Older Women, Marital Relationships, and Sexuality in China
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- Shea, J.L. Ageing Int (2011) 36: 361. doi:10.1007/s12126-011-9114-3
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Based upon field research conducted in China in the 1990s and 2000s, this article examines older Chinese women’s views and practices surrounding sexual interaction in later life. In contrast to local clinical depictions of middle-aged and elderly Chinese women as repressed by feudal superstitions concerning sex in later life, this research shows that more middle-aged and elderly Chinese women are sexually active than such clinical sources assume. Furthermore, there is no neat correspondence between sexual attitudes and sexual activity, and Chinese women’s attitudes concerning later life sex are often much more liberal than their behavior. Absence of sexual activity among older Chinese women is more closely related to problems in the marital relationship in general and/or to health problems than it is to attitudes about age and sex. At the same time, many Chinese women challenge the claims of western sexology that presume the marital relationship and sexual interaction to be a top necessity for a good quality of life in the later years. These findings have important implications for public health education, clinical training, and health and social service delivery in China.
KeywordsMarital relationshipSex or sexualityAgingMiddle ageOld ageChina or Chinese
Drawing on field research I conducted in China beginning in the 1990s and ending in 2008, this article examines older Chinese women’s views and practices on sexual interaction in later life in comparison with depictions common in Chinese clinical education publications. This research is significant in many ways, not least of which is its demographic import. China, the world’s most populous country, encompasses an enormous proportion of the globe’s elderly and middle-aged populations today. One-fifth of the world’s elderly population, and one quarter of the world’s middle-aged population, resides in China. As of 2010, there are 170.9 million people over the age of 60, and 381.6 million people between the ages of 40 to 59 living in China, comprising 12.8% and 28.7%, respectively, of the total Chinese population of 1.33 billion (US Census Bureau International Database 2011). Like many other economically privileged countries in the world, China is projected to experience a rapid increase in the elderly proportion of the population over the next several decades (Sokolovsky 2009; Hooyman and Kiyak 2011: 49), in 2050 it is projected that 35.4% of China’s population will be age 60 or older, with the middle-aged population holding steady at about a quarter of the total population (US Census Bureau International Database 2011). Based on the sheer magnitude of this population for the world and for China, it is important that gerontological researchers develop a greater understanding of this population and its needs, desires, views, habits, and capabilities.
As of yet, there is very little social scientific literature available on sexuality in later life, especially in non-western contexts where social scientific examination of sexuality at any age emerged decades later than it did in countries like the U.S. Even in western countries at the forefront of sex research, examination of later-life sexual issues is quite rudimentary compared with the volumes of research on sexuality in adolescence and young adulthood (Hooyman and Kiyak 2011). It is important that we conduct research in non-western contexts such as China in order to ascertain the cross-cultural applicability of the western sexological assertion that sexual interaction is one of the most important determinants of life satisfaction at any age in life.
The scholarly literature on sex in China has been growing over the last three decades (e.g., Liu et al. 1992; Pan 1993; Evans 1997; Jeffreys 2006), but there are still only a handful of scholarly sources that focus specifically on sexuality in middle and old age in China (e.g., Guan 2004; Shea 2005). This article aims to continue the process of filling in some of the gaps in our knowledge about Chinese views and practices related to sex in later life.
In this research I focus on women because in China women are labeled by clinical health education literature in gerontology and sexology as being the main obstacle to sexual liberation in the later years due to “feudal” attitudes that are assumed to be much more severe and entrenched in women than their male counterparts. I examine both middle and old age because debate in China over the past few decades has been somewhat different than the debate in the U.S. in that some clinical educators in China perceive a traditional taboo not only against sex in old age, but also against sex in middle age. My research questions are as follows: What are older Chinese women’s views of and practices surrounding sexual interaction in later life? How do their views relate to their practices? What factors are associated with negative views of later life sex and/or absence of sexual activity? What are the implications of these findings for public health education, clinical training, and health service delivery?
My theoretical approach draws upon life course theory which holds that it is important to look at things like sexuality in life course and generational perspective as flowing from human agency in the context of historical contingencies (Bengston et al. 2009), not just as reflections of presumably enduring ethnic, cultural, or regional traits. Theoretically, I follow Guan in taking a combined symbolic interactionist and ecological development approach (Guan 2004; Bengston et al. 2009; Hooyman and Kiyak 2011). Hooyman and Kiyak define a symbolic interactionist approach as positing that “interactions between individuals and their environment affect their experience of the aging process” (334). This view does not assume that either continuing activity or disengagement does or should occur, but rather focuses on how the responses of aging individuals depend on the meaning of various activities for them within their social environment. Most closely associated with Brofenbrenner, the ecological developmental approach views the individual as a “volitional agent” actively filtering and manipulating environmental input based on their interests and abilities from their position at the center of a nexus of nested environments extending from the more intimate contexts of home and neighborhood, to the broader society (Bengston et al. 2009: 438–39). In cultural anthropology, the approach taken in this piece is known as practice theory, in which the focus is on the interactions between volitional individuals and social structures, each of which may shape the other depending on the dynamics of social power and on historical contingencies (Bourdieu 1977).
