TENTwo-Way Global Traffic in Care

An ever-widening two-lane global highway connects poor nations in the southern hemisphere to rich nations in the North, and poorer countries in Eastern Europe to richer ones in the West. A Filipina nanny heads north to care for an American child. A Sri Lankan cares for an elderly man in Singapore. A Ukrainian nurse’s aide carries lunch trays in a Swedish hospital. Going in the other direction, an elderly Canadian migrates to a retirement home in Mexico. A British infertile couple travels to India to receive fertility treatment and to hire a surrogate mother. In all these cases, Marx’s iconic male, stationary industrial worker has been replaced by a new icon: the mobile as well as stationary female service worker.

If we step behind the front stage of the global free market—the jet-setting, briefcase-carrying businessmen forging deals in fancy hotels—to a lonelier backstage, we find, along one such global pathway, the female migrant worker.1 She is not doing the physical labor of paving roads, constructing buildings, or mowing lawns, but the emotional labor of caring for people. One part of that emotional labor is to address her relationships with those she cares for and who hire her, and another part addresses the wrenching ruptures with those she leaves behind. This hidden part of her work reflects the great potential costs of life in a grossly unequal world.

At the moment, such women are moving in five main migratory streams—from Eastern Europe to Western Europe, from Mexico and Central and South America to the United States, from North Africa to southern Europe, from South Asia to the oil-rich Persian Gulf, and from the Philippines to much of the world—including Hong Kong, the United States, Europe, and Israel.² Sometimes both parents leave. In western Ukraine in 2003, the Christian Science Monitor reported that “most of the adults in the mountain villages have made the crossing in order to work illegally in Central and Western Europe. But the price is high; a generation of children left behind with grandparents, and a region increasingly drained of its working population.”³ Many factors force people to migrate—stagnation or collapse of Second and Third World economies, political unrest, or the chance to fulfill economic ambitions.

Over the last century, migration studies have been dominated by the paradigm of the male migrant worker. This for good reason: half the world’s 214 million migrants (3.1 percent of the world population) are men, and historically, most of those who have migrated in search of paid work have been men.⁴ Meanwhile, most of those who have migrated in order to reunify their families have been women. Today, however, we are witnessing the “feminization” of migration, in which a growing proportion of female migrants move in search of jobs.

Until recently, First World scholars have focused on female migratory fiows as matters of money and labor whereas scholars of work-family balance have focused on First World families. But emotional life for migrant workers is as real as it is for anyone else—and more anguishing than for most. The same is true for the many Third World women to whom clients travel for service.

Women migrate to earn money that they transfer back to their home country in the form of remittances, which pay for different things. The Sri Lankan maids studied by Michele Gamburd and Grete Brochmann were funding desperately needed basic food and shelter.5 The wages of the Filipina nannies studied by Rhacel Parreñas mainly covered children’s school fees, housing upgrades, and money to hire a home-based nanny.⁶ Many in the sending countries benefit from the nanny’s income—her children, spouse, parents, other relatives, her local church and community. Third World governments also greatly gain from the inflow of hard currency. Indeed, the Philippine government has long recruited, trained, and supported female migrant workers, counting the revenue they bring in as an important part of the nation’s gross domestic product (GDP). At the receiving end, First World employers welcome the badly needed services migrants offer. All these parties agree on the benefits of female migration and talk of these women’s decision to migrate as the expression of a well-thought-out family strategy, a wise government policy, and, over the last thirty years, a developing national cultural norm.

But there is an emotional cost that is often lost to view in all the talk of money and tasks. I focus on that here in order to highlight the ways in which talk of globalization, with its focus on “free choice” in a “free market,” speaks more to the life of those on the front stage of globalization than to those on its backstage, for whom the phrase “free choice” exacts a higher emotional price.

