Transnational marriages and the health and well-being of Thai migrant women living in Norway

Transnational marriages

Marriages between women from low- and middle-income countries and men from high-income countries are often put under intense scrutiny in the public sphere. In the media, women are often portrayed as exploiting men for money or a visa, or as vulnerable and in need of protection from abusive men (Hedman et al., 2009; Leinonen, 2017). In politics, discussions centre around the concern that such marriages, particularly when partners differ vastly by age and education or do not share a common language, are purely of convenience (Eggebø, 2013). This scrutiny, often disproportionately directed at migrants, is a source of othering that serves to differentiate legitimacy of marriage motivations between nationals and non-nationals. Yet, the increase in transnational marriages can be seen as a result of globalisation as well as shaped by receiving countries themselves (Beck-Gernsheim, 2011; Schmidt, 2011). The introduction of the internet, new technologies and cheaper travel has enabled people from different parts of the world to connect, meet and fall in love more easily. Further, there is a demand for unskilled or semi-skilled labour, yet tightened migration policy in high-income countries. A shortage of women in rural areas also leads men in high-income countries to look elsewhere for potential partners (Schmidt, 2011). Several studies suggest economic mobility, autonomy, love and adventure are among the reasons for marriage migration among Thai women (Butratana and Trupp, 2014; Sinsuwan, 2018; Suksomboon, 2009).

Thai women in Norway

There are almost 10,000 Thai migrant women living in Norway (Statistics Norway, 2017a). While some come for work or study, majority who stay long-term are family migrants; either wives of Norwegians, or children of Thai wives. The number of Thai women who marry Norwegians outweighs any other migrant group (Dzamarija and Sandnes, 2016). Because of marriage, Thai women have settlement patterns close to that of Norwegians’ (Høydahl, 2013). Thus, Thai migrants are more likely to reside in rural areas than other groups of migrants. Recent figures suggest that 63 per cent of Thai women are employed, compared with an average of 57 per cent for all migrant women (Statistics Norway, 2017b). Further, families with Thai migrants in them are also less likely to experience poverty than many other families with migrants (Omholt, 2016). Only around 15 per cent of Thai migrant women may have higher education, however, compared with almost 37 per cent among Norwegian women (Statistics Norway, 2017c).

Health and well-being

Migration can be associated with a number of stress factors that can affect health and well-being, including language barriers, discrimination, lack of social support and employment opportunities (Delara, 2016). For women in transnational marriages, marital satisfaction also plays a role (Kim et al., 2011) and international research suggests that women in transnational marriages appear to report poorer health and mental health than local married women (Yang and Wang, 2011).

Norwegian studies on maternal health indicate that Thai women are at lower risk of adverse maternity outcomes than many other migrant groups (Naimy et al., 2013, 2015). The researchers suggested that having a native spouse can increase awareness, and use, of maternity services among Thai women, minimising the risk of poor outcomes. Findings from another study, however, indicated that Thai women were less likely to have a primary health care consultation for mental health problems than Norwegian women (Straiton et al., 2016). Further, Thai women who did consult were less likely to purchase psychotropic medicine or have conversational therapy with the doctor. This may indicate greater barriers to health care and treatment.

Despite the growing Thai population in Norway, to our knowledge, there are no other studies on their health and well-being, and none specifically on the perspectives of women in transnational relationships. These women may have different experiences than other migrants. Having a Norwegian spouse may assist with learning the language, understanding the culture, establishing a social network and obtaining employment. Spouses may also be able to orientate their Thai wife about the health care system, increasing access to some types of care (Naimy et al., 2013; Straiton and Myhre, 2017). However, Swedish research indicates that Thai women in transnational marriages still experience considerable barriers to seeking sexual and reproductive health care (Åkerman et al., 2016). Additionally, in many cases, women may not know their spouse well before marrying and some may be at risk of abuse or exploitation, increasing the risk of mental health problems (Fernbrant et al., 2014). Thus, in this study, we ask what are the factors that influence the health and well-being of Thai migrant women who have, or have had, a Norwegian spouse/partner?

Materials and method

Findings

During the interviews, a number of respondents mentioned health problems and majority indicated a reduced sense of well-being since moving to Norway. Examples of problems included high blood pressure, respiratory, kidney and gastric problems, headaches, pain, dizziness, stress, sleeping problems, anxiety, poor appetite, exhaustion and low mood. Four of the women also scored above 1.75 on the HSCL-10 scale, indicating clinically significant levels of distress.

Through the analysis, we identified a number of different factors that influenced the informants’ health and sense of well-being. We group them here into five main themes: initial culture shock, employment issues, transnational ties, marital relationships and social network. Through each of these themes, we see that these different factors have a positive or negative influence on health, depending on the women’s circumstances and resources. To animate the themes, we use translated anonymised citations in order to protect the women’s identities.

