Family Planning in Asia and the Pacific - International Council on ...
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Family Planning in Asia and the Pacific - International Council on ...

Family Planning in Asia and the Pacific - International Council on ... Family Planning in Asia and the Pacific - International Council on ...

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30.07.2015 Views

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Historical overviewIn ong>theong> ong>Asiaong>n context Sri Lanka is unique ong>inong> that it has a longhistory with regard to maternal care ong>andong> data collection.The first organized effort towards providong>inong>g childbearong>inong>gwomen ong>inong> Sri Lanka with such care commenced ong>inong> 1879with ong>theong> establishment of ong>theong> De Soysa Hospital forWomen ong>inong> Colombo. The registration of traditionalmidwives began ong>inong> 1887, ong>andong> from 1902 maternalmortality statistics were reported ong>inong> ong>theong> Annual Reportof ong>theong> Registrar General. The first antenatal clong>inong>ic washeld ong>inong> 1921, ong>andong> ong>theong> first health unit was established ong>inong>1926. By 1950, 91 health units had been established. Thehealth units provided domiciliary as well as clong>inong>ic servicesdurong>inong>g pregnancy; traong>inong>ed assistance at delivery throughong>inong>stitutions or at home; ong>andong> care durong>inong>g postnatal periodong>andong> ong>inong>fancy. The expansion of maternal ong>andong> child healthservices contributed significantly to lowerong>inong>g maternalong>andong> ong>inong>fant mortality rates. The maternal mortality ratiodeclong>inong>ed from 2,650 per 100,000 live births ong>inong> 1935 to 560per 100,000 ong>inong> 1950. Similarly, ong>theong> ong>inong>fant mortality ratedeclong>inong>ed from 263 to 82 per 1,000 live births durong>inong>g ong>theong>same period. Durong>inong>g ong>theong> period 1950-1965, ong>theong> maternalong>andong> child health ong>inong>frastructure was furong>theong>r developed; ong>theong>number of midwives ong>inong>creased by more than two-fold. Thematernal mortality ratio contong>inong>ued to declong>inong>e to 240 per100,000 live births ong>andong> ong>theong> ong>inong>fant mortality rate to 53 per1,000 by 1965.The family plannong>inong>g activities ong>inong> Sri Lanka commencedong>inong> a modest manner with ong>theong> establishment of ong>theong> ong>Familyong>ong>Plannong>inong>gong> Association ong>inong> 1953; it was founded by agroup of enlightened women who were concerned aboutong>theong> high maternal ong>andong> ong>inong>fant mortality rates that wereprevalent among low-ong>inong>come urban families due to poorbirth spacong>inong>g. Thus ong>theong> ong>inong>itial work of ong>theong> Associationfocused on reducong>inong>g maternal ong>andong> ong>inong>fant mortality ong>andong>malnutrition among ong>theong> poor. The government recognizedong>theong> work of ong>theong> Association ong>inong> 1954 by providong>inong>g it withan annual grant.In 1958, an agreement was signed between ong>theong> governmentsof Sri Lanka ong>andong> Sweden for cooperation ong>inong> a pilot projecton family plannong>inong>g. The maong>inong> objectives of ong>theong> project wereto ong>inong>vestigate attitudes towards family plannong>inong>g; assess ong>theong>prospects of family plannong>inong>g activities; provide ong>inong>formationon family plannong>inong>g methods; ong>andong> traong>inong> health personnel ong>inong>ong>theong> delivery of services ong>inong> selected project areas. A surveyon family plannong>inong>g attitudes revealed that ong>theong>re was nomajor religious opposition to family plannong>inong>g ong>andong> that alatent demong>andong> for family plannong>inong>g existed.Durong>inong>g ong>theong> period 1958-1965, family plannong>inong>g activitiescontong>inong>ued to gaong>theong>r momentum. The number of clong>inong>icsrun by ong>theong> ong>Familyong> ong>Plannong>inong>gong> Association ong>inong>creased from35 to 135. When ong>theong> 10-year economic development plan(Ten Year Plan) was presented ong>inong> 1959, it highlightedong>theong> implications of ong>theong> rapid ong>inong>crease ong>inong> population ong>inong>Sri Lanka after 1946 ong>andong> its effect ong>inong> skewong>inong>g ong>inong>vestmentaway from directly productive economic activities. In1960, a labour force survey conducted with ong>theong> assistanceof ong>theong> ong>Internationalong> Labour Organization showed thatong>theong> unemployment rate had ong>inong>creased to over 10 percent. Therefore, ong>inong> view of ong>theong> above, it became evident topolicymakers that ong>theong> population growth rate ong>inong> ong>theong> countryneeded to be brought under control. The governmentonce agaong>inong> emphasized ong>inong> its Short Term DevelopmentProgramme presented ong>inong> 1962 ong>theong> importance of brong>inong>gong>inong>gdown ong>theong> rate of population growth due to its adverseimplications for economic ong>andong> social development.Thus ong>inong> 1965, family plannong>inong>g became a nationalprogramme ong>andong> was ong>inong>tegrated with ong>theong> maternal ong>andong>child health programme of ong>theong> Mong>inong>istry of Health. Itwas three decades before ong>theong> ong>Internationalong> Conferenceon Population ong>andong> Development (ICPD), that Sri Lankarecognized ong>theong> importance of ong>inong>tegratong>inong>g family plannong>inong>gwith oong>theong>r reproductive services, such as maternal ong>andong>child health. The social ong>andong> political environment ong>inong> ong>theong>country was conducive to implementong>inong>g such a programme.The primary health-care system was well developed witha network of ong>inong>stitutions ong>andong> traong>inong>ed personnel. About70 per cent of women ong>inong> ong>theong> reproductive age groupwere literate. Meanwhile, ong>theong> Swedish-Sri Lanka ong>Familyong>ong>Plannong>inong>gong> Project, which collected a good deal of data,showed that fertility control could be achieved by familyplannong>inong>g methods acceptable to ong>theong> people. Thus ong>theong>efforts of both ong>theong> ong>Familyong> ong>Plannong>inong>gong> Association ong>andong> ong>theong>Swedish-Ceylon Pilot Project demonstrated ong>theong> need forfurong>theong>r action.Launchong>inong>g phase, 1965-1975In 1965, ong>theong> government renewed ong>theong> agreement withong>theong> government of Sweden to obtaong>inong> equipment ong>andong>contraceptive commodities to implement ong>theong> nationalfamily plannong>inong>g programme. In 1968, ong>theong> ong>Familyong> HealthBureau was established ong>inong> ong>theong> Mong>inong>istry of Health tocoordong>inong>ate ong>andong> implement ong>theong> maternal ong>andong> child healthong>andong> family plannong>inong>g activities. By 1971, as a result of ong>theong>rapid growth of ong>theong> youth population, ong>theong> unemploymentrate ong>inong>creased to more than 20 per cent of ong>theong> labourforce, which resulted ong>inong> a youth uprisong>inong>g ong>inong> April that year.Therefore, ong>inong> 1972, when ong>theong> Five Year Plan was presentedby ong>theong> government it emphasized ong>theong> need to slow ong>theong> rateof population growth, which ong>theong>n was growong>inong>g at 2.3 percent annually. The Plan stated that, if action was not taken,Sri Lanka would have a population of 27 million people byong>theong> year 2000. Therefore, ong>theong> Plan gave high priority to ong>theong>diffusion of family plannong>inong>g services among ong>theong> mass of ong>theong>adult population. In 1973, a project agreement was signedby ong>theong> government with ong>theong> ong>theong>n United Nations Fund for219

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