ECONOMIC RESEARCH CENTERDISCUSSION PAPER
E-Series

No.E14-15

The Role of Gender in Long-Term Care forOlder Parents: Evidence from India
byYoshihiko Kadoya
Mostafa Khan

Revised version as of May 2015

ECONOMIC RESEARCH CENTERGRADUATE SCHOOL OF ECONOMICSNAGOYA UNIVERSITYThe Role of Gender in Long-Term Care for Older
Parents: Evidence from India1
Yoshihiko Kadoya2

Mostafa Khan3

Abstract
This paper examines the role of gender in the long-term care of older parents in India, as
who provides long-term care to elderly parents is still not conclusive. The provision of
long-term care in developed countries may not be applicable to India because of thedifferences in socioeconomic status; as such, gender differences in the long-term care ofelderly parents in India need to be studied in light of these observed differences. Using
data from the ‘Preference Parameters in India, 2011’ conducted by Osaka University,
this study found that married sons and their spouses serve as the primary caregivers totheir parents, while daughters mostly provide care to their spouses` parents. After
controlling basic socioeconomic factors such as the level of education of one’s spouse,mother, and mother-in-law; age; and number of siblings, the results remained the same.
Other family members also play a significant role in elderly parent care, and parents
were found to rely least upon professional care. This paper contributes to the scarce
empirical evidence on the provision of long-term care for older parents by married sonsand married daughters. The results of this study have implications for the son preference
present at birth in India.
Keywords: Gender differences, Indian studies, Long-term Care, Population aging,
Professional care
JEL classification codes: I3, J1, Z1

Kadoya acknowledges the Grant-in-Aid of the Nitto Foundation for the financial
supports.
2 Graduate School of Economics, Nagoya University, Furo-cho, Chikusa, Nagoya
4648601, Japan. Email: yoshi.kadoya@soec.nagoya-u.ac.jp
3 Graduate School of Economics, Nagoya University, Furo-cho, Chikusa, Nagoya
4648601, Japan. Email: saidur_rahim@yahoo.com
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Introduction
This study examined gender differences in the long-term care of elderly parents
in India. Older people in general often suffer from losses in mobility, feebleness, andother physical or mental problems, thus requiring long-term care in the form of nursing,community care, assisted living, or residential and hospital care. Studies regarding thelong-term care of elderly parents have received greater global attention in recent
decades, which is justified by the dramatic shift in the age structure of the population;
the proportion of elderly people (i.e., those who are 65 years of age and over) in the
total world population will increase from 7.7% in 2010 to 15.6% in 2050 (United
Nations, 2012), and the ratio in the total population in developing countries is also
expected to increase rapidly from 5.8% in 2010 to 14% in 2050. That is, it is expectedthat the number of people who will not be able to take care of themselves in developing
countries will quadruple by 2050 (WHO, 2014). India, where the population is still
growing, is no exception in that the elderly population ratio is expected to increase from
5.1% in 2010 to 12.7% in 2050 (United Nations, 2012). According to other estimates,with a population of over 1 billion the elderly population exceeded 100 million in 2011,
and is expected to grow to over 170 million by 2026 (Agewell Foundation, 2011).
Hence, problems related to the increasing share of elderly people are becoming very
serious in India.
Considering India’s traditional social structure where elderly people are treatedwith respect and honor, concerns about who will care for them is of crucial importance.
In the Asian context where filial piety is very strong (Sung, 1998), professional care ofparents when children are eligible to do so is seen as a dishonor. Furthermore, intraditional Indian society, keeping older parents at nursing homes or hiring professional2care for them is not widely accepted, and it is almost universal that parents feel more
comfortable receiving care from family members in their old age. Furthermore,
literature on elderly caregiving has revealed that family members, especially spouses
and children, are the primary caregivers to their parents (McAuley and Arling, 1984;
Sangl, 1983).
The religious, cultural, and social environment of India suggests that malefamily members assume the overall responsibility of family matters, including elderly
parent care (Mandelbaum, 1948). The Indian social context also suggests that althoughunmarried daughters can provide care for elderly parents, married daughters have
limited scope to do so as they leave their parents’ home soon after marriage. There is,however, a lack of empirical evidence on who actually assumes the responsibility ofelderly parent care in India.
The interpretation of gender roles in elderly parent care can be viewed in lightof several theories. These include household labor (Ross, 1987), the stress and coping
framework (Pearlin et al., 1990), gender-role expectations framework (Barusch and
Spaid, 1989), and gender-role specialization framework (Gillian, 1982), which all
rationalize females as the primary caregivers to elderly parents. Literature in developed
countries also reports that wives appear to be the primary caregivers to their husbands,
as the female life expectancy is higher than that of males (Shanas, 1979). Furthermore,
previous studies in developed countries on the role of gender in long-term parent carehave found that among children, adult daughters are more engaged in parent care for theelderly and frail than sons (e.g., Dwyer and Coward, 1991; Horowitz, 1985; Stone et al.,
1987; Pinquart and Sorensen, 2006; Kadoya, 2011), and also emphasized the role of
spouses in long-term elderly care. In short, studies from developed countries mostly
3

