Plain English summary
Study setting and population
Selection of study sample
Selecting study participants
Data collection procedure
Social capital construct
Level & type of social capital
Selected verbatim from diaries
Selected verbatim from PHM/CD interviews
Domestic cohesion (husband)a
The emotional bonding that family members have towards one another and the degree of individual autonomy an individual experience in the family system (Oslon et al. 1979 )
Feel happy when the husband is around
“My husband was at home today. I love it so much when my husband is around. It is the best of satisfaction I could imagine.” Me04
“Most husbands are not at home. They work outside the village and visit home around once a month. When they are at home, they are very helpful to mothers.” Me Community Dweller (CD)
Being cared by the husband
“My husband take care of me now more than previously. He bought me a garden hose, as it was difficult for me to water the garden. He fixed it and I was very happy.” Mi 02
“Husbands are very concerned about their wives during pregnancy. Sometimes they call us even in the night asking for advise on their wives symptoms.” NPE PHM
Husband is providing care when ill
“I felt ill at around 1.00 P.M So I couldn’t conduct evening class. My husband suggested that we should take treatment. But I refused to go, as I’m pregnant and I shouldn’t take more drugs. He stayed closer to me & looked after me with kindness. I got the feeling that his kindness cured me.” GA01
Husband pay lot of attention on health of the wife during pregnancy. They are very supportive. When we visit the house, it is the husband that prepares and offers us refreshments while we are talking to the mother. GA PHM
Express love to husband
“When my husband is at home, I never feel alone. He is like a god to me. I feel that I’m the most fortunate wife in the world!” R04
Disharmony and conflicts with husband
“My husband came home and asked me for money. I asked why? He told that it is to get liquor. I was very angry and scolded him. He got angry too and slept. I felt very sad as to why he does this to us while we are struggling to overcome our problem.” V02
“Most of the husbands in this community do security jobs out of town. Therefore the relationship between the husband and the wife is poor. The love and care received by the females during pregnancy is low in this community. It is very difficult to get the husband to attend an antenatal session or a monthly weighing program of a child.” V PHM
Domestic cohesion (Family)a
Trust towards in-laws
My mother-in-law is very kind. She will not react even when we do something unreasonable for her. Such a good person she is! Better than my own mother. My Father in-law is the same. My sister in-laws never let my husband scold my children or me. In such situations they confront him. P01
Most of the time mother-in-laws take care of pregnant daughter-in-law as their own daughter. Conflicts are seen rarely when the daughter-in-law comes from an area with relatively higher socio-economic facilities is resistant to adjusting to this community.
Family members spend time talking together
“Evening was joyful. We were all sitting in the veranda and were teasing my sister-in- law. All of us were laughing. I forget my ailments when she says funny things..” NPC01
Family members work together
“As today is Friday, I came home at around 11.00A.M. Then my mother-in-law, sister-in-law & myself prepared the lunch” GA01
Family members are concern of the arrival of newborn
“Everybody in my house are awaiting for the great day! I’m very happy that my child is gifted with such a lovely family. The child is very lucky” NPC01
Feel cared at home when ill
“Today I had severe pain in my upper arm. My mother-in-law & sister-in-law did all household work. They applied medicines to my arm. They prepared food. I can’t forget their help.” GA 01
“This is a closely knit community. Usually the extended family live with the pregnant women and they take care of her.” GA PHM
Disharmony with in-laws
“Some of my husbands’ relatives are jealous of our love. I have no close relationship with my mother in-law. I talk what is necessary only. My mother-in-law’s marriage is not successful. Therefore they don’t like us to be happy.” R03
“There are problems with in-laws. There’s a generation gap. Pregnant daughters don’t want to listen to their mother-in-law. They say that she is old. Therefore there is disharmony in the family.” R PHM
Newborns arrival perceived as a burden
“When there are problems at home I feel angry all the time. It’s difficult for me to control my self. The main reason is my unborn child. My husband likes to have it, but not my elder children. They don’t like me becoming pregnant. It’s difficult for me to work. My whole freedom is gone. I have to do the whole stuff again.” V04
The tendency for a group to be in unity while working towards a goal or to satisfy the emotional needs of its members (Carron, A.V., Brawley, L.R. (2000).
