The impacts of migration on maternal and child health services utilisation in Sub-Saharan Africa: evidence from Togo.

Objectives: Togo is experiencing a growing phenomenon of migration and consequently receives remittances from international migrants back to their relatives. Remittances represent about 9.4% of the gross domestic product (GDP), placing Togo in the top 10 recipients of remittances in the world in 2014. Despite the importance of remittances, information on their health outcomes is inadequate, particularly if remittances have a positive impact on the utilisation of maternal and child health services. The aim of this article is to evaluate the impacts of migration on maternal and child health services utilisation.

Study Design: Cross-sectional data analysis of mothers aged 15-49 years who have recently given birth.

Methods: We used propensity score matching to compare the utilisation of health services by mothers and children from households with migrants to those without migrants. We simulated a potential confounder to assess the robustness of the effects of the estimated treatment (i.e. migration). We also addressed the problem of hidden biases with the bounding approach.

Results: Deliveries attended by skilled health personnel were found to be 10.3% higher in migrant households than in households without migrants. The antenatal visits of mothers in migrant households were 3.5%-9.5% higher than those of matched control groups. Compared to the non-migrant households, the migrant households had a positive welfare (postnatal checks at the hospital) impact of 11.9%-12.5% percentage points. Furthermore, through access to health insurance, mothers in migrant families enjoy more financial protection with regard to delivery, prenatal and postnatal care. We also found that children in migrant households benefit from more preventive health inputs such as postnatal checks and vaccinations.

Conclusion: Our results suggest that migration contributes greatly to improving births at hospitals, skilled birth assistance, and utilisation of antenatal and postnatal care through the return flow of financial resources. Efforts in health care reforms in Togo should take into account the scope of the positive impacts of migration on the utilisation of maternal and child health services.