Papers in Population Ageing No. 6 · iii Papers in Population Ageing No. 6 Asia and the Pacific...

iii

Papers in Population Ageing No. 6

Asia and the Pacific Regional OfficeBangkok, July 2009

DEMOGRAPHIC PROGNOSIS FOR SOUTH ASIA:A future of rapid ageing

Ghazy MujahidK.A.P. Siddhisena

iv

Acknowledgements

The preparation of this Report has been made possible by the contribution of several colleagues. ToMr. G. Giridhar, former Director of the UNFPA Country Technical Services Team for East and South-East Asia, Bangkok, we owe thanks for encouraging us to undertake the study. We owe gratitude toMs. Nobuko Horibe, Director, UNFPA Asia and the Pacific Regional Office, Bangkok for her constantencouragement and support at every stage of the study until its completion. We are indebted to Mr.Najib Assifi, Deputy Regional Director and Rep. in Thailand and Dr. Saramma Mathai, RegionalTeam Coordinator and Maternal Health Adviser of the UNFPA Asia and Pacific Regional Office fortheir able supervision and guidance without which this Report could not have seen the light of day.

All UNFPA Representatives in the South Asia region and the staff of the eight Country Officesprovided valuable inputs for their respective country briefs in section 5 and the illustrations. We wouldlike to thank them profusely for enriching the Report with their contributions and saving us theembarrassment of having gaps in country specific information.

We wish to acknowledge the valuable advice of Professor Lindy Williams of the Department ofDevelopment Sociology, University of Cornell (USA.) We wish to thank Mr. Pongthorn Raksawongfor assistance in compiling the statistics and to Ms. Suchitra Thamromdi for ungrudgingly providingsecretarial support. We are indebted to Ms. Udari Pereira of the University of Colombo andMs. D.M.M. Dissanayake of the Department of Women’s and Child Development for compilingresearch materials and data for Sri Lanka. Finally, to Ms. Duangurai Sukvichai, we owe gratitude forher diligence and meticulous efforts in supervising the printing of the Report.

K.A.P. Siddhisena Ghazy MujahidProfessor, former Population Policies AdviserUniversity of Colombo, UNFPA Asia and the Pacific Regional OfficeSri Lanka Bangkok

v

Foreword

Population ageing that had, until the turn of the century, remained a phenomenon largely exclusive tothe developed countries has been manifesting itself in an increasing number of less developedcountries. This Report shows how, after a late decline in fertility relative to South-East Asia and EastAsia, South Asia too is set on a course of rapid ageing. The eight countries of South Asia - Afghanistan,Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka - present marked diversity withrespect to population size, political structures and levels of human development. In all countries,including Afghanistan where a conflict situation has persisted for the past three decades, the increase inthe older population is projected to be far greater than during the past four to five decades.

The Report describes the current situation of population ageing and how it is expected to evolve until2050. It discusses the causes and consequences of the unprecedented foreseeable increments in theolder population and their implications for policies and programmes. It brings out the importanceof taking into account cultural influences in the formulation of policies for addressing issues arising asa result of rapid population ageing. The Report lays stress on ensuring for older persons an active andhealthy life in which their freedoms and dignity are guaranteed within the context of the goal ofcreating a “society for all ages” endorsed by 159 countries at the Second World Assembly on Ageing in2002. Taking note of how most of the countries of South Asia have, to varying extents, alreadyintroduced various measures to address ageing-related issues, the Report puts forwardrecommendations for improving the effectiveness of relevant policies and programmes.

The Report has benefited substantially from valuable inputs from the eight UNFPA Country Officesin South Asia. As such, the Report symbolizes increasing collaboration at the regional and nationallevels which UNFPA seeks to promote. I wish to thank the UNFPA Representatives in the sub-regionfor the invaluable contributions of the Country Offices. I would also like to thank my colleagues,Mr. Najib Assifi, Deputy Regional Director and Rep. in Thailand and Dr. Saramma Thomas Mathai,Regional Team Coordinator and Maternal Health Adviser of the Asia and the Pacific Regional Officefor providing overall guidance and supervision for this study. For Mr. G. Giridhar, former Directorof the Country Technical Services Team for East and South-East Asia, I would like to express myappreciation for initiating this study. Finally, I would like to thank Mr. Ghazy Mujahid, our formerAdviser on Population Policies and Development and our consultant, Professor K.A.P. Siddhisena ofthe University of Colombo for preparing this Report using a highly participatory and professionalprocess. Mr. Ghazy Mujahid also deserves to be commended for having started this series - Papers inPopulation Ageing - during his tenure with UNFPA.

Nobuko Horibe Regional Director UNFPA Asia and the Pacific Regional Office

vi

Acronyms

AIHRC Afghanistan Independent Human Rights CommissionANDS Afghanistan National Development StrategyCAFOD Catholic Agency for Overseas DevelopmentCBO Community Based OrganizationCPP Cyclone Preparedness Programme (Bangladesh)CRCA China Research Center on AgingDWARF Development, Welfare and Research Foundation (India)ECOSOC United Nations Economic and Social CouncilESCAP Economic and Social Commission for Asia and the PacificGAA Global Action on AgeingHAI HelpAge InternationalHPRA Health Policy Research Associates (Sri Lanka)IASC Inter-Agency Standing Committee (UN)ICESCR International Covenant of Economic, Social and Cultural RightsICRC International Committee of the Red CrossIFRCRC International Federation of the Red Cross and Red CrescentIDP Internally Displaced PersonILO International Labour OrganizationINPEA International Network for the Prevention of Elder AbuseMDG Millennium Development GoalMFS-UK Medicins San Frontieres-UKMIPAA Madrid International Plan of Action on AgeingMPF Maldives Planning ForumNGO Non-Governmental OrganizationNOAPS National Old Age Pensions Scheme (India)NPOP National Policy on Older Persons (India)PIDE Pakistan Institute of Development EconomicsRIC Resource Integration Centre (Bangladesh)SAARC South Asian Association for Regional CooperationSANEI South Asian Network of Economic InstitutesSLHA Sri Lanka Health AccountsTFR Total Fertility RateUNDESA United Nations Department of Economic and Social AffairsUNDP United Nations Development ProgrammeUNFPA United Nations Population FundWEAAD World Elder Abuse Awareness DayWHO World Health Organization

vii

Acknowledgements ............................................................................. ivForeword ......................................................................................... vAcronyms ......................................................................................... viExecutive Summary ............................................................................. x

Introduction ...................................................................................... 1

Section 1: Demographics of Population Ageing ........................................... 31.1 Fertility and mortality trends ...................................................................... 31.2 Changes in age structure ............................................................................. 41.3 Implications of changes in age structure ...................................................... 71.3.1 Dependency ratio ....................................................................................... 71.3.2 Ageing index ............................................................................................... 71.3.3 Median age ................................................................................................. 81.3.4 Potential support ratio ................................................................................ 91.3.5 Parent support ratio .................................................................................... 9

Section 2: Characteristic Features of Population Ageing ................................ 112.1 Ageing of the older population ................................................................... 112.2 Feminization of ageing ............................................................................... 122.3 Rural-urban differentials in ageing .............................................................. 15

Section 3: Inter-Country Variations in Population Ageing ............................... 163.1 Trends in fertility and mortality ................................................................. 163.2 Extent of population ageing ....................................................................... 173.3 Changes in population age structure .......................................................... 203.4 Ageing of the older population ................................................................... 223.5 Feminization of ageing ............................................................................... 233.5.1 Older female population increasing faster ................................................... 233.5.2 Greater vulnerability of older female population ......................................... 243.6 Rural-urban differences in population ageing ............................................. 24

Contents

viii

Section 4: Emerging Ageing-Related Issues ............................................... 264.1 Health services ............................................................................................ 264.2 Long-term care ............................................................................................ 284.3 Living arrangements .................................................................................... 304.4 Income security ........................................................................................... 324.4.1 Opportunities for gainful employment for older persons ............................. 324.4.2 Social security ............................................................................................. 344.4.3 Welfare benefits ........................................................................................... 354.5 Protection against abuse and violence .......................................................... 364.6 Special attention in emergencies .................................................................. 374.6.1 Long-term impact of conflict situations ....................................................... 384.7 Dispelling negative attitudes towards ageing ................................................ 39

Section 5: Policy Responses of South Asian Governments to Population Ageing .... 425.1 Afghanistan ................................................................................................ 425.2 Bangladesh ................................................................................................. 435.3 Bhutan ....................................................................................................... 465.4 India ........................................................................................................... 475.5 Maldives ..................................................................................................... 495.6 Nepal .......................................................................................................... 495.7 Pakistan ...................................................................................................... 515.8 Sri Lanka .................................................................................................... 53

Section 6: Conclusion and Recommendations ............................................. 566.1 Conclusions ................................................................................................ 576.2 Recommendations ..................................................................................... 596.3 The way forward ......................................................................................... 61

Endnotes .......................................................................................... 63Bibliography ..................................................................................... 66

Contents (continued)

ix

TABLESTable 1: Fertility trends, 1950-2050 .................................................................................. 3Table 2: Life expectancy at birth (years), 1950-2050 ......................................................... 4Table 3: Increasing importance of population ageing in South Asia, 1950-2050 ................ 6Table 4: Trends in median age (years), 1950-2050 ............................................................. 8Table 5: Potential support ratio, 1950-2050 ...................................................................... 9Table 6: Parent support ratio, 1950-2050 .......................................................................... 10Table 7: Life expectancy and survival rates of older and oldest old persons ........................ 11Table 8: Impact of the ageing of the older population in South Asia, 1950-2050 ............... 12Table 9: Gender differences in life expectancy and survival rates in South Asia .................. 13Table 10: Impact of feminization of the older population, 1950-2050 ................................. 14Table 11: Fertility trends in countries of South Asia, 1950-2050 ......................................... 16Table 12: Life expectancy at birth in countries of South Asia (years), 1950-2050 ................ 17Table 13: Extent of ageing in countries of South Asia to 2050 ............................................. 18Table 14: Increasing relevance of older population in countries of South Asia ...................... 19Table 15: Indicators of changing age structure in South Asia: 1950-2050 ............................ 20Table 16: Support available for the elderly in countries of South Asia: 1950-2050 ............... 21Table 17: Ageing of the older population in countries of South Asia: 1950-2050 ................ 22Table 18: Feminization of ageing in countries of South Asia: 1950-2050 ............................. 23Table 19: Gender differences in the socio-economic circumstances of the elderly ................ 24Table 20: Rural-urban differences in ageing and feminization of ageing in selected

countries of South Asia ........................................................................................ 25Table 21: Estimated share in health expenditures by age: Sri Lanka, 2005 ........................... 27Table 22: Specific morbidity data on older persons in India, 1996 ....................................... 28Table 23: Incidence of disability: India, 1995/96 ................................................................. 29Table 24: Disability by age, sex and residence: India, 1995 .................................................. 29Table 25: Percentage distribution of older persons by age, sex and living arrangement in

selected countries of South Asia ........................................................................... 30Table 26: Percentage of population economically active ....................................................... 33Table 27: Preparedness of relief organizations to address elderly needs ................................. 39Table 28: National Coordinating Bodies on Population Ageing and Elderly Persons ........... 58

FiguresFigure 1: Impact of declining TFR on births in South Asia, 1950-2050 .............................. 5Figure 2: South Asia’s changing age structure, 1950-2050 ................................................... 5Figure 3: Child and old age dependency ratios in South Asia, 1950-2050 .......................... 7Figure 4: Ageing index, South Asia, 1950-2050 .................................................................. 8

x

Executive Summary

IntroductionDuring the 1950s and 1960s, most less developedcountries were characterized by high fertilitylevels. Recognizing this as an impediment tosocio-economic development, governmentsundertook sustained measures to promotefamily planning and provide increasing access toquality health services. As a result, in manycountries there was a decline in fertility levels aswell as an improvement in life expectancy duringthe last quarter of the 20th century. Since theturn of the century, the age structure in manyless developed countries has been shifting moreand more towards the higher age cohorts. InSouth Asia (comprising Afghanistan, Bangladesh,Bhutan, India, Maldives, Nepal, Pakistan andSri Lanka) too, population ageing, defined as anincrease in the proportion of older persons (thoseaged 60 years and over), has emerged as adominant demographic trend. Population ageinghas manifested itself in all countries of SouthAsia, except Afghanistan which has been in aconflict situation for the last three decades.Projections show that the population of olderpersons is set to increase rapidly in South Asiaand in Afghanistan too, there will be a significantincrease in the older population after 2025. Thechanging demographic situation in South Asia,as reviewed in this study, points to rapid populationageing which will give rise to a number of issues.This study identifies these issues, describes whatpolicies and programmes governments haveintroduced to address them. It concludes withrecommendations on what would need to be donefurther to ensure for the increasing olderpopulation an active and healthy life in which

their freedoms and dignity are guaranteed.

1. Population ageingIn most countries of South Asia fertility remainedhigh during the 1950s and 1960s. It started todecline significantly during the late 1960s that islater than in other parts of Asia. At the same timethere were substantial improvements in lifeexpectancy which increased gradually from 40years in 1950 to 65 years in 2000. As a combinedresult of fertility-mortality trends, the proportionof older persons in South Asia’s population whichhad declined from 5.8 to 5.5 per cent during1950-1975, increased to 6.3 per cent in 2000.Projections show that by 2025 the proportion willhave increased to 10 per cent and to 19 per centby 2050. Nearly one in 5 South Asians in 2050will be an older person. The increase in olderpopulation is projected at 350 million during2000-2050, that is more than five times as muchas the 66 million during 1950-2000. The increasingimportance of the older population as a policytarget group is highlighted by the increasingproportion of older persons in the populationincrement: while older persons constituted lessthan 7 per cent of the increase in populationduring 1950-2000, they will account for 20 and62 per cent of the increase respectively during2000-2025 and 2025-2050. As result of rapidpopulation ageing, the potential support ratio,that is the working age population (15-64 years)per person aged 65 years and over, will declinefrom 14 in 2000 to 5 in 2050. This indicatesthat the support base for the older populationwill be reduced to almost one-third by 2050.

xi

2. Characteristic features of populationageingThree distinct features have been found tocharacterize the older population and becomemore pronounced with population ageing: (a) theincreasing proportion of the “oldest old” (thoseaged 80 years and over) in the older population;(b) feminization of the older population; and (c)the greater extent of population ageing in ruralareas. As these profoundly influence the resultingchallenges, they have to be taken into accountin the formulation of required policies andprogrammes.

Due to improving life expectancy and survivalratios at higher ages, the oldest old population inSouth Asia will increase at high rates during 2000-2050. As a result, the proportion of the oldestold population in the older population willincrease from the present 8 per cent to 10 percent in 2025 and further to 15 per cent in 2050.While during 1950-2000, the oldest oldpopulation increased by nearly 6 million, theincrease will exceed 14 million during 2000-2025and will further triple to 42 million during2025-2050. Policies and programmes aimed ataddressing issues related to older persons willtherefore have to be designed to focus increasinglyon issues which are more relevant to or specificto the oldest old, such as disability and long-termcare.

As a result of higher female life expectancy,women constitute a majority of the olderpopulation and even more so of the oldest oldpopulation. Moreover, the proportion of womenin both the older and oldest population isprojected to further increase by 2050. Olderwomen are more vulnerable than older men as ahigher proportion of older women are “single”,that is unmarried, divorced or widowed. Moreover,

they face a higher incidence of disability and havefewer opportunities of productive employment.They are financially less secure and have lessaccess to means of care and support in illness anddisability. These trends add a significant genderdimension when addressing issues related topopulation ageing.

The incidence of population ageing is higher inrural areas. Since both fertility and mortalityare found to be higher in rural areas, therural-urban differentials in population ageing areexplained by migratory flows. It is usuallyyounger adults who move from rural to urbanareas for education or employment, while someolder persons prefer to return to rural areas afterretirement from their urban jobs.

3. Inter-country variations in populationageingThere are considerable variations across the eightSouth Asian countries in the current situation ofpopulation ageing as well as the projected trends.The variations can be explained largely by pasttrends in fertility and to a lesser extent bydifferences in improvements in life expectancywhich have been relatively less marked. At theturn of the century, the extent of populationageing in South Asian countries varied from nearly10 per cent in Sri Lanka to under 4 per cent inAfghanistan. During 1950-2000, the TFR hadfallen most in Sri Lanka from 5.9 to 2.1 while inAfghanistan it remained high decliningmarginally from 7.7 to 7.1. India and Bhutanranked second and third with the proportionof older persons at respectively 7.1 and 6.8 percent. In all other countries it was between 5-6per cent and the variations could be largelyexplained by the extent of declines in fertility. Theprognosis for all countries is a rapid increase inageing in all countries relative to the past trends

xii

as a result of declining fertility levels. In allcountries, except Afghanistan fertility levels areprojected to decline to below or near replacementlevel. In Afghanistan the TFR will be 3.8 in 2050.

In all countries the proportion of the oldest oldin the older population will increase during2000-2050. The proportion of females in theolder population is more than 50 per cent in allcountries except Bhutan and Maldives where itis respectively 47 and 40 per cent. The proportionof females in the older population is projectedto increase continuously until 2050 but, despiteincreasing, will remain less than 50 per cent inBhutan. In all countries the proportion of womenin the oldest old population will continue toincrease until 2050 and women will constitute ahigher proportion of the oldest old populationthan of the older population. Like in mostcountries across the world, in all countries ofSouth Asia, older women are more vulnerablethan older men. A higher proportion of olderfemales are “single”, illiteracy rates are higheramong older females and a lower proportion ofthem are gainfully employed.

With the exception of Afghanistan, the countriesof South Asia are all faced with the prospects ofrapid population ageing. The older populationwill in each country constitute an increasingproportion of the future increments in totalpopulation. After 2025, older persons will bethe only increasing age-group in Bhutan and SriLanka and will account for more than half thetotal increase in Bangladesh, India and Maldives.Development policies and plans in South Asiawill therefore have to be increasingly linked tothese demographic changes

4. Emerging ageing related issuesA range of issues emerge with population ageing.

These can be grouped into the followingcategories: health services, long-term care,living arrangements, income and social security,protection against abuse, and need for specialattention in emergencies

Remaining healthy and active is a prime concernin old age. Since the incidence of morbidityincreases with age, population ageing isaccompanied by an increase in demand for healthservices. In addition to the increasing numberof older persons, population ageing results inincreased health expenditures because of the“epidemiological transition” - shift in the diseasepattern towards degenerative and mental illnesseswhich are more costly and take longer to treat.Population ageing also generates increasingrequirements of long-term care since theincidence of disability increases with age.

The support base for older persons shrinks withpopulation ageing. Traditional family ties haveremained strong throughout South Asia and inthe younger adults taking care of older parentsand relatives is an accepted norm. However,reduced family size, nuclearization of families,increasing incidence of paid employment amongwomen and migration have weakened thecapability of the family to provide care for olderparents/relatives. As such the increasing inproportion and numbers of older personsgenerate a growing need for alternativeappropriate living arrangements.

Employment and transfer payments fromrelatives are the two major sources of financialsupport for older persons. However, withdiminishing opportunities for work and theshrinking capacity of families to meet the economicneeds of older relatives, the coverage of socialsecurity and welfare schemes will have to be

xiii

extended to keep the growing older populationout of poverty. In South Asia, social security andwelfare schemes are either non-existent or haveminimal coverage. Given the projected rapidincrease in population ageing there will be anincreasing need for expanding social securitycoverage as well as the provision of welfarebenefits.

Increasing elderly abuse is another issue whichneeds to be addressed. As the increasing numberof older persons begins to exert a growingpressure on the resources of the family, theelderly face an increasing risk of abuse andneglect. Since elder abuse remains taboo, reportingand discussion of cases of abuse remain severelyrestricted. In addition to the home, elderly canalso be faced with abuse in the institutionalsetting such as discrimination, neglect andmaltreatment by caregivers and service providers.With growing preference for the nuclear family,an increasing proportion of older persons arechoosing (or being forced) to live on their own,thus becoming an easier target for criminals.Moreover, older women are more vulnerable toabuse and neglect. Older persons are also at greaterrisk during calamities both natural and man-made.The experience of the tsunami, for example,showed how older people, particularly women,face a greater of being victims of neglect and abuseduring relief operations.

The negative view of ageing and older personsneeds to be dispelled. The positive side ofpopulation ageing should not be lost sight of.Older persons have extensive potential forcontributing to development. The elderly,particularly older women, make significantcontribution to housework and in looking afterchildren in the extended family. The positive roleolder persons can and do play in promoting

economic development, preserving the socialfabric and in maintaining or restoring harmonyshould be emphasized and publicized through themedia.

