto. https://bit.ly/44gYa2p UN Women. 2015. Progress of the world’s women 2015-2016: Transforming economies, realizing rights. UN Women. https://bit.ly/3Nnj1dk 25