Twins Abelito and Sofia, seven months of age, are the greatest joy of their parents Abel Quintela Jiménez and Sindy Rodríguez Fernández, who received treatment for infertility for 12 years and accomplished their dreams of becoming parents in their second attempt with in vitro fertilization.
Sindy was diagnosed with hydrosalpinx (a fluid obstruction of the Fallopian tubes) and doctors in a multidisciplinary team from the Ramón González Coro Obstetrics Gynecology Hospital and Hermanos Ameijeiras Clinical Surgical Hospital, chose to employ novel techniques to achieve this pregnancy.
This is not the only case in Cuba. Doctor Roberto Álvarez Fumero, head of the Maternal-Infant Division at the Ministry of Public Health (MINSAP), explained that this is part of a state effort to implement strategies charted by the Communist Party of Cuba to raise the populations’ quality of life and increase the birth and fertility rates, given the aging of the Cuban population, something that affects many institutions and state organizations.
MULTIPLE ACTIONS AND ONE PURPOSE
MINSAP has adopted a series of measures to reach this goal, which include educational and preventive actions aimed at reducing pregnancy during adolescence, a stage of life that poses many complications from a physical and social standpoint.
When a teenager faces a pregnancy, and chooses to abort, she may suffer reproductive consequences in the future. If she chooses to carry the pregnancy to term, she is from eight to 10 times more likely to suffer from complications at birth, disease, or complications for the newborn. Likewise, there is a greater risk of serious morbidity or death for the mother, Álvarez Fumero explained.
Another initiative to increase the fertility rate, developed by MINSAP, seeks to guarantee a safe motherhood during a woman’s fertile stage, giving women and their partners access to health services to determine - before conception -risks associated pregnancy.
“Unfortunately, only 47% of the couples in Cuba who want to have children turned to the health system to have their reproductive risks assessed last year,” Álvarez Fumero explained. “However, this number surpasses that of the previous year by 7%.” He also insisted in the promotion of a responsible attitude among women when it comes to carrying a child.
Another element specialists consider is the number of abortions a woman has had. Women are at greater risk of suffering an infection that can lead to infertility as a result of chronic inflammation or ovary obstruction during this procedure. There is also the probability of having an ectopic pregnancy, a serious complication that can cause death.
The specialist explained that even though abortions are performed in Cuba in health institutions with all necessary safety measures in place, the procedure should never be used as a contraceptive method. He stressed that community doctor’s offices, policlinics, and obstetrics and gynecology hospitals offer advice on family planning, and that a wide range of efficient and safe methods to prevent unwanted pregnancies areavailable countrywide.
Among the educational actions carried out by MINSAP, there is a media campaign to raise awareness among men and women of the advantages of having children during the optimal reproductive period, from 20 to 35 years of age.
Cuban women, who have reached an advanced level of intellectual development and enjoy of a high level of empowerment and social inclusion, usually devote this time of their lives to the fulfillment of their spiritual and intellectual goals. Motherhood, however, should not be seen as an obstacle. Cuba offers broad protection with benefits for both members of the couple, something that should be borne in mind when planning a pregnancy, the specialist added.
Álvarez Fumero also explained that, even though women who are over 35 are at greater risk, age is not the determining factor in considering a pregnancy. At 35 years of age, women may have accumulated health conditions such as obesity, high blood pressure, hypothyroidism, diabetes, heart conditions, and liver conditions that can trigger non-communicable chronic diseases.
Cuban couples should not feel discouraged about conceiving children after the age of 35. “Our campaign is mainly aimed at encouraging men and women to keep a healthy body weight, follow a healthy diet, and participate in physical activity every day, in order to reduce obesity which causes serious complications during pregnancy, birth, and the postnatal period. A broad communication campaign is in place to teach teenagers and young people how to use the health system to get advice on family planning, and all sexual and reproductive health issues they may face,” the doctor stressed.
ALLTHE SENSITIVITY IN ONE PROGRAM
Ensuring the reproductive right of men and women to have as many children as they want, even when their biological conditions do not allow this, is another of the Ministry’s lines of action. The program providing assistance to reproductively challenged couples was created to help couples in this situation, offering material resources along with high doses of sensitivity.
This has been the prevailing spirit to address the difficulties recently discussed in a review meeting with President Miguel Díaz-Canel Bermúdez, where Health Minister José Ángel Portal Miranda explained efforts made to purchase progesterone and to achieve regular schedules in the consultation offices, all while preparing investments in two new high-tech infertility centers in Camagüey and Santiago de Cuba.
The Cuban President noted then that over 100,000 couples are awaiting the arrival of a child and that, by achieving greater efficiency in consultations, these families will not only be given great joy, but the birth rate will be positively impacted as well.
Last year, 158,638 procedures were carried out under the auspices of the program, which included sperm analyses, surgical interventions, laparoscopies, hysteroscopy, contrasted X-ray explorations, ultrasounds and others, Álvarez Fumero explained.
The Ministry of Public Health has also implemented a separate review in the development of the network of services to the reproductively challenged couple and monthly evaluations, in every municipality, of results.
Another fundamental element has been the dispensarization or active surveying of couples with reproductive difficulties, although there are couples who do not disclose their fertility issues given social and cultural prejudices, which makes educational work even more important.
The acquisition of equipment for the upgrading of the four high technology centers for assisted reproduction existing in the country and the establishment of semen donation techniques and the vitrification of embryos, which should be perfected by August this year, are among actions aimed at increasing the possibilities of couples who wish to have children.
The most important thing, in the words of the head of the Maternal-Infant Program, is to maintain a healthy lifestyle and see the doctor immediately, not only when faced with reproductive issues, but also to plan a family. Cuba’s health system is designed to make the dream of bearing healthy offspring come true.
FURTHER INFORMATION
•The program for reproductively challenged couples was created in Cuba in 2007.
•A couple is considered infertile and should seek assistance through the health system when they have been trying to have a child with a stable partner for a year or more, having frequent sexual relations with no pregnancy resulting.
•Thus far, 102,234 infertile couples have been identified in Cuba. However; at the end of March 2019, only 61,170 had visited a consultation office for the first time.
•In the first quarter of the year, 1,145 pregnancies have been achieved at municipal and provincial offices and regional high technology centers.
•In 2018, the program recorded 3,787 pregnancies, 2,485 more than in 2017.
•There are four High Technology Centers for the care of reproductively challenged couples in the country, located in the Hermanos Ameijeiras and Ramón González Coro hospitals in Havana, in the Gustavo Aldereguía Lima hospital in Cienfuegos and in the Vladimir Ilich Lenin hospital in Holguín. Currently investments are in preparation for two new centers in Camagüey and Santiago de Cuba.
