Emotional Well-Being of Live-In Migrant Domestic Workers: A Qualitative Study of the Experiences During Sociopolitical Crisis in Hong Kong
Abstract
This article explores the emotional well-being of live-in migrant domestic workers (MDWs) in Hong Kong during the 2019 sociopolitical crisis associated with the antiextradition movement (AEM). It examines their emotional experiences, the impact on their care work, and coping strategies, highlighting the interplay between emotions, emotional well-being, and mental health during the crisis. The study employs the concept of structural vulnerability to address gaps in the mental health literature. Qualitative data collection and analysis of interviews with 27 Indonesian live-in MDWs revealed their negative emotions (fear and anxiety) and suppressed positive emotions (attachment to Hong Kong), along with additional care duties and emotional labor. Coping strategies included silence and emotional distance, negatively affecting their self-perception, social connections, and mental well-being. This article argues that the unique emotional experiences of MDWs reflected internalized vulnerability, shaped by the intersection of oppressive social positions and the AEM crisis, which contributed to a heightened state of precarity for MDWs. It highlights the necessity for social care practitioners to address structural influences in their community and individual engagements. Neglecting this could hinder global efforts to promote health equity (SDG 3) and inclusive employment (SDG 8). Using an emotional lens reveals the complexity of MDWs’ work, highlighting their humanity.
1. Introduction
Emotional well-being is a vital aspect of mental health, influencing longevity, disease risk, and stress recovery [1–3]. It encompasses a range of positive emotions, such as happiness and life satisfaction and aligns with the World Health Organization’s definition of health, which emphasizes the importance of holistic physical, mental, and social well-being rather than merely the absence of disease [4]. Migrant domestic workers (hereafter MDWs) in different locations face significant mental health challenges, including high rates of stress (52.5% in Singapore) and anxiety (17.6% in Macao) [5, 6]. Key risk factors include post-migration stress, loneliness, and lack of social support [6, 7]. Recent studies [8, 9] highlight how the COVID-19 crisis intensified these vulnerabilities, exacerbating conditions of servitude and marginalization. Despite valuable insights offered by many studies, the importance of emotional well-being remains underexplored, particularly during crises for MDWs. The prevailing perception that MDWs primarily engage in physical and functional tasks often obscures the emotional dimensions of their work and lives.
Scholars [10, 11] identify two dimensions of emotions in care work: personal emotions and the emotional labor required to meet job demands. Cultural norms impose “feeling rules” that create tension between workers’ personal feelings and societal expectations, potentially leading to psychological harm [10, 12]. Although the literature on MDWs’ emotions and emotional labor is limited, research [13–15] highlights how oppressive workplace environments and power imbalances shape their emotional experiences while emotional labor can fulfill both protective and strategic functions. Building on this inquiry, this article employs the concept of structural vulnerability to explore how intersecting structural forces shape MDWs’ emotional experiences and emotional labor.
Mental health issues often become more pronounced during times of crisis, whether because of economic downturns or pandemics [16, 17]. The stress and uncertainty inherent in a crisis situation can exacerbate existing conditions and trigger new challenges for many individuals. In 2019, Hong Kong experienced the antiextradition movement (hereafter AEM), a crisis and significant social movement that deeply impacted society. The movement garnered widespread attention and emotional involvement from local Chinese residents, becoming a topic of discussion that was hard to escape. Conversely, MDWs, primarily working as live-in care workers for Hong Kong families, appeared to have distinct experiences of this crisis. Despite their significant presence—approximately 374,000 in 2020 [18]—and their partial citizen status, many MDWs have distanced themselves from the broader societal narratives [19, 20]. This raises important questions about the perspectives and experiences of this marginalized population during this crisis. While there is extensive literature on how MDWs navigated the pandemic as a crisis [8, 9, 21, 22], there is a notable lack of comparable studies examining their experiences of other crises such as the AEM. This study can serve as a case study to enrich our understanding of health and mental well-being of MDWs in crisis situations.
