Demographic and Health Survey 2009-10 - Timor-Leste Ministry of ...

68 | Family Planning
Contraceptive use varies by district with much of the difference due to the use of injectables.
Use of a modern method among currently married women is highest in Covalima (43 percent) and
lowest in Baucau (8 percent). The most popular method in Covalima is injectables where 39 percent
of currently married women use them. Three in ten currently married women in Dili, the most
urbanized district in the country, use a modern method of family planning, with 18 percent currently
using injectables, 5 percent using the pill, 3 percent using IUDs, and 2 percent using sterilization.
About 1 percent use implants, the male condom, and the standard days method. The scale-up in the
provision of implants in Timor-Leste has been relatively recent, but at the current rate, they may soon
overtake the IUD as the method of choice (Marie Stopes International, 2010). Sterilization services
have in recent years been very limited, with most sterilizations provided by visiting surgical providers
during a short window of time. Data for 2010 show that there is a full-time provider of both male and
female sterilization services currently as well as a plan for training others in these surgical techniques,
so use of sterilization could be expected to increase significantly over the coming years (Marie Stopes
International, 2010).
Although current use varies markedly between women who have some education and those
who have none, there is little variation among educated women by specific level of education. Women
with more than secondary education (30 percent) are twice as likely to use a modern method of
contraception as women with no education (15 percent). Women with more than secondary education
are more likely than other women to use male condoms (5 percent) and IUDs (4 percent), and they are
more likely to be sterilized and to use the standard days method (2 percent each). On the other hand,
injectables are most common among women with primary education (21 percent).
Wealth has a positive effect on women’s contraceptive use, with modern contraceptive use
increasing markedly as household wealth increases, from 15 percent among currently married women
in the lowest wealth quintile to 32 percent among those in the highest wealth quintile.
There is a direct association between the use of modern family planning methods and the
number of children that women have, except among women with five or more children. Not
surprisingly, use is lowest among women with no children (less than 1 percent), rises to 16 percent
among women with 1 to 2 children, is 26 percent among women with three to four children, and then
decreases slightly to 24 percent among women with five or more children. As expected, female
sterilization is popular among high-parity women (5+ children).
Current use of traditional methods is more common in urban than in rural areas and is highest
in Ermera district, among women with more than secondary education, among women in the highest
wealth quintile, and among women with five or more children. Effective use of a traditional method
requires knowledge of a woman’s fertile period, and educated women, who are also more likely to be
urban and belong to wealthier households, are most likely to effectively understand and use a
traditional method; hence there is this uncommon pattern of use by educated, urban, wealthy women.
Ermera appears to be an exception to this demographic pattern, but a detailed examination reveals that
Ermera has a different pattern of use of traditional methods when compared with the pattern in Dili.
Folk methods and withdrawal are the predominant methods in Ermera (at 2 percent each), with less
than 0.1 percent using the rhythm method. Dili, on the other hand, has 2 percent of currently married
women using the rhythm method. Similarly, the use of folk methods shifts to use of the rhythm
method as education increases.
5.7 NUMBER OF CHILDREN AT FIRST USE OF CONTRACEPTION
To examine the timing of initial family planning use during the family building process, the
2009-10 TLDHS asked all women about the number of living children they had at first use. Table 5.6
shows this information by age group and allows analysis of cohort changes in parity at first use of
contraception.