Much of the research on male migrants has focused on their role as economic providers, not on the emotional costs of their work. We can imagine a male Turkish migrant sweeping the streets of Amsterdam or a male Mexican gardener trimming the hedge in the backyard of a California suburban home, harvesting Florida oranges, or slaughtering chickens in a Chicago factory. But the emotional sides of their lives have often gone unnoticed. In the South African migrant labor system under apartheid, for example, many African men migrated to jobs in coal, gold, and diamond mines for eleven months at a time, far from the barren “homelands” to which their families were confined and to which they returned one month a year. As one wise miner told the South African economist Frances Wilson, he missed the chance to be with his children every day and to raise them. But even more, he told Wilson, “I miss having my children raise me.”7

Over the last forty years, women have become a growing proportion of migrant wage-earners. And compared to most male migrant workers, female migrant workers have based more of their identities on the nurture of children, the sick, and elderly. Many such women migrate in their late twenties, thirties, or forties—key childrearing years. Research suggests that, compared with migrant fathers, mothers leave behind children who are more strongly attached to them, a painful situation for both mother and child.⁸

To be sure, not all female migrant workers do care-based work, and care workers have not always come from abroad.⁹ African American slave mothers and poor American women of many races often left their own children behind to spend long hours caring for those of others, and we are tempted to believe their stories have faded into history. But in truth, they have continued and gone global. While many American black women have left domestic and personal care work for better paying jobs, many migrant women are filling their shoes. Earlier in the century migrant women seldom left children behind in their natal land. Robles and Watkins estimate that in 1919 only 7 percent of women immigrating into the United States left their children behind in their home country—a figure that is vastly higher today.¹⁰

VICKY: MIGRANT NANNY

Vicky Diaz, a 34-year-old mother of five, is a migrant nanny. She had been a college-educated schoolteacher and travel agent in the Philippines before she migrated to the United States to work as a housekeeper for a wealthy Beverly Hills family and a nanny for their 2-year-old son. Vicky explained her situation to the ethnographer Rhacel Parreñas:

[My children] were saddened by my departure. Even until now my children are trying to convince me to go home. . . . The children were not angry when I left because they were still very young when I left them. My husband could not get angry either because he knew that was the only way I could seriously help him raise our children, so that our children could be sent to school.11

Vicky left for the sake of the family but without their active consent. As she saw it, she made a free choice. But from a wider perspective her free choice was her way of compensating for the absence of good schools or well paying jobs.

Vicki’s free choice and that of many others help to redistribute the wealth of the world in the absence of national and global mechanisms for doing so. But it also adds to a global emotional inequality. She subtracts daily maternal care from her own five children back in the Philippines and adds a second layer of loving care to the child she’s hired to tend in America. The American child enjoys one more caring adult while Vicky’s children grow up with one less. Like others, Vicky participates in this emotional redistribution:

Even though it’s paid well, you are sinking in the amount of your work. Even while you are ironing the clothes, they can still call you to the kitchen to wash the plates. It . . . [is] also very depressing. The only thing you can do is give all your love to [the 2-year-old American child]. In my absence from my children, the most I could do with my situation is give all my love to that [American] child.¹²

The children left behind have their own point of view, of course. One mother told Parreñas that she had returned to the Philippines after a long period only to discover her grown daughter asking to be carried, as if time had stopped at the point her mother left.¹³ (See chapter 11 for more on the experiences of the children of migrant parents.)

We often imagine such anguish as a temporary sacrifice that will bring about economic growth in the poor countries. And it is true that a lot of money changes hands. According to the World Bank, the officially recorded remittances in 2010 exceeded $440 billion—nearly three-quarters of which went to residents in developing countries.¹⁴ Additionally, the unrecorded transfers have been estimated at about half again the value of the recorded ones.¹⁵ These funds make up 10 percent of the GDP of the Philippines, 21 percent of Haiti’s, 22 percent of Nepal’s, and 47 percent of Tajikistan’s.16 Even ten years ago, these monies were reaching about a tenth of the world’s population—the leading beneficiaries being India ($27 billion), China ($26 billion), and Mexico ($25 billion).¹⁷ Such remittances often pay for food, housing, dowries, wedding expenses, and school fees for the migrants’ families. But, as Elizabeth Gibbons of UNICEF notes, “Behind every remittance, there’s a separated family.”¹⁸

Remittances do reduce poverty, but they do not foster economic development.¹⁹ That is, remittances do not lead to investments in enterprises that would offer enough places for the well-educated children of migrant workers at home. If they did, Dilip Ratha and his coauthors at the World Bank argue, by now the Philippines would be a thriving South Korea and Sri Lanka a booming Singapore. Such structural changes have to begin with new international trade agreements, with “fair trade” pricing, and national government support for birth control, health care, and free quality education.

