Ethnolinguistic Concordance and the Receipt of Postpartum IUD Counseling Services in Sri Lanka

Mahesh Karra, Boston University Erin Pearson, Ipas David Canning, Harvard T.H. Chan School of Public Health Iqbal Shah, Harvard T.H. Chan School of Public Health Ranjith de Silva, Sri Lanka College of Obstetricians and Gynaecologists Arnjali Samarasekera, Sri Lanka College of Obstetricians and Gynaecologists

First published online:

| DOI: https://doi.org/10.1363/44e6918
Abstract / Summary

Ethnic and linguistic concordance are important dimensions of the patient-physician relationship, and are linked to health care disparities. However, evidence on the associations between health behavior and outcomes and patient-provider concordance is limited, especially in low- and middle-income settings.


To examine how concordance between women and their primary health midwife is associated with women's receipt of postpartum IUD counseling, observational data from a cluster-randomized trial assessing an intervention to increase postpartum IUD counseling were used. Data on 4,497 women who delivered at six hospitals in Sri Lanka between September 2015 and March 2017 were merged with data on 245 primary health midwives, and indicators of linguistic concordance, ethnic concordance and their interaction were generated. Multivariate logistic regression analyses were used to assess the associations between concordance and women's receipt of counseling.


Women from non-Sinhalese groups in Sri Lanka face disparities in the receipt of postpartum IUD counseling. Compared with the ethnolinguistic majority (Sinhalese women who speak only Sinhala), non-Sinhalese women have lower odds of having received postpartum IUD counseling, whether they speak both Sinhala and Tamil (odds ratio, 0.6) or only Tamil (0.5). Ethnic discordance— rather than linguistic discordance—is the primary driver of this disparity.


The findings highlight the need for interventions that aim to bridge the sociocultural gaps between providers and patients. Matching women and their providers on ethnolinguistic background may help to reduce disparities in care.

Author's Affiliations

Mahesh Karra is assistant professor, Frederick S. Pardee School of Global Studies, Boston University, Boston, MA, USA. Erin Pearson is senior researcher, Ipas, Chapel Hill, NC, USA. David Canning is the Richard Saltonstall Professor of Population Sciences, and Iqbal Shah is principal research scientist, both in the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Ranjith de Silva is national coordinator, and Arnjali Samarasekera is research associate, both at the Sri Lanka College of Obstetricians and Gynaecologists, Colombo.


The views expressed in this publication do not necessarily reflect those of the Guttmacher Institute.