Feel cared by the neighbors
“Every one in the neighborhood loves and cares about me.” NPC01
Like spending time with neighbors/ relatives/friends
“After preparing the dinner I went to the next door aunts’ house as I felt lonely and then to a friends house as well. I was able to get rid of the boredom. I was relieved.” Me04
Tolerance of diversity of neighbors
“I also take another child in the neighborhood when I take my child to school in a three wheeler. This child always try to provoke by pulling up things of my soul daughter. I advised my child not to react. I’m happy that my child still loves this child despite her irritating behavior.” NPE01
Belief in the honesty, integrity and reliability of neighbors (Taylor P., Funk C. 2010)
Perceive neighborhood as a favorable place to adopt the child
“I feel that this neighborhood is the best to bring up my child. When people around are generous my child will see it and hear good things always” NPC01
Have doubt or suspicion of neighbors
Refrain from visiting or talking to neighbors (mistrust)
Lack of bonding
“Although I feel alone at home, I don’t have the habit of going around to neighboring houses and spending time talking to them. Most of the people are relatives. But one should be careful of speaking to them. They utter slander. Nonrelated people help me more than my relatives.” R04
“When there’s a problem mothers come and tell us. They don’t want other people to hear it. They can get others support if they do so. But it does not happen here. There is some what mistrust in the neighborhood.”
Actions that are contingent on rewarding reactions from others and that cease when these expected reactions are not forthcoming. (Balu P.M. 1964)
Neighbors help each other
“My husband has gone for a course in “Ampara” district (Far away from this village). His family is not happy with me. I only have my neighbors to share my joy and sorrow. Therefore I keep in harmony with all my neighbors. They help me a lot. Today they brought me lunch” V01
Informal social controlc
Reactions of individuals and groups that brings about conformity to norms and laws. (Coklin J 2007)
People in the community give priority for pregnant women
“I went to meet the village leader today. I didn’t have to wait in the queue, as I’m pregnant. Work get done easily” NPC02
Usually when women become pregnant the villagers take care of her. They often offer food to a pregnant woman when they prepare a special meal. Even at social gatherings people give priority to pregnant women. V PHM
Concerned about other people
“I was asked to play the organ at the chapel but I told that I will do it next week as it will hurt feelings of the child who came to play it today” NPE02
“When my neighboring aunt was admitted to hospital, everyone in the village went to see her.” NPC01
Sense of belongingb
Feeling of acceptance as a member of a group (Yosephine E. 2014)
Receive complements on birthday
“Today is my birthday! My husband, family members and relatives wished me good luck.” NPC01
Being known by the villagers
“I have a fair reputation in the village. I’m an outsider and many do not know me. But all of them know my husband.” NPC01
Distressing feeling that occurs when ones social relationships are perceived as being less satisfied than what is desired. (Cacioppo J. T.,,Hawkley L. C. 2012)
Feel lonely at home
“Today was a very bad day for me. Nobody visited us and we didn’t go anywhere. My mother-in-law and myself stayed home alone. I was very lonely” NPC 03
Misses own family/relatives
Lack of bonding
“I came home from the clinic around 12.00 pm. I was so tired and unwell. At that time I remembered my own mother. If I was with her she will take care of me very well. I’m staying with my in-laws. I don’t receive the love and care that I would have received if Iwas with my mother.” R03
System of formal and informal relationships through which individuals receive emotional support, material or information to cope with stressful emotional situations (Caplang G. 1974)
Have support on household chores (instrumental support)
“I came home around 11.30 A.M from the nursery. I felt tired. My mother-in-law and sister-in-law had finished preparing lunch by that time. So I was able to have a nap. As I’m pregnant most of the time they do the household work.” GA01
Have a close person to share feelings (emotional support)
“A very close person to me visited our place today. It was a great pleasure to see her. She is an aunt whom I share my joy and misery with. She has brought dinner for me too” NPC02
Have a person to provide financial support when needed (Instrumental support)
“Although I felt reduced fetal movements, we did not have money to see a specialist doctor. But when I told this to my mother she gave me money which was a great relief” NPC06
