Elderly Care and Gender Dynamics in a Tibetan Village in Northwest China: Changes and Challenges

Literature Review: Social Transformations, Elderly Care and Gender Dynamics Among Tibetans

Conventionally, parental authority is highly respected by children, and caring for aged parents is a morally and religiously charged endeavor among Tibetans (Childs, 2008). Filial piety, a common term used to describe parent-child relations in many Asian societies, is a common Tibetan family ethics. Filial piety is believed to be one of the highest moral virtues continuously valued by contemporary Tibetans, and one of the main aspects of Tibetan children’s socialization in families (Fu, 2011).

However, in recent decades, rapid social transformations have occurred in nearly every aspect of Tibetan society in China (Levine, 2015; Yeh & Makley, 2019). The fertility rate has declined rapidly, and life expectancy has increased among Tibetans, resulting in both the Tibetan population and the proportion of the Tibetan population aged above 60 years rising rapidly (Childs, 2008; Fischer, 2008).

These changing social dynamics make it important to explore their impact on the ethics and provision of elderly care among Tibetans. To date, several important studies have been conducted in the Tibetan regions to explore the impact of social changes on elderly care. For instance, Goldstein, Childs, Puchung, and Beall (2013) revealed that the situation of the elderly in rural Tibet is better than that reported for the rural elderly elsewhere in China because the extent of social transformations in rural Tibetan areas has not yet reached that of other parts of rural China. The Tibetan elderly co-reside with the younger generations, have authority within households, and have subsistence farming livelihoods (Wang, 2018). Despite demographic changes in recent years, most people still live in stem family households, and parent-child relations are as important as, if not more than, conjugal relationships between spouses (Childs, 2008).

Traditional gender relations in Tibetan society are heterogeneous and vary across vast and diverse geographical and cultural landscapes (Goldstein, Jiao, Beall, & Tsering, 2002). Overall, Tibetan family relations are predominantly monogamous, patriarchal, and patrilocal; often, a woman marries into a household managed by her parents-in-law as the household decision-maker and is in charge of the family budget (Goldstein et al., 2002; Levine, 1987). Sons are more likely to inherit family wealth, including parental homes, are seen as more likely to make greater economic contributions to households, and are expected to financially support aging parents, whereas women are mostly confined to reproductive and caring roles within households (Levine, 1987; Rajan, 2016). Some Tibetans might also view women as prone to be “jealous, closed-minded, and too easily offended” and of “inferior birth” (Rajan, 2018, p. 276–277). Thus, women take up the heaviest labor with the least decision-making power under highly gendered norms and relations (Makley, 1997).

Tibetan women are increasingly involved in income-earning employment (Rajan, 2016). As the “Open up the West” campaign was initiated in 2000 to mitigate the development gap between eastern and western China, as well as rural and urban areas, Tibetan regions witness trends of rapid marketization and urbanization (Fischer, 2011; Makley, 2018; Yeh & Makley, 2019). Marketization and urbanization of Tibetan society, on the one hand, entail increasing pressure for Tibetan families to earn cash income and, on the other hand, provide women with more job opportunities and cash income: women leave home to engage in seasonal labor for pay, along with men. In some cases, women are more likely than men to leave home to earn cash income for rural families. These changes have empowered Tibetan women with increased decision-making power in their families (Rajan, 2016).

Tibetan women’s access to formal schooling has also expanded. Studies conducted in the 1990s and the early 2000s observed high dropout rates and reluctance among Tibetans to send their children to school (Gelek, 2006). However, over the last two decades, Tibetan student school enrolment rates have been rising (Ying, 2021). In Qinghai Province, the primary school enrolment rate of school-aged Tibetan girls reached 99.4 percent in 2012, and an increasing number of Tibetan women are receiving higher education (Li, 2015). However, little is known about how changing gender dynamics shape elder-care ethics and provisions among Tibetans.

