4. Building the care economy to empower women in Southeast Asia

Abstract

This chapter explores how Southeast Asian policy makers could leverage and invest in the care economy to advance women’s empowerment and inclusive development. The chapter starts by painting a panorama of the current state of care in the region, documenting its unpaid, private, informal and gendered dimensions. Drawing on social, demographic, educational and economic evidence, it then argues that Southeast Asian countries will soon face a growing demand for formal care services, requiring policy makers to further develop and structure formal care systems. The chapter lays out some of the benefits that the formalisation of care systems could yield, underscoring notably the impact it would have on women who already work in the care sector, and on women who are out of the labour force or would like to dedicate more time to it. It also shows how formal care sectors could improve the quality of the services provided and make societies more resilient to external shocks. The chapter concludes by highlighting three structural barriers that currently prevent the region from formalising the care sector: the deep-seated informality of employment in Southeast Asia, weak social protection systems and discriminatory social norms.

In Brief

Building a strong care economy could yield important benefits for women’s empowerment and inclusive development in Southeast Asia

The provision of care across Southeast Asia 1 is a private responsibility primarily fulfilled by women. Preferences for care provision by family members, together with social norms that uphold women’s role as caregivers, lead to a system that primarily relies on women’s unpaid care work.
The paid care sector is also highly feminised but remains small and largely informal, which increases women’s vulnerabilities. In particular, domestic workers face heightened risks of economic and sexual exploitation and often lack access to social protection. These vulnerabilities are accentuated for migrant domestic workers.
The region’s current social, demographic, educational and economic trends suggest that Southeast Asia is at a critical juncture. In the short and long terms, the demand for formal care services will rapidly grow, which requires urgent action to finance and steer the creation or expansion of reliable formal care sectors.
The benefits of formal care sectors could be substantial, ranging from women’s increased economic empowerment to better preparedness and resilience to external shocks.
- Investment in the care economy is expected to generate a substantial number of formal job opportunities, many of which women would take, given the gendered nature of care. Female care workers transitioning from informal to formal employment would benefit from better access to social protection schemes and improved labour rights.
- The provision of affordable formal care services would allow unpaid care providers, who are mostly women, to remain in the labour market, to allocate more time to it, or to join it altogether.
- A well-integrated and structured care economy strengthens countries’ resilience. Formal sectors are less vulnerable to external shocks, and formal care workers can be mobilised faster in times of crisis, including health-related ones. In the specific context of climate change, which particularly affects Southeast Asia, resilience-building through the care economy becomes even more critical to effectively address potential shocks induced by climate change.
However, Southeast Asian countries face certain structural constraints that hamper the emergence of strong care sectors.
- Labour informality remains the norm across most of the region’s economies regardless of the economic sector.
- Southeast Asian countries have been slow in implementing universal social protection systems. In the context of care, social protection systems can act as a powerful catalyser for the development and rapid expansion of formal care services. However, the absence of such mechanisms largely prevents the emergence of formal care sectors.
- Social norms continue to consider care as a private responsibility that must be assumed by female family members, which strongly influences the private-oriented design of care systems in the region.

← 1. Brunei Darussalam, Cambodia, Indonesia, Lao People’s Democratic Republic, Malaysia, Myanmar, the Philippines, Singapore, Thailand, Timor-Leste and Viet Nam.

Infographic 4.1. Building a strong care economy could yield important benefits for women’s empowerment and inclusive development in Southeast Asia

Everyone needs care at different stages of life – but especially at very young and old ages. As populations continue to grow around the world, so does the global demand for care. In Southeast Asia, the population is growing but also ageing,1 as fertility rates are falling and life expectancy is increasing (Figure 4.1). The share of the population aged 65 years and over is expected to double between 2023 and 2050 (from 8% to 16%), and the median age will rise from about 30 years in 2023 to over 37 years in 2050. Conversely, the share of the population aged 0 to 17 years is expected to decrease by 6 percentage points over the same period (from 29% in 2023 to 23% in 2050) (UN ESCAP, 2023[1]).

Despite lower fertility rates, demand for childcare remains a pressing issue for the region, and particularly in very populous countries such as Indonesia, the Philippines and Viet Nam. At the same time, the demand for elderly and long-term care will increase across the region as the share of elderly people continues to rise. In this context, how can these needs be met, and what lessons can be learnt from countries that are already facing the challenges of ageing societies? What do Southeast Asia’s demographic trends imply for the demand and supply of care in the region?

Figure 4.1. Demographic trends in Southeast Asia will increase demand for elderly care

In 2021, in response to the COVID-19 crisis and other challenges, the Association of Southeast Asian Nations (ASEAN) adopted a framework setting out the strategic priorities for developing the region’s care economy (ASEAN, 2021[4]).2 The COVID-19 crisis revealed the importance of strong care and social protection systems to guarantee the well-being of people and to ensure the functioning of society and the economy. Southeast Asia’s vulnerability to external shocks, such as climate hazards, further accentuates the need for well-functioning care and protection systems as they can increase societies’ resilience through better preparedness and faster response. The ASEAN Comprehensive Framework on Care Economy goes beyond the traditional understanding of care, highlighting the interlinkages between care, social protection, demographic trends and climate change. Moreover, the framework recognises the gendered nature of care provision and the vulnerabilities that carers and care workers face.

Within the broader goal of inclusive and sustainable development, more attention must be paid to the interlinkages between the care economy and gender equality targets. As recognised in the ASEAN’s framework on the care economy or, at the global level, in the International Labour Organization’s (ILO) framework on Decent Care Work, most care activities – paid and unpaid – are carried out by women (Box 4.1). Target 5.4 of the 2030 Agenda for Sustainable Development highlights the need to “[r]ecognise and value unpaid care and domestic work through the provision of public services, infrastructure and social protection policies and the promotion of shared responsibility within the household and the family as nationally appropriate” (United Nations, n.d.[5]). To account for the gendered provision of care, it is crucial to understand and address its underlying factors – particularly social institutions that uphold the status quo.

Box 4.1. How does the care economy intersect with gender equality?

The definition of the care economy covers a large and diverse range of activities

There are no internationally agreed statistical standards on the scope or measurement of the care economy. According to the ILO, the care economy offers goods and services required to ensure the physical, social, mental and emotional well-being of both care-dependent groups (e.g. children, the elderly, and ill or disabled people) and healthy working-age adults. The provision of care further includes self-care to support people to function capably, comfortably and safely. Care can be provided directly or indirectly to those in need of support, either through paid or unpaid activities (Figure 4.2). In general terms, direct care involves personal contact, whereas indirect care comprises tasks such as cleaning, cooking or non-care activities in the care sector.

Figure 4.2. Care can be provided in various manners

Four main actors are traditionally involved in care provision: families/households, market-based companies, the public sector and the not-for-profit sector. The importance of each one varies across countries, and they can overlap. For example, in many cases, the public sector subsidises the care provided by the private sector (Razavi, 2007[7]).

