Policy Research Working Paper 11150 Double Burden, Unequal Ground Childcare Challenges and Work-Family Conflict for Low-Income Mothers in Urban Burkina Faso Fiona Gedeon Achi Sophia Friedson-Ridenour Rachael S. Pierotti Nathalie Ouangraoua Alis Bambara Africa Region Gender Innovation Lab June 2025 Policy Research Working Paper 11150 Abstract The overlapping challenges of limited economic opportu- rarely eases maternal burden or ensures child safety. The nities, maternal responsibilities, and almost no access to consequences of work-family conflict are exacerbated by the childcare services have detrimental effects on the wellbeing dangers linked with poor quality infrastructure in low-in- of women and children in Sub- Saharan Africa. In urban come neighborhoods, by the physical burdens associated areas, shifting family structures and economic constraints, with available forms of work predominantly in the informal combined with gender norms that cast women as primary economy, and by the stresses induced by perpetual nego- caregivers, leave many mothers simultaneously managing tiations and compromises that affect caregivers’ ability to childcare and work, often in unsafe environments. The meet subsistence needs. This study prompts critical reflec- findings from this ethnographic study in Ouagadougou, tion on how to value investments in childcare programs Burkina Faso, illustrate the physical and emotional tolls that by underscoring why group-based childcare may yield arise for women and children in low-income households disproportionate benefits for low- income families—and when mothers lack access to reliable childcare, leading them conversely, why these families incur especially high costs to work under conditions of constant caregiving demand. in its absence. While home-based work is a common coping strategy, it This paper is a product of the Gender Innovation Lab, Africa Region. It is part of a larger effort by the World Bank to provide open access to its research and make a contribution to development policy discussions around the world. Policy Research Working Papers are also posted on the Web at http://www.worldbank.org/prwp. The authors may be contacted at friedsonridenour@worldbank.org. The Policy Research Working Paper Series disseminates the findings of work in progress to encourage the exchange of ideas about development issues. An objective of the series is to get the findings out quickly, even if the presentations are less than fully polished. The papers carry the names of the authors and should be cited accordingly. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the views of the International Bank for Reconstruction and Development/World Bank and its affiliated organizations, or those of the Executive Directors of the World Bank or the governments they represent. Produced by the Research Support Team Double Burden, Unequal Ground: Childcare Challenges and Work-Family Conflict for Low-Income Mothers in Urban Burkina Faso Fiona Gedeon Achi, Bordeaux Population Health, University of Bordeaux Sophia Friedson-Ridenour, Africa Gender Innovation Lab, World Bank Rachael S. Pierotti, Africa Gender Innovation Lab, World Bank Nathalie Ouangraoua, World Bank Alis Bambara, Université de Genève We thank Sara Deschênes, Estelle Koussoubé, and Kehinde F. Ajayi for their thoughtful feedback. We are grateful to Madeleine Wayack Pambè for intellectual guidance and to Wendpayandé Elisabeth Princesse Kafando for transcription assistance. Most importantly, we thank the childcare providers and all the study participants for their generous collaboration and participation, this research would not have been possible without them. This work was funded by the Umbrella Facility for Gender Equality multi-donor trust fund. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors and do not necessarily represent the views of the World Bank, its Executive Directors, or the governments of the countries they represent. Keywords: Gender and economic empowerment; Early childhood; Day care centers; Poverty JEL codes: J13; J22; J16; J46; I31 1. Introduction Many women in Sub-Saharan Africa must navigate the overlapping challenges of poverty, maternal responsibilities, and limited access to childcare services (Alarakhia et al., 2024; Bhan et al., 2020; Malta et al., 2021). In fact, while Sub-Saharan Africa has one of the highest rates of female labor force participation globally (World Bank, 2023), the vast majority of women work informally, without job and income security and excluded from maternity leave and other forms of social protections (Alarakhia et al., 2024; Bhan et al., 2020; Malta et al., 2021). At the same time, in many contexts, entrenched gender norms cast women as primary caregivers, which means that working mothers often shoulder the majority of daily childcare responsibilities (Cassirer & Addati, 2007; Hatch & Posel, 2018; Seedat & Rodon, 2021). But low-income households cannot rely on paid childcare services to address pressing childcare needs. Formal childcare services—whether professional home-based or quality center-based options—are largely restricted to high-income households who can afford their expensive cost (Hughes et al., 2023; Stumbitz et al., 2018). This situation creates severe work-family conflict that has far-reaching consequences for the wellbeing of women and their children (Annor, 2014; Aviv et al., 2024; Gromada et al., 2020; Sevilla & Smith, 2020). Historically, kin networks have played a central role in supporting caregiving across Sub-Saharan Africa (Gibson and Mace, 2005; Madhavan and Gross, 2013). However, shifting family structures, including the growing prevalence of nuclear households in urban settings, are altering these support systems (Donald et al., 2024). As extended family assistance becomes less reliable, research suggests that friends and neighbors are also playing a more limited role in childcare provision, thus intensifying the childrearing responsibilities of mothers in African cities (Clark et al., 2017; Donald et al., 2024; Oppong, 2004; Waterhouse et al., 2017). Without kin support or access to affordable childcare services, many women in low-income households must juggle simultaneous work and childcare, particularly for young children not yet of school age (Quisumbing et al., 2007). The widespread lack of childcare services has fueled the recognition of a global “childcare crisis” (Devercelli & Beaton-Day, 2020; Samman et al., 2016), disproportionately affecting the poorest households (ILO and WIEGO, 2020; Waterhouse et al., 2021). In this study, we investigate the experiences of women in low-income households in urban Burkina Faso as they navigate work-family conflicts, specifically those related to meeting childcare needs. Work-family conflict occurs when the responsibilities of work and family roles clash, creating tension that hinders an individual's ability to meet the demands of both domains successfully (Greenhaus and Beutell, 1985). We draw on twelve months of ethnographic research in Ouagadougou with mothers, fathers, and other caregivers to understand the caregiving demands and the available childcare options for women working primarily in the informal economy. The families in this study had an opportunity to enroll their children in heavily subsidized childcare centers, and so many had at least some exposure to these services, allowing them to compare the value and consequences of different childcare arrangements. Our study combines interview data that capture caregivers’ explicit assessments of their needs, with ethnographic observations of women’s daily caregiving routines, to understand how the social and physical context in which they live conditions their opportunities and choices. In this way, we are able to understand not only individual choices and individual consequences, but to shed light on the social determinants and structural factors that bear on the economic, mental, and social wellbeing of families. The data vividly illustrate the physical and emotional tolls that arise for women and children when mothers, in informal neighborhoods, work under conditions of constant caregiving demand, without reliable childcare assistance. Although engaging in home-based professional activities—such as knitting 2 or hairdressing—is a common strategy