Pregnancy and childbirth are highly politicised issues that have occupied a central place in the state agenda since the early days of the revolution. A system of state-run maternity homes and hospitals was installed as early as in the 1960s in order to prevent infant mortality (Perez 2002). Special state protection for pregnant women and babies is emphasised and Cuba’s low infant mortality rates have for long been Fidel Castro’s pride and joy, both at home and internationally. The care provided by the state to pregnant women and infants is therefore of particular ideological importance to the overall legitimacy of the socialist state system in the country (see also Andaya 2007, 2009b; Kath 2010).
The state closely monitors women throughout their pregnancy. A woman is required to have regular medical checks, see a dentist, have two interviews with a psychologist, and expected to follow the strict dietary and sexual health advice given to her by the doctor.40 For example, a female informant was strictly advised to have sex only with a condom in order to avoid STDs and infections. She was also told to renounce eating any white flour products, ice cream, sugared juices, sweets, and soft drinks because she was thought to be gaining too much weight during her pregnancy. The doctor recommended her to follow a diet of milk, chicken, and fish in order to avoid her blood pressure going too high or too low. Normally my informants followed such doctor’s orders, judging them to be in the best interests of the baby and themselves.
40 Kath states that in total, the minimum number of check-ups is between 10 and 12 (2010: 29 ff. 15, 90 ff. 4).
Andaya (2007: 86-118) states that women resist such dietary requirements and argues that they form part of state efforts to mould pregnant women into modern, disciplined subjects. However, this point of view does not pay close attention to food as a substance. In the context of personal social relations, food is a way to embody care and while recognising the normative quality inherent in such state practices, my informants’ close conforming to the dietary requirements suggests that they conceptualised such state practices primarily as indicating care rather than discipline.
In the local health care clinics pregnant women are given priority over other patients. After a baby is born, a woman has to continue visiting her local health clinic regularly until the baby is at least six months old. If she does not do this, the nurse comes to see her at home.
If a woman is considered to belong to a group of “high-risk” (Andaya 2007: 98) pregnancies, she is interned in a state-run maternity home or to a maternity hospital where she is required to stay for as long as necessary. The women who are seen to be of ‘high-risk’ are normally those who are perceived as receiving insufficient nutrition or as having inadequate housing conditions or problems (such as violence) at home. Often these tend to be women from the lower income groups (Kath 2010: 97, 127 ff. 6). Women who are carrying twins are almost always interned in a maternity home for a few weeks before the birth, as well as women with a permanent health condition, such as diabetes.
Andaya (2007: 87-118; see also Kath 2010: 92-98) points out that women with a previous history of several miscarriages are particularly likely to be placed in a maternity home since they are seen as undisciplined in their reproductive practices.41
These state actions focus exclusively on the mother-to-be. While for the pregnant woman check-ups and doctors’ appointments take place almost weekly throughout the pregnancy, the father-to-be is required to be present only in one appointment during the whole process. It is extremely rare for a man to accompany his partner to other medical checks and often men know little of what goes on during these encounters.
Indeed, pregnancy and childbirth as a whole are conceptualised very strongly as something that men are not even expected to handle, both in the context of state practices as well as more generally. A statement from Rosa, when I asked her whether her partner would go with her to the hospital when she goes to give birth, illustrates this well. Outright appalled by the suggestion, she replied: “Nooo! He would have a heart attack if he saw that! No, they [the
41 The only one of my informants who was interned in a maternity home had a history of several abortions, which also is likely to have influenced her being labelled as a “high risk” pregnancy.
hospital employees] don’t allow you to take anyone there with you; no one.”
During the actual childbirth, men are required to expect outside the hospital until they are called in to see the baby after the actual delivery is over.42 (Men often sit on the steps at the entrance of the hospital with a bottle of rum waiting for the news).
The maternity leave starts on the seventh or the eighth month of pregnancy depending on the type of work the woman is doing.43 However, many women stop working earlier. The maternity leave continues until the child is one year old and during this time, the woman is paid a full salary. There is no paternity leave.
