Gender, Health, and Aging
in China
Jeanne Shea
Associate Professor
University of Vermont
[email protected]
Outline
Basic demographic and public health situation
My related research on midlife Chinese women
Demographic and
Public Health Situation
China’s Population
• Overall population
– Mid 2008
– Mid 2025 (projected)
– Mid 2050 (projected)
1,324,708,000
1,476,000,000
1,437,000,000
• Decline in fertility and mortality
–
–
–
–
Birth Rate
TFR
Death Rate
Natural Increase
12/1000 (16,029,000 per year)
1.6
7/1000 (9,180,000 per year)
0.5% (6,849,000 per year)
(Population Reference Bureau 2008)
An Aging Population
• More than 10% of population is now age 60 or older
– Age <15
– Age 15-64
– Age 65+
256,993,000
967,036,840
107,301,000
• Life Expectancy at Birth
– Both Sexes
– Males
– Females
73 years
71 years
75 years
(Population Reference Bureau 2008)
(19%)
(73%)
(8%)
Percentage Age 65+, 1950-2050
Toshiko Kaneda 2008, www.prb.org/Articles/2006/ChinasConcernOverPopulationAgingand Health.aspx, Source:
World Population Prospects: The 2004 Revision (2005).
Population Pyramids
2000
2050
Toshiko Kaneda 2008, www.prb.org/Articles/2006/ChinasConcernOverPopulationAgingand
Health.aspx, Source: World Population Prospects: The 2004 Revision (2005).
Social Concerns
• Proportion of working-age (age 15-64) per elderly adults (age 65+) projected
to decline from 9 to 2.5 persons by 2050.
• Support and care of frail or senile elderly
• Increase in long-term chronic disease and disability
–
–
–
–
•
•
•
•
•
•
Chronic diseases almost 80 percent of all deaths in China in 2005
Death major causes- cardiovascular disease, cancer, chronic respiratory dis.
Over past decade adult obesity doubled to 7%
And adult hypertension increased by one-third to 19%
Large burden on singletons and other adult children: 4-2-1 problem
High male to female sex ratio -> deficit of daughters-in-law
Erosion of children’s moral drive to take care of elderly parents
Higher and longer labor force participation by women -> less informal care
Fear of caregiving burden reducing productivity of younger adults
Strain on pension, public welfare, and health care systems
– Rise in health care costs > growth of national economy and individual earnings
– Health care access difficult for rural populations (many rural elderly)
• Fear -> slowing of economic growth due to less investment & productivity
China Population Devel. & Research Center, www.cpirc.org.cn/en/enews20020329.htm, Toshiko
Kaneda 2008, www.prb.org/Articles/2006/ChinasConcernOverPopulationAgingand Health.aspx
Rural/Urban Divide
• Rural dwellers ages 50+ 30% higher death rate than urban
–
–
–
–
–
–
–
–
Lower wages
Fewer amenities, e.g., communication and transportation
Fewer short term health care facilities
Fewer long term care options – e.g., community care,
assisted living, nursing home
Despite recent expansion of coverage, at least half of rural
health care expenses still out of pocket
Little disposable income to pay for non-kin based care
Mass migration of rural youth to urban areas
Fewer kin available to provide care
(www.prb.org/Articles/2008/olderchinese.aspx)
Public health situation
•
•
•
•
•
•
•
•
•
•
•
•
•
Limited public funding for long term elder care
Social welfare reform, 1990s - decentralization, less govt. finance, more privatization
Locally funded public and private elder homes now accepting elderly with children
and some means of support; Increase in number of private elder homes
Elder homes very few, quality varies, too expensive for most, and few in rural areas
Community-based long-term care services emerging – checking in, daily care,
housekeeping, information, referral – but still very few
Some local govt. agencies and depts. of health - short-term training of laid-off
workers in basic care-giving – but still very limited
Govt. plans to develop undergrad. geriatric medical training and more geriatric units
MOH est. Natl. Ctr. for Chronic & Non-Communicable Disease Control & Prevention
and Disease Surveillance Points System (2002)
Working with WHO on 1st long-term (2005-2015) comprehensive national plan for
