Professional Documents
Culture Documents
An Unacknowledged Casualty of
Conflict in Sri Lanka
Sepali Kottegoda
Kumudini Samuel
Sarala Emmanuel
Content
Page
1.0 Introduction 11
1.1Exploring a Reproductive Rights Framework..................................... 13
1.2 Recognition of Conflict Impact on Health Research................. 15
1.3 National Health Policy and Programmes...................................... 17
1.4 Reproductive Health in Conflict and Displacement Settings..... 22
2.0 The Women and Media Research Study........................................ 25
2.1 Scope and Methodology........................................................................ 25
2.1.1 Ethnic Distribution of Interviewees.......................................... 27
2.1.2 Age Distribution of Interviewees.............................................. 28
2.1.3 Level of Education of Interviewees.......................................... 29
2.1.4 Marital Status of Interviewees.................................................... 30
2.2 Life Cycle Approach to Reproductive Health and Rights................ 30
2.2.1 Age at Puberty................................................................................ 31
2.2.2 Age at Marriage.............................................................................. 31
2.2.3 Age at First Live Birth................................................................. 34
2.2.4 Knowledge of Contraception.................................................... 35
2.2.5 Experience of Miscarriage........................................................... 36
2.2.6 Age at First Miscarriage................................................................ 37
2.2.7 Age at Menopause......................................................................... 38
2.2.8 Location of Childbirth.................................................................. 40
2.2.9 Traditional Midwives..................................................................... 42
3
iii
iv
4
List of Tables
v5
Foreword
Roshmi Goswami
10
x
1. Introduction
13. Interviews and discussions were held with administrators at the Ministry of Health,
Family Health Bureau, UNFPA, WHO, Family Planning Association Sri Lanka, and
Population Services Lanka, by Ms. Vivienne Choy of the WMC.
18
Lanka is low, wide variations exist among districts. In ten districts, most
of which are located in the conflict-affected North and East, maternal
mortality rates ranged from 14.3 to 9.7, much higher than the national
average.17 A key concern, however, has been the lack of comprehensive
data on the situation of reproductive healthcare available in the conflictaffected areas. In addition, abortion, which is still illegal, is one of the
leading causes of maternal mortality. Estimates of the number of
abortions performed per day in Sri Lanka range from 750 to 1,000 -a
concrete and accurate number is difficult to find given the illegality. What
is known, however, is that most abortion-related deaths occur among
poor women and/or in areas where emergency obstetric care is difficult
to access or otherwise unavailable. In 1992 induced abortions represented
a substantial proportion of abortion cases admitted to gynecological
wards in some major hospitals in Sri Lanka.18 Islandwide data show that
this trend has not declined.19
The reproductive health facilities and services in the plantation sector
is another area that shows up the differences in womens access to
information and right to make choices. The tea plantations of Sri Lanka
which were set up under British colonial rule saw the import of hundreds
of labour from South India to work on the estates. The plantation
Tamil population remains one of the poorest in the country, where the
focus on womens use of contraceptives and contraceptive methods has
coincided with the physical and mental trauma of having little power
of deciding on spacing, or the number of children, or being pushed
into sterilization either as a last resort or by their spouses for the small
monetary compensation offered by the health sector.
17. http://w3.whosea.org/drd/hlth_issues_srilanka.htm.
18. Fernando, D.N. and Rabel (1992), RAS. Induced Abortion A Hospital-based
Study, The Ceylon Journal of Medical Science, 35:1-5.
19. Hewage, P. Opinions of Health Professionals on Liberalizing Abortion in Sri Lanka
and the Actual Experience of Abortion Seekers; and Abeysekera, S. (1997).
Abortion as a Case for Human Rights Intervention: Building on the Sri Lankan
Experience, in, Reproductive Rights as Human Rights: Studies in the Asian Context. Asian Forum
for Human Rights and Development (Forum-Asia), Bangkok.
20
20. Cenwor (2003). Study on Sexual and Gender Based Violence in Selected Locations
in Sri Lanka, prepared for UNHCR, Colombo; Wijemanne, Hiranthi (2003). The
Role of NGOs in Gender Human Rights and Womens Development, speech given
at FPA Sri Lanka Golden Jubilee Symposium; Samuel, K. (1999). Womens Rights
Watch, Colombo: The Women and Media Collective.
21. UNFPA (2004). A Multisectoral Response Towards Eliminating Gender Based
Violence in Sri Lanka, study prepared by Sepali Kottegoda and Ramani Jayasundere,
Colombo.
21
Maternal Malnutrition
Use of Contraception
(ever used)
Current Use of
Contraception
Total Fertility Rate
Sri Lanka
24.9%
29.0%
29.8%
16.7%
4.0%
84.7%
46.2%
50.2%
42.3%
25.7%
19.4% (31.4% in
Batticaloa, 38.4% in
Mannar)
48.0%
51.3%
70.0%
36.2%
1.9
2.6
Limitations
It was envisaged that the first phase of the research would be carried
out between March and July 2004, in the districts of Mannar, Jaffna,
Polonnaruwa, Batticaloa, Ampara and Moneragala. However, this phase
had to be extended given the difficulties for researchers in some of the
districts to access a representative sample of interviewees. In addition,
difficulties in obtaining comprehensive data from the Moneragala District
compelled WMC to move its research focus from Moneragala to the
Puttalam District. The data collection and compilation of case studies in
the Puttalam District was carried out by four representatives of the Rural
Development Foundation (RDF) between February and April 2005.
While the Affected Womens Forum conducted the first phase of data
collection in the Ampara District in 2004, it was not in a position to
participate in the second phase of the research, nor was it possible to hold
a regional consultation in the Ampara District following the devastation
in the area as a result of the tsunami in December 2004. In this light,
the information from Ampara is confined to the primary questionnaire
administered in 2003-2004.
27
Jaffna
Batticaloa
Ampara
13.0%
1.0%
89.0%
89
9.6%
90.3%
104
57.7%
39.7%
76
44.6%
4.5%
50.9%
112
Total
Mannar
Muslim
Sinhala
Tamil
Total
Puttalam
Ethnicity
Polonnaruwa
Table 2
District-wise Ethnic Distribution of Interviewees
25.2% 100.0%
60.0% 12.6% 95
84
560
44.0%
24.7%
66.2%
30.9%
8.9%
Puttlam
Mannar
32.6%
28.8%
28.8%
47.3%
51.9%
51.9%
18.9%
18.2%
19.2%
Polonnaruwa
Batticaloa
Jaffna
12-18 years
19-40 years
31.3%
39.4%
49.1%
44.6%
9.6%
15.8%
Ampara
Total
41-60 years
In all the districts, 44% of the sample was from the age category 19-40
years, since this is the period when most changes would take place in a
womans life, both socially and physically. 15.7% of the total sample was
from the age category 12-18 years, and 39.5% from the age category 4160 years.
28
2
9
15
5
22
2
30
27
6
1
16
7
7
6
5
- 104 76
Puttalam
1
13
11
36
23
5
89
Polonnaruwa
Jaffna
None
Grade 1-5
Grade 6-8
Grade 9-10
Passed Olevel
Grade 11-12
Passed Alevel
Higher
NA
Total
Ampara
Education
Mannar
Batticaloa
Table 4
Level of Education by District
Total
16
40
22
17
9
3
2
2
1
112
8
27
24
31
1
4
95
2
19
14
31
18
84
38
129
105
172
17
49
13
13
24
560
6.7
23.0
18.7
30.7
3.0
8.7
2.3
2.3
4.2
100.0
29
Ampara
Polonnaruwa
Puttalam
24
61
4
0
0
89
Batticaloa
Unmarried
Married
Widowed
Divorced
NA
Total
Jaffna
Marital
Status
Mannar
Table 5
Marital Status of Interviewees
28
67
4
4
1
104
24
46
5
1
0
76
6
103
0
0
3
112
14
73
1
7
0
84
23
46
5
10
0
84
Total
119
396
19
22
4
560
%
21.25
70.7
3.3
3.9
0.7
100.0
30
Age
at Puberty
Mannar
Jaffna
Batticaloa
Ampara
Polonnaruwa
Puttalam
Table 6
Age at Puberty (Percentage)
9-12
13-15
16-19
NA
Total
16.8
73.0
8.9
1.3
89
8.6
72.1
14.4
6.5
104
40.5
58.1
1.3
3.8
76
24.1
64.2
9.4
6.2
112
26.3
64.2
9.4
95
27.3
64.2
7.1
1.1
84
31
Mannar
Jaffna
Batticaloa
Ampara
Polonnaruwa
Puttalam
Table 7
Age at Marriage by District (Percentage)
15-18
19-22
23-25
26-29
30-33
Above 33
Unmarried
NA
14.6
19.1
21.3
11.2
3.3
3.3
26.9
0
16.3
29.8
10.5
9.6
1.9
3.8
27.8
0
21.0
18.4
17.1
3.9
6.5
1.3
31.5
0
50.8
25.8
7.1
4.4
1.7
0.8
5.3
0.8
54.3
34.5
7.4
2.4
1.2
0
14.7
0
35.7
9.5
19.0
3.5
2.3
0
27.3
2.3
Total
Age
Marriage
Total
31.6% 177
22.6% 127
13.0% 73
5.8%
33
2.6%
15
1.6%
9
21.4% 120
1.0%
6
The respondents from Ampara and Puttlam were exclusively Muslim, and
early marriage may be due to the fact that the community does not have
a legally regulated minimum age of marriage.
However, it cannot be discounted that conflict-induced displacement to
Puttalam, and the intensification of inter ethnic tension and war in Ampara
over the years could also be contributing factors in young people seeking
or being compelled into early marriage. Batticaloa and the border villages
of Polonnaruwa also experienced constant dislocation and direct attacks
in the years of war. Young people in these areas were also increasingly
marginalized, often arrested, recruited into the military, the home guard27
or the LTTE. There is a perception that early and underage marriage was
a phenomenon of areas directly affected by conflict. This research study
appears to corroborate this view. As much as early marriage resulted in
underage pregnancies increasing the risk of mortality for young mothers,
it was also noted that there is a practice of young wives being abandoned
27 During the ethnic conflict, the government created a cadre of civilian males as Home
Guards who were to supplement village security activities along with the police and
the army.
32
at the time of pregnancy or after the birth of a few children and young
husbands seeking remarriage. Within the focus group discussions women
spoke of individual cases illustrative of this for example, one woman
spoke of a 15-year-old girl who had been abandoned by her husband
whilst pregnant. She delivered twins but one baby died in infancy.
