Fifth Asian and Pacific
Population Conference
11 – 17 December, 2002
Bangkok, Thailand
Sri Lanka Country Report
Population Division
Ministry of Health, Nutrition and Welfare
Colombo, Sri Lanka
December, 2002
Executive Summary
During the past decade, Sri Lanka has continued to consolidate on its achievements in the population, development and reproductive health fields. This period has seen an acceleration of population and socio-economic change. The level of poverty has shown a significant reduction in terms of consumption poverty due to the continued emphasis on the provision of income transfers to the poor through food subsidies, free education and health services. Considerable progress has been made in improving the level of health and education of the population. There has been significant improvements in the living standards, health and the educational levels of the people.
Sri Lanka today presents a picture of a country experiencing rapid and deep seated demographic and social change. The rate of growth of population has been reduced to 1.1 per cent. The total fertility rate has dropped from 3.4 in the early 1980s to 1.9 during 1995 to 2000. The contraceptive prevalence rate has increased from 66.1 per cent in 1993 to 70.0 per cent in 2000. The infant mortality rate has shown a steady decline from 19.3 per thousand live births in 1990 to 14.0 in 1998. Trained care during pregnancy and labour is high in Sri Lanka. Nearly 99 per cent of pregnant women receive antenatal care during pregnancy. Approximately 94 per cent of deliveries take place in medical institutions. The status of women in the Sri Lankan society is relatively high and in the South Asian context Sri Lanka ranks first in the gender related development index.
Yet, there are areas in Sri Lanka which need focused attention. A major challenge the country will face in the immediate future is to increase the pace of economic growth and thereby effectively eliminate poverty. It is clear that much higher rates of economic growth is needed to improve living standards of the population. The the government has set a target growth rate of 10 percent. This is indeed necessary not only to substantially reduce poverty, but also to carry out the required reconstruction and rehabilitation to ensure permanent end to the conflict in the north and east of the country. Another challenge is the ageing of the population. It is important to plan out adequate health care and social support programmes for this segment of the population. Although the pace of urbanization in the past has been relatively slow, by 2030 more than 40 per cent of the total population will live in the urban sector. It is therefore, necessary to ensure the planned planed growth and development of cities.
In spite the progress made in the field of maternal health, still two thirds of maternal mortality and morbidity are due to preventable causes. Of the infant deaths, about 75 per cent take place during the first month of life. Thus coverage of postnatal domiciliary care services need to be improved. Child mortality has declined steadily during the past decade. Though maternal and child care services have reached the greater majority of the population, the quality of services needs to be improved if maternal and child mortality and morbidity is to be further reduced.
The knowledge in respect of STD and HIV/AIDs and their prevention varies among different groups of the population. Some of the identified high risk groups include Sri Lankans employed in the Gulf States, workers in the Free Trade Zones, beach boys and young girls involved in commercial sex and displaced persons.
Associated with increasing life expectancy in Sri Lanka, the chronic non-communicable diseases such as diabetes, hypertension and cancers have become more important causes of morbidity and mortality. In females, 50 per cent of reported cancers are those of the reproductive tract. A screening programme for reproductive organ malignancies and certain other conditions has been introduced since 1996 through the establishment of Well Women’s Clinics.
Although appreciable reduction in fertility has been observed, still significant differentials exist between socio-economic groups as well as between geographic areas. Male methods of contraception are not quite popular. In 2000, only 2.1 per cent had accepted vasectomy, 3.7 per cent were using condoms and 7.1 per cent used Withdrawal as a method of contraption.
About 26 per cent of the Sri Lankan population comprise adolescents and youth. Though a considerable amount of work as been initiated, it is necessary to organize programmes to provide reproductive health information, education and services to this segment of population.
Sri Lanka continues to promote and sustain a policy environment that is conducive to gender equality and the empowerment of women. However, there is still a need for the greater involvement of women in policy, decision making processes at senior level managerial positions.
A well designed advocacy strategy is therefore necessary to create a supportive environment to address these issues with a view to promote changes in policy and resource allocations.
Among the areas of donor assistance in the future will include support to strengthen services to underserved geographic areas and specified vulnerable groups of population, consolidation and quality improvement in the delivery of services, prevention of abortions, reproductive tract infections including HIV/AIDS, adolescent reproductive health and counseling, prevention of gender based violence, support to NGOs, data collection and research, advocacy and building capacity at national and sub-national levels for effective implementation of policy and coordination and monitoring of programmes using results based management.
