The impact of rural-urban migration on child survival in India

Abstract

This thesis examines the impact that rural-urban migration has on child survival in India, and explores whether Brockerhoff's (1990) three-level relationship between migration and mortality can be applied to the Indian context. The Indian National Family Health Survey (1992) data is used for all 25 states of India, and logistic and multi-level logistic models are fitted for mortality outcomes in three periods, neonatal, early post-neonatal, and late post-neonatal/toddler. Models are fitted for north, south, and all-India with rural-urban migration as the key covariate of interest. The models control for socio-economic, bio-demographic, environmental, and health utilisation factors, and the clustering of cases within households and primary sampling units. Logistic models are used to examine the inter-relationships that exist between the determinants of child mortality, and to establish indirect routes through which migration status may influence child survival. In depth case studies were undertaken in Mumbai, examining the utilisation of maternal health care among rural-urban migrant and non-migrant groups. The results of these case studies are used to enhance the findings of the statistical modelling of mortality.

The results of the modelling of mortality show that, at the all-India level, migration status is not a significant determinant of mortality in any of the three periods analysed. However, the socio-economic status and use of maternal health care services of rural-urban migrants is between that of the rural and urban non-migrant groups, suggesting a three-level relationship between migration status and some of the determinants of child mortality. Hence, there are indirect routes through which migration status influences child mortality. In north India rural-rural migrants display higher odds of neonatal mortality than rural-urban migrants. The differences in socio-economic status and the use and availability of health services are suggested as the cause of this relationship. In south India urban-non migrants display lower odds of late post-neonatal and toddler mortality than rural-urban migrants.

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