Organising day-care for workers’ children so that women could work in paid jobs was one of the earliest priorities of the revolution in the 1960s (Bell et al. 2007: 29). A woman has to be employed by the state in order to gain access to state kindergartens and the child has to be at least one year old, able to walk, and toilet trained. Private arrangements widely patch up the problems in state arrangements. Female kin help each other in childcare and some women maintain unlicensed ‘private day-care centres’, where they take care of children for a small fee. Andaya (2009b) points out that deficient state services in the field of childcare during the post-Soviet period have shifted more caring work to women, resulting in an increased feminisation of nurturance as, for instance, grandmothers care for their daughters’ children more often than before the fall of the Soviet Union. At the same time, it should be reminded that such arrangements have been prevalent in the Caribbean for long (e.g.
Smith 1996a) and are therefore likely to have existed alongside the state-provided child care institutions also during the ‘good years’ of Cuban socialism (see Rosendahl 1997: 56).
The state has tried to balance the gendered nature of nurturing practices by promoting men’s responsibility for the care of their dependent kin (see also Andaya 2009b). However, historically Cuban socialism has maintained an ambiguous stand regarding local conceptualisations of the gendered division of labour. On the one hand, the need for both men and women’s equal participation in childcare and domestic work forms part of the Cuban Family Code (Código de familia –law on family relations). On the other hand, the state discourse strongly emphasises women’s central role as mothers (Andaya 2007) and in practice expects foremost material contributions from men when it comes to childcare (in the form of alimony payments).
42 Kath (2010: 127 ff. 12), however, mentions that some maternity hospitals allow men to be present during the labour.
43 In her ethnography on 1980s East-Cuba, Rosendahl mentions that women have an 18 weeks’ leave six weeks before the birth (so that 12 weeks are used after the delivery) and that they can be assigned easier or less dangerous work after the delivery (1997: 55). This differs from what my informants told me, reflecting possibly a change in state policy.
Women’s close connection with nurturing work seems to relate to both more-long term conceptualisations of gender and kinship in the Caribbean area and to shifts in state policies during the post-Soviet period. Therefore, even though state actions may cause shifts in gendered kinship responsibilities, they are often unable to overthrow these types of formal features of the local gender and kinship system completely (e.g. Cohen 2005; Friedman 2005 for China).
This relates to the question of the relationship between state structures – as both constraining and enabling – and the agency of individual women in the context of reproduction. In her account on the Cuban mother-infant healthcare program, Kath (2010) argues that the healthcare system is paternalistic and interferes with the individual agency of women to make decisions over their pregnancy and delivery. In a similar vein, Andaya emphasises the regulative and disciplining aspect of such state practices. While also recognising the nurturing qualities of state policies, she highlights women’s rejection of such close state involvement in their reproductive lives, stating, for instance, that women feel fear and horror towards maternity homes. (Andaya 2007: 110-111).
Both of these accounts draw attention to the dark side of Cuba’s extraordinary health statistics and the regulatory character of the state power.
While I understand the reasons that make researchers emphasise the controlling characteristics of Cuban state power, I never witnessed my informants directly criticise the state for trying to take excessive control over their pregnancies. However, my informants frequently complained about the bad quality and insufficiency of state services (see also Kath 2010: 104-109). When talking about maternity hospitals, my informants said that the rooms were too crowded, the food was bad, and the toilets were in a horrible condition. A female informant who was particularly critical of the conditions in the maternity hospital and who had been interned in her seventh month of pregnancy even ran away from the hospital before she was given the permission to leave. However, even though this could be interpreted as a rejection of the state participation in her pregnancy, she never explicitly stated that this would have been the reason for her leaving the hospital. While she was certainly unhappy with the conditions in the hospital, I would be cautious in automatically interpreting this as a rejection of the state system as such, as she never expressed that this was actually her intention. I did not witness my informants rejecting the actual state mother-infant care program nor did any of my informants question the authority of the state physicians that were treating them during their pregnancy; rather, my informants emphasised their expertise.44
Rather than highlighting the regulatory aspects of state power in relation to
44 The only exception is Desiree, who criticised the doctors treating her infertility.
their pregnancies, my informants embraced a view that in Cuba, pregnant women and children receive the best share of scarce resources, including the most nutritious foods available. They also mentioned that the state may help those pregnant women who have trouble with housing to find (at least a temporary) place to live. This view conforms to the official state ideology of emphasising pregnant women as a group that enjoys special protection from the part of the state. Thus, while the close monitoring of pregnant women gives the state control over the pregnancy, it also supports maternity.
