Collegian
Volume 19, Issue 1 , Pages 59-63, January 2012

Migration of women from the Philippines: Implications for healthcare delivery

  • Lourdes Marie S. Tejero, RN, PhD

      Affiliations

    • National Graduate Office for the Health Sciences, University of the Philippines Manila Philippines
    • University of the Philippines College of Nursing, Pedro Gil Street, Malate, Manila, Philippines
    • Corresponding Author InformationCorresponding author at: University of the Philippines College of Nursing, Pedro Gil Street, Malate, Manila, Philippines. Tel.: +63 2 5231494; fax: +63 2 5231494.
    • ,
  • Cathrine Fowler, RN, RM, B Ed, M Ed, PhD

      Affiliations

    • Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, Australia

Received 21 August 2011; received in revised form 12 December 2011; accepted 13 December 2011. published online 11 January 2012.

Article Outline

Summary 

Filipinos have been an important part of the global workforce since the first half of the twentieth century. The initial migration of primarily men has shifted to an increasing numbers of women in recent decades. These changes are primarily attributed to a high demand for domestic workers, nurses and occupations that are female dominated. In 2005, about 70% of the international labour migrants are women from the Philippines. Living in a foreign land, these women face challenges that affect their physical, emotional and social well being. Especially on their first year living abroad, these women experience significant stress which affects their health as they adjust to a new work environment, culture, social norms, diet, and weather. The emotional strain can be greater for those who have left their families behind in the Philippines and aggravated by the financial need to send money to them. Striking examples, such as the homicide rate of Filipino women married to Australian men being 5.6 times higher than that of Australian-born women, underscores the importance of supportive health care environments and appreciating socio-cultural factors. In the delivery of healthcare services to migrant women, it is critical to consider the unique socio-cultural background of women as well as health beliefs and practices.

Keywords: Women, Philippines, Migration, Healthcare, Health

 

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Introduction 

Increasingly we live in a culturally diverse and culturally pluralistic society (Gholizadeh, Salamonson, Worrall-Carter, DiGiacomo, & Davidson, 2009). This underscores the importance of addressing socio-cultural issues within health care delivery and striving for health equity (Davidson, McGrath, Meleis et al., 2011). Migration is increasingly defining the mosaic of modern society. Filipino migration began in the first half of the twentieth century when Filipinos sought employment in Hawaii and California under the American colonial policies (Barber, 2000). In the 1960s, more Filipino men joined the seafarers’ workforce. Migration of Filipinos then shifted to the Middle East in the 1970s in response to the increasing need for construction workers (Barber, 2000). This pattern of male dominated migration waves changed in the 1980s due to the demand for domestic workers (Asis, Huang, & Yeoh, 2004), resulting in an increase in female migration. The migration of women has given rise to a range of health care issues, both in their country of birth and their new country. Migration practices can change the social fabric of societies, the gender balance and health care issues (Carballo, Grocutt & Hadzihasanovic, 1996). The aim of this paper is to describe factors impacting on Filipino women migrants’ health status through the discussion of several health issues and beliefs. These issues have significant implications for health service delivery. This was undertaken by methods of a desktop review. Published articles were retrieved using the search terms, women, migration, Philippines and health. Reports and policy documents were hand searched for relevant information. Data applicable to the aim of the article were interpreted and synthesized to provide recommendations for health care providers.

In 2005, women comprised 70% of the international labour migrants from the Philippines (Briones, 2009). Filipino women migrants participate mainly in the unskilled labour sector, although skilled professionals like nurses make up a significant proportion of the migrants. More than 100,000 Filipino nurses have migrated since 1994, making the Philippines the leading exporter of nurses (Choy, 2010). Destination countries include Saudi Arabia, the United States of America (USA), the United Kingdom, and Singapore, among others (Lorenzo, Galvez-Tan, Icamina, & Javier, 2007). In many countries like Australia, Filipino women comprise one of the biggest groups of female immigrants from Asia (Kelaher, Williams, & Manderson, 2001). In the USA, there are 2.4 million Filipino Americans, making them the second largest Asian–American group (De Castro, Gee, & Takeuchi, 2008).

