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

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.