My analysis focuses on a comparison with the findings of Guan (2004), one of the few scholars other than this author who has examined sexual attitudes and activity among older people in mainland China. Echoing themes common in clinical health education literature in China, Guan frames his study in light of a concern with how traditional Chinese cultural beliefs carry discouraging messages about sexual involvement in later life. In his introduction, Guan sketches the potential influences of the three traditions that together form what is known as Chinese popular culture: Confucianism, Daoism, and Buddhism. Guan states that the “Confucian tradition outlined a code of appropriate behavior implying that sex properly occurs between married people only for the purpose of producing heirs. Sexual activities beyond this reproduction purpose were undignified and unrespectful” (105). Guan then writes of how the Daoist “teachings … viewed sex as harmful, dangerous for health, and self defeating, because during sexual intercourse men would lose their ‘yang essence’ (semen), which was a nonrenewable resource necessary for life” (105). Finally, Guan remarks on how the “Buddhist teachings required giving up worldly pleasure and being free from desires in order to achieve nirvana (perfect peace).” Buddhism, he argues, “considered involvement in sexual activities beyond the purpose of reproduction” to distract “one from the improvement of one’s karma” (105).
In order to test whether such beliefs had an impact on the ground, Guan’s research team conducted face-to-face questionnaire-based interviews in the mid-1990s among 400 Chinese rural elderly men and women aged 55–88 in six villages in Henan Province (225 men and 149 women; 78.9% married; average age 67.4 years old; age distribution 31.8% 55–64 years old, 56.2% 65–74 years old, and 12% age 75 and older). In examining the results of his community research, Guan found that of the 302 people who responded to the question of whether they had sexual intercourse, 53.3% said yes. Guan also asked people whether they engaged in “hugging, kissing, and/or touching” of a sexual partner; of the 274 responses given on this second question about “sexually expressive activities,” interestingly, only 32.5% said yes, considerably lower than on the previous question concerning intercourse. Following the international trend, Guan did find that the percentage reporting sexual activity was lower in the older than in the younger age groups. On attitudes, Guan found that approximately one-third of his sample felt that sex in later life was abnormal and/or unhealthy. Guan found a strong correlation in his sample between sexual attitudes and sexual activity, such that those who felt that sex was normal and healthy were more likely to engage in sexual intercourse and/or sexually expressive activities. Importantly, Guan’s inquiry also goes beyond attitudes to show that individuals who gave positive ratings of their relationship with their spouse were more likely to have positive attitudes toward sex. While positive ratings of marital relationship were not correlated with engaging in sexual intercourse, they were strongly correlated with sexually expressive activity such as hugging, kissing, or caressing. Although he does not provide any concrete correlational data on the relationship between sexual activity and household composition, Guan also suggests that whether older adults have a separate bedroom in the household, and the number of family members and generations in the household may also play a role in later life sexual activity.
My findings have many resonances with, but also some important differences from, those of Guan (2004). Rather than primarily mirroring the concerns with sexual liberation of elders found in the Chinese clinical education literature, I emphasize significant gaps between what is claimed in that literature and what I found on the ground. In the pages that follow, I argue that more middle-aged and elderly Chinese women are sexually active than is assumed in the many Chinese clinical publications currently decrying the stifling effect of “feudal” attitudes on older Chinese women. I also show that Chinese women’s attitudes toward sex in later life are much less conservative than such publications depict. At the same time, in contrast to the Chinese clinical literature and Guan’s findings that stress a correlation between attitudes and behavior, I find no neat correspondence between sexual attitudes and sexual activity among the Chinese women I studied; in fact, very often Chinese women’s attitudes concerning sex in later life are much more liberal than their own sexual behavior. In addition, I show that for older Chinese women absence of sexual activity is most closely related to problems in the marital relationship in general and/or to health problems in one partner or the other than it is to attitudes about age and sex. At the same time, however, I also illustrate how many Chinese women challenge the claims of western sexology that place the marital relationship and sexual interaction at the top of the list of necessities for a good quality of life in the later years. Finally, I examine some of the implications these findings have for public health education, clinical training, and health and social service delivery in China.
I conducted my ethnographic research on sex in later life between 1992 and 2007 in rural and urban communities in the municipality of Beijing in the People’s Republic of China. Fluent in Mandarin Chinese and a student of Chinese culture since 1985, I first came to Beijing as a foreign student for two extended stays totaling a year and a half in the mid to late 1980s. In the 1990s, I returned to conduct my dissertation research in conjunction with the Ph.D program in Anthropology at Harvard University. During my dissertation fieldwork, I lived in Beijing for almost a year and a half, spread across two short trips in 1992 and 1996 and a fourteen-month stay in 1993–1994. After graduating and coming to the University of Vermont in 1998 to join the faculty, I returned to China in the summers of 2000, 2007, and 2008 for further fieldwork.
