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Capitalism's Care and Social Reproduction Crisis Globally and the Struggles of Care Providers

Why is there a global social reproduction crisis?

On 12 May will be the International Day of the Nurse. ROSA along trade unions, and workers in the care sector focus on that date to highlight and fight the severe social reproduction crisis that is triggering the current care crisis around the globe.

What are the reasons for the social reproduction crisis? What are the implications? And how are workers of all genders fighting back?

Contribution from Anne Engelhardt, activist with ROSA International Socialist Feminists, Germany -- prepared by Anne for an International Socialist Alternative Women’s Bureau meeting in April 2023.

The social reproduction crisis is in many ways visible, but not in a way as the climate crisis, inflation and so on as it has many covered aspects. Those within the global working class that exercise (unpaid) reproductive tasks often have no time to write down their history and experiences.

Social Reproduction Feminism is a Marxist Feminist analysis that builds on Marx’ method of internal relations. This means to understand capitalism as the social whole in which we live and different social processes like racism, struggles, patriarchy as co-constituting parts. Neither capitalism, nor the other aspects of it exist without the other or are explicable without the other.

The opposite of such a theory would be some form of atomism, that we see in many pro-capitalist commentators, and also prevalent within the social democrat and Stalinist methods. Here, capitalism is one part and not a social whole, and other aspects such as racism, class, gender exist as further atoms in loose relations to one another. In my opinion intersectionality runs the danger of an atomist method, too. It overlaps atoms of processes of oppression but does not perceive how they co-constitute capitalism and how capitalism is co-constituting them. In this sense, they lack a thinking in processes, contexts and different spaces and a thinking of interrelation and mutuality with a capitalist history and totality, that has to be fought as a whole.

Social Reproduction Feminism starts deliberately with Marx and his analysis of class struggle. He explains the preconditions of those struggles due to the economic processes and never loses the dire life of workers and their brave resistance out of sight. Feminists like Maria Mies, Lise Vogel, Silvia Federici or Tithi Bhattacharya have advanced this class struggle centred Marxism or widened it by integrating more nuances and aspects to it, such as nature, homework, child bearing, commuting, sexuality, violence, sexism etc. Marx himself wrote in the first Volume of Capital in the 8th Chapter about the brutality of the exploitation of labour power with 20 hours shifts in the bakeries, the sinking quality of bread and food scandals [inspectors found sand and stones in breads], because of those conditions. The horrific deformed faces and bodies of workers in the match factories who have their lunch break room in the middle of toxic phosphor etc. We just commemorated the match workers strikes of the 19th century, in which women and girls took a leading role, at the ROSA congress in March this year. Marx did not forget women and children in his analysis of capitalism, but he did not push his theory of the working class in capitalism over the edge. His work largely misses the labour outside of the factories, or outside of creating variable capital. Social Reproduction Feminism does not disagree with Marx, but says: He could have been sharper and clearer if he would have deepened his understanding of how labour power is created itself.

What do we mean when we speak of Social Reproduction? We mean the reproduction of labour power in three ways: 1. Giving birth of potential workers 2. Educating, cleaning, teaching, healing, feeding, caring for workers power, resting, sleeping, healing as a process that workers who have to return to the factory each shift also need to do for themselves. 3. The reproduction of the capitalist society.

Social Reproduction Feminism has in my opinion the weakness of looking primarily at female workers and households, care, education etc. Also, there are currents that try to integrate domestic labour directly into the value theory, which is problematic for different reasons and leads to ideas such as the “household strikes” or “Conditional basic Income” models, which leave the fight for society as a whole out of sight and individualises the struggle.

However, social reproduction as it is theorised by some Marxist Feminists strands is a necessary process that permeates naturally in the whole working class.

