Transnational Caregiving: Experiences of Visible Minority Carer-Employees
Abstract
In Canada, approximately 35% of individuals in the workforce are carer employees (CEs). Workplaces lack support programs and initiatives resulting in CEs taking absences from work and opting for early retirement. These circumstances additionally decrease productivity and economic growth, and cause strains on the psychological, physical, and financial well-being of CEs. Many newcomers to Canada are providing care to those across transnational boundaries while being employed. These immigrants are known as transnational CEs (TCEs). The research questions this secondary analysis aims to answer are “What are the experiences of visible minority TCEs before and after the Covid-19 pandemic in London, Ontario, and what are the implications of these experiences for policymakers and employers?”. A qualitative thematic analysis by Braun & Clarke using the ATLAS.ti coding software was conducted to examine the dataset on South American, African, Pakistani, and Syrian descent TCEs. The philosophical orientation that underpins this study is constructivism and the theoretical framework that informs the findings is the intersectionality theory. Data analysis generated from the 29 participants in the study revealed three main themes: (1) the variations in gender-based transnational care, (2) cultural expectations of caregiving, and (3) recommendations to policymakers and employers. The results of the study suggest that male TCEs are more likely to provide financial caregiving, whereas female TCEs do more physical and emotional caring. Furthermore, culture influences caregiving as there are higher expectations from the only or eldest child in the family and those who live abroad. The findings also illustrate that there is a lack of caregiver-friendly workplace policies (CFWPs) in the workplaces (e.g., family responsibility leave) and TCEs lack knowledge about CFWPs. They recommended financial relief, employer support, and extended vacation/family leave to help them balance work and transnational caregiving. Study implications include employer engagement to promote and sustain visible minority TCEs’ health and well-being and educating TCEs and employers on the importance of CFWPs.
1. Introduction
1.1. Context of the Research
This study is part of a 5-year research program at McMaster University that addresses gender, health, and caregiver-friendly workplaces [1]. This program is in collaboration with diverse partners in the government, nonprofit organizations, and businesses, as well as academic researchers [2]. Through this partnership, the program of research aims to scale up the Canadian Standards Association (CSA) B701-17 Carer-Inclusive and Accommodating Organizations Standard (The Standard), a gender-sensitive guide for workplaces to provide support to caregivers that are employed in Canada [2, 3]. Another goal of the program is to build evidence relevant to the cultural competency of The Standard, while developing and implementing associated tools [1, 2]. The team associated with this research program strives to produce evidence-based research to advance The Standard across the nation. Furthermore, the team has built an International Standard, published by the International Organization for Standardization (ISO), entitled ISO 25551—General Requirements and Guidelines for Carer-Inclusive Organizations. ISO is a nongovernmental global management organization composed of experts creating International Standards for solutions to world challenges [2–4]. Funding for this research program is provided by Canadian tricouncil research bodies, specifically the Social Sciences and Humanities Research Council of Canada (SSHRC), and the Canadian Institutes of Health Research (CIHR) [1].
This research falls under “Stream B: Healthy, Productive Work Partnership Grant” of the broader research program [5]. Of the 17 projects making up Stream B, this study is contained within Project 5, entitled “Informing the Standard’s Cultural Competency: Caregiving Experiences of Immigrants & Indigenous Caregiving-Employees” [5]. The original objective of Project 5 was to examine the experiences of Indigenous and immigrant TCEs. However, the onset of COVID-19 modified the nature of this project into exploring the experiences of transnational carer employees (CEs) before and after the pandemic. Specifically, this paper is a secondary analysis that scrutinizes the experiences of visible minority immigrants who are providing unpaid care outside of Canada’s borders while working in paid employment or volunteering in the Canadian context.
1.1.1. Background and Significance of the Research
The growing aging population in Canada, together with the retreat of quality health care services, has contributed to a greater number of CEs [1]. CEs are friends, family members, neighbors, or other significant individuals who provide support to someone with a cognitive, physical, or chronic illness while being employed [6, 7]. Currently, 35% of the Canadian workforce is composed of CEs. Care responsibilities can include but are not limited to mobility assistance, managing doctor appointments, providing financial aid, etc. [8]. The lack of accommodation for CEs in the workplace adversely impacts their mental health and financial well-being. Insufficient support programs also compel CEs to take absences from their place of employment, modify or reduce their work hours, and opt for early retirement, decreasing productivity and economic growth [3].
The findings of the 2018 Canadian General Social Survey (GSS) included 4, 940 CEs and revealed that, due to caregiving responsibilities, 46% of CEs experienced presenteeism or difficulty concentrating at work, and 51% faced absenteeism or occasional nonpresence at their job [9]. The GSS also reported that employed caregivers were working 12 h less per week to engage in caregiving and that about 214, 000 Canadian employees entirely left their employment [9]. Collectively, this equals 312 million fewer hours that CEs were working. To fill this gap, establishments would need to take on approximately 171, 000 new full-time workers [9].
Furthermore, in 2018, female CEs living in Canada between the ages of 19 and 70 provided 13.8 h of caregiving, while male CEs provided 10 h of care weekly [8]. This accounts for approximately two full days of unpaid duties weekly [8]. A 2024 report by Petro-Canada CareMakers Foundation revealed that in comparison with men, women caregivers spend 50% more time providing care to loved ones and that they are more likely to face employment barriers [10]. Specifically, female employees who are engaged in caregiving tend to lose out on promotions in their workplace, take compassionate care leave, and retire with less money saved. Research indicated that female CEs earn $20, 000 less relative to male carers on an annual basis [10]. This employment income gap is greater for visible minority women and immigrants, placing them at an increased risk of negative outcomes such as higher psychological distress and financial constraints [10].
