High birth rates, combined with the health and nutritional problems associated with severe poverty, make birth a dangerous affair for mother and child in Timor-Leste. (Brendan Brady/IRIN)

ASULAO SARE, 10 August 2011 (IRIN) – Babies are plentiful in Timor Leste – almost seven per woman on average – and so too are health problems in a country where chronic malnutrition is rampant and access to effective healthcare remains a luxury.

That is why dozens of mothers from communities throughout the sub-district of Hatolia have travelled to the village of Asulao Sare, some walking more than an hour, for a check-up for themselves and their children from a visiting doctor.

“It started slowly, two years ago, with just this village, but now people come from far away,” says Aida Goncalves, a US-trained Timorese doctor who works for the international NGO Frontline.

Goncalves makes the three-hour trip here from Dili, the capital city, three times each month to see the patients, diagnose their ailments and distribute medication.

Dangers

High birth rates, combined with the health and nutritional problems associated with severe poverty, make birth a dangerous affair for mother and child.

One example is a 41-year-old mother of eight, whose newborn has an imperforate anus (the passage is closed) and appears to have Down’s syndrome.

“The health workers told me before that it was dangerous to my health to have many children and that it would be difficult to feed all of them, but I didn’t agree.”

Now, after her latest birth, she has accepted contraception.

But Goncalves sees the cycle repeating itself. Domingas dos Santos, 25, is four months pregnant; she already has children of eight months, two, four and five years old.

“I’ve been told about birth control and family planning but I’m not interested,” Dos Santos says.

A private affair

Rural Timorese view family planning and pregnancy as a private matter and the idea of consulting outside the family is foreign.

Three-quarters of births are unattended by trained health professionals and fewer than a third of families practise family planning, says Ross Brandon, an Australian doctor with Clinica Café Timor, the medical arm of the coffee cooperative Cooperativa Café Timor.

Studies have long shown birth spacing – the practice of regulating the intervals between pregnancies – significantly reduces maternal and infant health risks.

Among Timorese children, nearly half are underweight and more than half are stunted, according to government statistics. The risk of such problems is reduced dramatically when mothers have at least two years to recover between pregnancies, say health experts.

Acknowledging that culture, habit, and logistical concerns, such as financial and transport limitations, prevent many rural families from seeking professional help, groups such as Frontline and Clinica Café Timor are training community members to serve as midwives.

It is a role that Marcelina Suarez, a 37-year-old farmer and mother-of-six, has assumed with pride. She admits her medical skills are limited but even just ensuring that simple standards such as cleanliness are adhered to in childbirth can make a considerable difference. Of the nearly 50 babies she helped deliver last year, all have survived.

Outlining further improvement

Infant and maternal health in Timor Leste has improved in leaps and bounds over the past two decades.

In the 1990s, when the country was chaffing under a violent Indonesian occupation, the under-five mortality rate for children was 184 per 1,000, according to the UN Children’s Fund (UNICEF) [ http://www.unicef.org/infobycountry/Timorleste_statistics.html ]; by 2009 that figure had fallen to 56.

In July, the government set goals for further improvements. The Strategic Development Plan 2011 – 2030, drafted by the Prime Minister’s office, stipulates that by 2015 about two-thirds of pregnant women will receive regular pre-natal check-ups and give birth with the assistance of a government-trained health worker.

Health workers support this goal but believe meeting it will likely take longer.

In the meantime, the slowly growing body of community midwives is promoting pragmatic changes with limited means.

“Just getting pregnant women to think ahead about the day when they’ll give birth is an improvement,” says Suarez.

[Published by IRIN on August 10, 2011]