Instead of revitalizing local economies, female migration has paid vital family expenses but also contributed to a culture of remittance dependence. In many countries, it has led to a self-perpetuating system: the children of migrant mothers grow up, face the same dearth of good local jobs that their mothers earlier faced, and migrate to better-paying jobs abroad. They too have children they leave behind, many of whom will one day migrate themselves.

GEETA AND SAROJ: COMMERCIAL SURROGATES

Parallel to the movement of migrant women inbound from the Third to First World is an outbound flow of First World clients to care workers who remain in the Third World. Some retirees from the North, for example, make long-term moves to take advantage of the cheaper care and sunnier climates of the South. After cuts in pensions, a 65-year-old American whose middle-aged children work long hours and live far away might find it more affordable to retire and live—at a third of the cost, according to recent MetLife data—in an assisted living facility in Mexico.20 Indeed, 1.2 million American and Canadian retirees now live in Mexico. Similarly, a divorced or childless Japanese man might retire to northern Thailand. A French elderly person of modest means might retire to Tunisia or a Norwegian to Spain to be cared for by women who—in contrast to Vicky—stay in their country of birth.

Northern clients also make short-term trips to the global South as so-called “medical tourists.” A middle-class American may fly to Mexico to get a tooth capped at lower cost. A Canadian woman might travel to Brazil for half-price cosmetic surgery or to Mexico for a tummy tuck. A western European might turn for less expensive treatment to Thailand or India.

In 2012, medical tourism to India was worth about $2 billion and had become second only to Internet technology as a source of national revenue.²¹ Advertisements describe India as the global doctor offering First World skill at Third World prices with shorter waits, privacy, and—especially important when hiring surrogate mothers—an absence of legal red tape. At various Indian offices and hospitals, a bone can be reset, a knee replaced, or a heart valve repaired. In addition to medical or dental treatments, many facilities offer “pre-care” and “after-care” that can last some time.

Westerners have grown used to the idea of a migrant worker caring for a First World child and even to the idea of hopping an overseas flight for surgery, but a growing part of medical tourism now centers on reproduction, in particular on the sale of eggs and sperm and the rental of wombs. In India, commercial surrogacy is legal and, as of early 2013, still unregulated; nowadays a Westerner of moderate means can go to an Indian clinic to legally hire a surrogate mother to carry a baby to term. Normally the surrogate is implanted with a fertilized egg from the client couple, but if the wife cannot produce an egg, one can be bought and fertilized with the husband’s sperm. Egg, sperm, and womb can all be bought or rented in India or (as the documentary film Google Baby shows) from elsewhere around the world.²²

The Akanksha Infertility Clinic in Anand, Gujarat, houses the world’s largest collection of gestational surrogates—women who rent their wombs to incubate the fertilized eggs from clients in India and from around the globe. Since 2004, when Akanksha began offering surrogate services, it has supervised the births of over 500 babies. Sixty surrogates are gestating babies at any one time.23 Since 2002, when surrogacy was declared legal in India, well over 350 other assisted reproductive technology (ART) clinics have opened their doors around the country.

As the clinic’s charismatic director Dr. Nayna Patel views the matter, the client and the provider enact a mutually beneficial transaction.²⁴ A childless couple gains a child, and a poor woman earns money. “What could be the problem?” she asks. If one looked only at the front stage of the global free market, Dr. Patel has a very good point. But more goes on backstage. Like nannies, surrogates do a great deal of emotional labor to suppress feelings that might interfere with the performance of their job—including feelings about the babies they bear.²⁵

In January 2009,I followed a kindly embryologist, Harsha Bhadarka, to an upstairs office of the Akanksha Infertility Clinic in Anand, India, to talk with two surrogates whom I will call Geeta and Saroj.²⁶ They entered the small room, nodding shyly. Both lived on the second floor of the clinic, although most of its residents live in one of two hostels for the duration of their pregnancy. The women are brought nutritious food on tin trays, are injected with iron supplements (a common deficiency), and are kept away from prying in-laws, curious older children, and lonely husbands, with whom they are, for nine months, allowed no visits home or sex. (For more on surrogates, see chapter 12.)