In addition, the aging demographics of Canada will increase from 861,000 in 2021 to 2.5 million in 2046, negatively affecting all work environments [6]. Consequently, Canada will continue to depend on Transnational CEs to drive population growth and recover from the socioeconomic impacts of the COVID-19 pandemic [6, 9]. TCEs are immigrants that live and have paid employment in the country of resettlement while providing care to their parents, adults with a disability, extended family, and/or friends that reside in their home nation. Transnational caregiving can include any form of support such as emotional, financial, or moral [9]. Often, TCEs also have dependent family members to care for in Canada as well [9]. Thus, it is crucial for workplaces to adopt practices that are gender sensitive and carer-friendly, such as the CSA Standard. Formulated in 2017 by a partnership between McMaster University and the CSA group, The Standard provides a set of guidelines for employers in Canada to support CEs [1, 5]. Through the implementation of programs like The Standard, employers can enhance mental health, as well as Equity, Diversity, and Inclusion (EDI) initiatives, and employees’ overall work–life balance [3]. These programs can decrease costs related to health insurance, absenteeism, and presenteeism while improving retention, autonomy, and loyalty among the workforce [3]. It is pivotal to note that while many employers are aware that employees are increasingly taking on caregiving responsibilities, they lack an understanding of the new and emerging concept of transnational caregiving, its implications, and how workers can be supported [5, 9]. Thus, a strength of this paper is that it explores the experiences of employees providing care on a transnational scale and how they can be accommodated in the Canadian workplaces.
Research by Ramesh et al. [11] indicates that the dual arrangement of being a carer and an employee can lead to poor mental and physical health, in comparison with the general population. Sethi et al. [9] also report that caregiving can be stressful and drain energy. Other scholarly work by Sherman [12], Williams et al. [13], and Etters et al. [14] correspondingly states that unpaid care is linked to fatigue, muscle pain, sleep problems, unfavorable moods, and depression. Similar patterns are observed among transnational caregivers. Baldassar [15] and Bernhard et al. [16] determined that immigrants who are caregiving across international borders experience guilt and burnout for not being able to fulfill their unpaid care duties to elderly parents in their home nation. Ahmad [17] and Brijnath [18] further described that immigrants who care for family members on a transnational scale share feelings of anguish, shame, uselessness, and guilt for their inability to be in geographical proximity to their sick family members. Correspondingly, Lee et al. [19], and Şenyürekli & Detzner [20] determined that, despite caregiving being a cultural expectation, the financial remittances and emotional support that TCEs provide to their family members in their home country can create socioeconomic and psychological stressors for them.
A systematic review by Sethi [21] highlighted that the lack of support from workplaces employing TCEs, along with geographical constraints that hinder their ability to provide care, results in feelings of anxiety, guilt, and fear. Sethi [21] recommends that employers and the Canadian government need to work toward addressing the social, economic, and political factors that prevent TCEs from effectively balancing their employment and unpaid caregiving duties, such that there can be reduced risks to the health of TCEs and the Canadian economy [4]. The findings of Sethi [21] are consistent with the earlier results of Amin & Ingam [22], who also state that the lack of institutional policies, combined with geographical distance, results in TCEs experiencing psychological distress, overthinking, and increased worry. Williams [23] further supports these studies indicating that without accommodations in the workplace, the combination of paid and unpaid work can lead to TCEs facing financial hardships and strained relationships, in addition to poor mental and physical health. Williams [23] reveals that to prevent avoidable costs to employers and promote the health of TCEs, there must be continued efforts geared toward the implementation of carer-friendly workplace culture in the growing globalized care economy [23].
Furthermore, a paper by Jewell et al. [24] illustrates that despite ample evidence around the psychological, personal, and professional challenges directly associated with unpaid caregiving, research disproportionately neglects the distinctive experiences of visible minority TCEs before and after COVID-19. For the purposes of this research, “after COVID-19” refers to the time after COVID-19 restrictions were implemented. To our knowledge, this is the first study that scrutinizes the experiences of TCEs of South American, African, Pakistani, and Syrian descent prior to and after COVID-19 in London, Ontario. It is noteworthy that research participants from these four parts of the world experience poor gender parity due to structural and cultural barriers. The 2022 global gender gap index, published by the World Economic Forum, noted that gender parity for the Middle East and North Africa is 63.4%, whereas sub-Saharan Africa stood at 67.9%, and Latin America and the Caribbean at 72.6% [25]. Immigrating to North America, a region that is the most advanced in closing the gender gap, at 76.9% parity, can influence the way TCEs view the roles and expectations of caregiving given that Canadian norms increasingly promote women moving into paid work and leadership positions [25]. Thus, this secondary analysis scrutinizes the experiences of visible minority TCEs living in London, Ontario, and may inform decision-makers to implement gender-sensitive, culturally appropriate, and inclusive workplace policies that accommodate and improve the health of CEs engaged in transnational caregiving.
