HEALTH CHALLENGES OF OLDER WOMEN AND THEIR POSSIBLE REDRESSAL MECHANISMS
Society does recognise the special challenges of older women in the form of their widow hood, poverty, social isolation and special health and disability issues. Response of the State and Society has been a mixed one ranging from a positive one to a state of indifference and sometimes even a discriminatory one. Current resources for older women in the existing policy framework indicate certain positive intents as well as missing links for this segment of senior citizens.
Positive intents
National policy for older persons declared in 1999 stated that older widows are 4 times more frequent when compared to older widowers and called for a special attention to older women particularly the widows. The policy renamed as National policy for Senior Citizens as a revised draft in 2011 also recognised older women as one of the three special groups requiring special attention, the other two groups being the 80 + senior citizens and the rural elderly. National health policy of 2017 also addressed gender health inequalities through gender mainstreaming and enhanced provisions for reproductive morbidities and health needs of women beyond reproductive age i.e. 40+ and that the public hospitals to be more women friendly and that the victims of gender-based violence should be provided free treatment at both public as well as private sectors. A draft prepared by the Government of India for National commission for senior citizens in 2014 and another draft prepared by Delhi Government for the State commission for senior citizens in 2017 also mentioned about gender inequalities as one of their functional areas. Moreover, Union budget for the first time introduced the concept of gender budgeting in the year 2005-2006. Ministry of Women and Child Development (MOW&CD) is the nodal ministry for this gender budgeting and now almost all the Ministries are practising gender budgeting year after year. Ministry of Social Justice and Empowerment (MOSJE) which is the nodal ministry for senior citizens utilisesthis gender budgeting for two types of schemes, those with 100% provision for women and those with at least 30% of provision for women.
Following 5 Government schemes operate for older women and widows.
1.MOSJE under its Integrated program for senior citizens provides grant in aid to NonGovernment Organisations, Panchayat Raj Institutions and Voluntary Organisations for maintaining senior citizens homes for 50 elderly widows. These elderly widows are provided food, care, shelter and recreational facilities and also include those under the Sansad Adarsh Gram Yojna (SAGI).
2.MOSJE also has an initiative for Welfare of elderly widows which is funded by Senior Citizens Welfare Fund (SCWF) established since 2016 and this Fund provides financial support not only for initiatives of this Ministry but also of other Ministries as well through an Inter-Ministerial Committee. We will divert here a little bit to give a brief account about this important SCWF. Senior citizens fund was set up in the year 2016 for providing financial assistance to sectors that provide financial security for Senior citizens healthcare and nutrition (Portion Abhiyan which is about the supply of hot cook food for elderly) and for Welfare of elderly widows. The fund represents the unclaimed money of senior citizens lying in Government Securities for at least 7 years. Disbursement of this Fund is by the Inter-Ministerial Committee comprising of Ministries of Finance, Health, Rural Development, Housing and Urban Development and Ministry of Labour and Employment. Specifically, The Fund finances following schemes, namely Livelihood and skills initiative for senior citizens under AGRASR that is self-help groups funding and SACRED which is meant for reemployment of senior citizens, Promoting silver economy that is launching startups for senior citizens products, Channelizing CSR funds for elderly care, Awareness and capacity building through media and training etc., LASI and Senior citizens health Insurance scheme meant for toping up for the RSBY scheme (2021-2022) of the Ministry of Health and Family Welfare and Procuring Golf carts at Indian airports under the aegis of Ministry of Civil Aviation.
3. National social assistance program (NSAP) has the provision to cover widows of any age but they must be from the BPL category. There are two other components of NSAP and these are Indira Gandhi Old Age Pension Scheme and the Annapurna scheme. Financial assistance runs from Rupees 200-500 per month. Scheme is administered by Ministry of Rural Development.
4. Under Antodaya Anna Yojna (AAY) scheme, rice and wheat are provided at a heavily subsidized rate (Rs. 3/- and 2/- per Kg respectively) to homes headed by widows or by terminally ill/disabled/senior citizens with no assured means of maintenance or societal support. This scheme started in the year 2000 and is administered by Ministry of Consumer Affairs, Food and Public Distribution.
