Social capital, gender, and health: an ethnographic analysis of women in a Mumbai slum

Abstract

Objective: Quantitative studies have demonstrated that social capital can positively impact community health, but qualitative explorations of the factors mediating this relationship are lacking. Furthermore, while the world’s poor are becoming increasingly concentrated in the cities of lower-middle income countries, most of the existing literature on social capital and health explores these variables in Western or rural contexts. Even fewer studies consider the impact of social constructs like race, gender, or class on the creation of social capital and its operationalization in health promotion. Our study aimed to address these gaps in the literature through an ethnographic exploration of social capital among women living in Kaula Bandar (KB) – a marginalized slum on the eastern waterfront of Mumbai, India. We then sought to identify how these women leveraged their social capital to promote health within their households. Methods: This was a mixed-method, qualitative study involving participant observation and 20 in-depth, semi-structured, individual interviews over a nine-month period. Field notes and interview transcripts were manually analyzed for recurring content and themes. Results: We found that women in KB relied heavily on bonding social capital for both daily survival and survival during a health crisis, but that the local contexts of gender and poverty actively impeded the ability of women in this community to build forms of social capital – namely bridging or linking social capital – that could be leveraged for health promotion beyond immediate survival. Conclusions: These findings illustrate the context-specific challenges that women living in urban poverty face in their efforts to build social capital and promote health within their households and communities. Community-based qualitative studies are needed to identify the macro- and micro-level forces, like gender and class oppression, in which these challenges are rooted. Directly addressing these structural inequalities significantly increases the potential for health promotion through social capital formation.

Maternal and newborn health for the urban poor: the need for a new mental model and implementation strategies to accelerate progress

“…The literature on social support systems in slums most relevant to MNH is that focused on the role of friendship between mothers and peer educators, health workers, and/or community health workers. In Mumbai slums, social capital has been identified as crucial during health crises, allowing women to navigate complex networks of public and private clinics [ 25 ].…”

A Literature Review on Perceptions and Practices Related to Healthcare and Nutrition Amongst the Residents of Urban Slums Across India

“…A study conducted by Athavale et al across the Mumbai slums amongst young mothers indicated clear knowledge of exclusive breastfeeding from healthcare providers, there was however conflicting information on family elders regarding exclusive breastfeeding [ 15 ]. The study also recorded the knowledge about hygiene and safe cooking practices which were found to be adequate as per national guidelines on young infant and child feeding practices.…”

“…Most studies reviewed have not explored the attitude toward change-making directly. However some of the responses documented in the publication hint towards factors like: for male residents of the slums, across Delhi [ 14 ] and Mumbai [ 15 ], the quick service provisions were the key factor in shifting across various healthcare providers, they prefer shorter waiting times and medicines that can assure quicker recovery, thus the confidence of a healthcare provider also accounts to change making determinants. In the case of older residents closeness to the healthcare provider was a key factor in change-making, they preferred to change to the closest healthcare provider while relaxing on cost and waiting time.…”

“…The information on behavioural patterns of the urban poor regarding dietary patterns, and health-seeking behaviours are spatially, temporally, and age-group-wise distributed across the literature [13][14][15]. Also, the evidence on health-seeking behaviour, dietary practices, and individual and family perceptions, are not clearly evident through a single source and thus, there is a need to collate and synthesize the information regarding perceptions and practices of poor urban communities across India and provide a focal understanding for research needs [16,17].…”

Maternal and Newborn Health for the Urban Poor: The Need for a New Mental Model and Implementation Strategies to Accelerate Progress

“…In Mumbai slums, social capital has been identified as crucial during health crises, allowing women to navigate complex networks of public and private clinics. 22 Despite this positive association, much of the literature shows that women in slums often have weak and unreliable networks, described as fragile, non-existent, and incubators of misconceptions and poor practices -especially around newborn health and family planning. 23,24,25,26 Key informants confirmed that women in urban slums are vulnerable in ways that they are not when surrounded by family and community in rural areas, including being more easily victimized, and without a strong sense of support (Participant 2, personal communication, January 12, 2016; Participant 4, personal communication, March 2, 2016).…”