TYPE
Mini Review
18 July 2023
10.3389/fsoc.2023.1195790
PUBLISHED
DOI
OPEN ACCESS
EDITED BY
Delali A. Dovie,
University of Ghana, Ghana
The concept of informal care:
ambiguities and controversies on
its scientific and political uses
REVIEWED BY
Zafar Nazarov,
Purdue University Fort Wayne, United States
*CORRESPONDENCE
Sofia Alexandra Cruz
sacruz@fep.up.pt
28 March 2023
29 June 2023
PUBLISHED 18 July 2023
RECEIVED
ACCEPTED
Sofia Alexandra Cruz1*, José Soeiro2 , Sara Canha3 and
Valentina Perrotta4
1
Faculty of Economics, University of Porto, Porto, Portugal, 2 Faculty of Arts, Institute of Sociology,
University of Porto, Porto, Portugal, 3 Centre for Research in Anthropology (CRIA), University Institute of
Lisbon (ISCTE), Lisbon, Portugal, 4 Faculty of Social Sciences, University of Republic of Uruguay,
Montevideo, Uruguay
CITATION
Cruz SA, Soeiro J, Canha S and Perrotta V
(2023) The concept of informal care:
ambiguities and controversies on its scientific
and political uses. Front. Sociol. 8:1195790.
doi: 10.3389/fsoc.2023.1195790
COPYRIGHT
© 2023 Cruz, Soeiro, Canha and Perrotta. This
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provided the original author(s) and the
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original publication in this journal is cited, in
accordance with accepted academic practice.
No use, distribution or reproduction is
permitted which does not comply with these
terms.
Starting from an analysis of the scientific and political uses of the concept of
informal care, this paper raises questions and launches the debate on the causes
and effects of its uses. Recognizing the diversity and the contradictions found
across the use of the term, it explains how its predominant use in Europe can be
problematic. First, although it is widely recognized that care is provided primarily
by women, this gender dimension is not emphasized in a concept that obscures
the sexual division. Second, it does not render explicit that informal care is
work, despite being unpaid. Third, the allusion to informality is likely to generate
confusion with informal employment of care workers. Finally, studies often focus
exclusively on care provided by family members, without distinguishing the spaces
in which the work takes place and the social relationships it involves, namely
the family or community. In Europe, where documents from (non)governmental
organizations focus mainly on long-term care related to demographic aging, it
is the care crisis of formal care provision systems, faced with financial fragility,
reduction in funds and insufficient supply to meet the demand, that brings
informal care to the political and scientific agendas. This paper argues that it is
necessary to define conceptual boundaries that allow international studies on the
dimension and value of this care work to be compared. It also advocates the
importance of making visible that this is work, unpaid and female-dominated,
since this view supports action guidelines more focused on social transformation
and empowerment.
KEYWORDS
informal care, unpaid care, scientific uses, political uses, public policies, gender inequality
Introduction
The scientific literature addressing care and the role of informal care has gained
prominence in social sciences, particularly in analyses of long-term care systems and the
relationships between formal and informal care (Greve, 2017; Verbakel, 2018; Barczyk and
Kredler, 2019; Ariaans et al., 2021; Da Roit, 2021; Albuquerque, 2022; Tinios et al., 2022),
care and welfare regimes and policies (Anttonen and Sipilä, 1996; Bettio and Plantenga,
2004, 2008; Ferrera, 2012; Torres et al., 2012; Albertini, 2014; Frericks et al., 2014; Batthyány,
2020), as well as the economics of care (Zelizer, 2011), the role of care in social reproduction
(Bhattacharya, 2017) and the ethics of care (Tronto, 2013).
The current context of demographic, social and labor transformations has given care
greater public visibility and put pressure on the reorganization of public care policies,
which can be seen in the growing production of European, Latin American and Caribbean
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international reports and recommendations on long-term care
(IACO, 2018; Spasova et al., 2018; EC, 2021a; Rocard et al.,
2021; UN Women and ECLAC, 2021; ECLAC, 2022; PE, 2022)
and, in particular, on informal Care (Zigante, 2018; EC, 2021b;
Rocard and Llena-Nozal, 2022). On the other hand, changes in
gender relations have given visibility to the naturalization and
accountability of women as careers. These phenomena, together
with the shortage of accessible and good quality public care services,
have raised the debate on the sustainability of social protection
systems, constituting what has been called the care crisis (Tronto,
2005; Orozco, 2006; Ezquerra, 2012; Fraser, 2017; Batthyány and
Sol Sánchez, 2020; Dowling, 2022).
