BackgroundThe target date for achieving the Millennium Development Goals (MDGs) is now closer than ever. There is lack of sufficient progress in achieving the MDG targets in many low- and middle-income countries. Furthermore, there has also been concerns about wide spread inequity among those that are on track to achieve the health-related MDGs. Bangladesh has made a notable progress towards achieving the MDG 5 targets. It is, however, important to assess if this is an inclusive and equitable progress, as inequitable progress may not lead to sustainable health outcomes. The objective of this study is to assess the magnitude of inequities in reproductive and maternal health services in Bangladesh and propose relevant recommendations for decision making.MethodsThe 2007 Bangladesh demographic and health survey data is analyzed for inequities in selected maternal and reproductive health interventions using the slope and relative indices of inequality.ResultsThe analysis indicates that there are significant wealth-related inequalities favouring the wealthiest of society in many of the indicators considered. Antenatal care (at least 4 visits), antenatal care by trained providers such as doctors and nurses, content of antenatal care, skilled birth attendance, delivery in health facility and delivery by caesarean section all manifest inequities against the least wealthy. There are no wealth-related inequalities in the use of modern contraception. In contrast, less desired interventions such as delivery by untrained providers and home delivery show wealth-related inequalities in favour of the poor.ConclusionsFor an inclusive and sustainable improvement in maternal and reproductive health outcomes and achievement of MDG 5 targets, it essential to address inequities in maternal and reproductive health interventions. Under the government’s stewardship, all stakeholders should accord priority to tackling wealth-related inequalities in maternal and reproductive health services by implementing equity-promoting measures both within and outside the health sector.

The objective of this study was to develop and validate a screening instrument (Abuse Assessment Questionnaire) to estimate the prevalence of physical abuse in a cohort of pregnant women in a district of Sri Lanka. The samples of 1200 pregnant women were identified by using a cluster sampling technique. Public health midwives (primary healthcare workers) were selected as interviewers and the antenatal clinic was identified as the setting to identify physical abuse. The reliability and validity (sensitivity 85.7%; specificity 89.7%) of the screening instrument proved to be high. The prevalence of physical abuse in categories 'ever-abuse', 'current abuse' and 'current pregnancy'were 18.3%, 10.6% and 4.7% respectively. In addition, 'current sexual abuse' was reported by 2.7% of women. The prevalence rates indicate that the physical abuse of women is a significant public health problem. The Abuse Assessment Questionnaire, administered by public health midwives, proved valuable in detecting physical abuse in pregnant women. If this instrument is used universally to screen Lankan women for physical abuse in antenatal clinics, it has good potential for early detection and intervention.

Nepal and Sri Lanka ministries of health shared best practices and learnings, in a South-South learning exchange (SSLE) to improve access to quality and rights-based family planning services. The SSLE between the two countries followed a five-step methodology designed by the WHO, under the Family Planning Accelerator project. SSLE between the two countries started in January 2020 and is still continuing. Both countries started implementation of the learnings (step 4) at the time of preparing this manuscript (December 2021). An independent consultant from Sri Lanka carried out an evaluation, to inform future SSLEs. The evaluation included a desk review on SSLE and family planning in both countries and key informant interviews with Sri Lanka Ministries Health, WHO CO, external partners. A final evaluation of the outcomes/impact is planned in December 2022. The SSLE resulted in a systematic cross-country transfer of knowledge and implementation of the learnings. Sri Lanka implemented a web-based system for logistics management of family planning commodities and Nepal commenced implementing integrated family planning services in a decentralised environment using a lifecycle approach to improve postpartum family planning uptake. The success of this SSLE is attributed to the rigorous methodology, country-led designing of the learning agenda and process, extensive communication amongst the teams, a focus on outcomes, commitment and leadership by ministries of health in both countries. Learning and technical assistance needs of countries can be met by SSLE if national contexts, availability of resources are considered.

Using an analysis of primary documents and secondary sources, the problem of domestic violence against women in Sri Lanka is surveyed from the perspectives of public health, as well as human and legal rights. The limited Sri Lankan literature on the measurements, context and prevalence of such violence, as well as legislation for its prevention, is reviewed. Responses to the problem by the government and non-government organisations are described. These include using international organisations, forums and conventions to further the human rights dimensions of the problem, the establishment of support services and domestic legal reforms to accord greater protection to women. While The Prevention of Domestic Violence Act 2005 gave legislative recognition to the problem and put into place some welcome reforms, it lacked a comprehensive response to the problem. It is argued that health service providers need to be trained to be aware of domestic violence as the potential cause of physical injuries and mental conditions and that the medical record should document the circumstances and nature of domestic violence. Hospital outpatient departments should offer counselling, referrals to crisis centres and shelters, and should collect sex disaggregated data on domestic assaults. Finally, primary health care workers can both support women in dealing with domestic violence as well as performing a sentinel role in prevention. Specific and comprehensive public policy on violence against women must be developed to allow the health sector to play its role within a context of inter-sectoral collaboration.