Internal labour migration is an important and necessary livelihood strategy for millions of individuals and households throughout India. Participation in labour mobility can also influence health and development outcomes among migrant workers and their households. To understand the connections between internal labour migration, health, and rural livelihoods, a mixed methods (qualitative and quantitative) study including 66 semi-structured interviews and 300 household surveys (representing 1,693 individuals) was conducted in 26 rural villages in the Krishnagiri district of Tamil Nadu. Data were collected on the determinants, types, and outcomes of internal labour migration, the rate of participation in the Mahatma Gandhi Rural Employment Guarantee Act (MGNREGA), self-reported morbidity, and health seeking behaviour. Qualitative data were analyzed using thematic analysis and quantitative data were analyzed using multivariable logistic and linear models. Of the 300 households surveyed, 137 (45.7%) had at least one current migrant member, with 205 migrant workers (8.3% females and 91.7% males) included in total. Types of labour migration included daily labour commutes (12.2%), temporary labour migration (77.6%), and permanent migration (2.9%). Households from historically marginalized castes were 3.7 times more likely to engage in temporary labour migration than higher caste households. Participation in internal labour migration was financially advantageous, with the highest daily wages earned by high skilled workers and those in the construction industry. Despite public and political discourse on the subject, participation in MGNREGA did not act as a substitute for internal labour migration. Conversely, there was evidence that MGNREGA and internal labour migration were used as complementary livelihood strategies. In terms of self-reported morbidity, 22.3% of individuals experienced a chronic health problem at the time of survey administration. This prevalence did not differ between migrant and nonmigrant adults. The lack of confidence in the public healthcare system and the cost of private healthcare were barriers to seeking care. The overall findings underscore the significance of internal labour migration for these rural households and its role in shaping health and development outcomes.
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