Sexual Health Implications of Return Migration for Women and Their Partners in Rural Mexico: A Critical Ethnography

Abstract

The return of a migrant partner can negatively impact the sexual health of women who stayed in their communities. Understanding their sexual health needs is crucial for developing targeted interventions and support systems. Our study used a critical ethnographic approach in Agua Dulce, a rural community in Mexico, involving 50 key informants: women who stayed behind (n = 20), returnees (n = 12), community leaders (n = 12), and health care professionals (n = 6). We used participant observation, policy analysis, and interviews, using purposeful and snowball sampling methods. A gender-based thematic analysis revealed economic hardships and early separations affect the sexual well-being of women who stay behind. Infidelity, discovered through social media or calls, causes emotional distress and family disruptions. Male migrants spend an average of 8.85 years abroad, leading to fears of risky sexual behaviors. Our study highlights the urgent need for specialized support centers and comprehensive health interventions.

The phenomenon of women who remain in their communities of origin while their romantic male partners migrate internationally has garnered significant attention, specifically regarding their sexual health needs upon the return of their partners. Return migration refers to the arrival of migrants to their countries of origin for various reasons after having previously lived and worked across international borders. In Mexico, the rate of return migration substantially increased from 2021 to 2022, with 160,689 individuals returning in 2021 compared to 258,007 returnees in 2022 (Unidad de Política Migratoria, Registro e Identidad de Personas, Secretaría de Gobernación, 2022). Mexican migrants who return to their places of origin frequently encounter intertwined difficulties, including unemployment and family violence, often influenced by patriarchal norms and values (Saavedra Solano et al., 2023). However, despite the economic, social, and political implications associated with return migration (Jones, 2011; Tuccio et al., 2019), limited research has explored the health challenges faced by returning migrants and the consequent health needs of the romantic partners who stayed behind, particularly in Mexico.

Existing evidence has highlighted the potential implications for the well-being and health of these partners (Fernández-Sánchez, 2020; Fernández-Sánchez, et al., 2020). The return of migrants, particularly when accompanied by health issues or conditions acquired abroad (Martínez-Cardosa and Geronimus, 2021), may disrupt the dynamics within the relationship and place additional burdens on the partners who remained in their home country. Sexual health challenges among reunited couples may arise from prolonged separations, including issues of reestablishing intimacy, addressing potential infidelity concerns, and navigating changes in sexual health practices and preferences (Garbett et al., 2022; Parrado & Flippen, 2010). The dynamic of health issues, stress, and other factors can be bidirectional, so the potential impact of returning migrants on both partners in the relationship should be considered.

In addition, the physical and mental health challenges experienced by returning migrants (Duncan, 2015; Guzmán Elizalde, 2023; Hamilton et al., 2023) may also affect their ability to provide emotional and social support and to contribute to household responsibilities. These factors can strain the well-being of the partners who stayed behind, influencing their own health and overall relationship dynamics (Clairgue, 2012). Importantly, the literature in Mexico highlights lower health insurance coverage among returning migrants compared with the general population (Domingues-Villegas & Vargas-Bustamante, 2021). Further research is needed to deepen our understanding of this phenomenon and develop targeted interventions and support systems for both returning migrants and their romantic partners (Mudrazija et al., 2016; Rosete, 2012; Saggurti et al., 2012).

Given the lack of research on the sexual health needs of women who stayed behind and their returning migrant partners in Mexico, the purpose of our study was to examine these issues in depth. We sought to identify the specific sexual health challenges faced by Mexican women who stayed behind and their returning partners and to assess the impact of these challenges on their relationships. In the context of our study, “return migration” referred to situations in which the migrant intended to stay in Mexico upon their return. By shedding light on the health needs of this population, our study contributes to the development of evidence-based interventions and policies that promote the well-being of reunited transnational couples. In addition, this research provides insights into the broader context of return migration in rural Mexico, highlighting the importance of addressing health disparities and supporting individuals and families in their transitions back to their birth country.

