Care in Context

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CARE IN CONTEXT Transnational gender perspectives
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Contents
Figures and tables vi

Abbreviations and acronyms vii
Foreword by Phumzile Mlambo-Ngcuka ix
Preface by Joan Tronto x
Acknowledgements xi

1 Towards a critical theory of care 1
Vasu Reddy, Stephan Meyer, Tamara Shefer, Thenjiwe Meyiwa
Part 1: Theories and concepts of care 29

2 Revisiting the UNRISD research on the political and social economy of care:
Implications for future research and policy 32
Shahra Razavi
3 Integrating difference and care into social justice: Towards a normative
framework for care, welfare and social cohesion 52
Vivienne Bozalek
4 Care policy as government of life: Three models illustrated with Swiss examples 68
Olivier Giraud and Barbara Lucas
5 Care and social cohesion in South Africa: Political engineering versus dealing
with social discordance 86
Mpilo Pearl Sithole
6 Feminist ethics of care through a Southern lens 99
Amanda Gouws and Mikki van Zyl
Part 2: Policy imperatives and care 125

7 Parental incapacity and institutional non-responsiveness: The care framework
in prenatal and early life services in South Africa 128
Mokhantšo Makoae
8 The intersection of gendered subjectivities and child welfare discourses: An
examination of the developmental child welfare model and the child protection
model 153
Jeanette Schmid
9 The welfare mix, care and equality: Switzerland in comparative perspective 173
Michelle Beyeler
10 Private affairs: The welfare state, gender relations, and the Swiss road to
neoliberalism 190
Peter Streckeisen
11 Are men’s healthcare needs important?: A critical analysis of South African
health policy 207
Grace Khunou
Part 3: Practices and models of care 225

12 Developing a model for analysis of home-based care activities using South
African data 228
Nina Hunter
13 Gender and care in the non-profit sector in South Africa: Implications for
welfare policy 246
Leila Patel
14 To care and to be cared for: The role of elderly people in the Swiss care regime 265
Brigitte Schnegg, Sabin Bieri and Andrea Kofler
15 Faceless bureaucracy?: The challenges of gender-based violence and practices of
care in higher education 282
Anthony Collins
Part 4: Narratives of care 305

16 Narratives of gender and practices of care among young people in
contemporary South Africa 308
Tamara Shefer
17 ‘I am a male, although I am a little bit soft’: Men, gender, and care work in
South Africa 326
Robert Morrell and Rachel Jewkes
18 Fragile families’ experiences of caring for HIV-positive children: Selected cases
from the Eastern Cape and KwaZulu-Natal 342
Thenjiwe Meyiwa
19 Caregiving in the era of HIV and AIDS: Experiences of a South African HIV-
positive woman 359
Thelmah Xavela Maluleke
20 Early motherhood, education and childcare: Experiences of social and institutional
support among young mothers at school in Inanda, KwaZulu-Natal 376
Nomvuyo Nkani
21 Care worlds in context: Prospective perspectives for research, policy
development and public deliberation 395
Stephan Meyer, Vasu Reddy, Thenjiwe Meyiwa, Tamara Shefer
Contributors 407
Index 411
Figures and tables
Figures
Figure 3.1 Matrix for evaluating care, welfare and social cohesion 63
Figure 6.1 Sampling for case study 110
Figure 18.1 Inanda informal settlement housing structures, north of Durban,
KwaZulu-Natal 344
Figure 18.2 Typical Qweqwe village housing structures, Mthatha,
Eastern Cape 344
Figure 18.3 Typical Qweqwe village housing structures, Mthatha,
Eastern Cape 345
Tables
Table 3.1 List of human capabilities, compiled from Nussbaum 1995,
2000 and 2011 58
Table 6.1 Demographics of participants 112
Table 6.2 Gender and sexuality profiles of care recipients and caregivers 113
Table 6.3 Gender profiles of participants in focus groups 113
Table 9.1 Child-care situations in different European countries (type of care
in percentage of all respondents with children under 12) 180
Table 9.2 Income distribution in OECD countries 181
Table 9.3 Male-breadwinner ideology and care-policy attitudes in various
European countries 185
Table 12.1 Demographic characteristics of carers and care recipients 234
Table 12.2 Proportion of daily time spent on types of care activities 236
Table 12.3 Assumptions specific to the United Kingdom and to the KwaZulu-
Natal study 240
Table 14.1 Care activities according to different age groups, 2004 270
Table 16.1 Mean minutes per day spent on unpaid care-work activities
by sex 316
Table 16.2 Mean minutes per day spent on child care by relationship to
children 316
Table 17.1 Table of informants 330
vi
Abbreviations and acronyms
AHV Alters- und Hinterlassenenversicherung (Public old-age and

