UNA-NCA Snapshots
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UNA-NCA Snapshots

Op-Ed: The Need for an International Standard for Migrant Care and Domestic Workers

By Praveena Bandara, UNA-NCA Advocacy Fellow

Whom do you think of when you hear the term “care-worker”? Do you think of a home health aide or a nurse working at an elder care home? Do you think of someone working at a daycare center for toddlers? Or do you picture yourself doing all the unpaid household work such as cooking, cleaning, and laundry? Care work mainly consists of childcare and eldercare but can also include the aforementioned household care activities. A care worker is someone engaging in any of these activities or occupations related to these activities, and may or may not receive payment for these services. However, from a policy perspective, it is crucial to have an objective for classifying some occupations as care work and those engaged in these occupations as care workers. These classifications are often arbitrary and usually depend on policy objectives.

This article addresses the need for an international labor standard that protects care workers’ rights and ensures meeting the world’s demand for care workers sustainably. In this case, we target paid care workers who fall into the broad categories of health care workers or domestic workers. Furthermore, a workers’ economic vulnerability, migration status, and current level of legal protections influence whether this international labor standard applies to them. The intended demographic group of this standard is economically vulnerable, international migrant care workers (as opposed to internal migrant workers who migrate within a country), who have low to no protections under national labor laws.

Current status of dependence on “imported” care workers in the United States

Care work is essential for the smooth operation of an economy. Care work can be considered a vital complementary sector for typical production sectors such as agriculture or industry. Yet it was the COVID-19 pandemic that underscored the significance of care workers’ (including migrant care workers) contributions to our daily lives. We all have heard countless stories about parent’s struggles of having to perform additional care work and making sure their toddlers receive education vital for childhood development at home, on top of fulfilling job-related responsibilities. This demand for care work and services existed before the pandemic, and it will only continue to grow as households return to post-pandemic life.

Care work is unique because it involves high levels of emotional investment by the worker, with the care provider’s concern for the recipient affecting the quality of the work. It is not easy to quantify care work because of this component of concern, which is an input in the production of care work. And this inability to accurately quantify care work is one of the main reasons why it is undervalued. For example, how would you value a nurse’s concern towards you when caring for an injury? You may feel that the caring attitude of a care worker made all the difference, but it may be difficult for you to assign a monetary value to it. The salaries that care workers in the US receive reflects this inability to assign appropriate value to care. The general classification of healthcare occupations is healthcare practitioners and technical occupations and healthcare support occupations. If we compare the average salary of healthcare support occupations to the national average annual salary of $56,310, we can see that these occupations earn significantly less than the average citizen in the US. In particular, the average annual salaries of home health aides and personal care aides, nursing assistants, and healthcare support (and all others) are $28,060($13.49/hr), $32,050($15.41/hr), and $38,030($18.29/hr) respectively. These figures are better than the federal minimum wage of $7.5 an hour, but they are still low for essential services. It is also important to note that there is also an evident gender disparity in employment in the healthcare support occupations where the sector employed more females in all occupations that fall under the heading. The feminization of care work may also contribute to the low wages received by care workers.

Regarding immigrant healthcare workers, the Migration Policy Institute (MPI) reports that “[o]verall, immigrants ranging from naturalized citizens, legal permanent residents, and temporary workers to recipients of Temporary Protected Status (TPS) and the Deferred Action for Childhood Arrivals (DACA) program accounted for nearly 18 percent of the 14.7 million people in the United States working in a healthcare occupation in 2018”. This means that almost one out of every five healthcare workers is an immigrant. Furthermore, the MPI states that despite the essential role immigrants play in the healthcare services sphere, only 5 percent of working visa (H-1b) petitions filed by health care and medical workers were approved for initial employment in 2018 (according to the Department of Homeland Security data). Finally, in terms of insurance coverage, about 13 percent of immigrant healthcare support workers lacked health insurance in 2018. This discussion shows that despite being significant contributors to the US healthcare industry, migrant care workers are underpaid and lack employment stability. This situation affects care workers and receivers of care because the lack of adequate compensation and job stability could lead to workers exiting the workforce, putting pressure on the already strained care worker supply.

Figure 1: All civilian employed workers and healthcare workers, by occupational group and nativity 2018 | Source: Migration Policy Institute

In addition to immigrant health care workers, immigrant domestic workers are also a part of the care work labor force. The ILO defines domestic workers as “… those workers who perform work in or for a private household or households. They provide direct and indirect care services, and as such are key members of the care economy”. In a report titled “Domestic Workers Chartbook,” published in May of 2020, researchers at the Economic Policy Institute (EPI), identified the following characteristics of the domestic worker labor force in the US. About 91.5% of domestic workers are women, and over half (52.4%) are Black, Hispanic, or Asian American/Pacific Islanders. Their median salary is about $12.01 per hour (comparable to the hourly earnings of health aides and personal care aides). Looking at demographics related to migrant labor, Figure 2 — right side panel shows that the domestic work sector employs about 20% of migrant labor, out of which a significant portion (50%) are house cleaners. At the same time, 17% of them are employed either as nannies or provide in-home childcare.

