Sexual & reproductive health

Women and young people’s rights to reproductive health services, information and education cannot be protected without ensuring that they can determine when, how, and whether to bear children, control their bodies and sexuality, access universal sexual and reproductive health information and services, and be free from violence. UNFPA works at global and country office level to ensure that those elements are addressed through its programme and mission. In Sri Lanka, the UNFPA country office works with both duty bearers and rights holders with the vision of ensuring the reproductive rights of all including women, young and marginalized people are protected. The work will contribute to advance the realization of human rights within the framework of accountability, quality, equity and also by ensuring acceptability.

Women and young people’s rights to reproductive health services, information and education cannot be protected without ensuring that they can determine when, how, and whether to bear children, control their bodies and sexuality, access universal sexual and reproductive health information and services, and be free from violence. UNFPA works at global and country office level to ensure that those elements are addressed through its programme and mission.

In Sri Lanka, the UNFPA country office works with both duty bearers and rights holders with the vision of  ensuring the reproductive rights of all including women, young and marginalized people are protected. The work will contribute to advance the realization of human rights within the framework of accountability, quality, equity and also by ensuring acceptability.     

We support the development of standard operating procedures, national guidelines and programmes in women and young people’s reproductive health and rights in the following key areas of:

  • Emergency Obstetric Care
  • Family Planning
  • Condom Programming
  • Responding to gender-based violence(GBV) through the health sector

1.  Review of the national family planning programme

The national family planning programme of Sri Lanka has over six decades of history and has never undergone a comprehensive review. There are regional disparities in Contraceptive Prevalence rate (CPR) which has shown a very slow progression over the last decade. The unmet need for family planning is 7.1% while studies have shown a high number of abortions in the country, highlighting the gap in access to family planning. The Government offers free family planning services only for eligible couples (married,) which is questionable in terms of human rights standards.  In this context UNFPA supports the Ministry of Health to the adapt the Human Rights standards into the national family planning programme through the review of the programme in line with UNFPA FP2020 strategy.

2.  Support the implementation of the national condom programme Strategy 2016-2021

Sri Lanka is a low prevalence country in terms of HIV/AIDS. However, the growing youth population, internal and external migration, flourishing sex industry, and low levels of condom use may lead to the development of a concentrated HIV epidemic among female sex workers, and men who have sex with women and external sex partners.

Condoms are freely available in the government and private sector in Sri Lanka and categorized as a medical device with little or no restriction for access and use. However, various factors related to the accessibility, acceptability, attitudes, myths, social stigma, cultural beliefs and practices and gender related issues, act as barriers for the condom progrmming. Therefore, UNFPA supports the Ministry of Health to implement the national strategy for condom programming which directly addresses the issues reflected above to ensure the reproductive rights of people, especially marginalized and vulnerable groups. 

3.  Health sector response to GBV

UNFPA has supported the Ministry of Health to initiate the Health Sector Response to GBV in the aftermath of the Asian Tsunami of 2004. Subsequently, UNFPA has been working together with the Family Health Bureau (FHB) to develop a sustainable plan of action for the health system, including hospitals to integrate the prevention and management of GBV within their routine delivery. The plan has been submitted to the FHB for endorsement and implementation will commence in 2016.

4.  Support the implementation of the recommendations of the national EmONC needs assessment

UNFPA, together with UNICEF and WHO have supported the Ministry of Health to conduct a national EmONC needs assessment, which was concluded in 2013. There are several policy recommendations in the final report which UNFPA has been supporting to implement the basis of that those are directly relevant to improve the maternal health and reproductive rights of people the country. Accordingly in 2016, UNFPA will support the standardization of EmONC training system in the country by adopting the training course of the Liverpool School of Tropical Medicine. UNFPA will also support the development of monitoring tools on EmONC guidelines which has been prepared over the last two years.

5.  Support for the Implementation of Behavior Change Communication (BCC) Strategy Guides

UNFPA has supported Health Education Bureau (HEB) of the Ministry of Health to develop 5 BCC strategy guides (Well Women Clinics, Maternal and neo natal Health, Family Planning, Gender Based Violence & Adolescent Reproductive Health). The strategies are aimed at ensuring the affirmative actions by policy makers and officials in improving reproductive health and rights of people and empowering people to claim their reproductive services and rights. The HEB has developed plans in 7 districts to implement the BCC strategies. 

6.  Ensuring Reproductive Rights of Young People

UNFPA together with UNICEF has supported the Ministry of Health to finalise the Youth Health Survey and the Youth Health Policy. Accordingly, it is important to ensure that existing youth health services to be revisited to make it more relevant and accessible for young people. UNFPA will support this review process of youth-friendly health services. FHB has also initiated a development of a youth health website which UNFPA will support in 2016 to ensure the rights of young people for SRH information. As agreed in 2015, UNFPA also supports the FHB in terms of communication expertise to make the web youth-friendly.

7.  Triangulation of Maternal Mortality Data

Support to triangulate data of the Family Health Bureau, Register Generals Department, and Health institutions to arrive at consensus on Maternal Mortality Rate (MMR) for year 2014 which will serve as the baseline for SDG progression.  

8.  Comprehensive Reproductive Health Education and Advocacy 

Sri Lanka has achieved remarkable social and health indices however; sexual and reproductive health remains a big challenge for today’s young people. The quality of reproductive health education and services does not meet international standard and protocols. Limited and inadequate knowledge on sexual and reproductive health (less than 50% among school going adolescents), pre-marital sex and unprotected sex, teenage marriage and pregnancies (6.3%), increasing rate of sexually transmitted infections and HIV/AIDS, lack of accessibility and availability of family planning services, Lack of knowledge on contraceptive methods are major issues in Sri Lanka.

Goal: Enhance national capacity to design and implement community and school based comprehensive reproductive health education program that promote human rights and gender equality.

What we are working on

  • Advocating for the access to information on sexual and reproductive health by the inclusion of CRHE into the curricular of vocational training

o   Develop a SRH curriculum   

o   Develop a webpage based on curriculum   

o   Advocacy programs for Instructors 

o   National level orientation programs for Instructors

  • SRHR curriculum modification and advocacy program for teacher and students in formal school education system              

            o   Conduct research on CRHE – Knowledge Attitude and Practices (KAP) and Situation analysis studies among teachers and students;

o   Develop teacher training supplementary modules on CRHE;

o   Conduct TOT programs at National level  

Programmatic Interlinkages

The proposed activities are linked to the other programmatic areas in different ways. These linkages will be built through the progress of our work in 2016. 

  • The health sector response to GBV will be linking with the GBV referral system/SoPs as an essential entity in the process. It will also be linked to the  ‘Emergency app’ as an important referral point. 
  • The Mithuru Piyasa centres will support data collection on violence against women, which is a key element on GBV. 
  •  Youth-friendly services and youth-health web will be linked to CRHE as well constitute an important element of the provincial youth health policy formulation process. 
  • The implementation of the BCC strategy guides will facilitate the social change by empowering people and changes their behavior towards positive health outcomes. 
  • The comprehensive condom programme and review of the Family Planning programme will look at social norms, attitudes and behavior and will come up with strategies for social change to ensure the reproductive rights of all. 
  • The Health sector response to GBV and the issues of young people and marginalized people will be essential parts of the Policy Engagement Framework (PEF) that will contribute to the dialogue technically, as well as provide data/evidence for discussion.      

Main implementing partners

     Ministry of Education

     Ministry of Vocational Training

Reports

Sexual and Reproductive Health and Rights Terminology Guide