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.

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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.

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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.

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.

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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.

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’.

France is a relatively good country to be a father.

With four weeks of paternity leave (including four mandatory days) for no change in salary, it sits comfortably above its average European neighbour.

About 70% of eligible fathers actually take leave, and of those, about 65% use the full allocated time. We have a long way to go, and four weeks is still a far cry from what mothers need to truly flourish in their postpartum, but those are not terrible numbers.

Besides this common form of leave, France also has a more extensive version, confusingly called ‘educational parental leave’. This refers to the specific right of every worker to dedicate themselves to raising their first or second child up until its third birthday, without losing their job in the process (for the third child or more, the period can be extended up to five years). Though this is much less universally used, about 400.000 families benefit from it every year.

In theory, it is indiscriminately open to both parents. They can choose to completely stop working, and receive a monthly compensation of about 400€ - roughly 30% of French minimum wage - or work part-time, in which case the compensation drops to about 250€.

In practice, the policy is obviously designed for only one parent to take leave, given that it’s virtually impossible for a family to live off that kind of money. Unsurprisingly, in 2014, 95% of beneficiaries of the provision were women.

An attempt at change

That same year, French lawmakers decided to tackle this imbalance by reforming the compensation structure of parental leave. The objectives? Encourage a fairer split between parents, and boost mothers’ reentry into the workforce.

To achieve this, the duration of compensation payments was reduced from three to two years in case of non-shared leave, making it impossible for one parent only to be paid for three. This essentially earmarked one year specifically for dads, nontransferable. If a couple wanted to receive payments for the full three, they now had to take at least a year of leave each.

Last week, economists Mathilde Guergoat-Larivière and Mathieu Narcy published a paper evaluating the effects of this reform. Verdict: it didn’t do much.

To ensure that families observed would have comparable conditions in all respects bar that of the reform, they analysed couples’ rates of parental leave use the month just before it came into effect, versus the month just after. The effect was negligible. Rates of part-time leave use among fathers rose by a meagre 1.4 percentage points, and only by 0.2 for full-time leave.

Note: the second parent is most often a man and therefore referred to as a ‘father’, even though some couples in the sample are made up of two mothers.

Proponents of the reform were particularly banking on the fact that mothers, suddenly unable to be paid to stay with their child for a third year, would “pass the relay” onto their partners. But even in those scenarios, the objective of 25% shared-leave arrangements was far from met: for those fathers whose partner had to give up the extra year of compensation, the effect was a little stronger but still of only 4.4 points for part-time leave, and 0.6 for full-time.

Lawmakers were also hoping the policy would incentivise women to go back to work earlier. That, too, didn’t really happen. Two-thirds of those women who lost access to a 3rd year of compensation still stayed home, for no pay. Presumably because they either wanted to, or because even with a salary, it’s still often cheaper to stay home than to pay for childcare.

So, what does this tell us?

First, let it be said that the results themselves are not particularly surprising. It would be unrealistic, for one, to manage to drastically change something as ingrained as the socio-sexual division of care labour in the span of a month. What I am more surprised by is that those behind the policy were surprised. I think this example holds a precious lesson about how policymakers (and researchers!) categorise parenthood - and what they fail to understand about it.

The devil is in the sock drawer

As a potential cause for the weakness of the effects, the authors of the study first point to the weakness of the compensation: since men typically have higher salaries than women, the revenue loss associated with parental leave is greater for them. This higher opportunity cost probably explains why, when men do “take the relay” from their partners, they do so almost exclusively part-time.

But they nuance this by pointing out that fathers who make less than their partners (about 30% of the sample) also didn’t change their behaviour post-reform - even though it would’ve overall been financially advantageous for the household.

Even more telling is another study they cite, which shows that even fathers who were already working part-time did not decide to take part-time leave, even though that would have meant receiving extra money for no change in their work patterns and allowed them to avoid foregoing a full year of compensation.

