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by Prathibashi Seneviratne

Even after centuries of so-called human development, the fact that women's rights are human rights is still not recognized and women are not allowed the freedom to enjoy all human rights. This is very evident in the current issues women in Sri Lanka face regarding sexual and reproductive rights. Women's rights here are either ignored, or frowned upon as a license for women to devalue the country' culture and traditions.

The National Committee on women, with the collaboration of NGOs and their representatives, identifies several such issues related to women's health, which they have put forth in the National Plan of Action (NPA), along with various strategies to be implemented in the future to solve these issues.

Among these, first and foremost is the lack of accurate and gender-sensitive information on women's health, which is probably the root of many of the other problems. Women's health is not given the prominence it deserves. For example, although the Annual Health Bulletin publishes all available data on health, therein is no separate chapter on the status of women's health.

A priority goal indicated in the NPA is the biannual publication of a women's health bulletin providing accurate and adequate information to the country's policy makers. However, it is important that such a bulletin gives a clear and unbiased picture of the current situation regarding women's health.

In 1994 and 1995, two important world events took place: The International Conference on Population and Development (Cairo, 1994), and the Fourth World Conference on Women (Beijing, 1995). Both these conferences established the fact that women's sexual and reproductive health and rights were fundamental to human rights.

In addition, states present at those conferences agreed that it is the duty of all national governments to ensure that women have access to all information and services regarding sexual and reproductive health. The NPA points out some important issues that clearly indicate the lack of such information and services to Sri Lankan women.

Pregnancy

Pregnant women and lactating mothers receive inadequate nutrition which has resulted in the high prevalence of low birth weight babies and the high incidence of anaemia during pregnancy. According to the UNDP statistics for year 2000,25% of infants have a low birth weight, and 39% of pregnant women suffer from anaemia. 58.3% of pregnant women in the estate sector where antenatal care is very poor compared to the rural and urban sectors, have anaemia. The Annual Health Bulletin in 1994 stated that anaemia accounted for the third most significant problem that women succumb to in childbirth.

Sri Lankan women also show poor weight gain during pregnancy. Several studies have shown a weight gain of 6.7-7kg as opposed to 11.7-17kg in developed countries. Although 98% of pregnant women receive antenatal care, the maternal mortality ratio is 60 (per 100,000 live births) as opposed to numbers lower than 10 in developed countries.

However, we must also acknowledge the gender imbalance that occurs when it comes to accessing food, especially in the rural areas. Poverty and cultural practices very often push women to eat last, or eat less than the men and children, irrespective of whether they are pregnant or not. Also, with the rising cost of living in the country, farmers focus more on growing cash crops, rather than food for their own families' consumption. Thus, a change in attitude about the status of women in our society is imperative if the current situation is to improve.

Abortion

An alarmingly high number of unsafe abortions are performed throughout the country. A total of about 700 abortions are conducted daily. Recent surveys have concluded that abortions occur at 1.8/1000 population, 11.9/MWRA (married women of reproductive age), 11.7/100 live births and 9.6/100 pregnancies. A rough translation of the above statistics will give about 34,400 and 35,720 abortions performed in 1990 and 1994 respectively. However, other sources reveal a figure of 125,000-175,000 abortions performed annually. The number of abortions on teenage girls is indicative of the poor knowledge of sexual and reproductive health among adolescents.

The fact that abortion is illegal in Sri Lanka is the leading cause for the high number of unsafe abortions, which result in various medical complications and eventually, death. Abortion is the second most contributory factor to maternal deaths in Sri Lanka.

Section 303 of the Sri Lankan Penal Code states that the "voluntary causing of miscarriage, if not caused in good faith for the purpose of saving the life of the mother, can be punished for up to three years or a fine or both". The penalties and fines also depend on intention and length of gestation. Since the phrase "in good faith" in the above statement is defined in narrow terms, both the woman and the person who conducted the operation are liable to be convicted of it is proved that they violated the clause that permits abortion "for medical purposes only".

The present Sri Lankan law on abortion completely disregards the rights of rape and incest victims, and of women carrying severely abnormal foetuses. The law also ignores the fact that the contraceptive needs of all men and women are currently not met and that all contraceptives, whether traditional or modern, have failure rates of varying degrees. As a result, there will always be a percentage of women who will most definitely require abortion and should be lawfully entitled to safe operations conducted by qualified persons under hygienic conditions.

The NPA states that inadequate knowledge of modern family planning services available at grass root level and poor knowledge about reproductive health have led to unwanted pregnancies. Unwanted pregnancies are a major concern in Sri Lanka as they result in abortion.

Contraception

Only 40% of Sri Lankan women use modern contraceptives (of which 73% resort to female sterilisation). A mere 62% of married women use contraception at all, while a 22% still resort to traditional methods, and 15% rely on the rhythm method.

This is partly due to the strong cultural resistance in modern methods like the Pill and IUD, but also due to the lack of information and services regarding contraception.

For example, family planning agencies, both State and non-State, refuse to serve unmarried women unless accompanied by their parents.

The belief that it is a women's duty to take up the responsibility of contraception is evident in the fact that male methods are very unpopular in Sri Lanka. Only 3.7 of couples resort to vasectomy and only 3.3 percent use condoms. Surveys also show a decreasing trend in the acceptance of permanent methods which is most marked by vasectomies performed, indicating poor male participation.

The NPA includes the following strategies to improve family planning services for all: opening more centres for sterilisation, encouraging agencies like the Family Planning Association to increase its network to other family planning clinics and Well Women's clinics, establishing counselling centres and conducting education programs aimed at different target groups via appropriate media.

STDs and HIV/AIDS

Sexually transmitted diseases and HIV infections are on the increase in females in the country. The NPA species the need to reduce the incidence of these infections by conducting widespread campaigns promoting the use of condoms, increasing the marketing and availability of condoms, and conducting discussions with relevant community groups and school children on STDs and HIV/AIDS. In 1997, the total number of people aged 0-49 living with HIV/AIDS was 6900, and the total adult rate (age 15-49) was 0.07%.

Sri Lanka has a high incidence of breast and cervical cancer being detected in very late stages among those affected. Women must be made aware of the importance of having regular check ups, and also of the availability of services at Well Women clinics and hospitals.

Secondly, screening facilities for common cancers are very poor and therefore must be improved in all hospitals throughout the country.

Thirdly, the lack of knowledge of pre cancerous stages and the dependency on native treatments, prevent the early detection and required treatment of malignancies.

The NPA states that women and schoolchildren must be educated on common cancers, early detection of malignancies safe examination, modern treatment methods and pre cancerous stages of common malignancies, while health staff at hospitals and well women's clinics should be motivated to deliver better services to the community.

Finally many women give low priority to themselves as they have been taught to think that way. They require motivation to value their lives and consider themselves entitled to all health services and information.

Sri Lanka has much to achieve in order to ensure that women enjoy all universal human rights and fundamental freedoms regarding their health, and changes must occur at all levels of policy making and implementation.

The longer women's rights are denied, the longer we remain as we are now, a developing nation still clinging on to obsolete traditions and beliefs, and afraid to empower women with the right to control their bodies and make their own choices.

Courtesy: Options

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