Table of Contents
Research Design and Sampling
Data Collection Instrument and Measures
Data Collection and Data Analysis
Personal Characteristics of the Respondents
Lifestyle Pattern of the Respondents
Presence and Use of Protective Mechanisms
Health Conditions of the Respondents
Factors Associated with Their Health Conditions
Health Conditions of Adolescent Left behind by OFW-Parents
Factors Associated with the Health Conditions of Adolescent Left Behind by OFW-Parents
Self-rated Health Conditions of Adolescents Left Behind
by Migrant Parents from the Philippines
Myla M. Arcinas
This study examined the association of the health conditions of adolescents left behind by their Overseas Filipino Worker (OFW)-parent/s working abroad with their personal characteristics, lifestyle patterns, and use of protective mechanisms. Using a multi-stage sampling design, 400 school-going adolescents aged 13-17 were surveyed, with the use of a group administered questionnaire. Data were analyzed using descriptive statistics and multivariate ordinal logistic regression. Overall, the adolescents were found to be in good health. Of the five domains of health examined, their social and spiritual health domains were found to be moderately healthy, compared to their emotional health condition with good rating, and their physical and psychological health conditions with very good health ratings. Their overall health condition was tested for association with their personal characteristics, statistically significant predictors found were adolescents’ sex and family size. Females have better overall health condition compared to male adolescents, and those who belong to a family with > 6 members have better overall health condition compared to those <6. On their lifestyle pattern, those with good nutrition, good hygiene practices, and less engagement with vices have better overall health condition. On the use of protective mechanisms, those with strong attachment with their OFW parent/s were found to have better overall health condition and able to manage challenges of parent absenteeism. Their spiritual health condition was negatively affected the most by the absence of the OFW mother while their social health condition was found to be negatively affected by their erratic communication pattern with the parent/s away.
Keywords: international labor migration, children left-behind, adolescent, health, parents working abroad, Overseas Filipino workers, Philippines
International labor migration from the Philippines has began over four decades ago. It has since become routine for the country’s economy and many Filipino families to rely on the remittances sent home by Overseas Filipino Workers (OFWs) (Parreñas, 2006). In 2015, the World Bank (WB) Report named the Philippines as the third largest recipient of migrant remittances in the world, following India and China (World Bank, 2016; Ratha, Yi, & Yousefi, 2015). OFW remittances are highly lauded, for these bring better economic benefits for the country. The Cenral Bank of the Philippines (CSB) reported that cash remittances sent via the formal banking networks by overseas Filipino workers (OFWs) amounted to $25.76 billion in 2015, up 4.6 percent from $24.63 billion in 2014 (Chipongian, 2016 at http://www.mb.com.ph/ofw-remittances-reach-25-8b-in-2015/#z6zH73b6eB4ZhCQb.99). Remittances sent enabled the family left behind to ease household budget constraints, send children left behind to school, and improve children’s health (Alcaraz, Chiquiar, & Salcedo, 2012; Yang, 2004; Cox-Edwards & Ureta, 2003).
The Philippines is named as top three labor sending nations in the world (World Bank, 2016); Ratha, D., et al., 2015). In 2013, the Commission on Filipino Overseas (CFO) reported a stock estimate of Overseas Filipinos of 10, 238, 614 worldwide (http://www.cfo.gov.ph/index.php?option=com_content&view=article&id=1340:stock-estimate-of-overseas-fili-pinos&catid=134). It is important to note, however, that there is a continuous increased in the number of Filipinos leaving the country to work abroad. In 2014 alone, POEA reported a total 2,391,152 contracts processed for deployment. As a consequence, POEA gave a higher approximation of 9.5 million to 12.5 million OFWs in different parts of the world. And, as many of the overseas FIlipinos tend to be young, married, and have children, migratory separation between one parent or both parents and their child or children is thus a natural consequence (Asis & Ruiz-Marave, 2010). Though there is no systematic data on the number of children left behind (CLB) by OFW parents, Reyes (2009) estimated about 9 million children in the country were living away from one of their parents or both parents due to foreign employment.
