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Family Planning Programming in Timor-Leste. Maternal and Child Health in Developing Countries February 2011. Why Family Planning Matters. Spacing pregnancies at least 3 years = healthier moms and healthier babies

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Family Planning Programming in Timor-Leste

Maternal and Child Health in Developing CountriesFebruary 2011

why family planning matters
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)
the indonesian legacy
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 Berencana

Indonesian FP program

‘Dua anak cukup’

Coercive family planning

programming in East Timor

post conflict age pyramid 2003
Post-conflict Age Pyramid - 2003

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
Religion & Culture

Strong animist beliefs and practices

are prevalent among Timorese

97% of Timorese identify as Catholic

household characteristics
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
Education and Literacy

Overall, 37% of the population

have received no schooling

44% of women and 43% of men

are unable to read

For older women 40-44 years of

age, 81% have received

no schooling

household characteristics10
Household Characteristics

Firewood is the major source of

cooking fuel

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

moh health system post independence vote supply side
MOH Health System Post-Independence Vote (supply-side)

Health facilities destroyed and

poorly equipped

MOH ‘under construction’ with the

development of policies and

strategic approaches

Human resource pool at low level;

few Timorese doctors; new

Program to train CHWs

Midwives the backbone of the

Health—lots of training provided

Safe Motherhood/FP

community utilization of health services demand side
Community Utilization of Health Services(demand-side)

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
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
Baseline Data
  • MMR: 800/100,000
  • IMR: 80-90/1000 l
  • Under five mortality: 120-130/1000
2003 dhs family planning data
2003 DHS Family Planning Data

TFR at 7.8 births per woman is the

highest in the world

Only 19% of women have ever

used contraception

10% currently using a method

Over 60% of women cannot

spontaneously identify a

method of contraception

Overall, “ideal” family size

is 5.7 children

your turn
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
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
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
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
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
results 2003 2010 dhs
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%