By Valerie Reynoso
Cuba is an island in the Caribbean governed by a socialist state that has made strides in numerous aspects, including but not limited to socioeconomic equality, redistribution of wealth to the masses, advocacy for the end of apartheid in South Africa, and the end of the colonial rule in Angola during the 1960s. Cuba has served as an inspiration for the overthrow of fascist dictators in other Latin American nations such as Rafael Leonidas Trujillo in the neighboring Dominican Republic, along with an outstanding healthcare system that has even drawn attention from organizations such as the UN and UNICEF.
The United States, on the other hand, is a hegemonic Western nation with a capitalist-imperialist government that is rendered as the most superior in the world. The US is defined by the existence and persistence of systemic inequities, deepening class stratification, high rates of mass incarceration, homelessness, and poverty; as well as unique socioeconomic consequences faced by women, largely due to reproductive healthcare services not being universalized and not always covered by health insurance.
In comparison, Cuba outperforms the US in areas of women's reproductive rights and abortion access, given its complete legalization of abortion and other healthcare services to women for free. The US is unable and seemingly unwilling to meet the standards of Cuba, given primarily the Hyde Amendment and overall privatization ("profitization") of medical industries.
Cuba and Women's Health
The Cuban Revolution of 1959 brought radical change to the island in the form of new socialist socioeconomic and political structures, as well as a shift in the role of women in society and women's reproductive rights, distinct to pre-1959 Cuba. Cuban leader Fidel Castro believed that the liberation of women was vital to the socialist revolution. This idea stood in stark contrast to pre-revolutionary Cuba, which more closely resembled that of the United States, with regressive policies in terms of women's rights and reproductive care under General Fulgencio Batista. Prior to the rise of the Castro, abortion laws in Cuba were based on the 1870 Penal Code of Spain and had many restrictions, some of which were loosened in 1936 with the entry of the new Social Defense Code. This new penal code legalized abortion in the cases of endangerment of the life of the mother due to pregnancy, any form of rape, or serious medical complication of the fetus that would require the termination of pregnancy. During this time, Cubans who sought abortions due to health risks caused by pregnancy had to be granted permission from two physicians to get the procedure done.
Following the birth of the Cuban Revolution, Cuba became one of the first countries in the world to legalize abortion with full access in 1965, up to the tenth week of gestation, through their national health system. The Social Defense Code was replaced once again in 1979 with the adoption of a new penal code, which explicated what constituted as illegal abortion as well as punishments for those who conducted them. Illegal abortions were defined as those done under conditions that neglect health laws regarding abortion. Likewise, those caught in violation of said legal abortion regulations would potentially face three months to a year in prison. Abortions performed for profit, outside of accredited institutions, or by anyone other than a legitimate physician would result in culprits being subject to two to five years in prison. Abortions are also considered illegal in Cuba if executed without the consent of the pregnant patient and would result in two to five years of prison time for the executer of the procedure. If the non-consensual abortion is performed with force or violence, then the prison sentence is increased to up to eight years.
Likewise, menstrual regulation is implemented in the case that gestation is five weeks or less; women do not need to confirm their pregnancy, nor do minors need parental consent to receive menstrual regulation. Gestations of ten to twelve weeks would require confirmation of pregnancy to obtain an abortion and, along with that, the pregnant woman must be examined by a gynecologist as well as be given counseling from a social worker. For those who seek abortions services, parental consent is needed for women under eighteen, and permission from a medical committee is required for women under 16. A committee of obstetricians, psychologists, and social workers would have to approve a second trimester abortion in addition to the patient satisfying the regulations for a first trimester abortion. Moreover, in 1960, the Castro administration formed the Federation of Cuban Women (FMC), which was led by Vilma Espin, a revolutionary who resisted against the Batista regime and was also the partner of Raul Castro, Fidel Castro's brother. FMC has played a vital role in the advancement of gender equality and the enhancement of women's healthcare in Cuba.