My study is comprised of mixed methods research involving a combination of qualitative and quantitative research methods. Between 1992 and 2008, during each trip to the field I participated regularly in participant observation, visiting with hundreds of women in their homes, in the park, at the market, and at community gatherings, chatting casually and observing what people said and did as I took part in the activities they were doing. In 1994, with the assistance of a team of local retired health care workers, I conducted a survey of over 400 women between the ages of 40 and 65 (born 1928–1954), half in a rural village and half in an urban neighborhood in the municipality, with 196 women in their 40s, 126 in their 50s, and 77 in their 60s. The survey was based on a total sample of women in the targeted age group in each community. Conducted face-to-face in women’s homes or another mutually agreed upon nearby location, the response rate was 90%. Focused broadly on women’s health, experiences of their bodies and emotions, views of aging and menopause, their family and work life, and their sense of satisfaction with life, part of the questionnaire included questions concerning whether or not one was sexually active and about their attitudes toward sex in later life. In 1994, 1996, and 2007 I also conducted semi-structured tape-recorded interviews in which I asked local middle-aged and elderly women about their life stories and their experiences of aging. Many of these women were involved in the original survey, and some were women from nearby communities who later joined the research. Like the survey, the initial interviews were not primarily focused on sex in later-life.
In the late 1990s, however, I began to read some clinical educational materials on sex in later life1 that I had collected at various large retail bookstores in Beijing such as Xinhua Shudian, and I became intrigued with the representation of older women in those materials as culturally oppressed prudes. So, in the interviews that I undertook in 2007, I focused a portion of the questions explicitly on marital relationships, romantic interactions, and later-life sex. The twelve women taking part in the 2007 interviews came from urban communities in Beijing, and spanned middle and old age, with some in their fourth, fifth, sixth, seventh, and eighth decades of life, respectively. My research was approved by human subjects committees at Harvard University and the University of Vermont and by the research review committee at my host unit, Peking Union Medical College Hospital (PUMCH). All participation in the research was on a voluntary informed basis, and all participants’ identities are kept confidential.
Results: Analysis of Chinese Health Education Literature
Review of Chinese clinical health education literature related to sexuality in later life available in retail bookstores shows that these sources started to become widely available in the mid- to late 1980s. Distributed by the thousands and often tens of thousands to bookstores around the country, these kinds of books are aimed simultaneously at educating grassroots clinicians in general practice and at giving self-help advice to older adults. They tend to be written and edited by health care professionals, such as medical doctors or psychologists, with some clinical and/or research experience in gerontology and/or sexology, and to be published by well-respected medical, pharmacological, public health, or scientific presses. While a few of the authors and editors are women, the vast majority are male, and the analysis tends to be written from a tacitly male perspective. Some exemplary titles include: Advice on Sexual Issues in Old Age by Qian Xinzhong and Yang Wenzhi (1990), Old and Still Romantic Is a Sign of Longevity: Talking About Sex Among Middle-Aged and Old Friends by Qin Yunfeng and Hong Yang (1999), One Hundred Questions and Answers about Sex in Middle and Old Age by Zhou Dasheng and Niu Biao (2000), and Guide to a Healthy Psychological Life Among Elderly Persons by Xu Rongzhou and Cao Qiufen (2008).2 The expressed goals of such publications are to help clinicians, older adults, their families, and society to understand that romance and sex in later life are normal, natural, healthy, and a basic human right. They also argue that continuation of sexual interaction among couples in later life entails benefits for the health and happiness of older persons, the harmony and stability of the family, and the productivity of society in general.
Depiction of Traditional Prohibitions and Their Relation to Age
Such clinical health education books (e.g., Qian and Yang 1990; Qin and Hong 1999, Zhou and Niu 2000; Xu and Cao 2008) cite many different traditional Chinese prohibitions against sexual involvement in later life which they claim to have a large hold on the beliefs and behaviors of the common people. They relate these prohibitions to “feudalism” (fengjian) which is a term from the Chinese communist movement dating back to the 1920s, which refers to negative aspects of traditional Chinese culture, including “traditional feudal views” and “old worn-out traditional customs.” They index these prohibitions to chronological age, reproductive ability, and intergenerational life events.
As mentioned earlier, these authors do not confine their concerns to old age, but are deeply worried about sexual repression in middle age as well. They trace the problem both to traditional Chinese age-oriented expectations and to generational cohort issues. Qin and Hong write of the “harmful” (shanghai) ideas that people “ages forty, fifty, sixty, and older” harbor: “Compared with young people, middle-aged and older people have not received sex education before; instead they were subjected to stale, rotten, worn-out, out-dated notions passed down through the ages of history” (Qin and Hong 1999: 1). Zhou and Niu (2000) and Qian and Yang (1990) give older estimates of the applicable age range than Qin and Hong, but convey the same message about older cohorts. For example, Qian and Yang (1990) write that: Old people in China who are older than age fifty or sixty have been profoundly influenced and bound up by feudal cultural thoughts. They take sexual behavior and look at it like it is an “unsightly embarrassing matter” (Qian and Yang 1990: 238). Zhou and Niu write that “old people in China over the age of fifty or sixty” have been “influenced by feudal culture” and think that sex is an “embarrassing matter” that it “shouldn’t be talked about” and that due to the influence of “feudal culture,” a sizable portion of middle-aged and older people’s home life and sex life is subject to many “misunderstandings, incorrect attitudes, and distortions” (Zhou and Niu 2000: 105). One idea associated with these traditional age limits is that the body changes after a certain age such that sex entails more risk to one’s reserves of life essence and vital energy, an idea associated with Chinese medicine and its roots in ancient Daoist alchemy. Another is simply that certain behaviors are no longer socially appropriate after a certain age is reached, an idea more associated with popular Confucianism.
