Domestic work is characterized by labour for another family within their home. The term domestic workers should not be confused with homemakers and housewives, who work in their own home, or housekeepers, who work in institutions such as a hospital or school. The position of employment within a home is a unique and often isolated work environment. The position of domestic worker is almost always considered menial or inferior to the family for which they are employed. Indeed in the past, domestic work was sometimes done by slaves or indentured or bonded servants. Some of the job titles today for domestic workers include: servant, maid, housekeeper, au pair and nanny. While domestic workers can be either female or male, female workers are both much more commonly employed and most often paid less than males. Domestic workers are customarily immigrants or members of ethnic, national or religious minorities of the country of employment.
One should distinguish between domestic workers who are employed as live-in servants from those who live in their own home and commute to their place of work. Live-in domestic workers are isolated from their own family, as well as often from their own country of nationality. Because of the worker’s disenfranchisement, work contracts and health and other benefits are negligible. Sometimes, room and board are considered part or even complete payment for services rendered. This situation is particularly critical for the overseas domestic worker. Sometimes, infractions concerning agreed-upon salary, sick leave, working hours, vacation pay and regulation of working hours and duties cannot even be addressed because the worker is not fluent in the language, and lacks an advocate, union, work contract or money with which to exit a dangerous situation (Anderson 1993; ILO 1989). Domestic workers usually have no workers’ compensation, nowhere to report a violation, and are often unable to quit their employment.
Places where major employers of domestic workers are found include Britain, the Persian Gulf and Arab States, Greece, Hong Kong, Italy, Nigeria, Singapore and the United States. These domestic workers are from various countries, including Bangladesh, Brazil, Colombia, Ethiopia, Eritrea, India, Indonesia, Morocco, Nepal, Nigeria, the Philippines, Sierra Leone and Sri Lanka (Anderson 1993). In the United States, many domestic workers are immigrants from Central and Latin America and the Caribbean islands. Domestic workers are sometimes illegal immigrants, or have special limited visas. They are often not eligible for the basic social services available to others.
Tasks for domestic workers can include:
- Kitchen work: shopping for food, cooking and preparation of meals, waiting on the family and serving meals, cleaning up after mealtime and taking care of tableware
- Housecleaning and housekeeping: care of furniture and bric-a-brac, washing dishes, polishing silver and cleaning the house including bathrooms, floors, walls, windows and sometimes annexes, such as guest houses, garages and sheds
- Clothing care: washing, drying, ironing of clothing, sometimes mending of clothing or delivery/pick-up of clothing that is dry cleaned
- Child and elder care: babysitting or childcare, changing diapers and other clothes, washing children, supervision of meals and activities and delivery to and from school. Domestic workers will sometimes be given tasks that revolve around elder care such as supervision, bathing, companionship tasks, delivery to and from doctor visits and light medical chores.
Hazards and Precautions
In general, the intensity of hazards associated with live-in domestic workers is much greater than domestic workers who commute to work daily.
Some physical hazards include: long working hours, insufficient rest time and sometimes insufficient food, exposures to hot and cold water, exposure to hot kitchen environments, musculoskeletal problems, especially back and spinal pain, from lifting children and furniture, and kneeling to clean floors. “Housemaid’s knee” has been likened to “carpet layer’s knee”, the injury sustained by carpet layers. While mechanization of certain floor-polishing and waxing processes has resulted in less work from the knees, many domestics still must work from their knees, and almost always without padding or protection (Tanaka et al. 1982; Turnbull et al. 1992).
Precautions include limitations of working hours, adequate rest and food breaks, gloves for dishwashing and other water immersion, training in proper lifting techniques, mechanized carpet cleaners and floor polishers to minimize the time spent on the knees and provision of knee pads for occasional tasks.
Domestic workers can be exposed to a wide variety of acids, alkalis, solvents and other chemicals in household cleaning products which can cause dermatitis. (See also “Indoor cleaning services” in this chapter). Dermatitis can often be exacerbated by the immersion of hands in hot or cold water (Scolari and Gardenghi 1966). Domestic workers may not know enough about the materials they use or how to use these products safely. There is inadequate training in chemical handling or hazard communication for materials that they use. For example, a severe poisoning case in a servant who was using cadmium carbonate silver-cleaning powder has been reported. The worker used the product for one-and-a-half days, and suffered abdominal cramps, tightness of the throat, vomiting and low pulse. Recovery took 24 days (Sovet 1958).
Many products used or handled by domestic workers are known allergens. These include natural rubber protective gloves, house plants, waxes and polishes, detergents, hand creams, antiseptics and impurities in detergents and whiteners. Irritant dermatitis may be a precursor to allergic contact dermatitis in housekeepers, and often starts with the development of erythema patches on the backs of hands (Foussereau et al. 1982). Inhalation of solvents, household pesticides, dusts, moulds and so on can cause respiratory problems.