The ILO’s 5R framework recognises the intersection of care and gender

In 2019, the care economy was enshrined as a key policy area in ILO’s Centenary Declaration on the Future of Work (ILO, 2019[8]). The 5R framework for Decent Care Work was introduced, replacing the 3R framework. By adding “reward” and “representation” to “recognising”, “reducing” and “redistributing” unpaid care work, the ILO expands the understanding of care work. The new framework reflects the need for better-paid and decent work conditions for care workers and the need to guarantee care workers’ representation. Grounded in human rights, the 5R framework seeks to address care-related inequalities and the barriers that prevent women from entering into paid work. It further focuses on improving the working conditions of unpaid carers and care workers and, consequently, also the quality of care provided (ILO, 2018[6]).

The chapter starts by providing an overview of the current state of care in Southeast Asia, highlighting its private and gendered dimensions. The analysis then frames the provision of care and the participation of women in the labour market within the context of the region’s socio-economic development. It highlights that recent social, demographic and economic trends in Southeast Asia may soon create a growing demand for care services provided by people outside of the family sphere, which supports the argument for structuring and formalising care sectors across the region. In this perspective, the chapter underlines how the development of formal care sectors could have positive implications for women’s economic empowerment and could enhance countries’ resilience. In doing so, it also discusses the main challenges that currently prevent this formalisation from occurring across the region and outlines their policy implications.

What is the state of care in Southeast Asia?

The provision of care remains a private responsibility, predominantly shouldered by women

Paid employment in care sectors is low in Southeast Asia, and care work remains a private, often unpaid responsibility mostly handled by women within households. In Asia and the Pacific, employment in the care economy accounts for 9% of total employment, below the global average of 12% (Figure 4.3, Panel A). Among Southeast Asian countries with available data, the total care workforce ranges from 3% of total employment in Myanmar to 7% in the Philippines. Brunei Darussalam stands out as an exception with a total care workforce amounting to over 20% of total employment (Figure 4.4, Panel A).3 These low rates of paid employment in care sectors across the region suggest a relatively stronger reliance on the provision of care via unpaid arrangements within households. Moreover, as in the rest of the world, this unpaid care work is predominantly undertaken by women (ILO, 2018[6]). In the Lao People’s Democratic Republic (hereafter Lao PDR), where the gender-based division of unpaid care and domestic work is the least unequal across the region, women spend one hour more than men on these tasks every day. In Cambodia, women dedicate a similar amount of time to unpaid care and domestic work as in Lao PDR. However, they spend nearly three hours more on these tasks than men (Figure 4.3, Panel B), resulting in Cambodian women undertaking 91% of the daily unpaid workload.

Social norms uphold the gendered division of unpaid care and domestic work. Data in Southeast Asia reveal a social preference for receiving care from family members – ideally females (ISSP Research Group, 2016[9]; UN ESCAP, 2021[10]). Deeply rooted views held by both women and men designate mothers as irreplaceable caregivers, questioning fathers’ care abilities (Yeoh et al., 2020[11]). The preference for and reliance on women to provide care is further reflected in social norms that closely link women’s status to that of being caregivers and mothers. Conversely, men are viewed as decision makers and primary financial providers for their families (see Chapters 1 and 3). In line with this, data from the fifth edition of the Social Institutions and Gender Index (SIGI) show that 72% of the region’s population agree that being a housewife is as fulfilling as working for pay, and 64% think that men should have the priority to a job when those are scarce (OECD Development Centre/OECD, 2023[12]). Such pervasive attitudes reinforce the traditional gender-based division of unpaid care work.

Figure 4.3. Paid care in Southeast Asia remains limited, while unpaid care is predominantly provided by women

Certain groups of women, especially those living in poor or rural households, tend to face a heavier total workload. In households where the income of all working-age members is needed to sustain their livelihoods, women tend to shoulder a larger workload, as they not only carry out the bulk of unpaid care and domestic work but also engage in income-generating activities (Chopra and Zambelli, 2017[13]; OECD, 2022[14]). In addition, while essential infrastructures such as safe water, sanitation or transportation have become widely available in most parts of Southeast Asia, rural populations’ access to infrastructure lags behind that of urban populations (UN ESCAP, 2021[10]). Consequently, rural women’s daily working hours – paid and unpaid – tend to exceed those of men in their families or communities as well as those of women living in different socio-economic conditions (ILO, 2019[15]).

Ongoing trends such as increasing rural-urban or transnational migration, including due to climate shocks, may exacerbate women’s care burden. Several studies highlight the direct link between land degradation and the mobility of farming communities. Southeast Asian countries are particularly vulnerable to shocks induced by climate change such as heavy rainfalls, storms or droughts, all of which have a disproportionate impact on farmers’ livelihoods (Zander, Richerzhagen and Garnett, 2019[16]). As a coping strategy, farmers increasingly migrate to urban areas in search of more secure income sources. Evidence from Cambodia and Viet Nam documents this increased rural-urban migration as a result of climate shocks, notably by male farmers. In the origin communities, it partly results in a “feminisation” of agriculture, as women left behind undertake the work previously done by men. It also exacerbates women’s time poverty as they still need to fulfil their care and reproductive responsibilities (Bacud et al., 2019[17]; Natarajan, Brickell and Parsons, 2019[18]; ASEAN and UN Women, 2021[19]). Women’s unpaid care burden can also increase when the primary female caregiver migrates. Evidence from Indonesia and the Philippines shows that some of the care and domestic work is redistributed to fathers but also to other women within the direct and extended family, e.g. daughters, aunts or grandmothers (Yeoh et al., 2020[11]).

Paid care work is highly feminised and informal, which increases women’s vulnerabilities

The gendered dimension of the paid care sector is a reality worldwide, as in Southeast Asia. Data on the care sector and workforce are scarce, and the lack of internationally agreed statistical standards complicates the measurement and production of harmonised indicators on the care economy (Box 4.1). Globally, women are disproportionately represented in the care workforce. With 249 million women and 132 million men, two-thirds of the world’s care workforce are women (ILO, 2018[6]). Similarly, in Southeast Asia, women represented 68% of all workers employed in education, human health and social work activities in 2022 (ILO, 2023[20]). Overall, employment in care sectors is relatively low in the region, representing 9% of total employment (see above). In all Southeast Asian countries, most of the care workforce is employed in the education sector (Figure 4.4, Panel A). In more advanced economies such as Brunei Darussalam, Malaysia and Singapore, domestic workers also account for a significant share of the care workforce (ILO, 2018[6]; ILO, 2019[15]). In these economies, greater formalisation, coupled with higher disposal income among households, may serve as important factors influencing the decision to hire domestic workers.

Figure 4.4. Employment in care work remains limited in Southeast Asian countries

Employment in Southeast Asia is largely informal. On average, informal employment accounts for 70% of total employment in the region (ILO, 2023[22]). Across all Southeast Asian countries, apart from high-income economies such as Brunei Darussalam and Singapore, informal employment accounts for an even greater share of total employment – two-thirds or more (Figure 4.4, Panel B) – with no major differences between women and men (United Nations, 2023[21]).4 In line with this, the large majority of employees working in sectors of the care economy are informal. The share of informal workers is particularly elevated in less institutionalised sectors such as personal service activities or domestic activities. Conversely, informality is relatively lower in sectors where the public sector is traditionally more involved, such as education or health (Figure 4.5). Gender-based differences persist in terms of employment status, with women concentrated in the most vulnerable forms of informal work. For instance, 28% of women working informally are contributing family workers compared to 10% of men (ILO, 2023[22]).

