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Geographies and strategies of caregiving among skilledGhanaian migrant women

Madeleine WongGlobal Studies Department, St. Lawrence University, 23 Romoda Drive, Canton, NY 13617, United States

a r t i c l e i n f o s y n o p s i s

Available online 8 December 2013 Research on migrant women tends to address the experiences of women located in low skilled,low-paid work like domestic care work in receiving countries. Less attention has been directedtowards the mobility and experiences of skilled and elite professional women who, whilepursuing their professional careers and livelihood strategies, must also attend to socialreproductive roles. Drawing on research with two groups of skilled Ghanaian women – nursesin England and professionals who have returned to Ghana – this paper analyzes how theynavigate multiple caregiving responsibilities. The women's movements produced familyseparations that engendered a myriad of multiscalar strategies to negotiate and reconfigurecare relationships and obligations. Among nurses who are not from elite backgrounds, theirformal care work and competing caring roles are shaped beyond, but in constant reference to,demands placed on them in multiple local and transnational settings. Among highly skilledmigrants, their class status, access to resources and mobility mitigate the challenges ofcaregiving and the impacts of familial separation. In conclusion, the paper contributes to theliterature on skilled migration and care by presenting the gender and class tensions that thecombination of professional and personal caregiving create for skilled and mobile Africanwomen.

© 2013 Elsevier Ltd. All rights reserved.

Introduction

The recent transformations associated with economicglobalization and neoliberal capitalist development haveprecipitated unprecedented movements of women seekinglivelihood opportunities. While the diversity of individualand collective experiences of migrant women has been thesubject of a plethora of research, the overwhelming focus onlower-skilled and less-privileged women who engage inpaid work in highly feminized sectors like home care anddomesticwork has remained the cornerstone of current analyses(Gamburd, 2008; Hochschild, 2000; Hondagneu-Sotelo, 2001;Parreñas, 2001; Zimmerman, Litt, & Bose, 2006). Less attentionhas been directed towards the implications of economicrestructuring for the mobility and experiences of other classesof women – skilled and elite – who, while pursuing theirprofessional careers and livelihood strategies, have becomeincreasingly crucial income-earners for households (Kofman,

2000). As Parreñas (2005: 29) argues: “Women do not uni-formly experience the gender inequities of globalization.” Aswith lower skilled women, mobility has implications for thereorganization and renegotiation of social reproduction forprofessionalwomen as livelihood practices are extended acrossmultiple geographic sites and spaces, engendering diversefamily reconfigurations (Iredale, 2005; Kofman, 2000). Theselivelihood pursuits are often simultaneously empowering andconstraining; the material rewards associated with migrationare tempered by exclusionary practices and structural limits tothewomen's progress, and by family pressures and obligations.

This article contributes to the emerging literature onskilled women migrants by examining the manifold caregiv-ing implications of economic restructuring for two groups ofprofessional Ghanaian women who, while differentiated by“skill” levels, occupy privileged social locations that allow fora more nuanced examination of the sociospatial articulation ofclass behaviors in varied spheres of migrants' lives (McDowell,

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2008): nurses in England whose pursuits of professional care-work opportunities entail the management of myriad caringwork; and mobile highly-skilled women whose livelihoodoptions and choices that entail returning to Ghana engendershifting family reconfigurations and caregiving strategies. By“skilled”, I mean educated women who are defined by theirpersonal and professional skills that enable them to pursue acareer trajectory. As I discuss below, important differencescharacterize the experiences of both groups of women –

materially and culturally – in ways that reflect the complexintersections of gender, class and culture with migration andcare regimes, highlight the multiplicity of women's sociallocations, and reveal the implications of the interplay ofconstraints and agency for caregiving. I analyze how bothgroups of women are differently socially situated anddifferentially empowered to manage their individual inter-ests and goals, and navigate multiple caregiving responsi-bilities to multiply-situated families.

I employ the broad term “caregiving” to encompassparental caring of children, caring responsibilities to otherfamily members or friends, and paid caregiving work, asnavigating one kind is often inextricably linked to others.Kofman (2012) asserts that caregiving constitutes a complexactivity that entails multiple dimensions of time, effort,techniques, and social skills in addition to obligations, trustsand commitments to the wellbeing of others. I argue that thedecisions and actions of Ghanaian professional women notonly represent individual and collective compromises, butalso encompass renegotiations and reworking of genderpolitics of social reproduction. I posit that an engagementwith the ‘everyday’ serves to uncover the local and globalprocesses that delimit the women's navigation of multiplecaring responsibilities, and the ways in which caregivingstrategies are being constituted. Such an engagement permitsnew insights into how relations of gender, power and dif-ference not only shape, and are shaped by, social reproductivepractices, but also are temporally and spatially structured instrategic ways.

Ghanaian skilled women present an interesting empiricalcase study for a better understanding of caregiving and socialreproductive activities of skilled women. First, Ghana hasexperienced significant emigration and return migration ofprofessional women. Second, integrating analyses of culturalnorms illuminate the complex constructions of caregiving byillustrating how multiscalar and intersecting socioculturalcontexts, within which they are embedded, circumscribewomen's decision-making, negotiations and strategies. Specifi-cally, stressing the salience of matrilineal kinship for women'sautonomy and empowerment in decision-making and caregiv-ing strategies (Clark, 2010) challengeswidespread homogenizedconstructions of African women as uneducated, low skilled, anddisempowered. Finally, comparing two different groups ofwomen and phases of migration affords a closer scrutiny of theshifting temporality, spatiality and sociality of caregiving. Bothgroups demonstrate similar patterns that justify comparingthem: a) both groups draw on class and mobility, and employdiverse networks as a strategy of care to traverse some of theconstraints of migration; b) they are both products of educationsystems that prepares them for the global labor market; c) theycombine professional work and care work — often simulta-neously engaging in local and transnational caring activities and,

finally, d) the diverse circuits of migration lead to familyseparation where policy and legal constraints often extend thelength of separation and impede family reunification, even if thewomen can move to visit family and children.

Yet, the multiple intersecting dimensions of gender, class,culture, migration status and global and local forces impingeon the experiences of both groups of women in disparateways. While they are considered skilled professionals, nursesdo not often come from elite background and are located onthe continuum and hierarchy of feminized occupations (withdomestic workers on the lower end). Conversely, highly skilledwomen are engaged in gender-neutral or male-dominated pro-fessions. Second, though their employment status in England isrelatively stable – given the demand for care workers – nurses'caregiving options and choices are often curtailed by con-straints associated with their migration status and remunera-tion. Considering the stringent conditions imposed on theirmigration status that restricts their access to welfare, nursesoften navigate high childcare costs and constraints by pursuingcaregiving strategies comparable towhat those less skilled careworkers employ. In contrast, the highly skilled women comefrom elite backgrounds and enjoy a more privileged migrationstatus. The ways this group of women experience caregivingare inflected by class privilege that nurses do not enjoy, as theyare less constrained by state benefits and can mobilize diversematerial and social resources to perform and fulfill their care-giving responsibilities. This article, therefore, widens the opticfor expanding our understanding of different modalities andtrajectories of caregiving practices (Kofman, 2012).

I first outline the analytical framework circumscribingthe study, and the study context. I then turn to summarizingmy research methods and participants' characteristics. Insubsequent sections I present the women's experiences andassess how the various strategies of caregiving they marshaledconstitute a response to, and a product of, structural andmaterial transformations associated with changing immigrationand labor market polices. In conclusion, I address the contribu-tion of this paper to the migration and caregiving scholarship.

Situating caregiving in sociospatial context

This paper employs a conceptual framework that bringstogether feminist research on social reproductive labor mar-kets, and theorizing of local and transnational networks andpractices thatmigrants create and sustain. Themain theoreticalargument I advance in this paper is that caregiving decisions,negotiations and strategies must be understood within thecontext of the ways that children, parenthood, family, andkinship are inextricably intertwinedwith howGhanaianmigrantwomen navigate not only a political economy organized aroundneoliberal restructuring, but also the social and cultural forcesshaping their obligations and responsibilities. I employ Fisherand Tronto's (1990) notion of ‘caregiving’ as constituting theconcrete, hands-on care work that requires knowledge and skill,and enjoins time and resources. However, I extend this notion toincorporate the salience of variegated structures (social location,family, institutions, the state) and of place and space in shapingand reconfiguring caregiving. The geographic literature providesimportant insights into how care extends across public andprivate spaces, and how places are not only shaped by social

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relations but work to perpetuate inequalities intrinsic in globalcare chains (Conradson, 2003; Pratt, 2004; Silvey, 2006).

