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

six years before the survey is shown in Table 9.5. Age-specific mortality rates are calculated by
dividing the number of maternal deaths by years of exposure. To remove the effect of truncation bias
(the upper boundary for eligibility in the TLDHS survey is 49 years), the overall rate for women age
15-49 is standardized by the age distribution of the survey respondents. Maternal deaths are defined as
any death that occurred during pregnancy, childbirth, or within two months of the birth or termination
of a pregnancy.
112 | Adult and Maternal Mortality
Table 9.5 Direct estimates of maternal mortality
Direct estimates of maternal mortality for the period 0-6
years prior to the survey, Timor-Leste 2009-10
Age
Maternal
deaths
Exposure
years
Mortality
rates 1
Proportion of
maternal
deaths to
female deaths
15-19 8 26,996 0.286 20.2
20-24 22 26,051 0.862 43.3
25-29 24 20,387 1.198 48.2
30-34 32 17,247 1.842 46.4
35-39 12 14,917 0.836 45.2
40-44 15 10,412 1.439 45.5
45-49 6 5,917 1.026 33.5
Total 120 121,927 0.960a 41.7
General fertility rate (GFR) 0.172 a
Maternal mortality ratio (MMR) 2 557
1 Expressed per 1,000 woman-years of exposure
2 Expressed per 100,000 live births; calculated as the
maternal mortality rate divided by the general fertility rate
a Age-adjusted rate
na = Not available
Maternal mortality in Timor-Leste is high relative to many developed countries. However, for
each age group, maternal deaths are a relatively rare occurrence. As such, the age-specific pattern
should be interpreted with caution. Respondents reported 120 maternal deaths in the seven years
preceding the survey. The maternal mortality rate, which is the annual number of maternal deaths per
1,000 women age 15-49, for the period zero to six years preceding the survey, is 0.96. Maternal
deaths accounted for 42 percent of all deaths to women age 15-49; in other words, more than two in
five Timorese women who died in the seven years preceding the survey died from pregnancy or
pregnancy-related causes. The MMR, which is obtained by dividing the age-standardized maternal
mortality rate by the age-standardized general fertility rate, is often considered a more useful measure
of maternal mortality because it measures the obstetric risk associated with each live birth. Table 9.5
shows that the MMR for Timor-Leste for the seven years preceding the survey is 557 deaths per
100,000 live births (or alternatively, about 6 deaths per 1,000 live births). The 95 percent confidence
interval places the true MMR for 2009-10 anywhere between 408 and 706.
As pointed out at the beginning of the chapter, the MMR estimate from the 2009-10 TLDHS
is the first direct measure of maternal mortality because it is based on survey data and is therefore not
comparable to other model-based estimates of MMR that have been used in Timor-Leste in earlier
years. Nevertheless, it is important to point out that the MMR for Timor-Leste remains one of the
highest in the world, and government programs must address this problem. Necessary interventions
include increasing women’s access to reproductive health care, (through more and better health
facilities that offer family planning and maternity care), increasing skilled birth attendance, and
educating women about birth spacing. These issues are discussed in detail in the following chapters of
this report.