How to Make the U.S. a Better Place for Caregivers

An inventory of strategies that could improve the situation of America's working parents, from the beginning of their children's lives to their end of their own
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Breadwinning makes no sense without caregiving. Someone must transform income into the food, shelter, clothing, nurture, discipline, education, minding, nursing, transportation, and emotional support that creates life outside of the office, permits survival of the race, cares for the ill and disabled, and makes life livable when we can no longer care for ourselves. Yet the United States lags behind almost all other industrialized countries in providing the goods, services, and incentives that make it possible for women and men to be caregivers as well as breadwinners. What mothers need, as well as fathers, spouses, and the children of aging parents, is an entire national infrastructure of care, every bit as important as the physical infrastructure of roads, bridges, tunnels, broadband, parks and public works.

What are the elements of an infrastructure of care? Let's start at the beginning of life and work our way toward the end. According to Save the Children, an estimated 11,300 babies die on their first day of life in the United States, a number that is 50 per cent more first-day deaths than all other industrialized countries combined. All the EU countries together have 1 million more births each year than the U.S. does, but only about half as many first-day deaths. Reducing first-day deaths, the riskiest day of a baby's life, is hardly rocket science. Basic procedures such as steroid injections for women in preterm labor, resuscitation devices for babies who do not breathe at birth, cleaning solution to prevent umbilical cord infections, and injectable antibiotics to treat newborn sepsis and pneumonia can dramatically cut death rates. Death rates of roughly 30 newborns a day in one of the richest countries in the world is simply shameful.

Focusing on infant mortality is not typically on a white feminist agenda in the U.S.; the babies at risk are children of poverty, who are in turn more likely to be rural whites and ethnic minorities. But an infrastructure of care must provide care for everyone, just as roads and bridges provide transport for anyone who can drive or afford a bus ticket. Care is for the vulnerable, the sick, the disabled, and the dependent. All of us, rich or poor, qualify as vulnerable and dependent for at least some period after birth and before death.

Beyond birth, the U.S. model looks more and more like ancient Sparta, in which babies were purportedly left out on the mountainside to fend for themselves. Babies should ideally be breast-fed for a year and should have time to bond with both parents during the first year of life. Yet, as is gradually penetrating our national consciousness, the United States joins Swaziland, Lesotho, and Papua New Guinea as the only countries in the world that do not mandate paid maternity leave. Many Western European countries provide generous maternity and paternity leave (Britain, even under austerity, provides 280 days of leave for either parent at 90 percent pay). So do Brazil, Indonesia, Saudi Arabia, and Australia. And as for the private voluntary approach, only half of U.S. first-time mothers get any paid leave at all, and they are much more likely to be the more privileged half. At a time when 71.3 percent of American mothers are in the workforce, who is supposed to care for children in their first weeks and months of life?

And when parents go back to work? The best option, both for individual children and for society as a whole, is high-quality, affordable day-care, either at the workplace or close by. High-quality means care provided by trained professionals who are specialists in child development, who can provide a stable, loving, learning environment that can take care not only of children's physical needs but also provide stimulation and socialization. Yet as economists Nancy Folbre and Erik Olin Wright report in For Love and Money: Care Provision in the United States, only 33 percent of the children of working mothers are in such care, whether privately or government funded.

Care for healthy children is only one part of the care picture, however. What happens when a child falls sick or is diagnosed with special needs? Or an aging parent becomes increasingly dependent? Or a spouse, a sibling, or the worker him or herself needs care? We know the rates of diagnosis of disabilities and diseases from autism to cancer; every one creates the need for a small ecosystem of paid and unpaid caregiving. One of Bill Clinton's signature achievements was the passage of the Family and Medical Leave Act, which grants workers unpaid job-protected leave for up to three months. But as Janet Walsh of Human Rights Watch reports, "this applies only to enterprises with 50 or more employees, and eligibility requirements exclude many workers. Indeed, more than 40 percent of the American workforce has no protection under this law. Only about 12 percent of the workforce has access to paid family leave." Yet such leave can be provided at no financial cost to corporations and minimal cost to taxpayers. California and New Jersey provide 3 months of paid leave through a social insurance scheme that costs roughly $30 a year per taxpayer.

Equally important, for all kinds of care, are flexible work schedules. Drawing on a new book by Jocelyn Elise Crowley called Mothers Unite, Nanette Fondas lists a set of policies that five national mothers groups identify as necessary to allow productive individuals to be both breadwinners and caregivers. These include: "Flexible start and stop times, compressed workweeks, advance knowledge about overtime and shift schedules, part-time work, short-term time off, regular time off, and extended time off." These are workplace policies that enlightened employers are gradually discovering work not only for recruiting and retaining the most talented workers but also increase productivity and innovation. Government, at both the state and federal level can do much more either to mandate or encourage the adoption of such policies.

The policies and options listed thus far are familiar fare for activists in the work-family space. Real change would go much farther. Ann Crittenden, in The Price of Motherhood, lists an entire set of measures that would begin by making care work as visible as every other kind of work and proceed to support it in the way we support other kinds of economic activity. A first step would be to equalize Social Security for spouses, allowing both spouses automatically to earn equal Social Security credits during their marriage, which would "increase benefits for working and stay-at home mothers alike, and for divorced women, who are among the poorest old people in the country." Other measures include offering work-related Social Insurance programs to all workers, including unpaid caregivers, thereby making them eligible for temporary unemployment compensation, job training, and worker's compensation if they became divorced or injured; providing universal pre-school for all three and four-year olds; taxing members of a married couple separately in line with their individual rather than joint rate; paying a child allowance to all primary caregivers of young children, with the check made out directly to the caregiver; providing free health coverage for all children and their primary caregivers; and adding unpaid household labor to the national GDP.

All those measures, as far-fetched as they may seem to our breadwinning-obsessed society, reflect the reality of the human, economic, and social need for care. Women have long been socialized into providing such care without recognition or compensation, something that a growing number of men are discovering as they become primary caregivers in their turn, either inside or outside a marriage. But care is not "women's work." It is human work, work that embodies and expresses the love and connections to others that make us human in the first place.

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Anne-Marie Slaughter is the president of the New America Foundation and the Bert G. Kerstetter '66 University Professor of Politics and International Affairs at Princeton University. She was previously the director of policy planning for the U.S. State Department and the dean of Princeton's Woodrow Wilson School of Public and International Affairs. More

From 2009-2011, Slaughter served as Director of Policy Planning for the United States Department of State, the first woman to hold that position. After leaving the State Department, she received the Secretary's Distinguished Service Award, the highest honor conferred by the State Department, for her work leading the Quadrennial Diplomacy and Development Review. She also received a Meritorious Honor Award from the U.S. Agency for International Development (USAID). 

Prior to her government service, Slaughter was the dean of Princeton's Woodrow Wilson School of Public and International Affairs from 2002-2009. She has written or edited six books, including A New World Order (2004) and The Idea That Is America: Keeping Faith with Our Values in a Dangerous World (2007). From 1994-2002, Slaughter was the J. Sinclair Armstrong Professor of International, Foreign, and Comparative Law and director of the International Legal Studies Program at Harvard Law School. She received a B.A. from Princeton, an M.Phil and D.Phil in international relations from Oxford, where she was a Daniel M. Sachs Scholar, and a J.D. from Harvard.
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