Has Cuba no paracetamol and thus 'virtually no autism', as Trump claims?

Trump claims Cuba’s lack of Tylenol means low autism rates—but evidence linking paracetamol use in pregnancy to autism remains limited and contested

• CLAIM: U.S. President Donald Trump claimed: "There’s a rumour and I don’t know if it’s so or not that Cuba, they do not have Tylenol because they don’t have the money for Tylenol, and they have virtually no autism."

• BACKGROUND: After a months-long investigation, the Trump administration announced the contentious conclusion that paracetamol during pregnancy is linked to a higher risk of autism in children.

• METHOD: We looked at research papers, official documents and expert statements to investigate Trump's assertion.

• RATING: There is limited and contentious evidence to support Trump's assertion of significantly higher levels of autism in the U.S. than Cuba, and no means to link the prevalence in either country to the use of paracetamol.

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Background

U.S. President Donald Trump has made the highly contentious claim that there is a link between autism and the use of acetaminophen - also called paracetamol and branded as Tylenol in the United States - during pregnancy. The American president on Monday announced the US Food and Drug Administration will notify doctors that the use of the drug during pregnancy can be associated with a "very increased risk of autism." The scientific community immediately reacted, saying that there was no solid evidence of a link between this drug and autism.

During a press conference at the White House, Trump also said, "There is a rumour, and I don't know if it's true or not, that Cuba doesn't have paracetamol because they can't afford it, and there is practically no autism."

US Health Secretary Robert F. Kennedy Jr. said that the FDA wod update the drug's safety label to warn of a possible link between its use during pregnancy and autism in children. The discussion around medication use and autism is not new in the United States. US Health Secretary Robert F. Kennedy Jr. has previously promoted theories about rising autism rates in the United States and vaccines. In March 2025, the Centers for Disease Control and Prevention (CDC) announced plans to launch a large study into potential links between vaccines and autism. Many scientific studies across numerous countries have failed to establish any connections. There is no confirmed involvement from RFK Jr. in the planned CDC study.

On Monday, the FDA issued a more nuanced advisory, acknowledging no causal relationship has been established and that studies on the relationship between paracetamol and autism have produced conflicting results.

"It is important to note that while an association between acetaminophen and neurological conditions has been described in many studies, a causal relationship has not been established, and there are contrary studies in the scientific literature," it said.

YouGov reports that the OTC (over-the-counter) pharmaceuticals market in the US has had an estimated revenue of USD 40.72 billion in 2024 and is forecast to experience a compounded annual growth rate of 3.52% from 2024 to 2028.

Data from YouGov Profiles shows that cold and flu relief medication tops the list of OTC drugs purchased by Americans over the past six months (40%), followed by internal pain relief medicines (38%).

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Access to Paracetamol in Cuba

Cuba has no direct access to the drug marketed as Tylenol, which was referred to by Trump. However, the agent acetaminophen that is branded as Tylenol in the US is available in Cuba, typically referred to as paracetamol.

Paracetamol has been one of the most commonly used and prescribed medicines in the world since the early 1950s, known by different names depending on the country and market.

Various sources show Cubans use paracetamol. This list of products available in a pharmacy of La Habana mentions various painkillers sold under the label "paracetamol." The Ministry of Health of Cuba published a communication in February 2025 regarding the use of paracetamol, including a recommendation for its use.

However, there can be extreme shortages of the drug. In early September, the Spanish-language news agency EFE reported a five-year-old boy died and an eleven-year-old boy remained hospitalised in the eastern province of Santiago de Cuba after consuming expired paracetamol. It said (1, 2) that "Cuba has experienced a shortage of medicines across the island, and obtaining medicines such as paracetamol can be difficult. (...) A box of paracetamol, an antibiotic, an anticoagulant, or a tube of antifungal cream are sold for up to ten times their retail price in their country of origin on Facebook groups or websites."

Cubans don't have Tylenol, but they do have access to paracetamol. Though, as claimed by Donald Trump, the Cuban population has a more restricted access to the universally known painkiller due to regular shortages.

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Is there a scientifically proven link between acetaminophen and autism in children?

“There is no robust evidence or convincing studies to suggest there is any causal relationship, and any conclusions being drawn to the contrary are often motivated, under-evidenced, and unsupported by the most robust methods,” said Monique Botha, associate professor in social and developmental psychology at Durham University, UK.

The Swedish research of Karlinska University conducted a large-scale study on the risk of using acetaminophen during pregnancy. The data set was obtained from the Swedish registry of 2.4 million children born between 1995 and 2019. Some 186,000 children were selected based on their mothers' prescribed use of acetaminophen (paracetamol) during pregnancy. The results were compared with the prevalence of autism in siblings where there was no paracetamol treatment during pregnancy. The study found no increased risk of autism when paracetamol was used.

Similar results were found in a study conducted in Japan, where data for 200,000 children were examined. The initial results indicated a small risk of using acetaminophen during pregnancy. The final results show no link with the added comparisons of siblings and consideration given to potential biases.

The European Medicines Agency has issued a longstanding recommendation for the conservative use of paracetamol during pregnancy, advising individuals to consult a doctor and use the lowest effective dose for the shortest possible time. However, the study does not explicitly link this to autism.

Among the research referenced by The White House linking acetaminophen use in pregnant women, especially late in pregnancy, top long-term neurological effects in their children is a 2019 John Hopkins University. It analysed umbilical cord blood samples and found that newborns with the highest exposure to acetaminophen were about three times more likely to be diagnosed with ADHD or autism spectrum disorder in childhood.

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Difficulties comparing autism data globally

Comparing autism figures globally is a statistical challenge. Attempts have been made, such as a review of research literature published in the Lancet around the world that shows considerably lower prevalence of autism in Cuba.

There is no unique source, and data collection by each country does not follow the same criteria.

However, let's take the main European countries as an example. We see that they have a lower rate of autism than other regions, and paracetamol consumption during pregnancy is widespread, as the European Medicines Agency pointed out on Tuesday. EMA said on Tuesday that there was no new evidence that would require changes to the region's current recommendations for the use of paracetamol during pregnancy, adding paracetamol could be used during pregnancy when needed, though at the lowest effective dose and frequency.

Experts believe the prevalence of ASD is increasing in the US, from 1.1% in 2008 to 2.3% in 2018, is "likely associated with changes in diagnostic criteria, improved performance of screening and diagnostic tools, and increased public awareness," according to 'Autism Spectrum Disorder: a review', published by JAMA (Journal of the American Medical Association). The significant increase in autism diagnoses in the U.S. over the last 25 years is likely to be owed to the fact that there is more widespread screening and broader criteria, many researchers believe. In contrast, there is very little peer-reviewed, up-to-date epidemiological data on autism in Cuba, as the Cuban government has recognised.

A Google search reveals that autism in Cuba is a topic of public debate and a cause for concern in the health sector. The Cuban government has promoted national plans to improve care for patients and their families. For example, the Borrás-Marfán University Paediatric Hospital in Havana was recognised at the 2022 Eureka World Science Awards for its project providing early and comprehensive care for children with autism spectrum disorders.

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SOURCES

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Global Burden of Disease Study 2021 Autism Spectrum Collaborators. (2024) The global epidemiology and health burden of the autism spectrum: findings from the Global Burden of Disease Study 2021. The Lancet Psychiatry. 19 December 2024. doi: 10.1016/S2215-0366(24)00363-8.

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