The FMC has a membership that includes 85.2 percent of all eligible Cuban women and girls over 14 years of age. It is recognized as an NGO and as a national system for women, due to the overwhelming majority of Cuban women being participants, because the organization is not socioeconomically funded by the Cuban government, and because the federation has a hierarchy consisting of local, municipal, provincial, and national levels of representation and leadership. Along with endorsing the mass education of women, inclusion of women in the work force, and advocacy for legislative and social reform for gender equality, the FMC has also had a significant impact on the Cuban healthcare system and its regulations. One instance of the influence of the FMC on the Cuban healthcare regulations is their assistance in passing maternity leave laws in 1974, under which pregnant women are granted three months of paid leave. The FMC also played a role in the foundation of maternity homes for women to deliver their infants under the maintenance of primarily FMC volunteers who serve as trained attendants.
The FMC has proven to be successful in the mobilization and formation of solidarity amongst Cuban women, united under a common motivation to fight for women's rights to higher education, paid maternity leave, childcare provision, and free abortions and birth control.
The United States and Women's Health
In the US, the landmark Supreme Court case Roe v Wade was a victory for women's reproductive rights. However, the battle against women's rights are ongoing, with various conservative and right-wing interests, typically headed by men, continuing to mount a powerful opposition. Measures taken to diminish the impact of Roe v. Wade and strengthen anti-woman legislation like the Hyde Amendment have significantly changed abortion accessibility and affordability for women in the US.
Abortions were legal and frequently performed from the 18th century until approximately 1880 in the US. The idea that the fetus at conception and the early stages of pregnancy was a human life was not a conventional one held in US societies, nor the Catholic Church, for some time. The typical stance on this subject at the time was that it was centered on women's experiences and relations with their own bodies, rather than societal stances on what is considered immoral for women to do regarding abortion. The Catholic Church accepted early abortions before ensoulment; however, around 1869, began to denounce abortion, simultaneously when abortion became politicized in the US. In 1895, the church opposed therapeutic abortions, which were meant to save a woman's life. Abortions were outlawed in the US by 1880 due to pressure from medical groups, with the exception of cases involving medical complications that could endanger the woman's life.
Women in the US continued to seek abortions despite these newfound laws and those who could afford options often received services from practitioners in private homes. Those who could not afford private services were left with no other choice but to resort to near-lethal means out of desperation. Rates of women who obtained illegal abortions naturally increased with restrictions barring access to legal procedures. Between 200,000 and 1.2 million illegal abortions were conducted per year in the US in the 1950s and 1960s. Underground organizations that provided safe, illegal abortions were formed in the 1960s by individuals concerned about the well-being of the high number of women who dangerously sought to terminate their pregnancies. These organizations included the Clergy Consultation Service on Abortion and The Abortion Counseling Center of the Chicago Women's Liberation Union, also known as Jane. The Rubella outbreak in the US, which lasted from 1964 to 1965, endangered fetuses and hence was a major factor in a rehashing of the abortion debate in the country. This outbreak and the ongoing debate led to the passage of Roe v Wade in 1973.
Roe v Wade was decided on January 22nd, 1973 and ruled that state-sanctioned restrictions of abortion are unconstitutional. It was concluded that the criminalization of abortion under Texas statutes (for the most part) infringes upon the constitutional right to privacy women have under the due process clause of the fourteenth amendment. Numerous abortion rights activists wanted the case to be passed under the ninth amendment, so that it could be written in the constitution rather than malleable and subject to change. Although this case made legal abortion more available and safe for women in the US, barriers were still placed on them, including measures that were taken to restrict the effectiveness of Roe v Wade and socioeconomic disparities that made it more difficult for underclass women to receive services. Following Roe v Wade, several US states have enacted over 1,074 laws with the purpose of limiting access to abortion, with over a quarter of these legislations having been legalized between 2010 and 2015.
Part of the anti-woman crusade that was sparked by Roe v. Wade was the Hyde Amendment, which was passed in 1977 to prohibit the use of Medicaid to pay for abortions, excluding cases of rape, incest, or endangerment of the life of the mother. According to a study done in 1984 at the Guttmacher Institute, 44 percent of female Medicaid recipients who had abortions that year paid for them by using money they had initially saved for necessities, such as rent and food. Due to said women not being able to afford the costly prices of abortions, many were forced to save for a longer period of time for the procedure, which resulted in later, riskier, and more expensive abortions, or women being forced to carry unwanted pregnancies to term due to an inability to afford an abortion. This statistic increased to 57 percent of abortion patients paying out of pocket by 2010. The Hyde Amendment resulted in Medicaid-funded abortions decreasing from 300,000 per year to only a few thousand per year. As of 2010, seventeen states finance abortion care for citizens with Medicaid coverage, and 20% of abortions conducted in the US were funded with Medicaid in 2008. Additional barriers are posed to women in need of abortions per individual state. For instance, as of 2008, fifteen of the seventeen states that fund abortion care for its people have also established obstacles such as low reimbursement rates and delays in enrollment, which make it more difficult for women and providers to use Medicaid for abortion services.