women use to navigate the dual responsibilities of income generation and childcare, our findings suggest that this approach often fails to safeguard children's wellbeing or alleviate the strain on mothers. Moreover, our data reveal that the economic recession experienced acutely within Burkina Faso’s informal sector (IOE, 2023) appears to intensify these burdens, as household income becomes increasingly unstable and reliant on women’s labor. This study's primary contribution is an explication of how the structural and socioeconomic conditions of low-income families intensify the consequences of work-family conflict. The study sheds light on the real, overlapping challenges that low-income families deal with—like tough living conditions, poor infrastructure, limited job options, lack of childcare, and the combined effects of poverty and gender expectations. By highlighting these everyday hardships, the findings help explain why previous research has found that early childhood care and education (ECCE) services have especially strong benefits for low-income families (Bassi et al., 2024; Holla et al., 2022). In other words, the difficult conditions these families face help clarify why ECCE matters so much in their context. In revealing this fuller picture, the study prompts critical reflection on how we assess the value and cost-effectiveness of childcare programs. It also underscores why group-based childcare may yield disproportionate benefits for low- income families—and conversely, why its absence incurs especially high costs. 2. Consequences of the childcare gap for low-income households Previous research has documented numerous challenges faced by caregivers in low-income countries, particularly due to either the absence or insufficiency of childcare options that meet caregiver needs (Blimpo et al., 2022; Devercelli & Beaton-Day, 2020; Moussié & Alfers, 2018; Pilarz et al., 2019). As a result, women—who typically shoulder the majority of caregiving responsibilities—often face significant constraints on their ability to participate in the labor market or grow their businesses. The need to bring children to work restricts their productivity and limits both income-earning opportunities and business performance (Cassirer & Addati, 2007; Clark et al., 2019; Quisumbing et al., 2007). For self-employed women in particular, this dynamic results in direct productivity losses and, consequently, reduced revenues and profits (Bjorvatn et al., 2025; Delecourt & Fitzpatrick, 2021). Beyond economic consequences, researchers have documented, in a variety of country contexts across Sub-Saharan Africa, how the work-family conflict and role strain generated by the dual demands of paid work and childcare have negative health consequences for mothers and children (Clark, 1999; Mokomane, 2014; Waterhouse et al., 2017). Against this backdrop, there is a growing global recognition of the importance of investing in ECCE services. Existing evidence points to strong demand for center-based childcare and highlights its positive effects on both children’s developmental outcomes and caregivers’ economic and emotional well-being (Ajayi et al., 2024; Bassi et al., 2024; Bjorvatn et al., 2025; Clark et al., 2019; Hojman & Boo, 2022). However, while the overall benefits of ECCE are well documented, studies also reveal important variations in its impact. These differences often depend on the socio-economic status of households, the characteristics of caregivers and children, and the broader social and economic contexts in which they live. Understanding this heterogeneity is crucial for designing effective childcare policies. Indeed, quantitative studies document the heterogeneous impact of access to childcare services on children (Feller et al., 2016; Morris et al., 2018; Martinez et al., 2017). For example, Holla et al. (2021), in a meta-analysis of 54 studies across 19 countries—of which 18 studies come from 13 different low- and middle-income countries (LMICs), find that children from the most disadvantaged backgrounds 3 experience greater gains in combined cognitive and socioemotional skills. There is also suggestive evidence that these children see greater improvements in school participation and progression compared to their less disadvantaged peers. Evans et al. (2024) conduct a systematic review of the impacts of childcare interventions in LMICs and find no consistent pattern of greater or lesser benefit for the poorest children, highlighting the variability in outcomes. Research in Mozambique further illustrates this variability: expanding preschool access in poor rural communities boosted school enrollment most among children with lower baseline Ages-and-Stages Questionnaire (ASQ) scores, while those with higher scores saw the greatest gains in cognitive and socioemotional development (Bassi et al., 2024). This evidence underscores the nuanced interplay between economic disadvantage and the effects of childcare programs. Studies examining the impact of childcare access on mothers tend to focus primarily on labor market outcomes, such as employment and income gains. However, this narrow focus often overlooks a broader set of important benefits, including improvements in mental and physical health and overall well-being. In Viet Nam, Dang et al. (2022) find that the effects of childcare on the probability of having a wage job are larger for more educated women and women from the ethnic majority groups, characteristics that likely better position women to take advantage of formal wage-earning jobs. However, this does not mean that childcare is unimportant for others. Rather, it reflects underlying constraints in the labor market that limit opportunities for women who face structural disadvantages. Research from the United States further illustrates this point, showing that limited access to affordable childcare for low-income women can exacerbate income inequality by restricting their ability to participate in the workforce and increase their earnings (Gonalons-Pons and Marinescu, 2024). These findings highlight the need to recognize the inequities embedded in both childcare and labor market systems. Our study advances this literature by showing how the structural and socioeconomic conditions of low- income urban households exacerbate work-family conflicts for women. Given the current severe shortage of childcare provision, it is crucial that efforts to expand access in low-income countries consider how to prioritize and target new investments, as well as how to evaluate their effectiveness. This research offers timely insights to inform policy on government investment in ECCE, emphasizing the need to assess impact not just in terms of child development outcomes or labor market gains, but also through the lens of the cumulative burdens experienced by families without access. 3. Study context In Burkina Faso, the location of this study, 58 percent of women who are older than 15 years-old work for pay (Our World in Data, 2023). The fertility rate is among the highest in the world (World Bank, 2022) yet maternity leave (14 weeks) is only available to salaried women who work in the formal sector. Access to preprimary education is extremely low and varies by income distribution—in the highest income quintile, just over 19 percent of children attend a preprimary program, whereas among the lowest quintile, only 0.3 percent do (INSD, 2023). This qualitative research took place in four districts of Ouagadougou where government crèches were started as part of a labor-intensive public works (LIPW) program which provided temporary work opportunities to low-income households. Public works participants were selected through a call for applications by the government. Eligibility requirements included being a citizen of the country, between the ages of 16-35, out of school or never enrolled, and not a previous beneficiary of the project in earlier rounds. A two-step selection process was implemented: 1) registration of interested applicants; and 2) 4 participation in a public lottery. Participants selected for the project through the lottery worked from 8am to 2pm Monday to Saturday and received 37,000 CFA (approximately 62.60 USD) per month for six months of project participation between July 2019 to February 2020. Depending on