are work, as old as humanity itself, sustains life and enables economic productivity across all societies. It involves meeting the physical, psychological and emotional needs of others, whether or not they have disabilities or are sick, and includes self-care.

Care work is both paid and unpaid. Paid care workers include professional caregivers such as nurses, doctors, teachers, childcare workers, home health aides, domestic workers, eldercare workers, social workers and therapists. Unpaid care work is often done without monetary reward, typically by family members, especially women. Other than the direct care of children, the elderly, sick relatives or people with disabilities, it also includes household tasks such as cooking, cleaning, laundry, shopping for groceries, support activities such as collecting water and firewood, household planning and management and community work.

According to the ILO, there are an estimated 381 million care jobs globally, representing about 11.5 percent of total employment worldwide. This number includes all workers in health, education, social work and domestic work sectors. Unpaid care work contributes an estimated $11 trillion to the global economy annually, accounting for approximately 9 percent of the worldwide GDP.

Women perform over three-fourths (76 percent) of the unpaid care work globally. This stark gender disparity is a significant barrier to gender equality. On average, women spend 4 hours and 25 minutes per day on unpaid care work; men spend only 1 hour and 23 minutes per day on unpaid care work. This abundance of unpaid care work creates ‘time poverty’ where women have less time to access economic opportunities, education, paid work and personal or public activities.

This article examines the current state of social protection for care workers in Pakistan and recommends some actions for strengthening legal and institutional mechanisms to ensure decent work for this essential workforce.

In Pakistan, the burden of unpaid care work is predominantly borne by women. According to UN Women, women and girls spend 20 percent of their time on unpaid care and domestic work, compared to 1.8 percent by men. Recent analysis based on LFS data shows that women spend approximately 3 hours per day on non-market care and domestic work. A study by Pakistan Institute of Development Economics shows that when both market and non-market activities are taken into account, men spend 4.7 hours while women spend 3.5 hours per day on work. It is just that women’s work is not economically counted. Some other studies have highlighted that women spend around 6 hours per day on unpaid care work, which translates to a monthly contribution of Rs 35,000 rupees (180 hours per month valued at 192 rupees per hour). It must, however, be added that the above costing is done based on minimum wage for unskilled work, while the unpaid women care workers are generally skilled; some are highly skilled in what they are doing.

To achieve gender equality, in line with SDG 5, it is essential to recognise and value the unpaid care and domestic work performed by women. As indicated in SDG 5.4, this can be achieved through the promotion of shared responsibility within the household and family, as nationally appropriate, by developing and implementing supportive policies. There exists a 5R Framework by the ILO for Decent Care Work. According to this framework, unpaid care work should be recognised, reduced (through the provision of quality care services) and redistributed (allowing carers to join and re-enter the labour market and enacting family-friendly working arrangements). In contrast, paid care work should be rewarded through decent employment terms and working conditions and ensuring the representation of workers through promotion of freedom of association and social dialogue.

The 5R Framework is a comprehensive approach that can guide policy development and legislative reforms in Pakistan to improve social protection for care workers. While drafting the Punjab and Sindh Labour Codes, the Provincial Labour Departments have enhanced maternity leave to at least 14 weeks (Sindh already has 16 weeks), introduced provisions for paternity leave, established childcare centres at workplaces and provided options for flexible working arrangements. Under these Codes, the protection from dismissal is extended to complete pregnancy and four months after childbirth. Similar provisions are already included in Balochistan’s laws.

The 2024 ILO resolution on decent work and the care economy rightly points out that “care work, paid and unpaid, is essential to all other work”. This resolution emphasises the need for decent work in the care economy. It underscores the importance of social protection for care workers and the need to address the gender disparities in care work.

Pakistan’s current legal framework reveals significant gaps that leave millions of workers without adequate social security coverage. The existing social protection systems predominantly focus on formal sector workers while excluding large segments of the care workforce who operate in informal arrangements. While the Punjab (2019) and Islamabad Capital Territory (2022) have enacted legislation on domestic work, a regulation granting comprehensive access to social security contributions for domestic workers in the Punjab was notified only recently. Other provinces have yet to enact necessary legislation on domestic work and coverage of domestic and other care workers in their social protection systems.

Institutional mechanisms should be established to ensure care worker representation in policy-making processes, including recognition of care worker organisations’ collective bargaining rights.

