Current government health schemes often target adolescent girls (0-25 years) or elderly women (60+), leaving a significant policy blind spot for women aged 25 to 60.
Key Terms to Know
- Majhdhaar Initiative: Research by PCI India + AIIMS Patna; first major study on the health of women aged 25–60.
- Quarter-to-Midlife Women: Term coined by researchers Dr. Shivangi Shankar & Dr. Sudipta Mondal for women aged 25–60.
- The ‘Missing Middle’: Women in this age group are excluded from both maternal and elderly health schemes.
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About The “Triple Burden” and Socio-Economic Role
- Women in this age group, like the example of “Radha,” face a triple burden: childcare, eldercare, and professional/economic responsibilities.
- They play a “peak economic role” in families and Self-Help Groups (SHGs). If their health fails, entire families can fall below the poverty line.
- Health Transitions and Barriers:
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- This stage marks a shift from communicable to non-communicable diseases (NCDs) like diabetes and heart disease.
- Barriers to care include socio-cultural neglect (women eating last or ignoring their own health), mental health issues (anxiety/depression), and a lack of financial independence for major medical expenses.
Why are Quarter-to-Midlife Women neglected?
- 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.
Why Focus on Quarter-to-Midlife Women is Crucial?
- Economic Growth: Healthy midlife women enhance productivity, boosting household income and overall economic output.
- Intergenerational Impact: Women’s health directly influences family nutrition, immunity, and wellbeing across generations.
- Demographic Significance: Rising life expectancy makes midlife a critical phase for ensuring healthy ageing.
- Gender Equity: Focusing on this group affirms women’s health rights beyond reproductive roles.
- NCD Prevention: Early screening reduces long-term disease burden and healthcare expenditure.
- Human Capital Formation: Healthy women improve workforce efficiency and caregiving quality.
- Labour Force Participation: Better health enables sustained engagement in economic activities.
- Social Stability: Healthy women strengthen community networks and grassroots governance.
Major Issues Faced by Quarter to Midlife Women
- Policy Neglect: Health policies prioritise maternal and adolescent care, leaving midlife women outside focused interventions.
- Hidden Disease Burden: Poor screening and awareness cause late diagnosis of NCDs, raising health risks and costs.
- Socio-Cultural Barriers: Gender norms and family prioritisation delay women’s healthcare and preventive practices.
- Data Deficiency: Absence of longitudinal and life-course data creates gaps in targeted policymaking.
- Financial Constraints: Limited autonomy and high out-of-pocket expenses restrict timely access to healthcare.
- Mental Health Gap: Psychological issues remain under-recognised due to stigma and inadequate services.
- Occupational Risks: Informal sector work exposes women to unsafe conditions without health protections.
- Fragmented Care System: Lack of integrated, continuous healthcare leads to gaps in comprehensive service delivery.
Global Best Practices: What Can India Learn?
Japan: Preventive Model
- Ningen Dock: Comprehensive preventive check-up for 40–60 age group; integrated with workplaces.
- Covers NCDs, cancers, menopause, and bone health.
- Lesson for India: Institutionalise regular midlife screening and link health with employment.
United Kingdom: NHS Health Checks
- NHS Risk-Based Screening: Targets 40–74 age group; focuses on heart disease, diabetes, and mental health.
- Lesson for India: Use primary care physicians (MBBS doctors at PHCs) for risk-based preventive check-ups.
WHO: Life-Course Approach
- Life-Cycle Approach: Do not view health in silos. Integrate promotive, preventive, curative, and rehabilitative care from childhood to old age.
- Lesson for India: Move away from scheme-based fragmentation toward equity and life-cycle health models.
Way Forward
- There is a need to adopt a life-cycle approach to women’s health, ensuring continuous policy attention across all age groups.
- Strengthening preventive healthcare systems, especially at the primary level, can help in early detection and management of diseases.
- Addressing patriarchal norms and redistributing unpaid care work is essential for achieving gender equality.
- Enhancing awareness, mental health support, and data collection mechanisms will enable more inclusive and responsive policymaking.
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Conclusion
- The issue of the “Missing Middle” highlights deeper structural inequalities within Indian society, where women’s contributions are often undervalued beyond their reproductive roles.
- Addressing this gap is essential for ensuring gender justice, improving public health outcomes, and achieving inclusive and sustainable social development.
6 May 2026
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