the location, public works under the program included building bridges and rural roads, maintaining urban roads and administrative facilities, and undertaking reforestation efforts. This type of public works program is a way of reaching very poor populations without the need for targeting—people self-select into the program if their needs are great enough, and their outside earnings options are worse than the wage rate offered through the program. Initially, the LIPW program attracted a pool of interested participants that was 85 percent female. Although the eligibility requirements did not exclude women with young children or pregnant women, women with their children present during registration were required to appear without their children during the lottery. Pregnant women wore very loose clothing to hide their pregnancy, for fear of not being selected. Childcare needs, among other constraints, reduced women’s uptake of employment through the program to 64 percent. To address the fall in women’s participation, the project introduced mobile crèches, allowing mothers to keep their children nearby while working. Each crèche accommodated up to 50 children and moved between work sites, providing childcare under tents and offering an environment designed specifically for children. The childcare providers working in the mobile crèches were recruited among women who had signed up for the LIPW program. They received initial and follow-up training on childcare provision. After the program ended in 2020, the mobile crèches settled in permanent locations and opened to the public. Henceforth, we refer to these as LIPW crèches. This research examines select locations where LIPW crèches were established. During the period of the research, the LIPW crèches served children from zero to six years old, and registration ranged between 21 to 115 children depending on the crèche. Each LIPW crèche operates with about ten caregivers who rotate in shifts. Families have the option to leave their children a half day or full day until 5pm. Registration fees for the LIPW crèches range from 4,000-6,000 CFA per month (between 6.5 and 9.5 USD) for families that did not participate in the LIPW program and are between 1,500-3,000 CFA per month (between 2.5 and 5 USD) for families that did participate in the LIPW program. These fees are significantly lower than those at other private crèches in the area whose fees generally average at 15,000 CFA (24 USD) and can be as high as 30,000 CFA/month (48 USD). Most of these private crèches only serve children two to five years old. The LIPW crèche fees are comparable to public and nonprofit kindergarten fees, which usually cost around 4,000 CFA (6.5 USD), but which are in very limited supply across Ouagadougou and generally only accept children above 3-years- old.1 Our research in Ouagadougou took place from January 2022 to August 2023, a period during which Burkina Faso underwent two military coups, one in January 2022 and one in September 2022. These coups happened within a broader context of protracted and ongoing conflict between the Government of Burkina Faso and terrorist armed groups since 2015. Initially restricted to the northern part of the country, armed conflict and terrorist attacks spread widely in Burkina Faso, resulting in thousands of internally displaced people (Le Monde, 2024). This major political upheaval combined with the adverse effects of COVID-19-related measures in 2020, has triggered a severe country-wide economic crisis. Across the country, people have faced extreme economic uncertainty in the form of exponential price increases in staple goods as well as job loss as entire sectors of the economy (such as construction) were 1 Information on crèche cost was obtained from a census that was conducted as part of this study. For more information, see the following section on Research design and data. 5 shut down (MINEFID, 2021; Phelan, 2024). This has had particularly strong economic consequences on those who are more financially precarious, such as households working in the informal sector, whose livelihoods are tied to the ability to buy and sell goods at reasonable prices, or to find informal contracts as day laborers. 4. Research design and data The overarching goal of this research was to understand the perspective of low-income families managing the double demand of work and childcare in Ouagadougou. Data were collected in four of the six sites in Ouagadougou where LIPW crèches were established post-project. In February 2022, prior to selecting the four crèche sites for inclusion, researchers visited all six crèches in Ouagadougou and collected basic information to inform site selection. Selection criteria included: percentage of children enrolled whose mothers previously participated in the LIPW program, percentage of children below 3- years-old, total enrollment, physical infrastructure of the crèche, type of neighborhood (informal or formal settlement), geographic accessibility of the crèche, and fees. Four crèches were then selected to ensure variation across these dimensions. In-depth qualitative data were collected in two phases. Phase one took place from May to October 2022, and included 16 case studies, which centered on a focal woman living in each of the four research sites. A purposive sampling strategy was used to identify four types of focal mothers for the case studies: • Mothers who used mobile crèches while working in the public works program and continued to use LIPW crèches post-program. • Mothers who used mobile crèches while working in the public works program but stopped using them post-program. • Mothers who had access to mobile crèches but never used them. • Mothers who did not participate in the public works program and started using LIPW crèches post-program. The goal of these case studies was to understand how mothers simultaneously navigate their work and childcare responsibilities. In each of the four districts in our research, we conducted four case-studies, one fitting each of the four categories identified above. The second phase of data collection took place from December 2022 to July 2023 and included 55 interviews with caregivers (mothers and fathers) across the four research sites. The goal of these interviews was to compare usage and experience of LIPW crèches between parents who worked in the LIPW program (some of which were still using the crèches while others did not) and those who had recently enrolled their children in LIPW crèches post-program. The case studies were completed by the fourth and fifth authors, and all of the interviews in round two were conducted by the fourth author. Interviews were conducted in a mix of Moré and French. 6 Table 1: Data collection2 Round District Interviews Observations Female Male Round 1 District A 6 -- 3 District B 6 2 4 District C 5 2 4 District D 7 -- 4 Round 2 District A 12 9 -- District B 8 4 -- District C 7 1 -- District D 11 3 -- TOTALS 62 21 15 The 16 case studies consisted of: 1) an entire day of ethnographic observation to understand women’s daily routines and childcare arrangements, and 2) a follow-up interview to further explore how the focal woman manages her work and childcare, and how she evaluates different childcare options.3 To collect observational data, local researchers spent a full day with the focal women from morning to evening, following them as they moved in and out of different spaces including, but not limited to, their home, crèche (in some cases), workplace, markets, and neighbors’ houses. Each focal woman was asked not to change anything in her daily routine so that researchers could better understand how each woman navigates her (often overlapping) work, childcare and household responsibilities. This methodological approach pairs what women say about their childcare decisions, with palpable observation of how they navigate caring for their children. Although the presence of an outsider during direct observation may influence the behavior of those being observed, this risk is mitigated by the researchers' non-intrusive approach, which aims to minimize their impact. For eight of the 16 focal women, an interview was also conducted with another person in their care network. This was either their spouse or a relative or neighbor whom they had identified as having a significant role in helping with the care of their children. This provided important information about how family members and neighbors participate in the care of young children and gave another perspective on how families meet their childcare needs. Additional interviews were also conducted with caregivers working at the crèches. All women in our sample had at least one child below five-years-old at the start of the research. To recruit participants, researchers asked crèche personnel in each district to identify women who fit the criteria for each of the four categories identified above. Once a long list of 80 women was established, women with children below the age of three-years-old were prioritized for selection because we wished to understand how women navigate childcare care for very young children. When it was not possible to recruit a woman with a child below three-years-old, women whose children were younger than three 2 District “arrondissements” have been assigned letters instead of the official numbers to ensure anonymity of respondents. 