• No significant increase in home births, but medical specialists warn of pockets where it happens
• Govt., medical bodies do not encourage home births

Amid concerns about recent media promoting home births, professionals have expressed strong reservations about Sri Lanka’s readiness to facilitate such deliveries.

The World Health Organization notes that Sri Lanka’s maternal mortality rate per 100,000 live births has been improving since 2019, with Family Health Bureau data indicating a drop from 47 in 2021 to 25 in 2023. UNICEF data shows an under-five mortality rate of 6.1 deaths per 1,000 live births, demonstrating an improving trend since the 1990s.

Amid official data from the Department of Census and Statistics showing a fall in new births, from 328,409 in 2018 to 220,761 in 2024, a nearly 33% decline, safe maternity care has become an even more significant priority.  

Sri Lanka’s birth rate has declined over a period of 24 years from 18.5 per 1,000 persons in 2000 to 10.1 in 2024, which is almost a drop by half. Moreover, recent demographic research has estimated that Sri Lankan fertility is demonstrating a rapid decline after reaching below replacement level in 2016, with its current Total Fertility Rate (TFR) of 1.3 placing the country on the verge of entering an ultra-low fertility regime.

Professional opposition

Against this backdrop, any encouragement towards home births becomes especially contentious, with healthcare professionals strongly discouraging such measures in Sri Lanka.

While Government Midwifery Services Association (GMSA) President Devika Kodithuwakku noted that midwives had the training and skills to undertake births even at home, she stressed that there was no trend in home births occurring at present, adding that they had not received any such reports. 

Similarly, Family Health Bureau (FHB) Consultant Community Physician Dr. Asiri Hewamalage also noted that no significant increase in home births had been noted when considering the numbers. 

However, Dr. Hewamalage added: “We have seen certain pockets where home births are happening. At the same time, when you consider whether they are planned or accidental home births, planned home births are significantly less in number.”

The International Confederation of Midwives defines home birth as planned birth which occurs at home and is attended by an experienced midwife with collaborative medical backup in case transfer should be necessary. 

According to the American College of Obstetricians and Gynecologists, which notes that women inquiring about planned home birth should be informed of its risks and benefits based on recent evidence, although planned home birth is associated with fewer maternal interventions than planned hospital birth, it is also associated with a more than twofold increased risk of perinatal death (1–2 in 1,000) and a threefold increased risk of neonatal seizures or serious neurologic dysfunction (0.4–0.6 in 1,000).

Attendant risks

While there is a growing trend of planned home births globally in countries like the United States, particularly accelerated by the Covid-19 pandemic, experts continue to stress the implications on maternal and neonatal health.

The risks of home birth remain too high for Sri Lanka. Kodithuwakku strongly advised against home births, noting: “In the past, deaths of mothers and infants have occurred the most when home deliveries took place. This is why the family health service was started. After this service commenced, there was a gradual decline in home deliveries.”

Dr. Hewamalage too, when questioned whether home births were a realistic option for Sri Lanka, said: “Neither the Government nor the College of Obstetricians and Gynaecologists encourage home births.” 

She added: “In Sri Lanka, we have a very low target for maternal mortality rates. Regionally, our maternal mortality has been declining. 

“Our target is to reduce the maternal mortality rate to single-digit figures. Therefore, we advise all mothers to deliver in a facility where there are emergency obstetric and maternal care services available, because an emergency can happen at any time. A facility should therefore be available in very close proximity where the mother could be attended to if there is an emergency.”

She noted that Sri Lanka had a low infant mortality rate compared to the region, and often, the causes for infant mortality were congenital abnormalities, premature death, etc.

Outlining the risks of home births, Kodithuwakku stated: “Typically, unless home deliveries are unavoidable, it is not usually appropriate to advise home births, since it involves a massive procedure. The equipment and other facilities required for such a procedure are absent in homes. Should there be a need to resuscitate an infant, such facilities are not available.” 

Dr. Hewamalage pointed out that both the mother as well as the baby faced risks during home births, noting: “During birth, there can be bleeding and increased pressure; anything can happen at that time. If the baby is not attended to well, at least a two- or three-minute breakdown in the supply of oxygen can have a lifelong impact on the child. As long as nothing happens, it’s fine. But if certain things are missed, it can have an impact for the child’s entire lifetime.”

She stressed that home births were never considered medically appropriate, and that only in instances such as where the mother was unable to come to hospital on time due to an accident or emergency could home births be envisioned.

However, she pointed out: “In Sri Lanka, we have a very widespread hospital system. So anybody can reach a hospital in a very short time, at least a district hospital. We don’t have any programmes to promote or assist in cases of such rare incidents, but our Public Health Midwives (PHMs) are trained. If such a situation arises, what we advise mothers to do is to contact the PHM and get their support.”