The study of the specific role of informal care has benefited
from approaches that seek to locate it in a care diamond (Razavi,
2007), consisting of the State, the market, the community and the
family. The social relations of informal care have also been viewed
from an angle of the circuits of care (Guimarães, 2020), particularly
in two of them: care as obligation, within the framework of family
responsibility, and care as help, based on group or community
reciprocity (Guimarães, 2020; Guimarães and Vieira, 2020). The
reference to informal care refers to the provision of care to people in
situation of dependency by family members, friends and neighbors
(Lage, 2005; EC, 2021b). A comprehensive concept of care and
provision of care (Laugier and Paperman, 2009; Molinier, 2013)
makes it possible to capture the heterogeneities that differentiate
classes and social groups in this provision (Kergoat, 2016) and to
identify distinct modalities of social organization of care according
to national contexts (Hirata, 2021; Aranco et al., 2022). This
asymmetrical combination in each national reality of the different
vertices of the care diamond coexists with common modalities of
devaluation of informal care.
This article aims to critically analyse the use of the concept
of informal care in academic and non-academic vocabulary.
Recognizing the diversity and even the contradictions present in its
uses, we argue that this concept is problematic in four dimensions:
it makes the gender cut and sexual division invisible; it does not
render explicit that we are dealing with work, regardless of its
unpaid nature; the reference to informality may lead to confusion
with the informal employment of care professionals; it does not
distinguish the spaces in which this work takes place and the social
relationships involved, namely the family or community.
friends or community members, and in professional relationships
within the labor market (EC, 2021a; Jegermalm and Torgé, 2021;
Rocard and Llena-Nozal, 2022).
This ILO (2018) understanding of the broad sense of care,
although advocated by other organizations (Eurofound, 2020; EC,
2021a), is not always shared between researchers and organizations
particularly with regard to informal care (Rutherford and Bu,
2018). According to IACO∗ (2018), informal care is defined as
unpaid care provided by family members, neighbors, friends or
significant others who play the role of career to support someone
with declining physical capacity, debilitating cognitive condition
or life-limiting chronic illness. According to this perspective, care
is defined from a relational dimension of support due to illness,
disability and impairment, which implies a responsibility toward
someone’s life and wellbeing, and does not explicitly include
non-relational tasks, namely domestic tasks. The diversity of
conceptualizations about informal care is reflected in the guidelines
adopted by different countries (Batthyány et al., 2017; Hirata, 2020;
Araújo and Soeiro, 2021; Redondo and Benencia, 2021; Failache
Mirza et al., 2022).
Since most informal care is performed by family members,
mainly by women, the concept is often limited to particular types
of relationships, namely family and household relations. Most of
the literature focuses on family relationships, the studies on marital
and filial relationships in the provision of care being dominant
(Wagner and Brandt, 2018; Uccheddu et al., 2019; Bertogg and
Strauss, 2020; Heger and Korfhage, 2020; Mazzotta et al., 2020).
There are few studies that seek to examine other spheres of
relationships in the provision of care (Larkin et al., 2019) and
care within the community, which contributes to the dominant
understanding of informal care as belonging to the universe of
the family.
Most literature on care regimes and reproductive work
understands what has been called informal care as unpaid work
historically made invisible, being part of a widespread problem
of devaluation of care work and gender inequality. By contrast,
the literature on long-term care (LTC) systems in a context of
demographic aging places the emphasis not on the recognition
of informal care as unpaid work, but on the recognition of its
social value and its importance for the sustainability of care systems
(EC, 2021a; Tinios et al., 2022). Studies in the areas of health and
social policies and aging analyse different aspects associated with
informal care—the impacts on health (Verbakel, 2018; Zigante,
2018; Skinner and Sogstad, 2022), the role of gender (Uccheddu
et al., 2019; Bertogg and Strauss, 2020; Skinner and Sogstad,
2022), the socio-economic inequalities (Bertogg and Strauss, 2020;
Verbakel et al., 2022), the variation in the educational levels of
informal careers (Lera et al., 2020; Rodrigues and Ilinca, 2022;
Rostgaard et al., 2022).