Therefore, in order to consolidate the gains achieved thus far and to move forward to face the emerging challenges in the coming years, broader and deeper partnerships between the government, the NGOs, civil society and the international donor community is needed.
1. Overview of Population and Development Situation and Prospects
with Special Attention to Poverty
In the South Asian context Sri Lanka’s experience in achieving considerable progresses in reducing its rate of growth of population and the human development dimension of poverty has been unique. Enlightened social development policies pursued during the past five decades have no doubt contributed to this welcome change. The strong commitment by government to provide free education and health care services to all segments of the population and subsidized food for the entire population for about three decades and to more than one half of the population during the past two decades and the wide coverage of these services has resulted in very good indicators in terms of fertility, mortality, literacy and basic education enrollment. This marks Sri Lanka as an outlier in relation to other countries at similar levels of per capita income.
Sri Lanka’s progress in the population and development field during the past decade is significant. The rate of growth of population has declined from 1.5 per cent in the early 1990s to 1.1 per cent today. Similarly, the per capita income which was US $ 418 in 1990 has increased to US $ 841 in 2000. In addition, emphasis on establishing peace and ethnic harmony, the strengthening of democracy and human rights and maintaining economic progress have been reflected in government policies and programmes in the post-ICPD period.
Continued reliance on open economic policies and human resource development has enabled Sri Lanka to achieve an average economic growth rate of near 5 per cent during the past decade. The liberalization process set in motion for over two decades has contributed to diversification of the production structure of the economy. The expert-led diversification of the economy has also contributed to the changes in the composition of the Gross Domestic Product (GDP). In 1995, for the first time the industrial sector overtook the agricultural sector in terms of its share to the GDP.
The level of poverty in Sri Lanka has also shown a significant reduction in terms of consumption poverty due to overall economic growth and continued emphasis on the provision of income transfers to the poor in particular through food subsidies, free education and health services. The proportion of individuals at the household level with consumption expenditure below poverty level was estimated at 22 per cent in the early 1990s. If a United States dollar a day is used as the poverty line (adjusted for purchasing power parity), only about 7 percent of the Sri Lankan population is poor. However, when the poverty line is increased to US $ 2 a day, the poverty line increases to 45 per cent. The income distribution pattern of the population shows that there has been improvements among the middle 40 per cent and bottom 50 per cent of income groups during the period 1986 to 1997. In Sri Lanka, poverty groups are essentially the landless and small farmers, unskilled labourers, low skilled artisans, self employed , the unemployed, the aged in low income families and working poor at subsistence levels of income. Universal access to education and health care has to some extent protected these poverty groups.
Poverty is predominantly a rural phenomenon. Studies have shown that poor households are more likely to be found in rural than in urban areas. Households are more likely to be poor if their working members are employed in agriculture and other primary production activities. Poverty among female headed households is about the same as among male headed households. Poor households generally have a larger family size. Their members are less educated than those of non-poor households. Members of poor households who are in the labour force are more likely to be unemployed. It is also observed that the poor divert a large proportion of their consumption expenditure to food.
As the economic growth rate over the past few decades has not grown at an appreciable pace to reduce poverty, special programmes have been implemented to reduce consumption poverty in Sri Lanka. Moreover, despite the relatively slow economic growth rates, the macro-economic and structural adjustment programmes have aggravated the plight of the poor in certain areas. The major State strategy to alleviate poverty and generate incomes for the poor is the Samurdhi Programme, which replaced the Janasaviya Poverty Alleviation Programme implemented prior to 1994. The Samurdhi programme has several components; income transfers, compulsory savings and insurance schemes and loans and training for micro-enterprises. This programme services about 53 per cent of all households in the country.
During the past few decades, considerable progress has been made in improving the level of education of the population. These improvements have been greater for females. In 1994, 89.4 per cent of boys and 89.5 per cent of girls aged 5-14 years were in school. School dropout occurs mainly at the senior secondary level. The school participation rates in the age group 15-19 years were 55.3 per cent for girls and 53.4 per cent for boys. Literacy rates have improved from 92.5 per cent for males and 87.9 per cent for females in 1994 to 94.5 per cent and 89.8 per cent respectively in 1996/97. In January 1998, compulsory education regulations were introduced for the age group 5-14 years to ensure that the 5 per cent of those aged 5 years who do not attend school and those who drop out before aged 14 are retained in the educational system. The rising educational level of the population, in particular that of females have contributed to the decline of infant and maternal mortality and fertility in Sri Lanka.
