Cuba’s maternity homes were founded in 1962 as part of the general movement to extend health services to the whole population in the context of the post-1959 social transformations. The overarching goal of the homes was to improve the health of pregnant women, mothers and newborns. Hence, in the beginning when there were few hospitals in Cuba’s rural areas, their initial purpose was to increase institutional births by providing pregnant women a homelike environment closer to hospitals. There, they lived during the final weeks before delivery, where they received medical care, room and board free of charge. Over time, and with expanded access to community and hospital health facilities across Cuba, the numbers, activities, modalities and criteria for admission also changed. In particular, in addition to geographical considerations, expectant mothers with defined risk factors were prioritized. For example, during the 1990s economic crisis, the maternity homes’ role in healthy nutrition became paramount. The purpose of this essay is to provide a historical perspective of this process, describe the changes and results during the 55 years examined, and take a critical look at the challenges to successful implementation of this model, a mainstay at the primary healthcare level of the public health system’s Maternal–Child Health Program.
KEYWORDS Maternal health, maternal–child health, obstetrics, pregnancy, Cuba
Those of us who worked in Cuba’s countryside—even for a short time—still carry “rural doctor” as a badge of honor and pride.
A little more than 50 years ago, in 1960, I was one of the founders of Cuba’s Rural Medical Service (RMS). It was the first of several public health programs implemented under the new revolutionary government and grew out of an initiative by our class of medical graduates, voting overwhelmingly to devote a period after graduation to serving in the island’s rural and remote regions. There had never been anything like the RMS in those forgotten lands: free services for everyone, close-at-hand, and offered by qualified physicians who provided both preventive and curative care at any time of day or night, also dispensing free medications.
Cuba is a small country with one of the highest physician-percapita ratios in the world (1:155 in 2007). Since the 1980s, all new MDs are required to complete a family medicine residency, and many go on to pursue a second medical specialty or an advanced degree in public health, medical education or medical sciences. The numbers of other university-level health professionals are impressive. Cuba is also home to globally-respected biotechnology and medical research institutions, such as the Finlay Institute and the Pedro Kourí Institute of Tropical Medicine.
Yet, the number and frequency of articles by Cuban authors published in national and international journals does not reflect the breadth and depth of Cuban medical research and practice. The most frequently cited articles in international journals of impact are in the fields of genetics, neurosciences, immunology, pharmacology and oncology, and almost 80% of these are co-authored by non-Cubans. While it is certain that many of these articles reflect public health applications, you will find scant citations of articles on other important topics at the forefront of Cuban public health—such as primary health care, infectious disease control, human resource development, sexual and reproductive health, and social determinants of health and wellness.
