Reproductive health research and innovation in Sri Lanka: Challenges and the road ahead

Sri Lanka has achieved maternal and child health outcomes well above its income level, yet several reproductive health indicators have stalled or worsened. The prevalence of anaemia in pregnancy, for example, rose from 31.9% in 2009 to 35.4% in 2016. Since a national priority-setting exercise in 2007, research output on reproductive health has grown, but much of the local evidence has not been translated into practice.This article draws on two decades of work by a multidisciplinary team at the University of Peradeniya and Teaching Hospital Peradeniya. It summarises studies on maternal infections (varicella zoster, Toxoplasma gondii, human papillomavirus and group B streptococcus), metabolic disease in women, diabetes in pregnancy, the quality of intrapartum care, reproductive toxicology, and two medical devices developed with engineers: an automated urine volume monitor (patented) and an accelerometer-based fetal movement monitor (patent pending).The recurring barriers were the absence of national coordination and dedicated funding, fragmented research and data systems, slow policy translation, little work on environmental exposures, and limited time and supervision capacity. We propose a national reproductive health research registry and data repository, a National Reproductive Health Research and Innovation Council, a digital antenatal record, a training pipeline for clinician-scientists, investment in translational infrastructure, and incentives for interdisciplinary and international collaboration.