It has been observed elsewhere that women’s access to education and participation in employment has increased, and gender norms, elderly care ethics, and relations have changed in complex ways. For instance, Otis-Green and Juarez (2012) suggested that educated and economically independent women are more likely to seek information, make informed decisions about care options, and advocate for the well-being of their elderly family members. Other studies (Dhanaraj & Mahambare, 2019) revealed that women’s economic independence can alleviate the burden of caregiving on elderly people by providing professional caregiving services or support from external sources (Pinquart &Sörensen 2007; Roth, Fredman, & Haley, 2015).

There was also an increasing demand for men to cross the boundaries of conventional gender roles by caring for elderly parents and spouses once their wives began to become involved in the labor market (Long & Harris, 2000; Russell, 2007). In rural China, empowered daughters-in-law also have more bargaining power in their husbands’ homes and can provide resources and support to their aged natal parents (Shi, 2009).

However, while women’s economic independence and empowerment can have positive effects on care for elderly adults, several studies (Boudet, 2013; Razavi, 2015) highlight the persistence of gender norms and societal expectations that hinder women’s ability to fully engage in paid work or exercise decision-making power regarding care for elder adults. Other studies (Bardasi & Wodon, 2010; Razavi, 2007) have demonstrated that women’s caring roles are still emphasized despite their increased access to education and participation in employment, raising women’s overall responsibilities.

In rural China, rising “girl power” challenges the patriarchal order in rural families when a young woman has started to impose her own will on her parents-in-law (Yan, 2003). Young girls even challenge age-old notions of filial piety and parenthood and insist on a new principle of exchange; that is, if parents do not treat their children well or are otherwise not good parents, the children have reason to reduce the scope and amount of generosity to their parents. These observations provide a complex picture of gender dynamics and their implications for elderly care. Within this context, this study explored the abovementioned research questions.

Research Site

This research was conducted in Chuka (pseudonym), a rural Tibetan village five kilometers away from Rebgong (Chi. Tongren) City Town in Huangnan Tibetan Autonomous Prefecture, Qinghai Province, Northwest China, for 14 months (from April 2020 to December 2020, and April 2021 to August 2021). According to the 2020 Qinghai Provincial Statistical Yearbook, there are approximately 1.53 million Tibetans in Qinghai, constituting 25.23 percent of the provincial population (Qinghai Province Bureau of Statistics, 2020). They comprise the largest ethnic minority population in the province and live across large, sparsely populated areas outside Xining, the provincial capital city.

I chose Rebgong City as my field site because it has a large Tibetan population, and like many other Tibetan areas, it is undergoing rapid social transformation. Located in the Qinghai Province, Rebgong is 160 km south of Xining, the capital city of the province. Tibetans comprise 72.52 percent of the county’s population (94,000) along with smaller populations of multiple ethnic groups (Ying, 2023). Various state-led development campaigns have been in place in Rebgong since the beginning of the twenty-first century. In July 2020, the county was officially upgraded to a city, setting off a wave of government-initiated urban expansion and the construction of new roads, apartment buildings, public facilities, and school campuses in the valley (Qinghai News Website, 2020).

Chuka is a Tibetan village with 340 households and 1460 people. Subsistence agriculture is the main source of livelihood for rural families, but under the current socioeconomic transformation and marketization, cash income is considered more important than agricultural production to cover different expenditures, such as children’s education, building new homes, medical costs, phone bills, and the purchase of vehicles and motorcycles. Nowadays, Chuka people are mainly involved in temporary wage labor, harvesting caterpillar fungi, painting thang-kha², engaging in carpentry, or running small businesses to earn cash income.

Data Collection

Data were collected through household surveys and interviews with village elders and caregivers. First, to capture information about family structures, living arrangements, educational levels, livelihood strategies, incomes, and care arrangements, household surveys were conducted in all the households with at least one elderly person aged 60 years or above, thus,77 households were identified among the total of 340.