survivors’ insurance)
AIDS Acquired immune deficiency syndrome
ART Antiretroviral therapy
ARVs Antiretroviral drugs
ANC African National Congress
ASSA Actuarial Society of South Africa
BVG Berufliche Vorsorge (Occupational pension)
CC Community caregivers
CBC Community-based care
CBO Community-based organisation
CCTV Closed-circuit television
CD4 Cluster of differentiation 4
CEPD Centre for Education Policy Development
CG Caregivers
CHF Swiss franc
CR Care recipients
CSG Child support grant
DPO Disabled people’s organisation
DESA United Nations Department of Economic and Social Affairs
ECEC Early childhood education and care
ECD Early childhood development
EL Ergänzungsleistungen (Old-age and disability pension)
EO Erwerbsersatzordnung (Income compensation during military duties)
EPWP Expanded Public Works Programme
ESS European Social Survey
EU European Union
FBO Faith-based organisation
FSO Federal Statistical Office of Switzerland
GDP Gross domestic product
GEAR Growth, Employment and Redistribution Strategy
GHS General Household Survey
HBC Home-based care
HBCs Home-based caregivers
HCBC Home- and community-based care
HCT HIV counselling and testing
HIV Human immunodeficiency virus
HSRC Human Sciences Research Council
vii
ICD International Classification of Diseases
ICD-10 International Classification of Diseases and other Health Problems,
10th Revision
ICRW International Centre for Research on Women
ID Identification document
ILO International Labour Organisation
IPEC International Programme on the Elimination of Child Labour
IV Invalidenversicherung (Disability insurance)
KIDS KwaZulu-Natal Income Dynamics Study
KZN KwaZulu-Natal
LGBT lesbian, gay, bisexual and transgender
lgbti lesbian-gay-bisexual-transgender-intersex
MDG Millennium Development Goal
MGEPP The Men and Gender Equity Policy Project
NGO Non-governmental organisation
NPO Not for profit organisation
OECD Organisation for Economic Co-operation and Development
PLWHA people living with HIV and AIDS
PLWHIV people living with HIV
PSC Public Service Commission
PSC Public Service Contractor
R Rands
RDP Reconstruciton and Development Programme
SAKE Swiss Labour Force Survey
Samag South African Men’s Action Group
Sanac South African National AIDS Council
Sanpad South Africa Netherlands research Programme on Alternatives
in Development
Sassa South African Social Security Agency
SRC Student Representative Council
SUVA Schweizerische Unfallversicherungsanstalt (Swiss accident insurance)
SVP Schweizerische Volkspartei (Swiss People’s Party)
TAC Treatment Action Campaign
TB Tuberculosis
TP Triangle Project
UN United Nations
Unicef United Nations Children’s Fund
UNDESA United Nations Department of Economic and Social Affairs
UNDP United Nations Development Programme
UNRISD United Nations Research Institute for Social Development
US$ United States dollars
USAID United States Agency for International Development
WB World Bank
WHO World Health Organisation
viii
Foreword
The issue of care work is critical to social, economic and political discussions related to
the global achievement of gender equality and women’s empowerment.
In particular, women’s care work is vital to every national economy.
The public sector employs women as nurses, social workers, probation officers, and
caregivers for the elderly and people living with HIV and AIDS, to name a few. Many
women also work as teachers because they are seen and treated as natural nurturers of
vulnerable groups in society. In many societies women are over-represented as cleaners
in the private and public sectors. And domestic work for many women continues to be
exploitative.
It is estimated that women and girls spend approximately double the time that men do
on domestic and care work. In sub-Saharan Africa, they spend 40 billion hours a year
collecting water, the equivalent to a year’s labour by the entire French workforce. Their
burden only increases in times of economic hardship, environmental degradation,
natural disasters, health pandemics, and where infrastructure and services such as water
and sanitation are inadequate.
Women living in poverty spend more time on unpaid care work because they cannot
afford outside help or time-saving technologies such as fuel-efficient stoves. Rural areas
and slums are often cut off from public services such as preschools, health centres as well
as energy and water provision. This is both unproductive and inhumane.
An uneven and unfair division of labour means women endure the brunt of domestic
responsibilities, and their efforts are too often unrecognised, undervalued and underpaid.
This burden also poses significant obstacles to women’s access to education, training,
formal employment and other opportunities, including engagement in politics. Despite
international standards and national laws, some governments have often been slow to
implement policies that promote and protect the social and economic rights of women.
For women and girls to be able to reach their potential, the costs of caregiving need to
be more equally shared between women and men. It is encouraging that an increasing
number of governments are experimenting with new ways of responding to care needs
in their societies. Innovative approaches must be publicised and inform ongoing policy
deliberations on the post-2015 development agenda.
Governments, the private sector, international organisations and civil society must work
together and take concerted action to recognise, reduce and redistribute care work, so
that all people can fully enjoy their human rights and benefit equally from development.
Phumzile Mlambo-Ngcuka, United Nations Under-Secretary-General and UN
Women Executive Director
ix
Preface
Studying care, as care, is finally coming of age in the Western academy. For decades,
the concerns of caring were treated as adjunct to the study of families, or social
policies, or health care, or education, or even as solely historical or theological
concerns. From a Northern perspective, feminist focus on the concept of care,
beginning in the 1980s, began the demand to coalesce these concerns into one
conceptual lens, the lens of care. This remarkable collection of chapters continues
this work by combining theoretical musings about the meaning of care, from both
Northern and Southern perspectives, with concrete accounts of how care activities
are organised in South Africa and in Switzerland.
This collection makes a number of important contributions to both theory building
and to enriching our understanding of care practices. At the same time that we want to
discuss caring at an abstract level, this volume also brings us back to particular concrete,
difficult questions such as: what is the caring way for a university to face gender-based
violence? How can social reform in a federal state be fair? The comparisons between
Switzerland and South Africa in this volume suggest that while these two locales are
worlds apart, some questions of equity and justice, especially around entrenched
gendered assumptions about care, are both the same and different.
In raising these questions and addressing them in specific settings of care, the
chapters here ask us to consider what good caring might be. The editors put
the question this way in their conclusion: What would a life be like in which
instrumental relations to objects, and strategic relations to people and creatures are
surpassed by relations of care? (chapter 21, page 405). While the broader answers
to this question are beyond the scope of this volume, it is interesting to think about
the different answers the authors do offer here. For example, land ownership, argues
Mpilo Pearl Sithole (chapter 5), is essential to create solidarity that allows for care to
flourish in South Africa. Swiss authors raise questions about how democratic their
federal system can be. There will be many different lives in a world that cares well. In
the end, multiple accounts about care and caregiving will best suit different societies,
communities, and even individuals. Yet we can also say something more general. As
Ubuntu implies, care is a holistic concern. It thus presumes that economic life should
be oriented around caring for the world and others, not the other way around. There
is also a human rights dimension to this imperative: no one should be forced to
care. Whilst care should be pluralistic and flexible, in the end we will nonetheless
recognise that care is inextricably linked to justice.
Joan C. Tronto, University of Minnesota
x
Acknowledgements
This volume has had a long and protracted gestation period with its roots in a
symposium in Basel, Switzerland, in May 2010. It is fair to say that this collection
proved a somewhat larger, if also more interesting and challenging, project than
we had anticipated when we started. This also meant that it took a little longer to
complete than we had originally envisaged. As the editors, we are greatly indebted to
the contributors, both for agreeing to contribute and for their team spirit, patience
and timely responses to the meticulous review process. We also greatly appreciate
the constructive feedback by two independent peer reviewers commissioned by the
HSRC Press. Their advice and suggestions have helped significantly to strengthen
and improve upon the original draft.
This project is part of a long-standing Swiss–South African collaboration that
focuses on changes and persistences pertaining to gender in a global context. The
collaboration involves Women’s and Gender Studies at the University of the Western
Cape, Gender Studies at the University of KwaZulu-Natal, the Human and Social
Development Programme and the Education and Skills Development Programme
at the Human Sciences Research Council of South Africa, and the Zentrum Gender
Studies at the University of Basel. Early exchanges were made possible by funding
from the Swiss Commission for Research Partnerships with Developing Countries,
for which we wish to thank Jon-Andri Lys, the Swiss Academy of Humanities
and Social Sciences, and the Freiwillige Akademische Gesellschaft of Basel. The
symposium itself was funded as an International Joint Research Symposium by
the South African Department of Science and Technology, the National Research
Foundation of South Africa and the Swiss National Science Foundation.
The symposium, which was co-organised by all the editors of this book, was initiated
by Thenjiwe Meyiwa. We are grateful to the University of Basel’s Zentrum Gender
Studies, which hosted the event that provided the impetus for this publication.
We appreciate the efforts of those who supported, organised and administered the
meeting, namely Andrea Maihofer, Daniela Crescenzi and Sigrid Ayadi. We are
thankful to all the contributors to the symposium, many of whom are also authors
of chapters in this volume.
xi
The publication process has been well served by several people in a variety of ways.
We would like to thank Tracy Morison, Hannah Botsis, Tsitsi Chakauya, and Erin
MacIver for outstanding assistance. At the HSRC Press we express our sincere
appreciation for the care and meticulous attention provided by Samantha Phillips,
Patricia Myers Smith and Pippa Tsilik with the manuscript. We also thank Juliana
Veloen for her expert administrative assistance. We thank the Human Sciences
Research Council for supporting the editing process in several ways, which also
included hosting regular editors’ meetings. We also acknowledge the National
Research Foundation and the Swiss South Africa Joint Research Programme, in
particular Erich Thaler, for supporting some of our travel and meetings during
the publication phase. At UN Women we also like to thank Shahra Razavi, Nicolas
Burniat and Ann Erb-Leoncavallo for all their assistance.
Our heartfelt thanks also go to our friends, family and colleagues – your support,
encouragement and care are invaluable.
Vasu Reddy
(Human Sciences Research Council and University of KwaZulu-Natal)
Stephan Meyer
(University of Basel)
Tamara Shefer
(University of the Western Cape)
Thenjiwe Meyiwa
(Human Sciences Research Council and Durban University of Technology)
xii
1 Towards a critical theory of care
Vasu Reddy, Stephan Meyer, Tamara Shefer, Thenjiwe Meyiwa
Care is fundamental to our individual identity as this is played out in our

social interactions and relationships … Care is fundamental to who we are and
how we are viewed in both public and private spheres of life. (Phillips 2007: 1)
Care is existential – without it human beings do not live. Good care is indispensable
to the flourishing, wellbeing and prosperity of individuals and societies. The better
the care, the greater the prospects for human development. Yet, there is a persistent
disjunction between the existential significance of care and the attention given to
it. Many people habitually overlook care in everyday life and pay scant attention to
it intellectually. Perhaps this is because they have normalised its efficacy, or have
received notions about care. The price for such neglect is flawed care practices,
unsound care policies, and discordant care arrangements. On closer inspection, what
might initially seem like a mere oversight turns out to be, to some extent, strategic
disregard. Often, the significance of care is not only conveniently overlooked, but
strategically repressed. This has wide-ranging effects: care needs can go unattended
and caregiving can go unacknowledged.
The essays in this volume seek to counter the deleterious outcomes of such disregard
by means of a critical theory of care that highlights the significance of care and
contextualises it both conceptually and socially. Such a critical theory of care comprises
a constellation with at least three elements:
• an account of the social conditions that make it possible to give and receive good
care, which include the entwinements of care with related concerns such as welfare
and social cohesion;
• a critique of care discourses and regimes as forms of power in various guises; and
• fanning the embers that spark the unrealised utopian hopes which animate an
ethics of care.
With this three-fold goal, Care in Context seeks to contribute to an intellectual
tradition and public debates that move us closer towards a critical theory of care.
1
C a r e i n c o n t e x t : t r a n s n at i o n a l g e n d e r p e r s p e c t i v e s
Contexts of care: Connecting the universal, the global,