I employ Kofman's (2012:144) argument that “theconcept of social reproduction enables us to place care workwithin a wider landscape of activities and sites and to connectsupposedly disparate circuits of migration, in particular labor,family, and education, which are usually analyzed separatelybut which are in fact interconnected.” The global circulation ofwomenmigrants stems from social transformations associatedwith large-scale transnational and global processes that haveintensified inequalities and exacerbated north–south dispar-ities. The combination of economic decline, political instabil-ities of the 1970s, falling standards of living, insecurity andmaterial adversity – followed by neoliberal strategies thatfocused on the hollowing-out of state developmental functionsand social and public disinvestments in southern countries –

triggered mass migration. Regarding these transformations,women are situated differently from men as they often bearthe greater burdens of economic downturns and the demandsfor social reproductive labor in the era of global markets(Ehrenreich&Hochschild, 2002; Espiritu, 2005). Responding tonew migration opportunities engendered by restructuring,women pursued migration as a livelihood strategy to pursuetheir own personal ambitions and to fulfill obligations tofamilies they leave behind – often to serve as caregivers formore privileged families in northern countries – creatingtransnational families and reconfiguring household strategies,a process of ‘global householding’ (Douglass, 2010). Simulta-neously, the ‘care deficit’ arising from neoliberal policies innorthern countries, entailing restructuring of the welfarestate, widespread deregulation in the labor market, and theintroduction of market discipline and competition into socialspheres – described as ‘roll back’ neoliberalism (Peck & Tickell,2002) – shifted the burden of social reproduction towomen ashusbands failed to assume responsibility for domestic labor(Yeates, 2009). In the UK, employers in the care industryutilized recruitment agencies and foreign labor to address thecare deficit (Buchan, 2007; Hussein, Manthorpe, & Stevens,2010). These processes have gained much attention in themigration and care literature that delineates and expounds onthe transfers of physical and emotional reproductive labor andtheir impacts on households and families (Ehrenreich &Hochschild, 2002).

Yet, the extant literature on these processes has centeredprimarily on certain commodified forms of reproductivelabor, particularly on socially disadvantaged women workingin private households as domestic workers whose experi-ences are rooted in the milieu of racialized, gendered andclassed social marginalization (Hondagneu-Sotelo, 2001;Parreñas, 2001; Zimmerman et al., 2006). There is a limitedliterature on the reproductive labor and family practices ofmore privileged women who migrate independently or arerecruited into the expanding welfare, health and social servicesectors of wealthier nations such as the UK (see Kofman &Raghuram, 2005; Yeates, 2009). Even fewer studies address thehighly educated and skilled womenwhomigrate for educationor to work in areas other than the care and health sectors.When skilled migrant women are considered the literatureoften portrays them in family migrations as ‘trailing wives’accompanying elite skilled spouses (Cooke, 2007; Ryan &Mulholland, 2013; Yeoh & Willis, 2005), as competing with

men in masculinized and highly mobile sectors of the labormarket such as the knowledge economy (Czarniawska &Sevón, 2008; Kofman, 2007; Raghuram, 2004, 2008), or asexperiencing deskilling and downward economic and socialmobility (Liversage, 2009; Purkayastha, 2005; Raghuram &Kofman, 2004). Notably, the ways in which competingpressures of work-life affect highly skilled migrant womenwho are not in caring professions – but who nevertheless mustnavigate productive and caring responsibilities – have not beenwell documented. There is also a proclivity in this emergingliterature to separate out the experiences of skilled migrantwomen into the dichotomous arenas of their productiveengagement in public spaces and sites and their socialreproductive work in private spheres. Importantly, howwomen can be simultaneously providers of care work inpublic spheres and sites and employers of careworkers in privatespheres across multiple spaces and scales remain hidden.

Notwithstanding, the extant literature offers invaluableinsights into the profoundly gendered processes of caregiv-ing. Studies variously stress the gendered implications andimpacts of globalization for domestic work and child care,arguing that the ideology and practice of informal care –

increasingly an outcome of social displacement – rests on andreinforces a sexual division of labor which leaves womenresponsible for the day-to-day work of keeping families going(Hondagneu-Sotelo & Avila, 1997; Parreñas, 2001, 2005). Theliterature also explicates how interlocking systems of gender,race, social class, nationality and immigrant status not onlydifferentially shape men's and women's experiences, but alsocircumscribe the complex structures and dimensions ofcaring work (Silvey, 2006; Stasiulis & Bakan, 1997; Stiell &England, 1999). Lastly, emerging research expands under-standings of the concept of care work to encompass a varietyof social and spatial organization of care including, butnot exclusive to, reproduction of care within and outsidehouseholds and in formal state and private care institutions(Kofman, 2012). Following Isaksen (2012) and Ryan (2007),this paper will depart from the literature's emphasis on thecircuits of care labor in its nuanced explication of the complexand differentiated ways that skilled migrant women navigatetheir productive and reproductive responsibilities and arrange-ments in and across multiple public and private spheres,and invoke shifting combinations of local and transnationalnetworks. Further, the growing research on skilled migrantwomen has remarkably little to say about skilled Africanmigrant women (for a notable exception, seeMcGregor, 2008).In recognizing and more centrally incorporating the expe-riences of well-educated and skilled Ghanaian women, thispaper diversifies the empirical base for analyzing skilledmigration.

The flourishing transnational literature captures thedistinctiveness of the persistent ties that migrants maintainwith multiple places, and the complex ways they live their livesacross borders. Transnational scholars argue that migrationallows families to extend livelihood strategies across multiplegeographic sites and spaces, engendering spatially rupturedtransnational families (Basch, Schiller, & Blanc, 1994; Bryceson &Vuorela, 2002; Landolt & Da, 2005). Such ruptured familiesinduce new expansive and dynamic relations and practicesacross borders that challenge nuclear and, often, nation-boundedunderstandings of the family. Aided by time–space compressing

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technologies, migrants and non-migrants sustain intense andtransnational relations through the flow of remittances andgoods, and the exchange of values, ideas, knowledge andresources (Levitt, 2001; Vertovec, 2002). As pointed out byfeminist migration scholars, however, women's decisions,strategic intents and cross-border relationships are distinctfrom men's, as women must often negotiate the exigencies ofboth productive and reproductive work (Hondagneu-Sotelo,2000; Kofman, 2012; Silvey & Lawson, 1999). In particular, aconsiderable body of feminist work confirms how the politicaleconomic and sociocultural contexts of migration, withinwhich men and women are embedded, are patriarchal andpower-laden that affirm competing gendered interests, deci-sions and relations (Hondagneu-Sotelo, 1994; Parreñas, 2001;Silvey, 2006). In formulating their conceptualization of “gen-dered geographies of power,” Mahler and Pessar (2001) positthat such gendered processes and particularities are subjectto asymmetric production and reproduction across multiplescales and places.

Yet, while studies on transnational mothering and theredistribution of care work in family left behind abound (Coe,2008; Dreby, 2006; Gamburd, 2008; Hondagneu-Sotelo &Avila, 1997; Parreñas, 2005), the literature underplays theexperiences of skilled women who navigate care of theirresident and transnational families simultaneously, or thosewhose return to their home countries can mean separationfrom their family in the diaspora. In addressing these gaps, Itake up Nicole Yeates's (2009) challenge in calling for studiesto move beyond the current preoccupation with construc-tions of ‘immiserated women’ in domestic work situationsin receiving countries. She argues for the conceptualizationof “global nurse care chains” that link care institutions,legislative regulations, migrant women, and families intransnational spaces. My focus on how skilled Ghanaianwomen juggle multiple roles and status, and negotiate variedcaregiving responsibilities in the shifting context of liveli-hood trajectories and phases of migration not only revealsthe hidden geographies of caregiving, but also serves toshow how they are differentially positioned outside thenarratives of lower skilled women and skilled men (Kofman& Raghuram, 2005). Lastly, I draw on studies that incorpo-rate notions of social capital – resources that individuals areable to mobilize and their embeddedness in a multiplicity ofinstitutional, social and interpersonal relationships (Portes,2000) – to articulate how the women access and mobilizelocal and transnational networks, including those that gobeyond kinship or ethnicity, to mitigate the challenges ofmigration and care provision. In her work on Irish nurses inBritain, Ryan (2007) argues that women deploy differentsets of networks, which shift across different scales andplaces over the life course. This is an important point, asmigrant women – particularly independent migrants –mustrely on support in localized settings to cope with caregivingresponsibilities in the absence of the proximal familialsupport they enjoyed at home. In deploying the social capitaloptic to examine how skilled Ghanaian women developinteresting matrices of networks and resources to navigatetheir work and reproductive roles, this paper offers a deeperunderstanding of how particular relationships and activitiesstructure the emergence and endurance of networks over timeand place (Salaff & Greve, 2004).