Methods

Design

The study was conducted from January 2021 to May 2022 and used a critical ethnographic approach. This research design, rooted in critical social theory, promotes the emancipation of suppressed populations by uncovering the structures and systems of power relationships (Cook, 2012; Madison, 2020). Through this approach, the study aimed to examine the intersecting social locations that shape the reunification experiences of returning migrants and women who stayed behind. Critical ethnography was an appropriate design for this research because it allowed for a deep examination of the nuanced power dynamics that influence the experiences of the studied population, aligning with the overarching goal of promoting social emancipation.

Study Location

The research was conducted in Agua Dulce, a rural community in the northern part of Veracruz, Mexico. The lead author, a doctorally prepared registered nurse, resided in Agua Dulce for 6 months (January 2021–July 2021) to establish trust and rapport with key informants. Agua Dulce's economy comes primarily from agriculture. With a population of over 5,000 (including the Indigenous Totonacas and Spanish-speaking individuals) and a remarkable migration history, Agua Dulce proved to be an ideal setting for the study.

Advisory Committees

To navigate the challenges posed by COVID-19 restrictions, two advisory committees were established. One committee comprised three women who stayed behind while their partners migrated, and the other involved three community leaders. Monthly meetings were held to seek input on access to community members, assist with recruitment, review interview questions, and provide feedback on the findings.

Field Research

Of note, in adherence to the stringent COVID-19 safety measures in place during the 6-month fieldwork phase, the lead author always remained on the field site. Despite these restrictions, he remained fully engaged with the community by attending all outdoor events and accepting invitations from community members, ensuring his presence adhered to the safety guidelines. Aligned with the principles of critical ethnography, the lead author undertook the dual roles of participant and observer within the research setting (Bell, 2019). The dual roles involved immersing oneself in the fabric of everyday community life and providing valuable insights into various facets, including roles, communication patterns, gender dynamics, relationship behaviors, and the distress experienced by individuals and couples. Throughout this process, meticulous field notes were diligently maintained to document comprehensive observations of families, encompassing their physical locations, actions, behaviors, and activities.

Recruitment and Sample Size

The recruitment process for our study was a multifaceted and community-centered endeavor. To identify participants with the requisite knowledge and experience, a combination of purposeful and snowball sampling methods was used. The invaluable assistance of our advisory committee members proved instrumental in identifying potential participants. The lead author and the female research assistant pedaled through the community's streets and extended invitations to potential participants. When invited into people's homes, the team adhered to COVID-19 guidelines and politely declined such invitations. Furthermore, we implemented a unique mobile address system, which involved a vehicle equipped with a speaker going across the community to make announcements about our research and provide the research team's contact information. This innovative approach was suggested by the advisory committee, recognizing its effectiveness as a common means of communication within Agua Dulce. Our final sample, comprising 50 individuals, included 20 women, 12 returning migrants, 6 health care providers, and 12 community leaders, all of whom were selected for interviews.

Inclusion and Exclusion Criteria

Individuals ages 18 years or older were included as key informants if they were returning transnational migrants who had resided in Agua Dulce for at least 1 year or self-identified cisgender women who had stayed behind; the couples must have established their relationship before the migration process. Individuals were excluded if they were unable or unwilling to provide informed consent due to cognitive impairment. Factors such as gender identity, sexual preference, socioeconomic status, preexisting health conditions, and Indigenous background did not result in exclusion. Stakeholders (i.e., health care providers and community leaders) were included if they had served in their current position for at least 1 year in the community.

Data Collection

Data collection involved critical ethnographic interviews and participant observation (Madison, 2020). Interviews were conducted either by phone or in person, ensuring adherence to COVID-19 protocols. A woman researcher from Agua Dulce primarily conducted individual interviews in Spanish with women participants, each lasting 40–90 min. In addition, face-to-face interviews were conducted with stakeholders from Agua Dulce, including physicians, nurses, and community leaders (Table 1).

Table 1.