the national, and the particular
Although there is universal agreement on the indispensability of care across societies
and time, this book takes as its intellectual trajectory the idea that how care is
viewed and how it is practised depend heavily on context. A central motivation
behind this volume – in which contributions come from researchers based in South
Africa and Switzerland – is that, like justice (Fraser 2008), care too is played out on
various interlinked scales or dimensions. If we want to understand care, we need to
contextualise it in its proper dimension. In addition, we also need to connect these
different dimensions to each other. A sophisticated understanding of care requires
that we connect the universal existential dimensions of care to the global and the
national ones, and that we add to this a fine-grained analysis of particular practices,
attitudes and values in diverse settings. Establishing connections amongst contexts
will give an indication of the ways in which different care contexts may reinforce or
resist each other in sometimes surprising ways (Bisht et al. 2012; Eckenwiler 2012;
Raghuram 2012; Razavi & Staab 2012; Yeates 2011).
Besides the above-mentioned universal existential dimension of care, there are also
connections between trends that can be observed in different parts of the globe
and care on national scales. While some of these connections may correspond with
conventional wisdom on relations between European imperialism and care, others
question received opinions about directions of flow within globalisation as an
economic force and how these relate to care in different national markets. A pertinent
example is the transformation of healthcare on a global scale, and how South
Africa and Switzerland are tied to each other through these global developments.
Historically, when medical missionaries were instrumental in spreading Western
biomedical healthcare in a Christian philanthropic garb to diverse parts of the globe,
the Swiss Mission Romande founded the Elim Hospital (1899) in what is presently
Limpopo province (Mabika 2012). Today, in the age of the global marketisation
of care, this relationship has in some ways been inverted. Now, the South African
private healthcare provider Mediclinic International owns the biggest chain of
prestigious private clinics, increasingly aimed at an elite international health market
– Hirslanden – in Switzerland (Mortensen 2008).
Mounting crises of care and welfare that cut across national borders have sharpened
disagreements in various parts of the world amongst researchers, policy-makers
and members of civil society on what constitutes good care, how this should be
provided, and how it should be distributed. Economic restructuring and liberalisation,
along with recurrent financial crises, contribute to the global spiralling of costs and
dwindling of resources, with both Switzerland and South Africa, like other countries,
reporting pressures on the quality, scope and accessibility of care and welfare provision
(Campbell et al. 2000; Cook & Dong 2011; Goudge et al. 2007; Landman & Henley
1998; Macha et al. 2012; Madörin 2007; OECD/WHO 2011; Pfau-Effinger 2006;
2
t o wa r d s a c r i t i c a l t h e o r y o f c a r e
Pfau-Effinger & Tine 2011; Simonet 2010). In addition, population movements

contribute to both a care drain and a care strain in global care chains that criss-cross
continents in multiple directions (Isaksen et al. 2008; Pang et al. 2002; Schilliger
2013). Finally there are complex interrelationships between gender, care and welfare
regimes in both countries, as is reflected, for example, in the fact that in both
Switzerland and South Africa the time women devote to unpaid care work is at least
double that of men (Budlender et al. 2001; Schnegg 2009). This corresponds with
recent findings by the World Bank:
One domain where gender differences appear to be particularly persistent is
the allocation of time to housework and care. Over time and across countries,
irrespective of income, women bear disproportionate responsibility for
housework and care, while men are mostly responsible for market work.
These differences, deeply rooted in gender roles, reduce women’s leisure,
welfare, and well-being. An immediate outcome of these different domestic
responsibilities is that men and women have very different patterns of time
use and different amounts of leisure.
These patterns have implications for women’s ability to invest in education …,
their agency …, and their ability to take up economic opportunities …,
and to participate more broadly in economic, political, and social life …
(World Bank 2012: 80)
Notwithstanding very different incomes, economic structures, and social norms in
the countries the World Bank report discusses, there are striking similarities, with
women devoting ‘1 to 3 hours more a day to housework than men; 2 to 10 times the
amount of time a day to care (of children, elderly, and the sick), and 1 to 4 hours less
a day to market activities’ (World Bank 2012: 80).
A context-sensitive understanding of care requires that we add a fine-grained
analysis of particular practices, attitudes and values in diverse settings to the already
mentioned universal, global and national explorations of care. This applies to both
the African and European contexts in which individual countries have a rich diversity
of histories, cultures and traditions. Accordingly, the perception that paradigms of
care are uniform within any one country is certainly incorrect. Whilst global trends
and national care regimes frame local practices, the latter often retain inescapably
particular elements. In South Africa, for example, care concepts influenced by
African, oriental, and occidental traditions exist alongside each other, sometimes
at odds, sometimes in syncretic fusions. In Switzerland too, diverse life- and world-
views lead an often uneasy coexistence. Furthermore, in both South Africa and
Switzerland, care regimes are stratified by a plethora of social forces that combine in
various ways to produce a great diversity of everyday care practices. Some of these,
too, complement, while some contradict, each other.
This edited collection comprises original, hitherto unpublished essays, all of which
grapple with ways to overcome the persistent disjunction between the existential
3
significance of care, on the one hand, and the still limited attention that care
receives in policy and research, on the other. In bringing together diverse locally
anchored studies, this volume seeks to offer a perspective that does justice to the
aforementioned linkages amongst contexts of care: the universal context of care as
an inescapable human existential; the interlocking trends in global and national
contexts; and the contexts of particular everyday practices that shape individual
lives in innumerable ways. This aim makes for a diverse series of essays, though all
provide fresh and useful analyses on relatively little researched and theorised aspects
of care. They should therefore generate valuable insights that advance ways in which
care is researched and administered, thus promoting just care for women and girls,
men and boys.
In the next section of this chapter we briefly map the concept of care. This gives an
indication of the growing diversity in views on care, as well as care’s many dimensions
and the complexities associated with care. In the section following that, we sketch
the approach of the book, highlight some of the themes, and explain its structure.
Care matters: Towards mapping the concept

