Separation and Reunification: Mental Health of Chinese Children Affected by Parental Migration

Internal and international migration impacts family structure, parent-child relationships, and childcare arrangements for the world’s nearly 1 billion migrants.¹ When parents migrate without their children, this experience of prolonged separation from parents has profound repercussions on child development and well-being. As international migration disrupts family systems globally, internal migration, such as rural-to-urban migration in low- and middle-income countries (LMICs), also has massive impacts. In China alone, 61 million rural children are living apart from parents who have migrated to urban areas.² These so-called “left-behind children” comprise 34% of all rural children and 22% of total child population in China.² The well-being of children affected by parental migration has raised concerns worldwide. Although labor related migration tends to improve a family’s socioeconomic circumstances, prolonged separation from migrant parents places children at increased risk for psychosocial disorders.³ Even reunification with parents may lead to additional distress, due to an abrupt restructuring of family dynamics.^4,5 Despite the many clinical implications of parental migration and family separation, little information is available to help clinicians understand how parental migration may affect mental and behavioral development.

Parent-child separation and reunification in migrant families

Migrant parents often leave children behind in the pursuit of employment, even in Asian cultures that emphasize family connection as the major source of identity and protection. Factors that prevent migrant parents from bringing children along include residence permit policies, high cost of living, and lack of access to child care and education.^6,7 These barriers can exist even between different areas of the same country. For instance, In China, the urban-rural divide not only involves socioeconomic gaps, but a household registration system that restricts rural residents’ access to health care and education in urban areas.⁸

Due to the uncertainties and costs for migrant families, migration is often serial and cyclical in nature. If children subsequently migrate to rejoin their parents, the enduring effects of the experience of prolonged separation from parents are often overlooked in research and clinical practice. An estimated 200 million people in China, or 15% of the entire population, have experienced being left behind by migrant parents.⁹ While many children will ultimately rejoin their parents in urban areas, reunification can also occur upon migrant parents’ permanent return to their hometown, forcing the child to adapt to family structure change.

Sending infants born in the host country back to their country of origin has become another significant pattern in global migration.¹⁰ For instance, while nearly 20% of left-behind children in China were separated from their parents before their first birthday,² up to 57% of infants born in some Chinese immigrant communities in the U.S. are sent back to China,¹¹ to be cared for by grandparents, primarily due to the lack of affordable child care options and the desire to preserve the family’s culture.^10,11 After a few years, most of these so-called “satellite babies” are brought back to the U.S. to attend full-time preschool programs^10,11 that are often not equipped to understand or respond to the unique experiences and needs of these children.

Impact of parental migration on child well-being

Many children experience parental migration as a form of abandonment or rejection, becoming emotionally displaced, and may exhibit signs of disordered behavior.³ Coping ability with migration-related stress depends on the child’s personality traits, family functioning, and support within extended family and the community. ^3,12 Substantial research on the mental and psychological well-being of left-behind children has been conducted in many LMICs, especially in China. The results suggest increased risks of depression and anxiety,¹³ behavioral problems,¹⁴ injuries,¹⁵ substance use,¹⁶ and suicide attempts¹⁷ amongst left-behind children.

Over half of the left-behind children of migrant families in China see their mother no more than twice a year.¹⁸ The prolonged separation disrupts parent-child attachment and significantly limits parental roles in child development. Left-behind children are usually cared for by grandparents. Yet unlike the parents, rural grandparents are often ill-equipped to serve as sole guardians of children, with limited understanding about the child’s school life and emotional experience in the rapidly modernizing rural China. Additionally, some frail grandparents are cared for by left-behind children; heavy domestic chores occupy the child’s time and conflict with potential opportunities for social-emotional and educational development. ^19,20

In the absence of parents, many left-behind children develop strong attachment relationship with grandparents. Parents’ return to primary caregiving roles may cause distress with children who are taken from their familiar caregivers. When children migrate to join their parents, emotional displacement may be exacerbated by drastic life changes in the new environment, including the exposure to racism and anti-immigrant prejudice following transnational migration. ^21,22

Separation and reunification during infancy and early childhood may be particularly damaging to child social-emotional development, with long-term adverse impact. While some clinical reports in the U.S. suggest that the Chinese “satellite babies” have increased psychosocial risks after reuniting with parents,¹¹ few studies on left-behind children in China included preschool children. Effects of prolonged parent-child separation may also be compounded by additional adversities such as parents’ divorce and lack of socioeconomic support.²³ Similarly, parental incarceration was shown to impact child well-being through economic strain and disrupted interparental relationship. ^24,25 Meanwhile, protective factors such as strong social support ties may enhance children’s coping mechanisms. ²⁶

Implications for intervention programs and clinical practice

Despite the substantial literature on the impact of parental migration, research on policy and interventions providing psychosocial support for left-behind children has been scarce. The Chinese government has called on local authorities to prioritize improvements in education and social support for left-behind children,²⁷ and to strengthen social workers’ services for left-behind children and their families. ²⁸ These policy announcements have galvanized local pilot programs that serve vulnerable left-behind children and strengthen China’s child protection system. ²⁹ However, Zhao et al. (2017) ³⁰ has been the only evaluation study offering evidence on a specific intervention, demonstrating the feasibility and benefits of “Children’s Clubs”. In these Clubs children participate in fun-learning activities, under the care and supervision of local volunteers who coordinate a community support network. ³⁰ In Mexico, a report ³¹ described a similar community care program, comprising activities for left-behind children and participatory workshops for their caregivers. Existing early childhood development interventions may also benefit left-behind children, by incorporating understanding of the lived experience of family separation, and providing equitable access in low-resource contexts.

Further policy and program efforts are needed, to systematically identify children affected by parental migration at population levels, and examine features of separation and reunification, such as onset and duration of separation from parents. For social workers and primary care providers in communities affected by migration, these data are crucial in screening for children’s psychosocial risks, and identify appropriate areas for referral and support. Besides the common patterns of migration, clinicians should account for the cultural norms in childcare and family processes, including the desire to preserve the family’s culture of origin while adapting into a new environment.

Conclusions

As a toll of our increasingly mobile societies, children’s experience of separation and reunification needs to be recognized and validated. ³² Emerging evidence suggests that migratory separation from parents, and the subsequent changes in family structure, have long-term negative impacts on child development and mental health. Across countries and cultures, parental migration leads to similar challenges in childcare arrangements, and comparable patterns of risks to child well-being. ^6,33 The explicit inclusion of mental health in the targets of the Sustainable Development Goals suggests an urgency to address children’s mental health problems, besides the goals and metrics overtly associated with child mortalities. ³⁴ In addition to the wider efforts from community mental health, clinicians should play an active role in identifying and managing the specific risks associated with prolonged separation and reunification. Clinical and family services should help address parenting stress and adjustment problems in reunified families. Heightened awareness of the hidden challenges and joint actions across health and social sectors are required, to enable children affected by parental migration to thrive in their new home.