Typical of the other surrogates I spoke with, Geeta had only a brief encounter with the parents who paid her to carry their genetic baby. “They’re from far away. I don’t know where,” she said. “They’re Caucasian, so the baby will come out white.”

Seated next to Geeta was Saroj, a heavy-set, dark woman with intense, curious eyes, and a slow-dawning smile. Like the other Hindu surrogates at Akanksha, she wore sindoor (a red powder applied to the part in her hair) and mangalsutra (a necklace with a gold pendant), both symbols of marriage. She was, she told me, the mother of three children and the wife of a street vendor who sold vegetables. She had given birth to a surrogate child a year and three months ago, and she was waiting to see if a second implantation had taken. The genetic parents were from Bangalore, India. (It is estimated that half the clients seeking surrogacy from Indian ART clinics are Indian, and the other half are foreign. Of the foreign clients, roughly half are American.)27 Saroj, too, knew almost nothing about her clients. “They came, saw me, and left,” she said.

Saroj’s husband’s wages were 1,260 rupees (or $25) a month, so she turned to surrogacy so that they could move out of a shed with an earthen floor to a rain-proof house and she could feed her family well. Yet she faced the dilemma of all rural surrogates: being suspected by neighbors or distant relatives of adultery, a cause for shunning or worse. I asked the women whether the money they earned had not also improved their social standing. For the first time, the two women laughed out loud, and talked to each other excitedly. “My father-in-law is dead, and my mother-in-law lives separately from us, and at first I hid it from her,” Saroj said. “But when she found out, she said she felt blessed to have a daughter-in-law like me because I’ve given more money to the family than her son could. But some friends ask me why I am putting myself through all this. I tell them, ‘It’s my own choice.’”

Geeta and Saroj freely chose to become surrogates, but what were their options? Their villages reflected appalling government neglect—rundown schools, decrepit hospitals, and few well-paying jobs. Given these circumstances, surrogacy was the most lucrative job in town for uneducated women.

The director at Akanksha organized surrogacy much as she would have organized the manufacture of shoes. She proudly sought to increase inventory, exercise quality control, and improve efficiency. In the case of surrogacy, that translated into the goals of producing more babies, monitoring the surrogates’ diet and sexual contact, and ensuring a smooth, emotion-free exchange of baby for money. (For every rupee that goes to the surrogates, observers estimate, three go to the clinic.) In Akanksha’s hostel, the women slept on cots, nine to a room, for nine months. Their young children slept with them; the older children were not allowed to stay in the hostel, though they could visit. The women also exercised inside the hostel, rarely leaving it and then only with permission.

Dr. Patel also advised surrogates to limit contact with the clients. Half-hour meetings to sign a contract, perform the implantation, and pick up the baby were typical. Staying detached from the genetic parents, she said, helps the surrogate mothers give up their babies and get on with their lives and on with the next surrogacy. It increased efficiency.

What happens when a surrogate dies in labor? Or when the commissioning genetic parents reject a disabled newborn? Or the money does not come through? The laws regulating commercial surrogacy have been under consideration since 2004; but as of March 2013, no laws have been passed.28 Even if the laws were to pass, they would do little to improve the life of women such as Geeta and Saroj. The law currently under consideration specifies that the doctor, not the surrogate, has the right to decide on “fetal reduction” (abortion). Under no circumstances can the surrogate decide because, legally speaking, she is not carrying her baby.²⁹ Moreover, federal laws in India are merely advisory to powerful state governments which are free to disregard federal law.

Most Indian courts are woefully backlogged, causing years, even decades, of delay, and even if the laws were enforced, what surrogates can read the contracts they sign? Most have a seventh-grade education in Gujarati (some illiterate surrogates sign by thumbprint), but their contracts are written in English. Even if she could read her contract, what aggrieved surrogate could afford to hire a lawyer?