Informal care: scientific and political
uses
The concept of care is multidimensional and constructed from
distinct disciplinary, legislative and political frameworks, which
potentiates considerable ambiguity and controversy (Glenn, 2016;
Durán, 2018; ILO, 2018; Borgeaud-Garciandía and Guimarães,
2020; Fraser, 2020; Hirata, 2021; Tur-Sinai et al., 2022). Care work
encompasses direct, personal and relational care activities, as well
as indirect care activities (ILO, 2018). The former refers namely to
support activities provided to people in situation of dependency,
while the latter encompasses organization, preparation, tidying and
cleaning tasks. The provision of this care can be paid or unpaid,
have a short, medium or long-term duration, and take place within
the family, within non-market relations of mutual help among
Frontiers in Sociology
Informal care and inequalities: labor
market, families and state
In addition to population aging, the rising retirement age
(Starr and Szebehely, 2017; Mazzotta et al., 2020; Lam et al.,
2022) has also caused pressure on informal caregivers. Most
working-age informal careers combine care with paid work, but
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10.3389/fsoc.2023.1195790
They highlight the insufficiency of measures to support informal
careers (Lorenz-Dant and Comas-Herrera, 2021) and the lack
of data that would allow better knowledge of the phenomenon
(Rocard and Llena-Nozal, 2022). Its impacts on gender inequality
have received attention, including the increased workload of care
for women, and there is a growing emphasis on the need to
value care work (Bahn et al., 2020; Power, 2020; Seck et al.,
2021; Camilletti and Nesbitt-Ahmed, 2022) and to address the
intersection of gender, race and class inequalities (Lokot and
Amiya, 2020; Osorio-Parraguez et al., 2022). A clear distinction
in the approach to care according to the type of concept used
is expressed in this literature. The concepts informal care/family
care are used in the literature that underlines the social value of
care and the need to support these careers as co-producers in
the care system. The concept unpaid care predominates in the
literature that emphasizes the inequalities in the provision of care
and that explicitly recognizes the value of care as work. That is
the predominant approach in Latin America, in which research
has sought to identify the different unpaid activities as components
that contribute to social wellbeing in the same way as paid work.
In this process of recognition and visibility, care work has begun
to gain prominence among other types of unpaid work (Aguirre
et al., 2014; Batthyány, 2020). It should be noted that the main
distinction made in feminist academic studies that address care
provision has been whether it is paid or unpaid. They adopt a
political stance of transformation, based on denouncing the impact
on women’s rights of taking on the majority of unpaid care work,
particularly those with lower socio-economic status (Batthyány
et al., 2017).
the employment rate declines with the intensity of care provided
(EC, 2021a). Several recent studies have addressed the challenges
and impact of care responsibilities on employment (Burch et al.,
2019; Moussa, 2019; Clancy et al., 2020; Spann et al., 2020;
Charmes, 2022; Lam et al., 2022). The impact of different labor
market relationships on care is less studied (Mazzotta et al., 2020;
Koreshi and Alpass, 2022). Different studies address the role of
gender in the type of care provided and the consequent impact
in jobs and earned income (Heger and Korfhage, 2020; Hsu
et al., 2020; Peña-Longobardo et al., 2021; Hanson, 2022). The
growth in the number of studies on employment and informal
care shows a greater concern to support informal caregivers
and help them stay in employment, and less concern to reduce
their burden through redistributing care. Although the reduction
and redistribution of care are key aspects in the European
and international recommendations (ILO, 2018; Women, 2018;
European Parliament, 2022), the vast majority of studies referred
to focus on the impacts and promotion of informal care as coproducers of wellbeing in care systems and adopt a gender-blind
approach. With an overriding understanding of informal careers
as “genderless” family members, gender inequality is frequently
invisibilised. Even though the impact of policies on gender relations
is present in some studies (Szebehely and Meagher, 2018; Eggers
et al., 2020; Hansen and Dahl, 2021), other types of inequalities,
particularly socio-economic and ethno-racial, are little addressed
(EC, 2021b).
Informal careers do not always perceive themselves as such,
often because they consider the assistance provided as something
that is expected within their social and family context (Rocard
and Llena-Nozal, 2022). In this sense, it is important to recognize
that informal careers are not a homogenous group as they have
different burdens and responsibilities (Jegermalm and Torgé,
2021). Despite being a fundamental pillar of LTC in most countries,
with consequences and costs for both careers and care recipients,
as well as for the care sector in general (Ribeiro et al., 2021; TurSinai et al., 2022; Charalambous, 2023), informal care is often
overlooked, which makes the exercise of quantifying it difficult
(Rutherford and Bu, 2018; Cès et al., 2019; Tur-Sinai et al., 2020).