In light of this, this study aimed to address existing knowledge gaps by exploring the emotional experiences of live-in MDWs. Three research questions were examined. First, what were live-in MDWs’ emotional experiences during the 2019 AEM sociopolitical unrest? Second, how did these emotional experiences impact MDWs’ care work and daily lives? Third, what coping strategies did they use? Data collection took place between March 2020 and March 2021 as part of a larger study on non-Chinese populations during the AEM in Hong Kong. During this period, the breakout of the COVID-19 crisis resulted in a decline in large-scale demonstrations, while society experienced a tense atmosphere because of the implementation of the national security law and the crackdown on activists in 2020. This study utilized a qualitative descriptive approach based on Sandelowski [23, 24] and Nicholas and colleagues [25] because this methodology aimed to illuminate underexplored areas and identify emerging observations from narrative-based data. Qualitative thematic analysis [26, 27] was applied for analysis. This study contributes to the broader literature on mental health by illuminating the interplay between emotions, emotional well-being, and mental health among MDWs, particularly in a crisis situation. In doing so, it aligns with the global initiative to promote health and well-being for all and decent work and inclusive employment, as outlined in the United Nations’ Sustainable Development Goals 3 and 8 (SDG 3 and SDG 8), respectively. The experiences of MDWs during the 2019 AEM sociopolitical unrest in Hong Kong served as a unique case study for this investigation. The article begins with a literature review on mental health and emotional well-being, emotions and emotional labor, and the structural vulnerabilities of MDWs in Hong Kong. This is followed by sections on materials and methods, results, discussion and implications, and finally, a conclusion.
2. Literature Review
2.1. Health, Mental Health, and Emotional Well-Being
Emotional well-being is recognized as a crucial component of mental health, alongside psychological and social well-being [1, 3]. Research indicates that emotional well-being significantly influences longevity, morbidity, mortality, disease risk, interpersonal communication, and stress recovery [2]. Despite the lack of a universally accepted definition, emotional well-being can be understood as a holistic, subjective state characterized by feelings of happiness and confidence and a minimal presence of negative emotions, such as depressive symptoms. It includes a spectrum of emotions—energy, openness, enjoyment, calmness, care, and life satisfaction—that are essential for overall well-being [1, 3, 28, 29]. This understanding aligns with the World Health Organization’s [4] definition of health, which emphasizes the importance of complete physical, mental, and social well-being, rather than merely the absence of disease. Thus, assessing emotional well-being involves not only identifying the absence of distress but also acknowledging the presence of positive indicators, such as joy and love.
There has been growing attention to the mental health challenges faced by MDWs. Members of this occupational group often experience various mental health issues, including stress, somatization, anxiety, and depression. Research, particularly from Asia, highlights concerning statistics: 52.5% of MDWs in Singapore reported experiencing stress [5], while 17.6% in Macao suffered from anxiety. In addition, between 10% and 18.2% across different countries reported moderate to severe depression [6, 30]. Key risk factors contributing to these challenges include post-migration stress, loneliness, and a lack of social support [6, 7]. Recent studies [8, 9, 21, 22] have explored the impact of the COVID-19 pandemic on MDWs, highlighting how it has exacerbated and illuminated the social determinants of their vulnerability. The health risks associated with the pandemic have intensified conditions of servitude, indebtedness, and marginalization, leading to increased overall precarity [8] and systemic mental health issues linked to workplace dysfunction [9]. While these studies provide valuable insights, they overlook emotional well-being, which is a crucial component of overall mental health, especially during times of crisis for MDWs.
2.2. MDWs’ Emotions and Emotional Labor
One possible reason for the neglect of MDWs’ emotional well-being is the prevailing perception that, despite their role as care workers, they primarily perform functional and menial tasks [31, 32]. This type of work often requires them to manage their emotions and present a positive demeanor while caring for others, frequently at the expense of their own emotional needs. As a result, the emotional dimension of their work, such as loneliness and a sense of attachment, is often unrecognized and undervalued. Consequently, the physical aspects of their work tend to be focused on, sidelining the critical importance of emotional well-being for overall health.
