Towards a Bioethics of Care: Social Justice and the Sustainability of Life in Mexico and Latin America

March 23, 2026
Versión en español

Why talk about care today

At the heart of the stability of our societies lies a mechanism that has been rendered invisible yet is essential for the continuation of society’s basic dynamics: care-related activities. Talking about care today is not simply a matter of discussing domestic work or a display of affection; it means confronting a systemic crisis that calls into question the sustainability of our development model². The COVID-19 pandemic acted as a magnifying lens, revealing what feminist economics has denounced for decades: care is the central axis of the sustainability of life, but its current organization is unjust, unequal, and exhausted¹.

Reflecting on care from the perspective of global bioethics and biolaw entails recognizing our constitutive vulnerability as human beings². All of us, without exception, have needed, need, or will need others in order to survive. Yet this interdependence has historically been rendered invisible by a system that prioritizes the reproduction of capital over the reproduction of life². Today, the urgency of establishing comprehensive care systems arises from accelerated demographic change—the aging of the population—and the growing need to guarantee fundamental human rights in a context of extreme inequality³.

The conceptual transition of care has been profound: it has moved from being considered a women’s “natural obligation” in the private sphere to being recognized as a fundamental human right and a public obligation of the State¹. This interpretive shift, driven by frameworks such as the Buenos Aires Commitment⁸, defines care as the right of every person to provide care, to receive care, and to exercise self-care under principles of equality and universality³.

Care can no longer be seen as an individual contingency, but rather as a “fourth pillar” of well-being, on the same level as health, education, and social security¹. From a public bioethics perspective, this means the State must cease to be a marginal actor and become the guarantor of equitable access to quality services. Conceiving care as a social right means that its provision should not depend on families’ ability to pay or on the goodwill of community networks, but on a solid institutional structure that protects human dignity throughout the entire life cycle¹.

The current organization of care reproduces inequality

The current social organization of care in Latin America is based on a deeply unjust sexual division of labor. The traditional model of the “breadwinning father” and the “caregiving mother” has confined women to a disproportionate burden of unpaid work, which amounts to an invisible subsidy to both the State and the market¹. In the region, women devote three times as much time as men to these tasks, a gap that widens in households with children or dependent persons¹.

This feminization of care is not only a matter of gender roles, but also a factor in the reproduction of poverty. As Dora Villanueva points out in a recent piece in the newspaper La Jornada, there is a perverse link between poverty and care: three out of every four poor people engaged in unpaid care work never cease to be poor, trapped in what are known as “sticky floors”⁶,¹, a term that refers to the structural conditions that keep many women trapped at the lowest levels of the labor market, making it markedly harder for them to have real opportunities to advance or improve their working conditions. Women with lower incomes are less able to outsource care and, by devoting up to 45 hours a week to unpaid work, they face time poverty that prevents them from accessing education, formal employment, or political participation¹. Moreover, when care is commodified, it often falls to other women—migrant, Indigenous, or Afro-descendant women—under conditions of extreme precarity, lack of social security, and low wages, thus perpetuating global care chains marked by exclusion²,¹.

The impact of care extends beyond families’ immediate present; it is a structural determinant of life opportunities and social mobility⁷. Recent evidence in Mexico shows that care responsibilities shape educational and labor trajectories across generations. For example, more than one-third of women whose mothers performed unpaid care work now shoulder the same burden, revealing an intergenerational transmission of roles that limits social advancement⁷.

The inequality of opportunity is clear: whereas non-caregivers are more likely to attain professional education, caregivers face high persistence in low educational levels and a significant reduction in labor force participation⁷. This situation affects not only income but also mental and physical health. Being the primary caregiver is associated with effects such as lack of concentration, sadness, and the feeling that everything requires great effort, especially when support services are unavailable⁷. Ultimately, the absence of a public care system forces families to sacrifice their autonomy and resources, deepening the vulnerability of both those who provide care and those who receive it⁷.

To reverse these injustices, the political response must be the creation of Comprehensive Care Systems (CCS). These systems are not mere aggregations of scattered programs, but a new social organization based on shared responsibility¹. The structural elements of an effective CCS should include:

• Universality and progressivity: Guaranteeing that all people can exercise the right to care, prioritizing populations with the greatest unmet needs and ensuring that service quality does not depend on income level¹,³. 

• Shared responsibility: Care must be a responsibility shared among the State, the market, the community, and households, as well as between men and women¹. 

• Regulation and quality: Establishing clear standards for public and private services, protecting the rights of both care recipients and professional caregivers¹. 

• Sustainable financing: Exploring solidarity-based and tripartite financing models that ensure the long-term viability of the system¹,⁵. 

• Professionalization and recognition: Dignifying care work by ensuring fair pay, training, and access to social security for those who perform it as paid labor¹. 

• Institutional coordination: Overcoming current fragmentation through intersectoral governing bodies, such as interministerial roundtables, that coordinate health, education, and social protection¹,².

