MIGRATION OF GIRLS & WOMEN

Carol S. Camlin, PhD, MPH Dept. of Obstetrics, Gynecology & Reproductive Sciences

& Center for AIDS Prevention Studies University of California, San Francisco

Summer Institute on Migration and Health

24 July 2015, Oakland, CA

CONSEQUENCES FOR THEIR EMPOWERMENT

& HEALTH

Migrant adolescent girls and women: an important population in a world

undergoing rapid social transformations

International migration is increasing…

… and about half of all int’l migrants are female

Source: P. Martin, Population Reference Bureau, 2013

A feminization of int’l migration is underway

Percentage of women among all international migrants, 1990-2013

Source: UN Dept of Economic & Social Affairs, 2013

A global feminization of internal migration underway even longer (since ~1970s)

• Most migration is internal migration • Intra-sub Saharan Africa (SSA) emigration rate (65%) =

largest movement of people in the world (IOM 2005)

• Even in Africa, ≥ half of internal migrants are female (it’s not just truckers & miners) • Internal migration rates peak in young women

• Novel, complex forms of mobility are starting to predominate, because of women’s participation

Migration a major force for development – especially female migration

• Migration an important livelihood strategy for poor groups across the world • It’s not only a response to household shocks (IOM 2005)

• Female migration particularly benefits the poorest of the poor

• Migration as a force for development – especially women’s migration – is under-recognized

• Women's migration as a consequence of empowerment

• Changes in gender norms lifting of traditional constraints on women’s migration (Bozzoli 1991, Chant & Radcliffe 1992, Todes 1998, Jones 1994)

• Women's migration as a cause of empowerment

• Employment in destinations puts resources under women's control increased valorization as contributors to household income more equitable gender relations

• Provides opportunities to achieve aspirations, e.g. for autonomy, independence, and more gender-equitable relationships

(Assogba and Fréchette 1997, Lesclingand 2004, Hunter 2007, Camlin 2013)

Migration also a major force for women’s empowerment

Our research among female migrants in Kenya

Dignity, self-confidence & self-sufficiency • “I can now survive and look after myself.”

• “I can live independently… I have learned how to manage my finances.”

• “I can now see and detect when someone wants to harm me.”

Autonomy in decision-making • P2: “There are things that I can now do on my own that gives me joy and pride. If you

are living with someone, there are things that you cannot do because of fear. But now I feel liberated…. Ultimately it is me who gets to choose what to do and what not to do, not someone else.”

Social capital • “…coming to Kisumu has connected me to many other people”

• “I came to Kisumu and met a lot of friends… These are people who even advised me to have an HIV test […] These friends helped me to get a market stall.”

Improved gender relations in household • “We have in fact loved each other more than ever. We both make our money and no

one is a burden to the other.”

• “Nowadays he is a gentleman. He asks for things in a polite tone. His approach towards me is kind unlike in the past when he used to beat me and hurl insults at me.

But migration has negative health consequences, e.g. increased risk of HIV

• Aims of my studies in Kenya since 2008: • Characterize forms of mobility among women

• Describe spatial & social features of key destinations

• Describe behaviors and factors in social contexts that

facilitate risks for female migrants

• Test strategies to sample populations of highly mobile

women for surveys of mobility & HIV prevalence

Kibuye female market trader survey (2014)

Design:

1. Every market stall mapped

using GPS coordinates,

along with gender of trader

• Sampling frame: Total N=

6,674 stalls

2. Sample of n=306 stalls with

female traders randomly

selected from sampling

frame

Kibuye female market trader survey: HIV

prevalence

Overall: 25.8% (21.2 - 31.0, 95% CI) • Higher than Kisumu County prevalence in women in 2009 (20.9%) and

KAIS estimate for Kisumu women ages 15-49 (15.1%) in 2013

11.6

29.3 27.4

0

10

20

30

40

50

18 to 24 25 to 34 35 or older

Pro

po

rtio

n

HIV Prevalence (95% CI) by age group

Results of qualitative research (2010-2013)

Aspects of women’s migration experiences that may facilitate HIV acquisition risk at origin:

Before migration:

Widowhood

Separation or divorce

Gender-based violence

Exposure to HIV from spouse or ‘inheritor’ LOSS of property, housing, land, livelihood Social isolation & vulnerability

Results

Aspects of women’s migration experiences that may facilitate HIV acquisition & transmission risks at destination:

• Transactional sex among female informal sector traders: “she mixes her business”

• At beaches, participation in sex-for-fish economy - “jaboya system”

• High HIV risk behavior and vulnerability to sexual assault among house-helps

Transactional sex & commercial sex work among traders: Covert Overt

Source: internet (no copyrights)

The sex-for-fish economy at Lake Victoria

Photos: C. Camlin

Highly mobile women in western Kenya

• At high risk of transmitting HIV • Circumstances that drive migration, e.g. widowhood, also increase HIV risk

at origin

• At high risk of acquiring HIV infection • Migration contexts facilitate multiple main partners, transactional sex,

CSW

Conclusions re: HIV risks

Conclusion

Highly mobile women in western Kenya

• At high risk of transmitting HIV • Circumstances that drive migration, e.g. widowhood, also increase HIV

risk at origin

• At high risk of HIV acquisition • Migration contexts facilitate multiple main partners, transactional sex,

CSW

• Migration can be empowering • But women are still disempowered relative to men

• Thus are still at higher risk of HIV because of disempowerment

In conclusion

• Migration processes for women provide opportunities for empowerment that could be better harnessed

• Gender empowerment is the critical next step to mitigating the negative health consequences of migration

Acknowledgments

• Participants in the research

• Co-Investigators and collaborators: Z. Kwena, E. Bukusi (Kenya Medical Research Institute-KEMRI), C. R. Cohen, S. Dworkin, M. Johnson, T. Neilands, M. Comfort, W. McFarland (UCSF)

• Research team members: L. Achiro, S. Ambunya, M. Okumbo, P. Olugo, C. Makokha, D. Ang’awa (KEMRI)

• Funders • NIMH: (1K01MH093205-01)

• NIAID: UCSF-Gladstone Institute of Virology & Immunology Center for AIDS Research (CFAR) (P30 AI27763) & UC Berkeley Fogarty Int’l AIDS Training Program (AITRP), NIMH: UCSF-CAPS (2 P30 MH-062246-11)

• University of California Global Health Institute (Junior Faculty Fellowship)