5. Policy responses to population ageingIn all countries of South Asia, the governmenthas been focusing increasing attention onpopulation ageing, particularly since the SecondWorld Assembly on Ageing held in Madrid, Spainin April 2002. All countries, with the exceptionof Afghanistan, have designated an agency to beresponsible for ageing-related issues and thewelfare of the elderly. Differences exist betweencountries in their response to the emerging issuesdepending on their individual situation,particularly the proportion of older persons inpopulation. South Asia provides examples of awide range of policy measures including elderlypolicies, legislation, tax benefits, discounts andsocial protection and welfare measures. Welfaremeasures in most of the countries remain limitedand focus on older persons without families,having disabilities or having no assured means ofincome.

6. RecommendationsThe Report concludes with the following set ofrecommendations:

- Governments should enhance the availablemechanisms for the collection of relevant data toensure that data on older persons are collectedwith regular periodicity, disaggregated by age,sex, sub-national units and socio-economiccharacteristics.

- Institutional structures characterized by a stronghub, specializing on ageing-related issues shouldbe installed/strengthened and capacity should bebuilt to improve skills in collection and use of

xiv

data and in conducting research for policyformulation, programming and monitoring andevaluation.

- Special emphasis should be given to the needsof older women in view of their greater vulnerabilityand gender-based mainstreaming should be acompulsory consideration in the design ofschemes relating to older persons.

- Programmes for older persons should take intoaccount the higher incidence of poverty faced byolder persons predominantly in rural areas.

- Health policies should incorporate provisionsfor financially and physically accessible health careservices for the older population and adequateattention should be paid to equipping healthfacilities with medicines and equipment neededfor diseases of old-age and providing the requiredgeriatrics trained health personnel.

- Governments should seek to strengthen thecapacity of the family, which remains the mostpreferred and main source of care and supportfor older persons, through measures, such as taxbenefits, allowances, home improvement assistanceand other incentives to continue their caring role.

- Women should be provided appropriate incentivesto facilitate combining care giving and employmentthrough measures such as time off and promotingmale responsibility in the caring for older persons.

- Governments should encourage and supportcommunity-based care (health and psycho-social)for older persons who are single or in need ofacute and long-term care.

- Governments should encourage and facilitate

the formation of Older People’s Associations/Clubs/Activity Centres to promote active ageingand providing a chance for the community to gainfrom the experience of the older generation hencegiving a value for the older age and wisdom.

- Gainful employment for older persons shouldbe encouraged through improved access to creditand provision of inputs for the self-employedolder persons and incentives to employers foremploying older workers.

- Governments should increase the scope andcoverage of the state pension schemes, encourageengagement of contributory private insuranceplans and provide incentives for the developmentof traditional/indigenous community-basedpractices of ensuring social security.

- In emergency circumstances, Governments andaid agencies should ensure that older personsreceive focused attention during rescue, relief, andrecovery operations. Relief and rescue workersshould be appropriately trained and briefed toensure older persons get needed and adequateattention and participation where relevant.

- Steps should be taken to dispel the society’snegative attitude towards ageing and olderpersons by highlighting the contributions of olderpersons and promoting respect for older personsamong the coming generations.

Implementation of these recommendationswould involve Government, NGOs, civilsociety, media, academia and older personsthemselves. It will also call for mainstreamingpopulation ageing into all development polices,programmes and actions.

1

Four to five decades ago most less developedcountries were still at the initial stages of thedemographic transition, characterized by highfertility and high mortality. Their populationswere largely young and, in some of the countries,becoming increasingly younger. A visitor to thesecountries could hardly fail to observe thepresence of a large number of children as well aspregnant women. Realizing the adverse impactof these demographic realities on economicdevelopment, Governments responded bypromoting female education and introducing

INTRODUCTION

family planning programmes. The result was adecline in fertility rates, in some countries quitesubstantial, within a period of fifteen to twentyyears. At the same time advancements inmedical science and increasing access to qualityhealth care led to a decline in mortality rates andimprovements in life expectancy. Sustaineddeclines in fertility and improvements in lifeexpectancy resulted in accelerating thedemographic transition towards the lowerfertility-lower mortality stage.

Photo credit : Ali Rasheed, Club Hulhevi, Male, Maldives

2

The impact of these continuing trends isbecoming increasingly visible in the changingdemographic scenario in a number of countries -instead of seeing young children one cannot nowfail to observe the presence of a large number ofolder persons. It is becoming increasingly evidentthat even in countries where the population wasgrowing younger during the 1950s and 1960s, ithas been “ageing” since the turn of the century.More importantly, all projections indicate thatthe rate of population ageing will continue toaccelerate and the proportion of the olderpopulation (defined as those aged 60 years andover) will progressively increase. By 2050, theproportion of older persons in the population ofless developed countries will have increased tomore than 20 per cent from the current less than10 per cent.

This study analyses the situation of populationageing in South Asia.1 At present the eightcountries of this sub-region together account for15 per cent of the World’s and nearly 25 per centof the developing world’s older population. Theseproportions are projected to increase torespectively 22 and 28 per cent by 2050(UNDESA 2007a). The study reviews thechanging demographic scenario since 1950 andhow it is projected to evolve to the year 2050. Itbrings out the distinct difference between thechanges in the age structure of the populationduring the fifty years before and after 2000,highlighting issues relating to the older populationwhich the national governments will have to

address. It reviews policy measures which someof the governments in the sub-region have alreadyinitiated and outlines recommendations forfurther measures that should be consideredduring years to come. The Report is divided intosix sections. Section 1 explains the demographicsof ageing: how the decline in fertility andimprovements in life expectancy contribute tochanges in the age structure of the populationand the demographic impact of these changes.Section 2 describes the characteristic features ofthe older population, highlighting the graduallyincreasing shift towards older ages within theolder population, the high female:male ratioamong the older population and the rural-urbandifferences in population ageing. Section 3describes briefly the emerging population ageingsituation in each of the eight countries of SouthAsia bringing out the wide differences fromcountry to country. Key issues which willinevitably emerge over the period to 2050 as aresult of the demographic changes are discussedin Section 4. Section 5 provides a review ofrelevant policy measures and programmes thathave been introduced by Governments incountries where population ageing has alreadycome to be recognized as an issue to be addressed.This section includes a review of the role playedby other stakeholders, and both bilateral andmulti-lateral donors, including the UnitedNations, in supporting Governments to addressthe ageing-related issues. The concludingSection 6 summarises the main findings of thestudy and policy recommendations.

3

The socio-economic and demographiccharacteristics of the eight countries covered inthis Report vary widely. So also do the politicalstructures as over the past five decades thesub-region has continued to provide examples ofsecular and religious states, democratic structures,kingships and military dictatorships.Demographically the region includes India, theworld’s second most populous country with apopulation of more than 1.1 billion and Maldiveswith a population of about 300,000. The paceof the demographic transition, that is, changefrom high fertility/high mortality to low fertility/low mortality has also varied from one countryto the other. Some of the countries, notably SriLanka, are well ahead and nearing completion ofthe demographic transition while others are at

Section 1: Demographics of PopulationAgeing

different stages with Afghanistan still in theinitial high fertility/high mortality stage(Siddhisena 2004). This section reviews theimpact of trends in fertility and mortality in SouthAsia on ageing of the sub-region’s population,focusing on a comparison of the past trends to2000 and the future projections to 2050. Onthe whole, the sub-region figures as a “late starter”in the process of demographic transition in Asia,lagging behind Asia’s other two sub-regions, EastAsia and South-East Asia.2

1.1 Fertility and mortality trends

At the beginning of the 1950s fertility was highin South Asia with an average TFR (totalfertility rate) of 6.1 (Table 1).3

The rate declined to 5.2 during 1975-1980. Thedecline was less than the average for the lessdeveloped countries. Compared to other partsof Asia, the fertility decline was similar to that in

South-East Asia but much less than in East Asia.During the last quarter of the 20th century SouthAsia experienced a more rapid decline infertility and the TFR came down from 5.2 in

4

1975-80 to 2.9 in 2000-2005. The decline wasmuch more significant than during the previousthree decades and more than the average for theless developed countries. By the turn of thecentury, South Asia’s TFR had dropped to theaverage for the less developed countries. It isprojected that the rate will decline further to nearreplacement level by 2025 and to just belowreplacement level at 1.9 by 2050.

While fertility rates declined, there was an increasein the life expectancy at birth. Substantial declinesin mortality characterized South Asia during1950-1975 as a result of improved provisionof quality health services to an increasingproportion of the population. As shown in Table2, the resulting increments to life expectancy atbirth were substantial.

Life expectancy at birth in South Asia was only40 years during the early 1950s. There weresubstantial improvements during the secondhalf of the 20th century and, by the turn of thecentury, life expectancy at birth had increasedby 25 years to reach 65 years. In South Asia moreyears were added to life expectancy during 1950-2000 than on average in the less developedcountries bringing the sub-region at par with theless developed countries. Further increments tolife expectancy, though smaller given the largerbase, are projected during 2000-2050. By 2050life expectancy is expected to reach 75 years,slightly above the average for the less developedcountries and equal to the world average.However, it is projected to remain lower than inSouth-East Asia and by even more than in East Asia.

1.2 Changes in age structure

The impact of declining fertility and increasinglife expectancy described above has been a shiftin the age distribution of South Asia’s populationtowards the higher age groups. Falling fertilityreduces the number of births thereby reducingthe “inflow” of population into the lower agecohorts. Improvements in life expectancy resultsin an increasing number of persons reaching theage of 60 years and also surviving longer afterthat age. The combined effect of falling fertilityrates and improving life expectancy is thereforea decrease in the increment to the population ofyounger ages and an increase in the number ofthose 60 years and over, that is, the old agepopulation.

Section 1: Demographics of Population Ageing

5

Figure 1 depicts the past and projected trendsin the annual number of births in South Asia.During the 1950s the average annual number ofbirths in the sub-region was 22 million. Thenumber of births increased gradually to 38million by the turn of the century. This was despitethe decline in the total fertility as the past higherlevels of fertility contributed to a continuingincrease in the number of women in reproductiveages (15-49 years) more than offsetting theimpact of declining fertility on the number ofbirths. The average number of births is projectedto stabilize until 2010-2015. After that thecombined effect of the decline in TFR and theslowing down of the increase in the populationof women of reproductive ages will bring downthe number of births to 32 million by 2050.4

Increasing life expectancy results in an increasingproportion of the population able to reach age60 years, that is enter old age. Hence, while thenumber of births will decrease during 2010-2050,an increasing proportion of population will beable to reach the age of 60 as a result of improvinglife expectancy. It is estimated that 70 per centof the children born at present can be expected

to reach age 60 years. By 2050 this survival ratewill have increased to 87 per cent. A largerproportion of the population will therefore reachold age.

The impact of declining fertility andimprovements in life expectancy on the agestructure of the population is brought out inFigure 2.

In 1950, older persons accounted for 5.8 per centof the sub-region’s total population. Children(0-14 years) constituted 37.4 of the population.By 1975, the proportion of older population haddeclined to 5.5 per cent and that of the childpopulation had increased to 40.8 per cent. SouthAsia’s population was thus becoming “younger”.This was similar to the trend in the lessdeveloped countries. The next quarter saw asignificant change in trend reflecting the impactof the declines in fertility and improvements inlife expectancy. By the turn of the century theshare of the child population had fallen to 36.2per cent and that of the older persons hadincreased to 6.3 per cent. Though these changeswere modest in comparison to those in the less


6

developed countries as whole and in East Asiaand South-East Asia, the message at the dawn ofthe new century was clear that the population ofSouth Asia was also on the way to ageing.

The projected changes in the age structure showthat by 2025, the older population will constitute10 per cent of the total population and the shareof the child population will have declined to 26per cent. During the next twenty-five years, thetrends would continue and it is estimated that in2050, the share of the child population willdecline to 20 per cent and older persons willconstitute 19 per cent of the total population.Nearly one in five persons, compared to the

current one in fourteen persons in the sub-region,will be above the age of 60 years in 2050. Theproportion of the older population in South Asia’stotal population will be slightly below theaverage for the less developed countries and wellbelow the rest of Asia, particularly East Asia.However there is no reason for complacency asafter 2025 the older population in South Asiawill be increasing at a higher rate than inSouth-East Asia, East Asia and the less developedcountries as a whole.5

The relevance for policy of the changingdemographic trends is brought out by figuressummarized in Table 3.

The older population increased at a lower ratethan total population during 1950-1975 but outpacedit during 1975-2000. During the 2000-2050 thedifferential in the rates of increase is projected tofurther widen. While population growth willslow down to an average annual rate of 0.7 percent during 2025-2050, older population willcontinue to increase on average at an annual rateof 3.0 per cent. As a result older persons willconstitute an increasing proportion of theincrement in total population. Older personsaccounted for 5.2 per cent and 8.3 per cent of

the total population increase during 1950-1975and 1975-2000. The share is going to increaseto 20.3 per cent in 2000-2025 and 62.3 per centin 2025-2050. For policy makers and providersof services for older persons, the growingmagnitude of the task of dealing with the issue ismost vividly brought out by the projectedadditions to the older population. The increaseduring 2000-2025 is expected to be 120 millionthat is more than double that during 1975-2000.The additions will increase further to 230million during 2025-2050. The first half of this


7

century will see an increase of 350 million in thepopulation of older persons in South Asia, thatis, more than 5 times the increase of 66 millionduring the second half of the last century.

1.3 Implications of changes in age structure

The shifting age structure of the populationtowards older age cohorts results in changes inkey demographic indicators such as thedependency ratio, the median age, the ageingindex and potential and parent support ratios.Trends in these provide an indication of thesocio-economic implications of ageing whichpolicy makers would need to take into account.

1.3.1 Dependency ratio

The dependency ratio is a key indicator of thesocial support needs. The total dependency iscalculated as the ratio of the number of children(those aged 0-14 years) and persons aged 65 yearsor over to the number of persons aged 15-64 years.The assumption underlying the ratio is that allpersons under 15 and those aged 65 or over arelikely to be dependent on the rest of the populationof working ages. Since neither all those in thetwo “dependent” age groups necessarily requiresupport nor are all those aged 15-64 years areworking and having dependants to support, thedependency ratio provides at best only a roughapproximation of the actual dependency burdenin a society. Hence, if interpreted with caution,the dependency ratio is a useful indicator of trendsin support needs and how these can be expectedto change as the population ages.

Figure 3 shows the past and projected trends inthe dependency ratios in South Asia.

Prior to 1970 when the population was growing“younger”, old-age dependency ratio declinedslightly but the total dependency ratio increasedas a result of the increase in the child dependencyratio. Since 1970 both the child dependencyratio and the total dependency ratio have beendeclining. While the old age dependency ratiohas been increasing, the increase has not beenenough to offset the decline in the childdependency ratio. However, during the secondquarter of this century (2025-2050) it is projectedthat the increase in the old age dependencyratio will reach a level high enough to offset thedecrease in the child dependency ratio, therebyresulting in a slight increase in the totaldependency ratio.

1.3.2. Ageing index

The shift in the balance between the child andolder population is measured by changes in theageing index. The ageing index is the ratio of thepopulation aged 60 years or over to that underage 15. Figure 4 shows the past and projectedtrends in the ageing index in South Asia.


8

In 1950, the ageing index was 15, that is, therewere 15 older persons per 100 children. Theageing index fell to 13 by 1965 and then beganto increase reaching 14 in 1985. By the turn ofthe century it had increased to almost 18. It isprojected that it will more than double to 38during the period 2000-2025. The increase willbe much greater during the following 25 years

reflecting the increasing pace of populationageing and it is estimated that by 2050 theageing index will have reached 88. The ageingindex in South Asia has been and will remainlower than the average for East Asia as well as forSouth-East Asia where it will exceed 100 by 2020and 2040 respectively. However, it is thesignificantly increasing upward trend in theageing index during the next few decades thatdepicts the increasing pace of ageing of SouthAsia’s population.

1.3.3 Median age

The median age is the age that divides thepopulation into two equal parts, one with agesbelow the median age and the other with agesabove the median age. As the population ages,the median age usually increases. The median agein South Asia is currently about 24 years. Asshown in Table 4, this is lower than the medianage in East Asia and South-East as well as theaverage for the less developed countries.

After declining during 1950-1975, the medianage increased in the less developed regions andthe three sub-regions of Asia. By 2007, themedian age in South Asia had increased by 3 yearsabove the 1950 level compared to the increase by5 years in South-East Asia and 10 years in EastAsia. It is projected that in South Asia another

5.7 years will be added to the median age by 2025.With greater increases in other regions the gapwill thus widen. However, during 2025-2050there will be a narrowing of the gap and themedian age in South Asia will increase by 7.8 yearsreaching 37 years, slightly above the average forthe less developed regions.


9

1.3.4 Potential support ratio

The potential support ratio is a key age structureindicator relevant to population ageing. It isdefined as the ratio of population aged 15-64 tothat aged 65 and older and is intended toindicate the support base of persons in ages mostlikely to be economically productive and henceavailable to support the older population.Although the cut-off age for defining “olderpersons” is 60 years, for the purpose of calculatingthis measure those 60-64 are grouped withproductive age adults since a significantproportion of the 60-64 year olds are found to

be gainfully employed. Some persons aged 65 orolder continue to be self-supporting and thus arenot dependent on others and not all persons inages 15 to 64 are economically active, especiallyamong those still attending school at the youngercohorts of this age range. Nevertheless, eventhough the ratio is therefore not an exactmeasure of the support base, a falling potentialsupport ratio would reflect a shrinking supportbase of economically active adults on whom theold age population can depend. Table 5 showsthe past declines and the much larger projecteddeclines in the potential support ratio in SouthAsia and other parts of Asia.

In South Asia there were on average about 17adults to provide support for one older person.The ratio was higher than the average for the lessdeveloped countries and remained higher untilthe turn of the century. It is projected that thepotential support ratio in South Asia will remainhigher than the average for the less developedcountries and for both East Asia and South-EastAsia. However, the decline will be much largerthan during the past fifty years. While the ratiodeclined by only 3 during the last fifty years ofthe previous century, it will decline by 4.5 yearsduring 2000-2025 and a further 4.2 years during2025-2050. The potential support ratio in SouthAsia will be only 5.1 in 2050 compared to 13.8

at the beginning of the century. An increasingpace of population ageing will thus result in asignificant shrinking of the support base for theolder population.

1.3.5 Parent support ratio

With continuing improvements in life expectancyand increase in survival ratios, there is a gradualshift towards older cohorts within the populationof older persons (60+).6 The parent supportratio is used to monitor the trend in this shift. Itis defined as the number of persons aged 85 yearsor over per 100 persons aged 50 to 64. It relatesthose aged 85 or over to their presumed offspring,


10

who were born when the older persons were intheir twenties and thirties. As such it is used toassess the demands on families to providesupport for their oldest members. However,because the persons included in the numeratorare not necessarily related by kinship ties to those

In 1950, the parent support ratio in South Asiawas 1.4, that is, higher than in the less developedcountries as well as in East Asia and South-EastAsia. This could be explained by the relativelyhigher differentials in the life expectancy afterreaching the age of 85 years. By 1975, thesedifferentials had disappeared and by the turn ofthe century the parent support ratio in South Asiastood at 2.0, lower than the average for the lessdeveloped countries and the two other sub-regions of Asia. The ratio is projected to increaseto 3.4 by 2025 and 6.4 by 2050. This will belower than the average for the less developed

countries as well as less than in South-East Asiaand East Asia. It should be noted that the smallerincrease in the parent support ratio in South Asia,despite the faster pace of ageing, can be explainedby the time lag between the increase in the olderpopulation (60+) and the oldest population (85+).With ageing there is an increase first in thepopulation 60-84 years and then subsequentlyin the 85+ as the larger numbers of 60-84 startentering the oldest cohorts. As such the increasein the parent support ratio manifests itself at laterstages of ageing.


in the denominator, the parent support ratiorelates the oldest population (85+) to their“hypothetical offspring”. Table 6 summarises theinformation on the past and projected changesin this ratio.

11

The discussion in Section 1 has shown that withrespect to population South Asia has been arelatively “late starter” but its population isprojected to increase more rapidly during the nextfour to five decades than during the last fiftyyears of the previous century (1950-2000). Thisis also brought out by the significant differencesin the past and projected trends in key indicatorsof population ageing. It is evident that policymakers have no reason to be complacent and needto address the emerging ageing-related issues asa priority since South Asia is now set on the roadto rapid ageing. In addition to the overallincrease in the proportion and number of olderpersons, there are three distinct features of theolder population that would need to be taken intoaccount in the formulation of relevant policiesand programmes. These features which have beencommonly observed in other countries aroundthe world (Mujahid 2006) are (a) ageing of theolder population; (b) feminization of ageing; and(c) the higher rural concentration of olderpopulation.

