Carmen Silva: Analyzing Accessible Health Services and Income Related to Maternal Mortality Rates in Puerto Rico From 2002 to 2004

Carmen is a geographer, cartographer, and Geographic Information Science specialist. She graduated from the University of Puerto Rico and the University of Akron, Ohio. She is currently working at the Puerto Rico State Election Commission and the Federal Emergency Management Agency, and she is also a member of the Association of American Geographers.

Carmen_Silva_Map2.jpgThe goal of this study is to establish a relationship between maternal mortality rates and accessibility to hospitals with 24-hour emergency rooms. The purpose of this study is to determine if the accessibility to health services and income contributed to maternal mortality rates from 2002 to 2004 in Puerto Rico. 

Study Area
Puerto Rico is located in the Caribbean Region. The absolute location, or geographic coordinates, of Puerto Rico are 18° 29′ 0″ N, 66° 8′ 0″ W. All health services in Puerto Rico are located within eight different health regions delineated by the Puerto Rico Health Department.  Each health region is required to have one or more hospitals with the necessary equipment to attend to most emergencies.  As a last resource, the regional hospitals can transfer patients to “Centro Médico,” located in the Metro Health District Area. Critical resources such as doctors, specialists, and nurses are more prevalent in the Metro Health Area.

The data of maternal mortality events were provided by the Puerto Rico Health Department (División de Madres Niños y Adolescentes). Each maternal mortality home address and 24-hour emergency room was located using x and y data. The hospitals meeting the criterion of 24-hour emergency rooms were taken from “” The income data were taken from US Census Bureau 2000 block groups.

The selected method is a network analysis for 24-hour emergency room locations.
The travel time from and distance from the home address to the hospital of each
maternal mortality event  were calculated and divided into different time categories.
In order to measure the income variable an interpolation was used. An overlay method was used to establish the economic status of the area where each event occurred and measure the accessibility to 24-hour emergency rooms.

The network analysis shows 42% of maternal mortality events occurred in the time frame of 10 to 35 minutes.  The income variable shows that 83% of the maternal mortality events occurred in low-income areas. Table 2 shows that the 24-hour emergency rooms cover at least the half of the maternal mortality events. Table 3 shows the income and distance variables, with no correlation between them.

To conclude, using maternal mortality as a variable is quite complex. Many different factors can cause maternal mortality. The woman’s age, the point at which she became pregnant, accessibility to health services, and prenatal care are only a few aspects that need to be considered in this research project. Puerto Rico as the geographic setting provides several other factors that impact accessibility to health services such as traffic jams, distance from residences to health services, travelling time, and available transportation methods. Therefore, maternal mortality is not only a health services issue, but is also a geographic issue.


B.R. Ganatra, K.J. Coyali & V. N. Rao. “To far, too little. too late: a community- based case control study of maternal in rural west Maharashtra, India. .” Bulletin of The World Health Organization , 1998: 591-598.

Comas A, Navarro A, Conde J, Blasini I, Adamsons K. “Misreporting of maternal mortality in Puerto Rico.” Boletín de la Asociación Médica de Puerto Rico, 1990: 343-346.

Department of Reproductive Health and Research, World Health Organization,. Maternal Mortality in 2000 Estimates developed by WHO, UNICEF and UNFPA.

Geneva: WHO Library Cataloguing-in-Publication Data, 2004.

Dietz, James. Historia Económica De Puerto Rico. San Juan, PR: Huracán., 2002.

Graham, Wendy. “Translating Evidence Into Enhanced Strategies.” Reducing Maternal Mortality in Developing Countries. March 18, 2008. (accessed 10 27, 2008).

Hani K. Atrash, Herschel W. Lawson,Tedd V. Ellerbrock, Diane L. Rowley,Lisa M. Koonin,. “Pregnancy-Related Mortality.” REPRODUCTIVE HEALTH OF WOMEN, 1995: 140-155.

Koonin L.M., M.N., M.P.H. Hani K. Atrash, M.D., M.P.H. Roger W. Rochat, M.D. Jack C. Smith, M.S. “Maternal Mortality Surveillance, United States, 1980-1985.” Morbidity and Mortality Weekly Report, 1988: 19-29.

Organización Panamericana de la Salud . “Elementos básicos para el estudio y la prevención de la mortalidad materna.” Boletín Epidemiológico, 1986: 1-6.

Ross, Bulatao R. and J. “Which health services reduce maternal mortality? Evidence from ratings of maternal health services.” Tropical Medicine and International Health, 2003: 710-721.

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