Gender, Health, and Aging in China

1. Gender, Health, and Aging in China Jeanne Shea Associate Professor University of Vermont Jeanne.Shea@uvm.edu

2. Outline Basic demographic and public health situation My related research on midlife Chinese women

3. Demographic and Public Health Situation

4. China’s Population • Overall population • Mid 2008 1,324,708,000 • Mid 2025 (projected) 1,476,000,000 • Mid 2050 (projected) 1,437,000,000 • Decline in fertility and mortality • Birth Rate   12/1000 (16,029,000 per year) • TFR 1.6 • Death Rate 7/1000 (9,180,000 per year) • Natural Increase 0.5% (6,849,000 per year) (Population Reference Bureau 2008)

5. An Aging Population • More than 10% of population is now age 60 or older • Age <15 256,993,000 (19%) • Age 15-64 967,036,840 (73%) • Age 65+ 107,301,000 (8%) • Life Expectancy at Birth • Both Sexes  73 years • Males  71 years • Females   75 years (Population Reference Bureau 2008)

6. Percentage Age 65+, 1950-2050 Toshiko Kaneda 2008, www.prb.org/Articles/2006/ChinasConcernOverPopulationAgingand Health.aspx, Source: World Population Prospects: The 2004 Revision (2005).

7. Population Pyramids20002050 Toshiko Kaneda 2008, www.prb.org/Articles/2006/ChinasConcernOverPopulationAgingand Health.aspx, Source: World Population Prospects: The 2004 Revision (2005).

8. 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

9. 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)

10. 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

11. Research on Midlife Chinese Women in Beijing, 1992-present Jeanne L. Shea Associate Professor University of Vermont

12. 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

15. 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

18. 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?

19. Cross-Cultural Comparison of Symptom-Reporting

20. 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.

21. 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)

22. 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, anti-Rightist campaign, GLF, Cultural Revolution -mother-in-law/daughter-in-law issues -not prepared for change to market economy

23. Inspired Questions About:Chinese Women’s Experiences of Romance, Sex, and Marriage in Later Life

24. 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

30. Campaign against traditional views “feudal superstition” Confucian conservatism Daoist alchemy

31. Campaign for modern perspectives communist ethics scientific knowledge cosmopolitan views

32. Media Representations • Tradition and the Chinese past • Chinese people in later life • Middle-aged and old women • Prime victims • Prime perpetrators

33. Enlightenment  Liberation of Behavior 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

34. 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

36. Women’s Views and Behaviors

37. Chinese Women, Age 40-65, N=399

38. 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

39. Sexual Activity, Older Chinese Women

40. 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

41. 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

42. Sexual Activity and Menopause/Aging Info. Exposure

43. Sexual Activity and Rural/Urban Residency(Married Women Living With Spouse)

44. Sexual Activity and Education(Married Women Living With Spouse)

45. Sexual Activity and Household Composition(Married Women Living With Spouse)

46. 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

47. 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

48. 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

49. 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.

50. 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.