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Is Cuba's infant mortality rate really that low?

For decades, Cuba has touted low infant mortality rates as an indicator of the success of its socialist revolution.

The government claims infant mortality in Cuba rivals rates in the world's richest nations, such as the United States.

But a study by Roberto Gonzalez, a student at the University of North Carolina and the son of a Cuban doctor, suggests that Cuba's data is flawed.

His statistical analysis finds that the real infant mortality rate in Cuba is comparable to that of middle-income countries in Latin America, such as Chile and Costa Rica, and not the world's richest nations.

Gonzalez takes his cue from research in Europe and elsewhere that shows similarities between fetus deaths in the final months before birth and infant deaths in first months after birth.

But in Cuba, those numbers don't correspond. Instead, the rate of late-fetal deaths is significantly higher than deaths reported after birth, Gonzalez told the Association for the Study of the Cuban Economy (ASCE).

Gonzalez suggests that Cuban medical staff classify some after-birth deaths as prebirth in order to keep the infant mortality rate low. Fetal losses don't count toward infant mortality.

Adjusting the numbers to keep fetal and post-birth deaths similar, Cuba's infant mortality rate rises from about 6 deaths for every 1,000 live births to 7-11 deaths instead.

That's still low by global standards--but no longer among the world's lowest rates, he told ASCE delegates meeting in Miami.

Women in the audience asked whether late-term abortions also might skew Cuba's data. Doctors are known to perform high rates of late-term abortions in Cuba compared to the U.S. and other nations.

Gonzalez responded that data for late-term abortions is kept separately and does not influence his calculations.

Rodolfo Stusser, a Miami doctor and consultant, said he's done just what Gonzalez alluded to in his ASCE speech: While working in Las Tunas province in the early 1970s, his unit would record after-birth deaths as fetal deaths "to meet government goals to reduce the infant mortality rate," he said.

"The unit seemed to function better when you met the goals," Strusser said. "It's done to avoid problems."
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Author:Hemlock, Doreen
Date:Aug 1, 2013
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