Ruth Rosen: The Care Crisis





[Ruth Rosen, a historian, journalist and senior fellow at the Longview Institute, teaches history and public policy at the University of California, Berkeley. She is the author of The World Split Open: How the Modern Women's Movement Changed America.]

A baby is born. A child develops a high fever. A spouse breaks a leg. A parent suffers a stroke. These are the events that throw a working woman's delicate balance between work and family into chaos.

Although we read endless stories and reports about the problems faced by working women, we possess inadequate language for what most people view as a private rather than a political problem."That's life," we tell each other, instead of trying to forge common solutions to these dilemmas.

That's exactly what housewives used to say when they felt unhappy and unfulfilled in the 1950s:"That's life." Although magazines often referred to housewives' unexplained depressions, it took Betty Friedan's 1963 bestseller to turn"the problem that has no name" into a household phrase,"the feminine mystique"--the belief that a woman should find identity and fulfillment exclusively through her family and home.

The great accomplishment of the modern women's movement was to name such private experiences--domestic violence, sexual harassment, economic discrimination, date rape--and turn them into public problems that could be debated, changed by new laws and policies or altered by social customs. That is how the personal became political.

Although we have shelves full of books that address work/family problems, we still have not named the burdens that affect most of America's working families.

Call it the care crisis.

For four decades, American women have entered the paid workforce--on men's terms, not their own--yet we have done precious little as a society to restructure the workplace or family life. The consequence of this"stalled revolution," a term coined by sociologist Arlie Hochschild, is a profound" care deficit." A broken healthcare system, which has left 47 million Americans without health coverage, means this care crisis is often a matter of life and death. Today the care crisis has replaced the feminine mystique as women's"problem that has no name." It is the elephant in the room--at home, at work and in national politics--gigantic but ignored.

Three decades after Congress passed comprehensive childcare legislation in 1971--Nixon vetoed it--childcare has simply dropped off the national agenda. And in the intervening years, the political atmosphere has only grown more hostile to the idea of using federal funds to subsidize the lives of working families.

The result? People suffer their private crises alone, without realizing that the care crisis is a problem of national significance. Many young women agonize about how to combine work and family but view the question of how to raise children as a personal dilemma, to which they need to find an individual solution. Most cannot imagine turning it into a political debate. More than a few young women have told me that the lack of affordable childcare has made them reconsider plans to become parents. Annie Tummino, a young feminist active in New York, put it this way:"I feel terrified of the patchwork situation women are forced to rely upon. Many young women are deciding not to have children or waiting until they are well established in their careers."

Now that the Democrats are running both houses of Congress, we finally have an opportunity to expose the right's cynical appropriation of"family values" by creating real solutions to the care crisis and making them central to the Democratic agenda. The obstacles, of course, are formidable, given that government and businesses--as well as many men--have found it profitable and convenient for women to shoulder the burden of housework and caregiving.

It is as though Americans are trapped in a time warp, still convinced that women should and will care for children, the elderly, homes and communities. But of course they can't, now that most women have entered the workforce. In 1950 less than a fifth of mothers with children under age 6 worked in the labor force. By 2000 two-thirds of these mothers worked in the paid labor market.

Men in dual-income couples have increased their participation in household chores and childcare. But women still manage and organize much of family life, returning home after work to a"second shift" of housework and childcare--often compounded by a"third shift," caring for aging parents.

Conservatives typically blame the care crisis on the women's movement for creating the impossible ideal of"having it all." But it was women's magazines and popular writers, not feminists, who created the myth of the Superwoman. Feminists of the 1960s and '70s knew they couldn't do it alone. In fact, they insisted that men share the housework and child-rearing and that government and business subsidize childcare.

A few decades later, America's working women feel burdened and exhausted, desperate for sleep and leisure, but they have made few collective protests for government-funded childcare or family-friendly workplace policies. As American corporations compete for profits through layoffs and outsourcing, most workers hesitate to make waves for fear of losing their jobs.

Single mothers naturally suffer the most from the care crisis. But even families with two working parents face what Hochschild has called a"time bind." Americans' yearly work hours increased by more than three weeks between 1989 and 1996, leaving no time for a balanced life. Parents become overwhelmed and cranky, gulping antacids and sleeping pills, while children feel neglected and volunteerism in community life declines.

Meanwhile, the right wins the rhetorical battle by stressing"values" and"faith." In the name of the family they campaign to ban gay marriage and save unborn children. Yet they refuse to embrace public policies that could actually help working families regain stability and balance.

