Mainstream WeeklyIndia’s ongoing demographic transition, marked by rising life expectancy and the growing prevalence of chronic illnesses, has significantly intensified the demand for long-term care and support. The projected expansion of the elderly population in the coming decades is expected to deepen the country’s dependence on long-term informal care; unlike welfare-oriented states, where institutional mechanisms partially absorb these responsibilities, caregiving in India continues to be overwhelmingly dependent on informal familial structures. This dependence on families is often normalised through the language of duty and sacrifice. In many Indian households, caregiving is still treated primarily as a family responsibility, although family caregiving remains central to sustaining intergenerational relations and compensating for gaps in healthcare infrastructure, it highlights a deeper structural problem of invisibility. Care work remains unpaid, economically undervalued, and largely excluded from formal policy discourse (Addati et al. 2018).
The invisibilization of care is not merely a cultural phenomenon but also a political-economic one. The continued dependence on unpaid familial caregiving reflects the limited development of public care infrastructure and welfare provisioning in India, where households are expected to absorb the social and economic costs of care. Perhaps, the unpaid household and care work in India remains highly gendered and disproportionately concentrated within domestic spaces, with women undertaking the overwhelming share of caregiving responsibilities irrespective of employment status or educational background (Shukla and Reddy 2024). Such arrangements enable the state to externalise the costs of social reproduction into families while internalising the gender norms in society. This further minimises public expenditure on long-term care systems and caregiver support mechanisms. As a result, the reproduction of social and economic life is sustained through invisible household labour that remains outside formal systems of recognition, remuneration, and welfare protection.
Psychological implications of unpaid care work
Unpaid care is not just an issue for being economically invisible; it also poses social and psychological implications. Studies have proven that the burden of unpaid care has a negative effect on quality of life. Specifically, women suffer from a constant feeling of time poverty and emotional stress because of their caregiving roles (Sinha 2024). However, caregivers themselves tend to lack consideration in any policy-making process. The absence of institutional attention, social security systems, or governmental care provisions further complicates the problem. As a result, caregiving is no longer an individual matter but rather one of political economy.
Caregiving has been found to pose serious physical and psychological risks to people through research findings conducted in India. A study that was done following a longitudinal ageing study carried out in India (LASI, 2017-18) established that there were about 29% of caregivers suffering from depression, with worsening physical and psychological consequences being noted with regard to the caregivers providing intensive care. Care providers offering extensive care tend to suffer from depression, stress, and poor psychological well-being (Chakraborty et al., 2023).
The psychological impact involves chronic stress, anxiety, and emotional exhaustion arising from continuous engagement in stressful activities. There is no established system that would offer professional support and provide some means of relief. In addition, cultural pressure prevents individuals from accessing outside help because looking after their loved ones and family members is viewed as a responsibility rather than an illness. Over time, such pressures often result in exhaustion, sleep deprivation, and the neglect of caregivers’ own health needs. Scientific research proves the correlation between the health of caregivers and care quality, thus underlining the importance of providing necessary assistance (Schulz and Sherwood, 2008).
Informal care arrangements also produce significant forms of social isolation and role strain. First, the process of caregiving consumes a lot of time and makes it difficult for caregivers to interact socially. As a result, caregivers tend to withdraw from social interactions. The second problem faced by caregivers is related to role conflict or strain. Caregivers have to juggle multiple roles at once; they are employed, take care of the patient, and manage domestic affairs. All these activities cause stress and lead to lower levels of satisfaction in their lives (Márquez and Marwah 2024).
Economics of invisible care work
Apart from the psychological impacts of unpaid care, it can also be seen as a hidden economy that is necessary but overlooked in traditional economics. Despite the necessity of caregiving to society, unpaid care does not feature in economic statistics like GDP.
The cost of caregiving includes both direct and indirect costs. Direct costs consist of medical expenses, medication, transport, and aids. In the Indian context, with its out-of-pocket payments being exceptionally high, a family shoulders the lion’s share of this cost burden, leading to hardships (Ministry of Health and Family Welfare, 2021). Indirect costs cannot be underestimated either. Caregivers often cut back on their working hours or leave employment. These transformations lead to an immediate decline in income and potential economic instability in the future. In addition, the literature on healthcare services emphasises the relationship between the intensity of care provision, poor financial status, and intensified stress (Lillekroken et al. 2024). Scholars studying feminist political economy have traditionally claimed that domestic work is vital to the productive economy because it maintains the capacity for human labour (Folbre 2006). The informal system of care provided by the family becomes apparent in the case of India.
Caregiving in India tends to be highly gendered, where women are largely expected to do most of the unpaid care work. According to the Time Use Survey conducted in 2024, women have a much higher level of engagement with caregiving activities and chores than men (Government of India, 2024). These inequalities have adverse implications for both the welfare and participation of women in the workforce. Caregiver women suffer from high levels of psychological distress due to stress, anxiety, and depression, among other mental health issues (Pinquart and Sörensen, 2006). In addition to the high caregiving levels, women are expected to take up such responsibilities in light of gender roles. This unequal distribution of domestic responsibilities creates a dual burden for many women, who are expected to balance paid employment alongside unpaid household labour. The situation forces women to cut short their careers, which is one reason why female labour force participation in India is low.
