John Curtin Institute of Public Policy Curtin Business School Consequences of urban migration of adult children for the elderly left-behind in rural Vietnam Nguyen Thi Thu Hien This thesis is presented for the degree of Doctor of Philosophy of Curtin University November 2019 i Declaration To the best of my knowledge and belief this thesis contains no material previously published by any other person, except where due acknowledgement has been made. This thesis contains no material which has been accepted for the award of any other degree or diploma in any university. Signed: Date: 12th October 2019. Thi Thu Hien Nguyen Perth, Australia ii ACKNOWLEDGEMENTS I own a debt of gratitude to many people and institutions who have helped me in achieving the completion of this thesis. To my principal supervisor, Professor John Phillimore; without his support, mentoring, and patience since my first letter searching for a supervisor until the last page of my thesis, my dream of doing PhD would not have been possible. My sincere thanks to Dr Chris Birdsall Jones, for her intellectual guidance with my data collection during the fieldwork. It was invaluable. John and Chris, your kindness, sympathy, generosity and selfless help through both my education as well as personal journeys was touching and heartfelt, which personally completed me, and professionally my career ever changed for the better. Thank you to every staff member in the John Curtin Institute of Public Policy (JCIPP) who made it warm like our second family. A special thanks to Leza for your kind assistance as an administrator. The JCIPP family could not be better without your dedication. I will forever miss that. I am grateful to the Vietnamese Ministry of Education and Training and Curtin University of Technology. Their financial support made my journey possible. My special thanks to rural elderly for opening up and being willing to share their life stories. The warm welcome and great hospitality from Ms Oanh, and my friend's family Ms Bui Thi Tinh, during my fieldwork while staying in with them. Thank you, the leaders of the communities, for their enthusiasm in group discussions, and for contributing their opinions about the life of rural elders. I would like to thank Prof. Giang Thanh LongDean of Institute of Public Policy and Management (IPPM) at National Economics University, Hanoi; for his suggestions when I started my 1st year of research; for sharing his knowledge, advice and the same passion and care for the elderly population in Vietnam. I am thankful to my friends both in Australia and in Vietnam, who have shared the journey, and cheered me up when I felt down. Especially, I own a debt to my family, my lovely sons Matt and Harry for their sacrifice, unconditional love, care and support, who were always there for me when I needed them the most. iii ABSTRACT Since the subsidised economy was substituted by privatisation in 1986, family became the main source of support for the majority of Vietnamese elderly. Traditionally, old aged parents live under the same roof with their adult children, so that they can be looked after. Recently, the process of modernisation of its economy with the focus on urban areas in Vietnam has pushed young rural generations away from home and torn rural families apart. Scholars and experts have tried to understand if that movement is having any impact on the left-behind parents. However, the majority of the existing studies used secondary data, and quantitatively tested only the economic aspects. Other aspects of life of the left-behind elders attracted a limited amount of research. The voice of those left-behind elderly parents was also underestimated, and often not heard. This study utilised a qualitative approach and drew on the voice of those insiders, whose children had migrated to urban areas for employment. It explores the wellbeing of rural elderly individuals, not only the material aspects, but also emotional and physical care. This study used in-depth interviews, focus group discussion and observation techniques to collect data in three communities in rural areas of Vietnam. The participants were mainly the elderly parents of migrants; a total of 48 households. The elders without migrant children (12 households) were presented as the reference group. Both of those groups participated in the in-depth interviews. Key informants, who were leaders of the communes in the research settings, took part in focus group discussions to provide the additional opinions of outsiders. The observation method was also applied first-hand by the researcher. The study finds that the material aspect is the biggest concern for almost all rural households. Therefore, economic gain from urbanward migration had compensated the "emotional side effect" caused by the distant relationship between migrant child and parents. The absence of migrant children also led to reported reduced care provision to rurally based aged parents. However, the majority of rural elders still had remaining children looking after them. Given that condition, urban child migration overall seems to have a positive impact on the lives of rural elderly iv parents, even though it did not make a great difference. The positive result on the other hand, indicates that rural households were commonly and permanently facing financial difficulties, and urban migration is a strategy for rural families to break cycles of disadvantage and poverty. The intergenerational reciprocation, and filial transfers found in this study also show that geographical dispersion did not weaken family relationships. Far from concern of many people about eroding filial piety, in some case distances even made it stronger. For those elders whose children all migrated (especially single elderly households and grandparental elders), the study finds an adverse impact. Notably, in the worst situations, rural elderly parents, as my observation, seemed not to have any effective strategy to cope with, or to overcome the difficulties. They simply suffered from it, or received support from family, relatives and neighbours rather than welfare provision from the local or state government. Given the fact that the fertility rate sharply declines, and urbanward movement continues, this result raises a concern for rural Vietnam in the near future, when more elderly individuals will be living alone without children nearby. It is therefore suggested that urban migration should only be the solution for rural Vietnam in the short-term, where most of the elderly people have both migrant and non-migrant children. Arguably, without any action from government to control or manage the situation, urbanward movement over the long term may threaten the lives of the left-behind population, in particular the elderly. Furthermore, at the same time as causing great pressure and a heavy burden on cities, urbanward movement creates an unstainable future for agriculture, if farming continues to depend on the left-behind (feminisation of agriculture, or agriculturalisation of the grey population). For long-term sustainable development of the country, the study suggests that government should invest more in the agricultural and regional sectors, reducing the gaps in development levels between regions. Otherwise, an urgent call will be needed for the state to improve the welfare safety net for the rural elderly population regarding their material, emotional and health care, so that the out-migration of their adult children will not adversely affect their well-being. v TABLE OF CONTENTS CHAPTER 1. INTRODUCTION ............................................................................. 2 1.1 BACKGROUND TO THE DEMOGRAPHIC TRANSITION AND THE URBANISATION PROCESS IN VIETNAM ..................................................................................................................... 2 1.2 STATEMENT OF THE RESEARCH PROBLEM ...................................................................... 6 1.3 RESEARCH OBJECTIVES .............................................................................................. 7 1.4 MIGRATION INTERPRETATION SCHOOLS OF THOUGHT AND THEORY CONSIDERATION .............. 8 1.5 BACKGROUND OF THE CASE STUDY .............................................................................. 9 1.6 OUTLINE OF THE THESIS........................................................................................... 13 CHAPTER 2. THE IMPACT OF URBAN MIGRATION OF ADULT CHIDREN ON RURAL ELDERLY PARENTS: THEORETICAL PERSPECTIVES AND EMPIRICAL EVIDENCE .. 16 2.1 THEORETICAL PERSPECTIVES AND CONCEPTUAL FRAMEWORK .......................................... 17 2.1.1 Key terminologies, typologies of migration and the scope of the study ... 17 2.1.2 Rural-urban migration in developing countries: Scale and recent trends 24 2.1.3 The incentives for rural-urban migration in developing countries: Migration theoretical perspectives .................................................................... 27 2.1.4 Selectivity of migration in developing countries ....................................... 33 2.1.5 Patterns of dependency ............................................................................ 35 2.1.6 Familial relationships theoretical explanation ........................................ 35 2.1.7 Aspects of care provisions to the older adult and well-being theories ..... 38 2.1.8 Older adults in developing countries and their sources of income ........... 46 2.1.9 The impact of urban migration on rurally-based elderly relatives: Academic perspectives ....................................................................................... 49 2.2 EMPIRICAL EVIDENCE FROM DEVELOPING COUNTRIES. ................................................... 52 2.2.1 Evidence of material consequences .......................................................... 52 2.2.2 Evidence of emotional consequences ....................................................... 60 2.2.3 Evidence of physical care consequences ................................................... 65 2.2.4 Strategies for coping with difficulties ....................................................... 68 2.3 CHAPTER SUMMARY ............................................................................................... 69 CHAPTER 3. RURAL ELDERLY POPULATION IN RELATION TO URBAN MIGRATION IN THE CONTEXT OF VIETNAM ........................................................................ 75 3.1 INTERNAL MIGRATION IN THE PRE-AND POST-REFORM ERAS (1986) ................................ 75 3.1.1 Pre-reform (1975-86), and managed migration ....................................... 75 3.1.1.1 Centrally-controlled economy eliminated economic incentive for labour movement ................................................................................................................. 76 3.1.1.2 Household registration – a spontaneous migratory obstacle ...................... 77 3.1.1.3 "No Responsibility and No Rice" farmers were tied to agricultural cooperatives, preventing rural-urban migration ...................................................... 81 3.1.1.4 Population redistribution programs pre-reform and State-managed migration ................................................................................................................... 82 3.1.2 Post-reform (after 1986) and spontaneous migration .............................. 86 3.1.2.1 Crisis of Vietnam's centrally planned economy ............................................ 86 3.1.2.2 Transformation to a market-oriented economy and a globally integrated model ........................................................................................................................ 89 3.1.2.3 Economic reform results ............................................................................... 93 3.1.2.4 Factors promoting urbanward movement post-reform ............................... 97 3.1.2.5 Government ministries and departments responsible for migration ........ 106 3.1.2.6 Spontaneous rural-urban migration post-reform ....................................... 108 3.2 RURAL VIETNAMESE ELDERLY INDIVIDUALS IN THE CONTEXT OF URBANWARD MIGRATION OF THE YOUNG GENERATION ............................................................................................ 113 vi 3.2.1 The Vietnam demographic transition: Aging population ....................... 113 3.2.2 Vietnamese elderly status: Wealth and health ....................................... 115 3.2.2.1 The economic status of the elderly ............................................................ 115 3.2.2.2 Elderly health status and health care programs ......................................... 118 3.2.3 Laws related to elderly care and the support from the state ................. 125 3.2.3.1 Legislation relating to elderly care .............................................................. 125 3.2.3.2 Major agencies and organisation related to elderly care. .......................... 127 3.2.3.3 Social security retirement programs .......................................................... 128 3.2.4 Vietnamese traditional family values and elderly people. ...................... 129 3.2.4.1 The perception of the elderly in family and society ................................... 129 3.2.4.2 Family structure and the living arrangements of elderly individuals ......... 131 3.2.4.3 Family taking care of the elderly ................................................................. 133 3.3 A REVIEW OF LITERATURE CONCERNING THE WELL-BEING OF VIETNAMESE RURAL ELDERLY RELATIVES OF MIGRANTS ............................................................................................. 134 3.3.1 Economic aspects .................................................................................... 134 3.3.2 Emotional aspects ................................................................................... 136 3.3.3 Physical care aspects ............................................................................... 136 3.4 CHAPTER SUMMARY ............................................................................................. 137 CHAPTER 4. METHODOLOGY ......................................................................... 141 4.1 RATIONALE FOR THE USE OF A QUALITATIVE METHOD .................................................. 141 4.2 DATA COLLECTION METHODS ................................................................................. 142 4.2.1 In-depth interviews ................................................................................. 143 4.2.2 Participant observation ........................................................................... 150 4.2.3 Focus group discussions .......................................................................... 151 4.3 DATA ANALYSIS METHODS ..................................................................................... 153 4.4 ETHICS STATEMENT .............................................................................................. 155 4.5 DATA STORAGE ................................................................................................... 155 CHAPTER 5. THE DEMOGRAPHIC PROFILES OF PARTICIPANTS AND ECONOMIC CONDITIONS OF THEIR RESPECTIVE RURAL COMMUNES ................................ 156 5.1 DEMOGRAPHIC CHARACTERISTICS OF INTERVIEW PARTICIPANTS ..................................... 157 5.1.1 Age ranges .............................................................................................. 157 5.1.2 Gender ..................................................................................................... 158 5.1.3 Marital status .......................................................................................... 158 5.1.4 Number of children.................................................................................. 159 5.1.5 Living arrangements and trends ............................................................. 161 5.1.6 Education attainment and literacy ......................................................... 163 5.1.7 Job and occupation ................................................................................. 164 5.1.8 Working status ........................................................................................ 164 5.1.9 Pensioners, welfare beneficiaries ............................................................ 167 5.2 ECONOMIC CHARACTERISTICS OF RESEARCH LOCALITIES (MIGRANTS' PLACE OF ORIGIN) ...... 171 5.2.1 The similarities ........................................................................................ 171 5.2.2 The differences ........................................................................................ 177 5.3 FOCUS GROUP DISCUSSION ATTENDEES .................................................................... 179 5.4 CHAPTER SUMMARY ............................................................................................. 179 CHAPTER 6. MATERIAL, EMOTIONAL, AND PHYSICAL CARE CONSEQUENCES .. 180 6.1 ANALYTICAL FRAMEWORK: .................................................................................... 180 6.2 MATERIAL WELL-BEING CONSEQUENCES ................................................................... 182 6.2.1 The economic conditions of the elderly participants (self-rated) ........... 183 6.2.2 Children's financial status from the elderly parents' perspective ........... 193 vii 6.2.3 Material support to rural elderly parents by adult children ................... 194 6.2.3.1 Material support in general ........................................................................ 194 6.2.3.2 Comparison between the elderly with migrant children and elderly whose children have not migrated..................................................................................... 197 6.2.3.3 Comparison among the elderly parents of migrants .................................. 200 6.3 EMOTIONAL WELL-BEING CONSEQUENCES................................................................. 208 6.3.1 Comparison between the elderly with migrant children and elderly whose children have not migrated .............................................................................. 209 6.3.2 Comparison among the elderly parents of migrants .............................. 212 6.4 PHYSICAL CARE CONSEQUENCES .............................................................................. 215 6.4.1 Comparison between the elderly with migrant children and elderly whose children have not migrated .............................................................................. 216 6.4.2 Comparisons among the elderly parents of migrants ............................. 217 6.5 DIFFICULTIES AND COPING STRATEGIES OF RURAL ELDERLY PARENTS OF MIGRANTS ............ 221 6.5.1 Material difficulties and coping strategies ............................................. 221 6.5.2 Emotional difficulties and coping strategies ........................................... 221 6.5.3 Physical difficulties and coping strategies .............................................. 222 6.5.4 The role of local governments in supporting their elderly population .... 222 6.6 CHAPTER SUMMARY ............................................................................................. 222 CHAPTER 7. LIVES OF RURAL ELDERLY INDIVIDUALS: MYTHS AND REALITIES .. 224 7.1 DAILY LIFE AND SOCIAL CUSTOMS ............................................................................ 224 7.2 FINANCIAL DIFFICULTIES ........................................................................................ 225 7.3 WORKING HARD .................................................................................................. 226 7.4 HOSPITALISATION IS A BIG CONCERN ........................................................................ 227 7.5 LIVING ALONE IS NOT A CHOICE BUT A NECESSITY ........................................................ 227 7.6 ABUSE AND NEGLECT OF ELDERLY INDIVIDUALS........................................................... 230 7.7 MENTAL AND PHYSICAL OVER-BURDENING WHEN IN CHARGE OF GRANDPARENTING .......... 233 7.8 BURDENS IN TAKING OVER THE WORK OF TWO GENERATIONS ....................................... 234 7.9 MIXED FEELINGS WHEN TALKING ABOUT LIVING IN A NURSING HOME ............................. 235 7.10 BOTH DIRECTIONS OF FAMILY SUPPORT (BETWEEN RURAL-BASED PARENTS AND CITY-BASED CHILDREN) ............................................................................................................... 236 7.11 LACK OF SUPPORT FROM GOVERNMENT .................................................................. 236 7.12 THE ELDERLY ASSOCIATION IN RESEARCHED COMMUNES ............................................ 237 7.13 CHAPTER REMARK CONCLUDES ............................................................................. 238 CHAPTER 8. DISCUSSION AND CONCLUSIONS ................................................ 241 8.1 DISCUSSION ........................................................................................................ 241 8.1.1 Material consequences ........................................................................... 241 8.1.2 Emotional consequences ......................................................................... 247 8.1.3 Physical care consequences .................................................................... 251 8.1.4 The roles of localities in supporting the rural elders ............................... 255 8.1.5 Strategies for coping with financial, emotional and health care difficulties .......................................................................................................................... 256 8.2 CONCLUSION ...................................................................................................... 256 8.2.1 Major findings ......................................................................................... 256 8.2.2 Policy recommendations ......................................................................... 260 8.2.3 Limitations and future research directions ............................................. 261 REFERENCES ............................................................................................................. 265 APPENDICES ............................................................................................................. 283 viii LIST OF TABLES Table 1-1: Population changing over time from 1989 to 2016 .................................... 3 Table 1-2: Research problems and related theories ..................................................... 9 Table 1-3: Economic and Social Indicators for Thai Binh compared to the national average (2015) ......................................................................................... 12 Table 2-1: The categories and directions of internal migration ................................. 18 Table 2-2: Migration dimensional classifications ...................................................... 22 Table 2-3: Countries with the largest projected declines in rural population between 2014 and 2050 and relative change in rural population .......................... 27 Table 2-4: Consequences of urbanward migration in developing countries on elderly parents remaining in rural areas .............................................................. 71 Table 3-1: Regulations relating to Ho Khau registration 1957-2014 ......................... 80 Table 3-2: Vietnam, Urban and Rural Population Growth, 1976-1989 (official population in thousands) ......................................................................... 85 Table 3-3: Official statistics on North Vietnamese agricultural cooperatives, 1958-80 ................................................................................................................. 87 Table 3-4: Milestones of Doi Moi from 1987 to 1994 ............................................... 92 Table 3-5: Vietnam recent economic development ................................................... 96 Table 3-6: Vietnam development indicators .............................................................. 96 Table 3-7: Structure of sectors' GDP and contribution out of overall growth for the period 2011-2016 .................................................................................. 102 Table 3-8: Government policies to control and guide urban development in Vietnam ............................................................................................................... 103 Table 3-9: Internal migration in Vietnam pre and post-reform (1986) .................... 106 Table 3-10: Urban and rural population growth rates (% p.a.) ................................ 108 Table 3-11: Urban-rural population structure (% of total) ....................................... 109 Table 3-12: Health insurance entitlements of older persons .................................... 122 Table 3-13: Constitutional provisions on the rights of older persons ...................... 126 Table 3-14: Social allowances for Vietnamese elderly people ................................ 129 Table 3-15: Living arrangement of older people by sex and residence, 2011 ......... 132 ix Table 3-16: Consequences of urban child migration on rural communities, households, older adults in Vietnam ..................................................... 139 Table 4-1: The in-depth interview sample size and design for one research setting 149 Table 5-1: Working status of the rural elderly respondents ..................................... 165 Table 5-2: Key demographic characteristics of the elderly participants .................. 170 Table 5-3: Summarised key features of three research locations in 2015................ 178 Table 6-1: Total food cost for a rural family per month .......................................... 186 Table 6-2: Material consequences of urban migration of adult children on rural elderly parents (the elders' self-rated) ................................................... 201 Table 6-3: The grandparenting households that are materially supported by migrants ............................................................................................................... 202 Table 6-4: Welfare beneficiaries and pensioners ..................................................... 205 Table 6-5: Emotional consequences of urban migration of adult children for rural elderly parents (the elders' self-assessed) ............................................. 214 Table 6-6: Physical care consequences of urban migration of adult children for rural elderly parents (the elders' self-rated) ................................................... 218 Table 7-1: The UN human rights declarations and conventions for older people ... 238 x LIST OF FIGURES Figure 1-1: Population pyramid of Vietnam, 2014 2016 ........................................... 4 Figure 1-2: The location of Thai Binh province in the map of Vietnam ................... 10 Figure 1-3: Administrative Map of Thai Binh ........................................................... 11 Figure 1-4: Three research communes in Kien Xuong District, Thai Binh province, Vietnam. .................................................................................................. 13 Figure 2-1: Millions more urban people each year by world region.......................... 25 Figure 2-2: Urban population by major area, 1950-2050 .......................................... 26 Figure 2-3: Conceptualisations of Quality of Life ..................................................... 41 Figure 2-4: Relevant domains for quality of life assessment – A substantial overlap between sources....................................................................................... 42 Figure 2-5: A model of quality of life and well-being ............................................... 44 Figure 2-6: Percentage of the population aged 60 years or over, estimated for 19502014 and projected to 2050 ..................................................................... 47 Figure 2-7: Population of older persons, estimated for 2015 and projected for 2050 47 Figure 2-8: Source of finances for consumption among older persons, 2000's (a) ... 48 Figure 3-1: Foreign Direct Investments into Vietnam ............................................... 94 Figure 3-2: Foreign Direct Investment from 2010 to 2016 ........................................ 95 Figure 3-3: Vietnam's Organisational Chart of Administrative Structure regarding migration management .......................................................................... 107 Figure 3-4: Urban population dynamics of Vietnam (1960-2015) .......................... 110 Figure 3-5: Primary reason for population movement in 2004 in Vietnam ............. 111 Figure 3-6: Migration trend and ages in 2004 in Vietnam ....................................... 112 Figure 3-7: Share of population by age, annual: 1950 – 2100 in Vietnam .............. 113 Figure 3-8: Youth, Elderly and total dependency ratios, annual: 1950 – 2100 in Vietnam ................................................................................................. 114 Figure 3-9: Age structure and the proportion of population aged 60 and older in Vietnam, 1979 – 2049. .......................................................................... 115 Figure 3-10: Poverty rates of individual by age (left hand side) and Poverty rates by age of household head (right hand side) in Vietnam ............................. 117 Figure 3-11: Life expectancy at birth by sex among ASEAN nations, 2015 ........... 119 xi Figure 3-12: Self-assessment of health among older persons in Vietnam by demographic and geographic characteristics, 2011............................... 120 Figure 3-13: Outline of the Vietnam health system ................................................. 123 Figure 3-14: Health care network for older people in Vietnam ............................... 124 Figure 3-15: Health station where the elderly received treatment for an illness or injury in the last 12 months (% by population) ..................................... 125 Figure 3-16: Living arrangement among older persons in Vietnam, 2002 – 2012 .. 133 Figure 4-1: The design of in-depth interviews research samples ............................. 146 Figure 5-1: Participants' age, gender, marital status ................................................ 159 Figure 5-2: Participants' number of living children, and gender of children ........... 161 Figure 5-3: Elderly's' education level attainment, occupation, and working status 166 Figure 5-4: Rice fields .............................................................................................. 172 Figure 5-5: Lowland Integrated Farming System .................................................... 174 Figure 5-6: VAC system .......................................................................................... 176 Figure 6-1: Analytical framework for exploring the impact of migrant children for rural aged parents. ................................................................................. 182 Figure 6-2: A typical house design in the Northern lowland, rural Vietnam ........... 184 Figure 6-3: The combination of the old designs and the modern house styles in rural Vietnam. ................................................................................................ 185 Figure 6-4: Growing vegetables in the home garden ............................................... 187 Figure 6-5: Local markets in Vietnam ..................................................................... 187 Figure 6-6: A typical meal of a rural family in the North of Vietnam ..................... 188 Figure 6-7: An elderly couple with their meal ......................................................... 189 Figure 6-8: Water sources of households in rural areas, Northern Vietnam ............ 190 Figure 6-9: Fuel sources of households in rural areas, Vietnam .............................. 191 Figure 6-10: Material resources of the rural elderly ................................................ 193 Figure 6-11: The working status, support receipt, and financial support expectations of rural elderly adults ............................................................................ 195 Figure 6-12: The working conditions of rural elders and the material support from children. ................................................................................................. 198 xii Figure 6-13: Emotional care from adult children (parents' self-rated) .................... 210 Figure 6-14: Elderly participants' health conditions (self-rated) ............................. 216 Figure 6-15: Looking after a grandchild when their parents out-migrate ................ 220 xiii LIST OF APPENDICES Appendix 1: Working status of Vietnamese rural elderly and receiving material support from children......................................................................283 Appendix 2: Material consequences hierarchy and key strategies for coping with difficulties of rural elders.................................................................284 Appendix 3: Material, emotional and physical care consequences..................285 Appendix 4: The consequences of rural-urban migration of adult children on rural age parents.........................................................................................286 Appendix 5: In-depth Interview guidelines (for the elderly participants in rural area) .................................................................................................287 Appendix 6: Focus group discussion guidelines (for key informants) ... ..........292 xiv LIST OF ABBREVIATIONS ADLs Activities of Daily Living ASEAN Association of Southeast Asian Nations APEC Asia-Pacific Economic Cooperation BGC Border Guard Command BTA Bilateral Trading Agreement DAFELF Department for Management of Foreign Employed Labour Forces DRV Democratic Republic of Vietnam ELB Elderly Left-Behind FDI Foreign Direct Investment FGDs Focus Group Discussions IDIs In Depth Interviews HDR Higher Degree by Research HIV Human Immunodeficiency Virus HRQoL Health-Related Quality of Life GDP Gross Domestic Product GSO General Statistic Organisation IOM International Organisation for Migration LDCs Less Developing Countries LUCs Land Use Certificates MARD Minster of Agriculture and Rural Development MATs Mutual Aid Teams MOC Ministry of Construction MOF Ministry of Finance MOFA Ministry of Foreign Affair MOJ Ministry of Justice MOH Ministry of Health MOLISA Minister of Labour, War Invalids and Social Affairs MPS Ministry of Public Security NCDs Non-Communicable Diseases NEZs New Economic Zones ODA Development Assistance Capital STDs Sexual Transmission Diseases SWB Subjective Well-Being TAFE Technical and Further Education TFR Total Fertility Rate UNESCO United Nations Educational, Scientific and Cultural Organisation UNFPA United Nation Population Fund US United States of America USA United States of America VAE Vietnam Association of the Elderly VHLSS Vietnam Household Living Standard Survey VNAS Vietnam Ageing Survey VNCA Vietnam National Committee on Ageing VND Vietnam Dong VLSSs Vietnam Living Standard Surveys WTO World Trade Organisation 1 "Ageing, if it's not your issue, it will be" (Carbonell, 2002, p. 2) "Persons everywhere are able to age with security and dignity and to continue to participate in their society as citizens with full rights" (United Nations, 2002, p. 7) ---------------------------- The aim of the International Plan of Action on Ageing The Second World Assembly on Ageing, Madrid Meeting April 2002 2 CHAPTER 1. INTRODUCTION 1.1 Background to the demographic transition and the urbanisation process in Vietnam An 85-year-old woman was dipping in the cold water, catching crabs and snails for a living. Another old man was waiting for someone to hire him, doing whatever he could to earn money each day. An 84-year-old widow lived with her eldest son and was abused by him. Another elderly couple looked after their grandchildren who had been left-behind by their migrant parents, with their mental and physical suffering. Can one imagine their old age living such lives? These are just some of the many rural Vietnamese elderly individuals who are vulnerable and struggling in their old age. And many more stories were not told, won't ever be told, or will ever be hindered. By 2018, Vietnam had 10.3 million people over the age of 60 (who is considered to be an elderly person in Vietnam), accounting for more than 10% of the entire population of about 97 million. The United Nations Population Fund reports that the majority of these individuals about 72% are still living in rural and other disadvantaged areas. Only 21% receive public pensions (contributed pension for those who used to work for the public sector and since retired), while 8.3% earn their own living. More than 70% do not have an old age pension and are therefore without any regular income when they are no longer able to continue in paid work. Such individuals are financially supported by their family members. Fewer people can be self-reliant through their own labour or their pension. Family is the main source of support for most older people (UNFPA, 2011). The vulnerable situations aforementioned of the elderly raise questions such as: ➢ Is it a common and permanent problem for rural elderly individuals to face such a hard life during their advanced years? ➢ Or has this situation recently occurred because children who are supposed to give care, are now leaving their parents for the city? 3 Related to the phenomenon of urban migration and the older people left-behind, Vietnam after Doi Moi1 in 1986, is experiencing significant demographic and economic changes (Pfau & Long, 2010). The phenomenon of a rapidly ageing population is the most easily observed recent demographic change. It took only one year (2014-2015) for the number of people aged 60 and over to increase by about 1% of the population, compared to the situation only a decade or so ago. Similarly, the aging index increased rapidly recently, by around 6 percentage points in just two years (2014-2016) compared to a similar jump taking 10 years between 1989 and 1999 (See Table 1-1). Table 1-1: Population changing over time from 1989 to 2016 Proportion of population (%) 1989 1999 2009 2014 2015 2016 Age under 15 39.2 33.1 24.5 23.5 24.0 23.8 Age 15-64 56.1 61.1 69.1 69.4 68.4 68.2 Age 60 and above 7.1 8.0 8.7 10.2 11.3 11.9 Aging Index 18.2 24.3 35.5 43.3 47.1 50.1 Note: The Aging Index refers to the number of elders per 100 persons younger than 15 years old in a specific population. This index increases as population ages ("Aging Index," 2010, p. 4140 glossary). Source: (General Statistic Office, 2017, p. 31) General Statistic Office (2017, p. 32) explains that a country whose proportion of people aged 65 and older accounts for 7% to 10% of the population, is considered as being "aging". If so, Vietnam entered the so-called "aging phase" in 2011, when the elderly proportion reached 10% of the total population (GSO, 2011b). Notably, females characterised the aging population in Vietnam because of the consequences of the war and the inherited longer life expectancy for females (See Figure 1-1). 1 The economic innovation in Vietnam in 1986 called Doi Moi. This will be explained in detail in the following chapters. 4 Figure 1-1: Population pyramid of Vietnam, 2014 2016 Source: (General Statistic Office, 2017, p. 29) The proportion of elderly individuals in Vietnam is projected to grow faster than any other group, and will reach 27 million, or about 32% of the total population by 2049 (T. L. Giang & Nguyen, 2016). While the proportion of population aged under 15 declined or recently remained stable, the elderly population sharply increased. As anticipated, Vietnam will be mostly driven by an elderly dependency ratio in coming decades, which means Vietnamese policies will necessarily be driven by the needs of an ageing population. As forecasted, it will only need 20 years for Vietnam to transform from "aging to aged" population (when the older population accounts for more than 20% of the total population), compared to 22 years for Thailand and 26 years for Japan, where aging of the population was fastest in the Asian region (UNFPA, 2011). This demographic trend is putting Vietnam at risk of "getting old before getting rich" (T. L. Giang & Nguyen, 2016, p. 290). This demographic transition is marked by the following three characteristics: First, the total fertility rate (TFR the average number of children per woman of childbearing age) has remarkably decreased over the years since 1988, when the two-child policy was launched (Banister, 1992). For example, the TFR declined from about 6.0 in 1960s to 4.0 in 1980s and dropped to 1.9 by 2019 (Johansson, 5 Diwan, Hoa, Lap, & Eriksson, 1996; World Population review, 2019). Second, economic growth has improved the living standard and quality of life. With better nutrition and health care services, Vietnamese life expectancy will significantly increase from 75.4 in 2010 to 78 by 2030, and 80.4 by 2050 (GSO, 2010). Third, the mortality rate of Vietnamese people has also significantly declined. As a result, Vietnam is one of 15 countries in the world that has a rapidly aging population. The time span to reach the stage of "aged population will be much shorter for Vietnam than elsewhere" (GSO, 2010, p. 6). Along with the demographic transition is the economic transformation since Vietnam reformed its economy from a centrally subsidised system to a free market. Vietnam's economy is now characterised by "private sector development, foreign investment attraction and expansion of markets alongside profound changes in State management institutions towards an enhanced rule of law and democracy" (IOM, 2017, p. 6). Since Doi Moi, Vietnam's economy grew rapidly, with the Gross Domestic Product (GDP) increasing more than 8% per annum between 1992 and 1997. It then remained over 6.8% per annum after 2000 (International Monetary Fund, 2008). This was also the period where Vietnam moved from agricultural production to industrialisation. Since the internal economy was weak with severe financial constraints (a consequence of a long time practicing a subsidised economy), foreign capital was considered a key factor for modernising the economy. Thus, there have been many incentives to attract Foreign Direct Investment (FDI). Vietnam's Foreign Investment Laws were competitive compared to other nations in the region. This helped Vietnam become one of the countries attracting the largest portion of the FDI capital in the Asian area. This helped Vietnam open the door and become more integrated into the global economy. In this term, with the many advantages associated with city living, urban settings have attracted more FDI than other regions. Due to this, urbanisation has taken place profoundly all over the country in the post-Doi Moi era, causing an imbalance in development, particularly between urban and rural areas. This has caused urban migration to accelerate over the years since. Urban population annual growth rate was 2.94%, but only 0.12% in rural regions (General Statistic Office, 2017). Urbanward movement was a dominant pattern and characterised population 6 mobilities after Doi Moi (Yeung, 2007). According to UNESCO (2018), from 2010 to 2015, over a third (36.2%) of internal migration in Vietnam was rural-urban. A rapidly ageing population with accelerated urban movement has resulted in more and more elderly parents being left-behind in rural areas. The number of Vietnamese rural elderly left-behind has not been officially published yet. However, with a similar face of ageing and urbanisation that number in Vietnam anticipated was nearly that number in China, where one out of every three elderly individuals are 'left-behind' in rural areas (Biao, 2007; Connelly & Maurer-Fazio, 2016; General Statistics Office, 2011). The number of elderly individuals living alone or in households with only elderly people has continued to increase in recent years, while the number of elderly individuals as dependents has declined (Long & Pfau, 2009; UNFPA, 2011). Also, skip-generational households (households where the middle generation are absent) are anticipated to increase further in coming decades. 1.2 Statement of the research problem With state welfare for the elderly population being very limited, Mason (1992) and Schwarz (2003) raise a concern that economic transformation with urbanisation and increasing migration may weaken the traditional family structure and diminish conventional means of care for rural elderly. Whether the outflow of younger generations is impacting on the well-being of elderly villagers is a critical issue. While this problem is well discussed in other developing countries, it has not been seriously investigated in Vietnam. Also, in comparison to those who leave (migrants) and their destinations, little is currently known about the situation of those who are left-behind and their places of origin. For over 30 years since Doi Moi, the spontaneous influx of people increasingly flowed towards the city, with no particular guidance for that process from the government. Consequently, Vietnam now is facing many negative effects from urbanisation, including the phenomenon of left-behind populations in rural regions (children, and the elderly). Inevitably, any nation in its transformation process experiences 'pain and gain'. However, ideally there is 'more gain and less pain'. This study attempts to understand the impact of urban migration on elderly individuals left-behind in rural parts of Vietnam. It brings them back into view by listening to their voices. This is the first qualitative analysis to answer the question 7 of how does urbanward migration of adult children impact on the well-being of the elderly left-behind in rural Vietnam, and what strategies do the elderly left-behind use to cope with stressful situations arising from the migration of their children? Three main aspects of life for rural elderly individuals are explicitly explored in the following sub-questions, along with their response: 1. How is the urban migration of adult children impacting on the material wellbeing of elderly parents who remain in rural parts of Vietnam? 2. How is the urban migration of adult children impacting on the emotional wellbeing of elderly parents who remain in rural parts of Vietnam? 3. How is the urban migration of adult children impacting on the physical care of elderly parents who remain in rural parts of Vietnam? 4. What strategies do rural elderly individuals use to cope with difficult situations? 1.3 Research objectives This study attempts to achieve a greater understanding of urbanward movement (its good side and bad side) facing Vietnam since Doi Moi. However, it is mainly concerned with the well-being of the left-behind population and the countryside communities, which have captured less attention and discussion from scholars. By investigating the impact of migration on the well-being of the remaining elderly individuals and their strategies for coping with their difficulties, the study provides the necessary information about the situation of rural elderly in the transitional context of Vietnam. It eventually aims at providing policy advice on ways to improve the welfare of rural aged people, thereby contributing to a 'successful aging process' and 'sustainable regional development' in Vietnam. The study is mainly based on primary data collected by in-depth interviews (IDIs), focus group discussions (FGDs) and observation from a small-scale sample of migrant and non-migrant's families at the areas of origin. In addition to the four research sub-questions listed above, the study also aims: ● To investigate the support available for left-behind senior citizens from local government; and ● To provide practical evidence and recommendations for improving the wellbeing of senior dwellers in rural parts of Vietnam. 8 1.4 Migration interpretation schools of thought and theory consideration Migration can be seen through different lenses. For instance, economists approach it as a strategy to maximise income for rural households (De Haan, 1999; M. A. Gibson & Gurmu, 2012; McCatty, 2004; E. J. Taylor, 1999). Economic scholars tend to see migration as being primarily related to employment, job opportunities, and rural family livelihood and regard the economic aspect as crucial to how rural families or communities approach migration choices, and the outcome of labour movement Anthropologists and sociologists prefer to seek understanding of the social and cultural aspects of migration (Ye, Wang, Wu, He, & Liu, 2013). For example, when analysing migration in China in regard to its cultural aspect, Kandel and Massey (2002) note that young men in the community were expected to migrate out for work otherwise they would not be seen as a qualified as ambitious future husbands. Likewise, Oucho (1996) found that rural families in Kenya invest in the first boy as a traditional norm, with the hope that his migration could change the family circumstances. Many other approaches and explanations regarding migration exist using the lenses of ethnography, geography, public policy, regional studies, ageing studies, many with their own different analytical tools and competing schools of thought. This study adopts an eclectic approach. Instead of a single school of thought, a range of theory was encompassed in the theoretical framework and the analysis used in this research. Moreover, beyond the subject of migration itself, this research study explores the causal relationships between migrant children and older aged parents in rural settings. It concerns how those changes impact on the well-being of the older parents who were left-behind by their adult children. Further and broader than just the matter of migration, this study explores three main aspects: (i) a description and general explanation of the urban migration phenomenon where younger generations tend to move while the old people tend to remain; (ii) the explanation of the relationships 9 between old aged parents and their adult children in rural families; then finally, (iii) the well-being of old aged parents under those circumstances. Due to its multiple facets and related aspects, this study integrates across disciplines including theories of migration and family relationship theories, as well as theories of life satisfaction, quality of life and well-being (See Table 1-2), to support the arguments and highlight those different facets of the research problem. Those theories will be analysed in detail in the following chapter (chapter 2). Table 1-2: Research problems and related theories Research problems Theoretical sources Explain why young rural people out migrate ➢ Migration theories Explain the relationship between adult children and aged parents regarding their care exchange and provision ➢ Family relationship, and Sociology of aging theories Explain how rural aged people are satisfied with the migration of their adult children ➢ Well-being theories Source: Created by author 1.5 Background of the case study Thai Binh was selected as the research location for this study because this province was among those with the highest rate of migration in Vietnam over the past decade (Figure 1-2). Thai Binh is located in North Vietnam, 110 km from Vietnam's capital city of Hanoi. Thai Binh is considered an island, bound by three rivers Red, Luoc, and Hoa and around 53 km of coastline. Because of its location, Thai Binh is the only province that has never been merged or dissected. An eastern coastal province, it is the only province in Vietnam that does not have a mountain. It belongs to the Red River Delta in Plains and Midlands areas, and the fertile soil is excellent for growing grains, especially rice. This makes Thai Binh's rice very famous and acknowledged as the best grain in the North of Vietnam. Thai Binh is also 10 considered a granary of North Vietnam (a region that produces an excellent quality of grain). Figure 1-2: The location of Thai Binh province in the map of Vietnam Source: (Khuyen, 2012) 11 With an area of 1,509,00 square kilometers and a population of around 1.9 million, the province is divided into seven districts and one city (see Figure 1-3). The average farmland was around 550 square meters per capita (Thai Binh Portal, 2018). Figure 1-3: Administrative Map of Thai Binh Source: (T. Linh, 2019) Thai Binh has similar attributes to the other regions where labour outflow has been significant. For instance, industrialisation is undeveloped and still very poor. Approximately 90% of the labour force here work in the agricultural sector, but farmland per capita is low at 0.3 hectares per family (Khue, 2010). With the GDP per capita of USD 1,400 much lower compared to USD 2,109 nationally (Table 112 3), Thai Binh is a rural poor province in Vietnam (ERC, 2017). The very poor conditions and out of date technologies in agricultural production make it hard for farmers to be secure with so little farmland. The migration rate in Thai Binh is 57 per 1000 people, placing Thai Binh among the five provinces with the highest rate of out-migration in Vietnam (Dinh Cu, 2010). A large population and limited resources can be identified as the primary causes for high migration rates in this region. Table 1-3: Economic and Social Indicators for Thai Binh compared to the national average (2015) Indicators Thai Binh Vietnam Population 1.8 million 93.4 million Working population 1.1 million N/A GDP per capita USD 1,400 USD 2,109 GSO-World Bank poverty headcount 20% (rural) 19% Human Development Index N/A 0.666 (Ranking:116) Note: N/A is not applicable Source: Research Centre for Employment Relations (ERC, 2017, p. 8) This research was conducted in the Kien Xuong district of the province, where the rate of urbanward migration is also particularly high. The research focuses on three communes in Kien Xuong district specifically Vu Quy, Vu Cong, and Vu Trung (see Figure 1-4), each of which has different socio-economic conditions, ranging from poor and underdeveloped to better off (as discussed in detail in chapter 5). Other researchers have found that the socio-economic conditions of an area are an essential factor affecting elderly individuals left-behind by the migration of family members, which is why this was taken into account in this study. 13 Figure 1-4: Three research communes in Kien Xuong District, Thai Binh province, Vietnam. Note: Research communes (Vu Quy, Vu Trung, and Vu Cong) are marked with white dots. Source: (Thai, 2019) This research occurred over approximately four months. It ran from November 2014 to February 2015. Because first-hand observations were undertaken in this study, as the researcher, I was living with two of the respondents (Mrs O for 1.5 months and Mrs Ph for 2.5 months) in Vu Quy commune during the fieldwork. 1.6 Outline of the thesis The thesis is developed in a logical sequence: from theoretical to empirical discussion; and from international context to the internal situation of Vietnam. Opening with the general background knowledge, it then targets the specific research topic. It explains causes and effects of migration for rural older adults, followed by an analysis to draw out the implications of those findings for theory and policy; it then outlines a future research agenda for working towards a better safety net for the senior population, which aims at a healthy ageing population, a successful ageing process as well as sustainable rural development in Vietnam. It not only focuses on the specific research problem in Vietnam, but also compared to other developing countries which are similar socioeconomically to Vietnam. The analysis 14 covers different angles and layers, assisting a full and comprehensive understanding of the research problem. This thesis is structured into eight chapters, as follows: Introduction Chapter 1 describes the rapid trend of urban migration and aging population after Doi Moi in Vietnam and the challenges generated by that process. The research problem and research objectives are then stated. Literature Review includes two chapters: Chapter 2 sheds light on both the theoretical and empirical aspects of the urban migration of adult children in relation to the well-being of their rurally-based parents, before this problem is further investigated in the following chapters. Since there are many varieties of movement, this chapter introduces the scope of the study. By discussing key terminologies and typologies of migration, it determines which type of movements are examined in this research and which were excluded. This chapter also details the conceptual framework that the research rests on. Guided by the theoretical perspectives, the second part of chapter 2 provides empirical evidence concerning the well-being of rurally-based parents of adult children who have migrated. It reviews the international literature with a focus on developing countries whose socio-economic situation is similar to Vietnam. Findings from those countries can be compared and contrasted with results from Vietnam, helping to explain and understand more comprehensively the phenomenon in Vietnam. Overall, chapter 2 aims at providing broader background knowledge to the research problem focusing on international studies. Chapter 3 examines the problem in the context of Vietnam. It presents the status of migration pre and post-reform (1986) in Vietnam and argues that urbanward labour movement became more intensive only after the nation transformed its economy from one that was centrally planned and controlled, to a free market. Incorporating analysis of traditional values and culture, the responsibility of society and the underlying obligation of children towards their elderly relatives, chapter 3 then explains why urbanward movement of younger generations might affect the wellbeing of rurally-based, elderly parents. 15 This chapter also reviews all existing published studies concerning this particular issue in Vietnam, confirming that there is a lack of research especially qualitative on this topic. Pointing out the gap in the existing body of the knowledge, chapter 3 states the intention of this study to fill the gap. Methodology Chapter 4 explains the methodology applied in this research, namely qualitative methods. It introduces what techniques were employed for data collection, and the tools used to analyse the data. Findings are presented in three chapters: Chapter 5 provides an overview of the research population as well as research locations by detailing their characteristics and their key traits. Chapter 6 provides the findings that respond to the research questions and research objectives of the study. Material, emotional and physical care consequences are presented. Also, the role of local government regarding its support of older adult residents is detailed. This chapter reveals the strategies that older adult villagers use to deal with their difficult situations. Chapter 7 gives insightful evidence of the rural elderly individuals in their real lives. This rich data was collected by observation techniques, which captured the reality of rural elderly living. The stories of the daily life of those elderly participants is drawn in this chapter. Discussion and Conclusions Chapter 8 discusses the main findings in relation to the research questions. The conclusions of the thesis are also given in this chapter. The reflection of major findings is compared with the research objectives set in chapter 1. Also, the implications of those findings are brought out for theory, policy challenges and the agenda for future research. 16 CHAPTER 2. THE IMPACT OF URBAN MIGRATION OF ADULT CHIDREN ON RURAL ELDERLY PARENTS: THEORETICAL PERSPECTIVES AND EMPIRICAL EVIDENCE The main purpose of this chapter is providing the theories, concepts and empirical evidence, upon which the study has been built. The chapter begins by looking at the general theoretical perspectives on the topic. The conceptual framework and the scope of the study are then determined. A brief review about the current phenomenon of urban migration in developing countries (the scale and trends) is presented. This chapter also discusses what incentives exist for this movement in those countries. An explanation as to which groups are more likely to migrate is given, with a focus also on who remains in rural areas and why. While demonstrating that young generations tend to leave rural areas for employment in cities, this section also argues that elderly individuals are one of the most vulnerable groups in the society and tend to remain in their villages. Family relationships, particularly the obligation of children to care for elderly parents is then theoretically explained. Since state funded social welfare for senior populations in developing countries such as Vietnam is very limited, this section argues that family is the main source of support for older individuals. This chapter concludes that the phenomenon of rural-urban migration and of children leaving their elderly parents behind is concerning for many. Subsequently, this chapter provides empirical evidence by reviewing the literature surrounding the well-being of rurally-based elderly parents of migrants from other developing countries similar to Vietnam. The results are different between regions and countries. However, three main aspects of life that children have traditionally been responsible for regarding the well-being of their elderly parents emerged. They are material, emotional and physical care, which will then be applied to the case of Vietnam. By shedding light on both theoretical and empirical aspects of child urban migration in relation to the well-being of rurally-based elderly parents, this chapter aims at 17 providing background knowledge of the research problem internationally, before further examining that problem in Vietnam in the following chapters. 2.1 Theoretical perspectives and conceptual framework 2.1.1 Key terminologies, typologies of migration and the scope of the study Definition of migration In general, migration is the moving of a partial or complete population from one geographical place to another, either temporarily or for permanent settlement. From a human standpoint, migration is the movement of a person or group of persons from one region to another, often across an administrative or political border, with the intention of settling indefinitely or temporarily in a place other than their place of origin (IOM, 2011). Migration can also be defined as a process of moving, either across an international border or within a state. It includes migration of refugees, displaced persons, and migrants moving for other purposes such as traveling or studying (IOM, 2008). However, whilst it is important to acknowledge the many other reasons for movement, labour migration is the focus of this study. Typologies of migration Migration can be classified based on four typical dimensions: spatial displacement, the frequency of movement, duration of stay, and mechanism of movement. These different types of migration are explained in turn below. Internal and international migration Internal migration is movement within the same country, from one administrative unit to another, for example, a region, province, or municipality. Three categories and the directions of movement can be identified (Table 2-1): 18 Table 2-1: The categories and directions of internal migration Geographical administration of the population movement Direction of the movement Inter-province ➢ Rural to rural migration (R-R) ➢ Rural to urban migration (R-U) ➢ Urban to rural (U-R) ➢ Urban to urban migration (U-U) Inter-district Intra-district Notes: Interprovincial migrant persons moving from one province to another within the country; inter-district/intra-provincial migrants persons moving from one district to another within a province; and intra-district migrant persons moving within a district. Source: (GSO, 2011a, pp. 20, 21) Internal migration can also be identified by direction of movement. For instance, internal migration trends could be from rural to urban, urban-rural, urban-urban, or rural-rural. However, rural-urban movements dominate the volume of internal migration and have become the main trend in most countries and especially in developing countries. As defined by Rhoda (1983, p. 36), "rural-urban migration is residential relocation from a predominantly agricultural area to an area in which a majority of employment is in non-agricultural activities." Or "rural-urban migration represents a basic transformation of the nodal structure of a society, in which people move from generally smaller, mainly agricultural communities to larger, mainly non-agricultural communities" (Mabogunje, 1970, p. 2). This type of labour mobility is the focus of the current study. In contrast, international migration involves the crossing of one or several international borders, resulting in a change in the legal status of the individual concerned (IOM, 2011). While international migration is more prevalent between developed countries and more recently from developing nations to developed economies, internal migration (with the main flow being rural to urban) dominates in developing countries. Thus, this pattern of migration will be considered when examining the well-being of rurally-based elderly individuals in countries such as Vietnam. 19 Circular and seasonal migration Circular migration has been identified as a distinct type of mobility which is characterised by a repetitive pattern of coming and going between a 'home' place and a destination (Graeme Hugo, 2009). It is noted that this type of movement is not commuting to work, which involves daily movement, returning each night to home. The circular migrant needs to stay away from home for longer than a day. It could be weeks, months or years, depending on the distance between home and destination and the nature of the work; and will also be influenced by the cost of travel and other cultural factors (Graeme Hugo, 1978; Graeme Hugo, 2013; Wickramasekara, 2011). For example, a review of internal migration in Indonesia found that the patterns of circular migration vary from weeks of absence to annual, or even biannual return, depending on the distance between islands in the Indonesian archipelago. For international migration, the absences are likely to be longer, but in the cases where the home is near a border, the pattern of circulation can be more frequent for instance, the cases of migrant workers from Thailand working in northern Malaysia (Klanarong, 2003). Further clarifying this point, Graeme Hugo (2013, p. 2) also points out that "circular migration occurs on a substantial scale, both within and between countries and often involves movement from a peripheral location to core areas." The variables are the frequency of movement and the time spent at the destination. Thus, regardless of whether migration is internal or international, circular migration is conceptualised under the criterion of frequency and repetition of movement. Although circular migration has become a popular form of international migration for those in the developed world, this type of mobility is notably demonstrated in internal migration within developing countries, where there is an influx of rural workers into urban areas searching for work and periodically returning to their homes. China is a classic example of circular migration, with an impressive number of 125-150 million workers annually moving between rural sectors and major cities (Wickramasekara, 2011). Bedford (2009, p. 6) argues that "From the 1960s circular migration has been at the centre of debates about urbanisation and development in Africa, Asia, the Pacific Islands, and parts of Latin America". 20 Migration can be seasonal in character where movement is dependent on environmental conditions; thus, in some cases, migration is only undertaken during part of the year (IOM, 2008). Seasonal migrant worker programmes are another example of circularity, and in many studies, seasonal migration also qualifies as circular migration (Graeme Hugo, 2009; Wickramasekara, 2011). While rural to urban movement dominates the volume of internal migration in developing countries, circular and seasonal migration are becoming the typical pattern of rural to urban migration, rather than other forms of migration. Permanent and temporary migration Migration can be 'permanent' or 'temporary' depending on the duration of absence from the place of origin and the duration of stay at the destination. According to Bell and Ward (2000), permanent migration, which is a permanent change of usual residence, refers to a single transition with a lasting relocation and no intention to return. Temporary migration, on the other hand, includes all forms of non-permanent movements, involving returning 'home.' This movement relates to the repetitive and cyclical patterns of mobility between origin and destination. Therefore, temporary migration includes circularity and seasonality as previously explained. International circular migration refers to workers who enter a foreign country for a specified, limited period before returning to the country of origin (IOM, 2011). Wickramasekara (2011) argues that this form of movement is generally undertaken by persons with no citizenship or long-term residence in destination countries. Likewise, Graeme Hugo (2009) sees seasonal and circular migration as a subset of temporary migration. At present, most Western countries have temporary worker programmes, as a solution for labour shortages in specific sectors of the economy. Such sectors include those related to agriculture, construction, and tourism. Today, the majority of temporary worker programmes are circular in nature. According to Wickramasekara (2011), the desired transition in the management of temporary workers is towards volunteering to work in a circular migration pattern. 