Social Justice Is Overdue for Puerto Rican Mothers

• Published in: American journal of public health (1971) Vol. 114; no. S6; pp. S450 - S452
• Main Authors: Lebron, Cynthia N, Pérez-Ramos, José, Cardona-Cordero, Nancy, Morales, Vanessa, Rivera-Joseph, Samantha
• Format: Journal Article
• Language: English
• Published: United States American Public Health Association 01.07.2024
• Subjects: Banking; Birth control; Birth rate; Birth weight; Breastfeeding & lactation; Cesarean section; Childbirth & labor; Childrens health; Clinics; Community health care; Contraception; Coordination; Correspondence; Doulas; Earthquakes; Economic crisis; Empowerment; Ethics; Female; Food security; Food service; Health care; Health care access; Health care policy; Health disparities; Health services; Hispanic Americans; Hispanic or Latino; Hispanics/Latinas; Humanitarianism; Humans; Hurricanes; Infant mortality; Infectious diseases; Injustice; Insurance; Markets; Maternal & child health; Maternal mortality; Medicaid; Medical personnel; Medicare; Mortality; Mothers; Natural disasters; Occupational exposure; Opinions, Ideas, & Practice; Postpartum period; Prenatal care; Public health; Puerto Ricans; Puerto Rico; Race/Ethnicity; Risk factors; Scarcity; Seismic activity; Shortages; Social Justice; Socioeconomic Factors; States; Sterilization; Telemedicine; United States; Women; Womens health; United States; Puerto Rico; United States > US
• ISSN: 0090-0036; 1541-0048; 1541-0048
• DOI: 10.2105/AJPH.2024.307702

The notorious Law 116 (1937) legalized sterilization with clinics promoting irreversible procedures and serving as testing grounds for birth control trials.2 By 1965, a staggering 34% of Puerto Rican women of child-bearing age had been sterilized, perpetuating a disturbing trend.2 The coercion and promotion of sterilization had profound ethical implications, and postnatal sterilization disparities among Puerto Rican women highlighted the need for further investigation into sociocultural drivers. Despite having the lowest birth rate (5.9 per 1000 people) of any US state/territory (the US rate is 11.0 per 1000 people), Puerto Rico's cesarean section rate at 50.5% far exceeds the US average rate at 32.2%, emphasizing the urgency for ethical imperatives to reduce its usage.5 The transformation of Puerto Rico's health care system since the 1990s, from a regionalized public model to a for-profit market, has further compounded perinatal health challenges.6 With over 65% of the population reliant on Medicare and Medicaid, the island faces severe funding caps, resulting in a shortage of essential maternal and child health services.7 The disparities in reimbursement rates for Medicaid and Medicare exacerbate provider shortages, with 72 out of 78 municipalities in Puerto Rico deemed medically underserved areas.7 The economic and humanitarian crisis since 2006, coupled with natural disasters Hurricane Maria and earthquakes, has left Puerto Rico grappling with systemic disruptions.8 Pregnant and postpartum women, an already vulnerable population, faced additional challenges as a consequence of the breakdown of infrastructure, scarcity of essential services, and prolonged exposure to risk factors. [...]previous studies have demonstrated that telemedicine can reduce maternal mortality by improving access to care and providing early identification and treatment of complications Community health workers (CHWs) typically are from the same communities they serve, resulting in assisting and providing social (e.g., food banks, transportation assistance, services coordination) and health care that is culturally appropriate and sensitive to the needs of community members. The transformation of Puerto Rico's health care system into a forprofit market since the 1990s, coupled with economic and humanitarian crises, natural disasters, and emerging infectious diseases, has further exacerbated perinatal health challenges.