For the very wealthy, the care crisis is not so dire. They solve their care deficit by hiring full-time nannies or home-care attendants, often from developing countries, to care for their children or parents. The irony is that even as these immigrant women make it easier for well-off Americans to ease their own care burdens, their long hours of paid caregiving often force them to leave their own children with relatives in other countries. They also suffer from extremely low wages, job insecurity and employer exploitation.

Middle- and working-class families, with fewer resources, try to patch together care for their children and aging parents with relatives and baby sitters. The very poor sometimes gain access to federal or state programs for childcare or eldercare; but women who work in the low-wage service sector, without adequate sick leave, generally lose their jobs when children or parents require urgent attention. As of 2005, 21 million women lived below the poverty line--many of them mothers working in these vulnerable situations.

The care crisis starkly exposes how much of the feminist agenda of gender equality remains woefully unfinished. True, some businesses have taken steps to ease the care burden. Every year, Working Mother publishes a list of the 100 most"family friendly" companies. In 2000 the magazine reported that companies that had made"significant improvements in 'quality of life' benefits such as telecommuting, onsite childcare, career training, and flextime" were"saving hundreds of thousands of dollars in recruitment in the long run."

Some universities, law firms and hospitals have also made career adjustments for working mothers, but women's career demands still tend to collide with their most intensive child-rearing years. Many women end up feeling they have failed rather than struggled against a setup designed for a male worker with few family responsibilities.

The fact is, market fundamentalism--the irrational belief that markets solve all problems--has succeeded in dismantling federal regulations and services but has failed to answer the question, Who will care for America's children and elderly?

As a result, this country's family policies lag far behind those of the rest of the world. A just-released study by researchers at Harvard and McGill found that of 173 countries studied, 168 guarantee paid maternal leave--with the United States joining Lesotho and Swaziland among the laggards. At least 145 countries mandate paid sick days for short- or long-term illnesses--but not the United States. One hundred thirty-four countries legislate a maximum length for the workweek; not us.

The media constantly reinforce the conventional wisdom that the care crisis is an individual problem. Books, magazines and newspapers offer American women an endless stream of advice about how to maintain their"balancing act," how to be better organized and more efficient or how to meditate, exercise and pamper themselves to relieve their mounting stress. Missing is the very pragmatic proposal that American society needs new policies that will restructure the workplace and reorganize family life.

Another slew of stories insist that there simply is no problem: Women have gained equality and passed into a postfeminist era. Such claims are hardly new. Ever since 1970 the mainstream media have been pronouncing the death of feminism and reporting that working women have returned home to care for their children. Now such stories describe, based on scraps of anecdotal data, how elite (predominantly white) women are" choosing" to"opt out," ditching their career opportunities in favor of home and children or to care for aging parents. In 2000 Ellen Galinsky, president of the Families and Work Institute in New York, wearily responded to reporters,"I still meet people all the time who believe that the trend has turned, that more women are staying home with their kids, that there are going to be fewer dual-income families. But it's just not true."

Such contentious stories conveniently mask the reality that most women have to work, regardless of their preference. They also obscure the fact that an absence of quality, affordable childcare and flexible working hours, among other family-friendly policies, greatly contributes to women's so-called" choice" to stay at home.

In the past few years, a series of sensational stories have pitted stay-at-home mothers against"working women" in what the media coyly call the"mommy wars." When the New York Times ran a story on the controversy, one woman wrote the editor,"The word 'choice' has been used...as a euphemism for unpaid labor, with no job security, no health or vacation benefits and no retirement plans. No wonder men are not clamoring for this 'choice.' Many jobs in the workplace also involve drudgery, but do not leave one financially dependent on another person."

Most institutions, in fact, have not implemented policies that support family life. As a result, many women do feel compelled to choose between work and family. In Scandinavian countries, where laws provide for generous parental leave and subsidized childcare, women participate in the labor force at far greater rates than here--evidence that"opting out" is, more often than not, the result of a poverty of acceptable options.

American women who do leave their jobs find that they cannot easily re-enter the labor force. The European Union has established that parents who take a leave from work have a right to return to an equivalent job. Not so in the United States. According to a 2005 study by the Wharton Center for Leadership and Change and the Forte Foundation, those who held advanced degrees in law, medicine or education often faced a frosty reception and found themselves shut out of their careers. In her 2005 book Bait and Switch, Barbara Ehrenreich describes how difficult it was for her to find employment as a midlevel manager, despite waving an excellent résumé at potential employers."The prohibition on [résumé] gaps is pretty great," she says."You have to be getting an education or making money for somebody all along, every minute."