Sociodemographic, Migration, and Sexual Health Data for Women Who Stayed Behind

	Time	Range
Age	40.75 years	(21–53)
Duration of romantic relationship	19.6 years	(4–34)
Duration of romantic relationship before partner's migration	1.7 months	(3–5)
Time of migrant partner abroad	8.85 years

	n	Percentage
Occupation
Housewife	9	45%
Business owner	8	40%
Employed	3	15%
Education level
Elementary	4	20%
Middle school	7	35%
High school	4	20%
College	3	15%
None	2	10%
Religion
Catholic	11	55%
Other Christian religion	6	30%
None	3	15%
Condom use on first sexual encounter
Yes	3	15%
No	9	85%
STI testing upon return
Yes	9	45%
No	11	55%

Note. STI = sexually transmitted infection.

Data Analysis

The collected data were transcribed verbatim by either the lead author or a woman researcher. The initial five interviews with women were translated into English for supervisory purposes. Subsequently, these five interviews were independently coded by four members of the research team. Later, the team convened to reach a consensus on the assigned codes and emerging themes. A bottom-up approach was used, involving the identification and selection of recurring codes, which were then grouped into thematic categories. The six-step thematic analysis approach by Braun and Clarke (2006) (data familiarization, initial coding, theme search, theme review, theme definition, and final report writing) was followed. NVivo qualitative analysis software (v. 12) facilitated data exploration and analysis. A gender-based approach was used to identify common categories; examine contextual influences on identities; and uncover forms of power, inequality, and oppression (Saeidzadeh, 2023).

Rigor Strategies

To ensure credibility and rigor, various validation strategies were implemented. Methodological coherence was maintained by aligning epistemological and ontological viewpoints with intersectionality and critical ethnography (Johnson et al., 2020). Reflexivity was practiced throughout the research process to address power imbalances and foster empathy. In addition, diverse validation strategies, such as peer debriefing, member checking, and data source triangulation, were used to enhance the trustworthiness and credibility of the findings.

Practicing reflexivity and acknowledging our positionality was critical. Our research team comprised four nurse scientists, all of whom had expertise in health, sexual health, and migration research using critical feminist and behavioral science approaches. With diverse global experiences, our team members contributed to a comprehensive understanding of the topic.

The lead author draws upon his personal background to inform his dedication to advocating for women's and migrants' rights and promoting social justice. Born in Mexico, he experienced part of his life as an undocumented migrant in the United States. Subsequently, he returned to Mexico and later moved to Canada. He identifies as a member of both the lesbian, gay, bisexual, transgender, and questioning+ community and a Spanish-speaking community. These lived experiences have profoundly shaped his perspective and deepened his understanding of the challenges faced by returning migrants and their women partners during reunification.

Ethical Considerations

Ethical approval was granted by the Research Ethics Office of the University of Alberta (Pro00106680), and local ethics authorization was obtained from the Universidad Veracruzana in Mexico. Before data collection, all key informants provided either written or verbal informed consent. Key informants who had experienced violence were provided resources through the community clinic.

Results

On average, these women were around 40 years old during their interviews. Of note, 10% had Indigenous backgrounds but were fluent in Spanish. Almost all (90%) had received some level of formal education, and over 50% were employed. However, 92% of these women lacked health insurance. Most of the women (85%) identified with Christian faith-based religions. They had an average of approximately two children, adding a familial dimension to their profiles.

Among the returnees, the majority (85%) held undocumented immigration status while abroad. Those with undocumented immigration status (95%) chose to return home on their own for various reasons, such as achieving migration objectives, reuniting with family members, or returning due to health-related concerns. Notably, one returnee had Indigenous heritage but was proficient in Spanish. All returnees possessed some level of formal education, with over 50% being entrepreneurs who owned their businesses. Most of the returnees (92%) identified with Christian faith-based religions. Half of the respondents did not have health insurance. In addition, 92% of these returnees did not undergo medical examinations upon their return from abroad, indicating potential health-related gaps in their migration experiences.

