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University of Warwick institutional repository: http://go.warwick.ac.uk/wrap A Thesis Submitted for the Degree of PhD at the University of Warwick http://go.warwick.ac.uk/wrap/63815 This thesis is made available online and is protected by original copyright. Please scroll down to view the document itself. Please refer to the repository record for this item for information to help you to cite it. Our policy information is available from the repository home page. Women's Health as State Strategy: Sri Lanka's Twentieth Century By Darshi Nayanathara Thoradeniya A thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy in History Centre for the History of Medicine University of Warwick January 2014 Table of Contents Acknowledgements ….. 06 Abstract ….. 08 Abbreviations ….. 09 Chronology of Events ….. 10 Introduction ….. 11 Research Problem ….. 14 Objectives of the Research ….. 17 Historiography of Development, Modernization and Women’s Health ….. 18 Development, Modernisation & Women’s Health ….. 19 Literature on the Woman’s Body ….. 26 Scholarship on the Woman’s Body in Sri Lanka up until Now ….. 32 Methodology ….. 40 Archival Research ….. 42 Field Research ….. 44 Positioning Myself and Ethics ….. 47 Interviewing Women’s Health Policy Makers ….. 48 Interviewing Women’s Health Policy Recipients ….. 51 i) Interviewing FTZ Workers ….. 52 ii) Interviewing Migrant Workers in the Gulf ….. 53 iii) Interviewing WWC Attendees ….. 54 Challenges in the Research ….. 57 Structure of the Thesis ….. 58 Chapter One Population, Development and Women’s Health in Post Independence Sri Lanka (1950-1990) Abstract ….. 63 Introduction ….. 64 Sri Lanka Becoming a ‘Case Study’ within Population Research ….. 66 History of Demography in Sri Lanka ….. 70 Is Sri Lanka Actually a ‘Development Model’? ….. 71 Emergence of the Official Rhetoric on Population in Sri Lanka ….. 79 Population as a ‘Question’ in Ceylon (1881-1955) ….. 81 Planning as an Ideology ….. 84 2 Population as a ‘Problem’ in Sri Lanka (1955-1998) ….. 90 The 1950s – Planning Mode ….. 90 Official Response to the Population ‘Problem’ ….. 94 Formulation of a Population Policy ….. 95 The 1960s – Experimental Mode ….. 98 The 1970s – Implementation Mode ….. 100 Post-1977 – Open Economic Policy ….. 102 The 1990s – The Turbulent Decade ….. 109 Economic, Military and Political Milieu of the 1990s ….. 109 Women’s Health in Official Rhetoric ….. 112 Concluding Thoughts ….. 114 Chapter Two A History of Family Planning and Population Control in Sri Lanka (From the 1930s to the 1980s) Abstract ….. 116 Introduction ….. 117 Dr Mary Rutnam and Early Efforts of Family Planning in Sri Lanka ….. 120 Establishing the Family Planning Association of Ceylon – 1953 ….. 124 The Relationship between the State and the Family Planning Association ….. 130 A Brief History of Global Population Control Programmes ….. 133 Funding Population Control Programmes ….. 135 Family Planning as Part of Planning Ideology in the Late 1950s and 1960s ….. 137 Implementing Family Planning as Population Control Programmes in the 1970s ….. 140 The Role of Youth in Population Education ….. 143 Seeking the Support of Ayurvedic Physicians ….. 146 The Family Planning Programme during the Dynamic Implementation Mode of the Late 1970s ….. 150 Concluding Thoughts ….. 156 3 Chapter Three From Pincus’ Pill to Chinnatamby’s Vanda Beheth and Women’s Female Friend Mithuri (1950 – 1980) Abstract ….. 158 Introduction ….. 159 Sri Lanka’s Role in Global Pill Trials ….. 160 The Invention of the Pill in Worcester Foundation ….. 162 The Early Pill Trials ….. 164 Dr (Miss) Siva Chinnatamby (1921-2000) ….. 169 The De Soysa Lying-in-Home ….. 173 The Failure in Pap Smear Slides ….. 176 The Emergence of the Pill as the Best Tool to Plan Unplanned Families of Sri Lanka ….. 178 Women’s Bodies and the Framing of Contraceptive Discourses ….. 182 Vanda Beheth/Pethi Connotes … ….. 184 Chinnatamby as Mother of Vanda Beheth in Sri Lanka ….. 187 From Vanda Beheth/Pethi (Sterility Pills) to Mithuri (Female Friend) ….. 192 Pharmaceutical Policy of Sri Lanka (1971) ….. 196 Incorporating Ayurvedic Physicians into Family Planning Activities ….. 205 Concluding Thoughts ….. 209 Chapter Four The 1990s: A Decade of Turbulence Docile Girls, Responsible Mothers and Brave Mothers Abstract ….. 212 Introduction ….. 213 Women in the Patriarchal Welfare State ….. 214 Three Figures of the Ideology of Womanhood and Motherhood ….. 217 Figure 1: Docile Girls of the Free Trade Zones ….. 218 Emergency Contraceptive Pill and FTZ Workers ….. 223 Figure 2: Responsible Mothers in the Gulf ….. 229 Figure 3: Motherhood during the Militarisation of Conflict in the 1990s ….. 235 State Policies on Women ….. 239 4 Tropes of Motherhood ….. 241 The Northern Mothers’ Front ….. 241 The Southern Mothers’ Front ….. 243 Concluding Thoughts ….. 248 Chapter Five Reproductive Health and Rights in Post ICPD Sri Lanka Abstract ….. 250 Introduction ….. 251 ICPD Cairo: From Family Planning to Reproductive Health and Rights ….. 254 Well-Woman Clinics ….. 258 Well-Woman Clinic Programme of Sri Lanka – 1996 ….. 