Quarter-to-Midlife Women: Issues, Importance & Policy Solutions

Recent research has highlighted the neglect of women aged 25–60 (“quarter-to-midlife”) in health policies, bringing attention to this critical gap in the healthcare system.

• The research is conducted under the aegis of  initiatives “Majhdhaar” (by PCI India in collaboration with AIIMS Patna and others) has highlighted the neglect of women’s health beyond reproductive years. 

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About Quarter-to-Midlife Women (25–60 years)

• The term “Quarter-to-Midlife Women” has been conceptualised by researchers like Dr Shivangi Shankar and Dr Sudipta Mondal to describe women in the age group of 25–60 years, who fall between early adulthood and old age.

Why does this Category Matters?

• This phase represents the largest and most active segment of a woman’s life, yet it is largely ignored in health policy.
  • Post-reproductive exclusion: Many women exit maternal health programmes after childbearing years.
  • Pre-elderly neglect: They are not yet covered under geriatric care systems.

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Key Characteristics of Quarter-to-Midlife Women (25–60 years)

• High Responsibility Phase: Women serve as the primary caregivers, managing child upbringing and elderly support within households.
  • They face a dual burden of unpaid care work and paid employment, leading to time poverty and limited focus on self-care.
• Peak Economic Contribution: This stage marks the highest level of women’s economic participation, especially in SHGs, agriculture, and informal sectors.
  • They act as key drivers of household income, poverty reduction, and grassroots economic development.
• Health Transition Stage: This phase reflects a shift from reproductive health to chronic and lifestyle-related conditions.
  • Rising NCDs, menopause-related changes, and mental stress are compounded by low health-seeking behaviour and neglect of personal health.
• Decision-Making Role: Women increasingly participate in household decision-making, especially regarding finances, education, and health.
  • They also play an active role in community institutions like SHGs and local governance, shaping grassroots development.
• Financial Transition Phase – Limited Autonomy: Despite contributing economically, many women have restricted control over financial resources and assets.
  • Dependence on male members often limits independent health and livelihood decisions.
• Social Identity Transition: Women experience a shift from active motherhood to broader social roles within family and society.
  • This transition often brings identity challenges, reduced recognition, and changing societal expectations.
• Vulnerability to Social and Economic Shocks: Women in this phase are highly vulnerable to income loss, health shocks, and family crises.
  • Lack of social security and safety nets increases their risk of poverty and marginalisation.
• Limited Access to Preventive Healthcare: Preventive health services like regular screenings and check-ups are often underutilised.
  • This results in delayed diagnosis and progression of diseases, worsening health outcomes over time.

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Major Issues Faced by Quarter-to-Midlife Women

• Policy Invisibility: Health systems largely focus on adolescents and maternal health, leaving midlife women outside targeted interventions.
  • As a result, this group remains underserved and excluded from dedicated healthcare programmes.
• Silent Disease Burden: A significant proportion of health conditions remain undiagnosed due to inadequate screening and awareness. This leads to late detection of NCDs, increasing morbidity and treatment costs.
• Socio-Cultural Neglect: Women tend to prioritise family health and responsibilities over their own wellbeing.
  • Deep-rooted gender norms result in delayed health-seeking behaviour and neglect of preventive care.
• Limited Data and Evidence Gap: There is a lack of life-course and longitudinal studies focusing on midlife women’s health.
  • This creates policy blind spots and weak evidence-based interventions for this demographic.
• Financial and Access Barriers: Many women lack financial autonomy and health insurance coverage, limiting access to quality care.
  • Out-of-pocket expenditure and dependence on family decision-making delay timely treatment.
• Inadequate Focus on Mental Health: Mental health issues like stress, anxiety, and depression remain under-recognised and under-treated.
  • Social stigma and lack of services lead to poor psychological wellbeing.
• Workplace and Occupational Health Neglect: Women in informal and unorganised sectors face poor working conditions and lack of occupational health safeguards.
  • Absence of workplace health policies results in increased vulnerability to illness and fatigue.
• Fragmented Healthcare Delivery: Healthcare services remain episodic and scheme-driven rather than holistic and continuous.
  • Lack of integration across services leads to gaps in preventive, promotive, and curative care.

Why Focus on Quarter-to-Midlife Women is Crucial?

• Economic Growth: Healthy women contribute to higher productivity and workforce participation, strengthening economic output.
  • A healthy woman engaged in MSMEs or agriculture can work consistently, increasing household income and local economic activity.
• Intergenerational Impact: Women shape family health, nutrition, and wellbeing outcomes, influencing multiple generations.
  • A mother aware of nutrition ensures better child immunity and elderly care, reducing overall disease burden in the family.
• Demographic Transition: With rising life expectancy, this phase forms a larger share of women’s lifespan.
  • Early screening at 40 prevents complications at 60, ensuring healthy ageing and reduced dependency.
• Gender Equity and Rights: Recognises women as individuals with lifelong health rights, beyond reproductive roles.
• NCD Prevention and Cost Reduction: Early detection helps in reducing long-term disease burden and healthcare costs.
  • Timely diagnosis of hypertension prevents costly complications like stroke or heart disease.
• Strengthening Human Capital: Healthy women improve productivity and caregiving quality, enhancing overall human development.
• Enhancing Labour Force Participation: Good health enables women to enter and sustain employment opportunities.
  • Access to regular health check-ups helps women continue participation in self-help groups (SHGs) or small enterprises.
• Social Stability and Community Development: Women are central to community networks and social cohesion.
  • Healthy women actively participate in local governance (Panchayats) and community initiatives, strengthening grassroots development.

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Way Forward

• Adopt a Life-Cycle Based Health Policy Framework: Shift from a narrow maternal-centric approach to a comprehensive life-cycle model that integrates adolescent, reproductive, midlife, and geriatric health needs of women.
• Institutionalise Preventive Health Screening: Ensure universal access to regular screening for NCDs, cancers (breast, cervical), osteoporosis, and mental health, especially through primary healthcare systems like Health and Wellness Centres.
• Strengthen Primary Healthcare and Continuum of Care: Integrate promotive, preventive, curative, and rehabilitative services under a unified system to avoid fragmented and scheme-driven healthcare delivery.
• Enhance Financial Protection and Insurance Coverage: Expand schemes like Ayushman Bharat to include comprehensive outpatient care, diagnostics, and chronic disease management for midlife women.
• Promote Health Awareness and Behavioural Change: Launch targeted IEC campaigns to address gender norms, stigma, and low health-seeking behaviour, encouraging women to prioritise their own health.
• Focus on Mental and Occupational Health: Incorporate mental health services and workplace safety norms, especially for women in informal and unorganised sectors, ensuring stress management and occupational well-being.
• Improve Data Systems and Evidence-Based Policymaking: Invest in longitudinal studies, gender-disaggregated data, and research on midlife women to design targeted, evidence-based interventions and monitor outcomes effectively.

Global Best Practices on Women’s Health Beyond Maternity (Comparative Table)

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Conclusion

• Quarter-to-midlife women (25–60 years) represent a “missing middle” in health policy, economically productive yet medically neglected, requiring a life-course and inclusive healthcare approach.

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