Sri Lanka

Demographic and Health

Survey
2016

Department of Census and Statistics

Ministry of National Policies and Economic Affairs

Health Sector Development Project

Ministry of Health, Nutrition and Indigenous Medicine

September 2017

i
ISBN 978-955-702-053-2

Printed By: S&S Printers

No.49, Jayanthaweerasekara Mawatha,
Colombo 10.
Tel: 0112 384028 / 011 2 390873

ii Demographic and Health Survey - 2016, Sri Lanka

The 2016 Sri Lanka Demographic and Health Survey (SLDHS) was carried out by the Department of Census
and Statistics (DCS) for the Ministry of Health, Nutrition and Indigenous Medicine in collaboration with
The World Bank. ICF International (Inc.) provided technical assistance to Sri Lanka DHS 2016 through the
World Bank.
Additional information about the 2016 SLDHS may be obtained from the Department of Census and Statis-
tics, “SankyanaMandiraya”, No. 306/71, Polduwa Road, Battaramulla, Sri Lanka,
Telephone: (94)11-214-7000 or (94)11-214-7001; Fax (94)11-214-7011; Internet: www.statistics.gov.lk
Recommended citation:
Department of Census and Statistics (DCS) and Ministry of Health, Nutrition and Indigenous Medicine 2017.
Sri Lanka Demographic and Health Survey 2016 Sri Lanka.

iii
 CONTENTS
PREFACE xvii
ACKNOWLEDGMENTS xix
SUMMARY OF FINDINGS xxi

CHAPTER 1 INTRODUCTION
1.1 History 1
1.2 Climate 1
1.3 Economy 1
1.4 Demography 2
1.5 Health System 2
1.6 Demographic And Health Survey 3
1.7 Sample Design 3
1.8 Questionnaire 3
1.9 Training 4
1.10 Procurement 5
1.11 Selection Of Teams And Fieldwork 5
1.12 Data Collection Using CAPI 5
1.13 Data Processing And Tabulation 6
1.14 Data Dissemination 6
1.15 Results of the survey interview 7

CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS

2.1 Household Characteristics 11
2.1.1 Water And Sanitation 12
2.1.2 Drinking Water 12
2.1.3 Sanitation 15
2.2 Housing Characteristics 16
2.2.1 Household Possessions 17
2.2.2 Wealth Index 18
2.3 Household Population By Age And Sex 20
2.4 Household Composition 23
2.5 Children’s Living Arrangements, Orphanhood, And School Attendance 24
2.6 Education Of The Household Population 26
2.6.1 Educational Attainment 26
2.7 School Attendance Ratios 29
2.8 School Attendance Rates 32

iv Demographic and Health Survey - 2016, Sri Lanka

CHAPTER 3 CHERACTERISTICS OF RESPONDENTS
3.1 Basic Characteristics Of Survey Respondents 33
3.2 Educational Attainment By Background Characteristics 35
3.3 Literacy 36
3.4 Exposure To Mass Media 38
3.5 Internet Usage 40
3.6 Employment 40
3.7 Occupation 42

CHAPTER 4 FERTILITY LEVELS, DIFFERENTIALS AND TRENDS

4.1 Current Fertility Levels 45
4.2 Fertility Differentials 47
4.3 Fertility Trends 51
4.4 Children Ever Born And Living 52
4.5 Birth Intervals 53
4.6 Age At First Birth 55
4.7 Teen Age Pregnancy And Motherhood 57

CHAPTER 5 FAMILY PLANNING

5.1 Knowledge Of Contraceptive Methods 60
5.2 Current Use Of Contraception 62
5.3 Timing Of The Sterilization 67
5.4 Source Of Modern Contraceptive Methods 68
5.5 Informed Choice 69
5.6 Knowledge Of The Fertility Period 70
5.7 Discontinuation Of Contraceptive Methods 70
5.8 Need And Demand Of Family Planning 73
5.9 Future Use Of Contraception 76
5.10 Exposure To Family Planning Messages In The Media 76
5.11 Contact Of Nonusers With Family Planning Providers 76

CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY

6.1 Current Marital Status 79
6.2 Age At First Marriage 81
6.3 Age At First Sexual Intercourse 84
6.4 Post Partum Amenorrhoea, Abstinence, And Insusceptibility 86
6.5 Menopause 89

Contents v
CHAPTER 7 FERTILITY PREFERENCES
7.1 Desire For More Children 91
7.2 Ideal Number Of Children 95
7.3 Wanted Fertility Rates 98

CHAPTER 8 INFANT AND CHILD MORTALITY

8.1 Data Quality 102
8.2 Levels And Trends In Infant And Child Mortality 102
8.3 Socioecoomic Differentials In Infant And Child Mortality 103
8.4 Demographic Differentials In Infant And Child Mortality 106
8.5 Perinatal Mortality 107
8.6 High-Risk Fertility Behaviour 109

CHAPTER 9 MATERNAL HEALTH

9.1 Antenatal Care 111
9.2 Timing Of First Visit 113
9.3 Components Of Antenatal Care 114
9.4 Tetanus Toxoid Injections 116
9.5 Place Of Delivery 116
9.6 Assistance During Delivery 118
9.7 Timing Of First Postnatal Checkup For The Mother 120
9.8 Awareness Of Well-Women Clinic 122
9.8.1 Knowledge Of Well-Women Clinic 122
9.8.2 Knowledge Of Well-Women Clinics Services 124
9.8.3 Participation In Well-Women Clinics 126
9.8.4 Use Of Pap Test 126

CHAPTER 10 CHILD HEALTH

10.1 Child’s Weight At Birth 130
10.2 Vaccination Coverage 132
10.2.1 Differentials In Vaccination Coverage 133
10.3 Childhood Illness And Treatment 135
10.4 Acute Respiratory Infections And Treatment 135
10.5 Fever 137
10.6 Diarrhoeal Disease 139
10.7 Feeding Practices During Diarrhoea 142
10.8 Knowledge Of Ors Packets 143
10.9 Disposal Of Child’s Stools 144

vi Demographic and Health Survey - 2016, Sri Lanka

 10.10 Child Disability 146
10.10.1 Prevalence Of Functional Impairments Due To Disability 146
10.10.2 Vision Impairments 147
10.10.3 Convulsions 148
10.11 Early Child Development 149
10.11.1 Parental Access To Information Of Early Child Development (Books And
Information Through Child Health Development Record) 150
10.11.2 Children’s Access To Materials Helpful In Development
Stimulation (Books & Toys) 151
10.11.3 Access To Play Opportunities 153
10.11.4 Access To Early Learning Centers 153
10.11.5 Access To Psychosocial Stimulation By Adults 154

CHAPTER 11 NUTRITION OF CHILDREN AND WOMEN

11.1 Nutritional Status Of Children 158
11.1.1 Measurement Of Nutritional Status Among Children Under The
Age Of 5 Years 158
11.1.2 Stunting 159
11.1.3 Wasting 159
11.1.4 Underweight 162
11.2 Initiation Of Breastfeeding 162
11.3 Breastfeeding Status By Age 165
11.4 Duration And Frequency Of Breastfeeding 168
11.5 Types Of Complementary Foods 169
11.6 Infant And Young Child Feeding (Iycf) Practices 170
11.7 Presence Of Iodized Salt In Households 173
11.8 Micronutrient Intake Among Children 174
11.9 Nutritional Status Of Women 179
11.9.1 Height Of Women 179
11.9.2 Body Mass Index (Bmi) Of Women 179
11.10 Foods Consumed By Mothers 181
11.11 Micronutrient Intake Among Mothers 183

CHAPTER 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR

12.1 Hiv/Aids Knowledge, Transmission, And Prevention Methods 186
12.1.1. Awareness Of Hiv/Aids 186
12.1.2 Knowledge Of Hiv Prevention 187
12.1.3 Rejection Of Misconceptions About Hiv/Aids 189

Contents vii
 12.2 Knowledge Of Prevention Of Mother-To-Child Transmission Of Hiv 191
12.3 Coverage Of Hiv Testing 192
12.4 Self-Reporting Of Sexually Transmitted Infections 193
12.5 Hiv/Aids Knowledge Among Youth 194
12.6 Age Of First Sexual Intercourse Among Youth 195

CHAPTER 13 DOMESTIC VIOLENCE FROM INTIMATE PARTNER

13.1 Level Of Domestic Violence 198
13.2 Types Of Domestic Violence And Frequency 201
13.3 Help Seeking To Stop The Violence 202
13.4 Knowledge Of Service Providers 203

CHAPTER 14 MALARIA
14.1 Awareness Of Malaria 207
14.2 Household Ownership Of Mosquito Nets 208
14.3 Source Of Mosquito Nets 210
14.4 Use Of Mosquito Nets By Children Under Age 5 212
14.5 Use Of Mosquito Nets By Pregnant Women 213

CHAPTER 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH

OUTCOMES
15.1 Ownership Of Bank Accounts And Mobile Phones 215
15.2 Participation In Decision Making 217
15.3 Women’s Empowerment Indicator 218
15.3.1 Current Use Of Contraception By Woman’s Empowerment Status 219
15.3.2 Women’s Empowerment And Ideal Number Of Children And
Unmet Need For Contraception 219
15.3.3 Early Childhood Mortality Rates By Women’s Status 220

CHAPTER 16 NON COMMUNICABLE DISEASES, MENTAL ILLNESS, SUICIDE,

SMOKING AND DRUG CONSUMPTION
16.1 Non – Communicable Diseases 221
16.1.1 Heart Disease 224
16.1.2 High Blood Pressure 226
16.1.3 Wheezing/ Asthma 226
16.1.4 Diabetes 227
16.1.5 High Blood Cholesterol 228
16.1.6 Treatment Of Non – Communicable Diseases 229
16.2 Accidents 231

viii Demographic and Health Survey - 2016, Sri Lanka

 16.3 Mental Health 233
16.3.1 Suicides 236
16.4 Tobacco Use 237
16.5 Indoor Smoking Policy 238
16.6 Alcohol And Other Drug Use And Consumption 239

REFERENCES 240

APPENDIX A: SAMPLE IMPLEMENTATION 241

APPENDIX B: ESTIMATES OF SAMPLING ERRORS 243
APPENDIX C: DATA QUALITY TABLES 275
APPENDIX D: PERSONS INVOLVED IN THE 2016 SRI LANKA DEMOGRAPHIC AND
HEALTH SURVEY 277

TABLES AND FIGURES

CHAPTER 1 INTRODUCTION
Table 1.1 Results of the household and individual interview 07

CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS

Table 2.1 Household drinking water 14
Table 2.2 Household sanitation facilities 16
Table 2.3 Household characteristics 17
Table 2.4 Household possessions 18
Table 2.5 Wealth quintiles 19
Table 2.6 Household population by age, sex, and residence 21
Table 2.A Trends in population by broad age groups 22
Table 2.7 Household composition 23
Table 2.B Trends in mean household size 24
Table 2.8 Children’s living arrangements and orphanhood 25
Table 2.9.1 Educational attainment of the female household population 27
Table 2.9.2 Educational attainment of the male household population 28
Table 2.10 School attendance ratios 30

Figure 2.1 Percentage of household with improved source of drinking water by residence 13
Figure 2.2 Percentage of household with improved not shared sanitation facilities by sector 15
Figure 2.3 Population pyramid 22
Figure 2.4 Age -specific school Attendance Rates 32

Contents ix
CHAPTER 3 CHARACTERISTICS OF RESPONDENTS
Table 3.1 Background characteristics of respondents 34
Table 3.2 Educational attainment 35
Table 3.3 Literacy 37
Table 3.4 Exposure to mass media 39
Table 3.5 Internet usage 40
Table 3.6 Employment status 41
Table 3.7 Occupation 43

Figure 3.1 Ever-married Women 20-49 with completed Secondary Education or Higher 36
Figure 3.2 Percentage of currently employed ever married women among age 15-49 by level of
education 42
Figure 3.3 Percentage of ever-married women age 15-49 by occupation 42

CHAPTER 4 FERTILITY LEVELS, DIFFERENTIALS AND TRENDS

Table 4.1 Current fertility 47
Table 4.2 Fertility by background characteristics 48
Table 4.3 Trends in age-specific fertility rates 52
Table 4.4 Children ever born and living 53
Table 4.5 Birth intervals 54
Table 4.6 Age at first birth 55
Table 4.7 Median age at first birth 56
Table 4.8 Teenage pregnancy and motherhood 57

Figure 4.1 Age Specific Fertility Rates 46

Figure 4.2 Total Fertility Rates in the Region 46
Figure 4.3 Total Fertility Rates and Children Ever Born among Women 40-49 by
level of education. 49
Figure 4.4 Total Fertility Rates by District, 2016 SLDHS 50
Figure 4.5 Total Fertility Rates during the period 1963-2016 51
Figure 4.6 Trends in the Age Specific Fertility Rates (ASFR) during the period 1975-2016. 51
Figure 4.7 Birth intervals by level of education 55

CHAPTER 5 FAMILY PLANNING

Table 5.1 Knowledge of contraceptive methods 60
Table 5.2 Knowledge of contraceptive methods by background characteristics 61
Table 5.3 Current use of contraception by age 63
Table 5.4 Current use of contraception by background characteristics 64
Table 5.5 Timing of sterilization 67

x Demographic and Health Survey - 2016, Sri Lanka

 Table 5.6 Source of modern contraception methods 68
Table 5.7 Informed choice 69
Table 5.8 Knowledge of fertile period 70
Table 5.9 Twelve-month contraceptive discontinuation rates 71
Table 5.10 Reasons for discontinuation 72
Table 5.11 Need and demand for family planning among currently married women 75
Table 5.12 Future use of contraception 76
Table 5.13 Exposure to family planning messages 77
Table 5.14 Contact of nonusers with family planning providers 78

Figure 5.1 Trends in current use by contraceptive methods 65

Figure 5.2 Current use of contraception by level of education 65
Figure 5.3 Current uses of IUD, Implant and Injectable by level of education 66
Figure 5.4 Current uses of Pill and Condom by level of education 66
Figure 5.5 Current uses of Traditional Methods by level of education 67
Figure 5.6 Some reasons for discontinuations by contraceptive methods 72
Figure 5.7 Percentages of total demand for limiting by level of education, Sri Lanka 2016 74

CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY

Table 6.1 Current marital status 80
Table 6.2 Proportion of ever- married women 80
Table 6.3 Age at first marriage 82
Table 6.4 Median age at first marriage by background characteristics 83
Table 6.5 Age at first sexual intercourse 84
Table 6.6 Median age at first sexual intercourse by background characteristics 85
Table 6.7 Postpartum amenorrhea, abstinence and insusceptibility 87
Table 6.8 Median duration of amenorrhea, postpartum abstinence and postpartum
Insusceptibility 88
Table 6.9 Menopause 89

Figure 6.1 Trends in proportion of women age 20-24 who were ever-married 81
Figure 6.2 Percentage of births for which mothers are postpartum amenorrhea, abstaining and
insusceptible to pregnancy 87

CHAPTER 7 FERTILITY PREFERENCES

Table 7.1 Fertility preferences by number of living children 92
Table 7.2 Desire to limit childbearing 94
Table 7.3 Ideal number of children by number of living children 96

Contents xi
 Table 7.4 Mean ideal number of children 97
Table 7.5 Wanted fertility rates 99

Figure 7.1 Desire for more children among currently married women 92
Figure 7.2 Percentage of currently married women who want no more children by number of
Living children 93
Figure 7.3 Percentage of currently married women with two children who want no more
Children by district. Sri Lanka, 2016 95
Figure 7.4 Total wanted fertility rates and total fertility rates for the three years preceding the
Survey by district. Sri Lanka 2016 100

CHAPTER 8 INFANT AND CHILD MORTALITY

Table 8.1 Early childhood mortality rates 102
Table 8.2 Early childhood mortality rates by socioeconomic characteristics 104
Table 8.3 Early childhood mortality rates by demographic characteristics 107
Table 8.4 Perinatal mortality 108
Table 8.5 High-risk fertility behavior 110

Figure 8.1: Estimates of NNM, PNNM, IMR, 4q1 and U5MR for the 0-4 years before the survey,
obtained from the 2006-07 SLDHS and 2016 SLDHS 103
Figure 8.2 Under Five Mortality Rates in Sri Lanka, 2016 105
Figure 8.3: Under-five Mortality Rates in the 2006-07 SLDHS and the 2016 SLDHS 106

CHAPTER 9 MATERNAL HEALTH

Table 9.1 Antenatal care 112
Table 9.2 Timing of first visit 114
Table 9.3 Components of antenatal care 115
Table 9.4 Tetanus toxoid injections 116
Table 9.5 Place of delivery 117
Table 9.6 Assistance during delivery 119
Table 9.7 Timing of first postnatal checkup for the mother 121
Table 9.8 Knowledge of Well- Women Clinic 123
Table 9.9 Knowledge of Services 125
Table 9.10 Participation of Well - Women Clinic 126
Table 9.11 Ever had PAP Test 127

Figure 9.1 Percent distribution by duration of stay in the health facility for the last live birth 122
Figure 9.2 Knowledge of W-WC and PAP test by Wealth Quintile 128

xii Demographic and Health Survey - 2016, Sri Lanka

CHAPTER 10 CHILD HEALTH
Table 10.1 Child’s weight at birth 131
Table 10.2 Vaccinations by source of information 133
Table 10.3 Vaccinations by background characteristics 134
Table 10.4 Prevalence and treatment of symptoms of ARI 136
Table 10.5 Prevalence and treatment of fever 138
Table 10.6 Prevalence of diarrhea 139
Table 10.7 Diarrhoea treatment 141
Table 10.8 Feeding practices during diarrhea 142
Table 10.9 Knowledge of ORS packets or pre-packaged liquids 143
Table 10.10 Disposal of children’s stools 145
Table 10.11 Children Age 2-5 years by disability status 147
Table 10.12 Children age 2-5 by difficulty in seeing 148
Table 10.13 Children age 2-5 with fits or convulsions 149
Table 10.14 Mothers who read books given by the family health officer 150
Table 10.15 Children age 2-4 years by the number of books 151
Table 10.16 Children age less than 5 years and toys to play with 152
Table 10.17 Children age less than 5 years and play during the last 3 days 153
Table 10.18 Children age 3-4 years by education 154
Table 10.19 Children age less than 5 years by engagement in different activities 155

Figure 10.1 Percentage of Low birth weight children by mother’s education level 132
Figure 10.2 Feeding practices during diarrhoea 142

CHAPTER 11 NUTRITION OF CHILDREN AND WOMEN

Table 11.1 Nutritional status of children 161
Table 11.2 Initial breastfeeding 164
Table 11.3 Colostrum feeding 165
Table 11.4 Breastfeeding status by age 167
Table 11.5 Median duration of breastfeeding 169
Table 11.6 Foods and liquids consumed by children in the day or night preceding
the interview 170
Table 11.7 Infant and young child feeding (IYCF) practices 172
Table 11.7.1. Infant and young child feeding (IYCF) practices according to DHS-V
calculation 173
Table 11.8 Presence of iodized salt in household 174
Table 11.9.1 Micronutrient intake among children 175
Table 11.9.2 Micronutrient intake among children 177

Contents xiii
 Table 11.10 Nutritional status of women 181
Table 11.11 Foods consumed by mothers in the day or night preceding the interview 182
Table 11.12 Micronutrient intake among mothers 183

Figure 11.1 Trends in stunting of children under age 5 by district, 2006 - 2016 159
Figure 11.2 Trends in Wasting of children under age 5 by district ,2006 - 2016. 160
Figure 11.3 Trends in nutritional status of children under age 5 160
Figure 11.4 Comparision of underweight of children under age 5 by District,2006 and 2016 162
Figure 11.5 Infant feeding practices by age 167
Figure 11.6 Infant and young child feeding (IYCF) practices indicators on breastfeeding status 168
Figure 11.7 Percentage of consuming foods rich vitamin A and iron by Age Groups 176
Figure 11.8 Percentage of given Iron syrup and Vitamin A by age group 178
Figure 11.9 Percentage given deworming medication by age groups 178

CHAPTER 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR

Table 12.1 Knowledge of HIV or AIDS 186
Table 12.2 Knowledge of HIV prevention methods 188
Table 12.3 Comprehensive knowledge about HIV 190
Table 12.4 Knowledge of prevention of mother-to-child transmission of HIV 191
Table 12.5 Coverage of prior HIV testing: Women 192
Table 12.6 Self-reported prevalence of sexually-transmitted infections (STIs)and
STIs symptoms 194
Table 12.7 Comprehensive knowledge about HIV among young people 195
Table 12.8 Age at first sexual intercourse among young people 196

Figure 12.1 Knowledge of HIV /AIDS among age 15-49 ever-married women by education and
Wealth quintile 189
Figure 12.2 Percentage of HIV testing and getting result by education levels 193

CHAPTER 13 DOMESTIC VIOLENCE FROM INTIMATE PARTNER

Table 13.1 Summary on domestic violence by age 198
Table 13.2 Summary on occurring domestic violence by background characteristics 200
Table 13.3 Frequency of domestic violence 201
Table 13.4 The person/institute that provided help/advice 203
Table 13.5 Knowledge on service providers 205

Figure 13.1: Level of domestic violence 199

Figure 13.2: Domestic violence by district 199

xiv Demographic and Health Survey - 2016, Sri Lanka

 Figure 13.3: Percentage of ever-married women age 15-49 who have experienced various
Forms of violence in the 12 months preceding the survey, committed by their intimate
partner 201
Figure 13.4: Women Help Seeking from Institute/Person 202
Figure 13.5: Women Knowledge on Service Providers 204
Figure 13.6: Women Knowledge on Service Providers by Residence 204

CHAPTER 14 MALARIA
Table 14.1 Awareness of Malaria 208
Table 14.2 Household possession of mosquito nets 209
Table 14.3 Source of mosquito nets 211
Table 14.4 Use of mosquito nets by children 212
Table 14.5 Use of mosquito nets by pregnant women 213

Figure 14.1 Household ownership of ITNs (LLINs and Temporary ITNs) by district 210
Figure 14.2 Sources of Mosquito Nets 210

CHAPTER 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH

OUTCOMES
Table 15.1 Ownership and use of bank accounts and mobile phones 216
Table 15.2 Participation in decision making 217
Table 15.3 Women’s participation in decision making by background characteristics 218
Table 15.4 Current use of contraception by women’s empowerment 219
Table 15.5 Ideal number of children and unmet need for family planning by women’s
Empowerment 220
Table 15.6 Early childhood mortality rates by women’s status 220
Figure 15.1 Women’s participation in decision making 218

CHAPTER 16 NON COMMUNICABLE DISEASES, MENTAL ILLNESS, SUICIDE,

SMOKING AND DRUG CONSUMTION
Table 16.1 People suffering from non-communicable diseases during last 12 months 223
Table 16.2 Suffering from Heart diseases 225
Table 16.3 Suffering from High blood pressure 226
Table 16.4 Suffering from Wheezing / Asthma 227
Table 16.5 Suffering from Diabetes 228
Table 16.6 Suffering from High Blood Cholesterol 229

Table 16.7: Treatment of People suffering from non-communicable diseases during

last 12 months 230

Contents xv
 Table 16.8 People having an accident during the last 12 months 232
Table 16.9 Currently under treatments for mental illness 233
Table 16.10 Mental illness being treated 235
Table 16.11 Suicides 236
Table 16.12 Ever used tobacco 237
Table 16.13 Indoor smoking policy of ever-married women work place 238
Table 16.14 Current drugs consumption in household 239

Figure 16.1 People suffering from type of NCDs during last 12 months 224
Figure 16.2 Percentage of household members currently undergoing treatment for any kind
of mental illness by wealth quintile 234

APPENDIX
Table A.1 Primary Sampling Unit (PSU) Allocation by District and Sector, Sri Lanka 2016 241
Table A.2 Sample Implementation 242
Table B.1 List of selected variables for sampling errors, Sri Lanka, 2016 245
Table C.1 Household age distribution 275
Table C.2 Age distribution of eligible and interviewed women 276

xvi Demographic and Health Survey - 2016, Sri Lanka

 PREFACE
The Sri Lanka Demographic and Health Survey (SLDHS) - 2016 was carried out by the
Department of Census and Statistics (DCS) with the financial assistance from the Second Health
Sector Development Project (SHSDP) - Component II of the Ministry of Health, Nutrition and
Indigenous Medicine in collaboration with the World Bank. Technical support for the survey
was provided by ICF International (Inc.), USA. SLDHS 2016 is the fifth survey of this kind
conducted in Sri Lanka. The objective of conducting this survey is to gather the most needed
recent data to monitor and evaluate the impact of population, health and nutrition programmes
implemented by different government agencies. Additionally the survey aimed at measuring
the impact of interventions made under the SHSDP in improving the quality and efficiency of
health care services as a whole.

It is also expected that this survey will serve as a continuation of the series of
Demographic and Health Surveys conducted in Sri Lanka since 1987. This will also cater the
needs of complication of a number of Sustainable Development Indicators.

A nationally representative sample of 28,720 housing units was selected for the survey
and 27,210 households were enumerated to provide district level estimates. Detailed information
was collected from all ever-married women aged 15- 49 years and about their children who
born after January 2011. Within the households interviewed, a total of 18,510 eligible women
were identified, of whom 18,302 successfully interviewed.

Demographic and Health Surveys are normally designed to collect data on fertility
and determinants of fertility, family planning, fertility preferences, infant and child mortality,
reproductive health, nutrition, anthropometric measurements and HIV/AIDS related knowledge
and attitudes. Yet the present DHS initiated collecting information on new areas such as mental
health, awareness of well-women clinics, children who need special care and domestic violence
also. Further, information on topics such as malaria, use of mosquito nets, empowerment of
women, use of alcohol and narcotic drugs and some non-communicable diseases which are
highly relevant to the country, were also collected in 2016 SLDHS. An effort was also made to
incorporate standard questions as much as possible recommended globally.

Hemoglobin testing was carried out as a part of the survey. Data were collected by
teams of enumerators and each team was consisted of a nursing sister particularly to collect
information on hemoglobin, weight and height of all ever-married women aged 15-49 years
and their children below five years at the time of the survey. This report does not include
any findings of hemoglobin information as the Ministry of Health, Nutrition and Indigenous
Medicine and decided to produce a separate report on that.

There are certain limitations in comparing the findings of this survey with that of year
2000 and 2006/07 SLDHS, as the year 2000 DHS did not include Northern and Eastern Provinces
and the 2006/07 DHS did not cover Northern Province while the 2016 SLDHS covered the
entire country.

The survey is the result of concerted effort on the part of various individuals and
institutions and it is with great pleasure, I acknowledge their all contributions in conducting
the survey and preparing this report successfully. The tremendous contribution of the staff of
the Population Census and Demographic Division of the DCS and DHS experts from ICF
International (Inc.) is greatly appreciated. I would like to extend my appreciation to the World

Preface xvii
Bank for providing financial support for the survey. Particularly, I would like to thank the staff
of the Ministry of Health, Nutrition and Indigenous Medicine who got involved with this survey
for their co-operation throughout the survey programme.

This report serves not only as a valuable reference, but is a call for effective action. It is
my sincere wish that policy makers and researchers in the health sector would use this survey
findings extensively for the benefit of our nation.

Dr. A.J. Satharasinghe

Director General

Department of Census and Statistics

Sri Lanka

September 2017

xviii Demographic and Health Survey - 2016, Sri Lanka

 ACKNOWLEDGMENTS
We greatly appreciate and acknowledge the contribution of many institutions and individuals
who contributed in numerous ways to conduct this survey and to prepare this report successfully.
Some of such contributions are mentioned below.

- Mr.M.I.M.Rafeek, former Secretary Mr. Shantha Bandara, Secretary of the Ministry of

National Policies and Economic Affairs for their valuable guidance on administration
matters.

- The Director General, Department of Census and Statistics (DCS), Dr. A.J.Satharasinghe
for his guidance throughout the survey, Additional Director General (Statistics I)
Mrs. I.R. Bandara for coordinating the survey activities with Ministry of Health Nutrition
and Indegenous and ICF International (Inc.). All the members of the steering committee
who provided inputs at different phases of this survey to conduct this survey successfully.

- Mr. D.G.S.G. Munasinghe, Additional Director General (Statistic II) for coordinating
the field staff. To all the field staff (within as well as outside DCS) for their untiring
efforts on collecting data from selected households.

- To all heads of the divisions, branches and district offices of DCS and Divisional
Secretaries and the Heads of other government institutions who were kind enough to
release staff for the field work of the survey.

- Mr. S.A.S. Bandulasena former Additional Director General Information and

Communication Technology (ICT) Division of DCS for his inputs in the field of ICT.
Mrs.I.A.M.Fernando, Additional Director General (ICT), Mr. W.H.P.W. Weerasiri,
Director (ICT), Mr. K.M.R. Wickramasinghe, Deputy Director, Mr. E.M.D. Ekanayake,
Assistant Director and all other staff of ICT Division for assisting in developing CAPI
system for data collection together with international consultants.

- The Sample Surveys Division of DCS for designing the sample for this survey.
Mrs. Chandani Wijebandara, Statistician and Mrs. Manel Gunasekara for designing the
sample.

- To the team of ICF International (Inc.) for their valuable technical support on developing
CAPI technology for data capturing, calculate sample weights and sampling errors,
processing DHS survey data and data analysis and conducting final report writing
workshop.

- To Mrs. P.M.S.Senadeera the Chief Accountant and her staff, former Additional Director
General of the Establishment Division Mrs. K.M.M.Kumarihamy and her staff, Training
Division, Transport Division and Stores Division of the DCS for their support at different
stages of this survey.

- Contribution of the technical staff of the Population Census and Demographic Division,
Deputy Director, Mrs. C.D. de Silva, Statisticians ; Mrs. S.T.C. Gaveshika, Mr. L.C.
Amarathunga, Mr. J.M.S.U.B. Jayamaha, Mrs. D.D. Basnayake, Mrs. A.N. De Silva, Mr.
E.M.C. De Seram, Mrs. K.K. De Almeda, Ms. W.S.D. Jayasundara, Mrs. H.B.M.R.L.
Karunarathna, Statistical Officers ; Mrs. O.R. Wijegunasinghe, Mr. S. Poongundran,
Mrs. A.W.A.D.A.R. Abeyesekera, Mrs. P.G. Gayani Jayatissa, Statistical Assistant,
Mr. V.T. Anuruddha and all other staff of this Division for their fullest cooperation at
various stages of the survey including questionnaire designing, training of interviewers,
data editing, preparation of presentations and final report, co-ordinating activities with
Ministry of Health, Nutrition and Indigenous Medicine and ICF International (Inc).

Acknowledgments xix
- All other staff of DCS and medical persons of the Ministry of Health, Nutrition and
Indigenous Medicine in data collection.

- To the Ministry of Health, Nutrition and Indigenous Medicine (MHNIM), particulary

Mr. Anura Jayawickrama, former Secretary and Mr. Janaka Sugathadasa, Secretary of
MHNIM, Dr. P.G. Mahipala, former Director General of Health Services, Dr. J.M.W.
Jayasundara Bandara, Director General of Health Services, and also the Additional
Secretary (Medical Services), all Deputy Director Generals of Health Services, all the
Directors, and consultants in various specialties for their instinct support extended during
the planning and execution of the Demographic Health Survey - 2016.

- Dr. S.C. Wickramasinghe, Project Director, Second Health Sector Development Project
(Component II) and Deputy Director General (Non Communicable Diseases) MHNIM
for her tremendous commitment and endless contributions to make this survey a success.
Mrs. Gayani Wijesooriya, Project Accountant, Mr. Prasanna Gunawardena, Procurement
Specialist, Dr. Aravinda Wickramasinghe, Project Officer and all other offices of the
project office, SHSDP (Component II) for their support with planning, organizing and
conducting the Survey.

- The Provincial Directors of Health Services, Regional Director of Health Services, and
all the Public Health Nursing Sisters who worked hard in the field in collecting data.

- To Prof. Upul Senarath and Dr. Shreenika Waliange of Department of Community

Medicine, Faculty of Medicine, University of Colombo for the assistance they have
provided at various levels of the survey.

- Dr. Renuka Jayatissa of UNICEF, Sri Lanka and Dr. Anoma Jayathilake of WHO for
their contributions in certain technical matters.

- Dr. Kumari Navaratne former Senior Health Specialist, World Bank, Sri Lanka and
Dr. Deepika Attygale, Senior Health Specialist, for coordinating the DCS, WB & MOH
in very effective and efficient manner.

xx Demographic and Health Survey - 2016, Sri Lanka

 SUMMARY OF FINDINGS

The 2016 SLDHS was conducted by the Department of Census and Statistics (DCS)
for the Ministry of Health, Nutrition and Indigenous Medicine with assistance from the World
Bank. It collected information for a series of demographic and health indicators at the national,
urban and rural estate and district level to monitor progress and to support the identification
and development of policies, programs and interventions. The 2016 SLDHS was successfully
implemented in almost all households (99percent) selected and for almost all ever married
women (99percent) identified in the household. Data was collected using Computer- Assisted
Personal Interviewing technology (CAPI) for the first time in DCS. Some of the key finding of
the SLDHS-2016 are given below.

Household Characteristics:

Ninety percent of the households have access to improved source of drinking water
with 80 percent with access on premises (compared to 72 percent in the 2006/07 SLDHS).
However, for households in the Estate areas, only 43 percent reported access to improved
sources (compared to 83 percent in 2006/07). The main reason for this decline is
the change in classification of “springs” from protected in 2006 (33percent) to unprotected in
2016 (54 percent). As for sanitation, 90 percent of the households and population have access
to improved facilities. In terms of household amenities and practices:

• Almost all households (97 percent) have access to electricity ( 80 percent in 2006/07)

• Two thirds, or 66 percent use wood and solid fuel for cooking ( 79 percent in 2006/07)

• TV and mobile phones access has substantially increase to 87 percent and 91 percent
respectively (from 77 percent and 39 percent respectively in 2006/07)

Education:

The 2016 SLDHS confirmed the existence of high levels of education across the country
with a median of 9.4 years of education (yet 4 percent of the populations have no education).
Primary school attendance is almost universal. While net school attendance in secondary
education is only 83 percent, indicating that 17 percent of the 10-15 years of age population are
not attending school with no differences between boys and girls.

Ever- married Women (E-MW): The distribution of E-MW by place of residence, ethnicity, and
religion confirmed previous distributions: 81percent rural residence, 76 percent Sinhalese and
71 percent Buddhist. In addition:

• Ninty percent are currently married, 4 percent are living together and 6 percent are
widowed , divorced or separate;

• Only 18 percent have ever use internet and 16 percent use it during the last 12 month;

• One out of three E-MW indicated to be employed during the week before the survey;

Summary of Findings xxi

 • Median age at first sexual intercourse is 23.7 years, but 12 percent of them at age 18;

• The median age at first marriage is 23.7 years, but 12 percent of them married at age
18;

Fertility:

The 2016 SLDHS confirms low levels of fertility already identified in previous surveys
(2012 census and 2006/07 SLDHS) with a total fertility rate (TFR) of 2.2 in 2016. Substantial
changes are observed among adolescents and young people (15-19 and 20-24). The TFR
levels, trends and observed changes are well supported by the observed values under the basic
determinants of fertility, such as marriage, sexual intercourse, and contraception for spacing or
limiting. The median age at first birth has also increased substantially to 26 years. In addition,
only 3 percent of teenagers reported a live birth or to be pregnant at the time of the survey.
Fertility preferences show that 47 percent of the ever- married women “want no more children”
with 1.9 as the wanted TFR.

Contraception:

Contraception and contraceptive methods are universally known in Sri Lanka. Seventy
two percent of the currently married women have a demand for contraception in 2016. Of these,
close to two out of three (65 percent) currently married women are using contraception.Of the
total demand for contraception, close to 90 percent of the demand for contraception is satisfied,
mainly by modern contraception. Other highlights include:

• Increase in the level of contraceptive use was observed among adolescents and young
adults 20 – 24, particularly in the use of IUDs and implants.

• Yet 35percent of the currently married women are not using contraception of which
only 8percent have an unmet need for contraception.

• The public – sector act as the main provider of contraception (97 percent for IUD, 99
percent for implants, 94 percent of sterilizations and 57 percent for pills).

• The private sector’s participation is strong for the provision of injectable (68 percent),
male condoms (61 percent) and pills (43 percent).

As per informed choice, there are still challenges since:

• Only 53 percent of current users were informed about side effects.

• Only 51 percent were told what to do in case of experiencing side effects and,

• Only 42 percent were informed about other available methods.

xxii Demographic and Health Survey - 2016, Sri Lanka

Child mortality:

Under five year mortality is observed in the 2016 SLDHS at 11 per 1,000 live births,
down from 21 in 2006/07.

Infant and child mortality continue to decline during the last ten years. Areas of
investment are to be on interventions targeting high risk fertility behaviors: first birth, early or
late age pregnancies and, short birth intervals.

Reproductive Health:

Ninety nine percent of the pregnancies in the country received antenatal care assistance
from health facilities 92 percent of women having their first antenatal care visit before the 12
weeks of pregnancy, 96 percent attended by health personnel and 97 percent protected against
neonatal tetanus.

Almost all births taken place in a health facility (94 percent in public and 5 percent
in private). As for postnatal care, 99 percent of the births received assistance within two days
of birth. Unfortunately, 16 percent of the births have low birth weight at birth (less than 2500
grams). There are eight districts in which this percentage is 18 percent or greater.

Among children age 24-35 months, only one percent was not received any vaccination.
In terms of illness affecting children under the age of five (all below the levels observed in
2006).

• 2.4 percent are affected by Acute Respiratory infections(ARI);

• 14.3 percent were affected by fever;

• 2.7 are affected by diarrhea

• Almost all mother’s (97 percent) know about ORS;

• 91 percent of the mothers indicated proper ways of stool disposal.

Nutrition of Children and Women:

Stunting (height x age) = 17 percent; Underweight (weight x age) = 21 percent and

wasting (height x weight) = 15 percent. Among ever – married women, 9 percent were found to
be thin, 32 percent overweight and 13 percent obese (45 either one). The majority (99 percent)
of children are breastfed at some time (90 percent) within one hour, 98 percent within one day.
Almost all households (95 percent) have supplies of iodized salt at home.

HIV/AIDS:

Almost all ever married women (93 percent) have heard about HIV/AIDS but only
one out of three (33 percent) have comprehensive knowledge of AIDS (prevention and
misconceptions). Yet this value is only 24 percent among young adults age 15-24. Ten percent
of the ever- married women have been tested for AIDS but only 73 percent of them received the
results from the test.

Summary of Findings xxiii

Violence by intimate partner:

Overall, 17 percent of the ever-married women reported to be victims of any type of

violence, 2.1 percent on a daily basis. Unfortunately, only 28 percent requested help to deal
with the events.

Malaria

In Sri Lanka 69 percent of the households possesses at least one mosquito net of any
type while all types of insecticide- treated nets (ITNs) are possessed by only 13 percent.
Moreover the usage of mosquito nets by under 5 year children (71 percent and pregnant women
(60 percent) has increased during this decade (2006/2016)

Women Empowerment and Demographic and Health Outcomes:

The majority of ever – married women (83 percent) have access to a bank account and
78 percent use a mobile phone. Unfortunately, only 35 percent are, alone, making decisions
related to her health care, 20 percent on purchasing household amenities and /or 16 percent on
when to visit friends or family.

Non Communicable Diseases, Mental Illnesses, Suicides, Smoking and Drug Consumption

Overall, heart disease, high blood pressure and diabetes are mostly prevalent among older
population (40 or more years of age). Wheezing and asthma, and chronic kidney disease seem
to affect all age groups, although with slightly higher percentages among older population. And
less than one percent (0.7 percent) of household members were undergoing treatment for any
kind of mental illness. In 34 percent of household, at least one member smokes tobacco and
another 29 percent use smokeless tobacco.

xxiv Demographic and Health Survey - 2016, Sri Lanka

Introduction 1
S
ri Lanka is a pear-shaped Island in the Indian Ocean. The Island is separated from the southern tip of the
Indian sub-continent by a 35km long narrow strip of water called Polk Straight. Sri Lanka lies between
the northern latitudes of 5˚ 55´ and 9˚ 50´ and the eastern longitudes of 79˚ 42´ and 81˚ 52´. The land
size of Sri Lanka is 65,608 square kilo meters and the greatest length of the island is 435km and stretches
from Point Pedro in the North to Dondra Head in the South. The width between the broadest point is 225km,
from Colombo in the West to Sangamankanda in the East.

1.1 History
The history of Sri Lanka goes back about 2500 years. During its early history, “Yaksha, Raksha,
Naga and Deva” tribes inhabited the blessed land of Lanka. During the period 543–505 BC, the Indian Prince
Vijaya and his men established the foundation of a civilization. Later, Sinhala kings ruled the country. Even
today, one can see the prosperity, skills and talents of these ancestors in the form of huge tanks, irrigation
systems and architecture. From its early history, Sri Lanka has been well known for various spices and
precious stones. Due to Sri Lanka’s strategic location in the Indian Ocean and the precious products found in
the country, many western traders settled in this land. As a result of trade, the Portuguese, Dutch and British
colonized this land from 1505 to 1948. The island’s history of immigration, trade, and colonial invasion has
led to the formation of several ethnic groups, each with its own language, religious traditions and shared
cultural practices, beliefs, and values. The majority of Sri Lankans are Sinhala (74.9%) and Buddhists
(70.1%), while other ethnic groups consists of Sri Lankan Tamils (11.2%), Tamils of Indian origin (4.1%),
Muslims (9.3%), Burghers and a few others (0.5%).

1.2 Climate
Sri Lanka’s climate is tropical and can be divided into wet and dry zones based on precipitation.
The country receives rainfall mainly from two monsoons, the Yala and the Maha. The Yala monsoon brings
abundant rainfall to the country’s western and southern regions from May to September; this area generally
experiences its dry season from December to March. The Maha monsoon affects the Northern and Eastern
part of Sri Lanka and often lasts from October to January, with the dry season usually lasting from May to
September. This region receives approximately 1000 mm of precipitation annually, significantly less than the
other half of the country. There is also an inter-monsoonal period in October and November during which
rain and thunderstorms occur frequently across the island.
The country’s coastal belt consists mainly of beaches and bays, with rocky cliffs in the North-East
and South-West. Due to the southwestern location of the mountain range, precipitation is heavily weighted
towards this area, with the Northern and Eastern parts falling in the rain shadow of the central highlands.
The wettest parts of the country in the South and West receive around 4,000 mm of rainfall annually. With
this year-round rainfall, the country enjoys immense biodiversity. Average humidity is typically high in Sri
Lanka, averaging around 80% year-round. The coastal areas are warmer than the central hilly areas. Average
temperature from West to South is around 27˚C (80˚ F). During the March-June season slightly higher
temperatures (up to 33˚C / 92˚F) are usual, while temperatures in November-January are a few degrees lower
(around 24˚C / 75˚F at the coast). Sri Lankan weather along the shores is made more comfortable by cooling
sea breezes. The temperature of the surrounding sea remains rather constant at roughly 27˚C (80˚F) year-
round.

1.3 Economy
Sri Lanka has a middle level developing economy based largely on agriculture, services, and light
industry. Agriculture accounts for approximately 10 percent of the gross domestic product (GDP) and
employs 38 percent of the workforce. One-third of the land of this country is arable and both cash crops
and principal food crops are largely grown in every corner. The majority of rural people depend on rice
production and at present the country is self-sufficient in rice production. Manufacturing industries account

Introduction 1
for approximately 34 percent of the gross domestic product and employ about 17 percent of the workforce.
The main manufacturing industries include textiles, ceramics, petroleum products, fertilizers, and cement.
The service sector is the largest of the Sri Lankan economy, employing 45 percent of the workforce and
contributing roughly 56 percent of GDP. Tourism, banking, finance, and retail trade are major components of
the service sector. In Sri Lanka, both the private sector and the estate sector engage in the production process.
Sri Lanka has followed free market ideology since 1977. Foreign investments are encouraged and attractive
concessions have been given to establish free trade zones. The country’s banking system is well developed
and both foreign and local banks function in the economy.

1.4 Demography
The total population of the country in the year 2012 was around 20.4 million and the sex ratio was
93.8, according to the Census of Population and Housing (CPH) conducted in 2012. The population density
was 323 per square kilometer. Census data revealed that more than half of the island’s population is distributed
in Western, Central and Southern parts of the country. In addition 18.2 percent of the population lives in urban
areas of the country, while 4.4 percent live in the estate sector. The majority of the population lives in the rural
sector (77 percent, CPH 2012) Urban areas were defined as areas declared as municipal councils and urban
councils. However, an attempt has been initiated by the Department of Census and Statistics to re-define
this classification using Census of Population and Housing data, as the urban percentage seems to be under-
estimated according to the former classification.
When considering the total population based on broad age groups, nearly one fourth (25.2%) of the
population are children (less than 15 years) while 12.4 percent belong to the elderly population (age 60 years
and older). The work force of the country, defined as those 15-59 years of age, is 62.4 percent of the total
population. Education indicators show that the majority of the population has completed up to secondary
level while 4.7 percent of the population has never attended a school. The literacy rate of Sri Lankans stands
at 95.7 percent and the computer literacy rate is 24.2 (CPH 2012).
Marital status and fertility data were analyzed for age groups 15 years and above. The Census data
reveal that 70 percent of males in that population and 78 percent of females were ever married at the time
of Census taking. The singulate mean age at marriage is 27.2 years for males and 23.4 years for females.
This implies that males are on average 3.8 years older than their spouses. According to the Census data,
28.4 percent of the ever-married female population had two children. One fifth of the ever-married female
population had one child and the proportion of ever married women who had three children was reported as
20.5 percent. However, 8 percent of the ever-married female urban population, 7 percent of the same rural
population and 5.1 percent of the same estate population had no children. Census data were used to calculate
the total fertility rate (TFR) as 2.4. The Sri Lanka Yonaka (3.3) and Indian Tamil (2.9) populations reported
a higher TFR than Sinhala (2.3) and Sri Lankan Tamil (2.3) population.

1.5 Health system

Western, Ayurvedic, Unani, Sidda and Homeopathy are the components of the Sri Lankan Health
system. Among these, the majority of services are provided through Western medicine which is provided free
of charge by the government. The Ministry of Health is the central agency established for addressing health
issues of the Sri Lankan population. Key functions of the institution include setting policies, guidelines, and
programs to improve the quality of the health system in the country, managing and supplying medical needs
of institutions under the ministry, as well as training and appointing staff. The Ministry of Health is headed
by a cabinet minister who is assisted by a deputy minister and a secretary.
The main objective of the government health policy is to provide good quality, free health care for
all Sri Lankan citizens. The overall objective of the health policy is to improve the quality of life and increase
the life expectancy of the general public. This health policy ensures individual health care by improving
accessibility to care on an equal basis. The policy focuses on alleviating malnutrition of mothers and children,
promoting preventive medicine, improving health care facilities in remote areas, improving existing medical
facilities, developing additional services to meet a wider range and level of medical needs, providing focused,
immediate and intensive health interventions to underserved, under-privileged and vulnerable population,
and improving facilities and services for children with special needs. Further, the Ministry of Health provides
rules and regulations for streamlining private sector health institutions.

2 Demographic and Health Survey - 2016, Sri Lanka

1.6 Demographic and health survey
The fifth round of the Sri Lanka Demographic and Health Survey was conducted in 2016. This
survey was funded by the World Bank under the Second Health Sector Development Project (SHSDP) –
Component II. Survey planning, data collection, data processing and dissemination of final data of this survey
were carried out by the Department of Census and Statistics (DCS). The primary objective of the SLDHS is
to provide updated and reliable data to policy planners, program managers in the Ministry of Health (MOH),
and other relevant institutions and researchers. This data includes information on maternal and child health,
reproduction and fertility preferences, family planning, evaluation of maternal and child health services,
women’s status, and knowledge and behavior regarding HIV/AIDS and other sexually transmitted diseases.
This information can contribute to policy decisions, planning, monitoring, and program evaluation at both the
national and regional levels. For the first time in the DCS history, the Computer Assisted Personal Interview
(CAPI) method was used in this survey. Because the new technology was challenging, moving to CAPI for
the 2016 DHS was a great achievement for the department.

1.7 Sample design

As in many other household surveys, the Demographic and Health Survey 2016, uses a multistage
stratified area probability sample design. The survey uses a two-stage stratified sampling design. At the first
stage, 2500 Census Blocks were selected as primary sampling units (PSUs). At the second stage, 12 housing
units were selected from each selected PSU as the secondary sampling unit (SSU) from all strata except from
the strata of the districts in Western Province (ie : Colombo, Gampaha and Kalutara). In these districts, 10
housing units were selected from each selected PSU. A total of 28,800 housing units were selected for the
survey.
A sampling frame is the complete list of all sampling units that entirely covers the target population.
For the SLDHS 2016 the frame consisted of the Enumeration Areas (EAs) that were prepared for the Census
of Population and Housing 2012. These EAs are also called Census Blocks. A Census Block is a subdivision
of a Grama Niladhari division, which consists of about 150 building units. The Census Frame covers about
65,000 Census Blocks.
Stratification is the process by which the survey population is divided into subgroups or strata that
are as homogeneous as possible using certain criteria. Two- stage stratification was utilized for this survey,
which involves stratifying the population by district at the first level and then by Urban, Rural and Estate
within each district. The total sample of 2500 Census Blocks (PSUs) were allocated by districts and then by
sectors using the proportional allocation method and some adjustments considering the proportion of eligible
respondents by each district. All the selected PSUs were updated and separate lists of housing units were pre-
pared to be used for SSUs. This procedure is important for correcting errors existing in the sampling frame,
and it provides an updated sampling frame for household selection.
At the first stage, a stratified sample of PSUs was selected with probability proportional to size
(PPS): in each stratum, a sample of Census Blocks was selected independently with probability proportional
to the measure of size of the Census Block. In the selected PSUs, the list of households was updated making
sure that all and each household/dwelling were listed separately. At the second stage, a fixed number of
households was selected by equal probability systematic sampling in the selected PSUs. In each selected
household, a household questionnaire was completed to list all usual residents and visitors who stayed in that
household the night before the day of interview. During the planning stage, it had been decided to identify
ever-married women aged as eligible women for the interviews of individual women. Every eligible woman
was interviewed with an individual questionnaire.

1.8 Questionnaire
The 2016 SLDHS questionnaire was used to collect information from households and eligible wom-
en through personal interviews, to provide essential national level data for monitoring programs of the Min-
istry of Health, Nutrition and Indigenous Medicine and to provide information on important emerging health
and family welfare issues. The questionnaire was extensively adapted from the standard ICF DHS core
questionnaires with a large number of new country specific questions to reflect the health issues relevant to
Sri Lanka. A number of data user meetings were held with the Ministry of Health, Nutrition and Indigenous

Introduction 3
Medicine and representatives from relevant other agencies to discuss the questionnaire before finalization.
The questionnaire had two main sections, namely, a household section and a section on women and
children. The first section was used to list all usual residents in each sample household plus any visitors who
stayed in the household the night before the interview. For each person listed, information was collected
on age, sex and relationship to the head of the household. For persons aged 10 or above, information was
collected on marital status. Questions were asked about school attendance for children aged 5-22 years
and adequacy of their basic requirements. For children under 17, the survival status of the parents was
determined. The household section was used to identify eligible women and children for the main interview
and women who were eligible for the interview focusing on domestic violence. The household section also
collected information on the main source of drinking water, type of toilet facility, source of lighting, type of
cooking fuel, garbage disposal, ownership of a house, agricultural land, livestock and various durable goods,
use of mosquito nets and use of iodized salt. Under the household section, information was also collected
on non-communicable diseases, mental health, the use of smoking tobacco and smokeless tobacco, alcohol
and drugs. The health officers on each survey team measured the height and weight of eligible ever-married
women aged and children born since January 2011. The health officers also took blood samples from eligible
women aged and children (6 – 59 months) to measure hemoglobin levels, which indicate the prevalence of
anemia.
The second section was used to collect information from ever-married women aged 10-49. Women
were asked questions on the following topics:
• Background characteristics (place of residence, age, education, religion, ethnicity, marital
status, media exposure etc.)
• Reproductive history
• Knowledge and use of family planning methods
• Pregnancy and postnatal care
• Child immunization, health and nutrition
• Fertility preferences
• Husband’s background and woman’s work
• Awareness about AIDS and other sexually transmitted infections (STIs)
• Awareness about well-women clinics
• Children who need special care (disabled)
• Early childhood development
• Other health issues
Respondents were asked an extensive series of questions about their children who had been born since
January 2011. Topics covered were vaccinations, childhood illnesses, nutritional status and breastfeeding. In
addition, a calendar of events was used to record information related to the respondent’s marriage, pregnancies
and births, and contraceptives used. Paper-based and tablet-based questionnaires were pre-tested by a team of
experienced DCS staff. Questionnaires were prepared in Sinhala, and translated into Tamil and English.

1.9 Training
There were two different training programms: one for the pre-test, and one for the main survey. Each
training was conducted in two different stages. During the first stage, training was conducted on the paper-
based questionnaire, and during the second stage training concentrated on the application of the CAPI-based
program. For the pretest, three weeks of training in total (from February 8th to 27th, 2016) were conducted at
the DCS. The training team consisted of three consultants from ICF as well as the staff of the DCS. A total
of 50 trainees (supervisors, interviewers and field editors) attended the pretest training. The pretest included
in-class training, as well as field training. Fieldwork for the CAPI pretest was carried out by six teams in four
locations around DCS.

4 Demographic and Health Survey - 2016, Sri Lanka

 During the main training 172 interviewers, 38 field supervisors and 33 field editors were trained by
ICF consultants and local trainers. Separate training programs were organized for Sinhala and Tamil officers
from April 25th to May 8th, 2016 at the CHPB building in Battaramulla. During the last 2 days of the training
program, all trainees were send the field to practice with CAPI. During the training period, questionnaires and
instructions were clearly explained and interviewing techniques and field procedures, rules and regulations
of SLDHS were also explained. All nursing officers were given instructions and training to measure height,
weight and hemoglobin and all supervisors, enumerators and IT assistants were given through knowledge of
use of tablet computers.
In both trainings, the trainers used various techniques including presentations, lectures, mock
interviews, and role-plays. Additionally, in-class exercises included probing for age, checking age
consistencies, completing the reproductive calendar and practicing the interview. Also, there were special
lectures on child immunization, contraceptive use, domestic violence, epidemiology, mental health and non-
communicable diseases. Resource persons from the Ministry of Health, Nutrition & Indigenous Medicine
provided assistance. Officers of the Family Health Bureau assisted to train nursing officers.

1.10 Procument
Procurement activities for the Demographic and Health Survey (DHS) of Sri Lanka were conducted
in accordance with the available provisions of the procurement guidelines of the Government of Sri Lanka and
the World Bank. Standard Bidding Documents were used with the consent of the World Bank to procure goods,
consultancy services and other services under the accepted procurement methods of National Competitive
Bidding (NCB), National Shopping, and Single Source selection in line with the available provisions of the
guidelines and depending on the prevailing situation in the market. The authority limit of the procurement
activities vested from the level of Cabinet of Ministers to the Project Procurement Committee (PPC) with
necessary assistance of Technical Evaluation Committees (TECs). The officers of the Ministry of Health,
Nutrition and Indigenous Medicine and the Department of Census and Statistics closely monitored action
plans and the detailed procurement activities. Budget for the International consulting was approved by the
Budget for the (cabinet approved) project procument committee.

1.11 Selection of teams and fieldwork

An important feature of this survey was its coverage of the entire island. At the beginning of the
survey, 32 teams for Sinhala speaking communities and 8 teams for Tamil speaking communities were formed
for data collection. Each team was comprised of one female supervisor, four or five female interviewers, one
male or female IT officer, a nursing sister and a field assistant. The nursing sister was recruited from the
Ministry of Health, Nutrition and Indigenous Medicine in order to collect biomarker measurements (height,
weight and hemoglobin measurements).
The supervisors had overall responsibility of fieldwork. The supervisors were responsible for
reviewing all completed electronic questionnaires for their completeness, quality and consistency before
transferring data to the central office. IT officers assisted supervisors to solve IT related issues.
Fieldwork started on May 14, 2016 and was completed by the middle of November, 2016 with a total
of 40 teams. Time in the field for each team differed due to differences in the allocated number of clusters, the
field environment, and the number of interviewers in the team. Supervision and technical assistance during
fieldwork were provided by staff of the ICT division of DCS and two doctors specialized in IT from the
Ministry of Health, Nutrition and Indigenous Medicine.

1.12 Data collection using CAPI

Computer-Assisted Personal Interviewing (CAPI), coupled with the use of mobile and wireless
technology, is currently the data collection methodology of choice. Sri Lanka used tablet personal computers
(tablet PCs) and wireless technology for the data collection for the 2016 DHS. Feedback from interviewers
indicate that the use of tablet PCs and wireless technology can improve data quality and reduce data collection
time, as well as improve accuracy and reduce missing data. Availability of Electricity is not significant in the
use of tablets because almost all the country has a good electrical supply system.

Introduction 5
 The length and complexity of the DHS questionnaire was the main reason for using the Windows-
based DHS software, CSPro (Census and Survey Processing System). A tablet computer with keyboard and
touch screen was used as the primary data input device. The tablet computers were connected to Internet using
mobile network technology using mobile phones and Bluetooth for transferring data over short distances.
Using CAPI, the interviewers enter the responses directly into a tablet computer database. The system
helped in the selection of the appropriate language, skip-patterns and in selecting appropriate options from a
drop down menu. The interviewers closed the respondents’ data file and sent it to the supervisor via Bluetooth
file transfer system. The supervisors reviewed the data for inconsistencies and provided immediate feedback
to the interviewers. After that, the supervisor sent the data to the head office using Internet connections from
a mobile phone.

1.13 Data processing and tabulation

The DHS 2016 benefited from the CAPI (Computer Assisted Personal Interviewing) method which
uses the survey questionnaire interactively on-site in electronic format. Thus, in CAPI, the data entry and
validation of DHS 2016 was also done on-site using the digital questionnaire on tablet computers for the first
time in DCS history. When CAPI is compared to traditional paper-and-pencil data collection, CAPI allows
the data entry and data validation in the field at the field enumerator level. CAPI therefore results in decreased
cost of clerical editing, data entry, correction and related man power, printing and a vast reduction in time
taken for the whole process of producing a clean data file.
The CAPI System designed for the DHS 2016, controlled the operation of data capture at three ad-
ministrative levels namely enumerator, supervisor and central office. At the enumerator level, most of the
range checks and consistency errors were identified and removed while interviewing the survey respondents,
and at the supervisor level further checks in consistency and structural errors found in the questionnaires were
eliminated based on an error report generated by the system. Dedicated staff at the central office conducted a
series of checks which needed higher level decision making to correct country and regional level errors, such
as resolving cluster and questionnaire identification discrepancies and resulting inconsistencies found in the
questionnaires in the clusters assigned to different regions under different supervisors.
The DHS CAPI system uses Bluetooth technology to transmit data between tablet computers and that
feature was successfully employed for the data communication between the enumerators and supervisors, i.e.,
assigning households selected for the survey and system updates to enumerators by supervisors and sending
the survey data from the enumerators to the supervisors. The transmission of data from the supervisors
to the central office internet facility was facilitated via a popular Internet Service Provider (ISP). Before
transmitting the data via the Worldwide-Web using File Tranfer Protocol (FTP), the data files were encrypted
using strong encryption keys and algorithms to safeguard the confidentiality of the data.

1.14 Data dissemination

The Demographic and Health Survey is the most important source for generating data for the
development of the health sector in Sri Lanka. Key findings of this survey are presented in this report. This is
available in the DCS Website: www. statistics.gov.lk. Policy makers, planners, researchers and students will
have access to a large volume of health data through this final report.
Eventhough, it has been planned to collect information of ever-married women in the age group
10-49, according to the finding there were very few cases reported in 10-14 age group. Therefore please
note that information were provided for ever-married women in the 15-49 age group.

6 Demographic and Health Survey - 2016, Sri Lanka

1.15 Results of the survey interview
1.15 Results of the survey interview
Table 1.1 shows response rates for the SLDHS 2016. A total of 28,720 housing units were
Table 1.1 shows response rates for the SLDHS 2016. A total of 28,720 housing units were selected
selected for the sample, from which 27,455 were occupied at the time of the survey of those
for the sample, from which 27,455 were occupied at the time of the survey of those existing households
existing
27,210 households
were successfully27,210 were successfully
interviewed, interviewed,
yielding a household yielding
response rate of a99.1
household
percent. response rate
The household
of 99.1 percent. The household response rate is slightly higher in the rural sector within the
response rate is slightly higher in the rural sector than in urban and estates sectors. Within the households
interviewed
household ainterviewed
total of 18,510 eligible
a total of women
18,510(ever married
eligible womenwomen age married
(ever 10-49) were identified.
women age 10-49)
were identified.
Analysis was done only for the women age 15-49 as the number of women aged 10-14 were very
few.
Analysis was done only for the women age 15-49 as the number of women aged 10-14 were
very few.

table 1.1 results of the household and individual interviews

Number of households, number of interviews, and response rates,

according to residence (unweighted), Sri Lanka 2016

Residence
Result Urban Rural Estate Total

Household interviews
Households selected 4,743 22,072 1,905 28,720
Households occupied 4,485 21,230 1,740 27,455
Households interviewed 4,413 21,083 1,714 27,210
1
Household response rate 98.4 99.3 98.5 99.1

Interviews with women age

10-49
Number of eligible women 2,963 14,454 1,093 18,510
Number of eligible women
interviewed 2,910 14,344 1,048 18,302

Eligible women response

rate2 98.2 99.2 95.9 98.9
1
Households interviewed/households occupied
2
Respondents interviewed/eligible respondents

Introduction 7
 Training on pre-testing

Testing readiness of CAPI system

DHS pre-test Team

Training on enumeretors on CAPI system

8 Demographic and Health Survey - 2016, Sri Lanka

On their way to selected households

Collecting Bio-Maker Measurements

A team of enumerators

Some members of the report writting team

Introduction 9
10 Demographic and Health Survey - 2016, Sri Lanka
Household Population and
Housing Characteristics 2
Key Findings
• Source of drinking water: One in ten households obtain drinking water from
an unimproved source in the country as a whole and six out of ten households
do so in the estate sector.
• Toilet facilities: Ninety-one percent of households have improved toilet
facilities and 7 percent have improved shared toilet facilities.
• Electricity: Ninety-seven percent of households have access to electricity.
• Flooring: Ninety-five percent of households have some type of durable
flooring, cement, terrazzo, tiles, granite or concrete.
• Wealth quintile: forty-three percent of the population in urban areas are in the
highest wealth quintile and 71 percent of the population in the Estate sector
are in lowest wealth quintile.
• Sex ratio: Sri Lanka has an unbalanced sex ratio of 89 men per 100 women.
• Means of transportation: Over 41 percent of households own a motorcycle
or a scooter.
• Cooking fuel: Mostly used in the urban sector is LPG (67 percent) while wood
is mostly used the in rural and estate sectors (73 and 80 percent respectively).
• Dependency ratio: The overall ratio is 54.9 percent, which represents 1.8
working persons per 1 dependent person (<15 or >65 years of age).
• Head of the household: Twenty four percent of households are headed by a
woman.
• Net Attendance Ratio at the primary and secondary level: There is high
school attendance at the primary level with an equal sex ratio, compared to
secondary school where about 17 percent of children 10-15 are not attending
school.

T
his chapter provides a descriptive summary of some demographic and socio-economic characteristics
of the population in the households sampled in the 2016 SLDHS. Such information is intended to
facilitate interpretation of the key demographic, socio-economic, and health indicators presented later
in the report. It is also intended to assist in the assessment of the representativeness of the survey sample.
For the purposes of the 2016 SLDHS, a household was defined as a person or a group of persons,
related or unrelated, who live together and share a common source of food. The household questionnaire
included a schedule collecting basic demographic and socio-economic information for all usual residents and
visitors who spent the night preceding the interview in the household. This method of data collection allows
the analysis of the results for either the de jure (usual residents) or de facto (those who are there at the time
of the survey) populations. The household questionnaire also obtained information on housing facilities and
household possessions and a number of health conditions.

2.1 Household characteristics

Household characteristics surveyed are access to basic facilities such as, sources of drinking water,
access to sanitation facilities, housing structure; and type of fuel used for cooking as well as the general
socio-economic status of household members.

11
2.1.1 Water and sanitation
Two basic determinants of good health, are access to safe water and sanitation, Access to safe
drinking water and sanitation facilities are important to protect people from diseases, such as diarrheal
diseases, typhoid, and other water related diseases.

2.1.2 Drinking water

Improved source of drinking water

Include piped water, public taps, tube wells, protected wells, semi protected wells,
rural water supply projects, bottled water. Because the quality of bottled water is
unknown, households that use bottled water for drinking are classified as using an
improved source only if their water source for cooking and hand washing comes
from an improved source.

Increasing access to improved drinking water is one of the Sustainable Development Goals (SDGs)
(and previously the Millennium Development Goals (MDG)). According to the 2016 SLDHS, in Sri Lanka,
90 percent of households have access to improved drinking water. Sources of drinking water vary in their
suitability for drinking. Sources that are likely to provide safe drinking water are identified as improved
sources in Table 2.1. They include a piped source within the dwelling or yard, a public tap, a tube well, rural
water supply project, bottled water and protected well. Lack of a readily accessible source of water may limit
the quantity of suitable drinking water that is available to a household.
Table 2.1 shows the percent distribution of the households and the population by source of drinking
water, time to obtain drinking water, and treatment of drinking water, according to background characteristics.
The source of drinking water is an indicator of its suitability for drinking. Even if the water is obtained
from an improved source, it may be contaminated during transport or storage if fetched from a source not
immediately accessible to the household. Finally, home water treatment can be effective in improving the
quality of drinking water. Nine in ten households in Sri Lanka obtain drinking water from an improved
source, and ten percent of households still use water from an unimproved source. Households in the urban
areas have greater use of improved sources than those in other areas.
Overall, 36 percent of households have piped water into their dwelling or yard. The prominent type
of improved source varies across the residence sectors. In urban areas, household-level piped water (74
percent) is most frequent, but in rural areas, it is protected dug wells (34 percent). In the estate sector, tap
borne water (19 percent), followed by rural water supply projects (11 percent) are the most common safe
water sources. Non-improved sources of water are used by 57 percent of households in the Estate sector1, but
only 10 percent out of all households use risky sources of drinking water. The majority of households do not
need to collect water, as it is piped onto the premises. Overall, 19 percent of households have to travel to get
water, but are able to obtain it within 30 minutes. Naturally, this percentage is higher for the estate sector (30
percent) because rivers/ tanks/ streams/ springs are a frequent source for them.
Figure 2.1 shows 99 percent of the households in the urban sector are using an improved source
of drinking water, followed by 91 percent in rural sector and 43 percent in estate sector. The definition of
improved water sources differs between 2006/07 SLDHS and 2016 SLDHS and for this reason no attempt
is made to identify trends. Protected springs which are considered as improved water sources in the 2006/07
SLDHS, but are not considered as such in the 2016 SLDHS as all springs are categorized as unimproved
water sources.
The incidence of water-borne diseases can be reduced by treating water for drinking. Table 2.1 shows
that more than half of Sri Lankan households boil water before drinking. The percentage of households that
boil water is much greater (69 percent) in the estate sector compared to the other two sectors. So, even
1
The “River/Streams/Spring” category is considered as un-improved water source, compared with 2006-07
SLDHS when was considered as improved water source. This change has an important effect on the percentages for the
Estates sector values.

12 Demographic and Health Survey - 2016, Sri Lanka

though the sources in the estate sector may not have suitable water for drinking to begin with, the majority of
households take appropriate action to make the water safe to drink.

Figure 2.1 Percentage of Households with improved source of drinking water

by residence

99
100
91 90

80

60
Percentage

43
40

20

0
Urban Rural Estate Total

Household Population and Housing Characteristics 13

Table 2.1 Household drinking water
Percent distribution of households and de jure population by source of drinking water, time to obtain drinking water, and treatment
of drinking water, according to residence, Sri Lanka 2016

Households Population

Characteristic Urban Rural Estate Total Urban Rural Estate Total

Source of drinking water

Improved source 98.7 91.0 43.0 90.2 98.7 91.2 43.8 90.4
Tap borne water (main line) 73.5 28.3 19.2 35.1 73.6 28.7 19.7 35.7
Tube well 2.9 3.8 0.4 3.6 2.9 4.0 0.4 3.6
Protected well 11.0 33.8 8.1 29.1 10.7 33.6 8.2 28.7
Semi Protected well 3.4 13.1 4.3 11.2 3.5 12.9 4.3 11.0
Rural water supply project 4.3 8.7 11.0 8.1 4.7 8.7 11.3 8.1
Bottled water, improved source for 3.5 3.2 0.1 3.1 3.3 3.4 0.1 3.3
drinking1
Unimproved source 1.0 8.2 56.7 9.1 1.0 8.0 55.9 8.9
Unprotected well 0.2 2.4 2.8 2.0 0.2 2.4 3.0 2.0
Rain water 0.0 0.1 0.0 0.1 0.0 0.1 0.0 0.1
River/tank/streams/spring 0.5 5.2 53.6 6.4 0.5 5.0 52.7 6.3
Bowser 0.3 0.5 0.2 0.5 0.3 0.5 0.2 0.5
Other 0.3 0.8 0.3 0.7 0.3 0.8 0.3 0.7
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Time to obtain drinking water

(round trip)
Water on premises 91.6 77.9 69.1 79.7 91.8 78.4 69.2 80.2
Less than 30 minutes 7.0 18.3 27.0 16.9 7.0 17.7 26.8 16.4
30 minutes or longer 1.0 3.2 3.0 2.8 0.9 3.1 3.1 2.7
Don't know/missing 0.4 0.7 0.8 0.6 0.3 0.7 0.9 0.7
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Water treatment prior to drinking2

Boiled 46.9 38.0 68.7 40.6 45.6 38.1 69.0 40.6
Bleach/chlorine added 0.6 0.6 0.2 0.6 0.7 0.7 0.3 0.7
Strained through cloth 2.9 4.5 6.2 4.3 3.0 4.5 6.6 4.4
Ceramic, sand or other filter 22.8 21.1 4.8 20.7 23.5 22.0 4.9 21.5
Solar disinfection 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1
Let it stand and settle 0.7 0.4 0.1 0.4 0.7 0.4 0.1 0.4
Other 0.1 0.0 0.0 0.0 0.1 0.0 0.0 0.0
No treatment 36.2 44.0 25.1 42.0 36.7 43.3 24.6 41.4
Percentage using an appropriate 61.7 52.8 70.5 55.0 61.2 53.5 70.7 55.5
treatment method3

Number 4,309 21,778 1,122 27,210 17,212 82,864 4,492 104,569

1
Because the quality of bottled water is not known, households using bottled water for drinking are classified as using an
improved or unimproved source according to their water source for cooking and washing.
2
Respondents may report multiple treatment methods so the sum of treatment may exceed 100 percent.
3
Appropriate water treatment methods include boiling, bleaching, filtering, and solar disinfecting.

14 Demographic and Health Survey - 2016, Sri Lanka

2.1.3 Sanitation

Improved toilet facilities

Include any non- shared toilet of the following types : flush/pour flush toilets to
piped sewer systems, septic tanks, and pit latrines; ventilated improved pit (VIP)
latrines; pit latrines with slabs; and composting toilets.

Ensuring adequate sanitation facilities is another goal of the Government of Sri Lanka, particularly
in the context of the recently agreed SDGs. Table 2.2 shows that 91 percent of households have improved
toilets and 7 percent have a shared improved toilet facility. The most common type of toilet is an unshared,
pour/flush toilet (72 percent). Only 2 percent of households do not have access to any toilet facility, though
this percentage is as high as 4 percent in the estate sector. Figure 2.2 shows the sanitary facilities among
the sectors. In the estate sector, only 79 percent of households have improved facilities, compared with 90
percent and 91 percent in urban and rural sectors, respectively.

Figure 2.2 Percentage of Households with improved, not shared, sanitation

facilities by sector

100
91 90 90

79
80

60
Percentage

40

20

0
Urban Rural Estate Total

Household Population and Housing Characteristics 15

 Table 2.2 Household sanitation facilities
Percent distribution of households and de jure population by type and location of toilet/latrine facilities, according to
residence, Sri Lanka 2016
Type and location of toilet/latrine Households Population
facility
Urban Rural Estate Total Urban Rural Estate Total

Improved, not shared facility

Flush/pour flush to piped sewer 11.1 1.9 0.6 3.3 11.3 2.0 0.5 3.4
system
Flush/pour flush to septic tank 4.5 1.5 3.7 2.1 4.6 1.5 3.3 2.1
Flush/pour flush to pit latrine 72.1 84.6 72.0 82.1 72.3 85.9 73.4 83.1
Ventilated improved pit (VIP) 1.1 1.5 2.1 1.4 1.3 1.5 2.1 1.5
latrine
Pit latrine with slab 1.9 0.9 0.3 1.0 2.0 0.9 0.4 1.1
Composting toilet 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Total 90.8 90.3 78.7 89.9 91.5 91.7 79.8 91.2

Shared facility1
Flush/pour flush to piped sewer 1.0 0.2 0.1 0.4 1.0 0.2 0.1 0.4
system
Flush/pour flush to septic tank 0.6 0.1 0.4 0.2 0.5 0.1 0.4 0.2
Flush/pour flush to pit latrine 5.5 7.2 16.3 7.3 4.6 6.1 15.6 6.3
Ventilated improved pit (VIP) 0.0 0.0 0.2 0.0 0.0 0.0 0.2 0.0
latrine
Pit latrine with slab 0.1 0.1 0.1 0.1 0.1 0.1 0.1 0.1
Total 7.2 7.6 17.0 8.0 6.2 6.6 16.3 6.9

Unimproved facility
Flush/pour flush not to sewer/sep- 1.1 0.3 0.6 0.4 1.2 0.2 0.5 0.4
tic tank/pit latrine
Pit latrine without slab/open pit 0.1 0.2 0.1 0.2 0.1 0.2 0.0 0.2
Bucket 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0
No facility/bush/field 0.4 1.3 3.0 1.2 0.4 1.1 2.6 1.0
Other 0.4 0.2 0.6 0.2 0.5 0.2 0.7 0.2
Total 2.0 2.0 4.3 2.1 2.2 1.7 3.9 1.9

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Number 4,309 21,778 1,122 27,210 17,212 82,864 4,492 104,569
1
Facilities that would be considered improved if they were not shared by two or more households.

2.2. Housing characteristics

Housing characteristics and household assets can be used as a measure of the socioeconomic status
of household members. Cooking practices and cooking fuels also affect the health of family members and the
environment. For example, the use of biomass fuels exposes household members to indoor pollution, which
has a direct bearing on their health and surroundings.
Table 2.3 presents information on the availability of electricity, type of flooring material, type of
fuel used for cooking, and place where cooking is done. Overall, 97 percent of households in Sri Lanka
have access to electricity, 99 percent in urban areas and 97 percent in rural areas. This shows a marked
improvement since 2006.

16 Demographic and Health Survey - 2016, Sri Lanka

 Table 2.3 Household characteristics
Percent distribution of households by housing characteristics, by place
Among flooring materials, cement is
used for cooking and by the type of fuel used and by percentage using the most common (68 percent) material
solid fuel for cooking, according to residence, Sri Lanka 2016 for floor. Urban sector households used
Residence with Terrazzo/ Tile/ Granite (33 percent)
Housing characteristic Urban Rural Estate Total as floor material.
Almost 95 percent of households in
Electricity
Sri Lanka have some type of durable
Yes 98.6 96.7 95.3 97.0
flooring, cement, Terrazzo/ tiles/ Granite
No 1.4 3.3 4.7 3.0 or concrete). The remaining 5 percent
Total 100.0 100.0 100.0 100.0 have rudimentary flooring, such as mud
and sand, the percent with permanent
Flooring material flooring is higher in urban areas.
Cement 62.5 68.6 85.0 68.3
Households were asked about cooking
Terrazzo/Tile/Granite 32.8 15.8 2.4 17.9
fuel and the place used for cooking.
Mud 0.6 4.3 9.0 3.9 Overall 80 percent of households cook
Wood 0.1 0.0 0.0 0.0 in the house, whereas 12 percent of
Sand 0.2 0.4 1.4 0.4 households in the rural sector cook
Concrete 3.6 10.7 1.8 9.2 in a temporary hut, and 20 percent of
Other 0.2 0.2 0.4 0.2 estate-sector households use a separate
Total 100.0 100.0 100.0 100.0 building. The majority (66 percent) of
households uses wood for cooking, and
Place for cooking there is wide variation by residence.
In the house 88.9 79.3 65.7 80.3 Almost all households in the estate sector
In a separate building 3.8 6.2 19.9 6.4
(80 percent) and most of those in the
Temporary hut 4.1 11.9 11.9 10.7
rural sector (73 percent) use wood. The
majority (67 percent) of urban households
Outdoors 0.7 0.6 0.5 0.6
use LP gas or natural gas; only one-fourth
Other 0.0 0.0 0.0 0.0
of urban households use wood. Nearly
No food cooked in household 2.5 2.0 2.0 2.0
one fourth of household use LP gas in the
Total 100.0 100.0 100.0 100.0
rural sector and in the estate sector it is 15
percent.
Cooking fuel
Electricity 0.9 1.5 1.8 1.4
Gas (LP) 67.1 22.5 15.3 29.3
Kerosene 4.5 0.5 0.9 1.1
Wood 24.9 73.4 79.9 66.0
Saw dust/rice husk/charcoal 0.2 0.1 0.1 0.1
Other 0.0 0.0 0.0 0.0
No food cooked in household 2.5 2.0 2.0 2.0
Total 100.0 100.0 100.0 100.0
Percentage using solid fuel 25.0 73.5 80.0 66.1
for cooking1
Number 4,309 21,778 1,122 27,210
LPG = Liquefied petroleum gas
1
Includes wood, saw dust/rice husk/charcoal

2.2.1 Household possessions

The availability of durable consumer goods is a good indicator of a household’s socioeconomic status.
In the 2016 SLDHS, information on the possession of selected consumer goods was asked; results are shown

Household Population and Housing Characteristics 17

 in Table 2.4. There is some difference
Table 2.4 Household possessions between urban and rural households,
Percentage of households possessing various household effects, means with urban households much more likely
of transportation, agricultural land and livestock/farm animals by residence,
Sri Lanka 2016
to own these durable consumer items
Residence
than rural households. Information on
Possession household’s ownership of selected assets
Urban Rural Estate Total
has a strong association with poverty
Household effects
levels. Looking first at consumer goods,
Radio 68.2 70.1 64.4 69.5
almost 70 percent of the households have
Television 91.0 86.5 82.3 87.1 a radio and a television in their home.
Mobile phone 94.7 90.8 81.1 91.0 Possession of other household items,
Computer 42.0 21.5 8.1 24.2 such as mobile and land phones, and
Non-mobile telephone 41.9 29.8 32.9 31.9 refrigerators is higher in the urban sector
Refrigerator 71.7 54.3 24.6 55.8 than other sectors. With regard to means
Washing machine 42.5 17.6 4.1 21.0 of transportation, many households
Rice cooker 68.7 60.4 55.9 61.5 own a bicycle (36 percent) and over 41
percent have a motorcycle or scooter.
Means of transport Some urban households (22 percent)
Bicycle 33.3 37.8 8.3 35.8
own a car or similar motor vehicle.
Motorcycle/scooter 37.0 43.7 10.1 41.2
Motor car/van/jeep 21.9 9.8 2.3 11.4
Boat with a motor 0.7 0.5 0.1 0.5
Trishaw 14.6 16.7 10.9 16.1
Tractor/land master 0.7 4.1 0.3 3.4
Bus/lorry/truck 2.0 3.6 1.4 3.3

Ownership of agricultural land 12.6 41.8 17.0 36.1

Ownership of farm animals1 4.0 10.3 19.6 9.7

Number 4,309 21,778 1,122 27,210

1
Cows, bulls, other cattle, goats, chickens or pigs

2.2.2 Wealth index

The wealth index is a socio-economic indicator that is used throughout the report as a proxy for
long-term standard of living of the household. It is based on data on the household’s ownership of consumer
goods; dwelling characteristics; type of drinking water source; toilet facilities; and other characteristics that
are related to a household’s socio-economic status. To construct the index, each of these assets was assigned
a weight (factor score) generated through principal component analysis, and the resulting asset scores were
standardized in relation to a standard normal distribution with a mean of zero and standard deviation of one
(Gwatkin et al., 2000). Each household was then assigned a score for each asset, and the scores were summed
for each household. Individuals were ranked according to the total score of the household in which they
resided. The sample was then divided into quintiles from one (lowest) to five (highest). A single asset index
was developed on the basis of data from the entire country sample and this index is used in all the tabulations
presented (Rutstein and Johnson, 2004).
Table 2.5 shows the distribution of the de jure household population into the five wealth quintiles,
by residence. These distributions indicate the degree to which wealth is evenly (or unevenly) distributed by
geographic areas. Table 2.5 illustrates that 43 percent of the population in urban areas is in the highest wealth
quintile. In estate sector 71 percent of population in lowest wealth quintile. These results further confirm

18 Demographic and Health Survey - 2016, Sri Lanka

that poverty is more concentrated in the estate sector. Table 2.5 further shows that higher percentages of
people in Colombo and Gampaha districts, which are relatively more urbanized, are in the highest quintile.
Kilinochchi, Mulativu, Mannar and Nuwara-Eliya, fall into the lowest wealth quintile. Several districts have
a fairly balanced distribution across all quintiles, namely, Kalutara, Kandy, Galle, Kurunegala, Matara and
Hambantota.

Table 2.5: wealth quintile

Percent distribution of the de jure population by wealth quintiles, and the Gini Coefficient, according to
residence and region, Sri Lanka 2016
Residence/region Wealth quintile
Lowest Second Middle Fourth Highest Total Number Gini co-
of per- efficient
sons

Residence
Urban 7.6 11.4 15.3 23.3 42.4 100.0 17,212 0.07
Rural 19.8 21.8 21.8 20.3 16.4 100.0 82,864 0.05
Estate 70.8 20.5 5.4 2.6 0.8 100.0 4,492 0.08

District
Colombo 4.4 8.1 14.2 23.4 49.9 100.0 10,478 0.06
Gampaha 8.5 16.3 18.8 24.3 32.1 100.0 10,780 0.06
Kalutara 12.6 17.3 19.4 25.2 25.5 100.0 6,429 0.07
Kandy 16.3 15.4 18.9 22.7 26.7 100.0 7,195 0.06
Matale 21.9 20.9 24.5 18.2 14.6 100.0 2,701 0.07
Nuwara-Eliya 49.5 26.1 13.3 6.5 4.6 100.0 3,411 0.10
Galle 16.4 20.7 22.3 23.2 17.3 100.0 5,560 0.07
Matara 12.8 17.9 21.7 23.5 24.2 100.0 4,348 0.06
Hambantota 17.2 23.7 20.8 22.4 15.8 100.0 3,214 0.07
Jaffna 48.1 24.1 12.7 9.5 5.6 100.0 3,026 0.11
Mannar 60.6 21.5 8.5 7.0 2.4 100.0 508 0.04
Vavuniya 52.9 18.6 12.9 9.6 6.1 100.0 820 0.12
Mullaitivu 69.6 15.7 8.4 5.2 1.1 100.0 446 0.12
Kilinochchi 77.8 16.9 3.2 1.9 0.2 100.0 553 0.10
Batticaloa 36.0 22.6 18.2 14.7 8.6 100.0 2,822 0.10
Ampara 26.1 24.4 19.6 19.2 10.7 100.0 3,803 0.06
Trincomalee 41.3 21.0 15.1 14.7 7.8 100.0 2,017 0.10
Kurunegala 14.4 22.3 26.7 22.1 14.4 100.0 8,713 0.04
Puttalam 19.7 27.3 22.8 16.4 13.8 100.0 3,674 0.09
Anuradhapura 15.8 21.4 24.9 24.9 12.9 100.0 4,831 0.05
Polonnaruwa 17.1 23.6 26.0 22.9 10.3 100.0 2,149 0.03
Badulla 32.9 24.2 15.9 15.0 12.1 100.0 4,147 0.09
Moneragala 24.9 24.3 25.3 17.2 8.3 100.0 2,548 0.07
Ratnapura 25.0 28.0 23.1 14.4 9.5 100.0 5,994 0.07
Kegalle 19.5 22.9 24.0 18.8 14.8 100.0 4,402 0.05

Total 20.0 20.0 20.0 20.0 20.0 100.0 104,569 0.06

Household Population and Housing Characteristics 19

2.3 Household population by age and sex

Household
A person or group of related or unrelated person who live together in the same
dwelling unit(s), who acknowledge one adult male or female as the head of the
household, who share the same housekeeping arrangements, and who are consid-
ered a single unit.

De facto population
All persons who stayed in the selected households the night before the interview
(whether usual residents or wisitors).

De jure population
All persons who are usual residents of the selected households. whether or not
they stayed in the household the night before the interview.

Table 2.6 shows that the household population by the important demographic variables of age and
sex. The total population in the sample is 103,283 and the female population (54,667) is slightly larger than
male population (48,626); and males constitute 47 percent and females 53 percent of the population. This
translates to an unbalanced sex ratio of 89 men per 100 women. The percentages of all males who are in the
age groups up to age 20 are higher than those of females
The table also shows the child and adult dependency age groups. The population 0-14 is 25 percent
of the total population and those ages 65 and above population constitute 10 percent. The working age pop-
ulation of 15-64 is 65 percent. The overall dependency ratio is 54.9 percent, indicating the presence of 1.8
working persons per 1 dependent person (<15 or >65). This is an optimal condition for the further develop-
ment of a country which has been called the “demographic dividend”. Child and adult population percentages
show that those aged 0-17 are 30 percent of the population and those above age 18 are 70 percent.

20 Demographic and Health Survey - 2016, Sri Lanka

 Table 2.6 Household population by age, sex, and residence
Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Sri Lanka 2016
Age Urban Rural Estate
Male Fe- Total Male Fe- Total Male Fe- Total Male Fe- Total
male male male male
Age
<5 8.7 6.7 7.7 8.8 7.4 8.1 8.8 7.9 8.3 8.8 7.3 8.0
5-9 8.7 7.2 7.9 9.4 8.4 8.9 11.3 9.3 10.2 9.4 8.2 8.8
10-14 8.8 7.8 8.3 9.0 8.1 8.5 10.3 9.9 10.1 9.1 8.1 8.5
15-19 7.6 7.1 7.3 8.1 7.4 7.7 7.5 7.4 7.5 8.0 7.3 7.6
20-24 7.2 7.3 7.2 6.3 6.5 6.4 6.6 6.2 6.4 6.5 6.6 6.5
25-29 6.6 7.0 6.8 5.8 6.3 6.1 6.4 6.6 6.5 6.0 6.5 6.2
30-34 7.1 7.1 7.1 7.0 7.3 7.2 7.2 7.6 7.4 7.1 7.3 7.2
35-39 7.2 7.0 7.1 7.1 7.8 7.5 6.7 6.3 6.5 7.1 7.6 7.4
40-44 5.9 5.9 5.9 6.4 6.5 6.4 5.6 5.1 5.3 6.2 6.3 6.3
45-49 6.0 6.6 6.3 6.1 6.2 6.2 5.6 4.9 5.2 6.1 6.2 6.2
50-54 6.1 6.7 6.4 6.3 6.4 6.3 7.1 7.5 7.3 6.3 6.5 6.4
55-59 5.6 6.6 6.1 5.5 5.8 5.6 5.2 6.1 5.7 5.5 6.0 5.7
60-64 5.0 5.7 5.4 4.8 5.1 5.0 4.3 5.0 4.6 4.8 5.2 5.0
65-69 4.1 4.3 4.2 3.9 4.3 4.1 3.8 4.6 4.2 3.9 4.3 4.1
70-74 2.7 3.3 3.0 2.5 2.9 2.7 1.9 3.2 2.6 2.5 3.0 2.8
75-79 1.5 1.6 1.6 1.5 1.7 1.6 0.9 1.3 1.1 1.5 1.7 1.6
80 + 1.3 2.0 1.7 1.3 1.9 1.6 0.7 1.0 0.9 1.3 1.9 1.6
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Dependency age groups

0-14 26.2 21.7 23.8 27.3 23.9 25.5 30.4 27.1 28.7 27.2 23.6 25.3
15-64 64.3 67.0 65.7 63.5 65.2 64.4 62.3 62.8 62.5 63.6 65.4 64.5
65+ 9.6 11.3 10.5 9.2 10.9 10.1 7.3 10.1 8.8 9.2 10.9 10.1
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Child and adult populations

0-17 30.6 26.1 28.2 32.3 28.4 30.2 35.8 31.9 33.7 32.2 28.2 30.1
18+ 69.4 73.9 71.8 67.7 71.6 69.8 64.2 68.1 66.3 67.8 71.8 69.9
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Number of 8,028 9,038 17,066 38,482 43,295 81,777 2,116 2,324 4,440 48,626 54,657 103,283
persons

The population pyramid (Figure 2.3) shows the higher presence of females in age groups 20 and
over. The pyramid reflects the declining fertility and low mortality in Sri Lanka and increasing older age
population.

Household Population and Housing Characteristics 21

 Figure 2.3: Population Pyramid

80 +
75-79
Male Female
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
<5
-55 -4
4 -33 -22 -11 0 1 2 3 4 5
Percentage

Table 2.A shows that the percentage of children under five years observed in the 2016 SLDHS declined
slightly compared to the percentage from the 2012 Population Census. Since 1981, the proportion of children
under 15 years of age has declined, and the proportions of the working age and elderly populations have
generally risen. The proportion of women in the reproductive age group shows a decline since 2000, from
54 to 48 percent in 2016. The overall dependency ratio (proportion under 15 and 65 and older divided by the
proportion age (15-64) is 54.9, compared to 65.4 in 1981. The child dependency ratio has declined from 58
to 39 and the old-age dependency ratio has gone up from 7 to 16. The demographic dynamics of Sri Lanka
indicate that the dependency ratio (number of working age population per dependent population) will con-
tinue to decline in the future, bringing additional challenges since the number of dependents will continue to
increase due to the ageing process of the Sri Lankan population.

Table 2.A Trends in population by broad age groups

Percentage of the population in selected age groups from censuses and surveys, Sri Lanka 1981-2016
Age group Census DHS1 DHS1 DHS1 Census DHS
1981 1993 2000 2006-07 2012 2016
Children under 5 years 12.5 9.0 7.9 8.8 8.6 8.0
Children under 15 years 35.2 30.3 25.8 25.9 25.2 25.3
Women of reproductive age (15-49 years) 52.2 53.0 54.6 51.8 51.0 47.8
Working age population (15-64 years) 60.5 63.5 67.1 66.5 66.9 64.5
Elderly population (65 years and over) 4.3 6.1 7.2 7.5 7.9 10.1

Ratio of persons under 15 to those age 15-64 (%) 58.2 47.8 38.3 39.0 37.7 39.2
Ratio of persons 65 and over to those age 15-64 (%) 7.2 9.6 10.7 11.3 11.8 15.7
1
Exclude Northern and Eastern provinces

22 Demographic and Health Survey - 2016, Sri Lanka

2.4 Household composition
Information on key aspects of the composition of households, including the sex of the head of the household
and the size of the household is presented in Table 2.7. These characteristics are important because they are
associated with the welfare of the household. Economic resources are often more limited in larger house-
holds. Table 2.7 shows 3.8 as the mean size of a household in 2016. One fourth of households (i.e. one in
four) are headed by a woman in Sri Lanka. The proportion of female headed households does not differ much
by sector. It is highest in the estate sector (26 percent) and lowest in the rural sector (24 percent). There are
no marked differences by sector in distribution of household members. A trend towards decreasing household
size has continued in Sri Lanka since 1981 in all but the estate sector, where the household size has fluctuated
up and then down (Table 2.B).

Table 2.7 Household composition

Percent distribution of households by sex of head of household and by
household size; mean size of household, and percentage of households with
orphans and foster children under 18 years of age, according to residence,
Sri Lanka 2016
Residence
Characteristic
Urban Rural Estate Total

Household headship
Male 75.3 76.4 73.8 76.1
Female 24.7 23.6 26.2 23.9
Total 100.0 100.0 100.0 100.0
Number of usual members
0 0.1 0.0 0.1 0.0
1 5.6 6.5 6.7 6.4
2 14.1 15.1 15.0 15.0
3 21.2 20.9 18.4 20.8
4 24.9 26.3 22.5 25.9
5 17.0 17.9 18.7 17.8
6 9.1 8.7 10.4 8.8
7 4.9 2.9 5.5 3.3
8 1.6 1.0 1.6 1.1
9+ 1.6 0.6 1.1 0.8
Total 100.0 100.0 100.0 100.0
Mean size of households 4.0 3.8 4.0 3.8

Percentage of households with orphans and foster children under 18

years of age
Double orphans 0.1 0.1 0.0 0.1
Single orphans1 2.0 2.4 2.3 2.3
Foster children 2
2.6 2.9 7.0 3.0
Foster and/or orphan 4.2 4.8 8.3 4.8
children

Number of households 4,309 21,778 1,122 27,210

Note: Table is based on de jure household members, i.e., usual residents.
1
Includes children with one dead parent and an unknown survival status of
the other parent.
2
Foster children are those under age 18 living in households with neither
their mother nor their father present, and the mother and/or the father are
alive.

Household Population and Housing Characteristics 23

 Table: 2.B Trends in mean household size
Mean household size from censuses and surveys, according to residence, Sri
Lanka 1981-2016
Source Urban Rural Estate Total
Census 1981 5.4 4.9 4.3 4.9
1993 DHS1 5.0 4.7 4.4 4.7
2000 DHS 1
4.8 4.5 4.6 4.5
2006-07 DHS1 4.2 4.0 4.3 4.0
Census 2012 3.9 3.7 4.0 3.8
2016 DHS 4.0 3.8 4.0 3.8
1
Exclude Northern and Eastern province

2.5 Children’s living arrangements, orphanhood, and school attendance

The 2016 SLDHS collected information on living arrangements of children and orphanhood. Living
arrangements should be monitored together with the proportion of foster and orphan children because of their
significant effects on the comprehensive development of children.
Table 2.8 shows the percent distribution of children under age 18 by their living arrangements and
survivorship of parents. Among children under age 18 reported in the 2016 SLDHS, 78 percent live with both
parents, 14 percent live with their mother only, although their father is alive, 2 percent live with their father
only, although their mother is alive, and 3 percent live with neither of their natural or biological parents,
although both parents are alive.
Table 2.8 also provides information on the extent of orphanhood, that is, the proportion of children
who have lost one or both parents. Less than 1 percent of children under age 18 have both parents’ dead
and 3 percent have one or both parents’ dead. The percentage of children living with both biological parents
decreases with the age of the child. This may be due to children moving out of house to pursue further
education or seek work. In the urban sector 79 percent of children live with both parents. Children in urban
and rural areas are more likely than those in estate areas to live with both parents (79 and 78 percent versus
67 percent).
By wealth status, the proportion of children under age 18 living with both parents increases with
wealth quintile. The highest proportions are among children in the highest wealth quintiles (82 percent) and
the lowest proportion is in the lowest wealth quintile (73 percent).

24 Demographic and Health Survey - 2016, Sri Lanka

Table 2.8 Children's living arrangements and orphanhood
Percent distribution of de jure children under age 18 by living arrangements and survival status of parents, the percentage of children not living with a
biological parent, and the percentage of children with one or both parents dead, according to background characteristics, Sri Lanka 2016
Living with Living with
mother but not father but not Not living with either parent
with father with mother
Background char- Living Fa- Fa- Moth- Moth- Both Only Only Both Miss- Total Per- Per- Number
acteristic with ther ther er er alive father moth- dead ing cent- cent- of chil-
both alive dead alive dead alive er infor- age age dren
par- alive ma- not with
ents tion living one or
on with a both
fa- bio- par-
ther/ logical ents
moth- parent dead1
er
Age
0-4 80.6 17.0 0.3 0.5 0.1 0.9 0.0 0.0 0.0 0.4 100.0 1.0 0.5 8,182
<2 81.7 17.1 0.2 0.1 0.1 0.5 0.0 0.0 0.0 0.3 100.0 0.5 0.3 3,029
2-4 80.0 16.9 0.4 0.8 0.1 1.2 0.1 0.0 0.0 0.5 100.0 1.3 0.6 5,153
5-9 78.9 14.4 1.1 2.1 0.3 2.3 0.2 0.2 0.0 0.5 100.0 2.8 1.8 9,085
10-14 76.9 12.1 2.7 3.0 0.6 3.2 0.3 0.5 0.1 0.7 100.0 4.1 4.1 8,875
15-17 74.1 10.1 5.0 3.1 0.9 4.6 0.3 0.9 0.2 0.8 100.0 6.0 7.3 4,918

Sex
Male 78.2 13.8 1.8 2.2 0.3 2.4 0.2 0.3 0.1 0.6 100.0 3.0 2.7 15,663
Female 77.8 13.7 2.1 2.0 0.5 2.7 0.2 0.3 0.1 0.6 100.0 3.4 3.2 15,396

Residence
Urban 79.4 13.6 1.8 1.6 0.3 2.3 0.1 0.3 0.1 0.5 100.0 2.8 2.6 4,795
Rural 78.4 13.7 2.0 1.9 0.4 2.4 0.2 0.3 0.1 0.6 100.0 3.1 3.0 24,754
Estate 66.7 15.3 1.5 7.6 0.7 5.6 0.3 0.8 0.0 1.6 100.0 6.7 3.3 1,510

District
Colombo 83.4 10.2 1.9 1.5 0.2 2.0 0.1 0.2 0.1 0.6 100.0 2.4 2.4 2,689
Gampaha 84.5 9.7 1.7 1.6 0.3 1.9 0.1 0.1 0.0 0.3 100.0 2.0 2.2 2,896
Kalutara 80.9 10.9 2.1 2.0 0.6 2.3 0.4 0.4 0.0 0.5 100.0 3.1 3.4 1,858
Kandy 77.2 15.6 1.4 2.2 0.5 2.5 0.2 0.2 0.0 0.3 100.0 2.8 2.3 2,093
Matale 68.5 22.4 2.3 1.5 0.4 3.2 0.3 0.5 0.0 1.1 100.0 4.0 3.4 824
Nuwara-Eliya 70.9 19.5 0.7 4.0 0.7 3.2 0.2 0.2 0.0 0.6 100.0 3.5 1.8 1,115
Galle 73.7 17.4 2.6 1.8 0.2 2.7 0.1 0.6 0.1 0.8 100.0 3.5 3.6 1,676
Matara 80.2 14.7 0.9 1.2 0.5 1.8 0.1 0.4 0.0 0.3 100.0 2.2 1.9 1,316
Hambantota 79.9 12.4 1.9 0.8 0.2 2.5 0.2 0.4 0.0 1.7 100.0 3.1 2.6 1,026
Jaffna 78.8 11.2 4.6 0.2 0.2 2.6 0.5 0.5 0.2 1.2 100.0 3.8 6.0 887
Mannar 85.7 6.7 3.1 1.4 0.6 1.7 0.2 0.5 0.0 0.1 100.0 2.4 4.4 166
Vavuniya 77.9 8.9 4.4 3.4 0.4 3.3 0.6 0.6 0.1 0.4 100.0 4.6 6.1 275
Mullaitivu 75.2 11.1 7.6 0.7 2.0 1.6 0.6 0.2 0.2 0.9 100.0 2.5 10.7 157
Kilinochchi 75.2 14.5 5.3 0.7 0.7 1.8 0.0 0.1 1.0 0.7 100.0 2.8 7.1 197
Batticaloa 72.9 18.0 1.8 2.0 0.3 3.5 0.3 0.4 0.0 1.0 100.0 4.2 2.7 995
Ampara 76.7 15.2 3.1 1.0 0.4 2.7 0.3 0.4 0.2 0.0 100.0 3.6 4.4 1,323
Trincomalee 78.4 11.8 0.8 2.7 0.5 4.0 0.2 0.4 0.4 0.8 100.0 5.1 2.4 737
Kurunegala 73.2 18.6 1.5 2.9 0.3 2.5 0.3 0.4 0.0 0.3 100.0 3.2 2.5 2,573
Puttalam 75.7 13.8 1.0 3.4 0.6 3.5 0.4 0.5 0.1 1.0 100.0 4.5 2.7 1,120
Anuradhapura 80.6 10.9 1.5 2.5 0.4 3.2 0.2 0.5 0.1 0.1 100.0 4.0 2.7 1,490
Polonnaruwa 76.8 12.0 1.5 4.6 0.1 2.9 0.7 0.8 0.0 0.4 100.0 4.5 3.2 652
Badulla 69.6 20.5 1.5 2.8 1.0 3.7 0.2 0.3 0.0 0.5 100.0 4.1 2.8 1,276
Moneragala 80.5 11.6 2.3 1.1 0.6 2.9 0.0 0.4 0.0 0.4 100.0 3.3 3.3 812
Ratnapura 80.5 10.6 2.5 2.4 0.5 2.1 0.1 0.1 0.1 1.1 100.0 2.4 3.3 1,683
Kegalle 80.9 9.7 2.3 2.7 0.3 2.1 0.1 0.4 0.2 1.3 100.0 2.7 3.2 1,224

Wealth quintile
Lowest 73.3 13.2 3.0 3.8 0.6 3.7 0.4 0.8 0.1 1.1 100.0 5.0 4.8 6,695
Second 78.7 12.3 2.3 2.2 0.5 2.9 0.2 0.3 0.1 0.6 100.0 3.5 3.3 6,331
Middle 77.6 14.8 1.7 2.0 0.3 2.6 0.2 0.3 0.0 0.6 100.0 3.0 2.5 6,213
Fourth 79.2 15.2 1.3 1.2 0.3 1.9 0.2 0.2 0.1 0.3 100.0 2.4 2.1 6,122
Highest 82.0 13.4 1.3 1.0 0.4 1.5 0.0 0.1 0.1 0.2 100.0 1.8 1.9 5,698

Total <15 78.7 14.4 1.4 1.9 0.3 2.2 0.2 0.2 0.0 0.6 100.0 2.7 2.2 26,142

Total <18 78.0 13.8 1.9 2.1 0.4 2.6 0.2 0.3 0.1 0.6 100.0 3.2 3.0 31,060

Note: Table is based on de jure members, i.e., usual residents.

1
Includes children with father dead, mother dead, both dead and one parent dead but missing information on survival status of the other parent.

Household Population and Housing Characteristics 25

2.6 Education of the household population
Studies have shown that education is one of the major socioeconomic factors to influence a person’s
behavior and attitudes. In general, the higher the level of education of a person, the more knowledgeable
he/she is about the use of health facilities, family planning methods, and the health of their children, among
many other things. Results from the 2016 SLDHS can be used to look at educational attainment among
household members and school attendance and dropout rates among children and youth.
For the purpose of the analysis presented below, the official age for entry into the primary education
level is five. The official primary level of schooling consists of grades 1 through grade 5 and finishing grade
11 marks completion of secondary school. The school ages are 5-9 for primary education and 10-15 for
secondary education.

2.6.1 Educational attainment

Median educational attainment

Half the population has complete less than median number of years of schooling
and the half the population has completed more than the median number of years
of schooling.
Sample: De facto household population age 6 and older.

Tables 2.9.1 and 2.9.2 show the education status for male and female household members
separately. They indicate remarkable gender equity in educational attendance and attainment in Sri Lanka.
The distribution of median years completed by age is quite similar for both sexes; in fact, it is slightly higher
for females (9.4 years), compared to males (9.2 years).
The data shows differences by sector of residence. The estate sector lags behind urban and ru-
ral sectors on median years completed. Furthermore, females in the estate sector are more likely to have
no education (15 percent) than males in the same sector (7 percent). Although there is not much gender
difference by residence for the highest education category. The population with completed secondary level
is much lower in the estate sector (nearly 13 percent) compared with about one-third of rural residents, and
nearly 45 percent of urban residents.
Only a very small proportion of the population six years or older has never gone to school. The
percentage of males who never attended school is 2 percent, and the corresponding proportion for females is
4 percent. This difference is due to a wider gap between males and females age 65 years and above, which
suggests that in the past, girls were somewhat less likely to go to school than boys.

26 Demographic and Health Survey - 2016, Sri Lanka

Table 2.9.1 Educational attainment of the female household population

Percent distribution of the de facto female household population age six and over by highest level of schooling attended or completed and
median years completed, according to background characteristics, Sri Lanka 2016
Background char- No edu- Some Com- Some Com- More Don't Total Number Median
acteristic cation primary pleted second- pleted than sec- know/ years
primary1 ary second- ondary missing complet-
ary2 ed
Age
6-9 4.5 94.6 0.9 0.0 0.0 0.0 0.0 100.0 3,639 1.6
10-14 0.4 11.4 19.6 67.9 0.6 0.0 0.1 100.0 4,422 6.0
15-19 0.4 0.4 0.2 15.9 31.2 51.8 0.1 100.0 3,998 10.1
20-24 0.6 1.0 0.7 5.0 24.6 67.9 0.1 100.0 3,598 11.4
25-29 0.9 1.3 1.3 7.2 27.8 61.5 0.1 100.0 3,537 10.8
30-34 1.1 1.7 1.7 11.3 29.2 55.1 0.0 100.0 3,989 10.4
35-39 1.5 3.3 2.1 13.0 32.7 47.2 0.2 100.0 4,149 9.9
40-44 2.4 6.1 4.6 13.7 29.8 43.1 0.2 100.0 3,452 9.8
45-49 4.4 9.5 5.4 16.8 25.1 38.4 0.4 100.0 3,405 9.6
50-54 6.0 14.5 7.8 17.6 18.7 34.6 0.8 100.0 3,531 9.4
55-59 6.4 16.2 8.2 20.4 18.4 29.7 0.7 100.0 3,254 9.1
60-64 6.3 17.4 10.2 22.0 16.8 26.1 1.3 100.0 2,850 8.0
65+ 14.9 22.2 10.7 19.9 11.3 19.4 1.5 100.0 5,974 6.8

Residence
Urban 2.6 12.1 5.2 18.6 16.0 45.2 0.5 100.0 8,303 9.8
Rural 4.0 15.5 5.8 18.2 21.3 34.8 0.4 100.0 39,397 9.4
Estate 14.5 24.3 11.9 22.9 12.2 13.6 0.6 100.0 2,098 6.2

District
Colombo 2.1 11.3 4.1 18.0 16.1 48.0 0.6 100.0 5,065 9.9
Gampaha 1.6 11.3 5.0 18.1 19.5 44.2 0.3 100.0 5,100 9.7
Kalutara 2.6 13.6 5.5 16.9 21.8 39.0 0.6 100.0 3,043 9.6
Kandy 4.4 14.2 5.0 18.4 20.2 36.8 0.9 100.0 3,541 9.5
Matale 6.4 16.9 5.1 19.9 19.5 31.8 0.4 100.0 1,259 9.2
Nuwara-Eliya 10.4 21.4 9.7 20.5 17.2 20.4 0.4 100.0 1,601 7.5
Galle 3.8 14.0 6.5 19.2 22.1 34.2 0.2 100.0 2,725 9.4
Matara 4.0 15.4 4.6 16.2 21.0 38.1 0.7 100.0 2,108 9.5
Hambantota 4.4 15.1 6.7 15.6 20.2 37.4 0.5 100.0 1,494 9.5
Jaffna 0.9 13.8 8.3 19.9 18.0 38.4 0.7 100.0 1,496 9.4
Mannar 1.6 16.4 12.1 23.5 18.2 27.8 0.3 100.0 234 8.5
Vavuniya 3.1 13.5 9.1 20.7 13.1 39.7 0.8 100.0 385 9.3
Mullaitivu 2.8 20.2 9.2 25.2 16.9 25.6 0.1 100.0 212 8.0
Kilinochchi 3.3 17.9 7.1 26.1 25.9 19.7 0.0 100.0 254 8.6
Batticaloa 7.0 19.1 8.1 20.5 15.0 30.3 0.1 100.0 1,353 8.7
Ampara 5.6 24.1 7.5 19.9 15.5 26.8 0.6 100.0 1,732 8.2
Trincomalee 5.9 17.0 8.9 23.5 13.6 30.8 0.3 100.0 898 8.4
Kurunegala 3.8 15.9 4.9 17.2 24.4 33.4 0.5 100.0 4,240 9.4
Puttalam 3.4 18.7 6.3 23.0 21.8 26.3 0.5 100.0 1,733 9.0
Anuradhapura 2.8 16.1 6.3 18.7 17.9 37.8 0.4 100.0 2,241 9.4
Polonnaruwa 5.9 17.6 4.9 18.7 27.9 25.0 0.1 100.0 980 9.2
Badulla 9.3 16.2 7.3 17.7 20.4 28.6 0.4 100.0 2,023 9.2
Moneragala 4.9 18.4 5.9 18.4 21.3 30.8 0.4 100.0 1,161 9.2
Ratnapura 7.0 16.6 5.7 16.9 24.4 29.1 0.4 100.0 2,810 9.3
Kegalle 4.2 15.6 5.9 17.8 19.7 36.4 0.2 100.0 2,109 9.4

Wealth quintile
Lowest 9.8 22.6 9.4 24.0 18.9 14.6 0.7 100.0 9,815 7.2
Second 4.7 17.5 6.8 21.1 24.1 25.2 0.5 100.0 9,906 9.1
Middle 2.9 16.0 5.5 18.1 24.1 33.0 0.4 100.0 9,946 9.4
Fourth 2.1 11.9 4.8 16.7 20.8 43.3 0.3 100.0 9,899 9.7
Highest 1.6 8.9 3.2 12.8 12.3 60.9 0.4 100.0 10,233 10.8

Total 4.2 15.3 5.9 18.5 20.0 35.6 0.5 100.0 49,798 9.4
1
Completed 5 grade at the primary level
2
Completed 10 grade at the secondary level

Household Population and Housing Characteristics 27

Table 2.9.2 Educational attainment of the male household population
Percent distribution of the de facto male household population age six and over by highest level of schooling attended or completed and median
years completed, according to background characteristics, Sri Lanka 2016
Background No edu- Some Com- Some Com- More Don't Total Number Median
characteristic cation primary pleted second- pleted than sec- know/ years
primary1 ary second- ondary missing complet-
ary2 ed
Age
6-9 5.0 93.8 1.2 0.0 0.0 0.0 0.0 100.0 3,747 1.5
10-14 0.6 11.4 19.7 67.6 0.6 0.0 0.1 100.0 4,401 6.0
15-19 0.8 0.6 0.2 18.4 38.2 41.7 0.1 100.0 3,895 9.8
20-24 0.9 1.5 0.9 9.2 29.3 57.9 0.2 100.0 3,145 10.6
25-29 0.9 1.5 1.4 10.4 32.8 52.8 0.2 100.0 2,894 10.2
30-34 0.7 3.0 2.6 16.1 31.3 46.0 0.2 100.0 3,435 9.9
35-39 1.1 4.6 3.0 16.5 33.5 41.0 0.2 100.0 3,470 9.8
40-44 1.5 7.9 4.5 17.8 30.0 38.0 0.3 100.0 3,034 9.6
45-49 2.3 9.6 6.8 21.5 22.6 36.7 0.5 100.0 2,959 9.5
50-54 3.6 14.2 8.1 20.7 20.0 32.9 0.5 100.0 3,079 9.2
55-59 3.9 14.2 8.2 24.1 17.2 31.7 0.7 100.0 2,665 9.1
60-64 3.3 17.8 9.0 25.0 14.3 29.8 0.8 100.0 2,329 7.9
65+ 5.0 20.1 9.8 24.3 12.0 27.5 1.1 100.0 4,474 7.5

Residence
Urban 1.7 12.5 5.5 19.1 16.7 44.1 0.4 100.0 7,201 9.7
Rural 2.2 16.5 5.9 22.1 22.3 30.7 0.3 100.0 34,439 9.2
Estate 6.6 25.1 11.9 29.8 13.5 12.6 0.5 100.0 1,887 6.3

District
Colombo 1.3 11.2 5.1 18.3 17.8 45.9 0.4 100.0 4,529 9.8
Gampaha 1.4 10.5 4.2 20.0 22.0 41.5 0.5 100.0 4,686 9.6
Kalutara 1.3 15.4 5.9 21.8 21.6 33.5 0.4 100.0 2,680 9.3
Kandy 2.4 18.2 5.2 19.4 22.0 32.2 0.7 100.0 2,882 9.3
Matale 3.5 18.6 5.5 23.9 20.7 27.8 0.1 100.0 1,097 9.0
Nuwara-Eliya 4.0 19.8 10.5 27.5 16.2 21.5 0.6 100.0 1,434 7.6
Galle 2.1 15.7 6.0 22.2 25.1 28.6 0.2 100.0 2,258 9.2
Matara 2.1 17.9 5.6 19.3 23.0 31.6 0.5 100.0 1,761 9.3
Hambantota 2.4 18.8 7.5 20.6 19.4 30.9 0.3 100.0 1,361 9.1
Jaffna 0.4 12.3 7.0 22.3 18.8 38.3 0.9 100.0 1,240 9.4
Mannar 2.1 14.5 10.3 27.5 22.5 23.0 0.1 100.0 223 8.5
Vavuniya 1.6 15.3 8.1 22.7 13.5 38.2 0.6 100.0 348 9.2
Mullaitivu 2.0 19.0 10.6 22.9 22.2 23.4 0.0 100.0 182 8.2
Kilinochchi 2.0 18.2 8.3 27.7 27.8 15.9 0.0 100.0 223 8.3
Batticaloa 4.6 22.8 7.3 23.1 13.2 28.7 0.3 100.0 1,110 8.1
Ampara 3.0 24.9 6.9 24.2 13.5 27.4 0.1 100.0 1,506 7.8
Trincomalee 4.1 17.3 6.1 24.3 15.4 32.4 0.4 100.0 839 8.9
Kurunegala 1.7 16.6 5.4 22.5 25.8 27.4 0.5 100.0 3,621 9.2
Puttalam 2.1 17.0 6.9 26.9 23.9 22.9 0.2 100.0 1,557 8.7
Anuradhapura 2.7 14.9 5.3 23.2 18.4 35.4 0.1 100.0 2,001 9.3
Polonnaruwa 2.2 18.5 6.5 25.3 27.4 19.4 0.7 100.0 868 8.7
Badulla 4.5 18.0 6.7 24.0 20.5 26.2 0.0 100.0 1,738 8.7
Moneragala 3.4 20.3 6.6 21.5 21.7 26.4 0.1 100.0 1,054 9.0
Ratnapura 3.0 19.1 7.4 22.7 25.1 22.4 0.3 100.0 2,501 8.8
Kegalle 2.3 15.7 6.0 20.4 20.1 35.5 0.1 100.0 1,831 9.3

Wealth quintile
Lowest 5.1 24.1 9.7 29.2 19.2 12.1 0.5 100.0 8,660 7.0
Second 2.4 18.5 7.1 26.0 24.1 21.5 0.3 100.0 8,753 8.4
Middle 1.6 15.5 5.8 22.6 25.4 28.7 0.4 100.0 8,758 9.2
Fourth 1.3 13.4 4.6 19.0 23.1 38.3 0.3 100.0 8,597 9.5
Highest 0.9 9.6 3.1 12.8 13.3 60.1 0.2 100.0 8,760 10.7

Total 2.3 16.2 6.1 21.9 21.0 32.2 0.4 100.0 43,528 9.2
1
Completed 5 grade at the primary level
2
Completed 10 grade at the secondary level

28 Demographic and Health Survey - 2016, Sri Lanka

2.7 School attendance ratios

Net Attendance Ratio

Percentage of the school – age population that attends primary or secondary
school.
Sample : Children age 5 – 9 for primary school NAR and children age 10 – 15 for
secondary school NAR.

The 2016 SLDHS collected information on school attendance for the population age 3-24 that allows
the calculation of net attendance ratios (NARs) and gross attendance ratios (GARs). The NAR for primary
school is the percentage of the primary-school-age (5-9 years) children that are attending primary school
(right level for age). The NAR for secondary school measures school attendance of the secondary-school-age
(10-15 years) children (right level for age). By definition, the NAR cannot exceed 100 percent. The Gross
Attendance Ratio (GAR), measures participation at each level of schooling among persons age 6-25 (level for
any age). The GAR is mostly higher than the NAR for the same level because the GAR includes participation
by those who may be older, because they may have started school late, may have repeated in one or more
grades in school, or may have dropped out of school and returned later, or may be younger than the official
age range for that level.

Table 2.10 presents data on the NAR and GAR for the de facto household population by level of
schooling and sex, according to place of residence, district, and wealth quintile. Ninety eight percent of
children age 5-9 are attending primary school (right level for their age). The GAR at the primary school level
is 101 percent. The distribution shows that both the NAR and the GAR are little lower at the secondary school
level: 83 percent of students’ age 10-15 who should be attending secondary schools are in secondary school
(NAR). The GAR for secondary school is very close to the NAR at 85 percent.

The results show no differences in the primary or secondary school NARs between males and
females, indicating no notable gender gap in school attendance for the school-age population who should be
attending school at a given level.

When considering the NAR at the primary level, the differences in urban, rural and estate sectors,
district levels and among wealth quintiles are minimal. The NAR at the secondary school level also does not
have a large gap among urban, rural and estate sectors. District and wealth quintile show some differences in
secondary school NAR. The secondary school NAR is lowest in the Puttalam district (76 percent) and highest
in the Colombo district (87 percent). The secondary school NAR is lowest (80 percent) in the lowest wealth
quintile and highest (85 percent) in highest wealth quintile. The GAR at the primary school level does not
show large differences by sector, district and wealth quintile. However, there is almost no urban-rural-estate
difference in the GAR at the secondary school level. The GAR at the secondary school level is highest in
Hambantota district (88 percent) and lowest in Puttalam district (79 percent). By wealth quintile GAR at
secondary school level does not show major differences, except that it is slightly lower in the highest quintile
than the other quintiles.

This data shows that there is really not much difference in NAR and GAR at any levels of the coun-
try, showing the high efficiency of the educational system in Sri Lanka. It reflects probably that education is
free in Sri Lanka. However, the NAR for secondary schools can be improved.

Table 2.10 also shows the Gender Parity Index (GPI), which represents the ratio of the NAR and
GAR for females to the NAR and GAR for males. It is a more precise indicator of gender differences in
the schooling system. A GPI of less than 1 indicates that a smaller proportion of females than males attend
school. In Sri Lanka, the GPI is 1.01for primary school attendance and 1.00 for secondary school attendance,
indicating no gender gaps. There are no notable differences in GPI for NAR considering background charac-
teristics of primary and secondary school levels.

Household Population and Housing Characteristics 29

Table 2.10 School attendance ratios
Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de facto household population by sex and level of school-
ing; and the Gender Parity Index (GPI), according to background characteristics, Sri Lanka 2016

Net attendance ratio1 Gross attendance ratio2

Background charac- Male Female Total Gender Male Female Total Gender
teristic Parity Parity
Index3 Index3
PRIMARY SCHOOL
Residence
Urban 97.2 98.2 97.7 1.01 100.8 101.2 101.0 1.00
Rural 98.1 98.1 98.1 1.00 100.3 100.8 100.6 1.00
Estate 95.8 96.4 96.1 1.01 102.9 104.3 103.5 1.01

District
Colombo 97.2 99.6 98.3 1.02 99.7 101.5 100.6 1.02
Gampaha 97.9 98.5 98.2 1.01 99.6 102.4 101.0 1.03
Kalutara 99.0 98.5 98.7 1.00 100.7 100.4 100.6 1.00
Kandy 99.0 96.1 97.6 0.97 101.6 98.3 100.0 0.97
Matale 99.7 99.7 99.7 1.00 105.5 100.9 103.1 0.96
Nuwara-Eliya 93.6 99.3 96.6 1.06 98.7 103.2 101.1 1.05
Galle 98.5 98.5 98.5 1.00 99.8 100.0 99.9 1.00
Matara 98.4 98.9 98.7 1.01 99.7 102.8 101.2 1.03
Hambantota 95.6 99.5 97.5 1.04 96.8 100.1 98.4 1.03
Jaffna 93.1 95.0 94.1 1.02 98.9 99.8 99.4 1.01
Mannar 96.1 96.9 96.5 1.01 104.4 102.1 103.2 0.98
Vavuniya 98.0 96.8 97.4 0.99 101.7 104.9 103.1 1.03
Mullaitivu 94.4 87.3 90.6 0.92 105.8 91.8 98.4 0.87
Kilinochchi 98.9 99.1 99.0 1.00 100.9 100.2 100.5 0.99
Batticaloa 99.3 98.9 99.1 1.00 103.8 100.8 102.4 0.97
Ampara 98.2 98.2 98.2 1.00 101.5 104.0 102.6 1.02
Trincomalee 98.0 98.6 98.3 1.01 99.9 103.9 101.6 1.04
Kurunegala 98.5 98.5 98.5 1.00 101.8 101.9 101.9 1.00
Puttalam 97.3 99.0 98.2 1.02 101.6 103.1 102.4 1.01
Anuradhapura 97.7 95.4 96.5 0.98 100.7 98.4 99.5 0.98
Polonnaruwa 98.0 96.8 97.4 0.99 99.5 97.6 98.5 0.98
Badulla 97.1 98.0 97.6 1.01 99.5 100.8 100.2 1.01
Moneragala 97.9 98.7 98.3 1.01 99.2 100.9 100.0 1.02
Ratnapura 98.6 96.8 97.7 0.98 100.6 99.1 99.9 0.99
Kegalle 98.1 98.0 98.0 1.00 100.2 102.5 101.4 1.02

Wealth quintile
Lowest 97.5 96.6 97.0 0.99 102.7 100.9 101.8 0.98
Second 96.6 97.9 97.3 1.01 99.1 100.7 99.9 1.02
Middle 98.1 98.8 98.5 1.01 100.2 101.2 100.7 1.01
Fourth 98.9 99.0 98.9 1.00 100.5 101.4 100.9 1.01
Highest 98.1 98.1 98.1 1.00 100.0 101.0 100.5 1.01

Total 97.8 98.1 97.9 1.00 100.5 101.0 100.8 1.01

30 Demographic and Health Survey - 2016, Sri Lanka

Contd... Table 2.10 School Attendance ratios

Table 2.10 School attendance ratios

Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de facto household population by sex and level of school-
ing; and the Gender Parity Index (GPI), according to background characteristics, Sri Lanka 2016
Background charac- Male Female Total Gender Male Female Total Gender
teristic Parity Parity
Index3 Index3
SECONDARY SCHOOL
Residence
Urban 84.0 83.6 83.8 0.99 84.7 84.6 84.7 1.00
Rural 83.0 83.0 83.0 1.00 84.8 84.2 84.5 0.99
Estate 80.4 82.9 81.6 1.03 83.7 85.8 84.8 1.02

District
Colombo 86.6 85.7 86.1 0.99 87.2 86.4 86.8 0.99
Gampaha 83.7 81.3 82.5 0.97 85.6 81.5 83.6 0.95
Kalutara 85.2 82.9 84.1 0.97 85.7 83.8 84.8 0.98
Kandy 82.4 79.9 81.1 0.97 83.8 82.0 82.9 0.98
Matale 84.7 87.5 86.0 1.03 85.1 88.2 86.6 1.04
Nuwara-Eliya 83.6 79.4 81.4 0.95 87.7 81.8 84.7 0.93
Galle 82.3 86.4 84.4 1.05 83.2 87.3 85.3 1.05
Matara 81.7 83.7 82.9 1.02 83.7 83.7 83.7 1.00
Hambantota 88.4 82.6 85.5 0.93 92.0 84.7 88.3 0.92
Jaffna 83.2 86.5 84.9 1.04 85.6 88.8 87.3 1.04
Mannar 83.2 85.0 84.1 1.02 86.8 87.7 87.2 1.01
Vavuniya 80.9 77.3 78.9 0.95 84.9 80.9 82.7 0.95
Mullaitivu 79.5 87.7 84.0 1.10 83.3 89.5 86.7 1.08
Kilinochchi 83.2 87.5 85.4 1.05 85.6 87.5 86.6 1.02
Batticaloa 79.4 84.7 82.1 1.07 81.2 86.4 83.9 1.06
Ampara 87.3 75.6 81.2 0.87 88.6 78.6 83.4 0.89
Trincomalee 79.5 81.7 80.5 1.03 81.3 83.5 82.4 1.03
Kurunegala 82.5 82.2 82.4 1.00 84.3 82.6 83.5 0.98
Puttalam 75.5 80.0 77.7 1.06 77.7 81.1 79.3 1.04
Anuradhapura 83.3 88.2 85.7 1.06 86.4 91.3 88.8 1.06
Polonnaruwa 78.8 80.0 79.4 1.02 78.8 81.0 79.8 1.03
Badulla 81.4 82.5 81.9 1.01 83.8 82.7 83.3 0.99
Moneragala 77.5 88.4 83.3 1.14 77.5 89.4 83.8 1.15
Ratnapura 83.5 83.7 83.6 1.00 83.9 85.1 84.5 1.01
Kegalle 84.0 83.2 83.6 0.99 86.6 85.1 85.9 0.98

Wealth quintile
Lowest 80.4 83.1 81.7 1.03 82.5 85.8 84.1 1.04
Second 83.1 82.1 82.6 0.99 85.5 83.5 84.5 0.98
Middle 83.7 84.7 84.2 1.01 85.2 85.7 85.4 1.01
Fourth 84.1 85.2 84.6 1.01 85.1 86.0 85.6 1.01
Highest 84.6 80.4 82.4 0.95 85.8 80.7 83.2 0.94

Total 83.1 83.1 83.1 1.00 84.7 84.3 84.5 1.00

1
The NAR for primary school is the percentage of the primary-school age (5-9 years) population that is attending primary school.
The NAR for secondary school is the percentage of the secondary-school age (10-15 years) population that is attending second-
ary school. By definition the NAR cannot exceed 100 percent.
2
The GAR for primary school is the total number of primary school students, expressed as a percentage of the official prima-
ry-school-age population. The GAR for secondary school is the total number of secondary school students, expressed as a
percentage of the official secondary-school-age population. If there are significant numbers of overage and underage students at
a given level of schooling, the GAR can exceed 100 percent.
3
The Gender Parity Index for primary school is the ratio of the primary school NAR(GAR) for females to the NAR(GAR) for males.
The Gender Parity Index for secondary school is the ratio of the secondary school NAR(GAR) for females to the NAR(GAR) for
males.