Due to the relatively high fertility rates in the past, the current rate of growth of the labour force is 1.7 per cent, much higher than that of population which grows at 1.1 per cent. Although the overall unemployment rates have declined over the past decade, youth unemployment rates are about three times higher. Female rates are much higher than that of males, Labour force projections for the current decade indicate that the total labour force will increase from 8.9 million in 2000 to 10.1 million in 2010.
A developmental benefit from the slower rate of growth of population in Sri Lanka as a consequence of the decline in fertility is the trend towards lower dependency ratios. The dependency ratio which was 85.2 per cent in 1991 dropped to 46.4 per cent in 2000. It is expected to further decline to 44.5 per cent by the year 2010. Thus the demographic structure of Sri Lanka is well geared for social and economic advancement. Thus Sri Lanka therefore, has another window of opportunity to respond the current favourable population age structure. Before the older population dramatically increases, there will appear a bulge is the workforce, initially in the peak working ages. Therefore, it is important to create appropriate enabling economic conditions to take advantage of this opportunity.
Population projections for this decade indicate that the total population will increase from the current estimated number of about 19.0 million to about 20.7 million by the year 2010.
- Fertility Levels and Trends and their Implications for Reproductive Health, Including Family Planning Programmes
Sri Lanka has undergone significant declines in fertility during the past few decades. The level of fertility measured by total fertility rate show a decline from about 5 children per woman in the early 1960s to below replacement level of 1.9 children in 2000 making Sri Lanka the country with the lowest level of fertility in South Asia.
The age-specific fertility rates show that during the early 1980s fertility decline has been entirely due to the decline in fertility levels of women aged 30 years and over. However, since then significant declines have been observed for women aged below 30 years. Completed fertility measured by the average number of children ever born to currently married women aged 45-49 years also confirm the downward trend in fertility where it has declined from 5.1 children to 3.2 children.
Initial fertility decline in Sri Lanka was mainly attributed to the rise in the age at marriage of females. The mean age at marriage of females increased from
20.9 years in 1953 to 24.6 in 2000. The subsequent decline in fertility is attributed to the rise in contraceptive prevalence rate from 34.4 per cent in 1975 to 70.0 per cent in 2000. An examination of the demand for contraceptives by method show that until around the mid 1980s the contraceptive prevalence rate of modern temporary methods had remained around 10 per cent. Since then, it has increased to 17 per cent in 1993 and to 26 per cent in 2000. The demand for permanent methods of family planning has shown an increase in prevalence from about 11 per cent in 1975 to 30 per cent in 1987 and since then has declined to 23 per cent in 2000.
In addition to contraceptive use and rise in age at marriage, abortion and post-partum in fundability may have also contributed to fertility decline in Sri Lanka. Surveys have shown that the number of married women resorting to abortion has increased during the past decade. Similarly, the mean duration of breastfeeding has remained at around 23 months despite the rising educational levels of women.
While the rise in educational level of married females in the reproductive ages has contributed to the increase in the age at marriage and contraceptive use, in recent years, the upward social mobility of females brought about by the wider availability of economic opportunities and their participation in the modern economic sectors have also contributed to higher level of contraceptive use and fertility decline in Sri Lanka.
Studies have also shown that there is a clear inverse relationship between mothers education and fertility. Lower the level of education of the mother higher is the number of children in the family. Therefore, it is generally seen that family size is higher in low income families. Similarly, it also shows that in households where the husband is engaged in white colder work, the number of children in the household is lower than in households where the husband is engaged agricultural work.
Fertility decline in Sri Lanka has brought about both positive results and challenges. On the positive side it is seen that dependency ratios and the rate of growth of population have declined. Better birth spacing has no doubt contributed to the decline in infant and maternal mortality rates. The reduction in the absolute number of births has also put less pressure on primary education and primary health care services. It has also brought about a slower growth of labour force enabling the reduction of unemployment rates and increased labour productivity through the application of modern technologies.
The reduction of fertility also poses challenges in accelerating the process of population ageing in the future.
The projections of fertility for the future indicate that the total fertility rate will continue to decline to about 1.7 during 2015-2020 and thereafter gradually rise to replacement level.
One of the main goals of the Population and Reproductive Health Policy of the government presented in 1998 is to maintain current declining trends in fertility so as to achieve a stable population size at least by the middle of the 21st century.