Employees’ Old Age Benefits Institution, which provides old age pension and other benefits, does not cover domestic workers and other informal sector workers. Sindh has tried to give coverage to the self-employed workers by asking them to self-register and self-contribute; however, given that the contributions are too high (PKR 2400 per month), it becomes impossible for many informal sector workers to self-register. The Balochistan Labour and Manpower Department has drafted rules for extending social security to home-based workers, utilising the reduced contributions-reduced benefits method. Under this method, workers can self-register and contribute a significantly lower amount (Rs 800 per month), while also accessing some social security benefits. A similar scheme could be created for the domestic and other care workers.

The old-age benefits scheme currently requires 15 years of contributions to access an old-age pension. The current legislation does not account for the periods of absence from work due to childcare, except for the duration of maternity leave (which is limited to a maximum of 16 weeks in Sindh). The EOBI law could be amended to include provisions regarding “care credits” in pensions for time spent out of the labour force while providing childcare or elderly care. The 2023 Population Census, a comprehensive data collection effort conducted by the government, must already have the updated data on the elderly, which could provide the evidence to initiate such a scheme. Using the provisions of legislation on senior citizens, caregiver allowance or stipends could be initiated. A means-tested caregiver allowance could be started under the Benazir Income Support Programme for caregivers of children, people with disabilities and the elderly.

Based on the above analysis, several key recommendations emerge for strengthening social protection for care workers in Pakistan.

First, Pakistan should develop a comprehensive national care policy that explicitly recognises care work as essential work deserving of social protection coverage. This policy should establish universal coverage principles while addressing the specific needs of different categories of care workers, including healthcare professionals, teachers, domestic workers and informal care providers. The National Commission on the Status of Women could take a lead on the development of such a policy. It is relevant to mention here that the Centre for Labour Research is already developing a draft of this policy for submission to the government and other stakeholders.

Second, legal reforms should extend labour protections to all categories of care workers, eliminating exclusions that leave domestic workers and informal care providers without basic rights to minimum wages, working time limits, occupational safety protections, and access to social protection. The learnings from the Punjab (covering domestic workers under social security), Sindh (allowing people to self-register)and Balochistan (extending coverage to HBWs through a reduced contribution-reduced benefits scheme) should be utilised.

Third, Pakistan could implement a mixed financing model for extending social protection to care workers that combines contributory schemes for formal workers (like the EOBI, the PESSI) with non-contributory programmes (like the BISP) for informal and unpaid care providers. This could include universal pension schemes with care credits recognising periods of unpaid care provision, universal healthcare access regardless of employment status (Sehat Sahulat Card programme) and targeted income support for care providers during periods of illness or unemployment.

Fourth, institutional mechanisms should be established to ensure care worker representation in policy-making processes, including recognition of care worker organisations’ collective bargaining rights and formal consultation mechanisms in social protection policy development. The Domestic Workers’ Union, established in Lahore in 2014, has been active in the development of social security regulations for domestic workers.

Fifth, comprehensive data collection systems should be implemented to monitor care work patterns, protection coverage and the effectiveness of policies. This includes regular time-use surveys, expanded labour force surveys to capture care work and integrated administrative data systems tracking social protection coverage across different care worker categories. The Pakistan Bureau of Statistics could be engaged for this purpose.

Finally, Pakistan should ratify and implement relevant ILO conventions, including the Workers with Family Responsibilities Convention (No 156), the Maternity Protection Convention (No 183), the Nursing Personnel Convention, 1977 (No 149), and the Domestic Workers Convention (No 189), to align national frameworks with international standards and demonstrate its commitment to care worker rights. Thousands of lady health workers and essential care workers at the community level could be brought under the protection of the labour law by following the provisions of Convention 149.

It’s high time to recognise, reduce, redistribute, reward and represent care work to make it visible, valued, protected and equitably shared. The transformation of social protection for care workers in Pakistan requires sustained political commitment, adequate financing, and coordinated implementation across government levels and sectors. Decent work in the care economy is within reach by first granting the right to social protection to both paid and unpaid care providers and piloting the above-suggested schemes in major cities across the country. Social protection programmes should be structured to support women’s economic participation and not used as an excuse to reinforce their domestic confinement and restrict access to economic opportunities.

Iftikhar Ahmad is the founder of the Centre for Labour Research, Pakistan. He can be reached at ia72@cornell.edu

Sobia Mir is the director at Labour Lens, Pakistan.