Metabolic Rift and capitalism’s toll on our bodies and being

We start with Marx and his way of looking at nature destruction and capitalism. Marx developed the idea of a metabolism between capital and nature. The society in general but capitalism in particular relies on the ‘free gifts’ of nature such as air, wind, water, sun, soil, raw material. Marx observed that the capitalist centres, the industrialised cities were exploiting the land, like capitalism exploits nature. Because of the changes in how the working class had to live and eat in the cities and because of the hard work they needed a new way of eating (more carbohydrates and protein food), but where themselves cut off from subsistence work. Peasants and the lands had to produce more wheat, ray, meant and more. The soil became less and less fertile, because of over-exploitation. Marx described this continuous ecological crisis in capitalism as a metabolic rift: The metabolism between land and city breaks up and creates crises that for instance led to a war over the bird fertiliser from Peru, it led to a new wave of African colonialism by the mid-19th century, to famine and so on. And it led to a destruction of forests, to access more land and exploit its fertile grounds.

When we return to the working class and Social Reproduction Feminism, we should put the very working body in the centre of our analysis. Marx says, that the variable capital that workers produce – and they produce them via their bodies – that this capital is the only source for profit. We are a body and we have a body. We cannot do anything outside of it. Physically our bodies are nature as well. In a certain age, we are able to work more than we need for ourselves or our kin. But our bodies change a lot. As babies, children, and old people we have physical boundaries of what we can do and might even take or need more labour of other workers, than we can give. Our bodies are processes as well and change over years. This seems totally obvious, but the bourgeoisie and its ideology and atomist way in seeing workers as a source of labour and not of a changing human being, makes us forget the different natural features of our lives.

Marx wrote some remarkable material on it and this is my favourite quote where he says: Capital does not ask about the life span of labour-power. What interests it is solely the maximum of labour-power that can be made liquid in a working day. It achieves this goal by shortening the duration of labour-power, just as a greedy farmer achieves increased soil yield by robbing the soil of its fertility.” (Marx 1867 / 1957, 275–76) – Capitalists are robbing the workers of their energy and literally in some working processes also from their fertility itself, there are myriads of examples of how toxic materials that cleaners need to use, the work with silver, leather, oil etc can lead to infertility, on top of night shifts, too few sleep, food and so on.

When we look at the worker and its body in the social whole of capitalism – there it is made and remade by the metabolism between production and reproduction. Without producing variable capital, workers do not receive the wages they need to reproduce. And this social reproduction metabolism is also in a crisis – this is what we can call the social reproduction crisis.

It is in crisis, because the working conditions under neoliberalism have been “flexibilised”, the wages decreased, health and safety conditions at work have been dismantled over years. Breaktime has been shortened. Lean production has entrenched in all areas of work. Hence, the social reproduction metabolism is constantly at the edge to a metabolic rift, as are nature and climate itself.

The commodification of care and living under neoliberalism

In hospitals, we see that in many countries, every patient and its diagnosis have a particular price. It is called DRG – Diagnosis Related Group. This can include the bed, the cleaning and heating costs for the room, the food, the toilet water etc. The type of calculation to squeeze profit out of care work, is based on a global sum model and it is effectively the same model used as in lean- production for cars, electronics etc. However, factories and hospitals differ in their very nature to production industries. When for several reasons the patient needs more time to heal than the calculation of the lean production management means, then the hospital makes a loss. However, the privatisation of hospitals is only profitable if those lean-production logic works in all parts of the care processes. In some hospitals in Germany, nurses fought for more gloves, masks etc. as those “calculations” were far too low to safeguard a healthy working process of any kind.

Most patients are workers. A reason for an increasing number of patients were not only the Covid-19 pandemic and the increase in age, but the increase of work accidents, mental illnesses and burn-outs over the past years. In France, breast cancer has been accepted as a possible job-related illness. The risk to get breast cancer is 30% higher for workers in night shifts. Most night shift workers are in hospitals, cleaning, hospitality, and retail sector – most of them are female and genderqueer.

