South Asia

SOUTH ASIA

South Asia is the region approximately encompassed in the Indian subcontinent. It includes the modern nations of Bangladesh, India, Nepal, Pakistan, and Sri Lanka. Though these countries are very diverse in religion, language, customs, food, dress, political systems, and other details, they share broad historical and cultural similarities.

Trends in population aging

Until recently most South Asian populations were marked by high fertility and mortality, and therefore a younger age structure. In the 1950s fertility across South Asia was uniformly high (see Table 1). By 2000 Sri Lanka, India, and Bangladesh had markedly lower fertility. By 2050 all countries are projected to reach replacement level fertility. The decrease in mortality is reflected in increasing life expectancy at birth, with Sri Lanka in the lead. In the 1950s the South Asian countries under consideration had shorter life spans for women than for men (contrary to global mortality norms), for a variety of reasons ranging from discrimination against girl children to high maternal mortality rates. By 2000 female life expectancy at birth equaled or exceeded that of males in the countries being studied, except Nepal, reflecting amelioration of the female mortality disadvantage.

Concerns regarding the aging population are therefore coming to the forefront in South Asia, though they have been less documented and explored there than in other parts of the world where population aging has advanced further.

South Asian aging in regional perspective. Asia currently accounts for approximately 6 percent of the global elderly population (those age sixty-five and above). However, the proportion of old varies across its regions. In 2000 in East Asia, almost 8 percent of the population was age sixty-five and over. South Asia, Southeast Asia, and West Asia each had approximately 5 percent. In 2050 the figures are expected to be one in five in East Asia, one in seven in South Asia and Southeast Asia, and one in eight in West Asia (United Nations, 1998).

From 2000 on, India is expected to have the greatest absolute number of elderly persons, and in South Asia the highest proportion of seniors is projected to be in Sri Lanka (see Table 2).

Measures of population aging. The median age (the age that divides the population into equal halves) also illustrates the changing age structure of a population. The median age in the countries being considered will rise into the thirties by 2050 (see Table 3).

Living arrangements

Familial coresidence remains the norm for most seniors in South Asia. The availability of extrafamilial facilities for elderly persons is minimal, and social norms strongly favor familial coresidence and care. Variations in family and kinship structures in South Asia thus illustrate living arrangements and support for seniors.

Broadly speaking, South Asian kinship systems range from exogamous, patrilineal, and patrilocal systems in the northern half of the sub-continent, to endogamous, matrilineal, and matrilocal systems in many groups in southern India and Sri Lanka. These diverse systems all imply coresidence in joint family groups, but have different implications for elderly men and women. For example, under patrilineal/ patrilocal systems, elderly men, as the senior male in the household, can expect lifelong residential support and care, usually from married sons. However, such support is not universal, varying by socioeconomic status, landholding, presence of spouse, and number of surviving sons. Elderly women, particularly widows with no son, are more vulnerable under patrilineal/ patrilocal systems. While women have varying inheritance and property rights, in practice these are dependent upon the goodwill of male kin (Agarwal). The desire to bear several sons, in order to ensure that at least one will survive to adulthood and provide old-age care, underpins the persistent high fertility in South Asia.

Elderly women in groups that practiced matrilineal inheritance/matrilocal residence usually enjoyed considerable old-age security, because they resided with their married daughters and property was inherited in the female line. However, social and legal changes in the twentieth century dismantled these arrangements and introduced patrilineal inheritance and nuclear residence patterns. This has manifested in the hitherto unheard-of phenomenon of destitute elderly women in the state of Kerala in southwestern India, a region usually noted for the high status of women.

Before longevity increased, there was comparatively less chance that a husband and wife would survive to see all their grandchildren. Now people live longer on average, which implies a prolonged period of multigenerational family life. Declining fertility means fewer descendants to provide support. Other important changes influencing the living conditions of seniors include geographical mobility of the working-age population, increasing numbers of women working outside the household, and a greater move toward the nuclear family with emphasis on providing for children’s nurture, education, and careers. Working-age adults with young children and elderly parents thus encounter increasing difficulties. They face economic hardship when allocating resources between support of their elderly relatives and financing of their own advancement and the education of their children, and all generations face psychological stress. Where the working-age generation has migrated for employment, financial hardships may decrease, but at the cost of loneliness or isolation of the seniors.