Mexico in transition: the opportunity and challenge of a national care system

Mexico is at a historic moment of transformation. The current government’s commitment to consolidating a “care society” is reflected in the creation of the National and Progressive Care System (SNPC)⁴. This institutional advance seeks to coordinate efforts across 22 federal agencies in order to move from fragmented attention to a systemic, people-centered vision⁴.

Recently, the establishment of the Interinstitutional Coordination Roundtable and the implementation of Transversal Annex 31 in the budget have, for the first time, made it possible to make visible and track the resources allocated to this issue⁴. In addition, the development of the Care Information System (SIDECU) promises to be a fundamental tool for families to identify nearby services and for the State to plan strategically based on real demand⁴. However, monumental challenges remain: the need for a General Law that provides a solid legal framework, the challenge of territorial equity in a federal state, and the effective integration of the needs of Indigenous and rural communities that still remain at the margins of public policy⁵,².

Progress is being made on this issue in different federal entities. One example is the initiative promoted by the Congress of Mexico City to build a local care system⁹, notable for its participatory and rights-based approach. Through public consultations, forums, and surveys, the process has sought to ensure that, in April 2026, the voices of thousands of caregivers and care recipients are incorporated, making it possible to build a diagnosis that is closer to social realities.

This proposal recognizes care as a human right and as an axis of social justice, making visible the historical inequalities that have fallen primarily on women, who assume these tasks disproportionately and, in many cases, without pay. In this regard, it aligns with principles advanced by international organizations such as the United Nations and the International Labour Organization, particularly around the recognition, redistribution, and shared responsibility of care among the State, the market, the community, and families.

In this way, local experiences such as that of Mexico City show how it is possible to move toward the consolidation of a national care system by articulating institutional efforts with social participation and an approach centered on the dignity and well-being of people.

The urgency of an ethical and public agenda for the care system

From the perspective of public bioethics, building a care system is not a public policy option but an imperative of social justice. We cannot speak of substantive equality if the sustaining of life continues to rest on the shoulders of the poorest women in our region. The current organization of care is, in ethical terms, a form of exploitation that restricts the autonomy and dignity of millions of people².

The commitment must be to a care society that places life and its sustainability at the center of economic and political decisions². Investing in care generates a “triple dividend”: it improves people’s well-being, facilitates women’s economic autonomy, and energizes the economy through the creation of quality employment¹.

As CADEBI, we believe that care is the foundation of a new social contract. It is time for the State to assume its governing role and for civil society and the private sector to share responsibility in this task. Recognizing our shared vulnerability and acting to protect it is not only an act of solidarity, but the foundation of a truly just, democratic, and sustainable society. The care agenda is the agenda of life, and its implementation can no longer be delayed.

References

1. Bango, J., & Cossani, P. (2021, noviembre). Hacia la construcción de sistemas integrales de cuidados en América Latina y el Caribe: Elementos para su implementación. ONU Mujeres; Comisión Económica para América Latina y el Caribe (CEPAL). 
2. Carballo de la Riva, M., López Castelló, A., & Pajarín García, M. (2024, abril). Análisis comparado de sistemas integrales de cuidados en países referentes de la Unión Europea y América Latina y el Caribe. La Coordinadora de Organizaciones para el Desarrollo. 
3. Galián, C., Rubio, M., Escaroz, G., & Alejandre, F. (2023). Los sistemas de cuidado y apoyo en América Latina y el Caribe: un marco para la acción de UNICEF. UNICEF. 
4. Gobierno de México. (2025). El Sistema Nacional y Progresivo de Cuidados (SNPC): El mecanismo articulador de la oferta institucional y garante de la corresponsabilidad entre diferentes sectores de la sociedad. Secretaría de las Mujeres; Sistema Nacional para el Desarrollo Integral de la Familia (SNDIF). 
5. Huenchuan, S. (2024, 17 de diciembre). Cuidar en México: del ámbito familiar a un sistema público. Comisión Económica para América Latina y el Caribe (CEPAL). 
6. La Jornada. (2025). Tres de cada cuatro pobres dedicados al cuidado sin pago nunca dejan de serlo. Sección Economía. Recuperado de la liga proporcionada. 
7. Orozco Corona, M. E. (2026, febrero). Informe de movilidad social y cuidados: Un vínculo inseparable. Centro de Estudios Espinosa Yglesias (CEEY). 
8. Comisión Económica para América Latina y el Caribe (CEPAL). (2023). Compromiso de Buenos Aires (versión accesible). https://conferenciamujer.cepal.org/16/es/documentos/compromiso-buenos-aires-version-accesible 
9. Congreso de la Ciudad de México. (2026). Sistema de cuidados de la Ciudad de México. Recuperado de la página oficial

This editorial note was prepared on the basis of the sources cited in the references section. It also drew on artificial intelligence tools, such as NotebookLM and ChatGPT, as aids in organizing and synthesizing the information. The final content is the responsibility of the author.