21 Spontaneous and managed or regulated migration Labour movements can be divided into 'spontaneous' migration flows and 'managed' migration flows. The term 'managed' migration, defined by European Migration Network (2011) refers to migration within the bounds of a government programme, with specific conditions for the duration of stay and return between the place of origin and destination. The migrants perform a particular task within a specific period and once this period is up the migrant is expected to return home. Most international migration policies are structured this way. For internal migration, managed migration relates typically to a programme that has been planned, organised or regulated by national governments. The purpose of managed migration is to encourage workers to fill labour shortages in particular regions or fields. Such work is often seasonal. Thus, seasonal workers would generally be a major target group. By complying with the applicable regulations, migrants have a chance to return to the destination country repeatedly. Managed migration is a common form of international migration between European nations, and other developed countries such as the USA, Japan, and Australia. Spontaneous migration refers to migratory flows that arise spontaneously, without any intervention from a government, scheme or programme. It is also called 'voluntary' movement, as all migration is done by choice and is ultimately selfdetermined by the migrant, i.e., relocation happens according to personal desires. As previously mentioned, people decide to move to a new place for many reasons. However, those who voluntarily migrate are often motivated by economic reasons and are searching for a better life. In this sense, migration is driven by market mechanisms, depending on labour supply and demand factors, wage rates and also indirect social factors such as health and education infrastructure. A good example of spontaneous migration is the internal migration within developing countries where rural-urban flows predominate. Managed migration is more common in developed economies where international labour migration schemes are in place. 22 The definitions mentioned do not exclude each other, as sometimes they overlap, or occasionally in some cases, they are inclusive regarding their meanings. Table 2-2 summarises the various dimensions of migration. Table 2-2: Migration dimensional classifications Types of migration Typical dimension-based classification of migration Spatial displacement Frequencies of movement Duration of stay Mechanism of movement Internal migration International migration Circular migration Seasonal migration Temporary migration Permanent migration Spontaneous migration Managed migration Note: The minimum duration of migrated time in the researched locations was over six months prior to the interviews. Source: Created by author The scope of this study While international movement in developing countries is not as commonplace, the outflow of rural labour to urban areas is frequent (see the discussion in section 2.1.2). The frequency of internal migration can cause problems both for those who leave and for those who stay behind, as well as for the towns that migrants leave 23 from and the destinations that they migrate to. Due to the considerable impact it can have, urbanward migration has been a widely studied issue. In relation to the well-being of the elderly who remain in rural Vietnam, this study focuses only on internal spontaneous urban migration of young generations. It examines how the movement of adult children within the country (not between nations), impacts on rural elderly parents' lives. The domestic urbanward movement analysed in this study includes: temporary, permanent, circular, and seasonal migration. The analysis of this study, however, does not differentiate the consequences according to those types of migration. The well-being of older parents left-behind are analysed in relation to those voluntary domestic mobilities, which is differentiated from those occurring abroad. The international literature review (chapter 2, and 3), research methodology (chapter 4), and all discussions throughout the rest of this thesis concern the welfare of elderly parents of domestic migrants not overseas emigration. Instances of international and managed migration are not included in this research (see Table 2-2). Notably, migrants in the case of Vietnam in this study are defined as people who migrated out of their parents' village2 of residence for a minimum of the past six months at the time of the interviews. This helped to avoid temporary absences. Administrative boundaries such as inter-provinces or inter-districts were not relevant for this study. Rural adults who moved to live and work in metropolitan areas were defined as urban migrants, and their elderly parents who remained in the rural areas are the objects for this study. People other than those who moved to urban areas for work are considered as non-migrants. In this study, being defined as rural elderly left-behind (ELB) is based on being geographical left-behind by at least one migrant adult child. It does not count how many children had migrated. Thus, it does not matter if one, some or all the children had migrated. In other words, the elderly had been "left-behind" by at least one child, not necessarily left alone. 2 In rural Vietnam, a village is at an administrative level which is lower than a commune level. 24 2.1.2 Rural-urban migration in developing countries: Scale and recent trends On a global scale, internal migration is currently the most common form of migration. In 2005, it is estimated that around 12% of the global population about 763 million people live in their home countries, but outside of the region in which they were born (Bell & Charles-Edwards, 2013). This contrasts with an estimated 3% around 221 million who have migrated internationally (United Nations, Department of Economic, Social Affairs, & Population Division, 2013). Research shows that overall, the internal migration trend continues to increase, even though the pace has been concurrently slowing down in some regions and accelerating in others. Globally, from 2000 to 2010, slightly less than half of the world's urban population growth can be ascribed to internal migration. In Asia, even though the rate has recently decreased, internal migration makes up almost 60% of urban population growth and is expected to continue growing. It is estimated that about 50 million people are being added to Asia's urban settlements each year. In Africa, that number is 15 million, which is predicted to increase to 30 million by the year 2050 (Tacoli, McGranahan, & Satterthwaite, 2015) (See Figure 2-1). Taking Ethiopia currently one of the least urbanised countries in the world as an example, the proportion of people living in urban centres is expected to double over the next 40 years (from 17% in 2010 to 38% in 2050) (Hadley, Belachew, Lindstrom, & Tessema, 2011). 25 Figure 2-1: Millions more urban people each year by world region Note: Used data source from United Nations Population Division (2014) Source: (Tacoli et al., 2015, p. 10) As stated by Heilig (2012), for the first time in human history more than half the world's population lives in urban areas. This number "is expected to increase by more than two thirds by 2050 with nearly 90 per cent of the increase to take place in the urban areas of Asia and Africa" (United Nations, Department of Economic and Social Affairs, & Population Division, 2015c, p. 12). The United Nations state that 52% of the globe's urban population will be concentrated in Asia by midcentury, in 2050 (Figure 2-2). 26 Figure 2-2: Urban population by major area, 1950-2050 Source: (United Nations et al., 2015c, p. 12) There are several directions in which internal migration can flow, but rural to urban is the predominant movement. This is currently very well demonstrated in developing countries rather than elsewhere in the world. Rural-urban migration continues to be significant in scale and has been an essential part of the urbanisation process in developing regions. In his research about rural to urban migration in developing countries, Brockerhoff (1995) finds that migration from rural areas contributed at least half of the urban growth in Africa during the 1960s and 1970s, and about 25% of urban population growth in the 1980s and 1990s. Similarly, from the 1950s to 1970s in Brazil considered the peak period of urbanisation in that country 20 million rural dwellers moved to urban areas. In comparison, 20.5 million people from rural parts of India moved to metropolitan areas and contributed to 30% of national urban growth. Figure 2-3 shows urban population growth by world regions. 27 Table 2-3: Countries with the largest projected declines in rural population between 2014 and 2050 and relative change in rural population Source: (United Nations et al., 2015c, p. 15) 2.1.3 The incentives for rural-urban migration in developing countries: Migration theoretical perspectives Economic incentives In a systematic review of migration literature, De Haan (1999) concludes that even though the movement of people can be the result of many reasons such as environmental, social and political crises, the economic incentive has been considered the core reason. The author argues "labour migration, between and within urban and rural areas, has to be seen as a central element in the livelihoods of many households in developing countries, poor as well as rich" (De Haan, 1999, p. 1). For contemporary studies of migration in the developing world, De Haan (1999, pp. 1,3) notes that most scholars share the view of "migration as an option of last resort for pauperised peasants." For instance, circular migration in India has been seen as a syndrome of "poverty and mobility" (Mukherji, 1985, p. 270). Similarly, migration has been found to be linked to "pervasive rural economic insecurity" in Lesotho by Chirwa (1997, p. 633), who also found a straight link between increasing migration and rural poverty. Migration is a common financial strategy in rural Indonesia: by sending individuals effective labour resources to 28 different regions or countries, households can reduce risk and increase their income (Syafitri, 2013). From the micro point of view, at the rural household and individual level, Giesbert (2007) notes that the majority of the population in developing countries live in rural areas. Their livelihoods are based on agricultural activities or small-scale entrepreneurial endeavours, as in the case of self-employed petty traders, although their labour rarely offers an income that is more than the subsistence level. Households in these regions are often exposed to strong production risks and economic constraints. In reaction to this situation, these households have a range of adaption and coping strategies, urban migration being a major one. Giesbert's study was conducted in Kenya and is a key example of this. From a macro perspective, looking at rural development as a whole, McCatty (2004) argues that rural populations experience the highs and lows of a global economy e .g., if the price of their crop drops, then their sustainability is affected. During recessions in the economy, rural populations are often among the first to lose their livelihoods. According to the new economics of labour migration, "migration is hypothesised to be partly an effort by households to overcome market failures that constrain local production" (E. J. Taylor, 1999, p. 74). Additionally, in most developing countries, farming offers only seasonal employment and does not provide sufficient income to sustain the family household for an entire year. This explains why circular or seasonal migration is becoming more popular in those countries where prospects of year-round employment in rural areas are not positive, employment in urban areas seem more rewarding (McCatty, 2004). In terms of demographics, the increase in population caused by higher fertility rates in rural areas can lead to strains on land availability. A fundamental assumption is that the incentives to migrate are influenced by the needs and behaviours of other members of the household. For example, the arrival of new offspring may place an additional strain on scarce resources (such as food or land). In many rural areas, there are no adequate property rights in place (McCatty, 2004). This can be an important factor in pushing rural people to move out of their villages. M. A. Gibson 29 and Gurmu (2012, p. 5) note: "Migration as a strategy of resource diversification is a key motivator for out-migration in this land-limited rural population." Moreover, many people have firsthand accounts of the success that can be found in urban areas. These success stories about people who leave their communities and move to cities also act as an incentive for migration (McCatty, 2004; Zheren, 2008). The departure of one member of the family also can often create opportunities for others to move out. Advances in communication and transportation have improved ease of access to cities as well as being convenient for keeping in touch with the family left-behind. This also greatly motivates individuals to migrate to urban areas. Why rural to urban? The gap between rural and urban settings: push and pull factors People migrate mostly due to economic reasons, which to a great extent explains why movement is commonly from rural to urban areas rather than in other directions. The growing imbalance in development between urban and rural seems to be happening in most countries, especially in the developing world, and it is this gap that eventually creates push and pull factors for migration. While cities receive more investment and are more highly developed, there are many reasons pushing people away from rural areas. Those push and pull factors include: Imbalance of labour demand Capital constraints within developing countries mean urban areas are generally the priority for investment in development. Thus, rural parts appear to be lagging behind. This imbalanced development, in turn, creates a labour demand disparity between regions. The demand for labour in urban areas contrasts to the surplus of individuals looking for work in rural areas. Neoclassical macro theories explain that migration occurs as a result of geographical differences in the supply and demand of labour, mostly between the rural agricultural sector and the urban modern manufacturing sector. They assert that migration is a part of economic development (Zheren, 2008). While modern sectors, generally in urban areas, grow through capital accumulation, agricultural parts are often undeveloped, leading to labour 30 being insufficient in one and with a surplus in the other. As a result, a surplus labour force in rural areas will be absorbed by modern industries in urban areas (Louis, 1954; Ranis & Fei, 1961). The huge outflow of rural dwellers to metropolitan areas in search of employment is an inevitable trend and is expected to continue at a high pace in developing countries in coming decades. Income disparity Actual income differences Reasons for migration are not limited to inconsistencies in demand for labour. Unemployed individuals are not the only candidates for migration in fact, many employed individuals have also migrated from rural regions, with many farm workers abandoning land for work in the cities. Regarding the economic causes of urban migration, the neoclassical macro migration theories do not fully explain why rurally employed workers still leave their villages. The simplest economic models of migration highlight that even though rural people have jobs, they still potentially move out of their hometowns due to wage differences across the markets i.e., work in cities may pay more than work in rural areas. Migration streams result from this wage difference, where higher remuneration pulls a labour force, while lower wages push them to leave. This explains why the direction of population movement is primarily from rural to urban settings. For example, a study in China by McGranahan and Tacoli (2006) highlights inequalities between rural and urban incomes, acknowledging them as essential motives for migration. On average, rural residents earn less than a third than that of urban residents. The authors note that the gap may be larger when urban health and education benefits are factored in. As the neoclassical approach argues, differences in the real or expected income clearly drive migration in many cases. Likewise, theories of Louis (1954) and Ranis and Fei (1961) suggest that the core reason for migration is embedded in the wage difference, and this is what attracts rural workers to urban areas. This migration flow is therefore likely to continue until wage rates in rural and urban areas equalize. 31 In relation to this economic perspective of migration, Ye et al. (2013) argue that three essential theories with a common theme should be mentioned – Lewis's unlimited supply of labour, Todaro's expected income, and Stark's relative deprivation. Each theory suggests that income disparity is the main reason for ruralurban migration, though the theories differ on certain points. For example, (Lewis, 1954, 1958) believes the difference in income between rural and urban employment will inspire unemployed individuals in rural areas to transfer from agriculture to industry, and such a movement will not stop until surplus labour in rural regions has been entirely absorbed by the advanced industrial sector. In contrast, M. P. Todaro (1969) points out that actual income may not necessarily encourage a labourer to migrate, but that the anticipated higher income over time would push him or her to move to cities even when the urban unemployment rate might be high during some periods. Stark and Taylor (1991) focus on the income gap within the rural community and argues that the more a labourer feels deprived in the village, the more likely it is that he or she would choose to migrate. According to M. Todaro (1969) and Harris and Todaro (1970), absolute income equality with those in urban areas may not be achieved, but as argued, the 'relative' income difference is an indisputable and significant factor in making the migration decision. If there is the prospect of higher earnings, people will always move to where there is a higher income. Expected income advantages Harris and Todaro (1970) assert that migration may even be driven by an expected wage difference rather than the actual one. Migration is not entirely free of risk, as migrants might not get a job upon arrival in the city. However, as long as the expected income difference is positive, rural-urban migration occurs. The authors show that it can be perfectly rational to migrate, despite urban unemployment, due to the expected positive difference in income. Sharing the same point of view, The New Economics of Labour Migration notes the potential for earning higher incomes is important to potential migrants (E. J. Taylor, 1999). Social services disparity The neoclassical (or Harris-Todaro) model argues that difference in actual wage amount or in expected income clearly drives the supply of migration in many 32 cases, yet income differences only explain a portion of the overall migration phenomenon. This is true for both internal and international migration. For example, when discussing international migration, Mansoor and Quillin (2006) point out that migration between two countries with unequal average wages can still remain low if the quality of life is better in the lower income countries. The authors assert that "significant portions of any country's workforce may, all else being equal, prefer to remain at home rather than take on the risks of moving abroad, leaving family and friends" (Mansoor & Quillin, 2006, p. 76). Many households choose to leave family surroundings when their home countries do not provide for their physical protection from attack or abuse, have poor public-service delivery and poor governance at a local and national level, uncertain business investment environment, or high unemployment. In a review of the literature on the motives for internal migration, Lall, Selod, and Shalizi (2006) find that conflict or insufficient public services such as health and education may also push individuals out of their homeland. Thus, beyond economic reasons, concern for the quality of life is always a significant consideration when rural citizens decide to migrate. Social status perceptions Oded Stark and Stark (1991) highlight other reasons for migration, pointing out: in real life, it is likely that migration decisions are influenced by both absolute and relative income considerations. Relative income can be seen as social 'status' assessed in comparison to the peer reference group. The reference group can be the local community, village or towns. Status is not only of intrinsic value but might also translate into monetary benefits, for example in LDCs where money lenders often loan money with implicit social status as collateral (Hagen‐Zanker, 2008). The critical issue here is that even though cities or metropolitan areas may have a higher demand for labour and better actual or expected wage, rural dwellers may not leave their villages if they are comfortable living in the countryside. This is well demonstrated in developed countries, where rural-urban migration also takes place, but on a smaller scale than occurs in developing countries. To conclude: Cities or metropolitan areas so-called 'bright lights' have many attractive factors to tempt individuals from 'grey' rural areas. Beyond creating more jobs with higher income, cities offer better public services than rural regions. For instance, cities can deliver education, health care, and other services more 33 effectively than less densely settled areas (M. A. Gibson & Gurmu, 2012). However, economics appears to be the primary incentive among other reasons for rural to urban migration, in developing countries. Rural dwellers migrate with the hope that they will earn more for themselves, and also help to support family members leftbehind. 2.1.4 Selectivity of migration in developing countries Who tend to move? Which groups are likely to migrate regarding age, gender, education? Migration mainly involves young adults who are more likely to have a positive net return on migration due to longer remaining life expectancy, or because social norms require that young adults migrate in search of a better life (De Haan & Rogaly, 2002). Zaiceva (2014) believes that migration is an investment in human capital. Therefore, younger migrants would be expected to gain greater financial return than older ones because of their longer lifespan. Conducting a mixed-methods study in Ethiopia, Zaiceva found that males, unmarried, childless and from wealthier families were more likely to have migrated out. Young adults (18 – 40 years) were most likely to migrate. The study also found that migration can be a family strategy, involving the sending of young individuals to the city in the hope that they will send back the money they have earned (Lucas & Stark, 1985). Similarly, in China, it seems to be youths, men, better-educated individuals and also those in good health who tend to migrate (Wu, 2010). Similarly, young people were found to dominate the pattern of rural-urban migration in Taiwan (Sando, 1986). In Vietnam, 10 years after Doi Moi (1986-1996), about 80% of migrants were aged from 13 – 39 years. Most of them had low qualification achievement, only secondary school graduation with the average of nine-year schooling. About 94% reported good health, and more than 68% of them were unmarried (Dinh Cu, 2010). While both low and high skilled individuals are likely to migrate, they do so usually for different reasons: 'Surplus' low-skilled individuals have strong incentives to move to the city in search of a manual job that they may be unable to find in the rural area, while educated and experienced individuals may see that their human capital is better rewarded in cities than in rural areas (Agesa, 2001; Lanzona, 1998). 34 In most countries, internal migration concerns are reduced for young men, because urban job markets usually offer a more extensive choice of occupations to the rural male migrants, or because men bear lower risks of vulnerability than women when migrating. Menjívar and Agadjanian (2007, p. 1243) argue that "Men's role as breadwinners and primary decisionmakers is further strengthened, as is women's subordinate position in the household". This fact further reinforces gender inequality in Armenia and Guatemala where their research was taken. In many developing countries, for various reasons women are less likely to migrate for work than men (Lokshin & Glinskaya, 2008; Mendola & Carletto, 2009; Rodriguez & Tiongson, 2001). For example, in China the responsibility for looking after children, elderly parents and the farm normally keeps women at home after marriage (Mu & Van de Walle, 2009). Latin America stands out as an exception due to the predominance of female domestic workers migrating from rural to urban regions (Lall et al., 2006). Similarly, in Vietnam female migrants outweigh males. There were 109 females for every 100 males (from 2004-2009) (Dinh Cu, 2010). Interestingly, migrants do not always come from the most deprived areas. When examining those who migrate, both Mallee (1995) and Connell, Dasgupta, Laishley, and Lipton (1976) found that the most impoverished peasants are not the most likely to migrate. Du (2000) also argues that the poorest, even though they feel the most 'deprived,' do not have the highest motivation to seek work elsewhere. According to Ye et al. (2013, p. 1122), "migration 'opportunities' are not opened to all. In some extreme cases, some peasants are simply too poor/unhealthy/ bounded by family responsibilities to migrate". M. A. Gibson and Gurmu (2012), agreed and added that migrants were more likely to come from a higher class, wealthier individuals living in households with more land and larger herb size. The authors found household size did not appear to influence out-migration. This challenges the perception that many migrants usually come from poor families that are large in size. The authors also confirm that religion did not strongly influence the out-flow of labour. It is notable that migration is "a socially stratified process in which particular families, ethnic groups or classes 35 participate in and monopolize specific forms of migration." For those scholars, as for De Haan (1999, p. 18), migration seems to be a 'selective process.' 2.1.5 Patterns of dependency Who tend to remain in the villages? Like the question of which group would be most likely to migrate, the question of who would remain in rural areas is also a common concern about this phenomenon. Not surprisingly, those who remain in rural areas are commonly dependent family members such as children who are under 18 years old and committed to attending school, along with the elderly (those are 60+ and in retirement) (Biao, 2007). Youth and age are the main components of dependency patterns. According to Afsar (1995, p. 202) "The dependency ratio is defined as the ratio of persons in the 'dependent' age (under 15 and over 64 years) to those in the 'economically productive' ages (1564 years)". The author states that a comparison of dependency ratios among migrants in cities with those of their families in rural areas would reveal the impact of that movement on the family welfare and support system. Discussing the pros and cons linking aging and the scale of migration, the current research focuses on elderly individuals who are left-behind in rural Vietnam, and how their well-being is impacted by the move of their children. The impact on the migrants themselves and on other groups left-behind by migrants are beyond the remit and the scope of this study and are therefore topics for future research. 2.1.6 Familial relationships theoretical explanation The relationship between the leavers and the remainders Family relationships are inevitable and so obvious that we often forget to mention the explanations contained within family theory. However, when it comes to the changes of family structure due to the demographic, social and economic environments transitioning in many countries, Bianchi, Seltzer, Hotz, and McGarry (2006, p. 1) state that "understanding intergenerational relationship is becoming increasingly important." For the phenomenon of escalating urbanisation with large numbers of young rural dwellers leaving elderly parents behind for the city in many developing countries recently, many researchers and policy makers question whether relationships 36 between generations change. In this case, the impact it has for those parents who remained cannot be fully understood without considering the nature of the kin bonds. The previous sections seek to understand who tends to move and who stays in the home village. Subsequently, this section discusses the relationships between the movers (adult children) and the remainers (elderly parents) and brings insight into the nature of care and exchange between them. Theoretically, it is normally argued in the literature that familial relationships are a unique form of social relationship as follows: Family relationships first, can be seen as any other social relationship, commonly based on the principle of exchange and reciprocity. The exchange model explains that each member of family has his/her own objectives and resources. Like a normal social relationship, the interaction between family members is much like an action of trading goods and services in order to maximise their well-being. For instance, parents "buy" the care of their children later by pre-investing in children's schooling or by promising to give them a bequest. As a receiver, children will pay back at a later date by looking after their parents when they get old (Bernheim, Shleifer, & Summers, 1986). If the emotional involvement is not considered, the idea of reciprocity in sociology is simply identical to a normal economic exchange; an investment made is for either immediate profit or expected future benefits (Homans, 1961). However, beyond the terms of normal exchange and reciprocity in a social relationship, family relationships are mainly guided by altruism and caring. The evidence shows that members who are less fortunate in a family, tend to receive more support than the better off. This is not an investment to make a profit. Rather it is caring, loving and support to improve the well-being of family members. According to Becker (1974, 1991) "family members have a unique set of motivations and bonds that guide their interactions, namely they 'care' about one another and one another's well-being. Such altruistic feelings can motivate a parent to finance a child's education and thereby improve the child's future well-beingeven if there is no 'repayment' from the child; or motivate a child to care for his frail mother despite no possibility of a bequest" (As cited in Bianchi et al., 2006, p. 37 9). Similarly, elderly parents normally prefer to be looked after by their children rather than by outside providers (e.g. nursing homes) even though the latter may provide 'better' care. Bianchi et al. (2006, p. 9) conclude that "families do have power to ensure reciprocal transfers beyond what the market itself might produce." The motive for interactions between generations is rooted from the character of blood inheritance. This is an invisible string connecting family kin, making it so special that hardly any other social relationship could be compared with it. As stated by Bianchi et al. (2006, p. 9),"ties between family members would be expected to differ from those between unrelated individuals." The relationship between family members is believed to be not merely a normal responsibility and obligation between people. Rather, it comes with unconditional love, being the closest relationship, and would last one's lifetime. It explains why individuals are willing to assist family members rather than strangers in need, or have greater feelings for parents or children than they do to aunts, uncles or cousins (Nock, 1995; Rossi, 1990). Notably, the factors of culture, norms and economic situations only contribute to tightening of the blood kinship. Family, hence, after being self-reliant, is the first safety net for any individual in the event of risk. Family is the first cell of any society, and the tightest organisation of that society. Based on the nature of the blood relationship, the relative responsibility and obligations have been legalised and enforced by laws. It is almost universal that parents are required to support children under the labour age of 18, and in many countries, there is also a requirement for adult children to assist elderly parents in their retirement. In Vietnam for example, family is required to be the main source of support for the elderly members by law. Public welfare will be the last safety net for those who are without family. Kinship is either theoretically confirmed or legally enacted/enforced. In practice, how kinship applies is still a mystery. Regarding geographical separation, distances can make a normal social relationship become nothing. Whether or not geographical distances destroy a kinship will be examined in the current study. However, before providing the empirical results in findings chapters, how actual ties between kinship operate will be discussed from a theoretical perspective in the next section. In particular, this includes the aspects of life in which children support their elderly parents, which in fact reflects the well-being of those elderly parents. 38 2.1.7 Aspects of care provisions to the older adult and well-being theories Variation of well-being and life satisfaction definition As an elusive concept, well-being is approached diversely and varyingly "from the assessment of societal or community well-being to the specific evaluation of the situations of individuals or groups" (Felce & Perry, 1995, p. 51). There is no universal definition of well-being. However, in the literature there is a common agreement among scholars that well-being in general refers to the satisfaction with life, positive emotions and the absence of negative emotions (Diener, Suh, Lucas, & Smith, 1999). Well-being is closely related to other concepts such as welfare, utility, happiness, thriving, flourishing, life satisfaction, or quality of life. In both research and practice, those concepts are almost synonymously and interchangeably used. Well-being refers to various aspects of life. Therefore, rather than a single measurement, there is a multidimensional approach to well-being (Kern, Waters, Adler, & White, 2015). Well-being may reflect satisfaction in a number of life domains such as work, health, material comfort, learning and creation (Flanagan, 1978); relations with family, social relationships, work, health, leisure, living conditions, and religion (Lehman, 1988); and education, health, work, living standards, marriage and family life, friendships, and neighbourhood etc. (Campbell, 1981). Huppert and So (2013) suggest 10 domains associated with flourishing, whereas Ryff and Keyes (1995) identify only six items. As concluded by Steptoe, Deaton, and Stone (2015), overall economic status, physical and mental health as well as freedom are important dimensions to measure well-being. Coming from a different, psychological, point of view, it was explained in the PERMA model by Seligman (2011) that there are five core dimensions to measure well-being. They include positive emotions (joy, happiness, or hedonistic feelings), engagement (feeling connected, acknowledged by one's peers, in regular meaningful contact with others), positive relationships (feeling socially integrated, cared about and supported by others, or satisfied with social connections), meaning (feeling valuable), and accomplishment (feeling capable to reach goals and having sense of achievement). These five pillars contribute to one's overall well-being. The PERMA model was then applied to measured well-being in many case studies. 39 Well-being can be measured either objectively or subjectively. From an objective point of view, Butler and Kern (2016, pp. 1, 2) defined well-being as "sufficient resources to meet basic needs, opportunities for education, lack of environmental pollutants." The authors argue that, even though well-being resides within the experience of the individual, health, comfort or wealth are necessarily objective conditions. Subjective well-being is explained by Alexandrova (2005, p. 302): "subjective approach allows individuals to judge how their lives are going according to what they themselves find important for happiness", or how people think and feel about their lives (see Diener et al., 1999). While the current measures of economic performance such as GDP/capita are insufficient for showing the progress of society, self-reported well-being has been taken into account as another option. This measurement initiative is being used in many countries (Harter & Gurley, 2008). The factors of age, gender, health, education, income, characteristics, genetics, geography and culture were confirmed to play an important role for one's wellbeing. Over five decades ago, Wilson found that "the happy person emerges as a young, healthy, well-educated, well-paid, extroverted, optimistic, worry-free, religious, married person with high self-esteem, high job morale, modest aspiration, of either sex, and of a wide range of intelligence" (Wilson, 1967, p. 1). Likewise, a cross-sectional study examining the quality of life of rural Vietnamese older adults found that male elderly had higher levels of quality of life than their female counterparts regarding physical health, psychological health and environment. Sickness and older age were significantly correlated to a lower quality of life in both genders. This study also noted that males "who followed Buddhism and Christianity were more likely to have a favourable quality of life than those who did not" (Van, Van, & Duc, 2017, p. 70). Dolan, Peasgood, and White (2008) reviewed the literature on the factors associated with subjective well-being and found seven common factors: income, personal characteristics, socially developed characteristics; how people spend time; attitudes and beliefs towards self/others/life; relationships; and the economic, social and political environment. When comparing across European countries, Huppert and So found that well-being measured as an overall was similar between France and Spain. However, France scored high on engagement, moderately on competence, and low on self-esteem, whereas Spain scored the opposite, in that they put self-esteem domain higher than engagement 40 (Huppert & So, 2013). Notably, there is overwhelming evidence showing a relationship between income and subjective well-being. A review of 30 surveys of 90 countries conducted by Easterlin (1974) found a positive association between income and happiness, and that within these counties, those who were wealthier were happier than poorer persons. This was confirmed by Kahneman and Deaton (2010b). It was also true when comparing personal well-being between rich and poor countries (Deaton, 2008). Besides economic aspects (e.g. financial success), social and psychological dimensions were also added to well-being (Kern et al., 2015). A dynamic concept with multiple domains, well-being is thus a multifaceted construct (Forgeard, Jayawickreme, Kern, & Seligman, 2011; Michaelson et al., 2009). The "current measurement of well-being is haphazard, with different studies assessing different concepts in different ways" (Diener & Seligman, 2004, p. 2). Due to its diversity, the authors thus suggest a more systematic approach to wellbeing. Common ground for quality of life and well-being conceptualisation Despite the variability and diversity of well-being and quality of life measurements, a common agreement among scholars is that quality of life is a combination of both objective and subjective components, which are (a) life conditions such as material, social, behavioural, psychological and biological indicators, and (b) life satisfaction referring to the subjective feelings about each area of life weighted by scale of importance by individuals (Brown, Bayer, & MacFarlane, 1989). Landesman (1986) suggests that quality of life is a range of objectively measurable life conditions experienced by an individual and influenced by their personal values, aspirations, and expectations. It is the conditions in which life is lived, or the objective standards by which one can define a decent or reasonable quality of life. It is "the satisfaction of an individual's values, goals and needs through the actualisation of their abilities or lifestyle" (Emerson, 1985, p. 282). Felce and Perry (1995) emphasise the significant role of an individual's scale of values when assessing quality of life and well-being. For instance, income might carry a high weight among life satisfaction domains. However, it may contribute less to quality of life for those whose values are non-materialistic. Life satisfaction and well-being come at the point when a person's perception of their objective situation meets their needs and aspirations 41 (Andrews & Withey, 2012; French, 1974). Quality of life and well-being measurement is summarised in (Figure 2-3). Figure 2-3: Conceptualisations of Quality of Life Source: Felce and Perry (1995, p. 55) Agreement on the relevant life domains Systematically reviewing life domain measurement across the diverse literature concerning quality of life and well-being (15 significant studies in the field), Felce and Perry (1995) identified five common themes among scholars, as follows (also see Figure 2-4): 1/ Physical well-being appears as a main heading in the classification (health, fitness and physical safety). 2/ Material well-being (finance or income, quality of the living environment, privacy, possessions, meals or food, transport, neighbourhood, security, and stability or tenure). 3/ Emotional well-being (satisfaction, affection, self-esteem, personal status and respect, fulfilment, and religions and faith). 4/ Social well-being (family, relatives, and friend relationships). 5/ Development and activity relates to competence or independence, work, leisure activities, education and production and contribution. 42 Figure 2-4: Relevant domains for quality of life assessment – A substantial overlap between sources Source: (Felce & Perry, 1995, p. 61) 43 An overall model of quality of life and well-being In considering the three main elements of quality of life discussed in Figure 2-3, together with the relevent domains, which considerably overlapped among researchers in Figure 2-4, Felce and Perry (1995, p. 62) defined quality of life as "an overall general well-being that comprise objectives descriptors and subjective evaluations of physical, material, social and emotional well-being together with the extent of personal development and purposeful activity, all weighted by a personal set of values". Felce and Perry's model of quality of life is shown in Figure 2-5. The three components in the Felce and Perry's model causally interact with each other. Changes in any one factor may lead to a different result for both of the other two, even though one is objective and the other two are subjective. For instance, changes in some objective facets of life may change satisfaction or one's personal values or both. These three factors then contribute together with external factors (social, economic,and political variables) to the overall quality of life. Felce and Perry concluded that their model of quality of life "is proposed that integrates objective and subjective indicators, collectively reflecting a broad range of life domains, through an individual ranking of the relative importance of each domain. This model accommodates both concerns that objective data should not be interpreted without reference to personal autonomy and preferences and concerns that expressions of satisfaction are thermselves relative to the individual's temperament and the circumstances and experiences that have shaped their frame of reference" (Felce & Perry, 1995, p. 69). 44 Figure 2-5: A model of quality of life and well-being Source: (Felce & Perry, 1995, p. 62) Theoretical framework applied to the current study There are many models created to help quantitatively score and measure a person's well-being. There is less development of theoretical frameworks to guide qualitative research in this field. Based on reviewing and synthesising the common ground of the existing studies in the field, the model of Felce and Perry is one comprehensively 45 reflecting a person's well-being. This model, therefore, is chosen for the current study. Felce and Perry's complete well-being model is applied for the general population rather than for a particular study 'object' or sub-group of the general population. Their measurement is based on five main indicators including physical, emotional, material, and social well-being, and development and activities, as shown in Figure 2-4. However, due to the variability of well-being measurements across individuals in all groups within a society, Felce and Perry suggest that the indicators can be refined to match with characteristics of each particular researched population group. For example, Felce and Perry themselves conducted a study of staffed housing services, where they used three indicators (material and social well-being, personal development, and activity) instead of all five. Felce and Perry also outlined their desired research agenda examining the use and applicability of their model of wellbeing. The current study focuses on the well-being of those of advanced age living in rural regions, whose adult children are working away as migrants. This "defined group of interest" has a statistically significant different profile to the general Vietnamese population, as they experience disadvantaged circumstances (Felce & Perry, 1995, p. 70). Therefore, according to Felce and Perry their well-being indicators need to be refined to reflect their circumstances. As discussed earlier, there is a multidimensional approach to well-being. Also, it can be seen from different points of view, and well-being measurements can be influenced by many factors. Unlike the young, the dimensions of health care, social support (relationship with children) and income are the three most important aspects of an older person's life. Indeed, Steptoe et al. (2015) found that subjective wellbeing and health are closely related. For those of advanced age, when health problems increase, this link becomes more important. Maintaining health is, hence, a main component of the older adults' well-being. Besides the health element, the authors also confirm that subjective well-being at old age is more affected by material conditions, social and family relationships among many other factors. Consistently, Kafetsios and Sideridis (2006) confirm that support satisfaction perception was generally more strongly related with well-being of older adults 46 compared to young persons. The sources of social support that affect individual's well-being can come from a spouse, child, parent, friend, co-worker or anyone (Abbey, Abramis, & Caplan, 1985). Exploring the well-being of rural elderly individuals, considering the cohort of those without adult children present at home (as they used to be), therefore, only aspects that might be affected by that move were taken into account in this study. After refining the objective indicators, the current study focuses on the important aspects that children provide to their aged parents including material, emotional and physical care. It explores the monetary support such as remittances sending home, building new house for parents, housework help; the relationship between rurallybased parents and urban children, their phone contacts, or visits; health and physical care provision. A subjective approach is applied in this study. It means that rural elderly parents of migrant children self-rated and reported any changes with their income, emotional and health care support when their children migrated elsewhere instead of traditionally co-residing with or living in close proximity to them. This subjective well-being measurement is applied in three communities in rural areas of Vietnam. However, before analysing that issue in Vietnam, similar situations of rural older adults in other developing countries are first reviewed here. 2.1.8 Older adults in developing countries and their sources of income Data of the 2015 revision of the world population shows that people aged 60 and older are the fastest growing group, reaching 901 million, accounting for 12% of the global population. Of this, Asia is home to more than half with 508 million older people. The number of elderly persons in Asia is projected to more than double by 2050, reaching 1.3 billion (See Figure 2-6, and Figure 2-7). 47 Figure 2-6: Percentage of the population aged 60 years or over, estimated for 1950-2014 and projected to 2050 Note: Data source from United Nations (2013) World Population prospects: The 2012 revision Source: (United Nations, 2014, p. 1) Figure 2-7: Population of older persons, estimated for 2015 and projected for 2050 Note: Data source from United Nations (2015) World Population Prospects: The 2015 Revision (United Nations, Department of Economic and Social Affairs, & Population Division, 2015b). Source: (United Nations, 2015, p. 2) 48 The number of elderly individuals on the planet is, for the first time, exceeding the number of children aged 16 and under. Also, the old age population will be mainly characterised by females (United Nations, 2015). Approximately 80% of the world's elderly population has no pension or access to benefits (Holzmann, Robalino, & Takayama, 2009; Office, 2010). According to a 2008 report by the United Nations about regional dimensions of the ageing situation, many of those living in poverty are older individuals from less developed countries (LDCs) who are living in rural areas. Due to low and insufficient lifetime earnings, lack of savings, and with the absence of adequate social protection programs, such individuals must continue to work or rely on family or community support. However, sources of support are not always stable and may diminish over time with the advent of crises and with the migration of relatives to other areas (Handayani & Babajanian, 2012). In developing countries, data from the United Nations (2015) shows that assets and labour are the major sources of income for the elderly population, whereas public transfer is the main source of living for their counterparts in developed economies (See Figure 2-8). Figure 2-8: Source of finances for consumption among older persons, 2000's (a) Note: (a) A positive value indicates net receipt of income or transfers, while a negative value denotes net giving. Used data source from National Transfer Accounts, http:\ntaccounts.org.accessed on July 15, 2014. Source: (United Nations, 2015, p. 3) 49 In a Report of the Second World Assembly on Ageing held in Madrid, April 2002, (Issue 3: Rural development, migration and urbanisation, paragraph 29) the United Nations states that: "In many developing countries and countries with economies in transition, the ageing population is marked in rural areas, owing to the exodus of young adults. Older persons may be left-behind without traditional family support and even without adequate financial resources" (United Nations, 2002, p. 13). In relation to the latter part of this statement, it is important to examine the phenomenon of out-migration from rural regions to determine whether migration is putting elderly individuals in such areas at greater risk of poverty and general disadvantage. 2.1.9 The impact of urban migration on rurally-based elderly relatives: Academic perspectives Negative views of migration (The opponents) Many scholars express their concern about the plight of elderly individuals leftbehind in the rural areas. From their perspective, the migration of children undermines the family structure, creating family disruption (I. Aboderin, 2004; Jamuna, 1997; Kosberg & Garcia, 2004; Lloyd-Sherlock, 1998). With adult children absent, elderly parents may lose economic support, but it is the social and psychological support and, crucially, personal or health care support that are the most debated issues of concern. This is further confirmed by a report of the United Nations about ageing, which states that migration and urbanisation are undermining the extended family and are weakening traditional sources of support for older individuals (United Nations, 2002). According to J. E. Taylor et al. (1996), the migration of adult children disrupts family life and transforms social structures within the family unit. Social and physical day-to-day support is diminished increasing family members' emotional and physical burden. The detrimental impact of labour shortage within the home is especially strong in the rural areas where agricultural work dominates. Families in rural areas who have land to care for may find themselves having to take charge of the daily operation of a family business in the absence of migrated relatives, handling additional often very physical tasks. They must fulfil added family 50 obligations such as child care and family maintenance. In this respect, migration can give rise to stressful circumstances and is likely to have an adverse effect on physical and mental health. This can affect the entire family, and the negative psychological impact on them can be significant (Seck, 2009). Likewise, under the perspective of a sociologist, Guanchen and Shijie (2014) argue that solo elderly experience a heavier burden, with low income, unsatisfied psychological needs, spiritual desolation and poor health condition. Millions of family members have been left-behind during the urbanisation of China, creating families split by geography in the first instance. In agricultural China, 45 million of the elderly have been left-behind, with a similar number of the wives of internal migrants and nearly 60 million of their offspring (Li, Cai and Xinhua News Agency as cited in Ye et al., 2013, p. 1119). This trend also happens in many other developing nations around the globe, especially in Asia, Latin American and Africa, with the able-bodied men leaving for the cities, leaving behind the wives, children and elderly parents, who typically have low levels of education and who are physically less strong than the men who left them behind. Scholars are then concerned about gender and age equity, with vulnerable groups of population falling behind (Chiriboga, Charnay, & Chehab, 2006; De Brauw, 2003; Gou & REN, 2011; Lastarria-Cornhiel, 2006). As stated in a study by C. He and Ye (2014, p. 352),"family is no longer a 'network of safety' or reliable source of obtaining support for the elderly. Migration of the rural workforce to urban centres has degraded the welfare of the left-behind elderly." Positive views of migration (The advocates) In the academic literature, several theoretical arguments and empirical studies view migration in a mostly positive light, especially in developing economies. Economically, they argue that migration benefits both those who migrate and the family members who are left-behind. A relative is often sent to the city for a job to earn money as a part of a household strategy to maximise income and minimize material risks. Migration, therefore, benefits both the migrant and non-migrant family members including, in many cases, older parents (Cai, 2003; Osaki, 2003; 51 Oded Stark, 1988; O. Stark & Bloom, 1985; Vanwey, 2004). These scholars also argue that urban migration shows the ability to adapt to the changing circumstances of rural families. Ambivalent views However, there are also academics 'sitting on the fence'. For instance, when exploring the impact of rural to urban migration in Ethiopia, M. A. Gibson and Gurmu (2012, p. 5) admitted the double-sided effect of urbanward migration of adult children, and concluded that: "On the one hand, there is optimism that migration will bring new livelihood opportunities; presenting an attractive alternative to diversify income in the face of land shortages. On the other, there is a growing understanding of financial hardships and other risks associated with urban living, including theft, exploitation, and STDs." Besides the benefit that urban migration brings to rural households, it also has drawbacks. For instance, the majority of migrants are young individuals with low educational achievements. They are not mature enough to protect themselves from harmful situations. Living in the cities, beyond the reach of family, some of them are easily tempted to adopt bad behaviours. They are at high risk of falling into the trap of drug addiction, of becoming addicted to alcohol or experiencing sexual abuse, violence, of smoking, of prostitution, of contracting HIV or other sexual transmission diseases, or even committing crimes such as human or drug trafficking (Anderson, Apland, Dunaiski, & Yarrow, 2017). These problems do not directly involve rural elderly individuals but confront their migrant children on a daily basis. A big question for many elderly is 'do we let our children go or make them stay?'. These issues of migration therefore concern many rurally-based elderly parents of migrants. Similarly, Ye, He, Liu, Wang, and Chen (2017) concede that there are both advantages and disadvantages to migration for family members, but also note that the elderly left-behind are more likely to be disadvantaged. The authors explain that parents remaining in rural areas often had to take over the farm work, look after the house, and sometimes became the main care providers for grandchildren. Such factors can become physically and emotionally burdensome for them. 52 2.2 Empirical evidence from developing countries. This section provides the international empirical evidence with a focus on developing countries with similar socioeconomic characteristics to Vietnam. Based on the theoretical framework of Felce and Perry, this section analyses the well-being of rurally-based elderly individuals relating to child urban migration. Due to many external and internal influence factors, the results are varied, and were not the same between regions and countries. However, the most common themes that emerged from the literature review include: (i) positive, (ii) neutral and (iii) negative impacts. It means some might receive better support from their children once they have migrated, and others might not. In some cases, elderly parents even find themselves in a worse situation. Therefore, the aspects of material, emotional and physical well-being of rurally based parents are presented under those themes. 2.2.1 Evidence of material consequences In most developing economies, economic aspects are considered as the biggest concern of rural households, and the main reason for the young seeking employment elsewhere. The aspect of income in relation to migration, thus, attracted scholars the most. Positive consequences Positive material outcomes of child urban migration for rural elderly relatives were predominant in the existing studies. Research in Thailand shows that most elderly parents in rural Thailand benefited greatly from the urban migration of their children. According to a national survey in 1995 of Thai individuals aged 50 and over, 78% of rural parents who had at least one adult child living away received money, food or gifts from these children (Knodel & Saengtienchai, 2007). M. Abas et al. (2013) confirm the results of the Knodel and Saengtienchai study by acknowledging that more remittances were received by the elderly parents of migrants than those whose children had not migrated. Also, having all children migrate was strongly associated with receiving more money (M. Abas et al., 2013). Similar results were also found in China. Using quantitative techniques to compare parents with and without migrant children, Guo, Aranda, and Silverstein (2009) 53 found that two years after their children migrated out, parents of migrants received consistently higher remittances than their non-child migrant counterparts. Regression results of Ma and Zhou (2009) confirm that Chinese rural aged parents of migrants were more likely to be satisfied economically, even though by only a small amount, than those without any migrant children. Migrants increased the capital gain for elderly individuals left-behind in rural areas by between 16% and 43% (J. E. Taylor, Rozelle, & De Brauw, 2003). When asked about what change the elderly would expect to happen compared with the present situation if their children did not migrate, 58% of the study population believed their living standards "would be worse." A further 37.2% said: "probably no change," and just 4.8% answered: "It would be better" (C. He & Ye, 2014, p. 365). It means Chinese rural elders more than less were optimistic when considering the migration of children. Six-tenths of the ELB believe that they were better off with the migration of children compared to a few who felt they would worsen in economic terms. Likewise, a study by Ablezova, Nasritdinov, and Rahimov (2009) measuring the impact of migration on elderly people in Kyrgyzstan found that 62% of respondents considered migration to be a positive phenomenon. The authors confirm by saying that parents of migrants were happy both for the fact that their child had a job, and also because they received remittances. When comparing outcomes of staying or migrating, G. Luo (2012, p. 113) argues that: "Staying in the village could mean better care for the older people when they need it, but on the other hand, if that were the case, they would have less money and suffer from poverty." Therefore, most of the respondents preferred: "their children to migrate to the city to find a job" to "make some money and make the household get out of the poverty" (G. Luo, 2012, p. 112). Both Biao (2007) and G. Luo (2012) have come to the same conclusion that: it is better to be apart to earn more money than to stay together to be poor. Many other studies did not show the positive impact of urban migration to be directly on elderly relatives left-behind, but rather on their communities, or their households' income (Ajaero & Onokala, 2013; UNESCO, UNDP, IOM, & UNHabitat, 2010; Zimmer & Knodel, 2013). Giesbert (2007) highlight the substantial increases in income for families in rural China from participating in the migrant 54 labour market. Similarly, UNFPA (2007) indicates that both male and female migrants send money back to their families. Those who moved alone without family members were the group sending the highest amount. Also, those who migrate to urban areas are more likely to send more money to their families than the ones who migrate to rural areas. Remittances from rural-urban migration contributed significantly towards the development of rural communities in Nigeria, including: "road construction and rehabilitation, sinking of community water boreholes, rehabilitation of schools, and awarding of scholarships to brilliant and indigent students" (Ajaero & Onokala, 2013, p. 4). Both family members and the wider community can benefit economically from migrant contribution. Despite positive financial contributions, remittance experience varied considerably in amount and frequency. For example, when evaluating migrant children's financial support of their rurally-based parents in China, Guo et al. (2009) and B. Luo (2009) concede that the support was significant and frequently sent by migrant children. This could help many Chinese elderly parents to build a new house. A significant amount of financial support with a high frequency, however, was not common. The results of those studies might be explained by the higher level of economic development in China or may be specific to that particular research region. In contrast, the majority of existing studies found that the material impact of urban children on their rural-based parents is modest. M. A. Gibson and Gurmu (2012) using data from a longitudinal study of five Ethiopian villages, reveal an optimism that migration brought new livelihood opportunities and was an attractive alternative to diversify income in the face of land shortages. However, few migrants in their research reported sending large cash amounts back to their families. Due to the limitation of jobs and services in urban areas, most migrants return to their home villages within a year without advanced qualifications. Added to this, a case study of two communes in Battambang province, Cambodia, Zimmer and Knodel (2013, p. 156) concede that: "Most adult children remit money to their parents, but the majority of remittances are small." The scholars explain that: "Not everyone in the survey reported things to be 'better' because of migration, nor that 'flows' were necessary for the benefit of parents...while large remittances are atypical, migrants to Phnom Penh or across the border are more likely to send larger amounts of money. Migrants elsewhere are likely to remit small quantities that may be symbolic 55 and not helpful in moving an older adult out of poverty". Urban migration creates more expectation than real results: "in reality, the number of successful migrants that manage to send good money is very small, while for the majority, migration only helps family members to exist" (Ablezova et al., 2009, p. 41). In measuring the impact of remittances on the physical health of elderly Chinese parents in rural areas, Tse (2013) consistently found a marginal financial contribution from migrants to compensate physical health for ELB. Likewise, Ma and Zhou (2009) found a minimal financial compensation for the isolation of leftbehind Chinese rural elders. Examining whether monetary transfers from children help to reduce the need for elderly parents to work, H. Nguyen, Liu, and Booth (2012) appear to concur with the assumption that cash did help the elderly to cope with the risk of illness, but it wasn't enough to allow them to give up work completely. The amount given to Cambodian, Moldovan, and Ethiopian parents, and parents in other developing economies was irregular and lower in value (Ablezova et al., 2009; M. A. Gibson & Gurmu, 2012; Knodel, Kespichayawattana, Saengtienchai, & Wiwatwanich, 2010; Zimmer & Knodel, 2013). The primary source of income for those parents is their own labour; they are therefore self-reliant. Elderly parents of migrants in Moldova appear to rely mainly on their pension (HelpAge International & UNICEF, 2010). Ma and Zhou (2009) note that in China, interprovincial migrants send more money to their parents than migrants within the same province. The greater the number of children who have migrated, the higher probability for parents to receive remittances. Ma and Zhou, then, conclude that those with multiple children were the happiest and biggest receivers. Also, remittances were sent more to rural elders who are female, older, widowed or divorced and caretakers of their grandchildren, residents in more developed areas, as well as those maintaining close family and social ties. While family bonds were found to be strong in most rural communities, the modest amount of remittance was explained by the limitations of migrants' incomes. This is due to unskilled and low education attainments, or conditions of the destinations or labour market. For instance, conducting research about internal migration in Vietnam, UNESCO (2018) found that the majority of female migrants work in the garment sector, or as domestic workers, whereas males are commonly in production, 56 construction or taxi drivers. Only 2.3% and 0.4% respectively were employed in leadership positions. About 30.9% of them have a formal written labour contract, otherwise only verbal agreements and no contract at all. Therefore, many migrants are exposed to risk of exploitation and abuse. These findings are in line with Niimi, Pham, and Reilly (2009), who state that: "If the migrant has primary education, the amount of remittances sent home increases by one million VND compared to a migrant who is illiterate, on average and ceteris paribus. The marginal effect rises to 1.2 million dong for those with a college education or better" (Niimi et al., 2009, p. 33). These empirical findings confirm the theory by Lucas and Stark (1985) that migrants repay their family who previously invested in their education. A similar situation exists with migrants in Ethiopia: "Male migrants sought casual construction work, and females, jobs in domestic service, mainly in small nearby towns. However, jobs are commonly understood to be poorly paid and urban life, to be expensive". Migrants were more likely to make financial contributions to the family than their non-migrant peers who remained to work on the farm (27.5% versus 15.5%). However, they complained remittances are no larger than agricultural earnings (M. A. Gibson & Gurmu, 2012, p. 5). Toyota, Yeoh, and Nguyen (2007, p. 158) conclude that "in a community of acute poverty, a member's out-migration means one less mouth to feed and would thus almost certainly increase the welfare of the left-behind." The factor of destination could be a cause. Ye, He, Liu, Wang, and Chen (2017) note that migrants in Beijing China had higher income, which allowed them to send more remittances to their parents. Zimmer and Knodel (2013) also highlighted the significant role that the destination of migrants played. For instance, migrants who moved to big cities such as Phnom Penh, or across the border, are more likely to send substantial amounts of money home compared to those living elsewhere, implying the critical role played by migrants' destination. The differences in payment amounts and frequency were explained by Khue (2010, p. 24) who said that: "The volume and frequency of remittances sent back are largely determined by the level of income earned at the destination and the commitment within households." 