For security reasons such as child abductions, parents marry
girls off at a young age. Also, parents feel that as a young
mother, she would be able to look after a young daughter
when the child becomes a teenager. (Batticaloa)
It is among the poor households that early marriage is most
evident. Children cannot be protected from sexual abuse by
males in the family. (Batticaloa, Polonnaruwa)
Focus group discussions in Puttalam, Mannar, Jaffna, Polonnaruwa
and Batticaloa brought out the relatively widespread phenomena of
early marriage of young girls. In most of these districts, the primary
reasons given for this practice, which is reportedly supported by parents,
were poverty, ignorance, and the lack of economic and social security.
There were also specific factors cited in relation to some districts. For
example, the border villages of the Polonnaruwa District had seen much
interaction with armed personnel as village men were drawn into working
as home guards or leave their homes for long periods as soldiers in the Sri
Lankan army. Most villagers depend on agriculture for their livelihoods
and many live in poverty.
Underage marriages take place in some of the backward
villages in rural areas. There are some girls of 16 and 17
years who have children of 2 or 3 years of age. Since the
mothers are children, they are unable to take care of their
child well and this causes a lot of problems in their homes.
(Jaffna)
Early marriage is seen as a solution to a life of hardship and poverty
as parents attempt to allow the young girl to move out of poverty. It
was also acknowledged that child sexual abuse within the family unit
was common, and that parents but especially mothers feel that by giving
33
young daughters away in early marriage they can protect them from being
sexually abused by males in the family. In Batticaloa, child recruitment/
abductions by militant groups was cited as the other key reason for parents
to actively support early marriage of their children, whether girls or boys.
Age at
First Live Birth
Mannar
Jaffna
Batticaloa
Ampara
WPolonnaruwa
Puttalam
Table 8
Age at First Live Birth by District (Percentage)
15-18
19-22
23-25
26-29
30-33
Above 33
5.6
19.1
20.2
14.6
7.8
-
16.3
21.4
40.4
19.0
9.5
4.7
4.7
21.4
40.4
19.0
9.5
4.7
33.0
25.8
8.9
4.4
5.5
2.6
46.2
38.8
7.4
4.4
2.9
-
34.0
29.5
13.6
20.4
2.2
-
35
Table 9
Interviewees
who have a Knowledge of Contraception
Knowledge
of Contraception
(%)
72.6%
57.1%
63.4%
62.9%
56.2%
56.6%
Ampara
Total
19.7%
Puttlam
Mannar
Polonnaruwa Batticaloa
Jaffna
Table 10
Respondents who have Experience of Miscarriage of
Experience of Miscarriage of Pregnancy
Pregnancy (%)
23.0%
16.6%
16.4%
14.7%
7.8%
25.0%
6.5%
In four of the districts the number of women who had had miscarriages
was quite high - Jaffna 23%, Ampara 25%, Puttalam 16.6% and
Polonnaruwa 14.7%, as compared to 7.8% in Mannar and 6.4% in
Batticaloa. An average of 16.4% miscarriages is quite high and may be
related to poor reproductive health service delivery, stress and malnutrition
during the years of conflict, and conflict-related breakdown of health
services, restricted mobility, inability to deal with medical emergencies,
home deliveries. Repeated pregnancies, maternal malnutrition, shifts in
gendered responsibilities, which increase the work burden of women
responsible for both domestic chores and livelihood-related work, are
additional factors. These possible causal factors remain to be investigated.
37
Puttalam
Mannar
Batticalo
Polonnaru
Ampara
Jaffna
Table 11
Age at First Miscarriage*
12-15
0.1
16-19
19
3.3
20-23
21
3.7
Over 23
11
17
47
8.3
NA
71
82
72
81
86
80
472
4.2
Total
84
89
76
95
112
104
560
0.0
Age at First
Miscarriage
Total
Most women reported that they sought help from medical practitioners
or from midwives when they had suffered a miscarriage. Few said they
sought traditional medicine or that they did not seek any medical assistance.
38
Puttalam
Mannar
Batticaloa
Polonnaruwa
Ampara
Jaffna
Table 12
Age at Menopause
Age 25-30
0.6
31-35
1.3
36-40
13
8.4
41-45
21
13.7
46-50
22
14.3
51-55
15
22
14.3
NA
13
15
15
17
12
72
47.0
Total
14
22
21
31
35
30
153
100.0
Age at
Menopause
Total
From among those who responded, the following had prior knowledge
about menopause.
Puttalam
: 13 out of 14 in the age group
Polonnaruwa : 2 out of 31 in the age group
Mannar
: 8 out of 22 in the age group
Ampara
: 2 out of 35 in the age group
Batticaloa
: 7 out of 21 in the age group
Jaffna
: 15 out of 30 in the age group
Apart from the information from Puttalam, these findings indicate that
there is little discussion among women in general, and among women
from age groups other than those who are most likely to experience
menopause, about the life cycle changes in womens bodies. Framed
within the discourse of reproductive rights and the recognition of the
importance of enabling women to understand and care for their health,
such a pattern clearly points to the urgent need for comprehensive health
education programmes. The difference in the figures for Puttalam
merit further study to determine if older Muslim women traditionally
shared this information among each other or if newly emergent womens
39
Table 13
Location of Childbirth by Number of Children Born to Interviewees
Location of Childbirth by Number of Children Born to
(Percentage)
Interviewees (%)
11.6%
7.2%
7.8%
7.1%
92.1%
92.8%
35.5%
88.3%
92.7%
63.8%
Hospital
21.2%
15.8%
78.7%
84.0%
Home
Number of Respondents:
Mannar : 61
Ampara : 82
Total Number of Respondents: 355
Jaffna
: 57
Polonnaruwa : 68
Batticaloa : 41
Puttalam : 46
However, factors such as damage to facilities available in the vicinity of
their residence, distance to hospitals, conflict-induced danger and risks,
lack of transportation, poverty, and cultural practices may have accounted
for the 15.8% of home births reported by the interviewees. Focus group
discussions revealed that some women found the requirements, such as
money for travel, and clean clothes for the duration of the stay in hospital,
to be too much for poor households, and hence women preferred not to
enter hospital for the birth of the child. In some districts, it was reported
that Muslim women were sometimes reluctant to enter hospital due to
cultural factors.
41
30. The IPKF was stationed in the North of Sri Lanka between 1987 and 1990.
42
67.8%
49.1%
30.5%
14.7%
35.3%
28.9%
20.1%
45
There are also structural factors that exclude women from marginalized
communities accessing legal redress in instances of domestic violence.
One of the prominent obstacles faced by women victims of violence
in the conflict-affected areas is that the officers in the law enforcement
system, such as the Police, are male and from the majority ethnic group
Sinhala - and dont speak Tamil, which is the language of the communities
in the area. As one woman articulated:
In Mannar, there are 3 Police stations where there are special
desks reserved to deal with problems concerning women and
children. But the complaints are taken down only in Sinhala
while all the majority of the population is Tamil. Moreover, the
Police officers who note the complaints are males with whom
women cannot share their sufferings openly. (Mannar)1
Another structural factor that places an obstacles to womens freedom
and entitlements in relation to her wellbeing, are the customary laws
which apply to Muslim women. Cases of divorce are handled through the
Qazi courts which are outside the state legal system. Women spoke about
the experiences of women who have gone through these courts
Kaasi usawi (Qazi Court) is always very partial. Women are
never represented in the Jury which is dominated by men. There
should be women representatives in the courts so that there is
justice for women. In the case of divorce, the woman is severely
insulted, the judges are very rude towards the woman. (Puttalam)
Issues such as these are important to recognise since they impact on
womens ability to access not only services pertaining to their health and
wellbeing which are provided by the State but also religious bodies.
I felt it easier to consult female medical personnel than
males. I discussed my problems freely with the midwife but
was ashamed to allow the male doctor to examine me. (Ms.
R, 28 - Case Study, Batticaloa)
As some women observed that while they were mostly treated by male
doctors, they felt more comfortable when being seen by a female doctor.
47
49
50
Number of Childbirths Before and During Time of Active Conflict and After
the CFA
Period of
Pregnancy
Age Group
12-18
No
% of
Subtotal
Age Group
19-40
No
% of
Subtotal
Age Group
41-60
No
% of
Subtotal
Total
No
%*
% of
Subtotal
JAFFNA
No. of
respondents
Before
3.9
61
66.3
65
33.5
During
81
79.4
28
30.4
109
56.1
After
17
16.6
3.2
20
10.3
Subtotal
childbirth
102
100.0
92
194
100.0
37
26
63
100.0
BATTICALOA
No. of
respondents
Before
16
23.8
39
67.2
55
43.6
During
32
47.7
11
18.9
43
34.1
After
100.0
19
28.3
Subtotal
childbirth
100.0
67
100.0
58
22
17
40
13.7
100.0
28
22.2
126
100.0
POLONNARUWA
No. of
respondents
Before
33.3
24
25.5
49
50.5
74
38.1
During
46
48.9
22
22.6
68
35.0
After
66.6
24
25.5
26
26.8
52
26.8
Subtotal
childbirth
100.0
94
100.0
97
100.0
194
100.0
32
20
55
PUTTALAM
No. of
respondents
24
16
41
Before
12
16.4
48
72.7
60
42.8
During
13
17.8
14
21.2
27
19.2
After
100.0
48
65.7
6.0
53
37.8
Subtotal
childbirth
100.0
73
100.0
140
100.0
66
100.0
51
MANNAR**
No. of
respondents
Before
During
After
Subtotal
childbirth
38
18
56
5.3
32
58.1 37
25.0
61
65.5
22
40.0
83
56.0
27
29.0
1.8
28
18.9
93
100.0
55
148
100.0
100.0
AMPARA
No. of
respondents
Before
14
10.6
45
51.1
59
25.9
During
83
62.8
42
47.7
125
55.0
After
100.0
35
26.5
Subtotal
childbirth
100.0
132
100.0
46
20
88
72
1.1 43
100.0
227
18.9
100.0
The state health care system has recognized that women give birth to
babies with low birth weight because of malnutrition and has put in place
a programme to provide supplementary food during pregnancy. However,
women who live in displaced communities or communities which were
badly affected by the conflict found it hard to access such entitlements.
Women from Jaffna mentioned that sometimes when the supplementary
foods reached their areas it was contaminated, and there was once an
incident where a pregnant woman was hospitalized after consuming such
contaminated supplementary food.
A midwife from Jaffna who was part of the research study spoke of her
experiences during the conflict years. Over the past 26 years, she had
delivered more than a hundred babies. She said that usually families go to
the hospitals, but in instances where it is too late or this was not possible
due to the war, she had to perform deliveries. She noted that when the
Indian Peace Keeping Force (IPKF) was in Sri Lanka in the late-1980s,
travelling during the night was not allowed, so there were more deliveries
at home. She recalled how on one occasion when the womans life was in
danger and they were trying to get to the hospital, the IPKF had beaten
the driver of the vehicle and only after much pleading had allowed them
through.
