The Cuban Abortion Scheme Debunked (epilogue)

The latest news shows that Brazil, who's infant mortality rate seemed stagnant, has finally seen a reduction. The latest numbers from the Ministy of Health reveal a reduction from 49.7 to 28.91 deaths per 1000 live births, from 1990 to 2002. The health minister, Humberto Costa, is giving the credit to Brazil's Family Health program which he plans to extend to poorer municipalities and ask for more funding. The study also attributes the decrease in infant mortality to increased funding of education programs and access to potable water and sanitation.

On the other hand, the latest report on US health from the United Health Foundation, the American Public Health Association and Partnership for Prevention shows that since 2000 "the rate of improvement in the nation’s health status has essentially stagnated."[graph above] They attribute this stagnation to continued smoking, high infant mortality, an increase in obesity, and increase in uninsured Americans.

Infant mortality in the US is 6.6 per 1000 births. The report's media release points out that "Our rate of 6.6 deaths per 1,000 live births is double that of Japan, Sweden, Finland, Monaco and San Marino. Countries such as the Czech Republic, France, Germany and Spain also have better rates of infant survival."

We can also add Cuba.

[source: America's Health Rankings Online Report]

False Reality at Babalu

Val Prieto said:

More babies born = higher rate of possible infant mortality.
Less babies born = lower rate of possible infant mortality
Thus more babies being aborted = less babies born = lower infant mortality rate.

Given the information that I have presented, this simple logic is insufficient to describe reality. On the other hand, Prieto's remarks reveal the basic argument needed to quickly condemn the Cuban government, regardless of any relevant facts or efforts to find them, and thus support the Cuban Abortion Scheme.

BabaluBlog and its many authors continue their false arguments daily, yet their positions do not withstand scrutiny, of which they quickly take care of with ad hominems. It seems to me that Prieto and friends do not care for facts at all, but instead prefer a false picture of Cuba, an island that must be saved from the evil dragon. Its a fairy tale.

My argument does not suggest that all evidence that appears on BabaluBlog is false, but rather their author's interpretations of Cuba-related facts are disingenuous. As can be seen above.

Prieto calls Cuba's health care "smoke and mirrors." I say the same of Prieto's website.

The Cuban Abortion Scheme Debunked (Part 7)

Women in the US, like women in Latin America and the Caribbean, give similar reasons for having an abortion: economic reasons that would disrupt the care of dependents, to care for a child, or be a single mother. Most likely, these reasons also contribute to Cuba's abortion rate, not a government scheme.

In her Havana study, Stephanie Bernal pointed out that "[a]s a result of the economic crisis that occurred in the early 1990s, the number of abortions increased." She quotes a Cuban doctor, Dr. Urrusuno-Carbajal, saying that, at the time, Cuban women "just did not want to give birth." Yet, overall abortion rates have dropped since the early 90's. Bernal writes that "[t]o discourage abortion as a means of contraception, doctors educate their populations about family planning and contraceptive methods... these educational campaigns seemed to be successful. The abortion rate decreased from 70.0 per 100 deliveries in 1992, to 59.4 in 1996."

Interestingly, an abortion study from Cuba last year provided additonal support to Bernal's observations and pointed out a peculiar phenomenon on the island. Miriam Gran, a biostatistics expert, last year conducted a study of more that 4000 Cuban women titled: "Voluntary termination of pregnancy and contraception: two methods of fertility control."

She found that the Cuban abortion rate has been declining since 1986, when 93,649 abortions were reported, in contrast to 67,277 in 2004. Gran says that "[o]ver decades, the rate has indeed declined, which reflects well on family planning, health education and sex education. It has to be taken into account that whenever the birth rate falls, as has been happening in Cuba, abortions nearly always decline as well." Gran's study found 43% of respondents had used abortion in the past, 52.2% of those who had abortions gave reasons due to abandonment of other birth control methods, 30.1% due to "lack of knowledge," and 7.3% out of preference. The remaining women cited health-related issues and unwanted pregnancies.

These findings are quite unique in a country where abortion is permitted (with legal notification) at request to women. Dr. Leticia Artiles, coordinator of the Cuban Gender and Collective Health Network, believes that "[i]n Cuba, terminating a pregnancy is not charged with negative symbolism, it isn't seen as a crime... [or loaded with] social taboos against single women seeking contraceptive methods."

These findings do not support a scheme by the Cuban government, but rather a complex social preference, over time, for the procedure of abortion, a legitimate reproductive right, as a response to an environment where women's health is crucial in the developing world.

[Part 1] [Part 2] [Part 3] [Part 4] [Part 5] [Part 6] [Epilogue]

The Cuban Abortion Scheme Debunked (Part 6)

A report* produced in 2001 as a collaboration between the World Bank, the Inter-American Development Bank, and the Pan American Health Association addressed the dire need for effective women's health care in Latin America and the Caribbean. One of their conclusions was:

"To improve the health status of women, given tight budget constraints, countries... should focus resources on improving basic reproductive health conditions. The interventions required are relatively low-cost, in general, and yet have major pay-offs in health conditions and human welfare. Providing appropriate family planning methods to women who want to control their fertility, providing early and reliable prenatal and essential obstetric care, fostering good nutrition, and developing specially targeted services for women at high risk for sexually transmitted diseases should all be very high on the public priority list."