Discussion

Our study aimed to investigate the factors that influence the health and well-being of Thai migrant women who are in, or have been in transnational relationships in Norway. The study moves beyond discourses focusing only on Thai women’s vulnerable positions as wives and shows there are a multitude of factors that intertwine with each other. Despite marked differences in our informants’ life circumstances, marital status, education levels and Norwegian proficiency, they share a number of common factors that influence their health and well-being, either negatively or positively. We see that Thai networks and friendships are important for emotional and practical support, but some still suffer from loneliness. Despite having (had) a Norwegian partner, many Thai women living in Norway, particularly those with lower education levels, appear to remain socially and economically marginalised.

Like many migrants, the women had transnational lives and remained firmly rooted in two different spaces (Schiller et al., 1992). Their lives, socially, culturally and economically take place across borders. As Levitt (2001) indicates, both the migrant and their non-migrant families’ lives are transformed. Since economic and social mobility of families is an important motivation for some Thai women migrating to Europe (Sinsuwan, 2018), the practice of sending regular financial remittances to family is common. This not only benefits the family economically but also raises the family’s social standing within the community as well as increases the power and influence the woman herself has within her family (Suksomboon, 2008). However, we see that in our study the struggle to juggle the demands of their life in Norway and their roles as breadwinners, mothers or children in Thailand can have a negative effect on health and well-being. It has been argued that a migrant’s life should be understood not only by through their lives in the receiving country but also the continuation of their lives in the country of origin (Levitt and Jaworsky, 2007). Our study shoes that this is also important in relation to health.

Moreover, our findings also suggest that Thai migrant women often refrain from disclosing migration difficulties, health, financial or marital problems, to their family. This may be because of these enduring transnational ties and women not wanting to worry their family members in Thailand. Prioritising family’s well-being over one’s own may also be important in Thai culture (Angeles and Sunanta, 2009). Regardless of the reasons, the lack of public discussion in Thailand about failed foreign marriages, together with sending financial remittances can serve to maintain myths and unrealistic expectations about life and wealth in Europe among local Thai people (Suksomboon, 2008). Suksomboon suggests that this maintains the attractiveness of migration, particularly for women from rural areas with low education. Thus, many Thai women arrive completely unprepared for the challenges they will face in the new country, or without the knowledge and information to help deal with them.

Acculturation, employment, discrimination, social isolation, financial problems and language difficulties are commonly discussed factors in migration literature that affect migrant women’s health and well-being (Delara, 2016). This study highlights that Thai migrant women, who have (had) transnational relationships, struggle with many of the same difficulties as migrants without a native spouse. Yet, these women receive less organised assistance compared with other immigrant groups such as refugees and their family members. These groups receive an income while attending an introduction programme for up to two years in Norway (VelkommenOslo, 2016), as well as assistance from an advisor about education, career choices, integration and various social activities. Family migration policy, to reduce the burden on the social welfare system, expects marriage migrants to be supported by their spouse until they can support themselves (Eggebø, 2010). This arrangement, however, places the native spouse as the knowledgeable provider and the migrant spouse in a subservient, dependent position (Merali, 2008). While many of the women in our study reported receiving practical, emotional and financial support from their spouses, there was also indication that some men exploited this power imbalance. Other reports indicate that a migrant spouse’s precarious status as a dependent can enable exploitation or abuse (Fernbrant et al., 2014; Tyldum and Tveit, 2008; Vatcharavongvan et al., 2014). More organised assistance may be beneficial to facilitate integration, reduce social isolation and improve employment opportunities.

Yet, women are not passive receivers of information but actively seek it from other sources. Religious meeting places, voluntary organisations and other informal community networks commonly serve as important social arenas not only for friendships but for information exchange within migrant communities (Hynie et al., 2011; Straiton and Myhre, 2017). Thai women with higher education, in particular, were often a source of knowledge and advice about rights and available services, for women with lower education and limited language proficiency. Women active in such organisations, however, have competing demands in their home and working lives so providing help and support can be overwhelming at times. Further, one’s knowledge may be based on individual experiences or needs and there may be other appropriate sources of help that the women are unaware of. Given the importance of community networks for migrants as a source of information, formalised training courses for voluntary organisations and/or paid positions in migrant networks could be beneficial to ensure migrants get access to timely information or support in times of stress. Indeed, research suggests that community mediator programmes are beneficial in improving migrants’ access to appropriate health care (Abrahamsson et al., 2009; Nguyen et al., 2011).

