Cultural models, pregnancy, and stress: examining intracultural variation in Jalisco, Mexico

Abstract

The purpose of this research was to use cultural domain analysis (n=73) to determine if one or more shared models of a good pregnancy exist in Jalisco, Mexico, and to use cultural consonance analysis (n=88) to statistically determine the association between a woman's ability to approximate the shared model and maternal psychosocial and physiological health. Jalisco has a pluralistic reproductive health care system, including midwives and medical doctors, and widely varying sites with differential access to biomedical and traditional health care. In an effort to capture intracultural variability, the research was conducted in an urban area, a semi-urban city, rural municipal seats, small towns, and villages. I predicted that women who are more consonant with the specified model will have lower levels of psychosocial stress and altered immune response, and that social support moderates these relationships. Anthropologists have studied the effects of culture change and stress using both psychosocial and physiological markers, and have employed cultural domain analysis to build models based on informant knowledge and information. Intracultural variation in consonance with the models is associated with stress. Furthermore, psychosocial and physiological stress markers measured during pregnancy are associated with poor birth outcomes. In this study psychosocial measures of stress are pregnancy-related anxiety (PRA) and perceived stress (PSS). Epstein-Barr Virus antibody levels were analyzed to indicate stress-related altered immune function. The analysis controls for socioeconomic status, social class, site, household elements, gestation, parity, and age. Cultural consensus analysis found one cultural model of a good pregnancy with strong agreement. The model blends tradition and biomedicine with slight variation in belief in the traditional elements. Linear regression models indicate that participants who are more consonant in the model have lower levels of both PSS and PRA. Consonance is not associated with EBV antibody levels. Perceiving social support from family and non-family enhances the effect of consonance on PRA, unless perceived family support is above the mean. In this case, the effect is blunted. Social support does not moderate the effect of cultural consonance on PSS. This research demonstrates the critical role of culture in health outcomes.