57 A qualitative research by Knodel and Saengtienchai (2007) found that migration of Thai adult children to urban locations contributes positively to the material wellbeing of their adult parents who remain in rural areas. The authors did not express the extent of the impact but noted that monetary support from Thai migrants to their village-based parents varied considerably in amount and frequency. Also: "The receipt of various amounts of money fluctuates according to the migrant status of children" (Zimmer & Knodel, 2013, p. 162). Similarly, Niimi et al. (2009) state that the fluctuations of payments are driven by migrants' earning levels. (G. Luo, 2012, p. 113) also confirms that: "If somebody gets higher earnings when working outside the village, they can give more to the parents." G. Luo (2012, p. 113) concludes that: "People have a heart; no matter how far from their parents they live and work, they always manage to support them." Lei et al. (2012) also agree: "the financial capability of migrant children has a substantial impact on the transfer to elderly parents." Those scholars and many others, including (Khue, 2010; Knodel & Saengtienchai, 2007; G. Luo, 2012; Niimi et al., 2009; Zimmer & Knodel, 2013) come to the same conclusion that the material well-being of village parents is strongly associated with migrants' earnings and their economic conditions. Migrants' earning is related to their education level. However, "Maintaining good relationship between generations is crucial in guaranteeing that the elderly get proper support and care when they become weaker and more dependent" (G. Luo, 2012, p. 109). The evidence also shows that "The closer the ties that the migrant has with those left-behind, captured by the number of his or her return visits to the location of origin, the greater the level of remittances sent home" (Lucas & Stark, 1985, pp. 33,34). The relationship between intergenerational support and gender appears to depend on individual circumstances and can be significantly influenced by cultural norms. For instance, whilst differences in intergenerational support have decreased recently in relation to out-migration, L. Song, Li, and Feldman (2012) indicate that in China, elderly mothers receive more support than fathers, and sons take more responsibility for the family than daughters. In contrast, Thai migrant daughters are more likely to support their parents than sons, and adult children who have migrated to Bangkok sent money back more regularly than those who have migrated to other Thai cities (Knodel et al., 2010). 58 Cai (2003) reported that migrant sons in China are more likely to send higher remittances to parents than daughters, while Keasberry (2001) found similar in Indonesia. To the contrary, studies conducted in China by Song (2017) and in Ethiopia by Gibson and Gurmu (2012) show that migrant daughters equally support parents as migrant sons, even though they are not actually expected to provide financial help to their older parents. In contrast, female migrants are more likely to send remittances to Dominican households (De la Briere, Sadoulet, De Janvry, & Lambert, 2002). Zimmer and Knodel (2013, p. 163) also agree that "Those with only migrant daughters are more likely to receive larger amounts of money than those with only sons." However, the authors note that: "having both migrant sons and daughters is the most optimal situation." Interestingly, L. Song, Li, and Feldman (2012) note that gender differences in intergenerational support have decreased. The provision of economic support, however, is not necessarily all one way. It appears in many cases that elderly parents also support their migrant children by giving them money or raising grandchildren. Despite having received less attention from researchers, some studies have shown that elderly parents are frequently providing care for grandchildren in Thailand, Cambodia and many other developing countries throughout Asia (Bastia, 2009; HelpAge International & UNICEF, 2010; Knodel et al., 2010; Zimmer & Dayton, 2005; Zimmer, Korinek, Knodel, & Chayovan, 2008). In He and Ye's study of 400 ELB, 56% were fostering grandchildren. As a result of taking responsibility for raising their grandchildren, some of these elderly individuals might be economically disadvantaged and may find it to be a substantial economic burden (C. He & Ye, 2014). Neutral consequences There were also several cases where the ELB did not receive any economic support from their migrant children. For example, C. He and Ye (2014), when undertaking a study of 400 Chinese ELB, found that 18% of those surveyed reported they received nothing from their migrant children. The main source of income of 80% of those surveyed came from their own labour. Another study conducted in China by Lin, Yin, and Loubere (2014) compared the living conditions of two groups of elderly individuals and found that ELB are more likely to rely on themselves and their own work, while non-ELB mainly rely on their children for material support. 59 Interestingly, the income of non-ELB appeared to be even higher than the ELB group. The survey also found that the material condition of these non-ELB is relatively secure, so they are quite independent. For those ELB, the migration of children appears not to have brought any change and has not impacted on their material well-being. Notably, Lin et al. (2014) argue that the migration out of the villages of young farmers increases the possibility if the ELB falling into a poverty trap. Negative consequences Whilst fewer studies found adverse effects of migration on elderly individuals leftbehind , some reported that the economic situations of ELB had worsened. For instance, findings from Mongolia, Thailand, China, and Hong Kong have shown that "young farmers migrating out of the villages increases the possibility of the ELB falling into the poverty trap" (See Lin et al., 2014, p. 2). Using the data from the 2008 and 2009 household surveys with a sample of 3555 elders, 60 years and over, in 8000 rural households from eight provinces in China, the authors also assert that "not all elders with migrant adult children are equally at risk from the negative effects of migration. The group of elders who appear to be most vulnerable, in light of migration consist of those living alone or with their spouse only... Seventy-two percent of those who live alone have no children in the village. These elders appear to be the most at risk; they have low levels of employment and significantly lower measures of well-being than those who live with their spouse only. However, this group, those whom the term "left-behind" most evoke, represents just two percent of the RUMiC elders' sample" (Connelly & Maurer-Fazio, 2016, p. 152). Supporting the findings of this study, the results of research undertaken by Connelly and Maurer-Fazio indicates that elderly individuals who look after grandchildren in the absence of their migrant children ('skip-generational' households) are indeed significantly affected by migration. Individuals living alone are also a group more negatively impacted by migration, as Silverstein, Cong, and Li (2006) similarly found in their research. Both single elderly individuals and those supporting grandchildren are at greater risk of experiencing financial difficulties and falling into poverty, a point underlined by Zimmer and Knodel (2013) who while revealing positive overall effects of migration expressed concern for such groups. 60 Qin, Punpuing, and Guest (2008) also demonstrated that for single Thais, elderly individuals and those living with grandchildren also had significantly lower levels of household assets than parents of migrants who lived with others. Even though a positive outcome was dominant, many other cases showed no change or a worse situation after the migration of their children, especially with single elderly households where all children migrated. The situation of empty families or even empty villages, where there are only elderly residents, raises a serious concern about ELB in rural areas. Without material support from migrant children, ELB might be at high risk of impoverishment and overall insecurity. Therefore, it is important to recognize that urban migration may increase the prospects of some ELB, but also simultaneously destabilize life and decrease well-being for others. Typically, with a sharp decrease of fertility rate in many developing countries more recently; the future is not optimistic for the lives of the elderly left-behind in the villages. 2.2.2 Evidence of emotional consequences Emotional aspects of life refer to "the emotional quality of an individual's everyday experience – the frequency and intensity of experiences of joy, fascination, anxiety, sadness, anger, and affection that make one's life pleasant or unpleasant" (Kahneman & Deaton, 2010a, p. 16489). This section reviews literature surrounding the emotional well-being of rural older adults related to the migration of their children. The following are the results: Positive consequences In the case of elderly individuals in Thailand, the results of a survey of over a thousand Thais aged 60+ from 100 villages showed greater risk of depression among parents whose children did not migrate than those with migrant children. Also, having a migrant child moving back was associated with increased depression in parents due to feeling financially burdened by returning children (M. Abas et al., 2013). In this particular study Abas et al utilised quantitative techniques to examine the relationship between migration of children and depression in the older parents in rural Thailand. The authors explain that because they receive more financial support, elderly parents of migrants get less depression compared to other senior 61 groups. Observing a smaller sample from a region in Western Thailand, M. A. Abas et al. (2009) find a lower incidence of depression among ELB than non-ELB. Two years later using the same propensity approach these authors found similar positive results for ELB related to child migration (M. Abas et al., 2013). Emotional positive impact was consistently found in China. Using a t-test to compare two groups of elderly individuals in the years 2001 and 2003, Guo et al. (2009) found that after two years outward migration of adult children, their older parents had a relatively lower level of depression compared with elders without a migrant child. The explanation is "While emotional cohesion between migrant children and their parents may decline in the absence of children, the increased monetary support for parents may buffer the effect" (Guo et al., 2009, p. 1099). Guo and others conclude that parents of migrants are less stressed than those of non-migrants because they receive remittances which may buffer the effects of geographical dispersion. Cong and Silverstein (2008) have also questioned whether financial support from adult children reduces depressive symptoms in elderly grandparents. Confirming the results of Guo et al., their answer is "yes." Drawing on the mutual-aid model of the Chinese family, these authors suggested that "grandparents who received a greater economic reward for the care of grandchildren would be less distressed than those who were less compensated" (Cong & Silverstein, 2008, p. 21). Kuhn, Everett, and Silvey (2011) find a positive association in Indonesia between the health of elderly individuals and the migration of their children by using a propensity score and based on elderly parents' self-rated health. A similar conclusion has also been drawn by (Böhme, Persian, & Stöhr, 2015). M. Abas et al. (2013) indicate that elderly parents of migrants in Thailand are likely to have a greater sense of well-being, whereas elderly individuals without migrant children appear to experience greater levels of depression. The authors noted that having a migrant child return was also associated with higher levels of depression, perhaps due to the increased burden experienced by the parents. Return is mostly associated with unsuccessful migration (Hirvonen & Lilleør, 2015). Research conducted by (M. A. Gibson & Gurmu, 2012, p. 5) Gibson and Gurmu (2012, p. 5) also notes that "Wealthier individuals, those living in households with more land and larger herd size, were all more likely to out-migrate." Younger individuals especially men who are educated, healthy and with some money to 62 initially support themselves in a city are more likely to migrate out than others (Agesa, 2001; Lanzona, 1998, Wu, 2010). From the perspectives of many, urban migration, therefore, is expected to be selective (Connell, Dasgupta, Laishley, & Lipton, 1976; De Haan, 1999; Du, 2000; Gibson & Gurmu, 2012; Mallee, 1995; Ye, Wang, Wu, He, & Liu, 2013). For those reasons, most of the rural aged parents were proud of having migrant children, especially those elders whose offspring were successful with the city-life. Those feelings further enhance the psychological wellbeing of the remaining parents. It would appear that advances in communication and transportation technologies have significantly helped to mitigate the negative impacts of migration for ELB. Cell phones are now commonplace, making contact between children and parents easier than ever before (Zimmer & Knodel, 2013). This allays concerns of both migrants and elderly parents in a time of crisis, particularly when a parent fell ill. Mobile phone contact plays an important role in emotional support. More than 80% of elderly individuals in the Thai survey agreed that to be called often by their children makes them feel good. Therefore, their children who live far away do not need to visit them so frequently (Knodel et al., 2010). Some studies found that the migration of children had an adverse effect on the emotional well-being of parents for example, Lin et al. (2014) argue that the parents of migrants become isolated on the departure of their children, interacting less with neighbours and friends, and watching more television than elderly individuals whose children remain close by. Furthermore, Gautam (2008) states that ELB take on burdens of housework, farming, as well as social duties such as public meetings, birth or death rituals or wedding party participation, etc after the departure of their children. Adhikari, Jampaklay, and Chamratrithirong (2011) also agree that out-migration increases the loneliness of elderly parents. The authors note that elderly individuals with migrant children were more likely to have symptoms of poor mental health and accessed more health care services than those whose children had not migrated. The authors concede, however, that parents of migrants may simply be able to afford more health care due to remittances sent by their children. Yet it is possible that the absence of children and lack of immediate physical family support may lead to an increase in health care seeking behaviour in elderly parents of migrants. Q. Song (2017) found an association between increasing depressive 63 symptoms in older adults and having migrant children. However, Q. Song's research also acknowledges that age, health, education, the income level of the elderly individual and physical care given by their children are all factors in determining the risk of depression, corresponding with my findings. He et al. (2016) also found that elderly parents left-behind in rural China had a higher prevalence of depressive symptoms than the general elderly population. Negative impacts Fewer researchers have reported adverse impacts of migration on the emotional well-being of elderly parents in rural areas. Lin et al. (2014) simply state that urban migration of children has a strong negative social impact on the elderly. Comparing between two Chinese groups, these scholars found that ELB is relatively more isolated than NELB. ELB spend less time interacting with neighbours and more time watching TV. Likewise, ELB in India and Nepal experience feelings of loneliness, unhappiness and increased stress. Elderly women in China were found to have higher depressive symptoms than men; older elderly individuals and those unemployed were also found to have higher rates of depression than younger elderly individuals and those employed. Gender, age, health, the income of the elderly parents and the care given by children were found to be influential factors in depression (G. He et al., 2016; Huang, Lian, & Li, 2016). Notably, parents' emotional well-being was inversely related to the number of migrated children. With additional children have migrated, parents tended to have significantly higher rates of depression and lower life satisfaction (Guo et al., 2009). This is further confirmed by Q. Song (2017), who employed randomised multi-level modelling to analyse the first wave data of the China Health and Retirement Longitudinal Survey. The author indicated that there is a negative psychological impact on elderly individuals especially those in poor communities when all children migrate out. McKinnon, Harper, and Moore (2013) show 2.3% higher predicted prevalence of depressive symptoms in older adults living alone compared to individuals living with at least one working-age child. Notably, Zhou, Wang, Jia, and Ma (2018) even argue that the decreasing social support and increasing life stresses can elevate the suicide risk among elderly Chinese who have been leftbehind by migrated children. However, there is no evidence showing that Thai 64 elders had higher depression with additional migrant children. Abas et al. (2013) also strongly express contrary views, that having all children migrated halved the odds of depression for rural elderly parents in Thailand due to the receipt of remittances. Likewise, wives left-behind by migrants including elderly women scored higher in depression, stress, and passive coping styles, and scored significantly lower in social support and active coping styles compared with wives whose husbands had not migrated (Adhikari, Jampaklay, & Chamratrithirong, 2011). Similarly, elderly individuals who are caring for grandchildren in Indonesia, Philippines and Vietnam are more likely to suffer from mental disorders than those in non-migrant households (Graham, Jordan, & Yeoh, 2015). The authors argue that the benefits of relative financial security experienced by parents of migrants do not always outweigh the costs of having geographically dispersed family members. Among the households interviewed in their study, the following were common reasons stated: first, financial deficiency many reported that the extra money sent to parents commonly did not compensate for the childcare work. Second, the generational differences may cause conflict between grandparent and grandchild, which can increase stress and seemingly make the situation more serious. It has been noted that "there is a big generation gap between grandparents and their grandchildren. Grandchildren are often shy to openly discuss the problems that they face with their grandparents" (Ablezova et al., 2009, p. 38). This could lead to misunderstanding or cause conflicts between generations. The consequences can be severe when the child becomes stubborn and goes against the wishes of the family. Some even leave home and develop problems such as alcohol abuse, drug addiction, losing control of their faculties or behaviour. Another stress factor can be helping grandchildren with their studies. With their knowledge being out of date, this can seem impossible for grandparents, as many in this study reported. HelpAge International and UNICEF (2010) argue that instead of ELB being in charge of rearing and teaching left-behind grandchildren, they should be able to enjoy pleasurable activities such as reading newspapers, listening to radio, watching TV, etc., once their children migrated out. All of these challenging issues can stress both grandparents and grandchildren, increasing their emotional burden. Connelly and Maurer-Fazio (2016) conclude that elderly individuals who live alone without any 65 adult children in the village are most at risk, followed closely by those who care for grandchildren. A study by Teh, Tey, and Ng (2014) reaffirms the role of the family in alleviating the feelings of loneliness among the elderly by using cross-tabulation and logistic regression to examine a sample of 1791 Malaysian elderly aged 60 and over. While social security remains inadequate, the authors state that older parents promote and facilitate co-residence with children. This confirms the findings of a study by Chen and Silverstein (2000) that having a child nearby, regardless of their gender, elevates the morale of elderly Chinese parents. Disagreeing with the view of leaving the elderly behind, Silverstein, Cong, and Li (2006) further confirm that older parents living in three-generation households or living with grandchildren in skippedgeneration households had better psychological well-being than single household elders. Solo elders seemed to lock themselves away from the outside world all year around, except meeting with their child only about one month during the Lunar New Year celebration. They became more "clumsy", felt unsatisfied with psychological needs and spiritual consolation (Guanchen & Shijie, 2014, p. 133). Teerawichitchainan, Knodel, and Pothisiri (2015, p. 1332) note that "elders who live alone are typically female and widowed, attributes that are considered risk factors for psychological distress." Employing multiple regression analysis of 1,561 parents aged 60 and older in rural Anhui province in China, the authors estimate that multiple generational household elders also received greater remittances from migrants and stronger emotional connection with children than single elders. Therefore, the traditional living arrangement is beneficial for Chinese rural communities. 2.2.3 Evidence of physical care consequences Health care provision for elderly individuals has been widely discussed in many health science studies. This study only examines elements of physical care given to parents by adult children. It looks at the activities of daily living support (ADLs), which include: walking, meal preparation, dressing and personal hygiene, toileting, bathing and help with movement. It also looks at house and farm work undertaken by children. The question here is whether the absence of adult children has any impact on rural elderly parents. The results were found as follows: 66 Positive consequences There is a lack of evidence about migration having positive impact for rural parents. A study conducted by Chang, Shi, Yi, and Johnson (2016, p. 677) in China confirms that "adult child migration has a significant positive impact in the health of elderly family members." This was a quantitative result based on nationally representative data; the survey was from five provinces, 25 counties, 101 villages and 2,000 households including both the elders (60+) and their working aged children. Negative consequences Findings by Tse (2013) show that the rural-urban migration of adult children in China negatively impacts the health of elderly parents behind. Notably, parents having a migrant daughter were more greatly impacted, experiencing adverse health outcomes such as poor memory; they were also more likely to suffer severe falls than elderly parents with migrant sons. This could be due to the lack of activities of daily living support. Worsening physical status was found to be a primary factor in the reduction of the quality of life of a mother with a migrant child compared to those who did not have migrant children (Yi, Zhong, & Yao, 2014). Some Chinese experts highlight the contradictory impact of migration that while migration often enhances the material well-being of ELB, it inevitably reduces physical care for parents. For instance, Xiang, Jiang, and Zhong (2016) indicate that while giving more money to support their parents, migrant children relatively reduce the amount of time they physically take care of their parents. The study found an 8% increase in poor health among Chinese ELB if an additional adult child migrated to urban areas, with the situation even worse for those with just one child or an overall lowincome. Ye et al. (2017) also note that even though 80% of the deposits in the local bank were found to be from migrant workers, physical care given to elderly individuals and other children left-behind was reduced. Due to the adverse effects of adult-child migration on rural elderly relatives in China, Giles and Mu (2007) note that an adult child is less likely to migrate for work when a parent is sick. In such a situation, migration may depend on there being other siblings to remain at home who are available to provide care for ill parents. 67 Many studies in Thailand and other countries also found similar results, specifically that children migrating out of rural areas has an adverse effect on physical care for remaining parents. Rural elderly parents were found to receive less food and were less frequently taken to the hospital than those untouched by migration for labour. This is a conclusion of Qin, Punpuing, and Guest (2008), who used a logistic regression model to test how labour migration affects familial care of elderly parents of migrants in Thailand. The scholars note that labour migration often results in elderly Thai individuals living alone, which has a negative impact on intrahousehold elderly care. The paper raises concerns about the social impact of migration on the elderly in Thai society. Elderly parents of migrants in Mexico also reported suffering a lack of physical attention from their migrant children (Antman, 2010). Elderly mothers of migrants in China were found to have a lower quality of life compared to individuals whose children had not migrated, with worsening physical status a primary influencing factor (Yi, Zhong, & Yao, 2014). A similar situation of ELB health was found in Mexico, where having an adult migrant child was also related to greater utilisation of health facilities (Antman, 2010). The result might reflect the lack of informal home care given to parents. Knodel and Nguyen (2015) found that 4.8% of the elderly who were aged 60 and over in charge of grandchildren in "skip-generation households" complained about physical burdens. The elderly participants in research conducted in Kyrgyzstan complained that grandchildren rearing is a challenging physical job. They perceive it as a burden "that makes their life even harsher" (Ablezova et al., 2009, p. 35). Like elsewhere on the globe, Ye et al. (2017) argue about the unsustainable future of farming in China, if it depends only on the left-behind. Scholars also raise a concern about the uncertain lives of rural aged parents. Consistent with this, Biao (2007) concludes that the countryside in China as a whole has been left-behind, not only physically but also, and of greater concern, emotionally and socially. Neutral impact Some studies show no significant impact of child migration on the health of older parents left-behind (J. Gibson, McKenzie, & Stillman, 2011). Adhikari et al. (2011) found in Thailand that migration of adult children to be highly associated with poor mental health of their rural age parents. Even though rurally-based elderly parents 68 of migrants utilised health care services more than nonleft-behind elders, the authors did not find it to be significant associated with the quality of physical health of the ELB. 2.2.4 Strategies for coping with difficulties In addition to the positive outcomes, urban migration creates many difficulties and challenges for both the origin and destination including environmental pollution and overpopulation in the cities, abandoned land without cultivators, and the left-behind population in the countryside. Rather than paying attention to rural and regional problems, many scholars, planners, policy makers and government agencies are more interested in solving problems in the cities. Understandably, there are more urgent calls from cities, however, the issues facing rural areas are also pressing. For example, no one looks after the population left-behind such as elderly parents as well as children. Sadly, as a result of urbanisation, many new unexpected concepts were created such as "orphaned elderly", "skip-family", "grey countryside" and "empty-nest". The question arises what are the solutions for those issues? Whose responsibility is it individuals, households, local governments or the state? In many developing countries, including Vietnam, the fact is that while the government is so confused and struggling to deal with thousands of problems in the cities, associated with the phenomenon of urban booms, the related issues in the countryside would never be a priority. The issues of the left-behind population thus seem rather to be the responsibility of individuals and rural households. The role of the government is limited, and commonly either belated or almost completely absent in terms of responding to the very real needs. A study in China found that if elderly parents were sick, their migrant children had to return to look after them. For the emotional issues facing older left-behind parents, a study by Mellor, Firth, and Moore (2008) suggested that teaching Chinese rurally-based elderly parents how to use internet and technology for entertainment and to enable them to more easily connect with their city-based children, when needed, should be a good way to avoid loneliness, sadness or isolation. However, the authors were not certain about the positive impact of using the internet, because their quantitative data did not confirm the positive outcome given by their qualitative data. According to Falkingham, Baschieri, Evandrou, and Grant (2009), 69 remittances and private transfers played a crucial role in maintaining the well-being of the Tajikistan elderly population. While the Russian labour market the main source of those remittances – was tightening, this would not be a sustainable source, supporting Tajikistan elders. In case this source was diminished, a minimum state pension to cover the basic needs of an older person was suggested by the scholars. As a participant in this study states: "Frankly, if they would increase my pension I could cope with difficulties. When you have money, you have everything, wood, food, and clothes. If you do not have money, you have nothing" (Tajik female, 84 years, collective farm near Kulyab) (Falkingham et al., 2009, p. 17). There was one study urging local government to monitor the population left-behind. According to The Philippines News Agency (2015, p. 1), "the case in China's countryside, with many men having left for better-paying jobs in cities, leaving behind their wives and elderly parents to farm land and raise their children. Such groups are usually more fragile when disaster hit." The agency called for more training to raise preparedness and response capacity for natural disasters of the population left-behind. Given the significant number of calls or suggestions by many scholars to increase governmental support for the elderly, the assistance from the government to the elderly population is still very limited. There was still insufficient information discussing this research area. However, it seems that solving any problem related to left-behind issues, was almost always the responsibility of the individuals themselves and their family's obligation. 2.3 Chapter summary The well-being of elderly parents in rural areas who are left-behind by their migrating adult children is the cause of ongoing debate among scholars. Theoretically, there are two major school thoughts about this issue: those in favour of migration who highlight the positive impact of the phenomenon, and those opposed to migration who evidence the negative outcomes. Empirically, results from existing published studies vary between individuals, regions, and countries see Table 2-4. As shown in Table 2-4, the economic aspects of migration appear to attract more attention from researchers, and studies focusing on the economic side of migration appear to emphasize its positive impact. The 70 emotional aspects of migration are less studied, and of the research done in this area, there appears to be both advantages and disadvantages to migration. Studies examining the physical care of the remaining elderly parents of migrants offer a mostly negative view of migration. The wide variation in results, however, implies that there are a variety of influential factors. The pace of rural-urban migration appears to be increasing in line with rapid urbanisation in developing countries. Whether rurally-based elderly Vietnamese individuals are positively or negatively impacted by migration is a question yet to be answered. With the growing uncertainty concerning traditional family care arrangements for the elderly population in rural areas, the topic of intergenerational support has taken on a new sense of importance in recent years. The next chapter of this thesis reviews this issue in the context of Vietnam. 71 Table 2-4: Consequences of urbanward migration in developing countries on elderly parents remaining in rural areas A literature review of the most closely related papers up to date Authors and Years Research title Data sources/ Research sample size Research methods Consequences: (+), (-) or Nil Material Emotion Physical care Zhou, L., Wang, G., Jia, C., & Ma, Z. (2018) 2019 update Being left-behind, mental disorder, and elderly suicide in rural China: a case-control psychological autopsy study 484 consecutive samples of suicides aged 60+ from three provinces Case-control psychological autopsy study N/A N/A Song, Q. (2017) Facing "double jeopardy"? Depressive symptoms in leftbehind elderly in rural China China Health and Retirement Longitudinal Study (CHARLS) data includes 10,000 households and 17,500 individuals in 150 counties/districts and 450 villages/resident committees in 28 provinces Random Effect Multi-Level Modelling N/A N/A Chang, F., Shi, Y., Yi, H., & Johnson, N. (2016) Adult child migration and elderly parental health in rural China Nationally representative data from five provinces, 25 counties, 101 villages and 2,000 households, collected from two waves of data in 2007 and 2011 (elder 60+ and their working-aged children) Quantitative N/A N/A + Xiang, A., Jiang, D., & Zhong, Z. (2016) The impact of rural-urban migration on the health of the left-behind parents. China The RUMiC survey includes 8000, 5000, and 5000 rural, urban, and migrant households. Liner Probability Model + N/A Böhme , M. H., Persian, R., & Stöhr, T. (2015) Alone but better off? Adult child migration and health of elderly parents in Moldova. The "Children and Elderly Left-Behind" (CELB) dataset includes 3539 households in 129 communities out of which 2175 households have a member aged 60 or older. Quantitative + + (overall health improvement) 72 He, C., & Ye, J. (2014) Lonely sunsets: impacts of ruralurban migration on the left‐ behind elderly in rural China The samples 400 elderly who lived separately from their migrant children in 10 rural communities. Qualitative _ _ _ Lin, K., Yin, P., & Loubere, N. (2014) Social Support and the 'LeftBehind' Elderly in Rural China: A Case Study from Jiangxi Province The samples of 180 elderly people 60+ from three villages. Quantitative + ELB have a greater need for care services Xie et al., (2014) Mental health is the most important factor influencing the quality of life in elderly leftbehind when families migrate out of rural China The samples of 456 elderly left-behind Quantitative N/A Yi , J., Zhong, B., & Yao, S. (2014) Health-related quality of life and influencing factors among rural left-behind wives in Liuyang, China The sample of 1,893 left-behind wives and 969 non-left-behind wives. Quantitative N/A N/A M . Abas et al., (2013) Migration of children and the impact on depression in older parents in rural Thailand, Southeast Asia A stratified random sample of 1111 parents 60 years and older (1 per household) drawn from all 100 villages, of whom 960 (86%) provided depression data at follow-up. Quantitative + + N/A Zimmer, Z., & Knodel, J. (2013) Older-Age Parents in Rural Cambodia and Migration of Adult Children: A case study of two communes in Battambang province Data come from 264 older adults born between 1940 and 1950 living in a region in northwest Cambodia near the Thai border with good access to Phnom Penh, and 1233 children aged 15 years and older. Quantitative + + N/A Tse, C.-W. (2013) Migration and health outcomes of left-behind elderly in rural China Using a nationally representative survey of CHARLS, and cross-sectional data are collected from 28 provinces, 150 counties and 450 cities/villages between 2011 and 2012. Instrumental Variable Method - Gibson , M. A., & Gurmu, E. (2012) Rural to Urban Migration Is an Unforeseen Impact of Development Intervention in Ethiopia Rural-urban migration of young adults (15–30 years) over a 15-year period (15.5% migrate out, n = 1912 from 1280 rural households) Quantitative + (for few) Nil (for the majority) N/A N/A 73 Luo, G. (2012) China's family support system: Impact of rural-urban female labour migration Using secondary and primary data Mix methods + N/A N/A Adhikari, R., Jampaklay, A., & Chamratrithiron g, A. (2011) Impact of children's migration on health and health careseeking behavior of elderly leftbehind. Thailand A data from a national survey of older persons in Thailand conducted in 2007. The analysis is confined to those who were aged 60 years or above and who had at least one child (biological or step/adopted) (n = 28,677) Logistic Regression + N/A - (more seeking for healthcare) Antman, F. (2010) How does adult child migration affect the health of elderly parents left-behind? Evidence from Mexico The data come from the Mexican Health and Aging Study (MHAS), which is a nationally representative panel data set of Mexicans born before 1950 (n=1,286) Instrumental Variables Methods N/A N/A - Knodel, at al., (2010) How left-behind are rural parents of migrant children? Evidence from Thailand A total of 1,011 interviews were completed with approximately equal numbers for three age groups of parents (50–54, 60–64 and 70–79 years) leftbehind by migrant children. Quantitative + + Raise a concern about physical care Ablezova, M., Nasritdinov, E., & Rahimov, R. (2009) The impact of migration on elderly people. GrandparentHeaded Households in Kyrgyzstan The sample of 120 pensioners in Batken provinces of Kyrgyzstan Mixed method + (minor) Guo , M., Aranda, M. P., & Silverstein, M. (2009) The impact of out-migration on the inter-generational support and psychological well-being of older adults in rural China The sample comprised 1,237 older Chinese people aged 60 or more years in the rural province of Anhui, China, who completed baseline and follow-up questionnaires in 2001 and 2003, respectively Independent ttests, + (cash) - (in-kind) + (with at least one child nearby) - (with all children migrating) Luo, B. (2009) The impact of rural-urban migration on familial elder care in rural China Using data from a rural household survey conducted by Renming University in 2004 in three in-land migrant-exporting provinces. Quantitative ++ + Ma , Z., & Zhou, G. (2009) Isolated or compensated: The impact of temporary migration of adult children on the wellbeing of the elderly in rural China Based on the 2004 General Social Survey data in China (CGSS04) Regression method + More or less balanced 74 Qin, M. (2008) Labor migration and left-behind elderly living arrangements and intra-household elderly care in Kanchanaburi DSS., Thailand The analysis is based on panel data of the Kanchanaburi Demographic Surveillance System (KDSS) in Thailand. The first four rounds of data (collected in 2000, 2001, 2002 and 2003) with the total KDSS population was about 50,000 living in 100 rural villages and urban census blocks distributed throughout the province Logistic Regression Model Nil (no significant effect) N/A Cong , Z., & Silverstein, M. (2008). Intergenerational time-formoney exchanges in rural China: Does reciprocity reduce depressive symptoms of older grandparents? The sample consisted of 1,027 parents, aged 60 and older, living in the rural village of Anhui Province, a region with high rates of labor force migration Quantitative + + N/A Biao, X. (2007) How far are the left‐behind leftbehind? A preliminary study in rural China Using secondary data and in-depth interview data of 8 family having migrants Qualitative + Knodel , J., & Saengtienchai, C. (2007) Rural parents with urban children: social and economic implications of migration for the rural elderly in Thailand The analysis relies primarily on open‐ended interviews conducted in 2004 with older age parents with migrant children in four purposely selected rural communities (823 elders in 623 households) Longitudinal research interview techniques + Nil N/A Taylor, J. E., Rozelle, S., & De Brauw, A. (2003) Migration and incomes in source communities: A new economics of migration perspective from China A sample of 787 farm households from 31 villages in Hebei and Liaoning Provinces, collected by one of the authors (S. Rozelle) in the summer of 1995. Econometric Methods and Data + N/A N/A Notes: (+) Positive, (-) Negative, (Nil) Neutral, and (N/A) Not applicable Sources: Retrospective and compilation by author 75 CHAPTER 3. RURAL ELDERLY POPULATION IN RELATION TO URBAN MIGRATION IN THE CONTEXT OF VIETNAM This chapter discusses the situation of the rural Vietnamese elderly population in the context of the exodus to urban areas by younger generations, which has not been seriously noticed by scholars, policy makers or government. It first provides a description of the phenomenon of migration from rural areas to urban locations within Vietnam, pre-and post-reform (1986). It then discusses the situation of rurally-based elderly individuals in relation to young family members who have moved out of the villages for job opportunities in urban areas. The chapter ends with a review of the literature concerning the well-being of elderly Vietnamese parents in rural areas whose adult children (their main source of support), have migrated for city employment. 3.1 Internal migration in the pre-and post-reform eras (1986) The review in Chapter 2 of both theoretical and empirical literature internationally shows that economic factors are the key determinants driving migration, especially in developing countries like Vietnam. The socio-economic circumstances in Vietnam have been changing over time due, in part, to a long period of war. The country has experienced different migration trends and patterns. This section analyses migratory patterns; however, it only focuses on the two following phases: a) Before economic reform from the end of the American war in 1975 up until 1986 when economic reform took place; and b) After economic reform from 1986 to the present day. 3.1.1 Pre-reform (1975-86), and managed migration In the pre-reform period, there were three main barriers preventing spontaneous movement of rural workers to urban areas. They are discussed in this section, and are as follows: ● The subsidy mechanism and equal distribution, which had eliminated the economic incentive for labour movement; ● Household registration, which tied a person to their place of residence; and ● Peasants being bound to agricultural land and a cooperative labour system. 76 3.1.1.1 Centrally-controlled economy eliminated economic incentive for labour movement In 1975, the American war ended (2 years after the Paris Diplomatic Agreement in 1973), which brought peace to Vietnam, although Vietnam was left severely damaged. One significant consequence of the war was widespread poverty and national economic depression. There were millions of Vietnamese casualties in the war (four million)– many were killed at a young age and the environment was destroyed or severely polluted by American chemical warfare. According to Westing (1971), 35% of the land of South Vietnam was damaged over 10 years from 1961 to 1971 . Infrastructure was largely destroyed and, consequently, Vietnam became one of the most economically challenged countries on the globe (Dang, Tacoli, & Hoang, 2003). There was much fighting, at this time, for independence in various colonised countries worldwide. There was also a rise against capitalism, with the socialist model establishing itself in a number of places. This wave of socialism encouraged revolution in Vietnam and inspired Vietnam to move towards a socialist ideology. Strong belief in communist values prompted Vietnam's leaders to propose the development of a socialist economy as quickly as possible, in 1956 in North Vietnam and in the whole country in 1975 right after the nation ended its war with the Americans. According to Ronnås and Sjöberg (1991, p. 9), after the victory over the French at Dien Bien Phu and subsequent partition of the country in 1954, the North Vietnam government initiated a socialist economy. Democratic Republic of Vietnam - "the DRV model" – was adopted from the Soviet Union which had implemented socialism since the 1920's. It was known as a centrally planned economic system, where the state holds ultimate decision-making power over the economy. Economic activity is not driven by consumers, but by the government, which controls the allocation of resources, what is produced and how it is distributed. This model "aims at economic modernisation and growth through the development of large scale, predominately heavy or producer goods-oriented industry – at the expense of all other sectors of the economy" (Ronnås & Sjöberg, 1991, p. 9). As explained by Lynden (2018, p. 1), "The DRV Model's goal of 'producing the factors of 77 production' led to aggregated shortages, chronic fiscal deficits, and large dependency on imports to complement the established movement toward globalisation." Vietnam's centralised socialist economy was first established in the north of the country in 1958 and was soon imposed in the south when Saigon was taken over in April 1975. The decentralised market model that had been imposed under American occupation was now transformed to a centralised socialist economy. Central planning systems ran agriculture through cooperatives, while state-owned enterprises dominated the industrial sector and focused primarily on heavy production and large-scale projects (Fahey, 1997). This was common in all communist countries, where the planner pursued economic development through the expansion of heavy industry. Collectivisation, collective production, and equal distribution are the main ideas of the communist model with administration by the State being at the centre of the planned economy. As previously mentioned, if the economy is the primary reason for rural-urban migration, then the act of equal distribution destroyed the incentive for urbanward movement. This is because wherever people lived, city or countryside, all were provided equally regarding food and consumer commodities. Urbanward migration was therefore patchy and infrequent, reflecting the subsidised system. With a small and sporadic number of migrants, there was no clear migration flow, pattern or typology. 3.1.1.2 Household registration – a spontaneous migratory obstacle Any argument about migration, or about the welfare of migrants, pre-reform, must consider "Ho Khau" the system of household registration. The Ho Khau system originated in China and was initially brought into urban areas in Vietnam before expanding nationwide in 1960 (T. G. Linh & Thao, 2011). The system requires each household to record their information; names of residents, gender, birthdays, marital status, the occupation of all family members and their kinship with the household head, who are normally the senior member of the family 78 (or husband) and so on, in a registration booklet. Each person can only be registered in one booklet and can, therefore, only have one official permanent address. Thus, if a person moves to a new place, their Ho Khau must also be relocated to the new residence, although the movement must be authorised by the authorities (D. B. Le, 1999). Such movement was possible on paper but very difficult in practice, as "Potential migrants were required to go through a complex paperwork process which included from authorities at their place of departure. Such certificates could be obtained with proof of employment or university enrolment in the destination, but otherwise were difficult to obtain" (World Bank, 2016b, p. 4). The World Bank also reported that pre-Doi Moi, it was almost impossible to move without permission from the authorities, and those that did could barely survive without a local Ho Khau. Under the state subsidy system, a Ho Khau booklet was considered very valuable. Without it, people could not access government subsidies and rations to survive. Individuals could only claim their rights to food and other groceries etc. with their household registration booklet. Other social services such as healthcare were also only accessible with a registration booklet (Hardy, 2001; World Bank, 2016b). Le Bach Duong explains: "Almost all of the civil rights of an individual can be guaranteed only with the presence of ho khau. Other benefits and rights including rations for food and almost all necessary consumer items, ranging from cooking oil to the 'rights' to be on the waiting list for purchasing a bicycle or government house assignments, even summer vacation, all were bound to and determined by his specific position under the administration of a specific employer within the state sectors (in the countryside, people were also in the similar situation as their work and benefits were tied to the agricultural, fishing, or handicraft cooperatives)" (D. B. Le, 1999, p. 131). Hardy adds: "Even when one died, the ho khau was still of importance. Unregistered residents were not entitled to communal burial" (Hardy, 2001, p. 192). Furthermore, lack of Ho Khau meant living without any right to access state services. Before reform, personal identification and access to services were entirely contingent on Ho Khau (D. B. Le, 1999). Notably, Ho Khau could grant a person access to their rights and to services only in their registered place of residence. Households and individuals could only claim 79 welfare where their permanent residence was registered. Thus, people were effectively tied to where they lived. Consequently, it was almost impossible for anyone to change their Ho Khau from one location to another. Nominally, the Vietnamese government used Ho Khau as a means of providing essential commodities to its citizens. In another sense, it was a big barrier of movement and used as a powerful tool to control migration. This system was especially helpful during wartime and the years following when the national economy was centralised. Legally, Decree 495TTg in 1957 expressed definitively the government's intention to prevent rural Vietnamese moving to the cities of Hanoi and Haiphong. The decree stated: "In our current economic condition, the phenomenon of rural people moving to cities has caused many disadvantages, increasing the number of unemployed in the cities while reducing the number of farmers in the rural areas, thus affecting the implementation of the State plans" (World Bank, 2016b, p. 2). Some methods applied to hinder rural-urban flows, as explained in this document, included educating people, using the means of Ho Khau to keep villagers at home, and limiting street vendor activities. Table 3-1 presents the regulations relating to implementation of Ho Khau from its inception in 1957 until 2014. Ho Khau was central to regional economic planning; it was also significant for population redistribution, with the government directing migration to rural regions and to 'New Economic Zones' (NEZs) in the north, in an effort to ease issues related to population density, such as food shortages. Household registration underpinned this policy and limited the opportunity for individuals in rural areas to transfer to metropolitan areas unless they were officially sanctioned by the state (Hardy, 2001). 80 Table 3-1: Regulations relating to Ho Khau registration 1957-2014 Document No. Date Topic Key elements Circular495TTg 10/23/1957 Restriction of migrants from the rural areas to town (Hanoi & Hai Phong) Restrictive social unit registration stipulated as a decree to reduce urban migration. Decree 104/CP 06/27/1964 Registration and management of ho khau – the primary legal creation of ho khau system Ministry of security placed in duty of ho khau registration. All Vietnamese voters are issued a ho khau booklet. The local authority should learn about changes in home membership (birth, death, marriage). A certificate is needed for migration of a household. Decree 4HDBT 01/07/1988 Registration and management of ho khau Refinements to the management system. Decree 51-CP 05/10/1997 Registration and management of ho khau Refinements to the management system. Circular 6TT/BNV (C13) 06/20/1997 Registration and management of ho khau Ministry of Home Affairs placed in charge of registration and management of ho khau system. The circular specifies cases when citizens are able to adjust their ho khau status. New conditions for ho khau registration, as well as types of residential housing area unit, introduced. Additional refinements to the system. Article 81/2006/QH11 11/29/2006 Residential Law Substantial revisions to the system. Ministry of Public Security placed in a duty of Ho khau registration. The collapse of 4 status categories into two: temporary and permanent. Article 25/2012/QH13 2012 Capital City Law New necessities for permanent registration in Hanoi are introduced, as well as a 3-year period of living within the city Article 36/2013/QH13 06/20/2013 Modifications, additions of residential law Minor revisions. Decree 31/2014/NDCP 04/18/2014 Notes on the implementation of residential law Using Ho khau laws to limit the rights of citizens is prohibited. To register as a permanent resident, one must live in town for one year (when migrating into residential district area) and 2 years (when migrating into the urban district) of a municipality of Vietnam based on temporary residential booklet record. Regulation of migrating into Hanoi follows the Capital Law. Centrally administered cities introduced stricter needs for Ho khau registration, allowed by the 2013 Revised Law on Residence. The most common equiped tool is a minimum required area of rental housing. Source: (World Bank, 2016b, p. 3) 81 3.1.1.3 "No Responsibility and No Rice" farmers were tied to agricultural cooperatives, preventing rural-urban migration Agricultural collectivisation pre-reform (before 1986), was another critical obstacle for spontaneous urban migration, as it bound peasants to their villages and their farmland in rural areas. The model of socialist cooperatives operating on the principle of collective production effectively means collective labour, centralised management, and unified distribution. For example, two thirds to 90% of agricultural land was estimated to be controlled by cooperatives between 1976 and 1980 (Huynh, 1999; Q. H. Lam, 1985; K. N. Le, 2003). Production and distribution were a state, not individual, prerogative: "After harvest, the state took out a portion of the output as a lump-sum tax; around 20-30% of that in free markets. The distribution of the output of agricultural cooperatives was based on work points. Private trade in agricultural products was officially banned. Farming households could only use the 5% of remaining land for breeding of pigs, chickens and for vegetable production; private trade in these products was allowed but restricted to local markets" (K. N. Le, 2003, p. 16). Under the socialist model of collective farming, the administrative structure consisted of brigades of farmers, whose leaders were all members of a committee. Farmers in each brigade worked together for 'work-points' based on the percentage of the production targets that were achieved by that team and the individual level of contribution of each farmer. Based on the work-points earned, the person then received a proportion of the collective food output from the team. A degree of cross cooperation existed, where Mutual Aid Teams (MATs) aided other brigades based upon workload demand. The mutually beneficial nature of this should, in theory, raise output because more hands would be working in the same field (Que, 1998; Raymond, 2008). The Vietnamese government controlled the farmers through collectivisation and residential registration, via which they had access to food and rural-only work and achieved the government objective of a large agricultural workforce. Raymond (2008, p. 43) thus describes the system of agricultural collectivisation in Vietnam as one of "no responsibility and no rice", meaning that if a person didn't contribute to producing the collective rice harvest, they wouldn't receive any rice (food etc.) 82 in return. Peasants had been bound tightly to their cooperatives, and almost 90% of peasant households were involved in cooperatives (Que, 1998). In theory, cooperative participation was voluntary, yet in reality it was akin to being compulsory as it was hard for peasants to leave their place of residence. Cooperatives were a barrier for rural individuals to move to cities, thus managed migration was more popular than any other type of population movement before Doi Moi. 3.1.1.4 Population redistribution programs pre-reform and State-managed migration With the end of the war in 1975 and the reunification of the North and South, the relocation of individuals became a pressing issue. With the economy devastated and the country generally in a mess, population redistribution was deemed to be one of the most urgent tasks to rebuild the country. Population redistribution has been considered an essential strategy of development by many countries. According to Desbarats, "large-scale population redistribution programs feature prominently in the development plans of most Third World countries. These programs commonly aim at a more "efficient" balance between the distribution of resources and the population" (Desbarats, 1987, p. 43). The author asserts that Vietnam is one of 15 countries in the Asian and Pacific region that have indicated its distribution of the population was "extremely unacceptable" and in need of "radical intervention" Likewise, D. N. Anh (1999) concedes the redistribution of the population since reunification in 1975 focused on land-based settlement which aimed to: (i) compensate for the limited natural resources by utilising the largest resource, the people; and (ii) transfer population from densely populated provinces and cities and bolster security and defence. For these goals, urban to rural migration was encouraged, and urbanward movement was hindered, therefore, to limit rapid population increases in the larger metropolitan areas. Migration in Vietnam at this time, of course, was managed and controlled by the State. The government organised population resettlement directly, by implementing programs, for example, moving people from the populous Red River Deltas to lower density regions like 83 the mountainous Central Highlands. Two programs were particularly notable, as follows: First, the repatriation of war refugees (1975-6) when South Vietnam was liberated, and the nation reunified, saw the immediate launch of a relocation program to quickly return war refugees to their original villages. This served to tackle the problem of congestion in Southern cities by reducing urban populations. With the slogan of 'produce to survive return to the countryside', the overall target was to reduce Saigon's population from 3.5 million to 2 million by the end of 1976, as noted by Desbarats (1987). However, there were obstacles such as the reluctance of some to return to their native villages, or some such villages having been destroyed. Thus, the program 'Return to the Village' did not reach its initial goal. Second, one year later, in 1976, population redistribution on a national scale became the main objective of the Vietnamese government. At the Fourth Party Congress in that year, a large-scale resettled population program at the national level was launched, the so-called 'New Economic Zones' (NEZs). It was the most notable policy, a key element in Vietnamese planning, and given the highest priority at that time. NEZs were established to either reclaim land laid to waste by the war or break new land to help resettle the rural people whom the war drove into cities. However, NEZs later aimed beyond the original purpose of refugee repatriation. NEZs had been considered as the core of the population redistribution pre-reform, with the four following main goals: i. Post war, food shortages and an undernourished population led to the establishment of New Economic Zones (NEZ's) using both new and reclaimed farmland. NEZs aimed at facilitating the rational redeployment of the labour force over the national territory, reducing the unemployment ratio, facilitating crop specialisation and increasing food production. NEZs also paved the way for the establishment of state farms and laid the ground for rapid collectivisation to contain internal political resistance and to bolster external security. 84 ii. Demographic objectives of the government included reducing the population in heavily inhabited areas and simultaneously inhabiting areas with low population density, such as in the highlands. The workforce was, therefore, ruralised to some degree. iii. The reduction of the population in congested areas like the urban south was also a way to solve the urgent issue of internal security. According to (Desbarats, 1987), by the time of the fall of South Vietnam as many as 1.3 million Catholic refugees had fled the North in 1954; the military and police force of the former regime, with their family, made up about 25% of the Southern population, who potentially posed a threat to the Northern regime. Desbarats asserts that de-urbanisation, therefore, was useful in breaking up this potential nucleus of urban-based opposition. This helped to bring Southern cities into the orbit of the party and easier for them to control. Simultaneously, the loyal group of the population to the new regime could be moved to the sensitive provinces of the Central Highlands which potentially posed a security problem. iv. Finally, as people moved to the sparsely populated central regions, they also protected the regime from external threats, who might otherwise have attacked in the emptier areas. However, the government failed to provide sufficient basic services and infrastructure in the resettlement areas, resulting in as many as 50% of the people leaving those regions soon after arrival, and consequently, the NEZs program did not achieve its target (Desbarats, 1987). The number of returners reached its peak in the 1980s, reflecting the difficult conditions in the zones. A study conducted in the Central Highlands also revealed the severe hardship settlers encountered. The ambitious programs thus became unrealistic and migrant numbers reduced to about 20,000 by 1989. During 1984-1985, only one third of new economic zones achieved their settlement targets (D. N. Anh, 2006). Even though NEZs population resettlement did not achieve its goals, the redistribution population program overall was initially successful with the decline in proportion of urban dwellers from 20.6% in 1976 to 18.5% in 1982, before rising again to 20.1% in 1989 (Table 3-2). Banister (1992, p. 35) concludes that "the policy of deurbanisation was successful, in that the 85 absolute size of Vietnam's urban population declined from 1976 to 1979, while the rural population grew at 2.7 percent a year." Table 3-2: Vietnam, Urban and Rural Population Growth, 1976-1989 (official population in thousands) Year Total population Urban population Rural population Number % of total % annual growth rate Number % annual growth rate 1976 49,160 10,127 20.60 39,033 1977 50,413 10,108 20.05 40,305 1978 51,421 10,130 19.70 41,291 1979 52,462 10,094 19.24 42,368 1979, Census 52,742 10,115 19.18 42,626 1976-1979 -.04 2.71 1980 53,722 10,301 19.17 43,421 1981 54,927 10,223 18.61 44,704 1982 56,170 10,363 18.45 45,807 1979-1982 .88 2.62 1983 57,373 10,981 19.14 46,392 1984 58,653 11,102 18.93 47,551 1985 59,872 11,360 18.97 48,512 1982-1985 3.06 1.91 1986 61,109 11,817 19.34 49,292 1987 62,452 12,740 19.65 50,181 1989, Census 64,412 12,740 20.1 50,627 1985-1989 3.06 1.14 1979-1989 2.43 1.81 Source: (Banister, 1992, pp. 36, 37) In summary, both ownership and labour were collectivised. This, along with the principle of equal distribution, can be considered the barriers eliminating motivations of spontaneous migration. The subsidy by the government for its citizens destroyed economic incentive, a primary motivation for people to migrate. The system of household registration, determining one's right of access to staples and food provision, held people back and tied a person to their residential location, preventing them from moving freely. Rural dwellers were bound to cooperative 86 labour and their agricultural land; thus, the centralised subsidy economy had created a supreme power for the government. This model allowed the government to control everything from production and resource allocation to consumption, across the whole of society. Unsurprisingly, the population redistribution was also effectively under government control. However, migration behavior has changed significantly since Doi Moi. 3.1.2 Post-reform (after 1986) and spontaneous migration 3.1.2.1 Crisis of Vietnam's centrally planned economy Vietnam and other communist economies around the world have broadly followed similar patterns of growth. Socialist economies and Communist development principles are implemented, with administration by the State at the centre of a planned economy. The focus on heavy industry and the intensively practiced collectivisation of agriculture eventually revealed its drawbacks. High rates of investment initially allowed a rapid expansion of industrial production. However, distortion and inefficiencies appeared quickly and severely restricted economic growth, resulting in a major decline in productivity (Bryant, 1998). For example, in the North of Vietnam, industrial production reportedly increased by 6% a year between 1965 and 1975 and then declined to less than 1% per year from 1976 to 1980. Lack of resources and materials limited the productivity of factories, forcing them to run at half capacity. Similarly, paddy production reportedly grew at 15% a year from 1954 to 1975 but fell behind population growth after collectivisation (Vickerman, 1986). The shortcomings of the Communist model resulted in the great economic depression of the mid-late 1980s. It is believed that the central planning strategy created economic distortions and in addition, the philosophy of equal allocations eliminated the competition of production. Consequently, there was no motivation for continued development. Moreover, the rush to growth eventually limited further demand for growth. Because of the rushed initial growth, many factories were created with their production capacity greater than the amount of available resources. Eventually, those factories were not fully utilised due to lack of input materials. The model of the centrally planned economy was explained by Boothroyd and Phạm (2000, p. 26) thus: "It violated the most important motivation for product 87 development that is it worked against the working peoples' vital vested interest." Particularly in agriculture (a major element of the Vietnamese economy at that time), the process of collectivisation did not stem from the aspirations of the peasants. "It encroached on the principles of voluntarism, democratic management, and mutual benefits of the principles of cooperatives". The percent of peasant households belonging to cooperatives is presented in the Table 3-3. The authors note that land and labour collectivisation was enforced "abruptly and painfully" in the South after the reunification of the country in 1975. B. T. Thang (2001, p. 22) notes that: "People's personal interests were not protected, and the momentum of economic development was eliminated." By that means, collectivisation was ineffective and inefficient to promote and develop the agricultural and industrial productions. Table 3-3: Official statistics on North Vietnamese agricultural cooperatives, 1958-80 Year Percent of peasant household belonging to cooperatives Mean per cooperative Number of households Cultivated area (ha) Members of working age 1958 5 26 <20 _ 1959 45 40 _ _ 1960 86 68 33 125 1965 90 85 49 175 1970 96 _ _ _ 1975 96 199 115 337 1980 _ 369 202 _ Note: Dashes indicate no data available Source: (Bryant, 1998, p. 244) After more than 20 years of the existence in Vietnam of violent de-economic interventions, the model of centrally planned economy eventually sank into a deep crisis, especially in national agricultural output. There was a scarcity of staples and consumer goods. In a five-year period from 1976, Vietnam imported 5 – 6 million tons of food. As agriculture accounted for nearly 50% of GDP, and as over 80% of the population were living in the countryside, "any deterioration in agriculture and 88 disturbance in the rural sector was bound to have significantly negative socioeconomic consequences for the whole country" (Boothroyd & Phạm, 2000). In 1985, a severe economic crisis hit. The price-wage-currency adjustment scheme (cash printed with high values to reduce monetary inflation) failed, and inflation soared to 775%, resulting in resource scarcity, an array of national-level economic failings, and widespread poverty (Phạm Minh & Vương Quân, 2009; Vuong, Nhue, Van Houtte, & Tran, 2011). Economic cracks had already appeared with increasing intensity in the early 1980s. Industrial and agricultural production was seriously impaired. There was little capital for investment, low production yields per hectare, food shortages, hyperinflation, and corrupt and incompetent officials; which all combined to push the economy of the newly united Vietnam from stagnation to crisis. In agriculture, cooperatives lost out to smaller units, called brigades. In spite of attempting to suppress the market, private trading was rife, and by the late 1970s, Florde estimated that "with prices higher in the black and grey markets, the value of goods passing through these markets may have been almost equal to those of the fully legal channels" (cited in Bryant, 1998, p. 245) Resources continued to shift into the private sector as people took advantage of legal or illegal opportunities to make money. GDP growth gradually felt year by year, from 8.4% in 1984 to 2.6% in 1987 (Banister, 1992). Faced with the threat of economic collapse in 1979, the government announced that some of its economic policies would have to change to allow economic units to experiment with new institutional arrangements that could generate a rapid increase in output. The collapse of many other communist economies, such as in China in 1978, and with the systemic change after 1989 in Eastern Europe and Russia in the 1990s, further confirmed the failure of socialist regimes. While heavily depending on imports and foreign assistance, the difficult situation of other communist countries (from where Vietnam had been receiving substantial help) was leaving the country without sufficient aid (Migheli, 2012). This significantly impacted on the nation's economy. Internal forces broke down from within, while external forces relatively reduced. Both internal and external factors were pushing the crisis into more severe territory. The country had not yet recovered from the painful and costly war or from the economic embargo of 1975. Stagnation or reform was a challenging question for 89 Vietnam at that time. The nation had no better choice than to undertake economic reform, and a market economy was apparently the best system to choose. 