chronic disease control & prevention. Priorities - smoking, hypertension, obesity
Management of hypertension, diabetes (Beijing, Shanghai, Changsha, 1991-2000)
Program of Cancer Prevention and Control established
Ratification of WHO Framework Convention of Tobacco Control
Primary school nutrition education to prevent obesity
Toshiko Kaneda 2008, www.prb.org/Articles/2006/ChinasConcernOverPopulation
Agingand Health.aspx
Research on Midlife Chinese
Women in Beijing, 1992-present
Jeanne L. Shea
Associate Professor
University of Vermont
Chinese Women: Gender,
Culture, Health, and Aging
• Community-based field research conducted in
Beijing Municipality, 1992-2008
• Reading clinical and popular education
materials published in China
• Examining scholarly literature on gender, aging,
modernity, and experience/discourse
Fieldsites
Urban and rural
communities in
Beijing Municipality,
China
Research Methods
• Quantitative community research (1994)
– Over 400 Chinese women age 40-65
– Face-to-face interview using a questionnaire
– Half in a rural village and half in an urban neighborhood in
Beijing Municipality
– Total sample of village & block of neighborhood
• Qualitative community research (1993-94 and
summers of 1992, 1996, 2000, 2007, 2008)
– Conversations/participant observation: hundreds of women
in numerous rural and urban communities in Beijing
– Tape-recorded interviews - dozens of women age 40-85, half
in rural and half in urban communities in Beijing
• Media studies (1992-2007)
– Review of relevant local health education literature
Initial Research Questions:
Experiences of Aging
• How view and experience their health,
menopause, aging, middle age, and old age?
• What kinds of symptoms do they report, if any?
• How does this compare with cross-cultural
research done in Japan and North America?
Cross-Cultural Comparison of Symptom-Reporting
Core Symptom Profiles of Women Ages 45-55, Percent Reporting Symptom
50
45
40
35
30
Japan
Canada
25
U.S.
China
20
15
10
5
Core Symptoms
Ni
te
Sw
t
as
h
Ho
tF
l
ee
p
Tr
Sl
De
pr
es
s
Irr
it a
bl
e
Ba
ck
ac
he
Ac
he
Jo
in
t
He
ad
ac
he
re
d
Ti
zy
Di
z
Sh
Br
ea
th
Sr
Th
ro
at
Ps
tC
ou
gh
Pr
Ap
pe
t
tm
Up
se
tS
Di
a
rC
on
st
0
Chinese Women’s Views
Positive perspective end of menstruation
-end of mess, bother, expense
-not have to worry about birth control
NOT focused on:
-hormonal decline
-loss of physical attractiveness,
reproductive ability, empty nest, etc.
Some Potential Explanations
• Local reproductive endocrinology and soy
consumption only to hot flashes (NIH 2005)
• Confucian values instantiated differently in
Japan versus China
• Extent, severity, and rapidity of social change
• Cultural acceptability of monitoring symptoms
• Cultural construction of dominant concept of
female midlife (gengnianqi vs. konenki)
Chinese Women’s Experiences
In accounting for midlife symptoms and suffering,
they tend to focus on:
-experience of social history
-suffering and loss of opportunity due to
“feudalism,” Japanese occupation, civil war, antiRightist campaign, GLF, Cultural Revolution
-mother-in-law/daughter-in-law issues
-not prepared for change to market economy
Inspired Questions About:
Chinese Women’s Experiences of
Romance, Sex, and Marriage
in Later Life
Chinese Media Advocating
Romance, Sex, and (Re)marriage
In Later Life
• Doctors, psychologists, cadres, and educators
• Clinical/popular education
• Books, booklets, magazines, newspapers
• Some television shows, videos, posters
Campaign against
traditional views
“feudal superstition”
Confucian conservatism
Daoist alchemy
Campaign for
modern perspectives
communist ethics
scientific knowledge
cosmopolitan views
Media Representations
• Tradition and the Chinese past
• Chinese people in later life
• Middle-aged and old women
– Prime victims
– Prime perpetrators
Enlightenment View of Knowledge
• Educate the public on what is normal, natural,
healthy, and socially respectable,
• And thus modernize behavior of older Chinese
and promote their well-being.
Superstition  Unhealthy Constraint
Enlightenment  Liberation of Behavior
Why the campaign?