Figure 4.5. Sectors of the care economy are largely informal in Southeast Asian countries

Within the care economy, domestic workers play a key role in providing child and elderly care. In contexts where public care provision remains limited and/or is expensive, domestic workers represent a more accessible option for families that dispose of enough resources to outsource unpaid care activities.

In Southeast Asia, the majority of domestic workers are women. This is aligned with the social preference to be cared for by a woman (see section “Discriminatory social norms weaken the demand for and supply of formal care services”). In 2022, in Brunei Darussalam, Malaysia and Viet Nam, women accounted for more than 90% of employees of the ILO category grouping domestic workers,5 and in Lao PDR, the Philippines and Thailand, between 80% and 90% (ILO, 2022[24]). In addition, some countries’ care policies are designed to facilitate the hiring of domestic workers, through subsidies or tax breaks (ILO, 2018[6]). For instance, in Singapore, the Foreign Domestic Worker Levy (FDWL) Relief is granted to married women who employ a domestic worker. As the FDWL Relief aims at encouraging married women’s labour force participation, unmarried people and married men are not eligible to apply (Inland Revenue Authority of Singapore, 2023[25]).

Despite their essential role, domestic workers – primarily women – face significant challenges that can undermine their income security and well-being. In line with the rest of the region’s labour force, domestic workers largely operate in the informal sector and thus are not covered by existing social protection systems. Short- and long-term implications for their income stability and health are severe, as informal workers have no access to paid leave in case of sickness or pregnancy, lack unemployment benefits in case of job loss and do not contribute to the national pension system (Kolev, La and Manfredi, 2023[26]; ILO, 2021[27]). Regardless of their employment status – formal or informal – domestic workers mostly operate under poor working conditions, often at risk of exploitation as their labour and social protection rights are often not respected. For instance, evidence from Malaysia reveals that the working conditions of 29% of surveyed domestic workers fall under ILO’s classification of forced labour (ILO, 2023[28]). In addition, while all domestic workers, men and women alike, risk economic exploitation in terms of wages and working hours, female domestic workers face a disproportionate risk of experiencing violence or harassment (ILO, 2018[6]).

Migration plays a key role in the supply of domestic workers across the region. Although data remain scarce, estimates from 2013 show that migrant domestic workers accounted for 19% of all domestic workers in Southeast Asia and the Pacific – one of the highest shares worldwide (ILO, 2019[15]). In line with the rest of the world, these migrant domestic workers are mostly women. Globally, for instance, 73% of all migrant domestic workers are women, and 13% of female migrant workers are employed in domestic work compared to only 4% of male migrant workers. Moreover, nearly one-fourth of all female migrant domestic workers are located in Southeast Asia and the Pacific (ILO, 2019[15]). These female migrant domestic workers are subject to multiple vulnerabilities, with even weaker social protection than native-born domestic workers and increased risks of violence.

Southeast Asian countries are both the origin of and destination for migrant domestic workers. Indonesia, the Philippines and, more recently, Viet Nam are major origin countries of domestic workers whose destinations are the more advanced economies of the region, but also other countries of Asia and the Gulf (Yeoh et al., 2020[11]; ILO, 2019[15]). Within Southeast Asia, Malaysia and Singapore are the primary destinations for migrant domestic workers from Cambodia, Indonesia, Myanmar and the Philippines (UN ESCAP, 2021[10]). To support these flows and ensure that their economies have enough domestic workers, advanced economies of the region have established specific foreign worker programmes (ILO, 2018[6]). For example, Singapore introduced the so-called “Foreign Maid Scheme” as early as 1978 to facilitate the immigration of domestic workers from other Southeast Asian countries (ILO, 2019[15]). In these countries, through the provision of essential care and domestic services, foreign-born female domestic workers allow other women to reduce the amount of time they spend on unpaid care and domestic work and to re-allocate it to other activities such as paid employment (ILO, 2019[15]).

The reliance on migrant domestic workers for care provision has implications for organising the care economy not only in the destination country but also in the home countries of these workers. The long-term absence of predominantly female migrant workers alters the provision of unpaid care work in their countries of origin (Withers and Hill, 2023[29]). For instance, research from Indonesia and the Philippines shows that unpaid care and domestic activities that were carried out by a mother who then migrated to another country were redistributed to the father as well as to other women in the family, including daughters, aunts or grandmothers – thus increasing their daily time spent on care provision (Withers and Hill, 2023[29]; Yeoh et al., 2020[11]).

The effects of Southeast Asia’s economic transition on women’s labour status will fuel a growing demand for formal care services

At the heart of women’s provision of care are personal choices regarding the allocation of time between paid work and unpaid care work, constrained by the inherent limitation of 24 hours per day. In this context, women have historically made a trade-off between participating in the labour market and dedicating their time to unpaid care and domestic tasks within the household. Moreover, even when women work for pay, they bear the brunt of unpaid care and domestic work, which results in a double burden of paid and unpaid work, and a substantially larger total workload than men. The underlying factors that have pushed women to one side or the other of this trade-off on the allocation of their time are multiple and complex, and have been the subject of intense research over the last 50 years. Among the main factors that can explain women’s entry into or exit out of the labour force – and their consequences on the capacity of women to privately provide care – are countries’ economic development, sectoral transitions, women’s increasing levels of education and the structural role of social norms.

Historically, the correlation between women’s participation in the labour market and economic development follows a U-shaped trend: as countries develop, women’s participation in the labour market first decreases before increasing again at a later stage (Figure 4.6). In general, countries’ economic development has been and remains characterised by a two-stage sectoral transition, from agriculture to industry and from industry to services. At the end of the 20^th century, Goldin’s work underscored the impact of this transformational process on women’s labour force participation (Goldin, 1994[30]), which can be roughly described as follows:

At the initial stage, when the economy remains largely based on agriculture, most women are in the labour force, either as paid workers or unpaid family workers on farms and in household businesses.
As economies develop and household incomes increase, women’s earnings become less crucial to secure livelihoods, triggering a reallocation of their time to unpaid care activities, which pushes them to exit the labour force.
As human capital increases with higher levels of education and skills, and countries continue to develop and further transition towards service activities, women’s potential income in the labour market increases compared to the value of the unpaid care work they provide privately. When this potential value offsets the value of women’s unpaid care work, they re-enter the labour force, leading to the famous U-shaped curve popularised by Goldin (Figure 4.6).

In this process, social norms play a fundamental role, both in the downward phase of the U-shaped curve and during the upward phase. At the initial stage, the impact of discriminatory social norms on the role and place of women is offset by the fact that households need to have all their members contribute to their income-generating activities. As countries develop and households’ incomes increase, this balance shifts in favour of discriminatory social norms according to which men are breadwinners and women are, in the first place, responsible for care and domestic work. During this phase, women’s paid work is implicitly bought by their families who can do without their income contribution, leading to a reallocation of women’s time towards unpaid care work. Moreover, the transition towards industrial jobs exacerbates discriminatory social norms as many industrial activities may be perceived as unfit for women, further relegating them to the family sphere. In the upward phase of the U-shaped curve, women’s labour force participation theoretically increases, and care becomes increasingly provided by a third party. However, social norms can significantly constrain this dynamic. On the supply side of women’s labour, it involves social norms that can limit women’s access to capital or collateral (such as unequal inheritance rights), hinder their ability to work outside the household, or promote early marriage. On the supply side of care, it notably includes societal attitudes toward care provided by a third party and norms dictating that care must be performed by a female member at home. A lack of trust in the quality of the care provided by a third party can also restrict the adoption of formal care services.

