FIFTH ASIAN AND PACIFIC
POPULATION CONFERENCE
11 – 17 December, 2002
Bangkok, Thailand
SRI LANKA COUNTRY REPORT
Population Division
Ministry of Health, Nutrition and Welfare
Colombo, Sri Lanka
December, 2002
EXECUTIVE SUMMARY
During the past decade, Sri Lanka has continued to consolidate on its
achievements in the population, development and reproductive health fields. This
period has seen an acceleration of population and socio-economic change. The
level of poverty has shown a significant reduction in terms of consumption
poverty due to the continued emphasis on the provision of income transfers to the
poor through food subsidies, free education and health services. Considerable
progress has been made in improving the level of health and education of the
population. There has been significant improvements in the living standards,
health and the educational levels of the people.
Sri Lanka today presents a picture of a country experiencing rapid and deep
seated demographic and social change. The rate of growth of population has been
reduced to 1.1 per cent. The total fertility rate has dropped from 3.4 in the early
1980s to 1.9 during 1995 to 2000. The contraceptive prevalence rate has increased
from 66.1 per cent in 1993 to 70.0 per cent in 2000. The infant mortality rate has
shown a steady decline from 19.3 per thousand live births in 1990 to 14.0 in 1998.
Trained care during pregnancy and labour is high in Sri Lanka. Nearly 99 per cent
of pregnant women receive antenatal care during pregnancy. Approximately 94
per cent of deliveries take place in medical institutions. The status of women in
the Sri Lankan society is relatively high and in the South Asian context Sri Lanka
ranks first in the gender related development index.
Yet, there are areas in Sri Lanka which need focused attention. A major
challenge the country will face in the immediate future is to increase the pace of
economic growth and thereby effectively eliminate poverty. It is clear that much
higher rates of economic growth is needed to improve living standards of the
population. The the government has set a target growth rate of 10 percent. This is
indeed necessary not only to substantially reduce poverty, but also to carry out the
required reconstruction and rehabilitation to ensure permanent end to the conflict
in the north and east of the country. Another challenge is the ageing of the
population. It is important to plan out adequate health care and social support
programmes for this segment of the population. Although the pace of urbanization
in the past has been relatively slow, by 2030 more than 40 per cent of the total
population will live in the urban sector. It is therefore, necessary to ensure the
planned planed growth and development of cities.
In spite the progress made in the field of maternal health, still two thirds of
maternal mortality and morbidity are due to preventable causes. Of the infant
deaths, about 75 per cent take place during the first month of life. Thus coverage
of postnatal domiciliary care services need to be improved. Child mortality has
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declined steadily during the past decade. Though maternal and child care services
have reached the greater majority of the population, the quality of services needs
to be improved if maternal and child mortality and morbidity is to be further
reduced.
The knowledge in respect of STD and HIV/AIDs and their prevention
varies among different groups of the population. Some of the identified high risk
groups include Sri Lankans employed in the Gulf States, workers in the Free Trade
Zones, beach boys and young girls involved in commercial sex and displaced
persons.
Associated with increasing life expectancy in Sri Lanka, the chronic noncommunicable diseases such as diabetes, hypertension and cancers have become
more important causes of morbidity and mortality. In females, 50 per cent of
reported cancers are those of the reproductive tract. A screening programme for
reproductive organ malignancies and certain other conditions has been introduced
since 1996 through the establishment of Well Women’s Clinics.
Although appreciable reduction in fertility has been observed, still
significant differentials exist between socio-economic groups as well as between
geographic areas. Male methods of contraception are not quite popular. In 2000,
only 2.1 per cent had accepted vasectomy, 3.7 per cent were using condoms and
7.1 per cent used Withdrawal as a method of contraption.
About 26 per cent of the Sri Lankan population comprise adolescents and
youth. Though a considerable amount of work as been initiated, it is necessary to
organize programmes to provide reproductive health information, education and
services to this segment of population.
Sri Lanka continues to promote and sustain a policy environment that is
conducive to gender equality and the empowerment of women. However, there is
still a need for the greater involvement of women in policy, decision making
processes at senior level managerial positions.
A well designed advocacy strategy is therefore necessary to create a
supportive environment to address these issues with a view to promote changes in
policy and resource allocations.
Among the areas of donor assistance in the future will include support to
strengthen services to underserved geographic areas and specified vulnerable
groups of population, consolidation and quality improvement in the delivery of
services, prevention of abortions, reproductive tract infections including
HIV/AIDS, adolescent reproductive health and counseling, prevention of gender
3
based violence, support to NGOs, data collection and research, advocacy and
building capacity at national and sub-national levels for effective implementation
of policy and coordination and monitoring of programmes using results based
management.
Therefore, in order to consolidate the gains achieved thus far and to move
forward to face the emerging challenges in the coming years, broader and deeper
partnerships between the government, the NGOs, civil society and the
international donor community is needed.
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1.
Overview of Population and Development Situation and Prospects
with Special Attention to Poverty
In the South Asian context Sri Lanka’s experience in achieving
considerable progresses in reducing its rate of growth of population and the human
development dimension of poverty has been unique. Enlightened social
development policies pursued during the past five decades have no doubt
contributed to this welcome change. The strong commitment by government to
provide free education and health care services to all segments of the population
and subsidized food for the entire population for about three decades and to more
than one half of the population during the past two decades and the wide coverage
of these services has resulted in very good indicators in terms of fertility,
mortality, literacy and basic education enrollment. This marks Sri Lanka as an
outlier in relation to other countries at similar levels of per capita income.
Sri Lanka’s progress in the population and development field during the
past decade is significant. The rate of growth of population has declined from 1.5
per cent in the early 1990s to 1.1 per cent today. Similarly, the per capita income
which was US $ 418 in 1990 has increased to US $ 841 in 2000. In addition,
emphasis on establishing peace and ethnic harmony, the strengthening of
democracy and human rights and maintaining economic progress have been
reflected in government policies and programmes in the post-ICPD period.
Continued reliance on open economic policies and human resource
development has enabled Sri Lanka to achieve an average economic growth rate of
near 5 per cent during the past decade. The liberalization process set in motion
for over two decades has contributed to diversification of the production structure
of the economy. The expert-led diversification of the economy has also
contributed to the changes in the composition of the Gross Domestic Product
(GDP). In 1995, for the first time the industrial sector overtook the agricultural
sector in terms of its share to the GDP.
The level of poverty in Sri Lanka has also shown a significant reduction in
terms of consumption poverty due to overall economic growth and continued
emphasis on the provision of income transfers to the poor in particular through
food subsidies, free education and health services. The proportion of individuals
at the household level with consumption expenditure below poverty level was
estimated at 22 per cent in the early 1990s. If a United States dollar a day is used
as the poverty line (adjusted for purchasing power parity), only about 7 percent of
the Sri Lankan population is poor. However, when the poverty line is increased to
US $ 2 a day, the poverty line increases to 45 per cent. The income distribution
pattern of the population shows that there has been improvements among the
middle 40 per cent and bottom 50 per cent of income groups during the period
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1986 to 1997. In Sri Lanka, poverty groups are essentially the landless and small
farmers, unskilled labourers, low skilled artisans, self employed , the
unemployed, the aged in low income families and working poor at subsistence
levels of income. Universal access to education and health care has to some extent
protected these poverty groups.