Some legislation passed by Congress has exacerbated the care crisis rather than ameliorated it. Consider the 1996 Welfare Reform Act, which eliminated guaranteed welfare, replaced it with Temporary Assistance to Needy Families (TANF) and set a five-year lifetime limit on benefits. Administered by the states, TANF aimed to reduce the number of mothers on welfare rolls, not to reduce poverty.

TANF was supposed to provide self-sufficiency for poor women. But most states forced recipients into unskilled, low-wage jobs, where they joined the working poor. By 2002 one in ten former welfare recipients in seven Midwestern states had become homeless, even though they were now employed.

TANF also disqualified higher education as a work-related activity, which robbed many poor women of an opportunity for upward mobility. Even as the media celebrate highly educated career women who leave their jobs to become stay-at-home moms, TANF requires single mothers to leave their children somewhere, anywhere, so they can fulfill their workfare requirement and receive benefits. TANF issues vouchers that force women to leave their children with dubious childcare providers or baby sitters they have good reasons not to trust.

Some readers may recall the 1970 Women's Strike for Equality, when up to 50,000 women exuberantly marched down New York's Fifth Avenue to issue three core demands for improving their lives: the right to an abortion, equal pay for equal work and universal childcare. The event received so much media attention that it turned the women's movement into a household word.

A generation later, women activists know how far we are from achieving those goals. Abortion is under serious legal attack, and one-third of American women no longer have access to a provider in the county in which they live. Women still make only 77 percent of what men do for the same job; and after they have a child, they suffer from an additional"mother's wage gap," which shows up in fewer promotions, smaller pensions and lower Social Security benefits. Universal childcare isn't even on the agenda of the Democrats.

Goals proposed in 1970, however unrealized, are no longer sufficient for the new century. Even during these bleak Bush years, many writers, activists and organizations have begun planning for a different future. If women really mattered, they ask, how would we change public policy and society? As one writer puts it,"What would the brave new world look like if women could press reboot and rewrite all the rules?"

Though no widely accepted manifesto exists, many advocacy organizations--such as the Institute for Women's Policy Research, the Children's Defense Fund, the National Partnership for Women and Families, Take Care Net and MomsRising--have argued that universal healthcare, paid parental leave, high-quality subsidized on-the-job and community childcare, a living wage, job training and education, flexible work hours and greater opportunities for part-time work, investment in affordable housing and mass transit, and the reinstatement of a progressive tax structure would go a long way toward supporting working mothers and their families. (In these pages in 2003, Deborah Stone documented campaigns on many of these issues by organizations in California, Massachusetts and Washington.)

Democrats don't need to reinvent the wheel; these groups have already provided the basis for a new progressive domestic agenda. And if Democrats embrace large portions of this program, they might attract enough women to widen the gender gap in voting, which shrank from 14 percent in 1996 to only 7 percent in 2004.

This is an expensive agenda, but the money is there if we end tax cuts for the wealthy and reduce expenditures for unnecessary wars, space-based weapons and the hundreds of American bases that circle the globe. If we also reinstate a progressive tax structure, this wealthy nation would have enough resources to care for all its citizens. It's a question of political will.

Confronting the care crisis and reinvigorating the struggle for gender equality should be central to the broad progressive effort to restore belief in the" common good." Although Americans famously root for the underdog, they have shown far less compassion for the poor, the vulnerable and the homeless in recent years. Social conservatives, moreover, have persuaded many Americans that they--and not liberals--are the ones who embody morality, that an activist government is the problem rather than the solution and that good people don't ask for help.

The problem is that many Democrats, along with prominent liberal men in the media, don't view women's lives as part of the common good. Consciously or unconsciously, they have dismissed women as an"interest group" and treated women's struggle for equality as"identity politics" rather than part of a common national project. Last April Michael Tomasky, then editor of The American Prospect, penned an essay on the" common good" that is typical of such manifestoes. It never once addressed any aspect of the care crisis. Such writers don't seem to grasp that a campaign to end the care crisis could mobilize massive support for this idea of the common good, because it affects almost all working families.

