Caregiving for China’s one-child generation: a simulation study of caregiving responsibility and impact on women’s time use

• Published in: BMJ global health Vol. 9; no. 6; p. e013400
• Main Authors: Kwete, Xiaoxiao, Knaul, Felicia Marie, Essue, Beverley M., Touchton, Michael, Arreola-Ornelas, Héctor, Langer, Ana, Calderon-Anyosa, Renzo, Nargund, Renu Sara
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 05.06.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Aging; Child health; Children & youth; Chronic illnesses; Enforcement; Families & family life; Family planning; Females; Fertility; Health policy; Mathematical modelling; Original Research; Palliative care; Parents & parenting; Population growth; Prevention strategies; Public Health; Responsibilities; Sex discrimination; Siblings; Simulation; Women; China
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2023-013400

IntroductionThe introduction, strict enforcement and recent exit of China’s one-child policy (OCP) resulted in China’s demographical changes, and, alongside its epidemiological transition, disproportionately impacted caregiving needs and demands on women. This study examines women’s caregiving responsibilities in contemporary China and evaluates how the OCP affected them.MethodsWe simulated the female population aged 25–54 years in 2020 in China and their caregiving responsibilities based on epidemiological and demographic data for women, their parents and parents-in-law, and children under 10. Three different health states were simulated for children and the senior generation: (1) healthy, (2) end of life—decedents and (3) non-decedents in need of palliative care. We combine the care responsibility for senior family members and for children using an aggregate indicator—the Care Responsibility Score (CRS) –to compare the impact of the OCP across different generations of women.ResultsApproximately 60 million working-age women are living with medium to high levels of care responsibilities (a CRS over 0.8), which is equivalent to caring for a senior family member with palliative care needs without any assistance from siblings. This includes more than one-third of the 156 million women born after the OCP and only 5% of women born before the OCP.ConclusionFor women born under the OCP, the additional responsibility generated by a lack of siblings outweighs the benefit of having four dedicated grandparents to support them in raising children.