Male Migration, Women Left Behind, and Sexually Transmitted Diseases in Armenia

Long-term Consequences of Men's Migration for Women's Well-being in a Rural African Setting

Labor migration is a massive global reality, and its effects on the well-being of nonmigrating household members vary considerably. However, much existing research is limited to cross-sectional or short-term assessments of these effects. This study uses unique longitudinal panel data collected over 12 years in rural Mozambique to examine long-term connections of women's exposure to husband's labor migration with women's material security, their perception of their households' relative economic standing in the community, their overall life satisfaction, and their expectations of future improvements in household conditions. To capture the cumulative quality of such exposure, we use two approaches: one based on migrant remittances ("objective") and the other based on woman's own assessment of migration's impact on the household ("subjective"). The multivariable analyses detect a significant positive association between "objective" migration quality and household assets, regardless of women's current marital status and other characteristics. However, net of household assets, "objective" quality shows a positive association with life satisfaction, but not with perceived relative standing of the household or future expectations. In comparison, "subjective" quality is positively associated with all the outcomes even after controlling for other characteristics. These findings illustrate the gendered complexities of long-term migration impact on nonmigrants' well-being.

Investigating the Structure of Son Bias in Armenia With Novel Measures of Individual Preferences

Sex ratios at birth favoring boys are being documented in a growing number of countries, a pattern indicating that families selectively abort females. Son bias also explains why, in many countries, girls have more siblings and are born at relatively earlier parities compared with their brothers. In this study, we develop novel methods for measuring son bias using both questionnaire items and implicit association tests, and we collect data on fertility preferences and outcomes from 2,700 participants in Armenia. We document highly skewed sex ratios, suggesting that selective abortions of females are widespread among parents in our sample. We also provide evidence that sex-selective abortions are underreported, which highlights the problem of social desirability bias. We validate our methods and demonstrate that conducting implicit association tests can be a successful strategy for measuring the relative preference for sons and daughters when social desirability is a concern. We investigate the structure of son-biased fertility preferences within households, across families, and between regions in Armenia, using measures of son bias at the level of the individual decision-maker. We find that men are, on average, considerably more son-biased than women. We also show that regional differences in son bias exist and that they appear unrelated to the socioeconomic composition of the population. Finally, we estimate the degree of spousal correlation in son bias and discuss whether husbands are reliably more son-biased than their wives.

Male out-migration and the health of left-behind wives in India: The roles of remittances, household responsibilities, and autonomy

In developing countries, labor out-migration has led to millions of married couples living apart from each other. Male out-migration brings economic benefits to the families in places of origin, but also leads to profound changes in the lives of the left-behind wives. It is unclear how the husband's out-migration influences the health of wives, let alone the mechanisms through which any effects are transmitted. Using data from the Indian Human Development Survey (2004-2005 and 2011-2012), we estimated lagged dependent variable models (N = 19,737) to assess the health impact of husbands' out-migration for women in India. The results showed that left-behind wives had lower self-rated health than wives of non-migrants. Part of this negative health impact was driven by the low remittances sent by the migrant husbands. For both women in nuclear families and women in extended families, the negative health impact was partially attributable to women's added responsibilities, such as animal care and managing a bank account. For women in nuclear families, the negative health effect of husbands' migration has been partially suppressed by women's increased autonomy.

Men's migration and women's mortality in rural Mozambique

Labor migration is widespread and growing across the world. As migration grows, the economic outcomes of migration increasingly diversify, and so do its consequences for the well-being and health of both migrants and non-migrating household members. A considerable body of scholarship has examined the effects of migration on the physical and mental health of 'left-behind' household members. The impact of migration on mortality, particularly of non-migrating marital partners, is less well understood. Addressing this gap, we use data from a longitudinal survey of married women conducted over twelve years in rural Mozambique to examine the association between men's labor out-migration and their non-migrating wives' mortality. The analyses detect no significant differences when comparing non-migrants' wives to migrants' wives in the aggregate but point to instructive variation among migrants' wives according to the economic success of migration, as measured by the effects of migration on the household's material well-being. Specifically, women married to less successful migrants had higher mortality risks over the project span than women married to more successful migrants, regardless of other individual and household-level factors. Importantly for this setting with high HIV prevalence, the advantage of wives of more successful migrants is significant for HIV/AIDS-unrelated deaths but not for HIV/AIDS-related deaths. We situate these findings within the cross-national scholarship on migration and health.