Scholars recognize two dimensions of emotions in care work: personal emotions arising from care workers’ own experiences and the emotional demands inherent in the care worker role [11]. The latter, referred to as emotional labor by Hochschild [10], involves care workers’ regulating their outward display of emotions to meet job demands, sometimes conflicting with their personal inner feelings. It is to “sustain the outward countenance that produces the proper state of mind in others” [10]. Cultural and social norms impose “feeling rules” that often create tensions between personal emotions and societal expectations, leading individuals to adopt a facade that can be psychologically damaging [10, 12]. To cope, people may use defense mechanisms like emotional manipulation, which, while sometimes necessary, risk devaluing the individuality and dignity of both care workers and recipients, neglecting their genuine thoughts and feelings.
The literature on MDWs’ emotions and emotional labor is relatively sparse. However, several studies have investigated the effects of socioculturally oppressive workplace environments and power imbalances between these workers and their employers [13–15]. For instance, Shi [14] argues that emotions such as numbness and disgust experienced by MDWs are deeply intertwined with power dynamics, reflecting broader national inequalities and discriminatory policies rather than merely personal traits. These studies also indicate that emotional labor serves a strategic function, challenging the perception that it is passive. Ho and colleagues [13] suggest that emotional labor helps live-in MDWs avoid conflicts, thereby protecting their well-being while meeting societal care expectations. This dynamic not only reinforces existing power structures but also allows for acts of resistance. Similarly, Sahraoui [15] posits that migrant care workers actively engage in emotional labor, which fosters care, commitment, and attachment, ultimately contributing to their dignity and occupational identity.
2.3. MDWs in Hong Kong and Structural Vulnerability
In Hong Kong, approximately one in nine households employ a live-in MDW, accommodating about 374,000 MDWs in 2020. The majority of these, around 55%, originate from the Philippines and approximately 42% from Indonesia [18]. MDWs are primarily engaged to provide childcare and care of older people and carry out typical household tasks. Under the immigration regulations, MDWs are restricted to the role of live-in care worker within their employer’s household, meaning they are prohibited from seeking additional employment and residing outside their employer’s residence. While MDWs play a significant role in the lives of their care recipients—often taking on a “supplementary parenting” role in childcare and alleviating the stress of spousal caregivers of older people [33]—they face challenges in integrating into both family and the wider Hong Kong society.
The concept of structural vulnerability illustrates how an individual’s social position affects their ability to navigate power dynamics that influence their health, encompassing both objective structural forces and subjective individual perceptions [34]. MDWs experience compounded vulnerability because of intersecting forms of structural oppression linked to their socioeconomic status, ethnicity, and gender, intensified by labor migration and workplace regimes [35, 36]. These conditions create imbalanced power dynamics, leading to soft violence and heightened risks of abuse and neglect to which MDWs gradually habituate. This habituation and internalization of their vulnerability adversely impacts their health [37]. In Hong Kong, the boundaries between MDWs’ work and their personal life are often blurred because of the intertwining of their living and working environments based on the live-in rule. They endure challenges such as abuse, exploitation, and sexual harassment within their employer’s household, while racial and cultural stigmas further marginalize them in the wider Hong Kong society [38, 39]. Studies indicate that MDWs generally suffer from poorer physical and mental health than the wider population in Hong Kong [40]. The COVID-19 crisis worsened these vulnerabilities, as structural challenges intersected with health threats from the pandemic, pushing MDWs into a state of hyper-precarity [8, 22].