3 One focal woman did not agree to the participant observation and so there are only 15 observations among the 16 focal women. One focal woman was a grandmother, chosen because she was the primary caregiver of a young child going to crèche. An interview was also conducted with the mother of the child who attends university. 7 when they were first enrolled at the crèche but were older than three at the time of the study were selected. In addition to the case studies, the researchers visited each of the four LIPW crèches included in the study several times to understand how crèches operate and to meet with the childcare providers. One interview was conducted with a childcare provider in each of the four LIPW crèches to better understand their work, training, and interaction with parents. A census of the other available crèches and kindergartens in each of the neighborhoods was also completed, contrasting the types of services they provide to the four LIPW crèches in this study. As part of the census, the fourth author met with the principal or a head teacher in thirty-two crèches across the four neighborhoods to collect information about the status of the crèche (public or private), the location, the number and age of enrolled children, the number of caregivers, the educational services provided, the opening hours, the fees and the opening year of the crèche.4 All interviews were audio-recorded and then simultaneously translated and transcribed into French by the two local researchers, and an assisting transcriber. Regular debriefs to discuss the data supported an iterative approach to data collection, which allowed for emerging areas of interest to be identified as well as interview questions and observation protocols to be refined as needed. All data were systematically coded using the qualitative data analysis software, Dedoose, by the first author and an additional research assistant. An initial code list was established by the first, second, and third authors using an inductive and deductive approach. All data were coded using seven parent codes and 28 child codes. Parent codes included broad themes such as intrahousehold management and decision-making, childcare and work, and living conditions, while child codes were more detailed and included things such as decisions about income generating activities, multi-tasking and interruptions, and physical health of mother and child. Analysis of the coded excerpts revealed the salience of some themes and highlighted variation in others. For example, each code related to safety and health was attached to between 135 and 290 segments of interview transcripts or observation notes, indicating the primacy of this issue for caregivers. Reading data from across all transcripts that was coded as intrahousehold management, on the other hand, revealed variation in men’s role in childcare, even though women had primary responsibility for caregiving in all households. All participants in the study provided informed consent, and the study protocol was approved by the Burkina Faso national ethics committee for social science and health research. All names used below are pseudonyms. Of the 62 women in our sample, 87 percent were married, while the remaining were widowed, separated or single. Our sample included women who ranged between twenty and sixty years-old, although half of them were in their thirties. All the women in our sample were mothers, except for one grandmother interviewed as a primary caregiver. Only 27 percent had any formal education. All women in the sample had children: 52 percent had either two or three children, most others had more than three children, with the exception of three young women who only had their first child recently. Seventy-three percent lived in informal settlements, which often lack access to essential utilities such as piped water or electricity. All the women in our sample worked, yet most are self- employed, or are employed by others without formal contract. Most women had irregular and fluctuating work schedules and had to cover long distances every day on foot or bike to carry out their work. Only one woman owned a motorcycle, the rest had no vehicle and did not regularly use public transportation. 4 These were evenly distributed across the four districts: eight crèches in district A, nine crèches in district B, eight crèches in district C, and seven crèches in district D. 8 5. Findings Our findings reveal that mothers living in low-income, informal neighborhoods in Ouagadougou often favor group-based childcare not only for its perceived benefits but also because, in its absence, they are left with undesirable alternatives. Below, we briefly examine how families navigate childcare and work responsibilities and the ways in which these arrangements exacerbate work-family conflicts for women, in particular. Then, we focus on how the structural and socioeconomic disadvantages faced by these households intensify the negative consequences of work-family conflict. 5.1 Drivers of work-family conflict 5.1.1 Gender role expectations exacerbate work-family conflict for women Many mothers and fathers acknowledge that women often make an important, and often primary, financial contributions to the household. Several respondents referred to helping each other out when talking about how spouses must combine their respective incomes to pay for life’s necessities, and they emphasized that this was particularly true among low-income households. When asked why his wife worked, Sekou, a father of four who works as a mason, explained that for low-income couples, it is the expectation from the outset that the wife will work. He said, If you bring the woman home [when you marry her], you have to tell her that you didn't bring her to your house just so she could come and eat. You brought her so you could help each other. So, the help she can give you, she knows it's work, since you're not going out to steal. In fact, all but a few women in our study worked daily for income, underscoring that work is not optional for women in these low-income households. Several participants pointed out that the volatility of men’s income has been worsened by the protracted political and economic crisis underway since 2015 in Burkina Faso, which has made it increasingly hard to find steady jobs, especially for those employed in manual labor. Shila, a weaver and mother of 4 explained, [My husband] is a mason, he builds the buildings, the floors, and does all the tiling, all the construction work he does… often it doesn't go well, he can go more than four or five months without earning a job…When the country was under tension, he went more than six months without work, and it was really complicated. At least six women in our sample stated that their husband contributed close to nothing financially to their household’s expenses and that they covered all household expenditures with income from their own daily work. The data demonstrate, however, that while women’s income is often essential to household survival, women must still structure their work around the household’s caregiving needs, while men do the reverse—provide help with caregiving when their work schedule allows. It was not that fathers were