Can peer and neighbourhood effects improve maternal health outcomes in rural Bihar: Assessing the role of formal and informal networks

Bihar is a state with a long history of poor maternal health indicators. At the onset of the National Rural Health Mission in 2005, Bihar was listed as one of the High Focus states, and special attention was paid to improving health indicators. Data from the latest round of the Demographic Health Survey indicates that such attempts have not been successful. Policy interventions are hampered by low levels of education and awareness, low empowerment levels of women, and caste-based frictions within society. Consequently, efforts to improve maternal health outcomes in Bihar have not been very successful.

Recent studies in public health have stressed the role of networks in modifying healthcare seeking behaviour by disseminating information. Studies have established that social relationships can have a significant positive impact on physical and mental health outcomes. Peer and neighbourhood effects can amplify the impact and outreach of existing intervention strategies. In particular, social networks can play a crucial role among poor households in developing countries, for whom the adoption of health products and services often remains sub-optimally low, as peers, kin and neighbours often represent the only source of information on which decision making is based.

The researchers argue that social networks can be utilised to disseminate information about good practices, thereby encouraging optimal maternal health seeking behaviour and improving maternal health outcomes. This study aims to answer the following questions:

1. What are the attributes of social networks that encourage health outcomes?
2. What is the mechanism through which social networks modify decision-making and behaviour?
3. Do networks play a more important role in families where the male members are absent due to migration?

The researchers will employ an effective mix of quantitative and qualitative research by using both a primary survey and focus group. This project aims to disseminate results, obtain feedback from all stakeholders, and seek to improve service delivery mechanism by embedding lessons from the findings into existing service delivery models.