Primary Breadwinner Research Articles

Reconsidering gender norms in childcare within Chinese migrant families in Portugal.

Historically, Chinese societies have been characterized by patriarchal structures (Confucianism and filial piety) that assign distinct roles to men and women within the family unit. These norms typically dictate that women take on the primary responsibility for childcare and household duties, while men are expected to be the primary breadwinners. As the authors observe the second generation of Chinese immigrants settling in Portugal, the immigrants grapple with the significant challenge of striving to preserve cultural heritage with the adaptation to Western norms. Therefore, there is a growing recognition of the need to reassess these traditional gender norms. Women in these families are increasingly participating in the workforce, challenging the notion that childcare should be solely to their domain. This study focuses on the experiences of Chinese immigrants, including both married couples and single individuals residing in Portugal. Through qualitative research methods such as interviews (involving 25 participants) and observations, the research aims to gain a nuanced understanding of the attitude and engagement toward childcare, and the ways it differs between men and women in these immigrant families. Participants' responses indicate that men's anticipation of women dedicating more time to childcare is notably influenced by educational attainment and financial circumstances. Conversely, women generally believe that being exempt from labor is not a viable alternative irrespective of their educational qualifications. The traditional distribution of caregiving duties does not consistently apply to Chinese female immigrants. By exploring the influence of traditional Confucian culture on migrants' perspectives and challenges in assuming parental responsibilities, this study highlights gender disparities among Chinese immigrants and propose solutions to address this gender conflict on division.

THE ROLE OF ISLAMIC LAW IN THE EQUITABLE DIVISION OF JOINT ASSETS POST-DIVORCE WITHIN URBAN SOCIETY: A DESCRIPTIVE STUDY OF ITS APPLICATION IN BANDUNG HIGH RELIGIOUS COURT

This research examines the legal certainty of joint property, defined as assets jointly acquired by spouses during marriage, particularly within the context of urban Muslim society. Using a descriptive-analytical method, it explores the relevance of joint property in the lives of married couples and its division post-divorce. The study highlights the legal ambiguities in Indonesia's current framework, particularly in Law No. 1 of 1974 on Marriage and the Compilation of Islamic Law (KHI). These regulations often fail to address modern family dynamics, such as when the wife is the primary breadwinner. This gap has resulted in inconsistent rulings in religious courts, particularly in urban areas where economic roles and gender dynamics are rapidly evolving. Focusing on the Bandung High Religious Court, the research emphasizes the importance of equitable asset division that reflects fairness, justice, and the lived realities of urban Muslim families. Findings suggest that while courts generally provide justice and legal certainty, there is a growing need for updated legal interpretations that accommodate changes in societal roles and expectations.

Reshaping gender norms: Exploring the ripple effect of refugeeism on women's empowerment

AbstractMotivationDisplacement significantly disrupts physical environments, social structures, and personal identities, profoundly impacting people's well‐being. Recent studies indicate that displacement can also reshape gender dynamics, highlighting the potential of displacement to transform traditional roles and relationships.PurposeThis study investigates the transformative impact of displacement on gender roles in the context of the Za'atari camp in Jordan. Specifically, it examines how humanitarian aid and forced displacement converge to alter gender relations and enhance women's autonomy.Approach and MethodsThe research draws on qualitative interviews with 15 women residing in the Za'atari camp. By exploring their experiences, the study aims to understand how displacement can act as a catalyst for empowerment and self‐sufficiency, despite the inherent challenges faced by these women.FindingsThe study reveals that displacement increases independence and self‐awareness, and improves decision‐making among women, facilitating their active participation in society. Humanitarian interventions, particularly educational and vocational programmes, play a crucial role in empowering women by improving self‐confidence, communication skills, and legal awareness. These initiatives also provide access to the labour market, challenging traditional gender norms.Policy ImplicationsDespite the positive impacts, significant obstacles persist. Women often assume greater responsibilities as primary breadwinners, which can erode their control within personal spheres and increase vulnerabilities. Traditional norms continue to hinder complete gender parity. The findings underscore the need for comprehensive and sustainable humanitarian interventions to support and sustain positive changes in gender dynamics in displacement settings.