• Western enlightenment beliefs of some clinicians and
popular educators
• Globalization and increasing pressure across the
lifecycle to live like Westerners are believed to live
• Utility for nation to stress later-life conjugality at this
time
– Economic reforms
– Changes in kinship obligations
– Increased proportion of elderly in population
Women’s Views and Behaviors
Chinese Women, Age 40-65, N=399
40-49 (n=196)
n1 (%)
50-59 (n=126)
n1 (%)
60-65 (n=77)
n1 (%)
Total (N=399)
n1 (%)
Marital Status
Married, living together
Married, living apart
Widow
Divorced
Never married
189 (96.4)
4 (2.0)
1 (0.5)
0 (0.0)
2 (1.0)
110 (87.3)
3 (2.4)
10 (7.9)
2 (1.6)
1 (0.8)
61 (79.2)
4 (5.2)
12 (15.6)
0 (0.0)
0 (0.0)
360 (90.2)
11 (2.8)
23 (5.8)
2 (0.5)1
3 (0.8)
Times Married
Twice
Once
Zero
6 (3.1)
188 (95.9)
2 (1.0)
3 (2.4)
122 (96.8)
1 (0.8)
5 (6.5)
72 (93.5)
0 (0.0)
14 (3.5)
382 (95.7)
3 (0.8)
Menopausal Status
Premenopausal
Perimenopausal
Postmenopausal
111 (56.6)
77 (39.3)
8 (4.1)
4 (3.2)
20 (15.9)
102 (81.0)
0 (0.0)
1 (1.3)
76 (98.7)
115 (28.8)
98 (24.6)
186 (46.6)
Residence
Urban
Rural
112 (57.1)
84 (42.9)
57 (45.2)
69 (54.8)
31 (40.3)
46 (59.7)
200 (50.1)
199 (49.9)
11 (5.6)
1 (0.5)
142 (72.4)
43 (21.9)
37 (29.4)
8 (6.3)
62 (49.2)
27 (21.4)
51 (66.2)
26 (33.8)
10 (13.0)
16 (20.8)
99 (24.8)
35 (8.8)
214 (53.6)
86 (21.6)
6 (3.1)
153 (78.1)
37 (18.9)
0 (0.0)
12 (9.5)
59 (46.8)
51 (40.5)
4 (3.2)
23 (29.9)
20 (26.0)
34 (44.2)
0 (0.0)
41 (10.3)
232 (58.1)
122 (30.6)
4 (1.0)
Education
0-3 years
illiterate
4-9 years
10+ years
Household Composition
1 generation
2 generations
3 generations
4 generations
Not so “feudal”
• 75% of 399 women age 40-65 sexually active
• Sexual attitudes not as conservative as media depicts
• Urban women - expressed more liberal views on sex
• Rural women - higher incidence of sexual activity
• Sexual attitudes and behavior often not consistent
Sexual Activity, Older Chinese Women
Total sample
Currently married
Currently married and
living together
40-49
184 of 196
(93.9%)
184 of 193
(95.3%)
180 of 189
(95.2%)
50-59
76 of 126
(60.3%)
76 of 113
(67.3%)
74 of 110
(67.3%)
60-65
28 of 77
(36.4%)
28 of 65
(43.1%)
26 of 61
(42.6%)
Total
288 of 399
(72.2%)
288 of 371
(77.6%)
280 of 360
(77.8%)
Sexual Attitudes
• Only 20.6% agreed that women should abstain
from sex after menopause.