Domestic workers are about three times more likely to be living under the poverty line than the average American worker. The ILO states that “[d]omestic work remains one of the least protected sectors under national labor laws and it suffers from particularly poor monitoring, and implementation of existing laws […] Migrant domestic workers (MDWs) are even less protected by the law. Migrant domestic workers are vulnerable to human rights abuses, due to inequalities determined by gender, race, ethnicity, national origin and social status”. A defining challenge of domestic workers is that they work in isolation, which makes them more vulnerable because they cannot organize for better working conditions and share information or even grievances. Domestic workers are subject to low pay, and migrant domestic workers are particularly vulnerable to pay discrimination. In terms of benefits, more than 90% of domestic workers do not receive an employer-provided retirement plan, and only 20% of them receive health insurance coverage through their job. Though there has been some recent progress, domestic workers receive the fewest federal labor and employment protections.

Figure 2:Gender breakdown and nativity breakdown of domestic workers, 2019 | Source: Economic Policy Institute

Why do we need an international standard?

Migrant care workers have been part of the care labor force in the US and most other developed and — even some developing countries — for decades. The COVID-19 pandemic underscored the need for care workers in any economy and revealed the weaknesses of the global care worker supply. The pandemic resulted in mobility restrictions in the form of travel bans, stranding due to flight cancellations and border closures, and confinement because of quarantine and lock-down restrictions. Most workers faced increased work hours and workload that also led to high levels of work stress, and in some cases, increased violence against care workers. They also face a high level of uncertainty related to the stability of future work.

What are the existing frameworks that protect migrant care workers? The fact that there aren’t any international frameworks, conventions, or special provisions that specifically cover care workers reflects that policymakers seldom acknowledge the vital complementary tasks that careworkers perform and the indirect value these tasks add to an economy’s growth. Astonishingly, even as comprehensive a framework as the 17 Sustainable Development Goal’s (SDGs) missed out on dedicating a single target out of the 169 targets to care workers (or migrant care workers).

However, there are protections for migrant workers and domestic workers under the International Labor Organization (ILO). For example, the ILO’s International Legal Framework on Labor Migration is a set of comprehensive legal guidelines that have adapted to the changing world of work through continual revision of its central standards. Yet enforcement remains a significant obstacle to the ILO. The ILO notes that enforcement rates remain low in most developing countries, even if they have formally adopted the conventions and articles. Another issue with these conventions is that the language is vague and open for interpretation. Below are excerpts from the Convention concerning Decent Work for Domestic Workers (№189):

Remuneration Art. 11: each Member shall take measures to ensure that domestic workers enjoy minimum wage coverage, where such coverage exists, and that remuneration is established without discrimination based on sex.

Compliance and enforcement Art. 17(2): calls on Members to develop and implement measures for labor inspection, enforcement and penalties, in accordance with national laws and regulations.

Here, if we look at the Remuneration Article 11, it says that members must ensure workers receive a minimum wage. Yet, there aren’t any guidelines as to how this minimum wage is determined. Whereas in Article 17(2), the language is even less forceful, where members are only “call[ed]” to implement measures of enforcement. Even if the ILO uses definitive language, the enforcement issue is challenging to resolve regardless of the entity of authority involved. This is because there is no central authority that policies the enforcement of this framework and consequently it depends on the goodwill of the governments of the individual countries. Therefore, the solution is standardizing the care worker supply. This process would involve a multinational effort to reach a consensus on valuing care, depending on the education and training requirements for labor and occupational characteristics. Currently, countries may have bilateral armaments between receiving and sending countries to ensure care standards and care workers’ rights. Yet, there isn’t a universal standard for care workers and having varying arrangements between countries is not efficient for both receiving and sending countries.

What does standardizing care work look like?

Enacting and enforcing this international standard would involve the same obstacles as any other international labor standard. Therefore, the successful universal adoption and enforcement of the proposed standard depends on several factors working in tandem. Namely, getting the Governing Body of the ILO to present the standard to be discussed at a future International Labor Conference, putting together a committee to develop universal basic labor standards for migrant care and domestic workers, and changing the current discourse regarding migrant care and domestic workers.

