By Divya Mascranghe
Many married couples have at some point been asked personal questions about family planning and children. “When are the kids coming?”, “When will he/she get a brother or sister?” These intrusive questions from family members and various “aunties” and “uncles” have largely been accepted as normal. On the other hand, single women are stigmatised for sex and pregnancy outside of marriage.
Childbirth and motherhood are no easy feat, but no one really tells you that childbirth, motherhood, and reproduction is your choice.
According to the Family Association of Sri Lanka (FPA), family planning is the right to decide “whether, when, and how many children to have”. Access to contraception, fertility treatments, child rearing, and even access to safe and legal abortions allow people to decide whether to procreate or not, or when to procreate. The Arka Initiative Head of Mentors Dr. Rashmira Balasuriya sayssaid: “Family planning is not just about preventing pregnancies but is also to space out pregnancies. For example, if both are working it can give them a chance to delay pregnancy.”
Data also shows that early access to these programmes have long lasting effects on women’s fertility. Information on consent for sex, and access to birth control, family planning, period hygiene and testing such as pap smears, are important to ensure reproductive rights are protected and should be available to teenagers and adults.
Consent for sex, unplanned pregnancies, and abortions
Exercising a choice in pregnancy and child birth requires the woman or teenager to exercise consent – for sex, protected sex, and to bear a child. A girl must be over 16 years to give consent for sex yet cannot marry until she is 18.
Data shows that close to 14 million teenage girls give birth every year as a result of rape and unplanned pregnancies. Awareness of birth control and consent could reduce the number of unplanned pregnancies and unsafe abortions among teenagers and adults. While abortions are illegal in Sri Lanka, Medical Practitioner and Lecturer Dr. Chathuri Gunasekera said the most recent data from the Ministry of Health (2016) reports 658 abortions a day. Actual numbers could be much higher.
Dr. Balasuriya said more recent data is unavailable, but posited that “Covid-19 and the economic crisis would have dramatically increased the daily numbers due to low finances and lack of access to contraception”, and added that current estimates are higher than the data from 2016.
Temporary and permanent contraception
Unplanned pregnancies among teenagers and adults can be avoided with the use of birth control. Dr. Balasuriya says there are numerous methods of contraception, including hormonal as well as non-hormonal methods, such as condoms.
Condoms drastically reduce the risk of contracting Sexually Transmitted Infections (STI); common infections that spread from person to person through intercourse. Most can be easily treated and testing is available through the FPA and STI clinics available islandwide, private medical practitioners, and the National STD/AIDS Control Programme (NSACP). Dr. Balasuriya said: “HIV can’t be cured, but early detection and treatment could mean the virus cannot be transmitted to others.”
Dr. Balasuriya also stated: “Hormonal methods such as the oral contraceptive pill, emergency pill, and long-acting reversible options such as the subdermal implant are a few of the available methods in Sri Lanka, but the progesterone-only pill and the vaginal ring are difficult to find here.”
Access to information and services
Suresh (30) stated: “I have known about condoms and oral contraception from my late teenage years. Most of what I knew then was from Hollywood movies and TV shows. Access to information through Google expanded my knowledge in later years.”
Suresh added: “There is a lot of different information out there and people can be influenced by the content they watch either on the internet or in movies. Some movies romanticise harassment and behaviours that romanticise the lack of consent of women.”
Minali (29) said that she too, found out about the available options through conversations with friends and then the Internet.
Nelunika (60) said she has never used any form of birth control, but added: “I found out about the existence of contraception through other people talking about it.”
However, she does not have a detailed understanding of all options that are available.
Dr. Balasuriya says the younger generation is more aware of contraception. Information is available in a concise manner through the internet and social media.
“But whether all the information is available and whether correct info is available to them is a different story. Misinformation is damaging, but more credible information is available through sources like the FPA website.”
Suresh also stated that sometimes religion or culture can dictate the decision to use birth control in marriage, especially among married couples, and sometimes prevent them from using contraception.
Minali said some married members of her extended family (between the ages 30-40) have refused to use birth control and “leave it in the hands of the higher power they believe in to grant them with a child at the right time”.
This is irrespective of the financial status of the family, stability of the marriage relationship and work that takes a spouse out of the country. “Children can then suffer the consequences of poor family planning,” she added.
Dr. Balasuriya said that married couples are definitely open to using birth control, and teenagers and other adults can obtain information from the Government medical system.
“There are special adolescent clinics in the Government sector and those staff personnel have been trained – same for those at the NSACP, STD clinics, and FPA.”
“The Government medical system has very effective planning clinics in place. The Family Health Bureau in Colombo 7 and local Medical Officer of Health clinics are available outside Colombo. They are easy to access. Find out the date of the family planning clinic and get advice and counselling,” she said, adding: “The FPA offers contraception for a subsidised price in the private sector, and also provides information and consultation. Also, gynaecologists who consult in private hospitals can assist you.”
Accurate, verified, and up-to-date information on the uses and benefits of birth control and family planning from reliable sources are important to make informed decisions in exercising reproductive rights.
Child rearing, stigma around abortion, teenage pregnancy, and keeping up with gender roles and societal expectations of a good mother could mean delays in education, career progression, and financial independence – the lack of which leaves women vulnerable.
The inability to exercise procreative rights can therefore not only be a healthcare issue but also a human rights issue. It affects women physically, emotionally, and financially, and impacts their access to education and career. Procreation is a deeply personal choice, and a decision that should be made with accurate information without pressure or guilt.