Unpaid work, gender equity and health: how can Ukraine benefit from time-use data?

And the largest sector of the economy is…

As an Associate Professor at Kyiv School of Economics I often start my courses in Macroeconomics with a simple question – What is the largest sector of the economy? Students typically come with common answers such as residential construction, banking, finance or even industry. To the students’ big surprise all these answers are wrong… 

A recent article shows that the largest part of the global economy is unpaid work which is predominantly done by women and is disregarded in the current approach to calculating the gross domestic product (GDP). Focusing on a single economic metric of GDP and disregarding the effort of the hardest working people has resulted in enormous health and socio-economic inequities, environmental degradation, and growth without prosperity for the most vulnerable.  

These and other important insights (which are not taught at PhD programs in Economics dominated by the GDP paradigm) are coming from Dr Marilyn Waring, a former New Zealand politician and now a famous scholar, whose 1988-book “If Women Counted: A New Feminist Economics“, revealed how woman’s housework, caring of the young, sick and the old was (and still is) automatically excluded from value in economic theory. 

For example, a newborn in Australia adds 44 hours a week to a mother’s unpaid workload, with breastfeeding alone taking 8 to 16 hours per week. If that time were counted at market wages, unpaid childcare would become Australia’s largest industry (with an astonishing 20 percent of the economy!), followed by all other unpaid work (almost 8 percent), so that together these two would be four times the value of the financial and insurance services sectors in Australia. Similar picture obtains for other countries which collect time-use data showing how much time household members spend on different activities. For example, in the neighboring Republic of Moldova, the estimated value of the household service work was about $3.5 billion representing 43.6% of the national GDP in 2014.

What does it all have to do with health? Dr Marilyn Waring is also a member of the WHO Council on the Economics of Health For All, which was established by the Director-General of the World Health Organization Dr Tedros Adhanom Ghebreyesus and is led by the world-renowned economist Mariana Mazzucato, the founding director of the UCL Institute for Innovation and Public Purpose, and the winner of international prizes including the 2020 John von Neumann Award and the 2018 Leontief Prize for Advancing the Frontiers of Economic Thought. Accounting for the unpaid work (which has a non-obvious at a first glance connection to health which is discussed next) is among many powerful recommendations of the WHO Economics Council which Ukraine should use to reorient the economy to provide health for all. 

Time use, unpaid work and health

To continue with the breastfeeding example, mother’s milk is the ideal food containing antibodies which help to protect against many common childhood illnesses. What’s more, breastfed children are less likely to be overweight or obese and less prone to diabetes later in life. Should we then be surprised that only 44% of newborns are exclusively breastfed in the first 6 months of their life (as recommended by WHO), given that breastfeeding adds 8 to 16 hours to mother’s unpaid workload which is not even recognized in economic statistics not to say compensated for? Wouldn’t it be better to acknowledge the great effort of caring mothers in statistical books and create comfortable conditions for breastfeeding at workspace instead of paying up to 2.19% in losses of global GDP due to overweight and obesity? 

Breastfeeding is just one example of how gender inequities (revealed with the help of time-use surveys) translate into health inequities. To give another example, consider a series of recent lockdowns due to COVID-19 epidemic that hit the sectors with high female employment (such as tourism and hospitality), while school closures forced women to spend more time with school-age children everywhere in the world. A survey conducted in Ukraine during COVID-19 reveals that quarantine exacerbates the problem of gender stereotypes regarding the women’s and men’s roles in the family. The survey shows, for example, that 50.5% of females spent more time on cooking (compared to 27.8% of men). As a result, women, who during COVID-19 spent much more time on housework and childcare compared to men, were also more likely to report increased levels of psychological distress (Xue and McMunn 2021).

The unprovoked brutal russian aggression left 1.4 million people without access to safe water in the east of Ukraine and 4.6 million more people with only limited access bringing additional health risks to the people of Ukraine because poor water quality is a major risk factor for health. Even in this tragic situation time-use data can be helpful by informing policy makers about the lack of public infrastructure that requires additional investment. For example, in Mongolia women, who rely on surface water from lakes, rivers or ponds, spend 113 minutes per day more on unpaid work than women in households with piped-in water (Terbish and Floro 2016). 

Unpaid care work also silently covers up for the lack of “official” health care from under-financed healthcare systems globally. For example, in the United Kingdom unpaid work provides an astonishing 90% of adult care hours for more than 2.2 million fully dependent adults. During COVID-19 epidemic 53.3% of female respondents in Ukraine spent more time on providing emotional support to family members than before the pandemics. Women’s unpaid care burden has significantly worsened after February 24th, 2022 due to school closures, high demand for volunteer work and the absence of men. 

Thus, the time poverty of Ukrainian women linked to gender stereotypes has worsened during COVID-19 epidemic and, especially, after the full-scale russian aggression. Time poverty has been linked to lower well-being, physical health and productivity (Giurge, Whillans and West 2020). When it comes to Ukrainian women, time poverty results in higher levels of stress, less time available for self-care and sleep and even malnutrition which are all detrimental to health as explained in the next section.

Time-use data in Ukraine and policy recommendations

The pilot survey on Time Use was conducted in Ukraine in the Fall of 2020 covering 154 households of the cities of Kyiv and Bila Tserkva, and the villages of Vynarivka and Petropavlivska Borshchahivka. The survey shows that women spent on unpaid household work (housekeeping, care for children and other relatives, etc.) twice as much time as men which is not at all surprising and is consistent with the international evidence. 

In urban areas women spent 257 minutes per day on unpaid household work compared to only 124 minutes per day spent by men. The situation is even worse in rural areas with 382 minutes spent by women compared to 149 minutes spent by men. Thus, Ukrainian women in rural areas face an additional burden of 2 hours (!) of unpaid work every day compared to women in cities, most likely due to active female involvement in domestic agricultural production. This time poverty has clear and far reaching negative health consequences for Ukrainian women, especially, in the rural areas.

There is significant evidence that families who cook at home have a healthier diet because they consume fewer carbohydrates, less sugar and less fat compared to those who cook less (Wolfson and Bleich 2014). In many countries women play a significant role in food production by their involvement in agriculture, processing and food preparation in the household (Hyder et al., 2005). While these activities are clearly beneficial to the family health, the significant female involvement in agriculture leads to a much higher burden of malnutrition for women compared to men. During peak agricultural seasons women spend less time on cooking which is negatively associated with the intake of calories, proteins, iron, zinc and Vitamin A (Vemireddy and Pingali 2021). Increased time pressures in agriculture during peak seasons also leave less time for sleep, and other rest-related activities, impacting women’s overall health (Vemireddy and Pingali 2021).

Examples from other countries reveal how time-use data can guide social policies related to health such as gender equality policies in Albania and Mexico, child policies in Cambodia, Colombia and Finland, employment policies in Moldova, and the provision of home-based paid care in Uruguay. Although these efforts demonstrate the potential of time use to promote health and well-being, they are clearly not sufficient and should be extended to all countries, including Ukraine.

Hence, the pilot Time-Use survey of just 154 households is clearly helpful in determining the degree of gender inequality in unpaid work in Ukraine, but it should become a part of the annual UkrStat Household Budget Survey after our victory, if we are serious about achieving gender and health equity in the European family of free and prosperous nations. 

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