Pregnancy by Choice
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CONTENTS FOREWORD CELEBRATING THE ACHIEVEMENTS 01 02 03 04 05 06 07 SAVING PREGNANCY WHEN IN A SAFER MAKING INFORMED LOOKING ACCELERATING THE MOTHERS’ BY CHOICE CRISIS WORLD FOR HER DECISIONS AHEAD PROMISE LIVES Page 04 Page 06 Page 14 Page 26 Page 38 Page 50 Page 62 Page 74 Page 80 04 05 FOREWARD THE FIGHT FOR REPRODUCTIVE RIGHTS AND CHOICES MUST CONTINUE Imagine a world where every pregnancy is wanted, every Commemorating these The publication also focuses on Fifty years on, the fight for rights and childbirth is safe and every young person’s potential is milestones, it is our pleasure how rights and choices have been choices in reproductive health must fulfilled. Imagine a world where every person can exercise at the heart of the population and continue until the world we imagine, the right and have choices to make safe and informed to present ‘Perspectives – development agenda, yet, at the is the world that we live in right now. decisions on if and when to get married, and whether and A reflection on five decades same time, how thousands of people when to have children. At the United Nations Population of advancements in sexual are still waiting for the promise Let’s continue the unfinished Fund (UNFPA), this is the world we strive to build for and reproductive health in Sri of ICPD to be fulfilled. If we are agenda, and let’s start now. everyone, in every corner of the globe. to achieve the 2030 Agenda for Lanka’. Sustainable Development, if we are In 1973, UNFPA started its operations in Sri Lanka. Since to leave no one behind, then we must then, our combined efforts with the Government of Sri This publication celebrates the address the unfinished business of Lanka, civil society organizations, and development achievements during the last 50 the ICPD agenda. partners has assisted Sri Lanka to achieve remarkable years and earlier, and focuses Ritsu Nacken progress in advancing sexual and reproductive health of its on UNFPA’s key areas of work - Each narrative is a reflection Representative, UNFPA Sri Lanka people. Maternal Health, Family Planning, Comprehensive Sexuality Education, of the potential for sexual and reproductive health and rights This year, 2019, marks two important prevention of Gender-Based Violence, and Providing Humanitarian Relief, to transform the lives of milestones in the field of reproductive health through a compilation of stories from individual women and girls – globally: 50 years since UNFPA began its resilient, inspiring, and empowering and from there, like ripples in operations, and 25 years since the landmark people. The shared insights are from a pond, to drive change that International Conference on Population those who have dedicated years of service to addressing the challenges propels the wellbeing of their and Development (ICPD) in Cairo, which faced in each sphere of UNFPA’s families, communities and represented a paradigm shift for population work, paired with the stories of the the country itself. and development in the recognition that lived realities of women for whom people’s rights, choices, and well-being are the these vital services and far-reaching policies were intended. path to sustainable development. 2003 UNFPA conducts Global Survey to appraise national experiences post-ICPD in Cairo 14 15 CHAPTER 01 SAVING MOTHERS’ LIVES No mother should die giving birth. Making motherhood safer is a human rights imperative, and it is at the core of UNFPA’s mandate. In Sri Lanka, continuous investments in maternal health can be traced back to the beginning of the last century. Over the decades, maternal mortality has immensely reduced, resulting in Sri Lanka having the lowest maternal mortality in the South Asia region. Almost every mother in Sri Lanka gives birth in a health facility, and 99 percent of mothers receive antenatal and postnatal care by a skilled health professional. However, while significant strides have been taken, this is not enough because even one preventable maternal death is too many. Maternal health indicators have been stagnant over the last few years, and most maternal deaths have been preventable. UNFPA works closely with the Government of Sri Lanka to strengthen health systems and to promote international maternal health standards, thereby ensuring that every mother can live to witness the life of their child. © UNFPA Sri Lanka / Munira Mutaher 16 17 EVERY TIME I GOT PREGNANT, I WAS HOPEFUL, BUT I WAS ALSO AFRAID. ESHA KAPPARAGE, 52 © UNFPA Sri Lanka / Shehan Obeysekera 18 19 Esha Kapparage was told five placing Ajith’s sperm directly inside times that a child she desperately Esha’s uterus to increase the chances wanted would never be born. of fertilization. Accompanying