Social networks, social participation, and health among youth living in extreme poverty in rural Malawi
Introduction
In this paper, we examine the social networks and social participation of youth living in extreme poverty in rural Malawi. We analyzed baseline in-depth interviews conducted with youth (ages 13–19) and their caregivers who are participants in the Government of Malawi's Social Cash Transfer Program (MSCTP), a poverty alleviation program. We provide a rich description of youth participants' peer social networks, and compare network structure (e.g. size), function (e.g. social support) and social participation of girls and boys. We also illuminate how the context of extreme poverty influences their networks, social participation, and their health and wellbeing.
Social wellbeing is conceptualized as an aspect of overall health, along with physical and mental health, in the World Health Organization's 1948 foundational definition (International Health Conference, 2002). Social wellbeing is defined as individuals' perceived quality of their relationships with other people in their social networks, neighborhoods, and communities (Keyes and Shapiro, 2004). Other definitions emphasize people's performance in social roles and their social participation (Larson, 1993). An extensive literature also examines various aspects of social wellbeing, such as social networks, as correlates or predictors of physical and mental health outcomes. Social networks have influence in many health domains, including chronic and infectious disease, mental health, and health-related behaviors (e.g. Kawachi and Berkman, 2001, Smith and Christakisa, 2008). In Malawi, a robust literature documents relationships between social networks and HIV outcomes among adults (e.g. Helleringer and Kohler, 2007; Kohler et al., 2015). A smaller body of work examines social participation and physical and mental health (e.g. Myroniuk and Anglewicz, 2015).
Berkman et al. (2000) argue that to comprehend the multiple pathways through which social networks influence health, it is critical to conceptualize them as embedded within broader social and structural conditions – such as poverty and gender norms—that shape network structure and functioning. In high-income countries, measures of individuals' social status level and income predict social networks characteristics, such as size (e.g. Ajrouch et al., 2005). Menjívar (2000) depicted, in an ethnographic study, how a community's lack of material resources threatened social network stability by disabling the exchange of social support. Women have been found to have more intimate social ties than men and to provide more social support through their ties. For women with few resources to share, these relationships can generate rather than alleviate stress (Antonucci et al., 1998, Belle, 1987, Kawachi and Berkman, 2001). Studies also document how contextual factors relate to social participation—in an urban U.S. setting, neighborhood-level socioeconomic disadvantage was positively associated with rates of participation in neighborhood improvement organizations, but this relationship diminished at the highest levels of disadvantage (Swaroop and Morenoff, 2006).
Per Lin et al. (1999), social ties are organized in nested layers around the individual, ranging from participation in community and voluntary organizations within the outermost layer, to network relations within the middle layer, to intimate ties within the innermost layer. Each outer layer of ties affords the opportunity to construct inner layer ties. Empirically, community participation increases the likelihood of “constructing and maintaining interactive ties in social networks.” We examine youth's social participation–in which we include involvement in formal and informal institutions such as schools, religious community, and community organizations— in addition to social networks in order to gain a more complete view of their social wellbeing, and deeper understanding of the extent to which their social and structural environment affords opportunities to build and exercise networks.
Among adolescents, research in high-income countries has shown the particular importance of peer social networks for health. Peers can provide critical social support during difficult transitions or life events, and promote prosocial health behaviors (Bernat and Resnick, 2009). However, the peer context also plays an important role in the initiation and maintenance of a range of risky behaviors and negative outcomes, including substance use, obesity, suicidal behaviors, and increased number of sex partners (Abrutyn and Mueller, 2014, Ali and Dwyer, 2011, Bauman and Ennett, 1994, Faris and Ennett, 2012). The strength of the influence of peer ties vary according to network characteristics such as size (Faris and Ennett, 2012), and individual characteristics such as gender (Widman et al., 2016).
Research on social ties and health in youth populations in sub-Saharan Africa, including Malawi, is limited, and predominantly focused on children and adolescents “affected by HIV” and HIV risk behaviors (e.g. Ruiz-Casares, 2010, Sikstrom, 2014, Skovdal et al., 2009). However, the importance of peer networks and social participation for health is clear. In urban Tanzania, Yamanis et al. (2016) found that young men who were members of close knit peer networks, locally referred to as “camps”, had an increased likelihood of engaging in concurrency if the majority of their male camp members reported concurrency. Hargreaves et al. (2008) found lower HIV risk among school-attending youth in South Africa than among their non-school-attending peers. School-attending girls were less likely than non-school attending girls to have significantly older sexual partners, suggesting that school offers an environment for developing age-similar – and thus less risky-- ties and sexual networks. In this paper, we aim to expand the limited research on peer networks and social participation of youth in sub-Saharan Africa using a gender sensitive lens. We examine how the economic context shapes youth networks and participation, and how networks and participation influence multiple aspects of health. We also consider the implications of our findings for how poverty alleviation policy could improve youth social wellbeing, mental health, and physical health.
Section snippets
Study setting
Malawi is one of the poorest countries in the world, with an annual GDP per capita of US$250 and a poverty rate of 50 percent. Fifty-four percent of the population is below the age of 18, and life expectancy is 55 largely due to an HIV prevalence rate of 12 percent. The HIV epidemic has resulted in an estimate of over one million orphans in the country. 31 percent of women age 20–24 report at least one live birth before the age of 18 (National Statistical Office, 2015).
The formal education
Study population
The average age of the youth participants in the qualitative sample was 15 years. Participants were divided evenly between male and female and enrolled in school and not enrolled. Seven were double orphans and four were paternal or maternal orphans. These characteristics closely reflect the quantitative study youth sample in which the mean age was 15, 50% were girls, 55% were enrolled in school, and 62% were paternal, maternal, or double orphans. One quarter of girls and three quarters of boys
Discussion
We found that extreme poverty threatened the social well-being of youth living in extreme poverty in rural Malawi. Poverty hampered youth participants' engagement in both formal and informal institutions in which they could create, exercise, and maintain social network ties, namely school, Muslim religious school, and community organizations. The impact of poverty was direct, by denying the material means required for participation (e.g. clothes, school fees), and indirect, by reducing time and
Conclusion
We illustrate ways that poverty and gender influence the structure and functioning of youth social networks and social participation in a rural Malawian context. Youth who work to survive and to help their households survive have limited resources – whether cash, time, emotional capacity, or access to environments for social interaction– to pursue, maintain, or exercise relationships with peers. Consequently, their opportunities to receive social support and positive influence through
Acknowledgments
We are very grateful to the youth and adults who shared their experiences and time with us and to Charles Chiyamwaka, Mary Katuli, Shadrek Mughogho, and Twambilile Phanga for conducting interviews. The Carolina Population Center and NIH/NICHD provided training support (T32 HD007168) and general support (P2C HD050924) for this study. The Global Fund to Fight AIDS, Tuberculosis and Malaria, German government through KfW, Irish Aid, European Union, World Bank and the Government of Malawi provided
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