52
53
55
2.5.3 Abortion
We used to eat pineapple or raw papaya to abort pregnancy.
(Focus group participant, Jaffna.)
I will tell you about some of the traditional methods used to
get rid of unwanted pregnancies. Some women eat tender
papaw, tender pineapple and tender parts of the coconut
bark to induce an abortion. I had an abortion when I was
1- months pregnant because my husband was fighting
with me. I suffered from stomach pains subsequently and
got medicine for it from a doctor but I didnt tell him about
the abortion. (Ms. R, 28 - Case Study, Batticaloa)
An area which remains of critical concern is the criminalizing of abortion
irrespective of the circumstances of pregnancy. There has been no
change in the law despite the inclusion in the National Plan of Action
on Women since 1996, of specific situations of vulnerability of women
who may have become pregnant as a result of rape, incest or have been
found to have foetuses with congenital abnormalities.37 The number of
abortions islandwide has been estimated to be approximately 180,000 per
37. Ministry of Womens Affairs (1996). National Plan of Action on Women. Colombo.
57
year (15,000 per month).38 The health costs of complications arising due
to unsafe abortions are also very high. It is estimated that at least 20% of
hospital beds in gynecological wards in Sri Lanka are occupied by women
who have undergone unsafe abortions.39 A study done by Rajapaksa and
De Silva (2005)40 indicates that abortions were most predominant among
married women in the age group of 25-39, who already had two or more
children. Induced abortions were mainly sought by women for spacing
and limiting families. The authors also note 14% of the study sample had
had a previous abortion.
During the past three decades, there have been two failed attempts to
change the draconian abortion law, which now falls within the purview
of the Penal Code Sections 293 and 303.The first attempt in the late
1970s was to decriminalize abortion and the second attempt in 1995 was
to decriminalize abortion under specific situations such as rape, incest
or where the foetus is found to be congenitally abnormal.41 While the
Womens Charter (1993) recognizes the right of women to make decisions
relating to number and pacing of children, the National Plan of Action
on Women (1996/2000) calls for decriminalizing abortion under the
specific conditions (as in the draft abortion bill of 1995) and in situations
of contraceptive failure.
Despite the fact that available data indicates that most abortion seekers
are married women, and that medical complications arising from illegal
induced abortions has emerged as the third highest case of maternal
deaths in the country, the legal and policy-making bodies appear to be
unwilling to respond to this urgent need to decriminalize abortion under
these specific situations.42 It is imperative that institutional mechanisms are
put in place which would safeguard women from undergoing unwanted
or unplanned pregnancies.
38. Ministry of Health (2004). Op. cit.
39. Abeysekera. op. cit.
40. Rajapaksa, L. C. and De Silva I. (2005). A Profile of Women Seeking Abortion,
unpublished report for UNFPA, Colombo. The study was conducted among 786
women from urban and rural backgrounds who were seeking abortions from known
abortion providers.
41. Ibid.
42. Kottegoda, op. cit.
58
Although the WMC research study did not elicit information on induced
abortion as a widespread phenomenon, most likely also due to the fact
that women are aware that abortion is illegal, it was women in the age
categories 19-40 and 41-60 who reported that they had resorted to
induced abortions. Of the 16 abortions reported in the study from all
districts, 10 (62.5%) were by women in the age group 19-40. According
to the research findings, six women said they made the decision to abort
the pregnancy and five said that it was their husbands who wanted the
abortion carried out. The remaining six women said they consulted with
their husbands in making the decision. The most common reason for
seeking an abortion was financial problems in the family and the inability
to maintain another child. Women spoke of the different methods by
which they know abortions are induced.
From the North and East conflict-affected areas which suffered most
damage and loss of life during the tsunami, both the government and
LTTE made interventions to address the concerns of the survivors. An
interview with a key woman leader of the LTTE revealed that many
women survivors suffered much trauma and needed psychosocial support
to deal with their personal tragedies.
We have seen mothers who have lost the babies to the
tsunami not in control of themselves and unable to come
to terms with what has happened. I have seen mothers
carrying dead babies in their hands refusing to accept that
they are dead. They continue to kiss and caress them as if
they are alive. They had great trouble accepting that the last
rites needed to be performed on their babiesThe loss of
children has shaken us deeply and it is very difficult for us
to even think about it.47
The Affected Womens Forum from the Ampara district, which facilitated
this research there was unable to continue working with the second phase
of data collection as a result of the tsunami which devastated large areas.
47. www.tamilnet.com Interview with Ms. Thamalini. Options, Vol 36, Issue 1, January
2005.
61
2.8 Conclusion
As in other conflict situations women have been affected in particular
gendered ways by violent conflict and war in Sri Lanka, particularly in the
North and East and the border areas adjacent to them. As the internally
displaced, as refugees, as survivors of war offensives, landmine injuries and
sexual violence, as mothers, and girls, as wives and widows, as combatants
and as civilians, women have experienced conflict differently from men.
While women are victimized by war, they are not merely passive victims as
is often portrayed.1 In the course of Sri Lankas war and conflict women
have begun to assume new roles of leadership within their families
and communities, becoming providers for their families, assuming sole
responsibility for the household and holding together communities in
very adverse circumstances. Many women are today confident heads of
household; many have moved into the public domain to assume roles
previously played by men, negotiating with local authorities, police,
military and the combatants to carry on with their day to day lives.2 They
are more prominently visible in the sphere of economic activity and have
gained invaluable experience and expertise in negotiating and interacting
with state authorities and government officials.
1. Womens Concerns and the Peace Process Findings and Recommendations, International Womens Mission to the North East of Sri Lanka 12th to 17th October 2002,
Colombo: Women and Media Collective.
2. Ibid.
67
However, Sri Lankan women in general have little control over processes
that determine the course of economic, social and political decisionmaking in terms of designing programmes, policies and laws. During the
years of conflict, women were rarely, if ever, involved in decision-making.
In the years following the signing of the CFA, the continued exclusion
of women from the peace process is a matter of grave concern. Through
this exclusion, there was a very real possibility that the programmes for
reconstruction, rehabilitation and resettlement that are set in motion
as a consequence of the negotiations will be insensitive to the needs
and concerns of women and will, perhaps, even play a negative role in
relegating women once more to the private and domestic spheres of
life and activity. Such a process could well negate the critical role that
women have played throughout the decades of conflict in holding their
families and communities together.
Womens right to control their bodies, their reproductive functions and
their sexuality are crucial to enable their autonomy, freedom and their
lives and life decisions. However, little detailed and gender-sensitive
information is available on the consequences and impact of conflict
on womens reproductive health and rights. This study and available
indicators suggest the serious impact of conflict on the reproductive health
and rights of women. Reproductive health policy cannot be ignored or
relegated to long-term policy interventions; it must be considered both an
immediate need as well as a right that has to be met immediately. It is our
belief that womens participation in sustainable peace building includes an
informed and active participation in policy-making at all levels of planning,
monitoring and implementation. As Sri Lanka must necessarily engage in
conflict resolution, peace building and social transformation, it becomes
even more imperative that women have a say in the new interventions
that seek to rebuild their lives, societies and communities. As the Sub
Committee on Gender Issues to the peace process noted, reproductive
rights have to be a key focus of policy interventions. Women must
bring to these initiatives their lived local-level experiences that ensure a
framework for a just and sustainable peace that involves all communities
affected by the war.
68
70
3.0
District Level Research Findings
71
72
73
In 2002, at the national level, the population in Sri Lanka living below the
poverty line was estimated to be 22.7%; that of males living below the
poverty line was 23.0% and of women was 21.5%.48
The Puttalam District is one of the poorest in the country. In Puttalam,
the corresponding figures for the population living below the poverty
line in 2002 were 31.4% of males and 30.8 % of women.49 In terms
of household income and consumption per head (share of poorest
quintile 1/5th in national consumption), it was found that in Puttalam,
13.5% of female headed households were among the poorest while the
corresponding figure for males was 11.5%.50
In October 1990 all the Muslims living in the northern districts were
expelled by the LTTE; the vast majority of them were de facto resettled
48. Department of Census and Statistics (2005). Selected Millenium Development
Goals (MDG) Indicators, Colombo.
49. Ibid. The computation is done on the basis of the sex of the head of the household.
50 Ibid.
74
Ethnicity
A total of 84 women were interviewed in the sample survey all of whom
were from the Muslim community.
Table 1
Ethnicity by Age
Ethnicity
Muslim
Age 12-18
26 (30.9)
Age 19-40
37 (44.0)
Age 41-60
21 (25.0)
Total
84 (100.0)
75
Table 2
Marital Status of Interviewees
No
info,
0
Unmarried,
26.9%
Married,
68.5%
Level of Education
The highest level of education achieved in this sample was among those
in the age group 12-18 years, while the lowest level of education achieved
was among those in the age group 41-60; fifteen (17.8%) were from the
12-18 year age group, fourteen (16.6%) from the 19-40 age group, and
two (2.3%) were from the 41-60 age group. A cumulative figure of thirty
one women (36.9%) from all age groups had up to a secondary-level
education.
Table 3
Level of Education.
Education Level
35.7%
27.3%
19.0%
9.5%
3.5%
15-18
76
19-22
23-25
26-29
2.3%
30-33
2.3%
Above 33 Unmarried
NA
Age at Puberty
Of the total sample, 27% had reached puberty between the ages 9-12;
64% between the ages 13-15, and 29% between the ages 16-19 years.
Table 4
Age at Puberty
Age at
Puberty
9-12
13-15
16-19
NA
Total
12-18 %
5
20
0
1
26
Age
19-40 %
11
25
1
37
41-60
7
9
5
21
Total
23
54
6
1
84
%
27.3
64.2
7.1
1.1
100.0
From Whom
Mother
Grandmother
Sister
Friends
Own
NA
Total
12-18
3
0
1
7
15
0
26
Age
19-40
1
1
0
10
25
0
37
41-60
0
1
0
5
13
2
21
Total
4
2
1
22
53
2
84
%
4.7
2.3
1 1.1
26.1
63.0
2.3
100.05
77
Age at Marriage
My elder daughter was married at 16. Her husband left her
when she was 17 and she had one child. She was married
again to a man with a first wife and she is very unhappy.
My second daughter left her husband within a year of her
marriage because he sold all her jewellery and wasted the
dowry we gave her. My third daughter eloped and was later
married. All my daughters are tortured by their husbands and
their families, mainly for not bringing enough dowry. They
are verbally abused and beaten often. All their husbands
are without jobs. My sons did not allow their sisters to
acquire any skills and so they are unable to be self sufficient.
