In Cuba pregnancies are handled in a slapdash way. Couples that decide to practice family planning find that most of the general hospitals, where these medical offices are supposed to be, do not offer this type of service.
"In the hospitals people look for the best team they can find: that of their friends. And, if they don´t have any, they make some and they attend to you there," explained Tania, as the doctor rubbed her fingers together to make it clear that she was referring to money.
Yenia Rodriguez is about to have a second baby. She has been pregnant six times, but had four abortions.
"Do you know what it's like to have a child in Cuba?" She answers her own question: "A torture. They give you the basket whey they think you're not going lose the child. Sometimes you give birth and they still haven´t given you the pregnancy stipend, and consulting with the doctors about what you need is an ordeal.”
Ivania has just one. She gave birth at age 30. "This is to my duty to humanity, my mother and my husband, because if it were up to me, no way."
Nonarda has given birth three times, and all three times her mother practically raised the children. "I didn’t want them. They just came. Here having children and being a professional don´t mix. I admire those who can, but I can't," she says.
Nelys thinks just the opposite. "I had my daughter, and then I studied to be a teacher and everything. I did have her father, who helped me. Nevertheless, it wasn't easy."
"I was never as aware of time as when Sofía was born," Adriana explains. "Everything had to be to right on schedule, to have time to study. Now I have a very disciplined girl, and I'm neurotic."
Iris has had six, and ever since her career as an actress has been postponed - for another life, perhaps.
Pressure on the doctors, stress for the mothers
Cuba's economy, its social structures, and the mentality of its people prevent women from enjoying stress-free pregnancies. The government distributes propaganda about its programs for mothers, but the determination of those affected is not enough for it to work.
Doctor Tania, with 16 years of experience as a GP, explains the aims of the program for mothers: "It is aimed at pregnant women and babies during their first year. The goal is to monitor them more thoroughly through strict follow-ups, carried out in accordance with the patient's risk profile. Depending upon whether they suffer from a pathology or not, the consultation and follow-up time varies."
Because no doctor wants to have problematic pregnancies in his area, they normally make an effort for everything to work out. However, according to Tania "sometimes they write what should have happened rather than what actually did, becomes then the supervisors come and they really let you have it."
"If the pregnant woman does not show up to her appointments, the doctor is responsible. If there was no power and we couldn´t do the ultrasound, we're responsible once again. And the same is true of breastfeeding mothers," she explains.
Family doctors are charged not only with medical follow-up on new mothers, but also with personally calling upon each one of the mothers under their care, at home.
"It is a complex and flawed system, with them holding me responsible for something I don´t have control over, because they don´t take into consideration the Cuban population's levels of ignorance. It is not enough to just say that we are the most educated people on earth," says Doctor Tania.
A vitamin/mineral supplement for pregnant women is prescribed to all. Yenia says that she went two months without taking it. The tablets are free, but "there weren´t any," she says. "You read the box and it says that they are for 'the nutritional deficiencies specific to pregnancy,' but I keep wondering if it wouldn´t be better to have food."
Gynecologists go from medical office to office, seeing the pregnant women that they are supposed to, or those that they find. The clinical history of Elizabeth, a resident of Alamar, is held by the gynecologist in her area, but she is way off her schedule:_ by 28 weeks of gestation they should have calculated the baby's weight three times, but it hasn´t been done even once.
For pregnant women from Guanabo, Alamar, Cojímar, El Bahía, Casablanca and Camilo there is only one medical office for expecting mothers. "You've got to call at 4:00 in the morning. It’s true that they see all of us, but you run the risk of showing up at 6:00 in the morning and leaving at 6:00 in the afternoon," says Yenia.
"But that´s not all. The doctor used to come to the office, but now you've got to go to the general hospital, and my records are a mess because we spent four months without a family doctor. I believe that the only thing that has worked has been the nutritionist, because the dentist is a whole other problem," she complains.