Despite their structural vulnerability, some MDWs actively engaged in migrant organizations and labor rights activism before 2019 [41, 42]. This engagement was enabled by their partial citizenship [43], which, while lacking family reunification rights, formal political rights, and comprehensive social rights in Hong Kong, guarantees freedom of expression, access to information, and trade union membership in accordance with international standards [44]. Their involvement in these organizations was not only empowering but also challenged the assumption that partial citizens are uninterested in integrating into their host communities [43]. Therefore, while acknowledging their structural vulnerability, they should not be perceived solely as economic soldiers [45] whose work involves only functional elements and economic purpose, as this perspective overlooks their agency to foster change and their emotional connections and genuine care in their work [46].
The above literature review reveals that, while many studies provide valuable insights into the mental health challenges encountered by MDWs, the importance of emotional well-being—especially during crises—remains underexplored. The dominant perception of MDWs as primarily engaged in physical tasks often neglects the emotional dimensions of their roles. Besides, oppressive work environments and power imbalances have a significant impact on MDWs’ emotional experiences. Accordingly, this article employs the concepts of structural vulnerability [34] and emotional labor [10, 11] to analyze how intersecting structural forces influence MDWs’ emotional experiences and labor during the AEM in Hong Kong, a period of unprecedented societal crisis.
3. Materials and Methods
3.1. Target Participants and Data Collection
Indonesian MDWs were selected for this study for two reasons. First, there was more media coverage of their situation during the AEM than Filipinos [19], and second, Indonesian MDWs often encounter more challenges, including language barriers and cultural discrimination [39]. Studying their experiences during a crisis offered valuable insights into emotional labor and partial citizens’ emotional well-being. Participants were recruited through Indonesian MDWs’ associations, unions, religious organizations, and the research team’s contacts. The recruitment criteria were self-identification as an Indonesian MDW employed as a live-in care worker for a local Hong Kong family, specifically involving the care of children or older people. Efforts were made to ensure diversity in participants’ experiences and length of residence in Hong Kong. Initially, the plan was to conduct three focus group interviews and five individual interviews. However, the interview strategy was adjusted because of COVID-19 and social distancing regulations. Some participants raised concerns about discussing sensitive topics in a large group. Consequently, four small group interviews comprising three to five participants, nine individual interviews, and three two-participant interviews were conducted with twenty-seven female MDWs (see Table 1). While these participants were responsible for providing care to specific individuals within the family, such as children or older people, their employers were usually the parents of the children or the adult children of the older individual.
| No. of participants | Residence duration in HK | Age | Education level |
|---|---|---|---|
| 27 | Less than 1–5 years: 9 | 21–30: 4 | Primary: 3 |
| 6–10 years: 8 | 31–40: 18 | Secondary: 22 | |
| 11–20 years: 10 | 41–50: 5 | Tertiary or university: 2 |
St. Francis University (Hong Kong) granted ethics approval before data collection, and all participants provided informed consent, ensuring confidentiality. Most interviews were conducted face-to-face, although some were conducted online via Zoom because of COVID-19 restrictions. All interviews were audio-recorded and transcribed. An interview guide was prepared to explore participants’ emotional experiences and perceptions as live-in care workers during the AEM. Semi-structured questions covered four areas. First, participants’ overall experiences and reactions during the AEM. Second, changes in their daily care work and rest day activities during the AEM. Third, their interactions with care recipients during the AEM. Fourth, their interactions with fellow MDWs during the AEM. The interview began with the prompt: “Please share your experiences during the recent AEM and any changes in your daily care work and rest day activities.” All participants were informed about the purpose and content of the interview during the invitation process. They were made aware that some sensitive questions would be asked, and they could stop the interview at any time without negative consequences. Confidentiality was assured. As a result of this preparation, all participants who agreed to be interviewed felt comfortable expressing their opinions. Community interpreters helped to facilitate cultural mediation. During the interviews, the researcher followed the participant’s pace, asking questions flexibly and attentively. The emphasis was on listening, understanding, and fostering a balanced researcher-participant relationship. Interviews were conducted in Cantonese, English, or Bahasa Indonesian, with a community interpreter translating into English or Cantonese. Interviews lasted between 45 min and 2 h, with accompanying notes.