(48-year-old woman Case Study, Puttalam)
Table 6
Age at Marriage
35.7%
27.3%
19.0%
9.5%
3.5%
15-18
19-22
23-25
26-29
2.3%
30-33
2.3%
Above 33
Unmarried
NA
Of the sample, who had ever been married, 35.7% had got married
between the ages 15-18 and 9.5% between the ages 19-22. This
information indicates that the age at marriage in the Puttalam District
is much lower than in the other districts surveyed in this research. The
reasons may be due to cultural factors; the total sample in the district was
from the Muslim community which recognises minimum age of marriage
as twelve years.
78
Knowledge of Contraceptives
I was born in Mannar in 1986 and was displaced at the age of
four to Kalpitiya and lived in a refugee camp for five years. My
father is a tailor and my brother works for daily wages. When
the family had only one breadwinner we often went hungry. I
am still studying and am in the A/Level arts class. According
to our religion, customs and heritage, it is good to marry and
begin a family of our own. Family planning must be adhered
to by all since bearing more children causes complications and
difficulties. In order to maintain a healthy relationship and
mutual understanding between husband and wife one must not
plan on starting a family soon after marriage. I gained some
knowledge of family planning through newspapers, radio and
health education in school. Gaining reasonable education in this
subject is very important to all, since it is helpful to be prepared.
To gain knowledge we can approach the PSL organisation in
the hospital where they have posters, leaflets and booklets on
this subject. Apart from this we can inquire from midwives and
others at the information desks at health centres. When friends
get together we share relevant information with one another.
(19-year-old woman Case Study, Puttalam)
Table 7
Interviewees who Know About
Knowledge About Contraception
Contraception by their Age (%)
70.3%
52.4%
42.3%
Age 12-18
Age 19-40
Age 41-60
79
The table above indicates that there is a relatively high level (70.3%) of
knowledge on contraception among women. Of the thirty four women
who responded to the question as to how they had learned about
contraception, sixteen (42%) said they had obtained information from
non governmental health focussed organization, the Population Services
Lanka. Another 29.4% had learned about contraception from friends
and 11.7% from medical practioners while 5.8% had learned about
contraception from their spouses.
2.2%
15-18
19-22
23-25
26-29
30-33
Above 33
NA
Experience of Miscarriage
Information on experince miscarriage revealed that 7 (50%) of the 14
women had one miscarriage, while two women had had two, and four
women had suffered three miscarriages. Nine women had miscarriages
occurring in the first 3 months of their pregnancy. Eight women had been
in the age group 16-19 when they had had their first miscarriage. All the
women reported that they had sought medical advice.
80
Experience of
Miscarriage
Yes
No
NA
Total
Age
12-18
3
2
21
26
19-40
4
7
26
37
41-60
7
6
8
21
Total
14
15
55
84
%
16.6
17.8
65.4
100.0
Age at Menopause
Since I had menopause at 40 years, I have not wanted to
have sex with my husband, elders also told me that I should
not have sex. My husband doesnt like this. So he now goes
to Jaffna and comes home only once in about three months
and gives us only about Rs. 2000 to 3,000 to manage. (Ms.
ARJ, 48 years, Puttalam)
Table 9
Age at Menopause
Age at
Menopause
25-30
31-35
36-40
41-45
46-50
50-55
NA
Total
12-18
0
0
0
0
0
0
26
26
Age
19-40
0
0
0
0
0
0
37
37
41-60
1
1
5
4
1
2
7
21
Total
1
1
5
4
1
2
70
84
Fourteen women in the age category 41-60 years had reported to have
reached menopause; thirteen of them had prior awareness of this life
change.
81
Domestic Violence
Of the sample, 67.8% declared that they had been subjected to violence.
Of this number, 28% who had experienced violence were between the
ages 12-18, 49% were between the ages 19-40, and 22% were between
the ages 41-60.
Most domestic violence had been perpetrated by the spouse for reasons
ranging from drunkardness, drug addiction, and financial problems.
Mothers were reported to be the next highest instigator of violence
as punishment for socially unacceptable behaviour such as having
unauthorized love affairs, marrying out of caste, and moving around freely
with others. Fathers also were found to perpetrate domestic violence as a
result of alcoholism, and financial problems.
Of those married women who declared that they had been subjected to
domestic violence by their spouses, most reported that this had occurred
during the first three years of marriage.
Table 10 Interviewees who have
Experienced
Domestic
ViolenceDomestic Violence
by their Age (%)
75.7%
61.9%
61.5%
Age 12-18
82
Age 19-40
Age 41-60
Age Group
and
Number of
Respondents
Home
Sub total
% of Total
Which
Child
1
2
3
4
5
12-18
19-40
41-60
Total
3
(7%)
26
(57%)
17
(37)
46
(100%)
0
0
1
1
0
0
1
3
1.9
3
4
5
1
4
15
9.7
4
3
5
1
5
18
11.6
Ethnicity
Table 11
Location of Childbirth by Number and Order of Childbirths
MUSLIM
83
Hospital
Sub total
% of Total
Total
Which
Child
1
2
3
4
5
1
1
0.6
27
21
16
8
6
78
50.6
14
14
8
11
10
57
37.0
81
72
42
35
24
19
16
136
88.3
154
100%
MUSLIM
MUSLIM
84
Table 12
Pregnancies during Conflict Years: Number and Order of Childbirths
Age Group and Number
of Respondents
Before
Which
Child
1
2
3
4
5
12-18
1
(3%)
41-60
16
(39%)
Total
41
(100%)
4
4
3
1
12
8.5
14
13
8
7
6
48
34.2
18
17
11
8
6
60
42.8
3
3
3
2
2
13
9.2
2
2
4
2
4
14
10.0
5
5
7
4
6
27
19.2
1
-
19
13
8
4
4
2
2
20
13
8
6
6
Sub Total
% of Total
1
0.7
48
34.2
4
2.8
Total
73
66
53
37.8
140
(100%)
Sub Total
% of Total
During
Sub total
% of Total
After CFA
Which
Child
1
2
3
4
5
Which
Child
1
2
3
4
5
19-40
24
(59%)
0
-
Of the forty one women who responded to this question, the most
number of women who had been pregnant during the time of active
conflict were from the age group 19-40.
85
86
Due to the fact that the Department of Census and Statistics has not been
able to conduct comprehensive population census surveys in the North
and the East, including Mannar District since 1981, there is no recent
information available in these areas during the period of this research.
The WMC research survey on womens perceptions and experience of
reproductive health and violence against women was carried out by the
Mannar Womens Development Federation (MWDF). The research was
carried out in five villages: Tharapuram (population 444), Shanthipuram
(1400), Marunkapity (417), Pesalai (725) and Parikorikandal (165). Most
of the women were engaged in informal sector activities such as farm
labour, cooking and selling food, fishing and related activities such as
cleaning nets, drying fish.
A total number of eighty nine women from these villages were interviewed.
85% of them were from the Tamil community (Christians and Hindus)
and 13% were from the Muslim community. 1% of the sample were from
the Sinhala community.
87
Ethnicity
The sample from Mannar represented the broad ethnic distribution in
the district.
Table 1
Ethnicity of Interviewees
Ethnicity
Muslim
Sinhala
Tamil
Total
12-18
1
0
7
8
%
13
0
87
100
Age
19-40
% 41-60
7
12
4
1
2
0
51
86 18
59
100 22
% Total
18 12
0 1
82 76
100 89
%
13
1
85
100
Level of Education
As the table below indicates, a significant number (41.5%) of the
sample had received formal education only up to Grade 8; most
of these women were those in the age categories 19-40 and 41-60.
This could be related to the impact of conflict in the area, which
disrupted access to schooling for the women in this age groups.
Table 2
Level of Education
25.8%
14.6%
12.3%
5.6%
1.1%
None
88
Grade 1-5 Grade 6-8 Grade 9-10 O/L Passed Grade 11- A/L Passed Higher
No
12
Education response
The highest level of education was found to have been achieved by those
in the age group 19-40, while the lowest level of education (Grade 5 or
below) was found among those in the age group 41-60.
Of the total eighty nine women interviewed, 40% had studied up to
grades 9-10, 25% up to grades 11-12, 15% between grades 1-5 and, 12%
between grades 6-8.
Unmarried,
26.9%
Married,
68.5%
The majority of women in the sample (63.5%) were married. There was
a relatively high number of unmarried women in the age category 19-40
years.
Age at Puberty
Of the total eighty nine women interviewed, 73% had reached puberty
between the ages 13-15; 17% had reached puberty between 9-12 years,
and 9% between the ages 16-19.
89
Table 4
Age at Puberty
Age at Puberty
Age
2-18
19-40
41-60
Total
9-12
2
25 12
20 1
6 15
16.8
13-15
6
75 40
68 19
86 65
73.0
16-19
0
0
6
9 2
9 8
8.9
Total
8
100 59* 100 22
100 89 100.0
* Age at puberty of one woman in this age group was not recorded.
12-18
1
1
0
0
5
1
8
Age
19-40
5
3
2
7
27
15
44
41-60
1
0
0
1
12
8
14
Total
7
4
2
8
44
24
89
%
8
4
2
9
49
27
100
Age at Marriage
Compared with the data from the other districts, the data from Mannar
sample indicated a relatively high age at marriage. This may account for
the lower proportion of unmarried women noted in Table 3.
90
Table 6
Age at Marriage
19.1%
21.3%
14.6%
11.2%
15-18
19-22
23-25
26-29
3.3%
3.3%
30-33
Above 33
Unmarried
NA
Of eighty nine women interviewed 33.8% had been married between the
ages of 15-22; 21.3% had been married between the ages 23-25 and 3.3%
had been married above the age of 30.
77.3%
12.5%
Age 12-18
Age 19-40
Age 41-60
92
When I was pregnant with the fourth child after three girls
my husband said jokingly that if it was a girl he would kill
the child. I didnt mind the three girls. We did not want
to have children after the third but we both thought after
sometime that we must have another child because we
need to have at least one boy. I happened to read an article
translated from a Chinese paper where they said that within
a particular period if you had sex you could have a boy. I
really believed it and told my husband about it and he agreed.
After the third child was born my grandmother said that if
I lay down on my left side after sex it would be a boy. I
practiced that too along with what was said in the Chinese
paper. We were very happy when the fourth baby was a boy.
At the Mannar hospital if we ask about family planning
they give us an answer. There are male doctors and female
doctors but the female doctors are Sinhala speaking, so we
have a communication problem. (MC, 45 years - Case Study,
Mannar)
It is important to note that sociocultural practices and beliefs impact
strongly on womens ability to make decisions regarding the number and
spacing of the children they wish to have, as is illustrated from the above
case study.
