ARE Wives of Migrants in Rural Bangladesh Really “Left behind”? A Nuanced Analysis of How Spousal Migration Affects Women’s Healthcare Utilization

Research Objective Labor migration has a profound effect on the family at all levels, but evidence documenting the impact of migration on women "left behind" is still lacking. We analyze the effects of migration on healthcare utilization and outcomes of women "left behind," and consider the moderating effects of household structure on gender‐related barriers to healthcare utilization. Study Design We examine outcomes across 5 domains: healthcare utilization, mental health, self‐reported health, BMI, and gender equality. The primary independent variable is a categorical measure of the husband’s migration status, and the secondary predictor is the family context within which the women live, defined as their relationship to the household head. We conduct bivariate and regression analyses using linear, logistic, and multinomial models controlling for age, education, and geographic location. Population Studied Since 1966, the International Center for Diarrheal Disease Research, Bangladesh (icddr,b), has implemented a Health and Demographic Surveillance System in the rural Matlab area of Bangladesh, collecting data monthly on nearly the entire population of around 200 000. In 1996, the widely utilized Matlab Health and Socioeconomic Survey (MHSS1) was conducted on a representative sample of 7% of households, followed by MHSS2 in 2012‐2014, which had unusually successful migrant tracking, capturing 92‐94% of surviving members of all key age‐sex cohorts. Our sample is drawn from MHSS2 and includes 6983 currently married women between the ages of 15 and 45. Principal Findings More than twice as many women who had a cohabitating spouse could not access health care when they needed it (20.8%), compared to women with international migrant spouses (10.2%, P  < .001). International spousal migration remained a significant predictor of women's ability to access healthcare primarily through a reduction in financial barriers ( P  < .001), when controlling for age, education, relationship to household head, self‐reported health, depression, and geographic location. The barriers to healthcare access varied for women depending on the migration status of their spouse. Financial barriers decreased by 66% for wives of international migrants ( P  < .001), but barriers related to mobility, autonomy, and family approval increased for this same group of women. Gains in access to health care are also explained by improvements women’s mobility and economic empowerment associated with husband’s domestic and international migration ( P  < .001). However, these positive migration effects do not translate into significant differences in self‐reported health, BMI, or depression; and migration‐related improvements in economic empowerment and mobility are fully moderated for women who live with their parents or in‐laws. Conclusions The potential benefits of migration for women's healthcare utilization may be diluted by family structures that perpetuate unequal gender dynamics. Implications for Policy or Practice Due to the dynamic and evolving nature of migration, a comprehensive approach is essential to understand the health impacts on women and their families and inform policies in both sending and receiving countries. These efforts also help to answer growing calls for attention to gender, including those in the newly adopted UN Global Compact for Migration, and take an important step toward understanding, not just where communities stand in relation to global targets, but through what mechanisms progress on women's access to healthcare is being made or hindered. Primary Funding Source Agency for Healthcare Research and Quality.