Gender Norms in Agua Dulce

The findings are interpreted within the gender norms prevalent in the community of Agua Dulce. Traditional machismo ideals persist, with men typically viewed as breadwinners and women as caretakers responsible for children and the household. In the migration context, men often leave to seek job opportunities to support their families in Agua Dulce, while women remain at home to manage the household. Despite some women asserting agency during their partners' absence, societal expectations often compel reunited couples to revert to patriarchal norms upon reunion.

Early Separation and Well-Being

The young transnational couples in our study were often separated early in their relationships due to economic hardships (mean of 1.7 months after deciding to cohabitate). The early separation often affected the sexual well-being of the migrants and the women who stayed behind, during both the migration and reintegration processes. Sexual desire sometimes led both partners to seek other sexual partners and caused family conflicts. Infidelity, discovered through social media or phone calls, caused emotional distress and, in some cases, disrupted family bonds and ruptured the relationship. On average, migrants spent 8.85 years abroad without visits to Agua Dulce. The fear and insecurity associated with partners engaging in risky sexual behaviors while abroad had a significant impact on the sexual health and overall well-being of reunited couples.

Health Implications and HIV/Sexually Transmitted Infection Transmission

In Agua Dulce, access to sexually transmitted infection (STI) and HIV prevention, testing, and treatment is a pressing issue, as these services are currently only available for pregnant women. For anyone else seeking care, the nearest center is located 40–60 min away. This limited access to prevention, testing, and treatment services may have contributed to the startling finding that 85% of women did not request condom use during their partners' return, and 55% did not request STI or HIV testing before engaging in sexual activity. The prevailing machismo culture may have pressured women to adhere to preestablished gender roles, which often prioritize men's authority and decision-making power. Women shed light on the fear and insecurity they experienced when their partners engaged in infidelity during migration; however, challenging their partner's authority or questioning their fidelity may have resulted in social stigma. These circumstances can lead to STIs/HIV, as exemplified by a woman who discovered that she was positive for HIV during her pregnancy with her son. Her lack of awareness about her HIV status and the need for treatment underscores the vulnerability of women's sexual health in these challenging circumstances.

It was when I got pregnant with my son. We went to the gynecologist, and she told me that I had an infection. Supposedly, he [the partner] gave me something [an STI]. I was 2 months pregnant, and the gynecologist told me I had a strong infection. The doctor gave me and him [partner] pills for the infection, but the doctor did not tell me the name of the infection. On a later visit, I found out that I had HIV. —Woman, 43 years old; 17 years old when partner migrated; partner held undocumented status

In addition, a community leader recalled that a woman discovered a fungal infection upon her husband's return, suggesting the potential transmission of STIs during the partner's time abroad. The fear of transmission extended beyond the couples to their children, as evidenced by a health care provider's account of another instance in which both a mother and newborn tested positive.

When her husband was on the other side [abroad], she was with another person. When her husband returned, she told me that she had an infection, like a fungus that started to appear on her body, not just in her intimate area. She didn't really know why, but it was a very ugly fungus because she showed it to me, and it was indeed unpleasant. —Community leader

There was an HIV case in 2015 of a woman whose husband had returned from the other side [abroad]. It was detected through lab tests during the pregnancy at CAPACITS [HIV clinic]. After the third month of pregnancy, the mother went to the Coplamar Hospital, and continued going there throughout her pregnancy. When the baby was born, he also tested positive, but he quickly started treatment. They began treatment immediately after birth, and thanks to God, he is doing well. The child is now 4 years old. —Health care provider

This finding illustrates the far-reaching impact of infidelity and risky sexual behaviors on family well-being, as well as the emotional distress faced by women. One woman even recounted the tragic loss of her ex-husband due to HIV complications:

My ex-husband passed away due to HIV and lung complications. Initially, they diagnosed it as tuberculosis, but 3 days later, he tested positive for HIV. Both my children and I underwent testing, and fortunately, we all tested negative. The mere thought of my children possibly being infected or me having the virus and leaving them behind made me angry. —Woman, 33 years old; 20 years old when partner migrated; partner held undocumented status

These findings underscore the pressing need to expand access to STI and HIV prevention, testing, and treatment services to other population groups, including returning migrants and their families.

