Collections > Electronic Theses and Dissertations > A Mixed Methods Study of Social Network Charactaristics and Health Facility Delivery Among Women in Rural Ghana

Background: Most maternal deaths are preventable with health facility birth, but half of women in sub-Saharan Africa do not deliver in health facilities. Although theoretical and empirical evidence suggest that social networks influence facility delivery, examination of this relationship in Africa is very limited. The aims of this mixed-methods study were to: (1) examine the association between social network structural and functional characteristics and facility delivery in rural Ghana; (2) test whether these network characteristics had an interactive effect on facility delivery; and (3) explore how women’s network composition and social support influence facility delivery. Methods: Both quantitative and qualitative data came from the Maternal and Newborn Health Referral (MNHR) project in Ghana. I used multivariate logistic regression to analyze endline quantitative data from mothers (n=783) enrolled in the MNHR study. Qualitative data included in-depth interviews with mothers (n=40) and husbands (n=20), and 4 focus group interviews with mothers-in-law. I analyzed the data using narrative methods and thematic coding procedures. Results: Higher levels of instrumental support (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. In terms of social norms, knowing more women who had received pregnancy-related care in a facility (OR: 2.20, CI: 1.21-4.00) was significantly associated with higher odds of facility delivery. The number of network members that respondents lived near moderated the positive relationship between informational support and facility delivery. Informational support modified the positive relationship between number of women the respondents know that have utilized a facility for pregnancy-related care and facility delivery. The qualitative findings revealed that the social networks of women who delivered in a facility endorsed facility delivery and mobilized resources to support women’s facility delivery. Among women who had homebirths, social networks endorsed home birth and/or delayed in making arrangements to facilitate facility delivery. Conclusion: Women’s social networks influenced whether they delivered in a health facility. Social networks should be targeted in maternal health interventions to increase facility delivery uptake.