Precautions include using the least toxic household cleaning products possible, training in materials handling and safety of the various detergents and cleaning fluids, as well as the use of protective hand creams and gloves. Unscented products may be better for those individuals prone to allergy (Foussereau et al. 1982).
Domestic workers with responsibility for the care of young children in particular are at greater risk of becoming infected with a variety of illnesses, especially from changing diapers, and from contaminated food and water. Precautions include washing hands carefully after changing and handling soiled diapers, proper disposal of soiled items and proper food-handling procedures.
Psychological and stress hazards
Some psychological and stress hazards include isolation from one’s family and community; lack of paid vacation and sick or maternity leave; inadequate protection of wages; rape, physical and mental abuse; over-extended working hours; and general lack of benefits or contracts. Live-in domestic workers face greater danger from hazards including violence, harassment, physical and mental abuse and rape (Anderson 1993).
During a six-month period in 1990, there were eight deaths - six suicides and two murders - of Filipino domestic helpers recounted in a report filed by the Philippine Embassy in Singapore. Suicide is under-reported and not well documented; however, there were as many as 40 suicides reported to the Philippine Embassy in one time period (Gulati 1993).
To a lesser extent, these same hazards are relevant to non-residential domestic workers. In an Ohio (United States) study that looked at workers’ compensation claims filed for sexual assault from 1983 to 1985, 14% of the rapes occurred in motel maids and housekeepers (Seligman et al. 1987).
Prevention of abuses of domestic workers can be aided by establishment of laws that protect these comparatively defenceless workers. In the United States, the hiring of illegal immigrants as domestic workers was a common practice until the passage of the Immigration Reform and Control Act of 1986. This act increased the penalties that could be imposed on the employers of these workers. However, in developed countries the demand for domestic help is steadily increasing. In the United States, domestic workers must be paid at least the minimum wage and, if they earn $1,000 or more annually from any single employer, they are entitled to unemployment compensation and social security (Anderson 1993).
Other countries have taken steps to protect these vulnerable domestic workers. Canada started its Live-in Care-giver Program in 1981, which was amended in 1992. This programme involves recognition of immigrant domestic workers.
Acknowledgement of the immigrant domestic worker is the first step in being able to address heath and safety preventive issues for them. As initial recognition of these workers and their difficulties is achieved, dangerous working conditions can be addressed and improved with government regulations, unionization, private support groups and women’s health initiatives.
Health Effects and Disease Patterns
One study of mortality data of 1,382 female domestic workers in British Columbia (Canada) showed higher mortality than expected from cirrhosis of the liver, accidental death due to exposure, homicides and accidents of all types combined. Also, deaths due to pneumonia and rectal and eye cancer were higher than anticipated. The authors suggest that a major factor in the elevated deaths due to liver cirrhosis is because many domestic workers in British Columbia are from the Philippines, where hepatitis B is endemic (McDougal et al. 1992). Other studies point to alcoholism as a factor. In a review of a California (United States) mortality study, it was noted that the following occupations were associated with increased cirrhosis mortality rates in women: private housecleaner and servant; waitress; and nursing aide, orderly and attendant. The authors conclude that the study supports an association between occupation and cirrhosis mortality and, furthermore, that the greatest cirrhosis mortality is associated with low-status employment and jobs where alcohol is easily available (Harford and Brooks 1992).
In their 1989 study of occupational skin disease, the British Association of Dermatologists found that of 2,861 reported cases (of which 96%were contact dermatitis), the occupation of “cleaners and domestics” was the second-highest category of work listed for women (8.4%) (Cherry, Beck and Owen-Smith 1994). Similarly, in positive responses to dermatological patch tests performed on 6,818 patients, the most common professions of women studied were housekeeper, office worker, cleaner, needleworker and cosmetologist. Housework accounted for 943 of the positive responses to the patch tests (Dooms-Goossens 1986).
Other research has pointed to respiratory allergy and disease. Organic chemical-induced occupational allergic lung diseases were reviewed, and the category of domestic workers was noted as one occupation particularly affected by respiratory allergens (Pepys 1986). A Swedish study on mortality due to asthma looked at women who reported employment in the 1960 National Census. Smoking-adjusted standardized mortality ratios were calculated for each occupation. Increased mortality due to asthma was seen in caretakers, maids, waitresses and housekeepers (Horte and Toren 1993).
There is a lack of statistics and health information concerning domestic workers, especially for overseas immigrant workers, perhaps because of these workers’ temporary or even illegal status in their countries of employment. Governmental acknowledgement will only help enable more research and protection of these workers’ health.