not involved in childcare at all, they were. But most men appeared to provide sporadic help when they were 9 available, rather than reliable help that was driven by a mother’s need. This was true even for fathers who were not regularly working. Abdou, a mason who has four children, explained a common sentiment, Ah, if we [the children and I] are together, if I have nothing to do, the child stays with me. If I have no activity to go out to do, the child stays with me. It's my child, I cannot refuse to allow the child to stay with his father. Fathers were happy to help when they were around but were less amenable to changing their schedule to accommodate childcare needs. Mohamed, a father of two who works in a warehouse and who did not allow his wife to take a cleaning job which started at 5am stated, I don't want my wife to leave early in the morning for a job, and she's going to leave the housework to me, saying she's going to work. Should I be the one who has to get up in the morning, take care of the kids, wake them up and feed them before they go to school? Gendered social expectations did not prevent men from contributing to meeting the household’s childcare needs, but they did strongly influence how men and women organized their time and prioritized their responsibilities. Therefore, lack of access to childcare has an outsized impact on women in low-income households and exacerbates the work-family conflict they experience. Women’s experiences with the LIPW crèches, which enabled some of them to pursue different or additional income generating activities, illustrate that despite the importance of women’s income, their work options are constrained by childcare demands. Several respondents in our sample pointed to the ways in which the use of crèches allowed them to take up jobs they could otherwise not have done, or would have struggled to do, explaining that many employers dislike or do not accept the presence of children. For instance, Natalia, who works as a house cleaner and whose 4-year-old child attends a crèche stated, If I have to take him [her son] to work, I could lose my job. Because they [employer] don't allow children there. Because of the windows, they're afraid the children will destroy them…I've already had to bring him, and they [employer] didn't talk, but if it becomes every day, they'll complain. Leila, who works as a secretary, initially brought her son to work with her, but he was too disruptive, and she could not do her job. She found out about the crèche and enrolled him, stating, “…if the nursery wasn't there, I wouldn't know what to do, maybe I'd send him to his grandmother.” His grandmother lived in another city, and so it would have meant sending him far away. Thus, although women must work, their work opportunities are constrained by childcare responsibilities. 5.1.2 Relatives and neighbors cannot meet caregiving needs Relatives were seen as trustworthy caregivers by some respondents and not by others. In any case, relatives were not always available to provide help nearby. In fact, several parents described sending at least one of their children to the village to be taken care of by a relative. Some mothers, however, emphasized that family members were not always reliable caregivers and spoke about tensions within families which made them reluctant to leave their children in the care of relatives. Aissatou, who sells bowls, described leaving her youngest children with her sister-in-law when she must work, stating, 10 Before going out, I say to her [sister-in-law], ‘please take good care of my child, don't just watch TV or do something else and leave the child to get hurt or something will happen to him.’ I repeat this every day before I go out… Aissatou described coming back more than once to find one of the children had been hurt, as happens when children play, and was not properly attended to. Fatoumata, a single mother of four who sells vegetables, describes no longer feeling comfortable leaving her youngest child with her aunt because she has come back more than once to find that her child has gone to the bathroom on himself and been left in the dirt without being washed. Now she brings him with her to work instead. Talice, who knits from home, has older children and worries about siblings being inattentive when tasked with watching the younger ones, “I'm afraid to entrust small children to their elders. They are immature, distracted and lack vigilance, especially when they are busy playing.” In the absence of family members, neighbors sometimes provided childcare but help from neighbors was often limited or unavailable because neighbors also worked and were managing the same childcare and work challenges. Trinita who has four children and sells water explained, “But if the neighbor already has [a child] on her back and you go and give [her your child], she'll think: ‘you're the one who wants to go and get the money, no!’” Maya, who has four children and sells soap for a living, expressed a similar idea when we asked her if she has anyone around to whom she can entrust her young children: “[the neighbor], she’s not sitting down either, she goes out too. What's she going to do if she takes your child?” Due to the geographic concentration of poverty, women in low-income households are often surrounded by neighbors who face similar challenges and are unable to help with caregiving. Furthermore, study participants explained that they are not necessarily living in close knit communities and might not know their neighbors. Valérie, who works as a house cleaner and as a hairstylist from home, has sent her now 4-year-old to crèche since 2019, and contrasted the quality of care provided by neighbors as compared to the crèche, stating, If you entrust your child to a neighbor, you don’t know what they will do with your child. But if the child is at a crèche, you feel secure. You know that the child will not go out and go somewhere. Sometimes, when we leave the child with neighbors, we can return to find him sitting alone sorrowfully and this does not make you happy, but if he’s at crèche, all is fine. The general inability to depend on kin and social networks for reliable help with childcare exacerbates work-family conflicts for women as they navigate the conflicting time demands of work and caregiving. 5.1.3 For low-income households, most crèches are inaccessible Since 2020, in each of the four neighborhoods where this study was conducted, households could register children in an LIPW crèche in which enrollment fees were far lower than those usually charged by other private crèches. We sampled 26 women who had a child registered at one of the LIPW crèches at the time of the study and 29 who had formerly used them. Access to these crèches was highly valued, and caregivers spoke about their benefits, indicating that crèches are a desired service that was usually perceived as being out of reach for low-income families. Respondents were aware of other crèches and kindergartens in their neighborhoods but described them as unaffordable. These perceptions were corroborated by a census of existing crèches and kindergartens 11 conducted by the researchers in the four neighborhoods included in this study, which showed that fees were two to four times higher in these other private institutions.5 Shila, a weaver, explained, Yes, there are plenty of them [crèche]. It's the means that are lacking. It's too expensive. If I say it's not expensive, I've lied… It's not the children of the poor [who attend them]. They're the children of those who live in the upper floors. But not us who have half-houses [houses which are not yet fully built or are already damaged]. We can't send our children there. As she talked, Shila pointed to her neighbor’s multi-story house, a symbol of financial affluence. She and her husband Viktor, a carpenter, both explained in separate interviews that low-income households “have to wait for the government schools.” There was a general recognition that most people living in informal housing can only benefit from institutionalized childcare once their children have turned six and can enter public (and free) primary school. The low-income families in our sample who had access to the LIPW crèches articulated the value they derived from enrolling their children