3.2. Data Analysis
Qualitative thematic analysis [26, 27] was applied to the interview transcripts and notes, following Braun and Clarke’s five-step analytic process. First, we read and re-read the data, noting down ideas to gain familiarity. The second step involved generating initial codes, aided by NVivo 12 software. Initial codes included various themes such as lack of communication, fear, absence of rights, danger, family, consulate, employers, conflict, protection, misconduct, and sense of belonging. In the third step, codes were organized into potential themes, and relevant data extracts were collected within each theme. Themes such as emotional work, additional care, economic insecurity, anxiety over reputation, emotional distance, and ambivalent identity emerged. The fourth step involved reviewing the coded themes for coherence with the coded extracts and the dataset, resulting in a thematic “map.” Finally, after refining the themes, overarching themes were defined and named (see Table 2). To ensure trustworthiness, initial findings and analyses were shared with some participants and community interpreters through in-person or Zoom interactions.
| Themes | Overarching themes |
|---|---|
| Feeling fear and anxiety (economic insecurity, “danger,” and bad moral image) | Legitimate and ambivalent emotions |
| Struggling with ambivalent feelings and identity | |
| Taking up challenging caring tasks | Care obligations |
| Additional emotional labor | |
| Resorting to silence | Coping strategies |
| Creating emotional distance | |
4. Results
Our analysis revealed three main themes. First, participants experienced and displayed emotions considered legitimate and appropriate for MDWs in their specific social conditions. At the same time, they struggled with ambivalent feelings and identity. Second, they felt obliged to undertake additional challenging and burdensome emotional work responsibilities during the AEM. Third, they employed silence and emotional distance as coping strategies.
4.1. Legitimate and Ambivalent Emotions
4.1.1. Feeling Fear and Anxiety
Participants encountered fear and anxiety during the AEM about potential dangers, economic instability, and negative moral image. Participants were reminded by employers and fellow migrants about the risks and their limited rights. Employers restricted their movements and rest days, citing the risk of assault or arrest because of their nonlocal status. Consequently, they lived in constant fear and anxiety. Participant 18 recalled her employer’s alarmist remark: “My employer says they will arrest me …I did not go to Causeway Bay [where protests usually took place] anymore, it is dangerous … Yes, I haven’t met friends for a long time.”
[Consulate staff and employers] scare us, saying this and that are dangerous. In fact, if they want to protect us, they should tell us more, what is happening, let us decide for ourselves, let us protect ourselves … I feel that they look down on us, we are domestic workers, we are women, we do not have good education, they think we do not have the skills to understand the information…I am not scared, but I behave like I am scared.
When you are a foreigner in another country, definitely you have to learn a lot of rules…We [our union and the Consulate] both agree that as non-Hong Kong people, we should not involve ourselves in these protests … Hong Kong has kept domestic workers underground … invisible within the political life of Hong Kong. We are only visible in the economic life … why should you risk your own life for other people? … it is your personal choice if you join the protests.
My employer asked me if people gave me money to join the protests. No, I only went there at the beginning, because I was curious … They think that we are poor, if we joined the protest, we are doing [it] for money … I was unhappy hearing this, I could not sleep.
Participants reported fearing for their safety, economic security, and moral image because of messages from employers, the Indonesian Consulate, the Hong Kong public, and co-ethnic individuals. These messages implied that MDWs had no rights to participate in local affairs, could not grasp complex information, lacked self-protection, and protested solely for economic gain. They were expected to remain fearful, maintaining their servitude and submissiveness without voicing concerns. Such messages affected their daily care work, emotional well-being, and social lives, leading to reduced interactions and insomnia. Some participants displayed fear and anxiety to conform to societal expectations, even if they did not genuinely feel those emotions.
