Grandparents caring for grandchildren in skip-generation households in Cambodia: lived experiences and ethical issues

Contrary to common conceptions, low- and middle-income countries are rapidly ageing. Despite prevalent depictions of older people as dependent and burdensome, many older people make important contributions to their families and societies that have been largely overlooked in policy and research. Older people’s roles as caregivers for their grandchildren represents a prime example of this. This study aims to understand the lived experiences of grandparents who become primary caregivers to their grandchildren in skip-generation households in rural Cambodia. Based on thematic analysis of in-depth, semi-structured interviews and focus group discussions with 40 grandparent caregivers, this study offers insights into grandparents’ lived experiences, namely what drives skip-generation caregiving, grandparents’ roles and responsibilities, and issues pertaining to health and healthcare of grandparents and grandchildren in skip-generation households. Additionally, analysis of 18 in-depth interviews with professional stakeholders working in relevant fields of policy and practice reveal their perspectives on the current situation of skip-generation families and the various institutions and policies that impact their lives. The analysis shows that grandparents play a major and essential role as caregivers to their grandchildren in skip-generation households. However, due to widespread poverty and a dearth of formal and informal support for skip-generation households, grandparents face considerable struggles, including scarcity of money, food and healthcare, physical and mental health problems and moral dilemmas in trying to navigate their everyday caregiving responsibilities. Grandmothers appear to shoulder a disproportionately high caregiving burden. Professional stakeholders underscored that skip-generation households face multiple sources of vulnerability and viewed skip-generation households as makers of family vulnerability. Structural factors, including poverty, gendered roles and a weak healthcare system, largely determine the precarity of grandparent caregivers’ lives. By examining the findings presented in this thesis through the lens of intersectionality theory, the analysis foregrounds important overlapping and interconnected structural drivers that underpin and shape the lives of these skip-generation caregivers. In a context of increasing and long-term labour migration, grandparents’ and their family’s agency is constrained by the intersection of wider structural factors, including poverty, gender inequalities, poor healthcare infrastructure, and lack of access to social security and support. Applying a social relational approach to understanding migration and caregiving in Cambodia, the analysis further exposes the broader social processes and relations that shape child rearing and reproduction within these rural migrant families. This helps to expose the otherwise mostly hidden social reproductive labour of ‘left-behind’ grandparents, in the face of their adult children’s migration—a labour which to date has remained largely unseen. Existing policy initiatives on ageing and care in Cambodia currently fall short of addressing the issues faced by skip-generation grandparents and their families. Future policies and programmes need to recognise and address the broader intersecting structural drivers that underpin the complex vulnerabilities facing skip-generation households. Within this, it is essential that future policies account for the evidently shifting dynamics with regards to caregiving roles and social reproductive work within the family, in order to develop more equitable policies and social security mechanisms that adequately support skip-generation grandparents and their families.