Resumen

ALBIZU-CAMPOS ESPINEIRA, Juan Carlos  y  VARONA PEREZ, Patricia. Maternal mortality in Cuba. Color counts. Rev Nov Pob [online]. 2022, vol.18, n.36, pp. 292-330.  Epub 22-Nov-2022. ISSN 1817-4078.

Descriptive cross-sectional study which included all deaths in which complications of pregnancy, delivery or puerperium were mentioned, whether or not this was the basic cause of death. All deaths occurring during a pregnancy, during delivery or within 42 days after the end of the pregnancy are included, regardless of the cause of death, taking into account the definitions used in the health yearbooks and including those occurring after 42 days, but before one year after the end of the pregnancy, as well as those due to sequelae of obstetric causes.

Measuring the risk of maternal death through death probabilities, first, the study avoids the limitations of the maternal mortality ratio and authors isolated the distorting effect that changes over time introduce, both in the structure of ages of women exposed to risks during the fertile period as well as in their structure by the skin color. That is why the construction of a refined indicator of risk of death, “maternal”, was decided, in which the aforementioned problems have been eliminated. In addition, the conversion of age-specific death rates in the reproductive period into probabilities of death from such causes at those same ages and in total throughout that period allowed obtaining a summary measure of the risk of death of Cuban women from those complications, a novelty in the sense that it is the first time that it is done, despite the fact that the information to do so has always been available. The combined use with techniques for the construction of life tables, from demography, also allowed an important level of refinement in the indicators, which are now free from the biases previously described.

Historically inherited social asymmetries, due to the fact that blacks and mestizos always were in position of greater disadvantage, could not be solved in the context of the policies implemented in the las sixty years, at least as far as their survival disadvantage is concerned. The analysis of the results clearly showed higher premature mortality in black women than in the rest and, therefore, greater loss of survival capacity in face of complications of pregnancy, delivery or puerperium. These findings point out evidence on health inequalities, which suggest rethinking the problem of the risk of dying from maternal mortality according to skin color, stripped of the conventional biomedical gaze that privileges the role of clinical causes of death, and articulating it with processes taking into account the impact of social determinants, as well as the detection of inadequate life conditions during the reproductive stage in vulnerable mothers who start the reproductive cycle in less favorable realities to face the gestation process, which requires from institutions paying even closer attention to social and economic factors affecting women and deteriorate their health, when it is already known that a significant set of all the underlying conditions are beyond the exclusive control of the health sector.

Palabras clave : maternal mortality; skin color; Cuba; death probabilities.

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