Seeking to map, unravel and interpret care as a concept, Phillips (2007: 1) proposes
that the following questions are central: ‘What is care? How would we recognise it?
Who is a carer?’ These questions are admittedly a useful point of departure. Yet, as
Phillips quickly cautions, there may not be one answer to each of these questions,
adding that it is ‘the complexity of care that has made this concept one of relevance
to a range of audiences (2007: 2).’ Research in various settings has only begun to
scratch at the surface of the rich and varied meanings of care to which Phillips
alludes. Most conceptual mapping of these meanings is still framed by Anglo-
centric North Atlantic modalities of knowledge (England 2005; Van Staveren 2005).
Yet, both within and beyond Western societies, we should be wary of assuming
that these concepts are homogenous and static across communities and time.
With its geographic locus in societies in southern Africa and continental Europe,
where anglophone scholarship is but one perspective amongst others, this volume
encourages exploration of this varied conceptual terrain. In this section we outline
aspects of a conceptual map of care as an action, a mental state and a moral value.
We discuss some of the additions and shifts in emphasis that care as a concept
has accrued in different settings and over the years. We begin with some ordinary
language analyses of popular understandings of care and then proceed to debates on
the meaning of care in humanities and social science research.
In local South African languages, there are both noun and verb forms of words for
care – describing or denoting care as a concept, an act, an attitude and moral value.
In isiXhosa, for example, the basic form for care is inkathalo. In its noun form, this
can mean assuming ‘responsibility’ or ‘charge’ over something, which is ugcino. It can
also mean to ‘take care of ’, that is, khathalela, as in ‘look after’. An extended sense
4
would also be to ‘take into care’, as in habilitate, or faka elugcinweni. The intransitive
verb for ‘care’ would be khathala, as in ‘care about’. This is also related to nanza (‘have
a like for’), thanda (‘like to have’) and khathalela (‘look after’) (Fischer et al. 1985:
83). In Sesotho the English noun care may be translated as tlhokomelo, tsotello or
paballo. All these define ‘concern’. Care in Sesotho also carries a sense applicable to
‘carefulness’ in common English, for instance in words such as ho hlokomela or ho ba
hlokolosi. This is related to paballo, tshireletso (‘protecting care’), ho tsotella (‘heed’)
and ho baballa, or ho hlokomela (to ‘take care’). It may also suggest ‘oversight’, that is,
hoba hlokolosi, or to ‘take care of ’, ho hlokomela or ho tshireletsa. As an intransitive
verb, care in Sesotho – ho tsotella – may mean to ‘feel concern’. It could also mean to
‘care about’, as in ho tsotella toka (care about justice). And it may also suggest to ‘have
an inclination’, that is, ho ba le khahleho, or to ‘have fondness’, that is, ho boulella.
These examples from two South African languages give a flavour of the number of
words or derivatives in these two languages that can be translated into different uses
of the root ‘care’ in English. They illustrate the multidimensional and multilayered
conceptual maps of the meaning of care in these languages and therefore the
multiplicity of meanings of care in different community or cultural contexts, across
time and place.
The global dominance of English impacts on care discourses, in both South Africa,
and Switzerland on the levels of everyday language use, in official documents, and in
research. In Old English, care (as a noun derived from the Germanic kar) historically
denoted a burdened state of mind. Since early modernity it has evolved to connote
meanings associated with protection, responsibility, upkeep, maintenance, attentive
assistance and treatment for those in need (Oxford English Dictionary: care). Hence
the English notion of care historically captures two dimensions that shape current
debates around care as both a burden and an expression of an attitude of dedication.
This duality in English also alludes to the roots of the contemporary dominance of
regulatory and constraining associations with care practices globally, often framed
as protection and assistance, but contested in critical accounts of the disciplinary
frameworks of late modern care regimes. Other European languages too, including
those pertinent to Switzerland, such as French and German, have their own semantic
fields that must be kept in mind when the English term ‘care’ is imposed on local
contexts or when research is communicated in English. (For some elaboration of
the German, see the outline of Heidegger’s notion of care as existential, below.)
Increasingly, though, and also arguably reflecting a certain dominance both
linguistically and politically, the English loanword ‘care’ has become widely used in
French and German debates, dislodging everyday French terms such as soins and the
German Sorge, Fürsorge and Betreuung – see, for example, Burla et al. (2010), and the
various contributions in ‘Care-Ökonomie: Neue Landschaften von feministischen
Analysen und Debatten’, a special issue of the journal Olympe edited by Madörin
and Wiederkehr (2009).
5
Recently, there has been budding interest in African notions of care. In southern
Africa, this is often connected to the concept of Ubuntu, whose spreading presence
in popular culture is evident in the growing popularity of names for a variety of care-
service providers such as the Ubuntu Crisis and Family Care Centre in eThekwini,
the Ubuntu Education Fund in Port Elizabeth, Ubuntu Care in Rwanda and Ghana,
and Ubuntu Community Services in the United Kingdom. Difficult to define, the
African concept of Ubuntu in broad strokes denotes a world-view, a philosophy of
life centred on personhood, humanity and care that emphasises interdependence and
group solidarity essential to the survival of communities (Kamwangamalu 1999).
From the perspective of Ubuntu the potential of being human has much to do with
key social values (Kunene 1996). Linguistically, this interdependence is expressed as
Umuntu ngumuntu ngabantu (in isiZulu) which, when translated literally, means that
a person can only be a person through others (see also Kuzwayo [1990: 122] for an
exploration of this proverb).
While some have emphasised the convergences between Ubuntu and an ethics of care
(Haegert 2000; Bohler-Muller 2007; Waghid & Smeyers 2012), the question remains
to what extent notions of care as expressed in Ubuntu are distinctive and compatible
with notions of care from other cultural contexts. In some ways the relational notion
of the self, which foregrounds communal bonds and a humanistic orientation towards
fellow humans, contrasts with definitions according to which care is ‘fundamental
to individual identity’ (Phillips 2007: 1, emphasis added). Yet, several authors have
also emphasised convergences, although not necessarily complete overlaps, between
aspects of Ubuntu and communal ideas from elsewhere, in particular a feminist ethics
of care (Hall et al. 2013; Louw 2001; Letseka 2012; Masango 2005). In this vein, if
we align Phillips’s idea that care is ‘an evolving concept rather than a static concept
through history and through the life course and has different meanings depending
on the cultural context’ (2007: 3) to the idea that Ubuntu ultimately directs people to
compassion, human dignity and solidarity, we may find some common ground, in
spite of the differences amongst these world-views.
The conceptual mapping of care in the humanities and social sciences encompasses
a broad range of issues including care as a fundamental existential quality; care as
action and practice; the emotional dimensions of care; care as a moral, ethical and
political value; the relevance of care to interpersonal relations of interdependence;
and the entanglement of care with social and economic arrangements. A silver
thread running through all of these dimensions of the conceptual map of care is an
overarching concern with the ways in which gender and care are linked to each other
(Filgueira et al. 2011).
The fundamental existential quality of care is a topic of philosophical analysis in early
twentieth century German existentialism, which emphasises its centrality to authentic
human existence. In describing care as an existential, Heidegger (2006) means that
care is the way in which human existence (Dasein) is fundamentally concerned with
its own being in the world. Heidegger distinguishes three interrelated meanings of
6
the German root Sorge (care), namely concern and circumspection, solicitude, and
care. Concern and circumspection (Besorgen) denote the ways in which humans
relate authentically and with care towards the inanimate world, plants and animals.
Solicitude (Fürsorge) concerns the ways in which humans authentically care for
each other. Care (Sorge) concerns the ways in which humans relate authentically to
themselves as beings who are worried about and also plan for their own future. As
care, authentic existence is that which spans the distance between birth and death
(Bunnin & Yu 2009). The relationship between care for others and care for the self
is shaped by the importance existentialism ascribes to authenticity. Thus proper care
for others should not result in dependency. Instead, proper solicitude (Fürsorge) for
others aims to enable them to exist authentically. In other words good care for others
aims to enable them to care (Sorge) for themselves (Inwood 1999: 36–37).
More recent attempts to map care conceptually have foregrounded the dimensions
of action and mental states, especially the emotional aspects of care. Attention
has also extended to care as a practice, that is, a set of patterned multiple actions
(Tronto 1993), with Graham (1983) adding that because care involves physically and
mentally demanding activities, it depends on emotional bonds and personal relations.
Hochschild (1995: 333) reconfirms this by underlining that ‘we put feeling, acting,
thought, and time into caring’, emphasising that caring presumes not just the physical
but the mental and the emotional (see also Leira 1993). Emotions, Tronto (1993)
demonstrates, are the roots of an ethic of care, which she traces to accounts of moral
sympathies in early modern Scottish thought. This still resonates in the common use
of care as an adjective in English, a semantic addition that only emerged in the second
half of the twentieth century and which highlights feelings of concern and empathy
for others, including compassion (Oxford English Dictionary: caring). This emotional
aspect is also evident in emotions of intimacy and warmth that people seek to evoke in
common expressions in everyday speech such as ‘tender love and care’ and ‘take care’.
Arguably, the conceptual map of care that the social sciences and humanities have
bestowed upon us has been shaped most by analyses of the ethical and political
dimensions that accompany care as action and mental state. This threefold
perspective is succinctly captured in the summary description of care as ‘a labour,
an attitude and a virtue’ (Kittay 2002: 259–260). The valorisation of care as a moral
value has been a central theme in moral and developmental psychology and early
care ethics (Engster 2005; Finch & Groves 1983; Gilligan 1982; Noddings 1984).
Since then, interest has expanded beyond the more personal domains of moral
psychology and ethics to engage issues of citizenship from the perspective of political
philosophy and social justice. The fact that care is shaped by normative economic and
social frameworks has increasingly been emphasised (Daly & Lewis 2000), and the
relations between a political ethics of care and public policies have received growing
attention. It has been suggested that the ethics of care factors into a variety of social
policies and institutions, and holds value in rethinking social problems (Hamington
& Miller 2006; Hankivsky 2004). Detailed case studies that address parental rights,
7
healthcare, education and public health in a broader policy context have been used
to engage the discourses of care (Sevenhuijsen 1998). The interconnections between
care on the one hand and the economy and social policy on the other are reflected
in the ways in which care is now clearly seen to be coupled to welfare:
Care is a central analytic referent in social policy: a point at which social and
cultural transformations meet with changing relations of welfare. In political
terms, too, care has become increasingly significant in a number of different
policy-relevant discourses, for example, in the move to a ‘mixed economy
of care’, in community care, in the treatment of children in care, in debates
about what constitutes good parenting, in long-term care for older people,
and in claims for the recognition of care responsibilities in employment-
based ‘work-life balance’ policies. All focus, in one way or another, on what
care means, its uses and abuses, what it costs, how it is supported, how it is
delivered, and by whom. (Williams 2001: 470–471)
Expanding the conceptual map of care even further beyond the borders of nation
states, Held (2006) makes a case that an ethics of care holds great promise to deal
with global problems.
The conceptual map of care has been fundamentally moulded by a series of
dichotomisations, some of which can be traced back to early discussion on the
ethics of care. Much of such discussion centred on the extent to which women’s and
men’s actions and attitudes are considered to be shaped by their opposing gendered
moralities. Underlying this claim is the view that women prioritise relationality over
autonomy, the latter being favoured by men, and further, correlating with this, that
women prioritise care while men emphasise justice (Gilligan 1982). The debate about
relationality versus autonomy has remained fundamental to discussions on care, with
many care theorists emphasising the primacy of relations of reciprocity and, even,
unequal dependence over autonomy as a basic element of a care ethics (see Fine &
Glendinning 2005; Kittay & Feder 2002; Qureshi & Walker 1989; Thomas 1993). On
the one hand, this debate about relationality and autonomy can be viewed as a debate
in philosophical anthropology regarding what human nature actually is. On the other,
it can be viewed as a moral debate about how people ought to live.
Not only is care an expression of an underlying commitment to relationality,
but it also contributes to the establishment, existence and flourishing of specific
interpersonal relations. In this regard some (for example Himmelweit 1999: 134)
have also pointed out that care is widely perceived to be agent relative. This means
that who performs it is relevant to a care activity. Care for a specific person may be
motivated by the pre-existing relationship to that person (for example caring for a
child, sister, spouse or loved one is central to what it means to be in a relationship as
a parent, sibling or partner, and this task cannot be carried out by just any random
person outside that relationship). In addition, caring for a specific person generates,
sustains and energises the relationship one has with that person (for example, people
8
become, and become to a larger extent, parents, siblings, spouses and loved ones
through caring for children, sisters/brothers, and partners). Importantly, who has
what kind of a care relationship with whom may be shaped not only by the degrees of
commitment to relational notions of the self, but also by different cultural and social
notions of who can have what kind of care relationships with whom (for example
how narrowly or broadly family is conceived, what kinds of notions of community
prevail, and who is considered to belong to that community) (Homan et al. 2005).
The greater involvement of the social sciences in research on care has meant an
extension of attention to the social and institutional contexts of care. Social scientists
have drawn attention to the ways in which individual relations of care do not simply
depend on personal commitments, ties and interactions, but that care crosses what are
conventionally described as the public and private spheres. Along these lines Thomas
(1993: 665) defines care as ‘both the paid and unpaid provision of support involving
work activities and feeling states. It is provided mainly, but not exclusively, by women
to able-bodied and dependant adults and children in either the public or domestic
spheres, and in a variety of institutional settings’. Hence, care is also structured by
social institutions which include but extend well beyond families and households,
by the social arrangement of roles and hierarchies, and by a myriad of social forces
in societies (Tronto 2010). As a social activity and institutionally embedded value,
care has been increasingly associated with purpose and practical effects and the
contribution it makes to improvements to the quality of life across the lifespan (Greene
2007). Correspondingly, much of the current mapping of care focuses on the structural,
cultural, economic and political contradictions within a variety of care regimes, in
particular the gender dimensions of these contradictions (see, for example, Alfers
2006; Anderson 2004; Anderson et al. 1999; Anxo et al. 2010; Budlender & Lund 2011;
Campbell-Barr & Garnham 2010; Daly & Lewis 2000; Kröger & Sipilä 2005; Matthias
& Zaal 2009; Orloff 1996; Peng 2011; Razavi 2007, 2010; Schilliger et al. 2012). Greater
awareness of the institutions and social practices that shape the giving and receiving of
care has meant a growing alertness to the distribution of care in society, who gives and
who receives how much and what types of care, and how this is related to social status,
class and opportunities in life.
The quantitative methods and findings brought along by some social scientists have
also expanded the understanding of care in new directions. This research typically
defines care as a very specific type of activity, namely as work (Nelson & England
2002), and takes an economic perspective on care work which can be measured in
terms of money and time. Social scientists examining the economies of care have
extended the conceptual map of care by adding visibility to the monetary penalties
attached to care, in particular the extent to which care is unpaid or underpaid
(England et al. 2002; O’Brien 2012). Much of this research has also underscored
the gendered bias in this skewed distribution, showing the connections between
being a woman, bearing a considerable burden of care work, and monetary penalties
(Bauhardt & Çağlar 2010). Other quantitative studies have drawn attention to the
9
connections between care and time. Analogous to the findings that highlight the
monetary penalty associated with care work, these investigations employ time-use
studies to demonstrate that women spend more time on care work than men do,
and that this is the case across a broad range of settings (Budlender 2010). These
developments in the conceptual map of care have not gone uncontested though,
with critical voices which align themselves with care ethics pointing out that such
quantification may actually contradict the whole spirit of an ethic of care.
In unpacking the social and institutional contexts of the gendered ethics of care, the
social sciences have mapped out the ways in which care and gender interrelate in the
reproduction of both vertical and horizontal stratification and of various degrees of
inclusion and exclusion (Esplen 2009). These analyses have sought to make clear the
extent to which care is socially gendered precisely because the activities engaged in by
the majority of women who produce goods and services for the wellbeing of others are
often unpaid and outside the realms of the market. In addition, they have argued that
various permutations of class and status intersect with gender in shaping care regimes
and influencing who gives and who receives what kinds of care (Bozalek 1999; Burgard
2004; Kröger 2009).
There have been attempts to supersede the gender dichotomy that shapes some of
the early mapping of care. Critics actually argue that the gendered dichotomisations
pertaining to care and the valorisation of a purported women’s morality contribute
to the vertical and horizontal stratification related to care work described by social
scientists (Maihofer 1987, 1999). Sevenhuijsen (1998), for example, points out that
aligning care to women’s morality has the effect of locking women into care tasks and
locking men out of them. In this sense a dichotomising ethics of care may undermine
the emancipation of women, and, one may add, of men. Hence Tronto (1989, 1993)
has argued that in order for care to be a useful moral and political concept, its
ideological and traditional associations as a ‘women’s morality’ must be overcome,
while Sevenhuijsen (1998) has shown how social conditions need to be reshaped to
allow for an equitable share of just care to be borne by all, irrespective of their gender.
This abridged conceptual map of care as an action, a mental state, and a value has given
some indication of a constantly evolving and contested area of inquiry. We have given
an indication of the ways in which our understanding of the many dimensions of care is
extended and complicated through the combination of different disciplinary, theoretical,
methodological and axiological perspectives. Taken together, these different perspectives
shed light on the existential quality of care for the animate and inanimate environments
that sustain us as humans, as well as the existential quality of people’s care for others, and
for themselves. They also shed light on how care as an action relates to personal identities
and interpersonal relations, to autonomy and interdependence. We have shown how
care cuts across personal lives and public issues, and how it is imbricated with cultural
beliefs and commitments as well as social arrangements and institutions. We have
observed the dichotomisations between feminine and masculine moralities and how this
is connected to social stratification. And we have noted arguments in favour of moving
10
beyond these dichotomies as a way of doing away with these stratifications. Debates
keep on shifting and positions continue to be contested. However, the way in which care
is gendered, and how political and personal practices of care both reflect and serve to
rationalise and reproduce normative gender roles and unequal distributions of labour
and power across gender and other forms of social divide and inequality, continues to
be a key area of knowledge production in social science and humanities scholarship
on care. Care therefore conjures up meanings about the material and the abstract,
absence and presence, ideas and practice, intentions and effects, something concrete and
simultaneously elusive. These descriptions reiterate the fact that – notwithstanding the
fact that it is difficult to contain what exactly is constituted by care, thus prompting us to
probe further about its idea, meaning and practices – care matters.
Overview of approach, themes and structure

