Women’s Midlife Health (25–60): Challenges, Missing Middle & Policy Priorities

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:
• • 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.

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