Impact of Infidelity and Sexual Behaviors

The findings emphasize that both returning migrants and women who stayed behind exhibited sexual behaviors that may have increased their susceptibility to STIs, as reported by key informants. These behaviors can potentially jeopardize their partners' health and safety, highlighting that infidelity and HIV/STI transmission are two-way issues. It is essential to recognize here that labeling an entire gender as exclusively irresponsible partners is unfair. Instead, this bidirectional dynamic underscores the need for a deeper exploration of the underlying factors motivating these actions. The impact of gender norms in Agua Dulce is significant and cannot be underestimated. Within this context, women may experience pressure to conform to societal expectations of femininity. This pressure may manifest in reluctance to question their partners' sexual behaviors or to discuss their own experiences of infidelity.

Sexual desire among couples ages 20–35 leads to partner-seeking, initiating family conflicts. Men abroad discover wives' actions, while wives learn about men’s activities through social media or phone calls. Some men abandon their spouses for new partners, often leaving children behind. —Health care provider

Stakeholders have engaged in discussions regarding the motivations behind these behaviors, which may be influenced by factors such as the stigma surrounding STIs and the prevailing machismo culture in the community that imposes distinct expectations on both men and women. An understanding of these intricate factors is crucial for a more comprehensive perspective on the challenges faced by these couples in this context, moving beyond stereotypes and negative judgments.

Yes, many patients, especially those with HIV, have returned like that. Their condition is that of an immunocompromised individual. Some return with oral candidiasis, and I suspect some may have pulmonary tuberculosis due to their weakened immunity. Unfortunately, some of the men, due to alcoholism, drug use, and risky sexual behaviors, are more prone to sexually transmitted diseases. As a result, some have passed away, lasting only a couple of months after their return. —Health care provider

Yes, there are sexually transmitted diseases here [in the community]. We have cases of HIV, although syphilis is not as common. I have personally seen three cases of AIDS, particularly in young men who migrated and returned. Fortunately, their partners are under control and not affected. They are managing their lives well, and some have even remarried. There is sexual transmission of HIV, and some have contracted it abroad. When they return, they may not disclose it immediately due to stigma. I recall a consultation with someone who came in with COVID symptoms, but I had a hunch and decided to include an HIV test. He hadn't mentioned it, but I found it suspicious. I informed his family, and they were surprised. Unfortunately, he didn't receive treatment from me and passed away later. —Health care provider

The findings reveal that both genders engage in behaviors that can compromise their partners' health and safety. Stakeholders have recognized the need to understand the motivations behind these behaviors, influenced by factors like the stigma surrounding STIs and the influence of machismo culture.

Emotional Distress and Family Dynamics

Emotional distress and family dynamics are prominently influenced by community gender norms and power imbalances within relationships, sometimes leading to conflicts and fractures. In some instances, women challenged traditional roles and risked abandonment in response to their partner's infidelity or lack of support in household chores and childcare. This distressing situation prompts some women to make the challenging decision to end their relationship, requesting their partners to move out, while others choose to continue cohabiting without romantic involvement, often conforming to community expectations of family unity. These consequences of infidelity extend to financial instability and emotional turmoil for both women and men. The experiences shared by key informants vividly illustrate the extensive impact of infidelity, causing significant upheaval when partners become involved with other families.

The fear of losing financial support leads to heightened emotional distress, as highlighted in one woman's account of how her world changed upon discovering her partner's dual family situation, plunging her into depression. Isolation followed, until she received support and guidance to help her move forward.

