Migration and child health in Moldova and Georgia

Following the collapse of the Soviet Union, approximately 21% of the Moldovan and 25% of the Georgian adult population had emigrated by 2010 (World Bank, 2011). Many of these migrants have children who often stay behind because of financial constraints and because of the transient nature of the work that migrants may encounter at their destinations. This process creates transnational families, those in which children and other family members experience a change in their living arrangements due to migration. Although the precise number of children who stay behind is not available, some sources estimate that approximatively 36 and 39% of all Moldovan and Georgian children, respectively, live in households where at least one member has migrated (Svintradze & Ubiria, 2007; Vanore, 2015). Over time, this situation has contributed to a normative discourse in Moldova and Georgia in which migration is associated with child abandonment and poor outcomes. In the face of this discourse, there is a need to better understand the relationship between transnational family formations and the well-being of children who stay behind.

Traditionally, research on parent–child separation has focused on the negative consequences that children may experience when separated from their parents because of extraordinary situations such as union dissolution or parental death (Amato & Cheadle, 2005; Corak, 2001). Not until recently scholars started to investigate how migration relates to child well-being (Cebotari, Mazzucato, & Appiah, 2017; Jordan & Graham, 2012; Wen & Lin, 2012) and child health (Cebotari, Mazzucato, & Siegel, 2017; Donato & Duncan, 2011; Gao et al., 2010; Stillman & McKenzie, 2012; Wen & Lin, 2012). In general, labor migration is found to result in large income gains that may help children to access better healthcare services at the place of origin (Amuedo-Dorantes & Pozo, 2011; Gerber & Torosyan, 2013; Kanaiaupuni & Donato, 1999). At the same time, the separation of children from migrant family members may affect children’s psychological (Mazzucato & Cebotari, 2017; Robila, 2012; Vanore, 2015), as well as physical health (Dreby, 2010; Stillman & McKenzie, 2012). To date, most studies of the effect of migration on children’s health have focused on Latin America, especially Mexico (Frank, 2005; Donato & Duncan, 2011; Kanaiaupuni & Donato, 1999), China (Gao et al., 2010; Wen & Lin, 2012) and Southeast Asia (Asis, 2006; Jordan & Graham, 2012), with some recent attention to African countries (Carling & Tønnessen, 2013; Cebotari, Mazzucato, & Siegel, 2017; Yabiku, Agadjanian, & Cau, 2012). Despite the surge of migration in former Soviet countries, there is almost no evidence concerning the relationship between migration and children’s health in the region.

Although research in other geographical areas provides substantial insight into the relationship between migration and child health, gaps remain. More often than not, studies rely on single-country analyses and employ simplistic notions of transnational family life associated with which parent migrates (mother, father or both) and whether or not they remit, thus hindering the effort to understand how multiple characteristics of transnational families affect children’s health. In particular, we know little about children’s health when different forms of parental absence coalesce, such as when parental migration is accompanied by divorce. What is more, studies often tend to focus exclusively on children in transnational care, without considering an appropriate control group of children in non-migrant households. This limits the opportunity to observe if variations in health are indeed due to migration.

This study builds on these gaps and attempts to understand the broader implications of labor migration on children; that is, to what extent does migration of household members relate to the health of children who remain in Moldova and Georgia? As such, we compare children in migrant and non-migrant households and aim to contribute to the literature in four ways. First, we investigate children who simultaneously experience migration and parental divorce, thereby adding marital discord as a transnational family arrangement when measuring children’s health. Second, we explore, on a large scale, the extent to which different forms of transnational family life relate to children’s health. We do so by employing different transnational characteristics such as the migrant or returned household types, the duration of migration, remittances, and parental migration and the caregiver type. Third, we include a gender perspective by investigating children’s health given these different forms of transnational family life. Recent studies have emphasized the need to distinguish between child’s gender when measuring children’s outcomes (Antman, 2011; Cortés, 2007; Vanore, 2015). Finally, we look at these characteristics in two places: Moldova and Georgia, thereby adding Eastern European cases to the literature. The comparison of two countries provides evidence of how migration associates with children’s health in a wider regional context. Overall, by engaging in this area of research, the results also address the dominant narrative of child vulnerability and poor well-being outcomes that pervades the discussion of children in migrant households in Moldova and Georgia.

Of those children with migrant parents, the greatest proportion had fathers abroad, with mothers as caregivers. Children with mothers abroad and in the care of fathers accounted for 7.07% in Moldova and 7.30% in Georgia. Furthermore, children with both parents abroad and cared for by grandparents represented 3.17% and 2.47% of the sampled populations in Moldova and Georgia, respectively. The proportion of children cared for by others (non-parental/non-grandparental) is insignificant in both countries. It is therefore mentioned here but not included in the final analysis.