According to the sources cited, Cuba has met some of these needs through their Mother and Child Plan, but with a slight edge over the rest of its neighbors in Latin America and the Caribbean: legalized abortion since 1965.

The 2001 World Bank report states that "[i]n most Latin American countries, between one-quarter and one-third of women 18 years old or younger are pregnant or have already had a child... Up to half of the pregnancies in young women are unplanned"(emphasis added). Currently, abortion is illegal or highly restricted in Latin America and the Caribbean, thus many women seek clandestine abortion. A 1996 study found that "[e]stimated rates of [clandestine] abortion are highest in Peru and Chile (each year, almost one woman in every 20, aged 15-49 has an induced abortion), intermediate in Brazil, Colombia and the Dominican Republic (about one woman in 30), and lowest in Mexico (approximately one in 40)." The World Bank believes "an estimated one-fifth of maternal deaths are attributed to [clandestine] abortion-related conditions, and an estimated 40 percent... experience serious complications."

In 1990, a study in Bolivia, Colombia, Peru and Venezuela, "found that the vast majority of hospitalized [clandestine] abortion patients [due to complications]...half (51%) had two or more children." Several other studies have shown that "the majority of... patients appear to be married women who already have all the children they feel able to care for. The difficult social and economic conditions facing many millions of families in Latin America's poor rural areas and vast city slums spur the desire of couples to have fewer children."

These desires, with the help of other available contraception, have expressed themselves in the overall decrease of fertility rates in Latin America and the Caribbean over the years, yet it is mainly in the urban sectors, leaving the rural poor with higher fertility rates and higher maternal mortality rates.

According to the Alan Guttmacher Institute, "[t]he developing areas of the world, where 79% of the world's people live, account for 64% of legal and 95% of illegal abortions..."


*The World Bank, Inter-American Development Bank, and Pan American Health Association. (2001). The Health of Women in Latin America and the Caribbean. Washington DC: The World Bank.

[Part 7]

The Cuban Abortion Scheme Debunked (Part 5)

It is well known that Cuba offers such universal services, but in 1995 and subsequent years, Cuba made increased efforts to address the health of newborns and mothers. Cuba's "Programa de Atención Materno Infantil" (The Mother and Child Plan) is considered by the online publication MEDICC Review (Medical Education Cooperation with Cuba) as perhaps "one of the most important [national programs] within the Cuban health system". An observational study in Havana (Cerro district) conducted in 2000 by Stephanie Bernal from California State University at San Bernardino, highlighted the many dimensions of the Mother and Child Plan. She writes that "[t]his program places a special emphasis on the needs of pregnant women, newborns, and children. Bernal argues that "[b]etter data collection methods and research" and increased services have led the way in improved health statistics for newborns and mothers. "The average number of prenatal visits per woman increased from 17.2 in 1992, to 23.6 in 1996", says Bernal citing numbers from PAHO, and that "[p]renatal screenings are free of charge and include glycemia, urine, vaginal, and ultrasound tests."

In 2005, Jelka Zupan from the World Health Organization (WHO) wrote that "[t]he barriers to appropriate maternity care are not insurmountable. The cost, for example, is moderate, and some poor countries have proved that it is affordable." Cuba's Mother and Child Plan is one example of how Cuban health care has met the appropriate needs of maternity care. In a case of unintended irony, the WHO World Health Report of that year stated that improvements to children's health in the developing world "requires a cultural revolution among health workers to start working with households and communities as partners, and to look at children as children, and not merely as a collection of diseases."

[Part 6]

The Cuban Abortion Scheme Debunked (Part 4)

The numbers indicate a complexity of diseases that infants, in the developing world, face in their first months, or even first weeks of life. There is little debate as to what is the best approach in order to reduce infant mortality rates: a broad plan for effective maternal health services. According to the Fetal and Infant Mortality Review (a collaborative effort between the American College of Obstetricians and Gynecologists, the Maternal and Child Health Bureau and the Health Resources and Services Administration), "[i]nfant mortality is associated with a variety of factors including quality of and access to pregnancy and pediatric health care, socioeconomic conditions, family stressors, the strength of high risk safety nets, the quality of community resources and the cultural competence of local service systems."

Yet, in two studies in 2005, it was found that the most important factor to improve infant mortality rates was the availability of effective and accessible health care for mothers. One study published in the New England Journal of Medicine that initiated an intervention in Pakistan concluded that "[t]raining traditional birth attendants and integrating them into an improved healthcare system were achievable and effective in reducing perinatal mortality." In that same year, a study in the Lancet comparing improved neonatal mortality rates in Brazil from 1982 to 2004, found that "[m]ajor changes in health systems happened in these two decades, of which the most important was the creation of the Sistema Único de Saúde (Unified Health System)... ensuring free health care for every citizen. The expansion in health care in [the city of] Pelotas led to more than 98% of pregnant women receiving some antenatal care..."