Research on Filipino female migration has focused mainly on domestic workers and entertainers, and little is written about information technologists, doctors, and entrepreneurs (Asis, Piper, & Raghuram, 2010). In the 2000 US Census data, 43.8% of all Filipino Americans were college graduates (Langenberg, Araneta, Bergstrom, Marmot, & Barrett-Connor, 2007). This is reflective of the Filipino culture where education is highly prioritized. However, it is important to note that the degrees earned in the Philippines may not be recognized in the destination country and therefore many migrants are underemployed (Kelaher, Potts, & Manderson, 2001). This can lead to feelings of loss and challenge coping and adjustment in the newly chosen country.

The main reason for migration from the Philippines has been predominately motivated by a desire for better economic circumstances, although there are other aspirations for career advancement (Langenberg et al., 2007). Women's migration has been identified as posing a risk for undermining the social fabric of the Philippines and as a consequence health and well-being (Rodriguez, 2005).

For many Filipino women migration has been viewed as a journey of self-discovery. Hence, many women have expressed self-fulfilment, confidence, and self-reliance gained from this experience (Asis et al., 2004). Unfortunately, for many women this journey is not always the experience that was anticipated. Many have encountered negative experiences and challenges which have affected their physical, psychological and emotional well-being, as presented in the following sections of this article.

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Health of Filipino women migrants 

The health of Filipino women migrants is often compromised due to a disjuncture between cultural health beliefs and practices and the host country's health system. Changes to diet, differing beliefs about the body and privacy concerns all potentially impact on the Filipino women's ability to access health services.

As in most Asian countries, the Filipino diet consists of rice, meat and vegetables. Exposure to the Western diet with a high dairy intake may pose problems as many Filipinos have lactose intolerance (Andersen, 1983). Moreover, studies have suggested that greater levels of metabolic disorders are linked to diet change and increased food consumption (Langenberg et al., 2007). This is especially true for those who had chronic or intermittent malnutrition early in life that led to impaired development of the endocrine system (Victora et al., 2008). Low socioeconomic status contributes to a high prevalence of diabetes, and factors restricting growth in early life increases the risk for coronary heart disease among Filipino women (Langenberg et al., 2007).

Cervical cancer screening is reported to be lowest among Asian Americans (Ayres, Atkins, Lee, 2010). This may be due to the reservations they have in undergoing a procedure perceived to be an intrusion of one's privacy. However, with the appropriate social support, Filipino women will submit themselves for screening (Ayres et al., 2010). Social support may come from the relatives, friends and health workers. Filipinos tend to heed the advice of those closest to them, especially relatives. Following migration, many Filipino women become disconnected from their social networks and this lack of support can alter health seeking behaviours.

Health beliefs about menopause among Filipino women are highly influenced by the information provided by female relatives and friends (Berg & Lipson, 1999). Menopause is viewed as an expected occurrence once the woman reaches the appropriate age. The symptoms and discomforts that come during the perimenopausal period are commonly borne with indifference. Menopause is not considered a disease and therefore it does not need any medical intervention (Berg & Lipson, 1999).

Mortality among Filipino women is not only due to disease, but also as a result of violence. The murder rate of Filipino women married to Australian men is 5.6 times higher than that of Australian-born women, with most murders committed by a husband and preceded by a history of intimate partner violence (Woelz-Stirling, Kelaher, & Manderson, 1998). Although the death rate is higher, the reporting of violence is disproportionately lower. This may be because Filipinos view marriage as a sacrament considering that the Philippines is a predominantly Catholic country. As such, the wife is seen as having a pivotal role in making the marriage work. Moreover, her reporting of an abusive relationship would expose her to shame (‘hiya’) especially among her countrymen and kin. Health seeking behaviours of Filipino women are likewise determined in collaboration with their husbands (Kelaher, Williams et al., 2001).

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Psychological, emotional, social and economic milieu 

The main challenge most migrants encounter is related to their employment, considering that more than three quarters have immigrated for employment reasons. Immigrants frequently experience limited job availability or demotion and are often assigned undesirable tasks and work hours (De Castro et al., 2008). Many immigrants are college graduates but their university degrees may not be recognized in their destination country. They face discrimination in their workplace where verbal abuse and differential treatment occur. For instance, the clerical position of one woman was made redundant and she was subsequently given the position of a cleaner upon her return from maternity leave (Kelaher, Potts et al., 2001). These stresses were shown to adversely affect physical and psychological health (De Castro et al., 2008).