there, including educational benefits for the children and improved work opportunities for mothers. Mothers and fathers expressed a common belief that attending an LIPW crèche was stimulating for their children and made them more aware about the world. For instance, Leo, a father of three who works as a motorbike mechanic and whose wife works as a cleaner declared, “The best option is to leave our child to crèche. There you know that he will acquire knowledge, he will be well counseled. Being around his fellow classmates, he will learn more.” Other parents provided specific examples to attest to how their children were more “éveillés,” pointing to children’s capacity to recognize letters, sing, tell stories, express themselves, and behave properly. Overall, many families are interested in using childcare services and recognize their value. Interestingly, parents who had never used the crèches also shared the perception that crèches promote children’s safety and education and support better working conditions for women. Indeed, some mothers and fathers even underscored that this was why they were hoping to register their children in the near future. However, many cannot afford the available services unless they are heavily subsidized or free, and in the absence of access, working mothers are primarily responsible for arranging care for their children. 5.2 Consequences of work-family conflict for low-income urban households The previous section highlighted how women in low-income families, as primary caregivers and income earners, face intense work-family conflict. The following sections explore how their structural and socioeconomic conditions shape the impact of this conflict on both children and caregivers. In informal settlements, where work is precarious and infrastructure is inadequate, limited access to crèches severely affects safety, health, employment, and well-being. 5.2.1 Inadequate physical infrastructure amplifies safety issues when children are present while caregivers work More than 50 respondents commented on how caring for a child in the workplace is dangerous. For instance, Diana, a widow who can no longer afford to use the LIPW crèche after her husband’s passing, 5 The exceptions are the few public or non-profit kindergartens, whose fees are low, but which only accept children older than 3 and whose availability is scarce. 12 now brings her two younger children to the waste dump where she collects items to salvage and resell. On the day of ethnographic observation, Diana worked while her 4-year-old daughter watched her toddler. Diana acknowledged that she would prefer not to bring her children with her to the dump given the hazardous environment. Yet, she had no choice because her relatives in Ouagadougou, who work and study, cannot provide reliable supervision for her children, and she does not trust the grandmother in the village to take proper care of them. Bianca, a single mother who has a small business selling sandwiches, said that she registered her daughter at the LIPW crèche because she worried about her daughter’s safety. She explained, “It's not safe to leave the child with me in the morning while I'm selling bread. It's on the edge of a busy main road. The traffic is heavy and it's dangerous for a child.” Like many small businesses in informal neighborhoods, Bianca’s sandwich business is not a properly demarcated shop, with an inside, an outside, and a door that could potentially protect her child from traffic. Instead, it is stall with a counter, a few tables, and a small canopy where vehicles park directly along the side of the road to give and get their orders. Bianca worried about the real possibility that her daughter could be hit by a car while she worked. Similarly, Jessica, who makes and sells cakes, registered her daughter at the LIPW crèche to keep her safe, and would have otherwise stopped working in her current business. She stated, I said to myself that I was going to stop the work I was doing because if I have to keep the child [with me at work]. The handling of the hot oil, it's not safe… if something happens to the child because of the hot oil, it will be very serious. Before registering her daughter at the LIPW crèche, Jessica had planned to stop cooking because she could not risk her young daughter being burned by hot oil. These were the real decisions women were confronted with: work and risk your child being exposed to toxins in a waste dump, hit by a car, or burned by hot oil, or do not work and forego the necessary income to provide for your family’s basic needs. While many women take on home-based work to balance earning income and caring for their children, our findings indicate that this strategy often does not protect children's wellbeing or reduce the pressure mothers face. It was not just work environments out of the house that were unsafe for children, home environments could also be dangerous, especially in informal settlements. Many women found working from home stressful, as their neighborhoods offered little protection, making it no easier to balance work and childcare at home. Talice, for example, knits from home while caring for her five-year-old. She struggles to monitor her child, especially to prevent her from leaving the courtyard, which is difficult to secure due to shared access. Informal housing is cramped, poorly lit, and often extremely hot, as homes are not connected to utilities, forcing many to work outside their rooms in the shared courtyard. When Talice’s daughter was nearly three, she wandered off to play with another child while Talice worked, disappearing for hours until a town crier helped locate her three kilometers away. This experience led Talice to plan on enrolling her child in an LIPW crèche for safety, saying, “I then know that she’s in a fixed place.” Many parents reported that while they worked, their children frequently wandered outside, sometimes without their knowledge. Mothers recalled incidents of children getting lost, emphasizing the dangers of informal neighborhoods, where poor infrastructure posed serious risks. These concerns made crèches especially appealing, as they provided a secure, supervised space for children. 13 One of the most pervasive fears expressed by parents was children wandering off and drowning in flooded shallows, a common danger in Ouagadougou’s informal neighborhoods. Fatoumata, who sells vegetables next to a bridge, said she was always particularly worried when bringing her child to work with her during the rainy season. She explained, In any case, my heart's not quite at peace… I can't bring him [her son to work] all the time, because next to the bridge it's not safe, especially in rainy weather, when it's raining like this, there's water and the child wants to get into the water to have fun, often no matter what measures you take, you can't stop him from getting into the water, so right now I'm afraid too. Several participants reported incidents of children they knew drowning or almost drowning outside or inside the home. In fact, dangers included sewage drains, other deep holes, and barrels to store water in the house where children could fall and drown. Mothers described constant anxiety and the precautions and complex strategies they had to devise while working to minimize these risks. As Talice stated, To get to school, my children had to walk past a shallow…not far from the hospital. To avoid any danger, I would bring them their food at lunchtime, or my eldest daughter, who is a little older, would come and fetch lunch and go back to school so they could eat. Those with access to mobile crèches found relief, as Natalia explained, “My heart does not get dirty, because I know where my child is.” Like her, many saw crèches as essential for safety in their low-income neighborhoods that had poor infrastructure. 5.2.2 The nature of informal work results in health consequences for mothers and their children Informal work – often outside, strenuous, and spread across large distances– exposes mothers and children to health risks. Many women, particularly street vendors, emphasized how working with their children in tow made them and their children “suffer.” Without childcare options, they carried their children on their backs, sometimes until age three or four. Inaya, a soap seller and mother of five children, like many other mothers, noted that children tied to their mothers’ backs develop differently from those free to move and play. “The growth of a child who is tied to [their mother’s] back to work is not comparable to that of a child who is free and can play.