Section 2: Characteristic Features ofPopulation Ageing

2.1 Ageing of the older population

The increasing proportion in the olderpopulation of the “oldest old” (defined as thoseaged 80 years and over) is described as ageingof the older population. With improving healthstandards, an increasing proportion of olderpersons are able to reach the age of 80 years andalso live longer after that. Table 7 summarisesinformation on (i) life expectancy at age 60 yearsdefined as the average number of years a personreaching age 60 years is expected to live; (ii)survival rate to age 80 years, that is, the percentageof children born that can be expected to reachthe age of 80 years, and (iii) life expectancy at age80 years, defined as the average number of yearsa person reaching 80 years is expected to live. Allthese measures are computed assuming thecontinuation of prevailing mortality conditions.

12

At present life expectancy at age 60 years isestimated at about 18 years.7 This is projected toincrease to 19.5 in 2025-30 and to 21.1 in2045-50. During the next four to five decadeslife expectancy at age 60 years will increase by3.4 years. As such an increasing proportion ofthe population would be able to reach the age of80 years. Moreover, those reaching the age of 80in 2045-50 would on the average by expected tolive another 8.2 years compared to the 6.9 yearswhich a person reaching 80 years at present canbe expected to live. A gradual increase in the

proportion of population able to reach 80 yearsand living more years will contribute to anincreasing proportion of the oldest old in the olderpopulation. As a result the proportion of theoldest old in the older population will increasefrom about 8 per cent at present to 10 per centby 2025 and to nearly 15 per cent in 2050.

The magnitude of the task this increase willpresent for policy makers dealing with ageingissues is brought out in Table 8.

The oldest old population has been increasing ata higher rate than the older population and isprojected to continue doing so until 2050. Theoldest old will constitute an increasing proportionof the increments in the older population andduring 2025-2050 almost one-fifth of the increasein the older population will be accounted for bythe oldest old. In absolute terms there will be aphenomenal increase in the numbers of theoldest old. During 1950-2000, the oldest oldincreased by nearly 6 million. The increase willexceed 14 million during 2000-2025 and willtriple to 42 million during 2025-2050. Withinpolicies and programmes aimed at addressingissues related to older persons, increasing

attention will therefore have to be paid to issueswhich are more relevant to or specific to theoldest old.

2.2 Feminization of Ageing

In most countries, the older population isdisproportionately female. While the sex ratio atbirth is generally 104-106 males per 100 females,it is reversed in the older age cohorts. This isexplained by the higher life expectancy of women.In South Asia, female life expectancy was lowerbut gradually increased to exceed male lifeexpectancy during the 1970s. Table 9 summarisesinformation on differentials in female and male

Section 2: Characteristic Features of Population Ageing

13

life expectancy and survival ratios for South Asia.Until the 1980s life expectancy for males washigher than that for females. However, by theturn of the century female life expectancy in SouthAsia came to exceed male life expectancy. It isprojected that life expectancy at birth for femaleswill continue to improve at a higher rate thanthat for males and difference of 2.9 years will havewidened to 3.8 years by 2050. The differentialsare reflected in the higher survival rate of femalesto age 60 years. A higher percentage of female

babies than male babies is expected to reach theage of 60 years. The male advantage in sex ratioat birth is more than offset by the time of reachingold age. Moreover, on reaching old age, olderwomen are expected to survive on average moreyears than older men. Hence, a higher percentageof women than men reach age 80 years. Thegender difference in the survival rate to age 80years is wider than in the survival rate to age 60years. As evident from the gender differences inlife expectancy at age 80 years, the higherpercentage of women entering the oldest oldcohort are also expected to survive more years thantheir male counterparts.

As a consequence of the gender differences inlife expectancy and survival rates the proportionof women in the older population which declinedfrom 50 to 48 per cent during 1950-1975 hadincreased to 51 per cent by the turn of thecentury. It is expected to increase further to 52.1per cent by 2025 and to 52.7 per cent by 2050.Given the wider gender differences in lifeexpectancy and survival rates in the oldest age


Photo credit : UNFPA-Bangladesh Country Office, Dhaka

14

cohorts, women will constitute even a largerproportion of the oldest old population. Of theoldest old population 52 per cent were womenin 2000. Women will account for 56.5 per centof the oldest old population in 2025 and 58 percent in 2050.

What this increasing feminization of the olderpopulation will mean in terms of addressinggender issues within ageing-related policies andprogrammes is brought out by figures presentedin Table 10. Women will constitute an increasing

proportion of the additions to the olderpopulation. During 1950-2000, womenaccounted for 51.6 per cent of the increase in theolder population. The corresponding figures for2000-2025 and 2025-2050 will be 52.8 and 53.3.In absolute terms, the additions to the populationof older women will be 63 million during 2000-2025 and 123 million during 2025-2050. Giventhat the population of older women increased byonly 34 million during 1950-2000, this meansthat the increase of 186 million during the next50 years will be more than 5 times.

Feminization of the oldest population will be evenmore striking. While 50.5 per cent of theincrease in the oldest population was accountedfor by women during 1950-2000, women willconstitute 59 per cent of the increase in theoldest old population during 2000-2050. Thenumber of oldest old women will increase by 8million during 2000-2025 and by 25 millionduring 2025-2050. This projected increase of33 million in the oldest old female populationduring 2000-2050 will be more than 11 timesthe additions during the preceding 50 years.

The large additions to the population of olderand oldest old women will call for specialattention to be paid to the female populationwithin policies and programmes for olderpersons. Since older women are more vulnerable

than older men, their larger numbers becomeeven more significant. Differences in threeaspects - marital status, labour force participationand level of literacy - indicate the greatervulnerability of older women. More than half(53 per cent) of older women are “single”compared to 18 per cent older men.8 Olderpersons who are “single” are likely to be lesssecure financially and not enjoy as much care inillness and disability as those having a spouse.The reasons for a much larger proportion ofolder women being “single” are not far to seek.Wives usually outlive husbands since female lifeexpectancy is higher and husbands are generallyolder. Moreover, the re-marriage rate on losing aspouse through divorce or death is much loweramong women.


15

In South Asia, where social security and socialpensions cover at best a very small proportion ofthe older population, participation in the labourforce can be used as a proxy for financial security.Almost 50 per cent of men aged 65 years areeconomically active compared to only 12 per centof the women.9 Higher illiteracy levels amongolder females also contribute to their greatervulnerability.10

2.3 Rural-urban differentials in ageing

Population ageing has been observed to manifestitself earlier and advance more rapidly in ruralareas. This is despite the usually higher fertilityand lower life expectancy in the rural areascompared to urban areas. The higher proportionsof older persons in rural population can beexplained largely by the pattern of rural-urbanmigration in which younger family members aremore prone to move to the cities. The weakeningof family ties as a result of urbanization and thetransition to industrial societies thus add anotherdimension to issues related to population ageing.In the absence of adequate welfare systems, olderpersons left behind in the rural areas are likely tobe more adversely affected and stand in need ofsupport.

Information is available on the age-sex distribution

of population by rural and urban areas for mostof the countries of South Asia. However,aggregation of data at the regional level isvirtually impossible. The only reliable source ofthe rural-urban distribution of population byage are Population and Housing Censuses whichcountries conduct mostly every ten years and notin the same year. Then there is no standardizeddefinition of “rural” and “urban” and definitionsvary from country to country. Also, at timescountries change the definitions from one periodto another which precludes unqualifiedinter- temporal comparisons of rural-urbandistributions of population. Nevertheless, anumber of countries do distinguish between“rural” and “urban” areas at a given point in timeand valid comparisons within each country canbe made. Generally, rural areas are found to becharacterized by agriculture as the main economicactivity, higher incidence of poverty, poorerinfrastructure and access to social servicesrelative to urban areas. Moreover, under normalconditions in any given country urban populationsare known to increase at a faster rate than ruralpopulations due to migratory flows from rural tourban areas. Evidence on rural-urban differencesin population ageing are presented in the nextSection for whichever countries relevant data areavailable.


16

Discussions in Sections 1 and 2 show that SouthAsia as a region has been a “late starter” in theageing process but is projected to age rapidlyduring the next four to five decades. Though theproportion of older persons will remain relativelylower than in East and South-East Asia, thedifferences will continue to narrow until 2050.Moreover, the ageing process will be characterizedby the same features as observed in othercountries - ageing of the older population,feminization of ageing and higher rural ageing.However, the regional picture conceals widedifferences between the eight countries of SouthAsia. Countries fall between two extremes:Afghanistan where older persons constitute only4.4 per cent of the population and Sri Lankawhere the older population already exceeds 11per cent.11 Studying country level variationswithin the region will, on the one hand, helpidentify countries where population ageing callsfor more urgent attention and, on the other, bringout possibilities of inter-country collaborationin addressing ageing-related issues.

The inter-country comparison of the progress ofpopulation ageing12 will focus on:

- trends in fertility and mortality- extent of population ageing;- changes in age structure of the population;- ageing of the older population;- feminization of ageing; and- higher incidence of ageing in rural areas.

3.1 Trends in fertility and mortality

The data on TFR presented in Table 11 showthat in most countries of South Asia there was noappreciable decline in fertility until the 1970s.In four countries - Afghanistan, Bhutan, Maldivesand Pakistan - there was no change in the highfertility rates between 1950-55 and 1975-80.There was a moderate decline - 7 to 20 per cent -in Nepal, Bangladesh and India. The onlyexception was Sri Lanka where TFR declined by33 per cent.

Section 3: Inter-Country Variations inPopulation Ageing

17

During the following twenty five years, thedeclines in the TFR were larger. In Sri Lanka theTFR declined by 50 per cent to belowreplacement level at 1.9. In Afghanistan,however, the TFR declined by only 0.6 andremained at a high of 7.1. Further declines areprojected to 2025-30 with the TFR falling tobelow replacement level in India as well. By 2050,in all countries TFR will decline to below ornear replacement level except in Afghanistanwhere it is projected at 3.1.

Improvements in life expectancy have alsovaried widely across the countries. At thebeginning of the 1950s, life expectancy at birthin most countries except Pakistan and Sri Lankawas below 40 years. It was 43 years in Pakistanand highest in Sri Lanka at 53 years. The pasttrends and projected increases in life expectancyare shown in Table 12.

By the turn of the century, there had beensignificant improvements in life expectancy in allcountries, except Afghanistan. While there wasan addition of 20-30 years in life expectancy inother countries, life expectancy in Afghanistanincreased by only 16 years. At the beginning ofthis century, life expectancy was 48 years inAfghanistan and 75 years in Sri Lanka. In theother six countries it ranged from 63-69 years.Further increases are projected and by 2050 it isexpected that life expectancy in all countries,except Afghanistan, will exceed 75 years. InAfghanistan it will be 63 years, while in Sri Lankait will exceed 80 years.

3.2 Extent of population ageing

The inter-country variations in the extent ofpopulation ageing at the turn of the century andthe projected changes to 2050 (Table 13) reflectthe differences in the magnitude and timingof the fertility declines and improvements inlife expectancy. Sri Lanka has the highestproportion of older persons and will be the most“aged” country in South Asia in 2050. InAfghanistan the proportion of older personsremains below 4 per cent and will be only 5.6 in2050. The other countries fall in between thesetwo extremes.

Section 3: Inter-Country Variations in Population Ageing

18

The proportion of older persons was less than 6per cent in five of the countries. In 2000 SouthAsia’s population was thus still “young” with theolder persons accounting for less than 10 per centof the population even in the three most “aged”countries - Bhutan, India and Sri Lanka.However, the situation is changing rapidly andby 2025 the proportion of the older populationwill increase significantly in all countries, exceptAfghanistan. In three countries the proportionof older persons will exceed 10 per cent. In SriLanka, every one in five persons will be an olderperson. The proportion of older population inSri Lanka will thus be the fourth highest amongthe 24 countries of East, South-East and SouthAsia by 2025.13 The age ranking of the countrieswill remain the same, except for Bangladesh whichwill rank 4th in 2025 as against 7th at the turn ofthe century. Further increases in all countries areprojected to 2050. In all countries, exceptAfghanistan where the proportion of olderpopulation will remain less than 6 per cent, olderpersons will account for 20 per cent or more ofthe population in 4 countries. In Sri Lanka theproportion will increase to 29 per cent.

It is evident that in all the eight countries, exceptAfghanistan, the proportion of older populationwill increase over the first quarter of this centuryand then further and more significantly over thesecond quarter of this century. The implicationsof these changes in terms of the changingrelevance of the older population in each countryare brought out by figures summarized in Table14. Data for 1975-2000 have been added tocompare the change during the first quarter ofthis century with the change during the lastquarter of the previous century.


Photo credit : Ms. Asma Rahimi, Advocacy and CommunicationsOfficer, UNFPA-Afghanistan Country Office, Kabul.

19

In all eight countries, the increase in the olderpopulation during 2000-2025 will be two to threetimes larger than during 1975-2000. In India,for example, the older population will increaseby 92 million during 2000-2025 as against 39million during 1975-2000. Even in Afghanistan,where the proportion of the older population isexpected to remain unchanged, the absoluteincrease as during 2000-2025 will be four timesas much as during 1975-2000. Further increasesduring 2025-2050 of two to three times as muchas during 2000-2025 are projected in eachcountry, except Sri Lanka. In Sri Lanka, the olderpopulation is projected to increase by 2.3million during 2000-2025 and 1.4 millionduring 2025-2050. The impact of the earlierdecline in fertility in Sri Lanka will reach the oldercohorts ahead of the other seven countries. Theneed to focus increasing attention on the olderpopulation is indicated by the increasing share ofolder persons in the increment to total population.In all countries older persons will constitute amuch larger share of the change in populationduring 2000-2025 than during the preceding

twenty-five years. In Sri Lanka, during 2000-2025 only the older population (60+) will increasewhile the population below 60 years will decline.Total population will still increase as the increasein the older population will more than offset thedecline in the under-60 population. During2025-2050, this situation would hold in Bhutan,while in Sri Lanka the total population willdecline as the increment in the older populationwill fall short of offsetting the decline in theunder-60 population.

It is evident that, with the exception of Afghanistan,the countries of South Asia are all faced with theprospects of a rapid ageing of their population.During 2025-2050, in two countries - Bhutanand Sri Lanka - older persons will be the onlyincreasing age-group. In another three -Bangladesh, India and Maldives - the olderpopulation will account for more than half thetotal increase in population during 2025-2050.Development policies and plans in South Asiawill therefore have to be increasingly linked tothese demographic changes.


20

3.3 Changes in population age structure

It is important for policy makers to take intoaccount trends in key indicators of changes inthe age structure of the population - ageingindex, median age, potential support ratio and

parent support ratio - to understand theimplications of the process of ageing. The rateand extent of changes in each of these indicatorsvary with the pace of population ageing. Past andprojected trends in the ageing index and themedian age are shown in Table 15.

During the second half of this century theAgeing Index declined in all countries exceptBhutan, India and Sri Lanka. A declining ageingindex reflects a more rapid increase in the childpopulation (0-14 years) than the older population(60+). The ageing index increased most in SriLanka followed by Bhutan and India. These asshown by the discussion in section 3.2 are theearliest agers in South Asia. The ageing index isprojected to increase in all countries during 2000-2025 and by even more during 2025-2050. In2026, the older population will exceed the childpopulation in Sri Lanka. This will be the firsttime in any country of South Asia that olderpersons will outnumber children. The same willhappen in Bhutan and India during 2025-2050and in Maldives in 2050. In Sri Lanka there willbe 1.7 times as many older persons as children in2050.

The past and projected changes in the MedianAge follow more or less the same pattern as thatof the Ageing Index. During 1950-2000 bothindicators increased in Bhutan, India and SriLanka. Bangladesh was the only country wherethe ageing index declined but there was anincrease in the median age. Projections for themedian age show that it will increase in allcountries during 2000-2025 and further during2025-2050. In 2050, the median age will behighest in Sri Lanka (43 years) and lowest inAfghanistan (23 years).

It is evident that in most countries there will bean unprecedented increase in the size of the olderpopulation relative to that of the child populationduring the first and second quarters of thiscentury. In fact, in some countries the size of the


21

older cohorts decreased relative to that of youngercohorts during 1950-2000. Even the “earlyagers”, will experience much larger changes in theage structure than during the second half of theprevious century. It can therefore be concludedthat for countries of South Asia it will be the firsttime in history that they will be having to facethe challenge of population ageing and at suchscales.

What the change in the age structure of thepopulation will mean in terms of the change insupport that could be available for older populationfrom the younger cohorts is reflected in Table16 which provides figures for the PotentialSupport Ratio and the Parent Support Ratio.

During 1950-2000, the Potential Support Ratiodeclined in the three “early agers” but increasedin the other five countries. Significant declinesin the ratio are projected during 2000-2025 inall countries except Afghanistan. During 2025-2050 however the ratio will decline in allcountries. By 2050 the potential support ratiowill have fallen to less than 5 in Bhutan, Indiaand Sri Lanka. In all countries there will be onaverage a smaller number of economically activeadults to support one older person than at theturn of the century. In Sri Lanka there will beless than 3 economically active adults per olderperson compared to about 10 at present.

Between 1950 and 2000, the Parent SupportRatio increased by varying degrees in allcountries, except Bangladesh. In Afghanistan toothe ratio increased. This could be because of theconflict situation during the last two decades ofthe previous century in which a larger number ofadults than older persons are more likely to havebeen killed. Hence, the additions to the 50-64age cohorts would have been reduced to a greaterextent than additions to the 85+ which woulddepend on those who had already turned 60during the early years of the conflict and remainedless affected. It is projected that the ParentSupport Ratio will increase in all the countries


22

during 2000-2025 and by an even greater extentduring 2025-2050. The increase will be thelargest in Sri Lanka where the ratio will increaseto more than three times from 4.7 in 2025 to14.5 in 2050.

3.4 Ageing of the older population

Evidence on trends in the Parent Support Ratioindicate that, in all countries of South Asia, the

population of the oldest old would be increasingduring the next four to five decades. The oldestold have specific needs which give rise tospecific policy challenges. It is thereforeimportant to look at how the situation of theageing of the older population would evolvedifferently in these countries. Table 17summarizes the trends in the ageing of the olderpopulation.

In all countries except Afghanistan and Bangladesh,the proportion of the oldest cohorts in the olderpopulation increased during the second half ofthe previous century. However, the oldest oldpopulation increased by over 200 thousand.During 2000-2025 the proportion of the oldestpopulation in the older population will increasein all countries, except Sri Lanka. Nevertheless,the population of the oldest old will increase by212 thousand during the twenty-five year periodcompared to 201 thousand during the preceding50 years. In all countries the proportion of theoldest old in the older population will increase

during 2025-2050 and in most countries theincrease in the oldest old population will be 3-4times that during the preceding twenty five years.The most significant increase will be in Sri Lankawhere the proportion of the oldest old in the olderpopulation will nearly double between 2025 and2050. The projected ageing of the older populationin Sri Lanka is typical of countries which beginto age rapidly. The rate of increase in thepopulation of 60-79 years begins to accelerate andit is with a time lag that this impacts on the 80+population. Hence, in Sri Lanka the projectedincrease in the older population at an accelerated


23

pace during 2000-2025 will translate into a rapidincrease in the oldest population 2-3 decades later.

Evidence shows that, while the additionalnumbers of the oldest old will be much largerduring 2025-2050, the additions in the nearfuture too would be significantly larger thanwhat the countries have been used to during thelast few decades. As such it would be appropriatefor policy makers to also take into account thespecific needs of the oldest old in theformulation of policies and plans for the olderpopulation.

3.5 Feminization of Ageing

As shown by the regional overview, womenconstitute a majority of the older and oldestpopulation and a higher proportion of olderwomen than older men are single, not in thelabour force and not literate. It is important tosee how the extent of feminization of ageing aswell as the gravity of relevant gender issues variesacross the countries.

3.5.1 Older female population increasingfaster

Table 18 summarizes the data on the proportionof females in the older and oldest population ineach of the 8 countries.

The figures show that in 1950 the proportion offemales in the older population was less than 50per cent in four countries - Bhutan, Maldives,Pakistan and Sri Lanka. In another two -Afghanistan and India - it was about half and inonly Bangladesh and Nepal it was significantly

more than fifty per cent. By the turn of thecentury in Bhutan and Maldives there were lessolder women than older men, while in all theothers it had increased to more than 50 per cent.In Bangladesh, the proportion of older womendeclined from 58 to 51 per cent. The proportion


24

of women in the older population is projected toincrease during 2000-2025 in all countriesexcept Pakistan where it will decline to slightlybelow 50 per cent. In Bhutan it will remain lessthan 50 per cent. In most countries, the proportionof women is projected to increase between 2025and 2050 and in all countries, except Bhutan,women will comprise more than 50 per cent ofthe older population in 2050. The genderbalance in the oldest old population varied widelyacross the countries in 1950. However, by theturn of the century, in all countries except Bhutanand Pakistan, women constituted the majority ofthe oldest old population. By 2050, women will

constitute more than half the oldest oldpopulation in all the eight countries. Moreover,in all countries the proportion of women in theoldest old population will be more than theproportion of women in the older population.

