CARING AGAINST THE CURRENT: THE POLITICAL ECONOMY OF CARE POLICY ADOPTION IN PARAGUAY

Abstract

This thesis examines the politics of care policy adoption, focusing on the conditions under which transformative approaches to care emerge and become institutionalised in national contexts. Care is understood as the activities and relations necessary for the existence and well-being of societies, fundamental to sustaining life and economies, yet it remains persistently devalued and marginalised in economic and political frameworks. Linked to this devaluation, care responsibilities are unequally distributed along gendered, classed, racialised, and ethnic lines. This study addressed the overarching question: How does politics shape the adoption of care policies? It employs a qualitative case study of Paraguay, using process tracing to analyse how power and politics influence care policy reform. Paraguay provides an illustrative example of an ambitious but only partially institutionalised initiative, offering insights into the barriers and opportunities shaping care policy in Latin America. Unlike Uruguay, which established its National Integrated Care System (SNIC) in 2015, Paraguay’s efforts began in 2012 but advanced only incrementally, culminating in a 2022 National Care Policy approved by executive resolution that stopped short of expanding services and entitlements. The theoretical framework integrates feminist political economy scholarship on care with literature on the politics of development and gender and politics. It applies a political settlement and power domains framework to examine how power configurations, interests, and ideas generate incentives and constraints shaping transformative care policy adoption. The thesis argues that Paraguay’s care policy trajectory reflects tensions between external pressures for reform and the political settlement, historically dominated by elites, which maintains an exclusionary distributional regime and an extractivist economic model. Within this context, social policy, particularly gender equality, has consistently held a low priority. A temporary opening during the progressive government of Fernando Lugo (2008-2012) created momentum for debate on social rights and redistribution, offering a brief window for policy innovation within the care domain. Findings show that transnational actors, feminist advocacy, and committed bureaucrats were central in advancing care onto the policy agenda. The initial proposal articulated a transformative, rights-based approach, challenging the view of care as a private responsibility and calling for greater state and private sector involvement. However, these aspirations faced resistance embedded in the political settlement, particularly: (1) fiscal conservatism and elite interests opposing redistribution and public expansion; and (2) conservative ideologies opposing gender equality framings and reflecting the influence of anti-gender and religious discourses as powerful discursive constraints. Consequently, the policy coalition adapted its proposals, removing key redistributive measures and softening gender-related language to ensure political feasibility. The final 2022 National Care Policy represented discursive progress in recognising care as a social responsibility but lacked binding commitments or transformative provisions. The research advances a political economy analysis of transformative care policy adoption in the Global South, integrating political settlement and power domains analysis into the study of the political economy of care and extending it through an intersectional lens. The study demonstrates how misalignment between the political settlement and discursive representations of care within the policy domain explains the limited transformative potential of Paraguay’s reform, illustrating the vulnerability of externally driven agendas when domestic politics resists redistribution and gender equality.

Date of Award	13 Feb 2026
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Thomas Lavers (Main Supervisor) & Caitlin Henry (Co Supervisor)