4.1.2. Struggling With Ambivalent Feelings and Identity
They [employers] said I should better not talk about it, I don’t have to care about it and know about it … I am a human being, I can also read, I can also watch TV, and also meet with friends. … this is as if I were not a human being …When the AEM started in 2019, I was falling in love with Hongkongers … Hongkongers are my inspiration … When I saw the protesters being arrested by the police, I sometimes cried … I told my Chinese friends, if you go out to join the protest, you have to be careful … I support you and want to go with you, but now I cannot.
Honestly, I feel like I am part of Hong Kong…. We spent most of our youth here, we grew up here … here, we are more aware of things that open our minds, … When you ask if we think we are Hongkongers, in spirit, yes of course, but on paper, we will never be. We are just the minority, the domestic workers, the second class of Hong Kong.
They really discriminate against us in this respect. ‘They’ are the Hong Kong government, the locals, the Indonesian government, and even a great portion of our own community … they say that we are only women and should only do our job … obey the instructions of our employers … domestic workers are humans like everybody else.
In the above narratives, some participants acknowledged their inability to disconnect from Hong Kong despite being MDWs. They questioned their identity during the crisis and unrest, expressing love and a sense of belonging. However, Ana’s detention and deportation served to caution other Indonesian MDWs to suppress their feelings.
4.2. Care Obligations
4.2.1. Taking Up Challenging Caring Tasks
I wanted to go and see [what was happening] … But they [my employers] wanted me to take care of the kids … I prepared umbrellas, masks for protection [against tear gas] because they went there on Sundays …the kids and I watched TV, there was fighting, tear gas, the kids cried.
She was sad for many days, she then begged me twice [to go with her]… I took great care of her [on the street]. It is my job to do so…People on the street [demonstrators] were friendly and helpful. But I had never gone to a demonstration. I did not want it, I did not want other Indonesian people see me.
4.2.2. Additional Emotional Labor
I told the kids that we are a family, so don’t split [with] papa and mama …I talked to her [the mother of the family]: you work hard for your family [for so long], [now] why don’t you try to keep harmony in the family [in such situation]?
One of them is for democracy, another one for the government, so whenever we have dinner gathering on Saturday, they quarrel … I am very unhappy … I dare not ask … I make so much effort to cook [to make them happy].
In such circumstances, participants managed their private feelings, encompassing fear, curiosity, and disappointment, to create a proper working relationship and a harmonious environment within their employer’s family. Despite not having choices and feeling unprepared for unexpected challenges, most remained committed to their care duties.
4.3. Coping Strategies
4.3.1. Resorting to Silence
Those 360 [grocery shops] were broken up [by protestors], but other shops were fine, why? …they destroyed MTR [underground], destroyed buses, why? … I wanted to know a lot of things but dared not ask … I am your domestic worker, why should I ask so complicated questions, I told myself in this way. So, when they asked me about my opinion, usually I told them that I do not have any idea …shall I ask or not? I am afraid that they would think that I am too nosy, this is not your business.
Besides remaining silent in their workplace, some participants chose to maintain silence among their co-ethnic peers and even family members out of fear of being closely scrutinized by others in the community. For instance, one participant shared: “I do not share with my friends, my families [in Indonesia], no photos, no videos, no words about what we see.”
4.3.2. Creating Emotional Distance
I do not ask, they do not tell me … Once the son was hit by tear gas, when he returned home, I asked how it happened and wanted to help, but he was very rude, told me to go away… Okay I should not ask, [afterwards] I [just] do what they ask me to do.
Usually we [grandma and I] took the bus [to go to the hospital], but the road was blocked, no bus, no minibus… we finally got a taxi. But it was too late [for the medical appointment] …My employer was not happy … honestly, it’s not my fault, because I did not know the road was blocked.
