The Sri Lankan law only permits induced or iatrogenic abortion to save the life of the mother. Despite the restricted law, law enforcement mechanisms, and reported high national contraceptive prevalence rate, a significant proportion of pregnant women terminate their pregnancy outside the law. Despite the existence of restrictions and inertia, numerous stakeholders concerned about women’s health have made several attempts to liberalize the abortion law in Sri Lanka. Although several amendments were proposed to rationalize the abortion law in Sri Lanka, nothing has been successful – we are back to square one. Expansion of legal exceptions for induced abortions and improved safe abortion with the revolutionized medical abortion (MA) were observed in numerous countries globally during the past decade. On the other hand, some countries with broadly liberal laws, including the United States, have added restrictions. How these global changes have affected countries like Sri Lanka is worth studying. This article assesses the response of the Sri Lankan government and the society towards those global changes in terms of the policies and practices on induced abortion. Authors argue that the paradigm shift in abortion practices in Sri Lanka, driven by the emerging occurrence of medical abortion, has highlighted the disparity between the existing legal status and the aspirations of most Sri Lankans. Given the widespread support for legalizing abortion in cases of rape, incest, and fetal abnormalities, it is imperative the government seriously consider legal amendments.
Introduction:The global first national level social marketing programme (SMP) implemented by a non governmental organization was started in Sri Lanka on 1973 by The Family Planning Association of Sri Lanka. After four decades, this operation has grown to be the market leader of contraceptives, distributing over 15 products through 4867 pharmacies island wide. In 2020, despite the COVID-19 pandemic and other related challenges, it generated 367 442 couple years of protection (CYP).Objectives: To assess the impact and contribution of SMP to the National Family Planning Programme (NFPP) during the past two decades with a special focus on the effect of the COVID-19 pandemic in 2020 Methods: The product-wise annual sales figures of the SMP during past two decades (2001-2020) were analyzed using Marries Stop International Impact2 Calculation Tool (MSI-Impact2) to estimate the impact and contribution to the NFPP. The programme data published in the Annual Report of the Family Health Bureau was used to compare and triangulate the results obtained from MSI-Impact2.Results: Contribution of the SMP to the national modem contraceptive prevalence rate (mCPR) during the past two decades is 10-1 7%. The SMP averts over 40 000 unsafe abortions, 15 maternal deaths and 60 child deaths annually. Although the national level impact of COVID-19 on contraceptive SM is negligible, a significant shift in the contraceptive purchasing pattern was observed in 2020.Conclusions & Recommendations: SM of contraceptives has contributed to improving women's health significantly in Sri Lanka. In the absence ofSMP, the country mCPR would have been reduced by 10-17%.
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