مهاجرت والدین و بهداشت روانی کسانی که برای مراقبت از کودکان در جنوب شرق آسیافعال اند

The international migration of parents from the global south raises questions about the health impacts of family separation on those who stay behind. This paper uses data collected in 2008 and 2009 for a project on Child Health and Migrant Parents in South-East Asia (CHAMPSEA) to address a largely neglected research area by investigating the mental health of those who stay behind in Indonesia, Philippines and Vietnam to care for the children of overseas migrants. A mixed-methods research design is employed to answer two questions. First, whether carers in transnational (migrant) households are more likely to suffer mental health problems than those in non-migrant households; and secondly, whether transnational family practices and characteristics of migration are associated with mental health outcomes for stay-behind carers. The Self-Reporting Questionnaire (SRQ-20) was completed by carers in selected communities (N = 3026) and used to identify likely cases of common mental disorders (CMD). Multivariate logistic regression and thematic analysis of qualitative interviews (N = 149) reveal a nuanced picture. All stay-behind carers in the Indonesian sample are more likely than carers in non-migrant households to suffer CMD. Across the three study countries, however, it is stay-behind mothers with husbands working overseas who are most likely to experience poor mental health. Moreover, infrequent contact with the migrant, not receiving remittances and migrant destinations in the Middle East are all positively associated with carer CMD, whereas greater educational attainment and greater wealth are protective factors. These findings add new evidence on the ‘costs’ of international labour migration and point to the role of gendered expectations and wider geopolitical structures. Governments and international policy makers need to intervene to encourage transnational family practices that are less detrimental to the mental health of those who stay behind to care for the next generation.

The international migration of parents from the global south raises questions about the costs, as well as the benefits, of a livelihood strategy that results in families being divided across national borders. When parents migrate, new ‘transnational’ household arrangements and family practices emerge as childcare is (re)configured in ways that affect the well-being not only of children but also of their carers. This paper addresses a largely neglected area of research by investigating the mental health of mothers, fathers and other family members who stay behind in South-East Asia to care for the children of overseas migrants. Using data collected by our research team in three countries, the analysis examines the impact of parental absence on the mental health of carers in relation to, first, household arrangements, and second, transnational family practices and the characteristics of migration. Several previous studies of caregiving in the Asia–Pacific region have investigated the health and well-being of family members who provide care, especially for older relatives, but not in the context of migration. Gender differentiation in well-being has emerged as a cause for concern, with female carers at greater risk of poor psychosocial health compared to male carers (Chiou et al., 2005 and Ho et al., 2009). Moreover, maternal depression has been found to impact negatively on infant growth in Asia but not in Africa or South America (Stewart, 2007). Such regional differences may reflect variations in poverty and healthcare provision but are also likely to be influenced by different socio-cultural narratives that frame the role of ‘woman and mother’, and Asian motherhood may be especially disempowering (Harpham et al., 2005). However, none of these studies considered carer mental health from the perspective of the transnational family. Within the substantial body of literature devoted to the study of international migration from Asia, those studies that do consider psychosocial health have largely focused on migrants rather than on those who stay behind. Recent work has examined the well-being of immigrant Asian Americans (Qin, 2008), the difficulties facing migrants who are themselves care workers (Ohno, 2012), the mental health needs of Asian refugees (Hsu et al., 2004), and caregiving in diasporic communities (Lee, 1999 and Yoon, 2005). Exceptions which give attention to the impact of adult children's international migration on the health of older parents who stay behind include Kuhn's (2006) work on Matlab, Bangladesh where high rates of out-migration (internal and international) and remittance receipt were found to have a favourable effect on parents' physical health. There is also a small but growing body of literature that looks at the mental health of children who stay behind in Asia when parents migrate overseas (Battistella and Conaco, 1998, Graham and Jordan, 2011, Hewage et al., 2011 and Senaratna et al., 2011), or within China (Fan et al., 2010 and Zhao et al., 2014). Nevertheless, there remains a need to extend this work to other non-migrant members of transnational families, especially those who care for the children of migrants (Mazzucato and Schans, 2011). The few studies that have considered caregiving in South-East Asia in the context of migration have mostly examined the impacts of internal migration on family members who stay behind. Research has reported negative impacts on the intellectual development of Thai children raised by grandparents (Nanthamongkolchai et al., 2011), and several health risks for adults who stay behind in Indonesia, including a greater likelihood of psychosocial distress (Lu, 2012). To the best of our knowledge, the present study is the first to investigate mental health among those who stay behind in South-East Asia to care for children of international labour migrants. Previous studies point to a number of competing expectations in relation to psychosocial outcomes for stay-behind carers. While the wealth generated by remittances might be expected to mitigate or even eliminate any negative effects of parental