Several studies have endeavored to assess the economic value of
these tasks provided as part of family ties, often unrecognized
although they have been increasing (Hoefman et al., 2018; OlivaMoreno et al., 2019; EC, 2021a; Ekman et al., 2021; White
et al., 2021). Male and female time-use surveys (Rutherford and
Bu, 2018; Folbre, 2021; Ribeiro et al., 2021) rightly highlight
the need to consolidate definitions and classifications in order
to build more coordinated and comparable approaches. Thus,
the exercise of quantifying the economic value of this type of
care does not appear to be a simple task, clearly due to the
different methodological approaches used (Hanly and Sheerin,
2017; Durán, 2018; White et al., 2021; Perista and Perista,
2022).
The COVID-19 pandemic has expanded the attention and the
number of studies on pandemic impacts on LTC systems (Rocard
and Llena-Nozal, 2022) and on informal care (Dugarova, 2020;
UN Women, 2020a,b; Eurocareers/IRCCS-INRCA, 2021; LorenzDant and Comas-Herrera, 2021) has increased, mainly nationwide
studies (Chan et al., 2020; Moré Corral, 2020; Phillips et al., 2020;
Cohen et al., 2021; Rodrigues et al., 2021; Madia et al., 2023).
Frontiers in Sociology
Informal and formal care: a network of
interactions
The analysis of the role of informal care has been made
in the light of different care and welfare regimes, permeable to
movements of defamiliarization and re-familiarization (Le Bihan
et al., 2019; Da Roit, 2021; Cheneau and Fargeon, 2022). When
these regimes are compared, it is possible to distinguish various
models of interaction between informal care, with a family and
community nature, and formal care, in the form of market services
or public provision.
Comparative studies have highlighted national differences in
the institutional variations of the welfare mix, the prevalence of
health or social care and their articulation, the role of the family
and community, and the uneven development of social responses
for unpaid careers (Emilsson, 2009; Brimblecombe et al., 2018; EC,
2021a; Hirata, 2021). Some studies suggest that the incidence and
intensity of informal care is negatively correlated with formal care
provision (Barczyk and Kredler, 2019; EC, 2021a; Hollingsworth
et al., 2022). Others observe complementarity regarding formal
home care and informal care (Rapp et al., 2022; Tinios et al.,
2022). Verbakel (2018) notes that the generosity of formal care
varies the intensity of care, but that informal care is always
present. Courbage et al. (2020) draw attention to the fact that
the effect of public benefits on informal care depends on the
typology of public coverage for LTC. In response to authors who
considered policies that support extrafamily care as defamiliarising
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and policies (or lack thereof) that promote informal care provision
by relatives as familiarizing (Leitner, 2003, 2014; Saraceno, 2010,
2016), different authors have argued that these represent two
different types of policies that can vary relatively autonomously
from each other, that we can expect different combinations of
both types of policies, and that they will have varying effects
on gender equality (Eggers et al., 2020) and on socio-economic
inequalities (Verbakel et al., 2022). The disparate findings on
complementarity or substitution between informal care and formal
care of different types can be justified by the use of different
variables of analysis (Verbakel, 2018; Barczyk and Kredler, 2019),
and cultural factors may also contribute to explaining crossnational differences in people’s care behavior (Spann et al., 2020;
Tinios et al., 2022).
International comparison of data on the number of informal
careers of people with LTC needs does not allow for unambiguous
information. This difficulty becomes explicit when comparing, for
example, the results of the European Health Interview Survey, the
European Quality of Life Survey and the Study on Health and Aging
in Europe, which show different results for the same countries
(Tur-Sinai et al., 2022). In addition to the difficulty in measuring
the real universe of informal careers, there is the ambiguous place
they occupy in public policy: they are sometimes perceived as
a resource of care policies, sometimes as co-producers of care,
and sometimes as co-beneficiaries of care policies (Cheneau and
Fargeon, 2022).
The role of informal careers for LTC policies has been
internationally highlighted (Fiest et al., 2018; UNECE, 2019). In
the European framework, reference to care first appeared in the
context of health and childhood and, in recent decades, longterm care and the promotion of gender equality (di Torella and
Masselot, 2020). In 2022, a Resolution for a common European
action on care was adopted (European Parliament, 2022) in which,
among other actions, the European Commission is urged to present
a status and support for informal careers, and Member States
to consider formalizing informal care. The Latin American and
Caribbean region is discussing the implementation of national
care systems as a result of the positioning promoted by the
feminist movement together with the academia and the various
commitments made by States in the regional gender agenda
derived from the Regional Conference on Women of the Economic
Commission for Latin America and the Caribbean (CEPAL, 2021,
2022).
example, the European Directive on work-life balance for parents
and careers (Directive (EU), 2019), states that each worker should
have the right to careers’ leave of five working days per year,
should be able to adapt their working schedules to their needs
and preferences, and request flexible working arrangements, to
remain in the work force. The importance of the category of
informal careers in public policies is also the result of social
mobilization of this group (Poch, 2017; Soeiro and Araújo,
2020).