No one to care when ill
(Lack of instrumental support)
“There’s no one to inform when I fell ill at night. Cannot call my husband either as he sleeps after the days work. At such times I grab my small one towards me and shut my eyes tight!” R04
No one to accompany in going out
Lack of bonding
“I had to go for the ultra sound scan today. My number was ten. So I asked my mother-in law to get ready for the bus leaving at 12.10 pm. She told that she couldn’t come today, as she has to go to her own daughters place. Then I went to see whether my relative neighbor aunt was available. But she was not at home. I made my mind to go alone. What else to do, its for my child’s sake..” V01
Lack of support on house hold chores (Lack of instrumental support)
I’m struggling to work on my own. At this stage, it is difficult for me to do anything. Therefore I keep thinking a lot every day. It is with lot of difficulty that I brought up my elder two. Because of this new child I won’t be able to help the other two with their school work. I have to look into everything in he family on my own. There is no one to help. If I were not pregnant I would have cultivated and obtained electricity for the house. V04
“It varies among families. Some times the husband thinks only of his satisfaction. Total responsibility on maintaining the family is given to the wife. But sometimes both work as one.” V CD
Social responsibility/ contributionc
An individuals obligation to act for the benefit of the society (Sreenivasulu 2013)
House hold responsibility
“I woke up in the early morning as I had to wake up my child for his studies. He has become very lazy. It was difficult to wake him up. I made tea and while helping his studies prepared the breakfast. At 6.45 am, I sent him to school because his schoolwork starts at 7.00 am. I have to feed him make his clothes and help him to get ready. Otherwise he will leave without having a breakfast.” V04
“There are two types of mothers. Some are like babies and husband and family provide everything for them. But some holds the total responsibility on household and adopting young ones.” V PHM
Take responsibility in religious activity in the neighborhood
The prize-giving of the drawing competition in the church went well. Although it interrupted teaching at the Sunday school, organizing it gave me satisfaction. NPE01
Responsibility in education of young
“In the evening I taught my younger sister.” ME04
Hold responsibility in village organizations
“I have developed more relationships in my second pregnancy than in my first pregnancy. Because I did 1 year diploma in women empowerment & after that with the help of PHM we started “mothers’ club”. I had several meetings with pregnant women not only our village, but also in our neighboring village with the help of PHM. We advised them regarding pregnancy. With that I was happy & I lost sadness, laziness & fear. Instead leadership & courage was with me.” GA03
Trust in institutionsa
How people perceive how well the institutions are operating (Miller 1974)
“At around 9.00 am the PHM visited me. It was really good that she came. I had lot of things to ask her. She answered all of them with care. Then she examined me. She asked me whether I have any other discomfort. I trust her a lot!” Mi04
Mothers depend on us for all health activities. Even when the VOG asks to get a scan done, or admit to hospital or prescribe any drugs, the mothers ask us for advise and then proceed. NPC PHM
My sons’ class teacher said that he is doing well. I was so proud. He is only three and a half years. I was very happy.
“The priest in the temple is very well known to my in laws. They are members of the temple committee. We went and asked for special blessings (“varu pirith”) that are offered for pregnant women. The priest asked me to come to the temple to have these blessings. Usually every pregnant woman in this area receive this during pregnancy.” NPC02
“I usually don’t go for these committees. Husband goes. Three women have to get together to get money. Earlier we took from a different company. This time the other two people wanted to get money again therefore we joined as help.” NPC01
“Usually the primi mothers do not participate in micro credit committees. But when mothers become older, having 3–4 children, take part in these. They are the people who want to collect equipment to house. Usually when children are older they have free time and they join these committees. It’s like an epidemic in the village. Husbands are laborers if they cannot have daily work they are unable to pay. Therefore conflicts occur in the family. It’s a burden to the society.”