reported that female family members are the primary caregivers to the elderly. However,
empirical evidence to support this is not stable (Yee and Schulz, 2000), as Pinquart andSorensen (2006) conducted a meta-analysis of 229 studies on the gender issues
surrounding elderly care and reported that gender differences in caregiving were verysmall; the observed differences in gender roles in elderly parent care could be caused by
the social context and by what capacity males and females provide elderly care, and arealso influenced by the family structure and relationship that caregivers have with theirelderly parents (Datta et al., 2003). In addition, studies from developed countries ongender differences in the long-term care of elderly parents hardly made any distinction
between married and unmarried daughters, which seems very important in the Indian
context; as such, the role of married daughters needs to be evaluated alongside marriedsons and their spouses in order to gain better insight regarding gender issues inlong-term parent care.
The socio-cultural context of Indian society perceives sons as shouldering the
responsibility of caring for their parents (Hammad and Rajoria, 2013; Dharmalingam,
1996), as traditional Indian society is comprised of joint families where older family
members live with respect and honor, and the families of married sons, unmarried
children, and relatives usually take care of elderly parents. Indian society does notconsider girls as permanent members of the family, but rather as members of theirhusband`s family once they are married (Mandelbaum, 1948). Because of this belief,
Indian parents rely mostly on their sons and daughters-in-law for long-term care.
Moreover, the prevalence of son preference in India has been further intensified becauseof the decreasing number of children in a family; if their first child is a girl, parents`
desire for a boy becomes even stronger because of the fear that there will be no one to4take care of them in their old age. China and other South Asian countries also share asimilar outlook with India towards sons and daughters (Chen et al., 2012; Wang et al.,2012); for example, in a recent study, Kadoya and Yin (2014) provided evidence thatsons (and their wives) appear to be the primary caregivers to their parents in China.
They also found that with the present socioeconomic settings in China, parents`
dependence on sons for long-term care would not be reduced by developments in social
security. Larsen et al. (1998) found that parents’ concern for long-term care wassignificantly associated with the preference for sons in Korea, and further concluded
that long-term care is a manifestation of the kinship system, which is also common in
China and India.
Thus, in light of the observed inconsistencies in gender roles in the long-termcare of elderly parents and a lack of comprehensive studies on the Indian context, thisstudy aimed to provide empirical evidence on the role of married sons, their spouses,
and married daughters with respect to long-term care of elderly parents. Specifically,
this study tested the hypothesis that sons and their spouses are more responsible andinvolved in elderly parent care than married daughters are.

Literature Review
Many of the studies on gender differences in parental caregiving have foundthat females are more involved in caregiving activities than males. This phenomenon isevident for both activities of daily living (ADLs) and instrumental activities of dailyliving (IADLs). ADLs and IADLs are the classification of activities often used in thestudies of healthcare to refer the ability of any person to perform regular activities andlive independently in the society. ADLs include the functions needed to perform5

