HelpAge India is a not-for-profit organization, works to address elderly needs and advocates for their rights, such as right to Universal Pension, quality Healthcare, action against Elder Abuse and many more. It promotes elder friendly policies and their implementation thereof.

Q1. HelpAge India runs several outstanding programs supporting the elderly. In your experience, are there specific challenges that women seniors face that are not faced by men?

Anupama: Older women are at a clear disadvantage as age gets added to the list of impairments that they accumulate over their life course. Apart from our practical experiences on the ground, Longitudinal Aging Survey in India (LASI) data shows that women are twice or three times more disadvantaged as compared to older men when it comes to education, current work status, living arrangement and social support, role in decision making, awareness about welfare schemes and laws. Longevity has added challenges to the gender divide. Women at age 60 have an average life expectancy of 72.3 compared to 69.8 for men. So, widowhood is a possibility of many more women than in younger age groups. This, apart from the ritualistic stigma also increases their vulnerability and social isolation. Some are banished too. Widowers are half in number and face no stigma, though they face social isolation and lack of care giver.

In a pan-India research that HelpAge India conducted in the year 2023, the extent of their economic vulnerability and dependence was starkly reported. 69% didn’t own any assets and 75% did not have any savings, 47% felt secure economically, but 75% of them were dependent on adult children for support. Only 22% owned a smartphone and 60% had never used one. The full report is available on www.helpageindia.org/research

Culturally, women are home-bound in India and that means the information goes to them through gatekeepers in the community and family. This results in exclusion of or limited access to the most significant aspects of financial and healthcare instruments. In most cases, they are not part of the decision-making bodies and forums, thereby limiting their ability to influence the structures and the issues that get attention in the public domain.

Older men suffer from non-communicable diseases, but their health seeking behaviour is better than women’s for reasons of economic and social independence. Traditionally the family had looked after their nutritional and other needs better, so it continues.

According to LASI, the proportion of women over the age of 60 with multi-morbidities (24.6%) is almost double the proportion of women aged 45-59 with two or more health conditions (12.7%). Meanwhile, the healthcare access of the two segments of age remains almost similar, with the proportion of women receiving out-patient care, which is mostly for non-communicable diseases, remains at 25.5% for those aged 45-59, and 29.3% for those above 60 years of age. This highlights a serious challenge in the delivery of healthcare services to women.

Many older women rate their health as poor and experience relatively low mental well-being. One in five older women rated their health to be poor.[1] More than half of all older women indicate signs of mental distress according to measures of subjective well-being. They also carry a higher burden of both acute and chronic morbidity than their male counterparts. Social stigma, financial constraints, and inadequacy or lack of adequate health facilities limit their access to proper treatments.

According to Women’s Health and Wellbeing: Listening across the Lifespan dashboard, 37% of elderly women in India had healthcare services as their top demand, of which 73% of the responses were from rural elderly women.[2] 40% of those who wanted improvements in healthcare system pointed out affordability as the major hurdle for them. They demanded free, affordable or insured healthcare services. 22% of them pointed out the lack of facilities accessible to them, and demanded well-equipped facilities in their nearby locality or proximity.        

Q2. Do you have any programmes that are either directed solely at women or are used primarily by women?

Anupama: As our programmes are designed to cater to the specific needs of disadvantaged older persons, these are however more beneficial to older women. The two most important aspects are outreach, hand-holding and free facilities. 60% of our Mobile Healthcare Unit beneficiaries are women. We have more than 170 Units that cater to about 8 lakh older persons in 2,400 villages in 26 States and UTs  in the country. Apart from free treatment for NCDs, there are provisions for added services like cataract surgeries (more than 15,000), distribution of disability aids and awareness campaigns in the community means that the services are more effective for older women who may not have any other source.

More than 50% of our age care project beneficiaries are older women. Age care services include old age homes (8 homes directly and support for 400), physiotherapy centers (90,000 treatments) and helplines. Old age homes house more women than men as they are more likely to be abandoned or neglected in old age. Our helpline data shows that 30% of callers were older women. 17% compared to 10% of these older women callers were living alone. 7.5% women compared to 3.4% men callers had experienced abuse. The incidence of financial and physical despondence was double that of older men.

Our livelihoods programme called Elders’ Self-help Groups (ESHGs) has an overwhelming number of women members. There are more than 8,000 active groups with more than 1 lakh members that are present in Himachal Pradesh, Bihar, Odisha, West Bengal, Tamil Nadu, Rajasthan and Telangana. The groups are divided into all males, all females and mixed groups. The programme is designed to provide financial, social, digital and healthcare inclusion. These groups are into varied livelihood activities like pickles and jams, liquid manure, cotton weaving, handicrafts, and masala grinding, besides horticulture and pisciculture. Many of them have been provided saplings of fruit trees and seeds for kitchen gardens to also ensure their basic food requirements.

These groups are able to provide the much-needed social cohesion besides digital inclusion and linkages to various government schemes and Aadhar. More than 64 % of beneficiaries in the programme are older women. The ESHGs were able to enroll more than 1,000 members in the PMDISHA programme for digital literacy and most of them were older women. After successfully completing the training, they are able to use the smart devices to link themselves and others to the government schemes.

The healthcare program enabled them to be inoculated with greater ease for the Covid-19 vaccination. Besides, healthcare facilities in these ESHG villages improves their health seeking and awareness about management and prevention of diseases including NCDs.

