GENDER AND ELDER CARE IN CHINA The Influence of Filial Piety and Structural Constraints HEYING JENNY ZHAN Georgia State University RHONDA J.V MONTGOMERY University of Wisconsin-Milwaukee The authors explore the changing dynamics of gendered familial caregiving in urban China within the context ofeconomic reforms and the continued cultural influence of xiao (filial piety).Data collected in China through interviews with 110 familial caregivers were used to examine cultural and structural influences on the caregiving behavior of adult children.Results from multiple regression analyses pro- vide evidence of a gendered division of parental care tasks,a decline in the patrilocal tradition of caregiving,and a strong social pressure that influences caregiving behavior.Structural factors linked to caregiving performance included family size,lack of pensions for elders,and caregivers'employment status and income.Findings portend deleterious effects for the women who are now caregivers as they are likely to live longer but be more financially dependent and have fewer children available to help them. Keywords:elder care:gender:culture;China This article focuses on the changing dynamics of gendered family caregiving in China within the context of economic reform and the continued cultural influence of xiao(filial piety).Specifically,the article examines the relative influence of cul- tural beliefs and structural constraints-in the form of family resources-on the elder care practices among a sample of urban-dwelling adult children in interior China.Until recently,patterns of familial caregiving for elders in China(Davis 1993:Davis-Friedmann 1983:Sher 1984)had not varied significantly despite dra- matic demographic,economic,and political changes during the past 2,000 years, particularly in the last century.Children were raised for the security of old age Sons,in particular,were important for passing on the family name,continuing ancestor worship,and providing physical and financial care for their parents(Ikels AUTHORS'NOTE:We would like to acknowledge the support of a Fulbright Hays Dissertation Research Grant for the research abroad.We are thankful to the anonymous reviewers and editors of the special issue for their insightful and helpful comments on the earlier versions of this article. REPRINT REQUESTS:Heying Jenny Zhan,Sociology Department,Georgia State University.Atlanta, GA 30303:e-mail:sochjz@langate.gsu.edu. GENDER SOCIETY,Vol.17 No.2.April 2003 209-229 D0:10.11770891243202250734 2003 Sociologists for Women in Socicty 209 Downloaded from gas.sagepub.com at UCSF LIBRARY CKM on January 27.2015
10.1177/0891243202250734 GENDER & SOCIETY / Zhan, Montgomery / GENDER AND ELDER CARE IN CHINA April 2003 ARTICLE GENDER AND ELDER CARE IN CHINA The Influence of Filial Piety and Structural Constraints HEYING JENNY ZHAN Georgia State University RHONDA J. V. MONTGOMERY University of Wisconsin–Milwaukee The authors explore the changing dynamics of gendered familial caregiving in urban China within the context of economic reforms and the continued cultural influence of xiao (filial piety). Data collected in China through interviews with 110 familial caregivers were used to examine cultural and structural influences on the caregiving behavior of adult children. Results from multiple regression analyses provide evidence of a gendered division of parental care tasks, a decline in the patrilocal tradition of caregiving, and a strong social pressure that influences caregiving behavior. Structural factors linked to caregiving performance included family size, lack of pensions for elders, and caregivers’ employment status and income. Findings portend deleterious effects for the women who are now caregivers as they are likely to live longer but be more financially dependent and have fewer children available to help them. Keywords: elder care; gender; culture; China This article focuses on the changing dynamics of gendered family caregiving in China within the context of economic reform and the continued cultural influence of xiao (filial piety). Specifically, the article examines the relative influence of cultural beliefs and structural constraints—in the form of family resources—on the elder care practices among a sample of urban-dwelling adult children in interior China. Until recently, patterns of familial caregiving for elders in China (Davis 1993; Davis-Friedmann 1983; Sher 1984) had not varied significantly despite dramatic demographic, economic, and political changes during the past 2,000 years, particularly in the last century. Children were raised for the security of old age. Sons, in particular, were important for passing on the family name, continuing ancestor worship, and providing physical and financial care for their parents (Ikels 209 AUTHORS’ NOTE: We would like to acknowledge the support of a Fulbright Hays Dissertation Research Grant for the research abroad. We are thankful to the anonymous reviewers and editors of the special issue for their insightful and helpful comments on the earlier versions of this article. REPRINT REQUESTS: Heying Jenny Zhan, Sociology Department, Georgia State University, Atlanta, GA 30303; e-mail: sochjz@langate.gsu.edu. GENDER & SOCIETY, Vol. 17 No. 2, April 2003 209-229 DOI: 10.1177/0891243202250734 © 2003 Sociologists for Women in Society Downloaded from gas.sagepub.com at UCSF LIBRARY & CKM on January 27, 2015
210 GENDER SOCIETY /April 2003 1989;Meijer 1971;Yang 1959).Families were extended in structure and patriar- chal,patrilocal,and patrilineal in nature.Women were expected to marry into hus- bands'families and take care of their parents-in-law.Even during the Communist regime from 1949 to the 1970s,the family system remained fundamentally unchanged,particularly in the practice of parent care.However,since the late 1970s,economic reforms and an open-door policy have brought both economic growth and cultural diversity.The aim of our study is to examine the simultaneous influences of traditional cultural beliefs and economic reforms on current elder care practices,especially the gendered nature of these care practices. BACKGROUND The Gendered Culture of Xiao In China,as in the West,women have usually been care providers for parents (Xia and Ma 1995;Xu 1995).With the exception of the small percentage of elders who are childless,family members and adult children in particular are the care pro- viders for physically dependent elders.However,there has been a major difference between the West and China.In the West,daughters have been more likely to pro- vide personal parental care than sons (Abel 1986;Brody 1990:Stoller 1994), whereas in China,daughters-in-law traditionally have been the major care provid- ers for elder parents-in-law because of the patrilocal family structure(Ikels 1990, 1993;Lavely and Ren 1992;Sher 1984).At the same time,while sons and daugh- ters in the United States may share any elder care expenses not covered by parents or insurance,in China,sons have always been expected to be the ultimate financial providers because married daughters have traditionally been given over to hus- bands'families according to patrilocal tradition(Gui and Ni 1995;Guo and Zhang 1996:Xia and Ma1995;Xu1996). Findings