The Global Care Chain: Analyzing the Increasing Feminization of Care Work Across Borders

With the rise in globalization, there has been an increase in migration, specifically labor migration. Women migrating to perform care labor has exploded after women formally entered the global labor market. Although many female migrants are independently traveling as the primary breadwinners of their households, they remain underappreciated, invisible, under-waged, and exploited. Upon relocating from countries in the global south to conduct care work in more affluent nations or communities, they leave their dependents behind, ultimately in the care of another female, typically a family member, or yet another more impoverished woman. At this point, the global care chain is not a single, linear chain but rather an intersecting one composed of numerous chains that multiple women become a part of. Therefore these intersections between the public and private, the paid and unpaid, and the productive and reproductive forms of care work are present. In addition, although globalization and neoliberal policy have benefited <i>some</i> women globally, it has dramatically made women who migrate for global care work and labor suffer. When women migrate, the global care chain often becomes an entire phenomenon through which many things intersect. On the one hand, we witness capitalism, feminization of migration, globalization, and neoliberalism interacting while also intersecting with care, emotional work, and gender relations. The goal of this paper is to examine and connect the intersectional effects on women by examining global care work in Asia and Latin America. In addition, we ask the following questions: How can we create change so that women's work is no longer invisible? How can we build a society where individuals are esteemed not just on monetized work but also on reproductive work? Will reproductive labor ever be considered labor? And finally, we will propose some preliminary solutions to begin framing steps forward.

Undoing Gendered Identities? Centrality and Meanings of Parental and Work Identities in Semi-Traditional, Equal-Sharing and Role-Reversed Couples

This mixed-methods study explored the centrality and meanings of men’s and women’s parental and work-related identities by comparing semi-traditional, equal-sharing, and role-reversed couples. Quantitative analysis involved 2,813 British parents (1,380 men, 1,433 women) who were primary caregivers, primary breadwinners, or equal sharers with at least one child aged 11 or under. Qualitative analysis drew on 60 in-depth interviews with 10 couples from each of the three groups. Results indicated that the centrality of parental and work identities varied by role rather than gender, as both male and female caregivers reported less central work identities and more central parental identities compared to breadwinners and equal-sharers. Equal-sharers and role-reversers were characterized by women’s central work identity and men’s low centrality of work identity. In these couples, a `half and half` parenting ideology underlined the construction of mothering and fathering as equivalent interchangeable identities, each forming only one half of a child’s parenting. Intertwining their maternal identity with an equivalent construction of their partners’ identity allowed women to reconcile a good mother ideal with central work identities, by redefining mothering as a responsibility for only half of the caregiving.

Quality of life and quality-adjusted life years after stroke in Sierra Leone.

