Care Work: Gender, Labor, and the Welfare State. (Book Reviews).

Madonna Harrington Meyer (Ed.), Care Work: Gender, Labor, and the Welfare State. New York: Routledge, 2000. $85.00 hardcover, $23.99 papercover.

Are you afraid of getting old? Of having to rely on your children (read this "daughter or daughter-in-law") for care? Of living out your final days in a nursing home? Or are you a grandmother unexpectedly left with the responsibility of raising your grandchild? Maybe, you are a Latina woman who has come to this country to work as a live-in nanny for others' children while your children are left behind in the care of others? These are some of the issues addressed in the chapters of this broad-ranging, extremely interesting, instructive book, edited by Madonna Harrington Meyer, which deals with the topic of care work, who provides it (overwhelmingly women), how it is provided and at what cost, personally, professionally and emotionally.

This volume collects papers presented at an international conference on care work held at the University of Illinois in 1997. Though the contributors come from a variety of disciplines (sociology, women's studies, social policy, economics, political science and history), they agree about the gendered nature of care work, its relative invisibility and devaluation, the lack of adequate social supports for care work and the heavy toll care giving takes, most especially on women, the poor, minorities and immigrants. In addition, the authors concur that care work, rather than being biologically determined as "women's work," is a socially constructed phenomenon, with norms governing how the work should be done, where it is done and by whom, norms which vary in concert with changes in cultural values. Take, for instance, the description of women's care giving responsibilities in the eighteenth and early nineteenth centuries discussed by Emily Abel in her paper on care giving from an historical perspective. The expectation was that women caregivers not only would assist with feeding and other activities of daily living, but would also render what we would describe as skilled medical care. According to Abel, women "dispensed herbal remedies, dressed wounds, bound broken bones, sewed severed fingers, cleaned bedsores, and removed bullets" (p. 10). However, as medicine emerged as a profession in the nineteenth century, women's medical care giving was called into question and their healing knowledge labeled as "superstition" (p. 13).

Americans, particularly middle and upper class men, are fond of assuming that today, in the year 2001, women have come close to achieving equality with men. The four sections of this book, and the papers contained within them provide ample evidence to call this assumption into question. For instance, the chapter written by Sonya Michels demonstrates that when issues of race, class and marital status are crosscut by gender, it is a particular segment of the population, poor, single, predominantly women of color, who have been "targeted by public policy" (p. 37), and who must seek paid employment regardless of the care needs of those at home. Or, take the case made by Pierrette Hondagneu-Sotelo that the real casualties of the new global economy may be the transnational mothers and the children they are forced to leave behind, often for years at a time, in the care of others. These immigrant women who have come to the United States seeking employment as live-in nannies / housekeepers, find themselves cut off from their families and communities, while many are paid below minimum wage. Assata Zerai's research with African-American grandmothers raising their cocaine-exposed grandchildren substantiates many legal and practical barriers that make difficult their efforts to provide good care for these young family members. Stacey Oliker's paper, "Examining Care at Welfare's End" documents what many right wing conservatives do not want to acknowledge: while some states report high rates of employment for those women leaving the AFDC rolls, a majority of these jobs are short-term or high turn-over jobs and "most of those employed do not leave poverty" (p. 169). The chapters of Care Work provide many more examples of the negative impacts on specific groups resulting from most societies' continued insistence on placing "the burden of dependency squarely on the shoulders of families--and most notably the women within those families" (p. 1).

The breadth of issues addressed in edited volumes is both their strength and their weakness and this collection is no exception. With eighteen chapters and twenty-one contributors, Meyer has touched on many aspects and issues of care work in an attempt to explore the question of how best to locate the burden of dependency. Should families continue to bear the brunt, or are there more optimal market-based or entitlement funded alternatives?

The theme running through the collection is that the costs of "unacknowledged and uncompensated care work are enormous, particularly for women, the poor, and persons of color"(p. 3) and that we must find ways to underwrite the costs of care work through publicly-funded, universally entitled programs. However, because the chapters deal with such a range of issues and topics, it is sometimes hard to hang onto the "tie that binds." In addition, some of the chapters feel like a tease: they cover some topics, but only hint at others. For example, Francesca Cancian in "Paid Emotional Care," describes something called "The Clinical Practice Model of Nursing" (p. 146) used as a way to institutionalize and legitimate the provision of emotional care to patients. How extensively is it being used? Is the use of this tool, in fact, helping to transform the provision of nursing care? Cancian piqued my interest but leaves my questions unanswered.

While this book would benefit from some reorganization (I would put the two historical chapters in its own section and elaborate a little more on these), it nonetheless provides a thorough, informative and well-documented analysis of the critical problems resulting from the relative de-valuation of any work women do and, in particular, the de-valuation of care work in a world where what is valued is product and profit. In bringing this collection together, Madonna Harrington Meyer has created a whole which is greater than the sum of its parts: one comes away not only with an intellectual understanding, but also with a visceral sense of the impact of these stubbornly entrenched aspects of our current form of stratification on the lives of real people.

Diane M. Johnson
State University of New York at Stony Brook