Migration and early childhood health in Cambodia: A mixed-methods analysis

As migration rates rise globally, this population change has profound health consequences, including for children left behind. The degree to which migration advantages or disadvantages children’s health is determined in part by factors such as migrant parents’ ability to remit, children’s living arrangements in the face of parental absence, and caregiver characteristics, among others. The migration and child health literature has largely failed to examine care-seeking processes and child health behaviors, important dimensions of children’s well-being that are likely influenced by parental out-migration. Moreover, it has generally excluded skipped-generation households, an increasingly prevalent living arrangement that may have specific implications for the health and well-being of children. I address these gaps using a mixed-methods approach that leverages data from Cambodia, a high-migration setting. Using qualitative data, I identify the social process of care seeking for children’s health in skipped-generation households, including familial dynamics for decision-making, the agency of and constraints faced by grandparent caregivers, and the role of absent migrant parents. I find migration shifts familial roles whereby grandparents direct care seeking for children, but face distinct barriers to care. I use three waves of the Cambodia Socio-Economic Survey to examine whether families invest remittances in their children’s health. I use an instrumental variables approach to estimate whether acutely ill children whose households receive remittances are more likely to attend care with quality providers than children in non-migrant households. I find no evidence that remittances affect children’s access to curative care. Finally, I use four waves of the Cambodia Demographic and Health Survey to examine how children’s living arrangements associate with acute malnutrition in a period of increasing migration. I find children in skipped-generation households consistently experienced lower odds of acute malnutrition compared to children in nuclear families and other types of households. However, this relative advantage diminished over time as the diversity of children’s living arrangements increased. Together, these analyses illuminate the multiple mechanisms through which parents’ out-migration shapes their children’s access to care, and the strategies migrant-sending families employ to manage children’s health. This dissertation highlights the importance of understanding demographic context for child health interventions and policies