After nine months the baby is delivered by the physician on duty, who has no previous knowledge of the pregnancy's evolution. A tarjetón, a card containing a kind of clinical history on the patient, which she is to keep on her, is the only link between her and the stranger who will deliver her child.
"I haven't had a tarjetón for a month. Just a few white sheets. But you go to the Cuevita (illegal market) and you find them for 5 CUC ," reports Elizabeth.
Yesenia already give birth, at the Hospital Materno Hijos de Galicia, in Luyanó. "I could barely breastfeed, when I found out that the nurses were selling mother's milk for 20 pesos per ounce. What did I have to do? Buy it," she explains.
Some defend the nurses, saying that they see all kinds of women. "Those that give birth but don´t want to breastfeed, so that they're breasts don´t sag; those who say that it hurts; those who get depressed and don´t want to even deal with the fact that they’ve given birth; and adolescents who don´t even know what they want."
Two pounds of meat, a bag of milk
The government says that during the first half of the year the country saw economic growth of 4.7%, but pregnant women have seen no increase in their two pounds of meat, nor their monthly bag of milk, nor their allotment of chicken as part of their rations, which do not include fish or any other necessary protein.
"If you're going to get pregnant, don´t count on what they're supposed to give you. You'd better think about what you can buy at the store," says Yesenia. "I gave birth and they owed me the first chicken and two bags of milk, which never arrived."
"And they give you those rations if you have a document from the dentist," says Yenia, which she calls "one of the most absurd things" that has happened to her.
In stores using the national currency foam mattresses arrive once a month, selling for 40 pesos. The baby basket comes with 20 meters of antiseptic fabric so that the mother can cut, sew and stitch the diapers; a bottle of perfume and one of oil, two baby bottles, a towel, Nacar brand soap and a set of clothes.
"At the store they sell you the basket if you're past 28 weeks." I was saved because they give you a little acrylic bag. With my previous pregnancy they sold me things to in a jute sack," says Yenia.
"The conflict for us women is a big one," complains Adriana. "During pregnancy one becomes very tender and wants to buy the best for her baby. But then reality sets in. You have to choose between eating well or buying a 40-CUC stroller in the future; you have to think about disposable diapers, to wash less, or wet wipes."
"Cuban children are raised with hand-me-downs from their cousins, nieces and nephews, and their neighbors," Nely says. "She loaned me the cradle, but then she was expecting again, so I had to give it back to her, and put my daughter in a little cot until I could find another cradle."
Nonarda confesses that she has been telling her unmarried girlfriends that it is better to not even try.
"He helps me a lot"
Though we are in the 21st century, Cuban women can still be heard saying of their husbands that "he helps me a lot." The obligations of paternity are still seen as an extra effort for which women must be grateful.
"We men must face the seven-headed monster of supporting a family in Cuba," says Alberto. "When I found out I wanted to run away, but I stopped myself."
Pin calls himself "the best father in the world" because he always provides monthly payments. But he hasn't been there for any of the three pregnancies of the women in his life.
"Women turn to the justice system less and less to demand that fathers do their duties and respect their children's rights. Pensions, calculated based on the man's salary, continue to be a pittance," says a lawyer at a collective law firm, who did not wish to be identified.
"Monthly payments are not enough. Children require attention, and when there is a divorce, that is interrupted, just as easily as the marriage was ended," she adds.
Samanta is an example of this. "Adel gives money me for the baby when he is not jealous or angry with me. It is as if he took out on his family all the frustrations generated by his machismo," she says.
Another problem is emigration.
"We didn't want to have children until we managed to get away, but I got pregnant, the opportunity came, but there was only enough money for one of us," says Elizabeth. "Yunier left for Ecuador and, although he returns quite often, he's finding out about many things only via email," she adds.
The "help" provided by some men actually extends to becoming directly involved in raising their children. Though, at times, criticism by others can fuel complexes.
There are not many men like Radamet, who washes and irons, just like his wife does. "If they're going to talk anyway, what do I care if they have their fun, sticking their noses where they don´t belong, while I get work done at home?"