These authors also cite traditional prohibitions related to the assumed loss of reproductive ability coinciding with the end of menstruation, female menopause, and/or female or male climacteric. Here the underlying logic includes the idea that since sex is for reproduction, there is no point in having sex after one’s reproductive ability is compromised or lost or after bearing children is socially inappropriate, all ideas associated with popular Confucianism. In addition, the underlying logic also includes the idea that loss of reproductive ability is a sign that one’s internal reserves of life essence are running low and should not be expended in sexual activity, an idea, again, associated with Chinese medicine.
Beyond age and reproductive ability, these authors also refer to intergenerational life events that are linked with traditional restrictions on sex. These include, from most to least restrictive: one’s sons and daughters reaching adulthood, the marriage of one’s children, having a daughter-in-law in the family, one’s daughter-in-law becoming pregnant, and having a grandchild enter the family. The principle tying together this assortment of prohibitions is the idea that the roles of the generations should be kept separate, distinct, and mutually interdependent. In other words, a member of the parental generation should not be acting romantically, having sex, risking pregnancy, and/or getting married at the same time as their children are doing so. Instead, the elders should devote their energies to taking care of their children and grandchildren until the elders reach the advanced age where their children must (or should) take care of them.
Depiction of Older Chinese Women and Gendered Nature of the Discourse
The Chinese clinical health education literature is striking in the way in which it portrays Chinese women as being particularly vulnerable to being brainwashed and stymied by repressive traditional thought and customs. These sources portray older Chinese women as much more repressed, prudish, and ignorant than men and as posing a major hurdle for sexual modernization. For example, Qian and Yang (1990) write that many women “think that after you have entered old age to continue to have sexual contact would be to do something one knows is wrong and an abnormal behavior, and so they refuse to have sex anymore,” “think that a good woman would never have much interest in sex,” and are “constrained from initiating sex or cooperating enthusiastically in sexual interaction.” They argue that this is because the “teaching that they received when they were children and youth also denied the pleasures of sex. For instance, from the time they were little, they received stern lessons from their mother that sex is obscene” (6–7, 234–235, 246–47). Qin and Hong (1999) write that some older women are ignorant and “fear that having sex will influence negatively their husband’s bodily health,” and so they refuse to have sex and/or move into a “separate bed” or even a “separate bedroom” from their husband (45).
This discourse is also gendered in another way. It tends to place more emphasis on the negative implications of women’s refusing men sex than the other way around. For example, Xu and Cao (2008) write somewhat ominously of how women denying men sex may result for the men in “increased psychological pressure, irritability and feeling distraught, such that not only will it influence the balance of Qi and Xue [major aspects of life essence in Chinese medicine], but it will also result in a reduction in work productivity, and even an increased likelihood of traffic accidents” (309). Xu and Cao do mention a few negative consequences of sexual abstinence for older women, but, in my estimation, they are again written from more of a male perspective in emphasizing the ill effects on women’s “appearance and figure, becoming pale, thin, haggard, and old,” as well as more susceptible to disease and early aging (309).
As we have seen, the Chinese clinical health education literature described above has some areas of commonality with the themes laid out by Guan. However, as I will show, it also differs in important ways as well. The Chinese clinical sources are similar to the Guan article in that they both bring up problems with Chinese traditional culture, with Confucianism, and with thoughts about health stemming from Daoist alchemy by way of Chinese medicine. They also both highlight the promise to be found in modernity, science, and cosmopolitanism, and the importance of broadening the definition of sexuality to include kissing, hugging and caressing.
The Chinese clinical sources differ from Guan’s analysis in that they do not mention Buddhism or include references to Buddhist ideas or actions in their discussions of traditional Chinese culture. In addition, some of the clinical sources only speak of Chinese medicine and do not reach back to identify the Daoist roots of the sexual practices of cultivating life (yang sheng). In addition, some of the Chinese clinical sources take pains to distinguish between modern scientific Chinese medicine versus outdated feudalistic strands of Chinese medicine and locate scientific knowledge within both biomedicine and the right type of Chinese medicine. Finally, the Chinese clinical sources have a tendency to mention the importance of communist leaders and socialist modernity in granting elders and women sexual rights, something which Guan does not do.
There are a few historical facts important to our understanding of sexuality in China that are never mentioned either in Guan’s article or in the vast majority of Chinese clinical sources on later life sexuality. First, while Buddhism in China has involved renunciation of sexual interaction for some unmarried monks and nuns, this has certainly not been the case for married couples with ties to Buddhism. Furthermore, a finer reading of Buddhist tradition shows that it is not sex per say that is a problem, but sex with a desperate grasping nature directed solely at personal pleasure. In addition, just as there are ascetic threads within Buddhist tradition in China and elsewhere, there are also tantric forms of Buddhism in China that view certain forms of partnered sexual concourse as a path to enlightenment. Many Chinese elders have seen photos or statues at historical sites portraying seated Buddhist figures with the woman sitting on the man’s lap gazing into each other’s eyes in a long slow sexual embrace. Another aspect of Chinese tradition that is not given voice in Guan’s article or in the majority of the Chinese clinical literature is the wealth of sexual and sensuous material found in many forms of ancient Chinese art, including literature, poems, paintings, woodcut prints, carvings, music, dance, and theatre (with the exception of Sun 2008).