Household Population and Housing Characteristics 31

2.8 School attendance rates
Figure 2.4 shows the percentage of males and females attending school by single years of age up to
23 years of age. Almost all girls and boys age 6-14 are attending school. The decline starts from age 15 for
both sexes. However, an interesting pattern appears by gender. The decline in schooling is greater in boys
than in girls, which means girls stay in school longer than boys. Attendance drops below 50 percent for boys
at age 18, but for girls this reduction doesn’t happen until age 19.

Figure 2.4 Age-Specific School Attendance Rates

32 Demographic and Health Survey - 2016, Sri Lanka

Characteristics of
Respondents 3
Key Findings
• Age: Seventy-seven percent of all ever-married women age 15 to 49 are over
29 years old.
• Education: Forty-Seven percent of ever married woman age 15 - 49 in Sri
Lanka have completed more than secondary education. However, two percent
of women have never attended school.
• Literacy: Ninety-Four percent of ever married women age 15 - 49 in Sri Lanka
are literate.
• Exposure to mass media: Eleven percent of women are not exposed to any
mass media at least once a week. Estate women are almost two times more
likely than urban women to have “no” regular exposure to any form of mass
media (8 percent versus 17 percent).
• Internet usage: 16 percent of ever-married women have used the internet in
the past 12 months.
• Employment: Thirty three percent of ever-married women age 15 - 49 were
employed during the week before the survey.
• Occupation: Over one-third of employed woman works are unskilled manual
occupations.

T
his chapter provides information on the demographic and socioeconomic characteristics of ever-mar-
ried women who were interviewed in the 2016 SLDHS. The chapter begins by describing basic back-
ground characteristics, including age, religion, ethnicity, marital status, residence, education, and
wealth status. Information is also presented on exposure to mass media and employment status. This infor-
mation will help in understanding some of the factors that affect reproductive behavior, contraceptive use and
other health practices of women.

3.1 Basic characteristics of survey respondents.

A total of 18,302 ever married women were interviewed in the 2016 Sri Lanka DHS. Twenty-three
percent of the ever-married respondents are under 30 years of age. The majority of women are currently mar-
ried, with only 6 percent divorced and separated. Living together as if married is not popular in Sri Lanka;
only 4 percent of ever married women are in this category.
The distribution of respondents by residential sector reveals that the vast majority of the respondents
(81 percent) live in rural areas of the country. By district of residence, Colombo and Gampaha have 10 per-
cent each of the respondents, while districts in Western Sri Lanka comprise 25 percent of the ever-married
women included in the sample (see Table 3.1).
The majority of the respondents (71 percent) are Buddhist. Hinduism (11 percent) Islam (10 percent)
and Roman Catholic (6.5 percent) are the other religious with notable proportions. The distribution of eth-
nicity parallels the pattern for religions, with three –quarters (76 percent) of the respondents being Sinhalese,
followed by Sri Lanka Tamils (12 percent), Sri Lankan Moors (9 percent), and Indian Tamil (2 percent).
These distributions are similar to the ones reported from similar surveys and from the 2012 population cen-
sus.

Characteristics of Respondents 33
 Table 3.1 Background characteristics of respondents
Percent distribution of ever-married women age 15-49 by selected background characteristics, Sri Lanka 2016
Ever-married Women
Background characteristic Weighted percent Weighted number Unweighted number
Age
15-19 1.2 229 227
20-24 7.7 1,410 1,440
25-29 14.3 2,620 2,655
30-34 19.7 3,615 3,603
35-39 21.6 3,945 3,925
40-44 17.9 3,269 3,261
45-49 17.6 3,214 3,191
Religion
Buddhist 71.0 13,003 11,577
Hindu 11.4 2,078 3,242
Islam 9.7 1,772 1,825
Roman Catholic 6.5 1,196 1,365
Other Christian 1.4 249 290
Other 0.0 4 3
Ethnic group
Sinhala 76.1 13,928 12,372
Sri Lanka Tamil 12.4 2,271 3,658
Indian Tamil 2.1 383 519
Sri Lanka moor /Muslim 9.1 1,660 1,695
Malay 0.1 27 24
Burger 0.2 29 29
Other 0.0 5 5
Marital status
Married 90.4 16,545 16,538
Living together 3.9 712 632
Widowed/divorced/separated 5.7 1,045 1,132
Residence
Urban 15.6 2,855 2,910
Rural 80.5 14,737 14,344
Estate 3.9 710 1,048
District
Colombo 9.5 1,731 1,333
Gampaha 10.1 1,845 1,476
Kalutara 6.0 1,104 815
Kandy 6.7 1,223 1,093
Matale 2.7 490 484
Nuwara Eliya 3.1 572 633
Galle 5.1 935 857
Matara 3.9 718 698
Hambantota 3.0 556 563
Jaffna 2.6 471 520
Mannar 0.4 81 416
Vavuniya 0.7 136 451
Mullaitivu 0.4 81 378
Kilinochchi 0.5 94 384
Batticaloa 2.9 531 601
Ampara 4.0 731 799
Trincomalee 2.0 362 460
Kurunegala 8.7 1,592 1,383
Puttalam 3.6 664 661
Anuradhapura 5.4 984 816
Polonnaruwa 2.2 399 447
Badulla 4.0 735 767
Moneragala 2.6 485 543
Ratnapura 5.9 1,084 1,011
Kegalle 3.8 698 713
Education
No education 1.6 285 318
Passed Grade 1-5 6.9 1,257 1,431
Passed Grade 6-10 44.4 8,130 8,169
Passed G.C.E.(O/L) or equivalent 22.1 4,044 4,032
Passed G.C.E.(A/L) or equivalent 20.4 3,731 3,522
Degree and above 4.7 856 830
Wealth quintile
Lowest 18.5 3,390 4,295
Second 20.2 3,695 3,720
Middle 21.0 3,838 3,588
Fourth 20.9 3,816 3,501
Highest 19.5 3,562 3,198
Total 15-49 100.0 18,302 18,302
Note: Education categories refer to the highest level of education attended, whether or not that level was com-
pleted.

34 Demographic and Health Survey - 2016, Sri Lanka

3.2 Educational attainment by background characteristics

Education is one of the most influential determinants of an individual’s knowledge, attitudes, and
behaviors. The educational attainment of a population is an important indicator of the society’s stock of
human capital and level of socioeconomic development. Education enhances the ability of individuals to
achieve desired demographic and health goals. Table 3.2 presents differentials in the educational attainment
of ever-married women by selected background characteristics.
Table 3.2 shows the relationship between women’s level of education and their other background
characteristics. Forty-Seven percent of ever married women age 15-49 in Sri Lanka have completed more
than secondary education. However, 2 percent have never been to school, 20 percent have completed only
some primary education, just completed all primary education, or some secondary education, and 32 percent
have completed secondary education. Older women, women in the estate sector, and those in the lowest
wealth quintile are most likely to have no education. The median number of years of completed education
has levelled off at 11 years.

Table 3.2 Educational attainment

Percent distribution of ever-married women age 15-49 by highest level of schooling attended or completed, and median years completed,
according to background characteristics, Sri Lanka 2016
Highest level of schooling
Background charac- No edu- Some Com- Some Complet- More than Total Median Number of
teristic cation primary pleted second- ed sec- second- years com- ever-mar-
primary1 ary ondary2 ary pleted ried women
Age
15-24 0.1 0.9 1.0 9.4 43.5 45.0 100.0 9.9 1,639
..15-19 0.0 1.0 0.8 14.4 55.3 28.5 100.0 9.6 229
..20-24 0.2 0.9 1.0 8.6 41.6 47.7 100.0 9.9 1,410
25-29 0.4 1.3 1.6 8.7 33.4 54.4 100.0 10.3 2,620
30-34 0.7 1.4 1.7 11.8 30.4 54.1 100.0 10.3 3,615
35-39 1.3 3.2 2.0 13.3 32.9 47.3 100.0 9.9 3,945
40-44 2.0 6.3 4.6 14.0 30.3 43.0 100.0 9.8 3,269
45-49 4.0 9.3 5.4 16.9 25.6 38.7 100.0 9.6 3,214

Residence
Urban 1.0 2.7 2.8 13.5 23.0 57.0 100.0 10.4 2,855
Rural 1.3 3.8 2.5 12.0 33.8 46.6 100.0 9.9 14,737
Estate 8.4 14.4 10.9 26.3 20.9 19.0 100.0 8.2 710

District
Colombo 1.1 2.6 1.9 11.1 23.2 60.1 100.0 10.6 1,731
Gampaha 0.6 2.0 0.9 10.1 28.8 57.7 100.0 10.4 1,845
Kalutara 1.1 3.0 1.9 11.0 32.8 50.3 100.0 10.1 1,104
Kandy 1.7 3.6 2.2 11.1 30.2 51.1 100.0 10.1 1,223
Matale 1.8 2.9 2.8 15.5 33.5 43.6 100.0 9.8 490
Nuwara Eliya 3.9 8.9 8.9 17.5 29.7 31.1 100.0 9.4 572
Galle 1.4 3.7 2.2 11.2 35.9 45.6 100.0 9.9 935
Matara 1.1 4.2 0.5 7.8 35.1 51.2 100.0 10.1 718
Hambantota 0.3 3.2 2.2 9.1 33.9 51.2 100.0 10.1 556
Jaffna 0.0 3.4 4.6 13.2 28.2 50.5 100.0 10.0 471
Mannar 0.2 2.9 7.9 24.0 28.9 36.1 100.0 9.5 81
Vavuniya 3.1 4.7 4.8 16.4 16.5 54.4 100.0 10.2 136
Mullaitivu 0.6 7.6 6.7 20.4 25.9 38.9 100.0 9.6 81
Kilinochchi 1.2 4.8 4.8 21.9 40.0 27.3 100.0 9.4 94
Batticaloa 2.3 7.9 7.4 20.8 21.3 40.4 100.0 9.6 531
Ampara 2.8 10.1 5.9 18.1 24.7 38.4 100.0 9.6 731
Trincomalee 2.3 4.6 7.1 21.6 22.7 41.6 100.0 9.7 362
Kurunegala 0.9 3.4 2.0 9.6 39.8 44.3 100.0 9.9 1,592
Puttalam 1.7 6.2 3.9 21.3 32.8 34.1 100.0 9.5 664
Anuradhapura 0.9 1.7 2.7 13.1 29.1 52.5 100.0 10.1 984
Polonnaruwa 1.5 4.6 2.1 14.7 44.8 32.4 100.0 9.6 399
Badulla 4.5 4.1 3.1 14.4 33.8 40.1 100.0 9.8 735
Moneragala 1.9 4.7 3.0 12.9 35.2 42.2 100.0 9.8 485
Ratnapura 3.0 4.6 2.5 12.6 41.9 35.4 100.0 9.7 1,084
Kegalle 0.9 3.7 2.1 9.2 31.0 53.2 100.0 10.2 698

Wealth quintile
Lowest 5.6 10.2 7.3 23.9 33.8 19.1 100.0 9.2 3,390
Second 1.5 4.7 3.2 17.3 40.2 33.2 100.0 9.6 3,695
Middle 0.5 3.4 2.4 11.3 38.6 43.8 100.0 9.8 3,838
Fourth 0.4 1.6 1.3 8.5 30.6 57.6 100.0 10.4 3,816
Highest 0.2 0.6 0.5 3.6 14.4 80.7 100.0 12.2 3,562

Total 1.6 4.0 2.9 12.8 31.7 47.2 100.0 9.9 18,302
1
Completed 5 grade at the primary level
2
Completed 10 grade at the secondary level

Characteristics of Respondents 35
 Figure 3.1 Ever-married Women 20-49 with completed Secondary Education
or Higher

Percent

89 88
85
80
73
64

20-24 25-29 30-34 35-39 40-44 45-49

Age (years)

As figure 3.1 shows younger women have attained more years of education than older women. For
example, 89 percent of ever married women in age 20-24 have completed more than secondary education,
compared with only 64 percent of ever married women in age 45-49.
Women in the urban sector show the highest percentage with some education above the secondary
level (57 percent), compared with only 19 percent for women in the estate sector.

3.3 Literacy

Literacy
Respondents who have attended higher than secondary school are assumed to be literate. All other
respondents were given a sentence to read, and were considered literate if they could read all or part of
the sentence.

Literacy is widely acknowledged as benefiting both the individual and society. Particularly among
women, literacy is associated with positive outcomes, including inter-generational health and nutrition
benefits. The ability to read and write empowers both women and men. Knowledge of the level of literacy
that a population may attain is important for policy makers and program managers who design information
materials.
The 2016 SLDHS defined literacy based on the respondent’s ability to read all or part of a sentence.
To test respondents’ reading ability, interviewers carried a set of cards with simple sentences printed in
Sinhala, Tamil and English. Respondents who had attended at least some secondary school were assumed to
be literate. Respondents who had never been to school and those who had not attended school at the secondary
level were asked to read the cards during the interview. From Table 3.3 we can see that Sri Lanka has high
levels of literacy at 94 percent of ever-married women. However, there are substantial variations by place of
residence and household wealth. Thus, 25 percent of the women of the estate sector are illiterate, compared
to only around 5 percent in the urban and rural sectors. At the district level, four districts have illiteracy
levels of 12 percent or more (Baticaloa, 15 percent; Badulla, 13 percent; Nuwara Eliya and Trincomalee
with 12 percent respectively. Illiteracy is also greater among the poorest 20 percent of the women (18%) and
gradually declines with increased wealth to less than 1 percent among the richest women (see Table 3.3).

36 Demographic and Health Survey - 2016, Sri Lanka

Table 3.3 Literacy
Percent distribution of ever-married women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according
to background characteristics, Sri Lanka 2016
No schooling or primary school

Background char- Higher Can read Can read Cannot No card Blind/ Total Per- Number of
acteristic than a whole part of a read at all with visually centage ever-mar-
secondary sentence sentence required impaired literate1 ried
schooling language women

Age
15-24 45.0 47.1 4.4 3.2 0.3 0.0 100.0 96.5 1,639
15-19 28.5 59.1 7.2 5.2 0.0 0.0 100.0 94.8 229
20-24 47.7 45.2 3.9 2.9 0.3 0.0 100.0 96.7 1,410
25-29 54.4 39.3 3.6 2.5 0.1 0.0 100.0 97.3 2,620
30-34 54.1 39.3 3.6 3.0 0.1 0.1 100.0 96.9 3,615
35-39 47.3 42.5 4.3 5.6 0.2 0.1 100.0 94.2 3,945
40-44 43.0 41.9 7.1 7.6 0.1 0.3 100.0 92.0 3,269
45-49 38.7 40.6 8.5 11.2 0.2 0.8 100.0 87.8 3,214

Residence
Urban 57.0 32.9 4.7 4.5 0.8 0.1 100.0 94.6 2,855
Rural 46.6 43.1 4.9 5.1 0.0 0.3 100.0 94.6 14,737
Estate 19.0 38.9 16.5 25.2 0.2 0.2 100.0 74.4 710

District
Colombo 60.1 33.3 2.1 3.4 1.1 0.0 100.0 95.5 1,731
Gampaha 57.7 37.0 2.8 2.4 0.0 0.2 100.0 97.4 1,845
Kalutara 50.3 41.7 2.7 4.8 0.0 0.6 100.0 94.7 1,104
Kandy 51.1 36.4 4.2 8.1 0.0 0.1 100.0 91.8 1,223
Matale 43.6 45.2 5.5 5.0 0.0 0.7 100.0 94.3 490
Nuwara Eliya 31.1 44.9 11.7 12.3 0.0 0.1 100.0 87.6 572
Galle 45.6 44.5 4.6 4.9 0.0 0.4 100.0 94.7 935
Matara 51.2 42.1 2.0 4.2 0.0 0.5 100.0 95.4 718
Hambantota 51.2 41.9 2.7 3.9 0.2 0.0 100.0 95.9 556
Jaffna 50.5 36.1 6.5 5.7 0.0 1.2 100.0 93.2 471
Mannar 36.1 43.7 15.1 4.5 0.0 0.6 100.0 94.9 81
Vavuniya 54.4 26.5 9.5 8.8 0.0 0.9 100.0 90.3 136
Mullaitivu 38.9 41.6 10.2 7.8 0.0 1.4 100.0 90.8 81
Kilinochchi 27.3 56.7 7.6 8.2 0.0 0.2 100.0 91.6 94
Batticaloa 40.4 32.4 12.4 14.8 0.0 0.0 100.0 85.2 531
Ampara 38.4 35.8 16.5 9.2 0.0 0.1 100.0 90.7 731
Trincomalee 41.6 29.7 16.0 12.6 0.0 0.1 100.0 87.2 362
Kurunegala 44.3 47.9 4.3 3.3 0.0 0.2 100.0 96.4 1,592
Puttalam 34.1 51.8 8.4 5.8 0.0 0.0 100.0 94.2 664
Anuradhapura 52.5 40.1 5.2 2.2 0.0 0.0 100.0 97.8 984
Polonnaruwa 32.4 56.1 4.6 6.3 0.0 0.6 100.0 93.1 399
Badulla 40.1 39.6 7.3 12.3 0.8 0.0 100.0 87.0 735
Monaragala 42.2 47.5 4.9 5.2 0.0 0.2 100.0 94.6 485
Ratnapura 35.4 53.3 2.9 8.3 0.0 0.1 100.0 91.5 1,084
Kegalle 53.2 40.9 3.1 2.8 0.0 0.0 100.0 97.2 698

Wealth quintile
Lowest 19.1 49.5 13.3 17.6 0.1 0.4 100.0 81.9 3,390
Second 33.2 53.2 6.7 6.5 0.1 0.3 100.0 93.1 3,695
Middle 43.8 48.6 3.9 3.4 0.1 0.2 100.0 96.3 3,838
Fourth 57.6 38.1 2.1 1.8 0.3 0.2 100.0 97.8 3,816
Highest 80.7 17.2 1.2 0.6 0.1 0.1 100.0 99.2 3,562

Total 47.2 41.4 5.3 5.8 0.1 0.2 100.0 93.8 18,302
1
Refers to women who attended schooling higher than the secondary level and women who can read a whole sentence or part of a sen-
tence

Characteristics of Respondents 37
3.4 Exposure to mass media

Exposure to mass media

Respondents were asked how often they read a newspaper, listened to the radio or
watched television. Those who responded at least once a week are considered to
be regularly exposed to that from of media.

Access to information through the media is essential to increase people’s knowledge and awareness
of what takes place around them. The 2016 SLDHS assessed exposure to media by asking respondents if
they listened to the radio, watched television, or read newspapers or magazines at least once a week. This
information could be used effectively in determining the optimal media to use in passing health messages and
other information to the public, and specific target populations.
Table 3.4 shows that television is most the popular mass medium (81 percent) among ever-married
women, followed by radio (56 percent). Reading the newspaper is less popular (41 percent). It is also
important to note that 24 percent women are exposed to all three media, and 12 percent are not exposed to
any of the three media on a weekly basis. Estate women are less likely than urban women to have regular
exposure to any form of mass media (8 percent versus 17 percent).
District of residence shows important differentials in media access by ever-married women. The
percentage of women with no access to any of the three media at least once a week is highest in Kilinochchi
(37 percent), Trincomalee (28 percent), Kegalle (27 percent), Moneragala (19 percent), Batticaloa (19
percent), Ampara (18 percent) and, Mullaitivu (16 percent). Altogether, in 14 out of the 25 districts at least
10 percent of the ever-married women have no regular exposure to mass media.
Exposure to all three media increases with the level of education (from 1 percent for those with no
education to 45 percent for the highest education group). Media exposure is positively related to the wealth
of the households in which ever-married reside, going from 25 percent with no mass media access among
women in the poorest quintile to just 6 percent among those in the richest one.

38 Demographic and Health Survey - 2016, Sri Lanka

Table 3.4 : Exposure to Mass Media
Percentage of ever-married women age 15-49 who are exposed to specific media on a weekly basis, by background
characteristics, Sri Lanka 2016
Background characteristic Reads a Watches Listens to Accesses Accesses Number of
newspaper television the radio all three none of ever-mar-
at least at least at least media at the three ried
once a once a once a least once media at women
week week week a week least once
a week
Age
15-19 40.1 82.5 50.0 25.5 9.4 229
20-24 39.4 82.4 51.4 24.5 10.6 1,410
25-29 42.6 84.4 48.8 24.8 9.4 2,620
30-34 41.4 80.9 49.2 23.6 10.4 3,615
35-39 41.1 80.6 52.1 24.3 10.5 3,945
40-44 43.4 79.0 52.1 26.2 12.1 3,269
45-49 38.8 77.2 50.0 23.2 13.4 3,214

Residence
Urban 51.6 83.3 50.1 27.5 7.5 2,855
Rural 39.7 80.3 50.6 24.0 11.6 14,737
Estate 31.0 73.2 53.0 19.9 16.5 710

District
Colombo 59.0 85.5 51.1 30.7 6.0 1,731
Gampaha 53.9 83.8 51.7 30.7 8.6 1,845
Kalutara 49.0 84.0 54.8 28.2 7.3 1,104
Kandy 46.0 78.0 52.4 25.8 10.3 1,223
Matale 26.9 83.9 49.7 15.4 7.7 490
Nuwara Eliya 41.1 81.0 68.2 30.8 9.3 572
Galle 45.8 79.9 59.8 28.2 9.0 935
Matara 52.5 88.4 66.8 36.6 4.3 718
Hambantota 39.0 88.6 65.4 31.0 4.1 556
Jaffna 57.6 73.9 48.1 30.4 12.5 471
Mannar 52.0 82.0 60.4 41.6 10.3 81
Vavuniya 64.9 80.9 58.3 41.1 9.4 136
Mullaitivu 43.4 61.5 44.5 17.1 16.3 81
Kilinochchi 29.7 46.9 29.8 12.5 37.0 94
Batticaloa 22.8 72.8 35.6 12.4 18.8 531
Ampara 25.2 74.6 53.2 18.2 18.0 731
Trincomalee 31.9 63.3 40.1 17.9 28.1 362
Kurunegala 33.1 79.1 43.1 17.9 13.7 1,592
Puttalam 36.1 81.2 51.9 22.1 8.5 664
Anuradhapura 35.6 83.8 49.5 24.7 13.0 984
Polonnaruwa 33.1 82.8 53.5 19.8 10.0 399
Badulla 31.0 79.2 56.2 21.7 12.1 735
Moneragala 18.6 77.3 27.5 10.4 18.8 485
Ratnapura 29.1 83.9 46.3 14.5 6.5 1,084
Kegalle 38.5 68.3 30.6 20.5 26.8 698

Education
No education 0.6 49.4 40.4 0.6 37.4 285
Passed Grade 1-5 7.2 62.5 40.1 3.7 26.7 1,257
Passed Grade 6-10 32.0 80.2 47.8 18.7 11.8 8,130
Passed G.C.E.(O/L) or equivalent 48.2 83.5 53.7 28.7 8.7 4,044
Passed G.C.E.(A/L) or equivalent 60.5 85.6 55.7 36.1 6.1 3,731
Degree and above 75.4 83.4 58.2 45.2 6.8 856

Wealth quintile
Lowest 24.5 61.6 37.2 10.7 24.9 3,390
Second 31.1 80.1 46.2 17.3 11.5 3,695
Middle 37.9 85.7 51.4 22.6 8.2 3,838
Fourth 47.4 86.9 58.4 30.8 6.7 3,816
Highest 64.5 86.4 58.6 39.7 5.6 3,562

Total 41.2 80.5 50.6 24.4 11.1 18,302

Characteristics of Respondents 39
3.5 Internet usage

Table 3.5: Internet usage

Table 3.5 shows that almost
Percentage of ever-married women age 15-49 who have ever used the internet ever,
and percentage who have used the internet in the past 12 months, according to one in five (18 percent) of ever-
background characteristics, Sri Lanka 2016 married women age 15-49 have ever
Background characteristic Ever used Used the Number of
the internet internet in ever-mar- used the internet. This table also
the past 12 ried women indicates that only 16 percent of the
months
Age ever-married women have used the
15-19 21.3 18.5 229 internet in the past 12 months.
20-24 26.1 22.5 1,410
25-29 27.7 25.4 2,620 As expected, internet use is
30-34 23.8 21.7 3,615
35-39 16.6 14.8 3,945
higher among younger cohorts but
40-44 12.8 11.3 3,269 is at its highest among women 25-
45-49 8.6 7.4 3,214
Residence
29 years of age. Similarly, place of
Urban 35.1 32.9 2,855 residence predicts internet use well,
Rural 15.7 13.8 14,737 with the highest percentages in the
Estate 4.4 3.7 710
District urban sector (33 percent used in the
Colombo 39.1 37.1 1,731 past 12 months, compared to just
Gampaha 27.0 24.7 1,845
Kalutara 20.2 18.7 1,104 14 percent and 3 percent in the rural
Kandy 25.4 23.1 1,223 and estate sectors respectively) and
Matale 17.5 13.6 490
Nuwara Eiya 7.3 6.3 572
urban districts (Colombo, 37 percent,
Galle 18.0 15.9 935 Gampaha, 25 percent, and Kalutara,
Matara 13.2 12.0 718 19 percent).
Hambantota 14.3 11.1 556
Jaffna 17.8 17.2 471
Mannar 8.6 7.7 81
Education and household
Vavuniya 16.6 14.7 136 wealth also are good predictors of
Mullaitivu 9.1 8.2 81 internet use. Sixty eight percent of
Kilinochchi 9.6 9.3 94
Batticaloa 16.2 15.3 531 ever-married women with “degree
Ampara 11.7 9.8 731 and above” have used the internet
Trincomalee 18.8 17.0 362
Kurunegala 14.2 11.7 1,592 during the 12 months before the
Puttalam 15.6 13.5 664 survey, compared to five percent or
Anuradhapura 11.7 10.5 984
Polonnaruwa 9.7 8.4 399
less among those with no education,
Badulla 12.4 10.3 735 primary or secondary education
Moneragala 7.4 5.3 485 (passed grade 1-5 or passed grade
Ratnapura 11.6 9.2 1,084
Kegalle 9.4 8.6 698 6-10). Almost half (46 percent) of
Education ever-married women in the richest
No education 1.1 0.7 285
Passed Grade 1-5 2.0 0.9 1,257 households have used the internet
Passed Grade 6-10 6.5 5.3 8,130 in the last 12 months, compared to
Passed G.C.E.(O/L) or equivalent 17.0 14.9 4,044
Passed G.C.E.(A/L) or equivalent 40.1 36.6 3,731
only 2 percent of those in the poorest
Degree and above 71.8 68.4 856 households, a dramatic difference
Wealth quintile
Lowest 3.3 2.2 3,390
(see Table 3.5).
Second 6.8 5.3 3,695
Middle 11.0 9.2 3,838
Fourth 21.3 18.8 3,816
Highest 49.1 46.4 3,562
Total 18.3 16.4 18,302

3.6 Employment
Measuring employment status is difficult in part because some work, especially work in a family business
or in the informal sector, may not be perceived as employment. To avoid underestimating respondents’
employment, ever-married women were asked several questions to determine if they were employed or not.
They were asked whether, aside from household work, they were working in the seven days before the
survey. At the time of the survey, 33 percent of ever-married women age 15-49 indicated to be employed
(see Table 3.6). The proportion employed is lowest among women age 15-19 (7 percent) and peaks at 42

40 Demographic and Health Survey - 2016, Sri Lanka

percent in the 45-49 age group. The proportion of women employed decreases with increasing early levels
of education. Thus, 57 percent of women with no education are employed compared with 26 percent of

Table 3.6 Employment status

Percent distribution of ever-married women age 15-49 by employment status, according to
background characteristics, Sri Lanka 2016
Background characteristic Currently em- Total Number of
ployed1 ever-married
women
Age
15-19 6.9 6.9 229
20-24 17.3 17.3 1,410
25-29 24.4 24.4 2,620
30-34 30.7 30.7 3,615
35-39 33.8 33.8 3,945
40-44 40.3 40.3 3,269
45-49 42.2 42.2 3,214
Marital status
Married or living together 31.3 31.3 17,257
Divorced/separated/widowed 58.7 58.7 1,045
Number of living children
0 40.0 40.0 1,873
1-2 31.8 31.8 11,489
3-4 33.0 33.0 4,584
5+ 28.2 28.2 355
Residence
Urban 34.2 34.2 2,855
Rural 31.6 31.6 14,737
Estate 53.4 53.4 710
District
Colombo 39.0 39.0 1,731
Gampaha 36.8 36.8 1,845
Kalutara 41.4 41.4 1,104
Kandy 31.5 31.5 1,223
Matale 39.3 39.3 490
Nuwara Eliya 41.5 41.5 572
Galle 38.2 38.2 935
Matara 34.9 34.9 718
Hambantota 26.4 26.4 556
Jaffna 32.4 32.4 471
Mannar 17.4 17.4 81
Vavuniya 19.8 19.8 136
Mullaitivu 29.6 29.6 81
Kilinochchi 29.8 29.8 94
Batticaloa 22.7 22.7 531
Ampara 17.7 17.7 731
Trincomalee 20.3 20.3 362
Kurunegala 34.5 34.5 1,592
Puttalam 28.9 28.9 664
Anuradhapura 20.3 20.3 984
Polonnaruwa 27.1 27.1 399
Badulla 38.0 38.0 735
Moneragala 24.4 24.4 485
Ratnapura 37.0 37.0 1,084
Kegalle 31.3 31.3 698
Education
No education 57.0 57.0 285
Passed Grade 1-5 39.8 39.8 1,257
Passed Grade 6-10 26.3 26.3 8,130
Passed G.C.E.(O/L) or equiv- 24.6 24.6 4,044
alent
Passed G.C.E.(A/L) or equiv- 40.1 40.1 3,731
alent
Degree and above 84.7 84.7 856
Wealth quintile
Lowest 32.3 32.3 3,390
Second 29.2 29.2 3,695
Middle 28.7 28.7 3,838
Fourth 31.1 31.1 3,816
Highest 43.6 43.6 3,562
Total 32.9 32.9 18,302
1
"Currently employed" is defined as having done work in the past seven days. Includes per-
sons who did not work in the past seven days but who are regularly employed and were absent
from work for leave, illness, vacation, or any other such reason.

Characteristics of Respondents 41
women who completed secondary level. However, among women with more than secondary education it is
37 percent (see Figure 3.2).

Figure 3.2 Percentage of currently employed ever married women among age
15-49 by level of education

57
Percent

40
37
33
26

No education Primary Secondary More than Total

secondary
Level of education

3.7 Occupation
Women who had worked in the 7 days before the survey were asked about their occupations. As
shown in Table 3.7 and Figure 3.3, over one-quarter of employed women work in professional, technical, or
managerial positions and almost one-sixth work in sales and services. Over one-third of employed women
are unskilled manual workers. In urban areas, the most common occupations are Professional/Technical /
Managerial

Figure 3.3 Percentage of ever-married women age 15-49 by occupation

Occupation

Agricul-ture 4

Clerical 8

Skilled manual 11

Sales and services 17

Professi-onal/
26
technical/…

Unskilled manual 34

0 5 10 15 20 25 30 35 40

Percent

42 Demographic and Health Survey - 2016, Sri Lanka

Table 3.7 Occupation
Percent distribution of ever-married women age 15-49 currently working by occupation, according to background characteris-
tics, Sri Lanka 2016
Background characteristic Profes- Cleri- Sales Skilled Un- Agricul- Total Number
sional/ cal and ser- manual skilled ture of ev-
technical/ vices manual er-mar-
manage- ried
rial women
Age
15-19 * * * * * * 100.0 16
20-24 21.1 6.8 13.8 22.4 33.5 2.4 100.0 244
25-29 28.4 13.6 13.1 12.7 29.6 2.7 100.0 640
30-34 31.4 10.2 15.6 11.2 28.9 2.6 100.0 1,110
35-39 25.6 7.7 18.1 11.3 32.5 4.9 100.0 1,334
40-44 24.3 5.7 18.9 9.3 37.0 4.8 100.0 1,318
45-49 23.1 5.4 18.9 8.3 38.7 5.6 100.0 1,355

Marital status
Married or living together 26.7 8.3 17.1 10.8 32.9 4.3 100.0 5,402
Divorced/separated/widowed 19.0 3.7 19.3 11.1 42.7 4.2 100.0 614

Number of living children

0 33.6 14.8 15.2 14.5 20.5 1.4 100.0 749
1-2 28.0 8.4 17.2 11.1 31.8 3.5 100.0 3,656
3-4 18.6 3.3 18.2 8.4 44.2 7.2 100.0 1,512
5+ 4.5 1.4 19.8 8.6 57.9 7.8 100.0 100

Residence
Urban 30.4 12.6 23.3 10.4 22.9 0.5 100.0 977
Rural 26.5 7.4 16.4 11.5 34.2 4.0 100.0 4,660
Estate 7.7 0.3 12.5 3.6 59.4 16.5 100.0 379

District
Colombo 30.8 13.3 28.6 10.6 16.5 0.2 100.0 675
Gampaha 23.8 8.9 26.9 22.4 17.8 0.3 100.0 679
Kalutara 30.2 4.3 16.6 9.8 35.1 4.0 100.0 458
Kandy 34.5 7.5 17.1 9.8 25.9 5.2 100.0 386
Matale 16.2 6.3 13.9 11.3 51.1 1.1 100.0 192
Nuwara Eliya 13.4 2.6 8.7 2.9 52.7 19.8 100.0 238
Galle 13.6 6.0 13.5 5.7 58.1 3.1 100.0 357
Matara 55.5 5.2 15.8 3.9 10.3 9.2 100.0 250
Hambantota 24.8 4.9 21.5 18.6 25.5 4.6 100.0 147
Jaffna 26.3 20.2 10.6 5.9 35.4 1.7 100.0 153
Mannar * * * * * * 100.0 14
Vavuniya (27.3) (13.8) (21.4) (1.8) (26.3) (9.4) 100.0 27
Mullaitivu * * * * * * 100.0 24
Kilinochchi (5.3) (23.6) (10.3) (14.7) (38.0) (8.1) 100.0 28
Batticaloa 2.1 22.6 10.9 19.8 40.0 4.6 100.0 121
Ampara 2.3 6.8 10.0 11.2 67.4 2.2 100.0 129
Trincomalee 27.0 15.2 11.1 9.2 37.6 0.0 100.0 73
Kurunegala 32.1 5.0 10.9 5.7 45.0 1.2 100.0 549
Puttalam 27.2 7.5 23.4 13.3 17.0 11.8 100.0 192
Anuradhapura 25.6 6.9 5.6 4.5 54.8 2.6 100.0 199
Polonnaruwa 22.9 2.7 28.8 16.3 19.5 9.8 100.0 108
Badulla 22.0 4.3 7.0 1.4 64.6 0.7 100.0 280
Moneragala 39.2 6.7 19.6 4.4 29.3 0.8 100.0 118
Ratnapura 21.6 4.1 7.0 18.9 36.8 11.5 100.0 401
Kegalle 22.6 9.3 34.0 13.2 15.5 5.4 100.0 218

Education
No education 9.0 0.0 21.2 2.5 62.7 4.6 100.0 162
Passed Grade 1-5 8.2 0.0 12.7 8.0 60.4 10.7 100.0 500
Passed Grade 6-10 11.5 1.1 17.8 17.6 45.2 6.8 100.0 2,140
Passed G.C.E.(O/L) or equivalent 19.6 7.2 24.7 14.4 30.3 3.7 100.0 995
Passed G.C.E.(A/L) or equivalent 38.8 18.9 17.0 5.5 19.0 0.8 100.0 1,495
Degree and above 66.7 12.8 8.5 0.4 11.6 0.0 100.0 724

Wealth quintile
Lowest 10.0 1.6 12.7 11.9 54.6 9.2 100.0 1,097
Second 15.3 3.2 17.9 14.2 43.1 6.2 100.0 1,079
Middle 20.3 6.5 18.4 15.4 34.7 4.6 100.0 1,101
Fourth 28.4 10.3 19.6 11.1 28.4 2.3 100.0 1,186
Highest 46.6 14.4 17.6 4.2 16.6 0.6 100.0 1,554

Total 25.9 7.8 17.3 10.8 33.9 4.2 100.0 6,016

Note: An asterisk indicated a figur is based on dewer than 25 unweightd cases and has been suppressed and Figures
in parentheses are based on 25-49 unweciqhted cases.

Characteristics of Respondents 43
The type of occupation of ever-married women has an interesting association with the number of children.
On the one hand, greater participation in professional/technical/managerial, clerical, sales and services, and
skilled manual occupation are observed among women with lower numbers of living children. At the same
time, unskilled manual occupations tend to increase with the number of living children (see Table 3.7). For
example, the percentage of ever-married women working in professional/technical/managerial occupations
changes from 34 percent among those with no children to only 5 percent among those with 5+ living children.
This compares to those working in unskilled manual occupations where only 21 percent of childless women
work in such an occupation, compared to almost sixty percent (58 percent) among those with 5+ living
children. This pattern is similar across sector residence, with the Estate sector highly influenced by unskilled
manual and agricultural occupations.
At the district level, there are clusters of districts with higher percentages of either skilled or unskilled
occupations reflecting somehow the level of development of the country. Of particular importance is the high
percentage of unskilled manual and agriculture occupations observed in 6 of the 25 districts (50 percent or
more of the ever-married women): Nuwara Eliva (73 percent), Ampara (70 percent), Badulla (65 percent),
Galle (62 percent), Anuradhapura (57 percent), and Matale (52 percent).

44 Demographic and Health Survey - 2016, Sri Lanka

 Fertility Levels, Diferentials
and Trends 4
Key Findings
• Total Fertility Rate (TFR): The Total Fertility Rate (TFR) for the three years preced-
ing the survey is 2.2 births per woman.
• TFR trends: The TFR from the 2006/07 SLDHS, 2.3 and the TFR estimated from
the 2012 Population Census is 2.4.
• The fertility of women age 25-34 has increased while, among women in the other
age groups it has decreased over the past 20 years.
• TFR differentials: The TFR for the richest wealth quintile is 2.3 while the TFR for
the poorest quintile is 2.2.
• Number of children: Women age 40-49 in kilinochchi, Batticaloa and Trincomalee
have on average more than 3 children.
• Birth intervals: More than half of births (other than first birth) in the country occur
within five years of the previous birth, with 33 percent of births occurring in the in-
terval of 24-27 months.
• Teenage pregnancy: Thirty women out of thousands of age 15-19 have begun
childbearing.

F
ertility is one of the three principal components of population dynamics that determine the size and
structure of the population of a country. The other two are mortality and migration. One of the main
objectives of 2016 SLDHS was to identify current levels of fertility, as well as the recent trends and
the differentials of fertility in the country. Population growth related policies are often formulated depending
on the fertility trends.
The Sri Lanka Demographic and Health Survey (2016 SLDHS), collected data on fertility through
a number of questions asked of all ever married women including a complete birth history and a set of ques-
tions that can also help to produce indirect estimates of fertility (number of live births they had given birth to
during their lifetime, number of sons and daughters living with them, the number living elsewhere, and the
number who had died) as well as serve as a basis for questions on child health.
This chapter presents current fertility levels, fertility differentials, fertility trends, children ever born
and living, birth intervals, the age at which women initiate childbearing, and teenage pregnancy and moth-
erhood. Current fertility and fertility differentials are used to study the trends in fertility by comparing with
past fertility levels. Information on children ever born and living is an important measure used to monitor
the population growth. Statistics on birth intervals often reveal an association with infant and child mortality.
The age at first birth gives insight into the social and economic impacts of motherhood. The extent of teenage
pregnancy and motherhood is an important indicator for planning for the health and wellbeing of both the
mother and the child.

4.1 Current fertility levels

Total fertility rate

The average number of children a woman would have by the end of her childbearing years if she bore
children at the current age-specific fertility rates. Age-specific fertility rates are calculated for the 3
years before the survey, based on detailed birth histories provided by women.
sample : Women age 15-49

Fertility Levels, Diferentials and Trends 45

 Current fertility is measured through age specific fertility rates (ASFR), the total fertility rate (TFR),
the general fertility rate (GFR), and the crude birth rate (CBR). The ASFRs provide the age pattern of fertility.
The total fertility rate indicates the number of children a woman would have if she experienced the current
age-specific fertility rates at each age of her reproductive life (15-49 years). ASFRs are calculated by divid-
ing the number of births to women in a specific age group by the number of woman-years lived during a given
period.
Figure 4.1 shows the ASFR of the women of age 15-49.Age specific fertility rates reveals young age
fertility is low in the country. The fertility rate is highest among the women of age 25-34.

Figure 4.1 Age Specific Fertility Rates

The measures of
200
fertility presented
in this chapter refer
143 to the three-year
150 period prior to the
Number of Children

survey. Table 4.1

115
shows the current
100 fertility levels
86 of women in Sri
55 Lanka. The ASFRs
50 are indicative
of a late fertility
21 10 population with
0 1 low fertility levels.
15-19 20-24 25-29 30-34 35-39 40-44 45-49

Age Group

Figure 4.2 depicts the total fertility rates of countries in the region. Sri Lanka has the lowest TFR
among the other countries in the region compared here. The latest rate available for the total fertility of the
countries are used for comparison

Figure 4.2 Total Fertility Rates in the region

4.5

4 3.8

3.5

3 2.7 2.7
2.6
2.5 2.2 2.3 2.3
TFR

1.5

0.5

0
Sri Lanka Bangladesh Myanmar Nepal India Cambodia Pakistan
2016 2014 2015-2016 2011 2005-2006 2014 2012-2013

Year

46 Demographic and Health Survey - 2016, Sri Lanka

 A TFR of 2.1 children per woman is considered to be a replacement level fertility that is a fertility
that in the long run and if kept constant will replace the existing generations. Below the replacement level,
fertility will eventually produce, in the absence of considerable migration flows, a decreasing population.
The GFR for Sri Lanka is 72, which means that there were 72 births for every 1,000 women of re-
productive age during the three-year period preceding the survey. The CBR for the period is 15.7 per 1,000
populations.

Table 4.1 Current fertility

Age-specific and total fertility rates, the general fertility rate, and the crude birth rate for the
three years preceding the survey, Sri Lanka 2016
Age group Total

15-19 21
20-24 86
25-29 143
30-34 115
35-39 55
40-44 10
45-49 1

TFR(15-49) 2.2
GFR 72
CBR 15.7

Notes: Age-specific fertility rates are per 1,000 women. Rates for age group 45-49 may be
slightly biased due to truncation. Rates are for the period 1-36 months prior to interview.
TFR: Total fertility rate expressed per woman
GFR: General fertility rate expressed per 1,000 women age 15-44
CBR: Crude birth rate, expressed per 1,000 population

4.2 Fertility differentials

Table 4.2 presents the TFR, the percentage of women currently pregnant and, the number of children
ever born to women 40-49 (CEB) by background characteristics. The TFR represents hypothetical current
fertility, while the CEB measures the cumulated fertility of women 40-49 during most of their reproductive
period (15-39 and assuming low levels of fertility during the last ten years that is from age 40-49). There is
not that much difference between the TFR (2.2) and the CEB (2.3), indicating perhaps a relatively constant
fertility in Sri Lanka during the last 25 years. This is also supported by the low percentage of current
pregnancies (3 percent) among women 15-49
Women with no education would have 1.6 children by the end of her childbearing period while the
women who passed grade 1-5 would have 2.5 children in their reproductive live span. The Mean number of
children ever-born among women 40-49 for these educational groups is 2.5 and 2.6 respectively. The high
level of use of female sterilization among women with no education (44 percent) may in part explain this
difference.

Fertility Levels, Diferentials and Trends 47

 Table 4.2 Fertility by background characteristics
Total fertility rate for the three years preceding the survey, percentage of women age 15-
49 currently pregnant, and mean number of children ever born to women age 40-49 years,
by background characteristics, Sri Lanka 2016
Background characteristic Total fertility Percentage of Mean number
rate women age of children
15-49 current- ever born to
ly pregnant women age
40-49

District
Colombo 1.8 1.5 2.0
Gampaha 1.8 3.8 2.0
Kalutara 2.2 1.8 2.1
Kandy 2.6 3.3 2.1
Matale 1.9 2.4 2.4
Nuwara Eliya 2.2 2.8 2.4
Galle 2.1 3.3 2.3
Matara 2.3 3.9 2.2
Hambantota 1.9 2.0 2.5
Jaffna 2.1 2.4 2.8
Mannar 2.0 3.9 2.8
Vavuniya 2.0 2.5 2.8
Mullaitivu 2.0 1.4 2.9
Kilinochchi 2.1 2.7 3.4
Batticaloa 2.4 3.9 3.0
Ampara 2.4 4.1 2.8
Trincomalee 2.3 3.6 3.1
Kurunegala 2.2 3.7 2.2
Puttalam 2.1 3.5 2.5
Anuradhapura 2.4 3.7 2.2
Polonnaruwa 2.5 4.0 2.3
Badulla 2.3 3.1 2.4
Moneragala 2.4 3.8 2.7
Ratnapura 1.8 2.2 2.2
Kegalle
2.6 4.1 2.0
Education
No education 1.6 0.8 2.5
Passed Grade 1-5 2.3 1.3 2.8
Passed Grade 6-10 2.4 3.1 2.4
Passed G.C.E.(O/L) or equivalent 2.1 3.3 2.1
Passed G.C.E.(A/L) or equivalent 2.1 3.7 1.9
Degree and above
2.0 6.1 1.8
Wealth quintile
Lowest 2.2 2.8 2.7
Second 2.1 2.9 2.4
Middle 2.0 3.1 2.2
Fourth 1.9 2.6 2.2
Highest 2.3 3.6 2.1

Total 2.2 3.3 2.3

Note: Total fertility rates are for the period 1-36 months prior to interview.

48 Demographic and Health Survey - 2016, Sri Lanka

The TFR for the lowest wealth quintile is 2.2 and for the highest it is 2.3. The mean number of children ever
born at age 40-49 is 2.7 in the lowest and 2.1 in the highest quintile, testifying in this way to the high levels
of fertility in the past among women of the poorest households, a situation that seems to have changed in the
younger cohorts of women in the poorest households.

Figure 4.3 Total Fertility Rates and Children Ever Born among
Women 40-49 by level of education

Degree and above

Level of Education

Passed G.C.E.(A/L) or equivalent

Passed G.C.E.(O/L) or equivalent

Passed Grade 6-10

Passed Grade 1-5

No education

0 0.5 1 1.5 2 2.5 3

Mean Number of children ever born to women age 40-50

Total Fertility rate

Figure 4.4 shows the TFR by districts, the TFR for Colombo, Gampaha and Ratnapura is 1.8 and it is
the lowest compared to the TFR 2.6 for Kandy and Kegalle, followed by Polonnaruwa 2.5. The highest mean
number of children ever born for the age group 40-49 (CEB) was observed in the Kilinochchi district (3.4),
while the lowest values are observed among the women 40-49 of Colombo, Gampaha and Kegalle districts
(2.0) (see table 4.2 and Figure 4.4).

Fertility Levels, Diferentials and Trends 49

 Figure 4.4 Total Fertility Rates by District, 2016 SLDHS

Jaffna

1.80 - 1.90
¯
Kilinochchi
1.91 - 2.10
Mullaitivu
2.11 - 2.30
> 2.31
Mannar
Vavuniya

Trincomalee
Anuradhapura

Puttalam Polonnaruwa

Batticaloa
Matale
Kurunegala

Kandy
Ampara
Gampaha Kegalle
Badulla

Nuwara Eliya
Colombo
Moneragala

Kalutara Ratnapura

Hambantota
Galle
Matara

0 15 30 60 90 120
Kilometers

50 Demographic and Health Survey - 2016, Sri Lanka

4.3 Fertility trends
Sri Lanka has experienced a continued fertility decline since the 1960’s. This decline can be observed
as happening in four phases. The first phase from 1963 to 1975 was a period of decline that was sharp and
dramatic when the total fertility rate dropped from 5.0 children per woman in 1963 to 3.4 in 1975 – that is a
decline of 1.6 children per woman in 12 years. During the second phase, between 1975 and 1987, the TFR
appears to slightly increase in 1982 but then declined to 2.8 in 1987. During the third phase, 1987- 2000,
the TFR decreased further by 0.54 to a TFR in 2000 of 1.9 children per woman (a below replacement level).
The fourth phase was a period of relative stability during the 2000s when the total fertility rate has fluctuated
between 2.3 and 2.2.

Figure 4.5 Total Fertility Rates during the period 1963-2016

5 5

3.7
4

2.8
TFR

3 2.3 2.3
3.4

2.2
2

1.9
1

0
1963 1975 1982 1987 1993 2000 2006 2016

Year

Figure 4.6 included below, shows the observed age specific fertility rates (ASFRs) obtained from
different sources during the period 1975-2016. These fertility patterns show that the young adult age groups
(15-19, 22-24, and 25-29) are the ones with the greater fertility declines during the last 35 years. It can be
observed that in 2016 there is a slight increase in the ASFRs of these same age groups but caution should be
taken when interpreting these trends since the values can be affected by sampling errors. It is also important
to mention that for all the surveys except the 1975 WFS the highest levels of fertility is observed for the 25-29
age groups.

Figure 4.6 Trends in the Age Specific Fertility Rates

(ASFR) during the period 1975-2016.

180

160

140
Births per 1000 women

120

100

80

60

40

20

0
15-19 20-24 25-29 30-34 35-39 40-44 45-49
Age Group

1975 WFS 1987 DHS 1993 DHS

2000 DHS 2006/07 DHS 2016 DHS

Fertility Levels, Diferentials and Trends 51

 Fertility trends can also be calculated using past fertility data obtained from a birth history from
a single survey. Table 4.3 shows the age specific fertility rates (ASFRs) obtained from the birth history
collected in the 2016 SLDHS by five year periods before the survey. The analysis reveals that teenage fertility
rates have declined over the years (from 30 during the 15-19-year period before the survey to just 22 during
the most recent period (0-4 years before the survey). A similar pattern is observed among women 20-24
years of age. Fertility among women in the 25-34 age group has been rising due in part to late age entry into
childbearing and increasing birth intervals producing lower levels of the total fertility rate as documented
before.

Table 4.3 Trends in age-specific fertility rates

Age-specific fertility rates for five-year periods preceding the survey, by mother’s age at the time
of the birth, Sri Lanka 2016
Number of years
preceding survey
Mother's age at birth 0-4 5-9 10-14 15-19

15-19 22 29 30 32
20-24 91 97 99 100
25-29 143 142 139 128
30-34 115 117 114 109
35-39 55 59 66 *
40-44 11 19 * *
45-49 1 * * *

Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated.
Rates exclude the month of interview.

4.4 Children ever born and living

The number of children ever born (CEB) to a woman is also called the cumulative fertility of a
woman. Table 4.4 presents the cumulative fertility for all women and currently married women by age groups.
For all women age 15-19, only 2 percent of them have had children, but 32 percent is the figure among the
current-married women. Around 70 percent of married women of the age 20-24 have children, 55 percent of
them have 1 child and 20 percent of them have more than one child. The mean number of children ever born
for all the women is 2.3 compared to 2.5 for currently married women.
Ten percent of currently married 15-49 women are childless; while this number for all women is 36
percent nearly 10 percent of all women and 5 percent of currently married women of the age group 45-49
don’t have children. The currently married women of the age group 45-49 can likely be identified as infertile.
The percentage of infertility is 5 percent, compared to 3 percent observed in the 2006-07 SLDHS
The difference between CEB and children surviving indicates also the prevalence of low levels of in-
fant and child mortality with small differences at all age groups, particularly among currently married women
(see last two columns of Table 4.4).

52 Demographic and Health Survey - 2016, Sri Lanka

 Table 4.4 Children ever born and living
Percent distribution of all women and currently married women age 15-49 by number of children ever born, mean number of children ever
born and mean number of living children, according to age group, Sri Lanka 2016
Number of children ever born
Age 0 1 2 3 4 5 6+ 7 8 9 10+ Total Num- Mean Mean
ber of num- number
women ber of of living
children children
ever
born
ALL WOMEN
Age
15-19 98.0 1.9 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 3,744 0.02 0.02
20-24 72.7 21.8 4.9 0.5 0.1 0.0 0.0 0.0 0.0 0.0 0.0 100.0 3,563 0.33 0.33
25-29 38.6 32.1 23.6 4.9 0.7 0.1 0.0 0.0 0.0 0.0 0.0 100.0 3,510 0.97 0.96
30-34 15.4 26.7 38.3 16.3 2.6 0.6 0.1 0.0 0.0 0.0 0.0 100.0 3,946 1.66 1.64
35-39 8.3 16.0 41.7 26.0 5.9 1.6 0.5 0.1 0.0 0.0 0.1 100.0 4,103 2.12 2.09
40-44 8.8 12.1 39.0 28.8 7.7 2.7 1.0 0.1 0.1 0.0 0.0 100.0 3,420 2.27 2.22
45-49 10.1 13.6 34.2 27.5 9.2 3.5 1.9 0.4 0.2 0.0 0.0 100.0 3,371 2.31 2.24

Total 35.9 17.7 26.2 14.9 3.7 1.2 0.4 0.1 0.0 0.0 0.0 100.0 25,656 1.38 1.36
CURRENTLY MARRIED WOMEN
Age
15-19 68.3 29.8 1.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 225 0.34 0.32
20-24 31.5 54.6 12.6 1.2 0.1 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,373 0.84 0.83
25-29 17.9 42.5 31.9 6.6 1.0 0.1 0.0 0.0 0.0 0.0 0.0 100.0 2,559 1.31 1.29
30-34 7.3 28.3 42.7 18.1 2.8 0.6 0.1 0.0 0.0 0.0 0.0 100.0 3,481 1.83 1.81
35-39 4.1 15.6 44.1 27.9 6.2 1.7 0.5 0.1 0.0 0.0 0.1 100.0 3,735 2.24 2.20
40-44 4.2 11.2 41.7 31.2 8.0 2.7 0.9 0.1 0.0 0.0 0.0 100.0 3,033 2.40 2.35
45-49 5.6 13.1 36.6 29.7 9.3 3.6 2.1 0.5 0.2 0.0 0.0 100.0 2,851 2.45 2.37

Total 10.1 24.2 37.3 21.1 5.0 1.6 0.6 0.1 0.0 0.0 0.0 100.0 17,257 1.94 1.91

4.5 Birth intervals

Median birth interval

Number of months since the preceding birth by which half of children are born.
sample : Non-first births in the 5 years before the survey

Birth intervals are very much related with the health and wellbeing of mother and child and they
affect fertility too. Children born within 3 years from a previous birth tend to have greater risks of creating
difficulties for maternal health and facing undernutrition issues. More than half of the births in Sri Lanka oc-
cur within a period of five years from the previous birth. On average, women of Sri Lanka have a 53 months
birth interval between births. Lower birth intervals are observed among women from the estate sector (43
months) and those with education of degree and above (42 months). The median birth intervals decrease with
the level of education of women from 61 months among those without education to 42 months among with
degree and above.
Figure 4.7 shows that the intervals between births (number of months) of educated women and the
estate women are more or less same. This implies that the fertility behavior of the estate women has changed
substantially in the recent past. Fertility behavior of women in terms of birth interval by wealth quintile re-
veals that differences between the poorest and richest quintiles are also quite narrow. (see Table 4.5).

Fertility Levels, Diferentials and Trends 53

Table 4.5 Birth intervals
Percent distribution of non-first births in the five years preceding the survey by number of months since preceding birth, and median
number of months since preceding birth, according to background characteristics, Sri Lanka 2016
Months since preceding birth
Background characteristic 7-17 18-23 24-35 36-47 48-59 60+ Total Number of Median num-
non-first ber of months
births since preced-
ing birth
Age
15-19 * * * * * * 100.0 4 *
20-29 5.3 7.3 18.1 23.3 18.3 27.7 100.0 1,217 46.1
30-39 2.9 5.1 13.7 17.6 16.0 44.7 100.0 3,251 55.9
40-49 1.7 3.3 9.5 14.9 12.7 57.8 100.0 506 67.2
Sex of preceding birth
Male 3.1 5.9 14.0 18.4 16.8 41.8 100.0 2,512 53.2
Female 3.6 5.1 14.8 18.9 15.7 41.9 100.0 2,467 54.0
Survival of preceding birth
Living 3.1 5.2 14.2 18.7 16.5 42.4 100.0 4,897 54.2
Dead 17.2 24.7 25.3 18.5 2.7 11.7 100.0 81 26.0
Birth order
2-3 3.4 5.3 13.9 18.7 16.6 42.0 100.0 4,532 53.9
4-6 2.5 7.4 18.4 17.5 12.4 41.7 100.0 438 52.0
7+ * * * * * * 100.0 9 *
Residence
Urban 4.7 7.2 16.6 20.2 12.9 38.4 100.0 744 49.4
Rural 3.0 5.0 13.4 18.3 16.8 43.4 100.0 4,000 55.2
Estate 5.0 7.8 24.3 19.6 16.8 26.5 100.0 235 43.5
District
Colombo 3.7 6.1 16.4 17.3 13.5 42.8 100.0 385 51.6
Gampaha 5.0 6.8 13.9 17.3 12.3 44.7 100.0 459 55.3
Kalutara 2.2 7.8 14.1 21.9 17.0 37.1 100.0 303 50.4
Kandy 2.6 5.7 15.9 23.1 18.7 34.0 100.0 377 50.9
Matale 4.9 8.0 10.2 21.3 12.7 43.0 100.0 128 53.2
Nuwara Eliya 3.0 6.1 22.4 24.9 15.3 28.3 100.0 184 44.7
Galle 3.3 5.4 11.1 18.8 20.9 40.5 100.0 246 52.6
Matara 4.8 2.1 9.4 24.4 16.4 42.9 100.0 204 54.0
Hambantota 2.4 4.8 17.1 16.6 16.0 43.2 100.0 162 54.1
Jaffna 4.5 10.9 20.1 17.0 17.4 30.1 100.0 116 47.3
Mannar 4.3 7.3 14.9 26.3 18.6 28.6 100.0 28 46.7
Vavuniya 4.9 8.9 11.9 22.8 16.4 35.2 100.0 42 50.7
Mullaitivu 3.2 2.1 19.0 22.9 15.7 37.1 100.0 25 52.4
Kilinochchi 2.5 7.9 11.4 21.6 26.8 29.7 100.0 30 50.0
Batticaloa 4.6 4.4 10.2 12.0 19.4 49.3 100.0 154 59.0
Ampara 3.9 5.3 17.1 18.5 18.1 37.1 100.0 229 51.9
Trincomalee 4.0 6.5 15.2 19.9 13.5 40.8 100.0 133 52.8
Kurunegala 2.4 3.7 14.4 18.1 17.4 44.0 100.0 388 55.6
Puttalam 2.3 6.8 13.1 16.9 15.8 45.2 100.0 173 56.3
Anuradhapura 3.3 4.0 11.3 14.0 17.3 50.1 100.0 265 60.1
Polonnaruwa 0.5 4.1 9.6 13.7 15.7 56.4 100.0 125 64.9
Badulla 3.7 4.9 17.8 15.9 18.5 39.2 100.0 201 51.6
Moneragala 2.0 4.0 14.9 16.4 21.6 41.0 100.0 151 55.1
Ratnapura 2.8 4.6 13.9 15.9 12.3 50.5 100.0 275 60.2
Kegalle 4.1 3.7 13.2 22.3 12.5 44.3 100.0 196 54.6
Education
No education 3.4 4.6 9.4 17.1 14.9 50.6 100.0 44 61.2
Passed Grade 1-5 1.6 4.9 14.8 15.1 11.1 52.5 100.0 232 61.4
Passed Grade 6-10 2.8 4.4 13.2 16.8 15.5 47.3 100.0 2,370 58.1
Passed G.C.E.(O/L) or equivalent 3.5 4.7 13.6 20.1 18.2 39.9 100.0 1,081 53.3
Passed G.C.E.(A/L) or equivalent 4.2 8.2 16.4 21.0 17.6 32.6 100.0 1,039 48.1
Degree and above 6.7 8.7 22.0 25.2 14.0 23.3 100.0 212 41.8
Wealth quintile
Lowest 2.8 6.1 15.7 16.9 16.4 42.0 100.0 1,091 54.2
Second 3.4 4.9 13.0 17.2 14.4 47.2 100.0 1,032 58.0
Middle 2.2 4.9 10.2 19.3 19.9 43.4 100.0 976 55.5
Fourth 3.6 5.1 16.5 19.1 15.3 40.4 100.0 1,037 52.5
Highest 5.1 6.6 16.6 21.5 15.1 35.1 100.0 843 48.2

Total 3.4 5.5 14.4 18.7 16.2 41.9 100.0 4,979 53.7
Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in
a live birth.

54 Demographic and Health Survey - 2016, Sri Lanka

 Figure 4.7 Birth intervals by level of education

Degree and above

Passed G.C.E.(A/L) or equivalent

Level of Education

Passed G.C.E.(O/L) or equivalent

Passed Grade 6-10

Passed Grade 1-5

No education

0 20 40 60 80 100
Percentage

< 2 years 2-5 years > 5 years

4.6 Age at first birth

Median age at first birth

Age by which half of women have had their first child.
sample : Women age 20-49 and 25-49

The age at which childbearing starts has important consequences for the overall level of fertility as
well as the health and welfare of the mother and the child. Early age at initiation of childbearing lengthens the
reproductive period. Table 4.6 shows the percentage of women age 15-49 who gave birth by exact ages, the
percentage who have never given birth, and the median age at first birth, according to current age. Medians
for women age 15-24 are not presented because less than 50 percent had given birth before age 15.

Table 4.6 Age at first birth

Percentage of women age 15-49 who gave birth by exact ages, percentage who have never given birth, and median age at first birth,
according to current age, Sri Lanka 2016
Percentage who gave birth by exact age
Current age 15 18 20 22 25 Percentage Number of Median age
who have never women at first birth
given birth
Age
15-19 0.0 na na na na 98.0 3,744 a
20-24 0.2 3.4 12.5 na na 72.7 3,563 a
25-29 0.3 4.5 14.3 27.3 45.7 38.6 3,510 a
30-34 0.2 5.4 14.2 26.4 46.3 15.4 3,946 25.6
35-39 0.3 5.3 13.9 26.7 47.1 8.3 4,103 25.5
40-44 0.3 5.9 14.8 26.7 44.9 8.8 3,420 25.8
45-49 0.2 5.1 15.0 28.1 45.2 10.1 3,371 25.8

20-49 0.2 5.0 14.1 na na 25.3 21,912 a

25-49 0.3 5.3 14.4 27.0 45.9 16.0 18,349 a

na = Not applicable due to censoring
a = Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group

Fertility Levels, Diferentials and Trends 55

 Table 4.6 shows that 46 percent of ev-
Table 4.7 Median age at first birth
er-married women age 25-49 in Sri Lanka
Median age at first birth among women age 25-49 (30-49) years, have initiated childbearing by the time they
according to background characteristics, Sri Lanka 2016
reach their 25th birthday. The median age at
Background characteristic Women age Women age
first birth in the country is 26 a slight increase
25-49 30-49
compared to the 2006-07 SLDHS which
showed 25 years. Note also that only 0.3 per-
Residence
cent of ever-married women have given birth
Urban a 26.5
Rural a 25.5
by age 15 compared to 5 percent by age 18.
Estate 24.9 24.6 Table 4.6 also reveals that 27 percent of
the women of age 25-49 gave their first birth
District before their 22nd birthday. The percentage of
Colombo a 27.0 women of age 25-29 who have never given
Gampaha a 26.8 birth is 39 percent, compared to the previous
Kalutara a 26.3 age group (20-24) which has 73 percent who
Kandy a 27.0 have never given birth. This fact confirms the
Matale 24.9 24.9 prevalence of a late fertility behavior among
Nuwara Eliya 24.9 25.0 ever-married women in Sri Lanka.
Galle a 26.8
Matara a 26.6 The median age at first birth by back-
Hambantota a 26.3 ground characteristics is presented in Table
Jaffna a 26.4 4.7. Among ever-married women age 30-49,
Mannar 24.9 24.5 we can observe some variation in the median
Vavuniya 24.7 24.9 age at first birth by place of residence, educa-
Mullaitivu 23.1 23.6 tion and household wealth. Thus, the median
Kilinochchi 23.9 24.1 value for the urban sector is two years higher
Batticaloa 23.6 23.7 (27 years) than the one observed in the estate
Ampara 24.2 24.5 sector Similar differences are observed by ed-
Trincomalee 23.4 23.2 ucation (28 for the highest levels of education
Kurunegala a 25.5 compared to just 22 for those without educa-
Puttalam 24.0 23.6 tion or some primary education) and wealth
Anuradhapura 23.9 23.8 (24 among the poorest compared to 28 years
Polonnaruwa 23.9 23.9 for the richest quintile).
Badulla 24.5 24.6
Moneragala 24.1 24.2
Ratnapura a 25.4
Kegalle a 26.3

Education
No education 22.9 22.7
Passed Grade 1-5 22.0 22.1
Passed Grade 6-10 23.6 23.8
Passed G.C.E.(O/L) or equivalent a 25.6
Passed G.C.E.(A/L) or equivalent a 28.2

Wealth quintile
Lowest 23.4 23.6
Second 24.7 24.7
Middle a 25.2
Fourth a 26.2
Highest a 27.5

Total a 25.6
a = Omitted because less than 50 percent of the women had a birth
before reaching the beginning of the age group

56 Demographic and Health Survey - 2016, Sri Lanka

4.7 Teenage pregnancy and motherhood

Teenage childbearing
Percentage of women age 15-19 who have given birth or are pregnant with their first child.
sample : Women age 15-19

Teenage pregnancy
Table 4.8 Teenage pregnancy and motherhood
and motherhood has remained
Percentage of women age 15-19 who have had a live birth or who are pregnant with their first a major health and social
child, and percentage who have begun childbearing, by background characteristics, Sri Lanka
2016 concern because it is associated
Percentage of women age 15-19 who: with social and health issues of
Background characteristic Have had a Are pregnant Percentage who Number of the mother and the child. The
live birth with first child have begun women compulsory and free education
childbearing
in the country aims to develop
Age the education standards of
15 0.0 0.2 0.2 721
16 0.3 0.5 0.7 724 each citizen of the country. The
17 0.4 0.8 1.1 809 women who become mothers
18 2.8 0.9 3.7 726
19 6.5 2.5 9.1 764 in their teenage years are more
likely to curtail their education.
Residence
Urban * * * 450 Teenage mothers are also
Rural 2.3 1.2 3.6 2,538 more likely to suffer from
Estate * * * 266
severe complications during
District pregnancy and childbirth,
Colombo * * * 2,272
Gampaha * * * 182
which can be detrimental to
Kalutara * * * 464 the health and survival of both
Kandy * * * 69
Matale * * * 616
mother and child.
Nuwara Eliya * * * 47
Galle * * * 90 Table 4.8 depicts that
Matara * * * 126 most of the child bearing in
Hambantota * * * 531
Jaffna * * * 209 teen ages occurs in the rural
Mannar * * * 4 sector and in the poorest
Vavuniya * * * 54
Mullaitivu * * * 9 groups of the wealth quintile.
Kilinochchi * * * 41 In Sri Lanka, only 30 out of
Batticaloa * * * 89
Ampara * * * 231
1000 ever-married women
Trincomalee * * * 192 begun child bearing in their
Kurunegala * * * 318
Puttalam * * * 88
teen ages.
Anuradhapura * * * 365
Polonnaruwa * * * 81
Badulla * * * 106
Moneragala * * * 110
Ratnapura * * * 399
Kegalle * * * 91

Education
Passed Grade 1-5 * * * 25
Passed Grade 6-10 3.0 1.3 4.3 1,919
Passed G.C.E.(O/L) or 0.9 0.9 1.8 1,441
equivalent
Passed G.C.E.(A/L) or * * * 188
equivalent

Wealth quintile
Lowest 1.9 1.5 3.5 992
Second 2.8 0.5 3.2 1,121
Middle 1.3 1.0 2.3 1,013
Fourth (0.4) (0.2) (0.5) 2,532
Highest * * * 90

Total 2.0 1.0 3.0 3,744

Fertility Levels, Diferentials and Trends 57

58 Demographic and Health Survey - 2016, Sri Lanka
Family Planning 5
Key Findings
• Knowledge of contraceptive methods: Almost all ever married women in
reproductive age have heard about family planning methods in Sri Lanka.
Both ever married and currently married women between 15-49 years have
heard about nine or more contraceptive methods.
• Contraceptive prevalence rate (CPR): National level CPR is 65 percent. In
the district of Mannar have the lowest at only 18 percent
• modern contraceptive use: Female sterilization is the most commonly used
contraceptive method, used by 14 percent of currently married women. IUD
is the most popular non-permanent contraceptive method, which is used by 11
percent of currently married women.
• Source of contraception: More than 90 percent of current users of female
sterilization, IUD, and implants obtain their services from government sector
institutions.
• informed choice: Only 53 percent of ever-married women currently using
modern contraceptive methods were informed about the potential side effects
or other problems associated with the method prior to use and just over half
(51 percent) were informed about what to do if they experienced such side
effects. Merely 42 percent of them were informed on the available other meth-
ods that can be used.
• Contraceptive discontinuation: At the time of the 2016 SLDHS, 35 percent
of currently married women indicated no use of contraceptive methods in the
5 years before the survey and another 29 percent of those women who be-
gan using a contraceptive method, discontinued the method in less than 12
months. The leading reasons for discontinuation is reported as their “desire to
become pregnant” (42 percent).
• Percentage of demand and unmet need for family planning: Total demand
for family planning is 72 percent. Ninety percent of demand is satisfied (74
percent by modern methods.) Unmet need is reported as 7.5 percent.

D
uring last few decades family planning assisted many couples to plan their reproductive lives. In
Sri Lanka, the first state run family planning clinic was opened in 1937, but it was not continued.
In 1965, family planning was combined with maternal and child health programmes and three years
later the Family Health Bureau (FHB) was established to coordinate family planning under the Ministry
of Health.
In the developing world, woman’s reproductive health mostly depends on government policies and
programmes providing access to contraceptive methods. Direct support entails the provision of family plan-
ning services through government-run facilities, such as hospitals, clinics, health posts, health centers and
through government fieldworkers. In Sri Lanka, free family planning services are given by primary care
facilities and hospitals. Public health nurses and midwives provide maternal and child health as well as fam-
ily planning services at the grass root level. Oral contraceptive methods and condoms are available without
prescription from pharmacies and government and private sector facilities are available island-wide for other
contraceptive methods.
Under the family planning components of the survey, 2016 SLDHS, as with all the previous DHS
studies, mainly inquired about knowledge of contraceptive methods, use of different methods during the

Family Planning 59
five years period preceding the survey, institutions where individuals are able to obtain services, reasons for
discontinuations, knowledge of the fertile period and plans for future use, informed choice, and modes of
receiving family planning messages.

5.1 Knowledge of contraceptive methods

One key determinant of increasing use of contraceptive methods is knowledge of various methods
available in the country. Programmes conducted for introducing various methods at the community level
play a vital role in improving knowledge of contraceptive methods. In the 2016 SLDHS, 18,302 ever married
women age 15- 49 were interviewed and each respondent was asked whether they have heard about any con-
traceptive method. A list of 12 methods including 10 modern methods and 2 traditional methods were asked
about and provision was made in the questionnaire to record any other method which was spontaneously
mentioned by the respondent.
Knowledge of contraceptive methods among ever married and currently married women is shown in
Table 5.1. Knowledge of any method or any modern method is universal in Sri Lanka. Almost all ever mar-
ried and currently married women knew at least one method and on average nine methods were known by the
respondents. Knowledge of a wide range of methods helps women to choose their most suitable or preferred
method and ultimately make their own method choice. Among the currently married women in reproduc-
tive age, only 4 percent of women did not know of female sterilization as a family planning method and 33
percent were not familiar with male sterilization. As per Table 5.1, the most widely known modern methods
are injectable and pills. Only half of currently married women have heard of emergency contraceptive pills.
Knowledge of female condom is the least known method of contraception by women among the 12 methods
inquired.

Table 5.1 : Knowledge of contraceptive methods

Percentage of ever-married women and currently married women age 15-49 who know any contraceptive method,
by specific method, Sri Lanka 2016
Method Ever-married women Currently married
women
Any method 99.6 99.7
Any modern method 99.6 99.7
Female sterilization 95.9 96.0
Male sterilization 66.9 67.2

Pill 97.1 97.3

IUD 95.2 95.5
Injectable 97.2 97.3
Implants 89.0 89.5
Male condom 90.9 91.4
Female condom 19.2 19.4
Emergency contraception 53.1 53.7
Lactational amenorrhea (LAM) 41.6 42.1
Any traditional method 85.6 86.3
Rhythm 78.9 79.7
Withdrawal 69.7 70.5
Other 5.1 5.2
Mean number of methods known by respondents 15-49 9.0 9.0
Number of respondents 18,302 17,257

Table 5.2 presents knowledge of contraceptive methods by background characteristics. Knowledge

of both any or modern methods of family planning is as nearly as high as 100 percent in all districts, with
no variations between education levels and wealth quintiles. This indicates success of knowledge awareness
programmes conducted by public health nurses and midwives.

60 Demographic and Health Survey - 2016, Sri Lanka

Table 5.2 Knowledge of contraceptive methods by background characteristics

Percentage of currently married women age 15-49 who have heard of at least one contraceptive method and
who have heard of at least one modern method by background characteristics, Sri Lanka 2016
Background characteristic Heard of any method Heard of any modern Number of currently
method1 married women

Age
15-19 96.4 96.4 225
20-24 99.3 99.3 1,373
25-29 99.7 99.7 2,559
30-34 99.7 99.7 3,481
35-39 99.9 99.9 3,735
40-44 99.7 99.6 3,033
45-49 99.7 99.7 2,851

Residence
Urban 99.7 99.7 2,682
Rural 99.8 99.8 13,906
Estate 96.8 96.8 669

District
Colombo 99.7 99.7 1,625
Gampaha 99.8 99.8 1,755
Kalutara 99.9 99.9 1,040
Kandy 99.6 99.5 1,174
Matale 100.0 100.0 456
Nuwara Eliya 97.1 97.1 552
Galle 99.8 99.8 896
Matara 99.4 99.4 685
Hambantota 100.0 100.0 532
Jaffna 99.5 99.5 409
Mannar 99.3 99.3 76
Vavuniya 99.3 99.3 125
Mullaitivu 99.5 99.5 67
Kilinochchi 99.7 99.7 81
Batticaloa 99.6 99.6 491
Ampara 99.9 99.9 692
Trincomalee 99.7 99.7 331
Kurunegala 99.8 99.8 1,501
Puttalam 100.0 100.0 635
Anuradhapura 99.4 99.4 919
Polonnaruwa 99.8 99.8 381
Badulla 99.6 99.6 697
Moneragala 100.0 100.0 452
Ratnapura 100.0 100.0 1,025
Kegalle 100.0 100.0 658

Education
No education 96.4 96.4 235
Passed Grade 1-5 99.3 99.3 1,099
Passed Grade 6-10 99.7 99.7 7,629
Passed G.C.E.(O/L) or equivalent 99.8 99.8 3,842
Passed G.C.E.(A/L) or equivalent 99.9 99.9 3,611
Degree and above 99.9 99.9 841

Wealth quintile
Lowest 99.0 99.0 3,065
Second 99.8 99.8 3,459
Middle 99.8 99.8 3,621
Fourth 99.9 99.9 3,658
Highest 99.8 99.8 3,454

Total 15-49 99.7 99.7 17,257

1
Female sterilization, male sterilization, pill, IUD, injectable, implants, male condom, female condom, emer-
gency contraception, lactational amenorrhea method (LAM), and other modern methods

Family Planning 61
5.2 Current use of contraception

Contraceptive prevalance rate

Percentage of women who use any contraceptive method.
sample : Currently married women age15-49.

Modern methods
Include male and female sterilization, injectables, intrauterine devices (IUDs), contraceptive pills,
implants, female and male condoms, lacrational amenorrhoea, and emergency contraception.

Current use of contraceptive methods indicate the impact of family planning services provided by
health sector. In the 2016 SLDHS, ever married women age 15-49 years were asked if they were currently
doing something or using any method to delay or avoid getting pregnant at the time of survey. Women using
any contraceptive method were reported as current users.
Table 5.3 summarizes current use of contraceptive methods among ever-married and currently mar-
ried women. Currently married women, with the highest exposure to pregnancy are the most suitable group
to assess current use of family planning.
The contraceptive prevalence rate is the percentage of currently married women age 15-49 who are
currently using any method. It is 65 percent. As in previous surveys, female sterilization is the most used
among the 12 methods (see Figure 5.1). Probably due to recent interventions through government health
posts, the IUD is used by 11 percent of currently married women, the highest percentage among non-per-
manent methods. Even though the distribution methods for pills and injectable are not the same, an equal
percentage of currently married women indicated to be using pills or injectable (9 percent respectively). Use
of implants is less popular among currently married women with only 5 percent of them using it. Also from
Tables 5.1 and 5.3, we can observe that although more than two-thirds of currently married women (67 per-
cent) have heard about male sterilization but only a very small percentage are currently using this method
(0.1 and 0.2 percent among currently married women age 40-44 and 45-49 respectively). Use of traditional
methods in Sri Lanka, was reported by over 10 percent of currently married women (7 percent using Rhythm
and 4 percent using Withdrawal).
Current use of contraception by age is also presented in Table 5.3. Use of any method increases
with age up to age 40-44 and then declines among those aged 45-49. The majority of adolescents age 15-
19 favored the use of implant (14 percent of a total prevalence of 44 percent for this group). Among young
adult currently married women age 20-24 the preferred method is the injectable with 13 percent (of a total
prevalence of 56 percent). The use of traditional methods on the other hand increases with age and is highest
among women age 35-49 at values greater than 10 percent.

62 Demographic and Health Survey - 2016, Sri Lanka

 Table 5.3 Current use of contraception by age
Percent distribution of ever-married women and currently married women age 15-49 by contraceptive method currently used,
according to age, Sri Lanka 2016
Modern methods Traditional
methods
Num-

Female sterili- zation

Emer- gency contra-

Any modern method

Not currently using

ber of

Male sterili- zation

Female condom
women

Any tradi- tional

Male condom

With- drawal
Any method

Inject- able

Implants

Rhythm
method
ception

Total
LAM
IUD
Pill
EVER-MARRIED WOMEN
Age
15-19 43.4 37.4 0 0 9 3.8 8.1 13.9 2.7 0 0 0 5.9 3.6 2.4 56.6 100 229
20-24 54.7 46.7 0.2 0 9.1 10.1 12.6 9.3 4.9 0.1 0.3 0.1 8 4.2 3.8 45.3 100 1,410
25-29 57.3 50.3 1.3 0 9.9 10.7 12.5 7.1 8.7 0 0 0.1 7.1 4 3.1 42.7 100 2,620
30-34 61.5 52.2 6.9 0 10.2 10.8 10.5 5.7 8.1 0 0 0 9.3 5.6 3.7 38.5 100 3,615
35-39 67.9 57.6 15.9 0 9 12.7 8.7 4 7.1 0 0.1 0 10.3 7.2 3.1 32.1 100 3,945
40-44 68 54.5 23.8 0.1 6.9 9.8 5.7 2.1 6 0 0.1 0 13.5 9.7 3.9 32 100 3,269
45-49 55.9 43.1 26 0.2 3.9 6.3 1.8 0.7 4.3 0 0 0 12.8 8.8 4 44.1 100 3,214

Total 61.7 51.3 13.8 0 8.1 10.1 8.1 4.4 6.6 0 0.1 0 10.4 6.9 3.6 38.3 100 18,302

CURRENTLY MARRIED WOMEN

Age
15-19 43.5 37.5 0 0 9.2 3.4 8.2 14 2.7 0 0 0 6 3.6 2.4 56.5 100 225
20-24 56 47.8 0.2 0 9.3 10.4 12.9 9.4 5 0.1 0.4 0.1 8.2 4.3 3.9 44 100 1,373
25-29 58.6 51.3 1.3 0 10.1 10.9 12.8 7.2 8.9 0 0 0.1 7.2 4.1 3.2 41.4 100 2,559
30-34 63.6 54 7 0 10.6 11.2 10.9 5.9 8.4 0 0 0 9.7 5.8 3.8 36.4 100 3,481
35-39 71.1 60.2 16.5 0 9.5 13.3 9.2 4.1 7.5 0 0.1 0 10.9 7.6 3.3 28.9 100 3,735
40-44 72 57.4 24.6 0.1 7.4 10.4 6.1 2.2 6.5 0 0.2 0 14.6 10.4 4.2 28 100 3,033
45-49 60.6 46.3 27.2 0.2 4.4 6.9 2 0.7 4.9 0 0 0 14.3 9.8 4.5 39.4 100 2,851

Total 64.6 53.6 14 0 8.6 10.6 8.6 4.6 7 0 0.1 0 11 7.3 3.8 35.4 100 17,257
Note: If more than one method is used, only the most effective method is considered in this tabulation.
LAM = Lactational amenorrhea method

Table 5.4 presents the percent distribution of currently married women age 15-49 by contraceptive
method currently used, according to background characteristics. The number of living children reported
seems to have a clear influence on the use of female sterilization (small percentages among those with 2 or
less children use this method, but almost half (48 percent) of the women with 5 or more children use it. The
median age of female sterilization is reported as 32 years (Table 5.5). Use of sterilization is greater among
currently married women living in the estate sector (27 percent) than their counterparts of the urban (11 per-
cent) and rural (14 percent) sectors.
As expected, there are considerable variations in CPR across district. Currently married women in
the districts of Mannar (18 percent), Vavuniya (33 percent) and Batticaloa (32 percent) reported the lowest
levels of contraceptive use, while Kalutara, Matale, Galle, Polonnaruwa, Badulla, Moneragala and Ratnapu-
ra, all registered CPRs of 70 percent or higher (see Table 5.4). Contraceptive use is very similar across wealth
quintiles (values around 64 percent.) However: the higher the level of education, the lower the use of mod-
ern methods. At the same time there is a higher preference for traditional method use among more educated
women specially Rhythm (12 percent, see Figures 5.2, 5.3, 5.4 and 5.5).

Family Planning 63
Table 5.4 Current use of contraception by background characteristics
Percent distribution of currently married women age 15-49 by contraceptive method currently used, according to background characteristics, Sri Lanka
2016
Modern method Traditional method
Background charac-

Any tradi- tional method

teristic

Female sterili- zation

Emer- gency contra-

Any modern method

Not currently using

Number of women
Male sterili- zation

Female condom
Male condom

With- drawal
Any method

Inject- able

Implants

Rhythm
ception

Total
LAM
IUD
Pill
Number of living
children
0 15.7 9.2 0.1 0.0 4.1 0.0 0.2 1.2 3.2 0.0 0.2 0.0 6.5 3.7 2.8 84.3 100.0 1,760
1-2 66.2 52.8 4.3 0.0 10.6 13.5 10.5 5.0 8.8 0.0 0.1 0.0 13.4 9.1 4.3 33.8 100.0 10,821
3-4 79.9 72.4 41.1 0.2 5.8 8.4 7.5 5.0 4.4 0.0 0.1 0.0 7.5 4.6 3.0 20.1 100.0 4,351
5+ 71.3 66.3 47.5 0.0 3.8 2.5 5.1 4.1 3.2 0.0 0.0 0.0 5.0 3.0 2.0 28.7 100.0 325
Residence
Urban 56.8 45.5 11.2 0.1 7.0 8.6 5.0 3.8 9.6 0.0 0.1 0.0 11.4 6.8 4.5 43.2 100.0 2,682
Rural 66.4 55.1 13.9 0.0 9.0 11.2 9.4 4.6 6.7 0.0 0.1 0.0 11.3 7.6 3.7 33.6 100.0 13,906
Estate 58.9 54.8 27.4 0.2 5.6 5.3 7.0 6.3 2.9 0.0 0.0 0.0 4.2 1.8 2.4 41.1 100.0 669
District
Colombo 60.5 47.4 9.9 0.1 6.5 12.1 3.9 4.5 10.2 0.0 0.2 0.0 13.2 8.2 5.0 39.5 100.0 1,625
Gampaha 67.3 52.0 13.1 0.1 8.5 9.7 5.3 4.2 10.8 0.0 0.2 0.0 15.3 10.9 4.5 32.7 100.0 1,755
Kalutara 73.8 55.4 13.5 0.0 8.8 12.5 7.7 3.5 9.4 0.0 0.0 0.0 18.4 12.5 5.9 26.2 100.0 1,040
Kandy 61.8 52.3 14.0 0.0 9.8 7.6 7.2 4.6 8.7 0.1 0.2 0.1 9.5 6.6 2.9 38.2 100.0 1,174
Matale 71.4 61.7 17.2 0.0 10.2 12.2 10.6 4.7 6.9 0.0 0.0 0.0 9.6 6.5 3.1 28.6 100.0 456
Nuwara Eliya 66.6 62.7 28.8 0.0 8.3 7.7 7.2 7.2 3.5 0.0 0.1 0.0 3.9 2.8 1.2 33.4 100.0 552
Galle 70.6 53.8 13.8 0.2 10.2 11.8 4.7 3.9 8.9 0.0 0.3 0.0 16.8 11.6 5.1 29.4 100.0 896
Matara 65.0 52.9 9.1 0.3 11.0 13.2 6.6 3.4 9.2 0.0 0.0 0.1 12.0 10.6 1.4 35.0 100.0 685
Hambantota 64.5 54.0 13.4 0.0 10.0 15.3 4.6 5.4 5.2 0.0 0.0 0.0 10.5 4.7 5.8 35.5 100.0 532
Jaffna 46.6 42.7 19.8 0.0 4.7 4.5 6.1 3.0 4.6 0.0 0.0 0.0 3.8 2.0 1.8 53.4 100.0 409
Mannar 18.4 18.4 8.1 0.0 1.5 0.8 4.1 2.7 1.2 0.0 0.0 0.0 0.0 0.0 0.0 81.6 100.0 76
Vavuniya 33.0 30.7 10.0 0.0 5.1 1.7 7.7 2.7 3.6 0.0 0.0 0.0 2.2 1.2 1.0 67.0 100.0 125
Mullaitivu 67.2 63.9 16.1 0.3 10.3 8.9 14.7 10.2 3.2 0.0 0.0 0.0 3.4 1.9 1.5 32.8 100.0 67
Kilinochchi 58.4 56.3 20.7 0.0 4.5 12.0 6.9 8.5 3.8 0.0 0.0 0.0 2.2 1.5 0.6 41.6 100.0 81
Batticaloa 31.5 28.5 7.2 0.0 3.0 2.3 11.8 1.9 2.1 0.0 0.0 0.1 3.0 1.6 1.4 68.5 100.0 491
Ampara 45.7 40.6 9.2 0.0 3.7 5.8 12.0 6.4 3.5 0.0 0.0 0.0 5.1 2.3 2.8 54.3 100.0 692
Trincomalee 48.6 45.4 9.9 0.3 4.9 2.9 17.1 5.8 4.3 0.0 0.3 0.0 3.2 2.3 0.8 51.4 100.0 331
Kurunegala 69.5 55.8 11.8 0.0 9.1 15.2 8.4 3.1 8.2 0.0 0.1 0.0 13.7 10.4 3.4 30.5 100.0 1,501
Puttalam 69.3 55.6 14.9 0.0 10.3 8.7 9.6 6.6 5.5 0.0 0.0 0.0 13.7 9.9 3.8 30.7 100.0 635
Anuradhapura 67.2 62.5 14.2 0.0 10.2 12.8 18.7 3.4 3.1 0.0 0.2 0.0 4.7 3.1 1.6 32.8 100.0 919
Polonnaruwa 72.3 67.0 16.4 0.0 8.9 10.5 19.3 6.0 6.0 0.0 0.0 0.0 5.3 4.2 1.1 27.7 100.0 381
Badulla 71.3 64.7 24.9 0.0 9.2 12.8 8.4 6.8 2.6 0.0 0.0 0.0 6.6 5.3 1.3 28.7 100.0 697
Moneragala 72.7 63.7 17.3 0.2 10.0 13.2 12.2 5.6 4.9 0.0 0.2 0.0 9.0 8.3 0.7 27.3 100.0 452
Ratnapura 74.4 55.8 14.4 0.0 10.7 10.7 9.1 4.9 6.0 0.0 0.0 0.0 18.5 4.9 13.6 25.6 100.0 1,025
Kegalle 66.9 59.3 15.1 0.0 9.5 10.6 11.5 5.2 6.9 0.0 0.2 0.3 7.6 7.0 0.6 33.1 100.0 658
Education
No education 70.7 66.7 43.6 0.7 3.7 7.3 6.5 4.2 0.7 0.0 0.0 0.0 4.0 3.6 0.4 29.3 100.0 235
Passed Grade 1-5 63.8 56.6 30.7 0.1 4.2 7.4 7.6 4.6 2.0 0.0 0.0 0.0 7.2 4.1 3.1 36.2 100.0 1,099
Passed Grade 67.9 58.1 15.8 0.1 10.2 10.6 10.6 5.9 4.9 0.0 0.1 0.0 9.8 5.4 4.4 32.1 100.0 7,629
6-10
Passed 62.0 51.9 10.8 0.0 9.1 11.0 8.9 4.5 7.2 0.0 0.2 0.1 10.1 7.1 3.0 38.0 100.0 3,842
G.C.E.(O/L) or
equivalent
Passed 61.4 46.7 8.3 0.0 7.1 11.6 5.6 2.6 11.3 0.0 0.1 0.1 14.7 11.0 3.7 38.6 100.0 3,611
G.C.E.(A/L) or
equivalent
Degree and above 59.9 41.8 6.7 0.0 4.7 9.9 3.5 1.7 15.2 0.0 0.0 0.1 18.1 14.7 3.4 40.1 100.0 841
Wealth quintile
Lowest 64.5 59.0 18.7 0.1 9.0 9.7 11.0 7.6 2.9 0.0 0.0 0.0 5.5 2.6 2.9 35.5 100.0 3,065
Second 66.6 56.3 15.0 0.0 9.5 11.0 10.3 5.9 4.7 0.0 0.0 0.0 10.3 6.2 4.1 33.4 100.0 3,459
Middle 65.1 55.0 12.5 0.0 9.8 11.7 10.3 4.5 5.9 0.0 0.2 0.0 10.2 6.7 3.5 34.9 100.0 3,621
Fourth 63.8 51.3 12.4 0.1 8.3 10.3 7.7 3.6 8.8 0.0 0.1 0.1 12.4 8.4 4.0 36.2 100.0 3,658
Highest 63.0 46.8 12.0 0.0 6.4 10.2 3.9 1.7 12.3 0.0 0.2 0.0 16.2 12.0 4.2 37.0 100.0 3,454
Total 64.6 53.6 14.0 0.0 8.6 10.6 8.6 4.6 7.0 0.0 0.1 0.0 11.0 7.3 3.8 35.4 100.0 17,257
Note: If more than one method is used, only the most effective method is considered in this tabulation.

LAM = Lactational amenorrhea method.

64 Demographic and Health Survey - 2016, Sri Lanka

 Figure 5.1 Trends in current use by contraceptive methods

18
16.3
16 14.8
14.0
14

12 10.6
10.1
10 8.6 8.6
8.1
8 7.0 7.3
6.5
5.8 5.7
6 4.6
3.8
4

2
0.3
0
With-drawal Implants Male Rhythm Pill Inject-ables IUD Females
condom sterili-zation
2006 2016

Figure 5.2 Current use of contraception by level of education

80
70.7
66.7 67.9
70 63.8 62 61.4 59.9
56.6 58.1
60
51.9
50 46.7
41.8
40

30

20

10

0
No education Passed grade 1-5 Passed Grade 6- Passed Passed Degree and
10 G.C.E.(O/L) or G.C.E.(A/L) or above
equivalent equivalent

Any method Any modern method

Family Planning 65
 Figure 5.3 Current uses of IUD, Implant and Injectable by level of education

14
11.6
12 11
10.6
9.9
10

8 7.3 7.4
5.9
6
4.6 4.5
4.2
4
2.6
1.7
2

0
No education Passed grade Passed Grade Passed Passed Degree and
1-5 6-10 G.C.E.(O/L) or G.C.E.(A/L) or above
equivalent equivalent

IUD Injec-ables Implants

Figure 5.4 Current uses of Pill and Condom by level of education

16 15.2

14

12 11.3
10.2
10 9.1

8 7.2 7.1

6 4.9 4.7
4.2
3.7
4
2
2 0.7
0
No education Passed grade Passed Grade Passed Passed Degree and
1-5 6-10 G.C.E.(O/L) or G.C.E.(A/L) or above
equivalent equivalent

Male condom Pill

66 Demographic and Health Survey - 2016, Sri Lanka

 Figure 5.5 Current uses of Traditional Methods by level of education

20
18.1
18
16 14.7 14.7
14
12 11
9.8 10.1
10
8 7.2 7.1
5.4
6
4.0 3.6 4.1
4
2
0
No education Passed grade Passed Grade 6- Passed Passed Degree and
1-5 10 G.C.E.(O/L) or G.C.E.(A/L) or above
equivalent equivalent

Any tradi-tional method Rhythm

5.3 Timing of the sterilization

As mentioned before, female sterilization is the preferred method of 14 percent of currently married
women, particularly older women (25 percent or more among women age 40+). It was also noted that female
sterilization is used mostly by women with more than two living children, women in the estate sector and
currently married women with lower levels of education and of the poorest households. The information
about the timing of female sterilization can be found in table 5.5.
The median age of sterilization among all users of the method is 32.2. Only 7 percent of users had
the operation before age 25 years. Most operations took place 10 or more years ago. Twenty three percent of
current users of female sterilization had the operation at age group 25-29. The remaining 70 percent of users
got the operation at age 30 years or older.

Table 5.5 Timing of sterilization

Percent distribution of sterilized ever-married women age 15-49 by age at the time of sterilization and median age at
sterilization, according to the number of years since the operation, Sri Lanka 2016
Age at time of sterilization
Years since <25 25-29 30-34 35-39 40-44 45-49 Total Num- Median
operation ber of age1
women
<2 0.6 10.2 31.4 41.8 13.1 2.8 100.0 278 35.0
2-3 1.3 11.0 40.3 32.9 11.6 2.9 100.0 328 33.8
4-5 0.6 11.3 41.1 33.8 12.8 0.4 100.0 365 33.8
6-7 1.6 17.0 34.8 38.2 8.4 0.0 100.0 308 33.7
8-9 3.1 15.0 40.2 37.9 3.9 0.0 100.0 269 33.6
10+ 17.0 38.3 34.7 10.0 0.0 0.0 100.0 975 a

Total 7.4 22.7 36.6 26.3 6.2 0.7 100.0 2,523 32.2
a = Not calculated due to censoring
1
Median age at sterilization is calculated only for women sterilized before age 40 to avoid problems of censoring

Family Planning 67
5.4 Source of modern contraceptive methods
The distribution of family planning services by government network is organized through hospital
clinics, field clinics and more widely through midwives and all possible modern methods provided by the
government sector are provided free of charge. Seventy-two percent of current users have obtained family
planning service from government sector institutions while the private sector supplied only a little more than
one- fourth of demand at 28 percent (Table 5.6).

Table 5.6 Source of modern contraception methods

Percent distribution of users of modern contraceptive methods age 15-49 by most recent source of method, according to meth-
od, Sri Lanka 2016
Source Fe- Male . Pill IUD Injecta- Im- Male Female Emer- Total
male sterili- ble plants con- con- gency
sterili- zation dom dom contra-
zation ception

PUBLIC SECTOR 94.1 * 56.7 96.6 31.5 99.1 36.7 * * 71.6

Govt. specialized 53.1 * 1.7 25.4 8.8 30.0 1.2 * * 23.7
hospital
Govt. general hospital 38.2 * 15.5 42.3 14.5 38.3 10.3 * * 28.0
Family health bureau 2.2 * 4.0 17.4 5.1 21.1 2.6 * * 7.6
Mobile clinic 0.6 * 0.9 1.8 0.3 2.1 0.2 * * 0.9
Public health midwife 0.0 * 34.5 9.6 2.8 7.7 22.1 * * 11.3
Volunteer officers 0.0 * 0.2 0.0 0.0 0.0 0.1 * * 0.0
Other public sector 0.0 * 0.0 0.0 0.0 0.0 0.1 * * 0.0
PRIVATE SECTOR 5.7 * 43.0 3.3 68.4 0.9 61.1 * * 28.0
Private hospital 4.3 * 0.5 1.6 7.6 0.3 0.8 * * 2.9
Private doctor's clinic 0.3 * 1.2 1.6 58.8 0.5 0.4 * * 10.0
NGO 0.2 * 41.4 0.1 1.3 0.0 59.9 * * 14.7
Estate hospital 0.8 * 0.0 0.0 0.1 0.2 0.0 * * 0.2
Other private sector 0.0 * 0.1 0.1 0.6 0.0 0.0 * * 0.1
OTHER SOURCE 0.0 * 0.2 0.0 0.1 0.0 2.1 * * 0.3
Grocery 0.0 * 0.1 0.0 0.1 0.0 2.1 * * 0.3
Friend/relative 0.0 * 0.1 0.0 0.0 0.0 0.0 * * 0.0
Other 0.1 * 0.1 0.1 0.0 0.0 0.2 * * 0.1
Don't know 0.1 * 0.0 0.0 0.0 0.0 0.0 * * 0.0

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Number of women 2,523 8 1,481 1,847 1,488 803 1,212 1 17 9,381
Note: Total includes other modern methods but excludes lactational amenorrhea method (LAM).

As shown in Table 5.6 more than 90 percent of current users of female sterilization, IUD, and im-
plant obtained their method through the family planning services provided by the government sector institu-
tions while the injectable and male condoms users are obtained in facilities from the private sector. According
to the 2016 SLDHS, 43 percent of current Pill users obtain them from the private sector. The remaining 57
percent, obtained them from the government sector, with 35 percent was provided by the public health mid-
wife.

68 Demographic and Health Survey - 2016, Sri Lanka

5.5 Indformed choice

Informed choice
Informed choice is women being informed at the time they started the current episode of method use
about the method’s side effects, what to do if they experience side effects, and other methods they
could use.
sample : Women age 15-49 who are currently using selected modern conttaceptive methods and
who started the last episode of use within the 5 years before the survey.

Informed choice on contraception is an important indicator to assess quality of family planning

programmes conducted in a country. Currently in Sri Lanka, the state-run health posts provide seven modern
contraceptive methods. Part of the job of family planning service providers is to deliver broader knowledge
of different contraceptive methods. Whenever they introduce any method, it is desirable to inform clients
about all available methods and methods suitable for couples well before a couple starts using any method.
More specifically, family planning service providers need to inform clients about the side effects of each
methods, what to do when they experience any side effect and, other methods available that can be used.
Based on knowing all these facts the user can then choose which method is the most suitable for her needs.

Table 5.7 Informed choice

Among current users of modern methods age 15-49 who started the last episode of use within the five
years preceding the survey, the percentage who were informed about possible side effects or problems
of that method, the percentage who were informed about what to do if they experienced side effects,
and the percentage who were informed about other methods they could use, by method and initial
source, Sri Lanka 2016
Among women who started last episode of modern contraceptive
method within five years preceding the survey:
Method/source Percentage Percentage Percentage Number of
who were who were who were women
informed about informed about informed by
side effects or what to do if a health or
problems of experienced family planning
method used side effects worker of other
methods that
could be used

Method
Pill 49.4 43.3 43.0 1,043
IUD 58.1 61.9 46.7 1,117
Injectables 50.7 45.6 40.1 1,112
Implants 54.1 52.0 39.3 758
Emergency contraception * * * 13

Initial source of method1

Public sector 55.0 54.6 44.2 2,845
Government hospital 54.2 55.4 39.7 638
Government clinic 56.1 57.3 46.1 1,106
Family health bureau 55.2 53.1 42.4 466
Mobile clinic 66.3 54.4 51.4 58
Public health midwife 52.2 49.5 46.3 576
Volunteer officers * * * 2
Private medical sector 48.1 41.4 38.1 1,193
Private hospital 47.2 34.7 27.9 112
Private doctor's clinic 52.6 46.6 41.1 652
NGO 41.7 35.2 36.6 419
Estate hospital * * * 1
Other private sector * * * 9
Other sector * * * 3
Grocery * * * 2
Friend/relative * * * 1
Other * * * 1

Total 53.0 50.7 42.4 4,042

Note: Table includes users of only the modern methods listed individually.
1
Source at start of current episode of use

Family Planning 69
 Table 5.7 shows that only 53 percent of ever-married women currently using modern contraceptive
methods were informed about the potential side effects or other problems associated with the method prior
to use and just over half (51 percent) were informed about what to do if they experienced such side effects.
Only 42 percent of them were informed of the availability of other methods that can be used. Among the four
most widely used methods, pill, IUD, injectable and implant, informed choice is much higher among the IUD
users than among other methods (see Table 5.7).

5.6 Knowledge of the fertility period

All ever married women in reproductive age were asked about whether they can correctly describe
the most fertile period during the ovulatory cycle. More than half (58 percent) of ever-married women
reported that the most fertile period is halfway between two periods (Table 5.8). This figure is higher (82
percent) among users of the rhythm method than among users of other methods (56 percent). Of the eighteen
percent of rhythm users who could not correctly identify the most fertile period in the menstrual cycle, nearly
2 percent had no idea of the fertile period and 16 percent could not correctly specify the fertile period. Table
5.8 also shows that one fifth of ever married women (22 percent) who do not use the rhythm method have no
idea about the fertile period.
It is clear that many women of reproductive age have doubts about or no clear knowledge of their fertile
period. Therefore, irrespective of the contraceptive method used by current users, awareness programmes
need to be developed to improve knowledge of the fertile period among all women of reproductive age.

Table 5.8 Knowledge of fertile period

Percent distribution of ever married women age 15-49 by knowledge of the fertile period during the
ovulatory cycle, according to current use of the rhythm method, Sri Lanka 2016
Perceived fertile period Users of rhythm Nonusers of Ever married
method rhythm method women
Just before her menstrual period begins 2.1 2.3 2.2
During her menstrual period 0.1 1.1 1.0
Right after her menstrual period has ended 12.2 17.9 17.5
Halfway between two menstrual periods 82.1 55.9 57.7
Other 1.1 1.0 1.0
Don't know 2.3 21.9 20.5
Total 100.0 100.0 100.0
Number of women 1,257 17,045 18,302

Contraceptive discontinuation rate

Percentage of contraceptive use episodes discontinued within 12 months.
sample : Episodes of contraceptive use in the 5 years before the survey for women who are
currently age 15-49.

5.7 Discontinuation of contraceptive methods

All non-permanent contraceptive method users reported discontinuations due to many reasons. The
contraceptive discontinuation rate is the percentage of contraceptive use episodes that are discontinued within
12 months after start of using the method. One-year contraceptive discontinuation rates calculated using
calendar data are presented in Table 5.9. Twenty nine percent of the contraceptive use episodes observed
during the five years before the survey was discontinued within 12 months after starting use. This rate is
slightly lower than the one reported from the 2006-07 SLDHS (32 percent). Ten percent stop in order to
become pregnant, and another 5 percent cease using the method due to “health concerns or side effects”. Less
than 2 percent experienced method failure. Discontinuation rates are highest for pill (40 percent), withdrawal
(40 percent), and injectable (39 percent), and lowest for implants (6 percent).

70 Demographic and Health Survey - 2016, Sri Lanka

 Table 5.9 Twelve-month contraceptive discontinuation rates
Among ever married women age 15-49 who started an episode of contraceptive use within the five years preceding the survey,
the percentage of episodes discontinued within 12 months, by reason for discontinuation and specific method, Sri Lanka, 2016
Method Method Desire Other Side Wanted Other Other Any Switched Num-
failure to be- fertility effects/ more method rea- reason4 to ber of
come related health effec- related sons another epi-
preg- rea- con- tive rea- method5 sodes
nant sons2 cerns method sons3 of use6

Female sterilization 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 856
Pill 2.8 16.5 4.0 6.2 2.1 5.6 2.9 40.0 8.5 2,388
IUD 0.6 2.5 0.3 4.7 1.1 2.6 1.1 12.9 4.9 1,543
Injectable 1.1 8.4 2.4 11.2 3.3 9.4 3.0 38.7 16.0 2,417
Implants 0.2 1.3 0.6 1.0 0.7 1.6 0.6 6.0 1.5 861
Male condom 2.4 14.0 2.2 1.4 4.6 1.7 5.9 32.2 7.0 1,517
Rhythm 3.5 12.3 2.1 1.6 7.4 0.5 2.8 30.1 8.4 1,128
Withdrawal 3.8 15.2 4.2 1.2 9.9 0.9 5.2 40.3 12.0 816

All methods 1 1.8 9.7 2.2 4.8 3.7 4.0 2.9 29.1 9.0 11,636
Note: Figures are based on life table calculations using information on episodes of use that began 3-62 months preceding the
survey.
1
Includes LAM and other methods not listed separately
2
Includes infrequent sex/husband away, difficult to get pregnant/menopausal, and marital dissolution/separation
3
Includes lack of access/too far, costs too much, and inconvenient to use
4
Reasons for discontinuation are mutually exclusive and add to the total given in this column
5
The episodes of use included in this column are a subset of the discontinued episodes included in the discontinuation rate. A
woman is considered to have switched to another method if she used a different method in the month following discontinuation or
if she gave “wanted a more effective method” as the reason for discontinuation and started another method within two months of
discontinuation.
6
Number of episodes of use includes both episodes of use that were discontinued during the period of observation and episodes
of use that were not discontinued during the period of observation

Table 5.10, presents the percent distribution of discontinuations of contraceptive methods in the five
years preceding the survey by main reason stated for discontinuation. The main reason stated is “wanted to
become pregnant” with 42 percent of the discontinuations. This percentage is similar across methods. Among
the method related reasons, “side effects/health concerns” was cited in 15 percent of the discontinuations.
Side effects or health concerns were mostly reported as a reason to discontinue the use of the IUD or the
injectable (23 percent each). One in ten of the discontinuations reported either “lack of access/too far” or
“wanted a more effective method” as a reason to discontinue the use of the method (see Figure 5.6).
The discontinuation due to lack of access is much higher among those users of implant (19 percent),
injectable (17 percent), IUD (13 percent) and pill (12 percent). The highest percentage of method failure
(pregnancy) was reported by users of withdrawal (14 percent) and rhythm method users (12 percent)

Family Planning 71
Table 5.10 Reasons for discontinuation

Percent distribution of discontinuations of contraceptive methods in the five years preceding the survey by main reason stated for discontin-
uation, according to specific method, Sri Lanka 2016
Reason Pill IUD Injecta- Im- Male Emer- Rhythm With- Other All
ble plants condom gency drawal meth-
contra- ods
ception

Became pregnant while 8.0 4.8 3.2 2.0 8.8 (4.7) 12.1 14.4 0.6 7.1
using
Wanted to become 44.7 42.5 35.2 35.7 50.2 (24.1) 48.4 42.4 5.3 42.0
pregnant
Husband disapproved 1.3 1.2 1.6 3.1 5.8 (12.0) 3.0 3.9 5.2 2.5
Wanted a more effective 6.3 4.3 7.4 10.0 10.8 (12.4) 18.0 18.1 71.5 9.7
method
Side effects/health 14.9 22.7 23.0 17.0 5.4 (18.4) 3.7 3.3 6.0 14.8
concerns
Lack of access/too far 11.7 13.2 16.8 18.5 2.4 (12.3) 0.9 1.0 3.5 10.3
Cost too much 0.2 0.5 1.1 0.0 0.4 (0.0) 0.3 0.1 0.0 0.5
Inconvenient to use 0.3 0.0 1.2 0.0 0.6 (2.4) 0.5 0.0 2.4 0.6
Up to God/fatalistic 0.1 0.3 0.1 0.0 0.0 (0.0) 0.1 0.0 0.0 0.1
Difficult to get pregnant/ 0.5 0.7 0.5 0.6 0.4 (0.0) 1.5 0.9 2.9 0.7
menopausal
Infrequent sex/husband 6.1 1.9 3.9 5.6 5.6 (6.1) 5.4 7.6 0.0 5.0
away
Marital dissolution/sep- 0.5 0.4 0.5 0.9 0.2 (0.0) 0.3 0.5 0.0 0.4
aration
Other 3.6 4.3 4.0 5.3 6.0 (0.0) 3.3 4.3 2.5 4.1
Don't know 0.2 0.1 0.3 0.0 1.2 (3.0) 1.2 1.2 0.0 0.5
Missing 1.8 3.0 1.3 1.4 2.3 (4.7) 1.1 2.3 0.0 1.8

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Number of discontinu- 2,019 782 2,279 184 960 44 819 631 52 7,772
ations
LAM = Lactational amenorrhea method

Figure 5.6 Some reasons for discontinuations by contraceptive methods

25 23.0
22.7

20 18.5
16.8 17.0
14.9
15 13.2
11.7
10.0 10.8
10
7.4
6.3
5.4
4.3
5
2.4

0
Pill IUD Inject-ables Implants Male condom

Wanted a more effective method Side effects/health concerns Lack of access/too far

72 Demographic and Health Survey - 2016, Sri Lanka

5.8 Need and demand of family planning

unmet need for family planning

Proportion of women who (1) are not pregnant and not postpartum amenorrhoeic, are considered
fecund, and want to postpone their next birth for 2 more years or stop childbearing altogether but are
not using a contraceptive method. or (2) have a mistimed or unwanted current pregnancy, or (3) are
postpartum ammenorrhoeic and their last birth in the last 2 years was mistimed or unwanted.
sample : Currently married women age 15-49.

Demand for unmet need for family planning

family planning: + current contraceptive use (any method)

Proportion of current contraceptive use (any method)

demand unmet need + current contraceptive use (any method)
satisfied:

Proportion of
demand current contraceptive use (any modern method)
satisfied
by modern unmet need + current contraceptive use (any method)
methods:
Total demand for family planning is reported as 72 percent (52 percent for limiting and 20 percent
for spacing). Of the total demand, 65 percent (or 90 percent of the total demand) corresponds to the satisfied
demand expressed in the contraceptive prevalence rate (CPR). The remaining part of the total demand, 7.5
percent is the unmet need for contraception (4.4 percent for limiting purposes and 3.1 percent for spacing). It
is also interesting to note that 74 percent of the satisfied demand corresponds to modern methods alone (Table
5.11).
As expected, the total demand for contraception increases with age up to age 35-39 but declines
among older women. However, the total demand satisfied, as reported before, increases with age from the
lowest value of 67 percent for currently married adolescents age 15-19 to a highest value of 94 percent among
women age 45-49. Age is also a good predictor of total demand and for contraception for limiting or spacing
purposes. Thus, the highest level of satisfied demand among adolescents are observed for spacing purposes
(42 percent) compared to 60 percent or more of demand satisfied for limiting purposes among currently
married women age 35-49. The unmet need for contraception follows a similar pattern as the one described
before in terms of needs for limiting or spacing children. However, among adolescents (and to a lesser extent
among young adults age 20-24) the unmet need for contraception is not only the highest (21 percent) but
mostly for spacing purposes. This finding in itself calls a for the development of policies and programs that
respond to the needs of these particular groups of women.
Place of residence is also an important variable associated with the demand for contraception.
Currently married women from the rural sector account for the highest use of contraception (66 percent)
followed by the estate sector (59 percent) and the urban sector (57 percent). However, the unmet need
for contraception reverses this trend with the urban sector presenting the highest unmet need (11 percent),
compared to just 6.8 percent for the rural sector. In all sectors, a greater need was declared for limiting
purposes as documented before. Modern methods appear to be satisfying the highest percentage of the total
demand of currently women in the estate sector (80 percent compared to 75 percent and only 67 percent of
the demand in the rural and urban sectors respectively).
There are a set of districts with relatively low levels of demand satisfied, including Jaffna (47 percent),
Mannar (18 percent), Vavuniya (33 percent), Batticaloa (32 percent), Ampara (46 percent), Trincomalee
(49 percent). Of these districts, Batticaloa has the lowest proportion of demand satisfied (58 percent) and

Family Planning 73
therefore the highest unmet need for contraception (23 percent). Also of interest is the district of Mannar with
the lowest met need (CPR of 18 percent only) but also with relatively low unmet need for contraception (6
percent) producing in this way the district with the lowest total demand for contraception (24 percent).
Total demand for limiting decreases with increased level of education. (See Figure 5.7). The total
demand seems to be similar across wealth quintiles (around 72 percent) with higher demand for limiting
purposes around 52 percent. Similarly, the unmet need does not change much across quintiles.
The analysis presented before for currently married women is identical to the one corresponding to
ever-married women

Figure 5.7 Percentages of total demand for limiting by level of

education, Sri Lanka 2016

Degree and above 40

Passed G.C.E.(A/L) or equivalent 44

Passed G.C.E.(O/L) or equivalent 50

Passed Grade 6-10 56

Passed grade 1-5 64

No education 70

0 20 40 60 80

74 Demographic and Health Survey - 2016, Sri Lanka

Table 5.11 Need and demand for family planning among currently married women
Percentage of currently married women age 15-49 with unmet need for family planning, percentage with met need for family planning, the total de-
mand for family planning, and the percentage of the demand for contraception that is satisfied, by background characteristics, Sri Lanka 2016
Unmet need for family Met need for family plan- Total demand for family
planning ning (currently using) planning1
Percent- Percentage Num-
age of of demand ber of
Background For For Total For For Total For For Total demand satisfied women
spac- limit- spac- limit- spac- limit- satisfied2 by modern
characteristic ing ing ing ing ing ing methods3
Age
15-19 19.3 2.1 21.4 42.0 1.6 43.5 61.3 3.7 65.0 67.0 57.7 225
20-24 9.6 1.5 11.2 44.2 11.8 56.0 53.9 13.3 67.2 83.4 71.1 1,373
25-29 6.7 3.3 9.9 37.5 21.1 58.6 44.2 24.3 68.5 85.5 74.9 2,559
30-34 3.4 5.3 8.7 22.7 40.9 63.6 26.1 46.2 72.4 87.9 74.6 3,481
35-39 1.4 5.6 7.1 9.7 61.4 71.1 11.1 67.0 78.2 91.0 77.0 3,735
40-44 0.5 4.9 5.4 2.2 69.8 72.0 2.7 74.7 77.4 93.0 74.2 3,033
45-49 0.2 3.7 3.9 1.1 59.5 60.6 1.2 63.3 64.5 94.0 71.8 2,851

Residence
Urban 4.9 6.1 10.9 15.8 41.0 56.8 20.7 47.1 67.8 83.9 67.1 2,682
Rural 2.7 4.1 6.8 17.4 48.9 66.4 20.2 53.0 73.2 90.7 75.3 13,906
Estate 4.4 4.9 9.3 9.4 49.5 58.9 13.8 54.4 68.2 86.4 80.3 669

District
Colombo 4.2 5.5 9.7 16.7 43.8 60.5 20.9 49.3 70.2 86.2 67.4 1,625
Gampaha 2.1 5.5 7.6 15.9 51.4 67.3 18.0 56.9 74.9 89.9 69.4 1,755
Kalutara 2.4 3.5 5.8 21.1 52.8 73.8 23.4 56.2 79.7 92.7 69.5 1,040
Kandy 2.7 5.0 7.6 15.0 46.8 61.8 17.7 51.8 69.4 89.0 75.3 1,174
Matale 1.5 3.5 4.9 19.3 52.0 71.4 20.8 55.5 76.3 93.6 81.0 456
Nuwara Eliya 3.1 5.0 8.1 12.1 54.5 66.6 15.2 59.5 74.7 89.2 83.9 552
Galle 2.4 3.6 6.0 19.5 51.1 70.6 21.9 54.7 76.6 92.2 70.3 896
Matara 3.4 5.0 8.4 16.6 48.4 65.0 20.1 53.4 73.4 88.5 72.1 685
Hambantota 4.1 3.6 7.8 17.5 47.0 64.5 21.6 50.6 72.2 89.3 74.8 532
Jaffna 4.1 4.3 8.4 9.8 36.8 46.6 13.9 41.1 55.0 84.7 77.8 409
Mannar 3.2 2.8 6.1 5.7 12.6 18.4 9.0 15.5 24.4 75.2 75.2 76
Vavuniya 6.2 9.3 15.5 10.2 22.8 33.0 16.4 32.1 48.5 68.0 63.4 125
Mullaitivu 1.7 4.6 6.3 18.0 49.2 67.2 19.7 53.8 73.5 91.5 86.9 67
Kilinochchi 4.3 5.1 9.3 13.1 45.3 58.4 17.4 50.4 67.8 86.2 83.1 81
Batticaloa 9.9 12.9 22.8 8.2 23.3 31.5 18.1 36.2 54.3 58.0 52.5 491
Ampara 6.8 3.4 10.2 15.0 30.8 45.7 21.8 34.1 55.9 81.8 72.7 692
Trincomalee 8.4 6.0 14.4 16.9 31.6 48.6 25.4 37.7 63.0 77.1 72.1 331
Kurunegala 2.3 3.6 5.9 17.8 51.7 69.5 20.1 55.3 75.4 92.2 74.0 1,501
Puttalam 2.2 2.3 4.5 18.1 51.2 69.3 20.3 53.5 73.8 93.9 75.4 635
Anuradhapura 2.3 1.9 4.2 18.8 48.4 67.2 21.1 50.4 71.4 94.1 87.5 919
Polonnaruwa 2.4 3.6 6.0 17.3 55.0 72.3 19.7 58.6 78.3 92.3 85.6 381
Badulla 2.2 4.1 6.3 18.7 52.6 71.3 20.9 56.8 77.6 91.9 83.4 697
Moneragala 2.5 2.8 5.3 20.8 51.8 72.7 23.4 54.6 77.9 93.2 81.7 452
Ratnapura 1.5 2.4 3.9 20.7 53.6 74.4 22.2 56.0 78.2 95.0 71.3 1,025
Kegalle 2.0 5.9 8.0 13.6 53.3 66.9 15.6 59.2 74.8 89.4 79.2 658

Education
No education 0.7 1.6 2.3 1.9 68.8 70.7 2.6 70.4 73.0 96.9 91.3 235
Passed Grade 1.6 5.2 6.8 5.2 58.7 63.8 6.7 63.9 70.6 90.4 80.2 1,099
1-5
Passed Grade 2.6 4.2 6.8 15.9 52.0 67.9 18.5 56.2 74.7 90.9 77.7 7,629
6-10
Passed 3.6 4.7 8.2 16.8 45.1 62.0 20.4 49.8 70.2 88.3 73.9 3,842
G.C.E.(O/L) or
equivalent
Passed 4.0 4.9 8.9 22.1 39.3 61.4 26.1 44.1 70.2 87.4 66.5 3,611
G.C.E.(A/L) or
equivalent
Degree and 4.7 2.5 7.3 22.5 37.4 59.9 27.2 39.9 67.1 89.2 62.2 841
above

Wealth quintile
Lowest 3.1 5.0 8.0 15.4 49.1 64.5 18.4 54.1 72.5 89.0 81.4 3,065
Second 2.8 3.5 6.2 17.4 49.2 66.6 20.2 52.7 72.8 91.4 77.3 3,459
Middle 3.1 4.2 7.3 17.6 47.6 65.1 20.6 51.8 72.4 90.0 75.9 3,621
Fourth 3.5 4.1 7.7 17.7 46.1 63.8 21.2 50.2 71.4 89.3 71.9 3,658
Highest 3.2 5.4 8.5 16.1 46.9 63.0 19.2 52.3 71.5 88.1 65.4 3,454

Total 3.1 4.4 7.5 16.9 47.7 64.6 20.0 52.1 72.1 89.6 74.2 17,257
Note: Numbers in this table correspond to the revised definition of unmet need described in Bradley et al., 2012.
1
Total demand is the sum of unmet need and met need
2
Percentage of demand satisfied is met need divided by total demand
3
Modern methods include female sterilization, male sterilization, pill, IUD, injectable, implants, male condom, female condom, emergency contracep-
tion, standard days method (SDM), lactational amenorrhea method (LAM), and other modern methods

Family Planning 75
5.9 Future use of contraception
Family planning managers need to understand future use of different methods for planning purpos-
es. It is possible that currently married women, who were not using contraception at the time of the survey,
will start using a method in the near future. Those non-users were asked about their intention to use family
planning methods in future. According to the results presented in Table 5.12, 38 percent of nonusers said they
intend to use family planning methods in the future (5 percent declared to be unsure) and 57 percent said
that they have no intention to use contraception at all. The number of living children appears to influence the
decision on future use contraception. The percentage of nonusers who intend to use family planning in the
future is highest among those women with 1 living child (44 percent versus 35 percent among those without
children) and declines with the number of children to just 18 percent among those with 4 or more living chil-
dren.

Table 5.12 Future use of contraception

Percent distribution of currently married women age 15-49 who are not using a contraceptive method by
intention to use in the future, according to number of living children, Sri Lanka 2016
Number of living children1
Intention 0 1 2 3 4+ Total
Intends to use 34.6 43.7 39.4 34.3 17.9 38.1
Unsure 13.1 5.8 2.6 1.1 0.6 5.3
Does not intend to use 52.3 50.5 58.1 64.6 81.4 56.6
Total 100.0 100.0 100.0 100.0 100.0 100.0
Number of women 1,161 1,917 1,925 793 313 6,109
1
Includes current pregnancy

5.10 Exposure to family planning messages in the media

Family planning clinics provide key information for women visiting them. Media plays a key role
in communicating more effectively messages about family planning to all. In assessing the reach of family
planning messages, the 2016 SLDHS asked ever-married women whether they had heard or seen a message
about family planning on the radio, on television, in a newspaper or magazine, or on the internet in the last
few months before the survey. Table 5.13 presents the percentage of ever married women who had heard or
seen such a message from one of the media sources, by background characteristics.
In the last few months before the survey, 42 percent of women reported seeing family planning messages on
television. Media exposure to family planning messages is positively associated with the level of education
and wealth of the household in which the ever-married women live. In other words, the higher the level of
education and the higher the wealth quintile, the higher the exposure to media. By place of residence, and
compared to urban and rural sector ever married women, the estate sector ever-married women have less
exposure to these four media messages outlets.

5.11 Contact of nonusers with family planning providers

Contact of nonusers with family planning providers
Respondent discussed family planning in the 12 month before the survey with a fieldworker or during
a visit to a health facility.
sample : women age 15-49 who are not currently using any contraceptive methods.
Family planning managers are interested in knowing know how they could provide information to
non-users of contraception. The results from the 2016 SLDHS indicate that a large majority of the non-users
of contraception (86 percent) have not discussed family planning matters with a fieldworker or during a visit
to a health facility. According to table 5.14 this percentage is even higher (90 percent) among those ever-mar-
ried women with lower levels of education.

