The challenges facing Cuba, a society in transition as it implements economic reforms introduced in 2011, are myriad and complex. Some issues, though, like the rapidly aging population, are so pressing they’re classified as national security threats.
While the life expectancy in Cuba is an enviable 78 years – on par with or surpassing most developed countries – the greying of Cuba has been classified by President Raúl Castro as “one of the greatest challenges facing the nation because of its impact on social, economic and family life.”
It’s not just the aging population however, which is adversely affecting Cuban society: emigration of young people in the prime of their economic productivity and declining birth rates are aggravating a problem with few easy (or economical) solutions.
Getting notoriously libidinous Cubans to have more babies is among the major initiatives designed to kick start the birth replacement rate. The fertility rate (children per woman) is 1.7 and the crude reproductive rate, meanwhile, (daughters born per woman) is just .84. If these numbers hold, it’s predicted that deaths will outpace births within 15 years.
“My fiancé and I dream of having three kids – but not until the economy improves,” says 28-year-old Douglas Rudd, from Havana. “I don’t want to struggle to provide for my children like my parents did during the Special Period.”
A shortage of services
Economic considerations are among the top reasons Cubans cite for putting off procreation, along with overcrowding: Cuba currently has an estimated shortage of 500,000 housing units.
While there are no magic bullets for such complex problems, the Ministry of Public Health launched the National Program for Infertile Couples in 2010 in an effort to boost the birth rate. To this end, dozens of fertility services have opened across the country, an initiative which will eventually extend to each of the island’s 168 municipalities. These services include consultations – both clinical and psychological – and diagnostic testing.
More complex assisted reproductive technologies are provided at advanced reproductive centers, of which there are only three in the country — far fewer than what’s needed to satisfy demand. The shortage of centers essentially acts as a geographical barrier to care.
“We have an avalanche of patients for these services. People come from all over the country to our clinic in Havana; sometimes they have to wait months between appointments” stated a biologist in the study Perception of Infertility Services: An Anthropological Perspective, published in 2013.
Between 2010 and 2013, more than 20,000 couples were treated for infertility; to date, there have been 500 artificial insemination births in Cuba.
“If we promoted these services, our patient load would double; as it is we can’t keep up,” added the biologist cited in the study. According to official estimates, some 20 percent of couples of childbearing age are infertile.
The national program also offers a year’s maternity or paternity leave with pay and is preparing to roll out financial incentives to encourage couples to procreate. Additional services slated to be implemented in 2015 include sperm and egg-donor banks, requiring costly and complex protocols, training and equipment. These policies are complemented by the integrated, comprehensive services provided by the National Program for Maternal and Child Health; as with all levels and programs in Cuba’s universal health system, these services are free of charge to patients.
Same-sex couples left out
To be eligible for assisted reproductive services, couples must have been trying to conceive for at least a year or have experienced multiple miscarriages – disqualifying same-sex couples.
“Two fundamental requirements for good parenting are responsibility and love. Gay couples – just like heterosexual couples – can provide both; there are no biological or psychological reasons why not,” says Cuban psychologist and sexual diversity specialist Ariel Arcaute, whose research focuses on homo-maternity and -paternity.
But same-sex parenthood isn’t recognized legally or socially on the island, he points out.
“We’ve built a humanist revolution in Cuba, but we’re lagging behind other countries in the region like Ecuador, Brazil and Argentina which recognize reproductive rights, regardless of sexual orientation.”
Expanding the scope and reach of the national program to encompass reproduction, as well as infertility, is a practical next step for addressing Cuba’s negative population growth. Similarly, extending existing services to all municipalities, training the necessary specialists, and providing support for all couples who wish to have children bodes well for the island’s future.