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 Table of Contents  
Year : 2020  |  Volume : 6  |  Issue : 2  |  Page : 73-76

Social capital and maternal health: A narrative review

Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India

Date of Submission06-Apr-2020
Date of Decision13-May-2020
Date of Acceptance01-Jun-2020
Date of Web Publication21-Dec-2020

Correspondence Address:
Ariarathinam Newtonraj
Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry - 605 014
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcrsm.jcrsm_22_20

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Social capital (SC) is a well-known concept studied in developed countries, but it is relatively a new concept for Indian setting. Social scientists have studied this concept in detail, but in the medical field, this concept and its application is still unexplored. This article is a review conducted from the published literature, from all over the world on SC and its relationship with pregnancy and its outcome for the past 20 years. Along with other social determinants, namely, caste, religion, and socioeconomic status, SC also plays a vital role in determining the health of women in various ways. Poor SC has been found to be associated with low birth weight, depression, poor mental health, poor self-rated health, and quality of life. SC also helps in accessing better prenatal care and delivery care. To conclude, SC has a positive association with improving pregnancy and its outcome. There is a lot of scope to venture into this topic in the near future in India.

Keywords: India, social capital, social determinant, trust

How to cite this article:
Newtonraj A, Manikandan M. Social capital and maternal health: A narrative review. J Curr Res Sci Med 2020;6:73-6

How to cite this URL:
Newtonraj A, Manikandan M. Social capital and maternal health: A narrative review. J Curr Res Sci Med [serial online] 2020 [cited 2023 May 31];6:73-6. Available from: https://www.jcrsmed.org/text.asp?2020/6/2/73/304199

  Introduction Top

Social capital (SC) is relatively a new concept for India, but this has been well established in developed countries. It was first used to describe the advantages and opportunities available to people through membership of certain communities.[1] Putnam, while studying the regions of Italy, noted that the quality of government in different regions of Italy was determined by the traditions of civic engagement.[1] He concluded that a community or society, by developing SC, could become more productive. SC was defined in terms of the following four characteristics: (a) the existence of community networks; (b) civic engagement; (c) local identity, a sense of solidarity and equity with other community members; and (d) trust and reciprocal help and support.[1],[2],[3] Later, the World Bank report in 2004 added few more dimensions, i.e., groups and networks; trust and solidarity; collective action and cooperation; information and communication; social cohesion and inclusion; and empowerment and political action.[4]

SC and its contextual dimensions – social trust, reciprocity, neighborhood safety, neighborhood support, social control, empowerment, and political efficacy – have been associated with a large number of health outcomes: poor mental health, infant well-being, mortality, oral conditions, respiratory diseases, coronary diseases, and teenage pregnancy.[1],[2],[3],[4],[5],[6],[7],[8] SC may also play an important role in self-rated health (SRH). SRH is highly correlated with objective health measures.[9],[10],[11],[12],[13],[14],[15] Multilevel studies have shown an association between contextual SC and SRH, although there is some inconsistency in the measurement of SC.[16],[17] The striking differences in health, both within and between countries, strongly suggest that the social environment may play some role in it. According to Lomas, the way the society is organized, the extent to which interaction is encouraged, and the degree to which people trust each other is probably the most important determinant of health.[18]

SC is a well-known area of interest for social scientists but one of the less explored areas by medical researchers, especially from India. This review is concentrating on the role of SC in pregnancy from the available literature and the future opportunities of research in this high-thrust area.

  Methodology Top

We searched PubMed and Google Scholar between February 1, 2020, and February 28, 2020. All articles published within the reference period of 20 years (2000–2019) were included. Keywords used for the search were Social Capital, antenatal, pregnant, pregnancy, and maternal in title and abstract. Back reference searches were also done. Seventy-six articles were line listed after a complete search, of which 43 articles were excluded based on title screening and duplication. Twelve articles were excluded after abstract screening and finally, 21 articles were included for the review. This review is organized in the sequence of SC and pregnancy health and outcome, utilizing SC in health programs, scope of interventions, ways of measuring SC, and finally a conceptual framework of SC and health adapted from World Health Organization framework [Figure 1].
Figure 1: Flowchart for social capital review