3.5.2 Greater vulnerability of older femalepopulation

Women in the older and oldest population aremore vulnerable than their male counterparts asshown by gender differences in economicactivity, illiteracy and marital status summarizedin Table 19.

In all countries, a smaller proportion of olderwomen than older men are economically active.Except in Maldives, there are also wide differencesin illiteracy rates with a much higher proportionof older women being illiterate. A higherproportion of older women than older men aresingle.

3.6 Rural-urban differences in populationageing

Table 20 summarises information on rural-urbandifferences in ageing for countries of South Asiaexcept Afghanistan for which rural/urbandisaggregated data have not been available 14


25

In all countries the rural population is more agedthan the urban. Since both fertility and mortalitylevels are known to be generally higher in ruralareas, a priori one would expect the degree ofageing to be higher in urban areas. The higherincidence of ageing in rural areas suggests thatthe observed differences in ageing cannot beexplained by differentials in fertility and mortality.

The different patterns of ageing in rural andurban reflect the impact of internal migration.Internal migration is characterized by an outflowof young adult cohorts from rural to urban areas,with a larger number of younger people movingout to urban areas for education or for employment.A flow of older people returning to their villageson retirement from their urban jobs couldfurther contribute to the rural-urban imbalancein ageing.

Another feature, common to all countries is thelower proportion of females in the rural olderpopulation. Though the difference is not verysignificant in some countries, the direction of thedifference is consistent. This difference inrural-urban feminization of ageing too could beattributed to the pattern of migratory flows: ahigher incidence of return to rural areas of maleurban retirees leaving their spouses behind withtheir adult offspring and the greater likelihoodof rural elderly widows moving to urban areasfor joining the families of urban-based offspring.


Photo credit : Peter Lowe and UNFPA-Bhutan Country Office,Thimpu.

26

With South Asian’s changing demographicscenario, a wide range of issues will emerge whichpolicy makers in each country will have toaddress sooner or later. As yet it is only in SriLanka and, to a lesser extent in India, that olderpersons constitute a significant proportion of thetotal population. Hence, evidence of theemergence of key socio-economic, cultural andpolitical issues is available mainly from these twocountries. As such in providing examples of themost important ageing-related issues likely toemerge, evidence from other countries,particularly those of the other sub-regions ofAsia, may therefore be needed to supplement theinformation from South Asia.

In the light of the main features of the changingdemographic scenario characterizing populationageing as outlined in sections 1 to 3, the variousissues emerging as a country’s population ages canbe grouped into the following categories:

- Health services- Long-term care- Living arrangements- Income and social security- Protection against abuse- Special attention in emergencies- Others

4.1 Health services

Health has always been considered the primaryconcern in old age. Though older persons arenow entering old age on average in better healthand living longer than in the past, the increasing

life expectancy does not rule out but at bestpostpones the increasing incidence of morbidity.15

Meeting health needs of the ageing population isa priority ageing-related issue and has beendrawing increasing attention, particularly in thecontext of budgetary allocations for the healthsector. There should therefore be little surprisethat it is a very common notion to linkage anddeteriorating health and the need for increasinghealth sector allocations. The inter-linkages haveoften been emphasized to such an extent asbeing described a “threat” that populationageing poses.16 Though this is not altogether true,available evidence on the impact of ageing onhealth expenditures does point to ageingresulting in higher health expenditures, bothpublic and private.17

In addition to higher morbidity associated withageing, an important contributory factor toincreasing health expenditures as a result ofpopulation ageing is the shift in the patterns ofmorbidity and the causes of mortality, commonlyreferred to as the “epidemiological transition”. Asthe age distribution shifts more and more towardsolder cohorts, infectious and nutritional disordersyield place to chronic, degenerative and mentalillnesses as the leading causes of morbidity andmortality. The epidemiological transition is linkedclosely to the demographic transition and hence,as compared to the developed countries, istaking place at a much faster pace and atcomparatively lower levels of income with muchless social welfare provisions in place. Manydisabling and chronic illnesses such as heartailments, diabetes, stroke, hearing and visual

Section 4: Emerging Ageing-Related Issues

27

impairments, dementia as well as the effects oftrauma among older people are incurable andrequire longer term care. So do terminal diseasessuch as cancer. The higher incidence of morbidityand the epidemiological transition together callfor both increasing health services as alsore-structuring these to cater to the changingmorbidity pattern in an ageing population.

The frequency of accessing health services - suchas out-patient consultations, in-patient admissions

The estimates show the older persons to be theonly group whose share in total healthexpenditures is more than proportionate to theirshare in population. On average the total

medical costs in Sri Lanka of a person aged60-74 years are estimated to be 60 per cent aboveand for those 75+ nearly 100 per cent above theaverage. It should be noted that the estimation is


Photo credit : National Secretariat for Elders, Sri Lanka

and clinical tests - are known to increase withage. Per capita health expenditures of olderpersons are estimated to be higher than those ofthe not old; while within the older, the more agedincur even higher expenses than those below 70years (Mahal & Berman 2001). Evidence fromSouth Asia is not readily available but attemptshave been made at estimation. A recent study onpopulation ageing and health expenditures in SriLanka provides estimates for the distribution ofhealth expenditures across age groups on thebasis of the variation in volumes of servicesprovided to people in different age groups. Theaverage unit costs (prices) of outpatient andinpatient medical services delivered by thepublic and private sector were derived from thetotal number of annual contacts and the estimateof such expenditures as reported in the SLHA(Sri Lanka Health Accounts) database. Applyingthe annual number of visits disaggregated byprivate and public sectors per year within eachage group to these unit cost estimates, the studyestimated total expenditures by age group. Table21 summarizes the estimated distribution ofhealth expenditures by broad age groups.

28

based on a uniform average unit cost for eachservice accessed, for example, an outpatient visitor an inpatient day in hospital. To the extent theunit cost of service for an older person may behigher, the health expenditure of older personswould increase further.

Evidence on morbidity among older persons inIndia (Table 22) indicates higher morbidityamong older women than older men and revealsdistinct rural-urban differences in the pattern of

morbidity.

Except for diabetes, the prevalence of visualimpairment, hypertension and coronary heartdisease is higher among older women. Also, theprevalence of visual impairment is more commonin the rural areas, while the incidence ofdiabetes, hypertension and coronary heart diseasesare greater in the urban areas. This is as expectedfor these “diseases” which are known to berelated with relative affluence and modernization.

The data presented in Tables 21 and 22 arefragmentary but together indicate that theincreasing proportion of older persons inpopulation and a further ageing of the olderpopulation can be expected to result inincreasing health expenditures. Also, increasingfeminization of ageing would call for increasedexpenditures as well as targeting the specific needsof women. Health planning for older personswould also have to take into account rural-urbandifferences. In addition to demographic changes,another aspect which can be expected tocontribute to further increasing healthexpenditures as a result of ageing is the increasingawareness of the older population. Healthconsciousness of the older persons, as of the restof the population, will continue to grow withtheir increasing educational levels, exposure to themedia and improving availability of health

services. Measures need to be put in place for theincreasing proportion of older populationexpected to seek medical care and access to healthfacilities.

4.2 Long-term Care

The incidence of disability increases withpopulation ageing (De Silva, Amarabandu &Gunasekera 2008). Though there is no denyingassociation between morbidity, frailty anddisability, it is very important to emphasize thatolder persons in any country are a heterogeneousgroup not only in terms of various socio-economiccharacteristics (such as education and income) butalso in terms of their health status and the extentof loss in mental, physical and social functioning.Disability in the older population also hasgender connotations as generally the incidence


29

of disability is known to be higher among olderwomen than older men and to increase with age.Moreover, the chances of recovery or return toactive status are also lower among women anddecrease with age (Mujahid 2006). While allpersons with a disability, irrespective of age, needlong-term care, older persons, due to their frailty,stand in need of more intensive long-term care.18

As in the case of morbidity, evidence on disability

is also difficult to come by for developingcountries. Evidence from India (Table 23) showsthat incidence of disability is considerably highwith more than the one-third of the olderpopulation reporting at least some form ofdisability. The incidence of disability is higheramong females than males. It is also higher inthe rural areas except in the case of visualdisability among older women.

Further evidence (Table 24) shows that incidenceof disability in the older population increases withage. These trends - higher incidence of disabilityamong older women and incidence of disabilityincreasing with age - are also observed in othercountries (Ahmed 1995).

The percentage of persons physically immobile -defined as those who cannot move without help

- increases with age and is higher among women.Hence, not only the overall incidence ofdisability in total population going to increasewith population ageing, but also both ageing andfeminization of the older population will add tothe incidence of disability in the olderpopulation. Moreover, disability is expected toaffect the older population to a greater extent inrural areas.


30

4.3 Living arrangements

Throughout South Asia the responsibility ofcaring for older persons has been traditionallyrecognized as the responsibility of offspring,particularly sons, and other younger relatives.This is in conformity with the implicit“intergenerational contract” whereby the youngergeneration who have been brought up and takencare of through their childhood and youth by theolder generation “repay” the older generation bytaking care of it during old age. As such, in South

Asia the multi-generational household is theaccepted norm for families having one or moreolder relatives. However, with declining familysize and the increasing incidence of migration,co-residence arrangements would come underever increasing strain. Evidence is not availableto establish time trends in the extent ofco-residence in any South Asian country.However, data summarized in Table 25 suggeststhat as population ageing progresses, there willbe an increasing need for alternative livingarrangements for the older population.


31

Table 25 shows data for the latest available yearfor 4 countries of South Asia on the distributionof older persons by age, sex and form of livingarrangement. The figures are not comparableacross countries but, on the basis of the patternwithin each country, they bring out thefollowing common features:

● More than 80 per cent of older personsreside with a child or grandchild. The proportionof older men in such co-residence is slightly morethan of older women in all countries and for mostage-groups.

● Except in Pakistan, a higher percentageof older women than older men live on their own.

● A higher percentage of older men thanolder women live with a spouse. This conformswith the lower proportion of “single” older menthan men (Table 19 above).

● In most cases a higher proportion ofolder women than older men live with others,that is either distant relatives or non-relatives.

● The proportion of those living withothers increases significantly for the oldest oldand a much higher proportion of the oldest oldwomen than men live with others.

It is evident that co-residence in a multi-generational household is the norm. However, thegender differences in the pattern of livingarrangements indicate the greater vulnerability ofolder and oldest old females. A higher proportionof males live with a spouse and with a child orgrandchild. Hence, a higher proportion of oldermen live within the close family (spouse or/andchild/grandchild) where the level of care andconcern is likely to be higher. A higher proportionof females live alone and with distant relatives ornon-relatives. The proportion of those living withdistant relatives and friends is significantly higherfor the oldest old. This indicates that with

advancing age the elderly are compelled to seeksupport. It also shows that people are likely to bemore ready to assist oldest old distant relativesand friends, particularly the women. Partly thereadiness to assist older women and the oldestold could be explained by sympathy which meansbeneficiaries having to compromise their dignity.

While the most common living arrangement forolder persons continues to be co-residence withclose relatives, this traditional arrangementguaranteeing family support of the elderly can beexpected to undergo change (Mason 1992). Thetraditional family support base is likely to shrinkas a result of the reduction in family size and thenuclearisation of families, as well as bothinternal and international migration (De Silva2005). In addition, globalization is contributingto an increase in the pace at which the dividebetween the attitudes of the older and youngergenerations is widening. Hence, the younger mayprefer to live independently. Moreover, due to thewidening inter-generational division in attitudes,the older persons too may not find it easy to adaptthemselves to the rapidly changing life styles oftheir offspring. Traditionally, it is usually thedaughter-in-law or the daughter who takes theresponsibility for looking after the older relatives.With an increasing proportion of womenjoining the labour force this support base isdwindling as a working woman is neitheravailable nor can be expected to provide therequired care and support.19 With co-residencebecoming less and less feasible both the youngerpersons and older persons may increasinglyprefer alternative living arrangements. Theincidence of residing with the close family is loweramong older women and among the oldest old.Hence, ageing and increasing feminization of theolder population would also contribute to a moveaway from co-residence. While traditional


32

family ties continue to remain strong, effortsshould be made to strengthen these and promoteco-residence but measures would need to be takento ensure appropriate alternative arrangements insituations where co-residence is not or ceases tobe viable.

4.4 Income security

Income security for the older population is ofparamount concern as the probability of fallinginto poverty is known to increase with old age.A number of studies have shown that theincidence of poverty among the older populationis higher than the national average (World Bank2006; HAI 2007c). Moreover, the incidence ofpoverty among the older population progresseswith ageing. The Household Income andExpenditure Survey 2002 in Sri Lanka showed19.9 per cent of those aged 60-69 years, 22.2 percent aged 70-79 years and 25 per cent aged 80years and above as being in poverty (Sri Lanka2002a).20 Furthermore, older women are moreprone to poverty than older men (ECOSOC1999; ESCAP 2002). As such poverty amongthe older population is aggravated by both thefeminisation of ageing and ageing of the olderpopulation described in Section 3 above. In SouthAsia, as in other less developed regions,governments will have to focus increasingattention on ensuring that the projected largenumbers of older persons have sufficient resourcesfor meeting their basic needs.In most countries, older persons have been foundto rely on five main sources of income:

● Earnings from employment● Family transfers● Contributory pensions● Savings and investment● Non-contributory social pensions

Surveys conducted in a number of countries haveshown that the primary sources of financialsupport on which a majority of older persons relyare their own employment earnings and familytransfers (Mujahid, Pannirselvam & Dodge2008). As only a small proportion of thepopulation has been employed in the formalsector, the proportion of the older populationhaving pension coverage or savings andinvestment incomes sufficient to meet theirbasic needs has remained insignificant. NoSouth Asian country has any social security(contributory pensions) scheme applicable tothose working in the informal sector.21 Theprimary sources of income security for olderpersons are hence family transfers and their ownincomes from employment. While in South Asiathe traditional “inter-generational contract”whereby offspring and younger relatives providefinancial support to parents and older relatives isand can be expected to remain strong, it willnevertheless gradually dwindle as a support basedue to falling fertility levels and the subsequentdeclines in the potential support ratio(Shantakumar 2002).

In South Asia, older persons have therefore hadto continue working for as long as they have thestrength to do so. With the expected decline inthe family support base, an increasing proportionof South Asia’s older population would behoping to rely on employment as the primarysource of income security. It is thereforeimportant to assess the potential of employmentfor older workers as a source of incomesufficient to keep them above the poverty line.

4.4.1 Opportunities of gainful employment forolder persons

Employment has been an important, though not


33

the only, source of financial security for SouthAsia’s older population. A high proportion ofolder persons, both male and female, remaineconomically active. As can be seen from Table26, the activity rates fall with age but still remain

considerably high. In India, for example, 35per cent of males and 9 per cent of females aged80 years and more were reported as economicallyactive in the 2001 Census count.


Overall the data presented in Table 26 show thatparticipation of older persons in the labour forcehas been high and increased in most cases.Though the female participation rates have beenmuch lower than male participation rates, thesehave increased in all countries except Sri Lanka.The increase in the participation of older femalesin the labour force is largely a reflection of abroader trend of increasing female participationrates across all age groups.

Whether the increasing participation of olderpersons in economic activity is a positive signremains questionable. While, on the one hand,increasing participation rates indicate that a largerproportion of older persons are actively engagedand can earn their own living, on the other, itreflects dwindling traditional family support anda severe shortage of pensions. Such a largepercentage of the older population, particularlythe oldest old, should not be having to work for

34

a living. Moreover, participation in economicactivity does not necessarily mean having anadequate income. In fact, studies have shownthat older persons work for much lower wagesand the wage rate for older workers declines withage. A study of the labour market for olderpersons in Sri Lanka based on the World Bank2006 Sri Lanka Aging Survey concluded that“a vast majority of Sri Lankan old workers areengaged in the informal sector, work long hours,and are paid less than younger workers”(Vodopivec & Arunatilake 2008). It found thatwages of workers of those aged 65 years andabove are only a fraction of wages of workers intheir late 50s and early 60s in the public sector.A significant reduction of wages of older workersoccurs in the public sector, with workers aged 65and over earning barely over 1/3 of what theworkers in the 60-64 group are earning. Wagesfor women aged 65 and over were found to beonly one-fifth of those for workers in the 55-59age group. The reduction in wages for workersabove 65 years of age is more striking in thepublic than in the private sector.

With the unprecedented large increases in thenumber of older persons, particularly the oldestold, it would become increasingly difficult forolder persons to find gainful employment. Also,

because of rapid advances in technology olderworkers may need re-training in order to qualifyfor certain jobs. Moreover, as a result of theirincreasing numbers, older workers could facemore exploitation and receive even lower wages,particularly because unemployment andunderemployment among the younger workingage groups in South Asia are also high.22 Hence,opportunities of gainful employment can beexpected to fall increasingly short of ensuringincome security for the older population. Withthe likelihood of older persons facing increasingdifficulties in getting employment and theforeseeable decline in family transfers, increasingreliance will have to be placed on social securityand welfare schemes for ensuring incomesecurity for the older population. Social securitybenefits depend on the individual’s pastcontributions to a pension scheme, while welfarepayments are those to which a recipient isentitled because of need.

4.4.2 Social security

Social security coverage has been limited to thoseemployed in the organized sectors.23 Thoseemployed in the formal sector can, or may berequired to, contribute to a pensions schemewhich entitles them to receive a pension benefitafter retirement. The amount of the pensionreceived depends on the amount of thecontributions made during the working years.South Asia, together with sub-Saharan Africa,ranks lowest in social security coverage with5-10 per cent of the economically activepopulation covered by social security schemes(Reynaud 2002). In India, for example, of anestimated workforce of 397 million, only 28million employed in the formal sector werecovered by social security (India 2006). Thesituation is similar in Pakistan where provisions


Photo credit : Penny Tweedie/HelpAge India

35

of regular pensions are limited to employees inthe formal sector. Social security schemes in thepublic and private sectors cover a smallproportion of the older population (Mahmood& Nasir 2008). A significant proportion of theelderly population working in the informalsector has no access to social security schemes.

The burden of supporting a social securitysystem increases with the pace of ageing. Adecline in the potential support ratioaccompanying population ageing indicates thata smaller number of workers have to contributetowards paying for the social security benefits ofa growing number of older persons. This isparticularly the case in the more commontraditional social security systems - the Pay-As-You-Go - where the contributions of thecurrent work force pay for the benefits of currentretirees. Ageing of the older population addsfurther to the burden of maintaining socialsecurity systems. Not only are there more peoplewho have to be paid pensions but also on averagethey have to be paid for a longer period of time.Moreover, while governments are taking stepsto widen social security coverage,24 it cannot havea significant impact during the next ten tofifteen years. Even if the coverage were to beextended to cover the entire working population,those who will be able to make contributions forless than ten to fifteen years would not have anadequate pension. Extending the social securitycan therefore be viewed, as a long-term solutionwhile during the short-term increasing reliancewill have to be placed on the welfare system toguarantee income security for the increasingnumber of older persons leaving the labour force.

4.4.3 Welfare benefits

Welfare benefits are distinguished from pensions

in that they are not dependent on participationin a particular pension scheme or on pastcontributions. The entitlement to welfarebenefits, which are invariably state-funded, isbased solely on age or/and need. Welfarebenefits could take the form of cash payments(such as Old Age Pensions), food assistance, theprovision of free or subsidized services (like healthcare), tax exemptions and discounts (as inpharmacies, travel etc).

Some of the countries in South Asia have hadwelfare schemes targeting exclusively olderpersons but these have at best remained verylimited in coverage.25 Nepal has an Old-AgeAllowance Programme under which a universalpension of Rs. 100 (US$ = 80 rupees) is paid tothose aged 75 years. Widows aged 60 year andover are entitled to receive an allowance underthe Helpless Widows Programme (Shrestha &Satyal 2003). Similarly, in Bangladesh, theGovernment pays a monthly allowance of Taka100 (US$ = 65 taka) to ten very poor elderlypersons from each of the over 4,000 administrativewards in the country (Rajan, Perera & Begum2003). Poor persons aged 65 years and over inIndia are entitled to receive a means-testedmonthly pension of Rs 75 (US$ = 45 rupees)under the National Old Age Pensions Scheme(Chakraborti 2004).

The elderly, particularly the needy or thosehaving a disability, also benefit from generalwelfare schemes such as the ‘Samurdhi’ and‘Mahajandara’ Programmes in Sri Lanka and theZakat Fund in Pakistan. Governments have alsogradually been introducing measures aimed atalleviating the economic hardships faced by theelderly. These have included tax exemptions onincomes, higher rates of return on investmentsand subsidies on housing, health care and


36

transport facilities. With declining familysupport, shrinking employment opportunitiesand the time required before the coverage ofcontributory pensions can be increased to haveany significant impact, an expansion of welfaresystems would be required during the next fewyears to alleviate poverty among the increasingolder population (HAI 2006). Given the lowincome level of South Asian countries as well as anumber of other competing demands ongovernment funds, the burden of extending thecoverage of assistance to ensure incomesecurity for the elderly is generally viewed bygovernments as one of the most seriousageing-related issue they need to address.