Skilled Ghanaians on the move

Located within historical colonial and contemporaryglobal circuits of capital, labor and resources, Ghana hasexperienced significant skilled migration. In the 1960s and1970s, Ghanaians migrated as students for education totrain as civil servants (Peil, 1995). In the 1980s and 1990smigration, especially to places beyond the African continent,materialized as a vital livelihood strategy for Ghanaians fromdiverse socioeconomic backgrounds to cope with the disloca-tions associated with neoliberal economic restructuring —

instituted through Structural Adjustment Programmes(SAPs) imposed by the World Bank (WB) and the Interna-tional Monetary Fund (IMF) (Akyeampong, 2000; Manuh,2005). Today, Ghanaians constitute one of the African‘neo-diasporas’ (Yeboah, 2008), with large numbers con-centrated in Canada and the US (Arthur, 2008; Mensah,2009; Owusu, 2003), England (Krause, 2008; Vasta & Kandilige,2010), Germany (Schmelz, 2009), and the Netherlands(Mazzucato, 2008).

The neoliberal restructuring associated with SAPs wid-ened inequalities in gendered ways. In the context of men'sreduced capacity to provide for their families, Ghanaianwomen increasingly became primary income earners, migrat-ing independently – nationally and internationally – to fulfilltheir livelihood needs and family obligations (Awumbila &Ardayfio-Schandorf, 2008; Manuh, 1998, 2001; Wong, 2006),to engage in transnational entrepreneurial activities (Darkwah,2007a), and to pursue career goals internationally (Labonte,Packer, & Klassen, 2006; Nowak, 2009). With low salary andremuneration, poor long-term career prospects, low respectand value placed on health workers by Ghana's medicalsystem, and bleak prospects for saving enough money forretirement, approximately 20% of all trained nurses andmidwives left Ghana, starting in the early 1990s (Bump,2006). Having been educated on the inherited British nursingcurriculum, the majority migrated to the UK, from whereinformation concerning the demand for healthcare profes-sionals and the prospects of greater remuneration and careeradvancement emanate. Conversely, the UK welfare statebecame a major employer of African nurses as a strategy toaddress its ‘care deficit’ — in a context where there is anenormous gap in the nurse to population ratio between manyAfrican countries and the UK (Henry, 2007). Ghanaian nursesrepresented the fourth largest group of African nursesregistered in the UK by the Nurses and Midwifery Council(NMC), behind South Africa, Nigeria and Zimbabwe (Mensah,Mackintosh, & Henry, 2005). As is common among firstgeneration migrants, a strong homeland orientation prevailsamong many Ghanaian nurses in the UK who maintain andreinforce linkages with family and communities in Ghana andelsewhere, illustrating Mazzucato's (2008) concept of mi-grants' ‘double engagement’.

As with most liberalizing economies, Ghana's newneoliberal development agenda, augmented by the discoveryof oil in 2007, increasingly attempts to court skilled members ofthe diaspora – who embody the desired business knowledge,‘global’ and ‘western’ labor market experiences, and who havepotential access to capital networks – as a means to generatefinancial and human capital. Appealing to their sense of loyaltyanddesire to return ‘home’, theGhanaian state institutedpolicies

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that recognizes dual citizenship and opens opportunities forinvestments in the Ghanaian economy (Ammassari, 2004;Mohan, 2008). As western economies experience a crisisfollowing the 2008 global recession, increasing numbers offirst and second-generation, well-educated and highlyskilled Ghanaian diasporans are returning of their ownvolition to Ghana in their prime productive years (asopposed to those who return when they retire) to satisfythese demands. Gender has currency in this pattern ofmigration as the decision to return and the processesentailed disrupt and rework power relations within house-holds in gendered and culturally inflected ways (Wong, inpress). Despite these recent trends, the experiences of skilledwomen remain under researched in the literature, whichnormalizes the ‘gender neutral’, and implicitly masculinist,conceptualizations of return migration.

Methods and participants

This paper constitutes part of a larger on-going multi-sitedproject on the migration and transnational experiences ofskilled/professional Ghanaians across various Ghanaian dia-sporic sites. The material presented here emerges from semi-structured interviews I conducted with fifteen skilled nursesin London, and with fifteen highly skilled Ghanaian womenwho have returned back to Ghana in the last five years. As aGhanaian skilled professional, my own class positioning andmigration experiences parallel those of these women. Duringannual trips to visit family and friends in England and Ghana, Iengage in participant observation and interact with differentgroups of migrants at various social events organized by skilledGhanaian professionals, including nurses and migrants visitinghome. Coming from non-elite backgrounds, the nurses I inter-viewed did not attend the best schools and many did not gainentrance into university to pursue a nursing degree. They allreceived their first nursing certificate from different NursesTraining Colleges (NTC) in Ghana before migrating to the UK,most arriving from the late 1990s through themid-2000s. Theyexhibited a variety of employment histories, ranging fromworking as full-timeor part-time registerednurses in hospitals,to working in nursing homes, to juggling a variety of other jobs(e.g. office cleaning). All the nurses also had caring respon-sibilities of one form or another in their nuclear and/orextended transnational families. Among the highly skilledreturn migrant women, they hailed from elite backgroundswith multiple citizenship status, attended the prestigiousschools in Ghana with the cultural capital of an English-privileged school curriculum that produces the highestproportion of skilled graduates, confers entrance into elitewestern universities and, subsequently, into high skilledand specialized professions. They moved back to Ghanawithin the last six years and worked fulltime. Both groups ofwomen were also, primarily, matrilineal Akan, which allowsfor an analysis of the pervasive influence of the lineage inmigrant women's decision-making and strategies. For theempirical discussion, I selected particular women (identi-fied by pseudonyms) not only to represent the participants,but also privileging their individuality fosters an in-depthexamination of their experiences and insights into theircaregiving strategies and negotiations.

Findings and discussion

The realities of moving and the geographies of caregivingare integrally linked to social and spatial articulations ofinequities engendered by the wider material and discursivepolitical economic context of migration. For skilled Ghanaianwomen, their subjectivities and caregiving practices not onlydiffer according to individual goals, expectations and prefer-ences, but also are shaped beyond but in constant referenceto demands placed on them in the work place, in the home,from family and the broader society. In what follows, Iexamine the places and practices of caregiving by, first, nursesin the UK, followed by skilled women who returned to Ghana,highlighting their decision-making, the varying strategies theyemployed, the gendered and familial negotiations they exe-cuted, and the mediating role of their social capital.

Geographies of caregiving among Ghanaian nurses

In the pursuit of their professional interests and migrationgoals, Ghanaian nurses encounter, engage and navigatedifferent gender systems in multiple social spaces. Theyemployed diverse strategies to manage their formal carework (nursing) and caring responsibilities. For some, theirwork schedule dictated their caring practices; for others, thecaring constraints shaped their work experiences. The gen-dered experiences of these nurses in the labor market need tobe considered in concert with other axes and hierarchies ofdifferentiation. The experiences of Sekyiwaa – a nurse inher early 30s with an advanced degree in palliative care –

exemplify a common response nurses reiterated about work-ing in the UK, highlighting not only the adverse experiences ofthe workplace, but also the dissonance between the expecta-tions of opportunities in the UK and the realities that manynurses encounter:

It has not always been straightforward. You have to work tentimes harder to prove what you can do… to put across whatyou have learned and put it in practice. So you have to proveyourself to your co-workers, but also to yourself. […] Youalso work harder here because you don't get any help. InGhana, the patients' relatives helped you with caring for thepatients… they bring food for them and feed them; they helpthem to the bathroom, wash and clean them. Here, thefamily only comes to visit the patient during visiting hours.So you have to be more accountable to your practice. […]Patients here are quite racist… and they make it clear to youwhat their preference would be… they ask for a white nurse.[…] But you just keep doing the best you can and not let itaffect you.

As has been well documented for many internationalnurses migrating to England (Allan, Larsen, Bryan, & Smith,2004; Henry, 2007; Vasta & Kandilige, 2010), the nurses Iinterviewed exhibited similar experiences of working inphysically and emotionally stressful situations where theyencounter many forms of discrimination, institutional racism,and prejudice from managers, co-workers and patients alikein the work place. As Sekyiwaa's words connote, despitebeing skilledmigrants in awelfare state, Ghanaian nursesmustconstantly prove themselves and their skills, emphasizing their

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professionalism, while navigating different structures of oper-ation, new social relations with patients and families, andgreater responsibilities of formal caregiving. What is particu-larly interesting to note is Sekyiwaa's lamentation on the morerigid boundary between informal care practices by patients'family and formal carework of nurses in a newwork space andculture, a facet of paid work that impinges on their other careresponsibilities. This differs significantly from the Ghanaiancontext, where an ethic of shared responsibility – marked bycollective and communal support – defined the workplace.