Some working relationships evolved into mechanistic arrangements focused solely on fulfilling assigned tasks and responsibilities. Consequently, emotional detachment and the suppression of emotional expression became an integral part of participants’ work practices. This might negatively affect their working relationships as their work largely depended on emotional labor.
4.4. Discussions and Implications
4.4.1. Emotional Experiences, Impacts, Coping Strategies and Well-Being
Let us revisit our research questions. First, live-in MDWs had distinct emotional experiences during the AEM crisis. They faced negative emotions like fear and anxiety and suppressed their positive emotions, such as their emotional bond with Hong Kong. Some displayed negative emotions despite not genuinely experiencing them, simply to conform to societal expectations. Second, MDWs had to handle additional care duties and perform additional emotional labor to provide comfort and maintain harmonious relationships while suppressing their own emotions. These experiences impacted MDWs’ self-perception, social connections, and mental well-being, leading to reduced social interactions and sleep difficulties. Third, silence became participants’ primary coping strategy, with some using emotional detachment to protect themselves. For some, work relationships became more task-oriented, suppressing emotional expression.
These emotional experiences can be framed as emotional dissonance [10, 50], which describes the conflict between expected emotions and an individual’s genuine emotional state. Our participants primarily relied on emotional detachment as a coping mechanism to navigate the AEM crisis and fulfill their expected caring roles within their employer’s family, driven by the fear of losing their work residence. However, this reliance, especially in the absence of support, can be detrimental [10], resulting in unresolved emotional burdens and long-term psychological issues. Such coping strategies neglected MDWs’ own feelings, diminished their value, and ultimately impacted their mental well-being. This research corroborates the findings of several recent studies, underscoring the overlooked health and mental well-being of MDWs in Hong Kong, especially in a time of crisis [22]. Notably, MDWs generally experience worse physical and mental health than the general population in Hong Kong [40]. Our findings highlight a troubling paradox: while MDWs were expected to offer extra emotional support and care during a time of crisis, their own emotions, including some positive ones, were frequently dismissed, effectively treating them as expendable essential workers [51].
4.4.2. Intersection of Structural Vulnerability and Risks Induced by AEM
Our findings suggest that the unique emotions and emotional labor experienced by participants during the AEM were not solely results of personal characteristics. Instead, they were influenced by some perceptions (such as MDWs were the “second class”) deeply shaped by the intersection of MDWs’ structural vulnerability and the AEM, placing them in an increasingly precarious position during the sociopolitical crisis and limiting their previously exercised agency as partial citizens.
Originating from a lower-income country and possessing partial citizenship in Hong Kong, Indonesian MDWs are expected not to integrate or form genuine emotional connections within the receiving society [43] but are often seen as solely driven by economic gain. Indonesian individuals, stereotyped as having lower education and cultural understanding [39], were presumed to be incapable of comprehending complex information such as that related to the AEM. In addition, as female live-in workers, they faced expectations to fulfill gendered care obligations whenever it is needed. These structural factors (partial citizenship, obligatory live-in regulations, socioeconomic status, gender, and ethnicity) contributed to MDWs’ structural vulnerability, already positioning them at the bottom of the social hierarchy [35]. When the AEM occurred, MDWs’ initial curiosity and sense of belonging in Hong Kong were quickly discouraged and suppressed. They internalized and justified the belief that, as “second class” individuals, they should display fear and indifference rather than interest and concern. In response, they adopted silence and emotional detachment as coping strategies. Even MDWs who once felt empowered by social and labor activism [41, 42] began to fear losing their work and residency status if they did not conform to the expected feelings and silence. This fear was exacerbated by witnessing a fellow MDW being deported and recognizing the potential for unforeseen sociopolitical consequences for many in Hong Kong [19, 52]. Our findings resonate with recent studies on the impact of the COVID-19 pandemic crisis on MDWs [8, 9, 21], indicating that COVID-19 has worsened their conditions of servitude, indebtedness, and marginalization, resulting in heightened precarity and mental health challenges. Although these findings in crisis situations are not surprising, they remain deeply troubling because they contradict global initiatives aimed at promoting equitable health (SDG 3) and decent work for all (SDG 8).