4.5 Protection against abuse and violence

Population ageing has been seen to result inincreasing neglect and abuse of older persons.Elder abuse is defined by WHO as “a single orrepeated act, or lack of appropriate action,occurring in any relationship where there is anexpectation of trust that causes harm or distressto an older person” (WHO 2002). The growingnumber of older persons traditionally expectedto be taken care of is contributing to increasingstress in joint and extended families. The fasterpace of lifestyle changes has resulted in a quickerwidening of the generation gap making itdifficult for both the younger and older personsto adjust to each other’s attitudes. The youth failto understand the values cherished by the elderlywhile older persons are virtually bewildered atthe rapidly changing attitude and lifestyles of theyounger persons. Neglect and abuse of theelderly has come to be recognized as a universalphenomenon as reflected in the establishment ofthe International Network for the Prevention ofElder Abuse (INPEA) in 1997 and the designationof 15th June as World Elder Abuse Awareness Day

(WEAAD) in 2006.26 Abuse can be physical,psychological, emotional, financial or social.

Data on elderly abuse are not available for mostcountries as discussion of elderly abuse in SouthAsia remains a taboo. The incidence of neglectand verbal abuse of the elderly is reportedly muchhigher than that of physical abuse though it isnot unknown particularly cases of violent crimetargeting older persons. Generally, like domesticviolence elderly abuse goes unreported as victimsprefer to remain silent to avoid bringing shameto their own family as well as for fear of retaliation.So deeply entrenched is the psycho-culturalbarrier preventing elders to report abuse that thetendency is still to be found among the SouthAsian diaspora in North America (Gupta &Chaudhuri 2008). However, various types ofelderly abuse are known to exist and to be on theincrease in all countries of South Asia. Likedomestic violence, abuse and neglect of theelderly are also gradually coming out more intothe open as a result of awareness creationcampaigns (INPEA 2008).

A study on elder abuse in India based on focusgroup discussions involving older persons showedthat the elderly suffered abuse, neglect andemotional distress but by and large werereluctant to complain and even tried to justifytheir maltreatment by offspring and otheryounger family members (Soneja nd; Shah,Veedon & Vasi 1995). In Bangladesh, elderlyabuse, typically neglect and abandonment,particularly in the rural areas is reportedly on theincrease (Hossain, Akhtar & Tajuddin 2006). InPakistan, the elderly’s traditional place ofhonour in the family has been eroding and theGovernment is planning to use legislation - Se-nior Citizens Welfare Bill - to protect the olderpopulation from neglect and abuse and make it


37

mandatory for the offspring to provide care andsupport to their elderly parents (GAA 2009).

Elderly abuse is not confined to the home. Theelderly can also be faced with abuse in theinstitutional setting such as discrimination,neglect and maltreatment by caregivers andservice providers 27. Moreover, elder abuse is agender issue as generally older women are morevulnerable to abuse and neglect (Shankardass2003). In addition to abuse, older persons arealso becoming increasingly vulnerable to violentcrime. As population ageing progresses, thegrowing preference for the nuclear familycontinues and an increasing proportion of olderpersons choose (or are forced) to live on their own.Older persons living on their own become aneasier target for criminals. Priority needs to beattached to provide the elderly with protectionagainst abuse and crime as these pose a seriousthreat to the dignity and safety of the olderpopulation.

4.6 Special attention in emergencies

The risk of abuse and neglect of the elderly isaggravated during emergency situations arisingout of conflict-related or natural disasters. Thisis due to both their greater vulnerability and lackof the needed focus in rescue and reliefoperations (Wells 2005). During armed internalconflicts and wars as well as in the event ofearthquakes, cyclones and severe heat waves,adequate attention needs to be given to protectingolder persons and preventing neglect duringrescue and relief operations. The issue calls forgreater attention in South Asia as almost all thecountries have been affected by conflict situationsor natural disasters or both. Afghanistan and SriLanka have been engulfed in an internal conflictsituation for more than two decades. Nepal has

gone through a long period of civil strife. TheKashmir region, being at the centre of a borderdispute between India and Pakistan, has sufferedincidences of extreme violence over the last sixdecades. Bangladesh is prone to frequent cyclones.Afghanistan and Pakistan and, with some lessfrequency, India have experienced devastatingearthquakes. India, Sri Lanka and, on a muchsmaller scale Maldives were affected by theTsunami of December 2004. In all thesesituations older persons suffered more thanproportionately and were found to have beengenerally marginalised during rescue and reliefoperations.

As has been observed in Afghanistan (HAI 2001),older persons when displaced or forced to fleethe country are at greater risk due to the physicaland mobility problems that older people face. Asyounger family members move to safety theresulting separation of older people from theirfamilies increases their vulnerability. Olderpersons account for most of the people remainingin the IDP camps in Pakistan-administeredKashmir because of their fear of the hardships ofreturn and to protect the children left in theircare (IASC 2008). In Sri Lanka, too, the armedconflict in the Northern Tamil Region has takenits toll on the older people who have suffered morethan proportionately (Korf & Silva 2003).

The plight of the older persons during naturaldisasters is much worse than of younger persons.Lacking agility and strength, older persons havedifficulty in escaping to safety during naturalcalamities such as floods, earthquakes andcyclones. In Bangladesh, older persons are theworst affected by frequent floods (HAI 2004).During the devastating earthquake which hitPakistan- and Indian-administered Kashmir, olderpeople were among the worst affected and found


38

it difficult to access relief packages and sheltersor appropriate health services. Surveys in 41camps in and around Muzaffarabad found that8,400 older people had been left isolated andvulnerable (HAI 2008a). More comprehensiveinformation on the plight of older persons inemergencies is provided by a study on the impactof the Tsunami which hit Indonesia, Thailand,India, Sri Lanka and Maldives in December 2004:“Age discrimination caused older survivors to missout on distribution of relief supplies, monetarycompensation and access to services. Older peopleliving with their childrenís families became almostinvisible when the relief material was distributedto the younger adults. Relief workers interviewedgenerally identified children, particularly orphans,as the main group needing special provision and didnot regard older people as a vulnerable group with

particular needs” (HAI 2005). In Maldives, whichwas hit but not as hard as the other countries,most of the deaths were reported among childrenand the elderly (WHO 2005).

A major contributory factor in the greatersuffering of older persons during emergencysituations has been the lack of attention duringrescue and relief operations. Relief organizationshave not had adequate mechanisms andprocedures in place to cater specifically to thespecial needs of older persons or guide theirworkers to focus on the elderly (HAI 2008b). TheHumanitarian Practice Network of the UKOverseas Development Institute surveyed staff offifteen relief agencies28 to ascertain policies andprocedures the organisations had relating to careof the elderly during emergency situations. Theresults are summarised in Table 27.

The information provided by the staff of theorganisations showed that a majority of themdid not make efforts to identify the older peopleand only 6 per cent had any knowledge of directpolicies or operational procedures theorganizations had for older people. Given thecontinuing conflict situations in South Asia andthe vulnerability of the countries to naturaldisasters, the issue of ensuring adequateprotection and relief for older persons will needto be addressed by all countries.

4.6.1 Long-term impact of conflict situations

While protecting today’s elderly in emergencysituations is a current need, it is also importantto take note of a longer term impact of conflictsand natural disasters on the older population ofthe future. The ways in which conflicts andnatural disasters scar the lives of today’s youngerpopulation will have a profound impact on them


Photo credit : UNFPA-Maldives Country Office, Male

39

as the older population of the future. Conflictsituations, in particular, result in more male thanfemale deaths. Hence, among the survivors thereare more women than men who have lost theirfamilies - spouses and sons. The older populationafter two or three decades of a prolonged conflictsituation would therefore comprise a higherproportion of women and that too widows andthose who may have lost a son or two or even alltheir children. This situation is emerging inCambodia as a consequence of the lives lostduring the Khmer Rouge era about three decadesago (Cambodia & UNFPA 2007). Moreover, theincidence of disability in the projected olderpopulation can be expected to be higher as aresult of current conflict situations and naturaldisasters.

4.7 Dispelling negative attitudes towardsageing

Older persons have generally been viewed as weakand infirm and as those who have to be cared forand provided support. As such populationageing is widely feared for its adverse effects at alllevels - family, community and national. Anegative paradigm has emerged in which laterlife is often associated with dependency,vulnerability, an inherent lack of capability, andpoor quality of life (Lloyd-Sherlock 2004). Worstoff all, even older persons themselves tend to viewold age as the last stage of life characterised byhopelessness and as such lose self-confidence asthey age.29 With the proportion of older persons


40

increasing as projected, the need for dispellingsuch negative impressions relating to this largeand growing segment of the population assumesadded importance. Measures need to be takento counter the negative image of ageing andolder persons by highlighting the positivecontributions the elderly can and do make at thefamily, community and national levels. In themore developed countries the image hasgradually changed but in South Asia, as in mostless developed countries, the negative attitudeshave largely persisted.

The contributions and potentials of olderpersons need to be recognised and disseminatedto counter the negative impressions of ageing.30

Limitations of space preclude documenting thevarious ways in which older persons contributeto the well-being of the family and to communityand national development (Siddhisena 2005).Highlighting the following would serve thepurpose at hand:

● In many cases, older persons providematerial support to other family members.It is evident from the high rates of olderpersons’ participation in economicactivity that they do have earnings.Moreover, it has been shown by a numberof studies that older persons spend asignificant portion of their pensions inhelping other family members particularly


Photo credit : © UNFPA/ Pakistan CO2008-IMG0066

41

the education of their grandchildren(HAI 2006; Mujahid, Pannirselvam &Dodge 2008).● Older persons are the most trustworthyin looking after small children particularlytheir own grandchildren. They play asignificant role in looking aftergrandchildren and, particularly olderwomen, in helping with housework. In thisway older persons make a crucialcontribution towards facilitating full-timeemployment of women (daughters or/anddaughters-in-law) which is becomingincreasingly essential for adequatehousehold income and for nationaldevelopment.● Older persons, particularly older women,play an important role in looking after thewell-being of other older persons and sickor disabled family members. The careprovided by older women is especiallycritical. Such care assumes increasedimportance in countries where HIV/AIDSprevalence is high and older persons areleft as the sole caregivers of orphanedgrandchildren.● Older persons in rural areas haveextensive knowledge and experience

and can serve as invaluable sources ofinformation on traditional agriculturalpractices, natural approaches to healing andhealth maintenance, and coping withvarious challenges in food production(Stloukal 2004). With increasing rural-urban migration, their intergenerationalrole assumes greater importance,particularly when they are charged withcaring for and guiding young peoplewhose parents have moved to cities(Knodel 2007).● Older persons have various capacities,skills and wisdom as well as a wealth ofinformation and knowledge of the area andcommunity in which they have beenliving. They are also best positioned to helpresolve disputes, if necessary, amongvarious members of the community. Allthese, particularly the experience of pastconflicts and natural calamities, enableolder persons to render invaluable adviceand direction during emergency situations(HAI 2006). Evidence is available fromIndonesia to show how advice given byolder persons on an exit strategy resultedin saving a number of lives during theTsunami of 2004 (Abikusno 2005).


42

This section focuses on steps taken by the eightcountries of South Asia towards addressingpopulation ageing. Since the countries have beenaffected by ageing to varying extents and indifferent ways, the government responses havevaried considerably across countries. Sri Lankaand India, being more affected by populationageing, have already introduced a number ofpolicies while in Afghanistan, where thephenomenon is still not noticeable and there areother more urgent issues to address, thegovernment has not felt the need for any action.Hence, this section focuses more on somecountries than others. However, it should bepointed out that the review is not intended to bedetailed or provide an exhaustive list of actionsbeing taken by each country. The purpose is toprovide an idea of the awareness of eachgovernment of the process of progressivepopulation ageing and its consequences, and todescribe briefly key measures put in place. Itshould be pointed out at the outset that a criticalanalysis of the assessment of implementation ofpolicies and programmes is beyond the scope ofthis regional level review.31

5.1 Afghanistan32

With the proportion of the older populationprojected to remain at the current level of lessthan 4 per cent in Afghanistan, the Governmentdoes not consider population ageing to be anissue to be addressed as a priority.33 However,

due to the conflict situation stretching over thelast three decades, the Government does feel theneed to safeguard the rights of vulnerable groupsincluding older persons and to ensure that theelderly affected by the conflict receive adequateattention and assistance. Afghanistan’s legal andpolicy framework is drawn from two mainlegal documents, the 2004 Constitution ofAfghanistan and the International Covenant onEconomic, Social and Cultural Rights (ICESCR),coupled with the Millennium DevelopmentGoals (MDGs) for Afghanistan, and theAfghanistan National Development Strategy(ANDS). Article 53 of the Constitution ofAfghanistan guarantees the right to financialsupport of various vulnerable groups such asfamilies left without providers, persons withdisabilities and the vulnerable elderly (AIHRC2008). The Afghanistan National DevelopmentStrategy (2008-2013) identifies the elderly asdisproportionately represented among thechronically poor (Afghanistan 2008). It categoricallystates that “within the social protection policy,key undertakings will include the determinationof a national poverty line, a focus on redressinggender-related discrimination, and the effectiveinclusion of children and the elderly withinprogrammes”. Moreover, under Pillar 3(Economic and Social Development), one of thepriority areas in the Strategy is “SocialProtection” whereby, “....Government is committedto pursuing sustainable income and transfer policiesthrough pension reform and programmes focused

Section 5: Policy Responses of SouthAsian Governments to Population Ageing

43

on the extreme poor......”. (emphasis added). It isevident that the Government of Afghanistan isaware of the importance of issues facingAfghanistan’s older population but also has anumber of more urgent priorities arising outof the demands of conflict-resolution andreconstruction.

5.2 Bangladesh34

Following a decline during 1950-1975, theproportion of older persons in the population ofBangladesh increased from 4.8 per cent to 5.2 in2000. It is projected to increase to over 9per cent by 2025 and further to 17 per cent by2050. Until the late 1990s ageing was not seenas a priority issue and the Government did notformulate any policies and programmesspecifically targeting the elderly.

Older persons were specifically identified as avulnerable group in the Fifth Development Plan(1997-2002). One of the objectives of the SocialWelfare Programme incorporated in the Plan was“to undertake social security programmes forpersons who are under extremely difficultcircumstances due to old age, having no shelter/being homeless, unemployment, disability,widowhood, divorce, abandonment andviolence”. In 1998 the Government introducedthe ‘Old Age Allowance Programme’ (BoyoshkoBhata Karmashuchi). Under this scheme 20 of theoldest and poorest persons in each ward (ruraldistrict) were eligible to receive a monthlyallowance of Taka 165 (Taka 70=$1). At present,about 1.7 million people aged 65 years and overare benefitting from this programme. TheGovernment has allocated Tk. 4488 million forOld Age Allowance programme. TheGovernment is increasing the number ofbeneficiaries and also enhancing the amount of

allowances gradually (Bangladesh 2007).

Before 1997, however, ever since Bangladeshbecame an independent country in 1971, theolder persons were able to benefit from a rangeof social welfare schemes subject to meeting therequirements of eligibility of the respectiveschemes. Several ministries including theMinistry of Social Welfare, the Ministry of Healthand Family Welfare, the Ministry of Food andDisaster Management, the Ministry of Women’sand Children’s Affairs and the Ministry ofFreedom Fighters’ Affairs have administered arange of 27 social safety net programmes whichinclude:

(a) Food for work programmes(b) Cash for work programmes(c) Vulnerable group feeding(d) Gratuitous relief fund(e) Emergency fund for risk mitigation

during natural disaster(f ) Vulnerable Group Development (VGD)(g) Fund for Housing of Distressed

The social welfare programmes are designed andimplemented to ensure effective participation ofdisadvantaged groups including older persons inthe national development process both ascontributors and beneficiaries rather than as mererecipients of relief and charity. In theimplementation of the approach “Social SecurityProgramme for Old and Shelterless People”, theinvolvement of local government at the grassrootslevel is being encouraged. With this approachthese segments of people will be rehabilitated intheir own area, thereby minimizing theirmigration to urban areas in the long-run.

In 2004 the Government adopted a comprehensivePopulation Policy which included older persons

Section 5: Policy Responses of South Asian Governments to Population Ageing

44

among vulnerable groups and incorporatedprovisions for the elderly (Bangladesh 2004). Inline with one of its objectives, “activelysupporting measures to provide food and socialsecurity and shelter for the disadvantagedincluding the elderly, destitute, physically andmentally retarded persons”, the Population Policyincludes the following strategies:

1. Strengthening family support system throughadvocacy and counseling regarding responsibilitiesof family for elderly, physical and mental retardedmembers and creating awareness in the light ofreligious values;2. Increasing existing old age allowance andexpanding its coverage; and3. Ensuring social security and free medical carefor childless and helpless elderly couples.

In 2006, the Government adopted the NationalPolicy on Older People to be implemented bythe Ministry of Social Welfare (HAI 2007b). Itis expected that the Policy will contribute towardsmainstreaming older people’s issues and ameaningful recognition of older people as avulnerable group, leading to targeted fundingand plans. The main objectives of the Policy areto:

● Ensure the dignity of the elderly peoplein the society.

● Identify and address the problemsof the elderly people.

● Change the attitude of the peopletowards the elderly.

● Develop new programmes to addressthe needs of the elderly people for theirsocio-economic development.

● Develop special measures to help theelderly peoples during emergencies, likenatural calamities, cyclone, earthquakeetc.

● Ensure social security, health care,employment and rehabilitation.

● Implement the Madrid InternationalPlan of Action on Ageing (MIPAA).

The Policy also outlines an institutionalmechanism for its effective implementation. ANational Committee on Ageing, headed by theMinister of Social Welfare, will coordinateprogrammes for the elderly at the national level.There will be Committees at the District andUpazilla (Sub-District) level for addressingelderly issues. The former will be headed by theDeputy Commissioner and the latter by theUpazilla Nirbahi (executive officer).

Some other key measures the Government hastaken in view of the increasing number of olderpersons are:

(a) Under the comprehensive CyclonePreparedness Programme (CPP) jointly operatedby the Bangladesh Red Crescent Society and theMinistry of Disaster Management and Relief,training includes sensitizing relief and rescueworkers to the needs of older persons and theirrequirements for specific rehabilitative services.

(b) The Government has provided project aid,amounting to Tk. 100 million, to the “ProbinHitaishi Sangha” (Elderly Citizen WelfareAssociation).

(c) The Government supports advocacyprogrammes, awareness building and communityparticipation. It observes the International Dayof Older Persons and the International FamilyDay for improving the quality of life of theelderly people and sensitizing the people on theissues regarding welfare of elderly persons.


45

The Ministry of Social Welfare has provided Tk.2,910 million as micro credit since the inceptionof four micro-credit programmes in differenttimes starting from 1974 to 2003 for the poorand the distressed. The numbers of beneficiaryfamilies are 2.9 million and elderly people are partof the beneficiary families.

There is opportunity of retirement incentives forthe Government employees in Bangladesh.According to the Bangladesh service rulesdifferent types of pension are allowed by thegovernment for the officials of the public service.Majority of the labour force in Bangladesh livein rural areas and most of them serve in NonGovernmental organizations, and in most of thecases there is no provision for pension facilities(HAI 2007b).

A number of organizations have been active inthe cause of older people, through a limited, yetincreasing, number of programmes. Very recently,Bangladesh Girls Guides Association, BangladeshEducation Board, Retired Employee’s WelfareAssociation and Bangladesh Society ofGerontology have joined in working for thewelfare of the older population. NGOprogrammes directed specifically for olderpeople include outdoor and indoor medical care,maintenance of old age homes, recreationfacilities for the old people and seminars,workshops, training, research and publicationactivities:

(1) A few NGOs have also takeninitiatives for inclusion of disabled people in theirmicro-credit groups to help them with incomegeneration and older people are included.

(2) Bangladesh Retired GovernmentEmployees Welfare Association, which has been

working since 1976 as a registered organizationprovides medical services to the older population.Currently 62 district level organizations areworking as affiliated bodies.

(3) Bangladesh Association for the Agedand Institute of Geriatric Medicine (BAAIGM)popularly known as Probhin Hitoishi Sanghaactivities includes health care, recreation,rehabilitation, seminars, workshops, research andpublications. Currently it provides services at 34locations. Its programme will gradually beextended to all the 64 districts. It is the oldestand the largest of all organizations working forthe well being of older people since 1960 andworks mainly in urban areas.

(4) Bangladesh Women’s Health Coalition(BWHC) with 26 centres at the beginning of2004 is increasing including older women ineducation services for women and childrenthrough clinic based programmes in urban andrural areas by taking a “life-cycle approach” tohealth care. It has developed lot of IEC materialon ageing issues.