Comparing Cuba and the United States
The changes Cuba experienced in its transition from the Batista regime to the Castro administration, as well as the changes in abortion legislation the US experienced from the 18th and 19th centuries to the late 20th century, demonstrates that Cuba was making drastic improvements in the conditions of Cuban women. While the Cuban government made tremendous strides in forging women's rights, the accessibility of abortion declined for women in the US during the same period.
The radicalization of the Cuban government implemented by Fidel Castro set the foundation for the drastic modification of women's rights that would occur in the island throughout the latter half of the 20th century and 21st century. The FMC led by Vilma Espin was crucial to the development of universalized healthcare and inclusions of free abortions and other reproductive health services that overwhelmingly affect Cuban women. Contrarily, the Hyde Amendment, malleability of the Roe v Wade case, and constant pressure from a male-driven, conservative crusade have proven that the profits of US medical industries and artificial morals of fundamental Christianity are paramount to the reproductive rights of women in the US, especially given how expensive abortions are and that Medicaid cannot be used to pay for it in a majority of cases.
The capitalism system which dominates American life is a system driven by infinite profit extracted from the finite resources of the planet and exploitation of the labor of the working class. This exploitation is deepened when members of this working class are part of other marginalized groups as well, such as women, non-white people, and disabled people; all of which make up the overwhelming number of patients struggling to obtain legal abortions in the US. Many of these women have the misfortune of resorting to dangerous alternatives out of need. In comparison, the socialist system Cuba operates under has clearly succeeded in ensuring that Cubans of any racial or socioeconomic background have access to high quality, universalized healthcare and abortions without barriers of any kind.
Statistics prove that in terms of abortion access and reproductive healthcare, Cuba has a model that is more superior than that of the US. Chapter IV of the Cuban constitution contains articles that explicitly enforce the socioeconomic and political equality of all genders, as well as state-funding of financial support for pregnant women. Article 44 states that all genders enjoy equal rights in all aspects of society; women are guaranteed equal opportunities to men and will have an equal impact on the advancement of the island; and the state also manages institutions like child centers, boarding schools, and homes for the elderly with the purpose of helping working families. Article 40 dictates that the Cuban state provide working women with paid maternity leave before and after childbirth, as well as job options that would be suitable for pregnant people and mothers.
As of 2014, Cuba has a total expenditure on health per capita of $2,475 ; and a total expenditure on health as percent of GDP of 11.1 percent for a population of 11,147,407 as of July 2017. The Cuban government has no intervention concerning fertility level, allows abortions on request for any reason, and provides direct support on contraceptives for its citizens. As of 1987, 70 percent of married Cuban women between the ages 15 and 49 use modern contraception, which is available in all government health institutions and through one agency called the Sociedad Cientifica Cubana para el Desarrollo de la Familia (SOCUDEF) that receives full support from the government. Under these measures taken by the Cuban government, in accordance with the country's constitution, the amount of legal abortions quadrupled from 1968 to 1974 with a percent increase from 16.7 to 69.5 legal abortions per 1,000 fertile women. 85,445 abortions were conducted among women between the ages 12 and 49 in 2016, which totals to 41.9 abortions per 100 pregnant women, which is half of the figures from 12 years prior to that. Even more so, contraceptive use has caused a decline in abortion rates in Cuba over the past 15 years.