4.4.3. Practical Implications
MDWs are one of the most disadvantaged and underserved groups in Hong Kong. While the Hong Kong government acknowledges the importance of support services for caregivers and expresses its commitment to introducing more measures [53], the term “carer” primarily refers to family members providing informal care. This perspective overlooks the contributions of the occupational group of live-in MDWs, who not only support informal caregivers but also provide essential care directly to those in need. Moreover, mainstream health and social care services do not consider MDWs eligible for government-subsidized support or adequately address their health issues and mental well-being [54], probably because of their partial citizenship status. Consequently, there is a significant gap in the current health and social care framework regarding MDWs.
Given that mental health risks faced by MDWs are fundamentally rooted in unequal power dynamics and structural vulnerability, it is essential to recognize that promoting and intervening in mental health (encompassing emotional well-being) must attend to these structural factors and social determinants of health. Therefore, it is vital to address issues such as migration and employment policies for MDWs, including deportation regulations, live-in regulations, the blurred lines between work and rest, exploitation, abuse, and the racial and cultural stigmas that intersect to exacerbate MDWs’ mental health risks. In addition, proactive measures should be taken to prevent the marginalization of MDWs within the existing health and social care systems. Without addressing these structural issues, the emotional well-being and mental health of MDWs will remain stagnant. In addition to these structural factors, interventions should also be implemented at the meso- and micro-levels within the community. For instance, health workers and social workers can provide training in mental health self-care, including emotional well-being in the workplace and creation of peer support networks among MDWs. At the micro-level, social workers and community organizers should engage in meaningful dialog with MDWs, demonstrating cultural sensitivity and building strong relationships to help them navigate mental health challenges. Furthermore, emotional support services tailored to their specific needs should be made readily available. It is crucial to involve employers of MDWs in this process to enhance their understanding and support for MDWs. MDW associations, unions, and religious organizations are encouraged to take initiative in the process or be collaboration partners to ensure that culturally appropriate approaches are adopted.
5. Conclusions
This study is subject to limitations. First, its focus was confined to a specific group of MDWs because of funding and time constraints. Therefore, the generalizability of our findings is limited, given the exploratory nature of the study. Second, the limited funding and time also restricted the inclusion of additional stakeholders in the social care system, such as health workers and recipients of MDWs’ care, thereby narrowing the scope of our analysis. Nonetheless, this study contributes to scholarship and social care practice. First, it enhances the existing literature by exploring the interplay between mental health, emotional well-being, and emotional experiences during times of crisis—an area that has received limited attention. Framing MDWs’ experiences through an emotional lens reveals the complexity of their work life, which encompasses not only physical labor, functionality, and economic purpose but also emotions, a sense of belonging, and ambivalence [31, 32, 46]. This perspective underscores MDWs’ humanity and highlights that disregarding these emotional dimensions can adversely impact their emotional well-being and mental health. Second, this study emphasizes how the unique emotional experiences of MDWs were shaped by interlocking oppressive social positions and the AEM crisis. It aligns with existing literature by underscoring the critical need to tackle structural factors and social determinants of health [9, 21, 36, 55]. This perspective offers valuable insights for social care practice, urging practitioners to account for these structural influences while working with community and individuals. Failing to do so could undermine global efforts to promote health equity (SDG 3) and inclusive employment (SDG 8).
Conflicts of Interest
The authors declare no conflicts of interest.
Funding
The authors acknowledge the Public Policy Research Funding Scheme that funded the present study (SR2020.B23.002).
Acknowledgments
We thank the research participants for sharing their views and stories.
Open Research
Data Availability Statement
The datasets presented in this paper are not readily available because of confidentiality; only part of the dataset can be accessed upon request. Requests to access the datasets should be directed to the first author at [email protected].
