François Génin co-founded Voisins & Soins (Neighbours & Care), a French nonprofit that accompanies people living their final months and days at home. Small teams combine healthcare professionals and trained volunteers to provide holistic end-of-life care within a person’s home, while also providing respite and support to their loved ones.

Since The Fifth Wave was born, I’ve been wanting to write about how a care society would transform the way we experience grief and the way our institutions respond to death. Finding out about the profoundly important work of Voisins & Soins further cemented this. Theirs is a French model inspired by an experiment that started in India, being integrated within the national palliative care system, and whose success rests on proving that community-based care which centers human relationships and dignity as much as it does medical outcomes is both desirable and affordable.

It perfectly embodies our mission to highlight global innovations in caregiving that can be adapted and scaled anywhere people need good care — which is to say, everywhere. I hope it will inform those who wish to learn more about caring for those at the end of their lives, the problems it raises and how to approach them. And who knows, it might even inspire one of you to start their own local version of Voisins & Soins, the way a similar article inspired François to begin his journey.

How did Neighbours & Care begin?

In the richness of human connection I experienced around the end of my father-in-law’s life. We were very close.

He was fortunate enough to spend the last three weeks of his life in a remarkable palliative care unit: the Maison Médicale Jeanne Garnier. After ten years marked by serious medical episodes, this gave him — and us alongside him — the space to shift almost imperceptibly from constantly fighting the disease to a very different posture. He was able to live that time having accepted that it was his last.

This was made possible, for one, by highly skilled palliative care professionals managing his symptoms and providing appropriate pain relief. And it also owed a great deal to the profound humanity shown by both those professionals and the volunteers who took turns at his bedside.

I was deeply moved by what he went through, and by what we experienced around him. There were tears, but also so much warmth. And laughter. A blend of sadness and depth that speaks to the full human intensity that can characterise the end of a life.

This is how I discovered palliative care, in 2013. Once I had come through my grief, I began looking into it more closely. In 2015, the annual report of the Cour des Comptes, France’s public spending regulator, described access to palliative care as still deeply insufficient, covering only a fifth of the need — despite the fact that around 64% of people who died around that time were likely to require it, according to the National End of Life Observatory.

Today, as the population ages, needs are growing significantly. Public statistics forecast an average of more than 790,000 deaths per year in France from 2044 onwards, whereas between the 1970s and the end of the millennium, that figure was closer to 545,000. Coverage has improved since 2015, but not proportionally to that increase. Within ten years, at least 200,000 people will not be supported, or not adequately supported at the end of their lives.

It was a shock for me to realise that so many people could not access the great care we had experienced. Yet I couldn’t quite see what I could do, being neither a doctor nor a nurse, and not even working anywhere near healthcare.

One day, while looking at what was happening abroad, I came across a “quality of death” ranking by The Economist. It showed that inadequate palliative care coverage is a global reality, and one that is all the more glaring in emerging countries.

The study notably detailed the Neighbourhood Network in Palliative Care, an initiative of the Pain and Palliative Care Society (PPCS) launched by two doctors in the Indian state of Kerala. Having spent several years accompanying people at the end of their lives in clinics, M.R. Rajagopal and K. Sureshkumar had observed both the great human value of this work and the impossibility of scaling it nationally. It was simply not financially achievable.

They therefore devised an experimental model grounded in the observation that, outside the roughly 10% of medically critical situations for which the hospital is the right response, death is not primarily a medical problem. It can perfectly well be handled at home, by drawing on the dense networks of solidarity that exist within local communities.

The two clinicians went out and canvassed every actor likely to contribute to such a mobilisation: neighbourhood organisations, solidarity groups, Communist Party cells, all religious denominations, municipalities.

Within a decade, 10,000 volunteers had been trained. The PPCS approach obviously included a medical component — but the key was inverting the paradigm. Rather than inserting volunteers into a medically-centred framework, it anchored a medical component within a grassroots mobilisation.

For 10,000 volunteers, the network had 400 healthcare workers, doctors and nurses — that is, 25 volunteers for every healthcare professional. In France, after forty or fifty years of palliative care development, the ratio stands at 10,000 healthcare workers for 6,000 volunteers, mostly operating in hospitals and care homes. By contrast, the Indian model’s local dimension makes it far more oriented towards home care.

I began thinking about how to adapt the model to the French context. According to the then head of oncology at the WHO, Dr Jan Stjernswärd, it is not only the best model for emerging countries but the only one with which Western countries can aim for reasonably decent coverage. It costs considerably less, and it keeps people whose situation is well-suited to home care from going to the hospital out of a lack of alternatives.

I set about adapting it in 2015. This mattered because the relationship to the body, the place of medicine are not the same in France — in India, volunteers are trained to bandage wounds, for instance, something that here is reserved for professionals. My ambition was that this approach, without contradicting what already exists in palliative care, could complement it and offer a form of support oriented towards the home, rooted in a mobilisation of civil society at the local level.

How do the Voisins & Soins teams work?

They are neighbourhood teams (in rural areas, they cover a few villages each) of around ten people. They include on average seven volunteers who commit to half a day per week, a doctor for half a day, a nurse for 1.5, and a psychologist for a few hours. At the scale of a town, we need a minimum of two teams, ideally three, which allows us to accompany 40 to 50 people per year for an average of four months each.

This human-scale composition allows for the experience of professionals and volunteers alike to be meaningful and lively. That is the starting point for everything else.

Team life takes shape through a weekly coordination meeting — the equivalent of a medical staff meeting. Its primary purpose is to foster a team spirit, because we do not have the natural cohesion that a shared workplace like a hospital provides. Our teams are always actively caring for five people at any one time, and each one involves the whole team: we never entrust someone to a single person. The meeting is a moment of exchange so that everyone is on the same page, in a logic of shared responsibility that encourages collective intelligence.

Why is this shared responsibility so important?

It’s the heart of our organisational culture.

Palliative care encompasses four dimensions: the medical, of course, but also the psychological, the social, and the spiritual. This last one involves welcoming the metaphysical questions that death inevitably raises, about life and what comes after it. Some lean on a religion for this; others do not, but the questions arise nonetheless. It is important to make room for them.

These four dimensions are intimately connected. Many people in palliative care suffer from anxiety or sometimes severe depression, and these conditions can lead to up to twice the level of medical care consumption, and significantly increase recourse to emergency services.

Because of this interplay, it is essential to build a management culture that allows medical and non-medical skills to work together smoothly. This is not self-evident: it’s not easy for a volunteer to speak up in a team meeting after the doctor, and to feel fully legitimate in what they bring.

So from the outset, we chose to build our teams around a non-hierarchical approach, inspired by the Dutch home nursing model ‘Buurtzorg’.

Rather than having a leader who feels responsible for a person’s care, everyone is on an equal footing. Psychological support is valued on the same basis as medical care, so volunteers do not feel superfluous. In a hospital, volunteer organisations slot into an existing institution; with us, everyone belongs to a single structure.

This shared responsibility encourages a high dedication from everyone, and fosters a culture in which each person has the opportunity to give their best. It will also be crucial when the time comes to scale the model: there will be no need to find, for each team, a “super manager” capable of making healthcare workers, psychologists and volunteers work well together.

Close ties between healthcare workers and volunteers are also an essential prerequisite for good home-based care. Without coordination with the healthcare workers, volunteers cannot verify that symptoms and pain are actually being managed, and so cannot play their role properly. We would be sending them into poorly managed, deeply distressing situations. In a hospital, you only need to step into the corridor to find a nurse or a doctor; at home, this has to be thought through ahead of time.

In the same way, the presence of volunteers transforms the working conditions of healthcare workers. Bringing your medical expertise to a complete care situation where the other dimensions are already handled is a very different thing from being a GP on whom everything rests, from physical pain to the most intimate fears.

In a 2011 study, 70% of doctors surveyed expressed personal distress at the prospect of accompanying their end-of-life patients at home alone. Another found that 50% of doctors and 80% of nursing assistants feel uncomfortable when faced with questions from a palliative care patient. In a team, even with all the empathy they bring, they do not carry this alone.

We have some very moving testimonies of what this brings to volunteers and healthcare workers alike. I’m thinking in particular of someone who was going through workplace harassment. After a year, she told us that the weekly Voisins & Soins team meeting — where she knew she would experience something humane, intense, healthy, and reliable — had allowed her to hold on.

That quality of life within the team flows into the quality of the care itself.

In practice, does this always work smoothly?

There can be difficulties if team members have not been sufficiently trained. This is not a very natural organisational culture in France — people readily defer to a leader.

There is an ongoing exchange with the field so that horizontality becomes natural and lasting. It is painstaking work! Encouraging flexibility requires a sufficiently clear and structured framework, and training people in how to put its principles into practice.

The personal care sector suffers from high turnover rates. Do you manage to sustain volunteering over the long term?

Our turnover is low. Many volunteers have been with us since we were founded in 2017, and those who leave do so mainly because of a move or a change in their professional life — rarely out of weariness with the work itself.

The local dynamic contributes to this: organising in support of national-level issues is simply not the same as caring for people in your own neighbourhood. Many also get involved for reasons tied to their personal history — they experienced a relative’s final days in a peaceful way and want others to live it that way too, or conversely, they had a poor experience and want to offer others something better.

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In May 2025, it was announced that Voisins & Soins will be piloted for scaling purposes under Article 51, France’s healthcare experimentation program. What does this entail?

The opportunity has been validated, and a period of co-development is needed before it officially begins. In practice, we will continue to operate normally, but under the watch of the Ministry of Health and public health insurance authorities. The aim is to assess the quality of the service, its efficiency, and its reproducibility.

The pilot will look in particular at what we bring to the person at the end of their life and to their loved ones, as well as to the local medico-social ecosystem through avoided hospitalisations. A social impact study of our approach recorded a 66% reduction in hospitalisations during the period of care compared to national averages. These figures make a strong case for the model: not only does it improve the quality of end-of-life care, it also lightens the load of hospitals and the financial burden on the state.

Indeed, for the end-of-life trajectories our model supports, a hospitalisation costs between 600 and 650 euros per day, whereas our care costs less than 300 euros per week. This includes paying healthcare staff, recruiting and coordinating volunteers, and local outreach to make sure people know about our service.

That outreach enables early intervention: our care lasts an average of four months, whereas most overstretched home palliative care services today last one month on average. This is problematic because the significant rise in hospital use, as well as the emergence of practical and existential questions tend to occur four or five months before death.

There is therefore a strong case for starting early. It allows for genuine relationships to develop, for us to have a real impact on those we support and their caregivers, and to maximise our contribution to the health system.

Why is supporting family caregivers central, and how does it work in practice?

I remember my mother-in-law at the time when my father-in-law was still being cared for at home. She was on call day and night.

This reality has direct consequences on the physical and mental health of caregivers. According to a 2015 national study, over a third of seniors living with a dependent person are in a state of psychological distress. Caregivers become exhausted over time, especially when their care extends over a long period. Supporting them is essential.

So we make ourselves available throughout the entire end-of-life period, and afterwards as well. Visits do not stop at the moment of death. We are also in contact with local bereavement support organisations, because we are neither trained nor structured to provide this ourselves.

It’s important for the various actors in a given area working around end-of-life care to know one another: our teams, bereavement workers, hospital palliative care services, funeral services. This currently happens on an ad hoc and informal basis, but we are thinking about formalising this joint work, in the logic of “compassionate cities“. It’s a model that has yet to really emerge in France but exists in other places: cities that aim, under the auspices of the municipality, to bring together relevant actors so that the end of life ceases to be a taboo hidden behind hospital walls. To bring it back into the heart of the city.

We are pleased to be launching a pilot in this direction with the city of Asnières-sur-Seine.

You highlight this taboo in your manifesto: “Our modern societies are marked by the erasure of death as an essential reality.” Part of your mission is to “repatriate the reality of death into the field of life.”

Do the people who gravitate around the project develop a different relationship with death?

That is what they report. I’ve experienced it myself: death is a reality we don’t necessarily want to face, but which, when one decides to look at it, gives life a particular depth.

The Greek philosophers already said as much: memento mori, the invitation to think of death from the moment one wakes as an invitation to live fully. The more we face this reality, the more it draws us towards what appears most essential towards the end of a life.

At the scale of a city, this effort to break the taboo around death is equally valuable. We sometimes go to local schools to talk about death: when a grandparent or someone close dies, teenagers do not always have the opportunity to put words on what they went through, and being able to do so can be truly liberating. Teachers also report that the collective sharing of vulnerability transforms the atmosphere of the class.

Have you cared for young people at the end of their lives?

The youngest person we cared for was around fifteen. It was of course extremely painful — for him as well as for his parents, who were exhausted; he had a neurodegenerative condition, it had been a long journey.

But it was also an extraordinary time. A strong relationship developed between the whole family and the team. His classmates were able to come and see him: he had had to step away from school for several years because of his illness, and rebuilding those connections was very meaningful. He also benefited from biographical work: a professional writer came to gather his thoughts, the story of his life. It was powerful for him to be able to express himself that way, and for his parents to have that precious record to keep.

Your work is part of what is often called the “shift to home-based care” in response to a growing crisis in availability of hospital-based services. Do you encounter difficulties related to the material or family environment of the home?

It is never an insurmountable obstacle.

For one, we are a third-party actor, coming free of charge, which helps avoid some of the potential friction. And our presence often makes it possible to manage difficulties that the person or their loved ones could not handle alone. For example, we once supported someone suffering from Diogenes syndrome, i.e. a hoarding disorder: the team helped clear the space so that a medical bed could be installed. It’s very prosaic, but it transformed the situation. It made home care possible where, in a conventional context, it would not have been.

We also experienced a situation where the wife of a man we were caring for was very anxious about being alone at the moment of her husband’s death, particularly at night. As the moment drew closer, we encouraged her to tell her husband about her fear, to ask him not to die before the nurse had returned. One of the volunteers also offered to sleep on the sofa.

And in fact, though he was no longer really conscious, this man died in the early morning hours, a few minutes after the nurse had arrived.

Finally, the question I ask all my interlocutors: who do you care for, and who cares for you?

I am myself a member of a team, though I have been less present these past few months due to an excess of work. In that context, I take care of the person approaching their death, while feeling grateful to them for welcoming me at their bedside during such an intimate time, when life’s most essential questions present themselves.

This care circulates in such a way that it becomes difficult to know who is taking care of whom. What we live through draws on a human depth that comes as much from the person we support as it does from the team that makes it all possible.

And in a more personal sense, the answer to your question is my wife, Sophie. She made this whole adventure possible, the day she said yes.

Read on:

What is a good society?

Whatever one’s political positioning, any answer to that question must grapple with two central matters: protection, and punishment. Who does a good society protect? How? Does it respond to violence with punishment, and if so, by what means? What is the central purpose of punishment: preventing further harm, or addressing a perceived injustice by inflicting proportional harm? And what of the purpose of protection: is it to shield individuals from being on the receiving end of violence, or does it go further, setting out to equip them with what they need to flourish?

Around those questions emerge political and ethical fault lines. Everyone sees themselves, often in good faith, as protecting certain values or groups — but who to protect, what from, and by punishing whom are where camps start to form. It is pretty consensual, for example, that a good society prides itself on protecting its children: but from what? Widespread sexual abuse at home, or being taught about sex at school?

Progressive accounts of the role of the state emphasise its responsibility to nurture, to create the necessary conditions for individuals and communities to thrive — or, at least, to grant those disadvantaged by their circumstances no less of an opportunity to try. Conservative accounts point to the state’s role in preserving the social order, notably through the punishment and/or removal of those perceived to threaten that order. It’s the inevitably gendered “Mommy-Daddy divide”, it’s ‘hugs not bullets’ versus the ‘war on drugs’.

Notions of protection and punishment are uniquely effective rhetorical tools because they immediately trigger our moral heuristics — the cognitive shortcuts we use to make rapid ethical judgments. Protecting the innocent is good, letting the guilty run free is bad. At least until the advent of post-carceral societies, achieving one typically calls for doing the other: protection and punishment are inextricably linked. Different political forces simply make different cases for who to place in different categories: those who need protecting; those who protect; and those who must be punished.

Problems arise when we are confronted with the fact that these categories are deeply permeable.

For example, we might realise that those we’ve always painted as protectors — the ‘good family men’ — are perfectly capable of predation. #MeToo triggered a societal shift of planetary magnitude precisely because it flipped on their heads our traditional categories of respectability and abuse. That shift was then met with immense anger, as is customary any time an “old idea system from which the energy is gone but which has the heaped-up force of custom, tradition, money, and institutions behind it”, as Adrienne Rich brilliantly put it, is questioned.

That old idea system so begrudges any attempts to dislodge it that it has an unfortunate tendency to protect those who commit harm, and punish those who ask for protection. In 2025, the European Court of Human Rights condemned France for “secondary victimisation” during a trial for sexual assault; the defense lawyers had treated the woman who came forward as if she was herself guilty. Last month, the ECHR issued another condemnation, regarding a case where a French court gave a formal warning for libel to a young girl whose rape case against a classmate was dismissed.1 Ask the state to protect you, they say.

Going back to our categories, we might also realise that those who we have declared must be punished turn out to need care. This presents another unwelcome blurring of boundaries, which usually results in our desire to punish being stronger than our responsibility to protect. This was evident with the recent news that UK prisons are still handcuffing and shackling women who give birth while in detention, among other grave human rights violations recorded by the Birth Companions charity.

Finally, perhaps most damningly for the credibility of our institutions, we might realise that among those we punish is an over-representation of individuals we failed to protect. Incarcerated women are extremely likely to have been victims of domestic violence, and by extremely I mean basically guaranteed. Children who went through foster care are much more likely than their peers to end up in prison. And though clear research is still scarce, roughly a third of incest victims (which as a reminder concerns at least one in ten people worldwide) were abused not by an adult but by a fellow child, themselves often victims of incest by an older relative. Cycles of abuse and victimhood intertwine in ways our neat categories cannot possibly capture.

Now, the state is not exclusively responsible for the violence that takes place in people’s homes: but it is responsible enough to put into question its monopoly on punishment. Indeed, how legitimate are our justice systems if they primarily function to palliate our failures of care?

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The ethics of care offer a transformative new way to approach these failings. As an ethics of the particular, they force us to understand the complex and specific circumstances that surround human behaviour, rather than applying blanket logics.

Thinking about protection and punishment through the lens of care yields at least three very important shifts:

One, needing protection — and vulnerability more broadly, though not all vulnerability calls for protection — is neither a moral failure nor an injunction to passivity. Our societies treat deviations from the norm of being male, white, able-bodied, autonomous and economically productive almost like offences: ‘it’s a bit annoying that you’re having children, not great for company finances’; ‘it’s a shame you’re being abused, sure you aren’t a little responsible?’; ‘it’s too bad you’re homeless, but could you not sleep on that nice bench?’. By showing vulnerability and interdependence to be universal features of the human condition rather than anomalies, care ethics seek to address the enduring stripping of agency that still comes with receiving care. The title of a recent piece by anti-ableism journalist says it all: “Will you please treat me like a person?”.

Two, relatedly, being in a position to protect others is not an invitation to dominate. It is, rather, a responsibility to put one’s abilities at the service of others’ needs, building with and for them. As philosopher put it, “asymmetry doesn’t automatically create hierarchy”. The spaces most meant to welcome vulnerability — schools, hospitals, nursing homes, maternity wards — will not stop being spaces where harm is perpetrated against those who seek care until they shed this paternalistic attitude. All the empowerment in the world cannot make a labouring woman’s dignity be respected, be she imprisoned or not, if the people in charge of assisting her are not inherently convinced of her equal humanity2.

Three, having caused harm does not strip one of their right to basic protections. In progressive spaces, rejoicing at countries who introduce the death penalty for pedocriminals or joking about animal testing on rapists because “what are they going to say, no?” is counter-productive. It is merely indulging a deep-seated and understandable desire for vengeance, but it is not practically helping to protect anyone. It also once again flattens reality into ill-fitting boxes, omitting the fact that people have complex relationships even with those who abused them — something that an ethic of the particular does help to take into account.

These shifts all boil down to one overarching horizon: moving from a logic of control to a logic of care. The latter logic doesn’t entirely eschew the possibility of punishment, which can still be necessary. But it treats punishment as a mere means to the central end of protection, rather than a goal in itself; and as only a legitimate one if the avenues of prevention and care have been meaningfully invested in.

That might sound naïve to our ears trained on centuries of punitivism. But it is, in fact, the more rational way to do things. In an interview with Le Monde about former French prime minister Gabriel Attal’s proposal to harshen the sentencing of youth delinquency, historian of childhood and youth Véronique Blanchard said:

“We are witnessing a form of irrationality, decorrelated from all statistical and sociological reality. Like magical thinking. But what we don’t hear as much is that the history of repression and punishment when it comes to youth delinquency is much longer than the choice of education and protection (...), and it has never worked. Our society could make another choice, that of support, education and time. As a former educator, I know how much that allows children to find their place in society and to accept its rules.”

We can choose the logic of care. Millions of people already do, in their thinking, their practice, their activism. We can choose a future that does not throw around vague calls for more “security” for political clout without actually committing the resources that keep people truly safe.

This choice is not a simple one: care is the opposite of the easy way out. It crumbles under any attempt to make broad, sweeping statements; it is not readily grasped through number-crunching. And as Rich said, the logic of control has the weight of centuries propping it up. But it is a choice we can make, and one that has the potential to radically transform how we exist with one another.

Dear all,

Apologies for skipping last month’s letter. These have been intense weeks for a variety of reasons, including a peculiarly human mix of grief and joy, a lot of auntie-ing, and an overdue restructuring of my professional life. But then our April decided to masquerade as July, and Paris now stretches its legs out on the terraces, apricot juice in hand. All is well.

In practice, this restructuring means the care think tank I’ve been working towards — now Cara, soon-to-be a registered nonprofit — will focus on advancing the care society specifically in France, through previously mentioned research and ground action projects. This newsletter, The Fifth Wave, will remain what it has been: a space to imagine a future where care sits at the heart of our lives and our cities, and to explore the transformations needed for caregiving to get the support and recognition it deserves.

I spent a while making sense of the above thoughts, as I considered how the control-heavy ways in which our societies approach protection and punishment limit our ability to develop true logics of care. I hope they resonate — your reflections are always welcome, don’t hesitate to share them.

Finally, on the topic of exiting logics of control in relationships of care, I highly recommend ’s posts about authoritative parenting (and all of her writing, really, it is always deeply thought-through and leaves one looking at the world in a refreshed way.)

Thank you as always for being here,

— MM

Despite the critical role that caregiving plays in our societies, it is extremely difficult to meaningfully embed an ethos of care into a country’s school system. Transmitting relational skills is still commonly thought of as the job of parents, not institutions, creating great public resistance to approaches perceived as values-based education.

As a result, school boards and ministries tend not to prioritise it when designing how children learn. Pressures to reach standardised benchmarks make achievement and performance the highest goods in the classroom, while meaningful relationships, collaboration, and deep learning take a back seat.

Yet whether it admits it or not, every curriculum is a moral and relational project. Students do pick up the norms inevitably modeled for them in school — known in social science as the ‘hidden curriculum’.1 When schools aren’t intentional about transmitting positive values, children are more likely to adopt what is modeled for them: hierarchical, competitive, transactional, and domination-based understandings of relationships.2

Profound opportunities for change exist within countries’ early childhood education (ECE) curricula. A child’s first few years of life are some of their most formative, helping shape the kind of friends, neighbours, parents, caregivers, and citizens they will grow up to be. For societies looking to build a care-forward future, ECE — which runs from birth until compulsory primary school age, usually ages zero to five — is a prime environment to nurture a caring citizenry. Making this shift, however, requires reframing care as an essential pillar of educational infrastructure.

Implementing a pedagogy of care

Widely considered a leader in ECE, Aotearoa New Zealand’s ECE curriculum, Te Whāriki (pronounced Teh Fah-ree-kee) stands out as uniquely designed to support a care-oriented society. Established as the country’s first bicultural ECE in 1996, it embeds Indigenous Māori language and epistemology into everyday learning, aiming to foster a mutual sense of care and belonging amongst the country’s next generations.3

Its very name reflects this: a whāriki is a traditional woven mat meant “for all to stand on”, with different perspectives, goals, and Māori concepts woven in to support children holistically. The whāriki metaphor invites recognition that “care and education are inseparable concepts”.

“These Māori concepts suggest that caring for and about infants and toddlers is more than meeting their physical needs,” the official curriculum explains. “It involves establishing warm connections that foster each child’s sense of belonging, well-being, and identity, and [encourage] their connections with the natural environment.”

Māori are the people indigenous to Aotearoa (now commonly referred to as New Zealand). Like many Indigenous Peoples throughout the world, Māori communities have been economically, socially, and politically marginalised, dislocated in cultural identity and heritage.4 They continue to suffer disproportionately from human rights violations today.

The development of Te Whāriki began in the 1990s on the heels of two decades of political activism from a generation of young Māori fighting to prevent the engineered decline of their language and culture — a movement later labelled the ‘Māori renaissance’.5 Te Whāriki sought to respond to the “lack of educational success for tamariki [children] Māori, the increasing privatisation of early childhood education, and the lack of acknowledgement of multiple cultural perspectives”. Research suggested that Māori students whose schools taught in the Māori language and followed Māori principles substantially outperformed their peers in mainstream schools.6 The New Zealand government thus began efforts to integrate more of their philosophy into education.7

To build the curriculum, the Ministry of Education worked closely with the Te Kōhanga Reo National Trust, an organisation revitalising the Māori nation. Its development involved several years of discussions and working groups before a team published the curriculum’s first iteration in 1993. The draft was shared with all early childhood training providers, organisations, and centres for trial and feedback before the official curriculum went into effect in 1996.

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Nurturing reciprocal relationships

It is widely accepted in ECE that relationships are central to a young child’s life. However, the role of relationships in Te Whāriki differs from that in traditional Western curricula.8 Their guidance states that children “learn through responsive and reciprocal relationships with people, places and things”, and places real value on what children can teach adults, not just what adults can teach children.

“In reciprocal relationships (...) both kaiako (teacher) and child take on multiple identities as care-givers, care-receivers, and self-carers at different times”, the curriculum explains. This is demonstrated when “a toddler runs to a kaiako with a bandaged finger and asks what happened, while stroking the bandage, [or] a kaiako [openly] asks a colleague to step in to support them with a crying infant.”

This reciprocity is closely tied to the Māori concept of “aroha”. Commonly translated to “love” in English, Māori communities explain that it is more complex than this one-to-one translation suggests. “Aroha” better embodies a reciprocal sense of connection and belonging to all life.

Embedding aroha in ECE takes many forms. For one, it means involving children’s whānau tangata (family and community) closely in their education. Educators are encouraged to get to know a child’s family by regularly holding informal conversations with them, visiting their homes, and approaching their relationship as a personal connection instead of a client-provider one. Schools also make an effort to be more than a children’s learning environment, offering services like emergency food relief and family support programmes.9

Te Whāriki emphasises that “children are more likely to feel at home if they regularly see their own culture, language and world views valued in the ECE setting”, making it “important that whānau feel welcome and able to participate in [day-to-day] decision-making”. Families participate in the school’s self-review process, allowing them to voice their opinions on what is and isn’t working. They are also invited into the classroom to participate in daily activities, and encouraged to get involved in the children’s extracurricular pursuits.10

Children therefore get to interact with all kinds of families, championing not only their own learning but that of others. This relational orientation extending both from and beyond the nuclear family model holds great potential to help children grow into adults who make interdependence a centrepoint of their life.

See also:

Narrative assessments

Mainstream notions of learning are often measured numerically through tiered grading systems and tests with clearly delineated right and wrong answers. Governments usually require measurable proof of progress to ensure the efficacy of a curriculum.

But every educator is familiar with the pitfalls of this system. Benchmarks fail to equitably assess children with different learning abilities and teach them to value grades over authentic learning. This often leads children to cheat, superficially memorise facts just to forget them after the test, and tie their self-worth to their proximity to benchmarks. It can be an inherently dehumanising method of assessment, reducing a child to data points instead of considering their whole person.