5. Ministry of Women and Child Development launched in 2016 and inaugurated in 2018 a scheme in the form of a large old age home for widows of any age at Vrindavan. It was built at a cost of Rs. 57.48 crores on a 1.4 hectares area of land and was built by NBCC in consultation with HelpAge India. This is a 4 story building with 100 rooms and has a capacity for 1000 widows.
The Missing links
In spite of larger share of older women than older men among senior citizens and greater health and socioeconomic challenges faced by older women, most of our policy and legal framework is gender neutral. Specific deficiencies related to older women are 1. Awareness about legal remedies available for older women to address their difficulties is very low in the community. This applies to Maintenance and Welfare of Parents and Senior Citizens Act (MWPSC Act) 2007 as well as to National Legal Services Authority provisions concerning senior citizens. Impact of these legal instruments or of the Rights protective agencies on the life of older women remains largely invisible. Human right protection for older women particularly for those suffering from dementia also need more attention. As per government document of 2016 on the situation analysis for elderly people, 65% of these persons are dependent on others for their daily maintenance and that the situation of older women in matters of dependency Is even more precarious, yet the MWPSC Act continues to 3 be gender neutral. In year 2019 certain well thought of amendments (as per next shaded paragraph) were suggested and accordingly an amendment Bill was introduced in the Lok Sabha. Any amendment focussing on older women is not visible. it is hoped if any future amendment is suggested there will be something to look forward in favour of elderly women. Amendments include ensuing better physical and mental well-being, inclusion of daughter in law and son in law under children categories, improved time limit for case disposal like from the date of application rather than the date of service of notice to respondents, earlier disposal of cases for 80+, improved regulation of senior citizens’ care homes and day care centres and home care services for senior citizens, appeal by children allowed, on line application acceptable, creation of National Helpline, nodal officer at every police station and removal of Rs. 10000/- limit.
2. In spite of greater degree and duration of locomotor, visual and cognitive disabilities among older women the Rashtriya Vayoshri Yojna (RVY) for BPL senior citizens instead of disbursing physical aids and assistive devices to greater proportion of older women states that at least 30% of total beneficiaries under this scheme has to be older women. In fact the proportion needs to be raised to 60% for older women and 40% for older men.
3.Again in spite of larger proportion of elderly women most welfare schemeslike SACRED (Reemployment), AGRASR (Social reconstruction through Self-help group funding), Promoting silver economy (Startups for senior citizens products) and CSR for elder care are gender neutral. Something needs to be done for this in favour of older women.
Need for addressing health issues of aging women as being distinct from those of aging men.
Despite many senior citizens schemes being gender neutral, older women clearly experience disparity in terms of physical and functional health. Apart from their gynaecological problems, older women are likely to suffer more frequently from anaemia, high blood pressure, bronchitis and cancers. It would also be correct to stress on what is called Ominous Octet of older women’s health which broadly include body aches and pains, arthritis, dementia or forgetfulness, sleep deprivation, depression, frailty, falls and fractures and urinary incontinence, all being more common in older women compared to older men. Further, their health problems are compounded not only by socioeconomic marginalisation but also by difficulty in accessing healthcare and greater violations of their health-related human rights, neglect and abuse compared to older men. Many of their symptoms are passed off just as the consequences of normal aging by the health care providers who may not be as sensitive enough to older women’s health issues as to those of older men. All these women's health issues need to be effectively addressed by creating awareness among care givers, health and social care providers, families, societies and older women themselves. Preventive and promotive health strategies for elderly women need to be specifically incorporated in various healthcare programs of our country.
How these differences between older women and older men should be addressed under health policies and under the law?
Health and legal framework need to address more effectively the significance of actions at 3 levels.
1. Older women themselves
Having gone through medical, psychological, social and health related challenges over the entire life course, women are considered to become more resilient than men. Society does recognize their challenges right from the stage of girl child discrimination, onset of puberty, process of adjustment in the post marital home, pregnancy, labour, sustained child rearing process and care giving to geriatric members of the family-it is no wonder therefore, women as they age are able to face widowhood, poverty, loneliness and discrimination with fortitude and outlive older men by few years. Health program framework should further strengthen their physiological and psychological resilience through incorporating the necessary steps in the existing National Program for the Health Care of Elderly (NPHCE) based on a life cycle approach by harping on well-known active and healthy ageing commandments such as eating proper, exercising well, sleeping full, busting stress, keeping hygienic and engaging mentally, socially and spiritually etc.