absence, the dominance of traditional gender roles in the region (ascribing domestic tasks to women and breadwinning to men) suggests that fathers who stay behind to care for their children while their wives work overseas may face the biggest challenges to their (masculine) identities (Pingol, 2001 and Hoang and Yeoh, 2011), which could be detrimental to their mental health. On the other hand, women in low income countries are around three times more likely than men to suffer CMD (Patel, 2001), which suggests that mothers are more at risk of poor mental health than fathers. Further, those mothers coping without the co-resident support of their migrant husbands may be more vulnerable than mothers in non-migrant families. The carer's age and relationship to the child(ren) in their care may also influence their psychological well-being. Grandparent carers may be especially vulnerable to anxiety and stress if they struggle to cope with the physical demands of childcare, although any negative consequences could be outweighed by material security and improved self-esteem associated with the recognition of the importance of their role (Knodel and Chayovan, 2009). The mental health of stay-behind carers merits further examination. Our aim is to explore the relationships between different family arrangements (non-migrant and transnational) and the mental health of those principally responsible for childcare in selected communities in three countries: Indonesia, Philippines and Vietnam. We adopt a mixed-methods approach to investigate two specific questions: (1) Are those who stay behind to care for the children of overseas migrants more likely to suffer mental health problems compared to carers in non-migrant families?; (2) Are transnational family practices and the characteristics of migration associated with mental health outcomes for stay-behind carers? The questions are addressed in three stages. To answer the first question, we conduct quantitative analyses that distinguish the main correlates of poor mental health among carers in non-migrant and transnational households within each study country. Next, we examine qualitative data from in-depth interviews with a subsample of these carers in transnational households to ascertain their major concerns and thus possible sources of stress for those who stay behind. Lastly, we combine measures that capture these concerns along with the main correlates identified in the first-stage models to provide a further quantitative analysis predicting poor mental health among stay-behind carers. Qualitative evidence is also used to interpret the quantitative results. This provides a synthesis of the quantitative and qualitative findings and allows us to address the second research question.

Previous work on the health consequences of internal migration in Indonesia (Lu, 2012) recognised the need for research on the psychosocial costs of international migration for those who stay behind, as well as more explicit attention to the role of remittances and contact among family members. We have advanced this agenda by investigating the two research questions posed in the introduction using a combination of qualitative and quantitative evidence from the CHAMPSEA project. First, the comparative analysis of the three study countries shows that some carers in transnational households are more likely than carers in non-migrant households to experience mental health problems. Higher odds of CMD were found in all three country samples for mother-carers whose husbands were working overseas, in Indonesia for father-carers whose wives were working overseas, and in Indonesia and the Philippines for other carers in transnational households. The general pattern of disadvantage in the Indonesian sample was not replicated for the Philippines or Vietnam, where CMD prevalence rates were lower. Among possible confounders, only the association between CMD and low household wealth was common to all three countries. The finding that living in a low-wealth household is associated with a significantly higher likelihood of CMD among carers, while stay-behind mother-carers in the three study countries also have higher odds of CMD, indicates that the benefits of relative financial security do not always outweigh the costs of transnational family life. For mother-carers in low income transnational households there is a double jeopardy. The processes that underlie these costs are unobserved in the country-specific models but we surmise that they are related in part to a complex interplay between gendered expectations of ‘good parenting’ and the reconfigured role of the migrant parent within the transnational family. The qualitative interviews provide more specific insight into why stay-behind mothers are almost twice as likely to suffer common mental disorders compared to their counterparts in non-migrant households, and more than two and a half times as likely in the Vietnamese sample. When husbands go overseas to work, mothers often have to take on roles (such as agricultural work) previously performed by the men. Not only does this impose a physical burden but it may also be resented if the migrant husband does not fulfill his part of the bargain by regularly sending remittances home. The absence of migrant husbands also removes an important source of social support, which can be protective for depression and anxiety. Further, inevitable changes in the relationship between children and their non-resident father may become a source of stress for the mother if an emotional gap develops as children become used to having only one parent around. This may be particularly so if the father attempts to impose discipline on his children from a distance or during short visits home, as Parreñas (2008) has argued. In addition, prolonged separation may threaten the survival of the marriage, frequently leaving stay-behind mothers facing uncertainty and economic hardship. While stay-behind fathers may encounter similar sources of stress in the absence of their migrant wives, the qualitative evidence suggests that they do so to a lesser degree. For example, many fathers who become the principal carers for their children share the