76 Demographic and Health Survey - 2016, Sri Lanka

Table 5.13: Exposure to family planning messages
Percentage of ever married women age 15-49 who heard or saw a family planning message on radio, on television or in a newspaper or
magazine in the past few months, according to background characteristics, Sri Lanka 2016
Family planning messages on:
Background characteristic Radio Television News- paper/ Internet None of these Number of
magazine four media ever-married
sources women
Age
15-19 16.4 25.6 26.6 5.2 58.9 229
20-24 21.3 40.9 35.6 6.7 45.7 1,410
25-29 24.2 45.9 40.6 11.2 41.4 2,620
30-34 25.3 45.5 39.8 9.6 43.1 3,615
35-39 24.1 43.1 37.8 5.6 45.9 3,945
40-44 24.0 41.0 35.5 4.6 49.2 3,269
45-49 21.6 37.5 32.0 2.7 53.9 3,214

Residence
Urban 23.1 45.2 42.1 15.7 41.1 2,855
Rural 24.1 42.6 36.8 5.1 46.9 14,737
Estate 15.4 22.9 16.3 1.2 69.5 710

District
Colombo 24.1 47.5 48.9 18.7 35.9 1,731
Gampaha 27.0 43.6 45.4 8.6 42.8 1,845
Kalutara 22.5 37.6 35.7 7.7 52.6 1,104
Kandy 28.3 53.3 49.0 9.1 35.4 1,223
Matale 14.4 31.4 30.2 3.2 54.9 490
Nuwara Eliya 13.7 27.2 19.3 1.8 66.6 572
Galle 24.4 43.6 40.2 7.0 43.2 935
Matara 26.3 53.3 46.6 6.1 36.7 718
Hambantota 27.5 46.4 30.7 3.2 45.6 556
Jaffna 20.2 34.3 31.8 9.5 55.5 471
Mannar 38.3 54.9 31.3 7.8 42.5 81
Vavuniya 22.4 28.9 34.3 7.2 56.9 136
Mullaitivu 8.4 15.1 11.8 1.8 76.9 81
Kilinochchi 8.0 14.0 12.8 0.6 77.7 94
Batticaloa 15.9 45.0 19.9 8.2 50.8 531
Ampara 26.3 42.1 27.2 4.0 52.9 731
Trincomalee 23.5 39.6 29.7 7.8 51.3 362
Kurunegala 13.0 27.2 24.9 2.9 62.8 1,592
Puttalam 42.6 49.7 42.0 5.1 39.3 664
Anuradhapura 18.0 35.2 28.8 3.8 59.7 984
Polonnaruwa 34.4 57.8 34.9 2.9 35.0 399
Badulla 18.8 37.2 24.5 2.2 57.3 735
Moneragala 39.0 72.5 42.4 1.7 18.6 485
Ratnapura 20.5 44.0 40.9 2.9 42.6 1,084
Kegalle 28.6 39.5 49.7 3.9 38.5 698

Education
No education 8.5 13.8 0.6 0.0 83.5 285
Passed Grade 1-5 11.3 21.6 7.0 0.2 74.7 1,257
Passed Grade 6-10 21.5 39.9 29.5 1.4 51.5 8,130
Passed G.C.E.(O/L) or equivalent 26.1 45.5 43.0 5.2 42.6 4,044
Passed G.C.E.(A/L) or equivalent 28.4 50.9 53.9 15.4 33.1 3,731
Degree and above 32.6 51.4 58.9 35.6 29.6 856

Wealth quintile
Lowest 15.2 26.9 19.0 0.8 64.7 3,390
Second 21.1 40.8 30.8 2.0 49.8 3,695
Middle 24.6 43.9 36.9 2.6 45.9 3,838
Fourth 26.7 48.1 43.7 6.0 41.4 3,816
Highest 29.6 50.3 52.8 21.8 33.7 3,562

Total 15-49 23.6 42.2 36.9 6.6 46.8 18,302

Family Planning 77
 Table 5.14 Contact of nonusers with family planning providers

Among ever-married women age 15-49 who are not using contraception, the percentage who during
the past 12 months were visited by a fieldworker who discussed family planning, the percentage who
visited a health facility and discussed family planning, the percentage who visited a health facility but
did not discuss family planning, and the percentage who did not discuss family planning either with a
fieldworker or at a health facility, by background characteristics, Sri Lanka 2016
Percentage of women who visited a health facility in
the past 12 months and who:
Background charac- Discussed fami- Did not discuss Percentage of Number of
teristic ly planning family planning women who ever-married
did not discuss women
family planning
either with field-
worker or at a
health facility
Age
15-19 17.9 34.4 82.1 130
20-24 21.6 42.3 78.4 638
25-29 23.2 48.0 76.8 1,118
30-34 20.4 48.1 79.6 1,393
35-39 13.9 49.8 86.1 1,265
40-44 6.8 48.6 93.2 1,045
45-49 3.2 47.4 96.8 1,419

Residence
Urban 14.8 47.9 85.2 1,309
Rural 14.0 47.9 86.0 5,390
Estate 15.3 39.5 84.7 309

District
Colombo 15.2 52.7 84.8 733
Gampaha 13.1 53.9 86.9 648
Kalutara 15.7 58.0 84.3 327
Kandy 13.9 46.4 86.1 494
Matale 11.9 73.0 88.1 159
Nuwara Eliya 11.8 40.8 88.2 197
Galle 13.1 67.1 86.9 300
Matara 8.6 63.0 91.4 272
Hambantota 9.9 67.0 90.1 211
Jaffna 11.2 34.4 88.8 271
Mannar 22.0 15.7 78.0 67
Vavuniya 14.6 36.6 85.4 95
Mullaitivu 5.6 44.6 94.4 33
Kilinochchi 13.1 45.8 86.9 44
Batticaloa 8.0 41.6 92.0 374
Ampara 27.4 24.5 72.6 406
Trincomalee 18.3 30.1 81.7 199
Kurunegala 11.2 49.3 88.8 539
Puttalam 13.3 44.1 86.7 216
Anuradhapura 7.0 55.4 93.0 362
Polonnaruwa 17.1 38.6 82.9 119
Badulla 17.8 37.9 82.2 226
Moneragala 28.0 21.7 72.0 151
Ratnapura 11.4 50.3 88.6 315
Kegalle 23.0 38.1 77.0 252

Education
No education 4.5 42.0 95.5 105
Passed Grade 1-5 6.8 41.6 93.2 525
Passed Grade 6-10 14.7 45.6 85.3 2,881
Passed G.C.E.(O/L) 14.4 48.9 85.6 1,636
or equivalent
Passed G.C.E.(A/L) 15.9 51.5 84.1 1,511
or equivalent
Degree and above 16.7 50.9 83.3 350

Wealth quintile
Lowest 14.0 41.2 86.0 1,363
Second 13.0 46.5 87.0 1,358
Middle 15.0 47.5 85.0 1,453
Fourth 16.0 47.5 84.0 1,457
Highest 13.1 54.9 86.9 1,376

Total 14.2 47.5 85.8 7,008

78 Demographic and Health Survey - 2016, Sri Lanka

 OTHER PROXIMATE DETERMINANTS
OF FERTILITY 6
Key Findings
• Marriage: The median age at first marriage among women age 25-49 is 23.7
years.
• Age at first marriage: Median age at first marriage among women has in-
creased slightly since 2012, from 23.4 years to 23.7 years
• Marriage differentials: Ever-married women in the poorest wealth quintiles
and those with less education have lower median ages at first marriage than
those with higher education and those belonging to households in higher
wealth quintiles.
• Age at first sexual intercourse: The median age at first sexual intercourse
for women ages 25-49 at 23.7 years, equal to the age at first marriage.
• Amenorrhea, Abstinence and Insusceptibility: The median duration of
postpartum amenorrhea, abstinence and insusceptibility among ever-married
women who gave birth in the three years preceding the survey are 3.4, 3.2 and
5.1 months respectively.
• Menopause: Eleven percent of women age 30-49 are menopausal. Meno-
pause increases with age, from 5.2 percent among women age 30-34 to 35
percent among women age 45-49.

T
his chapter presents findings related to some key factors that affect a woman’s risk of becoming preg-
nant such as marriage and sexual activity. Marriage signals the regular exposure of women to the risk
of becoming pregnant. In societies where age at first marriage is low, childbearing typically also starts
early which results in higher fertility. Specifically, this chapter explores age at first marriage and age at first
sexual intercourse among Sri Lankan ever-married women. Finally, measures of several other proximate
determinants of fertility which, influence exposures to the risk of pregnancy are presented: durations of
postpartum amenorrhea, postpartum abstinence insusceptibility, and menopause. Marriage is a primary indi-
cation of the exposure of women to the risk of pregnancy and, therefore, is important for the understanding
of fertility. Populations in which age at marriage is low tend to be populations with early childbearing and
high fertility. For this reason, there is an interest in trends in age at marriage. Marriage, divorce, separation,
and widowhood are demographic events that influence exposure to pregnancy and thereby affect fertility. The
definition of marriage is not universal for all countries and religions in the world. In Sri Lanka, marriage is
very regulated by customs and laws that vary widely among ethnic groups. Although polygamy is illegal in
Sri Lanka but is permitted among Muslims, its practice is not very common among them.

6.1 Current marital status

Table 6.1 shows the current marital status of women age 15-49 according to age. In this table, the term “mar-
ried” is intended to mean legal, traditional, or formal marriage, while “living together” describes couples who
live together in an informal union as husband and wife. In later tables that do not list ‘living together’ as a
separate category, these women are included in the ‘currently married’ group. Respondents who are currently
married, widowed, divorced, or separated are referred to as ‘ever-married women’.

Other Proximate Determinats of Fertility 79

 Table 6.1 Current marital status

Percent distribution of women age 15-49 by current marital status, according to age, Sri Lanka 2016
Marital status

Age Never mar- Married Living together Widowed/ Total Percentage Number of
ried divorced/sepa- of respond- respondents
rated ents currently
in union

15-19 93.9 5.4 0.6 0.1 100.0 6.0 3,744

20-24 60.4 37.0 1.5 1.0 100.0 38.5 3,563
25-29 25.3 70.2 2.7 1.8 100.0 72.9 3,510
30-34 8.4 85.4 2.8 3.4 100.0 88.2 3,946
35-39 3.8 86.8 4.2 5.1 100.0 91.0 4,103
40-44 4.4 84.8 3.8 6.9 100.0 88.7 3,420
45-49 4.6 80.9 3.7 10.8 100.0 84.6 3,371
Total 15-49 28.7 64.5 2.8 4.1 100.0 67.3 25,656

The proportion of never married women age 15-49 is 29 percent. This proportion, as expected, falls
sharply with increasing age. It declines from 94 percent for women age 15-19 to less than 5 percent among
women age 35 or older. The opposite distribution is observed among married women, with its smallest per-
centage at age 15-19 (5 percent), growing to 70 percent at age 25-29 and stabilizing at 80 percent or higher
for ages 30-49. The high proportion of married women age for ages 30 and above indicates that marriage
is almost universal in Sri Lanka. Overall 65 percent of all women 15-49 years of age are currently married
and only four percent of women are widowed, divorced, and separated. The proportion of women who are
widowed, divorced or separated increases sharply with age,7 percent of women age 40-44 and 11 percent of
women age 45-49 are widowed, divorced or separated. As expected all the proportions of currently married,
divorced, widowed and separated increase with age.
Table 6.2 and figure 6.1 show the trend in the percentage of women who have never married by age
group for the 1963-2016 periods using different data sources. The proportion of women who have never
married affects fertility levels in a population. The singulate mean age at marriage (SMAM) is the average
length of single life expressed in years among those who marry before age 50. The SMAMin Sri Lanka has
been fluctuating around 22-25 years and is reported at 23.7 years in 2016. By age groups, the percentage of
ever-married adolescents (15-19) declined from 11 percent in year 2012 to 6 percent in year 2016. Among
20-24, the percentage of ever-married women decreased from 43 percent in 2012 to 40 percent in 2016 (see
Figure 6.1 included below). Some caution is advised in interpreting trends since some of the data sources
reflect the entire country, while most of the surveys omit the Eastern Northern districts. To be comparable to
the 2006-07 SLDHS, data from the 2016 SLDHS were re-tabulated to omit the Northern districts of Jaffna,
Mannar, Vavuniya, Mullaitivu and Kilinochchi.

Table 6.2 Proportion of ever- married women

Percentage of all women who have ever married according to age and singulate mean age at marriage (SMAM) from various
sources, 1963 to 2016
Current Census Census WFS Census DHS DHS DHS DHS Census DHS

age 1963 1971 1965 1981 19871 19931 20001 2006-071 2012 2016

15-19 14.8 10.6 6.8 9.9 7.3 7.1 8.6 9.6 10.6 6.1
20-24 57.6 46.8 39.4 44.7 42.9 38.8 37.1 43.1 43.2 39.6
25-29 81 75.4 68.1 69.6 70 66.3 66.7 74.1 75.6 74.7
30-34 88.6 89.1 86.3 84.2 85.8 82.3 84.2 89.2 89.8 91.6
35-39 89.8 94.2 94.2 91.1 90.9 88.9 89.3 93.6 93.3 96.1
40-44 86.1 95.3 95.4 94.1 93.8 90.8 94.2 93.8 94.3 95.5
45-49 81.6 95.9 97.9 95.5 96.5 94.8 93.5 94.3 94.6 95.4
SMAM 22.1 23.5 25.1 24.4 24.8 25.5 24.6 23.5 23.4 23.7
WFS = World Fertility Survey; SMAM = Singulate mean age at marriage Sources: DCS,1978 Table 4.1 ; DCS, 2002, Table 6.3;
special tabulation for 2006-07, 1 Excluding Northern and Eastern Provinces

80 Demographic and Health Survey - 2016, Sri Lanka

 Figure 6.1 Trends in proportion of women age 20-24 who were
ever-married

70
58
60

50 47 45 43 43 43
39 39 40
40 37
Pecentage

30

20

10

6.2 Age at first marriage

Median age at first marriage

Age by which half of respondents have been married

The start of marriage is an important social and demographic indicator and, in most societies, represents the
point in a person’s life when childbearing first becomes acceptable. Thus, trends in age at first marriage can
help in understanding the levels and trends in fertility for Sri Lanka. The duration of exposure to pregnancy
depends primarily on the age at which women first marry. Women who marry early will, on average, have
longer exposure to pregnancy and a greater number of lifetime births. Information on age at first marriage
was obtained by asking all ever-married women the month and year at which they married or started living
together with their first husband.
Table 6.3 shows the percentage of women age 15-49 who were first married by specific exact ages and me-
dian age at first marriage, according to current age. The results show no important differences in the ages at
first marriage among age cohorts. Overall, twelve percent of ever-married women 25-49 are already married
exact age at 18 and almost one fourth of them married by the time they were 20years. The median age at first
marriage is 23.7. Age at first marriage has been fluctuating around 23 years among ever-married women in
Sri Lanka. The median age at first marriage has remained constant during the recent past: 23.4 according to
the 2012 Population census and 23.7 years in the 2016 SLDHS. The proportions of women already married
exact ages 15 and 18 have declined further over time, as shown by comparing women in the youngest (20-24)
and oldest (45-49) cohorts.

Other Proximate Determinats of Fertility 81

 Table 6.3 Age at first marriage

Percentage of women age 15-49 who were first married by specific exact ages and median age at first marriage, according to current age, Sri Lanka
2016

Percentage first married by exact age:

Current age 15 18 20 22 25 Percentage Number of Median
never married respondents age at first
marriage
Age
15-19 0.3 na na na na 93.9 3,744 a
20-24 0.9 9.8 24.6 na na 60.4 3,563 a
25-29 1.2 11.2 25.9 39.2 59.0 25.3 3,510 23.5
30-34 1.0 12.5 25.6 39.5 60.1 8.4 3,946 23.5
35-39 1.3 11.7 25.4 38.9 60.4 3.8 4,103 23.5
40-44 1.4 12.0 24.4 36.9 57.5 4.4 3,420 24.0
45-49 1.8 12.5 25.7 39.4 57.3 4.6 3,371 23.8
20-49 1.3 11.6 25.3 na na 17.5 21,912 a
25-49 1.3 12.0 25.4 38.8 59.0 9.2 18,349 23.7

Note: The age at first marriage is defined as the age at which the respondent began living with her/his first spouse/partner
na = Not applicable due to censoring
a = Omitted because less than 50 percent of the women or men began living with their spouse or partner for the
first time before reaching the beginning of the age group

Table 6.4 presents differentials in the median age at first marriage among women age 25-49 by se-
lected background characteristics. As expected, rural women tend to marry at a younger age (23.5) than urban
women. The median age at first marriage among urban women (24.4 years), is over one year higher than the
median age at first marriage among estate women (23.3 years). There are marked differentials in the age of
first marriage by district of residence. Colombo, has the highest median at marriagewith 24.9 years. This is
about three years later than women from the Batticaloa, Mullaitivu, Trincomalee, Anuradhapura, Polonnaru-
wa, Moneragala and Puttalam districts. The median age at first marriage for the age group 30-49, increases
with education levels. The median age at first marriage among women with thirteen years of education is 26.2
years, more than five and half years higher than the median age among women who have no education (20.7
years) or primary (20.4 years) and about 3 years higher than among women who had “Passed G.C.E.(O/L) or
equivalent education” (23.6 years). Also, women from the highest wealth quintile marry more than four years
later than those from the lowest quintile (25.5 vs 21.7 respectively, see Table 6.4).

82 Demographic and Health Survey - 2016, Sri Lanka

Table 6.4 Median age at first marriage by background characteristics

Median age at first marriage among women age 25-49 and age 30-49, according to background character-
istics, Sri Lanka 2016

Women age

Background characteristic 25-49 30-49

Residence
Urban 24.4 24.5
Rural 23.5 23.6
Estate 23.3 23.0

District
Colombo 24.9 24.9
Gampaha 24.9 24.9
Kalutara 24.4 24.4
Kandy 24.6 24.9
Matale 22.8 22.9
Nuwara-Eliya 23.0 23.0
Galle 24.5 24.7
Matara 24.5 24.7
Hambantota 24.3 24.2
Jaffna 25.0 24.5
Mannar 23.0 22.7
Vavuniya 23.0 23.0
Mullaitivu 21.7 22.2
Kilinochchi 22.5 22.5
Batticaloa 21.6 21.8
Ampara 22.2 22.6
Trincomalee 21.7 21.4
Kurunegala 23.5 23.3
Puttalam 21.9 21.6
Anuradhapura 21.7 21.7
Polonnaruwa 21.7 21.8
Badulla 22.8 23.0
Moneragala 21.8 21.9
Ratnapura 23.4 23.3
Kegalle 24.1 24.3

Education
No education 20.8 20.7
Passed Grade 1-5 20.3 20.4
Passed Grade 6-10 21.7 22.0
Passed G.C.E.(O/L) or equivalent 23.4 23.6
Passed G.C.E.(A/L) or equivalent a 26.2
Degree and above a 28.7

Wealth quintile
Lowest 21.6 21.7
Second 22.7 22.8
Middle 23.3 23.2
Fourth 24.6 24.2
Highest a 25.5

Total 23.7 23.7

Note: The age at first marriage is defined as the age at which the respondent began living with her/his first
spouse/partner

a = Omitted because less than 50 percent of the women or men began living with their spouse or
partner for the first time before reaching the beginning of the age group

Other Proximate Determinats of Fertility 83

6.3 Age at first sexual intercourse

Median age at sexual intercourse

Age by which half of respondents have had sexual intercourse.

Age at first marriage can be used as a proxy for the beginning of exposure to the risk of pregnancy. However,
age at first sexual intercourse and age at first marriage may not necessarily occur at the same time, because
some women are sexually active before marriage, or sometimes it could be at a later date than the actual
recorded date of marriage. The age at which women initiate sexual intercourse more precisely marks the
beginning of their exposure to reproductive risks.
Table 6.5 shows the percentage of women age 15-49, who had first sexual intercourse by specific ages, the
percentage who never had sexual intercourse, and the median age of first sexual intercourse. The table was
generated using the information on the age at first sex from the ever-married women interviewed in the 2016
SDHS and assuming that never-married women have not had intercourse. Given the conservative nature of
the Sri Lanka society, that assumption is likely correct for many never-married women.
Table 6.5includes the median age at first sexual intercourse for women ages 25-49 at 23.7 years. Compared
with the median age at first marriage shown same age (23.7 years), these two figures indicate that first sexual
intercourse and first marriage occurs same time of the women life. Table 6.5 also shows that among women
ages 25-49, the percentage having their first sexual intercourse increases from 1 percent by age 15 to 12
percent by age 18. In fact, the percentage who had their first sexual intercourse by age 20 (25.4%) reaches
almost the double percentage found at age 18. This pattern persists across all current age groups. However,
the proportions of women having their first sexual intercourse by exact ages 15 has declined further over
time, as shown by comparing women in the youngest (15-19) and the oldest (45-49) cohorts; 0.3 percent to
1.9 percent, respectively.

Table 6.5 Age at first sexual intercourse

Percentage of women 15-49 who had first sexual intercourse by specific exact ages, percentage who never had sexual intercourse, and median age
at first sexual intercourse, according to current age, Sri Lanka 2016

Percentage who had first sexual intercourse by exact age:

Current age 15 18 20 22 25 Percentage Number Median
who never had age at first
intercourse intercourse
Age
15-19 0.3 na na na na 94.0 3,744 a
20-24 1.0 10.1 24.5 na na 60.8 3,563 a
25-29 1.3 11.5 25.8 38.7 58.4 26.0 3,510 23.6
30-34 1.2 12.7 25.7 39.3 59.8 8.6 3,946 23.5
35-39 1.4 11.9 25.4 39.0 60.2 4.0 4,103 23.5
40-44 1.5 12.3 24.5 36.9 57.0 4.6 3,420 24.1
45-49 1.9 12.8 25.7 39.4 57.4 4.9 3,371 23.8
20-49 1.4 11.9 25.3 na na 17.8 21,912 a
25-49 1.4 12.3 25.4 38.7 58.7 9.5 18,349 23.7
15-24 0.7 na na na na 77.8 7,307 a

na = Not applicable due to censoring

a = Omitted because less than 50 percent of the respondents had sexual intercourse for the first time before reach-
ing the beginning of the age group

Table 6.6 examines the median age at first sexual intercourse among women age 25-49 and 30-49 by
background characteristics. Women living in rural and estate areas tend to initiate sexual intercourse earlier
than their urban counterparts. The patterns are almost similar to median age at marriage: women in urban
areas, those with higher education and women from the richest households had their first sexual experience at

84 Demographic and Health Survey - 2016, Sri Lanka

later ages than rural and estate, less educated, and poorer counterparts. The differences are as marked as those
found in median age at first marriage. For example, median age at first sexual intercourse between urban and
rural areas differs by one year; very similar to the one year observed in age at first marriage between the two
areas is approximately.

Table 6.6 Median age at first sexual intercourse by background characteristics

Median age at first sexual intercourse among women age 25-49 and age 30-49, according to background
characteristics, Sri Lanka 2016

Women age
25-49 30-49
Residence

Urban 24.4 24.5

Rural 23.5 23.6
Estate 23.7 23.3

District
Colombo 24.9 24.9
Gampaha 24.9 24.9
Kalutara 24.4 24.4
Kandy 24.5 24.8
Matale 22.8 22.9
Nuwara-Eliya 23.4 23.5
Galle 24.5 24.7
Matara 24.5 24.7
Hambantota 24.4 24.4
Jaffna 25.0 24.4
Mannar 22.9 22.6
Vavuniya 23.4 23.6
Mullaitivu 21.6 22.1
Kilinochchi 22.5 22.5
Batticaloa 21.6 21.8
Ampara 22.3 22.6
Trincomalee 21.8 21.3
Kurunegala 23.5 23.4
Puttalam 22.0 21.6
Anuradhapura 21.7 21.6
Polonnaruwa 21.7 21.6
Badulla 22.8 23.0
Moneragala 21.9 22.0
Ratnapura 23.5 23.4
Kegalle 24.1 24.3

Education
No education 20.8 20.7
Passed Grade 1-5 20.3 20.4
Passed Grade 6-10 21.8 22.0
Passed G.C.E.(O/L) or equivalent 23.4 23.6
Passed G.C.E.(A/L) or equivalent a 26.2
Degree and above a 28.7

Wealth quintile
Lowest 21.6 21.7
Second 22.7 22.8
Middle 23.3 23.2
Fourth 24.6 24.2
Highest a 25.5

Total 23.7 23.7

a = Omitted because less than 50 percent of the respondents had intercourse for the first time before reach-
ing the beginning of the age group

Other Proximate Determinats of Fertility 85

6.4 Postprtum amenorrhoea, abstinence and insusceptibility

Median duration of postpartum amenorrhoea

Number of months after childbirth by which time half of women have begun mentruating
sample : women who gave birth in the 3 years before the survey

Median duration of postpartum insusceptibility

Number of months after childbirth by which time half of women are no longer protected against
pregnancy either by postpartum amenorrhoea or abstinence from sex.
sample : women who gave birth in the 3 years before the survey

Postpartum amenorrhea refers to the interval between childbirth and the return of menstruation. Dur-
ing this period, the risk of pregnancy is greatly reduced. The duration of this protection from conception after
childbirth depends on the duration and intensity of breastfeeding and the length of time before the resumption
of sexual intercourse. Postpartum abstinence refers to the period between child birth and the time when a
woman resumes sexual activity.Women who gave child birth during the three years prior to the survey were
asked about the duration of amenorrhea, and their sexual abstinence. Women are considered insusceptible if
they abstain from intercourse following childbirth and/or are amenorrheic.The duration of amenorrhea and
sexual abstinence following birth jointly determine the length of insusceptibility.
Table 6.7 and figure 6.2 show the percentage of births in the three years preceding the survey for
which mothers are postpartum amenorrheic, abstaining, and insusceptible by the number of months since
birth. The results are grouped in two-month intervals to minimize fluctuations in the estimates.
The median duration of amenorrhoea among women who gave birth in the three years preceding
the survey is 3.4 months and the median duration of postpartum abstinence is 3.2 months. The two factors,
postpartum amenorrhoea and abstinence, taken together indicate that the median duration of postpartum
insusceptibility to pregnancy is 5.1 months. The median duration of amenorrhea went down from 3.8 to 3.4
months from year 2006 to 2016 year. Women who gave child birth during the three years prior to the survey
were insusceptible to pregnancy (74 percent) after the first two months following childbirth. The majority of
women (59percent) are still abstaining in the first two months following birth. The contribution of abstinence
is greatly reduced after the third month. At 8-9 months, 22 percent of women are still amenorrheic, but only
13 percent are still abstaining. At 22-23 months after birth, insusceptibility drops to 13 percent or less.

86 Demographic and Health Survey - 2016, Sri Lanka

Table 6.7 Postpartum amenorrhea, abstinence and insusceptibility

Percentage of births in the three years preceding the survey for which mothers are postpartum amenorrheic, abstaining, and
insusceptible, by number of months since birth, and median and mean durations, Sri Lanka 2016

Percentage of births for which the mother is:

Months since birth Amenorrheic Abstaining Insusceptible1 Number of births

<2 84.0 94.9 98.7 288

2-3 49.7 58.9 73.5 228
4-5 37.8 21.5 50.3 245
6-7 31.8 17.6 41.5 277
8-9 21.7 13.3 30.7 254
10-11 14.3 12.3 23.0 257
12-13 11.7 7.4 17.1 235
14-15 10.3 9.3 18.1 252
16-17 7.9 6.9 14.2 292
18-19 7.5 8.9 15.3 245
20-21 8.7 9.5 17.4 253
22-23 7.0 6.3 13.0 283
24-25 6.3 6.8 12.2 261
26-27 4.0 7.0 10.5 294
28-29 5.7 4.7 10.3 265
30-31 4.7 5.2 9.1 241
32-33 4.7 8.1 12.8 317
34-35 4.7 4.6 9.3 307

Total 17.7 16.7 26.2 4,795

Median 3.4 3.2 5.1 na
Mean 6.8 6.3 9.8 na
Note: Estimates are based on status at the time of the survey.

na = Not applicable
1
Includes births for which mothers are either still amenorrheic or still abstaining (or both) following birth

Figure 6.2 Percentage of births for which mothers are postpartum

amenorrheic, abstaining and insusceptible to pregnancy

Percent
100
90
80
70
60
50
40
30
20
10
0

Months since birth

Amenorrheic Abstaining Insusceptible

Other Proximate Determinats of Fertility 87

 Table 6.8 shows differences in the median duration of postpartum amenorrhea, abstinence and in-
susceptibility according to background characteristics. In general, the differences in the median duration
of postpartum insusceptibility are small. Although the median duration of postpartum amenorrhea among
women age 30-49 is higher than among women age 15-29 (4.2 months and 2.7 months respectively), the
median duration of postpartum abstinence is nearly the same among these two groups (3.0 and 3.4 months
for amenorrhea and abstinence respectively, resulting in over 1-month difference in the median duration of
postpartum insusceptibility between younger women (4.4) and older women (5.6). Women in estate areas
have a longer median duration of amenorrhea than women in rural and urban areas. (4.1 Versus 3.5, and 2.7
months respectively), and they differ from women in urban and rural areas in median duration of postpartum
abstinence (3.3, 3.1 and 5.6 months respectively). Median duration of postpartum insusceptibility is substan-
tially longer among women in estate areas (8.2 months) than women in urban and rural areas (4.7, 5.0 months
respectively). The median duration of postpartum insusceptibility among women in the poorest households is
one month higher than the one observed among women in the richest households.

Table 6.8 Median duration of amenorrhea, postpartum abstinence and postpartum insusceptibility

Median number of months of postpartum amenorrhea, postpartum abstinence, and postpartum insusceptibility following births
in the three years preceding the survey, by background characteristics, Sri Lanka 2016
Percentage of births for which the mother is:
Background characteristic Postpartum amenorrhea Postpartum abstinence Postpartum insusceptibility1

Mother's age
15-29 2.7 3.0 4.4
30-49 4.2 3.4 5.6

Residence
Urban 2.7 3.3 4.7
Rural 3.5 3.1 5.0
Estate 4.1 5.6 8.2

Education
Passed Grade 1-5 (2.9) (3.4) (4.6)
Passed Grade 6-10 3.1 3.4 5.8
Passed G.C.E.(O/L) 3.4 3.4 4.4
or equivalent
Passed G.C.E.(A/L) 3.5 3.1 5.1
or equivalent
Degree and above (4.2) * (4.9)

Wealth quintile
Lowest 2.7 3.8 5.8
Second 2.8 3.2 4.4
Middle 3.7 3.2 5.4
Fourth 3.7 3.2 4.9
Highest 3.7 3.0 4.8

Total 3.4 3.2 5.1

Note: Medians are based on the status at the time of the survey (current status)
1
Includes births for which mothers are either still amenorrheic or still abstaining (or both) following birth

88 Demographic and Health Survey - 2016, Sri Lanka

6.5 Menopause

Menopause
Women are considered to have reached menopause if they are neither pregnant not postpartum
amenorrheic and have not had a menstural period in the 6 months before the survey, or if they report
being menopausal.
sample : women age 30-49

The risk of pregnancy declines with age as increasing proportions of women become infecund. The term
infecundity denotes a process rather than a well-defined event. Although the onset of infecundity is difficult
to determine for an individual woman, one indicator of infecundity is menopause.
Menopause is the culmination of a gradual decline in fecundity with increasing age. Women were
considered menopausal if they were neither pregnant nor postpartum amenorrheic at the time of the survey
and had not had a menstrual period for at least six months prior to the survey. Women who report that they
have had a hysterectomy are also defined as menopausal. Table 6.9 presents data on menopause for women
age 30 and older. Eleven percent of women age 30-49 are estimated to be menopausal. As expected, the pro-
portion of women who are menopausal increases with age, from 5.2 percent among women age 30-34 to35
percent among women age 45-49.

Table 6.9 Menopause

Percentage of women age 30-49 who are menopausal, by age, Sri Lanka 2016

Women Age Percentage menopausal1 Number of women

Age
30-34 5.2 3,615
35-39 6.5 3,945
40-41 8.8 1,350
42-43 8.0 1,272
44-45 14.0 1,281
46-47 19.4 1,348
48-49 35.0 1,232

Total 11.0 14,043

1
Percentage of all women who are not pregnant and not postpartum amenorrheic whose last menstrual
period occurred six or more months preceding the survey

Other Proximate Determinats of Fertility 89

90 Demographic and Health Survey - 2016, Sri Lanka
 FERTILITY PREFERENCES 7
Key Findings
• Desire for another child: Sixteen percent of currently married women age
15-49 want to have another child soon and 12 percent want to wait at least 2
years before having another child.
• Limiting child bearing: Sixty-one percent of currently married women in Sri
Lanka want to limit child bearing: 47 percent want no more children and 14
percent have been sterilized.
• Ideal Family: Women currently want 2.5 on average children. as their ideal
family size In the 2016 DHS.
• Wanted Fertility: The total wanted fertility rate (1.9) is lower than the current
total fertility rate (2.2)

I
nformation on fertility preferences can improve understanding of future fertility patterns, future demands
for contraception, and provides information related to attitudes on fertility intentions and preferences.
This chapter presents information on whether and when married women want more children or not, ideal
family size, whether the last birth was wanted at the time, and a theoretical fertility rate if all unwanted births
were prevented.
To analyze the attitudes regarding the desired number of children, ever-married women age 15-49
who were either not pregnant or unsure about their status were asked to set of questions to ascertain their
fertility preferences:Would you like to have (a/ another) child or would you prefer not to have any (More)
children? Women who were pregnant at the time of the survey were asked: After the child you are expecting
now, would you like to have another child, or would you prefer not to have any more children? Women who
indicated that they wanted another child were asked how long they would like to wait before the birth of the
next child. Finally, women were asked about the total number of children they would like to have, if they
were to start childbearing afresh.

7.1 Desire for more children

Desire for another child

Women were asked whether they wanted more children and, if so, how long
they would prefer to wait before the next child. Women who are sterilized are
assumed not to want any more children

Currently married women were asked whether they wanted more children and, if so, how long they
would prefer to wait before the next child. Women who are sterilized are assumed not to want any more
children. Table 7.1 presents the percent distribution of currently married women age 15-49 by the desire
for children, according to the number of living children. At the national level, thirty percent of the currently
married women want to have another child, 16 percent wanted soon and 12 percent later on. However, the
majority of currently married women (47 percent) indicated that they do not want to have more children than
the ones they already have. If we add to this percentage, the 14 percent of women who are sterilized, over 61
percent of currently married women do not want more children at all (see Figure 7.1 below) are to respond to
the needs expressed by these two numbers.

Fertility Preferences 91
 Table 7.1 Fertility preferences by number of living children
Percent distribution of currently married women age 15-49 by desire for children, according to number of living children, Sri Lanka 2016

Number of living Children

Desire for children 0 1 2 3 4 5 6+ Total 15-49

Have another soon2 67.4 31.0 7.2 1.0 0.9 0.1 1.0 16.3
Have another later3 8.4 32.5 7.6 2.0 0.8 0.7 0.0 12.2
Have another, undecided when 3.0 4.1 1.5 0.3 0.1 0.0 0.0 1.9
Undecided 10.8 4.1 4.5 2.1 1.3 0.3 2.7 4.2
Want no more 3.2 24.0 69.5 51.1 43.5 40.5 53.2 47.1
Sterilized4 0.2 0.9 6.4 39.3 43.3 49.1 40.6 14.0
Declared infecund 5.1 1.4 0.8 0.8 1.2 0.5 0.2 1.3
Missing 1.9 2.1 2.5 3.5 8.8 8.8 2.3 3.0

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Number 1,437 4,259 6,746 3,688 799 251 76 17,257
1
The number of living children includes the current pregnancy
2
Wants next birth within 2 years
3
Wants to delay next birth for 2 or more years
4
Includes both female and male sterilization
5
The number of living children includes one additional child if respondent's wife is pregnant (or if any wife is pregnant for men with more
than one current wife).

As with many statistics, the values presented above vary substantially according to the number of
living children the woman had at the time of the survey. From Table 7.1 we can conclude that the desire to
have another child (soon, later on or undecided when) is greater among the currently married women without
children or with one child (79 percent and 68 respectively), compared to 16 percent or less among those
with 2 or more children already. Similarly, among those who indicated that they do not want to have more
children, the highest percentages are observed among those currently married women who already have two
or more children or are already sterilized (76 percent among those with 2 or more children and 90 percent or
more among those with 5 or more children, see Table 7.1 and Figure 7.2).

Figure 7.1 Desire for more children among currently married

women
Want no more or
sterilized
61%

No Answer
3%
Declared infecund
2%
Undecides Have another soon
6% 16%
Have another later
12%

92 Demographic and Health Survey - 2016, Sri Lanka

 Figure 7.2 Percentage of currently married women who want
no more children by number of living children

100
90 90
90

80 76

70

60
Percentage

50

40

30 25

20

10 3
0
0 1 2 3 4+
Number of living children

Note : women who have been sterilized are considered do want no more children.
Table 7.2 presents the percentage of currently married women who want no more children (includ-
ing those who have already been sterilized) by the number of living children and according to background
characteristics. In general, the differences in the percentage currently married women who do not want more
children by background characteristics are relatively small, with a few exceptions. Women living in the estate
areas are most likely not to want to have any more children (66 percent). By district, the percentage who do
not want more children varies substantially, from just 34 percent in the district of Mannar to twice as many
(69 percent) in Kagalle. The desire for no more children fluctuates between 59 percent and 64 percent across
household wealth quintiles. By education the percentage of wanting no more children is highest (84 percent)
among those with no education and lowest (47 percent) among currently married women with degree and
above. This pattern is particularly found among currently married women with just one child. Similar differ-
ences are not observed among currently married women with three or more children.
The decisions of women with two or more children about not having any more children are pivotal
to the achievement of the near-replacement fertility in Sri Lanka as documented in previous chapters. Almost
61 percent of the currently married women express their desire to have no more children, this number varies
little across places of residence, education or wealth quintile. As figure 7.3 shows, in 8 districts, close to 80
percent of the currently married women with two children do not want to have more children.

Fertility Preferences 93
Table 7.2 Desire to limit childbearing

Percentage of currently married women age 15-49 who want no more children, by number of living children, according to background char-
acteristics, Sri Lanka 2016

Number of living children

0 1 2 3 4 5 6+ Total
Residence
Urban 2.9 24.8 73.8 87.0 86.2 (90.2) * 58.1
Rural 3.5 24.8 76.3 91.3 87.1 89.9 93.8 61.5
Estate 1.0 26.6 75.8 84.5 85.0 * * 65.7

District
Colombo 5.0 29.7 79.4 91.1 (93.7) * * 60.0
Gampaha 4.3 36.9 80.8 95.5 (91.8) * * 64.7
Kalutara 1.8 27.0 80.1 90.5 * * * 62.3
Kandy 3.1 27.9 73.4 91.4 94.0 * * 61.2
Matale (2.1) 18.0 75.7 95.6 * * * 62.0
Nuwaar Eliya (19.7) 25.2 77.0 87.2 (81.1) * * 67.2
Galle 3.8 18.0 78.5 94.4 (93.6) * * 62.6
Matara 5.4 24.2 77.6 96.0 (90.4) * * 65.3
Hambantota (0.0) 16.2 75.7 93.2 (76.3) * * 60.0
Jaffna (0.0) 6.9 69.4 77.7 (62.1) (86.7) * 53.0
Mannar * 5.9 40.3 47.0 28.0 (62.8) * 33.6
Vavuniya (0.0) 16.5 62.6 64.6 (54.4) * * 47.6
Mullaitivu * 21.6 73.5 93.0 (90.9) * * 64.6
Kilinochchi * 13.8 71.6 91.5 (88.3) * * 64.2
Batticaloa (2.5) 21.6 66.6 80.1 82.6 (81.0) * 55.9
Ampara 2.8 14.0 55.3 78.5 78.7 * * 49.6
Trincomalee (0.0) 9.8 51.8 76.8 (76.3) * * 50.0
Kurunegala 3.3 22.2 82.2 94.7 (96.9) * * 63.6
Puttlam 5.3 30.1 72.4 93.3 (90.5) * * 62.7
Anuradhapura 1.8 24.6 69.4 90.8 (90.8) * * 57.4
Polonnaruwa (3.8) 32.0 72.1 90.7 * * * 64.0
Badulla 1.5 17.0 72.2 90.5 (87.1) * * 61.9
Moneragala (0.0) 16.7 74.5 84.4 (97.4) * * 62.1
Ratnapura 3.1 22.2 78.7 94.8 (98.4) * * 60.7
Kegalle 0.0 32.5 88.2 93.3 * * * 68.9

Education
No education * * 92.1 89.8 (90.3) * * 83.9
Passed Grade 1-5 (16.6) 54.9 84.9 90.2 82.8 91.7 (96.6) 81.2
Passed Grade 6-10 2.5 24.3 75.3 90.5 87.7 89.1 (91.9) 64.5
Passed 2.3 25.6 77.2 90.5 84.8 (84.8) * 59.4
G.C.E.(O/L) or
equivalent
Passed G.C.E.(A/L) 3.5 22.2 73.0 89.8 94.4 * * 51.6
or equivalent
Degree and above 3.8 19.8 77.2 88.4 * * * 46.7

Wealth quintile
Lowest 3.0 25.4 73.4 88.5 86.0 89.8 92.4 64.3
Second 4.2 23.9 75.2 91.6 85.8 90.5 * 61.8
Middle 4.8 24.0 75.8 90.1 90.2 (84.9) * 59.8
Fourth 1.4 23.0 75.4 89.4 85.8 * * 58.7
Highest 3.2 28.2 79.0 92.3 87.8 * * 61.6

Total 3.3 24.9 75.9 90.3 86.8 89.6 93.7 61.1

Note: Women who have been sterilized are considered to want no more children.
1
The number of living children includes the current pregnancy

94 Demographic and Health Survey - 2016, Sri Lanka

 Figure 7.3 Percentage of currently married women with two
children who want no more children, by district Sri Lanka, 2016

7.2 Ideal number of children

Ideal family size

Respondents with no children were asked, “ if you could choose exactly the number of children to
have in your whole life, how many would that be?”
Respondants who had children were asked: “ if you could go back to the time when you did not have
any children and could choose exactly the number of children to have in your whole life, how many
would that be ?”

Fertility Preferences 95
 This section focuses on the respondents’ ideal number of children, implicitly taking into account
the number of children that the respondent already has. Ever-married women were asked about the number
of children they would choose to have if they could start afresh, with no reference to any particular change
in marital status. Respondents who had no children were asked “if you could choose exactly the number of
children to have in your whole life, how many would that be?” Responses to these questions are summarized
in Tables 7.3 and 7.4.

Table 7.3 Ideal number of children by number of living children

Percent distribution of ever-married women 15-49 by ideal number of children, and mean ideal number of children for all respondents and for
currently married respondents, according to the number of living children, Sri Lanka 2016

Number of living children

Ideal number of children 0 1 2 3 4 5 6+ Total

0 3.7 3.9 4.0 5.4 8.2 7.6 15.3 4.5

1 8.4 9.1 3.5 1.9 1.7 1.6 0.8 4.9
2 55.9 58.9 51.6 20.5 13.7 8.4 4.5 44.6
3 22.9 21.8 28.6 50.8 19.2 26.5 11.9 30.5
4 6.4 4.0 9.6 14.5 45.0 13.8 15.3 10.7
5 1.2 1.2 1.9 5.4 6.7 31.5 12.7 3.1
6+ 0.5 0.3 0.5 1.1 4.2 9.5 34.8 1.0
Non-numeric responses 0.9 0.9 0.3 0.4 1.3 1.0 4.8 0.6

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Number 1,551 4,634 7,039 3,847 873 271 87 18,302

Mean ideal number of children

for:2
Ever-married 2.3 2.2 2.4 2.9 3.3 3.8 4.4 2.5
Number ever-married women 1,537 4,594 7,016 3,832 861 268 83 18,191
Currently married 2.3 2.2 2.5 2.9 3.3 3.8 4.4 2.5
Number of currently married 1,429 4,231 6,726 3,673 788 249 73 17,169

1
The number of living children includes current pregnancy for women
2
Means are calculated excluding respondents who gave non-numeric responses.
3
The number of living children includes one additional child if respondent’s wife is pregnant (or if any wife is pregnant for men with more than
one current wife).

According to the data given in Table 7.3, the mean ideal number of children for currently married
women is 2.5. This mean value varies by the number of children a woman already has. It is lower among
those couples without children or with just one living child (2.3 and 2.2 respectively) and much higher among
those with greater number of living children (3.3 or greater for couples with 3 or more living children). Al-
most 45 percent women prefer to have two children and 31 percent prefer three children. The more children
the respondents already have, the more children they consider ideal.

96 Demographic and Health Survey - 2016, Sri Lanka

Table 7.4 Mean ideal number of children

Mean ideal number of children for ever-married women age 15-49 by background characteristics, Sri Lanka
2016
Background characteristic Mean Number of ever-married
women1
Age
15-19 2.2 225
20-24 2.3 1,407
25-29 2.4 2,609
30-34 2.5 3,598
35-39 2.6 3,922
40-44 2.6 3,243
45-49 2.7 3,189

Residence
Urban 2.6 2,818
Rural 2.5 14,665
Estate 2.5 709

District
Colombo 2.5 1,700
Gampaha 2.4 1,826
Kalutara 2.5 1,102
Kandy 2.6 1,218
Matale 2.8 488
Nuwara Eliya 2.5 572
Galle 2.5 911
Matara 2.4 715
Hambantota 2.7 553
Jaffna 2.5 461
Mannar 2.8 81
Vavuniya 2.5 136
Mullaitivu 2.2 80
Kilinochchi 2.8 94
Batticaloa 2.9 530
Ampara 2.8 731
Trincomalee 2.6 362
Kurunegala 2.4 1,591
Puttlam 2.4 664
Anuradhapura 2.7 984
Polonnaruwa 2.7 397
Badulla 2.6 733
Moneragala 2.3 485
Ratnapura 2.6 1,083
Kegalle 2.1 697

Education
No education 2.7 280
Passed Grade 1-5 2.8 1,248
Passed Grade 6-10 2.5 8,074
Passed G.C.E.(O/L) or equivalent 2.5 4,025
Passed G.C.E.(A/L) or equivalent 2.4 3,714
Degree and above 2.4 849

Wealth quintile
Lowest 2.6 3,367
Second 2.5 3,677
Middle 2.5 3,819
Fourth 2.5 3,798
Highest 2.5 3,530

Total 2.5 18,191

1
Number of ever-married women who gave a numeric response

Fertility Preferences 97
 Table 7.4 shows the mean ideal number of children for all ever-married women by background
characteristics. Overall, the mean ideal number of children increases gradually with the age of the woman,
from 2.2 children among women age 15-19 to 2.7 children among women age 45-49. There appears to be an
association between the mean ideal number and the educational level of the woman; the higher the educa-
tional level, the lower the mean ideal children. For women with no education the mean ideal number is 2.7
children, compared to just 2.4 children among women with degree and above. Greater variation is observed
in the mean ideal number of children by district. The range in this number goes from 2.1 in Kegalle to 2.9 in
Batticaloa.

7.3 Wanted fertility rates

Wonted fertility rate

The number of children the avarage woman would have over the course of her lifetime if she bore
children at current age-specific fertility rates, excluding unwanted births. A birth is considered wanted
if the number of living children at the time of conception is lower than the ideal number of children
cuurently reported by the respondent.
sample : British to women age 15-49 during the 3 years before the survey

The wanted fertility rate measures the potential demographic impact of avoiding unwanted births. The want-
ed fertility rate is calculated in the same manner as the conventional total fertility rate, except that unwanted
births are excluded. A birth is considered wanted if the number of living children at the time of conception
was less than the ideal number of children reported. The gap between wanted and actual fertility shows how
successful women are in achieving their reproductive intentions. A comparison of the total wanted fertility
rates and total fertility rates for the three years preceding the survey by background characteristics is present-
ed in Table 7.5.

98 Demographic and Health Survey - 2016, Sri Lanka

Table 7.5 Wanted fertility rates

Total wanted fertility rates and total fertility rates for the three years preceding the survey, by background
characteristics, Sri Lanka 2016
Background characteristic Total wanted fertility rates Total fertility rate

District
Colombo 1.6 1.8
Gampaha 1.6 1.8
Kalutara 2.1 2.2
Kandy 2.2 2.6
Matale 1.7 1.9
Nuwara Eliya 2.0 2.2
Galle 1.9 2.1
Matara 2.0 2.3
Hambantota 1.6 1.9
Jaffna 1.8 2.1
Mannar 1.8 2.0
Vavuniya 1.5 2.0
Mullaitivu 1.5 2.0
Kilinochchi 1.8 2.1
Batticaloa 2.2 2.4
Ampara 2.1 2.4
Trincomalee 1.7 2.3
Kurunegala 2.0 2.2
Puttlam 1.8 2.1
Anuradhapura 2.1 2.4
Polonnaruwa 2.3 2.5
Badulla 2.0 2.3
Moneragala 1.6 2.4
Ratnapura 1.7 1.8
Kegalle 2.2 2.6

Education
No education 1.4 1.6
Passed Grade 1-5 1.8 2.3
Passed Grade 6-10 2.1 2.4
Passed G.C.E.(O/L) or equivalent 1.9 2.1
Passed G.C.E.(A/L) or equivalent 1.9 2.1
Degree and above 1.9 2.0

Wealth quintile
Lowest 1.8 2.2
Second 1.8 2.1
Middle 1.7 2.0
Fourth 1.6 1.9
Highest 2.1 2.3

Total 1.9 2.2

Note: Rates are calculated based on births to women age 15-49 in the period 1-36 months preceding the
survey. The total fertility rates are the same as those presented in Table 5.2

Fertility Preferences 99
 Figure 7.4 Total wanted fertility rates and total fertility rates for the
three years preceding the survey by district Sri Lanka 2016

Total wanted fertility rates Total fertility rate

Colombo
Kegalle 3.0 Gampaha
Ratnapura Kalutara
2.5
Monaragala Kandy
2.0
Badulla Matale
1.5
Polonnaruwa 1.0 Nuwaraeliya
0.5
Anuradhapura Galle
0.0
Puttalam Matara

Kurunegala Hambantota

Trincomalee Jaffna
Ampara Mannar
Batticaloa Vavuniya
Killinochchi Mullaitivu

Figure 7.4 provides a comparison of the total fertility rates (observed and wanted) indicating a want-
ed fertility corresponding to replacement or below replacement level. The lowest level of the total wanted
fertility rate is observed in the districts of Vavuniya and Mullaitivu (1.5). There are no consistent variations in
the total wanted fertility rate by levels of education or wealth quintile, besides the fact that the highest values
are observed among the richest quintile (2.1) and among those women with primary education (1.8 children
per woman). However, these differences should be seen with care since they can be within the confidence
intervals of the sampling errors around the estimates

100 Demographic and Health Survey - 2016, Sri Lanka

 INFANT AND CHILD MORTALITY 8
Key Findings
• Current levels:Early childhood mortality is declining over time. One in every 100 children dies
before completing one year of life. Around 68 percent of infant mortality is attributed to deaths
of children before completing 1 month.
• Trends: All measures of childhood mortality show a marked decline over the past 10 years.
• Differentials: Differentials by background characteristics in early childhood mortality rates dur-
ing the past decade are small. However, neonatal mortality and infant mortality rates are lower
to the extent that the mother’s level of education is higher.
• High risk births:Of the total number of births in the five years preceding the survey, 23 percent
are in at least one avoidable high risk category.

E
arly childhood mortality is an important measure of a country’s socioeconomic development as well
as the quality of life. Sri Lanka has experienced a significant decline in the probability of dying in the
early childhood period during last decades. This chapter presents the levels, trends and differentials in
early childhood mortality rates in Sri Lanka during the 14 years prior to the 2016 SLDHS study. The mortal-
ity rates can be considered as indices that provide a baseline for the country’s initiatives on the 2030 agenda
for sustainable development. These data can also be used for monitoring and evaluating existing programmes
in the health sector.
The data for mortality estimation were collected in the birth history section of the women’s ques-
tionnaire of the 2016 SLDHS 2016. The birth history is preceded by a short section including questions about
the respondent’s experience with child bearing (number of sons and daughters living with the mother, the
number who live elsewhere, and the number who died). These questions were followed by a retrospective
birth history in which each respondent was asked to list each of her births, starting with the first birth. For
each birth, data were obtained on sex, month, and year of birth, survivorship status, and current age, or if the
child was dead, age at death. This information is used to directly estimate mortality levels, differentials and
trends. Age-specific mortality rates are categorized and defined as follows:

Neonatal mortality (NNM): the probability of dying within the first month of life
Post-neonatal mortality (PNNM):the probability of dying between the first month and first birthday (the
difference between infant and neonatal mortality)
Infant mortality (1q0): the probability of dying before the first birthday, or IMR
Child mortality (4q1): the probability of dying between the first and fifth birthday, or CMR
Under-five mortality (5q0): the probability of dying between birth and the fifth birthday, or U5MR
All rates are expressed per 1,000 live births, except for child mortality, which is expressed per1,000 children
surviving to 12 months of age. Under-five mortality consists of deaths among children from birth until exact
age five.

Infant and Child Mortality 101

8.1 Data quality
The quality of mortality estimates calculated from retrospective birth histories depends upon the
completeness with which births and deaths are reported and recorded. Retrospective birth history data are
known to be susceptible to several possible types of errors. One source of error relates to the facts that only
surviving women age 15-49 were interviewed, eliminating data on children of women who were not rep-
resented in the sample because they have already died. Resulting mortality estimates will be biased if the
fertility of surviving and non-surviving women would differ substantially.
A second factor that affects childhood mortality estimates is the quality of reporting of age at death,
which may distort the age pattern of mortality. If age at death is misreported, it will bias the estimates, es-
pecially if the net effect of the age misreporting results in transference from one age bracket to another. For
example, a net transfer of deaths from under one month to a higher age will affect the estimates of neonatal
and post-neonatal mortality. To minimize errors in reporting of age at death, interviewers were instructed to
record age at death in days if the death took place in the month following the birth, in months if the child died
before age two, and in years if the child was at least two years of age.
Another possible error is under-reporting of events; respondents are more likely to forget distant
events than recent events. Thus, deaths that occurred in the more distant past are less likely to be reported
than recent deaths, resulting in under-reporting of deaths. If selective omission of childhood deaths occurs,
it is usually most severe with deaths early in infancy. Generally, if deaths are substantially under-reported,
the result is a low ratio of early neonatal deaths (within the first week of life) to all neonatal deaths and a low
ratio of neonatal deaths to infant deaths.

8.2 Levels and trends in infant and child mortality

Early childhood mortality in Sri Lanka has declined to a low rate. Sri Lanka was able to achieve
MDG targets on infant and under-five mortality, as expected. Table 8.1 presents the levels and changes in
childhood mortality rates during the past fifteen years. Under five mortality (U5MR) was estimated as 11
deaths before age 5 per 1,000 live births for the 0-4 years period before the survey. This value compares to 13
and 17 for the 5-9 and 10-14 years before the survey respectively, indicating a reduction of about 30 percent
during the last 15 years.
Most of the U5MR in Sri Lanka occurs within the first year of life, particularly during the first month
after birth, also called the neonatal period. The infant mortality rate (IMR) was estimated at 10 per 1,000 live
births during the 0-4 years before the survey, of which 7 per 1,000 correspond to the neonatal mortality rate
(NNM, see Table 8.1). Data in Table 8.1 also show that post-neonatal, infant and child mortality rates have
declined during the last 15 years

Table 8.1 Early childhood mortality rates

Neonatal, post-neonatal, infant, child, and under-five mortality rates for five-year periods preceding the survey, Sri Lanka 2016
Years preceding Neonatal mortality Post-neonatal Infant mortality Child mortality Under-five mortality
the survey (NN) mortality (PNN)1 (1q0) (4q1) (5q0)

0-4 7 3 10 1 11
5-9 8 3 11 2 13
10-14 10 4 14 3 17

1
Computed as the difference between the infant and neonatal mortality rates .

Figure 8.1presents a comparison on childhood mortality rates for 0-4 years preceding the surveys
conducted in 2006-07 and 2016. The results confirm the declining trend in all indicators of infant and child
mortality. Notice also the expected similarity between the rates for the 0-4 period before the 2006-07 SLDHS
and the ones for the period 10-14 from the 2016 SLDHS.

102 Demographic and Health Survey - 2016, Sri Lanka

 Figure 8.1 Estimates of NNM, PNNM, IMR, 4q1 and U5MR for
the 0-4 years before the survey, obtained from the 2006-07
SLDHS and 2016 SLDHS

25
21
20

15
15
11 11
10
10
7
5 5
5 3
1
0
Neonatal mortality Post-neonatal Infant mortality Child mortality Under-five mortality
mortality

DHS 2006/07 DHS 2016

8.3 Socioeconomic differentials in infant and child mortality

Differentials in early childhood mortality with socioeconomic characteristics including residence,
mother’s education level and wealth quintile are shown in table 8.2. The data refer to the 10-year period
preceding the survey.
Children born in the estate sector have a slightly higher probability of dying before reaching year 1
of their life when compared to children in the urban and rural sectors. Neonatal and post neonatal mortality
show declines with the increase of mother’s education level.Wealth quintile has only a slight relationship
with deaths of children of under 1 year. Neither residence nor mother’s education nor wealth quintile shows
significant differences in child mortality.
The highest rate in under-five mortality is reported in Kilinochchi district, with 44 per 1,000 live
births, while the lowest is reported in Polonnaruwa district . Mortality estimates for most of the districts were
hindered by the low number of cases.
By sector of residence, the Estates has a higher U5MR (15 per thousand live births during the 10
years period before the survey), than the urban and rural sectors (11 and 12 respectively). These differences
are due to the differential NNM, with a much higher NNM levels among live births of mothers in the estate
sector (see Table 8.2 below).
Sector differential in under-five mortality rate between DHS survey conducted in 2006-07 and 2016
presents in the figure 8.3. Under-five mortality rate has fallen in urban sector from 19 to 11 deaths per 1,000
live births while in estate sector from 33 to 15 deaths per 1,000 live births when compared DHS 2006-07 and
DHS 2016 reporting comparatively high decline in the estate sector.
The level of education of the mother and household wealth present the expected differentials in in-
fant and child mortality. U5MR is much higher among mothers of children with no education (14 per 1,000
live births during the 10 year period before the 2016 SLDHS) than those with degree and above (just 6 per
1,000 live births). Similarly, children of the poorest households are also experiencing higher levels of U5MR
than those of the richest quintile (17 vs 9 respectively, see Table 8.2).

Please note that this rate has been calculated using less than 299 exposure cases.

Infant and Child Mortality 103

 Table 8.2 Early childhood mortality rates by socioeconomic characteristics

Neonatal, post-neonatal, infant, child, and under-five mortality rates for the 10-year period preceding the survey, by background
characteristics, Sri Lanka 2016
Background Neonatal mortality Post-neonatal Infant mortality Child mortality Under-five
characteristic (NN) mortality (PNN)1 (1q0) (4q1) mortality (5q0)
Residence
Urban 7 3 10 2 11
Rural 7 3 10 1 12
Estate 8 5 13 2 15

District
Colombo 5 4 9 0 9
Gampaha 2 3 5 2 7
Kalutara 9 7 16 0 16
Kandy 7 2 9 3 12
Matale (10) (4) (14) (1) (14)
Nuwara Eliya 7 2 9 0 9
Galle 4 3 8 2 10
Matara 7 0 7 0 7
Hambantota 6 2 8 0 8
Jaffna (7) (2) (10) (5) (15)
Mannar (0) (3) (3) (2) (4)
Vavuniya (15) (0) (15) (0) (15)
Mullaitivu (13) (9) (22) (0) (22)
Kilinochchi (21) (8) (28) (16) (44)
Batticaloa 8 2 10 0 10
Ampara 13 4 17 0 17
Trincomalee 25 (0) (25) (1) (26)
Kurunegala 7 3 10 2 12
Puttalam 14 5 19 4 22
Anuradhapura 7 3 10 1 12
Polonnaruwa (0) (0) (0) (3) (3)
Badulla 8 3 10 3 13
Monaragala 6 0 6 (0) (6)
Ratnapura 9 7 17 0 17
Kegalle 3 3 6 1 7

Mother's edu-
cation
Passed 9 5 13 1 14
Grade 1-5
Passed 7 4 11 2 12
Grade 6-10
Passed 8 3 11 1 12
G.C.E.(O/L)
or equivalent
Passed 8 2 10 1 11
G.C.E.(A/L)
or equivalent
Degree and 3 0 4 2 6
above

Wealth quintile
Lowest 10 5 15 2 17
Second 7 2 9 0 10
Middle 6 2 8 2 10
Fourth 8 4 11 2 14
Highest 6 2 8 1 9

1
Computed as the difference between the infant and neonatal mortality rates

104 Demographic and Health Survey - 2016, Sri Lanka

Figure 8.2 Under Five Mortality Rates in Sri Lanka, 2016

Infant and Child Mortality 105

 Figure 8.3 Under-five Mortality Rates in the 2006-07 SLDHS and the
2016 SLDHS

35 33

30

25 23
Per 1,000 live births

19
20
15
15 12
11
10

0
Urban Rural Estate
Residence

2006-07 SLDHS 2016 SLDHS

8.4 Demographic differentials in infant and child mortality

Demographic characteristics like sex of the child, mother’s age at birth, birth interval and birth
order are highly related to the death of a child. Table 8.3 presents the levels of early childhood mortality by
demographic characteristics as observed during the 10 years period before the survey. The results included
here confirm the traditional pattern of early childhood mortality by sex of the child in which males are more
likely to die before age five when compared to females. The pattern is also present for the NNM, and IMR.
The data included on IMR by age of the mother at birth confirm the U-shaped pattern of higher levels
of IMR at early and late ages of birth (15-19 and 40-49 respectively).The trend in NNM resembles a J-shape,
high when the mother’s age at birth is less than 20 and greater than 40. As expected, neonatal mortality is
substantially higher in cases where birth order is 4-6, than in cases where birth order is lower. The association
of the length of the previous birth interval to the neonatal mortality is marginal.

106 Demographic and Health Survey - 2016, Sri Lanka

 Table 8.3 Early childhood mortality rates by demographic characteristics

Neonatal, post-neonatal, infant, child, and under-five mortality rates for the 10-year period preceding the survey, by demographic
characteristics, Sri Lanka 2016

Demographic Neonatal mortality Post-neonatal Infant mortality Child mortality Under-five

characteristic (NN) mortality (PNN)1 (1q0) (4q1) mortality (5q0)
Child's sex
Male 9 3 12 2 14
Female 6 3 9 1 10

Mother's age at
birth
<20 10 3 12 3 16
20-29 7 3 11 2 12
30-39 7 3 10 1 11
40-49 (17) (1) (17) * *

Birth order
1 8 2 11 2 12
2-3 6 4 10 1 11
4-6 14 5 19 1 21

Previous birth
interval2
<2 years 8 5 13 3 16
2 years 10 2 12 na na
3 years 5 5 10 na na
4+ years 6 3 10 na na

1
Computed as the difference between the infant and neonatal mortality rates
2
Excludes first-order births

8.5 Perinatal mortalitt

Perinatal mortality – comprising pregnancy losses occurring after seven completed months of
gestation(still births) and deaths to live births within the first seven days of life (early neonatal mortality),
provides a measurement of the quality of a country’s health delivery services.
Table 8.4 presents the number of stillbirths, number of early-neonatal deaths, the perinatal mortality
rate, and the number of pregnancies of 7+ months duration for the five-year period preceding the surveyby
background characteristics. The perinatal mortality rate, which is reported as 11 deaths per 1,000 live births,
is comparatively high when compared to neonatal mortality in Sri Lanka (7). Babies born to mothers age
30 years or older and less than 20 years, experience considerably higher perinatal mortality, that those of
mothers between 20-29 years of age. Slightly higher perinatal mortality was reported in the urban sector (12
deaths per 1,000 live births), compared to the perinatal mortality in the estate sector (7 deaths per 1,000 live
births).For the first pregnancy as well as pregnancies occurring within less than 15 months and greater than 39
months of a previous pregnancy, higher perinatal mortality rates are observed. There is no clear relationship
between perinatal mortality and mother’s education level or wealth index, indicating perhaps a lower effect
of the social and economic levels of the households and families in the chance for early childhood survival.
Childhood mortality shows a U-shaped pattern in relation to mother’s age at birth and birth interval.

Infant and Child Mortality 107

 Table 8.4 Perinatal mortality

Number of stillbirths and early neonatal deaths, and the perinatal mortality rate for the five-year period preceding the
survey, by background characteristics, Sri Lanka 2016
Number of
Number of Number of early Perinatal mortality pregnancies of 7+
1 2 3
Background characteristic stillbirths neonatal deaths rate months duration

Mother's age at birth

<20 1 3 10 415
20-29 14 15 7 4,209
30-39 30 20 15 3,371
40-49 5 2 35 203

Previous pregnancy interval in

months4
First pregnancy 14 14 10 2,940
<15 4 4 11 713
15-26 1 3 6 641
27-38 1 5 9 734
39+ 29 13 13 3,171

Residence
Urban 9 6 12 1,299
Rural 39 33 11 6,539
Estate 2 1 7 359

District
Colombo 6 3 13 722
Gampaha 2 0 3 764
Kalutara 5 4 17 521
Kandy 1 2 6 577
Matale 3 2 22 220
NuwaraEliya 0 0 0 278
Galle 3 2 11 425
Matara 4 1 15 340
Hambantota 2 1 10 267
Jaffna 2 1 16 206
Mannar 0 0 0 41
Vavuniya 1 0 13 61
Mullaitivu 0 0 9 37
Kilinochchi 0 1 17 46
Batticaloa 0 1 3 245
Ampara 1 5 16 360
Trincomalee 1 2 15 195
Kurunegala 2 1 6 684
Puttalam 0 5 18 295
Anuradhapura 4 1 13 415
Polonnaruwa 1 0 7 188
Badulla 4 1 16 304
Monaragala 3 1 16 240
Ratnapura 3 4 17 452
Kegalle 1 1 7 313

Mother's education
No education 0 0 0 55
Passed Grade 1-5 0 0 0 291
Passed Grade 6-10 20 17 10 3,539
Passed G.C.E.(O/L) or equivalent 17 10 14 1,838
Passed G.C.E.(A/L) or equivalent 12 11 12 1,996
Degree and above 1 2 6 480

Wealth quintile
Lowest 9 8 10 1,638
Second 14 9 14 1,669
Middle 9 9 11 1,636
Fourth 16 4 11 1,771
Highest 2 10 8 1,483

Total 50 40 11 8,198
1
Stillbirths are fetal deaths in pregnancies lasting seven or more months.
2
Early neonatal deaths are deaths at age 0-6 days among live-born children.
3
The sum of the number of stillbirths and early neonatal deaths divided by the number of pregnancies of seven
or more months' duration, expressed per 1,000.
4
Categories correspond to birth intervals of <24 months, 24-35 months, 36-47 months, and 48+ months.

108 Demographic and Health Survey - 2016, Sri Lanka

8.6 High-risk fertility behaviour
Survival of a new born child depends, to some extent, on his/her mother’s demographic and bio-
logical characteristics. Ingeneral, children under 5 years have a higher risk of dying when their mother is
very young or old, born within a short birth interval or to mothers experiencing high parity. In this analysis,
children are classified at risk, if the mother is younger than 18 years or older than 34 at the time of child birth.
Birth intervals shorter than 24 months and birth order greater than 3 are also defined as risk factors. A child
may be at elevated risk of dying due to a combination of these factors. Since each birth has a risk, lowest
risk categories have been classified into two – not in any high risk category and in any unavoidable high risk
category.
Table 8.5 presents the percent distribution of children born in the five years preceding the survey
by category of elevated risk of mortality. Of the total births in the 5 years preceding the survey, 40 percent
occurred without any of the risk factors. Twenty-three percent of the births occurred in the 5 years preceding
the survey is in any avoidable high-risk category.
Single high risk ratios, the proportion dead among births in a specific high-risk category to the pro-
portion dead among births not in any high-risk category, are 3.3 for births to mothers whose age is less than
18, followed by mothers having a birth of order greater than 3 (1.9 higher risk than those not in any high-risk
category).
The last column of Table 8.5 presents the percentage of currently married women in different risk
categories. A birth to a currently married woman would fall into this category if she was pregnant at the time
of survey. Currently married women in single risk category (around 42 percent) and multiple risk category
(16 percent) should be provided with special health care during their pregnancy period. Around 36 percent
of currently married women are in “not in any high risk” category while 7 percent of women are in unavoid-
able risk category (first order births between ages 18-34 years). Finally, note that 57 percent of the currently
married women are recognized as “in any avoidable high-risk category”.

Infant and Child Mortality 109

Table 8.5 High-risk fertility behavior

Percent distribution of children born in the five years preceding the survey by category of elevated risk of mortality and the risk ratio, and
percent distribution of currently married women by category of risk if they were to conceive a child at the time of the survey, Sri Lanka
2016

Births in the 5 years preceding the survey

Risk category Percentage of births Risk ratio Percentage of currently married

women1

Not in any high-risk category 40.4 1.00 35.7

Unavoidable risk category

First order births between 36.6 0.93 7.2
ages 18 and 34 years

Single high-risk category

Mother's age <18 1.0 3.30 0.1
Mother's age >34 11.8 0.70 31.8
Birth interval <24 months 4.1 1.43 7.1
Birth order >3 2.6 1.85 2.5

Subtotal 19.5 1.14 41.5

Multiple high-risk category

Age <18 and birth interval 0.0 * 0.0
<24 months2
Age >34 and birth interval 0.6 0.00 1.2
<24 months
Age >34 and birth order >3 2.3 0.71 12.5
Age >34 and birth interval 0.1 * 0.7
<24 months and birth order
>3
Birth interval <24 months and 0.4 (0.00) 1.2
birth order >3

Subtotal 3.5 0.74 15.6

In any avoidable high-risk 23.0 1.08 57.0

category

Total 100.0 na 100.0

Number of births/women 8,230 na 17,257

Note: Risk ratio is the ratio of the proportion dead among births in a specific high-risk category to the proportion dead among births not
in any high-risk category.

na = Not applicable
1
Women are assigned to risk categories according to the status they would have at the birth of a child if they were to conceive at the
time of the survey: current age less than 17 years and 3 months or older than 34 years and 2 months, latest birth less than 15 months
ago, or latest birth being of order 3 or higher.
2
Includes the category age <18 and birth order >3

a Includes sterilized women

110 Demographic and Health Survey - 2016, Sri Lanka

MATERNAL HEALTH 9
Key Findings
• Antenatal care: Ninety-nine percent of mothers received antenatal care
from a skilled provider. The median duration of pregnancy at the first ante-
natal care visit is 7 weeks.
• Components of antenatal care: Almost all ever-married women with a
live birth during the five years before the survey received iron pills or cap-
sules (98 percent) and intestinal parasite drugs (97 percent). Similarly,
among those who received ANC, almost all had checked blood pressure
and urine.
• Protection against tetanus: Ninety-seven percent of mothers with a birth
in the five years preceding the survey were protected against neonatal
tetanus.
• Delivery: Nearly 100 percent (99.5%) of births were delivered in a health
facility and a skilled provider assisted during the delivery.
• Postnatal care: Ninety-nine percent of women received postnatal care for
their last birth in the first two days after delivery.
• Well-Women Clinics (W-WC): Eighty percent of the ever-married women
age 35-39 knew about W-WC. Fifty-six percent of them have attended a
W-WC and 42 percent have had a PAP test.
• Well-Women Clinics Services: Majority of ever married women (35-39)
(84 percent) knew tests for cancers (breast & cervical )were provided at
the W-WC, however 28 percent knew that family planning services offered
in W-WC.

T
he health care received by a woman during pregnancy, child birth and postpartum period decide the
survival health and well-being of both the mother and the child. A well designed and implemented
maternal care program facilitates the early identification and management of complications and em-
powers the women, families and communities to manage women and newborns at home. In the 2016 SLDHS,
ever-married women who had given birth in the five years preceding the survey were asked many questions
on antenatal care, delivery care and postnatal care.

9.1 Antenatal care

Antenatal Care aims to monitor the status of health of the mother and her baby to diagnose early any
pregnancy-related problems. Regular antenatal Care throughout pregnancy contributes to positive out comes
at delivery. Table 9.1 shows the percent distribution of ever-married women who had a birth in the five years
preceding the survey by the source of antenatal clinic care received during pregnancy. However in the anal-
ysis for ever-married women with two or more live births during the five-year period, data on antenatal care
refer to the most recent birth only.

Maternal Health 111

9.1 ANTENATAL CARE

Table 9.1 Antenatal care

Percent distribution of ever married women age 15-49 who had a live birth in the five years preceding the survey by
antenatal care (ANC) provider during pregnancy for the most recent birth and the percentage receiving antenatal care from
a skilled provider for the most recent birth, according to background characteristics, Sri Lanka 2016
Antenatal care provider
Percenta
ge
receiving Number
Medical antenatal of
officer of Public care from ever-
Obstetrici health Other health a skilled married
Background characteristic an (MOH) doctor midwife Other No ANC Total provider1 women

Mother's age at birth

<20 57.0 30.3 6.9 4.9 0.3 0.5 100.0 99.2 349
20-34 65.2 25.8 4.9 2.9 0.3 0.9 100.0 98.8 5,638
35-49 68.8 23.9 3.1 2.8 0.3 1.0 100.0 98.6 1,151

Birth order
1 69.2 22.2 4.5 2.7 0.4 0.9 100.0 98.6 2,612
2-3 64.5 27.0 4.5 3.1 0.3 0.7 100.0 99.0 4,125
4-5 50.9 35.8 6.8 4.9 0.4 1.3 100.0 98.3 372
6+ (37.2) (35.2) (21.5) (0.3) (0.0) (5.8) (100.0) (94.2) 29

Residence
Urban 68.5 21.4 5.8 2.8 0.3 1.2 100.0 98.5 1,114
Rural 65.5 25.9 4.5 3.0 0.3 0.7 100.0 98.9 5,728
Estate 51.1 37.3 3.8 5.4 0.2 2.2 100.0 97.6 296

District
Colombo 80.8 11.6 4.8 2.2 0.0 0.6 100.0 99.4 631
Gampaha 68.1 23.8 4.5 1.6 0.2 1.8 100.0 98.0 666
Kalutara 84.0 9.8 4.5 1.1 0.0 0.6 100.0 99.4 443
Kandy 61.2 32.6 0.9 2.8 0.1 2.5 100.0 97.5 489
Matale 89.5 5.7 3.7 1.1 0.0 0.0 100.0 100.0 192
Nuwara Eliya 55.2 36.0 2.1 4.8 0.3 1.6 100.0 98.1 232
Galle 81.3 14.1 1.7 1.9 0.3 0.7 100.0 99.1 380
Matara 80.5 9.7 4.4 2.5 2.6 0.4 100.0 97.1 291
Hambantota 83.1 15.1 0.0 1.3 0.0 0.5 100.0 99.5 233
Jaffna 39.4 37.7 12.3 8.3 0.0 2.2 100.0 97.8 170
Mannar 23.6 25.9 12.2 36.9 0.0 1.4 100.0 98.6 35
Vavuniya 18.5 56.2 17.9 5.0 0.0 2.3 100.0 97.7 53
Mullaitivu 44.6 44.6 10.2 0.0 0.6 0.0 100.0 99.4 32
Kilinochchi 54.1 42.7 0.9 0.0 0.8 1.5 100.0 97.6 40
Batticaloa 44.4 44.3 6.4 4.9 0.0 0.0 100.0 100.0 217
Ampara 48.1 48.3 1.6 1.0 0.6 0.3 100.0 99.1 305
Trincomalee 20.6 35.2 33.1 9.0 0.0 2.1 100.0 97.9 168
Kurunegala 73.4 16.6 6.1 2.9 0.6 0.5 100.0 99.0 613
Puttlam 68.6 20.9 8.0 0.8 1.0 0.7 100.0 98.3 262
Anuradhapura 21.5 75.6 2.6 0.0 0.0 0.3 100.0 99.7 369
Polonnaruwa 80.7 17.5 1.1 0.6 0.0 0.0 100.0 100.0 167
Badulla 52.2 39.6 5.0 1.1 0.8 1.2 100.0 98.0 271
Moneragala 46.4 27.6 0.7 24.1 0.0 1.2 100.0 98.8 208
Ratnapura 74.7 18.5 4.4 2.0 0.3 0.0 100.0 99.7 393
Kegalle 80.0 17.7 1.7 0.6 0.0 0.0 100.0 100.0 275

Education
No education 44.9 36.2 11.9 3.3 0.0 3.7 100.0 96.3 51
Passed Grade 1-5 45.1 38.3 8.5 5.8 0.3 2.0 100.0 97.7 257
Passed Grade 6-10 61.4 27.8 5.9 3.9 0.2 0.8 100.0 98.9 3,104
Passed G.C.E.(O/L) or
equivalent 61.3 30.7 4.3 2.6 0.4 0.7 100.0 98.9 1,608
Passed G.C.E.(A/L) or
equivalent 75.8 18.1 2.9 2.1 0.3 0.7 100.0 99.0 1,706
Degree and above 83.7 12.9 0.8 0.5 0.7 1.3 100.0 97.9 413

Wealth quintile
Lowest 50.3 35.5 7.3 5.2 0.2 1.5 100.0 98.3 1,413
Second 59.6 30.3 5.8 3.5 0.2 0.6 100.0 99.2 1,457
Middle 66.8 25.8 3.9 2.2 0.5 0.7 100.0 98.8 1,463
Fourth 70.2 21.9 4.4 2.7 0.2 0.6 100.0 99.2 1,524
Highest 81.2 14.0 1.9 1.4 0.6 0.9 100.0 98.5 1,280

Total 65.4 25.7 4.7 3.0 0.3 0.9 100.0 98.8 7,138
Note: If more than one source of ANC was mentioned, only the provider with the highest qualifications is
considered in this tabulation.
Figures in parentheses are based on 25-49 unweighted cases.
1
Skilled provider includes doctor, nurse, midwife

112 Demographic and Health Survey - 2016, Sri Lanka

Demography and Health Survey - 2016 113

 Ninety-nine percent of ever-married women received antenatal care from a skilled healthcare pro-
vider (doctors, nurses and midwives) for their most recent birth. Only one percent of ever-married women
did not receive antenatal care for a birth in the preceding five years. Of those who received antenatal care
from a health provider, 65 percent received it from an obstetrician, 26 percent from a medical officer of health
(MOH), 5 percent from another doctor and 3 percent from a public health midwife.
The proportion receiving antenatal care from a skilled health care provider is remarkably uniform
across all background categories for mother’s age at birth, residence, district, woman’s education and house-
hold wealth quintile. However, there are some differences by the provider of the ANC services across the
background characteristics. In the estate sector, half of the ever-married women with a birth in the last five
years received ANC (51 percent) from an obstetrician compared to 65 or more for those in the urban or rural
sector. Given the high ANC coverage, the differences in access is more in terms of quality of service via the
different providers described before. Access to obstetrician as the providers of ANC is much higher among
older mothers, for first births, for women residing in the urban sector, women with the highest levels of ed-
ucation and women belonging to the richest households. The ANC services provided by the medical officer
of health (MOH) counterbalances the unequal access to obstetrician services for women with lower access
to obstetrician (i.e. young mothers, second or higher birth order, estate sector, lower levels of education and
within the poorest sixty percent of the households).
At the district level, significant differences are not observed in the global coverage of ANC servic-
es. However, important differences can be observed at the district level on the provider of the services. For
example, in the districts of Mannar and Matale the provision of ANC services is almost universal (99 and
100 percent respectively). However, in Mannar, 37 percent of these services were provided by a public health
midwife (PHM) compared to only 1 percent in Matale. In Matale, on the other hand, 90 percent of the ANC
services were provided by an obstetrician compared to only 24 percent in Mannar. These findings deserve a
more detailed analysis to not only understand the differentials but also provide feedback to the current system
of services.

9.2 Timing of first visit

As complications can occur anytime during pregnancy, regular antenatal care is needed to be re-
ceived from a skilled healthcare provider. Antenatal care needs to starts as soon as a pregnancy is suspected
preferably before 12 weeks of pregnancy. In Sri Lanka antenatal care consists of two modalities of service
delivery: Domiciliary care provided by PHM and clinic care provided by medical officers. As soon as the
woman suspects a pregnancy, she needs to register with PHM and obtain pregnancy record. PHM refers them
for antenatal clinic care. According to Sri Lankan antenatal care guidelines a woman with uncomplicated
pregnancy, need to have at least 8 antenatal clinic visits with skilled healthcare provider and three or more
home visit by PHM. A pregnant woman with complication needs more visits both clinic and domiciliary. The
spacing of the visits is described in the maternal care guidelines of Sri Lanka.

Maternal Health 113

 Table 9.2 Timing of first visit

Percent distribution of ever married women age 15-49 who had a live birth in the five years preceding the survey by the
timing of the first visit, and among women with ANC, mean, and median weeks pregnant at first visit, according to residence,
Sri Lanka 2016
Residence

Timing of ANC visits Urban Rural Estate Total

Number of weeks pregnant

at the time of first ANC visit

No antenatal care 1.2 0.7 2.2 0.9

<8 57.8 54.9 42.1 54.9
8-12 33.2 37.8 39.9 37.1
13-16 4.0 2.9 4.1 3.1
17+ 2.5 2.6 5.7 2.7
Don't know/missing 1.3 1.1 6.0 1.3

Total 100.0 100.0 100.0 100.0

Number of women 1,114 5,728 296 7,138

Median weeks pregnant at first 7.0 7.0 8.0 7.0
visit (for those with ANC)

Mean weeks pregnant at first 8.5 8.6 14.1 8.8

visit (for those with ANC) 1,101 5,686 289 7,076
Number of women with ANC

Table 9.2 presents information on antenatal care visit for the most recent birth, including the timing
of the first visit, mean and median duration of pregnancy at the first visit by residential sector. Fifty-five per-
cent of ever-married women with a birth during the five years preceding the survey made their first antenatal
care visit, before the eighth weeks of pregnancy. Ninety-two percent of women having their first ANC visit
before the 12 weeks of pregnancy as recommended.
The median duration of pregnancy at the first antenatal care visit was 7 weeks and mean duration of
was 8.8 weeks. This indicates that, overall ever-married woman in Sri Lanka start antenatal care during the
first trimester of their pregnancy. Estate women tend to start ANC later in pregnancy than urban and rural
women where the median and mean duration of pregnancy are 8 weeks and 14.1 weeks respectively.

9.3 Components of antenatal care

Antenatal care consists of package of interventions which need to implement at various stages of
the pregnancy to ensure the health and wellbeing of the mother and newborn. The package of intervention
consists of screening early identification and management of diseases such as anemia, diabetes, hypertension,
syphilis, HIV, monitoring of growth and well-being of the baby micronutrient supplementation and health
education. To assess the ANC services they received, women in the 2016 SLDHS were asked a sereies of
questions.
Table 9.3 presents information on the percentage of ever-married women who received these routine
antenatal care services during the pregnancy for their most recent live birth in the five years before the survey.
Nearly all ever-married women (98%) with a live birth during the five years before the survey took iron pills
or capsules during pregnancy and 97 percent took intestinal parasite drugs. Three basic services provided
by ANC are measuring blood pressure, testing urine sample for sugar and testing blood sample for HIV, and
hemoglobin level. Data prove that all three services were provided for majority (90 percent or more). At these
high levels of access and use of ANC services, it is not surprising to find only small variations by background
characteristics, particularly by place of residence, level of education and wealth quintile. This is a good ex-
ample of equity in the provision of ANC services across Sri Lanka.

114 Demographic and Health Survey - 2016, Sri Lanka

 Table 9.3 Components of antenatal care

Among ever-married women age 15-49 with a live birth in the five years preceding the survey, the percentage who took iron pills
or capsules and drugs for intestinal parasites during the pregnancy of the most recent birth, and among women receiving
antenatal care (ANC) for the most recent live birth in the five years preceding the survey, the percentage receiving specific
antenatal services, according to background characteristics, Sri Lanka 2016
Among women with a live birth in the Among women who received antenatal care for their
past five years, the percentage who most recent live birth in the past five years, the
during the pregnancy of their last birth: percentage with selected services
Number of Number of
Took women with women with
Took iron intestinal a live birth Blood Urine Blood ANC for
pills or parasite in the past pressure sample sample their most
Background characteristic capsules drugs five years measured taken taken recent birth

Mother's age at birth

<20 98.6 97.2 349 98.7 98.4 97.1 347
20-34 97.9 96.9 5,638 98.8 98.9 91.7 5,590
35-49 97.3 96.7 1,151 97.4 97.0 86.6 1,139

Birth order
1 97.9 96.8 2,612 98.9 98.9 98.3 2,587
2-3 97.7 96.9 4,125 98.7 98.6 87.4 4,095
4-5 98.5 97.7 372 96.5 96.4 83.7 367
6+ (94.2) (94.2) 29 (87.3) (94.7) (78.0) 27

Residence
Urban 98.2 95.4 1,114 98.7 98.4 91.9 1,101
Rural 97.9 97.3 5,728 98.8 98.8 91.0 5,686
Estate 95.8 95.9 296 94.0 95.6 90.3 289

District
Colombo 98.9 94.0 631 98.9 98.7 93.3 627
Gampaha 96.7 95.9 666 100.0 99.9 88.3 654
Kalutara 98.8 98.1 443 98.8 99.0 90.2 440
Kandy 96.4 93.9 489 99.9 99.6 90.5 477
Matale 98.7 98.8 192 100.0 100.0 66.1 192
Nuwara Eliya 98.4 97.0 232 98.2 97.3 90.5 229
Galle 99.3 98.5 380 96.3 93.4 93.7 378
Matara 99.6 98.7 291 98.4 96.9 62.2 290
Hambantota 98.9 99.5 233 99.5 100.0 99.7 232
Jaffna 97.8 96.2 170 98.5 98.1 97.5 166
Mannar 98.6 98.0 35 100.0 100.0 100.0 35
Vavuniya 95.2 96.6 53 97.3 99.3 96.2 52
Mullaitivu 100.0 99.8 32 99.7 99.0 96.6 32
Kilinochchi 97.6 97.0 40 99.5 99.5 98.2 39
Batticaloa 100.0 98.9 217 95.3 95.2 94.1 217
Ampara 99.4 99.4 305 99.3 99.3 96.1 304
Trincomalee 96.5 97.8 168 95.0 96.2 91.2 165
Kurunegala 99.3 98.7 613 98.9 99.3 94.3 610
Puttlam 97.0 97.8 262 99.0 99.6 99.0 261
Anuradhapura 98.5 99.3 369 99.1 100.0 88.0 368
Polonnaruwa 100.0 100.0 167 97.9 98.2 92.0 167
Badulla 98.2 98.3 271 93.4 95.3 92.3 267
Moneragala 98.4 98.3 208 99.7 99.7 96.4 206
Ratnapura 100.0 99.5 393 99.4 99.8 93.5 393
Kegalle 81.6 80.9 275 99.3 100.0 98.8 275

Education
No education 96.3 93.9 51 97.0 97.0 86.5 49
Passed Grade 1-5 96.4 97.4 257 95.2 96.1 89.6 252
Passed Grade 6-10 98.3 97.9 3,104 98.5 98.4 91.2 3,077
Passed G.C.E.(O/L) or
equivalent 97.5 96.6 1,608 98.8 99.3 91.0 1,596
Passed G.C.E.(A/L) or
equivalent 97.6 96.4 1,706 99.4 98.8 91.5 1,695
Degree and above 97.3 92.6 413 97.7 98.1 91.7 407

Wealth quintile
Lowest 96.9 96.5 1,413 97.4 97.8 90.7 1,393
Second 98.0 97.4 1,457 98.8 98.7 92.9 1,449
Middle 98.2 98.0 1,463 98.8 98.4 91.3 1,452
Fourth 97.9 97.6 1,524 99.1 99.5 90.7 1,515
Highest 98.0 94.7 1,280 98.8 98.4 89.9 1,268

Total 97.8 96.9 7,138 98.6 98.6 91.1 7,076

Table 9.3 presents information on the percentage of ever-married women Maternalwho

Healthreceived 115
these
routine antenatal care services during the pregnancy for their most recent live birth in the five years before
the survey. Nearly all ever-married women (98%) with a live birth during the five years before the survey
took iron pills or capsules during pregnancy and 97 percent took intestinal parasite drugs. Three basic
Table 9.4 Tetanus toxoid injections
Among mothers age 15-49 with a live birth in the five years preceding the survey, the 9.4 Tetanus toxoid injections
percentage receiving tetanus toxoid injections during the pregnancy for the last live birth,
according to background characteristics, Sri Lanka 2016 Neonatal tetanus is a leading
Percentage receiving tetanus cause of death among infants in
toxoid injections during last
Background characteristic pregnancy 1 Number of mothers developing countries where a
Mother's age at birth considerable proportion of deliveries
<20 94.9 347 take place at home or at locations
20-34 96.8 5,545
35-49 96.1 1,061
where hygienic conditions may be
poor. Tetanus toxoid (TT) vaccine is
Birth order given to women during pregnancy
1 96.7 2,557 to prevent infant deaths caused by
2 97.0 2,726
3 96.1 1,387 neonatal tetanus, which can occur
4 94.1 283 when sterile procedures are not
followed during delivery. In Sri
Residence
Urban 94.7 1,077 Lanka Tetanus Toxoid immunization
Rural 97.2 5,592 for pregnant women is carried out
Estate 92.5 284 based on the national immunization
District
guidelines. In 2016, Sri Lanka
Colombo 93.8 618 is declared as a country which
Gampaha 96.4 647 eliminated neonatal tetanus after in
Kalutara 95.8 436
Kandy 98.0 473
depth evaluation.
Matale 95.9 192 According to Table 9.4,
Nuwara Eliya 91.9 228
Galle 98.1 369 Ninety-seven percent of mothers
Matara 97.8 285 reported receiving TT injections
Hambantota 97.8 226 during the pregnancy for her last
Jaffna 98.5 161
Mannar 92.0 33 live birth and that excludes mothers
Vavuniya 92.6 49 who have 5 or more births. The
Mullaitivu 96.9 31 proportion of receiving TT injection
Kilinochchi 98.1 37
is remarkably uniform across all
Batticaloa 96.0 211
Ampara 93.9 293 categories for mother’s age at birth,
Trincomalee 95.3 154 birth order, residence, district,
Kurunegala 97.0 602 mother’s education and wealth
Puttalam 95.7 253
Anuradhapura 98.7 360 quintile. The lowest percentage of
Polonnaruwa 96.9 167 protection about ninety-two percent
Badulla 96.7 262 occurs in two districts (Nuwara-Eliya
Moneragala 98.1 204
and Mannar).
Ratnapura 98.8 388
Kegalle 99.2 274

Education 9.5 Place of delivery

No education 97.0 37
Passed Grade 1-5 96.2 230 Skilled attendance at
Passed Grade 6-10 96.5 3,014
Passed G.C.E.(O/L) or
birth save thousands of lives and en-
equivalent 96.7 1,581 sure the health and wellbeing of the
Passed G.C.E.(A/L) or mother and the baby. Proper medi-
equivalent 97.0 1,684 cal attention and hygienic conditions
Degree and above 95.4 407
during delivery can reduce the risks
Wealth quintile of complications and infections lead-
Lowest 96.4 1,340 ing to morbidity and mortality of ei-
Second 96.5 1,418
ther the mother or the baby.
Middle 97.5 1,435
Fourth 96.9 1,505
Highest 95.6 1,256

Total 96.6 6,953

1
Includes mothers who have tetanus injection during the pregnancy of her last live birth
and excludes mothers who have 5 or more live births.

116 Demographic and Health Survey - 2016, Sri Lanka

According to Table 9.4, Ninety-seven percent of mothers reported receiving TT injections during
the pregnancy for her last live birth and that excludes mothers who have 5 or more births. The proportion
9.5 PLACE OF DELIVERY

Skilled attendance at birth save thousands of lives and ensure the health and wellbeing of the
mother and the baby. Proper medical attention and hygienic conditions during delivery can reduce the risks
of complications and infections leading to morbidity and mortality of either the mother or the baby.

Table 9.5 Place of delivery

Percent distribution of live births in the five years preceding the survey by place of delivery and percentage delivered in a health
facility, according to background characteristics, Sri Lanka 2016
Health facility
Percentage
delivered in a Number of
Background characteristic Public sector Private sector Home Other Total health facility births

Mother's age at birth

<20 99.1 0.7 0.2 0.0 100.0 99.8 423
20-34 94.0 5.5 0.1 0.3 100.0 99.5 6,587
35-49 92.5 6.8 0.2 0.4 100.0 99.4 1,220

Birth order
1 93.0 6.7 0.1 0.2 100.0 99.8 3,251
2-3 94.6 4.8 0.2 0.5 100.0 99.3 4,532
4-5 96.3 3.6 0.2 0.0 100.0 99.8 411
6+ (100.0) (0.0) (0.0) (0.0) (100.0) (100.0) 36

Residence
Urban 84.1 14.9 0.2 0.9 100.0 99.0 1,298
Rural 95.8 3.9 0.1 0.3 100.0 99.6 6,568
Estate 98.9 0.4 0.7 0.0 100.0 99.3 363

District
Colombo 78.6 20.0 0.0 1.3 100.0 98.7 721
Gampaha 86.6 11.9 0.5 1.0 100.0 98.5 769
Kalutara 88.3 11.7 0.0 0.0 100.0 100.0 520
Kandy 95.0 4.3 0.1 0.6 100.0 99.3 583
Matale 97.4 1.5 0.0 1.1 100.0 98.9 218
Nuwara Eliya 99.2 0.5 0.3 0.0 100.0 99.7 281
Galle 97.9 2.1 0.0 0.0 100.0 100.0 429
Matara 92.4 7.6 0.0 0.0 100.0 100.0 338
Hambantota 99.5 0.1 0.0 0.4 100.0 99.6 267
Jaffna 95.3 4.7 0.0 0.0 100.0 100.0 210
Mannar 99.6 0.4 0.0 0.0 100.0 100.0 42
Vavuniya 96.4 3.1 0.6 0.0 100.0 99.4 62
Mullaitivu 100.0 0.0 0.0 0.0 100.0 100.0 37
Kilinochchi 98.4 1.2 0.4 0.0 100.0 99.6 47
Batticaloa 95.9 4.1 0.0 0.0 100.0 100.0 249
Ampara 97.0 3.0 0.0 0.0 100.0 100.0 360
Trincomalee 98.3 0.8 0.4 0.5 100.0 99.1 195
Kurunegala 97.0 2.8 0.2 0.0 100.0 99.8 684
Puttlam 95.5 3.6 0.0 0.9 100.0 99.1 296
Anuradhapura 99.5 0.5 0.0 0.0 100.0 100.0 418
Polonnaruwa 99.0 1.0 0.0 0.0 100.0 100.0 188
Badulla 98.8 0.7 0.5 0.0 100.0 99.5 307
Moneragala 99.4 0.6 0.0 0.0 100.0 100.0 243
Ratnapura 98.0 1.7 0.3 0.0 100.0 99.7 452
Kegalle 98.0 1.8 0.3 0.0 100.0 99.7 315

Mother's education
No education 97.6 0.0 2.4 0.0 100.0 97.6 55
Passed Grade 1-5 99.1 0.4 0.5 0.0 100.0 99.5 295
Passed Grade 6-10 98.7 1.0 0.1 0.2 100.0 99.7 3,558
Passed G.C.E.(O/L) or
equivalent 96.3 3.3 0.1 0.4 100.0 99.5 1,838
Passed G.C.E.(A/L) or
equivalent 87.8 11.7 0.1 0.5 100.0 99.4 2,003
Degree and above 74.3 24.6 0.3 0.8 100.0 98.9 481

Wealth quintile
Lowest 99.3 0.3 0.4 0.1 100.0 99.5 1,653
Second 99.1 0.6 0.1 0.2 100.0 99.7 1,672
Middle 99.1 0.8 0.0 0.1 100.0 99.9 1,642
Fourth 96.0 3.5 0.1 0.4 100.0 99.6 1,771
Highest 74.8 24.0 0.1 1.1 100.0 98.8 1,491

Total 94.1 5.4 0.1 0.3 100.0 99.5 8,230

Note :Includes only the most recent birth in the five years preceding the survey
Figures in parentheses are based on 25-49 unweighted cases.

Table 9.5 reveals the percent distribution of live births in the five years preceding the survey by
place of delivery, according to background characteristics. Nearly hundred percent of births take place in a
health facility: ninety-four percent were delivered in public-sector health facilities, five percent in private
Maternal Health 117
Demography and Health Survey - 2016 119
Table 9.5 reveals the percent distribution of live births in the five years preceding the survey by place of deliv-
ery, according to background characteristics. Nearly hundred percent of births take place in a health facility:
ninety-four percent were delivered in public-sector health facilities, five percent in private health facilities
and only 0.5% at home or some other place. In estate sector nearly one percent (0.7 percent) of deliveries was
outside the health facilities.
There is little variation in the proportion of births occurring in health facilities by background char-
acteristics. However, the Colombo district shows the highest proportion of births delivered in a private health
facility (20 percent), while in the Mullaitivu district, 100 percent of the babies were delivered in public health
facilities. In two other districts, Gampaha and Kalutara, the percentage of births delivered at private health
facilities is also substantial (12 percent in each). All three of the afore-mentioned districts belongs to the
Western Province.
Background characteristics of the mothers also show considerable variations in the place of delivery.
The highest percentages of births delivered in a private health facility are observed in the urban sector (15
percent), among the richest households (24 percent), and for mothers with the highest educational level (25
percent).
The delivery of births in private health facilities is higher for older mothers (7 percent vs 1 percent
for younger counterparts) and those mothers of first births (7 percent vs 4 percent among those with a birth
of order 4-5).

9.6 Assistance during delivery

Obstetric care by a trained provider during delivery is recognized as critical for the reduction of
maternal and neonatal mortality. Table 9.6 shows the percentage distribution of live births in the five years
before the survey by person providing assistance during birth delivery. Nearly hundred percent of births are
delivered with the assistance of a trained health professional (i.e., specialist doctor, doctor, nurse, public
health midwife). The majority (84 percent) of the birth deliveries were assisted by doctors (27 percent by
a specialist doctor and 57 percent by another doctor), followed by a nurse (13 percent) and with a smaller
percentage, by a public health midwife (only 2 percent). This composition is very much consistent with the
fact that, as described before, the majority of the birth deliveries take place in health institutions. However,
some differentials are observed in the person providing the services at the delivery of the birth according to
place of residence and social and economic conditions of the mother.
The presence of a specialist doctor at the time of birth delivery follows a distribution similar to the
one described for delivery at private health facilities. Specialist doctors assisted in greater percentages the
delivery of births among older mothers, of first order births, among women with urban residence, and women
in the higher wealth quintiles (see Table 9.6 below). Doctors and nurses are those more often providing the
services for younger mothers, those with higher order births and the lower wealth quintiles. It is worth men-
tioning that in Killinochchi and Baticaloa, one out of every four birth delivery was assisted by a nurse and in
the Badulla district, 11 percent of the birth deliveries were assisted by a public health midwife.

118 Demographic and Health Survey - 2016, Sri Lanka

Table 9.6 Assistance during delivery

Percent distribution of live births in the five years preceding the survey by person providing assistance during delivery, percentage of
birth assisted by a skilled provider, according to background characteristics, Sri Lanka 2016
Person providing assistance during delivery
Percenta
ge
delivered
Public Traditiona by a
Background Specialist health l birth skilled Number
characteristic doctor Doctor Nurse midwife attendant Other No one Total provider1 of births

Mother's age at birth

<20 20.9 59.8 15.6 3.0 0.3 0.1 0.2 100.0 99.3 422
20-34 26.7 57.2 13.3 2.3 0.1 0.1 0.3 100.0 99.5 6,557
35-49 31.0 55.7 11.9 1.0 0.0 0.3 0.1 100.0 99.6 1,212

Birth order
1 29.3 56.3 11.9 2.1 0.1 0.0 0.3 100.0 99.6 3,243
2-3 25.8 57.9 13.5 2.2 0.1 0.2 0.2 100.0 99.4 4,501
4-5 23.7 54.5 19.3 2.3 0.0 0.3 0.0 100.0 99.7 410
6+ (17.0) (61.3) (21.7) (0.0) (0.0) (0.0) (0.0) (100.0) (100.0) 36

Place of delivery
Health facility 27.0 57.1 13.2 2.2 0.1 0.2 0.2 100.0 99.5 8,191

Residence
Urban 31.8 55.8 10.2 1.7 0.1 0.1 0.2 100.0 99.6 1,285
Rural 26.5 57.3 13.5 2.2 0.1 0.1 0.3 100.0 99.5 6,545
Estate 19.4 58.6 17.8 3.1 0.0 1.1 0.0 100.0 98.9 361

District
Colombo 36.9 53.2 8.6 1.0 0.0 0.0 0.3 100.0 99.7 712
Gampaha 32.6 58.1 8.2 1.0 0.2 0.0 0.0 100.0 99.8 758
Kalutara 32.1 58.0 8.5 1.2 0.3 0.0 0.0 100.0 99.7 520
Kandy 27.6 51.2 17.5 3.4 0.0 0.0 0.3 100.0 99.7 578
Matale 28.8 54.7 15.9 0.6 0.0 0.0 0.0 100.0 100.0 216
Nuwara Eliya 21.7 59.3 16.3 1.3 0.0 1.4 0.0 100.0 98.6 280
Galle 19.3 62.6 12.9 4.1 0.5 0.3 0.3 100.0 98.9 429
Matara 33.0 59.2 7.8 0.0 0.0 0.0 0.0 100.0 100.0 338
Hambantota 23.4 63.7 9.1 3.4 0.0 0.4 0.0 100.0 99.6 266
Jaffna 40.9 42.6 10.1 0.7 0.9 0.7 4.1 100.0 94.3 210
Mannar 38.3 51.5 8.1 1.6 0.0 0.0 0.5 100.0 99.5 42
Vavuniya 17.8 63.2 15.1 2.9 0.0 0.0 1.0 100.0 99.0 62
Mullaitivu 18.5 62.2 18.2 0.0 0.0 1.1 0.0 100.0 98.9 37
Kilinochchi 41.1 31.9 25.2 1.8 0.0 0.0 0.0 100.0 100.0 47
Batticaloa 19.4 53.5 24.7 2.2 0.0 0.2 0.0 100.0 99.8 249
Ampara 36.2 46.7 16.0 1.1 0.0 0.0 0.0 100.0 100.0 360
Trincomalee 22.6 61.2 11.8 4.4 0.0 0.0 0.0 100.0 100.0 194
Kurunegala 33.5 48.0 17.8 0.8 0.0 0.0 0.0 100.0 100.0 683
Puttlam 23.2 61.1 14.7 0.6 0.0 0.0 0.4 100.0 99.6 294
Anuradhapura 12.2 66.9 16.0 5.0 0.0 0.0 0.0 100.0 100.0 418
Polonnaruwa 23.9 60.6 12.6 2.8 0.0 0.0 0.0 100.0 100.0 188
Badulla 10.7 55.7 21.0 10.8 0.4 1.3 0.0 100.0 98.2 305
Moneragala 18.6 66.3 11.2 3.9 0.0 0.0 0.0 100.0 100.0 243
Ratnapura 22.3 58.5 17.5 0.9 0.0 0.0 0.8 100.0 99.2 451
Kegalle 21.6 74.9 2.6 0.9 0.0 0.0 0.0 100.0 100.0 314

Mother's education
No education 19.7 60.9 18.7 0.7 0.0 0.0 0.0 100.0 100.0 54
Passed Grade 1-5 19.0 59.7 18.3 2.7 0.0 0.3 0.0 100.0 99.7 293
Passed Grade 6-10 23.3 58.3 15.3 2.6 0.1 0.2 0.2 100.0 99.5 3,548
Passed G.C.E.(O/L)
or equivalent 24.0 61.2 12.1 2.0 0.1 0.2 0.4 100.0 99.3 1,829
Passed G.C.E.(A/L)
or equivalent 33.7 53.2 11.0 1.6 0.0 0.1 0.3 100.0 99.6 1,991
Degree and above 44.8 46.7 6.9 1.4 0.2 0.0 0.0 100.0 99.8 476

Wealth quintile
Lowest 21.0 57.4 18.1 2.7 0.0 0.3 0.4 100.0 99.2 1,646
Second 22.4 60.0 14.9 2.3 0.1 0.1 0.0 100.0 99.7 1,667
Middle 24.0 60.4 12.4 2.8 0.1 0.0 0.3 100.0 99.6 1,641
Fourth 23.3 61.9 11.9 2.4 0.1 0.2 0.2 100.0 99.4 1,764
Highest 46.9 44.0 8.3 0.4 0.1 0.1 0.2 100.0 99.7 1,473

Total 27.0 57.1 13.2 2.2 0.1 0.2 0.2 100.0 99.5 8,191
Note: If the respondent mentioned more than one person attending during delivery, only the most qualified person is considered in this
tabulation and Includes only the most recent birth in the five years preceding the survey
Figures in parentheses are based on 25-49 unweighted cases.
1
Skilled provider includes specialist doctor, other doctor, nurse, midwife

Maternal Health 119

9.7 Timing of first postnatal checkup for the mother
In Sri Lanka immediate and early postnatal care is provided at the hospital. The mothers need to
keep at least two hours in the labour room and before handing over to the ward they need to be examined by
a trained health officer (doctor, nurse or midwife). They need to keep at least 24 hours in the hospital after a
normal delivery and need to monitor every 4 hourly. Before discharge from the ward they need to be exam-
ined by a doctor.
After discharge from the hospital Public health midwife visit home to provide postnatal care accord-
ing to the following regime.
• Within first 5 days of delivery-one visit
• 6-10 days of delivery – one visit
• 14 – 21 days of delivery – one visit
• Around 42 days one visit
• Other than that at the postnatal clinic both mother and baby examine by a doctor after one
month of birth.
Postnatal care is a crucial component of safe motherhood and neonatal health. In postnatal health
examinations, mothers should also receive information on how to care for herself and her child as well as
counseling on nutrition, micronutrient supplementation and exclusive breastfeeding

Table 9.7 shows the timing of the first postnatal care for mothers giving birth in the two years preced-
ing the survey. Ninety-nine percent of mothers received postnatal care within the crucial first two days of
delivery, with 92 percent receiving assistances within the first four hours after delivery (see table 9.7 below).

120 Demographic and Health Survey - 2016, Sri Lanka

Table 9.7 Timing of first postnatal checkup for the mother

Among women age 15-49 giving birth in the two years preceding the survey, the percent distribution of the mother's first postnatal
check-up for the last live birth by time after delivery, and the percentage of women with a live birth in the two years preceding the
survey who received a postnatal checkup in the first two days after giving birth, according to background characteristics, Sri Lanka
2016
Time after delivery of mother's first postnatal checkup
Percenta
ge of
women
with a
postnatal
checkup
in the
first 2
Less Don't No days
Background than 4 4-23 7-41 know/ postnatal after Number
2
characteristic hours hours 1-2 days 3-6 days days missing checkup Total birth1 of women
Mother's age at birth
<20 87.4 6.8 5.6 0.0 0.0 0.0 0.2 100.0 99.8 152
20-34 91.5 6.2 1.7 0.0 0.1 0.0 0.5 100.0 99.4 2,433
35-49 92.6 3.9 1.5 0.1 0.0 0.5 1.4 100.0 98.0 482

Birth order
1 91.5 6.2 2.0 0.0 0.0 0.1 0.1 100.0 99.8 1,184
2-3 91.4 5.7 1.8 0.0 0.1 0.1 1.0 100.0 98.8 1,719
4-5 92.5 5.4 1.4 0.3 0.0 0.0 0.5 100.0 99.3 153
6+ * * * * * * * * * 11

Place of delivery
Health facility 91.8 5.9 1.9 0.0 0.1 0.1 0.3 100.0 99.6 3,056

Residence
Urban 91.4 5.4 2.2 0.0 0.0 0.0 1.0 100.0 99.0 487
Rural 91.4 5.9 1.9 0.0 0.0 0.1 0.6 100.0 99.3 2,443
Estate 92.4 6.0 0.5 0.3 0.3 0.0 0.6 100.0 98.9 138

District
Colombo 92.0 4.2 2.3 0.0 0.0 0.0 1.4 100.0 98.6 299
Gampaha 93.6 5.0 1.0 0.0 0.0 0.0 0.4 100.0 99.6 257
Kalutara 92.7 4.5 0.9 0.0 0.0 0.7 1.2 100.0 98.2 198
Kandy 94.9 3.0 0.7 0.0 0.0 0.5 1.1 100.0 98.5 211
Matale 68.7 23.9 5.0 0.6 0.0 0.0 1.9 100.0 97.6 69
Nuwara Eliya 93.2 5.5 1.0 0.0 0.3 0.0 0.0 100.0 99.7 107
Galle 90.9 8.3 0.7 0.0 0.0 0.0 0.0 100.0 100.0 157
Matara 91.9 5.8 1.4 0.0 0.0 0.0 0.9 100.0 99.1 129
Hambantota 74.0 8.1 16.8 0.0 1.1 0.0 0.0 100.0 98.9 105
Jaffna 97.4 1.2 1.3 0.0 0.0 0.0 0.0 100.0 100.0 73
Mannar 97.9 0.0 2.1 0.0 0.0 0.0 0.0 100.0 100.0 11
Vavuniya 96.0 4.0 0.0 0.0 0.0 0.0 0.0 100.0 100.0 20
Mullaitivu 97.6 2.4 0.0 0.0 0.0 0.0 0.0 100.0 100.0 13
Kilinochchi 85.9 13.1 1.1 0.0 0.0 0.0 0.0 100.0 100.0 15
Batticaloa 90.0 3.2 5.0 0.0 0.0 0.0 1.8 100.0 98.2 89
Ampara 93.6 5.5 0.0 0.0 0.0 0.0 0.9 100.0 99.1 125
Trincomalee 78.6 9.7 10.5 0.0 0.0 0.0 1.1 100.0 98.9 70
Kurunegala 94.7 4.8 0.0 0.0 0.0 0.0 0.5 100.0 99.5 274
Puttlam 86.8 12.4 0.0 0.0 0.0 0.0 0.8 100.0 99.2 110
Anuradhapura 97.5 2.5 0.0 0.0 0.0 0.0 0.0 100.0 100.0 153
Polonnaruwa 85.6 11.4 3.1 0.0 0.0 0.0 0.0 100.0 100.0 84
Badulla 93.3 3.0 2.7 0.0 0.0 0.0 1.0 100.0 99.0 97
Moneragala 99.1 0.9 0.0 0.0 0.0 0.0 0.0 100.0 100.0 91
Ratnapura 89.3 9.5 0.7 0.0 0.0 0.5 0.0 100.0 99.5 182
Kegalle 95.3 4.4 0.3 0.0 0.0 0.0 0.0 100.0 100.0 128

Education
No education * * * * * * * * * 19
Passed Grade 1-5 89.8 1.5 6.9 0.0 0.0 0.0 1.8 100.0 98.2 86
Passed Grade 6-10 92.6 5.7 1.3 0.0 0.1 0.1 0.2 100.0 99.6 1,288
Passed G.C.E.(O/L)
or equivalent 89.9 7.0 2.1 0.0 0.0 0.0 0.9 100.0 99.1 648
Passed G.C.E.(A/L)
or equivalent 90.6 5.7 2.3 0.0 0.0 0.2 1.2 100.0 98.6 819
Degree and above 93.4 5.8 0.8 0.0 0.0 0.0 0.0 100.0 100.0 208
Wealth quintile
Lowest 92.3 4.5 2.3 0.1 0.2 0.2 0.4 100.0 99.1 563
Second 90.2 7.3 2.1 0.0 0.1 0.1 0.2 100.0 99.6 599
Middle 92.0 5.7 1.7 0.0 0.0 0.2 0.4 100.0 99.4 641
Fourth 91.7 5.9 1.7 0.0 0.0 0.0 0.7 100.0 99.3 664
Highest 91.0 5.8 1.7 0.0 0.0 0.0 1.4 100.0 98.6 602

Total 91.5 5.9 1.9 0.0 0.1 0.1 0.6 100.0 99.2 3,068

Note : An asterisk indicated that a figure is based on fewer than 25 unweighted cases and has been suppressed
1
Includes women who received a checkup from a doctor, midwife, nurse, traditional birth attendant
2
Includes women who received a checkup after 41 days

Maternal Health 121

Demography and Health Survey - 2016 123
 Figure 9.1 Percent distribution by duration of stay in
the health facility for the last live birth

90
82
80

70 65

60
Percentage

50

40 36

30
19
20

10

0
1-2 days more than 2 days

Vaginal birth Caesarean section

According to figure 9.1, included 65 percent of mothers with vaginal delivery, stayed up to 2 days in
the health facility for the last live birth where delivery took place, compared to 19 percent among those de-
livering their birth via caesarean section. The majority of women delivering their birth via caesarean section
(82 percent) stayed at the health facility for three or more days. Caesarean-section mothers typically have to
stay in the health facility for at least 48 hours.

9.8 Awareness of well-women clinic

The concept of Well-Women Clinic (W-WC) programme was introduced in 1996, as a result of the Repro-
ductive Health Concept decided at the International Conference on Population Development (ICPD) held in
Cairo in 1994. Sri Lanka stands as a pilot country in the whole of South Asia to successfully implement the
W-WC programme at primary health care level with the aim of improving the health status of women. Family
Health Bureau is the focal point at the national level in the Ministry of health for the W-WC programme. In its
implementation, the Family Health Bureau works very closely with the National Cancer Control programme,
Sri Lanka College of Pathologists and Sri Lanka College of Obstetricians and Gynaecologists. Over the last
two decades the number of W-WCs have significantly risen to cover the whole country. W-WCs are mostly
based at MOH offices and maternity hospitals. At the end of the year 2014, 873 Well-women clinics were
functioning in Sri Lanka. These clinics provide services for women against common non-communicable
diseases, including screening, detection and referral. The conditions screened in the W-WCs are hyperten-
tion, diabetes, breast and cervical cancers, under nutrition and obesity. In addition W-WCs provide family
planning services and health education. Because of the importance of these clinics, the 2016 SLDHS decid-
ed to collect information on the awareness by ever-married women about the W-WCs, service availability,
women’s participation and awareness and use of the PAP test which is the screening method used to identify
cervical cancers.

9.8.1 Knowledge of well-women clinic

In order to measure the basic knowledge of W-WC, all ever-married women were asked whether
they have heard of a clinic called “Well-Women”. Seventy-one percent of them responded that they have
heard of the W-WCs, and with some variation across background characteristics. In general, ever-married
women from the urban and rural sectors have higher awareness about the W-WCs than those of estate sector
(61 and 74 percent for urban and rural respectively, compared to only 32 percent for the estate sector).
By districts, 90 percent of the ever-married women in Moneragala have heard about W-WCs. com-
pared to the lowest percentage observed in the Jaffna district (14 percent). In three additional districts (Man-
nar, Mullaitivu and Kilinochchi), awareness about W-WCs is below 20 percent.

122 Demographic and Health Survey - 2016, Sri Lanka

 Moreover, there is a positive association between the level of knowledge of the W-WCs and both
education level of the woman and the wealth of the households. Only 27 percent of women who have no edu-
cation have heard of W-WCs, whereas knowledge of W-WCs among women with higher levels of education
is around 80 percent.
In Sri Lanka, age 35 is the age that women should attend to a W-WC. From Table 9.8, we can also
see that 73 percent of ever-married women age 15-49 correctly indicated age 35 as the age at which women
should attend a W-WC. When considering the age groups, percentages increase with the age of the women,
is higher among the more educated women and those from the richest quintiles (see Figure 9.2 below). Only
59 percent of the women living in the estate sector recognized 35 as the age women should attend the W-WC,
compared to 65 percent of women in the urban and 74 percent in the rural.
Table 9.8: Knowledge of Well- Women Clinic

Percentage of ever-married women age 15-49 who have heard of the Well-Women Clinic, and among those the percentage who know at
what age a woman should attend a Well-Women Clinic by background characteristics, Sri Lanka, 2016
Background characteristic Heard of Well- Number Among women who have heard of the Well-Women Clinic: age to attend a Well-
Women clinic of Women clinic
women Below 50 and Don't Number of
20 20-29 30-39 40-49 above know Total Age 35 women

Age
15-19 40.7 229 3.3 5.7 47.1 1.0 0.0 42.9 100.0 41.1 93
20-24 54.2 1,410 2.6 3.0 64.2 3.6 0.6 25.9 100.0 56.3 764
25-29 64.7 2,620 1.9 2.1 73.2 3.5 0.7 18.7 100.0 65.0 1,695
30-34 72.8 3,615 1.6 1.6 82.0 2.5 0.3 12.0 100.0 76.3 2,632
35-39 79.9 3,945 1.3 1.6 86.9 1.6 0.1 8.5 100.0 81.9 3,151
40-44 74.1 3,269 1.4 2.1 78.7 6.3 0.2 11.2 100.0 73.5 2,421
45-49 67.7 3,214 1.6 2.3 72.1 8.4 1.1 14.4 100.0 66.9 2,177

Marital status
Married 71.2 16,545 1.6 2.0 78.7 4.1 0.4 13.2 100.0 72.8 11,781
Living together 77.1 712 1.4 1.7 81.4 3.4 0.0 12.2 100.0 78.0 549
Widowed/divorced/separated 57.6 1,045 1.5 1.7 71.6 6.3 1.0 17.9 100.0 65.4 602

Residence
Urban 61.2 2,855 1.9 2.3 70.4 5.8 0.6 19.0 100.0 65.2 1,748
Rural 74.3 14,737 1.6 1.9 80.0 3.9 0.4 12.1 100.0 74.1 10,955
Estate 32.4 710 0.9 2.7 65.8 3.5 0.0 27.1 100.0 58.5 230

District
Colombo 70.1 1,731 1.8 2.9 67.1 5.6 0.9 21.8 100.0 61.2 1,213
Gampaha 78.9 1,845 1.5 1.8 77.9 5.8 0.0 13.1 100.0 72.5 1,455
Kalutara 84.4 1,104 2.0 2.5 76.8 4.6 0.6 13.5 100.0 67.0 932
Kandy 72.4 1,223 1.5 2.7 78.9 3.7 0.2 13.1 100.0 73.0 885
Matale 84.5 490 0.4 1.5 87.6 1.4 0.6 8.6 100.0 80.3 414
Nuwara Eliya 55.0 572 2.0 2.1 77.9 1.8 0.4 15.7 100.0 72.4 315
Galle 83.8 935 2.7 3.5 74.6 6.0 1.7 11.5 100.0 68.1 783
Matara 78.2 718 1.0 1.4 72.8 3.6 0.7 20.5 100.0 69.9 562
Hambantota 83.3 556 0.6 1.7 82.3 0.9 0.6 13.9 100.0 77.7 463
Jaffna 13.6 471 11.3 12.4 41.5 8.3 0.0 26.6 100.0 40.1 64
Mannar 18.0 81 * * * * * * * * 15
Vavuniya 28.3 136 (2.1) (1.6) (75.6) (1.1) (0.0) (19.5) (100.0) (70.9) 39
Mullaitivu 14.3 81 * * * * * * * * 12
Kilinochchi 19.2 94 * * * * * * * * 18
Batticaloa 26.9 531 1.0 4.0 85.0 3.4 0.0 6.5 100.0 77.4 143
Ampara 60.7 731 0.4 2.1 86.5 1.0 0.2 9.8 100.0 84.0 443
Trincomalee 35.0 362 4.1 1.1 63.4 4.7 1.5 25.1 100.0 60.8 127
Kurunegala 85.8 1,592 1.2 1.2 80.8 4.2 0.1 12.4 100.0 75.4 1,366
Puttalam 71.9 664 2.2 1.5 83.9 5.1 0.6 6.7 100.0 74.5 477
Anuradhapura 76.2 984 0.4 0.0 85.4 0.2 0.0 14.0 100.0 85.0 750
Polonnaruwa 81.3 399 2.7 1.3 79.5 3.9 0.0 12.6 100.0 73.8 324
Badulla 58.9 735 3.5 3.2 72.3 4.2 0.3 16.6 100.0 64.7 433
Moneragala 89.5 485 0.5 0.5 93.9 1.7 0.0 3.3 100.0 87.1 434
Ratnapura 72.0 1,084 1.8 2.8 77.5 5.7 1.1 11.1 100.0 68.4 780
Kegalle 69.6 698 0.9 0.5 83.7 7.8 0.0 7.1 100.0 80.3 486

Education
No education 26.5 285 3.5 2.8 63.9 5.0 0.0 24.9 100.0 56.0 76
Passed Grade 1-5 41.2 1,257 1.4 1.8 72.2 5.3 0.3 19.1 100.0 62.9 517
Passed Grade 6-10 68.7 8,130 1.6 1.9 78.5 3.5 0.5 14.0 100.0 72.2 5,588
Passed G.C.E.(O/L) or
equivalent 74.4 4,044 1.2 1.7 80.5 3.9 0.7 11.9 100.0 75.0 3,011
Passed G.C.E.(A/L) or
equivalent 82.0 3,731 1.9 2.3 78.8 4.8 0.2 12.0 100.0 73.9 3,058
Degree and above 79.7 856 2.3 2.5 73.9 6.9 0.3 14.1 100.0 69.6 682

Wealth quintile
Lowest 48.7 3,390 1.8 2.8 74.9 3.6 0.4 16.5 100.0 67.3 1,649
Second 68.3 3,695 1.3 1.5 79.7 4.0 0.6 12.9 100.0 74.1 2,523
Middle 76.3 3,838 1.7 1.7 80.5 3.5 0.5 11.9 100.0 74.6 2,930
Fourth 78.7 3,816 1.4 1.7 81.0 3.5 0.3 12.1 100.0 75.7 3,004
Highest 79.3 3,562 1.9 2.5 74.6 6.0 0.4 14.6 100.0 69.2 2,826

Total 70.7 18,302 1.6 2.0 78.5 4.2 0.4 13.3 100.0 72.7 12,932
Note : Figures in parentheses are based on 25 – 49 unweighted cases
An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed

Maternal Health 123

9.8.2 KNOWLEDGE OF WELL-WOMEN CLINICS SERVICES

In order to assess the respondents' knowledge about the standard services provided by the W-
WCs, all ever-married women interviewed in 2016 SLDHS were asked about specific services. Almost
9.8.2 Knowledge of well-women clinics services
In order to assess the respondents’ knowledge about the standard services provided by the W-WCs,
all ever-married women interviewed in 2016 SLDHS were asked about specific services. Almost eight out
of ten ever-married women in Sri Lanka (77 percent) know about the test for cervical cancer and the test for
breast cancer services provided by the W-WCs. However, from Table 9.9 we can see that only a relatively
small percentage of ever married women in Sri Lanka knew about the W-WC services for high blood pres-
sure (33 percent), the test for diabetes (34 percent), family planning (24 percent) and health education (15
percent).
Knowledge for the two tests for cancers (breast and cervical) increases with the age of the woman to
a maximum of around 80 percent among women age 40-49. It shows similar increases by level of education
and wealth quintile (see Table 9.9 below). The data provides enough evidence to develop interventions that
increase the knowledge of family planning services offered by the W-WC, targeting in particular those geo-
graphic areas in which knowledge is the lowest (i.e. districts of Matale and Polonnaruwa with only, 8 and 11
percent of women who know that the W-WCs provide family planning services.)