2. Materials and Methods
2.1. Philosophical Orientation and Theoretical Framework
The philosophical orientation of constructivism underpins this study. This approach identifies that reality itself is a construct of the human mind and is perceived by individual experiences [26]. Constructivism is relevant herein as this study does not claim objectivity but rather recognizes subjectivity by focusing on a broad question and providing participants with the power to direct the data collection process [26]. Constructivism is also suitable in this research as TCEs are invited to discuss their unique realities of transnational caregiving. Furthermore, intersectionality theory by Kimberlé W. Crenshaw is the theoretical framework embedded in this research. Intersectionality theory originated from Black Feminist and Critical Race Theory [27, 28]. Intersectionality is appropriate for this paper as it will help explain that social positions present in a hierarchy of societal power are not independent but encompass individual experiences together. For instance, it can showcase that as the gender and race of TCEs intersect at an individual level, experiences at those intersections are impacted by the broader interpersonal and institutional systems of oppression—such as sexism and racism [27]. It is crucial to recognize that although intersectionality theory continues to progress across multiple disciplines, there are three common themes that have been observed [28]. These include the following: (1) all individuals have various identities that tend to coincide; (2) within each category, there is a layer of privilege and oppression; and (3) although identities are individual, they are developed by sociocultural contexts and can fluctuate [28]. Henceforth, intersectionality theory is used in this research as the theoretical framework as it will facilitate the exploration of intersecting identities such as race, gender, and ethnicity in association with the experiences of visible minority TCEs before and after COVID-19.
2.2. Study Design and Setting
This study used a community-based and ethnographic approach to gain insight into the experiences of visible minority TCEs living in London, Ontario. This type of study design enables individuals in the community and the researchers to work together in the research process [21]. It focuses on rapport building, community engagement, collective perspectives, and cultural understanding of community members. Ethnographic methods consist of interviews and observations to recognize the views and perspectives of the participants and how they function in their environments [21]. This research involved interview methods such that meaningful information about the mindsets, experiences, values, and traditions of the TCEs may be gathered. London was chosen as it has observed a rise in diversity and migration in the past few years. Between 2016 and 2021, approximately 20,495 immigrants have settled in this mid-sized city in Canada [29]. Among this, approximately 40% were from India and Syria, with many more emigrating from Africa and the Americas [29]. The immigrant population in London is about 21% of the general population, with 20% settling in the last 5 years and 16% being visible minority immigrants [21]. This qualitative study design is advantageous as it contributes to the generation of new theories and begins from a perspective free from hypotheses, and it can discover complexities that may be overlooked by more positivistic research [21].
2.3. Recruitment and Data Collection
The inclusion criteria of this study included being 18 years or older, living in London, Ontario, self-identifying as a visible minority individual, and providing care to a family member and/or a friend living across borders while at paid employment or volunteering. Volunteering at a workplace was added as an option in the inclusion criteria as new immigrants may start a position by volunteering to gain experience for future paid roles. It is also important to note that this research did not look at participants providing in-person care to relatives in their home nation. All care was conducted on a transnational level. There were no set requirements on how long immigrants have resided in Canada. To recruit participants, posters were emailed to local organizations that provide services to immigrants. Posters were also placed in mosques, libraries, community centers, and grocery stores. From October 2019 to March 2021, purposive and snowball sampling resulted in the participation of 29 visible minority TCEs. Prior to the pandemic, interviews took place at an agreed upon neutral location or at the participants’ home and audiotaped with their consent. After the pandemic, all interviews were carried out and recorded with consent on the video-conferencing platform, Zoom, due to physical distancing guidelines. One-on-one interviews were conducted in English, Spanish, or Arabic, and their length ranged from 60 to 90 min. Spanish and Arabic interviews were translated into English and translated back to ensure accuracy. Three research assistants (RAs) conducted and transcribed all the interviews. Although the authors of this paper were not directly involved in data collection, the interviews were carried out by RAs under the close supervision of the second and third authors. The second author served as the Principal Investigator, while the third author was a Coinvestigator for this CIHR/SSHRC Healthy Productive Work Partnership Grant, under which this project was conducted. The interview guide incorporated questions such as “How have cultural expectations informed the way that you provide care?” and “How does your employer inform you about specific policies and programs?”. Interview questions also inquired about how participants cope with their simultaneous paid and unpaid responsibilities, challenges and feelings associated with their personal experiences, how gender influences their caregiving roles, and recommendations for policymakers. The interview guide was modified with follow-up questions after COVID-19. This included inquiring the participants about how the pandemic-related implications such as the lockdown and social distancing impacted their employment, well-being, and caregiving experiences.
2.4. Data Analysis
A paper by Rottenberg [21], published in the Journal of Wellbeing, Space, and Society, broadly analyzed the same dataset as the present study. In this secondary analysis, the data were re-examined by the first author with a new and more narrow focus, specifically to explore the experiences of Pakistani, South American, African, and Syrian descent TCEs. For the purposes of this study, a thematic analysis by Braun & Clarke [30] using the ATLAS.ti coding software was chosen to assess the transcripts. Braun & Clarke’s [30] thematic analysis is a common qualitative descriptive analysis strategy that helps categorize, segment, and reconstruct data in a manner that highlights the significant themes and patterns. This methodological approach was selected as it allows researchers to get a better understanding of the experiences of the participants [31]. The intersectionality theory is a framework that helped guide the data analysis, specifically in examining the interconnectedness of various socially constructed categories such as ethnicity, immigration, gender, and how they collectively influence the lives and experiences of visible minority TCEs living in London [32].