Poverty is predominantly a rural phenomenon. Studies have shown that
poor households are more likely to be found in rural than in urban areas.
Households are more likely to be poor if their working members are employed in
agriculture and other primary production activities. Poverty among female headed
households is about the same as among male headed households.
Poor
households generally have a larger family size. Their members are less educated
than those of non-poor households. Members of poor households who are in the
labour force are more likely to be unemployed. It is also observed that the poor
divert a large proportion of their consumption expenditure to food.
As the economic growth rate over the past few decades has not grown at an
appreciable pace to reduce poverty, special programmes have been implemented
to reduce consumption poverty in Sri Lanka. Moreover, despite the relatively
slow economic growth rates, the macro-economic and structural adjustment
programmes have aggravated the plight of the poor in certain areas. The major
State strategy to alleviate poverty and generate incomes for the poor is the
Samurdhi Programme, which replaced the Janasaviya Poverty Alleviation
Programme implemented prior to 1994. The Samurdhi programme has several
components; income transfers, compulsory savings and insurance schemes and
loans and training for micro-enterprises. This programme services about 53 per
cent of all households in the country.
During the past few decades, considerable progress has been made in
improving the level of education of the population. These improvements have
been greater for females. In 1994, 89.4 per cent of boys and 89.5 per cent of girls
aged 5-14 years were in school. School dropout occurs mainly at the senior
secondary level. The school participation rates in the age group 15-19 years were
55.3 per cent for girls and 53.4 per cent for boys. Literacy rates have improved
from 92.5 per cent for males and 87.9 per cent for females in 1994 to 94.5 per cent
and 89.8 per cent respectively in 1996/97. In January 1998, compulsory education
regulations were introduced for the age group 5-14 years to ensure that the 5 per
cent of those aged 5 years who do not attend school and those who drop out
before aged 14 are retained in the educational system. The rising educational level
of the population, in particular that of females have contributed to the decline of
infant and maternal mortality and fertility in Sri Lanka.
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Due to the relatively high fertility rates in the past, the current rate of
growth of the labour force is 1.7 per cent, much higher than that of population
which grows at 1.1 per cent. Although the overall unemployment rates have
declined over the past decade, youth unemployment rates are about three times
higher. Female rates are much higher than that of males, Labour force projections
for the current decade indicate that the total labour force will increase from 8.9
million in 2000 to 10.1 million in 2010.
A developmental benefit from the slower rate of growth of population in Sri
Lanka as a consequence of the decline in fertility is the trend towards lower
dependency ratios. The dependency ratio which was 85.2 per cent in 1991
dropped to 46.4 per cent in 2000. It is expected to further decline to 44.5 per cent
by the year 2010. Thus the demographic structure of Sri Lanka is well geared for
social and economic advancement. Thus Sri Lanka therefore, has another window
of opportunity to respond the current favourable population age structure. Before
the older population dramatically increases, there will appear a bulge is the
workforce, initially in the peak working ages. Therefore, it is important to create
appropriate enabling economic conditions to take advantage of this opportunity.
Population projections for this decade indicate that the total population will
increase from the current estimated number of about 19.0 million to about 20.7
million by the year 2010.
2.
Fertility Levels and Trends and their Implications for Reproductive
Health, Including Family Planning Programmes
Sri Lanka has undergone significant declines in fertility during the past few
decades. The level of fertility measured by total fertility rate show a decline from
about 5 children per woman in the early 1960s to below replacement level of 1.9
children in 2000 making Sri Lanka the country with the lowest level of fertility in
South Asia.
The age-specific fertility rates show that during the early 1980s fertility
decline has been entirely due to the decline in fertility levels of women aged 30
years and over. However, since then significant declines have been observed for
women aged below 30 years. Completed fertility measured by the average
number of children ever born to currently married women aged 45-49 years also
confirm the downward trend in fertility where it has declined from 5.1 children to
3.2 children.
Initial fertility decline in Sri Lanka was mainly attributed to the rise in the
age at marriage of females. The mean age at marriage of females increased from
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20.9 years in 1953 to 24.6 in 2000. The subsequent decline in fertility is attributed
to the rise in contraceptive prevalence rate from 34.4 per cent in 1975 to 70.0 per
cent in 2000. An examination of the demand for contraceptives by method show
that until around the mid 1980s the contraceptive prevalence rate of modern
temporary methods had remained around 10 per cent. Since then, it has increased
to 17 per cent in 1993 and to 26 per cent in 2000. The demand for permanent
methods of family planning has shown an increase in prevalence from about 11
per cent in 1975 to 30 per cent in 1987 and since then has declined to 23 per cent
in 2000.
In addition to contraceptive use and rise in age at marriage, abortion and
post-partum in fundability may have also contributed to fertility decline in Sri
Lanka. Surveys have shown that the number of married women resorting to
abortion has increased during the past decade. Similarly, the mean duration of
breastfeeding has remained at around 23 months despite the rising educational
levels of women.
While the rise in educational level of married females in the reproductive
ages has contributed to the increase in the age at marriage and contraceptive use,
in recent years, the upward social mobility of females brought about by the wider
availability of economic opportunities and their participation in the modern
economic sectors have also contributed to higher level of contraceptive use and
fertility decline in Sri Lanka.
Studies have also shown that there is a clear inverse relationship between
mothers education and fertility. Lower the level of education of the mother higher
is the number of children in the family. Therefore, it is generally seen that family
size is higher in low income families. Similarly, it also shows that in households
where the husband is engaged in white colder work, the number of children in the
household is lower than in households where the husband is engaged agricultural
work.
Fertility decline in Sri Lanka has brought about both positive results and
challenges. On the positive side it is seen that dependency ratios and the rate of
growth of population have declined. Better birth spacing has no doubt contributed
to the decline in infant and maternal mortality rates. The reduction in the absolute
number of births has also put less pressure on primary education and primary
health care services. It has also brought about a slower growth of labour force
enabling the reduction of unemployment rates and increased labour productivity
through the application of modern technologies.
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The reduction of fertility also poses challenges in accelerating the process
of population ageing in the future.
The projections of fertility for the future indicate that the total fertility rate
will continue to decline to about 1.7 during 2015-2020 and thereafter gradually
rise to replacement level.
One of the main goals of the Population and Reproductive Health Policy of
the government presented in 1998 is to maintain current declining trends in
fertility so as to achieve a stable population size at least by the middle of the 21 st
century.
3.