Of course, formal grading typically doesn’t start until at least primary school — but even preschool systems can implement some form of success-or-failure assessments, with colour schemes or smiley faces. The Māori system of ECE learning, meanwhile, functions entirely on assessment through narration.

Narrative assessments capture children’s effort, progress, relationships, and emotions over time and in story form. Teachers must take time to consider each child carefully, writing up observations throughout the day. They eventually compile these into portfolios, which can include annotated photos, audio and video recordings, and examples of children’s work. These “learning stories” place value on children’s individual growth, allowing room to consider broader context and provide more holistic support in case of developmental difficulties.

These assessments are often conducted collaboratively with children’s whānau tangata, as equal experts on their children’s strengths and growth. As children get a bit older and more independent, teachers will also encourage them to dictate their own learning stories, set their own goals, and assess their own progress. They will frequently revisit the portfolios with the children, inviting them to recognise their progress and challenges, supporting their ability to honestly self-assess and set goals.

Empowering responsible, relational children

Te Whāriki’s principle of whakamana, or empowerment, aims to cultivate a curriculum that “recognises and enhances [children’s] mana (power of being) and supports them to enhance the mana of others”.

Teachers strive to create classrooms where “children have agency to create and act on their own ideas, develop knowledge and skills in areas that interest them and increasingly, make decisions [on matters relevant] to them”. They regularly encourage children to “discuss their feelings and negotiate on rights, fairness, expectations and justice” in the classroom, helping them think critically about these topics while having their perspectives valued.

Children’s rights advocates argue that strict educational hierarchies “risk alienating (...) students, who may consider it hypocritical to [be lectured] about equality from a privileged position of authority”. If they are to feel like true members of a collective, children need to feel like their input matters. Cognizant of this, Te Whāriki encourages teachers to grant children increased agency in order to nurture a strong sense of citizenship — or a “feeling of belonging to a community, whether neighbourhood, school, city, nation, humanity.”11

One of the ways children practice this is through collaborative inquiry learning, an approach that has also grown popular in other education systems. Carrying group research into a question or concept of their choice helps children “develop the capacity to listen and learn from each other, to negotiate, to sometimes lead, and at other times to compromise”. The approach aims to help them gain “a grounding of respect and care for humans and the non-human”.12

For example, when teachers at Rimu kindergarten discovered that the children were deeply curious about the animal observation tools in their local bush, these became the focus of their inquiry. The children took time each day to refill the ink traps that record animals’ footprints, developing “a sense of responsibility for this space, often initiating picking up pieces of rubbish and removing a common noxious weed”.13

Teachers also communicate to children that their right to contribute is earned. In order to guide others and dictate learning priorities, children must show their ability to accept others’ points of view, empathise, ask for help, see themselves as a help to others, and clearly communicate their ideas. Far from giving children free reign, this strategy teaches them how to navigate differences in a productive, caring way, while also emphasising that agency comes with responsibility towards others.

Scaling pedagogies of care

Today, all licensed ECE services in the country are required to implement Te Whāriki. This includes both public and private daycares, kindergartens, Kōhanga Reo (Māori language nests), home- and hospital-based services. One of the system’s most significant challenges is therefore ensuring consistently high standards while operating at a national scale.

Other ECE approaches with care-forward principles tend to have structures that help deliver steady results. To become a Montessori teacher, for example, one must complete a one–to-two-year postgraduate training. Teachers choose to invest time into learning the Montessori philosophy, making them more likely to effectively implement it.

At a much smaller scale, Bosque Escuela Tena, a school in the Kichwa Tamia Yura community in the Ecuadorian Amazon, won UNESCO’s 2025 Global Citizenship Education Prize for successfully guiding children to protect nature and become guardians of a more just and sustainable future. Not unlike Te Whāriki, the forest school’s Kenu pedagogy weaves Indigenous wisdom throughout its multicultural and multilingual curriculum, “fostering respect for diversity and heritage through creative, hands-on educational activities that nurture global citizenship and empathetic action”. Such an approach is undeniably more easily maintained within a single school.

See also:

But this doesn’t mean that care pedagogies cannot be meaningfully enacted nationally. Sweden is renowned for implementing an ECE system with interdependence at its core. Their preschools aim to help each child “develop a responsibility for (...) sustainable development and active participation in society, [and understand] how people, nature and society affect each other”.14

Unlike Te Whāriki, however, Sweden’s remains a largely monocultural curriculum, despite movements to integrate more Indigenous Sámi culture into schools.15

Framework limitations

To facilitate deployment at scale, Te Whāriki was designed to be flexible. Rather than imposing standardised requirements, it encourages each community to design their own curriculum with Te Whāriki’s principles in mind, responding to the identities, interests, and priorities of children and families.

Two schools in West Auckland, for example, found that many children had burgeoning interests in raising animals, as many of their parents were farmers and gardeners. Teachers therefore made animal lifecycles a pillar of their curriculum, introducing tadpoles and chickens for the children to raise in the classroom.16

Though well-intentioned, this flexibility brings up numerous practical challenges, particularly when it comes to its biculturalism. While some have praised the curriculum for allowing teachers to be more responsive to children’s inquiry17, others have argued that “it does not give sufficient guidance on [how] to realise a truly bicultural curriculum in practice”.18

Only one-tenth of early childhood teachers are Māori, and many of the remaining educators have reported not understanding enough Māori language and philosophy to effectively integrate them into their classrooms without greater guidance. This has placed extra pressure on Māori educators to step in, as non-Māori educators often seem to lack the motivation to learn the language and culture themselves.19 “Our Māori kaiako [are] used all the time by their non-Māori colleagues [as] bringers and teachers of all things Māori — [and] their colleagues don’t even want to learn. This is sad,” commented one educator.

However, educators have explained that they receive little opportunities to become fully acquainted with the Māori language and philosophy. For ECE teachers-in-training, becoming fluent in the Māori language is incredibly difficult during their packed three-year teacher education qualification. “Where do we go to get support for learning te reo [language] Māori? When out on practicum, no one used it. (...) It’s no wonder we don’t,” commented another teacher.

Without teachers and students fully learning te reo Māori and its guiding philosophies, Te Whāriki risks being reduced to mere tokenism — something over half the student teachers interviewed in a 2025 study described it as.20

To address this, Māori communities have recommended a more rigorous training and initiation programme for teachers, including ongoing language training and cultural immersion trips to Māori marae, where teachers can gain critical context and put Māori values of whanaungatanga (community relationships) and manaakitanga (care) into practice.21

“Yes, this does require resourcing and has financial implications. However, if we are to be a bicultural society with effective and meaningful education systems where Māori can succeed as Māori, then this needs to be accounted for within policy budgets,” wrote Williams, Fletcher, and Ma.22

To avoid extractive and tokenistic dynamics between non-Māori and Māori communities, schools must build practices that truly honour the latter’s culture, history, and contributions to Aotearoa New Zealand society. More than representation, being a bicultural nation requires the genuine reciprocity that is supposed to be at the heart of Te Whāriki.

A system under threat

Unfortunately, this reciprocity is being seriously challenged. In November 2025, New Zealand’s Education Minister Erica Stanford removed the requirement for schools to follow Te Tiriti o Waitangi, New Zealand’s founding document that has worked to safeguard the equity, inclusion, and cultural identity of Māori communities for centuries. The document was the basis of Te Whāriki to begin with, and a law mandating its implementation in schools went into effect in 2020.

Revoking this policy now leaves the decision up to schools whether they want to embed Māori culture into their curricula, and to what degree. This change has come with major pushback from Māori communities.

“They are clearly deprioritising Māori and Te Tiriti o Waitangi, te reo [language] Māori, tikanga [practices] and mātauranga [knowledge] Māori from legislation,” expressed Ripeka Lessels, president of the New Zealand Education Institute Te Riu Roa. “We have to challenge this removal. We don’t want future generations looking back and thinking this happened and nobody stood up against it.”

With urgent campaigning from Māori communities, around 70% of schools across the country have publicly committed to continue giving effect to Te Tiriti. However, without government mandates in place, critics worry that inconsistencies in its implementation will cause “significant and irreversible harm to Māori learners and their whānau”.

“Our tamariki Māori have a right to learn about their histories, hear their language and experience their culture,” explained Leanne Otene, president of the New Zealand Principals’ Federation. “Effectively, state schools don’t have to observe that anymore and without a clear obligation, schools will be pressured by extremists to delete Māori from the curriculum in the school programmes. Without accountability, everything changes and the minister knows this.”

Solving for care

This policy shift threatens to undo a lot of the work Te Whāriki has been doing for decades. The curriculum was partly designed with the intention of reducing the achievement gap between Māori and non-Māori students. But forty years on, it is still present, and critics worry it will worsen in light of the removed mandate.

In 2024, only 67.5% of Māori individuals aged 25 and over had attained an upper secondary school qualification or higher, compared to 78.2% of those in the same age group of European descent. And in 2022, 15-year-old Māori students scored an average of 60 points lower than their non-Māori peers on the Programme for International Student Assessment (PISA) — a standardised international literacy test.

The potential reasons for this gap are myriad and complex, likely stemming from broader systemic issues than could ever be fully addressed by any ECE curriculum. Because of course, schools don’t exist in a vacuum: children are shaped and affected by innumerable factors both in and outside the classroom, the home being an especially crucial environment. Care pedagogies can never be truly effective unless accompanied by broader societal change.

In 2022, Aotearoa New Zealand released their first well-being report, which tracks indicators against other Organisation for Economic Co-operation and Development (OECD) member states and is set to be released every four years. It showed some promising trends: violence and crime have decreased since 2000, they have the highest rates of volunteering in the OECD, their over-50 population report the third highest levels of social support, they have the fourth highest levels of weekly social contact, and on average report a higher-than-average sense of life satisfaction. It is also worth noting, however, that Māori, Pacific and Asian communities still suffer disproportionately across many of these wellness indicators.

Any presumed relationship between these trends and Te Whāriki is merely correlatory, as no research has been done to directly investigate it. Indeed, while these well-being reports indicate a positive shift in the way we assess our societies, education is still primarily measured against achievement benchmarks. In policy research, its contribution to the strength of communities, the quality of students’ connection to others and to nature remains marginal.

This highlights an important difficulty in the effort to build pedagogies of care: research on the link between educational approaches and metrics indicative of a care society is scarce, if not nonexistent. Even for the most well-studied alternative pedagogies, like Montessori, we lack consistent data on whether they foster long-term caring attitudes and caregiving behaviours.23

One culprit is the polysemic nature of the English word ‘care’, which can mean many different things: the closest substitute used in research is typically ‘prosocial behaviour’ — including kindness, fairness, attention to and respect for others — captured using declarative methods like interviews and surveys.24 How much one values care professions, or actual units of time spent engaging in community and dependency care in adulthood remain unexplored. Another factor is the expensive and resource-intensive nature of tracking the impact of schooling on these metrics across the lifespan.

Whatever the difficulties, the absence of such benchmarks means care remains largely invisible, and therefore harder to fund. Much remains to be done to pick apart the complex workings of care, if we hope to effectively cultivate caring schools and societies — and understand which systems favour, or hinder, healthy relationships and interdependence.

Based in Marseille, Spina is a journalist, writer, and the founder of media outlet Manifesto XXI. He is the author of Manifeste pour une démocratie déviante: Amours queer face au fascisme [Manifesto for a deviant democracy: Queer love in the face of fascism; éditions trouble, 2023, untranslated], in which he proposes pathways to resistance rooted in the radical power of tenderness and care.

In the below essay, of which a version was originally published in his newsletter, he examines care and its practices in light of his own experience of vulnerability, in the perspective of a left that would make true space for all lives and all bodies.

In 2022, a degenerative disease — scleroderma — upended my life. The following year, after an unexpected heart transplant, I found myself living with a disability. This pushed me to rethink my life and make significant decisions: I reconfigured some of my relationships, left a job that had become unbearable.

During my hospital stays, sharing daily life with other “fractured” bodies, I noticed the lack of solidarity networks — within my own circle and certain queer communities but also in public spaces.

I encountered a form of inhumanity that deeply shook me. In activist circles, even those claiming to be left-wing, I violently felt the gaze that reduced me not to a living, thinking, loving subject, but to a disabled body, a burden, almost unworthy. More than the illness itself, it was this ableist dehumanisation, sometimes well-intentioned but always brutal and controlling, that traumatised me.

The sense of existing halfway between life and death does not come solely from my transplanted heart, but from the way the social fabric around me stripped me of any legitimacy to fully exist within the spaces that were once mine. Day after day, my mental health deteriorated. I faced severe burnout, followed by medicated psychiatric care.

What I am going through — physical pain, fatigue, loneliness — is a profoundly widespread and shared experience. As the months passed, I discovered that while unique in some ways, my journey resonated with that of many others; including people with whom I would never have imagined forming connections. I met elderly people, isolated patients, activists from diverse political backgrounds, all united by the same ontological vulnerability.

Yet despite this undeniable reality, everything unfolds as if vulnerability always belonged to someone else. An unbounded hubris leads us to believe we will never find ourselves in that position. “Your able bodies are ephemeral,” chant the anti-ableist, feminist, and queer collective Les Dévalideuses1. This structural lack of empathy is entirely contradictory to any attempt to embody left-wing ideals.

For years, I had been passionately interested in the ethics of care and love as a political force. Nothing suggested I would be marked in my own flesh by the experience of permanent physical vulnerability. This experience pushed me to reassess the ableist bias through which I had viewed the world until the age of twenty-seven.

For while the transplant and disability transformed my daily life, they also offered me a new understanding of the fragilities many encounter — whether physical, psychological, social, or economic. During my lengthy stays at the clinic, including a month-long hospitalisation following the 2024 legislative elections, I had time to reflect on the left, its obstacles, and these essential questions:

Why does the left struggle to find its place within the ultra-liberal democracies of the West? Have fundamental mistakes been made in assessing the contemporary cultural landscape? Why do we fail to offer a compelling existential vision to many voters? What do our representatives lack to convey a message capable of convincing? How can the left reconnect with the realm of emotions to propose unifying and emancipatory perspectives, and thus inhabit differently the fears and feelings of abandonment that the far-right exploits?

As I explored in Manifeste pour une démocratie déviante, the far-right promises to eradicate insecurity and isolation while fuelling them. The ‘capitalocene’ — a term proposed by Italian essayist Marco Bersani2, which I prefer to that of ‘anthropocene’ to specifically designate the capitalist era — perpetuates this pandemic of loneliness by imposing a fragmented, primaverist3 temporality. This vicious cycle feeds on the very fragility it creates.

One possible path to overcoming the deadlocks of contemporary resistance lies in organisations rooted in care and an ethics of vulnerability. Political scientist Joan Tronto, a pioneer in care studies, defines care as the set of gestures, attentions, and practices that enable us to “maintain, perpetuate and repair our world”: our bodies, our relationships, our environments4. It is a collective effort to support everything on which life depends.

In the continuity of this thought, sociologist Judith Butler approaches vulnerability not as a marginal or shameful state, but as central to life itself. To be vulnerable is to be exposed to others, affected by them, dependent on material, emotional, and social support networks. Primarily corporeal, this exposure is also political: certain bodies and lives are made more vulnerable by social, economic, and racial structures that determine who deserves protection, care, or compassion5. To recognise this shared vulnerability is to found an ethics and politics of solidarity.

The precarity we experience throughout our lives, which I have felt in my own body, thus stems less from our physical conditions than from how society chooses to ignore or marginalise them. It is through the work of a long genealogy of queer, crip, and feminist thought that I have begun to accept and love this revolutionised life.

Anti-ableist author Alison Kafer defines ‘crip studies’ as a militant and theoretical field emerging from ‘disability studies’, which challenges social norms related to the body, autonomy, productivity, and validity. The term ‘crip’ — originally a slur derived from ‘cripple’ — is here politically reclaimed to describe ways of living and knowing that subvert an ableist order.

These studies draw on the experience of disability and illness to imagine new ways of inhabiting the world, valuing interdependence, slowed temporalities, care relationships, margins, and bodily dissidence. The aim is not to add disability to a list of oppressions, but to radically critique what society expects from a ‘normal’, capable, and performing body.

For the left to be more than a mere circle of belonging, it must once again become a proposal for evolving ecosystems. I advocate for a social movement that transports us into a new era, regardless of how long it takes. In this sense, the ethics of care (which align with the concept of romantic revolution I discuss in my first essay) and crip studies offer powerful levers for renewal.

Sometimes adopting harsh methods, akin to neo-populisms, the so-called ‘radical’ left seems trapped in a logic of confrontation that stokes tensions and fuels ambiguity with the very hierarchies it claims to oppose: vertical and patriarchal power relations, polemical use of social media, militant purity, purges, attacks on mental health, whiteness, ableism. The left in Europe struggles to make itself heard. It appears more focused on rhetorical techniques than on the strength of its vision and embodiment.

Yet, capitalism as an anthropological phenomenon is not merely an economic system: it is also a culture, an imaginary, a way of being in the world that is consubstantial with fascism. It permeates behaviours, shapes affects, transcends partisan divides, and defines who we are far beyond our political affiliations. Being ‘radically left-wing’ is therefore not enough to avoid being ‘capitalocentric’ — primarily concerned with the pursuit of social, material, erotic, reputational, and other forms of capital.

If we move beyond the narrow framework of mere political advocacy, often devoid of concrete embodiment, what does it still mean to ‘be on the left’ in our daily actions, our relationship to power, to the collective, to otherness? Even if we momentarily set aside the quest for power, what does it mean to practise and choose ‘the left’ every day as an ontological horizon?

The left today has a precious opportunity to enter a fertile phase of reinvention, where it could rethink its promises, representations, and the political alternative it offers in the face of the right.

This vision, extending my work on love as a social force, materialises in the construction of a ‘care society’, which would shift the centre of gravity of our priorities from economic performance to care relationships — and the professions that make them possible, often performed by marginalised individuals.

Like many, I see the rise of fascism, the genocidal wars waged with near impunity, the increase in social precarity. Yet, I feel the need to go beyond a stance of mere opposition to the far-right. The role of the left, I believe, is to open up horizons, to imagine an alternative social project, a world where life and its transmission would be fully possible. It is about accompanying a lasting transformation rather than a revolution that goes in circles — the literal meaning of the word ‘revolution’ implying something circular and repetitive. The left must be capable, even within its own ranks, of denouncing the powers in place and the deadly logics they perpetuate.

This echoes the critiques levelled by communist filmmaker and writer Pier Paolo Pasolini against the Italian left of the 1950s, which he accused of betraying the working classes by allying itself with the establishment. He denounced its bourgeoisification, its proximity to Christian Democracy, and its failure to truly transform the nation after fascism. Later, in his Scritti corsari (1975), the intellectual lambasted a left incapable, in his view, of understanding new forms of power — particularly consumerism, which he saw as a tentacular and impalpable totalitarian force. For him, fascism had never been as fertile as under the Republic, within which it became institutionalised and definitively normalised.

Politics is often the ambition of domination — the imposition of certain values and ways of living on others, with or without their consent. It is, in other words, the struggle to hold the monopoly of the norm. Communist philosopher Antonio Gramsci spoke of cultural hegemony. This goes beyond a simple ‘quest for power’, which is not in itself necessarily harmful: in the word ‘power’ also lie deeply vital values, the power to be, the power to do, as activist Starhawk writes.

And what, ultimately, is the role of the radical left, if not to detect all forms of domination, even the most insidious?

Vulnerability is an experience inherent to earthly existence, affecting each of us at different times. I deeply believe in its unifying power. Similarly, care is too often reduced to a soft aesthetic or an individual sympathetic behaviour. Instead, it should be conceived as a principle of collective organisation, a social architecture in its own right.

I would like a left that places these questions of vulnerability, care, and horizontal relationships at its core. An anti-ableist and anti-racist left, which would enable us to reflect on what, in our society, is considered fully human.

To think about the left and care is to question the presence or absence of death in our habitats. To contemplate mourning, to analyse how we hierarchise existences, render some deaths invisible, and mourn others. These burning questions permeate current events, where thousands of lives are erased in a chilling media normality.

Philosophers like Myriam Bahaffou propose moving beyond the humanist framework, so that we no longer have to measure the value of life through a utilitarian lens6. Instead, we should adopt a molecular vision of our political models, as imagined by Italian botanist Stefano Mancuso with his ‘plant democracy’. A society rooted in an underground, indestructible fabric because it is self-regenerating, nourished by attention and connections. The time is ripe for a political discourse that places all living beings, in their diversity, at the centre — far from the necropolitics of the far-right and the blind spots of the left.

Care allows us to rethink the left in its existential dimension, as a set of movements aimed, above all, at granting all lives the dignity of being lived and all deaths the dignity of being mourned.

I do not claim to open and close the subject of the left’s re-enchantment; simply to contribute a small stone to its edifice. What I sketch here is largely an invitation to widen the imagination, but many others work to craft concrete solutions that bring these principles into reality. One just has to be willing to look for them7.

The challenge is to make our struggles exist beyond the reductive logic of the conquest of power, turning away from regressive dreams of domination. Redesigning the left, its ambitions, its political programmes; enriching its methods of action, meditating on its very essence and how to embody it. Envisioning other forms of presence, other ways of inhabiting this world — other ways of fighting, together.

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Caregiving is often posed as the last bastion of life that should remain untouched by technology. Even traditionally tech-friendly news outlets are routinely concerned with the impact of AI and automation on our medical and interpersonal care systems:

The Economist: How AI is rewiring childhood
The Economist: Millions are turning to AI for therapy
The FT: Why your AI companion is not your friend
BBC: Is this the year domestic robots come into our homes?

Many see the application of technology to care as cold, sterile and removed of the essential humanity that care requires. But is this intrinsically true? Are technology and care truly incompatible, or is it our applications that need figuring out?

My master’s degree is in computer science, and my thesis was in the field of human-computer interaction (HCI). HCI is a multi-disciplinary area which studies how people interact with digital technologies in order to make those interactions useful, adequate, meaningful, and ethical. I focused on building play technologies – think interactive toys – to encourage social play in mixed groups of neurodiverse and neurotypical children. Play is essential for early development, but autistic children are often excluded from social play groups due to differences in social and communication preferences. Building the right kinds of toys can facilitate social play within groups, leading to more positive play interactions for all children.

An uneasy pairing
Technology is pervasive throughout caregiving: from toys for children and baby monitors to telephones and personal alarms (which detect falls or shaking motions and help access emergency care) as well as medical technology (x-rays, MRIs, ultrasounds) and accessibility tech (wheelchairs, hearing aids, prosthetics, and in the near future, self-driving cars). We use technology to extend human capacity and reduce unnecessary suffering, but also to facilitate connection where physical restraints preclude it. A loved one can be on the other side of the world, hard of hearing, or still inside the womb, and technology can help to connect us.

Despite this long history of compatibility, the addition of modern technologies to social wellbeing and care solutions often feels deeply uncomfortable. Even as someone who has spent time researching and building in this field, I feel a persistent unease when reading headlines about AI in schools, robots in houses, or surveillance technologies introduced into care homes for older people.

This discomfort reflects more than a fear of novelty. Instead, it points to an underlying awareness that modern societies are already struggling to provide care in ways that feel sufficiently humane and relational. We intuitively perceive that technology is being introduced not to deepen care, but to compensate for its absence. Care systems are overstretched, so technological solutions act as substitutes for true time and presence.

Maternal care is one such system. Modern obstetric technologies such as continuous fœtal monitoring have undoubtedly saved countless lives and remain essential in high-risk situations. Yet their routine and sometimes unnecessary application has also led to significant harm1. Over-medicalising a typically healthy physiological process tends to reduce the autonomy of those giving birth2, and marginalise midwifery and community-based birth practices. It is not surprising, then, that many people working at the frontiers of obstetrics respond by calling for a return to older or “lostˮ practises, forms of care grounded in community or embodied knowledge built up through generations of human experience. Yet once again, while the majority of women who have doula-assisted or home births feel empowered by the experience, a more extreme though fringe tendency to reject modernity altogether can have fatal consequences.

Similarly, the recent use of AI to address pervasive loneliness in society feels disturbingly miscalculated. The concern many of us experience when confronted with AI companions, chatbots designed for emotional support, or “friendshipˮ technologies that provide artificial intimacy stems from a recognition that these are being positioned as remedies for structural failures rather than as complements to a healthy social life. They fail to distinguish between supporting care and overriding it. If our patterns of work, urban design, digital use, and economic incentives have produced widespread isolation, fracturing communities and leaving people with little time or energy for relationships, introducing artificial companions merely risks compounding this harm.

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Money is of course a big factor here. It is much cheaper to offer someone a chatbot than to hire a care professional; and unlike relational care therapies, one can get very wealthy selling tech solutions. Technological tools facilitate the privatisation of care, allowing the state to outsource part of its responsibilities. This can be a good thing, enabling national institutions like the UK’s NHS to access ground-breaking treatment technologies they would not have had the capacity to develop themselves. For example, FLOW headsets used to treat treatment-resistant depression through stimulation of specific brain regions have shown really promising results, and are now used by the NHS in a number of areas. However, private companies’ growth imperative means they often need to continuously push these tools towards new users, even those who would be better served by relational therapies.

Like other societal failures of care, mental illness and loneliness at scale are the outcome of decades of policy choices and cultural shifts. Addressing them meaningfully will require slow, contested, and deeply political changes, along with significant investment whose returns will not be visible within one electoral cycle. Technological solutions, by contrast, can be developed and scaled rapidly by a small number of people. They offer the appearance of action without demanding structural change, and in doing so risk us dismissing loneliness as an individual condition rather than a collective failure. By investing in a technology, a company or government can say, “We are actively working to tackle loneliness and improve mental health” without actually having to make any difficult decisions or long-term changes. This is easy to see in the workplace, where companies will buy a subscription to apps like Headspace in the name of protecting employee wellbeing, without addressing the structural issues contributing to stress and burnout. We are adding plant food and hoping to see flowers bloom, while the roots continue to rot beneath the surface. Without looking at the underlying conditions that sustain human connection, technological interventions risk producing superficial growth while accelerating the decay below.

Given this, it might seem like the inclusion of tech in the future of care is exclusively problematic. Yet the benefits touched on above remain real, and there are constructive ways to harness them. To understand what a more balanced approach could look like, I spoke to Elaine Czech and Rachel Keys, two researchers from the BIG (Bristol Interaction Group) lab, which works to improve peopleʼs lives through the design and study of technology.

To trust or not to trust your smart watch
Rachelʼs motivations to work in HCI began as deeply personal. Her husband became unwell with a heart condition that doctors would not take seriously. Through a wearable device (think smart watches), he was able to gather data and use it as evidence that further investigation was needed. He was eventually rushed to hospital for treatment.

Following this experience, Rachel chose to do her PhD research on the use of wearables in the diagnosis and support of people with heart conditions. She has lived experience of the fact that technology can provide invaluable data that allows people to access the appropriate care. This has been particularly important for women and minority groups, whose self-reported symptoms are still not taken as seriously by medical professionals. Women’s health has historically been shockingly underresearched3, and the widespread use of digital trackers is helping to address this imbalance faster than the medical research community could do alone4.

These tools allow users to conduct long-term research on themselves, tracking symptoms over months and years. This, Rachel pointed out, is especially useful for women whose hormonal changes mean symptoms can appear over the course of many months, and present atypically. Wearables allow people to see what their “normalˮ is and track detailed information over extended periods of time. For women with POTS and long Covid, wearable-generated data can offer especially meaningful insights.

Here, technology helps people advocate for themselves and receive support tailored to their needs, without medical practitioners making potentially biased assumptions about which categories they fall into. We shouldn’t be in a situation where many people still have to fight for their symptoms to be taken seriously – but seeing as we are, we should make use of the tools we now have at our disposal as part of the push for substantial change.

The major downside at the moment, Rachel explained, is that “health care professionals donʼt know whether to trust the dataˮ. Wearables often cannot market themselves as medical devices, which would subject them to different product legislation – so they call themselves “wellnessˮ devices. They often function as black boxes, meaning we donʼt know exactly how the data is being collected and processed, and therefore struggle to assess the quality of the measurements. “It puts doctors in difficult situations, because the data is so medicalised that they feel they have to act on it. Research coming out of the US is showing that wearables lead to excess use of medical resources and over-intervention5”. We are all naturally concerned with our health – but having access to a constant feed of information risks encouraging us to needlessly investigate perfectly normal variations.