… The development of the children is not the same.” Before LIPW crèches existed, Pia, a street vendor selling soap and detergent, carried her son as she worked, unable to leave him with family. She described her experience, Before the crèche opened, the child was always on my back. Every day, I carried him on my back. I suffered, the child suffered. But I didn't have a solution… All day long, my child stayed on my back. Until he was about 3 or 4 years old, he was always on my back…he would sometimes tell me, ‘mama, mama, the sun is too strong.’ And I’d answer, ‘What are we going to do?’ I could not tell him that I was going to stay home. I will stay home and then how will I manage? I must support the family and go out to earn and buy food. Thankfully, he finally was big enough to go to school. By the time Pia had another child, the LIPW crèche had opened, and she enrolled him and switched to cleaning work. She now finds balancing work and childcare less strenuous, explaining, 14 Since the opening of crèche, the [younger] child has never had to climb on my back to go to work with me even once. When I wake up, I wash him, prepare him, and drop him at crèche and then go around Ouagadougou for my cleaning work. I know that nothing will happen to him there. He will eat, drink and then you go pick him up and you are very happy. As described by Pia, the LIPW crèche can relieve both mother and child of many physical (and mental) stresses induced by carrying a child while working. For those with infants, there was the added stress and acute anxiety of worrying about the delicate nature of their children’s health at this tender age. Informal workers lacked paid leave or affordable childcare, forcing them to work with their infants in tow. Mariam, a mother of four who’s youngest child is just a few months old, explained, It's really tiring [carrying the child to work], but as you have no solution, you have to. You ask God for the strength to do it. And you pray to God that one day the suffering will end…The suffering is waking up at 4 a.m. with a pitiful child. Instead of staying at home to go to bed and sleep until 7 or 8 a.m., you have to start carrying her at 4 a.m. The cold gets into her, and she doesn't sleep well either. So, you really have to suffer, but you have no choice. Mariam, like other mothers, did not view work and infant care as compatible, but rather as necessary, driven by the need to earn a daily income. Furthermore, mothers also feared exposing their older children to hazardous conditions. Diana, a waste collector, believed her children’s skin sores were caused by daily exposure to toxins at the dump. Without access to health care, she was unsure how to treat them. Many parents saw crèches as essential for keeping children safe and healthy, providing nutrition, hygiene education, and proper care. As Viktor, a father, put it, the crèche’s purpose was “for the child to be in good health.” While women primarily focused on the negative toll on children’s health, carrying children while working was physically exhausting for mothers as well. Lisa, a hair braider, endured hours on her feet with her baby strapped to her back, causing body aches. Natalia recalled constant soreness and fatigue, saying, “At night, your whole-body hurts.” Women often talked about their bodies aching, having sore feet, or their chest hurting from pedaling or walking with the extra weight of a child, and described their daily struggle as extremely tiring. 5.2.3 The mental and economic consequences of multitasking are particularly damaging for caregivers struggling to meet subsistence needs Balancing work and childcare not only poses health and safety risks to mother and child, but also leads to constant interruptions. Ethnographic observations highlighted how women's work was repeatedly disrupted when children were present. Marie, a food stall owner, illustrates this challenge. While working at the market while the LIPW crèche was closed for break, she juggled caring for her 4-year-old son Ugo, and 7-month-old baby. Between selling food and styling hair, Marie was constantly attending to her baby’s needs, breaking up fights between Ugo and other children, soothing cries, and feeding Ugo. She was regularly torn between attending to the needs of her children and that of her customers. She and her husband longed for Ugo to return to the LIPW crèche after the holiday for some relief. 15 The economic and mental toll of multitasking was evident in many observations. Cecilia, a seamstress who owned a small sewing shop, relied on the LIPW crèche for uninterrupted work. In contrast, her employee, Bridget, brought her toddler to the workshop daily. As field notes show, even in a few hours, a child’s routine needs can significantly disrupt the workplace (see Figure 1). Bridget spends much of her day tending to Madeline, often carrying her on her back. As the day progresses, Cecilia occasionally steps in to comfort, discipline, or put Madeline to sleep. Their daily routine highlights the challenges of juggling childcare and work for everyone involved—the exhaustion it causes and its impact on both mental health and productivity. Figure 1: Timeline of Bridget's morning multitasking work and childcare Women highlighted that the constant interruptions associated with children have negative consequences on their work productivity and income. Talice, who knits from home, was observed regularly stopping her work to attend to her daughter who was often fighting with the neighbor’s child, to sooth her daughter when she cried, or to return the neighbor’s child to his mother. On several occasions, Talice stopped her knitting to move the children further from her to be able to work more quietly, or she moved her knitting materials away from where the children were to try and focus. Talice 16 commented, “With the children, we can’t work well, there are too many breaks needed. All these interruptions mean that the work is not moving forward.” Many women recounted the ways in which the presence of children while they worked was detrimental to their income, especially when they were paid based on the number of tasks completed, such as sewing, hairdressing or cleaning. Latifa, who was a hairdresser when her child was still a toddler and took him to work with her, explained, Some customers don't want you to do their hair while the child is crying... They insist and say, leave it [the hair] and take care of it [the child], leave it and take care of it. Your heart wants the job, but if the child doesn't accept, what are you going to do? Her customers were understanding, and insisted she stop to attend to her child, but each time she stopped it meant it took longer to finish her client’s hair, and limited the number of clients she could take in a day, and hence her profits. Many mothers in our study described working longer hours to mitigate the economic losses caused by children’s interruptions. For example, Agathe manages informal credit associations, and her 18-month- old daughter often goes with her on the daily rounds to collect money from across the neighborhood. Agathe carries her daughter on her back while on her motorbike. On the day of the observation, Agathe’s daughter was sick, and she regularly had to stop to breastfeed and soothe her crying daughter. Agathe confided that when her daughter is under the care of a relative, she can finish her rounds much faster, around 5:45pm, but when her daughter comes along, it takes up to two hours longer, especially because in the rainy season, she must take shelter for the child, which she does not do when she is alone. Clarissa, who is a house cleaner, also explained that since 2019, when her youngest child started attending the LIPW crèche, she can work “more quickly.” This has also enabled her to increase her economic returns by cleaning at an additional location. The difficulties posed by caring for children and working often got worse as children aged. They got more restless, needed more attention, and