Mortality and Morbidity Trends and Poverty
A sharp reduction in mortality in Sri Lanka was observed during the period
1946 to 1957 which coincided with initiation of the intensive campaign to
eradicate Malaria and the expansion of health care services. This resulted in the
reduction geographic differentials in mortality by early 1960s. Further reductions
in mortality that followed in the next few decades is the result of further
improvement in the health care system, improved nutrition, personnel hygiene,
environmental sanitation and the rising educational attainment of the population.
The crude death rate which stood at 14.4 per thousand of the population
during 1946 to 1950 has declined to 5.6 during 1991 to 1995. The infant and
maternal mortality rates have declined from100.6 and 9.3 per thousand live births
to 17.1 and 0.3 during the same period. Data from Demographic and Health
Surveys clearly indicate that there is an inverse relationship between mother’s
educational level and infant and maternal mortality rates.
Sex differentials in mortality in Sri Lanka show that from birth to
advanced ages female have lower mortality than males. As a result the estimated
life expectancy for males in 2000 was 71.3 years compared to 76.5 years for
females.
Improvement in morbidity has been much less than that of mortality. It is
seen that traumatic injuries, diseases of the respiratory system and viral diseases
were the three leading causes of hospitalization during 1998 to 2000.
Also,
morbidity and mortality rate of inpatients in State hospitals indicate that
substantial increases are seen with regard to hypertension and ischaemic heart
diseases. In the year 2000 ischaemic heart disease, diseases of the gastrointestinal
tract and cerebro-vascular diseases were the leading causes of hospital deaths.
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Despite the epidemiological transition that has taken place in Sri Lanka,
infections and parasitic diseases including malaria, diarrheal diseases and acute
respiratory infections continue to be among the leading causes of out patient care
in hospitals. The underlying factors influencing the incidence of these diseases
are poor environmental sanitation and housing, poor personnel hygiene and
malnutrition.
The prevention and control of vaccine preventive diseases received
considerable attention during the past decade with the expansion of environmental
sanitation activities such as safe water supply, latrine construction and better
housing. Efforts were also directed at educating the population to improve
personnel hygiene through health education programmes.
Although infant, child and maternal mortality rates are low in Sri Lanka,
relatively high rates are found among sub-groups of the population such as urban
slums, estate population and under privileged groups. The major underlying cause
is poverty (poor living conditions, malnutrition, poor hygiene and sanitation) high
parity and poor birth spacing. Diarrheal diseases and acute respiratory infections
lead to chronic malnutrition and growth failure among infants and pre-school
children. Therefore, better environmental sanitation, housing, water and sewerage
disposal will reduce mortality and morbidity from respiratory and gastrointestinal
diseases which is a major cause of infant and child mortality and morbidity.
Psycho-social problems, sexual problems, and addictions are reported to be on
the increase among school children. During the past decade action has been taken
to improve the quality and coverage of the school health programme. A National
Coordinating Committee for School Health has been set up by the Ministry of
Health in collaboration with the Ministry of Education As a result, school medical
inspections and health promotion have been strengthened. A school sanitary
survey has been initiated to obtain information to improve school health.
4. Migration, Urbanization and Poverty
Migration to and from Sri Lanka has had both positive and negative
influences on the Sri Lankan society. Prior to gaining independence, migration
positively contributed to population growth and economic development with the
inflow of Indian Tamils to work in the tea and rubber plantations. Subsequently,
since independence with the restrictions of emigration and the repatriation of
stateless persons, migration ceased to influence the rate of growth of population.
However, during the past few decades, in a given period the number of female
migrants going to the Gulf States for temporary employment has been much larger
than those returning after completing their employment contracts. As a result,
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migration has contributed negatively to population growth during the past three
decades. In addition, the economic benefits to the country through remittances in
foreign exchange have to some extent being offset by the social costs to the
families that are left behind and to some migrants through harassment and
exploitation at work places abroad.
Internal population movements in Sri Lanka during the period 1946 to 1981
show that movements to the district of Colombo, the commercial city of Sri Lanka
has been mainly from south-western coastal districts. The volume of migration
has increased over this period. Migration from the northern district of Jaffna is
the only long distance flow to Colombo. Short distance movements between the
contiguous districts have been prominent. Large movements from the high rainfed and densely populated districts to low density and low rain fed districts have
been a post independence phenomenon. In 1994, there were eight in-migration
districts. In six, the female migration rates were equally high as males. There
were eleven districts where there was a net loss of population. Out of which nine
districts lost both male and female populations. The remaining two districts
namely Ratnapura and Kalutara had a loss of females only.
One of the significant developments in migration in the last decade is the
increase of independent migration of women. This is seen in the movement of
young rural women to urban areas for employment in modern sectors such as
garment industry in export processing zones and the outflow of women for
domestic employment in the Gulf States and South-east Asian countries. While
this has opened up many opportunities for improving the status of women, there
have been instances where women have been subject to exploitation.
The Population and Reproductive Health Policy of the Government
contains the following two strategies with regard to female employment abroad.
a)
“Provide international labour migrants support to acquire the
requisite social skills and attitudes to face new situations both at the
destination and on return”.
b)
“Provide families of female migrant workers with the necessary
support so that their young children can be taken care of while the
mother is abroad”
The pace of urbanization during the past two decades in Sri Lanka has
continued to be slow due to the weakening of both “push” and “full” factors. The
push factors have been wakened by the emphasis given by governments to rural
development to uplift rural communities and eliminate large urban-rural
disparities in living conditions. The “pull” factors have been weakened by the
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low level of growth and investment in the industrial and other modern service
sectors. However, with the emphasis given to rural development by successive
governments, by and large, urban poverty has also been kept under control.
Nevertheless, the pace of urbanization in Sri Lanka is expected to accelerate in the
coming decades, due to the growth of small and medium size towns around the
major cities of the country. According to projections of urban population, the
percentage of population living in urban areas is expected to increase from 24 per
cent in 2000 to 42 per cent in 2030. As a result, increase environmental pollution,
changes in occupational and consumption patterns and life styles would contribute
to greater health and social problems.
Therefore, it is the policy of the
government to promote the economic benefits of migration and urbanization while
controlling their adverse social and health effects.
5.
Population Ageing
The demographic transition that has taken place in Sri Lanka over the past
five decades is gradually transforming its population to an elderly one where
proportionately and in absolute numbers those aged 60 years and over will
increase.
The proportion of population under 15 years of age to the total population
has declined from 41.5 per cent in 1963 to 24.8 per cent in 2000. On the other
hand, the share of those aged 60 years and over has increased from 5.4 per cent to
10.0 per cent during the same period. This change has been brought about by the
rise in life expectancy at birth from 42 years in 1946 to about 73 years in 2000 and
the decline in the number of children per woman in the reproductive ages from
about five children in the early 1960s to the current level of about two children.
This favourable decline in morality and fertility has been achieved through the
effective implementation of primary health care and family planning and other
social development policies and programmes.
Unlike in western societies, elderly in Sri Lanka prefer to live with their
children. There is no strong preference for living with a son or daughter. In a
study of intergenerational relationships and reciprocity, has shown three distinct
patterns. First, the old earned support of their children by providing good care for
their children earlier in life; second, the old do value things to assist their children
and improve their well being in the household; and third one time substantial
assistance in the from of a dowry or inheritance to a childe balances the ongoing
support that the old parents receive in later life.
