Maternal social capital and birth outcomes in the mother–child cohort in Crete, Greece (Rhea study)

Impact of individual and neighborhood social capital on the physical and mental health of pregnant women: the Japan Environment and Children's Study (JECS)

Background

Previous studies revealed positive, negative, and no influence of social capital on the health outcomes of pregnant women. It was considered that such differences were caused by the disparities of outcome measures and sample sizes between studies. Our chief aim was to verify the positive influence of social capital on the health condition of pregnant women using established health outcome measures and large-scale nationwide survey data.

Methods

We employed questionnaire survey data from 79,210 respondents to the Japan Environment and Children’s Study, and physical and mental component summary scores from the 8-Item Short-Form Health Survey as outcome measures. We estimated the effect of individual and neighborhood social capitals on physical and mental component summary scores. To consider the property that the richness of social capital would be generally determined by individual characteristics, and to estimate the causal influence of social capital on health without bias caused by said property, we adopted average treatment effect estimation with inverse probability weighting. Generally, average treatment effects are based on the difference of average outcomes between treated and untreated groups in an intervention. In this research, we reckoned individuals’ different levels of social capital as a kind of non-randomized treatment for respective individuals, and we applied average treatment effect estimation. The analysis regarded pregnant women with the lowest level of social capital as untreated samples and women with other levels of social capitals as treated samples.

Results

For mental component summary score, the maximum average treatment effects in the comparison between the lowest and highest levels of social capital were approximately 4.4 and 1.6 for individual and neighborhood social capital, respectively. The average treatment effects for the physical component summary score were negligible for both social capital types.

Conclusions

Social capital particularly contributes to improving mental component summary score in pregnant women. The likelihood of a mentally healthy pregnancy may be increased by enhancing social capital.

Associations between maternal social capital and infant birth weight in three developing countries: a cross-sectional multilevel analysis of Young Lives data

OBJECTIVE

To explore how three indicators of social capital (ie, group membership, social support and cognitive social capital and specific types within each type) are associated with infant birth weight.

STUDY DESIGN AND SETTINGS

Cross-sectional analyses of the first wave of Young Lives Survey data collected in 2002 from India (Andhra Pradesh state), Peru and Vietnam.

PARTICIPANTS

807 mothers in India, 1528 mothers in Peru and 1706 mothers in Vietnam.

OUTCOMES MEASURE

Infant birth weight was measured in grams. Participation in specific groups, receipt of social support from specific groups or individuals and perceptions of their community were measured for social capital indicators. Two-level random intercept linear regression models were fit separately by country (first level: individual and second level: community).

RESULTS

Maternal group membership displayed a consistent positive association with infant birth weight across the three countries. There was no relationship with maternal cognitive social capital. Membership in a women's group was associated with infant birth weight consistently in all three countries (b=119.6, 95% CI 21.7 to 217.4 in India, b=133.4, 95% CI 40.9 to 225.9 in Peru, b=60.6, 95% CI 0.5 to 120.6 in Vietnam). However, membership in a political group in Peru was inversely associated with infant birth weight (b=-276.1, 95% CI -465.7 to -86.5).

CONCLUSION

Although a higher level of social capital is associated with higher infant birth weight, specific types of social capital may have different associations with infant birth weight depending on the social, political or cultural specificity of the country. These results pave the way for additional research on the mechanisms through which social capital influences birth weight outcomes in each country.

Higher child-raising costs due to maternal social isolation: Large population-based study in Japan

BACKGROUND

To assess the association between maternal social isolation and the child-rearing costs among mothers with 6-month-old infants.

METHODS

Data was analyzed from a population-based birth-cohort study in Japan, the Longitudinal Survey of Babies in the 21st Century (n = 40,643). Maternal isolation was defined by lack of social support among mothers expressing difficulties with child rearing. Child-rearing costs for one month (when the infant was 6-months-old) were self-reported in units of JPY 10,000 (approximately 80 USD). The association between maternal social isolation and child-rearing cost was assessed using generalized linear models adjusted for child, maternal, and family level characteristics.

RESULTS

Of the sample, 258 (0.6%) women were classified as socially isolated. In the crude model, isolated mothers paid JPY 6980 (95% confidence interval [CI]: 4753-9207), approximately USD$87, more per month on child-rearing expenses compared to non-isolated mothers. This finding was similar in the multivariable adjusted model (marginal effect: JPY 4,186, 95% CI, 2235-6136). Stratified analysis comparing low income vs. non-low income mothers showed that, among the former group, socially isolated mothers spend more on child rearing than mothers who are not isolated (marginal effect: JPY 13,218, 95% CI:784 to 2565), while among the non-low income group, a significant association was not observed.