from recent studies,however,have identified patterns in parent care which may indicate that changes are under way in elder care practices.For example, there is evidence of an increase in the number of parents being cared for by daugh- ters in urban China as opposed to daughters-in-law and sons(Cooney and Di 1999; Davis 1993;Xiong 1998).Similarly,there is evidence that large proportions of elders receive financial assistance from daughters as well as sons (Chen and Adamchak 1999:Gu et al.1995). Traditional patterns of parent care have been widely attributed to the deeply rooted cultural belief of xiao,or filial piety,which has been long believed to be the essential element holding together the Chinese familial system of care,determining who is likely to be a care provider,and deciding the types and amount of care that are provided.Filial piety or xiao is a Confucian concept that encompasses a broad range of behaviors,including children's respect,obedience,loyalty,material provi- sion,and physical care to parents.It applies even after the death of a child's parents, mandating that children sacrifice for parents and not change the ways of their Downloaded from gas.sagepub.com at UCSF LIBRARY CKM on January 27.2015
1989; Meijer 1971; Yang 1959). Families were extended in structure and patriarchal, patrilocal, and patrilineal in nature. Women were expected to marry into husbands’ families and take care of their parents-in-law. Even during the Communist regime from 1949 to the 1970s, the family system remained fundamentally unchanged, particularly in the practice of parent care. However, since the late 1970s, economic reforms and an open-door policy have brought both economic growth and cultural diversity. The aim of our study is to examine the simultaneous influences of traditional cultural beliefs and economic reforms on current elder care practices, especially the gendered nature of these care practices. BACKGROUND The Gendered Culture of Xiao In China, as in the West, women have usually been care providers for parents (Xia and Ma 1995; Xu 1995). With the exception of the small percentage of elders who are childless, family members and adult children in particular are the care providers for physically dependent elders. However, there has been a major difference between the West and China. In the West, daughters have been more likely to provide personal parental care than sons (Abel 1986; Brody 1990; Stoller 1994), whereas in China, daughters-in-law traditionally have been the major care providers for elder parents-in-law because of the patrilocal family structure (Ikels 1990, 1993; Lavely and Ren 1992; Sher 1984). At the same time, while sons and daughters in the United States may share any elder care expenses not covered by parents or insurance, in China, sons have always been expected to be the ultimate financial providers because married daughters have traditionally been given over to husbands’ families according to patrilocal tradition (Gui and Ni 1995; Guo and Zhang 1996; Xia and Ma 1995; Xu 1996). Findings from recent studies, however, have identified patterns in parent care which may indicate that changes are under way in elder care practices. For example, there is evidence of an increase in the number of parents being cared for by daughters in urban China as opposed to daughters-in-law and sons (Cooney and Di 1999; Davis 1993; Xiong 1998). Similarly, there is evidence that large proportions of elders receive financial assistance from daughters as well as sons (Chen and Adamchak 1999; Gu et al. 1995). Traditional patterns of parent care have been widely attributed to the deeply rooted cultural belief of xiao, or filial piety, which has been long believed to be the essential element holding together the Chinese familial system of care, determining who is likely to be a care provider, and deciding the types and amount of care that are provided. Filial piety or xiao is a Confucian concept that encompasses a broad range of behaviors, including children’s respect, obedience, loyalty, material provision, and physical care to parents. It applies even after the death of a child’s parents, mandating that children sacrifice for parents and not change the ways of their 210 GENDER & SOCIETY / April 2003 Downloaded from gas.sagepub.com at UCSF LIBRARY & CKM on January 27, 2015
Zhan,Montgomery /GENDER AND ELDER CARE IN CHINA 211 parents.To the extent that xiao is the basis for traditional patterns of parent care,one can argue that the recently observed increase of daughters'involvement in physical and financial care for parents might well reflect significant changes in the cultural value of xiao. Although the concept of filial piety has been widely cited as an important factor affecting elder care (Chen and Adamchak 1999:Gallois et al.1997),minimal empirical evidence of this link between parent care practices and beliefs about filial piety exists.Indeed,the majority of past research efforts primarily have been restricted to describing elder care patterns in China with little attention given to identifying the factors influencing them(Guo and Zhang 1996;Ikels 1985,1993; Xu 1995.1996).Moreover,minimal attention has been given to the conceptualiza- tion or measurement of xiao.Most often,xiao has been treated as a single unified cultural value with no identification of cultural components.Yet the concept of fil- ial piety appears to encompass both specific norms pertaining to care practices and a more generalized perception of social pressure to act in accord with these norms, as reported in Korea(Choi 1993).In this article,we address both of these limita- tions found in previous studies by directly assessing the relationship between mea- sures of two dimensions of xiao and parent care practices. Structural Constraints and Gendered Care Recent economic reforms may provide an alternative explanation for the chang- ing patterns of parent care observed in China.These reforms have led to widespread changes in the structure of families and their economic resources,which,in turn, may have served as pragmatic imperatives affecting care practices,if not overshad- owing the influence on care practices of the age-old norm of filial piety. Family structure and future changes.Family size has been one of the major issues of inquiry in the study of elder care in China.Whether the issue is one of direct care or financial assistance,family size is a factor that would be expected to influence care patterns.Some researchers have found that a greater number of fam- ily members,particularly adult children,usually means more financial and physical assistance for parents(Guo and Zhang 1996).Others have noted that having more children has not always meant more overall financial support because each child in a large family will simply contribute a smaller amount(Gui and Ni 1995;Xia and Ma 1995).Lee and Xiao (1998)reported that the level of parental need,rather than family size.was the most important factor determining the level of children's finan- cial support.By examining the influence of family size in the context of the func- tional needs ofelders,economic resources,and the cultural values of adult children, we hope to provide greater insight into the influence of family size on current pat- terns of parent care in China. An equally important contribution of this article is the insight that we can pro- vide about likely changes of care patterns in the future.To the extent that current patterns of care tasks are influenced by the presence of siblings,we can anticipate Downloaded from gas.sagepub.com at UCSF LIBRARY CKM on January 27.2015
