Elderly Women in India’s Health Policy: Addressing a Critical Gap in Geriatric Equity

By 2050, one in five Indians will be aged 60 or above — and the majority will be women.

The India Ageing Report 2023, released by UNFPA, projects that women in India will outlive men by an average of 2.7 years — yet they will spend 25% more of those additional years in poor health. Despite this stark reality, India’s health and social protection systems remain inadequately equipped to meet the gendered needs of its ageing female population.

This is not merely a demographic shift — it is a policy imperative.

📉 Key Challenges Facing Elderly Women in India

1. Delayed and Dependent Health-Seeking Behaviour

• Deep-rooted social norms compel women to prioritise family health over their own.
• Household decision-making structures often delay or deprioritise their medical care.
• Lack of autonomy in health choices — especially among widowed or economically dependent women.

2. Financial Vulnerability Undermines Access

• 60% of elderly women have no personal income (Longitudinal Ageing Study of India).
• Fewer than 20% can independently afford medical expenses.
• Economic dependence increases vulnerability to neglect and limits access to timely, quality care.

3. Digital Exclusion = Healthcare Exclusion

• Low digital literacy and limited smartphone access restrict use of teleconsultations, e-pharmacies, and online appointment systems.
• Forces reliance on male family members — reducing agency and increasing delays in care.

4. Gender-Insensitive Health Infrastructure

• Shortage of female healthcare providers in geriatric services.
• Absence of privacy, dignity, and gender-responsive design in public health facilities — discouraging women from seeking care.

The Gendered Disease Burden: What’s Being Missed

Elderly women face a disproportionate burden of chronic and under-diagnosed conditions:

• High Prevalence: Osteoporosis, osteoarthritis, cardiovascular diseases, and gynaecological cancers (breast, cervical, ovarian).
• Under-Diagnosed & Under-Treated: Uro-gynaecological disorders (e.g., incontinence, prolapse), depression, anxiety, and dementia — often dismissed as “normal ageing”.
• Compounded by Caregiving: Many continue to serve as primary caregivers for spouses or grandchildren — exacerbating physical strain and mental stress.

Eroding Support Systems: Widowhood, Migration, Isolation

• Widowhood: Over 40% of elderly women are widows — often with limited property rights or social support.
• Nuclearisation & Migration: Traditional joint family structures are dissolving. Adult children migrate for work, leaving elderly women behind — sometimes alone.
• Isolation: 18.7% of elderly women live alone — a figure rising rapidly. Social isolation correlates with higher morbidity, cognitive decline, and mortality.

Current Policy Landscape: Progress and Gaps

National Initiatives:

• National Programme for Health Care of the Elderly (NPHCE)
  Aims to provide geriatric care across primary to tertiary levels — but lacks gender-specific protocols and suffers from poor implementation.
• Ayushman Bharat – PMJAY
  Covers hospitalisation, but excludes outpatient care, diagnostics, and preventive geriatric services — critical for elderly women.
• Atal Pension Yojana (APY)
  Provides minimal fixed pensions without inflation-indexing. Gender-blind design ignores women’s longer lifespans and unpaid caregiving history.
• Rashtriya Vayoshri Yojana
  Offers assistive devices (walkers, hearing aids) to BPL seniors — useful but limited in scope and outreach.

State-Level Innovations:

• Kerala’s Vayomithram – Mobile geriatric clinics delivering doorstep care — a replicable, scalable model.
• Kudumbashree – Women-led SHGs providing economic empowerment, peer support, and community monitoring of elderly welfare.

Policy Recommendations: Building a Gender-Responsive Geriatric Ecosystem

1. Integrate Gender into Geriatric Care Standards

• Mandate routine screenings for osteoporosis, breast/cervical cancer, depression, and pelvic floor disorders in public health programmes.
• Train and deploy female frontline health workers and geriatric specialists.
• Ensure privacy, dignity, and safety in all geriatric service delivery points.

2. Expand Health Insurance to Cover Preventive & Outpatient Needs

• Introduce women-specific geriatric health packages under Ayushman Bharat, covering mammograms, DEXA scans, mental health counselling, and physiotherapy.
• Include chronic disease management and home-based care in coverage.

3. Reform Social Security with Gender Equity

• Index pensions to inflation and regional healthcare costs.
• Recognise unpaid caregiving in pension eligibility — grant credit for years spent raising children or caring for elders.
• Expand coverage of widows, informal workers, and rural elderly women through simplified enrolment.

4. Combat Isolation through Community Infrastructure

• Leverage Smart Cities Mission and Urban Local Bodies to establish Elderly Day Care & Wellness Centres — combining health check-ups with social, recreational, and skill-building activities.
• Integrate ASHA + Anganwadi networks for weekly wellness visits to isolated elderly women.

5. Bridge the Digital Divide with Inclusive Design

• Develop voice-enabled, vernacular-language health apps for appointment booking and medicine reminders.
• Mobilise community digital volunteers — youth, students, SHGs — to assist elderly women with tech navigation.

Conclusion: Ageing with Dignity is a Right — Not a Privilege

India stands at a demographic crossroads. The silent crisis of elderly women’s health is not inevitable — it is the result of systemic neglect. Addressing it requires more than token schemes; it demands gender-responsive policy design, inter-sectoral coordination, and societal reorientation.