– Rural 22.5%, Urban 18.6%
– Low ed. 30%, Mod ed. 22.1%, High ed. 14.1%
• Although 80%/86% felt that husbands’/wive’s
interest in sex declined some by middle age
Attitudes/Behavior
• Best to stop sex after menopause
– Disagree: 76.6% sexually active
– Agree: 56.1% sexually active
• Agree and postmenopausal: 32% sexually active
• Midlife decline in sexual interest in women
and/or in men
– Over 75% of sexually active women agreed
Sexual Activity and Menopause/Aging Info. Exposure
Gossip or hearsay
TV or film
Newspaper, magazine
Radio
Book or booklet
Advertisement, poster
Medical text
Expert lecture
40-49 (n=189)
x/ya (%)
140/149 (94.3)
129/135 (95.6)
102/109 (93.6)
79/80 (98.8)
60/64 (93.8)
23/23 (100.0)
14/14 (100.0)
13/14 (92.9)
50-59 (n=110)
x/y (%)
71/102 (69.6)
58/82 (70.7)
33/46 (71.7)
29/40 (72.5)
22/31 (71.0)
9/11 (81.8)
4/7 (57.1)
2/6 (33.3)
60-65 (n=61)
x/y (%)
20/52 (38.5)
14/40 (35.0)
6/19 (31.6)
9/20 (45.0)
4/14 (28.6)
2/3 (66.6)
2/8 (25.0)
2/4 (50.0)
Total (N=360)
x/y (%)
240/312 (76.9)
201/257 (78.2)
141/174 (81.0)
117/140 (83.6)
86/109 (78.9)
34/37 (91.9)
20/29 (69.0)
18/24 (75.0)
Sexual Activity and Rural/Urban Residency
(Married Women Living With Spouse)
Rural
Urban
TOTAL ACTIVE
40-49 (n=189)
x/ya (%)
106/108 (98.1)
74/81 (91.4)
180 (95.2)
50-59 (n=110)
x/y (%)
38/53 (71.7)
36/57 (63.2)
74 (67.3)
60-65 (n=61)
x/y (%)
10/21 (47.6)
16/40 (40.0)
26 (42.6)
Total (N=360)
x/y (%)
154/182 (84.6)
126/178 (70.8)
280 (77.8)
Sexual Activity and Education
(Married Women Living With Spouse)
Years of Education
0-3
4-9
10+
40-49 (n=189)
x/ya (%)
11/11 (100.0)
134/137 (97.8)
35/41 (85.4)
50-59 (n=110)
x/y (%)
19/31 (61.3)
36/56 (64.3)
19/23 (82.6)
60-65 (n=61)
x/y (%)
20/41 (48.8)
1/6 (16.7)
5/14 (35.7)
Total (N=360)
x/y (%)
50/83 (60.2)
171/199 (85.9)
59/78 (75.6)
Sexual Activity and Household Composition
(Married Women Living With Spouse)
One generation
Two generations
Three generations
Four generations
40-49 (n=189)
x/ya (%)
4/6 (66.7)
140/147 (95.2)
36/36 (100.0)
n.a./0 (--)
50-59 (n=110)
x/y (%)
6/8 (75.0)
36/51 (70.6)
30/47 (63.8)
2/4 (50.0)
60-65 (n=61)
x/y (%)
7/19 (36.8)
4/17 (23.5)
15/25 (60.0)
n.a./0 (--)
Total (N=360)
x/y (%)
17/33 (51.5)
180/215 (83.7)
81/108 (75.0)
2/4 (50.0)
Ideology/Practice
• General ideals distinguished from own situation
• Practicality emphasized more than ideology
– His/her health
– Basic subsistence
– Spatial convenience
– Quality of relationship – equality, respect, trust
• Second honeymoon vs. Release from duty
Women vs. Campaign
• Few women wish to remarry
• But mostly unrelated to conservative views
• Instead: Different view of liberation/burden
– Many see husbands as wet leaves
– Flatbread story about helpless husbands
– Some had difficult marriage, disrespectful husbands
– Differential costs and benefits of remarriage
• Household division of labor for these cohorts
• Gendered age differentials, mate choice, and caretaking
Caregiving Burden for Older Women
• Survey data from my 1994 Beijing survey, Chinese women,
ages 40-65 (N=399)
• Although only half were formally employed, most did a great
deal of informal domestic labor
• Interview and participant observation with Beijing women from
1992-2008 showed large amount of domestic labor among
many women into their late seventies
• Informal domestic labor of older women often not accounted for
in standard demographic representations of population ageing
Housework
• Average about 28 hours of housework per week.
• The older women spent more time doing housework than the
younger ones (women in their forties 23.5 hours per week,
women in their fifties and sixties 33 hours per week).
• While two thirds said their housework load had decreased over
time, over a third said it had increased or stayed the same.
Decreases mainly due to increases in appliances, ready-made
items, and other conveniences and money to spend on them.
