Issues and practices related to childbirth in Sri Lanka are influenced by the sociocultural composition, political history and violence within the country.
Background
Physical environment
Sri Lanka is a small island nation in the Indian Ocean, off the southeast coast of India. The island is characterized by a tropical monsoon climate that is divided into the northeast monsoon (December to March) and southwest monsoon (June to October). The terrain is mostly low, flat to rolling fertile plains. Highlands with deep valleys exist in the central-southern interior of the country. Nearly one-third of Sri Lanka's total land mass is covered by natural vegetation; however, much of it has been depleted due to intensive agricultural practices.
History
The Sinhalese, who likely migrated from India, are first people known to inhabit Sri Lanka. It is commonly believed that they arrived in the 5th century BC. Near 300 BC, there is evidence that Tamil people began to migrate from India to the island now known as Sri Lanka. The Portuguese discovered the island largely by accident in 1505 CE and established their first trading settlement in 1517. The Portuguese briefly controlled the coastal areas of the island, followed by the Dutch in the 17th century. With these colonizers came the introduction of Roman Catholic missionaries who sought to convert Sinhalese and Tamil people to Catholicism. By March 1815, the island was formally united under British rule Throughout the 19th century, the British brought Tamil workers from India to staff the growing number of rubber and tea plantations. The people of the island gained independence from the British in 1948 and formed the nation of Ceylon. The official name was changed to Sri Lanka in 1972, when Buddhism was named the primary religion of the country.
Throughout the late 20th century and into the 21st century, Sri Lanka remained a country wrought with turmoil and war. Increasing Sinhalese nationalism led to disenfranchisement of the Tamil minority. Beginning in 1983 and lasting nearly three decades, brutally violent armed conflicts took place between the separatist Tamil terrorist group, named Liberation Tigers of Tamil Eelam (LTTE), and the Sinhalese dominant Sri Lankan government force. These years were characterized by civil unrest, violence, guerrilla attacks, acts of terrorism and conventional warfare. During the conflict, Northern and Eastern provinces served as primary battlefields. It is estimated that more than 60,000 people were killed in the conflict. A ceasefire was signed in 2002, but mostly ignored and officially rejected by the Sri Lankan government in 2008 due to the continued attacks on civilians by the LTTE. The Sri Lankan government declared victory over the LTTE in May 2009 with the death of the LTTE's leader, Velupillai Prabhakaran.Goodhand, J. (2010). Stabilising a victor's peace? humanitarian action and reconstruction in eastern Sri Lanka. Disasters, 34, S342-S367.
Religion
Religion is a vibrant part of Sri Lankan culture. The predominant religions are Buddhism, Hindu, Muslim and Christianity. Buddhism was introduced sometime between 250 and 210 BC, and became the official religion of Sri Lanka in 1972. The 1978 constitution grants primacy to Buddhism, while also ensuring freedom of religion for all citizens. Throughout Sri Lanka's long history, Buddhism has remained an active part of the culture. Nearly 70% of the population is Buddhist. Due to the extensive conflict and war in the northern and eastern provinces, data regarding religious affiliation is variable. The national census states that 8% of the population identified as Muslim, 7% as Hindu, 6% as Christian, and the remaining 10% were unspecified.Department of Census and Statistics, in collaboration with Ministry of Health, Nutrition and Welfare. (2002). Sri Lanka demographic and health survey 2000. Pitakotte, Sri Lanka: State Printing Corporation The majority of Sri Lankan Muslims practice Sunni Islam. Sizable minorities of both Sinhalese and Tamils identify as Christians, most of whom are Roman Catholic.
Political system
Sri Lanka is governed within the framework of a presidential representative democratic republic. In this multi-party system the president is the head of state, head of government and the commander of the armed forces. The long-standing conflict between the majority Sinhalese and the Tamil minority is apparent within the political structure. The president is a member of the socialist capitalist Sri Lanka Freedom Party . The party was founded in 1951, and generally represents the interests of the nationalist Sinhala parties. The current Prime Minister is a member of the conservative United National Party. In 1959, Sri Lanka was led by Sirimavo Bandaranaike, the world's first female chief executive. Mahinda Rajapaksa became president in 2005 and was re-elected in January, 2010, two years before the end of his term. as now he is the leader of the primary opposition party that the socialist capitalist United People's Freedom Alliance.
Economic system
Sri Lanka's gross domestic product (GDP) per capita is US$4,900 with an annual growth rate estimated at 8%. The average annual income is US$964Kaiser Family Foundation, Global Health Facts. (2010). Country Data Source: Sri Lanka. Retrieved from http://www.globalhealthfacts.org/country.jsp?c=199 and about 6% of the population lives below US$1 per day. In 2001, the country faced bankruptcy when national debt overtook GDP. Crisis was averted when the government gathered international loans after a ceasefire was signed with the LTTE.