(5) Boisko Punorbashon Kendro Rehabili-tation Centre for the elderly population wasestablished in 1987 in Gazipur. It is a full-fledgedold home where elderly people 60 years and abovefrom any religious faith can live.

Resource Integration Centre (RIC) providescommunity level assistance to poor and disabledolder people with a primary focus on olderwomen and works more in rural areas. It isgradually bringing emphasis on recreationalactivities for older people and has also initiated aprogramme on ‘Older Citizens MonitoringProject.’ The aim of the older citizens’ monitoring(OCM) pilot project in Bangladesh is to increase


46

older people’s access to two government servicesthat are intended to alleviate poverty: the old-ageallowance and the vulnerable group developmentprogramme. There are also programmes toenhance intergenerational relationships. Oldercitizens monitoring projects have shown howgroups of older people have learnt about theirrights, monitored service delivery, and used theinformation they have collected to press forimprovements. This approach has resulted inmore eligible older people becoming registeredfor healthcare and pension programmes, fewerolder people being charged for free services, andbanks and health facilities improving proceduresfor serving older people (HAI 2007a). It has alsobuilt the confidence of older people and theirorganizations to lobby on older people’s behalf.

a) RIC has started advocacy programmesto include older people in relief measuresby understanding their needs anddifficulties.b) RIC has also been conducting awarenessprogrammes on rights of older people.They have also been publishing anewsletter since 2000 which hasinformation on various concerns of olderpeople and the community programmes onnutrition, dealing with emergencies,disaster management, etc. In recent localgovernment elections RIC provided aforum for politicians to interact with olderpeople and where older people questionedleaders on their plans and programmes.c) Recently a Forum for Rights of theElderly, ‘Probin Adhikar Forum’ has beenstarted and this is a non-political, non-profit making voluntary organization. It isan initiative to raise legal protection ofolder people.

d) Elderly Initiative for Development(EID) was established in 1995 as acommunity based self-help organization,and is registered with the Directorateof Social Welfare, Government ofBangladesh. It includes activities thatcentre around the following programmes:Health Care, Elderly Education, PensionSavings, Elderly Allowance, and AwarenessCreation.

The Government has also received increasingsupport of the UN system in the area of ageingand older persons. The main thrust of WHO’sprogramme is to conduct health promotion inhousehold settings where elderly people live andwork in a creative and cost effective environmentthat is supportive of health and of improvinghealth and quality of life. In its operations,UNHCR gives special attention to vulnerablefamilies like female-headed households and theelderly through the introduction of appropriatecoping mechaisms. UNFPA, on the occasion ofInternational Day of Elderly, and in line withICPD mandate has been supporting/providingfunds every year to national agencies/NGOs toobserve/celebrate the day in a befitting manner.The Country Office raises awareness on theageing population, and highlights the needs ofthe elderly and the responsibility of thecommunity for the old age population, under allits Advocacy and Gender projects.

5.3 Bhutan35

At 6.8 per cent of total population, the proportionof older persons in Bhutan is the third highestin South Asia after Sri Lanka and India. Theproportion of older persons in population isprojected to exceed 10 per cent in 2025. After2025, only the older population will increase


47

while there will be an absolute decline inpopulation below 60 years raising the proportionof older persons to 23 per cent by 2050. Bhutanwill then come to rank as the second most agedcountry next to Sri Lanka. However, despite theirhigh and increasing proportion, the elderly inBhutan do not have to face problems similar tothose in many other countries. In Bhutan,responsibility of old-age care rests with thefamily. The culture of respect, care andcompassion influenced by Buddhist philosophyhas led to a norm of shouldering the responsibilityof old-age care by family without taking it as aburden. The path of dependence of the elderlyon kith and kin has been followed for centuriesand intergenerational relations continue to be verystrong. The norm is for older persons to co-residewith their offspring or other younger relatives.

The situation in Bhutan was best summed up bya Government official at the time of the SecondWorld Assembly on Ageing in 2002: “Contraryto the focus of the Conference on problems of ageingin society, Bhutan faces an inverse situation. In ourcontext the aged are respected and well looked after,more so in our rural areas. But times are changingand it is possible that these issues discussed at theConference will one day be relevant here” (Bhutan2002). The Government is thus becoming awarethat “times are changing” and as the number ofyounger family members migrating fromvillages to urban areas for either education or jobsincreases, older persons left behind in the villagesare likely to face serious challenges. The NationalPlan of Action for Gender (2008-2013)formulated recently includes elderly careprogrammes. The King’s Secretariat also looksafter the welfare of the elderly and disabledpopulation through the kidu programme.Furthermore, Tarayana, an NGO set up by theQueen Mother, covers elderly beneficiaries within

its programme for providing support and anenabling environment for the poor.

5.4 India36

In India older persons constitute more than 7per cent of the total population making it thesecond most aged country in South Asia. Thisproportion is projected to increase to over 11per cent by 2025 and to 20 per cent by 2050.India is one of three countries in South Asia(alongwith Bhutan and Sri Lanka) where theproportion of older persons increased during1950-1975 and further during 1975-2000. TheGovernment of India has given priority toaddressing ageing-related issues since soon afterthe country became independent in 1947. TheDirective Principles of State Policy in Article 41of the Indian Constitution (promulgated in 1950)recognized the needs of the elderly and enjoinedupon the state the responsibility of makingeffective provisions for public assistance in casesof unemployment, old age, sickness, disablement,and in other cases of undeserved want.

Various programmes aimed at improving thewelfare of the elderly have been operational sincethe 1950s. Following the introduction of ameans-tested social pension by the state of UttarPradesh in 1957, every state has provided somekind of a means-tested pension to older citizens.Having developed more or less independently ofone another since the 1960s, eligibility rules andbenefit levels have varied significantly across statesbut coverage has remained far from universal. In1995, the Government of India launched theNational Social Assistance Programme (NSAP)which included the National Old Age PensionsScheme (NOAPS)37 to supplement the socialassistance being provided by each state. In 1999,the Government also adopted the National Policy


48

on Older Persons (NPOP) which took acomprehensive view of the needs of olderpersons and, recognising that ageing was a nationalconcern, aimed at ensuring that the elderly donot live unprotected, ignored or marginalized(India 1999). In line with the basic principles ofthe International Plan of Action on Ageing(adopted at Vienna in 1982), the National Policyenjoins the State and civil society to extendsupport for financial security, health care, shelterand other needs of older persons, provideprotection against abuse and exploitation andempower them. The Ministry of Social Justiceand Empowerment is the nodal point forcoordinating the implementation of the NPOPand all activities relating to elderly issues.

In 1999, the Government also launched a newscheme - Annapurna - aimed at providing foodsecurity to senior citizens having no income oftheir own and no one to take care of them.Under this scheme every older person eligible forthe NOAPS is given 10 kilogrammes of rice orflour free of cost. A five year plan of Action (2000-2005) was drawn up to identify the role of theState Governments and the Central Governmentin implementing the National Policy for OlderPersons and review its implementation everythree years (India 2002). A range of otherbenefits for older persons have been graduallyintroduced. The Income-Tax Act offers rebateto people aged 65 years and over. It also allowsthem a higher deduction - Rs. 15,000 - formedical insurance premia. In 2001, the ReserveBank of India authorised banks to pay personsaged 65 years and above a 0.5 per cent higherrate of interest on fixed deposits. Older personsare also given discounts on travel - a discount of30 per cent on train tickets for all persons aged60 year and over and 50 per cent discount on

domestic airfares for persons aged 65 years andover. To encourage the building of facilities forolder persons, the Ministry of Social Justice andEmpowerment provides financial assistance upto 90 per cent of the project cost to organisationsfor establishing and maintaining old people’shomes, day care centres and mobile medicareunits.

India has had a number of laws within thecontext of which older persons can demandfamily support. The Hindu Adoption andMaintenance Act, 1956, entitles a parent unableto maintain himself or herself to maintenance.Under Muslim law too offspring are required tomaintain needy parents, subject to certaincircumstances. In addition, every person withsufficient means who fails to provide sufficientmeans to maintain his or her parents if theyare unable to maintain themselves can be chargedunder the Code of the Criminal Procedure 1973.According to the provisions of this Code aperson can be ordered to pay a monthlyallowance not exceeding Rs 500 for themaintenance of his or her father or mother. Whileolder persons could benefit under these laws,none of these bestowed any special attention onthe aged people. In 2007, the Parliament enacteda more comprehensive law specifically for theprotection of older persons - The Maintenanceand Welfare of Parents and Senior Citizens Act2007 - which makes it mandatory for children toprovide support to elderly parents aged 60 yearsand over (Lingam 2007). It incorporates anumber of provisions to protect and empowerolder persons. Cases under the law would be triedby special Tribunals and settled within 90 days.Under this Act an older parent who has made agift to an offspring can cancel the gift in case theoffspring fails to provide adequate maintenance.


49

5.5 Maldives38

At the turn of the century the older populationconstituted only 5.9 per cent of Maldivespopulation of about 275,000. The proportionhad declined from 8.2 per cent in 1950 to 5.2 in1985 and then began to increase. The share ofolder persons in population is projected toincrease to 9 per cent in 2025. By 2050, almost22 per cent of the population of Maldives will beaged 60 years or more. Given the trends to-date,population ageing is not a priority issue inMaldives (Maldives 2007). However, theGovernment realizes that there will be a dramaticfourfolds increase in the older population during2006-2045 and “plans have to be in place toprovide for this group by the time it actuallyhappens” (Maldives 2007). The Government hasstarted identifying older persons as a section ofthe population requiring special attention andthe Department of National Planning recognizesthe need for further research on the situationof the elderly and for the Government to set upquality nursing homes for the elderly (MPF2009). The Government is therefore fully awareof the emerging importance of populationageing and within the context of its commitmentto “providing better transport facility, houses,advanced health facilities and .....”, thenewly-elected President announced a monthlyallowance (effective January 2009) of 2000Maldives Rufiyaa (US $150) for senior citizens,defined for the purpose as those above 65 years(Maldives 2008).

5.6 Nepal39

The proportion of older persons in thepopulation of Nepal declined from 6.6 per centin 1950 to 5.4 per cent in 1985. It then increasedgradually to 5.9 per cent by the turn of the

century. It is projected to continue increasingand reach 7.8 per cent in 2025 and 14 per centby 2050. Until the beginning of this century,population ageing was not considered an issueby the Government and the only measures putin place covering the elderly were the pensionschemes for government employees and militaryand police personnel, and a social pension forpersons aged over 75 years. The scheme forpaying a monthly pension of Rs. 100 ( Rs 75=USD 1) to people over 75 years of age wasintroduced in five districts in 1995 and thenextended to cover the whole country. The amountwas increased to 150 Rupees in 1999.40 Underthe same scheme, widows over 60 years of ageand disabled individuals over 16 years of age wereeligible to similar allowances (Chalise 2006).

The need to address elderly issues was firstmentioned in the Ninth Development Plan:1997-2002 (Nepal 1997) and since then theGovernment has paid increasing attention toageing-related issues. However, until the SecondWorld Assembly on Ageing in 2002, theGovernment had put in place only two majorprogrammes aimed at improving the welfare ofthe elderly (Nepal 2002a). One was the socialpension for the 75+ elderly and the other theSenior Citizens Treatment Service’ for theprovision of free basic health care services to thepoorer and sick elders. Following its endorsementof the Madrid International Plan of Action onAgeing (MIPAA), the Government circulated itstranslation in Nepali to the general public andgradually introduced various measures aimed atimproving the welfare of the elderly andprotecting their rights (Nepal 2007a). The TenthPlan (2002-2006) aimed at maximizing theknowledge, skill and experiences of the seniorcitizens in the social development sectors bycreating an environment conducive to respect,


50

protection and convenience for older persons. Itarticulated a ten-point programme including thedevelopment of laws and regulations, theencouragement of NGOs and CBOs in thewelfare, care and rehabilitation programmes ofsenior citizens and additional provisions for themin health and transport services.

The Government adopted the Senior CitizensPolicy and Working Policy (Nepal 2002b)designed to guide programmes and projectsrelating to serving senior citizens. The WorkingPolicy covered the following eight aspects: (i)economic, (ii) social security, (iii) health services,(iv) facility and honour, (v) participation andengagement, (vi) education and entertainment,(vii) miscellaneous and (viii) classification. ThePolicy ensured free medical treatment andservices and discounts in charges in the means oftransportation and communication. It alsostipulated to establish a Social Security Fund atthe national level to carry out the works relatingto appropriate social security and services to theelderly citizens. In 2004 the Governmentformulated the Guidelines for the Implementationof the Health Service Programme for SeniorCitizens (Nepal 2006). The Senior CitizensTreatment Service Guidelines cover 45 districts.In 2005, the Government approved the Plan ofAction on Ageing which is being implementedby line ministries, local government, non-government organizations and civil societies. Thelong term goal/objective is to make old agesecure and easy, and develop the capacity of theelderly utilizing their knowledge, skills,experiences and expertise in various spheres ofnation building whilst providing them social andeconomic security with a life of dignity.

The Three Years Interim Plan: 2007/08-2009/10 (Nepal 2007b) for socio-economic development

devotes an entire chapter (Chapter 25) to theageing situation and plans for senior citizensdefined as those aged 60 years and over. Itaddresses the following aspects:

● To make the life of older persons convenient.● To utilize the knowledge of older persons.● To create necessary infrastructure to

allow the elderly to live with dignity.● To develop among the youth a respect

for and a sense of duty towards the elders.● To create an environment for the

economic and social security and theprotection of the rights and welfare ofthe older population.

The Plan allocated Rs. 433 million in 2006/07for, among others, improvement of healthservices, strengthening social security andinsurance schemes, institution and capacitybuilding and research studies on ageing-relatedissues.

The Act relating to the elderly passed in 2006 forthe first time guarantees elderly persons specificlegal rights. It defines legal rights and offersprotection for elderly persons in relation to:

(a) State and family responsibilities fortheir maintenance and care.

(b) The coercion of elderly persons byothers in to begging or seculation(Sanyasi).

(c) Property ownership and transfer ofassets.

(d) Priority in terms of access to andconcession for public services.

(e) Priority to and support in accessinglegal rights.


51

The National Human Rights Action Plan (2002-2004) has also stipulated to protect the rights ofsenior citizens (UNDP 2004).

There are more than 25 institutions/NGOsregistered in the country to serve senior citizens.These include:

1. National Senior Citizen OrganizationNetwork (NSCONN)

2. Siddhi Saligram Briddhasram3. Senior Citizens Welfare Association,

Nepal (SCWAN)4. Nepal Participatory Action Network

(NEPAN)5. Asmi6. Help the Aged Nepal7. Old Age Management \ Social Welfare

Trust

Old People’s Homes have been on the increase inNepal. The need for these homes, calledBriddhashram has been growing due tomodernization, urbanization, and various otherfactors, which have resulted in the elderly beingneglected by family members. There are currentlymore than 100 registered homes of which abouthalf are situated in Kathmandu and the rest indifferent parts of the country (Shrestha & Satyal2003). The elderly are also found refugedinformally in different temples and monasteries.

UNFPA, as the focal agency providing financialand technical assistance in the area of population,has supported research and training activities.It has sponsored Nepalese to attend trainingprogrammes on population ageing and elderlyissues at the International Institute of AgeingINIA in Malta. It has also been active insupporting advocacy efforts aimed at enhancingthe awareness of the Government of Nepal,

political and community leaders of the emergingpopulation ageing situation.

5.7 Pakistan41

The proportion of the older population inPakistan declined from 8.2 per cent in 1950 to5.3 per cent in 1985. By the turn of the centuryit had increased to 6.0 per cent. It is projectedto exceed 9 per cent by 2025 and increase furtherto 18 per cent in 2050. The Government isbecoming increasingly aware of the growingnumber of older persons and of the need toaddress the various problems that arise withageing. The increasing Government concern withpopulation ageing is reflected in the holding ofthe National Seminar on Ageing chaired by thePrime Minister in February 2008 (Mahmood2008).

Of Pakistan’s older population, only a smallproportion who have worked in the public sectoror in formal private sector have post-retirementpensions as well as free or subsidized medical careand subsidized education for children. Those whohave held permanent jobs in the formal sector,particularly with multi-nationals may also haveother benefits such as subsidized housing anddiscount facilities at certain designated shops.The vast majority of the older populationcontinue to work for as long as possible to earn aliving and then relies on family support which,given the declining potential support ratio, isgradually dwindling calling for increasedGovernment involvement in ensuring thewelfare of the elderly. Hence, issues such asincome security, housing and medical care forelderly have assumed increasing importance inPakistan, and with the passage of time have beenreceiving greater attention of the policy makersin the Government (Pakistan 2002).


52

In 2000 the Government established a NationalSenior Citizens Task Force to carry out ananalysis of the ageing situation, identify needsof the elderly and draft a comprehensive NationalPolicy in line with national/internationalcommitments. Its mandate was to suggestmechanism for the implementation of allinter-sectoral activities related to the elderlypeople. A National Policy for Elderly wasformulated by 2004 (Pakistan 2004). TheGovernment also introduced some importantfacilities for elderly population. These consist ofvarious measures for Senior Citizens includingfree membership to all public libraries, finalizationof pension cases without delay and exemptionfrom payment of taxes on recreational activities.Government has set up separate counters forSenior Citizens at outdoor department of majorhospitals, all airport check points, airlinereservation offices and major railway stations.Government has decided to affix special stripsas mark of identification of senior citizens on theirNational Identity Cards to establish their rightto special treatment and specified concessions.Efforts have also been made to ensure properrepresentation of senior citizens on relevantgovernment bodies. Government has also notifiedfocal points for helping the elderly in all thegovernment hospitals.

A rebate of 50 per cent on income tax has beenintroduced for those aged 65 or over having anannual income of less than Rs. 200,000 (Rs 75=1USD). The Federal Government has announceda 100 per cent exemption from local property taxfor widows and retired government servantsrenting out property, and a 60 per centexemption for others living in cantonments.The widows and retired persons have access totwo savings products that give higher rates ofreturn: the Behbood Savings Account and the

Pensioners’ Benefit Account provide interest of10.8 per cent on an investment of up to Rs. 2million.

In addition to the Government, civil societyorganizations such as mosques, NGOs, financialinstitutions and private philanthropists have alsobeen showing increasing interest in the welfareof the elderly. The main organizations providingsocial assistance are Zakat and Bait-ul- Mal. Zakatis state-based as well as privately disbursed. Zakatis an obligation of Muslims to pay 2.5 per cent oftheir annual monetary savings and certainassets in charity to the poor and needy. Thoughit does not specifically target the elderly only,payments from both the state-based zakatsystem and zakat disbursed privately benefitthe older poor. Similarly, the Bait-ul-Mal, asemi-autonomous organization within theMinistry of Women Development, Welfare andSpecial Education has a mandate to providesocial assistance to the deserving poor and needypeople including the elderly. One of its leadingprogrammes - the Food Support Programme -provides Rs. 2,400 annually in two instalmentsto the poor inlcuding the elderly. The Bait-ul-Mal also provides funding for a large number ofNGO projects supporting institutions fordisabled, orphans, abandoned and destitutewomen and other poor needing care as well asassistance for health of aged persons, particularlyfrom rural areas.

The most recent decision is the landmarklegislation aimed at making provisions for thewelfare of senior citizens in Pakistan. ThePakistan Senior Citizens Welfare Act, 2007 hasbeen finalized by the Government (Pakistan2008a). The Act establishes a 10-membercouncil with the Prime Minister as its patron-in-chief, the Minister for Social Welfare and


53

Special Education as the Chairperson andhaving representation of relevant federal lineministries as well as some key provincialdepartments. Under this Act, the Council willensure settlement of their (senior citizens) allbenefits, including pension before reaching thedate of superannuation, besides providingfacility of special counters at pension receivingplaces. The Act provides elderly with, amongothers, the following privileges:

- 20-50 per cent discount in transportation:road, train, air and sea, as well as concessions inprivate sector and fixing of quota.- Free entry to public parks, museums, zoos,cinemas, theatres, public libraries and other publicplaces.- 10 per cent discount on telephone, electricity,gas and water charges provided the bill does notexceed Rs 1,000 per month.- Eligibility for one time for Hajj (the annualpilgrimage to Makkah) under a fixed quota forthe elderly (without the usual balloting) with thepermission of one accompanying attendant ifneeded.- A 50 per cent concession in income tax wherethe annual income does not exceed four hundredthousand rupees.

The Government is actively pursuing the passageof the law through Parliament (Pakistan 2008b).

