Project 2c
Migration and Child Survival in India

Summary
Most developing nations continue to struggle with persistently high rates of infant and child mortality and morbidity. The existence of rural-urban child mortality differentials in favour of urban areas suggests that rural-urban migration can improve childrenÁs survival chances (Brockerhoff 1994). However, studies investigating the relationship between migration and child survival in multivariate frameworks have sometimes found that migration status is not a significant mortality determinant (Stephenson et. al. 2003). However, once variables controlling for differences in socioeconomic status and use of health services between rural-urban migrant and non-migrant groups are omitted from the models, migration is an important factor explaining mortality. This finding suggests that the relationship between migration and mortality is explained by these differences. Other studies have found that children of female migrants from the countryside generally have much poorer survival chances than other urban children (Brockerhoff 1995). But it also appears that, in the largest cities at least, childrenÁs urban survival advantage over rural areas has narrowed considerably over time (Brockerhoff and Brennan 1998).

A number of studies on child survival focus attention especially on the role of parents (mothers in particular) as they are recognised to be the most common caregivers and are likely to determine compliance with health programs (Finerman 1995). Cultural and ideological contexts in particular are considered significant in understanding how parental responsibility, their assessment of health risks, their social and economic aspirations frame child survival outcomes (Bledsoe et.al 1988, Scheper-Hughes, 1985, 1987, Basu 1990, Dasgupta, 1990). In India, for example, such issues are crucially related to a noted discrimination against girls and female infanticide (Bose and Shiva, 2003). These studies although not directly linked to migration per se will provide a critical anthropological dimension to explore the meanings of migration for children's health and survival.

This project will investigate some of these issues for India. It willl draw on both demographic (K.McNay) and anthropological (M.Unnithan) expertise and perspectives. IndiaÁs two National Family Health Surveys will provide a useful starting point. One of the investigators already has experience of working with this material in a related area (McNay 2003). The surveys will enable us to explore differences in infant and child mortality by female migration status and length of stay in the current place of residence. Given the importance of differences in heath service utilisation between migrant and non-migrant groups suggested by previous research, we will also use the surveys to undertake a preliminary investigation of these differences. These findings will be enhanced by qualitative research involving a short period of fieldwork in Northwest India at a site in which previous work on a closely related topic has already been undertaken by one of the investigators (Unnithan-Kumar, 2003). In this work she found that the effects of migration on poor rural women migrants in terms of enhancing their reproductive choices was not clear cut. The ambivalence of these women to migration as resulting in enhanced reproductive choice was also reflected in their poor demographic outcomes compared to the non-migrant rural poor women.

Key Research Questions

	Does rural-urban migration of the poor improve infant mortality and child survival?
	Does increased proximity to a range of health sevices as a result of rural-urban migration result in better chances of child survival among the urban poor?
	How do the survival chances of children of poor rural female migrants compare with those of poor female urban non-migrants?
	What are parental roles in child survival across migrant and non migrant groups?
	Do the chances of female infant survival vary between migrant and non-migrant groups?