In 2009, a third of Sri Lankans worked in agriculture, a fourth in industry and the remainder primarily worked in services jobs. Four percent of males are unemployed. Women are becoming increasingly active in the job market and female unemployment has dropped from 22% in 1993, to 8% in 2009. The primary economic sectors include tourism, textiles, clothing manufacture, agricultural products and exportation of tea, apparel, gemstones and rubber.
Social structure and organization In Sri Lanka, there has not been a comprehensive national population census completed since 1981. The 2001 national census did not include vital information from conflict areas of the northern and eastern parts of the country. Due to the ongoing violence in Sri Lanka, most demographic data available is estimated based on 1981 or 2001 data, and variation exists among data sources. The CIA World Factbook lists Sri Lanka's current population as 20,653,913 persons. Considering the island is only , it is a very densely populated nation. Over 85% of the population live in non-urban environments. The largest city is Colombo, with a population of 1,819,777. Sri Lanka is occupied by several ethnic groups. The Sinhalese are the predominant ethnic group (74%), followed by Sri Lankan Tamils (13%), Indian Tamils (5%) and Moors (Muslim) (7%).Rannan-Eliya, R. P. and Sikurajapathy, L. (2008). Sri Lanka: "Good Practice" in Expanding Health Coverage. In World Bank (311-354) Sinhala is the national language and is the predominant language spoken by 74% of the population. Most Tamils and Moors speak Tamil, part of the South Indian linguistic group. Due to the extensive conflict between Sri Lankan government and Tamil separatists that took place in the late 20th and early 21st centuries, several hundred thousand Tamil citizens fled their homes in conflict zones and were placed in government run camps for internally displaced persons (IDPs), or sought refuge in other countries.Committee on Foreign Relations, United States Senate, One Hundred Eleventh Congress, First Session, December 7, 2009 The total number of displaced persons is unknown, though in 1994 it was estimated over 500,000 people were displaced internally and more than 200,000 people fled internationally.Chandrakanthan, A. J. V. (1994). An exodus sans destination: Refugees and the internally displaced in Sri Lanka. Paper presented at the 4th International Research and Advisory Panel Conference, University of Oxford, Oxford, England
Since 2009, considerable effort has been made to relocate the hundreds of thousand IDPs from government camps. When forced to flee conflict zones, most IDPs left behind their homes, assets, and tools necessary for their livelihoods. The Sri Lankan government reported that rations were provided for families selected for resettlement from IDP camps. These rations included agricultural tool kits, dry rations, an initial payment of Rs. 5,000 (est. US$44), a shelter grant of Rs. 25,000 (est. US$219), roofing sheets, provision of rice seed, fertilizer and transportation. Even in resettled communities, many people continue to face insecurity and poverty. As of February 2011, nearly 17,500 people continue to live at Menik Farm, Sri Lanka's largest camp for IDPs. Recent reports claim that the government hopes to resettle all conflict-displaced people by the end of 2011.Integrated Regional Information Networks (IRIN), Asia. (2011). Sri Lanka: displaced to be resettled by end 2011 Retrieved from http://www.irinnews.org/Report.aspx?ReportID=91888 Rebuilding infrastructure in northern and eastern provinces affected by war is an ongoing task.
Education
Sri Lanka's education system is state funded, and offered free of charge at all levels, including the university level. Schooling is compulsory for children from 5 to 13 years of age. The national literacy rate is 91%. The reported literacy rate of the urban population is 93%, 92% of the rural population and 75% of the estate population. The literacy rate among women is 89%. Nearly 70% of the population is educated beyond the 9th grade.
Health Information
Considering the low annual income and many years of internal conflict, Sri Lanka's health indicators are stronger than those of many other developing countries. According to the Kaiser Family Foundation's Global Health Database, 90% of Sri Lankans have access to water and 91% have access to sanitation. An estimated 2,800 people are living with HIV/AIDS, and 20,000 are living with tuberculosis. The life expectancy at birth is 74 years of age. Health services are provided to Sri Lankan citizens free of charge and over 93% of the population has access to basic health care. The national prevalence of anemia among school children is about 12%.Pathmeswaran, A., Jayatissa, R., Samarasinghe, S., Fernando, A., de Silva, R., Thattil, R., and de Silva, N. (2010). Health status of primary schoolchildren in Sri Lanka. Ceylon Medical Journal, 50(2), 46-50. About one third of Sri Lankan children are undernourished (BMI-for age below the 5th percentile for age and sex). Children in the northern and eastern provinces have a much higher proportion of health problems when compared to children living in other provinces.