Discussion

This is the first study to our knowledge which assesses the effects of domestic work on the psychosocial well-being of children. It has a number of limitations. First, sampling is biased by the clandestine nature of the worst forms of this work. Although we attempted to reach children in the most difficult situations, we are aware that this population is under-represented. Second, the psychosocial scoring system was developed for this study, and it was impossible to conduct formal validation. However, we believe that internal comparisons are useful and informative, especially regarding the responses to individual items as shown in table 4. In addition, we included some repeat questions, worded slightly differently, and these demonstrated good internal validity. The dichotomisation of scores to create a more vulnerable group is essentially arbitrary, but it was agreed among the researchers that children in the lowest tertile were likely to be highly vulnerable. Third, the quantitative approach may not encourage interviewees to raise specific concerns or share confidences and may lead to evasive or selective responses. But in the context and given the necessity to use local researchers, we deemed a quantitative approach more appropriate.

Despite the limitations, the findings in these two countries shed light on the diversity of expectations, conditions and outcomes encompassed in the term child domestic work. In India children generally enter domestic service young, live with their own families, are at risk of physical abuse, seldom attend school and have poor psychosocial outcomes, in the form of low self-esteem, stress and feelings of incompetence. In contrast, in the Philippines CDWs are mostly migrants, live with employers, combine education with work, appear to have a good relationship with employers and are proud of what they do. This results in good psychosocial outcomes, equivalent to those of school attenders. For many families in India child domestic work is a survival strategy, and 8.5% of CDWs were paying off family debts. In the Philippines domestic work is viewed more as a chance to earn money to attend better schools, providing an opportunity to move up the social ladder. This positive view coincides with earlier research from the Philippines which concluded that in poor families domestic work is seen as a highly pragmatic approach to continuing education.13 ,14

The bivariate analysis shows some strong and consistent risk factors for psychosocial vulnerability in the two countries. School attendance has highly beneficial effects. CDWs who are not in education are approximately three times more likely to be in the lowest psychosocial tertile in both India and the Philippines. The relationships between education and entry into domestic work are complex. Some children enter work as a means of continuing their studies, while other leave school in order to work. Importantly, attending school makes children visible, providing a form of protection and social capital in the form of friendship, social activities and supportive adults. Education also increases options, gives hope for the future, and offers a potential escape from long term domestic drudgery.15 ,16 Linked to this is the strong protective factor of social capital per se, which in this context consists of relationships with other CDWs, adult support, and attending a community group, illustrating the importance of support networks for well-being. Adult support and relationships with employers were especially important in the Philippines where the majority of CDWs are migrants, whose close family networks are out of reach, and where most lived-in. The potential vulnerability of child migrant workers has been highlighted elsewhere,10 ,13 and this emphasises the importance of increasing the awareness of employers. As Bourdillon et al point out, “It may not be the work per se which defines the boundary between harmful and benign work for children, but rather whether the children and their interests are respected by the controlling adults”.4

Although not surprisingly the overwhelming majority of CDWs reported good health (children in poor health will not continue to work, demonstrating a clear healthy worker effect), there was an association between poor or fair self-reported health and psychosocial well-being. While poor health of course impairs general well-being, it may be that these children are manifesting psychosomatic symptoms. An additional question asking about specific symptoms showed that most were headache and abdominal pain, classic psychosomatic symptoms.

Some psychosocial correlates differed between India and the Philippines. Younger children had lower psychosocial scores in India but not in the Philippines. It has been generally assumed that younger children suffer more from the adverse effects of all types of work due to their immaturity and lack of experience,2 ,4 and much national legislation concerns age restrictions for work. But where conditions are good and children can attend school, maybe this is not the case. Living-in was associated with poorer psychosocial outcomes in the Philippines, but not in India, although only 12% were living with employers in India, making generalisations difficult. Living-in has been thought of as higher risk, since it usually means less social contact.17 But in some cases living conditions and health are better in the employer's home than in the child's own home, sometimes simply because in a city food and health facilities are more easily accessed. A study from Senegal found that CDWs who had migrated from rural areas had better health and nutritional status than non-migrants, concluding that they were better fed and cared for in domestic service than at home.18 CDWs in Guatemala cited excessive workloads and long hours of unpaid work as reasons for leaving their rural homes to migrate to cities for paid domestic work.19

There are clear policy implications. The diversity of working and living contexts and psychosocial outcomes shown in just two countries suggests that classifying child domestic work as a ‘worst form of child labour’ is inappropriate. Enforcement of such a classification would mean that governments would have to take steps to remove children from domestic work, which would not only be impossible to enforce but would also be counterproductive, with the risk that these child workers would be driven further underground, making it more difficult to protect the most vulnerable children, or forced into worse forms of employment.4 Moreover, this would be hugely problematic to implement given the acceptance of child domestic work in many societies.

However, this study shows that it is not domestic work that is intrinsically harmful but rather the circumstances and conditions of work in the employer's home, in the family and in society, and much of this could be ameliorated through regulatory measures. Employers should not employ younger children, should allow their employees to attend school, should limit hours of work, allow time off to attend community groups, socialise with peers and visit family, and should be informed that correction or teaching should be used rather than punishment. These points should be included in a contract agreed with the CDW employer.20 Even simple education of employers about good practice could be beneficial. Any attempts at regulation and legislation are complicated by the fact that the place of work is a private home. For this reason regulation needs to be accompanied by a local strategy for enforcement. As long as there are huge inequalities in many societies child domestic work will persist. The most important measures in the short term should aim to reduce the potential harm and promote good practice.