Who Cares about Healthcare Workers? Care Extractivism and Care Struggles in Germany and India

Abstract

This paper suggests the concept of care extractivism to explore strategies and mechanisms which pursue the persistent low social and monetary acknowledgement of healthcare work in Germany and India. Recently, caretakers and nurses in both countries went on strike, pointing to a crisis situation in social reproduction and various forms of care extraction. In Germany, care for the elderly and nursing in hospitals are marked by strategies of familialisation and voluntarisation, of standardisation and digital surveillance and by transnationalisation through the import of migrant workers. In India’s rural health provision, voluntarism subsidises welfarism; in private and public hospitals, hierarchisation and contractualisation of employment deepen care extraction. Stereotypes of nursing as natural female, caste norms and various stigmata reinforce the low valuation of care work. In both countries, neoliberal policies merge with patriarchal structures of social reproduction, intensify care extraction and create a cheap care work force which however is no longer docile.

Social Inequities in Private Health Sector Workforce in India: Religion, Caste, Class, and Gender

“…Poor wages, long hours of work, lack of secure employment, leave and pension benefits are glaring for the lower levels in the work hierarchy in the private sector. These practices amount to extractivism as discussed by Wichterich (2020). As she opines: "The notion of extractivism marks the intensified commodification and exploitation of the resource labour in social reproduction for the purpose of managing crises situations without burdening the state or the health industry with additional costs and responsibilities.…”

“…While the deflated term exploitation highlights the offendervictim relationship, the concept of extractivism stresses the structural power relation in the political economy." (Wichterich, 2020). The term aptly defines the case with much of the private health sector in India that thrives on the vulnerability inflicting the majority of labour force, in addition to the nurses.…”

“…The secondary role is further reflected in the gendered wage gap and adverse working conditions. Stereotypes of nursing as natural female, caste norms and various stigma reinforce the low valuation of care work (Wichterich, 2020).…”

Merchants of Migrant Domestic Labour: Recruitment Agencies and Neoliberal Migration Governance in Southeast Asia

“…The biopolitical transfer of what might be called "social reproductive forces" from sending to receiving countries causes a "care deficit" (Williams, 2010). Caring capacities and resources are "extracted" (Wichterich, 2020) from poorer to richer countries, exacerbating care inequalities. In lieu of her actual labour, the domestic worker remits money back to her family to be spent on activities meant to reproduce the household back home (education, healthcare, expenses) (Rahman & Lian, 2009;van Naerssen et al, 2016).…”

Intersections of caste, class, and gender in healthcare sanitation work in India: Social work imperatives for restructuring marginalized women's care work

“…The feminine caste contract is a complex arrangement of precarious exploitative work conditions informed by the discrimination and exclusion inherent in the structural intersections of caste, class, and gender. Referencing Wichterich's (2020) concept of “care extractivism” – the structural arrangements and strategies by which gendered care labor is intensely commodified and resourced, the feminine caste contract coerces marginalized women housekeepers and sanitary workers to comply with a range of unsatisfactory terms and conditions through punitive measures such as structural discrimination, economic deprivation, sociocultural stigma, and the continuation of historic caste violence. Their work exposes them to a wide range of physical, biomedical, and chemical hazards.…”