Can Adoption of Cuban Maternity Care Policy Guide the Rural United States to Improve Maternal and Infant Mortality?

• Date: 01 September 2019
• Published date: 01 September 2019
• DOI: http://doi.org/10.1002/wmh3.312

316

doi: 10.1002/wmh3.312

© 2019 Policy Studies Organization

Can Adoption of Cuban Maternity Care Policy Guide the

Rural United States to Improve Maternal and Infant

Mortality?

Debra Pettit Bruns , Lisa Pawloski , and Cecil Robinson

In the rural United States the infant mortality rate (IMR)is 6.5 per 1,000, and in rural states like

Alabama this rate jumps to 9.1. Rural obstetric services are disappearing such that over half of U.S.

rural counties do not have enough obstetric services. In contrast, Cuba’s IMR is 4.3 while spending

half as much as a percent of their gross domestic product than the United States. This raises the

question: how has Cuba achieved this health outcome and what lessons can be learned and applied in

the United States given decreased availability of obstetric services? This paper presents a field case

study of one of Cuba’s national public health policies. Specifically, we explore Cuba’s Hogares Ma-

ternos, or maternity homes. We argue that the Cuban model, which focuses on social determinants of

health, ought to be explored. We discuss how Hogares Maternos may be adopted and adapted within

the rural United States by leveraging existing infrastructure.

KEY WORDS: maternal and infant policy, Cuba, maternal mortality

Background

The United States has experienced a significant rise in maternal mortality. From

1990 to 2013 it has more than doubled from 12 to 28 per 100,000 people. Meanwhile,

over the same time period, developed countries have halved their maternal mortality

rate from 26 to 16 per 100,000 people (World Health Organization [WHO], 2018).

Even with growing rural populations and Medicaid availability, the United

States is experiencing decreased access to obstetric care in many rural areas. In the

years 2004 through 2014, more than half (54 percent)of all U.S. rural counties either

did not have or lost local obstetric services (Hung, Henning‐Smith, Casey, &

Kozhimannil, 2017). In many U.S. states over 65 percent of counties do not provide

obstetric services (Maron, 2017); further, Young and Sundermeyer (2018)have re-

vealed the loss of family physicians providing obstetric services has been a sig-

nificant factor across the United States.

These statistics highlight issues concerning the lack of political policy and

medical priority given to 28 million women of reproductive age living in rural

America. Increasing prenatal and obstetric services by promoting health policy to

support these women and children is of paramount importance. Strong health

policy to improve social support and prioritizing pregnant women can potentially