Building with those we are building for
Elaine Czech’s research currently focuses on building tools for people with Parkinsonʼs. She has been designing a study that uses a wearable device triangulated with home cameras to monitor the progression of the disease over time. We spoke about the importance of people working in HCI acting as “translatorsˮ between the engineers and end users.

“End users can’t necessarily articulate what they want really clearly or in computer science terms”, she explained, “and so the engineers are stuckˮ. Translators are therefore vital in making sure that the needs of caregivers and care receivers are heard, while mitigating expectations of what a technology can truly deliver. Elaine emphasised the importance of engineers and researchers beginning to look at “care ecosystemsˮ. Care is, at its core, relational: it is never received or delivered in isolation. Yet most research is still focused on solutions for individuals. Elaine is lobbying for more research on dyads – mostly couples. Her research mainly centres on older people living with long-term health conditions, most of whom live with a partner, so any technological support needs to work for both people. Like physical spaces, care technology must be designed to center interpersonal exchange.

Giving people agency in the kinds of technologies available to them is an essential step towards this goal. Part of my own research focused on the importance of including the people you are building for as an essential part of the design process. In developing toys for social play, we designed activities that encourage children to come up with games that get everyone involved, including people with specific sensory or social preferences. These game designs were then used as foundational in the technology design phase. Co-design values lived experience alongside technical and design expertise, and involves actively listening to care recipients and practitioners to understand the heart of their concerns. As such, it stands a much better chance of addressing the root causes of failures of care.

To achieve co-design at scale, various groups need to be willing to participate in research and work with developers. This highlights another barrier researchers face: participation. Researchers fight an uphill battle in recruiting participants for studies. In the UK, one of the best ways to recruit from a diverse pool of people is to get NHS ethics approval, which allows you to advertise your study through hospitals and GP practices, and lends reassurance to wary volunteers. However, many researchers wonʼt even apply for NHS ethics because the approval process takes too long – up to 18 months, which on a 3-year PhD program, just isn’t viable. If we are going to build technologies that really work for the people who need them, we need to change the systems that prohibit this research from happening.

People also need to be willing to partake. It is a big ask to open your life up to potentially invasive research with no promise that it will be successful. This is further hampered by a history of unethical research programmes: Elaine pointed to the Tuskegee syphilis study, a shocking example of medical malpractice where known treatments were purposefully withheld from 400 African-American men with syphilis in order to observe the progression of the disease6. More than a hundred of them died as a result.

Stay in your lane
In many ways, our discomfort with the application of technology to care is less about the tools themselves than about what they reveal. The use of tech functions as a microcosm for our systems at large, making visible the absences and inequities already present in them. At its worst, tech can be used to dehumanise, isolate, over-intervene, and mask serious flaws in our delivery of care. At its best, it allows people to gain back their autonomy, and provides life-saving information or intervention.

The main issue seems to be a lack of what we could call ‘technological humility’. Tech enthusiasts are famously very good at claiming that tech will overtake our lives and solve all of our problems, and very bad at admitting that it makes some of the latter hopelessly worse. A welcome example of humility came from Arthur Mensch, the founder of Mistral, France’s AI giant. At a conference given last month to students of the country’s top engineering school, he said:

« We don’t believe in the techno-solutionism that seems to prevail on the US West Coast, which consists in thinking that all the world’s problems will be solved by artificial general intelligence. (…) It will not solve climate change — it objectively tends to make it worse — and it won’t solve our issues with care, with contact, with our ageing populations. There is an entire class of care and relational jobs where AI only has a minor role to play. »

Such pragmatism is refreshing. For tech to work in care, it has to accept being a supportive background player, instead of trying to take over the entire field. Public care systems need leadership that is extremely clear-eyed about the limitations of technological tools, and extremely ambitious about investing in people. That means higher salaries, better working conditions, more relational training, improved communication between designers and end users, and reduced barriers to essential research. It could also mean radical measures: France’s national agency for the social economy recommends the exclusive delegation of all care activities to the state and to mission-oriented private companies by 20507. Paradoxically, by bringing our failures to light, the technological revolution might be the very thing that forces us to confront what good care truly requires.

Sarah Kaddoura is a Palestinian feminist researcher, activist, content creator, and organizer. Based in Madrid, she is currently working towards a PhD focused on the Arab manosphere, and facilitates political education teach-ins with South Feminist Futures. She also analyses social movements and contemporary debates through the lens of feminist theory on her YouTube channel, Haki Nasawi.

In this interview for The Fifth Wave Institute, we spoke about the roots of her feminism, starting in Lebanon where the exploitation of domestic workers is a key issue for activism. We spoke about funding streams, how they boost masculinist groups and build structural barriers to feminist organising; about the violence faced by women in Gaza, and the risks of romanticising their pain.

Sarah’s words open paths of reflection into how a feminism rooted in care, community, interdependence and collective liberation offers an opportunity to go beyond the often narrow confines of Western liberal structures, and build new bridges towards each other.

What was your introduction to feminism?

I grew up in southern Lebanon, in the fairly conservative town of Saida. Before even knowing what feminism was, I always felt a strong sense of injustice. My father passed away when I was eight, so I was raised by my mum in a society that puts a lot of pressure on women and mothers, particularly widows. I was raised differently to my brothers – I didn’t have theory to back it up, but I could tell from daily interactions that there was a double standard. I became curious about what life could potentially be without the control of certain powers and norms.

My first proper interaction with feminist ideas was online. At the time, in the early 2010s, Tumblr brimmed with people sharing their experiences, their understanding of gender, women’s rights, sexuality. Many of those discussions challenged my ingrained principles.

Then, in 2013, I moved out to go to university and started to read feminist literature through the library there. I also had an incredible philosophy professor who made us read classic feminist texts. There were gradual levels of learning and finding my space within the movement.

Eventually, two of my friends and I co-founded an intersectional feminist club. We hosted readings, conferences, panels on feminist resistance and liberation. We were the first on campus to really broach the status of the LGBTQ+ community, the promises and limits of what could be achieved through legal change. Those were some of the harder conversations, as there was a lot of policing of how openly we could discuss these issues.

Through the club, we connected with other groups working in Lebanon. Anti-racist organisations came to speak to us about decolonial frameworks, especially with respect to Palestine; and migrant domestic workers’ (MDW) groups gave us lectures on global chains of care and the sponsorship system.

The sponsorship or ‘kafala’ system, which is directly rooted in the misogynistic devaluation of care work, is a key issue for feminist organising in Lebanon and other countries across the region. Could you explain how it works?

The kafala system refers to the employment structure of migrant workers in countries like Lebanon, Jordan, the UAE, Oman, and Kuwait.1 It involves binding the rights of a foreign worker to their employer, granting the individual ‘sponsor’ full decision-making power over their wage, their work hours, their ability to change jobs, travel, and access healthcare. As you can imagine, such a steep power imbalance is ripe for abuse and exploitation.

The system explicitly differentiates between the labour of domestic workers and that of ‘regular’ migrant labourers, with the former – overwhelmingly women – having even less protections, if not none at all. Say a wealthy Lebanese family wants to hire a cleaner: they will go to a recruitment agency, ‘pick out’ a woman, then be handed her passport, visa, and often also confiscate her phone to prevent her from communicating outside the home. It’s essentially a form of modern slavery.

Racial hierarchies play a role: female domestic workers in Lebanon mainly come from countries like Ethiopia, Sri Lanka, and the Philippines – but anti-Black racism means it’s more expensive to hire a woman from the Philippines than from Ethiopia. These countries’ embassies also participate in the dehumanisation and exploitation of their people: some lobby for the protection of their citizens, but most ignore their pleas.

Given the particular exploitation of women that the kafala system enables, dismantling it has been a central priority of Lebanese feminists. One emblematic group is the Anti-Racism Movement (ARM), a collective of feminists organising around migrants for “social, economic and gender justice”. They opened a migrant community center for MDWs to meet, socialise, learn new skills and advocate for their rights.

Another prominent organisation is Egna Legna Besidet (which roughly means ‘from us migrants to ourselves’ in Amharic), which is run by Ethiopian domestic workers and helps other MDWs access judicial support, workshops, and runaway assistance in Lebanon, as well as vocational training in Ethiopia for those who return. They were instrumental in distributing aid to MDWs during the financial crisis in Lebanon.

Despite these efforts, the situation hasn’t structurally improved. There was an attempt to put together a migrant domestic workers’ union back in 2015 – but the government detained and deported most of the people involved. And in any case, the wider conjecture is unfavourable to all organising: the banking crisis, the global funding drop, and the war with Israel have all led to the dismantling of militant spaces and the expulsion of many activists. Many MDWs themselves left when the crisis hit.

You’ve written about how some Arab feminist movements are increasingly adopting discourses that repackage conservative positions. Why is that?

It’s the result of a parallel process: the amplification of digital feminism on the one hand, and the disappearance of grassroots activism on the other.

In Saudi Arabia, for example, for many years there was a strong cyber feminist movement fighting for the right to drive and against the guardianship system – which treats women as legal children under the authority of their male relatives. Because the country is an authoritarian monarchy, the movement was mostly confined online, yet they managed to remain meaningful.

Then, in the last few years, the relative opening of Gulf countries came with some legal changes to the status of women, including the right to drive and lowered mobility restrictions. Yet at the same time, feminists who had pushed for this change and had already been organising on the ground were arrested or deported. Tens of feminist activists and human rights defenders, many of whom are still in prison today, paid the price for the liberalisation that MBS now takes credit for.

This led to the emergence of a new kind of ‘state feminism’ that supports women’s rights to a certain extent, and only insofar as they align with a patriotic, anti-migrant, classist discourse. A feminism without class-based analysis can never build solidarity around issues of care, like domestic work – which as we’ve seen mainly concerns the exploitation of poorer women. And indeed, you don’t see the struggle of MDWs appear nearly as much in the Gulf as it does in Lebanon.

Moreover, on top of being instrumentalised by the state, exclusively digital feminism ends up so detached from its local reality that it simply regurgitates Western discourses trending online. It’s not just the case for the manosphere, it’s the case for feminists. Its only exposure ends up being to notions like the ‘divine feminine’, ‘natural submission’, feminine and masculine ‘energies’, or movements like trans-exclusionary feminism. In other words, the lack of grassroots third spaces and democratic organising yields a feminism that often repackages patriarchy.

An example of this is sex work: when you’re never exposed to people’s lived realities because your involvement happens mostly online, you don’t have the full picture. I completely understand where abolitionist positions come from – but when feminists don’t physically meet or speak to sex workers, don’t witness their efforts to unionise, they can end up being outright dehumanising and humiliating to them. They might pin the responsibility of the industry on the women involved in it, or exclusively point to solutions like the Nordic model without considering how violently it impacts certain categories of women.

If you don’t organise alongside people, if you are never made to feel uncomfortable in-person and have to work through those conflicting feelings, you can end up taking a less challenging position that appeals to a sort of abstract morality.

You’ve spoken about how the genocide in Gaza, and the networks of solidarity that developed both within Palestine and outside it, are reshaping feminist discourse in the Arab world. In a video for Oxfam, you warn of the risk of excessively romanticising the “resilience” of women in conflict situations. Could you elaborate on that?

In communities with a high death toll, who face immense violence, who are under occupation, and where the loss of children – young or old – is a very common thing, people often turn to women for hope.

Similarly, we on the outside have this image of women as resilient through loss, who keep bringing children to life despite the horror. It’s often an understandable coping mechanism, but it’s a dangerous trope to be stuck in. It’s easier for us to take a backseat, look at these people’s suffering and think, ‘wow, they’re so powerful, courageous, resilient’. It alleviates some of the guilt of not being able to put an end to the violence.

Along with the loss of their loved ones, we mustn’t forget that these women are still exposed to the daily encounters of patriarchy. Sexual harassment and violence are made much worse in moments of precarity, during moves for shelter, in encounters with Israeli soldiers at checkpoints.2 Each family in Gaza had to move over ten times during those first two years, living in tents and makeshift camps.

Moreover, if a woman has lost her husband and older sons, she has to put herself out there to find shelter and food, things that men typically would be expected to do. That puts her at further risk of exploitation.

On top of all that, you have to navigate the demands of reproductive and sexual health: pregnancy, abortion, miscarriage, period pain, all without available medication or anesthesia. I was moderating a session with a couple of women journalists from Gaza recently, and they spoke of how things we usually take for granted suddenly feel hugely dehumanising: not having a space to change away from prying eyes, sharing bathrooms, the lack of basic hygiene, the lost privilege of having a shower. Small, intimate details of daily life that get lost in the big picture.

So the ‘resilience’ trope often ends up painting a one-dimensional image of what it’s like to be a woman living through war and genocide. These women’s lived reality goes far beyond the responsibility to keep everything and everyone together. That isn’t to say this war is any easier on men – but there are different layers to the experience.

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Your PhD research focuses on the Arab manosphere.3 Do you have any initiatives in mind across the region that successfully engage young men in the fight for equality?

In Lebanon at least, we have a long history of such initiatives. There is an organisation called ABAAD, which specifically works on including men in its campaigning, and offers workshops that help build non-violent forms of masculinity. Their ‘Men Centre’ also has a hotline specifically for men to receive support.

But I think that work will always be lacking – not in the sense that it’s not important, but that it should be happening on a much wider level than what can be achieved through NGOs and workshops. It should be an integral part of our curriculums, in schools, at university; in all of the media we consume. We can and do create alternatives, but it’s still limited; we’re still exposed to endless cultural productions that reproduce misogyny and rape culture.

There’s also only so much discourse can do: it’s really hard to reach young men when their distress is rooted in material conditions, in unemployment and precarity, and when endless amounts of funds are spent pushing the opposite attitudes at them. In Lebanon for example, there is a Christian fundamentalist group called Jnoud al-Rab (Soldiers of God), funded by a banker whose banking group was partly responsible for the financial crisis. They’re these macho men with big crosses, roaming the streets and producing social media content warning of moral degeneracy, anti-Christian values, LGBTQ conspiracies and low-value women.

It’s important to remember that these manifestations of violence, whether digital or IRL, are not as organic as they’d like to seem. They play on the fears, the anger, the disappointment of young men while being directly funded by the people causing these feelings. The banker I mentioned has strong connections to the US far-right; it’s an interlinked global network of funding. Ironically, they don’t struggle at all to organise across North and South! It’s primordial to turn our eyes there, and not just at the outcomes expressed by individual men.

Individual men, however, do have a responsibility to be actively engaging boys and other men in their communities. The same way that we, as women, often share experiences with each other, discuss feminism in subtle ways from quite a young age, challenge each other’s thought patterns as we grow up. Men should be doing that work with their nephews, their sons, their colleagues. It will have a much more lasting resonance than an anti-sexist workshop ever could.

Can feminist solidarity with and across the Global South help us build a feminism that is more about the collective and interdependence?

Historically, feminist movements across the Global South have been very intersectional, drawing on decolonial struggles, working towards collective liberation and being critical of liberal feminism’s focus on individual success and personal choices.

However, they also have to operate in a context marked by the heavy presence of NGOs. Take Lebanon: for such a small country, we have thousands of human rights and feminist NGOs. It’s not surprising, since these thrive in environments where social safety nets are lacking. There’s a gap to fill.

But the problem is that it can cause organising to fragment. Instead of having collective logics for radical action, it risks segmenting each struggle into neat boxes, with each organisation competing for funding by putting forward their niche.

Funding is of course also an issue. These NGOs are both local and international, but the money is mostly Western. It’s a new form of imperialism, where populations in the Global South are dependent on fluctuations in Western political trends and funding cycles to have their needs met. USAID was obviously a massive source of cash, and thousands of people have now been left on the street or without support since it’s been cut.

German funding, for example, typically comes with a lot of policing around politics, especially with respect to Palestine and occupation. In the last few years, we saw many German-funded organisations suddenly fire people, cut resources, or change their policy about what can be spoken about and who beneficiaries can be.

Not only does this model impact what kind of organising can take place, it also puts feminists in very awkward positions. Say an organisation you’ve contributed writing to or has supported one of your community programs posts a really dehumanising statement about Palestinians. You start being seen as an outsider. You can lose the trust of your community, something conservatives want to see happen.

This isn’t just German funding – it can be US funding or other European countries. It happened in Iraq, in Afghanistan, on other feminist issues like LGBTQ+ rights or abortion (with the Global Gag Rule).4 It serves to drive a divide between feminists and the communities they come from.

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I’m currently working with an organisation called South Feminist Futures (SFF), in their political education program. It’s been a wonderfully formative experience. It’s the first time I’ve been truly engaging with the work of feminists from all over the Global South, mobilising along with them. I’m in touch with many people from Latin America, Africa, Asia, whose work you might miss if you don’t actively look for it. Because the models they propose are not the mainstream.

There are people in Brazilian favelas planting these huge community urban gardens, where women and gender-nonconforming people in particular can cultivate, protect each other, and organise against incarceration. There are women-led solar cooperatives and startup incubators emerging across the African continent, for whom it’s a deeply feminist issue to challenge IMF standards that present as “gender-sensitive” and liberatory but barely take the reality of care work into account.

I’m exposed to a world of feminist organising that does not compromise on its ethics, that takes place outside of the structures we tend to get stuck in, yet also works to push those structures to evolve. There is much to be learned from it.

The last two years, as sad and terrifying as they have been, have also opened a space for many people to rethink their methods of action, meeting across the Global South and with organisers from the Global North. We have an opportunity to connect more meaningfully than we ever have.

In this vein, who are some international feminist thinkers you find inspiring?

I like the work of Verónica Gago, who is based in Argentina. She was very active in the social movements sparked by the 2001 debt crisis, and is one of the leaders today in the country’s #NiUnaMenos (Not One Less) movement against femicide.

Selected text: Feminist International: How to Change Everything. Verso Books, 2020.

There is Sylvia Tamale, who I got to work with through SFF. She’s a Ugandan lawyer, sociologist and activist, and the first-ever woman to be Dean of Law at Makerere University.

Selected text: ‘African feminism: How should we change?’ Development, 2006.

There’s the essential work of Nada Elia, a Palestinian feminist writer and theorist who writes on internationalism and solidarity.

Selected text: Greater than the Sum of Our Parts: Feminism, Inter/Nationalism, and Palestine. Pluto Press, 2023.

And finally, I can’t miss an opportunity to give my friend Islam al Khatib a shout-out. She works on surveillance technology and the tech industry in the region from a feminist and decolonial perspective.

To wrap up, the question I always ask: Who do you care for, and who cares for you?

I care for my partner and he cares for me. In our world right now, at this stage of our lives as recent immigrants, we mostly have each other. We put all the care we have into each other (and into our gorgeous orange cat).

We are also nourished and sustained by the years of care we both received and poured within our families, within our friendships. In the context of war and financial crisis, the last few years have been full of a profound care I don’t think I would have survived without.

Further resources:

• Know your African Feminists by the African Feminist Forum (AFF), a great resource to explore five decades of feminist activism across Africa.

• South Feminist Futures’ knowledge hub.

• Resources from the Palestinian Feminist Collective.

That violence is learned is one of the central contributions of the social sciences to our understanding of human behaviour.

We know, by now, that aggressive and dominating attitudes are progressively acquired through a number of social models, rather than primarily the product of an innate drive.1 We know there is a mutually reinforcing relationship between cultural, structural and interpersonal violence2, that becoming numb to one type of violence makes one more likely to engage in others – the way a slaughterhouse opening in a town drives up the local prevalence of domestic abuse.3

In Caliban and the Witch, Silvia Federici recounts how French Jesuit missionaries sought out to dictate to the Montagnais-Naskapi, an Indigenous nation of mid-17th century Canada, how to govern themselves:

“[The French] were scandalised by their ‘lack of morals’; they saw that the Nasapki had no conception (...) of authority, of male superiority, and they even refused to punish their children.” (...) A missionary recalled in his diary an exchange he had with a Nasapki man: “I told him it was not honourable for a woman to love anyone else except her husband, and that this evil being among them, he himself was not sure that his son, who was present, was his son. He replied, ‘Thou has no sense. You French people love only your children; but we love all the children of our tribe.’ I began to laugh seeing that he philosophised in horse and mule fashion.”4

The Jesuits eventually succeeded in persuading the Nasapki to whip their children by conditioning their fur trade agreements to such practices. We know, in other words, that violence is taught and continuously enforced, and not the spontaneous manifestation of our state of nature.

By contrast, we know a lot less about how care is learned. We infer it, to an extent, as the mirror image of the apprenticeship of violence – but the symmetry only goes so far. Only relatively recently have we begun to research care as a practice, with principles, which can be done well or badly, and therefore taught. Western philosophical traditions inquired at length into the nature of the self and our moral obligations to one another; yet their proponents rarely connected these questions to the everyday reality of those who cared for them, and how well – unsurprisingly, mostly how badly – they cared back. Domestic work and dependency care were of the realm of the mundane, the practical, unfit for philosophical reflection. They just… happened.

Even the idea that caregiving can be learned at all is a relatively new one. Attention to others, the capacity to nurture, reassure, comfort, were long considered innate qualities that come with being born female. Yet contradictorily, they were also thought to be fragile forms of knowledge that could be lost if one learned other things. The gradual opening of university examinations to women in 1870s England led to heated debates between proponents of ‘educational assimilation’ and those of ‘educational pluralism’, who preferred to keep boys’ schools and curricula separate from those of girls. Their central claim was that giving girls a “boys’ education”, with subjects such as physics and history, would result in the loss of their ‘natural sensuality’ and in “the creation of a new race of puny, sedentary and unfeminine students”. This would “destroy the grace and charm of social life, [and] disqualify women from their true vocation, the nurture of the coming race and the governance of well-ordered, healthy and happy homes.”5 One doctor even claimed that after a period of higher education, “flat-chested girls” would be “unable to suckle infants.”6

This marginalisation and long-lived misleading beliefs about the nature of care mean that unlike violence, we don’t have good mental models of what ‘structural care’ or ‘cultural care’ look like, or how they trickle down into interpersonal care. As a result, much of the way we structure caregiving in society is not, in fact, done with any deep understanding of how care works. France’s 2015 paternity leave reform, which I wrote about last July, is a good example of this: it failed to provoke any significant uptake among new fathers because it did not factor in that the ability to take care of a child is developed over time, rather than simply turned on and off.

As wisely pointed out, learning to care – in the broadest possible sense, of how we maintain our world and each other, how we build strong webs of interdependence without losing our unique selves – is mostly not an information problem. You do not learn it the way you would the date of a famous battle. You see it modelled all around you. At home, where you learn who does what kind of care, how much it is acknowledged and valued; whether it is an expansive force that spills out to all who pass through or an exclusive rarity, granted with conditions. At school, where you internalise authoritarian cultures that center punishment and hierarchy, or on the contrary, where healthy relationality to others and to nature is intentionally embedded in the curriculum.

None of these sites of learning operate in isolation. Cultural narratives, artistic representation, linguistic changes, our webs of weak and strong ties to the people in our lives – all of those shape our perception of how important care is and who is responsible for it. A child can be taught non-violent communication at their forest school yet see domination modelled at home every day. Teenage boys can be given anti-misogyny classes, but those are unlikely to mean much if they receive constant messaging that paints women as lesser humans.7

This is why care systems are such a central focus of The Fifth Wave’s work: they are the overarching structures that either support or suppress our learning of care. They have the power to keep vulnerability alien, dependency shameful, respect a sign of weakness, and hierarchy natural – but they also have the power to make them something else entirely. They can be built to make interdependence an utterly basic part of our social fabric, such that care flows with much fewer barriers.

They could mean every city center has somewhere people can come to with those they care for, so that a man who cares full-time for his wife with Alzheimer’s can get a few hours of rest and some warm conversation. They could make it possible to take a ‘care day’ off to support a sibling with their new baby; make alloparenting so banal that prenatal classes are almost superfluous; they could make dying at home, surrounded by relatives, a much more normal end to a person’s life. Once we stop accepting the systems we have today as the best we can get, a world of alternatives opens up.

These systems are costly and difficult to build; they require grit and imagination. Rita Thapa, who I interviewed in November, had to push through the skepticism of many a foreign donor and government official to transform Nepal’s primary care system and put mothers at its core. Cambodian Children’s Trust, whose pioneer ‘Village Hive’ model Bethany Hansel analysed last month, will have to mitigate the effects of corruption and antiquated charity structures to make it the country’s default child protection system. And in another analysis, Bethany showed the challenges faced by New Zealand in scaling its national ‘pedagogy of care’ rooted in Māori principles.

Despite these obstacles, such systems exist, and more of them are emerging. The ‘institutional paradox of care’ I wrote about in September, which seems to make rigid policy structures or profit-making companies incompatible with good care provision, can be overcome. My mission over the next few decades will be to help design institutions with care built in – that make care so supported, so obviously central to all of our lives that learning it simply becomes a normal part of being human.

Further reading:

Claire Favre is a clinical psychologist in the Varennes-le-Grand Penitentiary Centre in Burgundy, France, and an associate researcher of the Psy-DREPI lab at Bourgogne Europe University. She also trains professionals in addressing domestic violence for Solidarité Femmes 21, a victim support charity.

In a recent paper, she examines the growing intrusion of the carceral system into therapeutic relationships within prisons, and its ethical implications for her practice.

This interview for The Fifth Wave explores a central question, whose relevance goes far beyond the penal context: what does it mean to care in an environment defined by its violence?

Interview conducted, written and translated from French by Mélina Magdelénat.

What led you to become a prison psychologist?

A class on totalitarianism in middle school. Specifically, we read Death Is My Trade by Robert Merle. The novel tells the story of a Nazi officer tasked with finding the most efficient way to exterminate Jewish people — the ‘final solution’. He sees himself as trapped by an impossible choice, a classic illustration of Milgram’s obedience to authority experiment.

I discovered that people could commit atrocities without being inherently monstrous. Later, I explored this further through Eichmann’s trial and Hannah Arendt’s work on the banality of evil. I wanted to understand why people do atrocious things; prison felt like a natural extension of that inquiry.

Early in my psychology studies, I got involved with the Génépi [the National Student Group for Prison Education, dissolved in 2021], a student association that provided classes in prisons, which Robert Badinter1 helped set up. Its name comes from a plant that grows where no one else goes.

Its central mission was to give detainees access to education – it’s worth pointing out that the average educational level in prison is equivalent to primary school. I taught French and Spanish there. But it also allowed detainees to discover that young people could voluntarily want to spend time with them, want to engage. Prison is a strange space; if we don’t talk about it, it doesn’t exist. People don’t necessarily think about what happens behind those walls.

The organisation’s secondary mission was to raise public awareness of prison conditions – that was the more ‘activist’ side. Through the Génépi, I visited several types of prisons and later did internships in a remand centre (for pre-trial detainees and short sentences) and a penitentiary centre (which includes a remand centre and a detention centre for longer sentences and convicted individuals).

Did the reality of prison match your expectations?

We were repeatedly warned about security: in the Génépi, we were regularly told to be very careful with detainees, that it would be dangerous, especially as young students. There was a lot of pressure on how we should interact with them.

But in my experience, the environment is so secure — in consultation rooms, there’s an emergency pedal on the floor or a panic button, guards patrol behind glass doors — that we’re actually freed from the responsibility of securing ourselves. We can truly be available for the person.

I’ve actually felt much less unsafe working in prison than, for example, in a community mental health centre on a Friday evening, more or less alone in the building, attending to someone who’s drunk or difficult. Similarly, some colleagues who work in the ER are a lot more at risk than in prison.

You later moved into research alongside your clinical work. Why?

As a young graduate, I struggled to find meaning in certain violent acts. The literature explains that there isn’t one type of violent act, but many — but I needed to push the reflection further, to understand, by turning to research.

During my studies, I read the book on violent acts by Claude Balier, one of the first psychoanalysts to introduce psychological care, including psychoanalytic approaches, into prisons in the 1980s.

I contacted him because I wanted him to supervise me. He was retired, but we formed a bond, and he became my informal supervisor for a long time. He encouraged me to do my thesis on emotions and violent behaviour. It was a very meaningful encounter.