The lives of these nurses are defined by more than justtheir experiences as paid care workers. Nurses must alsofulfill their roles in the social reproduction of their respectivefamilies in the UK and in Ghana. With one exception, thenurses I interviewed were married with young children bornin the UK. The new work-life environment they encounteredrequired creative negotiations and strategies of caregivingthat traversed multiple places and scales – often bridgingpublic spheres of paid care work and private spaces of unpaidand paid care work – and revealed complex family and socialdynamics. The strategies were centered on the ‘dual-earnermodel’, but in most cases, the women earned more as nursesthan their spouses. They creatively adapted to and substitut-ed for the loss of two important sites of social reproduction intheir daily lives: household/family systems of support inGhana, and the state-funded channels of social provision inthe UK, particularly for nurses whose immigrant status madethem ineligible for childcare subsidies. To fully grasp thedynamic and lived complexities of caregiving among Ghanaiannurses requires entering into their lifeworlds. I employ extensiveexcerpts from interviews of three women to explore theircomplex but fluid matrix of caring arrangements.

Localized navigation of caregiving

Akuba, a mother of a 4 year-old and a 10 month-old inher late 30s, responds to my question about managing worklife and childcare, illustrating not only the struggles ofbalancing paid work and care work, but also how materialconditions give a particular texture to care work:

[Laughs] I'm a juggler. It's very difficult. I work at thehospital on Monday and Tuesday in the day. My husbandworks in the night. Then I do nights at a nursing home onWednesday to Friday. Sometimes I have carers, some of themare professional [certified], sometimes friends baby-sit them,and sometimes it can be neighbors who are not working. If Ihad a choice I would work full time in the hospital. With thetwo children, it will cost me £900 per week. My salary is only£1300 per month. What's the point of working then if I haveto pay 900 per week? So every week it's a juggling act to findchildcare… whoever I can find available to watch them.

Akuba's work-care strategies accord with what Wall andJose (2004) characterize as “mother-centered” strategy,where migrant women not only often assumed primaryresponsibility for childcare, but also rework their workschedule around the children's needs. Akuba's juggling actreflects a response to policy changes in childcare wrought byneoliberal reforms of the welfare state in the UK, which

advanced the marketization and privatization of care gener-ally, and childcare specifically. To address systemic unem-ployment, the state certified ‘for profit’ individual caregiverswho are able to charge higher fees for childcare (Penn, 2007),while simultaneously reducing spending on public childcareinfrastructures and imposing stringent restrictions on wel-fare benefit receipts on migrants according to their immigra-tion and residency status (Sales, 2007). Thus, nurses whoarrive to work on a student visa or work without properdocumentation are denied access to basic entitlements,welfare services and benefits, such as childcare subsidies(Allan et al., 2004). In so doing, the British state is complicitin the simultaneous recruitment of migrant labor andrestrictions on their access to welfare (Sales, 2007). Despiteholding permanent posts that provided themwith stability ofemployment, qualified nurses who acquired permanentresidency – and, therefore, eligibility for accessing statebenefits – could not easily afford the high costs of formalchildcare. According to Viitanen (2005), the typical cost of anursery place in the UK exceeds what the average householdspends a year on either food or housing.

With such high childcare costs, combining different worksites and shifts was a strategy that allowed Akuba to manageemployment and childcare. Dislocated from familial supportand wider kin networks (Oppong, 2004), Akuba employed arange of gendered strategies based on a combination ofboth informal and formal localized networks of childcareresourcefully, but her childcare arrangements were oftenunstable and unreliable. Besides, her labor market participa-tion and income-earning potential were constrained by theseobligations. Akuba could earn more if she worked at thehospital full-time; yet, she could not work full-time and fulfillher other care responsibilities, attesting to complex and oftencontradictory nature of balancing work and life. Thus, shecompromises by earning less working in a nursing home —

part of the private independent care sector where, thoughentering as skilled migrants, nurses were frequently hired ascare assistants, representing the deskilling process (Raghuram& Kofman, 2004). What is striking about Akuba's dilemma isthat she cannot not work, contrasting other research thatreveal how pressing domestic pressures encumber the labormarket entry of high-skilled immigrant women facing similarchildcare limitations (Liversage, 2009; Purkayastha, 2005;Ryan & Mulholland, 2013). The matrilineal Akan, especially,consider work to be not only critical for individuals tohave access to economic resources but also as important asparenting. Being able to provide for the needs of a child is asimportant as the day-to-day nurturing responsibilities of aparent. Akan women are encouraged to be industrious toensure the financial well being of their children rather thanto be dependent on men (Clark, 1999a). According toDarkwah (2007b: 209), “… a mother who is seen idling athome, unable to provide for the financial needs of a child,is seen as lazy and good for nothing.” Despite childcarechallenges, Akuba must work because, along with pursuingher personal aspirations, she has other obligations, such ascontributing to household expenses and assisting family inGhana. The trying conditions under which Akuba organizedchildcare matched those of the majority of the nurses Iinterviewed, though they exhibited varying responses andstrategies, and those of other lower-skilled migrant women

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elsewhere (Hondagneu-Sotelo, 2001; Parreñas, 2001; Silvey,2006).

Transnational mothering

The following conversation with 36 year-old Fremahdepicts alternate childcare arrangements that some nursesnegotiated with female kin to serve as a guardian for theirchildren during the initial challenges and uncertaintiesassociated with their work and immigration status. Fremahmigrated independently ahead of her husband, who joinedher after she secured work and sponsored his migration.After initially trying to balance work and childcare in themanner that Akuba did, Fremah decided to send her twochildren – aged two and four, and born in the UK – to heraunt in Ghana, with whom she had previously lived.Migration status clearly affects migrants' choices and opportuni-ties. Fremah's status as a work visa holder and not a permanentresident constrained her ability to exercise the rights that thelatter status bestows, thus necessitating the compromises shemade to accomplish her migration goals.

Author: Tell me a bit about your typical week work schedule.F: I work at the hospital 4 nights a week, and then I get 3days off. Sometimes it's 3 nights in a row, sometimes 2 nightsin the week and 2 nights on the weekend. But depending onthe demand I also work at the nursing home two to threetimes a week, but not every week.Author: It doesn't leave you much time to rest…F: I cannot afford childcare here, so I sent them home. MyAuntie is caring for them. When they were here, I onlyworked in the hospital but it was hard to find childcarebecause my husband also work nightshift as security. Butnow I can work more, and earn more to send home. I hope toget my indefinite stay, and then I can bring them back. Butnow at least we have a house [in Ghana] if I don't get theindefinite and we have to go back. I also heard from collegemates in Ghana that the government has increased nurse'ssalaries, so maybe it won't be as tough as before I left.

As with Akuba, Fremah expressed the very difficultconditions of meshing paid work with childcare responsibil-ities. Fremah resorted to “solve” her “double-day syndrome”by displacing and delegating everyday caregiving of herchildren to female kin in Ghana in a transnational motheringarrangement (Hondagneu-Sotelo & Avila, 1997; Leinaweaver,2010), which afforded her the time and choice to work fulltime on night shifts in the hospital because of its attendanthigher remuneration, and to strategically engage in shiftwork for maximizing earnings. Fremah's practice of sendingchildren home mirrored a common practice among manyAfrican immigrants (Bledsoe & Sow, 2011; McGregor, 2008).

Obligations in addition to childcare also shape Fremah'swork-care choices. The construction of a home in Ghanameant working long hours to earn money to finance theproject. The ability to construct a house confirms its culturaldesirability and serves as a testament to Fremah's migrationsuccess and her mothering responsibilities; that is, securing ahome for her children in case they had to return to Ghana —

an aspiration she might not have accomplished if she had not

migrated. Here, she discusses the implication of the separa-tion for the children:

The children are better there… it was too stressful, trying toorganize and find someone to watch them. They weren'tgetting the attention from me or my husband. I trust myAuntie… she cared for me most of the time when my parentstraveled. They have a stable life there… they are happy, theyplay with their cousins and local children. […] The money wesend can do more there… they go to a good private schoolthere, so when I'm ready to bring them back, they will adjustwell.

Fremah's words reveal many interesting themes. First, sheemphasizes that the separation from her children was anecessary sacrifice for a more promising future for her family –

such as the ability to construct a home for their (potentially)future return or future visits to Ghana – which parallel similarfindings by Coe (2008). Second, the children gained a solideducational foundation at a private school in Ghana that wouldfacilitate their adjustment to the British education system later.Third, the opportunity for them to grow up and be socializedin the local Ghanaian cultural environment with cousins andfriends reinforced their identity in a (non) racialized society.This construction of Ghanaian identity and values vis-à-visBritish norms regarding what is best for her children's ‘happi-ness’ reflects other work on African migrants (McGregor, 2008).Finally, Fremah's experiences are illustrative of the nature,culture andprevalence of child fostering in theGhanaian context,where the emotional and nurturing aspects of mothering can beshared by ‘other mothers’ while the child's mother is primarilyresponsible for the child's material needs (Goody, 1982).

