Exploring sources of social support during pregnancy- a qualitative study in rural southern India

Social support is known to influence pregnancy outcomes. We explored the sources of social support available to pregnant women in a rural setting in south India. We conducted 13 focus group discussions (FGDs) among women of child-bearing age, husbands, mothers/ mothers-in-law, community health workers, and community leaders. FGDs were transcribed and analysed using thematic analysis. Support received during pregnancy were mainly in three domains; tangible, informational and emotional support. Tangible support refers to providing practical support such as cooking nutritious food for the pregnant women, helping them with household chores, and accompanying pregnant women for hospital visits. Informational support refers to measures aimed at improving awareness during pregnancy and promoting informed decision making such as advice on dietary practices and remedies for common ailments. Emotional support refers to the support provided by family members and CHWs in fulfilling women’s desires during pregnancy and allowing them a safe space to share their problems. Sources of support identified include husbands, elders in the family, friends, the local community, and health service providers. In general, perceptions were similar across participant groups, age and gender. While tribal participants sought elders’ advice and relied on traditional remedies compared to non-tribal participants, they were more likely to access nutritional aids offered by the government. CHWs provide additional support to tribal communities in identifying pregnant women, closely monitoring them and extending informal support during pregnancy and delivery by taking them to the hospital. Members of the joint family including mothers-in-law and sisters-in-law actively helped in chores, nutrition and newborn care compared to the nuclear family. In general, women felt that they received valuable support from family and community. Participants felt that support from husbands, families and neighbours had an influence on women’s health and behaviour during pregnancy. The findings were used to develop intervention modules to promote maternal health and the health of their offspring.