Although the overall level of fertility is low, there are areas of relatively high fertility within low fertility districts as well as moderately high fertility areas within high fertility districts., In 1981, the total fertility rate in the country was 3.4 children and there were 93 sub-national (AGA) divisions having a total fertility rate more than 4 children.
Analysis of total wanted fertility rates reveals that greater potential for further reduction in fertility exists in the districts of Kalutara, Galle, Matara, Hambantota, Anuradhapura, Puttalam, and Moneragala. It appears that the estate sector which has shown the highest total wanted fertility rate needs intensified action in terms of IEC and service delivery. Priority areas can be identified for temporary methods and permanent methods separately. With reagrd to temporary modern methods, priority could be given to areas that have shown low prevalence rates and low acceptance rates. There are 28 such MOH areas. As regards permanent methods, priority could be given to areas which have shown low current use.There are 27 MOH areas which fall into this category. It is necessary, therefore, to undertake operation research studies to identify the specific service delivery and ICE needs in the low performing MOH areas so that action programmes could be implemented effectively.