regularly such as feeding, bathing, dressing, physical mobility, personal hygiene and soon. IADLs are not as fundamental as ADLs but needed to live independently in thesociety such as shopping, housekeeping, money management, safety measures, responseto emergency situation, and so on. For example, Dwyer and Coward (1991) found thatdaughters were significantly more involved in parent care than sons in terms of both
ADLs and IADLs, even after controlling for caregiver and care receiver characteristics.
Females as primary caregivers to frail parents was also reported in a study by Horowitz(1985), who also found that sons provided care to their parents only in the absence of
eligible female siblings, and would rely mostly on their spouses to provide care if they
were married. The findings from a study by Stone et al. (1987) were also similar to
those from previous literature, as they found that informal caregivers of disabled elders
are predominantly female. Female caregivers not only provide care to their elderly
parents, but also assume greater burdens and stress than male caregivers (Pinquart andSorensen, 2006; Horowitz, 1985). In addition, these female caregivers are also often inneed of maintaining a balance for other commitments involving child care, workplace,and other responsibilities. Coward and Dwyer (1990) studied informal caregivers basedon the composition of sibling status, and found that daughters appeared to provide morecare to their parents than sons, although daughters and sons were found to devote thesame amount of time per day to parent care when they are only children. However,daughters of mixed gender networks provide significantly more care than sons do, andalso face higher levels of stress and burdens.
A study by Lee et al. (1993) observed the gender differences in parental
caregiving from a different viewpoint, as their study partially rationalized why womenare more likely to provide caregiving services to elderly parents. They found that the6gender of the parent requiring care partially determined the gender of the childproviding care, as adult children were more likely to care for parents of the same gender,
and parents were also more likely to receive care from children of the same gender.
They also found that daughters are more prevalent in parent care because it ispredominantly elderly mothers that require care. Males` role as caregivers was alsostudied by Stoller (1990), although informal caregiving is predominantly provided by
women. Apart from husbands, sons help in caregiving activities, albeit occasionally, andthey are less involved in daily household activities than daughters.
However, Miller and Cafasso (1992) used a meta-analysis technique tocumulate the results of 14 studies related to gender differences in caregiving and foundno significant gender differences pertaining to care recipients and total caregiver
involvement, although female caregivers were found to be slightly more involved inpersonal care and household tasks. Pinquart and Sorensen (2006) studied the stress andburdens assumed by caregivers of both genders, and found that women bear higher
levels of burdens and depression and lower levels of subjective wellbeing and physicalhealth, but did not find much gender difference in caregiving.
The use of professional old age care is supposedly related to cultural and social
circumstances; for example, Wallace et al. (1998) found that racial differences exist in
the use of long-term care, as older African Americans are less likely to use nursing
home care. Moreover, they found that differences caused by culture, class, and/or
discrimination may hinder equitable access to such services. Besides cultural issues,
kinship, cost-effectiveness, stress of the caregiver, and capacity to provide advanced
care are some important issues that determine the choice of informal versus formal care.
Palm (2013) reported that although professional care is suitable for elderly people7requiring advanced care, cost-effectiveness is often an impeding factor. Informal
caregiving, which is thought to be more cost-effective than formal care, can only be a
viable alternative if the home caregivers have the capacity to do so. Palm (2013) also
stated that healthcare technologies have enabled the shift of advanced care for theelderly from institutions to homes, which ultimately ensures more comfort for elderly
care recipients. However, he also emphasized the emotional as well as economic stressfaced by informal caregivers in this process; if the needs and stress of informal
caregivers are overlooked, elderly care recipients may face the risk of mistreatment andabusive care.
[Insert Table I here]

Table I shows the development of long-term care programs in selected
countries. While long-term care is almost universal in developed countries, it isunderdeveloped in India and China, and Indian family members play the role oflong-term caregivers to older members in accordance with family tradition (Agewell
Foundation, 2013). Desai et al. (2010) also found that most elderly people in India arecared for by their sons` families.

Data
This study used data from the “Preference Parameters in India, 2011” study
conducted by Osaka University in six major cities in India: Delhi, Mumbai, Bangalore,
Chennai, Calcutta, and Hyderabad; the cities were selected based on population size andgeography. Face-to-face interviews were conducted with 1280 respondents between theages of 20 and 69, and out of 1037 valid responses, the present study used 556
8responses after scrutinizing the responses based on marital status and having no missing
answers. The study used multistage sampling and allocation methods while sampling
the data. To choose the number of respondents from each city, the study first made apredicted number of responses on the basis of the target population using the Statistical
Yearbook. An area from each city was randomly selected after dividing each city into
four sections (east, west, north, and south), which were then stratified into separate
categories by gender, age, and socioeconomic characteristics and finally, potential
participants from the families were chosen using the Kish grid method.
Table II shows the descriptive statistics of the variables used in this paper toexplain gender differences in the long-term care of elderly parents in India. A little lessthan fifty percent of the respondents are male, and the average age of the respondents isaround 45 years, with a maximum and minimum age of 70 and 21, respectively.
Respondents` level of education ranges from illiterate to the highest level of study, witha mean value of school level education, and spouses` level of education is almost
similar to that of respondents. The average level of education of parents is less thanrespondents and their spouses, which indicates that the country is progressing towards ahigher level of education. Yearly household income and assets, measured in thousands
INR, reveals a picture of economic inequality across society. Finally, the average
number of siblings shows that Indian families have three/four children per family.