Finally, while leaders in the Chinese communist party did initiate in the 1970s the beginnings of public sex education in China and while romantic love with a comrade was lauded for a time (1958–1961) as a way to embody ardor for the party and the masses, it was not all roses. While Mao himself indulged liberally in multiple marriages, affairs, and dalliances, the same luxury was not afforded the common people for most of the Maoist era (1949–1976). For much of this time, romantic interaction, conjugal love, sex for individual pleasure, and even a focus on one’s family was devalued as selfish, petty, and bourgeois. One was supposed to instead focus on the Communist party, the nation, and the collective. Courting, marriage, and sexual interaction still went on during this time, but it was supposed to be so far subordinate to the party and the masses that many couples were assigned to work in different provinces too far apart to visit each other until the dawn of the market reform era (1978 on). Probably the above are not mentioned because: 1) they would break up and complicate the progressivist anti-Victorian-Era Enlightenment theme that underlies Western sexology, and by virtue of its subsequent adoption, contemporary Chinese sexology; and 2) it is more politically expedient in public forums in the present to focus on the positive historical contributions of the Chinese communist party, rather than to dwell on past excesses.
Results: Analysis of Participant Observation, Interview, and Survey Results from Beijing Research
The data that I uncovered through participant observation, face-to-face structured questionnaire, and in-depth tape-recorded interviews among rural and urban women in Beijing share many resonances with Guan’s (2004) findings from his Henan research, but also some important differences. In comparison with the Chinese clinical health education literature, on the other hand, I find significant gaps between what those authors claim about women’s attitudes and behaviors related to later life sexuality.
Willingness To Talk
When I initially said that I would like to include a few questions about sex in my survey questionnaire, some of my colleagues in China felt that women of the generations that I was studying would not be willing to say anything in that regard. However, my mentor at PUMCH said that she thought that in the context of women’s health, most women would be willing to answer. She was right. While there were a few women in responding to the face-to-face survey in 1994 asked, “What are you doing asking a question like that?” most took it in stride since it was a study with ties to a well-regarded department of gynecology. Another important factor was that the local health care workers assisting with the survey suggested that we preface the question, “just between us old sisters,” a phrase which seemed to lower the sensitivity level. Even those who were initially surprised by the question were willing to answer when the interviewer offered that the question is included because it is a matter of concern for some older women. In the qualitative interviews conducted in 2007, this was not an issue. The women who were comfortable enough to participate in a tape-recorded interview had developed a warm relationship with the interviewer and were more enthusiastic about the research. In addition, more than a decade of social change had occurred between the original survey and the qualitative interviews focused on sexuality, leading many Chinese women to be increasingly open to discussing sexual matters. For example, R.M., a rural woman in her 60 s who I interviewed in 2007 said that it was nothing special to talk about marital intimacy, because older women in Beijing now talk and joke about things like this with each other. She said that you can’t help but be influenced by the changing times and that only those old women who never get out of the house remain very conservative.
Many Midlife and Older Women Sexually Active
Whereas many local clinical education sources published in China in the 1990s make out that a large proportion of Chinese women refrain from sex from the time their first child gets married or their menstrual periods stop, my survey results from 1994 show that a considerable number of middle-aged and some elderly Chinese women are sexually active. Out of my sample of 399 Chinese women, almost three-quarters (72.2%) said that they still have sexual relations (xianzai you xing shenghuo, you fang shi), and of those who were currently married and living with their spouse, 77.8% reported current sexual activity with their partner. Similar to what Guan (2004) found in Henan, however, the percentage reporting sexual activity did decline in the older age groups. Of those married and living with their spouse, 95.3% of the forty-somethings, 57.3% of the fifty-somethings, and 43.0% of the women in their sixties said that they were currently sexually active. This is still a much higher proportion than one would suspect from reading local clinical portrayals. Furthermore, these figures are probably an underestimate because none of the women in the survey who were never married or currently widowed or divorced admitted to being sexually active, although women told stories about other older women they knew who had a boyfriend who often came by the house to visit. Although a direct cross-national comparison is not possible at this time, these percentages among the Chinese women are not far from those found in a recent nationally representative sample of 1550 American women between the ages of 57 and 85 years old. In that study, 61.6% of the 57–64 year-old, 39.5% of the 65–74 year-old, and 16.7% of the 75–85 year-old women had had partnered sex in the past twelve months (Lindau et al. 2007).