3.1.2.2 Transformation to a market-oriented economy and a globally integrated model From 1981-85, the Third Five Year Plan, a number of piecemeal reforms had been implemented. For example, private enterprises were accepted, and households had more economic freedom. Private cultivation of unused land was permitted. For example, for the first five years of the initial reform, Harvie (1996) notes that economic performance improved noticeably. However, there were outstanding issues by the mid-1980s. The crops were levelled off, inflation continued to increase rapidly up to 700%, and the state budget was in deficit. These factors prompted the government to implement more fundamental reform measures. In December 1986, the government launched an extensive reform program with two main features: ● The transformation from a centrally planned to a market economy; and ● Open the door to international trade and investment. The year of 1986 "marked a significant turning point" as Vietnam officially launched its reform program under the banner 'Doi Moi', meaning 'renovation' (B. T. Thang, 2001, p. 23). Establish a market by creating its components The transformation from a centrally planned economy to a free market model was different among socialist countries, depending on many factors such as politics and the level of its democracy (Fischer & Gelb, 1991). However, the reform generally was the process of reducing the state-owned sectors and encouraging private ownerships, making private ownership dominate the economy. Fischer and Gelb (1991, p. 91) indicate that a market economy is one in which "most resources are allocated though markets", instead of management from the central government. Activity in a market economy is determined by the supply and demand of goods and services, and the market mechanism is the rule of the game, and ownership (privatisation) is the key of the game. Ownership (collectivisation and privatisation) 90 of the means of production is a key factor that makes a market economy different from a command economy. Historically, the market model stems from self-sufficiency, however, at a higher stage of development. A market economy appears when the means of production is privately owned, and the division of labour spontaneously came to the human society. Together with private ownership, the more intensive the division of labour is, the higher the level to which the market develops. Those factors were destroyed in Vietnam's command economy before Doi Moi and have now recovered and are encouraged. According to Fischer and Gelb (1991) and Harvie (1996, pp. 4-7), economic reform focused on the establishment of the key elements for a market economic as follows: Private ownership of the means of production "is the heart of the transformation process" (T. Nguyen, Le, Vu, & Le, 2019). Private ownership determines rights of the owner to their products, who can entirely and legally sell their product on the market, or also can give it away even for free if they would like to. Under collectivisation, when everything belongs to everyone, a product cannot be purchased but is equally allocated, as seen in the de-commodified socialist economies such as Vietnam before its reform. The private sector now was recognised in Vietnam after a considerable period of years of being discriminated against. The concept of a multi-sectoral economy with privatisation was promoted and recognised by the law, giving companies and private enterprises an official sanction (legal framework) for their operation. The rights of the private sector were further identified in the country's new Constitution (in 1992). The privatisation process began with agriculture, due to its severe crisis of inconsistent and unpredictable yields. Resolution Number 10 in April 1988, a guideline for private ownership in agricultural production, also confirmed that "farming cooperatives were no longer considered to be the centre of the production". Farm households became the essential production unit, with the cooperatives providing farm supplies, storage facilities, and marketing arrangements. Membership of a cooperative became optional, and rights of full land use, inheritance, and transfer were recognised by the state. The outcome of the radical changes was a vast increase in agricultural production, such that previous rice 91 shortages and famine no longer existed. Vietnam became an internationally significant rice exporter within a short span of years. Prior to 1986, the private sector was very limited in retail trade services. Since Doi Moi, small-scale enterprises have expanded significantly and are now an essential contributor to output and employment. Those engaged in non-farm self-employment generally enjoy higher living standards than other groups. Monetary reforms were undertaken, including currency devaluation, reform of interest rates, financial sector and fiscal reforms, then 'getting prices right' by liberalising the price. All were controlled mainly under the market rules. Opening the economy toward globally integrated foreign trade Prior to economic reform in 1986, Vietnam mostly had diplomatic relations with communist countries. In line with the economic embargo that America applied in Vietnam after the war ended in 1975, the country seemingly cut ties with capitalist nations. International trade was primarily conducted with communist countries in the Soviet sphere of influence, including Eastern Europe and was tightly under central government control. Multiple exchange rates were used, complicating the trading, with prices. Import/export targets were also fixed by the central government. From 1987 to 1994: The 1987 Foreign Investment Law enabled a surge of Foreign Direct Investment (FDI). New regulations governing FDI have been enacted since 1988 and are very competitive in the region. Theoretically, FDI is permitted for the entire Vietnamese economic system, although the government retained a degree of central control, targeting export oriented FDI, so that Vietnam could receive additional foreign currency inflow and maintain a positive trade position with the rest of the world. However, not all approved FDI projects are actually executed, although billions of dollars in investment flowed into the country under the new investment structure. In 1987, Land Law granted farmers land use rights and since 1989, reductions in quotas and exports were introduced along with new tariffs (Table 3-4). In 1990, new corporate and private investment laws broke away from an approach that favored 'educated scholars serving the government' (Vuong et al., 2011). From 1990, educated scholars increasingly worked in private industry, and not just for the 92 government. The 1992 Constitution acknowledged the multi-sectoral economy, simultaneously expanding human rights, and by 1994 more than 17,400 firms in various sectors had been established. All levels of government were encouraged to undertake foreign trade utilising businesses at the state, province and local government levels (Vuong, 2014). Table 3-4: Milestones of Doi Moi from 1987 to 1994 Year The content of the economic renovation from 1987-1994 1986 ● Sixth National Congress Meeting adopted Doi Moi 1987 ● Land Law introduced 1st time (amended in 1993, 1998, 2001, 2003, and 2013) ● Foreign Investment Law introduced (amended in 1990, 1992, 1995, 1996, 2000, 2005, 2009) 1988 ● Politburo released Resolution 10 in agricultural management, abandoning collectivisation 1989 ● Vietnam became the 3rd largest rice export country 1990 ● Corporate law and private enterprise law were launched to stimulate business ● First ideas about the privatisation of state-owned enterprises ● Changed one-tiered banking system into two-tiered one 1991 ● Despite the collapse of the Soviet Union, Communist Party of Vietnam decided to continue socialism 1992 ● Introduced new constitution replacing the 1980 constitution 1993 ● Normalised the relationship with International financial institutions Source: (Vuong, 2014, p. 5) Economic integration and adaption of the market economy (1995-1999): Vietnam joined the international system in full, when diplomatic and trade ties were established with the USA, which no longer punished Vietnam for the historical events of the war. Consequently, Vietnam was also provided access to organisations 93 such as the Asia Development Bank and the World Bank, which provided capital for economic expansion. In addition to joining the international banking system, Vietnam was diplomatically welcomed, joining ASEAN (1995) and APEC (1998). As is customary for developing nations that comply with US led international norms, a US-Vietnam Bilateral Trading Agreement (BTA) was established. The US-Vietnam BTA "had an important political economy impact" by "spurring political will to speed up negotiations on [Vietnam's] accession to WTO" in later years (Vuong, 2014, p. 4). Included in the international "rewards" for opening its economic, diplomatic and political systems, new market opportunities opened up and reform became virtually irreversible. "As a result, Vietnam has established diplomatic relations with over 170 countries around the world, expanding trade relations, exports of goods to over 230 markets countries and territories, signed more than 90 bilateral trade agreements, almost 60 agreements to encourage and protect investment, 54 agreements against double taxation and cooperation agreements of bilateral countries and other international organisations." (Q. A. Lam, 2018, p. 1) In conjunction with the changes in the international sphere, important national legal changes occurred as the lawyers established the internal legal framework consistent with the operation of a market economy and a significant reduction in direct government involvement. 3.1.2.3 Economic reform results The Doi Moi in 1986 was a significant milestone in Vietnam's economic development. The reforms brought about remarkable achievements for Vietnam in terms of GDP growth, poverty reduction, macroeconomic stabilisation, the attraction of foreign direct investment and export expansion. Instead of importing rice, by 1989-90 Vietnam became one of the top three rice exporters, after Thailand and the United States (Irvin, 1995; B. T. Thang, 2001). The inflation reduced from three-digit (780%) in 1986 to 14.8% in 1994 (Diez, 1999a). For ten years from 1985 to 1995, GDP annually increased by an average of 6.4%, and about 7% from 1995 to 2005 (World Bank, 2006). According to Dollar 94 (2000, p. 169) "This rate was the highest among the 40 poorest countries listed in the World Development Report 1996." At the same time the poverty rate had been sharply reduced from 75% to 50%. The author concludes that Vietnam had "the best performance among low-income economies." In 1996 alone, over USD10 billion of FDI entered Vietnam (see Figure 3-1), in addition to billions of dollars of Official Development Assistance capital (ODA) from the World Bank and Asian Development Bank, with a consequent increase in job creation in Vietnam (Athukorala & Tien, 2012). This saw an increase in business related taxation, consumption and competition, and export income growth (Xuan & Xing, 2008). Figure 3-1: Foreign Direct Investments into Vietnam Source: (GSO, 2019) A report from the World Bank (2016a) shows that FDI continues to accelerate recently with US$ 11.3 billion committed to Vietnam in 2016 (for the first six months) from more than 100 countries, which increased by 105% compared to the same period in 2015. About US$ 290 billion FDI accumulated in different economic sectors with a diversity of investment activities. 95 "The foreign-invested sector accounts for 71 % of exports and 59 % of imports, dominating the key manufacturing exports of Vietnam. The foreign-invested sector contributes about 18 per cent of Vietnam's GDP, nearly a quarter of total investment, two-thirds of total exports and millions of direct and indirect jobs" (World Bank, 2016a, p. 21). Figure 3-2 shows Foreign Direct Investment has significantly increased recent years from 2010 to 2016 with the largest proportion (65%) invested in manufacturing. Figure 3-2: Foreign Direct Investment from 2010 to 2016 Source: (MPI as cited in World Bank, 2016a, p. 22) 96 Table 3-5 shows Vietnam economic development from 2013 to 2018 with some key indicators Table 3-5: Vietnam recent economic development Selected Indicators 2013 2014 2015e 2016/f 2017/f 2018/f Real GDP growth, at constant market prices 5.4 6.0 6.7 6.2 6.3 6.3 Private Consumption 5.2 6.1 9.3 7.5 7.5 7.0 Government Consumption 7.3 7.0 7.0 6.9 7.0 7.2 Gross Fixed Capital Investment 5.3 9.3 9.4 8.8 8.5 7.5 Export, Goods and Services 17.4 11.6 12.6 13.4 13.8 14.0 Import, Goods and Services 17.3 12.8 18.1 14.8 14.7 14.3 Real GPD growth, at constant factor prices 5.3 5.7 6.8 6.4 6.5 6.5 Agriculture 2.6 3.4 2.4 1.0 1.5 2.0 Industry 5.1 6.4 9.6 9.0 8.8 8.5 Services 6.7 6.2 6.3 6.4 6.3 6.3 Inflation (Consumer Price Index) 6.6 4.1 0.6 3.5 3.8 4.0 Current Account Balance (% of GDP) 5.5 4.9 0.0 -0.6 -0.5 0.2 Fiscal Balance (% of GDP) -7.4 -6.2 -6.5 -5.9 -5.7 -5.5 Debt (% of GDP) 54.5 59.6 62.5 63.8 64.4 64.7 Primary Balance (% of GDP) -6.1 -4.5 -4.5 -3.8 -3.5 -3.0 Poverty rate ($1.9/day PPP terms) a, b, c .. 2.8 2.5 2.1 1.8 1.5 Poverty rate ($3.1/day PPP terms) a, b, c .. 10.7 9.5 8.4 7.5 6.6 Notes: e = estimate; f = forecast, (a) Calculations based on EAPPOV harmonisation, using 2014-VHLSS, (b) Projection using neutral distribution (2014) with pass through =0.87 based on GDP per capita constant PPP, (c) Actual data 2014. Projection were from 2015 to 2018 Source: (World Bank, 2016c, p. 220) Vietnam development outlook in 2015 is presented in Table 3-6 below: Table 3-6: Vietnam development indicators Vietnam development indicators 2015 Population 91.7 GPD, current US$ billion 191.5 GDP per capita, current US$ 2,089 Poverty rate (US$ 1.9/day 2011 PPP terms) a 2.8 Poverty rate (US$ 3.1/day 2011 PPP terms) a 10.7 Gina Coefficient b 34.8 School enrolment, primary (% gross) b 104.7 Life Expectancy at birth, years 75.6 Notes: a. Most recent value (2014); b. Most recent WDI value (2013) Source: (World Bank, 2016c, p. 218) 97 Despite the economic reform achievements that are broadly acknowledged, this move also had its limitations. Reform broadened the gap between rich and poor, saw urban areas favored for development over rural, and contributed to greater class stratification across the country. 3.1.2.4 Factors promoting urbanward movement post-reform Three main pre-reform barriers that prevented spontaneous movement of rural dwellers to cities (as discussed earlier) were removed after economic reform and are as follows: ● Cooperative labour was dismantled (rural people could move); ● Economic incentives were introduced (rural people wanted to move); and ● Household registration was loosened (rural people could move). Compulsory collective agriculture is dismantled According to Kirk and Tuan (2009), economic reform caused the dissolution of many rural collectives, returned land to rural households and assigned land rights to farmers. The 1987 Land Law recognised the land use rights of households and individuals and the second Land Law of 1993, established farmers' long-term and stable use of agricultural land (T. T. Nguyen, 2012). "By 1999, more than 10 million households had been granted land use certificates (LUCs) for agricultural land, accounting for 87% of agricultural households and 78% of agricultural land in Vietnam" (ANZDEC Limited as cited in Q. T. Tran, 2013, p. 1). However, the New Land Laws did not mean that the individuals or private organisations owned the land, which is owned by the state (the people of Vietnam). However, they have the rights to use, exchange, transfer, inherit, lease or mortgage land and generate income from it (Do & Iyer, 2008; Vietnam, 2003). These rights exist under current law, the third Land Law of 2003. With the implementation of the New Land Law, a peasant was granted full rights over his farmland. He could harvest or rent it out if he wanted to. Peasants could even transfer their plots to others. The New Land Law brought autonomy for farmers, allowing peasants to freely determine if they would like to move elsewhere, without any ties to their agricultural land, creating dynamic and flexible mobility for famers. 98 Regional and provincial disparities in growth create economic motivation for rural-urban migration In pre-reform Vietnam, egalitarian distribution through the centrally controlled economy attempted to eliminate the gap between the rich and the poor, and attenuate regional disparities. This misallocation of resources had terminated production incentives. Eventually, no one wanted to work and contribute. The egalitarian distribution meant people were all equal, so that the fear of being rich arose. The target of building a society that was fair to everyone in Vietnam according to that approach inadvertently led to a disrespect, bias, and discrimination against the rich. Consequently, it led to a severe economic crisis in 1980, and the failure of targeting a society of equity and "commonwealth". Vietnamese ended up sharing a "common poverty" (B. T. Nguyen, Albrecht, Vroman, & Westbrook, 2007, p. 469). In contrast, since Vietnam transformed to the free market model with the core factor of competition, it has created a strong economic motivation for development. However, on the other hand, it causes social class stratification/divisions and regional disparities. Competition leads to a distinction between the rich and the poor in the market economy and seems to be inevitable. Also, the uneven regional distribution of economic growth cannot be avoided, especially in LDCs where there are financial budget constraints. For example, the evidence in a study in Southeast Asia conducted by Diez (1999b, p. 358) shows that "Regional disparities between very rapidly growing regions and backward rural areas fall behind." The author notes that, in Thailand, the Philippines, and Indonesia, economic development has been confined almost exclusively to the respective capital cities, creating greater disparities between urban and rural regions. In those nations, structural economic change seemingly brings uneven development, meaning that some regions fall behind others. Vietnam is no exception. Agricultural production since Doi Moi undoubtedly had great achievements, with an annual growth rate of 4.3%, which contributed over 16% of the nation's GDP (Mai & Yen, 2018). In the agricultural sector, even though significantly improved compared to pre-reform years, there is still a big gap between rural parts and urban areas. Some scholars argue that "The benefits of Doi Moi have been unequally distributed among regions: while cities such as Ho Chi Minh and 99 Hanoi as well as surrounding provinces have received large levels of industrial capital, the northern mountains, north-central coast, central highlands, and other rural areas have lagged behind. These disparities have triggered a flow of rural-tourban migration" (United Nations and D. Phan as cited in Kim Anh, Hoang Vu, Bonfoh, & Schelling, 2012, p. 2). The disparities were not only between provinces but also between regions. Harvie (1996, p. 9) indicated that the "gulf" between the north and south of Vietnam threatened to become even more pronounced as freemarket reforms took root. Ho Chi Minh city was destined to become Vietnam's leading commercial central and international focal point, and it has happened as he predicted. Indeed, urban households expenditure (mean per capital) was found (based on the data from VLSSs between 1993 and 2006), to be double that of rural households (Thu Le & Booth, 2014). Likewise, UNESCO (2018) notes that the average income of urban dwellers is recently nearly double that of inhabitants of rural Vietnam. These disparities between rural and urban people are due to a range of factors. The advantages for development of urban areas: N. T. Nguyen (2015, p. 90) explains that "Wealthier localities have more capital to improve infrastructure in comparison to their poorer counterparts. They are able to attract more investment and their income per capital is much stronger. Essentially, with advantages in infrastructure and human resources, central cities of a region usually develop faster than their nearby provinces, which depend on the agricultural sector." Taking foreign capital attraction as an example, despite the attempts to diversity the location of FDI of the Vietnamese government post-reform, there was a great imbalance in distributing this source of capital between regions and provinces. The evidence from a study by Tien Quang Tran (2009) shows that the Southeast region was the destination of two-thirds of FDI projects (over 60% of total registered FDI) in 2005. The second location for this capital is the Red River delta, with nearly 30%. Ninety percent of the total registered FDI went into these two regions. Of these, Ho Chi Minh City and Hanoi were the biggest recipient of FDI projects in those regions. The disadvantages of rural parts: First, if the location and infrastructure (transport, electricity, water supply, information) benefited urban areas more (as aforementioned), it was comparatively due to the disadvantages of rural regions. 100 Second, human resources were limited in term of labour force quality, which contributed to the slow pace of rural development. For instance, even though the New Land Laws gave farmers the chance to consolidate and accumulate land for large-scale agricultural production (such as transferral, lease or inheritance), most them could not take it. Lack of skills and knowledge due to low educational levels was a great obstacle hindering most peasants from operating a large agricultural production unit. Agricultural production therefore remained fragile, small-scale, and characterised by manual labour. This seemingly cannot create a high income for most rural households. In addition, while agriculture was the main income source of most rural families, it is subject to climate uncertainty and natural shocks. Many rural families ended up with a low income. According to Van Arkadie and Mallon (2004), more than 90% of the poor lived in rural Vietnam. This proportion has now reduced, but still remains at a high proportion of around 70% (Mai & Yen, 2018). A vicious circle of illiteracy, poverty and financial constraints in turn prevent famers from becoming big businessmen owning large scale agricultural production (S. Fan, Huong, & Long, 2004). Thirdly, while most farmers had lack of knowledge and lived in poor economic conditions, the support they received from the government was also very limited. Undoubtedly, there are many policies implemented since Doi Moi which promote countryside and agricultural development, such as: land policies with land-use rights given to rural households; land titles; trade policies which support peasants with internal and international market development; financial and monetary policies which provide credit capital for agriculture and rural areas; as well as tax support etc. (T. C. Thang & Linh, 2015). However, it is a big challenge for the limited budget of the Vietnamese government to support a population of nearly 66 million living in rural areas, which accounted for 42% of the total labour force of the nation. Therefore, in order to get a good outcome, any program investing in rural areas and agriculture in Vietnam had always to be carefully managed, focused, and for the long-term. However, some programs were implemented in a half-hearted manner. For instance, according to the program of funding aid for the rural poor, households could borrow a certain amount of money to invest in agricultural production. However, without the support of training skills and knowledge for the businesses, 101 farmers did not know how to manage the borrowed money, rather than spending it on their living expenses such as buying a motorbike or fixing their houses. Some financial aid programs were inappropriate to the situation and needs of rural dwellers (P. Taylor, 2007). For example, for farmers too poor to make a move, financial support from government failed because it was insufficient. Ravallion and Van de Walle (2008, p. 21) complained about "credit-market failures, such that tenants or small farmers are unable to borrow enough to finance a purchase." In research testing the relation between land titling and rural transition in Vietnam, Do and Iyer did not find a great impact. The researchers state that "issuing land titles to all households would result in only a 0.3 standard deviation increase in the proportion of land devoted to long-term crops." They conclude that there was "no significant impact in overall household consumption expenditure or agricultural income" (Do & Iyer, 2008, p. 569). Individually, farmers themselves cannot make a great difference to their economic circumstances due to their educational shortcomings. Support from the state and foreign investment in agricultural and regional parts was limited. The comparative disadvantages of rural areas and the agricultural sector were also among the reasons the gap widened between rural and urban areas (Bui & Imai, 2018). Rural and agriculture industries have eventually lagged. Most farmers lived an uncertain life and many of them especially young generations moved elsewhere for better opportunities. The exodus of people moving out to cities caused farmland to be increasingly abandoned. This phenomenon raised concerns for many people. Regional and economic sector priority schemes: Industrialisation and modernisation are top priorities of the nation since Doi Moi. Vietnam strives to increase the share of industry and services while reducing the share of agricultural production (see Table 3-7). According to Leproux (2004) industry accounted for 34% of inflow capital as the largest share in 2003, and heavily concentrated in the cities. More than half of the FDI capital was attracted by Ho Chi Minh City and Hanoi. 102 Table 3-7: Structure of sectors' GDP and contribution out of overall growth for the period 2011-2016 Year Proportion of economic in total GDP (%) Economic sectors contribution to overall growth (%) Agriculture Industry Service Product tax minus product subsidies Agriculture Industry Service Product tax minus product subsidies 2011 19.57 32.24 36.73 11.46 0.78 2.44 2.76 0.26 2012 19.22 33.56 37.27 9.95 0.53 2.41 2.51 -0.19 2013 17.96 33.19 38.74 10.11 0.46 1.69 2.55 0.72 2014 17.70 33.21 39.04 10.05 0.59 2.13 2.36 0.90 2015 17.00 33.25 39.73 10.02 0.40 3.20 2.43 0.64 2016 16.32 32.27 40.92 10.04 0.22 2.59 2.67 0.73 Note: Based on the General Staticstics Office of Vietnam Source: (Mai & Yen, 2018, p. 23) Because industrialisation is the priority of the nation, and due to its concentration in big cities, there are more policies that favour urban migration since Doi Moi. They include Decision No.10 (1998) – Urban System and Development Strategy to 2020 which encouraged the development of medium and small cities, while still promoting the growth of big sized cities. After a long time restricting urbanward movements, the government eventually accepted mega-cities with more than 10 million citizens and recognised the role of migration in promoting industrialisation and modernisation. This was stated in the Table 3-8 the 2011-2020 Socio-economic Development Strategy (World Bank, 2011). 103 Table 3-8: Government policies to control and guide urban development in Vietnam Urban Development Policies Consequences Central Control of Administrative Boundary Shifts From 1954 to the present, administrative boundary changes required approval from the central government. This has historically been viewed as an effective tool for controlling city size and encroachment of urban areas into agricultural lands. With the increase in urbanisation since Doi Moi policies in the late 1980s, the loss of agricultural land to urban use is increasing conflicts at the urban fringe of many cities. Controlling Population Movements and the Demographic Transition The demographic transition has been largely controlled by the urban residency permission system. This was considered largely effective for its intended purpose from 1954 to 1990. Since 1990, this policy has been relaxed, the effects of which can be seen in the demographic transition since 1990; the urban population rose from 19.5% in 1990 to roughly 30% in 2009. However, remnants of this system may actually still result in an undercount of the actual urban population with many migrants potentially not accounted for in this number. Urban Service provision and the Welfare Transition From 1954 to early 1990s and the 2000s, reforms in service provision have been made to allow for cost recovery in tariffs and an orientation to commercial practices. This has had a general positive impact on increasing access to basic services across all urban classifications. Quality of services remains a problem. Urban Finance and the Economic Transition Urban Construction finance from 1954 to the present has been largely controlled through the state and the redistribution of revenues on a per capita basis. This has had a positive impact on equity between regions and urban areas. But many cities still struggle to make infrastructure investments necessary to keep them competitive and to keep pace with demand. There is a growing trend for cities and the private sector to take over urban construction, though large SOEs still dominate in many areas. Land sales are a big component of 'own source' revenues that cities have for infrastructure investments. There is growing debate nationally to create new rules for larger cities (e.g. The Law on the Capital City). 104 Land Markets and the Physical Transition Urban land markets were largely ignored form 1954 to the 1990s. The 1993 Land Law was a step forward to release land into the land and housing market. Conversion of farmland to urban use accelerated rapidly, though it was considered to have been chaotic due to low levels of legally recognised land use rights and many informal transactions. The 2003 Land Law further grants the use of the land as a resource input in business and as eligible for compensation when land is acquired by the government for development. The Land Price Framework (generally lower than 'market' rates by 30-70%) is intended to stimulate economic development. It is viewed as being successful in attracting real estate investment; but it is also view as source of land speculation, land conflicts, and as raising land prices to the end user to benefit the state and property developers at the expense of the original land owners and by the creation of a de facto two-tiered land price system. Transition towards Pro-Urban policies? The Government Decree No. 72 (2001) and Decree No.42 (2009) established city and two classification requirements in an attempt to distinguish between the roles of different cities. The classification system has implications for administrative functions, tax collection and state funding allocations. A possibly unintended consequence has been a trend for cities to exploit loopholes in the classification system to move up in the ranking. These moves are largely administrative and not necessarily based on the actual economic function of the cities. Government Decision No. 10 (1998) on the Urban System and Development Strategy to 2020 called for the development of medium and small sized cities and constraining the growth of the largest cities. By 2009, Government Decision No. 445 updating the 1998 Decision with a vision to 2050 accepts the possibility of mega cities with population over 10 million. The current thinking is to develop a system of cities that each play a role in the country's urban economy. However, these Decree are non-binding, and are seen as only statements of intent. The 2011-2020 Socio Economic Development Strategy de facto accepts urbanisation and modernisation. Source: (World Bank, 2011, pp. 4,5) 105 In addition, as a consequence of industrialisation and urbanisation, the phenomenon of farmland acquisition (accumulated land for industrial or national public projects) recently caused an increase in the number of rural households with no land or 'landless labour' (Trần, 2018). From 1990 to 2003 as many as 697,417 hectares of land was changed to usage purposes other than farming, such as for the construction of industrial zones, infrastructure and urban living extensions (D. P. Le, 2007). Approximately 5% of the total farmland from 2000 to 2007 in Vietnam was converted for non-farm use purposes. "Consequently, in the period 2003-2008, it was estimated that the acquisition of agricultural land considerably effected the livelihood of 950,000 farmers in 627,000 farm households. About 25-30% of these farmers became jobless or had unstable jobs and 53% the households suffered from a decline in income" (Vietnam Net as cited in Q. T. Tran, 2013, p. 4). Urban areas themselves not only have many advantages compared to rural parts but is also a priority for development of the nation. In a limited budget position, like many other developing economies, the Vietnamese government chose investing in cities in preference to the countryside. With many policies encouraging urbanisation, this led to uneven regional development in Vietnam, creating recent strong economic motivation for urbanward movement. Household registration was loosened Before Doi Moi, Ho Khau was utilised for controlling access to rights and services, rather than merely being used as a system of identification. This became the opposite, post-reform. According to the World Bank (2016b), after the launch of reforms Ho Khau became less essential to survival and was used more for identification purposes. It was said that: "The abolition of the state subsidy system in the late 1980s has made individual movement possible because even though registration is still mandatory, being unregistered no longer critically affects a person's livelihood" (World Bank, 2016b, p. 4). In brief, all the barriers were dismantled after Doi Moi in Vietnam. Reform loosened farmers' ties to the cooperative land and eliminated the constraints of rural inhabitants (i.e., everyone now had the right to move to wherever they wanted to live). The better urban development was a strong incentive for a massive rural-urban flow (Cam, Cao, & Akita, 2008; Fritzen, 2002; Thu Le & Booth, 2014). Table 3-9 106 shows the trends and patterns of domestic labour movement pre-post reform in Vietnam. Table 3-9: Internal migration in Vietnam pre and post-reform (1986) Migration Pre-reform (1975-86) Post-reform (1986-present) M o v em en t co n d it io n s Economic incentives Equally subsidised (Egalitarian distribution) Income Disparities Household registration A person's rights to access food in their residential home Only for identity purposes Private land use Collective ownership Private land use rights Migratory patterns Managed migration Spontaneous Migratory trend Rural-ward movement Urbanward movement Source: Created by author 3.1.2.5 Government ministries and departments responsible for migration Pre-reform, mandatory migration was controlled by The Ministry of Agriculture and Rural Development (MARD). This department of the government was responsible for the development of NEZs and was in charge of rural-ward movement. Post-reform, no agency and organisation are solely in charge of population mobility. Each of the relevant government ministries and departments take care of different aspects of population mobility. For example, The Ministry of Labour, War Invalids and Social Affairs (MOLISA) is responsible for employment and vocational training. MOLISA collaborates with MARD to alleviate poverty using labour and other population relocation programmes. The Department for Management of Foreign Employed Labour Forces (DAFELF) is in charge of the export labour industry. The Ministry of Finance (MOF) through the Bank for Social Policy and the Bank of Agriculture takes care of the rural poor, providing them with loans if they wish to work overseas as export labourers. Regarding the internal migration, the Ministry of Public Security (MPS) is more likely to be responsible and manages household registration when people migrate. Immigration is controlled by the 107 Ministry of Foreign Affairs (MOFA) and the Ministry of Justice (MOJ). In conjunction with the Border Guard Command (BGC), MPS investigates smuggling and human trafficking. The Ministry of Construction (MOC) is responsible for ruralurban planning and development (Dang et al., 2003). There is no government agency or organisation fully in charge of the matter of migration. Each of these departments, in other words, only solves problems relating to their responsibility. Migration, therefore, has spontaneously occurred Figure 3-3: Vietnam's Organisational Chart of Administrative Structure regarding migration management Source: (A. D. Nguyen, Tacoli, & Hoang, 2003, p. 29) 108 3.1.2.6 Spontaneous rural-urban migration post-reform Post-reform, the subsidy model was abandoned in favor of privatisation, meaning individuals had to support themselves entirely. Like everyone else, farmers were naturally attracted to wherever life was easier and better. While all the barriers were removed so that peasants could easily move, city life was the common choice of many. Urban migration in Vietnam has been increasing since Doi Moi and accelerated profoundly in recent years. Data from a population census conducted in 1999 showed that in the five years prior to data collection around 4.5 million people in Vietnam changed their home locations. Of them, around 55% moved within their own province, and 45% moved between provinces. In 1999, around 1.6 million individuals moved from rural to urban areas, contributing to around a third of urban population growth (UNFPA, 2007). According to Phuong, Tam, Nguyet, and Oostendorp (2008), 10.7% of individuals aged 15 and older left their home for long term migration between 2002 and 2004, and 70% of that movement was between provinces. Ho Chi Minh City has received the highest number of national migrants in Vietnam, and Hanoi was predicted to be the fastest growing city in the world (Anderson et al., 2017). Consequently, urbanisation has been accelerated postreform (Figure 3-10). The urban population annual grew about 3.2% from 2010 to 2017, of that migration mainly contributed. By contrast, rural population growth was only about 0.9% (P. Fan et al., 2018; Nhung, Thai, Trinh, & Phong, 2019). Table 3-10: Urban and rural population growth rates (% p.a.) Unit: % Urban Rural 2010 3.64 -0.01 2011 4.54 -0.48 2012 1.98 0.66 2013 2.14 0.57 2014 4.02 -0.31 2015 3.44 -0.08 2016 2.76 0.20 2017 2.78 0.15 Note: Data from Vietnam General Statistic Office 2012-2016 Source: (Nhung et al., 2019, p. 32) 109 While urban population increased from 30.50% in 2010 to 35.03% in 2017, the number of rural inhabitants declined from 69.50% to 64.97% (Figure 3-11). Yeung (2007) anticipates that the urban population will increase from 20 million in 2000 to 40 million in 2020. Table 3-11: Urban-rural population structure (% of total) Unit: % Urban Rural 2010 30.50 69.50 2011 31.55 68.45 2012 31.83 68.17 2013 32.17 67.83 2014 33.10 66.90 2015 33.88 66.12 2016 34.44 65.56 2017 est. 35.03 64.97 Note: Data from Vietnam General Statistic Office 2012-2016 Source: (Nhung et al., 2019, p. 32) Figure 3-4 shows the trend of urban population before and after Doi Moi (1986), in Vietnam. During the period from 1960 to 1985, urban population accounted for under 20% of the total population; it increased to more than 30% for 1986-2015 after reform. According to P. Fan et al. (2018), a faster pace occurred in the cities with more than 1 million citizens. Indeed, the population annual growth rate in those cities was 3.0% for 1960-1985, increased to 3.6% during 1986-2015, making up 14.4% of the total national urban dwellers in 2015. 110 Figure 3-4: Urban population dynamics of Vietnam (1960-2015) Source: (P. Fan et al., 2018, p. 5) In their research comparing internal migration in Vietnam and the Philippines, N. T. Anh, Rigg, Huong, and Dieu (2012) found that economic incentive was the primary driving factor for urban migration in both countries. Like most developing 111 economies as aforementioned in chapter 2, the evidence in Vietnam also shows that seeking a job and improving living conditions (41% and 30%) were among the most common reasons for urbanward flows (UNFPA, 2007) (see Figure 3-5). Figure 3-5: Primary reason for population movement in 2004 in Vietnam Source: (UNFPA, 2007, p. 12) Using economic models to analyse the determinants and impacts of migration in Vietnam, based on the data from VHSS 2004, Phuong et al. (2008, p. 2) concluded that "migration is a highly selective process and strongly affected by household and commune characteristics." Truong Huy (2009) found age as well as education significantly influenced migration behaviour, especially for those between 15 and 25 years old, who were groups with a higher probability of long-term out-migration, compared to older age groups and those without education (about 24.7% and 17.9%, respectively). Most urbanward migrants are young adults, with the median age around 25 (GSO, 2011a) (See Figure 3-6). It is mainly those who are young and single and, 41% 13% 30% 16% Job Family Improve living conditions Other 112 increasingly, those who are female, who leave home as part of a family strategy to boost household income. One popular trait of migratory labour is that many of them engage in work that is often insecure, informal and low paid rarely, is there the chance of progression (N. T. Anh et al., 2012). Figure 3-6: Migration trend and ages in 2004 in Vietnam Source: (UNFPA, 2007, p. 10) When an exodus of the younger generation (mainly of working age) move out of the villages, like everywhere else in the world, old people and children are subject to being left-behind in rural areas. As a dependent group, is being left-behind a disadvantage for rural elderly Vietnamese? To answer this question, the elderly's status (wealth and health), the welfare support from government and the family responsibility in taking care of the elderly are important factors to be considered. Those related factors are examined in the next section. 113 3.2 Rural Vietnamese elderly individuals in the context of urbanward migration of the young generation 3.2.1 The Vietnam demographic transition: Aging population With a two-child policy in place since late 1988, Vietnam was successful in reducing the fertility rate (from about 6.7 children/woman in 1970s, booming after the war, to 1.8 in 2019) (Minh, 2016; UNFPA, 2016). In addition to the subsequent mortality rate decline due to the economic improvement since Doi Moi, Vietnamese' life expectancy increased over time from 60 years in the 1970s to 76 in 2014, compared to 67 years in comparable lower-middle income countries (WDI as cited in World Bank, 2016a). As a result, the proportion of the working age group (people aged from 15 to 64 years old) tends to decline, the number of the retirement group increases, creating higher dependency ratios (United Nations, Department of Economic and Social Affairs, & Population Division, 2015a) (see Figure 3-7 and Figure 3-8). Figure 3-7: Share of population by age, annual: 1950 – 2100 in Vietnam Source: World Population prospects: Key findings & advance tables 2015 revision (United Nations as summarised and cited in World Bank, 2016a, p. 32). 114 Figure 3-8: Youth, Elderly and total dependency ratios, annual: 1950 – 2100 in Vietnam Notes: YDR-Youth dependency ratio, EDR-Elderly dependency ratio, TDR-Total dependency ratio. Source: World Population prospects: Key findings & advance tables 2015 revision (United Nations as cited in World Bank, 2016a, p. 32). It quickly moved Vietnam from a young population in the late 1980s, towards an ageing nation after only 30 years. The country officially entered an 'ageing' phase in 2011, when its old people accounted for more than 10% of the total population. Notably, 65% of Vietnamese elders are living in rural regions. As one of the nations with the fastest ageing process, it will take Vietnam less than 20 years to become an 'aged' population (when people over 60 years old account for more than 20% of the total population), compared to 115 years in France, 85 years in Sweden, 45 years in England, and 26 years in Japan and China (UNFPA, 2011). The proportion of aged population is estimated to account for nearly one-quarter of the total Vietnamese population by 2049 (Figure 3-9). 115 Figure 3-9: Age structure and the proportion of population aged 60 and older in Vietnam, 1979 – 2049. Source: Based on the data from the Population Census 1979, 1989, 1999, 2009 – GSO Vietnam 2014/15 (Vietnam Ministry of Health, 2018, p. 67). As a consequence of the recent escalating urbanisation, migration in Vietnam itself has created a large number of people who could be labelled as the left-behind population, and rural elderly are predominant among those. Together with the fast pace of the ageing process currently in Vietnam, more rural elders will potentially be added to the left-behind groups. Notably, less children in each family due to the fertility rate decline, raises a great concern – who will stay to look after elderly parents? Are rural old people safe and secure with the absence of their children? This will depend on: (i) their circumstances; (ii) the support from society; and (iii) family. 3.2.2 Vietnamese elderly status: Wealth and health 3.2.2.1 The economic status of the elderly Before Doi Moi 1986, the social welfare system had been fully subsidised by government, with education and health care services completely free for all. A 116 number of the welfare provisions in the late 1970s were described as follows: "the state sector workers like their counterparts in other communist countries, received guaranteed employment, sick pay, maternity leave, retirement pensions and subsidised housing, education, and health care. They ate cheap rice, which the government procured from agricultural cooperatives at artificially low prices" (Bryant, 1998). Surveys conducted by government in the Red River Delta during late 1970s found that 95% of elderly bought rice from their cooperatives at the subsidised prices, 30% of these were allocated appropriate work and a further 30% given allowances. This was especially relevant to the elderly who lost children in the wars. Members' funerals were also paid by cooperatives. Families with more children received extra land, though this rule was later rejected due to the numbers of household plots increasing. Urban state sector workers received more generous welfare provisions than their rural collective sector worker counterparts. State sector workers first qualified for the pension in 1947 and they could receive a pension close to the benefits they had received when working. Cooperative and communes thus had been urged to provide welfare services to their members. After Doi Moi era, the elderly who would previously have been cared for through government subsidies were now left on their own because of privatisation. Family became a primary care and support for the majority. The Vietnam Ageing Survey (VNAS) data conducted with a large-scale sample of 2789 elderly people as "the first-ever nationally representative quantitative survey on Vietnamese people aged 50 and over" in 2011, showed that only 20% of elderly Vietnamese, i.e. those who were public servants (e.g. ex-government officers, past state-enterprise employees, or communist party stalwarts), received a pension or allowance as contribution pension, when they retired. Less than 16% were eligible for social assistance schemes (Vietnam Women Union, 2012). A few were able to earn their own living. The rest, approximately 60% of the elderly, don't have any regular income after they are incapable of continuing in the workforce. There was no security net for this group other than the support from their family (UNFPA, 2014). Most elderly (68.1%), therefore, still take part in the labour force beyond their retirement ages (T. L. Giang & Nguyen, 2016). For example, over 50% of the elderly between 60 and 64 work full-time or part-time. That number is 37.1% for those aged between 65 and 69, and 18.2% for ages 70+ (Long & Pfau, 2009; UNFPA, 2011). 117 As one of a few studies focusing on the particular topic of the rural elderly's working status, (Friedman, Goodkind, Cuong, & Anh, 2001) found that almost all elderly individuals in rural areas do not receive a government pension, and 60% of them (aged from 60-69) and 23% aged 70 and older still worked and earned their own living. UNFPA (2011) found that 60.7% of the elderly worked in agriculture, forestry and the aquaculture sector, and were often self-employed or serving family. According to T. L. Giang and Nguyen (2016), only 15% of rural elders reported that their income was enough for daily costs, whereas, about 85% complained about insufficient income. Data from Vietnam household living standard survey (VHLSS) 2014 also shows more poverty for elders in rural parts compared to urban areas (Figure 3-10). Figure 3-10: Poverty rates of individual by age (left hand side) and Poverty rates by age of household head (right hand side) in Vietnam Source: Based on the data of VHLSS 2014 (World Bank, 2016a, p. 34) The proportion of elderly individuals continuing working varies by location, with most working elderly individuals (more than 80%) living in primarily agricultural or fringe areas. Women's income is usually lower than men and is more concentrated in informal sectors (UNFPA, 2011). Besides participating in economic activities to earn wages for themselves, many Vietnamese elderly also make a significant contribution to supporting their children with the household chores, committing and devoting their time and labour, as other 118 way of contributing to household's income. For example, individuals may look after grandchildren and help with the household work. By doing such work in the house, elderly adults feel useful and a part of family life. Most of them think it is their responsibility and they want to confirm their role in the extended family. Helping out with housework also strengthens the family bond with their children and grandchildren. As noted, most of the older people (80%) do not have a pension. Therefore, working beyond the retirement age for a living is common for the Vietnamese elderly population. The evidence shows less post retirement age work for those on higher incomes and for urban citizens (L. T. Giang & Le, 2017). Many elderly people "work until they drop", meaning that health condition was a determinant factor for them participating in the workforce. Because of better health, men and younger senior citizens take part in the workforce more than women and advanced age groups. Despite working hard, insufficient income was a common feature of this group. 3.2.2.2 Elderly health status and health care programs The health status of – and health care for – the elderly in Vietnam is an emerging issue. Although life expectancy of Vietnamese at birth is increasing and higher than that of other countries in the region, healthy life expectancy is not as high as other developing countries. The average period each older person suffers from an illness was 9 out of 73.3 years of life. Women had an average 11 years with disability while for men that number is 8 years (Figure 3-11). Vietnamese people are undeniably living longer, however, whether they are living sicker is a concern. 119 Figure 3-11: Life expectancy at birth by sex among ASEAN nations, 2015 Notes: Healthy life expectancy (HALE), Average years lived with disability (YLD) Source: Based on the data from World Health Organisation (Vietnam Ministry of Health, 2018, p. 76). Around 95% of elderly individuals in Vietnam have some form of health problem. On average, every elderly person suffers 2.69 diseases/person, for person 80+ years this number is 6.9. Data from the 2006 National family survey indicates 51.3% of the elderly reported having weak health. Just 10% of elderly men and 5% of elderly women reported their health as being good. Rural elderly individuals have a poorer health status than their urban counterparts (National Geriatric Hospital, 2016). Most of the elderly were bearing "double health burden" of both old and new diseases, resulting in health care treatment costing 7 to 8 times more than for a child (Pham and Do as cited in Long, 2010). Likewise, the evidence shows that about two-thirds of the elderly respondents (from 53.5%-73.5%) regularly suffer from diseases with the average duration of illness being 2.4 days/month (Lan as cited in Ngoc, Barysheva, & Shpekht, 2016). Women had poorer physical and psychological health and lower quality of life than men (Pham et al., 2019). Health status self-assessment by the elderly overview was not optimistic. According to data from the VNAS in 2011, about two-thirds (65.4%) of Vietnamese older 120 people rated themselves as having weak or very weak health when they were asked. Only 29.8% of the researched sample rated their health as normal. Only 4.8% reported they were in a good health condition (Vietnam Women Union, 2012). Selfreported health (Figure 3-12), even though it is not objective, is an indicator that reflects "an aspect of well-being of older persons" (Vietnam Ministry of Health, 2018, p. 76). Figure 3-12: Self-assessment of health among older persons in Vietnam by demographic and geographic characteristics, 2011 Source: Based on the Vietnam Ageing Survey data in 2011 (Vietnam Ministry of Health, 2018, p. 77). According to the data from Vietnam Ministry of Health Department, three main factors reduce health functioning of an older person or cause the loss of their full health; these are: (i) communicable diseases, (ii) non-communicable diseases (NCDs) and (iii) accidents and injuries. Disease patterns in Vietnam recently are 121 shifting from communicable to NCDs and chronic illness. The new diseases are now being associated with a changing lifestyle and include modern diseases such as cancer, stress and mental illness. However communicable diseases related to issues such as water supply and vector management still persist (UNFPA, 2011). Mwangi and Kulane (2015) found 42% of the elderly research sample had at least one common chronic disease, and more for female and more highly educated elders. Likewise, 51% of the elderly respondents in a study conducted by Van Minh et al. (2018) stated having at least one chronic noncommunicable disease but only 10.7% of them used health care services in the last 12 months prior to the study. The ethnic elderly with NCDs and those without health care insurance had lower rates of seeking treatment and accessing health care services compared to other groups. Bang et al. (2017) note that health self-ratings and health function decreased with age and is more limited in women than men. The authors also found that NCDs were among the most significant determinants of health-related quality of life (HRQoL). More than 50% of the respondents in their research (713 older people) requested more health care information especially in disease management. With the limitations in access to health care services, while chronic NCDs are increasing at the same time in the old age population in Vietnam, the authors suggested that promoting healthy lifestyles and reducing health risks are solutions to improve quality of life for the Vietnamese elderly population. In terms of health care access and utilisation by the older Vietnamese population; post-reform user-fees for services applied have been substituted for fully subsidised, fee-free government services (pre-reform); and a mixed system of both public and private health care providers is in place, where the public sector is the main provider rather than the only provider. There are 0.6 doctors/1,000 inhabitants and the number of nurses is 0.7/1000 and pharmacists are only 0.1/1000 (only counted on the public sector) (Van Hoi, 2011). Health insurance covered over 81.7% of the total population (C. K. Hoang, Hill, & Nguyen, 2018) (See Table 3-12). 122 Table 3-12: Health insurance entitlements of older persons Health insurance coverage Beneficiaries Co-payment rate Premiums paid by the state Aged 60-79 years (without family support) Poor Veterans Disabilities Aged 80+ 0% 20% 0% 0% 0% 0% Premiums paid by Vietnam Social Security Pensioners 5% Premiums paid on a voluntary basis The rest (who are not covered by the state) 20% Source: (Vietnam Ministry of Health, 2018) There are four levels of health care facilities by administrative structure: the national (Ministry of Health), provincial (Department of Health), district (Health Centres) and commune (Commune Health Station) (Figure 3-13). 123 Figure 3-13: Outline of the Vietnam health system Source: (D. C. Le, Kubo, Fujino, Pham, & Matsuda, 2010, p. 24). 124 Figure 3-14: Health care network for older people in Vietnam Source: (Vietnam Ministry of Health, 2018, p. 114) Despite being a segment of the population with a high level of need for health care, data from the VNAS shows that 26% of elderly people do not have any kind of health insurance. About 54.9% of the elderly with an illness access no treatment, the most common reason being that the elderly can't afford it. Other reasons for the elderly patients to not seek any treatment were: no one took them to health care facilities; or did not feel they were sick enough (Vietnam Women Union, 2012). Similar results were also found in a study by the National Institution on Aging in Hanoi, Hue and Vung Tau provinces that 45.3% were financially limited, 17.3% had difficulty travelling to the city, 16.5% because of low quality local health facilities, and 20.9% for other reasons (Lan as cited in Ngoc et al., 2016). Figure 3-15 shows health station where the elderly received treatment for a sickness in the Vietnam aging survey 2011. 125 Figure 3-15: Health station where the elderly received treatment for an illness or injury in the last 12 months (% by population) Source: Based on the data form the Vietnam aging survey 2011 (Vietnam Women Union, 2012, p. 53). Health care policies supporting the elderly, in particular those living in rural Vietnam, are very limited either in scope or scale, or both. Free health insurance for the elderly who are 80 and over is one of the few available healthcare support schemes. However, because the out of pocket payments for the related fees are too high to afford, this scheme is not overly effective. As was reported in the Vietnam Aging survey (2011), about 30% of the elderly who own health insurance do not use their cards for hospitalisation (Vietnam Women Union, 2012). 3.2.3 Laws related to elderly care and the support from the state 3.2.3.1 Legislation relating to elderly care Constitution: The rights of older persons were officially stated in the 1946 Vietnamese Constitution, which generally said that all old age people would receive assistance from the society and family. The Constitution then was revised in 1980, 1992 and 2013 (Table 3-13), which detailed that children and family are primarily responsible for looking after the elderly. The State and society have an obligation to assist older 126 persons who lack family support. All older persons have equal opportunities in accessing the social welfare of the government (UNFPA, 2011; Vietnam Ministry of Health, 2018). Table 3-13: Constitutional provisions on the rights of older persons Year Constitution provision 1946 Aged or disable citizens who cannot work shall get support (Article 14). 1980 Older persons without family support and people with disabilities shall be supported by the state and the society (Article 74). 1992 Children and grandchildren have the duty to respect and look after their parents and grandparents (Article 64). Older persons without family support, people with disabilities and orphans shall be supported by the State and the society (Article 67). 2013 The State shall create equal opportunities for citizens to enjoy social welfare, develop the social security system, and adopt policies to support older persons, people with disabilities, the poor, and other disadvantaged people (Article 59). Source: (Vietnam Ministry of Health, 2018, p. 62) Laws: According to Van Hoi (2011), the rights of elderly individuals to be cared for was specified in detail in the Vietnamese constitution as follows: The labour law specifies that the retirement age for a woman is 55, and for a man is 60. However, it states that one year before retirement age, employees are allowed to reduce working hours or working days, and employers are not allowed to assign employees who are reaching old age to hard or dangerous work or expose them to things that are toxic or harmful to health. The health care law specifies that older people are prioritised for disease examination and treatment and that the Ministry of Health and the general administration of sports and gymnastics are responsible for providing guidelines on physical practices, rest and relaxation, for prevention of aging. 127 The law on criminal affairs stipulates that levels of punishment should be reduced for older people who are criminals and increased for people who commit crimes against older people. The civil law highlights that the responsibility of children/grandchildren to take care of parents and grandparents is a moral tradition. The marriage and family law highlights that adult children are responsible for respecting, taking care of and nurturing their parents and that adult grandchildren are responsible for nurturing grandparents whose sons and daughters have all passed away. 3.2.3.2 Major agencies and organisation related to elderly care. Vietnam Association of the Elderly (VAE) has been in existence since 1994, representing the rights of Vietnamese older persons. VAE operates under the auspices of the Constitution, the Law and VAE regulations. It is established on a voluntary basis, with an expansive network throughout the country in all administrative levels from provinces to communities. Vietnam National Committee on Ageing (VNCA) started in 2004 following a Decision of the government and consists of appointed representatives who provide advice and assistance to the Prime Minister in overseeing the running of the various government and non-government organisations that administer matters relating to the elderly. Ministry of Health (MOH) – one of the groups that the MOH cater for is the elderly, although the financial and mobility limitations of the rural elderly mean that this ministry is often not effective in terms of health care of the elderly, who either can't afford to pay, or who are unable to travel to access health services, or both. Ministry of Labour Invalids and Social Affairs is the ministry with the most significant remit for the care of Vietnamese elderly, with the MOLISA Social Protection Department responsible for the elderly, poverty reduction, the disabled and the practical implementation of social protection policies. 128 3.2.3.3 Social security retirement programs About 37% of elderly people are receiving some type of monthly support, including both social allowances (16%) and pensions (21%). The other remaining 63% of elderly people are relying on family support and their own income (T. M. T. Tran, 2017). Approximately 5 million elderly Vietnamese live without the aid of a government pension of any kind, and for those who do receive some form of non-contributory social pension, the amount of money provided is not particularly generous. For the 1.4 million persons who are above 80 years of age, a typical amount is USD $9 per month, however, those poor living by themselves and without family support receive a slightly higher rate of USD $13.5 per month; and the severely disabled over 80 get USD $18. In addition, there are approximately 0.1 million people in the age bracket from 60-79 who are also paid a pension because they have been identified as poor, even though they have not attained 80 years of age. The badly disabled in this age bracket of 60-79 receive a higher amount of USD $13.5 per month. In addition, social security pensions are provided to 1.8 million elderly people. It is the case, however, that "The trend in Vietnam is towards progressively lowering criteria for eligibility for social pensions and increasing extended benefits to more groups" (Help Age Global Network, 2018; Ngoc et al., 2016). It could reasonably be argued, though, that both the number of elderly persons receiving a pension, and the amounts provided, fall far short of being described as generous. Allowances that are received are ineffective because the cost of living and healthcare are much higher than the amount received (T. M. T. Tran, 2017). Table 3-14 presents those who are beneficiaries of social allowance in Vietnam. Given the number of the poor and the limitations of social welfare coverage, family plays a crucial role in providing a stable shelter and a warm atmosphere for the elderly. The primary support and care for elderly individuals comes from family, primarily adult children. Whether they live in the same house or not, adult children bear the burden as the primary income providers for their elderly parents. 129 Table 3-14: Social allowances for Vietnamese elderly people The elderly beneficiaries Allowances The poor elderly from 60-80 years old 180.000 VND/month (9 USD/month) All elderly aged from 80 years old 180,000 VND/month (9 USD/month) The poor elderly from 80 years old 270,000 VND/month (13.5 USD/month) The elderly in social welfare institutions (who are poor, live alone and without family support) 360,000 VND/month (18 USD/month) Source: (T. M. T. Tran, 2017, p. 10). 3.2.4 Vietnamese traditional family values and elderly people. Family responsibility in taking care of the elderly is stated in Vietnam's Constitution and Laws. It is also a traditional culture for family and adult children to look after parents when they get old. 3.2.4.1 The perception of the elderly in family and society Unlike the encouragement of individualism in Western societies, family is the foundational unit in Vietnamese culture. It means that the family's welfare and wellbeing is the consideration of each member, as their priority in any decision making (Hunt, 2005). The oldest male takes the role as the family patriarch, only involving others in decision making at his own discretion. This traditionally comes from the idea of male superiority in Vietnamese culture (Mestechkina, Son, & Shin, 2014). Men have higher social status and more empowerment, with husbands and sons ranking higher than wives and daughters. Key to this has been the role of a son assuming the duties of ancestor worship and as head of the family. This concept is looser now, but it is still very seriously concerning for rural dwellers. 