[Insert Table II here]

Simple observation
To find the primary evidence to support the proposition that married sons and9their spouses provide more care to elderly parents than married daughters, this study
analyzed the answers of interviewees in response to the question concerning who theprimary caregiver of a parent is when they need long-term care. The respondents wererequired to choose from the following options: you (respondent), your spouse, yourbrother/sister or your spouse’s brother/sister, the spouse of the parent requiring care,other family member, nursing home or assisted living home, paid home help, or other.
To eliminate the problem of overlapping responses, the respondents were asked tochoose only one option. Table III summarizes the responses regarding the primary
caregiver by separating them based on gender. The reason for the unequal number of
responses between fathers and mothers is that some respondents have only one living
parent.

[Insert Table III here]

The responses regarding the primary caregiver of parents offer several
implications for long-term care and gender discrimination in India. First, as perceived,
Table III shows that 78.63% of Indian parents primarily rely on their children andchildren’s spouses for long-term care in old age, constituting the first three options of
the answer choices. This figure supports findings from other studies with respect to theaging population in India, as in a recent study on widow discrimination in India,
Kadoya and Yin (2012) provided evidence that children and their spouses served as theprimary caregivers for their mothers in over 80% of cases.
Second, Indian parents depend more on their sons than daughters for long-termcare in their old age; in other words, sons care more for their parents than daughters.
10When option one of the answer choice was classified based on gender, strong evidence
emerged that sons devote more care than daughters; while sons alone provided
caregiving in 32.46% of cases, this figure was only 2.83% for daughters, and when
including the support of spouses, these figures became 42.03% and 7.12%, respectively.
This supports the conjectures made in previous studies that Indian parents rely more onsons and their spouses for long-term care.
Third, the parents of female respondents would find it difficult to receive
long-term care from them, particularly when they are married and living in distantplaces. The figures regarding the primary caregiver need to be examined along with thethird and fifth options of the answer choices (i.e., caregiving by other siblings and otherfamily members) in order to gain a more precise outlook. In the case of female
respondents, caregiving by other siblings is 68.7%, which increases to 87.6% when
including other family members, indicating that parents of daughters need to depend
either on their other children or other family members. In the case of sons as primary
caregivers, other siblings also play a significant role (41.16%) in providing long-termcare for their parents, although less substantial than in the case of daughters. The figures
in Table II also reflect the outcomes of traditional Indian joint family structure and thenumber of children that parents have. Specifically, parents often have the option to get
long-term care from other children and family members; however, the privilege ofreceiving long-term care from other family members would eventually be narrowed
down due to the eroding joint family system. It would be interesting to observe theprovisions for long-term care of parents with only one son or daughter living in a
nucleus family.
Fourth, the results do not provide any concrete indications about the role of11social security in reducing parents` dependence on sons. It was observed that parents offemales rely on other family members instead of receiving professional care. In fact,choices six and seven, which could be better options for parents with only daughters andno other family members to take care of them, appear to be the least sought after options
for Indian parents. Kadoya and Yin (2012) also provided evidence on the reluctance ofIndian parents to rely on professional care in their old age, and found that almost all
widowed mothers relied on their families rather than opting for professional care. Thus,
the development of social security systems may not be very productive for Indian
parents, as they would be hardly likely to utilize professional care in old age.
However, the implications inferred above may be biased, as the figures of Table
III classify the responses based merely on gender. In reality, other attributes of
respondents such as age, income, educational background, siblings’ status, area ofresidence, religion, and caste may also affect the findings. As such, this research needs
to address the issue of a causal relationship between long-term care and genderdifferences while controlling for these variables.

Empirical Estimation
The models
This study used probit regression models to examine the role of gender in thelong-term care of elderly parents because these models allow estimation of binary
outcome variables. The parent care variables used in the estimation models are binary innature and assumed values of either 0 (not involved in parent care) or 1 (involved inparent care).

12

Description of the variables used in the estimation models
In the regression models, 5 outcome and 13 predictor variables were used. The
dependent variables were I_care_own (1 = respondents care for their own parent), I_care_spouse (1 = respondents care for parents of their spouse), Couple_care_own (1 = respondents or
spouses care for respondents’ parents), Couple_care_spouse (1 = respondents or spouses

care for spouses’ parents), and Professional_care_own (1 = parent care is by a nursing
home, assisted living home, or home helper). The dependent variables were dummy
variables that assumed the value of 1 when respondents were caregivers to their parents
or spouse`s parents individually or as a couple and 0 otherwise. The first dependent
variable addresses whether respondents provide care to their own parents individually,
the second dependent variable addresses whether respondents provide care to theparents of their spouses individually, the third dependent variable addresses whether
respondents care for their parents with their spouses as a couple, the fourth dependent
variable addresses whether respondents and their spouses care for their spouse’s parents
as a couple, and finally, the fifth dependent variable addresses whether respondents’parents receive professional care. The variables are designed in this way to distinguishbetween caregiving done as an individual and as a couple.

