Topics in Minority Health Childbearing Patterns Among Puerto Rican Hispanics in New York City and Puerto Rico

Hispanics are the second largest minority in the United States. In 1980, the two million Puerto Ricans in the continental United States constituted the second largest U.S. Hispanic group. This group of Hispanics has traditionally concentrated in New York City (NYC). There were also more than three million Puerto Ricans residing in Puerto Rico in 1980. In order to study the childbearing patterns of these two groups of Puerto Ricans, vital statistics for NYC residents for the period 1978 through 1982 and for residents of Puerto Rico in 1980 were used*.

Three groups of Puerto Rican infants were examined: infants born in Puerto Rico (islanders, N=72,085), first-generation Puerto Rican infants born in NYC to Puerto Rico-born mothers (N=48,794), and second- or higher-generation Puerto Rican infants born in NYC to New York-born Puerto Rican mothers (N=36,013). Single births in these three groups are compared with single births for non-Puerto Rican Hispanics (N=57,871), non-Hispanic blacks, and non-Hispanic whites in NYC. Only births occurring during the period 1979 through 1981 are included for blacks (N=96,352) and whites (N=96,780). An infant's race was determined according to the standard National Center for Health Statistics algorithm (1) for births of non-Hispanic descent. An infant's ethnicity was determined by referring to the self-reported ethnic identification of the mother at the time of birth registration. Births to Hispanics of non-Puerto Rican descent comprised 38% of all Hispanic births in NYC during the period 1978 through 1982; of these births, 92.4% were Central or South American, 4.4% were Cuban, and 3.4% were Mexican. The variables examined were maternal age, education, parity and marital status at the time of delivery, the trimester in which prenatal care began, and Medicaid coverage of the birth (Table 1).

The proportion of infants with mothers 18 years of age was highest among second- or higher-generation Puerto Ricans delivered in NYC (15.5%). This was twice the proportion for both islanders (7.6%) and first-generation Puerto Rican births in NYC (6.9%). The proportion of second- or higher-generation infants with mothers 18 years of age was 10 times higher than the proportion for whites (1.5%) and 1.7 times higher than the proportion for blacks (8.9%). Otherwise, first-generation and second- or higher-generation Puerto Rican births had a similar maternal risk profile except for parity.

Births of Puerto Rican descent in NYC differed markedly from births in Puerto Rico. In general, Puerto Rican mothers delivering in NYC were less educated, had less access to early prenatal care, and had more than twice the proportion of out-of-wedlock births as mothers delivering in Puerto Rico. Women in consensual unions in Puerto Rico were considered as unmarried in this analysis.

The maternal risk profiles for Puerto Rican and non-Puerto Rican Hispanic infants in NYC also differed markedly. Non-Puerto Rican Hispanic mothers were better educated, were less likely to give birth in unmarried circumstances or at younger ages, and had less Medicaid coverage than Puerto Ricans in NYC. Compared with whites in NYC, however, non-Puerto Rican Hispanics had a much higher risk profile. In general, Puerto Rican births had a maternal risk profile closer to blacks than to other Hispanics in NYC. Reported by Bureau of Maternity Svcs and Family Planning, New York City Dept of Health; Office of Planning, Evaluations and Reports, Commonwealth of Puerto Rico Dept of Health; Research and Statistics Br, Pregnancy Epidemiology Br, Div of Reproductive Health, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: Previous studies have shown that Hispanic women born in the United States have a higher pregnancy risk profile than Hispanic women born in their country of origin (2,3). U.S.-born Hispanic women tend to be younger and more likely to be unmarried than foreign- or Puerto Rico-born women delivering in the continental United States. This report extends the comparison further by examining births of infants of Puerto Rican descent in NYC to births in Puerto Rico for the same period.

Consistent with previous findings (2), slight differences in maternal education and marital status are present between the two generations of Puerto Rican infants born in NYC. The high proportion of 18-year-old mothers among second- or higher-generation Puerto Ricans in NYC is, however, quite remarkable. Lack of improvement in social and economic status between first-generation Puerto Ricans and second- or higher-generation Puerto Ricans is suggested by the similar proportions of Medicaid coverage in both groups. Although age- and sex-specific census data on Puerto Ricans in NYC are not available by birthplace for calculating the corresponding fertility rates, it is unlikely that the difference found is explained by the age distributions of the groups involved.

The proportion of Puerto Rican infants born to unmarried mothers in NYC is similar to the proportion for blacks and is higher than the proportion for non-Puerto Rican Hispanics. This latter is higher than the ones previously reported in the literature for other Hispanics (2,3). Both generations of Puerto Ricans in NYC have over twice the rate of out-of-wedlock births as Puerto Rican islanders, whose rate is twice that of whites in NYC. The factors responsible for this disparity should be explored further.

The differences in access to early prenatal care services between Puerto Ricans in NYC and those in Puerto Rico are significant. Puerto Ricans in NYC have the highest rates for lack of prenatal care of all groups considered. There are no significant differences in the proportions of women with no data on prenatal care in Puerto Rico and NYC that might explain these findings (Table 1). Because women in Puerto Rico are more likely to receive prenatal care than those in NYC, the high proportion of infants of Puerto Rican descent in NYC whose mothers did not have any prenatal care may be due to social and economic factors rather than to personal health practices.

Although Hispanics are not a homogeneous group, current ethnic/racial classifications group all Hispanics together. The large difference noted here between Puerto Rican and non-Puerto Rican Hispanics suggests the inadequacy of the current classifications for epidemiologic research. Births of infants of Puerto Rican descent present a maternal risk profile quite different from other Hispanics in the United States.

References

1. CDC. National infant mortality surveillance report--United States, 1980. Atlanta, Georgia: Public Health Service, (in press).

2. Ventura SJ, Taffel SM. Childbearing characteristics of US- and foreign-born Hispanic mothers. Public Health Rep 1985;100:647-52.

3. Williams RL, Binkin NJ, Clingman EJ. Pregnancy outcomes among Spanish-surname women in California. Am J Public Health 1986;76:387-91. *The Office of Epidemiologic Surveillance and Research, New York City Department of Health, provided computer tapes of birth and linked birth-death certificates for the years analyzed. The Vital Statistics Cooperative Program (now the Office of Planning, Evaluations and Reports), Commonwealth of Puerto Rico Department of Health, provided similar data. The figures reported here may not be exactly comparable to previously published vital statistics reports because of differences in the definitions of ethnic and racial groups.

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