130 Many Vietnamese families follow a patriarchal structure even to this day, despite the increase in feminism, gender equity and female participation in the workforce by married, dating and single women. The so called 'man of the house', the husband (note here the limited numbers of unmarried cohabiting couples and other nontraditional social groupings), is normally the breadwinner and bears primary responsibility for the financial status and well-being of the family unit (Hunt, 2005). Wives are expected to be relatively subservient to their husbands, undertaking the majority of the household and child rearing responsibilities (Locke, Hoa, & Tam, 2012). The nature of culture and Vietnamese family is based on the importance of the Confucian system of beliefs, including male domination in families and public affairs. Even though women are a greater part of the Vietnamese workforce, a wife or daughter isn't generally considered gender equal to a husband or son. Regardless of gender, elderly individuals are always the role models and leaders of the family, where their behaviour is followed by more junior family members and they are looked up to for advice during the making of key decisions. In over 60% of the households the elderly were the household head (Pfau & Long, 2010). While the social welfare of the elderly in Vietnam is very poor, living with family is really a desire and source of well-being for elderly parents. This explains why the need to bear a son is a big issue, especially in rural communities. Filial disrespect (e.g. elder abuse) is almost unheard of and families pride themselves on the caretaking of their elders in later life. In particular, the male hierarchy upholds the status of the family unit in the community, almost irrespective of their personal flaws, with the elderly male members respected more for their age and life experience than their accumulated wisdom and intelligence, both intellectual and emotional. It was believed that perfection involved following Confucian codes of behaviour, particularly in terms of respect for ancestors and elders, as well as fulfilling all duties to family and to society in general (Galanti, 2000). It is a perception that older people have more power in the family than political leaders had in the community, except in the mountainous highland regions. 131 3.2.4.2 Family structure and the living arrangements of elderly individuals Vietnamese people are highly family oriented, and there is often a strong bond between family members. Marriages and family life are very important in Vietnamese culture. Typically, children live with their parents until they get married. These traditional family values remain strong in Vietnam. After marriage, daughters leave their parents' house and move to live with depending on the situation her husband alone, or together with the husband's family as an extended type of family (a couple does not live together before marriage). Unlike elderly individuals in the West, the elderly in Vietnam rarely choose to live by themselves or in aged care facilities, often living instead with one of their children. Even though all children have the obligation of taking care of their elderly parents, a married son and his wife will be the ones mainly taking the role. It is usually the eldest married son (in the North of Vietnam) or the youngest son (in the South) who co-resides with elderly parents and primarily takes on that responsibility. Later on, it will also be this individual who inherits the most significant part of their parents' assets as is customary in the law or conventional practice (despite equal inheritance between children regardless of gender being written in the Law). However, regardless of inheriting or not (depending on the economic status of their parents: rich or poor), they still have to fulfil that filial obligation. This does not only make the child feel good, but also, they are respected by others in the community and are seen as having good morals. This is explained in a study by Theixos (2013), who notes that respecting and taking care of parents is considered as one of the most important tenements of the moral fabric of society. Conversely, being negligent in parental care is regarded as a moral failing. Similarly, other authors also explain that failing to care for an elderly parent can be manifested in social exclusion, strained familial relations, and a host of other familial/social stresses including criticism, disparagement, mistrust, and censure. According to Pfau and Long (2010), about 1 out of 3 households has at least one elderly member, and 70% of the elderly living in households with at least one child. The extended multi-generational family is, therefore, a common structure existing for many years in Vietnamese history, following Confucian ethics. People tend to live together in the extended family rather than nuclear families. A nuclear family consists of only two parents and their children co-residing in a household, while an 132 extended family refers to the co-residence of three or more generations living under the same roof. This may include parents, their sons, daughters-in-law, unmarried children, and grandchildren. It sometimes also includes close relatives such as aunts and uncles. Households thus vary greatly in size. The extended family has been reducing in number in modern life, while the number of nuclear families is increasing, and is preferred by metropolitan offspring, especially among wealthy Vietnamese young couple. According to the data of General Statistics Office, the average Vietnamese family's size decreased from 5.2 people (1997) to 4.5 in 1993 and 3.7 in 2012 (General Statistics Ofice of Vietnam, 2012). However, the pattern of multi-generational cohabitation was still a prevalent form of living arrangements and living with children is common for more than half of the Vietnamese elderly (Table 3-15). Table 3-15: Living arrangement of older people by sex and residence, 2011 Person Older person living with Total Gender Residence Male Female Urban Rural Children 69.5 72.0 67.7 78.0 65.4 Spouse 13.8 17.8 10.9 9.7 15.9 Alone 6.2 2.0 9.3 3.4 7.6 Grandchildren 5.9 4.4 7.0 5.1 6.3 Other persons 4.6 3.8 5.2 3.9 4.9 Total 100% 100% 100% 100% 100% Source: Based on the data from The Vietnam Aging Survey (Vietnam Women Union, 2012) Although respect for seniors is a strongly ingrained in Vietnamese society, there has been a reduction in attitudes and practice, as illustrated by the data contained in the Vietnam Aging Survey from 2011. A large, but decreasing, proportion of aging parents still live with their children, and an increasing number live with their spouse, alone or with grandchildren, rather than with their children. This is contributed to by the urbanisation of the children of elderly parents and multiple other societal factors, including the fact that most elderly parents not living with their children or spouse live in rural areas (Figure 3-16). 133 Figure 3-16: Living arrangement among older persons in Vietnam, 2002 – 2012 Source: Based on the data from GSO and VHLSS to 2012 (Vietnam Ministry of Health, 2018, p. 71) Approximately 80% of elders living alone come from the country, and of these, most (80%) are women (Long & Pfau, 2009; Ngo, 2013). 3.2.4.3 Family taking care of the elderly In theory, children's obligation and responsibility in looking after their elderly parents are obvious, as stated in Vietnam's Constitution and Laws: The 1992 Constitution stipulated that "children of older persons shall take the primary care of their parents while the State and the entire society are responsible for taking care of older persons who lack family support." (Vietnam Ministry of Health, 2018, pp. 61, 62). The Direction No. 59-CT/TW in 1995 emphasised that "The elderly people need to be appreciated for their contributions by giving birth, nurturing children, and teaching the younger generations of Vietnam; most of the elderly have also contributed to build up and protect the country." Therefore, "taking care of the material and spiritual aspects of life for the elderly is the responsibility of the Communist Party, the government, and society as a whole" (UNFPA, 2011, p. 40). 134 In practice, like many Asian countries, looking after parents is Vietnamese culture. Secondly, given the fact that most rural Vietnamese are poor, looking after old parents is necessary. The majority of old Vietnamese live in rural areas, have less education, lower incomes and are more likely to report poorer health than their urban counterparts. They display higher levels of poverty, poor living conditions and lack of a wide range of essential social services and therefore have greater difficulty accessing health care (I. A. Aboderin & Beard, 2015; Coburn & Bolda, 1999; Maharaj, 2012; McLaughlin & Jensen, 1998; Pillay & Maharaj, 2013). Traditionally, most of the elderly in rural Vietnam live with their married sons as a dependant. Many of them are considered to be in the most impoverished population group. Recently, loss of family support (the movement of young people from rural to urban areas for work) makes the elderly more vulnerable to poverty and, as a result, sickness (Long & Pfau, 2009; Ngo, 2013). Regarding the wealth and health status as just discussed, rural Vietnamese elderly need both. In the context of child urban migration, it needs to be understood whether that traditional family support is affected, and if so, how? These questions are at least partially answered by reviewing the literature about this phenomenon in Vietnam. 3.3 A review of literature concerning the well-being of Vietnamese rural elderly relatives of migrants 3.3.1 Economic aspects Although there have been a number of studies shedding light on the impact of urbanward migration on elderly relatives in rural Vietnam, most of these studies focus primarily only on the financial aspects, such as how much money was sent back to home and to their elderly parents. For example, De Brauw and Harigaya (2007) use panel data and the Vietnamese Living Standard Survey (1993, 1998) to investigate the consequences of seasonal migration on rural households' income and found that seasonal migration improved living standards of Vietnamese families. The annual expenditure per capita increased by 5.2%. Consequently, there was a 3% decrease in the poverty headcount. The results suggest a positive contribution of seasonal migration on poverty reduction in the places of origin. Adding to those findings, a study by L. D. Nguyen, Raabe, and Grote (2015) notes that the income of migrants' households positively grew by 19% to 20% after migration. Nguyen et 135 al. considered three key factors; (i) the interaction of migrants, (ii) vulnerability to poverty, and (iii) welfare of rural households in three Central Vietnamese provinces; and used economic analysis methods, namely 'the difference and difference specifications with propensity score matching techniques.' Positive result was also found by Narciso (2015) and other scholars. For example, World Bank (2005) states that 96% of sending households of migrants reporting a better family income as result of urban migration. About 54% of migrants have better employment and 52% with higher income at their destination (UNESCO et al., 2010). According to UNFPA (2007), 80% of Vietnamese migrants reported their lives were better after migration as it allowed them to assist parents who had stayed at home. A study conducted by Thu Phuong, Ngo Thi Minh Tam, Thi Nguyet, and Oostendorp (2008) found that the living conditions of rural households were especially promoted by internal migration. To compare with non-migration households, the Gini coefficient of per capita migrants' household increased from 0.38 to 0.42. Likewise, Khue (2010), who found that a large number of migrants in Thai Binh province, Vietnam, benefited from their migration and earned more than they could in agricultural work. In her study, 83.5% of respondents said they preferred the family member to migrate and send money home than to stay in the village. Using qualitative and quantitative techniques to investigate how the patterns of care for the elderly adapted to change in the context of socioeconomic transition in Vietnam, C. T. Hoang (2015) indicates that material support is given both to elderly individuals who reside with their other children and also to those who do not, including single individuals, those in a couple and those caring for grandchildren. The findings of Hoang's study suggest that elderly individuals receive support from their migrant children regardless of any forms of living arrangement. The main reason stated for migration is for children to enhance their family incomes and "remittances as a means of poverty reduction and as a risk-coping mechanism" (Narciso, 2015, p. 15). UNFPA (2007) also agrees that 70% of the urban movement in Vietnam is for employment or to improve living conditions. In the face of land shortages in agricultural areas, leaving the home village is also considered a strategy for diversifying resources and reducing financial risks for many rural families. These findings support migratory theories and confirm the assumption of many scholars (De Haan, 1999; M. A. Gibson & Gurmu, 2012; Giesbert, 2007; Lin et al., 136 2014; Mukherji, 1985; Phan, 2008; Syafitri, 2013; Vu, 2003), that economic incentives were the leading cause of the rural exodus of offspring to urban areas. Remittances, as indicated by Huy (2009), were a vital source of income for the households of migrants in the Mekong Delta in Vietnam. Agreeing with Dang et al. (2003, p. 17) concluded that "There is considerable evidence in Vietnam that migrant remittances play an essential role for many rural households' incomes." Using an econometric methodology to explore the impact of remittances from internal migrants in Vietnam, Niimi et al. (2009) highlight the crucial role of remittances as a means of risk-coping in times of economic uncertainty for rural households and mutual support within the family. However, recent updated research by Luong (2018, p. 636) notes that remittances were not always one direction from the cities sent back to the migrants' households in the villages. They now "become increasingly multidirectional", which in many cases flow "to family members residing and studying in cities." Some studies have found that remittances from migrant workers contribute positively to the life of family members left-behind (Barbieri, 2006; Cuong, 2009; Pfau & Long, 2010). 3.3.2 Emotional aspects A study conducted by T. Tran (2017) is one of a few studies to discuss the social situation of rural elderly parents. The author applies quantitative methods (logistic regression models) to data from the 2011 Vietnam Aging Survey, conducted with over 4000 people aged 50 and older, to find out how the internal migration of children impacted socially on elderly parents left-behind. The results showed that elderly parents with children who have migrated to other parts of Vietnam have better social lives than those without domestic migration children. 3.3.3 Physical care aspects The health impacts of urbanward migration on left-behind family members living in rural areas has received relatively little attention. Studies conducted by Van Hoi (2011) and Hoi, Thang, and Lindholm (2011) have analysed health care for older people in general, but not specifically for individuals whose children have migrated. There is very limited published material so far that explores the impact of urban child migration on the health and physical care for rural elderly parents in Vietnam. 137 In summary, a literature review regarding internal Vietnamese migration showed that the majority of studies focused on the relationships of migrants with their family or home community, and mostly considered the economic aspect of that relationship rather than other facets. Scholars seemed to be interested in exploring the economic situation of the migrants' sending community and how households improve as a result of migration, and mainly use quantitative methods for that purpose. Studies concerning the impact of migration on the leavers and those who are left-behind are still limited. Questions surrounding how the remaining people experience and cope with the absence of their main supporters has not been sufficiently addressed. Also, the financial, health and social care impacts of internal migration on elderly individuals left-behind is critical and needs to be answered. Table 3-16 summarises the literature relating to child urban migration and the well-being of the rurallybased elderly parents in Vietnam. 3.4 Chapter summary Between 1975 and 1986 (the pre-reform era after the end of the American war), the Vietnamese government launched a nationwide population redistribution scheme, moving people from densely populated areas to places less populated. The main direction of this state-led migration was from urban to rural parts. Internal migration was organised and controlled strictly by the state under the tools of Ho Khau and cooperative labour. Post-reform (from 1986 to the present day) migration has mainly been in the opposite direction, with labor flows mostly from rural to urban areas. With all prereform hurdles removed, migration after Doi Moi was free and spontaneous. Rurally-based individuals were at liberty to decide whether they wanted to move out of the village or not. In fact, abolishing the subsidised economy meant that individuals had to earn their living. Since the welfare system is inadequate and limited, family becomes the main source of support for elderly people. With cities offering more job opportunities and better services, urbanward movement has inevitably become a trend. The flowing out of young generations leaving elderly parents behind in rural areas raises concerns for many about the welfare for those individuals. 138 Clearly, Doi Moi was a catalyst for improvements in the lives of elderly Vietnamese due to the very large increase in the economic fortunes of Vietnam as a whole. However, this improvement has not been universal. It more favoured the elderly metropolitans than their rural counterparts. The rural elderly has been largely leftbehind, both literally and figuratively. While the circumstances of rural elderly dwellers have rapidly changed in the past 40 years, the area of public policy for that group of the population has changed little. Most of the elderly cannot be self-reliant because of health problems and no savings, and therefore family is still their main source of support. Are the old age population vulnerable to the disadvantaged circumstances while children working away? This is currently a major concern and challenge for most developing countries, including Vietnam. Any delay or failure in responding to this problem will cause negative impacts on the development of the country in the future. While migration studies in Asia and other developing countries have been expanding in scope and number (discussed in chapter 2), research in Vietnam is its initial stages. Most existing studies about this issue in Vietnam focused on the economic aspect and used quantitative methods for the measurements. The crucial aspects of emotional care and health care for rural age parents remain underresearched. The acceleration of urban migration and the unpredictability of the ageing process in Vietnam calls for more attention from scholars and researchers, especially those concerned for the well-being of rural elderly individuals. The current available literature on Vietnam shows that there has so far been very limited research into how the migration of individuals from rural to urban areas impacts on the well-being of rural elderly parents who are left-behind. Particularly, no empirical investigations comprehensively examine the main aspects of a person's life including material, emotional well-being and physical care, related to that movement. By drawing on the voices of those rural elderly parents, this is the first qualitative study that attempts to address this gap. It moves beyond the empirical issues of whether the elderly left-behind are simply better or worse off materially, to also explore in some depth the impact of migration on people's lives, and how they respond. 139 Table 3-16: Consequences of urban child migration on rural communities, households, older adults in Vietnam A literature review of the most closely related papers up to date Author and Year Research title Data sources/ Research sample size Research methods Consequences: (+), (-) or nil Material Emotion Physical care Luong, H. V (2018) The Changing Configuration of Rural– Urban Migration and Remittance Flows in Vietnam A longitudinal and panel study of seven rural communities in three regions of Vietnam Mixed methods + N/A N/A Tran, T. (2017) The impact of internal migration on the social aspect of the elderly left-behind of Vietnam N/A Logistic regression models + + N/A Nguyen, L. D., Raabe, K., & Grote, U. (2015) Rural-Urban Migration, Household Vulnerability, and Welfare in Vietnam Data from Vietnamese Aging survey in 2011 Difference-indifference and propensity score matching techniques + N/A N/A Hoang, C. T. (2015) Modes of Care for the Elderly in Vietnam: Adaptation to Change Nationally representative survey data and fieldwork Mixed methods + N/A N/A Duc, L. N., Raabe, K., & Grote, U. (2012) Rural-Urban Migration in Vietnam Do Households and Migrants Get Better Off Panel data of 2200 households from rural Vietnam covering the period 2007–2010, and a tracking survey of 299 migrants from 2010 Difference-indifference and propensity score matching techniques + N/A N/A Nguyen, H. T., Liu, A. Y., & Booth, A. L. (2012) Monetary transfers from children and the labour supply of elderly parents: evidence from Vietnam Vietnam Living Standard surveys data Econometric models + (modest) N/A N/A Pfau, W. D., & Long, G. T. (2010) Remittances, living arrangements and the welfare of the elderly in Vietnam Four household surveys conducted in Vietnam between 1992 and 2004 Logistic regression analysis + N/A N/A 140 Nguyen Thi Minh Khue. (2010) Circular migration and social differentiation in Thai Binh province, Vietnam 558 households include 235 migrant households and 323 non-migrant households Qualitative methods + N/A N/A Niimi, Y., Pham, T. H., & Reilly, B. (2009) Determinants of remittances: Recent evidence using data on internal migrants in Vietnam Data from the 2004 Vietnam Migration Survey on internal migrants Econometric methods + N/A N/A Huy, H. T. (2009) Rural to Urban Migration as a Household Decision: Experimental Evidence from the Mekong Delta, Vietnam A survey from 148 households in the Mekong Delta Economic models + N/A N/A Thu Phuong et. el (2008) Determinants and Impacts of Migration in Vietnam Data from Vietnam Household Living Standard Survey 2004. Economic models ++ N/A N/A Phan, D. N. (2008) The determinants and impacts of internal migration: The case of Vietnam Data from the 1989 and 1999 Population and Housing Censuses, also conducted by the GSO. Economic models Unclear results N/A N/A Pham, B. N., & Hill, P. S. (2008) The role of temporary migration in rural household economic strategy in a transitional period for the economy of Vietnam Qualitative data from the 2003 Young and Family Study conducted in four rural communes Qualitative Methods + N/A N/A De Brauw, A., & Harigaya, T. (2007) Seasonal migration and improving living standards in Vietnam Vietnam Living Standard Surveys 1992-1993 and 19971998 by the World Bank in collaboration with the Vietnam State Planning Committee and the General Statistical Office Logistic Regression methods + N/A N/A UNFPA. (2007) Internal Migration in Vietnam: The Current Situation The 2004 Viet Nam Migration Survey in 10 provinces Quantitative survey + N/A N/A Dang, N. A., Tacoli, C., & Hoang, X. T. (2003) Migration in Vietnam: A review of information on current trends and patterns, and their policy implications The national population and housing census in 1999 (CCSC, 1999; CCSC, 2000), covering 61 provinces in Vietnam Qualitative methods + N/A N/A Notes: (+) Positive impact, (-) Negative impact, (Nil) No impact, (N/A) Not applicable Source: Created by author 141 CHAPTER 4. METHODOLOGY This chapter presents the methodology used to address the study's research questions. The chapter begins with an explanation of why qualitative methods are most appropriate for this research. It then describes the data collection techniques including in-depth interviews, observations and focus group discussions. How data was analysed, and ethics approval obtained, are also explained. 4.1 Rationale for the use of a qualitative method Choosing an appropriate methodology and understanding research philosophies is very important. Since a number of different methodologies exist, every researcher must decide what are the most appropriate research methods for their topic. To answer this question, David (2015) explains that the selection of research methodologies will be mainly determined by the research questions. Other influential factors will inevitably also enter into the decision-making process, such as the availability of resources including the type of data available, and also the knowledge and skills of the person undertaking the research. The methods chosen must be appropriate for answering the questions that the researcher wants to investigate. Research questions may investigate either empirical data or conceptual data. If the research involves gathering and statistically analysing data that can be measured or counted, then quantitative methods are required. Whereas, conceptual research seeking the understandings of personal experiences, cultures, social phenomena and trends, prefers qualitative methods. Mixed methods are also applied in some cases where research questions cannot be fully answered by a single method. For this study, the research question is "how does urbanward migration of adult children impact on the well-being of the elderly left-behind in rural Vietnam, and what strategies do the elderly left-behind use to cope with stressful situations arising from the migration of their children?" This research focuses primarily on how 142 elderly individuals are impacted (material, emotional and physical care) by the migration of their adult children and how they cope. Most studies to date have been undertaken via large surveys using quantitative analytical techniques. By contrast, this study is most interested in exploring the perceptions and experiences of elderly individuals in rural Vietnam in the absence of their children. What these individuals feel, and experience could be very much different to how their situation is perceived from the outside (e.g., by their children or other observers). The focus is on exploring their worlds, to know how each individual perceives his/her situation. What are the strategies (if any) that help the elderly to cope with or to overcome the difficulties of being left-behind? The research objectives of this study are to understand the individual's feelings and their experiences in a particular social context and cultural situation. Different groups of the elderly with different ages, living arrangements, income levels, were chosen to participate in the study to obtain more diverse and multi-faceted levels of information, earning a deeper understanding about the phenomenon and events in real-life of the rural elderly. The research objective is relative, and therefore subjective. Many life stories were gathered, with data capturing different points of view. Data was collected during interviews between the researcher and an elderly cohort in rural areas in Vietnam. Data collection involved talking to individuals, asking questions, and observing living conditions. Gathered data was then interpreted and knowledge constructed under the lenses of the researcher and the researcher's understandings. For those reasons, qualitative methods are best suited to this study. Since the ontology of this study is mainly concerned with individual meaning, the epistemological stance is mainly constructivist in nature. In allowing researchers to view the world through the perceptions and experiences of the participants and by supporting researchers to explore their world by interpreting the understanding of individuals, the interpretive paradigm was, therefore, applied in this study. 4.2 Data collection methods There are a variety of methods of data collection that can be used in qualitative research. Three methods best suited to answering the research questions of this study were selected: in-depth interview, participant observation, and focus group 143 discussion. In-depth interviews with elderly relatives of migrants were ultimately key for data collection. Observation of the lives of elderly relatives of migrants, together with focus group discussion with key informants (leaders of the communes, etc.) were used to complement in-depth interview data as well as to clarify and verify responses from elderly participants. 4.2.1 In-depth interviews Why this method is most suitable According to Kahn and Cannell (1957), an interview is generally a purposeful discussion between two or more people. Through the conversation with the participants, the researcher gathers valid and reliable data that are relevant to research question(s) and objective(s) (Saunders, 2009). However, unlike quantitative research where structured, standardised, and short questions are commonly used, in-depth interviews are based on semi-structured or unstructured questions, which allows interviewees to either answer the questions directly or talk freely about other events, behaviour, and beliefs in relation to the topic area (Easterby-Smith, 2012). Thus, the researcher can dig more deeply into the stories of the respondents. Rather than the interviewers directing the conversation like in quantitative interviews, the interviewee's perceptions can guide the course of the interview (Robson & McCartan, 2016). Through free conversations, in-depth interviews aim at unpacking the knowledge of the research participant on a given topic, capturing details of participants' realities and gaining as much valuable data as possible (Creswell & Clark, 2017; Frechtling & Sharp, 1997). In-depth interviews, therefore, seem to be the most common technique for data collection employed in qualitative research. Stemming from the research questions and objectives of this study, in-depth interviews were considered the best choice for data collection. In-depth interviews in this study were semi-structured with open-ended questions. A questionnaire guided the interview (see more in Appendix 5), and had two sections: Section one (asking and answering questions) first introduced the purpose of the study and who was conducting the research. It also explained the ethical aspects of the interviews and the rights of the respondents to attend or withdraw from the 144 interview at any time if they wished. It then asked for the consent from respondents for the study to be conducted. Once consent was obtained, participants were asked to answer all questions related to their characteristics such as age, education, occupation, marital status, children etc. This section aimed at collecting the demographic data of research population. Section two was more of a relaxed conversation to find out what is really happening and to seek new insights (Robson & McCartan, 2016). The interviews emphasised the main themes of the research questions including material, emotional and physical care consequences of migration. In this phase, however, respondents were given the chance to freely talk about their experiences, feelings, thoughts, beliefs and expectations relating to the migration of their adult children. For example: 1. Under the theme of material well-being, respondents were able to talk freely about their current economic status compared with before their children migrated (i.e. is it any worse, better, or has it remained the same, how and why?). They could also speak about whether their city-based children financially supported them and if so how? Did sons or daughters provide better support? Did parents like that their children had migrated or would they have preferred them to stay? How did they feel their economic situation compared to that of their counterparts (e.g. elderly individuals who do not have any migrant children)? 2. With regard to the emotional aspect: the interviews focused on the emotional wellbeing of rurally-based elderly parents, such as how their daily social life was, whether the elderly parents' emotional and social well-being got any better or worse after their children moved out of the village, and how city-based children provided emotional support for their rurally-based parents (visits, phone calls, etc). 3. Under the theme of physical care: the conversation concerned whether the outmigration of adult children impacted on the physical care of rurally-based elderly parents, and if so how. It is clear that in-depth interviews using semi-structured and open-ended questions, allowed the researcher to collect data under the research themes and also to explore more deeply participants' personal stories within each theme through general conversation (Ghauri & Grønhaug, 2005). 145 Rather than using telephone, post, or electronic means such as the internet, the researcher conducted the in-depth interviews 'face-to-face' and on a one-to-one basis. This was because the subjects of this study were older people and lived in rural areas and also were not good with technology. The researcher visited participants and interviews took place in their homes. Interviewing participants were in an environment that they felt comfortable in, which can encourage greater openness and also allows the researcher to observe and better understand the living conditions of interviewees. In-depth interviews sample design The sample design for in-depth interviews was also guided by the research objectives, as follows: 1. To investigate how child urban migration impacts on the material, emotional and physical well-being of rural elderly parents. Since an assessment of elderly individuals whose children have migrated cannot be fully accurate without some form of comparison or benchmark, elderly individuals whose children have not migrated were also included in this study as a control group. 2. To explore whether the impact of migration on elderly parents is influenced by anything else, factors such as: age, income, living arrangement and community were also taken into account. In-depth interviews were designed as shown in (Figure 4-1) including age (from 6075 and 76+), income (having pension and does not), living arrangement (co-reside with remained children, living with spouse only, living with grandchildren only or living alone) and rural community where the research elderly participants live (sending places or the migrants' place of origin). 146 Figure 4-1: The design of in-depth interviews research samples Notes: Place of origin is the migrant's place of origin or home villages, the residential of their aged parents. Co-resident is the living arrangement of the elderly people who live under the same roof with their remaining children, while other children have migrated. Source: Created by author In-depth interviews sample size The purpose of this research is to explore the experiences of rural elderly individuals who remain in their village while at least one of their adult children move elsewhere for employment. Therefore, in-depth interviews were used as main technique to collect the qualitative data. Regarding the sampling size, Patton (2002) argues that understanding what the data shows is more to do with data collection than the size of sample. Therefore, non-probability sampling where samples are selected based 147 on the subjective judgement of the researcher rather than random selection is the most practical for this study. However, judging what size of the sample is sufficient for a qualitative study is a critical issue. In addressing this, it is recommended that: "continuing to collect qualitative data, such as by conducting additional interviews, until data saturation is reached: in other words, until the additional data collected provides few, if any, new insights" (Saunders, 2009, p. 235). A guidance about nonprobability sample size given by Guest et al (2006) is that 12 in-depth interviews should suffice for research aiming to understand commonalities within a homogenous group. It should expect to undertake between 25 and 30 interviews where the sample is drawn from a heterogeneous population (Creswell, 2007). The sample size of this study initially consisted of 60 elderly household units across three rural communes (with 20 households of each). It means this number could increase or decrease depending on where the saturation point is reached. The research was conducted at the household level and not on an individual basis. It can be single households (elderly individuals living alone) or couple households (those living with his/her spouse). This means that in the case of married couples there was a single interview and the researcher talked with the couple together where possible. If each interview participant had been counted on an individual basis, the number of respondents would be larger. There were 35 cases where couples were interviewed concurrently; plus, a further 25 single (individual) respondents. The total number of respondents was therefore 95 elderly individuals if all respondents were counted on an individual basis. Among different methods of non-probability sampling, this study employed purposive sampling because it enabled the researcher to use judgement to select cases that best answered the research questions and met the research objectives (Saunders, 2009). Since the research population of this study was heterogeneous, samples selected here were based on different criteria (as laid out in Figure 4-1), or a form of quota sampling. This means the researcher identified those diverse characteristics prior to selecting the sample (Patton, 2002). The following criteria were used: 148 ● The sending places of migrants included three communities with different economic conditions low, average and above average (based on the average income per capita at community level). ● Elderly individuals with and without migrant children: the elderly participants were divided into two categories: those who had migrant children and those who did not. Since the focus of this research study was the elderly parents of migrants, the sample size of this group is bigger than the number of counterparts (e.g. elderly individuals without migrant children). There were 48 and 12 households respectively. Only 12 out of 48 elderly households with migrants (which corresponded in traits with the 12 elderly households of non-migrants) were selected to make a comparison. ● Living arrangement: four distinct living arrangements were identified including elderly individuals who live with their other remaining children; individuals living with spouse only; individuals living with grandchildren only; and the elderly living alone without any children nearby because all of their children have migrated. Those elders were also referred to as the elderly left-behind. There were four household samples for each form of living arrangement, making 16 sample units of all forms in one commune (see the highlight in Table 4-1). ● Age group division, there were 30 cases of 'young seniors' (aged 60-75), and an equal number in the older senior cohort (aged 76 and above). ● Pension, the number of elderly individuals receiving a pension was 30, and there were also 30 individuals without any form of pension. 149 Table 4-1: The in-depth interview sample size and design for one research setting Elderly samples for In-depth interview Key attributes (age & income) 60 -75 years old (1 household has a pension, and the other does not) 76 and older (1 household has a pension, and the other does not) Elders with no migrant children 2 2 E ld er s w it h m ig ra n ts (l iv in g a rr an g em en ts ) Co-resides with other remaining children 2 2 Living with spouse only 2 2 Living with grandchildren only 2 2 Living alone 2 2 Sample size 20 Note: There were three research communes with the same sample size and design, making a total of 60 households involving in this research. Source: Created by author Participant recruitment With this purposive sampling technique, the researcher consulted the key informants (community leaders) to get lists of potential interviewees who satisfied the above criteria. From those lists, cases that were deemed highly representative of the local elderly population were selected. The researcher was introduced by the key informants to prospective interviewees and then visited households to verify their suitability for interview. Snowball sampling technique (a technique where one interview subject introduces the researcher to another potential interviewee) was also applied in this research because elderly individuals who were in the same situation knew each other well. The researcher (besides consulting with key informants) also asked participants to recommend other interviewees. Friends of individuals originally approached for an interview all expressed a willingness to participate in the research. This willingness translated into greater openness, producing deeper and better-quality interviews. 150 4.2.2 Participant observation After interviewing and listening to many interesting stories of rural elderly parents, true reflection is sitting back and observing everything with logic (Bogdewic, 1992). It means watching the elderly participants in their real lives. This is so-called participant observation. Together with in-depth interviews, participant observation is a popular technique used for data collection in qualitative research. According to Gill and Johnson (2002, p. 144), participant observation is where: "the researcher attempts to participate fully in the lives and activities of subjects and thus becomes a member of their group, organisation or community. This enables researchers to share their experiences by not merely observing what is happening but also feeling it". Participant observation used in this study aimed at: First, confirming the in-depth interview data is true. It is said that 'seeing is believing'. The stories told by respondents would be more meaningful in reality when things were put together in their surrounding environment. Things became more logical in its natural context of real life. For example, if the researcher only listens to what they have been told, and do not attend or see the real living conditions, they might not imagine how hard the life of a rurally-based elderly individual is. Also, the social life and health care for rural seniors would not truly be revealed until the researcher experienced it first-hand. According to Saunders (2009, p. 299), the advantages of participant observation is that it is good at explaining "what is going on" for real in a particular social situation. Participant observation can essentially back up information given in interviews. Second, minimising data error. Even though in-depth interviews can bring rich data, they have their shortcomings such as being prone to bias, or giving personal assumptions (Boyce & Neale, 2006). The truth might therefore be distorted. However, when life stories of the elderly participants and their private matters are not only heard, but also watched, the truth is verified. By using observation techniques, the researcher was able to address potential errors in data collection. Participant observation therefore helps enhance the reliability and validity of the research. 151 Third, participant observation enriches data sources by looking for information that in-depth interviews could not fully obtain. During the interview period of four months, the researcher had a chance to live with participants in their house (2,5 months with an 84-year-old widowed woman who lived with her adult daughter, and about 1,5 months with another widowed woman who was living alone). Living with the elderly, the researcher was able to interact and participate in aspects of their daily life in their natural surroundings (R. a. Singleton, 2018). Many private stories which were not picked up by interviews were now fully exposed. They included the elderly being neglected, even physically and verbally abused. The researcher could view how elderly parents were treated by their adult children, and how their social life and emotional well-being was. Through participant observation, a deeper level of data was collected. This was a great opportunity to capture the realities of elderly participants' daily life (by taking photos, recording their voices, and taking diary notes). By viewing things from a different angle, a broader picture of what life is really like for participants was obtained, thus enriching and enhancing researcher understanding about research subjects. Conclusions from the research are therefore more accurate (R. Singleton & Strait, 2010). However, a concern of this technique is that possibly the descriptive or narrative data might reflect the bias of the observer. As Delbridge and Kirkpatrick (1994, p. 43) note, "because we are a part of the social world we are studying we cannot detach ourselves from it, or for that matter avoid relying on our common-sense knowledge and life experiences when we try to interpret it". Therefore, focus group discussions with objective opinions of the outsiders were added to overcome the subjective point of views of these two techniques. 4.2.3 Focus group discussions In-depth interviews and observations may both easily be subject to bias from participants as well as the researcher. In addressing this problem, the current study considered opinion from a third party who were representative of the researched 152 communities. They were invited to attend focus group discussions. Those key informants from the three communities included two leaders of each community (one was leader of the community and the other was a leader of the elderly association). There were six participants across the three communities involving in focus group discussion. Focus group discussion is a group interview focusing on a particular issue or topic and encompasses the need for interactive discussion amongst participants (Carson, Gilmore, Perry, & Gronhaug, 2001). Thus, focus group discussions would be more objective and help minimize the bias from one party's opinions. Topics covered in each focus group discussion were surrounding the three main aforementioned themes. Key informants gave their opinion on how the migration of younger generations impacts on their older parents (materially, emotionally and physically). Insight was also gained into whether the elders of migrants have a better life than their counterparts (e.g. elderly individuals without migrant child). The focus group discussions were useful for comparing these two groups. Information from those who are leaders of the communities is helpful because not only do they represent the village, but they also share the neighbourhood with the elderly individuals participating in this study and may, therefore, understand their plight. Perspectives of the community leaders gained through focus group discussion has provided greater insight into the situation of elderly individuals in rural areas. As Krueger (2014) argues, participants are selected because they have certain characteristics in common that relate to the topic being discussed and they are encouraged to discuss and share their points of view without any pressure to reach a consensus. Briefly, in-depth interviews allowed the researcher to view the world through the eyes of participants, essentially allowing them to listen to the voices of the insiders. Focus group discussions considered perspectives of the outsiders. Observation gave the researcher opportunities to view firsthand the reality of the lives of those participating in the research. As McQueen (2002, p. 16) note, these research methods allowed the data to be viewed through a "series of individual eyes." It helped to contrast the views of insiders with those of outsiders, facilitating the researcher who needed "in-depth" and "insightful" information from this 153 population, rather than information from simple statistics (Thanh & Thanh, 2015, p. 26). 4.3 Data analysis methods Interviews and focus group discussion were conducted in rural areas, so no other language was used other than Vietnamese. Thus, both interviews and focus group discussion, as well as field notes from observation, documents, audio/video, diaries or life stories were conducted and recorded in Vietnamese. The data was then transcribed and translated into English, and ready for an analysis process. According to LeCompte and Schensul (1999), data analysis is the range of processes and procedures whereby a researcher moves from data that has been collected to some form of explanation to an understanding of the people and situations the researcher is investigating. In other words, analysis is a process by which a researcher reduces data to a story and makes sense of the researched situation. Types of qualitative analysis processes included summarising, categorising and structuring of the meanings using narrative. The process of data analysis could be deductive or inductive. This study used both approaches to analyse the data. Deductive approach is where data is analysed (categorised and coded) in a way that derives meaning from theory and follows a predetermined analytical framework. Basically, the researcher identifies key theories from existing literature, has established specific hypothesis she wishes to test, creates a list of codes that represent theories or categories of information to look for in the data and then applies this a priori code to the data to confirm or disprove the original theories. This is also called a top-down approach. One of the greatest benefits of this approach is that it is relatively easy to apply because codes are determined in advanced and the coding process only utilises these predetermine codes (Huberman & Miles, 1994). When reviewing the literature regarding the consequences of urban child migration for rurally-based elderly parents in developing countries, aspects of material, emotional and health care consequences were most discussed and emerged as key themes. The consequences were found to vary. That question for the elderly parents 154 in rural Vietnam who were in a similar situation had not been fully answered by previous research, as they had mainly focussed on income changes. This study investigated whether rurally-based elderly parents in Vietnam, were in any way impacted (physically, emotionally or materially) by the migration of their adult children and if so to what extent. The results could be negative, positive or neutral. With these hypotheses established, key themes were identified, and an analytical framework designed prior to data collection; a deductive approach was, therefore, applied for data analysis, especially with in-depth interview and focus group discussion data. An inductive approach was also employed mainly for analysing the observation data. According to Glaser and Strauss (1967) and Corbin and Strauss (2008) inductive based analytical procedures are where the research started with qualitative data that had no predetermined code. The data itself drives the structure of the analysis and development of the different codes. Living with the elderly participants and observing their daily life, listening to their stories and interacting with them every day has brought lots of data that the researcher had to note down in a diary; the researcher also took photos and recorded audio and video data. The data was collected whenever and wherever necessary and was not organised into themes. Therefore, when analysing observation data, the researcher carefully read through the texts, refined the data using the techniques of open coding, axial coding and selective coding to identify patterns and themes and then developed codes to represent these themes. From the careful examination of the data, patterns emerged, which allowed the researcher to generate hypotheses which can later lead to development of theories. Corbin and Strauss (2008) called it the bottom-up approach. There is no best single way to analyse data in this study. The combination of both deductive and inductive methods "allows a good 'fit' to develop between the social reality of the research participant and the theory that emerges – it will be grounded in that reality" (Saunders, 2009, p. 503). Data coding was also assisted by N-Vivo software (a data management program). Simple statistical tools were used for data analysis such as percentages, ratios, 155 proportions, and tables. However, it must be emphasised that this did not produce statistically significant results as the overarching methodology of this study was qualitative and the sample size was too small to conduct statistically rigorous analysis. 4.4 Ethics statement This research involved collecting, analysing and reporting the data from older adult individuals. It, therefore, required the appropriateness of researcher behaviour in relation to the rights of those rural elders. Cooper and Schindler (2008, p. 34) define ethics as the "norm or standards of behaviour that guide moral choices about our behaviour and our relationships with other". Ethics research was approved by Curtin University and the research considered low-risk. Consent was obtained from participants prior to the start of data collection. Information on privacy and confidentiality, the right of participants to withdraw from the study at any time, as well as the process of data collection, analysis and distribution of results was all provided to participants, allowing them to make an informed decision as to whether to participate in the study. 4.5 Data storage Data from this study was stored in compliance with Curtin University Guidelines for higher degree by research (HDR) students. The Australian Code for Responsible Conduct of Research (2007) was applied, which included a period of five years after the completion of the HDR program, storing data in a safe and secure location. 156 CHAPTER 5. THE DEMOGRAPHIC PROFILES OF PARTICIPANTS AND ECONOMIC CONDITIONS OF THEIR RESPECTIVE RURAL COMMUNES As argued in the literature review, the consequences of child urban migration on rurally-based elderly individuals vary from region to region as well as among individuals, which is influenced by different factors. They include attributes of the elderly themselves, their migrant children, state welfare provisions, as well as the socio-economic situation in both the migrants' destination and their area of origin. This study focuses solely on the demographic attributes of rurally-based elderly individuals. The attributes of the locality where elderly parents live is also taken into consideration. The chapter starts with introducing elderly participants' demographic attributes. They include age, gender, marital status, number of children, living arrangement, educational attainment and literacy, working status and income, health status and social status. It is then followed by a description of the economic conditions of the respective villages in which participants reside. Elderly parents of migrants who remain in rural areas may be or not be supported by their local government because of the variance in government support between regions, place of residence might influence the wellbeing of individuals. Therefore, the economic status of the rural communities where elderly participants reside is also examined in this chapter. By establishing the demographic characteristics of elderly individuals and their localities, this chapter therefore helps understanding better a general background as well as an insight into the lives of participants. Information in this chapter lays the foundation for the rest of the dissertation, complements and is a prelude to helping better understand the findings of this study, presented in the next chapters. 157 5.1 Demographic characteristics of interview participants 5.1.1 Age ranges This study focussed on rurally-based elderly individuals who were aged 60 and older with at least one adult child who had migrated for work. As the experiences of these elderly individuals were unlikely to be entirely uniform and might vary depending on age, respondents of a range of ages were recruited for this research study. The average age was 70, with the youngest respondent was 60 years old, and the eldest was 93. Respondents were divided into two age groups: the younger elderly, from 60 to 75 years of age; and an older group, aged 76 and above. If counted by household, there was an equal number of 30 in each group. However, if each respondent is counted individually, the overall number of younger elderly respondents was 60 compared with 35 in the older group. Because there were more households with couples in the younger elderly group, making this group larger than the older group (where widowed single households predominated). Most participants were young implying that many of them had marriages and children at a young age. Therefore, by the time of the interview, they already have grown up children who had migrated to cities for employment. National statistics from 1999 showed that the younger elderly population in Vietnam was far higher than the older elderly, with 75% of individuals falling into the 60 to the 75-year-old bracket and just 25% being 76 or over. However, due to the fact that Vietnam is now an ageing population, the proportion of younger old group has decreased, and the number of older elderly people has increased (N. Q. Anh et al., 2007). The ranges of ages were chosen purposely to assist the researcher in examining the varying degrees of impact of the migration of adult children on the parents remaining in the villages. Examining the experiences of such elderly individuals at different ages was intended to determine which groups are likely to be the most vulnerable, and to establish what welfare might be needed to support them. 158 5.1.2 Gender The research did not distinguish between the individual's gender. Recruitment for the study was gender-blind, with both male and female elderly individuals opportunistically recruited to participate in the research. The total number of participants from the three communes was 95, of which 52 were women and 43 men. More females than males took part in this study this is likely due to the fact that there are more widowed women among the older age group (76 and over), participating as single respondents. The gender imbalance is higher at older ages, reflecting the longer life expectancy of women as opposed to men in Vietnam. When the research took place in 2015, life expectancy was 71.2 years of age for men, and 80.6 years of age for women (UNDP, 2016). This imbalance is higher in rural areas than in urban areas and is predicted to become greater (Knodel & Anh, 2002). 5.1.3 Marital status Marital status includes the categories of single, married individuals who live together, married individuals who live apart, widowed, divorced, and separated. For ELB, marital status has been found to either improve or reduce an individual's well-being depending on the situation. It is, therefore, necessary to take marital status into account when assessing the well-being of ELB in this study. Of the 60 participating households, only one female respondent was found to be single. This was due to health issues which prevented her from marrying. This woman had one daughter, and as a single parent, she faced discrimination from within her community. Her daughter was married and had three children of her own, and living in a town of the same district. Remaining single with a single child or multiple children is very uncommon in Vietnam. It is financially and socially challenging to be without extended family and local community support. Similarly, only one individual was found to be divorced among the elderly respondents. The rest of the 58 cases were or had previously been married. Of this number, 35 couples currently lived with their spouses and 23 had been 159 widowed. The number of widowed females exceeded that of males (19 and 4 respectively). This illustrated the trend of female widows in Vietnam (Long & Pfau, 2009). None of the participants that were married were living separately. This also reflects the traditional Vietnamese culture as being family oriented (this was addressed in Chapter 3). Participants who were born during and prior to the 1950s appeared to strongly adhere to this tradition. Thus divorce and married couples living separately were very rarely encountered among those participants. A higher number of widowed participants was found in the older group, while the younger group reported more living together with their original spouse. Figure 5-1: Participants' age, gender, marital status Source: Created by author 5.1.4 Number of children. As was documented in Chapter 3, adult children actively contribute to every aspect of their parents' lives (providing financial, emotional and physical support). It is also stated in family law that looking after elderly parents is a child's obligation and responsibility (Van Hoi, 2011). However, it is also an unwritten rule in Vietnamese 160 society that beyond the obligation of that Law, children generally want to care for their parents when they get old because they love them. It is clear that children provide an important safety net for parents as they get older, especially a married son and daughter-in-law. Therefore, the number of children an individual has, and the gender of those children will significantly influence their quality of life as they age. Among the samples, many households were large in size, reflecting the high levels of fertility that characterised Vietnam's population during the past decades. Most of the participants came from a big family with many children. The biggest family had seven children; only one single woman had one child. The majority of them had at least four to six children. The average number of living children per female participant was 4.25. There was no family that had an adopted child or children; all participants' children were their own biological offspring. Some factors such as low education level, religious practice, and poor social welfare support can explain the high fertility rates of those aged 60 years and over (Goletti, 2015). However, the fertility rate declines rapidly especially in rural areas after the two-child policy was introduced in 1990. Parents aged 60 and older, therefore, had almost double the number of children compared with individuals that had started a family after the launch of the Family Planning Law. The trend today is towards smaller family sizes, with the fertility rate having declined from 6.35 to 1.8 by 2017 (Haughton, 1997). Since it is preferable in Vietnam to bear a son, many married couples continue having children until a son is born. This is why almost all participants (54 cases out of 60) had both sons and daughters. In rural parts of Vietnam, a family commonly has both sons and daughters. Just three participants reported having only daughters, and another three having only sons. All participants reported that their children reached adulthood, got married, had their own children and lived independently (see Figure 5-2 below). 161 Figure 5-2: Participants' number of living children, and gender of children Source: Created by author based on the primary data 5.1.5 Living arrangements and trends If having children is important for well-being in later life, then having a son is especially important for elderly individuals in rural Vietnam as they are likely to live with their parents as they age. The type and source of support may be determined by whether an elderly parent either lives alone or cohabits with their children, and whether they live in close proximity to their adult children or a distance away from them. Living arrangement is an important aspect of the elderly people's well-being which cannot be ignored. Different types of living arrangements were considered in this study including the elderly who live with their adult children, individuals who live with spouse only, individuals living with grandchildren only, and the elderly who live alone. Co-residing with one or more of their adult children in the same household (with preference to a married son), in fact, remains the most predominant type of living arrangement among older adults in Vietnam. A survey in Vietnam's two biggest cities (Hanoi and Ho Chi Minh City) shows that a substantial majority of older individuals co-reside with one or more of their adult offspring. The percentage of older people living with at least 1 adult child was 75% in Hanoi; in Ho Chi Minh 162 City it was 80%, (Truong, Bui, Goodkind, & Knodel, 1997). The authors state that elderly parents are more likely to live with a married son, and those who do not tend to live in close proximity to their adult children. Over 50% of elderly individuals live in extended households with at least three generations (Truong et al., 1997). Such situations are more common in rural parts where the vast majority of elderly parents either co-reside with a child, live adjacent to one or more of their children and have daily contact. While this trend of living with adult children has been gradually declining over time, it is still a dominant pattern. Therefore, individuals who live with their adult children were the first group to be investigated in this research study. Elderly individuals living with a spouse only or living alone accounted for only 56% of those interviewed. This is much lower than the number of individuals who co-reside with their children, though elderly individuals living without the daily support of their children may be the frailest and most vulnerable, and in need of enhanced care and support. It is perhaps most important then for the living arrangements of elderly individuals cohabiting with a spouse only or living alone to be taken into account in this study. Elderly individuals falling into this group is indicated to be increasing in number, while the number of elderly people co-residing with their children has been declining (Truong et al., 1997). A similar trend to those living alone can be seen among the number of elderly living with grandchildren e.g., it has been increasing. As a consequence of urban migration, the migration of middle age individuals left more children in villages with grandparents, creating a new type of family structure - 'so-called' skipgeneration families. This is also a critical issue facing Vietnamese in rural regions today. The number of skip-generation families in Vietnam has been increasing. Households, where grandparents are the primary carers for their grandchildren, are becoming more prevalent both in Vietnam and in other developing countries. Individuals who are often the frailest and most vulnerable members of society are now having to care for grandchildren rather than be cared for themselves. This presents a difficult situation for many elderly individuals and also for their grandchildren. Ironically, the elderly who are being left-behind by migrating 163 relatives must now care for the young who are also left-behind. This type of household is currently increasing in rural areas and is expected to increase further in the future, to the potential detriment of elderly individuals. 5.1.6 Education attainment and literacy From the 1950s to the 1970s, formal schooling in Vietnam finished at Year Ten. This was extended to Year Twelve in 1981 and remains this way today. Primary School education was from Years One to Five. Secondary School was from Years Six to eight, and High School was from Years Nine to Ten. After graduating from high school, individuals could progress to higher education at a technical college or university. Overall, education levels achieved among the research participants were low. Most of them 41 cases only attended primary school, completing the basic compulsory education of five years. A smaller number 35 cases continued to secondary or higher education. This appears to reflect national figures: in 1999, 33.7% of the population achieved only primary level education while 19.3% progressed to secondary school (Hoi et al., 2011). Of the respondents in this study, not many graduated from high school. Only 10 people attained a diploma, and one reported having a degree. A few respondents (8) were illiterate since they did not enter the education system at all. Elderly males were substantially more likely to be literate than females, and the younger elderly group attained higher educational levels than the older elderly group. However, there were no substantial differences between the different ages, genders, and place of residence of the participants in regard to education. For a long time, educational attainment was influenced and limited by the long American War in Vietnam which occurred when elderly individuals were of school ages. Due to the negative impacts of the war, the Vietnamese population generally did not attain qualifications as expected, especially those in rural areas aged 60 and over. Due to the war, the education system had not been addressed or upgraded for a long time. 164 5.1.7 Job and occupation Due to the long American war in Vietnam in the years before 1975, most of the respondents especially men joined the military during their youth. After 1975, the American war finished, and the whole country had been devastated and impoverished. The majority of soldiers returned to their hometowns to rebuild their communes and work as farmers. Just seven out of the overall 95 respondents (two females and five males) used to work in the public sector (three of them were primary teachers; two worked in mining; two served in the military) and therefore received a pension now that they were retired. The rest (88) remained as farmers. Some of those farmers received support from the government due to being veterans. The rest did not have any state support or a pension. 