parents. To the extent that xiao is the basis for traditional patterns of parent care, one can argue that the recently observed increase of daughters’involvement in physical and financial care for parents might well reflect significant changes in the cultural value of xiao. Although the concept of filial piety has been widely cited as an important factor affecting elder care (Chen and Adamchak 1999; Gallois et al. 1997), minimal empirical evidence of this link between parent care practices and beliefs about filial piety exists. Indeed, the majority of past research efforts primarily have been restricted to describing elder care patterns in China with little attention given to identifying the factors influencing them (Guo and Zhang 1996; Ikels 1985, 1993; Xu 1995, 1996). Moreover, minimal attention has been given to the conceptualization or measurement of xiao. Most often, xiao has been treated as a single unified cultural value with no identification of cultural components. Yet the concept of filial piety appears to encompass both specific norms pertaining to care practices and a more generalized perception of social pressure to act in accord with these norms, as reported in Korea (Choi 1993). In this article, we address both of these limitations found in previous studies by directly assessing the relationship between measures of two dimensions of xiao and parent care practices. Structural Constraints and Gendered Care Recent economic reforms may provide an alternative explanation for the changing patterns of parent care observed in China. These reforms have led to widespread changes in the structure of families and their economic resources, which, in turn, may have served as pragmatic imperatives affecting care practices, if not overshadowing the influence on care practices of the age-old norm of filial piety. Family structure and future changes. Family size has been one of the major issues of inquiry in the study of elder care in China. Whether the issue is one of direct care or financial assistance, family size is a factor that would be expected to influence care patterns. Some researchers have found that a greater number of family members, particularly adult children, usually means more financial and physical assistance for parents (Guo and Zhang 1996). Others have noted that having more children has not always meant more overall financial support because each child in a large family will simply contribute a smaller amount (Gui and Ni 1995; Xia and Ma 1995). Lee and Xiao (1998) reported that the level of parental need, rather than family size, was the most important factor determining the level of children’s financial support. By examining the influence of family size in the context of the functional needs of elders, economic resources, and the cultural values of adult children, we hope to provide greater insight into the influence of family size on current patterns of parent care in China. An equally important contribution of this article is the insight that we can provide about likely changes of care patterns in the future. To the extent that current patterns of care tasks are influenced by the presence of siblings, we can anticipate Zhan, Montgomery / GENDER AND ELDER CARE IN CHINA 211 Downloaded from gas.sagepub.com at UCSF LIBRARY & CKM on January 27, 2015
212 GENDER SOCIETY/April 2003 the long-term consequences for elder care that are likely to stem from the imple- mentation of the one-child family policy.Partially aimed at improving economic growth by curtailing population growth,the one-child-per-family birth control pol- icy was implemented in 1979,roughly at the same time that the economic reforms began.By the end of the 1990s,the one-child rates (or the percentage of all births that are first-parity birth)ranged from 85 to 96 percent (Falbo and Poston 1996; Tsui and Rich 2002).Families are consequently becoming smaller in size and nuclear in structure,especially in urban China. Although the one-child policy may not directly influence the behavior of current caregivers,this shift in family structure will create unprecedented societal chal- lenges as Chinese baby boomers age.While most current caregivers have multiple siblings to share parent care responsibilities,members of the Chinese baby boom generation(born roughly 1950 to 1970),who began families after the implementa- tion of the one-child policy,generally have produced only one child.Consequently, children of baby boomers will necessarily confront the tasks of caring for elderly parents without the benefit of siblings to share the responsibilities.Plausible impli- cations of these changes for elder care in the future can be gleaned from our study, which examines the influence of family size on current care patterns in the context of cultural values and family resources. Economic reforms.In addition to experiencing structural transitions at the famil- ial level,current caregivers and their adult children,who are expected to become the caregivers of the future,are contending with the repercussions of economic changes at the societal level.These families are struggling to survive the transition from a socialist to a free-market economy as well as the globalization of the Chi- nese economy,which has emerged since the open-door policy was initiated in the late 1970s.The decentralization and privatization of enterprises,which previously had been 95 percent state owned,have led to a contraction in available jobs.Free market competition,particularly between companies with joint venture or foreign investment and those locally operated and formerly government owned,have forced many small and interior companies to close down(Grogan 1995;Henderson et al.1995:O'Leary 1998).Consequently,there is a sharp decline in job security and a loss of health care benefits.This decline is much more intense in the interior of China where local businesses that were formerly state owned have limited access to joint-venture capital and foreign investment and are unable to compete with the larger companies in coastal regions.Hence,our study of a sample of adult children residing in interior cities provides an excellent opportunity to examine the simulta- neous influences ofeconomic reform in a global economy and traditional value sys- tems on parent care. The repercussions of economic reform have disproportionately affected both women and the elderly.Women have been negatively affected by these reforms for two reasons.First,although a large percentage of urban women have been in the labor force since 1950,they have tended to work in temporary jobs or jobs that offered no benefits (Johnson 1983:Stacey 1983;Wolf 1985).Second,since the Downloaded from gas.sagepub.com at UCSF LIBRARY CKM on January 27.2015
