Maternal Subjective Social Status in Rural Nicaragua: A Mixed-Methods Analysis of Cultural and Economic Factors

Abstract

Background: Across cultures, women, especially mothers, experience disproportionate levels of inequality, which generally manifests in relatively poorer health outcomes. One measure of inequality, socioeconomic status (SES), is strongly and positively associated with maternal health. Recently, subjective social status (SSS), one’s perceived rank relative to others in the social hierarchy, has been found to better predict health outcomes than objective measures of SES (OSS), such as income, education, and occupation. Indeed, in the rural community of Los Robles, Nicaragua, SSS was found to be positively correlated with maternal mental health (MMH). However, the variables that people use to determine their SSS are poorly understood. Purpose: This mixed-methods study investigates how maternal SSS is perceived and assigned within Los Robles. In the long term, it is hoped that this will, in turn, inform a better understanding of the determinants of MMH. Methods: Cross-sectional data collected in 2015 were used to examine factors associated with maternal SSS (n = 236), specifically household wealth (HHW), education, household food insecurity (HFI), MMH, and perceived social support (PSS). Ordinal logistic regression (OLR) modelling was used to assess these variables’ effect on SSS and to test the hypothesis that maternal SSS in Los Robles is more strongly associated with psychosocial factors (HFI, MMH, PSS) than OSS (HHW, education). In 2023, ethnographic fieldwork, including qualitative interviews (n = 16) with mothers who had participated in the 2015 surveys, was conducted to explore the context-specific dimensions of SSS. Interview data were analyzed using thematic analysis to complement and provide depth to the quantitative results. Results: Quantitative and qualitative analyses found that OSS factors, HHW (COR: 1.10; 95% CI: 1.04, 1.16), and income were positively associated with SSS. Notably, PSS had the strongest association with SSS in the OLR model, with a one-unit increase in PSS associated with an 84% (COR: 1.84; 95% CI: 1.34, 2.54) higher likelihood of higher SSS. Qualitative findings demonstrated further support for interpersonal relationships, self-esteem, and religiosity affecting SSS independent of OSS. Conclusions: These findings indicate that psychosocial factors, alongside OSS, influence how maternal SSS is perceived in Los Robles.