Meanwhile, education plays a crucial role in facilitating women’s re-entry into the labour market (upward phase). As economies develop, they transition towards service-based activities, while education levels tend to improve and gender gaps in education close. This dynamic leads to an increase in the returns on education for both men and women, provided that measures are implemented to address structural social barriers that may hinder girls’ and women’s skill development, such as early marriages. Additionally, efforts to improve the overall quality of education are essential. As returns on education continue to grow with economic development and women’s educational levels increase, their potential income in the labour market keeps rises until it surpasses the value of the unpaid work they provide in the household in the form of care and domestic tasks. In this regard, women’s higher levels of education are the key in enabling them to re-enter the labour market with higher wages – which shift the benefits of the working/not working trade-off in favour of working – and service-based jobs – which carry a lower social stigma than industrial jobs (Goldin, 2006[31]; Goldin, 1994[30]). However, discriminatory social norms may delay this dynamic, particularly if norms upholding a traditional division of gender roles and responsibilities, and opposing women’s paid work, change at a slower pace than women’s educational levels and the sectoral transition of the economy.

In Southeast Asia, evidence suggests countries are either reaching the end of the downward phase or starting to enter the upward phase of the U-shaped curve (Figure 4.6). For the last 50 years, the region has experienced continuous and sustained economic growth, characterised by rising income levels and a progressive sectoral transition (OECD, 2023[32]). The economic development of the region drew on a decline of the agricultural sector as a share of gross domestic product (GDP), dropping from nearly 30% of GDP by the end of the 1970s to around 10% in 2022 (World Bank, 2023[33]). From 1991 to 2022, the share of workers employed in agriculture dropped from 55% to 30% (ILO, 2023[20]). At the same time, the service sector expanded to account for 54% of the region’s GDP in 2022 and 47% of employment (World Bank, 2023[34]; ILO, 2023[20]). Moreover, access to higher education across Southeast Asia has expanded massively over the past 40 years (Lim et al., 2022[35]). Gender gaps in education have also narrowed, particularly in achieving parity in primary and secondary education (OECD, 2021[36]). In this context, current economic and labour data suggest that most Southeast Asian countries may soon enter the upward phase of the U-shaped curve during which women’s labour force participation normally increases (Figure 4.6).

Figure 4.6. Globally, women’s participation in the labour market relative to economic development is U-shaped

The anticipated increase in women’s labour force participation may soon result in a rapidly growing demand for care services. In the context of Southeast Asia where care continues to be provided privately and the paid care sector remains mostly informal and small, this growing demand may create a supply shortage. Moreover, the lack of care options may prevent women from taking advantage of new economic opportunities and benefiting from the increasing returns on education. Evidence from Indonesia shows that, although conditions are increasingly conducive to women’s labour force participation – structural changes to the economy, gains in education, declining early marriage rates and lower fertility rates –, the scarcity of childcare prompts many women to stop working for pay outside the home. In 2018, nearly half of the women who dropped out of the labour force cited family-related reasons (O’Donnell, 2023[40]).

As Southeast Asia’s societies are ageing, long-term care services for the elderly will become crucial in upcoming years. Evidence suggests that the provision of private unpaid care by women is closely related to gender gaps in the labour market and that, as gender gaps in labour market participation close, elderly people will be less likely to receive informal care from their children, and notably their daughters. In countries where the gender gap is large, daughters are the primary providers of care, mainly because of the adverse signal sent by the labour market. Conversely, in countries where gender gaps in employment are narrow, gender is no longer a crucial factor in who supplies care to the elderly (Bonsang and Costa-i-Font, 2023[41]). Consequently, policies aimed at closing the gender gap in employment, and the current trajectories of countries in this regard, may lead to an expansion of the demand for long-term care services and an increase in related expenditures. In this perspective, Southeast Asian countries are at a critical juncture, as most of them do not have long-term care service systems in place (Box 4.2), let alone a structured formal care economy (Addati, Cattaneo and Pozzan, 2022[42]).

Box 4.2. Long-term care services in Southeast Asia

The provision of long-term care service systems remains limited in Southeast Asia (Table 4.1). Countries that have long-term care systems in place fund it through general taxation or in combination with contributory social insurance. Only in Myanmar and Singapore are the services provided for free to all older persons irrespective of their socio-economic circumstances (Addati, Cattaneo and Pozzan, 2022[42]). Data show that most Southeast Asian countries have statutory provisions which provide for in-home personal care services. In addition, in four countries (Cambodia, the Philippines, Singapore and Viet Nam), the law requires family members to care for their relatives. This mirrors the presence of strong social norms which relegate the provision of care to the family sphere.

Table 4.1. Most Southeast Asian countries do not have well-developed public care systems for older persons
	Presence of a statutory public long-term care service system for older persons	Presence of statutory family obligations to care for relatives	Provision of statutory in-home personal care services for older persons	Provision of statutory residential care services in the long-term care system	Source of funding for long-term care services	Government support for long-term care services
Brunei Darussalam	Yes	Not found in the law	Yes	No	Taxation (oil fund)	Universal and free
Cambodia	No	Yes	-	-	-	-
Indonesia	No	Not found in the law	-	-	-	-
Lao PDR	No	Not found in the law	-	-	-	-
Malaysia	Sporadic: most care is provided by families	Not found in the law	No	Yes	Taxation	Out-of-pocket
Myanmar	Sporadic: most care is provided by families	Not found in the law	Yes	Yes	Taxation	Universal and free
Philippines	Sporadic: most care is provided by families	Yes	No	Yes	Mixed social insurance and taxation	Targeted or means-tested
Singapore	Yes	Yes	Yes	Yes	Mixed social insurance and taxation	Targeted or means-tested
Thailand	Sporadic: most care is provided by families	Not found in the law	Yes	Yes	Taxation	Targeted or means-tested
Timor-Leste	No, but provision of healthcare and a basic pension exists	Not found in the law	-	-	-	-
Viet Nam	Sporadic: most care is provided by families	Yes	Yes	Yes	Taxation	Targeted or means-tested
Note: The different categories of government support are defined as follows by the ILO: Universal and free = full or almost full cost of services is paid by social insurance, general taxation or a combination of these systems; Targeted or means-tested = the cost of services is shared between older persons and the above funding systems according to means tests and without causing financial hardship to older persons; Out-of-pocket = full or almost full cost of services is paid by users with no or very limited public subsidies, causing financial hardship to older persons. Older persons refer to individuals aged 60 years and over.
Source: Authors’ elaboration based on (Addati, Cattaneo and Pozzan, 2022[42]).