the long-term consequences for elder care that are likely to stem from the implementation of the one-child family policy. Partially aimed at improving economic growth by curtailing population growth, the one-child-per-family birth control policy was implemented in 1979, roughly at the same time that the economic reforms began. By the end of the 1990s, the one-child rates (or the percentage of all births that are first-parity birth) ranged from 85 to 96 percent (Falbo and Poston 1996; Tsui and Rich 2002). Families are consequently becoming smaller in size and nuclear in structure, especially in urban China. Although the one-child policy may not directly influence the behavior of current caregivers, this shift in family structure will create unprecedented societal challenges as Chinese baby boomers age. While most current caregivers have multiple siblings to share parent care responsibilities, members of the Chinese baby boom generation (born roughly 1950 to 1970), who began families after the implementation of the one-child policy, generally have produced only one child. Consequently, children of baby boomers will necessarily confront the tasks of caring for elderly parents without the benefit of siblings to share the responsibilities. Plausible implications of these changes for elder care in the future can be gleaned from our study, which examines the influence of family size on current care patterns in the context of cultural values and family resources. Economic reforms. In addition to experiencing structural transitions at the familial level, current caregivers and their adult children, who are expected to become the caregivers of the future, are contending with the repercussions of economic changes at the societal level. These families are struggling to survive the transition from a socialist to a free-market economy as well as the globalization of the Chinese economy, which has emerged since the open-door policy was initiated in the late 1970s. The decentralization and privatization of enterprises, which previously had been 95 percent state owned, have led to a contraction in available jobs. Free market competition, particularly between companies with joint venture or foreign investment and those locally operated and formerly government owned, have forced many small and interior companies to close down (Grogan 1995; Henderson et al. 1995; O’Leary 1998). Consequently, there is a sharp decline in job security and a loss of health care benefits. This decline is much more intense in the interior of China where local businesses that were formerly state owned have limited access to joint-venture capital and foreign investment and are unable to compete with the larger companies in coastal regions. Hence, our study of a sample of adult children residing in interior cities provides an excellent opportunity to examine the simultaneous influences of economic reform in a global economy and traditional value systems on parent care. The repercussions of economic reform have disproportionately affected both women and the elderly. Women have been negatively affected by these reforms for two reasons. First, although a large percentage of urban women have been in the labor force since 1950, they have tended to work in temporary jobs or jobs that offered no benefits (Johnson 1983; Stacey 1983; Wolf 1985). Second, since the 212 GENDER & SOCIETY / April 2003 Downloaded from gas.sagepub.com at UCSF LIBRARY & CKM on January 27, 2015
Zhan,Montgomery /GENDER AND ELDER CARE IN CHINA 213 economic reforms of the 1980s,women in interior China have been more likely than men to experience the consequences of reduced job security and health care benefits due to the uneven development between coastal and interior areas and the increased sex discrimination in the job market(Parish and Busse 2000:Sun 1993: Xu 1992).This pattern is reflected in the census data of 1993 and 1997.Even though 75 percent of women ages 20 to 45 were reported to be working in the labor force during the first half of the 1990s,there was a 7 percent decline in women's labor force participation in 1995 compared to 1990;this decline tends to be "for both city and town women"(Parish and Busse 2000). As a group,the elderly also have been more negatively affected by economic and health care reforms in urban China than other segments of the population.As pen- sions and health benefits have become unreliable or worthless,elders'needs for financial and physical assistance have increased.As a consequence.many of the elderly have been forced to rely on children.This is especially true for older women who are less likely than their male counterparts to have pensions(Beijing Geronto- logical Soceity 1996:Wang.Bai.and Jia.1998). In the past,economic insecurity among Chinese elders,particularly women,has been the focus of several studies(Goldstein and Ku 1993;Sun 1993;Xiong 1998; Xu 1992);however,the impact of their financial situation on patterns of family care under the new market economy has received minimal attention.Since the economic reforms in China have produced societal and familial changes that have affected the status and independence of elders,the question arises as to how these changes will be reflected in patterns of elder care,which have long been dominated by the cul- tural norm of xiao.Specifically,our interest is in the gendered nature of parent care and the implications of such care patterns for Chinese women.If elder care is strongly influenced by the constraints of family and economic structures,then the prevailing cultural belief in filial piety is not likely to guarantee the care of elders in the future.Moreover,if the impact of the structural constraints resulting from glob- alization and the one-child family policy is disproportionately experienced by women,then it is likely that the costs of long-term care in China,as in the United States and much of Europe,will be borne disproportionately by women(Estes 2001;Montgomery 1999).Our findings are intended not only to augment the cur- rent understanding of the dual influences of cultural values and structural con- straints (i.e.,economic and family resources)in patterns of elder care in China but also to provide insights into the gendered nature of elder care and its costs now and in the future. RESEARCH METHOD The central research question addressed by this study is,To what extent do cul- tural values and structural constraints influence parent care practices among this sample of urban-dwelling Chinese adult children?Specifically,the analyses focus Downloaded from gas.sagepub.com at UCSF LIBRARY CKM on January 27.2015
