Submission to the Working Group on Discrimination Against Women and Girls

Human Rights Watch welcomes the opportunity to provide input to the United Nations Working Group on discrimination against women and girls ahead of their upcoming report to the Human Rights Council on the gendered dimensions of care and support systems. Our responses and examples in this submission are based on Human Rights Watch’s research findings and analysis.

Paid Care (question 1: What national legislation and policies govern paid care work in your country?)

Lack of legal, labor, and social protections for domestic workers, including migrant domestic workers

Domestic workers play a crucial role in care giving around the world, and yet suffer from dire rights violations connected to their work, as well as a lack of protections.

Tens of millions of women and girls around the world are employed as domestic workers in private households. They clean, cook, care for children, support older family members, and perform other essential tasks for their employers. Despite their important role, they are among the world’s most exploited and abused workers. They often work 14 to 18 hours a day, seven days a week, for wages far below the minimum wage, and often without access to any form of social security. They may be locked within their workplace and subject to physical and sexual violence. Children and migrant domestic workers are often the most vulnerable.[1]

While some progress has been made, for example with the adoption in 2011 of International Labour Organization (ILO)  treaty No. 189, Concerning Decent Work for Domestic Workers, there remain serious gaps in legal protections for domestic workers.[2] Human Rights Watch has documented that inadequate labor protections and exploitative work sponsorship systems put migrant domestic workers at serious risk of abuse in Lebanon, Oman, and the United Arab Emirates.[3] In India, Human Rights Watch documented how poorly enforced laws left domestic workers with no recourse when they faced sexual violence.[4]

Governments need to do much more to ensure decent treatment of domestic workers and remove policies and laws that expose them to increased risks of abuse. Ensuring these reforms is a crucial part of a rights-respecting approach to care giving.

Unpaid Care (question 2: What national legislation and policies govern unpaid care work in your country?)

Shifting support responsibilities for people with disabilities to families

Mexico’s federal and state governments have yet to develop comprehensive programs and policies to enable people with disabilities to live independently and be included in the community. The lack of these policies places the responsibility for supporting people with disabilities on their families, especially on women. This has the potential to lead to an increase in domestic violence, abuse, and neglect against people with disabilities, as documented by Human Rights Watch, and it unfairly shifts support responsibilities onto families, with a disproportionate impact on women.[5]

Moreover, instead of ensuring that adults with disabilities can live independently, with support, and be included in the community, civil legislation in the states of Mexico City, Oaxaca, Jalisco and Nuevo León obligates families to support adults with disabilities who do not have the means to support themselves. This is a requirement imposed on parents, siblings, cousins, and aunts and uncles of the person concerned. In Mexico City, Jalisco, and Oaxaca, if a person’s income or assets exceed a certain threshold and they fail to support their family member with a disability, they can be held criminally liable, with penalties including imprisonment.[6] This is inconsistent with international law, which provides that the obligation to support people with disabilities in leading an independent life lies primarily with the state [and should not be transferred to private individuals.] Responsibility for the provision, funding, regulation, and assurance of high standards of quality, safety, and health for both care providers and people requiring care and support rests with the state.[7]

Universal Public Education (question 3: Does your country provide universal public education through i) high school ii) university education?)

Support Proposed Free Education Optional Protocol to Convention on the Rights of the Child

While the Convention on the Rights of the Child guarantees all children free and compulsory primary education, it does not require states to make secondary education free for all children, and it makes no explicit reference to early childhood care and education or pre-primary education.[8] Yet free primary education alone is clearly insufficient to prepare children to thrive in today’s world.

All states should therefore strongly support the recently established intergovernmental working group of the UN Human Rights Council in its efforts,[9] beginning in 2025, to elaborate and submit to the Council a draft optional protocol to the Convention on the Rights of the Child with the aim to: “(a) Explicitly recognize that the right to education includes early childhood care and education; (b) Explicitly state that, with a view to achieving the right to education, States shall: (i) Make public pre-primary education available free to all, beginning with at least one year; (ii) Make public secondary education available free to all.”[10]

Supporters of the new optional protocol include more than a half-million people who signed an open letter from activists Malala Yousafzai and Vanessa Nakate, various prominent children’s rights advocates, leading international scholars, and child activists. [11]