That means: On the one hand the danger to end up in hospital because of an over-exploiting deregulated capitalist working system has increased. On the other hand, hospitals have been prepared for years to become a new area for profit making. This is only possible when turning them into an industry similar to a car industry etc. However, as we deal with the materiality of our world, the physical boundaries of nature – industrialisation of care can only go wrong and create a severe crisis and resistance movements to it. We already see a class care system in which poor people have less access to care and on average die earlier from curable illnesses than rich people. Additionally, the illnesses that come with over-exploitation on the labour market are not very cost-efficient. They need more doctors, more care, more medication and more time to heal. Workers’ illnesses are therefore not profitable enough.

Capitalist care crisis in covid, cities, climate and more

In many countries, children suffer from post-covid symptoms. Mostly children from upper class families are treated. However, in poorer families in which parents were much more often exposed to the pandemic, as they worked in “critical infrastructures” the actual number of post-covid cases might be even much higher. However, the treatment is not easily accessible. We know that the reason for Covid-19 itself is the over-exploitation of nature and the crossing of several physical boundaries, of destroying natural habitats of animals, climate change and so on, that led to a zoonosis and a health and care crisis in the past couple of years.

On top of all of that there is the neoliberal way of how cities and living has changed. Housing has become one of the commodified goods in the recent years, making it impossible for many workers to live close to the city centres or where they work. Many workers must commute and in that have neither time to work, nor to recover. The shopping malls where poorer workers might find cheaper offers are often far outside of the areas where they live and take more time to access them.

In some regions, the climate crises even force mostly women workers to travel kilometres just to fetch water, food, or fuel which increases their time on reproductive work also dramatically.

The care crisis also hits everything that targets elderly care. When workers have been exploited enough – in some countries workers have fought for pension rights – i.e. - payment that workers need to barely survive. Elderly care is in many countries depending on the income of workers and their families. The Covid-19 crisis has exposed the dramatic and horrifying conditions under which poor workers and even skilled workers have to endure to the end of their lives. Bad elderly care hits women often more, because of the fact that their pensions are much lower. With low pensions they cannot provide to pay for better care for themselves when old.

In France, female workers are on the frontline of the current strike movement, because of their low paid and part time jobs, they will under the changing pension reform have to work longer than male workers for even lower pension. In Germany, the pension gap between male and female pensioners is 46%. In France, it is now already 33%.

In such a system, female and especially migrant workers are even more exploited by working for maintaining the family and for the wage. Additionally female workers do the mental load of planning, managing, scheduling everyone else needs and plans, losing their own so frequently in the process. It is therefore no surprise that over 70% of people diagnosed with burnout are female.

Exploiting female workers along the global care chain

Under neoliberalism, compared to the post-war period, the private care of often female workers has become an obstacle for the over exploitation in many countries, especially in the countries of the global North. Here, in the imperialist centres of the global value chains, more tech and white collar workers are needed, to manage and digest the commodities and capital flows from the extraction of value from other parts of the world. It is a myth that female workers just moved into the labour world in the 1970s. As in many parts of the world, women have never vanished from being part of the overall workforce. They toiled especially in agriculture, selling, sewing etc. and have been exploited in workshops, hospitals, cleaning etc. However, in the imperialist centres we see a drive towards “freeing” female workers from domestic and unpaid care work and being replaced by mostly migrant workers from poorer parts of the world. The female workers that employ other poorer workers to clean their house, take care of their elderly and children, often work themselves in the care sector. At the same time, the migrant workers who do this type of low paid work, left their care work, when leaving the country to even poorer migrant workers or unpaid relatives, such as younger siblings or older children. Often those migrant workers are women and queer people from the former colonial states who are in a way re-exploited under capitalist conditions. This interconnection between different care works is known as the “global care chain” – and it expresses clearly that social reproductive work cannot be eliminated or pushed aside. Rather, it is an intrinsic part of how capitalism functions.