Formal care sectors can support women’s economic empowerment and enhance countries’ resilience

Building and structuring formal care sectors can have major implications for women’s economic empowerment and for countries at large. On the one hand, given their gendered nature, care sectors primarily create jobs and economic opportunities for women while formalising and strengthening the status of women and men who already work in them. On the other hand, they increase the supply of care services and the options available to other working and non-working women, who can decide to dedicate more time and effort towards paid activities in other economic sectors. Moreover, formal care sectors can improve the quality of the care provided, and countries with strong formal care sectors tend to be more resilient to external shocks.

Formalising care can catalyse women’s economic empowerment

Investing in the care economy not only makes economic sense but can also significantly increase women’s employment. Estimates for Asia and the Pacific show that investments in the care sector could create about 300 million jobs by 2035, most of which would be in formal employment (84%) and carried out by women (78%) (Value for Women, 2023[43]). In Indonesia, investments in universal childcare and long-term care services may generate over 10 million jobs by 2035 (ILO, 2023[44]). Because care is primarily undertaken by women, the creation and/or expansion of the care economy would disproportionately benefit women and create employment opportunities for them.

Moreover, formalising the care sector can improve the well-being, working conditions and rights of current care workers, particularly domestic workers, and those who operate in the informal sector. As paid care services in Southeast Asia primarily rely on women employed informally, a progressive shift towards formal care jobs would enhance their rights and welfare. When formally employed, workers gain protection under existing labour laws and regulations, which can include statutory minimum wages, fixed working hours, protection from exploitation and sexual harassment, and social security benefits. Combined, these factors can increase care workers’ job security, income stability, health, and overall well-being (OECD, 2023[45]).

Recognising caregiving as a formal occupation can encourage the professionalisation of the care sector, offering career opportunities and increasing the quality of care. The formalisation of a sector or certain occupations tends to come with minimum requirements for qualifications and skills. Dedicated training programmes can help meet these standards, allowing care workers the chance to develop specific skills or to specialise in specific areas of the care sector. This is particularly relevant in the fields of elderly care, long-term healthcare or support for persons with disabilities. Care providers who increasingly qualify as skilled workers, may have more opportunities for career progression within the care sector, which can enhance their job satisfaction and, ultimately, ensure high-quality standards in care provision (ILO, 2018[6]).

Beyond the impact on current care workers, the increased provision and use of formal care services can enhance women’s labour force participation. When formal childcare and elderly care services are available, households with care-dependent people can outsource care responsibilities, alleviating the unpaid load of care providers from the family – most of whom are women. Depending on the intensity and amount of care provided privately, this outsourcing can allow the care provider to remain in the labour market, to allocate more time to it or to join it altogether (UN ESCAP, 2022[46]). The uptake of such services not only depends on the affordability of the care but also on its quality and social acceptance (Barigozzi, Cremer and Roeder, 2020[47]; Ahmed et al., 2023[48]). The quality of care – especially long-term care for sick or elderly people – is crucial to build trust in formal care services provided by a third party and to ensure the well-being of care receivers.

Formalising the care economy could reshape societal perceptions and valuations of care work, including through the income associated with care jobs. Evidence shows that sectors and professions perceived as typically female, and where women are overrepresented, tend to be undervalued (UN ESCAP, 2022[46]; Shannon et al., 2019[49]). A well-developed, formal care sector signals that care is essential and valuable for the functioning of society. Increased recognition of care workers and the services they provide may raise their status and help attract a broader range of workers, including men. Furthermore, a care economy that provides well-compensated jobs and decent working conditions can also attract more men, thereby diversifying the sector. In the long term, the existence of well-compensated job opportunities in the care sector that appeal to male workers could help shift social norms that traditionally assign the care of children, persons with disabilities, and elderly individuals to women. However, the experiences of other countries with well-developed formal care sectors reveal that ensuring social and financial recognition for all care workers, including elementary and primary school teachers or nurses, remains a key challenge. This challenge persists even after the COVID-19 pandemic, which highlighted the crucial role played by these care actors.

Strong care sectors increase countries’ resilience to external shocks

External shocks, including health pandemics, climate-change-induced disasters and long-term demographic changes, deeply affect people’s socio-economic stability and well-being, placing significant pressure on countries’ healthcare and social protection systems (Asian Development Bank, 2022[50]). In this context, formal care sectors, backed by comprehensive social protection systems (Box 4.3), are fundamental to strengthening Southeast Asia’s resilience.

In general, formal sectors prove less vulnerable to the impacts of external shocks. Labour market regulations, together with the protection enjoyed by workers of formal sectors, ensure a certain degree of stability – both for employers and employees. The COVID-19 pandemic showed that governments more easily channelled emergency support to formal sectors and their workers than to informal workers, who saw their livelihoods threatened, affecting the services and products they provide (OECD, 2023[45]; ASEAN, 2022[51]). As formal sectors prove to be more robust and faster in recovering from shocks, the disruption of services – such as care – and of workers’ livelihoods are also less intense.

The formalisation of the care sector can extend the coverage of social protection systems to more workers. Formal workers are better covered by social protection systems than informal workers. In Southeast Asia, most countries’ social protection schemes do not extend automatically to informal workers, leaving them with insufficient protection and benefits in times of sickness, unemployment or retirement (ILO, 2023[52]; ILO, 2023[53]; ISSA, 2023[54]). It is imperative to improve informal workers’ access to social protection, and a gradual formalisation of the care sector would increase the share and number of care workers covered by social security schemes. Expanding the coverage through the formalisation of the care sector would not only benefit current care workers, but also potential new care workers, most of whom currently provide care under unpaid private arrangements that do not grant access to any social protection schemes.

By broadening the contributory base, the formalisation of care sectors would also strengthen social protection systems and improve their capacity to overcome crises. Many Southeast Asian countries face substantial challenges in ensuring the financial balance of their social security systems; this is due to the limited number of employers and employees who contribute on a regular basis to social insurance schemes, or pay taxes in the case of social protection systems funded through taxation (ILO, 2023[52]). Irregular contributions tend to be lower in well-structured formal sectors. Increased resources could allow governments to implement social safety nets that can act as buffers in times of crisis.

The integration and co-ordination of formal care sectors with national healthcare systems can raise the region’s degree of resilience to shocks. Care workers are crucial to support the people most vulnerable to shocks, including children, people with disabilities and the elderly. During events of extreme cold or hot temperatures, which are becoming more frequent because of climate change, healthcare workers, but also domestic workers who are on the frontline, are key actors to prevent health issues and to provide adequate care for those in need. Moreover, care workers from the education sector can raise awareness of climate change among children and youth and equip them with important information on how to respond to cases of external shocks. Finally, mobilising formal care workers can be faster and easier than informal care providers. In particular, in the events of disasters, the co-ordination of emergency responders, healthcare professionals, social workers and care providers is crucial to ensure the speed and adequacy of help and relief. In this regard, the ASEAN Comprehensive Framework on Care Economy underscores that the care economy could be leveraged to improve Southeast Asian countries’ response to and recovery from disasters, mitigating the effects of climate change (ASEAN, 2021[4]).

Box 4.3. What are social protection systems?

Social protection is a human and labour right. It is the set of policies and programmes designed to reduce risks of income insecurity and vulnerability over the course of a worker’s life. Social protection includes health protection, as well as benefits for maternity and paternity, unemployment, employment injury, sickness, old age, disability, children and families.

Social protection system refers to all schemes and programmes of a country’s social protection – which can be contributory or non-contributory.