demanded more things, which was increasingly time consuming and expensive. Many mothers and fathers acknowledged that when children are with them, especially with their mothers, they constantly ask for snacks, juices, and treats, causing significant disruption if they are denied. The demand for these snacks adds up economically, with some parents even estimating that the costs of keeping children happy with snacks outpaces the cost for crèche. Cecilia, the seamstress, explained that when her child is with her and he asks for snacks, he always waits until there are customers present, which disrupts her work more. She ends up saying yes to him and buying him what he wants just to “have peace.” Béatrice explains that she and her husband registered their toddler at the LIPW crèche to “save money,” stating, So, when the children are in crèches, the money that you were going to spend, 25 CFA here, 25 CFA there, that money instead remains in your pocket and the kids will go to crèche and when they’re back, this money is still in your bag. Registering their daughter at the LIPW crèche was cost effective, in their estimation, in part because of the low fees charged. Beyond reducing daily snack expenses, mothers valued crèches for easing the mental burden of constant negotiations with their children. Maya, whose 3-year-old daughter is not enrolled in a crèche, shared, “We [she and her daughter] often fight, because often you haven't sold anything yourself, but what she's [her daughter] going to make you spend may exceed what you could have earned if you had sold.” Women described being tired from the constant demands from their 17 children, and the stress of not always being able to meet their child’s needs. The mental toll of these negotiations and compromises was acute because the families struggled to meet subsistence needs, and their decisions had implications for the family’s basic wellbeing. 6. Discussion and conclusion Our data indicate, as in many places around the world, that childcare remains women’s responsibility even when men actively help with caretaking tasks. Work is not optional for women living in low-income households, yet parental leave policies do not reach this population, and group-based childcare remains out of reach. Living in poverty, for the most part, locks women into a cycle of precarious informal work and their children out of reliable group-based childcare. Women in low-income urban households experience work-family conflict in the context of unsafe neighborhoods and severely constrained labor market options. The physical dangers of unguarded water, congested roads, open flames, as well as houses and compound doors that cannot be secured mean that even when caregivers are distracted for only moments, children can face severe harm. The same types of physical dangers are not faced by children in other neighborhoods or residential contexts. The nature of women’s options for earning income also exacerbate the difficulties of combining work and childcare. Much of the work available to women in this population requires regular travel around the city or involves hazardous conditions. Multitasking in those working conditions has negative wellbeing consequences for mothers and their children that would not be experienced by caregivers who bring children to sedentary and safe work environments. Finally, the mental and economic toll of multitasking contributes to the perpetuation of poverty. Unlike in households that have income to spare, the financial costs of exhaustion and lower productivity are potentially devastating for this population that is struggling to meet daily subsistence needs. Thus, the structural and socioeconomic position of these households and caregivers make the absence of accessible and affordable group-based ECCE services particularly damaging. The growing body of evidence highlighting the heterogeneous impacts of childcare often suggests that poorer populations benefit more from these services. Research in the United States demonstrates that heterogeneity in impacts stems from the fact that, in the absence of accessible group-based childcare, the poorest households have less desirable alternative care options (Feller et al. 2016). In the absence of group-based care, caregivers cannot afford to stay home to care for children full-time or enroll them in other care programs. The data from this study starkly illustrate the same concept by describing the counterfactual to accessible ECCE services for households living in poverty in urban Burkina Faso. This study has several limitations. The ethnographic data collection focused predominantly on the experiences of mothers who are primary caregivers for young children. While it would be valuable to explore issues related to the long-term sustainability of LIPW crèches, these questions lie beyond the scope of this research. The same applies to important questions related to fathers, such as whether they adjust their work or employment patterns when childcare constraints are eased, or how the absence of childcare affects their daily routines. Additionally, although our data capture key challenges women face in balancing childcare and work, they are not designed to quantify specific impacts—for example, the percentage of daily income lost due to workplace interruptions caused by children, or the time lost to childcare-related disruptions. These are critical areas for future research but fall outside the focus of this study. 18 The findings from this study raise important questions about how to measure the value or cost effectiveness of childcare programs. Many of the benefits of childcare centers that were described by study participants will not be included in cost-effectiveness studies that quantify benefits only in terms of mothers’ labor market gains or children’s cognitive development outcomes, measures that are too narrow to capture the multi-dimensional effects of childcare. How do you capture the value of a child not being hit by a car while at their mother’s workplace, or not being burned by cooking oil, or not developing sores from toxic exposure? How do you capture the benefit of a mother’s body not aching at the end of the day from carrying her child, or a child not overheating from being out in the mid-day sun? How do you capture the absence of anxiety because you know your child is safe while you are at work, or the lack of anguish you feel because you know someone can comfort your child and it does not come at the expense of lost customers? Researchers should consider standardizing a much wider range of outcomes when assessing the value of group-based childcare. Measures might include, for example, task-switching frequency, which increases cognitive load and mental fatigue; time fragmentation and number of tasks performed in a day, which contributes to exhaustion; indicators of decision fatigue stemming from chronic multitasking and role strain; delayed response to personal needs, signaling self-deprivation in favor of others; and emotional suppression, which can be linked to elevated stress. Those types of measures offer valuable ways to capture a broader conceptualization of mental health. Objective and subjective measures of caregivers’ physical health are also important and could draw inspiration from studies that have measured the impact of workplace conditions on health (e.g. Blattman and Dercon 2018). In terms of outcomes for children, measures might be expanded to more routinely include mental health indicators as children in poverty often experience chronic stress; children’s sense of safety and security, as feeling secure is foundational to healthy emotional development; an understanding of children’s daily routines and structure, as predictable routines support executive function; and measures of health and nutrition. More generally, calculating the benefit of group-based ECCE services must take into account the counterfactual—the realities of childcare for working parents when group-based care is not an option. The argument for targeting low-income households with childcare services becomes fully apparent when considering the wide range of costs associated with the status quo when group-based childcare is inaccessible for this population. 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