Upon discovering that my partner had another family, my world crumbled. I feared he would no longer support our daughters financially, leading me into a period of depression. I isolated myself, locked in my own world, until someone opened my eyes, offered valuable advice, and helped me move forward. Now, here I am. —Woman, 47 years old; partner held undocumented status

Similarly, another woman, upon encountering evidence of her husband's romantic involvement with another woman, confronted him about it, only to face his consistent denial of the allegations, adding to her emotional distress and underscoring how gender dynamics and infidelity profoundly impact emotional well-being and relationships in the community.

During a visit to my grandmother, I unexpectedly encountered a woman who informed me that my husband was romantically involved with the woman who cooked for him. My mother became angry and asserted, “That's why he doesn't provide you with financial support: he's involved with someone else.” I confronted him about it, but he consistently denied the allegations. —Woman, 32 years old; partner held undocumented status

Emotional distress and family dynamics in the community are significantly impacted by community gender norms. Some women challenge traditional roles in response to their partners' infidelity or lack of support, leading to potential conflicts. This may result in difficult decisions, such as ending the relationship or continuing to cohabit without romance, in line with community expectations. Personal accounts illustrate how the fear of losing financial support can lead to depression and isolation. These narratives emphasize how gender dynamics and infidelity profoundly affect emotional well-being and relationships in the community.

Discussion

The findings of our study provide valuable insights into the complexity around the sexual health and well-being of returning migrants in rural Mexico and the women who stayed behind. The research reveals significant sexual health challenges among reunited couples, with infidelity being prevalent among both men and women. However, gender disparities are evident, as women were more open to discussing their partners' infidelity, while men often denied their own and their partner's involvement. This indicates societal expectations and norms surrounding fidelity, which can influence relationship dynamics and well-being.

Sexual Health Challenges, HIV, and Sexually Transmitted Infections

The study's findings on sexual health challenges among reunited couples, including the prevalence of STIs, are consistent with recent research on migration and sexual health. Research in Latin American countries has shown that migration can contribute to increased STI transmission, owing to factors such as inconsistent condom use and multiple sexual partnerships (Goldenberg et al., 2012). Global research indicates that individuals migrating from Latin America often forego HIV testing because they perceive their risk as low, have apprehensions about losing their anonymity, and fear the prospect of rejection and discrimination (Hoyos et al., 2013). The fear and insecurity associated with partners engaging in risky sexual behaviors while abroad, as highlighted in our study, can be linked to previous studies that indicated the vulnerabilities of migrants and their partners to HIV/STIs during periods of separation and reunion (Fernandez-Sanchez et al., 2023; Jiang et al., 2023).

Despite gaining autonomy and agency during their partners' absence, women in our study were hesitant to request condom use or promote STI testing during initial sexual encounters after reunification, which differs from findings in other contexts (Miskinzod, 2015). The disparity in findings between our study in Mexico and Miskinzod's (2015) study in Tajikistan may be a result of cultural distinctions, contextual nuances, and variations in social norms regarding sexual health. Factors such as differing gender dynamics, access to resources, and migration experiences could contribute to women's varying abilities to negotiate condom use and promote STI testing with their partners. This suggests the need for context-specific interventions that consider the complexity of sexual health behaviors and practices among reunited couples in rural contexts. The limited access to STI testing and treatment in the community further exacerbates sexual health challenges for reunited couples. Addressing these concerns requires comprehensive interventions, including improved access to STI testing, education on safe sexual practices, and destigmatization of discussions around infidelity and sexual health. Moving beyond individual approaches, adopting family-based and community-based strategies that acknowledge the unique challenges of return migration and reunification is crucial (Batistella, 2018; Fernandez-Sanchez et al., 2023; King & Lulle, 2022a). Our study also highlights the high incidence of STIs, including HIV, among reunited couples. This finding aligns with previous research on return migration in Latin American countries, which showed that individuals with HIV may face challenges in disclosing their status to their partners, potentially leading to transmission (Fernandez-Sanchez et al., 2022). Moreover, the vulnerability of women to HIV and other STIs due to cultural expectations of unprotected sex for reproduction within certain communities (Rosete, 2012) underscores the importance of targeted interventions to address safe sexual practices.