Now that Democrats are emerging from the wilderness, there are scattered indications they are willing to use their power to address the mounting care crisis. The Congressional Caucus for Women's Issues, one of the largest caucuses, has access to Speaker Nancy Pelosi, who has supported previous efforts to address the care crisis. The Senate has just created a new Caucus on Children, Work and Family, a sign, says Valerie Young, a lobbyist with the National Association of Mothers' Centers, that"this is no longer a personal problem--it's a national problem." Connecticut Senator Chris Dodd says he will introduce legislation that would provide paid leave for workers who need to care for sick family members, newborns or newly adopted children. Senator Pat Roberts of Kansas has just introduced the Small Business Child Care Act, which would help employers provide childcare for their workers. Members in both houses of Congress are reopening the discussion of universal healthcare reform.

The truth is, we're living with the legacy of an unfinished gender revolution. Real equality for women, who increasingly work outside the home, requires that liberals place the care crisis at the core of their agenda and take back"family values" from the right. So far, no presidential candidate has made the care crisis a significant part of his or her political agenda. So it's up to us, the millions of Americans who experience the care crisis every day, to take every opportunity--through electoral campaigns and grassroots activism--to turn"the problem that has no name" into a household word.


Reprinted with permission from the Nation. For subscription information call 1-800-333-8536. Portions of each week's Nation magazine can be accessed at http://www.thenation.com.



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Frederick Thomas - 3/1/2007


It is interesting that the only efficient specialty in medicine is that which is completely unsupported by insurance: cosmetic surgery.

Prices have dropped, quality is up, and service is generally superb.

In all of those specialities supported by insurance, with few exceptions, the price is up, quality is poor, and service poor, because of price pressure. Are the nip and tuck guys telling us something important?

But insurance as bogeyman takes second place to lawyers, which have doubled the operating costs of most specialities and driven many orthopaedists, obstetricians and other risky specialities to get other work. Malpractice insurance of $300,000 per year is common. Care crisis? Nope. Lawyer crisis.

The effect of insurance and lawyers together has halted the advance of technology which can reduce
costs dramatically.

Is there any good reason other than insurance and legal influences, why we cannot walk into a physicians office and have the entire preliminary examination done automatically?

I mean blood pressure, temperature, pulse, the standard diagnostic questions, etc which are taken automatically and accurately in drug stores but which are done at great expense by nurses and doctors in doctors offices, because of lawyer and insurance terror.

Then consider that insurance forms should be totally standardized and eliminated, as should patient dossiers, all of which should have disappeared long ago, with great productivity benefits except that computer records are not accepted in court, so we cannot move ahead.

Hey Mr. Bush, how about some of that tort reform you used to talk about?


Lawrence Brooks Hughes - 2/27/2007

Ruth Rosen is obviously another coercive utopian who wants to sit on top of the bureaucracy and order everyone into pigeon holes...

Some things never mentioned are: a) children seldom get sick; b) when they do they don't stay sick for very long; and c) medical care for children costs extremely little compared to any other group. The Ruth Rosens of this world inveigh about sick children as a means of getting a foot in the door for enactment of state-run health care for all ages.

I say let the state pick up health care for all children, provided the parent is greeted with a $15 co-pay charge per kid per illness, just enough to keep the hypochondriacs at bay. And if that single mother doesn't have $15, let her borrow it from a friend, or beg it, or steal it.

Many of the 40-odd million who don't have health INSURANCE don't want to buy it--they get health CARE
when they need it without exception, and you don't see them writhing in in the streets... Mortality rates plunged in LA County 35 years ago when operating theater nurses went on strike and only emergency procedures were performed... A lot of people don't want American-style health care. How many Christian Scientists are there? How many favor vitamin pills and herbs? How many use witch doctors and voodoo? How many Canadians flee from their state system to come south when their malady is serious? (The answer is all of them who can afford it).


Nancy REYES - 2/27/2007

Your thesis is that of Betty Frieden's ignored book the third phase.
Alas, you assume that the answer is a big government program to do the caretaking.
Yet many mothers would prefer part time work, and child care by a friend or family member.
The idea you are missing is "subsidarity". Local solutions are not as utopian, but are more humane in the long run.
Big bureaurocracies will benefit bureaucrats more than mothers, and the increase in taxes will force more of them into working to pay those taxes.
FYI: I've worked and seen how government runs health care, was a single mother, and unlike you saw the attitude of my working class patients did not agree with the daycare/full time work agenda that I and you and other upper class professional women seem to feel is best.

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