This programme encourages and provides older women a platform to play a leadership role in villages and states through the village and state-level federations of the ESHGs.

HelpAge India reaches more than 1 lakh urban older persons through 10,000 awareness workshops on digital literacy, laws for protection of older persons, and financial literacy. Our special digital literacy and safety training programme in urban areas also caters to older person’s specific requirements for digital inclusion in almost all states with a special drive in 16 states. Here we face the challenge of inhibition by older women, who are hesitant to come for training in as many numbers as we would like to service. However, we make all efforts to encourage them to join in large numbers.

Q3. Indian families have been changing over time. Many parents have no children or have children who have migrated, either because of work or because of marriage. How does this affect the vulnerability of the older generation? Can you please provide some specific examples?

Anupama: The size of the Indian family has decreased over the years. Data from Fifth National Family Health Survey (NFHS) shows that we have achieved the target of replacement rate and in urban areas we have a negative rate of population growth. We should see this in the context of increasing longevity and changing ethos. Though the data shows that more than 55% of elderly Indians live with the family of their adult children, there has been steady increase in households with an elderly couple living alone and single older persons. The last category is particularly relevant here as we are talking of older women. As stated earlier, these are overwhelmingly single widows.

Migration has impacted older women in two segments: educated middle class and unskilled/ semi-skilled poor families. The former migrates out of urban areas and mega and metro cities, the latter from rural areas. The level of care required, sought and available varies. The former is able to pay for services and also more endowed than the latter. Here, as they have limited income after retirement unless they are retired from government service, their ability to pay for these services is also a big question. They also feel an emotional void and its impact on mental well-being. Women, who have been traditional care-givers, end up in homes or facilities with no family member around. Often, they feel what is called the ‘empty nest syndrome’.

The case of poor older persons left behind in villages is different in so far as community connects are stronger than in urban areas and people help each other to the extent possible. However, there are no services that are available for the poor nor are they able to pay for it. They also may be expected to take care of the agricultural land, if any, and also activities of daily living that may include fetching water and cooking, needing special medical treatment for non-communicable diseases and something as basic as physiotherapy. These services are not available in the villages, so we can very well imagine their ability to access them. In the LASI survey, when asked to rate their health, more women than men rated it as poor.

Q4. How did the Covid-19 pandemic hit the well-being of the elderly in India? Did you notice any differential impact between males and females elderly during this period? Were you able to continue the existing programmes during the Covid-19 pandemic?

Anupama: Covid-19 impacted older person in myriad ways. It made them anxious about their well-being. They were afraid of contracting the diseases, infecting others and the imminent danger of a lonely death. They were isolated, blitzed with an information deluge, not knowing what was authentic, disempowered, as now the younger members of family decided when to go out (not go out at all), to take vaccination or not, when to take it, etc. The world around them changed completed and became virtual, of which they knew next to nothing. Those who were dependent on daily wages suffered the most.

Lockdowns made the entire family stay at home, so families that didn’t have adequate space marginalised the older members. They could not enter the rooms where office meetings and school/college classes were going on. They could not go to the local park to take a morning walk, attend social get-togethers. This impacted their health and mental well-being. They could not consult their doctors for NCDs as all health facilities were repurposed to the pandemic.

The poor older persons who were daily wage workers lost their work opportunity, those from chronically poor households became a burden on the family whose ability to earn shrank suddenly with no information or expectation of restarting anytime soon. The insecurity led to older person being pushed further to the margins or doing it voluntarily.

There were no specific schemes for older persons except vaccination. Though many were pushed far below the poverty line, the benefits under social security schemes continued as before. Except for Kerala that made special provisions to reach healthcare to older persons, they continued to be neglected. You may like to see the detailed report of HelpAge India, The Silent Tormentor: COVID-19 and the Elderly on www.helpageindia.org/research

Elderly women living alone suffered more as expected; even those from well-to-do segments were completely dependent on others for accessing basic services like groceries, medicines, etc. as they were not digitally connected. Besides, suffering the morbid fear of being alone.

The efforts of HelpAge India and some other voluntary organisations in nine states and Union Territories in reaching services to older persons during the pandemic is documented in the UNFPA’s India Ageing Report 2023. The response ranged from providing cooked food to registering and facilitation of Covid-19 vaccination at home.

Q5. What do you see as major policy actions that the state can take to support our senior citizens, particularly women?

As demographers have forecast, feminisation of the ageing population is inevitable; we should start preparing for the situation before we arrive at it. Three important architectural shifts required are:

 

[1] Giridhar, G., et al. “Older Women in India: Economic, Social, and Health Concerns.” UNFPA, Thematic Paper 2. https://india.unfpa.org/sites/default/files/pub-pdf/ThematicPaper2-Womenandageing.pdf

[2] Women’s Health and Wellbeing: Listening Across the Lifespan. https://explore.whiteribbonalliance.org/en/healthwellbeing

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Anupama Datta has been working with HelpAge India for the last 20 years in Policy research and advocacy department. The major thrust of work is to research and mainstream the issues concerning older persons. The findings of the major research projects on elder abuse, impact of disasters on elderly, social security are used to sensitize the policy makers and legislators to take note and take appropriate action to deal with the issues. The findings are also used to help the older person articulate and aggregate their interest and put forth the relevant demands on to the political system. Editor of HelpAge India Research and Development Journal. Published 20 articles on ageing in various books and journals.