124 Demographic and Health Survey - 2016, Sri Lanka

Table 9.9: Knowledge of Services

Percentage of ever-married women age 15-49 among ever heard of well women clinic; who know about the services provided by the
Well-Women clinic, by background characteristics, Sri Lanka, 2016
Background characteristic Percentage who know of specific services
The test The test
for high The test The test for Family
blood for for breast cervical planning Health Don't Number of
pressure diabetes cancer cancer services education Other know women

Age
15-19 15.1 19.1 40.7 38.1 10.6 8.3 1.5 50.6 93
20-24 21.0 21.9 59.7 56.4 16.2 10.0 0.2 33.5 764
25-29 23.7 25.4 68.3 67.9 17.9 11.6 0.4 23.2 1,695
30-34 29.8 30.6 76.0 76.5 23.1 13.8 0.3 16.0 2,632
35-39 39.6 41.4 83.9 84.9 28.2 17.1 0.3 9.4 3,151
40-44 35.9 38.1 81.3 83.2 25.7 16.4 0.4 11.6 2,421
45-49 34.4 35.6 77.5 78.9 23.9 15.5 0.4 14.7 2,177

Marital status
Married 32.6 34.0 76.9 77.6 24.3 15.4 0.4 15.6 11,781
Living together 39.3 42.1 84.5 86.0 16.4 5.0 0.0 10.2 549
Widowed/divorced/separated 28.9 31.3 71.7 71.8 21.0 12.2 0.8 20.6 602

Residence
Urban 27.0 29.5 72.0 73.6 23.9 15.7 0.5 18.6 1,748
Rural 33.6 34.9 78.0 78.5 23.9 14.7 0.3 14.9 10,955
Estate 33.8 34.0 64.7 65.7 19.1 11.8 0.3 22.9 230

District
Colombo 20.9 25.2 67.8 73.5 21.4 12.5 0.6 19.8 1,213
Gampaha 37.3 40.6 83.1 83.7 22.3 10.7 0.0 12.8 1,455
Kalutara 37.5 39.2 78.6 79.1 25.2 18.5 0.1 17.8 932
Kandy 36.1 35.7 77.8 80.5 25.6 19.7 0.3 13.5 885
Matale 20.8 19.8 58.5 68.3 7.8 16.7 3.0 19.6 414
Nuwara Eliya 40.5 38.4 72.0 74.7 30.4 26.2 0.2 16.1 315
Galle 39.3 39.1 74.5 80.6 42.1 30.2 0.8 13.5 783
Matara 29.3 27.9 78.6 77.8 12.6 7.7 0.0 14.3 562
Hambantota 46.9 46.2 82.3 79.7 28.2 16.0 0.2 14.7 463
Jaffna 37.3 35.6 29.2 22.4 12.2 10.5 0.0 35.5 64
Mannar * * * * * * * * 15
Vavuniya (20.0) (33.0) (65.6) (62.7) (21.6) (9.7) (0.0) (25.8) 39
Mullaitivu * * * * * * * * 12
Kilinochchi * * * * * * * * 18
Batticaloa 17.9 14.7 65.8 59.9 16.7 3.3 0.0 17.1 143
Ampara 47.7 52.4 82.0 76.9 35.0 32.1 0.0 10.9 443
Trincomalee 17.7 15.9 66.3 57.4 19.4 6.1 0.0 24.4 127
Kurunegala 41.9 45.0 78.8 78.4 23.2 11.7 0.7 14.0 1,366
Puttalam 12.2 13.4 77.9 75.6 17.5 8.7 0.0 15.2 477
Anuradhapura 22.4 22.3 77.9 77.9 16.5 13.9 0.0 21.2 750
Polonnaruwa 19.8 22.7 72.7 72.0 11.0 12.7 0.0 19.5 324
Badulla 30.3 30.0 66.8 66.2 18.7 16.6 1.0 26.8 433
Moneragala 34.6 36.3 92.7 87.7 40.3 11.8 0.0 5.8 434
Ratnapura 41.1 41.7 78.6 78.6 17.7 7.4 0.0 15.4 780
Kegalle 19.0 23.0 91.2 89.4 39.1 13.1 0.0 5.5 486

Education
No education 29.0 29.4 63.3 62.6 22.9 17.4 1.0 29.4 76
Passed Grade 1-5 28.4 27.7 68.1 68.6 22.5 12.7 0.4 21.3 517
Passed Grade 6-10 30.8 32.5 74.0 74.2 20.6 12.4 0.4 18.4 5,588
Passed G.C.E.(O/L) or
equivalent 32.7 34.6 77.9 79.5 24.2 15.5 0.3 14.6 3,011
Passed G.C.E.(A/L) or
equivalent 36.4 37.0 82.0 82.4 28.2 18.3 0.4 11.1 3,058
Degree and above 35.5 38.7 82.7 84.9 29.0 16.9 0.2 10.9 682

Wealth quintile
Lowest 27.6 29.3 66.3 65.8 20.1 13.1 0.5 23.9 1,649
Second 31.7 32.5 75.0 74.8 22.1 12.9 0.3 16.7 2,523
Middle 32.8 33.8 77.5 79.2 22.5 14.0 0.4 14.9 2,930
Fourth 33.2 35.0 80.1 81.1 24.2 14.7 0.5 13.3 3,004
Highest 36.0 38.1 80.9 81.8 28.3 18.5 0.2 12.8 2,826

Total 32.7 34.2 77.0 77.6 23.8 14.8 0.4 15.6 12,932
Note : Figures in parentheses are based on 25 – 49 unweighted cases
An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed

Maternal Health 125

 this percentage is considerable higher among women 35 and older (56 percent among 35-39)
ng younger ones (less than 10 percent for ever-married age 15-34). By district, the participation in
is highest in the Kalutara district (39 percent) and the lowest in Jaffna district with only 16

Table 9.10: Participation of Well - Women Clinic

9.8.3 Participation
Percentage of ever-married women age 15-49 among ever heard of
well women clinic; who have attended a Well-Women Clinic by in well-women clinics
background characteristics, Sri Lanka, 2016
Ever attended a Number of W-WCs normally provide their services
Background characteristic Well-Women Clinic women to women who are 35 years of age and
older. Table 9.10 shows that only 33 per-
Age
15-19 3.2 93
cent of ever-married women age 15-49
20-24 2.6 764 have ever attended to a W-WC. Howev-
25-29 3.7 1,695 er, as expected, this percentage is consid-
30-34 9.5 2,632 erable higher among women 35 and old-
35-39 56.0 3,151
40-44 47.9 2,421 er (56 percent among 35-39) than among
45-49 46.5 2,177 younger ones (less than 10 percent for
Marital status ever-married age 15-34). By district,
Married 33.0 11,781 the participation in W-WCs is highest
Living together 35.1 549
Widowed/divorced/separated 31.7 602
in the Kalutara district (39 percent) and
Residence
the lowest in Jaffna district with only 16
Urban 29.1 1,748 percent.
Rural 33.8 10,955
Estate 28.5 230
District 9.8.4 Use of pap test
Colombo 30.0 1,213
Gampaha 37.1 1,455 A revised Guideline for Cervi-
Kalutara 38.6 932
Kandy 32.1 885
cal cytology Screening and Reporting
Matale 34.9 414 in Sri lanka was formulated in 2010 by
Nuwara Eliya 38.2 315 a committee comprising of representa-
Galle 29.5 783 tives from the College of Pathologists of
Matara 34.8 562
Hambantota 31.3 463 Sri Lanka, College of Obstetricians and
Jaffna 15.8 64 Gynaencologists of Sri Lanka and Fam-
Mannar * 15 ily Health Bureau. The guideline recom-
Vavuniya (15.4) 39
mends once in a life time screening using
Mullaitivu * 12
Kilinochchi * 18 conventional Pap smear cytology for the
Batticaloa 21.5 143 women of 35 years of age. The single
Ampara 38.2 443 age cohort was selected considering the
Trincomalee 18.3 127
Kurunegala 32.6 1,366 logistic convenience of identifying the
Puttalam 34.7 477 eligible women of one particular age and
Anuradhapura 31.9 750 feasibility of achieving a high coverage
Polonnaruwa 31.6 324
of the limited target population. Howev-
Badulla 33.0 433
Moneragala 31.5 434 er, the guideline also permits any wom-
Ratnapura 33.2 780 an (specially over 35 years) seeking the
Kegalle 30.0 486 screening services voluntarily to have
Education Pap smear through the same programme.
No education 42.6 76
Passed Grade 1-5 43.9 517 The Public Health Midwives
Passed Grade 6-10 34.6 5,588
Passed G.C.E.(O/L) or
(PHM) identify the women aged 35 years
equivalent 33.6 3,011 from the registers maintained at the of-
Passed G.C.E.(A/L) or fice of the PHM and invite them during
equivalent 29.2 3,058 the home visits to attend the W-WCs for
Degree and above 25.7 682
cervical cancer screening. A letter of in-
Wealth quintile
Lowest 30.3 1,649 vitation from the MOH is also sent to
Second 33.4 2,523 each woman as she attains the age of 35
Middle 33.7 2,930 years, reminding her to undergo screen-
Fourth 33.8 3,004
Highest 32.7 2,826
ing.
In the 2016 SLDHS, all ev-
Total 33.0 12,932
er-married women age 15-49 were asked
Note : Figures in parentheses are based on 25 – 49 unweighted cases
An asterisk indicates that a figure is based on fewer than 25 if they have ever had a PAP test. Twen-
unweighted cases and has been suppressed ty-one percent of them indicated that they

126 Demographic and Health Survey - 2016, Sri Lanka

y and Health Survey - 2016 129

Table 9.11: Ever had PAP Test have had the test in the past. This per-
centage is substantially higher among
Percentage of ever-married women age 15-49 who ever had a PAP test, by background
characteristics, Sri Lanka, 2016 older ever-married women (42 percent
Ever had a PAP Number of among women age 35-39), which indi-
Background characteristic test women cates the national concentration on the
Age
women at age 35 since 2010 for the cer-
15-19 0.0 229 vical cancer screening. The prevalence
20-24 0.5 1,410 of the use of PAP tests increases with
25-29 1.6 2,620 the level of education of the woman and
30-34 5.8 3,615
35-39 41.7 3,945 by the wealth quintile of the household
40-44 32.1 3,269 in which the woman resides (see Figure
45-49 29.3 3,214 9.2). By place of residence, the preva-
Marital status lence of the use of the PAP test is higher
Married 21.4 16,545 in the rural areas (22 percent) than in
Living together 26.9 712 the urban areas (18 percent) and in the
Widowed/divorced/separated 16.4 1,045
estate sector (9 percent). Ever use of the
Residence PAP test presents a wide range varia-
Urban 18.3 2,855 tion by district of residence, from just
Rural 22.4 14,737
Estate 9.2 710
2 percent in the Mullaitivu district to 32
percent in Kalutara.
District
Colombo 24.6 1,731
Gampaha 28.1 1,845
Kalutara 31.5 1,104
Kandy 21.3 1,223
Matale 27.2 490
Nuwara Eliya 14.9 572
Galle 21.0 935
Matara 24.6 718
Hambantota 18.8 556
Jaffna 2.8 471
Mannar 3.4 81
Vavuniya 3.0 136
Mullaitivu 2.4 81
Kilinochchi 5.2 94
Batticaloa 4.3 531
Ampara 14.7 731
Trincomalee 7.4 362
Kurunegala 25.8 1,592
Puttalam 22.9 664
Anuradhapura 17.8 984
Polonnaruwa 23.4 399
Badulla 16.5 735
Moneragala 26.2 485
Ratnapura 23.3 1,084
Kegalle 19.0 698

Education
No education 9.0 285
Passed Grade 1-5 15.4 1,257
Passed Grade 6-10 21.1 8,130
Passed G.C.E.(O/L) or equivalent 22.3 4,044
Passed G.C.E.(A/L) or equivalent 23.3 3,731
Degree and above 21.6 856

Wealth quintile
Lowest 12.1 3,390
Second 20.0 3,695
Middle 22.3 3,838
Fourth 23.8 3,816
Highest 27.6 3,562

Total 21.3 18,302

Maternal Health 127

 Figure 9.2 Knowledge of W-WC and PAP test by Wealth Quintile

90
79 79
80 76
68
70

60
49
50
Percent

40
28
30 24
22
20
20
12
10

0
Heard of Well-Women Clinic Ever Had a PAP test

Lowest Second Middle Fourth Highest

128 Demographic and Health Survey - 2016, Sri Lanka

CHILD HEALTH 10
Key Findings
• Low Birth Weight: 16 percent of newborn children in the five years be-
fore the survey that have a reported weight, have low birth weight (below
2.5kg).
• Vaccinations: In 2016, among children age 24-35 months, only one per-
cent were not received any vaccination.
• Diarrhoea: Three percent of children under age 5 years had diarrhoea in
the two weeks preceding the survey.
• Diarrhoea treatment: Of these children with diarrhoea, 91 percent were
taken for treatment to a health facility or health provider. Similarly, 54
percent received fluid from ORS packets or prepackaged ORS liquid and
63 percent continued feeding and were given oral re-hydration therapy
(ORT)
• Symptoms of acute respiratory infections: Two percent of children un-
der age 5 years had symptoms of acute respiratory infection (ARI) in the
two weeks preceding the survey and of those children affected 52 percent
were taken to a health facility or provider, for advice or treatment.
• Fever: Fourteen percent of children under age 5 years had a fever in the
two weeks preceding the survey and of these children, 92 percent were
taken to a facility or health provider for treatment. Among those who re-
ceived treatment, 48 percent received antibiotic drugs.
• Disability: Twenty-three percent of children age 2-5 years, had atleast
one development difficulty.
• Early Childhood Development: The Child Development booklets sec-
tion of Child Health Development Record were read by 79 percent of
mothers in Sri Lanka.

T
his chapter presents findings on aspects of child health that contribute to their survival and develop-
ment, such as birth weight, immunization, and prevalence and treatment of major childhood illnesses
(IRA, diarrhoea and fever). Information given in this chapter is very useful to assist in reducing neo-
natal, infant and child morbidity and mortality.
One of the most important indicators of a child’s vulnerability to the risk of childhood illnesses and
chance of survival is birth weight. Likewise, many deaths in early childhood can be prevented by immunizing
children against preventable diseases, with emphasis on children age 12-23 months. Universal immunization
of children against the six-preventable diseases (tuberculosis, diphtheria, whooping cough, tetanus, polio and
measles) is crucial to reducing infant and child mortality.
Examining treatment practices and contacts with health services for children affected by the three
most important childhood illnesses (diarrhoea, acute respiratory infection (ARI) and fever) helps in the as-
sessment of national programs aimed at reducing the mortality impact of these illnesses. Information is pro-
vided on the prevalence and treatment of acute respiratory infection (ARI) and treatments taken for it within
the same day or the next day, prevalence of fever and its treatment with antibiotics, and the treatment of
diarrhoeal disease with oral re-hydration therapy (including increased fluids) for the assessment of programs
that recommended such treatment. In addition, information on the disposal of child’s stools is important in

Child Health 129

preventing the spread of disease. The data collected in the 2016 SLDHS provides a basis for the monitoring
and assessment of existing programs and the development of new interventions and policies.

10.1 Child’s weight at birth.

Low birth weight

Percentage of births with a reported birth weight <2.5 kilogrammes regardless of gestational age.
sample : Live births in the 5 yers before the survey that have a reported birth weight, either from a
written record or mother’s report

In the 2016 SLDHS, interviewers were trained in the procedures to obtain birth weight from the
Child Health Development Record (CHDR) for all children who were born since January 2011 up to the date
of the interview in 2016. Birth weight is an important determinant of newborn survival and an indicator of a
child’s vulnerability to the risk of childhood illnesses. In the 2016 SLDHS, interviewers were able to obtain
the birth weight from the CHDR for 97 percent of these children. This high percentage is a good indicator of
the quality of the registration in the CHDR, one that is very uniform across background characteristics.
Children whose birth weight is less than 2.5 kilograms are considered as of low birth weight, and
therefore have a higher than average risk of early childhood death. Globally, 16 percent of newborn children
in the five years before the survey that have a reported weight, have low birth weight (below 2.5kg). There
are important variations in the percentage of children of low birth weight by background characteristics.
Children born to younger mothers, of first birth order mothers, mothers who did not complete prima-
ry school, and mothers in the lowest wealth quintile are more likely to have children of low birth weight at
birth (i.e. less than 2.5kg) than their counterparts. Higher prevalence of low birth weight is observed among
children of younger mothers (22 percent), first birth order mothers (18 percent), children of mothers residing
in the estate sector (25 percent), and children of women with no education (32 percent). The prevalence of
low birth weight is negatively associated with the level of education of the mother (see Figure 10.1 below)
and the household wealth. Twenty-one percent of the children born to mothers in the poorest households were
registered as of low birth weight, compared to 9 percent among the richest quintile.
There are also important variations in the low birth percentages across districts. The highest values
are observed in Ratnapura, Nuwara Eliya and Matara, where more than one in five children are born with low
birth weight. At the same time, districts such as Jaffna, Mullaitivu and Kilinochchi, are the least affected by
the burden of low birth weight among newborns (less than 10 percent).
During the last ten years, this indicator has remained relatively constant1 at the same levels observed
in the 2006-07 SLDHS (16 percent). However, the percentage of low birth weight babies in the estate sector
declined from 31 in 2006-07 percent to 25 percent in 2016.

1
The 2016 SLDHS found 16 percent with low birth weight, excluding Northern Province to make the data comparable

130 Demographic and Health Survey - 2016, Sri Lanka

Table 10.1 Child's weight at birth

percentage of live births in the five years preceding the survey that have a reported birth weight, and among live
births in the five years preceding the survey with a reported birth weight, percentage less than 2.5 kg, according to
background characteristics, Sri Lanka 2016
Among births with a reported birth weight1
Percentage of births
Background that have a reported Percentage less than
characteristic birth weight1 Number of births 2.5 kg Number of births

Mother's age at birth

<20 95.0 420 21.7 399
20-34 96.7 6,558 15.2 6,345
35-49 97.1 1,215 16.4 1,179

Birth order
1 96.7 3,238 17.8 3,130
2-3 96.8 4,512 14.2 4,366
4-5 97.5 407 14.3 396
6+ (84.2) 36 (18.8) 30

Residence
Urban 96.2 1,295 12.7 1,246
Rural 97.0 6,537 15.7 6,339
Estate 93.7 360 25.4 338

District
Colombo 96.8 717 12.4 694
Gampaha 95.8 766 15.2 734
Kalutara 97.5 519 15.3 506
Kandy 96.8 581 14.3 562
Matale 97.2 216 13.5 210
Nuwara Eliya 96.1 281 20.7 270
Galle 97.1 428 12.6 415
Matara 97.0 337 20.5 327
Hambantota 97.3 265 10.0 258
Jaffna 95.0 209 6.2 198
Mannar (92.1) 42 (14.7) 38
Vavuniya 94.9 62 19.4 59
Mullaitivu (92.1) 37 (9.4) 34
Kilinochchi (95.8) 47 (9.50 45
Batticaloa 95.7 248 18.9 237
Ampara 97.9 357 16.0 350
Trincomalee 94.6 194 15.0 183
Kurunegala 97.3 683 15.1 665
Puttalam 96.6 291 18.7 281
Anuradhapura 98.5 418 14.3 412
Polonnaruwa 97.6 188 17.3 183
Badulla 95.4 305 17.0 291
Moneragala 99.3 242 18.8 240
Ratnapura 97.9 448 22.4 439
Kegalle 92.9 314 18.8 292

Mother's education
No education 97.2 55 31.8 54
Passed Grade 1-5 95.7 294 24.3 281
Passed Grade 6-10 97.0 3,542 17.5 3,435
Passed G.C.E.(O/L)
or equivalent 96.6 1,827 15.5 1,765
Passed G.C.E.(A/L)
or equivalent 96.5 1,994 11.5 1,925
Degree and above 96.3 480 12.5 462

Wealth quintile
Lowest 95.2 1,648 21.3 1,569
Second 97.0 1,664 17.4 1,613
Middle 97.1 1,639 15.6 1,592
Fourth 97.8 1,759 14.5 1,720
Highest 96.3 1,483 9.1 1,429

Total 96.7 8,193 15.7 7,923

1
Based on a written record from health card

Child Health 131

 Figure 10.1 Percentage of low birth weight children by
mother’s education level

Percent

35 32
30
24
25

20 18
16
15 13
12
10

0
No education Passed Grade 1- Passed Grade 6- Passed Passed Degree and
5 10 G.C.E.(O/L) or G.C.E.(A/L) or above
equivalent equivalent

Mother's Education

10.2 Vaccination coverage

All basic vaccinations coverage

Percentage of children age 12-23 months who recieved specific vaccines at any time before the survey
(according to a vaccination card or the mother’s report). To have recieved all basic vaccinations, a
child must receive at least:
• One does of BCG vaccine, which protects against tuberculosis
• Three doses of DPT, which protects against diphtheria, pertussis (whooping cough), and tetanus
• Three doses of polio vaccine
• One does of measles vaccine
sample : Living children age 12-23 months

In 1961 the government of Sri Lanka initiated the National Immunization Programme and expand-
ed it after 1978 (DCS, 1995). The Sri Lankan National Immunization programme follows the international
guidelines recommended by the WHO. Vaccinations given, should be recorded in the CHDR given to the
child’s parents. The government of Sri Lanka provides all childhood vaccines free of charge.
The 2016 SLDHS collected data on child’s vaccinations for all living children born during the five
years prior to the survey. Normally, immunizations are recorded on the child’s vaccination card. During
this survey, if the mother was able to show the vaccination card, dates of vaccinations were copied from the
CHDR to the questionnaire. If the mother was unable to show the CHDR, she was asked to recall whether
the child received each vaccine. Table 10.2 represent the vaccination coverage among children aged 12-23
months and children aged 24-35 months according to the source of information.
In 2016, only one percent of the children ages 24-35 months were not received any vaccination. The
level of coverage for BCG, three doses of DPT/Pentavalent, Polio and Measles containing vaccines is 96
percent or higher.
Coverage for the Pentavalent/DPT and Polio vaccines by appropriate age are 98 percent and 99 per-
cent for the first dose, while declining with subsequent doses to 95 percent for third dose for DPT/ Penta and
Polio.

132 Demographic and Health Survey - 2016, Sri Lanka

 Table 10.2 Vaccinations by source of information

Percentage of children age 12-23 months and children age 24-35 months who received specific vaccines at any time before the
survey, by source of information (vaccination card or mother's report), and percentage who received specific vaccines by the
appropriate age, Sri Lanka 2016
Children age 12-23 months Children age 24-35 months
Vaccinated Vaccinated
by by
Vaccination Mother's Either appropriate Vaccination Mother's Either appropriate
1 2,3,4 1
Source of information card report source age card report source age2,3,4

BCG 92.7 6.5 99.2 98.8 91.5 7.1 98.6 98.2

DPT-HepB-Hib
1 92.0 6.5 98.6 98.4 91.3 7.0 98.3 98.1
2 91.6 6.4 98.0 97.9 91.2 6.9 98.1 97.9
3 89.8 6.2 96.0 95.3 89.7 6.6 96.3 95.2

Polio
1 92.5 6.4 98.9 98.7 91.7 7.1 98.8 98.7
2 92.2 6.4 98.5 98.5 91.2 7.0 98.2 98.0
3 89.9 6.2 96.0 95.4 89.1 6.8 95.8 94.4

Measles containing
vaccine
1 na na na na 90.4 6.8 97.1 96.5
2 na na na na 11.6 4.7 16.3 16.1

All basic
vaccinations5 0.0 0.0 0.0 - 86.4 6.2 92.6 90.3
No vaccinations 0.1 0.7 0.8 na 0.2 0.8 1.0 na
Number of children 1,443 113 1,556 1,556 1,553 133 1,686 1,686
na = Not applicable
BCG = Bacille Calmette-Guérin
DPT = Diphtheria-pertussis-tetanus
HepB = Hepatitis B
Hib = Haemophilus influenzae type b
1
Vaccination card, booklet or other home-based record
2
Received by age 12 months
3
For children whose vaccination information is based on the mother’s report, date of vaccination is not collected. The proportions of
vaccinations given during the first and second years of life are assumed to be the same as for children with a written record of
vaccination.
4
Received by age 12 months for all vaccines except [MEASLES CONTAINING VACCINE] 2, which should be received by age 24
months
5 BCG, three doses of [DPT-HepB-Hilb], three doses of oral polio vaccine (excluding polio vaccine given at birth), and one dose of
[MEASLES CONTAINING VACCINE]

10.2.1 Differentials
10.2.1 D IFFERENTIALS IN VACCINATION
in vaccination COVERAGE
coverage

Table
Table10.3 represents
10.3 the differences
represents in vaccination
the differences coverage
in vaccination for the children
coverage for the aged 12-23aged
children months and
12-23
children agedchildren
monthsand 24-35 months
aged by background
24-35 months characteristics
by background of the mother and children.
characteristics Vaccination
of the mother coverage
and children.
does not vary by
Vaccination the sex does
coverage of thenot
child andby
vary as the
birthsex
orderof increases
the childvaccination
and as birth coverage declines. vaccination
order increases Vaccination
coverage
coverageappears to be
declines. higher among
Vaccination children
coverage residing
appears to beinhigher
the rural sector
among than those
children of the
residing urban
in the ruralorsector
estate
sector important variations in the level of vaccinations among children aged 12-23 and children
than those of the urban or estate sector important variations in the level of vaccinations among children aged 24-35
months are observed
aged 12-23 across
and children districts.
aged 24-35 The analysis
months at the district
are observed acrosslevel couldThe
districts. benefit from at
analysis additional compar-
the district level
ison with data from administrative records.
could benefit from additional comparison with data from administrative records.
Social and economic characteristics are usually associated with the levels of vaccination coverage.
Social and economic characteristics are usually associated with the levels of vaccination coverage.
In the 2016 SLDHS, the relationship between the level of education and the wealth of the households and
In the 2016 SLDHS, the relationship between the level of education and the wealth of the households and
the levels of vaccination does not seem to show traditional patterns of positive associations. Rather, in 2016,
the levels of vaccination does not seem to show traditional patterns of positive associations. Rather, in
vaccination is higher among children of mothers with primary education “pass grade 1-5 ”, and lower the
2016, vaccination is higher among children of mothers with primary education “pass grade 1-5 ”, and
richest quintile.
lower the richest quintile.

Demography and Health Survey - 2016 138

Child Health 133

Table 10.3 Vaccinations by background characteristics

Percentage of children age 12-23 months and children age 24-35 months who received specific vaccines at any time before the survey (according to a vaccination card or
the mother's report), percentage with all basic vaccinations, and percentage with all age appropriate vaccinations, by background characteristics, Sri Lanka 2016

DPT-HepB-Hib Polio Children age 24-35 mon ths:

No
Background vaccin- Number Number
characteristic BCG 1 2 3 1 2 3 ations of children [MCV] 1 [MCV] 2 of children
Sex
Male 99.2 98.2 97.7 96.5 99.0 98.6 95.2 0.8 791 97.5 16.4 868
Female 99.2 98.9 98.3 95.4 98.8 98.5 96.9 0.8 765 96.7 16.2 818

Birth order
1 99.1 98.6 97.9 95.8 99.1 98.8 95.8 0.9 595 98.0 16.3 629
2-3 99.4 98.6 98.2 96.2 98.9 98.5 96.3 0.6 880 96.8 16.9 961
4-5 97.7 97.7 97.0 94.7 97.4 97.0 94.7 2.3 77 94.2 8.8 89
6+ * * * * * * * * 3 * * 6

Residence
Urban 98.7 95.9 94.9 91.9 97.4 96.7 93.2 1.3 228 94.0 10.0 256
Rural 99.3 99.1 98.5 96.9 99.2 98.9 96.6 0.7 1,253 97.7 17.4 1,366
Estate 98.3 98.3 98.3 93.6 98.3 98.3 95.9 1.7 75 98.3 17.6 63

District
Colombo 99.0 95.4 95.4 91.6 96.1 95.4 89.8 1.0 145 94.3 10.9 128
Gampaha 99.2 97.3 95.3 94.4 99.2 98.0 91.2 0.8 145 95.3 15.3 149
Kalutara 100.0 98.7 98.7 98.7 100.0 100.0 98.2 0.0 101 98.7 7.3 107
Kandy 97.7 97.7 97.7 97.7 97.7 97.7 95.0 2.3 108 97.6 18.7 136
Matale (100.0) (100.0) (100.0) (100.0) (100.0) (100.0) (100.0) (0.0) 35 (100.0) (9.6) 50
Nuwara Eliya 98.5 98.5 98.5 96.1 98.5 98.5 98.5 1.5 56 100.0 18.1 47
Galle 100.0 99.0 98.3 95.1 100.0 100.0 98.3 0.0 75 97.0 7.7 87
Matara 97.6 97.6 96.5 96.5 97.6 96.5 95.8 2.4 73 98.6 5.1 63
Hambantota (97.8) (97.8) (97.8) (97.8) (97.8) (97.8) (97.8) (2.2) 41 93.7 2.3 51
Jaffna (98.1) (98.1) (98.1) (98.1) (98.1) (98.1) (95.3) (1.9) 36 96.3 4.0 56
Mannar (92.9) (92.9) (81.0) (81.0) (88.9) (88.9) (81.0) (7.1) 6 (90.8) (11.7) 10
Vavuniya (96.7) (96.7) (93.9) (93.9) (96.7) (93.9) (93.9) (3.3) 10 (95.9) (32.4) 12
Mullaitivu (100.0) (100.0) (100.0) (100.0) (100.0) (100.0) (100.0) (0.0) 8 (95.6) (17.7) 9
Kilinochchi * * * * * * * * 6 (97.5) (11.9) 7
Batticaloa 100.0 100.0 100.0 98.2 100.0 100.0 100.0 0.0 47 93.3 2.7 56
Ampara 100.0 100.0 98.5 98.5 100.0 98.5 96.9 0.0 63 97.3 26.9 84
Trincomalee (97.4) (97.4) (97.4) (96.8) (97.4) (97.4) (96.8) (2.6) 29 93.1 14.5 40
Kurunegala 99.1 99.1 99.1 96.4 99.1 99.1 95.7 0.9 143 98.0 36.0 126
Puttalam 100.0 100.0 97.4 88.7 100.0 100.0 96.7 0.0 55 95.2 18.3 52
Anuradhapura 100.0 100.0 100.0 98.1 100.0 98.8 97.1 0.0 86 100.0 28.6 111
Polonnaruwa (100.0) (100.0) (100.0) (100.0) (100.0) (100.0) (100.0) (0.0) 35 (97.2) (5.1) 36
Badulla 99.1 99.1 99.1 91.0 99.1 99.1 94.0 0.9 52 98.2 10.6 78
Moneragala 100.0 100.0 98.1 90.4 100.0 100.0 98.1 0.0 51 96.9 38.2 55
Ratnapura 100.0 100.0 100.0 98.7 100.0 100.0 100.0 0.0 84 99.2 8.9 80
Kegalle 100.0 100.0 100.0 100.0 100.0 100.0 100.0 0.0 67 99.2 27.4 58

Mother's education
No education * * * * * * * * 10 * * 15
Passed Grade 1-5 100.0 100.0 99.4 99.4 100.0 100.0 99.4 0.0 40 98.9 7.8 63
Passed Grade 6-10 99.3 99.0 98.8 97.0 99.3 99.3 96.9 0.7 682 96.9 15.9 736
Passed G.C.E.(O/L) or
equivalent 99.6 99.2 98.6 96.1 98.7 98.3 95.5 0.4 313 97.3 21.6 385
Passed G.C.E.(A/L) or
equivalent 99.2 97.8 97.0 94.8 98.9 98.2 95.5 0.8 395 96.5 14.4 384
Degree and above 97.4 96.8 95.0 93.1 97.4 96.0 93.8 2.6 117 98.9 14.2 102

Wealth quintile
Lowest 98.8 98.8 98.4 96.0 98.8 98.7 97.1 1.2 303 96.6 16.2 336
Second 99.7 99.7 99.2 97.5 99.6 99.6 97.7 0.3 295 96.8 18.0 350
Middle 99.5 99.5 99.0 97.0 99.5 99.0 97.8 0.5 326 99.0 15.8 312
Fourth 99.2 98.8 98.8 97.6 99.2 98.9 94.5 0.8 320 98.4 15.8 378
Highest 98.7 95.9 94.6 91.7 97.3 96.5 93.1 1.3 313 94.6 15.6 310

Total 99.2 98.6 98.0 96.0 98.9 98.5 96.0 0.8 1,556 97.1 16.3 1,686
Note: Children are considered to have received the vaccine if it was either written on the child's vaccination card or reported by the mother. For children whose
vaccination information is based on the mother’s report, date of vaccination is not collected. The proportions of vaccinations given during the first and second years of life
are assumed to be the same as for children with a written record of vaccination.

134 Demographic and Health Survey - 2016, Sri Lanka

10.3 Childhood illness and treatment
The 2016 SLDHS collected data on three illnesses which mainly affect childhood morbidity and
mortality (diarrhoea, acute respiratory infection (ARI) and fever). Estimates of the prevalence of these
illnesses and feeding practices during diarrhoea are presented in this section.

Treatment of ARI symptoms

Children with ARI symptoms for whom advice or treatment was sought. ARI symptoms include
cough accompanied by
(1) short, rapid breathing that is chest-related, and/or
(2) difficult breathing that is chest-related.
sample : Children under age 5 with symptoms of ARI in the 2 weeks before the survey

10.4 Acute respiratory infections and treatment

Respiratory infections are common among children under the age of five years and sometimes they
lead to pneumonia or asthma. Fever and coughing are common initial symptoms of ARI, and early diagnosis
and treatment with antibiotics can prevent a large proportion of ARI and pneumonia deaths. In the 2016
SLDHS, questions were asked to separate children with symptoms associated with ARI from children suffer-
ing from a cold or a cough during the two-weeks preceding the survey.
Data collected in the 2016 SLDHS shows that only 2 percent of the children under five had symp-
toms of acute respiratory infection (ARI) in the two weeks preceding the survey (Table 10.4). This was esti-
mated by asking mothers whether their children under age 5 had been ill with a cough accompanied by short,
rapid breathing as a result of a problem in the chest in the two weeks preceding the survey. These symptoms
are compatible with ARI. It should be noted that data collected are subjective in the sense that they are based
on the mother’s perception of illness without validation by medical personnel.
No differences are observed between boys and girls. Considering the child’s age, the highest preva-
lence of ARI was reported for children 3 and 4 years of age (3 percent respectively), which are also the usual
ages when children attend pre-school education. High levels of ARI can also be observed among children of
mothers with no education and those residing in the poorest of households (6 percent and 3 percent respec-
tively) relative to the other children.
Place of residence also seems to show some differentials, with high prevalence among children
residing in the estates sector (3 percent). In two districts, Hambantota and Polonnaruwa the prevalence of
ARI among children under five reached the highest values (8 percent and 7 percent respectively, see Table
10.4 below), compared with Matara, Jaffna, Mullaitivu, Batticaloa and Ampara, where less than one percent
prevalence of ARI among under five children was reported.
Among those children under age five with symptoms of ARI in the two weeks before the survey,
more than half of them (52 percent) were taken to a health provider for treatment of their acute respiratory
illness (Table 10.4). Out of the children with respiratory illness, for one out of three children (32 percent)
treatment was sought the same day or the next day of the illness. There are no apparent differentials by back-
ground characteristics in the behaviors related to seeking advice or treatment from health facilities or the
promptness with which the advice was pursued. This is in part due to the relatively low prevalence of ARI in
Sri Lanka.

Child Health 135

 Table 10.4 Prevalence and treatment of symptoms of ARI

Among children under age five, the percentage who had symptoms of acute respiratory infection (ARI)
in the two weeks preceding the survey and among children with symptoms of ARI, the percentage for
whom advice or treatment was sought from a health facility or provider and the percentage who received
antibiotics as treatment, according to background characteristics, Sri Lanka 2016
Among children under age five with symptoms of ARI:

Percentage
for whom
advice or Percentage
Percentage treatment was for whom
with sought from a treatment was
symptoms of Number of health facility sought same Number of
Background characteristic ARI1 children or provider2 or next day children

Age in months
<6 1.0 757 * * 7
6-11 2.3 790 * * 18
12-23 2.2 1,556 (46.3) (22.9) 34
24-35 2.3 1,686 (50.6) (36.9) 39
36-47 3.0 1,665 (56.3) (33.8) 50
48-59 3.0 1,691 53.2 35.8 50

Sex
Male 2.7 4,216 52.2 29.3 113
Female 2.2 3,930 52.4 36.1 87

Cooking fuel
Electricity or gas 2.3 2,781 51.6 35.5 64
Wood/straw3 2.5 5,348 52.6 30.8 135

Residence
Urban 1.8 1,286 * * 23
Rural 2.6 6,500 56.7 34.0 167
Estate 2.6 359 * * 9

District
Colombo 3.3 716 * * 23
Gampaha 1.8 762 * * 14
Kalutara 1.9 512 * * 10
Kandy 3.7 579 * * 22
Matale 1.6 214 * * 4
Nuwara Eliya 3.6 279 * * 10
Galle 2.0 425 * * 9
Matara 0.6 337 * * 2
Hambantota 7.5 264 * * 20
Jaffna 0.9 207 * * 2
Mannar 1.7 42 * * 1
Vavuniya 5.0 62 * * 3
Mullaitivu 0.5 37 * * 0
Kilinochchi 1.5 46 * * 1
Batticaloa 0.0 247 * * 0
Ampara 0.9 353 * * 3
Trincomalee 4.5 190 * * 9
Kurunegala 1.9 680 * * 13
Puttalam 4.4 290 * * 13
Anuradhapura 1.2 416 * * 5
Polonnaruwa 6.8 188 * * 13
Badulla 1.8 302 * * 5
Moneragala 1.5 241 * * 4
Ratnapura 2.9 445 * * 13
Kegalle 1.2 314 * * 4

Mother's education
No education 6.3 55 * * 3
Passed Grade 1-5 2.6 292 * * 8
Passed Grade 6-10 2.7 3,524 53.1 30.8 93
Passed G.C.E.(O/L) or
equivalent 3.0 1,816 51.4 33.6 54
Passed G.C.E.(A/L) or
equivalent 1.7 1,980 (43.3) (31.1) 33
Degree and above 1.6 478 * * 7

Wealth quintile
Lowest 2.8 1,633 50.0 30.6 45
Second 2.2 1,660 (63.1) (34.6) 36
Middle 2.5 1,628 (52.0) (25.1) 41
Fourth 2.7 1,752 (60.3) (43.6) 48
Highest 2.0 1,474 (29.7) (23.7) 29
Total 2.4 8,146 52.3 32.3 199
1
Symptoms of ARI is defined as rapid breathing which was chest-related and/or difficult breathing
which was chest-related
2
Excludes pharmacy, shop, market, traditional practitioner, and itinerant drug peddler

136 Demographic and Health Survey - 2016, Sri Lanka

Demography and Health Survey - 2016 141

10.5 Fever

Treatment of fever
Children with fever for whom advice or treatment was sought.
sample : Children under age 5 with fever in the 2 weeks before the survey

Fever is a common health problem among children. It is a symptom of many acute infections,
including ARI, malaria, and diarrhea. Illnesses associated with fever contribute to malnutrition and child
mortality. Table 10.5 shows the percentage of children under 5 years of age who had fever in the two weeks
preceding the survey, according to the background characteristics. One out of six children (14 percent) under
age 5 were reported by their mothers as having fever in the two weeks before the survey. Higher prevalence
of fever was observed among children of mothers with no education. For about 92 percent of those children
affected by fever, their caretakers sought advice or treatment from a health facility or provider. Sixty-seven
percent did that within the same or the next day, and 48 percent took antibiotic drugs to treat the fever (Table
10.5).
The prevalence of fever among children under five varies with the age of the child. Children 6–59
months are more prone to have fever (14–16 percent) than children less than 6 months (only 6 percent prev-
alence). Place of residence also presents noticeable variations in the prevalence of fever among children un-
der five, with children residing in the urban and rural sectors being more affected by fever (15 percent each)
compared to their counterparts in the estates sector (only 8 percent). Four districts reported to have more than
twenty percent of their under five children affected by fever: Polonnaruwa (28 percent), Galle (25 percent),
Batticaloa (22 percent) and Hambantota (21 percent). At the same time, in two districts the prevalence of
fever among under five children is five percent or less: Mullaitivu (5 percent) and Mannar (3 percent). In
spite of the differentials presented before, there are no important variations in the treatment seeking behaviors
according to background characteristics (Table 10.5 below).

Child Health 137

 Table 10.5 Prevalence and treatment of fever

Among children under age five, the percentage who had a fever in the two weeks preceding the survey; and among children
with fever, the percentage for whom advice or treatment was sought from a health facility or provider, the percentage who
took antimalarial drugs, and the percentage who received antibiotics as treatment, by background characteristics, Sri Lanka
2016
Among children under age five: Among children under age 5 with
fever:

Percentage for
whom advice or Percentage for
treatment was whom treatment
sought from a was sought Percentage Number of
Background Percentage with Number of health facility or same or next who took children with
1
characteristic fever children provider day antibiotic drugs fever
Age in months
<6 6.1 757 (94.5) (73.0) (36.1) 46
6-11 14.9 790 93.3 65.6 56.9 118
12-23 15.7 1,556 90.0 64.9 47.1 245
24-35 15.1 1,686 93.1 70.2 47.8 254
36-47 14.4 1,665 91.8 63.6 45.3 240
48-59 15.5 1,691 92.7 66.3 50.7 262
Sex
Male 14.7 4,216 92.8 65.5 47.5 619
Female 13.9 3,930 91.4 67.7 49.1 546

Residence
Urban 15.2 1,286 86.8 62.7 40.9 195
Rural 14.5 6,500 93.2 67.0 49.7 941
Estate 7.8 359 (94.8) (75.4) (50.0) 28
District
Colombo 18.1 716 87.0 59.1 42.5 130
Gampaha 13.5 762 91.3 70.3 54.2 103
Kalutara 16.1 512 94.6 79.1 40.5 82
Kandy 8.3 579 (93.9) (70.3) (46.2) 48
Matale 14.2 214 (95.9) (73.4) (78.5) 30
Nuwara Eliya 7.0 279 * * * 20
Galle 24.9 425 96.9 77.1 71.3 106
Matara 12.5 337 (92.9) (64.0) (72.3) 42
Hambantota 21.3 264 96.7 61.9 28.6 56
Jaffna 15.0 207 (84.9) (48.4) (34.4) 31
Mannar 2.8 42 * * * 1
Vavuniya 11.5 62 * * * 7
Mullaitivu 5.0 37 * * * 2
Kilinochchi 14.3 46 (91.4) (39.7) (40.6) 7
Batticaloa 21.7 247 96.4 57.9 25.7 54
Ampara 11.7 353 (86.5) (43.7) (31.4) 41
Trincomalee 19.3 190 (90.0) (61.6) (27.3) 37
Kurunegala 12.2 680 96.4 70.1 63.1 83
Puttalam 15.9 290 (86.5) (57.1) (69.9) 46
Anuradhapura 8.7 416 (87.6) (83.6) (69.0) 36
Polonnaruwa 28.1 188 84.2 68.3 30.7 53
Badulla 15.5 302 98.0 70.6 19.8 47
Moneragala 7.3 241 * * * 18
Ratnapura 14.2 445 98.0 80.9 59.1 63
Kegalle 7.1 314 * * * 22
Mother's education
No education 21.3 55 * * * 12
Passed Grade 1-5 13.9 292 (91.2) (42.3) (44.6) 41
Passed Grade 6-10 15.4 3,524 93.2 66.0 46.5 542
Passed G.C.E.(O/L) or
equivalent 13.5 1,816 89.6 65.6 44.1 244
Passed G.C.E.(A/L) or
equivalent 13.3 1,980 92.7 74.0 53.5 263
Degree and above 13.2 478 91.3 61.6 59.6 63
Wealth quintile
Lowest 15.3 1,633 93.2 57.2 36.2 250
Second 14.5 1,660 90.8 65.0 43.8 241
Middle 14.8 1,628 95.4 75.2 51.7 241
Fourth 15.6 1,752 91.4 68.3 53.2 274
Highest 10.8 1,474 88.9 67.3 60.3 159

Total 14.3 8,146 92.2 66.5 48.3 1,165

1
Excludes pharmacy, shop, market, traditional practitioner, and itinerant drug peddler

138
Demography and Demographic
Health Surveyand Health Survey - 2016, Sri Lanka
- 2016 143
10.6
10.6 D
DIARRHOEAL DISEASE
iarrhoeal disease

Diarrhoea
Diarrhoea remains
remains a leading cause of childhood morbidity and mortality in developing countries.
Diarrhoea causes
Diarrhoea causes aarapid
rapidloss
lossofofbody
bodyfluid
fluidand
andleaves
leaves children
children at at risk
risk of of dehydration.
dehydration. Dehydration
Dehydration caused
caused by
by severe
severe diarrhoea
diarrhoea is a major
is a major causecause of morbidity
of morbidity amongamong young children.
young children. This condition
This condition can bewith
can be treated treated
oral
with oral re-hydration
re-hydration therapy,solution
therapy, a simple a simple solution
prepared byprepared
mixing aby mixing
desired a desired
amount amount
of water withof water with a
a commercially
commercially prepared packet of oral re-hydration salts (ORS), which are available through
prepared packet of oral re-hydration salts (ORS), which are available through health care facilities health care
and phar-
facilities
macies. and pharmacies.

Table 10.6 Prevalence of diarrhea

Percentage of children under age five who had diarrhea in the two weeks
preceding the survey, by background characteristics, Sri Lanka 2016
Percentage with Number of
Background characteristic diarrhea children

Age in months
<6 1.5 757
6-11 4.8 790
12-23 3.7 1,556
24-35 3.0 1,686
36-47 1.9 1,665
48-59 1.6 1,691
Sex
Male 3.1 4,216
Female 2.2 3,930
1
Source of drinking water
Improved 2.8 7,360
Not improved 1.7 786
2
Toilet facility
Improved, not shared 2.5 7,265
3
Shared 4.5 718
Non-improved 4.2 163

Residence
Urban 3.0 1,286
Rural 2.6 6,500
Estate 2.8 359

District
Colombo 3.3 716
Gampaha 3.0 762
Kalutara 4.3 512
Kandy 0.9 579
Matale 2.2 214
Nuwara Eliya 1.6 279
Galle 4.9 425
Matara 3.8 337
Hambantota 6.0 264
Jaffna 1.3 207
Mannar 2.6 42
Vavuniya 1.9 62
Mullaitivu 1.3 37
Kilinochchi 0.5 46
Batticaloa 6.2 247
Ampara 2.6 353
Trincomalee 2.8 190
Kurunegala 1.1 680
Puttalam 1.3 290
Anuradhapura 1.7 416
Polonnaruwa 4.2 188
Badulla 4.0 302
Moneragala 1.0 241
Ratnapura 1.7 445
Kegalle 0.4 314

Mother's education
No education 4.9 55
Passed Grade 1-5 3.6 292
Passed Grade 6-10 2.7 3,524
Passed G.C.E.(O/L) or equivalent 2.9 1,816
Passed G.C.E.(A/L) or equivalent 2.4 1,980
Degree and above 1.6 478

Wealth quintile
Lowest 3.1 1,633
Second 2.7 1,660
Middle 2.5 1,628
Fourth 2.6 1,752
Highest 2.4 1,474

Total 2.7 8,146

1
See Table 2.1 for definition of categories
2
See Table 2.2 for definition of categories
3
Facilities that would be considered improved if they were not shared by two
or more households

Demography and Health Survey - 2016 Child Health 139

139
 According to Table 10.6, only 3 percent of the children under five were reported by their mothers as
having diarrhoea during the two weeks preceding the survey. This figure is slightly lower than the percentage
reported from the 2006-07 SLDHS (3 percent) (DCS, 2009). 2
The prevalence of diarrhoea has declined slightly even in the estate sector-from 5 percent to 3 per-
cent.3
The prevalence of diarrhoea is higher among children aged 6 – 11 months (5 percent), ages at which
babies are usually introduced to solid and semi solid food. Children who have non- improved and shared toi-
let facilities are more likely to suffer from diarrhoea than children living in households with improved toilet
facilities. A decreasing pattern on the prevalence of diarrhoea can be observed according to the level of edu-
cation of the mother. Although the pattern by wealth quintile is not that clear, we can see that the prevalence
of diarrhoea is much higher among the children of the poorest households than in the other four quintiles.
Table 10.7 shows that 91 percent of children under 5 with diarrhoea in the two weeks before the sur-
vey have sought advice or treatment from a health facility or a provider. More than half of the children with
diarrhoea were treated with ORS. In addition, no difference in the patterns of treatment are observed by sex
of the child, or any other background variables (e.g., due to the lower prevalence of diarrhea and resulting
smaller sample sizes). In terms of treatment seeking behaviors, 67 percent of the children under five who
had diarrhea during the two weeks before the survey, were treated with recommended home fluids (RHF,
see Table 10.7). Another 86 percent of the children suffering from diarrhoea were given some form of oral
rehydration therapy (either ORS or RHF) or increased fluids, and almost half (47 percent) of the children with
diarrhoea received antibiotics.

2
The percentage for the 2016 SLDHS without Northern Province is 2.7 percent.
3
For residence the percentages in the 2016 SLDHS without Northern Province are: Urban, 3.1; rural, 2.7; and estate, 2.8

140 Demographic and Health Survey - 2016, Sri Lanka

Table 10.7 Diarrhoea treatment

Among children under age 5 who had diarrhoea in the 2 weeks preceding the survey, percentage for whom advice or treatment was sought from a health facility or
provider; percentage given fluid from an ORS packet or pre-packaged ORS fluid, recommended homemade fluids (RHF), ORS or RHF, zinc, ORS and zinc, ORS or
increased fluids, oral rehydration therapy (ORT), continued feeding and ORT, and other treatments; and percentage given no treatment, according to background
characteristics, Sri Lanka 2016
Percentage of children with diarrhoea
who were given:
Percenta
ge for
whom
advice or Fluid
treatment from ORT
was ORS (ORS,
sought packets Recom- ORS RHF,
from a or pre- mended Either or or
health package home ORS ORS increa increas Continued Anti- Anti- Intra- Home Number of
Background facility or d ORS fluids or and sed ed feeding biotic motility venous remedy No children with
1 2
characteristic provider liquid (RHF) RHF Zinc zinc fluids fluids) and ORT drugs drugs solution / other Missing treatment diarrhoea
Age in months
<6 * * * * * * * * * * * * * * * 11

6-11 (94.2) (42.7) (56.1) (64.8) (0.0) (0.0) (59.4) (72.7) (51.9) (46.7) (0.0) (0.0) (15.5) (0.0) (11.3) 38
12-23 93.0 53.1 72.5 86.8 0.0 0.0 64.4 86.8 59.1 35.5 0.0 0.0 17.3 0.0 7.6 58
24-35 (87.2) (59.4) (69.9) (83.5) (0.0) (0.0) (78.0) (94.6) (70.0) (54.8) (0.0) (0.0) (13.3) (0.0) (3.2) 51
36-47 (94.7) (62.6) (75.4) (90.1) (0.0) (0.0) (77.0) (94.5) (78.0) (51.9) (0.0) (0.0) (12.4) (0.0) (0.0) 32
48-59 (93.9) (63.5) (75.1) (84.0) (0.0) (0.0) (84.2) (94.3) (71.6) (46.5) (0.0) (0.0) (8.1) (0.0) (2.1) 27
Sex
Male 89.5 56.8 69.3 81.6 0.0 0.0 71.0 87.7 67.0 45.5 0.0 0.0 15.5 0.0 3.3 130
Female 91.9 49.8 64.6 77.4 0.0 0.0 67.6 84.5 57.3 48.7 0.0 0.0 13.6 0.0 8.7 88
Residence
Urban (86.9) (47.3) (60.5) (73.4) (0.0) (0.0) (63.8) (81.0) (62.6) (39.7) (0.0) (0.0) (23.9) (0.0) (7.1) 38
Rural 92.0 55.3 70.0 81.5 0.0 0.0 71.3 88.2 63.0 49.0 0.0 0.0 13.1 0.0 4.5 169
Estate * * * * * * * * * * * * * * * 10
Mother's
education
No education * * * * * * * * * * * * * * * 3
Passed Grade
1-5 * * * * * * * * * * * * * * * 11
Passed Grade
6-10 90.7 47.4 68.2 80.7 0.0 0.0 64.5 88.5 65.1 52.9 0.0 0.0 10.3 0.0 4.5 97
Passed
G.C.E.(O/L) or
equivalent 88.0 60.5 68.9 83.1 0.0 0.0 71.2 88.0 63.8 34.4 0.0 0.0 23.9 0.0 5.0 53
Passed
G.C.E.(A/L) or
equivalent (99.5) (60.0) (70.4) (78.4) (0.0) (0.0) (77.1) (84.1) (60.9) (56.6) (0.0) (0.0) (4.6) (0.0) (5.8) 47
Degree and
above * * * * * * * * * * * * * * * 8
Wealth
quintile
Lowest 86.0 52.1 49.4 74.9 0.0 0.0 68.3 80.8 62.6 49.1 0.0 0.0 14.3 0.0 9.7 51
Second (88.8) (52.9) (69.0) (75.5) (0.0) (0.0) (57.7) (80.0) (54.4) (47.8) (0.0) (0.0) (10.2) (0.0) (7.6) 45
Middle (90.1) (51.5) (79.7) (88.6) (0.0) (0.0) (61.2) (93.6) (62.3) (44.8) (0.0) (0.0) (17.1) (0.0) (0.0) 41
Fourth (93.1) (51.3) (69.9) (82.2) (0.0) (0.0) (74.4) (89.8) (65.2) (53.5) (0.0) (0.0) (15.8) (0.0) (2.1) 45
Highest (96.1) (64.2) (73.7) (79.5) (0.0) (0.0) (90.1) (90.1) (72.7) (36.0) (0.0) (0.0) (16.8) (0.0) (7.5) 36

Total 90.5 54.0 67.4 79.9 0.0 0.0 69.6 86.4 63.1 46.8 0.0 0.0 14.7 0.0 5.5 217

ORS = Oral rehydration salts

1 Excludes pharmacy, shop, market, traditional practitioner, and itinerant drug peddler
2 Continued feeding includes children who were given more, same as usual, or somewhat less food during the diarrhea episode

Child Health 141

3
For residence the percentages in the 2016 SLDHS without Northern Province are: Urban, 3.1; rural, 2.7;
and estate, 2.8
10.7 Feeding practices during diarrhoea

Appropriate
10.7 FEEDINGfeeding practices
PRACTICES DURING DIARRHOEA
Children with diarrhoea are given more liquids than usual, and as much food or more than usual.
sample : Children under age 5 with diarrhoea in the 2 weeks before the survey

Mothers are encouraged to continue feeding their children when affected by diarrhoea and are gen-
erally advised to increase the amount of fluids given to them. In the 2016 SLDHS, mothers who had a child
under age 5 Mothers are encouraged
with a recent episode oftodiarrhea
continue feeding
were askedtheir
howchildren whengave
much they affected by diarrhoea
the child to drink andand are
eat
generally advised to increase the amount of fluids given to them. In the 2016 SLDHS, mothers who had a
during the diarrhoeal episode compared with their usual practice. Table 10.8 shows that only 44 percent of
child under age 5 with a recent episode of diarrhea were asked how much they gave the child to drink and
children with diarrhea were given more fluids than usual, while 22 percent were considered to receive the
eat during the diarrhoeal episode compared with their usual practice. Table 10.8 shows that only 44 percent
sameofamount ofwith
children fluidsdiarrhea
as usual. Similarly,
were 34 percent
given more of children
fluids than with diarrhoea
usual, while 22 percentreceived a lesser amount
were considered of
to receive
liquid than usual or no liquids at all. During their diarrhoeal period, only 4 percent of children
the same amount of fluids as usual. Similarly, 34 percent of children with diarrhoea received a lesser received more
foodamount
than usual and 25
of liquid percent
than usual received the same
or no liquids at all.amount
Duringof food
their as usual.period,
diarrhoeal The percentage of children
only 4 percent with
of children
diarrhoea receiving
received morethan
more food liquids
usualthan
and usual has increased
25 percent received from 29 percent
the same amount in
of 2006-077 (DCS,
food as usual. The2009, Table.
percentage
10.9)oftochildren
45 percent
withindiarrhoea
2016.(The 2016 SLDHS
receiving found than
more liquids 45 percent withincreased
usual has diarrhoeafrom
reveving more in
29 percent liquids than
2006-077
usual, excluding
(DCS, 2009, Nothern Province
Table. 10.9) to makeinthe
to 44 percent data comparable)
2016.

Table 10.8 Feeding practices during diarrhea

Percent distribution of children under age 5 who had diarrhea in the 2 weeks preceding the survey by amount of liquids and food offered
compared with normal practice, by background characteristics, Sri Lanka 2016
Amount of Amount of food
liquids given given
Number
Some of
Same - Don't Same Some Never Don't children
Background as what Much know/ as - what Much gave know/ with
characteristic More usual less less None missing Total More usual less less None food missing Total diarrhea

Sex

Male 44.9 22.6 19.3 9.7 3.5 0.0 100.0 4.8 22.5 47.7 17.5 7.6 0.0 0.0 100.0 130

Female 42.7 22.1 24.9 8.1 2.2 0.0 100.0 1.5 28.7 35.3 28.4 6.0 0.0 0.0 100.0 88

Breastfeeding
status

Breastfeeding 41.1 21.9 22.0 11.0 4.0 0.0 100.0 1.5 24.9 41.0 23.4 9.3 0.0 0.0 100.0 155
Not
breastfeeding 51.4 23.7 20.4 4.2 0.4 0.0 100.0 8.4 25.4 47.0 18.1 1.2 0.0 0.0 100.0 62

Total 44.0 22.4 21.6 9.1 3.0 0.0 100.0 3.5 25.0 42.7 21.9 6.9 0.0 0.0 100.0 217

Note: It is recommended that children should be given more liquids to drink during diarrhea and food should not be reduced.

Figure 10.2 Feeding practices during diarrhoea

Figure 10.2 Feeding practices during diarrhoea

Percentage distribution of children under age 5 who had diarrhoea in the 2 weeks preceding the
survey by Amount
amountofof liquids
food and food
given 3.5 25.0
offered compared
42.7
with usual/normal
21.9
practices.
6.9 More Sri Lanka, 2016

Same as usual

Some- what less

Much less
Amount of food given 3.5 25 42.7 21.9 6.9 None
More
Amount of liquids given 44.0 22.4 21.6 9.1 3.0 Same as usual

Some- what less

Amount of liquids given 44 22.4 21.6 9.1 3 Much less

0% 20% 40% 60% 80% 100%
None

Percentage distribution of children

0% under
10% 20%age 5 who
30% 40% had
50%diarrhoea
60% 70%in 80%
the 2 90%
weeks preceding the survey by
100%

amount of liquids and food offered compared with usual/normal practices. Sri Lanka, 2016

Demography and Health Survey - 2016 147

142 Demographic and Health Survey - 2016, Sri Lanka
10.8 Knowledge of ors packets

Oral rehydration therapy

Children with diarrhoea are given a fluid made from a special packet of oral rehydration salt (ORS),
government-recommended10.8 homemade
KNOWLEDGE fluids
OF(RHF), or increased fluids.
ORS PACKETS
sample : Children under age 5 with diarrhoea in the 2 weeks before the survey

A simple and effective response to dehydration caused by diarrhoea is a prompt increase in the
child’s fluid intake through some form of oral rehydration therapy, which may include the use of a solution
prepared from packets of oral rehydration salts (ORS). To ascertain how prevalent, the knowledge of ORS is
in Sri Lanka, ever-married womenAwith simpleliving childrenresponse
and effective under five years of age
to dehydration were
caused by asked whether
diarrhoea theyincrease
is a prompt knew in the
about ORS packets. Almost all ever-married
child’s women
fluid intake through somewith a live
form of birth in thetherapy,
oral rehydration five years
whichbefore the survey
may include (97
the use of a solution
percent, Table 10.9) indicated thatfrom
prepared theypackets
knowofabout oral rehydration
oral rehydration salts
salts (ORS). To(ORS).
ascertainThis type of knowledge
how prevalent, the knowledge isof ORS
lower among mothers with no education (87 percent) and those residing in the estates sector (88 percent). The they
is in Sri Lanka, ever-married women with living children under five years of age were asked whether
knew about ORS packets. Almost all ever-married women with a live birth in the five years before the
same level of knowledge was observed in 2006-07.
survey (97 percent, Table 10.9) indicated that they know about oral rehydration salts (ORS). This type of
knowledge is lower among mothers with no education (87 percent) and those residing in the estates sector
(88 percent). The same level of knowledge was observed in 2006-07.

Table 10.9 Knowledge of ORS packets or pre-packaged liquids

Percentage of women age 15-49 with a live birth in the five years preceding the survey
who know about ORS packets or ORS pre-packaged liquids for treatment of diarrhea
by background characteristics, Sri Lanka 2016
Background characteristic Percentage of Number of women
women who know
about ORS packets
or ORS pre-
packaged liquids

Age
15-19 96.1 75
20-24 95.7 925
25-34 96.7 4,047
35-49 97.4 2,091

Residence
Urban 97.1 1,114
Rural 97.2 5,728
Estate 88.0 296

District
Colombo 98.2 631
Gampaha 98.6 666
Kalutara 97.7 443
Kandy 93.6 489
Matale 98.4 192
Nuwara Eliya 93.9 232
Galle 98.2 380
Matara 99.2 291
Hambantota 93.8 233
Jaffna 82.1 170
Mannar 96.8 35
Vavuniya 97.5 53
Mullaitivu 88.8 32
Kilinochchi 99.5 40
Batticaloa 98.2 217
Ampara 98.4 305
Trincomalee 97.3 168
Kurunegala 98.0 613
Puttalam 96.6 262
Anuradhapura 99.1 369
Polonnaruwa 95.6 167
Badulla 94.9 271
Moneragala 97.7 208
Ratnapura 95.3 393
Kegalle 96.9 275

Education
No education 87.3 51
Passed Grade 1-5 93.1 257
Passed Grade 6-10 96.2 3,104
Passed G.C.E.(O/L) or equivalent 96.8 1,608
Passed G.C.E.(A/L) or equivalent 98.3 1,706
Degree and above 98.0 413

Wealth quintile
Lowest 93.5 1,413
Second 96.9 1,457
Middle 97.1 1,463
Fourth 97.9 1,524
Highest 98.4 1,280

Total 96.8 7,138

ORS = Oral rehydration salts

Demography and Health Survey - 2016 148

Child Health 143
10.9 Disposal of child’s stools
Safe disposal of children’s stools
The child’s last stools were put or rinsed into a toilet or latrine, buried, or the child used a toilet or
latrine.
sample : Youngest child under age 2 living with the mother

The proper disposal of child’s stools is important in preventing the spread of diseases. Mothers were
asked in the survey about the procedures used to dispose of child’s stool and 91 percent of them indicated
the correct procedures for disposing of them safely: either children use a toilet/latrine, stools are rinsed into
the toilet/latrine, or they are buried. The majority of them are just rinsing the stools into the toilet/latrine (74
percent), while in 9 percent of the cases, the child is using the toilet/latrine and another 7 percent are just
burying the stools.
According to background characteristics of the mother, the child’s stools are more likely to be safely
disposed in the urban sector (93 percent) than in estates sector (83 percent). Likewise, children’s stools are
more likely to be disposed of safely in households with an improved toilet facility (91 percent) than those
with a non-improved facility (77 percent). Disposal of child’s stool varies substantially by the level of educa-
tion of the mother and by household wealth. In households of the richest quintiles, 95 percent of the mothers
indicated disposing the stools of their children safely. For their counterparts of the lowest wealth quintile,
only 85 percent report disposing of stools safely. Although there are some differences across districts in the
practices of disposing of the children’s stool safely, it is also important to mention the differences in the safe-
ty practices used. Thus, in the Batticaloa, Matara and Trincomalee districts, ninety percent or more of the
mothers indicated a safe way of disposing of the children’s stools, but with different emphasis in the way they
dispose it. In Batticaloa, the majority (55 percent) of the mothers buried the stools, while in Matara, they are
mostly rinsing the stools into the toilet/latrine (89 percent), and in Trincomalee, in 38 percent of the cases the
children use the toilet/latrine as the most frequently used practice (Table 10.10).

144 Demographic and Health Survey - 2016, Sri Lanka

Table 10.10 Disposal of children's stools

Percent distribution of youngest children under age 2 living with the mother by the manner of disposal of the child's last fecal matter, and
percentage of children whose stools are disposed of safely, according to background characteristics, Sri Lanka 2016
Manner of disposal of children's stools
Percentage
of children
whose
Child used Put/rinsed Put/rinsed Thrown stools are
Background toilet or into toilet into drain into Left in the disposed of Number of
1
characteristic latrine or latrine Buried or ditch garbage open Other Total safely children
Age of child in in
months
0-5 8.6 60.9 6.6 15.1 4.3 0.2 4.2 100.0 76.2 752
6-11 8.3 76.2 7.3 4.9 2.1 0.2 1.1 100.0 91.8 785
12-23 9.6 79.8 7.8 0.8 1.7 0.3 0.0 100.0 97.2 1504

6-23 9.2 78.6 7.6 2.2 1.8 0.2 0.4 100.0 95.3 2,289
2
Toilet facility
Improved, not
shared 9.1 75.6 6.5 5.1 2.2 0.2 1.3 100.0 91.2 2,743
3
Shared 8.6 67.3 11.6 8.1 3.2 0.0 1.3 100.0 87.5 238
Non-improved or
shared 5.4 39.0 32.4 8.5 11.3 0.0 3.4 100.0 76.8 59
Residence
Urban 12.5 75.4 5.3 2.5 3.4 0.2 0.7 100.0 93.2 486
Rural 8.2 74.3 8.1 5.7 2.2 0.2 1.4 100.0 90.5 2,418
Estate 11.7 68.7 2.6 10.2 4.3 0.5 2.0 100.0 83.0 136
District
Colombo 13.1 79.7 1.0 2.5 2.5 0.2 0.9 100.0 93.9 298
Gampaha 4.8 88.0 1.8 3.0 2.2 0.0 0.1 100.0 94.7 254
Kalutara 8.9 84.8 0.5 4.4 1.4 0.0 0.0 100.0 94.2 195
Kandy 15.4 71.0 3.1 7.3 1.0 0.0 2.2 100.0 89.5 208
Matale 5.4 66.3 8.0 5.6 2.8 0.0 11.8 100.0 79.7 69
Nuwara Eliya 13.5 74.7 0.5 8.0 2.0 0.0 1.3 100.0 88.7 107
Galle 5.5 75.6 2.5 14.0 1.5 0.0 0.7 100.0 83.7 156
Matara 7.9 89.0 1.0 0.8 1.3 0.0 0.0 100.0 97.9 129
Hambantota 5.2 79.6 7.3 5.8 1.2 0.0 0.8 100.0 92.1 104
Jaffna 0.0 57.1 28.3 2.7 10.4 0.0 1.5 100.0 85.4 72
Mannar 7.6 42.8 46.6 1.3 1.6 0.0 0.0 100.0 97.0 11
Vavuniya 7.0 71.4 18.8 0.8 2.0 0.0 0.0 100.0 97.2 20
Mullaitivu 8.3 50.1 38.1 0.0 3.1 0.0 0.4 100.0 96.6 13
Kilinochchi 5.6 48.2 33.7 8.8 3.6 0.0 0.0 100.0 87.6 15
Batticaloa 7.6 33.1 54.6 0.0 3.5 1.2 0.0 100.0 95.3 88
Ampara 7.5 72.4 11.9 3.6 4.6 0.0 0.0 100.0 91.8 125
Trincomalee 38.2 26.1 26.4 5.1 1.1 1.7 1.4 100.0 90.7 69
Kurunegala 6.6 76.0 8.3 5.5 3.1 0.0 0.5 100.0 90.9 272
Puttalam 12.5 65.3 9.7 6.4 6.2 0.0 0.0 100.0 87.4 108
Anuradhapura 10.1 78.7 8.5 1.6 1.0 0.0 0.0 100.0 97.4 153
Polonnaruwa 5.2 66.1 14.8 8.0 5.5 0.5 0.0 100.0 86.0 84
Badulla 7.1 74.8 4.4 9.8 1.9 1.9 0.0 100.0 86.3 95
Moneragala 10.7 79.6 1.1 6.5 1.2 0.0 0.9 100.0 91.5 90
Ratnapura 1.9 73.0 2.5 12.8 0.2 0.7 8.9 100.0 77.4 179
Kegalle 10.6 80.7 1.6 3.2 3.2 0.0 0.6 100.0 93.0 127
Mother's
education
No education * * * * * * * 100.0 * 18
Passed Grade
1-5 8.6 59.7 14.6 10.4 5.2 1.4 0.0 100.0 83.0 85
Passed Grade
6-10 8.6 69.3 10.6 6.4 3.0 0.2 1.9 100.0 88.5 1,277
Passed
G.C.E.(O/L) or
equivalent 11.2 72.9 7.0 4.9 2.8 0.2 1.0 100.0 91.1 644
Passed
G.C.E.(A/L) or
equivalent 8.3 82.3 2.8 4.2 1.0 0.1 1.2 100.0 93.4 810
Degree and
above 8.1 84.8 2.2 2.7 2.2 0.0 0.0 100.0 95.1 207
Wealth quintile
Lowest 8.5 58.1 18.3 8.4 5.2 0.2 1.4 100.0 84.9 557
Second 9.0 69.6 9.8 7.2 1.8 0.7 1.9 100.0 88.5 597
Middle 9.9 74.4 5.9 5.6 2.7 0.2 1.3 100.0 90.2 634
Fourth 10.7 79.9 3.4 3.6 1.2 0.0 1.1 100.0 94.1 657
Highest 6.8 87.3 0.6 2.8 1.6 0.0 1.0 100.0 94.7 597

Total 9.0 74.2 7.4 5.4 2.4 0.2 1.3 100.0 90.6 3,041
1 Children's stools are considered to be disposed of safely if the child used a toilet or latrine, if the fecal matter was put/rinsed into a toilet or
latrine or if it was buried.
2 See Table 2.3 for definition of categories
3 Facilities that would be considered improved if they were not shared by two or more households

Demography and Health Survey - 2016 Child Health 150

145
10.10 Child disability
Child disabilities limit mental and/or physical functions of children relative to their age specific
norms. These may be reflected in one or more developmental domains: physical actions, communication,
social and emotional relations, consciousness, language, speech, hearing, thinking processes and behaviors.
The 2016 SLDHS used child disability questions from the Multiple Indicator Cluster Survey (MICS) disabil-
ity module. These questions are designed to identify children who have a higher risk of some form of clinical
disability. However, they are not considered to be specific enough to use as diagnostic measures.
In the 2016 SLDHS, the mothers of children aged 2-5 years were asked whether the child has a
developmental difficulty in areas such as:
 Seeing
 Hearing
 Understanding
 Can’t understand the worlds spoken by the child
 Speech is not clear
 Is late in standing up and walking compared to other children
 Has difficulty in walking/moving hands or legs
 Suffers from fits or convulsions
 Has difficulty in doing activities like other children of the same age, or
 Shows any signs of slowness in mental development.
The tables included below give the percentages of children who are having various functional disabilities
according to background characteristics.

10.10.1 Prevalence of functional impairments due to disability

According to the 2016 SLDHS, 23% of children age 2-5 had at least one of the 10 functional
disabilities listed before. Previous surveys conducted in other countries using similar set of questions reported
values in the range 14-35 percent (Monitoring Child disability in Developing Countries, Unicef). The most
prevalent functional disabilities among children aged 2-5 are “difficulty in standing up and walking” (9
percent), followed by “show any signs of slowness in mental development”, and “difficulty in understanding”
(6 percent each). Over 3 percent of children indicated being unable to perform as their peers, suggesting
developmental delays. Children having unclear speech, identified in 2 percent of the children, is of importance
as some of them may have autism spectrum disorders.
The districts with the highest prevalence of functional disabilities among children aged 2-5 are
Batticaloa (55 percent), and Kilinochchi and Trincomalee (45 percent each), compared with Anuradhapura,
Mullaitivu, Ampara, Kegalle and Kalutara in which less than 15 percent of the children aged 2-5 were identified
by their mothers with a functional disability. Being late in standing up and walking is the main component
of the high level of disabilities in the high prevalence districts. Cultural and child rearing practices in these
districts should be reviewed to see if they had an effect on these very high levels of functional disability, as
reported.

146 Demographic and Health Survey - 2016, Sri Lanka

Table 10.11 Children Age 2-5 years by disability status

Percentage of children age 2-5 years by whether they have developmental difficulty, according to background characteristics, Sri Lanka
2016

Late in Difficulty Show

Can't standing Difficulty in doing any signs
Has at understa up and in Suffers activities of
least one Difficulty nd the walking walking/ from Fits like other slowness
developm Difficulty in words the Child's compare moving or children in mental Number
Background ental Difficulty in understa child speech d to other hands Convulsi of samedevelopm of
characteristic difficulty in seeing hearing nding speaks not clear children /legs ons age ent Children
Age
2 25.3 0.6 1.5 6.2 2.6 2.8 10.4 2.2 2.0 3.7 5.8 1,684
3 22.9 0.5 1.5 6.0 1.7 1.8 8.8 2.1 1.7 3.4 5.4 1,665
4 23.0 0.7 2.1 5.8 1.4 1.6 8.5 1.2 2.8 3.0 6.5 1,691
5 19.6 0.7 2.1 5.5 1.6 1.4 6.9 1.7 2.4 3.0 4.6 1,541

Sex
Male 23.4 0.5 1.8 5.8 2.0 2.3 8.5 1.7 2.6 3.3 5.8 3,410
Female 22.1 0.7 1.8 6.1 1.6 1.4 9.0 1.9 1.9 3.3 5.4 3,172

Birth order
1 19.9 0.6 1.5 4.9 1.4 2.1 7.8 1.6 2.1 2.9 4.9 2,687
2-3 24.5 0.7 1.9 6.7 2.0 1.8 8.9 2.0 2.4 3.5 6.3 3,523
4-5 28.3 0.3 2.9 6.2 3.6 1.9 13.4 1.5 2.5 4.7 4.6 335
6+ (15.1) (0.0) (0.0) (1.6) (0.8) (0.8) (10.5) (0.0) (0.0) (0.0) (3.9) 37

Residence
Urban 26.6 1.1 2.5 6.8 1.9 1.6 10.2 2.2 2.6 3.7 7.4 1,024
Rural 22.0 0.5 1.6 5.7 1.8 2.0 8.4 1.7 2.1 3.1 5.3 5,267
Estate 22.9 0.6 3.4 6.9 2.2 1.1 8.9 2.0 2.6 5.0 4.7 291

District
Colombo 26.7 1.7 0.8 7.2 1.0 0.4 7.9 2.3 2.1 2.8 10.7 537
Gampaha 27.7 0.1 0.3 10.2 2.5 0.9 10.4 1.8 4.0 3.9 7.0 650
Kalutara 13.7 0.3 0.8 3.7 2.1 0.8 5.2 0.6 2.3 2.1 1.3 401
Kandy 25.9 1.5 2.5 6.7 3.0 2.2 7.8 0.9 2.7 4.5 8.7 465
Matale 25.0 0.0 1.7 4.1 0.7 3.6 7.1 0.2 5.9 2.6 10.4 191
Nuwara Eliya 27.6 0.7 5.0 9.0 2.8 2.5 7.2 2.2 3.7 5.7 6.2 220
Galle 14.9 0.6 0.7 5.0 1.6 4.1 5.5 1.3 2.0 2.1 5.4 346
Matara 19.3 0.7 1.0 4.9 0.5 1.5 6.0 1.2 0.7 1.6 5.2 276
Hambantota 16.1 0.0 1.4 3.4 2.5 1.2 7.8 1.9 0.0 4.3 1.3 208
Jaffna 33.0 0.5 3.5 10.0 3.5 1.5 17.7 2.7 2.3 4.9 6.5 178
Mannar 29.8 1.6 3.2 3.2 3.4 1.7 21.1 4.9 2.9 8.1 12.5 36
Vavuniya 20.6 2.4 3.2 9.5 1.1 3.7 4.5 0.6 2.9 2.8 1.1 57
Mullaitivu 13.0 0.5 2.0 5.4 3.1 1.7 4.3 1.2 0.6 1.1 0.0 34
Kilinochchi 45.4 1.7 3.4 9.3 1.2 0.8 33.0 4.5 1.6 1.9 3.4 39
Batticaloa 55.0 0.5 12.4 3.5 0.2 2.3 45.3 2.4 2.6 2.2 3.8 198
Ampara 14.4 0.2 1.3 5.1 1.9 1.3 3.7 0.0 0.5 4.0 2.3 305
Trincomalee 45.1 1.7 5.3 7.5 3.6 3.6 28.8 1.6 2.3 8.1 9.7 156
Kurunegala 24.3 0.5 1.0 7.3 1.9 2.5 7.8 6.9 2.2 3.3 5.3 507
Puttalam 26.7 0.9 1.0 6.8 0.7 1.9 5.0 1.8 1.7 5.5 9.5 231
Anuradhapura 9.0 0.0 1.5 1.1 0.4 0.7 2.8 1.5 0.8 0.6 3.2 340
Polonnaruwa 19.2 0.7 0.0 5.9 3.1 4.2 5.3 0.0 1.3 3.1 5.9 146
Badulla 24.8 0.4 1.8 4.7 2.4 3.1 6.8 1.2 2.2 4.3 5.8 257
Moneragala 16.1 0.4 2.3 2.9 0.0 1.9 6.1 0.9 0.0 2.5 2.3 196
Ratnapura 16.8 0.4 0.6 3.9 2.3 2.7 5.0 1.3 4.9 2.8 2.7 360
Kegalle 11.1 0.0 1.0 4.7 1.0 1.5 2.6 0.4 0.0 1.4 2.7 248

Wealth quintile
Lowest 24.5 0.4 2.2 5.8 1.8 1.8 11.0 1.6 2.7 4.0 5.6 1,383
Second 24.6 0.7 1.6 6.7 2.1 2.3 9.1 1.9 2.2 3.4 5.4 1,337
Middle 21.4 0.8 1.6 5.4 1.7 2.2 7.6 1.9 1.6 3.3 6.0 1,303
Fourth 23.0 0.6 1.8 6.2 1.9 1.7 8.6 2.1 2.3 2.8 5.1 1,422
Highest 19.8 0.6 1.8 5.3 1.5 1.4 6.9 1.5 2.4 2.8 6.1 1,137

Total 22.8 0.6 1.8 5.9 1.8 1.9 8.7 1.8 2.2 3.3 5.6 6,582

10.10.2 Vision impairments

10.10.2toVthe
Further ISION IMPAIRMENTS
question regarding difficulty with the child’s vision, mothers with a positive response
were asked to indicate if the difficulty was observed during the daytime or during the night time. From Table
10.11, weFurther
can seetothat
theless
question
than one regarding difficulty
percent of with aged
the children the child’s
2-5 werevision, mothers
identified with adifficulty
as having positivein
response were asked to indicate if the difficulty was observed during the daytime or during the night
seeing (0.6 percent). Unfortunately, for one out of three of these children, the mother was unable to indicate time.
From Table 10.11, we can see that less than one percent of the children aged 2-5 were identified
when the child experienced the difficulty. The remaining number of cases are equally divided between day as having
difficulty
and in seeing
night vision (0.6 percent).
difficulties. The small Unfortunately, for one
number of cases out the
makes of comparison
three of theseby children,
backgroundthe characteristics
mother was
unable to indicate when the child experienced the difficulty. The remaining number of cases are equally
impossible.
divided between day and night vision difficulties. The small number of cases makes the comparison by
background characteristics impossible.
Child Health 147

Demography and Health Survey - 2016 152

 Table 10.12 Children age 2-5 by difficulty in seeing

Percentage of children age 2-5 with difficulty seeing and percentage by difficulties in seeing day time or night time,
according to background characteristics, Sri Lanka 2016
Day Time Night Time
Background Total number of
characteristic Difficulty seeing Yes Don't know Yes Don't know Children

Age
2 0.6 0.2 0.1 0.2 0.1 1,684
3 0.5 0.2 0.0 0.3 0.0 1,665
4 0.7 0.0 0.2 0.1 0.2 1,691
5 0.7 0.3 0.2 0.1 0.2 1,541

Sex
Male 0.5 0.3 0.0 0.2 0.0 3,410
Female 0.7 0.1 0.2 0.2 0.2 3,172

Birth order
1 0.6 0.2 0.2 0.3 0.2 2,687
2-3 0.7 0.2 0.1 0.1 0.1 3,523
4-5 0.3 0.0 0.3 0.0 0.3 335
6+ (0.0) (0.0) (0.0) (0.0) (0.0) 37

Residence
Urban 1.1 0.3 0.2 0.3 0.2 1,024
Rural 0.5 0.2 0.1 0.2 0.1 5,267
Estate 0.6 0.0 0.5 0.0 0.5 291

District
Colombo 1.7 0.5 0.3 0.3 0.3 537
Gampaha 0.1 0.1 0.0 0.1 0.0 650
Kalutara 0.3 0.0 0.3 0.0 0.3 401
Kandy 1.5 0.5 0.0 0.6 0.0 465
Matale 0.0 0.0 0.0 0.0 0.0 191
Nuwara Eliya 0.7 0.0 0.7 0.0 0.7 220
Galle 0.6 0.2 0.0 0.6 0.0 346
Matara 0.7 0.3 0.0 0.3 0.0 276
Hambantota 0.0 0.0 0.0 0.0 0.0 208
Jaffna 0.5 0.5 0.0 0.5 0.0 178
Mannar 1.6 0.0 0.0 0.5 0.0 36
Vavuniya 2.4 0.6 0.0 0.6 0.0 57
Mullaitivu 0.5 0.5 0.0 0.5 0.0 34
Kilinochchi 1.7 0.9 0.0 0.9 0.0 39
Batticaloa 0.5 0.0 0.0 0.5 0.0 198
Ampara 0.2 0.0 0.2 0.0 0.2 305
Trincomalee 1.7 0.5 0.0 0.5 0.0 156
Kurunegala 0.5 0.0 0.2 0.0 0.2 507
Puttalam 0.9 0.4 0.0 0.0 0.0 231
Anuradhapura 0.0 0.0 0.0 0.0 0.0 340
Polonnaruwa 0.7 0.0 0.0 0.0 0.0 146
Badulla 0.4 0.0 0.4 0.0 0.4 257
Moneragala 0.4 0.4 0.0 0.0 0.0 196
Ratnapura 0.4 0.0 0.4 0.0 0.4 360
Kegalle 0.0 0.0 0.0 0.0 0.0 248

Wealth quintile
Lowest 0.4 0.2 0.2 0.1 0.2 1,383
Second 0.7 0.1 0.0 0.2 0.0 1,337
Middle 0.8 0.2 0.2 0.3 0.2 1,303
Fourth 0.6 0.1 0.1 0.1 0.1 1,422
Highest 0.6 0.2 0.1 0.1 0.1 1,137

Total 0.6 0.2 0.1 0.2 0.1 6,582

10.10.3 Convulsions
10.10.3
Similarly, forCthose children aged 2-5 identified by their mother as having convulsions, the inter-
ONVULSIONS
viewers further asked if the convulsions occurred when the child was having fever. Convulsions or fit is a
Similarly,
condition where for those
body muscles children
contract agedrapidly
and relax 2-5 identified by their
and repeatedly, mother
resulting in anas having convulsions,
uncontrolled shaking the
of interviewers
the body. Among further askeditifisthe
children convulsions
mostly due to high occurred when
fever and the due
rarely child
to was havingcondition
a medical fever. Convulsions
known as or fit
is a condition
Epilepsy. From Tablewhere body
10.11, wemuscles contract
observe that over 2and relaxofrapidly
percent and
children repeatedly,
aged resulting
2-5 had a history in an uncontrolled
of having con-
vulsions
shakingat least once
of the in their
body. life, the
Among majority
children of mostly
it is them reporting
due to the
highconvulsions/fits
fever and rarely when thetochild
due had fever
a medical condition
(Table10.13). Here again, the low prevalence of convulsions accompanied by the resulting
known as Epilepsy. From Table 10.11, we observe that over 2 percent of children aged 2-5 had a history small number of
cases makes itconvulsions
of having impossible toatproduce any in
least once additional data
their life, theanalysis
majorityaccording
of themtoreporting
background thecharacteristics.
convulsions/fits when
the child had fever (Table10.13). Here again, the low prevalence of convulsions accompanied by the
resulting small number of cases makes it impossible to produce any additional data analysis according to
backgroundDemographic
148 characteristics.
and Health Survey - 2016, Sri Lanka

Demography and Health Survey - 2016 153

 Table 10.13 Children age 2-5 with fits or convulsions

Percentage of children age 2-5 who suffer from fits or convulsions and percentage of those
by whether they had fits or convulsion when they had fever or not, according to background
characteristics, Sri Lanka - 2016
Had fits or Had fits or
convulsions convulsions
Background Suffers from fits when did have a when did not Total number of
characteristic or convulsion fever have a fever Children

Age
2 2.0 1.8 0.3 1,684
3 1.7 1.5 0.2 1,665
4 2.8 1.8 0.9 1,691
5 2.4 1.7 0.5 1,541

Sex
Male 2.6 2.1 0.5 3,410
Female 1.9 1.3 0.5 3,172

Birth order
1 2.1 1.7 0.4 2,687
2-3 2.4 1.7 0.6 3,523
4-5 2.5 2.1 0.5 335
6+ (0.0) (0.0) (0.0) 37

Residence
Urban 2.6 2.0 0.6 1,024
Rural 2.1 1.6 0.5 5,267
Estate 2.6 2.4 0.0 291

District
Colombo 2.1 1.5 0.6 537
Gampaha 4.0 3.2 0.9 650
Kalutara 2.3 2.3 0.0 401
Kandy 2.7 1.9 0.4 465
Matale 5.9 5.4 0.6 191
Nuwara Eliya 3.7 1.7 1.9 220
Galle 2.0 1.0 1.1 346
Matara 0.7 0.4 0.3 276
Hambantota 0.0 0.0 0.0 208
Jaffna 2.3 1.9 0.0 178
Mannar 2.9 0.6 0.5 36
Vavuniya 2.9 1.2 1.6 57
Mullaitivu 0.6 0.6 0.0 34
Kilinochchi 1.6 1.6 0.0 39
Batticaloa 2.6 1.7 1.0 198
Ampara 0.5 0.5 0.0 305
Trincomalee 2.3 2.3 0.6 156
Kurunegala 2.2 1.7 0.5 507
Puttalam 1.7 1.4 0.0 231
Anuradhapura 0.8 0.3 0.2 340
Polonnaruwa 1.3 1.3 0.0 146
Badulla 2.2 1.3 1.3 257
Moneragala 0.0 0.0 0.0 196
Ratnapura 4.9 4.3 0.3 360
Kegalle 0.0 0.0 0.0 248

Wealth quintile
Lowest 2.7 1.8 0.7 1,383
Second 2.2 1.7 0.6 1,337
Middle 1.6 1.3 0.3 1,303
Fourth 2.3 1.6 0.5 1,422
Highest 2.4 2.1 0.3 1,137

Total 2.2 1.7 0.5 6,582

10.11 Early child development

Being able to carry
10.11 out more
EARLY and more
CHILD complex physical activities, gradual improvement of thinking
DEVELOPMENT
and feeling patterns and increasing socio emotional skills are common characteristics of early child hood.
These improvements are Beingcollectively identified
able to carry outas early
more childhood
and moredevelopment. Optimal
complex physical early childhood
activities, gradual improvement o
development is thinking
said to beand crucial in patterns
feeling influencing
anda increasing
range of health
socio and social skills
emotional outcomes across thecharacteristics
are common life of earl
course. The outcome
childof childThese
hood. development is dependent
improvements on the child’s
are collectively geneticasinheritance
identified and it development.
early childhood is heavily Optimal earl
modulated by environmental factors. Therefore,
childhood development is said toitbeiscrucial
very important that children
in influencing a range ofhave developmentally
health and social outcomes across th
conducive environment to liveThe
life course. in. Having
outcomeloving and caring
of child adults who
development actively engage
is dependent on theinchild’s
their psychosocial
genetic inheritance and it
stimulation by telling
heavilystories, singingbysongs,
modulated reading books,
environmental and going
factors. in to places
Therefore, is oneimportant
it is very of the mostthat children hav
important characteristic of a developmentally conducive environment. Availability of child centered books,
Demography and Health Survey - 2016 15
Child Health 149
play materials and playmates are also crucial for child development.
This survey tried to verify the presence of some of positive environments attributes in during early
This survey tried to verify the presence of some of positive environments attributes in during early
childhood among Sri Lankan Children. They included access to child centered booklets and play materials,
childhood among Sri Lankan Children. They included access to child centered booklets and play materials,
opportunities to play with peers, active participation of adults in psychosocial stimulation.
opportunities to play with peers, active participation of adults in psychosocial stimulation.

10.11.1 PARENTAL ACCESS TO INFORMATION OF EARLY CHILD DEVELOPMENT (BOOKS

10.11.1 Parental access to information
AND INFORMATION of early
THROUGH CHILD child
HEALTH (books) and
developmentRECORD
DEVELOPMENT information
through child health development record)
Awareness and knowledge of parents on the importance and best practices related to child
Awareness and knowledge of parents on the importance and best practices related to child develop-
development is crucial to ensure that they effectively engaged in development stimulation and monitor the
ment is crucial to ensure that they effectively engaged in development stimulation and monitor the develop-
development of their children. The survey inquired whether development related IEC materials that are
ment of their children. The survey inquired whether development related IEC materials that are supposed to
supposed to be given to parents by primary health care workers. There are 2 specific child development
be given to parents by primary health care workers. There are 2 specific child development materials are used
materials are used in Sri Lankan child health programme.
in Sri Lankan child health programme.
1) Booklets on1). Booklets
Early Childon Early Child Development
Development & Care & Care

2) Child Health2).Development
Child Health Record.
Development Record).
Table 10.14 shows
Tablethe percentage
10.14 shows theofpercentage
mothers who receivedwho
of mothers access to these
received items
access by background
to these items by background
characteristics.characteristics.

Table 10.14 : Mothers who read books given by the family health officer

Percentage of mothers with children age (0 - 4) who read books given by the public health midwives
family health officer before or after the birth of their last child, according to background characteristics,
Sri Lanka 2016
Child development Read both books
section of the child on early Number of
Books on early health Childhood mothers who have
Background Childhood development Development & children age 0-5
characteristic Development record(CHDR) CHDR year

Residence
Urban 63.8 74.7 60.1 1,111
Rural 71.7 80.4 68.0 5,699
Estate 55.8 62.5 51.2 293

District
Colombo 64.4 71.8 60.1 627
Gampaha 63.3 79.1 60.8 664
Kalutara 75.5 90.5 73.2 442
Kandy 74.4 76.8 67.2 487
Matale 69.9 85.3 66.7 190
Nuwara Eliya 71.1 71.3 64.6 232
Galle 56.5 72.9 53.3 379
Matara 75.1 90.5 73.0 290
Hambantota 89.6 80.8 79.4 233
Jaffna 73.9 80.4 71.1 169
Mannar 81.8 79.1 78.0 35
Vavuniya 81.3 84.1 80.6 53
Mullaitivu 63.7 71.9 63.3 32
Kilinochchi 84.7 92.6 83.6 40
Batticaloa 77.8 89.9 76.0 216
Ampara 71.8 79.0 69.2 302
Trincomalee 62.0 76.3 61.5 166
Kurunegala 74.8 81.8 72.5 612
Puttalam 54.8 67.5 50.0 257
Anuradhapura 70.3 84.4 69.6 369
Polonnaruwa 73.0 80.8 66.8 167
Badulla 68.1 64.8 63.0 269
Moneragala 84.8 78.9 75.6 207
Ratnapura 67.3 83.9 66.7 390
Kegalle 57.7 64.9 51.5 274

Wealth quintile
Lowest 60.4 68.3 56.3 1,408
Second 69.5 77.2 65.3 1,449
Middle 71.9 81.4 67.9 1,460
Fourth 74.7 83.7 71.5 1,513
Highest 72.3 83.2 69.3 1,273

Total 69.8 78.8 66.1 7,103

The child development booklets and child development section of the CHDR were read by nearly
70 percent to 80 percent of mothers. A wide district variation was seen in access to these child
development IEC materials. This finding indicate the importance and feasibility of using reading materials
as a strategy for making awareness among mothers in Sri Lanka.
150 Demographic and Health Survey - 2016, Sri Lanka
Demography and Health Survey - 2016 155
 The child development booklets and child development section of the CHDR were read by nearly
70 percent to 80 percent of mothers. A wide district variation was seen in access to these child development
IEC materials. This finding indicate the importance and feasibility of using reading materials as a strategy for
making awareness among
10.11.2 mothers in Sri Lanka.
CHILDREN ’S ACCESS TO MATERIALS HELPFUL IN DEVELOPMENT STIMULATION
(BOOKS & TOYS)
10.11.2 Children’s access to materials helpful in development stimulation (books & toys)
Table 10.15 presents the percentage of children 2- 4 years by the number of books they
Table 10.15 presents the percentage of children 2- 4 years by the number of books they have, accord-
according to background characteristics, Sri Lanka 2016. Nearly 20 percent of children in the co
ing to background characteristics, Sri Lanka 2016. Nearly 20 percent of children in the country seemed to
seemed
have no access to have
to child no access
centered to child
books during centered
early books
years. The during
access early
to books years.toThe
seemed vary access to books seemed to
by residence
sector andby residence
wealth sectorwho
where those andarewealth where
in urban those
settings who are
and highest in urban
wealth settings
quantiles and highest
have better access. wealth quantiles
better access.

Table 10.15: Children age 2-4 years by the number of books

Percentage of children age 2-4 years by the number of books they have, according to background
characteristics, Sri Lanka 2016
Percentage of children by number of books
Number of
children age
less than 5
Background characteristic No books 1-5 6 - 9 10 or more years

Residence
Urban 20.4 34.9 7.0 37.7 791
Rural 18.7 41.4 7.2 32.8 4,032
Estate 29.2 51.6 6.1 13.1 220

District
Colombo 12.5 35.3 3.7 48.5 410
Gampaha 16.8 44.3 7.3 31.6 502
Kalutara 12.4 26.0 8.1 53.5 312
Kandy 18.6 29.5 6.3 45.5 367
Matale 13.7 38.7 8.4 39.2 145
Nuwara Eliya 20.4 56.5 10.8 12.3 172
Galle 15.2 29.3 3.6 51.9 267
Matara 24.2 31.9 11.1 32.8 206
Hambantota 10.8 37.9 13.2 38.2 160
Jaffna 32.9 44.1 7.3 15.7 131
Mannar 20.1 52.0 1.6 26.3 30
Vavuniya 18.6 66.6 2.5 12.4 42
Mullaitivu 38.8 49.8 2.3 9.1 23
Kilinochchi 19.9 70.0 4.4 5.7 30
Batticaloa 31.7 46.8 16.7 4.8 156
Ampara 34.3 49.5 6.1 10.2 228
Trincomalee 28.9 47.3 3.8 19.9 121
Kurunegala 20.6 34.6 7.9 36.9 403
Puttalam 16.1 66.1 4.3 13.6 180
Anuradhapura 18.5 38.9 1.9 40.7 260
Polonnaruwa 26.6 36.8 5.7 31.0 104
Badulla 29.3 35.7 1.9 33.1 201
Moneragala 16.0 59.7 8.8 15.5 146
Ratnapura 15.9 41.4 9.4 33.2 261
Kegalle 14.5 54.8 13.7 17.0 186

Wealth quintile
Lowest 31.8 49.8 4.5 13.9 1,061
Second 20.9 45.8 9.8 23.5 1,054
Middle 17.1 39.6 7.4 36.0 983
Fourth 14.9 37.1 7.8 40.1 1,080
Highest 10.7 29.6 5.9 53.8 864

Total 19.4 40.8 7.1 32.7 5,042

Most children seemed to have access to play items. A relatively higher preference was seeme
manufactured toys compared to homemade ones. Improvising Child of household
Health objects
151
as play items
seemed to be quite frequent. A fair degree of equity was seen in the distribution of different types of
materials across the children from different residential sectors, districts and wealth classes (Table 10.1
Most children seemed to have access to play items. A relatively higher preference was seemed on manufac-
tured toys compared to homemade ones. Improvising of household objects as play items also seemed to be
quite frequent. A fair degree of equity was seen in the distribution of different types of paly materials across
the children from different residential sectors, districts and wealth classes (Table 10.16).

Table 10.16: Children age less than 5 years and toys to play with

Percentage of children age less than 5 years by types of toys they play with when at home,
according to background characteristics, Sri Lanka 2016
Types of toys
Number of
children
Background Homemade Manufactured Household age less than 5
characteristic toys toys objects years

Residence
Urban 65.9 90.7 78.4 1,286
Rural 69.9 89.6 80.3 6,500
Estate 71.4 88.1 79.8 359

District
Colombo 66.0 88.1 76.3 716
Gampaha 67.9 91.2 81.4 762
Kalutara 63.1 88.7 77.7 512
Kandy 78.0 88.8 80.6 579
Matale 67.0 93.9 83.4 214
Nuwara Eliya 73.6 91.2 79.6 279
Galle 69.9 90.8 80.9 425
Matara 74.6 86.0 77.9 337
Hambantota 67.9 90.7 79.1 264
Jaffna 71.2 87.9 81.1 207
Mannar 90.5 91.4 91.2 42
Vavuniya 70.4 92.2 83.5 62
Mullaitivu 58.6 89.0 83.2 37
Kilinochchi 86.7 88.7 76.9 46
Batticaloa 73.1 94.1 83.6 247
Ampara 75.1 89.5 84.4 353
Trincomalee 72.1 91.8 76.2 190
Kurunegala 76.8 89.5 81.7 680
Puttalam 74.2 86.1 79.6 290
Anuradhapura 43.7 91.3 77.8 416
Polonnaruwa 64.3 88.2 75.0 188
Badulla 66.8 89.0 80.7 302
Moneragala 85.5 93.6 87.9 241
Ratnapura 52.8 89.5 78.4 445
Kegalle 81.1 87.8 77.7 314

Wealth quintile
Lowest 69.4 89.2 82.0 1,633
Second 72.0 89.8 80.0 1,660
Middle 68.8 89.5 80.1 1,628
Fourth 68.6 90.1 80.1 1,752
Highest 67.8 90.1 77.6 1,474

Total 69.4 89.7 80.0 8,146

10.11.3 ACCESS TO PLAY OPPORTUNITIES

Table 10.17 presents the percentage of children age 2- 4 years by days they played du
days, according to background characteristics. Majority of children had opportunities to play in d
152
However nearly
Demographic and 8Health
percent
Surveyof children
- 2016, Sri Lankahad no opportunities play with other children.
10.11.3 Access to play opportunities
Table 10.17 presents the percentage of children age 2- 4 years by days they played during last 3
days, according to background characteristics. Majority of children had opportunities to play in daily basis.
However nearly 8 percent of children had no opportunities play with other children.

Table 10.17: Children age less than 5 years and play during the last 3 days

Percentage of children age less than 5 years by days they played during last 3 days, according to
background characteristics, Sri Lanka 2016
Played during last 3 days
Number of
children age
All three less than 5
Background characteristic days Two days One day Did not play years

Residence
Urban 85.8 2.9 2.1 8.5 1,286
Rural 87.6 2.3 1.4 7.6 6,500
Estate 83.0 3.2 4.5 6.5 359

District
Colombo 85.7 2.5 1.4 9.7 716
Gampaha 88.6 1.5 0.4 8.6 762
Kalutara 88.3 1.3 1.1 9.0 512
Kandy 90.3 2.2 0.7 5.4 579
Matale 94.6 0.5 0.5 4.2 214
Nuwara Eliya 87.7 2.0 4.7 4.9 279
Galle 90.1 0.9 0.8 6.8 425
Matara 85.9 2.5 1.2 9.7 337
Hambantota 90.1 1.7 0.4 7.3 264
Jaffna 74.8 8.4 7.5 7.0 207
Mannar 81.2 11.7 3.1 2.7 42
Vavuniya 84.3 7.8 3.7 1.6 62
Mullaitivu 79.9 7.1 8.1 3.7 37
Kilinochchi 78.2 7.7 5.7 5.5 46
Batticaloa 86.9 5.2 4.7 1.9 247
Ampara 85.1 2.9 1.5 9.3 353
Trincomalee 67.1 4.8 13.6 13.5 190
Kurunegala 89.6 1.5 0.3 8.2 680
Puttalam 80.3 6.3 2.4 10.5 290
Anuradhapura 89.7 2.1 2.0 4.3 416
Polonnaruwa 89.2 0.4 0.2 9.8 188
Badulla 86.4 1.2 1.9 7.0 302
Moneragala 91.1 3.8 0.0 4.1 241
Ratnapura 88.5 1.0 0.0 9.7 445
Kegalle 86.6 1.5 0.2 9.0 314

Wealth quintile
Lowest 84.7 3.8 3.0 6.8 1,633
Second 87.0 2.4 2.3 7.1 1,660
Middle 87.7 2.5 1.1 8.1 1,628
Fourth 88.4 1.9 1.2 7.6 1,752
Highest 87.9 1.5 0.7 9.0 1,474

Total 87.1 2.4 1.7 7.7 8,146

10.11.4 Access to early learning centers

10.11.4 ACCESS TO EARLY LEARNING CENTERS
Having exposed to early learning environment is crucial for optimal child development during pre-
school years. This ensures further improvements in socio emotional skills outside home environment and
Having
impart pre literacy andexposed to early
pre math skills learning
that ready environment
children is crucial
for formal schooling. The for optimal
following tablechild
(Tabledevelopment d
preschool years. This ensures further improvements in socio emotional skills outside
10.18) shows the important variations in the percentage of children age 3-4 years who attend a pre-school or home enviro
anand
earlyimpart
childhoodpredevelopment
literacy andcenter,
prebymath
background
skills characteristics.
that ready children for formal schooling. The following
(Table 10.18) shows the important variations in the percentage of children age 3-4 years who attend
Child Health
school or an early childhood development center, by background characteristics. 153
 Table 10.18: Children age 3-4 years by education

Percentage of children age 3-4 years who attend a pre-school or

an early childhood development center, according to background
characteristics, Sri Lanka 2016
Attending pre-
school or an early
childhood Number of
Background development children age 3-4
characteristic center years

Residence
Urban 72.5 535
Rural 58.3 2,666
Estate 47.6 157

District
Colombo 76.9 282
Gampaha 75.2 353
Kalutara 67.0 206
Kandy 49.7 231
Matale 37.1 95
Nuwara Eliya 49.0 124
Galle 66.1 180
Matara 58.4 143
Hambantota 52.4 109
Jaffna 80.6 76
Mannar 84.8 20
Vavuniya 75.9 30
Mullaitivu 80.8 15
Kilinochchi 87.8 23
Batticaloa 79.1 100
Ampara 65.3 144
Trincomalee 58.6 80
Kurunegala 51.7 277
Puttalam 59.3 128
Anuradhapura 56.6 150
Polonnaruwa 59.3 69
Badulla 47.3 123
Moneragala 59.6 91
Ratnapura 33.8 181
Kegalle 42.5 128

Wealth quintile
Lowest 52.3 724
Second 55.6 706
Middle 59.5 672
Fourth 63.2 702
Highest 72.6 554

Total 60.1 3,357

10.11.5 Access to psychosocial10.11.5

stimulation by adults
ACCESS TO PSYCHOSOCIAL STIMULATION BY ADULTS
Table 10.19 shows the level of engagement of under 5 children by adults with psychosocial
Table
stimulation activities such as having 10.19 told
read books, shows thesang
stories, levelsongs,
of engagement
taken outside of under
home, 5 children
played with, by adults
named and counted things. Singing sons
stimulation and taking
activities outside
such homesread
as having werebooks,
the most frequent
told activities
stories, adults taken outside h
sang songs,
engage children with. Drawing
namedthings and reading
and counted books
things. were relatively
Singing sons and less frequent.
taking Wider
outside homesresidence,
were the most freque
district and wealth based variations were also seen in these two indicators.
engage children with. Drawing things and reading books were relatively less frequent.
district and wealth based variations were also seen in these two indicators.

154 Demographic and Health Survey - 2016, Sri Lanka

Table10.19: Children age less than 5 years by engagement in different activities

Percentage of children age less than 5 years by engagement in activities, according to background characteristics, Sri Lanka
2016

Engagement in activities
Named/ Number of
counted/ children
Read books/ Took drew things age less
Background picture outside the Played with with some than 5
characteristic books Told stories Sang songs home some one one years

Residence
Urban 74.4 73.6 92.9 88.9 87.9 65.6 1,286
Rural 69.3 71.7 93.1 89.0 87.7 55.6 6,500
Estate 64.2 68.2 89.8 86.2 85.3 52.0 359

District
Colombo 77.5 71.0 93.8 88.2 86.4 65.1 716
Gampaha 80.5 79.8 95.7 91.6 91.2 69.8 762
Kalutara 68.3 66.9 94.0 82.4 87.1 54.5 512
Kandy 70.4 78.9 93.1 87.3 91.5 58.2 579
Matale 59.9 58.5 82.3 78.6 79.2 36.2 214
Nuwaraeliya 68.3 75.5 95.1 93.5 90.5 57.1 279
Galle 59.5 62.1 91.6 84.6 86.7 48.1 425
Matara 57.9 66.7 94.2 86.4 84.4 41.6 337
Hambantota 67.7 69.5 96.5 96.5 87.4 49.1 264
Jaffna 73.8 80.4 91.5 88.3 90.1 69.8 207
Mannar 90.0 89.8 96.5 96.5 96.5 92.7 42
Vavuniya 75.0 84.6 96.3 93.0 95.1 81.3 62
Mullaitivu 63.4 84.0 95.4 93.7 89.2 61.6 37
Killinochchi 75.9 81.1 95.2 91.6 90.4 72.6 46
Batticaloa 76.3 83.3 89.5 95.6 96.3 76.8 247
Ampara 84.4 82.5 93.9 95.8 91.7 80.8 353
Trincomalee 76.5 62.7 92.9 91.0 84.7 71.0 190
Kurunegala 66.1 69.3 89.9 86.3 82.8 48.8 680
Puttalam 71.6 68.2 89.1 91.7 87.0 58.7 290
Anuradhapura 64.9 81.2 96.3 87.9 85.9 42.9 416
Polonnaruwa 58.3 60.2 92.0 89.1 85.7 46.5 188
Badulla 63.9 68.5 91.4 80.7 83.3 45.0 302
Monaragala 75.8 70.3 92.7 94.1 94.5 63.5 241
Ratnapura 58.1 56.2 93.2 92.5 84.4 42.3 445
Kegalle 72.2 76.5 93.0 88.8 86.3 56.6 314

Wealth quintile
Lowest 64.5 70.7 90.7 87.9 87.9 54.1 1,633
Second 68.4 73.0 92.0 89.7 87.6 57.3 1,660
Middle 69.9 70.2 91.8 89.4 86.3 55.0 1,628
Fourth 72.1 73.3 94.6 89.5 88.3 57.6 1,752
Highest 74.9 71.8 95.5 87.6 87.8 61.5 1,474

Total 69.9 71.8 92.9 88.9 87.6 57.0 8,146

Demography and Health Survey - 2016 160

Child Health 155

156 Demographic and Health Survey - 2016, Sri Lanka
NUTRITION OF CHILDREN AND WOMEN 11
Key Findings
• Nutritional status of children: Seventeen percent of children under age
5 are stunted (short for their age); 15 percent are wasted (thin for their
height); and 21 percent are underweight (thin for their age).
• Early initiation of Breastfeeding: Ninety percent of children were breast-
fed within one hour of birth
• Exclusive breastfeeding: Eighty-two percent of children, less than age 6
months, are exclusively breastfed and the median duration is 5.2 months.
• Breastfeeding: Ninety-nine percent of children have ever been breastfed
and the median duration of breastfeeding among children born in the three
years before the survey is 30.2 months.
• Complementary foods: Generally complementary foods are introduced
at the recommended age; 89 percent of breastfed children aged 6-8
months received complementary foods in addition to being breastfed with-
in the 24 hours preceding the survey.

N
utritional status is the result of complex interactions between food consumption and the overall sta-
tus of health and care practices.Nutritional intake from birth to two years of age is a key determinant
of the future growth, health, and development of the child. However, faltering growth, micronutri-
ent deficiencies, and common childhood illnesses often mark this period. Proper breastfeeding practices,
including exclusive breastfeeding during the first six months of life, are crucial to the health and well-being
of a child. Continued breastfeeding for a longer period improves health and nutritional status of the child.
Complementary foods introduced initially around six months of age contribute to the nutritional needs of the
child.
A woman’s nutritional status has important implications on her health as well as the health of her
children. Malnutrition in women results in reducing productivity, increasing susceptibility to infections, slow
recovery from illness, and heightened risk of adverse pregnancy outcomes. For example, a woman who has
poor nutritional status, short stature, anaemia, or other micronutrient deficiencies has a greater risk of ob-
structed labour, dying due to postpartum hemorrhage, and morbidity from various conditions. If the mother’s
nutritional status is unsatisfactory, her baby is at a higher risk of low weight at birth and morbidities.
This chapter focuses on the nutritional status of children and woman. It also includes information
about feeding practices of infant and young children, diversity of food consumed, frequency of feeding, and
micronutrient intake children and mothers. The section on nutritional status covers anthropometric assess-
ment of the nutritional status of children aged 0-5 and of women aged 15 -49.

Nutrition of Children and Women 157

11.1 Nutritional status of children

Stunting or height-for-age
Height-for-age is a measure of linear growth retardation and cumulative growth deficits. Children
whose height-for-age Z-score is below minus two standard deviations (-2SD) from the median of
the reference population are considered short for their age (stunted), or chronically undernourished.
Children who are below minus three standard deviations (-3 SD) are considered severely stunted.
sample : children under age 5

Wasting or weight-for-height
The weight-for-height index measures body mass in relation to body height or length and discribes
current nutritional status. Children whose Z-score is below minus two standard deviations (-2sd)
from the median of the reference population are considered thin (wasted), or acutely undemourished.
children whos weight-for-age Z-score is below minus three standard deviations (-3 SD) from the
median of the reference population are considered severely wasted.
sample : children under age 5

Underweight or weight-for-age
Weight-for-age is a composite index of height-for-age and weight-for-height that accounts for both
acute and chronic undernutrition. Children whose Weight-for-age Z-score is below minus two
standard deviations (-2SD) from the median of the reference population are classified as underweight.
Children whose weight-for-age Z-score is below minus three standard deviations (-3SD) from the
median are considered severely underweight.
sample : children under age 5

Overweight in children
Children whose weight-for-height Z-score is more than two standard deviations (+2 SD) above the
median of the reference population are considered overweight.
sample : children under age 5

The anthropometric data on height and weight collected in the 2016 SLDHS permit the measurement and
evaluation of the nutritional status of children under the age of 5 years in Sri Lanka.

11.1.1 Measurement of nutritional status among children under the age of 5 years
The 2016 SLDHS collected data on the nutritional status of children by measuring the height and
weight of all children less than five years of age. Data were collected with the aim of calculating three indices:
namely, weight–for–age, height–for–age and weight–for–height. Weight was measured using lightweight
SECA bathroom–type scale with digital screens designed and manufactured under the authority of the United
Nations Children’s Fund (UNICEF). The measuring board was specially designed by SECA productions for
use in survey settings. Children younger than 24 months were measured lying down on the board. Older ones
were measured standing up.
The nutritional status of children in the survey population is compared with the World Health Organ-
ization (WHO) child growth standards, which are based on an international sample of ethnically, culturally
and genetically diverse, healthy children living under optimum conditions that are conducive to achieving a
child’s full genetic growth potential (WHO, 2006).
The analysis presented in this chapter uses measurements of length/height and weight obtained for

158 Demographic and Health Survey - 2016, Sri Lanka

all children under age 5 living in the households selected for the 2016 SLDHS sample. The following analysis
focuses on the 8,459 children for whom complete and plausible anthropometric and age data measurements
were collected.

11.1.2 Stunting
Assessment of child nutrition using the measurement of height-for-age is of crucial importance to
understand the health of children in the country. Data from the 2016 SLDHS revealed that 17 percent of the
children under age 5 in Sri Lanka are stunted, and 4 percent are severely stunted (Table 11.1). The levels of
stunting according to age of the child follow the traditional pattern of increasing with age, peaking at ages
24-35 months (22 percent), and then slowly declining to 14 percent among older children ages 48-59 months.
There is a negative association between stunting and the level of education of the mother and wealth of the
households. Place of residence also seems to impact the levels of stunting in Sri Lanka, with higher levels of
stunting in children in the estate sector (32 percent) than in those of the urban and rural sectors (15 percent).
The highest levels of stunting were observed in Nuwara Eliya (32 percent), followed by Kandy (26 percent)
, Kegalle (23 percent), Batticaloa (22 percent), Ampara(22 percent), Mannar, Killinochchi, and Badulla (21
percent). The lowest prevalence of stunting is observed in Polonnaruwa (11 percent), followed by Puttalam
and Hambantota (12 percent each, Table 11.1).
Figure 11.1 Trends in stunting of children under age 5 by
district, 2006-2016

45.0
40.0
35.0
30.0
Percentage

25.0
20.0
15.0 2006

10.0 2016

5.0
0.0
Galle
Kandy

Hambantota

Kegalle
Batticaloa

Kurunegala

Badulla

Ratnapura
Nuwara Eliya

Ampara
Trincomalee

Polonnaruwa

Moneragala
Gampaha

Puttalam
Kalutara

Anuradhapura
Matale

Matara
Colombo

District

Note : Excluding Northern Province

11.1.3 Wasting
Table 11.1 also contains information about weight-for-height to identify levels of wasting for chil-
dren under five years of age . The overall prevalence of wasting is 15 percent, with 3 percent identified as se-
verely wasted. Wasting is highest among children aged 0-5 months (19 percent), while the lowest prevalence
is observed among those children aged 18-23 months (13 percent). The level of education of the mother is
negatively associated with wasting. The birth interval of the child does not present a clear pattern in relation
to wasting.
Measures of wasting by sector of residence does not show any important differences, but higher
variations are observed across districts. The higher levels of wasting are observed in Moneragala (25 per-
cent), Mullaitivu, and Hambantota (22 percent each), compared with Matale (10 percent) and Polonnaruwa
(11 percent) where lower values are observed.

Nutrition of Children and Women 159

 Figure 11.2 Trends in Wasting of children under age 5 by district ,
2006-2016.

30
25
20
Percentage

15
10
2006
5
2016
0
Nuwara Eliya
Gampaha

Galle

Ampara
Kandy

Hambantota

Moneragala
Trincomalee

Puttalam
Colombo

Kalutara

Matale

Matara

Anuradhapura
Polonnaruwa
Badulla

Kegalle
Batticaloa

Kurunegala

Ratnapura
District

Note : Excluding Northern Province

Figure 11.3 Trends in nutritional status of children under age 5

25

21.1
20.5
20
17.3 17.3

14.7 15.1
15

2006

10 2016

0
Stunted Wasting Underweight

Note : Excluding Northern Province

160 Demographic and Health Survey - 2016, Sri Lanka

Table 11.1 Nutritional status of children

Percentage of children under five years classified as malnourished according to three anthropometric indices of nutritional status: height-for-age, weight-for-height, and
weight-for-age, by background characteristics, Sri Lanka 2016
1
Height-for-age Weight-for-height Weight-for-age

Percen- Percen- Percen- Percen- Percen- Mean Percen- Percen- Percen-

tage tage Mean Number tage tage tage Z- Number tage tage tage Mean Number
below below Z-score of below below above score of below below above Z-score of
2 2 2
Background characteristic -3 SD -2 SD (SD) children -3 SD -2 SD +2 SD (SD) children -3 SD -2 SD +2 SD (SD) children

Age in months
<6 3.1 11.6 -0.3 613 6.6 19.4 5.3 -0.6 584 4.7 14.8 1.2 -0.8 614
6-8 4.1 16.7 -0.6 396 4.0 15.8 4.1 -0.6 394 2.6 15.9 1.9 -0.8 400
9-11 5.8 15.4 -0.7 370 4.5 15.4 2.2 -0.8 372 3.9 16.3 0.8 -1.0 375
12-17 4.0 18.8 -1.0 747 4.1 14.4 1.5 -0.7 745 3.9 18.4 0.8 -1.0 752
18-23 5.6 21.2 -1.1 771 2.6 13.0 1.3 -0.8 767 5.2 19.8 1.0 -1.2 777
24-35 4.8 21.5 -1.1 1,652 2.2 14.0 0.9 -0.9 1,644 4.3 23.1 0.8 -1.3 1,660
36-47 4.5 16.8 -1.1 1,650 2.7 15.3 1.7 -0.9 1,643 4.1 23.2 0.7 -1.2 1,652
48-59 2.6 13.6 -1.0 1,670 1.9 15.4 2.2 -0.9 1,667 3.2 20.5 1.2 -1.2 1,677

Sex
Male 4.7 17.9 -1.0 4,066 3.3 15.4 2.2 -0.9 4,042 3.9 20.5 1.1 -1.1 4,088
Female 3.6 16.6 -0.9 3,804 2.7 14.7 1.7 -0.8 3,775 4.1 20.5 0.9 -1.1 3,821
3
Birth interval in months
4
First birth 3.5 15.5 -0.9 3,027 3.2 13.9 2.2 -0.8 3,007 3.6 19.9 1.2 -1.1 3,041
<24 5.8 17.7 -0.9 380 3.0 17.0 1.7 -0.9 377 4.2 21.2 0.4 -1.2 380
24-47 4.6 19.2 -1.1 1,511 2.9 17.0 1.7 -0.9 1,502 4.5 21.6 1.2 -1.2 1,525
48+ 4.3 18.0 -1.0 2,746 3.0 15.1 2.0 -0.9 2,724 4.2 20.3 0.6 -1.2 2,756

Mother's interview status

Interviewed 4.1 17.2 -1.0 7,663 3.0 15.1 2.0 -0.8 7,610 4.0 20.4 1.0 -1.1 7,701
Not interviewed but in
household 8.6 23.6 -1.0 56 0.5 20.1 0.0 -1.0 57 6.8 29.8 0.0 -1.4 57
Not interviewed and not in the
5
household 4.4 16.2 -0.9 150 2.6 12.0 1.8 -0.8 150 1.6 19.8 1.8 -1.1 150
6
Mother's nutritional status
Thin (BMI<18.5) 6.6 22.6 -1.2 814 4.9 24.5 0.8 -1.3 804 7.9 31.5 0.6 -1.5 816
Normal (BMI 18.5-24.9) 4.3 18.1 -1.0 3,415 3.2 15.7 1.7 -0.9 3,409 4.1 22.0 0.6 -1.2 3,440
Overweight/ obese (BMI >= 25) 3.3 15.5 -0.9 2,751 1.9 10.8 2.6 -0.6 2,737 2.9 15.5 1.3 -1.0 2,764

Residence
Urban 3.6 14.7 -0.8 1,214 1.6 12.9 2.9 -0.7 1,205 1.9 16.4 1.5 -0.9 1,220
Rural 4.0 17.0 -1.0 6,325 3.2 15.6 1.9 -0.9 6,286 4.2 20.8 0.9 -1.2 6,355
Estate 8.8 31.7 -1.4 332 3.7 13.4 1.3 -0.9 326 7.6 29.7 0.4 -1.5 334

District
Colombo 4.3 15.6 -0.7 669 1.7 11.9 2.8 -0.7 667 1.6 14.6 1.9 -0.9 674
Gampaha 2.9 12.8 -0.8 756 2.6 15.9 2.2 -0.8 749 4.1 19.6 1.4 -1.0 756
Kalutara 1.7 12.5 -0.7 497 2.9 16.6 2.1 -0.9 494 2.8 20.1 1.1 -1.0 496
Kandy 5.2 26.0 -1.2 549 2.3 12.7 3.4 -0.7 552 4.9 20.6 2.1 -1.1 559
Matale 2.8 14.0 -1.0 216 1.9 9.9 1.6 -0.8 215 3.1 17.8 0.0 -1.2 216
Nuwara Eliya 10.0 32.4 -1.5 250 3.2 11.8 1.5 -0.7 248 7.8 29.6 0.6 -1.4 250
Galle 3.7 12.5 -0.8 408 2.9 16.9 1.8 -1.0 401 4.7 17.8 0.5 -1.1 410
Matara 3.8 15.6 -0.9 336 2.2 16.8 1.3 -1.0 332 3.9 22.3 0.7 -1.2 337
Hambantota 2.6 11.8 -0.9 216 3.2 21.8 0.5 -1.1 214 5.1 22.4 1.2 -1.2 217
Jaffna 1.5 13.7 -0.8 197 2.2 11.7 0.8 -0.7 196 2.5 13.7 0.2 -1.0 197
Mannar 4.6 20.8 -1.1 41 2.4 13.1 3.5 -0.6 40 5.2 18.2 2.6 -1.1 41
Vavuniya 6.1 18.7 -0.9 64 3.5 16.0 0.6 -0.9 61 4.9 20.3 1.0 -1.2 64
Mullaitivu 6.0 16.7 -0.9 36 3.8 21.6 2.1 -1.0 36 8.5 25.5 1.5 -1.2 37
Killinochchi 6.6 20.9 -1.1 46 3.9 16.8 2.9 -0.8 45 3.1 16.6 0.0 -1.2 46
Batticaloa 3.6 20.6 -1.1 249 2.8 14.0 2.6 -0.9 248 2.8 21.4 1.5 -1.2 250
Ampara 7.2 21.9 -1.1 345 2.3 12.4 2.6 -0.7 342 3.3 18.1 0.7 -1.2 346
Trincomalee 3.5 15.5 -1.0 188 2.4 12.3 1.0 -1.0 184 5.8 22.7 0.4 -1.3 188
Kurunegala 2.0 17.7 -1.0 685 2.3 13.5 1.0 -0.9 683 3.3 21.9 0.4 -1.2 686
Puttalam 2.9 11.7 -0.7 276 6.5 17.2 2.5 -0.9 275 2.9 20.1 1.9 -1.0 276
Anuradhapura 5.9 19.1 -1.1 409 6.0 19.7 3.7 -0.8 404 6.1 24.7 0.8 -1.2 411
Polonnaruwa 3.0 11.1 -0.8 185 2.1 11.4 2.7 -0.9 184 2.3 18.7 1.0 -1.1 185
Badulla 6.5 20.6 -1.2 293 2.6 13.1 1.4 -0.9 294 5.2 22.6 0.0 -1.3 297
Moneragala 3.5 15.9 -0.7 244 5.3 25.4 0.4 -1.2 240 4.9 24.2 0.0 -1.3 244
Ratnapura 4.0 17.8 -1.1 440 3.7 16.0 1.0 -0.9 436 4.5 22.9 0.4 -1.2 446
Kegalle 8.4 23.1 -1.2 275 4.2 16.3 2.2 -0.8 275 4.5 19.9 0.8 -1.2 280

Mother's education
No education 17.5 37.6 -1.6 58 1.6 17.9 0.0 -1.0 58 6.9 33.9 0.0 -1.6 58
Passed Grade 1-5 8.4 27.2 -1.4 277 4.1 17.6 1.4 -0.9 275 8.5 30.2 0.9 -1.5 278
Passed Grade 6-10 5.0 20.3 -1.1 3,368 3.7 17.5 1.7 -0.9 3,349 5.2 24.6 0.5 -1.3 3,387
Passed G.C.E.(O/L) or
equivalent 3.4 15.9 -0.9 1,705 2.5 14.9 2.6 -0.8 1,690 3.6 18.6 1.4 -1.1 1,713
Passed G.C.E.(A/L) or
equivalent 2.8 12.2 -0.7 1,868 2.4 12.2 1.9 -0.8 1,853 2.1 15.4 1.2 -0.9 1,878
Degree and above 1.3 12.1 -0.6 444 2.0 8.7 2.8 -0.6 442 2.2 10.0 1.8 -0.7 445

Wealth quintile
Lowest 6.2 25.2 -1.3 1,595 3.6 17.3 1.5 -1.0 1,584 6.9 27.6 0.5 -1.4 1,599
Second 5.4 18.9 -1.1 1,620 4.3 18.3 1.6 -1.0 1,601 5.4 24.5 0.7 -1.3 1,625
Middle 3.3 15.9 -0.9 1,578 3.3 15.0 1.8 -0.9 1,572 3.4 20.9 0.5 -1.1 1,590
Fourth 3.4 14.0 -0.8 1,679 2.2 14.1 2.2 -0.8 1,669 2.1 16.1 1.4 -1.0 1,690
Highest 2.3 11.7 -0.6 1,397 1.5 10.0 3.2 -0.6 1,390 2.1 12.5 1.8 -0.7 1,404

Total 4.1 17.3 -1.0 7,870 3.0 15.1 2.0 -0.8 7,817 4.0 20.5 1.0 -1.1 7,908
Note: Table is based on children who stayed in the household on the night before the interview. Each of the indices is expressed in standard deviation units (SD) from the
median of the WHO Child Growth Standards adopted in 2006. The indices in this table are NOT comparable to those based on the previously used NCHS/CDC/WHO
reference.
Table is based on children with valid dates of birth (month and year) and valid measurement of both height and weight.
1 Recumbent length is measured for children under age 2, or in the few cases when the age of the child is unknown and the child is less than 85 cm; standing height is
measured for all other children.
2 Includes children who are below -3 standard deviations (SD) from the WHO Child Growth standards population median
3 Excludes children whose mothers were not interviewed
4 First-born twins (triplets, etc.) are counted as first births because they do not have a previous birth interval
5 Includes children whose mothers are deceased
6 Excludes children whose mothers were not weighed and measured, children whose mothers were not interviewed, and children whose mothers are pregnant or gave birth
within the preceding 2 months. Mother's nutritional status in terms of BMI (Body Mass Index) is presented in Table 11.10.
7 For women who are not interviewed, information is taken from the Household Questionnaire. Excludes children whose mothers are not listed in the Household
Questionnaire

Nutrition of Children and Women 161

Demography and Health Survey - 2016 160
11.1.4 Underweight
The 2016 SLDHS includes a third indicator for assessing malnutrition among children under five
years of age which identified 21 percent of children as of low weight or underweight for their age, and 4
percent as severely underweight. (Table11.1) Similar to the measurements for stunting and wasting, under-
weight percentages increase with the age of the child, the highest level at 36-47 months of age (23 percent).
Differences in the percentage of underweight children by sex, birth interval of the child,level of education,
nutritional status of the mother and wealth quintiles are similar to those previously observed and described
for stunting and wasting.
Place of residence again shows some interesting differences as with stunting, children living in the
estate sector (30 percent) haveing a much higher prevalence of underweight than their counterparts in the
urban and rural sectors (21 percent ,16 percent,respectively).Table 11.1, also reveals some differences in
underweight across administrative districts. Children in Nuwara Eliya have the highest level of underweight
(30 percent), followed by Mullaitivu (26 percent), Anuradhapura (25 percent) and Moneragala (24 percent).
The lower levels of underweight children are observed in Jaffna (14 percent) and in Colombo (15 percent).

