Voices of Midwives: Excerpts from the Eastern Province of Sri Lanka

Public health midwives from the Medical Officer of Health division in Eachilampattu, Sri Lanka.

Sri Lanka, with a free health care system has much to boast in the provision of reproductive health services. The country’s health indicators are often envied among its South Asian counterparts.

This is a result of investing heavily in maternal health since the beginning of the last century, which has reaped positive dividends in lowering the maternal mortality, to the lowest in South Asia — an impressive 33 per 100,000 live births.

The skill set of midwives play a crucial role here. Midwives save lives and support healthy families and communities.

Regional disparities

Despite these great advancements, regional disparities in the quality of healthcare still remain. The delivery of reproductive health services is not the same throughout all provinces of Sri Lanka, leading to inequality in health services and delivery in certain regions.

To get a more comprehensive understanding of the situation, the United Nations Population Fund (UNFPA), visited Poonagar, a community in the Eastern Province of Sri Lanka — located in the Medical Officer of Health (MOH) division of Eachilampattu.

The situation in Eachilampattu

Eachilampattu is located at the intersection of the Eastern and North Central province. Access to the area is not easy, and the scorching heat of the dry zone adds to the difficulty.

A mother and baby in the village of Poonagar, Eastern Province of Sri Lanka.

Eachilampattu is an area that was directly affected by the 26 year civil conflict in Sri Lanka, and was under the control of the Liberation Tigers of Tamil Eelam (LTTE) up until 2007. Today, Eachilampattu is home to around 3,000 families.

Consultant community physician, Dr. S. Arulkumaran, tells us that the health division has made great strides since the liberation from the LTTE.

“Vaccination coverage has increased to almost 100%, and no maternal deaths have been recorded in the past year”, he says.

There are still challenges, however.

Some politicians in the area lobby strongly against family planning programmes, which often interfere with MOH delivery of services.

Dr. Arulkumaran mentions that the Eachilampattu hospital has very basic facilities. Due to this, expecting mothers have to make the arduous, hour long journey (most often by bus) to the closest town, Trincomalee, to deliver their child.

Consultant Community Physician, Dr. S. Arulkumaran, provides an overview of the situation in Eachilampattu
“Due to the distance and isolation, skilled doctors and midwives are not willing to come and work in this area” — Dr. S. Arulkumaran.

Why Midwives Matter

The Public Health Midwives of the area echo other challenges.

“Language is sometimes a barrier” says Thilini, a young midwife working at the local hospital. While the majority of the population in the Eastern Province speak Tamil, the doctors and midwives that have been transferred from other parts of the country are only fluent in Sinhala.

English is not usually spoken in and around the communities.

“It was initially a struggle since we all spoke different languages, but we have now learned the local languages and are better able to communicate with each other, and the community”.

The supervising public health midwife, Arulrajah Gowri, believes that teenage pregnancy and early marriages are the main issues in the community. “Some are given-off in marriage as early as 16 years”, she says.

Youth from the village of Poonagar

Gowri shares a story of young 13-year-old girl in her community.

The young girl’s parents were away at work during the day, so she would spend a lot of time at the next house. When the girl suddenly became ill, her parents were shocked to learn that their daughter was pregnant. It was later revealed that the father of the baby was their neighbor — a married man with two children.

Supervising public health midwife, Arulrajah Gowri, shares stories from her community.

When Gowri got news of the incident, she met with the girl and her parents to have a discussion and advise them on their options.

How Midwives save lives

This incident created ripples within the community. But there was a silver lining.

Together with other midwives, Gowri has initiated a series of awareness programs on reproductive health in schools and community centers . She mentions that the programs have been received well within the community, with the parents and teachers extending their support.

These anecdotes affirm the critical role midwives play.

Thanks to midwives like Gowri and Thilini, births are made safer and women and girls can exercise their right to sexual and reproductive health services. Often, these midwives are key figures in their small, rural communities, and act as a solid support system for the people living here.

Since its inception in Sri Lanka, UNFPA has been supporting the Ministry of Health to strengthen the capacity and services delivered by midwives around the island. Recently, UNFPA supported the Family Health Bureau in the revision of the public health midwives curriculum, yet another step towards ensuring all women and girls in Sri Lanka have access to quality reproductive health care.

The public health midwives (left) and public health inspectors (right) work closely to ensure that women and girls can exercise their sexual and reproductive health rights in their community.

Challenges and gaps

The village of Poonagar is a great example of how midwives and health workers are pushing boundaries in their field, despite regional disparities. If Sri Lanka is to move forward and achieve universal success in its health indicators there needs to be an enabling environment for midwives to effectively serve the needs of women and girls.

The need to address these issues is a must in the journey towards achieving the 2030 agenda, while leaving no one behind.

On #MidwivesDay and every day, let’s honour midwives and their efforts in saving lives in Sri Lanka, and around the world.

Midwives from Eachilampattu embark on a community visit, striving to deliver a world where every pregnancy is wanted and every childbirth is safe.