Who are internal migrants?
Some DHS Program surveys include questions on previous place of residence and the number of years the respondent has lived in their current residence.
From these questions we can identify women who migrated from urban to rural areas and from rural to urban areas. We can also identify recent and non-recent migrants by how long they have stayed at their current residence. Recent migrants are defined as those who moved to their current residence within the last 3 years and non-recent migrants are defined as those who moved to their current residence 3-9 years ago.
A new analytical report uses Demographic and Health Survey data from 15 countries to explore the relationship between internal migrant status and four outcomes related to access and use of health services:
- Attending at least four antenatal care (ANC) visits;
- Using a modern method of family planning;
- Having a major problem accessing health care for self due to getting money for treatment;
- Having a major problem accessing health care for self due to distance to facility.
Nepal (18%), Kenya (13%), Bangladesh (12%), and South Africa (12%) have the highest levels of rural to urban migration among study countries.
While we may assume that more people move from rural areas to urban areas, 7 study countries have more urban to rural migrants than rural to urban migrants. Philippines (10%), Uganda (10%), Cameroon (9%), and Benin (7%) have the highest levels of urban to rural migration among study countries.
Selection nature of migration
Across all study countries, most women age 18-24 are recent migrants. In some countries, such as Tanzania and Uganda, most women age 18-24 are recent rural to urban migrants.
In many countries, recent rural to urban migrants have the lowest levels of women currently in a union. This supports the selection theory of migration that specific groups of people (e.g., younger age groups) tend to migrate more than others.
Migrants, whether rural to urban or urban to rural, have higher education compared to rural non-migrants across all study countries.
The study examines these specific questions:
Do recent migrants have difficulty accessing health care? Are non-recent migrants better adapted to access health care compared to recent migrants?
Let's take a closer look with a focus on the outcome of attending at least four ANC visits. For discussion of the findings for the remaining outcomes, see the full report.
There are many surveys with no significant differences between migrants and non-migrants in ANC visits, as indicated by the gray boxes in the figure below.
Where differences are significant, they are large. For example, in Cameroon and Haiti, recent rural to urban migrants have more than 50% lower odds of attending at least 4 ANC visits compared to urban non-migrants, as indicated by the red boxes in the figure below.
At the same time, there is no significant difference in ANC visits between non-recent rural to urban migrants and urban non-migrants in Cameroon and Haiti. This means that migrants who have stayed in urban areas longer may have adapted their behavior and are behaving like urban non-migrants.
In Bangladesh the difference between migrants and non-migrants in ANC visits persists even for non-recent migrants. Rural to urban migrants have roughly 50-60% lower odds of attending at least 4 ANC visits no matter how long they have lived in an urban area, compared to urban non-migrants.
Migrants from urban to rural areas
Have migrants from urban to rural areas kept their "urban advantage" even after years in their current residence?
In Bangladesh, Kenya, and South Africa recent urban to rural migrants have higher odds of ANC visits compared to rural non-migrants. However, there is no significant difference in ANC visits between non-recent urban to rural migrants and rural non-migrants. This suggests that migrants who have stayed longer in a rural area have lost their “urban advantage” compared to rural non-migrants.
Losing the “urban advantage” is also observed among women reporting a major problem accessing care due to getting money. Recent urban to rural migrants in Nepal, the Philippines, and Sierra Leone have lower odds of money being a barrier to care compared to rural non-migrants. Among longer-term urban to rural migrants and rural non-migrants there is no significant difference in money being a barrier for accessing health care compared to rural non-migrants.
In almost all study countries, urban to rural migrants (no matter how long they have lived at their current residence) and rural non-migrants have greater odds of distance to a health facility being a major problem when accessing health care compared to urban non-migrants. This reflects the overall issue of access to health care facilities in rural areas and is most likely not due to migrant status.
In other words, living in a rural area results in lower access to health care facilities regardless of migrant status. This is especially concerning as the study reveals no improvements in rural health care access over time even for surveys that are almost 10 years apart or more.
While there is a lot of attention given to urbanization and rural to urban migration, this study finds evidence of relatively high levels of urban to rural migration in some countries.
In some countries there are large disparities in terms of use and access of health services found between migrants and non-migrants which in some cases have persisted for nearly a decade.
Limitations to the available data and its cross-sectional nature make it difficult to examine the impact of migration on each woman’s life. However, the associations found give insight into where disparities exist to identify where interventions are needed and where further country-specific research is needed.
New migration questions in DHS-8
New indicators related to migration such as reasons for migration are available in DHS-8 surveys. These indicators are reported in the chapter on Characteristics of Respondents in DHS-8 survey final reports (usually chapter 3). Find updated DHS-8 code for chapter 3 on The DHS Program Code Share Library on GitHub.
Assaf, Shireen, Naba Raj Thapa, and Jeff Edmeades. 2023. Internal Adult Women Migrants’ Use and Access to Health Services in 15 DHS Countries. DHS Analytical Studies No. 87. Rockville, Maryland, USA: ICF.
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