Stroke is a leading cause of mortality and negatively affects health-related quality of life (HRQoL). HRQoL after stroke is understudied in Africa and there are no reports of quality-adjusted life years after stroke (QALYs) in African countries. We determined the impact of stroke on HRQoL after stroke in Sierra Leone. We calculated QALYs at 1 year post-stroke and determined sociodemographic and clinical variables associated with HRQoL and QALYs in this population. A prospective stroke register was established at the two-principal adult tertiary government hospitals in Freetown, Sierra Leone. Participants were followed up at 7, 90 days, and 1 year post-stroke to capture all-cause mortality and EQ-5D-3L data. QALYs were calculated at the patient level using EQ-5D-3L utility values and survival data from the register, following the area under the curve method. Utilities were based on the UK and Zimbabwe (as a sensitivity analysis) EQ-5D value sets, as there is no Sierra Leonean or West African value set. Explanatory models were developed based on previous literature to assess variables associated with HRQoL and QALYs at 1 year after stroke. To address missing values, Multiple Imputation by Chained Equations (MICE), with linear and logistic regression models for continuous and binary variables, respectively, were used. EQ-5D-3L data were available for 373/460 (81.1%), 360/367 (98.1%), and 299/308 (97.1%) participants at 7, 90 days, and 1 year after stroke. For stroke survivors, median EQ-5D-3L utility increased from 0.20 (95% CI: -0.16 to 0.59) at 7 days post-stroke to 0.76 (0.47 to 1.0) at 90 days and remained stable at 1 year 0.76 (0.49 to 1.0). Mean QALYs at 1 year after stroke were 0.28 (SD: 0.35) and closely associated with stroke severity. Older age, lower educational attainment, patients with subarachnoid hemorrhage and undetermined stroke types all had lower QALYs and lower HRQoL, while being the primary breadwinner was associated with higher HRQoL. Sensitivity analysis with the Zimbabwe value set did not significantly change regression results but did influence the absolute values with Zimbabwe utility values being higher, with fewer utility values less than 0. We generated QALYs after stroke for the first time in an African country. QALYs were significantly lower than studies from outside Africa, partially explained by the high mortality rate in our cohort. Further research is needed to develop appropriate value sets for West African countries and to examine QALYs lost due to stroke over longer time periods. The Stroke in Sierra Leone anonymized dataset is available on request to researchers, see data access section.

Submissive housewives, unfaithful spouses, dysfunctional marriages and violence: the portrayal of gender roles and marriage in Moroccan jokes

ABSTRACT This paper examines Moroccan marital discourse as portrayed in popular culture, specifically jokes that circulate orally and online. Our analysis focuses on fifty jokes related to husbands, wives, and marriage. We employed content analysis for the entire dataset and critical discourse analysis (CDA) using Van Dijk's ‘socio-cognitive’ method for a subset of jokes. The study reveals prevalent stereotypes and societal views on husbands and wives, with a special emphasis on the role of women in Moroccan marriages. These views represent shared ideologies, influencing how individuals in society think, speak, act, and interact. The humour reflects marital conflicts, infidelity, and misogyny as commonplace. Several jokes normalise violence and animosity toward wives. The selected jokes predominantly depict women as passive, insecure, nagging, and reliant on their husbands, who are the primary breadwinners. Women’s contributions to the family are typically limited to motherhood and cooking, and their concerns are shown to be trivial. Negative portrayals of wives, a prevalence of jokes in which females are engaged in infidelity, and reinforcement of traditional gender roles demonstrates a societal concern with regulating the female body and maintaining patriarchy.

Patriarchal Dominance in English Literature

Patriarchal dominance has been a prevalent theme in English literature throughout its history. Many literary works reflect and critique the societal norms and power structures that have historically favored men over women. Patriarchal norms prescribe rigid gender roles and expectations for men and women, reinforcing stereotypes and inequalities. Women are often relegated to traditional roles as caregivers, homemakers, and subordinate members of the family, while men are expected to be the primary breadwinners and decision-makers. These gender roles perpetuate unequal power dynamics and limit women's autonomy and agency. Prominent examples include Shakespeare's plays, where gender roles and power imbalances are often central to the plot, and classic novels like Jane Austen's "Pride and Prejudice," which explores women's limited options in a patriarchal society. Over time, literature has evolved to challenge and subvert these patriarchal norms, with authors like Virginia Woolf and Charlotte Perkins Gilman addressing issues of gender inequality and women's autonomy. Feminist literature and criticism have also played a significant role in analyzing and deconstructing patriarchal themes in English literature. Patriarchal dominance, characterized by the historical and societal power imbalance that favors men over women, has been a recurring theme in English literature throughout the ages. This theme reflects and critiques the prevailing gender norms, roles, and inequalities that have persisted within different periods and cultures of English-speaking societies. From early literary works to contemporary literature, patriarchal dominance remains a complex and enduring subject of exploration.

