Cuba has a lower infant mortality rate than the US. 4.2/1000 versus 6.1/1000. The rate does not vary all that much around the country, suggesting that good maternal and infant care are available wherever a woman lives.
Here are some of the reasons. Medical care is free; guaranteed in the Constitution as a responsibility of the government. Everyone in Cuba has a family doctor who usually lives above the clinic in the neighborhood and makes regular house calls. Really. He/she is required by the maternity protocol to do a full early pregnancy examination before the ninth week of pregnancy during which the potential complications are identified. A plan for the pregnancy is developed and reviewed with the consulting obstetrician. Both clinical and social risks are considered, for example twins, gestational diabetes or hypertension, inadequate nutrition and family environment. The family physician and nurse follow women in the low risk category. The national protocol includes 12 visits and timely screenings for developmental problems. Ultrasound exams are routine. Women get paid time off for their prenatal visits.
If there are any concerns about possible risks to delivering a healthy baby, the pregnant woman lives in a “maternity home” under medical, nutrition and social worker supervision. Saying no to this special treatment does not seem to be option. When the baby is about to be born the woman is transferred to a hospital that knows the individual treatment plan and is prepared for the mother and baby. There is extensive neonatal screening for all babies to identify both common and rare genetic, metabolic or hormonal abnormalities. All newborns are tested for hearing. Within three days after discharge the family doctor and nurse make a house call to assess baby, mother and the environment. Supplemental nutrition is provided for both. Babies and mothers see the family doctor regularly in the first year of life and all babies are immunized against 13 childhood diseases. All complications are reviewed with the consulting pediatrician who can see the baby and mother at the regional polyclinic (multi-specialty ambulatory center).
Without respect to the high level of care mothers and children receive, Cuba has a very low birth rate; currently 1.42 per woman, way below the population replacement rate of 2.1. In fact, the government announced new financial incentives just this week to encourage women to have more children. There is considerable skepticism they will do much good. People we talked with gave us powerful reasons there are so few babies. The education level for women has risen sharply, increasing their opportunities in the workplace. Housing is crowded and expensive. Young couples often have to delay living together and getting married until they can afford to buy even a tiny apartment. Salaries remain low, making many people afraid they cannot afford to raise a child, yet. Contraception is widely available at very low cost. Abortion is legal, free and not stigmatized.