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Full scope of improving women’s reproductive health
View(s):Dr. Sanath Akmeemana points the way in overcoming challenges while maximising opportunities
Covering a wide spectrum of issues impacting on the reproductive health of girls and women, the 39th President of the Sri Lankan College of Obstetricians and Gynaecologists (SLCOG), Dr. Sanath P. Akmeemana, promised an evidence-based approach not only to overcome the challenges but also to maximise the opportunities.
The SLCOG, with a history dating back to 1953, is the apex body providing maternity care services for expectant mothers and strongly supporting improvements in adolescent health and health of post-reproductive women.
Newly-inducted SLCOG President Dr. Sanath P. Akmeemana addressing the gathering
With his theme as ‘Improving Reproductive Health of Women: Challenges and Opportunities; Evidence Based Approach’, the SLCOG’s newly-inducted President reiterated that ‘reproductive health’ is at the intersection of biology, society and healthcare.
“It encompasses a broad spectrum of issues related to sexual and reproductive well-being,” he said, explaining that reproductive health goals broadly serve three purposes – upholding people’s dignity and rights; prioritizing human rights including reproductive rights; and empowering women and adolescents.
Detailing Sri Lanka’s achievements, Dr. Akmeemana said that Sustainable Development Goals (SDGs) 3 and 5 set by the United Nations relate to good health and well-being and thus to reproductive health.
He said: “Sri Lanka has surpassed SDG Target 3.1 to reduce the global Maternal Mortality Rate (MMR) to less than 70 per 100,000 live births by 2030. Even though our MMR is 25 per 100,000 live births,we cannot be complacent. We are far away from achieving the country’s target of a maternal mortality of 15 per 100,000 live births by 2030, an ambitious but challenging goal.”
According to him, the Confidential Enquiry into Maternal Deaths (CEMD) is a way forward in addressing this plateau, as it helps to take a closer view into maternal deaths. The CEMD pilot process is already on in the Southern and Central Provinces, with expansion to the other provinces on the cards.
With 22 years of experience as a Consultant Obstetrician and Gynaecologist, he highlighted the gaps and challenges that have led to this long-term plateau in the MMR and suggested a broader approach to change it.
The issues, he said, included inadequate staffing with the migration of doctors and nurses in large numbers impacting heavily on the system; need for regular in-service training; equipment shortages, supply-chain interruptions to essential medicines; lack of infrastructure; lack of ICU and Neonatal ICU facilities; and the need for components of respectful labour care.
Dr. Mangala Dissanayake inducting Dr. Sanath Akmeemana as SLCOG President
While there is an urgent need for the government to find suitable solutions to prevent the migration of doctors and nurses, he said that other aspects too need to be looked into urgently. Regular assessment and replacement of equipment, supply-chain strengthening to prevent patient care being affected and efficient management of ICU beds by appointing a bed manager at the centre are vital.
Looking at components of respectful labour care, Dr. Akmeemana said that drugs used for pain relief are in short supply from time to time. Meanwhile, with the benefits of a labour companion being well known, respective hospitals should be able to provide facilities to implement this process across the country. The SLCOG has also been “pushing” for the establishment of centres of excellence for the management of high-risk pregnancies.
Among the other important aspects he dealt with are the need to reduce the alarming rise in caesarian sections; the need for stronger enforcement of laws against gender-based violence (GBV) and child marriages; and the need for special attention for migrant workers in the female labour force who may not be able to attend health clinics in the mornings.
Referring to the sensitive and controversial issue of abortion, Dr. Akmeemana said that the SLCOG vigorously lobbied for the legalization of abortion in cases of lethal congenital abnormalities, rape and incest in the recent past. However, it could not succeed due to religious and political opposition. “As SLCOG President, I will explore the possibilities of advancing this initiative.”
The head-table (from left): SLCOG Secretary Dr. Achintha Dissanyake; Health Secretary Dr. Anil Jasinghe; SLCOG President Dr. Sanath P. Akmeemana; SLCOG Patron Dr. (Mrs.) Marlene Abeyewardena; SLCOG Immediate Past President Dr. Mangala Dissanayake; Director General of Health Services Dr. Asela Gunawardena; Educationist Dr. Jagath Alwis; and Senior Consultant Obstetrician & Gynaecologist Dr. M.D.P. Goonerathne
He said that the life course approach is the best way to define key indicators of reproductive healthy life, pointing out that the main challenges in improving reproductive health included socio-cultural barriers, lack of comprehensive sexuality education and limited resources.
“The best opportunities to address these challenges are evidence-based policies followed by innovative interventions. The Plan of Action includes multi-sectoral collaboration, investment in reproductive health research and strengthening the role of the SLCOG,” he added.
(KH)
| Different stages of life Dr. Sanath Akmeemana focused on the health problems which may be experienced by females at different stages in their lives. Infancy and childhood (till 9 years of age) – nutritional deficiencies, congenital disorders and low birth weight. Adolescence (10 to 19 years) – child abuse, teenage pregnancies, abortions, sexually transmitted diseases (STDs) and malnutrition. Reproductive years (20-44 years) – unplanned pregnancies, STDs including Acquired Immuno-Deficiency Syndrome (AIDS), abortions and pregnancy complications. Post-reproductive age (after 44 years) – Non-Communicable Diseases (NCDs), gynaecological cancers, osteoporosis and menopause Lifetime health problems include - occupational and environmental health hazards, gender-based violence and psychological problems
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