The new Family Code (FC) has come to revolutionize sexual and reproductive rights, and especially a series of aspects in the way of doing Assisted Reproduction (AR). To find out about the changes that this bill brings to Cubans, for which we will vote next Sunday, September 25, we spoke with Pedro Montes de Oca Santiago, 1st-grade specialist in Gynecology and Obstetrics, and head of the territorial RA of West.

In relation to the scope, impact and objectives of the Code, the assistant professor explained that it opens the possibility for AR to benefit not only the infertile couple but also the homoparental couple, and will also allow several things to be done that until now we had not done. “It even gives the possibility to the person who lives alone, to have the right to reproduce. The man who lives alone can have a child through the supportive womb, or the also named gestation and supportive motherhood, which in the world is called surrogate motherhood, "he specified.

The term used in our family code is “supportive womb”, which is nothing more than having a person so that the embryo is implanted in her womb, carrying the pregnancy to term and giving birth to a baby, for another person who will become the parent of the child. This requires the creation of a series of legal mechanisms to be able to do so. The code introduces the possibility, and from this the reproduction law is being elaborated, because in Cuba it did not exist.

_In relation to the RA, in which moments we find ourselves

A: Right now we are in a commission preparing that law. The first part of the process has already been done, now the lawyers are working. We put the technical part through a commission created some time ago that worked a lot on the subject.

_ From the medical side, who has participated in its elaboration

_In the Ministry, a commission of experts was formed that included colleagues who do assisted reproduction at the Hermanos Ameijeiras hospital, González Coro and other centers of this program in the capital.

Colleagues from Holguín and Cienfuegos, provinces where two of the four high-tech assisted reproduction centers in the country are located, were also summoned. The one from Holguín for the entire east; that of Cienfuegos for the center; the Hermanos Ameijeiras (the oldest) serves Matanzas and Mayabeque, and deals with intracytoplasmic sperm injection (ICSI).

_What does this technique consist of and what is its benefit

_It is an In vitro fertilization technique that is only performed in this institution, since it is the only one that has the instruments to do so. It is carried out when the masculine factor is very altered. Intracytoplasmic injection is a more specific technique: a microneedle breaks the cytoplasmic membrane of the egg to inject the sperm. In this case, an induced union is produced, and it is a procedure indicated in cases of severe male sterility, which cannot be resolved with other techniques.

_Which people may benefit from the RA modalities included in the Code

_The FC will establish which people can be done, how often and all the requirements for the technique. After the law is prepared, progress is made in the legal part, which will be approved, if the FC is endorsed. We are preparing action guides, specific methods of how each of these techniques will be implemented.

_Until now, what does the FC establish in terms of assisted reproduction.

_ The FC includes solidarity gestation, precisely this constitutes the most novel aspect for Cuba, and which is a very controversial technique in the world. Solidarity maternity is exceptional and carries a judicial approval in court. It proceeds between people united by family or emotionally close ties, for the benefit of women who cannot conceive, of sterile people. The most innovative aspect is the possibility that homoparental couples and people who are alone can access AR techniques, provided that the health of those involved in the medical procedure is not endangered and the requirements established by the law: that there is no economic compensation, and is based on respect for dignity as a supreme value.

_ If the code is approved, this program could be started.

_It is necessary to be clear that talking about the subject to the population raises hopes and we really do not have a forecast of when the program will begin. In the contact we have had in the preparation of the law, we have exchanged with colleagues from the Ministry who direct this program, and they do not have a short-term solution. At present, seeing the conditions that the country is facing and the efforts being made to guarantee such essential resources as food, medicine, and the vitality of key services for the population and the economy, it is not possible to allocate the necessary means to this program for its development and sustainability.

The cost of the technology and supplies required by the program is considerable. We understand that the country has it as a priority, but it is quite difficult to maintain it: you have to buy medicines, reagents to make hormonal determinations, culture media, expendable material, everything is very expensive, but they have to be there at the same time. Because if you have drugs and culture media are missing, you can't do anything. Stability in the supply of these resources is essential for us to get started.

_ What actions must be implemented to initiate the RA procedures included in the new Code.

_ In addition to material resources, it is also necessary to have a bank of ovules and semen, to have the cells or gametes suitable to be able to use them. In Cuba there are no these types of banks, nor legislation. However, the new code establishes the bases to create them. In reality, the bases have been created, we have been working on them for a long time, but we do not have donors. We have gone to the University of Havana and tried to do it with our comrades from the FAR to obtain donors.

