Achievements in Maternal and Neonatal Health: Survival in Sri Lanka

Abstract

In Sri Lanka the origin of the organized program for maternal and child health (MCH) dates back to 1906 and the establishment of a Maternal and Child Health Department in the Colombo Municipality. The 1st health unit was created in 1926 for field health activities and by 1936 8 such health units were functioning in the country. With the outbreak of a malaria epidemic in 1935, extension of maternal and child health services was channeled through the Malaria Control program to cover all districts in the country. Trained public health midwives were appointed to the health units and improved health care was provided for women during the prenatal, natal, and postnatal periods. The health unit was further expanded reaching a total of 91 health units by 1950. At this time there are 104 such units. This scheme provided the framework for the creation of a large number of institutional and field clinic centers throughout Sri Lanka. Trained medical and paramedical personnel employed showed a significant increase. The doctor/population ratio decreased from 1/18,000 in 1935 to 1/4000 in 1979. The specialist services also expanded rapidly with the result of a marked improvement in the quality of health care provided in the country. A significant improvement in the field of maternal and neonatal health has been observed in Sri Lanka during the postwar period. Since 1945, the mortality rates have dropped from 16.5/1000 live births to 0.8/1000 in 1978, a 95% reduction. There were 3423 maternal deaths in 1940; the figure was 385 in 1975. In the early 1940s, toxemia was the main cause of maternal death with sepsis and hemorrhage taking 2nd and 3rd places, respectively. During the 1970s, hemorrhage became the main cause of maternal death, as deaths from sepsis showed a marked decline. The age specific maternal mortality rate has shown a reduction in all age groups since 1954. The decline was most marked in the under 20 age group where there has been a 89% reduction. Statistics for 1979 reveal that approximately 62% of pregnant women in Sri Lanka received prenatal care from the health centers and 55% received domiciliary care provided by the field midwives. It was observed that each field midwife on the average had made 4.2 visits/pregnant mother during the prenatal period. Available statistics do not reveal the complete picture in regard to perinatal mortality. Stillbirths were high during the 1930s with a rate of about 83/1000. Thereafter the rate declined steadily reaching a level of 20/1000 births by 1978. Perinatal mortality showed a similar pattern, the rate declining from 77/1000 births to 60/1000 in 1966. Since 1940 a decrease of 66% was observed in neonatal mortality rates. Expectation of life at birth has shown a 2-fold increase since 1920, reaching a level of 64.8 for males and 67.2 for females.