Review: Labours of Love. The Crisis of Care, by Madeleine Bunting

It was fun while it lasted, neighbours meeting at a safe distance whilst clapping for carers. This was during Britain's first Covid-19 lockdown in March 2020. By autumn's second peak, there was little clapping, just mounting anxiety over all the ways government policies had failed us. Amid a third lockdown, in 2021, with over 100,000 dead—one of the highest per capita death rates in the world—people were simply waiting to be rescued by the rolling out of vaccines. Clapping is pointless when carers themselves no longer welcome it. They were working harder than ever, often still living with ‘in-work poverty’, their lives frequently at risk, and many already snuffed out by Covid-19.

It has left more people finally wondering why care itself has been for so long undervalued—paid or unpaid—despite being one of the most valuable of all forms of human labour. This is the crucial question that led writer Madeleine Bunting to produce her outstanding Labours of Love, her research completed just before the current pandemic. Bunting's framing is the knowledge that it is only through care that we become and remain human. Surely this is the lesson of 2020, as Bunting suggests in her preface, whilst conveying the hope that the pandemic may indeed engender change.

Caring is the key to human existence, yet it can be very challenging, especially when it remains marginalised in every sense. Bunting embarks on the difficult task of exposing the full complexities of care, with five years of intensive research into almost every form of hands-on care. She spent time in surgeries, hospitals, care homes, households, shadowing doctors, nurses, social workers, and carers of every stripe, including, importantly, those dealing with death.

Bunting insists that we need to expand our impoverished language of care, discussing the etymology of ‘care’ itself and related keywords between chapters—‘empathy’, ‘kindness’, ‘compassion’, ‘pity’, ‘dependence’, ‘suffering’—aware how glibly these are often invoked: ‘In a noisy culture which accords great significance to talking, the wordlessness of small actions can easily be overlooked.’ Meanwhile, the commercial world mendaciously incorporates affirmations of ‘care’ and ‘caring’ when marketing or delivering its wares, thereby eviscerating the substance of care.

With everybody now working long hours in paid work, caring has been increasingly outsourced and privatised, while a new managerial vernacular now dominates caring professions. It introduces sterile bureaucratic accounting, measuring compliance, risk-avoidance, regulation and outcomes, all at odds with the flexible creativity genuine caring requires. After all, the attentive, spontaneous nature of good caring relations involves those more subtle, tactile, visceral qualities necessary for communicating understanding, reassurance, comfort—far harder to encapsulate, let alone measure.

Hence the importance of Bunting's interviews in the heartlands of care, which often capture the elusive blend of attentive kindness that we know, intuitively, should be the essence of care. Her presence is felt throughout her reports, observing interactions not from a distance but—mirroring her theme—as a caring insider. In the process, Bunting highlights the overwhelming impediments faced at every level by carers and those in need, resulting in an unprecedented crisis of care. Whether in surgeries or hospitals, she finds that underfunding and bureaucratic surveillance leaves doctors and nurses vastly overworked, doing as much form-filling as patient care, leading to burnout, staff losses and recruitment failures.

Yet, if care in our public institutions is deteriorating, the situation surrounding social care is even worse—often on the point of collapse. Massive profits have been made from outsourced ‘care homes’, yet the resulting provision often affords little security for either their underpaid, overworked, untrained carers, or their care recipients. Unprofitable, strategically overleveraged care homes frequently shut down, creating ‘care deserts’ in poorer parts of the UK. Bunting captures the commitment of many care workers who, while knowing themselves demeaned as ‘just’ carers, suggest to her: ‘I am not bothered. I know I’m making someone's life a lot better.’

This is the spirit that corporations exploit, leaving carers routinely battling poverty and exhausted by overwork. Indeed, increasingly, even rudimentary caring interactions are shrinking, with carers’ time clipped so tightly that even eye contact, let alone a cup of tea, must be avoided. It explains why there are massive staff shortages, and the suicide rate of care workers is now twice the national average. Meanwhile, with community resources and respite leave disappearing, home carers also find it ever harder to manage, whoever they are nurturing. Bunting is especially moving on the parents of disabled children, who recount how they have spent endless hours fighting for minimal rights for their children, filling in complicated, weighty forms, almost impossible to complete. They are agonised by the knowledge that they live in a society so uncaring, even cruel, towards their child.

Bunting emphasises that a large part of the undervaluing of caring is its perception as intuitively ‘feminine’, barely recognised as work, let alone requiring any skill. She also notes that hands-on caring puts one in touch with vulnerability, dependency, ageing and mortality. This places care firmly at odds with hegemonic market ideologies fetishising youth, individual resilience, ambition and productivity, thereby deepening the disavowal of human needs other than for self-care. However, apart from the briefest mention, disappointingly Bunting has little to say about the ambivalence and conflicts of caring, a topic many feminists have tackled well.

Indeed, a blind spot pervades her text, paying little attention to all the most influential feminist writers on mothering and care, from Adrienne Rich and Nancy Chodorow in the 1970s, through Carol Gilligan and Sarah Ruddick in the 1980s, to Joan Tronto and an expanding plethora of others today. It leads to her extraordinary caricature: ‘feminism has forged ahead on many fronts … but a recognition and valuing of care is noticeably absent’. This odd dismissal comes from her reducing feminism from its beginning to a largely media celebrated liberal variant of aspirational feminism. She thereby traduces the transformative politics of second wave feminism, with all its commitment to shared childcare, nurseries, community building, and the promotion of democratised caring infrastructures for wellbeing overall.

As most feminists always have, Bunting stresses the inevitability of human interdependency. She affirms that the urge to care is a basic human proclivity, along with the potential reciprocity of caring relations. Bunting condemns the political dimensions of needlessly imposed austerity policies, with their disastrous outcomes for care. But hers is, above all, an ethical agenda, often stressing the primacy of religious currents behind compassion and calls to care. Bunting even wonders whether secular humanism can ever see care as an ethical imperative, suggesting the decline of religion may make it harder to provide any ‘bulwark against the values of consumerism’.

Thus, while Bunting applauds social democracy, and notes the ambitious commitment of the Labour Party's 2019 manifesto to a National Care Service, there is no mention of socialism in her text. Somehow, values need to change, but she says little on the political mechanisms needed for confronting the predatory capitalism underpinning the neglect and early death of swathes of humanity. Separating out hands-on care from the caring infrastructures necessary to enable it, including more indirect but interlinked sustaining practices, Bunting does not expand on the forms of community building, or radical municipalism, which are essential for repairing care. Missing as well is any concern with the environment, and the need to care not just for each other, but for the world itself—all issues highlighted in The Care Manifesto, which I co-authored as part of The Care Collective (and reviewed in the previous issue of PQ).

Nevertheless, the overwhelming significance of Labours of Love is the compelling passion Bunting brings to her case for confronting our careless world. Her elegant writing is constantly enriched by literary, poetic, artistic and philosophical reflections, all supporting her call to overturn the current ‘cultural orphaning of care’. It is a crucial document for our time: itself a labour of love.