I then started teaching alongside my clinical practice, so I wear both hats. It’s good to step out of the prison environment from time to time.

In your article Psychological care in prison: the importance of ethical reflection, you examine a certain “infiltration” of the judicial institution into the process of care2.

You cite an interview with Michel Foucault and Pierre Werner, where Foucault discusses the central role of medical practice in mechanisms of social repression: “As if punishing a crime no longer made much sense, we assimilate the criminal to a patient, and the sentence claims to be a therapeutic prescription.”3

How does this infiltration alter the encounter between caregiver and patient, which is essential to a true care relationship?

To take a recent example, a man told me at the beginning of a session, “The judge said I won’t go to trial until I’ve put meaning to my actions.” So he doesn’t come to the consultation to deeply understand the causes of his distress or his actions. He comes with an order, to tick a box.

Detainees struggle to imagine that our sessions could be solely for them, to relieve their suffering, rather than another instrument of the prison institution. It’s very difficult as a care professional to break free from this once the mechanism is set in motion. But on the other hand, we can understand that he wants his trial to take place, that he wants to move forward in his incarceration.

Many patients also ask us if we will write a report for the judge, because they think it might benefit them. But it can just as easily harm them. There’s confusion between care and expertise: we’re perpetually forced to reset the framework.

We regularly clarify in interviews that we have nothing to do with forensic psychiatrists, that we don’t write reports, that we don’t transmit information, that professional secrecy is preserved. We remind them that here, we are under the responsibility of the Ministry of Health, not the Ministry of Justice, which is the case for the rest of the facilities.

And a few months later, we have to clarify it again, because in the meantime, people receive conflicting instructions. Other intervenors tell them, “I’ll talk to your psychologist,” or ask them to work on a specific topic, rather than letting them come to me autonomously.

My mission is a public health mission, aimed at relieving suffering. The person works on what they want to work on. Often it’s around the violent act, but it can also be about relational and family issues outside, or about incarceration itself — living in nine square metres with a cellmate you didn’t choose to live with, yes, that can make you want to go mad.

We try to access the authentic in the encounter with detainees. And that’s very difficult when the person acts based on an external, institutional injunction. It’s only possible after we’ve explained to them at length that what they say will not leave our exchange.

It should also be noted that infiltration can go both ways: we, in the care world, can also, out of convenience, infiltrate the judicial. We can start wanting to know a lot of things about a patient, to have access to information that isn’t intended for us. Maintaining our stance requires real ethical rigour.

What risks do you see in approaching care in prison settings by categorising people based on what they did?

Categorisation traps people. Before even meeting someone, we’ve already formed a simplified idea of who they are.

Of course, it’s human nature. We need to categorise to understand, to reassure ourselves. But the risk lies in confusing penal and psychiatric categories — when within the “sexual offender” category, for example, there are many different psychological mechanisms. The same goes for domestic violence offenders or drug users.

The same act can reveal a very different cognitive structure: for one person, a reactivation of trauma; for another, psychopathy. It’s not the same approach to care.

Similarly, as the psychoanalyst Christophe Dejours shows, there are sexual crimes that are more about violence than sexuality, and violent crimes that are highly eroticised. That’s something the penal category might miss.

The risk, then, is having a “tell me what you did, and I’ll tell you who you are” approach. One day, I had an older man come in; and with the extension of the statute of limitations for sexual violence, we had many older men arriving in prison with convictions of that type. I admit that in my head, I thought he was definitely a sex offender.

And turns out, not at all, he had dealt drugs, even though he was over 80. I wasn’t the only one, by the way — everyone else also thought he was a sex offender. And that’s not well seen at all in prison: other detainees call them “pointeurs,” don’t tolerate them, mistreat them. The man had to ask prison staff to be allowed to carry his criminal record on him, to get others to stop bothering him and see him as the ‘grandaddy dealer’ instead.

To avoid these pitfalls, with my colleagues, we propose therapeutic groups that consider psychological symptoms rather than penal categories — for example, alexithymia, the inability to express one’s emotions.

It’s interesting to see how these categories not only trap people but also permeate social relations within the prison itself.

Yes, there’s a whole hierarchy. To caricature, at the top are robbers without blood on their hands, then dealers who don’t use drugs themselves, then traveler people, and so on. In some prisons, they almost have entire floors based on these categories; others are specifically designated for sex offenders.

So detainees don’t meet a person, they meet an act. That’s why I rarely ask my patients what they’ve done. Sometimes, it comes up after two or three interviews if the person wants to talk about it; but it’s not my mission. Many announce it immediately, very easily, because they’re used to being asked; in those cases, I often say, “We’ll talk about that later, I’d first like to know who you are.”

In prison, there are so few boundaries, the intimate systematically becomes extimate. My role is to help people put boundaries back in place. To make them understand that we can meet without necessarily being determined by the penal context.

This “forced extimacy” ties in to the notion you address in the article of a prison system that “traps patients in heteronomy4, not giving them the possibility to access physical and psychological autonomy.”

The fact that you help these people “put boundaries back in place” may seem counterintuitive to some — it requires us to question our ingrained punitive reflex that would deny a detainee any right to claim autonomy, especially a sexual offender who themselves took away another’s autonomy. But it’s essential if we want to build a society no longer enslaved to violence.

What strategies do you implement with your patients to allow them to maintain a semblance of autonomy and intimacy in the prison space?

To me, that’s partly what therapy is meant for. When patients have gone through a trial, they’ve been “narrated” by everyone else: their family, witnesses, sometimes even their kindergarten teacher came to talk about who they are. Therapy sessions are one of the rare places where they can “subjectify” themselves, tell their own story, make their own narrative without it being used for any purpose.

It is therefore vital to offer a secure framework. That’s why I reiterate the dimension of professional secrecy so much — something I wouldn’t necessarily do in other structures or workplaces. Autonomy is partly built through it.

The notion of “good care” as that which allows a person to regain autonomy is central to the construction of better care systems.

As philosopher Christine Leroy explains in her interview with the Fifth Wave Institute:

“Those who educate or provide care are often dominant when they should be supportive. (...) This dilemma lies at the heart of the difficulty of caregiving: does helping someone mean doing things for them, or enabling them to do things themselves? (...)

It’s not that the person isn’t autonomous; it’s that we deprive them of their desire for autonomy. Letting them try would require time and resources that are cruelly lacking. In this context, care – or what remains of it after hyper-rationalised costs and work schedules – often contributes more to the loss of autonomy than to its preservation.”

For a concrete example of a system that contributes to such ‘reablement’, see this Danish study on home care reforms5.

Autonomy also comes from breaking free from external injunctions coming from the judicial system or the family. On the contrary, we ask detainees: “What about you? What are your anxieties, your desires?” Without positioning ourselves as experts, without telling them we know what’s good for them. They have resources, we help them find them. Discovering a capacity to reflect on themselves will also help them when they’re back outside.

In the context of sexual violence in particular, it is often said that psychiatry is too mobilised in the judicial process, to the detriment of other explanatory frameworks for violent acts, like sociology. Do you agree?

There is definitely a difficulty in considering the patriarchal context beyond the individual context. Judge Édouard Durand said about incest, “We have freed speech, but we haven’t yet freed listening.” It’s true for all of society, whether it be about incest or rape or domestic abuse: people are not yet ready to hear that violence is systemic. There’s still a lot of work to be done.

I’m currently training in systemic therapy — a discipline that takes into account the environment, the competence of families, the competence of individuals, and how to activate them, to achieve more comprehensive care.

Systemic theory speaks of equifinality: there can be multiple causes for the same result. This aligns with Edgar Morin’s complex thought theory, which invites us to resist the tendency to simplify, to categorise. Having a field of practice shouldn’t blind us or confine us to a very linear understanding.

And at the same time, we always start from the principle that people are responsible for their actions. Reflecting on the reasons why a person acted violently never aims to excuse the violence.

You host workshops for Solidarité Femmes 21, a charity that supports victims of domestic violence. What’s the goal of these workshops?

We mainly train VIF (intrafamilial violence) networks in Saône-et-Loire and Côte-d’Or. The goal is that on the same territory, a set of professionals — caregivers, social workers, lawyers, police officers — can meet, exchange, reflect together, and coordinate care provision.

The workshops must imperatively be multi-institutional and multi-professional. Meeting each other allows for a better understanding of the limits of each other’s missions: in case of failed care, it helps avoid the pattern of always blaming others for not doing their job properly.

My colleague, who works with victims, and I with perpetrators, bring an important base of theoretical knowledge. This allows us to go beyond a very Manichaean conception of “good victims, mean perpetrators” as well as to constitute a common language within the network on one territory: what are we talking about when we talk about domestic violence? What are the different types, the different mechanisms?

Finally, understanding allows us to move from reaction to intervention. Domestic violence produces a high level of reactivity: we want the violence to stop as quickly as possible, partly because we ourselves, as professionals, can’t take it anymore.

For example, when some women return to their violent homes, care providers can get frustrated, because they don’t understand why. So in our sessions, we explain to them that these are not pointless back-and-forths that reset everything to zero but that at each stage, a little power has been gained, something has evolved, we can work on it.

Understanding allows us to work with, rather than against, the unique temporality of each person. Rushing them risks aggravating the situation. The workshops allow us to put the person back at the center, to make them the master of their life, and not to replay the violence they have experienced by ordering them what to do.

Do the workshops also include femicide prevention?

Yes, we work on assessing levels of danger. Beyond observed physical violence, coercive control and the context of separation are major risk factors. And one can be very controlling without being physically violent.

We also work on anticipating intervention: how to react if tomorrow, within my institution, I am confronted with a risk of femicide? For example, if I’m attached to the hospital, the lifting of professional secrecy is subject to rigid procedures, whereas other institutions approach it differently.

To explain a detainee’s journey, we often point to unidentified violence and missed opportunities for psychological or psychiatric care. Is this something you’ve observed?

Yes, our patients often grew up in contexts of violence and neglect. Childhood and its difficulties are very present. It’s often normalised: they say their childhood was “like everyone else’s”, but we quickly realise that wasn’t the case. And often, indeed, they themselves say that they might have turned out better if they had seen a psychologist earlier.

But we also have the wrong filter: we only see those whose paths have led them to prison. If we take domestic violence, for example, 70% of people who grow up in such a context do not reproduce it in adulthood. But I see those who, among the 30%, become perpetrators; and my colleague who works with victims sees those who reproduce the cycle in the other direction.

So we must not forget that beyond those for whom difficulties persist, there are those who are doing well.

Moreover, even if therapy occurs upstream, a certain mindset and living environment are also needed to truly work on oneself. Time must be freed up. Prison is obviously very heavy, but it also has a “parexcitatory” dimension: it isolates one from the external environment. Therapeutic introspection can therefore be made easier.

I work with a few people who’ve been released from prison, and it’s often complicated to maintain constructive exchanges; they are caught in other difficulties. So it’s a shortcut to say that if a person had been taken care of earlier, they wouldn’t have acted out violently — because even if they had benefited from therapy, they might not have been able to do it properly.

Finally, we also cannot place the responsibility for a violent act — or the lack thereof — on psychology alone. A psychiatrist colleague reminded me that some people can do intense work on themselves and reoffend, while others do none, but the sanction of prison will be enough to stop them reoffending. We must not see psychologists as a deus ex machina: when someone’s entire life context is violent, it’s never linear.

Finally, a question I ask all my interviewees: who do you care for, and who cares for you?

I take care of those we forget. Those we don’t see — they may be in the news all the time, but it’s not really them we look at, but rather what they did. Even within prison walls, I am very sensitive to the quiet ones, those we don’t hear. I’ve worked on the silence of emotions a lot, I’m particularly sensitive to it.

On the other hand, my team takes care of me. I couldn’t work without them. We operate in an environment with a lot of destruction, so it’s vital to have pockets of support. Supervision, in particular, plays an important role for me, to be able to put thought back into lived experiences.

Finally, in the context of care, we are very exposed to compassion fatigue and vicarious trauma. We must therefore implement practices that take care of us: reading light things, spending time with family, creating a soothing environment. It’s vital to have the space to do this.

Thank you for reading this interview. If you know care workers, caregivers, policymakers, researchers or other actors invested in the construction of better care systems, don’t hesitate to share our work with them. And if you have suggestions of people you think we should interview, don’t hesitate to let us know :)

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“There is nothing new under the sun, but there are new suns.”

This quote by Octavia Butler has infused my work since the birth of Cara and The Fifth Wave, a little over five months ago. It captures a dual reality behind their creation.

First, the current organisation of care in our societies is a broken one. It’s disproportionately shouldered by certain groups of people. It fails to provide the adequate care all of us need to thrive. It denies that vulnerability and interdependence are essential dimensions of our shared human condition, treating them as odd glitches. It prioritises clinical and short-term economic outcomes over a holistic understanding of well-being. It siloes care into separated segments of our lives, rather than grounding it at the heart of community, work, and family life. It is ill-equipped to deal with the consequences of substantial ongoing demographic changes.

Second, this isn’t a fatality. There are new suns. Better systems exist and are being built across the world. Others are being imagined by researchers, activists, organisers, and can be made a reality. Better ideas about care exist, new ones are continuously emerging, and they can be made to reach many more minds than they currently are.

This dual reality is our ‘why’. The way we structure and understand care is inadequate, and we need to envision bold and interconnected solutions to fix it.

As the first month of this new year comes to a close, and in the spirit of building in public, I wanted to make our ‘how’ a bit more explicit. To clearly lay out the different areas of our work, and give you an idea of what’s to come. As I set out to do so, I was reminded – by the lovely – of another quote, this time by a thoughtful scholar of Butler, :

“We need to move from competitive ideation, trying to push our individual ideas, to collective ideation, collaborative ideation. It isn’t about having the number one best idea, but having ideas that come from, and work for, more people.”1

The association felt fitting. Black feminists have already said much of what we need to change the world. So that’s our ‘how’: grounded in the insights of care ethics and feminist care studies2, we work to a) apply those insights to transform our understanding of care and b) scale them into replicable policy solutions. In other words, we aim to take the products of collective ideation, and use them to build care systems that work for more people.

This work is organised as follows:

Analyses

We analyse local and national alternatives to current care systems, in order to learn from, adapt, and replicate them. These are incredibly useful for three reasons.

One, the necessity of care and the essence of what constitutes good care transcend borders: care systems need to be tailored to their specific cultural, social, political and economic context, but the broad principles that make them successful and the lessons extracted from their challenges can inform systems-building across the world.

Two, when it comes to social innovation, the “local initiative —> replication —> integration into the national infrastructure” pipeline is a tried and tested way to drive society-wide change. We believe in starting small, and scaling what works.

Three, ‘care systems’ is a huge umbrella: it includes spaces like schools, hospitals, birthing homes, domestic violence shelters, families, nursing homes, foster centers, community health centers or even public housing, as well as the institutions, laws, and economic forces that determine how those are organised. We don’t claim we’ll know how to transform them all — and much specialised knowledge already exists. Rather, our value lies in taking a connected look at how care flows within and across these systems, in order to inform better, integrated solutions.

Analyses we’ve published include:

Interviews

We publish interviews with people building the futures of care, whether through their practice or their thinking. People who try their hardest to make up for the harshness of our systems with creativity and passion.

And because the best insights on care come from caring, I ask all my interviewees: “Who do you care for, and who cares for you?”

Essays

We publish writing which helps us understand what our relationship to care is lacking, why it matters, and envisions another way forward. We aim to elevate the importance of caregiving in all its forms, as essential public infrastructure, as a structuring principle of social life, and as a central concern of political decision-making.

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This dual goal of thinking and acting will mean we’ll often have to help build things under this sun while we imagine life under new ones. I don’t see that as a contradiction. The spectrum of social change ranges from a radical reinvention of our existing structures — radical in its primary sense of ‘at the root’, not necessarily most extreme — to incremental progress within existing constraints.

We want to do both, even if that means often having to make do with the trappings of bureaucracy, politics, and human stubbornness. Even if that means helping to build imperfect systems; as long as they’re systems that work for more people.

This is going to be an exciting year. Again, we welcome collective ideation. Don’t hesitate to share your thoughts with us, topics you’d like to see more research on, or innovative systems we could analyse. Moreover, if you know caregivers, midwives, researchers, journalists, organisers, local officials, anyone who cares about care, anyone building the care society who you think would benefit from engaging with our work, don’t hesitate to share it with them too.

Thank you,

With care,

— MM

This week, I am sharing this beautiful, if alarming, text by Rebecca Mack – who writes the newsletter ‘This Woman’s Work’.

The impetus behind The Fifth Wave came partly as a result of my reading ‘Of Woman Born: Motherhood as Experience and Institution’, by Adrienne Rich, sitting on the steps of the Bodleian Library during my last few days in Oxford.

Reading that book, and diving into the world of thought that subsequently revealed itself to me, was probably one of the single richest intellectual experiences I’d had up until that point. In it, drawing on extensive research as well as her personal experience in her first heterosexual marriage and then as a lesbian mother, Rich picks apart how the figure of the mother – imagined, fantasised, imposed, enforced, all but defined by its actual embodied experience – has for millennia been a central tool of the subjugation of women.

In the below, Rebecca writes of her experience as a midwife in the UK’s NHS, and the systemic failures that ultimately led her to seek a different way to care for women. I’m sharing it here (it has been slightly edited) because it deeply resonates with the Institute’s vision for a different, care-centered world. It also feels appropriate as C-section rates have recently surpassed those of vaginal births in England.

Both this essay and ‘Of Woman Born’ exemplify two of our deeply held beliefs: our systems are broken, and they can be rebuilt. “The fields need to be radically dug up and new ones sown”, as Rebecca puts it – in midwifery as in all other spheres of human activity that involve people taking care of each other.

As Rich writes in her 1977 essay of the same name,

“We need to imagine a world in which every woman is the presiding genius of her own body. In such a world, women will truly create life, bring forth not only children (if we choose) but the visions, and the thinking necessary to sustain, console, and alter human existence — a new relationship to the universe. Sexuality, politics, intelligence, power, motherhood, work, community, intimacy, will develop new meanings; thinking itself will be transformed.

This is where we have to begin.”

I came late to midwifery. I was twenty-seven, earning 25K a year as Personal Assistant to a group of corporate directors. Free gym, nice offices, lovely boss. It wasn’t enough. I had a calling. Possibly a catholic or middle daughter thing, I don’t know – I just knew I wanted to help people.

Midwifery looked like the perfect job: women-centred, empowering work and oodles of babies to cuddle. Whilst training, I did a two-week placement on a special care baby unit where my main job was to sit, skin-to-skin-cuddling preemie babies in my cleavage. After the two weeks ended, they practically had to escort me off the ward. It was joyous.

I knew instantly at my university interview that this was the career – or rather, the place for me. Not long after, I was called back to the office of the midwifery lecturer who had just interviewed me. She sat at her desk, swinging on her chair, shoes off, chatting animatedly to her colleague who was curled up on the sofa. ‘I’m home’, I thought. ‘I want to stay in this world forever.’

The training lasted 3 years and was hard going from the start. We spent half the week working on the wards and the other half studying in classrooms. There were no long holidays like other students and if you missed a shift, even due to illness, you were required to make up the hours in your own time – meaning most ‘holidays’ were spent back on the wards. We were paid a small bursary (not meant for anyone to live on) which has since been terminated for new cohorts. The real payment came in the satisfaction of learning and experiencing the craft you loved.

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Lovestruck I was. Many a time, I walked on air as I bounced home, remembering the beautiful newborn that had just been miraculously pushed into my hands. But as time progressed, I missed – or ignored – the emerging red flags.

The wards were permanently short staffed. By the second year, I found myself being used as ‘staff’ instead of ‘student’ in low-risk areas. ‘Breaks’ on an eight- or twelve-hour shift were a luxury, not an essential. A quick dash to the loo whilst running in between patients and finding sustenance from the ‘thank you’ chocolates left in reception became the norm.

Shifts never ended on time – typically due to a lack of staff to hand over to. The fear of litigation loomed large, and practice often felt more ‘defensive’ than ‘responsive’. The constant requirement for documentation interrupted the flow of organic relationship building and care providing.

As students, we were shielded to an extent from the negative sides of midwifery. Kind mentors would insist we take a break or encourage us to go home before our legs gave way. Unqualified, we were free from the threat of losing our registration, and we could spend time building relationships with our women and their families instead of documenting our every breath. Alas, we would not remain students forever.

With the thrill of qualification came the terrifying removal of the protective mentor’s shield. Caring for women and their families was still the ultimate high for me; but unfortunately, the anxiety around their safety – and my sanity – became the ultimate low. The system wore me down, not the people I cared for. The lack of staff, the overcrowded wards, the constant life-threatening juggling act. I was permanently anxious. I would frequently leave a shift exhausted, back literally breaking, bladder bursting and spirit just a tiny bit more broken.

The unpredictability of each shift terrified me. I can remember starting a night shift on the postnatal ward, being moved to the antenatal ward – while still caring for my postnatal charges – and then delivering one of my antenatal women on labour ward. After 14 long hours with no break, I emerged from the delivery room with a fresh newborn wrapped around my neck, begging to go home to my own children.

Yet barely through the door home, I was back on the phone. ‘Has that baby in bed 3 fed yet?’, ‘Can someone check the CTG on the woman in bed 6?’. My husband removed my shoes, I drank a longed-for cup of tea, then another, and then another.

This was not the exception but the accepted rule. I would have loved to spend that night providing life-changing care to all those women and babies. Instead, I was gasping for air just trying to keep everyone safe. Too many women, too many babies, not enough staff.

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The professional cost of giving the ‘bare bones’ of care was a constant source of frustration and anger to me. Job dissatisfaction corrodes morale. I have a friend who is a decorator. He painted my living room last year. He is a perfectionist, prides himself on his smooth finishes and straight lines. He offers sage advice when I get carried away with clashing colours and he leaves every house he paints a better place to live. Each job he completes fires him up for the next. He is proud to show his customers his work.

Imagine if he was a midwife. ‘I’ve slapped some colour on the walls – if you squint a bit, you can’t see the dodgy lines; sorry I didn’t get a chance to do the skirting boards, you can hide them with the furniture; didn’t do the ceiling but it’s not so bad, just try not to look up. Anyway, got to go, didn’t want to say but I’ve been decorating two other houses at the same time, and I’ve not finished them either.’

It would be demoralising, embarrassing, sad. Not what he trained for.

During my last shift, I attended to a distraught mum as she delivered a 20-week-old, much-wanted baby in the maternity reception bathroom. The desperate mum was waiting for a bed. There were no beds. And not enough midwives to staff one even if one was available. It was 3 a.m. in the morning. Ten years from that inspiring interview and seven years on since qualification, I was done.

Sadly, I was not alone. Approximately one-third of my cohort of 30 had left the profession by the time I hung up my stethoscope. Some stayed within the NHS (I did). Some could not get far enough away and went into other roles, as diverse as overseas property management and cake making.

The solution appears simple – hire more midwives. But like me, so many just would not go back, and so many newly qualified just will not stay. Changing the landscape of midwifery goes far deeper than throwing more hands into the fields. The fields need to be radically dug up and a new fresh and women-centred field sown.

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Answer me this… would midwifery be in this dire a state if men gave birth? I can’t see that men would be expected to tolerate a maternity system that struggles to provide safe, never mind (don’t make me laugh), holistic care if they were the pregnant ones.

The way we treat our pregnant, labouring and postpartum women is a tragic indictment of the way society too often treats women, and mothers in particular. Second-class, disposable, put up and shut up, vessels for male folly, unworthy of care. That women and their bodies don’t matter is no more evident than in maternity wards worldwide.

My love affair with midwifery will never end. I can’t go back to the trauma of the wards, but I can’t completely walk away either. My passion for the care of women is still as unshakable and necessary as it ever was, if not more so. Grassroots change is needed, and my pen is mightier than my stethoscope at this point.

So, I sit here, shoeless, swinging on my chair, animatedly chatting to Substack, writing about midwifery, misogyny, mental health, and more. Advocating for women, for mothers, for families. I never wanted to leave midwifery; midwifery is my home. I cannot deliver babies anymore, but I am working on delivering the truth about the treatment of women and mothers. I would love for you to join me.

A major transformation is taking shape in Cambodia’s social care system. What started as a grassroots effort to stop children from being put into orphanages is now being scaled nationwide as the blueprint for social protection — thanks to one community model revolutionising the country’s approach to care.

What should a society do when families are unable to care for their children?

For decades, the default answer was orphanages — residential institutions where children without parental care are looked after by staff. However, as evidence mounted that orphanages do more harm than good to children’s well-being, many countries moved beyond the orphanage model, opting instead for foster, family- and community-based systems to house and care for vulnerable children.

In countries with underdeveloped social support systems, though, charity-run orphanages remained a prevailing solution. And in Cambodia, where about one in six people live below the poverty line, families who couldn’t provide their children with adequate food, healthcare, or education turned to orphanages as a last resort. This is why 80% of children living in Cambodian orphanages are not actually orphans, but children whose families felt they couldn’t afford to care for them1.

A care system in crisis
In the early 2010s, Cambodian orphanages came under fire. Emboldened by the growing demand for “orphanage tourism”, it became obvious that many had been abusing and exploiting children for profit.

Orphanage or ‘volontourism’ emerged in the 2000s as an increasingly popular form of tourism in developing countries. Seduced by the promises of white saviourism, wealthy tourists and young international volunteers would visit orphanages for a “feel-good” travel experience, unaware of – or undisturbed by – the fact they were helping to create an “orphan-industrial complex”2.

Between 2005 and 2015, the number of orphanages in Cambodia increased by more than 60%. Children were often “recruited [or] trafficked to fulfil the demand for ‘orphans’”3, and purposefully “kept in poor health, poor conditions and malnourished in order to elicit more support in the form of donations and gifts”. Once supposedly an institution of care for vulnerable children, Cambodian orphanages had become a profit-generating machine, with children the commodity being sold4.

Recognising what had now burgeoned into a full-blown crisis, the Cambodian government made a public commitment in 2017 to shut down all their orphanages and shift to a family- and community-based care model.

However, until recently, those efforts had largely failed. Critics argued that the solution was a cosmetic one: it didn’t address the social realities at the root of why children end up in orphanages in the first place. Forcing their closure with no formal protection system in place to ensure children’s safety going forward meant many would merely return to a life of poverty – putting them at further risk of trafficking, child labour, underage marriage, and other forms of abuse and exploitation5.

But in June 2025, that changed. Inspired by a grassroots social protection initiative developed in the northwestern province of Battambang, the Cambodian government finally took steps to address these root issues when they adopted the Village Hive Model as their national child protection framework.

The model
Kickstarted by Cambodian Children’s Trust (CCT), a local orphanage-turned-NGO, the Village Hive Model offers a groundbreaking framework for a community-led social protection system. The three-tiered, upstream model works to eradicate both poverty and local dependence on charity.

Tier 1: Universal prevention
The foundation of the Hives is the strengthening of public services, like schools and health clinics, to ensure universal access. These essential services raise well-being and living standards for every family in the village.

To prioritise community agency, the programme challenged school and clinic staff to identify their own strengths and needs. CCT’s role then became primarily to supply what they asked for — a non-directive approach rare amongst NGOs.

The Hives invest in public health infrastructure by stocking up on essential supplies, ensuring clean, functioning, and accessible facilities. They provide health workers with additional staff and training opportunities. Local health centres are then better equipped to prevent disease and manage acute and chronic conditions when they arise.

Within schools, the Hives ensure that facilities and curriculums are accessible and of high quality. They provide teachers with additional staffing support, supplies, and training in pedagogy, ICT literacy6, child protection, child rights, and positive behaviour management.

Furthermore, the model provides opportunities for students to participate in extra-curricular activities, life skills classes, remedial tutoring, and more. These efforts create a public school system that helps every child learn and thrive in a safe, nurturing, and stimulating environment.

Together, the strengthening and universalising of these essential services are designed to set children, families, and communities up for success for years to come.

Tier 2: Early intervention
Once basic public services are in place, the Hives’ early intervention scheme attempts to anticipate crises by tackling poverty at its core. Social workers are referred to at-risk families, who they guide through a six-step journey to financial independence.