Taken together, several contributions to this collection shed light on the intricate
interdependencies between care and welfare and how various care and welfare
arrangements can contribute to the erosion or enhancement of social cohesion.
They pay particular attention to gender, but also consider other mediated factors
that shape and are shaped by this constellation, such as age, health status, class, race
and identity. Some of the key questions occupying this volume are: What is care?
And what constitutes good care? How do answers to these conceptual and normative
questions relate to concrete care arrangements across private and public domains?
How does care interconnect with related issues such as welfare and social cohesion?
How do differences and inequalities shape the dilemmas of social justice and care,
and how does care impact on the production of difference and (in)equality? How
is an ideal care mix achieved, which involves individuals, families and households;
states; not for profit organisations (NPOs); and markets? And how is this care mix
framed by trends in local and global contexts? What do detailed case studies of
localised care practices reflect about Switzerland and South Africa as states in which
an initially very limited understanding of welfare is gradually expanding, although
this is not linear and there have also been some setbacks?
Approach
In seeking to address these questions, the present volume takes a longitudinal,
multidisciplinary, intersectionalist and multiple setting approach to care.
The perspective on care taken in this volume is longitudinal in three ways. Firstly, it is
assumed that the growing intellectual and policy attention given to care has emerged
in a specific historical constellation propelled by feminist discussions that are presently
unfolding in new terrains. Secondly, the volume is informed by the view that notions
of care and care practices change over time. Historical changes in gender identities
and arrangements, as well as economic changes and changes in social policy (for
example the expansion or shrinking of welfare services and welfare payments) impact
11
upon and are in turn influenced by notions of care. Finally, the giving and receiving of
care concerns the whole life course, from conception to death. Different contributors
foreground different moments in the life course, while others emphasise the relevance
of care over the lifespan as a whole. The importance of care over the timespan of the
whole life course enables an understanding of how care changes in different phases of
individuals’ lives. It also draws attention to the ways in which social institutions shape
both the life course and notions of care that operate in different stages of the life course.
The authors write from the perspectives of a variety of disciplines and areas, such
as anthropology, education, gender studies, philosophy, policy analysis, political
science, psychology, public health, sociology and social work. This disciplinary and
conceptual diversity reflects an important evolution in investigations on care. It shows
that there is a growing awareness that care is relevant to diverse aspects of society and
life. In addition, such a multidisciplinary approach generates multifaceted analyses
that escape disciplinary bias and simplification. Finally, it invites identification of the
continuities between domains that are still often severed from each other, such as
social care and healthcare.
Whilst the approach is broadly intersectionalist, particular emphasis is given to
gender. One reason for the priority given to gender is the fact that the present
mounting awareness of the significance of care is impossible to imagine without
feminist scholarship on gender and care, which has been accumulating since the
last two decades of the twentieth century. A second reason for prioritising gender is
the fact that it continues to have a major impact on how care is conceptualised and
who gives and receives which forms of care. At the same time, the conceptualisation
of care along with care practices and roles continues to shape gender orders. The
volume does not, however, focus on gender in isolation. It is assumed that gender is
always interwoven with and shaped by other forms of difference and social divides,
including inequality. Hence, while gender is foregrounded, readers are encouraged
to consider the interrelations amongst care and a variety of social structuring factors,
such as generation, race, class, ethnicity, nationality and health status.
We have noted above that, whilst the need for and provision of care are indispensable
universals, this volume takes a multisetting perspective on care. It reflects the
conviction that the ways in which care needs are articulated and how these are
responded to are historically, economically, politically, socially and culturally inflected.
This is a central point of this volume, which to some extent follows the approach
of methodological nationalism, with Switzerland and South Africa delineating the
geographical contours of chapters. This multisetting approach further builds on the
multinational research project on the Political and Social Economy of Care conducted
by the United Nations Research Institute for Social Development (UNRISD),
which has foregrounded the ways in which policies and practices of care relate to
development and how they continue to reflect and reproduce gender and forms of
social inequality. The multicountry UNRISD study included the two countries focused
on in this volume – South Africa and Switzerland – along with Tanzania, Argentina,
12
Nicaragua, South Korea, India and Japan. The arguments and findings emerging
from the UNRISD project have stimulated a growing interest in care arrangements in
diverse settings. Switzerland and South Africa, from neighbouring continents, differ
radically in many respects, including the specific care-related needs and problems they
face, the resources at their disposal, and the ways in which they seek to address these
problems. Some basic statistics on health and social care below give a flavour of this.
Data on life expectancy and health status suggest a major healthcare deficit in South
Africa when it is compared to Switzerland. For 2013, life expectancy at birth in South
Africa is estimated at 57.7 years for males and 61.4 years for females (Statistics South
Africa 2013). In Switzerland it was 80.2 for males and 84.6 for females born in 2010
(Bundesamt für Statistik Lebenserwartung n.d.). With an under-5 mortality rate
(deaths per 1 000 live births) of 50 for males and 44 for females, South Africa ranked
well below Switzerland’s 5 for males and 4 for females reported for 2010 (Unicef n.d.).
In South Africa the total number of people living with HIV was estimated at 5.26
million in 2013. For adults aged between 15 and 49 years, it was estimated that 15.9
per cent of the population is HIV positive (Statistics South Africa 2013). According
to Statistics South Africa (2011), 25 per cent of deaths were attributed to ‘certain
infectious and parasitic diseases’, with the Medical Research Council declaring HIV/
AIDS as the main cause of death (Norman et al. 2006). In Switzerland, the main causes
of death are cardiovascular disorders and cancer (Bundesamt für Statistik 2008).
Social inequality and dependency ratios differ considerably between Switzerland and
South Africa. This reflects different relations within the population between those
whose care needs are unmet and those who have the financial capacity to access paid
care. This gives an indication of social cohesion as a silent cause and effect of how
care is arranged. Switzerland is a high-income country with an average household
income of CHF (Swiss francs) 7 621 (that is, R (rands) 75 000) per month reported
for 2011 (Bundesamt für Statistik Haushaltseinkommen und -ausgaben n.d.).
South Africa is classified as a middle-income country with an average household
income ranging from R5 610 (CHF530) for female-headed households to R10 695
(CHF1 010) for male-headed households (Statistics South Africa 2012). The Gini
coefficient for Switzerland in 2011 was 29.7 (Bundesamt für Statistik 2011); for
South Africa it was 63.1. In South Africa, 26 per cent of the population live below the
international poverty line of US$1.25 per day. In Switzerland 6.8 per cent of children
live in poverty, which is defined as below CHF4 600 per month (US$40 per person
per day) for a household of four. While the working poor in Switzerland comprised
only 3.8 per cent of the population in 2008, recent figures that reflect the current
economic downturn can be expected to be higher. In South Africa nearly one-third
of the population is below 15 years, and 7.5 per cent is above 60. In Switzerland the
relationship is inverted, with 15 per cent of the population below 15 years, and 16
per cent above 65 years; this is expected to rise to 24 per cent in the next 20 years.
In Switzerland, the dependency ratio – defined as the population above 65 years old
in relation to that between 20 and 64 years – was 24.9 per cent in 2000 (projected at
13
42 per cent for 2050) (Bonoli et al. 2007). In South Africa the dependency ratio is
53.29 per cent. According to official records, unemployment in South Africa stood at
24 per cent in the latter part of 2010. In Switzerland it was estimated at 4.6 per cent.
Correlating to the distribution of income, access to highly developed technology is
widely spread throughout the Swiss population; in South Africa highly developed
infrastructure is available but it is much more unevenly spread. As the material base,
along with infrastructure and technology, plays a considerable role in how much
time is devoted to care, this is a difference with far-reaching implications.
South Africa and Switzerland differ considerably concerning welfare provision. This
reflects different understandings of care and has significant impact on the meeting of
care needs. The South African welfare regime is described by some as developmental
(DoW 1997; Hassim 2006, 2008; Lund 2008; Patel 2008; see also Seekings (2005) for
a proposed typology of southern welfare regimes.) In South Africa 30 per cent of the
49.9 million population received some form of social grant in 2009, although the
amount of such grants is relatively low. In 2011, children on the child support grant –
which is means tested and amounted to R260 per month – accounted for 70 per cent
of all people on social welfare. Old-age pension – which is means tested and amounted
to R1 140 a month – beneficiaries accounted for only 18 per cent of all people on
social welfare. As a total, the largest proportion of grant expenditure (39 per cent) was
devoted to old-age pensions, whilst the child support grant accounted for 36 per cent
of total grant expenditure, according to the South African Institute of Race Relations.1
Switzerland is often categorised as a liberal–residual welfare regime. The proportion
of the population receiving welfare (which includes unemployment, social assistance,
subsidies for accommodation and medical aid) ranged between 5.6 per cent for the
canton of Basel to as low as 1.1 per cent in the canton of Grishon.2 In addition, there
is universal, employment-related old-age provision in the form of a state pension that
covers basic needs, and child cash transfers that are independent of caregivers’ means
and are automatically paid out to them. These ‘dry’ statistics give some indication
of the care and welfare regimes as well as aspects of social cohesion that frame the
examination of theory, policy and practice in the contributions to this volume. Even
though these statistics are only a basic starting point, they give an indication of some of
the indispensable quantitative data that need to be integrated with the predominantly
qualitative inquiries in this collection so as to achieve the multifaceted understanding
that is needed to promote caring societies. Given the differences and similarities between
South Africa and Switzerland outlined in this introductory chapter, the global, national
and local dimensions of analyses of the policies and practices of care, and the underlying
conceptualisations that shape care arrangements, warrant further investigation.
Themes
Key arguments in this volume coalesce around the following themes in the evolving
scholarship on care: (1) promoting change through improved visibility of care;
(2) elaborating nuanced profiles and identities of caregivers and care receivers;
14
(3) developing a complex understanding of the intermeshing of the four sectors of the
‘care diamond’ – that is, families, states, NPOs and markets; and (4) enhancing the
grasp of the local inflections of global trends pertaining to care in South Africa and
Switzerland.
Making care visible in order to effect change

