Effects of spousal migration on access to healthcare for women left behind: A cross-sectional follow-up study

Abstract

Background Women left behind by migration represent a unique and growing population yet remain understudied as key players in the context of migration and development. Using a unique longitudinal survey of life in Bangladesh, the Matlab Health and Socioeconomic Surveys, we examined the role of spousal migration in healthcare utilization for women. The objective of this study was to assess realized access to care (do women actually get healthcare when it is needed) and consider specific macrostructural, predisposing, and resource barriers to care that are related to migration. Methods and findings In a sample of 3,187 currently married women, we estimated multivariate logistic and multinomial regression models controlling for a wide range of baseline sociodemographic factors measured as far back as 1982. Our analyses also controlled for selection effects and explored two mechanisms through which spousal migration can affect healthcare utilization for women, remittances and frequent contact with spouses. We found that women with migrant spouses were approximately half as likely to lack needed healthcare compared to women whose spouses remained in Bangladesh (predicted probability of not getting needed healthcare 11.7% vs. 21.8%, p<0.001). The improvements in access (logistic regression coefficient for lacking care for left-behind women -0.761 p<0.01) primarily occurred through a reduction in financial barriers to care for women whose spouses were abroad. Conclusions Wives of international migrants showed significantly better access to healthcare even when accounting for selection into a migrant family. While the overall story is one of positive migration effects on healthcare access due to reductions in financial barriers to care, results also showed an increase in family-related barriers such as not being permitted to get care by a family member or travel alone to a facility, indicating that some of the benefits of migration for women left behind may be diluted by gendered family structures.

The effects of spousal migration on perinatal healthcare utilization

“…Covariates were selected based on their known linkage to migration within the household and use in studies that have used the same data [ 19 ]. For example, out-migration to internal and international destinations in MHSS2 was higher among younger male cohorts.…”

“…Receipt of remittances was measured using a binary item in which respondents indicated whether they had received money from their spouse in the past year (0 = no, 1 = yes). Receipt of remittances was measured using a binary measure rather than a continuous measure of monetary value since values could vary throughout the year and remittances received in prior years could be used for perinatal health care (West et al, 2021). Finally, respondents reported spousal communication through a measure that assessed how often they were in contact with their spouse (by telephone, text message, email or post) in the past year (0 = less than daily, 1 = daily).…”

“…For example, some studies report that left-behind women exhibit higher levels of stress, depression, and anxiety [12][13][14][15][16][17] and engage in lower levels of communication with their partners on issues of family planning and childbearing [18]. However, studies conducted in Bangladesh and Sub-Saharan Africa found that spousal migration was directly associated with increased rates of general and maternal and child healthcare utilization [19,20]. Changes in healthcare utilization among leftbehind women may relate to changes in a woman's positionality in the household after the migration of a spouse.…”

“…Family members can also influence left-behind women's healthcare utilization [19]. For example, compared to women who live alone, women who live in a multigenerational home (i.e., with their in-laws or natal family) may have difficulty obtaining permission to travel to health facilities alone or face pressure to have a home birth [29,[34][35][36][37][38][39].…”

Long-term Consequences of Men’s Migration for Women’s Well-being in a Rural African Setting

“…Thus, a considerable and growing body of research has looked at the effects of labor migration on the physical health of nonmigrating adult household members. It has been argued that the economic and social resources generated through migration lead to improvement in left-behind spouses’ and other household members’ physical health, and corresponding reduction in mortality, by enhancing food security and facilitating access to and utilization of health care (e.g., Amuedo-Dorantes and Pozo 2011; Green et al 2019; Kan 2021; Lopez-Cevallos and Chi 2012; Lu 2013; West et al 2021; Zezza et al 2011). However, some studies have questioned the benefits of migration for nonmigrants’ physical health.…”