[Insert Table IV here]

The 13 independent variables used in this study include “gender,” whichindicates the gender of respondents; it assumed a value of 0 for female respondents and
1 for male respondents. If married sons were the primary caregivers, then the gendercoefficient will be positive. A number of variables were used to take into account the13educational background of respondents and their spouses, fathers, and mothers, as
education is assumed to make caregivers more responsible and capable. The level of
education of respondents` and spouses` parents was used as a dummy variable forjoining the pension programs by assuming that a higher level of education would enable
parents to depend less on their children and rely more on professional care. Householdincome and assets were also dummy variables used to measure the capability to avail
professional long-term care. Household income refers to the total annual income of thefamily, and household assets, to the balance of assets of the family. Sufficient income
and assets enable elderly parents to access other means of long-term care and thus
reduce the responsibilities of their children; this is particularly beneficial for elderly
parents who do not have any children capable of providing long-term care. The
scheduled caste variable was also a dummy variable used to denote socially andeconomically vulnerable people. This variable was used to control for a particularsection of the population whose social structure is different from that of other castes andclasses (Dasgupta et al., 1999). Sibling_self and Sibling_spouse indicate the number ofsiblings that respondents and their spouses have. Our study used these two variables tocontrol for the effect of number of siblings, as previous literature has found that sibling
network composition affects parent care (Coward and Dwyer, 1990).

Estimation models
Estimation models based on the 5 explained and 13 explaining variables are as
follows:(1) Prob(I_care_own = 1) = a + b (Gender) + c (age) + d (Education) + e
14(E_spouse) + f (E_father) + g (E_mother) + h (E_spouse_father) + i(E_spouse_mother) + j (hincome) + k (hasset) + l (Scheduledcaste) + m(sibling_self) + n (sibling_spouse)

Our study hypothesized that married sons would be more involved in caring for
elderly parents, which requires the gender variable used in the model to have asignificantly positive coefficient value. On the other hand, if the hypothesis were wrong,married daughters would be providing more care to their parents and the gender variable
would be negative.

(2) Prob(I_care_spouse = 1) = a + b (Gender) + c (age) + d (Education) + e(E_spouse) + f (E_father) + g (E_mother) + h (E_spouse_father) + i(E_spouse_mother) + j (hincome) + k (hasset) + l (Scheduledcaste) + m(sibling_self) + n (sibling_spouse)

This estimation model is quite the opposite of the first model. This equation
assumes that married daughters provide more care to their spouse`s parents, and thus,
the gender variable would be negative. However, if this assumption is wrong, marriedsons would be providing more care to their spouse`s parents and hence, the maledummy variable would be positive.

(3) Prob(couple_care_own = 1) = a + b (Gender) + c (age) + d (Education) + e(E_spouse) + f (E_father) + g (E_mother) + h (E_spouse_father) + i(E_spouse_mother) + j (hincome) + k (hasset) + l (Scheduledcaste) + m
15

(sibling_self) + n (sibling_spouse)

This model hypothesizes that both sons and their spouses would be caring forsons` parents, and so the gender value would be positive. On the other hand, if thishypothesis is incorrect, the value of the male dummy would be negative, indicating thatdaughters are more involved in parent care.

(4) Prob(Couple_care_spouse = 1) = a + b (Gender) + c (age) + d (Education)+ e (E_spouse) + f (E_father) + g (E_mother) + h (E_spouse_father) + i(E_spouse_mother) + j (hincome) + k (hasset) + l (Scheduledcaste) + m(sibling_self) + n (sibling_spouse)

This model is opposite to the third model, and hypothesizes that daughters andtheir spouses are primarily involved in parent care, and so the gender value would be
negative. If the hypothesis is wrong, sons and their spouses would be the primary
caregivers of their parents and the gender value would be positive.

(5) Prob(Professional_care_own = 1) = a + b (Gender) + c (age) + d(Education) + e (E_spouse) + f (E_father) + g (E_mother) + h(E_spouse_father) + i (E_spouse_mother) + j (hincome) + k (hasset) + l(Scheduledcaste) + m (sibling_self) + n (sibling_spouse)

This model hypothesizes that parents covered by pension programs are lessdependent on their children and rely more on professional care in old age. As
16dependence on sons is the primary reason for gender discrimination at birth in India, thedevelopment of social security systems is expected to reduce gender imbalances. If thishypothesis is true, E_father and E_mother would be positive; however, negative orinsignificant values of E_father and E_mother would indicate that the development ofsocial security systems would not reduce gender imbalances in India.

