Complications of childbearing and childbirth ..
Maternal mortality ratio (per 100,000 live births; 1990):
In pre-revolutionary Cuba, abortion laws were modelled after the 1870 Penal Code of Spain and were very restrictive. Some restrictions were removed in 1936 with the introduction of the new penal code, named the Social Defense Code, which permitted abortion when necessary to save the life of a pregnant woman or prevent serious injury to her health; in cases of rape, abduction not followed by marriage or statutory rape; or in order to prevent the transmission to the foetus of a serious hereditary or contagious disease. Authorization by two physicians was reportedly required for abortions performed in cases of risk to health. However, abortion was easily available in private clinics at a reasonable cost.
In the early years after the revolution (1959-1964), enforcement of abortion laws was somewhat stricter. Stricter enforcement
, combined with the emigration of a substantial proportion of the physicians from Cuba, contributed to an increase in the number of abortions performed by unqualified personnel. The resulting rise in maternal mortality led the Cuban Government to adopt the World Health Organization definition of health as “a state of complete physical
, mental and social well-being and not merely the absence of disease or infirmity”, which permitted a more liberal interpretation of the abortion law and led to the institutionalization of induced abortion by the national health system. Thus, since 1965, abortion has been available on request up to the tenth week of gestation through the national health system.
The new Penal Code adopted in 1979 to replace the Social Defense Code defines the conditions under which abortion would be considered illegal and establishes punishments for those performing an illegal abortion. An abortion is considered “illegal” if performed in disregard of health regulations established for the performance of abortion, and the person performing such an abortion is subject to imprisonment for a period of three months to one year. If the abortion is performed for profit or outside of official institutions or not performed by a physician
, the possible punishment is increased to imprisonment for two to five years. An abortion is also considered “illegal” when performed without the consent of the pregnant woman. A person who performs such an abortion is subject to two to five years’ imprisonment, if the abortion is performed without force or violence
, and to three to eight years’ imprisonment if force or violence is employed.
If gestation is 5 weeks or less, menstrual regulation is employed. Women require no confirmation of pregnancy and minors do not require parental consent for menstrual regulation to be performed. For abortions
, gestation of 10-12 weeks requires confirmation of pregnancy. The pregnant woman must be examined by a gynaecologist and must receive counselling from a social worker. Women under 18 years of age must have parental consent. Women under 16 require authorization by a medical committee. For an abortion performed in the second trimester, in addition to meeting the conditions for abortion in the first trimester
, the case must be authorized by a committee of obstetricians, psychologists and social workers.
Between 1968 and 1974, the rate of legal abortion quadrupled
, increasing from 16.7 to 69.5 legal abortions performed per 1,000 women of reproductive age. Since then, abortion rates have fluctuated between 47 and 62 abortions per 1,000 women. Although an increase in contraceptive use in Cuba has reduced abortion rates in the past 15 years, levels remain fairly high.
Contraception is widely available in Cuba in all government health centres and through one private agency
, Sociedad Científica Cubana para el Desarrollo de la Familia (SOCUDEF), which receives the full support of the Government. It is estimated that approximately 70 per cent of Cuban women of reproductive age are currently using a contraceptive method. However, supplies of some contraceptives are still insufficient and contraceptive choice is limited.