Abstract
BackgroundDimensions of social capital relevant to health in pregnancy are sparsely described in the literature. This study explores dimensions of social capital and the mechanisms in which they could affect the health of rural Sri Lankan pregnant women.MethodsAn exploratory qualitative study of solicited diaries written by pregnant women on their social relationships, diary interviews and in-depth interviews with key informants was conducted. A framework approach for qualitative data analysis was used.ResultsPregnant women (41), from eight different communities completed diaries and 38 post-diary interviews. Sixteen key informant interviews were conducted with public health midwives and senior community dwellers. We identified ten cognitive and five structural constructs of social capital relevant to health in pregnancy. Domestic and neighborhood cohesion were the most commonly expressed constructs. Social support was limited to support from close family, friends and public health midwives. A high density of structural social capital was observed in the micro-communities. Membership in local community groups was not common. Four different pathways by which social capital could influence health in pregnancy were identified. These include micro-level cognitive social capital by promoting mental wellbeing; micro-level structural social capital by reducing minor ailments in pregnancy; micro-level social support mechanisms promoting physical and mental wellbeing through psychosocial resources and health systems at each level providing focused maternal care.ConclusionCurrent tools available may not contain the relevant constructs to capture the unique dimensions of social capital in pregnancy. Social capital can influence health during pregnancy, mainly through improved psychosocial resources generated by social cohesion in micro-communities and by the embedded neighborhood public health services.
Highlights
Dimensions of social capital relevant to health in pregnancy are sparsely described in the literature
The exploratory aspects of the study was propitious in identifying the real life descriptors of each construct, identifying new constructs and formulating a new framework for the association of social capital to pregnancy outcome
This study shows that the health system is the only organization through which linking social capital comes into play in pregnancy
Summary
Dimensions of social capital relevant to health in pregnancy are sparsely described in the literature. Emerging as a factor among the social determinants of health, social capital, has been extensively studied in high income countries (HIC) [3,4,5,6,7]. The maternal mortality rate is low (32.5/100,000 live births) [10], compared to other LMICs and the country has 99–100% coverage in antenatal care This success has been attributed to a strong public health network, promotion of institutional deliveries (99.9%) [10], free preventive and curative care services, high female literacy level and a favorable culture that provides care for pregnant women. A further reduction of maternal mortality has been a challenge; one of the neglected areas has been social aspect of health during pregnancy
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