More than half of babies in Puerto Rico were delivered via cesarean in 2022. Here’s why.

Image via Shutterstock/Supawat Eurthanaboon

By Crystal Harlan

January 17, 2024

Ponce had the most dramatic increase in cesarean deliveries (16%), followed by San Juan (15%) and Baymón (12%), where 63.9% of babies were born via surgery. 

In 2022, more than half of babies in Puerto Rico were delivered via cesarean, according to data released last week by the US Centers for Disease Control and Prevention.

The island’s 50.5% cesarean birth rate not only marks a dramatic 9% increase since 2018, but it’s also significantly higher than the cesarean rate for the United States, which was 32.2%.

The largest increase (14%) was for mothers under the age of 20, and the second highest was for mothers under 25 (10%).

Ponce saw the most dramatic rise in cesarean deliveries (16%), followed by San Juan (15%) and Baymón (12%), where 63.9% of babies were born via surgery.  

Cesarean section is generally performed when a vaginal delivery is not safe or possible, however doctors in Puerto Rico are increasingly using this procedure as a first option, even when there are no health risks.

“What we’re seeing aren’t emergency cesarean deliveries. They’re not performed to save the mother or child’s life, following guidelines,” Ana Parrilla Rodríguez, a physician and maternal and child health professor at the graduate school of public health at the University of Puerto Rico told The Guardian. “A lot of the time, cesareans are performed for the doctor’s convenience.”

It’s common for doctors to schedule cesarean surgeries at times that are convenient for medical staff, like during the day and before holidays, Parrilla Rodríguez added.

But the reasons for the dramatic increase in cesareans goes beyond convenience. After Hurricane Maria devastated the island in 2017, experts estimate around 10 doctors were leaving the island daily in the three months following the disaster, so the island is already dealing with a shortage of healthcare professionals. As a result, more than a dozen delivery rooms have closed across Puerto Rico in the past decade, according to the Associated Press.

To complicate matters even more, in Puerto Rico only obstetricians can legally deliver babies—delivery nurses and midwives are not legal options.

Due to crippling staff shortages, the few obstetricians that are on the island cannot wait for hours on end while their patients are in labor. 

“In general, hospitals have limited personnel and few economic resources,” said Dr. Carlos Díaz Vélez, president of Puerto Rico’s Association of Surgical Doctors told the Associated Press.

Another reason for the increase in cesareans is that some women prefer them to avoid the pain associated with vaginal birth as epidurals are not routinely covered by insurance companies on the island, Dr. Annette Pérez-Delboy, a maternal-fetal medicine specialist who specializes in high-risk pregnancies, told the Associated Press.

RELATED: Puerto Rico records lowest birth rate since 1888. What are some solutions?



  • Crystal Harlan

    Crystal is a bilingual editor and writer with over 20 years of experience in digital and print media. She is currently based in Florida, but has lived in small towns in the Midwest, Caracas, New York City, and Madrid, where she earned her MA in Spanish literature.


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