Conceiving Cuba: Reproduction, Women, and the State in the Post-Soviet Era

1. Introduction

1 By the time the family doctor clinic opened its doors to the waiting line of patients at eight thirty in the morning, the streets were already bustling in this densely populated Central Havana neighborhood. Flower sellers set up their brightly colored stands on the broken pavements. Convivial groups of people on their way to work gathered under the peeling, wrought-iron balconies of nineteenth-century homes while they drank small shots of strong, sweet coffee sold from the street-level windows. Adding a constant level of noise to this scene, battered American Fords and Chevrolets—that pre-date the 1959 revolution and now serve as collective taxis—clattered and banged their way down the street, stopping frequently to pick up and discharge passengers, while the boxy, Russian-made Ladas imported during Cuba’s Soviet-subsidized 1970s and 1980s wove briskly between them. The health clinic where I observed weekly neonatal and prenatal health consultations was unremarkable. Except for the fact that the wall sported a nowfaded revolutionary slogan—“Lies may go a long way, but in the end the truth prevails. Viva Fidel!”—the building was virtually indistinguishable from the concrete houses and state-run businesses surrounding it. Its windowless and graying cinder-brick walls were interrupted only by a narrow band below the roof, where latticed bricks permitted the circulation of both air and extremely high levels of street noise. Today was Wednesday, a day supposedly reserved for prenatal health consultations, although when I entered the waiting room, I noted that as usual the wooden benches were filled with elderly patients hoping to receive immediate medical attention. Smiling at the people I recognized from the neighborhood, I passed into the sparsely furnished office. At the desk sat Dr. Janet Torres,1 a plump, dark-skinned woman whose gentle manner and quick smile made her a favorite among patients. Despite 1 Introduction Reproduction, Women, and the State 2 CONCEIVING CUBA the fact that the clinic had just opened, she was already with a patient whom I recognized, Gisela Navarro, a slight woman in her mid-thirties who was now in the twenty-sixth week of her second pregnancy. I sat as Janet continued with the standard physical examination of pregnant women that included blood pressure reading, comparison of uterine measurements against gestational age, weight gain, and other routine tests. She carefully recorded each number in the patient’s clinical chart, while I helped by recording the results for the file that Gisela would keep with her. When Janet reached the line of numbers that charted Gisela’s weight gain over the course of her pregnancy, she paused, frowning. “Are you eating well?” she asked. Gisela responded in the affirmative. Janet shook her head in disbelief , and told Gisela that her weight gain continued to fall under desired norms. “I’ll give you a couple more weeks,” she went on, “But if your weight gain continues to be below normal I’ll have to admit you to a hospital until your weight improves.” Gisela nodded, and promised that she would pay more attention to her diet. After she had carefully slipped her patient file into a tattered ziplock bag and departed, Janet shook her head again. She knew this family; Gisela worked in a nearby government ministry and her husband, stepfather to Gisela’s daughter from a prior relationship, was a state-employed chemist in a Cuban pharmaceutical factory. They were gente humilde (“humble people”), Janet told me, who lived entirely on their low state salaries without support from remittances or work in the informal entrepreneurial sector with which many Cuban families supplement their wages. Like all pregnant women in Cuba, Gisela received special prenatal rations that included additional milk and yogurt allotments. Yet given Gisela’s continued insufficient weight gain, Janet suspected that she was giving away her supplementary rations rather than consuming them herself. The recipient, Janet believed, was Gisela’s daughter, who had recently turned seven years old and had thus become ineligible for the additional dairy rations that the state provides to young children. While most families were able to supplement their older children’s diet with food purchased outside the ration system, this family ’s tight household economy forced Gisela to choose between nourishing herself and her daughter. “It’s true, her daughter is very thin, probably not well nourished,” Janet acknowledged. “But what can I do? I can’t have her giving up the food she needs for her [unborn] baby...