Villanova professor and students, Kensington residents team up to improve maternal health for Puerto Rican women
Dr. Linda Maldonado and her cohort of students and focus group participants formed ‘Team Latina’ to look for ways to improve healthcare among Puerto Rican women in Kensington.
Racial and economic disparities in maternal healthcare and infant mortality rates in the U.S. are well-documented and as urgent a reality as ever. Overall, the U.S. has the highest rate of deaths related to pregnancy and childbirth of any country in the developed world.
Maternal health and infant mortality are closely linked, and have been shown to be a significant issue for Puerto Rican women of childbearing age both on the island and living on the U.S. mainland. Compared to non-Hispanic white mothers, and other Latina women subgroups, Puerto Rican women have some of the poorest maternal and infant health outcomes in the U.S. According to a September 2011 study published by the National Center for Health Statistics (NCHS), from data in 2007, an infant mortality rate of 7.71% was 37% higher than the rate for non-Hispanic white women, and the highest rate among Latina women subgroups. The study found that the disparity in infant mortality rates for Puerto Rican women was a result of preterm births and other preterm-related causes, often impacted by maternal health in a myriad of ways.
It’s a story that Leslie Gonzalez knows firsthand.
Gonzalez, 35, worked as a bank loan officer in her hometown of Guayama, in southeastern Puerto Rico, before moving to Philadelphia nine years ago. In 2016, she was expecting her son, Derrick - but her pregnancy with her youngest child of four was “poor,” Gonzalez said, as she suffered from hemorrhaging. So when she saw a flyer asking for her participation in a study led by researcher, Dr. Linda Maldonado of Villanova University, on maternal healthcare for Puerto Rican women, she was intrigued.
“I didn’t know the statistics. I didn’t know that from all Latin women, Puerto Ricans had the worst rate of how their health was during pregnancy and childbirth. So that to me was very engaging,” Gonzalez said.
She was part of the last focus group before the research was presented, and afterwards she was invited to different community events, as Maldonado kept in touch with the participants and began forming “Team Latina” - a network of research participants, Villanova students, and Maldonado herself, that seeks to address the issues surrounding poor maternal health in the Puerto Rican community in Kensington.
“Eventually, I think I feel like I graduated from being researched, to part of the group. So now I try to put the voice out there about what Team Latina is doing and I just like sharing my story with other women,” Gonzalez said.
“So from there on, I’m here. I’m planning on following forever, as long as they let me,” Gonzalez said with a laugh.
It was the day after Valentine’s Day, a cold Saturday in North Philadelphia. On the second floor of Community Center at Visitation, though, it was bright, warm, and noisy. As children ran around in the hallway, supervised by a few of the Villanova college students who came to the event that day, a group of women and students sat in a circle and shared cookies, coffee, advice, and stories from their own lives about what had brought them there to be a part of “Team Latina.”
The gathering, dedicated to workshops on self-love on the day after Valentine's Day, had its roots 12 miles away, on the campus of Villanova University.
In 2016, Dr. Linda Maldonado, an assistant professor at Villanova University’s College of Nursing, began to assemble a team of 20 students to research maternal health for Puerto Rican women in Philadelphia.
Maldonado’s research team wanted to know why Puerto Rican women have the poorest maternal health and infant mortality outcomes of all Latina women subgroups. But out of her research came even more questions, and together with the participants in her focus groups in Kensington, whom she met via the research study’s partnership with Temple University's OBGYN clinic, Maldonado is still working towards answering some of the most pressing challenges faced by Puerto Rican mothers.
Maldonado, herself Puerto Rican, was a National Institute of Minority Health and Health DIsparities (NIMHD) Health Disparities Research Institute Scholar in 2016, and is focused on incorporating a community-based participatory research structure, that allows for more direct intervention models. Her goal, she said, is that the research is informed by the needs and vision of some of the original women who participated in the study - or the “OGs”, as Gonzalez, a participant in the initial research and current member of Team Latina, refers to herself and the group of women who were there at the beginning of the project.
The focus groups were held at Philadelphia’s Temple University Hospital OB-GYN Clinic, in partnership with Dr. Arleen Ayala-Crespo, MD. Maldonado and the students who participated in the research study at the time developed close bonds with the clinic staff, as well as research participants and their families.
Those connections in and of themselves are part of the intervention related to their research results, which revealed that lack of community and stress in the environment can influence maternal health. Another recent study, published in May 2018 in The Journal of Women’s Health, linked psychosocial stress among Puerto Rican women to pre-term birth and low birthweight among infants and higher infant mortality rates.
After the study was concluded, one of the Villanova students who participated in conducting the focus groups, Antonio Garcia, created a private Facebook page where Team Latina women could connect and share with one another as well as Maldonado,Villanova nursing students and others who are part of the project.
“We’re doing all this so that Puerto Rican women won’t be so likely to have preterm babies,” Maldonado said, emphasizing that “doing work in the community indirectly affects the Puerto Rican women who live there,” and in that sense, Team Latina and their research is “taking more holistic approach.”
The group has partnered with Prevention Point, the Medical Mission Sisters, as well as Temple OBGYN clinic, and are looking to develop collaborative partnerships with other community organizations in Kensington.
In May 2019, Maldonado and Team Latina received the inaugural grant of $5,000 from the Sigma/National Association of Hispanic journalists research grant. At the beginning of 2020, the project received an additional $10,000 grant from the Pennsylvania Action Coalition’s Promise of Nursing Small Grants Program and the Foundation of the National Student Nurses’ Association (FNSNA)
The funding was originally intended for use in how to learn about how different alternative therapies can decrease stress among Puerto Rican women in the Kensington neighborhood, and how community building can play a role in improving Puerto Rican maternal health. But the ongoing global pandemic has changed many well-laid plans, and now, Maldonado said that the research will be restructured to instead focus on using quantitative surveys to look at how COVID-19 has impacted Puerto Ricans of childbearing age in Kensington. Maldonado hopes to involve Gonzalez and other research participants who have stayed involved as paid representatives of the project in its next phase.
“One of the things that I noticed with the Puerto Rican community that we’re working with is that there is no sense of community. I think with other Latina subgroups, there is an attempt to have community. We don’t have that. I don’t trust my neighbor,” Maldonado said.
Glenda Vargas, along with Leslie Gonzalez, is one of the original members of Team Latina who was present at their last in-person event, held in February, prior to COVID-19 regulations. She said it’s this sense of community that drew her to continue participating in the project after the research study ended.
Vargas, who lives near Second Street and Indiana Avenue, is a full-time caretaker for her mother and grandfather, as well as her son. She is also an entrepreneur, who creates elaborate cookie and dessert arrangements via her business, Wicked Treats by Glenda.
She said that though she considers Kensington her home and has lived there all her life, she wants to see change.
Before Team Latina, she didn’t really have relationships with other women in the neighborhood. Being a part of the group has connected her to her neighbors, in ways large and small. Gonzalez does nails, and Vargas will go to her to get her nails done, just as Gonzalez is planning to buy Glenda’s cookies for her daughter’s quinceañera.
“It’s a really good way to network, not only just business,” Vargas said.
Before Team Latina, Gonzalez said she also didn’t have much connection with other women and mothers in her community.
“It’s amazing because this is great research and I hope to see Team Latinas….all over the nation. I think whether it’s focused on Puerto Ricans or whatever it is, groups like this are needed,” Gonzalez said.