5.8 Sri Lanka42

The proportion of older persons in Sri Lanka’spopulation is currently the highest in SouthAsia. Fertility decline in Sri Lanka startedearlier than in the other South Asian countriesand the proportion of older population increasedgradually from 5.5 per cent in 1950 to 9.3per cent in 2000. It is projected to increase to

nearly 20 per cent in 2025 and to about 30per cent by 2050. Sri Lanka has a history ofGovernment measures targeting the elderlypopulation dating back to before the countrybecame independent in 1948 (Sri Lanka 2002b).

Retirees from the public service have beencovered by a pension system since 1901.However, these constituted a very small minorityof the older population and the remainder didnot receive any assistance from the state. ThePoor Law Ordinance of 1939 was the firststatutory provision of relief and benefit for those,including the elderly, who were unable tomaintain themselves owing to physical or mentalinfirmity or incapacity. The legislation wasinitially operative in only three municipalities:Colombo, Kandy and Galle. The Governmentestablished a Provident Fund scheme in 1942 tocater to temporary and contract employees inthe public sector not covered by the pensionscheme. In 1944 the Government appointedthe Social Service Commission to look into theproblem of destitute elders. The Commissionpointed out that nearly 37 per cent of therecipients of relief assistance were older personsand this led religious bodies and charitableorganizations to open homes for the elderly.

At Independence, therefore, the Government ofSri Lanka inherited a tradition of concern for theelderly and subsequently introduced furthermeasures. The Central Department of SocialServices was established in 1948 with branchesin District kacheris to provide social services tothe elderly. Following a decision to set up statehomes for lonely elderly without family support,the Government set up the first state run homefor the elderly in Koggala in 1951. Three morehomes for the elderly followed in Anuradhapura,Mirigama and Jaffna in 1952. By 1964-65,


54

80,000 aged people had been given publicassistance. In 1957 there was a change in policyand cottage type accommodation housing nomore than 25 persons was established. Thesecottage homes, which soon became the preferredmode of housing the aged, were establishedmainly by NGOs with government subsidiesand to a lesser extent by local authorities andRural Development Societies. While severalsuch piecemeal measures were taken by theGovernment, it was mainly after 1982,following Sri Lanka’s participation in the FirstWorld Assembly on Ageing (Vienna, 1982) thatGovernment began to pay increasing attentionto ageing-related issues and introduced a numberof coordinated measures for the welfare ofelderly people. It established a NationalCommittee on Ageing under the Ministry ofSocial Welfare as the apex body to assist inpolicy making and the formulation of nationalplans and programmes for the welfare of elderlypeople. The Committee co-ordinates all publicand private sector activities for elders. TheGovernment reconstituted the Committee in1992 and adopted a National Policy and a Planof Action. The Policy focused primarily onpreparing the population for a productive andfulfilling life in old age, socially, economically,physically and spiritually and ensuringindependence, participation, care, self-fulfillmentand dignity for the elderly.

A very significant development was the enactmentof the Protection of the Rights of Senior CitizensAct (Act No. 9 of 2000) which made provisionsfor:

a) A statutory National Council for Elders andSecretariat

b) Maintenance Board for determination ofclaims from elders

c) A National Fund for Elders andd) Protection of Rights of Elders. (ILO 2008)

Following Sri Lanka’s endorsement of the MadridInternational Plan of Action on Ageing at theSecond World Assembly on Ageing (Madrid,2002), the Government established the NationalCouncil of Elders and the National Secretariat(Mendis 2007). The National Council hasregistered recognized NGOs who work for seniorcitizens, and established a network of 10,000Village Level Elders Committees and 125Divisional Level Elders Committees throughoutthe country (Jegarasasingam 2004, 2007). It haspromoted the wider use of the Elders IdentityCards through facilitating the procedures for itsissue to those aged 60 years and over. TheCouncil has secured a number of privilegesfor the elderly in the form of priority treatmentat hospitals, post offices and other public places,discounts at pharmacies and in means oftransport. The Maintenance Board isempowered by the Act to inquire into complaintsof elders including claims for maintenancefrom offspring or responsible younger relativeswho may be failing to provide financial support.In 2006 the Cabinet of Ministers adopted aNational Charter and National Policy for SeniorCitizens. The National Policy seeks to assuresenior citizens that their concerns are nationalconcerns and they will not live unprotected,ignored or marginalized. The goal of the NationalPolicy is the well being of the senior citizen. Itaims to strengthen their legitimate place insociety and help senior citizens to live the lastphase of their life with purpose, dignity and peace.

Sri Lanka does not as yet have a social pensionsscheme specifically targetting older persons.However, older persons benefit from the nationalpoverty alleviation programme, known as the


55

“Samurdhi Programme,” which was initiated in1995. In addition, a more targeted povertyalleviation programme, the Monthly PublicAssistance Programme (‘Mahajanadara’) is aimedat vulnerable groups, including those withdisabilities and destitute older persons. The cashtransfers range from 100 to 400 Rupees (Rs 100= USD 1) per month and go a long way to helppoor elderly persons (Mujahid, Pannirselvam &Dodge 2008). The Government has alsointroduced three contributory social securitypension schemes for farmers, fishermen and the

self-employed in addition to the already existingpension scheme and the Employees ProvidentFund. All the three are voluntary and contributoryschemes with contributions from theGovernment. The benefits under the schemes arein the form of a monthly pension for life afterreaching the age of 60. Various financial andinsurance institutions operate social securityschemes on voluntary contributory basis. All theschemes are based on a regular saving plan over agiven period of time.


56

This study shows that the eight countries ofSouth Asia account for 15 per cent of the World’sand nearly 25 per cent of the developing world’solder population. In all the countries theincrease in the older population is projected toaccelerate during the next four decades.Population ageing is a relatively recentphenomenon in South Asia. In five of thecountries - Afghanistan, Bangladesh, Maldives,Nepal and Pakistan - it is only since the

mid-1980s that the proportion of the olderpopulation has been increasing. However, in allcountries the share of older persons inpopulation is projected to increase and by 2050South Asia will account for 22 per cent of theWorld’s and nearly 30 per cent of the developingworld’s older population. It is thereforeimportant that governments and developmentpartners have a realistic assessment of themagnitude and nature of the problem and

Section 6: Conclusion andRecommendations

Photo credit : United Nations Mission in Nepal (UNMIN)

57

formulate policies and plans to address theemerging issues as well as exploit opportunitiesarising from population ageing.

Global and regional initiatives during the pastten to fifteen years, in particular, the SecondWorld Assembly on Ageing in Madrid (2002) andthe Macao Regional Review of the Implementationof the MIPAA (2007) have contributed toraising awareness among governments onpopulation ageing and emerging ageing-relatedissues. All countries have framed some policies,laws or programmes to address various issues inthe context of older people, but still there is aneed to improve policy and programme measuresand increase budgetary allocations to foraddressing the issue. Countries, in which thephenomenon of population ageing becameevident earlier, an institutional framework hasbeen in place for a longer period and is moredeveloped. The main conclusions of thesituation analysis of ageing in South Asia andrecommendations for improving the response topopulation ageing are summarized in this section.

6.1 Conclusions

● The process of ageing is irreversible.Therefore, the proportion of the “olderpersons” will continue to increase. Theunderlying demographic factors such asdeclines in fertility and mortality cannotbe influenced by policy. Fertility is unlikelyto rise again, at least in the foreseeablefuture, and mortality rates will improvefurther or at least stabilize.

● Pressures on the productive workforce tosupport the older population will increasedue to the fact that older persons arethemselves “ageing” and the increasing

proportion of the “oldest old” will continueto rise adding a special dimension to theneeds of care and welfare.

● Proportion of women is higher in thepopulation of both the “older” and the “oldestold” making women more vulnerable, evenmore so in their old age. A much higherproportion of older women than older menare single, financially dependent, illiterateand in need of long-term. Moreover, themale dominated property rights aggravatethe marginalization of women in old age.

● Population ageing is a greater phenomenonin rural areas than in urban areas, largelydue to the out-migration of younger adultsfrom predominantly farmer communitiesin the villages.

● Though females comprise the majority ofolder persons in both rural and urbanareas, the ratio of older women to oldermen is generally lower in the rural areas.

● The implicit “intergenerational contract”whereby the younger generation whohave been brought up and taken careof through their childhood and youthby the older generation “repay” the oldergeneration by taking care of it during oldage remains strong and the multi-generational household is the acceptednorm for families having one or more olderrelatives. However, with declining familysize and the increasing incidence ofmigration, co-residence arrangements ofextended families would become an everincreasing strain.

● Opportunities of gainful employment

Section 6: Conclusion and Recommendations

58

for the elderly, particularly women, areexpected to become scarce, both due to thecontinuing increase in the working agepopulation and the introduction of newtechnology for which older persons lack theexpertise. Global economic downturns, likethe one presently gripping most countries,can be expected to result in increasedcompetition for employment opportunitieswhere the older people would be furthermarginalized.

● With declining proportion of working agepopulation, narrowing of the tax basewould be inevitable resulting in aggravationof the issue surrounding the availability ofadequate funding to support pension andwelfare schemes for the older persons.

● Social security schemes are not well establishedin the region and in most countries coverageis at best extremely limited both in termsof number of beneficiaries and the amountof benefits.

● Older persons undergo greater hardship incoping with day to day living as well as inemergency situations such as naturaldisasters and man-made disasters suchas armed conflicts.

● The positive side of population ageing andthe contributions older persons can maketo socio-economic development have notbeen adequately highlighted resulting in anoverall negative attitude, even among olderpersons themselves, towards ageing.

● Awareness of the phenomenon of populationageing and its consequences has beengrowing among the national governments.Every government has introduced at leastsome measures aimed at improving thewelfare and security of its older populationand designated a body to coordinateprogrammes relating to the elderly


59

6.2. Recommendations

All sectors of civil society led by the respectivegovernments would hold the responsibility ofimplementing the recommendations listedbelow. As such NGOs, research and academicinstitutions, media, private sector, faith-basedorganizations, community-based organizations,national and local support networks would allneed to contribute towards implementation.However, the Government would have to takethe initiative and provide an enabling andsupportive environment.

● Providing a better understanding onpopulation ageing and assessment of itsimpact for a broader audience should beprioritized by Governments and shouldenhance the available mechanisms for thecollection of relevant data. It is importantto ensure that data on older persons arecollected with regular periodicity,disaggregated by age, sex, sub-nationalunits and socio-economic characteristics.

● Institutional structures characterized by astrong hub, specializing on ageing-relatedissues should be installed and in cases wherethere is an existing structure (such as thecoordinating bodies), necessary alterationsshould be done in order to strengthen thesame for enhanced effectiveness. Capacityof relevant staff should be built to deepentheir understanding of population ageingand to improve their skills in collection anduse of data and in conducting research forpolicy formulation, programming andmonitoring and evaluation.

● In all policies and programmes for olderpersons, emphasis should be placed on

addressing the needs of women whousually form a majority of the older andildest old populations. Their greatervulnerability should be taken into accountin the formulation and implementationof all relevant policies and programmes.Gender-based mainstreaming shouldbe of compulsory consideration in thedesign of schemes relating to older persons.

● Programmes for older persons shouldtake into account the higher incidenceof poverty and accessibility issues pertainingto services, both physical barriers andsocio-economic barriers faced by the olderpersons predominantly in rural areas. Olderpersons in rural areas are in a far morevulnerable situation than their urbancounterparts, particularly in terms of thedeclining family support due to theout-migration of young rural adults.

● Health policies should incorporateprovisions for financially and physicallyaccessible health care services to meetthe needs of the older population. Adequateattention should be paid to equippinghealth facilities with medicines andequipment needed for diseases of old-ageand providing the required geriatricstrained health personnel.

● Given the regional, cultural and historicbase, Governments should seek to strengthenthe capacity of the family, which remainsthe most preferred and main source of careand support for older persons, to be ableto continue providing such care andsupport. Policy measures, such as taxbenefits, allowances, home improvementassistance and other incentives should


60

be introduced to support and encouragefamilies to continue their caring role.Multi stakeholder initiatives involvingthe Government, the private sector andthe NGO sector should be consideredan ideal tool in such exercises.

● Women, who constitute the majority ofcare givers at the family and communitylevels, should be provided appropriateincentives to facilitate combining caregiving and employment through measuressuch as time off and promoting maleresponsibility in the caring for olderpersons. In this case, a balance is requiredto be maintained between elderly careand nurturing the young with possiblyadded responsibilities for the malecounterparts.

● Governments should encourage andsupport community-based care (healthand psycho-social) for older personswho are single or in need of acute andlong-term care, which is found to becost-effective and conforming to the olderpersons’ preference for ‘ageing in place’.Governments should make provisions forinstitutional care where necessary, withsufficient inputs into standardization offacilities and personnel attached to serviceprovision in the given sector.

● Governments should encourage andfacilitate the formation of Older People’sAssociations/Clubs/Activity Centres topromote active ageing by providing aforum for older persons to participatein community affairs, leisure andrecreational activities and, where necessary,

influence decision making, assert theirrights and claim their entitlements fromthe duty bearers. Further, this would alsoprovide with a chance for the communityto gain from the experience of the oldergeneration hence giving a value for theolder age and wisdom.

● Gainful employment for older personsshould be encouraged and facilitatedto enhance productivity. In the informalsector, older persons should be encouragedto continue in employment throughimproved access to credit and provision ofinputs and means of skills upgrading.In the formal sector, continuation ofemployment of older persons should beencouraged by raising the mandatoryretirement age and providing tax rebatesfor employers employing older workers.

● Governments should increase the scopeand coverage of the state pension schemes,encourage engagement of contributoryprivate insurance plans and provideincentives for the development of tradit-ional/indigenous community-basedpractices of ensuring social security. Inaddition, Governments should makeadequate budgetary allocations for theprovision of welfare benefits to all deservingolder persons in an equitable way.

● In emergency circumstances, such as naturaldisasters, epidemics and conflict situations,Governments and aid agencies shouldensure that older persons are directlytargeted in rescue, relief, and recoveryoperations, as well as in developmentprogrammes. Relief and rescue workersshould be appropriately trained and briefed


61

to ensure older persons get needed andadequate attention and participationwhere relevant.

● Governments, probably with the privatesector and NGO involvement shouldundertake to dispel the society’s negativeattitude towards ageing and older personsthrough measures such as media campaignshighlighting the contributions of olderpersons at the family, community andnational levels and also on social justice.Teaching of respect for older persons andthe inevitability of reaching old age toprepare younger generations to enterold age better prepared and with a positiveattitude should be introduced in thecurricula at various levels of formal andinformal education.

Above recommendations suggest, as shown by theanalysis in this study, that population ageingimpacts all aspects of life and a noteworthyaspect of a wide range of sectors. Essentially,Governments should seek to mainstream ageingin all development policies, programmes andstrategies, such as those for poverty alleviation,rural development and designing of infrastructure.It is near compulsory to have a strong coordinatingministry to develop a comprehensive policy forolder persons jointly with relevant ministries,NGOs, civil society, donors, older personsorganizations and other relevant stakeholders.

6.3 The Way forward

In almost all countries of South Asia, thefoundation has already being laid to meet thechallenges arising with the unprecedented growthof the older population for future developmentthrough the existing institutional structures.

However, there is need for further strengtheningand enhancement of awareness on populationageing. A number of the recommendations givenabove are being acted upon in varying degrees.Nevertheless, there is need for increasing themomentum and emphasis and to strengthen bothnational efforts and regional cooperation withinthe global context in the area of populationageing.

It is important that a comprehensive andsystematic framework for gathering data andinformation and promote research to identify thecircumstances and needs of older persons withina broad spectrum be put in place at the nationallevel. Research should include identifying andestablishing indicators which can be used tomonitor the implementation of various measuresaimed at improving the quality of life of the olderpopulation through sustainable programmedevelopment initiatives given that theGovernments of concern have a culture orpolitical will or the vision to allocate substantialproportions of financial resources to be investedinto social welfare. Governments shouldencourage the active participation of NGOs, civilsociety and older persons’ organization associationsin the formulation, implementation and reviewof national policies and programmes of action onageing. As the older persons are affected by andhave a role in every aspect, emphasis should beplaced on a multi-sectoral approach to populationageing.

South Asia includes countries such as Sri Lankaand India which have been faced with ageingissues since a long period of time as well ascountries such as Afghanistan and Maldives wherethe issue is now emerging and is expected toassume some seriousness in the next few years.This provides a unique opportunity of cooperation


62

at the regional level which needs to be furtherexploited in addressing population ageing.Inter-country exchanges of information andexperience on ageing should be promoted throughsub-regional, regional and interregional activities,including South-South cooperation. However, thenational agendas would need to prioritizepopulation ageing to facilitate inter-countrycooperation.

UNFPA has assisted member countries inaddressing ageing issues and also activelypromoted and participated in relevant regionallevel and global level activities, both on its ownand in collaboration with other agenciesparticularly the UN-ESCAP, the Economic andSocial Commission for Asia and the Pacific.However, ESCAP does not have an explicitmandate nor the necessary capacity to undertakecountry level activities. UNFPA, being UN’s leadagency in the area of population, should investin drawing attention in each country to therapidly emerging issue of population ageing. Itshould encourage and assist member states in


undertaking detailed situation analysis ofpopulation ageing and how it is seen evolvingduring the next four or five decades, particularlyin countries where the proportion of olderpersons has already reached relatively high levels.Just as the extent of ageing varies betweencountries and between rural and urban areas inmost countries, it also varies between regionswithin each country. The regional dimension ofageing should be looked at within each countryso that priority can be given to the more agedareas in efforts towards addressing the issues ofconcern.

UNFPA should also enhance its activities inassisting inter-country as well as inter-regionalexchanges that would enhance best practices tobe replicated with conditional alterations. Givencultural similarities, the experiences of East andSoutheast Asian countries can help providecountries of South Asia with greater insight intothe issues emerging as a result of the rapid ageingof their populations as projected for during thefirst half of this century.

63

Endnotes

1 South Asia is here defined to cover eightcountries - Afghanistan, Bangladesh,Bhutan, India, Maldives, Nepal, Pakistan andSri Lanka. They are all members of the SouthAsian Association for Regional Cooperation(SAARC) formed in December 1985. Whileseven of the countries are founding membersof the Association, Afghanistan joined in April2007.

2 East Asia includes the People’s Republic ofChina, Japan, the Democratic People’sRepublic of Korea, the Republic of Korea andMongolia. South-East Asia includes BruneiDarussalam, Cambodia, Indonesia, Lao PDR,Malaysia, Myanmar, Philippines, Singapore,Thailand, Timor-Leste and Viet Nam.

3 All statistics for “South Asia” given in thisReport, unless otherwise stated, are weightedaverages for figures reported in the source foreach of the eight countries. The weights havebeen appropriately selected. For example, TFRfor South Asia has been estimated as theaverage of country TFRs weighted by thepopulation of women 15-49 years in eachcountry.

4 It should be noted that the population ofwomen of reproductive ages (15-49 years) willnot decline. The size of the increment willstart becoming smaller after 2025.

5 During 2025-2050, the older population willincrease at an average annual rate of 3 per cent.The corresponding rates of increase will be 1.5per cent in East Asia, 2.7 per cent in South-

East Asia and 2.5 per cent in the lessdeveloped countries as a whole (UNDESA2007a).

6 This will be discussed further under “ageingof the older population” in the next section.

7 Corresponding data for earlier years are notavailable.

8 The term “single” is used to cover thosedivorced, widowed and who never married.The figures are the weighted average of 7countries (excluding Bhutan) for which dataare given in (UNDESA 2006a).

9 Figures are weighted average of economicactivity rates reported in (UNDESA 2007b)for population aged 65 year and over.

10 Sex-disaggregated data on illiteracy rates ofolder persons are not available for all the 8countries. However, figures available for someof the countries as given in (UNDESA 2006a)show that illiteracy rates are significantlyhigher among older women.

11 To facilitate comparability between countries,data for all countries (except where stated) aretaken from UN or World Bank databases andmay therefore differ from figures availablefrom particular national sources.

12 The purpose of this country level review is tohighlight significant trends to help providesome guidance for policy formulation. It isnot intended to provide a detailed analysis

64

of trends in each country. It is expected thatthe brief review provided here will assist eachcountry in deciding to undertake a nationalsituation analysis in which the issueshighlighted in this regional review could befurther analysed.

13 The proportion of older persons in Sri Lankawill be lower than in only Japan, Republic ofKorea and Singapore.

14 It should be pointed out that the figurespresented in Table 20 may not necessarilymatch the figures given in Tables 13 and 18due to different sources. Figures in Table 20are from national Censuses and Surveys asreproduced in various issues of the UNDemographic Yearbook.

15 The impact of increasing life expectancyon the onset of morbidity and its durationis being widely discussed in the developedcountries (Hellner 2005).

16 It is not rare to come across in the literaturepapers with titles like “Health expendituregrowth: reassessing the threat of ageing”(Dormont 2006).

17 Evidence on the correlation between ageingand health expenditure is available for severaldeveloped countries but is very hard to comeby for developing countries.

