Families that are planned with proper spacing in between the birth of each child is vital, especially, in over populated South Asian countries like Sri Lanka where the current population has far exceeded the availability of land for those living in this tiny island . Over and over, health authorities have reiterated how proper family spacing results in wide ranging benefits of health and well being for women and families. They have pointed out that using scientifically tested contraceptives can not only set the foundation for strong healthy families, but carry a plus bonus of protecting mothers against sexually transmitted organ tract diseases, including HIV/AIDs , all of which put the mother and child’s life at risk.
The Family Planning Association of Sri Lanka ( FPASL) is one of the pioneer non profit non governmental organizations which has spearheaded several innovative programs in keeping with modern needs to further strengthen family bonds, family health and Reproductive Health, for all. Educating and raising awareness of free sex and sex with same sex among beach boys, with the Health Ministry is one such project. The outcomes of the Happy Life project where couples on the threshold of marriage are able to chat, phone or email questions that trouble them with a trained counsellor at the other end of the line, which began due to a survey on Reproductive Health which showed a high percentage of Lankan youth being unaware of the basic facts of life have also been rewarding.
Yet, despite the joint efforts of the Ministry of Health and the FPASL as well as other non profit organisations, to promote scientifically proven family spacing methods, recent surveys indicate there is still an unmet need, especially, among married women in certain parts of the country due to various reasons.
With President Sirisena now calling on all medical officers and heads of provincial councils to increase their inputs on improving the overall nutrition of the general population, family spacing which allows each child to enjoy the maximum benefits of a nutritious meal, another step forward has been taken to add to the dimension of future family spacing activities.
The Sunday Observer spoke to the Medical Director, FPASL, Dr Harischandra Yakandawala to find out more about the methods currently in use, how they work, and future plans of the FPASL to help pave the way for healthy families in Sri Lanka.
Excerpts…
Q. The Family Planning Association of Sri Lanka ( FPASL) has been in the forefront of campaigning for Sexual and Reproductive Health for all. As an umbrella of the International Planned Parenthood Federation (IPPF ) which marked its 60th anniversary last year, tell us about some of the most recent changes your Association has seen in terms of services for safe and proper family spacing.
A. FPA was established in 1953 and is the 1st organization to provide family planning services to the needy people. Currently, we provide services through our main centre in Bullers Lane, Colombo 7 and 6 field clinics.
Our services include Family planning, Sub fertility investigation and treatment, Counselling service, Sexual health services, Men’s health care, Gynaecological care, Well women clinic, Sexually transmitted infections and HIV Clinic, Pre-marital counselling services and treatment and advises for any other sexual and reproductive health issues. We have introduced a range of lifestyle condoms to the market with different specifications and a new range of oral contraceptives. Emergency contraceptive pill is the most popular pill for women who had unplanned engagement. We are in the process of introducing a new self administered family planning injection to the market. Any person married or unmarried with any type of sexual and reproductive health issue can visit the FPA and get professional advice and service.
Q. Tell us in what respect these services are different from those which the FPASL started off 60 years ago with a brief history of the FPASL.
A. This organisation was started by some dedicated volunteers to provide family planning services to the poor. This includes making awareness and providing services such as oral pills , injectables, tubectomy and vasectomy. The services were provided in accordance with government policy. Currently, services are provided after counselling and introducing all the available methods for the client to decide, based on their requirement and lifestyle.
We provide after care services as well for people who experience side effects. Our aim is to provide a quality service with a high client satisfaction. FPA is partnering the government in implementing HIV preventing activities among most-at-risk populations such as, sex workers, men having sex with men, HIV positive people and beach boys. We work closely with the Health Ministry and other relevant Ministries, and also with UN Agencies and bilateral organisations, in the planning and implementation of activities related to Sexual and Reproductive Health.
Q. Have they expanded to other fields?
A. Yes, we provide services to other fields, such as, Prevention of Gender based Violence, Comprehensive Sexual and Reproductive Health Education, Disaster and Emergency Response, Adolescence and Youth Health, Prevention of Sexually Transmitted Infections and HIV AIDS,
Q. What benefits have they had in making family planning safer for those who want to space their families?
A. We guide people to use the most suitable method for spacing after counselling and introducing all available methods. We discuss about their lifestyle, the need for health education and many other aspects before deciding on a method. FPA provides after care as well for those who use FP methods.
