14 Nov Cuban Programs Confront Low Birth Rate & Aging Population
Havana, November 14, 2016 – Cuba is facing a double demographic threat. According to 2015 data from the National Office of Statistics and Information, 20% of the population is over 60 years of age (if this pace is maintained, by 2050, Cuba will have the oldest population in Latin America and the 9th oldest population in the world) and the fertility rate (number of children per woman) is just 1.7. The number of Cuban women giving birth to daughters—an important indicator for future demographic growth—is even lower, at .8 per woman (aged 15 and 49). Cuba’s aging population, coupled with the island’s low birth rate, has spurred several national programs to address the special health needs of older adults, while others are designed to encourage more births.
Cuba’s low birth rate is largely attributable to three factors: the sluggish economy, emigration of women of child-bearing age, and the fact that over 70% of the labor force is professional women (who tend to delay childbirth while they pursue careers). Several years ago, Cuba started implementing programs to head off this pending demographic disaster, with promising results. A program to assist the 20% of infertile Cuban couples across the island, for instance, is helping people realize their dream of becoming parents. In Cienfuegos, assisted reproductive services have been available since 2010 at the PAHO-accredited specialized Provincial Center for Assisted Reproduction, where more than 400 children have been born using a variety of techniques, including in vitro fertilization; like all health services in Cuba, the 3,000 couples attended at the Cienfuegos center each year receive treatment and counseling free of charge. In Camagüey’s Provincial Center, meanwhile, more than 100 babies have been born since services began in that province two years ago.
Identifying infertile couples and candidates for reproductive assistance (women must be between 18 and 40 years old, for example) in each health catchment area, is the responsibility of primary care providers. From there, eligible candidates continue their journey towards parenthood at the secondary and tertiary levels of the health system, attended by a multi-disciplinary team including OB-GYNs, endocrinologists, urologists, geneticists and psychologists.
At the other end of the life span, at 78, life expectancy in Cuba is on par with more developed countries —with credit shared by social determinants such as educational levels, as well as the island’s universal health care system for its 11 million population, with a strong emphasis on health promotion and disease prevention. Cross-sector programs for seniors—by 2030, it’s estimated over 30% of the Cuban population will be 60 years or older—are now a priority for sustainable social and economic development. One major initiative by the Ministry of Public Health (MINSAP) includes offering specialized geriatric services at all levels of the health system, beginning in primary care settings. This is complemented by the country’s medical universities’ emphasis on training more geriatric specialists – in 2015, Cuba had only 778 geriatricians.
Other programs for Cuba’s older population include the national network of senior homes—147 around the country, with at least one in each province—and the 265 senior day centers, also located throughout the provinces (both alternatives provided free of charge). These centers are a key link in the chain of social assistance for Cuban elders, providing specialized services, including individualized nutritional and medical attention, recreational activities and exercise classes. Having a safe social space for elders to go each day is advantageous for family members who can continue working or studying, rather than providing round-the-clock elder care, while promoting healthy, productive aging for seniors. Additionally, Cuba encourages healthy aging through senior clubs (offering tai chi and other activities to maximize mobility and well-being), university extension classes for seniors (the Older Adult University with over 600 classrooms across the island), and maintains a national social security system to help retired workers offset the rising cost of living in Cuba.
In any case, the challenge is great, since the working-age population will certainly carry more of the financial burden for supporting Cuba’s children and elders as the country moves into the next decades.