Figure 11.4 Comparision of underweight of children

under age 5 by District, 2006 and 2016
35.0
30.0
25.0
Percentage

20.0
15.0
10.0 2006
5.0
2016
0.0
Gampaha

Ampara
Kandy

Galle

Hambantota
Colombo

Trincomalee

Puttalam
Kalutara

Matale

Matara

Anuradhapura
Polonnaruwa
Badulla
Monaragala

Kegalle
Batticaloa

Kurunegala

Ratnapura
Nuwara Eliya

District

Note : Excluding Northern Province

11.2 Initiation of breastfeeding

Early breastfeeding
Initiation of breastfeeding with in 1 hour of birth.
sample : Last born children who were born in the 2 years before the survey

Feeding practices play a pivotal role in determining the optimal growth and development of infants.
Poor breastfeeding and undesirable complementary feeding practices have adverse consequences for the
health and nutritional status of children which could affect their mental and physical development. Exclusive
breastfeeding also affects mothers by physiologically suppressing the return of fertility, thereby contribute to
lengthening the interval between pregnancies. The pattern of feeding a child has an important influence on
both the child and the mother and is one of the key determinants of a child’s nutritional status.
Early breastfeeding practices determine the successful establishment and duration of breastfeeding.
Moreover, during the first three days after delivery, colostrum, an important source of nutrition and protection
for the newborn, is produced and should be given to the newborn while awaiting the let-down of regular/
mature breast milk. Thus, it is recommended that children be put to the breast immediately or within one
hour after birth, while discouraging pre-lacteal feeding (i.e. feeding newborns anything other than breast milk
before early breastfeeding is initiated).

162 Demographic and Health Survey - 2016, Sri Lanka

 In 2016, almost all of the last-born children under age two (99 percent) had been breastfed at some
time (ever breastfed). About 90 percent of the children were breastfed within one hour of birth (98 percent
within one day of birth). The percentage of children breastfed within one hour has increased during the last
ten years from 80 percent to 90 percent. The percentage of children breastfed within one day has remained
stable at 98 percent (compared to 97 percent in 2006-07). Disparities on breastfeeding initiation across dis-
tricts are notable. The percentage of infants put to the breast soon after birth ranges from only 77 percent in
Mannar to 100 percent in Anuradhapura.
The proportion of children who have ever been breastfed does not show a clear relationship with
wealth quintile, but a higher percentage of last-born children of households in the fourth wealth quintile are
breastfed within one hour than in any of the other quintiles. The percentage of children who were breastfed
within one hour of birth are also higher among children born to mothers who have Passed G.C.E.(A/L) or
equivalent education than to mothers of other educational groups.
Table 11.2 shows that thirteen percent of newborns in Sri Lanka received pre-lacteal feeds. The per-
centage is higher among infants born in the urban sector, mothers whose education is “degree and above”, or
living in the richer wealth quintiles. This practice is discouraged because pre-lacteal feeds are less nutritious
than breast milk, more susceptible to contamination, and may reduce milk flow.

Nutrition of Children and Women 163

Table 11.2 Initial breastfeeding

Among last-born children who were born in the two years preceding the survey, the percentage who were ever breastfed and the
percentages who started breastfeeding within one hour and within one day of birth; and among last-born children born in the two years
preceding the survey who were ever breastfed, the percentage who received a prelacteal feed, by background characteristics, Sri Lanka
2016
Among last-born children born in the past two years: Among last-born children born in
the past two years who were ever
breastfed:

Percentage who Percentage who

started started
Percentage breastfeeding breastfeeding Number of Percentage who Number of last-
ever within 1 hour of within 1 day of last-born received a born children
Background characteristic breastfed birth birth1 children prelacteal feed2 ever breastfed

Sex
Male 99.4 90.2 97.4 1,544 14.3 1,535
Female 99.4 90.4 98.4 1,524 11.1 1,515

Residence
Urban 99.4 87.0 97.4 487 18.4 484
Rural 99.5 91.2 98.0 2,443 11.6 2,430
Estate 98.9 86.3 98.1 138 11.4 136

District
Colombo 99.6 88.7 98.2 299 23.5 298
Gampaha 100.0 94.4 99.5 257 16.2 257
Kalutara 98.8 87.5 95.9 198 21.8 195
Kandy 98.8 79.8 97.0 211 10.3 208
Matale 100.0 91.1 99.5 69 15.6 69
Nuwara Eliya 100.0 90.3 100.0 107 8.9 107
Galle 99.1 86.7 98.3 157 15.8 156
Matara 100.0 93.0 93.0 129 10.2 129
Hambantota 100.0 92.1 98.2 105 5.5 105
Jaffna 100.0 90.8 98.1 73 22.8 73
Mannar 100.0 77.1 100.0 11 12.9 11
Vavuniya 100.0 91.7 98.5 20 21.2 20
Mullaitivu 100.0 97.6 100.0 13 14.1 13
Kilinochchi 100.0 83.9 96.5 15 9.7 15
Batticaloa 98.9 92.4 97.6 89 12.9 88
Ampara 98.8 94.5 97.7 125 13.7 124
Trincomalee 96.8 78.2 96.8 70 13.5 68
Kurunegala 100.0 92.1 99.2 274 8.9 274
Puttalam 98.5 87.5 98.5 110 5.6 108
Anuradhapura 100.0 100.0 100.0 153 0.2 153
Polonnaruwa 100.0 84.9 94.7 84 16.0 84
Badulla 99.1 90.5 99.1 97 2.9 96
Moneragala 100.0 95.0 100.0 91 9.9 91
Ratnapura 98.9 91.7 95.8 182 10.1 180
Kegalle 99.3 94.5 97.6 128 8.0 127

Mother's education
No education * * * 19 * 17
Passed Grade 1-5 100.0 89.5 97.8 86 14.8 86
Passed Grade 6-10 99.4 88.3 98.0 1,288 8.8 1,281
Passed G.C.E.(O/L) or equivalent 99.6 90.6 97.8 648 10.6 646
Passed G.C.E.(A/L) or equivalent 99.4 93.2 98.2 819 16.8 814
Degree and above 99.6 91.5 97.6 208 26.1 207

Wealth quintile
Lowest 99.2 89.5 98.2 563 10.6 558
Second 99.5 90.3 98.4 599 8.8 596
Middle 99.5 89.1 96.5 641 9.8 637
Fourth 99.5 92.0 98.6 664 13.5 660
Highest 99.5 90.6 97.8 602 20.8 599

Total 99.4 90.3 97.9 3,068 12.7 3,050

Note: Table is based on last-born children born in the 2 years preceding the survey regardless of whether the children are living or dead
at the time of interview.
1
Includes children who started breastfeeding within one hour of birth
2
Children given something other than breast milk during the first three days of life
3
Doctor, nurse/midwife, or auxiliary midwife

Colostrum, which has also been called the “first milk”, is thick milk that is produced by mothers
of newborns. Colostrum provides a host of benefits for infants. The ministry of health in Sri Lanka
164 Demographic and Health Survey - 2016, Sri Lanka
encourages all mothers to breastfeed their babies with colostrum. The majority of children born during the
 Colostrum, which has also been called the “first milk”, is thick milk that is produced by mothers of
newborns.five
Colostrum provides
years before a host of
the survey (98benefits forwere
percent) infants. Thecolostrum.
given ministry ofThis
health in Sri Lanka
percentage encourages
has increased in the past
all mothers to breastfeed their babies with colostrum. The majority of children born during the five years
ten years from 92 in 2006-07 to 98 in 2016. There are hardly any differences among background variable
before the survey (98 percent) were given colostrum. This percentage has increased in the past ten years
categories. A slightly higher percentage of women in the richest wealth quintiles and those with higher
from 92 in 2006-07 to 98 in 2016. There are hardly any differences among background variable categories.
A slightlyeducation have given
higher percentage colostrum
of women thanrichest
in the those wealth
womenquintiles
with lower
and education
those withand belonging
higher to households
education have in
lower wealth
given colostrum quintiles.
than those women with lower education and belonging to households in lower wealth quin-
tiles.
Another notable improvement has occurred in the estates sector, where the percentage of children
Another notable
receiving improvement
colostrum increased has
fromoccurred in the
70 percent estates sector,
in 2006-07 where the
to 97 percent percentage of children
in 2016.
receiving colostrum increased from 70 percent in 2006-07 to 97 percent in 2016.

Table 11.3 Colostrum feeding

Among children born in the five years before the survey who were ever breastfed, percentage of the most
recent births who were not given colostrum and among those, the percentage whose mothers were advised by
a health provider not to give colostrum, according to background characteristics, Sri Lanka 2016

Number of Percentage
lastborn children advised by a Number of
born in past five health provider children who
Percentage not years who were not to use were not given
Background characteristic given colostrum ever breastfed colostrum colostrum

Sex
Male 2.2 3,697 24.4 83
Female 1.6 3,441 17.8 54

Residence
Urban 1.6 1,114 * 18
Rural 1.9 5,728 25.6 110
Estate 2.7 296 * 8

Mother's education
No education 7.9 51 * 4
Passed Grade 1-5 1.9 257 * 5
Passed Grade 6-10 2.0 3,104 25.7 64
Passed G.C.E.(O/L) or equivalent 1.8 1,608 (8.1) 29
Passed G.C.E.(A/L) or equivalent 1.4 1,706 * 23
Degree and above 3.0 413 * 12

Wealth quintile
Lowest 2.7 1,413 13.0 38
Second 1.8 1,457 (24.5) 27
Middle 1.6 1,463 * 23
Fourth 1.8 1,524 (24.6) 27
Highest 1.7 1,280 * 22

Total 1.9 7,138 21.8 137

11.3 Breastfeeding status by age

11.3 B
UNICEF REASTFEEDING
and STATUS
WHO recommend BY AGE
that children be exclusively breastfed during the first six months
of life and that they be given age-appropriate solid or semisolid complementary food in addition to contin-
ued breastfeeding UNICEF
from age and WHOtorecommend
6 months at least agethat
24 children be exclusively
months. Exclusive breastfed during
breastfeeding duringthethefirst
firstsix
six months
months isofrecommended
life and thatbecause
they bebreast
givenmilkage-appropriate
contains all ofsolid or semisolid
the nutrients complementary
necessary for childrenfood
in theinfirst
addition to
continued breastfeeding from age 6 months to at least age 24 months. Exclusive
few months of life. In addition, the mother’s antibodies in breast milk provide immunity to diseases or in- breastfeeding during the
first six months is recommended because breast milk contains all of the nutrients necessary
fections. Early supplementation is discouraged for several reasons. First, it exposes infants to pathogens and for children in
increases the
theirfirst
riskfew months of
of infection. life. Init addition,
Second, decreases the mother’s
infants’ intakeantibodies in breast
of breast milk milk provide
and therefore immunity to
suckling,
which reduces
diseasesbreast milk production
or infections. and the infant is is
Early supplementation deprived of all for
discouraged theseveral
benefitsreasons.
of breast milk.
First, Third, ininfants to
it exposes
pathogens and increases their risk of infection. Second, it decreases infants’ intake of breast milk and
therefore suckling, which reduces breast milk production and the infant is deprived of all the benefits of
breast milk. Third, in low-resource settings, complementary Nutrition
foodofisChildren and Women inferior.
often nutritionally 165

After six completed months, a child requires adequate complementary foods for normal growth.
Lack of appropriate complementary feeding may lead to malnutrition and frequent illnesses, which in turn
low-resource settings, complementary food is often nutritionally inferior.
After six completed months, a child requires adequate complementary foods for normal growth.
Lack of appropriate complementary feeding may lead to malnutrition and frequent illnesses, which in turn
may even lead to death. However, even with complementary feeding, the child should continue to be breast-
fed for two years or more. Interviewers obtained information on complementary feeding by asking mothers
about the current breastfeeding status of all children under age 5 and, for the youngest child born in the two-
year period before the survey and living with the mother, foods and liquids given to the child the day and
night before the survey.
Table 11.4 shows the percent distribution by breastfeeding status of youngest children under age 2
living with their mother and the percentage of children under age 2 using a bottle with a nipple, according to
age in months. Exclusive breastfeeding for the first six months in Sri Lanka is 82 percent for children under
age 6 months (Table 11.4 and Figure 11.5). Among age subgroups, the percentage of children exclusively
breastfed decreases sharply from 93 percent of infants aged 0-1 month to 87 percent of infants’ age 2-3
months and, further to 64 percent of infants aged 4-5 months.
In addition to receiving breast milk, 6 percent of children under age 6 months receive plain water,
5 percent receive other milk, and 6 percent are given complementary foods. After the age of 5 months, a
majority of children (88 percent or more) receive complementary foods in addition to breast milk, as recom-
mended; however, 12 percent of children aged 6-8 months did not receive complementary foods the day or
night preceding the survey.
Only two percent of children below 6 months and 11 percent of children aged 6-8 months used a
bottle with a nipple the day or night preceding the survey. Bottle feeding is a concern because of possible con-
tamination due to unsafe water and lack of hygiene in its preparation; it also may reduce the child’s interest
in breastfeeding, with a consequential decline in the mother’s milk production.
Continued breastfeeding is recommended until a child is 2 years of age or beyond. In Sri Lanka
breastfeeding is widely accepted and of long duration. The proportion of children who are currently breast-
feeding decreases with the age of the child, from 94 percent among children aged 12-17 months to 88 percent
among children aged 18-23 months.
Although it is recommended that breastfeeding be continued throughout the second year of life, 9
percent of children 12-23 months old are not receiving any breast milk. Figure 11.5 illustrates the patterns of
child feeding by the age of the child.

166 Demographic and Health Survey - 2016, Sri Lanka

 Table 11.4 Breastfeeding status by age

Percent distribution of youngest children under two years who are living with their mother by breastfeeding status and the
percentage currently breastfeeding; and the percentage of all children under two years using a bottle with a nipple, according to age
in months, Sri Lanka 2016
Breastfeeding status

Number of
Breast- Breast- Breast- youngest Number
feeding feeding Breast- feeding Percenta children Percenta of all
and and feeding and ge under age ge using children
Not consuming consuming and consuming currently 2 living a bottle under
Age in breast- Exclusively plain water non-milk consuming compleme breast- with their with a two
months feeding breastfed only liquids1 other milk ntary foods Total feeding mother nipple years

0-1 0.6 93.4 1.1 0.0 1.8 3.1 100.0 99.4 286 0.8 287
2-3 0.0 87.2 5.3 0.0 6.6 0.8 100.0 100.0 223 0.7 226
4-5 0.0 63.8 12.5 1.7 7.7 14.3 100.0 100.0 243 5.6 244
6-8 1.2 2.2 6.8 1.8 0.2 87.9 100.0 98.8 404 10.7 406
9-11 4.3 0.3 0.4 0.0 0.4 94.6 100.0 95.7 381 10.5 384
12-17 5.7 0.1 0.3 0.0 0.2 93.8 100.0 94.3 766 9.6 773
18-23 11.8 0.0 0.0 0.0 0.1 88.1 100.0 88.2 738 10.6 783

0-3 0.3 90.7 3.0 0.0 3.9 2.1 100.0 99.7 509 0.8 513
0-5 0.2 82.0 6.0 0.6 5.1 6.0 100.0 99.8 752 2.3 757
6-9 1.6 1.8 5.2 1.4 0.2 89.9 100.0 98.4 528 10.4 531
12-15 4.7 0.2 0.4 0.0 0.1 94.6 100.0 95.3 479 10.7 482
12-23 8.7 0.1 0.1 0.0 0.1 91.0 100.0 91.3 1,504 10.1 1,556
20-23 13.4 0.0 0.0 0.0 0.1 86.6 100.0 86.6 503 10.7 536
Note: Breastfeeding status refers to a "24-hour" period (yesterday and last night). Children who are classified as breastfeeding and
consuming plain water only consumed no liquid or solid supplements. The categories of not breastfeeding, exclusively breastfed,
breastfeeding and consuming plain water, non-milk liquids, other milk, and complementary foods (solids and semi-solids) are
hierarchical and mutually exclusive, and their percentages add to 100 percent. Thus, children who receive breast milk and non-milk
liquids and who do not receive other milk and who do not receive complementary foods are classified in the non-milk liquid category
even though they may also get plain water. Any children who get complementary food are classified in that category as long as they
are breastfeeding as well.
1
Non-milk liquids include juice, juice drinks, clear broth or other liquids

Figure 11.5: Infant feeding practices by age

Figure 11.5: Infant feeding practices by age

100%

90% Breast- feeding and consu- ming

comple- mentary foods
80%
Breast- feeding and consu- ming
70% other milk
60%
Breast- feeding and consu- ming
50% non milk liquids1

40% Breast- feeding and consu- ming

plain water only
30%

20% Exclusively breastfed

10%
Not breast- feeding
0%
0-1 2-3 4-5 6-8 9-11 12-17 18-23
Age group in month

Figure 11.6, included below, shows the 2016 SLDHS results for key infant and young child
feeding (IYCF) practices on breastfeeding for children under age 2. Although 82 percent of all children
under age 6 months are exclusively breastfed, only 64 percent of those aged 4-5 months are exclusively
breastfed. Almost all children (95 percent) continue breastfeeding at age 1, and 87 percent continue to
breastfeed until age 2. Eighty-eight percent of children are introduced
Nutrition oftoChildren
complementary
and Women foods at
167an
appropriate age. Eighty-nine percent of children aged 0-23 months are breastfed appropriately for their
 Figure 11.6, included below, shows the 2016 SLDHS results for key infant and young child feeding
(IYCF) practices on breastfeeding for children under age 2. Although 82 percent of all children under age 6
months are exclusively breastfed, only 64 percent of those aged 4-5 months are exclusively breastfed. Almost
all children (95 percent) continue breastfeeding at age 1, and 87 percent continue to breastfeed until age 2.
Eighty-eight percent of children are introduced to complementary foods at an appropriate age. Eighty-nine
percent of children aged 0-23 months are breastfed appropriately for their age, i.e., exclusive breastfeeding
for children aged 0-5 months and continued breastfeeding along with complementary foods for children aged
6-23 months. Predominant breastfeeding (receiving breast milk and only plain water or non-milk liquids such
as juice, clear broth, and other liquids) is prevalent in 89 percent of the children. Eleven percent of infants
aged 6-11 and eight percent of children under age 2 are bottle-fed.

Figure 11.6 Infant and young child feeding (IYCF)

practices-indicators on breastfeeding status

Exclusive breastfeeding 0-5 month 82

Exclusive breastfeeding 4-5 month 64

Continued breastfeeding at 1 year(12-15 months) 95

Introduction of solid, semi-solid or softfoods (6-8… 88

Continued breastfeeding at 2 years 87

Age-appropriate breastfeeding (0-23 months) 89

Predominant breastfeeding(0-5 months) 89

Bottle feeding (6-11 months) 11

Bottle feeding (0-23 months) 8

0 50 100
Percentage

11.4 Duration and frequency of breastfeeding

Table 11.5 provides information on the median duration of any breastfeeding, exclusive breastfeed-
ing, and predominant breastfeeding among children born in the three years preceding the survey. The median
duration of any breastfeeding in Sri Lanka is 30 months. Differences in the median duration of breastfeeding
by background characteristics are small and affected by small sample sizes. Table 11.5 also shows the median
duration of predominant breastfeeding, which is defined as exclusive breastfeeding or breastfeeding in com-
bination with plain water and/or non-milk liquids only. The median duration of predominant breastfeeding is
5.8 months.

168 Demographic and Health Survey - 2016, Sri Lanka

 Table 11.5 Median duration of breastfeeding

Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding

among children born in the three years preceding the survey, by background characteristics, Sri
Lanka 2016
Median duration (months) of breastfeeding among
children born in the past three years1

Any Exclusive Predo- minant

Background characteristic breastfeeding breastfeeding breastfeeding2

Sex
Male 0.0 4.3 5.1
Female 0.0 4.4 5.1

Residence
Urban 29.0 4.3 5.1
Rural 0.0 4.4 5.1
Estate (30.6) 4.5 5.2

Mother's education
Passed Grade 1-5 (33.9) (3.8) (4.5)
Passed Grade 6-10 0.0 4.4 5.3
Passed G.C.E.(O/L) or equivalent 0.0 4.7 5.4
Passed G.C.E.(A/L) or equivalent 33.1 4.2 4.7
Degree and above 0.0 (4.0) (4.3)

Wealth quintile
Lowest 0.0 4.3 5.6
Second 34.4 4.2 5.0
Middle 0.0 4.8 5.3
Fourth 33.8 4.4 5.0
Highest 31.4 4.2 4.4

Total 0.0 4.4 5.1

Mean for all children 30.2 5.2 5.8

Note: Median and mean durations are based on the distributions at the time of the survey of the
proportion of births by months since birth. Includes children living and deceased at the time of
the survey.
1
It is assumed that non-last-born children and last-born children not currently living with the
mother are not currently breastfeeding
2
Either exclusively breastfed or received breast milk and plain water, and/or non-milk liquids
only

11.5 Types of complementary foods

Table 11.6 provides information on the types of food given by mothers to children under 3 years of
11.5 TYPES OF COMPLEMENTARY FOODS
age on the day or night preceding the interview, according to breastfeeding status. The consumption of infant
formula and other milk, among breastfed children, increases with the age of the child. Solid and semi-solid
foods are introduced toTable
infants11.6 provides
around the ageinformation
of 6 months on theLanka,following
in Sri types of food given by mothers
the guidelines to children under 3 ye
and recom-
of age on the day or night preceding the interview, according to breastfeeding
mendations of UNICEF and WHO. Thus, by the ages of 6-8 months, almost 89 percent of the children are status. The consumption
receiving any infant
solid orformula andfood.
semi-solid other milk,
This amongisbreastfed
percentage an increasechildren, increases
from 85 percent with the
observed ten age
yearsofago
the child. Solid a
from the 2006-07 SLDHS.
semi-solid foods are introduced to infants around the age of 6 months in Sri Lanka,following the guidelin
and recommendations of UNICEF and WHO. Thus, by the ages of 6-8 months, almost 89 percent of
children are receiving any solid or semi-solid food. This percentage is an increase from 85 perc
observed ten years ago from the 2006-07 SLDHS.

Overall, nearly one hundred percent of children (98 percent) aged 6-23 months of age receive a
solid or semisolid complementary foods in addition to breast milk. Consumption of foods made fr
grains (88 percent) and fruits and vegetables richNutrition
in vitamin A (86 percent) is high in the children aged
of Children and Women 169
23 months. The consumption of food made from legumes and nuts (66%), food made from roots a
tubers (58%) , meat, fish, poultry and eggs (58%) is relatively low. Moreover consumption of sugary foo
among children under the age of 3 years decreased drastically by 35 percent compared to 2006/07 SLDH
Overall, nearly one hundred percent of children (98 percent) aged 6-23 months of age receive any solid or
semisolid complementary foods in addition to breast milk. Consumption of foods made from grains (88 per-
cent) and fruits and vegetables rich in vitamin A (86 percent) is high in the children aged 6-23 months. The
consumption of food made from legumes and nuts (66%), food made from roots and tubers (58%) , meat,
fish, poultry and eggs (58%) is relatively low. Moreover consumption of sugary foods (34%) among children
under the age of 3 years decreased drastically by 27 percent compared to 2006/07 SLDHS (61%). The con-
sumption of food made with oil, fat and butter increased from 34 percent (2006/07 SLDHS) to 42 percent
(2016 SLDHS excluding northern province) in this decade (2006-2016)

Table 11.6 Foods and liquids consumed by children in the day or night preceding the interview

Percentage of youngest children under three years of age who are living with the mother by type of foods consumed in the day or night preceding
the interview, according to breastfeeding status and age, Sri Lanka 2016
Liquids Solid or semi-solid foods
Fruits
and Food Food
vegeta- Other made made Cheese Any Food Number
Food bles fruits from from Meat, , yogurt, solid or made of
Fortified made rich in and roots legume fish, other semi- with oil, children
Age in Infant Other Other baby from vitamin vege- and s and poultry, milk solid fat and Sugary under
1 2 3 4
months formula milk liquids foods grains A tables tubers nuts eggs product food butter foods age 3
BREASTFEEDING CHILDREN
0-1 2.3 0.8 4.4 0.5 1.6 1.1 0.0 0.6 1.2 1.0 0.4 3.1 0.7 0.9 284
2-3 5.6 3.3 8.1 0.1 0.8 0.8 0.0 0.1 0.7 0.1 0.7 0.8 0.8 0.0 223
4-5 13.2 3.7 13.3 4.1 6.8 8.8 2.7 6.0 8.1 4.4 1.8 14.3 4.8 0.0 243
6-8 19.4 7.8 45.8 35.1 68.3 75.6 28.6 54.4 58.8 36.9 29.5 88.9 32.7 8.6 399
9-11 24.3 9.6 52.4 40.0 88.2 88.0 43.3 65.0 68.1 54.3 46.1 98.9 38.7 22.0 364
12-17 30.6 17.4 64.6 35.3 93.5 89.7 52.5 58.5 67.8 64.9 47.6 99.4 42.6 38.4 722
18-23 35.2 28.1 76.7 32.5 94.9 87.1 53.5 55.4 66.9 65.1 42.0 99.9 44.1 50.1 651
24-35 33.4 37.7 84.4 29.1 96.6 86.8 53.9 50.1 70.2 60.7 41.9 99.7 46.5 57.4 1,051

6-23 28.8 17.5 62.7 35.2 88.3 86.0 46.8 57.9 65.9 57.9 42.2 97.5 40.6 33.6 2,137

Total 25.9 20.0 58.1 27.2 74.3 70.5 39.9 45.2 55.1 48.0 34.3 80.7 34.8 33.6 3,939
NONBREASTFEEDING CHILDREN
0-1 * * * * * * * * * * * * * * 2
2-3 * * * * * * * * * * * * * * 0
4-5 * * * * * * * * * * * * * * 0
6-8 * * * * * * * * * * * * * * 5
9-11 * * * * * * * * * * * * * * 16
12-17 (83.8) (47.2) (79.7) (61.8) (88.5) (84.0) (58.5) (72.3) (69.4) (83.1) (63.3) (100.0) (62.0) (36.0) 43
18-23 72.7 42.9 83.1 39.9 94.8 91.8 50.7 58.7 63.6 74.7 47.0 100.0 47.4 57.4 87
24-35 53.5 48.6 84.5 41.3 92.4 84.6 51.6 50.5 60.3 69.2 37.8 99.6 47.4 59.8 475

6-23 77.9 42.5 79.6 48.9 92.4 87.0 51.9 63.8 64.2 76.5 52.6 99.2 52.8 46.5 152

Total 59.5 47.0 83.1 43.0 92.2 84.9 51.5 53.6 61.1 70.8 41.3 99.2 48.6 56.4 628
Note: Breastfeeding status and food consumed refer to a 24-hour" period (yesterday and last night).
1
Other milk includes fresh, tinned and powdered cow or other animal milk
2
Doesn't include plain water
3
Includes fortified baby food
4
Includes [list fruits and vegetables included in the questionnaire such as pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, dark
green leafy vegetables, mangoes, papayas, and other locally grown fruits and vegetables that are rich in vitamin A]

11.6Infant
11.6 INFANTand
AND YOUNG
young CHILD
child FEEDING
feeding (iycf(IYCF) PRACTICES
) practices
Appropriate IYCF practices include timely initiation of feeding solid and semisolid foods from age 6 months
and increasing the amount
Appropriate IYCF and variety
practices of foods
include andinitiation
timely frequency of feeding
of feeding solidasand
the semisolid
child getsfoods
olderfrom
while
maintaining
age 6 monthsbreastfeeding (WHO,
and increasing 2008). The
the amount and age ranges
variety of various
of foods indicatorsofoffeeding
and frequency IYCF practices presented
as the child gets
inolder
this chapter have been updated
while maintaining based on
breastfeeding the most
(WHO, recent
2008). Thedefinitions
age rangesof breastfeeding and complementary
of various indicators of IYCF
feeding indicators (WHO, 2010).
practices presented in this chapter have been updated based on the most recent definitions of breastfeeding
and complementary feeding
Minimum dietary indicators
diversity (WHO,
means 2010).
feeding the child food from at least four food groups. This cut-off
was selected because it is associated with better-quality diets for both breastfed and non-breastfed children.
Minimum dietary diversity means feeding the child food from at least four food groups. This
Studies have shown that plant-based complementary foods by themselves are insufficient to meet the needs
cutoff was selected because it is associated with better-quality diets for both breastfed and non-breastfed
for certain micronutrients (WHO and UNICEF 1998). Therefore, it is recommended that meat, poultry, fish,
children. Studies have shown that plant-based complementary foods by themselves are insufficient to meet
or eggs be eaten daily or as often as possible. Vegetarian diets may not meet children’s nutrient requirements
the needs for certain micronutrients (WHO and UNICEF 1998). Therefore, it is recommended that meat,
unless supplements or fortified products are used. Iron rich food as well as Vitamin A-rich fruits and vegeta-
poultry,
bles shouldfish, or eggs bedaily.
be consumed eaten daily or as often as possible. Vegetarian diets may not meet children’s
nutrient requirements unless supplements or fortified products are used. Iron rich food as well as Vitamin
Table and
A-rich fruits 11.7vegetables
presents ashould
summary of IYCFdaily.
be consumed practices along with the background characteristics. The
indicators take into account the percentages of children for whom feeding practices meet minimum standards
Table 11.7 presents a summary of IYCF practices along with the background characteristics. The
indicators
170 take into account
Demographic the percentages
and Health of Lanka
Survey - 2016, Sri children for whom feeding practices meet minimum
standards with respect to food diversity (i.e., the number of food groups consumed), feeding frequency
(i.e., the number of times the child is fed), and consumption of breast milk or other types of milk or milk
products (accounting for number of milk feeds for non-breastfed children). Breastfed children are
with respect to food diversity (i.e., the number of food groups consumed), feeding frequency (i.e., the number
of times the child is fed), and consumption of breast milk or other types of milk or milk products (accounting
for number of milk feeds for non-breastfed children). Breastfed children are considered to be fed within the
minimum standards if they consume at least four food groups and receive food other than breast milk two
to three times per day in the case of infants aged 6-8 months and three to four times per day in the case of
children aged 9-23 months (Arimond and Ruel, 2003). Non-breastfed children are considered to be fed in ac-
cordance with the minimum standards if they consume milk or milk products at least twice a day, are fed four
food groups each day, and are fed at least four to five times per day (including milk feeds). Meal frequency
is considered a proxy for energy intake from foods other than breast milk; therefore, the feeding frequency
indicator for non-breastfed children includes both milk and solid and semi-solid foods (WHO, 2008).
According to the results presented in Table 11.7, seventy two percent of breastfed children aged 6-23
months were given foods from four or more food groups in the 24 hours preceding the interview, and 86 per-
cent were fed the minimum number of times in the preceding 24 hours. About 2 in 3 (63 percent) breastfed
children fell into both categories; that is, their feeding practices met minimum standards with respect to food
diversity as well as feeding frequency.
Among non-breastfed children aged 6-23 months, 69 percent were given milk or milk products, 86
percent were given food from at least four food groups, and 88 percent were fed four or more times per day.
Forty-five percent of non breastfed children aged 6-23 were fed in accordance with all three IYCF practices.
Appropriate feeding practices were more common among breastfed children than non-breastfed
children. Overall, 62 percent of Sri Lankan children aged 6-23 months met the minimum standard with re-
spect to all three IYCF feeding practices (Table 11.7). Ninety eight percent of all children aged 6-23 months
received breast milk or other milk or milk products during the 24-hour period before the interview, and 86
percent were fed the minimum number of times in the preceding 24 hours. The most common problem with
feeding practices was an inadequate number of food groups; only 73 percent of children aged 6-23 months
received foods from the minimum number of food groups for their age.
The proportion of children aged 6-23 months, meeting all three recommended IYCF practices in-
creases from 45 percent among children aged 6-8 months to 69 percent among those aged 12-17 months and
then declines to 65 percent among those aged 18-23 months. The proportions of children who met the crite-
ria did not vary by sex of the child. On the other hand, urban and rural children were more likely to be fed
according to all of the IYCF practices than their counterparts in the estate sector (64 and 62 percent versus
50 percent, respectively). There are no large regional differences in feeding practices. The proportions of
children fed in accordance with the recommended IYCF practices increases with the levels of education of
the mother and with wealth of the households (three forth among the most educated and richest households
compared to less than half of the mothers with primary education or in the poorest of the quintiles, Table
11.7).

Nutrition of Children and Women 171

Table 11.7 Infant and young child feeding (IYCF) practices
Percentage of youngest children age 6-23 months living with their mother who are fed according to three IYCF feeding practices based on breastfeeding
status, number of food groups, and times they are fed during the day or night preceding the survey, by background characteristics, Sri Lanka 2016
Among breastfed children 6-23 Among non-breastfed children 6-23 Among all children 6-23 months,
months, percentage fed: months, percentage fed: percentage fed:
Both 4+
food Number Number
groups of of non- Breast-
and breastfe breastfe milk, Number
Minimu minimu d Milk or Minimu With 3 d milk, or Minimu With 3 of all
m meal m meal children milk m meal IYCF children milk m meal IYCF children
Background 4+ food frequen frequen 6-23 product 4+ food frequen practice 6-23 product 4+ food frequen practice 6-23
characteristic groups1 cy2 cy months s3 groups1 cy4 s5 months s6 groups1 cy7 s months

Age in months
6-8 52.0 82.0 45.1 399 * * * * 5 100.0 52.3 82.2 45.2 404
9-11 69.9 83.3 59.5 364 * * * * 16 99.1 70.1 83.7 59.5 381
12-17 77.9 87.9 70.4 722 (63.6) (92.3) (87.3) (49.8) 43 97.9 78.7 87.8 69.2 766
18-23 77.6 88.0 68.6 651 67.7 86.0 86.1 38.6 87 96.2 78.6 87.8 65.1 738

Sex
Male 71.4 86.0 63.1 1,099 73.1 84.7 82.2 46.6 67 98.5 72.2 85.8 62.1 1,165
Female 71.8 86.1 63.5 1,039 65.4 87.3 91.9 43.1 85 97.4 73.0 86.5 61.9 1,123

Residence
Urban 76.8 84.4 66.7 307 (66.8) (85.8) (86.6) (43.0) 43 95.9 77.9 84.7 63.8 350
Rural 71.0 86.6 63.3 1,732 70.2 88.6 88.3 47.3 103 98.3 72.0 86.7 62.4 1,835
Estate 65.0 81.4 52.5 98 * * * * 5 98.0 63.7 81.5 50.1 103

District
Colombo 85.7 89.2 77.5 180 (71.5) (87.7) (96.4) (51.6) 36 95.2 86.0 90.4 73.2 216
Gampaha 81.4 83.4 69.7 180 * * * * 20 96.0 82.4 82.8 66.7 200
Kalutara 83.0 88.5 73.2 142 * * * * 7 100.0 83.7 88.1 73.4 149
Kandy 58.8 85.0 52.6 141 * * * * 7 99.3 59.8 85.7 53.2 148
Matale 74.3 97.5 74.3 45 * * * * 1 100.0 74.8 97.6 72.7 46
Nuwaraeliya 73.0 80.6 61.9 76 * * * * 4 96.7 71.7 79.3 59.0 80
Galle 74.7 90.6 68.1 120 * * * * 2 100.0 75.2 90.7 68.0 122
Matara 80.7 91.5 76.2 96 * * * * 5 96.6 81.7 90.8 74.1 101
Hambantota 78.9 79.9 64.3 71 * * * * 2 97.8 79.3 80.4 62.9 73
Jaffna 53.6 80.5 42.1 48 * * * * 9 98.3 59.4 81.8 42.6 58
Mannar (66.2) (87.2) (57.8) 7 * * * * 1 (94.4) (68.5) (83.5) (54.8) 8
Vavuniya (41.1) (33.3) (14.5) 14 * * * * 2 96.1 45.0 38.6 12.4 16
Mullaitivu (53.6) (91.6) (47.5) 10 * * * * 1 98.1 53.7 90.4 45.6 11
Killinochchi (36.5) (80.7) (32.9) 9 * * * * 2 (91.1) (40.6) (78.7) (31.5) 10
Batticaloa 48.4 74.5 38.6 60 * * * * 10 94.9 49.1 74.5 36.4 70
Ampara 63.1 74.2 56.2 83 * * * * 11 98.2 67.0 76.6 58.3 94
Trincomalee 58.8 67.9 46.3 40 * * * * 3 95.7 58.8 67.9 45.1 43
Kurunegala 65.0 90.5 59.9 207 * * * * 4 98.9 65.7 90.7 59.1 212
Puttalam 71.6 91.8 63.4 84 * * * * 4 98.1 73.1 90.3 62.2 89
Anuradhapura 67.6 95.2 66.2 118 * * * * 4 98.6 68.6 95.3 65.9 122
Polonnaruwa 68.7 88.6 62.9 55 * * * * 2 100.0 69.8 89.1 62.6 57
Badulla 66.9 87.5 58.1 67 * * * * 2 100.0 65.4 87.9 56.8 70
Monaragala 69.9 94.2 65.6 63 * * * * 4 95.8 71.5 94.5 61.9 67
Ratnapura 75.3 95.5 72.5 128 * * * * 3 99.2 75.8 95.6 71.1 131
Kegalle 74.6 62.3 45.5 91 * * * * 5 99.6 76.0 64.3 48.0 96

Mother's education
No education * * * 13 * * * * 2 * * * * 15
Passed Grade 1-
5 63.6 76.8 48.4 58 * * * * 6 96.9 63.6 76.0 46.2 64
Passed Grade 6-
10 64.7 86.9 58.0 935 (75.1) (79.5) (83.3) (36.3) 38 99.0 65.3 86.7 57.1 973
Passed
G.C.E.(O/L) or
equivalent 73.0 84.1 63.6 441 (57.8) (86.9) (88.2) (40.2) 27 97.6 73.8 84.3 62.3 468
Passed
G.C.E.(A/L) or
equivalent 80.8 85.3 70.8 552 66.0 89.9 89.6 46.9 56 96.9 81.6 85.7 68.6 608
Degree and
above 83.4 92.0 76.0 139 * * * * 21 96.8 85.6 92.2 74.6 160

Wealth quintile
Lowest 56.5 84.0 48.6 395 (65.1) (70.0) (84.0) (23.0) 25 97.9 57.3 84.0 47.1 420
Second 67.5 84.4 60.2 440 (69.9) (58.6) (70.2) (22.6) 17 98.9 67.1 83.9 58.8 457
Middle 68.9 85.0 60.0 444 * * * * 22 98.3 70.1 84.8 59.3 466
Fourth 79.1 87.5 70.6 466 (72.3) (87.8) (96.7) (56.2) 28 98.4 79.6 88.0 69.7 494
Highest 85.7 89.2 76.5 392 70.0 96.7 92.3 54.3 59 96.1 87.1 89.6 73.6 451

Total 71.6 86.0 63.3 2,137 68.8 86.2 87.6 44.6 152 97.9 72.6 86.1 62.0 2,289
1
Food groups: a. infant formula, milk other than breast milk, cheese or yogurt or other milk products; b. foods made from grains, roots, and tubers, including
porridge and fortified baby food from grains; c. vitamin A-rich fruits and vegetables (and red palm oil); d. other fruits and vegetables; e. eggs; f. meat, poultry,
fish, and shellfish (and organ meats); g. legumes and nuts.
2
For breastfed children, minimum meal frequency is receiving solid or semi-solid food at least twice a day for infants 6-8 months and at least three times a
day for children 9-23 months
3
Includes two or more feedings of commercial infant formula, fresh, tinned, and powdered animal milk, and yogurt
4
For non-breastfed children aged 6-23 months, minimum meal frequency is receiving solid or semi-solid food or milk feeds at least four times a day
5
Non-breastfed children aged 6-23 months are considered to be fed with a minimum standard of three Infant and Young Child Feeding Practices if they
receive other milk or milk products at least twice a day, receive the minimum meal frequency, and receive solid or semi-solid foods from at least four food
groups not including the milk or milk products food group
6
Breastfeeding, or not breastfeeding and receiving two or more feedings of commercial infant formula, fresh, tinned and powdered animal milk, and yogurt
7
Children are fed the minimum recommended number of times per day according to their age and breastfeeding status as described in footnotes 2 and 4

172 Demographic and Health Survey - 2016, Sri Lanka

Demography and Health Survey - 2016 171

 Table 11.7.1. Infant and young child feeding (IYCF) practices according to DHS-V calculation

Percentage of youngest children aged 6-23 months living with their mother who are fed according to three IYCF practices based on breastfeeding
status, number of food groups, and times they are fed during the day or night preceding the survey, by background characteristics, Sri Lanka, 2016
Among breastfed children 6-23 months, Among non-breastfed children 6-23 months, Among all children 6-23 months, percentage
percentage fed: percentage fed: fed:

Both 3+
food
groups Number of With Number
and Number of Milk or Minimum With 3 non- Breast Minimu all 3 of all
Minimum minimum breastfed milk meal IYCF breastfed milk, milk, 3+ or 4+ m meal IYCF children
Background 3+ food meal meal children 6- product 4+ food frequenc practices children 6- or milk food frequen practi 6-23
1 2 3 1 4 5 7 7 8
characteristic groups frequency frequency 23 months s groups y 23 months products groups cy ces months

Total 89.6 86.0 78.6 2,137 89.5 86.9 62.3 52.5 152 99.3 89.4 84.4 76.9 2,289

1
Food groups: a. infant formula, milk other than breast milk, cheese or yogurt or other milk products; b. foods made from grains, roots, and tubers, including
porridge and fortified baby food from grains; c. vitamin A-rich fruits and vegetables (and red palm oil); d. other fruits and vegetables; e. eggs; f. meat, poultry,
fish, and shellfish (and organ meats); g. legumes and nuts; h. foods made with oil, fat, or butter.
2
For breastfed children, minimum meal frequency is receiving solid or semi-solid food at least twice a day for infants 6-8 months and at least three times a
day for children 9-23 months
3
Includes at least one feeding of commercial infant formula, fresh, tinned and powdered animal milk, yogurt, cheese and other milk products
4
For non-breastfed children aged 6-23 months, minimum meal frequency is receiving solid or semi-solid food at least four times a day
5
Non-breastfed children aged 6-23 months are considered to be fed with a minimum standard of three Infant and Young Child Feeding Practices if they
receive other milk or milk products at least once a day, receive solid or semi-solid foods at least four times a day, and receive solid or semi-solid foods from at
least four food groups (including the milk or milk products food group)
6
Breastfeeding or not breastfeeding and receiving two or more feedings of commercial infant formula, fresh, tinned, and powdered animal milk, and yogurt
7
At least 3 food groups for breastfed children and at least 4 food groups for non-breastfed children
8
Fed solid or semi-solid food at least twice a day for infants 6-8 months, at least 3 times for other breastfed children, and at least 4 times for non-breastfed
children

11.7 PRESENCE OF IODIZED SALT IN HOUSEHOLDS

11.7 Presence of iodized salt in households
Iodine is an important micronutrient and dietary iodine deficiencies are a major public health
Iodine is an important micronutrient and dietary iodine deficiencies are a major public health con-
concern worldwide. A lack of sufficient iodine is known to cause goiter, cretinism (a severe form of
cern worldwide. A lack of sufficient iodine is known to cause goiter, cretinism (a severe form of neurological
neurological defect), spontaneous abortion, premature birth, infertility, stillbirth and increased child
defect), spontaneous abortion, premature birth, infertility, stillbirth and increased child mortality. Iodine defi-
mortality. Iodine deficiency disorder is the most common cause of preventable mental retardation and
ciency disorder is the most common cause of preventable mental retardation and brain damage in the world.
brain damage in the world. In the 2016 SLDHS all visited households were requested to provide a sample
In the 2016 SLDHS all visited households were requested to provide a sample of the salt used for cooking
of the salt used for cooking to test the level of iodine. The iodine testing was successfully completed in 96
topercent
test theoflevel of iodine. The
the households iodine
included in testing wasofsuccessfully
the sample completed
the 2016 SLDHS. The in 96 percent
remaining of the of
4 percent households
the in-
cluded in the sample of the 2016 SLDHS. The remaining 4 percent of the households
households did not have salt in the household at the time of the survey (Table 11.8). did not have salt in the
household at the time of the survey (Table 11.8).
The results of testing the salt indicate that over ninety-five percent of households have salt with
The results of testing the salt indicate that over ninety-five percent of households have salt with some
some iodine, a percentage that is very similar across sectors of residence. However, at the district level,
iodine, a percentage that is very similar across sectors of residence. However, at the district level, the testing
the testing found that less than ninety percent of households in Batticaloa and Puttalam Districts had
found that less than ninety percent of households in Batticaloa and Puttalam Districts had adequately iodized
adequately iodized salt (only 85 percent each). The percentage with iodized salt is also greater in the
salt (only 85 percent each). The percentage with iodized salt is also greater in the richest households than
richest households than among the poorest 20 percent of the households.
among the poorest 20 percent of the households.

Demography and Health Survey - 2016 172

Nutrition of Children and Women 173
 Table 11.8 Presence of iodized salt in household

Among all households, the percentage with salt tested for iodine content and the percentage with no salt in the household;
and among households with salt tested, the percentage with iodized salt, according to background characteristics, Sri
Lanka 2016
Among all households, the percentage Among households with tested
salt:

With no salt in Number of Percentage with Number of

Background characteristic With salt tested the household households iodized salt households

Residence
Urban 96.3 3.7 4,309 95.9 4,148
Rural 96.3 3.7 21,778 95.0 20,964
Estate 95.4 4.6 1,122 96.1 1,071

District
Colombo 96.8 3.2 2,722 97.3 2,635
Gampaha 95.4 4.6 2,815 93.8 2,684
Kalutara 97.2 2.8 1,618 96.3 1,572
Kandy 93.6 6.4 1,872 96.3 1,752
Matale 94.7 5.3 720 98.0 682
Nuwara Eliya 95.2 4.8 895 97.9 852
Galle 94.0 6.0 1,461 94.8 1,373
Matara 97.3 2.7 1,107 94.3 1,077
Hambantota 93.3 6.7 846 99.3 789
Jaffna 98.1 1.9 720 98.4 706
Mannar 99.1 0.9 126 97.9 125
Vavuniya 98.3 1.7 199 94.9 196
Mullaitivu 94.8 5.2 116 96.3 110
Kilinochchi 98.3 1.7 141 95.8 139
Batticaloa 99.2 0.8 699 85.1 693
Ampara 98.9 1.1 909 98.7 898
Trincomalee 97.1 2.9 507 96.1 492
Kurunegala 95.9 4.1 2,416 92.3 2,317
Puttalam 92.9 7.1 1,007 85.0 936
Anuradhapura 98.3 1.7 1,245 94.5 1,224
Polonnaruwa 95.3 4.7 577 98.9 550
Badulla 94.7 5.3 1,114 95.7 1,056
Moneragala 98.4 1.6 678 97.6 668
Ratnapura 98.5 1.5 1,567 98.0 1,543
Kegalle 98.1 1.9 1,134 92.6 1,113

Wealth quintile
Lowest 92.2 7.8 6,149 93.5 5,670
Second 96.2 3.8 5,504 94.5 5,294
Middle 97.5 2.5 5,301 95.2 5,170
Fourth 97.8 2.2 5,164 95.9 5,050
Highest 98.2 1.8 5,094 97.1 5,000

Total 96.2 3.8 27,210 95.2 26,183

11.8MMicronutrient
11.8 ICRONUTRIENT INTAKE AMONG CHILDREN
intake among children

Micronutrient deficiency is a major contributor to childhood morbidity and mortality. Children

receive Micronutrient
micronutrientsdeficiency
from food, is afood
majorfortification
contributor and direct supplementation.
to childhood The 2016 Children
morbidity and mortality. SLDHS
collected information on consumption of foods rich in vitamin A and iron and the coverage
receive micronutrients from food, food fortification and direct supplementation. The 2016 SLDHS collected status of
children receiving
information vitamin Aof mega
on consumption foodsdose capsules,
rich in vitaminiron supplements
A and iron and the(syrup) andstatus
coverage a deworming medication.
of children receiving
vitamin A mega dose capsules, iron supplements (syrup) and a deworming medication.
Vitamin A is an essential micronutrient for the immune system that plays an important role in
maintaining the A
Vitamin is an essential
epithelial tissue micronutrient for the vitamin
in the body. Severe immuneAsystem that plays
deficiency (VAD) an important
can cause role
eye in main-
damage.
taining
VAD can also increase the severity of infections, such as measles and diarrheal diseases in children can
the epithelial tissue in the body. Severe vitamin A deficiency (VAD) can cause eye damage. VAD and
also
slowincrease thefrom
recovery severity of infections,
illness. Vitamin A such
is as measles
found and diarrheal
in breast diseases
milk, other milk,inliver,
children
eggand slow
yolk, recovery
fish, butter,
from illness. Vitamin A is found in breast milk, other milk, liver, egg yolk, fish, butter, mangoes, papayas,
mangoes, papayas, carrots, pumpkins and dark green leafy vegetables. The human liver can store an
carrots, pumpkins and dark green leafy vegetables. The human liver can store an adequate amount of the
adequate amount of the vitamin for four to six months.
vitamin for four to six months.

174 Demographic and Health Survey - 2016, Sri Lanka

 Table 11.9.1 Micronutrient intake among children

Among all children aged 6-59 months who are living with their mother, the percentages who consumed vitamin A-rich and iron-rich
foods in the day or night preceding the survey, by background characteristics, Sri Lanka 2016

Among youngest children aged 6-23 Among all children aged 24-59 months
months living with the mother: living with the mother:
Percentage Percentage Percentage
Percentage who who who
who consumed consumed consumed consumed
foods rich in foods rich in foods rich in foods rich in
vitamin A in last iron in last 24 Number of vitamin A in iron in last 24 Number of
Background characteristic 24 hours1 hours2 children last 24 hours1 hours2 children
Sex
Male 93.0 60.4 1,165 89.2 60.2 2,525
Female 91.6 57.9 1,123 89.6 61.1 2,272

Breastfeeding status
Breastfeeding 91.9 57.9 2,137 93.5 61.4 1,918
Not breastfeeding 97.7 76.5 152 86.6 60.2 2,879

Mother's age at birth

15-19 (83.1) (42.7) 44 * * 11
20-29 91.1 59.4 1,032 86.2 58.5 1,611
30-39 93.7 59.9 1,116 90.4 61.7 2,728
40-49 93.8 55.1 96 94.6 62.2 446

Residence
Urban 91.5 69.3 350 89.7 70.4 742
Rural 92.5 58.1 1,835 89.5 59.4 3,852
Estate 91.4 44.5 103 86.7 48.9 203

District
Colombo 96.4 65.0 216 89.6 66.9 392
Gampaha 94.6 69.8 200 88.6 64.0 466
Kalutara 96.6 67.7 149 91.7 64.4 300
Kandy 83.7 42.1 148 81.3 44.9 354
Matale 93.4 47.6 46 89.1 49.4 141
Nuwara Eliya 94.7 44.5 80 87.2 45.7 166
Galle 92.6 51.7 122 85.0 65.9 259
Matara 90.5 58.7 101 89.5 62.6 192
Hambantota 88.6 55.5 73 87.1 59.5 150
Jaffna 86.8 57.2 58 88.5 53.1 120
Mannar (98.6) (94.0) 8 92.4 79.6 28
Vavuniya 79.5 58.2 16 93.4 68.8 39
Mullaitivu 86.7 68.0 11 86.9 63.7 23
Kilinochchi (80.3) (54.4) 10 84.6 63.7 29
Batticaloa 78.5 69.7 70 89.3 72.7 148
Ampara 84.3 75.0 94 89.3 78.6 217
Trincomalee 91.6 73.6 43 85.2 76.3 114
Kurunegala 93.4 50.9 212 92.7 56.0 384
Puttalam 93.3 62.7 89 94.0 64.8 171
Anuradhapura 96.5 67.2 122 96.4 70.4 251
Polonnaruwa 93.0 53.5 57 91.4 50.2 101
Badulla 94.4 41.9 70 89.9 48.2 189
Moneragala 97.4 67.3 67 88.2 58.2 138
Ratnapura 90.8 51.1 131 89.7 49.3 247
Kegalle 100.0 61.6 96 94.0 64.2 177

Mother's education
No education * * 15 (89.9) (45.6) 34
Passed Grade 1-5 92.9 56.7 64 83.2 55.6 192
Passed Grade 6-10 90.0 53.2 973 87.4 56.3 2,115
Passed G.C.E.(O/L) or
equivalent 92.4 59.2 468 90.3 62.1 1,118
Passed G.C.E.(A/L) or
equivalent 94.5 66.7 608 92.5 67.0 1,089
Degree and above 98.2 69.3 160 93.0 69.3 249

Wealth quintile
Lowest 87.5 53.5 420 85.2 54.1 1,007
Second 90.6 53.6 457 90.2 55.6 996
Middle 92.6 56.1 466 88.7 56.5 944
Fourth 93.9 64.0 494 91.2 65.4 1,026
Highest 96.4 68.0 451 92.0 73.5 824

Total 92.3 59.2 2,289 89.4 60.7 4,797

Note : An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed and figures in
parentheses are based on 25 – 49 unweighted cases
na = Not applicable
1 Includes meat (and organ meat), fish, poultry, eggs, pumpkin, orange or yellow yams or squash, carrots, yellow sweet potatoes,
dark green leafy vegetables, mango, papaya, and other locally grown fruits and vegetables that are rich in vitamin A
2 Includes meat (including organ meat), fish, poultry and eggs

Nutrition of Children and Women 175

Demography and Health Survey - 2016 174

 According to Table 11.9.1 ninety-two percent of children aged 6-23 months consumed foods rich
in vitamin A the day or night preceding the survey. The consumption of foods rich in vitamin A increases
with wealth quintile. The consumption of vitamin A rich food the day or night before the survey also varies
by district, pointing to the need to target those districts in which children are less protected (Vavuniya and
Batticaloa, among others)
Among children aged 24-59 months, eighty-nine percent of children consumed foods rich in vitamin
A the day or night preceding the survey. A larger percentage of breastfed children aged 24-59 months con-
sumed foods rich in vitamin A than non-breastfed children in the same age group (94 percent vs 87 percent).
Very little variations are observed in the proportion of children who consumed food rich in vitamin A by
residence, wealth quintile and districts. Percentage of children aged 24-59 months who consumed foods rich
in vitamin A is positively associated with mother’s age at birth and mother’s education.
Iron is essential for cognitive development and low iron intake can contribute to anemia. Iron re-
quirements are greatest at the age of 6-23 months, when growth is extremely rapid. According to Table 11.9.1,
three in five children (59 percent) consumed food rich in iron in the 24 hours prior to the survey. A higher
percentage of children in urban areas consume food rich in iron than those in the rural or estates sector (69,
58 and 45 percent respectively).
Among children aged 24-59 months, sixty-one percent of children consumed food rich in iron in the
previous 24 hours with a higher percentage in urban sector than in the rural or estate sector. (70, 59 and 49
percent respectively). The highest percentages of children aged 24-59 months who consumed food rich in
iron are observed among older mothers (62 percent) , the richest household (74 percent) and mothers with the
highest educational level (69 percent).
Figure 11 .7 Percentage of consuming foods rich in vitamin A
and iron by Age Groups
120

100 94 96 95
89
79
80
66 66
Percentage

61
60 55 Percentage who
consumed foods rich in
37 vitamin A in last 24 hours
40

Percentage who
20 consumed foods rich in
iron in last 24 hours

0
6-8 9-11 12-17 18-23 24-59

Age group (months)

Figure 11.7 - shows the 2016 SLDHS results for infants and young children aged 6-59 months con-
suming foods rich in vitamin A and iron in the day or night preceding the survey. Trends of both consuming
vitamin A rich foods and iron rich foods are positively associated with child age groups from 6 to 23 months.
The proportions of children who consumed foods rich in vitamin A in the age group 24-59 months is less than
the proportion of children in the age group 18-23 months.

176 Demographic and Health Survey - 2016, Sri Lanka

Table 11.9.2 Micronutrient intake among children

Among all children 6-59 months, the percentages who were given vitamin A supplements in the six months preceding the survey, who were
given iron syrup in the past fourteen days, and who were given deworming medication in the six months preceding the survey, and among all
children aged 6-59 months who live in households that were tested for iodized salt, the percentage who live in households with iodized salt, by
background characteristics, Sri Lanka 2016
Among all children aged 6-59 months: Among children aged 6-59
months living in households
tested for iodized salt
Percentage Percentage Percentage
Percentage given vitamin A given dewor- living in
given iron supple- ments ming medica- house- holds
syrup in past in past 6 tion in past 6 Number of with iodized Number of
1 2 3 4
Background characteristic 14 days months months , children salt children

Sex
Male 7.3 54.7 65.7 3,844 95.6 3,790
Female 7.8 55.7 64.7 3,545 95.0 3,483

Breastfeeding status
Breastfeeding 7.7 59.6 58.6 4,107 95.2 4,042
Not breastfeeding 7.3 49.7 73.4 3,282 95.5 3,231

Mother's age at birth

15-19 12.3 60.2 43.6 56 98.3 54
20-29 7.1 57.0 62.1 2,738 95.1 2,691
30-39 7.7 54.2 67.0 4,034 95.5 3,976
40-49 7.7 53.0 69.6 562 94.4 551

Residence
Urban 11.6 52.9 62.3 1,149 95.0 1,133
Rural 6.9 55.8 65.7 5,914 95.3 5,819
Estate 4.2 52.0 65.3 326 97.2 321

District
Colombo 9.0 39.3 60.8 634 96.3 626
Gampaha 5.2 56.9 65.3 707 93.0 700
Kalutara 4.2 34.6 69.6 466 94.6 466
Kandy 4.5 45.7 59.6 519 95.7 503
Matale 5.3 74.6 82.3 191 97.7 187
Nuwara Eliya 4.2 50.0 70.5 253 98.5 247
Galle 5.2 47.8 60.6 392 94.9 382
Matara 5.1 76.1 72.9 309 95.7 308
Hambantota 1.5 66.9 72.0 232 100.0 226
Jaffna 14.4 53.8 60.8 193 99.5 187
Mannar 4.1 40.4 74.8 39 99.6 38
Vavuniya 11.0 39.2 43.5 58 94.8 58
Mullaitivu 1.6 68.7 50.6 35 97.8 34
Kilinochchi 13.3 64.9 62.4 41 95.5 41
Batticaloa 42.9 63.7 66.0 228 89.6 227
Ampara 9.9 70.0 60.2 323 98.9 323
Trincomalee 19.0 43.2 66.1 164 97.2 164
Kurunegala 5.3 37.8 64.1 618 92.7 604
Puttalam 10.0 64.7 51.2 270 82.4 255
Anuradhapura 5.9 53.3 60.2 385 95.5 377
Polonnaruwa 5.4 70.1 75.7 161 98.9 159
Badulla 4.9 61.7 69.7 275 95.9 265
Moneragala 7.8 69.1 69.0 217 97.2 216
Ratnapura 3.7 79.6 75.7 396 98.8 396
Kegalle 6.9 65.3 61.0 283 95.2 283

Mother's education
No education 6.3 65.6 53.1 53 90.2 52
Passed Grade 1-5 7.9 57.7 58.8 271 94.7 265
Passed Grade 6-10 7.3 55.3 65.9 3,219 94.4 3,173
Passed G.C.E.(O/L) or equivalent 8.4 52.9 65.3 1,640 95.1 1,614
Passed G.C.E.(A/L) or equivalent 6.9 57.2 66.0 1,776 97.0 1,743
Degree and above 8.6 51.9 62.1 431 96.8 426

Wealth quintile
Lowest 8.1 55.3 63.5 1,495 93.8 1,459
Second 6.8 56.4 65.5 1,520 94.1 1,492
Middle 7.1 55.1 67.4 1,460 95.4 1,440
Fourth 7.4 55.7 65.7 1,587 96.2 1,567
Highest 8.2 53.3 63.7 1,328 97.2 1,314

Total 7.5 55.2 65.2 7,389 95.3 7,273

1
Based on mother's recall
2
Based on both mother's recall and the Child Health Development Record (where available)
3
Deworming for intestinal parasites is commonly done for helminthes and for schistosomiasis.
4
Excludes children in households in which salt was not tested.

Nutrition of Children and Women 177

 According to Table 11.9.2 eight percent of all children aged 6-59 months were given iron syrup in
the fourteen days preceding the survey. Greater variation in the coverage of giving iron syrup in the past 14
days is observed in Batticaloa with the highest coverage of 43 percent compared to percentages in Mullaitivu
and Hambantota Districts (2 percent).
Periodic dosing (every six months) of vitamin A is one method of ensuring that children at risk do
not develop VAD. Table 11.9.2 also shows that more than half of the children aged 6-59 months were given
vitamin A (55 percent) in the past six months. There are only slight differences in the proportion of children
receiving vitamin A by background characteristics.

Figure 11.8 Percentage given Iron syrup and Vitamin A

by age group

80
75

61
53 51

9 11 10 9 7

6-8 9-11 12-17 18-23 24-59

Age group ( months)

Given Iron syrup in past 14 days Given vitamin A Mega dose in past 6 months

According to figure 11.8 , there are no large differences among percentages of children given iron
syrup in past 14 days (around 9 percent to 11 percent) up to age group 18-23 months after which it reduces to7
percent in age group 24-59 months. Over 80 percent of children have been given vitamin A before their first
birthday. Fifty-one percent of children aged 24-59 months of age received vitamin A in the past six months.
Periodic deworming for organisms such as helminthes can improve children’s micronutrient status.
Sixty-five percent of children received deworming medication in the six months before the survey. The
likelihood of receiving deworming medication increases with the child’s age. (see figure 11.9) However it
must be noted here that the preventive periodic deworming programme starts from the age of 18 months.

Figure 11.9 Percentage given deworming medication by

age groups
90

80 77
71
70

60
Percentage

50
42
40

30

20 14

10 6

0
6-8 9-11 12-17 18-23 24-59

Age group (months)

178 Demographic and Health Survey - 2016, Sri Lanka

 As mentioned in the previous section, iodine deficiency, most frequently caused by inadequate
iodine intake, has serious effects on physical growth and mental development. Fortification of salt with
iodine is the most common method of preventing iodine deficiency. Over ninety-five percent of children
aged 6-59 months live in households with adequately iodized salt. There are few differentials in this figure by
background characteristics. The percentage of children living in households that use adequately iodized salt
is lowest in the Puttalam District (eight-two percent).

11.9 Nutritional status of women

Low pre-pregnancy BMI and short stature of women are risk factors for poor birth outcomes and
delivery complications. The height of a woman is associated with past socio-economic status and nutrition
during childhood and adolescence. The cut-off point at which mothers can be considered at- risk because of
short stature is normally taken as below 145 cm. In developing countries being underweight during pregnancy
is the leading risk factor for preventable death and diseases (WHO, 2002).
The BMI is used to measure underweight or obesity. It is expressed as weight in kilograms divided by height
in meters squared (kg/m2). A cut-off point of 18.5 is used to define thinness or acute under-nutrition. A BMI
of 25 or above usually indicates being overweight, and 29.9 or above indicates obesity (WHO, 1995). The
prevalence of overweight women is a concern because it predisposes them to a wide range of health problems
such as diabetes and heart disease, as well as poor birth outcomes. On the other end of the continuum,
chronic energy deficiency of women leads to low work productivity and reduced resistance to illness. In the
2016 SLDHS measurements of weight and height was obtained for the majority of the ever-married women
included in the sample (92 percent).
Tables 11.10 presents the mean values of the two indicators of nutritional status and the proportion of women
falling into high-risk categories according to their background characteristics. Respondents for whom there
was no information on height and/or weight, or for whom the values obtained were implausible, are excluded
from this analysis. The data analysis on BMI is based on 16,806 ever-married women, while the height
analysis is based on 17,888 ever-married women aged 15-49 years (98 percent).

11.9.1 Height of women

In 2016, 7 percent of ever-married women fall below the cut-off of 145 cm. This value is slightly
lower than the approximately 11 percent reported in 2006. Small stature is higher among women 40 and older
than those under that age. The prevalence of shortness decreases as women’s education and household wealth
increase (11 percent among the poorest quintile compared to only 4 percent for the richest quintile).
The prevalence of short stature among ever-married women in the estate sector is three time shigher
than that observed among those residing in the urban sector (15 and 5 percent, respectively). Variations are
also observed across districts, with higher percentages of women below 145 cm in Nuwara-Eliya (13 percent)
and Ratnapura (15 percent).

11.9.2 Body mass index (bmi) of women

Body mass index (BMI)

BMI is calculated by dividing weight in kilograms by height in metres squared (kg/m2). A BMI less
than 18.5 indicates that the woman is too thin for her height and has a chronic energy deficiency. At
the other end of the scale, women are considered overweight if their BMI falls between 25.0 and 29.9
and are obese if their BMI is greater than or equal to 30.0.
sample : Women age15-49 who are not pregnant and who have not had a birth in the 2 months
before the survey

Nutrition of Children and Women 179

 The mean BMI for ever-married women age 15-49 years is 24.8. This value is an increase from 23.1
as measured in 2006-07. From the BMI distribution, we can see that only 46 percent of the ever-married
women have a normal BMI (between 18.5 and 24.9). Of the 54 percent remaining, 9 percent are considered
thin (BMI<18.5), 32 percent overweight (BMI between 25.0 and 29.9), and 13 percent obese (BMI of 30 or
higher) (Table 11.10).
The prevalence of thinness varies with the place of residence of the woman (22 percent among ever-
married women residing in the estates sector, compared to less than seven percent among those of the urban
and rural sectors. Women in the districts of Ratnapura (15 percent) and Killinochci (14 percent) have the
highest prevalence of thinness.
Most women who are thin are mildly thin (5 percent); however, 4 percent of women are moderately
or severely thin (BMI<17), which indicates chronic energy deficiency. Moderate to severe thinness is highest
in the youngest age group (11 percent). Women in the estate sector are three times as likely to be in this
category as urban and rural woman. As with low stature, the prevalence of severe and moderate thinness
decreases with the level of education of the woman and wealth of the household.
Forty-five percent of ever-married women are overweight or obese (BMI>25). The percentage of
women who are overweight or obese increases with the age of the woman, their level of education, and the
wealth of their households. Compared to 2006-07, the percentage of ever-married women overweight or
obese has increased substantially. Thus, in the last ten years, the percentage of overweight women increased
by 33 percent (from 24 percent in 2006-07 to 32 percent in 2016), while the percentage of obese ever-married
women increased from 7 percent to 13 percent during the same period.
The prevalence of overweight and obesity is much higher among women living in the urban sector
(36 percent and 20 percent, respectively) than in the rural or estates sectors. The prevalence of overweight
and obesity is positively associated with the level of education of the woman and the wealth of the household
in which they reside (Table 11.10). By district, the prevalence of overweight and obesity is at the highest
points in Colombo (37 and 19 percent), Gampaha (35 and 16 percent), and in Mannar (39 and 16 percent).

180 Demographic and Health Survey - 2016, Sri Lanka

Table 11.10 Nutritional status of women

Among ever married women aged 15-49, the percentage with height under 145 cm, mean Body Mass Index (BMI), and the percentage with
specific BMI levels, by background characteristics, Sri Lanka 2016
Height Body Mass Index1

Perce
nt- Mean <17 >=25.0
age Number Body (Moderatel (Total 25.0- Number
below of ever- Mass 18.5-24.9 <18.5 17.0-18.4 y and over- 29.9 of ever-
145 married Index (Total (Total (Mildly severely weight or (Over- >=30.0 married
Background characteristic cm women (BMI) normal) thin) thin) thin) obese) weight) (Obese) women

Age
15-19 7.2 219 21.9 56.1 22.9 11.5 11.4 20.9 15.8 5.2 170
20-29 5.3 3,930 23.3 51.0 16.3 9.2 7.0 32.8 24.4 8.4 3,383
30-39 6.1 7,406 24.9 46.3 7.8 4.8 3.0 45.9 32.3 13.6 6,943
40-49 9.6 6,332 25.5 41.8 6.2 3.8 2.3 52.0 36.1 15.9 6,310

Residence
Urban 5.2 2,790 26.1 38.6 5.6 3.0 2.6 55.8 35.8 20.1 2,629
Rural 7.2 14,427 24.6 46.6 9.1 5.5 3.6 44.2 31.9 12.4 13,558
Estate 14.9 671 22.2 54.6 22.0 12.7 9.3 23.4 17.3 6.1 620

District
Colombo 5.8 1,703 26.1 39.0 4.6 2.7 1.9 56.4 37.1 19.4 1,604
Gampaha 4.8 1,832 25.4 42.2 6.6 3.9 2.7 51.2 35.1 16.1 1,718
Kalutara 7.2 1,095 24.8 45.9 9.0 5.6 3.3 45.1 31.3 13.8 1,043
Kandy 9.9 1,191 24.8 47.6 7.9 5.8 2.1 44.5 30.6 13.9 1,120
Matale 9.2 488 24.9 44.9 8.3 4.8 3.4 46.9 31.7 15.2 454
Nuwara Eliya 12.7 545 23.6 53.4 13.4 7.3 6.1 33.3 22.8 10.5 518
Galle 7.1 902 24.2 46.0 12.3 7.5 4.9 41.7 31.0 10.7 850
Matara 8.3 705 24.1 49.6 12.3 6.6 5.7 38.1 26.0 12.2 665
Hambantota 6.5 478 24.1 47.7 10.7 4.0 6.7 41.5 31.6 9.9 438
Jaffna 3.7 463 25.0 45.0 7.4 4.4 3.0 47.6 34.9 12.7 440
Mannar 3.0 81 25.4 37.8 7.6 4.1 3.5 54.6 38.6 15.9 75
Vavuniya 5.8 135 24.8 46.6 7.9 6.4 1.5 45.5 32.4 13.0 130
Mullaitivu 5.9 80 24.2 52.0 8.9 6.1 2.9 39.1 27.7 11.3 79
Kilinochchi 3.5 93 23.8 50.1 14.0 9.9 4.1 35.9 24.0 11.8 88
Batticaloa 6.1 528 25.0 40.7 10.7 5.4 5.3 48.7 31.8 16.9 496
Ampara 5.6 725 25.0 45.4 8.4 5.2 3.2 46.2 31.6 14.5 669
Trincomalee 8.0 351 25.5 41.0 7.4 4.6 2.9 51.5 33.5 18.0 324
Kurunegala 7.1 1,584 24.4 48.3 9.5 5.2 4.3 42.2 32.1 10.1 1,481
Puttalam 4.5 655 25.5 41.3 7.6 3.6 4.0 51.1 32.8 18.2 617
Anuradhapura 6.0 978 24.8 47.9 7.4 4.7 2.6 44.7 32.7 12.0 917
Polonnaruwa 5.9 392 24.1 49.3 12.0 6.3 5.6 38.7 26.6 12.1 360
Badulla 8.7 708 24.1 50.1 9.7 7.7 2.0 40.2 31.9 8.3 665
Moneragala 6.5 469 24.3 48.1 9.7 6.5 3.2 42.2 31.8 10.5 440
Ratnapura 11.8 1,073 23.7 46.2 15.2 8.9 6.2 38.6 29.7 8.9 1,022
Kegalle 7.7 634 24.5 48.8 8.5 5.3 3.2 42.8 32.1 10.7 594

Education
No education 23.9 279 23.3 53.1 15.9 10.2 5.7 31.0 21.4 9.6 276
Passed Grade 1-5 14.2 1,229 24.4 44.8 13.3 7.3 6.0 41.9 27.3 14.6 1,202
Passed Grade 6-10 8.2 7,927 24.6 46.7 9.7 5.7 4.0 43.6 30.4 13.2 7,503
Passed G.C.E.(O/L) or
equivalent 4.9 3,958 25.0 44.1 7.7 4.8 2.9 48.2 34.5 13.6 3,691
Passed G.C.E.(A/L) or
equivalent 4.3 3,654 25.0 45.0 8.0 4.8 3.2 47.0 33.5 13.4 3,387
Degree and above 5.2 841 25.2 44.7 4.8 3.1 1.7 50.4 38.5 11.9 748

Wealth quintile
Lowest 10.9 3,290 23.2 50.9 16.1 8.9 7.3 33.0 24.5 8.5 3,109
Second 8.8 3,600 24.2 48.5 11.4 6.8 4.6 40.1 28.8 11.3 3,399
Middle 6.8 3,748 24.7 47.1 8.1 5.2 2.9 44.8 32.4 12.4 3,524
Fourth 5.7 3,738 25.3 43.3 6.1 3.8 2.3 50.6 35.3 15.3 3,465
Highest 4.1 3,512 26.2 38.9 4.1 2.5 1.5 57.1 38.2 18.8 3,309

Total 7.2 17,888 24.8 45.7 9.1 5.4 3.7 45.3 31.9 13.3 16,806
Note: The Body Mass Index (BMI) is expressed as the ratio of weight in kilograms to the square of height in meters (kg/m2).
1
Excludes pregnant women and women with a birth in the preceding 2 months

11.10 Foods consumed by mothers

Mother’s consumption of a variety of nutritious foods influences the health condition of mothers
and their children. Adequate amounts of carbohydrates, protein, fat, vitamins and minerals are required for a
well-balanced diet. The 2016 SLDHS includes a set of questions to inquire about the type of foods consumed
by mothers of children under 3 years of age, during the day or night preceding the interview. Food consump-
tion was obtained with a 24-hour dietary recall.

Demography and Health Survey - 2016

Nutrition of Children and Women 181
180
 Eighty-eight percent of mothers had eaten vitamin A rich food, and 62 percent had eaten animal
protein (other than dairy). Sixty-nine percent of women ate legumes or legume –based food in the previous
day. The consumption of animal protein (other than dairy) increases with the level of education of the moth-
er and wealth of the household. In the estate sector, the consumption of all protein sources such as milk,
meat/fish/poultry/ eggs, legumes and cheese/ yogurt is lower than in urban and rural areas. Sugary foods
and foods made with oil/fat/butter are most commonly consumed by the mothers in urban sectorsrather than
rural or estate sector mothers. Mothers in the lowest wealth quintile have less variety in their diets than those
in the highest wealth quintile, a diet that is particularly deficient in the consumption of cheese/yogurt. The
consumption of cheese/yogurt in the highest wealth quintile mothers is approximately 3 times of that of the
lowest wealth quintile.

Table 11.11 Foods consumed by mothers in the day or night preceding the interview

Among mothers aged 15-49 with a child under age three years living with them, the percentage who consumed specific types of foods in the day or
night preceding the interview, by background characteristics, Sri Lanka 2016
Liquids Solid or semi-solid foods

Foods Meat/ Other Foods

Foods made Foods fish/ solid or made
made from made shellfish/ Vitamin A - semi- with oil/ Number
Background Tea/ Other from roots/ from poultry/ Cheese/ rich fruits/ Other fruits/ solid fat/ Sugary of
characteristic Milk coffee liquids grains tubers legumes eggs yogurt vegetables vegetables food butter foods women

Age
15-19 17.7 87.3 31.9 96.5 53.9 64.2 55.5 20.3 85.4 43.2 89.0 49.4 25.6 70
20-29 18.0 89.9 26.9 95.6 53.1 68.1 61.7 21.2 87.5 50.3 88.9 45.5 27.3 1,952
30-39 18.6 91.8 23.7 95.9 55.3 68.8 63.4 22.1 89.1 52.6 89.0 47.5 28.0 2,272
40-49 16.8 92.0 24.0 97.5 60.6 73.1 54.9 20.3 86.7 56.7 93.5 56.5 33.4 223

Residence
Urban 23.2 89.4 34.9 94.1 55.1 64.3 73.7 26.6 85.2 50.8 83.4 49.6 35.5 708
Rural 17.5 91.2 23.5 96.4 54.6 69.5 60.6 21.1 89.2 51.8 90.4 46.7 26.4 3,620
Estate 14.5 92.7 21.5 93.6 52.0 68.0 47.4 12.6 81.1 52.6 86.8 45.6 28.9 189

District
Colombo 17.3 90.5 39.0 96.7 58.1 68.1 71.1 29.6 88.9 49.2 83.1 53.1 37.5 412
Gampaha 15.1 91.5 25.8 98.7 55.7 72.6 63.8 23.4 85.1 50.8 87.1 56.1 26.2 383
Kalutara 10.4 97.8 15.8 98.9 56.5 86.1 61.7 17.2 92.4 63.9 86.5 44.5 15.0 285
Kandy 36.2 88.9 26.5 99.2 45.4 68.8 46.4 23.9 83.9 55.1 89.5 65.6 34.1 322
Matale 10.9 94.4 28.3 98.5 42.8 75.0 58.4 25.5 95.5 46.9 98.5 84.3 36.0 113
Nuwara Eliya 13.1 92.4 16.5 92.6 57.5 66.7 50.3 16.3 88.4 55.9 89.0 43.2 30.4 146
Galle 6.0 86.3 20.2 98.9 45.9 78.4 57.6 24.7 88.5 63.1 94.8 65.3 33.0 236
Matara 6.2 94.5 16.7 90.5 53.7 83.3 68.9 26.2 91.2 69.5 97.1 62.2 30.7 183
Hambantota 15.8 85.1 31.5 97.9 63.3 83.7 76.8 47.2 92.6 84.8 97.2 68.0 28.4 149
Jaffna 68.7 85.9 38.2 88.7 57.4 43.4 58.0 15.8 73.2 48.1 81.1 39.4 30.7 115
Mannar 48.9 80.0 33.6 94.3 46.9 36.5 87.9 20.8 69.0 30.1 83.4 56.4 25.1 20
Vavuniya 57.7 83.9 24.9 90.3 46.5 19.7 60.8 6.7 75.5 36.7 68.5 13.2 28.5 30
Mullaitivu 65.6 95.6 19.7 99.2 50.3 37.0 68.1 4.0 75.6 40.0 72.9 30.9 9.1 21
Kilinochchi 60.9 82.6 29.7 74.6 39.8 29.9 67.0 8.4 79.8 21.1 61.6 39.8 16.6 21
Batticaloa 35.7 92.6 28.2 94.1 53.5 38.9 80.9 19.1 78.7 44.1 80.8 16.5 41.6 137
Ampara 25.1 85.0 19.4 73.4 56.7 49.4 80.6 22.8 78.4 53.0 84.9 29.7 24.6 197
Trincomalee 20.5 83.4 44.1 95.0 54.4 34.7 86.7 19.4 78.9 58.0 88.5 19.4 24.5 106
Kurunegala 11.5 90.6 19.9 97.5 54.9 68.6 54.1 17.4 89.5 45.8 93.4 32.8 29.1 388
Puttalam 14.7 97.0 26.7 97.4 68.9 65.1 63.1 13.1 97.7 37.3 86.5 30.4 25.8 156
Anuradhapura 14.8 97.2 51.7 98.1 72.0 71.9 75.4 24.4 97.3 53.0 93.3 18.2 27.6 250
Polonnaruwa 30.9 88.2 12.7 97.8 58.0 66.3 58.7 20.3 94.4 40.8 94.0 51.4 30.0 114
Badulla 9.3 89.9 17.6 96.5 35.6 63.4 45.5 12.9 92.3 47.8 86.6 30.6 21.4 168
Moneragala 2.0 93.6 13.8 97.8 40.1 80.5 53.5 6.6 90.7 23.2 82.1 52.8 7.1 140
Ratnapura 20.0 92.4 16.2 100.0 49.3 77.8 50.5 17.5 82.1 61.0 95.2 66.9 33.3 249
Kegalle 4.3 88.9 14.3 95.9 65.7 74.3 53.6 24.4 98.1 28.3 92.9 46.0 12.9 178

Education
No education (16.0) (98.3) (6.0) (100.0) (58.8) (63.3) (46.8) (8.1) (69.3) (31.7) (73.0) (49.9) (20.5) 32
Passed Grade
1-5 17.9 90.6 22.6 91.1 39.6 59.9 56.4 11.8 74.6 41.3 78.8 38.3 27.7 143
Passed Grade
6-10 17.1 91.0 19.6 95.3 48.6 64.1 56.3 15.6 85.2 48.3 88.1 42.0 24.8 1,931
Passed
G.C.E.(O/L) or
equivalent 19.2 91.0 28.8 95.4 56.9 66.5 64.2 23.1 88.5 51.4 90.1 46.7 27.9 979
Passed
G.C.E.(A/L) or
equivalent 17.9 91.0 29.5 97.3 61.4 76.6 67.6 28.4 93.7 57.5 91.8 54.2 31.5 1,134
Degree and
above 24.0 90.1 36.8 97.9 66.4 79.9 76.4 35.9 94.8 59.1 89.6 58.9 35.4 298

Wealth quintile
Lowest 19.7 91.0 18.3 93.9 45.3 57.7 55.5 12.7 79.3 46.3 85.3 37.6 21.6 859
Second 17.9 89.7 22.3 95.8 50.3 66.7 55.7 14.3 87.0 47.2 89.3 41.2 22.9 903
Middle 17.3 91.6 24.5 95.7 57.5 70.0 58.5 18.4 89.6 52.5 92.0 48.6 30.1 905
Fourth 15.3 90.6 27.7 96.5 58.8 72.1 67.0 27.6 92.3 54.4 90.7 50.4 31.3 990
Highest 21.5 91.9 33.1 97.4 60.4 76.3 73.7 34.6 92.3 57.8 88.1 57.5 33.3 861

Total 18.2 90.9 25.2 95.9 54.6 68.7 62.1 21.6 88.2 51.7 89.2 47.1 27.9 4,518
Note: Foods consumed in the last "24-hour" period (yesterday and last night).
1
Includes [list fruits and vegetables included in the questionnaire such as pumpkin, or yellow yams or squash, carrots, yellow sweet potatoes, green leafy
vegetables, mangoes, papayas, and other locally grown fruits and vegetables that are rich in vitamin A]

182 Demographic and Health Survey - 2016, Sri Lanka

11.11 Micronutrient intake Table 11.12 Micronutrient intake among mothers

among mothers Among ever-married women age 15-49 with a child born in the 5 years preceding the
survey, percentage who took deworming medication during the pregnancy of the last
Low nutritional status is child; and among women age 15-49 with a child born in the 5 years preceding the
survey and who live in households that were tested for iodized salt, percentage who live
one of the most important health in households with iodized salt, according to background characteristics, Sri Lanka 2016
and welfare problems in Sri Lan- Among women
with a child born in
ka. Young children and women of the last five years,
reproductive age are especially who live in
households that
vulnerable to nutritional deficits were tested for
and micronutrient deficiencies. iodized salt
Micronutrient intake can improve Percentage of
women
the nutritional and immune status who took
of pregnant women and conse- deworming
medication Percentage
quently, prevent maternal and ne- during living in house-
onatal deaths. Micronutrient de- Background pregnancy of Number of holds with Number of
characteristic last birth women iodized salt1 women
ficiencies during pregnancy may
be caused by inadequate intake of Age
15-19 100.0 75 98.7 74
meat, fruits and vegetables or by 20-29 97.3 2,727 95.3 2,684
infections (WHO, 2011). 30-39 96.6 3,788 95.6 3,734
40-49 97.0 548 94.2 538
Parasitic infections may
cause iron-deficiency anemia. Residence
Urban 95.4 1,114 95.2 1,098
Deworming during pregnancy is Rural 97.3 5,728 95.3 5,640
an effective preventive measure Estate 95.9 296 97.6 291

against this type of anemia and District

can improve both the health of Colombo 94.0 631 96.5 624
Gampaha 95.9 666 93.8 658
the woman and her unborn child. Kalutara 98.1 443 95.4 442
In the 2016 SLDHS, all ever mar- Kandy 93.9 489 96.4 474
Matale 98.8 192 97.5 188
ried women aged 15-49 with a Nuwara Eliya 97.0 232 98.7 229
birth in the five years preceding Galle 98.5 380 94.8 372
Matara 98.7 291 95.1 290
the survey were asked if they Hambantota 99.5 233 100.0 228
ever took any drug for intestinal Jaffna 96.2 170 99.5 165
worms during the pregnancy of Mannar 98.0 35 99.6 35
Vavuniya 96.6 53 95.6 53
their last birth. Table 11.12 shows Mullaitivu 99.8 32 97.6 31
that, overall, 97 percent of these Kilinochchi 97.0 40 93.9 39
Batticaloa 98.9 217 88.6 217
women took deworming medi- Ampara 99.4 305 98.6 304
cation during the pregnancy of Trincomalee 97.8 168 96.0 168
Kurunegala 98.7 613 92.4 598
their last birth. This high percent- Puttalam 97.8 262 83.7 248
age presents small variations by Anuradhapura 99.3 369 96.0 363
Polonnaruwa 100.0 167 99.0 164
background characteristics of the Badulla 98.3 271 95.0 263
mother, in particular for younger Moneragala 98.3 208 97.6 208
mothers (less than age 20) who Ratnapura 99.5 393 98.8 393
Kegalle 80.9 275 94.6 275
appear to be more likely to take
deworming medication during Education
No education 93.9 51 92.2 49
pregnancy than older women. Passed Grade 1-5 97.4 257 94.6 253
No reasonable variations are ob- Passed Grade 6-10 97.9 3,104 94.6 3,059
Passed G.C.E.(O/L)
served among mother’s residen- or equivalent 96.6 1,608 95.2 1,581
tial sector nor in the wealth quin- Passed G.C.E.(A/L)
or equivalent 96.4 1,706 96.9 1,679
tiles from lowest to highest. Degree and above 92.6 413 97.1 408

Wealth quintile
Lowest 96.5 1,413 93.6 1,382
Second 97.4 1,457 94.3 1,432
Middle 98.0 1,463 95.7 1,442
Fourth 97.6 1,524 96.3 1,505
Highest 94.7 1,280 97.1 1,268

Total 96.9 7,138 95.4 7,029

1 Excludes women in households where salt was not tested.

HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR 183

184 Demographic and Health Survey - 2016, Sri Lanka
HIV/AIDS-RELATED KNOWLEDGE,
ATTITUDES,AND BEHAVIOR 12
• Knowledge about HIV transmission and prevention: Awareness of
HIV/AIDS is almost universal in Sri Lanka. Ninety-three percent of ev-
er-married women aged 15-49 have heard about HIV/AIDS.
• Comprehensive knowledge: Only 33 percent of ever-married women
aged 15-49 have comprehensive knowledge about HIV/AIDS prevention
and transmission.
• HIV among young adults: Among young (15-24) ever-married women,
comprehensive knowledge about HIV/AIDS is very low (24%). Among
ever-married women aged 18-24, 32% reported having their first sexual
intercourse before age 18.
• Knowledge of mother-to-child transmission: Over 70 percent of ev-
er-married women aged 15-49, are aware that HIV can be transmitted
through breastfeeding (73 percent) and another 63 percent know that
mother-to-child transmission (MTCT) can take place during delivery.
• Coverage of HIV tests: Only 10 percent of all ever-married women, were
tested for HIV during the last 12 months before the survey and of those
tested, only 73 percent received the results from the test.

A
cquired immune deficiency syndrome (AIDS) is caused by the human immune deficiency virus
(HIV), which weakens the immune system and makes the body susceptible to and unable to recover
from other opportunistic diseases that can lead to death. The predominant modes of HIV transmis-
sion are through sexual contact; mother-to-child transmission, in which the mother passes the virus to her
child during pregnancy, delivery, or breastfeeding; use of contaminated blood supplies for transfusions; and
injections using contaminated needles or syringes.
Since the identification of the first HIV infected Sri Lankan in 1987, a cumulative total of 2,308 HIV
positive persons have been reported up to the end of 2015. In 2015, 235 HIV cases had been reported to the
National STD/AIDS control program (NSACP) which is responsible for coordinating, planning and imple-
menting the HIV National Strategic Plan and the AIDS Policy in the country. However, the reported numbers
represent only a fraction of HIV infected people in the country, as many infected persons may perhaps not be
aware of their HIV status and in addition, stigma and discrimination towards HIV infected people adversely
affect voluntary testing for HIV (2015, Annual Repot NSACP).
HIV infection is not a notifiable condition in Sri Lanka. Therefore, HIV case reporting is not a robust
method of knowing the HIV situation in the country. However, NSACP is one of the main sources of data
available in the country. Since Western-Blot, the confirmatory test for HIV, is available only at the National
reference laboratory of the NSACP, all confirmed HIV positive cases get reported. However, it is not un-
common to find incomplete basic epidemiological information about the infected persons. Further, another
concern is ‘double counting’ as some persons get tested more than once after the initial test results reveal that
they are HIV positive, in order to recheck their HIV status. However, NSACP has taken all possible efforts
to avoid these errors by rechecking laboratory data.
The 2016 SLDHS questionnaire included a series of questions that ask about respondents’ knowledge
of HIV prevention, misconceptions about HIV transmission, and knowledge of mother to child transmission
(MTCT) of HIV and means to prevent it. The survey also included questions relating to HIV testing such
as whether the respondent had ever been tested for HIV and received results. Respondents were also asked
their experiences with regard to symptoms of sexually transmitted infections (STIs) and their health seeking
behaviors relating to STIs. The chapter also highlights HIV/AIDS knowledge and patterns of sexual behav-

HIV/AIDS-Related Knowledge, Attitudes, and Behavior 185

 12.1 HIV/AIDS KNOWLEDGE, TRANSMISSION, AND PREVENTION METHO

Working Table 12.1 Knowledge of HIV or AIDS

ior among young people, since young adults are
more likely to be in the process of establishing
patterns of sexual behaviors and hence are the Percentage of ever-married women age 15-49 who have heard of AIDS, by
background characteristics, Sri Lanka 2016
primary target of many prevention strategies. Women

In the survey, information was

Have heard Number of
collected from ever-married women aged 15- Background characteristic of AIDS respondents
49, about knowledge, attitudes and behaviors
towards HIV/AIDS; and testing. Data are Age
presented at the national level as well as within 15-24 90.2 1,639
15-19 83.3 229
different subgroups according to background 20-24 91.4 1,410
characteristics. Information provided in this 25-29 93.9 2,620
chapter will be useful for service providers in 30-39 93.9 7,560
identifying various socio-economic as well 40-49 91.7 6,483
as geographic subgroups who are lacking Marital status
knowledge on HIV/AIDS and hence are at risk Married/Living together 93.1 17,257
of being infected. Divorced/Separated/Widowed 87.7 1,045

Residence
Urban 95.5 2,855
12.1 Hiv/aids knowledge, transmis- Rural 93.8 14,737
sion, and prevention methods Estate 60.4 710

District
Colombo 97.6 1,731
12.1.1. Awareness of hiv/aids Gampaha 97.3 1,845
Kalutara 94.9 1,104
The 2016 SLDHS asked respondents Kandy 90.6 1,223
whether they have heard of an illness called Matale 98.0 490
AIDS. Table 12.1 shows the percentage of ever- Nuwaraeliya 71.7 572
married women aged 15-49 who have heard of Galle 94.1 935
Matara 90.2 718
AIDS, by background characteristics. In Sri
Hambantota 93.9 556
Lanka, knowledge of AIDS is virtually universal. Jaffna 97.4 471
There is no noticeable variation in awareness by Mannar 93.2 81
respondents’ background characteristics. This Vavuniya 81.3 136
is consistent with the 2006-07 SLDHS. In the Mullaitivu 93.0 81
Killinochchi 77.2 94
absence of a cure or a vaccine for HIV/AIDS, Batticaloa 84.0 531
preventive measures contribute immensely to Ampara 93.2 731
reducing the spread of the infection. This can Trincomalee 94.3 362
be achieved only if individuals have accurate Kurunegala 93.7 1,592
Puttalam 94.7 664
knowledge about the infection.
Anuradhapura 93.0 984
Although ever-married women from Polonnaruwa 93.4 399
urban and rural areas have a very high awareness Badulla 80.6 735
Monaragala 93.8 485
about HIV/AIDS (94 percent for both groups), Ratnapura 91.9 1,084
only 60 percent of their counterparts living in Kegalle 98.5 698
the estate areas are aware of HIV/AIDS. Only 72
Education
percent of ever-married women in Nuwaraeliya No education 52.9 285
district—which predominantly consists of Passed Grade 1-5 71.8 1,257
estates—have heard of the disease, compared Passed Grade 6-10 91.7 8,130
with well over 90 percent of women in all the Passed G.C.E.(O/L) or equivalent 96.9 4,044
Passed G.C.E.(A/L) or equivalent 99.3 3,731
other districts (except Vavuniya, Killinochchi,
Degree and above 99.6 856
and Batticaloa). Among ever-married women
age 15-24, 90 percent have heard about HIV/ Wealth quintile
AIDS, a very positive step toward progress in Lowest 80.4 3,390
the prevention of HIV/AIDS. Second 91.7 3,694
Middle 95.4 3,840
Moreover, there is a positive Fourth 97.1 3,817
association between the level of knowledge Highest 98.4 3,561
Total 15-49 92.8 18,302
and both education level and household wealth.

186 Demographic and Health Survey - 2016, Sri Lanka

Demography and Health Survey - 2016
Knowledge of HIV/AIDS among women with higher education is almost universal, whereas only 53 percent
of women who have no education have heard of HIV/AIDS. Although, this percentage has not changed since
the 2006-07 SLDHS, the size of the “no education” category in the sample has substantially declined.

12.1.2 Knowledge of hiv prevention

Among adults, HIV is mainly transmitted through sexual contact between an infected partner and an
uninfected partner. Most HIV/AIDS programs have been promoting mutual monogamy and using condoms
as the primary ways of avoiding HIV infection. Understanding and effectively promoting these behaviors
are crucially important in combating the spread of HIV/AIDS. In the 2016 SLDHS, if a respondent reported
that she had heard of HIV/AIDS, she was asked questions on whether limiting sexual intercourse to one
uninfected partner (being faithful), and correct and consistent use of condoms can reduce the chances of
getting HIV/AIDS.
Table 12.2 shows that knowledge about condom use and limiting sexual partners as methods of
avoiding HIV transmission is generally high and widespread. Almost 68 percent of ever-married women
know that the risk of getting HIV can be reduced by using condoms. Seventy-nine percent of ever-married
women know that limiting sexual intercourse to one uninfected partner can reduce the chances of contracting
HIV. Sixty-three percent of ever-married women are aware of both of these prevention methods. Young ever-
married women aged 15-19 are least likely among all age groups to be aware of both prevention methods (46
percent), an important finding for policy and program development.
Knowledge of HIV prevention is higher among women who are currently married than among those
who are divorced, separated, or widowed. Compared with other sectors, knowledge is really low among
ever-married women in the estate sector, less than 35 percent of whom know that the risk of getting HIV
transmission can be reduced by using condoms, and only 40 percent of whom know it can be reduced by
limiting sexual intercourse to one partner. Similarly, the lowest level of knowledge is observed in Trincomalee,
Nuwaraeliya, Batticaloa and Badulla districts.

HIV/AIDS-Related Knowledge, Attitudes, and Behavior 187

 12.1.2
12.1.2 Knowledge of Knowledge of HIV Prevention
HIV Prevention

Table
Table 12.2 Knowledge 12.2prevention
of HIV Knowledge of HIV prevention methods
methods

Percentage of women Percentage

age 15-49ofwho,
women age 15-49
in response to who, in response
prompted to prompted
questions, questions,
say that people say thatthe
can reduce people can
risk of reduce
getting HIVthebyrisk of getting HIV by
using condoms everyusing
timecondoms
they haveevery
sexualtime they haveand
intercourse, sexual intercourse,
by having andpartner
one sex by having
whoone sex infected
is not partner who is not
and has no infected
other and has no other
partners,
partners, by background by background
characteristics, characteristics,
Sri Lanka 2016 Sri Lanka 2016

Women Women
Using condoms and Using condoms and
limiting sexual limiting sexual
Limiting sexual
Limiting sexual intercourse to one intercourse to one
intercourse to one intercourse to one
uninfected uninfected
12 2 1,2
Background characteristic
Background characteristic Using condoms
1 Using condoms
uninfected partner uninfected partner
partner1,2 Number partner
of women Number of women

Age Age
15-24 15-24 60.3 60.3
73.0 73.0
54.7 54.7
1,639 1,639
15-19 15-19 51.4 51.4
62.8 62.8
45.7 45.7
229 229
20-24 20-24 61.7 61.7
74.7 74.7
56.2 56.2
1,410 1,410
25-29 25-29 68.2 68.2
80.2 80.2
63.1 63.1
2,620 2,620
30-39 30-39 70.3 70.3
80.5 80.5
65.6 65.6
7,560 7,560
40-49 40-49 66.4 66.4
77.8 77.8
62.2 62.2
6,483 6,483

Marital status Marital status

Married/Living together
Married/Living together 68.2 68.2
79.4 79.4
63.6 63.6
17,257 17,257
Divorced/Separated/Widowed 60.1
Divorced/Separated/Widowed 60.1
70.3 70.3
54.8 54.8
1,045 1,045

Residence Residence
Urban Urban 68.2 68.2
81.1 81.1
64.9 64.9
2,855 2,855
Rural Rural 69.3 69.3
80.1 80.1
64.3 64.3
14,737 14,737
Estate Estate 34.0 34.0
43.0 43.0
30.0 30.0
710 710

District District
Colombo Colombo 71.9 71.9
83.8 83.8
68.4 68.4
1,731 1,731
Gampaha Gampaha 74.3 74.3
88.9 88.9
70.4 70.4
1,845 1,845
Kalutara Kalutara 66.0 66.0
83.1 83.1
62.3 62.3
1,104 1,104
Kandy Kandy 60.7 60.7
73.7 73.7
54.7 54.7
1,223 1,223
Matale Matale 68.7 68.7
80.7 80.7
62.7 62.7
490 490
Nuwaraeliya Nuwaraeliya 44.5 44.5
56.4 56.4
41.6 41.6
572 572
Galle Galle 77.5 77.5
86.2 86.2
73.7 73.7
935 935
Matara Matara 75.7 75.7
84.9 84.9
74.8 74.8
718 718
Hambantota Hambantota 65.6 65.6
78.0 78.0
61.4 61.4
556 556
Jaffna Jaffna 67.1 67.1
77.6 77.6
61.7 61.7
471 471
Mannar Mannar 63.8 63.8
64.0 64.0
60.2 60.2
81 81
Vavuniya Vavuniya 61.9 61.9
69.3 69.3
58.4 58.4
136 136
Mullaitivu Mullaitivu 68.0 68.0
80.3 80.3
62.3 62.3
81 81
Killinochchi Killinochchi 58.6 58.6
61.4 61.4
51.1 51.1
94 94
Batticaloa Batticaloa 46.0 46.0
61.7 61.7
42.7 42.7
531 531
Ampara Ampara 58.4 58.4
67.9 67.9
55.8 55.8
731 731
Trincomalee Trincomalee 47.4 47.4
62.3 62.3
39.6 39.6
362 362
Kurunegala Kurunegala 68.2 68.2
81.4 81.4
63.9 63.9
1,592 1,592
Puttalam Puttalam 69.2 69.2
79.1 79.1
60.1 60.1
664 664
Anuradhapura Anuradhapura 80.0 80.0
82.5 82.5
75.9 75.9
984 984
Polonnaruwa Polonnaruwa 67.5 67.5
79.3 79.3
62.1 62.1
399 399
Badulla Badulla 52.7 52.7
63.4 63.4
46.5 46.5
735 735
Monaragala Monaragala 73.7 73.7
86.6 86.6
70.0 70.0
485 485
Ratnapura Ratnapura 70.6 70.6
82.5 82.5
65.6 65.6
1,084 1,084
Kegalle Kegalle 81.0 81.0
77.3 77.3
70.1 70.1
698 698

Education Education
No education No education 24.0 24.0
32.5 32.5
20.3 20.3
285 285
Passed Grade 1-5 Passed Grade 1-5 35.3 35.3
46.4 46.4
30.5 30.5
1,257 1,257
Passed Grade 6-10 Passed Grade 6-10 62.8 62.8
76.0 76.0
58.1 58.1
8,130 8,130
Passed G.C.E.(O/L) orPassed G.C.E.(O/L) or equivalent74.7
equivalent 74.7
83.4 83.4
68.8 68.8
4,044 4,044
Passed G.C.E.(A/L) orPassed G.C.E.(A/L) or equivalent81.0
equivalent 81.0
91.2 91.2
77.2 77.2
3,731 3,731
Degree and above Degree and above 85.8 85.8
94.0 94.0
82.7 82.7
856 856

Wealth quintile Wealth quintile

Lowest Lowest 48.8 48.8
61.6 61.6
44.6 44.6
3,390 3,390
Second Second 63.3 63.3
74.6 74.6
58.2 58.2
3,695 3,695
Middle Middle 70.4 70.4
81.3 81.3
65.0 65.0
3,838 3,838
Fourth Fourth 74.4 74.4
85.7 85.7
69.8 69.8
3,816 3,816
Highest Highest 80.2 80.2
89.8 89.8
76.3 76.3
3,562 3,562

Total 15-49 Total 15-49 67.7 67.7

78.8 78.8
63.1 63.1
18,302 18,302
1
Using condoms everyUsing condoms
haveevery
sexualtime they have sexual intercourse
1
time they intercourse
2
2 Partner
Partner who has no other who has no other partners
partners

188 Demographic and Health Survey - 2016, Sri Lanka

 As shown in Figure 12.1, level of education has a strong positive association with the level of knowl-
edge of the two separate HIV prevention methods, ranging from 15-35 percent for uneducated ever-married
women up to 80-90 percent for ever-married women with some higher education. Similarly, ever-married
women from the richest households have broader knowledge of HIV prevention methods compared with
ever-married women in the lower wealth quintiles, although the differences are not as large as for education.
Figure 12.1 Knowledge of HIV/ AIDS among age 15-49 ever-married women by
education and wealth quintile

percentage percentage
90
77.2 82.7 90
80 76.3
68.8 80 69.8
70 65
58.1 70
60 58.2
60
50
50 44.6
40 30.5
40
30 20.3
20 30
10 20
0 10
No Passed Passed Passed Passed Degree 0
education Grade Grade G.C.E.(O/L) G.C.E.(A/L) and above Lowest Second Middle Fourth Highest
1-5 6 - 10 or or
equivalent equivalent

Level of Education Wealth Quintile

12.1.3 Rejection of misconceptions about hiv/aids

Correct knowledge of HIV/AIDS not only requires a person to know about the methods of preven-
tion, but also to know which commonly held beliefs are false. To investigate whether respondents have cor-
rect knowledge about methods of prevention of HIV/AIDS, the 2016 SLDHS included questions related to
misconceptions about HIV transmission. Respondents were asked whether it is possible for a healthy-looking
person to have HIV and whether HIV is transmitted through mosquito bites or sharing food with a person
who has HIV/AIDS.
Seventy-one percent the ever-married women aged 15-49 agreed that a healthy-looking person can
have HIV. About HIV transmission, 63 percent of women said that HIV cannot be transmitted by mosquito
bites; and only 66 percent of women said that a person cannot become infected by sharing food with a person
who has AIDS. Altogether, 42 percent indicated that a healthy-looking person can have HIV and rejected the
two most common local misconceptions (HIV can be transmitted by mosquito bites and a person can become
infected by sharing food with a person who has HIV).
The data collected in the 2016 SLDHS allow for the assessment of comprehensive knowledge about
HIV/AIDS among respondents. Comprehensive knowledge is defined as knowing that consistent use of
condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chance of
getting HIV, knowing that a healthy-looking person can have HIV, and rejecting the two most common local
misconceptions about HIV transmission. According to the SLDHS in 2016, comprehensive knowledge of
HIV/AIDS among women aged 15-49 is 33 percent in Sri Lanka.

HIV/AIDS-Related Knowledge, Attitudes, and Behavior 189

Table 12.3 Comprehensive knowledge about HIV

Percentage of women age 15-49 who say that a healthy-looking person can have HIV and who, in response to prompted questions,
orrectly reject local misconceptions about transmission or prevention of HIV, and the percentage with a comprehensive knowledge about
HIV, according to age, Sri Lanka 2016
Percentage of respondents who say that:
Percentage who
say that a healthy Percentage
A person cannot looking person can with a
become infected by have HIV and who compre-
A healthy- HIV cannot be sharing food with a reject the two most hensive
looking person transmitted by person who has common local knowledge Number of
1
Age can have HIV mosquito bites HIV miscon- ceptions about HIV2 respondents
WOMEN
Age
15-24 65.7 59.2 59.5 34.2 24.0 1,639
15-19 57.3 47.3 49.7 25.8 16.4 229
20-24 67.1 61.2 61.0 35.5 25.2 1,410
25-29 73.1 62.1 68.5 42.5 33.0 2,620
30-39 72.7 64.9 69.4 43.9 34.8 7,560
40-49 69.3 61.5 62.5 40.2 32.6 6,483

Residence
Urban 70.2 64.8 66.4 40.5 32.3 2,855
Rural 72.7 64.1 67.8 43.2 34.2 14,737
Estate 36.6 28.3 26.3 10.6 6.1 710

District
Colombo 76.4 68.5 69.8 45.7 37.6 1,731
Gampaha 81.8 68.0 77.6 51.7 40.8 1,845
Kalutara 75.4 63.3 68.7 42.6 31.9 1,104
Kandy 68.4 60.1 64.2 37.3 27.2 1,223
Matale 81.7 61.1 64.9 40.5 30.8 490
Nuwaraeliya 51.2 37.1 38.0 20.2 13.9 572
Galle 81.3 63.8 73.3 46.7 40.8 935
Matara 79.1 76.6 78.2 62.3 54.9 718
Hambantota 73.7 61.0 71.5 45.9 33.3 556
Jaffna 45.8 57.2 43.5 13.5 10.9 471
Mannar 25.8 66.3 55.3 12.6 8.6 81
Vavuniya 43.1 59.5 52.8 24.1 17.6 136
Mullaitivu 53.4 57.6 40.3 21.9 17.9 81
Killinochchi 42.7 54.8 42.6 15.7 11.3 94
Batticaloa 24.6 55.1 43.5 6.0 02.6 531
Ampara 71.9 48.5 49.4 33.1 22.9 731
Trincomalee 45.2 60.1 54.1 22.6 15.8 362
Kurunegala 76.0 66.2 69.2 46.4 37.1 1,592
Puttalam 79.4 61.5 62.7 42.6 31.8 664
Anuradhapura 69.0 72.7 83.1 59.5 50.5 984
Polonnaruwa 75.6 59.8 63.1 38.4 29.4 399
Badulla 65.5 45.3 45.4 27.1 19.6 735
Monaragala 68.6 72.8 78.0 47.5 34.4 485
Ratnapura 75.1 54.7 64.7 38.7 31.0 1,084
Kegalle 71.9 80.0 75.1 53.1 45.6 698

Education
No education 30.8 16.8 19.4 7.5 4.3 285
Passed Grade 1-5 39.1 28.5 28.6 10.4 6.6 1,257
Passed Grade 6-10 66.6 58.0 58.4 33.7 25.4 8,130
Passed G.C.E.(O/L) or
equivalent 74.5 67.9 74.1 45.6 35.8 4,044
Passed G.C.E.(A/L) or
equivalent 86.3 78.1 84.6 61.7 51.0 3,731
Degree and above 87.4 82.1 88.0 66.2 57.5 856

Wealth quintile
Lowest 49.5 45.6 43.1 21.1 14.4 3,390
Second 66.6 56.8 59.2 34.0 26.1 3,695
Middle 74.0 64.9 69.6 43.8 34.3 3,838
Fourth 78.1 68.9 74.5 48.4 39.0 3,816
Highest 84.8 76.4 81.7 58.9 49.1 3,562

Total 15-49 70.9 62.8 66.0 41.5 32.8 18,302

1
Two most common local misconceptions: HIV CAN be transmitted by mosquito bites and a person CAN become infected by sharing
food with a person who has HIV
2
Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one uninfected
faithful partner can reduce the chance of getting HIV, knowing that a healthy-looking person can have HIV, and rejecting the two most
common local misconceptions about AIDS transmission or prevention.

Demography and Health Survey - 2016 192

190 Demographic and Health Survey - 2016, Sri Lanka
 12.2 KNOWLEDGE OF PREVENTION OF MOTHER-TO-CHILD TRANSMISSION
OF HIV

Prevention of mother-
to-child transmission (PMTCT)
12.2 Kof HIV is a key component
nowledge of preven to-
Table 12.4 Knowledge of prevention of mother-to-child transmission of HIV
reduce of transmission
tion of mother-to-child trans- of HIV
infection. Prevention of mother
mission of hiv
Percentage of women age 15-49 who know that HIV can be transmitted from mother
to child during delivery, by breastfeeding, and by all two means, according to age, Sri
to child transmission of HIV is Lanka 2016
Prevention
aided of mother-to-
by encouraging pregnant Percentage who know that HIV can
be transmitted from mother to child:
child women
transmission
to know (PMTCT)
their HIV of
HIV status.
is a key component to reduce
In the survey, to assess By By all two Number of
Age During delivery breastfeeding means respondents
of transmission of HIVrespondents
PMTCT knowledge, infection. Age
Prevention of mother
were asked whether HIV can to child
be 15-24 65.4 59.2 53.9 1,639
transmission of HIV is aided by ..15-19 55.1 53.1 47.8 229
transmitted from mother to child ..20-24 67.1 60.3 55.0 1,410
encouraging pregnant women to 25-29 74.4 63.9 59.0 2,620
during child birth and by breast
know their HIV status. In the survey, 30-39 75.0 64.3 60.0 7,560
feeding. 40-49 72.2 62.6 58.4 6,483
to assess PMTCT knowledge,
respondents wereTableasked
12.4 whether
shows that HIV
in
Residence
Urban 73.3 60.0 55.1 2,855
can be transmitted from
the 2016 SLDHS, over 70 mother to Rural 74.6 65.0 60.6 14,737
child percent
during child birth and by
of ever-married women breast Estate 41.3 37.6 35.0 710

feeding.
aged 15-49, are aware that HIV District
Colombo 72.8 55.8 51.2 1,731
canTable
be 12.4transmitted
shows thatthrough
in the Gampaha 80.9 68.0 63.1 1,845
Kalutara 74.3 61.4 57.1 1,104
2016 breastfeeding
SLDHS, over (73 70 percent of
percent). Kandy 70.2 57.7 54.2 1,223
ever-married women
Sixty-three aged know
percent 15-49,thatare Matale 81.8 72.3 66.9 490
Nuwaraeliya 52.5 46.8 43.9 572
awaremother-to-child
that HIV can be transmission
transmitted Galle 83.8 72.0 68.2 935
through breastfeeding
(MTCT) can happen (73 percent).
during Matara 76.3 60.2 56.2 718
Hambantota 69.8 60.1 55.3 556
Sixty-three percent
delivery. know that mother- Jaffna 73.7 68.0 63.0 471
to-child transmission (MTCT) can Mannar 75.9 78.6 74.4 81
Vavuniya 66.3 65.7 61.9 136
happen duringIndelivery.
Sri Lanka prior to Mullaitivu 73.3 69.7 66.0 81
scaling up of the PMTCT Killinochchi 62.8 60.4 55.0 94
In Sri Lanka prior to scaling Batticaloa 66.9 69.0 62.3 531
program, two premier maternity
up of the PMTCT program, two Ampara 73.9 70.4 68.5 731
hospitals have been screening Trincomalee 63.7 66.5 56.3 362
premier maternity hospitals have Kurunegala 71.9 66.4 62.2 1,592
antenatal
been screening mothers for HIV
antenatal since
mothers Puttalam 77.8 72.1 65.4 664
earlysince
for HIV 2000.
early Antenatal
2000. AntenatalHIV Anuradhapura 62.1 54.5 52.1 984
Polonnaruwa 78.3 67.2 62.9 399
prevalence is taken as
HIV prevalence is taken as a proxy a proxy Badulla 64.2 51.7 47.6 735
prevalence
prevalence of thepopulation.
of the general general Monaragala 73.1 54.8 52.7 485
Ratnapura 77.8 67.1 61.4 1,084
population. However,
However, these two hospitals these two Kegalle 75.2 68.3 63.1 698
hospitals
represent represent
urban antenatal women urban
and Education
antenatal women and
their HIV prevalence is considered their HIV No education 29.9 29.0 26.2 285
Passed Grade 1-5 46.1 45.8 41.4 1,257
higherprevalence
than the is considered higher
rural antenatal Passed Grade 6-10 69.1 63.7 59.0 8,130
than the rural
prevalence (2015, Annual Report antenatal Passed
G.C.E.(O/L) or
prevalence
NSACP). (2015, Annual equivalent 78.2 68.5 63.4 4,044
Report NSACP). Passed
G.C.E.(A/L) or
equivalent 84.8 64.7 61.0 3,731
Degree and above 89.7 63.7 61.1 856

Wealth quintile
Lowest 58.7 54.8 50.6 3,390
Second 69.0 63.4 58.5 3,695
Middle 74.8 66.0 61.3 3,838
Fourth 78.6 68.0 63.2 3,816
Highest 83.1 62.8 59.2 3,562

Total 15-49 73.1 63.2 58.7 18,302

Demography and Health Survey - 2016 193

HIV/AIDS-Related Knowledge, Attitudes, and Behavior 191

 specific decisions that will reduce the risk of becoming HIV positive and enable them to remain HIV free.
For those who are HIV positive, knowledge of their HIV status allows them to live an affirming life,
protecting their sexual partners, accessing care and treatment, and planning for the future. To assess
awareness and coverage of prior HIV testing behavior, all ever-married women were asked whether they
had ever been tested for HIV. If they said they had been tested for HIV, respondents were asked if they had
received the results
12.3 Coverage of hiv testing of their last test.

In the case of persons who Table 12.5 Coverage of prior HIV testing: Women
are HIV negative, knowledge
Percentage of women age 15-49 who know where to get an HIV test, and the percentage of
of their HIV status helps in women age 15-49 who were tested in the past 12 months and received the results of the last
making specific decisions test, according to background characteristics, Sri Lanka 2016
that will reduce the risk of
Percentage who Percentage who
becoming HIV positive and have been tested have received the
enable them to remain HIV for HIV in the past results of the last Number of
free. For those who are HIV Background characteristic 12 months test women

positive, knowledge of their Age

HIV status allows them to 15-24 15.9 12.5 1,639
live an affirming life, pro- ..15-19 13.2 9.4 229
..20-24 16.3 13.0 1,410
tecting their sexual partners, 25-29 19.5 15.3 2,620
accessing care and treatment, 30-39 12.0 8.7 7,560
40-49 3.5 2.1 6,483
and planning for the future.
To assess awareness and Marital status
coverage of prior HIV test- Married/Living together 10.8 8.0 17,257
Divorced/Separated/Widowed 4.2 2.5 1,045
ing behavior, all ever-mar-
ried women were asked Residence
Urban 12.0 9.9 2,855
whether they had ever been Rural 10.3 7.4 14,737
tested for HIV. If they said Estate 7.4 4.7 710
they had been tested for HIV,
District
respondents were asked if Colombo 13.7 12.3 1,731
they had received the results Gampaha 9.6 8.1 1,845
of their last test. Kalutara 11.8 8.4 1,104
Kandy 11.5 8.7 1,223
Matale 3.1 2.6 490
Nuwaraeliya 5.1 4.6 572
Galle 11.6 10.1 935
Matara 9.8 7.8 718
Hambantota 9.9 8.6 556
Jaffna 9.9 8.4 471
Mannar 13.5 7.5 81
Vavuniya 6.5 5.4 136
Mullaitivu 6.2 5.2 81
Killinochchi 11.4 9.4 94
Batticaloa 5.4 3.9 531
Ampara 3.9 2.6 731
Trincomalee 7.8 4.2 362
Kurunegala 8.1 5.7 1,592
Puttalam 15.3 6.7 664
Anuradhapura 9.4 7.7 984
Polonnaruwa 10.9 6.5 399
Badulla 9.4 7.7 735
Monaragala 8.5 6.9 485
Ratnapura 18.1 8.0 1,084
Kegalle 15.0 9.5 698

Education
No education 3.3 2.1 285
Passed Grade 1-5 3.4 1.7 1,257
Passed Grade 6-10 8.4 5.9 8,130
Passed G.C.E.(O/L) or equivalent 10.9 8.1 4,044
Passed G.C.E.(A/L) or equivalent 15.5 11.7 3,731
Degree and above 18.4 14.7 856

Wealth quintile
Lowest 7.9 5.5 3,390
Second 8.9 6.5 3,694
Middle 10.2 7.2 3,840
Fourth 12.4 9.1 3,817
Highest 12.5 9.8 3,561

Total 15-49 10.4 7.6 18,302

192 Demographyand
Demographic and Health
Health Survey
Survey - 2016
- 2016, Sri Lanka 194
 Tables 12.5 and Figure 12.2 present information on HIV testing among ever-married women. One in
ten women aged 15-49 in Sri Lanka (10 percent) have ever been tested for HIV and 73 percent of those have
received their results. The percentage of ever-tested for HIV and who received the test results increases with
the level of education and the wealth quintile.
As expected the more urbanized the place of residence, the higher the percentage of HIV testing and
reporting. In the urban areas, 90 percent of the ever-married women tested received their results, compared
to 72 percent in those of the rural sector, and only 63 percent for the estates sector residents. Likewise, the
residents of Colombo and Gampaha registered higher percentages of HIV/AIDS test takers that received their
results (90 percent and 85 percent, respectively) compared to about 44 percent in the districts of Puttalam and
Ratnapura (Analyzing Table 12.5).

Figure 12.2 Percentage of HIV Testing and Getting Result by

Education Levels

20
18
16 Percentage who
14 have been tested
for HIV in the
12
past 12 months
Percentage

10
Percentage who
8
have received
6 the results of the
4 last test
2
0
No Passed Passed Passed Passed Degree and
education Grade 1-5 Grade 6-10 G.C.E.(O/L) G.C.E.(A/L) above
or or
equivalent equivalent

Level of Education

12.4 Self-reporting of sexually transmitted infections

Sexually transmitted infections (STIs) are closely linked with HIV because they share similar risk factors for
partners. In the 2016 SLDHS, ever-married women were asked whether they ever had a sexually transmitted
infection or symptoms of an STI with a bad-smelling, abnormal discharge from the vagina or a genital sore
or ulcer in the 12 months preceding the survey.
The results presented in Table 12.6 indicate that less than 2 percent of ever-married women aged 15-49 have
had an STI or symptoms of an STI, in the past 12 months. There are no important differences in this percent-
age by marital status or any other background characteristic of the ever-married women.

HIV/AIDS-Related Knowledge, Attitudes, and Behavior 193

 Table 12.6 Self-reported prevalence of sexually-transmitted infections (STIs) and STIs symptoms

Among women age 15-49 who ever had sexual intercourse, the percentage reporting having an STI and/or symptoms of an STI in
the past 12 months, by background characteristics, Sri Lanka 2016
Percentage of women who reported having in the past 12 months:
STI/ genital
Bad smelling/ discharge/ Number of women
abnormal genital Genital sore or sore or who ever had
Background characteristic STI discharge ulcer ulcer sexual intercourse

Age
15-24 0.6 0.5 0.5 1.4 1,621
..15-19 0.5 0.6 0.5 1.6 224
..20-24 0.7 0.5 0.4 1.3 1,397
25-29 0.8 0.7 0.4 1.4 2,599
30-39 0.8 0.5 0.3 1.4 7,545
40-49 0.7 0.5 0.3 1.3 6,469

Marital status
Married or living together 0.7 0.5 0.3 1.4 17,195
Divorced/separated/widowed 0.7 0.5 0.5 1.5 1,039

Residence
Urban 0.6 0.7 0.5 1.6 2,840
Rural 0.8 0.5 0.3 1.3 14,687
Estate 0.7 0.4 0.2 1.1 708

District
Colombo 0.6 0.7 0.6 1.6 1,719
Gampaha 0.4 0.2 0.3 0.8 1,845
Kalutara 1.7 1.3 0.3 2.9 1,104
Kandy 0.5 0.8 0.1 1.4 1,208
Matale 0.7 0.8 0.5 1.7 490
Nuwaraeliya 1.2 0.1 0.0 1.2 572
Galle 0.6 0.3 0.3 0.6 935
Matara 1.6 0.1 0.0 1.8 718
Hambantota 0.5 0.1 0.0 0.7 555
Jaffna 0.2 0.4 0.2 0.7 470
Mannar 0.2 0.0 0.0 0.2 81
Vavuniya 0.0 0.0 0.0 0.0 136
Mullaitivu 0.0 0.0 0.0 0.0 81
Killinochchi 0.0 0.0 0.0 0.0 94
Batticaloa 0.2 0.4 0.0 0.4 529
Ampara 0.1 0.3 0.1 0.4 731
Trincomalee 0.3 1.3 0.4 1.7 358
Kurunegala 1.1 0.3 0.4 1.6 1,572
Puttalam 2.1 1.1 1.3 3.0 664
Anuradhapura 1.3 0.5 0.4 2.0 983
Polonnaruwa 0.6 0.0 0.0 0.6 399
Badulla 0.0 0.0 0.0 0.0 724
Monaragala 0.5 0.0 0.0 0.5 485
Ratnapura 0.5 2.1 0.8 3.0 1,084
Kegalle 0.3 0.2 0.3 0.8 698

Education
No education 0.4 1.0 0.3 1.4 285
Passed Grade 1-5 0.2 0.3 0.2 0.5 1,256
Passed Grade 6-10 0.7 0.5 0.4 1.3 8,110
Passed G.C.E.(O/L) or equivalent 0.7 0.5 0.3 1.4 4,034
Passed G.C.E.(A/L) or equivalent 1.0 0.7 0.3 1.8 3,701
Degree and above 1.0 0.7 0.4 1.9 848

Wealth quintile
Lowest 0.6 0.4 0.3 1.0 3,385
Second 0.9 0.6 0.2 1.4 3,680
Middle 0.6 0.7 0.3 1.4 3,830
Fourth 0.9 0.5 0.4 1.6 3,799
Highest 0.7 0.6 0.3 1.5 3,541

Total 15-49 0.7 0.5 0.3 1.4 18,235

12.5 Hiv/aids knowledge among youth

12.5 HIV/AIDS KNOWLEDGE
Younger people AMONG
are often at a higher risk of YOUTH
contracting STIs, as they are more likely to experiment
with sex before marriage. Therefore, condom use among young adults plays an important role in preventing
Younger ofpeople
the transmission areother
HIV and oftensexually
at a higher risk of
transmitted contracting
infections, STIs,
as well as they are
as unwanted more likely
pregnancies. to
At the
experiment with sex before marriage. Therefore, condom use among young adults plays an important
same time, they may be using condoms during sexual intercourse and having more partners, expanding the role
in preventing
risks the totransmission
of exposure of HIV
HIV and other and other These
STI infections. sexually transmitted
risks infections,
can be reduced as well as
by increasing, unwanted
among young
pregnancies. At the same time, they may be using condoms during sexual intercourse and having more

194 Demographic and Health Survey - 2016, Sri Lanka

Demography and Health Survey - 2016 196

partners, expanding the risks of exposure to HIV and other STI infections. These risks can be reduced by
increasing, among young people, the comprehensive knowledge about STIs and of HIV in particular.
people, the comprehensive knowledge about STIs and of HIV in particular.
In Sri Lanka, over 90 percent of ever-married women aged 15-24 have heard about HIV or AIDS,
In Sriand
(Table 12.1) Lanka, over 90
24 percent of percent of ever-married
them indicated women aged 15-24
having comprehensive have heard
knowledge about about
AIDS,HIV or AIDS,
substantially
(Table 12.1) and 24 percent of them indicated having comprehensive knowledge about AIDS,
less than the other age groups. Table 12.7 shows the levels of comprehensive knowledge about HIV orsubstantially
less
AIDS than the other
among age groups.women
ever-married Table 12.7
agedshows
15-24theaccording
levels of comprehensive
to backgroundknowledge about The
characteristics. HIV level
or AIDS
of
among ever-married women aged 15-24 according to background characteristics. The level of comprehen-
comprehensive knowledge about HIV increases with age and level of education of the woman. It is also
sive knowledge about HIV increases with age and level of education of the woman. It is also higher among
higher among those residents of the rural sector (26 percent) compared to those of the estates sector (only 8
those residents of the rural sector (26 percent) compared to those of the estates sector (only 8 percent).
percent).