The legal and policy framework surrounding caregiving in India continues to treat unpaid care work as a natural extension of women’s familial responsibilities rather than recognising it as economically productive labour requiring institutional support (Folbre 2006). In addition, the social construction of caregiving duties from a moral perspective acts as a hurdle in redistributing caregiving duties among men and women equally.
State, welfare, and the structural invisibility of care
Further structural transformation of Indian society has made these problems even more complicated. The transition from joint to nuclear families, along with increased urbanisation and migration, has limited the option of community care. Thus, care-giving is a burden to shoulder individually. The lack of community care institutions, which may include inadequate care services and care-giving clubs, leads to social isolation. In the absence of institutional and community support structures, caregiving increasingly becomes an individualised responsibility associated with isolation and emotional strain.
India’s existing welfare and policy framework remains inadequately equipped to address the realities of unpaid informal care. For example, policies such as the Maintenance and Welfare of Parents and Senior Citizens Act (2007) concentrate more on the well-being of dependents rather than the caregivers who provide continuous care at home. Similarly, recent labour reforms such as the Code on Social Security (2020) continue to exclude unpaid familial caregivers from formal frameworks of labour recognition and social protection. Such policy gaps reinforce the assumption that unpaid care is a private familial obligation rather than a form of socially necessary labour requiring public investment and institutional recognition. Healthcare policies like Ayushman Bharat place more emphasis on treatment and health services through insurance rather than addressing issues relating to caregiver health, respite care, and the provision of long-term care services. In addition, the government relies on the work done by unpaid caregivers to make up for the failure of its welfare system.
The absence of financial support mechanisms, such as caregiver allowances, tax benefits, or social protection, places the entire burden on families. Additionally, the lack of formal long-term care infrastructure further entrenches dependence on unpaid family-based care arrangements.
Towards a care economy framework in India
The growing crisis of unpaid care requires moving beyond the understanding of care as a private family obligation toward recognising it as a broader social and economic concern. This is where the idea of the care economy helps achieve this goal.
To begin with, recognition is important, as integrating unpaid care work into national accounting systems will demonstrate its contribution to society and the economy. Measures such as introducing financial arrangements, such as caregivers’ benefits and social protection, can help reduce the economic burden associated with caregiving responsibilities. At the same time, strengthening public care infrastructure through community-based services and accessible support systems remains equally necessary. A comprehensive and gender-responsive care framework can significantly improve both social well-being and the quality of life of caregivers themselves (Ghosh 2025). There is a need for a gender-based approach to deal with structural discrimination and ensure a more balanced distribution of care duties. Policies favouring the sharing of domestic responsibilities as well as flexible working practices can go a long way toward addressing this issue.
Comparative experiences from several Global South countries demonstrate that caregiving can be addressed more effectively when treated as a matter of public policy rather than a purely private family responsibility. Several South Asian and Global South countries, including Thailand, Sri Lanka, Brazil etc. have increasingly attempted to integrate care support into broader welfare and localised elderly health frameworks. For example, the community-based approach to long-term care for the elderly in Thailand relies on local governmental bodies, trained caregivers, and primary health-care services to provide care for the elderly in the community, instead of placing the responsibility solely on the family members. Similarly, Sri Lanka’s ageing policy framework has increasingly emphasised localised elder-support systems, social assistance, and active ageing programs in response to demographic transition. Such models indicate that even middle-income developing countries with limited resources can expand caregiving support through decentralised public systems, local participation, and state-backed care infrastructure. International policy discussions led by organisations such as the International Labour Organisation and UN Women have also highlighted that investing in the care economy not only ensures well-being among caregivers but also creates jobs, improves social protection programs, and supports economic development. Within this framework, it is evident that India’s crisis regarding care cannot be addressed by means of family-based coping strategies alone; rather, institutional attention needs to be paid to the issue.
The provision of caregiving in India still seems to be a paradoxical phenomenon as it is necessary from both the social and institutional perspectives, but not recognised and valued accordingly. Unpaid caregiving generates serious physical, emotional, and economic consequences for caregivers, particularly in contexts where institutional support systems remain inadequate. Chakraborty et al. (2023), in their comparative analysis of informal caregivers in India, identify caregiving as a significant risk factor associated with poor health outcomes and depression. Similar concerns are reflected in studies on dementia caregiving in India. The caregivers report chronic stress, emotional exhaustion, lack of relaxation, and insufficient institutional assistance; this is worsened by the inflated medicine market (Lillekroken et al. 2024). These findings are further accentuated by the situation in India, whereby the amount being spent on health-care services and provision of long-term care facilities remains inadequate, thus causing families to bear the brunt by having to take care of their loved ones at home. With the increase in the ageing population and burden of chronic illnesses, such reliance on informal family care is unsustainable. Care, thus, cannot be a question that only concerns the private domain because, with the increasing population of the aged and the rising number of people with chronic illnesses, the reliance upon unpaid domestic labour is unlikely to be sustained. Invisibility of care in economic and policy discourses is a reflection of the larger system of welfare in which unpaid labour is used by families to compensate for government failures.
(Authors:
Dr. Aneesh K A is Assistant Professor of Economics & Fellow at the Centre for Studies in Population and Development (CSPD), CHRIST (Deemed to be University),
Delhi NCR Campus. Email ID: aneesh.ka[at]christuniversity.in
Arya Joshi is an intern at the Centre for Studies in Population and Development (CSPD), CHRIST (Deemed to be University), Delhi NCR Campus. Email ID: arya.joshi[at]bapecoh.christuniversity.in )
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