Centering BIPOC Voices Is the Only Way to Overhaul Our Care Infrastructure


How do we meaningfully center BIPOC in all aspects of our work to rebuild the care infrastructure? What does this look like in practice? What are practical ways to do this that moves beyond symbolism and representation to real engagement? What are the challenges and barriers? What are the opportunities?

Key Words:

care infrastructure, BIPOC, childcare, paid family and medical leave, long term services and supports, BIPOC women, direct care workforce, unpaid family caregivers

America is at a crossroads, our care infrastructure, long term services and supports, childcare and early education, and paid family and medical leave, are not equipped to assist families, specifically, families who are Black, indigenous, and people of color (BIPOC) to meet their caregiving needs. The pandemic has unearthed previously buried truths about access and deep-seated inequities in the foundation upon which America was built that contribute to a fractured care infrastructure.

In many of our systems of care, most notably long term services and supports (LTSS), communities of color encounter structural racism, sexism, information scarcity, bias on the part of healthcare providers, obstacles in accessing care and coverage for themselves or older loved ones, in addition to other social factors that contribute to disparities and inequality. To mend this broken system and create structures that are equitable for all generations at every stage of life, it is imperative to purposely and meaningfully center BIPOC in all aspects of the work.

Large Increase in Care Need Requires Fixing the Care System

Our population is aging rapidly. The recent Census Bureau reports the 65 and older population grew over the past decade by 34.2 percent and from 2018 to 2019 by 3.2 percent (U.S. Census Bureau, 2020). As our population ages, we are witnessing an increased number of older adults and people with disabilities who require assistance with serious health issues or chronic illnesses. Individuals who deserve to receive services and support in the setting of their choosing, who need support to live independently, work, and be integrated into their communities.

To meet this increased level of need requires many of our older family members and loved ones to rely upon the paid direct care workforce, which is disproportionately made up of BIPOC women. A long-term care system that relies upon the paid labor of BIPOC women, while simultaneously failing to provide them with adequate wages, access to training, career advancement, and workplace support is one that does not value or center BIPOC, nor women.

In addition to relying upon paid caregivers, there is a heavy dependence upon the unpaid and often invisible labor of family caregivers, who also are overwhelmingly women. The long-term care system is beyond overtaxed, and those who bear the brunt of the burden caused by this inadequate system are BIPOC and women who are BIPOC.

This narrative is repeated throughout our care infrastructure, starting with childcare and the early education system, moving onto the absence of adequate paid family and medical leave for most workers, and ending with the care of older adults. BIPOC face an impossible choice: provide care for their families and loved ones, or earn a paycheck. But this is a false choice, especially for BIPOC women, as they bear the burden of providing childcare, care for themselves or their loved ones, and eldercare (paid and unpaid), while being undervalued and underpaid at their places of employment.

Even before the pandemic, high quality and affordable childcare, including infant and toddler care, was inaccessible and unaffordable to many working families. Years of underinvestment in the childcare system and an overreliance on families paying exorbitant childcare costs, placed parents and families under immense strain primarily for Black, Latinx, and Indigenous families. Also bearing the pressure from an inadequate child care system are childcare workers, nearly all of whom are women and make up 95 percent of the child care workforce (Ewing-Nelson, 2020).

As our population ages, we see an increased number of older adults and people with disabilities who require help.

BIPOC have suffered from years of systemic racism, occupational segregation, and economic disparity that contributes to disparities in their inability to access affordable and quality childcare. Families with young children require reliable and affordable child care but childcare’s high price makes it difficult for many families. An average Black family with two adolescent children would often have to spend 56 percent of their income on childcare—a greater proportion of total family income compared to any other group (Novoa, 2020). As a result, women who, due to cultural and societal norms, hold a greater share of caregiving responsibilities, are also tasked with performing or arranging paid childcare, placing their labor force participation and economic security at risk.

Paid Family and Medical Leave Is One Solution

Paid family and medical leave could address many of the cultural and economic realities of today’s families by meeting the needs of parents, older Americans, people with disabilities, and the growing number of unpaid and paid caregivers who will someday or soon need to take leave to help care for an aging adult.

