The Maternal Health In Sri Lanka

Published Date: 02 Nov 2017

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Institution

Maternal Health in Sri Lanka

The maternal healthcare problem in Sri Lanka is justified by the fact that, for many years, mothers have been losing their lives due to malnutrition and complications during delivery. The problem spans through pregnancy all the way to post-delivery; hence, making the problem worth for investigation and discovery of possible solutions. Most deliveries in the country occur in a health facility supported by competent midwives. This makes it necessary for the study to be conducted because a third of the population is said to be way below the nation's line of poverty. However, the country has made efforts to ensure that the maternal mortality ratio is among the lowest in the third world fraternity (Datt & Gunewardena, 1997).

The government in this country should be commended for the good job they are doing in improving health care and education standards. This is justified in that there is a high degree of female literacy; hence, raising the female status. However, being a low income country, exceedingly many women here still have no access to decent medical care and nutrition during their expectancy period (Datt & Gunewardena, 1997).

The study's target population is all mothers in Sri Lanka who are in their active reproductive years. This means that even the mothers who get into motherhood prematurely are also captured. The target population also includes mothers who graduate into motherhood against their will like in cases of rape or forced marriages. This population will also include mothers who are educated, elite and have first class healthcare services, as well as the women who are not educated and they have poor healthcare services (Domestic violence, 2012). The population will also include first time mothers and women who have been mothers before. This will be done to capture the element of experience and exposure to maternal health care.

There are also rural dwellers and the urban dwellers in this population. The mothers who live in urban areas have an upper hand in terms of better distribution of healthcare facilities and better quality of services, and they hardly have to worry about access and quality problems. On the other hand, mothers in the rural setting have to worry about access and quality owing to the sparse distribution of healthcare facilities in the rural areas. The other demographic of this population is those mothers who are in correctional facilities. This is also applicable to mothers who go to correctional facilities during pregnancy, who need to exercise their prenatal care under the supervision of the officials at the correctional facilities (Gunetilleke, 2008). The survey will focus on the pregnant women aged between 18-45 years.

The Sri Lankan government is involved in finding ways to improve the health services in rural settings through a rural health network. Also, offering effective community investment in primary health services, improvement of basic living standards and the increase in the level of female education. Kramarae & Spender (2000) argue that this health focus is essential to the target population because; the health of a mother significantly affects the health of her child. In case of adverse effects to the child, the country will be less productive because of the emergence of less productive generations.

The maternal health problem should be thoroughly addressed to create awareness for the mothers. This is so that they can have a frequency of pregnancy that is healthy to them, good for planning for care of children, and also gives them time to engage in fruitful economic activities. More importantly, the mothers will have better quality of life in which they have control of their maternal health and nutrition issues (Kramarae & Spender, 2000).

A survey on the subject matter should be used so as to conduct an effective assessment of the health condition. The survey is necessary so that a clear image of the condition is drawn to the public’s attention. Also, to draw attention to the donors for grants and any party willing to support the maternal health program is another importance. This can be done by the surveyor having an open mind, and hence engage the target population in order to understand what actually matters to them rather than the proposed subject matter. It is necessary to determine the main causes of the poor health condition from lack of finances, lack of education or even lack of adequate government intervention (UNICEF, 2008). In general, the survey should be focused on interaction with the target population.

The primary stakeholders will be the respondents. For this survey, the target population will be pregnant Sri Lankan women aged between 18- 45 years. There will be significant attention to the group of women from the rural sections of Sri Lanka. The secondary stakeholders will be community volunteers and professional midwives who will be charged with the responsibility of maternal health sensitization for the women (Medical Statistics Unit, 2008). This area requires more funds; hence, the help from donors will be of considerable impact on the positive side.

The key stakeholders will be the donors, the ministry of public health, and the media. The ministry of public health will have the final word on whether or not the proposals on regulations are passed and applied (Medical Statistics Unit, 2008). The media would be a useful tool in the promotion of the program. This will enhance publicity and create more awareness as the media penetration in Sri Lanka is fairly good. The doctors and nurses will be useful in the provision of medical services as the donors help with the financial needs of the process.

The reduction of negative maternal outcomes will be the key objective of this process. The people who are expected to change are the priority population, and the expected improvement is about the maternal health. The pregnant woman in the priority population will be more valuable for change monitoring. Another aspect of this case that will be beneficial is the extent of change or how much is expected to change. The maternal health should be seen to improve by at least 50% courtesy of this program. The time frame of this change is also a vital factor placing the end of the year 2015 as with time the changes will take effect (Brin & Pillay, 2009). This gives the program over two years for implementation and evaluation. This is also enough time for any necessary changes.

The SMART objective of this process is to see that the negative maternal outcomes among the Sri Lankan women are reduced by half at the end of the year 2015. Some of the negative maternal outcomes that the program seeks to address are malnutrition for the expectant mother, lack of proper prenatal care, and lack of professional midwifes or doctors for the delivery process. In addition, it also seeks to address poor post-natal conditions including malnutrition of mother and child, lack of adequate post-natal care, and high frequency of births that make the mothers unable to have quality time for their babies and families. The use of contraceptives like condoms both male and female and the adoption of family planning would reduce the number of pregnancies (Brin & Pillay, 2009).