93
Table 8
Age at First Live Birth
Age at First Live Birth of the Interviewee (%)
30.3%
19.1%
20.2%
14.6%
7.8%
5.6%
2.2%
15-18
19-22
23-25
26-29
30-33
Above 33
NA
Experience of Miscarriage
Few women reported to have undergone miscarriage of their pregnancies
in this sample. Four out of the Seven women reporting miscarriage
were from the age category 41-60. Three of these women had suffered
miscarriage in the 4-6 months of pregnancy, while this was also the case
for two women from the age category 41-60 years. All the women had
sought medical advice either from a midwife or doctor.
Table 9
Experience of Miscarriage
Experience of
Miscarriage
Yes
No
NA
Total
94
12-18
0
0
8
8
Age
19-40
4
10
45
59
41-60
3
5
14
22
Total
7
15
67
89
%
7.8
16.8
75.2
100.0
Age at Menopause
Most women had undergone menopause after the age of 40.
Table 9
Age at Menopause
Age at Menopause
12-18
0
0
0
8
8
41-45
46-50
50-55
NA
Total
Age
19-40
0
0
0
59
59
41-60
4
4
1
13
22
Total
4
4
1
80
89
Domestic Violence
The main perpetrator of domestic violence was reported to have been the
spouse. The most common reasons were cited as alcoholism, suspicion
and drug addiction. The father of the interviewee was also reported to
have been responsible for violence in the home.
Table 10
Interviewees
Domestic
Violence who have Experienced
18.2%
0.0%
Age 12-18
Age 19-40
Age 41-60
95
Location of Childbirth
The research brought out the fact that while most childbirths took place
in hospitals, there were a number which took place in the home. In the
Mannar District, the number of home births reported in this study was
7.2% compared to 92.7% in hospital. Most women had given birth to
their children in hospitals.
Table 11
Location of Childbirth by Number and Order of Childbirth
Age Group and
Number of
Respondents
Home
Sub total
% of Total
Hospital
Subtotal
% of Total
Total No.
Childbirths
96
Which
Child
1
2
3
4
5
Which
Child
1
2
3
4
5
12-18
19-40
41-60
Total
40
21
61
0
0
1
2
1
1
1
6
3.6
2
3
1
6
3.6
3
5
1
2
1
12
7.2
39
28
16
7
2
92
19
17
14
8
3
61
58
45
30
15
5
153
0
0
55.7
98
36.9
67
92.7
165
(100.0%)
97
Table 12
Pregnancies during Conflict Years by Number and Order of Child birth
Age Group and Number
of Respondents
Before
Sub Total
During
Sub total
After
Sub Total
Total
12-18
0
Which
Child
1
2
3
4
5
Which
Child
1
2
3
4
5
Which
Child
1
2
3
4
5
19-40
38
(68%)
41-60
18
(32%)
Total
56
(100%)
0
0
0
0
0
0
3
2
5
11
9
6
4
2
32
14
11
6
4
2
37 (25%)
0
0
0
0
0
0
25
23
9
3
1
61
7
8
5
1
2
32
31
14
4
3
84 (56%)
0
0
0
0
0
10
3
7
5
2
0
0
0
1
0
10
3
7
6
2
0
0
27
93
28 (18.7%)
149 (100%)
12.9 for males.53 The national-level maternal mortality rate was 42.2 in
1991 and 27.5 in 2002. However, these figures are not recorded for the
Polonnaruwa district.54
Polonnaruwa Background
The Polonnaruwa study was carried out by two researchers affiliated to
the Polonnaruwa Womens District Committee.
These villages have an ethnic mix of Sinhalese, Tamils and Muslims. Some
of them are old established villages, purana gam, while others are fairly
new village settlements established under the Mahaweli Authority with
mainly Sinhala settlers. During the years of conflict a number of villages
in this area came under LTTE and state attacks and counterattack. A
number of village massacres took place in villages such as Bo-Atta. Such
attacks led to mistrust and hostility among Sinhala, Tamil and Muslim
villagers who had traditionally intermarried and co-existed amicably. The
establishment of home guards, mostly Sinhalese and Muslims, to protect
Sinhala and Muslim villages further exacerbated the problem and provided
the impetus for more LTTE led attacks and counterattacks. These villages
are among the poorest and most marginalized in the conflict zone and
receive insufficient attention from policy makers and policy implementers.
Research Locations
Bo-Aththa. This border village which was set up under the Mahaweli
project has over 250 families comprising both Sinhalese and Tamils. The
villagers are mainly cultivators; few are engaged in government or private
sector employment. While there are some female-headed households,
most households are headed by men.
53 bid. Infant mortality rate is the probability (expressed as a rate per 1,000 live births)
of a child born in a specified year dying before reaching the age of one if subjected
to current age-specific mortality rates.
54 Ibid. Maternal death is the death of a woman while pregnant or within 42 days of
termination of pregnancy, irrespective of the duration and the site of the pregnancy,
from any cause related to or aggravated by the pregnancy or its management, but not
from accidental or incidental causes.
100
Ethnicity
The ethnic balance of the interviewees reflects the multi-ethnic nature of
the population living in the border villages of the Polonnaruwa District.
Table 1
Ethnicity of Interviewees by Age
Ethnicity
Sinhala
Tamil
Muslim
NA
Total
12-18
10
3
5
1
19
Age
19-40
28
5
12
0
45
41-60
19
4
7
1
31
Total
57
12
24
2
95
%
60.0
12.6
25.2
2.1
100.0
103
Level of Education
I went to India in 1990 as a refugee when I was 14, due to
the conflict and ensuing problems. I had to stop my studies
at Grade 6 due to the war. I did not continue my studies in
India because I did not want to study with younger students.
Now I dont have the time with two young children. I
returned from India in 1997. I went to the Middle East as a
housemaid and returned within a year. My promised salary
of 400 Riyads per month wasnt paid, but I was too scared
to go to the agent thinking he would send me back. I went
to the Police and returned to Sri Lanka. (RB Case Study,
Polonnaruwa)
Table 2
Level of Education by Age Group:
Education Level of the Interviewee (%)
32.6%
28.4%
25.2%
8.4%
4.2%
1.0%
None
Grade 1-5 Grade 6-8 Grade 9-10 O/L Passed Grade 11- A/L Passed Higher
No
12
Education response
Marital Status
Most of the interviewees (76.8%) were married. The unmarried women
were recorded to have been from the age categories 12-18 years and 1940 years.
104
Table 3
Marital Status of Interviewees
Marital Status of the Interviewee (%)
No
info, 0
Married, 76.8%
Age at Puberty
A significant number of the sample had attained age between 9 and 12
years. 70% of the total sample had reached puberty by the time they were
15 years old.
Table 4
Age at Puberty
Age at
Puberty
9-12
13-15
16-19
Total
12-18 %
7
12
0
19
Age
19-40 %
12
27
6
45
41-60 %
6
22
3
31
Total
25
61
9
95
%
26.3
64.2
9.4
100.0
105
From Whom
Mother
Grandmother
Sister
Aunt
Friends
Own
NA
Total
Age 12-18
14
1
1
2
0
0
1
19
Age 19-40
28
4
4
3
0
0
6
45
Age41-60
17
4
2
3
0
0
5
31
Total
59
9
7
8
0
0
12
95
Age at Marriage
When I was 15 my parents married me off although I did not
like to get married then. After a month I was pregnant, in
three months my husband left me. After a while I got pains
and my mother took me to hospital. I was in hospital for two
months and three days. Then they said I was going to have
106
29.5%
14.7%
6.3%
15-18
19-22
23-25
2.1%
1.1%
26-29
30-33
Above 33
Unmarried
NA
107
Age 12-18
Age 19-40
Age 41-60
14.7%
15-19
108
20-24
16.8%
23-25
1.0%
2.1%
1.0%
26-29
30-33
Above 33
NA
Experience of Miscarriage
Out of the sample, 14.7% had suffered at least one miscarriage. Of these,
eight had been in the first 3 months of the pregnancy while six had been
in the period between 4-6 months of pregnancy. All women reported that
they had sought medical treatment at hospitals or clinics.
Table 9
Experience of Miscarriage
Experience of
Miscarriage
Yes
No
NA
Total
Age
12-18
19-40
41-60
1
2
16
19
7
8
30
45
6
12
13
31
Total
%
14
22
59
95
14.7
23.1
62.1
100.0
Age at Menopause
Women over the age category 41-45 years reported that they had
experienced menopause from their early 50s.
Table 10
Age at Menopause
Age at Menopause
Age 25-30
31-35
36-40
41-45
46-50
51-55
NA
Total
12-18
0
0
0
0
0
0
19
19
Age
19-40
0
0
0
0
0
0
45
45
41-60
0
0
1
0
0
15
15
31
Total
0
0
1
0
0
15
79
95
109
Domestic Violence
In response to the question on whether the interviewee had been subject
to domestic violence, twenty nine women (30.5%) answered that they
had. Of these, 82.7% were between 19-60 years of age. The persons who
had inflicted violence on them were: their mother in their youth for being
disobedient or not fulfilling household tasks, and the spouse as a result
of drunkardness.
Table 10
Domestic Violence
Domestic
Violence
Yes
No
NA
Total
12-18
5
8
6
19
Age
19-40
11
23
11
45
41-60
13
15
3
31
Total
29
46
20
95
%
30.5
48.4
21.0
100.0
110
Table 11
Pregnancy During the Conflict Period: Number and Order of Child Births
Age Group and
Number of
Respondents
Before
Sub Total
% of Total
During
Sub total
% of Total
After the CFA
Sub Total
% of Total
Total
Which
Child
1
2
3
4
5
Which
Child
1
2
3
4
5
Which
Child
1
2
3
4
5
12-18
19-40
41-60
Total
32
20
55
1
1
0.5
11
8
4
1
24
14.2
23
13
8
3
2
49
29.1
35
21
12
4
2
74
44.0
47.2
28.3
16.2
5.4
2.7
100.0
16
13
8
4
5
46
27.3
3
4
6
4
5
22
13.0
19
17
14
8
10
68
40.4
27.4
25.0
20.5
11.7
14.7
100.0
2
-
11
5
3
3
2
13
5
3
3
2
50.0
19.2
11.5
11.5
7.6
24
100.0
94
71
26
15.4
168
100.0
40.4% of childbirths had taken place during the time of active conflict.
44.0% had been born before the onset of the conflict, and 15.4% after
the signing of the CFA.
111
Location of Childbirth
From the responses of the women, it is clear that while 63.8% had
delivered their children in hospital, a significant number, 35.5%, had
delivered their babies at home. Home birth was highest among the women
from the Muslim community; cultural practice was cited as a possible
reason for this. There was one woman who had delivered her baby in a
vehicle on the way to the hospital during a military encounter between the
Sri Lankan army and the LTTE.
