a mixed-methods study among female migrants in Accra, Ghana.

This thesis contributes to understanding female migration and health in Ghana at the national and sub-national levels. It presents the first detailed comparative analyses of female migration using data from Ghana’s Population and Housing Censuses (2000−2010) and exploits these data to understand the gendered dimensions of migration in Ghana. This thesis then presents primary analyses from mixed-methods fieldwork to examine health and migration at the sub-national level among female migrants who work in the informal sector as market porters (kayayei). Primary data on migrant kayayei in Accra were collected using respondent driven sampling in an attempt to overcome challenges reported by other researchers surveying kayayei. Analyses of survey data (n = 625) and in-depth interviews (n = 48) examine the usefulness of respondent driven sampling in sampling migrants and assess health insurance and careseeking behaviours among recently ill/injured migrant kayayei. The findings in this thesis highlight that working-age migration is particularly pronounced in 2010, reinforcing economic opportunity as a likely driver of migration for both sexes. Census data identify one in three Ghanaian girls and women as internal migrants. Capturing data on highly mobile, vulnerable migrant populations can be difficult. Respondent driven sampling is not a one-size-fits-all solution for sampling hard-to-reach migrants in low- and middle-income countries, although respondent driven sampling produced the most comprehensive data set on migrant kayayei to date. These data show that access to formal health care in Accra remains largely inaccessible to kayayei migrants who suffer from greater illness/injury than the general female population in Accra and who are hindered in their ability to receive insurance exemptions. Too often, the lack of data on female migration reinforces the out-dated stereotype that girls and women do not participate in migration. The analyses in this thesis refute this stereotype and challenge historical assumptions that underestimated female migration. With internal migration on the rise in many settings, including Ghana, health systems must better recognise and respond to the varied needs of populations in multi-ethnic and multilingual countries to ensure that internal migrants can access affordable, quality health services across domestic borders.