Structural and functional network characteristics and facility delivery among women in rural Ghana
Open accessAbstract
BACKGROUND: Health 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. METHODS: Data 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. RESULTS: Higher 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. CONCLUSIONS: Social 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.
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Women in Ghana are reported to lack autonomy in decisions regarding seeking skilled attendant at delivery, and are thus influenced largely by their husbands and households.
“Also, women are reported to lack autonomy in decisions regarding seeking skilled attendant at delivery, thus are influenced largely by their husbands and households [54,57].”
From A scoping review of the residual barriers to skilled birth attendance in Ghana: A conceptual framework and a fish bone analysis (2024) · cites this paper as [57]
The Results (page unavailable) report that husbands alone usually made health-care decisions for 67.1% of the women surveyed, and the Discussion describes husbands and other household members providing support for facility delivery. The autonomy measure concerns health-care decisions generally, however; the paper does not establish that husbands or households made the specific decision to seek a skilled attendant at delivery. (LLM, conf=0.84)
Experimental — accuracy not yet measuredCofie, Barrington [57] and Cofie, Barrington [58] found that the availability of a network of family and social support improved women's uptake of facility delivery.
“Similarly, Cofie, Barrington [57] and Cofie, Barrington [58] in their study found that the availability of a network of family and social support, improved women’s uptake of facility delivery.”
From A scoping review of the residual barriers to skilled birth attendance in Ghana: A conceptual framework and a fish bone analysis (2024) · cites this paper as [57]
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- Authors
- Cofie, L. E., Barrington, C., Singh, K., Sodzi-Tettey, S., Ennett, S., & Maman, S.
- Affiliations
- The University of Texas Medical Branch at Galveston (US)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Cofie, Leslie E.
- Venue
- BMC Pregnancy and Childbirth
- Published
- 2017-12
- Volume
- 17
- Issue
- 1
- Pages
- 425-425
- ISSN
- 1471-2393 (ISSN-L)
- PMC
- PMC5735796
- OpenAlex
- W2779842688
- Cited by
- 13
- References
- 47
- Citations by year
- 2026: 1 · 2024: 3 · 2023: 2 · 2022: 3 · 2021: 4
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Pregnancy and Childbirth (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Greater South Information System
- Funders
- Bill and Melinda Gates Foundation
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Social Sciences › Health › Public Health and Social Inequalities
- Keywords
- institutional delivery, social networks, social support, instrumental support, information support, social norms, personal networks, rural Ghana, maternal health, health facility births, network structure
- MeSH terms
- Adolescent, Adult, Female, Ghana, Health Facilities, Home Childbirth, Humans, Middle Aged, Patient Acceptance of Health Care, Pregnancy, Rural Population, Social Support, Delivery, Obstetric, Young Adult, Social Networking, Social Norms
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