Chinese clinical health education literature often assumes that older women are urban or highly educated. In contrast to these assumptions, analysis of my data on the married women in my sample (N = 360) show that rural married women were actually slightly more likely to report being sexually active than urban married women were; looking across the three age groups, sexual activity was reported by 98.1% of the rural versus 91.4% of the urban women in their forties, by 71.7% of the rural versus 63.2% of the urban women in their fifties, and by 47.6% of the rural versus 40.0% of the urban women in their sixties. Although I did not collect formal data on this,3 it may relate to what I observed informally that housing in the rural community was much more spacious with a larger number of rooms than that in the urban community. Analyzing across educational level, there was no clear cross-cohort relationship between sexual activity and years of schooling completed: among women in their forties, women with ten or more years of education were the least likely to be sexually active, but among women in their fifties, they were most likely to be sexually active. Among women in their sixties, women with four to nine years of education were less likely to be sexually active than women with three or fewer or ten or more years of schooling.
More Positive Than Negative Attitudes Concerning Later-Life Sex
Chinese women in my survey sample displayed more positive than negative attitudes concerning sex in later life. Only one-fifth of the women surveyed (N = 399) felt that women should stop having sex after menopause. Even among the women in their sixties, only a third agreed with this idea. This is a similar level to what Guan (2004) found, also in the mid-1990s, among 400 Chinese rural elderly men and women aged 55–88 years old in Henan Province; in that study, again, only a third of the subjects felt that sex among the elderly was not normal (122).
Looking across residency, there was only a very slight difference in attitudes between the rural and the urban women, so slight that it is uncertain whether it is a meaningful difference; 18.6% of the urban and 22.5% of the rural women agreed that a woman should refrain from sex after the end of menstruation. Women with fewer years of schooling were more likely to agree with postmenopausal abstinence than women with more schooling, but at each level of education, only a minority agreed with the need to stop having sex after menopause (32.5% with zero to three years, 22.1% with four to nine years, and 14.1% of women with ten or more years of schooling).
Attitudes Do Not Match Up Neatly With Behavior
While there is some correlation between attitudes toward sex in later life and behavior, there is not a neat correspondence. For example, even among the 50 post-menopausal women (n = 186) in my study who agreed with the statement that women should abstain from sex after menopause, a third nonetheless reported still being sexually active. In his analysis, Guan (2004) emphasizes the correlation, but I believe that the discrepancy is large enough that it should be emphasized that sexual attitudes are no guarantee of sexual behavior, and vice versa.
Sexual Liberation in Later Life More of a Western Priority
In the conversations I have had and the interviews that I have conducted, I found that although many Chinese women are aware of and agree with the abstract idea of sexual rights of elderly people, many women do not consider it a priority for them personally. For example, the same rural sexagenarian, R.M., talked in 2007, many years after her husband’s death, about how although she felt that elderly people had a right to be sexually active and get remarried if they wanted to, she herself didn’t feel a need for sex. Earlier in her life, she said, when she was younger and her husband was alive, she had a really high sex drive, but now she feels liberated precisely because she doesn’t feel a need for this kind of physical affection with a man at this time. In this respect, she said that Buddhism was a great source of health and happiness in her life, helping her to calm her previous cravings for large amounts of food and sex, bringing her body to a healthy weight and freeing her up to visit friends, travel, listen to meditational tapes, and join group exercises and enjoy a new and different stage of life.
Marital Relationship Not Necessarily Number One
Although familiar with the idea much repeated in the local clinical literature that the marital relationship should be elders’ top priority because it is the most important ingredient in life satisfaction for elderly people, many of the Chinese women I interviewed did not feel that it was the premier relationship for them. While some women did value their marital relationship as primary, for many women it was one of many important relationships, including those with their children and their close friends. In an interview in 2007, G.X., a rural school teacher in her fifties, went one step further to say that she and others she knew felt closer to their children than to their husbands. Although she described her marital relationship as very harmonious, she argued that “the relationships across the generations are closer than those between a husband and wife in midlife. In comparison to relations with your children, a husband and wife feel like unfamiliar separate parts, and not as close and affectionate as the relationships across the generations (linked by blood) in a family.” She said that she had heard of a saying in Chinese that nothing is deeper than the bonds between a husband and wife in midlife, but that she and the women she knew disagreed with it. Mere knowledge of such idealized statements or what things ideally “should” be like is not sufficient to change women’s attitudes or behaviors. The felt flow of their social experience and life histories is too powerful for that.
Sex Not Necessarily Crucial Factor in Later Life
Many of the Chinese women I interviewed who did feel that their marital relationship was very important often did not see sex as a very important part of their relationship. For example, in response to the interview question about how they and their husband showed each other their mutual feelings for each other, they were more likely to emphasize concrete everyday gestures of pragmatic thoughtfulness, like cooking their husband’s favorite dish or putting the most choice foods on their plate for them, or doing extra housework so that the spouse could rest if they weren’t feeling so well. Most women born before 1949 said that even when they were young, they didn’t practice the habit of doing the kind of romantic things recommended as foreplay or as other forms of non-penetrative sex by local clinical literature I had read, such as saying I love you, hugging, sitting close together, or holding hands (unless it was to steady each other’s gait). While some had tried adopting some of these new customs and some couples enjoyed these practices, many still felt them foreign, awkward, and unnatural. Not only were these kinds of behaviors not fostered for many women during the “feudal” pre-communist years, but they were also discouraged during the collectivist Maoist years.