Should the law pass in the Indian parliament, it would do nothing to address the crushing poverty that presses women into surrogacy in the first place.³⁰ The Indian government itself considers surrogacy a form of “economic development.” It gives tax breaks to the private hospitals that treat overseas patients and lowers import duties on medical supplies. As a $455 million a year business in India, surrogacy improves the national bottom line.³¹ But, as in the case of migrant remittances, revenue helps individual surrogates alleviate their poverty without doing much to revitalize the overall economy.

Moreover, the surrogates are also exposed to the global free market’s “race to the bottom.” Indian surrogates charge less than American surrogates by a factor of one to ten.³² But Thailand could undersell India, Cambodia could undersell Thailand, Laos could undersell Cambodia, and Sri Lanka could undersell Laos. Each country could undercut the next cheapest, cutting fees and reducing the legal protections for surrogates along the way. If the race to the bottom, as William Greider calls it in One World, Ready or Not, can apply to the global competition to sell cheaper cars, computers, and shoes, it could tragically apply to the global competition for inexpensive surrogacy.33

Like immigrant nannies, surrogates do a hidden form of emotional labor. If nannies suffer separation from their biological children who grow up half a world away, surrogates suffer detachment from the babies they carry but must give away. Both struggle with the issue of self-estrangement (see chapter 12).

ON YOUR OWN IN THE FREE MARKET

Vicky says she freely chose to leave her children behind, and Geeta and Saroj freely chose to give up the babies to whom they gave birth. Given their extraordinary circumstances, their choices made sense to them, as they would to many in their shoes. By their own accounts, in no sense were those choices easy. Yet our free market culture invites us—and them—to look past the painful circumstances to their “free” choices in an imagined world of “win-win” market transactions.

In the free-market imagination of those on the front stage of global life, the object of fear and dread is Big Brother government. Such novels as George Orwell’s Nineteen Eighty-Four, with its “Ministry of Truth,” or Ray Bradbury’s Fahrenheit 451, with its image of Nazi-type book burning—offer an image of coercion, intrusion, and utter control over what we think and do.³⁴ Aldous Huxley’s 1932 Brave New World offers the image of the London Hatchery in which babies are designed by white-uniformed eugenic scientists.³⁵ Margaret Atwood’s disturbing 1985 novel The Handmaid’s Tale describes a right-wing Christian state that divides women into Handmaids who procreate, Marthas who tend house, and Wives who are wives.³⁶ In all these nightmares, our fear is directed toward an all-powerful government that undermines and replaces the family and community.

But the stories of Vicki, Geeta, and Saroj point toward another nightmare. In this one, there is no menacing policeman, no harsh jailer, no Big Brother. Indeed, the free-market exchanges go on with almost no government regulation—or help—at all. Instead of a paramilitary trooper breaking into one’s home at night, there is the opposite sense of no one coming to one’s aid in an hour of need. Indeed, in this nightmare, the government provides no fine schools, no well-equipped hospitals, no reliable police service, no beautiful parks, no safety-checked water or food, and no effective safety net. We face a world starved of public services, where helpless people make “free choices” between harrowing options. Many of us are poised to look for a Mack truck coming from the left where Big Bad Government is found, but the other big truck of unregulated capitalism is already approaching from the right, though the purr of its engine is hard to hear. The so-called free market—composed of international treaties governing the flow of goods, services, and people, and the flow of things and people itself—can be shaped by the policies of do-nothing governments in the Third, Second, and First Worlds. In this dystopia, a “structural tragedy,” as the German sociologist Kai-Olaf Maiwald calls it, takes place.37

Most migrant care workers want a government that neither oppresses nor abandons them and a world more equal than the one they have. But in the absence of a more positive alternative, Vicky, Geeta, and Saroj may say they are freely choosing to take part in the two-way global traffic, but what they really need is the freedom to choose between the world we have and a world that tends to the happiness of those on the backstage—a world that brings the backstage to the front.