Contributory social protection schemes are financed through a mix of workers’ and employers’ social contributions – sometimes supported by the government. They can be managed by the state, such as social insurance for pensions, but the private sector can also offer voluntary schemes. Social insurance schemes are the most common form of contributory schemes. The insured person contributes financially along with his/her employer, which entitles him/her to social insurance benefits, such as health insurance, sickness or parental benefits, unemployment benefits or a pension.
Non-contributory social protection schemes are mainly financed through general taxation, with funding sometimes coming from other actors such as the private sector or donors. Non-contributory schemes can be universal or targeted at specific groups of the population – often based on income levels. Examples include social assistance, universal healthcare, social pensions and social safety nets.

Source: (OECD, 2018[55]; ILO, 2023[52]; WIEGO, 2021[56]).

Structural socio-economic challenges hamper the emergence and formalisation of Southeast Asia’s care sectors

The formalisation of the care economy and its sectors remains a distant reality for most Southeast Asian countries. Among the many challenges that policy makers face, three structural socio-economic barriers hamper the emergence of strong and formal care sectors: (i) labour informality remains the norm; (ii) social protection systems are weak and cannot act as a catalyser for the care economy; and (iii) discriminatory social norms continue to consider care a private matter that must be handled by female family members.

Labour informality remains the norm, making it challenging to develop a formal care sector

Apart from Brunei Darussalam and Singapore, employment in Southeast Asia is primarily informal (see section “Paid care work is highly feminised and informal, which increases women’s vulnerabilities”). As previously discussed, the care sector is no exception, with most paid care workers in the region operating under informal arrangements. However, because informality affects all Southeast Asian economies, the formalisation of the care economy would not be an isolated endeavour. Rather, it would take place within the broader context of the efforts aimed at formalising Southeast Asia’s economies.

The formalisation of employment, including in the care sectors, may come at a cost for the most vulnerable workers and necessitates a specific approach. Formalising care sectors may exacerbate the pre-existing vulnerabilities of paid care workers operating in the informal sector, particularly domestic workers, for instance through job losses. With its standards and norms, formalisation can leave behind workers with low levels of education or sets of skills and deprive them of their livelihoods. For these reasons, formalising Southeast Asia’s care sectors requires an approach that is comprehensive in design but context-specific in practice.

The process of formalising the region’s care sectors poses the crucial question of informal employers. One of the main challenges of the formalisation of employment is whether and how to make informal employers comply with labour regulations and offer their employees formal benefits and protections (WIEGO, 2023[57]). In the context of the care economy in Southeast Asia, difficulties vary across sectors. Given the nature of the employers and their size, ensuring employers in the education or health sectors comply with labour regulations is easier than verifying compliance by employers of domestic workers – often households.

Weak social protection systems hamper the formalisation of the care sector

Current government spending on social protection in Southeast Asia remains weak, while the coverage of existing systems is limited and often blind to care. Government spending on social protection stands at about 2%, well below the global average of 13%. Apart from Timor-Leste, government spending on social protection does not exceed 4% (Figure 4.7, Panel A). This translates into countries’ social protection systems having a limited reach. For instance, the proportion of the population that is covered by at least one social protection benefit ranges from 6% in Cambodia to 68% in Thailand (Figure 4.7, Panel B). Singapore is the exception where everyone has access to at least one type of social protection benefit which includes social assistance for those in need (ILO, 2021[27]; ILO, 2023[52]).

Non-contributory schemes dominate the social protection landscape in Southeast Asia, resulting in a coverage gap of the “missing middle”. The region’s social protection systems are limited in terms of the different pillars they cover but also in terms of actual reach. With a strong focus on old-age benefits and health insurance, other crucial areas such as unemployment insurance fall short. Conversely, social assistance programmes occupy an important space in Southeast Asia’s social protection systems, targeting primarily the poor and marginalised population groups. Contributory schemes, and notably social insurance, are in place in most countries to support workers in case of work injury, sickness or pregnancy. However, these social insurance schemes are only mandatory for formal workers, which undermines their effective reach. As a consequence, people who are not poor enough to benefit from social assistance and do not operate in the formal sector – the so-called “missing middle” – are left without effective social protection. Governments have started to set up voluntary contribution schemes for informal workers, but the nature of informal work may obstruct their effective take-up (Kolev, La and Manfredi, 2023[26]; ILO, 2023[52]; ILO, 2021[27]).6

Figure 4.7. Social protection spending and coverage remain low on average in Southeast Asia

Social assistance programmes targeted at children risk reinforcing traditional care patterns. Data show that overall government spending on social protection benefits women and men equally in most Southeast Asian countries, although women and men may benefit from it through different channels.7 Countries’ efforts to increase health coverage tend to equalise spending on men and women. However, men are more likely entitled to social security, while social assistance programmes targeted at children focus on mothers as the main recipients (Asian Development Bank, 2022[50]). These programmes generally target women in their traditional role as mothers or caregivers to promote children’s health and well-being. This prevents breaking with long-standing gender roles and responsibilities, which are currently limiting women’s economic empowerment (Unicef, 2023[59]).

The integration of care-sensitive and gender-transformative social protection systems is costly but indispensable. As formal care services are likely to be more expensive than informal ones, governments must allocate money to subsidise them in order to ensure access for all groups of society. Investments are required to expand existing care infrastructure, to improve the design of employment-related care policies – such as parental leave schemes or family-friendly working arrangements – and to enhance their effective reach, as well as to foster the provision of care services for children, older persons and persons with disabilities or illnesses (UN ESCAP, 2021[10]).

In the context of care, social protection systems can act as a powerful catalyst for developing and rapidly expanding formal care services, but limited government action has prevented their establishment. By structuring care programmes and establishing subsidies for institutions and companies operating in the care sector, social protection systems can incentivise workers and economic actors to progressively formalise. To apply and obtain government subsidies targeted at care providers, actors and organisations that currently offer informal care services would need to structure and formalise. However, Southeast Asian governments have been slow in establishing such mechanisms and subsidies, and their absence acts as a powerful barrier to the emergence of formal care sectors.

Discriminatory social norms weaken the demand for and supply of formal care services

In Southeast Asia, social norms uphold care systems that rely on intergenerational support. These norms establish that the family, rather than the state, is responsible for providing essential care services, and have resulted in a system that relies heavily on (unpaid) care provided within households. For instance, in 2012, in the Philippines, 60% of the population reported that the best family model to ensure childcare is when the mother stays at home and the father works full time. In addition, 97% of the population agreed that the family – rather than the state, the private sector or non-governmental organisations – should provide childcare for children under school age; and 96% declared that the family should bear the costs of this type of care. Likewise, 90% of the population reported that families should be responsible for helping older people with their daily domestic tasks; and 65% declared that the elderly themselves or their families should bear the associated costs (ISSP Research Group, 2016[9]).