Table 12
Location Where Child was Born by Number and Order of Childbirth
Age Group
Home
Sub Total
% of Total
Hospital
Sub Total
% of Total
Other
Sub Total
Total
Which
Child
1
2
3
4
5
Which
Child
1
2
3
4
5
Which
Child
1
2
3
4
5
12-18
19-40
41-60
Total
8
5
1
5
3
22
11
9
7
6
4
37
58
64
88
55
57
100
18
14
8
11
7
58
35.5
3
-
29
18
14
3
3
15
9
8
2
-
32
33
36
40
-
47
27
22
5
3
67
34
0
3
1
1
90
0
72
104
63.8
-
1
0
163
The Batticaloa reseach was undertaken with the assistance of the Suriya
Womens Development Centre.
Batticaloa District Background
Batticaloa is one of four districts in the research for which there is limited
national-level data, given that the ethnic conflict restricted the areas in
which censes could be carried out over the last 20 years. However, some
information is available through more recent data from the Department
of Census and Statistics. Accordingly, it is found that in 2002, the under
5 mortality rate was17.5 for females and 23.6 for males. The comparative
national level figures were as follows: 12.0 for females and 14.9 for
males.55 The infant mortality rate is recorded as 14.4 for females and 17.4
for males, while the corresponding national rate was 10.2 for females and
55. Department of Census and Statistics (2005). Op cit.
113
12.9 for males.56 Maternal mortality for this reference period was 32.9
for Batticaloa; at the national level it was 27.5.57 These statistics indicate
that in terms of access to healthcare, the Batticaloa District is clearly
disadvantaged compared to other parts of the country.
As the conflict grew in intensity Batticaloa experienced frequent cordon
and search operations, arrests and detentions. There were also increasing
instances of torture and ill treatment of young persons, mostly men, when
in detention, and a significant number of disappearances also occurred
in the region. With the withdrawal of the IPKF in 1990 Batticaloa was
severely affected by the break out of Eelam War II. As fighting intensified
between the state armed forces and the LTTE for control of territory, a
large percentage of the inhabitants of Batticaloa were displaced in 1991
and sought refuge in the south, particularly Colombo, where the majority
of them lived in camps for the displaced. By 1993 these camps were
arbitrarily shut down by the state and people returned, some to their
own homes and others to resettlements or welfare centres. Batticaloa
also experienced a series of massacres or large-scale disappearances in
the early 1990s, infamous among them the disappearances of over 150
displaced who were sheltering in the premises of the Eastern University
at Vandaramoolai, Kathankudi, Eravur and Oddamavadi Muslim
enclaves following the mosque massacres at Eravur and Kathankudy
in the early 1990s. This period also saw interethnic tension between
Muslims and Tamils. In the last decade i.e. since the mid 1990s, there has
been an increase in the number of women from the Batticaloa District,
in particular from Oddamavadi, seeking employment in West Asia.
56 Ibid. Child mortality rate is defined as the probability (expressed as a rate per 1000
live births) of a child born in a specified year dying before reaching the age of five is
subjected ti current age-specific mortality rates.
57 Ibid. Maternal death is the death of a woman while pregnant or within 42 days of
termination of pregnancy irrespective of the duration and the site of the pregnancy,
from any cause related to or aggravated by the pregnancy or its management, but not
froom accidental or incidental causes.
114
116
118
Research Findings
Ethnicity
Ethnicity
Muslim
Tamil
NA
Total
Age
19-40
21
20
0
41
12-18
10
4
0
14
41-60
14
7
0
21
Total
45
31
0
76
%
59.2
40.7
0
100.0
Level of Education
The table below indicates that the highest participation and comparative
educational achievement has been among women in the age cohort 1940, indicating a higher level of education in the years pre-conflict and in
the early period of the conflict when the district was less affected by its
ravages.
Table 2
Level of Education by Age Group of theIinterviewees
Education Level of the Interviewee (%)
35.5%
19.7%
15.7%
11.8%
9.2%
6.5%
1.3%
None
Grade 1-5 Grade 6-8 Grade 9-10 O/L Passed Grade 11- A/L Passed Higher
No
12
Education response
119
Marital Status
While 60.5% of the sample were married it is interesting to note that
fourteen (58%) of the 24 unmarried women were from the age group
19-40.
Table 3
Marital Status by Age
NoMarital Status of the Interviewee (%)
info, 0
Divorced,
Widowed, 1.3%
6.5%
Unmarried,
31.5%
Married,
60.5%
Age at Puberty
The above data shows that most women reached puberty between the
ages 13-15, although a significantly high 40.5% reached it between the
ages of 9 and 12. Reflecting the national average, 53.1% of women had
reached puberty by the age of 15.
Table 4
Age at Puberty by Age Group of Interviewees
Age at Puberty
9-12 years
13-15
16-19
NA
Total
120
12-18
7
7
0
0
14
Age
19-40
13
25
1
2
39
41-60
10
11
0
2
21
Total
30
43
1
2
76
%
40.5
58.1
1.3
2.6
100.0
From whom
Friends
Grandmother
Mother
Found out herself
Sister
Own friends and others
Not Available
%
9
1.3
4
70
2.6
2.6
Age at Marriage
I was in Grade 4 when I attained age and my mother stopped
me from going to school after that. Since I married very young
(at 16 years) my husband took all the decisions regarding the
family. I do that now in consultation with the elder children.
However, my husband and I decided together about spacing
children, because I did not want to give birth every year and
also because it would be difficult to bring up the children. I had
no training nor did I learn any other skill. I am now a widow
with four children. I weave mats and sell a mat to a trader at
Rs.50/-. (Ms.T, 38 - Case Study, Batticaloa)
121
Table 6
Age at Marriage by Age Group of Interviewees
Age at Marriage of the Interviewee (%)
31.5%
21.0%
18.4%
17.1%
3.9%
15-18
19-22
23-25
26-29
6.5%
1.3%
30-33
Above 33
Unmarried
NA
As the above table indicates, most women got married between the ages
19-25, although 30% of the sample were married between 15 and 18,
indicating a significant percentage of early marriage.
0.0%
Age 12-18
Age 19-40
Age 41-60
123
Table 8
Age at First Live Birth
Age at First Live Birth of the Interviewee (%)
40.4%
21.4%
19.0%
9.5%
4.7%
4.7%
0.0%
15-18
16-19
20-24
25-28
29-32
Above 32
NA
Age at Menopause
Most women in the age cohort 40-55 years of whom this question was
asked appear not to have provided an answer, indicating possibly that they
were not aware of menopause. This lack of response is worth further
investigation since in other districts viz. Jaffna - women of the same age
group appeared to have a much greater knowledge of menopause.
Table 9
Age at Menopause
Age at Menopause
36-40
41-45
46-50
50-55
NA
Total
12-18
0
0
0
0
14
14
Age
19-40
0
0
0
0
41
41
41-60
0
2
4
0
15
21
Total
0
2
4
0
70
76
Miscarriage
I am a teacher and am 43 years old. I first conceived soon after
marriage but miscarried three months later. I lost my second
pregnancy too and was blamed for not seeking medical advice.
I consulted a private practitioner who performed a D and C
124
Experience of
Miscarriage
Yes
No
NA
Total
12-18
0
1
13
14
Age
19-40
3
13
25
41
41-60
2
3
16
21
Total
5
17
54
76
Domestic Violence
I have been subject to domestic violence. He [husband] started
assaulting me when I was 17 years old and my first child was
three months old. He assaulted me till he died because I would
scold him for not going to work regularly, for playing cards
with friends or borrowing money. (Ms.T, 38 - lkCase Study,
Batticaloa)
125
28.6%
14.3%
Age 12-18
Age 19-40
Age 41-60
Age Group
and Number
of
Respondents
Before
Which
Child
1
2
3
4
5
1218
5
4
4
2
1
% of
Sub Total
During
% of
Sub Total
After CFA
% of
Sub Total
Total
Which
Child
1
2
3
4
5
0
Which
Child
1
2
3
4
5
% 1940
1
1
1
% 4160
22
17
11
11
9
5
3
18.6 17
18.6 16
15.2 14
8.4 8
5.0 4
28.8
27.1
23.7
13.5
6.7
16
27.1 39
66.1 59
100.0
11
9
6
4
2
25.5
20.9
13.9
9.3
4.6
9.3 15
6.9 12
4.6 8
2.3 5
2.3 3
34.8
27.9
18.6
11.6
6.9
43
100.0
9
7
4
4
4
28
32.1
25.0
14.2
14.2
14.25
100.0
44.6 130
100.0
8.4
6.7
6.7
3.3
1.6
0 32
3.5
0
0
0
0
3.5
% Total
4
3
2
1
1
11
7
5
2
2
3
19
25.0
17.8
7.1
7.1
10.7
67
51.5 58
1
2
2
2
1
8
3.5
7.1
7.1
7.1
3.5
127
Location of Childbirth
In the Batticaloa District, most childbirths of interviewees had taken place
in hospitals. Only 8% reported home births. Focus group discussions and
case studies revealed that most home births took place when the mother
lived far away from medical centres with little or no transport facilities, or
where the mother could not afford the clothing and other requirements
to enter hospital.
Table 13
Location of Chil birth by Number and Order of Childbirth
Age Group and
Number of
Respondents
Home
Sub Total
Hospital
Sub Total
Other
Sub Total
Total
128
Which
Child
1
2
3
4
5
Which
Child
1
2
3
4
5
Which
Child
1
2
3
4
5
12-18
19-40
41-60
Total
%
of
Total
22
17
40
2
1
3
3
2
2
7
5
3
2
0
0
10
1
-
21
14
11
9
3
14
15
13
9
5
36
29
24
18
8
58
56
115
92.1
0
1
0
61
0
63
0
125
100.0
7.8
Background
In the absence of comprehensive census data from the North and East
since 1981, the information available at the national level for the Jaffna
District is limited. The Assessment of Needs in the Conflict Affected Areas carried
out in 2003 notes that health infrastructure has been severely affected
in the North and East.58 Historically, the North had exceptionally good
health service delivery structures, which were severely impaired, damaged
or destroyed in the years of conflict. Particularly affected were many
health institutions hospitals, clinics, and water supply and sanitation
systems. Compounding this damage to infrastructure was the widespread
shortage of health personnel. The breakdown of reproductive healthcare
services, which had been among the best in the country, had resulted
in emergency obstetric care and family planning services, drugs and
operational healthcare institutions being unavailable to provide healthcare
to most of the population. Another serious obstacle to the effective
58 UN (2003). Sri Lanka Assessment of Needs in the Conflict Affected Areas: Districts of Jaffna,
Kilinochchi, Mullaitivu, Mannar, Vavuniya, Trincomalee, Batticaloa and Ampara, prepared with
the support of the Asian Development Bank, UN and World Bank, Colombo.