In Sri Lanka, maternal health care has had challenges. The condition of inequality in the maternal health care program is caused by several environmental determinants, which include housing, sanitation, work place, the quality of air among other determinants. In this study, the main factors of focus are sanitation, the quality of air and the work place of mothers. Expectant mothers and post-delivery mothers live in different and poor environmental conditions. Being a developing country; these cases are rampant because of the big number of women living poorly. In the traditional set up, global health policy’s main focus was to fund and provide for medical care, which included maternal health care. It is different in the world today since environmental conditions in which a mother lives in are main factors in determining her health condition pregnant women require enough nutrients but the poor environmental conditions pose danger. The health of children is at risk because, their growth require more energy, which is compromised by poor nutrition due to unfit environmental conditions (Unies, 2000).

There are different ways in which maternal health care in Sri Lanka can be addressed. This helps in reducing the dangers associated with this health problem. The factors to be considered in developing strategies are the inadequate and inefficient medical facilities, low education levels in some women and no access to good nutrition by pregnant women. One of the strategies that can be used to reduce dangers in maternal health is by improving the utilization of health care facilities. This implies that all expectant mothers in the country, irrespective of their location should be encouraged to be in constant communication with the health care providers (Skolink, 2012). This is necessary so that they can get educated on how to take care of pregnancy and also identification of any maternal health complications. The lack of communication which can be due to poor transport services leads to the risk of increasing dangers of maternal healthcare. This is because poor transport is a hindrance to emergency actions of life saving. Communication can be also due to language and cultural challenges or barriers where it is necessary that the respective parties involved should learn to involve their peers in their experiences of maternity.

Another strategy is that education should be provided to all pregnant women. This can be achieved by having pre natal classes during every clinic visit. In these clinics, the women can be reminded of the dangers at their exposure and how they can be averted. This is the best strategy since educated women, in most cases, realize the importance of using maternal health care services. This will have an impact on their attitude towards maternal healthcare services. The healthcare stakeholders should improve their management skills and ensure that the entire pregnant mother attending prenatal care should be attended to in the shortest time possible. Delays in service delivery should be minimal since the pregnant mothers are quite often tired. Record keeping of the prenatal attendance should be updated by the nurses in charge accordingly. The timing for the prenatal care and education should be during the morning hours to give allowance for the pregnant mother to rest in the afternoon (Ricci, 2009).

The maternal health care services should be affordable for every woman so that none of the expectant woman lacks the services; hence, reducing mortality rates due to complications in pregnancy. The hospital management should equip the hospital with necessary resources required during emergencies. The ambulance and the communication services to the hospital should be accessible when need be. Being a developing country, the state has a task to improve the infrastructure and communication network across the country which is important aspects to look at in the case of pregnancy immergence (Ricci, 2009). Medical facilities should be improved yearly based on the innovations and technology around the globe to enable Sri Lanka to cub the increased mortality rate.

It has been established that most Sri Lankan women are subject to domestic violence. The UN reported in 2008 that 60% of the women underwent such abuse. Specifically, the Domestic Violence (2012) reported 90, 000 such cases in their department. Men should be a reinforcing factor in the development of these maternal health strategies. They should also be educated on the dangers of violence on their women during pregnancy periods, and the importance of good maternal care to them and the unborn children. Tough policies should be enacted by the policy makers to punish the men who endanger a pregnant woman’s life through violence (Medical Statistics Unit, 2008).

Several intervention programmes are identified so as to help in reducing mortality rates and dangers associated with the maternal health problem. The intervention programmes should be divided into three stages with respect to the strength they have on the problem. These stages should be primary intervention, which may affect secondary intervention programmes and finally affect the tertiary intervention programmes. These programmes are based on the strategies used to reduce maternal health problems in Sri Lanka.

In the course of training women about good maternal care, the service providers should primarily encourage them to avoid any pregnancies when they do not have enough medical facilities in their location. This program should be facilitated by the government to help ensure that all women are exposed to the knowledge about dangers associated with irresponsible pregnancy. Women in their reproductive years will be targeted by educational programs. For the young ones, they will be educated on the dangers of early pregnancies while the older ones will be educated on the dangers of forcing the young girls into marriage at an early age. These programs will be aired through the media, and they will also be incorporated into the learning curriculum in schools. Medical facilities will provide this information through booklets and discussions of doctors with patients after their treatment. The government should be able to provide free condoms to the public for sexually active people who might not be able to purchase one to easily access it (Gunetilleke, 2008).

The secondary intervention program should encompass having mothers prevent obstetric complications in the course that pregnancy is unavoidable. This implies that since getting pregnant has no other alternative due to unavoidable circumstances, the woman should ensure that she has medical attention in the course of the pregnancy so that she does not develop problems based on the pregnancy. This will target the rural population mostly as this is the area with the lowest levels of literacy on maternal health importance, as well as scarce distribution of medical facilities. Medical professionals will travel from door to door, educating these pregnant women on the importance of seeking professional Medicare during the pregnancy period. Contact information for the nearest facilities will be provided to these women to use in the event of emergencies, and medical supplies will also be distributed to them. Home deliveries should be discouraged by the health professionals offering the education. This program should be able to run every morning during weekdays so that the women can have a chance to choose the day they are free to attend the lesson. The government should support the program by funding it for the purposes of purchasing the resources (Gunetilleke, 2008).