Inaccessible or unaffordable childcare options prior to free primary school can preclude parents, particularly women, from engaging in paid employment should they need or choose to do so, or otherwise participating in public life. It can also preclude adolescent girls—either as mothers or older siblings—from benefiting from their right to education. The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) requires states to promote “the establishment and development of a network of child-care facilities” to enable parents to combine family obligations with work responsibilities and public participation.[12] But ignoring early childhood care and education, including free public pre-primary education, as every child’s right, leaves the human rights framework with an unbalanced approach to “daycare” focused disproportionately on parents’ rights, without adequately accounting for how children’s rights should be an important consideration in reaching many of the same goals. Recognizing an explicit right to early childhood care and education, including free public pre-primary education, in the proposed new optional protocol to the Convention on the Rights of the Child, would be more consistent with a child rights approach by formulating the objective of such services and facilities to maximize the child’s development with early childhood education.[13]

Adolescent girl students who are mothers or care givers to younger siblings or other family members often experience a lack of support, encouragement, and accommodations at the school level that make it impossible for some to juggle schooling and care-giving responsibilities. Due to the cost, their children often have no access to early childhood education programs, whether through nurseries or state- or community-managed crèches. Evidence from numerous countries shows that the accumulation of these barriers means pregnant or parenting girls are far less likely to return to school.[14]

In a world where many parents with limited financial resources face social pressure to prioritize their boys over their girls, secondary-education fees may become a discriminatory barrier in violation of international law.[15]

Quality, free pre-primary education can particularly benefit children with disabilities, including by strengthening their capacity to benefit from education, promoting their enrollment and attendance, and reducing stigmatizing and discriminatory attitudes against them.[16]

Persons with Disabilities (question 7: What economic and social policies and programs exist to ensure that persons with disabilities receive quality care? Please indicate the name of any programs that exist, and the relevant ministry/agencies. Do these policies respect their inherent dignity, and individual autonomy including the freedom to make their own choices?)

Using a Dependency Framework to Refer to People with Disabilities and Older Persons

Uruguay adopted an innovative care law (Law No. 19353) on November 27, 2015, creating the National Integrated Care System (Sistema Nacional Integrado de Cuidados, SNIC), which includes sections related to personal assistance services for people with disabilities and older persons.[17]

According to Law No. 19353, the care system is the set of actions that society undertakes to ensure the comprehensive development and well-being of those in a “situation of dependency.”[18] This law lists three categories of people who have the right to receive care: children up to age 12, people 65 years old and older, and people with disabilities under 29 who are in a “situation of dependency.”[19] While the law establishes that people age 65 and older can access the benefit, the National Care Board is implementing it progressively, and is thus prioritizing people age 80 and older.[20]

Dependency is an overarching concept used by Uruguay’s legislation to describe children under 12 and people with disabilities and older persons who require the assistance of another person or persons or significant help to carry out basic activities and satisfy the needs of daily life as described above.[21] Dependency is a problematic concept when used to refer to people with disabilities or older persons, as it implies that their condition is a purely individual deficiency that can be determined and measured objectively, disregarding the social environment in which the person develops. It also fails to frame their requirements for exercising their rights in a positive way. A narrative based on dependency projects a negative image of persons with disabilities and older persons, portraying them as a burden.

Under Uruguay’s 2015 law, not everyone with disabilities has the right to a personal assistant. This is only available to those who are considered to have “severe” disabilities and a “high level of dependency;” who do not reside in an institution; who qualify based on means testing; who are under 29 years old or are 80 or over; and those whose income is below a certain threshold.

Older Persons (question 8: What economic and social policies and programs exist to ensure that older persons receive quality care? Please indicate the name of any programs that exist, and the relevant ministry/agencies.)

Older women not only provide more care for and support to others beside older men, but also require more care and support themselves.[22]

Limited Access to Home- and Community-based Care and Support Services

Older persons have the right to live independently in the community. Yet, many do not have access to the home- and community-based care and support services essential to the full enjoyment of this right, including in the United States, Russia, and South Africa.[23]

Older persons in South Africa today, 61 percent of whom are women,spent at least half of their lives living under apartheid. [24] The vast majority were denied a decent education, decent work, access to workplace pensions, and the ability to save for their older age.

South Africa has post-apartheid laws that guarantee older persons’ right to care and support so they can live independently. The Older Persons Act guarantees older persons the right to live in an environment that caters to their changing capacities,[25] with community and home-based care and support services provided to enable that to happen.[26] The Social Assistance Act provides financial support, the Grant-in-Aid, to persons who need full-time assistance at home.[27]

South Africa’s Department of Social Development is responsible for providing care and support services. At the national level, it is responsible for policy and standard setting. Provincial Departments of Social Development are responsible for the delivery of community- and home-based care and support services in their province. They set the priorities and budget, part of which they use to subsidize non-profit organizations to fulfill the government’s duties under the Older Persons Act to deliver community- and home-based care and support services.

