IN 25 years, Pakistan is projected to become the world’s third most populous country, a figure highlighted at the Dawn Population Summit held earlier in December. With a rising population, care needs across the country will increase just as quickly, including direct personal care and indirect care activities in domestic, hospital, and community settings. Despite being essential, care work continues to be treated as a responsibility that naturally belongs to women, rather than as skilled labour that deserves dignity, protection, or policy attention.
Recently, to mark the International Day of Care and Support, the International Labour Organisation called for “stronger recognition of care work and coordinated action to ensure decent work, social protection, and equality for all care workers” in Pakistan. However, a darker truth must be addressed. Not only is there a disproportionate burden of formal and informal care work on women, but it is also borne unequally among women, making care work a deeply intersectional issue.
If we are to understand care work, we must not look at gender in isolation but confront the intersecting inequalities that dictate whose labour counts and whose is quietly ignored. In Pakistan, the experience of being a woman is never isolated. For instance, women’s identity in care work is entangled with gender, class, and religion, producing an unequal burden for women in care work. The relationship of these intersectional factors determines who performs the most exhausting labour, trapped in time poverty and economic precarity. Without confronting who carries the weight, we cannot hope to build a care economy that is just, inclusive, or decent.
Looking closely at the research emerging from Pakistan, the intersectional nature of women’s role in care work is difficult to ignore. The burden of care and low-paid labour falls heaviest on women positioned at the margins of social power. Research from Sargodha shows how women domestic workers stand at the intersections of gender, class, and minority identity.
Women’s identity in care work is entangled with gender, class, and religion.
Poor, often migrant and sometimes religious minority women keep urban households running, yet remain invisible because home-based work, shaped by social and class hierarchies, makes exploitation easy to hide. Covid-19 research in Abbottabad confirmed how these inequalities compound. Women performed several times more unpaid care work than men, reinforcing a gender order in which men’s paid work depends on women’s unrecognised labour. In hospitals, recent research on nursing identity illustrated how gender, class, and professional hierarchy combined to devalue nurses, who are treated as servants stigmatised for night shifts and physical proximity to male patients, as well as disrespected by doctors and patients. And even lady health workers, who are globally celebrated as public health heroes, navigate conservative public spaces, political risks, and community expectations, yet continue to face insecurity, harassment, and chronic struggles for recognition and regularisation.
These layers of inequality do not compete; they compound. The women in the Pakistani care workforce, for instance, are not ‘just’ women, or ‘just’ poor, or ‘just’ Muslim, Christian or Hindu, or ‘just’ from the village; all these identities together shape where they can work, how they are spoken to, whether they are safe, and whether the law protects them. Being a woman, economically deprived, from a ‘low’ or stigmatised group, and working in the formal or informal care system is not four separate problems. It is one deeply entangled condition of vulne- rability.
Intersectionality simply asks us to be honest about our own hierarchies. Who changes the sheets in private homes and hospital wards? Who cleans our toilets? Who cleans our streets? Who walks from house to house with the vaccine carrier? Who cares for our parents as they grow older? Who cooks, washes, and cares without it ever being paid or even acknowledged?
Pakistan cannot build a fairer future without recognising how paid and unpaid care work is organised through layers of inequalities. A fairer care economy is possible, if care work is recognised as skilled work, whether done by a mother and wife at home, a domestic worker, personal attendants, hospital staff, or community workers. If we truly wish to imagine a more equal Pakistan, we must start by answering another, more uncomfortable question. Who cares for the people who care for us?
The writer is a research fellow at the London School of Hygiene and Tropical Medicine, UK, and holds a doctorate in public health and policy, with extensive experience in Pakistan’s public health sector.
Published in Dawn, December 27th, 2025