Facility Based Postnatal Care in Sri Lanka: Achievements and Challenges

Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Background: Sri Lanka has demonstrated remarkable progress in its health indicators with a relatively modest investment in health. The maternal mortality ratio is around 30 per 100,000 live births and antenatal care coverage is almost universal with 99.9% institutional deliveries in which more than 95% are at facilities where comprehensive emergency obstetric and neonatal care services are available.

Methodology:  A comprehensive desk review of documents on postnatal care (PNC) was carried out with the objective of identifying approaches used for PNC and achievements of facility based PNC.

Results: The facility based maternity care services were introduced in the 1870’s and registration for practicing midwives was made policy. In 1926, trained midwives were appointed to the field with the objective of providing skilled maternity care at home. With the expansion of the hospital network, home deliveries declined and by the 1990’s more than 90% of deliveries were institutional. The policy of keeping women in hospital for at least a day after a delivery was practiced from the inception.  The delivery care is provided by a trained midwife. Immediate essential newborn care, including delayed cord clamping, thermal care, skin to skin care, eye care, initiation of breastfeeding and immediate postpartum care, take place in the labour room where both are observed every 15 minutes for 2 hours. At postnatal ward they were observed every 4 hours for 24 hours. BCG immunization, birth registration, establishment of breast feeding, counselling on family planning and emergency preparedness, newborn and maternal examination are carried out before discharge. The referral pathway has been established to care for the most vulnerable.

Conclusion:  Although Sri Lanka has achieved universal coverage of facility based PNC, more opportunities are available to improve the quality of care to reach effective coverage.