The Role of Women in Aged Care:

Perspectives on Ageing and Gender in

the MENA RegionDr Shereen HusseinSenior Research FellowKing’s College London

Institute for Policy Research - Beyond International Security - Univeristy of Bath 2

Presentation structure• Overview of the MENA region: Similarities and differences• Population Ageing as a policy issue in MENA• Current aged care model in the region • Competing demands and women role in aged care

provisions– Demographic and population trends focus on nuptiality, co-

residency and labour participation trends• Viability of MENA current aged care model• Call for integrated age and gender social policy

development

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The Middle East and North Africa: .. How similar?

• Lies at the crossroads of Europe, Africa and Asia• The birthplace of civilization and the three great monotheistic religions of

the world• 22 countries• Share similar language (Arabic in the majority)• Share very similar cultural norms based on religious/spiritual beliefs

– governing family roles and ties- influencing both women and the aged• Some geographical coherence with sub-groups

– Arab Asia (Iraq, Jordan, Lebanon, Palestine, Syria, Yemen)– Gulf Cooperation Council (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia,

United Arab Emirates)– North Africa (Mauritania, Morocco, Algeria, Tunisia, Libya, Egypt,

Sudan, Somalia, Djibouti, Comoros)

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The Middle East and North Africa: .. How different?

• Huge variability in:– Poverty and per capita income– Population size– Literacy and unemployment rates– Migration, geographical mobility, co-residency arrangements and

other socio-economic and socio-demographic characteristics• While all experience some forms of demographic and

nuptiality transition– Fertility: some at or near replacement levels, in others high

fertility persist– At different tempo and stage

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Population Ageing in the MENA region

• Population ageing is relatively a recent phenomenon in the region– traditional higher fertility rates slower pace of

population ageing in other developing countries• Different degrees of population ageingbut all

on the same road– More rapid population ageing is expected, by 2050

proportion of older persons projected to reach 19%• Gender life-expectancy differences

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Population Ageing as a Policy Issue in the Region

• The region has historically shown a strong commitment to social welfare– Post independence– Majority linked to employment

• E.g. pensions and retirement schemes, however, favouring public sector and can be regarded as gender biased

– Universal health and education service• but actual delivery is relatively poor in most countries

• No ‘formal’ aged policy strategic vision– However some recent attention to the phenomenon in

recent policy discussions

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Ageing is not a ‘major’ policy concern for the majority of countries in the region

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Aged-care model in the region• Mainly a family-based model

– Embedded within religious beliefs and duty of care to the elder– A two way beneficial model – Gender imbalance of expectations of financial, physical, emotional and

personal care• Absence of formal long term care provision

– With limited availability and use of residential care• Charitable (voluntary) sector is an important provider of social

activities for the elderly– mainly religion based

• Women play a pivotal role in sustaining this model• A model based on certain assumptions around family structure and

women’s availability sustained by strong cultural and religious ideology– Challenged through another set of demographic changes03/12/2013 Institute for Policy Research - Beyond International Security - Univeristy of Bath

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Women competing demands• A sea of demographic and social change !!• Family formation

– Age at marriage, celibacy rates, marriage dissolution, marriage patterns and types of contracts …. ‘marriage revolution’

– Spousal choice and co-residency after marriage• Migration

– Geographical proximity – Married women as female-headed households: new responsibilities, financial

involvements, decision making etc.

• Urbanisation – Co-residency & geographical proximity

• Education and labour participation• Overall women status and societal/political involvement

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Nuptiality trends: Age at first marriageCountry Source and year Median age at first

marriage (female)Egypt DHS 1988

DHS 1992DHS 1995DHS 2005

18.519.219.319.5

Morocco DHS 1987DHS 1992DHS 2003/04

18.518.819.8

Sudan DHS 1990 17.8

Saudi Arabia MCHS 1996 16.3

Tunisia DHS 1988 21.1

Jordon PFHS 1990PFHS 1997

19.621.5

Yemen DHS 1992DHS 1997

15.116.8

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Source: Hussein (2002)

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Nuptiality trends: Marriage stability

• Marriage stability measured by different elements– Marriage dissolution

• Divorce and widowhood – unclear direction of trend– Duration of marriage – divorce usually occur in early years– Remarriage rates – very low overall, except in some countries (e.g. Morocco)

• Influenced by other nuptiality elements including:– Marriage contracts– Consanguinity and polygyny– Inter-spousal age and educational gaps– Observed changes in all the above

• Affect women on a number of ways– Female headed-household– Welfare– Financial and social status

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Source: El-Saadani (Undated)

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Marriage dissolution, due to divorce, working for cash and education – not a consistence relationshipExample 1: Tunisia

Source: Hussein (2002)

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Marriage dissolution, working for cash and education – not a consistence relationshipExample 2 Morocco

Source: Hussein (2002)

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Marriage dissolution, working for cash and education – not a consistence relationshipExample 3 Egypt

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Husband selection and co-residency

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Women labour-force participation

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Viability of current family-based care model

• Assumes a certain family and societal structure• Women are key players in providing care• Other demographic and social changes challenging such structure

on a number of ways:– Family unit availability and ability to provide increasing care– Competing demands on women time, emotional strengths,

and finance• Lack of vision to link with existing charitable and societal activities• Includes risk elements:

• Lack of awareness of old age care needs including dementia and associated risks

• Lack capacity building

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Ageing and gender issues go hand-in-hand

• An opportunity to develop a policy direction that integrates both ageing and gender issues

• Women over represented in the ageing population• Women main providers of aged care, and will continue to be • Need for wider policy support for women to enable their

pivotal role in aged care– at different levels including employment, respite care, flexible

working conditions, recognition of increased duties • Develop policy that enables the family, community and the

state to support and maintain aged care in a complementary (not substitution) structure

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Thank you for listening

• Shereen.hussein@kcl.ac.uk• 0207848 166903/12/2013