economic reforms of the 1980s, women in interior China have been more likely than men to experience the consequences of reduced job security and health care benefits due to the uneven development between coastal and interior areas and the increased sex discrimination in the job market (Parish and Busse 2000; Sun 1993; Xu 1992). This pattern is reflected in the census data of 1993 and 1997. Even though 75 percent of women ages 20 to 45 were reported to be working in the labor force during the first half of the 1990s, there was a 7 percent decline in women’s labor force participation in 1995 compared to 1990; this decline tends to be “for both city and town women” (Parish and Busse 2000). As a group, the elderly also have been more negatively affected by economic and health care reforms in urban China than other segments of the population. As pensions and health benefits have become unreliable or worthless, elders’ needs for financial and physical assistance have increased. As a consequence, many of the elderly have been forced to rely on children. This is especially true for older women who are less likely than their male counterparts to have pensions (Beijing Gerontological Soceity 1996; Wang, Bai, and Jia, 1998). In the past, economic insecurity among Chinese elders, particularly women, has been the focus of several studies (Goldstein and Ku 1993; Sun 1993; Xiong 1998; Xu 1992); however, the impact of their financial situation on patterns of family care under the new market economy has received minimal attention. Since the economic reforms in China have produced societal and familial changes that have affected the status and independence of elders, the question arises as to how these changes will be reflected in patterns of elder care, which have long been dominated by the cultural norm of xiao. Specifically, our interest is in the gendered nature of parent care and the implications of such care patterns for Chinese women. If elder care is strongly influenced by the constraints of family and economic structures, then the prevailing cultural belief in filial piety is not likely to guarantee the care of elders in the future. Moreover, if the impact of the structural constraints resulting from globalization and the one-child family policy is disproportionately experienced by women, then it is likely that the costs of long-term care in China, as in the United States and much of Europe, will be borne disproportionately by women (Estes 2001; Montgomery 1999). Our findings are intended not only to augment the current understanding of the dual influences of cultural values and structural constraints (i.e., economic and family resources) in patterns of elder care in China but also to provide insights into the gendered nature of elder care and its costs now and in the future. RESEARCH METHOD The central research question addressed by this study is, To what extent do cultural values and structural constraints influence parent care practices among this sample of urban-dwelling Chinese adult children? Specifically, the analyses focus Zhan, Montgomery / GENDER AND ELDER CARE IN CHINA 213 Downloaded from gas.sagepub.com at UCSF LIBRARY & CKM on January 27, 2015
214 GENDER SOCIETY /April 2003 on the relative influences of the cultural value of xiao,family structure,and eco- nomic resources on gendered patterns of parent care. Guiding Model for Analysis For this analysis,family size and economic resources are viewed as structural factors that are influenced by the societal changes that have been introduced in China as part of globalization,economic reform,and the one-child policy.Conse- quently,our analyses serve as an initial assessment of the likely effect of these struc- tural changes on women's role as caregivers for elders in interior China in the con- text of current cultural values To accurately assess the impact of the structural factors on care patterns,we first analyze the gendered nature of care task performance and of cultural values.Next, we include the gender of the caregiver and the care recipient in our regression mod- els along with control variables for the level of physical need of the elder and the marital status of the care recipient.In addition,we have included two measures of the cultural value of xiao in the models.In this way,we are able to examine the influence of structural factors after taking into account the influence of elder need and cultural beliefs. The data for this study were obtained through structured interviews in interior China with 110 urban-dwelling familial caregivers who were assisting an elderly parent or parent-in-law.A snowball method was used to identify the caregivers in Yiyang City,Hunan Province,and Baoding City,Hebei Province.Both Yiyang and Baoding are medium-sized cities located in the interior of China.They were selected because they are smaller cities,which are not often studied but are repre- sentative of the places where the majority of the interior urban population reside and work.It is in cities like these that most Chinese who have experienced privatiza- tion and globalization of their economy still live in a relatively traditional style and where cultural norms and practices ofelder care are more likely to remain relatively stable.Hence,our sample provides an excellent opportunity to assess the dual impacts of economic reform and traditional cultural values. Within the context of our available resources,it was not possible to obtain a rep- resentative sample of caregivers.However,an effort was made to select a sample that was sufficiently diverse in terms of the key independent variables including gender,employment status,and health care benefits.To maximize the variation of class status within the sample,the snowball process was initiated in four district cat- egories:factory,school,government,and residential.As most families still lived in apartments assigned by work units,though purchased by employees in the mid- 1990s,this method facilitated the inclusion of individuals with very diverse back- grounds.There was little variation in ethnicity because the vast majority of urban dwellers in these two cities are Han Chinese,as is true for most Chinese cities.To be included in the study,caregivers had to be providing financial,physical,or emo- tional assistance to parents or parents-in-law on a regular basis,and the care Downloaded from gas.sagepub.com at UCSF LIBRARY CKM on January 27.2015
on the relative influences of the cultural value of xiao, family structure, and economic resources on gendered patterns of parent care. Guiding Model for Analysis For this analysis, family size and economic resources are viewed as structural factors that are influenced by the societal changes that have been introduced in China as part of globalization, economic reform, and the one-child policy. Consequently, our analyses serve as an initial assessment of the likely effect of these structural changes on women’s role as caregivers for elders in interior China in the context of current cultural values. To accurately assess the impact of the structural factors on care patterns, we first analyze the gendered nature of care task performance and of cultural values. Next, we include the gender of the caregiver and the care recipient in our regression models along with control variables for the level of physical need of the elder and the marital status of the care recipient. In addition, we have included two measures of the cultural value of xiao in the models. In this way, we are able to examine the influence of structural factors after taking into account the influence of elder need and cultural beliefs. The data for this study were obtained through structured interviews in interior China with 110 urban-dwelling familial caregivers who were assisting an elderly parent or parent-in-law. A snowball method was used to identify the caregivers in Yiyang City, Hunan Province, and Baoding City, Hebei