Greater efforts are now needed to tackle the many challenges women face in accessing health care in Timor-Leste, which has one of the highest maternal mortality ratios (MMR) in the world, experts say.
“Although there are 2.3 health workers for every 1,000 people, which meets the international minimum standard set by the World Health Organization (WHO), the quality and competency of these health professionals is questionable given the training available and shortage of trained doctors,” Jannatul Ferdous, a maternal and child health adviser at HADIAK, a locally implemented health project, working with the Ministry of Health, told IRIN.
“The main problems with providing emergency and child health services include the poor quality of health service providers, the shortage in trained health professionals and the logistics involved in accessing services,” Ferdous said.
According to a recent report entitled Trends in Maternal Mortality, only 30 percent of women give birth with a skilled birth attendant present.
Seventy percent of the country’s 1.1 million inhabitants live in remote areas.
“Health-seeking behaviour is one of the major issues, reflected by a low utilization of health services for antenatal and postnatal care. Some factors for low utilization of health services include concern about the availability of drugs; availability of healthcare providers, especially female health providers; distance to health facilities; and concern about getting permission to go for treatment from husbands and other family members,” Hongwei Gao, country representative for the UN Children's Fund (UNICEF), explained.
Timor-Leste was a former Portuguese colony before it was occupied by Indonesia, and achieved independence only 11 years ago. Three hundred mothers die per 100,000 live births, the UN Population Fund (UNFPA) reported in 2012. In Asia, only Laos and Afghanistan have a higher MMR, at 470 and 460 respectively.
But even when expectant mothers are able to access health services, obstacles remain.
According to AusAID, the Australian government’s overseas aid programme, a major challenge facing Timorese women is access to skilled care at delivery, which is vital for preventing deaths from common pregnancy complications.
“The risk to Timorese women dying during childbirth is also increased because of the many pregnancies and births each woman has,” said an AusAID official who preferred anonymity.
Timor-Leste has one of the highest fertility rates in the world with each woman having on average 5.9 children, according to UNFPA.
Agencies say challenges to mothers include the limited availability of key health services - such as family planning, antenatal care, skilled care at delivery, postnatal care, immunization, vitamin A supplementation, and antibiotic treatment for pneumonia - in poor, rural communities.
According to the Timor-Leste Demographic Health Survey in 2009-10, only 20 percent of mothers deliver babies in a health facility and only 30 percent of births are assisted by a skilled provider, such as a doctor, nurse, or midwife.
A further 18 percent of women are assisted by a traditional birth attendant. Meanwhile, 49 percent are assisted by untrained relatives or friends.
“Accessing health services is a huge problem for pregnant mothers in Timor-Leste, especially in the rainy season from December to April when it might not even be possible for women to walk to the hospital if it is nearby,” Ferdous noted.
“Timor-Leste is a young nation and, as a result, the Ministry of Health is still building its capacity to deliver a full set of basic health services across the country,” the AusAID’s spokesperson told IRIN.
Improving facilities at district level
A focus on strengthening the quality of health services in rural areas is important to address maternal health needs, say health workers.
HADIAK, together with the Ministry of Health, works to educate women on the importance of accessing health services, as well as improving the quality of care available.
“We work on improving the quality of health services at community level, and also provide trainings for health workers, including doctors and midwives, and community members,” said Ferdous.
With support from AusAID, the Ministry of Health is also developing a better reach of services to isolated and rural areas through mobile health clinics. These clinics travel to more than 400 villages to provide prenatal and postnatal care for women and babies, immunization for children, family planning support, treatment and prevention of common diseases and infection, and information on nutrition and hygiene.