In the first phase of the thematic analysis by Braun & Clarke [30], the primary author uploaded the study materials to the ATLAS.ti coding software and got familiarized with the data. To do this, interview transcripts and field notes were read, and interview recordings were watched. In the second phase, initial codes were created that represented the meaning and pattern of what was being observed in the data. This phase consisted of inductive, open coding, as there were no preset codes that were followed; rather, the coding process was developed, modified, and exclusively data driven [31]. The same codes were applied to excerpts that were representative of a similar pattern or idea. In the third phase, themes that captured significant insights associated with the study objectives were searched. At the end of this step, homogenous codes were brought under one code group and organized into themes that captured information regarding the research question. In the fourth stage, the initial themes that were developed in the third phase were modified and edited to ensure they were coherent. To do this, the following questions were considered: (1) Are the themes distinct from one another and making sense? (2) Are the themes supported within the dataset? (3) Is there too much information in one theme? (4) Are there any additional themes? [32] After these questions were addressed, the primary author moved onto the fifth stage, which consisted of finalizing the themes. This was the last step in which the themes were refined. The goal here was to succinctly name each theme and identify its essence such that it can be finalized for the write-up (Table 1).
| Codes of theme 1: the variations in gender-based transnational care | Codes of theme 2: cultural expectations of caregiving | Codes of theme 3: recommendations to policymakers and employers |
|---|---|---|
| Female caregiving experiences | Caregiving as a cultural obligation | Lack of awareness of CFWPs |
| Male caregiving experiences | Caregiving as a religious commandment | Financial relief |
| Financial caregiving pre-COVID-19 | Caregiving as a moral responsibility | Increased vacation time |
| Financial caregiving post-COVID-19 | Caregiving pressures from care-recipients back home | Greater interpersonal relationships with employers |
| Emotional caregiving pre-COVID-19 | Caregiving as the eldest child responsibility | |
| Emotional caregiving post-COVID-19 | ||
| Physical caregiving pre-COVID-19 | ||
| Physical caregiving post-COVID-19 |
2.5. Ethics Approval
This research was reviewed and approved by McMaster University’s Research Ethics Board (MREB#: 4881) and King’s University College Research Ethics Committee. Informed consent for the present study was obtained through the Qualtrics software. All respondents were made aware that their contribution to the study is only voluntary and they can withdraw from it at any time without any repercussions. Interviewees were given a $35 honorarium for their participation. To keep anonymity, participants have pseudonyms or fictious names that are used throughout this paper.
3. Results
3.1. Participants
Among the 29 TCEs living in London, Canada, that participated in this research, 14 were females and 15 were males. Of these, one was interviewed before COVID-19, 15 during the pandemic, and 13 were interviewed both pre–post-COVID-19. While efforts were made to recruit participants from a broad spectrum of visible minorities, genders, and sexualities, participants were identified as male and female. The data of this research disclosed that 4 participants were from Syria, 2 from Pakistan, 14 from South America (Venezuela, Barbados, Columbia, Haiti), and 9 from Africa (Kenya, Uganda, Zimbabwe, Nigeria) (refer to Table 2). Five participants reported that they held a volunteer position in London, where in addition to their transnational caregiving, they were providing support to the local community. The experiences of Pakistani, South American, and African-origin TCEs before and after COVID-19 somewhat overlapped with the exception of Syrian descent respondents. The cohort comprising Syrian interviewees faced disproportionate stressors because of the humanitarian conflict in the Middle East. Most participants had a stable job pre–post the COVID-19 pandemic. These included being a professor, retail worker, school custodian, house cleaner, Uber Eats driver, etc. Thematic analysis by Braun & Clark [30] revealed the following three overarching themes from the dataset: (1) the variations in gender-based transnational care, (2) cultural expectations of caregiving, and (3) recommendations to policymakers and employers.
| Participant characteristics | Number of participants |
|---|---|
| Sex | |
| Male | 15 |
| Female | 14 |
| Type of caregiving | |
| Financial, emotional, and physical | 11 |
| Emotional only | 1 |
| Financial and emotional | 17 |
| Origin | |
| South American | 14 |
| Syrian | 4 |
| Pakistani | 2 |
| African | 9 |
The results of this paper determined that participants of this research engaged in financial, physical, and emotional transnational caregiving. In terms of financial caregiving, participants reported sending money via service providers like the Western Union or through friends to multiple care-recipients back in their home country, such as parents, grandparents, nieces, nephews, uncles, and aunts. Physical caregiving consisted of sending medications, clothing, electronic devices, and other necessities their immediate or extended family members required. With respect to emotional caregiving, respondents incorporated talking on the phone or video calling through WhatsApp to check up on the care-recipients, listen to their concerns, and provide any advice, encouragement, or comfort that they may need. Across all visible minority groups in the study, men provided more financial caregiving, whereas women engaged in greater physical and emotional caring.
3.2. The Variations in Gender-Based Transnational Care
The findings of this study suggest that there are variations in the experiences and the type of care that visible minority men and women from Syria, Pakistan, Africa, and South America provide. Generally, the dataset revealed that men tend to provide greater financial caregiving, whereas women engage in more emotional and physical caregiving.