Outlined in the graph below, that journey starts with conducting a full audit of the family’s basic needs, as well as their monthly income and expenses. This helps connect each family to appropriate public services, design them a financial literacy training and budget, calculate a support payment, and help them set a financial goal.

The social workers then work with families to build a business plan or connect them to employment, and continue monitoring and supporting them to help them reach their goals.

Poverty is a root cause of many issues facing local communities, including family separation, child labour, and trafficking. The support provided to these families equips them with the tools they need to shift their focus from day-to-day survival towards long-term stability. When families gain financial literacy and independence, they become less reliant on charities and are better able to support their children, ultimately decreasing the likelihood of these children falling into exploitative situations.

Tier 3: Crisis response
With prevention and early intervention systems in place, fewer families reach a point of crisis. This means response services are no longer overburdened, allowing them to deliver care more effectively to those in need.

When a crisis does arise, such as reports of abuse, neglect, family separation, child labour, or trafficking, the Hives are equipped with a range of services to address the issue and offer safe alternatives. These include a 24/7 emergency hotline, counselling, crisis housing, kinship care, care leaver support7, family reintegration, addiction support groups, and disaster relief.

When social workers determine that a child can’t safely be cared for by their parents, they work with the extended family network to find other options, prioritising placing the children with family and friends they feel comfortable with before resorting to foster care. They support carers with child protection training and financial support to ensure they are well equipped to provide a safe and nurturing home for the child. They also offer counselling to the child and family to help them work through their challenges.

With this multi-layered and interlocking network of social protection, the Village Hives work to systematically ensure no more children end up in institutional care — providing a blueprint for what truly effective community-based social support can look like8.

Empowering communities
The process of building the Hives began with ‘co-creation workshops’ in each target community. These brought in the voices of local leaders, public servants, and other stakeholders to identify local child protection issues and brainstorm potential solutions. Since this initial ideation, co-design workshops have continued to inform the evolution of the Village Hives.

“I’ve never seen another NGO work like CCT. The Village Hive is as pioneering as the astronauts on the Apollo mission”, said Hak Chanley, Deputy Head of the Cambodian Ministry of Social Affairs, Veterans, and Youth (MoSVY). “I saw the commune chiefs, local leaders, government and CCT working so well together. Everyone has the same goal [...], supporting families who have problems until there are none.”

This ability to drive and define their own solutions is one that Cambodian communities have routinely been deprived of. When the genocidal Khmer Rouge regime effectively demolished the country’s care infrastructure in the 1970s, international NGOs stepped in to fill the gaps. Though most of these organisations had good intentions, they created a national care system that depended on foreign charities to deliver essential services.

For decades, this cycle of dependency has deprived locals of empowerment and leadership opportunities, making them reliant on foreign actors to define their issues and prescribe solutions. And sadly, those were rarely rooted in local context and long-term sustainability.

“We want to start a movement to shift power from NGOs back to local communities,” said Pon Jedtha, CCT co-founder and Country Director. “Instead of all the NGOs working in the private sector, which they have full control over, we want to see [them] work within the public sector, using their donations and philanthropy from around the world to invest in building universal public services and trusting communities to do this work.”

CCT’s path towards “breaking the cycle of charity” has not been straightforward. In fact, Pon Jedtha and co-founder Tara Winkler initially developed CCT itself as an orphanage in 2007, before undergoing a restructuring when they realised that most children ending up in their care were not actually orphans. Since then, the organisation has only continued to learn and adapt to what local communities actually need to thrive.

“In 2019, we realised we had hit a dead end. If CCT continued down the same path we were on, Battambang would be dependent on us delivering essential services forever,” said Jedtha. “We deserve a community that can stand on its own and care for its people. Our children, and our children’s children, should grow up knowing the safety of a well-resourced community.”

Working themselves out of a job
This realisation is precisely why one of the organisation’s core tenets is its exit strategy.

It’s a paradox many nonprofits face: if they actually solve the problems they set out to solve, they render themselves redundant. While many organisations shy away from this reality, CCT has made obsolescence central to its mission. As Winkler explains:

“The international development sector was built on a mindset of empire-building, where organisations grow their own brands, programs and infrastructure that they operate privately in parallel to public systems. Shifting to a deeper, more humble focus on solving the root causes of problems in the Global South requires that those same organisations let go of the structures that keep their own names alive.

That’s uncomfortable, because it means losing the ability to stake a claim and say: ‘This is our school, our centre, our program.’ Yet that loss of ownership is precisely the point. When projects blend seamlessly into public systems, the logo may fade, but what remains is far more powerful: a lasting solution owned by the community itself.”

CCT hopes to ‘work themselves out of a job’ by 2032, made redundant by fully functional and self-sustaining Village Hives. This would mean that communities have taken complete charge of their own social protection services, successfully tackling issues as they arise and implementing ongoing, locally driven and informed solutions.

And they’re well on their way. To prioritise localisation, CCT has shifted to a fully Khmer leadership team and implemented an affirmative action policy that ensures equal pay between local and expatriate employees. This policy also stipulates that CCT can only hire expatriates if there is demonstrable proof that their expertise is not available in Cambodia9. As a result, there have been no expat employees at CCT for the past five years.

Since their launch in 2019, the Village Hives have had an enormous impact. According to CCT’s data, families have been shown to increase their income by 142%, reduce their debt by 61%, and continue thriving independently even after completing the early intervention journey10.

As of 2024, the Hives were supporting over 50,000 people across three communes and 18 villages in Battambang province. CCT plans to have the district’s ten communes and 62 villages fully integrated by 2032. And with the model now being adopted by the national government, its scale and impact are only going to keep growing.

“We plan to expand the Village Hive to all 25 Cambodian provinces and the capital city,” explained Siem Sopheak Votey, Family Affairs Director within MoSVY. “We want provincial, commune, and NGO partners to implement [it] together to create one cohesive system to address the root causes of poverty.”

Rebuilding trust
One of the most common concerns about shifting towards a community-based model and integrating the Hives into the public system is about government corruption. In 2024, Cambodia ranked 158 out of 180 countries in the Corruption Perceptions Index, making its corruption issue amongst the worst in the world. Because of this, a lot of foreign trust has been lost in the country’s public institutions.

Sustainable, publicly-integrated Hives require complete trust and cooperation between all its stakeholders. This is why the Hives tackle corruption head-on to rebuild this trust. They’ve implemented strict anti-corruption policies and procedures, requiring regular reporting, training, and discussion forums to evaluate progress and brainstorm solutions11.

“There’s a deeply entrenched idea that communities in the Global South can’t be trusted to run their own affairs. But corruption isn’t an insurmountable problem — it’s not [inherent to] the culture or character of the people. Corruption is simply a symptom of a flawed system,” said Tara Winkler. “We are proving that with the right checks, controls and transparency, we can overcome concerns of corruption.”

These efforts are ongoing, but most participants report that they are already proving effective in ensuring accountability and preventing corruption. Local leaders are also reporting a better functioning relationship between governments and communities.

“[The Village Hive] has promoted inclusivity and encouraged greater engagement between the community and local government,” said Chea Vibol, from Ou Char’s Commune Council. “Local governments have become more responsive to community needs, actively listening to feedback and making fair, impartial decisions that reflect the best interests of our people.”

Funding systems change
While corruption is a major concern, it’s not CCT’s only barrier to securing funding for the Hives. The organisation has found that their project’s complex and long-term nature often confuses donors, who are usually more attracted to clear visions and immediate results.

“Systems change work takes time, and it is not always easy to explain. It was much easier for CCT to raise funds when we were an orphanage!”, Keir Drinnan, Managing Director of CCT Australia – a branch that provides financial and strategic support to the Hives – told me.

As an NGO, CCT has historically mobilised international donors to raise much of the money needed for their projects. However, creating sustainable, publicly-integrated Hives ultimately requires financial backing from the state — and that has often proved difficult to come by. “A lack of understanding by the general public about the upstream approach that CCT is working on”12 can make it challenging to get communities on board and pitch the project to government officials, who might struggle to see the vision the Hive is working towards.

But CCT carries on demonstrating the model’s evidence-based impact. To them, self-sustaining communities where each member receives the care they need to thrive is a vision worth fighting for. And despite initial challenges, the Cambodian government is now contributing their own funding to the project, marking a major step towards the Hives’ sustainability — and CCT’s dissolution.

Globalising localisation?
Localisation is at the heart of the Hives. Their very essence is to be built by Cambodians, for Cambodians. But this doesn’t mean that their community-driven framework is not applicable in other cultural contexts. For CCT, localisation must be the basis of any systems change.

“At its core, localisation should be a matter of power — who is in control and who is making the decisions,” said Winkler. “Power never truly shifts if it remains within the orbit of foreign-controlled NGOs and donors. The only way to create lasting change is to build robust social welfare services within the public system, where the roots of control are inherently local.”

So, while the Hives’ specific characteristics may not work anywhere, its core tenets can.

The Village Hives conceptualise care as a deeply communal, shared responsibility; a process of co-creation and co-evolution. Theirs is a complex, interconnected system of protection which acknowledges that the issues our care systems attempt to fix are mutually inextricable, and thus require a holistic approach.

The model shows that far from a saviour gallantly swooping in to save someone in crisis, effective care systems work outwards from the core. Systems where each member not only has their immediate needs met, but is set up to continue flourishing for decades to come, require the active involvement of communities.

On a global scale, this means communities have power — from the grassroots, village level all the way up to the national policy level. Governments and NGOs need to trust and support them to drive their own change.

And as for each of us, it means we carry a responsibility to ground our practice of care within our own communities, in our daily interactions, as a precondition for building anything else.

Myriam Chatot is a sociologist working on family, gender, and health, affiliated with the Centre Max Weber in Lyon. Marine Quennehen is a sociologist focusing on family, gender, and prison, based at the Interdisciplinary Research Centre on Families and Sexualities at the Catholic University of Louvain.

Their book, “Being a feminist dad: mission impossible?”1, presents a central observation: there is a disconnect between perceived changes in how involved modern dads are, and a reality that remains deeply unequal.2

That disconnect stems partly from shifting reference points. Men compare themselves to their own fathers, relative to whom they are indeed much more present. But sociologists, feminists, and many women measure fathers’ involvement against that of mothers – who still bear the bulk of family responsibilities.

How can we acknowledge the efforts being made without obscuring the work that remains? Do the mainstream discourses around involved fatherhood strip it of its feminist content? Can institutions help us move beyond an exclusively two-person model of parenting? In this interview for The Fifth Wave, the researchers reflect on the obstacles still standing in the way of true feminist fatherhood.

Despite talk of significant shifts in fatherhood, you note that the time fathers actually spend with their children hasn’t increased all that much. And even when it is more evenly distributed, qualitative studies reveal persistent knowledge gaps within couples – dads can be very present yet shoulder little to none of the mental load.

Should we move the debate away from the notion of ‘involved fatherhood’ toward something more explicit, like ‘competent’ or ‘capable fatherhood’?

Marine Quennehen: The question would quickly become who gets to define what a “capable” or “competent” father is. If men define themselves as such, we’re back to the same problem: they may be more capable than their grandfathers, but they’re not necessarily as capable as their partners.

We’d need to clarify expectations: as sociologist Michèle Ferrand famously showed, being competent isn’t just about giving a bottle, but knowing the right amount of formula, how to wash, sterilise, and put away the bottle. Adding new categories without clear content risks leading to purely cosmetic change.

Myriam Chatot: When I hear “capable father,” I think of autonomy. That’s what emerged from my interviews with fathers on full-time parental leave: being alone with their child forces them into responsibility and self-sufficiency. Each couple can then set its own standards as to what being autonomously capable looks like.

As we argue in the book, the norms of “good parenting” are shaped by institutions and the upper-middle class. The risk with “capable father” is therefore also that it could become another way to stigmatise working-class fathers.

Because if these fathers are deemed “not capable,” it implies they need re-education, that programs must be put in place – when in reality, their limited involvement often stems from lack of time, economic resources, or cultural capital.

Marine Quennehen: The key is that fathers feel able to act, to care for a child without their partner’s oversight. The notion of autonomy helps confronts the reality of a fatherhood that happens mostly alongside the mother, the one really giving the instructions.

The language of education comes up a lot in the book: the “bad student strategy” [i.e., weaponised incompetence], women’s role as “transmitting parental knowledge”. There’s a kind of infantilization of men as attending “the school of parenting”.

Yet these same men routinely highlight their professional competence. They don’t see the contradiction between their infantilization at home and their autonomy at work. It’s a strange dissonance.

M.C.: It’s an inferiority that’s fully compatible with their masculinity because it’s tied to tasks themselves perceived as inferior.

A study from a few years ago on domestic chores in the military showed that these tasks were assigned to the lowest-ranking conscripts, those at the bottom of the hierarchy. When we had mandatory military service, that means we were teaching entire generations of young men that housework is degrading, uninteresting – and that it’s therefore only natural for women and those deemed inferior to be assigned to it.

So they understand there’s no prestige in these tasks. But this perception can also benefit men who do invest heavily in the private sphere: they are praised as heroes for caring about something others consider secondary.

You write that some discourses “capitalise on fatherhood,” making the subject increasingly consensual while erasing its feminist political dimension. But at the same time, isn’t that the inevitable fate of any social movement: as it becomes more mainstream, it gets diluted? Isn’t it still a feminist victory, regardless of whether it’s acknowledged as such?

M.Q.: It’s always positive that fatherhood is gaining importance. But outside certain social circles, I’m pessimistic about how widespread this consensus really is. Looking at the comments under recent articles about our work… There’s still massive resistance. Even when attitudes do shift, men are reluctant to call themselves “feminist fathers” or even feminists. The word is seen as scary.

There are notable individual changes. Some fathers adjust their careers, have real conversations with their partners about equitable parenting. But at the macro level, deep change is much slower.

M.C.: Feminist struggles have secured major victories in this respect, that’s undeniable. It’s now widely accepted that men should be more involved in the home. But what does “more” actually mean? That’s the question our book explores.

It looks like politics also has that kind of ‘flattening’ effect on the fight for equal parenting.

M.C.: Absolutely. One thing we don’t discuss in the book is the 2014 French parental leave reform, which reserved part of the allotted leave for the second parent. It was passed as part of the law on real equality between women and men, and hailed as a revolutionary measure that was going to change everything.

But when you look at parliamentary debates, the arguments revolved mostly around work. Supporters of the reform wanted to encourage women to return to the workforce earlier; opponents wanted to protect businesses and men’s role as breadwinners.

Either way, the well-being of parents and children, and factors that influence it like perinatal mental health, was barely considered. The central assumption was that both parents’ primary commitment should always be work, and that nothing should disrupt the economic status quo.

And by the way, unlike the German reform which led to 20% of fathers taking leave from a prior 3%, the French version had negligible effects.

For more info on this reform, see my analysis of why it failed:

The book notes that the perspectives of children themselves are often overlooked in discussions around parenting choices. You mention the case of a father who explained that his kids asked him to work less on Wednesdays, as he’d been given the option to; he replied that he couldn’t, or else they wouldn’t be able to go skiing or to sailing camp.

But at no point did he ask them whether they’d prefer spending Wednesday afternoons with their dad over an annual ski trip. The way these men articulate it, fatherhood often comes across more as a social role – a checklist of duties and tasks – than as the construction of real relationships with individual children.3

M.Q.: This came up clearly in my research on pilots and flight attendants. For men in these jobs, family is just one variable among many, far from a priority. They often see themselves as model fathers because their irregular schedules mean they’re home when others are working, and because they provide a high standard of living. They don’t realize what their prolonged absences mean for their children, for their marriage.

Female pilots and flight attendants, on the other hand, feel the weight of absence more acutely. They prepare everything ahead of their departure: meals, clothes, childcare, pick-ups and drop-offs; they choose flights around their children and to attend family events. Yet they’re accused of having “Disneyland jobs.” Their children complain that they don’t see them; school staff remark, “You look tired” or “We don’t see you much.”

They embody absence, while the father’s absence goes unquestioned. Their partners sometimes even weaponise the children’s words: “See, they’re sad when you’re not here.” Suddenly, the children’s perspective matters – but only to guilt-trip the mother.

M.C.: There’s no secret: an interpersonal relationship develops with time, listening, attention, availability – care, in short. The more present fathers are – whether by choice or because they were made to by a shift in trajectory – the more they pay attention to their children as individuals.

I had one participant who was overwhelmed by work, on the brink of burnout. His wife threatened to leave him because she was equally exhausted. To reorganise his life and his availability and preserve his marriage, he changed jobs. Thanks to that, his perspective on fatherhood changed, too: he got to know his children better, learned more about their actual personalities. Today, he picks up his eldest from school, they chat, his son jumps in puddles on the way home; it’s an important moment of connection.

This theme of an awakening after a crisis or “shift in trajectory” is a recurring one, both in the book and in cultural narratives. It’s that image of the father who realises – too late, after burnout, a fight, a divorce – that it wasn’t worth it, that he missed out on his children’s childhoods, that he asked too much of his wife.

How can we ensure it doesn’t take a crisis to spark this realisation?

M.C.: Unfortunately, these regrets are often seen as inevitable. I remember a survey a couple years ago that asked fathers of young children, “Do you feel you spend less time with your children than you’d like?” Nearly half said yes.

When asked whether this made them feel dissatisfaction, frustration, or guilt, dissatisfaction was most commonly picked, whereas mothers would be more likely to feel guilt. Many fathers feel trapped by their work arrangement and powerless to change it.

That said, it would help to have more transparent discussions about both the joys of fatherhood and its bitter regrets. In the book, we talk about fathers showing their joy at being dads, showing they’re present; one man told us, ‘Feminism has allowed us to be a truly happy couple’; others told me in interviews that they didn’t expect to love their children this much.

Sharing these stories is essential, and we also need more men to speak openly about what they didn’t do, how they could have done better – especially from older generations, for whom this feeling is widespread, to help younger generations avoid repeating their mistakes.

M.Q.: When we asked men about who were their “go-to” people they could talk to about what it’s like to become a father, few could name any. The advice they got from their male relatives and friends was usually, “Don’t worry, you’ll figure it out as you go, don’t overthink it.” And maybe in a way that’s good advice! But when there’s an asymmetry, it means one person is doing all the worrying and thinking. They socialise each other into a kind of conscious passivity, avoiding real reflection or admitting difficulties.

We need to encourage men to question the deeper dimensions of fatherhood earlier – how it transforms their inner lives and relationships. Women are expected to talk about motherhood; it’s an experience that’s passed down across generations. But you rarely hear a father-in-law sharing his parenting experiences with his son-in-law or giving him advice.

What would a truly transformative parental leave reform look like?

M.C.: Mandatory, well-paid, longer parental leave. A paternity leave aligned with maternity leave for essential co-presence early on, followed by staggered periods that can’t be taken simultaneously. As it stands, maternity leave still contributes to setting early asymmetries into stone.

With respect to work, we need to stop considering that it’s necessarily a person’s primary organisational concern – not everything has to be organised around work, work could also be organised around other areas of life. And we need to stop treating parenthood like a hobby you have to apologize for to your employer.

M.Q.: And beyond the focus on the parental couple, there’s a huge urban planning challenge to rethink our modes of living and inch towards more collective spaces.

Our current spaces aren’t designed for children to move around independently, to be autonomous; commute times can be long, communities are spread out. Relying on other parents or family is harder when people live far apart, but it can lighten the load and give children a network of support and role models. We need to move away from the idea that child-rearing rests solely on two people.

The risk is that even the work of maintaining community-based models tends to fall to women. Some people advocate for introducing “grandmother leave,” for example, without realizing that they’re still assigning all care work to women, just of a different generation.

M.Q.: Exactly. We have to ask: who sustains the village? And we need to adapt institutions to this new paradigm. I’ve heard from fathers who had to insist and argue with daycares to be listed as equal contacts on their children’s files. Some couples create shared email addresses, because we’re not used to sending child-related information to two people. But we have to ensure the shared address doesn’t by default become the mother’s.

M.C.: Systematically informing fathers could also help working-class men who can’t be at school pickup. If they had access to information, they might feel more involved, ask questions, and strengthen their bond with their children. This would expand the notion of “presence” without reinforcing unequal norms.

Finally, who do you care for, and who cares for you?

M.C.: I care for my parents, not in a daily way because they live autonomously, but psychologically. I try to help them articulate things, open up about unspoken feelings, especially my father. It’s a generation that doesn’t talk, so there’s a kind of reverse socialisation involved in getting him to express himself. And as for me, my friends and partners take care of me.

M.Q.: I care for my partner, my roommate, and my rabbit. They’re my daily companions. To care for me, I can count on my friends, who are very feminist and deeply care about care; and I can count on my partner, too.

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Christine Leroy is an associate professor of philosophy at the École des Arts de la Sorbonne (Paris I University) and the University of Lille (STL lab). Her book Kinaesthetic Empathy, Ethics and Care: A Phenomenology of Dance1 offers a reflection on the embodied roots of our concern for others: without the body, there is no care.

From palliative care and disability rights to the place of motherhood in feminism, Christine’s interview with The Fifth Wave Institute examines how an ethic of care can enrich our collective ability to carve out space for alterity.

Pour lire cet entretien en français:

Your master’s thesis focused on the history of euthanasia and its moral stakes for today’s societies. What does an ethic of care bring to the discussion?

It points to a troubling gap: that between the state’s investment in the right to die and its disinvestment from care that helps people live better. It considers three perspectives in particular: that of disabled people, that of care professionals, and that of the individuals themselves facing the end of their lives.

Drawing on arguments laid out by disability rights activists, sociologist Patricia Paperman – a key figure in the dissemination of care ethics in France – points out that disabled individuals are regularly encouraged to consider suicide, through back-handed remarks like “you’re so brave; I couldn’t live like you”.

It does indeed take immense courage for disabled people to assert their right to exist and the value of lives that defy conventional norms. Lives with disabilities are costly for society; the state’s withdrawal of support discourages access to medical assistance, subtly pushing people to prefer death to a life lived in undignified conditions.

The choice of assisted suicide, then, is not always free, despite what theory might suggest: ultraliberalism devalues disabled human life, placing extreme pressure on those deemed ‘unnecessarily burdensome.’

Far from this being a traditionalist or reactionary position, many radical-left activists like No Anger, a queer, anarchist, and disabled artist, or Elisa Rojas, a poly-disabled lawyer and activist, have been sounding the alarm.

Deeply invested in fighting for the recognition of the right to vulnerability, Rojas sees France’s proposed euthanasia bill as a betrayal by the left of disabled and marginalised people. To her, the legalisation of euthanasia would mean the surrender of humanist values to the pressures of economic liberalism.

As for care professionals, though few would openly admit to it, many know they have sometimes wished to forever silence those difficult and sometimes unfriendly bodies – if only in a fleeting, quickly suppressed thought. This is especially true given the exhausting working conditions in hospitals. And unlike procedures like abortion, which is only legally allowed under highly regulated conditions, current euthanasia legislation authorises without truly prohibiting.

It is therefore extremely anxiety-inducing to place this burden of life or death on caregivers – who already often face precarity themselves – while simultaneously keeping palliative care underfunded2. We cannot emphasise an ethic of care without acknowledging the suffering that legislative decisions can inflict on those who provide care.

Finally, from the perspective of those nearing the end of their life, practice once again clashes with theory. My grandmother is in a nursing home. Every day, she says she wants to die. But when the nurses make a mistake with her medication, she shouts, “They’re trying to kill me!” Does she really want to die? It seems to me she would rather live better. She feels condemned to isolation, lacking any sense that she matters to anyone. She wants social connection, relationships, and life around her.

As a philosopher working on care and someone who espouses left-wing humanism, I see the legalisation of euthanasia in its current form as dangerous. But nothing is either simple or final when it comes to death: I once had a deeply painful experience with a great-aunt who, after a stroke that left her able to move only her left eyelid, tore out her own feeding tube. She took her own life, in a way.

The debates on euthanasia remind us that death is at the heart of our lives, despite neoliberalism’s vast efforts to distract us from that fact. Applied to the end of life, an ethic of care calls for humility rather than certainty, while challenging us to be critical in the way we view solidarity. I do not believe we should force individuals to live, but I do believe we must listen to their pain rather than turning away and telling those who suffer to be forever silent.

Your book ‘Kinaesthetic Empathy, Ethics and Care’ argues for a particular care dynamic in the experience of dance. Where does this idea come from?

My own dance practice was never very caring. Trained in classical ballet, I developed a complex relationship with my body. The body is not something you manipulate like a pen: it sometimes does what it wants, and when the mirror does not reflect what you hope to project, you enter into a conflict with your own body.

And yet, paradoxically, even if you torture yourself to achieve a perfect arch, even if your feet bleed from friction in your pointe shoes, you also take great care of your body to make sure it moves in the desired way.

I had to stop dancing due to repeated fractures—sometimes, the body also breaks—and for a time, I could only watch. I found something in it that went beyond pleasure, a kind of balm for the soul, but I couldn’t pinpoint what.

I was particularly moved by the momentum, the lift, the sensuality of grace… It was neither purely intellectual nor merely aesthetic, but ethical: watching dance was good for me, regardless of the beauty of the choreography. It seemed to me that between what I saw and what I experienced, something akin to care was at play.

In the book, you write: “Ethics consists in restoring to the individual their human dignity; […] such care is a vector of cure in the therapeutic sense, its foundation: there can be no healing without the patient reclaiming their own body; to heal is precisely to move from the state of the patient—etymologically, one who suffers passively—to that of an autonomous agent.”

In contexts like disability, where the notion of autonomy differs from that of an able-bodied person, what does it mean to say that caring is about restoring someone’s autonomy or agency?

I think it is important to caveat that theory does not always hold up well against the harshness of reality. There is often more hope than reality in what I write.

That said, in contexts of reduced autonomy, such as disability or early childhood, we often face a dilemma: should we do things for the other person – which is obviously more efficient with respect to the end result – or should we accept that they are slower, less precise, and help them act?

When developing the concept of “portance” (carrying, support) philosopher Emmanuel de Saint Aubert borrows from theology the idea of an “all-sustaining” rather than “all-powerful” God: omnitenens3 and not omnipotens. Those who educate or provide care are sometimes too dominant when they should be supportive. Saint Aubert draws on osteopathy: when held from below, a baby will lift up their head. If you need someone to rise up, it’s better to support them than to try to pull them up.

This dilemma lies at the heart of the difficulty of caregiving: does helping someone mean doing things for them, or enabling them to do things themselves? It’s the basis of educational methods like Maria Montessori’s: if a child needs help, they’ll ask for it. Only help if asked, and never deprive a child of the desire to try for themselves.

For caregivers, it’s even harder to accept the slowness of a disabled person because everything has to be done quickly. It’s tough to accept the mediocrity of a gesture when you’re the one dealing with the consequences: if the person’s hand is shaking and they risk spilling everything, you’d rather pour the water yourself.

It’s not that the person isn’t autonomous; it’s that we deprive them of their desire for autonomy. Letting them try would require time and resources that are cruelly lacking. In this context, care – or what remains of it after hyper-rationalised costs and work schedules – often contributes more to the loss of autonomy than to its preservation.

Toward the end of the book, you write: “To exist for oneself, to give oneself form, is not to tear oneself radically away from a whole in order to face it, but to participate in it in one’s own way; to contribute ethically to the community is not to melt into it but to take up a unique, irreplaceable place within it.”

This passage echoes the parallel with dancing, where one can be simultaneously part of a whole and detached from it in a singular way. Binary discourses are rife on the tension between individualism and community, so it’s really interesting how this idea reconciles the two: we can be “irreplaceable” within a group, carve out a distinct place for ourselves through our contribution to the collective.

This is the direction my work is taking today. I’m trying to show that the common opposition between individualism and community is often not an opposition at all. It’s really two forms of individualism: a self-sufficient, sterile individualism on the one hand, and a fusionary individualism on the other, where identities and the uniqueness of individuals dissolve into a pathological indistinction. This is not a community but a vague amalgam of individuals.

To move beyond this opposition, I explore the idea that one cannot be unique without others: alterity must support, rather than erase, singularities. As philosopher Edith Stein argued, for empathy (Einfühlung) to exist, for there to be a relationship, there must be an awareness of separation. Without otherness, there can be no relationship. Similarly, for there to be a group, there must be individuals; but without separation between individuals, between self and non-self, there can be no true bond between subjects, and thus no collective.