Feminist scholarship has not only argued that there are vested interests in making
care, especially unpaid and underpaid care, invisible. Feminists and others have also
contributed to ensuring that caregivers are better ‘seen, counted and heard’ (Razavi
2012). The contributions to this volume continue this line of investigation. To begin with,
they draw attention to some of the mechanisms that conceal the giving and receiving
of care. Furthermore, they show how – insofar as it remains hidden, unrecognised and
unacknowledged – care work serves as catchment area for costs displaced from other
parts of society and the economy (see Chapter 5, by Sithole). With its largely qualitative
approach, this volume adds a crucial dimension to valuable quantitative studies that
have made care visible by putting it into numbers. With their broad scope covering
different aspects of the life course, the contributions in this volume also add valuable
empirical evidence that reconfirms the idea that care pervades and shapes human life.
The detailed accounts in many of the chapters (for example Chapter 12, by Hunter;
Chapter 14, by Schnegg, Bieri and Kofler; Chapter 18, by Meyiwa; and Chapter 19,
by Maluleke) of the array of everyday embodied care practices offer insight into the
vast scope of care. In addition, they also offer a fine-grained account of the plethora
of minute activities, attitudes, and values involved in caring. Taken together, these
contributions give a flavour of how care practices may congeal in sometimes coherent
arrangements. Additionally they also demonstrate how different care practices and
arrangements may jar, adding discordance and further complexity to the often already
looming challenges facing care provision. By drawing attention to the mechanisms used
to keep care hidden and by deliberately making care more visible, authors consolidate
an early but decisive step towards a further goal, namely explicitly addressing care as an
issue for policy and practice. Ultimately, making care visible is therefore also a crucial
move in the direction of exploring these fundamental questions: What kind of society
do we as people want? And what kind of lives do we want? These are questions to which
we return in the concluding chapter of the volume.
The chapters in this volume also explore the ways in which care is implicated in the
paradoxical coexistence of change and persistence that characterises society at large.
There is reasonable evidence from the contributions that the budding acknowledgement
of the significance of care coexists alongside its continued devaluation, which is
intimately linked with the powerful association between care and debasing notions of
femininity (see, for example, Chapter 16, by Shefer, and Chapter 20, by Nkani). This
poses a major challenge for the transformation of entrenched and received notions of
gender roles as well as care and welfare practices, from the micro to the macro levels.
Some chapters document encouraging changes, including emergent changes in gender
15
stereotypes (see Chapter 16, by Shefer, and Chapter 17, by Morrell and Jewkes) and in
states’ involvement in care (see Chapter 9, by Beyeler). Nevertheless, the widespread
persistence of residual care arrangements means that large parts of care hierarchies
remain entrenched and changing care needs go unmet. One reason for the tardiness
of change in this domain is that care is enmeshed in webs of values that are slow, and
sometimes resistant, to change. This is especially the case where power is at stake.
Thus, on the one hand, devalued care activities are still relegated to women, and, on
the other hand, some women ensconce themselves in domains of care to which they
cling as a remaining stronghold that has been parcelled out to them. The persistence
of residual care practices can furthermore be ascribed to institutional lethargy and
invisibility. Fossilisation is a common feature of large and established institutions
like states or educational institutions. While they may be quick to transform in some
respects, they often remain sluggish and resistant in others. This is especially the case
where prejudices are not proclaimed policy but hidden in structural arrangements that
require considerable analysis and advocacy to expose them and make them visible (see
Chapter 15, by Collins).
Yet, optimism may need to be tempered. Recent changes cannot simply overwrite
the past. Analogous to health, poverty and education in which the past may haunt
the present for many generations, earlier conditions which shape care may also
have long-term effects. For example, the formative stages in the life course can bear
relevance to the present and may even perpetuate intergenerationally (see Chapter 7,
by Makoae). For instance, care practices that shaped the childhood of a generational
cohort have ongoing and tangible impacts on the members of those cohorts and
their society when they reach middle and old age, which can range between 30 and
70 years later. In brief, much as visibility may be believed in as a step towards change,
and much as pleas may be made for changes to care arrangements, it is necessary
to remain aware of the fact that the care habitus of present everyday life remains
haunted by a legacy of care practices and notions of care that go back generations.
Care relations: Profiles and identities of caregivers and care receivers