However, current government policies are leaving hundreds of thousands of older persons, the majority of them women, without access to the support services they are entitled to. This negatively impacts their physical well-being and safety, and may impede their dignity, autonomy, and independence. Some fear institutionalization. Others may be at greater risk of violence, abuse and neglect.

Government targets on access are based on budgetary allocations rather than on older persons’ requirements, and given rates of disability,[28] chronic illnesses,[29] and dementia,[30] are extremely low. Provincial governments have not increased their budgets to meet growing needs, and there are insufficient numbers of social workers.[31] In addition, although the government contracts non-profit organizations to deliver community- and home-based support services on its behalf, overly prescriptive rules and insufficient funding impede organizations’ capacity to deliver those services.

These challenges are exacerbated by the government’s over-reliance on family members, most often younger women, to provide home-based support to older persons.[32] Few older persons are aware they may be eligible for the Grant-in-Aid, a social security entitlement intended to cover the costs of full-time home-based support. This monthly grant, however, is woefully inadequate at ZAR530 (US$30) per month.[33]

Use of Residential Care Facilities as Alternatives to Home- and Community-based Care and Support

Human Rights Watch has considerable research showing the abuses inherent in the institutionalization of individuals, many of whom are older persons with disabilities who are denied the right to decide how and with whom to live and to control their support systems. Human Rights Watch has also documented these practices in Armenia, Brazil, Croatia, Ghana, India, Indonesia, Japan, Kazakhstan, Kyrgyzstan, Nigeria, Russia, Serbia, Somaliland, and Ukraine.[34]The Committee on the Rights of Persons with Disabilities provides essential guidance on the need to create support systems consistent with the right of persons with disabilities to live independently and to honor their right to make their own decisions with community services.[35] Countries such as Brazil often see institutionalization as an alternative form of care when family or social support networks are lacking.[36] However, this should not be the case, as institutionalization based on disability is a form of discrimination.[37]

Chemical Restraint of Older Persons in Residential Care Facilities

Several international conventions prohibit torture and other cruel, inhuman or degrading treatment or punishment. Human Rights Watch has documented that nursing homes in the United States and Australia routinely give older people, including older women, antipsychotic drugs as chemical restraints.[38]  “Chemical restraint” is the use of medications to control behavior without a therapeutic purpose. Antipsychotic drugs almost double the risk of death in older people with dementia.[39]

Human Rights Watch research in 2020 and 2021 on older people, including older women, in nursing homes in the United States documented serious concerns including extreme weight loss, dehydration, untreated bedsores, inadequate hygiene, mental and physical decline, and inappropriate use of psychotropic medications among nursing home residents.[40] Staffing shortages, a longstanding issue that was a significant problem during the pandemic, and the absence of family visitors, many of whom nursing homes rely on to help staff with essential tasks, may have contributed to possible neglect and decline.[41] In 2024, the Centers for Medicare & Medicaid Services (CMS) released minimum staffing standards for nursing homes.[42] University of Pennsylvania research showed their implementation could save thousands of lives annually.[43] Despite this, 20 state attorneys general, and the American Health Care Association and other nursing home providers, have filed lawsuits against CMS to block the standards’ implementation.[44]

In Australia, Human Rights Watch has documented the widespread use of chemical restraint in aged care facilities.[45] As best as Human Rights Watch could determine, staff in the aged care facilities where Human Rights Watch conducted research did not seek or secure informed consent prior to giving these medications. Regulations introduced in 2019 to minimize the use of restrictive practices have failed to protect aged care users from the use of chemical restraint. [46] Human Rights Watch’s review of non-compliance reports for aged care facilities across Australia from July 1, 2020 to June 30, 2021 found use of chemical restraints in more than 150 aged care facilities.[47] Despite this, new legislation before the Australian Parliament, the Aged Care Bill 2024, fails to ban chemical restraint and only seeks to minimize its use.[48]

Increasing Women’s Labor Force Participation (question 14: What policies are there to increase women’s labor force participation? What challenges remain to women’s labor force participation? Please comment on how different groups of women may experience these challenges based on their intersectional identities shaped by class, race, ethnicity, rural/urban location, religion, sex/gender, sexual orientation, etc.)