Next, in-depth semi-interviews were conducted with the elderly and their caregivers in those 77 households. An initial analysis of household surveys showed that there were 100 elder adults (34 males and 66 females) aged above 60 years in Chuka. Based on random sampling, 105 people were interviewed, including 73 elder adults (32 males and 41 females) and 32 caregivers (12 males and 20 females) from 77 households.

All the household surveys and interviews were conducted with the aid of a local research assistant. Through local connections in Rebgong, I hired a female research assistant from Chuka Village. She assisted me in my research in multiple ways. First, she served as a gatekeeper to gain access to the community. Second, a person from the local community would typically be concerned with the health and welfare of community members and thus could reduce or prevent any potential harm that might arise from this research. Third, conducting research with a female research assistant mitigated the patriarchal relations between me as a male and the caregivers, who were mostly female.

Data Analysis

Data from the household surveys were analyzed to acquire descriptive statistics on family sizes, structures, living arrangements, schooling levels, care patterns, economic roles, and families’ economic conditions. During the analysis, I categorized family members into generations A, B, C, and D (See Table 1) based on their relationships with the elders in the families. People from Generation A (GA) were older adults aged 60 and above; Generation B ( GB) were the children of the elderly, including their sons, daughters, sons-in-law, daughters, nieces, and nephews. They were the main caregivers of the GA.

Table 1

Categorization of generations

Generation C (GC) were the grandchildren of the elderly, some of whom also took on caregiving roles. Generation D comprised the great-grandchildren of the elderly, who were predominantly born in the new millennium to GC and were mostly enrolled in school; thus, they were not interviewed in my research. In total, there were 100 elderly adults in the GA, 135 in the GB, and 106 in the GC in 77 households.

This method of generational categorization makes it possible to better analyze and illustrate the changing gender and intergenerational dynamics and their implications for family care relations in Chuka. School levels, caregiving, domestic chores, and economic roles were further analyzed for comparison between the male and female groups in each generational cohort.

Interview recordings were transcribed and translated simultaneously from Amdo Tibetan into English and analyzed using a content analysis method to code themes and sub-themes regarding gender dynamics and care relations.

In my research, the principles of not harming the research subjects, receiving their informed consent, and not exploiting or revealing the identity of my informants were the foremost important ethical practices. I also went through an ethics screening process via the Research Ethics Committee within International Institute of Social Studies, Erasmus University Rotterdam, and got their approval to carry out this research.

Household Structures and Living Arrangements in Chuka

Chuka has a large household size. In 2021, there were 340 households with a total population of 1460 people and an average household size of 3.5, which was larger than both the Qinghai provincial average household size, 2.79 (Qinghai Province Bureau of Statistics, 2021), and the national average household size, 2.62 (National Bureau of Statistics, 2021a). The percentage of the population aged above 60 years in Chuka was 6.85 percent, lower than the percentage of the same population group at the prefectural level (8.34 percent) and much lower than those at the provincial (12.15 percent) and national (18.7 percent) levels (National Bureau of Statistics, 2021b).

The extended family or multigenerational co-residence in patrilocal families was the main basis of elderly care in Chuka families. As Figure 1 indicates, among the 77 households, 12 were one-generation households with only elderly people. The remaining 65 households had at least two generations: four two-generation households, 46 three-generation households, and 15 four-generation households.

Figure 1.

Household structures in Chuka Village

Elderly people also had different living arrangements (Figure 2); among 100 elders, there were 80 elders (from 65 households) living with at least one younger generation whereas four elders lived alone (from four households) and 16 lived with their spouses (from eight households).

Figure 2.

Living arrangement of the elders

Under such household structures and living arrangements, care in intergenerational households was mainly provided by sons and daughters-in-law (55 of 77 households), but some elders were cared for by daughters, sons-in-law, and other relatives. Although co-residency does not automatically guarantee full care and support for the elderly, there is a strong correlation between co-residence, intergenerational resource flows, and support (Croll, 2006; Eklund & Göransson, 2016). The multigenerational co-residence arrangement in Chuka guaranteed that the elderly received, at least, financial support, health care, and daily life support from their adult children and grandchildren. Under such living arrangements, I explored how gender dynamics are changing and how elderly care ethics and relations have been shaped by the changing gender dynamics in Chuka families.