5.1.8 Working status For the purposes of this study, an elder was considered to be actively working if they either worked for an income or regularly did housework. Table 5-1 shows work tasks and working status of the total 95 elderly participants. Only 5 respondents did not work as they were too old (80 and above) or too sick and needed care from their children. The rest of them around 95% (90/95 people) reported engaging in work. The evidence showed that most of them tried to remain economically productive as much as they were physically and mentally able, as the household required their continued contribution. Around half of all respondents (44) were younger elderly individuals (aged 60 – 75) and reported that they continued working just as their younger counterparts of working age do (despite the fact that they are of retirement, which in Vietnam is 55 for women and 60 for men). These elderly individuals were usually found to be either living alone, living with their spouse only, living with and caring for their grandchildren (e.g., they were the household head or breadwinner of their family). They did every kind of work from the heavy labour such as crop cultivation on the fields to the lighter jobs such as working around the house. If some parts of the job were too hard, they had to pay someone else to take over. 165 Of the respondents, 46 individuals (mostly in the older senior group, aged 75 and over) did lighter work due to health limitations. Work undertaken by those seniors varied from working around the house such as the growing of vegetable gardens as well as livestock rearing for direct household consumption and sales. These elders, especially women, support households through domestic activities such as cooking, cleaning, washing, and other household chores. Both older men and older women acted as primary caregivers for grandchildren. Compared with the younger elderly, this group was more involved in lighter work. They tended to stay at home doing housework and supporting their children, rather than working in the fields. These elders were more commonly in the older group and cohabited with their grown-up children. Table 5-1: Working status of the rural elderly respondents Work tasks Working status (%) Full-time (46.3%) Part-time (48.4%) Not working (5.3%) Work (around the house) ● VAC activities: growing vegetable garden, and looking after livestock animals at home ✓ ✓ ● Housework: cooking, cleaning, washing ✓ ✓ ● Caring for grandchildren ✓ ✓ ● Looking after house security ✓ ✓ Heavier work (on the fields) ● Growing rice in the fields ✓ ● Growing annual and seasonal crops in the fields ✓ ● Rear the livestock in the fields ✓ Note: VAC – Garden, pond and raising livestock pen – a model of agricultural production applied by many rural households in Vietnam. Source: Created by author based on the primary data Clearly, older individuals tend to work less, which is in line with the findings of M. Evans and Harkness (2008) whose research showed that 60% of men aged 70 were 166 employed compared with 35% of 75 years old. Due to physical labour associated with agricultural work, the younger the age, the harder the form of work they were doing. This is explained by T. L. Giang and Nguyen (2016), who note that elderly individuals cannot continue working as they age due to their increased vulnerability to ill health. The authors also claim that there is a higher incidence of employment among healthier older individuals than those whose health is not good. Elderly parents who live with their children appear to work less and complete more housework than their counterparts who live apart from their adult children (M. Evans & Harkness, 2008). These authors found that in general elderly people perform 40% of all household work. They play a significant role in 26% of this work, which enables other family members to be more economically productive. Being elderly and being retired are definitely not synonymous. This is happening not only in Vietnam but also in most developing countries, where the agricultural production and household businesses are still the primary sources of income for the majority (M. Evans & Harkness, 2008). Figure 5-3: Elderly's' education level attainment, occupation, and working status Source: Created by author based on the primary data 167 5.1.9 Pensioners, welfare beneficiaries As previously mentioned, the majority of the elderly population (over 70%) don't have any support from the government. The most important form of day-to-day provision stems from their own economic activity, alongside benefits from coresiding with adult children (married son in particular) and informal support from family members. Only a small number of elderly individuals (21%) receive a pension or some kind of support from the State. Those who used to serve in the public sector will receive a pension when they get to retirement age. Others who are entitled to benefits or another form of State support include veterans (those disabled during wars or conflict who qualify for assistance), disabled elderly individuals, single elderly individuals living alone, or individuals aged 80 and over. Cash is the primary form of welfare. Cash will be given monthly, on a particular day, generally in the middle of the month. The degree of support varies depending on the beneficiary, and this is defined explicitly in welfare state policies. While state monetary transfers exist, their coverage is limited and skewed to specific groups, with only a minority in receipt of them. It is important to determine whether being a welfare beneficiary or not makes any difference to elderly parents who remain in their village without the presence of their adult children. It is also important to determine how much having a source of support beyond that traditionally given by family really matters for the remaining parents. As such, both pensioners and non-beneficiaries were purposely chosen for inclusion in this study. An equal number of households that received welfare and that did not receive welfare (30 of each) were included. If couples resided together and at least one of them (husband or wife) was a beneficiary, then the household was classed as a welfare recipient. There were 30 households across the three locations in this study that received either pension or some form of welfare. Of this number, 7 elders were pensioners and 23 beneficiaries of another form of welfare. Pensioners were those who used to serve in the public sector. When reaching the ages of 55 for women and 60 for men, they retired and began receiving their pension. 168 Pensions varied in amount, depending on the duration (years) a person had contributed and what job had been held. For this research, the pensioners' occupations were mainly primary teachers and soldiers. After retirement age, former civil servants and some workers in the formal sector have contribution pensions as their financial security. But most elderly individuals have worked in informal sectors in which social welfare benefits and their own savings are relatively minimal. Beneficiaries are people receiving support from the government, including disabled elderly individuals, veterans, and persons age 80 and over. Most beneficiaries included in this study were veterans (being injured in the American war) who receive compensation for their devotion to the nation. The amount of money received depended on their injury. Noticeably, there were significant differences among pensioners and beneficiaries regarding how much money they received. The most significant sum was about VND 10.000.000 (USD 500) per month and was received by a pensioner who had been a soldier. This starkly contrasts with the smallest amount of welfare VND 180.000 (USD 9) which is the amount given by the state to those aged 80 and older. Overall, pensioners had a bigger income than beneficiaries. A pensioner received the average amount of VND 3.000.000/month (USD 150), while beneficiaries only received around VND 800.000/month (USD 40). Pensioners could live on their salary, but beneficiaries could not. Hence, beneficiaries still had to work or be supported by their family. Only one household had both the husband and wife receiving pensions. The rest of the 29 researched households just had one pensioner or beneficiary. This means that regardless of the amount, most couples had to rely on one income. As it is really hard to make money in rural regions, every bit of money counts. Even with a very small amount of money or with two people sharing only one income any support from the government was crucial for their livelihood. Elderly individuals whose children have not migrated (Non-child migrant elder). The validity and accuracy of this research is greatly improved by comparing and contrasting the situation of elderly individuals whose children have migrated with elderly individuals whose children have not migrated. As such, a number of elderly individuals, none of whose children have migrated, took part in this study as a 169 control group. The majority of elderly individuals whose children have not migrated lived in close proximity to their children, often in the same or nearby villages. Living arrangement was therefore excluded, as it was not a factor for differentiating between them. The factors of age and income were chosen when comparing with the samples of the elders with migrant children, such as one who has a pension, and one who does not; one aged from 60-75 and the other aged over 75. Cohabitation was still a predominant form (80%) of the living arrangement of these Vietnamese elders. This is also a central feature of family support for many other developing countries. Among the various forms of living arrangement, elderly living with their adult children predominated. Other living arrangements such as elderly living with a spouse, those living alone or living with grandchildren are all predicted to increase in future and were therefore included in this study. Examination of living arrangements aimed at discovering the impact of urban child migration on elderly parents who are left-behind. The researcher felt it was important to determine whether the remaining elderly were in any way affected by the move of their adult children and if so whether it is a positive impact or negative. It is also important to determine which of them are suffering the most and which group requires better care and support. To answer those questions and find out what the results are, the wellbeing of elderly individuals both with and without migrant children were compared and analysed. An in-depth investigation was conducted among and within those groups. Summary As the summary of demographic features of the research participants in Table 5-2 shows, there were more 'younger older' adult participants if we count individuals rather than households. This was due to early marriages and having children at a young age. Also, there were more women in the cohort as there were more widows, which is a consequence of the longer life expectancy of women compared to men. Around 98% of the respondents were married and had a big family with many children. Low education background was a notable trait of the research subjects. Due to low educational achievement, the majority of those who had a job worked in farming. With low income as a farmer, all individuals tried to engage in the 170 workforce to earn their living, even those of retirement age, with the exception of the ones who were very old and too sick. Table 5-2: Key demographic characteristics of the elderly participants Influence factors Attributes Numbers Households (60) Individuals (95) Percentage (%) Ages Young elderly from 60 to 75 60/95 63.1 Older elderly from 76 and older 35/95 36.8 Genders Male 43/95 45.3 Female 52/95 54.7 Marital status Married and live with a spouse 35/60 58.3 Widow 23/60 38.3 Divorced 1/60 1.7 Single 1/60 1.7 Number of children 1 child 1/60 1.7 2 children 5/60 8.3 3 children 13/60 21.6 4 children 18/60 30.0 5 children 8/60 13.3 6 children 12/60 20.0 7 children 3/60 5.0 Gender of children Son and daughter 54/60 90.0 Only son Only daughter 3/60 3/60 5.0 5.0 Education levels Primary education 41/95 43.1 High school 35/95 37.0 Diploma 10/95 10.0 Tertiary education 1/95 1.0 Illiterate 8/95 8.4 Jobs Famer self-employment 88/95 92.6 Public-worker 7/95 7.4 Working status Full-time working (field crops +livestock) Part-time working (work around the house) Not-working (be looked after) 44/95 46/95 5/95 46.3 48.4 5.2 Source: Created by author based on the primary data 171 5.2 Economic characteristics of research localities (migrants' place of origin) As previously mentioned, the socio-economic status of an elderly individual's place of residence is one of the factors contributing to that person's well-being. Without the presence of their children, rurally-based elderly individuals may not feel lonely or be isolated if they receive proper support from the community where they live. To better understand the impact of community status on individual well-being, three communes named VU QUY, VU TRUNG and VU CONG with different levels of economic condition (low, average and above average – based on the average income per capita at community level) were chosen as research locations. 5.2.1 The similarities Like many rural communities in Vietnam, the villages involved in this study were purely agricultural communities, and more than 95% of the population were peasants. Cultivating crops and raising different types of livestock were two of the main economic activities of peasant farmers in these villages. Rice, a major staple of the Vietnamese diet (supplying 75% of the total calorie intake), occupies 94% of Vietnam's arable land. According to Goletti (2015) ANZDEC Limited (2000), 80% of rural households grow rice, and almost half of them produce more than they personally need so that they can sell the surplus to make money. This number is even higher in the Northern Upland where 91% of rural households grow rice, 62% grow maize, 49% grow cassava, and 47% grow bananas. In terms of value, rice is the most important crop, accounting for 46% of the total net value of crop production, followed by maize (15%). Tea, cassava, and litchi/longan each account for 5-10% of the value of crop production (Minot, 2006). Thai Binh is considered one of the primary rice-growing regions in Vietnam due to its fertilised delta soil, a product of the natural irrigation system fed by the many local rivers. Being a province in the Red River Delta with abundant natural resources, this region produces annual and seasonal crops. However, it did not produce as many perennial crops (rubber, coffee, tea, cashew nuts, and others) as mountainous areas. 172 Rice is the most important crop in each of the study commues. There are two main cultivating seasons a year: rice is harvested in June, and early 'Mua' rice crop is harvested at the beginning of November. Following these two rice crops are potato, beans, etc or, at the end of October, it could be corn, sweet potato or soybean. Farmers can get more cash from growing temperate vegetables such as cabbage and cauliflower. Those crops in rotation with two rice crops are considered as sub-crops, which minimizes land preparation and weed control cost, and requires the farmer to spend less on fertilizer (Papademetriou, 2001). Figure 5-4: Rice fields Source: Fieldwork, 25th January 2015 (Vu Cong commune, Thai Binh, Vietnam) Other foods cultivated in between rice crops are maize, cassava, potatoes, beans, and vegetables. These are cultivated to ensure crop diversification and to safeguard villagers' food supplies and nutritional intake. Livestock farming was also considered a good source of money for households looking to diversify their income. Commonly, farmers keep an average flock of seven to eight strong but low-yielding poultry birds such as chicken and ducks, 173 mainly as a source of eggs for home consumption but also to meet one-off expenditures. Almost all of the families reared piglets to maturity and then sold them to meet immediate cash needs, for example in cases of sickness or to purchase other vital things that they cannot produce themselves. It takes around six months of raising by feeding them in traditional ways (homemade feed) not by industrial animal feeding before a financial outcome is achieved. Thus, those farmers can have a maximum two terms of pig raising in a year. This study found that pig rearing contributed significantly to the income of almost all households in the study communities. Chicken and pigs were reported to be the most popular livestock for farming in those household samples. Only a few families kept buffalo (only one buffalo not a herd) for labour support purposes, such as animal traction during the planting seasons or transporting goods during harvesting time. This research did not identify any other animals as being farmed in these communities. Animals were most commonly reared by smallholders. No one reported keeping large flocks of birds for profit. Also, each family reported having a mini pond of about 100 to 500 square meters in the household's living area to raise fish. Almost all households in these communities have incentives to keep livestock because of the wide spectrum of benefits rearing livestock provides, such as cash income, food for personal consumption, manure, and hauling services. Keeping animals is a way of saving money or a form of insurance; it also contributes to social status and social capital. However, the poorer the household, the less investment in livestock farming because of their financial constraints. 174 Figure 5-5: Lowland Integrated Farming System Note: VAC model and the practice (VAC in Vietnamese is: Vuon, Ao, Chuong, which means garden/ pond/livestock pen). Source: (T. L. Le, 2001). The combination between farming and animal rearing created a closed agricultural production cycle that was called the VAC system (Figure 5-5 and Figure 5-6). This is a model of integrated farming between the home lot, garden, livestock and fishpond, which has been active since the early 1980s. According to T. L. Le (2001) the purpose of widespread promotion of the VAC system was to increase and stabilize the nutritional standard of the rural poor. "Because of adoption of the VAC system, the dietary standard of the rural poor significantly improved, particularly in the isolated villages in the high mountainous regions" (T. L. Le, 2001, p. 1). The VAC model was constructed as follows: V (Vuon – garden): In the lowland areas of northern Vietnam (Ha Noi, Hai Duong, Ha Nam, Hai Phong, and other provinces including Thai Binh). The garden is usually smaller in comparison to the garden of the mountainous areas, around 400500 m2 in size, because of the greater population density. Different kind of vegetables is grown in the family garden such as green onion, sweet potato, cress, tomato, cabbage, water spinach, etc. Fruit crops are also planted in the garden including banana, orange, papaya, peach, litchi, longan and apple. In many rural family gardens, ornamental trees and flowers are planted as the main income source. 175 Both perennial and annual crops are planted to provide year-round food for the house and products for the market. A (Ao pond): Most families have a pond of 50-400 m2. While they may differ in shape, all have an average depth of 1.0-1.2 m. Ponds are constructed primarily for fish supply, and also shifted the soil for building home and garden. Ponds are drained after the final harvest (usually in January/February). The pond is then kept dry for a few days, lined manured and refilled with rainwater or irrigation water (early rains may start at the end of March). Ponds are normally constructed next to the garden so that mud can be annually removed and used on fruit trees. Water from the pond is used for irrigating the garden, especially vegetables, and for other domestic purposes. Ponds are also used to produce aquatic weeds for animal feeding. Domestic washing and kitchen waste may be channeled into the pond with a small amount of livestock waste used to feed the fish in the pond. Also, leaves of legumes, such as peanuts, green beans, etc., are used for manuring the ponds (T. L. Le, 2001). C (Chuong livestock animals): Most rural households keep various forms of livestock including one or two water buffalo, one or more pigs and a flock of 10 or more ducks or chickens. The livestock animals are fed by kitchen waste as well as other crop products such as cassava, rice bran, sweet potato, banana trunks, and water hyacinth. The animal manure is then used to feed fish in the pond, or used to fertilize vegetables or the field crops, especially rice. The livestock pens are typically constructed at the corner of the garden, close to the pond. The process is cyclical and starts with rice and other products, which are used to feed pigs, chicken, and ducks. As previously stated, water from the pond is used for domestic purposes and to produce aquatic weeds for animal feeding. VAC is a circular process of production, helping to avoid waste and maximise resources. This farming system is family-managed with practically all labour coming from the household. This is a traditional approach to family food production in the poor rural regions of Vietnam. In his research, T. L. Le (2001, p. 1) notes that "VAC farms can be found in various agro-ecological conditions, including irrigated lowlands, rainfed upland, and periurban areas. It is estimated that 85-90% of the rural family maintain a garden and 176 livestock pen, with 30-35% of these having fishponds. In many villages, 50-80% of rural families have the full VAC system. Figures show that 30-60% of the income of most villages families may come from the system; in many cases, it may be 100%". Figure 5-6: VAC system Source: Fieldwork 30th Januay, 2015 All of the research households were either entirely involved in agriculture or held a job in some way related to agriculture and farming. VAC production was common among the research households. Domestic consumption was the primary reason for crop production, with surplus production if any subsequently sold to boost household cash flow. This smallscale farming and self-sufficient production are a typical model not only in those communities but also for rural regions all over Vietnam. The industrialisation and modernisation of agriculture in rural areas has been actively pursued since economic reform in 1986. Since the centrally planned economy was transformed to a market-oriented economy, peasants have been 177 encouraged to move from small-scale household farming to large industrial agriculture (based on the accumulation of agricultural land). They have been encouraged to move from simple production for their own needs to large-scale production that is export-oriented. However, this process is still at a slow pace, especially in disadvantaged and underdeveloped regions like Thai Binh province. In brief, the three research communities did not have any other kind of economic activity other than on-going agricultural work. The VAC model of farming and ranching has been applied in these communes and implemented largely all-over rural Vietnam in recent years. High population density due to the scarcity of farmland has pushed younger generations to move out of the villages for better opportunities. In addition, outdated agricultural production practices that resulted in low productivity discouraged the peasants to remain in their communities. Such agricultural practices are still typical features of the study communities. 5.2.2 The differences Vu Cong was the poorest community of the three research locations. It is situated in the southwest of the region, about 8 kilometres from the centre of Kien Xuong district. The total area is 495.3 hectares. The average farmland per capita was 695m2. Vu Cong is a purely agricultural community, and 98% of the population are peasants. Since there are no other trades or forms of traditional production and low productivity in agricultural activities, young villagers have to migrate to urban areas for better opportunities. By the time of the fieldwork in February 2015, approximately 1400 to 1700 people (around 30% of the population) had migrated from the area to cities for better economic opportunities. The elderly in Vu Cong 1 ,067 people accounted for 18.98% of the population, of which 953 elderly people registered in Vietnam Association of The Elderly. The proportion of elderly individuals in this commune was higher than that of the national average (10.8% in 2015). At a religious level, one-third of the population was Christian, and the rest were Buddhist. Vu Cong was poorer than other communities because of its inconvenient location and less fertilised farmland. Lower educational levels also added to its overall disadvantage. 178 Vu Quy was in the middle of the three. Its total area of 280 hectare is smaller than Vu Cong's. However, Vu Quy has a more convenient location with the main road connected to the centre of the district and CDB of the province. This could be a reason helping Vu Quy be more developed than Vu Cong commune. Vu Quy has five administrative villages, with 1301 households and a population of 5130 residents. About 92% of the population were farmers. The elderly accounted for 16.2% of the total population. By the time of the interviews there were about 31% out-migrated. Vu Trung was in a better economic condition compared to Vu Cong and Vu Quy communes. It is located in the West, 8 km from the CBD centre of Kien Xuong district. Vu Trung spreads over 355.9 ha with an average farmland per capita of 629m2. Vu Trung is nearer to the centre of the regions, compared to the other two. There were more people integrated in other businesses than in farming work. It had the lowest percentage of the population working as farmers, only about 83% of the population. It also has the highest rate of out-migratory population (35%). Having more advantageous conditions helped this commune become financially better off than the other two communes. Table 5-3: Summarised key features of three research locations in 2015 Key features Differences Similarities Poorer (1) Average (2) Better off (3) • Most households purely doing agricultural cultivation with two main economic activities: Growing crops especially rice production and raising livestock species like chicken, pigs • Small-scale farming • Family labour used as major sources of the production • Self-sufficient was the primary motive for agricultural production. Area square (hectare) 495.3 280.0 355.9 Population 5627 5130 5656 Land per capita (m2) 695 527 629 Income per capita (million VND/year) 20.5 25,07 28.2 Number of households 1866 1301 1925 Number and (%) of out-migrants 1700 (30%) 1572 (31%) 1987 (35%) Number and (%) of the elderly people 1067 18.9% 832 16.2% 1102 19.5% Note: Three communes namely Vu Cong (1), Vu Quy (2), Vu Trung (3) Source: Created by author 179 5.3 Focus group discussion attendees The participants of the focus group discussions were leaders from the three researched communities (three leaders of the communities and three leaders of the associations of the elderly people). They were born and raised in the same villages as the respondents. Since they resided in the same neighbourhoods, those leaders understood the situations of these elderly individuals more than anyone else. They are not only the ones who enforce policies, but they also share the same socioeconomic and cultural environment as the elderly individuals involved in this study. Insight from the community leaders was very helpful, as it deepened discussions regarding elderly individuals in the community and helped to verify information collected from the elderly themselves. Hence, the collected data can be considered accurate and reliable. 5.4 Chapter summary After the war ended in 1975, Vietnam was one of the poorest countries in the world. Agriculture became the main form of production across the nation. Because of this, the majority of elderly participants in the current study were farmers. Households analysed in this study were characterised by low income, large numbers of children, and low educational attainment. Like many rural parts of Vietnam, each of the research locations in this study revolved around agricultural production. There were not many differences between the three research settings. The land shortage, population density, lack of job opportunities and low wages were the predominant traits of these research communities. Each of these factors seemed to be contributing to massive urban migration in these communes. 180 CHAPTER 6. MATERIAL, EMOTIONAL, AND PHYSICAL CARE CONSEQUENCES This chapter addresses the research questions and presenting the findings. It starts with an explanation of the analytical framework. Based on the guidance of this framework, the data was then analysed to answer three central research questions. 6.1 Analytical framework: A comparison with "non-migrant child" elders helps create a better understanding of the situation of rural elders of migrant children. Also, a comparison among the elders of migrants helps explore to what extent or degree child urban movement benefited each group of those elders in terms of material, emotional and physical care. These two relationships were thus, taken into account in the analysis. They were designed specifically using the following framework, which allowed the researcher to address the research questions of the study. First, the comparison between non-migrant child elders and elders of migrants. The focus of this analysis is on the elderly relatives of migrants. The contrast with elderly parents of non-migrant children aims at answering the question of whether the elders with migrant children were affected by the geographical relocation of their children. Thus, elders without migrant children appear only as a reference group. Because none of their children migrated, most of the non-child migrated elders cohabited with their children. The similar attributes between the two compared groups result in the maximun possible validity of the outcome. Thus, of 48 elderly relatives of migrants only 12 cases (selected from three research settings of four samples from each), who co-reside with their remaining children, were chosen for comparison, to make sure that both groups have similar traits of age, income and living arrangement criteria. For example, two younger elderly adults aged from 60 to 75, and two older elderly adults aged 76+. Of them, one had a pension, and the other did not. The other three groups of ELB who had different attributes to the nonELB, were not used for the comparison (for example: the elderly living with spouse only, living with grandchildren, and living alone). 181 Second, a distinction among groups of migrant child elders. Since they have a different set of circumstances, each elderly individual may be affected differently by the separation from their adult children. Therefore, the variables of age, income and living arrangement (the most significant influencing factors of a rural elder's life) were considered in this analysis. The study was designed as follows: There were 48 elderly households selected from three communes with 16 samples from each. Four types of living arrangements were examined: the elderly who resided with their remaining children; the elderly who resided with their spouse only; grandparenting households; and elderly individuals who lived alone. Each of these forms had four samples: two families with younger elderly individuals (aged 60-75) – one with at least a pension, and the other without – and the same design but with older elderly individuals aged 76+. Those participants were asked the same question as to whether their material, emotional and physical well-being has improved, diminished or remained the same after the migration of their children. Based on their answers, the analysis identified how variables of age, income and living arrangement influence the consequences of urban migration for elderly parents in rural areas. The three central research questions of this study were then, in turn, addressed based on the guidance of this analytical framework (Figure 6-1). 182 Figure 6-1: Analytical framework for exploring the impact of migrant children for rural aged parents. Source: Created by author 6.2 Material well-being consequences In addressing the first research question of how urban child migration materially affects rurally based ageing parents, this section sheds light on the three following significant aspects: • First, the economic conditions of elderly parents with and without migrant children. This section explores the economic conditions of those individuals. It explores whether rurally-based elderly adults are wealthy or poor and whether they are independent or need support. • Second, the current financial status of migrant and non-migrant children. Are they in a position financially to support their parents? • Finally, the comparison between elders of migrant children and elders whose children have not migrated in receiving material assistance from their children. The comparison is also conducted among the elderly of migrants. 183 6.2.1 The economic conditions of the elderly participants (self-rated) The economic circumstances of a rurally-based elderly person are relevant to gauge whether the out movement of their adult children has any impact. If it does have an effect, the extent of the effect should be considered. Therefore, identifying the living conditions of an elder (such as housing, income, expenditure, and saving), will help to assess the impact more accurately. The discernment of the elders' economic status was based on the self-reporting of respondents, key informants in focus group discussion, and through the researcher's observations. Housing Traditionally, houses and lands in agricultural societies are inherited, passed down within the family rather than traded commercially on the market. The intergenerational inheritance of properties is customary in Vietnam. It is a part of Vietnamese cultural identity and is more readily observed in rural communities. Ancestral estates must be handed down intact to descendants. Due to a long history of patriarchy in Vietnam, in which males are deemed more important than females, the recipient of estate inheritance are almost always sons. It is similar to Chinese culture, where parents prioritize sons over daughters. However, between the sons, the support from parents is provided equally. "Any perceived noncompliance with this principle would cause damage to the interdependent networks within the family" (Liu, 2014, p. 310). Hence all sons will be the ones who inherit and are expected to reside with parents as they age. Married sons will take the crucial role in looking after elderly parents. Nowadays, in the context of migration, even though daughters play an increasing role in caring for the parents, the patriarchal practice that only sons could inherit the parental house persists. According to Liu "regarding care for parents, daughters are better than sons. But sons are needed to continue the family line" (2014, p.310). The interviewees in Liu's research assert that it cannot be changed, still "This is the way it is." Daughters would inherit properties from their husband's family. Accordingly, all the respondents in the current research lived in their own houses, which had been passed down through generations. The concept of renting a home or living in a government (subsidised) house was not practiced in rural settings. The 184 average size of a house in this research was around 500 square metres. The structure of a typical home in rural Vietnam was old in style and design (see Figure 6-2). This is typical of houses in the Northern lowland, rural Vietnam. The ancestor's altar and a living area was designed in the middle space of the house. Two beds were set up on both sides, which was considered as spacious bedrooms for people to sleep. Typically, the elderly parents will sleep there. There are two private rooms which ended on both sides of the house, that can be used as storerooms or bedrooms for young couples. Figure 6-2: A typical house design in the Northern lowland, rural Vietnam Source: Fieldwork 30th January, 2015 (Vu Quy commune, Thai Binh, Vietnam). Unlike townhouses, these rural houses were very simple in design and held a minor investment due to the common reason of financial restraints as reported by many respondents. Nevertheless, it satisfied for the requirement for a living place for those elders. Research conducted by Tuyen Quang Tran and Van Vu (2017) notes that around 63% of Vietnamese elderly felt satisfied with their housing conditions. Importantly, none of the researched participants have to pay rent. 185 With population growth and limitation of land resources, house sizes have been getting smaller and are being subdivided. Many new homes were built by young couples with the modern designs making country towns a mix of old and contemporary styles. Gradually, old houses were replaced by the new contemporary designs (Figure 6-3). Figure 6-3: The combination of the old designs and the modern house styles in rural Vietnam. Source: (Kien Viet, 2019) Income and expenditures With the exception of retirees that have pensions, agricultural production was the primary source of income for elderly individuals in rural areas. Food satisfaction almost came from home-grown production (rice, vegetables, meat, egg, fish etc.), and money they had from selling of surplus agricultural products when needed. Most of the respondents said they earned about one to two million VND per month (equal to UDS 50 to USD 100). It is consistent with the research result of Hoa Hoang about the total food cost per month for a rural family calculated in March 2016 in Thai Binh and Soc Trang provinces (See Table 6-1) 186 Table 6-1: Total food cost for a rural family per month Unit Food Costs VND USD Food cost/person/day 24,604 $ 1.11 Food cost for a family of four people/day 98,416 $ 4.45 Monthly food cost for a family (four people) 2,993,487 $ 136.06 Note: Food prices were collected in March 2016 in Thai Binh and Soc Trang provinces. Source: (H. Hoang & Meyers, 2017) Regarding rice: with rice as the primary staple of the Vietnamese diet, 96% of the respondents reported that they did not have to worry about this basic staple food. The growth of rice was enough for their family consumption all year-round. Vietnam has been ranked as the second largest rice exporter in the world since economic reform in 1986. Rice supplies were not as concerning as they were before. Thus, it is reasonable and understandable that none of the respondents spoke about the insufficiency of rice supply. Most of those households even sold surplus rice for cash when needed. Many of them (82 people), mainly younger elderly individuals, still grew rice in their fields themselves. For those too old to work, they still had enough rice for their consumption year-round by renting out their plots (including the plots of their absent children). Assuming one plot of land of 360 square metres for someone to grow rice, they will receive 30kg to 40kg per term which means about 80kg/year. The land rented out provided the elders enough rice to eat (per capita rice consumption by Vietnamese was 124kg/year as calculated by VHLSS 2010). Vegetables are also a main feature in Vietnamese meals. Due to food autonomy and food safety reasons, most of the households surveyed grew vegetables in home gardens. However, those that were not able to buy vegetables in the local markets. Some of those families also relied on eggs from their own poultry. Village dwellers went shopping every day in their local markets to buy beef, chicken, fish, tofu and mostly pork, but rarely seafood. 187 Figure 6-4: Growing vegetables in the home garden Source: Fieldwork 29th January, 2015 (Vu Quy commune, Thai Binh, Vietnam) Figure 6-5: Local markets in Vietnam Source: (D. Thang, 2017) 188 Rural families often have a simple meal. There are no appetizers or desserts, only the main course, composing of two dishes including meat and vegetables. The families included in this study either grew vegetables in their home garden or bought them from the local market. Vegetables are much cheaper than meat or fish. Therefore, rice and vegetables are popular dishes amongst most families. Sometimes, their meals only contained vegetables because they cannot afford to buy meat (Figure 6-6). Our meals are quite simple, having only two main dishes which generally includes one plate meat, eggs or fish, with one plate of steamed or stir-fried vegetables. We eat more rice than food, so our rice cookers are big. A 70-year-old man co-resident with children Figure 6-6: A typical meal of a rural family in the North of Vietnam Source: (Women's Today, 2019) 189 Figure 6-7 shows meal for the elderly in the village is even modest, as the picture below depicts Figure 6-7: An elderly couple with their meal Source: Fieldwork 28th January, 2015 (Vu Quy commune, Thai Binh, Vietnam) Water: piped water was supplied mostly in urban wards – it has not yet reached many rural areas. Therefore, all respondents are self-sufficient when it comes to water supply. They were using a well or water pump at the time of interviewing. In addition, every household either has tanks or man-made containers to collect and store rainwater. For convenience, all families used a water pump instead of water well (Figure 6-8). We use well water for washing clothes and cleaning things. Rainwater tastes purer and fresher, and it is also limited in amount, so we only used it for cooking and drinking. A 60year-old-elderly woman. 190 Figure 6-8: Water sources of households in rural areas, Northern Vietnam Source: (Vietnam News, 2019) Fuels: another area of self-sufficiency is fuel. For convenience, gas cylinders and electricity have been increasingly used in rural families for cooking. However, this is often not affordable for most rural families. Hence, straw is often used for cooking in rural lowland regions. Straw was reportedly collected after harvesting rice crops. They were then dried under the sun and stored for use all year round. Some families used both gas and straw for cooking (around 20% of the researched households). The rest of the 80% only used straw (Figure 6-9). 191 Figure 6-9: Fuel sources of households in rural areas, Vietnam Source: Fieldwork 28th January, 2015 (Vu Quy commune, Thai Binh, Vietnam). Electricity was used sparingly for lighting, watching TV or powering the water pump. Only two families used the fridge because it is expensive to buy and energy consuming, as reported. Of course, we cannot generate electricity ourselves like we can with foods. We must pay monthly for access. If it is overused, you could not afford to pay the bill, and if it goes overdue, your power will be cut off. That is why we must limit our use of electricity. Only poor households receive the subsidy from the government for about VND 30.000,00 per month (the US $1.1). The irony is that lots of people were upset if they 192 were not elected as a poverty household to get that subsidy. A 73-year-old man, living with grandchildren We do not turn on the TV for a long time, only for the programs that we really love to watch. So we do not have to pay much for the electricity bill. An elderly parent whose children have not migrated. Monetary saving Small-scale agricultural production has provided insufficient income, as in some cases, limited output only just covered the daily cost of living. Because of this, many agricultural workers, even the young ones, lived day by day without capital accumulation or any safety net. Nearly 98% of respondents had no savings. Only about 2% of them reported having a savings account with just a small sum of money saved. "Sweat dried, running out of money" is a famous phrase describing the harsh life of these farmers. Since children themselves are also struggling to earn their basic needs, most of the elders continued working until they can no longer work. However, due to not having a savings account, most of the respondents reported they would soon be in debt or become impoverished if any extra costs arise. In brief, "Peasant societies" are seemingly characterised by their self-sufficiency, with limits regarding both land transmission and means of production. Most of the elderly who took part in this research worked to support themselves and be independent. However, incomes only covered their daily consumptions. They did not have savings, which is a significant feature of the economic condition of rural elderly households in Vietnam. Material sources of the rural elderly are presented in Figure 6-10. 193 Figure 6-10: Material resources of the rural elderly Source: Own calculation from author's primary data 6.2.2 Children's financial status from the elderly parents' perspective A few children achieved a tertiary education. The majority of them obtained low qualifications, as reported by many parent respondents (see Table 5-2). Therefore, most worked in unskilled, manual, casual, seasonal and hard jobs, which were low paid and unstable. Men usually worked in construction sectors either private or public, while women frequently worked as a nanny or as a kitchen hand in restaurants. Some others worked in New Economic Zones for foreign companies. It was difficult for them to find a permanent job to have a constant income. Additionally, the ages of the migrants averaged around 30. Most of them were at the stage of getting married and starting their own family. It generally took about five to ten years for a person settling down into a new job, in a new place, and starting their own family life. Due to many being unable to get a permanent job, seasonal and temporary work was common among migrants. For many, urban life was challenging, where they were struggling to survive. Lots of them gave up their dreams of the city life. Hence, many parents indicated that they were uncertain about 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 100% 96% 65% 60% 100% 100% 2% 194 the permanency of their children's migration and could only hope for the best for them. Given this uncertainty, many migrants were unable to take on responsibilities and obligations generally expected of their age group. 6.2.3 Material support to rural elderly parents by adult children This section firstly explores material support from adult children to their rural elderly parents. It then assesses whether the elderly whose children have migrated are at a financial disadvantage compared to those whose children have not migrated. Considering the variables of age, income, living arrangement of the elders, and the economic conditions of where they lived, it finally compares among the elderly parents of migrant children to explore which of them was in a financially better position. 6.2.3.1 Material support in general Who needed help from adult children? Not every old age parent needs help from their children. In addition, not every child could help their aged parents. Regarding financial assistance from adult children, the elderly respondents in this study could be categorised into three major groups: the totally independent, the entirely supported, and the partly supported. The proportions of dependency of each group are illustrated in Figure 6-11. About 42% of the participants reported that their finances were entirely separate from that of their children. These elders were in the younger elderly adult group aged from 60 to 75, who were still capable of working. Regardless of having a pension or not, 83% of them reported that they attended full-time work as farmers, growing crops and raising livestock on the fields to be self-reliant. In cases where children were unable to support, or the pensions were too small to cover their living cost, some of the elderly parents – despite having health problems – must work fulltime to earn a living. Another 42% of the respondents claimed that they were partly supported by their children. The majority of them were from the older elderly adult group (aged 76 80 ). Their health did not allow them to work full-time. They commonly engaged in part-time work as farmers and did housework as well as helping to care for their 195 grandchildren at home. Since they could not rely on their labor or their pensions, this group needed financial assistance from their children. Figure 6-11: The working status, support receipt, and financial support expectations of rural elderly adults Source: Own calculation from author's primary data The remaining 16% of participants reported that their children entirely supported them. Those elders were found to be almost entirely in the oldest elderly adult group (aged 80 and above), who were too old, weak and frail to work. Disabled elderly adults also relied entirely on the support of their children. How was the help? Material provision to parents was determined by the parents' economic situations, which are highlighted as follows: For those who needed partial assistance: This group commonly undertook part-time farm work, the pay from which was not enough to cover their daily living costs. Even where work could cover the daily cost of living, most did not have savings. If any unforeseen incidents arose, such individuals must either sell rice or livestock to 42% 42% 16% Totally-independent Partly-supported Entirely-supported 196 cover expenses or ask for help from their children. Support primarily stemmed from parents' requests – in other words, parents had to ask for help rather than receiving an offer of help from their children. This is not because the children did not want to help, but the capacity of the younger generations to help older people is severely limited. Rarely are children in an excellent financial position to offer help. This form of support from adult children to their elderly parents was the same regardless of whether the children had migrated or not. Commonly reported 'unexpected incidents' included illness and hospitalisation of the elderly parents, and also events such as weddings, births, or the deaths of relatives, friends and neighbors. There is a solid sense of community in rural regions, meaning that most of the time people could not deny attending an event when they were invited. Many elderly adults reported that unexpected events and incidents took a significant amount of their income I am scared when someone invites me to their party. We cannot attend without an envelope with money in it. This is our custom and seems to be a non-written mandate that everyone complies with. It will be an embarrassment if I do not go since they attended our children's wedding before, and now it is my turn to pay them back. Sometimes, we had more than four invitations or more in a month. It means we are invited at least once a week. How can I have that much money for those parties? It has been a big concern for many older people like us. The only way is asking children for money or selling our rice, livestock or whatever we can. A 75-year-old woman with urban children For those who were entirely dependent: Elderly adults who were too old or weak to live on their own must live with their adult children. For those whose children had all migrated, they either had to move to live with children in the cities, or their children must return to the hometown to take care of them. The eldest or youngest son usually took the role of looking after parents; caring duties could also be shared among siblings. In these cases, parents were entirely financially supported. Both monetary and in-kind support provided to parents. In-kind support included food, clothing or medicines. Furniture and household goods were also offered such as televisions, fans, air-conditioning units, rice cookers, fridges, chairs, and tables. 197 Children helped parents renovate or build new houses. They also assisted parents with both domestic and farm work. My daughter lives nearby. She brings me a small amount of whatever she has, after shopping. She often buys me several sesame balls and tofu that I love. She really cares about me and looks after me very well. A 75-year-old, non-migrant child woman My daughter cooks and brings me whenever she can. She gives me rice and vegetable she grew in her gardens, which is safe because it does not have chemicals. A 78-yearold widow, living alone Financial assistance was also reported by many respondents – money was either transferred through the banks or more commonly given in person when children visited their parents, especially on Lunar New Year when children traveled back to their home village for the holiday celebration. They gave the 'lucky cash' to their parents as a tip, but it is also meant as support. 6.2.3.2 Comparison between the elderly with migrant children and elderly whose children have not migrated Figure 6-12 shows the economic conditions of elderly parents living in rural areas (both those with children who have migrated and those with children who have not) and the material support received from their adult children. The findings are highlighted as follows: 198 Figure 6-12: The working conditions of rural elders and the material support from children. Note: total numbers of the elderly respondents was 24 (12 migrant child elders and 12 non-migrant child elders) Source: Own calculation from author's primary data The correlations: Elderly but unable to retire: Both the elderly adults with and without migrant children seemed to continue working till "drop-off." About 70% of respondents were still working (including part-time and full-time) at the time of the interview. Only 30% of them were not working. Support given by children when needed: Around half of the elders reported that they received either in-kind or monetary support from children when requested. The willingness to assist parents shows the strong family bonds in the three research localities. Migrating out was better than staying: Interestingly, even though the support given to parents was not great, all respondents preferred their children to migrate when 83.3% 16.7% 50% 25% 100% 58.3% 41.7% 41.6% 66.6% 100% Working Notworking In-kind support Monetary supportPrefer children to migrate Non-migrant child elders Migrant child elders 199 they were asked. This was not because respondents were seeking to benefit, but parents wished their children to have a better life. It is better for my children to move to the city, where they can find a job and help themselves. Staying here there is no work; it means no money. Sometimes we had to support them. We are alright here, I only worry about my children. We wish them a better life. So, we encouraged them to move. A co-resident 72-year-old man Men and women do not show the differences in regard to the migration of their adult children. They were in line with each other's perspective and both the mother and father shared the same point of view, which is to support their children to move. The differences: The elderly parents of migrant children tend to retire and rely on the children, while those whose children have not migrated tend to continue working and be independent. Approximately 42% of those with migrant children did not work compared to 58% who attended work, while that number was 17% and 83% for those whose children had not migrated. The elderly parents of migrant children tend to receive more monetary help (remittances), while those whose children have not migrated tend to receive in-kind support (foods). The elderly parents of migrant children tend to be supported better regarding the material values and frequency of remittances than those whose children have not migrated. About 66.6% of elderly individuals with migrant children received cash support, of which 25% got the value more than USD 50/month. Just 25% of elderly individuals whose children had not migrated had monetary help, with none receiving over USD 50/month. Of those with migrant children, 25% received remittances monthly and had houses built by their children – none of their counterparts received this kind of support. We pay ourselves for everything. My roof is leaking severely, but I cannot fix it this year. We must wait until next year for saving money. Hopefully, we have enough to amend it sooner. My children are all living in the same village. They are poor and cannot help us. I feel sorry for them as well. An elderly female whose children have not migrated, 200 living with spouse only Due to having children who have migrated and also children who have not, the elderly of migrants not only received in-kind support which was similar to that amount of the elders who had no migrants (the average 33.2% compared to 33.6%) but also received 41.6% in additional remittances. The elders of migrant children financially are in a better position compared with those whose children have not migrated. Because most of them have two sources of support provided by both migrant and non-migrant children. FGD -A leader of VT commune Most of the leaders of three research communes agreed that migration of children had a positive impact on the older parents, as the high fertility rate allowed some children to remain in the village for parents, while others can work away to earn more (see more in Appendix 1). 6.2.3.3 Comparison among the elderly parents of migrants With the purpose of distinguishing the degree to which urban child migration impacted on remaining elderly parents, this section focuses only on the elderly parents of migrant children. The elderly parents of children who have not migrated were not included in this analysis. For this investigation, the elderly participants were asked to talk about their financial situation (become better, worse or remained stable), after the out-migration of their adult children. Table 6-2 presents results drawn from participants' answers. 201 Table 6-2: Material consequences of urban migration of adult children on rural elderly parents (the elders' self-rated) Influential factors (variables) Elderly samples (total N=48) Better Worse Same or not sure Percentages (%) Ages (N=24 each) 60 -75 12.5 16.6 70.9 76 and over 25.0 12.5 62.5 Pension or welfare beneficiaries (N=24 each) Have at least one 12.5 12.5 75.0 Don't have 25.0 20.8 54.2 Living arrangements (N=12 each) Living with other remaining children 33.3 0 66.6 Living with spouse only 41.7 0 58.3 Living with grandchildren only 8.3 41.7 50.0 Living alone 16.7 25.0 58.3 Notes: Comparative groups of each variable were even in number. The highligted numbers show the elderly groups who were either negatively or positively effected the most by out-migration of their adult children, or remained the same. Source: Own calculation from author's primary data The financial situation has gotten better: The elders living with spouse only were among the most benefited group with 41% reporting their financial situation had gotten better after their children migrated out. Many respondents said that they preferred living independently rather than with their children if they had enough money to do so. Indeed, those who lived only with their spouse seemed to be in a better position either financially or physically compared to other groups, allowing them to live independently. Seemingly, their burden reduced after the children left. Before we had to support our children, life was so hard at that time. After our children migrated to Ho Chi Minh City, we feel better as they are doing well and support us back. I visit them once per year, and they give us about VND 20 million (USD 1000), which can help us live for one year. VTa 75-year-old-man, living with spouse only 202 This man used to work as a carpenter with his own business and was the only one who had a saving account. The couple was independent and healthy. The older elderly adults co-reside with remaining children (33.3%) reported having positive results because they had another source of assistance from their migrant child meant that this group had a more favorable outcome than others. The financial situation has worsened: The grandparenting households were among the most negatively affected groups, with 41.7% reporting that their financial situation has worsened. Grandparenting elders, including 12 skip-generation families (in which the middle age members were absent) of three researched locations (four houses/commune), were chosen for the investigation. These elders had to look after their grandchildren whose parents are working away. Table 6-3: The grandparenting households that are materially supported by migrants Parental characteristics Numbers (mean) Number of grandchildren to care for 2 grandchildren/household Age of the grandchildren 8.8 years old Duration of grandparenting 4 years The values of remittances 295.000 VND/household/month (USD 14) The remittance frequency Infrequent Note: The numbers were average as calculated by mean Source: Own calculation from author's primary data Table 6-3 describes the characteristics relating to grandparenting households. The highest number of grandchildren to be looked after was four, but the mean number of grandchildren per household was two. The mean age of the children was 8.8 years old. The parenting duration varied, with the longest time being 18 years and the shortest just one year; the average was four years. The youngest child cared for by grandparents was only two months old. Money was reportedly the only form of support for these households, with migrants sending remittances through the bank. Monetary support varied in amount (from VND 200.000 to VND 2.000.000/month). The average was VND 295.000/household/month, which was less than the average expenditure per month of VND 2,993,487, calculated in 2016 for a rural household (of four people) in Thai Binh and Soc Trang provinces by H. Hoang and Meyers 203 (2017). Therefore, remittances were not enough to raise a child, especially those in their teenage ages, as many interview respondents highlighted. Remittances were determined by migrants' income rather than the number of children left for grandparents to look after. In fact, 80% of migrants worked in the private sector, in manual jobs as discussed earlier. Job instability prevented migrants from sending regular remittances of high value. Only two respondents caring for grandchildren received monetary assistance on a frequent basis. The rest were irregularly supported. My son works as a bricklayer; sometimes he sends us VND 2.000.000/month when he gets a job and an income. Other months he has no money to send home as he lost his job. Remittances that we receive depend on his work stability. We cannot complain. We manage to live within the amount we have. VQA couple without a pension, raising four grandchildren The small amount of remittances and their infrequency were not enough for many to raise the children left-behind. Those with a pension reported that they must spend all their income to raise their grandchildren. Even though pensioners were financially better off than those without a pension, this still put them under pressure, as indicated. In some cases, elderly parents were left to raise their grandchildren on their own, without any financial support from their migrant children. Financial constraints and difficulties significantly impacted their well-being. Instead of being happy and enjoying life, all the respondents were stressed and worried. I have been raising my grandson for 18 years since he was a year old. His dad moved to the city for employment. He did a manual job related to construction. Unfortunately, he got addicted to drugs. He left his one-year-old son with me and then disappeared, which is sad. VQa 79-year-old widow without a pension, raising her grandson Our biggest concern is the lack of money to feed my grandchildren. We are old while our migrant children do not have permanent jobs. Grandchildren are demanding things in their teenage years. VCa 65-year-old-widow without a pension, raising three grandchildren However, no one refused the hard job of raising their grandchildren. Most of the respondents expressed their willingness to look after them so that their migrant 204 children can be comfortable working away. "We have been raising my two grandchildren for seven years now since my daughter started working away. She sends money monthly, but I save it for her so that she can buy a house when she comes back. We also send rice that we grow and chickens that we raise to the city for my children. They all love the organic products that we made. We are happy to help our children." VTa 75year-old man, a pensioner Households with single elderly individuals experienced the most significant adverse consequences of their children's out-migration. Most single elders were widows or widowers (only one woman divorced). They either had only daughters who got married and lived with their husband's family or were left alone because all of their children had migrated. Since they were geographically separated from their children, they sometimes had needs that could not be met. My son is away in Hanoi; I live here by myself. My daughter also married and lived in a different village. My son works as a taxi driver, so he did not earn much. He gives me some cash occasionally when he visits me. I know he wanted to give me more, but he does not earn much. He had just married for two years and had one child. His wife does not work. She got the heart disease and only stays at home looking after her baby. I manage to grow vegetables and rice for daily expenditure. We spare the money given by our children to pay my bills. My daughter is also poor; she gives me some foods when visiting me. VQa 70-year-old woman, living alone Those without a pension were also at the higher risk of financial difficulties compared to other groups. One-fifth of this group reported their financial situation had gotten worse and were generally between 75-80 years old. They could not be self-sufficient through their own labor due to health conditions getting worse, nor were they fully supported, making this particular group more vulnerable than others. I do not have a pension. My son works in a different province, but he did not have a permanent job so he could not support us. VTa 79-year-old woman without a pension and supporting grandchildren The financial situation has remained the same: Elderly living with the remaining children were considered to be the least impacted group, with 91.7% claiming that their financial situation almost remained the same. The absence of other children did not strongly affect them, as the remaining family 205 still supported them. However, in this situation, those living with their remaining children did not have full autonomy. Thus, most of them did not want to live with their children, unless they were sick or unable to look after themselves. I live with my youngest son, which is good when I need help. However, I must take care of my two grandsons, who are one and three years old. Their parents work in the fields every day. It is hard for me, as I got back pain and knee problems. Long hours carrying them gets me in pain and tired. Instead of doing the things that I want and eating the foods that I like, I must follow them and their timetables. Babies cry, and the noise gives me a headache. If I had the money, I would prefer living separately in a quiet place, but close to my children. So that I can eat the foods that I want and cook the ways that I like. VQa couple living with their remaining children Pensioners and elderly benefit recipients receiving some form of public benefits were also less impacted by the out-migration of their children. In this group there were 24 elderly households; each had at least one form of monthly income. It could be a pension for those who used to work in the public sector and are now retired (41.6%), or it could be social welfare for those eligible (45.8%) such as disabled elders, veterans or those who qualify for other support (as shown in Table 6-4). Table 6-4: Welfare beneficiaries and pensioners Characteristics Number and percentage (mean) Average amount of the pension VND 2.245.000,00 /household/month (≈USD 103) VND 1.497.000,00 /capita/month (≈ USD 74.8) Average benefit duration 8.6 years The average age of the beneficiaries 75.3 years old Types of beneficiary 41.6% salary pensioners 45.8% welfare beneficiaries 12.5% old age beneficiaries (who were 80+) The elders received material support from children 45.8% did not need assistance or children did not support 45.8% required support partly 8.3% helped children back Source: Own calculation from author's primary data The average pension was about USD 74.8/capita/month. The average age of those receiving a pension was 75.3 years old, and the duration for which they had already 206 received it was 8.6 years. Most of them did not need support from their children. Some pensioners even helped their children and grandchildren. One pensioner explained: We do not require material support from our children. I receive my salary monthly, which is VND 8780.000, as I served in the Vietnamese military. This amount is enough for our daily expenses. Our children do not have to worry about us. They visit us every three weeks, and it is lovely to see them and our grandchildren. We go shopping, cooking, chatting and having fun together, which is a great time. We love being independent like we are now. It makes all of us happy, and no pressure at all. We enjoy life. VT a 79year-old man, receiving a military pension and living with spouse only. The results showed that the higher the wage that an elder received, the happier they were with their lives. The degree of the well-being of an elderly individual seemingly depended on their amount of salary. Among pensioners, the man just mentioned, received the highest salary. From my observation, they were the happiest interviewees, by far. The couple seemed to be healthier, and their living conditions were better than others. Another retired primary school teacher said: My salary is VND 2.700.000 per month (UDS 103). This is not a big amount, but it is ok for me to tailor my daily expenses to. I live on my own, so it is just right. I do not need help. He cannot help me anyway, as his income is low. VQ a 65-year-old-woman on a teacher's pension, living alone Having a pension not only made the elders feel more comfortable but also reduced the stress and sense of being a burden to their children. Even with the minimal pension support of VND 180.000/month for those aged over 80, an 89-year-old woman was able to buy minimum foods required for daily consumption, as indicated by her son: VND 180.000 is a very little support. However, mum has at least VND 6.000 to buy foods daily. We count every coin, as we are poor and could not support her much. VT a 54-year-old male caring for his elderly mother who lives alone This lady was 89 years old with health problems. She lived alone in her own house, 207 which was very old and in deplorable condition. Their children, either living in nearby villages or urban-based, alternatively assisted her. The man I met in the interview was the one living closest, coming to support his mum on alternate days. The pensioners looked much happier and more confident than those receiving benefits due to their higher income. However, both pensioners and elderly benefit recipients felt better than those not receiving any public funds at all. Any monetary assistance from the government, rather than traditional ways from family, created feelings of being independent for them. It released the stress of being someone else's burden. It was a vital contribution to the well-being of elderly people living in rural areas. It was clear that monetary support from the state played a crucial role in the lives of the elderly. It could actively enhance material well-being for older people, which they considered to be a core determinant of happiness. Interestingly, pensioners should have been the least impacted group. However, some had a high income from their pension and used this to help their migrant children and the grandchildren left-behind. The younger elderly adults (60-74 years old), who could still be self-reliant was the third group to show stability after children migrated out. If an elderly person aged 60-74 years of age does not have a pension, they could still work to earn their living. Since those elderly individuals lived independently, the staying or leaving of their adult children did not change their financial situation, as indicated by 70.9%. Only 12.5% of this group stated their financial situation has gotten better, and 16.6% reported a worsening. At our retirement ages, we do not want to work, but we do not have a pension and our children are poor. We have no choice so we must try our best and luckily, we are still healthy to work. We have been working and are independent. Thus, there is no change and no problems with us when our children are moving out. A 65-year-old woman, living with spouse only We encourage our children to move out of the village. There are no jobs here. They need to earn and be independent. Otherwise, we must support them. We are happy that my youngest son has followed his brother-in-law and has been working in Hanoi for a month now. A 66year-old woman who lives with her remaining children 208 In summary, Although the elderly individuals with migrants were materially better supported than those whose children had not migrated, the results showed no significant financial gap between them. Among the elderly parents of migrants, single and grandparenting elders were the most negatively impacted groups. Households with a single elderly parent could not receive the immediate financial support when needed. Similarly, elderly parents of migrants who are supporting grandchildren experienced fiscal constraints because of the insufficient and infrequent remittances from their migrated children; they were also overworked due to raising grandchildren. The outcome was a bit better for elderly parents living with their remaining children, as they at least had the support of their remaining children if the migrants did not support them with remittances. However, living with their remaining children sometimes limited their independence in the family, especially for those who were sick and vulnerable. Not surprisingly, younger elderly adults were less impacted, since those seniors were still healthy enough to be self-reliant. Thus, the absence of their children did not cause them any problem. However, most of these respondents said that they reluctantly worked because of the lack of support from others. If they had a source of support, they would not have worked, choosing instead to relax and enjoy their old age. The most independent group was those receiving a pension and those receiving a benefit of some kind – in other words, those who lived by their own money. They are decision makers in their household and have full autonomy. Overall, the pensioners residing with their spouse only were found to be happiest. Having their own income and living as a couple in their own house, separately from their children, was the ambition of most. Living with spouse only and independent is the most popular trend in developed countries, but it has not yet reached developing countries such as Vietnam (see more in Appendix 2). 