Women’s social networks influence decisions around prenatal care

Early prenatal care is critical for protecting the health and lives of mothers and babies. It provides opportunities for screening, treatment, and prevention of complications. Yet most women in sub-Saharan Africa, including Uganda, don’t seek care until later in pregnancy.

A new study led by Alison Comfort, PhD, together with colleagues in Bixby and at Makerere University, explores reliance on social ties for information about when to start prenatal care. Researchers conducted interviews with 30 pregnant cisgender women at their first prenatal visit in Kampala, Uganda.

The study shows that social networks—meaning people's ties to their family members, friends and others—play an important role during pregnancy in providing information about when they should start prenatal care. Overall, the women's own mothers seem to be the most influential source of information on the benefits of prenatal care and timing of the first visit. Other important sources include mothers-in-law (for women who are partnered) and female elders in the community, including grandmothers. In some cases, sisters, female friends, and aunts also played a role, but not all women turned to them.

While male partners also provide information and advice about starting prenatal care, they are much more likely to be involved in decision-making about where to seek care and going with women to the appointment.

Pregnant women themselves hold a range of beliefs about the importance of early prenatal care. Some believed it was only necessary for women with complications, while others saw the benefits of attending prenatal care early and frequently. There was a lot of variation in ideas of when they should have their first visit, ranging from as soon as they confirmed their pregnancy to 2-3 months, 4-5 months, or any time. While their social networks encouraged seeking prenatal care, advice on timing varied and some people provided misinformation on ideal timing.

This study confirms that women’s social networks serve as an important source of information about the benefits of prenatal care and when they should start. Pregnant women seemed less likely to delay prenatal care when more than one person in their network encouraged prompt care. To improve mothers’ and babies’ health, it’s critical to engage women’s social ties and educate them on the benefits of early prenatal care.

“[My mother] told me, ‘If the pregnancy is 4 months, you are already late for antenatal care. You should start.’ I didn’t tell her that my partner had refused the idea, I just told her that I haven’t gone because I feel fine. Besides, I thought it’s only those with complications that go for antenatal care. She advised me to go for antenatal care immediately.”

- 24 years old, nulliparous, 20 weeks pregnant

“It was my husband. He told me, ‘you are delaying the antenatal visit, and you will hurt the child!’ but I kept on telling him that I will go. I wasn’t feeling any discomfort, so I thought [I] was fine. Then, this friend of mine kept on saying, ‘days are running out, you are going to deliver without receiving antenatal care. You don’t know how the child is. You don’t know your health status. You have to go to the hospital!’”

- 28 years old, nulliparous, 28 weeks pregnant