UNDERSTANDING GUJARAT'S INVESTOR ATTITUDES TOWARDS LIFE INSURANCE FIRMS

Life insurance plays a crucial role in providing financial security and protection to individuals and their families. It serves as a safety net, offering coverage in the event of unexpected circumstances such as death, disability, or critical illness. One of the key benefits of life insurance is its ability to provide financial stability and support to dependents, ensuring that they can maintain their standard of living and meet financial obligations even in the absence of the primary breadwinner. Additionally, life insurance serves as a valuable investment tool, offering opportunities for wealth accumulation and long-term financial planning. This study investigates the attitudes of investors in Gujarat towards life insurance firms, aiming to provide insights into their perceptions and preferences within the insurance sector. A sample size of 150 investors was targeted for comprehensive analysis, utilizing a mix of demographic variables such as age, gender, and education level. The research objectives include analysing investors' attitudes towards life insurance firms and exploring any potential associations between demographic profiles and these attitudes. Findings indicate that investors in Gujarat generally express satisfaction with the quality of customer service provided by life insurance firms, perceive clarity of information about policies, and report ease of access to information and assistance. Interestingly, no significant associations were found between demographic profiles and attitudes towards life insurance firms, suggesting uniform perceptions across different demographic groups. Overall, this study sheds light on the importance of understanding investor attitudes in shaping the strategies and services offered by life insurance firms in Gujarat.

Determinants of Life Insurance Purchase Intention using Structured Equation Modelling with Focus on Saving Motive and Financial Literacy

Life insurance serves as an important financial instrument, which effectively safeguards the family against adverse financial consequences resulting from an untimely demise of the primary breadwinner. This research paper delves into the factors that impact the purchasing intentions of life insurance among married working professionals. Employing Structural Equation Modelling (SEM), the study analyses the impact of saving motives and financial literacy on life insurance purchasing intentions. The findings suggest that saving motives and financial literacy have a positive and significant effect on the purchase intention of life insurance. Furthermore, the paper demonstrates that incorporating continuous manifest variables enhances the model fit and provides more accurate estimates of the relationships between variables. This provides valuable insights for life insurance providers, enabling them to gain a better understanding of the factors influencing consumers’ purchase intentions.

‘Away From Home’ - A Systematic Literature Review of the Factors and Challenges of Women Migration

Feminization of Migration refers to the increasing participation of women in long-distance migration, a trend driven by the evolving gender dynamics in the workforce. This shift is characterized by the engagement of women in occupations traditionally perceived as feminine, demanding the presence of women in these sectors. Consequently, the concept of the "Feminization of Migration" has prompted a gender-focused perspective on migration, redirecting attention towards the rights and interests of women within migration streams. Global patterns of women's migration have undergone a transformation, moving beyond the traditional role of women migrating as dependents with their families. Instead, there is a notable trend of women migrating independently, driven by economic motives and assuming the role of primary breadwinners for their families. This shift has not only altered the landscape of migration but has also amplified the presence of women in migration literature and practical policies designed with a gender-responsive approach. In light of these developments, this paper aims to conduct a systematic literature review that explores the factors and challenges associated with women's migration.

The economic impact and role of health communication in the economic recovery of tuberculosis (TB) patients in Indonesia

Tuberculosis (TB) patients suffer physically and bear the economic burden as many patients cannot work or generate income when ill. Concerning this issue, health communication plays a role in addressing the economic impact through advocacy strategies. This study aims to analyze how the economic impact and health communication advocacy conducted by Aisyiyah and Terjang NGOs contribute to TB patients' economic recovery in Bandung. This research adopts a cross-sectional approach involving data collection at a specific point in time. The findings indicate that the average percentage of patients who are the primary breadwinners of the family is 44.33%, patients who have lost their jobs is 82.33%, patients with loans is 38.67%, patients selling property is 55.67%, patients receiving government assistance is 68.33%, patients receiving assistance from private institutions is 21%, patients receiving assistance from family is 78%, and the median value of aid in the last three months is 21.83 USD. Aisyiyah and Terjang provide information on treatment costs, skills training, access to social support programs, and awareness of stigma and discrimination among TB patients. Terjang also provides legal assistance to patients who experience discrimination. This health communication advocacy can enhance social and economic support for TB patients and their families.