Parent migration, which inherently involves parental physical absence from home, threatens the parent-child subsystem/relations (Bowen, undated) and is a stressful situation that can have undesirable effects on the child’s health outcomes (Tong, Luo, & Piotrowski, 2015; Mazzucato, Cebotari, Veale, White, Grassi, & Vivet, 2015; Smeekens, 2013; Xu, S., Zhu, H., & Li, 2013.; He, Fan, Liu, Li, Wang, Williams, & Wong, 2012; Graham, E., & Jordan, L. P., 2011; Carandang, 2007; University of the Philippines, Tel Aviv University & Kaibigan, 2002; Batistella & Conaco, 1998). Parents, being the most immediate persons in a child’s life, are their significant source of strength, guidance and inspiration (Glascoe, 1998). The absence of one parent or both due to foreign employment, hence, does not just alter the family structure and its functioning. It also affects the lifestyle of the children left behind, and can also eventually affect the latter’s health condition (Smeekens, 2013; Carballo & Mboup, 2011; Ma, 2010; Chen, 2011; Stroebe, Folkman, Hansson, & Schut, 2006; Battistella, G. & Conaco, M. C. G., 1998; Lazarus and Folkman, 1984; Bowen, undated).
The health of left-behind children is a special concern since it predicts the future development of a nation. Examining health is not easy. The World Health Organization (WHO) refers to health as the “dynamic state of physical, mental, spiritual, and social well-being and not merely the absence of disease or infirmity” (WHO, 1948 and 1998 in Grad, 2002). Thus, key health domains include: 1) Physical, 2) Mental, 3) Emotional, 4) Social, and 5) Spiritual. Measuring health is also very intricate and maybe measured not only through bio-medical science but also via self-reporting or self-rating. Self-rated health is a powerful predictor of mortality and is a reliable and valid measure for assessing the subjective and objective health of individuals (Snead, 2007).
Studies on adolescent left behind by OFW parents are limited. Asis & Ruiz-Marave (2010) and Smeekens (2012; 2013) have directly examined the impacts of parent separation (OFW-parents) on the health condition of adolescent left behind and interestingly, contrasting results were found. Smeekens (2013, 2013) observed negative effects on the health conditions of the adolescent left behind, while Asis & Ruiz-Marave (2010) concluded otherwise and showed that there is no difference between the health condition of CLB and that of children of non-OFW-parents. These two studies have addressed health in terms of physical and psycho-emotional conditions of the children left behind and did not cover their spiritual health. With WHO’s new definition of health, a comprehensive understanding of the CLB’s health condition is thus necessary in order to give a more complete picture.
OFW-parent/s sacrifice being away from their child/children in order to be able to give the best to them. Aside from addressing their nutritional and educational needs, medical expenses or health care of the child/children are a major concern that OFWs spend their remittances on (UN-INSTRAW, 2005; Bryant, 2005, 2007; Garcia-Dungo, 2007; Scalabrini Migration Center, 2005; UNESCAP, 2008 cited in Kofman & Raghuram, 2010). With the benefits that the country has gained from the remittances sent by OFWs, it is but right that the health conditions of their child/children be given attention. Concrete evidence is therefore needed for effective policy formulation and program design, but with scarce studies that show mixed or contrasting research findings, additional research is desired to validate results from previous studies done. This is the raison d'être for the present study. It seeks to focus on the health condition of the adolescent left behind of OFW-parents. Adolescent left behind by OFW-parents need effective policies and programs that can maximize the positive effects of parent/s’ migration and can minimize its negative effects, particularly with regard to adolescent left behind health conditions.
Children left behind by OFW parents are of different age groups. This study focuses on the adolescents left behind by OFW parents. The adolescent years are crucial since it is at this stage of development that they encounter many physical, emotional, and personal changes. Such changes are sometimes confusing but are normal parts of growing up, from being a child to an adult (Simpson, 2001). The body develops as do intellectual characteristics; moods may be unpredictable, while some personal and social issues like the formation of self- identity, self- esteem and peer pressure enter the picture. Concerns at this stage may lead to involvement in some risk-taking behaviors (Steinberg, 1997; ). The presence of parents helps the child cope with all the challenges taking place that also have health implications. A WHO report shows that while most adolescents are healthy, there is still significant deaths, illnesses and diseases among adolescents. Illnesses can hinder their ability to grow and develop to their full potential. Promoting healthy practices during adolescence, and taking steps to better protect young people from health risks, are critical for the prevention of health problems in adulthood, and for countries’ future health and social infrastructure. Adolescent health, therefore, is crucial to the health of the whole population and the economic development of nations (Viner, et al. 2012).