Paid family and medical leave is essential for working people who need time off when a new child arrives, to take care of themselves or a loved one when a critical health issue arises, for unpaid family caregivers who are the backbone of our care system, and for paid caregivers. Workers who are BIPOC experience disproportionate rates of economic insecurity, many hold low-paying jobs and barely have enough saved to cover three months of expenses, let alone an extended leave period (Brown, 2020). Paid leave would go a long way toward alleviating the emotional, physical, and financial costs many caregivers and BIPOC families encounter.

The inherent and long established structural racism built into our care infrastructure has been allowed to permeate without consequence and perpetuates disparities and inequities to the detriment of BIPOC and BIPOC women who have limited income and wealth. Discrimination, poverty, occupation, education level, and the wealth gap are all factors that can impact use and access to various forms of care among BIPOC (Centers for Disease Control and Prevention [CDC], 2021).

BIPOC should be viewed as experts in their own right.

There are solutions to our existing and ongoing problems within the care infrastructure, ones that establish balance and create equity in a crumbling system whose very foundation was built upon systemic racism and injustice. To rebuild the care infrastructure, the United States should look no further for ideas and feedback than to those who are closest to the problem, BIPOC and BIPOC women; however, it must do so in a manner that goes beyond symbolism and instead fosters real engagement.

Centering, Not Symbolism

A lack of investment in home- and community-based services guarantees that family caregivers who are BIPOC women will continue to have to provide unpaid care and financial support to fill in the gaps of a deficient system. The poor job quality of direct care jobs, their meager pay and working conditions maintains the status quo and leads to increased turnover in the direct care labor field.

Our systems of care do not operate in silos—families and individuals will need access to various forms of care throughout their lives. And while these systems of care are in place, determining who has access to them, who can afford them, and who utilizes them is one reason it is vital that we center BIPOC in our work to rebuild the care infrastructure.

There are a number of ways to center BIPOC, starting with viewing them as experts in their own right. BIPOC have a wealth of knowledge and experience regarding what is needed in our care infrastructure versus what is currently provided, because they routinely both need care and provide care. Second, the United States must provide BIPOC with the tools, resources, and information they need to empower them to make their own decisions for themselves and their communities.

And lastly, their needs should be placed at the center of policies that aim to address their issues. BIPOC need to be at the table when policy is discussed, to ensure we are not overlooked, denied access, discriminated against, and disproportionately impacted by a system that is not set up for us to thrive.

Symbolic gestures; painted murals in solidarity with BIPOC and the removal of racist statues and symbols are admirable but do nothing to address the creation and enacting of policies that inadvertently affect BIPOC. Moving beyond symbolism to actual representation involves designing a care infrastructure that is informed by those who have been overlooked, denied access, discriminated against, and disproportionately impacted by a system that is not set up for BIPOC to thrive.

To address gaps in the system, we must be willing to move past placating and into action by way of power shifting; allowing BIPOC to be in control, to take action, and make decisions. We must work together to achieve real engagement. By not acknowledging, centering, and receiving the input of BIPOC and BIPOC women, those in positions of privilege will continue to make broad decisions and implement sweeping policies, regardless of the intent, about what all families, but especially BIPOC families, need and want.

Namatie Mansaray, MSPP, is a senior director for Paid Family and Medical Leave at MomsRising, a veteran, and a local elected official, in Washington, DC.


Brown, S. 2020. “How COVID-19 is Affecting Black and Latino Families’ Employment and Financial Well-Being.” Urban Institute. Retrieved July 24, 2021.

Centers for Disease Control and Prevention. 2021. “Health Equity Considerations and Racial and Ethnic Minority Groups.” Retrieved July 28, 2021.

Ewing-Nelson, 2002. “One in Five Child Care Jobs Have Been Lost Since February, and Women are Paying the Price.” Retrieved August 26, 2021.

Novoa, C. 2020. “How Child Care Disruptions Hurt Parents of Color Most.” Retrieved July 24, 2021.

U.S. Census Bureau. 2020. “65 and Older Population Grows Rapidly as Baby Boomers Age.” Retrieved July 23, 2021.