Saturday, December 19, 2020

Older Women And Mental Health

 - Nighat Gandhi 

Image credit Guardian

Let’s compare 2 case scenarios. Bothare older women with challenging life situations:

1.        A retired University professor in her 60s with a comfortable pension,  unmarried, living alone, owns her home, has poor vision and other health problems, has access to reliable health care services, has few friends and relatives.

Mental Health Challenges: loneliness, depression, anxiety, limited mobility, by poor health, limited opportunities for travel and recreation.

2.       A homeless woman in her 60s, widowed, homeless, has worked previously as domestic worker, has primary school education, is hard of hearing, has impaired vision, has a married daughter but son-in-law doesn’t let her live with them.

Mental Health Challenges: loneliness, depression, financial anxiety, restlessness, poor emotional stability, lack of income, no housing, poor hearing and vision, no friends, no access to medical care, no opportunity for travel or recreation.

Whose shoes would you rather be in?  The retired professor’s or the homeless widow’s? Or neither?

Why does Age matter?

Aging is a biological and a social construct. Socio-economic status, living arrangements, access to affordable medical care, social contacts and family support, are all determining factors in how well or badly a person will age. For the sake of discussion, let’s define older population aspersons over 60.  According to a WHO (World Health Organization) report[1]among the older population, the proportion of older women is increasing rapidly and by 2050 (that’s just in 30 years!) there will be a billion women aged 60+.  That means 1000,000,000 older women!The majority of the world’s older population (i.e. 80%) is living in the developing world according to the report.


In India too, life expectancy is increasing steadily. At present it is 69 years for women and 66 years for men. It is estimated that by 2050, 20% of India’s population will be 60+ persons. Every fifth person will be 60+. The more startling fact is that because of women’s slightly higher life expectancy, of this 20% older population, women will form the majority. According to the 2011 census data, while the overall sex ratio is in favour of men (940 women: 1000 men), by age 60+ the sex ratio tilts in favour of women (1022 women: 1000 men) and by age 80+, the sex ratio tilts drastically in women’s favour: 1980 women: 1000 men[2]. The fastest growing group among older women is the 80+ group. There are almost twice as many women aged 80+ as men. And, the majority of the older population is living in rural areas.

Does it make sense to not take into account the mental and emotional well-being of such a statistically significant group?



The stereotype of the older woman in our cultural imagination is still that of the grandmother. She can be a doting grandma, or a whining and nagging grandma.Other prevailing stereotypes about older people also abound: socially and politically conservative, limited interests and activities, excessively religious, progressing towards senility, pessimistic, unattractive, and definitely without any sexual desires. With such an unappealing image of the older woman, it is easier to dismiss her mental health concerns such as depression, anxiety, sleeplessness, and tendency to complain or repeat herself as inevitable and unpleasant consequences of aging.


Factors affecting the mental and emotional well-being of older women:

In a youth-obsessed culture it is the younger generation that matters. Especially in urban areas, the youth finds less value in interacting with older generation. Many older women are likely to feel socially marginalized, may suffer domestic violence and abuse when living with their adult children and grandchildren.  In addition, if they happen to be underprivileged economically, they can also face risk of homelessness and destitution.  Since most women marry men older than themselves, and men’s average life expectancy is less than that of women, most married older women are likely to spend many years as widows.And since majority of older women live in rural areas, they are unlikely to have heldpaid employment that comes with retirement benefits or pensions.Thus financial insecurity adds to women’s woes in old age.With limited income, threat of isolation and/or destitution, inadequate medical care, health and emotional concerns of the older woman are likely to go unaddressed.

The average literacy rate among older women is 28%, which is half that of older men. And this already low percentage drops even lower for older rural women. So one in three older women living in rural areas is working to support or supplement family income, doing mostly marginal kinds of work[3].