Considering the state’s strong ideological commitment to the prevention of infant mortality, pregnant women’s wellbeing is crucial to Cuba’s reputation in the international arenas (see also Andaya 2007; Kath 2010). While my informants were of the opinion that pregnant women are prioritised as a group in Cuba, they also thought that the state should do more, in particular when it comes to material conditions. The issue was thus about the state not fulfilling its caring responsibilities adequately.
These deficiencies in state care are compensated through personal social relations. A pregnant woman’s kin visits her in the hospital and brings her little gifts of food and material items (such as cotton), that are frequently missing in the hospital. More importantly, the baby’s father supplies the pregnant woman with money and/or objects to be given as gifts to the health care personnel in order to ensure her a better treatment during pregnancy and delivery. Depending on the financial possibilities of the provider, these gifts may range from cans of soft drinks to large, expensive leather-coated agendas.
I was told that without gifts, the health care personnel may refuse seeing the patient or treat her badly. Despite the socialist rhetoric of free health care, gifts are in practice almost indispensable in order to receive (decent) health-care (see also Brotherton 2005; Andaya 2009a; Kath 2010: 131-164).45 While this is an aspect of the health care system that my female informants criticised, the contributions from their partners and families allowed them to overcome such problems. Moreover, by downplaying the importance of the state as an adequate provider of material care whether in the context of the maternity collection or the conditions in the hospital, my informants gave more emphasis to the material contributions from their male partners and/or family members.
45 However, doctors do not blatantly refuse to treat a patient if he or she does not bring them a “little gift” (un regalito).
Rather, gifts install an amicable social relation between the doctor and the patient and therefore ensure a better treat-ment for the patient (see also Andaya 2009a). Desiree comtreat-mented on the subject like this: “How I dislike these doctors that don’t even talk (…) to you, or explain to you why you have to do this, they only tell you that you have to do this test and that’s it, nothing more! I dislike it so that it takes away my desire to go to the doctor. And you have to bring them something because if not, they don’t attend you. The other day I went there empty-handed and he didn’t even speak to me, (…) they should tell you why, that; ‘do yourself this little test so that you will finally resolve your issue (resolver lo tuyo), and can have your little child.’ Now I have to take four soft drinks; I will call Osbel so that he resolves it for me at work, because they are a team of doctors; [two] nurses and two doctors.”
At the same time, such deficiencies in the state services increase the pressure that women lay on their male partners to supply them with cash during pregnancy and when their children are small. My informants frequently complained that especially children’s clothes, shoes, and other material items are too expensive. Due to Cubans’ meagre level of income, a pair of shoes can cost more than a month’s salary and people frequently criticised the state’s inability to provide them with affordable goods.
In terms of gendered notions of care, the state provides pregnant women with two forms of care: ‘female’ nurture and ‘male’ material care. However, what my informants complained most about was how the state fails to provide them with sufficient material care. This suggests that the state fails as a source of male care in particular. This appears to have shifted more emphasis on individual men as providers of material care than during the more prosperous years of Cuban socialism.46
The current deficiencies in state services and the greater introduction of globalised consumption models to Cuba since the 1990s may have shifted more expectations on individual men as material providers. Thus, while Andaya (2007: 169-175, 205-221, 2009b) argues that more caring work has shifted on women during the post-Soviet era, I suggest that there has also been a change in male caring work in the sense that since the fall of the Soviet Union, the expectations have shifted more on individual men to patch up for the deficiencies in state material care. At the same time, coping with the state’s material deficiencies with the help of their partners and family members provides women with an opportunity to reject full engagement with the state as a social relation of primary significance and emphasise other types of relationships instead: those based on kinship and alliance.