Reproductive rights in Cuba
An example for the divided USA?
Cuba legalized abortion in 1965, thus becoming the first country in Latin America and the Caribbean to decriminalize abortion. In Cuba today, the exercise of reproductive rights is constitutionally guaranteed; Article 43 of the 2019 Constitution affirms the sexual and reproductive rights of women. There was barely any mention of it in the extensive public and people’s constitutional debate in 2018 and 2019, reflecting the high level of support for the protection of reproductive rights in Cuban society.
In a recent newspaper interview, Cuban Minister of Public Health José Angel Portal Miranda explained that Cuban reproductive rights are sustained on a base of three fundamental principles: a woman decides over her body and whether she will terminate a pregnancy; the voluntary interruption of pregnancy is carried out in a controlled environment by specialized personnel; and it is entirely free, as are all health services. Abortions are provided in maternal hospitals and in general hospitals and polyclinics that have gynecological services. Some 80% of voluntary abortions are carried out using Misoprostol.
However, this does not mean that there is abortion on demand in Cuba. As Portal Miranda explained, in practice abortion is permitted for up to twelve weeks of gestational age, without restrictions concerning the reason. It is permitted for up to 26 weeks for reasons of fetal malformation that are incompatible with life. In addition, with respect to minors of age, cases of legal interruption are conducted with the informed participation and consent of a parent or guardian, as is the case with respect to all medical interventions in Cuba. Moreover, abortion in Cuba is a crime if it is carried out for profit motives, without the consent of the woman, or in conditions that could threaten her life and health.
Portal Miranda noted that in Cuba abortion is not considered a contraceptive method. Cuba is committed to the prevention of unwanted pregnancies through family planning policies involving sexual education and the availability of contraception. However, the rate of abortion is high, because the family planning program has not been able to attain its goals. Nonetheless, the rate of abortion in Cuba has been declining over time. From 55.0 per 1000 women aged 12 to 45 in 1985, it declined to 45.6 in 1990, to 30 in 2015, and to 22.1 in 2020.
In the world, Portal Miranda observed, there are around 56 million abortions each year. Approximately 45% are conducted in an unsafe form, and there is a high maternal mortality rate in places where abortion is severely restricted. He further noted that conservative and fundamentalist ideas are spreading in the world, which threatens the right to abortion; for this reason, the new Cuban health law presently in preparation is going to reinforce its legal protection of reproductive rights.
In a recent newspaper column in Cuba, “Abortion in Cuba and the right to decide”, Susana Antón and Yaditza Del Sol highlight the situation of young university student who confronted a pregnancy in what she felt was not a good moment, and she did not feel prepared to assume the responsibility of being a mother. Even though her parents asked her to think it through, saying that they would help with the care of the child, she knew what she wanted, and she today has no regrets.
What can we learn from the example of Cuba?
Cuba was historically a Catholic country, but Cuban Catholicism was never doctrinal. Beyond the relatively small middle class, the great majority of Cubans practiced a syncretic religion that synthesized Catholic teachings with the practices of African religious traditions, a form of religion that was and is primarily oriented to asking for the intercession of the saints for protection in health and other personal concerns. It was not oriented to complying with the teachings of the Church, with respect to abortion or any other issue. In this context, there emerged a belief among the people that a fetus was not yet a human being until 12 weeks of gestation, such that abortion was considered murder only if it were carried out after twelve weeks. At the same time, the personal decision concerning abortion was made in a context defined by a strong extended family, in which the mothers, sisters, and cousins of the woman were available to provide support in childcare. All of this dovetailed with the commitment of the revolution to protect the rights and health of women, which arrived to the conclusion that abortion before twelve weeks is a women’s right, but after twelve weeks is injurious to health.
The ideological situation is entirely different in the United States, where there are clear ideological divisions. On the one side, the demand for the right of the woman to choose; and on the other side, the belief that life begins at conception, and therefore abortion is murder. I personally am in the latter camp. It seems to me unreasonable to deny that a healthy fetus is a potential human being, and therefore is in essence a human being; and that the taking of a human life has to be justified for reasons more compelling than the fact that an unexpected pregnancy implies an unexpected turn in one’s life plan. But my personal views aside, and taking into account the enormous ideological difference between the USA and Cuba, I think that we in the USA can learn from the experience of Cuba and apply some lessons from the Cuban experience to our own reality.
The first lesson to be learned is the possibility of consensus. When it comes to Cuba, we in the United States have to begin, on this and other issues, with appreciation of the significance of the achievement of social and ideological consensus. Cubans are consensually united on issues on which we in the USA are permanently and hopelessly divided. We need to see and appreciate this important fact, and ask the question, how did they do that?
On the question of abortion, we ought to note that in Cuba there is not unrestricted abortion. It is not practiced after twelve weeks, a practice arrived at through a synthesis of health considerations and popular religious beliefs. Is not this approach a possible basis for finding common ground in the USA?
In the recent decision of the Supreme Court overturning Roe v. Wade, I was struck by the fact that the Mississippi law in question prohibited abortion only after fifteen weeks. The Mississippi law, perceived by many as a violation of the right of women to choose, was more liberal than the Cuban practice, a nation that is widely regarded, and rightly so, as a protector of the reproductive rights of woman. We in the United States need to step back from our ideological wars and dedicate ourselves to finding common ground, for the good of the nation.
The hard part about finding common ground with respect to abortion concerns those who believe, as do I, that a human life begins from the moment of conception. For people with such a belief, especially if it is tied to religious convictions, compromise is virtually impossible, for it is tantamount to tolerating the murder of innocent children. However, I would say to persons with such convictions that we should pay attention to an observation of the Cuban Minister of Health, an observation consistent with what we know from common-sense intelligence, that in places where abortion is severely restricted, nearly half of the abortions are carried out in unsafe conditions, and the maternal mortality rate is high. We need to ask, is it possible to implement a law that mandates severe restrictions on abortion?
If we lived in a world in which there were a widespread conception that abortion at any stage of fetal development is the unjustifiable taking of a human life, then a law severely restricting abortion would be possible. But we do not live in such society, neither today nor in traditional societies.
There is another noteworthy issue about the Cuban experience that perhaps is relevant for our reflections in the USA, namely, Cuba discourages abortion in two ways. First, the Ministry of Health is committed to a family planning program, with the intention of preventing unwanted pregnancies. And secondly, a strong extended family is present to offer significant childcare support to women with young children. We have structures of support for pregnant women in the United States, and perhaps those scandalized by abortion could seek to expand and intensify these efforts as an urgent necessity. Such measures encounter little political resistance in the United States, beyond resistance that is found for ideological and political reasons against any social welfare expenditure.
I reiterate, let us try to overcome the ideological divide and search for common ground, out of a sense of patriotic duty to our nation. We could, for example, permit abortion for any reason in the first twelve weeks gestation, either because we believe it is the woman’s right to choose, or because we recognize the negative practical consequences of making it illegal at this early stage. And we could combine this window of opportunity with a substantial, widely supported anti-abortion program, either because we believe that abortion is morally wrong, or because we recognize negative consequences of abortion with respect to health. This anti-abortion program could include: abortions for minors only with the participation and consent of a parent or guardian; abortions after twelve weeks only in life threatening situations; a sexual education program that includes explanations of both natural and artificial methods of contraception; and well-developed structures of support for pregnant women and mothers, sustained through the first five years of the child’s life.
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