Empirical Results
Table V shows the results of the estimation models. The LR chi square value
shows that our model fits statistically well for determining gender differences inlong-term care. The result of the fifth model where professional care is regressed by the
independent variables is not reported in the table, as the value of coefficients is
insignificant. We attribute this result to the insufficient number of parents relying on
professional long-term care.

[Insert Table V here]

The hypotheses for the first four models require observing the value and levelof significance of the gender variable in order to determine the role of gender in thelong-term care of elderly parents in India. The gender variables in models 1 and 3 arepositive and highly significant, while those in models 2 and 4 are negative and highly
significant. The gender coefficient in the first model (respondents care for their own
parent) is significantly positive, meaning that married sons provide more care thandaughters. The gender coefficient in the third model (respondents care for their parents
with their spouses) is also significantly positive, indicating that sons and their spouses17are more involved in parent care than daughters and their spouses. These two models
justify the role of married sons and their spouses as the primary caregivers to elderly
parents. The second and fourth models were designed to check the results found in thefirst and third models, and are opposite to them. The gender coefficients in the secondand fourth models are significantly negative, indicating that female respondents,
individually and as part of a couple, are involved in their spouse`s parent care.
The level of education of respondents and their spouses was not found to be an
important factor affecting parent care. Only in the fourth model was spouse’s education
found to affect parent care, although not strongly. The values of E_father and E_motherwere not significantly positive in the fifth model, and thus do not support the hypothesisthat educated parents opt for professional care and are less dependent on their sons.
However, the number of observations for the fifth model was very low, which certainly
limits the predictability of the model. Indian parents rarely opt for professional care in
old age, and the pension coverage rate of employees in India is among the lowest
worldwide (OECD, 2013). However, the number of parents using professional care andthe unreported results of the model imply that improvements to the social security
system may not reduce parents` dependence on children for long-term care.
In models 1, 3, and 4, age was significantly negative, indicating that older
respondents are less involved in parental care. Descriptive statistics rationalizes thisfact; the average age of respondents was 46 years, which makes older respondents
unable to serve as primary caregivers to their parents. Household income, household
assets, and belonging to a scheduled caste do not have much implication for the role ofgender in elderly parent care. In addition, number of siblings has limited implication forparent care, as we found it significant only in the second model.
18

Discussion
We examined the provision of elderly parent care by married sons and theirfamilies in addition to married daughters. Besides descriptive analysis and uncontrolled
observation, we also controlled a number of socioeconomic factors in order to control
observations on the relationship between gender and long-term parent care. We foundthat married sons and their spouses are the primary caregivers to elderly parents, whilemarried daughters hardly help their elderly parents. The social structure of India canrationalize these results, as in most cases Indian combined families are comprised ofparents, unmarried sons and daughters, and married sons and their spouses. As
daughters leave their parents’ home as soon as they are married, their minimal role inelderly parent care is justified. Other family members such as spouses and unmarriedsons and daughters were also found to be significant in providing long-term care. The
results cannot be seen as a contradiction to previous findings of females` role in family
caregiving in developed countries; rather, this study provides evidence of the caregivingrole played by sons and daughters in the context of Indian society. Previous literature on
the gender issues surrounding long-term parent care in the Asian context supports our
findings, as a number of studies reported the responsibility of sons as primary
caregivers to their elderly parents in India (Hammad and Rajoria, 2013; Babu et al.,
2003; Dharmalingam, 1996). In a recent study, Kadoya and Yin (2014) provided
evidence that sons also appear to be the primary caregivers to their parents in China.
They also found that with the present socioeconomic setting in China, parents`
dependence on sons would not be reduced even with the development of social security.
Furthermore, Larsen et al. (1998) found that parents’ concern for long-term care is19

significantly associated with the preference for sons in Korea. They further concluded
that long-term care is a manifestation of the kinship system, which is also common in
China and India.
Our empirical models found that sons, both individually and jointly withspouses, provide long-term care to their elderly parents, even when controlling for othersocioeconomic factors such as age, education, sibling network, caste system, andhousehold income and assets. On the other hand, married daughters were found to playa very limited role in elderly parent care. This study also found that the age of the
caregiver was negatively associated with elderly parent care, indicating that older sonsand their spouses become incapable to serve elderly parents. In addition, level of
education, caste system, sibling network, and household income and assets were foundto hardly affect the long-term care of elderly parents in India. Although previous
literature (Coward and Dwyer, 1990) reported that sibling networks affect elderly parent
care, we found only a limited effect in our study.
This study contributes to the field of gender differences in the long-term care ofelderly parents in at least two ways. The primary contribution of this study is to address
the gender issue from a different viewpoint, as rather than focusing on the traditional
method of dividing caregiving activities by sons and daughters, this study attempted todetermine the caregiving role of married sons and their spouses individually and jointly
compared with married daughters, which to the best of our knowledge is absent in theexisting literature. Second, this study contributes to the lack of a comprehensive study
on the gender issues in long-term parent care in India.
This study has some limitations as well, which should be considered whileinterpreting the results. In a highly populated and geographically large country like
20