Further, a short period of migration is more common than longer periods of migration in both countries. We also noted that more children live in migrant households who receive remittances in Georgia than in Moldova (27.89% compared with 17.84%). The percentages of children living in migrant households without remittances are 10.27% and 11.22%, respectively, in Moldova and Georgia. The relatively high proportion of children living in migrant households without remittances may reflect irregular remitting channels and the commonality of seasonal migration, which is less lucrative in terms of remittances.

In both countries, models show that children with migrant parents in a stable marital relationship are better off in terms of health than children in non-migrant households whose parents are also in a stable union. Notably however, children with divorced parents, whether in the country or abroad, do not appear to experience significantly poorer health than children of non-migrants. Based on this evidence, we reject Hypothesis 1. Further, interaction terms are included to examine whether the effects of different dimensions of parental absence vary by child’s gender. In Georgia, we find that being a girl reduces the overall positive effects of parental migration and a stable marital relationship on child health (Models 4–6, Table 2). This finding gives initial support to Hypothesis 6 and may point to persistent gender inequalities, described in Georgia (Vanore, 2015) and in other contexts (Cebotari, Mazzucato, & Appiah, 2017; Gao et al., 2010; Cortés, 2007; Parreñas, 2005).

In Moldova and Georgia, children are likely to be in better health when living in households in which relatives remain abroad for extended periods (Model 8, Table 3; Model 12, Table 4). There is no difference in reported health between children living in migrant and non-migrant households when migrantts remain abroad for shorter periods of time. Hypothesis 4 is thus rejected. However, Georgian girls were less likely to be assessed with better health when relatives stayed longer periods abroad. This finding provides an indication that while caregivers generally assess children’s health more positively, they nevertheless may view longer periods of absence as particularly harmful for girls.

To assess whether children’s reported health varies according to the migration status of parents, we regressed categories measuring parental migration and caregiver’s identity (non-migrant, migrant fathers and caregiver mothers, migrant mothers and caregiver fathers, and both parents migrants and caregiver grandparents) on the full set of controls (Model 9, Table 3; Model 13, Table 4). In both countries, children whose mothers are caregivers when fathers migrate are more likely to have better health than children living in non-migrant households. Again, gender differences are observed, with girls less likely to be assessed with better health when fathers migrate and mothers are caregivers in the two contexts in focus of this study. Notably, in both countries, no significant effects are observed when mothers migrate and fathers are caregivers or when both parents migrate and children are cared for by grandparents. Consequently, we reject Hypothesis 3.

The final part of the analysis considers whether the presence or absence of remittances is linked to children’s health. In Moldova, results show no differences in the health assessments of children in transnational and non-transnational care when households receive or do not receive remittances (Model 10, Table 3). In Georgia, however, children in households who receive remittances are more likely to be assessed with better health (Model 14, Table 4). This evidence gives partial support to Hypothesis 5. In Georgia, there is also evidence that girls in migrant households who receive remittances are generally less likely to have better health. In this country context, girls may benefit less from improved material well-being of households from remittances.

The separation of children from family members because of migration is increasingly common in developing countries such as Moldova and Georgia. As migration unfolds, there are concerns that living in transnational care may result in negative consequences for children. Although the migration of household members may come at the cost of separation and loss, it can also bring advantages, such as the potential for development through remittances. The empirical evidence to date, however, is mixed, with no studies looking at the health of children in transnational care in Moldova and Georgia. In line with the emergent field of transnational family studies, this analysis adds four reflections to the current scholarship. First, this study is among the first to distinguish between migration and marital discord as forms of separation when assessing children’s health. Second, the life of children in transnational care is complex and we acknowledge this complexity by investigating different transnational family forms in relation to children’s health. Third, our findings integrate a gender perspective by comparing boys and girls when measuring the outcome. Finally, this study adds evidence from two Eastern European contexts to a body of research that is scarcely represented in the region. We discuss these contributions below.

The findings of this study contribute to an emergent stream of research that looks at migration and marital dissolution and how this relation may affect children. Previous research found negative health outcomes for children when parents are abroad and divorced (Carling & Tønnessen, 2013; Cebotari, Mazzucato, & Siegel, 2017). Our study runs counter to such an assumption and shows that children whose parents are divorced and away do not have differing health from that of children in non-migrant households. However, this finding does not necessarily indicate that the divorce narrative in the context of migration is totally misplaced. Over the past decade, the boom in communication technologies has made transnational communications easier for parents and children alike, with positive effects for child well-being, including health (Asis, 2006; Nobles, 2011; Wen & Lin, 2012). It may be that phone and online interactions with children increase the chances that divorced parents stay engaged with specific aspects of children’s lives, including decisions concerning children’s health. Indeed, one study notes that children’s health is one of the most frequent subjects of conversation when Moldovan migrant parents, either married or divorced, communicate with family members back home (UNICEF, 2008). In this sense, the involvement patterns of divorced migrant parents may not be far from the involvement patterns of migrant parents who are in a stable marital relationship. More attention should be given in future research to specifics of parental involvement in child rearing when migration is marked by marital tensions.