Table 12.7 Comprehensive knowledge about HIV among young people

Percentage of young women age 15-24 with comprehensive knowledge

about HIV, according to background characteristics, Sri Lanka 2016
Women
Percentage with
comprehensive Number of
Background characteristic knowledge of AIDS1 respondents

Age
15-19 16.4 229
15-17 (11.4) 39
18-19 17.4 190
20-24 25.2 1,410
20-22 26.5 689
23-24 24.0 721

Marital status
Ever married 24.0 1,639

Residence
Urban 19.6 222
Rural 25.6 1,346
Estate 8.3 71

Education
No education * 2
Passed Grade 1-5 (4.1) 32
Passed Grade 6-10 18.9 867
Passed G.C.E.(O/L) or equivalent 26.4 477
Passed G.C.E.(A/L) or equivalent 39.2 251
Degree and above * 9

Total 24.0 1,639

1
Comprehensive knowledge means knowing that consistent use of condoms
during sexual intercourse and having just one uninfected faithful partner can
reduce the chance of getting HIV, knowing that a healthy-looking person can
have HIV, and rejecting the two most common local misconceptions about
AIDS transmission or prevention of HIV. The components of comprehensive
knowledge are presented in Tables 13.1, and 13.2.

12.6 Age of first sexual intercourse among youth

Marriageable
12.6 AGEage OF(orFIRST
marriage age) is theINTERCOURSE
SEXUAL minimum age at which a person YOUTH
AMONG is allowed by law to marry, either
as a right or subject to parental or other forms of consent. Although, age and other prerequisites to marriage
vary between jurisdictions,
Marriageable marriage
age (or marriageage age)
is often set minimum
is the at 18. Dataage
related to agea at
at which first sexual
person intercourse
is allowed by lawwasto
collected in the 2016 SLDHS by asking about the age of the respondents when they had their first sexual
marry, either as a right or subject to parental or other forms of consent. Although, age and other
intercourse. Table 12.8 shows that 7 percent of ever-married women aged 15-24 had their first sexual inter-
prerequisites to marriage vary between jurisdictions, marriage age is often set at 18. Data related to age at
course experience before the age of 15. If the analysis is restricted to ever-married women aged 18-24, 32
first sexual
percent intercourse
of them reportedwas collected
having in the intercourse
first sexual 2016 SLDHS by asking
before about the age of the respondents when
age 18.
they had their first sexual intercourse. Table 12.8 shows that 7 percent of ever-married women aged 15-24
Considering sectors
had their first in intercourse
sexual the country, experience
the rural sector hasthe
before the age
highest percentage
of 15. of early is
If the analysis sexual intercourse
restricted for
to ever-
both age groups 15-24 and 18-24. The level of education seems to have a positive effect on the age at first
married women aged 18-24, 32 percent of them reported having first sexual intercourse before age 18.
sexual intercourse. By sector of residence, the higher prevalence of first sexual intercourse before age 18 is
observedConsidering
among thosesectors
ever-married
in the women
country,agedthe 18-24 of the rural
rural sector sector
has the (33 percent)
highest percentagecompared
of earlyto sexual
27 and
25 percent (urban and estate sectors respectively).
intercourse for both age groups 15-24 and 18-24. The level of education seems to have a positive effect on
the age at first sexual intercourse. By sector of residence, the higher prevalence of first sexual intercourse
before age 18 is observed among those ever-married women aged 18-24 of the rural sector (33 percent)
compared to 27 and 25 percent (urban and estate sectors respectively).
HIV/AIDS-Related Knowledge, Attitudes, and Behavior 195
 Table 12.8 Age at first sexual intercourse among young people

Percentage of young women age 15-24 who had sexual intercourse before age 15 and percentage of
young women age 18-24 who had sexual intercourse before age 18, according to background
characteristics, Sri Lanka 2016
Women
Percentage
Percentage who who had
had sexual Number of sexual Number of
intercourse respondents (15- intercourse respondent
Background characteristic before age 15 24) before age 18 s (18-24)

Age
15-19 9.5 229 na na
15-17 (14.8) 39 na na
18-19 8.4 190 54.5 190
20-24 6.8 1,410 28.8 1,410
20-22 6.9 689 33.2 689
23-24 6.6 721 24.6 721

Residence
Urban 3.3 222 27.2 217
Rural 8.1 1,346 33.0 1,316
Estate 1.7 71 24.8 67

Education
No education * 2 * 2
Passed Grade 1-5 (16.2) 32 (67.0) 31
Passed Grade 6-10 9.6 867 42.1 834
Passed G.C.E.(O/L) or equivalent 4.5 477 26.7 472
Passed G.C.E.(A/L) or equivalent 2.6 251 4.2 251
Degree and above * 9 * 9

Total 7.1 1,639 31.9 1,600

na = Not available

196 Demographic and Health Survey - 2016, Sri Lanka

Demography and Health Survey - 2016 198

DOMESTIC VIOLENCE FROM
INTIMATE PARTNER 13
Key Findings
• Prevalence of domestic violence: In Sri Lanka, 17 percent of ever-married wom-
en age 15-49 have suffered from domestic violence from their intimate partner.
• Forms of domestic violence: Two percent of ever-married women who suffered
from domestic violence, experiences in any form of domestic violence daily.
• Differentials of domestic violence: Prevalence of domestic violence by an inti-
mate partner increases with the age of the women. Urban residents also reported
the highest percentage of domestic violence (20 percent). Kilinochchi and Batti-
caloa districts have the highest level of domestic violence (50 percent). Ever-mar-
ried women who belong to the lowest wealth quintile and those with primary edu-
cation reported the highest percentages in domestic violence (28 and, 30 percent
respectively).
• Support for domestic violence: Among women who suffered from domestic vio-
lence, only just over one fourth of women (28 percent) have sought help, with three
fourth of them (75 percent) seeking help from their family members, 27 percent
from friends or neighbors and only 18 percent seeking help from the police. Half of
the ever-married women age 15-49 (50 percent) indicated to know about the Sri
Lanka Women Bureau to combat violence, while 26 percent mentioned the mid-
wife and Women Help Line.

T
here has been an increasing attention to domestic violence against women, in both developed and
developing countries, since the 1990s. The United Nations defines domestic violence as “any act of
gender based violence that results in, or is likely to result in, physical, sexual, or psychological harm
or suffering to women, including threats of such acts, coercion, or arbitrary deprivation of liberty, whether
occurring in public or in private life” (United Nations 1993). An increasing amount of research has high-
lighted the health and psychological burdens, intergenerational effects, and consequences of such violence
(United Nations, 2006). Violence can take many forms, including physical, sexual, emotional, economic, and
psychological abuse. It can have devastating consequences on the short- and long-term health and well-being
of the women affected as well as their over-all quality of life (Hutchins and Sinha, 2013).
One third of woman all over the world suffers from domestic violence by intimate partner. This is
considered as a hidden problem in most of the women do not reveal about their sufferings due to reasons such
as culture, fear of reprisal, and concern over children, shame and internalizing the violence. It is also an ever
increasing burden to the health care services, social and economy of the country.
Domestic Violence during pregnancy which is a common occurrence leads to many negative preg-
nancy outcomes including miscarriages, still births and maternal deaths. Also, Domestic Violence in one
generation can influence the behaviour of the next generation by a process of learned behaviour. When chil-
dren are exposed to violence between their parents, boys learn violence as a means of achieving control and
eventually have a greater chance of being a perpetrator. On the other hand girls learn to accept violence as an
inevitable helplessness and have a higher chance of being survivors in adult life.
The health sector in Sri Lanka has responded favourably by addressing Domestic Violence in the
areas of prevention as well as in the response to the survivors, in an effective manner. Gender and Wom-
en’s Health Unit of the Family Health Bureau (FHB) is the nodal agency at National Level responsible for
addressing Domestic Violence in the health sector. The programmes which focus mainly on prevention of
Domestic Violence, response and care for survivors of Domestic Violence are implemented by Family Health
Bureau.

Domestic Violence from Intimate Partner 197

 Affirming the important and specific role that the national health system should play in responding
to domestic violence, Family Health Bureau has taken a few significant steps forward in various aspects such
as setting up of domestic violence care centres called “Mithuru Piyasa” at hospitals, which are dedicated to
provide emotional and medical support to survivors of Domestic Violence. They are operated by the hospital
staff working in the out patients’ department. The staff at Mithuru Piyasa are given a training conducted by
FHB . The location for the centre in the hospital is selected based on several criteria to ensure the privacy
and confidentiality of the clients while ensuring the easy access and proper referrals. Family Health Bureau
provides the logistic support to hospital administration on selecting the venue and with.
Many programmes are implemented for capacity building of health staff such as ,in basic, in-service
and postgraduate courses on domestic violence. Inclusion of a module on domestic violence in the curriculum
of Medical Undergraduates on the responsibilities of a Medical Officer in responding to Domestic Violence
is one such programme.
Also, an action plan for health sector to response on Domestic Violence has been developed by the
Ministry of Health Sri Lanka, in order to streamline its’ response, inclusive of prevention, responding to
survivors and addressing perpetrators on domestic violence in an effective and a responsive manner using a
survivor centered approach which is institutionalized within the existing structure of the Ministry of Health
and it is sustainable. Coincidentally the Ministry of Women’s Affairs developed a national plan to address
sexual and domestic violence in Sri Lanka.
To study the level and characteristics of domestic violence or violence perpetrated by an intimate
partner, a module with questions on women’s experience of domestic violence in the last 12 months was in-
cluded in the 2016 SLDHS questionnaire for the first time in Sri Lanka. In accordance with the World Health
Organization’s guidelines for the ethical collection of information on domestic violence, only one eligible
woman per household was randomly selected for this module; the module was not implemented if privacy
could not be obtained; the respondent was read an additional consent statement at the start of the interview
using the domestic violence module, informing her that the questions could be personal and reassuring her of
the confidentiality of her responses(WHO 2001).

13.1 Level of domestic violence

The domestic violence set of questions was administered to 91 percent of the eligible ever-married wom-
en age 15-49. For seven percent of them the questionnaire was not implemented due to lack of privacy or
because security concerns. Two percent of eligible women rejected to answer the questions of the domestic
violence module because of privacy concerns or other reasons (Figure 13.1).
The prevalence of domestic violence by an intimate partner increases with the age of the woman, going from
13 percent among ever-married women age 15-19 to 19 percent among the oldest 45-49 women. A similar
pattern is observed by age among those rejected to answer the questions on the module.

Table 13.1 Summary on domestic violence by age

Percentage of women who suffered no violence from intimate partner, experienced any of the violent behaviors mentioned, experienced
any type of violence daily, rejected to answer questions on domestic violence and who requested help for domestic violence according to
age groups
Age

Description 10-19 20-24 25-29 30-34 35-39 40-44 45-49 Total

No violence from intimate partner 86.7 83.6 83.5 82.4 82.3 81.5 79.4 82.0
Experienced any violent behaviors 12.7 14.7 15.5 16.5 16.2 17.0 18.9 16.6
Experiencing any type of violence daily 1.3 2.0 1.5 1.5 2.0 2.5 3.2 2.1
Rejected to answer on domestic violence 1.8 2.0 1.5 1.7 2.0 1.9 2.6 2.0

Number of women 169 1,130 2,335 3,364 3,720 3,056 2,856 16,629

198 Demographic and Health Survey - 2016, Sri Lanka

Figure 13.1: Level of Domestic Violence

 Figure 13.1 Level of Domestic Violence

20
18 16.5 17
18.9
16 14.7
14 16.2
15.5
12
12.7
Percentage

10
8
6
4 2 2.6
2 1.7 1.9
1.8 1.5
2
0
15-19 20-24 25-29 30-34 35-39 40-44 45-49

Age Group

Experienced any violent behaviors Rejected to answer on domestic violence

Table 13.2 presents the percentage of ever-married women age 15-49 by experience of domestic
violence by their intimate partner, experience of daily domestic violence, and percent who requested help for
domestic violence according to background characteristics.
Among the eligible ever-married women, 17 percent indicated to have suffered from domestic vio-
lence from their intimate partner during the 12 months preceding the survey. Furthermore, 13 percent of all
the women who suffered from violence, declared to have suffered violent behaviors by an intimate partner
on a daily basis and violence increases with the age of the women. Among all women who have experienced
domestic violence, only twenty eight percent (28%) sought help to escape from violence (Table 13.2).
More women from the urban sector have experienced violence (20 percent) compared to women
living in the other sectors (16 percent of the rural and 17 percent of estate counterparts). Experience of vi-
olence by the intimate partner among ever-married women varies according to the districts of residence: in
Batticaloa and Kilinochci, the districts with the highest prevalence, half of the women indicated to be affected
by violence from their intimate partner. Figure 13.2 shows clearly the highest domestic violence prevails in
Northern and Eastern provinces. In contrast, in Hambantota, Anuradhapura and Monaragala, the districts
with the lowest prevalence, less than eight
Figure 13.2 Domestic Violence by District
percent indicated to be affected by
domestic violence by an intimate
Kegalle
Ratnapura
partner. Experience of domestic vi-
Moneragala olence declines with the education-
Badulla
Polonnaruwa
al level, excluding the educational
Anuradhapura category “No education”. The sur-
Puttalam
Kurunegala vey results suggest that there is a
Trincomalee negative relationship between the
Ampara
Batticaloa prevalence of physical violence
Kilinochchi and household wealth (the lowest
Mullaitivu
District

Vavuniya wealth quintile has a significantly

Mannar higher prevalence of domestic vio-
Jaffna
Hambantota lence than women in the other four
Matara quintiles).
Galle
Nuwara Eliya
Matale
Kandy
Kalutara
Gampaha
Colombo
0 10 20 30 40 50 60

Percentage

Domestic Violence from Intimate Partner 199

 Table 13.2 Summary on occurring domestic violence by background characteristics

Percentage of women age 15-49 who have not experienced any violence from intimate partner, experienced at least one
violence, and percentage of women who have experienced in daily violence among women who suffered, from violence and
percentage of women who requested help for domestic violence among women who suffered from violence according to
background characteristics
Experienced in domestic violence
Number
No any of
Requested
violence Experienced Number Experienced women
help for
Background characteristic from at least one of any form of Who
domestic
intimate violence women violence daily suffered
violence
partner from
violence

Age
15-19 86.7 12.7 169 7.8 * 21
20-24 83.6 14.7 1,130 12.0 30.1 166
25-29 83.5 15.5 2,335 9.0 27 361
30-34 82.4 16.5 3,364 9.0 27.9 553
35-39 82.3 16.2 3,720 12.0 29.1 603
40-44 81.5 17 3,056 15.1 25.4 518
45-49 79.4 18.9 2,856 19.3 28.4 539

Residence
Urban 79.3 19.8 2,582 8.4 26.8 512
Rural 82.6 16 13,403 13.2 27.8 2,140
Estate 80.5 17 643 18.7 31.3 110

District
Colombo 85 14.3 1,625 6.0 38 233
Gampaha 86.9 12.8 1,564 7.8 30.3 200
Kalutara 90.9 8.3 968 17.5 38.1 80
Kandy 73.9 24.7 1,117 16.3 20.8 275
Matale 69.7 30 432 27.1 31.8 130
Nuwara Eliya 83.5 15.7 543 22.3 30.8 85
Galle 77.1 21.1 818 10.8 29.3 172
Matara 81.8 17.9 681 13.8 61.6 122
Hambantota 93.5 5.7 519 4.2 -14.9 30
Jaffna 58.9 38.9 443 15.1 11.1 172
Mannar 76.8 20.5 78 6.0 7.9 16
Vavuniya 79.6 18 125 11.4 8.6 23
Mullaitivu 68.3 28.3 76 12.0 6.8 22
Kilinochchi 48.7 49.6 88 28.3 13.5 44
Batticaloa 49.9 49.6 493 25.3 7.3 244
Ampara 72.6 27 669 12.0 12.1 181
Trincomalee 70 29.4 334 34.9 26.3 98
Kurunegala 87.7 10.1 1,481 15.7 31.2 149
Puttalam 82.3 16.2 620 12.0 28.1 101
Anuradhapura 88.2 7.4 907 7.2 82.3 67
Polonnaruwa 90.1 9.7 376 7.2 -32.5 37
Badulla 88.7 10.3 656 10.8 32.2 67
Moneragala 91.3 7.4 436 7.8 -32 32
Ratnapura 84.8 13.2 1,016 9.6 36.8 134
Kegalle 86.7 8.6 564 10.2 30.5 49

Education
No education 71.4 24.8 248 31.9 33.4 61
Passed Grade 1-5 67.6 29.8 1,121 33.7 24.8 334
Passed Grade 6-10 80.4 18.1 7,351 15.1 26.8 1,334
Passed G.C.E.(O/L) or
84.1 14.6 3,682 10.2 29 538
equivalent
Passed G.C.E.(A/L) or
87.6 11.5 3,438 4.8 30.3 396
equivalent
Degree and above 86.4 12.5 788 3.0 30.8 99

Wealth quintile
Lowest 70 28.1 3,062 27.1 24.4 859
Second 80.7 17.8 3,351 16.3 28.9 595
Middle 84.5 13.7 3,501 9.0 30.2 480
Fourth 86.2 12.8 3,473 6.6 22.6 443
Highest 87.3 11.9 3,241 6.0 36.6 385

Total 10-49 82 16.6 16,629 12.6 27.8 2,762

200 Demographic and Health Survey - 2016, Sri Lanka

13.2 Types of domeestic violence and frequancy
13.2 TYPES OF DOMESTIC VIOLENCCE AND FREQUANCY
Table 13.3 presents the frequency of domestic violence by the types of violence suffered by ever-married
women age 15-49 from Tabletheir
13.3 intimate partner.
presents the The domestic
frequency violence
of domestic module
violence by theused
typesinofthe 2016 SLDHS
violence suffered col-
by ever-
lected detailed information on the types or forms of violence and the frequency with which
married women age 15-49 from their intimate partner. The domestic violence module used in the 2016 they occurred
during the SLDHS
12 months beforedetailed
collected the survey. The most
information predominant
on the type of violence
types or forms violence and
identified was “belittled
the frequency with which
or seriouslythey
offended
occurredyou” withthe
during three
12 quarter of women
months before who suffered
the survey. frompredominant
The most domestic violence (75 percent),
type of violence identified
followed by “Slapped,
was “belittledbeaten, or thumped
or seriously you”you”
offended (45 percent),
with threeand “pushed
quarter or shoved
of women who you” with 33
suffered percent
from domestic
(Fig 13.3).violence
The frequency with followed
(75 percent), which the bydomestic
“Slapped,violence
beaten, orhappens
thumpedvaries from
you” (45 13 percent
percent), indicating
and “pushed a
or shoved
daily occurrence to 4833percent
you” with percentamong thoseThe
(Fig 13.3). whofrequency
indicatedwith
“monthly” anddomestic
which the to 67% violence
who reported thatvaries
happens violence
from 13
occurred less often.indicating a daily occurrence to 48 percent among those who indicated “monthly” and to 67% who
percent
reported that violence occurred less often.

Table 13.3 Frequency of domestic violence

Percentage of women who suffered from domestic violence according to types and frequency of domestic
violence

Type of violence Daily Weekly Monthly Less often Total

Slapped/Beaten/Thumped 3.0 4.8 22.3 15.1 45.2

Pushed/Shoved 2.4 4.2 12.7 12.7 32.5
Tried to Strangulate 1.8 1.8 4.8 4.8 13.3
Dragged/Pulled 1.2 2.4 5.4 7.2 16.3
Beat with an object 1.2 2.4 4.2 6.0 13.3
Burned - 0.6 0.6 1.8 3.0
Prevented leaving home 1.2 2.4 6.6 9.6 19.9
Forced to have sex 3.0 3.0 3.0 6.0 15.1
Belittled/Seriously offend 10.8 6.6 24.1 33.7 75.3

Any type of violence 12.7 15.1 47.6 66.9 100.0

Figure 13.3 Percentage of ever-married women age 15-49 who have experienced various forms
Figure 13.3 Percentage
of violence of ever-married
in the 12 months preceding the women age 15-49bywho
survey, committed theirhave
intimate partner
experienced various forms of violence in the 12 months preceding
the survey, committed by their intimate partner

Belittled or seriously offend you 75

Forced to have sex 15

Prevented leaving home 20

Types of Violence

Burned 3

Beat with an object 13

Dragged/Pulled 16

Tried to Strangulate 13

Pushed/Shoved 33

13.3 HELP SEEKING TO

Slapped/Beaten/Thumped STOP THE VIOLENCE 45

0 20 40 60 80
Ever-married women who responded to be affected by domestic violence from their intimate
partner were asked if they asked for help from anybody and if yes, who provided them with the help or
Percentage %
advice. Only 28 percent of the women suffering from domestic violence asked for help, and the majority
(75 percent) did that from “Parents/brothers/sisters/relatives”. Another 27 percent went to
“friends/neighbors”, followed by the “Police” with only 18 percent (Fig 13.4).

Domestic Violence from Intimate Partner 201

Demography and Health Survey - 2016 205
13.3 Help seeking to stop the violence
Ever-married women who responded to be affected by domestic violence from their intimate partner
were asked if they asked for help from anybody and if yes, who provided them with the help or advice. Only
28 percent of the women suffering from domestic violence asked for help, and the majority (75 percent) did
that from “Parents/brothers/sisters/relatives”. Another 27 percent went to “friends/neighbors”, followed by
the “Police” with only 18 percent (Fig 13.4).

Figure 13.4 Women Help Seeking from Institute/ Person

74.7
80

60

40 27.1
18
Percentage

20 7.4 2.9
1.4 0.4
0

Non Government
Parents /Brother /Sister

Friends /Neighbours

Public Health Officer /Midwife

Other
Police

Government Institutions

Organizations
(Except police)
/Relations

Sources of saught help by the women who suffered from Domestic Violence

The person/institution from which help was sought appears to be negatively associated with age of the
woman. Thus, the percentage of those seeking help from “parents/brothers/sisters/relatives” is higher among
younger women. However, among those who went to the “police”, higher percentages are observed among
the older women(30-49), rural sector, those with lower levels of education and those from poorer quintiles.
These findings are of singular importance to inform the development of policies and programs geared to
support women affected by intimate partner violence in the household.

202 Demographic and Health Survey - 2016, Sri Lanka

Table 13.4 The person/institute that provided help/advice

Percentage of women age 15-49 who suffered from domestic violence and requested help from a person or an organization according to
background characteristics
Person/Institute
Number of
Parents Public Government women
/Brother Health Institutions Non who
/Sister Friends Officer (Except Government requested
Background characteristic /Relations /Neighbours /Midwife Police police) Organizations Other help

Age
15-19 * * * * * * * 5
20-24 91.8 22.0 2.3 9.7 0.0 0.0 0.0 50
25-29 80.4 24.1 9.2 10.6 2.5 0.3 1.4 97
30-34 70.7 24.2 9.0 22.3 0.7 0.6 4.8 154
35-39 72.2 27.0 8.1 19.9 2.3 0.0 2.3 176
40-44 76.6 32.6 6.5 16.9 0.7 1.0 1.9 132
45-49 71.3 28.8 6.8 20.5 1.6 0.6 3.3 153

Residence
Urban 80.5 16.8 5.1 12.1 2.7 0.0 6.2 137
Rural 74.7 28.8 7.0 19.3 1.2 0.6 2.0 596
Estate (52.8) (38.6) (24.9) (18.5) (0.0) (0.0) (4.1) 34

District
Colombo 71.4 13.2 5.5 11.3 0.0 0.0 13.8 88
Gampaha (75.2) (27.2) (9.2) (24.9) (0.0) (0.0) (0.0) 60
Kalutara * * * * * * * 31
Kandy 79.8 16.9 4.6 7.4 2.3 0.0 3.6 57
Matale (85.0) (15.2) (10.7) (15.2) (7.7) (0.0) (2.6) 41
Nuwara Eliya (49.7) (20.4) (34.1) (30.4) (0.0) (0.0) (6.2) 26
Galle (80.0) (37.7) (10.4) (2.0) (0.0) (0.0) (5.5) 50
Matara 81.5 27.2 2.0 5.8 0.0 0.0 1.5 75
Hambantota * * * * * * * 4
Jaffna * * * * * * * 19
Mannar * * * * * * * 1
Vavuniya * * * * * * * 2
Mullaitivu * * * * * * * 1
Kilinochchi * * * * * * * 6
Batticaloa * * * * * * * 18
Ampara * * * * * * * 22
Trincomalee (75.2) (15.2) (2.6) (28.6) (0.0) (0.0) (0.0) 26
Kurunegala (84.6) (30.1) (7.8) (9.3) (0.0) (2.1) (2.5) 46
Puttalam (80.1) (21.7) (13.8) (35.6) (0.0) (0.0) (0.0) 28
Anuradhapura (94.8) (41.2) (4.0) (8.0) (0.0) (0.0) (0.0) 55
Polonnaruwa * * * * * * * 12
Badulla (71.3) (24.6) (5.4) (15.9) (1.8) (0.0) (0.0) 22
Moneragala * * * * * * * 10
Ratnapura (52.2) (38.2) (2.5) (38.3) (2.3) (2.5) (0.0) 50
Kegalle * * * * * * * 15

Education
No education * * * * * * * 20
Passed Grade 1-5 72.8 32.4 12.7 18.8 0.0 0.0 4.0 83
Passed Grade 6-10 74.5 26.9 6.4 22.0 2.4 0.6 1.3 358
Passed G.C.E.(O/L) or
equivalent 72.1 26.4 8.0 16.8 1.3 0.8 4.3 156
Passed G.C.E.(A/L) or
equivalent 80.4 24.1 7.7 7.0 0.0 0.0 3.0 120
Degree and above (74.1) (32.7) (0.5) (11.4) (0.0) (0.0) (8.7) 30

Wealth quintile
Lowest 69.5 32.3 7.6 25.5 1.4 0.4 3.1 210
Second 74.7 21.3 9.4 24.0 2.2 1.5 2.2 172
Middle 80.0 33.7 6.4 12.5 0.0 0.0 0.6 145
Fourth 70.1 20.7 12.3 8.5 2.0 0.0 4.1 100
Highest 80.4 24.1 2.5 11.9 1.5 0.0 4.8 141

Total 10-49 74.7 27.1 7.4 18.0 1.4 0.4 2.9 767

13.4 Knowledge of service providers

13.4
All KNOWLEDGE
ever-married women OF SERVICE
were PROVIDERS
asked about the organizations they knew which provide services to combat
violence against women. From Table 13.5 and Figure 13.5, shows that the “Sri Lanka Women Bureau” was
mentionedAll
by ever-married womenfollowed
half of the women, were askedby about the organizations
the “Women help line”they
and knew which(26
“Midwife” provide services
percent each),tothe
combat violence against women. From Table 13.5 and Figure 13.5, shows that the “Sri Lanka
“Legal Aid Commission” (18 percent), and the “Department of Social Services” (17 percent). Also men- Women
Bureau”
tioned but was
with mentioned by half of
lower percentages thethe
were women, followed
“Mithuru by (13
Piyasa” the percent),
“Women and helpthe
line” and “Midwife”
“MOH” (26
(10 percent).
percent each), the “Legal Aid Commission” (18 percent), and the “Department of Social Services” (17

Domestic Violence from Intimate Partner 203

Demography and Health Survey - 2016 207

 Figure 13.5 Women Knowledge on Service Providers

60 50.2
50

Percentage 40
25.8 26
30 20.8
18 17.1
20 13.2
9.8
10
0
Midwife

Women Help line

Other
Dep. Of Social Service
MOH

Mithuru Piyasa

Legal Aid Commission

Sri Lanka Women Bureau

Sources of Service Providers to combat violence

The “Sri Lanka Women Bureau” was better known by older women, those living in the urban and
the rural sector, with higher levels of education and with greater household wealth. The knowledge of the
“MOH”, as an institution providing services to combat violence against women, follows a flat pattern by
background characteristics. The knowledge by district follows distinct patterns for each one of these availa-
ble institutions and as such deserve a separate analysis. The district with the highest levels of knowledge by
organization is as follows:
“Sri Lanka Women Bureau” observed in Matara (72 percent),
“Women help line” observed in Anuradhapura (61 percent),
“Midwife” observed in Kegalle (50 percent),
“Legal Aid Commission” observed in Anuradhapura (53 percent),
“Department of Social Services” observed in Vavuniya (48 percent),
“Mithuru Piyasa” observed in Galle (25 percent), and
“MOH” observed in Moneragala (25 percent).

Figure 13.6 Women Knowledge on Service Providers by Residence

60
50
Percentage

40
30
20
10
Urban
0
Rural
Midwife

Women Help line

Other
Dep. Of Social Service
MOH

Mithuru Piyasa

Legal Aid Commission

Sri Lanka Women Bureau

Estate

Service Providers to Combat Violence

204 Demographic and Health Survey - 2016, Sri Lanka

 The figure 13.6 clearly shows that the estate sector people have less knowledge on formal organi-
zations or specific people to stop violence. The category ‘Other” has recorded the highest percentage (37%)
for estate sector. One fourth of people in the estate sector knows about midwife to stop violence. Half of the
people in urban and rural sectors aware about the Sri Lanka Women’s Bureau.

Table 13.5 Knowledge on service providers

Percentage of women age 15-49 who know specific people/ organizations that combat violence against women according to
background characteristics
Person/Institute
Legal Aid Sri Lanka Dep. Of
Mithuru Commissi Women Women Social Number of
Background characteristic Midwife MOH Piyasa on Help line Bureau Service Other women

Age
15-19 29.2 9.7 8.1 12.5 17.3 37.9 12.1 27.8 169
20-24 28.3 9.6 10.8 16.2 26.0 45.1 16.1 22.7 1,130
25-29 27.0 10.1 12.5 17.6 26.3 50.0 17.0 18.8 2,335
30-34 26.4 11.3 13.1 19.1 27.2 51.5 18.1 18.5 3,364
35-39 25.7 9.9 14.4 18.2 27.4 52.6 16.8 20.4 3,720
40-44 24.4 8.6 14.1 17.9 25.4 50.1 17.4 21.0 3,056
45-49 24.7 9.3 12.6 18.1 24.0 48.3 17.0 24.5 2,856

Residence
Urban 17.9 7.7 13.6 18.3 25.6 52.0 16.3 22.6 2,582
Rural 27.4 10.4 13.5 18.6 26.5 51.4 17.6 19.7 13,403
Estate 25.4 6.2 5.1 5.3 18.8 17.1 10.1 37.0 643

District
Colombo 15.4 6.4 14.5 13.2 20.8 60.5 8.0 21.2 1,625
Gampaha 23.7 5.3 13.2 10.0 28.8 64.2 7.2 11.7 1,564
Kalutara 36.9 11.1 16.9 12.9 16.4 63.8 23.3 12.1 968
Kandy 25.8 7.7 12.1 10.8 24.2 49.1 13.1 21.4 1,117
Matale 22.1 9.1 3.3 6.3 9.1 50.9 17.9 46.1 432
Nuwara Eliya 17.6 6.6 8.4 14.0 25.1 28.0 12.8 36.1 543
Galle 41.0 17.8 24.7 38.3 42.9 66.3 45.7 23.9 818
Matara 18.4 10.7 17.8 19.7 33.3 71.5 9.9 18.8 681
Hambantota 35.2 13.1 11.6 20.1 23.7 44.4 10.0 25.5 519
Jaffna 19.9 4.6 1.7 35.0 29.3 16.8 16.3 18.7 443
Mannar 41.1 7.7 2.9 27.5 36.8 19.5 10.0 0.9 78
Vavuniya 25.1 10.7 8.1 19.2 31.0 32.7 47.8 1.7 125
Mullaitivu 16.8 6.0 1.7 14.0 23.5 27.1 34.8 39.9 76
Kilinochchi 40.7 13.1 4.3 8.5 18.7 10.1 18.1 19.6 88
Batticaloa 10.1 3.7 11.0 5.9 11.2 22.4 39.9 32.7 493
Ampara 37.3 15.3 6.3 22.6 15.3 32.5 37.3 6.3 669
Trincomalee 5.9 2.7 23.7 23.7 25.8 38.6 13.8 7.1 334
Kurunegala 15.4 9.0 17.4 14.0 26.4 46.8 13.6 29.8 1,481
Puttalam 23.5 13.7 8.1 13.7 23.2 53.5 19.2 5.4 620
Anuradhapura 22.1 14.1 21.8 53.1 60.6 59.8 16.2 4.5 907
Polonnaruwa 38.7 14.1 17.1 13.0 18.3 52.7 16.2 26.9 376
Badulla 24.4 6.9 5.6 4.4 7.7 31.1 8.9 47.1 656
Moneragala 49.4 24.6 13.3 39.3 48.9 60.3 20.6 2.7 436
Ratnapura 28.9 5.7 3.1 5.8 16.8 42.8 16.7 41.8 1,016
Kegalle 50.4 17.5 20.9 28.7 30.8 48.4 13.1 1.1 564

Education
No education 29.4 6.2 3.7 9.7 9.7 16.2 10.5 39.9 248
Passed Grade 1-5 25.4 6.8 5.4 11.6 14.9 25.5 15.6 33.8 1,121
Passed Grade 6-10 26.2 8.8 9.3 15.2 22.1 44.1 15.4 25.1 7,351
Passed G.C.E.(O/L) or
equivalent 26.9 10.4 15.6 21.1 30.2 53.1 16.7 14.7 3,682
Passed G.C.E.(A/L) or
equivalent 24.5 11.7 18.8 21.1 32.1 65.8 19.7 15.0 3,438
Degree and above 22.5 14.5 27.7 28.7 37.8 70.6 28.4 10.1 788

Wealth quintile
Lowest 27.1 8.0 6.9 14.8 17.9 29.7 16.6 27.5 3,062
Second 26.8 9.9 9.8 16.7 23.6 44.1 16.3 25.7 3,351
Middle 27.5 9.5 12.4 18.1 26.5 52.0 16.9 19.5 3,501
Fourth 24.1 10.4 16.4 19.3 30.0 58.9 17.6 16.9 3,473
Highest 23.5 11.2 20.2 20.8 31.5 64.4 18.3 15.2 3,241

Total 10-49 25.8 9.8 13.2 18.0 26.0 50.2 17.1 20.8 16,629

Domestic Violence from Intimate Partner 205

206 Demographic and Health Survey - 2016, Sri Lanka
MALARIA 14
Key Findings
• Awareness of Malaria: Sixty three percent of the households in
Sri Lanka are aware on the requirement to take malaria preventive
medicines before travelling to a malaria endemic countires.
• Ownership of bed-nets: Sixty nine percent of the households in
Sri Lanka possess at least one mosquito net (treated or untreated),
while all types of insecticide-treated nets (ITNs) are possessed by
only 6 percent. On average, each household has 2 mosquito nets of
any type.
• Most of the insecticide-treated nets (91 percent) are donations and
none-treated nets are purchased (93 percent).
Use of ITNs: Usage of any type of mosquito nets by under five year
children (71 percent) shows a growth during this decade (2006-
2016).
• Sixty percent of pregnant women slept under any type of mosqui-
to net the night before the interview and shows an increase than
2006/007 SLDHS

C
onsiderable progress has been made against malaria since the beginning of the century with the drastic
decreases in cases and no indigenous case of malaria being reported since October 2012. Anti-malaria
campaigns have been able to interrupt indigenous transmission of malaria during the years 2013-
2016. Sri Lanka obtained the malaria-free certificate from WHO in 2016.
Currently, the biggest threat to the elimination efforts is the risk of resurgence due to imported ma-
laria and the continuing receptivity in several parts of the country due to the persistence of malaria vectors.
Over the past few years, most of the imported malaria cases were reported by foreign travelers or by Sri
Lankan nationals returning from malaria endemic countries. With enhanced parasitological surveillance, 36
cases were reported in 2015 and 41cases in 2016. The implications of the imported cases are discussed in
the context of the challenges faced by the Anti-Malaria Campaign (AMC) and measures taken to prevent the
reintroduction of malaria.

14.1 Awareness of malaria

All households were interviewed in the 2016 SLDHS and quizzed whether the respondent have ever
heard of malaria and essentialness to obtain malaria prevention treatment before traveling to countries that
have a high prevalence of malaria. A responsible person in the household had answered for these questions.
Table 14.1 presents that the ninety seven percent (97%) of households aware about the malaria and only three
percent (3%) have never heard. Only 63percent of households knew about the requirement to obtain malaria
prevention treatment before traveling to countries that have a high prevalence of malaria. More attention
should be given to educate people on the requirement to take preventive medicine before traveling to malaria
endemic countries since that knowledge seems to be inadequate (37 percent of house holds were not aware).

Malaria 207
 to obtain malaria prevention treatment before traveling to countries that have a high prevalence of malaria..
More attention should be given to educate people on the requirement to take preventive medicine before
traveling to malaria endemic countries since that knowledge seems to be inadequate (37 percent of house
holds were not aware).

Table 14.1 Awareness of Malaria

YES NO DON'T KNOW

Awareness of malaria (%) (%) (%)
Ever heard of malaria 97.1 2.9 -

Essential to obtain malaria treatment before traveling in high

prevalence countries 62.9 11.1 26.0

14.2 Household ownership of mosquito nets

Ownership of insecticide-treated nets

Household
Demography andwith at Survey
Health least one insecticide-treated
- 2016 net (ITN). An ITN is defined as: (1) a factory- treated212
net that does not require any further treatment (long- lasting insecticidal net (LLIN) or (2) a net that
has been soaked with insecticide within the past 12 months.
sample : Households

Full household ITN coverage

Percentage of households with at least one ITN for every two people.
sample : Households

All eligible households were visited during the 2016 SLDHS and information was obtained on the
ownership of mosquito nets and, if so, how many. Respondents were also asked to show the mosquito nets
they owned to the interviewer so that the interviewer could identify the type. There are two types of insecti-
cide treated nets i.e. long lasting insecticide treated nets (LLIN) and temporary insecticide treated nets (Tem-
porary ITN). The long lasting net is a factory-treated net that does not require any further treatment while the
temporary insecticide treated net is a net that has been soaked with insecticide and will need to be re-soaked
over time. Hence, all together these two types of nets are named as ITNs in this chapter. Table 14.2 presents
the percentage of households with at least one mosquito net (normal net or ITN), the average number of nets
per household, and the percentage of households with at least one net for every two people who slept in the
household the previous night by background characteristics.
At the time of the 2016 SLDHS, 69 percent of the households had at least one mosquito net (normal
net or ITNs). On average, each household has nearly 2 mosquito nets of any type (Table 14.2). In addition,
almost half of the households (48 percent) had at least one net for every two persons who stayed in the house-
hold the night before the survey.
The household ownership of mosquito nets varies with residence. Households in the rural sector
recorded the highest percentage of households with at least one type of mosquito net (72 percent compared
to only 26 percent in the estates sector and 60 percent in the urban sector.). The use of ITNs is also higher
in the rural areas and shows an inverse relationship with wealth. The same pattern can be observed in the
previous SLDHS round (2006/07) but the all types of mosquito net usage was somewhat lower, 64 percent.
The proportion of households possessing any type of mosquito nets and any ITNs in the estate sector is sig-
nificantly lower than in other areas, perhaps due in part to the geographical variation (higher elevation and
cooler climate) around the country.
The highest ownership of any type of mosquito net by district was reported for the Polonnaruwa
district (97 percent), followed by Kurunegala (92 percent), Hambantota (88 percent), Kilinochchi (84 per-
cent), Trincomalee (83 percent) and Anuradhapura (83 percent). Similarly, the lowest values were reported
for Nuwara Eliya district (30 percent) due in part to the low prevalence of mosquitos and the high altitude of
the district.
In terms of the household ownership of ITNs, the Trincomalee district has the highest proportion
of households that possess ITNs (38 percent). Matale district shows a rapid growth in possession of ITNs
compared to the SLDHS 2006/07 (up from just over 2 percent in 2006/07 to 21 percent in 2016), benefiting
substantially from the donation of mosquito nets (see Table 14.2 below).

208 Demographic and Health Survey - 2016, Sri Lanka

 Table 14.2 Household possession of mosquito nets

Percentage of households with at least one mosquito net (treated or untreated), insecticide-treated net (ITN), and long-lasting insecticidal net (LLIN);
average number of nets, ITNs, and LLINs per household; and percentage of households with at least one net, ITN, and LLIN per two persons who stayed
in the household last night, by background characteristics, Sri Lanka 2016
Percentage of households with at Average number of nets per Percentage of households with
least one mosquito net household at least one net for every two
persons who stayed in the
household last night
Number of
households
with at
least one
Long- person who
Insecticide- Long- Insecticide- Long- Number Insecticide- lasting stayed in
Any treated lasting Any treated lasting of Any treated insecticid the
Background mosquito mosquito net insecticidal mosquito mosquito insecticidal househol mosquito mosquito al net household
1 1 1
Characteristic net (ITN) net (LLIN) net net (ITN) net (LLIN) ds net net (ITN) (LLIN) last night

Residence
Urban 59.5 2.6 2.5 1.3 0.0 0.0 4,309 38.8 0.5 0.4 4,299
Rural 72.4 7.5 7.2 1.7 0.1 0.1 21,778 52.3 2.4 2.3 21,645
Estate 26.2 0.2 0.2 0.4 0.0 0.0 1,122 9.4 0.1 0.1 1,119

District
Colombo 57.5 0.3 0.2 1.3 0.0 0.0 2,722 40.1 0.0 0.0 2,715
Gampaha 71.1 0.2 0.2 1.6 0.0 0.0 2,815 49.7 0.0 0.0 2,806
Kalutara 69.3 0.5 0.5 1.6 0.0 0.0 1,618 47.2 0.1 0.1 1,607
Kandy 49.7 1.6 1.5 1.0 0.0 0.0 1,872 30.4 0.3 0.3 1,868
Matale 75.8 20.9 20.6 1.8 0.3 0.3 720 59.1 7.2 7.0 699
Nuwara Eliya 30.2 1.3 1.3 0.6 0.0 0.0 895 16.1 0.4 0.4 887
Galle 72.4 0.9 0.9 1.6 0.0 0.0 1,461 51.4 0.5 0.5 1,448
Matara 76.5 0.9 0.9 1.9 0.0 0.0 1,107 56.6 0.0 0.0 1,101
Hambantota 87.8 13.1 12.7 2.1 0.2 0.2 846 67.4 3.4 3.4 842
Jaffna 45.8 7.9 7.1 0.9 0.1 0.1 720 20.8 2.7 2.4 719
Mannar 62.0 12.0 11.9 1.1 0.2 0.2 126 25.8 4.9 4.9 126
Vavuniya 63.8 11.4 9.8 1.2 0.2 0.2 199 36.4 4.8 4.6 199
Mullaitivu 69.2 15.5 14.9 1.3 0.2 0.2 116 42.1 5.8 5.5 115
Kilinochchi 84.1 18.8 8.1 1.6 0.3 0.2 141 52.7 8.9 4.9 139
Batticaloa 57.8 6.5 6.4 0.9 0.1 0.1 699 22.8 2.0 1.8 696
Ampara 72.4 8.2 6.8 1.5 0.1 0.1 909 43.3 3.0 2.4 905
Trincomalee 83.3 37.7 37.1 1.8 0.6 0.6 507 55.2 13.6 13.6 504
Kurunegala 92.3 18.1 17.9 2.4 0.2 0.2 2,416 77.5 5.7 5.6 2,399
Puttlam 74.3 13.0 13.0 1.7 0.2 0.2 1,007 56.1 4.7 4.7 998
Anuradhapura 82.6 15.5 14.9 2.0 0.2 0.2 1,245 65.0 4.0 3.9 1,242
Polonnaruwa 96.5 7.5 6.5 2.6 0.1 0.1 577 85.2 2.6 2.2 576
Badulla 45.6 1.9 1.9 1.0 0.0 0.0 1,114 29.9 0.7 0.7 1,108
Moneragala 78.6 9.4 8.6 1.8 0.1 0.1 678 55.9 3.4 3.2 673
Ratnapura 64.7 4.0 4.0 1.4 0.0 0.0 1,567 42.5 0.5 0.5 1,556
Kegalle 62.8 0.4 0.2 1.5 0.0 0.0 1,134 44.8 0.2 0.1 1,133

Wealth quintile
Lowest 54.7 7.9 7.4 0.9 0.1 0.1 6,149 32.8 3.3 3.1 6,084
Second 69.3 7.6 7.3 1.4 0.1 0.1 5,504 45.9 2.3 2.2 5,481
Middle 74.7 7.6 7.4 1.8 0.1 0.1 5,301 54.8 1.8 1.8 5,279
Fourth 75.5 5.8 5.6 1.9 0.1 0.1 5,164 56.7 1.7 1.7 5,143
Highest 70.6 2.8 2.7 1.9 0.0 0.0 5,094 54.6 0.8 0.7 5,077

Total 68.5 6.4 6.2 1.6 0.1 0.1 27,210 48.4 2.0 1.9 27,063
1
An insecticide-treated net (ITN) is (1) a factory-treated net that does not require any further treatment (LLIN) or (2) a net that has been soaked
with insecticide within the past 12 months

Figure 14.1 presents

Figure the
14.1possession
presents theofpossession
ITNs (LLINs and and
of LLINs temporary ITNs)
temporary ITNsbybydistrict,
district,The highest prevalence
demonstrating the
of theseimpact
nets isof observed in the districts
the Anti-Malaria Campaignof(AMC)..The
Trincomalee, Matale,
highest Anuradhapura,
prevalence Kurunegala,
of these nets is observed Kilinochchi,
in the
Mullativu and Hambantota.
districts of Trincomalee, Matale, Anuradhapura, Kurunegala, Kilinochchi, Mullativu and Hambantota.

Malaria 209
 Figure 14.1 Household ownership of ITNs (LLINs
and Temporary ITNs) by district
Kegalle By wealth quintile, household
Ratnapura ownership of at least one mosquito net
Moneragala
Badulla increases up to the fourth wealth quintile
Polonnaruwa from 55 percent to 76 percent, although
Anuradhapura
Puttalam it is lower in the highest wealth quintile
Kurunegala 37.7 (71 percent). Households in the highest
Trincomalee
Ampara wealth quintile can afford to use other
District

Batticaloa methods of mosquito control such as

Kilinochchi
Mullaitivu air-conditioning. The percentage of
Vavuniya households owning either an ever-treated
Mannar
Jaffna net or a temporary ITN declines with
Hambantota wealth quintile increasing and is highest
Matara
Galle among the poorest households. Although
Nuwara Eliya the absolute difference between lowest
Matale
Kandy and highest figures is not that large because
Kalutara ITNs of the overall low percentage having
Gampaha
Colombo these types of nets. This result reflects
0 5 10 15 20 25 30 35 40 the government’s program of targeted
% distribution of ITNs, in communities at
risk for malaria.

14.3 Source of mosquito nets

The population in general have access to buy normal mosquito nets from the market. Insecticide-
treated mosquito nets (ITNs) are distributed by anti-malarial campaigns and by NGOs free of charge. In the
2016 SLDHS, respondents at the household level were asked about the source from which they obtained the
mosquito net.
According to Table 14.3, the most common source of acquiring mosquito nets is purchasing. The
majority of the untreated mosquito nets were obtained via direct purchase (93 percent).
Donation as a source of nets is highest in households of the rural sector (11 percent) compared with
urban (6 percent) and estate (3 percent) households. By district, the percentage of households acquiring free
nets is notably higher in the districts in the northern and eastern provinces.
The results presented in Figure 14.2 also indicate that most of the ITNs were acquired for free as a
donation (91 percent) while only 9 were purchased or home made ITNs.

Figure 14.2 Sources of mosquito nets

100

90
93.4
90.8
80

70

60

50

40

30

20

10 5.3 9

0
Donation Bought

ITN Normal

210 Demographic and Health Survey - 2016, Sri Lanka

 Table 14.3 Source of mosquito nets

Percent distribution of mosquito nets by source of net, according to background characteristics, Sri Lanka 2016
Number of
mosquito
Background Characteristic Donation Bought Home made Other Total nets

Type of net
ITN1 90.8 9.0 0.1 0.0 100.0 2,274
Normal2 5.3 93.4 1.1 0.2 100.0 40,082

Residence
Urban 5.6 92.7 1.5 0.2 100.0 5,645
Rural 10.6 88.2 1.0 0.2 100.0 36,250
Estate 2.7 96.6 0.2 0.6 100.0 461

District
Colombo 2.4 96.4 1.1 0.1 100.0 3,439
Gampaha 0.9 98.3 0.7 0.1 100.0 4,452
Kalutara 2.5 96.5 0.9 0.1 100.0 2,552
Kandy 5.9 93.2 0.4 0.5 100.0 1,920
Matale 20.7 79.1 0.1 0.1 100.0 1,325
Nuwara Eliya 5.6 93.6 0.4 0.3 100.0 498
Galle 3.3 94.3 1.8 0.6 100.0 2,377
Matara 2.4 95.7 1.3 0.6 100.0 2,156
Hambantota 11.6 87.2 0.9 0.3 100.0 1,745
Jaffna 30.6 63.0 6.3 0.0 100.0 630
Mannar 36.5 52.7 10.8 0.0 100.0 133
Vavuniya 41.7 57.4 1.0 0.0 100.0 246
Mullaitivu 42.3 55.5 2.1 0.0 100.0 153
Kilinochchi 58.6 38.3 3.1 0.0 100.0 225
Batticaloa 32.5 67.5 0.0 0.0 100.0 614
Ampara 19.0 80.5 0.5 0.0 100.0 1,356
Trincomalee 33.2 66.4 0.4 0.0 100.0 910
Kurunegala 11.3 87.5 0.9 0.3 100.0 5,684
Puttalam 16.2 81.8 2.0 0.0 100.0 1,678
Anuradhapura 16.0 82.9 1.1 0.0 100.0 2,550
Polonnaruwa 7.1 91.0 1.8 0.1 100.0 1,474
Badulla 9.4 89.9 0.6 0.2 100.0 1,151
Moneragala 22.2 77.5 0.2 0.1 100.0 1,238
Ratnapura 5.5 93.1 0.5 0.9 100.0 2,178
Kegalle 0.7 98.9 0.3 0.2 100.0 1,668

Wealth quintile
Lowest 24.3 74.0 1.1 0.7 100.0 5,601
Second 12.6 86.2 1.0 0.3 100.0 7,978
Middle 9.0 89.8 1.0 0.2 100.0 9,340
Fourth 6.8 91.9 1.1 0.2 100.0 9,724
Highest 3.2 95.8 0.9 0.0 100.0 9,712

Total 9.9 88.9 1.0 0.2 100.0 42,356

1
An insecticide-treated net (ITN) is (1) a factory-treated net that does not require any further treatment
(LLIN) or (2) a net that has been soaked with insecticide within the past 12 months.
2
Any net that is not an ITN

Demography and Health Survey - 2016 216

Malaria 211
14.4 Use of mosquito nets by children under age 5
Young children are especially vulnerable to malaria and other mosquito borne diseases therefore it
is important to protect them with mosquito nets at night. Table 14.4 shows that 71 percent of children under
5 years of age, slept under a mosquito net (treated or untreated) the night before the survey. This value is
an increase over the 64 percent reported in 2006-07. Excluding northern province the figure for 2016 is 73
percent.
The data represents that the age of children and the use of mosquito nets are negatively related.
(The lowest age group <12 months has the highest percentage (80%) of use of mosquito nets and highest
age group 36-47 months has the lowest percentage (66%) of use of mosquito nets). Children in rural areas
are more likely to sleep under a treated or untreated mosquito net (76 percent) than those in the urban (58
percent) and the estate (35 percent) sectors. Children from the Polonnaruwa district have the highest percent-
age who slept under a mosquito net (treated or untreated) the night before the surveys (95 percent), followed
by those in Kurunegala (93 percent), and Hambantota (90 percent). The lowest percentages are observed in
Jaffna (22 percent), and Nuwaraeliya (40 percent). The percentages of children who slept under an ITNs are
very low (4 percent). The percentage of children who slept under a mosquito net (treated or untreated) during
the night before the survey increases with household wealth up to the middle wealth quintile and declines
afterwards (see Table 14.4).

Table 14.4 Use of mosquito nets by children

Percentage of children under five years of age who, the night before the survey, slept under a mosquito net (treated or untreated),
under an insecticide-treated net (ITN), under a long-lasting insecticidal net (LLIN); and among children under five years of age in
households with at least one ITN, the percentage who slept under an ITN the night before the survey, by background characteristics,
Sri Lanka 2016
Children under age 5 in all households Children under age 5 in
households with at least one
ITN1
Background Characteristic Percentage Percentage Percentage Percentage
who slept under who slept under who slept under who slept under
any mosquito an ITN1 last an LLIN last Number of an ITN1 last Number of
net last night night night children night children

Age in months
<12 79.6 3.6 3.3 1,496 44.7 119
12-23 73.7 3.3 3.1 1,596 47.9 109
24-35 71.4 4.3 4.3 1,739 55.0 136
36-47 66.2 3.4 3.4 1,710 55.9 105
48-59 65.6 3.0 2.7 1,734 49.7 104

Sex
Male 71.4 3.5 3.3 4,278 51.5 287
Female 70.6 3.6 3.4 3,997 49.9 286

Residence
Urban 58.2 1.5 1.5 1,307 44.8 44
Rural 75.6 4.1 3.9 6,598 51.2 529
Estate 35.4 0.0 0.0 369 * 0

District
Colombo 59.7 0.4 0.4 720 * 5
Gampaha 75.0 0.2 0.2 776 * 1
Kalutara 75.1 0.3 0.3 517 * 4
Kandy 61.4 2.1 2.1 589 * 19
Matale 78.0 11.8 11.8 220 (49.9) 52
Nuwara Eliya 39.5 1.0 1.0 281 * 3
Galle 76.0 0.2 0.2 439 * 6
Matara 78.5 0.4 0.4 345 * 1
Hambantota 90.1 5.1 5.1 269 (53.1) 26
Jaffna 21.6 2.4 2.4 208 * 19
Mannar 46.1 2.4 2.4 42 * 4
Vavuniya 60.1 11.1 10.1 64 (82.5) 9
Mullaitivu 63.4 9.4 8.9 38 (57.3) 6
Kilinochchi 66.9 11.0 5.6 46 (55.7) 9
Batticaloa 44.3 2.4 2.4 248 * 14
Ampara 68.5 4.4 4.0 363 (55.0) 29
Trincomalee 64.0 21.7 20.7 191 52.9 79
Kurunegala 93.2 7.6 7.6 690 45.0 117
Puttalam 77.5 4.4 4.4 296 (44.1) 30
Anuradhapura 85.1 8.2 7.9 422 51.0 68
Polonnaruwa 94.9 5.6 4.5 188 * 13
Badulla 55.1 2.4 2.4 306 * 13
Moneragala 81.9 5.9 5.6 244 (59.9) 24
Ratnapura 69.3 1.6 1.6 450 * 20
Kegalle 79.5 0.7 0.4 320 * 2

Wealth quintile
Lowest 56.9 4.8 4.5 1,662 55.7 143
Second 70.8 4.4 4.2 1,693 56.0 133
Middle 78.2 4.4 4.3 1,655 50.0 145
Fourth 76.6 2.9 2.8 1,769 45.8 113
Highest 72.3 0.8 0.8 1,495 (30.9) 40

Total 71.0 3.5 3.4 8,275 50.7 573

Note: Table is based on children who stayed in the household the night before the interview.
1
An insecticide-treated net (ITN) is (1) a factory-treated net that does not require any further treatment (LLIN) or (2) a net that
has been soaked with insecticide within the past 12 months
2
Indoor residual spraying (IRS) is limited to spraying conducted by a government, private or non-governmental organization

212 Demographic and Health Survey - 2016, Sri Lanka

14.5 Use of mosquits nets by pregnant women
In order to prevent complications from malaria during pregnancy, such as anemia, low birth weight,
and trans- placental parasitemia, all pregnant women are encouraged to sleep under mosquito nets. However,
and as mentioned before, since October 2012, Sri Lanka has eliminated malaria and no native transmitted
malaria patients are found. During the 2016 SLDHS, all ever-married women age 15-49 who were pregnant
at the time of the survey were asked if they had slept under a mosquito net the night before the survey.
In national level 60 percent of the pregnant women age 15 to 49 slept under any net the night before
the interview; in 2016 SLDHS, this figure is 62 percent excluding Northern Province. Use of any type of
mosquito net is higher among pregnant women residing in the rural sector (64 percent) than urban (51 per-
cent) and estate (16 percent) sectors. Pregnant women with higher educational level are more likely to have
slept under any type of mosquito net the night before the interview (68 percent among those with degree and
above) than those with lower educational levels. The percentage of pregnant women who slept under a mos-
quito net (treated or untreated) during the night before the survey increases with household wealth up to the
middle wealth quintile and it declines at the highest quintile. (See Table 14.5)

Table 14.5 Use of mosquito nets by pregnant women

Percentages of pregnant ever married women age 15-49 who, the night before the survey, slept under a mosquito net (treated or
untreated), under an insecticide-treated net (ITN), under a long-lasting insecticidal net (LLIN); and among pregnant women age 15-
49 in households with at least one ITN, the percentage who slept under an ITN the night before the survey, by background
characteristics, Sri Lanka 2016
Among pregnant women age 15-49 in all households Among pregnant women
age 15-49 in households
with at least one ITN1
Percentage
who slept under
Percentage an ITN1 last
who slept Percentage night or in a Percentage
under any who slept Percentage dwelling who slept
mosquito under an who slept under sprayed with under an
net last ITN1 last an LLIN last IRS2 in the past Number of ITN1 last Number of
Background Characteristic night night night 12 months women night women

Residence
Urban 51.0 0.0 0.0 0.0 120 * 5
Rural 64.1 4.1 3.9 4.1 682 39.7 70
Estate 16.4 1.8 1.8 1.8 39 * 1

District
Colombo 55.5 0.0 0.0 0.0 65 * 0
Gampaha 53.4 0.0 0.0 0.0 91 * 0
Kalutara (32.0) (0.0) (0.0) (0.0) 34 * 0
Kandy 52.1 5.9 5.9 5.9 49 * 3
Matale (59.1) (3.6) (3.6) (3.6) 29 * 5
Nuwara Eliya * * * * 20 * 0
Galle (52.9) (0.0) (0.0) (0.0) 42 * 0
Matara (64.2) (1.9) (1.9) (1.9) 38 * 1
Hambantota (83.8) (0.0) (0.0) (0.0) 29 * 1
Jaffna * * * * 20 * 2
Mannar * * * * 4 * 1
Vavuniya * * * * 5 * 1
Mullaitivu * * * * 2 * 0
Kilinochchi * * * * 4 * 0
Batticaloa (37.3) (0.0) (0.0) (0.0) 27 * 1
Ampara (56.1) (0.0) (0.0) (0.0) 44 * 5
Trincomalee (46.8) (15.8) (15.8) (15.8) 22 * 9
Kurunegala 90.0 6.9 6.9 6.9 80 * 16
Puttalam (75.2) (18.9) (18.9) (18.9) 29 * 8
Anuradhapura (85.6) (6.8) (4.1) (6.8) 55 * 9
Polonnaruwa * * * * 21 * 4
Badulla (48.4) (0.0) (0.0) (0.0) 30 * 0
Moneragala (68.1) (0.0) (0.0) (0.0) 27 * 3
Ratnapura (60.7) (4.3) (4.3) (4.3) 39 * 6
Kegalle (56.6) (0.0) (0.0) (0.0) 35 * 1

Education
No education * * * * 3 * 1
Passed Grade 1-5 * * * * 17 * 1
Passed Grade 6-10 61.6 4.1 4.1 4.1 330 (36.9) 37
Passed G.C.E.(O/L) or
equivalent 55.1 3.3 3.3 3.3 206 * 15
Passed G.C.E.(A/L) or
equivalent 61.9 1.6 0.9 1.6 212 * 13
Degree and above 68.0 6.5 6.5 6.5 73 * 10

Wealth quintile
Lowest 46.0 2.4 2.4 2.4 142 * 14
Second 58.8 5.2 5.2 5.2 159 * 15
Middle 64.0 3.5 2.7 3.5 182 * 19
Fourth 66.7 4.0 4.0 4.0 209 * 21
Highest 60.2 1.4 1.4 1.4 150 * 7

Total 60.0 3.4 3.2 3.4 841 37.4 76

Note: Table is based on women who stayed in the household the night before the interview.
1
An insecticide-treated net (ITN) is (1) a factory-treated net that does not require any further treatment (LLIN) or (2) a net
that has been soaked with insecticide within the past 12 months
2
Indoor residual spraying (IRS) is limited to spraying conducted by a government, private or non-governmental
organization

Malaria 213
214 Demographic and Health Survey - 2016, Sri Lanka
WOMEN’S EMPOWERMENT AND
DEMOGRAPHIC AND HEALTH
OUTCOMES 15
Key Findings
• Ownership of bank accounts and mobile phone: Eighty-three
percent of women use an account in a bank or other financial institution
and 78 percent own a mobile phone.
• Participation in decision-making: Overall, 77 percent of the currently
married women participated in the three key household decisions
identified and only 6 percent participated in none of the three decisions
• Women’s empowerment: Forty-five percent of the women not
involved in the decision process in the household (“0” decisions) are
not using contraception, compared to only 35 percent among those
involved in one or more of the three decisions.
• Women’s empowerment and unmet need for contraception:
women who participate in the three main decisions in their household
reported lower percentages of unmet need for contraception (7 percent)
compared to 10 percent among those without participation. The
percentages are similar for both types of unmet need for contraception
(for spacing and for limiting).

T
he 2016 Sri Lanka Demographic and Health Survey (SLDHS) collected data from eligible respondents
on general background characteristics of female respondents and their households, including: age,
place of residence, level of education, household wealth, and employment status. In addition, data
was collected on issues related to women’s empowerment, such as the ownership and use of bank accounts
and mobile phones and woman’s participation in household decision-making. For this report, an index
of empowerment was developed based on the number of household decisions in which the respondent
participates. The ranking of women on this index is then related to selected demographic and health outcomes
including contraceptive use, ideal number of children, unmet need for contraception, and reproductive health
care (antenatal, delivery and postnatal care).

15.1 Ownership of bank accounts and mobile phones

Ever-married women age 15-49 included in the sample of the 2016 SLDHS were asked about their
ownership and use of accounts in a bank or other financial institution, and the ownership of a mobile phone
and its use to conduct financial transactions. Overall, use of bank accounts and ownership of mobile phones
among ever-married women is high. Thus, 83 percent of them use an account in a bank or other financial
institution, and 78 percent own a mobile phone. However, only 4 percent of them use the mobile phone to
complete financial transactions (Table 15.1).
Ever-married women from the rural and urban sectors are more likely to use a bank account, own a
mobile phone, For example, more than eighty percent of the women from the rural and urban sector use a
bank account, compared with 69 percent of those in the estates sector; more than three out of four women in
the rural and urban sectors own a mobile phone, compared with just 55 percent in the estates sector. The use
of the mobile phone for transactions according to sector of residence shows a different pattern in which the
urban and estates sector women make greater use (7 percent and 8 percent) than those in the rural sector (3
percent, Table 15.1).

Women’s Empowerment and Demographic and Health Outcomes 215

 Use of aofbank
Use account,
a bank mobile
account, phone
mobile ownership,
phone and and
ownership, mobile phone
mobile use for
phone usefinancial transactions
for financial in-
transactions
creases with education of the woman and household wealth. For example, while only 39 percent of
increases with education of the woman and household wealth. For example, while only 39 percent of ever- ever-mar-
ried womenwomen
married with nowith
education own a mobile
no education own a phone,
mobile this percentage
phone, is at the highest
this percentage is at thevalue (99value
highest percent)
(99among
percent)
ever-married
among ever-married women with degree and above. Similarly, 57 percent of ever-married women in20the
women with degree and above. Similarly, 57 percent of ever-married women in the poorest
percent of 20
poorest thepercent
households own
of the a mobile own
households phone compared
a mobile withcompared
phone 93 percent of those
with in the of
93 percent richest
those20in percent.
the richest
20 percent.

Table 15.1 Ownership and use of bank accounts and mobile phones

Percentage of ever-married women age 15-49 who use an account in a bank or other financial institution and percentage who
own a mobile phone; among women who own a mobile phone, percentage who use it for financial transactions, according to
background characteristics, Sri Lanka 2016
Use mobile
phone for Number of
Use a bank Own a mobile Number of financial women who own
Background characteristic account phone women transactions a mobile phone

Age
15-19 67.7 64.5 229 1.6 148
20-24 79.4 77.0 1,410 5.1 1,085
25-29 85.0 84.2 2,620 5.1 2,206
30-34 85.5 83.3 3,615 3.8 3,011
35-39 84.6 79.8 3,945 4.2 3,148
40-44 83.7 74.8 3,269 3.2 2,446
45-49 78.1 67.6 3,214 2.4 2,174

Residence
Urban 81.0 84.6 2,855 6.8 2,414
Rural 83.9 77.4 14,737 3.1 11,414
Estate 69.1 55.1 710 8.3 391

District
Colombo 83.9 87.0 1,731 5.3 1,506
Gampaha 84.6 81.1 1,845 3.6 1,497
Kalutara 79.9 77.0 1,104 2.5 851
Kandy 80.6 81.2 1,223 3.9 993
Matale 80.5 73.4 490 1.2 360
Nuwaraeliya 78.3 68.6 572 7.8 392
Galle 85.1 79.6 935 5.2 744
Matara 89.2 85.0 718 4.4 611
Hambantota 85.3 74.4 556 2.0 414
Jaffna 85.1 79.4 471 5.2 374
Mannar 85.7 89.3 81 3.0 73
Vavuniya 74.9 84.0 136 7.6 115
Mullaitivu 85.7 78.4 81 1.0 64
Killinochchi 76.7 75.0 94 3.1 70
Batticaloa 75.3 73.3 531 24.0 389
Ampara 74.9 69.0 731 1.5 504
Trincomalee 71.6 65.7 362 13.9 238
Kurunegala 86.1 78.9 1,592 1.5 1,257
Puttalam 82.6 79.6 664 2.6 528
Anuradhapura 85.7 76.0 984 1.4 748
Polonnaruwa 87.0 72.0 399 2.1 287
Badulla 84.1 67.6 735 2.6 497
Monaragala 84.1 75.8 485 0.8 367
Ratnapura 82.7 70.0 1,084 1.3 758
Kegalle 84.6 83.5 698 0.7 583

Education
No education 49.1 39.4 285 6.1 112
Passed Grade 1-5 63.3 50.3 1,257 4.2 632
Passed Grade 6-10 79.1 71.9 8,130 2.4 5,841
Passed G.C.E.(O/L) or equivalent 86.5 83.8 4,044 3.7 3,388
Passed G.C.E.(A/L) or equivalent 93.1 91.0 3,731 5.2 3,394
Degree and above 98.4 99.3 856 8.7 850

Wealth quintile
Lowest 70.7 56.8 3,390 4.2 1,925
Second 78.9 71.7 3,695 2.7 2,649
Middle 84.7 79.3 3,838 2.5 3,045
Fourth 87.6 85.8 3,816 3.6 3,273
Highest 91.9 93.4 3,562 6.2 3,326

Total 82.9 77.7 18,302 3.9 14,218

216 Demographic and Health Survey - 2016, Sri Lanka

15.2 P
15.2 articipation
PARTICIPATION IN DECISION
in decision making MAKING
Currently married women were asked in the 2016 SLDHS about the person (respondent, her husband
Currentlyormarried
or partner, together, someonewomen weremakes
else) who askedtheindecisions
the 2016about
SLDHS
a) theabout
healththe person
care (respondent,
for herself, b) majorher
husband or partner, together, or someone else) who makes
household purchases, and c) visits to her family or relatives. the decisions about a) the health care for
herself, b) major household purchases, and c) visits to her family or relatives.

Participation in major household decisions

Women are considered to participate in household decision if they make decisions alone or
jointly with their husband in all three of the following areas: (1) the woman’s health care, (2) major
household purchases, and (3) visits to the woman’s family or relatives.
sample : Currently married women age 15-49

TheThe majority
majority of of
thethe currently
currently married
married women
women in in
SriSri Lanka
Lanka (85(85 percent
percent or or more)
more) participate
participate in in each
each
of three common household decisions. However, a smaller percentage indicated that
of three common household decisions. However, a smaller percentage indicated that they were the main they were the main
decision-maker:
decision-maker: 35 35 percent
percent on on
herher
ownown health
health care,
care, 2020 percent
percent onon major
major household
household purchases,
purchases, and
and just
just 1616
percent
percenton on
visits to her
visits family
to her or relatives.
family Overall,
or relatives. 77 percent
Overall, of theofcurrently
77 percent married
the currently womenwomen
married indicated that
indicated
they participate
that in all three
they participate in decisions and only 6and
all three decisions percent
onlyparticipate
6 percent inparticipate
none of theinthree
nonedecisions (Table
of the three 15.2,
decisions
Table 15.3, Figure 15.1).
(Table 15.2, Table 15.3, Figure 15.1).

Table 15.2 Participation in decision making

Percent distribution of currently married women age 15-49 by person who usually makes decisions about various issues, Sri
Lanka 2016
Wife and Mainly Number of
Decision Mainly wife husband jointly husband Someone else Total women
Own health care 34.5 51.5 13.5 0.5 100.0 17,257
Major household purchases 20.2 64.7 13.7 1.5 100.0 17,257
Visits to her family or relatives 15.9 72.6 10.7 0.8 100.0 17,257

Since 2006-07, there is an increase in the number of women who report participation in these
Since 2006-07,
three common householdtheredecisions.
is an increase
Womenin theinvolved
numberin of decisions
women who report
about theirparticipation
health care in these three
increased from
common household
78 percent to 86 decisions.
percent inWomen involved in
2016. Women’s decisions about
involvement their health
in decisions aboutcare increased
major householdfrom purchases
78 per-
cent to 86 percent
increased from 83 in 2016. Women’s
percent involvement
to 85 percent, in decisions about
and participation major household
in decisions about visits purchases
to familyincreased
increased
from 83 percent to 85 percent,
from 80 percent to 89 percent. and participation in decisions about visits to family increased from 80 percent
to 89 percent.
TheThe before
before mentioned
mentioned changes
changes areare primarily
primarily due
due to to increases
increases in in
jointjoint decision
decision making
making as as opposed
opposed
to increases
to increases in women’s
in women’s exclusive
exclusive decision
decision making making in three
in these these situations.
three situations.
Changes Changes
in exclusivein exclusive
deci-
sion
decision making is negligible for decisions related to the woman’s health care, while women’s for
making is negligible for decisions related to the woman’s health care, while women’s sole decision sole
major household
decision purchases
for major actually
household decreased
purchases from 25
actually percent in
decreased 2006-07
from to 20 percent
25 percent in 2006-07in 2016.
to 20Similarly,
percent in
exclusive decision making for visits to family also declined from 22 percent to 16 percent in 2016. Yet, the
2016. Similarly, exclusive decision making for visits to family also declined from 22 percent to 16 percent
“mainly husband” decision category, declined for “own health care” from 21 percent in 2006-07 to 14 percent
in 2016. Yet, the “mainly husband” decision category, declined for “own health care” from 21 percent in
in 2016.
2006-07 to 14 percent in 2016.
By background characteristics, currently married women’s involvement in all three decisions in-
creases withByagebackground
from 66 percentcharacteristics,
among women currently married
age 15-19 to awomen’s involvement
peak 78 percent amonginwomen all threeagedecisions
30-34.
Consequently,
increases with 10 age
percent
fromof 66the 15-19among
percent currently
women married womentodo
age 15-19 not participate
a peak 78 percent in any of
among these age
women three30-
decisions (Table 15.3).
34. Consequently, 10There
percentappears
of theto be nocurrently
15-19 differences in thewomen
married decision-making participation
do not participate in any by of sector of
these three
residence,
decisionssince the 15.3).
(Table majority of the
There currently
appears to bemarried women participate
no differences in all three decisions
in the decision-making (71 percent
participation by sectorforof
theresidence,
estates sector,
since74 theformajority
urban sector
of theand 78 percent
currently marriedfor the
womenruralparticipate
sector). However, a greater
in all three decisionspercentage of
(71 percent
currently married women in the estate sector (10 percent) do not participate in any
for the estates sector, 74 for urban sector and 78 percent for the rural sector). However, a greater of the three decisions.
percentage of currently
By district married
of residence, thewomen in the
percentage estate sector
of women (10 percent)
with no-voice in any doofnot participate
these in any var-
three decisions of the
iesthree decisions.with the highest percentages observed
substantially, among currently married women of Mullaitivu
(20 percent), Batticaloa (18 percent) and Jaffna (18 percent).
Women with at least secondary education are more likely to report participation in decision-
making compared to women with less or no education. For example, 55 percent of women with secondary
education and 77 percent of women with more than secondary education participate in all three decisions
compared with 44 percent of women with Empowerment
Women’s primary and andno education.
Demographic By district
and Health Outcomesof residence, the
217
percentage of women with no-voice in any of these three decisions varies substantially, with the highest
percentages observed among currently married women of Mullaitivu (20 percent), Batticaloa (18 percent)
 Figure 15.1 Women’s participation in decision making
The lowest percentages were reported
by currently married women in Ham- 100
13.5 10.7
bantota, Polonnaruwa, Ratnapura, Mat- 13.7

ara and Kalutara (all with 2 percent or 75

less).
51.5
The participation in all three 50 64.7 72.6
decisions by currently married women
increases with the level of education
and the household wealth. Currently 25
34.5
married women in the highest wealth 20.2 15.9
quintile are more likely to participate in 0
decision-making compared with wom- Own health care Major household purchases Visits to her family or
relatives
en in lower wealth quintiles (80 percent Mainly wife Wife and husband jointly Mainly husband Someone else
compared with 73 percent).

Table 15.3 Women's participation in decision making by background characteristics

Percentage of currently married women age 15-49 who usually make specific decisions either by themselves or jointly with their
husband, by background characteristics, Sri Lanka 2016
Specific decisions
making major Visits to her None of the
W oman's own household family or All three three Number of
Background characteristic health care purchases relatives decisions decisions women

Age
15-19 80.1 76.2 81.9 65.9 10.2 225
20-24 83.8 80.2 84.3 71.4 8.0 1,373
25-29 85.2 83.8 87.2 75.1 6.5 2,559
30-34 87.5 85.7 89.3 78.1 5.3 3,481
35-39 85.8 85.9 88.7 77.8 6.0 3,735
40-44 86.5 85.2 90.3 78.4 5.6 3,033
45-49 86.4 85.8 89.1 78.1 6.3 2,851

Number of living children

0 82.8 81.6 86.0 72.4 7.8 1,760
1-2 87.0 85.7 89.1 77.9 5.5 10,821
3-4 85.4 84.5 88.4 76.9 6.5 4,351
5+ 78.3 78.5 83.7 69.2 11.6 325

Residence
Urban 83.7 83.5 87.1 73.7 6.8 2,682
Rural 86.7 85.3 89.0 77.8 5.8 13,906
Estate 80.8 80.6 83.3 71.0 9.5 669

District
Colombo 87.2 86.9 89.4 77.8 4.9 1,625
Gampaha 82.1 86.0 88.8 74.1 5.4 1,755
Kalutara 86.6 87.8 94.0 80.2 2.4 1,040
Kandy 89.6 85.2 87.6 79.7 5.8 1,174
Matale 85.9 78.9 79.5 62.7 4.0 456
Nuwaraeliya 81.8 85.3 86.3 76.9 9.8 552
Galle 82.4 83.2 88.7 70.1 4.8 896
Matara 92.3 86.4 95.1 80.6 2.2 685
Hambantota 94.4 92.2 95.2 86.8 1.6 532
Jaffna 66.8 69.7 78.4 58.6 17.9 409
Mannar 90.0 90.4 90.6 89.2 8.7 76
Vavuniya 77.5 84.8 89.5 72.8 5.6 125
Mullaitivu 73.8 74.6 78.5 69.0 19.9 67
Killinochchi 79.1 69.2 81.7 57.1 8.7 81
Batticaloa 76.7 70.9 75.8 66.7 18.3 491
Ampara 89.1 92.3 94.1 85.3 3.3 692
Trincomalee 83.8 85.1 92.6 75.6 3.6 331
Kurunegala 86.3 83.4 86.6 78.7 9.6 1,501
Puttalam 85.1 86.3 86.5 78.0 8.2 635
Anuradhapura 88.6 86.8 88.5 81.8 5.5 919
Polonnaruwa 94.3 89.0 90.4 82.5 1.7 381
Badulla 85.4 80.6 85.8 72.3 5.9 697
Monaragala 83.5 81.8 83.3 78.8 14.5 452
Ratnapura 90.0 85.1 92.4 76.5 1.7 1,025
Kegalle 89.9 86.7 89.1 82.4 6.6 658

Education
No education 82.8 78.1 81.0 70.3 9.4 235
Passed Grade 1-5 83.0 82.5 85.6 74.3 9.4 1,099
Passed Grade 6-10 85.1 84.0 88.0 76.0 6.6 7,629
Passed G.C.E.(O/L) or equivalent 85.2 83.9 88.5 75.4 6.2 3,842
Passed G.C.E.(A/L) or equivalent 89.5 87.7 90.7 80.5 4.2 3,611
Degree and above 88.4 89.2 90.0 82.0 5.0 841

Wealth quintile
Lowest 83.3 81.4 85.6 73.1 8.3 3,065
Second 84.8 83.3 87.5 75.3 6.8 3,459
Middle 86.9 85.4 89.0 78.2 6.3 3,621
Fourth 86.9 86.0 89.2 77.9 5.4 3,658
Highest 87.8 87.6 90.9 79.7 4.3 3,454

Total 86.0 84.8 88.5 76.9 6.1 17,257

218 Demographic and Health Survey - 2016, Sri Lanka

15.3 WOMEN’S EMPOWERMENT INDICATOR

One indicator is included here to represent the empowerment of currently married women and is
based on women’s participation in making household decisions. This indicator asks the number of
15.3 Women’s empowerment indicator
ranges from 0 to 3 and reflects the degree of decision-making control that women are able to exercise in
One indicator is included here to represent the empowerment of currently married women and is
areas that affect their lives and the level of women’s empowerment in a society.
based on women’s participation in making household decisions. This indicator asks the number of decisions
in which women participate either alone or jointly with their husband or partner. This index ranges from 0 to
3 and reflects the degree of decision-making control that women are able to exercise in areas that affect their
15.3.1 CURRENT USE OF CONTRACEPTION BY WOMAN’S EMPOWERMENT STATUS
lives and the level of women’s empowerment in a society.
A woman’s desire and ability to control her fertility and her choice of contraceptive methods are
affected by her status in the household and her own sense of empowerment. A woman who is unable to
15.3.1 Current use of contraception by woman’s empowerment status
control other aspects of her life may be less able to make decisions about her fertility. She may also need to
A woman’s desire
choose contraceptive methodsand ability
that aretoless
control her fertility
obvious or do notandrequire
her choice of contraceptive
the approval or knowledge methods are
of her
affected
husband.by her status in the household and her own sense of empowerment. A woman who is unable to
control other aspects of her life may be less able to make decisions about her fertility. She may also need
to chooseParticipation
contraceptive in methods
household that are less isobvious
decisions or do
positively not require
associated withthecontraceptive
approval or knowledge of her
use (both modern
husband.
and traditional methods). As the number of decisions in which a woman participates increases, so does the
use of any contraception,
Participation includingdecisions
in household any modern contraception.
is positively The data
associated withshow that participation
contraceptive use (bothinmodern
one to
two household decisions indicates a noticeable increase in the likelihood the woman will
and traditional methods). As the number of decisions in which a woman participates increases, so does the use contraception
(Table
use 15.4).
of any The distribution
contraception, of currently
including married
any modern women not The
contraception. usingdata
contraception is associatedinwith
show that participation onethe
to
levelhousehold
two of decision-making in whicha women
decisions indicates areincrease
noticeable involved. Almost
in the half of
likelihood thethe women
woman willnotuseinvolved in the
contraception
(Table 15.4). The distribution
decision-making process in the of currently
household married women notinusing
(“0” decisions Tablecontraception
15.4) are notis using
associated with the level
contraception (45
of decision-making in which women are involved. Almost half of the women not
percent), compared to only 35 percent among those involved in one or more of the three decisions. involved in the decision-
making process in the household (“0” decisions in Table 15.4) are not using contraception (45 percent),
compared to only 35 percent among those involved in one or more of the three decisions.

Table 15.4 Current use of contraception by women's empowerment

Percent distribution of currently married women age 15-49 by current contraceptive method, according to number of decisions in which
women participate, Sri Lanka 2016

Temporary
Any Female Male modern Any Not
Empowerment Any modern sterili- steriliz- female Male traditional currently Number
indicator method method zation ation methods2 condom method using Total of women

Number of decisions
in which women
participate1
0 55.4 48.1 14.1 0.1 28.0 5.8 7.3 44.6 100.0 1,058
1-2 64.9 53.6 13.7 0.0 32.4 7.4 11.4 35.1 100.0 2,923
3 65.3 54.0 14.0 0.1 32.9 7.0 11.3 34.7 100.0 13,276

Total 64.6 53.6 14.0 0.0 32.5 7.0 11.0 35.4 100.0 17,257
Note: If more than one method is used, only the most effective method is considered in this tabulation.
1
Women’s own health care; specific decisions making major household purchases and; visits to her family or relatives.
2
Pill, IUD, injectable, implants, female condom, emergency contraception, standard days method, lactational amenorrhea
method, and other modern methods

15.3.2 Women’s empowerment and ideal number of children and unmet need for contraception
A15.3.2
womanWwho becomes more empowered is more likely to have a say in the number of children
OMEN’S EMPOWERMENT AND IDEAL NUMBER OF CHILDREN AND UNMET NEED
(ideal number of children) she desires and the time at which she has her children. She has more control over
FOR CONTRACEPTION
her ability to access and use contraceptives and to space and limit her family size.
A woman
Women whowho becomes in
participate more empowered
household is more
decision likely have
making to have a sayideal
similar in thenumbers
number of of children
(idealthose
than number of children)
without she desires
participation, and is
a fact that theassociated
time at which shealready
with the has herrelatively
children. low
She fertility
has more control
discussed
in previous
over chapters
her ability of this
to access andreport. However, women
use contraceptives and towho
spaceparticipate
and limit in
herthe threesize.
family main decisions in their
household reported lower percentages of unmet need for contraception (7 percent) compared to 10 percent
among those Women whoparticipation
without participate in(Table
household
15.5).decision making have
The percentages similarfor
are similar ideal
bothnumbers
types ofof children
unmet needthan
for
those without(for
contraception participation,
spacing anda for
factlimiting).
that is associated with the already relatively low fertility discussed in
previous chapters of this report. However, women who participate in the three main decisions in their
household reported lower percentages of unmet need for contraception (7 percent) compared to 10 percent
among those without participation (Table 15.5). The percentages are similar for both types of unmet need
for contraception (for spacing and for limiting).
Women’s Empowerment and Demographic and Health Outcomes 219
 Table 15.5 Ideal number of children and unmet need for family planning by women's empowerment

Mean ideal number of children for currently married women age 15-49 and percentage of currently married women age 15-49 with
an unmet need for family planning, by number of decisions in which women participate, Sri Lanka 2016
Percentage of currently married women with
an unmet need for family planning2
Mean ideal
number of Number of Number of
Empowerment indicator children1 women For spacing For limiting Total women

Number of decisions in which

women participate1
0 2.6 1,045 4.6 5.4 9.9 1,058
1-2 2.6 2,900 3.7 3.8 7.6 2,923
3 2.5 13,224 2.9 4.5 7.3 13,276

Total 2.5 18,191 3.1 4.4 7.5 17,257

1
Mean excludes respondents who gave non-numeric responses.
2
Figures for unmet need correspond to the revised definition described in Bradley et al., 2012.
3
Restricted to currently married women. See Table 15.2 for the list of decisions.

15.3.3
15.3.3 E REPRODUCTIVE
arly childhood HEALTH
mortality CAREbyBYwomen
rates WOMEN
’s ’empowerment
S EMPOWERMENT STATUS
status

The ability of women

Empowered women to areaccess
moreinformation,
likely to bemake abledecisions,
to seek and and act
useeffectively in theirtoown
health services interests
meet their
or in the interests of those who depend on them is essential to their empowerment.
reproductive health goals, including safe motherhood. The relationship between the women’s If women, the primary
caretakers
empowerment of children,
index andarethe
empowered, the health
use of maternal andcare
health survival ofhowever.
is flat, their children will also
In general, be enhanced.
women who measure
the mostAccording
empowered to on
theeach
data index
presentareinnot more
table 15.6likely to have
no clear received
pattern can bematernal
observedhealth
betweencare. Forchildhood
early example,
96 percent of the currently married women
mortality rates and woman’s empowerment status. who fully participated in all household decisions received a
postnatal check in the first 2 days after birth, compared with 96 percent among women who participated in
no decisions (Table 15.6). This finding in itself points to two major facts: first the high levels observed in
the reproductive health care indicators, and second, the high levels of equity observed across populations
and women
Table in particular.
15.6 Early childhood mortality rates by women's status

Infant, child, and under-five mortality rates for the 10-year period preceding the survey, by indicators of women's
Table 15.6 Reproductive
empowerment, Sri Lankahealth
2016 care by women's empowerment
Infant mortality Under-five mortality
Percentage of women
Empowerment age 15-49 with a live birth in the five years preceding
indicator (1q0)theChild
survey who received
mortality (4q1) antenatal care, (5q0)
delivery assistance
Number and postnatal
of decisions care
in which from health personnel for the most recent birth, according to number of decisions in
women
which women participate, Sri Lanka 2016
participate 1

0 9 Percentage2 of 12
1-2 Percentage Percentage
9 women 2 with a 11
3 receiving antenatal receiving 11 delivery postnatal checkup 1 Number of women
12
1
Restricted to currently married women. careSee
fromTable
a skilled
15.2 care from
for the listaofskilled in the first two days with a child born in
decisions.
1 1 2
Empowerment indicator provider provider after birth the last five years
Number of decisions in which women
1
participate
0 97.7 99.0 96.4 435
1-2 98.8 99.1 93.1 1,199
3 98.9 99.1 95.6 5,387

Total 98.8 99.0 95.2 7,138

1
'Skilled provider' includes doctor, nurse, midwife
2
Includes women who received a postnatal checkup from a doctor, nurse, midwife, community health worker or
traditional birth attendant (TBA) in the first two days after the birth. Includes women who gave birth in a health facility
and those who did not give birth in a health facility.
3
Restricted to currently married women. See Table 15.2 for the list of decisions.

15.3.4 EARLY CHILDHOOD MORTALITY RATES BY WOMEN’S EMPOWERMENT STATUS

The ability of women to access information, make decisions, and act effectively in their own
interests or in the interests of those who depend on them is essential to their empowerment. If women, the
primary caretakers of children, are empowered, the health and survival of their children will also be
enhanced.

According to the data present in table 15.7 no clear pattern can be observed between early
childhood mortality rates and woman’s empowerment status.
220 Demographic and Health Survey - 2016, Sri Lanka
NON COMMUNICABLE DISEASES,
MENTAL ILLNESSES, SUICIDES,
SMOKING AND DRUG CONSUMPTION 16
Key Findings
• Non-Communicable Diseases: Overall, heart disease, high blood pressure diabetes and
high blood cholesterole are mostly prevalent among older population(40 or more years of
age). Wheezing and asthma, and chronic kidney disease seem to affect all age groups, al-
though with slightly higher percentages among older population.
• Heart Disease: Two percent of the population.
• High Blood Pressure: Eight percent of the population.
• Wheezing/Asthma: Four percent of the population.
• Diabetes: Six percent of the population.
• High Blood Cholesterol: Five percent of the population.
• Chronic Kidney Diseases: One percent of the population.
• Accidents: Road accidents, Serious Fall and Animal Bites have the highest prevalence at
only 1 percent.
• Mental Illnesses: Globally, less than one percent (0.7 percent) of household members were
undergoing treatment for any kind of mental illness.
• Suicides: Less than one percent of the households in which at least one person has tried to
commit suicide during the year before the survey.
• Tobacco Use: In 34 percent of households, at least one member smoke tobacco and another
29 percent use smokeless tobacco.
• Alcohol and Drugs : In 37 percent of households at least one member currently consumes
alcohol and less than one percent have used either ganja (0.4 percent) or heroin (0.1 percent).

T
his chapter presents information about non-communicable diseases, mental health and suicides and the
tobacco use. It also includes the 2016 SLDHS for people suffering from the following non-communi-
cable diseases during the 12 months before the survey: heart diseases, high blood pressure, wheezing/
asthma, paralysis, diabetes, cancer, high blood cholesterol, chronic kidney disease and cirrhosis. The ques-
tions were asked for all household members at the time of the survey.

16.1 Non-communicable diseases

Each year nearly 38 million people die from Non-Communicable Diseases (NCD) in the world. The
majority of these deaths are due to four common non-communicable diseases: cardiovascular diseases (heart
attack and stroke), diabetes, cancer and chronic respiratory diseases. Around 70 percent of the disease burden
in Sri Lanka is due to non-communicable diseases.
For all household members, interviewers of the 2016 SLDHS asked if, during the 12 months before
the survey, any had suffered from each one of the diseases listed previously. For those household members
affected by a specified disease, interviewers asked if they were under treatment. Table 16.1, included below,
presents the percentage of people suffering from diseases during the last 12 months, by background charac-
teristics. Overall, heart disease, high blood pressure diabetes and high blood cholesterol are mostly prevalent
among older population (40 or more years of age). Wheezing and asthma and chronic kidney disease seem
to affect all age groups, although with slightly higher percentages among older populations (Table 16.1 and
Figure 16.1).

Non Communicable Diseases, Mental Illnesses, Suicides, Smoking..... 221

 The results by sector of residence confirm the expected higher prevalence of diseases associated with
the pace of life of the urban inhabitants: high blood pressure, diabetes, high blood cholesterol, heart disease,
wheezing and asthma, compared to the prevalence observed in the rural and estates sector residents. The
distribution by wealth quintile for these NCDs show different but expected patterns, with high blood pressure
and diabetes increasing with household wealth, while wheezing and asthma seem to affect more the popula-
tion of the poorest quintiles than the richest ones. Heart disease appears to be similarly prevalent across all
wealth quintiles.
Some variations are also observed for these NCDs across districts. The highest rates are observed as
follows:
• High blood pressure in Colombo with 12 percent of the population,
• Diabetes and high blood cholesterol in Colombo with 9 percent of the population,
• Wheezing and asthma in Polonnaruwa and Batticaloa with 7 percent of the population,
• Heart disease in Matale with 3 percent of the population.

222 Demographic and Health Survey - 2016, Sri Lanka

 Table Table
16.1: People suffering
16.1: People from non
suffering fromcommunicable diseases
non communicable duringduring
diseases last 12last
months
12 months

Percentage of people
Percentage suffering
of people from diseases
suffering duringduring
from diseases the lastthe
12last
months, by background
12 months, characteristics,
by background Sri Lanka
characteristics, 2016 2016
Sri Lanka
High High Chronic Chronic Number of
Number of
Background
Background Heart Heartblood blood
Wheezing/
Wheezing/ High blood kidneykidney
High blood household
household
characteristic
characteristic disease pressure
disease pressureasthma Paralysis
asthma Diabetes
Paralysis CancerCancer
Diabetes cholesterol disease
cholesterol Cirrhosis
disease members
Cirrhosis members

Sex Sex
Male Male 2.4 2.4 6.0 6.0 4.2 4.2 0.6 0.6 5.2 5.20.3 0.3 4.1 4.1 0.7 0.7 0.1 0.150,27350,273
Female
Female 2.1 2.1 10.1 10.1 5.7 5.7 0.4 0.4 6.1 6.10.4 0.4 6.5 6.5 0.4 0.4 0.0 0.055,67455,674

Age Age
<5 <5 0.3 0.3 0.0 0.0 2.6 2.6 0.0 0.0 0.0 0.00.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 8,373 8,373
5-9 5-9 0.5 0.5 0.0 0.0 4.3 4.3 0.0 0.0 0.1 0.10.0 0.0 0.0 0.0 0.1 0.1 0.0 0.0 9,152 9,152
10-14 10-14 0.5 0.5 0.1 0.1 4.3 4.3 0.0 0.0 0.0 0.00.1 0.1 0.0 0.0 0.1 0.1 0.0 0.0 8,928 8,928
15-19 15-19 0.3 0.3 0.1 0.1 3.2 3.2 0.1 0.1 0.1 0.10.1 0.1 0.1 0.1 0.2 0.2 0.0 0.0 8,046 8,046
20-24 20-24 0.2 0.2 0.2 0.2 2.6 2.6 0.0 0.0 0.1 0.10.1 0.1 0.2 0.2 0.1 0.1 0.0 0.0 7,037 7,037
25-29 25-29 0.3 0.3 0.5 0.5 2.6 2.6 0.1 0.1 0.4 0.40.1 0.1 0.4 0.4 0.1 0.1 0.0 0.0 6,675 6,675
30-34 30-34 0.5 0.5 1.6 1.6 2.9 2.9 0.1 0.1 1.6 1.60.1 0.1 1.8 1.8 0.2 0.2 0.0 0.0 7,644 7,644
35-39 35-39 1.1 1.1 3.2 3.2 4.6 4.6 0.2 0.2 3.6 3.60.2 0.2 3.3 3.3 0.3 0.3 0.0 0.0 7,879 7,879
40-44 40-44 1.7 1.7 5.8 5.8 4.7 4.7 0.2 0.2 5.9 5.90.2 0.2 6.0 6.0 0.4 0.4 0.0 0.0 6,681 6,681
45-49 45-49 2.3 2.3 10.3 10.3 6.3 6.3 0.3 0.3 8.7 8.70.4 0.4 9.0 9.0 0.7 0.7 0.1 0.1 6,534 6,534
50-54 50-54 4.1 4.1 14.8 14.8 6.0 6.0 0.5 0.5 12.6 12.60.5 0.5 11.2 11.2 1.1 1.1 0.1 0.1 6,789 6,789
55-59 55-59 4.9 4.9 19.7 19.7 6.7 6.7 1.0 1.0 15.4 15.40.8 0.8 14.4 14.4 1.3 1.3 0.1 0.1 6,092 6,092
60 + 60 + 7.7 7.7 30.7 30.7 9.7 9.7 2.2 2.2 17.3 17.31.2 1.2 16.1 16.1 1.7 1.7 0.1 0.116,11716,117

Religion
Religion
Buddhist
Buddhist 2.3 2.3 8.3 8.3 5.2 5.2 0.5 0.5 5.7 5.70.4 0.4 5.5 5.5 0.6 0.6 0.0 0.075,02275,022
Hindu Hindu 1.8 1.8 6.2 6.2 4.3 4.3 0.5 0.5 3.6 3.60.3 0.3 3.2 3.2 0.6 0.6 0.1 0.112,75812,758
Islam Islam 1.9 1.9 8.6 8.6 3.7 3.7 0.4 0.4 7.3 7.30.2 0.2 6.3 6.3 0.4 0.4 0.0 0.0 9,811 9,811
RomanRoman
Catholic
Catholic 2.3 2.3 9.6 9.6 6.1 6.1 0.6 0.6 7.1 7.10.5 0.5 6.1 6.1 0.4 0.4 0.1 0.1 6,908 6,908
Other Other
christian
christian 2.5 2.5 9.5 9.5 6.5 6.5 0.4 0.4 6.9 6.90.5 0.5 6.2 6.2 0.4 0.4 0.1 0.1 1,413 1,413
Other Other (2.3) (2.3)(2.3) (2.3) (5.0) (5.0) (0.0) (0.0) (5.4) (5.4)
(8.4) (8.4) (8.2) (8.2)
(0.0) (0.0) (0.0) (0.0) 35 35

Ethnicity
Ethnicity
SinhalaSinhala 2.4 2.4 8.5 8.5 5.3 5.3 0.5 0.5 5.9 5.90.4 0.4 5.6 5.6 0.6 0.6 0.0 0.080,26480,264
Sri Lanka Tamil Tamil
Sri Lanka 1.6 1.6 6.2 6.2 4.6 4.6 0.5 0.5 3.9 3.90.2 0.2 3.8 3.8 0.6 0.6 0.1 0.113,65413,654
Indian Indian
Tamil Tamil 2.4 2.4 6.0 6.0 3.2 3.2 0.5 0.5 2.2 2.20.3 0.3 1.4 1.4 0.3 0.3 0.0 0.0 2,439 2,439
Sri Lanka moor moor
Sri Lanka
/Muslim/Muslim 1.9 1.9 8.6 8.6 3.8 3.8 0.4 0.4 7.5 7.50.2 0.2 6.4 6.4 0.4 0.4 0.0 0.0 9,213 9,213
Malay Malay 1.5 1.5 18.7 18.7 7.1 7.1 0.6 0.6 7.4 7.40.9 0.9 5.1 5.1 3.3 3.3 0.0 0.0 157 157
BurgerBurger 2.0 2.0 6.8 6.8 8.2 8.2 0.0 0.0 8.9 8.90.0 0.0 5.4 5.4 0.0 0.0 0.0 0.0 180 180
Other Other (0.0) (0.0)(0.0) (0.0) (5.9) (5.9) (0.0) (0.0)
(11.1) (11.1)
(0.0) (0.0) (0.0) (0.0)
(0.0) (0.0) (0.0) (0.0) 41 41

Residence
Residence
Urban Urban 2.6 2.6 10.3 10.3 5.2 5.2 0.4 0.4 8.2 8.20.3 0.3 7.5 7.5 0.4 0.4 0.1 0.117,49117,491
Rural Rural 2.2 2.2 7.9 7.9 5.0 5.0 0.5 0.5 5.3 5.30.4 0.4 5.1 5.1 0.6 0.6 0.0 0.083,92383,923
EstateEstate 2.4 2.4 5.6 5.6 3.9 3.9 0.5 0.5 2.0 2.00.2 0.2 1.6 1.6 0.2 0.2 0.0 0.0 4,534 4,534

District
District
ColomboColombo 2.9 2.9 11.7 11.7 5.6 5.6 0.3 0.3 9.2 9.20.4 0.4 8.5 8.5 0.3 0.3 0.1 0.110,66310,663
GampahaGampaha 2.5 2.5 9.3 9.3 4.9 4.9 0.6 0.6 7.5 7.50.5 0.5 5.9 5.9 0.4 0.4 0.0 0.010,89210,892
Kalutara
Kalutara 2.5 2.5 9.5 9.5 5.6 5.6 0.4 0.4 7.0 7.00.2 0.2 7.0 7.0 0.3 0.3 0.0 0.0 6,506 6,506
KandyKandy 2.7 2.7 9.1 9.1 5.3 5.3 0.5 0.5 6.2 6.20.2 0.2 6.0 6.0 0.4 0.4 0.0 0.0 7,333 7,333
MataleMatale 3.4 3.4 8.9 8.9 6.4 6.4 0.4 0.4 5.1 5.10.3 0.3 5.9 5.9 1.1 1.1 0.1 0.1 2,759 2,759
Nuwaraeliya
Nuwaraeliya 2.8 2.8 6.2 6.2 4.4 4.4 0.5 0.5 3.0 3.00.3 0.3 2.3 2.3 0.4 0.4 0.0 0.0 3,450 3,450
Galle Galle 2.6 2.6 8.0 8.0 5.8 5.8 0.4 0.4 5.3 5.30.5 0.5 6.4 6.4 0.5 0.5 0.0 0.0 5,709 5,709
MataraMatara 2.6 2.6 8.0 8.0 5.6 5.6 0.5 0.5 5.7 5.70.3 0.3 6.1 6.1 0.3 0.3 0.1 0.1 4,407 4,407
Hambantota
Hambantota 1.4 1.4 6.3 6.3 6.4 6.4 0.4 0.4 4.3 4.30.5 0.5 4.9 4.9 0.6 0.6 0.0 0.0 3,240 3,240
Jaffna Jaffna 1.1 1.1 4.5 4.5 2.1 2.1 0.3 0.3 4.2 4.20.3 0.3 4.1 4.1 0.7 0.7 0.0 0.0 3,054 3,054
Mannar Mannar 0.5 0.5 5.6 5.6 2.1 2.1 0.5 0.5 4.3 4.30.2 0.2 4.2 4.2 0.2 0.2 0.0 0.0 508 508
Vavuniya
Vavuniya 1.4 1.4 6.8 6.8 3.6 3.6 0.7 0.7 3.6 3.60.2 0.2 5.7 5.7 1.8 1.8 0.0 0.0 828 828
Mullaitivu
Mullaitivu 0.9 0.9 3.0 3.0 2.6 2.6 0.2 0.2 1.6 1.60.3 0.3 1.2 1.2 0.5 0.5 0.1 0.1 449 449
Kilinochchi
Kilinochchi 1.3 1.3 5.1 5.1 3.8 3.8 0.3 0.3 2.8 2.80.3 0.3 1.9 1.9 0.4 0.4 0.0 0.0 562 562
Batticaloa
Batticaloa 1.1 1.1 6.5 6.5 6.6 6.6 0.6 0.6 4.6 4.60.1 0.1 4.2 4.2 0.4 0.4 0.1 0.1 2,841 2,841
Ampara Ampara 1.6 1.6 7.4 7.4 4.6 4.6 0.9 0.9 4.8 4.80.2 0.2 5.0 5.0 0.8 0.8 0.1 0.1 3,815 3,815
Trincomalee
Trincomalee 1.6 1.6 7.2 7.2 5.9 5.9 0.5 0.5 5.0 5.00.1 0.1 4.3 4.3 0.9 0.9 0.2 0.2 2,045 2,045
Kurunegala
Kurunegala 1.9 1.9 8.3 8.3 4.3 4.3 0.6 0.6 4.8 4.80.5 0.5 4.2 4.2 0.6 0.6 0.0 0.0 8,849 8,849
Puttalam
Puttalam 1.7 1.7 8.0 8.0 5.5 5.5 0.6 0.6 5.8 5.80.5 0.5 4.1 4.1 0.5 0.5 0.0 0.0 3,691 3,691
Anuradhapura
Anuradhapura 1.1 1.1 5.5 5.5 3.3 3.3 0.7 0.7 4.4 4.40.2 0.2 3.2 3.2 1.3 1.3 0.0 0.0 4,847 4,847
Polonnaruwa
Polonnaruwa 2.0 2.0 8.4 8.4 7.3 7.3 0.4 0.4 5.4 5.40.3 0.3 6.1 6.1 1.6 1.6 0.0 0.0 2,170 2,170
BadullaBadulla 2.8 2.8 8.8 8.8 5.1 5.1 0.5 0.5 4.4 4.40.3 0.3 3.6 3.6 0.7 0.7 0.0 0.0 4,242 4,242
Monaragala
Monaragala 1.6 1.6 6.1 6.1 4.4 4.4 0.4 0.4 3.4 3.40.4 0.4 4.3 4.3 0.5 0.5 0.0 0.0 2,604 2,604
Ratnapura
Ratnapura 2.5 2.5 7.7 7.7 5.3 5.3 0.4 0.4 4.6 4.60.3 0.3 5.0 5.0 0.6 0.6 0.1 0.1 6,076 6,076
KegalleKegalle 2.4 2.4 6.5 6.5 2.9 2.9 0.4 0.4 4.8 4.80.2 0.2 4.9 4.9 0.2 0.2 0.0 0.0 4,408 4,408

WealthWealth
quintile
quintile
LowestLowest 2.4 2.4 6.6 6.6 6.2 6.2 0.7 0.7 3.2 3.20.4 0.4 3.3 3.3 0.5 0.5 0.1 0.121,11321,113
Second Second 2.3 2.3 7.1 7.1 5.2 5.2 0.6 0.6 4.4 4.40.3 0.3 4.3 4.3 0.7 0.7 0.0 0.021,19321,193
MiddleMiddle 1.9 1.9 7.9 7.9 4.5 4.5 0.4 0.4 5.0 5.00.3 0.3 5.0 5.0 0.6 0.6 0.0 0.021,20421,204
FourthFourth 2.2 2.2 8.5 8.5 4.6 4.6 0.4 0.4 6.6 6.60.4 0.4 5.9 5.9 0.6 0.6 0.0 0.021,18121,181
HighestHighest 2.4 2.4 10.7 10.7 4.5 4.5 0.4 0.4 9.1 9.10.3 0.3 8.3 8.3 0.4 0.4 0.1 0.121,25621,256

Total Total 2.2 2.2 8.2 8.2 5.0 5.0 0.5 0.5 5.7 5.70.3 0.3 5.4 5.4 0.6 0.6 0.0 105,947
0.0 105,947
Note: Note:
Figures in parentheses
Figures are based
in parentheses on 25 on
are based - 4925unweighted cases.cases.
- 49 unweighted An asting

Demography and Health

Demography Survey
and Health - 2016- 2016Non Communicable Diseases, Mental Illnesses, Suicides, Smoking.....
Survey 231231
223
 An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been
suppressed.
Figure 16.1People suffering from type of NCDs during last 12 months

Figure 1:People suffering from type of NCDs during last 12 months

11.0
10.0
9.0
8.0
7.0
Percentage

6.0
5.0
4.0
3.0
2.0
1.0
0.0

Male

Female

16.1.1 HEART DISEASE

16.1.1 Heart Asdisease

mentioned before, 2 percent of the Sri Lankan population was identified as having heart
disease (Table 16.1). The disease increases with age and is slightly more prevalent among males, and
As mentioned
residents before,sector,
of the urban 2 percentandofamong
the Sri the
Lankan population
richest was identified
20 percent as having20heart
and the poorest disease
percent of the
(Table 16.1). The disease increases with age and is slightly more prevalent among
households. By districts, Matale (3.4 percent) Colombo (2.9 percent) and Nuwara Eliya& Badulla males, and residents of (2.8
the urban sector,
percent) and among
havethe highestthe richest 20ofpercent
prevalence and thethan
heart disease poorest 20districts.
other percent of the households. By districts,
Matale (3.4 percent) Colombo (2.9 percent) and Nuwara Eliya& Badulla (2.8 percent) havethe highest prev-
alence of heartTable
disease16.2than otherthedistricts.
shows percentage distribution of people suffering from heart disease by age group
andTable
background
16.2 showscharacteristics.Out of the total of
the percentage distribution heart disease,
people one from
suffering percent correspond
heart disease bytoage
children under 5
group and
years. This
background percentage of of
characteristics.Out heart
thedisease of children
total heart disease, aged under 5correspond
one percent is higher for
to children living
under 5inyears.
the estate
This sector than of
percentage that of other
heart sectors
disease (2.3 percent
of children versus5 1.3
aged under percent
is higher forinchildren
the rural sector).
living Similar
in the estate percentages
sector than are
that of other sectors
included (2.3 with
by district percent
theversus
highest1.3 percent
values in the rural
observed sector).
in Nuwara Similar
Eliya (3.0 percentages are included
percent), Puttalam by
(2.6 percent)
district
andwith the highest
Ampara values observed in Nuwara Eliya (3.0 percent), Puttalam (2.6 percent) and Ampara
(2.5 percent).
(2.5 percent).

Demography and Health Survey - 2016 232

224 Demographic and Health Survey - 2016, Sri Lanka
Table 16.2: Suffering from Heart diseases

Percentage distribution of people suffering from Heart diseases by age group and background characteristics, Sri Lanka 2016
Age
Don't
Background know/ Number of
characteristic <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60 + missing Total members

Sex
Male 1.4 1.9 2.5 1.1 0.4 1.1 1.0 3.3 5.0 5.1 10.9 13.6 52.8 0.0 100.0 1,197
Female 1.0 1.7 1.1 0.8 0.9 0.8 2.0 3.7 4.4 7.6 12.3 11.6 52.1 0.0 100.0 1,177

Residence
Urban 0.8 0.6 1.5 0.4 1.3 0.1 1.2 1.9 5.0 6.9 8.6 16.8 54.9 0.0 100.0 452
Rural 1.3 2.1 1.8 1.0 0.4 1.0 1.3 3.8 4.6 6.1 12.0 11.7 52.9 0.0 100.0 1,812
Estate 2.3 1.9 2.7 2.5 1.3 3.1 4.8 5.7 4.5 8.9 16.4 10.7 35.1 0.0 100.0 111

District
Colombo 0.0 0.4 1.6 0.0 1.0 0.0 0.4 1.8 6.1 7.2 9.0 13.6 58.7 0.0 100.0 306
Gampaha 0.8 0.5 0.0 0.4 0.5 0.5 1.0 3.0 2.1 6.2 8.1 12.5 64.5 0.0 100.0 268
Kalutara 0.9 0.0 0.0 0.0 0.0 0.0 1.9 3.1 5.0 3.4 7.4 13.3 65.1 0.0 100.0 163
Kandy 0.7 3.2 3.8 2.6 1.4 0.2 3.4 2.9 3.6 5.9 11.3 9.0 52.1 0.0 100.0 202
Matale 1.0 6.1 1.5 1.3 1.5 2.5 0.0 4.0 3.8 6.1 21.0 11.5 39.8 0.0 100.0 95
Nuwaraeliya 3.0 4.9 3.3 2.1 1.2 0.5 1.8 4.8 1.2 15.3 17.6 11.0 33.4 0.0 100.0 95
Galle 1.5 1.6 0.0 2.2 1.4 0.3 2.4 3.9 5.1 3.2 9.6 13.1 55.9 0.0 100.0 151
Matara 1.2 2.4 0.0 0.9 2.1 2.0 0.0 4.8 8.5 2.8 13.0 6.9 55.4 0.0 100.0 115
Hambantota (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (10.4) (6.8) (6.8) (7.1) (17.6) (51.3) (0.0) (100.0) 45
Jaffna (4.4) (0.0) (2.5) (3.4) (0.0) (6.3) (3.0) (7.5) (7.8) (0.0) (16.7) (10.8) (37.7) (0.0) (100.0) 33
Mannar * * * * * * * * * * * * * * * 2
Vavuniya (0.0) (4.6) (3.0) (7.0) (1.9) (0.0) (0.0) (9.6) (4.2) (5.9) (8.0) (11.2) (44.4) (0.0) (100.0) 11
Mullaitivu * * * * * * * * * * * * * * * 4
Killinochchi (0.0) (4.4) (7.9) (2.8) (5.0) (4.7) (0.0) (0.0) (15.5) (9.8) (7.6) (13.7) (28.6) (0.0) (100.0) 8
Batticaloa (0.0) (4.8) (3.0) (3.1) (0.0) (1.3) (3.8) (4.5) (12.8) (3.3) (15.3) (12.2) (36.1) (0.0) (100.0) 30
Ampara 2.5 3.4 4.9 1.9 0.0 1.5 3.1 3.2 7.8 8.0 12.6 15.5 35.6 0.0 100.0 61
Trincomalee (4.9) (0.5) (0.5) (2.5) (0.0) (3.2) (1.5) (6.8) (5.9) (6.2) (8.3) (16.9) (42.8) (0.0) (100.0) 32
Kurunegala 1.5 3.5 5.0 0.8 0.0 0.6 0.0 4.6 3.0 5.0 11.5 9.9 54.5 0.0 100.0 172
Puttalam 2.6 3.8 1.8 0.0 0.0 1.3 0.0 2.0 6.4 11.4 9.6 19.0 42.2 0.0 100.0 63
Anuradhapura (0.0) (0.0) (3.9) (0.0) (0.0) (0.0) (5.0) (5.1) (4.4) (4.1) (15.2) (16.1) (46.1) (0.0) (100.0) 54
Polonnaruwa (4.7) (0.0) (5.0) (0.0) (0.0) (0.0) (0.0) (4.1) (0.0) (1.6) (12.0) (24.2) (48.4) (0.0) (100.0) 43
Badulla 0.9 0.0 0.9 1.0 0.5 0.0 0.0 3.2 7.1 9.5 15.9 18.0 42.9 0.0 100.0 118
Monaragala (0.0) (3.1) (4.8) (0.0) (0.0) (0.0) (3.7) (1.8) (1.8) (3.8) (10.7) (8.8) (61.6) (0.0) (100.0) 43
Ratnapura 2.6 1.4 1.1 0.5 0.0 4.8 3.8 3.0 2.1 11.8 13.6 11.0 44.2 0.0 100.0 153
Kegalle 0.5 0.8 0.0 0.0 0.0 1.1 1.1 2.2 6.1 3.6 14.0 11.4 59.2 0.0 100.0 107

Wealth quintile
Lowest 1.3 3.1 3.3 2.1 0.9 2.4 2.5 4.0 5.7 5.6 15.4 9.5 44.3 0.0 100.0 510
Second 2.0 2.3 2.2 1.5 0.8 0.7 1.0 3.7 4.2 7.2 12.2 11.3 50.8 0.0 100.0 480
Middle 1.3 0.0 1.3 0.8 1.1 0.6 2.1 7.3 5.2 9.0 11.3 12.7 47.5 0.0 100.0 400
Fourth 1.0 2.8 1.0 0.1 0.6 0.8 0.7 1.4 4.6 6.7 10.3 14.0 56.1 0.0 100.0 473
Highest 0.5 0.4 1.0 0.2 0.0 0.2 1.2 1.9 3.8 4.0 8.6 15.4 62.8 0.0 100.0 510

Total 1.2 1.8 1.8 0.9 0.7 1.0 1.5 3.5 4.7 6.3 11.6 12.6 52.5 0.0 100.0 2,374
Note: Figures in parentheses are based on 25 - 49 unweighted cases. An asterisk indicates that a figure is based on fewer than
25 unweighted cases and has been suppressed.

16.1.2 HIGH BLOOD PRESURE

Table 16.1 shows that 8 percent of the total population are affected by high blood pressure.
Among the sexes, females are more likely to be affected (10 percent) than males (6 percent). Among the
sectors, 10 percent of urban household members are suffering from high blood pressure compared to 8
percent of their rural counterparts. According to the wealth quintile, people living in households from the
richest 20 percent have the highest prevalence at 11 percent. For the districts of the Western Province, the
percentages are the highest among all districts: Colombo (12 percent), Kalutara (10 percent) and, Gampaha
(9 percent). The lowest prevalence of high blood pressure was reported in Mullaitivu district (3 percent).
The distribution of the percentage of the population affected by high blood pressure by age is presented in
Table 16.3. Starting with the age group 30-34, high blood
Non Communicable pressure
Diseases, starts to Suicides,
Mental Illnesses, increaseSmoking.....
with the percentage
225
thereafter reaching up to 58 percent among people of the age group 60 and above.
16.1.2 High blood presure
Table 16.1 shows that 8 percent of the total population are affected by high blood pressure. Among
the sexes, females are more likely to be affected (10 percent) than males (6 percent). Among the sectors, 10
percent of urban household members are suffering from high blood pressure compared to 8 percent of their
rural counterparts. According to the wealth quintile, people living in households from the richest 20 percent
have the highest prevalence at 11 percent. For the districts of the Western Province, the percentages are the
highest among all districts: Colombo (12 percent), Kalutara (10 percent) and, Gampaha (9 percent). The
lowest prevalence of high blood pressure was reported in Mullaitivu district (3 percent). The distribution of
the percentage of the population affected by high blood pressure by age is presented in Table 16.3. Starting
with the age group 30-34, high blood pressure starts to increase with the percentage thereafter reaching up to
58 percent among people of the age group 60 and above.

Table 16.3: Suffering from High blood pressure

Percentage distribution of people suffering from High blood pressure by age group and background characteristics, Sri Lanka 2016
Age
Number
Background of
characteristic <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60 + Total members

Sex
Male 0.0 0.0 0.1 0.2 0.2 0.3 1.1 2.8 5.6 7.8 11.9 14.7 55.3 100.0 3,023
Female 0.0 0.0 0.1 0.0 0.2 0.4 1.6 3.0 3.9 7.8 11.4 13.4 58.2 100.0 5,643

Residence
Urban 0.1 0.0 0.0 0.0 0.2 0.5 1.2 3.6 4.0 8.4 12.1 14.9 55.0 100.0 1,806
Rural 0.0 0.0 0.1 0.1 0.1 0.3 1.4 2.8 4.6 7.6 11.4 13.5 58.0 100.0 6,608
Estate 0.0 0.4 0.2 0.0 0.3 0.6 3.7 2.1 5.2 8.7 14.2 13.9 50.8 100.0 252

District
Colombo 0.1 0.1 0.1 0.2 0.2 0.8 1.5 3.5 3.7 7.9 11.9 15.2 54.7 100.0 1,249
Gampaha 0.0 0.0 0.0 0.1 0.2 0.0 1.8 2.9 4.9 7.7 10.7 13.0 58.8 100.0 1,016
Kalutara 0.0 0.0 0.2 0.0 0.0 0.2 0.7 2.8 5.2 8.5 9.9 13.2 59.2 100.0 616
Kandy 0.0 0.0 0.0 0.0 0.0 0.5 0.8 1.8 3.5 6.1 11.8 11.8 63.5 100.0 664
Matale 0.0 0.0 0.0 0.0 0.0 0.6 2.0 2.4 2.4 9.9 13.2 14.4 55.1 100.0 247
Nuwaraeliya 0.0 0.4 0.0 0.0 0.4 0.0 2.5 1.8 4.0 11.4 14.2 13.0 52.3 100.0 214
Galle 0.2 0.0 0.0 0.0 0.0 0.0 0.8 2.6 4.6 7.3 9.8 9.3 65.5 100.0 458
Matara 0.0 0.0 0.0 0.0 0.0 0.2 0.9 2.8 3.4 7.1 12.3 12.7 60.5 100.0 351
Hambantota 0.0 0.0 0.5 0.0 0.5 0.0 0.6 2.5 3.5 4.8 8.8 12.5 66.4 100.0 204
Jaffna 0.0 0.0 0.8 0.9 0.0 0.0 2.9 3.7 4.8 4.4 7.0 11.0 64.5 100.0 138
Mannar 0.8 0.0 0.0 0.0 0.0 0.0 0.0 0.8 6.2 13.1 18.7 13.0 47.4 100.0 29
Vavuniya 0.0 0.0 0.0 0.0 0.0 0.6 1.2 4.1 8.2 13.0 12.4 16.1 44.4 100.0 57
Mullaitivu 0.0 0.8 0.0 1.8 0.0 2.7 9.1 4.3 5.3 13.5 6.9 15.1 40.5 100.0 13
Kilinochchi 0.0 0.0 0.0 0.0 0.7 0.0 5.5 6.1 8.2 7.9 10.6 17.7 43.4 100.0 29
Batticaloa 0.0 0.0 0.0 0.0 0.6 0.7 2.3 6.8 5.4 8.9 20.0 13.1 42.1 100.0 185
Ampara 0.0 0.0 0.0 0.0 0.5 1.9 2.8 4.1 6.0 10.2 12.8 17.3 44.2 100.0 283
Trincomalee 0.0 0.0 0.0 0.0 0.0 0.3 3.9 5.1 7.2 12.6 17.0 11.6 42.3 100.0 147
Kurunegala 0.0 0.0 0.3 0.0 0.4 0.3 0.9 2.8 4.0 6.3 9.2 14.9 60.8 100.0 737
Puttalam 0.0 0.0 0.3 0.0 0.0 0.0 0.7 2.0 5.5 9.5 10.2 13.8 58.0 100.0 294
Anuradhapura 0.0 0.0 0.0 0.0 0.0 0.5 1.1 2.2 5.8 8.4 17.2 20.5 44.2 100.0 268
Polonnaruwa 0.0 0.0 0.0 0.3 0.0 0.6 3.6 3.3 4.9 9.0 11.5 17.8 49.0 100.0 182
Badulla 0.0 0.0 0.1 0.0 0.0 0.3 1.6 1.9 7.6 6.1 13.5 13.4 55.3 100.0 375
Monaragala 0.0 0.0 0.0 0.0 0.5 0.0 1.2 4.6 5.3 9.9 11.5 10.7 56.2 100.0 160
Ratnapura 0.0 0.0 0.0 0.0 0.0 0.2 1.4 3.5 2.3 7.2 12.2 13.4 59.8 100.0 466
Kegalle 0.0 0.3 0.0 0.0 0.0 0.3 0.4 1.6 3.4 6.3 8.4 16.6 62.8 100.0 285

Wealth quintile
Lowest 0.0 0.1 0.1 0.1 0.3 0.8 1.8 2.6 4.4 6.8 10.1 11.9 61.0 100.0 1,404
Second 0.0 0.1 0.2 0.1 0.0 0.3 2.2 3.2 4.8 7.5 11.7 12.7 57.3 100.0 1,512
Middle 0.0 0.1 0.1 0.0 0.2 0.3 1.4 3.3 4.0 7.5 12.5 15.6 55.1 100.0 1,665
Fourth 0.1 0.0 0.1 0.0 0.2 0.5 1.0 2.7 4.4 8.4 10.9 14.0 57.8 100.0 1,805
Highest 0.0 0.0 0.1 0.1 0.1 0.2 1.1 2.9 4.7 8.3 12.3 14.3 55.8 100.0 2,280

Total 0.0 0.0 0.1 0.1 0.2 0.4 1.4 2.9 4.5 7.8 11.6 13.8 57.2 100.0 8,666

16.1.3 Wheezing/asthma
16.1.3 WHEEZING/ASTHMA
Table 16.1shows that 5 percent of household members suffer from wheezing/asthma. This percent-
Table
age is slightly 16.1shows
higher that female
among the 5 percent of household
population members
(6 percent) suffer
than the male from wheezing/asthma.
counterparts ThisThe
(4 percent).
percentage
percentage is slightly
of the higher
population among
affected by the female population
wheezing/asthma (6 percent)
increases thanfrom
with age, the the
male
agecounterparts (4
<5 (2.6 percent)
percent).
to 9.7 percentThe percentage
among 60 andofolder
the population affected
population. by wheezing/asthma
The population increases with
of the Polonnaruwa andage, from thedistricts
Batticaloa age
has <5
the(2.6 percent)
highest to 9.7 percent
prevalence amongor60asthma
of wheezing and older population.
(7 percent). The living
People population
in theofpoorest
the Polonnaruwa
householdsand
have
Batticaloa
higher districts
percentage has the highest prevalence
of wheezing/asthma of wheezing
than the ones or asthma
living in the (7 percent). People living in the
richest households.
poorest households have higher percentage of wheezing/asthma than the ones living in the richest
households.
226 Demographic and Health Survey - 2016, Sri Lanka
Table 16.4: Suffering from Wheezing / Asthma

Percentage distribution of people suffering from Wheezing / Asthma by age group and background characteristics, Sri Lanka 2016
Age
Number
Background of
characteristic <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60 + Total members

Sex
Male 6.2 11.2 10.5 6.1 3.3 2.2 2.9 5.1 4.3 5.3 6.4 6.7 29.8 100.0 2,130
Female 2.6 4.9 5.2 4.1 3.6 4.1 5.0 8.1 6.9 9.4 8.6 8.4 29.1 100.0 3,166

Residence
Urban 3.9 7.0 8.7 5.5 4.7 2.8 4.6 6.6 6.7 8.4 7.4 8.7 25.1 100.0 918
Rural 4.0 7.5 7.3 4.9 3.3 3.4 4.1 7.0 5.8 7.5 7.5 7.5 30.2 100.0 4,199
Estate 5.6 7.1 0.9 2.4 2.8 4.5 3.0 5.8 3.8 10.1 13.5 9.0 31.5 100.0 179

District
Colombo 4.0 7.0 10.1 6.6 4.8 3.9 5.6 5.9 5.7 8.7 7.1 7.8 22.9 100.0 592
Gampaha 5.3 7.5 7.7 6.1 2.6 2.0 3.1 7.9 6.7 7.8 7.5 7.1 28.7 100.0 535
Kalutara 5.8 7.4 7.6 5.6 3.9 1.4 3.8 8.2 6.2 6.9 5.9 9.3 28.1 100.0 366
Kandy 3.7 4.0 3.2 3.6 4.1 3.8 1.5 6.6 5.2 6.9 10.0 7.1 40.2 100.0 387
Matale 2.5 7.5 7.2 2.8 2.9 7.5 5.4 4.0 1.7 9.1 8.6 5.2 35.6 100.0 177
Nuwaraeliya 3.1 2.7 3.9 3.6 1.9 3.1 2.7 4.0 3.1 11.3 12.4 9.0 39.2 100.0 152
Galle 5.3 13.3 5.8 4.5 2.3 1.8 2.5 6.8 5.4 8.0 4.5 6.6 33.3 100.0 330
Matara 4.5 8.4 6.9 4.4 3.7 4.0 5.5 8.0 4.9 8.2 5.5 6.3 29.6 100.0 245
Hambantota 4.8 8.7 15.8 5.2 2.6 3.1 2.8 5.1 7.5 8.6 4.9 6.7 24.3 100.0 209
Jaffna 4.5 2.5 5.1 1.7 1.5 6.8 3.3 6.6 6.6 6.0 11.9 5.9 37.6 100.0 64
Mannar 1.0 7.4 4.9 4.4 1.7 3.2 0.0 3.0 2.1 5.6 7.3 11.9 47.5 100.0 11
Vavuniya 3.6 8.1 4.2 4.0 3.4 2.5 8.4 6.9 15.3 9.0 12.4 5.4 16.7 100.0 30
Mullaitivu 0.0 6.7 10.8 9.3 4.3 3.8 9.8 5.1 3.0 8.8 10.0 6.7 21.6 100.0 12
Kilinochchi 4.7 3.8 5.8 5.6 0.9 2.9 11.2 13.0 8.3 1.4 3.9 7.1 31.4 100.0 21
Batticaloa 6.1 9.9 7.2 4.1 4.3 4.1 7.0 8.0 10.8 7.1 6.7 8.0 16.7 100.0 188
Ampara 1.3 8.5 7.0 1.5 3.1 6.8 6.1 7.5 7.7 8.8 5.3 8.7 27.9 100.0 175
Trincomalee 4.5 7.7 7.8 5.0 4.0 5.3 7.0 7.7 9.3 4.8 8.2 6.7 22.0 100.0 120
Kurunegala 1.3 8.0 6.1 5.2 2.7 3.0 2.7 6.3 4.1 6.7 8.8 9.0 36.0 100.0 379
Puttalam 5.4 6.4 9.2 4.9 7.1 2.4 3.9 11.6 8.0 4.3 5.5 6.7 24.6 100.0 204
Anuradhapura 2.3 5.2 5.0 2.0 5.7 3.2 3.2 6.4 6.7 12.2 12.6 12.2 23.4 100.0 162
Polonnaruwa 2.9 6.8 7.5 6.7 4.1 5.0 9.9 5.9 4.8 10.3 11.1 7.6 17.4 100.0 159
Badulla 2.2 3.6 9.6 7.2 2.1 2.6 2.4 6.0 6.4 8.1 7.8 10.4 31.8 100.0 216
Monaragala 3.3 8.9 7.1 5.6 0.7 2.9 3.7 8.9 6.1 8.1 9.1 5.3 30.4 100.0 114
Ratnapura 5.1 9.6 5.8 4.7 4.1 3.2 4.6 7.8 3.8 8.1 6.6 6.5 30.1 100.0 323
Kegalle 4.2 5.7 5.8 3.9 2.8 1.4 3.5 1.8 4.9 1.6 12.6 10.9 40.9 100.0 127

Wealth quintile
Lowest 4.3 6.3 6.9 3.5 3.1 3.4 4.1 5.1 6.0 7.0 7.3 8.6 34.4 100.0 1,299
Second 4.4 8.0 7.9 4.6 3.7 3.5 4.5 6.4 5.2 8.7 8.6 7.0 27.6 100.0 1,107
Middle 3.6 5.7 6.4 3.9 2.8 4.0 3.8 8.7 6.3 7.6 8.4 8.6 30.2 100.0 961
Fourth 4.5 8.1 6.6 6.0 4.0 2.7 4.3 6.2 6.4 7.9 6.9 7.7 28.8 100.0 967
Highest 3.4 9.2 8.9 7.1 4.1 3.0 3.8 8.7 5.7 7.6 7.3 6.6 24.6 100.0 961

Total 4.0 7.4 7.3 4.9 3.5 3.3 4.1 6.9 5.9 7.8 7.7 7.7 29.4 100.0 5,295

16.1.4 D16.1.4
iabetes
DIABETES

From
Fromtable
table16.1
16.1wewe indicated
indicated before that 6 percent
percent of
of the
the members
membersofofhousehold
householdwerewereaffected
affectedbyby
diabetes.
diabetes.WeWecould
couldalso
alsosee
seethat
that the
the female
female population tends
tends to
to suffer
suffer from
fromdiabetes
diabetesatataaslightly
slightlyhigher
higherrate
rate
than
thanmales.
males.From
Fromtable
table16.5
16.5thethe
prevalence of of
prevalence diabetes increases
diabetes increaseswith thethe
with ageage
of the person,
of the particularly
person, from
particularly
ages
from30-34
ages and above
30-34 and(up to 47(up
above percent
to 47 amongthe population
percent amongthe 60 years 60
population old years
and above).
old andFrom tableFrom
above). 16.1 table
diabe-
tes is also higher in the urban sector (8 percent, compared to 5 percent in rural sector) and
16.1 diabetes is also higher in the urban sector (8 percent, compared to 5 percent in rural sector) and among populations
living
among in populations
the richest households
living in the (9 richest
percenthouseholds
for the highest wealthfor
(9 percent quintile). Diabetes
the highest appears
wealth to beDiabetes
quintile). higher in
the districts of Colombo (9 percent), Gampaha(8 percent), Kalutara (7 percent). The prevalence
appears to be higher in the districts of Colombo (9 percent), Gampaha(8 percent), Kalutara (7 percent). of diabetes
The
isprevalence
shown below (Table 16.5).
of diabetes is shown below (Table 16.5).

