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Stress and the Social Determinants of Maternal Health among Puerto Rican Women.
– Reported, June 05, 2013
Excessive stress exposures during the life course have been demonstrated to have an impact on birth outcomes. It is well documented that highly threatening situations during childhood may generate stress-induced emotional and physiological health consequences, including poor birth outcomes among African American women. To our knowledge, there are no studies that have examined the possible link between stress during the life course and maternal health among Latinas. This knowledge gap has strong implications for Puerto Rican women, as they have the highest incidence of premature delivery among Latinas. Thus, it is essential to conduct community-based participatory research (CBPR) studies to identify the perceived social determinants of stress among Puerto Rican women.
Raising children as single mothers was a stress: I am a single mom and Im pregnant, sometimes you dont have money for what they [the children] need . Another participant reported being unable to count on family to help her when she needs it: but when you need them you want to talk to somebody or when you are in need of a favor they are limited. Oh, I cant do this, oh you know Im busy, or I cant come and visit. Thats a lot of stress
Poor educational system
When asked to discuss education as a stressor, participants articulated the following concerns as the main problems with the school system: a) very poor quality of education; b) lack of important resources for learning; and c) school safety.
a) Very poor quality of education. Participants stated that the quality of education their children receive is not equal to education provided in other places. They also commented, based on their own schooling experience, that teachers are often not engaging students in learning.
Participants talked about how their financial situation prevents them from transferring their children to a better school district: if I can remove my kid from Hartford for his education, I will do it; I think if they want a good thing for their kids, they should move and put their kids in another school system.
Most participants also felt that college education was not an attainable or reachable goal for most students in their communities:
The elementary schools do not offer a good education for our children, how are they going to even make it to, to middle school?
I said that if my child stays here in Hartford middle school, hes not going to want to go to high school.
is easy to be a dentist assistant, nurse assistant, and assistant for everything but is very difficult to be a doctor.
b) Lack of important resources for learning. Women expressed concerns such as
the childrens desks are broken
the books are broken
hello, whats going on?
c) School safety. Participants talked about the violence in the schools and their lack of trust in the security staff. They were also concerned about bullying: My kid was new in the middle school, there was another kid looking for problems with my kid. I went to the office and they did nothing, I had to talk to the other kid, because they [referring to the school] did nothing
Food insecurity
Food insecurity is defined as the limited ability to acquire nutritionally adequate and safe foods in socially acceptable ways. Participants reported food insecurity experiences since childhood:
when we were growing up
we used to tell each other dont eat too much we have to save that for next week; If I stayed home I was only going to eat one time, then I will stay hungry, so
I never missed school because they offered lunch, I was the first one at the lunch line.
Food insecurity was reported to be a powerful stressor: Its a stress to have to think for tomorrow what you are going to eat when there is nothing in the refrigerator; Well, you have to feed your children first and youre pregnant and you dont have nothing else to feed yourself; if your kids ask for something, Oh, I want a snack for school and you dont have the money to afford, Food Stamps or whatever. It is stressful.
Women also felt that the food assistance programs, such as WIC and SNAP helped but did not provide enough to feed the family for the entire month: to her [referring to her daughter who received WIC] they give her juice, cereals, cheese, beans but I have three more and I have to divide the milk between four; you know the Food Stamps do not last the whole month; I have seen myself at the end of the month with no groceries, with nothing.
Participants discussed their own experiences and their fear of letting their children play outside because of worries about child rape, kidnapping, and exposure to violence: another thing too, that when you live around this area, theres a lot of drug movement This is a very bad area for someone to walk alone there is always fights, shootings, and that bullet has no name.
Mothers talked about the stress of having to explain street violence to their children: then how you gonna explain your child, how you going to sit there and explain to your child if theyve seen somebody with a needle in their arm, its to say somebody killed, somebody died, thats another stress .
Participants talked about their fear of collaborating with authorities because they and/or their families might become targets, but also articulated the importance of reporting these incidents.
Other social determinants of stress
Although perceived discrimination/racism, and lack of health care access and treatment were not directly identified as main stressors among most participants, their experiences suggested that some had experienced discrimination: Like every time I go to
the mall to a store and you see that they are hiring because they have the paper outside but when you go in, they said to you they are not, they dont accept applications
there are people that are
racists and dont care, do you understand me?
The limitation of not having health insurance was a stressor, preventing participants from going to the doctor when feeling ill: But I mean its nice to feel that you have insurance cause me, personally, Im always sick, like, Im always feeling like I know there is something wrong with me and I want to go get checked, but I cant cause I dont have insurance.
Consequences of stress related to maternal health
The majority mentioned how stress affects their mental health: You dont think right,
you just constantly
just step up to a mirror and look at yourself and think, what, like, like, who am I? like who am I looking at? am I looking at myself or am I looking at somebody [else]? Participants reported that they cry a lot when they are stressed. One woman commented on depression:
stress has really caused a history of depression in my family
as a result my mother has depression, my sister
she is worried about my mom, for her health, also acquired depression;
my problems, I have depression, not for worrying about her but because of my things, well we all have depression and its like a chain
. One participant described her experience with co-workers and how the stress of poverty caused one to have suicidal thoughts and another to prostitute herself.
CREDITS.
Angela Bermúdez-Millán, Grace Damio, Joan Cruz, Karen DAngelo, Sofia Segura-Pérez, Amber Hromi-Fiedler, and Rafael Pérez-Escamilla.
http://www.ncbi.nlm.nih.gov/
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