Attempts to decrease care work for one part of society will immediately lead to other workers having to do more care work under worse conditions. It is an equilibrium that cannot be resolved. Not by automation, not by machine, because it is a materiality, it is a basic need to be cared for, to talk to other people, to be loved, to be healed, to be spoken to, to listen, to eat together and to break free from isolation.

The atomist method that I described at the beginning, is not just an analytical method. It is a real abstraction, a violent reality that capitalism enforces on us. Capital accumulation processes need a society to uphold a system that exploits surplus labour from naturally social human beings who take the extra amount of energy which they normally would need to care for one another and themselves. In capitalism, the link between care and work is broken up. What we produce is privatised in private hands. It is energy and time taken away from us and our communities. To break us into individuals and detach us from another means to alienate us from work, but also alienate us from our own social reproduction. In capitalism, we hardly work based on our free choice, but because we must. Patriarchy is a further tool to upheld labour division and to force us to do unpaid care work for mostly male workers who do too much of productive work and have hardly energy left to reproduce themselves or others. Atomism is a violent reality of trying to turn workers into robots – which is, however, by nature impossible.

The social reproduction crisis hits all workers

Social Reproduction does not only happen in the household and it is not solely provided by women. The recent railway strike in the UK was a lot more about social reproduction labour, than it was discussed. Disability organisations and people with disabilities spoke up in favour of that strike, because it was also about keeping staff in trains, at stations and in ticket offices. For people with special needs, it is imperative that there are workers in the trains and on the platforms that provide support – no matter if they are blind, temporarily injured, unable to walk, or whatever. Without help to access the right train in the right direction, without support on opening and closing toilet doors in the train or being accompanied in the night on the platform or in the train, for many people mobility becomes right away inaccessible. But for this extra care work, the train companies are not willing to pay. In cutting staff on platforms, trains, and offices they destroy – what we can call – the social kit of society and mobility for all.

In the US, workers in the railway sector have attempted to launch a strike which the “pro-labor” Biden government shamefully prohibited. The reason for the conflict has not been money but the right to take sick-leave. It is unbelievable, that railway workers like train drivers, engineers and so on lose wage and pension points when deciding to go to the doctor. There have been reports of drivers dying with a heart attack during their shifts.

The discussion on a shorter working week, ‘quiet quitting’, ‘lying flat’ are not an expression of any type of laziness (if that term is anyways not an invention of the capitalist class, to domesticize workers), but an expression of how neoliberalism has first and foremost intensified tasks and productivity on the back of workers’ bodies and minds.

The social reproduction crisis is a symptom of a boundlessly profit-hungry capitalist system in crisis that is destroying every boundary and physical natural structure there is.

How are workers fighting back ?

The economic crisis of 2007/2008 has increased the contradictions in global social reproduction. Hospitals and other infrastructures have been privatised, closed down or exposed to severe cuts to “save” money for bailing out banks and the financial system. The marketisation of health has led to a dramatic decrease of care workers in the sectors, as they are only profitable, when running on solely a few backs.

A few examples from Germany: female and migrant workers were considered for a long time within conservative trade union officialdom as “unorganisable”. However, the crisis has changed that image drastically. In Berlin in 2009, the IG BAU – the construction workers union, organised the “revolt of the invisible” a strike of predominantly female cleaners who were often unseen, as they clean in the night or the early mornings and they dressed as ghosts, and made demonstrations to made their cause visible. In that same year, the first kindergarten strike occurred with a high militancy, that would return six years later in 2015 with a four weeks national kindergarten and social workers’ strike. In 2011, the first hospital strike in the Berlin Charité was called for four days, in which there was a lot to be learned about the difference between striking in a car factory and in a hospital, in terms of the type of relentless and hypocritical pressure that can be exerted by the capitalist establishment. All of a sudden the media and politicians turn on the water works in mendacious concern for patients’ lives when there is a strike. But they do not matter during the day-to-day care crisis. From that hospital strike, several other movements in different parts of Germany were inspired These often did not even demand much more wages, but more staff and the right to close down beds, when not enough workers appear on a shift. Also, kindergarten workers were demanding the right to close down groups on days when they would be alone with more than 15 kids – as there had been situations when kindergarten teachers stayed alone with about 30 kids under six, leading to massive burnout.

