SES is one key indicator affecting both caregiver and care-recipient in the caregiving context. It is crucial to develop targeting measures by analyzing the SES among female caregivers, so as to design welfare programs for informal care in China. To our knowledge, this was the first study to investigate the SES of married women who providing intensity informal care for their parents/parents-in-law in need of care in China. One of the key conclusion could be drawn from our findings was that higher SES women were more likely to provide care for the elderly compared with lower SES women, which was in agreement with the study by Benedicte De [13]. To be specific, those with higher educational attainment, higher economic status and urban Hukou were more likely to provide high-intensity care, and women who were employed and with urban Hukou were more likely to provide low-intensity care.
The current study found that the women with higher educational attainment were more likely to play the role of be high-intensity caregivers, while this education effect was not found to be statistically significant in low-intensity informal caregivers. One important reason for this finding might be due to the “feedback theory” proposed by Xiaotong Fei [31]. The “feedback theory” pointed out that children have the responsibility to support their parents in order to repay for their upbringing and education. Education has long been an important factor in social and personal development, and attaining higher education requires greater parental and household investment. Those have attained higher education may view caregiving as a way to provide for parents and repay them for their investment [32]. In addition, the women with higher education tended to be motivated by Chinese traditional culture that it is a virtue to support parents, especially when they were under need of care[33, 34].
Surprisingly, the employed women were found to be more inclined to provide low-intensity informal care, whereas this association was not statistically significant in high-intensive care. In order to further explain this phenomenon, we had an in-depth analysis to examine the correlation of the different variables of SES (See the Appendix Table 1). We found that there was a positive correlation between education, income, and Hukou, while employment status was only negatively correlated with Hukou. Based on this result, we speculated there may be a selection effect involved, especially for those rural women with lower SES. Such rural women usually had to find a job for basic livelihood. It may be that when they are weighing decision to find a job versus take care of their parents or parents-in-law who need care, they would consider the care intensity the parents need. If the parents or parents-in-law just need a low-intensity care, they would prefer to find a job. But high-intensity care required a certain amount of time and effort, the women had to spend much time providing informal care for their parents or parents-in-law, regardless of the employment status.
Consistent with previous studies, we also found that women with urban Hukou were more likely to provide informal care than those with rural Hukou [35, 36]. There were several potential explanations for the urban-rural disparity observed in this study. First, with China’s rapid industrialization and urbanization, a large number of young people, including young women, have moved to urban areas for better job opportunities, leaving their aged parents behind in the rural areas [37]. According to the National Health and Family Planning Commission of China[38], about 252 million rural people have moved to urban areas by the end of 2014, of which 78 percent were aged between 15 and 59 years old. As a result, the migrant young women were unable to provide the necessary care and support for the left-behind older parents. Second, compared with rural women, urban women have higher educational level, and higher education was found to be associated with more informal caregiving. This associate was also demonstrated in the Appendix Table 1.
Interestingly, one study in Japan found women with lower SES were more likely to be primary caregivers, which was inconsistent with the current study [12]. One of the possible explanations may be due to the difference of long-term care system between two countries. In China, the long-term care system is still in its infancy, and informal care remains the dominant. In contrast, taking care of the elderly is mainly provided through public sectors under a long-term care insurance scheme in Japan. This thus, the women with higher SES have a greater capacity to purchase formal institutional care for the aged parents instead of informal care in Japan.
As can be seen from time trends, the number of people providing high-intensity informal care has been increasing over the last two decades. There are two possible reasons for this finding. First, according to the National Bureau of Statistics[39], the proportion of the population over 65 years has been entered in a rapid increase since 2000, which brings a higher need for high-intensity care for the elderly. However, the Chinese government has not been well ready for coping for this challenge, and the supply for the formal care is not sufficient. As an alternative, an increase in the informal high-intensity care was observed. Second, even though we used clustering robust standard error to avoid individual autocorrelation across eight waves of the data, the increase of high-intensity care in recent waves might be partly due to the fact that the care recipients were older, and also the need for high-intensity care increased.
Although this study explored the SES among female informal caregivers using the nationally representative population-based data, there were still several limitations. First, information including weekly hours of informal care was self-reported, which could lead to recall bias. Second, some variables, such as the types of care activities, the care recipient's age and his or her marital status, were not available in the database, making the analysis less comprehensive.