Changing Gender Dynamics

My findings show that recent social transformations have shaped gender dynamics and changes in Chuka. For instance, women’s access to education has expanded rapidly across generations. Drolthar, an 81-year-old woman, said,

Very few Tibetan girls in Rebgong would have attended school in my time. But in the last two decades, more and more girls attended school and some even pursued postgraduate studies.

Chuka women born after the late 1980s generally had higher levels of education than their parents and parents-in-law. This parallels China’s adoption of the 1986 Compulsory Nine-Year Education Law. In 2021, almost all school-aged girls in Chuka will be enrolled in primary and junior secondary schools. Anecdotes indicate that there were at least tens of female PhDs from Rebgong now.

This intergenerational rupture in women’s education was captured well by my household surveys (Table 2). First of all, a comparison of average years of schooling of women in GA (1.5 years), GB (2.2 years) and GC (10.5 years) shows that years of schooling for women in GC had increased dramatically. Meanwhile, the gender gap in the average number of years of schooling has disappeared in recent years. For GA, male elderly participants had more years of schooling (3.1) than female elderly participants (1.5), and for GB, men had more years of schooling (5.3) than women (2.2). However, this gender gap had almost vanished recently as women’s average years of schooling for GC reached 10.5 years, in comparison to 10.8 years for men, and more women (14) than men (13) were enrolled in tertiary education.

Table 2

Years of schooling of generations A, B and C by sex

Amid wider socioeconomic transformations, more women in Chuka were involved in urban-based cash-generating employment. There were two, 45, and 24 women from GA, GB, and GC in Chuka enrolled or enrolled in case-generating activities, respectively (Table 3). The rate of involvement in the labor market for GC was lower than that for GB, as 38 students and 11 recently graduated students were preparing for job recruitment exams.

Table 3

Involvement in labor market by generations A, B and C by sex

GB women who participated in the labor market were mostly engaged in jobs such as day labor and running small businesses. For instance, Lhamo (GB), a 37-year-old woman with a primary school education, worked on construction sites for approximately eight months per year, with a monthly salary around RMB3000. Drolgar (GB), a 34-year-old woman with a high school education, worked as a cashier in a restaurant in Rebgong for 11 months per year, earning a monthly salary of approximately RMB2000. Their participation in the labor market increases families’ financial capacities and their own family status. Both Lhamo and Drolgar mentioned that they made many household decisions during negotiations with their husbands and parents-in-law.

With increasing access to education and employment opportunities, women in Chuka, particularly younger women with more education, were inclined to be influenced by the values of gender equality and individual autonomy and challenged traditional gender norms and unequal family relations. For instance, in a religious village gathering, male villagers sat in the upper part of the yard, whereas all female villagers sat in the lower parts near the gate, as was the convention. However, some female college students sat with the males and resisted moving, even though some elderly women gestured to do so. A female college student recalled that when she attended a chanting ritual with a shorter skirt and with her hair down to the shoulders without being plaited, her mother urged her to go home and change her clothes and braid her hair, but she refused.

Puma (GA), a 75-year-old man, believed that younger women in his village had increased their personal autonomy in making marital decisions.

Before, marriages were arranged by parents and people considered marriage as something more static than nowadays. A woman whose husband died when she was young might remain widowed in her husband’s home. However, attitudes toward marriages have been changing. Young women choose whom to marry and when by themselves. A daughter-in-law might just leave or stay away from her parents-in-law if she thinks she is unhappy or mistreated by the parents-in-law.

