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.

In the contemporary context of global population ageing, anthropological studies of elder care offer a lens onto the ways global processes are experienced and managed in everyday lives (Buch, 2015; Cole and Durham, 2007). Care itself is an increasingly international phenomenon, with, for example, carers from the Global South hired as domestic carers in the Global North (Ahlin, 2017), with migrant children enacting ‘care at a distance’ (Pols, 2012), and with increasing exposure to elder care norms from different societies. In this way, as shown in the conversation with the principal hospital administrator in the Kampala fieldsite cited here, everyday family health care practices are an observable lived experience of wide-reaching socio-political processes. Elder care, or lack thereof, in turn, reflects, reinforces, and in some instances, disrupts these processes (Buch, 2015). This is both interesting for anthropological analysis, linking the individual and historical, and for the potential of sharing this knowledge to improve the health and welfare of our research participants.

In Kampala, an understanding of elder care norms in other societies present an idealised or disparaged alternative against which existing family expectations are re-established. Nakito is the principal hospital administrator at the regional government hospital near the Kampala fieldsite, which itself was built with international funding. She feels the health system she works in needs to have “better provisions for these [older] people”. With the ‘youthful population’ in Uganda, she finds that health policy and funding often forget older people, an approach which she feels should be rectified as the older population grows. She has been particularly inspired by the approach to hospital care for older people she observed on a recent training course in Korea, where she found that there were separate specialised geriatric services in hospitals. This highlighted for her the gaps in the Ugandan health system for older people. She finds that elderly people come to the hospital with multiple conditions and have to “roam around” for all the services they’re referred to, with long queues at each department. “They’re lining up around the hospital”, she says.

Queueing at the hospital. Photo by Charlotte Hawkins (CC BY)

In line with many other researchers (e.g. Nzabona et al., 2016; Oppong, 2006; Whyte, 2017), participants, policymakers and NGO advocates, Nakito is concerned about the future of elder care in Uganda, as institutionalising older relatives like in Europe and the US is “not allowed” and instead “they would rather abandon them”. She predicts that by 2040, 50% of people may choose not to take care of their older relatives, depending on their upbringing. The “natural rule and regulation” of family obligations means that global media portrayals of alternative, independent, selfish ways of life “make you feel freer than your original cultural norms”. Younger people may be influenced to become more ‘independent-minded’, with the ‘self’ more “on the agenda”. She said it’s now more common to hear people say, “I’m actually very busy”, instead of conforming to the expectation that “you must be there for people, as a team” and “check on your people” and “be responsible for your community, and your own belonging”.

Despite these concerns, Nakito herself takes care of her mother, visiting her every weekend in her home village a 5-hour drive from Kampala. She finds that most of her friends do the same thing at least once a month. Even when she allows herself a day off, at the end of it she feels it’s a day wasted without visiting someone. These family care obligations “leave little time for self”, particularly for women (see also Wallman and Bantebya-Kyomuhendo, 1996). Nakito thinks this leads people to focus on the “smaller picture of family units, and sometimes forget society”. She attributes that to the “pressure of globalisation”, which has reduced the community bond to smaller units, based on proximity. In other words, paradoxically, personal pressures imposed by global processes are turning a once more social outlook inward to immediate families or within the household.

The “pressures of globalisation” are also evident in the health outcomes of contemporary lifestyles in the city, with cooking oil and sugar prominent in people’s diets, work over long hours an economic requirement that continues into old age, and increasingly prevalent chronic long-term non-communicable diseases. In this context, the family is crucial to supporting the health of the individual, particularly to supply the time and resources for care. This can result in older people and their relatives adapting to long-term treatment routines. As Sandra Wallman & Grace Bantebya-Kyomuhendo, anthropologists of ‘informal economies of health’ in Kampala, put it; “in economically constrained settings, health choices become health compromises which in turn, become family routines” (Wallman and Bantebya-Kyomuhendo, 1996: 151). As with the ASSA project’s health collaborations and later outputs, by ‘meticulously documenting’ observations of these routines and also the ways in which health conditions are understood, medical anthropology can promote an understanding of the impact of the political economy on marginalised low-income people (Farmer, 2004; Kleinman, 2012), and attempt to centralise human experiences in health systems.

References

1. Ahlin, T., 2017. Only Near Is Dear? Doing Elderly Care with Everyday ICTs in Indian Transnational Families: Elderly Care with ICTs in Indian Families. Medical Anthropology Quarterly. https://doi.org/10.1111/maq.12404
2. Buch, E.D., 2015. Anthropology of Aging and Care. Annual Review of Anthropology 44, 277–293. https://doi.org/10.1146/annurev-anthro-102214-014254
3. Cole, J., Durham, D.L., 2007. Generations and globalization youth, age, and family in the new world economy.
4. Farmer, P., 2004. An Anthropology of Structural Violence. Current Anthropology 45, 305–325. https://doi.org/10.1086/382250
5. Kleinman, A., 2012. Medical Anthropology and Mental Health: Five Questions for the Next Fifty Years.
6. Nzabona, A., Ntozi, J., Rutaremwa, G., 2016. Loneliness among older persons in Uganda: examining social, economic and demographic risk factors. Ageing and Society 36, 860–888. https://doi.org/10.1017/S0144686X15000112
7. Oppong, C., 2006. Familial Roles and Social Transformations: Older Men and Women in Sub-Saharan Africa. Research on Aging 28, 654–668. https://doi.org/10.1177/0164027506291744
8. Pols, J., 2012. Care at a distance: on the closeness of technology, Care & Welfare. Amsterdam University Press, Amsterdam.
9. Susan Whyte, 2017. Epilogue: Successful Aging and Desired Interdependence., in: Successful Aging as a Contemporary Obsession: Global Perspectives. Rutgers University Press., NEW BRUNSWICK, CAMDEN, NEWARK, NEW JERSEY; LONDON, pp. 243–248.
10. Wallman, S., Bantebya-Kyomuhendo, G., 1996. Kampala women getting by: wellbeing in the time of AIDS, Eastern African studies. James Currey ; Fountain Publishers ; Ohio University Press, London : Kampala : Athens.