Province. Both Yiyang and Baoding are medium-sized cities located in the interior of China. They were selected because they are smaller cities, which are not often studied but are representative of the places where the majority of the interior urban population reside and work. It is in cities like these that most Chinese who have experienced privatization and globalization of their economy still live in a relatively traditional style and where cultural norms and practices of elder care are more likely to remain relatively stable. Hence, our sample provides an excellent opportunity to assess the dual impacts of economic reform and traditional cultural values. Within the context of our available resources, it was not possible to obtain a representative sample of caregivers. However, an effort was made to select a sample that was sufficiently diverse in terms of the key independent variables including gender, employment status, and health care benefits. To maximize the variation of class status within the sample, the snowball process was initiated in four district categories: factory, school, government, and residential. As most families still lived in apartments assigned by work units, though purchased by employees in the mid- 1990s, this method facilitated the inclusion of individuals with very diverse backgrounds. There was little variation in ethnicity because the vast majority of urban dwellers in these two cities are Han Chinese, as is true for most Chinese cities. To be included in the study, caregivers had to be providing financial, physical, or emotional assistance to parents or parents-in-law on a regular basis, and the care 214 GENDER & SOCIETY / April 2003 Downloaded from gas.sagepub.com at UCSF LIBRARY & CKM on January 27, 2015
Zhan,Montgomery GENDER AND ELDER CARE IN CHINA 215 recipient had to be in need of assistance with one or more activities of daily living (ADL)or instrumental activities of daily living(IADL).Although some secondary caregivers were interviewed,only data for primary caregivers are included in this analysis. Data Collection Process Structured interviews with the 110 caregivers were conducted in Chinese by the senior author during the fall of 1997 and 1998.Most of the interviews were con- ducted in the caregiver's home,although a few were conducted in the caregiver's workplace during lunch break or in an agreed-on public meeting place.Each partic- ipant was given a questionnaire written in Chinese and asked to either complete the questionnaire or allow the investigator to read the questions and complete the form for the participant.Only 18 caregivers chose to complete the form themselves. Information collected through the interview process included basic demographic data,the health and functional status of the elder and the caregiver,caregivers'atti- tudes and beliefs about caregiving responsibilities,and the type and extent of assis- tance that the caregiver was providing to the parent or parent-in-law. Sample Description Caregiver characteristics.The demographic characteristics for both the elders and the caregivers included in the sample are shown in Table 1.The majority(68 percent)of the caregivers in the sample were women.The caregivers ranged in age from 27 to 60.with the vast majority(86 percent)being between the ages of 30 and 49.All but seven of the caregivers were married.Fifty-six of the caregivers were daughters assisting parents,19 were daughters-in-law assisting parents-in-law,33 were sons assisting their parents,and 2 sons-in-law were primary caregivers for their fathers-in-law. Coresidence with parents or parents-in-law in this sample did not occur as fre- quently as in other studies,which have reported rates greater than 80 percent (Lavely and Ren 1992).Nearly half of the caregivers(46 percent)did not live with their care recipients.About a third (31 percent)of the caregivers lived with parents, while 23 percent lived with parents-in-law.One of the major reasons for this differ- ence in patterns of coresidence was that caregivers in this sample resided in urban interior China where elders were more likely to own apartments and live by them- selves than is the case among rural elders. The large majority (86 percent)of the caregivers had at least a middle school education,and their mean income was between 200 to 300 yuan(or $25 to $35)per month.Nearly half(43.6 percent)of the interviewees reported that they were not working full-time.Most of these caregivers were laid off;however,a few reported going to their former workplace to register their presence,but they rarely obtained work.While most caregivers(66.4 percent)received no reimbursement for medical Downloaded from gas.sagepub.com at UCSF LIBRARY CKM on January 27.2015
recipient had to be in need of assistance with one or more activities of daily living (ADL) or instrumental activities of daily living (IADL). Although some secondary caregivers were interviewed, only data for primary caregivers are included in this analysis. Data Collection Process Structured interviews with the 110 caregivers were conducted in Chinese by the senior author during the fall of 1997 and 1998. Most of the interviews were conducted in the caregiver’s home, although a few were conducted in the caregiver’s workplace during lunch break or in an agreed-on public meeting place. Each participant was given a questionnaire written in Chinese and asked to either complete the questionnaire or allow the investigator to read the questions and complete the form for the participant. Only 18 caregivers chose to complete the form themselves. Information collected through the interview process included basic demographic data, the health and functional status of the elder and the caregiver, caregivers’attitudes and beliefs about caregiving responsibilities, and the type and extent of assistance that the caregiver was providing to the parent or parent-in-law. Sample Description Caregiver characteristics. The demographic characteristics for both the elders and the caregivers included in the sample are shown in Table 1. The majority (68 percent) of the caregivers in the sample were women. The caregivers ranged in age from 27 to 60, with the vast majority (86 percent) being between the ages of 30 and 49. All but seven of the caregivers were married. Fifty-six of the caregivers were daughters assisting parents, 19 were daughters-in-law assisting parents-in-law, 33 were sons assisting their parents, and 2 sons-in-law were primary caregivers for their fathers-in-law. Coresidence with parents or parents-in-law in this sample did not occur as frequently as in other studies, which have reported rates greater than 80 percent (Lavely and Ren 1992). Nearly half of the caregivers (46 percent) did not live with their care recipients. About a third (31 percent) of the caregivers lived with parents, while 23 percent lived with parents-in-law. One of the major reasons for this difference in patterns of coresidence was that caregivers in this sample resided in urban interior China where elders were more likely to own apartments and live by themselves than is the case among rural elders. The large majority (86 percent) of the caregivers had at least a middle school education, and their mean income was between 200 to 300 yuan (or $25 to $35) per month. Nearly half (43.6 percent) of the interviewees reported that they were not working full-time. Most of these caregivers were laid off; however, a few reported going to their former workplace to register their presence, but they rarely obtained work. While most caregivers (66.4 percent) received no reimbursement for medical Zhan, Montgomery / GENDER AND ELDER CARE IN CHINA 215 Downloaded from gas.sagepub.com at UCSF LIBRARY & CKM on January 27, 2015