Demography and Health Survey - 2016 235

Non Communicable Diseases, Mental Illnesses, Suicides, Smoking..... 227

Table 16.5: Suffering from Diabetes
Percentage distribution of people suffering from Diabetes by age group and background characteristics, Sri Lanka 2016
Age
Don't
know
Background /missi Number of
characteristic <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60 + ng Total members

Sex
Male 0.0 0.1 0.1 0.1 0.1 0.3 2.2 5.0 7.7 10.3 15.7 14.7 43.8 0.0 100.0 2,604
Female 0.0 0.2 0.1 0.1 0.2 0.5 1.9 4.6 5.6 8.7 13.1 16.3 48.6 0.0 100.0 3,403

Residence
Urban 0.1 0.1 0.1 0.1 0.0 0.3 1.4 5.3 5.4 9.0 14.4 15.8 48.1 0.0 100.0 1,442
Rural 0.0 0.1 0.1 0.1 0.2 0.5 2.3 4.7 6.9 9.6 14.1 15.6 46.0 0.0 100.0 4,472
Estate 0.0 0.0 0.0 0.0 0.0 0.6 1.9 1.7 6.7 10.9 18.6 13.9 45.6 0.0 100.0 92

District
Colombo 0.0 0.0 0.1 0.0 0.0 0.3 1.6 5.9 4.4 9.2 13.8 16.4 48.3 0.0 100.0 979
Gampaha 0.0 0.2 0.2 0.0 0.0 0.2 2.7 5.9 7.3 9.5 11.1 15.9 47.1 0.0 100.0 821
Kalutara 0.0 0.0 0.3 0.2 0.0 0.0 3.3 3.2 5.3 12.7 14.0 12.8 48.3 0.0 100.0 453
Kandy 0.0 0.0 0.0 0.0 0.0 0.5 0.7 3.5 5.7 5.2 17.2 14.0 53.2 0.0 100.0 454
Matale 0.0 0.0 0.0 0.0 0.0 1.6 0.9 5.6 2.4 8.2 14.2 15.6 51.6 0.0 100.0 142
Nuwaraeliya 0.0 0.0 0.0 0.0 0.0 0.0 2.5 6.4 5.3 8.7 16.1 15.1 45.9 0.0 100.0 104
Galle 0.3 0.0 0.0 0.0 0.8 0.4 2.0 4.4 7.2 8.9 12.0 13.3 50.7 0.0 100.0 303
Matara 0.0 0.0 0.0 0.0 0.0 0.0 0.8 2.8 7.5 7.8 13.7 17.1 50.4 0.0 100.0 250
Hambantota 0.0 0.0 0.0 0.0 0.0 0.0 1.5 5.9 11.3 8.6 12.3 16.1 44.2 0.0 100.0 140
Jaffna 0.0 0.0 0.0 0.7 0.0 1.2 2.1 3.9 6.5 8.9 11.7 15.2 49.8 0.0 100.0 127
Mannar 0.0 0.0 0.0 0.0 0.0 1.5 1.0 2.6 11.4 9.4 20.6 16.6 36.9 0.0 100.0 22
Vavuniya 0.0 0.0 0.0 0.0 0.0 1.2 1.4 4.0 7.6 9.1 11.6 15.2 49.8 0.0 100.0 30
Mullaitivu (0.0) (0.0) (0.0) (0.0) (0.0) (3.2) (0.0) (0.0) (10.7) (9.5) (11.7) (29.2) (35.8) (0.0) (100.0) 7
Kilinochchi 0.0 0.0 2.1 0.0 0.0 0.0 1.9 5.7 8.2 12.5 6.3 12.5 50.8 0.0 100.0 16
Batticaloa 0.0 0.7 0.0 0.0 0.0 0.6 3.9 5.5 6.7 15.5 14.9 10.4 41.8 0.0 100.0 130
Ampara 0.0 0.0 0.0 0.5 1.1 0.6 0.9 6.9 9.0 9.1 16.7 19.3 35.9 0.0 100.0 182
Trincomalee 0.7 0.0 0.0 0.0 0.7 0.0 1.6 7.6 10.9 14.6 18.9 15.2 29.7 0.0 100.0 103
Kurunegala 0.0 0.0 0.0 0.0 0.0 0.6 2.4 4.3 7.7 8.0 13.7 16.3 46.8 0.0 100.0 428
Puttalam 0.0 1.0 0.0 0.0 0.0 0.6 1.5 4.9 6.1 10.6 17.7 14.1 43.6 0.0 100.0 213
Anuradhapura 0.0 0.0 0.0 0.0 0.5 2.3 5.2 3.5 6.6 13.9 16.5 14.1 37.5 0.0 100.0 215
Polonnaruwa 0.0 0.0 0.0 0.5 0.0 1.5 3.7 4.4 5.4 9.7 15.7 23.3 35.9 0.0 100.0 118
Badulla 0.0 0.5 0.0 0.0 0.6 0.0 1.8 2.4 12.1 9.1 18.7 19.6 35.3 0.0 100.0 188
Monaragala 0.0 2.3 0.0 0.0 0.0 1.1 1.0 5.8 3.9 10.2 19.5 12.3 44.0 0.0 100.0 89
Ratnapura 0.0 0.0 0.0 0.4 0.1 0.4 2.0 4.5 6.3 9.9 15.2 15.3 45.9 0.0 100.0 281
Kegalle 0.0 0.0 0.0 0.0 0.0 0.4 0.7 4.3 6.1 7.1 10.4 17.7 53.5 0.0 100.0 212

Wealth quintile
Lowest 0.0 0.1 0.0 0.1 0.3 0.8 1.5 4.1 6.0 6.3 14.3 13.9 52.5 0.0 100.0 681
Second 0.1 0.1 0.0 0.2 0.2 0.7 3.2 4.4 7.5 11.1 14.1 13.5 45.0 0.0 100.0 935
Middle 0.0 0.2 0.0 0.2 0.2 0.6 2.2 5.5 6.5 10.9 14.3 16.3 43.1 0.0 100.0 1,070
Fourth 0.0 0.2 0.1 0.0 0.1 0.6 1.8 5.1 6.3 9.0 13.8 18.2 44.8 0.0 100.0 1,397
Highest 0.0 0.0 0.1 0.0 0.0 0.0 1.8 4.5 6.4 9.2 14.5 15.0 48.3 0.0 100.0 1,924

Total 0.0 0.1 0.1 0.1 0.1 0.5 2.0 4.8 6.5 9.4 14.2 15.6 46.5 0.0 100.0 6,006

Note: Figures in parentheses are based on 25 - 49 unweighted cases. An asterisk indicates that a figure
is based on fewer than 25 unweighted cases and has been suppressed.

16.1.5 HIGH BLOOD CHOLESTEROL

Table
16.1.5 High 16.1 shows that 5 percent of the total populations are affected by high blood cholesterol.
blood cholesterol
Among the sexes, females are more likely to be affected (7 percent) than males (4 percent). Among the
sectors,Table 16.1 of
8 percent shows
urbanthat 5 percent
household of the are
members total populations
suffering are affected
from high by high compared
blood cholesterol blood cholesterol.
to 5
Among
percenttheofsexes, females
their rural are more According
counterparts. likely to betoaffected
the wealth(7 percent) than males
quintile, people living(4inpercent). Among
households from the
the sec-
tors, 8 percent of urban household members are suffering from high blood cholesterol compared
richest 20 percent have the highest prevalence at 8 percent. For the districts of the Western Province, the to 5 percent
of their
percentages are the highest among all districts: Colombo (9 percent), Kalutara (7 percent) and, Galle, 20
rural counterparts. According to the wealth quintile, people living in households from the richest
percent
Matara,have the highest prevalence
Polonnaruwa (6 percent).at 8The
percent.
lowestFor the districts
prevalence of of theblood
high Western Province,was
cholesterol the percentages
reported in are
theMullaitivu
highest among all districts: Colombo (9 percent), Kalutara (7 percent) and, Galle, Matara,
district (1 percent). The distribution of the percentage of the population affected by high Polonnaruwa
blood
(6 percent). The lowest prevalence of high blood cholesterol was reported in Mullaitivu
cholesterol by age is presented in Table 16.6. Starting with the age group 30-34, high blood cholesterol district (1 percent).
Thestarts
distribution of the
to increase withpercentage of the
the percentage population
thereafter affected
reaching up toby46
high bloodamong
percent cholesterol
peoplebyofage
the is presented
age group in
Table 16.6.
60 and above.Starting with the age group 30-34, high blood cholesterol starts to increase with the percentage
thereafter reaching up to 46 percent among people of the age group 60 and above.

Demography and Health Survey - 2016 236

228 Demographic and Health Survey - 2016, Sri Lanka

Table 16.6: Suffering from High blood cholostrole

Percentage of people suffering from High blood cholostrole by age group and background characteristics, Srilanka 2016
Age
Don't
know Number
Background /miss of
characteristic <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60 + ing Total members

Sex
Male 0.1 0.0 0.1 0.1 0.3 0.9 3.5 7.0 10.1 10.9 13.3 14.5 39.2 0.0 100.0 2,059
Female 0.0 0.0 0.0 0.2 0.2 0.3 1.7 3.3 5.3 10.0 13.5 16.0 49.6 0.0 100.0 3,622

Residence
Urban 0.1 0.0 0.0 0.2 0.2 0.4 1.7 4.6 5.5 10.0 14.1 16.1 47.1 0.0 100.0 1,311
Rural 0.1 0.0 0.0 0.1 0.2 0.5 2.5 4.6 7.5 10.4 13.3 15.2 45.6 0.0 100.0 4,296
Estate 0.0 0.0 0.0 0.0 0.0 0.0 5.9 6.5 8.9 14.5 10.7 15.6 38.0 0.0 100.0 74

District
Colombo 0.0 0.0 0.0 0.0 0.4 0.4 2.7 4.7 4.6 8.9 14.8 14.8 48.7 0.0 100.0 907
Gampaha 0.0 0.0 0.1 0.0 0.0 0.7 2.0 4.4 7.0 12.5 12.2 13.8 47.4 0.0 100.0 645
Kalutara 0.0 0.0 0.0 0.0 0.0 0.6 2.6 2.4 8.3 9.9 11.6 15.1 49.6 0.0 100.0 457
Kandy 0.4 0.0 0.0 0.0 0.0 0.3 1.2 2.6 5.7 8.2 16.0 14.5 51.3 0.0 100.0 437
Matale 0.0 0.0 0.0 0.0 0.0 0.8 2.8 3.9 3.2 16.5 11.6 17.0 44.2 0.0 100.0 163
Nuwaraeliya 0.0 0.0 0.0 0.0 0.0 1.2 3.2 4.5 8.0 11.7 19.2 18.3 33.9 0.0 100.0 79
Galle 0.2 0.0 0.4 0.0 0.3 0.4 1.8 4.3 7.4 9.0 10.2 14.1 51.9 0.0 100.0 367
Matara 0.0 0.0 0.0 0.3 0.0 0.0 3.5 3.6 5.7 7.2 11.4 18.7 49.6 0.0 100.0 269
Hambantota 0.0 0.0 0.0 0.8 0.0 0.6 2.1 3.7 6.3 7.2 10.3 16.5 52.5 0.0 100.0 160
Jaffna 0.0 0.0 0.0 0.7 0.0 0.0 2.2 5.6 8.0 9.4 6.2 10.3 57.6 0.0 100.0 125
Mannar 0.0 0.0 0.0 0.0 0.0 0.8 1.3 5.2 3.9 10.0 23.4 12.9 42.5 0.0 100.0 21
Vavuniya 0.0 0.0 0.0 0.0 0.0 1.7 3.9 7.9 6.0 15.9 8.1 15.1 41.4 0.0 100.0 47
Mullaitivu (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (2.4) (9.5) (22.0) (4.3) (14.0) (22.0) (25.8) (0.0) (100.0) 6
Kilinochchi (0.0) (0.0) (0.0) (0.0) (0.0) (1.4) (0.0) (8.7) (12.4) (10.2) (10.5) (16.8) (40.1) (0.0) (100.0) 11
Batticaloa 0.0 0.0 0.0 0.0 0.0 2.5 4.7 11.3 9.8 19.4 13.6 14.0 24.6 0.0 100.0 118
Ampara 0.0 0.0 0.0 0.5 0.7 1.3 1.4 7.1 8.7 9.8 19.3 19.7 31.4 0.0 100.0 191
Trincomalee 0.0 0.0 0.0 0.0 0.0 0.8 2.8 9.2 11.0 11.9 16.5 13.9 33.9 0.0 100.0 88
Kurunegala 0.0 0.0 0.0 0.3 0.0 0.6 1.9 6.1 5.5 9.0 13.6 16.8 46.2 0.0 100.0 367
Puttalam 0.0 0.0 0.0 0.0 1.9 0.7 3.0 6.0 6.3 9.5 10.8 11.9 49.8 0.0 100.0 151
Anuradhapura 0.0 0.0 0.0 0.0 0.8 0.0 4.3 2.5 10.0 20.2 18.5 14.0 29.7 0.0 100.0 157
Polonnaruwa 0.0 0.0 0.0 0.0 0.7 0.0 5.8 3.5 9.9 12.3 16.1 19.3 32.3 0.0 100.0 133
Badulla 0.0 0.0 0.0 1.6 0.0 0.0 0.8 6.1 14.7 8.3 17.5 18.7 32.3 0.0 100.0 152
Monaragala 0.0 0.0 0.0 0.0 0.0 0.0 1.2 6.4 8.0 12.2 14.9 11.9 45.3 0.0 100.0 111
Ratnapura 0.0 0.0 0.0 0.0 0.0 0.4 2.0 4.9 8.4 10.0 14.8 17.0 42.5 0.0 100.0 301
Kegalle 0.3 0.4 0.0 0.0 0.6 0.0 1.8 3.9 7.6 8.4 8.5 17.8 50.8 0.0 100.0 216

Wealth quintile
Lowest 0.0 0.0 0.0 0.3 0.3 0.1 2.0 5.2 5.5 7.5 14.3 12.2 52.6 0.0 100.0 688
Second 0.0 0.1 0.1 0.1 0.5 0.7 2.8 4.6 5.7 10.4 13.5 15.5 46.2 0.0 100.0 917
Middle 0.0 0.0 0.0 0.1 0.2 0.8 2.9 6.1 7.9 10.5 12.9 16.5 42.1 0.0 100.0 1,050
Fourth 0.0 0.0 0.0 0.2 0.3 0.6 2.7 4.6 8.1 9.6 13.2 16.3 44.3 0.0 100.0 1,252
Highest 0.2 0.0 0.0 0.1 0.0 0.3 1.8 3.5 7.0 11.8 13.5 15.4 46.3 0.0 100.0 1,773

Total 0.1 0.0 0.0 0.1 0.2 0.5 2.4 4.6 7.0 10.3 13.4 15.4 45.8 0.0 100.0 5,681
Note: Figures in parentheses are based on 25 - 49 unweighted cases. An asterisk indicates that a figure is
based on fewer than 25 unweighted cases and has been suppressed.

16.1.6 Treatment of non-communicable diseases

16.1.6
Table TREATMENT
16.7 OF NON-COMMUNICABLE
presents the percentage of people suffering DISEASES
from specific NCDs that are being treated
during the last 12 months by background characteristics.Almost all persons affected by NCDs at the time
Table 16.7 presents the percentage of people suffering from specific NCDs that are being treated
of the survey were receiving treatment. No variations are observed in the treatment coverage of NCDs by
during the last 12 months by background characteristics.Almost all persons affected by NCDs at the time
background characteristics.
of the survey were receiving treatment. No variations are observed in the treatment coverage of NCDs by
background characteristics.

Demography and Health Survey - 2016 237

Non Communicable Diseases, Mental Illnesses, Suicides, Smoking..... 229

 Table 16.7: Treatment of People suffering from non-communicable diseases during last 12 months
Percentage of people suffering from non-communicable diseases that are being treated during the last 12 months, by background characteristics, Sri Lanka 2016
Heart disease High blood pressure Wheezing asthma Paralysis Diabetes Cancer High blood cholesterrole Chronic kidney disease Cirrhosis

230
Back Percent Number of Percent Number of Percent Number of Percent Number of Percent Number of Percent Number of Percent Number of Percent Number of Percent Number of
ground being people being people being people being people being people being people being people being people being people
characteristic treated suffering treated suffering treated suffering treated suffering treated suffering treated suffering treated suffering treated suffering treated suffering
Sex
Male 91.1 1,197 92.9 3,023 83.3 2,130 82.6 292 92.5 2,604 87.9 128 86.4 2,059 90.6 366 (81.4) 34
Female 91.8 1,177 93.2 5,643 86.2 3,166 88.3 232 95.0 3,403 86.3 235 89.9 3,622 86.5 224 * 13
Age
<5 (73.8) 29 * 2 81.9 214 * 0 * 1 * 3 * 3 * 4 * 0
5-9 (72.4) 42 * 4 83.7 392 * 4 * 7 * 2 * 1 * 10 * 0
10-14 (67.1) 42 * 9 74.6 388 * 3 * 4 * 7 * 2 * 11 * 0
15-19 (66.3) 22 * 6 75.0 260 * 6 * 4 * 5 * 7 * 13 * 0
20-24 * 15 * 14 75.4 186 * 2 * 7 * 7 * 12 * 6 * 0
25-29 (66.5) 23 (62.4) 33 79.3 177 * 4 (75.5) 27 * 3 (66.5) 29 * 7 * 3
30-34 (82.7) 35 59.9 125 79.9 218 * 6 83.4 123 * 6 65.3 135 * 14 * 0
35-39 82.6 83 79.5 254 84.1 364 * 15 87.7 287 * 18 75.1 262 (94.0) 27 * 2
40-44 84.7 111 85.9 387 80.7 311 * 11 91.5 393 * 15 80.4 399 (85.3) 29 * 2
45-49 83.6 151 87.7 675 87.5 411 * 20 91.2 567 (82.9) 27 82.1 587 (93.0) 46 * 5
50-54 92.8 275 91.8 1,005 86.5 408 (87.7) 33 92.8 854 (87.2) 34 89.6 763 88.8 74 * 9
55-59 94.5 299 93.5 1,199 89.7 409 87.0 63 95.3 937 79.9 48 89.7 877 91.1 82 * 7
60 + 95.9 1,246 96.5 4,955 91.3 1,556 87.7 356 96.1 2,794 85.9 186 93.8 2,603 88.7 268 * 18
Residence
Urban 93.1 452 93.7 1,806 82.6 918 87.5 69 94.2 1,442 80.9 57 88.9 1,311 90.7 63 * 10
Rural 91.1 1,812 93.0 6,608 85.3 4,199 84.1 433 93.8 4,472 88.0 298 88.6 4,296 88.8 515 (88.4) 37
Estate 89.0 111 91.0 252 90.2 179 (96.5) 24 92.2 92 * 8 88.3 74 * 11 * 0
District
Colombo 92.9 306 93.2 1,249 80.9 592 (89.0) 35 93.3 979 (86.0) 44 86.3 907 (91.5) 37 * 8
Gampaha 94.4 268 94.6 1,016 85.4 535 86.2 64 93.9 821 (77.8) 53 88.0 645 (96.5) 42 * 5
Kalutara 94.0 163 95.6 616 90.5 366 * 27 94.0 453 * 14 91.3 457 * 17 * 0

Demographic and Health Survey - 2016, Sri Lanka

Kandy 94.6 202 96.2 664 90.0 387 (68.8) 34 97.2 454 * 17 96.3 437 * 28 * 3
Matale 85.4 95 91.0 247 84.8 177 * 11 90.3 142 * 9 85.0 163 (95.4) 32 * 2
Nuwaraeliya 93.6 95 94.7 214 88.5 152 * 17 96.4 104 * 12 96.4 79 * 14 * 0
Galle 87.6 151 92.8 458 80.9 330 * 24 93.3 303 * 27 83.2 367 (80.2) 29 * 2
Matara 84.5 115 91.9 351 83.8 245 * 24 92.7 250 * 11 86.4 269 * 14 * 4
Hambantota (93.2) 45 91.7 204 84.5 209 * 12 94.6 140 * 16 83.1 160 * 21 * 2
Jaffna (88.2) 33 94.5 138 81.2 64 * 8 96.4 127 * 11 97.4 125 * 22 * 1
Mannar * 2 98.4 29 98.5 11 * 3 95.8 22 * 1 96.1 21 * 1 * 0
Vavuniya (72.2) 11 89.0 57 79.2 30 * 6 94.8 30 * 2 92.6 47 (92.9) 15 * 0
Mullaitivu * 4 95.9 13 93.6 12 * 1 (97.6) 7 * 1 (84.9) 6 * 2 * 0
Kilinochchi (88.9) 8 89.1 29 76.2 21 * 2 92.9 16 * 2 (98.2) 11 * 2 * 0
Batticaloa (90.3) 30 91.1 185 86.9 188 * 17 93.5 130 * 3 92.0 118 * 10 * 3
Ampara 90.8 61 89.1 283 86.8 175 (74.8) 32 91.2 182 * 8 89.7 191 (72.3) 32 * 4
Trincomalee (88.4) 32 86.0 147 80.7 120 * 10 94.6 103 * 3 85.1 88 * 18 * 3
Kurunegala 90.3 172 94.1 737 86.7 379 (88.7) 55 91.7 428 (78.2) 47 89.3 367 (88.0) 50 * 3
Puttalam 89.9 63 92.7 294 84.5 204 * 21 94.0 213 * 18 85.7 151 * 19 * 0
Anuradhapura (97.4) 54 91.8 268 91.3 162 (86.9) 34 95.3 215 * 11 95.4 157 (100.0) 61 * 1
Polonnaruwa (79.8) 43 83.9 182 81.5 159 * 9 92.0 118 * 7 79.0 133 (92.1) 35 * 1
Badulla 93.0 118 94.0 375 81.7 216 (94.1) 22 96.2 188 * 14 92.6 152 (89.3) 29 * 0
Monaragala (96.9) 43 93.6 160 94.9 114 * 11 97.6 89 * 9 94.7 111 * 13 * 0
Ratnapura 88.1 153 89.5 466 77.2 323 (95.6) 27 92.2 281 * 18 82.7 301 (83.5) 36 * 6
Kegalle 95.2 107 97.2 285 92.2 127 * 20 95.6 212 * 8 91.5 216 * 10 * 0
Wealth quintile
Lowest 88.8 510 91.0 1,404 84.9 1,299 79.1 147 93.9 681 87.9 83 90.2 688 91.7 113 * 11
Second 90.7 480 93.0 1,512 84.2 1,107 87.1 122 93.4 935 88.8 62 89.4 917 89.7 152 * 5
Middle 89.5 400 92.8 1,665 86.0 961 88.3 95 92.7 1,070 83.3 66 87.8 1,050 92.9 125 * 10
Fourth 93.3 473 93.9 1,805 86.3 967 88.7 82 93.9 1,397 88.1 81 87.9 1,252 85.1 120 * 8
Highest 94.4 510 94.1 2,280 83.7 961 85.8 78 94.8 1,924 85.9 71 88.7 1,773 84.0 80 * 13
Total 91.4 2,374 93.1 8,666 85.0 5,295 85.1 525 93.9 6,006 86.9 363 88.6 5,681 89.0 590 (81.6) 48
Note: Figures in parentheses are based on 25 - 49 unweighted cases.An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed.
16.2 Accidents
In the 2016 SLDHS, interviewers inquired about accidents among members of the household during
the 12 months before the survey, and if the person affected by the accident received treatment in a hospital
or clinic at the time of the accident. Table 16.8 presents the percentage of people having an accident during
the last 12 months by type of accidents and background characteristics. The types of accidents referenced
are road accidents, serious burns, serious falls, fall into water, suffering any kind of poisoning, animal bites,
snake bites, serious cut, electric shock or natural disaster. At the level of the total population, accidents appear
to have very low prevalence (1 percent or less, Table 16.8). According to the survey findings, road accidents,
serious falls and animal bites have the highest prevalence at only 1 percent. Results also indicate that the male
population is more prone to accidents than the female population, particularly in the case of road accidents
and serious falls. Road accidents tend to be concentrated among the population age 20-39, while serious falls
mostly affect the population 50 years or older. No clear pattern seems to appear from the data by the other
background characteristics (religion, ethnicity, place of residence, or household wealth)

Non Communicable Diseases, Mental Illnesses, Suicides, Smoking..... 231

Table 16.8 : People having an accident during the last 12 months
Percentage of people having an accident during the last 12 months by type of accident and background characteristics, Sri Lanka 2016
Fall in Suffer of Number of
Background Road Serious Serious to the any kind of Animal Bitten by a Serious Electric Natural household
characteristic accident Burns Fall water poisoning bites snake cut shock disaster members

Sex
Male 1.7 0.1 1.1 0.0 0.1 1.1 0.4 0.5 0.1 0.6 50,273
Female 0.4 0.1 0.8 0.0 0.2 1.0 0.3 0.2 0.1 0.5 55,674

Age
<5 0.1 0.3 0.3 0.0 0.1 0.7 0.0 0.1 0.0 0.4 8,373
5-9 0.3 0.1 1.0 0.0 0.1 1.4 0.2 0.3 0.1 0.5 9,152
10-14 0.6 0.1 0.8 0.0 0.1 1.6 0.2 0.2 0.0 0.5 8,928
15-19 1.0 0.0 0.6 0.0 0.1 1.0 0.3 0.3 0.0 0.6 8,046
20-24 1.8 0.1 0.7 0.0 0.2 0.6 0.3 0.2 0.1 0.7 7,037
25-29 1.3 0.1 0.4 0.0 0.1 0.7 0.1 0.4 0.1 0.6 6,675
30-34 1.5 0.1 0.6 0.0 0.1 0.8 0.4 0.4 0.1 0.6 7,644
35-39 1.7 0.1 0.8 0.0 0.1 0.8 0.4 0.6 0.1 0.6 7,879
40-44 1.4 0.1 0.8 0.0 0.1 1.0 0.6 0.5 0.1 0.7 6,681
45-49 1.3 0.2 0.9 0.0 0.3 1.4 0.5 0.5 0.1 0.7 6,534
50-54 1.1 0.1 1.4 0.0 0.2 1.0 0.6 0.5 0.0 0.6 6,789
55-59 1.0 0.1 1.3 0.0 0.2 1.1 0.4 0.4 0.0 0.6 6,092
60 + 0.7 0.1 1.7 0.0 0.2 1.2 0.5 0.3 0.1 0.4 16,117

Religion
Buddhist 1.0 0.1 1.0 0.0 0.2 1.1 0.4 0.3 0.1 0.4 75,022
Hindu 0.9 0.1 1.0 0.0 0.1 0.9 0.3 0.3 0.1 0.5 12,758
Islam 0.8 0.1 0.7 0.0 0.1 0.5 0.1 0.3 0.0 1.1 9,811
Roman Catholic 1.2 0.1 0.8 0.1 0.1 1.1 0.2 0.5 0.1 1.0 6,908
Other Christian 0.7 0.0 1.2 0.0 0.3 1.2 0.2 0.3 0.1 0.4 1,413
Other (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) 35

Ethnicity
Sinhala 1.0 0.1 1.0 0.0 0.2 1.1 0.4 0.4 0.1 0.5 80,264
Sri Lanka Tamil 1.0 0.1 0.9 0.0 0.1 1.0 0.4 0.3 0.1 0.5 13,654
Indian Tamil 0.7 0.0 1.2 0.0 0.1 0.6 0.2 0.3 0.1 0.4 2,439
Sri Lanka moor
/Muslim 0.8 0.1 0.8 0.0 0.1 0.5 0.1 0.2 0.0 1.0 9,213
Malay 0.9 0.0 0.8 0.0 0.0 0.7 0.0 0.0 0.0 10.0 157
Burger 1.1 0.0 0.0 0.0 0.0 1.9 0.0 0.0 0.0 0.0 180
Other (0.0) (0.0) (1.0) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) 41

Residence
Urban 1.1 0.1 0.9 0.0 0.2 1.0 0.1 0.3 0.0 1.0 17,491
Rural 1.0 0.1 0.9 0.0 0.2 1.1 0.4 0.3 0.1 0.5 83,923
Estate 0.4 0.1 1.2 0.0 0.1 0.6 0.5 0.4 0.1 0.0 4,534

District
Colombo 1.4 0.2 1.0 0.0 0.3 0.8 0.1 0.3 0.1 3.6 10,663
Gampaha 1.0 0.1 0.8 0.0 0.1 0.5 0.2 0.3 0.0 0.6 10,892
Kalutara 1.4 0.1 1.2 0.0 0.1 0.8 0.3 0.4 0.0 0.1 6,506
Kandy 0.7 0.2 1.4 0.0 0.2 1.1 0.2 0.3 0.1 0.1 7,333
Matale 0.5 0.1 1.1 0.1 0.4 1.1 0.7 0.6 0.1 0.0 2,759
Nuwara Eliya 0.4 0.1 1.0 0.0 0.1 1.1 0.3 0.3 0.1 0.0 3,450
Galle 1.3 0.1 1.2 0.0 0.1 1.3 0.5 0.4 0.1 0.4 5,709
Matara 1.2 0.1 0.8 0.0 0.2 0.9 0.3 0.1 0.0 0.1 4,407
Hambantota 1.3 0.1 0.8 0.1 0.2 1.2 0.4 0.2 0.1 0.0 3,240
Jaffna 1.2 0.0 0.7 0.0 0.0 1.0 0.4 0.2 0.1 0.0 3,054
Mannar 0.5 0.1 0.3 0.0 0.1 0.1 0.4 0.1 0.1 0.0 508
Vavuniya 1.1 0.0 0.9 0.0 0.1 0.8 0.1 0.4 0.0 0.0 828
Mullaitivu 1.4 0.2 1.0 0.0 0.0 1.0 0.5 0.3 0.0 0.0 449
Kilinochchi 0.9 0.1 1.2 0.0 0.0 1.9 0.6 0.3 0.0 0.0 562
Batticaloa 1.0 0.0 0.8 0.0 0.1 1.6 0.3 0.3 0.1 0.0 2,841
Ampara 1.0 0.1 0.9 0.0 0.0 0.6 0.4 0.4 0.1 0.0 3,815
Trincomalee 1.7 0.1 0.8 0.1 0.1 0.9 0.3 0.1 0.1 0.2 2,045
Kurunegala 0.7 0.1 0.7 0.0 0.3 1.3 0.4 0.4 0.0 0.2 8,849
Puttalam 1.5 0.1 0.7 0.1 0.1 1.1 0.4 0.7 0.2 0.8 3,691
Anuradhapura 0.4 0.0 0.3 0.0 0.1 0.8 0.3 0.2 0.0 0.0 4,847
Polonnaruwa 1.1 0.2 0.8 0.0 0.1 1.5 0.4 0.4 0.0 0.0 2,170
Badulla 1.0 0.1 1.2 0.0 0.1 1.2 0.2 0.3 0.1 0.1 4,242
Moneragala 0.3 0.3 0.6 0.0 0.1 0.8 0.4 0.3 0.0 0.0 2,604
Ratnapura 1.1 0.2 1.1 0.0 0.2 2.0 1.1 0.6 0.1 0.1 6,076
Kegalle 0.4 0.0 0.9 0.0 0.0 0.8 0.2 0.1 0.0 0.3 4,408

Wealth quintile
Lowest 0.9 0.1 1.3 0.0 0.1 1.3 0.6 0.5 0.1 0.5 21,113
Second 0.9 0.1 0.9 0.0 0.1 1.2 0.5 0.4 0.1 0.5 21,193
Middle 1.1 0.1 0.9 0.0 0.1 1.1 0.3 0.3 0.0 0.5 21,204
Fourth 1.1 0.1 0.8 0.0 0.2 0.9 0.3 0.3 0.1 0.6 21,181
Highest 1.0 0.1 0.8 0.0 0.2 0.7 0.1 0.1 0.0 0.6 21,256

Total 1.0 0.1 0.9 0.0 0.2 1.0 0.4 0.3 0.1 0.5 105,947
Note: Figures in parentheses are based on 25 - 49 unweighted cases.
An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed.

Demography and Health Survey - 2016 240

232 Demographic and Health Survey - 2016, Sri Lanka

16.3 Mental health Table 16.9 Currently under treatments for mental illness

For the first time in the history Percentage of household members currently under treatments for, any kind of
mental illness by background characteristics, Sri Lanka, 2016
of the SLDHS, data on mental illnesses Currently under Total number of
and suicides were collected. These data Background characteristic treatment household members
were gathered because a population Sex
with good mental health is important for Male 0.7 50,273
Female 0.7 55,674
the country’s development. Information
on mental illnesses was gathered on Age
whether a family member is currently <5 0.0 8,373
5-9 0.2 9,152
undergoing any kind of treatment for 10-14 0.3 8,928
mental illness and, if so, what kind of 15-19 0.3 8,046
20-24 0.6 7,037
mental illness. 25-29 0.6 6,675
30-34 0.7 7,644
Table 16.9 includes the per- 35-39 0.7 7,879
centage of household members cur- 40-44 1.1 6,681
45-49 1.2 6,534
rently under treatment for any kind of 50-54 0.9 6,789
mental illness. Globally, less than one 55-59 1.2 6,092
60-64 1.4 5,353
percent (0.7 percent) of household 65-69 0.7 4,381
members were undergoing treatment 70-74 1.1 2,963
75-79 1.3 1,696
for any kind of mental illness. When 80 + 1.1 1,724
considering the age of the member of
Residence
the household, the higher percentages Urban 0.8 17,491
tend to be concentrated among the adult Rural 0.7 83,923
Estate 0.3 4,534
population (20 years and older) rather
than in the younger population groups. District
Considering residence, there are no im- Colombo 0.8 10,663
Gampaha 0.8 10,892
portant differences between urban and Kalutara 0.6 6,506
rural sector residents (0.8% and 0.7% Kandy 1.0 7,333
Matale 0.8 2,759
respectively), but the percentage is Nuwara Eliya 0.3 3,450
lower in the estates sector (0.3 percent Galle 0.7 5,709
Matara 0.7 4,407
only). Hambantota 0.5 3,240
Jaffna 0.8 3,054
When considering districts, Mannar 0.5 508
the lowest percentage is observed in Vavuniya 0.6 828
Mullaitivu 0.7 449
Nuwara Eliya district (0.3%), and Kilinochchi 1.1 562
the highest in the Kilinochchi district Batticaloa 0.5 2,841
Ampara 0.5 3,815
(1.1%). By wealth quintile, the highest Trincomalee 0.5 2,045
rate is reported from the poorest house- Kurunegala 0.6 8,849
Puttalam 0.4 3,691
holds (1 percent) whereas the lowest Anuradhapura 0.4 4,847
rate is reported from the richest 20 per- Polonnaruwa 1.0 2,170
Badulla 0.6 4,242
cent of the households (only 0.4%). It Moneragala 0.4 2,604
can be hypothesized that as the social Ratnapura 0.7 6,076
Kegalle 1.0 4,408
and economic status decreases, the in-
tensity and pressure of social, cultural Wealth quintile
and economic problems due to poverty Lowest 1.0 21,117
Second 0.8 21,189
increase, and thus people in the lowest Middle 0.6 21,200
wealth quintile could be more affected Fourth 0.5 21,186
Highest 0.4 21,255
from mental illnesses.
Total 0.7 105,947

Non Communicable Diseases, Mental Illnesses, Suicides, Smoking..... 233

Demography and Health Survey - 2016 2

 Figure 16.2 Percentage of household members currently
Figure 16.2 Percentage of household members currently undergoing treatment for any
undergoing treatment for any kind of mental illness by wealth
kind of mental illness by wealth quintile
quintile

1.2

0.8
Percentage

0.6
1
0.4 0.8
0.6
0.2 0.5
0.4

0
Lowest Second Middle Fourth Highest
Wealth quintile

According to Table 16.10, among people being treated for mental illnesses, the most common
mental illnessAccording to Table
is depressive 16.10, among
conditions, people
reported forbeing treated of
37 percent forthe
mental illnesses,
cases, followedthe by
most common(17
psychosis mental
illness is depressive conditions, reported for 37 percent of the cases, followed by psychosis (17 percent). At
percent). At the other extreme of the distribution, substance dependence appears with less than one
the other extreme of the distribution, substance dependence appears with less than one percent. Compared to
percent. Compared to the male population, females tend to have higher percentages for depressive
the male population, females tend to have higher percentages for depressive conditions, anxiety disorders and
conditions, anxiety disorders and psychosis. For the remaining four categories of mental illnesses, higher
psychosis. For the remaining four categories of mental illnesses, higher rates are reported for male members
ratesofare
thereported for male
household. Whenmembers of the
considering household.
age When considering
groups, depressive conditions agearegroups,
higherdepressive
among adult conditions
populations
are higher
(20–74 years). The percentage of mental illnesses being treated by type of illness does not appear totype
among adult populations (20–74 years). The percentage of mental illnesses being treated by be asso-
of illness
ciated does notwealth
with the appearoftothe
behousehold,
associated since
with in
thethe
wealth of the
majority household,
of the illnesses,since in the majority
the percentages of the
are very similar
illnesses,
acrossthe percentages
wealth quintile.are very similar across wealth quintile.

234 Demographic and Health Survey - 2016, Sri Lanka

Demography and Health Survey - 2016 243

 Table 16.10: Mental illnesses being treated

Among household members currently under treatments percentage with specific mental illnesses which are being treated by background characteristics, Sri Lanka, 2016
Total number of
Mental illness being treated
household
Obsessive Alcohol
Anxiety Compulsive Dependence Substance members being
Background characteristic Depressive Disorder Disorder /Abuse Dependence Psychosis Bipolar Disorder Others Don't Know treated

Sex
Male 32.5 3.8 2.6 2.2 1.5 15.1 4.6 7.4 23.2 346
Female 40.2 9.7 0.7 0.0 0.0 18.0 4.1 9.9 16.1 375

Age
<5 * * * * * * * * * 1
5-9 * * * * * * * * * 21
10-14 * * * * * * * * * 24
15-19 (25.2) (4.7) (9.3) (0.0) (0.0) (4.5) (0.0) (0.0) (13.7) 27
20-24 (30.8) (3.6) (3.1) (3.6) (5.5) (12.2) (5.9) (6.2) (21.6) 39
25-29 (41.6) (4.3) (0.0) (0.0) (0.0) (20.7) (1.6) (14.2) (4.3) 42
30-34 46.7 4.6 2.7 0.0 2.7 14.4 1.1 6.1 8.1 51
35-39 31.9 5.1 0.0 0.0 0.0 19.0 0.0 5.2 24.1 57
40-44 40.0 3.7 1.0 1.6 0.0 17.9 3.6 10.1 26.0 71
45-49 42.5 6.0 0.0 1.6 0.0 26.9 9.2 11.1 13.0 78
50-54 29.8 5.2 0.0 0.0 0.0 29.6 8.1 20.5 23.2 58
55-59 36.5 8.6 5.4 0.0 0.0 10.1 9.6 4.4 26.0 70
60-64 39.5 7.3 2.7 3.1 2.2 19.1 5.6 7.2 17.9 77
65-69 (44.1) (15.3) (0.0) (5.1) (0.0) (6.7) (3.8) (0.0) (20.8) 30
70-74 (32.5) (23.0) (0.0) (0.0) (0.0) (16.7) (0.0) (15.7) (21.9) 34
75-79 * * * * * * * * * 23
80 + * * * * * * * * * 19

Residence
Urban 39.1 3.3 1.0 1.1 0.0 24.5 3.3 16.3 18.5 131
Rural 35.4 7.8 1.8 1.1 0.9 14.9 4.3 7.0 19.6 575
Estate (54.3) (2.6) (0.0) (0.0) (0.0) (12.3) (13.2) (6.5) (23.7) 15

Wealth quintile
Lowest 39.1 5.2 2.6 0.6 1.2 16.3 4.6 6.7 19.6 221
Second 30.2 7.4 0.0 1.4 1.6 14.8 7.8 8.2 26.2 163
Middle 34.8 8.4 1.6 0.9 0.0 18.4 2.4 5.4 14.7 133
Fourth 38.9 11.4 1.2 1.1 0.0 16.6 2.2 13.7 14.2 112

Non Communicable Diseases, Mental Illnesses, Suicides, Smoking.....

Highest 40.8 2.1 2.8 1.6 0.0 17.8 2.7 13.0 20.8 93

Total 36.5 6.9 1.6 1.1 0.7 16.6 4.3 8.7 19.5 721

Note: Figures in parentheses are based on 25 - 49 unweighted cases.

235
An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed.
Information on Dementia, Development Delays/Disorder, Attention Deficit Disorder and Autism were excluded from the above table due to inconsistant errors.

244
16.3.1 Suicides
According to World Health Organization “suicide is the act of deliberately killing oneself”. Why
do people deliberately end their lives before their natural death? This may happen due to mental or physical
illness, inability to cope with the break-ups of human relationships, inability to bear day-to-day stress, and
financial problems. In addition, experiencing conflict, disaster, violence, abuse or loss and a sense of isolation
are strongly associated with suicidal behavior.
Although every person has to face such problems in their day-to-day lives, their mental status and
their personality determines how they react to the situation. Every suicide is a tragedy that affects families,
communities and the entire country and has long lasting effects on the people left behind. Because it is a
serious social problem, it is useful to conduct a survey to determine its prevalence, and find out methods to
minimize the suicide rate.
The 2016 SLDHS collected information at the household level to learn if at least one person has tried
to commit suicide or if there are households in which anyone has actually committed suicide during the 12
months preceding the survey. According to Table 16.11, the survey found less than one percent of households
in which at least one person has tried to commit suicide during the year before the survey (0.5 percent).
When considering residence, the rural sector has the maximum percentage of 0.6 percent of house-
holds in which at least one person has tried to commit suicide, compared to only 0.3 percent among those
residents of the urban and
estates sectors. However, Table 16.11 Suicides
the estate sector is the only Percentage of households in which at least 1 person has tried to commit suicide and
sector in which anyone ac- percentage of households in which anyone has actually committed suicide, in the last 12
months by background characteristics, Sri Lanka, 2016
tually committed suicide Total number of
(0.2 percent). Background characteristic Tried to commit suicide Committed Suicide households

Considering dis- Residence

Urban 0.3 0.0 4,309
tricts of residence, the low- Rural 0.6 0.0 21,778
est value of households in Estate 0.3 0.2 1,122
which at least one person District
has tried to commit suicide Colombo 0.4 0.0 2,722
Gampaha 0.4 0.1 2,815
is reported in Nuwara Eliya Kalutara 0.2 0.0 1,618
(0.1 percent) and the maxi- Kandy 0.8 0.1 1,872
Matale 0.8 0.0 720
mum is reported in Mullai- Nuwara Eliya 0.1 0.0 895
tivu district (1.1 percent). Galle 0.4 0.0 1,461
When considering house- Matara 0.3 0.1 1,107
Hambantota 0.7 0.0 846
holds in which anyone has Jaffna 0.5 0.1 720
actually committed suicide, Mannar 0.9 0.2 126
Vavuniya 0.5 0.0 199
Puttalam district has the Mullaitivu 1.1 0.0 116
highest rate of 0.3%. Kilinochchi 1.0 0.0 141
Batticaloa 0.9 0.0 699
According to the Ampara 0.6 0.0 909
Trincomalee 0.3 0.0 507
wealth quintile, the highest Kurunegala 0.6 0.1 2,416
percentage of households Puttalam 1.0 0.3 1,007
Anuradhapura 0.3 0.0 1,245
in which at least one person Polonnaruwa 0.3 0.0 577
has tried to commit suicide Badulla 0.4 0.1 1,114
Moneragala 0.2 0.0 678
and in which anyone has Ratnapura 0.7 0.1 1,567
actually committed suicide Kegalle 0.3 0.0 1,134
is reported in the lowest Wealth quintile
wealth quintile, with 0.8 Lowest 0.8 0.1 6,147
Second 0.7 0.0 5,502
percent and 0.1 percent re- Middle 0.3 0.0 5,305
spectively. Fourth 0.5 0.0 5,163
Highest 0.2 0.0 5,094

Total 0.5 0.0 27,210

236 Demographic and Health Survey - 2016, Sri Lanka

16.4 TOBACCO USE
16.4Smoking
Tobacco
has ause
powerful, negative impact on a population’s health. Smoking is a known risk factor
for cardiovascular
Smokingdiseases. It causes
has a powerful, lung impact
negative canceronand other forms
a population’s of cancer,
health. Smoking and
is ait known
contributes to the
risk factor
severity of pneumonia,
for cardiovascular emphysema,
diseases. and
It causes chronic
lung cancerbronchitis. It mayofalso
and other forms haveand
cancer, anitimpact on individuals
contributes who
to the sever-
are ity
exposed to secondhand
of pneumonia, emphysema, smoke. For example,
and chronic bronchitis.inhaling secondhand
It may also smokeonmay
have an impact adversely
individuals who affect
are
children’s
exposedgrowth and cause
to secondhand childhood
smoke. illnesses,
For example, especially
inhaling respiratory
secondhand smokediseases. Because
may adversely smoking
affect is an
children’s
acquired behavior, all morbidity and mortality caused by smoking is preventable.
growth and cause childhood illnesses, especially respiratory diseases. Because smoking is an acquired be-
havior, all morbidity and mortality caused by smoking is preventable.
As shown in Table 16.12 below, in 34 percent of households included in the 2016 SLDHS, at least
one memberAssmokes
shown intobacco and another
Table 16.12 2934percent
below, in percentuse smokeless included
of households tobacco.inThethe percentage
2016 SLDHS, of ‘ever
at leastuse
one member smokes tobacco and another 29 percent use smokeless tobacco. The percentage of
smoke tobacco’ of tobacco by sector of residence is higher among rural residents. By district the higher ‘ever use
smoke tobacco’
percentages of tobacco
are observed by sectorHambantota,
in Matale, of residence isPolonnaruwa
higher amongand
rural residents.
Galle By district
(all higher than the
40 higher
percent)per-and
the centages are observed
lowest (less in Matale,
than 25 percent) in Hambantota, Polonnaruwa
Mannar, Jaffna, VavuniyaandandGalle (all higher
Batticaloa than 40 percent) and the
districts.
lowest (less than 25 percent) in Mannar, Jaffna, Vavuniya and Batticaloa districts.
Smoke tobacco
Smoke consumption
tobacco consumptiondeclines
declineswith
with the
the wealth of the
wealth of the household.
household.The
Thepercentage
percentageis is highest
highest
among the poorest households (40 percent compared to 24 among the richest ones).
among the poorest households (40 percent compared to 24 among the richest ones).

Table 16.12 Ever used tobacco

Percentage of households in which at least one member has used tobacco or smokeless
tobacco according to background characteristics Sri Lanka 2016
Ever used
Smokeless Total number of
Background characteristic Smoke tobacco tobacco households

Residence
Urban 31.6 14.4 4,309
Rural 34.5 30.5 21,778
Estate 31.6 53.0 1,122

District
Colombo 36.1 18.8 2,722
Gampaha 32.9 26.3 2,815
Kalutara 37.7 34.0 1,618
Kandy 35.6 19.4 1,872
Matale 45.8 25.2 720
Nuwara Eliya 31.6 43.1 895
Galle 40.5 31.3 1,461
Matara 33.6 31.6 1,107
Hambantota 44.0 34.0 846
Jaffna 22.0 12.6 720
Mannar 19.7 10.9 126
Vavuniya 23.8 14.4 199
Mullaitivu 29.4 25.2 116
Kilinochchi 25.4 24.8 141
Batticaloa 22.1 24.0 699
Ampara 26.9 22.7 909
Trincomalee 25.8 18.8 507
Kurunegala 32.0 34.4 2,416
Puttalam 25.8 26.2 1,007
Anuradhapura 38.9 21.1 1,245
Polonnaruwa 42.5 42.3 577
Badulla 34.8 35.1 1,114
Moneragala 38.3 34.9 678
Ratnapura 36.6 53.9 1,567
Kegalle 25.4 26.4 1,134

Wealth quintile
Lowest 39.7 39.9 6,149
Second 37.7 36.3 5,504
Middle 35.6 30.3 5,301
Fourth 31.6 22.9 5,164
Highest 23.6 12.2 5,094

Total 33.9 28.9 27,210

Non Communicable Diseases, Mental Illnesses, Suicides, Smoking..... 237

248
 16.5 INDOOR SMOKING POLICY

Women surveyed were questioned regarding the policy on smoking tobacco in their workplaces.
16.5 Indoor
Eighty-six smoking
percent policy
of the workplaces did not allow smoking anywhere in the workplace, 9 percent allowed
smoking either surveyed
Women anywhere were
(3 percent) or in some
questioned areas (6
regarding thepercent),
policy and the remaining
on smoking fivein
tobacco percent
their either did
workplaces.
not have a policy (4 percent) or did not know (1 percent).
Eighty-six percent of the workplaces did not allow smoking anywhere in the workplace, 9 percent allowed
smoking either anywhere (3 percent) or in some areas (6 percent), and the remaining five percent either did
not have a Greater
policy (4restrictions
percent) orfordidindoor
not know (1 percent).
smoking in the workplace is observed among respondents from
both the urban and
Greater rural sectors
restrictions (86 percent)
for indoor and among
smoking in the respondents
workplace from the following
is observed amongdistricts: Kegalle,
respondents from
Anuradhapura, Polonnaruwa, Matale, Matara, and Mullaitivu, in which 91 percent or more do not
both the urban and rural sectors (86 percent) and among respondents from the following districts: Kegalle,allow
smoking anywhere.
Anuradhapura, By socialMatale,
Polonnaruwa, and economic
Matara,status, the restrictions
and Mullaitivu, for indoor
in which smoking
91 percent or is greater
more among
do not allow
respondents with higher levels of education and greater household wealth (Table 16.13).
smoking anywhere. By social and economic status, the restrictions for indoor smoking is greater among re-
spondents with higher levels of education and greater household wealth (Table 16.13).

Table 16.13: Indoor smoking policy of ever-married women work place

Percentage distribution of ever-married women working mostly inside by indoor smoking policy of their work place, according to
background characteristics, Sri Lanka 2016
Smoking Smoking Not Total number of
allowed allowed in allowed Women working
Background characteristic anywhere some area anywhere No policy Don't know Total inside

Residence
Urban 2.1 6.5 86.4 3.6 1.4 100.0 893
Rural 2.6 6.0 86.4 4.1 0.9 100.0 3,453
Estate 6.4 5.2 80.1 3.9 4.4 100.0 81

District
Colombo 2.5 5.4 87.5 3.1 1.5 100.0 633
Gampaha 2.1 5.0 88.7 3.3 0.9 100.0 635
Kalutara 1.8 7.4 82.3 6.6 1.9 100.0 386
Kandy 3.6 7.7 84.0 2.8 1.8 100.0 315
Matale 0.0 3.6 94.3 2.1 0.0 100.0 111
Nuwara Eliya 9.5 3.8 82.8 3.4 0.6 100.0 58
Galle 3.4 6.5 85.0 3.5 1.6 100.0 256
Matara 0.3 6.3 91.3 1.5 0.6 100.0 190
Hambantota 0.5 6.4 89.4 2.8 0.9 100.0 112
Jaffna 0.0 10.7 84.0 2.3 3.1 100.0 111
Mannar 7.2 9.5 78.1 3.4 1.8 100.0 12
Vavuniya (0.0) (0.0) (81.6) (18.4) (0.0) 100.0 14
Mullaitivu 0.0 2.5 93.0 4.6 0.0 100.0 16
Kilinochchi 0.0 2.7 77.7 18.4 1.2 100.0 16
Batticaloa 3.6 2.1 85.5 4.3 4.6 100.0 84
Ampara 0.7 6.0 81.2 12.0 0.0 100.0 105
Trincomalee 8.8 6.9 75.9 8.4 0.0 100.0 55
Kurunegala 3.9 6.4 83.8 5.4 0.4 100.0 397
Puttalam 8.3 6.4 82.7 2.6 0.0 100.0 127
Anuradhapura 0.0 5.1 93.1 0.8 1.0 100.0 140
Polonnaruwa 1.2 4.3 94.5 0.0 0.0 100.0 78
Badulla 1.2 10.1 83.8 4.9 0.0 100.0 118
Moneragala 2.9 11.0 83.0 1.8 1.4 100.0 68
Ratnapura 5.1 6.5 80.9 7.6 0.0 100.0 224
Kegalle 0.6 2.6 95.0 0.8 1.0 100.0 165

Education
No education 10.6 6.3 68.7 3.8 10.7 100.0 60
Passed Grade 1-5 7.8 8.4 72.4 6.7 4.7 100.0 174
Passed Grade 6-10 3.6 7.5 83.1 4.7 1.1 100.0 1,344
Passed G.C.E.(O/L) or equivalent 2.4 6.0 85.0 4.7 2.0 100.0 813
Passed G.C.E.(A/L) or equivalent 1.5 5.2 90.3 2.9 0.1 100.0 1,348
Degree and above 1.1 4.5 91.3 3.0 0.2 100.0 688

Wealth quintile
Lowest 5.7 9.1 75.9 5.6 3.6 100.0 445
Second 3.6 8.0 81.7 5.8 1.0 100.0 686
Middle 2.7 4.8 87.0 4.2 1.4 100.0 825
Fourth 2.4 4.7 89.0 3.1 0.8 100.0 1,020
Highest 1.3 5.9 89.3 3.0 0.3 100.0 1,451

Total 2.6 6.1 86.3 4.0 1.1 100.0 4,427

249

238 Demographic and Health Survey - 2016, Sri Lanka

 16.6 ALCOHOL AND OTHER DRUG USE AND CONSUMPTION
16.6 AInlcohol and
the 2016 other respondents
SLDHS, drug use andwereconsumption
asked if any of the household members currently drink
alcohol,Inuse
theganja,
2016 orSLDHS,
use heroin. Table 16.14
respondents wereshows
askedthat in 37ofpercent
if any of households
the household membersat least one member
currently drink
currently
alcohol, useconsumes
ganja, or alcohol and Table
use heroin. less than oneshows
16.14 percentthathave
in 37used eitherofganja
percent (0.4 percent)
households at leastorone
heroin (0.1
member
percent).consumes alcohol and less than one percent have used either ganja (0.4 percent) or heroin (0.1
currently
percent).
According to the place of residence, households from the estate sector recorded a higher
According
consumption to the place
of alcohol (45 ofpercent)
residence, households
than those offrom the the estateorsector
urban ruralrecorded
sectors a(35
higher
andconsumption
37 percent,
ofrespectively).
alcohol (45 percent) than those of the urban or rural sectors (35 and 37 percent, respectively).
As with the analysis of many other indicators, the percentage of alcohol use by members As withof
the analysis of many other indicators, the percentage of alcohol use by members of the household
the household has greater variation across districts: Ratnapura, Kalutara and Galle districts with 47 percent has
greater variation
each, and Jaffna,across districts:and
Trincomalee Ratnapura,
Ampara Kalutara
with less and
thanGalle districts
half of with 47 percent
this percentage each, and
(22 percent). Jaffna,
Household
Trincomalee
wealth does and Ampara withthe
not differentiate less than halfofofalcohol
percentage this percentage (22 percent).
use by members Household wealth does not
of the household.
differentiate the percentage of alcohol use by members of the household.

Table 16.14 : Current drugs consumption in household

Percentage of households in which at least one member currently drinks alcohol, uses ganja or uses
heroin according to background characteristics, Sri Lanka 2016
Percentage of households in which at least one
member currently
Total number of
Background characteristic Drink alcohol Use ganja Use heroin households

Residence
Urban 34.6 0.3 0.3 4,309
Rural 37.4 0.4 0.0 21,778
Estate 44.9 0.4 0.0 1,122

District
Colombo 39.8 0.5 0.4 2,722
Gampaha 42.9 0.2 0.1 2,815
Kalutara 46.7 0.5 0.0 1,618
Kandy 33.9 0.1 0.0 1,872
Matale 41.7 0.4 0.0 720
Nuwara Eliya 35.6 0.4 0.0 895
Galle 47.3 0.4 0.0 1,461
Matara 38.0 0.1 0.0 1,107
Hambantota 35.0 1.0 0.1 846
Jaffna 21.6 0.0 0.0 720
Mannar 24.8 0.1 0.0 126
Vavuniya 28.4 0.2 0.0 199
Mullaitivu 31.0 0.0 0.0 116
Kilinochchi 26.5 0.0 0.0 141
Batticaloa 23.2 0.5 0.0 699
Ampara 22.3 0.4 0.0 909
Trincomalee 21.9 0.3 0.2 507
Kurunegala 29.8 0.1 0.0 2,416
Puttalam 35.2 1.2 0.0 1,007
Anuradhapura 36.5 0.3 0.0 1,245
Polonnaruwa 42.5 0.3 0.0 577
Badulla 41.2 0.5 0.1 1,114
Moneragala 45.7 1.5 0.1 678
Ratnapura 47.8 0.5 0.0 1,567
Kegalle 31.5 0.1 0.0 1,134

Wealth quintile
Lowest 38.5 0.7 0.1 6,149
Second 37.2 0.5 0.0 5,504
Middle 37.5 0.4 0.1 5,301
Fourth 37.3 0.2 0.0 5,164
Highest 35.7 0.1 0.0 5,094

Total 37.3 0.4 0.1 27,210

250

Non Communicable Diseases, Mental Illnesses, Suicides, Smoking..... 239

REFERENCES

Department of Census and Statistics (DCS) (Sri Lanka) and Institute for Resource Development/ Westing-
house. 1988. Sri Lanka Demographic and Health Survey 1987. Colombo: DCS and IRD

Department of Census and Statistics (DCS) (Sri Lanka). 1995. Sri Lanka Demographic and Health Survey
1993. Colombo: DCS

Department of Census and Statistics (DCS) (Sri Lanka). 2002. Sri Lanka Demographic and Health Survey
2000. Colombo: DCS

Department of Census and Statistics (DCS) (Sri Lanka). 2009. Sri Lanka Demographic and Health Survey
2006-07. Colombo: DCS

Ministry of Health, Nutrition and Indigenous medicine (Sri Lanka). 2015. Annual Health Bulletin 2014.

UNAIDS, 2008. Report on the Global HIV/AIDS Epidemic 2008: Executive Summary. Geneva: Joint United
Nations Programme on HIV/AIDS(UNAIDS)

World Health Organization (WHO) Multicentre Growth Reference Study Group.2006.WHO Child Growth
Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass in-
dex-for-age: Methods and development. Geneva: World Health Organization.

World Health Organization. 2008. Regional Office for Southeast Asia. Sri lanka and Family Planning: An
Overview. http://www.searo.who.int/LinkFiles/Family Planning Fact Sheets Sri Lanka

World Health Organization. Health topics: Suicide. http://www.who.int/topics/suicide/en/

240 Demographic and Health Survey - 2016, Sri Lanka

 Appendix A
Sample Implementation Appendix A
Sample Implementation

Table A.1: Primary Sampling Unit (PSU) Allocation by District and Sector ,Sri Lanka 2016

Sector
District Total
Urban Rural Estate

Colombo 230 177 51 2

Gampaha 235 39 196 0

Kalutara 124 9 109 6

Kandy 150 20 105 25

Matale 65 7 49 9

Nuwara Eliya 100 5 35 60

Galle 115 20 92 3

Matara 92 12 77 3

Hambantota 75 6 69 0

Jaffna 70 14 56 0

Mannar 60 13 47 0

Vaunia 60 12 48 0

Mullativu 50 0 50 0

Kilinochchi 50 0 50 0

Batticaloa 70 20 50 0

Ampara 85 21 64 0

Trincomalee 60 13 47 0

Kurunegala 179 4 173 2

Puttalam 90 10 80 0

Anuradhapura 90 7 83 0

Polonnaruwa 55 0 55 0

Badulla 105 8 70 27

Monaragala 65 0 63 2

Ratnapura 125 11 100 14

Kegalle 100 5 85 10

Total 2500 433 1904 163

Note: From each selected PSUs 12 housing units were selected as secondary sampling units (SSUs) except from the
PSUs in Colombo, Gampaha and Kalutara districts from where 10 SSUs were selected.

Appendix A 241
251
 Table A.3 Sample Implementation

242
Percent distribution of household and eligible women by results of the household and individual interviews, and household, eligible women and overall response rates, according to urban – rural residence and district, Sri Lanka 2006-07
Result Residence Districts
Selected households Urban Rural Estate Colo Gamp Kaluta Kandy Matal Nuwa Galle Matar Hamb Jaffna Mann Vavun Mullai Kilino Battic Ampa Trinco Kurun Puttal Anura Polon Badull Mone Ratna Kegall Total
mbo aha ra e ra a antot ar iya tivu chchi aloa ra malee egala am dhapu naruw a ragala pura e
Eliya a ra a
C 93.0 95.5 90.0 93.4 95.2 96.2 94.0 92.0 88.9 96.4 96.3 94.8 94.9 92.8 93.9 93.3 96.2 94.7 96.3 91.9 96.5 93.9 95.0 96.4 93.5 99.3 95.9 95.8 94.7
NHM 0.8 0.3 0.6 1.3 - 0.3 0.1 0.4 1.0 0.2 - - - 0.1 2.3 0.2 - 0.4 0.4 0.7 0.2 0.3 - 0.3 0.6 0.3 0.1 0.4 0.4
EHA 0.7 0.8 1.5 0.7 1.0 0.4 0.2 1.0 2.1 0.6 0.3 1.0 0.4 0.3 0.9 - 0.5 2.4 0.4 2.8 0.9 0.1 1.6 0.5 1.2 - 1.0 0.8 0.8
P 0.1 0.1 0.2 0.1 - - 0.2 - 0.1 - - - - - - - 0.2 - 0.1 - 0.2 0.4 - 0.2 0.2 - - - 0.1
R 0.5 0.2 0.3 1.0 0.3 0.1 0.4 - 0.3 0.4 0.1 - - - 0.3 0.2 0.2 0.5 0.2 0.4 0.3 0.1 - 0.2 0.7 - - 0.3 0.3
DV 4.2 2.6 6.9 2.9 3.0 2.6 4.5 5.7 6.9 1.9 3.3 3.8 4.0 6.5 1.4 6.0 2.2 1.4 2.4 3.7 1.2 5 3.0 2.1 3.0 0.3 2.7 2.5 3.2
DD 0.3 0.3 0.1 0.3 0.3 0.3 0.3 0.4 0.4 0.2 - 0.2 0.6 0.3 0.3 0.2 0.8 0.5 0.2 0.3 0.3 0.2 0.2 0.3 0.5 0.1 0.3 0.1 0.3
DNF - 0.1 0.3 0.1 0.1 - 0.2 - 0.1 0.1 - 0.1 - - 0.9 0.2 - 0.2 0.1 - 0.2 - 0.3 - 0.2 - 0.1 - 0.1
O 0.2 0.1 0.2 0.3 0.1 0.1 0.1 0.5 0.2 0.3 - 0.1 0.1 - 0.1 - - - - 0.1 0.2 0.1 - 0.2 0.1 - - 0.1 0.1
Total 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
Number of sampled 4,743 22,072 1,905 2,306 2,336 1,245 1,801 778 1,210 1,373 1,105 898 842 694 703 586 601 842 1,021 708 2,164 1,061 1,077 662 1,255 755 1,497 1,200 28,720
households
Household response rate 97.8 98.6 97.2 96.8 98.7 99.2 99.1 98.5 96.2 98.8 99.6 99.0 99.6 99.6 96.4 99.6 99.1 96.6 98.9 95.9 98.4 99.1 98.3 98.8 97.2 99.7 98.9 98.5 98.3
(HRR)
Eligible women
EWC 98.2 99.2 95.9 97.3 99.4 99.4 98.8 99.0 92.4 99.0 99.6 99.1 99.6 99.8 99.8 98.7 99.2 99.2 99.8 97.9 99.4 99.0 100 99.3 98.7 99.5 99.4 99.4 98.9
EWNH 0.4 0.1 1.0 0.9 - 0.1 - - 1.2 0.1 0.1 0.2 - - - - - - 0.1 0.2 - - - 0.2 0.4 0.2 0.2 0.1 0.2
EWP 0.1 0.1 1.1 0.2 - - - 0.2 2.9 0.1 - 0.2 - - - 0.3 - - - - - 0.1 - - 0.1 0.2 - - 0.2
EWR 0.7 0.3 1.5 0.8 0.5 0.1 0.8 0.2 2.2 0.7 - - 0.2 - - 1.0 0.8 0.8 - 1.1 0.3 - - 0.2 0.4 - - - 0.4
EWPC - - - - - - - - 0.1 - - - - - - - - - - 0.2 - 0.1 - - - 0.2 0.2 - -
EWI 0.2 0.1 0.2 0.4 0.1 0.2 - - - - - - - - - - - - - 0.6 0.1 0.6 - 0.2 0.1 - 0.2 0.1 0.1
EWO 0.4 0.2 0.4 0.4 - 0.1 0.4 0.6 1.2 0.1 0.3 0.5 0.2 0.2 0.2 - - - 0.1 - 0.2 0.1 - - 0.3 - - 0.3 0.2

Demographic and Health Survey - 2016, Sri Lanka

Total 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
Number of women 2,963 14,454 1,093 1,370 1,485 820 1,106 489 685 866 701 568 522 417 452 383 387 606 801 470 1,391 668 816 450 777 546 1,017 717 18,510
Eligible women response 98.2 99.2 95.8 97.3 99.4 99.5 98.8 99.0 92.4 99.0 99.6 99.1 99.6 99.8 99.8 98.7 99.2 99.2 99.8 97.9 99.4 99.1 100 99.4 98.7 99.4 99.4 99.5 98.9
rate (EWRR)
Overall response 96.0 97.8 93.1 94.2 98.1 98.7 97.9 97.5 88.9 97.8 99.2 98.1 99.2 99.4 96.2 98.3 98.3 95.9 98.7 93.9 97.8 98.2 98.3 98.2 95.9 99.1 98.3 98.0 97.3
rate(ORR)
1
Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as:
100*C.
C+NHM+EHA+P+R
2
Using the number of eligible women falling into specific response categories, the eligible woman response rate (EWRR) is calculated as:
100*EWC.
EWC+EWNH+EWP+EWR+EWPC+EWI+EWO
3
The overall response rate (ORR) is calculated as: ORR = HRR * EWRR/100

Selected Households Eligible women

C - Completed EWC - Completed
NHM - No household member or no eligible respondent EWNH - Not at home
EHA - Entire household absent for extended period of time EWP - Postponed
P - Postponed EWR - Refused
R - Refused EWPC - Partly completed
DV - Dwelling vacant/address not a dwelling EWI - Incapacitated
DD - Dwelling destroyed EWO - Other
DNF - Dwelling not found
O - Other

252
 ESTIMATES OF SAMPLING ERRORS Appendix B

The estimates from a sample survey are affected by two types of errors: non-sampling errors and
sampling errors. Non-sampling errors are the results of mistakes made in implementing data collection and
data processing, such as failure to locate and interview the correct household, misunderstanding of the ques-
tions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts
were made during the implementation of the 2016 Sri Lanka Demographic and Health Survey (LKDHS) to
minimize this type of error, non-sampling errors are impossible to avoid and difficult to evaluate statistically.
Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents select-
ed in the 2016 LKDHS is only one of many samples that could have been selected from the same population,
using the same design and expected size. Each of these samples would yield results that differ somewhat
from the results of the actual sample selected. Sampling errors are a measure of the variability between all
possible samples. Although the degree of variability is not known exactly, it can be estimated from the sur-
vey results.
A sampling error is usually measured in terms of the standard error for a particular statistic (mean,
percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confi-
dence intervals within which the true value for the population can reasonably be assumed to fall. For exam-
ple, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range
of plus or minus two times the standard error of that statistic in 95 percent of all possible samples of identical
size and design.
If the sample of respondents had been selected as a simple random sample, it would have been
possible to use straightforward formulas for calculating sampling errors. However, the 2016 LKDHS sam-
ple is the result of a multi-stage stratified design, and, consequently, it was necessary to use more complex
formulae. The computer software used to calculate sampling errors for the 2016 LKDHS is a SAS based
procedure. This procedure uses the Taylor linearization method of variance estimation for survey estimates
that are means or proportions. The Jackknife repeated replication method is used for variance estimation of
more complex statistics such as fertility and mortality rates.
The Taylor linearization method treats any percentage or average as a ratio estimate, r = y/x, where
y represents the total sample value for variable y, and x represents the total number of cases in the group or
subgroup under consideration. The variance of r is computed using the formula given below, with the stand-
ard error being the square root of the variance:

1 f H mh  mh 2 zh2 
SE ( r )  var( r )  2
2
   zhi  
x h 1  mh  1  i 1 mh 

in which

z hi  y hi  rx hi , and z h  y h  rx h

where h represents the stratum which varies from 1 to H,

mh is the total number of clusters selected in the hth stratum,

yhi is the sum of the weighted values of variable y in the ith cluster in the hth stratum,

xhi is the sum of the weighted number of cases in the ith cluster in the hth stratum, and

f is the overall sampling fraction, which is so small that it is ignored.

The Jackknife repeated replication method derives estimates of complex rates from each of several
replications of the parent sample, and calculates standard errors for these estimates using simple formulae.
Each replication considers all but one cluster in the calculation of the estimates. Pseudo-independent
replications are thus created. In the 2016 LKDHS, there were 2106 non-empty clusters. Appendix B 2106
Hence, 243
replications were created. The variance of a rate r is calculated as follows:

k
1
SE 2 ( r )  var ( r )   (r  r )
i
2
 yhi is the sum of the weighted values of variable y in the ith cluster in the hth stratum,

xhi is the sum of the weighted number of cases in the ith cluster in the hth stratum, and

f is the overall sampling fraction, which is so small that it is ignored.

The Jackknife repeated replication method derives estimates of complex rates from each of several
replications of the parent
The Jackknife sample,
repeated and calculates
replication standard
method derives errors for
estimates these estimates
of complex using
rates from simple
each formulae.
of several
Each replication considers all but one cluster in the calculation of the estimates. Pseudo-independent
replications of the parent sample, and calculates standard errors for these estimates using simple formulae. repli-
cations are thus created. In the 2016 LKDHS, there were 2106 non-empty clusters. Hence,
Each replication considers all but one cluster in the calculation of the estimates. Pseudo-independent 2106 replications
were created.
replications Thecreated.
are thus variance In
of athe
rate2016
r is calculated as follows:
LKDHS, there were 2106 non-empty clusters. Hence, 2106
replications were created. The variance of a rate r is calculated as follows:

k
1
2
SE ( r )  var ( r )  
k ( k  1) i  1
(ri  r ) 2

in which

ri  kr  ( k  1) r(i )

where r is the estimate computed from the full sample of 2487 clusters,

r(i) is the estimate computed from the reduced sample of 2486 clusters (ith cluster excluded),
and

k is the total number of clusters.

In addition to the standard error, the procedure computes the design effect (DEFT) for each
In addition
estimate, which to the
is defined asstandard
the ratioerror, the procedure
between computes
the standard the design
error using effectsample
the given (DEFT)design
for each
andestimate,
the
standard error that would result if a simple random sample had been used. A DEFT value of 1.0 indicateserror
which is defined as the ratio between the standard error using the given sample design and the standard
that would result if a simple random sample had been used. A DEFT value of 1.0 indicates that the sample
that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates
design is as efficient as a simple random sample, while a value greater than 1.0 indicates the increase in the
the increase in the sampling error due to the use of a more complex and less statistically efficient design.
sampling error due to the use of a more complex and less statistically efficient design. The procedure also
The procedure also computes the relative error and confidence limits for the estimates.
computes the relative error and confidence limits for the estimates.
Sampling
Samplingerrors forfor
errors thethe2016
2016LKDHS
LKDHS are are calculated for forselected
selectedvariablesconsidered
variablesconsideredto tobe be of
of prima-
primary interest for the women’s survey and for the men’s surveys, respectively. The results are presented this
ry interest for the women’s survey and for the men’s surveys, respectively. The results are presented in
appendix
in this for for
appendix the the
country as aaswhole,
country forfor
a whole, urban, rural
urban, andand
rural estate areas,
estate andand
areas, forfor
each of of
each thethe
2525districts of the
districts
country.
of the For For
country. eacheach
variable, the type
variable, of statistic
the type (mean,
of statistic proportion,
(mean, or rate)
proportion, and the
or rate) andbase
the population are given
base population
are in Table
given in B.1.
TableTables B.2 to B.30
B.1. Tables B.2 topresent the value
B.30 present theof the statistic
value (R), its(R),
of the statistic standard error (SE),
its standard errorthe number
(SE), the of
number of unweighted (N-UNWE) and weighted (N-WEIG) cases, the design effect (DEFT), the relativeerror
unweighted (N-UNWE) and weighted (N-WEIG) cases, the design effect (DEFT), the relative standard
(SE/R),
standard and(SE/R),
error the 95 percent
and theconfidence
95 percent limits (R±2SE),
confidence for each
limits variable.
(R±2SE), for The
eachDEFT is considered
variable. The DEFT undefined
is
when the standard error considering simple random sample is zero (when the estimate is close to 0 or 1). In
the case of the total fertility rate, the number of unweighted cases is not relevant, as there is no known un-
weighted value for woman-years of exposure to child-bearing. 232
The confidence interval (e.g., as calculated for children ever born) can be interpreted as follows:
the overall average from the national sample is 1.384 and its standard error is 0.027. Therefore, to obtain
the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e.,
1.384±2×0.027. There is a high probability (95 percent) that the true average number of children ever born
to all women is between 1.330 and 1.439.
For the total sample, the value of the DEFT, averaged over all variables, is 1.107.This means that,
due to multi-stage clustering of the sample, the average standard error is increased by a factor of1.107 over
that in an equivalent simple random sample.

244 Demographic and Health Survey - 2016, Sri Lanka

 i.e., 1.384±2×0.027. There is a high probability (95 percent) that the true average number of children ever
born to all women is between 1.330 and 1.439.

For the total sample, the value of the DEFT, averaged over all variables, is 1.107.This means that,
due to multi-stage clustering of the sample, the average standard error is increased by a factor of1.107 over
that in an equivalent simple random sample.

Table B.1 List of selected variables for sampling errors, Sri Lanka, 2016

VARIABLE ESTIMATE BASE POPULATION

Urban Proportion Ever-married women

No education Proportion Ever-married women
Secondary or higher Proportion Ever-married women
Currently married Proportion All women
Married before age 20 Proportion All women age 20-49
Currently pregnant Proportion All women
Children ever born Mean All women
Children surviving Mean All women
Children ever born to women age Mean All women age 40-49
40-49 Proportion Currently married women
Knows any contraceptive method Proportion Currently married women
Knows a modern method Proportion Currently married women
Currently using any contraceptive method Proportion Currently married women
Currently using modern method Proportion Currently married women
Currently use a traditional method Proportion Currently married women
Currently using pill Proportion Currently married women
Currently using IUD Proportion Currently married women
Currently using injectables Proportion Currently married women
Currently using condoms Proportion Currently married women
Currently using female sterilization Proportion Currently married women
Currently using rhythm method Proportion Currently married women
Currently using withdrawal Proportion Current users of modern methods
Used public sector source Proportion Currently married women
Want no more children or sterilized Proportion Currently married women
Want to delay birth at least 2 years Mean Ever-married women
Ideal family size Proportion Women with at least one live birth in five years before
Mothers received antenatal care for last birth Proportion survey
Mothers protected against tetanus for last birth Proportion Women with at least one live birth in five years before
Assistance by a skilled provider at delivery Proportion survey
Having diarrhoea in two weeks before survey Proportion Births in a health facility occurring 1-59 months before
Treated with oral rehydration salts (ORS) Proportion interview
Taken to a health provider Proportion Children age 0-59 months
Vaccination card seen Proportion Children with diarrhoea in two weeks before interview
Received BCG Proportion Children with diarrhoea in two weeks before interview
Received DPT-HepB-Hib (3 doses) Proportion Children age 12-23 months
Received Polio (the third dose) Proportion Children age 12-23 months
Received easles contaning vaccination Proportion Children age 12-23 months
Fully vaccinated Proportion Children age 12-23 months
Height-for-age (-2SD) Proportion Children age 12-23 months
Weight-for-height (-2SD) Proportion Children age 12-23 months
Weight-for-age (-2SD) Proportion Children age 0-59 months who were measured
BMI<18.5 Proportion Children age 0-59 months who were measured
Prevalence of anemia (children) Proportion Children age 0-59 months who were measured
Prevalence of anemia (women) Rate Ever-married women who were measured
Total fertility rate (3 years) Rate All children 6-59 months who were tested
Neonatal mortality (0-4 years)1 Rate Ever-married women who were tested
Post-neonatal mortality (0-4 years) 1 Rate All women 15-49
Infant mortality (0-4 years) 1 Rate Children exposed to the risk of mortality
Child mortality (0-4 years) 1 Rate Children exposed to the risk of mortality
Under-five mortality (0-4 years) 1 Children exposed to the risk of mortality
Children exposed to the risk of mortality
Children exposed to the risk of mortality
1
0-4 years for national only; 0-9 years for background characteristics

233

Appendix B 245
Table B.2 Sampling errors: Total sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.156 0.003 18302 18302 1.198 0.021 0.150 0.162
No education 0.016 0.001 18302 18302 1.124 0.066 0.014 0.018
Secondary education or higher 0.916 0.002 18302 18302 1.189 0.003 0.911 0.921
Currently married 0.673 0.013 25599 25656 1.084 0.019 0.647 0.698
Married before age 20 0.253 0.003 21981 21912 1.194 0.013 0.246 0.259
Currently pregnant 0.033 0.001 25599 25656 1.048 0.039 0.030 0.035
Children ever born 1.384 0.027 25599 25656 1.080 0.020 1.330 1.439
Children surviving 1.357 0.027 25599 25656 1.080 0.020 1.303 1.411
Children ever born to women age
40-49 2.291 0.016 6757 6790 1.118 0.007 2.259 2.323
Knows any contraceptive method 0.997 0.000 17170 17257 1.091 0.000 0.996 0.998
Knows amodern method 0.997 0.000 17170 17257 1.089 0.000 0.996 0.998
Currently using any method 0.646 0.004 17170 17257 1.160 0.007 0.638 0.654
Currently using a modern method 0.536 0.004 17170 17257 1.154 0.008 0.527 0.544
Currently using a traditional
method 0.110 0.003 17170 17257 1.162 0.025 0.105 0.116
Currently using pill 0.086 0.002 17170 17257 1.119 0.028 0.081 0.091
Currently using IUD 0.106 0.003 17170 17257 1.175 0.026 0.100 0.112
Currently using condoms 0.070 0.002 17170 17257 1.127 0.031 0.066 0.075
Currently use injectables 0.086 0.003 17170 17257 1.185 0.029 0.081 0.091
Currently using female sterilization 0.140 0.003 17170 17257 1.108 0.021 0.134 0.146
Currently using withdrawal 0.038 0.002 17170 17257 1.102 0.042 0.035 0.041
Currently using periodic
abstinence 0.073 0.002 17170 17257 1.158 0.032 0.068 0.077
Used public sector source 0.716 0.005 9125 9381 1.125 0.007 0.705 0.726
Want no more children 0.611 0.004 17170 17257 1.112 0.007 0.603 0.620
Want to delay birth at least 2
years 0.122 0.003 17170 17257 1.093 0.022 0.116 0.127
Ideal family size 2.529 0.011 18199 18191 1.293 0.004 2.507 2.551
Mothers received antenatal care
for last birth 0.988 0.001 7187 7138 1.061 0.001 0.985 0.991
Assistance by a skilled provider at
delivery 0.994 0.001 8276 8191 1.092 0.001 0.992 0.996
Having diarrhea in the last 2
weeks 0.027 0.002 8132 8064 1.099 0.075 0.023 0.031
Treated with oral rehydration salts
(ORS) 0.540 0.037 221 217 1.086 0.069 0.466 0.614
Taken to a health provider 0.905 0.019 221 217 0.970 0.021 0.866 0.943
Vaccination card seen 0.928 0.007 1551 1556 1.088 0.008 0.913 0.942
Received BCG 0.992 0.002 1551 1556 1.016 0.002 0.987 0.997
Received DPT-HepB-Hib (3
doses) 0.960 0.005 1551 1556 1.074 0.006 0.949 0.970
Received polio (third dose) 0.971 0.005 1551 1556 1.161 0.005 0.962 0.981
Received measles contaning
vaccination 0.953 0.006 1551 1556 1.051 0.006 0.942 0.965
Fully immunized 0.914 0.008 1551 1556 1.100 0.009 0.898 0.929
Height-for-age (-2SD) 0.173 0.005 7954 7870 1.107 0.028 0.163 0.182
Weight-for-height (-2SD) 0.151 0.005 7885 7817 1.099 0.031 0.142 0.160
Weight-for-age (-2SD) 0.205 0.005 7987 7908 1.104 0.025 0.194 0.215
Prevalence of anemia (children) 0.472 0.007 6795 6729 1.169 0.015 0.457 0.486
Prevalence of anemia (women) 0.493 0.005 17265 17261 1.208 0.009 0.484 0.502
BMI < 18,5 0.091 0.002 16788 16806 1.114 0.027 0.086 0.095
Total fertility rate (last 3 years) 2.153 0.028 73984 73883 1.067 0.013 2.096 2.210
Neonatal mortality (last 0-4 years) 6.841 0.978 8333 8245 1.027 0.143 4.885 8.798
Post-neonatal mortality (last 0-4
years) 3.012 0.610 8355 8256 1.017 0.203 1.792 4.233
Infant mortality (last 0-4 years) 9.854 1.153 8334 8246 1.026 0.117 7.548 12.159
Child mortality (last 0-4 years) 0.969 0.333 8445 8324 1.004 0.344 0.303 1.634
Under-five mortality (last 0-4
years) 10.813 1.195 8338 8249 1.023 0.110 8.424 13.202

234

246 Demographic and Health Survey - 2016, Sri Lanka

Table B.3 Sampling errors: Urban sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 1.000 0.000 2910 2855 na 0.000 1.000 1.000
No education 0.010 0.002 2910 2855 1.160 0.215 0.006 0.014
Secondary education or higher 0.935 0.006 2910 2855 1.324 0.006 0.923 0.947
Currently married 0.709 0.034 3848 3785 1.055 0.048 0.640 0.777
Married before age 20 0.206 0.009 3389 3335 1.304 0.042 0.189 0.223
Currently pregnant 0.032 0.003 3848 3785 1.028 0.101 0.026 0.038
Children ever born 1.444 0.074 3848 3785 1.062 0.051 1.297 1.592
Children surviving 1.414 0.072 3848 3785 1.064 0.051 1.269 1.558
Children ever born to women age 40-49 2.271 0.044 1111 1079 1.215 0.020 2.183 2.360
Knows any contraceptive method 0.997 0.001 2745 2682 1.083 0.001 0.995 0.999
Knows amodern method 0.997 0.001 2745 2682 1.083 0.001 0.995 0.999
Currently using any method 0.568 0.011 2745 2682 1.179 0.020 0.546 0.591
Currently using a modern method 0.455 0.011 2745 2682 1.176 0.025 0.432 0.477
Currently using a traditional method 0.114 0.007 2745 2682 1.167 0.062 0.100 0.128
Currently using pill 0.070 0.005 2745 2682 1.084 0.075 0.059 0.081
Currently using IUD 0.086 0.006 2745 2682 1.192 0.074 0.073 0.099
Currently using condoms 0.096 0.006 2745 2682 1.142 0.067 0.083 0.108
Currently use injectables 0.050 0.005 2745 2682 1.218 0.101 0.040 0.060
Currently using female sterilization 0.112 0.007 2745 2682 1.108 0.060 0.099 0.125
Currently using withdrawal 0.045 0.004 2745 2682 1.061 0.093 0.037 0.054
Currently using periodic abstinence 0.068 0.006 2745 2682 1.209 0.085 0.057 0.080
Used public sector source 0.638 0.016 1220 1239 1.145 0.025 0.606 0.669
Want no more children 0.581 0.011 2745 2682 1.120 0.018 0.559 0.602
Want to delay birth at least 2 years 0.123 0.007 2745 2682 1.193 0.061 0.108 0.138
Ideal family size 2.574 0.028 2877 2818 1.256 0.011 2.519 2.630
Mothers received antenatal care for last birth 0.985 0.004 1145 1114 1.109 0.004 0.977 0.993
Assistance by a skilled provider at delivery 0.995 0.002 1322 1285 1.050 0.002 0.991 0.999
Having diarrhea in the last 2 weeks 0.030 0.005 1313 1278 1.050 0.169 0.020 0.040
Treated with oral rehydration salts (ORS) 0.473 0.084 41 38 1.027 0.177 0.305 0.641
Taken to a health provider 0.869 0.055 41 38 1.017 0.064 0.758 0.979
Vaccination card seen 0.925 0.019 233 228 1.097 0.021 0.887 0.963
Received BCG 0.987 0.008 233 228 1.053 0.008 0.971 1.003
Received DPT-HepB-Hib (3 doses) 0.919 0.021 233 228 1.180 0.023 0.876 0.961
Received polio (third dose) 0.957 0.015 233 228 1.120 0.016 0.927 0.987
Received measles contaning vaccination 0.937 0.016 233 228 1.021 0.017 0.904 0.970
Fully immunized 0.877 0.024 233 228 1.110 0.027 0.829 0.925
Height-for-age (-2SD) 0.147 0.012 1252 1214 1.119 0.079 0.124 0.171
Weight-for-height (-2SD) 0.129 0.010 1238 1205 1.045 0.079 0.109 0.150
Weight-for-age (-2SD) 0.164 0.012 1257 1220 1.093 0.072 0.141 0.188
Prevalence of anemia (children) 0.469 0.019 1031 1014 1.199 0.040 0.431 0.506
Prevalence of anemia (women) 0.472 0.011 2671 2639 1.172 0.024 0.449 0.494
BMI < 18,5 0.056 0.005 2669 2629 1.016 0.081 0.047 0.065
Total fertility rate (last 3 years) 2.190 0.079 11085 10910 1.096 0.036 2.033 2.348
Neonatal mortality (last 0-9 years) 7.014 1.652 2673 2587 0.990 0.236 3.710 10.319
Post-neonatal mortality (last 0-9 years) 2.657 1.030 2683 2596 1.065 0.388 0.597 4.716
Infant mortality (last 0-9 years) 9.671 1.911 2673 2587 0.995 0.198 5.849 13.494
Child mortality (last 0-9 years) 1.541 0.839 2699 2621 1.089 0.545 0.000 3.220
Under-five mortality (last 0-9 years) 11.197 2.067 2675 2589 1.003 0.185 7.064 15.331

235 Appendix B 247

Table B.4 Sampling errors: Rural sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.000 0.000 14344 14737 na na 0.000 0.000
No education 0.013 0.001 14344 14737 1.146 0.082 0.011 0.016
Secondary education or higher 0.924 0.003 14344 14737 1.198 0.003 0.919 0.929
Currently married 0.698 0.008 19428 19936 1.074 0.011 0.682 0.714
Married before age 20 0.265 0.004 16985 17397 1.176 0.014 0.257 0.272
Currently pregnant 0.034 0.001 19428 19936 1.053 0.040 0.031 0.037
Children ever born 1.428 0.019 19428 19936 1.044 0.013 1.391 1.466
Children surviving 1.401 0.018 19428 19936 1.045 0.013 1.364 1.438
Children ever born to women age 40-49 2.306 0.018 5261 5427 1.092 0.008 2.271 2.342
Knows any contraceptive method 0.998 0.000 13445 13906 1.144 0.000 0.997 0.999
Knows amodern method 0.998 0.000 13445 13906 1.137 0.000 0.997 0.999
Currently using any method 0.664 0.005 13445 13906 1.159 0.007 0.654 0.673
Currently using a modern method 0.551 0.005 13445 13906 1.153 0.009 0.541 0.560
Currently using a traditional method 0.113 0.003 13445 13906 1.153 0.028 0.107 0.119
Currently using pill 0.090 0.003 13445 13906 1.114 0.030 0.085 0.096
Currently using IUD 0.112 0.003 13445 13906 1.162 0.028 0.106 0.119
Currently using condoms 0.067 0.002 13445 13906 1.113 0.036 0.062 0.072
Currently use injectables 0.094 0.003 13445 13906 1.170 0.031 0.088 0.100
Currently using female sterilization 0.139 0.003 13445 13906 1.104 0.024 0.132 0.145
Currently using withdrawal 0.037 0.002 13445 13906 1.098 0.048 0.033 0.040
Currently using periodic abstinence 0.076 0.003 13445 13906 1.138 0.034 0.071 0.082
Used public sector source 0.720 0.006 7348 7769 1.119 0.008 0.708 0.732
Want no more children 0.615 0.005 13445 13906 1.106 0.008 0.606 0.624
Want to delay birth at least 2 years 0.122 0.003 13445 13906 1.066 0.025 0.116 0.128
Ideal family size 2.523 0.012 14276 14665 1.293 0.005 2.499 2.548
Mothers received antenatal care for last birth 0.989 0.001 5596 5728 1.058 0.001 0.987 0.992
Assistance by a skilled provider at delivery 0.994 0.001 6408 6545 1.102 0.001 0.992 0.996
Having diarrhea in the last 2 weeks 0.026 0.002 6287 6433 1.107 0.087 0.022 0.031
Treated with oral rehydration salts (ORS) 0.553 0.042 165 169 1.091 0.077 0.468 0.638
Taken to a health provider 0.920 0.020 165 169 0.953 0.022 0.880 0.960
Vaccination card seen 0.930 0.008 1203 1253 1.088 0.009 0.914 0.946
Received BCG 0.993 0.002 1203 1253 1.017 0.002 0.989 0.998
Received DPT-HepB-Hib (3 doses) 0.969 0.005 1203 1253 1.031 0.005 0.958 0.979
Received polio (third dose) 0.975 0.005 1203 1253 1.187 0.005 0.964 0.985
Received measles contaning vaccination 0.957 0.006 1203 1253 1.056 0.006 0.944 0.969
Fully immunized 0.921 0.008 1203 1253 1.100 0.009 0.904 0.938
Height-for-age (-2SD) 0.170 0.006 6178 6325 1.110 0.032 0.159 0.181
Weight-for-height (-2SD) 0.156 0.005 6134 6286 1.100 0.034 0.145 0.166
Weight-for-age (-2SD) 0.208 0.006 6204 6355 1.107 0.028 0.196 0.219
Prevalence of anemia (children) 0.474 0.008 5306 5426 1.160 0.017 0.458 0.490
Prevalence of anemia (women) 0.498 0.005 13647 13993 1.207 0.010 0.487 0.508
BMI < 18,5 0.091 0.003 13196 13558 1.130 0.031 0.086 0.097
Total fertility rate (last 3 years) 2.175 0.032 57381 58841 1.066 0.015 2.111 2.239
Neonatal mortality (last 0-9 years) 7.351 0.809 13294 13456 1.008 0.110 5.732 8.969
Post-neonatal mortality (last 0-9 years) 3.136 0.552 13294 13449 1.056 0.176 2.032 4.240
Infant mortality (last 0-9 years) 10.487 0.975 13294 13456 1.011 0.093 8.536 12.438
Child mortality (last 0-9 years) 1.390 0.322 13423 13590 0.991 0.231 0.747 2.033
Under-five mortality (last 0-9 years) 11.862 1.015 13302 13462 1.002 0.086 9.832 13.892

248 Demographic and Health Survey - 2016, Sri Lanka 236

Table B.5 Sampling errors: Estate sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.000 0.000 1048 710 na na 0.000 0.000
No education 0.084 0.011 1048 710 1.225 0.125 0.063 0.105
Secondary education or higher 0.663 0.018 1048 710 1.213 0.027 0.627 0.698
Currently married 0.512 0.041 1860 1306 1.266 0.080 0.431 0.594
Married before age 20 0.234 0.015 1570 1040 1.349 0.063 0.205 0.264
Currently pregnant 0.031 0.004 1860 1306 1.023 0.134 0.023 0.039
Children ever born 1.208 0.103 1860 1306 1.233 0.085 1.003 1.414
Children surviving 1.175 0.099 1860 1306 1.224 0.084 0.977 1.373
Children ever born to women age 40-49 2.488 0.077 344 238 1.206 0.031 2.335 2.641
Knows any contraceptive method 0.968 0.007 980 669 1.208 0.007 0.954 0.982
Knows amodern method 0.968 0.007 980 669 1.208 0.007 0.954 0.982
Currently using any method 0.589 0.016 980 669 1.048 0.028 0.556 0.622
Currently using a modern method 0.548 0.018 980 669 1.104 0.032 0.512 0.583
Currently using a traditional method 0.042 0.006 980 669 0.998 0.153 0.029 0.055
Currently using pill 0.056 0.009 980 669 1.257 0.166 0.037 0.074
Currently using IUD 0.053 0.009 980 669 1.204 0.162 0.036 0.071
Currently using condoms 0.029 0.008 980 669 1.462 0.271 0.013 0.045
Currently use injectables 0.070 0.011 980 669 1.336 0.155 0.048 0.092
Currently using female sterilization 0.274 0.017 980 669 1.191 0.062 0.240 0.308
Currently using withdrawal 0.024 0.005 980 669 1.125 0.230 0.013 0.035
Currently using periodic abstinence 0.018 0.004 980 669 0.953 0.225 0.010 0.026
Used public sector source 0.885 0.013 557 373 0.998 0.015 0.858 0.912
Want no more children 0.657 0.017 980 669 1.151 0.027 0.622 0.692
Want to delay birth at least 2 years 0.103 0.011 980 669 1.120 0.105 0.082 0.125
Ideal family size 2.461 0.041 1046 709 1.304 0.017 2.379 2.544
Mothers received antenatal care for last birth 0.976 0.008 446 296 1.029 0.008 0.960 0.991
Assistance by a skilled provider at delivery 0.987 0.006 546 361 1.140 0.006 0.975 0.999
Having diarrhea in the last 2 weeks 0.028 0.008 532 354 1.073 0.276 0.013 0.044
Treated with oral rehydration salts (ORS) 0.568 0.153 15 10 1.187 0.269 0.263 0.874
Taken to a health provider 0.788 0.110 15 10 1.041 0.140 0.567 1.009
Vaccination card seen 0.900 0.031 115 75 1.086 0.034 0.839 0.962
Received BCG 0.983 0.013 115 75 1.031 0.013 0.957 1.008
Received DPT-HepB-Hib (3 doses) 0.936 0.024 115 75 1.020 0.025 0.888 0.983
Received polio (third dose) 0.959 0.019 115 75 1.002 0.020 0.921 0.997
Received measles contaning vaccination 0.947 0.025 115 75 1.069 0.026 0.897 0.997
Fully immunized 0.895 0.031 115 75 1.028 0.035 0.832 0.958
Height-for-age (-2SD) 0.317 0.022 524 332 1.003 0.068 0.274 0.360
Weight-for-height (-2SD) 0.134 0.019 513 326 1.112 0.143 0.096 0.173
Weight-for-age (-2SD) 0.297 0.023 526 334 1.062 0.078 0.251 0.343
Prevalence of anemia (children) 0.444 0.028 458 288 1.129 0.063 0.387 0.500
Prevalence of anemia (women) 0.477 0.020 947 629 1.223 0.042 0.437 0.518
BMI < 18,5 0.220 0.015 923 620 1.076 0.067 0.191 0.250
Total fertility rate (last 3 years) 1.857 0.104 5479 3802 1.212 0.056 1.648 2.066
Neonatal mortality (last 0-9 years) 7.886 2.994 1103 755 1.025 0.380 1.898 13.874
Post-neonatal mortality (last 0-9 years) 5.424 2.076 1100 751 0.918 0.383 1.272 9.576
Infant mortality (last 0-9 years) 13.310 3.797 1103 755 0.968 0.285 5.716 20.904
Child mortality (last 0-9 years) 1.643 1.307 1091 754 1.053 0.795 0.000 4.257
Under-five mortality (last 0-9 years) 14.931 3.983 1103 755 0.972 0.267 6.965 22.898

237 Appendix B 249

Table B.6 Sampling errors: Colombo sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.734 0.011 1333 1731 0.935 0.015 0.712 0.757
No education 0.011 0.003 1333 1731 1.051 0.268 0.005 0.017
Secondary education or higher 0.944 0.008 1333 1731 1.302 0.009 0.928 0.960
Currently married 0.367 0.083 3329 4426 1.044 0.226 0.201 0.533
Married before age 20 0.173 0.010 1658 2154 1.178 0.060 0.152 0.193
Currently pregnant 0.015 0.004 3329 4426 1.031 0.262 0.007 0.023
Children ever born 0.688 0.159 3329 4426 1.058 0.231 0.370 1.006
Children surviving 0.677 0.156 3329 4426 1.057 0.231 0.365 0.990
Children ever born to women age 40-49 2.042 0.057 506 650 1.183 0.028 1.928 2.155
Knows any contraceptive method 0.997 0.002 1254 1625 1.068 0.002 0.994 1.000
Knows amodern method 0.997 0.002 1254 1625 1.068 0.002 0.994 1.000
Currently using any method 0.605 0.016 1254 1625 1.124 0.026 0.574 0.636
Currently using a modern method 0.474 0.015 1254 1625 1.069 0.032 0.443 0.504
Currently using a traditional method 0.132 0.011 1254 1625 1.139 0.083 0.110 0.154
Currently using pill 0.065 0.007 1254 1625 0.944 0.101 0.052 0.078
Currently using IUD 0.121 0.010 1254 1625 1.115 0.085 0.100 0.142
Currently using condoms 0.102 0.009 1254 1625 1.056 0.089 0.083 0.120
Currently use injectables 0.039 0.007 1254 1625 1.200 0.169 0.026 0.052
Currently using female sterilization 0.099 0.009 1254 1625 1.086 0.092 0.081 0.118
Currently using withdrawal 0.050 0.006 1254 1625 0.993 0.122 0.038 0.062
Currently using periodic abstinence 0.082 0.009 1254 1625 1.119 0.106 0.064 0.099
Used public sector source 0.635 0.021 604 784 1.086 0.034 0.593 0.678
Want no more children 0.600 0.014 1254 1625 1.027 0.024 0.571 0.628
Want to delay birth at least 2 years 0.116 0.011 1254 1625 1.171 0.092 0.095 0.137
Ideal family size 2.461 0.035 1310 1700 1.058 0.014 2.391 2.531
Mothers received antenatal care for last birth 0.994 0.004 477 631 1.010 0.004 0.986 1.001
Assistance by a skilled provider at delivery 0.997 0.002 539 712 0.931 0.002 0.993 1.001
Having diarrhea in the last 2 weeks 0.034 0.009 538 711 1.149 0.277 0.015 0.052
Treated with oral rehydration salts (ORS) 0.634 0.099 20 24 0.927 0.156 0.437 0.831
Taken to a health provider 0.850 0.073 20 24 0.869 0.086 0.704 0.997
Vaccination card seen 0.890 0.034 106 145 1.147 0.038 0.822 0.958
Received BCG 0.990 0.010 106 145 1.052 0.010 0.970 1.010
Received DPT-HepB-Hib (3 doses) 0.916 0.029 106 145 1.118 0.032 0.858 0.975
Received polio (third dose) 0.908 0.030 106 145 1.107 0.033 0.847 0.969
Received measles contaning vaccination 0.916 0.026 106 145 0.977 0.028 0.864 0.967
Fully immunized 0.832 0.039 106 145 1.091 0.046 0.755 0.910
Height-for-age (-2SD) 0.156 0.021 513 669 1.251 0.135 0.113 0.198
Weight-for-height (-2SD) 0.119 0.013 511 667 0.925 0.107 0.093 0.145
Weight-for-age (-2SD) 0.146 0.017 517 674 1.091 0.120 0.111 0.180
Prevalence of anemia (children) 0.520 0.026 437 573 1.113 0.051 0.467 0.573
Prevalence of anemia (women) 0.460 0.016 1249 1630 1.134 0.035 0.428 0.492
BMI < 18,5 0.046 0.006 1232 1604 0.980 0.127 0.034 0.058
Total fertility rate (last 3 years) 1.770 0.097 9905 13158 1.050 0.055 1.577 1.964
Neonatal mortality (last 0-9 years) 4.894 2.039 1114 1457 1.005 0.417 0.816 8.972
Post-neonatal mortality (last 0-9 years) 4.005 1.879 1110 1452 1.017 0.469 0.247 7.763
Infant mortality (last 0-9 years) 8.899 2.739 1114 1457 1.003 0.308 3.421 14.377
Child mortality (last 0-9 years) 0.258 0.258 1118 1468 0.538 1.001 0.000 0.774
Under-five mortality (last 0-9 years) 9.154 2.750 1115 1457 0.993 0.300 3.654 14.655

250 Demographic and Health Survey - 2016, Sri Lanka238

Table B.7 Sampling errors: Gampaha sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.142 0.010 1476 1845 1.135 0.073 0.121 0.163
No education 0.006 0.002 1476 1845 1.011 0.350 0.002 0.010
Secondary education or higher 0.965 0.005 1476 1845 1.006 0.005 0.956 0.975
Currently married 0.727 0.031 1937 2414 1.084 0.043 0.665 0.789
Married before age 20 0.190 0.010 1788 2232 1.134 0.053 0.170 0.210
Currently pregnant 0.038 0.004 1937 2414 1.026 0.119 0.029 0.047
Children ever born 1.360 0.062 1937 2414 1.059 0.046 1.236 1.485
Children surviving 1.337 0.061 1937 2414 1.061 0.046 1.214 1.459
Children ever born to women age 40-49 1.992 0.041 586 731 1.026 0.021 1.909 2.074
Knows any contraceptive method 0.998 0.002 1404 1755 1.386 0.002 0.994 1.001
Knows amodern method 0.998 0.002 1404 1755 1.386 0.002 0.994 1.001
Currently using any method 0.673 0.013 1404 1755 1.063 0.020 0.647 0.700
Currently using a modern method 0.520 0.015 1404 1755 1.106 0.028 0.491 0.550
Currently using a traditional method 0.153 0.010 1404 1755 1.031 0.065 0.134 0.173
Currently using pill 0.085 0.008 1404 1755 1.096 0.096 0.069 0.102
Currently using IUD 0.097 0.008 1404 1755 1.026 0.084 0.081 0.113
Currently using condoms 0.108 0.008 1404 1755 0.970 0.074 0.092 0.125
Currently use injectables 0.053 0.007 1404 1755 1.124 0.127 0.039 0.066
Currently using female sterilization 0.131 0.010 1404 1755 1.109 0.076 0.111 0.151
Currently using withdrawal 0.045 0.005 1404 1755 0.986 0.122 0.034 0.055
Currently using periodic abstinence 0.109 0.009 1404 1755 1.121 0.086 0.090 0.127
Used public sector source 0.628 0.019 729 928 1.055 0.030 0.590 0.666
Want no more children 0.647 0.013 1404 1755 0.998 0.020 0.622 0.673
Want to delay birth at least 2 years 0.085 0.008 1404 1755 1.113 0.098 0.068 0.101
Ideal family size 2.367 0.037 1460 1826 1.219 0.015 2.293 2.440
Mothers received antenatal care for last birth 0.980 0.006 534 666 0.966 0.006 0.968 0.992
Assistance by a skilled provider at delivery 0.998 0.002 607 758 0.994 0.002 0.995 1.002
Having diarrhea in the last 2 weeks 0.030 0.007 604 755 1.016 0.245 0.015 0.045
Treated with oral rehydration salts (ORS) 0.595 0.114 20 23 0.964 0.192 0.366 0.824
Taken to a health provider 1.000 0.000 20 23 na 0.000 1.000 1.000
Vaccination card seen 0.963 0.018 117 145 1.048 0.019 0.926 1.000
Received BCG 0.992 0.008 117 145 0.983 0.008 0.975 1.008
Received DPT-HepB-Hib (3 doses) 0.944 0.022 117 145 1.022 0.023 0.900 0.988
Received polio (third dose) 0.951 0.026 117 145 1.312 0.028 0.898 1.004
Received measles contaning vaccination 0.971 0.016 117 145 1.038 0.017 0.939 1.004
Fully immunized 0.892 0.033 117 145 1.153 0.037 0.825 0.958
Height-for-age (-2SD) 0.128 0.015 599 756 1.019 0.114 0.099 0.157
Weight-for-height (-2SD) 0.159 0.015 595 749 0.952 0.096 0.128 0.189
Weight-for-age (-2SD) 0.196 0.019 600 756 1.101 0.096 0.158 0.233
Prevalence of anemia (children) 0.457 0.025 514 647 1.094 0.054 0.408 0.506
Prevalence of anemia (women) 0.467 0.015 1428 1787 1.171 0.033 0.436 0.498
BMI < 18,5 0.066 0.007 1373 1718 1.097 0.111 0.051 0.081
Total fertility rate (last 3 years) 1.807 0.097 5682 7066 1.059 0.054 1.613 2.002
Neonatal mortality (last 0-9 years) 2.200 1.297 1241 1553 0.976 0.590 0.000 4.794
Post-neonatal mortality (last 0-9 years) 2.829 1.485 1243 1556 0.995 0.525 0.000 5.800
Infant mortality (last 0-9 years) 5.029 1.953 1241 1553 0.982 0.388 1.122 8.935
Child mortality (last 0-9 years) 1.748 1.237 1280 1612 1.047 0.708 0.000 4.223
Under-five mortality (last 0-9 years) 6.768 2.293 1242 1555 0.996 0.339 2.181 11.354

239 Appendix B 251

Table B.8 Sampling errors: Kalutara sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.078 0.015 815 1104 1.583 0.191 0.048 0.108
No education 0.011 0.003 815 1104 0.824 0.279 0.005 0.017
Secondary education or higher 0.941 0.010 815 1104 1.153 0.010 0.922 0.960
Currently married 0.553 0.065 1391 1880 0.994 0.117 0.424 0.683
Married before age 20 0.227 0.015 1045 1416 1.246 0.068 0.196 0.257
Currently pregnant 0.018 0.004 1391 1880 1.007 0.231 0.010 0.026
Children ever born 1.109 0.132 1391 1880 0.974 0.119 0.846 1.373
Children surviving 1.087 0.129 1391 1880 0.971 0.118 0.830 1.345
Children ever born to women age 40-49 2.120 0.073 295 398 1.114 0.034 1.975 2.266
Knows any contraceptive method 0.999 0.001 767 1040 1.044 0.001 0.996 1.001
Knows amodern method 0.999 0.001 767 1040 1.044 0.001 0.996 1.001
Currently using any method 0.738 0.016 767 1040 1.022 0.022 0.706 0.771
Currently using a modern method 0.554 0.019 767 1040 1.032 0.033 0.517 0.591
Currently using a traditional method 0.184 0.015 767 1040 1.059 0.080 0.155 0.214
Currently using pill 0.088 0.010 767 1040 0.974 0.113 0.068 0.108
Currently using IUD 0.125 0.014 767 1040 1.138 0.109 0.098 0.152
Currently using condoms 0.094 0.011 767 1040 1.045 0.117 0.072 0.116
Currently use injectables 0.077 0.011 767 1040 1.166 0.146 0.054 0.099
Currently using female sterilization 0.135 0.013 767 1040 1.043 0.095 0.109 0.161
Currently using withdrawal 0.059 0.008 767 1040 0.947 0.137 0.043 0.075
Currently using periodic abstinence 0.125 0.012 767 1040 1.021 0.097 0.101 0.150
Used public sector source 0.699 0.023 426 586 1.033 0.033 0.653 0.745
Want no more children 0.623 0.017 767 1040 0.973 0.027 0.588 0.657
Want to delay birth at least 2 years 0.107 0.011 767 1040 0.969 0.101 0.086 0.129
Ideal family size 2.515 0.045 812 1102 1.327 0.018 2.425 2.605
Mothers received antenatal care for last birth 0.994 0.004 328 443 0.995 0.004 0.985 1.002
Assistance by a skilled provider at delivery 0.992 0.006 383 520 1.245 0.006 0.981 1.003
Having diarrhea in the last 2 weeks 0.043 0.012 375 508 1.025 0.268 0.020 0.066
Treated with oral rehydration salts (ORS) 0.473 0.145 17 22 1.079 0.307 0.183 0.763
Taken to a health provider 0.936 0.063 17 22 1.031 0.068 0.809 1.062
Vaccination card seen 0.968 0.023 74 101 1.115 0.023 0.923 1.014
Received BCG 1.000 0.000 74 101 na 0.000 1.000 1.000
Received DPT-HepB-Hib (3 doses) 0.987 0.013 74 101 0.984 0.013 0.962 1.013
Received polio (third dose) 1.000 0.000 74 101 na 0.000 1.000 1.000
Received measles contaning vaccination 1.000 0.000 74 101 na 0.000 1.000 1.000
Fully immunized 0.987 0.013 74 101 0.984 0.013 0.962 1.013
Height-for-age (-2SD) 0.125 0.019 364 497 1.097 0.154 0.086 0.163
Weight-for-height (-2SD) 0.166 0.020 362 494 0.951 0.122 0.125 0.207
Weight-for-age (-2SD) 0.201 0.022 363 496 0.985 0.107 0.158 0.244
Prevalence of anemia (children) 0.568 0.034 290 394 1.177 0.060 0.500 0.637
Prevalence of anemia (women) 0.564 0.021 775 1054 1.182 0.037 0.521 0.606
BMI < 18,5 0.090 0.011 767 1043 1.025 0.118 0.069 0.111
Total fertility rate (last 3 years) 2.220 0.123 4119 5560 0.991 0.056 1.974 2.467
Neonatal mortality (last 0-9 years) 8.935 3.658 754 1024 1.060 0.409 1.618 16.251
Post-neonatal mortality (last 0-9 years) 6.584 3.415 758 1028 0.999 0.519 0.000 13.414
Infant mortality (last 0-9 years) 15.519 4.824 754 1024 1.006 0.311 5.871 25.167
Child mortality (last 0-9 years) 0.000 0.000 763 1038 na na 0.000 0.000
Under-five mortality (last 0-9 years) 15.519 4.824 754 1024 1.006 0.311 5.871 25.167

252 Demographic and Health Survey - 2016, Sri Lanka 240

Table B.9 Sampling errors: Kandy sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.099 0.008 1093 1223 0.847 0.077 0.084 0.115
No education 0.017 0.004 1093 1223 1.024 0.236 0.009 0.025
Secondary education or higher 0.925 0.010 1093 1223 1.236 0.011 0.905 0.945
Currently married 0.788 0.016 1369 1491 1.032 0.020 0.756 0.819
Married before age 20 0.189 0.013 1306 1422 1.166 0.067 0.164 0.215
Currently pregnant 0.033 0.005 1369 1491 0.990 0.147 0.023 0.042
Children ever born 1.552 0.045 1369 1491 1.018 0.029 1.461 1.643
Children surviving 1.522 0.044 1369 1491 1.007 0.029 1.434 1.610
Children ever born to women age 40-49 2.075 0.050 410 477 0.926 0.024 1.975 2.176
Knows any contraceptive method 0.996 0.002 1045 1174 0.885 0.002 0.992 0.999
Knows amodern method 0.995 0.002 1045 1174 0.889 0.002 0.991 0.999
Currently using any method 0.618 0.016 1045 1174 1.033 0.025 0.587 0.649
Currently using a modern method 0.523 0.016 1045 1174 1.031 0.030 0.491 0.555
Currently using a traditional method 0.095 0.013 1045 1174 1.381 0.132 0.070 0.120
Currently using pill 0.098 0.011 1045 1174 1.182 0.111 0.076 0.119
Currently using IUD 0.076 0.010 1045 1174 1.165 0.126 0.057 0.095
Currently using condoms 0.087 0.009 1045 1174 1.076 0.108 0.069 0.106
Currently use injectables 0.072 0.009 1045 1174 1.162 0.129 0.054 0.091
Currently using female sterilization 0.140 0.012 1045 1174 1.093 0.084 0.116 0.163
Currently using withdrawal 0.029 0.006 1045 1174 1.112 0.199 0.017 0.040
Currently using periodic abstinence 0.066 0.010 1045 1174 1.272 0.148 0.046 0.086
Used public sector source 0.726 0.024 546 616 1.238 0.033 0.678 0.773
Want no more children 0.612 0.018 1045 1174 1.189 0.029 0.576 0.648
Want to delay birth at least 2 years 0.099 0.010 1045 1174 1.130 0.106 0.078 0.120
Ideal family size 2.624 0.046 1088 1218 1.234 0.017 2.532 2.716
Mothers received antenatal care for last birth 0.975 0.008 446 489 1.055 0.008 0.959 0.991
Assistance by a skilled provider at delivery 0.997 0.003 524 578 1.249 0.003 0.991 1.003
Having diarrhea in the last 2 weeks 0.009 0.005 517 572 1.130 0.528 0.000 0.018
Treated with oral rehydration salts (ORS) 0.328 0.228 4 5 1.031 0.695 0.000 0.783
Taken to a health provider 0.886 0.117 4 5 0.783 0.132 0.653 1.120
Vaccination card seen 0.909 0.032 102 108 1.089 0.035 0.845 0.973
Received BCG 0.977 0.016 102 108 1.068 0.017 0.944 1.010
Received DPT-HepB-Hib (3 doses) 0.977 0.016 102 108 1.068 0.017 0.944 1.010
Received polio (third dose) 0.950 0.023 102 108 1.026 0.024 0.904 0.996
Received measles contaning vaccination 0.954 0.023 102 108 0.975 0.024 0.908 0.999
Fully immunized 0.927 0.027 102 108 0.977 0.030 0.872 0.981
Height-for-age (-2SD) 0.260 0.023 503 549 1.079 0.087 0.215 0.305
Weight-for-height (-2SD) 0.127 0.018 504 552 1.176 0.142 0.091 0.163
Weight-for-age (-2SD) 0.206 0.020 510 559 1.128 0.098 0.165 0.246
Prevalence of anemia (children) 0.398 0.030 434 476 1.250 0.074 0.339 0.457
Prevalence of anemia (women) 0.409 0.019 1047 1167 1.227 0.046 0.372 0.446
BMI < 18,5 0.079 0.009 996 1120 1.060 0.114 0.061 0.097
Total fertility rate (last 3 years) 2.576 0.109 4108 4473 0.928 0.042 2.358 2.793
Neonatal mortality (last 0-9 years) 6.734 2.602 1041 1166 1.053 0.386 1.530 11.938
Post-neonatal mortality (last 0-9 years) 2.153 1.880 1045 1169 0.958 0.873 0.000 5.914
Infant mortality (last 0-9 years) 8.888 3.148 1041 1166 1.001 0.354 2.593 15.183
Child mortality (last 0-9 years) 2.809 1.651 1053 1188 1.054 0.588 0.000 6.111
Under-five mortality (last 0-9 years) 11.672 3.462 1041 1166 0.997 0.297 4.747 18.597

241 Appendix B 253

Table B.10 Sampling errors: Matale sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.102 0.020 484 490 1.459 0.197 0.062 0.142
No education 0.018 0.007 484 490 1.125 0.380 0.004 0.031
Secondary education or higher 0.926 0.015 484 490 1.250 0.016 0.896 0.955
Currently married 0.383 0.106 1072 1192 1.068 0.276 0.171 0.594
Married before age 20 0.297 0.018 574 576 1.007 0.061 0.261 0.333
Currently pregnant 0.024 0.008 1072 1192 0.990 0.316 0.009 0.039
Children ever born 0.788 0.222 1072 1192 1.065 0.281 0.345 1.232
Children surviving 0.776 0.219 1072 1192 1.066 0.282 0.338 1.213
Children ever born to women age 40-49 2.388 0.107 168 169 1.243 0.045 2.173 2.602
Knows any contraceptive method 1.000 0.000 447 456 na 0.000 1.000 1.000
Knows amodern method 1.000 0.000 447 456 na 0.000 1.000 1.000
Currently using any method 0.714 0.025 447 456 1.177 0.035 0.663 0.764
Currently using a modern method 0.617 0.028 447 456 1.218 0.045 0.561 0.674
Currently using a traditional method 0.096 0.018 447 456 1.257 0.183 0.061 0.131
Currently using pill 0.102 0.017 447 456 1.170 0.165 0.068 0.135
Currently using IUD 0.122 0.015 447 456 0.944 0.120 0.093 0.151
Currently using condoms 0.069 0.011 447 456 0.919 0.159 0.047 0.092
Currently use injectables 0.106 0.020 447 456 1.400 0.193 0.065 0.147
Currently using female sterilization 0.172 0.017 447 456 0.929 0.097 0.139 0.205
Currently using withdrawal 0.031 0.009 447 456 1.059 0.279 0.014 0.049
Currently using periodic abstinence 0.065 0.015 447 456 1.268 0.228 0.035 0.094
Used public sector source 0.701 0.035 285 287 1.270 0.049 0.632 0.770
Want no more children 0.620 0.022 447 456 0.942 0.035 0.577 0.664
Want to delay birth at least 2 years 0.129 0.015 447 456 0.971 0.120 0.098 0.160
Ideal family size 2.824 0.062 483 488 1.360 0.022 2.699 2.948
Mothers received antenatal care for last birth 1.000 0.000 184 192 na 0.000 1.000 1.000
Assistance by a skilled provider at delivery 1.000 0.000 210 216 na 0.000 1.000 1.000
Having diarrhea in the last 2 weeks 0.022 0.013 205 213 1.239 0.568 0.000 0.048
Treated with oral rehydration salts (ORS) 0.858 0.127 6 5 0.786 0.148 0.604 1.111
Taken to a health provider 1.000 0.000 6 5 na 0.000 1.000 1.000
Vaccination card seen 0.971 0.029 38 35 1.018 0.030 0.912 1.029
Received BCG 1.000 0.000 38 35 na 0.000 1.000 1.000
Received DPT-HepB-Hib (3 doses) 1.000 0.000 38 35 na 0.000 1.000 1.000
Received polio (third dose) 1.000 0.000 38 35 na 0.000 1.000 1.000
Received measles contaning vaccination 0.933 0.044 38 35 1.046 0.048 0.844 1.022
Fully immunized 0.933 0.044 38 35 1.046 0.048 0.844 1.022
Height-for-age (-2SD) 0.140 0.027 213 216 1.092 0.194 0.085 0.194
Weight-for-height (-2SD) 0.099 0.023 210 215 1.132 0.234 0.053 0.146
Weight-for-age (-2SD) 0.178 0.027 213 216 1.053 0.154 0.123 0.233
Prevalence of anemia (children) 0.423 0.048 191 193 1.303 0.112 0.328 0.519
Prevalence of anemia (women) 0.505 0.032 480 486 1.411 0.064 0.441 0.570
BMI < 18,5 0.083 0.013 449 454 1.001 0.158 0.057 0.109
Total fertility rate (last 3 years) 1.859 0.179 3149 3480 1.034 0.096 1.500 2.217
Neonatal mortality (last 0-9 years) 9.726 4.787 432 445 1.025 0.492 0.152 19.300
Post-neonatal mortality (last 0-9 years) 3.844 2.787 435 446 0.802 0.725 0.000 9.418
Infant mortality (last 0-9 years) 13.570 5.455 432 445 0.944 0.402 2.660 24.481
Child mortality (last 0-9 years) 0.662 0.665 439 454 0.536 1.003 0.000 1.992
Under-five mortality (last 0-9 years) 14.224 5.483 432 445 0.927 0.385 3.258 25.190

