Infant mortality (IM) is an indicator of socioeconomic development. In this sense, in order to achieve low rates, several conditions that determine the quality of life must be combined. Cuba closed 2022 with an IM rate of 7.5 per 1,000 live births: the second highest in the last two decades.
The IM defines the number of deaths during the first year of life that occur per thousand births. On the island, its highest previous figure in this century (7.6) was reported in 2021, a year that drastically reversed the behavior of the indicator. In 2012, Cuba had registered an infant mortality rate of 4.6%, the lowest in the American continent.
Since 2000, Cuba had not registered a rate higher than 7. In fact, the country began the century with a downward trend that it maintained for almost two decades and whose culminating point was the achievement, for two consecutive years (2017-2018), of its lowest historical record: 4.0.
In 2021, according to experts, the direct influence of the pandemic on the health of pregnant women and the stress to which the health system was subjected had a definitive weight on the statistics. That year was, without a doubt, the turning point.
Two years later, with the coronavirus under control, and despite the declared efforts to reverse the figures, at the close of the first four months of 2023, Cuba already registers an IM rate of 7.2.
When poverty is stronger
IM is not an easy indicator to reverse. In order to achieve and maintain low rates, a series of critical conditions must be met, including good health care in general, correct nutrition for mother and child, good living and sanitary conditions, and infrastructure and income that can make their use and access sustainable.
Cuba is experiencing a process of impoverishment. Since 2019, the year in which the IM rate rose to 5.0, the island has been going through the most recent of its crises, classified by some as the most complex in its history since 1959.
The truth is that, after the decline observed in the structural growth of the gross domestic product (GDP) between 2010 and 2019, in 2021 this parameter fell by 11%. In recent years Cuba has faced persistent problems with the supply of energy; drop in exports and imports; low productivity; inflation; and shortages of basic resources, including medicines and food.
The impact on health care has been overwhelming. The devastating blow was dealt by the pandemic. However, the loss of good organization and discipline practices, the emigration of professionals, the obsolescence of equipment, the deterioration of infrastructures and the lack of supplies and medicines are, among others, phenomena prior to the virus. But, unlike COVID-19, these have managed to persist and worsen.
In 2022, First Deputy Public Health Minister Tania Margarita Cruz recognized that the lack of properly prepared cadres has had a negative impact on “the necessary effectiveness” of “the control and inspection actions that they must carry out.”
The insufficient management and control of resources “in some centers” brought with it “non-compliance with hygienic-sanitary regulations,” according to Health Minister José Ángel Portal Miranda. The work without adherence to the protocols caused “the appearance of Infections Associated with Health Care and the occurrence of institutional outbreaks,” with particular incidence in the Maternal and Child Care Program (PAMI).
In January 2023, the death of eight newborns at the 10 de Octubre Gynecology and Obstetrics Hospital in Havana made headlines. Four of them died due to a septic outbreak; the rest, due to extreme prematurity and retarded intrauterine growth, according to Dr. Yaima Rodríguez, a first-degree specialist in pediatrics and head of the center’s maternal-infant section.
In 2022, “acquired sepsis” was once again (as in the previous year) among the top five causes of infant death, together with perinatal conditions (low birth weight, and prematurity), congenital malformations, and hemorrhages.
In the case of Cuba, low weight and prematurity remain closely related to indicators such as deficiencies linked to preconception reproductive risk control1 and teenage pregnancy, which, although in 2022 it decreased from 18.1% to 17.8 %, continues to maintain a high rate.
Early pregnancy is a social and health problem. Six of the 15 Cuban provinces have an index higher than 18%; among them Las Tunas, Holguín, Camagüey and Granma.
According to studies carried out by the sociologist Norma Fleitas, early motherhood occurs more in mixed-race and black teenagers, residing in rural environments, disconnected from school life or work and in low-income housing, in precarious conditions.
The basic cause of early pregnancy in the last two decades has been the failure or non-use of contraception, as well as the low perception of the risks of induced abortion.
Since the end of 2018, the deficiencies related to the control of preconception reproductive risk have been particularly aggravated. As part of the shortage of supplies and medicines whose critical point began in 2021, widely used contraceptive methods, including condoms and pills, are reported to be lacking or with low coverage.
In 2022 the authorities recognized the absence of prenatal tablets and folic acid for pregnant women. The deficiency persists. Leidys Pérez, 36 years old and 20 weeks pregnant, assures that she has taken these supplements thanks to the help of her family in the United States, who have sent them to her.
Prenatal tablets generally contain folic acid, iron, calcium, and other vitamins and minerals essential for the development of the baby. Deficiency of these nutrients during pregnancy increases the fetus’s risk of developing neural tube defects, anemia, and resulting in low birth weight, or intrauterine growth retardation.
Crisis de insumos y medicamentos: causas conocidas, nuevos desafíos
Those who leave and what remains
For Cuba and its health system, one of the most sensitive phenomena of the crisis has been emigration. The human factor, which affects the availability and quality of services, as well as the administration, management and control of resources, is being lost.
Data presented by the researcher Juan Carlos Albizu-Campos show that “current migration is mostly female (133 women for every 100 men) and 76.7% of those who migrate are between the ages of 15 and 59.” On the island, more than 70% of doctors and almost 90% of nursing professionals are women.
Although the figures for specific decreases in the sector are not public, the emigration of young or experienced specialists is verified in incomplete staffs. In 2022, the Family Doctor and Nurse Program — the initial link in care for pregnant women within PAMI — presented problems with the “stability and operation” of the family doctor offices and, among other processes, affected “the quality of admission to the home,” according to the health authorities.
Primary care not only faced difficulties with the availability of personnel, but also with the deterioration of the facilities. 29% of the family doctor offices were registered with fair or poor construction status. Added to this is the overexploitation of the rest of the sanitary buildings, an accumulated result of the lack of means for restoration and maintenance.
Another expression of the loss of professionals are the weaknesses in “hospital management.” In 2022, these were associated with “management, organizational and resource” deficiencies, as Minister Portal said.
The cadres that today replace those who migrate, retire or change jobs, do not reach the necessary preparation. The authorities recognize it. The deficient management and control of resources in deteriorated infrastructures — including delivery rooms and caesarean sections — becomes a catalyst for the appearance of infections acquired within medical centers.
In terms of income, the possibility of retaining human resources is not encouraging. The process of partial dollarization of the economy and inflation have caused the purchasing power of salaries and pensions to plummet, frozen since January 2021. The average monthly salary in Public Health is 4,054 CUP.
Meanwhile, the freely convertible currency (FCC), in which basic necessities and food are sold, is quoted in the informal market at around 200 CUP x 1 FCC.
Due to its multidimensional nature, the reduction of IM in Cuba depends on overcoming the crisis. But this requires reversing the lack of income in foreign currency, recognized by the authorities as the main obstacle in solving the most serious problems: food production, energy crisis and acquisition of resources that guarantee health demands.
However, as the authorities also state, there is nothing to indicate that there will be a change in the country’s financial conditions soon. Consequently, comprehensive development and the recovery of better quality of life standards that contribute to lower IM figures will be difficult to achieve in the short term.
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Note:
1 Risk is defined as the probability of suffering harm, thus, reproductive risk is the probability that a woman or her baby has of suffering harm, injury or death during the reproduction process. The majority of women who belong to a pregnancy risk group are unaware of this, and are unaware of the importance of using different contraceptives, as an important method, to space births. Under ideal conditions, pregnancies should be planned and pregnant women should have medical support 6 months before conception.
