Male migration, women’s decision-making autonomy and reproductive health-care utilization in Pakistan

Purpose The purpose of this study is to examine the association between international migration and utilization of reproductive health care among women left behind in Pakistan by male migrants, in comparison with women in non-migrant households. Design/methodology/approach From the nationally representative Pakistan Demographic and Health Survey, 2017–2018, 8,158 currently married women who had delivered a child during the five years before the survey were included. Among the 8,158 women, 811 lived in a household that had at least one international migrant, while 7,347 lived in households without migrant. Descriptive statistics as well as logistic regression was used to analyze reproductive health care. Satisfactory reproductive health was defined as: 4+ antenatal visits; 2+ tetanus injections; delivery in a health-care facility; and delivery by a skilled birth attendant. Findings Logistic regression indicates that women in migrant households had a significantly higher utilization of all four health-care services, after controlling for their autonomy level. However, once background characteristics (woman’s age, education, rural-urban residence and wealth status) were factored in, women in migrant households were not significantly different from those in non-migrant households, except for delivering in a medical health-care facility, the former being 1.3 times more likely to deliver in a health facility than the latter. A higher level of autonomy was associated significantly with greater utilization of reproductive health services. Originality/value This study adds the dimension of international migration to the existing knowledge on utilization of health-care services, a subject that is relatively under researched in Pakistan.