Individually and in combination, several chapters show the extent to which persons’
relations to care co-constitute part of their multiple constructed identities. These
identities and relations may be perceived as more or less malleable and prone to
reformulation and negotiation (Jegermalm 2006). Providing and receiving care –
whether by choice or circumstance – pushes people to reflect on who they are, what
they wish they could be, or how they wish others to understand them. Some features of
identity that are particularly pertinent to care include gender, age and intergenerational
interdependencies, as well as a whole array of social markers and inequalities.
The primacy of gender as a core and ongoing determinant of caregiving is confirmed
– some would say reproduced – by many of the contributions. Unsurprisingly the
picture that emerges is that women still bear most of the care burden while the inter-
relations between masculinity and care are only beginning to emerge (see Chapter 11,
16
by Khunou; Chapter 16, by Shefer; and Chapter 17, by Morrell and Jewkes). What is
also becoming clearer is that the closer a task gets to bodily intimate care, to dealing
with aspects that relate to historical constructions of care as ‘dirty’ or ‘inferior’ work,
the more powerful is the gendered impact. Even when men do care, they care in ways
that resist that which has been coded ‘feminine’, ways that resist intimate nurturing
that somehow is perceived as defiling or demeaning of the person doing it. Possibly,
although evidence is still thin on this, sexual orientation plays a role in this too,
with queer3 men more likely than their heterosexual counterparts to engage in these
intimate forms of care (see Chapter 6, by Gouws and Van Zyl).
Age and intergenerational relations also play a considerable role in the identities of
caregivers and care recipients. Children and the elderly are often construed as net
care recipients, while adults between these two phases are primarily construed as
net caregivers. This is the approach taken in the calculation of dependency rations.
Contributions to this volume confirm that in both South Africa and Switzerland,
parental status does play a considerable role, and that persons with dependent
children typically struggle to cope with care demands (see Chapter 9, by Beyeler
and Chapter 20, by Nkani; see also Staab and Gerhard 2011). However, some
contributions question and challenge the received dichotomous constructions of
care recipients and caregivers. They underline the care needs of healthy adults and
also show that the elderly, who are themselves in need of care, can again become
considerable contributors to care (see Chapter 14, by Schnegg, Bieri and Kofler, and
Chapter 18, by Meyiwa). When they are no longer in paid employment or when a
crisis such as a pandemic strikes a community, elderly persons may in fact become
net caregivers. These issues underscore three related concerns that are obvious
but often forgotten: first, caregiving and care receiving are not mutually exclusive;
second, there can be an exponential increase in the intensity of both caregiving and
care receiving at one and the same time; and third, caregiving and care receiving
shape and are shaped by the intergenerational contract.
Social inequalities are reproduced or even exacerbated through the distribution of the
extent of caregiving and care receiving and the quality of such care. In societies with
large status inequalities (whether these are tied to class, race, caste, health or migration
status) and poverty associated with such status inequalities, better-resourced segments
of the population are able to outsource to the market what they perceive as the less
rewarding and the more tedious aspects of care. In addition, they are able to buy in
high-quality care services unavailable to the under-resourced population, who may be
forced to sell care work at cut-throat prices. This, in turn, can contribute to the further
erosion of social cohesion, as better-resourced buyers of care can invest more in their
self-care and care for their dependents, thereby enhancing their capacity to generate
even more resources. At the same time the less resourced, who often include the sellers
of care work, have less time and other resources to invest in self-care and care of their
dependents, thereby in turn reducing their capacity to generate more resources that
could be devoted to development and care (Faur 2011).
17
Analytic tools: The care diamond

Many contributions to this volume directly or indirectly seek to develop appropriate
tools for describing and analysing care. To a greater or lesser extent they engage
with Razavi’s notion of the care diamond – a heuristic device which aims to enhance
our understanding of the social and political economy of care (see Chapter 2, by
Razavi). The care diamond stakes out some of the key players involved in the very
broad landscape of care. In particular it alerts the reader to the intricate and often
concealed care interconnections amongst four domains: families, households and
intimate relations; the state; NPOs; and markets.
Many of the contributions confirm that what is sometimes called the private sphere of
families, friends and households seems to continue to be a main locus of care provision.
This has several implications, some of which are congruent with earlier research
(Palriwala & Neetha 2011; Sevenhuijsen & Švab 2004; Wecker 2006). One implication
of this domestic insulation is the loss of some of the potential benefits entailed by the
socialisation and collectivisation of care. The failure to socialise and collectivise care
can, for example, result in what some experience as the social isolation of caregivers
and care receivers (see Chapter 18, by Meyiwa). Another effect is the loss of possible
gains in the rationalisation of care work. The familialisation of care also means that
most caring takes place in the unpaid economy, although this need not be the case,
as when grants are paid to home-based carers. Given the gendered segmentation of
paid, underpaid and unpaid activities, the familialisation of care mostly means that a
disproportionate part of care work falls to women and girls.
Generally, families, households and personal relations as the locus of caregiving
are riddled with tensions. Given that many people experience care as agent relative
– in other words it matters to them who gives care to whom – it might also be a
constitutive part of their understanding of family and intimate life, namely that it is
the prime site of caring (Engster & Stensöta 2011; Schuh 2012). Since they are wed to
the many positive associations that many people ascribe to family, caregivers as well
as care recipients may actually be unable or reticent to give up care within the family/
household even when the personal costs of home-based care become extremely high.
They hold on to the family, households and personal relations as locus of care as a
way of resisting the loss or redefinition of both family/household/personal relations
and care that outsourcing would imply.
Several chapters in this volume underscore the ways in which public authorities such
as states can make a considerable contribution to care provision in both high- and
low-income societies. In this regard, the welfare state in its many mutations plays a
significant role. Welfare regimes may differ both in the extent and the type of care
they provide; for example, some may have dedicated care ministers, such as the
United Kingdom’s Minister of State for Care and Support, while others, such as the
Swiss Federation, may develop an explicit care policy (Stutz & Knupfer 2012). Typical
ways in which welfare states may contribute to care provision is through cash transfers
18
and subsidies paid towards users and/or institutions that offer services (Hunter &
Adato 2007). In addition, as Makoae (Chapter 7) and Schmid (Chapter 8) argue, the
state, through its defining authority in policy and law as well as its many institutions,
can also be involved in delivering actual care services or can foster conditions that
enhance the capacity of others to care. The ways in which authorities directly or
indirectly define and structure care provision have an immense impact on the options
and life chances available and contribute to the subjectivation of citizens (see Chapter
4, by Giraud and Lucas). Particularly in times of austerity, states and public authorities
may seek to displace care responsibilities from the public to the private domain. This
may lead to the overburdening of households as well as to the colonisation of care by
the private care industry. Accordingly, as elsewhere (Commission on Funding of Care
and Support 2011), both caregivers and care receivers are engaged in major struggles
with authorities over the type, quality and extent of care provision in which states
should be involved.
The role of volunteers and NPOs in caregiving is often underexamined. This
domain is extremely mixed and complex. It ranges from care provision without any
payment at all to the caregiver, to paid care work in organisations that charge fees
directly from care recipients or from sponsors like states and non-governmental
organisations (NGOs) but do not aim to make a profit. In this domain women seem
to be overrepresented and the care penalty seems to be particularly high (see Chapter
13, by Patel, as well as Rozenberg et al. [2008]).
In comparison to the other three sectors of the care diamond, relatively little is known
about the role of markets. Findings from Switzerland and elsewhere nonetheless point
to the considerable significance of this sector as welfare states shrink or expand (see
Chapter 10, by Streckeisen). Shrinkage in any of the other three sectors of the care
diamond opens up possibilities for the commodification of care. This can be obvious
in times of restructuring of care arrangements when markets colonise previously
protected care worlds. However, as the marketisation of care becomes accepted as the
norm, its impact and effects often go unexamined and unacknowledged.
Comparing care worlds: Local inflections of global trends

