Rougeaux, Emeline; (2024) Associations of maternal internal migration and child growth and nutritional health in Peru. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Despite large reductions in undernutrition, overweight is increasing across most LMICs. Studies suggest that parental internal migration may be associated with child growth and nutritional health. While a recent study of Peruvian adults has shown rural-urban migration to increase risks of obesity, intergenerational associations have yet to be explored. Peru has an important history of internal migration, driven notably by violent conflict in the 1980s-90s and persistent rural-urban inequalities. This thesis aimed to assess the associations of maternal internal migration, particularly towards urban areas, and child growth and nutritional health in Peru. To address this, first quantitative analyses were undertaken in secondary data of children under 5 years using cross-sectional Peru Demographic and Health Surveys (DHS). These consisted of two parts. Trends in child birthweight across conflict and post-conflict years and by maternal migration status were explored in unlinked DHS surveys from 1991 to 2020. Then, . associations of recent growth and nutritional status by pathway of maternal internal migration were estimated in the DHS from 2017. Second, a primary research study of women and children aged 5-15 years was conducted in a low-income area on the outskirts of metropolitan Lima, Peru and quantitative analyses were carried out to associations of growth and nutritional status by maternal internal migration in this older group of urban children. These analyses also considered a wider range of outcomes and maternal explanatory factors. Results across all analyses indicated there were intergenerational associations between maternal internal migration and child growth and nutritional health up to 15 years, with the main common findings being that maternal migration, particularly from rural to urban areas, may benefit later offspring linear growth but increase their risk of overweight when compared to rural non-migrants, and may also provide some advantages in terms of both their linear growth and a reduced risk of overweight when compared to urban non-migrants. Though maternal socio-economic and social capital and physical and mental health were associated with both internal migration and child outcomes, they did not mediate the associations found in children aged 5-15 years. The findings provide new evidence on child health inequalities in Peru and further insight into determinants of child health and the impacts of internal migration to urban areas in low- and middle-income countries, which may stimulate further research and help inform policy and intervention looking to reduce child health inequalities and prevent obesity and non-communicable disease across the life course.

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