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With increasing longevity in Sri Lanka, families with four living
generations will increase. However, the decrease in the number of children per
family and their dispersion due to migration and urbanization would result in a
fewer number of children available for home care The demographic ageing in Sri
Lanka will decrease the ratio of middle aged women to elderly people. This
“daughter care potential” for Sri Lanka is expected to decline from around 1.8 to
1.0 by 2040. The decline in the ratio particularly form 2010 onwards, would pose
significant issues with regard to care of the elderly. Thus there would be an
increasing need for externally provided support services to assist families to care
for their elderly relatives and a corresponding need for the development and
expansion of community based health care as an alternative to home care.
Sri Lanka has been providing social security to the elderly population and
has expanded its coverage in recent years. An Act to provide for the establishment
of a National Council for elders with the objective of promoting and protecting the
welfare and the rights of the elders was enacted in Parliament in the year 2000.
There
are
also important
government
superannuation
schemes that cover the aged who have been employed in the formal and informal
sectors of the economy. Day care centers for the elderly have been established in
a limited way in addiction to full time institutional care.
Currently, the Ministries of Health and Social Services are engaged in
developing programmes and to strengthen the existing mechanisms to provide
support the elderly, specially in respect of heath care, housing, income security,
care giving facilities and living arrangements. There is also a need for providing
social and economic security to the poor segments of the elderly in particular to
those who are single and widowed living in low income households.
The Population and Reproductive Health Policy of 1998 has outlined the
following strategies for the care of elderly:
-
Encourage the private sector, NGOs, CBOs and the local community
to provide community care and services to the elderly.
-
Initiate social security schemes for the elderly not already covered
by EPF, ETF, etc.
-
Provide incentives to families to care for the elderly at home
-
Provide appropriate training for out of school youth awaiting
employment to enable them to take care of the elderly at home.
-
Provide special care units for the elderly in the State Health Care
System.
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-
6.
Establish a cadre of Community Health Nurses with responsibility
for the care of the elderly.
Reproductive Health
Sri Lanka has been providing integrated family planning and maternal and
child health services form the late 1960s. The border concept of reproductive
health was adopted in 1998 with the formulation of national policy on population
and reproductive health.
From the inception of the family planning programme, the government has
adopted a “cafeteria” approach for delivery of family planning services. Clients
are given the option of selecting a contraception method of their choice from
range of methods made available through family planning service outlets. To
facilitate decision making by the clients, advice and counseling is provided by
health workers.
Family planning services (temporary and modern methods) are provided
through a wide network of MOH/FP clinics conducted regularly (usually once in
two weeks) in medical institutions and health centers . The Public Health
Midwives provide oral pills and condoms during their field visits.
The
government effort is supplemented by the NGO sector. The permanent methods
of family planning (tubectomy and vasectomy) services are provided through the
larger hospitals and the NGOs. Currently more than 50 per cent of the demand for
sterilizations is met by the NGO sector.
About 95 per cent of deliveries take place in medical institutions. The
number of births that occur in government medical institutions have increased
steadily during the past four decades. Easy access to institutional care and regular
contract with the Public Health Midwives have influenced the choice in favour of
institutional deliveries. Of the deliveries that take place in government
institutions, nearly 70 per cent occur in larger hospitals where specialist services
are available.
After delivery, the mother and child are followed at home by the area
Midwife with necessary post-partum care. Approximately 65 per cent of women
receive post-natal care at least once during the first ten days after delivery. As a
result, maternal and infant mortality rates have declined appreciably during the
past decade.
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Sexually transmitted diseases (STDs) are a major public health issue and
constitute one of the important causes of infertility/ sub-fertility in Sri Lanka. It is
estimated that around 60,000 new episodes of STDs occur annually of which
about 1.5 per cent are seen at the government clinics with the majority seeking
treatment from the private sector.
With increasing life expectancy and changing life styles, noncommunicable diseases such as diabetes, hypertension and cancers have become
important causes of morbidity and mortality in Sri Lanka. In females, 50 per cent
of reported cancers are those of the reproductive system.
A screening programme for reproductive organ malignancies and certain
other conditions has been introduced since 1996, through the establishment of
“Well Women’s Clinics” (WWC). These clinics are conducted every two weeks
or monthly by trained Medical Officers, and women over 35 years of age could get
themselves checked for conditions like hypertension, diabetes, breast malignances
and cervical cancers. This organized WWC programme in Sri Lanka is unique in
the region where asymptomatic women are screened for debilitating and life
threatening illnesses.
It is estimated that about 10 to 12 per cent of married couples in Sri Lanka
are sub-fertile. The services for infertility/sub-fertility constitute an important
component of the national reproductive health programmes.
Although considerable progress has been made in the field of reproductive
health, particularly in maternal and child health and family planning, quality of
service delivery needs further improvement in order to attain some of the targets
set for end of this decade.
Despite the significant declines in maternal and infant and child mortality
rates, there are geographic areas of high maternal and infant mortality within the
country. About two thirds of the maternal mortality and morbidity are due to
preventable causes. Poor nutritional status and inadequate weight gain in
pregnancy together with a high incidence of anemia and inadequate birth spacing
are major factors contributing to maternal morbidity and mortality.
Anemia has been identified as a common problem among pregnant women.
Studies show that about 50 to 60 per cent of pregnant women are anemic. A
national strategy to prevent and control anemia in pregnancy has been formulated
and is currently being implemented to overcome this situation.
The incidence of low birth weight is relatively high in Sri Lanka, although
it has shown a steady decline during the past decade. Nearly 16 per cent of
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children born have a low birth weight of less than 2500 grams. There is
considerable variation among districts with regard to low birth weight babies.
Despite a relatively high contraceptive prevalence rate of 70 per cent, the
incidence of induced abortion is high. Many unwanted pregnancies terminate in
unsafe abortions exposing women to higher risks of mortality and morbidity.
Studies also show that over 90 per cent of abortion seekers are married women.
Majority resort to abortions due to contraceptive method failure (oral pills and
traditional methods) About 10 per cent of maternal deaths are due to causes
related to abortion.
Availability of proper guidelines and protocols on important areas of
reproductive health would improve the quality of services. Currently, action is
being taken in this regard to improve the quality of reproductive health care
services at all levels.
7.
Adolescent Reproductive Health
Adolescents (aged 10-19 years) comprise 17 per cent of the total
population. Adolescence is a dynamic phase of development in the life of young
people. It is a period of change from childhood to adulthood characterized by
physical, mental, emotional and social development. Thus it is a period often not
very well understood by both adolescents themselves as well as by adults. This is
particularly evident with regard to sexuality and reproductive health . The risk of
unwanted pregnancy and sexually transmitted diseases including HIV/AIDS and
induced abortions are some of the emerging issues confronting adolescents. In
view of the above concerns, the national reproductive health programme in Sri
Lanka gives very high priority to the provision of both education and services to
the adolescents.