India, the sample used to conduct this study may not be sufficient. The sample wasdrawn from six major cities in India; as a result, the implications of the results may not
be applicable to the whole country. This study considered several control variables inthe empirical models, but it is not impossible that we have not included some importantvariables or included some relatively less important variables, which could cause themodels to lose some strength. Finally, the study could have been more insightful if wereported empirical results regarding how respondents` status of employment and theproximity of residences of married daughters to their elderly parents affected caregiving,which are two factors that future research should focus upon.

Conclusion
This paper provides empirical evidence on gender differences in the long-termcare of elderly parents in India. Previous literature on the gender issues surrounding
elderly parent care in developed countries reported that female family members,
particularly spouses and daughters, are the primary caregivers to elderly parents;
however, in the context of Indian society it is presumed that sons assume the role ofprimary caregivers to elderly parents, although empirical evidence on the role of sonsand daughters in the Indian context was limited prior to our study. Thus, our study
contributes to the lack of empirical evidence on gender issues surrounding elderly
parent care and provides new evidence on the role of married sons and their spouses inlong-term elderly parent care, as married sons and their spouses were found to be more
involved than married daughters. In addition, other family members such as spouses andmarried children were also found to provide long-term care to elderly parents, who were
found not to rely on professional care or nursing homes. Besides gender issues, findings21

from this study also have implications for the son preference present at birth in India, as
parents may have a preference for sons because they provide long-term care for them intheir old age.

22

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26

Table I

Major public long-term care programs in selected countries

India

China

UK

Germany

FranceUSA

Japan

South Korea

Under

Under

SocialSocialAPA

Medicaid

Long-termLong-term

development

development

services/long-term(universal)(means-tested)care

care insurancesocial security

care

insurance(universal)

benefits

insurance(universal)(means-tested)(universal)

27

Table II Descriptive Statistics
Mean

SD

Max.

Min.

Obs.

1. I_care_own

0.11870.323710556

2. I_care_ spouse

0.10250.303610556

3. Couple_care_own

0.16910.37521

0556

4. Couple_care_spouse

0.18530.38891

0556

5. Professional_care_own

0.01440.119210556

1. Male Dummy

0.44250.49711

0556

2. Age0.456612.9043

70

21

556

3. Education

9.20324.4882180556

4. E_spouse

9.05584.5412180556

5. E_father

6.24284.57.73

18

0

556

6. E_mother4.42993.8076160556

7. E_spouse_father

6.28244.6427180556

8. E_spouse_mother4.61693.9372160556

9. hincome

5739.277

22926.41

10000024556

10. hasset

14999.1

35638.95

1000000556

11. Scheduledcaste

0.10970.31061

0556

12. sibling_self

3.82371.64549

0556

13. sibling_spouse

2.68351.60209

0556

Explained variables

Explaining variables

28

Table III Primary caregiver for parents according to respondents’ gender
Respondent = Male (Son)

Respondent = Female (Daughter)

Total

Own Father

Own Mother

Sub-total

Own Father

Own Mother

Sub-total

Own Father

Own Mother

Sub-total

1

You (=Respondent)

55 (32.35%)

57 (32.57%)

112 (32.46%)

6 (2.64%)

7 (3.00%)

13 (2.83%)

61 (15.37%)

64 (15.69%)

125 (15.53%)

2Your spouse

15 (8.82%)

18 (10.29%)

33 (9.57%)

7 (3.08%)

10 (4.29%)

17 (3.70%)

22 (5.54%)

28 (6.86%)

50 (6.21%)

3

Your brother/sister or your70 (41.18%)

72 (41.14%)

142 (41.16%)

156 (68.72%)

160 (68.67%)

316 (68.70%)

226 (56.93%)

232 (56.86%)

458 (56.89%)

6 (3.53%)

2 (1.14%)8 (2.32)

10 (4.41%)

13 (5.58%)

23 (5.00%)

16 (4.03%)

15 (3.68%)

31 (3.85%)

42 (18.03%)

87 (18.91%)

66 (16.62%)

63 (15.44%)

