La Crisis de la Atención de Maternidad: Experts’ Perspectives on the Syndemic of Poor Perinatal Health Outcomes in Puerto Rico

Abstract

The purpose of this study was to center the voices of maternal and infant health care (MIH) clinicians and public health experts to better understand factors associated with persistently high rates of poor perinatal health outcomes in Puerto Rico. Currently, Puerto Rican physicians, midwives, and other care providers’ perspectives are absent from the literature. Guided by a syndemics framework, data were collected during eighteen months of ethnographic fieldwork and through open-ended, semi-structured interviews (n=20). Three core themes emerged. The first two themes: (1) Los estresores diarios: poor nutrition, contaminated water, and psychosocial stress; and (2) Medicina defensiva: solo obstetrics and fear-based medicine, describe contributing factors to Puerto Rico’s high preterm and cesarean birth rates. The third theme: (3) Medicina integrada: midwives, doulas, and comprehensive re-education explores potential solutions to the island’s maternity care crisis that include improved integration of perinatal care services and educational initiatives for both patients and providers. Collectively, participants’ narratives expose a syndemic of poor perinatal health outcomes that emerges from the structural vulnerability generated by decades of colonial domination embedded in the daily lives of island residents and in the Puerto Rican maternity care system.

keywords:

• Puerto Rico
• maternal and infant health
• syndemic
• preterm birth
• cesarean birth

Additional information

Notes on contributors

Holly Horan

Holly Horan is an Assistant Professor of Anthropology at the University of Alabama. Her research interests include Puerto Rico, perinatal stress, timing of delivery, health care reform, and the scaling up of maternity care services to include integrated models of maternity care.

Melissa Cheyney

Melissa Cheyney is Associate Professor of Anthropology at Oregon State University. She studies childbirth and midwifery in the United States.

Yvette Piovanetti

Yvette Piovanetti is a pediatrician in Hato Rey, Puerto Rico, and the co-founder of Centro Pediátrico de Lactancia y Crianza. She is also an Associate Attending at the Department of Pediatrics, University of Puerto Rico School of Medicine.

Vanessa Caldari

Vanessa Caldari is a certified professional midwife, co-founder of the nonprofit Mujeres Ayudando Madres (Centro MAM), and Director of the Southwest Tech Midwifery program. She is a perinatal health provider, educator, and community activist.