One of the early attempts at providing population education to adolescents
was in 1973 when the Department of Education embarked on a Population
Education programme for school children. The introduction of population
education in schools was considered a bold initiative considering the socio cultural
background of the Sri Lankan society at that time. Since then considerable
progress has been made and from the early 1990s family life education programme
has been implemented through the formal school system. Two important activities
through this project that were implemented are (a) incorporation of test items to
cover population and family life education at national level public examinations
conducted throughout the country by the Department of Examination and (b) the
involvement of parents in family life education by organizing programmes to
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create awareness on adolescent issues among parents through parent-teacher
organizations.
The National Youth Services Council conducts reproductive health
information programmes with the objective of providing leadership training for
youth and poor groups.
In 1993 a National Steering Committee on Adolescent Health was
established to coordinate adolescent health activities and develop new initiatives.
The committee made far reaching recommendations regarding the promotion of
adolescent health. A book on common adolescent health issues was developed for
higher grade school children titled “Dawn of Adolescence” and was distributed to
all relevant school children.
In 1998, a directorate for youth was established in the Ministry of Health
for promotion of life skills education as an important element to reduce adolescent
health problems including reproductive health issues.
Many NGOs have been involved with adolescent related programmes
concerning education, training and counseling. The Family Planning Association
of Sri Lanka has been in the forefront of reproductive health education as well as
service provision. The Family Planning Association is also the lead organization in
the UNFPA/EC initiative in addressing adolescents and youth and their
reproductive health needs. The project focuses on counseling and provision of
services to adolescents and youth in thirteen districts of the country.
8.
Demographic, Economic and Social Impact of HIV/AIDS
Sri Lanka has an estimated 7,200 adults and children living with HIV
infection. The prevalence rate of HIV is estimated at 0.06 per cent in the adult
population. According to the UNAIDS classifications Sri Lanka has a “low-level
HIV epidemic”.
By end of June, 2002, a cumulative total of 425 HIV infections have been
reported to the National STD/AIDs Control Programme. Of these 134 have been
diagnosed as AIDs and 102 have died. Of the 388 HIV infected persons with
known age, 90 per cent are aged 15 to 49 years. Since HIV affects the most
productive age group of the population, it is estimated that the morbidity it causes
will result in productivity loss of approximately US $ 30 million per year and
225,000 person years of life lost.
17
With the changing demographic and social and economic structure, there
has been an increase in youth practicing unsafe and unprotected sexual behaviours.
In the first five years of the epidemic (1987-1991) the male to female ratio
was 4.1, however by end of 2001 the ratio had decreased to 2.1. At the end of
2001, 48 per cent of reported HIV cases were women who had gone abroad for
employment. In Sri Lanka approximately 180,000 persons seek foreign
employment annually and woman account for nearly 80 per cent of migrant
workers. From all provinces of the country HIV has been reported with 63 per
cent of cases being reported from the Western Province.
One of the key factors precipitating the spread of HIV is sexually
transmitted infections (STDs). Thus provision of comprehensive care in the
management of STIs is a major strategy adopted for prevention of HIV through
sexual transmission, National guidelines on clinical management of STIs have
been developed. Syndromes management of STIs has been introduced at the
primary health care level.
Sri Lanka is one of the first South Asian Countries to reform its blood
banks to prevent HIV transmission. Screening of donor blood of HIV antibodies
commenced in 1987. The Central Blood Bank in Colombo and 56 regional blood
banks distributed throughout the country screen donated blood on site. All blood
and blood products are screened for HIV, Hepatitis B, syphilis and Malaria before
transfusion.
Guidelines on safer blood has been developed and circulated to all health
care institutions in the public and private sector. A national blood policy has been
formulated. A Private Medical Institutions Bill that incorporates legislative power
to the Ministry of Health to regulate public and private sector blood banks has
been presented to Parliament.
The preventive education aimed at persons with increased risk as well as
the general public commenced in the mid 1980s and continue to be implemented
both through the government and NGOs. Attempts to modify sexual behaviour
through information and education have been one of the major prevention
strategies. Knowledge of HIV transmission and prevention methods among
married women of
reproductive age group is relatively high except on the
plantation (Estate) sector of the country.
The government, NGO and community based organizations and the private
sector are responsible for the implementation of the National Programme. The
National STD/AIDS Control Programme provides technical support to all
collaborating agencies in order to enable them to implement their activities
18
effectively. The NGOs have been focusing their attention on HIV prevention
services to key vulnerable and high risk groups.
The HIV/AIDs is not only a health problem. It is development issue as
well having both economic and social consequences. Therefore, the epidemic
cannot be talked only through medical interventions. It involves a multicultural
approach, involving sectors other than health. Ministries such as education,
defense, labour, Women Affairs, Youth Affairs are encouraged to formulate their
own action plans for HIV prevention and interventions. Such sectors are not only
able to draw upon their own resources but are in a better position to reach
vulnerable populations such as soldiers, migrant workers, youth etc.
Sri Lanka with its deep commitment to human development, literate
population and a well developed health infrastructure is in a strong position to
confront and control the spread of HIV infections in the country. The recently
formulated National Strategy Plan draws on these strengths to address the priority
areas in the prevention and control of HIV/AIDs in the country.
9.
Gender Equality and Development
The status of women in Sri Lanka is relatively high compared to their
counterparts in other South Asian countries. Ratification of the convention on
elimination of all forms of discrimination against women provided the impetus for
women in Sri Lanka to persuade the State to take more active interest in promoting
gender equality in the country. Women’s Charter the policy document on women
was prepared based on the convention in 1993. The National Committee on
Women was established in the same year.
The Ministry of Women’s Affairs as the main agency for policy
formulation on women’s issues has prepared a National Plan of Action for women
(NPA) based on the Beijing Platform for Action. This Plan which was developed
in consultation with government and non governmental agencies was updated in
2001 to cover the period 2001-2005.
Action has been initiated to implement the Plan of Action through
mainstreaming gender. The main gender mainstreaming attempt by the Ministry
of Women’s Affairs is the formation of gender focal points in line Ministries to act
as catalysts in promoting gender responsive policies and programmes, collecting,
analyzing, interpreting and disseminating gender disaggregated data, ascertain the
19
impact of polices and programmes on gender; formulating sectoral plans and
programmes in conformity with the NPA and allocating resources for gender and
monitoring gender programmes.
Gender parity is enshrined is Article 12 (2) of the Constitution of Sri Lanka.
Since rectifying the UN convention on elimination of all forms of discrimination
against women in 1981, Sri Lanka has become a party to many international
conventions with regard to women’s issues and rights. Amendment to the Panel
Code has been made after a review of laws prior to 1995. The law on sexual
offences, marital rape in the event of judicial separation incest, trafficking, and
sexual separation, are the main areas taken up with the amendments. Age at
marriage has been raised to 18 years.
