Men’s Labor Migration and Women’s Health and Mortality in Rural Mozambique Victor Agadjanian , University of Kansas Sarah R. Hayford , Ohio State University Natalie A. Jansen , University of Kansas Abstract As in many other parts of the world, labor migration is widespread and growing in southern Africa. Yet the economic outcomes of migration diversify, and so do its consequences for the wellbeing and health of non-migrating household members. We use data from a longitudinal project conducted over eleven years in rural Mozambique to examine the association between men’s labor out-migration and their non-migrating wives’ self-rated health and mortality. The analyses detect no significant differences when comparing non-migrants’ wives to migrants’ wives in the aggregate but point to instructive variation among migrants’ wives according to the economic success of migration. Specifically, women married to unsuccessful migrants are less likely to report being in good health and have higher mortality risk over the project span than women married to successful migrants. These patterns generally persist whether migration success is defined based on reported remittances or on the wife’s subjective assessment and are impervious to the addition of individual and household-level controls.
Introduction Labor migration has been shown to improve non-migrating household members’ health and wellbeing by generating remittances that increase household food supply and access to health care (Adams & Page 2005; Adams & Cuecuecha 2013; Böhme et al. 2015; Frank & Hummer 2002; Gupta et al. 2009; Hamilton et al. 2009; Ponce et al. 2011). However, the migrant’s absence from the household may also increase psychological strain, depressive symptoms and other health impairments among non-migrating adult household members (e.g., Adhikari et al. 2011; Chen et al. 2015; Huang et al. 2016; Lu 2012; Lu et al. 2012; Menjívar & Agadjanian 2007; Nobles et al. 2015). In addition, considerable research has documented an association of men’s migration with greater perceived and actual risks of HIV and other STIs among their left- behind wives (Agadjanian et al. 2011; Agadjanian & Markosyan 2016; Agadjanian et al. 2013; Hirsch et al. 2007; Sevoyan & Agadjanian 2010; Weine & Kashuba 2012). In this study we use data from a longitudinal project in rural southern Mozambique to examine the relationship of men’s labor migration with their marital partners’ health and mortality while focusing in particular on the variation in the economic impact of migration. As in many parts of the world, labor migration, both internal and international, is widespread and growing in southern Africa. Most international labor migration flows in the region are directed toward the Republic of South Africa (RSA) and originate from its poorer neighbors, including the Republic of Mozambique. Given its proximity to RSA and volatility of its rural economy, the southern part of Mozambique has traditionally been a major source of primarily male labor migration, and this migration continues today. However, in recent times this labor migration has increasingly shifted from highly regulated employment mainly in the South African mining industry to less formal and temporary work. Accordingly, the economic 1
outcomes of migration and the impact of migration on sending households, which is largely shaped by economic remittances, have also become more diverse. Our analyses seek to account for this growing diversity of migration outcomes. Conceptualization and hypotheses To the extent that migration-generated remittances are used for food or health care needs and enhance the household overall economic security, we would expect a positive association between migration and the health and well-being of members of the sending household that varies depending on the level of remittances. By the same token, migration that supplies the household with stable resources should be associated with lower mortality risks of non-migrating members. In contrast, migration that does not produce a steady flow of remittances may be detrimental to health and mortality outcomes of the household members, as such migration imperils the household’s economic security, thus further aggravating the social and psychological consequences of the migrant’s physical absence from the household. Our approach builds upon previous studies that have illustrated the importance of accounting for the diversity of migration economic outcomes. For example, Yabiku, Agadjanian, and Cau (2012) found that migration was associated with lower mortality among migrants’ left-behind children in rural Mozambique, but that this association was only present for economically successful migrants. Other studies, including those carried out in the same context as the present analysis, also show that the effects of migration on health and general wellbeing of non- migrating household members vary according to the economic returns of migration to the households (e.g., Agadjanian and Hayford 2017; Agadjanian, Arnaldo, and Cau 2011; 2
Agadjanian, Yabiku, and Cau 2011, Lu 2010; Lu et al. 2012; Yabiku and Agadjanian 2017; Yabiku, Agadjanian, and Cau 2012). While the economic returns from migration to the household are critical for its members’ wellbeing and health, migration may affect these outcomes through other pathways. Thus, migrants’ exit from the community may expose them to greater risks of sexually transmitted diseases, including HIV, especially in settings of high HIV prevalence, which may, in turn, affect their marital partners back home (Agadjanian et al. 2011; Agadjanian & Markosyan 2016; Agadjanian et al. 2013; Hirsch et al. 2007; Sevoyan & Agadjanian 2010; Weine & Kashuba 2012). Migrants’ prolonged absence from the household may also lead to heightened anxiety, stress, and depression among their non-migrating partners and other household members (e.g., Adhikari et al. 2011; Chen et al. 2015; Huang et al. 2016; Lu 2012; Lu et al. 2012; Menjívar & Agadjanian 2007; Nobles et al. 2015). Yet, as Lu et al. (2012) argued in their study of rural China, migrant remittances may partly offset the negative effects of migration on non-migrant household members’ mental health. Finally, migration may lead to the dissolution of migrants' marital unions, exposing their partners, children, and other family members to economic and social hardships and, by extension, heightening their health vulnerabilities. However, again, as Agadjanian and Hayford (2017) showed in Mozambique, marital unions of economically successful migrants are less likely to dissolve than those of unsuccessful ones. Importantly, because labor migration is typically a long-lasting state, and because improved nutrition and improved medical care may have long-term impacts, the impact of migration on health of non-migrants may accumulate over time. However, the cumulative effects of migration on health of non-migrating household members are not well understood largely because adequate longitudinal data to capture and measures these effects are often lacking. Arguably, this 3
knowledge gap is especially critical for the understanding of health implications of migration for migrants’ non-migrating marital partners, who typically experience the most direct impact both of the economic returns to migration and of the social and emotional disruptions and strains caused by the departure and prolonged absence of the migrant. In this study, we seek to fill this gap in the literature by investigating the association between men’s migration and their marital partners’ self-rated health and mortality in rural southern Mozambique. For both outcomes, we compare wives of migrants and non-migrants, but we also seek to capture the effect of diverging economic fortunes of migrant households. Following the previous research that highlighted the importance of this divergence, rather than a simple migrant vs. non- migrant dichotomy, we contrast self-rated health and mortality of women whose husbands have been economically successful migrants with those of women married to economically unsuccessful migrants. Importantly, migration success is defined here from the standpoint of the migrant’s household in the community of origin, i.e., the actual or perceived impact of migration on the household wellbeing, rather than the absolute amount of migrant earnings. Guided by previous work (Agadjanian, Arnaldo, and Cau 2011; Yabiku, Agadjanian, and Cau 2012), we conceptualize migration success both objectively, in terms of remittances received by the migrant’s household, and subjectively, i.e., in terms of the assessment of the impact of migration on the household wellbeing by non-migrating wives. We formulate and test two general hypotheses. First, we hypothesize that women married to unsuccessful migrants will have worse self-rated health that those married to successful migrants, net of other factors (Hypothesis 1). Second, we hypothesize that mortality risks will be higher among wives of unsuccessful migrants compared to successful migrants’ wives (Hypothesis 2). 4
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