Specifically, pre-COVID-19, Syrian male and female participants from London indicated that gender played a significant role in care. They shed light on how the role of women was limited in relation to monetary aid, but they still provide a large portion of emotional caregiving to care-recipients. Rasha, a Syrian TCE reveals “He [husband] is supposed to provide the finance […] but the women have a bigger role […] she is the controller for the whole family.” Post-COVID-19, both male and female TCE participants disclosed that caregiving was harder and decreased for the Syrian care-recipients because money is often lost through service providers. Adam declared “It [caregiving] is […] difficult because of the COVID-19 and specially transferring the money […] we are talking about 60% losses or something.” Therefore, the experiences of Syrian background TCEs illustrate that normative gender expectations influence caregiving and that because of money being lost through service providers, transnational caregiving among this cohort decreased postpandemic.
In addition, prior to the pandemic, both the male and female Pakistani respondents currently residing in London conveyed that there are no impacts of gender in caregiving. A.D., a Pakistani male, stated that “It could be anyone [caregiver], it doesn’t really matter.” Similarly, pre-COVID-19, the female participant from Pakistan, Sabrina, explained that in her house, there was “no discrimination” between a man and a woman; however, women tend to provide more physical caregiving activities such as “making food” in comparison with Pakistani men. Post-COVID-19, both Pakistani background participants reported that there was an increase in caregiving. A.D. stated “The money I was sending […] I increase that a little bit, because I understand that the situation is the same globally.” Henceforth, the experiences of Pakistani TCEs exhibited that caregiving increased post-COVID-19 and that while they personally do not believe that gender impacts caregiving duties, there is still an underlying responsibility for women to engage in more physical care.
Moreover, before COVID-19, some of the African male respondents from London expressed that gender does not play a big role in caregiving. L.A., a male participant from this cohort, mentioned “I think it depends on your personality […] there is nothing a man can do that a woman cannot do in caregiving.” On the other hand, the multiple female respondents in this cohort said that women are expected to lead the families. Lulu says “If you raise a girl, you’re raising the support system of the family.” Post-COVID-19, the male interviewees with African origin indicated that there were more people contacting them for help, compelling them to send money. Alajide discussed “Well a lot more money has to go out now because due to the whole pandemic, it has affected Nigeria’s economy pretty bad.” Furthermore, female African descent interviewees stated that after the pandemic, they were providing more emotional care as there was an increase in virtual connection and support through WhatsApp, Zoom, and other social media platforms. However, they went on to explain that they gave less financial help than before and felt less guilt about it. Nina quoted “Even if the financial support may not be as much as I want […] but just having more time to talk with my family has been very valuable for me.”
In comparison with all other TCE cohorts in the study, South Americans living in London were the ones in which most of the participants, both male and female, engaged in financial, emotional, and practical caregiving. The majority of these South American TCE interviewees occurred post-COVID-19 and they revealed that is not gender but birth order that impacts caregiving duties. Jemmy says “my brother is the last one, I am the big girl, and the responsibility lies entirely on my shoulders.” Likewise, Martina adds “Well, I don’t think so [if gender plays a role] not as much about gender. Maybe because I’m the oldest daughter, that’s why I think that I have more responsibility.” Therefore, many South American descent participants explained that while women tend to provide more physical and emotional caregiving, it is being the eldest or an only child that significantly influences caregiving expectations and sways the responsibility.
3.3. Cultural Expectations of Caregiving
“In the western culture there’s so much individualism. And when people come and say they don’t talk to their parents, to me that’s mind blowing. Cause my perspective and my culture, that is never a thing […] you can be mad at your parents, but you don’t cut ties off… family comes first. That’s how I see it and that’s how kinship influences me… it matters—our connections, our bloodlines. It matters.”
This quote explains that Western individualism is not relevant among the recruited TCEs and that they were born and raised to value the interdependent family system.
Additionally, Pakistani, Syrian, and a few African-origin participants stipulated that looking after parents and providing caregiving services to those in need is a commandment of their religious beliefs. Nogi, an African TCE stated “I think caregiving for me is a way of life […] I think this knowledge [caregiving] stems from the bible […] you feed the poor.” Correspondingly, Sabrina said: As a Muslim […] you are supposed to look after your parents always. It is one of the basic I would say teaching of Islam. These quotes showcase that caregiving is not an option, rather it is engrained in the lives of TCEs.
“I see them [parents] as a tree that bears a fruit, they a bear a fruit, and it’s because they nurtured you. They nurtured you, so you became a fruit. Then when you became a fruit you are going to hopefully become a tree, eventually. You are going to become a tree; you have to help someone as well. So, it’s just natural.”
This quote goes to show that the nature of two-way care is embedded in the lives of TCEs as they are raised in a manner where they are taught from a young age that caregiving is fruitful. Hence, it can be noted that taking care of each other is an important pillar in the upbringing of visible minority TCEs.
“There is a culture in our country of origin that because we live abroad, because we in a different country, those developed countries that have a high purchasing power, that we’re always going to have a lot of money to send.”
These quotes demonstrate that there are cultural expectations and assumptions of those living abroad having more money and high-income jobs, and hence, there is greater pressure on those that live abroad to provide caregiving to their family or friends in their country of origin.
3.4. Recommendations to Policymakers and Employers
“I do not particularly know about any policy regarding caregiving at [redacted] and I do not know if I expect that [redacted] as a university would have a policy regarding caregiver or caregiving.”
Thus, it can be noted that there is a lack of awareness and presence of gender and carer-friendly policies in the workplaces that can accommodate TCEs.
