In Europe, women make up almost 90% of the formal care workforce, with migrant women in particular accounting for a growing share of personal care workers in health services and a majority of domestic workers directly employed by households.
The care sector, which includes a wide range of professions in education, health and welfare, is simultaneously one of the fastest growing and lowest paid in Europe. Demographic changes, including ageing populations and longer life spans, are driving the need for formal care. Yet, this essential work is undervalued, and the sector continues to be plagued by low wages, precarity, harsh working conditions, and staff shortages.
“In Czechia, women working in social services and care earn a wage 55% below the national average, keeping them in poverty despite full-time employment, with shifts often reaching 12 hours a day,” says Dana Búriková, Chair of ALICE, a trade union that organises, trains, and advocates for care workers in the country.
At the EU level, care workers rank ninth lowest in gross income out of 40 professions and recorded the second slowest income growth across all occupations from 2019 to 2023.
Importantly, not only do women constitute the majority of care workers, they are also overrepresented in lower paid positions within the sector. This is what the World Health Organization calls a “double pay penalty”.
For example, according to LevFem, an organisation working towards building connections and organising with women workers in feminised sectors, in Bulgaria, within the health and social work sectors, women’s incomes are 31.8% lower than those of men.
Similarly, in Greece, men make up a significantly larger share of leaders and decision-makers within the long term care sector.
Gender stereotypes and segregation in employment
Persisting gender stereotypes associating caregiving with women are at the basis of this stark overrepresentation in the care sector and within lower paid roles, restricting career choices and promotions. In Europe, three out of four graduates in health and welfare programmes and four out of five in education are women.
At the same time, stereotypes about women’s supposed natural propensity for caregiving also serve to justify the harsh working conditions within the sector.
“Women are seen as possessing ‘natural qualities’ that make them more suited to providing care,” according to LevFem’s report Who Cares? Feminised care labour and the crisis of social reproduction in post-socialist Bulgaria. These notions have an impact on the material conditions of care work, normalising self-sacrifice and exploitation.
The persistence of these norms also means that women still shoulder most of the burden of unpaid care, so care workers frequently perform a “double shift”, coming home from their jobs to look after children and older family members.
Intersecting discrimination
As highlighted in a recent report, care work is also distributed differently between women. In fact, some of the worst work conditions in the sector – irregular hours, low pay, lack of legal protections, isolation, risk of violence – are experienced by domestic workers, most of whom come from migrant backgrounds.
“Migrant women are at an even greater disadvantage and are more hesitant to join workers’ associations. This leaves them vulnerable and more prone to end up working under more precarious conditions, which characterise the care sector,” explains Dana from ALICE.
What care workers need right now
In Bulgaria, the term ‘care work’ is not widely used and the care sector is not generally recognised as a unified field. Based on 40 in-depth interviews with professionals working in education, health and social work, LevFem’s study Who Cares? captures not only the shared challenges, uncovering their structural nature, but also the needs and demands of care workers in a context where this has, so far, been missing.
The research, supported by the Alliance, found that care workers need recognition, professionalisation, unionisation, regulated working hours and paid overtime, increased public awareness about the importance of care work, and coordination among sectors to advance common demands.
“As a feminist organisation, we see the struggle for dignified care work as an antidote to the onslaught of far-right politics. Conservative propaganda that pushes women back into the domestic sphere is used to justify low-paid labour and the neglect of collapsing public systems of care,” explains Darina Kokonova from LevFem.
These findings underpin LevFem’s ongoing evidence-based advocacy work, culminating in the first-of-its-kind nation-wide petition for better labour conditions for care workers and improved quality of care for all.
The power of collective action
Meanwhile, in Czechia, collective organising is already showing encouraging results.
Last year, ALICE, with the support of the Alliance, signed four collective bargaining agreements, including with one of the largest employers in the private long-term care sector in Central Europe, improving the working conditions and wages of around 6,700 care workers.
The organisation strives for care work to be recognised as the critical, demanding, and valuable work that it is and for care workers to be treated accordingly.
“Social work and care are indispensable for both individuals and society as a whole, and we believe that dignified conditions are deserved not only by the recipients of this care, ie our clients, but by all those who perform this demanding, important and great work,” adds Dana from ALICE.
The bargaining agreements were negotiated by women care workers, trained by ALICE in labour law and empowered to represent their own interests. When care workers realise their own strength and become leaders, they can also secure better working conditions and create lasting change.
ALICE now has its sights set on sectoral negotiations, hoping to further expand the coverage of these agreements.
Main photo by National Cancer Institute.
In-article photo by Phillip Goldsberry.