In contrast, despite the increase in healthcare spending and decline in legal abortion rates in the US, the spike in illegal abortions and barriers posed by the Hyde Amendment indicate that US women still do not have full access to reproductive healthcare. The total expenditure of health in the US rose by 4.3 percent in 2016, at a ratio of $10,348 per person, and made up 17.9 percent of the national GDP. In addition to this, the national abortion rate decreased by 2 percent between 2013 and 2014, where there was a rate of 12.1 abortions for every 1,000 women aged 15 to 44, or 186 abortions per 1,000 live births. Frequent Google searches for self-induced abortions in US regions with low access to health institutions imply a spike in the obtainment of illegal abortions, although an exact statistic for this is difficult to determine given that illegal procedures are not easy to keep track of. In 2015, the Guttmacher Institute found that there were 119,000 searches on how to have a miscarriage as well as other phrases of a similar nature, such as how to self-abort, etc. In total, there were over 700,000 Google searches that year on how to conduct a "self-induced abortion." There were also 3.4 million searches for abortion clinics, 160,000 for how to find abortion pills through unverified sources, tens of thousands on herbal remedies for abortions, 4,000 on instructions for coat hanger abortions and a few hundred on abortion methods through bleaching the uterus. It was found that a disproportionately large number of these Google searches were in the state of Mississippi, which only had one abortion clinic in 2016. For perspective, the Guttmacher Institute reported that there are approximately one million legal abortions per year in the US. Based on this research, a correlation between economic insecurity and abortion seems clear. Online searches related to "self-conducted abortions" surged towards the end of 2008, during the financial crisis and great recession at the time. Legislative barriers also seem clear, as these searches increased by 40 percent in 2011, the year when 92 laws that restrict abortions were passed in the US.
Conclusion
Cuban women have free reproductive care and are provided abortions at their request for free as well, under one of the statistically best healthcare systems in the world. In the US, a significant number of pregnant women cannot afford nor have access to legal abortions; therefore, being forced to endanger their lives through illegal procedures. The Cuban state operates under a socialist system that places the lives of its women citizens before corporate or private profit, to the point where it is illegal for abortions to be conducted for profit in the nation and prison terms are possible for violators of this policy. The fact that access to abortion clinics in the US has dwindled, causing legal abortions to decline while searches for illegal abortions have drastically spiked, is yet another failure of the capitalist healthcare system in the country. Specifically, the US for-profit system has failed the women it is meant to serve and will only continue to fail them as these dangerous statistics further grow.
In addition to operating for profit, US healthcare and medical industries remain beholden to patriarchal (and downright misogynistic) values that are tied to its economic system. Capitalism is a system founded on imperial conquests of Global South nations and the enforcement of patriarchy and class stratification on these matriarchal, communal societies by European Crowns. These structures have disproportionately affected women, and especially women who are oppressed in other aspects of their being. This has resulted in the devaluation of feminized labor, usage of women as domestic tools for the social reproduction of working men, and now high costs of abortions as well as barriers that prevent women from getting them. All of this leads to already underpaid and underprivileged women risking their lives to get their necessities out of despair because the system that governs them does not value them.
As maternal mortality rates are skyrocketing in the US, Cuba boasts one of the lowest infant and maternal mortality rates in the world. As of 2015, Cuba has a maternal mortality rate of 39 deaths for every 100,000 live births and an infant mortality rate of 4.2 deaths for every thousand births. The probability of children under the age of five dying in Cuba is 0 per 1,000 live births based on data from 2015. In addition to this, in June 2015, Cuba became the first nation in the world to be praised by the World Health Organization (WHO) for their achievement in eradicating mother-to-child transmission of HIV and syphilis through medical innovation. The corollary benefit to this is enjoyed by pregnant women who may otherwise seek abortions due to them having HIV and not wanting to infect their baby. With this ability, and the expectation of a healthy baby, those mothers may now choose to carry full term. Since 2010, the WHO has been teaming up with Cuba and other nations in the Americas to execute a regional plan to get rid of mother-to-child transmission of HIV and syphilis. As part of this program, Cuba has guaranteed early access to prenatal care, HIV and syphilis testing for pregnant women and their partners, treatment for women who test positive for the infections and their babies, caesarean deliveries and substitution of breastfeeding-all of which is provided under the universalized healthcare system of the island. These statistics make Cuba the country with the lowest infant mortality rate in the Americas, in the Global South as a whole, and one of the lowest in the world.