Such preferences limit the possibilities of alleviating women’s unpaid care burden for two reasons. First, they make it difficult to redistribute care work more equally between men and women within households. Second, they obstruct the outsourcing of care to non-family members even when households can afford it. These limitations come at a cost: on the one hand for women themselves, in the form of limited economic opportunities, and on the other hand for societies as a whole, in the form of foregone qualified labour force. In this context, recognising unpaid care as the backbone of a functioning society and economy is the first step out of five to promote a more equal distribution of care work between women and men, enhance women’s economic empowerment, and create stronger economies. The ILO’s 5R framework highlights the need not only to recognise unpaid care work but also to reduce and redistribute it, as well as to reward it through better-paid and decent work conditions, and to ensure better representation of care workers (Box 4.1) (ILO, 2019[8]; UN Women, 2022[60]). In particular, it is crucial to develop new models to assess the economic contribution of unpaid care workers and to find ways of financially compensating these indispensable unpaid services.

Policies across the region reflect these norms and preferences for a private form of care provision. Government spending on social protection remains limited following the understanding that the provision of care and health services, as well as income security, is a family matter, whereby individuals should rely on intergenerational support. Data show that Southeast Asian governments allocate limited budgets to address women’s unpaid care needs or to develop gender-responsive care policies, which reinforces existing gender dynamics in care provision (UN ESCAP, 2021[10]).

Beyond financial considerations, social preferences are pivotal in shaping the design of care systems. In Singapore, Southeast Asia’s wealthiest country with the lowest fertility rates, the government has restructured the care system, moving away from institutionalised care services towards more in-home and daycare services. Despite Singapore’s greater capacities in domestic resource mobilisation compared to other countries in the region, this option represents a lower-cost alternative. In-home carers, although less skilled than healthcare professionals, tend to be less expensive. Moreover, the approach caters for older people’s preference to stay in their own homes. In many instances, families may view hiring a live-in domestic worker and keeping care within the household as an acceptable compromise. This may align with their preference that the provision of care should remain a family responsibility. In fact, in 2010, eight out of ten Singaporean families reported hiring a foreign domestic worker to care for an older person (Addati, Cattaneo and Pozzan, 2022[42]). Across the region, notably in contexts where fiscal space may be constrained, most countries have enacted statutory provisions that provide for in-home personal care services. In four Southeast Asian countries (Cambodia, the Philippines, Singapore and Viet Nam), the law specifically mandates family members to care for their relatives (see Box 4.2).

Conclusion and policy recommendations

The formalisation of the care economy in Southeast Asia presents a myriad of potential advantages ranging from enhancing women’s economic empowerment to strengthening countries’ resilience to external shocks. Over the long term, it can also play a pivotal role in transforming ingrained discriminatory social norms. Notably, formal workers tend to be better protected by labour laws and have better access to social protection schemes than informal ones. Additionally, the establishment of a formal care sector would provide households with viable options to outsource unpaid child and elderly care responsibilities, thereby freeing up women’s time for other types of activities such as education, paid work and running income-generating businesses.

However, Southeast Asia faces a unique challenge: the current characteristics of care provision also constitute the main structural barriers that impede formalising care sectors. For instance, traditional gender roles and societal preferences that establish female family members as primary caregivers perpetuate care systems that heavily rely on women’s unpaid care services. These social norms not only shape the way care is currently provided across the region but also contribute to the limited public spending on formal care services and social protection systems. Furthermore, they explain the low uptake rate of external care services, thereby diminishing the incentives to develop a formal care economy facilitated by non-family actors. This creates a vicious circle where causes and consequences are closely intertwined, locking countries in a status quo – and sometimes aggravating it.

In the context of rapid demographic changes that will substantially escalate the demand for care, Southeast Asian countries must therefore exit this vicious circle. They must transition into a positive dynamic whereby the emergence and expansion of a formal care economy becomes a catalyst for women’s empowerment and inclusive development. This shift requires understanding how causes and consequences may be profoundly intertwined. For instance, as institutional care services become increasingly available, challenging social norms that establish family members as the primary providers of care may become easier. In return, transforming these norms and people’s preferences would not only boost the demand for formal care services but also reduce families’ reliance on women’s unpaid care work. Overall, such a transformation would encourage a more gender-egalitarian approach to the division of household and care tasks. However, altering the inherent gendered nature of the care economy could prove more difficult and may depend on a variety of structural and socioeconomic measures.

This shift also requires addressing two other major obstacles: the affordability and the quality of formal care services. In many Southeast Asian countries, restricted fiscal space, low domestic resource mobilisation and limited household resources for a substantial part of the population require innovative solutions that integrate the affordability constraint from the onset. Moreover, in a regional context where most of the population desires to receive care from family members, the quality of care is crucial to build trust in formal care services provided by a third party and to ensure the well-being of both care providers and care receivers. In parallel, acknowledging that not everyone will rely on formal care services, adequately compensating unpaid care work would help meet these preferences for family-based care while recognising the value of these indispensable unpaid services.

All in all, Southeast Asian countries stand at a crucial juncture where they can either perpetuate the current care provision model or opt for decisively investing in a robust and resilient care economy. The latter choice demands strong political will and long-term commitments from policy makers. To pursue this objective, countries can capitalise on the current momentum created by the increased awareness of the importance of strong care and social protection systems following the COVID-19 pandemic and the adoption of the ASEAN Comprehensive Framework on Care Economy in 2021.

Policy makers, in close collaboration with key stakeholders, must commit to addressing structural socio-economic barriers that currently prevent the emergence of a strong and formal care economy. Dedicated actions are required across four key pillars.

Address the informal nature of labour markets

Policy makers in close collaboration with experts and labour market representatives should develop policies that (i) target groups of workers and economic units operating in the informal economy; (ii) encourage the formalisation of micro- and small enterprises; (iii) promote the development of sector-based approaches to formalisation; and (iv) take into account non-standard forms of employment.
To tackle structural drivers of informality, policy makers should focus on extending social security coverage and improving compliance with the law, developing labour market institutions, structuring and empowering organisations of informal workers and employers, and designing and implementing integrated approaches to formalisation that cut across sectors (ILO, 2021[61]; ILO, 2015[62]).
Policy makers should account for the different needs of informal workers and the specificities of the sectors in which they operate. Understanding these needs and differences is crucial to adequately design the incentives offered by formalisation policies. This understanding is also critical to ensure that formalisation policies protect current informal workers, and particularly informally employed domestic workers, from the risks of job losses and income insecurity.
Strong political commitment and allocation of sufficient resources are indispensable in a context where informality is rampant. From the onset, policy makers should acknowledge that formalisation has its limits and that not all workers or enterprises will formalise (WIEGO, 2023[57]). This consequently requires developing innovative solutions to enhance the rights and working conditions of workers who will remain informal.

Strengthen social protection systems

Policy makers should invest in the creation of comprehensive social protection systems which can catalyse the formalisation of the care economy. This requires integrating the provision of care services as a central pillar – especially child and elderly care (UN ESCAP, 2022[46]).
Policy makers should ensure that social protection schemes are available to the entire population, e.g. through broad-based social insurance programmes. Extending the coverage of and updating social protection systems requires innovative approaches to reach informal workers. This may necessitate making legal changes, as certain groups of workers are explicitly excluded by existing legal frameworks, and/or designing voluntary contribution schemes for informal workers, recognising the specific challenges these workers face in paying regular contributions.

