Abstract
BackgroundThe Maldives faces challenges in the provision of health services to its population scattered across many small islands. The government commissioned two separate reproductive health surveys, in 1999 and 2004, to inform their efforts to improve reproductive and sexual health services.MethodsA stratified random sample of islands provided the study base for a cluster survey in 1999 and a follow-up of the same clusters in 2004. In 1999 the household survey enquired about relevant knowledge, attitudes and practices and views and experience of available reproductive health services, with a focus on women aged 15-49 years. The 2004 household survey included some of the same questions as in 1999, and also sought views of men aged 15-64 years. A separate survey about sexual and reproductive health covered 1141 unmarried youth aged 15-24 years.ResultsThere were 4087 household respondents in 1999 and 4102 in 2004. The contraceptive prevalence rate (CPR) for modern methods was 33% in 1999 and 34% in 2004. Antenatal care improved: more women in 2004 than in 1999 had at least four antenatal care visits (90.0% v 65.1%) and took iron supplements (86.7% v 49.6%) during their last pregnancy. The response rate for the youth survey was only 42% (varying from 100% in some islands to 12% in sites in the capital). The youth respondents had some knowledge gaps (one third did not know if people with HIV could look healthy and less than half thought condoms could protect against HIV), and some unhelpful attitudes about gender and reproductive health.ConclusionsThe two household surveys were commissioned as separate entities, with different priorities and data capture methods, rather than being undertaken as a specific research study. The direct comparisons we could make indicated an unchanged CPR and improvements in antenatal care, with the Maldives ahead of the South Asia region for antenatal care. The low response rate in the youth survey limited interpretation of the findings. But the survey highlighted areas requiring attention. Surveys not undertaken primarily for research purposes have important limitations but can provide useful information.
Highlights
The Maldives faces challenges in the provision of health services to its population scattered across many small islands
The analysis reported here relied on CIETmap open source software [11]
The field teams did not collect data on the number of households and individuals that were approached and declined to participate in the survey, nor on the number of households where they found no one at home at the time of the survey
Summary
The Maldives faces challenges in the provision of health services to its population scattered across many small islands. The Republic of Maldives has 199 inhabited islands and about 1000 other islands, including resorts, stretching north-south across 500 miles of the Indian Ocean. These islands form 26 natural atolls, which are grouped into 20 administrative units. The geography of the country, coupled with the costs of transport and diseconomies of scale, makes delivery of public services of any kind very expensive and difficult. This is certainly true of reproductive health services, especially obstetric care. Malealso has a floating population of several thousands who come from other islands for commerce, education and medical treatment
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