On the other hand, as of 2015, the US has a maternal mortality rate of 26.4 deaths per 100,000 live births, up from around 17 deaths per 100,000 live births in 1999. Other Western nations rank much lower in comparison to the US regarding maternal mortality, such as 9.2 for the UK and 7.8 for France per 100,000 live births respectively. According to a six-month long examination conducted by NPR and ProPublica on maternal mortality in the US, more women in the US are dying from complications due to pregnancy than any other Western nation, and the US is the only country where this rate is actually increasing. While the neglect of women's health is certainly predetermined by the for-profit system, it is also systematically neglected by the US government and its health agencies. Only 6 percent of block grants designated for maternal and child health end up being used for the health of the mothers, as revealed by federal and state funding. This is despite the increase in spending in overall healthcare in the US. The fact that only a minimum percent of block grants that are meant to be used for maternal and child health is utilized to help them further illustrates how the well-being of pregnant women and abortion patients is not paramount in the capitalist healthcare system of the US. Additionally, US hospitals that must worry about "bottom lines" (like any for-profit company) can be extremely unprepared for maternal emergencies such as self-induced abortions having gone wrong, even if the hospital has an intensive care unit for newborns and their mothers. Medical training in the US is also suspect. Some US doctors may specialize in maternal-fetal medicine without ever having to spend time in a labor-delivery unit that would further develop their specialties.
Cuba's healthcare system is world-renowned for many reasons: It was among the first of nations to fully legalize abortion; it has successfully eliminated mother-to-child transmission of HIV and syphilis through medical innovation; it has implemented universalized healthcare such that all reproductive services are free for all citizens; it has scored low maternal and infant mortality rates; and it is a significant factor in creating one of the highest standards of living for women in the world. All of this is due to taking profit and personal interest out of healthcare by making it a social imperative and human right. In comparison, the US has systematically restricted women's reproductive rights, increased barriers for women who seek abortions, has one of the highest maternal mortality rates in the West, is forcing women who seek illegal abortions due to lack of access to legal services, and has implemented high costs for legal abortions and other basic services, therefore diminishing the quality of living for millions of marginalized women. All of this is due to putting profit above people while pushing patriarchal values that do not recognize women as human beings who should have full agency over their bodies.
Bibliography
"Central America and the Caribbean: Cuba." The World Factbook, Central Intelligence Agency, 11 Apr. 2018.
Encyclopaedia Britannica, Roe v Wade. 26 Apr. 1999.
Falk, Pam, et al. Cuba's Constitution of 1976 with Amendments through 2002. Oxford University Press Inc.
Ginsburg, Faye D. Contested Lives: The Abortion Debate in an American Community. University of California Press, 1998.
Jatlaoui, Tara C., et al. "Abortion Surveillance - United States, 2014." Morbidity and Mortality Weekly Report, Center for Disease Control and Prevention, 24 Nov. 2017.
Jones, Rachel K., et al. "At What Cost? Payment for Abortion Care by US Women." Women's Health Issues Journal, no. 23-3, 4 Mar. 2013. Elsevier.
Kassebaum, Nicholas J. "Global, Regional, and National Levels of Maternal Mortality, 1990-2015: a Systematic Analysis for the Global Burden of Disease Study 2015." The Lancet, vol. 388, 8 Oct. 2016.
Last Five Years Account for More Than One-Quarter of All Abortion Restrictions Enacted Since Roe. Guttmacher Institute, 13 Jan. 2016.
Montagne, Renee, and Nina Martin. "U.S. Has The Worst Rate Of Maternal Deaths In The Developed World." Lost Mothers: Maternal Mortality in the U.s., NPR, 12 May 2017.
National Health Expenditure Data. Centers for Medicare and Medicaid Services, 8 Jan. 2018.
Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. Cuba: Abortion Policy. The Population Policy Data Bank.
Reagan, Leslie J. When Abortion Was a Crime: Women, Medicine and Law in the United States, 1867-1973 . University of California Press, 1998.
Stephens-Davidowitz, Seth. Abortions at Clinics, or Somewhere Else. Guttmacher Institute, 5 Mar. 2016.
"The Federation of Cuban Women." The Federation of Cuban Women, Stanford University.
World Health Organization. Facts on Cuba.
WHO Validates Elimination of Mother-to-Child Transmission of HIV and Syphilis in Cuba. World Health Organization, 30 June 2015.
