Study settings: Moldova and Georgia
Following the Soviet Union’s collapse in 1991, Moldova and Georgia became independent countries and began a difficult transition to democracy and market economy that continues relatively unabated today. In both countries, the economy and living standards declined steadily, especially during the first decade following independence. At the turn of the century, approximately 71% of Moldovans and 60% of Georgians were living below the national poverty line (Vanore, 2015). A number of factors contributed to this decline, including political instability, the loss of subsidies and access to the markets of the Soviet era, hyperinflation and a dramatic drop in economic outputs of both countries. These problems were amplified by separatist movements and the outbreak of civil wars in the Transnistrian region of Moldova and in Abhazia and South Osetia regions of Georgia. Over the last two-and-a-half decades, active and passive forms of warfare have persisted and there is yet to be reconciliation between the separatist regions and central state authorities.
The combination of conflict and economic difficulties encouraged sustained out-migration flows from Moldova and Georgia. The main destinations of Moldovans are Russia, Ukraine, Italy, and Romania while Georgian migrate mostly to Russia, Greece, Turkey, the United States, and Germany (World Bank, 2011). The majority of Moldovans and Georgians who migrate are working age, skilled individuals: this is true for both men and women although more men migrate eastwards to Russia whereas more women migrate westwards to meet the growing demand for home and elderly care services in the European Union countries (Labadze & Tukhashvili, 2013; UNICEF, 2008).
In Moldova and Georgia, family systems are characterized by norms in which the nuclear or the extended family are responsible with the daily care of children whose parents migrated. Although the function of care stays within the family, there are some nuances worth noting. Specifically, Moldovan households are more nuclear whereas Georgian households are often multigenerational (Vanore, 2015). It is also more common for children in Moldova to experience the migration of both parents, which results in more cases of Moldovan children who live without an adult caregiver or who often move to another residency to stay with a family relative (Cebotari, Siegel, & Mazzucato, 2016; UNICEF, 2016).
The absence of family members and Children’s health
Money and time are crucial resources that family members can provide for children (Suárez-Orozco, Todorova, & Louie, 2002). When family members migrate, the stress and distance associated with their departure may have a deleterious effect on the psychological health (Mazzucato & Cebotari, 2017; Vanore, 2015) and the physical health (Dreby, 2010; Stillman & McKenzie, 2012; Wen & Lin, 2012) of children in transnational care. However, children may also be better off when household members migrate because migration generally yields economic benefits such as remittances that can be used to invest in children’s health (Amuedo-Dorantes & Pozo, 2011; Donato & Duncan, 2011; Gerber & Torosyan, 2013). Thus, there may be advantages and disadvantages to children’s health when household members migrate.
The main consequence of migration for children is that they often live separated from one or both parents for an extended period of time. Importantly however, migration is not the only reason parents and children may be separated, and other events like divorce factor in as well. Traditionally, the consequences of union dissolution have been analyzed by family studies in Western contexts, revealing the emotional and behavioral disadvantages for children living in single-parent families compared with children in two-parent families (Amato & Cheadle, 2005; Corak, 2001). Until recently, the effects of parental divorce in the context of migration have received little scholarly attention. In one of the few studies that examines marital relationships in the context of migration, Nobles (2011) observed that separation because of divorce affects Mexican children more negatively than separation because of migration. In Ghana, Mazzucato and Cebotari (2017) found deleterious psychological health among children whose parents migrated and were divorced but not when parents migrated and were together. Similarly, in Ghana and Nigeria, children of divorced migrant parents were less likely than children in non-migrant families to rate their health as good (Cebotari, Mazzucato, & Siegel, 2017). Furthermore, in Malawi, Carling and Tønnessen (2013) observed that children living with both parents and children with migrant fathers in stable relationships had better physical health and nutritional outcomes than children with divorced parents.
In general, then, migration and divorce seem to pose different experiences for children, and the two combined often reflect on children’s health more negatively. The different outcomes associated with migration, divorce, or both are likely explained by specifics in these forms of absence. Intrinsically, migration is often motivated by a desire to improve the lives of children and of other family members who stay at origin (Nobles, 2011). In cases of divorce however, the well-being of children does not always motivate the intention to migrate. For instance, migration was found to be a way to escape a problematic marriage for some Filipina wives (Constable, 2003). Migration also has the potential to strain marital relationships (Pribilsky, 2004), especially when women migrate alone, or when migrant spouses have different ethnic backgrounds (Kulu & González-Ferrer, 2014). When migration and divorce coalesce, parents may lack the necessary resources to invest in children, particularly when the divorced parents re-marry and have children in those new unions (Dreby, 2010). These processes were found to affect children’s living arrangements, including the ability to adapt to new authority figures (Suárez-Orozco et al., 2002) and to the loss in the remitting flow from divorced migrant parents (Abrego, 2009). The dynamics of living with migration and divorce point to the need to study the effects of marital dissolution on children in transnational care.