Many well-meaning contemporary discourses ignore this human need for separation. Social media, which perpetuates the illusion of a loving collective, erases the boundaries between people, intrudes into the private sphere, and blurs the lines of intimacy. This is extremely anxiety-inducing and fuels a desperate need for barriers, for borders, which escalates into xenophobia and paranoia about “intruders” that threaten one’s identity. A lack of healthy otherness leads to dangerous othering.

The only ‘border’ that can remedy this social and nationalist anxiety is separation, distance between individuals, and the reinstatement of space and time for private life. These are essential conditions for creating liberating connections.

This dichotomy seems to reproduce the one between a total lack of concern for the other and a ‘pseudo-care’, a suffocating care, which Maurice Hamington calls ‘bad care’4: “I’m helping you, I help you so much that you no longer exist, only I exist”. There must be a middle ground. An ethic of care isn’t about everyone getting along and being nice: it’s an ethic that emphasises the relationship over theoretical norms about what one should or should not do, about what’s good and what’s evil.

But for there to be such a relationship, there must be distance between two distinct, separate poles. If we do everything for someone else, we’re not respecting this distance: we absorb difference into unity. Without true listening, there is no bond, no care. We must value distance, difference, otherness without othering: it’s a sine qua non of good care, care which respects both the caregiver and the care-receiver and leaves space for an encounter.

In a 2021 article titled “Killing the Mother”, you speak of a “symbolic matricide in the feminist quest.” What do you mean by that?

Feminism is to me first and foremost a struggle against male domination, which imposes itself on women and gender minorities through violence. Since this violence primarily comes from men, feminism understandably harbors a certain mistrust of men, who are more likely to be violent or dominant. And I can only agree – there was a femicide in my family.

But I also sense that within feminism sits another equally complex and difficult-to-articulate struggle between generations of women. For example, after Simone de Beauvoir’s generation fought for women’s rights, the following generation, that of Judith Butler and Monique Wittig, sought to challenge the idea that categories like “woman” and “man” could be so easily defined as mutually exclusive.

The next generation, in turn, revalued non-Western and sometimes essentialist or matriarchal conceptions of what it means to be a woman, as seen in Latin American and some Asian feminisms. Each generation continues to challenge the certainties of the previous one.

If there is a common thread in all feminisms – namely, the fight against male violence – each generation also asserts the right to be a woman differently, to be a woman in place of the other woman, the one we need to distance ourselves from in order to become who we are. And this symbolic woman, who passed on to us the rules of her generation, is often projected onto the figure of the mother. Hence my use of the term “matricide.”

This explains part of some feminists’ rejection of motherhood: it’s a refusal to pass on what was received5. This was especially true in the generation before mine.

There was a time in France when being a mother was seen as anti-feminist, a submission to the injunction of motherhood. The new feminist generation is now much more inclined to talk about motherhood and fight for mothers’ rights – the right to breastfeed in public, the right of single mothers to be supported.

Today, being a mother, with or without a partner, is more widely recognised by feminists as simultaneously beautiful, worthwhile, and difficult. We grant more of its full complexity to the experience, which is as universal as it is unique. But let’s not fool ourselves: there is still much to be done for the recognition of the rights and needs of mothers.

In any case, I’ve benefited first-hand from the lasting impact of feminism. I recently filed a police report against an erotomaniac individual who has been harassing me for thirty years, and for the first time, my complaint was taken very seriously, even with a degree of concern, by the officers. Fifteen years ago in Paris, I had been met with laughter and indifference. This time, I felt support, a form of care from the police. That is no small thing.

And finally, as I always ask: who do you care for, and who cares for you?

I take special care of my relationships with current or former students. They’re a bit like my kids – with added distance, of course, we’re not family; but it’s very precious. And it goes both ways: my former and current teachers care for me. A few weeks ago, my old primary school teacher sent me photos of myself that she’d found. I saw the letter, recognised her handwriting on the envelope, and started crying.

My current dance teacher also continues to help me grow, assert my femininity. She’s an extraordinary woman: I really admire her as a potential horizon for myself. She’s the one who told me recently, “those we care for are always a bit like our children.”

Perhaps that is the care relationship: raising others and being raised ourselves – in the literal sense of elevation, of reaching higher6. It does not always take hold: there can be missteps, followed by efforts to repair; like with our parents, with whom there is less distance with them, more projection, which can make the relationship more difficult. We return to separation: distance lets us build a relationship more thoughtfully, since it isn’t self-evident. And this effort elevates both parties.

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Since the Covid-19 pandemic, countries across Latin America and the Caribbean have been making significant strides when it comes to re-centering, valuing and supporting care. Caregiver-friendly urban innovation, grassroots community initiatives, bold policy commitments, and shifts in economic calculations are reshaping the place of care in many of these societies, providing scalable models for other regions to replicate.

In Bogotá’s “Manzanas del Cuidado”, carers come in for the homemade breakfast, to exercise, file their taxes, or simply for a break and a chat. While she works on the script for a play her and other local mothers are putting on, Natalia Moreno’s elderly mum is over at the cycling session and her son is taking an art class.

There are twenty-five of these ‘Care Apples’ (also referred to as ‘Care Blocs’) in the Colombian capital, with the city planning to reach 45 by 2035. These free public facilities are designed for unpaid caregivers to access a range of activities, services and training programs while the people they care for are attended by staff. Mobile units are dispatched to reach those unable to leave their homes.

Though beneficiaries are primarily women – who in Latin America spend about three times as many hours on unpaid care work as men – the Manzanas also have a “School of Care for Men” as part of their educational component. Practical courses teach men a range of care tasks, and theoretical ones work to dispel the myth that only women can innately care.

Launched in 2020 under the leadership of Diana Rodriguez Franco, the Secretary for Women in then-Bogotá mayor Claudia Lopez’s office, the initiative targets the city’s 1.2 million women who spend their days informally caring for others. According to Colombia’s National Statistics Department, 90% of them are very-low-income, 20% have a chronic illness, and 33% report “never having any free time”1. That means no time to go to the doctor, work out, or see friends. Most of them also never complete high school.

A region-wide trend

The ‘Manzanas del Cuidado’ initiative is part of Bogotá’s participatory care system, which coordinates care provision to the city’s households between the state, the district, the private sector and civil society. It’s far from an outlier: in the last few years, cities like Buenos Aires, Santiago, Monterrey, Quito, Panama City and others have set up their own innovative local frameworks to support caregivers.

In Brazil, Belém’s Municipal Care Policy supports the ‘Ver-o-Cuidado’ project, through which public officials and civil society leaders are trained in care policy design and advocacy. Hundreds of paid and unpaid female caregivers have also received guidance to better understand their rights, defend the value of their work, and demand better care policies. The training has since been expanded to a national e-learning platform.

In Mexico City, intergenerational centres known as “Utopias” (Unidades de Transformación y Organización Para la Inclusión y la Armonía Social, or Units of Transformation and Organization for Inclusion and Social Harmony) bring together swimming pools, sports grounds, children’s play areas, and free activities for the elderly – which include dance classes, massages, aromatherapy, and martial arts.

Piloted by visionary mayor Clara Brugada in Iztapalapa, one of the city’s poorest neighbourhoods, the Utopias have reportedly already brought down serious offences like assault, robbery and murder by 25 to 74 percent depending on the area.

While these innovations are not all new – Uruguay’s National Integrated Care System (SNIC) has been operational for over a decade – they are part of a wider regional trend that picked up in the wake of the Covid-19 pandemic. Societies often experience a renewed need for social support and community ties in the wake of an economic crisis: but Covid highlighted more blatantly than ever the chronic lack of recognition and grossly uneven distribution of care, as well as the inadequacy of public infrastructure.

In Latin America, the pandemic set women’s labour market participation 10 years back as majority-women service jobs in tourism, hospitality and paid domestic work were particularly impacted by the crisis. Many struggled to return to work even after restrictions were lifted. They often faced choices not uncommon to women across the region who struggle to provide for their families: the informal economy – picking up odd jobs or selling cigarettes on the street – prostitution, or becoming drug mules for the cartels.

This reality compounded an already precarious situation marked by population ageing, the worsening impacts of climate change, and mounting political tensions over the harshness of life under neoliberalism. A wave of protests swept countries like Nicaragua (2018), Chile (2019), Colombia (2021), and Cuba (2021) during this period, some of which were violently repressed.

The combination of these various crises laid bare the need for a bold approach to care as a strategic investment in social justice and development. Rather than taking surface-level steps to appease specific interest groups, many Latin American countries began redesigning entire economies around care as essential public infrastructure.

Significant progress has been made since then. To point to just a few national examples, Panama’s 2024 care law created new diplomas to better recognise skills in eldercare and disability care; Colombia and Chile’s new care systems are already estimated to contribute 19.6 percent and 25.6 percent of their respective economies. Meanwhile, Mexico and Peru are promisingly moving towards embedding their own comprehensive frameworks into law.

The essential role of grassroots activism

Particularly crucial to these policies’ effectiveness and revolutionary nature is the fact that many of them were developed with genuine input from civil society. Chile Cuida, Chile’s ambitious project for a new care-forward constitution, was the product of a large-scale public consultation conducted in 2023 by a specially created Constituent Assembly2.

More than twelve thousand people – 80 percent of them women – shared their lived experiences, helping tailor Chile Cuida to their specific struggles and needs. The process was also enriched by the tight collaboration between public officials and grassroots organisations like APañales, a network supporting caregivers in vulnerable communities.

Similarly, Belém’s municipal care policy was developed in conjunction with the Belém Care Activist Network, which brings together thirteen feminist organisations who have spent decades laying the seeds of this change.

“The biggest shift has been putting care at the centre of public policy, not just academic debates”, said Virginia Gontijo, programme lead for UN Women Brazil. “For the first time, care policy in Brazil is being shaped with full participation from both government and civil society.”3

Persistent obstacles

The region is, of course, not homogenous in its outlook on care. There are 33 countries in Latin America and the Caribbean, and only 17 are actively building transformative care systems4 – each within its particular political, social and economic situation.

Entrenched gender norms and powerful religious institutions can delay progress on policies seen to disrupt the traditional family structure: most Latin American countries, for example, still provide less than 10 days’ statutory paternity leave.

Right-wing electoral victories are also threatening to reverse the last few years’ advances, as ambitious care policies become prime targets for neoliberal cost-cutting. In the two years since his election, hard-right libertarian Javier Milei has killed or cut back 47 out of Argentina’s 50 care provisions – including various childcare benefits, pensions for the elderly, and food stamps. Fifty ‘Community Care and Support Centres’ for people struggling with substance abuse have also been closed.

The region’s persistent security challenges mean that care is often a variable in the push-and-pull between short-term repressive frameworks and long-term, prevention-based approaches to tackling organised crime. It takes exceptional leadership to navigate this delicate balance, like that of Mexico’s Claudia Sheinbaum, who has so far managed to hold firm on both a bold care strategy and a strong stance on cartel violence.

Her administration is betting on a ‘third way’ between the equally ineffective strategies of two of her predecessors – Felipe Calderón’s ‘War on Drugs’ and Andrés Manuel López Obrador’s ‘hugs, not bullets’. Though recent assassinations are testing Sheinbaum’s stance, preliminary results showing a 32% drop in the country’s murder rate could make for convincing evidence that being both generous on care and ‘tough on crime’ is, in fact, possible.

Care-forward institutional leadership

The new ambitious tone on care echoes at the very top. In March 2025, the Inter-American Development Bank (IDB) launched a new initiative called “IDB Cares” to better structure and fund the development of care infrastructure across the region, stating that “care is the foundation of thriving societies and economies”. Last August, the Inter-American Court of Human Rights became the first international tribunal to recognise the right to care – which includes giving care, receiving care and caring for oneself – as an autonomous human right.

One regional institution in particular has been consistently pushing for a more holistic understanding of care: the Economic Commission for Latin America and the Caribbean (ECLAC). In 2022, at the commission’s 15th Regional Conference on Women in Latin America and the Caribbean, member states adopted the Buenos Aires commitment, placing care at the center of the region’s socio-economic agenda.

Last August, at the most recent conference, the Tlatelolco commitment established a Decade of Action (2025-2035) to build a “care society”. ECLAC defines it as such:

“A profound transformation in the social, economic, and environmental dimensions of development, recognising the role of care in sustaining life and the planet, acknowledging eco-dependence (human dependence on nature), interdependence among people, and care as a necessity, an essential job, and a right.”5

Their 175-page proposal draws on the likes of Joan Tronto, Judith Butler and the Indigenous ‘Buen Vivir’ social philosophy, which defends “community-centric, ecologically balanced and culturally sensitive” modes of living.

In genuinely quite radical language for an international economic institution, ECLAC recognises that “vulnerability is intrinsic to the human condition” — going beyond the limited understanding that people need care only at particular moments of their life. The commission positions the care society as “an alternative to extractive economies that dispossess indigenous land and livelihoods and lead to an increase in violence.”

Playing catch-up

These institutional commitments matter. While many have diagnosed the UN’s normative positioning with terminal irrelevance, the ability of rights-based frameworks to act as vectors for change is not to be entirely discounted.

First, because care-forward economic restructuring can be “a strategic entry point for advancing feminist principles in policy negotiations, as the topic of care in general is sometimes less contentious than other topics related to gender equality.”6 In a time where many other rights are threatened, and states like Sweden and Canada are reneging on their feminist foreign policy (FFP) commitments, care is a good way to keep building coalitions around frameworks that directly improve women’s lives while losing nothing of their political strength and explicit feminist nature.

Second, because Latin American countries are creating essential blueprints and dragging others along with them. Just last month, the EU and sixteen countries of Latin America and the Caribbean agreed to an ‘EU-LAC Bi-regional Pact on Care’, which “builds on the momentum of key regional and multilateral commitments that call for care work to be recognised, valued, and fairly distributed at the global level”.

This twists on its head the linear story Global North countries like to tell themselves – and everybody else – about development. When it comes to care policy, the Global North is playing catch-up. Far from centering vulnerability and interdependence, leaders in the West are still confining care to a narrow, compartmentalised and largely health-based understanding.

A global moment

This cross-pollination from Latin American countries outwards mirrors the one underway at the local level: initiatives like the Manzanas del Cuidado and Utopias are being piloted in cities around the world. As Manuel de Araújo, mayor of Quelimane (Mozambique) put it: “It’s an idea that is replicable not just from Addis Ababa to Maputo, but in London and Bristol.”

It’s now up to us to take those blueprints and replicate them in our own countries, our own cities, our own communities. To bring forth a truly wholesale understanding of care as a right, a public good, a structuring principle of social life, and a central concern of political decision-making.

The construction of a care society is still in its inception. To help us take it forward, please consider becoming a paid subscriber.

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If you want to partner with or write for the Institute, reach out to Mélina Magdelénat at melina@fifthwaveinstitute.com.

Prof. Dr. Rita Thapa is a renowned Nepalese public health leader, widely recognised as the visionary behind the country’s maternal, child and primary health care framework. A relentless advocate for reproductive rights and women’s empowerment, her programme of female community health volunteers (FCHVs) was and remains the backbone of Nepal’s health system.

Today, as the founder and executive director of the Bhaskar-Tejshree Memorial Foundation, she leads the implementation of interactive educational programmes in schools aimed at preventing high-risk behaviours such as alcohol, tobacco and carcinogenous food consumption, as well as gender-based discrimination and sexual harassment.

In this interview for The Fifth Wave, Dr. Thapa reflects on her six decades of transformative work in maternal, child and community health. We discuss the integration of family planning with maternal and child health, the struggle that led to the legalisation of abortion in 2002, and how one mother’s care inspired the entire FCHV programme – all of which have made Nepal a global model in reducing maternal mortality.

This interview is the third in our inaugural series on perinatal care. You can read the first two here and here.

What led you to work in maternal and child health?

What I saw in Nepal’s first maternity hospital in the 1960s. Women coming in with repeated unwanted pregnancies, suffering complications from dangerously performed clandestine abortions. Women feeling helpless and powerless, unable to make their own reproductive choices.

I had just come out of med school, and I naively asked one woman, ‘Why do you always want to get pregnant?’. She paused, and replied: ‘Doctor, we are not like you. We have to do whatever our husband wants.’ I knew that if those women were given access to even the most minimal family planning services, much pain and many deaths could be prevented.

That’s why in 1964, despite my supervisor’s warning that public health had “neither money nor glamour”, I became the head of Nepal’s first ‘Maternal and Child Health and Family Planning’ programme. It was hard: we had to start from scratch, and very few people involved had any meaningful experience. I had to fight the male representative of a foreign donor agency to carry out my vision of integrating the MCH and FP components into a single department. But I’m tremendously proud of all the change that first programme initiated.

You pioneered the creation of a now-celebrated Female Community Health Volunteers programme. How did you go about it?

Once the MCH-FP department was well-established, which strengthened the evidence base in favour of de-siloing health systems, I went on to lead the national integrated primary health care project. This was a key priority in the Nepalese government’s first long-term health plan (1975-1990), sparked by a worrying resurgence of malaria and other communicable diseases, as well as alarmingly high maternal and child mortality. My mandate was to unify five vertical programs – maternal and child health, smallpox, malaria, TB, and leprosy – under one administrative umbrella, to deliver an integrated package of basic health care.

It felt like another ‘Mission Impossible’. Once again, the heads of all five vertical programs were united in opposing the integrated approach. But I soldiered on, and managed to unify thousands of community-based health workers from the five verticals, allocating one to each village to guarantee comprehensive coverage. However, we soon realised a single ‘village health worker’ could not deliver the full package of basic health services across all priority areas. This signaled an imminent crisis: failure to show results would mean losing the hard-won gains of the entire project.

Then, my mind flashed back to a scene I’d witnessed back in 1968. I was in a village in Ilam establishing a new MCH-FP clinic for the area. A desperate mother came in at midnight with her severely dehydrated, listless baby. I had nothing on hand to help her, the clinic hadn’t been furnished yet. But as a doctor, I had to do something.

Though I had little hope this would work, I hurriedly taught her how to make a homemade oral rehydration solution using boiled water, sugar and salt, and told her to feed it to her baby while intermittently breastfeeding. Importantly, this went against the folk knowledge in the villages that forbade people from giving fluids to children who suffered from diarrhea – the leading cause of death among children in those years. I went to bed with a lingering fear that the little girl wouldn’t make it.

The mother and child stayed in a room next to mine. At around five in the morning, I opened the door… only to see the child happily playing and cooing on her mother’s lap. It felt like a miracle. It was a vivid manifestation of what Professor Carl Taylor had taught me at Johns Hopkins: mothers are frontline caregivers. Not only had that woman been willing to trust me against popular advice, but she’d competently done what it took to save her child with a few kitchen ingredients. And maybe she could be relied on to pass that knowledge to others.

We therefore decided to leverage local married women’s community leadership and caregiving skills by training one “community health leader” (CHL) per village. These women would take on the bulk of health education and preventive work at the community level: delivering contraceptives, setting up immunisation outreach clinics, teaching homemade oral rehydration techniques, and promoting clean birthing practices to avoid infection.

They were also responsible for referring cases of illness to the relevant local integrated health post. That way, medical staff could focus on providing clinical services, while we ensured that our CHLs reached every locale in their perimeter.

The concept was strong, but it had to be backed by solid scientific evidence to survive the political challenges ahead.

In 1978, we piloted a CHL training program. We designed a job description and training manual, using a staggered model of an initial 12-day session followed by one day per month of both additional training and reporting at the local health post over the remainder of the year. The women received compensation for each day’s wage lost – about 50 rupees or $4 at the time.

The evaluation showed significant improvements to service delivery: the CHLs were performing as expected. Encouraged by the positive feedback, I submitted a proposal to the ministry of health, asking for funding to train one CHL per health post in the country. I heard nothing for a month. I approached the health secretary, and he said to me: “I thought you were an intelligent woman, but now you want to place a leader in every village. How many leaders do you need in such a small country, Dr. Thapa, isn’t one enough?”

I understood the political undertones. In my enthusiasm, I’d almost forgotten Nepal was then under an absolute monarchy. Leaders in every village sounded like an uprising in the making. I withdrew my proposal and re-labelled CHLs ‘female community health volunteers’.

I liked the original name, it was a way for us to pay tribute to women’s enduring leadership in their communities. But what’s in a name? A rose is a rose, and that leadership endures, whether recognised by the authorities or not. I returned to the health secretary and got immediate approval.

That’s how the program began, out of necessity, with grit. I never imagined it would grow into 50.000 volunteers, recently recognised as the WHO South-East Asia Public Health Champions. It is profoundly rewarding.

Nepal’s FCHVs each lead a monthly “Mothers’ Group” to share health information and coordinate prevention efforts. What is the history of these groups?

The Mother’s Groups emerged out of centuries of patriarchal oppression in Nepal. They first started as informal village groups, gathering to discuss how to improve local women’s lives by tackling deep-rooted problems, such as men’s alcohol abuse and associated violence. Today, they are well-structured national-level advocacy groups, working on maternal health and domestic abuse but also agriculture, microfinance, and peacebuilding. I remember reaching out to them for support in identifying and recruiting motivated mothers as FCHVs. They are truly vital sites of change in the country. Honestly, they should form a political party.

Nepal legalised abortion in 20021, while neighbouring countries like Sri Lanka, Pakistan or Bhutan still broadly restrict it to life-threatening cases. What explains this outlier status?

Three factors: activism, public health research, and democratisation.

Debates around abortion were already brewing when I first joined the medical field, largely thanks to the work of women’s rights activists. It was a dangerous fight: even before the Panchayat era2, activists were being jailed for campaigning in favour of girls’ schooling, and women were imprisoned with draconian sentences for soliciting abortions – many of whom had gotten pregnant following rape.

Several large-scale studies then made it impossible to ignore the extent of the public health emergency. One showed that as many as 50% of maternal deaths in hospitals were due to abortion-related complications; several others that one-fifth of women in Nepalese prisons had been convicted of performing or receiving abortions.

The end of the Panchayat era further opened the doors to change. Newfound media freedom allowed a variety of television channels and newspapers to spread information about women’s rights and abortion to the public. After much legislative reticence, the government passed the Muluki Ain3 11th Amendment Bill, which enshrined the right to terminate a pregnancy of up to 12 weeks, or 18 weeks in the case of rape or incest.

Thousands of women were released from prison. It was a historic milestone. Together with the broader advances in maternal healthcare, the legalisation of abortion further contributed to the sharp decline in maternal mortality. For reference, there were about 1500 deaths per 100,000 live births during the 70s, and by 2000 that had dropped to less than 500. In 2023, the ratio was down to 142 – a 70% drop in under twenty-five years. It’s still too many, but we’ve come a long way.

You founded the Bhaskar-Tejshree Memorial Foundation, named after your son Bhaskar Thapa, a geological engineer, and your daughter Tejshree Thapa, a renowned human rights advocate who helped establish wartime rape as a crime against humanity. What does it focus on?

The foundation was born out of our unbearable grief. We lost two of our precious children in the prime of their years. Bhaskar was such a thoughtful young man, whom we lost to a heart attack. And Tejshree… She was a different character. She took everybody’s pain as her own pain. We pledged to do our best to protect other families from suffering the loss we did.

As in many other places, heart disease is now the number one cause of death in Nepal, followed by other non-communicable diseases (NCDs) like cancer, kidney failure or diabetes. For a long time, many Global South countries battled tirelessly against communicable diseases like malaria; much of that fight has now shifted to NCDs. We know that about 80% of NCDs are preventable through better lifestyle habits. Things like junk food, sugary drinks, tobacco, alcohol, physical inactivity and stress are huge problems in Nepal that can’t be addressed by building more hospitals. We wanted to focus on prevention.

Over the last decade, we’ve developed and implemented two flagship initiatives for experiential school-based prevention: one focused on heart disease (dedicated to Bhaskar), the other on raising awareness of sexual harassment and gendered discrimination (in memory of Tejshree). Both are designed to help adolescents question the attitudes and consumption patterns that carry the greatest physical and mental health risks, at a period in their lives where they haven’t yet cemented those harmful habits.

Both programmes are now a part of school curricula across all provinces of Nepal. It heartens me to think that even when I’m gone, we’ll have helped some of these young men and women to grow into more conscientious, kind, thoughtful adults.

Any other words of wisdom for public health leaders everywhere?

One, reach every doorstep. Always focus on the most vulnerable, underserved groups of population. They may be in the cities, they may be in the countryside. But try to reach them.

Two, practice what we know works. We have so much proven knowledge by now, we know community-based health works – yet there is a reluctance to empower communities to be better informed and take charge of their own healthcare, even for low-technicity tasks that don’t require extensive training. People have a deep capacity for caregiving when they’re well-supported: we need institutions to understand and mobilise that.

Some of the richest countries in the world are withdrawing funds from rural health, letting small-scale birthing homes close down, and encouraging the further centralisation of care provision. Nepal has far fewer resources, but we’re managing to reach almost everyone by tapping into the energy and creativity of the women in our communities. That takes a particular kind of political will.

And finally, as I always like to ask: Who do you care for, and who cares for you?

I’m blessed to be a part of a deeply caring family, which includes my husband and our remaining daughter. I cherish them every moment. My daughter-in-law and grandchildren also care for me. And in a different way, I always feel invigorated and hopeful when meeting people like you who are taking this work forward!

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Eva-Luna Tholance is a doula, queer feminist activist, and journalist specialised in sexual health and medical violence. She co-edited the collective volume Coming into the World: Autonomy, Dignity, and Struggles for Reproductive Justice, [in French, not yet translated] published in September.

In this interview for The Fifth Wave, she reflects on her journey to becoming a doula, the need to change our perceptions of parenthood, and the transformative power of a philosophy of care rooted in reproductive justice.

This interview is the second in our inaugural series on perinatal care. You can find the first one here.

How did you come to work on reproductive justice?

I started with activism. I was part of a collective focused on menstruation and endometriosis awareness, which gradually expanded its work to sexual and reproductive health. I also wrote about these issues as a journalist.

I first encountered the reproductive justice movement through Amandine Gay, a French Afrofeminist filmmaker and writer, and then Alana Apfel’s Birth Work as Care Work: Stories from Activist Birth Communities. It’s a stunning book that explores the central role of midwives and doulas in shaping an alternative vision of birth.

I had never heard the word “doula” before, nor the concept of reproductive justice. It was a revelation. It perfectly encapsulated the role I wanted to play in my community and in society: providing care, engaging with the medical world yet fighting obstetric violence, humanising patient experiences — all while steeped in the militant and feminist legacy of birth work.

I looked into becoming a doula but hesitated: I felt illegitimate. I was 22, and thought one needed to have had children to support others through perinatal experiences. But that’s not true. A friend preparing for IVF asked me to be her doula, and that pushed me to train. There were very few training programs in France at the time, so I enrolled online with Birthing Advocacy.

It was incredible—a second political awakening. The school was founded by Sabia Wade, a Black queer American activist, so the courses were deeply rooted in reproductive justice, with a queer and decolonial approach to doula work. It’s a political school as much as a practical one: the first lessons cover antiracism and queerness in perinatal care, and obstetric violence. Their philosophy isn’t just to train competent doulas, but “active partners in the movement to transform birth and reproduction.”

I began with postpartum training, then ‘full-spectrum’ training1, supplemented by specialised courses on childbirth preparation, disability, mental health, and abortion. The only one I haven’t yet completed is on supporting people with histories of addiction, which I’m eager to do, especially since it’s a significant issue in the queer community.

Your work focuses particularly on LGBTI individuals, survivors of sexual and domestic violence, and those whose bodies have been “pathologised and harmed by the medical industry.” As a care professional, how do you address their distrust of the medical world?

My support complements, not opposes, the medical system. I’ve attended prenatal appointments and hospital births, including C-sections. I am not against medicalised birth as such; my work is about preventing abuse and violence.

During preparation, we discuss different scenarios and how to respond: What’s a routine intervention? How does a cascade of interventions happen? What constitutes medical violence, and how do you confront it? Often, we dedicate a session to the birth plan, clarifying in advance which interventions are welcome and which are not. I also teach self-defense and co-defense techniques. Ultimately, we focus on how to make a space for oneself in the medical system, how to be heard.