The final intervention program is based on providers of medical services which are known as tertiary intervention program. In this case the medical specialist will have to ensure that they avoid any mortality cases that arise due to obstetric complications. In this case, after a discovery of pregnancy complications, the medical team in every hospital both in the urban and the rural set up should work towards ensuring that there are no major cases of death. This will be achieved by using the medical facilities equipped to handle any and all complications that may arise. Donors will be looked upon to help see to this, by approving program implementations which will ensure the fulfilment of this objective. The doctors and nurses should be keen with their work to minimise complications due to pregnancies. All these intervention programs are possible only if they are based on the strategies to alleviate mortality in pregnancy (Medical Statistics Unit, 2008).

Timeline of Program Activities

Activity Period (in Months)

Signing agreements 2

Conducting of Outreach Meetings 4

Recruiting Participants 3

Assessment of needs 2

Staff Training 5

Program Evaluation 6

Signing of the program should be done by the government official, the hospital administrator and the proposer of the program. The hospital examines the intervention programmes identified in order for them to assess the possibility of attaining the goal of the project. The management come up with policies and assess the resources required for the program to be successful and reliable. The hospital management looks at the budget of the programme, the time required to accomplish the program purpose and the personnel. This can be done by the use of several project management tools like the Gantt chart or the critical path method. These tools help in identifying how long the project will take and how the tasks involved will affect the duration of the project. The resources needed should also be identified in terms of finances, technical support and even instructional resources. Personnel are also important for the general knowledge success of the program since the team to facilitate the end product should be identified in good time. The final analysis is handed to the ministry of health offices for government approval and signing (Gunetilleke, 2008).

The outreach program should be conducted by the personnel identified. The personnel encourage the mothers and expectant women to attend and gain the knowledge. The meetings are to be scheduled for the morning hours for convenience purposes. The resources available for these strategies include sufficient types of media to air the programs; for example, television, radio and internet. There are also schools with qualified teachers who will be able to educate the young girls efficiently and effectively (Medical Statistics Unit, 2008).

The participants should be all interested mothers and expectant women. The teenage girls ought to get the education from the identified teachers in their various schools. Forums are held to educate the girl child of their rights to education and not early marriage. They are also reminded of the consequences of early pregnancies. Some officials from the ministry can be appointed to participate, supervise and monitor the progress of the program. The number of medical officers should also be increased. The medical schools should admit more students to train for the job, such that there will be enough staff to attend to patients. Currently, too many patients require the attention of one doctor according to statistics, which means the officers are overworked, which could affect the quality of their work (Gunetilleke, 2008).

The resources are assessed together the needs of the society. The management is to determine which resources, required in the case of emergencies that are not available. Similarly, the need of the community must be put into consideration. However, medical facilities are yet to be fully equipped as they should be to provide high quality services to pregnant women. The distribution of such facilities should also be addresses in the rural areas. The supplies needed for the medical staff who will be visiting homes might not be enough. More facilities should be built and stocked well (Brin & Pillay, 2009).

This program aims have a 50% decrease effect by the year 2015, on the maternal problems experienced in the country. The use of critical path method should help in determining the projects that would require the most time in the program, so that the focus would be on them to achieve the expected results on time (Medical Statistics Unit, 2008). Some of the strategies will be influenced by other factors. For instance, culture allows men to ‘discipline’ their wives in whichever way they see fit, which has contributed to cases of domestic violence. It is also part of the culture to marry off young girls to strengthen family ties or business relations. Persuading the community, especially the men as the major decision makers of the family to abandon some of these cultures could prove difficult. It could be a while before they finally accept, and this could deter the effectiveness of the strategies.

The effectiveness of the program and the individual strategies could be measured by observing the reported domestic violence cases, observing the number of unexpected teenage pregnancies and observing the number of infant mortality cases in medical facilities (Medical Statistics Unit, 2008). This will help in determining which strategies are working well for the program and which ones need to be changed. The number of available medical officers should also be noted, to improve the quality of services provided by each one of them.

Conclusion

The government and all health providers should come up with a plan that will help in the implementation of the successful program. This is done by prioritizing the different strategies to reduce dangers of maternal health. Also, ensuring that a specific time is allocated for the strategy to be complete. This is because one strategy should be able to affect the other. This may only be attained by forming a schedule that is relevant to the program, and a budget that is feasible with respect to the funds available.

The government should also formulate a plan that will ensure expansion of medical facilities especially in the villages and rural set up of Sri Lanka so that even the women in the village have access to qualified medical specialists. Bottom line of the whole issue is that education should be embraced as an intervention strategy for improving maternal health care in the country. At the end of the administrative assessment, the government should be able to identify what is important and come up with a budget for the program to succeed.