259 Did Reproductive Rights Miss the Flight From Cairo? ….. 261 Reproductive Rights as an ‘Official Oversight’ ….. 263 Reproductive Rights as an ‘Official Impasse’ ….. 267 Introducing Reproductive Health through WWCs ….. 270 WWC as a Clinic ‘Beyond Reproduction’ ….. 271 ‘Beyond Reproduction’ within Public Health Infrastructure ….. 274 WWCs are to Screen Healthy Bodies ….. 277 Population and Reproductive Health (PRH) Policy – 1998 ….. 284 Instead of ‘People,’ ‘Couples’ were Adopted ….. 286 Instead of ‘freedom to decide’, freedom to ‘decide responsibly’ was Adopted ….. 287 Instead of ‘if, when and how often to do so’, ‘the number of children they may have’ was Adopted ….. 289 Concluding Thoughts ….. 292 Conclusion ….. 293 Main Contributions ….. 294 Conceptual Contribution ….. 295 Analytical Contribution ….. 298 Limitations of the Study ….. 300 Future Research ….. 301 Appendix ….. 304 Bibliography ….. 308 5 Acknowledgements No thesis can be completed without the support and collaboration of many people. My PhD journey has been especially collaborative due to the extended family that I am from. I am deeply indebted to my life partner, Rajith, not only for taking care of our children but also for having faith in me when I was losing confidence in me. His unfailing confidence in my work, constant support and encouragement kept me going through some of the most challenging times. To my putha Charitha for being understanding and hopeful of my work and to my duwa Adithi for being ever so loving and caring and for both of them for helping Rajith to run a smooth house in my absence. I am deeply grateful for Dr. Sarah Hodges’ training and guidance. She gave me confidence, stayed calm when I panicked and pushed me along when I got stuck. Most of all for placing so much confidence in me when I almost lost hope. I owe a big thank you to Dr. Malathi de Alwis, my master’s supervisor first for encouraging me to apply for the scholarship and reading and discussing my work during my brief periods of stay in Sri Lanka at the writing stage. I am grateful to my amma who became a mother to my children during my long absences and my mother-in-law and father-in-law for being a strength and support to my family. My akka Kalani’s unfailing weekend telephone calls from Australia through out my stay in the UK was a great relief for my homesickness and I am grateful to her and my brother-in-law Dhammika for the financial support extended during my trip to Warwick for submission. I extend a special thank you for my sisters-in-law, Tharangi, Chuti and Lakshi for being lovely aunts and my ayya Thusith for being a caring uncle to my children. I owe my nieces, Chamethya, Charanya, Chavinya, Tarani, Oneli and Shamali and my only nephew Ramitha hugs and kisses for playing and taking care of my children (their cousins) in their own special ways. I extend a big thank you to my maid, Kanthi for taking care of the household work in my absence and mostly for preparing meals for my children and Rajith. This would not have been possible without the financial support from the Wellcome Trust and the University of Warwick and I extend my appreciation to these two institutions. And a warm thank you to Tracy Horton (Administrator for the Centre for the History of Medicine, University of Warwick) for helping me out with all the technical and administrative difficulties through out my stay at Warwick. Further, I thank Jean Noonan and Robert Horton for extending administrative support during my stay at Warwick. I am grateful to the Royal Historical Society and the McCullum Award of the University of Warwick for funding my archival research trip to the US. Of course many people helped me with various parts of the thesis and my grateful thanks to all of them: Sharmaine Gunaratne, Tharanga Amarakoon, Nadi Kammallaweera and Suresh Fernando for questioning my research which was a great stimulus. Asha Abeysekere Van-dort deserves a special thank you for reading 6 all my chapters and the valuable comments given. Doing a PhD can be a challenging, often frustrating and frightening experience: the support and encouragement of close friends made it that much more bearable. A big thank you to my PhD colleagues: Jossette Duncan, Stephen Soanes, Harriet Palfreman, Stephen Bates, Rebecca Williams, Andrea Cadelo, Martin Moor, Anne Moeller, Malik Ahmad and Jack Elliot for encouraging me and helping me with various ways throughout my stay in Warwick. A special thank goes out to my land lady in Coventry Penelope Halpin for giving me abode in a homely house and for treating me as a friend not as a lodger. Rajith’s cousins Dhammika akka and Sisira ayya and their friend Wendy are remembered with gratitude for letting me stay with them while I researched old documents at the Rockefeller Archives in New York and Library of Congress in Washington DC. I appreciate the kindness extended to me by my cousin Sandun Ranatunga and his friends Sameera, Anjana and Krish by letting me stay at their house in London during my visits to the British Library and picking me up and dropping me off at the air port on various occasions during the last four years.
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