[COLOMBO] Sri Lanka has made significant progress on maternal and child health but falls short on critical health services for vulnerable women, sexual minorities, the country’s at-risk population and those who live in former conflict areas, say the authors of a country profile on sexual and reproductive health.
This two-part report on Universal Access to Sexual and Reproductive health produced by Colombo-based Women and Media Collective (WMC) focuses on access to health services and rights issues around sexual and reproductive health. It says that the favourable national maternal mortality statistics hide regional and sectoral differences.
For instance, in the Northern district of Mullaitivu, in the former conflict zone, the maternal mortality rate is 110 per 1000 live births, while in the more prosperous district of the capital Colombo the rate stands at 8.7 per 1000 live births.
“Women from former conflict areas find it difficult to access health services which may not be easily available in their district,” notes Kumudini Samuel, a senior programme and research associate at WMC. “Women in these districts could be supported if community centres hosted regular clinics.”
Across the island, single women are often overlooked in government health schemes which adhere to conventional notions of reproductive services offered to traditional, heterosexual families. “Marriage may not be something they want for themselves, but they still want access to sexual and reproductive services,” adds Samuel
The country profile says that a lack of data on sexual minorities, in particular on Sri Lanka’s transgender population, has left the medical establishment ignorant of the health challenges faced by the group. “The members of LGBTQ community are hidden because they are criminalised, so data gathering is difficult,” Thiloma Munasinghe, a consultant community physician tells SciDev.Net. Samuel notes that sexual minorities feel unsafe about coming out because they fear losing access to health and legal services.
Evangeline de Silva, gender and sexuality programme officer at WMC, stresses the need to develop formal data gathering systems to support evidence-based policy and programming. She says such systems need to target areas where there are data gaps related to gender-based violence, sexual health rights of men, sexual dysfunctions, and sexual health rights of those beyond reproductive age.
Experts say Sri Lanka owes its impressive maternal and child care figures to policies adopted in the 1940s — healthcare in the island nation is financed primarily by the government, and a nationwide network is in place. However, Munasinghe notes that 30 years of war have impacted the delivery of essential health services and that “poverty pockets”, where access is poor, remain.
Gaps also exist in accurate data on HIV and AIDS. Sri Lanka is currently classified as a country with low prevalence with some 2,074 cases identified as of December 2014. “We can’t say those are the only ones because we still haven’t reached the most at-risk population,” cautions Madhusha Dissanayake, director of HIV/AIDS and advocacy at the Family Planning Association. According to the report, men who work as migrant workers, men who have sex with men, sex workers and members of the armed and police force fall into the at-risk population.
The country’s healthcare infrastructure will be put to the test as Sri Lanka sets out to eradicate syphilis and prevent new transmissions of HIV from mother to child by 2017. Munasinghe explains that a key part of the government’s strategy would be to package HIV testing with the standard health screening for pregnant women.
“Although we have a robust health service, we need to be aware of gaps,” says Samuel, adding that lack of access to and availability of public health services in under-serviced areas should be cause for concern.