Class status mitigates the exigencies of transnational care.Fremah's parents were themselves skilled migrants whoworked in Europe, leaving her in the care of her aunt. Herown experiences with her aunt's caregiving reinforcedFremah's decision to entrust the care of her own children toher aunt, who represents norms around the notion of “othermothers” in the global circuits of care (Leinaweaver, 2010;Parreñas, 2001) and underscores the salience of familialnetworks through which relationships are regenerated andreproduced. Irrespective of their everyday presence in the UK,the children received little attention from her; yet, separationmeant Fremah could do more for them in other ways. Thisarrangement depends on local family care, highlighting theoften invisible but critical care work that sustains socialreproduction in the welfare state (Isaksen, 2012).

Fremah's transnational caregiving practices are exemplary ofAkan cultural discourse and expectations of what constitutes“good mothering” and appropriate childcare. Among the Akan,descent and inheritance are traced and reproduced throughfemale members of the matrilineage (abusua) that value andhonor childbearing as children belong to the lineage (Dolphyne,1991). Matrilineal gender ideologies posit that women's role asreproducers of their lineage take precedence over their role aswives in conjugal relationships (Clark, 1999b). The lineagepromotes activities that foster the effectiveness of women asmothers in ways that serves the interest of the children andabusua, particularly recognizing and legitimizing the right ofmarried women to earn and control an independent income,and providing abundant assistance for child rearing (Clark,

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2010). Understanding her responsibilities through the prism ofmatrilineal cultural norms on ‘good mothering’, Fremah'scaregiving strategies entail balancing short versus long-termbenefits for the children and her family, rather than a trade-offbetween family interests and work demands. These culturalnorms contrast prevailing western conceptions of mothers asthe primary caregivers of children, and of ‘good mothering’ asconstituting time intensive, emotionally engrossing and dailynurturing of children often at the expense of mothers' ownconveniences or paid work commitments.

During a later encounter with Fremah, she had broughtthe children back to the UK after successfully acquiring herindefinite stay (permanent residency) in the UK because shecould now qualify for different kinds of institutional supportthat status confers, and the children were old enough to be inschool fulltime, eliminating the need for multiple carers.When I asked her how she managed childcare now, sherevealed yet another strategy that involved negotiations withher work manager.

I now do day and night shift. We care for the children on ourown. I have told my manager. So whenever my manager ismaking the work timetable, yeah the rota, I take myhusband's work rota to show her so that she can scheduleme at times that I can work. So I work nights when myhusband is off, and I work days when he works nights. […]Yes, he helps with the children but in terms of cooking andhousekeeping I do most of that.

What this quote suggests is that professional women likeFremah have a greater opportunity for converting temporarystatus to more long-term ones. Ghanaian gender norms alsooften construct women not only as nurturers and carers of theyoung, old and sick, but also as responsible for other domestictasks. Such gendered expectations are often preserved andreinforced, rather than challenged, with migration as illus-trated by Fremahwho, despite beingmore skilled and earningmore than her husband, performed more of the childcarearrangements and household work, which is quite common(Hondagneu-Sotelo & Avila, 1997; Ryan, 2007; Wong, 2006,2000).

Blurring social and spatial boundaries of care

Naana, a 37-year-old mother of two girls born in the UK,joined her husband who already lived in the UK and throughwhom she was recruited into the UK health sector. As withAkuba, Naana implemented multiple local strategies to navi-gate the complexities of her work-care demands but in hercase, they involved more active participation of her husband,Yao.

On the days that we both work, I try to get home by 8:00 am,wash down from the night's work and try to get a few hoursof sleep. He [husband] leaves for work around 11:30 am. Sohe looks after the children while I sleep. During the schoolyear, I have to wake up by 11:00 am to pick up my olderdaughter from pre-school at 11:30 am. […] In the evening hehas to get home from work by 7 pm. I start work at 7:15. Ifhe is not home by 7, I take the children with me in the car towork and wait for him in the parking lot to hand them over

before I go in… [Author's name], it's very tough… it's verydifficult. We can't afford a child minder. You have to payeven if the child does not go because of illness or familyactivity, like vacation. In the past, when I was working dayshift, we tried a live-in nanny for my first girl, an Africanwoman, but that didn't last long because of some issues withher behavior. At one time, she felt she was underpaid, and Ifinally decided to do night shift only.

Naana's narrative reveals not only the temporal and spatialjuggling act of caregiving, but also the agency and fluidity withwhich she constantly navigates the constraints of childcare. Sheillustrates the complex dynamics of multiple caring responsi-bilities with little institutional support, how different forms ofpaid caregiving operatewithin one household, and the blurringof boundaries between public and private space and betweenformal and informal care work.

As a dual income family with greater financial resources,Naana and her husband shifted the burden of care to anotherwoman in a live-in-care arrangement. While Naana worked asa caregiver in the public realm, she simultaneously employed anon-Ghanaian, undocumented woman who is neither a recog-nized worker nor a family member in her home. The relationsof power this situation expressed reflects Massey's (1994)‘power geometry’ – particularly, the intersection of class,gender and immigrant status – and speaks to the perpetuationof inequality among women and the reproduction of socialclass in care chains. The termination of this arrangement alsosignified the class struggles that occurred within the home —

articulating how interclass social relations revolving aroundcare are negotiated and contested (Pratt, 2004). Naana ex-pressed to me that the live-in carer demanded more that shecould afford to pay her, even after including extra for the carer'sfood expenses. For Ghanaian professional women abroad –

including nurses – employing domestic workers, thoughfraught with tensions, allows them to cope with high childcarecosts and fulfill transnational obligations. While underscoringimportant class-based differences associated with differentoccupations, these practices not only reveal how the flows ofunskilled and skilled labor intersect in the spaces of the homebut also reflect a common practice in Ghana (Akurang-Parry,2010), which reproduce and reinforce, rather than compro-mise, the women's middle-class status. This contrasts Aguilar's(1996) notion of ‘transnational shame’ for Filipino profes-sionals in the contextwhere the Filipino state is complicit in thediscursive representation of Filipino domestic workers.

Following this episode, Naana decided to work thehigher-paying night shift exclusively. During a later interview,she informed me of a recent change to her work structure – inresponse to the NHS closure of smaller district hospitals to copewith the financial squeeze associated with austerity measureson spending cuts (MacLeavy, 2011) – which compounded thechallenges of her work-care balance, accenting the salientbroader structural contextswithinwhich caregiving and familystrategies are exercised.

It's actually worse now, since I was moved to a differenthospital further away. Now I have to leave at 6:30 before hegets off work. So we have to find ways to bridge the 1-hourgap. Luckily, I found a student who can babysit for 1–2 h. Ipay her £5/h. But she can only do Wednesday, Thursday and

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Friday. If I work Monday or Tuesday, I have to ring around tosee if friends can help, like my Zimbabwean friend on theother side… she's a nurse too… sometimes I watch her kidwhen I'm off. Or I look at the rota to see if I can switch. […]But now the younger one is in school, I can sleep a bit longer.I have to pick them up at 3:00, so I leave the house around2:30. Sometimes Eman's [her daughter's African friend]mother will pick them up for me and take them to her houseto give me more time to rest. She helps me a lot.

Naana demonstrates the diverse array of localized strat-egies and the dynamic spatial and temporal networking sheemploys in adjusting to the different needs of her children asthey grow and shift school schedules. While children's needsconstrain women's optimal labor market participation, theyare conduits for the forging of new relationships that wentbeyond ethnic-specific norms and enabled reciprocal childcare;along with a British teen, Naana relied on the local supportivekinship-like ties with other African (non-Ghanaian) friends ofsimilar cultural backgrounds orwork experiences to alleviate theburdens of childcare and to recover from the physical andemotional demands of formal care work, echoing the findings ofother studies on the importance of local friends and neighbors infacilitating mother's paid employment (Ryan, 2007).

Increased commuting times associated with the spatialextension of her workplace engendered further negotiationswith and greater reliance on her husband for childcare. Onoccasion, I spoke with Naana's husband, Yao, who addressedthe challenges they faced:

Madeleine, it's worse now. You know I was offered themanager's position at work, but I couldn't take it. It went tosomeone who is below me, someone I trained. I would havehad to stay at work until about 8 pm. Right now, if I finishmy work I can try to leave early to get home on time. […] So,I'm looking for other work. I am retraining and looking. Asyou know the economy is bad and it's hard to find somethingwith the hours I am looking for. They want me to start early,but by then Naana hasn't come home. She comes backaround 7:30–8:00 am. So, something like 9 to 6 would helpus manage.

Yao's response reveals how they scrambled to navigatethe stresses and challenges brought on by the spatial andstructural changes associated with healthcare restructuringin their local areas. The newer demands of both formal carework and childcare inhibited both Naana and Yao's workprospects. On the one hand, as with Akuba and Fremah andmost of the nurses I interviewed, the night shift curtailedNaana's career aspirations for specialized nursing optionsthat are primarily day shifts. On the other hand, Yao not onlydeclined a more remunerative position with managerialresponsibilities, but also readjusted his schedule to fit withNaana's schedule, as she is the primary source of income.Notwithstanding these changes, the narratives show thecomplex gender division of labor in adjusting to labormarket constraints and opportunities. Navigating caregivingengenders constant negotiation, adjustment of workingschedules, andmutual commitment of Naana and her husband,resonating similar findings among other nurses (Espiritu,2005; Ryan, 2007).

