Can Adoption of Cuban Maternity Care Policy Guide the Rural United States to Improve Maternal and Infant Mortality?

In the rural United States the infant mortality rate (IMR) is 6.5 per 1,000, and in rural states like Alabama this rate jumps to 9.1. Rural obstetric services are disappearing such that over half of U.S. rural counties do not have enough obstetric services. In contrast, Cuba's IMR is 4.3 while spending half as much as a percent of their gross domestic product than the United States. This raises the question: how has Cuba achieved this health outcome and what lessons can be learned and applied in the United States given decreased availability of obstetric services? This paper presents a field case study of one of Cuba's national public health policies. Specifically, we explore Cuba's Hogares Maternos, or maternity homes. We argue that the Cuban model, which focuses on social determinants of health, ought to be explored. We discuss how Hogares Maternos may be adopted and adapted within the rural United States by leveraging existing infrastructure.