Journal of Current Research in Scientific Medicine

: 2020  |  Volume : 6  |  Issue : 2  |  Page : 73--76

Social capital and maternal health: A narrative review

Ariarathinam Newtonraj, Mani Manikandan 
 Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India

Correspondence Address:
Ariarathinam Newtonraj
Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry - 605 014


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.

How to cite this article:
Newtonraj A, Manikandan M. Social capital and maternal health: A narrative review.J Curr Res Sci Med 2020;6:73-76

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 Feb 6 ];6:73-76
Available from:

Full Text


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.


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}


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}

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.


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.


1Pilkington P. Social capital and health: Measuring and understanding social capital at a local level could help to tackle health inequalities more effectively. J Public Health Med 2002;24:156-9.
2Lochner KA, Kawachi I, Brennan RT, Buka SL. Social capital and neighborhood mortality rates in Chicago. Soc Sci Med 2003;56:1797-805.
3Pattussi MP, Marcenes W, Croucher R, Sheiham A. Social deprivation, income inequality, social cohesion and dental caries in Brazilian school children. Soc Sci Med 2001;53:915-25.
4The World Bank. Measuring Social Capital – An Integrated Questionniare. The World Bank; 2004. Available from: [Last accessed on 2020 Apr 06].
5Skrabski A, Kopp M, Kawachi I. Social capital in a changing society: Cross sectional associations with middle aged female and male mortality rates. J Epidemiol Community Health 2003;57:114-9.
6Pattussi MP, Hardy R, Sheiham A. Neighborhood social capital and dental injuries in Brazilian adolescents. Am J Public Health 2006;96:1462-8.
7Ziersch AM, Baum FE, Macdougall C, Putland C. Neighbourhood life and social capital: The implications for health. Soc Sci Med 2005;60:71-86.
8Runyan DK, Hunter WM, Socolar RR, Amaya-Jackson L, English D, Landsverk J, et al. Children who prosper in unfavorable environments: The relationship to social capital. Pediatrics 1998;101:12-8.
9Verhaeghe PP, Tampubolon G. Individual social capital, neighbourhood deprivation, and self-rated health in England. Soc Sci Med 2012;75:349-57.
10Simon JG, de Boer JB, Joung IM, Bosma H, Mackenbach JP. How is your health in general? A qualitative study on self-assessed health. Eur J Public Health 2005;15:200-8.
11Santos SM., Chor D, Werneck GL, Coutinho ES. Association between contextual factors and self-rated health: A systematic review of multilevel studies. Cad Saude Publica [Internet]. 2007;23: 2533-4. Available from: [Last accessed on 2020 Jun 10].
12Giordano GN, Lindstrom M. The impact of changes in different aspects of social capital and material conditions on self-rated health over time: A longitudinal cohort study. Soc Sci Med 2010;70:700-10.
13Borges CM, Campos AC, Vargas AD, Ferreira EF, Kawachi I. Social capital and self-rated health among adolescents in Brazil: An exploratory study. BMC Res Notes 2010;3:338.
14Subramanian SV, Kawachi I, Kennedy BP. Does the state you live in make a difference? Multilevel analysis of self-rated health in the US. Soc Sci Med 2001;53:9-19.
15Subramanian SV, Kim DJ, Kawachi I. Social trust and self-rated health in US communities: A multilevel analysis. Urban Health 2002;79 4 Suppl 1:S21-34.
16Engström K, Mattsson F, Järleborg A, Hallqvist J. Contextual social capital as a risk factor for poor self-rated health: A multilevel analysis. Soc Sci Med 2008;66:2268-80.
17Snelgrove JW, Pikhart H, Stafford M. Multilevel analysis of social capital and self-rated health: Evidence from the British household panel survey. Soc Sci Med 2009;68:1993-2001.
18Lomas J. Social capital and health: Implications for public health and epidemiology. Soc Sci Med 1998;47:1181-8.
