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Health Status of Children Left Behind in Rural Areas of Sichuan Province of China: a Cross- Sectional Study Daisheng Tang1†, Weng I

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Health Status of Children Left Behind in Rural Areas of Sichuan Province of China: a Cross- Sectional Study Daisheng Tang1†, Weng I Tang et al. BMC International Health and Human Rights (2019) 19:4 https://doi.org/10.1186/s12914-019-0191-9 RESEARCHARTICLE Open Access Health status of children left behind in rural areas of Sichuan Province of China: a cross- sectional study Daisheng Tang1†, Weng I. Choi2†, Liyuan Deng3, Ying Bian2 and Hao Hu2* Abstract Background: In recent decades, many workers from rural areas in China migrated to urban cities in search of a better livelihood. Due to the household registration policy and other financial barriers, more than 40 million of children were left behind in their rural home by their migrated parents in 2015. In this cross-sectional study, we aimed to investigate the influence of being left behind on these children’s physical and mental health. Methods: A self-administered questionnaire was completed by participants about their demographic background and health status. Chi-square Test was conducted to investigate the influence. Results: A total of 1662 participants responded and completed all the questions in the questionnaire. Significant differences existed between left-behind children group and non-left-behind children group on several health issues such as not going to school due to sickness (p = 0.080), completeness of the vaccination scheme (p = 0.036) and feeling of loneliness (p = 0.039). However, regarding symptoms like fever, cough or respiratory difficulties, diarrhea and twitch, as well as mental health problems like unhappiness and insomnia, no significant difference was found. Gender difference was also demonstrated showing that girls were more vulnerable than boys to certain symptoms and emotional problems. Conclusion: This study indicated that both being left-behind and gender had an impact on the children’s health. It is necessary to further reform the household registration system to improve rights of equal access to employment, education and health resources for workers and their children from rural areas in China. Keywords: Left-behind children, China, Physical health, Mental health, Household registration Background the population not working and living in their registered Under the promulgation of economic reform policy in residential place for six months or longer. According to 1978, China has transformed from a planned system to a the 2010 Population Census of The People’s Republic of market-oriented economy, resulted in an accelerated China, the number of migrant works numbered at more process of industrialization and economic growth. In than 170 million [1] as compared to 22 million in 1990 order to fulfill the tremendous labor demand, govern- [2]. Until now, the increasing trend is still accelerating mental policies were issued to permit and even encour- due to the uneven economic development between age the labor migration from rural to urban areas. urban and rural areas. This dramatic increase in prod- Meanwhile, rapid development in agricultural technol- uctivity explained why China’s Gross Domestic Product ogy reduced the labor demand in rural areas. Conse- (GDP) has remarkably risen from 19 billion United quently, a large-scale internal rural-to-urban labor Stated Dollar (USD) in 1980 to 12 trillion USD in 2017 migration was resulted. Migrant workers were defined as [3, 4]. However, this economic prosperity was also asso- ciated with various social issues such as the emergence * Correspondence: [email protected] † of left-behind children, raising general awareness within Daisheng Tang and Weng I. Choi contributed equally to this work. hukou 2State Key Laboratory of Quality Research in Chinese Medicine, Institute of the society. Household registration ( ) system Chinese Medical Sciences, University of Macau, Macao, China which was established officially in 1958 is one of the Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Tang et al. BMC International Health and Human Rights (2019) 19:4 Page 2 of 11 underlying causes for the left-behind children (e.g. height, weight, dietary intake etc.) [16–18]. Due to phenomenon. Under this system, each Chinese citizen weak parent-child bonding, left-behind children were was registered according to his/her permanent residen- more likely to experience unhappiness, depression, loneli- tial area, based on which the residents were conse- ness, anxiety and to consider leaving home prematurely quently classified into rural or urban categories. This among Asian populations [19–22]. Studies conducted in classification led to unequal accessibility to governmen- Asian countries and Caribbean area reported that tal resources between rural and urban residents, includ- left-behind children were more likely to have unhealthy ing education, healthcare and retirement pension etc. behaviors, such as physical inactivity, internet addiction, The residents in rural areas usually had less access to smoking and being overweight [19, 23–27]. Moreover, employment, education and healthcare resources. Des- lower coverage rate of vaccination, lower medical services pite the relaxation of this household registration policy utilization, and lower health expenditure were observed over decades, the overall situation was still not favorable among left-behind children [17, 28]. On the other hand, for the migrants relocating their families to urban area. some studies showed no differences in aspects of psycho- It is particularly difficult for the migrants’ children to logical and behavioral problems between left-behind chil- move in order to receive education at urban public dren and comparison group [29, 30]. It was even found schools due to the limits of household registration sys- that left-behind children had a higher height-for-age tem. Therefore, a large population of children and eld- z-scores among Central American and Central Asian pop- erly were left behind in their residential places. ulations [31, 32]. The affected children being left behind has been Global studies suggested that parents played a key role booming due to the unprecedented internal migration. in children development through their communication, Compared with the data in 2000, more than 40 million support and supervision. With such influential impacts, children were left behind in rural home in 2015, ac- scholars from various field have investigated impacts of counting for almost 15% of total children population [5]. family separation, such as divorce or death of one of the This increasing group represents an important segment parents, on multidimensional developmental outcomes of of youth population and warrants public concerns over children, including health, education and behaviors etc. the profound effects. On one hand, better employment [33]. Among these, a small portion of studies examined and higher income can improve the financial situation of the influence of migration-induced parental absence [27]. the rural family [6, 7]. With improved financial income, Due to the late emergence of left-behind children in the children’s living condition, nutrition and health sta- China, most studies mainly examined the issues in west- tus could be improved [8]. Apart from materialistic ben- ern countries, such as Mexico and Philippines, in where efits, migrants may widen their horizon and gain left-behind children was a prominent phenomenon. inspiration through their work life in urban areas [9]. Previous studies conducted in China have researched Subsequently, left-behind children might benefit from about the impacts of parental migration on education the exposure to new environments and perspectives. and psychological health. At present, little research fo- Taking education as an example, migrated parents might cuses on the impact on physical health of left-behind become more aware of the importance of the education children. There is only limited research on the physical quality for their children [10]. However, being separated health of the left-behind children which only reported from the parents could also be problematic not only to about whether the participants feel sick or not during a the development of a parental relationship, but also to given period of time. The data about the impact on spe- the children’s health, academic result and performance cific health signs and symptoms, utilization of medical in school, and sense of security. As reported previously services, coverage and concepts of vaccination remains about school performance, left-behind children had scarce. In addition, mixed results were yielded from the poorer academic result than those whose parents did literature concerning the impact on the left-behind chil- not migrate [11]. dren. As the current empirical result in China is limited It has been well reported that family structure and care and inconclusive, further studies are warranted to fur- is always one of the dominant factors affecting children’s ther determine whether there is any difference in the de- development [12–15]. Lack of parental support and
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