“We went to town in the motorbike, my husband did not have license and we were not wearing helmets. The traffic police stopped us. But fortunately they let us go because I’m pregnant. I was so happy. Rarely that such good people exist in this community. It convinced me of the status given to a pregnant mother in this society.” R04
Structural social capital construct
Level and type of Social capital
The action taken by a group (either directly or on its behalf through an organization) in pursuit of members’ perceived shared interests. (Marshall 1998)
People get together in a tragedy
“People get together when there is a problem to any one of the villagers. One day, our house was struck by lightening. We were not at home. When we arrived, all neighbors were already there.”
Informal social networksa
Web of relationships that people use to exchange resources and services (Cook 1982; Scott 1991; Wellman 1983). Informal networks are distinct from formal networks in that they are not officially recognized or mandated by organizations and in that the content of their exchanges can be work-related, personal, or social (Ibarra 1993).
Visiting or visited by neighbors/friends or relatives
Informal networks are dense, rich and are providing support in most of the communities.
People’s social involvement and interaction with others that includes activities such as volunteering, making donations, participating in sports, and recreational activities are all forms of social participation.
Participation in religious activity
Individual Bonding & bridging
Religious participation has an individual as well as community variation. Generally in pregnancy the frequency of visits to religious institutions are high. Mothers participate in the weekly ritual of “Bodhipuja” & “Varu pirith” a religious blessings conducted by the Buddhist priests.
Participation in cultural events
Individual/ community Bonding
“Today I was mostly in my mothers place. I helped my sisters to prepare sweets. It was a special occasion where we celebrate cooking the new rice from the paddy field. Although I felt tired I was happy to prepare sweets with my sister.” NPC06
Participation in leisure activities
People do not use their leisure time properly. Instead they had few routine activities such as going for a bath in the tank, visiting the ancient city and taking children out into the field (“chena”) or park near by.
Going to the fair This could be merged with above – its not different.
Sometimes pregnant women and most of the time their husbands visit the weekly fair held in the nearest town every Sunday.
Visiting the city – same as above
Frequency of visiting the city varies in different communities. Some who are living near to the city visited daily. But the women in rural villages rarely saw the city.
“There are mothers who visit the main city only 2–3 times per year” V PHM
Participation/membership in organizationsc
Generally, mothers are not active members of any of the committees except the women’s welfare societies.
In some communities, these welfare societies are provide social support and help each other.
Womans’ welfare committees
Links to government resourcesb
Access to health systemsb
Linking & Bonding
Every pregnant woman is under the care of a PHM appointed to that area. Pregnant women have a good relationship with the PHM and she provides emotional, instrumental and informational support regarding health.
Almost all mothers visit the specialist (VOG) at least once in their pregnancy. The routine scan recommended by the government antenatal care program receives high priority not only by mothers but also by their husbands. Many mothers visited the VOG at the private sector and others at the hospital clinic.
Antenatal clinic/ sessions
All mothers routinely visit field antenatal clinics held in the community.
Mothers visit the hospital once in a while for investigations & ultra sound scanning.
Access to educational institutionsc
Visiting childs’ school
Mothers who had children are concerned of the children’s education and communicate with class teacher and the school regularly.
Access to village leadersc
Mothers in this community rarely visit the community leaders.
Access to other resourcesa
Almost every mother have a mobile phone except one or two. It was a means of creating and sustaining social networks. Especially for mothers living away from their own relatives and in families where the husband works far away, the mobile phone act as a means of emotional support and care.
Not every family own a vehical. But most of them had access to three-wheelers in an emergency.
Many families have a television at home. Watching television reduced loneliness, offered informational support on health and some times created family cohesion.