18 It should be noted that those born with orincurring a disability at a young age are morelikely to adopt a lifestyle to cope with thedisability than those who incur a disability inold age.

19 For a discussion of how the system of familialcare of the elderly is coming under strain inSri Lanka, see (Vodopivec 2008).

20 For similar evidence for China, see (CRCA2007).

21 Sri Lanka’s contributory pension scheme forinformal sectors which currently has a verylimited coverage is a striking exception (ILO2008).

22 As pointed out by Professor Kabir, “In viewof the prevailing unemployment situation inBangladesh, extending the age of retirementand taking up initiatives towards thegeneration of employment opportunities forelderly may not be feasible options forBangladesh. Long-term planning is requiredto cater to the changing needs over time ofthe young, elderly and working-agepopulations in order to ensure that adequateresources are available when and where theyare needed” (Kabir 2009).

23 For the exception from Sri Lanka see note21 above.

24 Steps being taken by governments in SouthAsia are discussed in section 5.

25 Some illustrative examples are cited here.For measures in other countries see section 5.

26 The Network was established as anInternational NGO in 1997 and hasconsultative status at the Economic andSocial Council of the United Nations.

27 For a discussion of elderly abuse in theinstitutional setting see (WHO 2002).

28 The questionnaire involved staff from thefollowing agencies: Action Aid, the British RedCross, CAFOD, CARE, Christian Aid,Concern, Islamic Relief, Merlin, MFS-UK,

65

Oxfam, the IFRC, the ICRC, Save theChildren UK, Tear Fund and World Vision

29 The views expressed by an older womanfrom Thailand “I feel older persons haveno value; I don’t know what I live for. I amwaiting to die as I have no hope” could wellbe shared by a large number of poverty-stricken older persons in South Asia (Mujahid,Pannirselvam & Dodge 2008)

30 In the developed countries, Governmentshave pursued policies to counter the negativeattitudes towards older persons and themedia too has played a major role. In Australia,for example, The Office for Older Australians,in the Department of Health has created anonline gallery of positive images of olderpersons. The site also provides informationrelating to positive and healthy ageing, workand later life planning, and health and care.(UNDESA 2008)

31 A critical assessment of national policiesis beyond the scope of this regional levelsituation analysis. It is, however, expectedthat this review will help in raising awarenessamong some of the countries of the need toundertake a detailed situation analysis ofageing at the national level including acritical assessment of policy implementation.

32 The authors wish to thank Mr. Younus Payabof the UNFPA-Afghanistan Country Office,Kabul for providing valuable inputs for thissub-section.

33 It should be pointed out that these figuresrefer to population 60+ while in Afghanistanboth the Afghanistan Census Act and theAfghanistan Pension Law define older personsas those aged 65 and over.

34 The authors wish to thank Ms. Nazia Yusufof the UNFPA-Bangladesh Country Office,Dhaka for providing valuable inputs for thissub-section.

35 The authors wish to thank the UNFPA-Bhutan Country Office, Thimpu for providingvaluable inputs for this sub-section.

36 The authors wish to thank the UNFPA-India Country Office, New Delhi and Prof.P.M. Kulkarni of Jawaharlal Nehru University,New Delhi for providing valuable inputs forthis sub-section.

38 The authors wish to thank Ms. KumikoYoshida of the UNFPA-Maldives CountryOffice, Male for providing valuable inputs forthis sub-section.

39 The authors wish to thank Mr. Bijay Thapaof the UNFPA-Nepal Country Office,Kathmandu for providing valuable inputs forthis sub-section.

40 In September 2008, the newly electedGovernment increased the allowance to Rs500 per month and lowered the age ofeligibility to 70 years.

41 The authors wish to thank Dr. MohammedNizamuddin and Ms. Fauzia Mahmood of theUniversity of Gujrat, and Dr. Sara Raza Khanof the UNFPA-Pakistan Country Office,Islamabad for providing valuable inputs forthis sub-section.

42 The authors wish to thank Ms. MalathiWeerasooriya of the UNFPA-Sri LankaCountry Office, Colombo for providingvaluable inputs for this sub-section.

66

Bibliography

Abikusno, N. (2005) - Needs and Follow Up ofOlder Persons and Disabled Tsunami Victimsin Nias Island, 2004. (Paper presented atWomen Empowerment Policy DevelopmentMeeting, Ministry of Women Empowerment,Jakarta).

Afghanistan (2008) - Afghanistan NationalDevelopment Strategy (2008-2013), (Government of the Islamic Republic of Afghanistan,Kabul).

Ahmed, T. (1995) - “The population of personswith disabilities in Pakistan”, Asia-PacificPopulation Journal, (Vol. 10, No. 1, pp. 39-62).

AIHRC (2008) - Economic and Social RightsReport in Afghanistan - III, (Afghanistan Independent Human Rights Commission).

Bangladesh (2004) - Bangladesh PopulationPolicy 2004, (Ministry of Health and FamilyWelfare, Government of the People’sRepublic of Bangladesh, Dhaka).

Bangladesh (2007) - Country Report presentedto the High-level Meeting on the RegionalReview of the Madrid International Plan ofAction on Ageing (MIPAA), 9-11 October,Macao, China. UN ESCAP.

Bhutan (2002) - “Bhutan attends forum onageing in Madrid”, Kuensel Online: Bhutan’sDaily News Site,http://www.kuenselonline.com/modules.php?name=News&file=article&sid=1461.

Cambodia & UNFPA (2007) - PopulationAgeing in Cambodia: Planning for SocialProtection, (Cambodia Office of the Councilof Ministers and UNFPA Cambodia).

Chakraborti, R. D. (2004) - The Greying ofIndia: Population Ageing in the Context ofAsia, (SAGE Publications, New Delhi4).

Chalise, H.N. (2006) - “Demographic situationof population ageing in Nepal”, KathmanduUniversity Medical Journal, Vol. 4, No.3,2006, pp.356-64.

CRCA (2007) - Demographic Change in China:Ageing of the World’s Largest Population,(China Research Center on Aging, Papers inPopulation Ageing No.4, UNFPA CountryTechnical Services Team for East andSouth-East Asia, Bangkok).

De Silva, I. 2005 - “Family Transition in SouthAsia: Provision of Social Services and SocialProtection”, Asia-Pacific Population Journal,(Vol.20, No. 2, pp. 13-46, UNESCAP,Bangkok).

De Silva, I., W., Amarabandu, W.P. &Gunasekera, H.R (2008) - Disability amongstthe elderly in Sri Lanka: Comparison ofdisability rates in the censuses of 1981 and2001, (Research Studies Series No.1, Institutefor Health Policy, Colombo, Sri Lanka).

67

Dormont, B. (2006) - “Health expendituregrowth: reassessing the threat of ageing”,Health Economics, (Vol. 15, No. 9, pp.947-963).

ECOSOC (1999) - Gender and ageing:problems, perceptions and policies, (Reportof the Secretary-General to the Commissionon Women, 43rd Session, United NationsEconomic and Social Council, New York).

ESCAP (2002) - National Policies and Programmeson Ageing in Asia and the Pacific: AnOverview and Lessons Learned, (Social PolicyPaper No.9, UN Economic and SocialCommission for Asia and the Pacific, New York).

GAA 2009 - Global Action on Aging Newsletter,(December 15 2008-2 January, New York).

Gupta, R. & Chaudhuri, A. (2008) - “Elder abusein a cross-cultural context: assessment, policyand practice”, Indian Journal of Gerontology,(Vol.22, No.3, pp. 148-71).

HAI 2001 - Ageing and Development, (No.10).

HAI 2004 - Older People Stranded by BangladeshFloods, (HelpAge International) accessible athttp://www.helpage.org/News/Latestnews/OlderpeoplestrandedbyBangladeshfloods.

HAI (2005) - The Impact of the Indian OceanTsunami on Older People: Issues and Recommendations, (HelpAge International inconjunction with HelpAge India, HelpAge SriLanka, InResAge Indonesia and Help theAged).

HAI (2006) - Why Social Pensions are NeededNow, (HelpAge International).

HAI (2007a) - “Practical issues in Ageing andDevelopment”, Ageways: Issue 67, (HelpAgeInternational).

HAI (2007b) - Age Demands Action in Bangladesh:Progress on the implementation of theMIPAA. (HelpAge International).

HAI (2007c) - Income Security in Old Age,(Paper contributed by HelpAge Internationalto the Expert Group Meeting on the Regionalpreparations for the Global Review of MadridInternational Plan of Action on Ageing,UN-ESCAP, Bangkok).

HAI (2008a) - Asian Earthquake Disaster, reportof HelpAge International at www.helpage.org/Emergencies/Asianearthquakedisaster.

HAI (2008b) - Integrating Older People: A trainingof trainers manual for successful mainstreamingof age-friendliness in Canadian Red CrossProgramme in Aceh, Indonesia, (HelpAgeInternational).

Hellner, B.M (2005) - “Care At Home”, GlobalAging (AARP International).

Hossain, M.I., Akhtar, T. & Tajuddin, M. (2006)- “The elderly care services and their currentsituation in Bangladesh: an understandingfrom theoretical perspective”, Journal ofMedical Sciences, ( pp. 131-38, Faisalabad,Pakistan).

HPRA (2005) - ILO Social Security Inquiry inSri Lanka: Project Report prepared for ILO(Health Policy Research Associates, Colombo).

IASC (2008) - Humanitarian Action and OlderPersons: an essential brief for humanitarian

68

actors, (Inter-Agency Standing Committee,Geneva).

ILO (2008) - Social Security in Sri Lanka: areview of the social security system for theMinistry of Labour Relations and Manpower,(ILO, Geneva).

India (1999) - National Policy on Older Persons,(Government of India, Ministry of SocialJustice and Empowerment, New Delhi).

India (2002) - Statement by the Leader of India’sDelegation to the Second World Assembly onAgeing, Madrid

India (2006) - Why Do We Need SocialSecurity, (Government of India, Ministry ofLabour and Employment, Press Release) athttp://labour.nic.in/ss/overview/html

INPEA (2008) - “INPEA: Experience the Future”,Bulletin of the International Network forPrevention of Elderly Abuse, (Toronto,Canada).

Jegarasasingam, V. (2004) - Government Policies,Programmes and Institutional Arrangementson Ageing, Ageing Population in Sri Lanka:Issues and Future Prospects, UNFPA & PASL,Colombo: 303-338.

Jegarasasingam, V. (2007) - Delivery of SocialServices for Enhancing Family Well-Being inSri Lanka, (Ministry of Social Services andSocial Welfare, Battaramula).

Kabir, M. (2009) - “Demographic and EconomicConsequences of Aging in Bangladesh: AStudy”, The Independent, (internet edition,Dhaka, 18 February).

Knodel, J. et.al. (2007) - Migration andIntergenerational Solidarity: Evidence fromRural Thailand, (Papers in PopulationAgeing No.2, UNFPA Country TechnicalServices Team for East and South-East Asia,Bangkok).

Korf, B. & Silva, T.D. (2003) - “Poverty, Ethnicityand Conflict in Sri Lanka”, (paper presentedto the Conference “Staying Poor: ChronicPoverty and Development Policy”, (ChronicPoverty Centre, University of Manchester).

Kumar, V. (2003) - “Health Status and HealthCare Services among Older Persons in India,Journal of Ageing and Social Policy, (Vol. 15,Nos.2/3, pp.67-83).

Lingam, R. (2007) - A Unique Act Called ‘TheMaintenance and Welfare of Parents andSenior Citizens Act, 2007’, http:EzineArticles.com/?expert=Rama Lingam.

Lloyd-Sherlock, P. (editor) (2004), Living Longer:Ageing, Development and Social Protection,(United Nations Research Institute for SocialDevelopment, Geneva).

Mahal, A.& Berman, P. (2001) - Health Expen-ditures and the Elderly: A Survey of Issues inForecasting, Methods Used, and Relevance forDeveloping Countries, (The Global Burdenof Disease 2000 in Ageing Populations, Research Paper No. 01.23, Harvard Burden ofDisease Unit, Centre for Population and Development Studies, Cambridge, MA 02138).

Mahmood, N. & Nasir, Z.M. 2008 - Pensionsand Social Security Schemes in Pakistan: SomePolicy Options, (PIDE Working Paper 42,Pakistan Institute of Development Economics,Islamabad).

69

Mahmood, R. (2008) - “The Issues and Problemsof the Elderly in Pakistan”, Global Watch,Spring http://findarticles.com/p/articles/mi_qa5445/is_200804/ai_n27899645.

Maldives (2007) - Maldives Population andHousing Census 2006 Analytical Report,(Government of Maldives, Ministry ofPlanning and National Development, Male).

Maldives (2008) -“MALDIVES: Elderly to getmonthly allowance from January 2009”,Seniors World Chronicle: Daily Digest ofInternational News about Aging (12 November):from www.seniorsworldchronicle.com.

Mason, K.O. (1995) - “Family Change andSupport of the Elderly in Asia: What Do WeKnow?”, Asia-Pacific Population Journal,(Vol.7, No.3, pp. 13-32).

Mendis, A. (2007) - Country Report: Sri Lanka,(UN-ESCAP High-level Meeting on theRegional Review of the Madrid InternationalPlan of Action on Ageing, Macao, China).

MPF (2009) -“Investing for future population”(Department of National Planning paper forthe Maldives Partnership Forum (MPF),23-24 March).

Mujahid, G. (2006) - Population Ageing in Eastand South-East Asia: Current Situation andEmerging Challenges, (Papers in PopulationAgeing No.1, UNFPA Country TechnicalServices Team for East and South-East Asia,Bangkok).

Mujahid, G., Pannirselvam, J. & Dodge, B.(2008) - The Impact of Social Pensions:

Perceptions of Asian Older Persons, (UNFPA,Country Technical Services Team for East andSouth-East Asia, Bangkok).

Nepal (1997) - Ninth Development Plan (HisMajesty’s Government of Nepal/NationalPlanning Commission)

Nepal (2002a) - Nepal’s Official Statement at theSecond World Assembly on Ageing, Madrid,(His Majesty’s Government of Nepal, Ministryfor Women, Children and Social Welfare).

Nepal (2002b) - Senior Citizens Policy andWorking Policy, (His Majesty’s Governmentof Nepal/Ministry of Women, Children andSocial Welfare).

Nepal (2006) - The Second Periodic Report onthe Implementation of the InternationalCovenant on Economic, Social and CulturalRights submitted by Nepal to the ECOSOC.

Nepal (2007a) - Country Report submitted byNepal to ESCAP’s High-level Meeting on theRegional Review of the MIPAA, Macao,China).

Nepal (2007b) - The Three Years Interim Plan2007/08-2009/10, (Government of Nepal/National Planning Commission).

Pakistan (2002) - Pakistan’s Statement at theSecond World Assembly on Ageing.

Pakistan (2004) - National Policy for ElderlyPeople soon, (Pakistan Press InternationalInformation Services Limited, FinancialTimes, London) at http://www.accessmylibrary.com/coms2/summary_0286-20447352_ITM.

70

Pakistan (2008a) - Draft Bill for providingfacilities to Senior Citizens finalized,(Associated Press of Pakistan, 19 August) athttp://www.app.com.pk/en_index.php?option=com_content&task=view&id= 15015.

Pakistan (2008b) - “Senior Citizens Welfare Billin Parliament soon: minister”, Daily Times,(Lahore, November 29, 2008); http://www.dai lytimes.com.pkdefault.asp?page=2008%5C11%5C29%5Cstory.

Prakash, I.J. 2003 - “Ageing, Disability, and OlderPersons in India”, in Liebig, P.S. & Rajan, S.I.(editors): An Ageing India: Perspectives,Prospects and Policies, (The Haworth Press,Inc.).

Rajan, S.I., Perera, M. & Begum, S. (2003) -Economics of Pensions and Social Security inSouth Asia: Special Focus on India, Sri Lankaand Bangladesh, (South Asia Network ofEconomic Research Institutes, PakistanInstitute of Development Economics,Islamabad).

Rannan-Eliya, R.P. 2007. - Population Ageingand Health Expenditure: Sri Lanka 2001-2101, (Institute for Health Policy 2, Colombo, Sri Lanka).

Reynaud, E. (2002) - The extension of socialsecurity coverage: The approach of theInternational Labour Office, (ESS WorkingPaper No.3, ILO, Geneva).

Shah, G., Veedon, R., & Vasi, S. (1995) - “Elderabuse in India”, Journal of Elder Abuse andNeglect, (Vol.VI, Nos 3/4, pp. 101-118).

Shankardass, M.K. (2003) - Ageing Women andAbuse: Concerns and Need for Action,(DWARF Research Brief, Development,Welfare and Research Foundation, New Delhi).

Shantakumar, G. (2002) - “Aging populations andincome security: a framework for analysis andaction” in Asher, M., Newman, D. & Snyder,P. (eds) - Public Policy in Asia: Implicationsfor Business and Government, (GreenwoodPublishing Group).

Shrestha, H.S. & Satyal, V.R. (2003) - “Economicsof pensions and social security in South Asia:special focus on Nepal”, (paper presented atthe Fifth Annual Conference of the South AsiaNetwork of Economic Research Institutes,Colombo, Sri Lanka, August).

Siddhisena, K.A.P. (2004) - Demography ofAgeing in Sri Lanka, Ageing Population in SriLanka: Issues and Future Prospects, UNFPA& PASL, Colombo: 7-43.

Siddhisena, K.A.P. (2005) - Socio-economicimplications of ageing in Sri Lanka: Anoverview, Working Paper, Number WP105,Oxford Institute of Ageing. Ageing WorkingPapers, http://www.aging.ox.ac.uk.

Soneja, S. (nd) - Elderly Abuse in India: CountryReport for World Health Organization,(HelpAge India, New Delhi, no date).

Sri Lanka (2002a) - Household Income andExpenditure Survey, Department of Censusand Statistics, Sri Lanka.

Sri Lanka (2002b) - Sri Lanka: Statement at theSecond World Assembly on Ageing

71

Stloukal, L. (2004) - Rural population ageing indeveloping countries: issues for considerationby FAO, (FAO, Rome) (available from http://www.fao.org/sd/dim_pe3pe3_040401a1_en.htm).

UN (vy) - UN Demographic Yearbook (variousannual issues).

UNDESA (2006a) - Population Ageing Chart

UNDESA (2006b) - Living Arrangements of OlderPersons Around the World: SupplementaryTables, (UNDESA, New York) http://www.un.org/esa/population/publ icat ions/livingarrangement/report.htm.

UNDESA (2007a) - World Population Prospects:the 2006 revision, (United NationsDepartment of Economic and Social Affairs,New York).

UNDESA (2007b) - World Population Ageing2007, (United Nations Department ofEconomic and Social Affairs, New York) .

UNDESA (2008) - Guide to the NationalImplementation of the Madrid InternationalPlan of Action on Ageing, (UNDESA, NewYork).

UNDP (2004) - Nepal Human DevelopmentReport 2004: Empowerment and PovertyReduction, (UNDP Nepal, Kathmandu).

Vodopivec, M. (2008) - Addressing the Needs ofan Aging Population, (The World Bank).

Vodopivec, M. & Arunatilake, N. (2008) - TheImpact of Population Aging on the LaborMarket: the case of Sri Lanka, (Institute forthe Study of Labor, Bonn, Germany).

Wells, J. (2005) - Protecting and Assisting OlderPeople in Emergencies, (HumanitarianPractice Network Paper No.53, OverseasDevelopment Institute, London, UK).

WHO (2002) - World Report on Violence andHealth, (WHO, Geneva).

WHO (2005) - Maldives Tsunami Report,(WHO Southeast Asia Regional Office, NewDelhi).

World Bank (2006) - Sri Lanka: StrengtheningSocial Protection, World Bank.

72

Papers in Population Ageing

No. 1: Population Ageing in East and South-East Asia: Current Situation and Emerging Challengesby Ghazy Mujahid, 2006

No.2: Migration and Intergenerational Solidarity: Evidence from Rural Thailandby John Knodel, Jiraporn Kespichayawattana, Suvinee Wiwatwanich and ChanpenSaengtienchai, 2007

No. 3: Older Population in Indonesia: Trends, Issues and Policy Responsesby Nugroho Abikusno, 2007

No. 4: Demographic Change in China: Ageing of the World’s Largest Populationby China Research Center on Aging, 2007

No. 5: Population Ageing and the Well-being of Older Persons in Thailand: Past trends, currentsituation and future challengesby John Knodel and Napaporn Chayovan, 2008

No. 6: Demographic Prognosis for South Asia: A future of repid ageingby Ghazy Mujahid and K.A.P. Siddhisena, 2009

Date post:	02-Aug-2020
Category:	Documents
Upload:	others
View:	0 times
Download:	0 times

Papers in Population Ageing No. 6 · iii Papers in Population Ageing No. 6 Asia and the Pacific...

Documents