Despite his lower earning power, relative to Naana, Yaostill exercised his masculine authority as head of thehousehold. When I asked both of them about sending thechildren home, as Fremah had done, Yao was adamantthat this was not an option, reflecting conflicting meaningsof child rearing (Naana earlier expressed that she wouldconsider it only if her husband agreed), though his wordsalso reveal other strategies of care they considered.

No, Madeleine! I cannot do that [send them home]. As for mygirls, I cannot be apart from them. When I went home for justtwo weeks I missed them so much, I couldn't wait to comeback. Yeah, we discussed that option. What's the use ofhaving children and not enjoying them… watching themgrow? What we are trying to do is to bring her mother hereto help us… or maybe try to adopt her sister's daughter andbring her here to go to school and help.

Despite the difficulties of juggling multiple care respon-sibilities in the UK, Naana never reneged on her obligationsto her mother, even if this meant foregoing investments inher own well being or that of her children in the UK. Theseaccommodations demonstrate Clark's (1999a: 81) observa-tions that for many Akan groups, migrants “still honor bloodkinship while feverishly renegotiating its obligations.” Naana,like many of the nurses I interviewed, was primarily respon-sible for the social reproduction of her transnational family,given her relatively greater financial resources. She discussedher obligation to assist her mother with healthcare, illustratinghow unpaid caregiving is also done on behalf of a dependentother than children.

When I first came to the UK, it was just me, so I could sendmore money home. Now that it is me, my husband and thetwo girls, I don't send as much and as often as I did in thepast… But at least I make sure that I send money to mymother for her medical check-up… she had a stroke a fewyears ago. She goes to a see a doctor at a private clinic. Thedoctor's wife is my friend and she gets her BP [bloodpressure] pills from her pharmacy. […] In fact, I have beentrying to sponsor my mother to come here on a visit to helpme with these children but they [British Consulate] haverejected her application twice now. [She shows me a copy ofthe rejection letter]. So I just have to manage like that. Icannot work as much as I want to. I cannot do overtime orbank work [agency] which pays more.

Here, Naana exhibits multiple attachments and rolesthrough the ethic of long-distance care. She supports herfamily and kin in Ghana financially and facilitates their accessto health providers, which have salient consequences forthe performance of long-distance caregiving and for thewell-being of the care-recipients such as her mother. Shecalls her sister for the list of medicines (e.g., blood thinner),acquires them in the UK, and sends them back to Ghanamaking sure that there are no drug interactions. Naanahighlights the irony of her emigration as a health professionaland the shortage of skilled labor in the under resourcedpublic health care sector in Ghana to provide good care forher mother. Nonetheless, the ability to pay for private careand to mobilize transnational social capital and networks of

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friends allows Naana to monitor her mother's health andnecessary medications and to maintain a position of socialrecognition in her family (Smith, 2007). The concern expressedfor mothers, as Naana exhibits, is consistent with research onGhanaian migrants in Toronto (Manuh, 2001; Wong, 2006).Naana's strategy of bringing hermother to the UK failed due, inpart, to more stringent migration policies that increasinglyconstrained family reunification and relocation, resulting inextended periods of separation (Krause, 2008).

Finally, caregiving and relations of obligation go beyondthe site of the local household and transnational family; theyalso encompass caregiving to members in the community.Along with her caring responsibilities, noted above, Naanaalso cared for a colleague who was seriously injured in anaccident and required a long rehabilitation. While the statecovered the formal rehabilitation services and costs, Naanaengaged in the everyday informal care of her colleague whohad provided intermittent childcare for her in the past.

You remember Auntie Dzifa? She was involved in a seriousaccident. I'm actually cooking for her. You know she can'tmove around well, and her daughter is in school most of thedays. So, I take food over to her and sit with her and chatwith her… it's very difficult. She has other people [formalcarers] come and help with bathing, cleaning, checking theinjury, exercising her, but they don't cook… like our food.[…] Sometimes, I help her with transport to drop her off atthe shopping center, or picking up her prescriptions from theGP and the pharmacy. […] I visit with her, you know, giveher some psychological and emotional support. If I can't goand visit, I call her and chat over the phone to check in withher to see how she's doing.

This experience represents an explicit example of ‘unpaidcare’ work involving the care of persons beyond kin andhousehold for no monetary reward; in this case, Naanaassumed the costs of this form of caregiving — buying andcooking food, transportation, and time (Razavi, 2007). Naanaalso exhibits how migrant women bring particular values tocaregiving that are strongly rooted in familial and caringideologies from Ghana – a ‘migrant ethics of care’ (Datta etal., 2010) that go beyond one's family or household tomembers of the community – thereby contributing to theunderstanding of care as a reciprocal and relational process.Thus, as a nurse, Naana is part of the “global nurse care chains”where work, parenting, marriage and multiscalar networksconstitute key sites of navigating care and emotional work andnegotiating gender and kinship identities.

Geographies of care among highly skilled Ghanaianwomen (returnees)

This section of the paper concerns the caregiving strategiesof highly skilled migrant women, for whom migration andreturn constitutes part of the life course. Among the women Iinterviewed in Ghana, they articulated that a strong attachmentto Ghana and a commitment to return circumscribed theiremigration goals and length of stay in the diaspora. While thedecisions to return to Ghana – temporarily or permanently –

are varied, they constitute complex familial negotiations andstrategies. My research indicates that skilled women are as

ambitious as men in deciding to return to Ghana, though theircapacity to access and deploy social capital and transnationalmobility as mechanisms of return is context-dependent, andthe familial outcomes manifest in class and gender-specificways (Wong, in press). The case of Kesewa, a 37-year oldmother of three, who put her engineering career on hold inGhana to join her husband in the US, is particularly telling of theinnovate navigation of caregiving she exercised that laid thefoundation for a successful return. Her words attest to not onlythe contingency of choices women make, but also theindependence and creativity in reconfiguring her skills into ameaningful income earning opportunity to manage childcare.

I quit that [professional] job and then I opened a day care…that was because my second daughter was born premature. Ihad to stay home with her. So I was thinking, “what can I doat home and still make some money.” So I worked online andsaid I could do day care but I needed the training, theirevening classes and all those things. So, I got the certificationthrough the Internet… I took evening classes. Then I got anassociate degree in early childhood development. So that'swhat I did.

Kesewa pursued a Masters degree soon after arriving inthe US and worked until her second daughter was born.When I asked her about the decision-making with herhusband over staying at home with her daughter, Kesewaexplains:

I talked to him about it… that I think I should do somethinginstead of… I mean, at that time, he had a very good job andwe could live comfortably if he was the only one working,but I just thought that I could do something. I can't just sit athome from morning to evening with one child because theolder one is in school. So what can I do at home? … Whenthe childcare came into my mind, I knew that's what Iwanted to do. […] And then, when I came [to Ghana], Idecided to establish it, make it bigger than what I had in theUS. In the US, I had my living room and my dining room. Buthere, I am able to have the infants, the toddlers and the pre-schoolers.

While her mothering and caregiving responsibilitiesimpacted her formal work experiences, Kesewa's drive andstrategy embody the blurring of the public/private distinction.In contrast to studies that reveal that losing their professionalidentity cast skilled women back onto a gendered identity ofbeing ‘just housewives’ with little life or purpose of their own(Liversage, 2009; Purkayastha, 2005), Kesewa reinforcesmatrilineal cultural ideology about workingmothers discussedpreviously. The very notion of a full-time, stay-at-homemother – even with a pre-mature baby – was incongruentwith her socialization in a cultural environment that extols thevalue of work, especially for women's sense of security andindependence. Having worked in the skilled labor market inGhana and the US, Kesewa committed herself and strove forpersonal achievement to retrain in a vocation that allowed herto become self-employed and to combine paid and unpaid carework.While providing her the necessary space and time to carefor her daughter full-time, the day care enabled Kesewa toprovide certified paid care to other children in her home. Her

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ability to do so rested on her class privilege afforded by herhusband's income to support the family, reflecting how classintersects gender in complicated ways (Ryan & Mulholland,2013). Thus, while constituting a temporary shift from highlyskilled to lower skilled work, her day care earnings not onlysupplemented the household income in the US, but also laidthe foundation for the return to Ghana. Capitalizing on thisexperience and the savings she accumulated, Kesewa opened acrèche in Ghana when she returned, which she currentlymanages alongside her career. Understanding the long-termlife trajectory and aspirations for migrant women is critical toexplaining the strategic decisions and choices they make.