Research rigor and quality control
Streamlining data collection methods, tools and analysis
Contribution from different qualitative methods
Dimensions of social capital in pregnancy
Social capital constructs of pregnant women
Social capital and its pathways to health in pregnancy
Informal social networks and social participation as a means of reducing minor physical ailments in pregnancy
“My relatives brought me food today. We all had dinner together. I was very happy. It made me forget all my bodily ailments” NPC02“All pregnant women share their experience in bearing children. Every one see how their sisters, cousins and aunts go through pregnancy, have children and how they manage day-to-day activities. Therefore they do not complain about minor ailments.” PHM GA
Cognitive social capital as a means of promoting mental wellbeing
Domestic cohesion; husband’s role
“My husband brought me fresh milk today as I had a food craving. He thinks about me a lot after I became pregnant.” Med 03“I went to the hospital with my sister. My husband frequently phoned her and asked about my condition during the hospital visit. In the evening he came home and eagerly asked about the scan (ultrasound scan of the fetus). The doctor told me everything was fine, I said. He blessed me to spend the rest of my pregnancy safely. I’m happy. As I’m pregnant he cares a lot and sees to everything.” Mi 02
Domestic cohesion; family
"All people at home are awaiting for the great day! I'm very happy that my child is gifted with such a lovely family. He is very lucky" NPC01
“Today was a sad day for me. My husband got angry with me. We were supposed to go to my parent’s home at seven months of gestation (usually women go to their parents home for delivery). But I suggested leaving at sixth month. My husband became angry due to this and didn’t speak with me for two hours. After that he spoke. I love to be with my own family. I miss them a lot. The only person close to me in this family is my husband. So when he scolds me I’m so upset.”
"Every one in the neighborhood loves and cares about me. I'm very relaxed. This community is good, I would be able to deliver my child with good mental wellbeing." NPC01
"Today I took the child to pre-school English class. There I met other parents. We are friends. There are two friends who are pregnant as well. One of the parents had brought mango pickle. We tasted it until the class was empty. It’s joyful to spend time like this rather than staying alone at home. It makes me happy!"
“Today was a very sad day for us. I woke up in the early morning and prepared food for my husband to take when he leaves (for work). My mother also helped me. My aunt (lokuamma) brought us fresh milk. As my husband is leaving, the grandfather (kiriaththa) came and tied a “pirith” string (a piece of string which is blessed with Buddhist chanting that is tied around a persons’ wrist which is meant to provide blessings). My uncle also came for the occasion. My husband left very sad. In the afternoon two nearby aunts came to see me with sweets. In the evening my mother, father and sister phoned me.” Med 03“When I’m alone at home I feel very lonely. Therefore I’m used to visit my aunt or other neighbor all the time. It relieves loneliness and makes me happy.” V2
“By that time I was very ill. Because of the wound foot I had enlarged glands. My whole leg was swollen and it was difficult for me to walk. It was so painful. With all this, I helped my child to do the homework given by the school. Today there is a private class held at my place for children. Eleven children come for this. I was burning with high fever. I could not get up from bed. There was no one (to help). My husband goes out from the house to work. Only my child and myself live in our house. Luckily, the parents who brought their children to the class offered me great support. I would be helpless otherwise?” Mi01
"Although I had a problem with fetal movements, we did not have money to channel a doctor (means; go to a private practitioner). But when I told this to my mother she gave me money, which was a big relief" NPC06
"A very close person visited us today. It was a great pleasure to see her. She is an aunt who is by my side - at times of joy and misery. She has brought dinner for me too" NPC02
Linking social capital experienced through health services to promote maternal health during pregnancy
The public health midwife
"The public health midwife visited around 10.30am. She examined me. She told me that my child is well and have turned to birth position now. She also inspected the bag I have prepared to take to the hospital. She told me the procedures that I will go through when I'm admitted to hospital" NPE02“Our PHM is very good. She’s so close to us. She advise us on everything” R03
“Today I was not well with backache. I had numbness in one leg. The PHM told me not to worry. She said it’s because I’m a little overweight. She’s living next door. Therefore we are not afraid of illnesses. Can ask anything.” P03
Antenatal clinics and sessions
“Having the antenatal clinic is a big relief. I can learn a lot. Everyday is a new experience. Today I cooked early morning and set off to the antenatal clinic with my husband. My blood was taken for investigation and they also did a dental examination.” Med03
“The MOH talked about the impact of the living environment on health during pregnancy. She told us lot of things. We learnt a lot” Mi04
Meeting the specialist; visiting obstetrician & gynecologist (VOG)
“I met the obstetrician only twice in private health care institutions. Local health personnel told me that it is not compulsory to see him. My husband took me to see the VOG. He said that my child is well, and gave a date to be admitted at the hospital.” NPC01