Young women tend to express their own needs and make decisions for themselves. Even though Namgyid’s (GB) mother-in-law expected her to work in the field and engage in temporary migrant work, which bore no risk of bankruptcy, Namgyid insisted on and received funds from her mother-in-law to run a shop. Such changing gender dynamics raise important questions about family care ethics and relations in a society where women are conventionally the main caregivers.

Elderly Care and Gender Dynamics

Even though women had increased educational attainment and economic independence, men were still highly respected and held a higher status in the family and village, while women generally tended to be quiet, humble, submissive, and occupied with household chores, and elderly care within the realm of the Tibetan family was still highly gendered. As Table 4 shows, in contemporary Chuka, women still assume the lion’s share of everyday caregiving responsibilities within their households. In total, there were 341 people (183 females and 158 males) in 77 households with at least one elderly person. Of the 183 females, 129 (70.5%) performed caring responsibilities, while only five males (3.2%) performed caring responsibilities out of 158 males. It should be noted that outside the domestic sphere, men were also responsible for earning financial income to support the elderly or support the elderly through activities such as driving to the hospital or pilgrimages; however, within the domestic sphere, it was mainly the female’s responsibility to take care of the elderly family members.

Table 4

Involvement in elderly care by generations A, B and C by sex

Another prominent feature was that female within households performing care responsibilities based on their identities as mothers, spouses, mothers-in-law, daughters-in-law, and daughters. For instance, statistics show that more than half of elderly women from GA provided self-care and care for their spouses. Among the 12 single-generation households with only elderly people, female elders mostly provided care for themselves and their spouses.

There were four generations of households. These included a household with an elderly woman in her early 60s and her two unmarried sons in their mid-twenties; a household with an elderly woman in her late 60s and her unmarried son in his mid-thirties; a household with an elderly couple in their early 60s and their two unmarried sons in their mid-twenties; a household with an elderly woman in her early 80s and her son and daughter in-law in their early 50s. In the first three two-generation households with elderly people in their 60s, the elderly mothers were caregivers for their sons and themselves. In the last household with a daughter in her early 50s, she was the main caregiver for her mother-in-law.

Women in GB were the main caregivers, and 67 of the 68 women from GB took up elderly care responsibilities. The proportion of women in GC performing care responsibilities was lower than that in GB because many of them were college students or had recently graduated from colleges and were preparing for exams for jobs. Staying in rural communities and being involved in agriculture was not a desired option for them. They were more likely to be involved in the labor market in the future (Washul, 2018). Thus, they were less likely to perform caring responsibilities than their parents did when they reached the parents’ age.

In particular, daughters were expected to be hardworking, caring, and responsible for family care and household chores. They were expected to take over the mother-in-law’s family care tasks and become the primary caregivers within the family. As Tsegyid (GA), an elderly woman in her 60s, recollected, after she got married, she would get up first in the morning every day, make a fire on the stove, prepare breakfast, and clean the house before others in the family got up.

Daughters-in-law in their early 50s in three- and four-generational households were especially burdened by care responsibilities. Many of these daughters gave up on economic opportunities to care for their families. As individual narratives demonstrate, faced with a dilemma in their caregiving and economic roles, some women, mostly from GB, were compelled to compromise their choices and economic roles. As Sonam explained,

My wife wanted to go out and do day laboring or digging caterpillar fungus for money (cash income), but I didn’t let her go. It would be very difficult for my old parents to take care of themselves and our children. So I let my wife stay at home to take care of my parents and our children.

Similarly, Dortso (GB) also gave up her aspiration for economic independence for elderly care responsibilities despite wanting to earn a cash income.

I would really like to go for day laboring and have some cash with me. I need to buy many things for the family such as vegetables, meat, and snacks for children. I ask money from my husband. I always feel uneasy asking for money from my husband even though I spend all the money on family stuff. But my husband does not know the needs of the family and sometimes complained that I have spent too much. If I had some cash income, I could buy whatever I want for the family. But I need to take care of the children and my mother-in-law. So, I just stay at home.