According to the WHO report on aging women and their health, “while women do not experience more mental illness than men, they are more prone to certain types of disorders, including depression and anxiety. Studies have shown that the elevated risk for depression in women is at least partly accounted for by negative attitudes towards them, lack of acknowledgement for their work, fewer opportunities in education and employment, and greater risk of domestic violence. The risk of mental illness is also associated with indicators of poverty, including low levels of education and, in some studies, with poor housing and low-income. Women and men are equally likely to develop Alzheimer’s disease and other dementias in old age; however, the prevalence is higher among women because they live longer. The emotional, social and financial costs of Alzheimer disease to families and societies are already massive and will continue to increase.”

Given such a toxic mix of emotional, social, financial and physical health burdens, anybody could lose their emotional and mental balance. Add to all this the natural infirmities of old age, and the poor mental health of older women is not such a hard-to-explain phenomenon.



So, what’s the Solution?

The long term solution is to take a life-course approach, starting even before birth of a girl-child.


·         Value  birth of daughters as much as that of sons

·         Ensure girls’ proper nutrition, and education at primary and secondary levels

·         Ensure paid employment for women, especially wages for housework and family farm work

·         Ensure women’s right to inherit parental and marital property

·         Ensure that  women have access to affordable or free health care, especially  in old age

·         Build more helplines and geriatric counseling services with trained counselors

·         Provide support to older women and widows who live alone

·         Provide safe housing for older women

·         Build women’s community centres for social interactions and recreation

·         Provide psychiatric and counseling services for older women

·         Promote cultural values of nurturing, caring, and care-workas social responsibility for both men and women equally in the family and educational institutions

·         Make a commitment to promote socio-political change that empowers the older woman.


Easier listed than done!  So, what’s doable in the short-term?

       Understand that a woman’s well-being is shaped by her social, cultural, economic, political, and historical contexts.

       Treat older women as valuable persons deserving respect and dignity.

The reason I highlighted the point about promoting nurturing, caring and care-work equally among men and women is because we live in a culture where care work is performed primarily by women. Carol Gilligan[4] questioned the cultural privileging of masculine values, such as autonomy, decision-making, rationality, individuality, self-interest, efficiency, competence. Men are respected for being more assertive, focused, competitive, action-oriented, ambitious and driven to achieve material success. Women are perceived as having a broad awareness, more empathetic, nurturing, compassionate, process-oriented, focused on personal relations and concern for justice.  Women are not only focused on the results, but also on the process.

Traditionally, masculine values tend to be valued more over feminine values such as empathy, emotion, relatedness, caring and care work such as taking care of children, the ill, and the elderly. These caring and nurturing activities, mostly performed by women, areunderpaid or unpaid, undervalued or devalued. Gilligan proposed a return to a so-called feminine ethics of care in her book way back in the 80’s. Care-work has to be promoted as valuable, gender-neutral work which men too must learn to perform equally well. This redistribution of care work and cultural transformation in gender roles is not just an idealistic feminist demand, but a crucial necessity if the well-being of the steadily aging world population is of concern.


If the state and society could implement even some of the above measures, older women would feel valued, and enjoy a more joyous, dignified, and emotionally fulfilling aging process. Mental health cannot be maintained in isolation from one’s socio-cultural, political and economic context. A toxic, unsupportive living environment will not produce balanced, healthy individuals, regardless of age.  The vulnerabilities that compromise mental well-being of children and younger adults, become all the more disadvantageous in old age.


The unfortunate reality is that given the present state of uncaring, most older women in the subcontinent cannot expect to live to enjoy a mentally and emotionally balanced, healthy old age.





[1] Women, Ageing and Health: A Framework for Action

[2]A note on older women in India.

[3]Elderly in India (2016).

[4]Carol Gilligan: In a Different Voice: Psychological Theory and Women’s Development. Harvard University Press, (1982).


Unknown said...

सबसे पहले इस विषय पर लिखने का लेखक को और स्त्री मुक्ति का बहुत शुक्रिया । आखिरी पैरा हमारे समाज का रास्ता होना चाहिए ।

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