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As Populations Age, Women Bear a Heavier Burden

Developing countries are seeing the fastest acceleration in population aging, but policies for hospices and caregivers aren’t keeping pace. For many women, age-based discrimination exacerbates a lifetime of gender inequality.

Written by Christine Chung Published on Read time Approx. 4 minutes
Elderly women chat as they rest at a residential compound in Beijing, China, March 31, 2016. AP/Andy Wong

The world is getting older, and that’s not great news for women. Today, one in every nine people is aged 60 years or over, and projections say that will increase to one in five by 2050. While population aging is a global demographic phenomenon, it’s happening faster in developing countries. For experts, organizations and governments, the question is how to ensure that both men and women can age with dignity and security even in places with low resources.

But for many women, aging places additional burdens on them and compounds experiences of gender inequality with age-based discrimination. In places where women have fewer opportunities for education and work or face barriers in obtaining property rights, they are more vulnerable as they approach old age. For example, more older women than older men are blind, not only because women are living longer but also because they have less access to medical treatment. The “feminization of aging” reflects the fact that women already outnumber men in older age groups, and this disproportionately increases the older they get.

There’s widespread consensus that aging is a major trend that requires attention. The problem is how to translate understanding into action. “Everyone is feeling the impact, but they’re still figuring out how to address the need,” says Lisa Walke, associate chief for clinical affairs in geriatrics at Yale University. In low-income countries where she’s worked like Nigeria and the Dominican Republic, Walke says it’s really about how to divide up limited healthcare resources. While older adults are respected in Nigeria, for example, many still have trouble accessing care.

According to Eric Miller, an anthropologist specializing in aging in China at Virginia Tech University, the Chinese government is paying attention. “If I turn on Chinese TV, there’s a 50 percent chance that I’ll land on a program on aging,” he says. Central authorities in Beijing have been calling for more hospice and palliative care to help elderly people cope with terminal illness, but Miller says local governments are slow to respond.

It’s been said that China’s major modern challenge is to get rich before it gets old. But with more than 167 million people over 60 and slowing population growth, in many respects, it’s an impossible race. Moreover, China faces a daunting situation made worse by its enforcement until recently of a one-child policy that means in the future, millions of Chinese individuals will each potentially have to support, without siblings to share the burden, their two parents and four grandparents.

Asked whether China’s aging population poses a crisis, Miller says, “It’s not a catastrophe because China does have a medical system in place. [But] there’s a low-level crisis, a silent crisis, in terms of caring for the elderly as there’s no hospice.” Miller says that when an elderly person has to stay in hospital for treatment, it poses both financial and practical burdens on the family because Chinese hospitals generally don’t provide basic nursing care like feeding or bathing. Unless they happen to live in Shanghai or Beijing, where some hospitals provide international standards of care, or they can afford to pay for help, family members are expected to look after the basic needs of their hospitalized relatives.

In many instances, women end up shouldering the responsibility of caring for older family members. From his field work in Shanxi and Shandong provinces, Miller recounts one woman’s story: her mother had esophageal cancer, her father was too frail to provide assistance and her brother suffered from mental illness. So she attended to her mother while her young child was in school. “Her story was not atypical of one woman holding together the whole family,” he says.

According to Miller, even if men are deciding on the care of their parents and feel the pressures of filial piety, sons are often unable to play an active role in providing family-based care. So, in many cases, elderly mothers end up caring for elderly fathers.

Without hospice, terminally ill patients face going home to die without any additional medical support or prospects for pain relief. “The bleakest point is that patients really suffer,” Miller says. “We’d like to see comfortable, meaningful end-of-life experiences.” As China’s government has indicated the need for hospice, property developers interested in buying land at preferable prices have chosen to establish old-age homes even while operating at a loss, just for the land concessions. Others jumping on the aging bandwagon include proprietors of underutilized hotels who have transformed their businesses into elderly care outlets. “Unfortunately,” says Miller, “they don’t know anything about elderly care.”

In China, smaller entrepreneurs have started offering home-care services or small facilities at the village level. But it’s difficult to find qualified health aides, although some organizations in Beijing have started to offer training.

Walke says that international organizations like the World Health Organization and Pan American Health Organization are well aware of the enormous challenges of an aging global population and what needs to be done. That includes investments in health systems, long-term care and broader enabling environments, such as creating equitable and sustainable mechanisms for financing care, ensuring medical professionals are properly trained in geriatric care and gerontology, and enshrining policies to support caregivers.

Together, these changes would greatly improve the lives of the women in the world’s aging populations and the female family members who so often act as their caregivers. “But there’s not enough money to implement every recommendation,” says Walke. ”People agree on the principles, but not how to divide the pie.”

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