Maternal and Infant Mortality in Cuba: Trends, Structural Determinants, and Policy Implications (2010–2026)

Excerpt

Cuba once stood as one of the great paradoxes of global health: a nation with limited economic resources but maternal and infant outcomes rivaling those of the world’s wealthiest countries. For decades, its infant mortality rate hovered near 4 per 1,000 live births—lower than that of the United States—and its maternal‑child health system was celebrated as a model of prevention, equity, and community‑based care.

That era is now under threat.

Between 2018 and 2026, Cuba’s maternal and infant mortality indicators have shifted from global outlier to global warning. A system that once defied economic gravity is now being pulled downward by forces no health ministry can overcome alone: collapsing fuel supplies, severe medicine shortages, post‑pandemic fragility, and the cumulative impact of one of the most restrictive sanctions regimes in the world. Neonatal units face blackouts. Obstetric emergencies are delayed by lack of transport. Pharmacies sit empty. Clinicians work without the tools they once relied on.

The result is measurable in lives. Infant mortality, which had fallen to 4.0 per 1,000 in 2018, has risen sharply in multiple independent assessments. Maternal mortality, once among the lowest in the region, has become increasingly unstable. These are not abstract indicators—they are the lived consequences of structural determinants that shape who survives pregnancy, who survives birth, and who does not.

Yet even in the midst of crisis, Cuba’s maternal‑child health system continues to demonstrate extraordinary resilience. In 2023, official data showed a temporary decline in infant mortality, driven by the dedication of clinicians and the strength of long‑standing programs like PAMI and the maternity homes. But resilience is not the same as recovery. Without structural relief—particularly in energy and medical supply chains—these gains cannot be sustained.

Cuba’s trajectory is no longer just a national story. It is a global health signal: a reminder that maternal and infant survival depends not only on clinical skill, but on the political and economic conditions that make care possible. When fuel cannot reach hospitals, when medicines cannot reach pharmacies, when sanctions restrict the basic inputs of life, mortality rises. Mothers and infants pay the price.

This report examines that reality with clarity and evidence. It traces the arc of Cuba’s maternal and infant mortality from 2010 to 2026, analyzes the structural determinants driving the current crisis, and outlines the policy actions urgently needed to prevent further loss of life. The data are clear. The implications are global. And the stakes could not be higher.

1. Background: Cuba as a Global Outlier in Maternal–Child Health

For decades, Cuba has been cited as a “positive outlier” in global health. Bragg et al. (2012) documented that Cuba achieved:

• Neonatal mortality: 3 per 1,000 (2010)

• Infant mortality: 5 per 1,000 (2010)

• Under‑five mortality: 7 per 1,000 (2010)

• Life expectancy: 79 years (2010)

• Maternal mortality: 53 per 100,000 (2008), lower than regional averages

These outcomes were achieved through:

• Universal access to care

• A dense primary‑care network

• Community‑embedded family doctors

• Over 300 maternity homes (hogares maternos)

• A prevention‑oriented national maternal‑child program (PAMI)

Cuba’s model demonstrated that political prioritization of maternal‑child health can overcome economic scarcity.

2. Trends 2010–2026: A System Under Increasing Strain

2.1. The 2010–2018 Stability Period

Cuba maintained infant mortality rates between 4.0–5.0 per 1,000, among the lowest in the Americas.

2.2. The 2019–2022 Deterioration

Multiple sources document rising mortality:

• Infant mortality: increased to 7.5 per 1,000 (2022)

• Maternal mortality: increased to 40.9 per 100,000 (2022)

Drivers included:

• COVID‑19 system strain

• Fuel shortages

• Medicine scarcity

• Workforce attrition

2.3. The 2023 Temporary Improvement (Granma, 2024)

Granma reported:

• Infant mortality: decreased from 7.5 → 7.1 per 1,000

• Maternal mortality: decreased from 40.9 → 38.7 per 100,000

• 25 municipalities reported zero infant deaths

• Congenital anomaly mortality fell to 0.7 per 1,000, the lowest in the Americas

This improvement reflects clinical effort, not systemic recovery.

2.4. The 2024–2026 Crisis Period

Independent reporting shows renewed deterioration:

• 14ymedio (2025): Infant mortality reached 8.2 per 1,000 (Jan–Jul 2025)

• US‑ELAM Physicians (2026): CEPR analysis found infant mortality rose 148% (4.0 → 9.9) between 2018–2025 (This figure should be independently verified from CEPR’s primary report.)

• Medicine availability: Only 3% of Cubans could find needed medicines in pharmacies (ELAM letter)

• Drug availability in clinics: Only 30% of essential medicines available (14ymedio)

• Fuel collapse: Blackouts and transport failures disrupted neonatal and obstetric care

The convergence of these factors marks the most severe maternal‑child health crisis Cuba has faced since the 1990s.