Reasons Cited for Lack of Sex Life Among Married Older Couples
Rather than feeling constrained by traditional attitudes about sexual propriety, one of the most common reasons that abstinent married older Chinese women gave in conversation for being sexually inactive was that their overall relationship with their spouse was not very good from the start. For example, some said that their husband did not treat them with respect or, less often, that their husband beat them or let the woman’s mother-in-law beat them.4 These qualitative results are backed up by my survey data as well. Among the married women currently living together with their husband (N = 360), there was a strong relationship between level of marital satisfaction and sexual activity. Nine out of every ten women who rated their marriage as very happy were currently sexually active, and three out of four women who rated their marriage as “happy” were sexually active, but only six out of ten women who rated their marriage as “not very happy” currently had sexual relations with their partner. Although, oddly enough, in his research sample in Henan, Guan (2004) found no relationship with sexual intercourse per say, he did find that older women with a poor self-rated marital relationship were less likely to engage in sexually expressive activities, such as kissing, hugging or caressing, something about which I did not ask in my survey and only asked about later in qualitative interviews.
Among women who felt that they had satisfying relationships with their husbands, the most common reason they gave for sexual inactivity was that their husband had a health problem that made it risky or difficult to have sex, such as heart disease, history of stroke, or diabetes. This is similar to findings in the US that show that the primary factor in whether older women are sexually active is the presence and health of a partner, rather than attitudes toward sex (Hooyman and Kiyak 2011). While I did not ask formally about their husband’s health in the survey, women brought it up spontaneously as side comment during the survey and in informal conversations and interviews. Sometimes, though less often, women mentioned their own health as a factor. In the survey I did ask women about their own health, and in analyzing its relationship to sexual activity, there is a strong correlation between better self-rated health and being sexually active; 80.0% of women who rated their health as “good” reported that they were sexually active, while 72% who rated their health as “so-so” and only 56% who reported their health as “bad” reported such.
In side comments during the survey and in informal conversations, some women, who knew about vaginal lubricant, said that they felt that sex was still physically uncomfortable for them. Although I did not ask about lubricant use in the survey portion of the research, I did ask about vaginal discomfort (itching, pain, or burning) and about vaginal pain during sex. Of the married women living with their spouse (N = 360), 15% reported vaginal discomfort and 6.7% reported sex-related vaginal pain. Yet, 85.2% of the women with vaginal discomfort and 95.8% of the women with sex-related vaginal pain continued to be sexually active. The meaning of these results requires further investigation as does whether and how such women are using lubricant and foreplay, and to what degree untreated vaginal or urinary tract infection, sexually transmitted disease, or tissue changes related to diabetes are contributing to their vaginal difficulties.
While Chinese clinical education sources and Guan (2004) list the size of the family and number of generations in a household as a possible factor, the data I collected showed no relationship between these factors and the presence or absence of a sex life in the women surveyed. Contrary to clinical assumptions, married women with only one generation in the household were equally as likely to be sexually active as women with four generations living under one roof (about 50%). It was the women with households somewhere in between, with two generations or three generations living together, who had the highest rates of sexual engagement (16.3% and 25.0%, respectively). Very few households had only one (11.0%) or as many as four generations (1.0%) living together; most consisted of two (59.7%) or three generations (30.0%) in one home. Contrary to expectations in clinical education books, sheer number of household members was also not a good predictor of whether an older woman is sexually active. For the most part, married women living alone with their spouse in a 2-person household actually tended to be less likely to be sexually active (60.6%) than women with additional household members (81.3% in 3-person, 85.5% in 4-person, 75.4% in 5-person, 57.9% in 6-person, 66.7% in 7-person, 75% in 8-person, and 0% in the single 9-person household.)
Views on Consequences of Not Having Sex
Despite the weighty concerns raised in the Chinese clinical health education literature, although some women and their husbands had or were still enjoying some sex, the middle-aged and elderly Chinese women who I interviewed did not seem concerned about or convinced of serious personal, health, familial, or social repercussions of having little or no sexual interaction for themselves or their husbands in later life. Unlike the concern with lack of sex harming women’s appearance and figure that was cited in the clinical health education book by Xu and Cao (2008), when I asked over 400 Chinese women in the 1994 survey whether they worried about becoming unattractive when they got older (without mention of the cause), the majority of them said that they did not worry about that (94.2%), some joking that they were never good-looking in the first place. Overall, the women with whom I interacted in the 1990s and 2000s in Beijing did not appear to be consumed with worries over whether or not, or how often or how much, they had sex. However much they loved their deceased spouses, widows with whom I spoke said that they would rather not get remarried because they would prefer to be free to do what they felt like on an everyday basis rather than take care of another old man.
