Social Connections and Maternal Care-Seeking Behavior: From Collective Capabilities to Commoning

Abstract

Purpose: The purpose of this paper is to examine the social factors that explain maternal health-seeking behavior. Several studies show that good health is a consequential effect of one's socioeconomic status (SES). However, regarding how social support systems relate to health-seeking behavior, particularly in rural settings in developing countries, conceptual clarity and empirical evidence are limited. Empirically, the understanding of the nuances of how social support independently affects maternal health-seeking behavior, particularly in impoverished communities, is limited. In rural Sub-Saharan Africa, where households are predominantly collectivistic, many studies fail to examine these relationships from conceptual lens attuned to collectivistic cultures. Failure to account for reliance on support networks and kinship ties diminishes the role of social support systems in how women make health-related choices. This study sheds light on how social support helps explain maternal health-seeking behavior through the framework of the commons.

Design/methodology: The paper uses cross-sectional data from households in the Awutu-Senya district in Ghana and generalized ordered logistic regression to examine the role of social ties, kinship, and support systems on maternal health-seeking behavior. The current study measures maternal health-seeking behavior as the use of skilled prenatal care and the utilization of facility-based deliveries. For this study, the nature of social network support was a composite score obtained through an aggregation of households' sources of financial help in accessing health facilities.

Findings: When it comes to the utilisation of facility-based delivery, the findings show that households with more social connections are more likely to utilise facility-based delivery (b = 0.23, odds = 1.26; 95% CI 1.09-1.55, p < .01). Also households with more social support networks were more likely to utilise skilled antenatal care (b = 0.21, odds = 1.23; 95% CI 1.02-1.48, p < .05). The findings also indicate that the number of years in education (b = 0.09, odds = 1.10; 95% CI, 1.02, - 1.19, p < .05); the number of transportation assets (b = 0.81, odds = 2.24; 95% CI, 1.08-4.63, p < .05), and having health facility in the community (b = 0.80, odds = 2.23; 95% CI 1.02-4.87, p < .05) were associated with maternal health-seeking behaviour.

Practical implications: The findings have implications for community-based health intervention. Self-help groups focussed on pregnancy-related support and education may hold prospects for expectant mothers. Similarly, the findings have potential implications for asset-building initiatives. The nature of social connection may mean that the accumulation and appropriations of resources can be achieved through collaborative efforts.

Originality/value: Through the lens of the commons and collective capabilities, this paper sheds light on how normative sharing of tangible and intangible resources among households can be critical to maternal and health-seeking behavior. Traditional sharing norms within kinship networks in some African communities affect decision-making around resource access and use in households more profoundly than typically acknowledged in the literature.