Gender Disparities and Infidelity

Recent research has highlighted the gendered nature of infidelity and its implications on relationship dynamics. Studies have found that women may be more likely to be open about their partners' infidelity owing to societal norms that often place the unequal burden borne by women in such situations, as observed in our study (Wróblewska-Skrzek, 2021). On the other hand, men may feel pressure to deny their involvement in extramarital affairs to conform to societal expectations of masculinity and gender inequality and to avoid potential consequences (Boyce et al., 2016). In patriarchal and machismo cultures, the inflexible range of social norms and attitudes attributed to men frequently exerts influence over their conduct (Walters & Valenzuela, 2019). The gender disparities observed in the present study can be understood in the context of traditional gender norms and expectations within the rural Mexican community.

The emotional distress experienced by women upon discovering their partner's infidelity, as depicted in our study, reflects the significant impact of infidelity on emotional well-being and relationship dynamics. Recent literature has emphasized that infidelity can lead to profound emotional consequences for individuals and couples, with feelings of betrayal, depression, and anxiety being common reactions (Whisman et al., 2007). The unequal burden borne by women in such situations, as observed in our study, can be linked to the power imbalances within relationships and societal expectations that place women at a disadvantage when facing infidelity-related challenges (Pichon et al., 2020).

Implications for Policy, Practice, and Research

The findings of our study have significant implications for policy, practice, and research. Our study's focus on rural Mexico highlights the importance of considering contextual factors in understanding return migration and reunification. Recent literature has explored how rural migration can lead to specific challenges for individuals and families, including limited access to sexual health resources, health care services, and social support networks (Cabieses et al., 2023). These contextual factors can shape the experiences of reunited couples and impact their sexual health and well-being. In this regard, adopting an intersectional perspective is important to understand and address the complex challenges faced by reunited families in rural Mexico. Policymakers and practitioners need to recognize the potential impact of intersecting identities and systems of power on the health and well-being of reunited couples. Tailored interventions are crucial to meet the specific needs of these intersecting identities, promoting holistic support and successful reintegration of returning migrants and their families (Fernandez-Sanchez et al., 2023; King & Lulle, 2022b).

Health interventions, including HIV and STI prevention interventions, are vital in this context, as highlighted by community leaders and health care providers in our study. These interventions can serve as valuable resources for providing information, education, therapy, and counseling, helping individuals and families cope with the emotional distress and challenges arising from infidelity and migration. By offering improved access to health care services and comprehensive support systems that address mental health, government officials and relevant stakeholders can foster healthier reunions and enhance relationship dynamics among reunited couples. Such measures will contribute to the overall well-being and resilience of families in the community.

A proactive approach to policy and program development is crucial to address the unique health challenges faced by reunited families effectively. By providing guidance, support, and resources to promote their well-being, policymakers can contribute to the creation of a supportive and nurturing environment for these families. In addition, lessons can be drawn from the experiences of similar regions, such as the state of Tabasco, which shares a similar socioeconomic and cultural context with Veracruz. Researchers in Tabasco suggested designing and implementing effective policies and interventions to facilitate reintegration and promote a sense of belonging among returning migrants (Ramirez-Armas, 2018).

Our study underscores the need for further investigation into the health implications of infidelity and risky sexual behaviors among reunited couples in rural Mexico. Longitudinal studies that follow the experiences of couples over time can provide a deeper understanding of the long-term effects of infidelity and migration on individuals and families. Moreover, research focusing on the perspectives of men in these contexts can shed light on the gender dynamics at play and provide a more comprehensive understanding of the challenges faced by both partners. Collaborative research involving community members and stakeholders can lead to contextually relevant and culturally sensitive interventions that address the unique needs of reunited families in Agua Dulce and similar settings.