the Each miscarriage felt different, yet treatment were a number of injections heartbreakingly familiar: the shortest and oral drugs. Thanks to her training, pregnancy was three months, the Esha was able to simply inject herself. longest four. Sometimes, she knew she had lost the child because of She knew first-hand how excellent the the blood staining her clothes; at healthcare for mothers and children other times it was because the foetal provided by the state was, but felt that monitor revealed that the baby had the hospitals were poorly equipped gone still and lifeless within her to treat couples who needed fertility womb. “Each time it was a great treatments. Asked to provide sperm, emotional blow to me,” she says, “a Ajith was appalled by the conditions loss of all our hopes.” of the toilets he was sent to. There was a clear lack of sensitivity to the Esha had always known she wanted needs of couples such as themselves. to have children. A trained nurse, Switching to the private sector, she had met her husband, Ajith, in however, brought with it its own Peradeniya, where she was attached challenges. Treatments and tests put to the local hospital. The two hit a dent in their budget, and with every it off right away. Ajith was deeply miscarriage, Esha’s heart sank. progressive in his outlook, unlike other men she knew. An English teacher, he “Because I worked in the sector, I could discuss literature and politics knew there were healthcare services for hours. She loved the dark colour of available, but there was no other his skin and the respect with which he system of assisting women to help treated her and all other women. The them cope with the mental pressure two were married after a whirlwind we had to face. There was no courtship. emotional support,” remembers Esha. She adds: “Every time I got pregnant, I After being happily married was hopeful, but I was also afraid.” for a year, Esha and Ajith At the time she was grateful that planned to have a child. Six both his family and her own were months later, it was clear willing to give them some space. Even something was wrong. the neighbours in their village were They went to see a doctor generally respectful. Esha spent hours on the phone with her mother, who and underwent a battery of encouraged her to keep trying. Ajith tests. The diagnosis was was a quietly supportive presence. sub-fertility, which meant He told her that it was her choice, that Esha had a condition and that they would handle it as she wanted. It was the best gift he could of reduced fertility. More give her. tests and treatments were scheduled, with the hope of However, after nine years of having having a child together. her hopes lifted, only to have them so painfully shattered time and time Since Esha was working as a nurse, again, Esha was finally ready to call it she would go for her appointments quits. With Ajith’s support, they began during her breaks at work. They went to think about other options, such as through four rounds of Intrauterine adoption. Insemination (IUI), which involved © UNFPA Sri Lanka / Shehan Obeysekera 20 21 They registered with an adoption Another year passed, and centre and put the word out among Esha was pregnant again. their network. They found a possible candidate, a woman who was “We were both over forty,” she expecting twins but could not afford says, admitting that she was to keep both of them. deeply anxious that the child would be born with Down’s Excited now, they began to prepare to welcome a child into their home. They syndrome. They went for turned in their motorcycle for a car tests, but found that the most with a child seat and went shopping reliable one would also be for baby things. the most expensive, and was Then Esha discovered she was simply beyond their means. pregnant for the sixth time. “We decided to take a leap of faith and just take whatever The first month passed, and then the was given to us,” she says. second. The third came and went without incident. When the fourth When Madhuriya, meaning musicality, month went by, Esha finally breathed was born on December 19, 2009, she a sigh of relief. was a completely healthy baby girl. Nine months later, on April Today, families like Esha’s benefit 24, 2007, their daughter was from the work UNFPA does with born via a C-section. Esha the Government of Sri Lanka to strengthen the capacity of health wept as the doctor held up care providers to deliver quality family a girl. Ajith chose the name planning services, and in conducting Sililari, meaning river or research on subfertility towards stream, for their firstborn. developing a national subfertility package. Ajith would tell people later that their daughter saved Meanwhile, Madhuriya and Sililari their lives.