Q. What are the most popular methods now being used by the majority of those opting for scientific techniques of family planning? IUD?, Implants?
A. Oral pill is the most popular method and condoms are used as a dual protection method - Family planning and prevention of STDs and HIV. Injectables , IUDs and Implants are also popular methods among women in need. The use of the Emergency Contraceptive Pill is also becoming popular as some women who need to use a regular method do not use them and use ECP after having unsafe sexual act.
Q. What about male and female sterilizations?
A. We were the pioneers in doing male and female sterilization, but we do not conduct any permanent methods now. We promote long term methods such as, IUCD and implants for needy people or refer to the places where sterilization is conducted.
There were some objections by some organisations against permanent methods.
Q. According to a survey by the Guttmaker Institute published in 2015 online, the FPASL efforts achieved considerable success in the late 20th century. However it says the overall levels and trends may mask relatively high levels of unmet need under certain conditions . It adds that data from the 2007 Demographic and Health Survey of Sri Lanka were used to estimate unmet need for limiting /spacing births among married women between 15-49 years which ranged from 1.6% to 19.3% which was particularly high in traditional contraceptive methods and practice of prolonged abstinence . Do you agree?
A. I agree up to some extent. Traditional methods are not effective when the couples don’t have a high level of control. But, there are also some ethnic groups who do not use any method due to different reasons. We need to work harder to reach them.
Q. Since the International Conference on Population & Development in Cairo in 1999 ,the concept of Reproductive Health has been introduced with a focus on RH issues of the adolescent and post-adolescent woman, with education starting even before girls become mothers. What has the FPASL done to promote this concept?
A. FPA is working in collaboration with the Ministry of Education, Ministry of Health and Provincial Councils to reach adolescents with comprehensive Sexual and Reproductive Health education.
This will help our future generation to take effective decisions regarding Sexual and Reproductive Health issues.
Q. I understand that a life cycle approach to family health care has now been developed with certain issues being given to organ malignancies, prevention of RH tract infections, including, sexually transmitted diseases (STDs) as well as HIV/AIDs. Could you tell the inputs of the local program conducted by the FPSAL?
A. Educating, and raising awareness among vulnerable populations. We regularly conduct awareness programs through media, mobile clinics and special programs.
We have a call centre “Happy Life” that any person with a problem can call and get information and guidance on SRH issues
Q. Should both, women and men be equally involved in achieving these goals?
A. Yes. it is important for both men and women to get involved in the process. In Sri Lankan traditional society mostly men take decisions on family planning often without any knowledge. We always encourage the couple for discussion on our services.
Q. What are the specific health benefits of a wanted child in a correctly spaced period of the mother and the child?
A. It is important that married couples should consider when to have a child. Conceiving before the age of 18 is not recommended as the woman’s internal organs are not matured to bear a child.
There should be at least a 2 year gap between 2 children for the mother to regain her body structures and also for her to give proper care for the child, including breast feeding.
The mother and the father can give proper care, security, nutrition , education and a good social environment for children, if the family is well planned. It would definitely help the mother’s health as well as the health of children.
Q. Is there an ideal period for having children?
A. The best is around 24 years to have the 1st child and before 40 years.
Q. Is there an ideal size for a family?
A. Two is the accepted norm, but if the family can afford to have more with proper planning, they can do so with medical advice.
Q. From your experiences in your Happy Life program, what are the most important concerns young couples want sorted out before they get married?
A. They mostly concern delaying the 1st child, some reproductive health knowledge and sexual matters.
Q. Finally, your word of advice to couples who want to have the ideal family unit?
A. Having an ideal family unit is the dream of any couple but there are many issues a couple would face if they are not properly educated on important things about life such as, SRH, how to face day to day challenges effectively.
Understanding between the husband and the wife is very important to answer most of the issues faced on a day to day basis.
Effective Communication between them is important in taking decisions, including having children spacing , what method to use, and sexual life satisfaction based on scientific evidence.
Q. How can you be contacted for more information on safe family spacing?
A. Call us through the Happy Life Call centre 0112 588 488 or visit Family Clinic , Family Planning Association of Sri Lanka ,No 37/27, Bullers Lane, Colombo 7