2. Society and family support
Women who are more likely to bear the brunt of care giving fatigue in addition to their enormous but unpaid contribution as home makers can be supported by shifting some care giving responsibilities to society through long term insurance wherein payment of premium becomes mandatory for 40 or 45+ population to pay for non-family formal paid care giving if such a need arises in future-a sort of crowd funding. Other avenues of support include establishment of Respite Care Homes, Social support Groups etc.
3. Government, policy and law
This includes establishing a Department of Senior Citizens Affairs under the Central Ministry of Social Justice and Empowerment together with corresponding Directorates in various States of the country to focus on issues facing senior citizens including older women. In addition, a National Commission for Senior Citizens and corresponding State Commissions are needed. Initiatives for imparting digital, financial and legal literacy need to be undertaken in full swing. It is equally important to take steps for awareness generation of various social welfare schemes and utility of elder Helpline for senior citizens throughout the country. Financial incentives for family care giving and enhancement of existing old age pension need to be instituted as compensation for unpaid household work that is almost universally under taken by women in India. Finally necessary amendments in the Maintenance and Welfare of Parents and Senior Citizens Act and specific provisions for senior citizens with a focus on older women under National Legal Services Authority (NALSA) and protection of human rights for this segment of population are required.
MISCELLANEOUS INFORMATION
1. NPHCE: As per Niti Aayog document of 2024, under NPHCE there are 3 National Centres for Aging (NCAs), 18 Regional Geriatric Centres (RGCs), 718 District Hospitals (DHs), 4869 Community Health Centres (CHCs), 18407 Primary Health Centres (PHCs) and 90719 Sub Centres (SCs).
2. Legal provisions for senior citizens include MWPSC Act of 2007, Section 125 of Criminal Procedure Code of 1973, The Hindu Adoption and Maintenance Act of 1956-Section 20, The Himachal Pradesh Maintenance of Parents and Dependents Act of 2001 (NPOP refers to its related Act as of 1996), National Legal Services Authority (NALSA) as constituted in 1987 to provide free legal services to weaker sections of the society including senior citizens. A specific subsection of NALSA helps senior citizens to access legal and welfare measures. Core group for the protection and welfare of elderly persons of National Human Rights Commission is another legal provision available.
3. Atal Vayo Abhyudaya Yojna (AVYAY), (formerly known as National Action Plan for Elderly) is now an umbrella term from first April 2021 and comprises of Integrated Program of Senior Citizens, State Action Plan for Senior Citizens, Rashtriya Vayoshri Yojana (RVY), National Helpline for Elderly and Senior Care Ageing Growth Engine (SAGE) which is about promoting silver economy through startups for senior care products.
4. Pradhan Mantri Vayo Vandana Yojana (PMVVY) protects elderly persons from future fall in their interest income. Assured return is 8%. Sum is invested by LIC and if the return generated by LIC is less than 8%, Government will bear the difference. Interest is payable monthly and the duration of scheme is 10 years. The scheme is gender neutral.
5. Varishth Pension Bima Yojana (VPBY). If someone pays a lumpsum amount, he gets monthly pension which starts after 15 years. Any shortfall in the interest generated by LIC on the sum assured is borne by the Government. The scheme is gender neutral
6. Senior citizens savings scheme which is operated through banks and post offices is also gender neutral
7. Insurance Regulatory Development Authority (IRDA) has removed any upper age bar for buying a health insurance product with effect from first April 2024.
8. Pradhan Mantri Jan Arogya Yojana (PMJAY) under Ayushman Bharat scheme proposes to give free treatment for senior citizens aged 70 years and above up to a sum of Rs. 5 lakhs a year. This is a part of Manifesto of one of the political parties.
9. UN principals for older persons declared in 1991 consist of dignity, independence, selffulfilment, care and participation
_20240725123207.jpg)