CONCLUSIONS

Socially isolated mothers spent JPY4,186 (approximately USD 35) more per month on child-rearing costs compared to non-isolated mothers when the infant was aged 6 months old. In nationwide terms, this cost could be roughly calculated as JPY 350 million (approximately USD 2.9 million) in 2001. Provision of social network connections and support for socially isolated mothers is suggested to be an efficient public health policy.

Generation and evaluation of an indicator of the health system's performance in maternal and reproductive health in Colombia: An ecological study

Objective

To generate and evaluate an indicator of the health system’s performance in the area of maternal and reproductive health in Colombia.

Materials and methods

An indicator was constructed based on variables related to the coverage and utilization of healthcare services for pregnant and reproductive-age women. A factor analysis was performed using a polychoric correlation matrix and the states were classified according to the indicator’s score. A path analysis was used to evaluate the relationship between the indicator and social determinants, with the maternal mortality ratio as the response variable.

Results

The factor analysis indicates that only one principal factor exists, namely "coverage and utilization of maternal healthcare services" (eigenvalue 4.35). The indicator performed best in the states of Atlantic, Bogota, Boyaca, Cundinamarca, Huila, Risaralda and Santander (Q4). The poorest performance (Q1) occurred in Caqueta, Choco, La Guajira, Vichada, Guainia, Amazonas and Vaupes. The indicator’s behavior was found to have an association with the unsatisfied basic needs index and women’s education (β = -0.021; 95%CI -0031 to -0.01 and β 0.554; 95%CI 0.39 to 0.72, respectively). According to the path analysis, an inverse relationship exists between the proposed indicator and the behavior of the maternal mortality ratio (β = -49.34; 95%CI -77.7 to -20.9); performance was a mediating variable.

Discussion

The performance of the health system with respect to its management of access and coverage for maternal and reproductive health appears to function as a mediating variable between social determinants and maternal mortality in Colombia.

Preterm Birth and Social Support during Pregnancy: a Systematic Review and Meta-Analysis

BACKGROUND

Additional social support is often recommended for women during the prenatal period to optimise birth outcomes, specifically to avoid preterm birth. Social support is thought to act in one of two ways: by reducing stress and anxiety, or by providing coping mechanisms for women with high stress. However, evidence in this area is mixed. The purpose of this meta-analysis is to determine if low levels of social support are associated with an increased risk for preterm birth.

METHODS

Six databases were searched for randomised control trials and cohort studies regarding social support and preterm birth with no limits set on date or language. Inclusion criteria included the use of a validated instrument to measure social support, and studies conducted in high-income or high-middle-income countries.

RESULTS

There were 3467 records retrieved, 16 of which met the inclusion criteria. Eight studies (n = 14 630 subjects) demonstrated a pooled odds ratio (OR) of 1.22 (95% CI 0.84, 1.76) for preterm birth in women with low social support compared with high social support. Among women with high stress levels, two studies (n = 6374 subjects) yielded a pooled OR of 1.52 (95% CI 1.18, 1.97). The results of six studies could not be pooled due to incompatibility of outcome measures.

CONCLUSIONS

There is no evidence for a direct association between social support and preterm birth. Social support, however, may provide a buffering mechanism between stress and preterm birth.

Social Capital as a Determinant of Pregnant Mother's Place of Delivery: Experience from Kongwa District in Central Tanzania

INTRODUCTION

Maternal ill health contributes highly to the global burden of diseases in countries South of Sahara including Tanzania. Ensuring that all deliveries take place in health facilities and hence attended by skilled health personnel is one of the strategies advocated by global and national policies, including the Millennium Development Goals (MDGs). However, the number of women delivered by skilled health personnel has remained low in sub Saharan Africa despite of a number of interventions. We sought to determine the role of social capital in facilitating health facility delivery.

METHODS

We randomly selected 744 households with children aged less than five years from two randomly selected wards in a rural area in Tanzania. Mothers were enquired about place of delivery of the last child. Social capital was assessed using a modified questionnaire with both structural and cognitive aspects of social capital, administered in face-to-face interviews. Principal Component Analysis (PCA) was used to develop asocial capital index measure. Uni-variate and multivariable regression models were run using STATA 12.

RESULTS

Majority (85.9%) of the mothers reported to have delivered in a health facility during their last birth. Compared to the lowest social capital quintile, delivering in a health facility increased significantly with increase in social capital level: low (Adjusted Odds Ratio (AOR) = 2.9; Confidence Interval (CI): 1.4-6.1, p = 0.004); moderate (AOR = 5.5, CI: 2.3-13.3, p-value<0.001); high (AOR = 4.7; CI: 1.9-11.6, p-value<0.001) and highest (AOR = 5.6, CI: 2.4-13.4, p-value<0.001) and χ2-test for the trend was significant (χ2 = 17.21, p<0.001).

