Men on the move and the wives left behind: the impact of migration on family planning in Nepal

Abstract

Nepali migration is longstanding, and increased from 2.3% of the total population in 2001 to 7.2% in 2011. The estimated 1.92 million migrants are predominantly men. Consequently, 32% of married women have husbands working abroad. Social structures are complicated as many married women live with their inlaws who typically assume decision-making power, including access to health services. This study compares access to reproductive health services, fertility awareness, and decision-making power among a sample of married women aged 15-24 years (n = 1123) with migrant husbands (n = 485), and with resident husbands (n = 638). Predictably, women with migrant husbands had significantly lower contraceptive use than other married women (9.3% vs 30.3%, respectively), and expressed a higher intention to become pregnant in the next year. Despite their intentions, women with migrant husbands scored lower on a fertility awareness index, were less likely to discuss pregnancy planning with their spouse, and less likely to describe their relationships positively. Decision-making for both groups of married women was dominated by both husbands and in-laws in different ways. Yet, across multiple normative scales, fewer women with migrant husbands felt pressure to conform to existing social norms. Married women with migrant husbands reflect a subset of women, with unique fertility issues and desires. Interventions that increase knowledge of fertility among this subset of women, promote healthy preconception behaviours. Linking women for counselling opportunities throughout the pre and postnatal periods may help improve health outcomes for mothers and children.

Migration and family planning in the state with highest total fertility rate in India

“…One of the factors that could have played a role in low mCPR is male out-migration. A great deal of evidence from Nepal, sharing an open border with Bihar, suggests that women with migrant husbands were less likely to use contraceptives and access FP services though they had greater autonomy than those with resident husbands [9][10][11][12]. Primary research conducted in Nepal also noted that women with migrant husbands were less likely to discuss FP issues with their spouses [10,13,14].…”

“…A great deal of evidence from Nepal, sharing an open border with Bihar, suggests that women with migrant husbands were less likely to use contraceptives and access FP services though they had greater autonomy than those with resident husbands [9][10][11][12]. Primary research conducted in Nepal also noted that women with migrant husbands were less likely to discuss FP issues with their spouses [10,13,14]. Other studies in Nepal documented that conversation on reproductive health and contraceptive use was dependent on frequency of the husband's visit to the home state, and duration and destination of migration [12][13][14].…”

Women Left Behind: Migration, Agency, and the Pakistani Woman

“…It was also the older woman in the focus group who would answer most of the questions. This is common in the South Asian context and has been observed in Bangladesh (Debnath and Selim 2009) and even Nepal (Shattuck et al 2019). Younger women, particularly daughters-in-law, felt more comfortable talking with me in private, in a different room away from their mothers-in-law.…”

“…Others note that in the absence of the migrant husband, surveillance and control over women left behind is maintained by other family members. Further, they argue that any power women left behind gain in decision making or mobility is lost when the migrant husband visits home or moves back, as demonstrated in cases from Armenia and Guatemala (Menjívar and Agadjanian 2007), Mexico (McEvoy et al 2012), China (Chuang 2016), and Nepal (Shattuck et al 2019). Debnath and Selim’s (2009, 133) research in Bangladesh captures this well:In cases where remittances were received by the in-laws (for instance, by the respondent’s father-in-law or mother-in-law), the left behind wife’s situation within the household (if she is living with her in-laws) did not change most of the time.…”

“…In addition to being monitored by husbands via phones, women left behind are also subject to surveillance and control by in-laws (Chuang 2016; Menjívar and Agadjanian 2007; Shattuck et al 2019). Rashid (2013) hence cautions against oversimplifying increased visibility and mobility of women left behind in the absence of migrant husbands as empowerment.…”