Support ILO Convention No. 190 and Address Violence Against Women

Violence against women in the world of work remains a key barrier to women’s labor force participation, and women working in paid care giving roles are often at heightened risk of violence and harassment in the workplace. The International Labour Organization (ILO) Convention No. 190 on Violence and Harassment at Work lays out comprehensive standards for preventing and responding to violence and harassment in the world of work.[49]

This landmark treaty is especially relevant for feminized industries including domestic workers, other care workers, and for women working in the informal economy. Human Rights Watch research has long documented the impact of violence and harassment at work, including in domestic and informal work.[50] The treaty requires that special attention be paid to sectors, such as domestic and care work, that have a heightened risk of harassment and violence.

All states should ratify Convention No. 190 and incorporate its standards into law and practice, ensuring a safer and fairer world of work for everyone. Doing so will help provide an adequate supply of care workers, by ensuring that care workers feel safe at their jobs.

Reducing Women’s Unpaid Care Work (question 16: What policies are there in your country to reduce women’s unpaid care work and to promote a more equal sharing of care work between men and women?)

Greater Gender Equity in Care Giving

Care giving is a feminist issue because the care givers remain so deeply gendered. Up to 81 percent of care givers for older people are women, and according to the World Economic Forum (WEF), women “carry out nearly three times more of the daily care of children, homes and the elderly than men.”[51] These inequities are linked to deeply rooted gender stereotypes, but there are practical steps that can help, including changing employer practices and social security legislation related to care giving leave. The WEF reports that as of 2022, 186 countries had laws ensuring parental leave for mothers, but only 122 did so for fathers, and when leave was offered for fathers, they received an average of 22.5 days compared to 192.3 days for mothers.[52]

An urgent priority in trying to strengthen care, support, and social security systems and address the gendered dimensions of those systems is to both enable and urge men to take a more equitable role in care giving. Some countries have passed laws to do just that, for example by incentivizing men to take parental leave by offering longer paid parental leave if that leave is shared by both parents.[53] These are important initiatives that should be replicated and expanded; such policies benefit the men who undertake care giving, the women who face fewer gendered expectations, a decreased likelihood of workplace gender discrimination, and less pressure to leave paid employment, and the children who receive care.

Civil Society Consultation (question 23: Does your government consult civil society organizations in drawing and evaluating policies and their implementation (for example organizations representing care workers, persons with disabilities, older persons)? If yes, which civil society groups are consulted? Through what institutional mechanisms is their input considered?)

Lack of Involvement of Organizations of People with Disabilities in the Design and Implementation of the Care System in Uruguay.

In Uruguay, the National Integrated Care System established an Advisory Committee that involves various sectors of civil society, including organizations of people with disabilities. However, these groups’ level of influence on government policy has not been very significant according to some of their leaders.[54]

Some organizations and experts working on disability rights in Uruguay, including Human Rights Watch, have expressed concerns that the role of the personal assistant, as established in the 2015 legislation, and the growing world care agenda in general, does not align with the values of the right to independent living for people with disabilities.[55] A personal assistant should be treated not merely as a care worker, but also as an enabler of the exercise of rights of people with disabilities. For example, they may enable a person with a disability to be able to live independently in the community and fully exercise their rights protected under the Convention on the Rights of Persons with Disabilities (CRPD).

Uruguay and other countries in the process of implementing care and support systems should establish permanent mechanisms to ensure that people with disabilities, including women with disabilities, actively participate in the design, administration, and monitoring of these systems. This approach aims to ensure compliance with the standards set out in the CRPD, including the right of people with disabilities to have control and decision-making power over their support systems.

Challenges (question 29: What are the challenges to creating a robust care and support system in your country? What is the attitude of the general public in the country towards care work and the family’s role in providing care to the family members? Does this attitude differ depending on the region of the country or by other factors?)

Gendered Impacts of Care and the Covid-19 Pandemic

The failure of governments to address deep-seated gender inequality presents a major barrier to the creation of robust, rights-respecting care and support systems worldwide.

The Covid-19 pandemic illustrated and intensified the underlying gender imbalances in the global care and support systems, which too often rely on the unpaid and underpaid work of women and girls.[56] Before Covid, women did 2.5 times as much domestic care work as men.[57] Between March 2020 and September 2021, data showed that women and girls were disproportionately affected by the pandemic, with significantly higher rates of employment loss than men, higher rates of school dropouts for reasons other than school closures, and increases in uncompensated labor.[58]

These setbacks in women’s rights stemmed from deeply ingrained inequalities that were further deepened during the pandemic. For example, gendered expectations around care, and the gender pay gap, pushed women to sacrifice their paid employment options instead of men.[59] Women were also more likely than men to lose their jobs during the pandemic because they disproportionately work in roles, including in the informal economy, where they have little or no job security or social security.[60]

Moving forward, policymakers should learn from the pandemic experience and: a) work to help women recover ground they lost during the pandemic; and b) prioritize addressing the inequities in caregiving that made the pandemic's impact so gendered. This includes implementing caregiving leave policies, including paid caregiving, paternity, and parental leave, in ways that permit and incentivize men to take an equal role in caregiving.[61]

Disability Stigma and Discrimination

One of the main challenges in building care and support systems, according to research conducted by Human Rights Watch in countries like Uruguay, is that these systems are not fully aligned with basic principles of international human rights law, in particular regarding the rights of people with disabilities.

