Maternal and child-health: What can emerging economies learn from Sri Lanka?

>98%   Child-births within hospitals (attended by midwives) 85%     Of women who deliver in facilities supervised by obs/gyn specialists ~1,000  Midwives in 2010 (as compared to 5000 in 1989) <1%        Home deliveries in Sri Lanka in 2014 (as compared to 25% in 1958)

Sri Lanka is one of the few countries with an impeccable record in maternal and child health outcomes. At ~35 deaths per 100,000 live births, the country has one of the most impressive maternal mortality rates in the entire APAC region. Policies focusing on empowering and training midwives have been critical to the country’s success in this regard.  In addition, Sri Lanka has also been able to effectively utilize health information to identify challenges and guide their decision making.

In 1930, Sri Lanka was faced with a daunting task of curbing their maternal mortality rate which stood at 2000 per 100,000 live births. Some of the key steps taken since then are summarized below:

  • Establishment of a field health system to deliver maternal and child health services
  • Field training and empowerment of midwives
  • Improved antenatal care: 99% of the population in the country is covered for antenatal care. This is primarily delivered by medical officers and public health midwives in primary health centres and by obs/gyn specialists in tertiary care centers. A nationally issued mother’s card captures detailed medical history including blood pressure and urine tests
  • Evolving continuum of care: Sri Lanka discourages home deliveries as a health policy. All the initial assessments of expecting women are conducted by nursing officers and institutional midwives followed by detailed examination by medical officers.  Once the mother and child are discharged from the hospital post delivery, the responsibility of care is passed on to the public health midwives (PHMs). As per the policy, every  postnatal  mother  needs to  be  visited  by  the  PHM  at  least twice within the first 10 days; at least once between the 11th and  28th day  and  for a visit at six weeks  postpartum
  • Neonatal care: Sri Lanka has raised the norms of neonatal care by ensuring that the majority of births happen in hospitals and supervised by trained healthcare workers. In addition, all labor rooms have basic resuscitaires for newborns
  • Sustained focus moving into 2015: The Sri Lankan Ministry of Health signed an agreement with the Netherland Government for the construction of Sri Lanka’s first fully fledged Maternity and Children’s Hospital in Beliatta. It is anticipated that the cost of setting up the entire hospital complex would be around 4,870 million Rupees. The six-storey hospital is expected to be completed in three years and will have an ICU, OR, a labour room, OPD and blood bank

Certain challenges related to maternal death from postpartum haemorrhage and unsafe abortion, and perinatal deaths due to congenital abnormalities and prematurity remain. However, given the country’s sustained focus on improving maternal and child health, Sri Lanka is expected to march steadily towards its specific millennium development goals.