Let’s talk about Coming into the world, which you co-edited with Johanna-Soraya Benamrouche. It’s structured around the three pillars of reproductive justice, as defined by the SisterSong collective in the 1990s:

1. “The right not to have children, through abortion, sterilisation, contraception, or choosing never to have them.

2. The right to have children when and how we want, and to give birth under the conditions we choose.

3. The right to raise children in safe, fulfilling environments, free from violence and environmental harm.”2

How does the concept of reproductive justice expand on the more commonly used ‘reproductive rights’?

It emphasises that rights alone aren’t enough. It adds an intersectional lens—antiracist, decolonial, queer. SisterSong’s core insight was that a right taken for granted by middle-class white women doesn’t necessarily mean justice for others. While women in mainland France fought for abortion rights, for example, many women in La Réunion were still subjected to forced sterilisation and coerced abortions.

Structural obstacles, systemic discrimination, and material barriers often prevent people from fully exercising their rights. French patients’ rights law, for example, guarantees informed consent, interpretation services, and the right to have a support person present at all times—but these are unevenly applied.

And finally, rights can always be revoked, as we’re seeing unfold in the United States.

In the intro to the book, you cite activist and poet Malkia Cyril:

“Right-wing movements have invested in culture wars, often led by women portrayed in the media as spokespeople for conservative visions of family, work, and the economy—vehement opponents of migrant rights and restorative justice. Conservative organisations have cultivated a generation of anti-feminist female leaders who continue to redefine feminism and motherhood in their most destructive, hierarchical forms. By underestimating their impact and failing to invest in cultural and communication strategies that center the voices of marginalised mothers, progressive movements have weakened themselves.”

This resonates with a central thesis behind the creation of The Fifth Wave Institute: that faced with the co-optation of natality, parenthood, and family, it is vital to shed greater light on feminist and research-based perspectives on those issues.

One such perspective highlighted in the book comes from the founders of La Bulle, a collective which sets up child-friendly spaces at activist events so parents can participate. They critique the portrayal of parenthood as “dull, exhausting, and boring,” in contrast to the “cool” freedom of non-parenthood — a binary, dogmatic narrative that often goes unchallenged even in supposedly subversive circles. It refuses to acknowledge parenthood as a rich, intellectually and emotionally profound experience, often out of a legitimate fear of reinforcing the injunction leveraged at women to become mothers.

This narrative also erases the historical role of parents, especially mothers, in revolts and uprisings — and their ongoing activism. In France, for example, ethnic minority mothers have been at the forefront of denouncing violence and discrimination against their children, as have many parents fighting against child abuse.

How do we change this reductive perception of parenthood?

Precisely through initiatives like La Bulle: by creating truly intergenerational spaces, by including children and parents in our movements and our thinking. By considering parenting as deserving of as much nuanced and complex attention as other experiences.

We do it by showing that children’s rights are radical struggles, that the fight against childism3 is fundamental to building a society that stops crushing the most vulnerable. We also need to reject the idea that the only voices advocating for children are those opposing comprehensive sex education or trans children’s rights.

Reproductive justice also helps to reclaim parenthood by confronting the ways the concept of family has been frozen in whiteness and heteronormativity. This means addressing uncomfortable truths: the reproductive barriers placed on people of colour, the criminalisation of their families, the historical exclusion of queer people from family-making. It’s about showing that family can mean a thousand things.

You offer specialised support for people undergoing abortions. In the book, you write that “of all perinatal experiences, abortion is the most solitary.” Why?

The discourse around abortion is just as binary as that around parenthood, leaving little room for nuance. On one side, it’s framed as liberating and feminist—asking for help is seen as admitting failure. On the other, it’s assumed to be inherently traumatic, shameful, and taboo. In reality, it’s usually somewhere in between. People are often relieved because they didn’t want or weren’t capable of welcoming a child, but also sad if they had envisioned themselves as parents. And no one is safe from feeling shame and guilt.

This is experienced in isolation, especially among young people: few ask friends to support them during a medical abortion. It happens in private, unlike surgical terminations where a midwife or healthcare provider can be present. With medical abortion, you’re alone in your living room, unprepared for the physical symptoms, the bleeding, the pain—with only a prescription for paracetamol. I’ve heard many stories of people thinking they were dying because they hadn’t been warned of what to expect.

The book mentions that doulas in France are monitored by Miviludes, the government agency combating sectarian tendencies. Is this rooted in genuine concern or resistance to the autonomisation of birth?

Both.

The skepticism isn’t baseless: in 2008, Françoise Souverville, a Franco-American who worked as a midwife in the U.S., moved to France. Her degree wasn’t valid here, so she became a doula and attended unassisted births4. A baby died during one of these home births. She was sentenced to 18 months in prison for illegal practice of medicine and involuntary manslaughter.

After that, doulas were especially scrutinised, catapulted into the public eye as women who deliver babies in the woods, a bit witchy, shamanistic. And there is definitely some truth to that: some incorporate the whole “divine feminine” thing into their practice, some sell overpriced energy healing products and supplements. All the new age elements you find online can seep into the profession.

But most doulas do rigorous, ethical work. And that work doesn’t always sit well with the medical establishment: we’re present in delivery rooms, we know patients’ rights, we encourage questions. Not to slow things down pointlessly, but to ensure birth plans and informed consent are respected—rights guaranteed by law. In a system that prioritises speed, this is disruptive.

I’ve learned to defuse potential tensions. When I intervene, I always address my clients: “Do you understand everything? How are you feeling? Do you want to take five minutes?” I’m not the center; I won’t create conflict where there isn’t any.

The book stresses the importance of comparing maternity ward practices when planning for birth, as levels of medicalisation and respect for autonomy vary. How can we improve national frameworks for more humane perinatal care and greater reproductive justice, regardless of where someone gives birth?

Laws have limited reach. They can’t, and shouldn’t, dictate every aspect of private life or professional practice. But there’s much to be done regarding the training healthcare providers receive. For example, normalising the use and respect of birth plans as serious documents — they aren’t a Christmas wishlist.

The shift can’t be exclusively top-down; our entire philosophy of care must evolve. We need a more human, person-centered, inclusive approach and a broader definition of a ‘good birth’. Does ‘it went well’ just mean ‘mum and baby are alive and healthy’, or does it account for the fact that both feel emotionally secure, and aren’t traumatised?

Today, care is performance-driven. Many providers are paid per procedure and thus push certain interventions, like epidurals, even when unnecessary. Some anesthesiologists resort to threats during prenatal visits: “If you don’t take the epidural when offered, I won’t come back when you need me.”

It’s a system that exhausts both providers and patients—but the latter still bear the brunt of medical violence.

The book includes an ecofeminist angle, with an article by the Vietnam-Dioxin Collective on the impact of Agent Orange on pregnancies and fertility. You also discuss your investigation into the link between tear gas, reproductive disorders, and miscarriages. How did you conduct it?

During France’s 2021 protests against a controversial security bill, my partner always had painful periods afterward. She came across a post by Gina Martinez, founder of the Colorado Doula Project, who had researched the issue. I realised there was extensive global documentation, especially from Black Lives Matter, but little in France. I put out a call for testimonies on Instagram and interviewed Martinez and Rohini Haar, a member of Physicians for Human Rights and co-author of a report on tear gas use in Bahrain. That became my first article.

After each Saturday protest, I repeated the call. I gathered about a hundred testimonies from people with a variety of backgrounds. Many reported the same symptoms at the same point in their cycles, even while on testosterone, birth control, or in perimenopause. It’s self-reported, but it’s the most ethical scientific method available—you can’t expose pregnant women to tear gas for a study. This approach was later used in a U.S. epidemiological study on the same topic.

Despite this data, building a legal case would be difficult. The miscarriage stories shared with me weren’t medically documented—only one participant who miscarried following a protest saw a gynecologist, but she hadn’t yet made the connection with tear gas. Gathering sufficient evidence would require many people to have the information, energy, and willpower to get blood tests immediately after a miscarriage.

One of The Fifth Wave Institute’s missions is to highlight initiatives shaping the futures of care. Do you have one in mind that advances reproductive justice?

The Observatoire féministe des violences médicales (Feminist Medical Violence Observatory). It was founded in 2024 by Johanna-Soraya Benhamrouche and Tsippora Sidibé after the death of Aïcha, a 13-year-old Black girl who died after being accused of faking her symptoms by emergency responders. I sit on their advisory board.

It’s a fantastic organisation working to change minds and practices through advocacy, victim support, and training for providers and patients in respectful care. They just launched a campaign to display patients’ rights in waiting rooms, with downloadable posters in multiple languages.

Initiatives like this give me hope for the future of reproductive justice. I trust the people doing this crucial work and my doula colleagues who offer beautiful support.

Finally: Who do you care for, and who cares for you?

I care for my clients, my friends (I hope), and my partner. And he cares for me.

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Rubi Rodriguez Nieto is a Mexican-born anthropologist, doula, and community organiser. She also manages the volunteer team at Birth Companions, a London-based charity that supports disadvantaged pregnant women, mothers and babies. She recently started RedMAMI: The Latin American Migrant Maternities Network to tackle systemic inequality in maternity care in her community.

In our conversation for The Fifth Wave, she reflects on her family heritage of traditional healing practices, her intellectual debt to Indigenous autonomous organisations, and outlines concrete pathways to providing migrant women with culturally aware and empowering maternity care.

What inspires your work in maternity care?

I grew up in a small town called Ciudad Valles, in Mexico. It’s a really culturally rich region with a strong presence of Indigenous communities. Even though I didn’t grow up learning an Indigenous language, our traditions are intertwined with their cultural practices.

I also grew up in a family of healers, with practices unconventional to Western medicine. I am marked by the way my grandma used to heal us with touch, with food, with songs, when we’d get ‘susto’ (startled), said to harm your spirit and make you vulnerable to illness. These beliefs are part of what it means to be a Mestiza woman1.

I then left my town to study anthropology at university, where I started thinking more deeply about my background and the complexities of cultural identity. Passionate about social justice, I got involved in environmental activism – which, in Latin America, tends to be about opposing mega infrastructure projects and supporting Indigenous communities’ right to self-determination.

One of those communities I’ve always admired are the Zapatistas. They are an autonomous group led by Indigenous people in Mexico’s southern Chiapas state, where they’ve now recovered a substantial amount of territory. They started out as the ‘Zapatista National Liberation Army’ with the explicit goal of freeing themselves from 500 years of colonial and capitalist oppression – a process they call ‘The Long Night’. They organised clandestinely, and in the 90s became an armed movement and started recovering their ancestral territories.

The movement is now over 30 years old. They function in mirror resistance to the intentional erasure, starving, discrimination and exclusion from political life of Indigenous people: so they have their own governance, currency, food, health and education systems. More recently, they’ve been raising funds to open surgery centres, because the children who were born in Zapatismo are now studying and preparing to take on more specialised roles in their communities.

I’ve visited and learned from those communities several times, and I always carry their teachings with me. One thing the Zapatistas say is “another world is possible”. We are made to believe that the current capitalist system is the only way. But after 30 years, they are still standing, proving it is possible through regaining power and organising. It’s a great message of hope.

Their political ideology inspired many of the principles of collective organisation and self-determination which infuse my work with mothers today. That’s the intellectual terrain I come from.

You ended up leaving Mexico. Why?

At university, my research focused on how Indigenous agriculture adapts to competition from bigger players. I started working in a community-managed forest, where locals used reforestation and other techniques to preserve their environment, as well as protesting the construction of a highway through their lands. We organised visits with schools and organisations from the nearby city, so they’d get a sense of the work and resistance involved in keeping their air and water clean. I also got involved in national political activism.

That was twelve years ago. In those years, it started becoming dangerous for anyone to be politically outspoken, particularly for journalists and women, and especially in Veracruz where I lived. My family received threats to my safety, my compañeros de lucha (fellow activists) were intimidated with physical violence. So I made the difficult decision to leave. It wasn’t paranoia – barely a year after I left, two known critics of Veracruz governor Javier Duarte were murdered in an atrocious massacre.

Has the situation gotten better with the new president, Claudia Sheinbaum?

It’s definitely not as bad. The historical vectors of instability haven’t changed much: we’re close to the US and their oversupply of guns, we have a perpetual debt to the World Bank. But Duarte is now in prison for corruption, so there was some level of accountability.

Greater transparency also has its downsides: Sheinbaum has a lot more eyes on her, and developing a country always implies trade-offs. For example, the Mayan Train project is quite controversial, because it brings dynamism and infrastructure to the long-forgotten South, but also raises serious environmental and safety concerns.

Your son was born in the UK. What was your experience with pregnancy and perinatal care?

At some point in life comes the ‘baby wave’. There’s something about sharing in that experience and not wanting to do it alone. As I left Mexico, most people my age I knew were having babies. I was in a very serious relationship, so it felt like the right time.

Another big drive behind my desire to become a mother was the Zapatistas. Their thinking is, the people who’d rather we didn’t exist are reproducing, so why wouldn’t we? If we want to stay alive, if we want to build the future we believe in, we need more Zapatistas. We need to grow as a community. This is an especially strong sentiment in Indigenous communities, just like in other groups that have survived attempts at forced sterilisation and eradication: we will not be erased.

I was seeing some people around me have children, and I thought, ‘I don’t necessarily want to live in a world where their kids are in charge of the country’. We want the children of the people that surround us to take part in building the future.

I had my son just over a year after I moved to the UK. It was hard, it was isolating, it was very lonely. Coming from Latin America, our culture of obstetrics is cut through with deep misogyny and violence, which makes the bar extremely low for the quality of care we feel we deserve. In Mexico, you are made to feel like you know nothing – the doctor knows. The way you eat is wrong, your weight is wrong, your exercise is wrong. Everything about you is wrong, and little by little, you get stripped of any power you had to advocate for yourself. Some women recall being treated ‘peor que una chancla’ – worse than a slipper.

Coming from that context, I was very grateful for my care in the NHS. I didn’t have to pay, I could be seen by a midwife, and she actually listened during our appointments. She made me feel safe and confident. However, when I gave birth, it was a different story. I wasn’t informed or supported enough, my history and background weren’t taken into consideration. Even though I spoke English, when someone gives you technical information very quickly in the middle of labour, it’s hard to feel like you truly know what’s going on. And I know now there were resources they could’ve shared, organisations they could’ve told me about to help me feel less alone.

It took me many years to finally acknowledge that my needs hadn’t been met. I always sort of said, ‘Yeah, I felt like a train ran over me, but it doesn’t matter, I have my baby!’

My highest point at the time was when I attended a breastfeeding group. I was about to have mastitis, and ended up cancelling my GP appointment. Theirs was all the help I needed. I showed up, interacted with a few people, got some advice, and everything was suddenly more positive. The mere fact of someone acknowledging that what I was going through was rough, that they were there – it changed a lot for me.

Later on, after I came out of the fog that is caring for a tiny baby, I needed to decide what to do with my life. Being a migrant and being a mother is similar in that way: as a migrant, you often have to rebuild a career from zero in a new context, and as a mother, your brain and body takes some time to guide you to who you are as a new person, with a child that fully depends on you. I looked into becoming a lactation consultant, but it required many years of training. I decided to become a doula.

I did two different trainings. The first one felt disconnected from my values: the trainers were renowned, the clients wealthy, and the whole thing made having a doula feel like a luxury item. The second one was amazing. The woman I trained with founded Doulas without Borders, so we had many shared concerns – coming from abroad, how do we empower someone to advocate for herself? If she’s never been given the opportunity to be the leading agent in her own medical care, how do we change that?

As a doula, you provide ‘culturally competent’ perinatal care to women in your community. What does that look like, in practice?

I’d pinpoint two layers of cultural awareness. One, as I mentioned, is awareness of the medical culture we carry in our luggage. Knowing that Latin America has some of the highest rates of C-section and obstetric violence, and understanding how that affects the way we relate to doctors, to medical environments.

The second is a decolonial awareness that for us, ‘health’ goes beyond Western perceptions. The hospital is an authority, in the same category as the state or the law. But then we go home, and our grandmothers, our mothers, our aunties see it differently. For example, the Indigenous understanding of health where I’m from is based on a balance between hot and cold. Any imbalance leads to illness.

So if you went outside without a coat, or early at dawn, your body was thrown off-balance. To heal, you need something hot, like nurturing food, to restore the balance. Warmth can also come from the act itself of someone caring for you, or through a ‘rubbing’ – we have a lot of touch-based healing. I once explained to a psychologist the way my grandma would press on specific spots in order to heal us, and she said, ‘Oh, that’s EFT!’ My grandmother didn’t finish primary school, but she had knowledge that’s since been theorised by Western medicine.

So cultural competency means understanding that we navigate between our traditional, home care, and our less-than-ideal relationship with medical culture. My clients continue to teach me about it every day: I can see them balancing these two paradigms when thinking about their own pregnant body or birth.

Could you describe the practice of the Rebozo ceremony?

In rural Mexico, a woman’s postpartum recovery process typically involves a woman healer, a mother, or an auntie coming to her house and giving her a bath of herbal water. It’s a sacred moment, meant for her to reconnect with her body as well as with higher forces. We don’t even call it a ‘ceremony’, it’s just what is done. I had my own back home when my son was 6 months old, and I wanted to integrate it into my own doula practice. As a Mestiza woman, I feel I have a responsibility to honour these Indigenous traditions that otherwise would be either forgotten or appropriated.

I start with a massage, connecting my energy to the person as a whole as well as my own guides, my abuelas, my ancestors. Then I prepare the bath, adjusting the herbs depending on how she wants to feel coming out of the ceremony. I use locally sourced (European) herbs – there are centuries-old postpartum healing traditions here as well, not just in Mexico!

The bath is a very tender moment – it’s as much for their bodies as their minds. Sometimes they want to chat or confide in me, sometimes they want me to pour water over them, sometimes they just want to sit in silence with the dim lights. One woman told me, ‘No one has even given me a bath since I was a baby, yet I do this for my kids every day.’ It’s a rare moment for them as a caregiver to receive the care they deserve.

You’ve just started RedMAMI, a London-based network of community support and resource sharing for Latin American women and mothers. What sparked its creation?

Discussions with friends about parenting issues specific to us Latin American migrant mothers. For example, one of my friends didn’t feel like people in the UK understood her fears around girls’ safety, rooted in her experience of being a woman in Latin America. We shared stories with each other of being a mother in a foreign country, of feeling different from others at the school collection or nursery.

Culturally, we’re more “huggy” and physically close with our kids: I had a (white British) therapist once tell me I didn’t set enough boundaries with my son because I let him sleep in my bed every once in a while. We’d just moved flats then, he was 8. I thought, ‘I used to sleep in my mum’s bed until much older!’

We realised that there are vital cultural elements to parenting that need to be acknowledged. Our culture of care is different, our culture of mothering. Our fears, too. That’s how the group was formed. We wanted to reduce the isolating feeling of, ‘is this normal? Am I doing this right?’.

Because of our specific relationship to medical culture, we also wanted to help each other exercise having a voice. We see each other in waiting rooms and discussion groups, try to look out for each other, but we don’t always have a space to share our experiences. RedMAMI is that space. It’s there to spread information, support women to be more empowered, in their own voice but also by having advocates in and outside the labour room, so they feel confident to demand better care.

Speaking of advocates in the labour room, a big focus of RedMami’s work is on interpreters. You cite the 2024 perinatal confidential enquiry, which reviewed the care of 24 recent migrant women with language barriers whose babies died. The study showed that while 96% of them needed an interpreter, only 27% used one. What are the main obstacles to accessible communication, and what are the consequences?

The first problem is that most midwives don’t seem to know what the process is to request an interpreter. And when they do, it’s often long and complicated, ill-adapted to the swift decision-making childbirth calls for.

The second is that they have a very limited amount of time to dedicate to each woman – and handling language barriers takes time. You might need to ask the attendant to repeat something two or three times, and by the fourth time, you just give up. Us migrant women, we have our pride, same as anyone else: we don’t want to come across as not understanding anything. So you say, ‘okay’. Your face is not saying ‘okay’. But the midwife doesn’t have time to pick up on your body language, she has three other women to attend to, she’s under-resourced and underpaid.

I’ve seen improvements in the last couple of years: I recently came across a specialist midwife who works exclusively with refugees and asylum-seekers. She works across four hospitals, so she’s obviously stretched, but it’s a start.

In terms of consequences, when you don’t fully understand what someone explains to you, it’s very difficult to know your options, feel confident to question things or ask for clarifications. It affects how you advocate for yourself, accepting procedures and medicalised pathways that you might not otherwise have wanted. If you have prior vulnerabilities in your history and didn’t feel confident enough to disclose them, that can also lead to tragic outcomes.

The other repercussion of women lacking accessible information is that some are going to seek out that information from friends and relatives, where the most traumatic stories tend to get shared the most – and fear does not aid a good birth outcome. Fear inundates your body with adrenaline, inhibiting the production of oxytocin which is essential to birth. What you need in the birthing room is to be fully present, confident, and trusting of the people caring for you.

What does it mean to be a part of RedMAMI?

We have two levels of participation. There are those who simply want to get support, meet other mothers, receive guidance and be better informed. That works through community events and a WhatsApp group. The second level involves organising the network and being part of the decision-making. It’s horizontal, anyone can bring their ideas to the table.

We also want to hold thematic workshops and create charts in Spanish and Portuguese to help walk women through ‘who’s who’ in maternity care. There is a lot of UK-specific terminology, like gas and air or health visiting, that we can help clarify. At this stage, we’re mostly determining what resources are needed: asking people about their needs, where they feel they struggle the most, and how we can help.

In the meantime, we’re holding each other, to feel less alone. We just had the first open meeting, and interestingly, the people who came were more on the giving than the receiving side of care. There was another doula, a lactation consultant, a pediatrician – all wanting to prevent other women from going through negative maternity care experiences. From feeling lost, unheard, unseen.

Thank you for all your insights and wisdom, Rubi. Finally, a question I like to ask all my guests: who do you care for, and who cares for you?

I care for Emilio, my son. He’s ten years old and an amazing little boy. My boyfriend cares for me, cooks for me. And even though most of them aren’t in the UK, the people who mostly hold me emotionally are my friends.

Miscarriage is a relatively common occurrence – roughly one in five women go through it at some point in their lives. For some, it’s a dreaded, recurring experience. For many, it’s an incredibly taxing one, physically and emotionally.

It wasn’t always recognised as such. Advocacy campaigns, academic research and women openly sharing their stories have done a great deal to raise awareness of the reality of pregnancy loss. Those changes have been gradually matched by evolutions in its clinical management — notably, the recognition of ‘pregnancy remains’ as deserving of respect and sensitivity, to be handled separately from clinical waste.

In the UK, ‘pregnancy remains’ refers to any tissue expelled or removed from a woman’s body following the end of her pregnancy prior to 24 weeks’ gestation1. It is legally the woman’s tissue, and those who miscarry at home are free to handle the material in any way they wish, with most flushing it down the toilet. But the clinical setting is an institutional context, imbued with meaning-producing power not held by the home. Clinical practices are an extension of social beliefs: as such, they are subject to much higher-stakes scrutiny.

British public opinion was especially roused to the issue of proper disposal following a series of scandals. The unauthorised storage of 1,500 miscarried, stillborn or aborted fetuses at Alder Hey Children’s Hospital caused widespread outrage, leading to the passing of the 2004 Human Tissue Act and the creation of the Human Tissue Authority (HTA) to establish a framework for sensitive disposal. Later scandals saw the establishment of specific HTA guidance and a National Bereavement Care Pathway (NBCP) to help professionals provide more humane and understanding care.

With these developments, practices evolved to distinguish the treatment of fetal tissue from that of clinical waste, “on the basis of its potential to develop into a human being”2. Official guidance also evolved to present women with choices commensurate with the pain of their loss: ceremonial cremation or burial, release for private arrangements or to a funeral director, and separate incineration. To ensure a paper trail, this choice is typically recorded using a consent form — a seemingly bureaucratic detail that actually proves central to women’s experiences.

A world of lived experiences

Susie Kilshaw, a professor of medical anthropology at University College London, has been studying ‘pregnancy ends’ for a decade. She uses the term in order to better “encapsulate the complexity and nuance of women’s experiences”, from miscarriage to stillbirths, ectopic pregnancies, molar pregnancies and terminations.

This semantic choice also aims to “remove intentionality as the defining element”. Women’s complex and nuanced reproductive experiences are often restrictively categorised using only the metric of choice — not just pregnancy outcomes, but infertility and childlessness, as ’s work sensitively highlights. Talking about ‘pregnancy ends’ lessens the potent moral assumptions that come with categories of loss, and makes room for women moving between categories, as when a miscarriage happens just before a planned abortion.

Similarly, Kilshaw’s work “engages with understandings of the foetus” but speaks of ‘pregnancy remains’ to acknowledge the fact that not all situations include a foetal body (in the case of partial miscarriage, for example) and honour the extreme emotional ambiguity that surrounds the material reality of pregnancy. “The foetus”, she writes, “is a shifting and flexible entity, which can be several things simultaneously, from a part of the woman’s body to separate tissue, a bundle of cells, a site of diagnosis, a baby, or a child”.

This ambiguity is precisely what Kilshaw explores in two 2024 papers based on ethnographic research conducted between 2012 and 2023 with women in England3. Most of her participants had experienced first-trimester miscarriages requiring surgical management, “either to remove the entire pregnancy or ‘retained products of conception’ when a miscarriage was incomplete”. Interviews focused on their experience of the consenting process for sensitive disposal, including both the discussions with the medical staff and the aforementioned physical consent form.

‘I’m a mum too’

For some interviewees, institutional assumptions surrounding miscarriage supported their own framing. Malaika4, who miscarried at 14 weeks, was grateful for the ability to spend a few final moments with her baby, and the sensitivity with which its body was treated:

“I was in hospital for four or five days, and the sisters on the ward said, ‘Do you want to see your baby?’... They brought him with so much respect… in a little basket. He was on a beautiful, embroidered sheet with a little blanket on top. […] I was able to sit with him. I took a little picture. His body had changed a lot… so I just took a picture of his little foot near my fingernail.”

Jennifer and her partner similarly welcomed the ceremonial service offered to them by the clinic after their 10-week miscarriage, and the opportunity to write their child’s name in a book of remembrance.

“You didn’t just lose a pregnancy, you lost the one-year-old you imagined and the five-year-old on the first day of school and the grown-up that you pictured in your mind, even in just those few short weeks… Even though they might not have been public and it might not have been a child you met and held… It was your child… I’m a mum too. Just because I’m not pushing a buggy or going to the school gate, it doesn’t mean that I wasn’t a mum.”

For these women, the understanding of miscarriage as “the loss of a baby, who leaves behind a mother whose appropriate reaction is one of bereavement” was crucial to their grieving and healing process. It was a much-needed recognition of the magnitude of their loss — especially vital when the outside world might not always validate their pain, particularly for shorter pregnancies like Jennifer’s. The institutional framework comforted them in their experience.

‘It wasn’t a baby’

But all of Kilshaw’s participants did not feel the same. In an otherwise extremely understanding and gentle process, with most women voicing their gratitude at the incredible care provided to them by the medical staff, the disposal pathway stood out to many as “inappropriate” if not “distressing”.

For Scarlett, language like ‘funeral director’ and ‘ceremonial cremation’ felt alien to how she had been conceptualising of her pregnancy end:

“For me... with my personal belief system... it’s not a baby. It’s a clump of cells that has a lot of hopes and dreams attached to it and it could be a baby, but it’s not a baby... So then being confronted with ... that consent form and the treating of it as more than a small clump of cells, [...] it made it a lot more upsetting because it makes it a baby, which isn’t how I had been thinking of it.... So being asked to treat it like it was a baby suddenly became very upsetting.”

The women’s testimonies repeatedly highlighted a disconnect between the object of their loss and the biological material. For many, their grief was directed towards an abstract idea of what could have been rather than towards the remains themselves — especially at an early gestational stage, before the 12-week scan that typically marks a crucial step in the “production of fetal personhood”5.