129
Ethnicity
The Jaffna district sample reflected the broad ethnic distribution of the
population.
Table 1
Ethnicity of Interviewees
Ethnicity
Tamil
Muslim
Total
12-18
18
2
20
19.2
Age
19-40
48
6
54
% 41-60
51.9
28
2
30
Total
94
10
28.8 104
90.3
9.6
100.0
Level of Education
The overall educational level of the sample was relatively high with only
two women from the oldest age group recording no formal education.
21% of women from all three age categories were found to have obtained
education between grade 6-8. The highest level of education was found to
131
have been achieved by those in the age group 19-40, with 31.7% obtaining
education levels between grades 6 and 12. The lowest level of education
(Grade 5 or below) was found among those in the age group 41-60.
Table 2
Level of Education
14.4%
5.7%
6.7%
5.7%
1.9%
None
Grade 1-5 Grade 6-8 Grade 9-10 O/L Passed Grade 11- A/L Passed Higher
No
12
Education response
Table 3
Marital Status of Interviewees
Marital Status of the Interviewee (%)
Divorced, No info,
1.0%
Widowed, 3.8%
3.8%
Unmarried,
26.9%
Married,
64.4%
Of the sample 72% were married or had been married, while 26.9% were
unmarried. This relatively high percentage of unmarried women could well
be directly related to the lack of sufficient men in the younger age group
suitable for marriage. The lower percentage of men in the peninsula has
been attributed to the higher exodus to safer locations; greater numbers
of men joining militant movements and possibly dying in combat; greater
numbers of young men being detained, arrested or disappeared. Another
132
Age at Puberty
The age at puberty reflected the average figures found in the other five
districts surveyed as part of this research, although Jaffna recorded the
lowest average for the 9-12 age cohort. Of the total number of women
interviewed 72% had reached puberty between the ages 13-15; 8.6 % had
reached puberty between 9-12, and 14.4% between the ages 16-19.
Table 4
Age at Puberty
Age at Puberty
9-12
13-15
16-19
Incomplete info
Total
12-18
1
16
0
3
20
Age
19-40
6
38
8
2
54
Total
41-60
2
21
7
0
30
9
75
15
5
104
%
8.6
72.1
14.4
4.8
100.0
seek out relevant information, and this indicates very clearly that accurate,
useful and relevant information must be made accessible to boys and
girls through accessible means, such as the education system, community
youth groups, media and the family.
Table 5
Knowledge about Puberty
From Whom
Mother
Aunt
Sister
Friends
Own
No response
Total
12-18
3
0
0
7
10
0
20
Age
19-40
4
1
3
17
27
2
54
41-60
4
0
0
6
20
0
30
Total
11
1
3
30
57
2
104
%
10.5
0.9
2.8
28.8
54.8
1.9
100.0
Age at Marriage
This sample indicates that there seems to be a shift to marriage at a
younger age (between the ages 15-18) among the age category of women
who are currently between 19-40, compared with the women who are
currently in the 41-60 age cohort. This appears to be a comparatively
recent phenomenon in Jaffna society.
Overall, 46.1% of women interviewed had been married between the
ages of 15-22, 10.5% between the ages 23-25, and 5.7% above the age of
30. 27.8% of women were unmarried.
134
Table 6
Age at Marriage
29.8%
27.8%
16.3%
10.5%
9.6%
1.9%
15-18
19-22
23-25
26-29
30-33
3.8%
0.0%
Above 33
Unmarried
NA
Experience of Miscarriage
I was displaced from Atchuveli and later lived in the Vanni.
I left school in 1995 and joined the LTTE. I left the LTTE
after earning my discharge and married in 2000. My parents
accepted me only when I was five months pregnant with my
daughter. I was pregnant again last year but did not know that
I should not do strenuous work during pregnancy. I tried to
shift to a new house during my pregnancy but had to return
because it was already occupied. When I got home I found
a slight discharge. I went by bus to my husbands workplace
and while returning home on the bus found that the blood
flow had increased. While walking home through the shrubs
I fainted and was sent to hospital. From there (Vanni), I was
sent to the Jaffna hospital because the cord had not come out.
At the Jaffna hospital the police questioned me about abortion.
I said I had not had an abortion. The doctor X rayed me and
then discharged me. I found many women who had attempted
abortions at the hospital. (RK, 22 Case Study, Jaffna)
135
Age at Menopause
Awareness of menopause was found only among the age group 41-60;
most women found out about menopause from their friends, mothers or
grandmothers.
Table 7
Age at Menopause
Age at Menopause
36-40
41-45
46-50
50-55
No response
Total
12-18
0
0
0
0
20
0
Age
19-40
0
0
0
0
54
0
41-60
4
5
7
2
12
30
Total
4
5
7
2
86
104
136
Table 8
Knowledge About Contraception
Knowledge about
Contraception
Yes
No
No response
Total
12-18
1
3
16
20
Age
19-40
42
1
11
54
41-60
23
2
5
30
Total
66
6
32
104
%
63.4
5.7
30.7
100.0
13.4%
11.5%
5.7%
16-19
20-24
25-28
29-32
2.8%
Above 32
NA
Domestic Violence
He [son-in-law] harassed my daughter very much He gave
my daughter karate kicks and beat her with chains. No one
took action to stop his atrocities. He came in the night and
beat my daughter with a chain. She did not shout because
she did not want me to hear. She went to a neighbolurs and
slept there. In the morning she returned home and slept
with the child. But he returned soon and found her sleeping.
137
26.7%
20.4%
10.0%
Age 12-18
Age 19-40
Age 41-60
Most of the violence in the home was reportedly perpetrated by the spouse
for reasons such as not giving him money to buy alcohol, suspicion and
dowry issues. There were also incidents reported of violence perpetrated
by mothers-in-law on account of the woman not getting pregnant.
Mothers and sisters were reported to have used violence in relation to
love affairs or for not agreeing to marry the partner chosen for marriage.
Most women had the first experience spousal violence when they were
in their 20s. In the absence of legislation which criminalizes marital rape,
incidents such as those quoted above continue to take place with no
punishment metered out to the perpetrators of violence.
My eldest daughter fell in love when she was studying and
eloped Her husbands mother came along and took him
away saying the dowry was not sufficient. My daughter went
in search of him and he returned with her. My daughter
conceived and he went away. We were then displaced to
Madduvil I heard he had married another girl at Mirusuvil.
I told the person who had told me that he was married to
my daughter and he came back. In this manner has married
six times. (MN, 52 Case Study, Jaffna)
138
As the above case study illustrates, women face physical and mental abuse
in situations where sociocultural practices such as dowry upon marriage
are deeply entrenched. Such situations are often compounded by families
being displaced due to military engagements by the armed forces and the
resultant breakdown of social norms in society.
139
Table 11
Pregnancy During the Conflict Period: By Number and of Order of
Childbirths
Age Group
and
Number of
Respondents
Order of
12-18
childbirth
0
Before
Which
Child
1
2
3
4
5
Sub Total
% of Total
During
Sub total
% of Total
After
Sub Total
Total
140
Which
Child
1
2
3
4
5
Which
Child
1
2
3
4
5
19-40
41-60
Total
36
26
62
3
1
0
0
0
4
20
18
12
6
5
61
23
19
12
6
5
65
35.3
29.2
18.4
9.2
7.6
100.0
33.5
26
24
14
11
6
81
6
6
6
5
5
28
32
30
20
16
11
109
29.3
27.5
18.3
14.6
10.9
100.0
56.1
9
2
2
3
1
2
1
9
2
4
3
2
0
0
17
102
3
92
20
194
45.0
10.0
20.0
15.0
10.0
100.0
100.0
Clearly, the Jaffna data indicates that women currently in the age group
41-60 have had the most number of childbirths, both before and during
the period of active conflict. Whether this situation arose as a result of
the nonavailability or nonaccessibility of reproductive health services in
the area or whether sociocultural factors contributed needs to be further
investigated. It is evident that there has been an increase in the number
of childbirths among women in the age cohort 19-40 in the period after
active military engagement in the area.
Location of Childbirth
While this research found that most women had sought care in hospitals
for the birth of their children, there is also strong evidence to show that
the period of conflict severely disrupted womens access to reproductive
health services provided by the government.
It is evident that the role played by traditional midwives remains a key
factor in ensuring womens access to safe delivery, particularly where
mainstream facilities and care are not accessible.
141
Table 12
Location of Childbirth by Number and Order of Childbirths
Age Group
and
Number of
Respondents
Home
Sub Total
% of Total
Hospital
Sub Total
% of Total
Other
Sub Total
Total
142
Order of
childbirth
Which
Child
1
2
3
4
5
Which
Child
1
2
3
4
5
Which
Child
1
2
3
4
5
12-18
19-40
41-60
Total
29
12
41
2
3
1
-
1
2
2
3
3
5
3
0
3
14
7.1
36
24
15
14
7
58
25
22
18
11
9
85
61
46
33
25
16
181
2.8
0
0
0
102
0
93
0
195
21.4
35.7
21.4
0
21.4
100.0
33.7
25.4
18.2
13.8
8.8
100.0
0
100.0
143
Ethnicity
The ethnic breakdown of the Ampara sample reflects the broad ethnic
distribution of the district.
Table 1
Ethnicity of Interviewees
Ethnicity
Muslim
Sinhala
Tamil
Total
Age
12-18 % 19-40 %
9
26
1
2
12
27
22 (19.6) 55 (49.1)
41-60 % Total
15
50
2
5
18
57
35 (31.2) 112
%
44.6
4.4
50.8
100.0
Level of Education
The highest level of education was found to have been achieved by
those in the age group 19-40. 35.7% of the sample had obtained formal
schooling only up to grade 5 or below
Table 2
Level of Education
Education Level of the Interviewee (%)
35.7%
19.6%
14.2%
15.1%
8.0%
2.6%
None
144
1.7%
1.7%
0.8%
Grade 1-5 Grade 6-8 Grade 9-10 O/L Passed Grade 11- A/L Passed Higher
No
12
Education response
Marital Status
The majority (91.9%) of the respondents in the age categories 19-40
and 41-60 were married. 59% of those in the age category 12-18% were
married, while 27.2% were unmarried.
Table 3
Marital Status of Interviewees
Marital Status of the Interviewee (%)
Widowed, 0.0%
Divorced, 0.0%
Unmarried,
5.3%
No info, 2.6%
Married, 91.9%
Age at Puberty
Of the total number of women interviewed, 60.7% had reached puberty
between the ages 13-15, 24.1 % between 9-12, and 7.1% between 16-19.
