Introduction
There are two distinct stages in Cuba’s history with regard to child development services. In the first stage, before the Revolution, health services were quite limited; there were only 300 children’s health centers in the entire country, and the child mortality rate was 54 per 1,000 live births. In the second stage, following the Revolution, health services became universal, with rates of child mortality and low birth weight comparable to those in developed countries and 99.8 percent of children under the age of six attending early education programs.
Cuba’s advancement with respect to child development services is a result of the ideology, culture, and values that have oriented and driven the country’s social policies in recent decades. Among the key events in that historic processwere the creation of the National Health System (1960), the National Literacy Campaign (1961), the U.S. embargo and the Cuba-USSR trade agreement (1962), the creation of community polyclinics (1976), the creation of the Early Education System (1980), the introduction of the family doctor concept (1984), the fall of the socialist bloc and the beginning of a period of economic crisis (1989), and the launch of the social-educational program Educa a Tu Hijo [Educate Your Child] (1992). Other important changes also took place, related to university education and teaching institutes, reform of the health and education sectors, the decentralization of the government, and the contributions of Círculos Infantiles (day care centers) and scientific research centers.
The fall of the socialist bloc in Eastern Europe in 1989 and the disintegration of the Soviet Union in 1991 sparked an acute economic crisis in Cuba known as the “período especial en tiempos de paz [special period in times of peace].” With the tightening of the U.S. embargo in 1992, the crisis became even more acute. Imports and exports fell 20 to 25 percent between 1989 and 1993, and the fiscal balance as a percentage of gross domestic product (fiscal balance/GDP) fell 33.5 percent (Mesa Lago, 2005).
The tightening of the embargo and the deepening of the crisis interrupted the major advances made by Cuba in health care and education. Food and medicine became scarce, and health and education services deteriorated. Between 1989 and 1993, per capita daily caloric intake fell from 3,130 to 1,823 kcal (kilocalories) a day and daily protein intake fell from 76 to 46 grams, causing a severe drop in average weight for both children and adults. Child morbidity and mortality, mortality in children under the age of five, and birth weight indicators all deteriorated.
The Cuban government’s response was consistent with its socialist principles. Despite the economic difficulties of the special period, the Cuban government increased the percentage of the gross domestic product allocated for health and education, expanding disease prevention and health care programs and establishing universal preschool education with the launch of the Educate Your Child Program. Through that and other initiatives, Cuba was able not only to reduce the initial impact of the crisis on child development but also to improve all basic child development indicators throughout the 1990s. In short, the special period was a time of crisis for Cubans and its economic consequences could still be seen in 2003, but the period also saw progress in the implementation of social policies and programs for children.
