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20th April 2016

Meet the Sri Lankan midwives bringing miracles to families

In the small island nation of Sri Lanka, a midwifery training program founded in the 1880s by a revered native entrepreneur has evolved into a community health program that has taken maternal and infant mortality rates close to rich-country levels, for a tiny fraction of the money.

Lying off the tip of India, Sri Lanka has a population of 20 million, 72 percent of whom live in rural areas where qualified medical workers are scarce. The country’s thousands of midwives fill the gap, providing services far beyond the original mission of delivering babies.

A Sri Lankan midwife helps newlyweds with family planning, provides prenatal care and ensures that high-risk pregnancies receive specialist care. Within two months after a delivery, she’ll visit the mother and baby four times to perform thorough checkups.

Until children turn five, she’ll follow their development and give vaccinations. When they reach adolescence, she’ll impart sex education.

All of her services are free.

The long history of Sri Lanka’s trained midwives began with Charles Henry de Soysa, the richest Ceylonese of the 19th century. A tea grower, exporter, and banker, de Soysa established the nation’s first maternity hospital and midwife training program in his childhood home.

In the years since, midwives have helped make Sri Lankan health care the envy of many of its neighbors in Southeast Asia.

Although Sri Lanka spent just $127 per capita on public health in 2014, the maternal mortality rate in 2015 was 30 per 100,000 births, according to World Bank, versus 176 in Bangladesh, 161 in Cambodia and 126 in Indonesia. In Nepal, the rate was 258 – a rate not seen in Sri Lanka since the 1930s, according to the World Health Organization.

In Belgium, which spent $4,884 per capita on public health, the rate was 7. In the U.S., which spent $9,403, the rate was 14 — just under half of Sri Lanka’s.

Sri Lanka also has an exceptionally low infant mortality rate of 8 per 1,000 births, compared with 38 in India, 66 in Pakistan and 31 in Bangladesh. Belgium’s rate was 3.

The care is highly personal. A reporter from Al Jazeera followed a veteran midwife known as Ari on her rounds and watched mothers stop her on the street and on the stairs for a quick word and help interpreting test results. Ari, who has been the village’s midwife for more than 20 years, has known many of her patients since they were children.

“Sri Lanka represents a unique and inspiring success story in terms of the country’s achievements in maternal health,” Ana Langer, director of the Women and Health Initiative at the Harvard TH Chan School of Public Health, told Al Jazeera.

International health officials have taken notice. Well-trained midwives could help avert roughly two thirds of all maternal and newborn deaths, according to a 2014 United Nations report.

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