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Universal access to sexual and reproductive health

17 January 2016 07:39 pm - 0     - {{hitsCtrl.values.hits}}

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14% of girls marry before 18 years

  • Sri Lanka’s Maternal Mortality Rate (MMR) stands at 32.5 maternal deaths for every 100,000 live births

  • Early marriage continues to happen in the North Central Province and the estate and plantation sectors

  • The Muslim Marriage and Divorce Act of 1951 does not specify the minimum age of marriage

  • Essential list of services is not available at district level



 
Sexual and reproductive health has been a sensitive issue that has been discussed over the years in Sri Lanka. Amid issues such as teenage pregnancies, sexual harassment, child abuse and other crimes increasing, many civil society groups have been instrumental in raising their voices against them. However, over the recent past there have been several instances where women and children have been subjected to the devastating consequences of violence. The following are the views expressed by Dr. Thiloma Munasinghe, Dr. Sepali Kottegoda and Dr. Nethranjali Mapitigama at a panel discussion to highlight the importance of sexual and reproductive health rights.
 

Establish Mithuru Piyasa Centres: Dr. Mapitigama

In her comments, Dr. Mapitigama suggested the setting up of ‘Mithuru Piyasa’ free counseling centres to assist victims of violence. “So far we have set up 39 centres countrywide but our aim is to have such centres at all hospitals. It is also necessary for the staff to be properly trained to empathise with the victims. In a situation where sexual harassment and violence is on the rise, we need to encourage the staff to build their capacity to be empathetic when handling these victims.”
The event was also followed by the launch of the country profile on Universal access to sexual and reproductive health and rights. Some of its highlights are as follows:
 

Sexual and reproductive rights status in Sri Lanka

According to the country profile on universal access to sexual and reproductive rights in Sri Lanka, these services have to be prioritized mainly around maternal and child health and family planning. The median age at first marriage has declined from around 25 years to 23.3 years while the Total Fertility Rate has increased from 2.1 to 2.13. Sri Lanka’s Maternal Mortality Rate (MMR) stands at 32.5 for every 100,000 live births as recorded by the Family Health Bureau (FHB). Further, data from 2013 indicates that 99.9% of all births were institutional deliveries and only 0.1% of all deliveries were conducted by untrained personnel. Sri Lanka is classified as a country with a low prevalence level of HIV/AIDS in the South Asian region with an estimated 2000 to 3000 people infected with HIV and an estimated prevalence rate of less than 0.1% adults as at 2014.

The country profile further states that Sri Lanka has signed and ratified many international conventions that attempt to address the empowerment of women, combat gender-based violence, improve the health and wellbeing of women and girls and ensure gender equality. At a domestic level, Sri Lanka has addressed sexual and reproductive rights through several policies; for example gender-based violence is addressed through various legislations, policies and programmes while HIV/AIDS is addressed through policies that address non-discriminatory practices in the work place. It also states that comprehensive sexuality education for adolescents and youth is a priority area that needs attention. Therefore, while considerable progress has been made in line with international conventions, there is still much to be done especially in terms of rights and services for vulnerable sub-populations such as women, which includes young girls from rural backgrounds, which are identified by their profile.
 

Median and Legal Minimum age at Marriage

The Asia-Pacific Resource and Research centre for Women (ARROW) highlights the purpose of understanding the difference between the median age at marriage and the legal minimum age at marriage to identify the extent to which the legal age is adhered to. According to the Sri Lankan Demographic and Health Survey (SLDHS 2009), the legal age of marriage is 18 for both males and females while the age of discretion is 16 years for females. Yet, though the median age at marriage is 23.3 years for females, 14% of girls marry before reaching 18 years of age. However, a research conducted by Goonesekere and Amarasuriya mentions that during the days of the conflict, early marriage has been adopted as a mechanism to safeguard girls and boys against conscription by the LTTE. As such early marriage continues to happen in the North-Central Province and the estate and plantation sectors. The profile also states that as Sri Lanka is a multi-ethnic and multi-religious country, legislation relating to marriage consists of the general law, customary law and personal law. It should also be noted that Muslims are governed by the personal law and as such the Muslim Marriage and Divorce Act of 1951 does not specify the minimum age of marriage. However, on the contrary the criminal law makes sexual intercourse with a child-bride below 16 years of age a rape which is a punishable offence, but it has never been implemented to prosecute a male Muslim. According to the United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP) the respect for religious ideology is identified as an argument to resist changes to the law permitting early marriage.


 

"According to the United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP) the respect for religious ideology is identified as an argument to resist changes to the law permitting early marriage."

 

Availability of sexual and reproductive health services at different levels of care

The Ministry of Health is responsible for almost all public service provisions through its extensive network of facilities throughout the island as highlighted in the country profile. The country profile on universal access to sexual and reproductive rights states that while from the 1850s to the 1980s, administration was centralized in the Ministry of Health, following the 13th Amendment to the Sri Lankan Constitution, responsibility for lower level health services was devolved to eight provincial councils. The provincial councils therefore are responsible for the management of national facilities, medical education, formulation of the health policy and bulk purchase of drugs and medical supplies. Institutional services for pregnant women are provided through a graded network of 603 hospitals spread throughout the country which have specially identified maternity wards. At district or primary level, services are provided through a network of medical institutions and health units where the Medical Officer of Health area is the smallest health unit which is managed by the Medical Officer of Health (MOH) and each district comprises seven to twenty health divisions. When looking at an overview of sexual and reproductive health services provided through the health system of Sri Lanka it was found that emergency obstetric care, HIV and other Sexually Transmitted Illnesses (STI) prevention and treatment, cervical and breast cancer screening and safe abortion services (as permitted by the law) are not available at a primary or district level.
 

Conclusion

As recommended by the Country profile on universal access to sexual and reproductive rights, Sri Lanka has made considerable advancements in the provision of health services. Yet however, the health policies currently in place need to be strengthened through the development of inclusive sexual and reproductive health policies. These policies should ensure the availability of services without discrimination on the grounds of sex, gender, age, race, marital status and other factors. In addition to that the country profile also requests the implementation of policies to address the allocation of sufficient human and financial resources to implement and monitor current health policies. It has also been identified that more efforts should be made to improve communication between men and women on issues of sexuality and reproductive health. Therefore it could be concluded that the gaps in infrastructure could result in patients facing numerous inconveniences.


Pic by Kushan Pathiraja

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