1. The Impact of Male Migration on Women’s Reproductive Health Decisions
Dominick Shattuck, PhD | Sharada Wasti, PhD | Nokafu Sandra Chipanta, MPH | Naramaya Limbu, MS
Institute for Reproductive Health, Georgetown University (IRH)
Background
Understanding Migration in Nepal
Migration’s Impact on Women
Family Planning (FP) and Left Wives
Nepal has a long history of migration.
Migrants aim to improve life for their families.
Until 1981, India was the primary destination for most migrant workers
In 2011, 7.2% of Nepal population lived abroad
There are 1.92 million migrant Nepalese, with migrants coming from all districts of the country
50% of Hill Dalits and 46% of Muslim households have a migrant family member
Gap in literature to understand the gender dynamics of migration on:
Power relationships
Changing roles of men and women
Impact on children
Women with migrant husbands are referred to as “left wives.”
Migration is linked to increased discontinuation of modern FP
Left wives take on almost all of the workload
Migration alters exiting norms associated with autonomy and decision-making power (Lokshin and Glinskaya, 2009)
Research suggests that migration negatively impacts left wives’ health, education, and child wellbeing
FP use is three times higher among married women who live with their husbands (62%) than left wives (23%)(NDHS, 2012).
Left Wives discontinue FP…
To avoid rumors about infidelity
Due to low frequency of coitus and reduced risk of pregnancy
Due to increased demand for children as a source of labor and support
The Study
OBJECTIVE: Describe the sexual and reproductive health profile and decision-making dynamics of women with migrant husbands in Nepal
STUDY DESIGN & METHODS
Examination of baseline data from longitudinal, quasi-experimental study assessing the association between increased fertility awareness (FA) and increased family planning uptake in Nepal.
Average CPR (42%) across the five study districts was used to estimate a sample size of 162 women per cluster to detect a 10% increase in CPR among women years old
2,430 married women extracted from the data set (1,123 married women, 485 left wives)
All study tools were pilot tested
Data was collected using mobile tablets and uploaded daily to secure server
Approved by Georgetown and US and Nepali IRB approval received
Study Results
KEY: WOMEN WITH MIGRANT HUSBANDS OTHER MARRIED WOMEN
Demographics
Family Planning
Access to Health Services
Financial Autonomy
Spousal Communication
Health Seeking and Spending Autonomy
Using modern FP method
8.9%, 29.5%
Wish to become pregnant in the next year
36.5%, 26.1%
Intend to use FP method in next 6 months
28.2%, 40.6%
Discussed using FP with husbands
37.7%, 53.4%
Both groups reported going to the health facility for children’s medical care and FP counseling similarly
Although women with migrant husbands were less likely to interact with Female Community Health Volunteers (FCHVs)**, they were more likely to interact with clinic outreach staff*.
FCHVs are a constant presence in the communities, while clinic outreach staff work in the communities during specific campaigns (i.e.; malaria, vaccinations, etc.)
485 women with migrant husbands
638 other married women
Mean age: 21.5 years (SD 2.5), no differences between groups
Women with husbands at home were more likely to have 2 or more children
Statistically significant at p < 0.01, ** Significant at p <0.05
Relationship Strength
In both groups, more than 90% of women reported agreeing with their husband on the number of children they will have.
About half of the women are included in health care seeking behaviors (joint and respondent)
Conclusions
The reproductive health decisions of couples in this study were shaped by the social and gender normative composition of their households.
Fertility desires differ between the two groups of young women. How do their reproductive health needs of Left Wives change when reunited? Need to learn more about how fertility desires of women change over time.
In some families, in-laws assume decision-making power in the husbands’ absence, which can negatively impact health decisions and compromise women’s autonomy.
Programmers should work with in- laws and husbands to address potential negative gender and power dynamics within homes that limit women’s autonomy over her health and financial choices. 2 3 4 1