The ‘new sandwich generation’ in urban China

By alex.clegg, on 14 February 2022

Author: Xinyuan Wang

The recently released seventh national census in China shows that today’s China not only has one of the lowest fertility rates in the world (on average Chinese women are expected to have 1.3 children each throughout their lives, compared to the UK  where in 2020 it was 1.58), but also is facing ageing crisis where 149 Chinese cities are now classed as ‘deep ageing’. What do these figures mean to ordinary Chinese households? What does that mean to the very experience of ageing among older people in China?

As observed during my field work in Shanghai, a striking feature of this older generation in China is, what I call, a ‘new sandwich generation’. The concept of a sandwich generation used to refer to middle-aged people who are burdened by taking care of their young children and parents. But what is the new sandwich generation? To show what this means for ordinary Chinese people, I would like to introduce one of my key research participants Fangfang and her four-generation family.

Fangfang’s four generation household. Infographic by Xinyuan Wang

As shown on the chart, Fangfang is the second generation compared to her 89-year old mother, represented by the top bar. Fangfang’s daughter, the third bar from the top is 36, and has two young children, aged 9 and 2, who were born just after the thirty yearlong one-child policy was abolished in 2015.

Fangfang’s mother Hui was born in 1929 and belongs to the generation that suffered long periods of war and poverty. Hui fled into the former French concession in the city centre with her family to avoid shelling when Japan invaded Shanghai in 1937. During this period of time (from 1937 to 1949) the Sino-Japan war and civil war took place in China. For a brief period, life for Hui seemed to be less constrained as she married into a relatively well-off family, however, soon after the establishment of communist New China, the family business started to decline. All private businesses were cracked down on becoming state or collective owned and whole households were persecuted during various political struggles.

The second daughter in her family, Fangfang was born in 1949, just after the revolution. In the 1950s, the Party encouraged high fertility rates, as the population was regarded as the essential force of revolution and production, and women with many children were officially rewarded as ‘honourable mothers’ (guangrong mama). Despite limited life resources, Hui gave birth to seven children (from 1948 to 1965) and six of them survived to adulthood. During her childhood, Fangfang witnessed how her mother struggled to raise young children during a time of pervasive scarcity and uncertainty, and how her young brother, who suffered from congenital heart disease, only survived seven days due to the lack of medical treatment in 1950s.

Fangfang’s own life changed drastically when the Cultural Revolution started. All the schools closed, and urban youth nationwide were sent to the countryside to receive education from farmers. In 1966, when 17-year-old Fangfang said goodbye to her family in Shanghai, she did not expect she would be ‘stuck’ in the countryside for 12 years. In 1978, when Fangfang finally got transferred back to Shanghai, working in the factory where her father used to work, she was already 29 years old, she then married one of her former neighbours, and their daughter Lan was born in 1982.

Lan was the only child in the family, since the one-child policy had been enforced since 1979 in urban areas. Lan was born in a rather different era, when the egalitarianism that characterised the period of the planned economy had started to collapse because of the market-orientated economic reforms, which started in 1978. Fangfang clearly remembered how things were getting more competitive both at work and at Lan’s school.

When Fangfang’s granddaughter Joy was born in 2009, Lan only took half of her maternity leave and went back to work straight away to keep her promotion at work. At that time, Fangfang had just retired and in her words quite ‘naturally’ stepped into the role of being the mother of little Joy. In 2014, ‘only-child’ couples (meaning both the wife and the husband were the only children in their family) were allowed to have a second child in Shanghai and Lan gave birth to a boy in 2016. This time, Joy’s paternal grandmother (nai nai) had to come to help with raising the baby as Fangfang was too busy with taking care of the girl and her own mother.