This study has aimed to describe the health conditions of adolescent-children left behind (ages 13-17) by OFW parents and to determine factors that predict their health conditions. It examines how their health condition is associated with and predicted by their personal characteristics, lifestyle patterns, and their use of protective mechanisms, given the challenges of being a child left behind by one OFW parent or both parents working as OFWs.
The family systems theory, introduced by Murray Bowen (n.d.), views the family as a dynamic, interactive unit that undergoes continual evolvement in structure and function as it relates with the supra-system. Families are seen as systems of interconnected and interdependent individuals, none of which can be understood in isolation from the system. There are subsystems that are discrete units, such as mother-father, sister-brother, and parent-child [father-child and mother-child]) and there is a supra-system (the society/community). The main functions of the family are to provide support, regulation, nurturance, and socialization; specific aspects of the functions change as the subsystems interact with the supra-system. The change in functions or roles may maintain the stability of the family as a unit or a subsystem within a family, but it may also lead to dysfunctions that affects the family as a unit or members of the family or its subsystems.
The wave of international labor migration from the Philippines has started over forty years ago. Around 11 million Filipinos are spread over different parts of the world (CFO, 2013). As Filipinos migrate outside the country for employment, many families need to live away from a family member working abroad. While the benefits of remittances sent by Filipinos abroad to the country’s economy and their families cannot be denied (Parreñas, 2006), the structure and function of the family slowly evolves to accommodate the demand for more Filipinos to work abroad. The Family Systems Theory allows one to understand the organizational complexity of families, as well as the interactive patterns that guide family interactions.
OFW families are unique and complex in themselves. As many Filipino migrants are parents with children, many children need to live away from their OFW parents. The migratory separation between one parent or both parents and the child is thus a natural consequence (Asis & Ruiz-Marave, 2010) that disrupts the family structure and function. This could affect the state of health of the children left behind. International labor migration of the parents disrupts the parent-child subsystem which could be distressing, more so for the child left behind. This study examines the health conditions of adolescents that is, those 13 to 17 years of age left behind by OFW-parents. It has also aimed to examine the association of their health conditions with their personal characteristics, lifestyle patterns, and use of protective mechanisms (see Figure 1).
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Figure 1: Conceptual Schema
The personal characteristics of the adolescent left behind by OFW parents covered their socio-demographic and family characteristics. Socio-demographic characteristics included their age, sex, grade level, birth order, and religious affiliation. Family characteristics included their family type, family size, parent working abroad, and the sex of the main care provider. Lifestyle patterns examined include day-to-day behavioral patterns or living routines of the children that can be said to contribute to healthy or unhealthy living. Lifestyle patterns in this study cover four areas: health and nutrition; personal hygiene and cleanliness; pattern of sleeping behavior; and personal interests and engaging in vices. Lastly, this study looks at the extent to which selected protective factors can positively or negatively influence or affect the health condition of adolescents left behind by OFW-parents. Protective factors referred to conditions present and used by the child to cope with their situations or circumstances as children left behind by OFW-parents. Protective factors included their level of attachment to the parent away, pattern of communication between the parent and the child, parent’s behavior in monitoring and supervising the child; level of family functioning resiliency; pattern of social emotional support from family members and others, availability of concrete support, and the social and emotional competence of the child.
Research Design and Sampling
The study used a descriptive research design as it aimed to examine the health conditions of adolescents left behind by Overseas Filipino Worker (OFW)-parents. It also aimed to determine the association of their health conditions with their personal characteristics, lifestyle pattern, and their use protective mechanisms. A quantitative methodological approach, with the use of the survey method, was used to generate data. A structured questionnaire was used to gather the data.
A multi-stage geographical cluster/area probability sampling was used in the study. The province of Laguna was identified as its research locale, with its distinction of being the top three province in Region IV-A with the most number of OFWs sent outside the country and the top three province with the highest remittances sent to the country. In 2014, Region IV-A (known as CALABARZON) was named by POEA as the region in the country with the most number of OFWs sent outside the country followed by Region III (Cental Luzon) and the National Capital Region (Metro Manila) on the third post.. All these three regions are based in Luzon.
In 2000, there were 30,802 OFWs in the province of Laguna (NSO Quickstat, September 2013) and current estimates show around 120,000 children left behind by OFW-parent/s in the province of Laguna. From the above data, four hundred (400) adolescents left behind by OFW parents from the Province of Laguna were included in the study. The following criteria were used in the selection of respondents: 1) should be between 13 to 17 years old during the conduct of the survey, 2) should have a parent or both parents working abroad for at least a year, and 3) should be officially enrolled in one of the schools identified in the research locale.
