East Timor’s Dire Family Planning Needs

East Timor, the world’s
newest nation, is currently threatened with a soaring population, expected to double by 2020. UNFPA reports that Timor-Leste has the
highest fertility rate in the world, averaging 7.8 children per woman. It is additionally alarming that countries
with high birth rates tends to have high
maternal and infant mortality.

Reliable child and maternal mortality rates are hard to obtain for East Timor,
but it is unquestionable that the poor quality and accessibility of family
planning has directly impacted the health of Timorese women and children.
According to WHO, East Timor has a maternal mortality rate of 380 deaths per 100,000
live births. UNICEF report correspondingly shocking rates of death
exist for infants and children under the age of five, with an under-five
mortality rate of 55 per 1,000 live births in 2006, and an infant mortality
rate of 47 in 2006.

It is promising that the former-President, turned Prime Minister, Xanana
Gusmao, recently noted that "fertility is a matter of education". Improved access to family planning education
and services together are vital not only as a matter of reproductive choice but
to ensure that East Timor achieves some level of sustainable development. Yet,
this "new approach" may have to face the notable influence of the Catholic
Church. If the state of family planning in the Philippines, the other
predominantly Catholic country in Asia, is a reflection of what is to come in
East Timor, we should be alarmed. Millions of
Filipino women of reproductive age have limited or no access to modern
contraceptives. National figures suggest almost half of all pregnancies in the
Philippines are unwanted, especially in rural areas and amongst low-income
families. The entrenchment of fundamentalist religious beliefs in laws and
policies and the promotion of "natural family planning" have undermined women’s
choice and posed grave threats to their health and lives.

Low rates of contraceptive prevalence in East Timor
are equally alarming, though, in this case, the Catholic Church has taken a more reasonable stance
and has been more receptive to the promotion of contraceptives. According to
WHO, only around 22% of the Timorese use modern
contraceptives. Lack of awareness about contraceptives amongst the population
is potent, with the former first lady and Prime Minister’s
wife, Kirsty Gusmao affirming that the combination of
poor education, poverty and the influence of the Catholic Church means that
contraception is rarely discussed. According to a survey conducted in 2003 by
the Ministry of Health, over 94% of currently married female adolescents and
87% of 20-24-year-old currently married young women were not using any
contraception. The survey also reported that more than 90% of
youth did not receive any information on family planning.

When it
comes to abortion, the Catholic Church in the Philippines and East Timor are
much more in sinc. The Philippines has one of the most restrictive abortion
laws in the world, with no express exception to save a woman’s life, and
penalizing both the woman and her provider. Criminalization of abortion has
resulted in a overwhelming number of illegal and unsafe abortions. In 2000,
approximately 473,000 women had abortions and an estimated 79,000 women were hospitalized for complications arising from the
abortion. Similarly, the Timorese Government and Catholic Church do not endorse
abortion and the Timorese law severely punishes abortion, even when the mother’s life is in

Despite the
sensitivity of discussing sexual health and family planning, the health needs
of Timorese cannot be ignored. Achieving high standards of reproductive health
is not only a question of reproductive choice. It is in fact essential to the
achievement of sustainable development for East Timor, a country that is
evidently still very much undergoing transition.

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  • http://www.the-wisdom.com invalid-0

    Yes, East Timor has rotten access to reproductive health services. But it was not ever thus. Until the melt-down that preceded independence from Indonesia, the then province was well-enough provided with primary health services, and very well provided with maternal and child health clinics, which also provided contraceptive services. Indeed, this is part of the problem.

    The Suharto regime’s determination to reduce population growth put family planning at the top of the political agenda. Services were generally pretty good, though over-enthusiasm occasionally verged on the coercive, and were similar nation-wide. However some pro-independence activists (and some foreign journalists who should have known better, including the sainted John Pilger) chose to portray this service provision as the imposition of unwanted fertility limitation on the Catholic populace by a predominantly Moslem occupying force — a moderate form of ethnic cleansing. In short, family planning has a very bad name in East Timor.

    This history has cast a long shadow. It was one reason why provision of reproductive health services was not a priority for the post-independence health ministry (with whom I briefly worked in 2002/2003). Yes, the Church is an additional obstacle. But it needn’t have been. Archbishop Bello, who was jointly awarded the Nobel Peace Prize for standing up against Jakarta’s worst excesses, was in fact fairly supportive of the provision of quality reproductive health services in Timor. The (understandable) demonisation of all things Indonesian by the incoming government had at least as much to do with the current paucity of service provision as the church does.

  • invalid-0

    This article highlights the dire need for better maternal and child services in East Timor. However, it is a fundamental misreading of the situation in East Timor if the article believes the solution to the situation to be abortion and contraception. East Timor is one of the poorest countries in the world and needs better health services. Moreover, it would uninformed to say the least to “blame” East Timor’s high fertility rate on the Catholic Church. This does not accord with the reality in East Timor. The high fertility rate has to do with the particular historical circumstances in East Timor as it comes out of a brutal period of widespread oppression and death as well as poorly informed cultural beliefs and practices. Who is anyone to tell and force the Timorese to stop producing life when they have come out of a period of brutal violence and overwhelming death?

    As I have witnessed and conducted studies in East Timor, the Catholic Church certainly encourages an emphasis on life within East Timor – whether it be in the family, in resolving communal or political violence, in working with young people or in material development. The Catholic Church is one of the active and most effective bodies in East Timor, including in educating the people about fertility (a subject that is not discussed ) and improving fertility practices. The Church is effective because it is trusted by the people as it stood with the people through 24 years of violence and death (unlike many organisations now telling the Timorese what to do in regards to any number of subjects, including fertility). As I have seen it on the ground, the Church is active in rural and urban areas educating people about health, fertilty and promoting gender equality. The experience on the ground is that there is such a low level of knowledge and many cultural barriers to navigate. It will take time to adequately inform East Timorese people and it will take time for the people to make their own decisions. However, promoting methods of death – such as abortion, which is what these methods are seen as – in a culture that has experienced so much pain and violence not only seems inappropriate but abhorrent. Moroever, it seems to jump the gun – East Timor needs education and better health services and that is what we should be focusing on.