6.3 Emotional well-being consequences Here we address the second research question: how does urban child migration emotionally affect rurally-based elderly parents? To assess whether the elders of 209 migrants feel better than those whose children have not migrated, and to understand how urban child migration affects those left-behind, it is useful to compare parents' emotional well-being between and within those elderly groups. Unlike many Western counterparts, in developing world economies, financial constraints do not allow most older people to be independent or to pursue their hobbies. Also, the traditional culture ties a person to their family or requires them to be family oriented, especially in Asian countries like Vietnam. Therefore, family responsibilities play an essential part in elderly adults' well-being, especially the relationship with their children. Given that fact, the emotional well-being of rural elders who participated in this research was examined mainly on the basis of the relationship with their migrant children, specifically: how the reciprocity with their migrant children satisfied the elderly villagers; whether they kept in touch (phone call, social media contact, or visiting in person) to maintain their connections, and how good was the mutual care between them. 6.3.1 Comparison between the elderly with migrant children and elderly whose children have not migrated Figure 6-13 illustrates the emotional care provided to rural seniors by adult children. Twelve (12) elderly household samples which did not have a migrant were compared with the same number of household samples where elderly adults did have migrant children. Both groups of elders were asked if they were happy with the care shown or given to them by their children, with that care being expressed through visits and telephone calls. Their answers to this question helped to construct an understanding of how urban migration emotionally impacted on those who were left-behind. The findings were as follows: 210 Figure 6-13: Emotional care from adult children (parents' self-rated) Source: Own calculation form author's primary data The elders of migrants received more phone calls, while those whose children have not migrated were visited more frequently by their children. 75% of the elderly respondents who had migrant children received phone calls; for elderly individuals whose children had not migrated, this was just 16%. In contrast, 83.3% of the latter were visited at least monthly by their children compared with 66.8% of the former. The elders of migrant children received better emotional care than their counterparts. An average of 70.9% of elderly individuals with migrant children received monthly contact (both visit and phone call) compared with only 45.6% for those without. It was an indisputable fact that those without migrant children found it easier to frequently catch up with their rurally-based children since they usually lived in the same or nearby villages. Most of this group reported that they were visited daily or weekly by their children. However, the older adults with migrant children indicated that the movement of their children could significantly reduce opportunities for face to face interaction, but geographical separation did not preclude contact between them by phone or 83.3% 8% 75% 66.8% 75% 91.6% 0 10 20 30 40 50 60 70 80 90 100 Visit at least monthly Phone contact at least monthly Happy with emotional care of children Non-migration children elders Migration children elders 211 other means of social media. Nowadays, with the support of advanced technology and convenient transport options, it was easy for rural parents to maintain contact with their city-based children or to meet in person if needed. Therefore, most of those who took part in the research revealed that there was no problem regarding emotional care with the absence of their children. Geographical separation was no longer an issue – it was now considered advantageous, something which benefited both the leavers and those who remained behind. Most elderly individuals with migrant children not only received care from migrants, but most of them also had remaining children to see at least once a month. My sons living in Saigon call us at least one per month. One is living in Hanoi and visits us sometimes. However, my daughter who lives nearby attends us every week. It was not a problem at all. We are happy with the care they show us. VTa couple living together The elderly with migrant children felt more comfortable and more pleased with their situation than elderly individuals whose children have not migrated. Figure 6-13 shows 91.6% of those with migrant children were delighted with their children. Only 75% of those whose children have not migrated said the same, and the reasons for this were found mostly to relate to financial issues, as one woman explained: My children are all here, two of them live next-door and the other lives in a nearby village. They are all farmers and very poor, which is sad. We encouraged them to find a job in the city, but they did not have money to move, and also don't have any citybased friends or relatives for the initial help. One of my children living next-door does not care much about us. Sometimes we must help them back, which makes us tired. VT a couple whose children have not migrated Most of the elderly individuals who did not get on well with their children reported that those children that had not migrated were a burden. This made the relationship between them not as good as expected or even fractured. A man with migrant children explained: Children having a good job and a good income is more important than being geographically close to them. I only worry if my children are stuck in the village without a job, but we are lucky and glad that our children have good lives in Hanoi and can care 212 for us. From my point of view, keeping a certain geographical distance is somewhat better to reduce the conflicts and discord between generations, which is difficult to avoid if living together and very close to each other. A 75-year-old man with migrant children Consistent with this perception, one of the village leaders in the group discussion confirmed that: From my observation as a person sharing the neighborhood with those researched elders, having younger generations settled in the city is a pleasure, which many village parents are proud of. Apparently, they are happier than the elderly without migrant children. FGDa key informant 6.3.2 Comparison among the elderly parents of migrants Among the parents of migrants, the same question was asked about whether they emotionally felt better, worse or remained stable after children migrated. Table 6-5 shows the results to the participants' answers. Emotional well-being has become better: Those living with spouse only were in the best emotional state following the migration of their children, with 58.3% reporting an increase in well-being; this was followed by those who resided with their remaining children (50%). Of the younger elderly adult group, 45.8% also admitted that they felt better after the move of their children. Living with spouse only and younger elderly adults were usually self-reliant or financially independent. They were either working full-time or had a pension. Thus, if their children could move elsewhere to get a job and look after themselves, the parents were happy. Our children all migrated to Southern Vietnam. We live on our own here. I have a pension as a primary teacher, and so does my husband. We are happy that our children could settle down and have a job there. VQ-A 74-year-old man, living with his spouse only 213 Those living with their remaining children also felt better than other groups. Without the presence of their migrant children, this group still had at least one child staying in the house to look after them. With this type of living arrangement, elderly parents did not feel deserted by their migrant children. Although, most of the elderly felt more comfortable with the care provided by their spouse, cohabiting with the remaining child was the best choice for those who were frail or vulnerable, for those who were widowed, and for those with age-related disabilities. I am 84 now, living with my youngest son. He married and had two kids. My wife passed away more than ten years ago. I am too old to live by myself. My other children are spread out all over the country. They visited me on the lunar New Year, but they call me sometimes. My son looks after me, which is good. VTAn 83-year-old man who lives with his remaining children However, cohabiting with the remaining children also had shortcomings compared to living with spouse only. Reported shortcomings included being tired when looking after grandchildren, not having a quiet space to rest, losing autonomy in the house, and occasional tension with extended family members. Some reported that this affected their emotional well-being. A couple living with their married son complained: We are living with our married son, but we do not have our private space. At our age, we need a quiet and peaceful place to rest and relax. Here I have two young grandchildren. They make noise all the time, which is disturbing and gives me a headache. I have had problems with sleeplessness. I could not sleep at night time and get proper rest when I need, as grandchildren cry. This is stressful sometimes. A couple, co-residing with remaining children 214 Table 6-5: Emotional consequences of urban migration of adult children for rural elderly parents (the elders' self-assessed) Influential factors (variables) Elderly samples (total N=48) Better Worse Same or not sure Percentages (%) Ages (N=24 each) 60 -75 45.8 25.0 29.2 76 and over 29.2 41.6 29.2 Pension or welfare beneficiaries (N=24 each) Have at least one 41.6 25.0 33.4 Don't have 33.3 37.5 29.2 Living arrangements (N=12 each) Living with other remaining children 50.0 0 50.0 Living with spouse only 58.3 16.6 25.0 Living with grandchildren only 25.0 50.0 25.0 Living alone 16.7 66.6 16.7 Notes: Each comparative group of the variables was even in number. The highligted numbers show the elderly groups who were either negatively or positively effected the most by out-migration of their children or remained the same. Source: Own calculation from author's primary data Emotional well-being has become worse: Interestingly, for single household ELBs who lived alone, 66.6% of them reported as the loneliest group. Almost all the elderly living alone complained about feeling lonely, despite talking with their migrant children weekly by phone. They still felt sad and missed their children and grandchildren. I have three daughters. One lives in South of Vietnam, Ho Chi Minh City. One lives in Hanoi, and my youngest daughter lives 20 minutes away from here. I live alone and feel lonely. I am sick of living on my own. My granddaughter sometimes comes and stays a night with me, but I want one of the children to live with me permanently. I know this is impossible. My children must work and must stay there. Traditionally, elderly parents live with a married son, not with a married daughter. It is not easy for me as I 215 do not have a son. A 65-year-old woman living alone Of those who lived alone, many reported keeping a close friendship with their neighbors and nearby relatives, as this was the only way to reduce their loneliness and feel connected. They tended to spend daytime catching up with friends or visiting neighbors. Whilst not as lonely as those living alone, many of those living with and supporting grandchildren felt burdened (50%). The absence of the middle generation made it harder for the elderly who had grandchildren to care for. 90% of those caring for grandchildren complained of being emotionally stressed because of not knowing how to teach the grandchildren or to look after them in the right ways. I am stressed because my grandson sometimes does not listen to me. He is a teenager, learning bad things from his peers. He plays games all the time and is often absent from school without any authorisation. My daughter is away at work. She is living in Hanoi. She can't stop working to return here, so I am the only one looking after him, A 64-year-old woman, living with grandchildren. Many elders indicated that caring for grandchildren was not only an economic burden but also an emotional pressure for them. In summary The data from the current study show that urban migration of adult children brought joy and happiness to most of the rurally-based elderly parents. However, some of them – such as those living alone and those raising grandchildren – expressed feelings of loneliness and pressure with the absence of their children. Local governments do not organise any social activities to support their senior dwellers. Therefore, many elderly with migrant children are left to deal with that situation themselves by communicating more with their neighbors, watching TV, or contacting their children. 6.4 Physical care consequences In addressing the third research question of how out-migration of children affects physical care for rural parents, this section analyses the daily care for parents to 216 find out whether the absence of their children had any impact on their physical health. Overall, the respondents are likely to report poor health, with 98% of them reporting that they had at least one chronic disease (Figure 6-14). Health problems varied, but the most common health issue that was reported related to bones and joints such as back and knee pain, which prevented individuals from doing many things. Figure 6-14: Elderly participants' health conditions (self-rated) Source: Own calculation from author's primary data 6.4.1 Comparison between the elderly with migrant children and elderly whose children have not migrated Regarding health care and personal assistance, elderly individuals without migrant children received better assistance than those with migrant children. Care in hand support includes the activity of daily living (ADL) such as eating, showering, dressing, toileting, physically assisting disabled parents; also, housework support or farm work assistance when parents were unwell. 5.3% 32% 63.7% Good Normal Not good 217 Geographical separation made offering this kind of support a challenge for migrant children. In contrast, those who had not migrated were present to help where needed; this was especially convenient in cases of immediate or emergent health issues. The close proximity of their children made the elderly parents of children who had not migrated feel safe, and this positively contributed to their overall sense of wellbeing. Caregiving could also be easily shared between siblings, and so no one got pressured by the expectation of taking on such a hard job. The majority (83%) of elderly individuals whose children remained close by indicated satisfaction with health care assistance from their children, while only 66.6% of those with migrant children felt this way. I have five children, and they all live in the same village. I live alone, but when I get sick, my children alternatively take turns to look after me. My daughters cook for me every day and help me with housework and ADL. I am grateful for that. A 77-year-old whose children have not migrated, living alone In the same situation a woman with migrant children had a different experience: I fear to get as sick as my children live far away from me. I must look after myself, not tell them if I am ill. If they know, they can do nothing but worry. A 65-year-old woman of migrant children, a single household 6.4.2 Comparisons among the elderly parents of migrants Elderly individuals living with a spouse, who are financially independent and in good health were most optimistic (Table 6-6). Of them 33.4% indicated they had better physical care after children migrated. Those with migrant children and who lived with their spouse were commonly younger elderly adults who had lower demand for healthcare support due to being in better health. These people noted that they only called their children for help when a severe health issue arose. Otherwise, the couple could look after each other for most of their simple sicknesses. As they did not require much in terms of care and physical support, individuals in this group did not feel a significant change after the migration of their children. The impact of their children's migration was reportedly either neutral or positive. 218 Table 6-6: Physical care consequences of urban migration of adult children for rural elderly parents (the elders' self-rated) Influential factors (variables) Elderly samples (total N=48) Better (+) Worse (-) Same or not sure Percentages (%) Ages (N=24 each) 60 -75 8.3 37.5 54.2 76 and over 8.3 41.7 50.0 Pension or welfare beneficiaries (N=24 each) Have at least one 12.5 33.3 54.2 Don't have 8.3 41.7 50.0 Living Arrangements (N=12 each) Living with other remaining children 0 8.3 91.6 Living with spouse only 33.4 16.6 50.0 Living with grandchildren only 0 41.7 58.3 Living alone 0 91.7 8.3 Notes: Each comparative group of the variables was even in number. The highligted numbers show the elderly groups who were either negatively or positively effected the most by out-migration of their children, or remained the same. Source: Own calculation from author's primary data Elderly individuals who live with their remaining children were in a "safety zone," meaning this group has children close by who can act as caregivers when needed. However, cohabitation raised some concern over care received. Individuals felt that they had less autonomy due to their dependency on the children they live with. Their children were the decision makers, sometimes going against the parents' needs. In many cases – for example, when parents were sick – instead of seeking professional treatment, children simply kept their parents at home because they thought it was nothing serious. Parental care entirely depended on the child's knowledge and their financial capacity. Consequently, many elderly parents did not receive the right healthcare treatment. During the interview period, I lived in the same house as an 80-year-old woman. 219 She was disabled, being looked after by her step-daughter. The children thought their mother was old enough to die, so they did not bring her to the hospital for a cure or any treatment. She was kept in bed and treated at home. Caregiving was shared among her three remaining children. Her other two children lived in Hanoi and occasionally visited her. Rather than consulting a medical specialist, the treatments all depended on her children's knowledge and understanding. This lady was groaning in pain, all day long. Instead of seeking healthcare treatment, she had been left at home in bed for two years. Her situation was very typical for the elderly in rural Vietnam. This sort of tradition leaves elderly individuals at risk of insufficient care and unintentional emotional abuse by the unknowledgeable children. The 84-year-old woman next door to the family that I lived with was living with her eldest son. She was weak and frail. Her son shouted and yelled at her most days. Although many rural old people had been nicely cared for by their children, others are at risk of abuse, especially the elderly with disabilities who needed a lot of care. This was the voice of a carer: We feel exhausted as my mum has been in intensive care (served in bed) for almost four years now. We alternatively take care of her. If my sister looks after daytime, I must take over at night time. I went to see the fortune teller early this year; he said my mum might go this year. We were praying and hoping that she can go smoothly. It would be better for her to go than lying in bed for years. A 49-year-old man, a carer for his mother who is 80 years old Some children felt overwhelmed by looking after their sick parents for years. They were stressed and could not control their behavior sometimes. This resulted in the elderly parents sometimes being neglected or abused by their children. Elderly individuals living alone and those living with and caring for grandchildren were particularly vulnerable (Fingure 6-15). While those living alone had more mental health problems with stress and pressure, the elderly living with grandchildren had more physical health problems. 220 Figure 6-15: Looking after a grandchild when their parents out-migrate Source: Fieldwork, 21 January 2015 (Vu Trung commune Thai Binh, Vietnam) A woman living with grandchildren said: I have had headaches for more than ten years now, and they are getting worse. I often get dizzy and vomit. I must lie in bed for some days. Sometimes I must get over it by myself. I did not tell my daughters that I was sick as they all live far away. They cannot help me, so I do not want them to be worried. I only inform them when I get severe illnesses. It is a tough situation. One day while working in the garden in front of the house I got dizzy and became unconscious. I did not know what was happening to me. After a while, I realised that I was lying in the vegetable patch. No one was aware I was in that situation. My grandchildren were not at home. That was dangerous. Luckily, I am still alive. A 66year-old woman, living alone Single and skip-generation households were at high risk of health problems. Most of those elderly felt deserted and struggled with their situation. 221 6.5 Difficulties and coping strategies of rural elderly parents of migrants 6.5.1 Material difficulties and coping strategies Many older adults maximised working hours as a primary strategy to cope with financial challenges. Minimising living costs – for example, only watching the programs that they like, and thus saving electricity – was another strategy. Buying cheap foods and in the minimum quantity was also reported as a way of saving money. Some of them only purchased meat for children and adults who were sick. For example, a conversation between researcher and a respondent: Researcher: do you watch TV when you are free? Mrs Ng: We cannot afford to pay the electricity bill, so I work instead. Researcher: What do you do? Mrs Ng: I knit clothing. Researcher: How much do you earn per day? Mrs Ng: VND 5,000 (=USD 2,5) Borrowing money from others was the last solution for elderly individuals in financial crisis. Money was borrowed only from people close to them such as relatives, best friends, and good neighbors – people they trust and who trust them. With access to resources not always possible due to the distance between elderly individuals and their children who have migrated, many elderly individuals had to manage their expenses within their own financial capacity. 6.5.2 Emotional difficulties and coping strategies When an elderly individual felt lonely, sad or under pressure, they commonly reported watching TV, but many preferred talking to their neighbors or relatives who lived nearby. Telephoning their children was less common. With their finances constrained, elderly villagers could not afford to partake in leisure activities or go on holidays. As Mrs O, who lives alone, said: "Sometimes, I stay in my neighbour's house all day, helping look after their infant who is 6 months old. The mother works 222 as a high school teacher. She has an after-school class at home. I help them for free, because I just want to escape from my house. I feel so lonely staying at home alone all the time." 6.5.3 Physical difficulties and coping strategies The family was confirmed as the primary source of health care and physical support for elderly adults. When old parents are facing severe health issues, children must stay or return to look after them. 6.5.4 The role of local governments in supporting their elderly population Surprisingly, the conditions of the original place of migrants did not seem to have any influence on the elderly households' economy. There was no systematic difference between the elderly in better off communities and the ones living in underprivileged villages. In all cases, there was no material or physical support from local government or other official agencies. The only difference was that infrastructure such as roads were a little better in wealthier more developed communities. There was no social welfare support for the elders at local levels. They are only able to implement policies given to them by the state. When asked: "Do you want support from the local government?" Mr D in Vu Trung commune said: "All of us wish to be assisted by the local government, but we cannot complain if they cannot afford to help us." Regarding emotional difficulties, the local elderly association visited their members if they were sick, or attended the funeral if someone passed away. However, both circumstances relied mainly on the financial contribution of the elderly themselves. 6.6 Chapter summary To compare with elderly individuals whose children have not migrated: the situation for elderly parents of migrants has been financially and emotionally improving, but daily care has been reduced. Among the elders of migrant children: It would seem that migration contributes positively to rural seniors' well-being. However, the benefits of migration do not 223 contribute equally to all elders. Indeed, groups of the younger elderly adults (60-75 years old), the pensioners, and those who cohabited either with remaining children or spouse were found to be in a "safety zone," while single and grandparenting households were in an "alarming situation." The extent to which this movement has positively impacted rurally-based elderly parents was dependent on many factors, of which income, age, and living arrangements are found to be the most important factors affecting the disparity in well-being among the elders in our study population (see more in Appendix 3 and 4). Those with at least one safety net were found in a better position than those without any safety net. Notably, in the worst situations, rural elderly parents, as my observation, seemed not to have any effective strategy to cope with, or to overcome, the difficulties. Rather they simply suffered from it. For example, as reported, they reduced living expenditure, did not get medical treatment when sick, withdrew and isolated themselves from social contacts. Interestingly, the economic conditions of the local (commune) did not appear to significantly influence villagers' well-being. Family care is the most important factor in elderly parents' survival. Commune status – how developed level or wealthy a commune is – did not make any difference to the lives of rural elderly individuals when children are working away. 224 CHAPTER 7. LIVES OF RURAL ELDERLY INDIVIDUALS: MYTHS AND REALITIES Despite the positive effects on both the material and emotional well-being of aged rural parents, there were also many problematic issues that arose in the rural elder's real-life situations. This chapter reveals the realities behind the scenes that many rurally-based elderly individual face daily which came mostly from the observation data. Other subjects emerged from the collected data were also thematically identified. 7.1 Daily life and social customs Most of the farmers start their working day early to avoid being out in the sun during the hottest part of the day. The women in the house (mother or grandmother) wake up and cook breakfast for the whole family at about 4.30 to 5am. As farmers have to work hard in the field throughout the morning, breakfast is their main meal of the day. Elderly parents who are too old to work in the fields stay at home and support their children with household chores such as looking after the grandchildren, feeding the animals (e.g. dogs, cats, chicken, pigs and fish), go shopping at the local market, and preparing lunch and dinner for their children returning from work, for those coresiding with an adult child. If they have free time, elderly parents visit their other nearby children, relatives or neighbours and spend time chatting and having fun. This seems to be a routine of rural people's daily life, especially elderly female individuals. Men more often stay at home and watch TV, but most of them limit their use of electricity by turning off the TV and playing chess with friends or neighbours. Elderly individuals can call on neighbours any time and do not need to inform them in advance. Any rural family that keeps the door to their house closed is considered to be unfriendly and can to an extent be excluded from the community. The connections between rural residents are closer than that in metropolitan areas and appear to be stronger in developing countries than in other more advanced 225 modern societies. Neighbours are not simply people who live nearby but are individuals who you can share your life stories with or support with money or food when needed. After family and relatives, neighbours are another safety net for rural dwellers. Family, relatives and neighbourhood connections are the main source of social engagement and activity for rurally-based individuals. Unlike the busyness of life in urban areas, life in rural parts is at a relatively slow pace. Most rural regions grow quiet around 10pm when people go to sleep, ready for an early morning of working in the fields. Most of the elderly interview participants could not drive, especially women. If elderly individuals need to go somewhere far away, their children or relatives will take them. If the distance is short i.e. around the village, or from house to house they will just walk. Motor bikes were used as the main mean of transportation in rural villages. Most rural households owned motorbikes or bikes. There was no public transport available in the researched villages. Hays (2008, p. 1) comments that "for many Vietnamese, the village encompasses their lives. They are born, grow up, marry, have children, grow old, if fortunate, and die; often without ever having left the village environment." This was true of the situation of the people in the research locations of this current study. Hays concludes that "the rural lifestyle of the Vietnamese population is closely related to its villages and native lands." Many of the respondents in the current study have not been out of their village at all since they were young. All they know is within the boundaries of their neighbourhood. The world outside of their village is known only through television. Some of the elderly participants reported visiting their migrant children in the cities where they worked, but this was not common. There was a lack of sport/physical activities among the elderly participants. There was only one couple that reported that they do exercise (jogging) in the morning. Travelling seems a non-existent notion for many and is a luxury for the majority, if not for all. 7.2 Financial difficulties Financial difficulties emerged as the central concern of more than 90% of respondents and was the most common theme. Many complained about not 226 watching the TV because they could not afford the electricity bill. A couple said they gave their own food to their grandchildren because it was too expensive to buy meat every day. Meals were malnutritious for many elderly participants. "We buy pork every day but only small amount (0,3kg) because we have two granddaughters living with us. We mostly eat vegies and save meat for the children." A grandparenting couple (Vu Quy commune) Others had tried to cover all of the heavy workload in the fields instead of hiring someone, in order to save a little money. A lot of elderly patients were suffering from sickness during the time of my interviews because they did not have money for treatment and hospitalisation. A majority were struggling even with their basic needs, so travelling was too much of a luxury. Only five households reported that their income was enough for their everyday expenses. Of them, two were supported by their migrant children and three had a pension. The other 55 households all were in a financially difficult position. They complained about low income and could not afford to pay for daily food and medicines. The following discussion illustrates the point. Researcher: What do you think about the elderly's financial situation? Key informant in focus discussion group: Most of them are in a very difficult situation financially. Many of them still worry about affording food. They do not have an income and cannot afford health care when they need it. 7.3 Working hard Many elderly parents kept working as much as they can to earn a living. There were many reasons for the elderly individuals in the current study continuing to work in their old age, including to feel useful; to not feel as though they are a burden or helpless, and to keep themselves physically and mentally active. Working also helps elderly individuals to interact and better communicate with family members, neighbors and the broader community, which in turn enriches them emotionally, as reported by many. Being able to contribute towards the income or general running of the household safeguards their sense of self-worth and their overall social status. However, the primary incentive for these elderly individuals to keep working was 227 financial. Beyond the above-mentioned reasons, this is the most important motivation. Most of the respondents complained that working was not comfortable at their old age, especially for those who were unwell. But they had no choice because they need to survive. Most of them tried to live their life independently and did not want to lean on the support of their children. "Being a burden on someone is not good at all since children have had enough hard life themselves." The elderly in VT commune 7.4 Hospitalisation is a big concern Most of the participants had health problems, reporting at least one chronic disease. However, none of them sought formalised treatment due mostly to financial difficulties. They either continued to suffer, cared for themselves informally at home, or only sought care at local, grassroots clinics where a lot of diseases cannot be treated. Going to the larger, province-level hospital is too expensive and can be very difficult for elderly individuals to afford, as a 67-year-old widow reported: You have to pay for everything you need and also for those looking after you food, accommodation, medicines, it is a lot of money. Also, hospital condition in Vietnam is not good. It is too busy with overload of patients in which two or three patients share one bed. Rural people are normally poor, so they are not treated well by doctors. Given those obstacles, especially the financial constrains situation, most of the rural elderly people were discouraged by official treatment from hospital when needed. Because of that, some died without knowing about their health issues. 7.5 Living alone is not a choice but a necessity Living alone in rural Vietnam typically occurs because the person's options are very limited. The following vignettes give an idea of the situation. Note that all names have been changed to preserve anonymity. Mr Ngh was 93 years old at the time of the interview. He has five children, two sons and three daughters. All of his children have grown up, had their own families and 228 now live apart from their father. Three of this man's children have migrated to the south of Vietnam (Ho Chi Minh City) and settled there. The other two live in the same province but different districts. Mr Ngh is a widower and has lived alone for more than 20 years since his wife passed away. He resides in his own house and his living conditions are poor. The house is small and very old. There is nothing of real value in the house, other than a bed that he sleeps on and one table for him to drink tea with neighbours every day. He receives only VND 180.000/month (USD $ 10) from a pension for those aged over 80 years. This is the main source of his income. His children also help out financially, but not often. During the interview, he stated: "when I receive this pension, I have to buy rice first and I buy other food after if I have any money left, otherwise my meal contains only rice and vegetables that I grow in my garden. That small amount of money is not enough for me to live on". When he was asked about why he did not live with any of his children as other elderly individuals often did, he said: "my eldest son's wife is sick. She had a stroke and needs intensive care. She is now needing mobility support. I cannot add more burden to my son's life. His life is already hard with a sick wife. My other son lives in the south of Vietnam. I wish my kids were here with me, but they cannot be. They are too busy with their lives and do not visit me often. I have been in pain with my left shoulder for three days now, but I have not called my children. I only ask for help when I get seriously sick. I wish one of my children lived with me, but it seems impossible". This old man looked sad and unhappy when telling his stories. Mrs On Nguyen is a 66-year-old farmer and a widow. She is retired, but sometimes works as a nanny taking care of a newborn baby for a young neighbouring couple when they need help. She is the mother of three daughters her eldest lives in Hanoi, her second-born in Ho Chi Minh city, and the youngest lives in a nearby village. Due to her daughters all being married, they now live with their husbands' families. As is traditionally the case, elderly parents only live with married sons and not married daughters, so Mrs On Nguyen lives alone in her own house since her husband passed away 14 years ago. Her house is very small, and her living conditions are poor. She is without any valuable things no TV, radio, or fridge. She said, "living alone was not my choice, but is a necessity." 229 As a spouse of a pensioner, Mrs On Nguyen was eligible to receive a 70% pension when her husband passed away, which was around VND 460.000/month (UD $ 25) at that time. This woman was so upset and in tears when telling her life story: "It is sad living alone. I feel so lonely every day. How should I complain? My children did not get much education and I felt guilty about that. They moved elsewhere seeking jobs and their lives are so hard as well. My second daughter migrated to Dong Nai province (South Vietnam) and has not visited me for nine years now since she left. She cannot afford for such a long trip to visit me, and even limited in phoning mum as it costs lots of money for an inter-province call. She only phones me once every two months. My eldest daughter lives in Hanoi. She rarely visits me as she has two little girls and is very busy with her life there. I have not seen her for almost one year now. But she calls me monthly. My youngest daughter lives in a nearby village. She checks up on me sometimes, whenever she passes by my house, and buys me food when she can. My nieces visit me at the weekend and sometime sleep over. Still, I feel lonely almost all the time. I have to save money to fix the leaking roof. My children help me with money, but it is just a little. They bought me an old mobile phone for convenient communications. I work part-time as a nanny for my neighbour when she is busy. She is a high school teacher. She has after school classes, so I helped take care of her newborn. She gives me some cash. It is not only cash. It makes me feel needed and in touch with people. I stay in her house most of the day even when I am not in charge of her baby, but for two months now I could not work as I have been sick. My health is not good. I have been getting chronic migraines and a bad stomach, high blood pressure, and dizziness for more than 10 years now. When I am sick, I feel terrible. I cannot cook and sometimes I am hungry but do not feel I want to eat. I am terrified when I think about going hospital. My children said they will arrange something for me when I am too old or too sick. I feel life is meaningless. Death is a release. I do not have a son to live with and I cannot live with my daughters. They are with their husbands and their families. I just wish God would let me go so I do not have to worry about everything and anything." When asked for her thoughts about living in an elderly care facility, she answered immediately without any hesitation: "yes, please." This woman is the only individual from the study to feel the need for a care home. I lived with this woman about 1,5 months while I conducted in-depth interviews in the village. She said she was so happy having me, having someone to talk to. She 230 said she was normally in her neighbour's house all day, helping them and watching TV there. She went to bed quite early, around 8pm, and woke up early around 5.30am. She complained about her difficulty sleeping and said that made her tired every day and made her stomach ache and migraines worse. She did not have an inside toilet, so at night she had a bucket in the house in case she needed. She cooked once in the morning for the whole day. She raised some chickens for food and in case of a family reunion for lunar New Year celebrations. "Such a boring life", she added. There is an increasing trend globally of old age people living separated from their adult children as they become wealthier (B. Evans & Palacios, 2015; World Bank, 2016a). The reluctance to live alone of those elders showed that for the elderly participants in this research, either their health or financial conditions were poor and uncertain. 7.6 Abuse and neglect of elderly individuals Elder abuse occurs often in Vietnamese society according to the norms of the developed world; however, both the perpetrators and victims regard it as a normal part of life and wouldn't regard it as abuse. The following two cases give an idea of its occurrence. Again, all names have been changed. Case 1 I lived with an elderly family for 2.5 months whilst conducting the research. There were only two people in the house one 80-year-old widowed woman and her 57year-old daughter who had never married. The widow Mrs Ph reported having seven grown-up children. Three of them live in nearby villages and the others live in Hanoi. At the time of research, the mother had been confined to bed for more than three years, and therefore needed a full-time caregiver. The daughter who lived with her was in charge of that role and assisted her mother with all daily personal activities including cooking, feeding, and upkeep of personal hygiene. Since the development of the mother's health problems, she had never been taken to hospital for a proper health check. Also, she had not had any formal treatment for her health issues. When 231 I asked the daughter about what disease her mother had, she said: "Mum has difficult mobility and cannot walk because she is too old. It is normal with an elderly person." However, from my own experience (as a care worker in a nursing home facility in Australia), immobility is not simply a result of old age. Often, immobility means that there is something wrong. The mother was calling her daughter's name all day long. "Do [daughter's name] – I am hungry, I want to eat" even though she had just eaten. "Do I want to pee" even though the daughter had just helped her with her toileting. "Do give me a comb" and so on. Given her behaviour, it appeared that the mother may have had dementia. The mother obviously appeared to be in pain from long hours lying immobile in bed and many years without much movement. The mother's immobility caused pressure sores and necrosis in some parts of her body. No medication had been given. "We do not want mum to take any medicine as it is not good. She might become addicted to it", the daughter explained. When the daughter was tired, she shouted at her mother: "I am sick of you, shut up – don't call my name". The daughter roughly handled her mother when toileting her. It is a hard job to be a full-time caregiver, despite three of the daughter's nearby siblings taking it in turns to care for the mother, alternatively looking after her at night time so that the residing daughter could sleep in preparations for her daytime responsibilities. The mother's eldest son from Hanoi visited and stayed with her for two weeks. The son was an alcoholic, drinking every day. "I wish you would just die" he yelled at his mum when he was drunk. Verbal and physical abuse was happening almost every day. The mother was neglected most of the time when she asked for help as the children put her demands down to her dementia. The son swears if the mother wakes him up often at night while he is caring for her. The children all expressed love for their mother, but the way they treated her was often with no dignity or respect. However, none of the children recognised their adverse reactions to their mother or their neglect of her as abuse. The situation was not alleviated by small financial contributions from the mother's city-based children (compensation for their absence). Due to financial constraints, the children refused to take their mother to hospital. Without any proper treatment, the mother's situation was getting worse. When one 232 was asked whether they would get their mother proper treatment if they could afford it, one daughter's response was: "Maybe". It can be seen clearly that both financial difficulty and lack of knowledge puts rural elders in an uncertain and, at times, unsafe situation at this late point in their lives. While elderly individuals in the West can often determine where to live (either in their own home or a retirement/care facility), and which hospital to go to for treatment by using their own money, the lives of rurally-based elderly individuals in Vietnam are in the hands of their children. Being dependent and without any autonomy can be difficult and sometimes unsafe for such individuals. Elderly parents may die because medical treatment is unaffordable some may even lose their life because the care given to them by their child or children is insufficient. Sadly, many individuals may die without anyone really knowing why the only explanation given is "because they are old." Case 2 Mrs Ha lives next door and shares the front yard with the family I lived with during the research. She is related to the family I stayed with. Mrs Ha was 84 years old at the time of research, a widowed woman living with her eldest son and daughter-inlaw. The son and daughter-in-law were around sixty years of age and had grandchildren, therefore Mrs Ha was a great-grandmother. Mrs Ha was still in good health for her age. She helped with housework such as mopping the floor and other light work around the house. Surprisingly, during two months of observation, she rarely talked. She remained quiet all the time, and I rarely felt her presence in the family. Sometimes grandchildren came to visit, and the son and daughter-in-law were so happy, laughing and talking. Yet Mrs Ha was sitting around, quiet and sad, and it seemed as though no one really cared about her. Sometimes, her son raised his voice - "why did you do that mum?" when he was angry with his mother. I heard the son telling his mum "You know nothing". When I asked Mrs Ha: "How do you feel about living with your son? Can you tell me anything that upsets you or you are happy with?", she said "It is fine. I am too old, so my son is looking after me. It has been the same for more than 20 years now". The woman herself seemed to accept life as it was. She appeared used to the situation and did 233 not recognise the mental and emotional treatment she sometimes received from the family as elder abuse. In traditional Vietnamese rural society, the elders consider it better to suffer the hidden abuse and save the family name, rather than leave the family in a public way and dishonour the family name. Emotional and social isolation is quite common among very old individuals in rural areas (Dugan & Kivett, 1994). However, in contrast to Mrs On Nguyen, Mrs Ha said that she did not feel lonely or disconnected in her house, even though she quite likely did. The statement of Advocare (2016) that elder abuse can be silent and unseen and that often goes unrecognised and unreported, reflects the situation of many elderly individuals in rural Vietnam. 7.7 Mental and physical over-burdening when in charge of grandparenting Elderly individuals in charge of their grandchildren's care more frequently reported mental and physical suffering. For example, Mrs Che (name has been changed) is a 65-year-old widowed woman whose husband passed away 20 years ago. She is the mother of three children: two sons live in South Vietnam. Her daughter is also widowed and works in Hanoi as a nanny. Since life in cities can be hard, Mrs Chen's children left their own children at home with her. Mrs Che has been taking care of three grandchildren (two of the daughter's children and one child from her son). She has been raising her grandchildren for more than 14 years since they were toddlers. "I have lower back pain, so I cannot do the hard work. I rent my farmland. I do not have any income; my daughter assists me financially for raising her kids (about VND 500.000/month = UD $ 25). She pays tuition fees, this is only for our expenses. My son was in debt, as he paid lots of money for working overseas, but he had to return because they cheated him. Now he has to migrate to Ho Chi Minh City, working hard so he can pay off that big debt. He sends money for his child's tuition fees only, so I have to cover my grandson's food. I grow vegetables at home in my garden and have some chickens for eggs." "I have a low blood pressure problem, and I have had this trouble many times. One night I was severely dizzy, my 14-year-old grandson called his mother in Hanoi. My relatives nearby 234 were informed by my daughter. They took me to hospital and saved my life. Otherwise, I would not have been with you today. Another time, I was collecting vegetables in the garden. I did not know that I was unconscious until I woke up and realised that I was lying on the ground. I also fall on the floor sometimes. Luckily, I am still alive after many times of being unconscious. It was a very hard job taking care of the grandchildren when they were small in terms of physical burden. I got back pain because I was carrying them a lot. Now it is getting better as they all are more independent. However, I face other difficulties in teaching and supporting them in their studies, especially those in their teenage years." Mrs Che complained: "It is the biggest challenge keeping them under control. My grandson is 14 years old. He is addicted to online gaming, playing whenever he can, even played truant from school. I am upset and so worried for him." Researcher: What do you wish for life in the future? Mrs Che: "My grandchildren will grow up and may move somewhere else, so it might be only me living here. This house is too old, so I wish to renovate it and have a toilet inside so that I do not have to go outside when I need the toilet at night. It is unsafe when I am older." As shared by NganVu Cong commune, age 70 living with her grandchildren: "my grandchildren cannot help because they are too young, only 2 and 7-year-old. Instead, I had to do everything for them. When I was sick, it was difficult to ask for help as my children were not here, while grandchildren were too young and relative or neighbor was busy. I had to overcome myself. This makes me scared of being sick." 7.8 Burdens in taking over the work of two generations A couple left-behind by all their migrant children, Mr La and his wife live in a small house. The couple were purely farmers having no pension. It was at around 7pm when I visited them. The husband had just come home from their fields and was still busy feeding their pigs. The wife was cooking their dinner. I had to wait for them, and conversation could only start when they finished the work. The husband complained about his long working hours every day from 6am till 7pm. He had some health problems and nominated his lower back pain as the most annoying. He said "I have three children. They all live far away. My two sons live in the South of Vietnam for more than 10 years. They seemed settled there and do not want to come back to the village. 235 My daughter is married and lives with her husband in a different village. We have to do double agricultural jobs. We crop on our two sons' farm land after they moved. There are five plots of farm land to cultivate. We do not have money to hire helpers, so we almost do it ourselves. It was a hard job at our ages (myself 77 years old and my wife 70). I have to try my best even when I have some pain and feel very tired. I cannot complain as my second son is also having a hard life. He has two kids to raise, plus he has health issues as well. He could not help us and never sent money since he moved. Our kids can't help us, and we have not reached the age of 80 yet to receive the support from the government. We have to work to survive." Mr La and his wife Mrs Ngo were one of many cases of those elders in Vietnam that have no safety net during their old age. If the family support network is not effective, they are in a situation of self-reliance. It means "work or die". As stated by (Sando, 1986, p. 163) "The large number of these young people leaving rural areas has led to the depopulation of many villages. Older villagers are left to absorb the economic consequences of depopulation." 7.9 Mixed feelings when talking about living in a nursing home Most of the elderly study participants expressed mixed feelings when asked about living in a nursing home later on in life. Many of them first showed curiosity and excitement about this new concept: "It might be good to live there", one man commented. At the same time, many expressed feelings of shame and embarrassment. Eventually, most respondents (70%) said "No" as "It is not the traditional way. People may think children do not care about you, and they are biased about that, which brings bad feelings", a woman explained. About 10% of the respondents (all of them living alone) responded positively to the idea of living in a facility for elderly individuals. "I would love to live in a nursing home rather than living alone here. It is so boring and lonely", a widowed single woman stated. The rest (20%) were okay both with living at home or in an elderly care facility. However, a big concern for most of the elders was "It might cost a lot, and we cannot afford it". Many key informants in focus group discussions admitted that elderly individuals in rural areas like to live independently as much as they can. When they are too old and weak, they wish their children would move back to live in the village with them. 236 7.10 Both directions of family support (between rural-based parents and city-based children) It was not only a one-way provision of support given to parents by children (by sending remittances, buying medication, providing emotional and physical support etc.). It was also very common for parents to want to help their children by either looking after grandchildren or growing organic food and sending it to the city for their children. Rice, vegetables, and eggs are among the typical foods reported to be supplied to city children by many rural parents. Mr Huan (a 74-year-old man living with spouse) said: My sons do not have to buy rice as we send it to them. At the weekend when they visit us, I normally give them vegetables that we grow in our home garden, also eggs from the free-range livestock that we raise at home. All is safe because we do not use any kind of chemicals. Also, I give them for free. Our children love that, especially our daughter in-laws. We feel good that we still can care and look after our kids in that way. 7.11 Lack of support from government A very common topic of concern that almost of the elderly participants complained about is the lack of support from the government. Only elderly who were aged 80+ and had no existing pension, were eligible for claiming VND 180.000/month as a government pension under the Social Protection Scheme (Clause 5, Article 5, Decree 136/2013). "That amount is too small to cover expensive living costs" one man reported. "Also, the eligible age for receiving benefits is too high. How many of us live that long to claim? It is not support. It is merely a token gesture or a joke" the man said sarcastically. To conclude, financial hardship and health problems were common in the research population. Most rurally-based elderly individuals depended on their adult children to some extent, which limited their autonomy and control over their own lives. Even though the majority of rurally-based elderly parents appeared to be well cared for by their family, some of them were subject to abuse. Unfortunately, the issues of abusive behaviour have not been recognised by the victims as well as the perpetrators. 237 Having their own income and living in their own house in their native land is the desire of the majority. 7.12 The elderly association in researched communes There was only one organisation, called The Elderly Association, in each of the communities where research was undertaken. Anyone aged 60+ can register to be a member of this organisation. It is established and funded by donations of time and money from its members. Whoever wants to withdraw can do so easily. With very limited funds, this association only organises visits to its elderly members when one gets sick or experiences a death. The organisation is therefore more focused on providing spiritual and emotional support for its members, than material aid. The organisation does occasionally organise a trip for its members, because most of them cannot afford to travel, though this is rare, perhaps occurring once per year or two years. Trips commonly encompass visiting pagodas, temples or religious sites within the country. The following was discussed in focus group discussions with key informants, with those representatives of the local neighbourhood committees, and with the elderly association: Researcher: How does the local government and the association of the elderly support the senior population in rural areas? Key informant participant (focus group discussions): We do not have enough funding to properly support them. Elderly individuals in the villages have to pay for themselves for all the activities that they wish to do such as travelling, sport, traditional music groups or other activities of interest. There are some interest groups that were established but they did not last long because of funding constraints. It can be seen clearly that the connection between the elderly and their family, relatives and neighbours was stronger than that with their peer group or other groups of interest. Elderly individuals demonstrated having a social connection everyday such as meeting with their children if possible, catching up with relatives or chatting with neighbours; it seemed that these connections mainly filled their social activities. 238 7.13 Chapter Remark concludes What does this qualitative data mean? 1. To compare rural elderly among other population groups within Vietnam. Compared to the young, rural elders obviously were physically weaker, financially poorer, and emotionally more vulnerable. While the young were "on the move" with more choices of living, elderly parents did not and have to stay back in the villages. They, therefore, lagged behind and most of them leaned on the support from their children. In comparison with their city counterparts, they were also far lower in living conditions. Clearly, rural elders are among the most vulnerable citizens in society. 2. To determine the situation of rural Vietnamese elderly individuals when compared to the standard rights of the elderly, as stated by the United Nations. According to the human rights declarations and conventions for older people stated by United Nations in "International Plan of Action on Ageing", at The Second World Assembly on Ageing, at the Madrid Meeting in April 2002, "Persons everywhere are able to age with security and dignity and to continue to participate in their society as citizens with full rights" (United Nations, 2002, p. 7). The rights of older adults are explained in Table 7-1 as follows: Table 7-1: The UN human rights declarations and conventions for older people A full range of basic human rights for older people • The right to adequate standard of living, including adequate food, shelter, and clothing • The right to adequate social security • The right to freedom from discrimination based on age or any other status, in all aspects of life (access to housing, health care, and social services) • The right to the highest possible standard of health • The right to be treated with dignity • The right to full and active participation in all aspects of political, economic, social, and cultural life of society • The right to full and effective participation in decision-making concerning their well-being Source: (Tang, 2008, p. 109) 239 By taking this statement as a reference (baseline/benchmark) regarding the rights of the older people, the qualitative data in the present study helps to visualize the status of rural Vietnamese elderly. Indeed, when compared to some of the standard criteria, the following are the positions of rural Vietnamese elderly: Vietnamese rural elders were insecure. Regarding their economic situation, the evidence shows that majority did not have a regular income, and had to depend on their children, who were also poor. Most of them were financially insecure. In terms of emotional aspects, rural elderly parents must accept the split-up of their family, and geographical separation from their adult children, which most did not want. Health and health care were the most insecure aspects of the participating elders in this research. More than 90% of them complained that they suffered current health problems without any significant treatment, which put them at a high risk of health breakdown at any time. Vietnamese rural elderly lacked dignity. Dependency made many of the rural elderly lack confidence, and autonomy. They were disempowered, with a weak voice. It was even worse in some cases where rural elderly parents were abused, neglected, ignored, or disrespected by others. Vietnamese rural elders were living without full rights. A majority of Vietnamese rural elderly did not have the basic needs such as food, shelter, transport, the ability to raise their voice or access health care. 3. To determine the level of life satisfaction or quality of life when compared to the well-being model of Felce Perry 1995 There are five elements that contribute to one's overall well-being that Felce and Perry (1995) introduced in their model. It refers to life conditions and personal satisfaction (e.g. material, emotional, physical well-being). In some cases, the elderly reported that they felt disconnected, depressed and lonely. They were sad, disappointed, disrespected and felt meaningless about life. One even said that she wanted to die, rather than suffer from those feelings. Finding from this study cannot generalise for the whole Vietnamese population; however, it would concern most people that Vietnamese rural elderly living 240 standards were well below the baselines in every aspect, when referring to the standard rights of ageing people as stated by the United Nations. Many of them were unable to age with security, dignity and with their full rights as citizens, where financial constraints were the main reason/cause of all. Referring to the well-being framework of Felce Perry, for a majority of Vietnamese rural elderly individuals, their quality of life is at a very low level. Thus, it is not a surprise that most expressed sadness with life rather than satisfaction. In brief, the marginal contribution of remittances cannot change the situation of rural dwellers. The majority of the rural population is basically still facing a very hard life. Financial hardships also force rural elders to keep 'working until they drop', either on the farm or doing housework and parenting, which makes them physically tired and sick. Financial struggle causes stress for many people and puts pressure on most of them, in some cases contributing to abusive family relationships, leading to unhappy emotional lives. Sometimes, these soured relations, or a lack of finances, prevented the elderly accessing health care services. As a result, a cycle of poverty and sickness was created. Given their background of low education and poor living conditions, it would not be easy for rural people themselves to break that cycle and change their situation without support from government. Economic solutions may help to solve most of the other problems for rural dwellers. 