One study in southern India (Irudaya Rajan et al.) suggests that only 46 percent of elders (and only 25 percent of female elders) who stated a preference to stay with their children during old age were actually able to do so. Indian National Sample Survey data for 1991 show that elderly persons express an increasing preference over time to stay in old age homes. The number of old age homes in India increased from 29 before 1901 to 329 after 1976; 57 percent of them were located in southern India. These facilities are far fewer than the number needed to meet the potential demand.

Widowhood. South Asian women are more at risk of widowhood than men, partly because of early and nearly universal marriage of younger women to older men. Though until recently the life expectancy at birth was lower for most South Asian women than for men, the risk of widowhood still remains substantially higher for women, and life expectancy is projected to increase more for women. This means that many more women than men will be widowed, for several years, in these populations. There are region-, religion-, and caste-based restrictions on widow remarriage, ranging from enforced leviratic unions to bans on remarriage. Widowed men usually do not face these restrictions.

There appear to be broad similarities in the socioeconomic situation of widows in Pakistan, northern India, and Bangladesh. Widows in northern India suffer from economic deprivation, social isolation, and higher morbidity and mortality rates, compared with married women in the same age groups (Chen and Dreze).

Increasing age brings the growing risk of widowhood and of female household headship, though the proportion of female-headed households in South Asia is much lower than elsewhere in Asia. Forty-seven percent of the widows in one study resided in households headed by themselves (Chen and Dreze). Evidence for Bangladesh suggests that 12 percent of widows lived alone (Chen and Dreze). Members of female-headed households are more at risk of poverty because of the absence of a male earner. Men usually hold the titles to productive assets, command higher wages than women, and are more likely to be economically active. Female-headed households tend to be smaller but have a higher proportion of dependents than households headed by males. Members of such households are less likely to be beneficiaries of government programs designed to help the poor (United Nations, 1994).

Economic status and retirement patterns

In most South Asian countries only the very small proportion of the population that belongs to the salaried class (overwhelmingly urban and male) has access to pensions and social security after retirement. In many cases widows can draw a deceased husband’s pension. Rural women in particular are often not aware of their entitlements or are not easily able to keep track of the rules and regulations that govern their receipt. The bulk of the population depends on familial support or personal savings, or simply keeps working as long as possible. The formal age of retirement for the salaried class in most South Asian countries ranges from fifty-five to sixty years. Nevertheless, work participation among those age sixty-five and above for the South Asian countries being studied (except Sri Lanka) is high, ranging from almost one-third to almost one-half, and is projected to decline very little by 2050 (see Table 4).

Pension and social security programs in South Asia. Old age pensions and other forms of social security are less developed programs in most of South Asia. As the population ages, the issue of financing social security will grow more pressing. In 1989 social security expenditures accounted, on average, for approximately 0.9 percent of gross domestic product in Bangladesh, India, Pakistan, and Sri Lanka; by 1992 the average had increased to 1.6 percent. For instance, the percentage was 1.8 for India and 4.7 percent for Sri Lanka (International Labour Office).

Sex ratios in the elderly population

The male-dominant sex ratios in the age group above sixty-five in some South Asian countries are counter to the global norm of female-dominant sex ratios among older age groups. Male-dominant sex ratios were observed in 2000 for those age sixty-five and above in Bangladesh and India (see Table 5). This indicates a cumulative female mortality disadvantage over the life course, though age-specific death rates are higher for men than for women in India after about age thirty-five. Nepal, Pakistan and Sri Lanka exhibit ‘‘normal’’ female-dominant sex ratios among the elderly age group. By 2025 only Bangladesh is projected to have a male-dominant ratio. Other countries’ ratios are expected to decline steeply (plunging to 72.2 in Sri Lanka), reflecting amelioration of the female mortality disadvantage.

Emerging health concerns

Increasing longevity implies a rising burden of degenerative disease that characterizes an elderly population, but health care systems across most of South Asia are designed to cope with infectious disease control and maternal/child health issues that face a younger population. Preventive or palliative care for chronic conditions among elders is lacking. The concept of ‘‘healthy aging’’ has yet to be widely accepted. Individuals expect to ‘‘suffer various aches and pains’’ as they grow older, and may not seek treatment for even quite serious conditions. Health practitioners also tend to view chronic conditions as a natural consequence of aging rather than as diseases to be prevented or treated.

