Daymarys Gonzalez's first attempt to have a child ended with an ectopic pregnancy at age 31. She stopped trying to conceive after a miscarriage the following year.
Now, the 37-year-old pet-bird breeder is unexpectedly pregnant again, and Cuba's communist government is doing all it can to make sure she has a successful delivery. Three months before her due date, she's living fulltime at a special government medical care center for women with high-risk pregnancies as part of a broad campaign to drive up a birth rate that has fallen to the lowest in Latin America.
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Years of fewer births mean the number of working-age people in Cuba is expected to shrink starting next year, terrible news for an island attempting to jumpstart its stagnant centrally planned economy.
The country's governing Council of Ministers announced this week that it will soon unveil yet-unspecified financial incentives for couples considering starting families. It had already expanded maternity, and in some cases paternity leave, to a full year with pay.
The government also has opened dozens of special centers for infertile couples and special maternity units. At one of the centers in central Havana, Gonzalez and 50 other expectant mothers chat and watch television as nurses check their blood pressure and happy babies smile down from posters on the wall.
"We've been evaluating this low birth rate for years," said Roberto Alvarez Fumero, chief of the maternity and child health unit at Cuba's Ministry of Health. "Now we're taking action to improve sexual and reproductive health, which can help drive up the country's birth rate."
Cuba's baby problem is a result of some of the most notable successes of its 55-year-old socialist revolution: more working women with professional jobs and universal access to medical care, which includes contraception and free, legal abortion. It's also a product of its failures: a lackluster economy, persistently high levels of emigration by young people and an island-wide housing shortage.
"People in Cuba wait because they don't have the economic or housing situation they need and they know that life gets tougher with a baby," Gonzalez said. "I'm definitely only going to have one child."
Analysts estimate that Cuba has a deficit of 500,000 homes, a number growing because of the cash-poor state's difficulties in maintaining publicly owned buildings. So many young people share homes with uncles, parents, grandparents and cousins.
They also earn less than $50 a month. Despite many free or highly subsidized services like food, education, health, telephone and electricity, many Cubans depend on higher-quality imported products that can only be had at high prices. A pack of diapers can go for $10.
With less time at home, little space or privacy and salaries that don't cover basic baby supplies, many couples are putting plans for children on hold, or having only one.
"You wait to have economic stability to bring a child into the world," said Maria Isabel de Armas, a childless 31-year-old unemployed waitress.
Cuba has long prided itself on care of pregnant women and newborns, and officials often boast of an infant mortality rate lower than that of the United States.
Now it's going further, opening special centers for infertile couples in each of the country's 168 municipalities. The government says it treated 3,000 couples for infertility in 2010, and more than doubled that number in the following three years. The country has also tripled the number of special reproductive technology centers, to three, and there have been 500 births by artificial insemination.
"I always wanted a child but it never came, and suddenly at 46, I got pregnant," said Lucia Quesada, a bank worker who became the oldest women in Havana's special maternity unit after she and her partner unexpectedly conceived naturally. "I was really nervous but I said, 'I'm going to try to have it,' and here I am."
For others less eager, Cuba's liberal abortion policies have made it easy to wait.
Twenty-one percent of Cuban women between the ages of 15 and 54 say they had had at least one abortion, according to a 2009 poll on fertility by National Office of Information and Statistics. Eighty percent of the population use contraception including IUD's, condoms or sterilization.
The average Cuban woman had nearly five children in the 1960s but that number dropped below the replacement rate of two children per woman in 1978 and hasn't recovered since. Although it started climbing slowly again in 2006, the birth rate of 1.7 in 2012 remains well below the regional average of 2.3 children per woman.
As a result, doctors are going further than ever to see older and at-risk mothers like Gonzalez take their pregnancy to term.
"We don't stigmatize it these days," Alvarez said. "This new policy has changed our doctors' way of thinking."
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