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

Abstract

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 Maternos, 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.

Understanding maternity waiting home uptake and scale-up within low-income and middle-income countries: a programme theory from a realist review and synthesis

“…To champion implementation of the MWH-facility birth intervention, government stakeholders needed to believe in the intervention’s potential to contribute to achieving health promotion priorities and commitments to reducing MNMM. This belief was fostered by evidence of the interventions’ success within a setting in the country or from another country 20 21 26 27 30 33 41 80 84 85 101 117 120 121 127 151. Government stakeholders were more likely to support implementation if they had confidence in the intervention’s feasibility.…”

“…These stakeholders’ commitment was fostered by the availability of resources and technical expertise to implement the intervention within relevant ministries, departments and agencies (MDAs), or through external donor support. Champions were likely to contribute to the mobilisation of resources for MWH implementation (online supplemental appendix E provides examples of resources) 41 120 121. Belief in the intervention, especially where it produced local impact, appeared to motivate policymakers to embed the MWH-facility birth intervention into existing health policies and strategies, which in turn, facilitated the integration of the intervention within the healthcare system 20 26 27 30 51 80 84 85 101 151…”

“…Included studies involved qualitative, quantitative or mixed-methods design (see online supplemental appendix C). Sixty-six sources involved one or more countries in Africa (62.3%),9–15 23 25 28–32 34 36 37 39 42–47 49 77–119 25 involved 1 or more countries in South America (23.6%)8 18 19 21 22 24 26 33 35 40 41 48 50 51 81 120–129 and 7 involved one or more countries from Asia (6.6%) 38 130–135. Eight sources involved multiple continents (7.5%) 16 17 20 136–140…”

Reducing Infant and Under-5 Mortality Rate Through Government Health Expenditure: a Systematic Review

“…Several recommendations have been proposed to address problems regarding infant and child mortality. These recommendations may vary, for examples, from government health programs in Indonesia (Hyre et al, 2019;Pedrana et al, 2019), or policies in India (Chaudhary, Rohilla, Kumar and Kumar, 2017;Gupta et al, 2017) and Cuba (Bruns, Pawloski, and Robinson, 2019), or increasing health services and capacity (Russo et al, 2019;Walker et al, 2020), or conducting activities or programs that involve the community in certain areas (Houweling et al, 2019;Nyqvist et al, 2019;Pulkki-Brännström et al, 2020).…”