Image Credits: Ministry of Information & Broadcasting (GODL-India), GODL-India via Wikimedia Commons
People aged 60 years and above currently constitute 6.4% of India’s total population. The number is expected to rise to 13.8% over the next 30 years. Kerala is an outlier among other states, where 20% will be aged 60 and above in just five years. Among the older population in the state, women outnumber men, and 57% of the older women are widows. A research team led by the Health Research Institute, University of Canberra, Australia, ventured to understand the different factors influencing healthcare access for older widows living in Kerala. Their findings have been published in the Ageing & Society Journal.
The global trend of women outliving men termed the ‘feminisation of ageing’, has been identified as a challenge to healthcare systems worldwide. The chances of falling ill also increase with age. Along with this, older widows tend to face financial challenges, stigmatisation, and isolation, lowering their access to healthcare. Moreover, healthcare services are often not designed to cater to the needs of older women in the first place.
In this study, the researchers investigated the factors influencing the access to healthcare services for older widows in Kerala. They conducted the study in the Kottayam district of Kerala. More than 70% of the 20 lakh people inhabiting the Kottayam district live in rural areas. Around 16% of the total population is above the age of 60. The research was conducted in healthcare centres, homes of older widows, and MGNREGA (Mahatma Gandhi National Rural Employment Guarantee Act) work sites where older widows worked.
The researchers interviewed widows in the Above Poverty Line (APL) category, who named family and pension schemes their primary finance sources. They also interviewed women in the Below Poverty Line (BPL) category, who relied on the state government’s widow pension scheme and income gained from MGNREGA work. Diabetes, hypertension, cancer, cardiovascular illnesses and poor hearing/eyesight were common health problems they faced.
Loneliness emerged as a prominent problem faced by these women. Many of them were a part of large joint family households, taking care of their parents and grandparents during their younger years. However, the rise in migration of younger generations for better work opportunities and the general transition to smaller family structures has left the same women living alone in their houses. Most of them do not have children and grandchildren to provide care or companionship for them. The arising loneliness leads to depression in many women, with detrimental effects like lowering their motivation to go to hospitals or seek treatment for their ailments until the illness reaches a severe, unmanageable stage.
While healthcare workers were aware of this issue, the current healthcare system is not equipped or designed to address such mental health concerns for older adults in Kerala. Although admission to institutional care homes was a possible solution, many women expressed a strong desire to live in their own homes and maintain a sense of independence and control over their lives.
In rural areas, older women are often part of different social networks that provide relief from their loneliness and even strengthen their access and utilisation of healthcare services. These social networks include neighbours, religious congregations, members of MGNREGA worksites, and healthcare workers. Whether neighbours help them travel to clinics and buy medications or the women participate in neighbourhood celebrations, healthcare workers remarked that these social networks effectively enabled healthcare access and greater wellbeing in older widows.
The researchers observed acts of solidarity by the community, such as shopkeepers allowing older widows to delay their payments until they received their pension payments and remuneration provided for MNREGA work, even if they do not contribute much. This sense of solidarity and the presence of social networks is found predominantly in rural areas. Also, the decentralised panchayat raj system in rural areas has information and records of the number of older adults in local areas, making it easier for ASHAs (Accredited Social Health Activists) and other community healthcare workers to identify and help older widows.
On the other hand, there is a lack of information on older widows in urban localities. Urban apartments have tight security systems, hindering ASHAs and the public health system to reach out to the older widows. Additionally, the apartments are usually isolated, with minimal interaction between the older women and their neighbours. There is little opportunity for social networks to form and offer support to the older widows in urban areas. Thus, even though older widows in cities have better financial stability than widows in rural areas, they face greater challenges in accessing healthcare services.
“Economic status is generally taken as a marker of vulnerability. However, this can be misleading. We found that social connections and networks were far more important than economic status,” says Mr Sunil George, the lead author of the study. They found that social networks seemed to be associated with higher healthcare access in both urban and rural areas among the participants of this study.
Older widows in India find themselves in a vulnerable state, with poorer health and financial stability than married women and lower healthcare access and utilisation. This study has highlighted the need to address the looming concern of mental health and other barriers to accessing healthcare. Strong social networks act as a saving grace for older widows, where even financial support cannot remedy the challenges caused by isolation.
When asked about possible solutions, Mr George says, “it is essential that we develop a social protection policy that incentivises social networks among and for the elderly.” He adds that the healthcare system can work with social organisations, local clubs, faith-based groups and other voluntary agencies to reach out to isolated older widows in urban areas. The need is a culturally sensitive and decentralised geriatric healthcare system with a focus at the ward level in urban centres and the sub-centre level in rural areas. Providing mental health and counselling services for older widows would also be a crucial step in enhancing their lives.
This article has been run past the researchers, whose work is covered, to ensure accuracy.