A Social Capital Theory Analysis of Community-Level Determinants of Maternal Healthcare Utilisation in Rural South East Nigeria

Social capital theory posits that the density, quality, and structure of social networks within communities influence health behaviour and outcomes, yet its application to maternal healthcare utilisation in rural South East Nigeria has not been theoretically developed or empirically tested. This dissertation applies social capital theory to analyse community-level determinants of maternal healthcare utilisation in rural communities of Imo, Abia, and Ebonyi States, South East Nigeria. A two-level mixed-methods design combines a community-level survey of 360 women across 30 village clusters with in-depth ethnographic interviews in 12 communities and social network analysis of maternal health decision influencer networks in three purposively selected communities. Social capital was operationalised through bonding, bridging, and linking dimensions. Multilevel regression analysis separates individual-level from community-level determinants of antenatal care attendance, facility delivery, and postnatal care. Community-level bridging social capital (inter-group network connectivity) independently predicted facility delivery rates above and beyond individual sociodemographic factors (beta 0.38, p < 0.001). Strong linking social capital (vertical connections to health authority) amplified the effect of community health worker presence on utilisation rates. Women-led village health committees, as a bonding social capital structure, were significantly associated with higher postnatal care rates. The dissertation introduces the Social Capital-Maternal Health Utilisation Framework (SCMHUF), a theoretically grounded model demonstrating how social structure mediates maternal health behaviour in Igbo rural communities. Keywords: social capital theory, maternal healthcare utilisation, South East Nigeria, community-level determinants, social network