Parental and work-related identities among primary caregiving and primary breadwinning mothers and fathers

This study draws on identity theory to explore parental and work-related identities by comparing primary caregivers and breadwinners. It examined how the salience and centrality of identities vary by gender and family role, and the relationships between identities and individuals’ involvement in paid work and childcare. A sample of 236 parents with young children completed extensive questionnaires. As hypothesised, primary breadwinners had more salient and central work identities than primary caregivers. However, there was no difference in parental identities, and within each role category, women had more salient and central work identities than men. Finally, the salience and centrality of parents’ work-related identities were positively related to time investment in paid work and negatively related to hours of childcare. These findings shed light on the complex relationships between family roles, gender and identities and emphasise the importance of distinguishing between identity salience and centrality as two components of self-structure.

POVERTY ALLEVIATION AND EMPOWERMENT OF WOMEN IN SELF-HELP GROUPS: WITH SPECIAL REFERENCE TO MUTUKKADU VILLAGE IN CHENGAPATTU DISTRICT A CASE STUDY

Of the world's 1.3 billion individuals who are relegated to lives of abject poverty, women make up about 70 per cent of the total. Women in India generate 30 per cent of all food commodities but only receive 10 per cent of the country's property or wealth. This disparity exists even though women in India are the primary breadwinners. Despite the considerable contribution that rural women make to their households and the country's economy, they have historically been undervalued and discriminated against in all aspects of life. This makes it evident that women's rights and the protection they receive from societal disparities are insufficient. As a result, specific feasible remedies must be acknowledged and, more crucially, put into action. For economic development projects to be practical, they need to incorporate initiatives that boost the financial standing of women and work to improve their status. Especially among women, developing Self-Help Groups (SHGs) is one of the most effective strategies for empowering women and reducing poverty. SHGs can also help alleviate poverty. SHGs are groups of low-income women who manage themselves and come into being for the primary purpose of aggregating financial resources through the members' savings and lending those resources to one another to satisfy the members' requirements for credit. The typical membership of a SHG is from fifteen to twenty low-income married women residing in the same geographic area. Each SHG operates based on the concepts of self-help, shared trust, and cooperative effort, and each one has its one-of-a-kind method for organizing and managing its own money.
 Aside from that, routine transactions such as savings, granting loans, and collecting payback occur at specific intervals where all members are present, and decisions are made collectively. These are their primary operations. SHGs not only function as a forum for social interactions but also as an alternative social structure for engagement at the peer level. Most of the monies contributed to SHGs were initially put toward satisfying short-term consumption and meeting urgent needs. In recent years, the formation of SHGs has received growing attention as a potentially significant development mechanizing for generating income and employment opportunities among the less fortunate. The Self-Help Groups contribute to an improvement in the status of women as participants, decision-makers, and beneficiaries in the democratic, social, and economic sectors of life, as well as the cultural sphere. The self-help groups have given the women living in rural areas a greater sense of self-assurance, which has helped them do better in their day-to-day lives. This article explores training sessions, members have access to loans for personal needs, education, and business purposes. However, have we considered that some members may struggle to pay back the loans, leading to financial difficulties? While the SHGs have been successful in increasing women's literacy levels, what about women who are unable to participate due to family obligations or other reasons? How can their economic empowerment be addressed? Fishing may be the primary occupation in the studied area, but what about other potential sources of income? Have the SHGs explored other economic opportunities for the members, or are they limited to the fishing industry?