CONCLUSION

Overall, social capital seems to play an important role in enhancing health facility delivery that may lead to improved maternal and child health. Concerted efforts should focus on promoting and supporting effective social capital and in particular cognitive social capital.

The different effects of neighbourhood and individual social capital on health-compromising behaviours in women during pregnancy: a multi-level analysis

Background

This study assessed clustering of three health-compromising behaviours and explored the association of neighbourhood and individual social capital with simultaneous health-compromising behaviours and patterns of those behaviours in women in the first trimester of pregnancy (baseline) and during the second and third trimesters of pregnancy (follow-up).

Methods

A longitudinal study was conducted on a representative sample of women recruited in antenatal care units grouped in 46 neighbourhoods from Brazil. Neighbourhood-level measures (social capital and socioeconomic status), individual social capital (social support and social networks) and socio-demographic variables were collected at baseline. Smoking, alcohol consumption and inadequate diet were assessed at baseline and follow-up. Clustering was assessed using an observed to expected ratio method. The association of contextual and individual social capital with the health-compromising behaviours outcomes was analyzed through multilevel multivariate regression models.

Results

Clustering of the three health-compromising behaviours as well as of smoking and alcohol consumption were identified at both baseline and follow-up periods. Neighbourhood social capital did not influence the occurrence of simultaneous health-compromising behaviours. More health-compromising behaviours in both periods was inversely associated with low levels of individual social capital. Low individual social capital predicted smoking during whole pregnancy, while high individual social capital increased the likelihood of stopping smoking and improving diet during pregnancy. Maintaining an inadequate diet during pregnancy was influenced by low individual and neighbourhood social capital.

Conclusions

Three health-compromising behaviours are relatively common and cluster in Brazilian women throughout pregnancy. Low individual social capital significantly predicted simultaneous health-compromising behaviours and patterns of smoking and inadequate diet during pregnancy while low neighbourhood social capital was only relevant for inadequate diet. These findings suggest that interventions focusing on reducing multiple behaviours should be part of antenatal care throughout pregnancy. Individual and contextual social resources should be considered when planning the interventions.

Social capital, tolerance of diversity and adherence to Mediterranean diet: the Rhea Mother-Child Cohort in Crete, Greece

OBJECTIVE

To estimate the associations of individual maternal social capital and social capital dimensions (Participation in the Community, Feelings of Safety, Value of Life and Social Agency, Tolerance of Diversity) with adherence to the Mediterranean diet during pregnancy.

DESIGN

This is a cross-sectional analysis of data from a prospective mother-child cohort (Rhea Study). Participants completed a social capital questionnaire and an FFQ in mid-pregnancy. Mediterranean diet adherence was evaluated through an a priori score ranging from 0 to 8 (minimal-maximal adherence). Maternal social capital scores were categorized into three groups: the upper 10 % was the high social capital group, the middle 80 % was the medium and the lowest 10 % was the low social capital group. Multivariable log-binomial and linear regression models adjusted for confounders were performed.

SETTING

Heraklion, Crete, Greece.

SUBJECTS

A total of 377 women with singleton pregnancies.

RESULTS

High maternal Total Social Capital was associated with an increase of almost 1 point in Mediterranean diet score (highest v. lowest group: β coefficient=0·95, 95 % CI 0·23, 1·68), after adjustment for confounders. Similar dose-response effects were noted for the scale Tolerance of Diversity (highest v. lowest group: adjusted β coefficient=1·08, 95 % CI 0·39, 1·77).

CONCLUSIONS

Individual social capital and tolerance of diversity are associated with adherence to the Mediterranean diet in pregnancy. Women with higher social capital may exhibit a higher sense of obligation to themselves and to others that may lead to proactive nutrition-related activities. Less tolerant women may not provide the opportunity to new healthier, but unfamiliar, nutritional recommendations to become part of their regular diet.

Social capital and adherence to cervical and breast cancer screening guidelines: a cross-sectional study in rural Crete

Breast and cervical cancers are among the leading causes of female mortality. The reasons that make women adhere, or not, to screening guidelines are not only related to individual and health characteristics but are also placed in a wider social and cultural context. Social capital might facilitate the dissemination of relevant knowledge of and the adherence to cancer screening guidelines. This cross-sectional study explored the associations of individual-level social capital with breast and cervical cancer screening and the knowledge for the existence of relevant screening tests (Pap test and mammography) in the municipality of Gorgolaini, a rural area in Crete, Greece. A random sample of 131 of the 592 women of the 2001 electoral register were invited to participate in the study and 125 completed the Social Capital Questionnaire and two questions on self-reported health knowledge and behaviour (participation rate 95.4%). Women were eligible to participate if they were aged 35-75, had lived in the area for the last 10 years and were of Greek origin. Multiple logistic regressions were performed to establish associations among each social capital factor (total, participation in the community, value of life, tolerance for diversity, feelings of safety, family/friends connections) and knowledge of and adherence to breast and cervical cancer screening guidelines after adjustment for confounders. Our results suggest that early detection of breast and cervical cancers may be facilitated when taking into account the social context of the population.