burden with other (female) members of their extended family (Hoang and Yeoh, 2011). The modelling results suggest that only stay-behind father carers in Indonesia have significantly higher odds of CMD and this may be due as much to the employment circumstances of their migrant wives as it is to the need for them to redefine their gender role within the household. The second research question asked more explicitly about the role of transnational family practices and migration characteristics. The narratives of two stay-behind mothers illustrate how the migration of their husbands had, at times, negatively impacted on their ability to care for their children. Remittances and communication from a migrant husband are signs that he is fulfilling his roles as father and spouse. Migrants who fail to communicate or send remittances may be seen as betraying expectations, and stay-behind carers may have to seek employment outside the home to provide for the children in their care. These circumstances are likely to increase CMD among carers by causing stress and uncertainty. The failure to communicate or send remittances regularly is not always a matter of choice, and destination-specific barriers deserve greater recognition. The modelling results (Table 3) indicate that both transnational family practices (contact and remittance receipt) and migration characteristics (migrant destination and sending country) influence the likelihood of CMD for stay-behind carers. Infrequent contact with the migrant, not receiving remittances in the past six months and caring for children in a transnational household where the migrant is working in the Middle East are all associated with higher odds of carers experiencing CMD. In addition, stay-behind carers in Indonesia are most likely to suffer mental health problems. This answers our second research question, but also raises further questions. While the effects of family practices are modified by household wealth, the mental health deficit for carers of children whose parents are working in the Middle East is not. The qualitative evidence suggests that concern about the welfare of the migrant parent is a possible source of stress for the carer, as stories of migrants being suddenly sent home must surely circulate within communities. However, more research is needed to determine why the odds of CMD are significantly higher for these carers. Future work will investigate the possible processes underlying this finding, including whether it is related to particular destinations within the region and/or particular types of migrant employment. Equally, the significantly higher likelihood of CMD among stay-behind carers in the Indonesian sample, whatever their gender, wealth or personal circumstances, requires further investigation. The interviews with carers lead us to suspect that both are indicative of international circuits of labour mobility structured by geopolitical contexts that severely constrain family practices in ways detrimental to psychosocial well-being. This study has demonstrated that living in a transnational household and caring for children left behind is associated with an increased likelihood of poor mental health for carers in particular circumstances. The quantitative analyses distinguished major correlates of carer CMD and investigated differences among carers in transnational households, while the thematic analysis provided greater insight into the processes at work. Despite utilising the strengths of both approaches, the study is subject to limitations arising from the nature of the main survey. First, the use of cross-sectional data means that the direction of causation cannot be ascertained. Further, while individual circumstances can and do change over time, this dynamic is not captured in the quantitative analyses. Detailed longitudinal data, currently not available, would be needed to explore this further. Secondly, given the sampling strategy, the study findings cannot be generalised beyond the study communities. It is possible, for example, that stay-behind carers in major metropolitan areas in the study countries have different mental health outcomes. Nevertheless, by identifying significant differences in the likelihood of CMD among carers in transnational and non-migrant households and by establishing a connection between poor mental health and transnational family practices, we have fulfilled our aim of demonstrating, for the first time, important vulnerabilities among those providing childcare in transnational households in South-East Asia. These deserve much more research attention. The agenda for future work should not only include further studies on transnational households in other communities but also attend to the ways in which geopolitical context and gendered expectations play a role in creating vulnerabilities to poor mental health. The viability of transnationalism as a way of “doing family” depends to a considerable extent on geographically separate family members playing their part, often in accordance with gender role expectations. The migration of a parent – whether a father or a mother – is part of a livelihood strategy that seeks to secure a better future, especially for children. However, transnationalism involves often hidden costs as well as potential benefits. For some carers who stay behind, the promise of financial security comes at a cost to their mental health. In less developed parts of South-East Asia such as the sites where the CHAMPSEA project was conducted, the absence of remittances has severe implications for the well-being of non-migrant family members, including stay-behind carers, who are heavily dependent on this source of income for daily subsistence and debt repayment, as well as peace of mind that their sacrifice has been worthwhile. The findings of this study suggest that the difficulties faced by many of these families may be shaped by geopolitical structures over which they have no influence, and which need to be addressed by governments and international policy-makers to encourage transnational family practices that are less detrimental to the mental health of those who stay behind to care for the next generation.