Cuba’s infant mortality rate at its lowest level ever

Cuba’s infant mortality rate (IMR) for 2014 was 4.2, unchanged from the previous year and again the lowest in Cuban history. The IMR reflects the number of babies dying during their first year for each set of 1,000 births.

The IMR tells about babies, but is a measure too of the wellbeing of everybody in a society. It’s “the most sensitive indicator of overall societal health,” says the U.S. Centers for Disease Control and Prevention. A low IMR “is associated with a variety of factors such as maternal health, quality and access to medical care, socioeconomic conditions, and public health practices,” says another U.S. public health authority.

An infant’s chances for survival are much improved if  its mother enjoys competent, readily available prenatal health care; possesses personal confidence through education and integration within the larger society; has eaten well during her pregnancy; has not smoked, and, if need be, has access – and her baby too –  to intensive hospital-based care.

In announcing the data on Jan. 4, Roberto Álvarez, head of the Program for Maternal Infant Health in Cuba’s health ministry, pointed to steps taken to reduce premature births as crucial for Cuba having been able to reduce infant deaths. Cuba still makes use of maternity homes for providing expectant mothers with nutritional support, education, and early identification of potential health risks to mothers and babies. The homes were introduced during the 1990s as one way to protect mothers from rampant shortages in Cuba after the Soviet Bloc disappeared.

Álvarez also noted remarkable uniformity of IMR’s among particular regions and municipalities, thus suggesting equitable distribution of health and social services throughout the island. In the United States, by contrast, infant mortality rates vary markedly according to geographical regions, income levels, and racial identity. Mississippi’s IMR of 9.6, for example, was the nation’s highest in 2011; Alaska’s 3.8 figure was the lowest. Mississippi’s Blacks make up 55 percent of the population there; there are very few in Alaska.

The IMR for African-American babies in the United States overall was 11.5 in 2011; that for all U.S. babies was 6.1, which internationally ranks 55 points down from the most favorable IMR. (Cuba is in 38th place). Presumably variations in living conditions and availability of services in the United States contribute to its relatively high IMR.

Indeed, researchers taking socioeconomic status into account found that “children of poor minority women in the U.S. were much more likely to die within their first year than children born to similar mothers in other countries.” The implication is that in those other countries, Cuba among them, support mechanisms are available that save babies’ lives. Yet those countries are not alike. Most of them, mainly in Europe, have applied plentiful economic resources – which Cuba lacks – to democratic socialist imperatives; that is to say, the welfare state.

The difference is that of a socialist revolution. And the one in Cuba sticks to its job description. Reshaping health care for the good of all was part of that.

As 3,000 physicians left for abroad during its first two years, the new government looked to the future and made sure that teachers among the 3,000 remaining physicians became the island’s highest paid employees. Cuba’s IMR, over 50 during the 1950s, began descending to the 30s within a decade and thence down to its present low level.

By 1985 Cuba was a specialty referral center for Latin America and socialist countries. Health care officials were refurbishing primary care to establish the current family doctor system, notable for accessibility, emphasis on prevention, and community immersion. In doing so, they abandoned big changes two decades earlier that weren’t working. Cuba advanced from one medical school to 24, teaching medical students from dozens of other countries, and sending doctors throughout the world.

A personal note: At the beginning of each year, the present writer, a former child health worker, has eagerly gone to Cuban news sources to learn about Cuba’s IMR for the previous year. It’s always a news story and always at hand. But to find out comparable U.S. data takes work. The government’s own source, the Centers for Disease Control and Prevention, provides IMR figures on its website that at best are two to three years old. One teases them out from complicated listings and graphs. So speculation arises that if news tends toward embarrassment, handlers might prefer, even unthinkingly, to let it lie. In Cuba the IMR is a matter of pride, is broadcast widely, and with good reason.

Photo: Danny Lawson/AP