Education polices have helped women to move forward to acquire a better
quality of life and enter gainful employment. In both participation in education
and performance at examinations, women have shown a steady progress.. The
educational reform introduced through legislation in 1998 making education
compulsory for the age group 5-14 years has contributed to greater participation of
girl children in education. The female literacy rate was 89.4 per cent during
1996/97 period.
A positive development noted in recent years is the increased percentage of
females being admitted to universities. However, a distinct gender difference is
apparent in their distribution among disciplines. A relatively lower percentage of
females seek science based courses.
The expansion of free health care services during the past five decades have
benefited women in all economic strata in achieving a better quality of life. The
female life expectancy at birth of 76 years is higher than that of males by six
years. Malnutrition among women has been a problem for decades. Anemia in
women is found to be higher than in males. The nutrition requirement of pregnant
women are not adequately met leading to higher incidence of low birth weight
babies.
The labour force participation of women has increased from 32 per cent in
1994 to 37 percent in 2000. There is a heavy concentration of women in
subsistence agriculture, plantations, textiles and garment industry, teaching and
nursing, clerical services and domestic work.
The number of females employed in the primary sector has declined from
54 per cent in 1990 to 43 per cent in 1998. In the secondary sector, female
employment has increased from 22.6 per cent to 24.8 percent during the same
period. Similar shift is seen in the tertiary sector where the proportions have
20
increased from 28.4 per cent to 30.1 per cent. The economic liberalization
policies, expert orientation and private sector participation have further played a
positive role in women’s employment during the last decade.
Pressing economic difficulties and low wages earned as unskilled labour
have compelled many women especially from rural areas to seek employment
abroad as domestic workers. The Sri Lanka Foreign Employment Bureau, the
State institution dealing with foreign employment has expended its activities to
meet welfare needs of migrant women.
In spite of the continuous decline in female unemployment rate during the
past decade, it is nearly double that of man. According to the labour force survey
of 2001, the unemployment rate for females remained at 11.6 per cent compared to
5.8 per cent for males. A relatively high percentage of unemployed women are
educated and are in the age group 15 to 24 years.
Low participation of women in policy formulation is seen despite a high
percentage of voters being females. The female members of Parliament comprise
only 4 per cent. In the more recent past, the government as well as NGOs have
advocated the increase in women’s participation in politics. Political parties have
been requested to revamp their women’s wings to have more women candidates to
contest at elections.
Women in households below the poverty line are affected to a greater
extent than men as they are not sufficiently equipped to combat problems
connected with adversity. Female headed households, war windows, ageing
women, women lacking resources, low wage earners, destitutes are the categories
of poor women. The Samurdhi programme of the government is the major
poverty alleviation programme which include income transfers, compulsory
savings schemes, insurance and credit for self-employment. Women in poor
households have benefited form this programme. Studies have shown that about
10 per cent of the poor have been able to come out of the poverty trap.
Violence against women is one of the important concerns of the Ministry of
Women’s Affairs and the NGOs. Women’s Charter has a special section dealing
with this issue.
Measures suggested in this respect are the promotion of
legislative reforms the promotion of structural reforms within the criminal justice
system and the provision of support to non governmental organizations working
with women victims of violence. There are several steps taken to combat this
situation, one important step is the revision of the Penal Code in 1995, which
made substantive changes relating to rape, incest, trafficking and sexual
harassment.
21
10.
Behavioural Change Communications, Advocacy and Information and
Communication Technology as Tools for Population Development and
Poverty Reduction
Since the mid 1990s the information, education, communication and
advocacy activities in Sri Lanka have been focused on the holistic approach to
reproductive health.
The advocacy programmes in population and reproductive health is aimed
to create a socio-political climate within which relevant awareness, knowledge and
motivation for behaviour changes are imparted with a view to bring about better
reproductive health services to the target population.
The advocacy strategy seeks to increase the awareness and strengthen the
capacity of the Parliamentary Forum on Population and Development to be the
leading advocate of population and reproductive health issues in the country. The
Parliamentary Committee on Population and Development was reestablished in
1997 and subsequently reconstituted in July 2002.
Consisting as it does of members of Parliament of the major political
parties, it represents a valuable multi-party political consensus which can be
utilized to provide legislative support for population and development initiatives.
The Committee is currently focusing its attention on some of the important
population and development issues such as youth unemployment, population
ageing, rising incidence of abortions, environmental degradation, and water
resources. These issues are not only discussed at the national level, but also at the
sub-national level among elected members of local bodies and divisional councils.
There are also advocacy activities directed at mass media personnel and
religious leaders. The current activities include the establishment of a forum of
journalists representing all media channels, a newsletter aimed at journalists,
orientation seminars for journalists at national and sub-national levels, and the
production of handbooks and information kits on reproductive health issues for
distribution to the media personnel. In addition, advocacy seminars are conducted
for local level opinion leaders and religious authorities.
Advocacy strategy also aims at women’s organizations. The leaders of
grass roots level women’s societies are provided with training and orientation on
reproductive health and advocacy skills.
22
The major issues which call for advocacy include reducing the incidence of
abortions and information and services to adolescents and youth. As regards
abortion, it is necessary to ensure wider availability and effective use of
contraceptives and to reduce the need for abortion. In view of the magnitude of
unwanted pregnancies resulting due to
method failure and unplanned
pregnancies, advocacy for the use of post coital contraception is being
implemented.
While the level of information provided to adolescents and youth who are
unmarried through the media and interaction with peer groups is perhaps
adequate, a real lacunae in the past has been the access to contraceptive services,
counseling etc. owing to widespread opposition in the community that assess to
contraceptives would lead to greater promiscuity. In 1998, the Ministry of Health
issued circular instructions that the marital status of clients should not be inquired
into before health staff provide services on request.
The behavioural change communication has focused on specific target
audience such as adolescents and youth, and the married couples in the
reproductive age group. The adolescents are provided reproductive health
education through the school system, with the objective of reducing anxieties
connected with growing up, sexuality and gender relations and enhance their
knowledge on population and reproductive health issues. Information and
education on population and reproductive health are also being provided to out of
school youth through youth clubs, vocational training centers and outreach
programme for young females workers in Free Trade Zones. In addition,
counseling is also provided to undergraduates in the universalities. Information
and education is provided to the adult population by interpersonal contracts
through home visits and at clinics by grass root level health workers.
Sri Lanka is in the transition stage of using information and communication
technology in population, development and reproductive health. The Sri Lanka
Population Information Centre is linked to the Asia Pacific POPIN network
through the internet and has up-to-date global information on population and
reproductive health. In addition, in-country information network is developed on
a limited scale to exchange information through the e-mail. In the area of
reproductive health, action is being taken to repackage electronic information into
print formats and disseminate it to relevant health workers particularly those who
work in remote areas and in geographic areas where the level of poverty is
relative high. This is an area when Sri Lanka will need the assistance of the
international donor community to expand its network of information and
communication technology to the sub national level.
23
11.