Most of the professional women I interviewed were clearabout the decision to return to Ghana. For some, however,the processes and strategies constituting the return werecomplex and depended not only on the conditions in thediaspora and at home, but also on shifting family dynamicsand obligations. Tawiah, a 38-year-old architect and mother oftwo who received her college education and training in the US,illustrates the contingency of the decision-making process andthe multidimensional nature of caregiving and movementsinvolved.

Tawiah: I sent the kids homewithmymomafter she's beenwithme for 10 months andwas itching to go back home to Ghana… Isent them home in May of 2007. I lost my job a year later.Madeleine: So, how often did you see them/talk to them beforeyou came down in 2009 to care for your mom?Tawiah: I called everyday at the same time. We sang theirfavorite cartoon jingles and I came home once a year till I joinedthem in 2009. I talked to them and made them laugh. It wasimportant to me that they remembered who I was. My son didbut Iwasn't suremydaughter did as shewas still a baby but sureenoughwhen I would come home to visit, she would cling to mefor dear life and that warmedmy heart. I came back for them forabout 9 months and then they came back in 2008. Then Ifollowed in 2009. The decision to send them was really mymom's reasoning that I needed to recoup my losses from thedivorce and get my life back together.

Tawiah's account showcases the fluidity of family move-ments as a strategy of social reproduction. Tawiah's mothertraveled to the US to assist her with caring for the children,during her divorce, representing examples of family flowsand caring labor. A highly successful person in her own right,Tawiah's mother could care for her grandchildren in Ghanacomfortably, thereby providing Tawiah not only a reprievefrom caregiving while she recovered from the divorce, butalso the means to redistribute care across generations andplaces. During the separation, Tawiah not only engaged intransnational mothering from afar – performing ‘emotionalcare work’ through, phone calls and sending materialsto foster a sense of family accord – but also her skilledprofession, immigrant status as a US permanent resident, andclass privilege afforded her opportunities and financialresources that furnished her mobility to visit her children inGhana and to bring them to the US for short visits with her.Tawiah spoke of her daughter's “clinginess” and “insecurity”because of her absence, an indication of the emotional costsinvolved (Coe, 2008; Parreñas, 2001). The reprieve, however,did not last long as Tawiah received news of her mother's ill

health, soon after being made redundant by virtue of therecent financial crisis.

Madeleine: So how did you find out about your mother?Tawiah: A week before that my mom had called me and toldme that she was going in for a routine check. It turns out sheneeded surgery. […] So, when we found out, I had lost myjob. I had been with this company and they did six rounds oflayoffs and it finally hit me. I lost my job in June 2009 and Iwas taking my exams to become licensed. I figured if I hadlost my job then I could work hard on these exams and passthem and get them behind me so that the next job I would belicensed. So when I heard the news and you know thechildren are there, she's taking care of them, now she's sick. Itjust made sense that I come home and take care of her whileshe recovers. […] I was free to come so that is why I made thedecision. If I had a job I wouldn't be making that decision aseasily as I did.

Tawiah's accounts reveal how women's decisions arecircumscribed by their gendered roles as daughters andmothers,and reaffirm the traditional gendered expectations of womenregarding family and caring responsibilities. While Tawiah hassiblings living outsideGhana, as the oldest daughter andonly oneunemployed, she was the one to return to care for her mother.Tawiah's justification for returning to Ghana appeals to tradi-tional gender-role sensibilities, particularly deep obligations tomothers (Clark, 1999a), demonstrating how gender roles thatare associated with matriliny are also reproduced with return.Returningmeant that Tawiah could render everyday care for hermother and to mother her own children simultaneously.

I would take her to the hospital, Korle-Bu, for dressing once aweek for about 6 weeks and then she started chemo, whichwas once a week for 3 months. I shared the chemo trips witha friend of hers and myself as I had started work by then. […]We spent time talking and sometimes we didn't say much.[…] As for taking care of other things, we had house help tohelp with the cooking, cleaning and helping with the kids.She wasn't sickly so it wasn't difficult.

We see the multidirectional shifts of caregiving inresponse to varying economic and social transformations atdifferent scales. In Tawiah's case, securing the well being ofone's family – her mother and children – necessitated asacrifice of her personal socioeconomic mobility in the US.Family socioeconomic background, however, plays severalimportant roles in facilitating women's mobility and activi-ties by giving them access to a broader range of options tomitigate the disruptive impacts of economic restructuringand return. Tawiah's professional family afforded her theresources to sustain her and her children until she could workin Ghana. Given the demand for her skills Tawiah securedemployed soon after returning and reconfigured her work-carebalance. Moreover, the use of house help (abaawa) for childcareand household chores, prevalent in upper and middle-classGhanaian homes, not only released Tawiah from the dailyburden of childcare to reconstitute her career in Ghana, but alsopoint to the problemof social and gender inequality between theupwardly mobile and educated and a large underclass in Ghana(Akurang-Parry, 2010).

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Finally, the experiences of Amerle – a 40-year old highlysuccessful entrepreneur, manager, and mother of two –

articulate how women who initiate the decision to return toGhana have to contend with the concomitant ruptures fortheir diaspora families, which produce transnational familyarrangements (Bryceson & Vuorela, 2002). While most of thewomen returned with their children, the case of Amerle isparticularly instructive for demonstrating how legal regimesand child policies in host countries reinforce separation andmake reunification challenging. Amerle decided to return toGhana with her young children after her divorce. After a longseries of court battles over their custody, which she lost, herchildren returned to live with their father in the UK.

I got divorced [in the UK] and I thought it was time to start anew chapter in my life, and I had always wanted to comeback to Ghana. After living there for a number of years yourealize it was a cycle… hand to mouth. You were not gettingricher but rather you were getting more in debt, credit carddebt… you just couldn't keep up… it was time to come backhome. […] So I came down to Ghana with my kids over thesummer holiday… and left them with my sister and thenwent back to resign and came back. […] For the kids thetransition was difficult, it was rough for them. They wereused to extracurricular activities. […] By that time I wastaking them there [UK] for summer holidays, but then theydecided to go back with their father. […] I went to courtseveral times… you know it was after the divorce and theywent back, and I was concerned with their care there, so Iwent to court only for them to go to the final hearing anddecide that they want to live in the UK.

Amerle represents the skilledwomen forwhommobilitywasa strategic livelihood response to the stagnant economic andsocial conditions in the diaspora. She discusses the strategies,sacrifices and compromises circumscribing caregiving associatedwith return migration and separation:

When I was working with the airline, I use to go [to the UK]every six weeks. Take Thursday off and Monday off and goand spend the weekend with them. So as they grew I juststopped going often… now, I'm tired of traveling, seriously…fingers crossed, I'll go in May, and… so that's how I shuttledto and from… It was low pay, but the airline job helped me.Madeleine: How often do you see them now?Amerle: At Christmas time and then at summer, we have areunion every year. My older sister and my younger brotherlive in the US… so I from Ghana, my sister from London, we tryandmeet at one location every summer, and we are due in theStates this summer and at Christmas, they'll come down.

While reminiscent of the ‘astronaut’ phenomenon ofhighly mobile male migrants shuttling between origincountries and places of immigration where their familiesreside (Kobayashi & Preston, 2007), Amerle transnationalparenting underscores the cultural and gendered dynamics ofseparation. She married into a patrilineal family, where thechildren belong to the father's lineage, giving her ex-husbandthe justification to appropriate the British courts and socialservices to win custody of the children who are Britishcitizens. The courts would have also taken the children's

desire to stay in the UK into account. As Amerle also shows,the shifting nature and spaces of mothering and caregiving –

from local to transnational – occurs during different phases offamily rupture. She demonstrates the mitigating implicationsof her privilege and resources, earned through her highprofile jobs, that affords her the financial resources to engagein frequent transnational mobility to visit her children and tofinance their activities in the UK and their mobility.

Thanks to technology these days we can talk on the phoneeveryday. […] They have somebody taking care of them…

and my sister is there. Now that my daughter is old enough,she can go to my sister's place and we get to Skype. […] Wehave a great relationship. I mean if I had to come back to thisworld again, I wouldn't let my children grow somewherefrom me, be a remote control mom mother, I don't like it! If Ihad a choice, I would want them to be here… that's why Ispent all my money to fight in court.Madeleine: So do you support them?Amerle: Ooh, yes, it's a pain! High maintenance teenagers!That's what I call them. I pay their phone bills by direct debit.It's supposed to be £31 each a month, but sometimes they willdownload some stuff from YouTube and it's direct debit, so £99will go out of your account before you realize. […] And I givethem pocket money, I pay for their tickets to come down atChristmas and I pay to go with them on summer holidays. So,it's quite expensive… that's why I have three jobs!

