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Background: Adolescent health needs, behaviours and expectations are unique and routine health care services are not well geared to provide these services. The purpose of this study was to explore the perceived reproductive health problems, health seeking behaviors, knowledge about available services and barriers to reach services among a group of adolescents in Sri Lanka in order to improve reproductive health service delivery.

Background: Exclusive breastfeeding up to the completion of the sixth month of age is the national infant feeding recommendation for Sri Lanka. The objective of the present study was to collect data on exclusive breastfeeding up to six months and to describe the association between exclusive breastfeeding and selected socio-demographic factors.

IntroductionHarmful alcohol use has been found to cause detriment to the consumers and those around them. Research carried out in Sri Lanka has described the socioeconomic consequences to families owing to alcohol consumption. However, the social processes around alcohol use and how it could result in behaviour such as self-harm was unclear. With an outset in daily life stressors in marriages and intimate relationships we explored alcohol use in families with a recent case of self-harm.MethodsQualitative data were collected for 11 months in 2014 and 2015 in the North Central and North Western provinces of Sri Lanka. Narrative life story interviews with 19 individuals who had self-harmed where alcohol was involved and 25 of their relatives were conducted. Ten focus group discussions were carried out in gender and age segregated groups. An inductive content analysis was carried out.ResultsParticipants experienced two types of daily life stressors: non-alcohol-related stressors, such as violence and financial difficulties, and alcohol-related stressors. The alcohol-related stressors aggravated the non-alcohol-related daily life stressors within marriages and intimate relationships, which resulted in conflict between partners and subsequent self-harm. Women were disproportionately influenced by daily life stressors and were challenged in their ability to live up to gendered norms of marriage. Further, women were left responsible for their own and their husband’s inappropriate behaviour. Self-harm appeared to be a possible avenue of expressing distress. Gendered alcohol and marriage norms provided men with acceptable excuses for their behaviour, whether it was alcohol consumption, conflicts or self-harm.ConclusionsThis study found that participants experienced both alcohol-related and non-alcohol-related daily life stressors. These two categories of daily life stressors, gender inequalities and alcohol norms should be considered when planning alcohol and self-harm prevention in this setting. Life situations also reflected larger community and structural issues.

BackgroundThe recently published WHO guidelines on applications of ICD-10 to deaths during pregnancy, childbirth, and the puerperium (ICD-MM) aimed at enabling a comprehensive framework for international comparison of maternal deaths, which includes maternal suicides as a direct cause of maternal deaths. At present, most developing countries do not include suicide as a maternal death.MethodsWe extracted and analysed data from the maternal death surveillance system in North Central Province of Sri Lanka for the period of 2005 to 2011, in order to identify the implications of this new classification on maternal mortality estimates. All reported deaths of pregnant women and women within 12 months of termination of pregnancy were included in this study. Causes of deaths were extracted and coded using ICD-10 reclassified according to new ICD-MM for maternal deaths.ResultsOf the 118 deaths analysed, the maternal death investigation system had classified 53 (44.9%) deaths as maternal deaths. These 53 maternal deaths included one deaths due to suicied, out of 21 (17.8%) suicide deaths among 118 reported deaths. Application of the new ICD-MM showed 83 maternal deaths which resulted in a 56.6% increase of number of maternal deaths in the province. Detailed analysis of all individual causes by ICD 10 codes showed that intentional self-poisoning by an exposure to pesticide (ICD code X63) as the leading cause of maternal deaths in NCP (n = 11, 13.3% of all maternal deaths) during this period. The estimated MMR in the study area based on the new classification in years 2009, 2010 and 2011 was 115, 103 and 88 per 100,000 live births respectively.ConclusionsThe new classification system may have an immediate effect in raising maternal mortality thresholds, making the MDG Goal 5A more elusive for many countries. However, this new approach may ultimately lead to a more accurate understanding of maternal mortality, as well as the real number of maternal deaths attributed to suicide. This more accurate accounting has implications for policymakers andpractitioners globally as they strive to meet women's needs during pregnancy, including attention to detection and treatment for maternal depression, given its close correlation with maternal suicide.