• A fifth of the women said they got no help whatsoever with the
housework from other members of the household, and four out
of five women said that they did most of the housework. In that
half were still employed, this translates into a large volume of
labor on their shoulders.
Taking Care of Their Children
• Although four out of five women said the amount of time they
spent taking care of their children had declined from when they
were younger, two thirds still spent some time therein.
•
For the numerous women with adult children, this meant tasks
such as cooking their meals, washing their clothes, buying
groceries, and running errands. Overall, the 393 women with
children reported spending an average of 10 hours per week
doing things for their offspring.
• The women in their forties and fifties spent more time on this
than the women in their sixties, but those oldest women were
still spending six hours per week caring for their children.
Taking Care of Their Grandchildren
• About one third of the women surveyed spent some time taking
care of grandchildren.
• Only about five percent of the women in their forties had
grandchildren, but sixty percent of the women in their fifties and
seventy-seven percent of the sixty-year olds had grandchildren.
•
• Among the 168 women who had grandchildren, they spent an
average of 27.5 hours per week taking care of them.
• About a third of the women in their fifties and sixties said that
the amount of time spent in grandchild care had stayed the
same or increased.
Elder Care
• About three in ten of the women spent some time taking care of
elderly family members, most of whom were parents-in-law or
parents, but some of whom were elderly husbands.
• Overall, women in their forties spent more time doing eldercare
than women in their fifties or sixties.
• Of the 111 women who did some elder care, they averaged 11
hours per week.
• The 247 women with living parents-in-law or parents did an
average of 5 hours per week of elder care.
• Time spent taking care of elders increased or stayed the same
for two out of every ten woman surveyed, with this figure
nearing a third for the women in their forties.
A Different Kind of Daughter-in-Law
While Western popular media posits Chinese daughters-in-law as
sweeping in to save their mothers-in-law from housework and
care-giving from about age 50:
• In those few households in which someone else did most of the
housework, it was actually slightly more likely to be a male
household member than another female, usually the woman’s
husband.
• Fewer and fewer daughters-in-law live with their mothers-in-law
and those who do only do so for a short period of time.
• Increasingly, mothers-in-law are doing housework and childcare
for their daughters-in-law (and in some cases, daughters) into
their seventies or later.
Ma Fengxiang, age 61, urban,
retired garment factory worker
• “In the past, it was the daughter-in-law who served her fatherin-law and mother-in-law. Now it’s reversed. Now the motherin-law takes care of the daughter-in-law. Because the daughter
in law goes out to work. The mother-in-law has time. So the
mother-in-law should cater to her. Now it’s reversed. Now it’s
all like this. It’s all like this. You babysit your grandson. You
serve your son.”
• “In the old society as a daughter-in-law, women suffered once,
and then after Liberation, things were reversed, and they
suffered another time as a mother-in-law. But the kind of
suffering of today’s mothers-in-law is different from the suffering
of daughters-in-law in the past. What mothers-in-law do today
for their daughters-in-law is because they want to do it.”
Ning Guiqin, age 60, rural,
retired schoolteacher
• Since her sons and daughters-in-law all have to work, she does
most of the housework, cooking, sewing, eldercare, and
childcare by herself. In addition to taking care of her five year
old granddaughter and ten year old grandson, she also feeds,
washes, and dresses her husband who is bed-bound due to
severe heart disease and stroke complications.
• “I don’t feel like I’ve gotten old. I’m still capable of everything. I
still don’t want to ask other people to look after us. If someone
else does things for me, then soon I won’t be able to do it
myself any more. As long as I can still do things, I’ll do them. I
don’t need someone else to take care of me. When I do things
now, I still have energy left over when I’m done. I still feel like
doing things.
Women vs. Campaign
• Generation realism vs. Enlightenment idealism
• Gender-sensitive vs. Gender-blind
• Local context vs. Universalism
A Different Kind of
Later-Life Liberation
Envisioned by most,
though not all,
of the women studied
Not This
Primary Notions of
Later Life Romance
• Enjoying being freed from domestic burdens
• Playing, often in local parks
• Traveling, even if only to new parts of Beijing
• Cultivating one’s own health
完
Download

SheaGendHlth_AgingChina112408