241 CHAPTER 8. DISCUSSION AND CONCLUSIONS This chapter summarises the thesis, discusses its findings, strengths and limitations as well as outlining some policy options and directions for future research. 8.1 Discussion As in many Asian countries, caring for elderly parents in Vietnam is traditionally the responsibility of adult children. The phenomenon of out-migration where younger generations are leaving rural areas to find work in cities has raised concerns regarding the well-being of elderly parents who are left-behind. Based on data drawn from interviews with elderly individuals who have remained in rural areas, focus group discussions with the leaders of communes and observation, this study has attempted to understand how migration affects the parents of migrants. The data collected focused on three significant aspects of life, including material, emotional and physical care, and with how the elderly coped with their situation. This section discusses the findings and highlights significant results, which were presented in the previous two chapters (chapter 6 and chapter 7). 8.1.1 Material consequences Regarding the first research question of how urban child migration materially affects rural aged parents, findings from this study show that: ● Urban movement of adult children positively contributes to older parents' material well-being, albeit to a modest degree; ● Parents of migrant children were financially supported better than those with no migrants; ● Single and grandparenting households were among the most vulnerable groups. Positive material contribution Unsurprisingly, findings from this study show that most of the elderly in researched locations benefited financially from the migration of their children. As explained by many elderly respondents, cities create more jobs and generate higher incomes, 242 unlike in rural areas. This accords with the findings from other studies, as discussed in Chapters 2 and 3 above. Notably, the impact of migration on rurally-based parents is positive, albeit to a moderate degree. There was limited evidence in the current study to show a significant economic impact on the elderly parents of migrating children. Only two of the 48 respondents were given money for home renovations, and just one received regular monthly financial support. The rest reported modest financial support, with money often only enough to cover immediate needs or unforeseen emergencies. Small amounts of money were also sent irregularly. Support generally was not enough to boost the economic status of most elderly villagers. Many rurally-based parents were selfsufficient, relying on their labour as a primary source of income and survival. The migration of their children had not altered their living conditions very much. In some cases, a significant economic contribution from migrants to rurally-based parents can occasionally be perceived. The modest material impact of urban children on their rural-based parents found in this study is consistent with the majority of existing studies such as: Zimmer and Knodel (2013), Ablezova et al. (2009), H. Nguyen et al. (2012), (Knodel et al., 2010) and (M. A. Gibson & Gurmu, 2012). The evidence shows that family bonds are powerful in the researched communities and that spatial separation did not reduce intergenerational support and assistance. The amount a migrant earns dictates how much money they send home and due to limited earnings migrants could not afford to send much back to their elderly parents. Most of the elderly participants in this study reported that their migrant children's income was low. Due to lack of skills and low educational achievements, many of the migrant children could not get a highly paid job. Manual, seasonal and casual employment was most common and, as previously discussed, was reflected in the meagre support given to their parents. Even though income was a core determinant in parental assistance, maintaining a positive relationship with their children appeared to enhance support for the elderly who remained in rural areas. 243 The amount and frequency of remittances sent home were found to vary. The findings of the study detailed in this paper suggest two possible reasons for low earning of migrants. First, the infrequency of remittances reflects the unstable nature of migrant work where jobs are often under threat. Second, the areas to which individuals migrate may determine how much they are paid and therefore how much they are able to send home to their parents. My findings show that children who settle in Hanoi, Ho Chi Minh City, or other developed urban areas in Vietnam could better support their parents than those who found work in less affluent urban settings. Remittance support for parents by gender Regardless of sex, sons and daughters are almost equal in monetary support to rural based parents. When analysing the determinants of remittances of internal migrants in Vietnam, Niimi et al. (2009, p. 32) consistently found that: "characteristics of migrants, such as their age, gender and ethnicity do not appear to affect remittance behaviour." Evidence from the present study confirms this finding, in that it does not show much difference between the genders of migrating children in terms of how much money they send home to their elderly parents. Remittances are vital for most rurally-based elderly individuals, regardless of the amount or frequency. The findings of this study show the poor economic conditions of most rurally-based elderly individuals and their adult migrant children. Due to their lack of finances, many elderly people in rural areas had to keep working for as long as they could. For most respondents (especially the ill, frail and generally vulnerable), any help from their children however small was needed and appreciated. However, while self-employment was the primary source of income for most elderly in rural areas, family support was considered a crucial safety net. These findings are consistent with the limited number of previous studies on Vietnam. For example, in a qualitative study conducted in four rural Vietnamese communities exploring the impact of temporary migration on rural household 244 income, Pham, and Hill (2008) concluded that many rurally-based elderly individuals do not have a pension or any social support. Therefore, remittances from migrants are a vital source of income after retirement. UNESCO et al. (2010) noted that financial remittances help to cover a significant proportion of household expenditure (food, health care, children's education expenses) and contribute to improving living conditions, rather than production or business expansion. Pfau and Long (2010) further confirmed the vital role played by adult children in support of elderly relatives in rural areas. Financial assistance is the most common method of support. This study shows that the self-sufficient agricultural economy in rural Vietnam uses little cash. However, in cases of sickness, death, or at events such as weddings or the birth of a baby, cash is sometimes required; monetary support is therefore preferred to in-kind support in rural households. When cash is needed, individuals in rural areas are often forced to sell crops or livestock. Because of this, migrants more commonly support their parents financially than in other ways. Notably, parents of migrants receive more money and less physical help than parents without migrants. In brief, as in other developing countries, the financial incentive is the leading cause of urban ward migration in Vietnam. However, due to low educational achievements and lack of skills, migrants are often earning less than anticipated and jobs can be insecure. As a result, remittances to their parents are often minimal and infrequent. Yet whilst material contribution is often modest, it is still a valuable source of income for elderly parents in rural areas, especially for those in vulnerable groups. Remittances were marginally more likely to be sent to parents by sons than daughters, but the difference between the gender of migrants was not significant enough to be of note. Family ties are strong in rural areas and adult children continue to be a primary source of support for ageing parents. Elderly parents with migrant children were materially better supported than elderly individuals whose children had not migrated Of the other studies referenced so far, most did not offer comparisons between the elderly with migrant children and those without. The focus was solely on elderly 245 individuals with migrant children, analysing a range of factors before and after their children migrated. Longitudinal surveys were often used for such comparisons, observing the same factors repeatedly over time to identify differences. In contrast, this current study compares those two groups (elderly individuals whose children have migrated and elderly individuals whose children have not migrated) and found that elderly parents of migrants in the researched regions were better supported than those whose children had remained in their hometowns. These findings are similar to those of Zimmer and Knodel (2013), who also show that elderly individuals with migrant children in Cambodia had a higher chance of receiving a greater amount of financial support than those without migrant children. Another study, of two communities in Anhui province, China, showed that parents of migrant children received more monetary support than those without migrant children (Guo, Aranda, & Silverstein, 2009). However, in Vietnam, remittances were much lower than those sent by migrants in the Chinese study. This could be due to higher economic development in China and the higher wages earned by Chinese migrants. Another China-based study, by Giles, Wang, and Zhao (2010), found that financial assistance received by a family with migrant children appeared to be similar to that received by families without migrant children thus they suggested elderly parents with migrant children were equally at risk of falling into poverty. Distinguishing itself from other research conducted in China, the authors explain that: "Migrants employed in non-agricultural work are frequently in the informal sector, they often have more risky incomes, and so it is not surprising that this risk is reflected in transfers to their parents" (Giles et al., 2010 p.185). The findings of this current study show that the meagre remittances given to parents of migrants in Vietnam may also be explained in this way. As in China, there is a range of factors that influence the amount and frequency of remittances given to elderly parents in rural areas by their migrant children. However, the results of this study – and the findings of Giles et al. – confirm that the income of migrants is a critical factor in determining the amount of material support given to the parents of migrants. In stating that elders of migrants tend to retire earlier and rely more on their children than non-migrant child elders, my finding conflicts with Lin, Yin, and Loubere 246 (2014), who found the opposite to be true in China, where elderly parents whose children have not migrated were likely to lean more on their children, while parents of migrants relied more on themselves and their own labour. However, this disparity may partly be explained by the difference between Chinese and Vietnamese birth rates higher birth rates in Vietnam could mean that Vietnamese rural elders have other children remaining nearby who can continue to care for them. Whilst fully exploring the impact of migration on rurally-based elderly parents of migrants, comparatively analysing the difference in well-being and lifestyle between those whose children have migrated and those whose children have not is equally important. By combining both forms of research, a comprehensive picture of the circumstances of rurally-based elderly individuals can be formed. Few studies have attempted such research thus far; therefore, this study extends existing knowledge and makes a valuable contribution. The elderly living alone or living with grandchildren were among the most vulnerable groups. Not only did this study make a distinction between elderly individuals with and without migrant children, but it also compared different groups of elderly individuals whose children have migrated, thus identifying the degrees of impact migration has had on each group. The evidence reveals that single elderly individuals and those living with and raising grandchildren were at highest risk of financial trouble and poverty. The data collected during this study suggests that this is because individuals belonging to such groups often have little safety net – if they become sick and cannot work they have no way of supporting themselves and no nearby physical support; financial support may also be limited and inconsistent due to the often low paid and unstable nature of the work their migrant children have. Government funding in Vietnam is limited, thus recognising and distinguishing between the different circumstances of elderly individuals could help policymakers identify the most vulnerable groups to prioritize action. For instance, social welfare might be targeted towards single elderly parents of migrants and skip-generational households with migrant children before extending coverage to other less vulnerable 247 elderly individuals. Therefore, in addition to extending the body of knowledge on this subject an understudied topic in Vietnam this study could inform policy and help guide implementation of more effective strategies. In summary By comparing the situation of elderly parents of migrants in rural areas, this study has shown that the living conditions and overall well-being of such groups were not remarkably improved by migration, but that migration was still looked upon positively. In terms of financial support, migrant children were found to provide greater assistance to their elderly parents than non-migrants. However, there was a concern for elderly parents of migrants that were living without a pension or consistent income, particularly those who live alone, who care for grandchildren, and those who are very old. 8.1.2 Emotional consequences Regarding the second research question of how urban child migration emotionally affects rural age parents, findings from this study show that: ● Urbanward migration of adult children contributed positively to the emotional well-being of rurally-based parents, but this was primarily due to the financial support they could offer. ● Single individuals with migrant children and elderly individuals who care for their migrated children's children (grandchildren) were among the most vulnerable groups. Positive emotional impacts Positive emotional impacts associated with financial satisfaction Regarding the positive emotional outcomes related to the out-migration of adult children, this study found that the emotional well-being of rurally-based elderly parents was highly associated with their financial status. The happiness of an older parent with distant offspring was not merely reliant on how often they kept in touch but was found to relate more to family income. Evidence from this study reveals that higher levels of interpersonal contact experienced by those whose children remained close by did not make individuals any happier than those whose children 248 had migrated and who experienced less contact. Though grateful for the care and attention provided by their children, elderly individuals whose children had not migrated appeared more likely to be anxious due to financial difficulties. In contrast, the elderly parents of migrants appeared happier due to remittances. By sending adult children to the cities to earn a higher income, the anxiety of financial pressures is often reduced or completely diminished, resulting in lower levels of stress and improved emotional well-being among family members. Contact with children who have migrated undeniably influences parental well-being, however, the economic benefits of migration appear to have a more significant impact on the emotional state of elderly individuals. The findings of this study indicated lower levels of depression among parents of migrants compared to elderly individuals whose children had not migrated, confirming the results of M. A. Abas et al. (2009) who found depression to be higher in poorer households with no migrant children. These findings, on the other hand, indicate the true needs of rurally-based elderly adults; they also suggest that many older adults in rural Vietnam are vulnerable and have a low standard of living. While elderly individuals in developed countries are able to pursue leisure activities and enjoyment in their older years, many seniors in rural parts of the developing world including Vietnam continue to struggle to earn a living. Money is therefore a central factor to the well-being of most rurallybased elderly individuals. Many might define happiness as having enough food to eat, clothes to wear and a place to live the well-being of elderly individuals in rural Vietnam appears reliant on the fulfillment of these basic needs, with the living standard of most being considerably low. The findings of this study suggest that beyond contact with their children, the well-being of most elderly individuals in rural areas is reliant on money. Therefore, this study recommends that better material support for such individuals is the most important factor in improving the overall well-being of elderly people in rural Vietnam. Studies conducted in other countries with circumstances similar to Vietnam have produced equivalent results. 249 Overall, findings from the Thai and China studies correlate with the findings of this study, again emphasising the association between material satisfaction and emotional well-being. This challenges the perception that older people in rural parts of developing countries are being deserted by their migrating children. Research conducted by L. Nguyen, Yeoh, and Toyota (2006) also highlights how remittances indirectly affect the well-being of those left-behind since money sent increases the living standards of households. Cong and Silverstein (Cong & Silverstein, 2008, p. 10) found that financial aids reduced depression in older parents, which contributed positively to the psychological well-being of Chinese older adults in rural villages. The circumstances of elderly adults in rural areas in the present study appear similar to those of elderly individuals in other developing countries, hence its relevance to these other similar studies. Given the apparent link between psychological well-being and financial situation, it would seem remiss to examine the well-being of elderly adults in rural regions without considering this relationship. However, some studies have primarily focused on the relationship between emotional state and frequency of contact (telephone calls or visits) between parents and their migrant children. Such approaches may only scratch the surface of emotional well-being determinants and crucially obscure other equally important factors. Studies that approach the subject in this way may offer more comprehensive findings if they take into account other variables such as material satisfaction. By taking this particular approach, this current study was able to identify a link between financial satisfaction and the psychological well-being of rurally-based elderly individuals, revealing a greater depth of truth about Vietnam's rural elderly population. Positive emotional impact associated with the sense of having a better social status (social prestige) In addition to increasing financial income, urbanward migration can boost emotional well-being for elderly parents who remain in rural areas. This study has found that many parents of migrants feel proud to have migrant children and are happy to see them find work in cities and be successful. However, whilst migrants often come from more impoverished rural communities, the very poorest cannot 250 afford to migrate. Evidence from this study shows that only individuals with enough money to make a move to a city and the initial capacity to survive there can realistically migrate. "Migration is a highly selective process and strongly affected by household and commune characteristics" is also confirmed by (Phuong et al., 2008, p. 2). Younger ages (from 15 to 25) and more highly educated groups were also found to significantly influence migratory behaviour (Truong Huy, 2009) Positive emotional impact of advanced transport and communication technologies Geographical separation of family members undeniably has its shortcomings and inconveniences. It can lead to emotional difficulties such as feelings of sadness, loneliness, and social isolation, both for those who migrate and those who remain behind. Separation may have been a greater concern for parents and their migrant children in years gone by. However, similar to Knodel and Saengtienchai (2007), my findings show that the advance of communication technologies and improvement in transport links now make it easier for parents and migrant children to stay in touch. Migrant children are able to maintain contact via telephone and the Internet and are able to visit home easier, thus fulfilling responsibilities to their elderly parents despite the distance between them (Zimmer and Knodel, 2013). With such advances, the benefits to elderly parents of the urbanward migration of their children now outweigh the disadvantages. Single and grandparenting households are among the most vulnerable groups Many respondents in this study who had children that had migrated were very happy with the migration of their children as they had other children who remained close by. However, the migration of additional children was found to significantly reduce the emotional well-being of elderly individuals. This study found that the emotional well-being of elderly parents was more adversely affected by the number of children migrating, which is consistent with the findings of other scholars (Connelly & Maurer-Fazio, 2016; Lin et al., 2014; Zimmer & Knodel, 2013). These findings suggest that in the absence of a sufficient welfare system in Vietnam, rurally-based elderly individuals should not be left-behind without any form of family support. Chen and Silverstein (2000) suggest that having a child close by regardless of gender elevates emotional well-being, and Silverstein et al. (2006) 251 similarly point out that individuals living in multigenerational households were better off than those living alone. Qin, Pungpuing, and Guest (2008, p. 1) conclude that "labour migration triggers transitions in elderly living arrangements from coresidence to living alone." These studies, therefore, suggest that living with children should be promoted among elderly individuals; failing this, the government should support the elderly or create work opportunities to enable younger generations to stay in the village (Teh, Tey, & Ng, 2014). The current study did show that elderly individuals who are in charge of the grandchildren in the absence of their migrant children, suffered adverse emotional effects of migration. Luo (2012) also notes that it seems unfair for older individuals especially older women to have to take on the responsibility of caring for grandchildren having already cared for and raised their own children. The negative emotional impact of migration on single elderly individuals, and on those raising grandchildren raise concerns about the well-being of these groups. It is noteworthy that the number of elderly adults living alone is increasing due to a decline in fertility rate. Thus, it is important that the findings of studies like this are not ignored. As previously highlighted, this research suggests that the government should focus on the development of rural regions to encourage younger generations to stay, or they should find ways of supporting the most vulnerable elderly groups, such as those with migrant children who live alone or are raising their grandchildren. 8.1.3 Physical care consequences Regarding the third research question of how child urban migration physical care affects rural age parents, findings from this study show that: ● Urban migration of adult children negatively impacted on physical care for rural older parents. ● Single and grand-parenting households were among the most vulnerable groups. Adverse physical care consequences of migration While urbanward migration of children has been shown to improve material and emotional well-being, it can adversely impact the daily physical care of rurallybased elderly parents. Those of particularly advanced age may be weak and at risk 252 of illness as their physical health declines. This makes them more dependent on others and needing extra physical care (Xie et al., 2014). Adult children who have migrated to cities may struggle to provide practical care to their ageing parents due to geographical separation. Unlike elderly parents whose children remain close by, elderly parents of migrants may find themselves without someone who can provide timely and adequate care. These adverse effects can be compensated by: First: helping elderly individuals in rural areas to be financially selfsufficient. If elderly individuals have savings or a pension, they are able to meet the costs of health care if they fall ill. For example, many older adults in developed countries have their own money saved or regularly draw a pension and do not need to rely on their children to meet health care costs. Furthermore, individuals who are financially self-sufficient have power over their own decisions and are able to choose what services to access and how. Such autonomy allows many elderly individuals in the West to actively participate in their own health care and medical treatment as needed. For instance, they can choose to pay for a carer to assist them at home or pay for a place in a nursing home if necessary. If elderly individuals are financially self-sufficient, they may not require children to remain at home to care for them. Sadly, 98% of elderly individuals who participated in this study had no savings. Their primary source of income was from their adult children, thus diminishing their ability to access their own health services as and when needed. Second: if remittances sent by migrant children were sufficient to hire a care worker who could assume a supportive role while the child worked away. If elderly individuals were able to fill the gap in physical support left by their migrant children, migration might not impact individuals to the same degree. However, data gathered on remittances in this study demonstrate that money sent home by migrant children is not enough to support such a service. Even if remittances were high enough, tradition in Vietnam might not allow the hiring of care workers. Finally: ensuring health services in rural areas are adequate and effective. Improvement of health services in rural areas could potentially compensate for the absence of migrant children, allowing individuals to access treatment and medicines regardless of their children's location. In developed countries, for example, elderly people have easy access to services and have the option of entering a nursing home if necessary. The health care system is very underdeveloped in Vietnam, with most 253 elderly individuals only able to access treatment at district hospitals which may not be close by. Also, in the absence of free health care, many cannot afford what they need and therefore have no chance of being cured. Ultimately though, none of these factors can adequately compensate for the absence of migrant children in rural Vietnam. Parents have no savings, receive limited financial support from children, and have inadequate access to primary health care. Unaffordability and inaccessibility prevented most of the elderly in this study from accessing health care. Many sick individuals are instead kept at home and looked after by remaining children. Due to the geographical distance between migrants and their parents, care for elderly parents cannot easily be shared by migrants with their siblings. The remaining children are, therefore, often overwhelmed; due to tiredness and stress, they may be unable to provide good quality care for their parents, especially those requiring long-term care such as those needing palliative care or those with disabilities. In some cases, parents were neglected, abandoned or even abused by their children something I witnessed myself when living with a family during this research (the mother was in a wheelchair and needed much care). These findings are in line with the majority of existing published studies (Benjamin, Brandt, & Rozelle, 2000; B. Luo, 2009; Tse, 2013). ELB in China were found to have a higher need for care services than non-ELB, as also found by Lin et al. in their research (2014). Likewise, in Thailand, Qin et al. (2008, p. 21) conclude that "Elderly who are exposed to labour migration are less likely to receive intrahousehold elderly care of receiving food and being taken to the hospital compared to those without exposure." Similarly, Xiang, Jiang, and Zhong (2016) confirm these findings. Ye et al. (2017) state that 80% of the deposits in local banks come from migrant workers, which is critically important to local development. However, the most negative effect is the lack of care for elderly people and children. In contrast, Adhikari et al. (2011) found no link between the physical health of ELB and the migration status of their children. The authors explain that adult children are less likely to migrate when a parent is ill. However, the authors note that a significantly higher proportion of elderly individuals with migrant children sought health care treatment compared to those who had no migrant children. These results indirectly confirm my findings that elderly individuals who are left-behind by 254 migrant children in rural areas experience negative physical and emotional health consequences from migration. This raises concerns about the quality of life and the overall well-being of elderly populations in rural Vietnam where both formal and informal health care services are lacking. The findings of this study highlight the importance of establishing a formal care system for rural elderly populations, a system which may complement the traditional family care system present in these areas. Single and grandparental households were among the most vulnerable groups. Unsurprisingly, the findings again confirm that elderly individuals who live alone or those who are caring for grandchildren in the absence of migrant children are often in the most challenging situations financially, emotionally and also in terms of physical care. The benefits associated with the migration of children are clearly shown in this study. However, the data shows that having almost or all children migrate urbanward adversely affects the parents. My findings concur with those of Xiang et al. (2016) who state that "having one additional adult child migrated to an urban area increases the probability of the left-behind elderly parents being in poor health condition by about 8%". Zhu and Otuski (2018) also note that parents living alone suffer more health problems than who live with other offspring. Furthermore, parents having only one child, from low-income households, or aged above 60 years are affected more." The authors also show that parents with only one child are among the most vulnerable groups. The number of older adults living alone has been increasing over time due to declining birth rates. The absence of working age individuals in rural families due to migration increases the burden of rearing grandchildren for the elderly. While adult children are encouraged to move out of the village to provide better financial support to parents, they are unable to offer physical care, to the detriment of their elderly parents. These findings suggest that the government should: ✓ Raise the pension for the elderly because it currently is too low (only about USD10/month). ✓ Lower the eligible age for receiving a pension it is currently at 80 years old which is too high to benefit many who currently need it. 255 ✓ Improve the health care system at grassroots levels, making services accessible and affordable for vulnerable groups within the population. ✓ Diversify health services to meet the needs of older adults, from care in the home to old-age care facilities such as nursing homes. 8.1.4 The roles of localities in supporting the rural elders The three communities selected for this research have different economic conditions (poorer, average and better off). My findings suggest that each of these commune – regardless of economic status – do not have the funds to support senior citizens and that caring for the elderly is seen as a family obligation. If extra assistance is to be provided to senior citizens, it must come from state funding, or from policy or programs at the national level, rather than from the localities. There are two possible reasons for this. Firstly, the communities do not have the financial capacity to support the elderly even where the commune is considered as better off than others. Key informants in this study confirmed that the economies of the commune researched are agricultural. Like most rural parts of Vietnam, these communes are poor and underdeveloped compared with urban areas. Secondly, caring for the elderly is seen purely as a family responsibility and therefore not an obligation for the local government. This particular result contrasts with findings from a study conducted in China by Lin, Yin, and Loubere (2014b), The study focused on three communes in Jiangxi province, comparing living conditions of ELB and non-ELB. It found that monetary support from community funding was the second most important source of income from elderly in these areas. Local funding was second only to assistance from family members. Clearly, aid from the locality contributed positively to the well-being of elderly residents. However, the amount of monetary support depended on either the locality's economic development or the circumstances of its elderly individuals. The better off community helped its residents more than the impoverished community, and ELB received a higher amount than non-ELB. 256 8.1.5 Strategies for coping with financial, emotional and health care difficulties When confronted with economic challenges, the traditional solutions for most elderly individuals are to increase working hours, minimise expenditure, maximise production and ask children, relatives, neighbours or friends for help. Due to low labour productivity, rurally-based elderly individuals were unable to accumulate much money, and therefore many do not have savings. They usually do not have a plan or strategy when faced with economic hardship. Emotional difficulties such as feelings of sadness or loneliness are often shared with neighbours of relatives who live nearby. Most elderly individuals with migrant children must accept that they will not receive the same amount of physical care and attention from their children as is received by those who do not have migrant children. 8.2 Conclusion 8.2.1 Major findings Positive results Many citizens, scholars and policy makers are concerned that the recent process of industrialisation and urbanisation in developing countries is weakening traditional norms of filial duty in rural families. They fear that increased labour mobility reduces willingness and capacity of young generations to support their ageing parents (Luo, 2012). Very limited evidence was found in the current study to support this argument. Family bonds have not been broken or eroded instead, the bonds between generations in many rural families are firm, and urbanward migration of children appears to improve that relationships. Also, limited evidence that parents of migrant children suffer economic loss or are psychologically disadvantaged, except in a few cases. The findings in this study therefore do not confirm such fears and concerns. It appears that rural communities in Vietnam, like regional Cambodia and most other developing nations, are experiencing "migration but not desertion" as stated by (Zimmer and Knodel, 2013: p. 171). It means urban child migration more positively contributes to the well-being of the rurally-based elderly parents. 257 The findings confirm the empirical evidence found in many other developing countries. Reasons for the positive results include: Financial support: migrant children contributed positively to parents' material wellbeing. Even though remittances often did not make a big difference to the living conditions of most rurally-based elderly individuals, those with migrant children were clearly better supported than those without. The evidence in this study confirms that parents' financial situation was better after children migrated and that they were in a better position financially compared to elderly individuals whose children had not migrated. The emotional connection between parents and geographically dispersed children was indicated to be good, often as a result of communication and transportation improvements. The advent and widespread use of mobile phones have recently enabled parents and migrant children to communicate easier over long distances. Phone contact was predominantly used by the majority of respondents. Likewise, improvements to vehicles and roads help children visit parents more regularly, reducing the impact of the physical gap between them. However, emotional positives were found to be stronger when associated with financial improvement. Also, due to previously high fertility rates, elderly adults aged 60+ had an average of 4.2 children. This allows for some to migrate and others to remain in the home village. Therefore, most of the older parents had not been left alone. Elderly individuals with both children who have migrated and children who have not benefit from the migration of some of their children, while also receiving support from those children remaining nearby. Negative results While the pros of urbanward child migration appear to outweigh the cons for elderly parents, there are still areas of concern: First: low income is the biggest concern for both migrants and those left-behind. Many elderly parents expressed their gratitude towards their children for sending them money, but also showed sympathy towards migrants for the hardships their children face, with many migrants obtaining low paid work due to low educational 258 achievements. Almost all families who participated in the research were impoverished and had many children; together they were unable to escape the cycle of poverty. Migrant work was often manual, seasonal, casual and lacking stability. This is reflected in the often-meagre remittances and their infrequency, and also explained why many rural elderly individuals continued working until "drop off." With the often-minimal financial benefit of migration, the question might be asked whether migration is ultimately worth it. Many elderly respondents felt that it is but do so by looking at it from the point of view of their offspring rather than themselves, with their answer being "children should go, with no jobs for them here, to stay means no choice." Second: physical care is often needed by some elderly individuals, and traditionally requires children to remain close by. Migration of children, therefore, had a negative impact on physical care provided to parents. Remittances sent back home are often insufficient to cover parents' health care needs, and the health system itself was generally insufficient at the grassroots level. This poses a big challenge for elderly individuals in many parts of rural Vietnam. Third: some individuals are left-behind because all of their children have migrated out. This appears to be most keenly felt by elderly living alone and those raising grandchildren. Those elderly are therefore among the most vulnerable groups, requiring more help and care from society both financially and emotionally, and also in terms of daily care and support. The number of individuals in this group is currently smaller than other elderly groups, due to the high fertility rate for those older adults around 60-80 years old. However, the fertility rate is sharply declining over time (since the 'two-child policies applied in Vietnam in 1990), while urbanward migration of children continues to grow, meaning single elderly households are increasing in number (UNFPA, 2011). This study, therefore, suggests a need for more attention from policymakers and the government to address the needs of these alone elderly individuals. To conclude Rural elderly parents are not, as is often supposed, abandoned by the movement of their adult children to bigger towns and cities. Rural households did not turn out to 259 be worse when their children have migrated. Contrary to the common assumption, urban child migration, on balance, has a positive impact on the lives of rural families. The positive outcome implies that the cycle begins with a big size family with many children –> lack of education –> no job –> poverty, which seems a chronic and permanent problem for many Vietnamese rural families. Out-migration is seen as a solution to make life different, and to improve the situation. When asked "What if your adult children had not migrated?", a participant said: "Oh, we would be still poor and struggling a lot. We only have a better life because our children migrate." Undeniably, many rural dwellers would be forever in a poorer and more difficult situation if their adult children did not move. Most of them face a life of hardship otherwise, until they move out of the villages. Urban migration is a way to escape poverty, a livelihood strategy to improve the lives of rural people. Urbanward movement currently represents a short-term strategy for alleviating resource scarcity. However, it should only be a temporary solution. This is because taking care of the elderly parents in Vietnam is not only a traditional obligation but is also a privilege for grown children. The irony found in this study is that many rural dwellers, if not desirous, at least accept migration voluntarily and happily; meaning that rural residents, especially young generations, even though they did not want to move out, had no choice to remain in home villages. This seriously concerns those who care about rural development. The government should pay more attention to rural citizens' livelihoods. This needs to be done either by improving rural dwellers' livelihoods so that young generations do not need to move elsewhere, and they can look after their old age parents, or by enhancing welfare for the elderly so that children could move elsewhere without worrying about their parents at home in their villages. Ideally, the best situation is that young adults do not need to migrate, that they can still have good life conditions in their hometowns and can fully support their parents financially, emotionally and physically. It is, therefore, as Ablezova et al., (2009, p. 41) conclude, better "to create a paradise garden in one's own backyard, rather than look for it behind many mountains". 260 8.2.2 Policy recommendations With outcomes predominantly more positive than negative, this research concludes that temporary urbanward migration of adult children should be encouraged for several reasons. First, it can improve the income and overall well-being of rural families. Second, it helps resolve labour shortages in urban areas and provides work for those from rural regions who may otherwise be unemployed. It fulfills the gap of the development between urban and rural. Those benefits of urbanward movement favour it in the short-term. However, it is important to recognise that urbanward migration may be unsustainable in the longer term without provision for elderly individuals leftbehind in rural areas. Since there is currently little care provision for the elderly population in rural areas beyond the informal care provided by relatives, this study calls for alternative methods to provide care effectively so that individuals whose children have migrated are not left without help. This could include a formal social security system of provision from the state. To ensure the well-being of elderly individuals whose children migrate, the government should: In the short-term ▪ Given the central importance of migration currently, policy should aim at enhancing its contribution to people's livelihoods. This includes supporting young agricultural workers with vocational training. This could help them gain qualifications and improve their skills so that they are able to engage effectively in the labour force. ▪ Provide information about the areas of destination in order to make their migration successful. Taking Ethiopia as an example, due to the lack of information about jobs, housing and services to support the growing demand, most of the young adults returned to their villages within a year of migrating out (Gibson & Gurmu, 2012). ▪ Support the elderly in rural regions with free health care services to partially compensate for the absence of the offspring. ▪ Expand welfare schemes to support those left-behind without any nearby children. 261 For the long-term ▪ Invest more in rural parts, create better living conditions and job opportunities to encourage the young to stay in improved rural settings. In doing so, the economic gap between urban and rural regions may be shortened, helping to create sustainable growth for long-term development. Economic zones have been built recently all over the country as well as in Thai Binh, which creates job opportunities for local young people. They are moving in the right direction. However, there are still many problems for rural young generations to get jobs in these companies as well as the low pay, local environmental pollution, etc. ▪ Introduce universal health coverage to help rural seniors easily access health care right at the grassroots level. ▪ Move towards a universal pension scheme that covers all of the elderly population. 8.2.3 Limitations and future research directions Widen the sample to include a range of different voices The results of this study are based on interview data and whilst care was taken to ensure respondents were comfortable and able to answer questions honestly, there is always potential for reporting bias. According to Li and Tracy (1999, p. 369), "the social desirability bias [i]s difficult to eliminate from self-report." In addition, when studying a causal relationship, it is desirable to have all parties participate and for each individual to have their own voice heard. For instance, this research has sought to understand the consequences of migration on elderly parents left-behind in rural areas, Vietnam. Therefore, both those who have left and those who have stayed should be involved in the interview to avoid bias from gathering just one side of the story, for example: Firstly, when interviewing participants about the material consequences of migration, parents reported that they received financial support but that this was very limited since the income of their children was low. If migrant children in the place of destination also were interviewed, different information might have been recorded. 262 Secondly, regarding the emotional consequences, many parents simply said that they were happy with the care they received from their children. However, if migrant children had been interviewed, a more detailed picture may have been formed. Finally, parents complained about a reduction in personal care in the absence of their migrant children. It might have been interesting to interview the siblings of migrants (who remained in the home village, resided with or lived close to elderly parents) to see what difficulties and pressures they faced in providing care to their ageing parents. Their views could then be compared with the experience of their parents. However, due to time and budget limitations, this study was based solely on the opinions of older parents. The data may, therefore, be partial and subjective. Distinguishing between genders of elderly left behind individuals, rather than treating married couples in households as one unit, is also a suggestion for future research, as is exploring the level of support parents receive from sons compared to daughters. Collect a greater depth of data This study found that 'core' ELB (elderly individuals living alone in the village because all of their children have migrated, and the elders living with grandchildren in skip-generation households) were often more vulnerable than other elderly individuals. Given the dramatic decline in Vietnam's fertility rate, the number of these elderly is expected to increase quickly in the coming decades, putting Vietnam in the same situation as China currently is. However, the data in this study does not allow us to examine what is the proportion of those left-behind elders, and how the predicted number of this population segment is increasing. Future research should examine the living arrangements of older adults in rural Vietnam and focus on how better to support them, especially those who live alone and live with grandchildren. With regards to the adverse effects on health and physical care for rurally-based parents caused by the absence of their migrant children, the data from this study does not allow for a full examination of the extent of this problem. This matter should also be measured and be a topic for more in-depth future research. 263 Collect and analyse longitudinal data Due to time limitations, this study does not allow for evaluation of changes over time. To increase the veracity of the results, interviews could be repeated after a certain period of time (e.g., 5 or 10 years later). It would allow for a more accurate assessment of the impact of urbanward migration on rurally-based elderly individuals by tracking data and follow up studies. Longitudinal data and subsequent analysis is needed to address this concern. Conduct cross-sectional research to improve generalizability This study was conducted in just three rural communities in a district of Thai Binh province; the sample size was also small meaning the general population may not have been effectively represented. Both of these factors limit the generalizability of results (Rubin & Babbie, 1993). Cross-sectional studies are, therefore, recommended for future research to ascertain whether similar results can be produced in different locations with varying socioeconomic conditions. Apply different methods to compare the results As a qualitative study with a small research sample, this study does not intend to provide a complete and universal picture of the ELB in rural Vietnam, but instead tries to capture and understand the plight of elderly individuals in rural areas through recording and to analyse first-hand experiences. The results of this study cannot be generalised to the broader population of Vietnam or generalised to all elderly individuals living in rural areas. This natural shortcoming of qualitative enquiry could be counterbalanced by future quantitative or mixed-methods study. Different methodological approaches would enrich the interpretations of this qualitative analysis. Research subjects should be extended to other related groups including the leavers (migrants themselves), and others who are left-behind such as children and spouses of migrants Not only are remaining parents in a critical situation, but migrants may also be struggling and faced with many difficulties settling in cities. Migrants might, therefore, need support as much as their left-behind relatives. Thus, the situation of 264 the movers also needs further attention to be better understood. It is not only the parents of the migrants, but also their other relatives such as children and spouses who get leftbehind. Likewise, more attention from scholars and society needs to be paid to those groups of the population. They should also be topics of interest, and the critical subjects suggested for future research. In summary, 'Too old to escape'. If that is the case, then it is unfair for the rural elderly. The present study has provided some insight into the circumstances of rurally-based Vietnamese elderly individuals who are in some way touched by urbanward migration. However, given its barriers and limitations, further studies must in future be undertaken, better measures must be developed, and larger sample sizes utilised to gain a broader and consistent picture of elderly individuals in rural areas, improving our understanding and responding to the left-behind phenomenon. 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Journal of Marriage and Family, 70(3), 585-598. 283 Appendices Appendix 1: Working status of Vietnamese rural elderly and receiving material support from children The assessment criteria Elderly whose children have not migrated (N=12) Elderly whose children have migrated (N=12) Total (N=24) Number and Percentages (%) Working status Working full-time 6/12 50.0 4/12 33.3 10/24 41.6 Working part-time 4/12 33.4 3/12 25.0 7/24 29.1 Not working 2/12 16.6 5/12 41.7 8/24 33.3 In kind-support Provided food, clothes, medicines 6/12 50.0 5/12 41.6 11/24 45.8 Helped with housework 5/12 41.6 3/12 25.0 8/24 33.3 Helped with farm-work 6/12 50.0 5/12 41.6 11/24 45.8 Provided household goods and furniture (TV, fan, aircondition, rice cook, fridge, chair, table, etc.,) 3/12 25.0 5/12 41.6 8/24 33.3 Helped renovate or build new houses 0 0 2/12 16.6 2/24 8.3 Monetary support Under 1,000,000.00 VND (<50USD) 3/12 25.0 5/12 41.6 11/24 45.8 Over 1,000,000.00 VND (>50 UDS) 0 0 3/12 25.0 3/24 12.5 Monthly 0 0 1/12 8.3 1/24 4.1 Yearly 3/12 25.0 7/12 58.3 10/24 41.6 Prefer children to migrate Yes 12/1 2 100 12/1 2 100 24/24 100 No 0 0 0 0 24/24 100 284 Appendix 2: Material consequences hierarchy and key strategies for coping with difficulties of rural elders Notes: The arrow shows the more severe degree of impacts when compared within rural elderly of migrant children and worse economic situation of the rural elderly having no migrant compared to those with migrant children. The blue boxes depict common coping stratergies that many rural elders used when facing financial difficulties. 285 Appendix 3: Material, emotional and physical care consequences Influential factors Elderly samples (total N=48) Material Emotion Physical care + _ Same or not sure + _ Same or not sure + _ Same or not sure Percentages (%) Ages (N=24 each) 60 -75 12.5 16.6 70.9 45.8 25.0 29.2 8.3 37.5 54.2 76 and over 25.0 12.5 62.5 29.2 41.6 29.2 8.3 41.7 50.0 Pension or welfare beneficiaries (N=24 each) Have at least one 12.5 12.5 75.0 41.6 25.0 33.4 12.5 33.3 54.2 Don't have 25.0 20.8 54.2 33.3 37.5 29.2 8.3 41.7 50.0 Living arrangements (N=12 each) Living with other remaining children 8.3 0 91.7 50.0 0 50.0 0 8.3 91.6 Living with spouse only 41.7 0 58.3 58.3 16.6 25.0 33.4 16.6 50.0 Living with grandchildren only 8.3 41.7 50.0 25.0 50.0 25.0 0 41.7 58.3 Living alone 16.7 25.0 58.3 16.7 66.6 16.7 0 91.7 8.3 Notes: (+) Positive, (-) Negative 286 Appendix 4: The overall consequences of rural-urban migration of adult children on rural age parents Compared before to after the migration of children (1) Compared to elderly whose children have not migrated (2) Compared among the elderly groups with migrant children (based on the factors of age, income, living arrangement) (3) Material consequences (+) Better (+) non-pensioners, spousal, older adults (-) parental and single elders (Nil) young-old, pensioners, co-reside elders Emotional consequences (+) Better (+) young-old adults, co-reside, spousal elders (-) parental and single elders (Nil) pensioners, co-reside elders Physical care consequences (-) Worse (+) spousal, pensioner elders (-) single, parental, older, non-pensioners elders (Nil) co-reside, parental elders Notes: (+) Positive, (-) Negative, (Nil) Same or not sure. 287 Appendix 5: In-depth Interview guidelines (for the elderly participants in rural area) Instructions: 1. Explain fully the purpose of the study and the researcher who is conducting the study. Give the respondent a chance to ask questions about the interview and research. It also explained the ethical aspects of the interviews and the rights of the respondents to attend or withdraw from the interview at any time if they wished. It then asked for the consent from respondents for the study to be conducted. Once consent was obtained, ask permission to tape record the interview and explain why we are doing so (for example, the interviews will be recorded to ensure fidelity of information collected. However, information on the identities of those involved will not be disclosed in any part of the thesis and will not be used to sharing outside the researcher to reach the confidential regulation). 2. The interview will be arranged in a private place, no impact or interference of any one from their family and others. The elderly left-behind will be encouraged to show up the most their personal perspective. 3. The interview should be carried out in the conversational style at a leisurely pace. Do not fill out the form during time of interview, but be sure sufficient information is provided so that the form can be filled out later. Only notes on the matters that can facilitate the interview such as listing the children's name and whereabouts. 4. In cases of a married couple try to interview together. Note when interview is with couple, try to get both to participate in the conversation. Also, in such cases refers to both husband and wife. 5. Be aware of the possible interview fatigue. If appropriate make more than one visit to complete the interview. 288 SECTION 1 DEMOGRAPHIC BACKGROUND INFORMATION Identification Province: ............................................................................................................................................................. District: ............................................................................................................................................................. Case ID of the older person: ..................................................................................................................................... Commune number: ................................................................................................................................................. Demographic background information Name(s) of older person/couple................................................................................................................................................................ Gender: .......................................................... .......Male ....................................Female........................................ Age: .....................................................................Man (husband)........................Woman (wife).............................. Level of education: ................................................................................................................................................. Marry status: ............................................................Married live together/Married live apart...............Separated/Divorced.......................... Widowed............................... Single............................................................. How many children do you have?...............................................Sons.................................... Daughters.......................................................... How many of your adult children migrate?.................................Sons.................................... Daughters.......................................................... Where are migrants' work places? ............................................................................................................................... How many of your adult children stay remain in the villages? ...Sons....................................Daughters......................................................... Who do you live with?.................................................................Sons.................................... Daughters..................Other............................ Working status?........................................................................... Working part-time/full time.........Not working.................................................... Job (occupation).................................................................................................................................................... Living arrangement................................................................................................................................................. 289 SECTION 2 MATERIAL, EMOTIONAL AND PHYSICAL CARE A. Financial situation, assets and economic support Open ended questions Suggestions (includes personal stories, experience, feelings, examples) How is your financial situation? Are you currently still working? Yes (describe type of activities, frequency of work and own income) No (explain when and why) How much do you pay monthly for basic living cost (food, clothing and other goods)? How much do you pay monthly for medical? How much all your average monthly savings? Are you financially supported by someone? Yes: Fully/partly support, from who, what kind of support, amount and frequency How financial situation of your children? Compare the support between migrant children non-migrant children if having Compare financial situation before and after the migration of children if having No: Why? Which source is your main income? Own labour, family support, community or government support Financial difficulties Did you have any financial difficulty? Yes: Describe what, when and why How did you do to cope with financial difficulties? No: Why? Financial expectations From family and community and government B. Health condition and physical care What do you rate your health? Do you have any health issues? Yes: What, when and why? No: Why? 290 How is you your health status? Did you seek any treatment for your health issues last year? Yes: (describe details including for what, place of treatment, for how long, cost, who paid) No: Why? Who look after you when ill? (Why and how? Who do you prefer?) Do you have any kind of health insurance? (describe details including for what, when and how do you think about health insurance) Does the migration of your children impact on your health care support? Yes: How? No: Why? Health difficulties Did you have any health difficulty? Yes: Describe what, when and why How did you do to cope with difficulties? No: Why? Health care expectations C. Social life activities and relationships How is your emotional status? How is your relationship with your children, neighbours and relatives? What relationship is most important to you? Why? Does the relationships with your children affected after their out-migration? Yes: How and why? No: Why? How often do they contact you? (including phone calls, letters or other forms and from who sons/daughters) How often they go back to visit you in person and how long? (Sons/daughters) Describe your most important activities of your daily life Do your village have specifically provided for the elderly venue? Yes: What, when, why and how? No: Why? Do they provide community support facilities or venues (or any counselling network)? Do you want local residents' committees to organise elderly cultural activities? Yes: What, when, how and why? No: Why? Emotional difficulties Emotional expectations 291 Elderly participants' satisfactions with their life How do you satisfy with your life? Which aspects of life are you most satisfied with? A. Health condition B. Economic condition C. Social life D. Emotional difficulties Which aspects of life are you most dissatisfied with? A. Health condition B. Economic condition C. Social life D. Emotional difficulties How do you feel the current living conditions? A. Very satisfied B. Satisfied C. Dissatisfied D. Very dissatisfied What are your feelings about future living conditions with the above: A, B, C, D options? What are the problems faced by the elderly left-behind? A. Low level of economic security B. In poor health, lack of childcare for C. Lonely D. Home is not complete E. Other Future expectations Do you think any of your children who moved out will eventually come back to live in your village? Why or why not? If yes, what would they do for a living if they moved back? Do you think other children will move out in the future? Why or why not? Would it be (Is it) a problem for you to live here without any children nearby? Why? If all your children move out, would you want to go to live with one of them? Why or why not? If so which one and why? If you start having serious health problems who will care for you (Prove if any migrant children would come back, If you would go join a child elsewhere, or if will some other arrangement be made?) 292 Appendix 6: Focus group discussion guidelines (for key informants) Introduction The purpose of the focus group discussions is to find out how child urban migration impact on the life of their rural elderly parents. The information obtained from this study will help the authorities to fully understand the situation of the elderly in rural Vietnam in general and the elders have children working away from home in particular, from which to build a better safety policy for the elderly population. To get the correct information, I would like to record this discussion. However, your personal information is always respected and not disclosed in any situation and anywhere in the results report. Key informants' background information Name Date of birth Position Genders Commune 1 Better off (Vu Trung commune) 2 3 Average (Vu Quy commune) 4 5 Poorer (Vu Cong commune) 6 293 A. Material consequences Open ended questions for discussion Suggestion sub-questions How economic status of the elderly population? The percentage of the elderly of the total community's population? How their working status? How many percent of them receive pension or any kind of welfare beneficial? What are sources of their income? which of those is the main source of their income? Are they economically independent or depend on their children? if yes (who, why, when and where) What are their financial difficulties? What are coping strategies? Are there any economic differences between those having pension and those don't have? What is different between those having migrant children and those do not have? Can you compare their income before and after their children migrated? Which children support parents better? (sons or daughters) B. Emotional consequences: 294 How is emotional status of the elderly population? 1. Do you compare the emotional spirit of the elderly with no children to work away from home with those who have children working away from home? The elderly live alone with the elderly living with their children or NCT living together. 2. Do you compare the emotional spirit of the EL before your children work away from home after their children work away from home? 3. To help improve the spiritual life for NCT, it is more fun, healthy and useful than what do you recommend to the government in terms of policies? C. Health and physical care consequences: How is health status and health care provided by family for the elderly? 1. How do you assess the health status of elderly people in the locality? Good, medium, weak 2. How is the health insurance card for the elderly in the locality? % Of ELs were granted health insurance % of the ELs self-purchased health insurance? 3. The care for the elderly in the family? And how does NCT access to health services? 4. What difficulties does EL often have when sickness (money, medical services, carers)? If so, how do they overcome those difficulties? 5. Does NCT health care living with children compared with NCT live far from their children?