The also Master in comprehensive care for women commented that with semen and ovules it does not work like with blood donation, which is done and is available. This activity, he said, must contemplate regulations for the donor, guarantee the safety and cryo-conservation of the samples. According to Montes de Oca, this is a more complex process that will also be addressed in the FC.

"The correct and established norm in the world, he indicated, is that the donation be totally anonymous. In our country there is the will to do it, but the problem is finding people who do it in solidarity. In relation to the way in which it proceeds in Cuba, he maintained: "We have given the possibility, and this was in law, of having a family donor. This possibly extended to emotionally close people. In women, steps had been taken, they could bring a family member, but still altruistic donors are few, with respect to the number of people who require the technique. In the case of man, it was more complicated and this possibility did not exist. With the FC you can also bring a family member, or another man.

"Until we have an egg or sperm bank, well, we will have to use these options. That is, the person comes with her donor, selected by him or her," he added.

_What message would it convey to the population?

_The most objective message that I would transmit to the population is that the possibility exists. The legal framework is being created and requires many actions and resources to make it available to people. I think that, even if the FC is approved, we are not going to carry out these procedures immediately. You must first have the regulatory framework, and have the resources required to start.

_How do you assess the opinions and resistance of some people in relation to assisted reproduction in FC.

_The Cuban population still sees FC as too advanced for our idiosyncrasies. Naturally, like any change, it must be implemented little by little. Now it seems like a very new thing but it is not so, if we talk about what is happening in the world. And Cuba necessarily has to travel there. What is favorable about the Code is that it is giving us the possibility of having a law that lasts over time. These changes will be implemented little by little, the first thing that must exist is a legal framework that protects everyone's right to form a family. And that is precisely what the code is giving: legal protection for the expansion in the use of a medical service that, with restrictions, has been used in the country for years. Afterwards, it will be up to the Ministry of Public Health to create the objective, structural, scientific and human bases for all this to develop, basically speaking of AR.

There are many people who call and ask what they want to know, but we cannot create a very high expectation due to the difficulties explained. I imagine that there are many hopeful people, because those who want to have children, especially homoparental couples, at least see a light at the end of the tunnel. Because until now it is not possible, and the Code, under an absolutely inclusive criterion, will allow everyone to resort to AR techniques, to make this dream come true.

_ What other projects do they work on?

_ We are immersed in a joint project with France for the preservation of fertility in cancer patients who have not had children or who wish to have children. Its objective is to give them the possibility of preserving their eggs or sperm, so that, after completing the chemotherapy or radiotherapy treatment, if they meet the medical criteria and the oncologist allows it, they can undergo In vitro fertilization.

Principles of Assisted Reproduction

Solidarity gestation will have three fundamental controls: legal, health and judicial scrutiny. A court will issue a warrant if all legal and medical requirements are met.

In solidarity gestation, any type of remuneration is prohibited, except the legal obligation to provide food in favor of the conceived and the compensation of the expenses generated by the pregnancy and childbirth. The pregnancy will be for altruistic reasons or unrelated to any monetary or commercial compensation.

For assisted reproduction, there must be the consent of the participants. The will of the people involved in the process is understood to be externalized through free, informed, express and previously issued consent before the health institution or in notarial public deed.

Consent may be revoked at any time until the procedure has been initiated or the embryo transfer has occurred, and must be renewed before the health institution or in a notarial public deed, each time gametes or embryos are used.

The health centers cannot carry out the embryo transfer in the surrogate mother without judicial authorization.

People born through assisted reproduction techniques have the right to know that they were conceived through such procedures when it is relevant to their health. In addition, they can obtain information on their gestational or genetic origin and the medical data of the gamete donor, excluding their identity.

Only in exceptional cases in which the identity must be made known, the existence of a relevant reason with duly founded reasons must be proven through the courts.

The acknowledgment or the exercise of action to claim filiation with respect to the person who gives the gametes is not admissible, nor in this respect to the determination of the biological filiation of the daughters and sons born through the use of assisted reproduction techniques in which their gametes were used.

When third-party gametes obtained by anonymous dation are used, no legal link is generated with it. This would also be the case if it occurs with the use of gametes from a known person, with their consent, unless there is an agreement to assume a multiparental relationship, that is, that all the participants contribute to the upbringing of the baby in a legal and affective way. .

read also

Guide to read the new Family Code

Download: Law 156/2022 "Family Code" - Official Gazette

By Yuliet Gutierrez Delgado