Data, Research and Training
Sri Lanka has a long history of data collection on population and
reproductive health. The first scientific Census of Population was conducted in
1871. Collection vital statistics on a continuous basis commenced even earlier in
1867. Sample surveys on fertility and other demographic and health information
have been collected on a regular basis since 1975. The most recent Demographic
and Health Survey was conducted in the year 2000. Routine data on maternal and
child health and family planning on a regular basis have been collected and
tabulated since the early 1970s.
Despite the availability of data from population censuses, surveys and the
management information system, the quality and coverage of data and their
relevance to current needs have not been quite satisfactory. In developing a
holistic reproductive health service, and adequate data base for planning and
resource mobilization, supported by an effective behavioural change
communication, advocacy and information system is essential. Currently very
little data exists on socially sensitive areas such as adolescent reproductive health
and abortion. There is also a need to obtain client based data eliciting individual
views on service needs on quality of service for the design and implementation of
effective quality reproductive health service.
The decentralization of health services to provincial, district and divisional
levels calls for effective coordination of the data collection systems at different
levels. There is a need to conduct studies on the effect of decentralization on the
process of planning and management and the availability and quality of health
services at the sub-national level. These studies could also identify additional
data required at the central level for monitoring purposes, under the decentralized
environment.
The stage of demographic transition that Sri Lanka is currently passing
through warrants studies to be undertaken on macro and micro level consequences
of population growth, for sectoral planning and strategy development. There is
also the need to develop national research priorities which would address critical
current concerns and on emerging problem areas.
The government policy on devolution also requires training at all levels to
be strengthened including the sub-national institutions. The prime mover
institutions in this regard are the Sri Lanka Institute of Development
Administration and the National Institute of Health Sciences. These institutions
are being strengthened to provide regular in-service training on both technical and
managerial aspects to the staff at Divisional level and below. This is particularly
necessary to standardize training curriculum and methodology.
24
Data collection systems on population and reproductive health at the
national and sub-national are being strengthened to obtain quality data on time for
monitoring and decision making. In order to improve measurement and
monitoring of population and reproductive health programme at all levels, action
is being taken to (a) strengthen the management information and statistical system
(b) improve skills in monitoring evaluation and analysis.
A major challenges for the future is the need the consolidate on what has
been achieved in the past and to move forward to achieve higher quality of
reproductive health services to the eligible population through an effective
management information system.
12.
Partnerships and Resources
The partnership between Sri Lanka and the donor community in the field of
population and family planning commenced as far back as 1958 when an
agreement was signed between the Governments of Sweden and Sri Lanka to
provide assistance to strengthen the Maternal and Child health and family
planning activities. The USAID also provided assistance in the late 1970s and
1980s mainly to NGOs through central funding mechanisms. During this period,
organizations such as the Population Council and the Ford Foundation brought
their expertise and support to the programs. Japan too was a bi-lateral donor to
population and related programmes in the 1980s. In the late 1980s the World
Bank/IDA provided support through a soft loan to the national population
programme through the Health and Family Planning Project. The UNICEF
continues to be source of major support in the field of safe motherhood and
support to the girl child. The HIV/AIDs prevention programme has received
major support from the World Bank, UNAIDS and the WHO. The Dutch
government has been a major multi-bi donor to Sri Lanka to support family
life/reproductive health education in the formal school system. AUSAID has
provided support to strengthen reproductive health services in the conflict affected
areas of the country. Through a regional project the European Union provides
funding for adolescent reproductive health.
Partnership between the United Nations Population Fund (UNFPA) and the
Government of Sri Lanka commenced in 1969. The UNFPA remains the largest
means of external assistance in the field of reproductive health to Sri Lanka. Since
other early 1970s, the UNFPA has up to date completed five cycles of programme
assistance to Sri Lanka in the field of population, family planning and
25
reproductive health. In the current sixth cycle of assistance for the period 2002 to
2006 the UNFPA is committed to provide US $ 5.5 million to the government of
Sri Lanka to implement its reproductive health programme. Under this
programme the UNFPA will assist the government in strengthening the national
capacity to provide increased access to quality reproductive health including
family planning services for populations living in underserved areas and in
conflict affected zones. The UNFPA is also committed to providing assistance to
increase awareness of sexual and reproductive health issues, including responsible
and gender sensitive behaviour among adolescents and youth and advocacy
activities on emerging population development and reproductive health issues
targeted at parliamentarians, sub-national level elected representatives,
administrators, religious and community leaders.
Although Sri Lanka has made considerable progress in the field of
population and reproductive health, there are critical areas of concern which
require the assistance of the international community to enable the national
authorities to address these issue effectively.
There are vulnerable groups of population and under-served geographic
areas where the indicators are much less favourable than the national averages.
These include districts that were affected by the ethic conflict, marginalized rural
areas, migrant women, the plantation sector, women working in Free Trade Zones
and urban slum dwellers.
The government has launched Well Women’s Clinics an innovative
approach to provide holistic reproductive health services and screening to women
over 35 years of age. There is a need to strengthen training of health personnel,
technical support, medical equipment and IEC activities in this regard.
Despite relative high prevalence of contraceptive use, there is a need to
improve family planning services in the under-served areas and vulnerable groups
of the population. It is necessary to improve quality of care, assessment of unmet
needs, upgrading of family planning clinics in under served areas and
contraceptive commodity assistance.
The incidence of maternal anemia is high in Sri Lanka. As a result of the
increased incidence of unsafe abortions, about are fifth of beds in maternity wards
in government maternity homes consist of patients suffering from abortion
complications and morbidity. Therefore, donor support is required for reduction
of maternal anemia, improve coverage of VDRL testing for syphilis, assistance to
manage complications of abortions including support to maternity institutions and
emergency obstetric care to vulnerable populations particularly those in the
conflict affected areas.
26
Violence against women is a serious social and human rights issue.
Although the number of cases of violence reported are on the increase, many are
not reported due to cultural constraints and reporting of domestic violence is very
rare. It is necessary to address these issues and promote GO/NGO cooperation in
the implementation of action programmes.
Another area of support envisaged is advocacy for reproductive health
issues. Advocacy for critical and burning issues such as abortion, reproductive
health heeds of vulnerable groups, violence against women, adolescent health,
reproductive health of older women and male participation in reproductive health.
The target groups include Parliamentarians, sub-national level elected
representatives, health authorities, journalists and women and youth leaders.
In the considerable tasks that Sri Lanka has to undertake in the immediate
future, the support of the international community would be of much value. Sri
Lanka has effectively and efficiently utilized domestic and international resources
in the field of population and reproductive health. Continued support on a much
larger scale will enable the country to continue its efforts at capacity building and
self-reliance.
