Fernando Dulitha, Jayatilleka Anoma, Karunaratna Vinitha
Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
Br Med Bull. 2003;67:85-98. doi: 10.1093/bmb/ldg008.
The declining trend in the maternal mortality rate (MMR) from the 1930s to the late 1990s resulted from several strategies implemented within and outside the health sector. Expansion of both field-based and institutional services through the past decades contributed to improved geographical access and provision of 'free' services improved economic access. These led to increased use of antenatal and natal services provided by trained midwives and other personnel followed by improvements in the availability of specialized care and emergency obstetric care. Integration of family planning and other inputs to the maternal health programme has yielded positive results. The role of the private sector is limited to provision of a component of antenatal services. The organization for service provision and an information system made significant contributions towards improvement. The commitment of the health sector to provide services free of charge supported by non-health inputs, especially female education, has enabled Sri Lanka to make gains in maternal health.
从20世纪30年代到90年代末，孕产妇死亡率（MMR）呈下降趋势，这得益于卫生部门内外实施的多项策略。在过去几十年里，基于现场和机构的服务得以扩展，这有助于改善地理可及性，而“免费”服务的提供则改善了经济可及性。这些举措使得由训练有素的助产士和其他人员提供的产前和产后服务的使用增加，随后专门护理和紧急产科护理的可及性也得到了改善。计划生育与孕产妇健康计划的其他投入相结合产生了积极成果。私营部门的作用仅限于提供部分产前服务。服务提供组织和信息系统为改善工作做出了重大贡献。卫生部门在非卫生投入（特别是女性教育）的支持下，致力于免费提供服务，这使得斯里兰卡在孕产妇健康方面取得了进展。
