Maternal Health in Sri Lanka: 75 years of national commitment towards excellence.

Sri Lanka has a legacy of religious and cultural practices promoting health, and its rulers have been responsive to health needs of the populace. The healthcare milieu that prevailed in the pre-colonial and colonial periods favorably influenced the evolution of maternal health in the last 75 years. Since independence, maternal health in the country improved in many dimensions and directions, in the backdrop of multiple sociodemographic changes and geopolitical fluxes, while far-reaching advances in the medico-technological and communication fields were taking place at global level. By 1948, maternal health services were extensive with maternity hospitals, midwifery training school and functional health units in place. The establishment of a cadre of government-trained midwives instead of training traditional birth attendants (TBAs) was a key policy decision that brought long-term dividends. The WHO supported training primary health care workers even before opening their country office in 1952. In the early days, obstetricians relied mostly on their skills to conduct dexterous maneuvers with the generous use of rotational forceps rather than resorting to abdominal deliveries. The Family Planning Association was founded in 1953, which introduced family planning services to the country till the government took over the subject in 1958. A rigorous campaign (punchi pawla raththaran), promoting sterilization was conducted for population control in 1974 ,which resulted in the total fertility rate coming down significantly. Maternal Death Surveillance and Response system (MDSR) was established in 1981 which has been recognized globally as a success and is being upscaled to a confidential Inquiry status. Commitment and untiring efforts of the Ministry of health: Family Health Bureau, professional organizations, development partners including the WHO, have contributed for the achievements in the area of women's health.