129 (16.02%)

2 (0.43%)

3 (0.76%)

3 (0.74%)

6 (0.75%)

2 (0.43%)

2 (0.50%)

2 (0.49%)

4 (0.50%)

1 (0.25%)

1 (0.24%)

2 (0.25%)397 (100%)

408 (100)

805 (100%)

spouse’s brother/sister
4

The spouse of the parent
requiring care

5

Other family member

21 (12.35%)

21 (12.00%)

42 (12.17%)

45 (19.82%)

6

Nursing home/assisted

1 (0.59%)

3 (1.71%)

4 (1.16%)2 (0.88%)

1 (0.44%)

living home
7Home helper

1 (0.59%)

1 (0.57%)

2 (0.58%)

8

Other

1 (0.59%)

1 (0.57%)

2 (0.58%)

170 (100%)

175 (100%)

345 (100%)Total

227 (100%)29

1 (0.43%)233 (100%)

460 (100%)

Table IV Variables and Description
Variable

Description

Explained variables
1. I_care_own (dummy)

Who will be the primary caregiver for your own parents when
they need long-term care?
(1 = respondent, 0 = others)

2. I_care_ spouse (dummy)

Who will be the primary caregiver for your spouse’s parents when
they need long-term care?
(1 = respondent, 0 = others)

3. Couple_care_own (dummy)

Who will be the primary caregiver for your own parents when
they need long-term care?
(1 = respondent or respondent`s spouse, 0 = others)

4. Couple_care_spouse (dummy)

Who will be the primary caregiver for your spouse`s parents when
they need long-term care?
(1 = respondent or respondent`s spouse, 0 = others)

5. Professional_care_own (dummy)

Who will be the primary caregiver for your own parents when
they need long-term care?
(1 = Nursing home/assisted living home/home helper, 0 = others)

Explaining variables
1. Male_Dummy

Respondents` gender
0 = Female, 1 = Male

2. AgeAge of respondents

3. Education

Years of education of respondents

4. E_spouseYears of education of respondents` spouses

5. E_father

Years of education of respondents` fathers

6. E_motherYears of education of respondents` mothers

7. E_spouse_father

Years of education of respondents` fathers-in-law

8. E_spouse_motherYears of education of respondents` mothers-in-law

9. hincome

Yearly household income of respondents (unit: thousand Rs)

10. hasset

Household assets of respondents

11. Scheduledcaste

Respondents from the scheduled caste

12. sibling_self

Number of siblings of respondents

13. sibling_spouse

Number of siblings of respondents` spouses

30Table V Estimation Results
(1)

(2)

(3)

(4)

I＿care_own

I＿care_spouse

Couple_care_own

Couple_care_spouse

1.421***-1.472***

1.286***-1.137***(7.25)(-5.10)(7.90)(-6.30)Gender

-0.0158***-0.0174(-1.96)(-1.31)(-3.00)(-2.69)-0.0102-0.000560-0.00193-0.00461(-0.47)(-0.03)(-0.10)(-0.24)-0.00846

0.0121-0.00984

0.0488**(-0.38)(0.52)(-0.49)(2.45)-0.00268-0.02900.00971-0.0271(-0.07)(-0.70)(0.29)(-0.82)-0.0126

Education

E_father***-0.00922

Age

E_spouse*

E_motherE_spouse_father**

0.0417-0.0587

0.0340-0.0817(-1.33)(0.78)(-2.21)(1.17)

0.007230.04980.02140.0465(0.19)(1.27)(0.64)(1.48)***-0.0409

0.0727(1.73)(-1.13)(2.24)(-1.46)*-0.5250.399-0.2270.294(-1.67)(1.53)(-0.91)(1.29)

0.00000244-0.000000955

0.00000180

0.00000365(0.56)(-0.21)(0.46)(1.05)

0.00000168-0.00000227

0.00000129

0.000000541(0.62)(-0.72)(0.53)(0.22)

0.00843

0.148

***

0.003900.0640(0.17)(2.62)(0.08)(1.31)-0.0441-0.00630-0.03780.0298(-0.80)(-0.11)(-0.76)(0.63)***-1.187**-0.917**-0.752*(-3.08)(-2.44)(-2.40)(-1.90)

N

556

556

556

556

Pseudo R2

0.199

0.195

0.179

0.200

80.50***

71.64***

90.51***

106.61***

E_spouse_mother0.0658scheduledcaste

Hincome

Hassetsibling_self

sibling_spouse_cons

LR Chi Square-1.322t statistics in parentheses*

p < 0.1, ** p < 0.05, *** p < 0.01

31

-0.0446