When parents are not present: Decision-making dynamics for young children's health and illness in migrant-sending households in rural Cambodia

Abstract

As migration rates increase globally, an increasing proportion of children in low- and middle-income countries live apart from their parents. In particular, skipped-generation households are becoming more common, with grandparents serving as primary caregivers for young grandchildren whose parents migrate and provide remittance support. Yet, how families living apart make decisions for young children's healthcare is not well understood. Processes of care seeking for children's health are examined in Cambodia, which has high rates of internal and international migration, and an increasing number of skipped-generation households. We conducted semi-structured in-depth interviews with grandparents who are primary caregivers for children under ten in skipped-generation households in rural migrant-sending areas. Respondents discussed their family's migration history, care seeking and decision making for grandchildren, dynamics with absent migrant parents, and sources of support. Decisions for children's care are intimately tied to the availability of migrant remittances, which are the modality of the relationship between grandparents and parents. Additional remittance support allows grandparents to make decisions for grandchildren's health based on convenience rather than cost, given the burdens of caring grandparents have taken on a result of the parent's migration. Instrumental supports such as in-kind assistance and informational supports further facilitated children's access to healthcare. This qualitative study informs and explains findings from recent quantitative studies of migration and child health.