216 GENDER SOCIETY /April 2003 TABLE 1: Characteristics of Elders and Caregivers(N=110) Elders Caregivers Variable n ojo n % Sex Men 3 29.1 5 31.8 Women 78 70.9 75 68.2 Age 20-29 2.8 30-39 43.1 40-49 4 43.1 50-59 3.6 10.0 60-69 41.9 1 0.9 70-79 1613 41.9 80-89 11.8 90 and older 》 0.9 Marital status Married o 53.6 104 94.5 Widowed 42.7 0.9 Divorced 3.6 42 3.6 Other(never married) 18 Relationship between caregiver and care recipient Daughters caring for parents 56 50.9 Daughters-in-law caring for parents-in-law 19 17.3 Sons caring for parents 30.0 Sons caring for fathers-in-law 1.8 Living arrangements With parents 30.9 With parents-in-law 22.7 Elders by themselves or alone 34655 46.4 Individual income None 36 33.0 5 7.4 Less than 200 yuan 2 25.5 21.5 201-400yuan 25.5 35.5 401-600yuan 17 15.5 41 37.3 More than 600 yuan 5.9 3.6 Educational levels No formal education 52 47.3 244 1.5 5 years or less 19.1 12.7 Middle school 10 9.1 30.9 High school 10.9 验 47.3 College 1.5 62 5.5 Beyond college 1.5 1.8 Percentage of medical bills reimbursed 0 70 63.6 66.4 Less than 50 23 33.8 14 12.7 Greater than 50 1 15.4 19.1 Downloaded from gas.sagepub.com at UCSF LIBRARY CKM on January 27.2015
216 GENDER & SOCIETY / April 2003 TABLE 1: Characteristics of Elders and Caregivers (N = 110) Elders Caregivers Variable n % n % Sex Men 32 29.1 35 31.8 Women 78 70.9 75 68.2 Age 20-29 3 2.8 30-39 47 43.1 40-49 47 43.1 50-59 4 3.6 11 10.0 60-69 46 41.9 1 0.9 70-79 46 41.9 80-89 13 11.8 90 and older 1 0.9 Marital status Married 59 53.6 104 94.5 Widowed 47 42.7 1 0.9 Divorced 4 3.6 4 3.6 Other (never married) 2 1.8 Relationship between caregiver and care recipient Daughters caring for parents 56 50.9 Daughters-in-law caring for parents-in-law 19 17.3 Sons caring for parents 33 30.0 Sons caring for fathers-in-law 2 1.8 Living arrangements With parents 34 30.9 With parents-in-law 25 22.7 Elders by themselves or alone 51 46.4 Individual incomea None 36 33.0 5 7.4 Less than 200 yuan 28 25.5 23 21.5 201-400 yuan 28 25.5 39 35.5 401-600 yuan 17 15.5 41 37.3 More than 600 yuan 4 5.9 4 3.6 Educational levels No formal education 52 47.3 2 1.5 5 years or less 21 19.1 14 12.7 Middle school 10 9.1 34 30.9 High school 12 10.9 52 47.3 College 1 1.5 6 5.5 Beyond college 1 1.5 2 1.8 Percentage of medical bills reimbursed 0 70 63.6 73 66.4 Less than 50 23 33.8 14 12.7 Greater than 50 17 15.4 21 19.1 Downloaded from gas.sagepub.com at UCSF LIBRARY & CKM on January 27, 2015
Zhan,Montgomery GENDER AND ELDER CARE IN CHINA 217 TABLE 1(continued) Elders Caregivers Variable n % n % Full-time employment Yes 61 55.5 No 48 43.6 Received pension Men 31 91 Women 33 42.9 NOTE:Percentages may not sum up to 100 due to missing data. a.At the current rate,100 yuan equals roughly $12. expenses or doctor visits,some reported they supposedly had insurance that pro- vides coverage only for hospitalization. Elder characteristics.Different from the United States where most elders do not become physically dependent until after age 80,a large majority of Chinese elders in this sample(87.4 percent)were physically dependent between the ages of 50 and 79.Slightly more than half of the elders were married(54 percent),47(43 percent) were widowed,and the remaining 4(4 percent)care recipients were divorced. However,3 of the divorced elders were remarried.Nearly half(47.3 percent)of the care recipients had no formal education.The mean income for these recipients was between 100 and 200 yuan (or $15 to $25)per month,which was generally lower than that of the caregivers due to the lack of pensions.Almost two-thirds(63.6 per- cent)reported having no medical coverage.In most cases,even those elders who had medical coverage relied on their children for medicines,doctor visits,and/or hospitalization due to their own meager coverage. Variables and Their Measurement Dependent variables.Three measures representing different aspects of caregiving performance were included in the analyses as dependent variables: hours spent on care tasks per week,frequency of personal care tasks,and level of financial assistance.The measure of hours spent per week was a summary score that included three items that ascertained the number of hours a caregiver spent each week performing personal care tasks,household chores,and transportation. The measure had a reliability of.80. The measure of personal care captured the frequency with which a caregiver assisted an elder with six tasks:Bathing,shaving,changing,daily laundry,toilet usage,and handling daily bills.Caregivers used a five-point response set to code these items that ranged from once a month to every day.The six-item composite score had an internal reliability of.91. Downloaded from gas.sagepub.com at UCSF LIBRARY CKM on January 27.2015
expenses or doctor visits, some reported they supposedly had insurance that provides coverage only for hospitalization. Elder characteristics. Different from the United States where most elders do not become physically dependent until after age 80, a large majority of Chinese elders in this sample (87.4 percent) were physically dependent between the ages of 50 and 79. Slightly more than half of the elders were married (54 percent), 47 (43 percent) were widowed, and the remaining 4 (4 percent) care recipients were divorced. However, 3 of the divorced elders were remarried. Nearly half (47.3 percent) of the care recipients had no formal education. The mean income for these recipients was between 100 and 200 yuan (or $15 to $25) per month, which was generally lower than that of the caregivers due to the lack of pensions. Almost two-thirds (63.6 percent) reported having no medical coverage. In most cases, even those elders who had medical coverage relied on their children for medicines, doctor visits, and/or hospitalization due to their own meager coverage. Variables and Their Measurement Dependent variables. Three measures representing different aspects of caregiving performance were included in the analyses as dependent variables: hours spent on care tasks per week, frequency of personal care tasks, and level of financial assistance. The measure of hours spent per week was a summary score that included three items that ascertained the number of hours a caregiver spent each week performing personal care tasks, household chores, and transportation. The measure had a reliability of .80. The measure of personal care captured the frequency with which a caregiver assisted an elder with six tasks: Bathing, shaving, changing, daily laundry, toilet usage, and handling daily bills. Caregivers used a five-point response set to code these items that ranged from once a month to every day. The six-item composite score had an internal reliability of .91. Zhan, Montgomery / GENDER AND ELDER CARE IN CHINA 217 Full-time employment Yes 61 55.5 No 48 43.6 Received pension Men 31 91 Women 33 42.9 NOTE: Percentages may not sum up to 100 due to missing data. a. At the current rate, 100 yuan equals roughly $12. TABLE 1 (continued) Elders Caregivers Variable n % n % Downloaded from gas.sagepub.com at UCSF LIBRARY & CKM on January 27, 2015
