Globalizing Care Economies and Migrant Workers: Explorations in Global Care Chains By Nicola Yeates, New York: Palgrave Macmillan, 2009, 258 pp., ISBN 978-0-23000-534-1.

The aim of this book is to advance a new, global analysis of care through the exploration of global nursing care chains. These are defined as the equivalent of global production chains, as applied to the study of production and migration of nurses. Yeates argues that two elements must be understood: the personal experiences of these nurses, and the features of wider social systems. To do this, the author highlights the transnational features of global nursing care chains as well as their place within global social hierarchy construction and reproduction. The author, through an historical approach, focuses on migrant nurses, and then compares their situation to that of female religious. This term, which is somewhat ambiguous, is taken to mean nuns. This approach allows her to highlight common aspects of female care migration, and to differentiate context-specific elements that help understand the complexities of global care chains.

The introductory chapter outlines the book’s theoretical perspective, empirical approach and pertinence. The author characterizes her approach as being globalist, institutionalist, labourist and feminist, with a focus on transnational structures and practices of care. Chapter two reviews the various bodies of literature and theoretical perspectives, paying particular attention to the globalization of reproductive labour. The author concludes that the literature says little about how social reproductive labour has become globalized. Chapter three then develops the core concept of global care chains, expanding the concept from production to reproduction (care). Chapters four through seven represent the empirical core of the book, with chapters four through six dealing with nursing, and chapter seven, with global religious care chains. More specifically, chapter four offers an historical perspective of the production of nurses for export as well as recruitment systems and their regulation. Here Yeates highlights the inequalities in power and territorial reach of the state, recruitment agencies and the workers. Then, chapter five provides a case study of Irish nurse migration in order to illustrate the importance of colonial land structure, employment opportunities in the homeland, and the potential for class and gender conflicts as factors influencing states’ decisions to encourage such migration. Chapter six explores the reversal of the care chain; that is, the import of nurses into Ireland. Historically, Ireland exported nurses to England and to developing countries, but that trend is now reversed. The author draws attention to the fact that Asia is now the beginning of the global nursing care chain. She focuses on working relations involving migrant nurses in Ireland and the “double helix” of nursing and motherly care. This concept is used to explain that the transfer of nursing care from the source country to the host country is intertwined with the transfer of motherly care because most nurses are also mothers. Motherly care is modified because the nurses now must mother their children from afar, since their children rarely migrate with them. In chapter seven, the discussion turns to global religious care chains, in order to compare and contrast them to global nursing care chains. Religious care is not clearly defined by the author, but is taken to include the provision of health, education and social welfare services by workers in faith-based NGOs. Thus, it is unclear as to whether it is necessarily provided by nuns. However, migration flow is different in that it is from developed (core) to developing (periphery) countries, and it usually requires that nuns be separated from their birth family, thus enabling their hypermobility. The aim of this comparison is to show that female religious migrants played an important role in shaping the nursing profession as well as its globalization. In the eighth and final chapter, the author concludes that by selecting nurses, comparing them to nuns, and conducting interviews with the migrant nurses, she broadens the focus of the study of female migration (which usually concerns motherly care), thus revealing its complexity as well as the diversity of sectors involved.

A central theme of the book is global supply chains, which highlight the relationship between peripheral and core countries. An important feature of this relationship is the relative transfer of wealth from peripheral to core countries, in the form of care labour. The author shows how the export of nurses has lead many countries to face a nursing labour shortage, such as is the case in Ireland, causing it to switch from being an exporter to an importer of nurses.

Another of the book’s main themes about of the experience lived by female migrant nurses, especially with regards to family dynamics. In contrast to religious labour, contemporary nurses view migration as a family project, either to send money home to aid extended family, or as a way to improve their immediate family’s situation by bringing their husbands and children to live in the host country. In order to capture these dynamics, the author performs interviews, thus providing more insight into the lived experience as well as the processes involved. In particular, it is this approach that leads the author to note the importance of the “double helix” of nursing and motherly care.

Finally, by discussing the production and training of nurses for export, recruitment, and work relations in the country of migration, the author initiates a discussion on regulation of these by states on both sides of the migratory process. This discussion shows the existence of a “global migration-industrial complex,” framed by the institutional context in which it operates. On this topic, the author shows how recruitment agencies and labour go beyond the territoriality of the state, thus making regulation a central concern to global nursing care chains.

In spite of its sometimes unclear use of unconventional terms, this book offers a refreshing take on the realities of women who migrate in order to provide care by focusing on skilled labour, and thus paying attention to the agency of these women rather than simply treating them as a homogenous body of unskilled, victimized workers. Furthermore the author succeeds in extracting generalizations from varying contexts in order to provide basic guidelines for further analysis, using such analytical tools as (re-) production process, territoriality and governance.