Abstract
BackgroundAmong Bangladeshi men, international labor migration has increased ten-fold since 1990 and rural to urban labor migration rates have steadily increased. Labor migration of husbands has increased household wealth and redefined women’s roles, which have both positively and negatively impacted the health of wives “left behind”. We examined the direct and indirect effects of husband labor migration on chronic disease indicators and outcomes among wives of labor migrants.MethodsWe collected survey, anthropometric, and biomarker data from a random sample of women in Matlab, Bangladesh, in 2018. We assessed associations between husband’s migration and indicators of adiposity and chronic disease. We used structural equation modeling to assess the direct effect of labor migration on chronic disease, undernutrition, and adiposity, and the mediating roles of income, food security, and proportion of food purchased from the bazaar. Qualitative interviews and participant observation were used to help provide context for the associations we found in our quantitative results.FindingsAmong study participants, 9.0% were underweight, 50.9% were iron deficient, 48.3% were anemic, 39.6% were obese, 27.3% had a waist circumference over 35 in., 33.1% had a high whole-body fat percentage, 32.8% were diabetic, and 32.9% had hypertension. Slightly more women in the sample (55.3%) had a husband who never migrated than had a husband who had ever migrated (44.9%). Of those whose husband had ever migrated, 25.8% had a husband who was a current international migrant. Wives of migrants were less likely to be underweight, and more likely to have indicators of excess adiposity, than wives of non-migrants. Protection against undernutrition was attributable primarily to increased food security among wives of migrants, while increased adiposity was attributable primarily to purchasing a higher proportion of food from the bazaar; however, there was a separate path through income, which qualitative findings suggest may be related to reduced physical activity.ConclusionsLabor migration, and particularly international labor migration, intensifies the nutrition transition in Bangladesh through increasing wealth, changing how foods are purchased, and reducing physical activity, which both decreases risk for undernutrition and increases risk for excess adiposity.
Highlights
Rural Bangladesh is currently undergoing a nutrition transition, defined by changes in diet and physical activity patterns associated with increasing rates of morbidity and mortality due to chronic disease [1, 2]
Epidemiologic transitions are often linked with nutrition transitions, as diets high in fat and sugar, especially co-occurring with low physical activity, increase rates of overweight and obesity in previously lean or underweight populations [4] and contribute to risk for chronic disease [5] including for hypertension and diabetes [6, 7]
We explored the extent to which marriage to a labor migrant and to an international labor migrant was independently associated with chronic disease outcomes, indicating an effect of psychosocial stress, and the extent to which predicted associations were mediated by increased household monthly income, food security, and/or purchasing food
Summary
Rural Bangladesh is currently undergoing a nutrition transition, defined by changes in diet and physical activity patterns associated with increasing rates of morbidity and mortality due to chronic disease [1, 2]. The nutrition transition hypothesis posits that populations experience similar changes in subsistence, diet, and physical activity with increasing economic development and globalization. This is thought to present in five stages with the first three stages being collection of food, nutritional stress due to famine, and the end of famine. Epidemiologic transitions are often linked with nutrition transitions, as diets high in fat and sugar, especially co-occurring with low physical activity, increase rates of overweight and obesity in previously lean or underweight populations [4] and contribute to risk for chronic disease [5] including for hypertension and diabetes [6, 7]. We examined the direct and indirect effects of husband labor migration on chronic disease indicators and outcomes among wives of labor migrants
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