The Safe Motherhood Initiative reduces maternal deaths in Sri Lanka

 

Sri Lanka reduces maternal deaths

In Sri Lanka, where a third of the population are estimated to live below the national poverty line, maternal mortality ratios are among the lowest in the developing world. Most deliveries take place in a health facility, with the support of a skilled birth attendant. This achievement is the result of government commitment to improving education and health care in Sri Lanka, the relatively high status of women, and high female literacy rates.

In many developing countries, women still do not have access to good antenatal care or adequate nutrition during pregnancy. Only about half of all deliveries are assisted by a skilled birth attendant (a doctor, midwife, nurse or community worker with midwifery training) -- one of the key requisites for safe motherhood. Every year, 60 million births take place in which the mother is helped by a family member or an untrained traditional birth attendant -- or gives birth alone. The problem is often compounded by poor follow-up care for both mother and baby and by a lack of family planning services to ensure that any future births are well spaced. WHO estimates that providing this minimum level of care -- the so-called Mother-Baby Package -- would cost about US$ 3 per person each year in low-income countries.

In the midst of this casual disregard for the human rights and well-being of millions of women in developing countries, Sri Lanka is one country that stands out for its long-term commitment to safe motherhood. Infection rates have been reduced and the maternal mortality ratio is one of the lowest in the developing world at 60 per 100 000 live births. Since 1990, the number of maternal deaths has been halved from 520 to 250 in 1998.

Today, over 96% of deliveries in Sri Lanka are attended by a skilled birth attendant and over 90% take place in a health facility -- with a referral system in place to ensure transport to one of 45 hospitals if complications occur. All first pregnancies and high-risk pregnancies are referred to health facilities with obstetricians. And a network of community midwives provides antenatal care for about 75% of women throughout their pregnancy.

Yet Sri Lanka is not a rich country. In 1998, its GDP was only US$ 802 per capita and more than a third of the population were estimated to be living below the national poverty line. By comparison, in Côte d'Ivoire, with a slightly higher GDP of US$ 823, maternal mortality ratios are ten times higher.

Sri Lanka's success in preventing maternal deaths has been achieved against a backdrop of government commitment to improving education and health care. Over 93% of people today have access to basic health care. Health services are provided free of charge -- although over 50% of people use the private sector -- and few people are more than 1.4km from the nearest health centre. Maternal and child health services are available at community level as part of integrated reproductive health services. Contraception is used by over 60% of married women -- allowing them to space pregnancies and limit family size. This has also helped reduce maternal deaths.

Another driving force today is the education and relatively high status of women. Adult literacy rates among women are 88% and girls have access to free education up to university level. As a result, there has been an increase in the age of marriage -- to 25 in 1993 -- and women are better able to take advantage of family planning and maternal health services.

However, continuing efforts will be needed to reach the small percentage of women in Sri Lanka who still do not have access to good maternal health care. Of the 5% of women who give birth at home, not all have access to a skilled birth attendant. And maternal death ratios are far higher in the north of the country due to the ongoing civil conflict and poor living conditions. Elsewhere, unsafe abortions account for an estimated 5%-9% of maternal deaths each year.