[Part 5]

The Cuban Abortion Scheme Debunked (Part 3)

According to the most recent report from the Pan American Health Organization (PAHO) titled "The ten leading causes of death in countries of the Americas," they confirm that "[a]s might be expected in the less than one year age group [infant category], the leading cause of death in 30 of 31 countries was certain conditions originating in the perinatal period [five months before and one month after birth period]. This was followed by congenital malformations, deformations and chromosomal abnormalities which ranked second..." These second-ranked malformations eventually take their toll in the few following years where "[c]ongenital malformations were highly ranked in 25 countries and the leading cause in both (one to four year old) male and female deaths in Argentina, Costa Rica, Cuba, Mexico, Puerto Rico, Trinidad and Tobago, and Uruguay."

According to a 2000 longitudinal study from the Journal of Epidemiology and Community Health, "in Latin America the proportion of infant deaths attributable to congenital anomalies increased from 2-6 per cent in the 1950s to 12-25 per cent in the early 1990s", and that "[i]n absolute terms... infant mortality attributable to congenital anomalies caused more infant deaths in poorer countries than in wealthier countries." In Cuba, according to PAHO, "63% of [infant] deaths occurred in the neonatal period [first month]. Perinatal disorders, birth defects, sepsis, influenza, pneumonia and accidents accounted for more than 80% of all deaths in this [one year] age group."

It is within this context that we should receive the news about "automatic" abortions following prenatal diagnosis of congenital malformations and if "[a] heart murmur or other serious problems required an abortion", or any other claims made by Dorschner and his single source: Jesús Monzón. Monzón, Dorschner's only source from Cuba who makes the direct accusation of the abortion scheme, was an obstetrician-gynecologist in Pinar del Río before he left in 1995. Dorschner interviews another exiled Cuban doctor, but he is not quoted making the same accusation.

A 2004 study in the journal of Prenatal Diagnosis concluded that "[d]epending on the gestational age and legal situation the counselor is operating in, termination of pregnancy may be one of the options to consider and one that should ALWAYS be raised in discussion" (emphasis added) when dealing with fetal congenital heart disease. In 1998, according to PAHO, the leading cause of infant deaths in the US was due to congenital anomalies.

[Part 4]

The Cuban Abortion Scheme Debunked (Part 2)

After having read numerous health related articles, it seems that these accusations are fraudulent and only support the assumption that many Cuban Americans have an apparent bias towards the Cuban government (which might be justified in some cases) and thus are willing to sacrifice important facts for an immediate and selfish condemnation.

The false argument basically accuses the Cuban government of a deliberate abortion scheme to keep infant mortality rates low. The facts point to the contrary and reveal a complex picture of Cuban society, which undoubtedly is unique among the rest of Latin America and the Caribbean. My argument will focus on directly debunking the myth of the Cuban abortion scheme, and replacing the argument with a more appropriate discussion about women's reproductive health in Latin America and the Caribbean. I hope to provide a more reasonable answer to why Cuban women are getting more abortions and why the infant mortality rate is low.

In plain simple terms, Cuban women have easy access to and see little taboos about abortion, and furthermore, Cuban healthcare provides effective primary care to women, especially prenatal care in comparison to the rest of Latin America and the Caribbean. These two factors, in my opinion, are significant in explaining why the abortion rates are high, fertility rates are low and the infant mortality rate is low, and why Cuba continues to stand out in the health sector among the rest of its neighbors in the Western Hemisphere.

[Part 3]

The Cuban Abortion Scheme Debunked (Part 1)

On January 28, 2007, John Dorschner, health reporter for the Miami Herald, wrote four articles about health care in Cuba and the US. Only one of those articles got immediate attention from some fellow bloggers, especially those who are always looking to condemn the Cuban government and quickly smash any realities that come from that island of controversy. Without question, there are many actions to condemn the Cuban government for, and with good reason, but this time the reaction was based on pure ignorance and apparent bias that is found in some hard-liners writing in the Blogosphere.

The article in question is Dorschner's piece titled "Infant mortality rate in Cuba raises eyebrows", which tries to cast doubt on Cuba's infant mortality statistic. Dorschner writes that "[s]ome doctors say they were told to use any means possible to keep the infant mortality rate low." Dorschner relies on two former Cuban doctors, who are now living in the US, and two academic professors (Cuban studies experts) to support the claim that "abortion is a tool used to keep infant mortality low".

This story in the Blogosphere was met with proud confirmation that "Cuba's much touted free healthcare system is starting to be exposed as the propaganda myth that it is," and also that it "reveals another horror about the Cuban revolution: The forced killing of unborn children in order to hold down the regime's infant mortality rate." Obviously, according to these bloggers, the purpose of this evil scheme is so "the regime and its international apologists can confidently use the infant mortality statistics to counter concerns about Castro's otherwise nasty and oppressive record."

[Part 2]