Data Collection Instrument and Measures
A structured questionnaire, with closed ended questions, was used as the study’s data collection instrument. It was divided into 4 major sections: 1) personal characteristic of the respondents, 2) lifestyle pattern, 3) protective mechanisms, and 4) health conditions.
The Personal Characteristics of Adolescents Left Behind by OFW-parents include variables such as their age, sex, grade level, birth order, religious affiliation, family type, family size, parent working abroad, and the sex of the main care provider.
Lifestyle Pattern considered 4 domains: 1) Health and Nutrition (eating pattern and schedule, type of food served at home and preferred food, vitamins intake, number of times sick within a year, experience of sickness or hospitalization); 2) Personal Hygiene and Cleanliness (hygiene pattern - bathing schedule/routine, tooth brushing, hair cutting, nail cutting, clothes worn at home and outside home); 3) Sleeping Behavior Pattern (schedule of sleeping at home, behavior before and after sleeping, sleeping alone or with someone, person who assists before and after a night of sleep); and 4) Personal Interest and Vices (personal hobbies, interest in arts and engagement in sports, computer/internet use, playing computer games, smoking).
Protective Mechanisms looked into the presence and use of seven domains: 1) Attachment to the Parent Who is Away (bond between the parent who is away and the child); 2) Communication Pattern (number of times they talk, mode of communication, degree of openness to the parent on the topics discussed); 3) Monitoring and Supervision (ways to control or regulate behavior, type/forms of rewards/punishment); 4) Social and Emotional Competence of the Child (understanding and utilizing effective management techniques to develop and sustain appropriate emotional disposition and sustain relationship with others - level of self-esteem, level of maturity, level of acceptance/adaptation to stressful situations); 5) Family Functioning Resiliency (adaptive skills and strategies to persevere in times of crisis, family’s ability to openly share positive and negative experiences and mobilize to accept, solve, and manage problems); 6) Social Connection (perceived informal support [from family, friends, neighbors, classmates, teachers] that helps provide for emotional need); and 7) Concrete Support ( access to tangible goods and services from friends, neighbors, private and government institutions to cope with the absence of one or both parents in the family).
Health condition was examined based on five domains: 1) Physical Health (appetite, exercise, intake of vitamins/medicines, hospitalization); 2) Psychological Health (level of child’s cognitive/mental maturity to cope state of mind or level of mental capacity to accept the truth of the situation/circumstances of being a child left behind by OFW-parent/s); 3) Emotional Health (child’s level of ability to articulate or communicate his or her feelings in a constructive or affirmative ways as well as control of his or her mood appropriate to the situation); 4) Social Health (degree to which the child is able to develop good relationships with immediate family members and non-family members); and 5) Spiritual Health (living according to one’s ethics, morals, compliance to the rules of the religious group, and values and behavior based on one’s belief in a supernatural being).
A five (5) point Likert scale (5 - Strongly Agree, 4 - Agree, 3 - Neutral, 2 - Disagree, and 1 - Strongly Disagree) was used to measure the lifestyle pattern and use of protective mechanisms of the respondents, while a four (4) point Likert scale (4 - All of the time, 3 - Most of the Time, 2 - Some of the Time, and 1 - Never/None of the Time) was used to measure their health condition.
To ensure scale reliability, items were subjected to Cronbach’s Alpha test: lifestyle pattern (.775, good), protective mechanisms (.918, excellent), and health condition (.784, good).
Data Collection and Data Analysis
Data were gathered with the use of a group administered questionnaire (Trochim, 2006). Data collection was done at the identified schools with the help of the guidance counselors in the two biggest barangays (local communities) in the town of Calamba in the province of Laguna. Approval of the school authorities (principal, guidance counselor and adviser) and informed consent of the guardian and the children were sought before the actual data collection was done.
A quantitative analysis was employed in the interpretation of the gathered data. Data were tabulated and a combination of descriptive and inferential statistics was applied using the Statistical Package for Social Sciences (SPSS) 20. Descriptive statistics (frequency counts, percentages, range scores, mean scores, and weighted mean) were employed to analyze the data on the respondents personal characteristics (which include their socio-demographic and family characteristics), lifestyle pattern, use of protective mechanisms, and health condition. To determine predictors of the health condition of the adolescents left behind by OFW parents, the multivariate ordinal logistic regression was performed.