The second contribution of this study is towards the analysis of different transnational forms of living in relation to children’s health. We found that regardless of the transnational setting, the overall relationship between migration and children’s health is positive or neutral. This finding suggests that more often than not, the benefits of migration overshadow the potential costs of separation. Such benefits are reflected in children’s health because this outcome is closely linked to household’s resources, as described by research in other contexts (Amuedo-Dorantes & Pozo, 2011; Donato & Duncan, 2011; Gerber & Torosyan, 2013; Stillman & McKenzie, 2012). However, depending on the specifics of transnational care, there are nuances on how migration relates to children’s health. In this study, children in returned migrant households, compared to children in non-migrant households, fared better or in no differing way in both countries. Return migration is beneficial for children because it encourages the transfer of norms and brings in additional human capital to the household (Lindstrom & Muñoz-Franco, 2006), especially when the returnee is the child’s primary caregiver (Vanore, 2015). Within the context of transnational migration, we also questioned whether the care arrangement linked to maternal and/or paternal absence is associated with decreased health for children. Other studies found more negative outcomes for children when mothers migrate (Cortés, 2007; Jordan & Graham, 2012; Parreñas, 2005; Schmalzbauer, 2004). Our findings run counter to these studies and show that maternal migration and the absence of both parents, when parents are in a stable marital relationship, do not result in poorer assessments of children’s health. It is important to note, however, that we specifically looked at who the caregiver of the child is when mothers and/or fathers migrate – something only a handful of studies have done before (e.g. Cebotari, Mazzucato, & Appiah, 2017; Mazzucao & Cebotari, 2017; Vanore, 2015). When fathers migrate and children are cared for by mothers, positive assessments of children’s health are found in Moldova and Georgia. When both parents migrate, data show that grandparents almost always assume the role of children's primary caregivers. Maternal and grandparental care was previously observed to play a key role in the coping process of Moldovan and Georgian children in that it was more likely to result in adequate nutritional intakes and proper access to healthcare services for children (Badurashvili & Nadareishvili, 2012; Robila, 2012; Vanore, 2015). Overall, our findings contradict the current narratives in Moldova and Georgia that characterize children of migrants as abandoned and instead emphasize ways in which household members stay engaged, as caregivers, with children back home. Policy initiatives that cater to children of migrants would do well to inform families on the advantages of care by a close family member and provide state subsidies for caregivers who stay in the country of origin.

This study also examines children’s reported health in relation to the duration of migration – a dimension that has proven important in transnational family research in other contexts (Donato & Duncan, 2011; Jordan & Graham, 2012; Vanore, 2015). Findings show that, over time, children in migrant households may develop resilience and adapt to changes in household configurations involving longer periods of migration. A long period of absence may indicate a stable labor residency abroad, better pay and stronger channels for remittances. These characteristics have been long praised by scholars for their potential to positively influence the development of children (Abrego, 2009; Amuedo-Dorantes & Pozo, 2011; Donato & Duncan, 2011; Gerber & Torosyan, 2013). Drawing on these studies, we also questioned whether the availability of remittances could be indeed a factor that positively associates with children’s health. Our findings show no differing health for children in migrant households compared to children in non-migrant households, when households receive remittances or not. This finding indicates that economic benefits from migration do not impact on the dimension of health measured here, and therefore provide no support to the claim that material gains from migration may be an influential factor in relation to children’s health in Moldova and Georgia. One plausible explanation for the absence of a remitting effect on reported health hinges on the social protection systems in the two countries. Specifically, both Moldova and Georgia provide free basic healthcare services to children, irrespective of the location of household members or the socio-economic status (Rukhadze, 2013; UNICEF, 2008). This largely reduces the need to pay for basic healthcare for children. Our data (not shown) support this assumption and reveal that only 1.3 and 1.4% of Georgian and Moldovan migrant households, respectively, had to use remittances to cover medical costs for children. Free access to vaccinations, doctors and basic medical facilities may level-up the general health of children in the country, rendering the effects of remittances insignificant. Another explanation relates to the remitting behavior of migrants with regard to health. Our data (not shown) indicate that 10.5 and 9.4% of Moldovan and Georgian migrant households, respectively, received medical provisions in cash or in-kind from migrants abroad. This evidence may suggest a contextualized remitting behavior, where households request and receive from migrants abroad medical provisions and additional cash when there is a medical emergency in the family. Because the analysis is based on cross-sectional data, we are unable to account for the time-varying component of this assumption. Future research involving panel data may shed light on the extent to which health outcomes benefit from migrants’ remitting behavior. Because our results may reflect the access to healthcare or a specific remitting behavior, or both, we caution readers to keep this in mind when assessing the results.