Nonetheless, respondents from all four cohorts provided some suggestions and recommendations that they, as visible minority TCEs living in Canada, can potentially benefit from. Specifically, Pakistani descent participants communicated that some sort of financial relief would support them. A.D. quoted “Financially [support]… If you’re getting $100, they match it with $20. Ten percent or a percentage that could be a very noble gesture and could be a lot of money too.” From this quote, it can be observed that even an assistance of 10% would be an accommodation that TCEs may highly value that may also promote retention of workers.
The most suggested recommendation from participants across all cohorts’ before and after COVID-19 was to have more vacation time as that would help them in their caregiving responsibilities. Lulu stated “I get 14 days, but if four of those days I’m travelling, do I really get 14 days’ vacation time? Um, and maybe it’s time to increase the vacation time.”
“For those of us taking care of people outside of the country, and it will take two days to travel to that place, take you another two days to come back, so a week is gone right there. So, if there could be a mechanism put in place to accommodate immigrants that need to travel out of the county […] it’s something that I believe that the government or the institutions can look into.”
Therefore, participants report that employers should consider that many of their employees want to travel to their home country during their vacation. However, 2 weeks is not sufficient and that increasing vacation time is needed to effectively balance paid and unpaid duties.
“I would strongly encourage employers to open their doors, because at the end of the day it boils down to productivity… if they [caregivers] are open to talk about something to their employer, their employers should have an open-door policy.”
Thus, participants of this study pointed out employers are distant from their employees and that building interpersonal relationships with their employers in the workplace would be beneficial for them.
4. Discussion
4.1. Intersectionality
This research looked at the intersectionality of geography, immigration status, and gender.
While the data in this study did not reveal supports or barriers specific to oppression in London, past research indicates that racism in this area can further hinder TCEs from providing transnational care to their families [33]. A report by Vaswani & Esses [34] looked at the experiences of 829 immigrants, visible minorities, and Indigenous people in London-Middlesex. Their results disclosed in the last 3 years; 4 out of 10 respondents from the visible minority and immigrant groups faced discrimination [34]. Furthermore, a recent and shocking incident of racism and Islamophobia in London was the killing of the Afzaal family, which sent waves of fear among Muslim immigrants in Canada [35]. The city of London is currently taking steps for antiracism and antioppression in the region [36]. The participants in this study reported a lack of carer-friendly policies, which is indicative of broader systemic neglect toward the unique caregiving roles of minority immigrant populations. A major barrier like racial discrimination as discussed by Vaswani & Esses [34] can hinder the ability of TCEs to access resources or maintain job security to fulfill their transnational caregiving responsibilities. This research highlighted that visible minority women are more likely to engage in emotional and physical caregiving. From an intersectional lens, gender expectations may further exacerbate the neglect by employers, leading to female TCEs experiencing heightening challenges as a result of racial and gender bias along with the burnout of their caregiving struggles [33]. It is also important to note that the Canadian government is moving immigrants away from Montreal, Toronto, and Vancouver, but there are minimal resources to help them with resettlement [37]. A paper by Simich et al. [37] shows that systemic challenges such as the lack of resources, and limited integration of programs and policies are barriers to immigrant settlement in Canada. The study states that enhanced service coordination, better governance, and increased public discourse on immigrants’ contributions are vital for supporting the health, well-being, and settlement of newcomers in Canada [37]. The results of the current research distinguished that the cultural expectations of providing transnational care are intensified by the perception that immigrants living in Western nations have greater financial resources. In particular, South American TCEs talked about the cultural pressure to engage in caregiving, which intersects with their immigration status and the stereotypes about wealth in affluent countries. This pressure, along with the barriers to resettlement as outlined by Simich et al. [37], can amplify challenges related to the caregiving burden for the TCEs. Therefore, this paper suggests factors such as gender, culture, immigration status, and geography intersect to shape the experiences of the visible minority TCEs.
4.2. The Variations in Gender-Based Transnational Care
Although not specific to caregiving across international borders, the findings of this paper are consistent with the results of a scoping review by Maynard et al. [38], which reports that male CEs tend to provide a higher proportion of financial assistance to their care-recipients. Lee et al. [39] also reported that male CEs take on more monetary management responsibilities, whereas female CEs assist with most of the hands-on caregiving, such as making food, and give emotional support. All visible minority cohorts except for Syrians living in London reported that transnational caring increased after the pandemic. Syrian TCEs explained that their care-recipients in the conflict-affected country are not worried about COVID-19, rather they are concerned about survival as less financial relief is reaching them because of COVID-19 and the United States sanctions. Jamali [40] revealed that war-torn Syria has been under U.S. sanctions and money-transferring service providers such as Western Union and MoneyGram still do not allow financial relief to be sent to Syria from the United States. As a result, people are relying on social networks and connections to send remittances directly to the households of their care-recipients [40]. Aside from the disproportionate impacts of COVID-19 on Syrians, other TCEs mentioned that caregiving had largely increased for them post-COVID-19 as more relatives and friends were asking them for help. A paper by Beach et al. [36] discloses similar findings, stating that post-COVID-19, there was an increase in family caregiving duties, both emotionally and financially. Correspondingly, Boyd et al. [41] established that caregiving heightened from 18% in 2015 to 21% in 2020 or post-COVID-19, among adult women in the United States providing unpaid caregiving to at least one family member or friend. Subsequently, a study by Bergman & Wagner [42] analyzed the effects of COVID-19 on caregivers and recipients across Europe. The research signified that in the spring of 2020, when the first phase of the pandemic was on-going, caregivers across Europe experienced a strong increase in the provision of personal care to care-recipients outside their own houses as there was a lack of paid services and care support because of COVID-19 [42].