In Thailand, the Informal Workers Administration Plan (2023-27) focuses on extending social protection to informal workers. In Indonesia, discussed initiatives foresee providing pension security for informal workers or establishing contribution or subsidy assistance schemes for vulnerable and poor informal workers. In Cambodia, the National Social Security Fund (NSSF) has launched a pilot project to allow voluntary self-employed contributors to access healthcare benefits such as medical care services and maternity allowance (Sevilla, 2023[63]).

In Malaysia, the Employment Insurance System Act of 2017 and amendments to the Employee’s Social Security Act adopted in 2018 extended the social security coverage to domestic employees in 2021 (Malaysia, 2017[64]; Malaysia, 1969[65]). As of June 2022, employers must officially register domestic workers for the social protection scheme (Government of Malaysia, 2021[66]).

Experiences from European countries, as well as Singapore, reveal the importance of informal care workers in the provision of care. Policy makers should recognise the role of informal care providers and foster effective collaboration between them and care professionals (Juin, 2019[67]; Hengelaar et al., 2017[68]). Public policies and social protection systems should seek to improve access to formal home care services while encouraging informal support and solidarity, not only from family members but also from the social network of dependent elderly people (Juin, 2019[67]).

Reinforce the quality and the recognition of the care services provided

Policy makers, investors and the private sector must prioritise quality in the design of formal care systems and services. In a context where most of the population prefers care from family members, the uptake of institutionalised care services hinges not only on affordability but also on quality. This requires the establishment of regulations specifying minimum standards for care providers and mechanisms to ensure service quality. These standards should be tailored to meet the needs and well-being of both care providers and care receivers.
Policy makers should recognise the value of unpaid care work for individuals who will not rely on formal care services. Targeted financial and social security provisions can help recognise unpaid care work for its real economic value, thereby improving the livelihoods of current unpaid care providers, who are predominantly women. At the same time, such provisions could offer viable options for those who desire to care for family members, but refrain do so due to potential economic losses. To prevent unintended negative consequences, such as increased reliance on women’s unpaid care work, policy makers and key stakeholders must complement these measures with gender-transformative policies and programmes.

In Malaysia, the Kumpulan Wang Simpanan Pekerja or Employees Provident Fund (EPF), which manages the compulsory savings plan and retirement planning for private sector workers, implemented two programmes aimed at strengthening the financial security of unpaid care and domestic workers. The i-Suri programme allows housewives to register to the EPF and to contribute to a dedicated retirement savings plan. The scheme includes a 50% incentive contribution deposited by the EPF for every monetary unit contributed by the beneficiary. Eligible beneficiaries are Malaysian housewives registered under the National Poverty Data Bank and who are below 55 years (Employees Provident Fund, 2024[69]). The i-Sayang programme allows a male EPF member (giver) to transfer 2% of his employee’s contribution share received from the employer to his spouse’s (recipient) EPF account (Employees Provident Fund, 2024[70]).

Transform discriminatory social norms

Policy makers, together with all actors of society – including development partners, private and philanthropic actors, academic and research institutes, as well as feminist and civil society organisations – should design initiatives and programmes that shift social norms and expectations related to gender roles and care provision. This is necessary to ensure the uptake of care services provided by non-family members.
Interventions aimed at transforming discriminatory social norms should build on evidence-based initiatives that have proved successful. This notably includes leveraging the power of edutainment – a mix of education and entertainment – to promote more equitable alternatives to long-standing gender roles and responsibilities.
Empowering civil society actors, working with gatekeepers, such as religious or community leaders, and putting gender equality principles at the heart of the education system are further key features to lastingly transform discriminatory gender and social norms.
Transforming norms and expectations related to traditional gender roles also requires engaging with men and boys. Policy makers, with the support of gender experts and civil society organisations, should design programmes that aim at turning restrictive norms of masculinities into gender-equitable ones (see Chapter 3).

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Notes

← 1. According to the United Nations, a country is “ageing” when more than 7% of the population is 65 years old or older, and a country is “aged” when that age group accounts for more than 14% of the population.

← 2. The ASEAN Comprehensive Framework on Care Economy includes six strategic priorities: (i) promoting healthy ageing in light of the increasing number of elderly people and demand for long-term care; (ii) leveraging the role of the care economy to build disaster resilient societies; (iii) accelerating the digital transformation of the care economy along with technological innovations; (iv) building stronger and more resilient families – focusing on mental health and a better combination of work and family responsibilities – as the foundation of the care economy; (v) enhancing social protection to ensure that the human and labour rights of care workers are guaranteed; and (vi) increasing the resilience and care for the environment, including through green recovery (ASEAN, 2021[4]).

← 3. Brunei Darussalam is one of Southeast Asia’s two high-income countries. It provides its small population with universal healthcare coverage, financed by oil and other natural resource revenues. The availability of resources and the development of a strong national healthcare system are among the main factors explaining why employment in care sectors (including both care workers and non-care workers) is relatively high compared to other Southeast Asian countries. Moreover, data show that domestic workers constitute a substantial share of the employed population. This is in line with the literature and observed trends, according to which more affluent households outsource unpaid care, notably to domestic workers who are often foreign-born (ILO, 2021[74]). The situation is similar in Singapore – the region’s other high-income country.

← 4. Regarding the proportion of informal employment in the agricultural sector in Brunei Darussalam and Myanmar, significantly more women than men work informally. In the remaining Southeast Asian countries with data available, gender gaps are limited, ranging between one and six percentage points (United Nations, 2023[21]).

← 5. Economic activities follow the fourth revision of the International Standard Industrial Classification of All Economic Activities (ISIC Rev 4). Under the ISIC Rev 4 framework, domestic workers are categorised under Section T: “Activities of households as employers; undifferentiated goods- and services-producing activities of households for own use” (United Nations, 2008[71]).

← 6. For instance, in half of the regions’ countries, social security and labour market regulations regarding old-age benefits provide informal workers with the possibility to voluntarily contribute to existing social protection programmes. In Lao PDR, Malaysia, Thailand and Viet Nam, informal workers’ access to old-age, disability and survivor benefits is regulated through voluntary contributions to social insurance or provident funds. In Indonesia, informal workers are covered by life insurance but, unlike formal workers, are not covered by social insurance (ILO, 2023[52]). In Malaysia, in 2022, the Housewives and Social Security Act introduced a social security scheme for housewives (SKSSR) which seeks to protect them against domestic accidents and invalidity while performing their household duties (Malaysia, 2022[73]). The new scheme substantially increases the social security coverage of households and housewives, many of which are not actively engaged in the labour force (Government of Malaysia, 2022[72]). Overall, informal workers’ capacity to contribute to social protection programmes that require regular payments remains constrained by the nature of their income which is often irregular and/or low (Asian Development Bank, 2022[50]; Kolev, La and Manfredi, 2023[26])

← 7. Government spending on social protection is fairly gender-balanced in most Southeast Asian countries. In Cambodia and the Philippines, there are no gender differences, and in Indonesia, Lao PDR, Malaysia and Viet Nam, spending is fairly balanced. In Thailand, government spending is slightly skewed towards women. Conversely, in Singapore, social protection spending is biased towards men, as most spending is allocated to social insurance which largely benefits those employed in the formal sector; as women’s labour force participation rate is below that of men’s, a smaller share of social protection spending reaches them (Asian Development Bank, 2022[50]).

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