Abstract
BackgroundHealth facility births contribute to the prevention of maternal deaths. Although theoretical and empirical evidence suggest that social network characteristics influence facility delivery, examination of this relationship in sub-Saharan Africa is limited. We determined whether network structural and functional characteristics were associated with, or had an interactive effect on health facility delivery in rural Ghana.MethodsData on mothers (n = 783) aged 15–49 years came from a Maternal and Newborn Health Referral (MNHR) project in Ghana, and included egocentric network data on women’s social network characteristics. Using multivariate logistic regression we examined the relationship between facility delivery and women’s network structure and functions, as well as the interaction between network characteristics and facility delivery.ResultsHigher levels of instrumental support (e.g. help with daily chores or seeking health care [OR: 1.60, CI: 1.10–2.34]) and informational support (OR: 1.66, CI: 1.08–2.54) were significantly associated with higher odds of facility delivery. Social norms, such as knowing more women who had received pregnancy-related care in a facility, were significantly associated with higher odds of facility delivery (OR: 2.20, CI: 1.21–4.00). The number of network members that respondents lived nearby moderated the positive relationship between informational support and facility delivery. Additionally, informational support moderated the positive relationship between facility delivery and the number of women the respondents knew who had utilized a facility for pregnancy-related care.ConclusionsSocial support from network members was critical to facilitating health facility delivery, and support was further enhanced by women’s network structure and norms favoring facility delivery. Maternal health interventions to increase facility delivery uptake should target women’s social networks.
Highlights
Health facility births contribute to the prevention of maternal deaths
We examine the association between network structural and functional characteristics and health facility delivery
The proportion of women with no formal education was significantly greater among respondents who had homebirth than those who had facility birth (69% vs. 32%, p < 0.01)
Summary
Health facility births contribute to the prevention of maternal deaths. theoretical and empirical evidence suggest that social network characteristics influence facility delivery, examination of this relationship in sub-Saharan Africa is limited. Determinants of health facility delivery in sub-Saharan African countries like Ghana include distance to a facility, available transportation, affordable cost of facility care, maternal socio-demographics (e.g. age, parity, education level, wealth, health decision making autonomy), perceived needs/benefits of facility birth, and facility factors (e.g. health provider attitude, privacy, and quality of care) [8,9,10]. An indepth examination of the link between women’s network characteristics and their pregnancy related experiences could contribute to knowledge on improving uptake in facility delivery care. To address this gap in the literature, we examined the role of social networks in women’s use of health facility for delivery in Ghana
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