According to ‘filial piety’ (xiao) principles found in Confucian ethics, adult children are supposed to take care of their old parents in order to pay back the ‘care debt’ they owe to their parents. Previously, in Chinese agricultural society, children were regarded as the ‘pension’ of the family. As the old Chinese saying goes ‘children are reared to provide support in old age’ (yang er fang lao). When Fangfang’s mother fell ill and needed intensive care, she made it clear that she did not want to be taken care of by non-kin so as not to ‘lose-face’, as that would suggest she raised ungrateful, or ‘unfilial’ (buxiao), children.

Therefore, Fangfang and her siblings, who are in their 60s and 70s have to take care of their mother in turns. Fangfang’s 70-year-old older brother fell ill himself because of the taxing labour of caregiving. He sighed,

‘You know in old days; I am already in the age of enjoying ‘filial piety’ from my children…but now I am still fulfilling ‘filial piety’ towards my mother. My mother is very fragile, but given medical treatments nowadays, she can easily live for another five years or longer…but I don’t know how long I can hold on…I am just emotionally and physically tired.’ 

According to Fangfang, all her siblings, including herself and her husband, can imagine themselves spending the last stages of their lives in a care home, being taken care of by care workers, so that their own children will be free of the ‘unbearable burden’ of elderly care.  They are pretty sure they will be the last generation in China to practice the traditional ‘in the way of providing actual elderly care labour. Another background fact is that, In China, the national pension scheme was first introduced in 1950s. In a way, retirement is an unprecedented life experience for the generations who lived in urban China.

‘We are struggling to take care of our mum, but at least we have siblings that we can share this burden with…it is 6 households with 12 people altogether, all taking care of one old person…our children are unlucky because they are part of the only-child generation…that is to say that at some stage, a couple with an only child will need to take care of old parents from both sides, which is four old persons. Can you imagine what kind of burden our generation will become to our children?’ Fangfang asked, rhetorically.

Furthermore, Fangfang thinks her daughter’s family could not even take care of their children without her support, not to mention their ability to support her in the future.

As Fangfang’s story shows, the new sandwich generation refers to retired people in their 50s to 70s who are simultaneously burdened with heavy care commitments for both their elderly parents and their grandchildren. This is partly a consequence of the extended life expectancy, the decades-long one-child policy, relatively early retirement, and the significantly improved health situation of older people. It is also an outcome of a multi-generational household strategy to deal with the intense social competition inherent in contemporary China. The situation of older people actively engaging with grandparenting is not unusual across the world as observed by the ASSA project, however, the heavy labour of care weighed on the shoulders of the older generation in urban China is rather pronounced. This is a vastly different situation from the connotations of ‘retirement’, which literally means ‘step back and rest’ in Chinese. In practice the experience is closer to the phrase ‘lean-in and be busy’, especially when taking care of both elderly parents and young grandchildren.

Understanding Covid Vaccine Resistance

By Laura Haapio-Kirk, on 19 January 2022

Authors: Sheba Mohammid and Daniel Miller

Open access image by Volodymyr Hryshchenko.

Right now, Trinidad and Tobago are suffering amongst the highest death rate from Covid in the world. As small islands, everyone seems to know people who have died. According to a Trinidadian doctor specialising in this field one reason for this is co-morbidity with diabetes, obesity and hypertension. Diabetes is also the leading co-morbidity factor in Europe^[1]. These are exactly the health conditions our final ASSA project in Trinidad is focusing on. Yet we would estimate perhaps half the population is resistant to getting the Covid vaccination, either not having it (48.3%), or being vaccinated only because of pressure, such as keeping their job. In response Sheba Mohammid has focused on researching the reasons people remain opposed to vaccination even in such tragic circumstance, as part of her online ethnographic in Trinidad.

The first thing that became clear in Sheba’s investigations was a fundamental problem with research on this topic. She began, as most researchers would, by asking the people concerned. People gave her many reasons for not being vaccinated, but it soon became obvious that when one reason no longer applied, the emphasis was shifted to another. For example, a person might say they didn’t want AstraZeneca and were waiting for Pfizer. But when Pfizer came along, they give an entirely different reason based on some nurses not being vaccinated. It gradually became clear that what people say in answer to this question is based on the pressure to legitimate their actions. The way these various forms of rationale are replaceable suggests that a deeper investigation was required.

