The Personal Social Networks of Resettled Bhutanese Refugees During Pregnancy in the United States: A Social Network Analysis

  • Diana M. Kingsbury
  • Madhav P. Bhatta
  • Brian Castellani
  • Aruna Khanal
  • Eric Jefferis
  • Jeffery S. Hallam
Original Paper


Women comprise 50% of the refugee population, 25% of whom are of reproductive age. Female refugees are at risk for experiencing significant hardships associated with the refugee experience, including after resettlement. For refugee women, the strength of their personal social networks can play an important role in mitigating the stress of resettlement and can be an influential source of support during specific health events, such as pregnancy. A personal social network analysis was conducted among 45 resettled Bhutanese refugee women who had given birth within the past 2 years in the Akron Metropolitan Area of Northeast Ohio. Data were collected using in-depth interviews conducted in Nepali over a 6-month period in 2016. Size, demographic characteristics of ties, frequency of communication, length of relationship, and strength of connection were the social network measures used to describe the personal networks of participants. A qualitative analysis was also conducted to assess what matters were commonly discussed within networks and how supportive participants perceived their networks to be. Overall, participants reported an average of 3 close personal connections during their pregnancy. The networks were comprised primarily of female family members whom the participant knew prior to resettlement in the U.S. Participants reported their networks as “very close” and perceived their connections to be supportive of them during their pregnancies. These results may be used to guide future research, as well as public health programming, that seeks to improve the pregnancy experiences of resettled refugee women.


Refugees Maternal and child health Social network analysis Social support Community health 