4.3. Cultural Expectations of Caregiving
Furthermore, many visible minority TCEs from London that took part in the present study revealed that rather than gender, it is being the eldest that significantly affects caregiving responsibility. A study by Grigoryeva [43] also suggests that birth order, regardless of gender, is a factor that gives higher responsibility of parental caregiving to the eldest child in the family. A paper by Suitor & Pillemer [44] also explored the role of birth order among 426 mothers and their relationships with their 1823 children. The authors of the research confirmed that the odds of mothers choosing their firstborn child for caregiving in times of crises were 70% higher than the odds of choosing their middle children or last-born children [45]. Equivalently, the odds of mothers choosing the eldest child to discuss their personal issues were approximately 33% higher in comparison to their other children [44]. Consistent with the experiences of many participants of the current study, Suitor & Pillemer [44] thus demonstrates that it is not so much gender but being the eldest child that leads to greater caregiving burden and responsibilities.
All the participants of this research revealed that caregiving was an obligation on them and that they do not relate to the individualism and lack of family dependability they observed in Western culture. TCEs expressed that they had grown up with strong family support and connections, which promotes providing caregiving to family members, friends, and those in need. These results are comparable to a paper by Pharr et al. [45], which assessed caregiving responsibilities among ethnic minorities in comparison to non-Latino Whites. The findings brought to light that caregivers living in the United States from Asian, Hispanic, and African backgrounds had caregiving so embedded in their lifestyle that they did it naturally and without conscious thought or question [45]. Phar & colleagues also described that caregivers from Europe did not have any example of family caregiving in their upbringing and that the life experience of providing care was unexpected to them. Moreover, the existing scholarly literature by Hsueh, Hu, & Clarke-Ekong [46], Guo et al. [47], and Flores et al. [48] supports the results of the current study as they also reported that providing caregiving is a cultural expectation and norm among individuals that belong to ethnic minority cultures. In addition, participants of the current research also shed light on how caregiving goes beyond culture, as it stems from their religious beliefs and practices. This is consistent with the results of research by Andruske & O’Connor [49] that investigated family care across South Asian, Chinese, and Latin Americans living in Canada. Their findings found that while participants positioned caregiving as a cultural obligation, they were more likely to express that religion formed their understanding and family care norms. Andruske & O’Connor [49] revealed that caregiving to family members was ingrained in the lives of the participants and linked to religious teachings. Another study by Ismail [50] looked at caregiving in multigenerational Arab families in Denmark and elucidated that religiosity influences caregiving experiences and expectations among Muslims. Ismail [50] informs that Islamic textual tradition mandates children to treat parents, especially those who reach old age, with honor, gentleness, patience, appreciation, and respect. Henceforth, like the results of the present study, Ismail [50] establishes that caregiving is a fundamental religious duty for many ethnic minority individuals. Parveen et al. [51] & Van-Eechoud et al. [52] also confirmed that the willingness to provide caregiving is related to religious beliefs and obtaining blessings for fulfilling this obligatory duty.
4.4. Recommendations to Policymakers and Employers
All visible minority participants in this research stated that they were not aware of and did not receive any carer-friendly accommodations. Carer-inclusive policies consist of organizational changes in the practices in a workplace that support the lives of employees outside the place of employment. Confirming the lack of employment support, Wu et al. [53] examined the stresses CEs experience post-COVID-19 across China, India, Australia, Spain, Brazil, and G7, revealing that Canadian CEs have the least employer support across all 12 countries that were compared. Specifically, 70% of CEs in the Canadian workforce did not receive any carer-friendly practices or policies from their employers during the pandemic [53]. Nevertheless, the participants of the current research explained that financial relief and increased vacation days, as well as building interpersonal relationships with their employers, would help them better manage their responsibilities.
Moreover, a United Kingdom-based study by Brimblecombe & Cartagena-Farias [54] disclosed that caregivers who provide 10 or more hours of unpaid care per week tend to cut down on working hours and consequently experience a penalty of £10, 000 in their income per year. Similarly, a cross-sectional study by Fakeye et al. [55] brought to light that from a sample size of 844 unpaid caregivers, 200 respondents reported productivity loss as they decreased 40 h of work in 1 month due to care-related work. This is equivalent to approximately 5, 571.24 USD lost in compensation on an annual basis [55]. Existing research acknowledges that caregivers lack access to flexible schedules, paid leave, or the option to work from home, which are critical initiatives that could help them manage their combined roles more effectively [56]. In particular, Vos et al. [57] assessed the experiences of 25 CEs in the Netherlands and described the pressing need for supportive workplace environments where employers foster an open dialog and do not instill guilt around caregiving-related tasks. Interviewees emphasized that employers should demonstrate empathy and offer tailored support options, such as flexible schedules and remote work [57]. Other scholarly papers demonstrate that formal support such as compassionate leave and flexible work hours and informal support such as employer goodwill and understanding can facilitate the well-being of family carers [58, 59]. Unpaid caregivers also state that social and financial support such as respite care, counseling services, and employer-sponsored health benefits can help reduce the economic hardships associated with caregiving [60].