These systems should address the need to treat both those providing care and those who require it, as full rights-holders. For men and women, it is essential to honor their right to decide on the type of care and support they wish to receive. Some countries, such as Mexico, are even proposing, as care policies, creating institutions for people with disabilities or older persons to live in, as alternative forms of care, which is inconsistent with these individuals' right to decide how and with whom they live and to have the necessary supports to do so.[62] The types of support an individual needs depend on that person’s individual conditions and circumstances; care and support systems must address the diverse requirements people have in individualized ways. For instance, some individuals need assistance to process and understand information and to make informed decisions based on that understanding--the process of making a care plan for them must also accommodate their disabilities. An integrated perspective is needed to adequately respond to the different conditions and various types of disabilities among those who require support.[63]

Care systems need to recognize and address the needs of people with disabilities, especially women with disabilities, as caregivers as well as care recipients. Too often people with disabilities are only recognized as a care-dependent group in care discourse and policies – a stigmatizing designation that ignores their agency and fails to recognize the care and support they often provide to others.

The impact of gendered expectations of care work on women extend to women with disabilities.[64]But disability stigma, which perpetuates perceptions that people with disabilities are not capable caregivers, along with a lack of data on disability status and caregiving, all work to render care work performed by women with disabilities even more invisible. Care and support policies that purport to address gender inequality by recognizing women’s unpaid care work and redistributing caring responsibilities will fall short of real gender equality if women with disabilities are excluded.

Recommendations and Comments

Respect for the rights of those working as paid carers

Encourage all states to:

• Ratify and fully implement the ILO Convention No. 190 on harassment and violence in the world of work.
• Ensure that labor protections fully apply to domestic workers, including migrant domestic workers.
• Revoke all laws and policies that harm domestic workers, such as systems that tie a migrant domestic worker’s visa status to a specific employer and create specialized protections for migrant domestic workers, recognizing the specific vulnerabilities they face.

Recognizing all children’s rights to early childhood care and education, free pre-primary education, and free secondary education.

Encourage all states to:

• Support the proposed Optional Protocol to Convention on the Rights of the Child, to recognize all children’s rights to early childhood care and education, free pre-primary education (beginning with at least one year), and free secondary education.

Reducing Women’s Unpaid Care Work

Encourage all states to:

• Incentivize and require employers to expand paid care giving leave and other accommodations in the workplace that provide flexibility to workers who are also care givers including access to flexible and part-time schedules, unpaid leave, among others.
• Increase gender parity in care giving through laws and policies that enable and incentivize men to play a larger role in care giving such as parental leave policies that specifically provide men with leave and grant additional leave when it is shared by two parents.
• Examine the lessons learned from the Covid-19 pandemic regarding how gendered expectations around care giving led to the pandemic disproportionately harming women.
• Seek to redress harms women disproportionately experienced during the pandemic due to gender inequities in care giving and remove the inequities that led to those harms.

Increasing People with Disabilities and Older Persons’ Access to Home- and Community-based Care and Support Services

Encourage all states to:

• Put in place systems to determine the number of people with disabilities and older persons who require community- and home-based care and support, including to support their own care giving responsibilities.
• Review current funding models for these services and allocate sufficient funding to ensure that those entitled to such services have access to them.
• Review and reassess whether social security entitlements are sufficient for people with disabilities and older persons to live independently and within the community, and develop public plans of action to increase as expeditiously as possible the level of entitlements to cover the full costs of care and support services.
• Actively involve people with disabilities and older persons in the design, administration, and monitoring of community services to ensure the right to independent living.

Deinstitutionalization and Ending the Use of Chemical Restraint of Older Persons

Encourage all states to:

• Create community-based care and support alternatives for people with disabilities and older persons, including plans for the progressive deinstitutionalization of individuals in residential care facilities.
• Prohibit all use of chemical restraints.
• Guarantee adequate minimum staffing levels to provide support to older persons.
• Mandate training for all residential care facility staff in dementia and alternative methods and skills to de-escalate unwanted behavior and support the needs of people with dementia.