Table 4
Age at Puberty
Age at Puberty
9-12
13-15
16-19
NA
Total
Age
12-18 %
8
12
0
2
22
19-40 %
13
33
6
1
55
41-60 %
6
23
2
4
35
Total
%
27
68
8
7
112
24.1
60.7
7.1
6.2
100.0
145
From Whom
Mother
Grandmother
Sister
Friends
Own
NA
Total
12-18
3
2
1
3
10
3
22
Age
19-40
9
0
1
8
17
19
55
41-60
8
1
1
1
11
13
35
Total
20
3
3
12
38
35
112
17.8
2.6
2.6
10.7
33.9
31.2
100.0
Age at Marriage
A high 50.8 % of women interviewed had been married between the
ages of 15-18. When compared with the data in Table 4, this indicates a
close relationship between the age of puberty and marriage. With 25.8 %
married between the ages 19-22, the sample shows that 76.6% of women
had been married by the time they were 22.
146
Table 6
Age at Marriage
Age at Marriage of the Interviewee (%)
50.9%
25.9%
7.1%
15-18
19-22
4.5%
23-25
26-29
1.8%
0.9%
30-33
Above 33
5.4%
3.6%
Unmarried
NA
Knowledge about
Contraception
Yes
No
No response
Total
Age
12-18
19-40
41-60
7
1
14
22
35
9
11
55
21
3
11
35
Total
63
13
36
112
%
56.2
11.6
32.1
100.0
147
25.8%
21.4%
8.9%
15-18
19-22
23-25
4.4%
3.5%
2.6%
26-29
30-33
Above 33
NA
Experience of Miscarriage
Of the interviewees, 25% indicated that they had suffered at least one
miscarriage. Of these, 15.1% had experienced one miscarriage, while
9.8% had experienced between 2 and 3. The majority of those who had
experienced miscarriage had sought medical treatment at hospitals or
clinics in the area.
Table 9
Experience of Miscarriage
Miscarriage
Yes
No
NA
Total
148
Age Distribution of
Respondents
12-18
19-40
41-60
2
13
13
2
13
2
18
29
20
22
55
35
Total
28
17
67
112
%
25.0
15.1
55.8
100.0
Age at Menopause
Menopause was reported only from women in the age category 41-60.
Of them, only two had been aware of menopause prior to the experience.
Those who had reached menopause had sought advice from a medical
practitioner, 11 (9.8%).
Table 10
Age at Menopause
Age at Menopause
31-35
36-40
41-45
46-50
51-55
NA
Total
12-18
0
0
0
0
0
22
22
Age
19-40
0
0
0
0
0
55
55
41-60
1
3
6
6
2
17
35
Total
1
3
6
6
2
94
112
%
0.8
2.6
5.3
5.3
1.7
83.9
100.0
Domestic Violence
Of the sample surveyed, 49.1% had experienced domestic violence.
Women in the age category 19-40 were among those most likely to
experience domestic violence. It was found that 43.7% reported that it
was their spouse who was the perpetrator.
The most common reasons for spousal violence was his alcoholism,
demand for sexual services, the delay or womans inability to conceive,
his financial problems, his extra marital relationships, and if she was
perceived to not cleaning the house or having his meals ready on time, or
for no known reason.
149
Table 11
Interviewees
Domestic
Violence who have Experienced
Age 12-18
Age 19-40
Age 41-60
150
Table 12
Pregnancy During the Conflict Period: Number of Childbirths *
Age Group and
Number of
Respondents
Before
Sub Total
% of Total
During
Sub total
% of Total
After
Sub Total
% of Total
Total
12-18
19-40
41-60
Total
35
15
50
44.6
4
4
4
1
1
14
12
12
9
7
5
45
16
16
13
8
6
59
25.9%
27.1
27.1
22.0
13.5
10.1
100.0
34
27
15
5
2
83
8
8
10
8
8
42
42
35
25
13
10
125
55.0
33.6
28.0
20.0
10.4
8.0
100.0
8
7
9
6
5
0
1
14
8
9
6
6
35
132
88
43
18.9
227
Which
Child
1
2
3
4
5
Which
Child
1
2
3
4
5
Which
Child
6
1
1
2
3
4
5
32.5
18.6
20.9
13.9
13.9
100.0
100.0
151
Location of Childbirth
While most women sought hospital care for the birth of their children,
Ampara data indicates a relatively high incidence of home births compared
with the data from the other five districts. This was most frequent among
the age category 41-60 and could be indicative of poor health delivery
services during the time of conflict.
Table 13
Location of Childbirth by Number and Order of Child Births
Age Group &
Location of
Respondents
Order
of liveBirths
Home
Which
Child
1
2
3
4
5
Sub Total
% of Total
Hospital
Sub Total
% of Total
Other
Sub Total
Total
152
Which
Child
1
2
3
4
5
Which
Child
1
2
3
4
5
Age Group
12-18
19-40
41-60
Total
4
7
5
3
2
21
10
10
10
5
6
41
14
17
15
8
8
62
21.2
22.5
27.4
24.1
12.9
12.9
100.0
6
1
0
45
33
27
10
7
122
22
21
20
20
18
101
73
55
47
30
25
230
78.7
31.7
23.9
20.4
13.0
10.8
100.0
0
7
0
143
0
142
0
292
0
100.0
Annexure 1
Reproductive Health Concerns and Related Violence Against
Women Questionnaire:
1st Phase
1. INTRODUCTION
Rationale for the Study
Selection of Specific Districts:
Polonnaruwa, Jaffna, Mannar
Moneragala,
Akkaraipattu,
Batticaloa,
-----
B. Health Concerns
2. What are your main health problems/concerns?
C. Health Services
-- What are the health services/facilities that you have used ?
-- What are the health services/facilities that are available in your area
(village, district/municipal, cooperative, etc.) ?
-- For what reasons have you used these facilities ?
-- Was the ailment cured as a consequence?
-- What type of services/facilities do you feel are lacking in the area?
D. Reproductive Health
-- What are reproductive health issues as you understand it? (guidance
necessary from Research assistant to bring out issues such as puberty,
menstruation, pregnancy, childbirth, menopause, breast, ovarian
and womb-related health issues, sex, sexually transmitted infections,
contraception).
-- What are your RH problems/concerns?
-- What do you do when you have such a problem (specify depending on
the problem) ?
-- Who do you approach ?
-- What type of treatment have you been asked to take (specify for what
ailment)
-- Are you aware of the type of practices and methods which relate to
reproductive health (e.g., personal cleanliness, regularity in menstruation,
changes in your body, conception, contraceptive methods, etc.)
-- If yes, how did you find out about these?
E. Institutional Healthcare Facilities
-- Have you ever sought medical advice or treatment for reproductive health
problems?
-- If yes, where and when?
-- Preconflict (pre-1983 for North, pre-1990 for East, pre-1989 for the
South) ?
154
--------
--
--
Where did you birth the child? (in a hospital/ your own home/ another
persons home, etc.)
Who delivered the baby qualified medical doctor, qualified midwife/
traditional midwife/other ?
Was it a normal delivery/caesarian section ?
Were your pregnancies before, during or after the conflict period ?
Which ones were during the conflict years ?
Did you have specific problems during the pregnancies in the conflict
years ?
If yes, what were these ?
--
------
I. Sub-fertility/Infertility
-- Have you had difficulties in getting pregnant?
-- Why do you think this is the case?
-- What has been/was the response of your spouse/own family/in-laws to
this situation ?
-- Have you sought advice regarding difficulty in getting pregnant?
-- From whom and where?
-- What was the advice you were given?
-- Have you been able to get pregnant subsequently?
H.Contraception
-- Do you have knowledge of contraception ?
-- How did you get this knowledge ?
-- Have you ever used contraception ?
-- What contraception services were/are available to you ?
-- What was the nature of the services available (through clinics, hospital,
regular check-ups, etc.) ?
-- What type of contraception have you/do you use ?
-- Has your spouse ever used contraception ?
-- Do you use traditional methods of contraception ?
-- What choice did you have in deciding on contraception use ?
-- What influenced your choice ?
J. Miscarriage
-- Have you had any miscarriages?
-- If yes, how many?
-- How old were you when this first happened?
156
--------
K. Abortion
-- Have you ever had to get an abortion done?
-- What was the reason for this?
-- How was it done/where/by whom?
-- Did you face any health complications following an abortion?
--
L. Menopause
-- At what age did you stop menstruation?
-- Were you aware that this would happen to you?
-- If yes, from whom did you get to know about this?
-- What did you do when this happened?
--
157
Annexure 2
Reproductive Health Concerns and Related Violence Against
Women Questionnaire:
2nd Phase
Ages 12-18, 19-40 and 41-60
If the interview is a continuation of a person who was interviewed during the
first phase, please give the corresponding number of the interviewee.
1. Personal Information
-- Name
-- Age
-- Ethnicity
-- Marital Status
-- Level of Education
-- Main source of personal income
-- Main source of household income.
-- Are you a native of this village/area ?
-- Since when have you been living in this area?
2. Education
-- Did you go to school?
-- Where did you go to school?
-- Why did you stop going to school?
-- Have you participated in any skills development/training after leaving
school?
3. Marriage
-- Are you married?
-- Is your husband a native of this village/area?
-- If married, how was the marriage arranged?
-- Was it your choice/parents/relations ?
-- Do you have siblings?
-- What do they do occupation ?
-- Where do they live?
-- Are they married?
-- If yes, how were their marriages arranged?
158
---
4. Unmarried
-- Are there plans for you to get married?
-- If so, when how has the marriage partner been found?
-- What do you look for in a husband?
-- Where will you live after marriage?
-- Do you plan to have children immediately after marriage?
-- If yes, why?
-- If no, why not?
-- Are you aware of contraceptive methods?
-- If so, do you plan to use any which methods?
-- If no, do you want to find out about contraceptive methods?
-- Who do you think could tell you about these?
5. If Married
-- How are major decisions made in your household e.g., regarding purchase
of food, rent, medicines, childrens school expenses, festivals? ( Please
find out whether it is the wife or the husband or any other who would
pay for such events)
-- Do you and your husband consult each other on important issues give
examples?
-- Are there issues on which you and your husband have had disagreements?
-- What are these issues (household expenses, personal expenses, visiting
own relatives, use or not use of contraceptives, inability to conceive,
unfaithfulness, etc.)?
-- Do these disagreements result in physical violence against you/husband?
-- How often do such disputes occur?
-- How are such disputes resolved?
6. Reproductive Health
-- What does reproductive health mean to you? (encourage an extended
discussion to elicit how reproductive health is understood by her)
-- Are you aware of who in the village is the most knowledgeable about
reproductive health issues?
-- Do you know whether there is a clinic or hospital nearby where you can go
for medical help if you have some reproductive health related problem?
-- If you have gone to such a place did you go with someone else? If so,
with whom?
159
160