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.