Changing family structures and self-rated health of India's older population (1995-96 to 2014).

Judith Lieber,Lynda Clarke,Poppy Alice Carson Mallinson,Sanjay Kinra,Ian M Timæus

doi:10.1016/j.ssmph.2020.100572

Abstract

A common view within academia and Indian society is that older Indians are cared for by their families less than in the past. Children are a key source of support in later life and alternatives are limited, therefore declining fertility appears to corroborate this. However, the situation may be more complex. Having many children may be physiologically burdensome for women, sons and daughters have distinct care roles, social trends could affect support provision, and spouses also provide support. We assessed whether the changing structure of families has negatively affected health of the older population using three cross-sectional and nationally representative surveys of India's 60-plus population (1995–96, 2004 and 2014). We described changes in self-rated health and family structure (number of children, sons, and daughters, and marital status) and, using ordinal regression modelling, determined the association between family structure and self-rated health, stratified by survey year and gender. Our results indicate that family structure changes that occurred between 1995-96 and 2014 were largely associated with better health. Though family sizes declined, there were no health gains from having more than two children. In fact, having many children (particularly daughters) was associated with worse health for both men and women. There was some evidence that being sonless or childless was associated with worse health, but it remained rare to not have a son or child. Being currently married was associated with better health and became more common over the inter-survey period. Although our results suggest that demographic trends have not adversely affected health of the older population thus far, we propose that the largest changes in family structure are yet to come. The support available in coming years (and potential health impact) will rely on flexibility of the current system.

Highlights

The Indian 60-plus population is growing rapidly and is predicted to triple to 300 million by 2050 (Dey, 2016)
It has been theorised that having multiple children provided parents with survival benefits in historical populations as children were necessary for support at older ages, while large family sizes in contemporary pop ulations are more likely to result in financial strain and stress (Hurt et al, 2006)
In an effort to understand whether demographic trends have adversely impacted health of the older Indian population, this paper described how family structures have changed, and examined the link between family structure and health

Summary

Introduction

The Indian 60-plus population is growing rapidly and is predicted to triple to 300 million by 2050 (Dey, 2016). A common perception within academia and Indian society is that older people are cared for by their relatives less than in previous years, due to social (e.g. perceived rise in individualistic attitudes) and demographic (e.g. household nuclearisa tion) changes (Cohen, 1998; Kumari Bhat & Dhruvarajan, 2002; Lamb, 2000). A meta-analysis of historical populations (and populations of less economically developed countries) demonstrates declining mortality for women with increasing numbers of births (Hurt, Ronsmans, & Thomas, 2006) Children can both positively and negatively influence their par ents’ health over the lifecourse, and these influences vary by context, thereby underscoring these differing relationships. It has been theorised that having multiple children provided parents with survival benefits in historical populations as children were necessary for support at older ages, while large family sizes in contemporary pop ulations are more likely to result in financial strain and stress (Hurt et al, 2006)

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Conclusion