In Belgium and in Austria, ROSA alongside ISA activists were able to initiate campaigns like “santé en lute” and “Sozial aber nicht blöd” – in Belgium together with the trade union – in Austria more as a network of colleagues. In many hospitals in the US, and now also in Germany, more left-wing trade unions concentrate on deep organising. Working groups firstly initiate signature campaigns among all their colleagues and single out best organising and best known and trusted workers to be then elected as shop stewards from their teams to which they also report back on negotiations. In terms of fighting against the racism and xenophobia ingrained in the so-called “global care-chain”, Ruth Coppinger from ROSA in Ireland is working with groups of migrant nurses who are organised both in the wider nurses’ union, but also within their own migrant nurses’ association -- they’re fighting for equality and recognition for their exemplary training, the lack of recognition of the same sees fully qualified migrant nurses toiling for less pay than their already underpaid colleagues, and for assistance and rights in terms of visas for themselves and family members, alongside other issues.

There was a ten days hospital strike in South Africa in March2023, and a doctors’ strike in Zimbabwe. There were hospital strikes in China about the lack of staff and protective gear for medical students. 2022 also saw a return of the so-called white wave of hospital and care workers strikes in Spain which in December 2022 led to the occupation of the health ministry in Madrid. In Russia, there was a slowdown strike in several cities of doctors who fought against cuts and low wages.

Currently, there are communal hospital strikes in Germany and one doctor wrote on Twitter “A strike is the greatest declaration of love to our health system and the only way it can get better”.

Socialist alternative puts care, not profit at the centre

ROSA supports the struggles around the world of healthcare workers, to improve their working conditions, to train and employ more staff, for immediate wage increases above inflation etc. We call for an immediate halt to privatisation in the care sector; re-socialise care, take it completely out of private hands and take down Fresenius, Helios, Orpea etc. We support fully public, quality, free at the point of delivery universal care -- this should be paid for by utilising the wealth that is in private hands that must be taken over in the interests of caring for humanity.. For public, secular and progressive health and social care, it must be taken completely out of the hands of churches and other religious institutions. As well as public services like universal free childcare, local and quality schooling, elder care and so on, we recognise that unimpeded and free access to abortion, contraception and trans healthcare on request, without shame, legal barriers, or gatekeeping, are essential rights for both those in the caring workforce, and those burdened with unpaid care. Care workers, especially nurses are subject to assault, sexual harassment and racism on the job frequently. Furthermore, medical misogyny, racial disparities in care, brutal treatment of trans people, and a interconnection of the same are some of the issues that patients face. In this way, the fight for proper care, must innately be an anti-sexist, anti-transphobic, and anti-racist struggle.

Care should be democratised -- for example by public care providers being run by elected committees comprised of representatives of care workers, of patients/clients and of the broad trade union movement. Fundamentally, the capitalist system and its brutal drive for profit is a hazard to human health and the planet. The drive for profit at the centre of capitalism is diametrically opposed to centring care. Profit and care will always clash. This fact is at the heart of capitalism’s intractable care crisis. Care workers’ struggles, movements for increased rights and access to care, to health, to social supports and services, are struggles located at the site of this collision -- and are struggles innately connected with the entire global working class’s needs and interests. Care crisis related struggles must be joined up with other struggles of workers and oppressed of the world in a socialist movement against the rule of profit -- a struggle to take wealth and resources out of private hands. With the key levers of the economy in public ownership -- fought for and won by an active, conscious, organised and socialist working class and poor masses arisen against the private ownership of wealth and the state that defends it -- a democratic plan of the economy could put care for people and the planet at the very centre of everything. This is integral to the socialist struggle, and socialist change.

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