3. Provincial Disparities: Uneven Burden Across the Island

Granma’s 2023 data reveal significant provincial variation:

Lowest infant mortality (2023):

• Pinar del Río — 3.1

• Artemisa — 3.9

• Holguín — 4.7

• Sancti Spíritus — 4.8

• Villa Clara — 5.7

• Matanzas — 6.9

Highest infant mortality (2023):

• Havana — 7.9

• Santiago de Cuba — 8.0

• Guantánamo — 9.0

• Mayabeque — 9.1

These disparities reflect:

• Urban overcrowding

• Uneven resource distribution

• Differential impact of fuel shortages

• Variability in workforce retention

4. Structural Determinants: How Sanctions and Resource Scarcity Shape Mortality

4.1. Energy‑related sanctions as a health determinant

The US‑ELAM physicians’ letter (2026) states:

• January 2026 sanctions “collapsed Cuba’s oil supply”

• Hospitals cancelled surgeries

• Staff could not reach patients

• Power outages affected neonatal wards

These claims align with independent reporting and are consistent with known pathways linking energy insecurity to maternal‑infant mortality.

4.2. Medicine shortages

Multiple sources confirm:

• Over 460 essential medicines in shortage

• Only 30% of essential drugs available in clinics

• Only 3% of Cubans could find needed medicines in pharmacies

This directly affects:

• Hypertensive disorders of pregnancy

• Neonatal sepsis

• Preterm birth management

• Emergency obstetric care

4.3. Workforce attrition

14ymedio reports:

• Incomplete staffing across 16,541 health facilities

• Professional exodus

• Delays in surgical care

• “Illegal sale of services” in some institutions

These factors reduce system resilience.

4.4. Post‑pandemic fragility

PAHO (2024) notes:

• Over 20 innovations added to PAMI

• Strengthening of maternal mortality committees

• Continued challenges with adolescent pregnancy

Despite these efforts, structural constraints limit impact.

5. Clinical Implications: How System Stress Translates Into Mortality

5.1. Obstetric emergencies

Fuel shortages and blackouts delay:

• Management of postpartum hemorrhage

• Treatment of eclampsia

• Emergency cesarean sections

5.2. Neonatal care

Blackouts compromise:

• Incubators

• Oxygen supply

• Temperature regulation

• Infection control

5.3. Preterm birth

Medicine shortages affect:

• Antenatal corticosteroids

• Tocolytics

• Antibiotics

• Neonatal surfactant

5.4. Congenital anomalies

Despite improvements in 2023, shortages in:

• Folic acid

• Prenatal screening

• Ultrasound equipment

increase long‑term risk.

6. Policy Implications and Recommendations

6.1. For international actors

• Recognize sanctions as a structural determinant of health

• Exempt fuel, medical supplies, and hospital equipment from sanctions

• Support PAMA/Global Health Partners technical cooperation

• Expand humanitarian corridors for maternal‑child health inputs

6.2. For the Cuban government

• Prioritize fuel allocation to maternal‑child facilities

• Strengthen retention incentives for clinicians

• Expand telemedicine for prenatal care

• Reinvest in maternity homes (hogares maternos)

• Improve data transparency for real‑time monitoring

6.3. For global health organizations

• Conduct independent assessments of maternal‑child health under sanctions

• Provide technical support for neonatal intensive care

• Support supply‑chain stabilization initiatives

7. Conclusion

Cuba’s maternal‑child health system has demonstrated extraordinary resilience for decades, achieving outcomes that defied economic expectations. Yet resilience is not invulnerability. The convergence of intensified sanctions, fuel shortages, medicine scarcity, and workforce attrition has pushed the system into a period of instability, reflected in rising infant and maternal mortality.

The temporary improvements observed in 2023 underscore the dedication of Cuban clinicians and the strength of the PAMI system. But without structural relief—particularly in energy and medical supply chains—these gains cannot be sustained.

Maternal and infant mortality are not merely clinical indicators; they are measures of a society’s capacity to protect life. The data presented here call for urgent, coordinated action to ensure that Cuba’s mothers and children are not left to bear the consequences of geopolitical decisions beyond their control.

Works Cited

Bragg M, Salke TR, Cotton CP, Jones DA.No Child or Mother Left Behind; Implications for the US from Cuba’s Maternity Homes. Health Promotion Perspectives. 2012;2(1):9–19.

“Cuba utilizes community-based regional maternity homes to provide comprehensive care for women with high-risk pregnancies.”

Granma.Descendió en 2023 la tasa de mortalidad infantil en Cuba. January 3, 2024.

“La tasa de mortalidad infantil en Cuba durante el año 2023 fue de 7,1 por mil nacidos vivos…”

14ymedio.In a Dark Year for Health in Cuba, Maternal and Infant Mortality Rates Go Up. July 15, 2025.

“The infant mortality rate rose to 8.2 per 1,000 births…”

ACN (Agencia Cubana de Noticias).Reducing maternal and infant mortality rates, priority in Cuba. April 7, 2025.

“The maternal mortality figure in 2024 was 40.6 per 100,000 women…”

PAHO/WHO.Cooperation between Cuba and PAHO/WHO to reduce maternal deaths. May 6, 2024.

“The initiative aimed to strengthen the competencies of professionals in charge of the Maternal and Child Care Programme…”

US ELAM Alumni Association.Urgent Opposition to the U.S. Economic Blockade… May 21, 2026.

“Cuba’s infant mortality rate rose 148%… representing an estimated 1,800 preventable infant deaths.”