EXCLUSIVE: US Sanctions and Cuba’s Infant Mortality Crisis

Cuba’s healthcare system was once one of the strongest public-health stories in Latin America. Its infant mortality rate was low by regional standards, and the country’s medical system remained a point of national pride even through years of economic pressure.

That picture has changed sharply.

A new report from the Center for Economic and Policy Research (CERP) links Cuba’s rising infant mortality rate to the tightening of US sanctions since 2017, arguing that the measures have helped create shortages in medicines, equipment, fuel and medical staff.

In an interview with the Wyoming Star, Alexander Main, CEPR’s Director of International Policy and lead author of the report, said the crisis is not the result of one single shortage, but of a system under pressure from several directions at once.

“US sanctions, and particularly the measures imposed since 2017, have had direct and indirect effects that have contributed to the unprecedented rise in Cuba’s infant mortality rate,” Main said.

According to Main, the most immediate mechanisms are practical and brutal: hospitals struggling to secure medicines, spare parts and functioning equipment.

“The direct effects include shortages of key medicines and medical supplies and of spare parts for medical devices, such as incubators and ventilators, as a result of measures like the 10 percent de minimis restriction on imports and the State Sponsor of Terrorism Designation, which greatly complicates payments to foreign suppliers and access to international credit lines to finance purchases,” he said.

The fuel crisis has added another layer, affecting not only transport and logistics but also the functioning of medical facilities.

“The current fuel blockade also has direct effects as it leads to the disruption of the functioning of key medical devices,” Main said.

The indirect effects are harder to measure neatly, but no less serious. Main pointed to malnutrition among pregnant women, the departure of medical personnel and a decline in preventive care for expecting mothers.

“The indirect effects include increasingly widespread malnutrition affecting many pregnant women, a dire shortage of key medical staff due to out-migration and a decline in preventitive care for expecting mothers, all of which are in part attributable to the broader economic impact of the hardening of US sanctions,” he said. “These effects create conditions that lead to a greater number of deaths of infants.”

The report’s argument is especially striking because Cuba entered this period with a healthcare system that had historically outperformed much of the region. The question, then, is not simply why conditions worsened, but why the system became more vulnerable after 2018.

Main points first to the loss of personnel.

The timing of equipment purchases also mattered. Cuban healthcare institutions acquired medical devices before later restrictions made maintenance and spare parts harder to secure.

“In the years immediately prior to the 2019 tightening of the de minimis restriction on imports with US content the Cuban healthcare sector made significant purchases of medical devices – including imaging devices and radiotherapy devices – only to end up not being able to purchase the necessary spare parts to keep many of these devices functioning, as a result of measures like the tightening of the de minimis restriction and the SSOT designation,” Main said.

That is the kind of vulnerability that rarely shows up in political rhetoric about sanctions. A device may exist inside a hospital, but without a replacement component, payment channel or supplier willing to take the risk, it can become functionally useless.

The picture is complicated by COVID-19 and Cuba’s broader economic stagnation. Main does not dismiss those factors, but argues that US sanctions made both harder to manage.

Still, he said the collapse in foreign income from areas directly affected by US measures points strongly toward sanctions as the main driver.

“However, when you look at the extent of the decline in foreign income from sectors that have been directly targeted by US measures – in particular tourism and medical cooperation – it appears to be highly likely that US policy was the primary cause of this deterioration,” Main said. “It helps account for the lack of a real economic rebound in Cuba following the pandemic as was witnessed in nearly every country in the region.”

Among the constraints affecting neonatal care (such as medicines, equipment and fuel), Main was cautious about ranking them definitively. But he said the current fuel shortages may be doing the most immediate damage.

That caution matters. The report is not framed as a claim that sanctions alone explain every death or every failure in the health system. Rather, it argues that sanctions have intensified the conditions under which neonatal care becomes more fragile: fewer staff, fewer supplies, fewer functioning devices and fewer resources for prevention.

Main also draws a broader lesson about how policymakers talk about sanctions. In public debate, sanctions are often presented as a cleaner alternative to military force. But he argues that broad economic sanctions should be understood as a form of coercion that affects entire populations.

“In the past, broad economic sanctions were typically imposed in the context of wars between nations, e.g., in WWI and WWII,” he said. “Over the last few decades, they’ve been largely dissociated from contexts of warfare and typically there is little discussion of the potential human impact of economic sanctions even though they are designed to have effects on whole populations.”

For Main, the comparison with armed conflict is not rhetorical excess. It is meant to force a more direct accounting of human costs.

The concern now is that conditions may still be worsening. Main said updated official infant mortality data is not yet available, but the signals are troubling.

“Though we don’t have updated statistics on Cuba’s infant mortality – and presumably won’t have new data until late this year – the anecdotal evidence, including many media reports, suggest that many more infants are dying and that the rate of infant mortality has increased significantly since 2025 as a result of the fuel blockade and the continued tightening of sanctions,” Main said.