This thesis investigates barriers to population fertility in Havana, Cuba. Cuba’s extremely low fertility rates jeopardize its future as the population ages without corresponding growth in new citizens. This thesis uses Cuba as a case study of the limits of traditional demographic theoretical paradigms that focus on associations between education attainment and fertility rates, taking a critical approach to paradigms based on class-based systems. This thesis employs theories in social sciences and social epidemiology, using a multi-level approach to explain contemporary barriers to fertility in Cuba. This study uses mixed methods: 1) a qualitative data collection phase consisting of interviews with Cuban citizens and health experts in Havana and, 2) a quantitative study using UNICEF Multiple Indicator Cluster Survey data to test proximate fertility determinants as informed by the qualitative phase. Study participants in Havana reported material scarcity, relational barriers due to poor household conditions, visions of a better future, and conflicting and changing relationships with the nation-state influence their fertility decisions. Using survey data, I employed an observational cross-sectional study design to test a model assessing the relationship between the reported minimum expected fertility outcomes of women in Cuba and a set of independent variables informed by the qualitative study. A binary logistic regression model produced significant results suggesting that women’s educational attainment, age, household sanitation facilities, household water source, and number of household members had a significant effect on the odds of observing the higher category of the fertility outcome variable. Controlling for all other variables, education proved not to be a significant explanatory variable. Household members and water source were significant explanatory variables while sanitation facilities was not. Recent attempts by the Cuban government to increase fertility fail to address reported systemic challenges. However, recent economic reforms such as opening the economy to a small private sector, increasing foreign remittance caps, and investing in tourism do begin to address barriers to fertility but opportunities are unevenly distributed, with pre-Revolution patterns of racial inequality emerging. I call for future research that examines how this racialized division may position White and Afro-Cubans unequally in terms of overcoming fertility barriers.