Monday, January 29, 2007

Infant mortality rate in Cuba raises eyebrows

Posted on Sun, Jan. 28, 2007

Infant mortality rate in Cuba raises eyebrows
Cuba is known to have one of the lowest infant mortality rates in the
world, but the issue is how Cuba goes about keeping its death rate among
babies down.

The one health statistic Cuba gives the most publicity to -- and appears
to spend the most resources on -- is its infant mortality rate.

On Jan. 3, the official Communist Party newspaper Gramna boasted the
country had reduced its infant mortality rate in 2006 to 5.3 per 1,000
live births, considerably below the U.S. rate of 6.0, from 2004, and
leading all of Latin America.

Granma noted that infant mortality was ``such an important indicator,
considered internationally a reflection of the state of health of the

Cuba had managed to assemble this complicated statistic just two days
after the year ended, with detailed figures for all major
municipalities. The United States by contrast needs two years to
assemble all the information to make sure its mortality figures are
accurate, says Mary Jones of the National Center for Health Statistics.

Darsi Ferrer, a dissident physician in Havana, doesn't doubt the Granma
report. ''That number is indeed low,'' he told The Miami Herald by
telephone. ''That program takes a large amount of resources'' out of the
system. ``They don't care about 1- to 5-year-olds.''

Keeping infant mortality low can certainly improve a country's overall
life expectancy and at a cost much cheaper than paying for the elderly
to have lengthy intensive care stays in their last weeks of life. But
the issue is how Cuba goes about keeping its death rate among infants down.


Some doctors say they were told to use any means possible to keep the
infant mortality rate low. Jesús Monzón, an obstetrician-gynecologist in
Pinar del Río until he left in 1995, says pregnant mothers were required
to appear monthly for sonograms and other tests to make certain the
fetus was healthy.

''If there was any malformation in the fetus, they would interrupt the
pregnancy,'' said Monzón, now a lab technician at Mercy Hospital in
Miami. A heart murmur or other serious problems required an abortion.
This was ''automatic,'' he said. If the mother objected, a team from the
hospital would persuade her an abortion was necessary.

Other sources also say abortion is a tool used to keep infant mortality
low, including Andy Gomez at the Institute for Cuban and Cuban-American
Studies at the University of Miami, and Carmelo Mesa-Lago, a retired
University of Pittsburgh economics professor who has spent decades
studying Cuba.

Recent Cuba abortion data is not available, but a study by the Pan
American Health Organization from 1998 states Cuba had 70 abortions per
100 deliveries in 1992 and 59.4 in 1996, far higher than the 34 to 38
abortions per 100 live births reported during that time in the United

Néstor Viamonte, a primary-care doctor in Ciego de Aguila until 2003,
says all Cuban doctors are told to focus on babies. Infants under 1 and
those with serious chronic diseases were the only ones who could get in
to see a doctor without waiting days for an appointment.

Mothers were required to bring in their babies monthly for examinations.
Babies who died in the first month were reported to have died before
birth to keep the numbers low, Viamonte said.


Two scholars have written in the Latin American Research Review that
Cuba's infant mortality rate is indeed impressive, but its importance is

James W. McGuire of Wesleyan University and Laura B. Frankel of the
University of Oxford noted that in 1960, the year Castro's reign began
and before he socialized the health system, Cuba's infant mortality rate
was already among the best in Latin America and was better than Italy's
and Spain's. There were disparities in care, but Cuba then ranked third
among 20 nations in doctors per capita, according to McGuire and Frankel.

In the intervening years, Cuba's infant mortality rate improved
immensely, the researchers said, but other countries in Latin America
improved at a faster rate, and Italy and Spain bypassed Cuba.

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