Most large-scale studies on transnational families restrict their focus to children whose migrant parents are in a stable union in order to isolate the sole effects of migration on children’s health (Donato & Duncan, 2011; Wen & Lin, 2012). These studies show that the migration of household members is often a household strategy to increase the welfare and well-being of members who stay behind. A stream of research also looks at the economic benefits of migration and shows that remittances sent home are often used to improve children’s health (Asis, 2006; Donato & Duncan, 2011; Frank, 2005) and provide better access to healthcare services (Lindstrom & Muñoz-Franco, 2006). Furthermore, evidence shows that in Mexico, the health of infants in migrant remitting households is improved compared to that of infants in non-migrant households (Frank, 2005). Similarly, in the Philippines and Georgia, remittances from migrant household members were found to positively associate with children’s health (Asis, 2006; Gerber & Torosyan, 2013). The effect of remittances on health also has a positive spillover effect on children in non-migrant households because better access to healthcare for children in migrant households reduces the emergence and transmission of preventable diseases within the larger community (Kanaiaupuni & Donato, 1999).
However, these and other studies offer little insight into differences in health for children in households whose members migrated but returned. Understanding the health implications of return migration is important because prior research notes difficulties for former migrants upon return. For example, studies in Mexico found that migrants who return are less healthy, which may affect children’s health prospects as well (Donato & Duncan, 2011). Former migrants and their children may also be disadvantaged because they no longer have regular access to financial capital from abroad or to the health services that capital purchases (Dreby, 2010). Furthermore, returned migrants have often poor knowledge of the public health programs and a less stable employment history in the country of origin, which, in contrast to non-migrant families, may limit the access of family members to public-based health insurance schemes (Donato & Duncan, 2011; UNICEF, 2016).
The literature on parental absence because of migration generally indicates harmful effects of parental separation although the magnitude of these effects appears to vary according to which parent has migrated (Cortés, 2007; Jordan & Graham, 2012; Parreñas, 2005; Schmalzbauer, 2004). According to these studies, the mother’s absence often has greater behavioral consequences and leads to problems for children. When fathers migrate, mothers generally take over the caregiving responsibilities within the household, whereas when mothers migrate, fathers often rely on other household members to care for the children (Cortés, 2007). More recently, research has emphasized the need to consider parental migration in relation to the caregiver of the child who stay behind. Studies conducted in Moldova (Vanore, 2015) and in Ghana and Nigeria (Cebotari, Mazzucato, & Siegel, 2017) observed no differences in children’s health when mothers migrate while children stay in the care of the father. Another study found improved child health when fathers migrate and children remain in the care of mothers in Mozambique (Yabiku et al., 2012). More evidence is needed from large-scale studies to assess the role of parents and other household members as caregivers for children in transnational families, as this has only started to be investigated in relation to children’s health.
Previous research has also detected significant gender differences when measuring the health of children living in migrant households. In China, for example, girls were observed to be more at risk for unhealthy behaviors, such as smoking and drinking, and boys were on average more overweight and less physically fit than children living in non-migrant families (Gao et al., 2010). In Moldova, boys were observed to have more abnormal psychological health when fathers were abroad and when they were cared for by non-parental caregivers (Vanore, 2015). Some of these gender differences may be caused by different gender roles in countries of origin. Different values and norms related to family and care may shape the behavior of child rearing in migrant sending communities (Kulu & González-Ferrer, 2014). For instance, Cortés (2007) observed that girls have more physical chores at home compared to boys, even when the household’s economic situation is improved by remittances. In Mexico, however, studies concluded that traditional gender inequality is reduced in migrant households, especially when household members return from abroad (Antman, 2011). More studies are warranted to explore the gender differences in children’s health when household members migrate.
Hypotheses
The extant research reviewed above encompasses many conditions that influence children’s health. Collectively, it suggests that migration does not always result in worse health for children who stay in the home country. Based on this research, we advance several hypotheses.
Hypothesis 1. We expect that the presence of parental divorce, whether accompanied by migration or not, will affect children’s health more negatively compared with children living in non-migrant households whose parents are in a stable marital union.
Hypothesis 2. We expect that children living in households with current or returned migrants will have more means to invest in children’s health, resulting in better health compared with children in non-migrant households.
Hypothesis 3. We expect that maternal migration and the migration of both parents, regardless of who the caregiver is, will have a more negative effect on children’s health when compared with children in non-migrant households.
Hypothesis 4. Because longer periods of absence may result in less contact among households members, we expect the duration of migration to be negatively associated to children’s health.
Hypothesis 5. We expect the absence of remittances to relate more negatively, whereas the presence of remittances to associate more positively with the health of children in transnational care, compared with children living in non-migrant households.
Hypothesis 6. We expect that girls are more at risk to have poorer health compared to boys when living in different transnational forms of care.