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Sri Lanka - a role model for best maternity practices

Aug 23, 2010

Unlike many Asian countries, Sri Lanka boasts of excellent health indicators including the practice of breastfeeding among women. Professor Priyani Soysa from Colombo has revolutionised the health system through institutional and behavioural interventions, which have ensured that Lankan children are raised hale and hearty.

maternal and child health sri lanka.jpgColombo: "Ninety eight per cent of child births in Sri Lanka take place in hospitals and 79% of infants receive breast milk within the first hour of birth. Seventy five per cent are fed only on breast milk during the first six months." This positive bit of news was shared by Dr Deepika Attygalle of Sri Lanka's Ministry of Health at a seminar to mark the National Breastfeeding Week in Colombo recently.

Attygalle is not wrong when she says that Sri Lanka is well ahead of most countries in breastfeeding and various other health indicators. In fact, a survey (2008) of breastfeeding in Asia by the International Breastfeeding Activity Network (IBFAN) has placed Sri Lanka at the top in terms of breastfeeding in Asia.

Of course, this was not always the case. Almost three decades back, aggressive marketing campaigns and distribution of gift samples of formula milk by multi-nationals in hospitals led mothers, especially those who were working, to believe that giving infants artificial formula is not just a beneficial but convenient option as well.

It took almost 25 years to change this mindset and it all started with Professor Priyani Soysa, the then President of the Nutrition Society in Sri Lanka. Adopting the tagline 'Breast is best', Soysa and her dedicated team embarked upon a long and difficult campaign to turn mothers away from the bottle.

Professor Emeritus Sosya has spent most of her working life among children, as the head of the Lady Ridgeway Hospital in Colombo, the largest children's hospital in the country. It was here that she saw malnourished mothers and children at close quarters and decided to take up issues related to mother and child health. When in 1981 the World Health Organisation (WHO) initiated the International Code of Marketing of Breastmilk Substitutes that banned all promotion of bottle feeding and set out requirements for labelling and information on infant feeding, Soysa was part of the decision making group.

But while steps were being taken at the international level to ensure that infants got breastfed in the first six months, for Soysa the challenge back home was tougher. Initially, she encountered a lot of resistance to the move to ban infant milk products. This delayed her campaign but with the assistance of sympathetic lawmakers she was able to cross this hurdle.

One of the first steps to begin a campaign to improve breastfeeding had to be linked with maternity leave for working mothers, she decided. The provision of six weeks' maternity leave was hardly sufficient for working mothers to continue breastfeeding and, as a result, mothers were putting their infants on formula right from the start.

With the support of UNICEF, Soysa got several studies conducted among working women - in the public, private and estate sectors - across the nation. And the results proved her point. The hard work of the dedicated team of volunteers that undertook the task of conducting the studies and, as Soysa puts it, "badgering the authorities", brought about the change she hoped for: Sri Lanka decided to give four months of maternity leave on full pay to its new mothers from 2008.

To ensure that healthy children are raised in Sri Lanka, many reforms to ensure a proper environment for mothers to breastfeed their infants, especially in hospitals, have been carried out

"At the moment there is a move by several pediatricians to get the four months extended to six months and also two weeks paternity leave to consolidate the family unit, but nothing has happened on that front - yet," remarks the dedicated campaigner, who was also the first woman professor in the Sri Lankan University system and the first woman MD in the country.

To ensure that healthy children are raised in Sri Lanka, many reforms to ensure a proper environment for mothers to breastfeed their infants, especially in hospitals, have been carried out by the department of Health Services. "Training health staff to assist mothers to breastfeed and educating policy makers and politicians on the national policy on breastfeeding are just some of these," informs Dr Palitha Maheepala, Deputy Director General, Health Services.

Adds Soysa, "Along with the extended quota of maternity leave there have been other improvements. Continuous breastfeeding during the first six months of a child's life and better child nutrition coupled with the country's free health services, the high literacy rate, especially among women (94%), has contributed widely to the improvement of the country's health indicators."

Though retired from government service, Soysa - who at the age 40 was appointed to the Chair of Pediatrics at the University of Ceylon - continues to actively promote child nutrition and infant feeding and weaning practices. Her recent research covers a number of health priorities such as nutrition, infectious diseases and community pediatrics. Her studies have contributed new knowledge to diseases that mainly afflict children - intestinal helminthiasis, patterns and determination of infant feeding practices, low birth weights, malnutrition among the under-fives, among others. Another area in which she has played an important role is the Expanded Programme of Immunisation (EPI) across the nation, including in the north during the worst period of the war against the LTTE.

Soysa's long years of work as a pediatrician have taken her across the country and to conferences in many parts of world. She fondly recalls her years in Jaffna, the capital city of the Tamil dominant Northern Province. A young Soysa started her stint as a Consultant Paediatrician in Jaffna in the 1950s under the most challenging circumstances. The largely Tamil population was naturally hostile to a Sinhala woman who had come to care for their children, but her principles of non-racism stood her in good stead.

At the Jaffna Teaching Hospital she won the hearts of many, especially the women, who called her the "Big Lady" of the Children's Ward. Here she brought about many reforms, especially in the way lower caste women were treated. Soysa recalls the time when the rigid caste system that prevailed during those days prevented these women from covering the upper part of their bodies. This was certainly not conducive for new mothers nursing their children and so using her good sense she ensured that they wore hospital jackets instead.

Blazing new trails as a young woman, did she encounter any gender barriers in her working life? "No, none at all," answers this loving grandmother, emphatically.

Today, as the world is trying to bring down levels of infant mortality and child malnutrition, especially in the developing countries, Sri Lanka is a unique exception. And the reason behind healthy and happy Lankan children is Professor Soysa.

Source : WFS
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