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  Results Top

Social capital and pregnancy

SC plays several roles in the health of pregnant women. SRH: a study conducted in Brazil found that low individual SC during pregnancy, social support, and social network are independently associated with poor SRH of women.[19] Women with good SC have good quality of life.[20] Teenage pregnancy: SC had a strong impact on preventing teenage pregnancies in a part of the United States.[21] Teenage girls with good SC were found to be resilient to teenage pregnancy in Ghana.[22] Gestational diabetes mellitus (GDM), smoking, and diet: emotional support and neighborhood trust is significantly associated with lesser incidence of GDM.[23] Low individual SC is associated with smoking and low diet, whereas low neighborhood SC to inadequate diet in Brazilian women.[24] In smokers, the effects of social support on pregnancy complications, including preterm delivery, and babies' birth weight and size were remarkable. Birth weights of babies born to mothers who had smoked during early pregnancy were markedly and significantly reduced in women with low support (3175 ± 453 g) compared to babies of smoking mothers with high support (3571 ± 409 g).[25]


An increase in the risk of preterm birth for every unit increase in maternal participation in community especially in the risk of medically indicated preterm birth has been found. The reason may be women who participate more in their communities may have enhanced access to information and/or resources, easier access to health care and support when they face maternal and fetal conditions that trigger the need for medical intervention.[26] Neighborhood SC was found to be associated with low birth weight and prematurity in the Netherlands.[27] Low birth weight: babies born to mothers with low social support during early pregnancy were smaller and had a markedly reduced birth weight by nearly 200 g on an average, after exclusion of preterm deliveries, reflecting the effect of SC on pregnancy outcome. The adverse effects of low social support on pregnancy complications and pregnancy outcomes, including birth weight, have also been discussed.[25] This may be probably through pathways of the biological stress systems, including hormones and immune mediators.[25]


The role of social support in fetal intrauterine development is an area that still needs to be explored. Women with low social support lack effective psychosocial resources, particularly social stability and social participation, and therefore receive insufficient emotional and instrumental support from the partner, family, and/or friends.[25]

During early pregnancy, a time of significant life change requiring major psychological adjustment, the perception and expectation of insufficient support may have a detrimental impact on maternal psychological well-being. Hence, one obvious mechanism mediating the effects of social support on pregnancy outcomes could be increased maternal stress, anxiety, and depression.[25] Women living in a specific community in Sri Lanka found to have poorer mental well-being.[28] A study from Los Angeles found that living in a good neighborhood SC attenuates maternal depression.[29] On the other hand, low SC was found to be associated with depression among Chinese women.[30],[31]

Social capital in health programs

The utilization of prenatal care was found to be positively associated with high SC.[32] Access to health care through social network was found to be good among rural Cameroon women.[33] SC promotes institutional deliveries in Tanzania.[34] SC is negatively associated with preventive care, but positively associated with professional delivery care.[35] “One hundred intentional acts of kindness” is an impressive interventional study by Jones et al. on improving SC among pregnant women in Los Angeles, which could be replicable in the Indian setting.[36]

Measuring social capital

Different people have adapted different methods and different questionnaires to measure SC.[37] Most widely available tools is the one which is shared by the World Bank.[4] Agampodi et al. have adapted, modified, and used the same tool as per their local need after validation.[28],[37] Measurement of SC will be complete only if all the domains considered in the SC are considered. Hence, studies should include all the domains while measuring the SC and its association with pregnancy outcomes.

Framework of social capital

A analytic framework [Figure 2] was developed, which is based on the World Health Organization's framework of social determinants to understand and relate SC with health outcomes.[38],[39] In this analytic framework, social factors operate through the proximate medical risk factors to determine birth outcomes.
Figure 2: Framework of social determinants of health

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Way forward in India

Most of the studies on SC were conducted in developed countries. Only few studies on SC and health have emerged from developing countries. The association of socioeconomic and educational status and pregnancy outcome is well understood, but the association with SC along with these factors needs attention of public health researchers from India.

  Conclusions Top

SC has a positive association with improving pregnancy and its outcome. There is a lot of scope to venture into this topic in the near future in India.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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The World Bank. Measuring Social Capital – An Integrated Questionniare. The World Bank; 2004. Available from: http://documents.worldbank.org/curated/en/515261468740392133/pdf/281100PAPER0Measuring0social0capital.pdf. [Last accessed on 2020 Apr 06].  Back to cited text no. 4
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  [Figure 1], [Figure 2]


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