family planning programming in timor-leste maternal and child health in developing countries...

Family Planning Programming in Timor-Leste

Maternal and Child Health in Developing CountriesFebruary 2011

HEALTH ALLIANCE INTERNATIONAL

Why Family Planning Matters

Spacing pregnancies at least 3 years = healthier moms and healthier babies

Contributes to women’s empowerment through more opportunities in education, employment, community involvement

FP is one of the most cost effective life saving public health interventions in the world (Mosely)


Map of Timor-Leste


Timor-Leste: New nation in 2002


The Indonesian Legacy

24 years of brutal Indonesian military occupation

An estimated 100,000 – 250,000 died, human rights abuses: torture,

imprisoned, rape, forced displacement

Keluarga BerencanaIndonesian FP program

‘Dua anak cukup’

Coercive family planning programming in East Timor


Post-conflict Age Pyramid - 2003

12 11 10 9 8 7 6 5 4 3 2 1 0 1 2 3 4 5 6 7 8 9 10 11 12

0-4

10-14

20-24

30-34

40-44

50-54

60-64

70-74

80+

Age

Gro

up

Percent of Total Population

A dearth of males aged in their twenties

A very youthful population with 52% of the population < 15 years

A post-independence baby boom


Religion & Culture

Strong animist beliefs and practicesare prevalent among Timorese

97% of Timorese identify as Catholic


Household Characteristics

Majority of the population live in rural areas, often hard to access

28% of households have electricity urban = 74%

rural areas = 3% - 20%

Only about half of households obtain their drinking water from a

protected source


Education and Literacy

For older women 40-44 years of age, 81% have received

no schooling

Overall, 37% of the population have received no schooling

44% of women and 43% of men are unable to read


Household Characteristics

Radio: 64% ever listen TV: 35% ever watch

Newspaper: 18% ever read

4% of households have a motorcycle, 1.5% a private car/truck

GNI per capita in 2003 = $460/year

Firewood is the major source of cooking fuel


MOH Health System Post-Independence Vote (supply-side)

Human resource pool at low level; few Timorese doctors; new

Program to train CHWs

MOH ‘under construction’ with the development of policies and

strategic approaches

Health facilities destroyed and poorly equipped

Midwives the backbone of the Health—lots of training provided

Safe Motherhood/FP


Community Utilization of Health Services(demand-side)

t

Distrust and very low utilization of government health services

Difficult access to reach a health facility

Strong traditional beliefs and practices regarding health

and care seeking


Utilization of Services

90% of women deliver at home

20% of births were attended by a SBA

Only 10% current users of a modern contraceptive

Postpartum and newborn care negligible


Baseline Data

MMR: 800/100,000 IMR: 80-90/1000 l Under five mortality:

120-130/1000


2003 DHS Family Planning Data

TFR at 7.8 births per woman is the highest in the world

Over 60% of women cannot spontaneously identify a method of contraception

Overall, “ideal” family size is 5.7 children

Only 19% of women have ever used contraception

10% currently using a method


Percentage of Women Wanting No More Children by Current Parity: Country Comparison

Number of living children

0 1 2 3 4 5 6

Timor Leste 2003 1.1 3.4 6.2 11.0 17.4 24.0 33.7

Cambodia 2000 3.0 7.8 28.3 44.1 51.5 51.0 51.6

Indonesia 2002/3 2.8 11.3 58.4 79.4 88.9 90.4 89.2

Philippines 1998 1.4 16.8 53.2 74.6 84.8 87.1 89.1

Vietnam 2002 1.6 15.7 91.9 93.9 94.6 96.2 91.2


Your turn!

How would you propose HAI respond to the situational analysis in order to develop a program to promote demand for family

planning

What additional information do you need?What are some key strategies you would you

employ?What are 2-3 key messages you would

recommend?


HAI Program: ‘Promoting community demand for child spacing in Timor-Leste’Baseline Qualitative Assessment Describe the prevailing knowledge,

beliefs, practices, preferences and care-seeking behaviors related child spacing

What & who influences reproductive choices?

What do women and families want with regard to spacing their children or limiting family size?

How do community members access and use information regarding child spacing?


“My mother said I should have many children because I am the only girl in the my family.”

“Two to three children is not enough for me, I would like to have nine children. “ “Because people have many children they can’t afford to feed them and have not money to pay for the school fee.”


“When we want to stop having babies then we inform the Kukunain (magic/mystic man), so that they can ask at the Sacred House and we will not get pregnant again.”

“The number of children is determined by the husband’s parents. We just do whatever they say because they gave the dowry for us.” (female respondent)

“I think for child spacing ideally 2 to 5 years to have a child again, should give time to the mother to get strong again.”


Improve capacity of MOH family planning services

Partner with MOH to improve the quality of services delivered through integrated MNC supervision visits of MWs

Provided follow-up FP skills check for MWs Conducted workshops to train MWs on

working in communities and improving counseling skills

Developed health promotion tools and provided MOH staff and CHW training for use in communities


Increase community demand

Emphasized the notion of child spacing versus limiting family size

Community level health promotion Benefits of spacing your children Target men and family members as well as women Increase knowledge of modern methods Debunking some myths

For legitimacy and entry into communities, worked closely with MOH, Church and Village Chiefs/Leaders


Child Spacing Film: Espaco Oan

Developed and produced a culturally relevant two-part film

MOH and Church buy-in Work with community stakeholders to

schedule community viewing Train local NGO team to show film

conduct community conversation Village-based community viewing with

follow-up discussion


Bringing Espaco Oan to communities


‘Mai Ita Koko’ (Come lets try): CHW home visits


Results: 2003 & 2010 DHS

TFR decreased: 7.8 to 5.7

CPR doubled: 10% to 22% (still lots to do!)

Significant increase in desire to delay or limit

childbearing Desire to have another child soon: 32.4% to 8.5% Desire to have another child later: 10.5% to 35.7% Desire no more children: 17% to 34.7%


Results: 2003 DHS/HAI 2008 Survey


Thank you!

family planning programming in timor-leste maternal and child health in developing countries...

Documents

child health

public health interventions

catholic slide

protected source slide

world mosely slide

east timor slide

safe motherhoodfp slide

newborn care negligible