Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States of America.
Department of Gender Studies, University of California Los Angeles, Los Angeles, CA, United States of America.
PLoS One. 2021 Dec 2;16(12):e0260219. doi: 10.1371/journal.pone.0260219. eCollection 2021.
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.
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.
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.
移民留下的妇女是一个独特且不断增长的群体，但作为移民和发展背景下的关键角色，她们的研究仍然不足。本研究利用孟加拉国一项独特的生命纵向调查——Matlab 健康和社会经济调查，考察了配偶移民对妇女获得医疗保健的影响。本研究的目的是评估实际获得医疗保健的情况（当妇女需要医疗保健时，她们是否实际获得医疗保健），并考虑与移民相关的特定宏观结构、倾向和资源障碍。
在 3187 名目前已婚的妇女中，我们使用多元逻辑回归和多项逻辑回归模型进行估计，控制了广泛的基线社会人口因素，这些因素可追溯到 1982 年。我们的分析还控制了选择效应，并探讨了配偶移民影响妇女获得医疗保健的两种机制，即汇款和与配偶频繁联系。我们发现，与配偶留在孟加拉国的妇女相比，有移民配偶的妇女缺乏所需医疗保健的可能性约为一半（预测未获得所需医疗保健的概率为 11.7%比 21.8%，p<0.001）。获得医疗保健的改善（留守妇女缺乏医疗保健的逻辑回归系数-0.761，p<0.01）主要是通过减少在国外的配偶的妇女的医疗保健经济障碍来实现的。
即使考虑到选择移民家庭的因素，国际移民的妻子在获得医疗保健方面也明显更好。虽然总体情况是由于减少了医疗保健的经济障碍，移民对获得医疗保健的影响是积极的，但结果也显示出家庭相关障碍的增加，例如不允许家庭成员获得医疗保健或独自前往医疗机构，这表明，移民对留守妇女的一些好处可能因性别化的家庭结构而被削弱。