Invested Mothering: An Intersectional Analysis of Mothers’ Feminized Breadwinning Strategies Under State-Mandated Child Support Arrangements

This article conceptualizes invested mothering to explain how mothers typically serve as both primary caregivers and financial providers under court-mandated shared parenting. A line of feminist literature has conceptualized hegemonic expectations of women’s caregiving through the umbrella theory of intensive mothering, and family scholars have studied how these ideologies influence parental investments in children. I assert that more research is necessary at the juncture of this scholarship, especially in contemporary family forms which reflect most parents’ reality. In this study, I analyze 46 in-depth interviews with parents under state-mandated child support arrangements as an empirical case of shared parenting experiences. I show that the onus is on mothers to secure financial resources for children’s basic and enrichment needs through relational, paid, and invisible work strategies—mothers enact invested mothering. An intersectional analysis reveals the distinct invested parenting work that mothers, especially low-income Black mothers who are the most disadvantaged, perform as adaptive strategies in the face of interlocking sexism, systemic racism, and historical economic inequality. Overall, mothers’ financial role as primary breadwinners is feminized as their contributions are unsupported, unacknowledged, and undervalued by both the courts and fathers.

Gender role reversal: Civilian husbands of U.S. military servicewomen as tied‐migrant workers

AbstractObjectiveThis qualitative study examined the experiences of male spouses of female service members in the U.S. military (civilian husbands of servicewomen) in their positions as tied‐migrant workers.BackgroundEmployment of civilian husbands of servicewomen is frequently affected when they geographically relocate due to their wives' military service. Because societal norms for husbands as primary breadwinners in marriages persist and the majority of military couples consist of male service members married to female civilian spouses, civilian husbands of servicewomen may experience a gender role reversal in their identities as a spouse and as a provider within their relationships and military culture.MethodSemistructured interviews were conducted with 22 civilian husbands who experienced at least one geographic relocation due to their wife's military service. Descriptive phenomenological analysis was used to discover the essence of participants' experiences.ResultsThemes around defining masculinity, minority experiences in the military, and nontraditional gender provider roles as tied‐migrant workers emerged. Participants experienced a gender role reversal as tied‐migrant workers and as military spouses, and they had some difficulties integrating into military communities. Participants expanded their masculine identities to include performing traditionally feminine tasks and valuing egalitarianism in their spousal relationships when they experienced barriers to breadwinning.ConclusionFindings indicated the importance of emotional support as civilian husbands navigate their masculine identities and relationships both with spouses and as gender minorities in their communities.ImplicationsClinical recommendations for psychotherapists are provided with an emphasis on using emotionally focused therapy with couples consisting of civilian husbands and servicewomen.

Social Security Policy and Employment Issues of Electronic Workers in Industrial Parks Affected by the COVID-19 Pandemic

The COVID-19 pandemic, countries' responses, and the disruptions of supply chain have all had a significant impact on worker employment and income. Enterprises are required to reduce employee hours in order to maintain productivity, yet many are forced to close their busineses. Because of the low starting compensation, industrial park workers rely heavily on overtime. Because of their low starting compensation, industrial park workers rely heavily on overtime. Workers lose a relatively large amount of revenue due to the decrease in working hours and the loss of overtime pay, and they must attempt to maintain their lives throughout the epidemic season. Those who are the primary breadwinner in the household, have small children, or are caring for someone in need quickly fall into debt if they do not have any savings. Policies on this subject have not been thoroughly addressed, especially for workers in the electronics industries. As a result, this paper focuses on social security policies and the challenges that electronic workers face in industrial parks. The study uses secondary data from well-known local and worldwide organizations as well as some in-depth interview data of electronics workers who received support during the COVID-19 outbreak in 2020-2022. From that, the study aims to provide instructions on how to deal with similar pandemics to COVID-19 in the future.

Fathering Here, Fathering There… A Phenomenological Study of the Impact of Forced Migration and Resettlement on Syrian Refugee Fathers in Canada

Refugee fathers have been largely ignored by family researchers and service providers. This article presents an interpretive phenomenological analysis (IPA) of data from semi-structured interviews conducted between November 2020 and March 2021 with 17 Syrian refugee fathers resettled in Canada. The interviews focused on the meanings refugee men gave to fatherhood, their fathering practices, and the sense they made of their experience of being a Syrian refugee father in Canada. This article highlights how Syrian fatherhood is shaped by cultural norms of the home country as well as by religious beliefs. However, participants’ definitions of fatherhood as head of the household, primary breadwinners and decisionmakers in the family, holding unique positions both within their families and in their communities, shifted during the resettlement process. Following resettlement, these meanings were revisited and redefined. Hyper-fatherhood and adjusted fatherhood practices are new types of fatherhood that emerged during resettlement for Syrian refugees.