Men on the move and the wives left behind: the impact of migration on family planning in Nepal

Nepali migration is longstanding, and increased from 2.3% of the total population in 2001 to 7.2% in 2011. The estimated 1.92 million migrants are predominantly men. Consequently, 32% of married women have husbands working abroad. Social structures are complicated as many married women live with their in-laws who typically assume decision-making power, including access to health services. This study compares access to reproductive health services, fertility awareness, and decision-making power among a sample of married women aged 15-24 years (n = 1123) with migrant husbands (n = 485), and with resident husbands (n = 638). Predictably, women with migrant husbands had significantly lower contraceptive use than other married women (9.3% vs 30.3%, respectively), and expressed a higher intention to become pregnant in the next year. Despite their intentions, women with migrant husbands scored lower on a fertility awareness index, were less likely to discuss pregnancy planning with their spouse, and less likely to describe their relationships positively. Decision-making for both groups of married women was dominated by both husbands and in-laws in different ways. Yet, across multiple normative scales, fewer women with migrant husbands felt pressure to conform to existing social norms. Married women with migrant husbands reflect a subset of women, with unique fertility issues and desires. Interventions that increase knowledge of fertility among this subset of women, promote healthy preconception behaviours. Linking women for counselling opportunities throughout the pre and postnatal periods may help improve health outcomes for mothers and children.

Is left-behind status related to differences in sexual health of Armenian mothers? Evidence from the Demographic and Health Survey in 2010 and 2015

Background

Migration caused by poverty is a growing public health issue around the world. Migrants are at heightened risk of HIV/STIs and yet the vulnerability to poor sexual health of their left-behind partners, in relation to their household wealth, remain understudied. This investigation examines differences in sexual health from 2010 to 2015 among Armenian mothers, with a specific focus on their left-behind migration status and household wealth.

Methods and findings

Using the population-based Demographic and Health Surveys from Armenia, multilevel logistic models were used to examine the various relationships between sexual health, left-behind status, and household wealth. The multivariate analysis results showed that self-reported sexually transmitted infection (STI) symptoms (AOR = 1.45; p<0.01) and intimate partner violence (IPV) (AOR = 1.45; p<0.01) increased from 2010 to 2015; furthermore, negotiation power over sex (AOR = 0.77; p<0.01) declined among Armenian mothers. Left-behind mothers (LBMs) were more likely to report STI symptoms than their non-LBM counterparts (AOR = 1.61; p<0.01). In addition, significant differences in sexual health between LBMs and non-LBMs with different levels of household wealth were observed. The poorest wealth quintiles were associated with a higher likelihood of self-reported STI symptoms (AOR = 1.74; p<0.05) and IPV (AOR = 1.78; p<0.01), as well as a lower likelihood of utilizing HIV testing (AOR = 0.48; p<0.01) and negotiating power over sex (AOR = 0.47; p<0.01).

Conclusions

This study strives to fill gaps in the literature related to the relationship between left-behind status, household wealth, and sexual health among Armenian mothers in a context of economic expansion. Among these mothers, poor sexual health outcomes increased from 2010 to 2015. Both low household wealth and a left-behind status were associated with adverse sexual health outcomes. These findings suggest future campaigns aimed at improving the sexual health of Armenian mothers need to be migration-status appropriate and socioeconomic-sensitive.

A Cross-Sectional Study to Explore Intimate Partner Violence and Barriers to Empowerment of Women in Armenia

BACKGROUND

Intimate partner violence is a major problem worldwide and it is one of the most social issues in Armenia. Empowerment is one of the important factors that helps women to break the cycle of violence by their husband/partner. The aim of this research is to explore the impact of intimate partner violence on empowerment of Armenian women of reproductive age group.

METHODS

This cross-sectional study used data Armenia Demography and Health Survey Data 2015-16. A total 6116 women were selected from 8749 households at both urban and rural places of Armenia for interview using multistage cluster sampling technique. Data analysis was performed using SPSS version 24.

RESULTS

The respondents aged between 35 and 49 years are more likely to face violence compared to other age group (p≤0.001). The respondents who have no decision-making power, about 89% of them, are experiencing intimate partner violence, whereas only 11% are facing intimate partner violence among those who have decision-making power (p≤0.001). The logistic regression analysis reveals that age of the respondents, number of children in the households, wealth index, and empowerment status are significantly associated with intimate partner violence.

CONCLUSION

Intimate partner violence has significant impact on the empowerment of women in Armenia. This study revealed that women with no empowerment are more likely to experience intimate partner violence compared to those women who are empowered in Armenian society.