27
TABLE 1
GROWTH OF POPULATION
1992 - 2001
Year
Population
(000)
Annual
Increase
(000)
Annual Growth
Rate (%)
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
17406
17619
17865
18112
18336
18552
18774
19043
18359
18732
213
246
247
224
216
222
269
316
-
1.2
1.4
1.4
1.2
1.2
1.2
1.4
1.7
-
Source: Registrar General’s Department. The 2001figure
is the enumerated and estimated population at the
2001 Census of Population.
28
TABLE 2
THE INCIDENCE OF CONSUMPTION POVERTY
1990/91 – 1996/97
1990/91
1995/96
(Percent)
1996/97
Lower Poverty Line
20
25
19
Higher Poverty Line
33
39
31
Sources: Household Income and Expenditure Survey 990/91, Department
of Census and Statistics (DCS), Consumer Finances and
Socio-Economic Survey 1996/97, Central Bank. Central
Bank estimates are not strictly comparable with DCS estimates.
Note : The DCS used a lower poverty line of Rs. 791 and a 20 percent
higher poverty line of Rs. 950 while the CB used a lower poverty
line of Rs. 860 and a 20 per cent higher poverty line of Rs. 1,032 per
person per month, to estimate the incidence of consumption poverty.
29
TABLE 3
INCIDENCE OF POVERTY BY PROVINCE, 1995/1996
Province
(Percent)
Lower Poverty Line Higher Poverty Line
Western
14
23
Central
28
43
Southern
26
41
North Werstern
34
52
North Central
31
47
Uva
37
55
Sabaragamuwa
32
47
Source : Household Income and Expenditure Survey
1995/96, Department of Census and Statistics.
30
TABLE 4
INCIDENCE OF POVERTY BY SECTOR, 1995/1996
(Percent)
Lower Poverty Line Higher Poverty Line
Sector
Urban
15
25
Rural
27
41
Estate
25
45
Source :
Household Income and Expenditure Survey
1995/96, Department of Census and Statistics.
TABLE 5
PERCENTAGE DISTRIBUTION OF INCOME
1986/87 AND 1996/97
Income Group
1986/87
1996/97
Top 10%
41.1
37.3
Top 20%
56.8
53.0
Middle 40%
25.3
27.5
Bottom 50%
17.1
19.0
Bottom 10%
1.1
1.3
Source: Central Bank, Consumer Finance Surveys
31
Table 6
HOUSEHOLD SIZE AND COMPOSITION BY PERCENTAGE
OF THE REFERENCE POVERTY LINE, 1990/91
Category
% of the Population within the age group
Household Size
Under 10
10-15
15-60
Over 60
Ultra Poor
24.5
14.4
54.6
6.5
5.92
Poor
23.8
14.5
55.1
6.6
5.39
Non Poor
16.5
11.1
62.4
9.9
4.54
19.1
12.3
59.8
8.7
4.89
All
Source: Economic Review, Colombo,1995.
32
TABLE 7
CRUDE BIRTH RATE, CRUDE DEATH RATE
AND RATE OF NATURAL INCREASE,
1992 - 2000
Year
Crude Birth
Rate
Crude Death
Rate
Rate of Natural
Increase (%)
1992
1993
1994
1995
1996
1997
1998
1999
2000*
20.1
19.9
19.9
19.3
18.6
17.9
17.3
16.8
16.3
5.6
5.3
5.6
5.8
6.5
6.1
5.9
6.0
6.1
1.5
1.5
1.4
1.4
1.2
1.2
1.1
1.1
1.0
Source: Registrar General’s Department
* Estimated
33
TABLE 8
CRUDE BIRTH RATE AND TOTAL
FERTILITY RATE
1980 - 2000
Period
Crude Birth
Rate
Total Fertility
Rate
1980-1982
27.8
3.4
1982-1987
24.0
2.8
1988-1993
20.6
2.3
1995-2000
17.4
1.9
Source: Demographic and Health Surveys
and Registrar Generals Department
TABLE 9
INFANT MORTALITY RATE AND
MATERNAL MORALITY RATIO
1981 - 1995
Period
Infant Mortality
Rate (per 1000 live
births)
Maternal Ratio
Mortality (per
100,000 live births)
1981-1985
28.0
40
1986-1990
20.4
40
1991-1995
17.1
27
Note : Computed from data of the
Registrar General Department
34
TABLE 10
EXPECTATION OF LIFE AT BIRTH BY SEX,
1981 - 2000
Sex
1981
1991
2000*
Total
69.9
72.9
73.8
Male
67.7
71.1
71.4
Female
72.1
74.8
76.1
Source: Department of Census and Statistics
* Estimated
TABLE 11
INTERNATIONAL MIGRATION TRENDS
1971 - 2000
Period
Net Migration
Migration Rate
(per 000)
1971-1980
-46,539
-3.4
1981-1990
-43,031
-2.4
1991-2000*
-23,530
-1.3
Source: Registrar General’s Department
* Estimated
35
TABLE 12
GROWTH OF URBAN POPULATION, 1981-2005
Year
Urban
Population
(000)
Percent
Urban
1981
3,192
21.5
1995
4,538
25.0
2000*
4,986
26.0
2025*
9,095
38.6
Source: Census of Population
*Estimated
TABLE 13
POPULATION COMPOSITION AND
DEPENDENCY RATIOS, 1981 – 2020
Year
0-14
years
15-64
years
1981
1991
1995
2000
2010
2020
35.2
31.2
27.2
24.8
22.2
19.2
60.5
63.4
66.1
68.3
69.2
68.7
(per cent)
65 years Dependency
Index
& over
Ratio
Ageing
4.3
5.4
6.2
6.9
8.6
12.1
65.2
57.7
51.3
46.4
44.5
45.6
12.2
17.3
22.8
27.8
38.7
63.0
Source : Computed from Census data and Population Projections.
36
. TABLE 14
CONTRACEPTIVE PREVALENCE
1987 - 2000
1987
(Per cent)
1993
2000
Any Method
61.7
66.1
70.8
Any Modern Method
40.6
43.7
49.5
Modern Temporary
10.8
16.5
26.4
Modern Permanent
29.8
27.2
23.1
Any Traditional Method
21.1
22.4
21.3
Source: Demographic and Health Surveys , 1987,1993 & 2000.
Excludes the Northern and Eastern Provinces.
TABLE 15
YOUTH UNEMPLOYMENT RATES
1992 AND 1997
Age
Group
Male
1992
Female
Male
1997
Female
Total
Total
15-19
38.4
46.4
41.5
30.9
40.1
34.8
20-24
27.3
45.5
34.3
23.4
35.1
28.0
15-24
30.7
45.8
36.4
25.9
36.9
30.0
Source: Labour Force Surveys 1992 and 1997
37
Table 16
NUMBER OF REPORTED HIV AND AIDS CASES
1987 - 2001
Period
HIV
Male
Female
AIDS
Male
Female
1987-1984
89
34
38
9
1995-2001
163
119
59
26
Source : STD and AIDS Control Programme,
Ministry of Health
TABLE 17
GENDER RELATED
DEVELOPMENT INDEX
Country
Rank
Sri Lanka
90
Maldives
95
India
128
Pakistan
138
Bangladesh
140
Nepal
152
Bhutan
155
Source: Human Development
Report, 1998
38
39