So, financial incentives are not it. The authors then point to the obvious culprits: culture, gender roles, stigma and negative employer attitudes around paternity leave. They also acknowledge that women are typically the ones handling the paperwork associated with family benefits, which ties them to the caregiver role.

But wait: this last point, mentioned in passing, seems to me to be the absolute heart of the matter.

What the reform’s designers seem to have failed to consider is that taking care of a child does not just require continuity of presence - having someone there, whoever it may be. It requires continuity of knowledge.

Parenting is not a hobby you can take up, then transfer to someone else for a couple months, then pick back up again. Parenting is hard work. And like any form of work, it requires patience, time, mistakes, and a lot of learning to develop the set of skills needed to do it properly.

Handing over the full-time responsibility of children to your husband when you have spent the last two years taking care of them without him makes about as much sense as writing the first half of a novel, then handing the manuscript over to your toddler who can’t read.

I caricature, of course. Many men who work full-time are also very involved fathers. (Many are not.) But there is a crucial difference between ‘involved parent’ and ‘parent who knows’. Knows what foods the kids will and won’t eat, the name and address of their dentist, when the eldest has to go to football practice and which socks to pack for her; knows the kids’ vaccine history, the last time the fridge was fixed, what groceries are low in the pantry, how to pay the fee for the youngest’s school outing and how to sign him up for cello practice and when the annual talent show is and what costumes they need for that… and when the next child benefits payment is coming.

In a podcast conversation about parental leave with Elena Bridgers, marriage and motherhood expert Cindy DiTiberio explains:

“Incompetence can start very early on, because an infant requires very specific things. If you are not there to know all the things, you look to your wife, and she becomes the expert. [The only way to avoid this is] if both parents are tasked with fully being responsible for that infant early on - and by fully, I mean, let that mother leave for a day. She probably won’t like it either! I don’t know how young the infant needs to be, but let it happen early enough on so that the father is fully responsible.

[That is the only way] he can feel just as capable. He’ll learn his own methods. But the hierarchy starts there, in those early days. Again, it’s hard, especially when breastfeeding is involved. But I just think we have to be really careful. We’re all so tired during that stage, without some intentional practices, what ends up happening is we slip into, ‘mom knows all the things and dad bumbles along as a helper’. […]

That parent will also be responsible for that child for the rest of their life. He should be an equal parent, an equal partner.”

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Bibbidy, bobbidy, parent!

This ‘hierarchy of knowledge’ produced by mother-centric parental leave structures cannot be magically fixed over the course of a month just because the state said so.

Maybe part of the reason French men didn’t take parenting over from their wives for the last year of paid leave is because they would not even know where to begin. In a professional job replacement, they would go through a handover period, with some training. But here, they are to be suddenly entrusted with a set of responsibilities that they’ve had no part in shouldering since the birth of their children. And to make matters worse, be paid very little for it.

This study does not allow us a closer look at these in-couple dynamics. But it shows that cosmetic changes to the incentive structure of parental leave policies cannot disrupt the deeper roots of the gender parenting imbalance. Making parenting a truly shared enterprise starts in the very beginning. And the ‘one caregiver, one worker’ model (even in a world where they did alternate) still not only cements the idea that care is not work, but that a child’s early years are best spent in the care of one exclusive caregiver. A far cry from “it takes a village”.

As often with public policies around care, this reform was neither malicious nor completely unwelcome. But it failed to grapple with the gendered micro-dynamics that structure family relationships. It failed to recognise (and properly compensate) parenting for what it is: a lot of work, involving specific knowledge and specific skills. And therefore, it inevitably failed to deliver the kind of creative, radical overhaul of our current systems that is needed to truly make parenting - and all care work more broadly - fair, valued and collective.

If that’s something you care about making happen, you’re in the right place. Welcome to The Fifth Wave.

Guergoat-Larivière, Mathilde, and Mathieu Narcy. 2025. “What can we learn from the 2015 parental leave reform?”. Centre for the Study of Employment and Work.
[In French, untranslated]

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