Male labor migration, patriarchy, and the awareness-behavior gap: HIV risks and prevention among migrants' wives in Armenia

Unlike in most of the world, HIV incidence in the former Soviet Union continues to rise. While international labor migration has been identified as a potentially important contributor to this trend, most attention has been focused on risks of male migrants themselves. This study uses recent household survey data to examine HIV-related perceptions and actions of migrants' left-behind wives in Armenia. Multivariate logistic regression analyses show that migrants' wives are significantly more likely to suspect their husbands of extramarital sex than are non-migrants' wives. The analyses detect greater worries about HIV infection and a higher likelihood of spousal communication on HIV matters among migrants' wives, compared to non-migrants' wives, but these differences are largely explained by the suspicion of husband's extramarital sex. Finally, no difference between the two categories of women in the probability of consistent condom use with husbands is found. These findings are interpreted within the context of patriarchal culture and unequal gender relations in Armenian society as they are further reinforced by male migration. Implications of these findings for policies to increase women's awareness of HIV risks associated with migration and their ability to reduce those risks are discussed.

Access to antiretroviral therapy and survival in eastern Europe and central Asia: a case study in Armenia

Introduction

Antiretroviral therapy (ART) substantially improves the health of people living with HIV and contributes to preventing new infections. While HIV incidence is decreasing in most regions, the epidemic in eastern Europe continues to rise, as new infections currently outnumber the rate of ART initiation. In this study, we assess ART use in Armenia and its impact on the number of AIDS diagnoses and mortality.

Methods

National surveillance data were obtained from the National Centre for AIDS Prevention, Armenia. Cox-proportional hazard models were used to determine the effect of demographic and clinical risk factors, including access to ART, on AIDS and mortality.

Results

Among people diagnosed with HIV since 2005, approximately 40% per year were diagnosed with CD4<200 cells per mL. Overall, 232 people (57.1%) with AIDS or a low CD4 count had not received ART by the end of 2010. Mortality was 34.1% among people living with HIV who did not initiate ART, and 0.3% among people who received ART. Among people diagnosed with HIV from 1996 to 2010, age at diagnosis, no use of ART, likely mode of transmission, likely place of transmission, low baseline CD4 count and no STI diagnosis at last contact are significantly associated with death.

Discussion

In Armenia, HIV is frequently diagnosed at a late stage of disease, indicating low testing rates. Of people diagnosed with HIV and in need of ART, a large proportion (approximately 60%) either do not provide consent for treatment, or are who migrants who cannot be located.

Conclusions

Globally, the scale-up of ART has resulted in substantial reductions in mortality among individuals initiating therapy. However, in an era of momentum for treatment as prevention, treatment levels are not at adequate levels for preventing morbidities and mortality in some settings. Particular focus should be placed on key at-risk subgroups.

Male labour migration, spousal communication, and STI treatment in Armenia

This study aims to add to the scant research on the association between labour migration and sexually transmitted infections (STIs). It builds upon earlier findings suggesting that left-behind migrants' wives tend to have higher risks of contracting STIs than women married to non-migrants. Using data from a 2007 survey in rural Armenia, a post-Soviet patriarchal setting with high levels of seasonal male migration and high rates of STIs, we examine how migration influences spousal communication about STIs, and how this communication, in turn, affects women's use of medical care for STI-like symptoms. The results of random-intercept logistic regression models show that migrants' wives were significantly more likely to talk about STI-related risks with their husbands than were non-migrants' wives. However, among women reporting STI-like symptoms in 12 months before the survey, migrants' wives were less likely to have talked to their husbands about these symptoms. We also find that women married to migrants were less likely to seek professional care for their STI-like symptoms than those married to non-migrants, but this association was moderated by women's communication about these symptoms with their spouses.

High adult sex ratios and risky sexual behaviors: a systematic review

Background

Thirty-four countries worldwide have abnormally high sex ratios (>102 men per 100 women), resulting in over 100 million missing women. Widespread sex selective abortion, neglect of young girls leading to premature mortality, and gendered migration have contributed to these persistent and increasing distortions. Abnormally high adult sex ratios in communities may drive sexually transmitted disease (STD) spread where women are missing and men cannot find stable partners. We systematically reviewed evidence on the association between high community sex ratios and individual sexual behaviors.

Methods and Findings

Seven databases (PubMed, Web of Science, Embase, Scopus, The Cochrane Database of Systematic Reviews, Sociological Abstracts, and PopLINE) were searched without restrictions on time or location. We followed PRISMA guidelines and evaluated quality according to STROBE criteria. 1093 citations were identified and six studies describing 57,054 individuals were included for review. All six studies showed an association between high community sex ratios and individual sexual risk behaviors. In high sex ratio communities, women were more likely to have multiple sex partners and men were more likely to delay first sexual intercourse and purchase sex. Only two studies included STD outcomes.

Conclusions

High community sex ratios were associated with increased individual sexual risk behavior among both men and women. However, none of the studies examined unprotected sex or appropriately adjusted for gendered migration. Further studies are needed to understand the effect of community sex ratios on sexual health and to inform comprehensive STD control interventions.