A common view within academia and Indian society is that older Indians are cared for by their families less than
in the past. Children are a key source of support in later life and alternatives are limited, therefore declining
fertility appears to corroborate this. However, the situation may be more complex. Having many children may be
physiologically burdensome for women, sons and daughters have distinct care roles, social trends could affect
support provision, and spouses also provide support. We assessed whether the changing structure of families has
negatively affected health of the older population using three cross-sectional and nationally representative
surveys of India’s 60-plus population (1995–96, 2004 and 2014). We described changes in self-rated health and
family structure (number of children, sons, and daughters, and marital status) and, using ordinal regression
modelling, determined the association between family structure and self-rated health, stratified by survey year
and gender. Our results indicate that family structure changes that occurred between 1995-96 and 2014 were
largely associated with better health. Though family sizes declined, there were no health gains from having more
than two children. In fact, having many children (particularly daughters) was associated with worse health for
both men and women. There was some evidence that being sonless or childless was associated with worse health,
but it remained rare to not have a son or child. Being currently married was associated with better health and
became more common over the inter-survey period. Although our results suggest that demographic trends have
not adversely affected health of the older population thus far, we propose that the largest changes in family
structure are yet to come. The support available in coming years (and potential health impact) will rely on
flexibility of the current system