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Family Planning Programming in Timor-Leste

Family Planning Programming in Timor-Leste. Maternal and Child Health in Developing Countries February 7, 2012. Outline and Flow. A quick review of global family planning A situational analysis of Timor-Leste prior to designing & implementing a family planning (FP) pogram

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Family Planning Programming in Timor-Leste

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  1. Family Planning Programming in Timor-Leste Maternal and Child Health in Developing CountriesFebruary 7, 2012

  2. Outline and Flow • A quick review of global family planning • A situational analysis of Timor-Leste prior to designing & implementing a family planning (FP) pogram • Small group work to discuss key questions that will be presented • Group report out • Finish the Timor story

  3. Family Planning: Unmet Need Globally WHO estimates that 200 million couples in developing countries would like to delay or stop childbearing but are not using any method of contraception

  4. MDG 5: Improve Maternal Health • 5a: Reduce by ¾ maternal mortality • Maternal mortality ratio • Proportion of births attended by skilled health personnel Added in 2005: • 5b: Universal access to reproductive health • Antenatal care visits (at least 1, at least 4) • Adolescent birth rate • Contraceptive prevalence rate • Unmet need for family planning

  5. FP has the potential to prevent maternal deaths (~32%) and newborn/infant/child death (~10%) Spacing pregnancies at least 3 years = healthier moms and healthier babies The Benefits of Family Planning

  6. Decreases unintended and unwanted pregnancies ( induced abortion & miscarriages) Offers women more opportunities for education, employment, community involvement Can prevent the transmission of HIV Can prevent MTCT of HIV by avoiding unintended pregnancies among HIV+ women Slows population growth—reduces poverty, hunger, and is positive for the environment The Benefits of Family Planning

  7. The Methods • Combined oral contraceptives (COC), “the pill” • contains 2 hormones: estrogen and progestogen • Progestogen-only Pills (POP) “the mini pill” • Implants • small, flexible rods or capsule place udner the skin of the upper arm, long lasting at 3-5 years • Injections (Depo Provera) • progestogen injectables, every 2-3 months • IUD • small flexible device inserted into the uterus; 5-10 years

  8. Methods (cont) • Condoms (male and female) • Sterilization (male and female) • Vasectomy (males), tubal ligation (females) • Standard Days/Cycle beads • Lactational Amenorrhea (LAM) • requires exclusive breastfeeding an infant for up to 6 months • Traditional Methods • calendar, withdrawal, periodic abstinence, herbs

  9. Contraceptive Use in Asia Among WRA Family Planning Worldwide 2008 Data Sheet

  10. Contraceptive Use among WRA Timor:Leste Data Source: DHS 2009/10

  11. Global Trends in Induced Abortion • From 19952003 the # of abortions / 1000 WCBA worldwide fell from 3529 • 2008 only declined to 28 • Nearly half of all abortions worldwide are unsafe • ~All unsafe abortions occur in developing countries • In 2008, 6 million abortions in developed countries and 38 million in developing countries • Abortion accounts for 13% maternal mortality

  12. World Abortion Law Map http://www.pregnantpause.org, 2002

  13. Timor-Leste: The birth of a new nation

  14. Timor-Leste: Where is it?

  15. Maternal and Infant Mortality & TFR • Maternal Mortality: 660-800/100,000 live births (WHO 2003) • Infant Mortality : 60/1000 live births* • Under 5 Mortality: 83/1000 live births* • Total Fertility: 7.8* * Demographic and Health Survey 2003

  16. 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; poorly trained health staff Midwives the backbone of the health system

  17. Community Utilization of Health Services(demand-side) Distrust and very low utilization of government health services Increased dispersion of the population t Strong traditional beliefs and practices regarding health and care seeking

  18. Utilization of Maternal Health 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

  19. 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 and 10% are currently using a method Over 60% of women cannot spontaneously identify a method of contraception Overall, “ideal” family size is 5.7 children

  20. The Indonesian Legacy 24 years of brutal Indonesian military occupation An estimated 180,000 died, human rights abuses: torture, imprisoned, rape, forced displacement Keluarga Berencana Indonesian FP program ‘Dua anak cukup’ Coercive family planning programming in East Timor

  21. 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

  22. Religion & Culture Strong animist beliefs and practices are prevalent among Timorese 97% of Timorese identify as Catholic

  23. 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

  24. 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

  25. Your turn! How would you propose HAI respond to the situational analysis in order to develop a FP program that seeks to increase demand for, and ensure high quality FP services Timor-Leste? • What additional information do you feel you need, and how would you propose getting it? • What would be 1-2 key objectives and how would you propose measuring success? • What are 1-2 key strategies you would you employ to achieve our proposed outcomes goals? • What are 1-2 key messages you would recommend using to promote FP utilization?

  26. 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?

  27. “My mother said I should have many children because I am the only girl in the my family.” “Because people have many children they can’t afford to feed them and have not money to pay for the school fee.” “Because of barlaque (bride price) husbands and their families feel they can make decisions about how many children women have. ..”

  28. “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.” “How many children we have is up to God” “We don’t want to be told to limit the number of children we have, this is what the Indonesians did.”

  29. Improve capacity of MOH family planning services What we did: • Emphasized the notion of child spacing versus limiting family size • 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

  30. Increase Community Demand What we did • Community level health promotion • Benefits of spacing your children • Knowledge of modern methods • Debunking myths • For legitimacy and entry into communities, it is critical to work closely with MOH, Church and Village Chiefs

  31. 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

  32. Bringing Espaco Oan to Communities

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

  34. Results: 2003 & 2010 DHS • TFR decreased: 7.8 to 5.7 • CPR doubled: 10% to 22% • Unmet need: dramatic increase • 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%

  35. Results: 2003 DHS/HAI 2008 Survey

  36. Thank you!

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