The 2006-07 Sri Lanka Demographic and Health Survey (SLDHS) is the fourth in a series of DHS surveys to be held in Sri Lanka-the first three having been implemented in 1987, 1993, and 2000. Teams visited 2,106 sample points across Sri Lanka and collected data from a nationally representative sample of almost 20,000 households and over 14,700 women age 15-49.
A nationally representative sample of 21,600 housing units was selected for the survey and 19,872 households were enumerated to give district level estimates (excluding Northern Province). Detailed information was collected from all ever-married women aged 15-49 years and about their children below five years at the time of the survey. Within the households interviewed, a total of 15,068 eligible women were identified, of whom 14,692 were successfully interviewed.
The Department of Census and Statistics (DCS) carried out the 2006-07 SLDHS for the Health Sector Development Project (HSDP) of the Ministry of Healthcare and Nutrition, a project funded by the World Bank. The objective of the survey is to provide data needed to monitor and evaluate the impact of population, health, and nutrition programmes implemented by different government agencies. Additionally, it also aims to measure the impact of interventions made under the HSDP towards improving the quality and efficiency of health care services as a whole.
All 25 districts of Sri Lanka were included at the design stage. The final sample has only 20 districts, however, after dropping the 5 districts of the Northern Province (Jaffna, Kilinochchi, Mannar, Vavuniya, and Mullativu), due to the security situation there.
OBJECTIVES
The objective of this report is to publish the final findings of the 2006-07 SLDHS. This final report provides information mainly on background characteristics of respondents, fertility, reproductive health and maternal care, child health, nutrition, women's empowerment, and awareness of HIV/AIDS and prevention. It is expected that the content of this report will satisfy the urgent needs of users of this information.
MAIN RESULTS
FERTILITY
Survey results indicate that there has been a slight upturn in the total fertility rate since the 2000 SLDHS. The total fertility rate for Sri Lanka is 2.3, meaning that, if current age-specific fertility rates were to remain unchanged in the future, a woman in Sri Lanka would have an average of 2.3 children by the end of her childbearing period. This is somewhat higher than the total fertility rate of 1.9 measured in the 2000 SLDHS.
Fertility is only slightly lower in urban areas than in rural areas (2.2 and 2.3 children per woman, respectively); however, it is higher in the estate areas (2.5 children per woman). Interpretation of variations in fertility by administrative districts is limited by the small samples in some districts. Nevertheless, results indicate that Galle and Puttalam districts have fertility rates of 2.1 or below, which is at what is known as “replacement level” fertility, i.e., the level that is necessary to maintain population size over time. Differences in fertility by level of women's education and a measure of relative wealth status are minimal.
FAMILY PLANNING
According to the survey findings, knowledge of any method of family planning is almost universal in Sri Lanka and there are almost no differences between ever-married and currently married women. Over 90 percent of currently married women have heard about pills, injectables, female sterilization, and the IUD. Eight out of ten respondents know about some traditional method of delaying or avoiding pregnancies.
Although the proportion of currently married women who have heard of at least one method of family planning has been high for some time, knowledge of some specific methods has increased recently. Since 1993, knowledge of implants has increased five-fold-from about 10 percent in 1993 to over 50 percent in 2006-07. Awareness about pill, IUD, injectables, implants, and withdrawal has also increased. On the other hand, awareness of male sterilization has dropped by 14 percentage points.
CHILD HEALTH
The study of infant and child mortality is critical for assessment of population and health policies and programmes. Infant and child mortality rates are also regarded as indices reflecting the degree of poverty and deprivation of a population. Survey data show that for the most recent five-year period before the survey, the infant mortality rate is 15 deaths per 1,000 live births and under-five mortality is 21 deaths per 1,000 live births. Thus, one in every 48 Sri Lankan children dies before reaching age five. The neonatal mortality rate is 11 deaths per 1,000 live births and the postneonatal mortality rate is 5 deaths per 1,000 live births. The child mortality rate is 5 deaths per 1,000 children surviving to age one year.
REPRODUCTIVE HEALTH
The survey shows that virtually all mothers (99 percent) in Sri Lanka receive antenatal care from a health professional (doctor specialist, doctor, or midwife). The proportion receiving care from a skilled provider is remarkably uniform across all categories for age, residence, district, woman's education, and household wealth quintile. Even in the estate sector, antenatal care usage is at the same high level. Although doctors are the most frequently seen provider (96 percent), women also go to public health midwives often for prenatal care (44 percent).
BREASTFEEDING AND NUTRITION
Poor nutritional status is one of the most important health and welfare problems facing Sri Lanka today and particularly affects women and children. The survey data show that 17 percent of children under five are stunted or short for their age, while 15 percent of children under five are wasted or too thin for their height. Overall, 21 percent of children are underweight, which may reflect stunting, wasting, or both. As for women, at the national level, 16 percent of women are considered to be thin (with a body mass index < 18.5); however, only 6 percent of women are considered to be moderately or severely thin.
Poor breastfeeding and infant feeding practices can have adverse consequences for the health and nutritional status of children. Fortunately, breastfeeding in Sri Lanka is universal and generally of fairly long duration; 97 percent of newborns are breastfed within one day after delivery and 76 percent of infants under 6 months are exclusively breastfed, lower than the recommended 100 percent exclusive breastfeeding for children under 6 months. The median duration of any breastfeeding is 33 months in Sri Lanka and the median duration of exclusive breastfeeding is 5 months.
HIV/AIDS
The HIV/AIDS pandemic is a serious health concern in the world today because of its high case fatality rate and the lack of a cure. Awareness of AIDS is almost universal among Sri Lankan adults, with 92 percent of ever-married women saying that they have heard about AIDS. Nevertheless, only 22 percent of ever-married women are classified as having “comprehensive knowledge” about AIDS, i.e., knowing that consistent use of condoms and having just one faithful partner can reduce the chance of getting infected, knowing that a healthy-looking person can be infected, and knowing that AIDS cannot be transmitted by sharing food or by mosquito bites. Such a low level of knowledge about AIDS implies that a concerted effort is needed to address misconceptions about HIV transmission. Programs might be focused in the estate sector and especially in Batticaloa, Ampara, and Nuwara Eliya districts where comprehensive knowledge is lowest.
Moreover, a composite indicator on stigma towards HIV-infected people shows that only 8 percent of ever-married women expressed accepting attitudes toward persons living with HIV/AIDS. Overall, only about one- half of ever-married women age 15-49 years know where to get an HIV test.
WOMEN'S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES
The 2006-07 SLDHS collected data on women's empowerment, their participation in decisionmaking, and attitudes towards wife beating. Survey results show that more than 90 percent of currently married women, either alone or jointly with their husband, make decisions on how their income is used. However, husbands' control over women's earnings is higher among women with no education (15 percent) than among women with higher education (4 percent).
In Sri Lanka, the husband is usually the main source of household income; two-thirds of women earn less than their husband. Although the majority of women earn less than their husband, almost half have autonomy in decisions about how to spend their earnings.
The survey also collected information on who decides how the husband's cash earnings are spent. The majority of couples (60 percent) make joint decisions on how the husband's cash income is used. More than 1 in 5 women (23 percent) reported that they decide how their husband's earnings are used; another 16 percent of the women reported that their husband mainly decides how his earnings are spent.