PUERTO RICO PREGNANCY RISK ASSESSMENT MONITORING SYSTEM (PR-PRAMS) PR-PRAMS pursues to collect and describe the health status, maternal attitudes, behaviors and experiences that occur prior to, during, and after pregnancy to allow for informed decision making and resource allocation that supports effective, efficient and quality programming for women and infants health, policies as well as maternal behaviors in order to reduce maternal and infant morbidity and mortality. PR-PRAMS has several objectives to: 1) establish and maintain the PR-PRAMS on selected maternal attitudes, behaviors and experiences that occur prior to, during, and after pregnancy; 2) gather population-based data on maternal and child health indicators in PR using the CDC PRAMS protocol and methods; 3) conduct an analysis of PR-PRAMS data based on an analytic plan to inform programmatic activities and public health practices in PR; 4) translate and disseminate analytic results into practical and useful information for public health action in PR to guide program development and evaluation in collaboration with the Steering Committee; 5) establish and maintain a project-based organizational structure for the implementation of a survey supplement or oversample to investigate emerging maternal and child health issues, including post-disaster or pandemic needs that may arise during the data collection cycle. PR-PRAMS will be a standardized data collection methodology that allows for comparisons with other states and for optimal use of the data for single-state analysis. It will include a customize questions to adapt to the needs of PR. PR-PRAMS protocol combines two modes of data collection; a mailed questionnaire with multiple follow-up attempts, and telephone interviews. Each month, a stratified sample is drawn from the vital statistics data file and the sequence of contacts is attempted. A questionnaire will be mailing 2 to 4 months to sample selected women who have recently delivered live born infants. The data collection cycle takes 60 to 95 days. The expected outcomes are: 1) have statistically representative data and provide access to high quality data on diverse topics for analysis and for giving proper advice to public health and health systems leaders responsible for establishing priorities and transforming maternal and child health in PR; 3)use PR-PRAMS data to inform community, local and state health programs and policies that can be useful to introduce changes to the health care system targeting maternal and child health; 4) have PR-PRAMS data available to CDC, state public health agencies, providers and external researchers and quality improvement of MCH programming.