Among the main policies on informal careers the following
were identified: their legal recognition within the framework of
care systems; direct cash benefits to careers or indirect care
allowances, through the recipients of care and tax benefits; paid
and unpaid leave and flexitime measures for workers-careers;
psychological support and support groups; training and capacity
building; assistive technologies; services provided to the people
cared for as forms of support and redistribution of the work of
informal careers, particularly home support and carer respite by
sending the person cared for to long-term care facilities, under
the health systems, social support structures or local authorities
(Brimblecombe et al., 2018; Spann et al., 2020; Da Roit, 2021; EC,
2021a; IACO, 2021; Koreshi and Alpass, 2022). Policy measures
differ according to national reality, namely regarding: the scope
of the concept of informal carer, who may only be someone
with family ties (Spain, Portugal, Denmark) or include other ties
(Australia, France, Germany, UK, Finland); the duration of unpaid
leave; the existence of paid leave, its duration and scope (only
family members or not); the type of support equipment available.
There has been important debate on referral criteria and how
selective is the access (namely through determining the dependency
of the person cared for or the socio-economic status of careers
and dependent people); the integration between systems and the
coherence of care policies; and the impact of the economic and
pandemic crises on LTC (Da Roit, 2021; EC, 2021a; IACO, 2021;
Cheneau and Fargeon, 2022).
Based on the literature on informal care, we identified three
critical aspects in the uses of the concept in public policies. First,
the porousness and blurring of the boundaries of the concept
allows for very different operational definitions, which makes
it difficult to compare international studies on the dimension
and value of this type of work. Second, the choice of the term
“informal care,” rather than “unpaid care work” mainly done by
women, may render unequal care regimes natural and provide a
basis for action orientations focused on individual empowerment,
self-care and training, rather than on social transformation.
Third, there is a contradiction between the apparently broader
description of informal care and its operationalization for the
purpose of access to policies supporting careers. These are
often based on a narrow concept of informal care that only
recognizes family care. In addition to disregarding community care,
they may contribute to concealing the dynamic that reinforces
(re)familiarization currently present in the social organization
of care.
As we have seen, the concept of informal care is scientifically
unstable and its use in public policies is delicate, particularly
because it does not allow us to distinguish what is intended to
be transformed as regards its informality. If we recognize the
Public policies for informal careers:
framings and limitations
The justification for the public policy measures on informal
careers has been based on the need to mitigate the negative
consequences of informal care, namely those related to the risk
of poverty and physical and mental health deterioration (Bom
et al., 2019; Kim, 2020; EC, 2021a; European Parliament, 2022)
as well as those that have to do with employment, absenteeism,
abandonment and absence from the labor market, difficult reentering into that market, the need to promote a balance between
care and work that results in extending careers (Bauer and SousaPoza, 2015; OECD, 2019; EC, 2021a; Grünwald et al., 2021). For
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Funding
existence of this unpaid care and work to build its capacity and
to make the conditions of informal careers legal, but do it without
considering its remuneration or the disproportionate distribution
of this work by gender, a reproductive effect on inequalities is to
be expected. On the other hand, aspects such as the level of wages
or the working conditions are also frequently missing when formal
care, that is care provided by professionals, is referred. Concepts
should make it possible to describe and understand the social
phenomena, as well as to contribute to their transformation. The
formal/informal binomial, as a useful category when thinking about
care and classifying it, tends to obscure central dimensions of the
phenomenon, rather than elucidate them. In this paper, we intend
to contribute to the questioning and critical overcoming of this
binomial by the research and intervention agenda in this area.
This work was funded by the Foundation for Science and
Technology under Project UIDB/00727/2020.
Conflict of interest
The authors declare that the research was conducted in the
absence of any commercial or financial relationships that could be
construed as a potential conflict of interest.
Publisher’s note
All claims expressed in this article are solely those of the
authors and do not necessarily represent those of their affiliated
organizations, or those of the publisher, the editors and the
reviewers. Any product that may be evaluated in this article, or
claim that may be made by its manufacturer, is not guaranteed or
endorsed by the publisher.
Author contributions
All authors listed have made a substantial, direct, and
intellectual contribution to the work and approved it
for publication.
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