The second stage of her research then tried to focus on two main issues that had developed as possibly the core underlying reasons for taking this stance, using additional evidence from their wider discussions and concerns. The first is general fear and mistrust that the vaccine might itself make one ill. The second was a general resistance to top-down assertions that the facts were clear and that they should take the vaccine. Indeed, it is likely that a response such as fact-checking would only harden the resolve to resist those people from above who cannot be trusted and keep insisting that only their facts were the true facts. By contrast, the stories that made them more fearful of vaccination came not from government, but from people more like themselves. Yet it was also clear that this opposition to authority was different from other regions. The people in Trinidad did not call themselves anti-vaxx or associate with US opposition movements to the vaccine about which they were well informed.

The third stage, began with a realisation that these oppositions may have deeper roots that relate more to local cultural values. The US movement is a more organised opposition reflecting the current degree of politicisation in the US. Danny’s conversations with people in Ireland suggest that an important factor there is the degree of personal support that people opposed to vaccination give each other in the community. Trinidad turns out to have its own quite specific reasons for opposing the vaccine, less political than the US and more individualised than Ireland for opposing the vaccine. In each region      there are deeper resonances that may account for the local resistance.

The traditional relationship in Trinidad between health and the body is not a culture of preventative medicine but rather “If it eh broken, why fix it.” Healthcare is often framed as problem-solving medical intervention that seeks to ease the consequences of an illness and is a last resort. Medicine then is largely framed as curative and many people recount how they avoid health tests saying that they “have one life to live and doh want to know,” but will only seek medical care as a treatment if they feel all else has failed and they are now willing to go to the doctor for help. Indeed, patients may then complain when a doctor merely gives them a painkiller that they could get over the counter  since they expect a special injection. But otherwise, in deeper discussion and sustained participant observation as to why people have not taken the vaccine, they insist that `Ah Good’ – basically they are feeling fine and they fully intend to remain feeling fine. So, at that stage why take a risk by being injected with something that at least some other people are saying, especially on circulating social media, that will itself harm your health.

Sheba interviewed doctors regarding diabetes and hypertension who regularly underscored that a main challenge is this lack of preventative healthcare that is in fact a key challenge to the health system. This idea of “being good” intersected with the insights she gleaned on how people refuse to take high blood sugar or pressure seriously if on the surface they seem fine and thus the proliferation of these “silent killers” in the population.  She found that it was the norm that if participants were taking something to keep healthy it should be a natural food or substance that has no associations at all with becoming ill and seem to pose no risk. This meant that an illness which has an asymptomatic phase such as Covid19 would be particularly devastating, because as long as people feel good, they are confident that they cannot be a danger to others or contract it themselves if they spend time with people who seem asymptomatic. In the meantime, it is taking the vaccine that represents risk, not the failure to have taken it. Appearance matters and there is considerable stress on showing to others that one is healthy, while even talking about ill health and medicines ‘kills the vibe’ and should be avoided unless one is actually ill. This study also showed us that our original plans for helping to improve diet in relation to diabetes would probably not have worked, at least in this context, and a different approach is now being considered.

Clearly these generalisations only apply to some of this population. But it may be an important underlying part of the culture surrounding the body and health. Extrapolating from this conclusion, it would seem that research based simply on asking people for their reasons for not taking the Covid vaccination, or worse still projecting upon them one’s assumptions, are not likely to be helpful. A more anthropological insistence on taking vaccine hesitancy seriously and finding the deep roots that sustain it in people’s values and wider attitudes may be required for each region of concern.

^[1] Corona. G. et. al 2021 Diabetes is most important cause for mortality in COVID-19 hospitalized patients: Systematic review and meta-analysis Rev Endocr Metab Disord Jun;22(2):275-296.

doi: 10.1007/s11154-021-09630-8.