Above age thirty-five, Indian men have significantly shorter life expectancies than women, and the age-specific death rates are about twice those for women above thirty-five (review in Basu). High levels of adult male mortality may be partly attributed to tuberculosis and to aggravating lifestyle factors, such as tobacco and alcohol consumption. Increasing rates of cardiovascular disease can also be attributed to lifestyle factors. For women, increasing rates of cervical and breast cancer are noted. Indian women develop osteoporosis (and consequent hip fractures, therefore experiencing premature death) ten to fifteen years earlier than their counterparts elsewhere. Indian men also have a higher risk of hip fracture than do other men (Gupta).

Conclusion

South Asian countries need to document and face the challenges posed by the increasingly elderly populations. Timely collection and release of high-quality data should be prioritized to facilitate the planning process. Social security schemes need to be expanded to cover vulnerable segments of the population. Familial support systems also should be strengthened by various means. Private and nonprofit sector efforts must be developed to supplement those of the over-burdened public sector. At the same time elements of Asian culture that respect elders and view old age as a time of wisdom should not be lost. That is, making adequate provision for seniors should not be accompanied by approaches or assumptions that view old age as a looming problem or the proportion of elders in society as a burden. A social construction of the aging process as inherently problematic serves to legitimize a transfer of responsibility for elders from the state to individual older persons (Estes et al.). For each country or subgroup in South Asia, an appropriate balance needs to be developed between individual and public provision for the growing elderly population.

S. Sudha S. Irudaya Rajan

See also China; Japan; Population Aging.

BIBLIOGRAPHY

Agarwal, B. A Field of One’s Own: Gender and Land Rights in South Asia. Cambridge: Cambridge University Press, 1994.

Basu, A. M. ‘‘Women’s Roles and the Gender Gap in Health and Survival.’’ In Women’s Health in India: Risk and Vulnerability. Edited by Monica Das Gupta, L. C. Chen, and T. N. Krishnan. Bombay: Oxford University Press, 1995. Pages 153–174.

Chen, M. A., and Dreze, J. ‘‘Widowhood and Well Being in Rural North India.’’ In Womens Health in India: Risk and Vulnerability. Edited by M. Das Gupta, L. C. Chen, and T. N. Krishnan. Bombay: Oxford University Press, 1995. Pages 245–288.

Estes, C. L.; Linkins, K. W.; and Binney, E. A. ‘‘The Political Economy of Aging.’’ In Handbook of Aging and the Social Sciences, 4th ed. Edited by Robert H. Binstock and Linda K. George. San Diego, Calif.: Academic Press, 1996. Pages 346–361.

Gupta, A. ‘‘Osteoporosis in India: the Nutritional Hypothesis.’’ National Medicine Journal of India 9, no. 6 (1996): 268–274.

International Labour Office. World Labour Report 2000. Geneva: United Nations, 2000.

Irudaya Rajan, S.; Mishra, U. S.; and Sarma, P. S. ‘‘Living Arrangements among the Indian Elderly.’’ In Hong Kong Journal of Gerontology 9, no. 2 (1995): 20–28.

Murray, C. J. L., and Lopez, A. D. Global Health Statistics: A Compendium of Incidence, Prevalence, and Mortality Estimates for over 200 Conditions. Cambridge, Mass.: Harvard University Press, 1996.

Rama Rao, S., and Townsend, J. ‘‘Health Needs of Elderly Women: An Emerging Issue.’’ In Gender, Population and Development. Edited by Maithreyi Krishnaraj, Ratna M. Sudarshan, and Abusaleh Shariff. Delhi: Oxford University Press, 1998.

United Nations. Demographic Yearbook Special Issue: Population Ageing and the Situation of Elderly Persons. New York: United Nations, 1991. Special Topic Table 4. Page 394.

United Nations. Women in Asia and the Pacific: 1985–1993. New York: United Nations, 1994.

United Nations. World Population Prospects. New York: Population Division, Department of Economic and Social Affairs, 1998.

U.S. Census Bureau. ‘‘International Data Base Summary Demographic Data.’’ Available on the World Wide Web at www.census.gov