Many of the women who migrate from the Philippines are married and have left their families behind. The resulting separation affects both the mother and the family remaining in the Philippines. The mother is constantly thinking about the status of her children and frequently redefines her concept of motherhood (Fresnoza-Flot, 2009). In Filipino culture, the family is closely knit and is regarded as the most important part of one's life, especially that of the mother. The Filipino woman migrates mainly to secure her family's economic future (Reyes, 2007). Those working as domestic helpers verbalized some sense of guilt as they take care of their employers’ children, wondering how their own children are being fed and cared for (Asis et al., 2004).

The family members most affected by the departure of the mother are the children. Children left behind by their mothers experience greater difficulty in school and social adjustment as compared to those whose fathers are abroad (Episcopal Commission on Migrants, 2004). One child deliberately dropped out of school in an attempt to bring his mother back home, as the mother's reason for migration was to earn money for her son's education (Asis et al., 2004).

The husbands left behind are forced to take on the responsibilities in the home traditionally assumed by the wife. This seemingly feminizing role is reluctantly taken on considering the ‘machismo’ male image in Philippine society. This reversal of roles increases the regard that husbands have of their wives and women's work (Asis et al., 2004).

These transnational families, where the core members are living in two or more countries (Asis et al., 2004), attempt to connect continuously through their available communication systems. Mobile phones are more commonly used by children of transnational families (Madianou and Miller, 2011). Although these communication tools may be available, the degree of intimacy or closeness as physical presence provides is missing.

Migrant women working as domestic helpers “relativise” the notion of family to encompass the employing family (Asis et al., 2004). They regard their charges as their own children in the aspiration that their employers treat them similarly. Many of their employers likewise consider them so; but this “being part of the family” may serve as a justification by the employers to give the migrant more responsibilities beyond domestic work (Asis et al., 2004). This has the potential to result in exploitation of the worker.

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Implications for healthcare delivery 

This review has demonstrated that the migration of Filipino women impacts not only on their own health but the family they leave behind. Healthcare delivery to Filipino women migrants should take into account the physical, social, emotional and economic conditions that this specific population encounter on a daily basis. In attending to Filipino women's physical needs, their socioeconomic background from childhood to adulthood should be actively assessed as these women are potentially predisposed to a range of health conditions and complications (Victora et al., 2008). For example, nutritional advice is helpful but care is required as a diet change may affect their gastrointestinal as well as metabolic processes. Metabolic disorders such as diabetes even in the absence of obesity may become a major issue that impacts the woman's physical and emotional well-being. The presence of factors limiting the woman's growth early in life may likewise contribute to the development of coronary heart disease (Langenberg et al., 2007).

Vitamin D deficiency is common among dark-skinned individuals because of decreased synthesis of this vitamin (Nowson et al., 2004). Filipinos have relatively dark skin and may have the mistaken notion that this skin colour indicates adequate exposure to the sun. Moreover, Filipino women avoid the sun because of the scorching heat they have experienced in the Philippines. Another reason is that many desire a fairer complexion which is viewed as being more beautiful than a dark complexion in the Filipino culture; hence, women shelter from the sun. With this minimal sunlight exposure, their presenting symptoms may be the systemic effects of Vitamin D insufficiency which include impaired immune response and muscle and bone function (Nowson et al., 2004). This insufficiency becomes more crucial for pregnant women considering the increased need for Vitamin D for the mother and the developing fetus. It is therefore beneficial to include this data in the health assessment of a Filipino client.

For invasive procedures especially those experienced as intruding into “one's privacy”, i.e., cervical cancer screening, the optimum benefits and the avoidance of negative effects should be thoroughly explained in an atmosphere of care and respect. The physical set-up of the room where the procedure is performed must be closed from public views, protecting the privacy of the client. It is worth noting that Filipino women prefer female health professionals to examine them. In cases where only a male health worker is available to perform the procedure, the woman may be asked if this is acceptable to her and if she requires her husband or guardian to accompany her during the procedure.