Daughters-in-law in the four-generation households were especially burdened with care responsibilities. They not only needed to care for their parents-in-law, but also for their grandchildren. Dromo (GB), a daughter-in-law in her 40s, explained:

I would like to go and earn some cash income in Rebgong City, but I need to take care of my parents-in-law and the children [her grandchildren]. I am tired with the endless chores at home. I don’t have time to rest. Doing day laboring not only can earn some money, but sometime is not as labor intensive as doing endless household chore. But I need to care for my family.

As indicated by the narratives above, women from GB often gave up their economic opportunities to care for family. In other words, not all women who have a desire to be involved in cash-earning work were able to do so because they were bound by family responsibilities and caring work within families. These narratives demonstrate rural Tibetan women’s lack of capacity to choose their preferred way of living because of their highly gendered caregiving responsibilities.

Moreover, as Dortso’s statement shows, the compromises made by women between productive and reproductive roles make them more vulnerable in the family and in relation to male family members, as they are deprived of the means to improve their economic capacity. Even if some women were capable of being involved in a cash-based economy, their roles as primary caregivers were emphasized, and their roles as mothers and housekeepers were regarded as their primary responsibilities. Thus, women’s burdens increase when they engage in both productive and reproductive roles. Sharwotso (GB), a daughter-in-law in her early 40s, described her daily routine.

I go for day laboring in a construction site in Rongbo Town for two months. Every day, I go to work at six o’clock in the morning and come back at seven o’clock in the evening. I also cook dinner and bake bread for grandpa (her father-in-law) and my children after coming back from work in the evenings. Occasionally, I do the laundry for grandpa and the children when the weather does not allow me to work on the construction site.

Daughters who married into families in Chuka were particularly supportive of their natal parents. As his son and daughter-in-law were working as migrants in Xining, Dorjebum (GA), a 65-year-old man, lived alone on weekdays. On weekends, his grandchildren returned home from school. Most of the time, Dorjebum’s daughter, who married into another family in Chuka, cooks and does laundry for her father and children. Therefore, in accordance with recent scholarly observations made in other Tibetan and non-Tibetan contexts in and outside China (Childs, Goldstein & Wangdui, 2011; Shi, 2009; Wang, 2018), changing gender norms and relations brings better elderly care experiences for aging parents from their daughters, who become an important source of support for their natal families.

However, with increased levels of educational attainment and labor participation, daughters-in-law in their 30s in three- and four-generational households were capable of negotiating certain caregiving and gender roles. As mentioned earlier, in their 30s, both Lhamo and Drolgar were daughters-in-law and involved in a cash-based economy for an extended period of a year. Both mentioned that because they were mostly based in Rebgong City, they could not provide much care to their parents-in-law and children.

In some families, rising assertiveness, involvement in economic roles, and decision-making power among younger generations of women might also cause tensions and conflicts in family relations, which seemed to particularly impact the emotional well-being of elderly. For instance, many elders complained that the elderly care and respect they received from their daughters-in-law decreased as daughters-in-law were not as compliant as expected of women in old times. Phatar (GA), an elderly man in his 80 recounted,

My parents always told my wife to do this and to do that... But now as a father-in-law, I try my best to keep my mouth shut and say nothing to my daughter-in-law because there would be a family conflict if we tell our daughter-in-law to do this, to do that, or blame her for anything.

Several elders recollected that even in cases of disagreement with their daughters-in-law, they made concessions and kept quiet. Meanwhile, there were a few cases in which younger generations of women may have completely disregarded their family care responsibilities. For instance, after getting married, Tsomo (GB), the daughter-in-law of Tsejyi (GA), refused to take care of her parents-in-law and took her husband to live with her natal parents, leaving Tsejyi and Tsejyi’s husband, who was paralyzed uncared for. Kandrol, a woman in her 90s, was also left alone by her son and daughter-in-law, with whom she had conflicts. The findings in this section show the complex dynamics of gender norms and relationships and elderly care in Chuka.