A third contribution of this study is to the transnational family literature in that we employ a gender perspective when measuring the health of children in transnational care. We find, similar to studies in other contexts (Cebotari, Mazzucato, & Appiah, 2017; Cortés, 2007; Gao et al., 2010; Antman, 2011), that Moldovan and Georgian girls in transnational households are less likely to have better reported health. The effects of various transnational characteristics and the size of the net relationships balance out in the two contexts, although the gender differentials seem to be slightly more evident in Georgia than in Moldova. Specifically, Moldovan girls in migrant households and girls with migrant fathers and cared for by mothers were more likely to have poorer reported health. In comparison, Georgian girls in migrant households, girls who were cared for by mothers when fathers were abroad, girls with household members remaining abroad for longer periods, and girls living in migrant households who received remittances were more likely to be assessed with poorer health. These findings merit special attention. Previous research has documented that both Moldova and Georgia are riddled by traditional gender norms that favor males (Badurashvili & Nadareishvili, 2012; UNICEF, 2008; Vanore, 2015). When family members migrate, households generally redistribute remaining work among those who stay behind. One study observed that Moldovan girls performed more physical chores at home than boys and also performed more chores when the family’s economic situation was improved by remittances (Cortés, 2007). Another study noted that Moldovan girls were “highly affected” by the extra physical work at home, compared with boys, who were only “moderately affected” by chores when family members migrate (UNICEF, 2008). In Georgia, Tchaidze and Torosyan (2010) revealed that females in migrant households were more likely than females in non-migrant households to assume traditionally male tasks which they may not have skills or the physical strength to perform properly. In addition, Georgian girls were found to be vulnerable to verbal abuse from caregivers, which subsequently affected their psychological health (Vanore, 2015). This evidence suggests that the relation between gender, migration and children’s health is not simple. Additional research is warranted to examine the particularities of gender with regard to health in these two contexts.

A final contribution of this study is towards the inclusion of two Eastern European countries to a body of literature dominated by research in Latin America and Asia. Overall, we find that children in transnational households are doing better or in a no differing way than children in non-migrant households. The consistency of results in both Moldova and Georgia suggest a wider regional pattern. What is especially noteworthy is that while we find advantages for children of migrants in Moldova and Georgia, there is also evidence of a more universal benefit from migration for children in a wider global context. Studies in Latin America (Amuedo-Dorantes & Pozo, 2011; Donato & Duncan, 2011; Frank, 2005; Lindstrom & Muñoz-Franco, 2006), Southeast Asia (Asis, 2006; Jordan & Graham, 2012) and Sub-Saharan Africa (Carling & Tønnessen, 2013; Cebotari, Mazzucato, & Appiah, 2017; Yabiku et al., 2012) found contextually-based evidence that children in transnational care are not necessarily disadvantaged in health outcomes when family members migrate. Yet, under certain circumstances, as this study shows, girls in transnational care may have poorer health compared to boys. This evidence is indicative of the hardship and loss that some children may experience when family members migrate (Dreby, 2010; Parreñas, 2005; Schmalzbauer, 2004; Wen & Lin, 2012), although only a handful of studies were able to distinguish the results by gender (Antman, 2011; Cortés, 2007; Gao et al., 2010). To the extent this study is suggestive of a differential health effect of migration by gender, more cross-regional evidence from matching data sources is needed.

This study is not without limitations. One limitation concerns the cross-sectional nature of our data. Because data capture snapshot reports, the results imply correlations and not causation, and we caution readers to consider this difference when assessing the findings. Another limitation relates to the use of caregiver-reported subjective health. Previous studies found that caregivers sometimes under-report children’s outcomes (Cebotari, Siegel, & Mazzucato, 2016; Jordan & Graham, 2012). Future research is advised to include two comparable sets of questions to be answered by both caregivers and children to increase the reliability of assessments. A final limitation concerns the complexity of factors when analyzing comparative data. Despite employing a number of different transnational characteristics, we could not identify all factors that describe the life of children in transnational care in the two countries. It was thus not possible to conduct analysis on specifics of migration such as multiple migration spans, the frequency of contact, the country of destination, children’s ages at separation, the type of employment, or the residency status abroad. Future analyses must detail these factors in relation to children’s health.

Despite these limitations, this study is a rare opportunity to consider how children in origin countries experience transnational migration with population-representative evidence. Overall, the findings suggest that children’s health is more sensitive to proximate characteristics such as gender than it is, perhaps, to migration. Future research based on different transnational factors and employing longitudinal data in different contexts will be helpful to further test this line of inquiry.