The ILO is the international body responsible for setting universal labor standards. Setting labor standards is a well-established practice at the ILO. The standard procedure is for the ILO to set the standards and for individual countries to ratify, adopt and enforce these standards as part of its domestic labor laws. Presenting an issue to be discussed at a future International Labor Conference by the Governing Body is the first step, after which the International Labor Office prepares a report addressing these concerns. This report is then communicated to the member states, whose comments lead to a second report that goes through the aforementioned cycle. It is then taken up at the International Labor Conference, at which a two-thirds majority leads to the adoption of the standard. The United Nations has two parts to play here: first, the United Nations must put pressure on the Governing Body to present the proposed standard to be discussed; and then, it must put together an international committee of experts that determines basic labor standards and aid the International Labor Office in preparing their report.

One of the most important tasks of this proposed framework is to establish basic labor standards. Basic labor standards include setting working hours, pay structures, and occupational structures. In addition to determining occupational hierarchies, working and overtime hours, nations would have to agree on a baseline pay for each occupation. This baseline pay should reflect elements of care that go into the “production” of the service and complement the professional training required to perform care-related tasks. These basic labor standards significantly resolve issues migrant care workers face, such as low wages, underemployment, and non-standard working hours. Another task would be to set international training and certification requirements. This involves determining the level of training each caring occupation requires and streamlining certification with working visa documentation requirements. Setting quality standards can minimize unfair practices of unscrupulous employment agencies, reduce language barriers between employees and employers, and grant care workers the ability to demand wages that correspond to their skills, and negotiate fair working hours and employment contracts. On the demand side, employers have an assurance of the quality of the services they receive. Establishing these standards will go a long way in the monetary valuing of care work as well. Developing international basic labor standards for migrant care and domestic workers is a task that requires collaboration among experts from varying fields such as labor and gender economists, care and domestic work sector employers and employees, lawyers specializing in international labor law, labor rights advocates, and government representatives of the world’s nations. It is a complex task that must be backed by rigorous data collection and research, especially when negotiating and assigning true values for care services.

Negotiating and reaching an agreement among multiple nations is the most critical yet challenging task. On the one hand, the lower price of migrant care and domestic workers drives their demand. Additionally, some developing countries depend on migrant labor income to earn foreign exchange. On the other hand, though setting labor standards would increase the welfare of migrant care and domestic workers via improved compensation and benefits, this would inevitably increase the price of migrant care and domestic workers, which could cause foreign demand to decrease. This potential decrease in demand could be a major disincentive for governments of developing countries to agree to set international labor standards for migrant care and domestic workers since it could cause overall foreign exchange earnings to decrease. Another issue to consider is whether the labor standard would apply retroactively or proactively. If the standard was proactive, workers who migrated before the standard’s enactment may still face the same undesirable working conditions and pay. Whereas with the retroactive enactment of the standard, workers may need grace periods to ensure they meet the training and certification requirements. Some veteran workers may not meet these requirements and might need time off to obtain certification or training, putting them at risk of being replaced by more qualified workers.

In the long run, the successful enforcement of this international labor standard partly depends on a universal change in social attitudes towards care work and migrant care and domestic workers. The strength of enforcement of international standards depends on the individual country’s attitudes towards the issue. The United Nations is highly involved in the migrant worker and domestic worker rights spheres, and the dialogue has been ongoing for several decades. Special provisions for care workers are a natural step and essential step forward. The United Nations provides a global platform for dialogue and negotiation for issues of importance to the world’s wellbeing. We know that the United Nations places great importance on women and migrants, as reflected in the SDGs. And as discussed above, both groups play essential roles in the care sector. The United Nations needs to take the initiative because this is not solely about creating provisions in a rule book — It is about facilitating the conversation about the value of care work. The United Nations has a vital role in changing social norms about the importance of care work, leading to the equitable valuation of care work.

The pandemic has exposed weaknesses in the current global supply of care workers and impacted trends in future demand. As economies continue to recover and grow, post-pandemic demand for care workers will also continue to grow. This demand will most likely be met by migrant care and domestic workers. The rights of these international care and domestic workers are yet to be addressed by an international legal framework. The proposed international labor standard addresses this lack of an international labor standard aimed explicitly at migrant care and domestic workers. The standard focuses on setting a global care and domestic worker occupational structure to ensure the proper valuation of care services and a sustainable global care worker supply. This framework is a step in the direction of eliminating all forms of discrimination in vital yet historically feminized and underpaying care occupations.



UNA-NCA Snapshots provides a platform for our community leaders, partners, members & staff to publish op-eds, reviews, and innovative research. The views in this blog do not necessarily reflect the views of UNA-NCA. Ready to write? Submit your pitch to communications@unanca.org.

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