Before dawn breaks in a small village of Keshabpur, Jessore, Ayesha Begum (58) is already awake. Her son lies in bed, paralyzed after a stroke, waiting for her. She lifts him carefully, checks for bedsores, bathes him, changes his clothes, and prepares his breakfast. Each movement sends jolts of pain through her back and shoulders. Yet she cannot stop.
“My body hurts all the time,” she said. “But if I rest, he suffers. So, I do not rest.”
In rural households already teetering on the edge of survival, caregiving is not an act of kindness. It is unpaid, unrecognized labour that keeps life going.
When disability enters such a household, it multiplies poverty, anxiety, and exhaustion. And all of it falls on the caregiver, usually a woman, whose work remains invisible to family, society, and the state.
During recent fieldwork across Jessore, Jhalokathi, Habiganj, Sirajganj, Kurigram, and Mymensingh districts -- conducted as part of a study by the Brac Institute of Governance and Development (BIGD) -- caregivers repeatedly described lives shaped by relentless labour and unacknowledged sacrifice. One grandmother caring for her granddaughter with a physical disability put it simply:
“My hands shake when I lift her. Sometimes I feel dizzy. But if I fall, who will pick us up?”
Her daily routine is not measured in hours, but in tasks -- feeding, bathing, cleaning, lifting, walking to distant clinics, soothing tears, and performing exercises she was never trained to do. It is skilled, exhausting labour, but no one calls it work.
Invisibility at home
Within families, caregivers’ labour is assumed, expected, and rarely recognized. Girls are pulled out of school to assist. Elderly mothers lift adult sons. Wives care for husbands. Husbands and other relatives sometimes step aside, viewing the labour as a woman’s “natural duty” rather than labour.
“They say that it’s my fate. And so, I stay,” said a mother quietly in Sirajganj. “So, I stay.”
The emotional cost is steep. Caregivers are constantly torn between compassion and survival, their own needs ignored. Another mother confessed: “Sometimes I cry in the courtyard when no one is watching. No one asks how I am.”
Invisibility in the community
Outside the home, the caregiver disappears entirely. Neighbours see the person with disability but rarely notice the exhaustion etched on the face of the caregiver. Health and social services rarely account for the physical and emotional strain she endures. Disability allowances, when provided, go to the person with disability, not the caregiver whose labour sustains life.
“People see him, disability and all.” Ayesha said. “No one sees me.”
Invisibility in policy
At the policy level, caregiving is absent. Bangladesh’s Persons with Disabilities Rights and Protection Act (2013) does not recognize caregiving as labour deserving protection, compensation, or support.
There are no caregiver allowances, no respite services, no counseling, and no formal training. When caregivers fall sick or die, the system collapses because it was never formally acknowledged.
“If I become disabled from this work, who will care for both of us?” one caregiver asks.
The burden of invisible labour
Caregiving consumes bodies, time, and opportunities. Women stop working to provide care. Hospital visits drain savings; medicines and transport push families into debt. A day spent caregiving is a day without income.
“On hospital days, everything stops,” said Abdul Majid (45), caring for his visually impaired wife. “No work, no food, only expenses.”
National surveys indicate households that consist of a person with disability are 50% more likely to experience chronic poverty, underscoring how disability and unpaid care work deepen economic vulnerability. Yet the unpaid labour of caregivers -- absorbing economic, physical, and emotional shocks -- remains unmeasured, undervalued, and ignored.
Women's unpaid work: The hidden engine of the economy
According to the first national Household Production Satellite Account (HPSA), unpaid household and care work in Bangladesh was worth Tk6.7 trillion in 2021, equivalent to nearly 19% of GDP. Women accounted for about 85% of this labour, which includes cooking, cleaning, childcare, elder care, and care for people with disabilities.
Another breakdown reveals that unpaid care work alone -- feeding, bathing, helping, and supporting family members constitutes a significant portion of this value, yet it has long been excluded from official economic measures.
These figures confirm what caregivers like Ayesha experience daily: The labour that keeps households functioning is essential yet invisible in the statistics that shape national policy.
The gendered trap
Caregiving is overwhelmingly done by women: Mothers, wives, daughters, and grandmothers. They bear the physical strain, emotional weight, and social expectation that it is their “duty.”
Caregiving locks women into unpaid labour, erodes their health, and perpetuates intergenerational cycles of poverty.
The economic burden
The burden of caregiving is also deeply economic. In ultra-poor households, the caregiver often manages both care and income. She runs a small business -- tends livestock or manages a poultry farm -- while maintaining a demanding rehabilitation schedule.
She is expected to be an entrepreneur, nurse, therapist, and homemaker all at once. Her life sits at the cruel intersection of poverty, disability, and gender inequality.
This impossible balancing act comes at a cost. If she focuses on the family business, caregiving suffers. If she focuses on caregiving, the family income declines.
The constant tension between economic survival and emotional duty keeps her trapped in a cycle of anxiety and exhaustion.
Recognition must be real
As a society, we must stop viewing caregivers merely as instruments of care and begin recognizing them as individuals with their own rights to health, rest, and dignity. This crisis cannot be solved by sympathy alone. It requires systemic reform.
Caregivers need official recognition in society and community. Caregivers should be registered at the union or village levels, counted in social protection systems, and included in community development planning.
Moreover, stipends, allowances, or micro-grants for caregivers would acknowledge their labour as economic and essential. They should be afforded access to healthcare for caregivers.
Many suffer from chronic pain, stress, and untreated illnesses. Routine checkups, subsidized treatment, and mental health support are essential.
Psychosocial care for caregivers should be a mandatory component of all relevant programs. Practical guidance on safe lifting, therapeutic care, hygiene, and first aid would help protect both caregivers and those they support.
Volunteer networks or local NGOs could provide temporary relief so caregivers can rest or pursue income-generating work, even if just for a few hours a week.
In rural ultra-poor Bangladesh, caregivers are the invisible system holding households and lives together. They absorb pain, poverty, and responsibility so others can survive. As Ayesha said at the end of our interview: “I am always tired. But I cannot stop.”
Until families, communities, and policy-makers recognize caregiving as real labour with real costs and responsibilities, millions of women will continue to shoulder invisible, unrecognized work -- quietly sustaining life while remaining unseen and unsupported.
Md. Al-Mamun is a Research Associate, and Faruq Hossain is a Research Coordinator at the BRAC Institute of Governance and Development (BIGD), BRAC University. The views expressed in this article are the authors’ own.