Although our informants were entitled to free Norwegian language classes and Norwegian social studies upon arrival, we found that not all women attended classes. Many Thai women make the decision to migrate in part to provide themselves and their family left behind with a better future (Plambech, 2008). As dutiful mothers or daughters (Suksomboon, 2008), women with families who rely on them for financial support may favour working and earning at the first opportunity, rather than attending Norwegian classes. The importance of language proficiency has been increasingly recognised not only for integration in the job market but also in order to learn about their rights and obligations. To encourage completion of language, family reunification migrants arriving after September 2013 are obliged to complete a minimum of 600 h in order to obtain permanent residency (UDI, 2017). However, the right to free lessons falls away after the first three years, and thus, migrants have less opportunity to improve their language skills at a later stage. Removing, or extending the three year limit may encourage more women to return to language classes, which could aid both social and economic empowerment.

While statistics show that Thai women are less likely to be in households of poverty and more likely to be employed than other migrant women (Omholt, 2016; Statistics Norway, 2017b), this study indicates that many still experience financial difficulties. Additionally, in line with other migrant studies, our informants had low job security (Vrålstad and Wiggen, 2017), often working on short-term contracts or with a low number of contracted hours. Thus, most women were unable to fully utilise their skills. For some, education is not recognised and further study or conversion courses are required in order to work in similar professions in Norway as in Thailand. Underemployment is not only “brain waste” at the societal level but deprives immigrants of economic empowerment and also affects their self-identity and their health and well-being (Mutuku, 2017). Other women in our study had skills and years of experience but no formal education. Thus, in a job market that requires formal qualifications (Brochmann and Hagelund, 2011), women with low education have difficulties in competing for jobs. This is likely to reflect a common difficulty among many Thai women in Norway, given the relatively low levels of education compared with the general population. While most education in Norway is free, also for migrants, the reduction in income associated with studying instead of working may make this a less feasible option for women with families to support in Thailand or spouses with low incomes.

Marital dissatisfaction has been linked to poorer mental health in migrant women (Kim et al., 2011). In our study, we see that the practice of sending financial remittances is an issue that can place strain on marital relationships. As Suksomboon (2009) discusses, sending remittances is often accepted by husbands if the woman earns her own income and is also able to contribute to household bills. This may push women to take on more work in order to provide for their families without affecting their financial situation in Norway. Migrants tend to work in less optimal physical environments than the rest of the population and are more likely to be on their feet for longer periods of time (Revold, 2017). Poor working conditions can lead to long-term health problems. We see that this also applies to some of our informants. Some women become trapped in a cycle of cumulative stress; working extra to send remittances home but over time, increases in stress and health effects of physical work leads to sick leave and eventually reduced income, which increases worries about providing for family.

We also see that immigration policy can have an effect on the well-being of mothers in particular. Since policy stipulates that a sponsor needs to earn a certain amount to have a family member join them in Norway, women with low household incomes are denied the right to family life. The rights are therefore different for Norwegian-born and Thai migrant mothers and can be perceived as discriminatory. Although migration is often construed as a personal choice, leaving children is rarely a choice but rather a result of their socioeconomic circumstances and the global economy (Hochschild, 2004). Thus, this policy contributes to, and maintains, power imbalances, resulting in the marginalisation of migrant women (O’Mahony and Donnelly, 2007).

Finally, a couple of women in our study also spoke of discrimination in the workplace. This is prohibited in all aspects of employment including job advertisement, appointment, training, pay and working conditions (Arbeidstilsynet, 2017). Yet, a recent survey suggests that around 16 per cent of migrants experience discrimination in the workplace (Hamre, 2017). Studies show that workers’ perceptions of discrimination are associated with increased stress, decreased satisfaction and intentions to seek new employment (Regmi et al., 2009). It is important that discrimination is tackled, at both management and employee level, not only for the well-being of individual employees but also to better utilise migrants’ skills and reduce staff turnover.

Conclusion

Research on health of Thai women in transnational relationships tends to focus on their position as migrant wives and the vulnerabilities to exploitation and abuse they face as a result. While, due to their position as women, as migrants and (often) of low socioeconomic status, these vulnerabilities do exist, focusing on only discourses around marital relationships are limiting when trying to understand factors that influence their health and well-being. This study gives a more nuanced description of the factors that play a role.

We found that while most of the identified factors occur throughout their time in Norway, we hypothesise that Thai migrant women may experience higher periods of stress when they first move to Norway due to initial culture shock and challenges in finding employment. However, chronic stress associated with the competing demands of living in two spaces together with working in labour jobs, such as cleaning can lead to some Thai women’s health status and well-being deteriorating over time. Our study also suggests that structural issues including discrimination in the workplace and migration policy contributes to reduced health and well-being. At the same time, Thai women make up a heterogeneous group of women with diverse circumstances and different resources. They are not passive receptors of their situations in Norway but actively seek solutions and ways of coping. Social networks may be of particular importance and many try to help empower other Thai women who experience greater marginalisation. More formalised ways of supporting marriage migrants could be beneficial and should be considered.