A cross-country analysis of the effects of spousal migration on health care access for families left behind.

Introduction: Health care utilization is affected by outmigration in communities around the world.

Methods: This quantitative cross-sectional study evaluated the impact of male spousal migration on women and children's health care access and utilization in high-outmigration contexts using nationally representative Demographic and Health Surveys from Bangladesh, Indonesia, Nepal, and the Philippines (71 045 married women aged 15-49 years).

Results: Having a migrant spouse was associated with a significant reduction in the probability of experiencing any barriers to care (adjusted odds ratio [aOR]: 0.83; P < .001), permission (aOR: 0.864; P < .01), financial (aOR: 0.839; P < .0001), and traveling-alone barriers (aOR: 0.899; P < .001). The greatest reductions in the odds of experiencing any barriers, and the specific permission, distance, and not being able to go alone barriers, were seen in Indonesia. In Bangladesh and Nepal, financial barriers were the most sensitive to migration. Despite these improvements in access to care, spousal migration was not a significant predictor of postpartum care utilization or health care use for children experiencing fever or diarrhea.

Conclusion: These results suggest health systems and policies may need to attend to maternal and child health care needs and gender inequalities that outmigration does not directly address through accompaniment programs, telehealth policies, and interventions at multiple levels of society to improve women's status.