254 Demographic and Health Survey - 2016, Sri Lanka 242

Table B.11 Sampling errors: Nuwaraeliya sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.055 0.019 633 572 2.094 0.347 0.017 0.093
No education 0.039 0.009 633 572 1.122 0.220 0.022 0.057
Secondary education or higher 0.783 0.018 633 572 1.085 0.023 0.747 0.818
Currently married 0.751 0.031 817 734 0.880 0.042 0.689 0.814
Married before age 20 0.289 0.018 764 687 1.131 0.061 0.254 0.324
Currently pregnant 0.028 0.007 817 734 1.230 0.258 0.014 0.043
Children ever born 1.689 0.085 817 734 0.931 0.050 1.520 1.859
Children surviving 1.653 0.082 817 734 0.918 0.049 1.490 1.816
Children ever born to women age 40-49 2.388 0.062 226 211 0.970 0.026 2.264 2.511
Knows any contraceptive method 0.971 0.007 607 552 1.080 0.008 0.956 0.986
Knows amodern method 0.971 0.007 607 552 1.080 0.008 0.956 0.986
Currently using any method 0.666 0.018 607 552 0.961 0.028 0.630 0.703
Currently using a modern method 0.627 0.021 607 552 1.046 0.033 0.586 0.668
Currently using a traditional method 0.039 0.010 607 552 1.251 0.251 0.020 0.059
Currently using pill 0.083 0.012 607 552 1.052 0.142 0.059 0.106
Currently using IUD 0.077 0.014 607 552 1.258 0.177 0.049 0.104
Currently using condoms 0.035 0.008 607 552 1.050 0.223 0.020 0.051
Currently use injectables 0.072 0.013 607 552 1.211 0.177 0.046 0.097
Currently using female sterilization 0.288 0.021 607 552 1.124 0.072 0.247 0.330
Currently using withdrawal 0.012 0.005 607 552 1.127 0.422 0.002 0.021
Currently using periodic abstinence 0.028 0.008 607 552 1.259 0.303 0.011 0.045
Used public sector source 0.897 0.016 379 353 1.021 0.018 0.865 0.929
Want no more children 0.672 0.022 607 552 1.133 0.032 0.629 0.716
Want to delay birth at least 2 years 0.091 0.014 607 552 1.241 0.160 0.062 0.120
Ideal family size 2.517 0.049 633 572 1.258 0.019 2.420 2.615
Mothers received antenatal care for last birth 0.981 0.007 261 232 0.869 0.007 0.966 0.996
Assistance by a skilled provider at delivery 0.986 0.007 320 280 0.997 0.007 0.972 1.000
Having diarrhea in the last 2 weeks 0.016 0.007 316 277 0.957 0.429 0.002 0.030
Treated with oral rehydration salts (ORS) 0.396 0.201 6 4 0.911 0.507 0.000 0.798
Taken to a health provider 0.386 0.198 6 4 0.903 0.513 0.000 0.783
Vaccination card seen 0.924 0.035 60 56 1.033 0.038 0.854 0.994
Received BCG 0.985 0.015 60 56 0.974 0.015 0.955 1.015
Received DPT-HepB-Hib (3 doses) 0.961 0.023 60 56 0.932 0.024 0.915 1.007
Received polio (third dose) 0.985 0.015 60 56 0.974 0.015 0.955 1.015
Received measles contaning vaccination 0.963 0.027 60 56 1.123 0.028 0.909 1.017
Fully immunized 0.938 0.032 60 56 1.051 0.034 0.874 1.003
Height-for-age (-2SD) 0.324 0.025 305 250 0.896 0.077 0.274 0.374
Weight-for-height (-2SD) 0.118 0.024 298 248 1.269 0.203 0.070 0.166
Weight-for-age (-2SD) 0.296 0.032 304 250 1.185 0.108 0.232 0.359
Prevalence of anemia (children) 0.343 0.035 261 214 1.203 0.103 0.272 0.413
Prevalence of anemia (women) 0.364 0.021 571 506 1.043 0.058 0.321 0.406
BMI < 18,5 0.134 0.017 571 518 1.173 0.125 0.100 0.167
Total fertility rate (last 3 years) 2.195 0.151 2452 2203 1.006 0.069 1.894 2.496
Neonatal mortality (last 0-9 years) 6.546 3.269 650 576 1.025 0.499 0.008 13.083
Post-neonatal mortality (last 0-9 years) 2.288 1.713 643 572 0.909 0.749 0.000 5.714
Infant mortality (last 0-9 years) 8.833 3.613 650 576 0.981 0.409 1.607 16.060
Child mortality (last 0-9 years) 0.000 0.000 650 584 na na 0.000 0.000
Under-five mortality (last 0-9 years) 8.833 3.613 650 576 0.981 0.409 1.607 16.060

243 Appendix B 255

Table B.12 Sampling errors: Galle sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.116 0.008 857 935 0.718 0.068 0.100 0.131
No education 0.014 0.004 857 935 1.064 0.308 0.005 0.022
Secondary education or higher 0.927 0.011 857 935 1.183 0.011 0.906 0.948
Currently married 0.704 0.018 1169 1274 0.954 0.025 0.668 0.739
Married before age 20 0.238 0.015 1078 1184 1.258 0.063 0.207 0.268
Currently pregnant 0.033 0.006 1169 1274 1.150 0.180 0.021 0.045
Children ever born 1.441 0.049 1169 1274 0.921 0.034 1.342 1.540
Children surviving 1.412 0.049 1169 1274 0.929 0.035 1.315 1.510
Children ever born to women age 40-49 2.345 0.073 333 362 1.101 0.031 2.198 2.492
Knows any contraceptive method 0.998 0.002 823 896 0.948 0.002 0.995 1.001
Knows amodern method 0.998 0.002 823 896 0.948 0.002 0.995 1.001
Currently using any method 0.706 0.020 823 896 1.262 0.028 0.666 0.746
Currently using a modern method 0.538 0.019 823 896 1.097 0.035 0.500 0.576
Currently using a traditional method 0.168 0.016 823 896 1.247 0.097 0.135 0.200
Currently using pill 0.102 0.011 823 896 1.070 0.111 0.080 0.125
Currently using IUD 0.118 0.012 823 896 1.090 0.104 0.093 0.143
Currently using condoms 0.089 0.012 823 896 1.209 0.135 0.065 0.113
Currently use injectables 0.047 0.008 823 896 1.091 0.171 0.031 0.063
Currently using female sterilization 0.138 0.011 823 896 0.949 0.083 0.115 0.161
Currently using withdrawal 0.051 0.009 823 896 1.152 0.173 0.034 0.069
Currently using periodic abstinence 0.116 0.012 823 896 1.105 0.106 0.092 0.141
Used public sector source 0.710 0.024 443 485 1.108 0.034 0.662 0.758
Want no more children 0.626 0.018 823 896 1.059 0.029 0.591 0.662
Want to delay birth at least 2 years 0.136 0.013 823 896 1.103 0.097 0.110 0.163
Ideal family size 2.523 0.043 835 911 1.235 0.017 2.436 2.610
Mothers received antenatal care for last birth 0.991 0.005 343 380 1.050 0.005 0.980 1.001
Assistance by a skilled provider at delivery 0.989 0.007 387 429 1.261 0.007 0.976 1.002
Having diarrhea in the last 2 weeks 0.050 0.011 377 418 1.009 0.224 0.028 0.073
Treated with oral rehydration salts (ORS) 0.666 0.113 20 21 1.052 0.170 0.440 0.892
Taken to a health provider 0.882 0.079 20 21 1.069 0.089 0.725 1.039
Vaccination card seen 0.869 0.042 70 75 1.037 0.048 0.785 0.954
Received BCG 1.000 0.000 70 75 na 0.000 1.000 1.000
Received DPT-HepB-Hib (3 doses) 0.951 0.026 70 75 0.990 0.027 0.899 1.002
Received polio (third dose) 1.000 0.000 70 75 na 0.000 1.000 1.000
Received measles contaning vaccination 0.953 0.029 70 75 1.131 0.030 0.896 1.011
Fully immunized 0.911 0.037 70 75 1.085 0.041 0.836 0.985
Height-for-age (-2SD) 0.125 0.019 367 408 1.067 0.154 0.087 0.164
Weight-for-height (-2SD) 0.169 0.020 360 401 0.989 0.118 0.129 0.208
Weight-for-age (-2SD) 0.178 0.022 369 410 1.097 0.123 0.134 0.222
Prevalence of anemia (children) 0.466 0.032 280 305 1.055 0.069 0.402 0.531
Prevalence of anemia (women) 0.514 0.022 741 804 1.218 0.044 0.469 0.558
BMI < 18,5 0.123 0.013 781 850 1.069 0.102 0.098 0.148
Total fertility rate (last 3 years) 2.112 0.133 3508 3821 1.132 0.063 1.846 2.378
Neonatal mortality (last 0-9 years) 4.354 2.458 807 883 0.909 0.565 0.000 9.270
Post-neonatal mortality (last 0-9 years) 3.250 1.940 808 883 0.975 0.597 0.000 7.131
Infant mortality (last 0-9 years) 7.604 3.099 807 883 0.911 0.408 1.405 13.803
Child mortality (last 0-9 years) 2.477 1.833 825 902 1.158 0.740 0.000 6.142
Under-five mortality (last 0-9 years) 10.062 3.559 807 883 0.953 0.354 2.944 17.179

256 Demographic and Health Survey - 2016, Sri Lanka 244

Table B.13 Sampling errors: Matara sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.125 0.017 698 718 1.331 0.133 0.092 0.158
No education 0.011 0.004 698 718 1.066 0.378 0.003 0.020
Secondary education or higher 0.941 0.010 698 718 1.074 0.010 0.922 0.960
Currently married 0.723 0.044 952 947 0.968 0.060 0.636 0.810
Married before age 20 0.212 0.016 800 821 1.194 0.078 0.179 0.245
Currently pregnant 0.039 0.007 952 947 0.958 0.166 0.026 0.052
Children ever born 1.465 0.099 952 947 0.976 0.067 1.268 1.662
Children surviving 1.449 0.097 952 947 0.974 0.067 1.255 1.644
Children ever born to women age 40-49 2.244 0.062 268 274 0.954 0.028 2.120 2.368
Knows any contraceptive method 0.994 0.003 666 685 0.939 0.003 0.988 1.000
Knows amodern method 0.994 0.003 666 685 0.939 0.003 0.988 1.000
Currently using any method 0.650 0.020 666 685 1.089 0.031 0.610 0.690
Currently using a modern method 0.529 0.020 666 685 1.055 0.039 0.489 0.570
Currently using a traditional method 0.120 0.015 666 685 1.162 0.122 0.091 0.150
Currently using pill 0.110 0.013 666 685 1.040 0.115 0.085 0.135
Currently using IUD 0.132 0.017 666 685 1.266 0.126 0.099 0.165
Currently using condoms 0.092 0.012 666 685 1.026 0.125 0.069 0.115
Currently use injectables 0.066 0.011 666 685 1.113 0.162 0.045 0.088
Currently using female sterilization 0.091 0.012 666 685 1.047 0.128 0.068 0.115
Currently using withdrawal 0.014 0.004 666 685 0.971 0.313 0.005 0.023
Currently using periodic abstinence 0.106 0.014 666 685 1.186 0.134 0.078 0.134
Used public sector source 0.733 0.025 354 363 1.078 0.035 0.682 0.783
Want no more children 0.653 0.018 666 685 1.001 0.028 0.616 0.690
Want to delay birth at least 2 years 0.121 0.011 666 685 0.903 0.094 0.098 0.144
Ideal family size 2.414 0.049 695 715 1.209 0.020 2.316 2.512
Mothers received antenatal care for last birth 0.971 0.011 285 291 1.056 0.011 0.949 0.992
Assistance by a skilled provider at delivery 1.000 0.000 328 338 na 0.000 1.000 1.000
Having diarrhea in the last 2 weeks 0.038 0.013 325 335 1.202 0.338 0.012 0.063
Treated with oral rehydration salts (ORS) 0.608 0.175 12 13 1.254 0.288 0.258 0.958
Taken to a health provider 0.956 0.043 12 13 0.733 0.045 0.869 1.042
Vaccination card seen 0.950 0.025 69 73 0.964 0.026 0.899 1.000
Received BCG 0.976 0.017 69 73 0.916 0.017 0.943 1.009
Received DPT-HepB-Hib (3 doses) 0.965 0.020 69 73 0.915 0.021 0.925 1.005
Received polio (third dose) 0.965 0.020 69 73 0.915 0.021 0.925 1.005
Received measles contaning vaccination 0.965 0.020 69 73 0.915 0.021 0.925 1.005
Fully immunized 0.965 0.020 69 73 0.915 0.021 0.925 1.005
Height-for-age (-2SD) 0.156 0.022 324 336 1.093 0.139 0.113 0.200
Weight-for-height (-2SD) 0.168 0.027 321 332 1.115 0.159 0.115 0.222
Weight-for-age (-2SD) 0.223 0.026 325 337 1.077 0.114 0.172 0.274
Prevalence of anemia (children) 0.376 0.026 299 313 0.934 0.068 0.325 0.428
Prevalence of anemia (women) 0.510 0.021 693 712 1.085 0.040 0.469 0.551
BMI < 18,5 0.123 0.014 648 665 1.099 0.116 0.094 0.151
Total fertility rate (last 3 years) 2.284 0.166 2773 2766 1.053 0.073 1.952 2.617
Neonatal mortality (last 0-9 years) 6.506 3.159 685 711 1.028 0.486 0.187 12.825
-
Post-neonatal mortality (last 0-9 years) 0.000 0.000 685 712 na 15.538 0.000 0.000
Infant mortality (last 0-9 years) 6.506 3.159 685 711 1.028 0.486 0.187 12.825
Child mortality (last 0-9 years) 0.000 0.000 683 711 na na 0.000 0.000
Under-five mortality (last 0-9 years) 6.506 3.159 685 711 1.028 0.486 0.187 12.825

245 Appendix B 257

Table B.14 Sampling errors: Hambantota sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.048 0.008 563 556 0.891 0.167 0.032 0.065
No education 0.003 0.002 563 556 0.993 0.717 0.000 0.008
Secondary education or higher 0.942 0.010 563 556 0.994 0.010 0.922 0.961
Currently married 0.373 0.040 1404 1426 0.946 0.108 0.293 0.454
Married before age 20 0.207 0.013 896 894 0.980 0.063 0.181 0.233
Currently pregnant 0.020 0.004 1404 1426 0.977 0.199 0.012 0.029
Children ever born 0.780 0.088 1404 1426 0.919 0.113 0.604 0.957
Children surviving 0.770 0.087 1404 1426 0.915 0.113 0.597 0.944
Children ever born to women age 40-49 2.492 0.106 199 191 1.198 0.043 2.280 2.705
Knows any contraceptive method 1.000 0.000 536 532 na 0.000 1.000 1.000
Knows amodern method 1.000 0.000 536 532 na 0.000 1.000 1.000
Currently using any method 0.645 0.020 536 532 0.988 0.032 0.604 0.686
Currently using a modern method 0.540 0.023 536 532 1.079 0.043 0.493 0.587
Currently using a traditional method 0.105 0.013 536 532 0.987 0.125 0.079 0.131
Currently using pill 0.100 0.014 536 532 1.059 0.137 0.073 0.127
Currently using IUD 0.153 0.017 536 532 1.069 0.109 0.120 0.187
Currently using condoms 0.052 0.010 536 532 1.054 0.194 0.032 0.073
Currently use injectables 0.046 0.009 536 532 1.023 0.200 0.028 0.065
Currently using female sterilization 0.134 0.015 536 532 1.028 0.113 0.103 0.164
Currently using withdrawal 0.058 0.011 536 532 1.077 0.188 0.036 0.080
Currently using periodic abstinence 0.047 0.009 536 532 1.025 0.200 0.028 0.066
Used public sector source 0.810 0.024 292 289 1.041 0.030 0.762 0.858
Want no more children 0.600 0.023 536 532 1.069 0.038 0.555 0.646
Want to delay birth at least 2 years 0.129 0.014 536 532 0.988 0.111 0.100 0.157
Ideal family size 2.696 0.050 560 553 1.069 0.018 2.597 2.796
Mothers received antenatal care for last birth 0.995 0.005 234 233 1.120 0.005 0.984 1.005
Assistance by a skilled provider at delivery 0.992 0.005 264 266 1.012 0.005 0.982 1.003
Having diarrhea in the last 2 weeks 0.060 0.014 261 263 0.941 0.229 0.033 0.088
Treated with oral rehydration salts (ORS) 0.363 0.123 16 16 1.029 0.340 0.116 0.610
Taken to a health provider 1.000 0.000 16 16 na 0.000 1.000 1.000
Vaccination card seen 0.978 0.022 39 41 0.945 0.022 0.935 1.021
Received BCG 0.978 0.022 39 41 0.945 0.022 0.935 1.021
Received DPT-HepB-Hib (3 doses) 0.978 0.022 39 41 0.945 0.022 0.935 1.021
Received polio (third dose) 0.978 0.022 39 41 0.945 0.022 0.935 1.021
Received measles contaning vaccination 0.857 0.056 39 41 1.032 0.066 0.745 0.970
Fully immunized 0.857 0.056 39 41 1.032 0.066 0.745 0.970
Height-for-age (-2SD) 0.118 0.023 213 216 1.052 0.191 0.073 0.163
Weight-for-height (-2SD) 0.218 0.033 211 214 1.082 0.152 0.152 0.284
Weight-for-age (-2SD) 0.224 0.028 214 217 0.935 0.124 0.169 0.280
Prevalence of anemia (children) 0.447 0.047 162 169 1.186 0.105 0.353 0.541
Prevalence of anemia (women) 0.473 0.028 390 402 1.137 0.060 0.416 0.529
BMI < 18,5 0.107 0.015 441 438 1.038 0.142 0.077 0.138
Total fertility rate (last 3 years) 1.898 0.154 4098 4143 0.994 0.081 1.589 2.206
Neonatal mortality (last 0-9 years) 6.413 3.854 549 549 0.926 0.601 0.000 14.121
Post-neonatal mortality (last 0-9 years) 1.602 1.604 543 543 0.933 1.001 0.000 4.809
Infant mortality (last 0-9 years) 8.015 5.235 549 549 0.926 0.653 0.000 18.484
Child mortality (last 0-9 years) 0.000 0.000 547 544 na na 0.000 0.000
Under-five mortality (last 0-9 years) 8.015 5.235 549 549 0.926 0.653 0.000 18.484

258 Demographic and Health Survey - 2016, Sri Lanka 246

Table B.15 Sampling errors: Jaffna sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.203 0.023 520 471 1.290 0.112 0.157 0.248
No education 0.000 0.000 520 471 na na 0.000 0.000
Secondary education or higher 0.920 0.013 520 471 1.062 0.014 0.895 0.945
Currently married 0.492 0.074 925 832 1.004 0.151 0.344 0.640
Married before age 20 0.234 0.020 683 623 1.200 0.085 0.194 0.273
Currently pregnant 0.024 0.006 925 832 1.070 0.272 0.011 0.037
Children ever born 1.289 0.194 925 832 0.980 0.151 0.901 1.678
Children surviving 1.241 0.186 925 832 0.973 0.150 0.869 1.614
Children ever born to women age 40-49 2.802 0.116 207 187 1.123 0.041 2.570 3.035
Knows any contraceptive method 0.995 0.003 453 409 1.030 0.003 0.989 1.002
Knows amodern method 0.995 0.003 453 409 1.030 0.003 0.989 1.002
Currently using any method 0.466 0.027 453 409 1.131 0.057 0.413 0.519
Currently using a modern method 0.427 0.028 453 409 1.186 0.065 0.372 0.483
Currently using a traditional method 0.038 0.010 453 409 1.137 0.268 0.018 0.059
Currently using pill 0.047 0.010 453 409 0.984 0.209 0.027 0.066
Currently using IUD 0.045 0.009 453 409 0.928 0.200 0.027 0.064
Currently using condoms 0.046 0.011 453 409 1.145 0.246 0.023 0.068
Currently use injectables 0.061 0.012 453 409 1.064 0.196 0.037 0.085
Currently using female sterilization 0.198 0.020 453 409 1.057 0.100 0.158 0.238
Currently using withdrawal 0.018 0.007 453 409 1.069 0.368 0.005 0.032
Currently using periodic abstinence 0.020 0.007 453 409 1.064 0.351 0.006 0.034
Used public sector source 0.817 0.026 198 185 0.955 0.032 0.764 0.869
Want no more children 0.530 0.026 453 409 1.087 0.048 0.479 0.581
Want to delay birth at least 2 years 0.086 0.014 453 409 1.054 0.162 0.058 0.114
Ideal family size 2.468 0.056 509 461 1.193 0.023 2.356 2.580
Mothers received antenatal care for last birth 0.978 0.011 192 170 1.045 0.012 0.955 1.000
Assistance by a skilled provider at delivery 0.943 0.020 237 210 1.081 0.021 0.903 0.983
Having diarrhea in the last 2 weeks 0.013 0.007 228 201 0.981 0.580 0.000 0.028
Treated with oral rehydration salts (ORS) 0.437 0.305 3 3 1.037 0.698 0.000 1.048
Taken to a health provider 0.437 0.305 3 3 1.037 0.698 0.000 1.048
Vaccination card seen 0.927 0.042 41 36 1.011 0.045 0.843 1.012
Received BCG 0.981 0.019 41 36 0.878 0.020 0.942 1.019
Received DPT-HepB-Hib (3 doses) 0.981 0.019 41 36 0.878 0.020 0.942 1.019
Received polio (third dose) 0.953 0.033 41 36 0.960 0.034 0.888 1.018
Received measles contaning vaccination 0.953 0.034 41 36 0.992 0.035 0.886 1.020
Fully immunized 0.925 0.042 41 36 0.994 0.045 0.841 1.009
Height-for-age (-2SD) 0.137 0.027 221 197 1.155 0.200 0.083 0.192
Weight-for-height (-2SD) 0.117 0.021 221 196 0.961 0.177 0.076 0.158
Weight-for-age (-2SD) 0.137 0.025 222 197 1.022 0.183 0.087 0.187
Prevalence of anemia (children) 0.631 0.038 203 179 1.080 0.061 0.554 0.707
Prevalence of anemia (women) 0.683 0.025 513 464 1.203 0.036 0.633 0.733
BMI < 18,5 0.074 0.013 487 440 1.070 0.172 0.048 0.099
Total fertility rate (last 3 years) 2.051 0.133 2776 2497 0.906 0.065 1.784 2.318
Neonatal mortality (last 0-9 years) 7.466 3.739 475 428 0.954 0.501 0.000 14.945
Post-neonatal mortality (last 0-9 years) 2.308 2.314 477 431 1.048 1.002 0.000 6.936
Infant mortality (last 0-9 years) 9.774 4.282 475 428 0.958 0.438 1.211 18.337
Child mortality (last 0-9 years) 5.077 3.175 489 441 0.984 0.625 0.000 11.428
Under-five mortality (last 0-9 years) 14.802 5.091 476 428 0.928 0.344 4.620 24.984

247 Appendix B 259

Table B.16 Sampling errors: Mannar sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.176 0.020 416 81 1.061 0.113 0.136 0.215
No education 0.002 0.002 416 81 0.913 1.006 0.000 0.006
Secondary education or higher 0.890 0.019 416 81 1.242 0.021 0.851 0.928
Currently married 0.699 0.029 561 109 0.971 0.041 0.642 0.757
Married before age 20 0.257 0.020 529 104 1.086 0.078 0.217 0.297
Currently pregnant 0.039 0.009 561 109 1.120 0.238 0.021 0.058
Children ever born 1.754 0.110 561 109 1.123 0.063 1.534 1.974
Children surviving 1.740 0.108 561 109 1.119 0.062 1.523 1.957
Children ever born to women age 40-49 2.764 0.107 161 31 1.003 0.039 2.550 2.979
Knows any contraceptive method 0.993 0.004 390 76 0.970 0.004 0.985 1.001
Knows amodern method 0.993 0.004 390 76 0.970 0.004 0.985 1.001
Currently using any method 0.184 0.021 390 76 1.056 0.113 0.142 0.225
Currently using a modern method 0.184 0.021 390 76 1.056 0.113 0.142 0.225
Currently using a traditional method 0.000 0.000 390 76 na na 0.000 0.000
Currently using pill 0.015 0.007 390 76 1.063 0.436 0.002 0.028
Currently using IUD 0.008 0.005 390 76 1.014 0.569 0.000 0.017
Currently using condoms 0.012 0.006 390 76 1.050 0.485 0.000 0.024
Currently use injectables 0.041 0.012 390 76 1.178 0.290 0.017 0.064
Currently using female sterilization 0.081 0.013 390 76 0.971 0.166 0.054 0.108
Currently using withdrawal 0.000 0.000 390 76 na na 0.000 0.000
Currently using periodic abstinence 0.000 0.000 390 76 na na 0.000 0.000
Used public sector source 0.929 0.031 72 15 1.029 0.034 0.866 0.992
Want no more children 0.336 0.028 390 76 1.183 0.084 0.279 0.392
Want to delay birth at least 2 years 0.054 0.014 390 76 1.228 0.260 0.026 0.082
Ideal family size 2.802 0.076 416 81 1.328 0.027 2.650 2.955
Mothers received antenatal care for last birth 0.986 0.010 179 35 1.097 0.010 0.966 1.005
Assistance by a skilled provider at delivery 0.995 0.005 213 42 1.010 0.005 0.986 1.005
Having diarrhea in the last 2 weeks 0.027 0.011 212 41 1.039 0.427 0.004 0.049
Treated with oral rehydration salts (ORS) 0.435 0.232 5 1 1.112 0.535 0.000 0.900
Taken to a health provider 0.099 0.101 5 1 0.800 1.020 0.000 0.300
Vaccination card seen 0.810 0.092 29 6 1.256 0.113 0.627 0.994
Received BCG 0.929 0.046 29 6 0.972 0.050 0.836 1.022
Received DPT-HepB-Hib (3 doses) 0.810 0.092 29 6 1.256 0.113 0.627 0.994
Received polio (third dose) 0.810 0.092 29 6 1.256 0.113 0.627 0.994
Received measles contaning vaccination 0.708 0.102 29 6 1.200 0.144 0.505 0.912
Fully immunized 0.708 0.102 29 6 1.200 0.144 0.505 0.912
Height-for-age (-2SD) 0.208 0.033 207 41 1.131 0.160 0.142 0.275
Weight-for-height (-2SD) 0.131 0.019 206 40 0.822 0.147 0.092 0.169
Weight-for-age (-2SD) 0.182 0.025 207 41 0.933 0.140 0.131 0.233
Prevalence of anemia (children) 0.457 0.035 194 38 0.927 0.076 0.388 0.527
Prevalence of anemia (women) 0.497 0.030 413 81 1.228 0.061 0.436 0.557
BMI < 18,5 0.076 0.018 386 75 1.346 0.239 0.040 0.113
Total fertility rate (last 3 years) 1.986 0.181 1682 326 1.052 0.091 1.623 2.348
Neonatal mortality (last 0-9 years) 0.000 0.000 440 85 na na 0.000 0.000
Post-neonatal mortality (last 0-9 years) 2.573 2.582 439 85 1.066 1.004 0.000 7.738
Infant mortality (last 0-9 years) 2.573 2.582 440 85 1.069 1.004 0.000 7.738
Child mortality (last 0-9 years) 1.604 1.609 455 88 0.856 1.003 0.000 4.822
Under-five mortality (last 0-9 years) 4.173 3.009 440 85 0.986 0.721 0.000 10.191

260 Demographic and Health Survey - 2016, Sri Lanka 248

Table B.17 Sampling errors: Vavuniya sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.180 0.022 451 136 1.241 0.125 0.135 0.225
No education 0.031 0.010 451 136 1.196 0.313 0.012 0.051
Secondary education or higher 0.873 0.021 451 136 1.325 0.024 0.832 0.915
Currently married 0.585 0.098 711 213 1.087 0.167 0.389 0.780
Married before age 20 0.296 0.022 532 160 1.151 0.074 0.252 0.340
Currently pregnant 0.025 0.006 711 213 1.007 0.249 0.013 0.038
Children ever born 1.458 0.239 711 213 1.022 0.164 0.980 1.936
Children surviving 1.421 0.233 711 213 1.023 0.164 0.955 1.887
Children ever born to women age 40-49 2.823 0.117 161 47 0.996 0.041 2.590 3.057
Knows any contraceptive method 0.993 0.005 414 125 1.319 0.005 0.983 1.004
Knows amodern method 0.993 0.005 414 125 1.319 0.005 0.983 1.004
Currently using any method 0.330 0.025 414 125 1.067 0.075 0.280 0.379
Currently using a modern method 0.307 0.025 414 125 1.084 0.080 0.258 0.357
Currently using a traditional method 0.022 0.008 414 125 1.102 0.361 0.006 0.038
Currently using pill 0.051 0.012 414 125 1.114 0.237 0.027 0.075
Currently using IUD 0.017 0.006 414 125 0.968 0.360 0.005 0.030
Currently using condoms 0.036 0.010 414 125 1.111 0.283 0.016 0.056
Currently use injectables 0.077 0.014 414 125 1.104 0.188 0.048 0.106
Currently using female sterilization 0.100 0.018 414 125 1.212 0.179 0.064 0.135
Currently using withdrawal 0.010 0.006 414 125 1.242 0.600 0.000 0.023
Currently using periodic abstinence 0.012 0.006 414 125 1.049 0.473 0.001 0.023
Used public sector source 0.740 0.046 127 39 1.183 0.063 0.648 0.833
Want no more children 0.476 0.026 414 125 1.055 0.054 0.425 0.528
Want to delay birth at least 2 years 0.063 0.012 414 125 1.027 0.195 0.038 0.087
Ideal family size 2.502 0.065 451 136 1.265 0.026 2.372 2.631
Mothers received antenatal care for last birth 0.977 0.011 172 53 0.990 0.011 0.955 0.999
Assistance by a skilled provider at delivery 0.982 0.012 201 62 1.316 0.012 0.958 1.006
Having diarrhea in the last 2 weeks 0.020 0.010 195 60 1.012 0.506 0.000 0.040
Treated with oral rehydration salts (ORS) 0.132 0.134 4 1 0.785 1.018 0.000 0.400
Taken to a health provider 0.366 0.273 4 1 1.123 0.746 0.000 0.913
Vaccination card seen 0.967 0.033 37 10 1.085 0.034 0.901 1.033
Received BCG 0.967 0.033 37 10 1.085 0.034 0.901 1.033
Received DPT-HepB-Hib (3 doses) 0.939 0.041 37 10 1.001 0.044 0.857 1.021
Received polio (third dose) 0.939 0.041 37 10 1.001 0.044 0.857 1.021
Received measles contaning vaccination 0.919 0.045 37 10 0.965 0.049 0.829 1.009
Fully immunized 0.919 0.045 37 10 0.965 0.049 0.829 1.009
Height-for-age (-2SD) 0.187 0.033 208 64 1.179 0.178 0.121 0.254
Weight-for-height (-2SD) 0.160 0.028 199 61 1.076 0.173 0.105 0.216
Weight-for-age (-2SD) 0.203 0.034 206 64 1.128 0.170 0.134 0.272
Prevalence of anemia (children) 0.517 0.040 124 40 0.946 0.077 0.437 0.597
Prevalence of anemia (women) 0.574 0.031 428 130 1.317 0.055 0.512 0.637
BMI < 18,5 0.079 0.015 429 130 1.142 0.188 0.050 0.109
Total fertility rate (last 3 years) 1.967 0.195 2134 640 0.986 0.099 1.576 2.358
Neonatal mortality (last 0-9 years) 14.908 5.574 451 141 1.017 0.374 3.760 26.056
-
Post-neonatal mortality (last 0-9 years) 0.000 0.000 454 141 na 10.146 0.000 0.000
Infant mortality (last 0-9 years) 14.908 5.574 451 141 1.017 0.374 3.760 26.056
Child mortality (last 0-9 years) 0.000 0.000 466 145 na na 0.000 0.000
Under-five mortality (last 0-9 years) 14.908 5.574 451 141 1.017 0.374 3.760 26.056

249 Appendix B 261

Table B.18 Sampling errors: Mullaitivu sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.000 0.000 378 81 na na 0.000 0.000
No education 0.006 0.003 378 81 0.896 0.615 0.000 0.012
Secondary education or higher 0.852 0.025 378 81 1.378 0.030 0.801 0.902
Currently married 0.530 0.063 598 127 1.280 0.119 0.403 0.656
Married before age 20 0.327 0.044 534 118 1.444 0.136 0.238 0.415
Currently pregnant 0.014 0.005 598 127 0.998 0.350 0.004 0.023
Children ever born 1.501 0.196 598 127 1.278 0.131 1.109 1.893
Children surviving 1.427 0.189 598 127 1.301 0.132 1.050 1.804
Children ever born to women age 40-49 2.886 0.173 140 29 1.252 0.060 2.541 3.232
Knows any contraceptive method 0.995 0.004 313 67 0.903 0.004 0.988 1.002
Knows amodern method 0.995 0.004 313 67 0.903 0.004 0.988 1.002
Currently using any method 0.672 0.036 313 67 1.353 0.054 0.600 0.744
Currently using a modern method 0.639 0.037 313 67 1.361 0.058 0.565 0.713
Currently using a traditional method 0.034 0.011 313 67 1.046 0.318 0.012 0.055
Currently using pill 0.103 0.021 313 67 1.225 0.204 0.061 0.146
Currently using IUD 0.089 0.017 313 67 1.070 0.193 0.055 0.124
Currently using condoms 0.032 0.010 313 67 1.029 0.320 0.012 0.053
Currently use injectables 0.147 0.019 313 67 0.972 0.133 0.108 0.186
Currently using female sterilization 0.161 0.021 313 67 1.033 0.133 0.118 0.204
Currently using withdrawal 0.015 0.008 313 67 1.142 0.531 0.000 0.030
Currently using periodic abstinence 0.019 0.008 313 67 0.982 0.400 0.004 0.034
Used public sector source 0.833 0.034 205 46 1.308 0.041 0.765 0.902
Want no more children 0.646 0.026 313 67 0.954 0.040 0.594 0.698
Want to delay birth at least 2 years 0.082 0.017 313 67 1.074 0.204 0.048 0.115
Ideal family size 2.223 0.065 371 80 1.080 0.029 2.092 2.354
Mothers received antenatal care for last birth 0.994 0.006 147 32 0.982 0.006 0.981 1.007
Assistance by a skilled provider at delivery 0.989 0.008 173 37 1.003 0.008 0.972 1.005
Having diarrhea in the last 2 weeks 0.013 0.009 169 36 0.988 0.671 0.000 0.030
Treated with oral rehydration salts (ORS) 0.000 0.000 2 0 na na 0.000 0.000
Taken to a health provider 1.000 0.000 2 0 na 0.000 1.000 1.000
Vaccination card seen 0.860 0.054 36 8 0.945 0.063 0.752 0.968
Received BCG 1.000 0.000 36 8 na 0.000 1.000 1.000
Received DPT-HepB-Hib (3 doses) 1.000 0.000 36 8 na 0.000 1.000 1.000
Received polio (third dose) 1.000 0.000 36 8 na 0.000 1.000 1.000
Received measles contaning vaccination 0.927 0.049 36 8 1.149 0.053 0.829 1.026
Fully immunized 0.927 0.049 36 8 1.149 0.053 0.829 1.026
Height-for-age (-2SD) 0.167 0.033 169 36 1.118 0.199 0.100 0.233
Weight-for-height (-2SD) 0.216 0.036 167 36 1.049 0.164 0.145 0.287
Weight-for-age (-2SD) 0.255 0.035 170 37 1.023 0.136 0.186 0.324
Prevalence of anemia (children) 0.544 0.050 151 32 1.285 0.093 0.443 0.645
Prevalence of anemia (women) 0.632 0.029 365 78 1.129 0.045 0.575 0.689
BMI < 18,5 0.089 0.015 364 79 1.003 0.167 0.060 0.119
Total fertility rate (last 3 years) 1.991 0.264 1795 381 1.426 0.132 1.464 2.519
Neonatal mortality (last 0-9 years) 12.930 5.972 396 87 1.063 0.462 0.986 24.873
Post-neonatal mortality (last 0-9 years) 8.801 5.005 399 88 1.087 0.569 0.000 18.811
Infant mortality (last 0-9 years) 21.731 9.582 396 87 1.334 0.441 2.567 40.894
Child mortality (last 0-9 years) 0.000 0.000 404 88 na na 0.000 0.000
Under-five mortality (last 0-9 years) 21.731 9.582 396 87 1.334 0.441 2.567 40.894

262 Demographic and Health Survey - 2016, Sri Lanka 250

Table B.19 Sampling errors: Killinochchi sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.000 0.000 384 94 na na 0.000 0.000
No education 0.012 0.008 384 94 1.354 0.620 0.000 0.028
Secondary education or higher 0.891 0.023 384 94 1.452 0.026 0.845 0.937
Currently married 0.557 0.106 565 145 1.155 0.190 0.346 0.769
Married before age 20 0.333 0.026 429 105 1.182 0.077 0.282 0.384
Currently pregnant 0.027 0.008 565 145 1.040 0.305 0.011 0.043
Children ever born 1.647 0.316 565 145 1.132 0.192 1.016 2.279
Children surviving 1.555 0.302 565 145 1.149 0.194 0.950 2.159
Children ever born to women age 40-49 3.365 0.207 122 30 1.272 0.061 2.952 3.779
Knows any contraceptive method 0.997 0.003 332 81 0.968 0.003 0.991 1.003
Knows amodern method 0.997 0.003 332 81 0.968 0.003 0.991 1.003
Currently using any method 0.584 0.026 332 81 0.951 0.044 0.533 0.636
Currently using a modern method 0.563 0.026 332 81 0.961 0.047 0.510 0.615
Currently using a traditional method 0.022 0.009 332 81 1.071 0.397 0.004 0.039
Currently using pill 0.045 0.012 332 81 1.037 0.263 0.021 0.069
Currently using IUD 0.120 0.022 332 81 1.253 0.187 0.075 0.165
Currently using condoms 0.038 0.011 332 81 1.071 0.297 0.015 0.060
Currently use injectables 0.069 0.014 332 81 1.032 0.208 0.040 0.098
Currently using female sterilization 0.207 0.024 332 81 1.077 0.116 0.159 0.255
Currently using withdrawal 0.006 0.004 332 81 1.033 0.715 0.000 0.015
Currently using periodic abstinence 0.015 0.008 332 81 1.117 0.494 0.000 0.030
Used public sector source 0.912 0.021 196 48 1.012 0.023 0.871 0.953
Want no more children 0.642 0.026 332 81 0.996 0.041 0.589 0.694
Want to delay birth at least 2 years 0.135 0.022 332 81 1.174 0.163 0.091 0.179
Ideal family size 2.820 0.054 384 94 0.954 0.019 2.711 2.929
Mothers received antenatal care for last birth 0.976 0.013 157 40 1.047 0.013 0.951 1.001
Assistance by a skilled provider at delivery 0.994 0.005 185 47 0.989 0.005 0.984 1.005
Having diarrhea in the last 2 weeks 0.006 0.006 174 44 1.024 1.023 0.000 0.017
Treated with oral rehydration salts (ORS) 0.000 0.000 1 0 na na 0.000 0.000
Taken to a health provider 0.000 0.000 1 0 na na 0.000 0.000
Vaccination card seen 0.942 0.057 23 6 1.169 0.060 0.829 1.055
Received BCG 1.000 0.000 23 6 na 0.000 1.000 1.000
Received DPT-HepB-Hib (3 doses) 0.914 0.060 23 6 1.037 0.066 0.794 1.035
Received polio (third dose) 1.000 0.000 23 6 na 0.000 1.000 1.000
Received measles contaning vaccination 0.790 0.099 23 6 1.156 0.125 0.592 0.987
Fully immunized 0.704 0.108 23 6 1.124 0.154 0.488 0.920
Height-for-age (-2SD) 0.209 0.036 179 46 1.142 0.174 0.136 0.282
Weight-for-height (-2SD) 0.168 0.036 177 45 1.323 0.214 0.096 0.239
Weight-for-age (-2SD) 0.166 0.023 180 46 0.820 0.135 0.121 0.211
Prevalence of anemia (children) 0.435 0.039 160 41 1.021 0.091 0.356 0.513
Prevalence of anemia (women) 0.569 0.029 381 93 1.152 0.051 0.511 0.628
BMI < 18,5 0.140 0.017 357 88 0.928 0.121 0.106 0.174
Total fertility rate (last 3 years) 2.055 0.208 1610 412 1.118 0.101 1.640 2.471
Neonatal mortality (last 0-9 years) 20.555 8.020 425 106 1.042 0.390 4.514 36.596
Post-neonatal mortality (last 0-9 years) 7.836 4.509 427 107 1.070 0.575 0.000 16.854
Infant mortality (last 0-9 years) 28.391 10.134 425 106 1.117 0.357 8.123 48.660
Child mortality (last 0-9 years) 15.679 7.598 429 106 1.271 0.485 0.482 30.875
Under-five mortality (last 0-9 years) 43.625 11.603 428 107 1.114 0.266 20.418 66.831

251 Appendix B 263

Table B.20 Sampling errors: Batticaloa sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.310 0.017 601 531 0.898 0.055 0.276 0.344
No education 0.023 0.006 601 531 1.059 0.284 0.010 0.036
Secondary education or higher 0.825 0.018 601 531 1.140 0.021 0.789 0.860
Currently married 0.723 0.040 758 679 1.048 0.055 0.643 0.802
Married before age 20 0.376 0.023 666 590 1.281 0.061 0.330 0.422
Currently pregnant 0.039 0.008 758 679 1.115 0.206 0.023 0.055
Children ever born 1.680 0.109 758 679 1.038 0.065 1.462 1.899
Children surviving 1.640 0.106 758 679 1.036 0.065 1.427 1.852
Children ever born to women age 40-49 2.996 0.133 185 161 1.119 0.044 2.730 3.261
Knows any contraceptive method 0.996 0.003 556 491 1.018 0.003 0.991 1.002
Knows amodern method 0.996 0.003 556 491 1.018 0.003 0.991 1.002
Currently using any method 0.315 0.024 556 491 1.220 0.076 0.267 0.363
Currently using a modern method 0.285 0.024 556 491 1.265 0.085 0.237 0.334
Currently using a traditional method 0.030 0.008 556 491 1.100 0.266 0.014 0.046
Currently using pill 0.030 0.007 556 491 1.016 0.246 0.015 0.045
Currently using IUD 0.023 0.007 556 491 1.158 0.317 0.009 0.038
Currently using condoms 0.021 0.008 556 491 1.343 0.385 0.005 0.038
Currently use injectables 0.118 0.015 556 491 1.091 0.127 0.088 0.147
Currently using female sterilization 0.072 0.013 556 491 1.192 0.181 0.046 0.099
Currently using withdrawal 0.014 0.005 556 491 0.953 0.338 0.005 0.024
Currently using periodic abstinence 0.016 0.006 556 491 1.075 0.359 0.004 0.027
Used public sector source 0.499 0.045 167 141 1.171 0.091 0.408 0.590
Want no more children 0.559 0.024 556 491 1.136 0.043 0.511 0.607
Want to delay birth at least 2 years 0.150 0.016 556 491 1.026 0.104 0.119 0.181
Ideal family size 2.887 0.064 600 530 1.213 0.022 2.758 3.015
Mothers received antenatal care for last birth 1.000 0.000 244 217 na 0.000 1.000 1.000
Assistance by a skilled provider at delivery 0.998 0.002 280 249 0.781 0.002 0.994 1.002
Having diarrhea in the last 2 weeks 0.063 0.016 272 242 1.040 0.252 0.031 0.095
Treated with oral rehydration salts (ORS) 0.464 0.130 18 15 1.031 0.280 0.204 0.725
Taken to a health provider 0.942 0.057 18 15 1.016 0.060 0.829 1.056
Vaccination card seen 0.948 0.029 51 47 0.954 0.031 0.890 1.006
Received BCG 1.000 0.000 51 47 na 0.000 1.000 1.000
Received DPT-HepB-Hib (3 doses) 0.982 0.018 51 47 0.998 0.019 0.945 1.018
Received polio (third dose) 1.000 0.000 51 47 na 0.000 1.000 1.000
Received measles contaning vaccination 0.940 0.033 51 47 1.004 0.035 0.874 1.006
Fully immunized 0.922 0.037 51 47 0.995 0.040 0.848 0.995
Height-for-age (-2SD) 0.206 0.030 279 249 1.154 0.144 0.147 0.265
Weight-for-height (-2SD) 0.140 0.025 278 248 1.174 0.176 0.090 0.189
Weight-for-age (-2SD) 0.214 0.027 280 250 1.057 0.127 0.160 0.269
Prevalence of anemia (children) 0.595 0.029 262 232 0.956 0.049 0.537 0.653
Prevalence of anemia (women) 0.482 0.024 596 528 1.179 0.050 0.434 0.530
BMI < 18,5 0.107 0.016 562 496 1.225 0.150 0.075 0.139
Total fertility rate (last 3 years) 2.362 0.169 2203 1965 0.941 0.071 2.025 2.699
Neonatal mortality (last 0-9 years) 8.240 3.597 574 515 0.965 0.436 1.047 15.433
Post-neonatal mortality (last 0-9 years) 1.953 1.957 573 514 1.061 1.002 0.000 5.866
Infant mortality (last 0-9 years) 10.193 4.001 574 515 0.964 0.393 2.191 18.195
Child mortality (last 0-9 years) 0.000 0.000 597 533 na na 0.000 0.000
Under-five mortality (last 0-9 years) 10.193 4.001 574 515 0.964 0.393 2.191 18.195

264 Demographic and Health Survey - 2016, Sri Lanka 252

Table B.21 Sampling errors: Ampara sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.224 0.011 799 731 0.741 0.049 0.202 0.246
No education 0.028 0.006 799 731 1.090 0.228 0.015 0.040
Secondary education or higher 0.812 0.020 799 731 1.426 0.024 0.773 0.852
Currently married 0.655 0.035 1144 1058 1.154 0.054 0.584 0.725
Married before age 20 0.335 0.021 910 827 1.410 0.062 0.293 0.376
Currently pregnant 0.041 0.006 1144 1058 1.105 0.157 0.028 0.054
Children ever born 1.484 0.082 1144 1058 0.958 0.055 1.320 1.647
Children surviving 1.423 0.080 1144 1058 0.991 0.056 1.262 1.584
Children ever born to women age 40-49 2.798 0.119 263 240 1.252 0.043 2.559 3.037
Knows any contraceptive method 0.999 0.001 757 692 0.967 0.001 0.996 1.001
Knows amodern method 0.999 0.001 757 692 0.967 0.001 0.996 1.001
Currently using any method 0.457 0.028 757 692 1.534 0.061 0.402 0.513
Currently using a modern method 0.406 0.029 757 692 1.601 0.070 0.349 0.463
Currently using a traditional method 0.051 0.009 757 692 1.068 0.167 0.034 0.068
Currently using pill 0.037 0.007 757 692 1.009 0.186 0.023 0.051
Currently using IUD 0.058 0.010 757 692 1.206 0.176 0.038 0.079
Currently using condoms 0.035 0.010 757 692 1.427 0.273 0.016 0.054
Currently use injectables 0.120 0.018 757 692 1.530 0.151 0.084 0.157
Currently using female sterilization 0.092 0.011 757 692 1.072 0.123 0.069 0.114
Currently using withdrawal 0.028 0.007 757 692 1.089 0.235 0.015 0.041
Currently using periodic abstinence 0.023 0.006 757 692 1.175 0.276 0.011 0.036
Used public sector source 0.773 0.026 312 289 1.101 0.034 0.721 0.825
Want no more children 0.496 0.024 757 692 1.329 0.049 0.448 0.545
Want to delay birth at least 2 years 0.107 0.011 757 692 1.017 0.107 0.084 0.129
Ideal family size 2.845 0.101 799 731 1.892 0.035 2.644 3.047
Mothers received antenatal care for last birth 0.991 0.005 340 305 0.987 0.005 0.981 1.001
Assistance by a skilled provider at delivery 0.998 0.002 401 360 0.977 0.002 0.993 1.002
Having diarrhea in the last 2 weeks 0.026 0.010 392 353 1.200 0.369 0.007 0.046
Treated with oral rehydration salts (ORS) 0.601 0.146 11 9 0.951 0.243 0.309 0.893
Taken to a health provider 0.907 0.071 11 9 0.780 0.078 0.764 1.049
Vaccination card seen 0.892 0.041 73 63 1.097 0.046 0.810 0.974
Received BCG 1.000 0.000 73 63 na 0.000 1.000 1.000
Received DPT-HepB-Hib (3 doses) 0.985 0.015 73 63 0.993 0.015 0.956 1.014
Received polio (third dose) 0.985 0.015 73 63 0.993 0.015 0.956 1.014
Received measles contaning vaccination 0.962 0.030 73 63 1.299 0.031 0.902 1.022
Fully immunized 0.962 0.030 73 63 1.299 0.031 0.902 1.022
Height-for-age (-2SD) 0.219 0.021 379 345 0.979 0.095 0.177 0.261
Weight-for-height (-2SD) 0.124 0.018 376 342 1.037 0.146 0.088 0.160
Weight-for-age (-2SD) 0.181 0.021 380 346 1.054 0.119 0.138 0.224
Prevalence of anemia (children) 0.456 0.028 331 302 1.026 0.062 0.400 0.513
Prevalence of anemia (women) 0.478 0.018 769 706 0.976 0.037 0.443 0.513
BMI < 18,5 0.084 0.010 731 669 0.985 0.120 0.064 0.104
Total fertility rate (last 3 years) 2.432 0.146 3356 3078 0.993 0.060 2.141 2.723
Neonatal mortality (last 0-9 years) 13.142 3.606 831 751 0.916 0.274 5.931 20.354
Post-neonatal mortality (last 0-9 years) 4.203 3.243 830 749 1.420 0.772 0.000 10.690
Infant mortality (last 0-9 years) 17.345 4.556 831 751 1.010 0.263 8.234 26.457
Child mortality (last 0-9 years) 0.000 0.000 846 766 na na 0.000 0.000
Under-five mortality (last 0-9 years) 17.345 4.556 831 751 1.010 0.263 8.234 26.457

253 Appendix B 265

Table B.22 Sampling errors: Trincomalee sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.235 0.026 460 362 1.289 0.109 0.184 0.286
No education 0.023 0.008 460 362 1.181 0.358 0.007 0.040
Secondary education or higher 0.859 0.020 460 362 1.208 0.023 0.820 0.899
Currently married 0.534 0.089 791 621 1.185 0.167 0.356 0.712
Married before age 20 0.351 0.018 548 429 0.963 0.052 0.314 0.388
Currently pregnant 0.036 0.009 791 621 1.262 0.263 0.017 0.055
Children ever born 1.356 0.224 791 621 1.116 0.165 0.908 1.805
Children surviving 1.309 0.217 791 621 1.120 0.166 0.875 1.743
Children ever born to women age 40-49 3.070 0.125 146 117 1.094 0.041 2.820 3.321
Knows any contraceptive method 0.997 0.003 422 331 1.076 0.003 0.992 1.003
Knows amodern method 0.997 0.003 422 331 1.076 0.003 0.992 1.003
Currently using any method 0.486 0.033 422 331 1.345 0.068 0.420 0.551
Currently using a modern method 0.454 0.034 422 331 1.401 0.075 0.386 0.522
Currently using a traditional method 0.032 0.011 422 331 1.244 0.336 0.010 0.053
Currently using pill 0.049 0.010 422 331 0.984 0.211 0.029 0.070
Currently using IUD 0.029 0.008 422 331 0.926 0.260 0.014 0.044
Currently using condoms 0.043 0.010 422 331 0.964 0.222 0.024 0.062
Currently use injectables 0.171 0.020 422 331 1.069 0.115 0.132 0.211
Currently using female sterilization 0.099 0.020 422 331 1.407 0.207 0.058 0.140
Currently using withdrawal 0.008 0.004 422 331 0.947 0.504 0.000 0.017
Currently using periodic abstinence 0.023 0.009 422 331 1.182 0.374 0.006 0.041
Used public sector source 0.656 0.040 190 152 1.146 0.060 0.576 0.735
Want no more children 0.500 0.032 422 331 1.317 0.064 0.436 0.564
Want to delay birth at least 2 years 0.235 0.023 422 331 1.129 0.099 0.188 0.282
Ideal family size 2.636 0.102 460 362 1.346 0.039 2.432 2.841
Mothers received antenatal care for last birth 0.979 0.012 216 168 1.167 0.012 0.956 1.002
Assistance by a skilled provider at delivery 1.000 0.000 247 194 na 0.000 1.000 1.000
Having diarrhea in the last 2 weeks 0.028 0.010 242 189 0.926 0.352 0.008 0.048
Treated with oral rehydration salts (ORS) 0.148 0.137 7 5 1.003 0.926 0.000 0.421
Taken to a health provider 0.809 0.129 7 5 0.854 0.159 0.551 1.067
Vaccination card seen 0.947 0.036 38 29 0.979 0.038 0.874 1.019
Received BCG 0.974 0.026 38 29 0.987 0.027 0.921 1.026
Received DPT-HepB-Hib (3 doses) 0.968 0.027 38 29 0.925 0.028 0.915 1.022
Received polio (third dose) 0.974 0.026 38 29 0.987 0.027 0.921 1.026
Received measles contaning vaccination 0.907 0.068 38 29 1.414 0.075 0.772 1.043
Fully immunized 0.902 0.068 38 29 1.380 0.075 0.766 1.038
Height-for-age (-2SD) 0.155 0.028 243 188 1.184 0.179 0.099 0.210
Weight-for-height (-2SD) 0.123 0.021 239 184 0.984 0.167 0.082 0.164
Weight-for-age (-2SD) 0.227 0.029 243 188 1.078 0.130 0.168 0.286
Prevalence of anemia (children) 0.569 0.034 211 162 0.968 0.059 0.502 0.636
Prevalence of anemia (women) 0.533 0.025 443 348 1.064 0.047 0.483 0.584
BMI < 18,5 0.074 0.020 412 324 1.532 0.267 0.034 0.114
Total fertility rate (last 3 years) 2.316 0.170 2203 1726 0.976 0.073 1.976 2.656
Neonatal mortality (last 0-9 years) 25.012 7.630 501 390 0.988 0.305 9.751 40.273
Post-neonatal mortality (last 0-9 years) 0.000 0.000 504 394 na na 0.000 0.000
Infant mortality (last 0-9 years) 25.012 7.630 501 390 0.988 0.305 9.751 40.273
Child mortality (last 0-9 years) 1.395 1.399 493 388 0.803 1.003 0.000 4.194
Under-five mortality (last 0-9 years) 26.372 7.643 501 390 0.971 0.290 11.085 41.659

266 Demographic and Health Survey - 2016, Sri Lanka 254

Table B.23 Sampling errors: Kurunegala sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.016 0.001 1383 1592 0.392 0.083 0.013 0.019
No education 0.009 0.002 1383 1592 0.938 0.262 0.004 0.014
Secondary education or higher 0.937 0.008 1383 1592 1.158 0.008 0.922 0.952
Currently married 0.685 0.036 1892 2191 1.002 0.053 0.612 0.758
Married before age 20 0.251 0.010 1626 1873 0.982 0.040 0.231 0.271
Currently pregnant 0.037 0.004 1892 2191 0.959 0.116 0.028 0.045
Children ever born 1.322 0.078 1892 2191 1.030 0.059 1.167 1.478
Children surviving 1.302 0.077 1892 2191 1.029 0.059 1.149 1.455
Children ever born to women age 40-49 2.192 0.045 509 580 1.046 0.020 2.103 2.281
Knows any contraceptive method 0.998 0.001 1302 1501 1.036 0.001 0.996 1.001
Knows amodern method 0.998 0.001 1302 1501 1.036 0.001 0.996 1.001
Currently using any method 0.695 0.014 1302 1501 1.064 0.020 0.668 0.722
Currently using a modern method 0.558 0.014 1302 1501 1.031 0.025 0.530 0.586
Currently using a traditional method 0.137 0.009 1302 1501 0.994 0.069 0.118 0.156
Currently using pill 0.091 0.009 1302 1501 1.095 0.096 0.074 0.109
Currently using IUD 0.152 0.012 1302 1501 1.157 0.076 0.129 0.175
Currently using condoms 0.082 0.008 1302 1501 1.061 0.098 0.066 0.098
Currently use injectables 0.084 0.008 1302 1501 1.058 0.097 0.068 0.100
Currently using female sterilization 0.118 0.010 1302 1501 1.137 0.086 0.097 0.138
Currently using withdrawal 0.034 0.005 1302 1501 0.983 0.146 0.024 0.043
Currently using periodic abstinence 0.104 0.008 1302 1501 0.987 0.080 0.087 0.120
Used public sector source 0.769 0.017 731 848 1.119 0.023 0.734 0.803
Want no more children 0.636 0.016 1302 1501 1.169 0.025 0.605 0.667
Want to delay birth at least 2 years 0.158 0.011 1302 1501 1.062 0.068 0.137 0.180
Ideal family size 2.401 0.033 1381 1591 1.435 0.014 2.336 2.466
Mothers received antenatal care for last birth 0.990 0.005 529 613 1.056 0.005 0.980 0.999
Assistance by a skilled provider at delivery 1.000 0.000 588 683 na 0.000 1.000 1.000
Having diarrhea in the last 2 weeks 0.011 0.004 584 678 0.988 0.385 0.003 0.020
Treated with oral rehydration salts (ORS) 0.538 0.196 7 8 1.004 0.365 0.146 0.929
Taken to a health provider 1.000 0.000 7 8 na 0.000 1.000 1.000
Vaccination card seen 0.914 0.026 125 143 1.017 0.028 0.863 0.965
Received BCG 0.991 0.009 125 143 1.058 0.009 0.973 1.009
Received DPT-HepB-Hib (3 doses) 0.964 0.018 125 143 1.050 0.018 0.929 0.999
Received polio (third dose) 0.966 0.016 125 143 0.993 0.017 0.934 0.998
Received measles contaning vaccination 0.951 0.018 125 143 0.925 0.019 0.916 0.987
Fully immunized 0.900 0.026 125 143 0.964 0.029 0.848 0.952
Height-for-age (-2SD) 0.177 0.016 588 685 1.010 0.088 0.146 0.208
Weight-for-height (-2SD) 0.135 0.015 586 683 1.062 0.112 0.105 0.165
Weight-for-age (-2SD) 0.219 0.018 589 686 1.002 0.081 0.183 0.254
Prevalence of anemia (children) 0.474 0.025 507 589 1.116 0.053 0.424 0.525
Prevalence of anemia (women) 0.490 0.016 1324 1524 1.181 0.033 0.457 0.522
BMI < 18,5 0.095 0.008 1288 1481 0.983 0.085 0.079 0.111
Total fertility rate (last 3 years) 2.161 0.101 5464 6346 1.094 0.047 1.959 2.362
Neonatal mortality (last 0-9 years) 7.161 2.447 1220 1412 1.019 0.342 2.267 12.055
Post-neonatal mortality (last 0-9 years) 2.838 1.438 1219 1410 0.946 0.507 0.000 5.715
Infant mortality (last 0-9 years) 9.999 2.779 1220 1412 0.984 0.278 4.440 15.557
Child mortality (last 0-9 years) 2.465 1.420 1224 1411 0.991 0.576 0.000 5.305
Under-five mortality (last 0-9 years) 12.439 3.064 1222 1414 0.973 0.246 6.311 18.568

255 Appendix B 267

Table B.24 Sampling errors: Puttalam sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.084 0.009 661 664 0.810 0.104 0.066 0.101
No education 0.017 0.005 661 664 1.033 0.303 0.007 0.028
Secondary education or higher 0.882 0.015 661 664 1.183 0.017 0.852 0.911
Currently married 0.759 0.037 847 837 0.912 0.049 0.684 0.833
Married before age 20 0.348 0.022 742 748 1.292 0.062 0.305 0.392
Currently pregnant 0.035 0.007 847 837 1.046 0.191 0.022 0.048
Children ever born 1.601 0.093 847 837 0.940 0.058 1.415 1.788
Children surviving 1.564 0.093 847 837 0.953 0.059 1.379 1.749
Children ever born to women age 40-49 2.500 0.101 243 240 1.266 0.040 2.298 2.702
Knows any contraceptive method 1.000 0.000 631 635 na 0.000 1.000 1.000
Knows amodern method 1.000 0.000 631 635 na 0.000 1.000 1.000
Currently using any method 0.693 0.022 631 635 1.221 0.032 0.648 0.738
Currently using a modern method 0.556 0.023 631 635 1.162 0.041 0.510 0.602
Currently using a traditional method 0.137 0.014 631 635 1.037 0.104 0.108 0.165
Currently using pill 0.103 0.012 631 635 1.029 0.121 0.078 0.128
Currently using IUD 0.087 0.012 631 635 1.081 0.140 0.063 0.111
Currently using condoms 0.055 0.011 631 635 1.165 0.193 0.034 0.076
Currently use injectables 0.096 0.014 631 635 1.151 0.140 0.069 0.123
Currently using female sterilization 0.149 0.015 631 635 1.077 0.102 0.119 0.180
Currently using withdrawal 0.038 0.007 631 635 0.933 0.187 0.024 0.052
Currently using periodic abstinence 0.099 0.011 631 635 0.954 0.115 0.076 0.121
Used public sector source 0.694 0.026 353 361 1.065 0.038 0.642 0.746
Want no more children 0.627 0.019 631 635 0.995 0.031 0.588 0.665
Want to delay birth at least 2 years 0.132 0.013 631 635 0.990 0.101 0.105 0.158
Ideal family size 2.403 0.055 661 664 1.248 0.023 2.294 2.512
Mothers received antenatal care for last birth 0.983 0.008 264 262 0.949 0.008 0.968 0.998
Assistance by a skilled provider at delivery 0.988 0.007 295 294 1.060 0.007 0.975 1.002
Having diarrhea in the last 2 weeks 0.013 0.006 291 289 0.973 0.506 0.000 0.026
Treated with oral rehydration salts (ORS) 0.391 0.240 4 4 0.940 0.614 0.000 0.872
Taken to a health provider 1.000 0.000 4 4 na 0.000 1.000 1.000
Vaccination card seen 0.843 0.048 53 55 0.968 0.057 0.747 0.938
Received BCG 1.000 0.000 53 55 na 0.000 1.000 1.000
Received DPT-HepB-Hib (3 doses) 0.887 0.043 53 55 1.009 0.049 0.801 0.974
Received polio (third dose) 1.000 0.000 53 55 na 0.000 1.000 1.000
Received measles contaning vaccination 0.940 0.035 53 55 1.077 0.037 0.871 1.009
Fully immunized 0.828 0.053 53 55 1.027 0.063 0.723 0.933
Height-for-age (-2SD) 0.117 0.021 275 276 1.018 0.178 0.075 0.158
Weight-for-height (-2SD) 0.172 0.029 274 275 1.217 0.171 0.113 0.231
Weight-for-age (-2SD) 0.201 0.036 275 276 1.379 0.179 0.129 0.273
Prevalence of anemia (children) 0.689 0.032 231 235 1.048 0.047 0.624 0.753
Prevalence of anemia (women) 0.600 0.021 648 651 1.101 0.035 0.557 0.642
BMI < 18,5 0.076 0.013 613 617 1.217 0.171 0.050 0.102
Total fertility rate (last 3 years) 2.113 0.141 2458 2442 0.953 0.067 1.832 2.394
Neonatal mortality (last 0-9 years) 13.879 5.348 588 583 0.990 0.385 3.183 24.575
Post-neonatal mortality (last 0-9 years) 4.639 3.385 590 585 0.922 0.730 0.000 11.408
Infant mortality (last 0-9 years) 18.518 6.497 588 583 1.000 0.351 5.523 31.512
Child mortality (last 0-9 years) 3.707 2.669 591 589 1.020 0.720 0.000 9.044
Under-five mortality (last 0-9 years) 22.156 6.830 589 584 0.982 0.308 8.495 35.816

268 Demographic and Health Survey - 2016, Sri Lanka 256

Table B.25 Sampling errors: Anuradhapura sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.040 0.008 816 984 1.164 0.200 0.024 0.056
No education 0.009 0.003 816 984 1.010 0.369 0.002 0.016
Secondary education or higher 0.947 0.009 816 984 1.137 0.009 0.929 0.965
Currently married 0.625 0.049 1204 1471 1.010 0.079 0.527 0.723
Married before age 20 0.340 0.017 915 1106 1.117 0.049 0.307 0.373
Currently pregnant 0.037 0.005 1204 1471 0.888 0.145 0.026 0.048
Children ever born 1.243 0.108 1204 1471 1.033 0.087 1.027 1.459
Children surviving 1.224 0.106 1204 1471 1.030 0.087 1.012 1.437
Children ever born to women age 40-49 2.235 0.073 295 358 1.179 0.033 2.090 2.381
Knows any contraceptive method 0.994 0.003 763 919 1.215 0.003 0.987 1.001
Knows amodern method 0.994 0.003 763 919 1.215 0.003 0.987 1.001
Currently using any method 0.672 0.020 763 919 1.176 0.030 0.632 0.712
Currently using a modern method 0.625 0.020 763 919 1.139 0.032 0.585 0.665
Currently using a traditional method 0.047 0.008 763 919 1.031 0.168 0.031 0.063
Currently using pill 0.102 0.014 763 919 1.236 0.133 0.075 0.129
Currently using IUD 0.128 0.014 763 919 1.188 0.113 0.099 0.156
Currently using condoms 0.031 0.007 763 919 1.055 0.215 0.017 0.044
Currently use injectables 0.187 0.016 763 919 1.160 0.088 0.154 0.220
Currently using female sterilization 0.142 0.011 763 919 0.885 0.079 0.119 0.164
Currently using withdrawal 0.016 0.006 763 919 1.198 0.335 0.005 0.028
Currently using periodic abstinence 0.031 0.006 763 919 0.989 0.202 0.018 0.043
Used public sector source 0.560 0.023 476 579 1.009 0.041 0.514 0.606
Want no more children 0.574 0.020 763 919 1.101 0.034 0.534 0.613
Want to delay birth at least 2 years 0.151 0.013 763 919 1.023 0.088 0.125 0.178
Ideal family size 2.692 0.050 816 984 1.243 0.019 2.592 2.792
Mothers received antenatal care for last birth 0.997 0.003 306 369 0.939 0.003 0.991 1.003
Assistance by a skilled provider at delivery 1.000 0.000 349 418 na 0.000 1.000 1.000
Having diarrhea in the last 2 weeks 0.018 0.008 340 409 1.105 0.447 0.002 0.033
Treated with oral rehydration salts (ORS) 1.000 0.000 5 7 na 0.000 1.000 1.000
Taken to a health provider 1.000 0.000 5 7 na 0.000 1.000 1.000
Vaccination card seen 0.914 0.032 74 86 0.974 0.035 0.850 0.979
Received BCG 1.000 0.000 74 86 na 0.000 1.000 1.000
Received DPT-HepB-Hib (3 doses) 0.981 0.014 74 86 0.858 0.014 0.954 1.009
Received polio (third dose) 0.983 0.016 74 86 1.071 0.017 0.950 1.016
Received measles contaning vaccination 0.969 0.022 74 86 1.046 0.022 0.925 1.012
Fully immunized 0.933 0.029 74 86 0.970 0.031 0.875 0.990
Height-for-age (-2SD) 0.191 0.026 335 409 1.193 0.137 0.138 0.243
Weight-for-height (-2SD) 0.197 0.026 331 404 1.179 0.130 0.146 0.249
Weight-for-age (-2SD) 0.247 0.026 337 411 1.100 0.106 0.194 0.299
Prevalence of anemia (children) 0.404 0.035 300 365 1.234 0.087 0.334 0.474
Prevalence of anemia (women) 0.535 0.020 804 969 1.158 0.038 0.494 0.576
BMI < 18,5 0.074 0.010 762 917 1.076 0.138 0.053 0.094
Total fertility rate (last 3 years) 2.397 0.138 3477 4254 0.926 0.058 2.120 2.673
Neonatal mortality (last 0-9 years) 7.491 4.022 706 841 1.040 0.537 0.000 15.534
Post-neonatal mortality (last 0-9 years) 2.683 1.767 708 843 0.939 0.659 0.000 6.218
Infant mortality (last 0-9 years) 10.174 4.347 706 841 1.019 0.427 1.481 18.868
Child mortality (last 0-9 years) 1.393 1.394 713 847 0.969 1.001 0.000 4.180
Under-five mortality (last 0-9 years) 11.553 4.487 706 841 1.002 0.388 2.578 20.528

257 Appendix B 269

Table B.26 Sampling errors: Polonnaruwa sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.000 0.000 447 399 na na 0.000 0.000
No education 0.015 0.006 447 399 1.077 0.416 0.002 0.027
Secondary education or higher 0.918 0.014 447 399 1.050 0.015 0.891 0.946
Currently married 0.717 0.051 597 531 1.025 0.071 0.616 0.819
Married before age 20 0.341 0.020 504 449 0.993 0.058 0.301 0.381
Currently pregnant 0.040 0.008 597 531 0.958 0.202 0.024 0.056
Children ever born 1.464 0.111 597 531 0.976 0.076 1.241 1.687
Children surviving 1.449 0.109 597 531 0.964 0.075 1.231 1.666
Children ever born to women age 40-49 2.338 0.082 163 143 1.044 0.035 2.174 2.503
Knows any contraceptive method 0.998 0.002 428 381 0.980 0.002 0.993 1.002
Knows amodern method 0.998 0.002 428 381 0.980 0.002 0.993 1.002
Currently using any method 0.723 0.026 428 381 1.206 0.036 0.670 0.775
Currently using a modern method 0.670 0.025 428 381 1.112 0.038 0.619 0.721
Currently using a traditional method 0.053 0.012 428 381 1.139 0.234 0.028 0.077
Currently using pill 0.089 0.014 428 381 1.023 0.158 0.061 0.117
Currently using IUD 0.105 0.016 428 381 1.098 0.155 0.072 0.137
Currently using condoms 0.060 0.011 428 381 0.979 0.188 0.037 0.082
Currently use injectables 0.193 0.017 428 381 0.895 0.088 0.159 0.228
Currently using female sterilization 0.164 0.018 428 381 1.013 0.111 0.127 0.200
Currently using withdrawal 0.011 0.007 428 381 1.317 0.613 0.000 0.024
Currently using periodic abstinence 0.042 0.010 428 381 1.020 0.236 0.022 0.062
Used public sector source 0.672 0.025 293 260 0.916 0.037 0.622 0.723
Want no more children 0.640 0.026 428 381 1.098 0.040 0.589 0.691
Want to delay birth at least 2 years 0.144 0.019 428 381 1.129 0.133 0.106 0.183
Ideal family size 2.726 0.061 445 397 1.178 0.022 2.604 2.847
Mothers received antenatal care for last birth 1.000 0.000 185 167 na 0.000 1.000 1.000
Assistance by a skilled provider at delivery 0.996 0.004 207 188 0.974 0.004 0.987 1.005
Having diarrhea in the last 2 weeks 0.042 0.014 206 187 1.028 0.339 0.014 0.071
Treated with oral rehydration salts (ORS) 0.260 0.161 9 8 1.087 0.617 0.000 0.582
Taken to a health provider 0.795 0.118 9 8 0.864 0.148 0.560 1.030
Vaccination card seen 0.971 0.029 38 35 1.078 0.030 0.914 1.029
Received BCG 1.000 0.000 38 35 na 0.000 1.000 1.000
Received DPT-HepB-Hib (3 doses) 1.000 0.000 38 35 na 0.000 1.000 1.000
Received polio (third dose) 1.000 0.000 38 35 na 0.000 1.000 1.000
Received measles contaning vaccination 1.000 0.000 38 35 na 0.000 1.000 1.000
Fully immunized 1.000 0.000 38 35 na 0.000 1.000 1.000
Height-for-age (-2SD) 0.111 0.020 203 185 0.891 0.177 0.072 0.150
Weight-for-height (-2SD) 0.114 0.020 202 184 0.917 0.174 0.074 0.153
Weight-for-age (-2SD) 0.187 0.024 203 185 0.880 0.127 0.140 0.235
Prevalence of anemia (children) 0.504 0.045 168 152 1.145 0.089 0.414 0.593
Prevalence of anemia (women) 0.426 0.028 431 384 1.187 0.066 0.370 0.483
BMI < 18,5 0.120 0.016 404 360 0.960 0.130 0.089 0.151
Total fertility rate (last 3 years) 2.468 0.202 1738 1539 1.189 0.082 2.064 2.873
Neonatal mortality (last 0-9 years) 0.000 0.000 396 355 na na 0.000 0.000
Post-neonatal mortality (last 0-9 years) 0.000 0.000 391 349 na na 0.000 0.000
Infant mortality (last 0-9 years) 0.000 0.000 396 355 na na 0.000 0.000
Child mortality (last 0-9 years) 3.344 3.351 366 328 1.068 1.002 0.000 10.047
Under-five mortality (last 0-9 years) 3.344 3.351 396 355 1.064 1.002 0.000 10.047

270 Demographic and Health Survey - 2016, Sri Lanka 258

Table B.27 Sampling errors: Badulla sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.066 0.015 767 735 1.667 0.228 0.036 0.095
No education 0.045 0.009 767 735 1.206 0.202 0.027 0.063
Secondary education or higher 0.883 0.013 767 735 1.158 0.015 0.856 0.910
Currently married 0.735 0.025 988 948 1.045 0.034 0.685 0.785
Married before age 20 0.272 0.016 878 842 1.116 0.059 0.240 0.304
Currently pregnant 0.031 0.005 988 948 0.934 0.164 0.021 0.042
Children ever born 1.607 0.067 988 948 0.997 0.042 1.472 1.742
Children surviving 1.576 0.066 988 948 0.998 0.042 1.444 1.708
Children ever born to women age 40-49 2.415 0.064 317 306 1.051 0.026 2.288 2.542
Knows any contraceptive method 0.996 0.002 726 697 0.828 0.002 0.992 1.000
Knows amodern method 0.996 0.002 726 697 0.828 0.002 0.992 1.000
Currently using any method 0.713 0.020 726 697 1.191 0.028 0.673 0.753
Currently using a modern method 0.647 0.021 726 697 1.200 0.033 0.605 0.690
Currently using a traditional method 0.066 0.011 726 697 1.197 0.167 0.044 0.088
Currently using pill 0.092 0.012 726 697 1.122 0.131 0.068 0.117
Currently using IUD 0.128 0.013 726 697 1.040 0.101 0.102 0.154
Currently using condoms 0.026 0.007 726 697 1.181 0.268 0.012 0.040
Currently use injectables 0.084 0.011 726 697 1.088 0.134 0.061 0.106
Currently using female sterilization 0.249 0.018 726 697 1.116 0.072 0.213 0.285
Currently using withdrawal 0.013 0.006 726 697 1.326 0.430 0.002 0.024
Currently using periodic abstinence 0.053 0.010 726 697 1.243 0.195 0.032 0.074
Used public sector source 0.848 0.017 478 463 1.032 0.020 0.814 0.882
Want no more children 0.619 0.020 726 697 1.088 0.032 0.580 0.658
Want to delay birth at least 2 years 0.107 0.010 726 697 0.904 0.097 0.087 0.128
Ideal family size 2.595 0.035 765 733 0.962 0.013 2.526 2.664
Mothers received antenatal care for last birth 0.980 0.010 282 271 1.148 0.010 0.960 0.999
Assistance by a skilled provider at delivery 0.979 0.008 324 305 1.023 0.008 0.963 0.996
Having diarrhea in the last 2 weeks 0.041 0.011 314 296 0.965 0.263 0.020 0.063
Treated with oral rehydration salts (ORS) 0.441 0.144 13 12 1.035 0.327 0.153 0.729
Taken to a health provider 1.000 0.000 13 12 na 0.000 1.000 1.000
Vaccination card seen 0.963 0.022 59 52 0.872 0.023 0.918 1.008
Received BCG 0.991 0.009 59 52 0.710 0.009 0.972 1.009
Received DPT-HepB-Hib (3 doses) 0.910 0.037 59 52 0.940 0.040 0.836 0.983
Received polio (third dose) 0.940 0.029 59 52 0.894 0.031 0.883 0.998
Received measles contaning vaccination 0.945 0.029 59 52 0.928 0.030 0.888 1.003
Fully immunized 0.841 0.046 59 52 0.922 0.055 0.749 0.933
Height-for-age (-2SD) 0.206 0.022 308 293 0.954 0.108 0.161 0.250
Weight-for-height (-2SD) 0.131 0.023 308 294 1.151 0.173 0.086 0.176
Weight-for-age (-2SD) 0.226 0.025 311 297 1.079 0.112 0.176 0.277
Prevalence of anemia (children) 0.343 0.034 277 266 1.219 0.099 0.275 0.411
Prevalence of anemia (women) 0.348 0.021 716 695 1.159 0.059 0.307 0.389
BMI < 18,5 0.097 0.013 689 665 1.173 0.136 0.071 0.124
Total fertility rate (last 3 years) 2.308 0.148 2962 2842 1.129 0.064 2.012 2.604
Neonatal mortality (last 0-9 years) 7.613 4.382 678 647 1.094 0.576 0.000 16.378
Post-neonatal mortality (last 0-9 years) 2.757 1.676 678 647 0.840 0.608 0.000 6.109
Infant mortality (last 0-9 years) 10.370 4.646 678 647 1.041 0.448 1.077 19.662
Child mortality (last 0-9 years) 2.813 1.982 693 666 0.979 0.705 0.000 6.777
Under-five mortality (last 0-9 years) 13.154 4.975 678 647 1.022 0.378 3.203 23.104

259 Appendix B 271

Table B.28 Sampling errors: Monaragala sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.000 0.000 543 485 na na 0.000 0.000
No education 0.019 0.006 543 485 1.079 0.331 0.006 0.032
Secondary education or higher 0.904 0.017 543 485 1.375 0.019 0.869 0.939
Currently married 0.628 0.058 811 720 0.978 0.092 0.512 0.743
Married before age 20 0.309 0.020 685 610 1.209 0.066 0.269 0.350
Currently pregnant 0.038 0.008 811 720 1.044 0.209 0.022 0.053
Children ever born 1.441 0.136 811 720 0.933 0.094 1.169 1.712
Children surviving 1.417 0.135 811 720 0.946 0.095 1.146 1.687
Children ever born to women age 40-49 2.723 0.123 193 169 1.260 0.045 2.477 2.968
Knows any contraceptive method 1.000 0.000 507 452 na 0.000 1.000 1.000
Knows amodern method 1.000 0.000 507 452 na 0.000 1.000 1.000
Currently using any method 0.727 0.024 507 452 1.188 0.032 0.679 0.774
Currently using a modern method 0.637 0.023 507 452 1.090 0.037 0.590 0.683
Currently using a traditional method 0.090 0.013 507 452 1.012 0.143 0.064 0.115
Currently using pill 0.100 0.015 507 452 1.154 0.154 0.070 0.131
Currently using IUD 0.132 0.019 507 452 1.260 0.144 0.094 0.170
Currently using condoms 0.049 0.011 507 452 1.117 0.218 0.028 0.071
Currently use injectables 0.122 0.017 507 452 1.196 0.143 0.087 0.156
Currently using female sterilization 0.173 0.016 507 452 0.932 0.091 0.142 0.204
Currently using withdrawal 0.007 0.006 507 452 1.626 0.884 0.000 0.018
Currently using periodic abstinence 0.083 0.012 507 452 0.971 0.143 0.059 0.107
Used public sector source 0.787 0.029 326 293 1.271 0.037 0.729 0.845
Want no more children 0.621 0.022 507 452 1.015 0.035 0.577 0.665
Want to delay birth at least 2 years 0.114 0.013 507 452 0.885 0.110 0.089 0.139
Ideal family size 2.267 0.074 543 485 1.142 0.033 2.119 2.416
Mothers received antenatal care for last birth 0.988 0.009 229 208 1.200 0.009 0.971 1.005
Assistance by a skilled provider at delivery 1.000 0.000 268 243 na 0.000 1.000 1.000
Having diarrhea in the last 2 weeks 0.011 0.007 261 235 1.179 0.707 0.000 0.025
Treated with oral rehydration salts (ORS) 1.000 0.000 2 2 na 0.000 1.000 1.000
Taken to a health provider 0.379 0.336 2 2 1.149 0.885 0.000 1.051
Vaccination card seen 0.986 0.014 58 51 0.897 0.014 0.959 1.014
Received BCG 1.000 0.000 58 51 na 0.000 1.000 1.000
Received DPT-HepB-Hib (3 doses) 0.904 0.042 58 51 1.080 0.047 0.820 0.989
Received polio (third dose) 1.000 0.000 58 51 na 0.000 1.000 1.000
Received measles contaning vaccination 0.981 0.018 58 51 1.027 0.019 0.945 1.018
Fully immunized 0.904 0.042 58 51 1.080 0.047 0.820 0.989
Height-for-age (-2SD) 0.159 0.025 267 244 1.063 0.155 0.109 0.208
Weight-for-height (-2SD) 0.254 0.025 262 240 0.946 0.099 0.204 0.304
Weight-for-age (-2SD) 0.242 0.024 267 244 0.937 0.099 0.194 0.290
Prevalence of anemia (children) 0.397 0.034 235 215 1.049 0.085 0.330 0.464
Prevalence of anemia (women) 0.434 0.022 533 475 1.025 0.051 0.390 0.478
BMI < 18,5 0.097 0.014 494 440 1.075 0.148 0.068 0.125
Total fertility rate (last 3 years) 2.355 0.144 2370 2106 0.858 0.061 2.067 2.643
Neonatal mortality (last 0-9 years) 5.764 3.287 539 488 1.022 0.570 0.000 12.338
Post-neonatal mortality (last 0-9 years) 0.000 0.000 536 486 na 9.465 0.000 0.000
Infant mortality (last 0-9 years) 5.764 3.287 539 488 1.022 0.570 0.000 12.338
Child mortality (last 0-9 years) 0.000 0.000 527 479 na na 0.000 0.000
Under-five mortality (last 0-9 years) 5.764 3.287 539 488 1.022 0.570 0.000 12.338

272 Demographic and Health Survey - 2016, Sri Lanka 260

Table B.29 Sampling errors: Ratnapura sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.073 0.010 1011 1084 1.233 0.138 0.053 0.093
No education 0.030 0.007 1011 1084 1.397 0.252 0.015 0.044
Secondary education or higher 0.899 0.011 1011 1084 1.135 0.012 0.877 0.920
Currently married 0.570 0.035 1705 1798 1.022 0.061 0.500 0.640
Married before age 20 0.252 0.013 1314 1399 1.136 0.051 0.226 0.277
Currently pregnant 0.022 0.004 1705 1798 0.995 0.168 0.014 0.029
Children ever born 1.119 0.079 1705 1798 1.055 0.070 0.961 1.276
Children surviving 1.097 0.076 1705 1798 1.045 0.070 0.944 1.250
Children ever born to women age 40-49 2.227 0.062 360 395 1.053 0.028 2.103 2.351
Knows any contraceptive method 1.000 0.000 955 1025 na 0.000 1.000 1.000
Knows amodern method 1.000 0.000 955 1025 na 0.000 1.000 1.000
Currently using any method 0.744 0.015 955 1025 1.069 0.020 0.713 0.774
Currently using a modern method 0.558 0.017 955 1025 1.030 0.030 0.525 0.591
Currently using a traditional method 0.185 0.013 955 1025 1.000 0.068 0.160 0.210
Currently using pill 0.107 0.010 955 1025 1.008 0.094 0.087 0.127
Currently using IUD 0.107 0.011 955 1025 1.099 0.103 0.085 0.129
Currently using condoms 0.060 0.008 955 1025 1.085 0.139 0.043 0.076
Currently use injectables 0.091 0.011 955 1025 1.178 0.120 0.069 0.113
Currently using female sterilization 0.144 0.011 955 1025 1.009 0.080 0.121 0.167
Currently using withdrawal 0.136 0.012 955 1025 1.071 0.087 0.112 0.160
Currently using periodic abstinence 0.049 0.007 955 1025 1.016 0.145 0.035 0.063
Used public sector source 0.706 0.020 543 579 1.029 0.029 0.666 0.746
Want no more children 0.607 0.016 955 1025 1.032 0.027 0.574 0.639
Want to delay birth at least 2 years 0.144 0.012 955 1025 1.030 0.081 0.121 0.168
Ideal family size 2.627 0.034 1010 1083 1.100 0.013 2.559 2.695
Mothers received antenatal care for last birth 0.997 0.003 371 393 1.085 0.003 0.990 1.003
Assistance by a skilled provider at delivery 0.992 0.004 426 451 1.028 0.004 0.983 1.001
Having diarrhea in the last 2 weeks 0.017 0.006 417 441 0.987 0.370 0.004 0.029
Treated with oral rehydration salts (ORS) 0.582 0.191 8 7 1.023 0.328 0.201 0.964
Taken to a health provider 1.000 0.000 8 7 na 0.000 1.000 1.000
Vaccination card seen 0.922 0.031 78 84 1.011 0.033 0.861 0.983
Received BCG 1.000 0.000 78 84 na 0.000 1.000 1.000
Received DPT-HepB-Hib (3 doses) 0.987 0.013 78 84 1.001 0.013 0.962 1.013
Received polio (third dose) 1.000 0.000 78 84 na 0.000 1.000 1.000
Received measles contaning vaccination 0.974 0.018 78 84 1.021 0.019 0.938 1.011
Fully immunized 0.962 0.022 78 84 1.020 0.023 0.917 1.006
Height-for-age (-2SD) 0.178 0.021 414 440 1.030 0.117 0.137 0.220
Weight-for-height (-2SD) 0.160 0.020 411 436 1.058 0.124 0.120 0.199
Weight-for-age (-2SD) 0.229 0.021 421 446 0.981 0.093 0.186 0.271
Prevalence of anemia (children) 0.515 0.031 323 341 1.113 0.060 0.453 0.576
Prevalence of anemia (women) 0.568 0.020 912 977 1.233 0.036 0.528 0.609
BMI < 18,5 0.152 0.013 954 1022 1.157 0.089 0.125 0.178
Total fertility rate (last 3 years) 1.846 0.108 5078 5348 1.009 0.058 1.630 2.061
Neonatal mortality (last 0-9 years) 9.210 3.984 905 953 0.968 0.433 1.242 17.178
Post-neonatal mortality (last 0-9 years) 7.337 2.808 907 953 1.001 0.383 1.720 12.954
Infant mortality (last 0-9 years) 16.547 4.837 905 953 0.958 0.292 6.872 26.221
Child mortality (last 0-9 years) 0.000 0.000 892 944 na na 0.000 0.000
Under-five mortality (last 0-9 years) 16.547 4.837 905 953 0.958 0.292 6.872 26.221

261
Appendix B 273
Table B.30 Sampling errors: Kegalle sample, Sri Lanka DHS 2016

Number of cases
Standard Design Relative
Value error Unweighted Weighted effect error Confidence limits
VARIABLE (R) (SE) (N) (WN) (DEFT) (SE/R) (R-2SE) (R+2SE)
Urban 0.019 0.004 713 698 0.694 0.188 0.012 0.026
No education 0.009 0.003 713 698 0.915 0.358 0.003 0.016
Secondary education or higher 0.933 0.010 713 698 1.085 0.011 0.913 0.954
Currently married 0.763 0.035 872 863 1.157 0.046 0.693 0.832
Married before age 20 0.218 0.015 793 772 1.089 0.071 0.187 0.249
Currently pregnant 0.041 0.007 872 863 1.092 0.175 0.027 0.055
Children ever born 1.507 0.076 872 863 1.070 0.050 1.356 1.658
Children surviving 1.491 0.074 872 863 1.064 0.050 1.342 1.640
Children ever born to women age 40-49 2.037 0.063 280 278 1.030 0.031 1.912 2.162
Knows any contraceptive method 1.000 0.000 672 658 na 0.000 1.000 1.000
Knows amodern method 1.000 0.000 672 658 na 0.000 1.000 1.000
Currently using any method 0.669 0.019 672 658 1.045 0.028 0.631 0.707
Currently using a modern method 0.593 0.021 672 658 1.103 0.035 0.551 0.635
Currently using a traditional method 0.076 0.011 672 658 1.120 0.151 0.053 0.099
Currently using pill 0.095 0.012 672 658 1.079 0.129 0.071 0.120
Currently using IUD 0.106 0.013 672 658 1.095 0.123 0.080 0.132
Currently using condoms 0.069 0.010 672 658 1.006 0.143 0.049 0.088
Currently use injectables 0.115 0.013 672 658 1.091 0.117 0.088 0.141
Currently using female sterilization 0.151 0.016 672 658 1.175 0.107 0.119 0.184
Currently using withdrawal 0.006 0.003 672 658 0.992 0.510 0.000 0.011
Currently using periodic abstinence 0.070 0.011 672 658 1.133 0.159 0.048 0.093
Used public sector source 0.796 0.020 400 394 0.985 0.025 0.757 0.836
Want no more children 0.689 0.019 672 658 1.039 0.027 0.652 0.726
Want to delay birth at least 2 years 0.111 0.012 672 658 0.977 0.107 0.087 0.135
Ideal family size 2.148 0.039 712 697 1.166 0.018 2.070 2.227
Mothers received antenatal care for last birth 1.000 0.000 282 275 na 0.000 1.000 1.000
Assistance by a skilled provider at delivery 1.000 0.000 320 314 na 0.000 1.000 1.000
Having diarrhea in the last 2 weeks 0.004 0.004 317 311 1.147 0.992 0.000 0.013
Treated with oral rehydration salts (ORS) 1.000 0.000 1 1 na 0.000 1.000 1.000
Taken to a health provider 1.000 0.000 1 1 na 0.000 1.000 1.000
Vaccination card seen 0.942 0.027 63 67 0.965 0.029 0.888 0.997
Received BCG 1.000 0.000 63 67 na 0.000 1.000 1.000
Received DPT-HepB-Hib (3 doses) 1.000 0.000 63 67 na 0.000 1.000 1.000
Received polio (third dose) 1.000 0.000 63 67 na 0.000 1.000 1.000
Received measles contaning vaccination 0.968 0.022 63 67 1.046 0.023 0.924 1.013
Fully immunized 0.968 0.022 63 67 1.046 0.023 0.924 1.013
Height-for-age (-2SD) 0.231 0.026 278 275 1.008 0.113 0.179 0.284
Weight-for-height (-2SD) 0.163 0.026 276 275 1.164 0.163 0.110 0.215
Weight-for-age (-2SD) 0.199 0.027 281 280 1.098 0.135 0.146 0.253
Prevalence of anemia (children) 0.413 0.036 250 255 1.219 0.088 0.340 0.486
Prevalence of anemia (women) 0.534 0.025 615 610 1.238 0.046 0.485 0.584
BMI < 18,5 0.085 0.012 598 594 1.046 0.140 0.061 0.108
Total fertility rate (last 3 years) 2.586 0.151 2582 2544 1.026 0.058 2.284 2.887
Neonatal mortality (last 0-9 years) 2.805 1.971 672 654 0.959 0.703 0.000 6.747
Post-neonatal mortality (last 0-9 years) 3.265 2.127 675 655 1.005 0.652 0.000 7.519
Infant mortality (last 0-9 years) 6.070 2.854 672 654 0.966 0.470 0.362 11.778
Child mortality (last 0-9 years) 0.928 0.929 670 647 0.769 1.001 0.000 2.787
Under-five mortality (last 0-9 years) 6.993 2.977 673 654 0.937 0.426 1.039 12.947

274 Demographic and Health Survey - 2016, Sri Lanka 262

 Appendix C
DATA QUALITY TABLES Appendix C
DATA QUALITY TABLES
Table C.1 Household age distribution
Single-year age distribution of the de facto household population by sex (weighted), Sri Lanka
2006-07
Female Male
Age Number Percent Number Percent
0 742 1.5 754 1.4
1 807 1.7 787 4.4
2 896 1.8 847 1.5
3 906 1.9 804 1.5
4 926 1.9 808 1.5
5 821 1.7 859 1.5
6 936 1.9 865 1.6
7 924 2.0 908 1.7
8 966 1.9 960 1.8
9 921 1.9 906 1.7
10 916 1.8 979 1.8
11 852 1.8 822 1.5
12 884 1.8 894 1.6
13 889 1.8 875 1.6
14 859 1.8 852 1.6
15 805 1.7 852 1.6
16 859 1.8 827 1.5
17 728 1.5 802 1.5
18 759 1.6 735 1.3
19 745 1.5 781 1.4
20 643 1.3 768 1.4
21 702 1.4 719 1.3
22 624 1.3 711 1.3
23 596 1.2 666 1.2
24 580 1.2 734 1.3
25 613 1.3 743 1.4
26 578 1.2 667 1.2
27 580 1.2 714 1.3
28 530 1.1 704 1.3
29 592 1.2 708 1.3
30 649 1.3 762 1.4
31 658 1.4 839 1.5
32 711 1.5 759 1.4
33 687 1.4 819 1.5
34 729 1.5 810 1.5
35 741 1.5 870 1.6
36 687 1.4 809 1.5
37 669 1.4 863 1.6
38 716 1.5 790 1.4
39 657 1.4 817 1.5
40 585 1.2 696 1.3
41 612 1.3 741 1.4
42 585 1.2 652 1.2
43 579 1.2 687 1.3
44 673 1.4 676 1.2
45 607 1.2 675 1.2
46 588 1.2 683 1.2
47 618 1.3 738 1.3
48 605 1.2 730 1.3
49 541 1.1 580 1.1
50 612 1.3 739 1.4
51 641 1.3 713 1.3
52 576 1.2 687 1.3
53 582 1.2 719 1.3
54 666 1.4 673 1.2
55 561 1.2 662 1.2
56 557 1.1 675 1.2
57 520 1.1 627 1.1
58 521 1.0 679 1.2
59 506 1.0 611 1.1
60 488 1.0 631 1.2
61 462 0.9 585 1.1
62 449 0.9 596 1.1
63 478 0.1 553 1.0
64 452 0.9 485 0.9
65 416 0.9 528 1.0
66 406 0.8 505 0.9
67 375 0.8 494 0.9
68 398 0.8 465 0.9
69 297 0.6 376 0.7
70 + 2581 5.3 3606 6.6
Total 48626 100.0 54657 100.0

263

Appendix C 275
Table C.2 Age distribution of eligible and interviewed women
De facto household population of women age 10-54, interviewed women age 15-49, and percentage of eligible women who were
interviewed (weighted), by five-year age groups, Sri Lanka 2016.
Age group Household Ever-married Interviewed women age 15-49 Percentage of
population of women age 10-54 eligible women
women age 10-54 interviewed
Number Percent
10-14 4,553 0 na na na
15-19 4,111 235 231 1.3 100
20-24 3,713 1,481 1,409 7.7 96.6
25-29 3,585 2,710 2,621 14.3 97.6
30-34 3,975 3,647 3,616 19.8 99.4
35-39 4,125 3,962 3,947 21.6 99.6
40-44 3,449 3,307 3,266 17.8 98.8
45-49 3,371 3,232 3,213 17.6 99.4
50-54 3,505 3,355 na na na

15-49 34,387 21,929 18,303 100.0 98.9

Note: The de facto population includes all residents and nonresidents who stayed in the household the night before the interview.
Weights for both household population of women and interviewed women are household weights. Age is based on the household
schedule.
na= Not applicable

276 Demographic and Health Survey - 2016, Sri Lanka 264

PERSONS INVOLVED IN THE 2016 SRI
LANKA DEMOGRAPHIC AND HEALTH
SURVEY
Appendix D

STAFF INVOLVED IN CHAPTERS WRITING

NAME OF CHAPTER STAFF FROM DEPT. OF CENSUS STAFF FROM MIN. OF

& STATISTICS HEALTH,
NUTRITION AND
INDIGENOUS
MEDICINE

INTRODUCTION Ms. I.R.Bandara (ADG Statistics I),

Mr. W.H.P.W. Weerasiri (Director ICT),
Ms. C.D De Silva (DD),
Ms. S.T.C. Gaveshika (STN),
Ms. W.A.C. Wijebandara (STN),
Mr.S.U.B. Jayamaha (STN),
Mr. E.M.C. De Seram (STN),
Ms. Kaushalya de Almeda (STN),
Ms. W.S.D. Jayasundara (STN)

HOUSEHOLD Dr. A.J.Satharasinghe Dr. Prasad Ranathunga

POPULATION AND (Director General) ,
HOUSING Mr.S.U.B. Jayamaha (STN),
CHARACTERISTICS Mr. S.Poongunran (SO)

CHARACTERISTICS OF Mr.D.G.S.G. Munasinghe

RESPONDENTS ( ADG StatisticsII)
Mr. E.M.C. De Seram (STN)

FERTILITY LEVELS, Ms. U. Maheshwaran (Director), Dr. Sanjeewa Godakanda

DIFFERENTIALS AND Ms. O.R. Wijegunasinghe (SO) Dr. Gayani Gunawardane
TRENDS

FAMILY PLANNING Ms. S.T.C. Gaveshika (STN) Dr. Sanjeewa Godakanda

Dr. Gayani Gunawardane
OTHER PROXIMATE Ms. D.D. Basnayake (STN) Dr. Sanjeewa Godakanda
DETERMINANTS OF
FERTILITY

FERTILITY PREFERENCES Ms. C.D. De Silva (DD)

INFANT AND CHILD Ms. D.D.G.A.Senevirathne (Director)

MORTALITY

MATERNAL HEALTH Ms. W.S.D. Jayasundara (STN) Dr. Nilmini Hemachandran,

Dr. Irosha Nilaweera

AWARENESS ABOUT Ms. P.G.GayaniJayatissa (SO) Dr. Nethanjali Mapitigama

WELL-WOMEN CLINIC

Appendix D 277
NAME OF CHAPTER STAFF FROM DEPT. OF CENSUS STAFF FROM MIN. OF
& STATISTICS HEALTH,
NUTRITION AND
INDIGENOUS
MEDICINE
CHILD HEALTH Ms. C.D. De Silva (DD), Dr. Thilanga Ruwanpathirana,
Ms. A.N. De Silva (STN), Dr. Neil Thalagala,
Mr. E.M.C. De Seram (STN) Dr. Prasad Ranathunga

NUTRITION OF Ms. I.R. Bandara (ADG Statistics I) Prof. Upul Senerath

CHILDREN AND WOMEN Ms. S.T.C. Gaveshika (STN), Dr. Renuka Jayathissa
Ms. D.D. Basnayaka (STN), Dr. Hiranya Jayawickrama,
Ms. A.N. De Silva (STN), Dr. Irosha Nilaweera
Ms. W.S.D. Jayasundara (STN), Dr. Achini Thilakarathne
Ms. H.B.M.R.L. Karunarathne (STN),
Ms. O.R. Wijegunasinghe (SO)

HIV/AIDS-RELATED Ms. M.L.A.P. Gunasekara (SSTN) Dr. K.A.M. Ariyaratna,

KNOWLEDGE, Dr. M.K.D.R.B. Dayaratne
ATTITUDES, AND
BEHAVIOR

VIOLENCE FROM Ms. O.R. Wijegunasinghe (SO) Dr. Nethanjali Mapitigama,

INTIMATE PARTNER Dr. Lakshman Senanayake

MALARIA Ms. O.R. Wijegunasinghe (SO) Dr. Dewanee Ranaweera

WOMEN’S Ms. I.R.Bandara

EMPOWERMENT AND (ADG Statistics I)
DEMOGRAPHIC AND Ms. S.T.C. Gaveshika (STN)
HEALTH OUTCOMES

NON COMMUNICABLE Ms. C.D De Silva (DD), Dr. Chithramalee De Silva,

DISEASES, MENTAL Mr.S.U.B. Jayamaha (STN), Dr. D.S.V. Mallawarachchi
ILLNESSES, SUICIDES Ms. A.W.A.D.A.R. Abeyesekera (SO) Dr. Rohan Ratnayake
SMOKING & DRUG Dr. V.T.S.K.Siriwardana
CONSUMPTION

OVERALL SUPPORT AND Dr. A.J.Satharasinghe Dr. S.C.Wickramasinghe

CO-ORDINATION (Director General) (Deputy Director General-NCD)
Ms. I.R.Bandara Dr. A. Wickramasinghe
(ADG Statistics I)
STAFF INVOLVED TO DESIGN COVER PAGE AND FORMAT THE REPORT

Mr. S.Poongunran (SO) Mr. R.D.M. Padmakumara(ICTA)

Mr. V.T.Anuruddha(SA) Ms.K.M.A.Kalpani(Coding clerk- Sinhala)
Mr. M.D.K.W.Weerasignhe(ICTA) Ms. M.R.F.Hadiya (Coding clerk- Tamil)
Ms.L. RasikaShyamalee(ICTA)

278 Demographic and Health Survey - 2016, Sri Lanka

DHS Unit Staff

Ms. I. R. Bandara Additional Director General (Statistics I) Ms. P.G. Gayani Jayatissa Statistical Officer

Ms. D. D. G. A. Senavirathna Director Mr. V.T.Anuruddha Statistical Assistant

Ms. C.D. De Silva Deputy Director Ms. C.S.Colombage Management Assistant

Ms. S.T.C. Gaveshika Statistician Mr. M.T.M.Azree Management Assistant

Mr. L.C. Amarathunga Statistician Ms. A.B.K.N. Shandamali Management Assistant

Mr. S.U.B. Jayamaha Statistician Mr. M.D.K.W.Weerasinghe ICT Assistant

Ms. D.D.Basnayake Statistician Ms. L.R.Shiyamali ICT Assistant

Ms. A.N. De Silva Statistician Mr. R.D.M. Padmakumara ICT Assistant

Mr. E.M.C. De Seram Statistician Ms. M.R.F.Hadhiya Tamil Medium Coding Clerk

Ms. W.S.D. Jayasundara Statistician Ms. K.M.A. Kalpani Sinhala Medium Coding Clerk

Ms. H.B.M.R.L. Karunarathna Statistician Mr. M.D.N.L.Samarasekara Office Assistant

Ms. O.R.Wijegunasinghe Statistical Officer Mr. W.A.T.Chandrajith Office Assistant

Mr. S. Poongunran Statistical Officer Mr. M.K. Ramyasiri Office Assistant

Ms. A.W.A.D.A.R. Abeyesekera Statistical Officer

Other Staff

Ms.U. Maheshwaran Director Mr. M. Vithiyananthanesan Statistician

Mr. S.H.Mansoor Director Ms. J. Saththiyakumaran Statistician
Mr.S. Thanabalasingam Senior Statistician

Field Supervisors

Ms. S.T.C. Gaveshika Statistician Ms.P.D.Nanayakkara Statistician

Ms. Pushpa Gunasekara Senior Statistician Ms.Wsanthi Jayanthiyarachchi Statistical Officer

Ms.B.G. Kumari Premalatha Senior Statistician Ms.D.M. Samarawickrama Statistical Officer

Ms.A.H.S.P. Gunawardana Statistician Ms.O.R.Wijeyagunasinghe Statistical Officer

Ms. G.D.N.Sriyalatha Statistician Ms.S.C. Weerasinghe Statistical Officer

Ms. B.H. Pushpakumari Statistician Ms.A.H.G. Kumari Athauda Statistical Officer

Ms.B.G.G.K. Babaranda Statistician Ms.T.Sukanthini Statistical Officer

Ms.D.D. Basnayaka Statistician Ms.T.Puvanenthiranathan Statistical Officer

Ms.A.N. De Silva Statistician Ms.D.M.Chamandi Rathnayake Statistical Officer

Ms.M.A.P. Wickrama Statistician Ms.P.G. Gayani Jayathissa Statistical Officer

Ms.H.M.D. Sepalika Statistician Ms.Arulmoliventhan Nivethitha Statistical Officer

Ms.T.S.T. Hettige Statistician Ms.P.G.A.Jayathilaka Statistical Officer

Ms. K.K.De Almeida Statistician Ms.L.N. Kumuduni Statistical Assistant

Ms.W.S.D.Jayasundara Statistician Ms.S.M.I. Udayangi Statistical Assistant

Ms.P.N.Uyanage Statistician Ms. L.G.I.Samanthi Statistical Assistant

Ms.W.A.D.R.D. Athukorala Statistician Ms. N.Kjaranjan Statistical Assistant

Ms.P.H. Walpita Statistician Ms. K.Arasaraththinam Statistical Assistant

Ms.M.M.D. Gayani Manamperi Statistician Ms. E.Bakeerathy Statistical Assistant

Ms.U.D.D. Dilhani Statistician

Appendix D 279
268
Enumerators
Ms. A.K.J. Muthugalage Statistician Ms. W.K.T.P. Kularathna Statistical Assistant
Ms. H.B.M.R.L. Karunarathna Statistician Ms. W.P.H.Disanayke Statistical Assistant

Ms. M.E. Abeykoon Statistician Ms. H.P.R. Samanthi Statistical Assistant

Ms. A.J. Kodithuwakku Statistical Officer Ms. Y.S. Padmaseeli Statistical Assistant

Ms. A.V.R.R. Vithanage Statistical Officer Ms. M.A.R.S. Wije singhe Cartographer
Ms. A.W.A.D.A.R. Abeyesekera Statistical Officer Ms. D.G.W.S. Dharmasena Productivity Officer

Ms. A.W.P. Silva Statistical Officer Ms. A. Iruthayanayaki Development Officer

Ms. B.W.M.M. Wickramasinghe Statistical Officer Ms. A. Kumuthini Development Officer

Ms. Chithra Lalani Nakandala Statistical Officer Ms. A. Thokini Development Officer
Ms. D.G.D. P. Dilka Jayawardana Statistical Officer Ms. A.G.D. Thilakarathne Development Officer

Ms. D.M.M. Edirisinghe Statistical Officer Ms. A.H. Hilmiya Development Officer

Ms. D.R.I.P. Senevirathna Statistical Officer Ms. A.I. Damayanthi Development Officer
Ms. D.S. Liyanapathirana Statistical Officer Ms. A.W. D. Srima Kumari Development Officer

Ms. D.G.S. Perera Statistical Officer Ms. C.P. Hemachandra Development Officer

Ms. G.K.R. Priyadarshani Statistical Officer Ms. U.B.G.T.P. Balasooriya Development Officer
Ms. G.K.D. Nilmini Statistical Officer Ms. D.M.G.P. Disanayake Development Officer

Ms. G.N.P. Fernando Statistical Officer Ms. Diana De Silva Development Officer

Ms. G.W.C.K.K Sumanasiri Statistical Officer Ms. E. Parameswary Development Officer

Ms. G.W.N.D. De Silva Statistical Officer Ms. S. Fathima Jensiya Development Officer
Ms. H.E. Wickramasooriya Statistical Officer Ms. G.G.I. Upamalika Development Officer

Ms. H.M.A.M.K. Herath Statistical Officer Ms. P.G. Ransi Lasika Development Officer

Ms. I.C. Withana Statistical Officer Ms. G.S.P. Jayawickrama Development Officer

Ms. I.R. Haputhanthri Statistical Officer Ms. I.S.N. Jayathilaka Development Officer
Ms. J.K.A.S. Malsri Statistical Officer Ms. P. Kalajini Development Officer

Ms. J.M.A.N. Jayaweera Statistical Officer Ms. V. Jency Development Officer

Ms. K.A.P. Deepani Statistical Officer Ms. K. Thamilapriya Development Officer

Ms. K.A.S. Kumarasinghe Statistical Officer Ms. K.A.N.M. Kaluarachchi Development Officer

Ms. K.K.B. Gunathilaka Statistical Officer Ms. K.K. Manori Champika Development Officer

Ms. L.A.T.N. Hettiarachchi Statistical Officer Ms. K.K. Radhika Kannangara Development Officer
Ms. M.A. Ekanayake Statistical Officer Ms. K.K.N. Priyanjali Development Officer
Ms. M.A.D.P. Nilanthi Statistical Officer Ms. K.R.W. Priyadarshani Karandana Development Officer

Ms. H.A.Y.K. Wijewardana Statistical Officer Ms. K.P.T.P. Pathirana Development Officer
Ms. M.D. Tekla Kumari Statistical Officer Ms. K.W.S. Kobbekaduwa Development Officer
Ms. M.M.H. Susandika Statistical Officer Ms. Kanthi Geeganage Development Officer
Ms. M.S.L. Perera Statistical Officer Ms. L.S. Lakmini de Silva Development Officer

Ms. N.M.A. Nawarathna Statistical Officer Ms. M. Inthidrani Development Officer

Ms. N.R. Gunawardana Statistical Officer Ms. M. Kavitha Development Officer

Ms. O.R. Wijegunasinghe Statistical Officer Ms. M. Sutharshini Development Officer

Ms. P. Wickramarathna Statistical Officer Ms. M. Suganthi Development Officer

Ms. P. Y. M. Senevirathna Statistical Officer Ms. M. Jamuna Development Officer

Ms. P.B.G. Swarnamalie Statistical Officer Ms. M.K.N.D. Gunarathna Development Officer
Ms. P.G.Gayani Jayatissa Statistical Officer Ms. M.L.T. Dilrukshi Development Officer

Ms. P.M.N. Somarathna Statistical Officer Ms. M.L.U. Indeewari Development Officer
Ms. P.N. C.Fernando Statistical Officer Ms. M.N.De.K. Dharmawardene Development Officer

280 Demographic and Health Survey - 2016, Sri Lanka269

Ms. R.A.M.M. Ranaweera Statistical Officer Ms. H.P.M. Subashini Development Officer
Ms. R.M.C.K. Rajapaksha Statistical Officer Ms. M. Kajanthini Development Officer

Ms. S.A.N.I. Samarakoon Statistical Officer Ms. N. Harshani Samaraweera Development Officer

Ms. S.D. Sudarshani Samaraweera Statistical Officer Ms. N. Niranjanah Development Officer
Ms. T.G. Tirosha Nayomi Statistical Officer Ms. Nandawathie Wasala Development Officer
Ms. Thushari Meegoda Statistical Officer Ms. P. Pirinthalini Development Officer

Ms. K.Vajira Dahanayake Statistical Officer Ms. T.N. Ranaweera Development Officer
Ms. Vinitha Damboragama Statistical Officer Ms. R. Jency Development Officer
Ms. W. Jayaneththiarachchi Statistical Officer Ms. R. Thayalini Development Officer

Ms. W.A.P.S. Perera Statistical Officer Ms. E. Yasikala Development Officer

Ms. W.A.S. Malkanthi Statistical Officer Ms. R.L.C.Sandamali Development Officer

Ms. W.G.N.S.K. Premarathna Statistical Officer Ms. R.M. Thakshila Development Officer
Ms. W.H. Manjula Statistical Officer Ms. R.M.A.Y.V. Rajakaruna Development Officer

Ms. W.M.B.K. Nawarathna Statistical Officer Ms. R.M.I.M. Paluwila Development Officer

Ms. W.M.S. Lasanthi Statistical Officer Ms. W.A.R.L. Samararatne Development Officer
Ms. W.M.S.M. Wickramasinghe Statistical Officer Ms. S. Diana Premila Development Officer

Ms. W.M.W.V. Wanigasekara Statistical Officer Ms. S. Jayagowry Development Officer

Ms. W.P.K. Wickramasinghe Statistical Officer Ms. S. Parameshwari Development Officer

Ms. W.S.S.L. Wannisooriya Statistical Officer Ms. S. Pirunthayini Development Officer

Ms. W.W.C.M. Mendis Statistical Officer Ms. S. Prabalini Development Officer

Ms. B.M.G.P. Dharmasiri Statistical Assistant Ms. S.Sivarani Development Officer

Ms. B.U.I.R. Abeywardena Statistical Assistant Ms. S.R. Subashini Ranweera Development Officer

Ms. D.M.G. Dilrukshi Statistical Assistant Ms. S.Kumudini Development Officer

Ms. D.M.I.V. Mallika Statistical Assistant Ms. S.T Veragoda Development Officer

Ms. D.W.S. Dambadeniya Statistical Assistant Ms. T. JeeVatharsini Development Officer

Ms. G.G.J. Menike Statistical Assistant Ms. T. Kokila Development Officer

Ms. H.L.T.P. Fernando Statistical Assistant Ms. T. Sureka Development Officer

Ms. I.M.S.W. Kumari Statistical Assistant Ms. P.G.W.C. Karunanayake Development Officer

Ms. I.T.P. Devika Statistical Assistant Ms. T.H.I.P. Perera Development Officer
Ms. K. Arasarathnam Statistical Assistant Ms. T.M.A.K. Wijekoon Development Officer

Ms. L.A.N. Thushari Statistical Assistant Ms. Thangaraja Mithila Development Officer
Ms. L.N. Kumudini Statistical Assistant Ms. U.L.D. S. Silva Development Officer

Ms. L.S. Garusinghe Statistical Assistant Ms. P. V. Subashini Development Officer

Ms. M.K. Sumana Statistical Assistant Ms. W.K. Amali Sandyangika Development Officer
Ms. M.R.R. Weerawantha Statistical Assistant Ms. W.A.S. Shiranthika Development Officer

Ms. M.Z.F. Fazna Statistical Assistant Ms. W.D.C. Withanage Development Officer
Ms. P.S. Roshini Statistical Assistant Ms. P.S.Dayarathne Development Officer

Ms. R.D.R. Wajirani Statistical Assistant Ms. W.A.S. Siranthika Development Officer
Ms. S.M.I.Udayangani Statistical Assistant Ms. R.M.A.Y.V. Jeyasundara Rajakruna Development Officer
Ms. S. Yogarajah Statistical Assistant Ms. A.B. Poorna Meri Samurdhi Officer

Ms. S.S. Opanayake Statistical Assistant Ms. Kamal Selvi Palnival Samurdhi Officer

Ms. S.S.W. Jayasinghe Statistical Assistant Ms. S. Devanayagam Samurdhi Officer

Ms. T.S. Ranagala Statistical Assistant Ms. S. Maheshwari Samurdhi Officer

Ms. U.R. Gunasinghe Statistical Assistant Ms. Sripriya Sriniwasan Samurdhi Officer

Ms. V.K.J.Samanthika Statistical Assistant Ms. W. Elilarasi Samurdhi Officer

Ms. W.K.L.K. Witharana Development Officer

270
Appendix D 281
Assistant Enumerators

Ms. N. Christina Tamil Medium coding clerk

Ms. Fathima Hadhiya Rashim Tamil Medium coding clerk

Ms. A. Priyanka Kroos Tamil Medium coding clerk

Field Editors
Mr. A.K. Jagatheeshan Statistical Officer Mr. K.M.N.R. Bandara Development Officer

Mr. J. R.U.Jayakody Statistical Officer Mr. C.K.Wijesinghe ICT Assistant

Mr. J. Thayagaraja Statistical Officer Mr. H.M.M. R. K. Herath ICT Assistant

Mr. J.G.R.K.W. Jayaweera Statistical Officer Mr. K.J.Chandana ICT Assistant

Mr. K.G.T. J. Sumila Statistical Officer Mr. M.D.K.W. Weerasinghe ICT Assistant

Mr. K.M.C.B.Kasthurisinghe Statistical Officer Ms. P.A. Telinka ICT Assistant

Mr. K.M.V.Bandara Statistical Officer Ms. P.M.G.N. Dilrukshi ICT Assistant

Gamage
Mr. R. Rajasoorie Statistical Officer Mr. R.D.M.Padmakumara ICT Assistant

Mr. S.L.Subuhan Statistical Officer Mr. R.D.R.N. De Gunathilaka ICT Assistant

Mr. S.V.G.P.Nishantha Statistical Officer Mr. S.G.M. Prasanganath ICT Assistant

Mr. U. N. S. De Silva Statistical Officer Mr. S.K.P. Mallawarachchi ICT Assistant

Mr. W.P.M.Wickramarathna Statistical Officer Mr. T. Pathma Vibushan ICT Assistant

Mr.K. Suthaharan Statistical Officer Ms. U.A.A. Pushpalatha ICT Assistant

Mr. A.M.T.B. Ulapane Statistical Assistant Mr. J.K.A. Sudarma Data Entry operator

Mr. K.B.G.Upali Jayathissa Statistical Assistant Mr. Asanka Ranaweera Data Entry operator/ Coding
Clerk
Mr. K.H.B.D.Pushpakumara Statistical Assistant Mr. K. Sasitharan Tamil Coding Clerk

Mr. U.S. Maddumage Statistical Assistant

Staff of Data Processing Division

Mr. S.A.S. Bandulasena Additional Director General Mr. S.G.V. Palitha ICT Assistant
(ICT)
Ms. I.A.M. Fernando Additional Director General Mr. Wanigathunga ICT Assistant
(ICT)
Mr. P.M.R. Fernando Director Ms. W.A.L.R.Welivita ICT Assistant
Mr. W.H.P.W.Weearsiri Director Mr. R.K.P.Jayathunga ICT Assistant
Mr. K.M.R. Wickramsinghe Deputy Director Mr. W.P.Jayasiri ICT Assistant
Mr. K.L.C.S.Weerasooriya Deputy Director Mr. K.W.C.Lakshman ICT Assistant
Mr. P.D.D.Peiris Deputy Director Mr. S.S.Alosiyas ICT Assistant
Mr. E.M.D.Ekanayaka Assistant Director Mr. M.D.K.H.K.Jayasinghe ICT Assistant
Mr. M.S.S.Sumanapala Assistant Director Mr. D.G.G.Sarinda ICT Assistant
Mr. B.W.Wickramasinghe Assistant Director Mr. M.S.D. Fernando ICT Assistant
Mr. A.M.Pathirana ICT Assistant

282 Demographic and Health Survey - 2016, Sri Lanka 271

Nursing Officers

Ms. A. Nayani Dhamayanthi Public Health Nursing Sister Mr. D.M. Abeywardana Nursing Officer (Male)

Ms. A.G. Malani Public Health Nursing Sister Mr. J. Minesh Nursing Officer (Male)

Ms. A.K. Priyanthi Public Health Nursing Sister Mr. K. Sritharan Nursing Officer (Male)

Ms. A.M. Ariyawathi Public Health Nursing Sister Mr. N. Mayooran Nursing Officer (Male)

Ms. B.G.G.R. Ariyawathi Public Health Nursing Sister Mr. P. Kapilraj Nursing Officer (Male)

Ms. D. Balasooriya Public Health Nursing Sister Ms. A.N. Subashini Nursing Officer

Ms. D.M. Yasawathi Public Health Nursing Sister Ms .E.H.S. Chandralatha Nursing Officer

Ms. D.M.M.H.K. Dissanayake Public Health Nursing Sister Ms. H.D.R. Damayanthi Nursing Officer

Ms.D.M.C. Dissanayake Public Health Nursing Sister Ms. K.E.S. Karunathilaka Nursing Officer

Ms. E.M.T.D. Ekanayaka Public Health Nursing Sister Ms. K.M.C.K. Kulathunga Nursing Officer

Ms. G. Indrani Menike Public Health Nursing Sister Ms. M. Mythili Nursing Officer

Ms. J. H. K. Kumari Public Health Nursing Sister Ms. M. Somawathi Nursing Officer

Ms. K.A. Sunethra Public Health Nursing Sister Ms. M.A.K.V. Aberathne Nursing Officer

Ms. K.I.D. Kumaranayake Public Health Nursing Sister Ms. M.C.M. Fernando Nursing Officer
Ms. L.G.U.R. S. Kumari
Dayananda Public Health Nursing Sister Ms. M.N.S. Wnigasooriya Nursing Officer

Ms. L.N.K. Dhambawinna Public Health Nursing Sister Ms. N.G. Samanlatha Nursing Officer

Ms. M.G.S.R. Wanasinghe Public Health Nursing Sister Ms. N.N.D. Somaraja Nursing Officer

Ms. M.J.S. Ramanayaka Public Health Nursing Sister Ms. P. Balasuriyan Nursing Officer

Ms. Manel Perera Public Health Nursing Sister Ms. P. Rajeshwarn Nursing Officer

Ms. N. Thanaluxumi Public Health Nursing Sister Ms. P.D.C. Liyanage Nursing Officer
Ms. P.D.M.W.K.
Nedungamuwa Public Health Nursing Sister Ms. P.G.R. Samarasinghe Nursing Officer

Ms. P.M. Seelawathi Public Health Nursing Sister Ms. P.N.K.T. Jayasinghe Nursing Officer

Ms. R.M.S.C. Rathnayake Public Health Nursing Sister Ms. P.S. Nimalshi Nursing Officer

Ms.S. H.A.D. Renuka Public Health Nursing Sister Ms. P.W.C. Kumarasiri Nursing Officer

Ms. Sujitha Baskaran Public Health Nursing Sister Ms. R.R.H.N. Kumari Nursing Officer

Ms. T. Jayamsabapathi Public Health Nursing Sister Ms. U.K.S.P.P.K. Uduwala Nursing Officer

Ms. U.G. Nayanika Public Health Nursing Sister Ms. V. Muththuvel Nursing Officer

Ms. W.A. Indrani Public Health Nursing Sister Ms. W.A.K.S. Wickramasingha Nursing Officer

Ms. W.S. Kalyani Public Health Nursing Sister Ms. W.A.L. M.K. Somasingha Nursing Officer
Ms. W.K.C. Sandya
Ms.W. Shirani Fonseka Public Health Nursing Sister Malhengoda Nursing Officer

Ms. W.W.E.M.B.K. Ekanayake Public Health Nursing Sister Ms. Y.C. Weerasinghe Nursing Officer

Ms. Y.M.B. Menike Public Health Nursing Sister Ms. Y.M.I.H. Yapa Nursing Officer

Mr. A.M.R. Adikari Nursing Officer (Male) Ms. Y.M.J.H. Harshani Nursing Officer
Mr. Buddika Chandimal
Nissanka Nursing Officer (Male) Ms. Y.T.M.P. Kumari Nursing Officer

272 Appendix D 283

Measurer Assistant

Mr.Dhamith Chandana Mr. H.N. Jayasinghe Mr.M.R.P.M. R. Bandara Mr.T.H.W.D.A. Peiris

Mr.A.M. Asmir Mr. H.R.S. Perera Mr.M.W.A.I. Chathuranga Ms. Thevatharshini

Mr. A.J.A. Basheer Ahamed Mr.H.M.S.B. Ihalagama Mr. N. Subatharshan Mr. Upul Senavirathna

Mr. D. Abeywardana Mr. K.S. Soyza Mr.O.K. Ananda Mr. W.G.T. Chandrajith

Mr. M.D.D.Perera Mr.K.G. Priyantha Mr.R.P.C.D.K. Rajapaksa Mr.W.A.D.A.S.Wijesinghe

Mr.D.M. Thilakarathne Mr.L.D.A. Jayasinghe Ms. R. Shanthi Mr. Y. Uthayakumar

Mr. Y.M.T. Janaka Indunil
Mr. G.P.A. Hemantha Mr. M. Kokuladas Mr. S. Anura Yapa

Mr.G.H. Kapila Kumara Mr. M.D.N.L. Samarasekara Mr. S.J. Manilak

Mr. H.B.G. Nilupa Mr.M.K. Ramyasiri Mr. T. Muraleesan

Mr. Amila Sanjeewa Mr.K.G.T. Indika Mr. P.R.R. Buddhika Mr.S. Dineshan

Mr.D.A. Damith Nadeeka Mr. K.W.M.A.U. Wijethilaka Mr. R.D.S. Lalantha Samira Mr.S. Manoj Prasanna

Mr.H.M.D.M. Herath Mr. L.A. Dammika Bandara Mr. R.M. Wasantha Kumara Mr. U.W.T.S. vijayapala

273
284 Demographic and Health Survey - 2016, Sri Lanka
QUESTIONNAIRE
Appendix E

Appendix E 285
286 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 287
288 Demographic and Health Survey - 2016, Sri Lanka
(2A)

1 2 8 1 2 8

1 2 8 1 2 8

1 2 8 1 2 8

1 2 8 1 2 8

1 2 8 1 2 8

1 2 8 1 2 8

Appendix E 289
 1 2 8 1 2 8

1 2 8 1 2 8

1 2 8 1 2 8

1 2 8 1 2 8

1 2 8 1 2 8

1 2 8 1 2 8

290 Demographic and Health Survey - 2016, Sri Lanka

Appendix E 291
292 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 293
294 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 295
296 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 297
298 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 299
 1
1
2

2
1

2
1

1
8

300 Demographic and Health Survey - 2016, Sri Lanka

1

1
8

8
2

Appendix E 301
302 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 303
304 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 305
306 Demographic and Health Survey - 2016, Sri Lanka
-
(

Appendix E 307
308 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 309
310 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 311
312 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 313
314 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 315
316 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 317
318 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 319
320 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 321
322 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 323
324 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 325
326 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 327
328 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 329
330 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 331
332 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 333
334 Demographic and Health Survey - 2016, Sri Lanka
 1
2

1 1 2 8

1 2 8

1 2 8

1 2 8

1 2 8

1 2 8

1 2 8

1 2 8

1 2 8

1 2 8

1
2
8

Appendix E
1
2
8

335
 2

2
'

336 Demographic and Health Survey - 2016, Sri Lanka

Appendix E 337
338 Demographic and Health Survey - 2016, Sri Lanka
1300

Appendix E 339
340 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 341
342 Demographic and Health Survey - 2016, Sri Lanka
Appendix E 343
344 Demographic and Health Survey - 2016, Sri Lanka
345 Appendix E
2012 2013 2014 2015
2011 2012 2013 2014 2015