The association of neighbourhood and individual social capital with consistent self-rated health: a longitudinal study in Brazilian pregnant and postpartum women

BACKGROUND

Social conditions, social relationships and neighbourhood environment, the components of social capital, are important determinants of health. The objective of this study was to investigate the association of neighbourhood and individual social capital with consistent self-rated health in women between the first trimester of pregnancy and six months postpartum.

METHODS

A multilevel cohort study in 34 neighbourhoods was performed on 685 Brazilian women recruited at antenatal units in two cities in the State of Rio de Janeiro, Brazil. Self-rated health (SRH) was assessed in the 1st trimester of pregnancy (baseline) and six months after childbirth (follow-up). The participants were divided into two groups: 1. Good SRH--good SRH at baseline and follow-up, and, 2. Poor SRH--poor SRH at baseline and follow-up. Exploratory variables collected at baseline included neighbourhood social capital (neighbourhood-level variable), individual social capital (social support and social networks), demographic and socioeconomic characteristics, health-related behaviours and self-reported diseases. A hierarchical binomial multilevel analysis was performed to test the association between neighbourhood and individual social capital and SRH, adjusted for covariates.

RESULTS

The Good SRH group reported higher scores of social support and social networks than the Poor SRH group. Although low neighbourhood social capital was associated with poor SRH in crude analysis, the association was not significant when individual socio-demographic variables were included in the model. In the final model, women reporting poor SRH both at baseline and follow-up had lower levels of social support (positive social interaction) [OR 0.82 (95% CI: 0.73-0.90)] and a lower likelihood of friendship social networks [OR 0.61 (95% CI: 0.37-0.99)] than the Good SRH group. The characteristics that remained associated with poor SRH were low level of schooling, Black and Brown ethnicity, more children, urinary infection and water plumbing outside the house.

CONCLUSIONS

Low individual social capital during pregnancy, considered here as social support and social network, was independently associated with poor SRH in women whereas neighbourhood social capital did not affect women's SRH during pregnancy and the months thereafter. From pregnancy and up to six months postpartum, the effect of individual social capital explained better the consistency of SRH over time than neighbourhood social capital.

Social capital in pregnancy and postpartum depressive symptoms: a prospective mother-child cohort study (the Rhea study)

BACKGROUND

Depression, and to a lesser extent postpartum depressive symptoms, have been associated with characteristics of the social environment and social capital. Up to the present, mostly cross-sectional studies have explored such an association without providing a clear temporal relationship between social capital and depression.

OBJECTIVES

To estimate prospectively the effect of individual-level self-reported maternal social capital during pregnancy on postpartum depressive symptoms.

DESIGN

Prospective mother-child cohort (Rhea study).

SETTINGS

4 prenatal clinics in Heraklion, Crete, Greece.

PARTICIPANTS

All women for one year beginning in February 2007. From the 1388 participants, complete data were available for 356 women.

METHODS

Women self-completed two questionnaires: The Social Capital Questionnaire at about the 24th week of gestation and the Edinburgh Postnatal Depression Scale (range 0-30) at about the 8-10th week postpartum. Maternal social capital scores were categorized into three groups: the upper 10% was the high social capital group, the middle 80% was the medium and the lowest 10% was the low social capital group that served as the reference category. Multivariable log-binomial and linear regression models were performed for: the whole available sample; for participants with a history of depression and/or prenatal EPDS≥13; for participants without any previous or current depression and prenatal EPDS score<13. Potential confounders included demographic, socio-economic, lifestyle and pregnancy characteristics that have an established or potential association with maternal social capital in pregnancy or postpartum depressive symptoms or both.

RESULTS

Higher maternal social capital was associated with lower EPDS scores (highest vs lowest group: β-coefficient=-3.95, 95% CI -7.75, -0.14). Similar effects were noted for the subscale value of life/social agency (highest vs lowest group: β-coefficient=-5.96, 95% CI -9.52, -2.37). This association remained significant for women with and without past and/or present depression only for the subscale value of life/social agency although with a more imprecise estimate. No effect was found for participation, a structural dimension of social capital.

CONCLUSIONS

Women with higher individual-level social capital in mid-pregnancy reported less depressive symptoms 6-8 weeks postpartum. Given the proposed association of perceptions of the social environment with postpartum depressive symptoms, health professionals should consider evidence-based interventions to address depression in a social framework.