218 GENDER SOCIETY/April 2003 Level of financial assistance was measured by the amount of money caregivers spent on food,clothing,medicine,doctor's visits,home care,and hospitalization for one's relative.Respondents used a five-point response set ranging from the elder pays it all to we pay it all to answer these questions.The Cronbach's alpha for financial assistance was.98. Independent variables.Three sets of independent variables were included in the regression analysis:caregiver/care recipient attributes,the cultural aspects of xiao. and the structural constraints of family resources.The first set of variables included the gender of the caregiver and four control variables representing characteristics of the care recipient:the gender and marital status of the care recipient and two mea- sures of the elder's functional level.The elder's need for assistance with ADL was measured with four items using a five-point response set ranging from 1 =no help needed to 5=cannot perform the activity.The items included using the toilet,dress- ing,moving in and out of the bed and chairs,and eating.The mean score was 2.96, and the internal reliability alpha for ADL was.94.The elder's need for assistance with IADL was measured with eight items:bathing,doing light housework,doing heavy housework,laundry,shopping,mobility outside,transportation,and money management.The mean score was 4.19,and the Cronbach's alpha level was.96. Two measures were constructed to capture the cultural attitudes associated with xiao.These measures of patrilocal norms and social pressure were constructed from items adapted from measures developed by Montgomery(1996),Gallois et al. (1996),and Choi (1993)and were adjusted to correspond to the Chinese context. Caregivers were asked to respond by using a five-point scale ranging from com- pletely disagree to completely agree.The three items included in the measure of patrilocal norms reflect a traditional cultural norm for elder care under the patri- local family structure,which may differ from the contemporary urban practice of elder care."The three items included in the measure of social pressure reflect a per- son's psychological or emotional acknowledgment of peer pressure as the major impetus for provision of care.The Cronbach's alphas for the measures of patrilocal norms and social pressure were.73 and.70,respectively. The third set of independent variables was intended to capture the structural con- straints placed on the family resources.These included measures of the caregiver's monthly income and two dichotomous variables indicating the employment status of the caregiver and whether the elder received a pension.A measure reflecting the elder's receipt of medical benefits was originally included in the study but was omit- ted from this analysis due to its high correlation with receipt of a pension(r=.72). Family size was measured as the number of family members available to be involved with care for the dependent elder.Other than assistance from a dependent elder's living spouse,family assistance virtually always refers to help from the caregivers'siblings.There were twoexceptions in this sample:One woman assisted briefly with the care of her daughter's mother-in-law,and another granddaughter provided most of the financial assistance for the care of her grandmother. Downloaded from gas.sagepub.com at UCSF LIBRARY CKM on January 27.2015
Level of financial assistance was measured by the amount of money caregivers spent on food, clothing, medicine, doctor’s visits, home care, and hospitalization for one’s relative. Respondents used a five-point response set ranging from the elder pays it all to we pay it all to answer these questions. The Cronbach’s alpha for financial assistance was .98. Independent variables. Three sets of independent variables were included in the regression analysis: caregiver/care recipient attributes, the cultural aspects of xiao, and the structural constraints of family resources. The first set of variables included the gender of the caregiver and four control variables representing characteristics of the care recipient: the gender and marital status of the care recipient and two measures of the elder’s functional level. The elder’s need for assistance with ADL was measured with four items using a five-point response set ranging from 1 = no help needed to 5 = cannot perform the activity. The items included using the toilet, dressing, moving in and out of the bed and chairs, and eating. The mean score was 2.96, and the internal reliability alpha for ADL was .94. The elder’s need for assistance with IADL was measured with eight items: bathing,1 doing light housework, doing heavy housework, laundry, shopping, mobility outside, transportation, and money management. The mean score was 4.19, and the Cronbach’s alpha level was .96. Two measures were constructed to capture the cultural attitudes associated with xiao. These measures of patrilocal norms and social pressure were constructed from items adapted from measures developed by Montgomery (1996), Gallois et al. (1996), and Choi (1993) and were adjusted to correspond to the Chinese context. Caregivers were asked to respond by using a five-point scale ranging from completely disagree to completely agree. The three items included in the measure of patrilocal norms reflect a traditional cultural norm for elder care under the patrilocal family structure, which may differ from the contemporary urban practice of elder care.2 The three items included in the measure of social pressure reflect a person’s psychological or emotional acknowledgment of peer pressure as the major impetus for provision of care.3 The Cronbach’s alphas for the measures of patrilocal norms and social pressure were .73 and .70, respectively. The third set of independent variables was intended to capture the structural constraints placed on the family resources. These included measures of the caregiver’s monthly income and two dichotomous variables indicating the employment status of the caregiver and whether the elder received a pension. A measure reflecting the elder’s receipt of medical benefits was originally included in the study but was omitted from this analysis due to its high correlation with receipt of a pension (r = .72). Family size was measured as the number of family members available to be involved with care for the dependent elder. Other than assistance from a dependent elder’s living spouse, family assistance virtually always refers to help from the caregivers’siblings. There were two exceptions in this sample: One woman assisted briefly with the care of her daughter’s mother-in-law, and another granddaughter provided most of the financial assistance for the care of her grandmother. 218 GENDER & SOCIETY / April 2003 Downloaded from gas.sagepub.com at UCSF LIBRARY & CKM on January 27, 2015