Overall, the findings of our study call for concerted efforts from policymakers, practitioners, and researchers to address the complexities of return migration in shaping the health and well-being of reunited couples in rural Mexico. By implementing context-specific interventions and adopting an intersectional approach, we can foster healthier reunions and support the resilience of these families in the face of challenges arising from migration and infidelity.

Limitations

Our study provides valuable insights into sexual health challenges among reunited families in the context of migration. However, its generalizability is limited owing to the specific focus on women from Agua Dulce with demographic characteristics. The study also lacks perspectives from other family members, potentially affecting the overall understanding of health challenges in reunited families. Moreover, the findings may be influenced by Agua Dulce's unique sociocultural and health care context, limiting their applicability to other settings. Longitudinal studies and comparison groups are needed to gain a more comprehensive understanding of health challenges and outcomes associated with migration and reintegration. Future studies should also include the male perspective on migration, sexual behaviors, and reunification experiences. It is crucial to acknowledge the potential role of biomedical HIV prevention strategies like pre-exposure prophylaxis and post-exposure prophylaxis in addressing the sexual health challenges faced by reunited families. However, we recognize that the availability and accessibility to such resources may vary across settings, including Agua Dulce, highlighting the need for broader access to these interventions.

Conclusion

The study provides valuable insights into the sexual health challenges faced by reunited couples in rural Mexico. Young transnational couples experience early separation due to economic hardships, leading to sexual and mental health challenges for women who stay behind during migration and reintegration processes. Infidelity, often discovered through social media or phone calls, causes emotional distress and disrupts family bonds, potentially resulting in ruptures. The fear and insecurity associated with partners engaging in risky sexual behaviors abroad significantly impact women's mental health. Vulnerabilities to STIs, including HIV, are prevalent among returnees, and limited access to health care resources exacerbates sexual health challenges. Gender disparities and power imbalances within relationships contribute to emotional distress and potential abandonment for women.

By accounting for the complexity of return migration and reunification, this research contributes to the development of targeted interventions and policies promoting the well-being and support of reunited transnational couples. Moreover, it informs broader efforts to address health disparities and support individuals and families during their transition back to rural Mexico.

Data Accessibility Statement

Data may be available upon request to the corresponding author, depending upon privacy/ethical/embargo restrictions.

Disclosures

The authors report no real or perceived vested interests related to this article that could be construed as a conflict of interest.

Author Contributions

All authors of this paper meet the four criteria for authorship as defined by the International Committee of Medical Journal Editors (ICMJE). Each author has contributed to the conception and design of the study, participated in drafting or revising the manuscript, reviewed the final version before submission, and agreed to be accountable for all aspects of the work. Specifically, using the CRediT taxonomy, the contributions of each author are as follows: conceptualization: H. Fernandez-Sanchez. Formal analysis, funding acquisition: H. Fernandez-Sanchez. Investigation, methodology: H. Fernandez-Sanchez, B. Salami, J. Salma, M. Rocha-Fernandez, D. Santa Maria, R. Benavides. Project administration: H. Fernandez-Sanchez. Validation, writing–original draft: H. Fernandez-Sanchez, B. Salami, J. Salma, M. Rocha-Fernandez, D. Santa Maria, R. Benavides. Writing–review & editing: H. Fernandez-Sanchez, B. Salami, J. Salma, M. Rocha-Fernandez, D. Santa Maria, R. Benavides.

Key Considerations

• The study highlights the critical need for comprehensive sexual health interventions that include HIV and STI prevention, testing, and treatment for returning migrants and their families. Ensuring access to these services can mitigate the risk of STI transmission and improve overall health outcomes in rural communities.

• Gender norms and infidelity significantly impact the emotional and sexual health of reunited couples. Health care providers should be aware of these dynamics and offer counseling and support that address both partners' experiences, promoting open communication and mutual understanding within relationships.

• Implementing community-based health education programs can increase awareness about safe sexual practices, STI prevention, and the importance of regular health check-ups. These programs should be culturally sensitive and tailored to the specific needs and dynamics of rural communities like Agua Dulce.