As we enter cold, flu and COVID season, Canada continues to experience a health care crisis. One in six Canadians do not have a family doctor, and less than 50 percent can see a primary care provider the same or next day. Both the British Columbia Nurses Union and the Hospital Employees Union report that over a third of their members are considering leaving, largely due to burnout.
Because women make up 75 percent of the health care workforce—and are responsible for the majority of care in the community and at home—women bear the brunt of this crisis, as they did during the COVID-19 pandemic.
In 2020 and 2021, as one of the leaders of the Gender and COVID-19 Project based at Simon Fraser University, I spoke to nearly 200 women working on the front lines of the COVID-19 response.
Their stories collected in my book Called for care, ranged from well-paid doctors to minimum-wage cleaners in long-term care (LTC) facilities, with participants identifying a range of social positions related to factors including race, ethnicity, and sexuality. Their combined experiences illustrate the cracks in our health care system created by gender inequality.
Health care is built on women’s work
Not only is the health care sector feminized, but women — especially racialized women — are more likely to be in positions at the lower end of the pay scale, which also require close and prolonged contact with patients. When space, equipment, and staff are scarce, these front-line workers are left to fill the intractable gaps.
A long-term care aide describes working in conditions so short-staffed that some residents have missed several baths in a row:
“You feel bad because there are people and these are their homes and their lives potentially, right? And they’re not getting the care that they need, so what I mean, it always comes back to us is that eventually we just have to stop and find the energy or the time – eventually it just catches up with us. The work just doesn’t go away, we just don’t do it for the day.”
Such circumstances can lead to moral distress, the experience of being unable to provide ethically required care due to structural constraints. In a recent survey, we found that 57 percent of long-term workers surveyed were considering leaving their profession due to moral distress.
The care economy depends on women’s labor
The care economy is paid and unpaid work related to caregiving, such as childcare, elderly care, and domestic chores.
Like healthcare, the care economy is predominantly made up of women. For example, in Canada, over 96 percent of early childhood educators (ECE) are women.
Jobs in the care economy tend to be poorly paid and poorly valued. ECEs felt this difference during the pandemic, noting that they are rarely mentioned in celebrations of essential workers:
“You know, they applaud the nurses, they applaud all the essential workers, but they never mention us. For example, we take care of your children and yet no one applauds us.”
The pandemic has shown how important childcare is to a strong healthcare workforce. A nurse I spoke to described how a lack of access to childcare had forced her to cut her hours by 50 per cent, and a doctor described how, due to a nanny having to self-isolate, she was called out of surgery by the school’s his child when he was ill. Midwives described leaving the field because of a lack of childcare consistent with shift work.
How the burden of care falls on women
Due to gender norms and roles in Canada, women do 1.5 times more unpaid care work than men. This means that when formal health and care systems fail, the burden is most likely to fall on women.
For example, in 2020, a mother who had recently immigrated to Canada explained how her child suffered from severe anxiety due to past experiences of abuse, but received support at his daycare.
When the daycare closed due to COVID, the child’s health deteriorated to the point where he was throwing up from stress. The mother called the nurse hotline and was told to leave her child at home for fear of a COVID infection in the hospital, leaving her to care for her sick and distressed child alone.
A single mother and community health worker has explained how she struggles to balance the needs of those she cares for at work and at home during the pandemic.
“I am a single mother. It’s how I show up in the world, it’s a huge part of how I identify. There are many things that must be done because there is no other choice. I have little people to keep alive and try to keep their sanity intact through a pretty harrowing experience. I mean, if no one else is going to show up, you can count on mom. She’s going to show up, and it’s beautiful and wonderful, but also very exploitative as hell.”
Tackling gender inequality
Although pandemic restrictions have exacerbated weaknesses in the health and care system, the side effects continue with the current crisis and are felt most acutely by frontline staff – most of whom are women. This leads to an increased risk of moral stress and burnout, which in turn fuels the crisis.
Policy responses can break this vicious cycle through increased investment in the care economy and increased mental health services for caregivers.
Improved working conditions—including flexibility, pay and benefits—in the feminized health and care sectors would empower caregivers to give their best. After all, we all rely on these women.