19Lamarca GA, Leal MD, Sheiham A, Vettore MV, Leal Mdo C, Sheiham A, et al. The association of neighbourhood and individual social capital with consistent self-rated health: A longitudinal study in Brazilian pregnant and postpartum women. BMC Pregnancy Childbirth 2013;13:1.
20Niaraki MR, Roosta S, Alimoradi Z, Allen KA, Pakpour AH. The association between social capital and quality of life among a sample of Iranian pregnant women. BMC Public Health 2019;19:1497.
21Crosby RA, Holtgrave DR. The protective value of social capital against teen pregnancy: A state-level analysis. J Adolesc Health 2006;38:556-9.
22Gyan SE, Ahorlu C, Dzorgbo DS, Fayorsey CK. Social capital and adolescent girls' resilience to teenage pregnancy in Begoro, Ghana. J Biosoc Sci 2017;49:334-47.
23Mizuno S, Nishigori H, Sugiyama T, Takahashi F, Iwama N, Watanabe Z, et al. Association between social capital and the prevalence of gestational diabetes mellitus: An interim report of the Japan Environment and Children's Study. Diabetes Res Clin Pract 2016;120:132-41.
24Tofani AA, Lamarca G, Sheiham A, Vettore MV. The different effects of neighbourhood and individual social capital on health-compromising behaviours in women during pregnancy: A multi-level analysis. BMC Public Health 2015;15:890.
25Elsenbruch S, Benson S, Rücke M, Rose M, Dudenhausen J, Pincus-Knackstedt MK, et al. Social support during pregnancy: Effects on maternal depressive symptoms, smoking and pregnancy outcome. Hum Reprod 2007;22:869-77.
26Kritsotakis G, Vassilaki M, Melaki V, Georgiou V, Philalithis AE, Bitsios P, et al. Social capital in pregnancy and postpartum depressive symptoms: A prospective mother-child cohort study (the Rhea study). Int J Nurs Stud 2013;50:63-72.
27Schölmerich VL, Erdem Ö, Borsboom G, Ghorashi H, Groenewegen P, Steegers EA, et al. The association of neighborhood social capital and ethnic (minority) density with pregnancy outcomes in the Netherlands. PLoS One 2014;9:e95873.
28Agampodi T, Agampodi S, Glozier N, Wms C, Ypjn W, Siribaddana S. How context matters: Demonstrating microgeographical differences in social capital and its implications for mental wellbeing in pregnancy with a novel bubble diagram technique. Health Place 2019;60:102231.
29Delany-Brumsey A, Mays VM, Cochran SD. Does neighborhood social capital buffer the effects of maternal depression on adolescent behavior problems? Am J Community Psychol 2014;53:275-85.
30Zhou C, Ogihara A, Chen H, Wang W, Huang L, Zhang B, et al. Social capital and antenatal depression among Chinese Primiparas: A cross-sectional survey. Psychiatry Res 2017;257:533-9.
31Zhou C, Zheng W, Yuan Q, Zhang B, Chen H, Wang W, et al. Associations between social capital and maternal depression: Results from a follow-up study in China. BMC Pregnancy Childbirth 2018;18:45.
32Leal Mdo C, Pereira AP, Lamarca Gde A, Vettore MV. The relationship between social capital, social support and the adequate use of prenatal care. Cad Saude Publica 2011;27 Suppl 2:S237-53.
33McTavish S, Moore S. On est ensemble: Social capital and maternal health care use in rural Cameroon. Global Health 2015;11:33.
34Semali IA, Leyna GH, Mmbaga EJ, Tengia-Kessy A. Social capital as a determinant of pregnant mother's place of delivery: Experience from Kongwa District in Central Tanzania. PLoS One 2015;10:e0138887.
35Story WT. Social capital and the utilization of maternal and child health services in India: A multilevel analysis. Health Place 2014;28:73-84.
36Jones L, Lu MC, Lucas-Wright A, Dillon-Brown N, Broussard M, Wright K, et al. One Hundred Intentional Acts of Kindness toward a Pregnant Woman: Building reproductive social capital in Los Angeles. Ethn Dis 2010;20:S2-36-40.
37Agampodi TC, Agampodi SB, Glozier N, Lelwala TA, Sirisena KD, Siribaddana S. Development and validation of the Social Capital Assessment Tool in pregnancy for Maternal Health in Low and middle income countries (LSCAT-MH). BMJ Open 2019;9:e027781.
38Solar O, Irwin A. A Conceptual Framework for Action on the Social Determinants of Health. World Health Organization, Location: Geneva; 2007.
39Bezo B, Maggi S, Roberts WL. The rights and freedoms gradient of health: Evidence from a cross-national study. Front Psychol 2012;3:441.