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Psychosocial concerns and issues 

The psychosocial concerns of the working woman are primarily job-related and concern for family left behind. This is especially true for those who have been away from the Philippines for less than a year (De Castro et al., 2008). Their adjustment to a new way of life and in a different culture subjects them to a significant amount of stress. There is a high level of pressure on women to keep their jobs and possibly to earn more because they are expected to remit money back to their family in the Philippines. This is the case even for those who are single as they generally are dutiful daughters and responsible sisters who help their parents and finance the education of the other siblings. As for those who are unemployed but need to earn, the stress is significantly increased as they are not only anxious about their own upkeep, but also about failing their families’ expectations. The economic well-being of the Filipino woman involves the welfare of a number of people depending on her for financial support, her immediate family members as well as her extended family (Fresnoza-Flot, 2009). In the Filipino culture, the family often includes grandparents, cousins, aunts and uncles. Assessment of the economic situation of a Filipino woman should also be included in her health history as this affects her overall well-being, and therefore her health.

The emotional concerns of the Filipino woman revolve around marital and familial circumstances. Crucially, an understanding of the woman's marital and familial situation is essential. If the woman is married and has a family left in the Philippines, or is married to a non-Filipino as in either situation the woman is likely to be experiencing anxiety and stress affecting that will impact on her physical and mental health. Being married to a foreigner especially if there was minimal time for their relationship to develop prior to marriage predispose the couple to having unrealistic expectations of their marriage. One of the main sources of conflict is the wife's commitment to remitting money to relatives in the Philippines. The husband may not be as rich as the woman had anticipated, or the husband does not permit her to work, or that he scorns such remittance and prohibits it (Woelz-Stirling et al., 1998). As for the Filipino woman's relationship with her children, the latter may resent the former's emphasis on education as this is given prime importance in the Philippines (Kelaher, Potts et al., 2001). Recognizing the woman's cultural beliefs she brings into the family system will assist to understand the interplay of factors which will enable the holistic care of this specific population.

The data retrieved above provide some useful direction for health care professionals. Filipino women are generally open in communicating their personal circumstances and may confide easily to an empathic health professional. In general, Filipinos put more emphasis on non-verbal cues than what is said verbally. The tone of voice and the manner, with which something is said, is given more importance than the content of the statement. Hence, they may easily be won over by a warm smile and a sincere manifestation of concern. This trusting relationship will support the woman to discuss her fears and anxieties. A significant positive attribute is the Filipino women's relative English language fluency that facilitates this open communication. However, it remains important to consider issues of health literacy.

The importance of social support for Filipino women cannot be overemphasized. Filipino women seek the company of others especially those whom with they share a similar socio-cultural background. Women are more likely to discuss female-specific issues such as menopause with their female relatives and friends, rather than their husbands. Much of their health knowledge and behaviours are influenced by the people around them. Hence, it is essential to assess the kind of social support that these women have and strengthen this support to encourage the adoption of positive health practices. Moreover, health education may be done more effectively when given in their usual community settings like Sunday group gatherings.

Healthcare education of Filipino women is of prime importance. Although many women have completed tertiary education, their health knowledge may still be mixed with traditional beliefs. For example, the concept of hot and cold environments being responsible for cough and colds may be evident among many. Exploring their health beliefs and practices before prescribing an intervention will make healthcare delivery relevant and more likely to be effective.

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Conclusion 

In conclusion, Filipino women migrants face a great many early physical and psychosocial challenges that affect their current and ongoing physical and mental health. As many of these women who migrate come from low socioeconomic background, the deprivations experienced early in life may have significant detrimental repercussions for their physical and mental health. Moreover, the psychosocial pressures from their job and environment, aggravated by emotional problems concerning their families, affect their total well-being. The socio-cultural factors impacting on the health behaviours of Filipino women need to be understood and considered in order to make healthcare delivery for this population more relevant and effective. Higher levels of intimate partner and domestic violence are of a concern and underscore the importance of considering the unique attributes of women in health care encounters.

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PII: S1322-7696(11)00083-7

doi:10.1016/j.colegn.2011.12.003

Collegian
Volume 19, Issue 1 , Pages 59-63, January 2012

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