It was noted above that while there is a universal need for care, and while global
trends may penetrate deeply into national and local contexts, care can be heavily
shaped by contextual particularities. In order to understand global trends concerning
care, it is necessary also to grasp simultaneously the local inflections of these trends
and how such local trends may take on global dimensions. Whilst the contributors to
this volume have only to a limited extent engaged in direct comparisons, the issues
that emerge at some level or other resonate with similar concerns in other parts of
the world. In this sense, the contributions make important strides in familiarising
members of different care worlds with each other. As has already been indicated
when discussing the various interlinked scales or dimensions of care, there are many
19
divergences and convergences regarding care in Switzerland and South Africa. Here
we highlight one similarity and one difference.
The insights offered in this volume question presumptions about people and societies
in Europe and Africa as either particularly caring or devoid of care. They show the
passion and commitment to care for others displayed in both places, thus questioning
the absolute uniqueness of either a European or an African ethics of care. They also
showcase caregivers and care recipients in different Swiss and South African settings
engaged in arduous attempts to find a feasible care mix where there is a synergy rather
than discord between caring in families/households/personal relations; the state;
NPOs; and markets. And they show caregivers and care recipients demanding from the
state improved care policies and practices that set limits to the marketisation of care.
Arguments in the South African contributions primarily foreground the care deficit,
directing attention to issues of absence, lack, and loss while concurrently offering
suggestions for improvements. This is probably tied to one of the most glaring
features of South African society compared to that of Switzerland, namely the extent
of debilitating inequalities that manifest in poverty, unemployment and inhuman
economic conditions experienced by the majority of South Africans. In spite of
South Africa’s being one of the biggest economies on the continent of Africa, with
an advanced liberal constitution, the living conditions of most of its inhabitants
are far from satisfactory. This complicates how care is motivated, constructed and
exercised in broad socioeconomic terms. Whilst some of the Swiss contributions also
underscore the care deficit, they additionally alert us to the ways in which care can
be a form of biopower that produces compliant citizens. Reflecting the greater reach
of welfare as a broad entitlement for all in Switzerland, rather than welfare as help
for the needy, some of the Swiss studies also alert readers to ways in which the state’s
involvement in care can attain disciplinary features.
Structure
The book is structured in four thematic parts as follows:
1. Theories and concepts of care
2. Policy imperatives and care
3. Practices and models of care
4. Narratives of care.
Part 4 is wholly South African in focus; the other three parts include contributions
on both countries. Each part is introduced with an overview of the focus of the part
and of the chapters in it. Chapters are allocated to specific parts according to the
extent that they foreground one of these four areas; many of the chapters, however,
also speak to a number of issues and cut across parts.
In Part 1 (Theories and Concepts of Care), the focus is on some of the theoretical
and conceptual underpinnings of contemporary care practices that raise both global
debates regarding how to theorise care as a universal existential as well as more localised
20
areas of contestation in thinking about care. In Part 2 (Policy Imperatives and Care),
we present chapters that speak to policies of care in the two different national contexts
but which also contribute to global policy imperatives. These chapters apply critical
and gendered lenses to contemporary state policies around care and how these impact
on practice and the lived experience of being a care provider and/or care recipient. In
Part 3 (Practices and Models of Care), chapters focus more on the material practices
and arrangements of care in different Swiss and South African contexts. Chapters
critically evaluate particular practices of care, highlighting key challenges and gaps
in provision of care in a range of different organisational and institutional sectors. In
Part 4 (Narratives of Care), chapters provide rich stories about how people think
about care and/or experience the provision and reception of care in different locations.
Narratives of people across differences such as age and socioeconomic status, and
including both providers and recipients of care, reveal the textures and nuances of how
care is constructed, practised and experienced in the day-to-day lived experience of
current caring practices and relations.
The concluding chapter attempts to synthesise key threads emerging out of these
different parts and points to areas that require further intellectual inquiry and public
deliberation.
In sum, the perspectives explored in this book show that research into the dynamic
facets of care – including especially its theoretical underpinnings, policy, practice
and material elements – allows a closer understanding, not only of how people
experience and remould the care diamond, but also how strategies of resistance
and change might enable new modes of living in and with care. Ultimately care
emerges as something that does matter, substantiated and materialised through the
conditions of engaging with care and its varied heterogeneous contexts in South
Africa and Switzerland. In all of this, both countries are intrinsically galvanised
politically and socially to advance and fashion a cohesive society in which citizens’
wellbeing is paramount. The chapters in this volume begin the process of addressing
these important issues, if only by speaking about the production and limits of
care in particular and material terms, and engaging the social, political and policy
perspectives that imply ongoing embodied struggles. They build on current
knowledge and generate further debate and discussion about the implications of
care, welfare and social cohesion and the relationship between gender, policy and
practice more broadly. These accounts present opportunities for researchers and
members of civil society to learn from each other, acknowledging cultural contexts,
as well as sociopolitical and economic conditions that distinguish South Africa and
Switzerland. In presenting this volume we hope that its contents stimulate scholars in
Switzerland and South Africa, as well as in other countries, and contribute to forging
further active and engaged research exchanges.
The chapters collected in this volume furthermore also signal the idea that care is
about contestation and growth. In other words, care is a precondition to human
wellbeing, but it is not a given. On the contrary, it is something which people ought
21
to pursue consistently and struggle to achieve. Therefore, beyond some of the critical
questions prompted by the chapters, we urge our readers to consider a future,
imagined possibility of a socially just and equitable society in which the shaping
of care itself is transformed. But perhaps more importantly, the greatest danger
in scholarly work examining care is that the ideas are taken for granted. We have
shaped this volume to make this difficult.
Notes
1 South African Institute of Race Relations, Press Release: Construction of a welfare state in
progress, 31 January 2011; South African Institute of Race Relations, Press Release: Children
on social grants increase thirteen-fold, 18 January 2012.
2 Switzerland is a federation with three tiers of government: the federal, the cantonal, and
the local (sometimes called communal) authorities. The cantons and local authorities have
considerable autonomy allowing for a great variety of legislation and policies across the country,
with associated variety in care regimes (see Chapter 4 of this volume, by Giraud and Lucas).
3 The term queer here refers to people with gender non-conforming identities.
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CARE IN CONTEXT Transnational gender perspectives

Book · January 2014

Stephan Meyer Tamara Shefer

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critique of contemporary sexualities research in SA View project

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Figures and tables vi

Part 1: Theories and concepts of care 29

Part 2: Policy imperatives and care 125

Part 3: Practices and models of care 225

Part 4: Narratives of care 305

AHV Alters- und Hinterlassenenversicherung (Public old-age and

Care is fundamental to our individual identity as this is played out in our

Contexts of care: Connecting the universal, the global,

Pfau-Effinger & Tine 2011; Simonet 2010). In addition, population movements

Care matters: Towards mapping the concept

Overview of approach, themes and structure

Making care visible in order to effect change

Care relations: Profiles and identities of caregivers and care receivers

Analytic tools: The care diamond

Comparing care worlds: Local inflections of global trends

Gilligan C (1982) In a different voice. Cambridge: Harvard University Press

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AHV Alters- und Hinterlassenenversicherung (Public old-age and