“[T]here wasn’t a real emotional attachment. That’s not to say I wasn’t upset, there was a lot of crying and upset about what could have been, but not really upset about what it was at that point.... For me, it wasn’t a baby loss. That’s very different. I think if it had been something like 22 weeks or something much later, I would have had a completely different response to it”.

Thinking of the pregnancy remains as medical waste or tissue, an extension of their own bodies similar to material removed during other kinds of surgeries, often helped the women cope with their loss. Being confronted with ‘person-making’ language suddenly made it “babylike” and therefore “much more traumatic”.

In most clinics, no differentiation was made between different types of pregnancy remains, which also led to even starker disconnects: one participant who had an anembryonic pregnancy (no fetus or embryo present) was still presented with the option of a funeral service.

The timing of the process sometimes worsened the disconnect. The topic of disposal was only broached at the time of surgery, which could come weeks after women were told they had miscarried6. The disposal discussion therefore often re-opened a healing wound, stirring up emotions many had already processed and begun to recover from:

“Then to have the consent... to talk about the remains... it really threw me... because I think for a while now it hasn’t been a pregnancy for me, it’s been an illness, a chronic illness that I’ve been dealing with and trying to get better from.”

Several women also felt that the consenting process robbed them of agency in their own miscarriage, merely informing them rather than “including them as active participants” — despite the fact that had they been home, they would’ve been free to handle their pregnancy end as they wished. Others, by contrast, were overwhelmed by the introduction of a choice they were not warned about at any point in the care pathway:

“I did not realise there was going to be a discussion, I thought … they take it out and it goes down a tube into medical waste… it almost bothered me that I had to make that decision. [...] I would have preferred not to have the choice”.

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It might seem odd that tick-boxes on an administrative form should hold so much emotional weight for these women, especially as the more ‘personhood-dependent’ choices were typically offered alongside neutral ones.

But as Kilshaw’s work shows, in times of uncertainty and ambivalence, official meanings hold a special kind of normative authority. The form does not draw an explicit moral hierarchy between the choices, of course — but motherhood is already so laden with moral categories, with pronouncements of good and bad mothers, helicopter mothers and refrigerator mothers, that value judgments have a tendency to creep into every stage of the journey.

Maggie’s fetus’ heartbeat stopped at 18 weeks, and she underwent medical management of miscarriage to remove it from her body. She told Kilshaw:

“The specialist midwife said: . . . ‘what we do is if you don’t want to have a service or funeral. . . all of the babies are cremated’ . . . And that just made me burst into tears because I felt like somebody else is arranging a service for my. . fetus that I am not going to. So now I am like a weird mother that doesn’t care: ‘there was a service for your baby, and you didn’t go?’”

Even a hint of, “just so you know, others are choosing to do X, to enact this special kind of reverence” is enough to make women feel like their choice is the wrong one. And in a time as sensitive as pregnancy loss, that feeling is a failure of care7.

The overcorrection trap

Paradoxically, in trying to be more sensitive, the evolution of disposal guidance inadvertently introduced new potential for pain. The pendulum swung too far in one direction, leaving little space for experiences that didn’t match the upgraded understanding.

This pattern has been highlighted in other healthcare settings. In a conversation with On Being host , surgeon, writer, and public health expert explains that in gradually moving away from ‘doctor knows best’ paternalism towards patient autonomy, modern medicine sometimes leaves too much room for agency, creating unduly anxiety in patients who seek a reassuring expert opinion.

“‘Here is your condition. Here are the options: option A, option B, option C. Here are the pros, the cons, the risks, the benefits. Now what do you want to do?’ [...] That was the way I was taught to exercise my authority, give people knowledge and then ask what they want to do with it. But what I found in the real world was that patients would ask back, ‘Well, what would you do?’

And so what we’re taught to say, and so that you don’t take away their agency, was, “No, no, no. This is not for me to decide, this is for you to decide. […] You have to make the call here, around what’s more important to you.” And people felt completely abandoned. […] But the palliative care clinicians or geriatricians, they would go one step further. They would listen, and ask, “What are your goals? What are your priorities? What really matters to you?

You have to be a genuine counselor, and the only way you can offer wisdom is by connecting what you know and have observed […] to the goals that this individual person has. […] And that is hard, I had to learn from the palliative care folks.”

It isn’t a coincidence that palliative care professionals bring the most sensitive approaches. They also happen to be the ones whose work is closest to the ongoing, intimate dependency care that one might give to a child or an elderly parent. They understand most viscerally that care has to be tailored; that flexibility is key to adapt to an individual’s ever-changing needs and circumstances.

In the same way, Kilshaw’s research shows that even the best-intentioned approaches fail if they remain ‘one-size-fits-all’. Some women were comforted by the assumption of bereavement, some distressed. Some found it validating to be asked if they wanted to give their baby a name, while some felt that once offered, declining to choose would mean denying their fetus an identity. In caregiving contexts, which deal with incredibly complex emotional worlds, being prescriptive rarely works. The strength of the anthropologist, like that of the caregiver, lies in shedding in-built assumptions in order to get as close as possible to the reality of individual experience.

Changing the rules

This adaptability is precisely what Kilshaw managed to bake into the 2024 updated HTA guidance. Indeed, this wouldn’t be The Fifth Wave if we didn’t talk about innovation: and in a move many academics spend entire careers dreaming about, Kilshaw actually got the official policies changed based on her findings.

She worked for months with the HTA and the NBCP, tailoring their guidance to better “accommodate a diverse range of approaches” and avoid “challenging a woman’s experience of and agency about her body, pregnancy and pregnancy remains”. The previous version already specified that women should be afforded the possibility not to have to make a decision, but many trusts didn’t allow for this. Even when they did, women were still confronted with the sometimes distressing list of options in order to decline choosing.

So Kilshaw pushed for a clear and mandatory opt-out from the consenting process itself, with better, discussion-based information sharing earlier in the care pathway so as to gradually appraise what information the patient wants, instead of immediately presenting them with potentially upsetting language.

Moreover, if the choices do get presented, offering all disposal options is now mandatory, including regular incineration previously listed as an option only ‘in certain circumstances’. This means all women now have the choice not to pick a ‘personhood-centred’ option at odds with their understanding of their pregnancy remains.

I was able to track down the archived 2015 version of the guidance8. On top of the changes to the actual rules, there are subtle but crucial changes in language that further emphasise the breadth of possible lived experiences. For example, the 2024 update adds a mention that “some women might not experience pregnancy loss as a bereavement”; as well as, “in some cases, a woman may welcome receiving the information”, to honour the fact that it isn’t the automatic or even the majority view.

No longer in charge

Beyond the UK context, Kilshaw’s research in Qatar shows that experiences of pregnancy loss are not only dependent on the individual, but culturally and socially contingent. Qatari women are more likely than British women to know of others who have miscarried, and typically perceive the event as “relatively normal and common”, a natural, inevitable process that simply means the baby was not meant to be born. Strong faith helps in retaining joy and hope: lost babies are ‘birds in heaven’ who will welcome their mothers into paradise.

Building on both her research and her own experience of miscarriage, Kilshaw offers a fascinating reflection on control:

“The British women we spoke to waited until later in life to get pregnant and were used to managing their careers and lives to a fine-tuned degree. Most of our interviewees were in their 30s and had decided to get married as a preface to family life, with the intention of having a baby as soon as possible after the wedding. Most planned their pregnancies and prepared their bodies by taking vitamins, exercising, limiting their alcohol intake, and using various tools to chart and map their fertility. They often had named their babies and thought of them as children by an early stage of pregnancy. The sense of loss in the wake of a miscarriage was as much about losing control and an envisioned future as about the death of the baby.

In Qatar, where faith is pervasive, the women we spoke with often felt that things were in God’s hands rather than their own. Control had already been ceded, and the grief was often less intense compared to what most of our U.K. interviewees experienced. Although birth control is available, women saw pregnancy as the expected outcome of sex with their husbands, and miscarriage as part of the normal experience of a woman’s reproductive journey.

After my first miscarriage 10 years ago, I felt isolated, devastated, and unable to access a framework that would help me make sense of the experience. But each time I had a miscarriage I responded differently. For me, the ultimate lesson I learned from my pregnancies and miscarriages was that I would have to relinquish a sense of control over my life—a message that became even more significant after I had two healthy daughters. If there’s one thing a baby teaches us—whether through a miscarriage or a full-term delivery—it is that we are no longer in charge.”

Kilshaw’s research drives home the fact that caregiving, too, be it in an intimate home setting or a clinical one, is about relinquishing a sense of control over those we care for. How they experience the world, how they react to their circumstances, even when it doesn’t fit what we expect or think is right. Rather than imposing pre-conceived frameworks, caregiving is about offering a presence that makes space for every shade of experience, every tear — or lack thereof.

This research also shows that building the futures of care takes many forms: from the most radical new models to painstaking word changes to obscure official documents. And each of those changes matters, visible or invisible. They are building, brick by brick, a more caring future.

References

• Kilshaw, S. (2024). ‘Now I’m a weird mother who doesn’t care’: Women’s experiences of pregnancy remains disposal following miscarriage in England. Mortality, 30(1), 215–232.

• Kilshaw, S. (2024) Women’s experiences of the consenting process for pregnancy remains disposal following early miscarriage. BMJ Sexual & Reproductive Health, 50, 99-106.

• Kilshaw, S. (2017) ‘How Culture Shapes Perceptions of Miscarriage‘. Sapiens.

There are many more fascinating insights and subtleties in Kilshaw’s work, I really recommend reading the papers themselves if you are interested. All open access.

For more resources, check out the Sands charity or Tommy’s, both doing crucial work in this space. The new Birth Companions Institute also has great material.

Further reading

Last year, Mexico’s president Claudia Sheinbaum introduced a new national pension for women aged 60 to 64, in recognition of the unpaid care work they have done and continue to do. More than a million women aged 63-64 already receive it, and the government recently announced its imminent rollout for the second half of women.

The provision comes as a gender-specific complement to the existing universal pension for those aged 65+, established by former president Andrés Manuel Lopez Obrador (known as AMLO) in 2001. Both are non-contributory, bimonthly cash transfers, meaning they aren’t conditioned to prior labour market contributions. The ‘Women’s Well-Being Pension’ (Pensión Mujeres Bienestar) comes at about half (3,000 pesos, roughly $160) of the national pension’s 6,200 pesos.

In her press conference announcing the policy, Sheinbaum delivered words rarely pronounced by a head of state:1

“One of the reasons we’re supporting women aged 60-64 is that not only did they take care of their children, they are now taking care of their grandchildren, and they should have economic support. Many of them don’t have a proper revenue, they have no economic independence: they will now receive support from the government so they at least have some resources for themselves.”

She then lamented the use of the term ‘ama de casa’ (homemaker) in a pejorative sense, claiming “I am a president, a grandmother, a mum and a homemaker, and with pride. So to all those who think ‘homemaker’ is an insult, I say no. We’re going to take charge, as women, to recognise the work done by so many women in the home”. She rejected the devaluation of housework, constitutive of a “macho culture”2.

Like a lot of recent policy decisions in Mexico, this is bold and exciting. The unconditional aspect is particularly interesting: it takes for granted that all women have done some amount of care work, and therefore deserve compensation. No further questions asked.

There is an ongoing debate about the potential (or lack thereof) female political leadership holds for changing the culture around care. I would just like to say: exhibit A. Women like Sheinbaum who ‘lean in’ and ‘climb to the top’ (quite literally, to the highest office in the land) can also use their position to make everyday life easier for everyday women, while at the same time openly acknowledging and valuing the place of care in their own lives.

Care pensions in the world

Curious to see whether this was replicated in other countries, I asked AI to make the neat little table below:

As you can see, recipients vary from women or mothers specifically to caregivers broadly construed. This is not an exhaustive list, but it’s heartening to see the variety of places these policies exist in.

For the last two lines, I asked for examples of countries where caregiving pensions were proposed or discussed, but not implemented.

Unsurprisingly, the US was the first answer. In 2023, Democratic Senator for Connecticut Chris Murphy proposed the Social Security Caregiver Credit Act to “credit certain individuals who provide at least 80 hours of care per month to dependent relatives without monetary compensation with up to five years of deemed wages (...) for purposes of determining their Social Security benefit amounts”. The bill did not go through.

The second unsuccessful example featured, from India, was not a care pension but a ‘wage for housewives’ reminiscent of the original 1970s plea, brought forward by the Makkal Needhi Maiam (People’s Justice Centre) regional party founded by actor Kamal Haasan.

Criticisms of that proposal mirrored those leveraged at the original International Wages for Housework Campaign (IWFHC): no precise specification of how much homemakers would be paid, risk of women being “bullied to take the government’s money and stay home”, worries about exploitation and the lack of labour laws.

These policies, even those that were eventually rejected, are proof some things are shifting when it comes to the economic valuation of care. And it’s important to acknowledge it. Historian Emily Callaci, who wrote a book retracing the story of the original Wages for Housework campaign, gave an interview which states she is “feeling sad that [the movement] got nowhere in practice”. I think the wide range of different care pensions outlined above shows it did get at least somewhere.

Obviously, the Sheinbaum policy and equivalents are not perfect. They aren’t an income, although many of these countries also have caregiver and parental stipends. They’re sometimes gender-specific, begging the perennial dilemma of ‘is it giving long-overdue recognition to women for doing this work or is it perpetuating the idea that care is women’s work and disregarding the fact that many carers are men?’. They maintain a rather strict compartmentalisation of people into ‘workers’ and ‘carers’ with language like ‘care gaps’, which doesn’t reflect the real-life fluidity of care.

But they’re also concrete, implementable and more accessible than broader proposals often dismissed as utopian. Global Women’s Strike, the heir organisation to IWFHC which lives on through the work of Selma James and others, has notably morphed the original plea from ‘wages for housework’ to ‘a care income for all caring work for people and planet’. They call on countries to fairly compensate “all those:

• caring for people of every age and condition;

• protecting and regenerating the land and the water from poisonous chemicals which ruin the soil, the health of those who work it, the nutritional value of the food, and the climate;

• defending human rights and the natural world, risking their lives;

• surviving and resisting climate change”.

That’s quite a program. Now, again, the spectrum of change is not zero-sum — I am aware this is more a radical proposal meant to spread ideas about the economic value of care than a point-by-point policy outline with its accompanying budget spreadsheet. But just thinking about the administrative load that would come with identifying, vetting, tracking and monetarily compensating all those who fall under any of the categories above (not to mention the inherent contradictions and slippery-slope risks of people who engage in environmental and human rights activism being completely dependent on their government for their livelihoods) gives me a headache. I’m tempted to whisper: wouldn’t it be easier to just call for UBI?

It seems we often inevitably find ourselves back here. Maybe UBI is to care economics what crabs and trains are to biology and engineering. Of course, the original ‘wages for housework’ campaigners had already reached that conclusion themselves: Selma James favoured a 20-hour working week and a guaranteed income regardless of working status. I assume part of the rationale for calling for a ‘care income’ instead of UBI is its greater efficiency in terms of awareness-raising of the specific value of care work.

One of UBI’s main strengths when it comes to care, though, is its potential for a more flexible distribution of caregiving responsibilities. Take a woman caring full-time for her disabled child: a single ‘wage for housework’ or care pension going exclusively to her risks isolating her in her caring role and strengthening the work/care division. UBI could mean that her partner, less reliant on his salary, could work 4/5ths of the week and take a regular day off to care for their child while his wife gets to pursue other interests, hang out with her friends or work part-time if she so wishes. This is a similar idea to that explored by degrowth scholars like Timothée Parrique, for whom unlocking time for care is one of the key advantages of a reduced emphasis on ‘productive’ labour.

Blueprints, blueprints, blueprints

This is by no means a definitive set of assertions on any of these issues - just some reflections sparked by hopeful news. Sweeping claims when it comes to policymaking are of course to be taken with a sizeable portion of salt, seeing as specific local conditions require tailored approaches. But it remains that moves like Sheinbaum’s – even when imperfect and incremental – provide concrete examples to point to when told ‘it can’t be done’.

Since care is so universal, it is fundamental that those building its futures learn from both ancestral practices and innovative solutions being implemented around the world. The Van Leer Foundation does a fantastic job of spotlighting many of these (thanks for introducing me to their work) through their annual journal, .

In their latest issue, you can for example read about how the Nurturing Neighbourhoods initiative is transforming urban spaces in India with ‘pocket parks’ and caregiver-friendly amenities at healthcare centers. You can learn from Ethiopia’s former Minister of Health, Kesete Admasu, about how healthcare policy teams used the traditional coffee ceremony to conduct focus groups with pregnant women and birthing mothers and co-design relaxed, home-like birthing environments tailored to their needs and desires.

This is exactly the kind of global vision The Fifth Wave is rooted in.

For anyone curious to learn more about all things politics, policy and society in Mexico, I recommend Viri Rios’ excellent newsletter . Thank you also to for bringing the Sheinbaum policy to my attention in her post ‘No one wants to do housework’.

The term ‘institutional care’ is an ambiguous one. On the one hand, it can simply refer to care in institutions, i.e., organisations and spaces that formally structure the provision of care to specific groups of people: nursing homes, daycares, hospitals, maternity wards, at-home healthcare services.

But another, pejorative association refers to orphanages — or, according to British charity Hopes and Homes for Children, “residential facilities for large groups of children” characterised by a one-size-fits all approach, depersonalisation, rampant sexual abuse, lack of privacy, disempowerment, and social isolation. This is not what this piece is about.

However, one sentence in Hopes and Homes for Children’s explanatory article struck me: “‘Institutional care’ is an oxymoron – institutions cannot by definition care”.

Putting aside the specific context of HHC’s mission, that sentence sums up much of the current sentiment around the organisation of caregiving in modern societies. Formal structures and institutions are often synonymous with chopping up family life, breaking up communities, and compartmentalising society into neat categories. Eldercare on one side, daycare on the other. Work is work, family is family, and the two can’t interact. Parenting is a private thing to be managed by the parents alone, and “kid-free” cafés ensure that people who dislike children can opt out of interacting with them (apparently even in places originally designed for kids).

The various industries in the care sector are plagued by headline after headline showing how privatisation, optimisation and compartmentalisation produce hyper-strained systems with dangerous if not outright life-threatening failures of care. See Australia’s scandals over private aged care, childcare and acute hospitals, or French journalist Victor Castanet’s two investigative books that respectively exposed the country’s private eldercare then private childcare corporate monoliths. It’s fairly evident by now that caregiving and private equity do not tend to make for great bedfellows. In many countries, childcare is even described as an outright market failure.

None of that girly stuff

This tension has deep roots. With a feminist lens, the history of economic, social and cultural change over the past five hundred years can be broadly understood as the manufactured separation of worlds and their reconstruction as opposites: public versus private; the medical versus the embodied; masculine versus feminine; adult from child; ‘rational’ from ‘emotional’; the industrial from the natural. And in those artificial separations are of course hierarchies: the public, the medical, the male, the adult, the ‘rational’, the industrial: we could call that the Tier 1 world, i.e. the serious world, the real world, the economically valuable world, the productive world. The rest – the private, the human, the female, the child, the emotional, nature, all of which caregiving is associated with – is Tier 2. Secondary, less worthy of attention, of policymaking, of academic study.

For something like caregiving, the process of bringing it from the private Tier 2 sphere to the public Tier 1 world by formalising it into institutions therefore often means stripping it of its pesky Tier 2 attributes: empathy, feelings, human connection. What matters is keeping its technical, ‘logical’, ‘rational’ (heavy on the quotes here) aspects, central to well-functioning economic systems. The rest is fluff.

In practice, this looks like care systems prioritising medical and sanitary outcomes over meaningful human connection and emotional well-being, which get relegated to mere add-ons instead of central KPIs. The history of the institutionalisation of care is rife with iterations of this, with the medicalisation of childbirth through the exclusion of (Tier 2) midwives by (Tier 1) male doctors being perhaps the most well-documented example with the most dire consequences for mothers. More recent ‘innovations’ like task-based pricing in hospitals incentivise the optimisation of each technical procedure at the expense of the equally vital moments of interaction between patients and staff. Compassionate explanation, connection and reassurance get squeezed in between bloodwork and surgery - leading to worse health outcomes, lower patient satisfaction and higher rates of medical staff burnout.

This status quo can be summarised by ’s formula of ‘minimum viable care’: “a system designed to sustain just enough care from just enough caregivers, [which] prioritises maximum efficiency and minimum surplus, [stripping] dignity and stability from both labor and consumers.”1

The tendency to formalise things by segmenting them is not unique to systems of care. It's also not necessarily harmful: it can make some things work much better. But unlike automobile assembly lines or management consulting, caregiving suffers especially from compartmentalisation. Because the connection, the empathy, the deeply intimate… are kind of the whole thing. That’s what care is. Care is what makes the self relational - it’s the antithesis of separation. It is interdependence. A hand held out. A stranger offering to hold your baby. An Auntie spending time with children who aren’t her own. Care is about the process of human connection much more than about measurable outcomes. So when you strip that, well, you basically strip care altogether.

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To the forest we go

In the face of all this, some are tempted to just do away with formal care institutions. It can seem that, since institutions are bound to be compartmentalised, and compartmentalisation acts on care like Roundup on a patch of green grass, institutions indeed “cannot by definition care”. Care can never be healthily coupled with any kind of profit-making, daycare is cruel, and putting one’s parents in a nursing home is inhumane. Away with all that, let’s have exclusively natural, home births, reject modern medical systems, and go raise our children on feminist communes in the woods.

I’m obviously being caricatural here. Efforts to strengthen community life, re-build ‘the village’ and recreate conditions akin to that of small-scale societies are extremely valuable. But even those typically require a lot of intentional thinking and concrete action, in order to build structural conditions that allow for spontaneous and collective care to take place. Complete withdrawal from organised care is almost never an option, and it also does not scale well into systemic solutions.

This becomes very obvious when comparing the state of public policy discourse around care in different countries: in places with existing universal support systems, public opinion is often focused on pointing out their inadequacies, but in countries like the US, many parents and caregivers are desperately begging for the implementation of formal structures to help relieve the pressure off of individuals.

This is the institutional paradox of care: the same structures that make care institutions deeply flawed also make them absolutely essential to well-functioning modern societies. Faced with this paradox, it often seems we have a binary choice: we can either completely disengage from formal structures to preserve the spontaneous and organic nature of care (but as I said, that’s only an option for a very select few), or ‘give in’ to institutions that inevitably strip it of its relational essence.

But reality isn’t binary, and when we step out of manichean frameworks, we see that formal care structures don’t have to be (and so many aren’t!) soulless vessels we’re just forced into by modernity for lack of viable, organic alternatives. When built correctly, they can also be places of beautiful connection and joy, allow caregivers to pursue meaning in other ways, and help shift some of the heavy responsibility that interdependence tends to place on women to keep communities thriving. Institutions can help ensure that a greater number of people get adequate levels of care without relying exclusively on the sometimes fluctuating goodwill of family members.

So how do we overcome the paradox? How do we formalise care in a way that provides much-needed structure to social life and relief for caregivers, without manufacturing disconnection? As often, the boring, nuanced answer is the most promising one: it’s all about compromise. Not opting out of institutions entirely, but building ones that leave enough space for the natural porousness of care to freely manifest. Ones that institutionalise fluidity.

This isn’t to say that everyone should have to opt in to institutions – there should also be substantial support, resources and recognition for those who want to give birth at home, stay home with their kids in the first few years and live with their ageing parents to support them in late life. But institutional alternatives that preserve the essence of care should be widely available for those who need them.

Building the futures of care institutions

One strategy involves making existing institutions and spaces more porous through external intervention – like with ’s “bring your baby to work” proposal. While of course impossible to generalise to every type of workplace and work schedule, this is a great way to normalise both the presence of babies and children in spaces not ‘meant for them’ (thereby also questioning the legitimacy of such segmentation) and the fact that alloparents can also play a role in caring for children (thereby reducing the expectation that parents have to do it all by themselves). It also helps to make visible the work associated with parenting, potentially raising its value in the eyes of those with no direct experience of it.

Another strategy consists in building porous care institutions from the start. Michel Odent’s concept of ‘home-like birth centres’, for example, is a now increasingly adopted compromise that brings both the benefits of a familial, organic-feeling environment and the safety of an institutional setting. In a similar spirit, there has been a recent re-emergence of intergenerational shared sites that merge childcare and eldercare facilities.

Pioneered in Japan in the 1970s, these facilities come in a variety of forms: a preschool or a daycare inside a nursing home, a residence for older adults next to an afterschool community centre for kids, etc. Kids might simply play in a delimitated area within the nursing home’s garden, or have dedicated shared activity times with elderly residents - reading, creative writing, theater, cooking. The sites have nothing but benefits for everyone involved: the young are more tolerant, more comfortable around disability and difference; they learn skills and hear life stories from their elders, and develop creative pursuits under their coaching. They learn to be around a variety of adults who aren’t family, with a diversity of lived experiences.

The elderly participants, meanwhile, are healthier, less isolated, live longer, and most importantly feel helpful, needed, and valued. The sites encourage prosocial behaviours, sensory stimulation and intellectual development in both age groups. One paper also highlights that “the nurturing presence of older adults helps bring a familial aspect to the preschool setting”, potentially offsetting some of the more anxiety-generating aspects for young kids.

Shared sites are also more attractive to staff, raising the value and meaning of their work while making it logistically easier for them to meet their own family caregiving needs. French startup Tom&Josette, a network of micro-creches implanted within eldercare facilities, built their entire organisational model around valuing the expertise and field experience of daycare workers. On each site, decisions are decentralised, teams are more engaged, and governance is shared and more flexible. On top of their day-to-day responsibilities with the children, the early childhood professionals design the modalities of their interactions with the elderly residents and have their say in the recruitment of incoming daycare staff.

Founders Astrid Parmentier and Pauline Faivre say they were inspired by Dutch at-home healthcare company Buurtzorg, founded in 2006 by Jos de Blok and a team of professional nurses. Frustrated with years of bureaucratic reforms that impoverished their profession and stripped their relationships with patients of their humanity and of opportunities for connection (that lovely institutional care-icide effect again), they set up Buurtzorg “to look after people at home, in a way their values and craft demanded.” [The name translates to ‘neighbourhood/community care’].

The Buurtzorg model has three core principles: a holistic, rather than purely medical, view of the human person and her needs beyond the physiological; an emphasis on the quality of the caregiver-patient relationship, notably by minimising the number of different individuals caring for a single person; and a priority put on the patient’s autonomy, through therapeutic education and the mobilisation of their social support network. Buurtzorg nurses also have a much greater latitude in making decisions around timetables and patients’ needs.

Over the course of a couple years, the company revolutionised in-home care in the Netherlands, rising to the top of patient satisfaction rankings and reducing spending by about 40% per accompanied person, which translated to an average of 3000€ in savings for the patients themselves. They showed that bureaucracy and aggressive management styles were not vital, but actually detrimental to good care organisations. In 2011 and 2012, they were voted the country’s ‘best employer of the year’.

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All hands on deck

Tom&Josette and Buurtzorg are both for-profit companies. They’re also remarkable examples of formalised caregiving that doesn’t completely drain care of its human and relational essence. They show that the spectrum of social change around caregiving is not zero-sum: while we should keep radically rethinking the way we structure care in our societies, there is also hope in building desirable innovations within existing constraints. As put it in her interview with Anu Sharma, founder of perinatal care startup Millie:

“It’s tempting to join the ‘blow up the model and build something better!’ rally cry [...], but the conversation with Anu added a critical angle: how do we ground the rally cry within the constraints of the healthcare system, target the right levers of change, and continue to effectively move the needle forward.”

We can still be critical of institutions, still strive to foster organic spaces and community outside of economic equations. We can also build resilient alternatives that future generations will have the luxury of taking for granted.

The fact that an organisational philosophy originally designed for at-home eldercare can inspire innovations in childcare is also a perfect example of the need for further integration across care systems, as well as between thinkers and practitioners. The Fifth Wave’s mission is to be a space for such integration to happen. A platform where a philosopher specialised in the ethics of care can learn from the hands-on experience of a nursing home worker; where a father eager to do more for parents can connect with a midwife to start a local perinatal support center. A hub for bold, radical and pragmatic thinking about the futures of care.

If that’s something you care about, you’re in the right place. Welcome to The Fifth Wave.