Amerle's experiences clearly convey the challenges ofbeing available emotionally and physically to maximizechildrearing (Parreñas, 2001). While reconciling with thefact that she fought to win custody of her children, Amerlereflects on her absentee mothering, expressing feelings ofguilt and regret over her separation from the children. Thus,while Amerle was empowered by the decision and agency toreturn back to Ghana and achieve her goals, the emotionaland social dislocation of being separated from her childrenprofoundly tempered her sense of accomplishment. Thecaregiving strategies and experiences of Tawiah and Amerlehighlight how class-privileged families whose professionalpursuits give rise to transnational families are able to deployhuman and social capital and flexible citizenship to facilitatereunification.

Conclusion

In contributing to the literature on skilled migration andcaregiving, the empirical analysis presented in this paperelucidates a complex and multifaceted rendering of care-giving among different groups of skilled Ghanaian migrantwomen to expose the structures and processes circumscribingtheir experiences. Specifically, the women's account offers anexplicit classed gender analysis of caregiving (McDowell,2008). Skilled migrant women do not form a homogenousunified group that experience gender inequalities and caregiv-ing in the same way. Yet, reflections on the empirical findingsin relation to the emerging scholarship on skilled migrantwomen suggest some commonalities and differences in andacross transnational spaces. The analysis illustrates the com-plexity of forces that shape different patterns and strategies ofcaregiving, and highlights the importance of unpacking how

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class, social networks and transnationalism are deployed inunderstanding everyday practices and relationships of care. Assuch it moves beyond the preoccupation of the care literature onthe experiences of unskilled and lower skilled women in thedomestic arena. A focus on caregiving, as broadly construed andemployed in this paper, reveals theways inwhich caregiving notonly constitute gendered social practices, but also is locallyand transnationally contingent. As the empirical material andanalysis presented illuminates, the multidimensional nature ofcaregiving the women exhibited underscores that their lives arenot confined to the local context but traverse the borders ofmultiple nation states and involve multiple locally situated andtransnational actors.What emerges as a key dimension of skilledwomen caregiving is the intersection of ideologies with thechanging material realities of work and family life, in particularthe intersection of gender, class and family in shaping thecultural values and obligations circumscribingwomen's adaptiveresponses to myriad forces.

First, the analysis extends the literature by showcasinghow skilled women are bound by gender norms in similarways to lower-skilled women. Ghanaian women's roles andresponsibilities are premised on autonomy and the goals offurthering the lineage. They are not only socialized intocaring roles, but also expected to be economically independent.Balancing work and caregiving, however, required strategiesand negotiations that not only conform to and reproducecultural norms of gender and generational relations, but alsoassuage the limitations imposed by institutional and welfareregimes. The women's caregiving performance and strategiesembody specific social relations that are grounded in and acrossparticular places. Yet, these activities cannot be romanticized orcelebrated as the women face challenges engendered by thecomplex interplay of sociocultural and wider global processes.

Second, the article sheds further light on how the caregivingstrategies of skilled women are embedded in political economicsystems and ideologies that justify them. In particular, theanalysis highlights the crucial role of state social policy provisionsand restrictions in shaping the patterns ofwomen's labormarketand caregiving experiences. Located within multiple hierarchiesof power operating in and across transitional spaces, Ghanaiannurses were affected by both changing labor market policiesvis-à-vis restructuring of the UK health sector and childcareprovision services, and by immigration policies that stipulateoccupational categories, visa restrictions, and their entitlement(or lack thereof) to rights and benefits. On the other hand, returnmigrants' responses to poor employment prospects in thediaspora and better opportunities in Ghana engendered familialruptures – temporary and permanent – and strategies ofcaregiving. Nevertheless, the women's strategic deployments ofexpansive social fields to mobilize complex geographies ofsupport illustrate the critical part played by family relationsand multiscalar social networks in mitigating the livelihood andcare challenges that migration engendered, and in enhancingmigrants' women sense of economic and social security.

Third, the analysis further explicates not only how“geographies of privilege” (Twine & Gardener, 2013), withinwhich skilled migrant women are embedded, facilitateparticular caregiving activities, but also how power operatesbetween differentially positioned women in the care chain. Themultiple intersecting dimensions of gender, class, migration andcitizenship status not only circumscribe different caregiving

strategies and stratify care labor, but also inform access tovarying sources of support for social reproduction. As I havedemonstrated, the gendered experiences and strategies ofcaregiving among skilled Ghanaian women diverge on classlines, which not only reflect differential earning power but alsocrosscut other social divisions that differently position them inparticular ways. While they are considered skilled profes-sionals, nurses do not often come from elite background andtheir caregiving options and choices are often abridged byconstraints associated with their migration status and theirlocation on the lower end of the skilled spectrum. Consideringthe stringent conditions imposed on their migration status thatrestricts their access to welfare, nurses often navigate highchildcare costs and constraints by pursuing caregiving strate-gies comparable to those lower-skilled care workers employ.On the other hand, the highly skilled professional womenengaged in gender-neutral or male-dominated professionscome from elite backgrounds and enjoy a more privilegedmigration status with their attendant rights and entitlementsthat confers them advantages over nurses, and furnishes themwith different caregiving experiences. The privileges andadvantages that migration, advanced education and workingin high-paying occupations as a skilled worker accrue to themand their families mean elite women are less constrained bystate benefits, and can mobilize and devote more material andsocial resources – mobility of other family members – toperform their traditional gender roles and caregiving respon-sibilities. Additionally, for these women, paid domestic care-givers often mediate the tensions associated with balancingcareer aspirations, work and family, an exploitative practicethat reinforces their class privilege.

Echoing Mahler and Pessar's (2001) articulation of powergeometries, both groups of women do exert some degree ofagency, given their unequally positioned social location, todeploy social capital and mobility to actively navigate caregiv-ing. Women continually reconstitute and reconfigure theircaregiving strategies in response to changing demands of thework place and shifting migration status. While nurses do notcontrol the forces that affect them and their families, such as thelack of access to entitlements, they nevertheless are creative andresourceful. Though they often pursue strategies akin to thoselower-skilled women employ, they also pursue strategies thatthe highly skilled women employed. Specifically, the employ-ment of paid domestic caregiver in the home – a practice that ispervasive among middle-class families in Ghana – constitutes astrategy to navigate the constraints imposed by restrictions onwelfare and the high cost of childcare in the UK. However, asNaana's experiences reflect, the private spaces of the home notonly reflect the porous interface between formal and informalcare and private and public spheres of care, but also constitute anarena of gender and class inequality. The spaces of home thatrepresent sites of caring and interdependent relationships arealso fraught with challenges and tensions that widen classinequality between different groups of migrant women. For thehighly skilled women, while they may have fewer problemssecuring migration status and resources, as Amerle demon-strates, they show imaginative and substantive agency inplanning and strategizing caregiving across transnational spacesthat are of both material and emotional significance.

Finally, the employment of multi-sited, qualitative re-search approach enhances epistemological understandings of

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caregiving in and across transnational spaces. In particularsuch an approach allows for a closer analysis of how local andtransnational caregiving and relationships are fluid andunder constant negotiation. To that end, the ways in whichclass and social capital circumscribe the experiences ofskilled migration women merits further research. Not allskilled migrant families can move (or return) as a unit, giventhe associated costs involved, engendering reconfigurationsof family and strategies of care across space. This study hasimportant implications for the conceptualization of the geogra-phies and strategies of caregiving, and for more attention to theinstitutions and the environment/milieu in which multiplecaregiving occurs. In particular, analysis of different scales andplaces of caregiving would be fruitful for understanding thecomplex interweaving of global processes with institutionalpolicies and the everyday caregiving experiences and practices ofindividuals and families of diverse socioeconomic backgroundsand life histories. The experiences of Ghanaianwomenpresentedhere are far from singularly “African”. African identities andexperiences are not monolithic; they are multifarious,complex, fluid and traverse varied multiscalar contexts.Global restructuring and increasing African mobility signifiesthat Africans increasingly inhabit multiple subject positionsand live simultaneous lives transnationally and more researchis required to grasp their multifaceted experiences fromdiverse theoretical and methodological perspectives. In partic-ular, more research is needed on skilled African women tochallenge dominant tropes of African women as uneducated,unskilled, ‘immiserated’ and disempowered. This article takesthat step forward by presenting the gender and class tensionsthat the combination of professional work and personalcaregiving create for skilled and mobile African women.

Acknowledgments

The research presented here was made possible withthe financial support of the William B. Bradbury Jr. FacultyAward, St. Lawrence University. I am grateful to the Ghanaiannurses and professional women who graciously shared theirreturn experiences with me. I thank Valentina Mazzucato andparticipants at the ‘Transnational Child Raising Arrange-ments between Africa and Europe (TCRAf-Eu) Conference’ inMaastricht, The Netherlands, for the engaging discussions andfeedbacks on the presentation of an earlier version of thisarticle. Finally, I would like to thank editor Afroditi Pina and theanonymous reviewers for their comments and useful insights.

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