The care economy is aging

At 3 a.m., in the midst of labor, a doula we’ll call Renee stepped into the hallway to steady herself. She had been supporting a laboring client for nearly 12 hours. The room was warm, the lights low, the energy focused. But outside, her body told a different story. A sudden wave of heat rose through her chest, her heart began to race, her shirt damp and sticky with sweat. She hadn’t slept well in weeks. The brain fog had been hijacking her daily functions. Still, she took a breath, wiped her face, and walked back in to continue holding space for her client’s imminent birth. “I know how to guide someone through birth,” she later shared. “No one ever taught me how to move through whatever this is.” Renee is not alone. Across the United States, women are sustaining the care economy; doulas, midwives, and other birthworkers are entering perimenopause and menopause with very little guidance, limited clinical support, and almost zero structural protection. This gap undermines not only caregiver well-being but the stability of the workforce. CLOSE THE GAP Women spend an average of nine years of their lives in poor health, much of it during their working years. More than half of the women’s health gap occurs during this period, shaping productivity, workforce retention, and economic participation. Closing that gap could add at least $1 trillion to the global economy annually by 2040, according to the McKinsey Health Institute. The care economy is a vast and layered system spanning both paid and uncompensated work. In the U.S., formal sectors like healthcare, childcare, and long-term care account for several trillion dollars in annual economic activity. Meanwhile, unpaid caregiving—largely performed by women—adds trillions more in hidden value that isn’t captured in GDP. These systems underpin the broader economy, supporting workforce participation, productivity, and population health, yet remain structurally undervalued and underinvested relative to their impact. As the in