The findings from this research raise a number of interesting questions for practical application. Is the way in which many Chinese women are thinking and acting wrongly (false consciousness) and in need of intervention, or should gerontologists pay closer attention to what women are saying? Based on these results, it appears that abstract ideals from western biomedical sexology do not necessarily fit with the realities of all women’s lives, with regard to the quality of their relationship, what feels natural or comfortable to them, and which aspects of life they prioritize. So, what would be the implications of the latter view for patient education and service delivery in China? One important question we can ask ourselves is how useful is it for public health education to be focused on advocating an ideal that many women in China can only get behind in the abstract and feel that it doesn’t apply to their personal situation. In assuming an enlightenment model of the relationship between knowledge, attitudes, and behavior, the Chinese clinical educational literature is missing the point that change in knowledge and attitudes concerning ideal scenarios is not necessarily going to translate to behavioral change on the ground. The evidence shows that it was primarily practical exigencies and historically-shaped personal priorities that led women to behave as they did, more than it was lack of knowledge. Another issue would be that of how much can one re-socialize or re-enculturate generations of older women who viewed sex as not very important to them beyond reproduction and as not integral to emotional intimacy even in their earlier years. Researchers can ask if it is okay for older Chinese women to view their own sexual revolution as being liberated from sexual desire and obligations, as in the case of R.M.
I believe that findings like these underline two main points for practice. It is important not to assume that sex must be a priority and a crucial dimension of life satisfaction for all older women or men. Secondly, in giving examples of broadening the notion of sexuality beyond sexual intercourse (e.g., Hooyman and Kiyak 2011), we must be more aware that oft-cited examples like kissing, hugging, sitting close together, holding hands, or saying “I love you,” which seem like human universals, may not make sense personally or socially for women in some domestic situations, cultural contexts, or generational cohorts. In our zeal to give everyone freedom to have sexual interaction and romantic intimacy, it is important not to forget that an absence of sexual activity is not always due to ignorance or social repression; for some women and men, it reflects a desire for liberation from sexual obligations or an acceptance of changing circumstances or the informed choice of other social priorities.
Activity theory and the biomedical use-it-or-lose-it dictum come with the strong assumption that sexual interaction in the form of intercourse, kissing, hugging, or caressing must be a high priority in everyone’s life throughout the life course. However, if we take seriously life course theory, symbolic interactionism, the ecological development approach, practice theory, and the data presented here, then it becomes clear how important it is to emphasize that one size does not fit all cultures or all individuals. Instead, views and behavioral tendencies regarding later life sexual and erotic interaction vary by culture, generational cohort, and individual life histories and life circumstances. The knowledge or even endorsement of certain abstract beliefs, traditional or modern, cultural or scientific, does not mean that women will believe that it applies to their own personal situation. Furthermore, we must not forget that each person is balancing many competing priorities, and having sex or kissing may or may not be one of them.
So, how might public health educators work to change publically available materials to make them more compatible with Chinese women’s views of themselves and more applicable to their lives? When at the end of some of my interviews in 2007, I shared with women how some of the clinical health education materials claimed that older Chinese women were reluctant to have sex, be romantic, or get remarried due to being constrained by feudal attitudes and lack of scientific knowledge, not surprisingly they expressed annoyance at those sources for grossly underestimating Chinese women. One step in the right direction, I believe would be for a public health educator to write a new book with ordinary women involved in the process from the ground up. Statements about what is typical of Chinese women should be based on real hard social research data rather than on speculation, and the existence of variation from whatever is typical should be valued, rather than marginalized. In the true spirit of participatory action research, a core group of local women from the community to be studied should be consulted during the process of designing the research and in the process of writing and revising the book. Similar to the process followed by the Boston Women’s Health Collective which has produced successive editions of Our Bodies, Ourselves and Our Bodies Ourselves Growing Older, this process would then be repeated in future decades as new scientific knowledge is produced and new generations with different life experiences emerge with their own particular distribution of needs and priorities.
These Chinese clinical health education books are written in Chinese characters, an ideographic form of writing that is understood all across the nation of China, despite its many spoken dialects.
Chinese names are written surname first, followed by personal name, such as Xu Rongzhou.
Guan’s article shows that in his rural Henan study, 78.9% of the sample was married, and 78.9% of the sample had their own bedroom. He does not explicitly say that all of the married couples had their own bedroom, but it seems like so much of a coincidence that the percentage would be precisely the same, that either this is the case or perhaps the second figure is a typo.
Xu (1997) suspects that abuse of wives by husbands and mothers-in-law is based first in patriarchal, patrilineal, patrilocal Confucian culture that treated incoming wives as inferiors meant to serve their husbands and mothers-in-law by bearing sons and doing housework. Xu also suspects that the dehumanizing violence of the Cultural Revolution added another layer of brutality to domestic life. In analyzing survey data from Chengdu in Sichuan Province from prior to 1988 (N = 586), she found that about 13% of the sample of women said that their husband had kicked, hit, or beat them in the past decade.
This research was supported by the National Institute of Mental Health Predoctoral Award, the National Science Foundation Graduate Fellowship, the Committee on Scholarly Communication with China Graduate Fellowship, the Cora DuBois Dissertation Fellowship, the Dean's Fund Award for Faculty Research of the University of Vermont (UVM), and the Asian Studies Faculty Research Award funded through grants to UVM from the Freeman Foundation, the Parimitas Foundation, and the Lintilac Foundation.