Sri Lanka perpetuates gender disparity

On paper, the Sri Lankan healthcare system is doing quite well. It is free and universal, and it scores higher than the regional average, thanks to a high life expectancy rate and a lower maternal and infant mortality rate than neighbouring countries. However, whilst national statistics paint a flattering picture, they hide regional and sectorial disparities. This façade quickly dissolves when a critical view is taken of quality of healthcare services for vulnerable women, sexual minorities, the country’s at-risk population and those who live in former conflict areas.

Healthcare facilities in conflict-affected areas suffered lasting damage during the civil war, and the Sri Lankan government has yet to allocate a sufficient budget to restore them. The national maternal mortality rate average is currently reported to be around 26.8 for every 100,000 live births, but can be as high as 76.2 for every 100,000 live births in Batticoloa and 57.5 for every 100,000 live births in Mannar. These two large Sri Lankan cities, respectively in the East and North of the country, are both located in conflict-affected areas. On this matter, the report written in 2017 by the UN Convention on the Elimination of Discrimination Against Women (CEDAW) called for the allocation of an adequate budget to meet the health needs of women in conflict-affected areas, but, so far, the government has failed to act on this recommendation.

The maternal mortality rate is also heavily linked to other factors, such as the mother’s age or illegal abortions. In Sri Lanka, abortion is only permitted if the life of the mother is at risk, and the punishment for intentionally causing a miscarriage is three years imprisonment. However, abortion rates are high: the Ministry of Health reported 658 abortions happening each day in Sri Lanka in 2016. Most women who seek abortion are married, but cannot afford another child. The high rates of unsafe illegal abortions has had dramatic consequences and in Sri Lanka, 12.5% of maternal deaths are due to illegal abortions. It is easy to see that the decriminalisation of abortion and provision of safe abortion facilities to the women of Sri Lanka is a matter of urgent national public health.

In 2017, the European Union granted Sri Lanka a Special Incentive Arrangement for Sustainable Development and Good Governance called the Generalised Scheme of Preferences Plus (GSP+). In the last GSP+ report in 2018, along with the 2017 CEDAW report, the European Union for Foreign Affairs and Security Policy called for the decriminalisation of abortion in Sri Lanka. In 2017, the government attempted to reform the law, but their initiative was blocked by religious leaders.

The legalisation of abortion would dramatically decrease the number of maternal deaths as would the provision of sexual health education for all. A 2014 study assessing the sexual knowledge of Sri Lankan teenagers has shown alarming results: less than 1% of the teenagers surveyed demonstrated satisfactory sexual and reproductive knowledge levels, and only 57% of the sexually active teens used contraception during their first experiences of intercourse. In light of the poor level of sexual education in the country, the 2017 CEDAW report also asked Sri Lanka to ensure access to sexuality information. Implementing a proper sexual education curriculum in schools will play a crucial role in the diminution of abortion rates and, eventually, maternal mortality rates.

The CEDAW, the GSP+ report, and the UN Committee on the Rights of the Child have all expressed concerns on the child marriage rates in Sri Lanka. The most recent data, from 2006, indicates that 12% of Sri Lankans are married by 18, and 2% by 15. The legal age of marriage in Sri Lanka is 18, but the Muslim Marriage and Divorce Act (MMDA), the law regulating Muslim marriages, does not set a minimum age for Muslim marriages in Sri Lanka. The Muslim population represents 9.66% of the country’s total population, all living under the rule of the MMDA. The MMDA, also called the Muslim Personal Law, established a court system, comprised of 65 courts ruled by all male Quazi (judges) boards. This law is problematic because it limits access to justice, and allows child marriages to continue unchecked in the Muslim community. In recent years, the government has set up committees with the aim to reform the MMDA. The last appointed committee emphasised the need to change the age of marriage and to authorise the appointment of women as Quazis. In February this year, however, the Minister of Justice called a meeting to discuss these reforms but failed to include women in this process. The meeting was led by conservative male-groups and Muslim male religious leaders, although women have been the driving force behind the reform. As the Minister of Justice has shown no interest with meeting Muslim women activists on the matter, it has become clear that the Sri Lankan government does not have a coherent agenda to reform the MMDA.

Relations between the EU and Sri Lanka are governed by a Cooperation Agreement on Partnership and Development. Sri Lanka’s efforts to improve the living conditions of the poorer sections of the population has been positioned as one of the key areas of cooperation with the EU. Sri Lanka is a recipient of GSP+ and the EU has also provided a total of approximately EUR 760 million in assistance to Sri Lanka over the past years, with the aim of supporting development in the country. The EU therefore, has significant leverage in the country when it comes to public health matters. The EU’s influence can be crucial in bringing about new initiatives for Sri Lanka and the health of its women and girls.

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