Social networks, normative influence and health delivery in rural Bangladesh

This paper examines the association of social networks with the experience of neonatal death and the type of assistance that a woman obtains at childbirth in rural Bangladesh. Data were collected by interviewing 694 women from seven villages using a structured questionnaire. From the use of both social network analysis and statistical methods, we find that the experience of neonatal death and the type of assistance that a woman gets at childbirth are associated with the characteristics of their social networks along with a set of socioeconomic factors that are usually considered to be important. The higher the degree of centrality of a woman in her social network, the less likely it is that she will experience neonatal death, and the experience of neonatal death is significantly associated with the type of assistance she obtained at giving birth. Using a multivariate multinomial logistic regression model to explore the likelihood of using different types of birth assistance, we find that the higher the degree centrality of a woman, the less likely she will be attended by professional assistance. Further investigations reveal that the dominant norm in villages is to use traditional birth attendants and the perception about professional birth assistance is that it is ‘not needed’. Moreover, the respondents’ network members were also interviewed, and from the sociograms we find that there was an inward connectivity between the same types of assistance users. These findings have implications for norm change interventions among the village women using a network approach and in particular using opinion leaders.