Compliance with Ethical Standards

Conflict of interest

The authors declare they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    United Nations High Commissioner for Refugees. (n.d.). What is a refugee? Retrieved from
  2. 2.
    United Nations High Commissioner for Refugees. (n.d.). Figures at a glance. Retrieved from
  3. 3.
    United Nations High Commissioner for Refugees. (n.d). Women. United Nations High Commissioner for Refugees website.
  4. 4.
    Carballo, M., Grocutt, M., & Hadzihasanovic, A. (1996). Women and migration: A public health issue. World Health Statistics Quarterly, 49(2), 158–164.Google Scholar
  5. 5.
    Collins, C. H., Zimmerman, C., & Howard, L. M. (2011). Refugee, asylum seeker, immigrant women, and postnatal depression: Rates and risk factors. Archives of Women’s Mental Health, 14, 3–11.CrossRefPubMedGoogle Scholar
  6. 6.
    Smith, L. R. (2013). Female refugee networks: Rebuilding post-conflict identity. International Journal of Intercultural Relations, 37, 11–27.CrossRefGoogle Scholar
  7. 7.
    Ryan, L., & D’Angelo, A. (2017). Changing times: Migrants’ social network analysis and the challenges of longitudinal research. Social Networks. Scholar
  8. 8.
    Ameresekere, M., Borg, R., Frederick, J., Vragovic, O., Saia, K., & Raj, A. (2011). Somali immigrant women’s perceptions of cesarean delivery and patient-provider communication surrounding female circumcision and childbirth in the USA. Obstetrics and Gynecology International Journal, 115(3), 227–230.CrossRefGoogle Scholar
  9. 9.
    Balaji, A. B., Claussen, A. H., Smith, D. C., Visser, S. N., Johnson Morales, M., & Perou, R. (2007). Social support networks and maternal mental health and well-being. Journal of Women’s Health, 16(10), 1386–1396.CrossRefPubMedGoogle Scholar
  10. 10.
    Bokore, N. (2013). Suffering in silence: A Canadian-Somali case study. Journal of Social Work Practice, 272(1), 95–113.CrossRefGoogle Scholar
  11. 11.
    Carolan, M., & Cassar, L. (2007). Pregnancy care for African refugee women in Australia: Attendance at antenatal appointments. Evidence Based Midwifery, 5(2), 54–58.Google Scholar
  12. 12.
    Flynn, P. M., Foster, E. M., & Brost, B. C. (2011). Indicators of acculturation related to Somali refugee women’s birth outcomes in Minnesota. Journal of Immigrant and Minority Health, 13, 224–231.CrossRefPubMedGoogle Scholar
  13. 13.
    Gagnon, A. J., Van Hulst, A., Merry, L., George, A., Saucier, J. F., Stanger, E., et al. (2013). Cesarean section rate differences by migration indicators. Archives of Gynecology and Obstetrics, 287, 633–639.CrossRefPubMedGoogle Scholar
  14. 14.
    Lowe, S. M. P., & Moore, S. (2014). Social networks and female reproductive choices in the developing world: A systematic review. Reproductive Health, 11, 1–11.CrossRefGoogle Scholar
  15. 15.
    Borgatti, S. P., Mehra, A., Brass, D. J., & Labianca, G. (2009). Network analysis in the social sciences. Science, 323, 892–895.CrossRefPubMedGoogle Scholar
  16. 16.
    Heaney, C. A., & Israel, B. A. (2008). Social networks and social support (4th edn., pp. 189–207). San Francisco: Health Behavior and Health Education.Google Scholar
  17. 17.
    Soto, S., Arredondo, E. M., Villodas, M. T., Elder, J. P., Quintanar, E., & Madanat, H. (2016). Depression and chronic health conditions among Latinos: The role of social networks. Journal of Immigrant and Minority Health, 18, 1292–1300.CrossRefPubMedGoogle Scholar
  18. 18.
    United Nations High Commissioner for Refugees. (2015, November 19). Resettlement of Bhutanese refugees surpasses 100,000 mark. Retrieved from
  19. 19.
    Yun, K., Paul, P., Subedi, P., Kuikel, L., Nguyen, G. T., & Barg, F. K. (2016). Help-seeking behavior and health care navigation by Bhutanese refugees. Journal of Community Health, 41, 526–534.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Kue, J., Hanegan, H., & Tan, A. (2017). Perceptions of cervical cancer screening, screening behavior, and post-migration living difficulties among Bhutanese-Nepali refugee women in the United States. Journal of Community Health, 42, 1079–1089.CrossRefPubMedGoogle Scholar
  21. 21.
    International Institute of Akron. Refugee intake numbers over the last five years (2009–2014) [Data file]. Retrieved via electronic communication with the International Institute of Akron.Google Scholar
  22. 22.
    United States Department of Health and Human Services. (2015, November 24). Office of refugee resettlement: Refugee arrival data. Retrieved from
  23. 23.
    Borgatti, S. P., Everett, M. G., & Johnson, J. C. (2013). Analyzing social networks. New York: SAGE Publications.Google Scholar
  24. 24.
    Githens, P. B., Glass, C. A., Sloan, F. A., & Stephens, S. (1993). Maternal recall and medical records: An examination of events during pregnancy, childbirth, and early infancy. Birth, 20(3), 136–141.CrossRefPubMedGoogle Scholar
  25. 25.
    Newman, M. E. J. (2010). Networks: An introduction. Oxford: Oxford University Press.CrossRefGoogle Scholar
  26. 26.
    Hanneman, R. A., & Riddle, M. (2005). Introduction to social network methods. Riverside: University of California.Google Scholar
  27. 27.
    Valente, T. W. (2010). Social networks and health: Models, methods, and applications. New York: Oxford University Press.CrossRefGoogle Scholar
  28. 28.
    Wellman, B. (1991). Which types of ties and networks provide what kinds of social support. Advances in Group Processes, 9, 207–235.Google Scholar
  29. 29.
    Saldaña, J. (2016). The coding manual for qualitative researchers (3rd edn.). London: SAGE Publications.Google Scholar
  30. 30.
    Elliot, S., & Yusuf, I. (2014). ‘Yes we can: But together’: Social capital and refugee resettlement. Kotuitui: New Zealand Journal of Social Sciences Online, 9(2), 101–110.Google Scholar
  31. 31.
    Johnson, C. M., Rostila, M., Svensson, A. C., & Engstrom, K. (2017). The role of social capital in explaining mental health inequalities between immigrants and Swedish-born: A population-based cross-sectional study. BMC Public Health, 17, 117.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Njororai, F., & Lee, S. (2017). Social capital and health among Burundian refugees in the United States. International Social Work. Scholar
  33. 33.
    Obaa, B. B., & Mazur, R. E. (2017). Social network characteristics and resource access among formerly displaced households in Lira, Uganda. Disasters, 41(3), 468–486.CrossRefGoogle Scholar
  34. 34.
    Shishehgar, S., Gholizadeh, L., DiGiacomo, M., Green, A., & Davidson, P. M. (2017). Health and socio-cultural experiences of refugee women: An integrative review. Journal of Immigrant and Minority Health, 19, 959–973.CrossRefPubMedGoogle Scholar
  35. 35.
    Dunn, C. L., Pirie, P. L., & Hellerstedt, W. L. (2003). The advice-giving role of female friends and relatives during pregnancy. Health Education Research, 18(3), 352–362.CrossRefPubMedGoogle Scholar
  36. 36.
    Lamba, N. K., & Krahn, H. (2003). Social capital and refugee resettlement: The social networks of refugees in Canada. JIMI/RIMI, 3, 335–360.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Diana M. Kingsbury
    • 1
    • 3
  • Madhav P. Bhatta
    • 1
  • Brian Castellani
    • 2
  • Aruna Khanal
    • 1
  • Eric Jefferis
    • 1
  • Jeffery S. Hallam
    • 1
  1. 1.College of Public HealthKent State UniversityKentUSA
  2. 2.Department of SociologyKent State UniversityAshtabulaUSA
  3. 3.Department of Family & Community MedicineNortheast Ohio Medical University (NEOMED)RootstownUSA

Personalised recommendations