The livelihood of Rickshaw Pullers in Dhaka City During Covid-19 Pandemic: A Social Review

Introduction: A rickshaw puller is a worker who makes a living by pulling rickshaws. A rickshaw puller's main task is to transport passengers and goods from one location to another. Their lives are fraught with difficulties. Because of the epidemic condition, the majority of Dhaka's rickshaw pullers are experiencing unemployment and joblessness. The majority of rickshaw pullers are the primary breadwinners in their families. They spend their lives based on their daily earnings; thus, they must pull their rickshaw. Aim of the study: The study aimed to observe the lifestyle of rickshaw pullers during the Covid-19 pandemic, focusing on their livelihood. Methods: This cross-sectional quantitative analytical study was conducted targeting rickshaw pullers of dhaka city only. The study was conducted in a 1-year period, from february 2021 to january 2022, with a total of 200 rickshaw pullers from 3 places in dhaka city, badda, mirpur, and Bashundhara. Result: 55% of the participants were the sole earner in the family, 90% had been married, and only 12% had owned their rickshaws. 96% of participants lived in financial deficiency, 70% had been living in debt, and only 1% had savings. The average work day was 8-10 hours long for the majority (61%) of participants, 89% did not have a habit of wearing a facemask. Among the 178 participants who did not wear face masks, 91.01% cited difficulty in breathing during rickshaw pulling as the cause, while 7.87% said that masks were costly. 96% of participants had a significant decrease in their income. Conclusion: during the statewide shutdown induced by the covid-19 epidemic, the income of rickshaw pullers in the capital decreased. Rickshaw drivers live hand to mouth. They endure regular challenges at work due to limits on their operations such as harassment from passengers and traffic cops.

The Association Between Household Financial Burden and Patient Mobility and Their Impact on Loss to Follow-Up Among Multidrug-Resistant Tuberculosis Patients in Guizhou, China.

We aimed to assess the household financial burden due to multidrug-resistant tuberculosis (MDR-TB) treatment and its predictors, examine its association with patient mobility, and test their impact on patient loss to follow-up (LTFU). A cross-sectional study combining follow-up data collection was conducted at the largest designated MDR-TB hospital in Guizhou. Data were collected from medical records and questionnaires. Household financial burden was measured by the incidence of 2 indicators: catastrophic total costs (CTC) and catastrophic health expenditure (CHE). Mobility was classified as mover or non-mover after the patient's address was verified twice. A multivariate logistic regression model was used to identify associations between variables. Model I and Model II were separated by CHE and CTC. Out of 180 households, the incidence of CHE and CTC was 51.7% and 80.6%, respectively. Families with low income and patients who were primary income earners were significantly associated with catastrophic costs. 42.8% of patients were movers. Patients from households with CHE (ORadj=2.2, 95% CI: 1.1-4.1) or with CTC (ORadj=2.6, 95% CI: 1.1-6.3) were more likely to move. Finding a job against financial difficulty (58.4%) was the top reason for movers. 20.0% of patients experienced LTFU. Patients from households with catastrophic payments (CHE: ORadj=4.1, 95% CI 1.6-10.5 in Model I; CTC: ORadj=4.8, 95% CI 1.0-22.9 in Model II), patients who were movers (ORadj=6.1, 95% CI 2.5-14.8 in Model I; ORadj=7.4, 95% CI 3.0-18.7 in Model II) and primary income earners (ORadj=2.5, 95% CI: 1.0-5.9 in Model I; ORadj=2.7, 95% CI 1.1-6.6 in Model II) had an increased risk of LTFU. There is a significant association between household financial burden due to MDR-TB treatment and patient mobility in Guizhou. They impact patients' treatment adherence and cause LTFU. Being a primary breadwinner increases the risk for catastrophic household payments and LTFU.