Although not specific to transnational caregiving, the existing literature published in the National Library of Medicine disclosed that family caregivers are vulnerable to financial insecurity, which is a cause of distress for them as they tend to pay many out-of-pocket expenses [61, 62]. Previous scholarly work affirms that caregivers need greater financial security and help for them to continue supporting the well-being of their family and friends [61, 62]. Furthermore, Achor & Gielan [63] report that taking more vacation time correlates to increased happiness and success at the workplace, as well as decreased stress related to work. Similarly, a report by the American Psychological Association disclosed that when employers and workplaces encourage more vacation time, employees experience greater motivation and productivity, and their overall quality of work is enhanced [64]. Increased time off was also linked to employees feeling more valued and satisfied with their job and employer [64]. Additionally, research by Raykov [65] explains that having support from employers and a more connected work culture contributes toward employees having a greater quality of life, decreased job-related distress, and an increase in perceived job security. Henceforth, it is important to recognize that the recommendations made by the participants in this study such as more interpersonal relationships with employers, increased vacation time, and financial relief may help them with their experiences of transnational caregiving while improving their health outcomes.
4.5. Limitations and Future Studies
A limitation of constructivist research is that because reality and knowledge are deemed to be human constructs, the conclusions of the research cannot be generalized to other populations [26]. This study captures the experiences of a certain group TCEs in a specific geographical space and time. Specifically, experiences of participants in this larger Metropolitan area of London, Ontario, may differ from other regions and populations. One more limitation of this research is that the term “visible minority carer-employees” may risk oversimplifying the diversity within these cohorts of immigrants, particularly in how cultural norms around caregiving are discussed. Nonetheless, it is vital to note that the use of this term is grounded in the context of the research’s focus on experiences of being a visible minority TCE in a Global North context. Another limitation of this study is that it assesses gender-based transnational care; however, the participants in this study were representative of cisgender females and cisgender males only. It is pivotal to recognize that not all individuals fall under a binary approach of sex or gender categories of a female and male. Thus, there is a need for more research to incorporate participants of various gender identities and expressions to examine their unique experiences of transnational caregiving more inclusively. Additionally, it is pivotal to point out that although participants of this research discussed providing caregiving for immediate family members, extended relatives, friends, and people in need in the country of their origin, future studies should place a greater emphasis on the specific caregiving needs of care-recipients and its impact on TCEs.
5. Conclusions
In Canada, one in every five individuals is a visible minority, of which approximately 65% are immigrants [21]. Most of the immigrants in Canada are involved in transnational care because of the heightening global mobility and a rapid increase in the aging population globally [21]. If it was not for immigrants, there would be a significant shortage of skilled professionals in the Canadian employment sector [66]. Decreased birth rates and the aging population in Canada have caused the country to predominantly rely on immigrants to boost the economy. Immigrants address the gaps in the workforce, pay taxes to fund public services such as healthcare, and spend money on goods, housing, and transportation [54]. All of these factors are essential for the economic well-being of Canada; however, workplaces rarely have policies and benefits that support TCEs, especially those from visible minority backgrounds. This research brings to light that, among Pakistani, Syrian, South American, and African TCEs living in London, Ontario, normative gender roles influence caregiving as men provide more financial caregiving and women provide higher emotional and physical support. Among those who said gender does not shape caregiving expectations, there was an explanation of being the eldest or the only child in the family that leads to greater responsibility. The visible minority TCEs in this study also expressed that caregiving is a cultural and religious obligation for them and that among family members, there is more pressure on those who live abroad to engage in transnational care. Finally, some of the recommendations for accommodations that the respondents of the present study mentioned included financial relief, increased vacation time, and building interpersonal relationships with the employers. Moreover, it is imperative to note that nations across the world such as the United Kingdom, Germany, United States, and Italy are heavily dependent on immigration for economic productivity, but they also lack carer-friendly programs in the workplaces [67]. In the context of long-term implications, the results of this study may inform policymakers to implement programs and policies targeted toward enhancing the health of visible minority TCEs around the world. Implementation of gender-sensitive and carer-friendly initiatives, such as the CSA and ISO Standards, allows TCEs to stay healthy and remain employed [9]. These Standards can help workplaces in carrying out accommodating programs for unpaid caregiving employees. This may include but is not limited to support and resources such as financial relief, communication and networking opportunities, and flexible hours such that their mental, physical, and financial well-being is not negatively impacted by caregiving. Future studies should place a greater emphasis on understanding the implications of their transnational caregiving responsibilities for their work obligations and the kind of support that would help them meet these obligations.
Conflicts of Interest
The authors declare no conflicts of interest.
Funding
The funding for this research was provided via the CIHR/SSHRC Healthy Productive Work Partnership Grant “Scaling up the Carer-Inclusive Accommodating Organizations Standard” under Nos. FRN: HWP-146001 (CIHR) and 890-2016-3018 (SSHRC).
Acknowledgments
The primary author Reemal Shahbaz is an MSc Global Health student and would like to thank all the respondents of this study, her academic supervisor, Dr. Allison Williams, her committee members, Dr. Bharati Sethi and Dr. Olive Wahoush, and the Gender, Health, and Caregiver Friendly research program at McMaster University.
Open Research
Data Availability Statement
The data and materials that support the findings of this study are made available from the corresponding author upon request.
