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

Date01 September 2019
Published date01 September 2019
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
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, Cubas 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 Cubas national public health policies. Specifically, we explore Cubas 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
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, HenningSmith, 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

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